Traumatic Period Research Articles

Complex Therapy for Intraoperative Blood Loss during Pelvic Bone Repair

Objective: to introduce blood saving technologies and to develop algorithms for management of patients with pelvic fractures. Subjects and methods. Sixty patients aged 40.6±2.3 years with pelvic fractures were examined. The banking of packed autoerythrocytes and auto freshly frozen plasma (AutoFFP), intraoperative acute hypervolemic hemodilution (AHH), and instrumental reinfusion of washed autoerythrocytes were made in all the patients. Blood loss volume averaged 32.1±1.7 ml/kg. The parameters of central hemodynamics (CH), blood oxygen-transport function, the blood system (red blood cells, hemoglobin, packed cell volume, and platelets) were studied. AutoFFP was transfused in the most traumatic period of surgery, autoblood was on completion of surgical hemostasis, and washed autoerythrocytes were within 3—4 hours after surgery. Postoperative reductions in hemoglobin to below 80 g/l and packed cell volume below 25% are indications for packed autoerythrocyte transfusion. Results. During preoperative autoblood banking, the parameters of CH and the blood system underwent no changes, all variations in the parameters were within the normal range and compensatory. When AHH and instrumental washed erythrocyte reinfusion were conducted, there was a significant increase in cardiac index (CI), stroke index by 37 and 30%, respectively; reductions in total peripheral vascular resistance index by 38%, mean blood pressure by 18%, moderate hypercoagulation, and significant decreases in hemoglobin, packed cell volume, red blood cells by 17, 15, and 18%, respectively. The values of acid-base condition and homeostasis underwent no considerable changes. Arterial blood O2 content was significantly lowered by 16%; however, global O2 uptake remained unchanged at the baseline levels due to the increase of CI by 30% of the baseline level. Conclusion. The application of blood saving technologies, preoperative autoblood banking in particular, AHH, and instrumental washed autoerythrocyte reinfusion allowed a refusal to use allo-geneic blood components during pelvic repair, by preventing the development of hemotransfusion complications. Key words: blood loss, blood saving, packed autoerythrocytes, auto freshly frozen plasma, acute hypervolemic hemodilution, autohemotransfusion, instrumental washed autoerythrocyte reinfusion, spinal epidural anesthesia.

The Reconstruction of Islamic Social Thought in the Modern Period: Nursi’s Approach to Religious Discourse in a Changing Society

AbstractIn this article I will analyse the social aspects of Said Nursi’s thought in the context of late Ottoman and modern Turkish intellectual history within the boundaries of social philosophy and theology. I aim to discuss the outcome of Nursi’s work in formulating a live discourse that corresponds to the needs of modern Muslim society in Turkey and around the world. Nursi’s life and thought comprises interesting evidences to comprehend the transition of Muslims in the traumatic period of the two World Wars in the twentieth century and their resistance to the challenges of a new ‘weltanschauung’ and various philosophical ideas, as well as a new political design that tried to reshape society by pursuing a hard-line modernisation process.

Constructing the past and constructing themselves: the Uruguayan military's memory of the dictatorship

Institutional identity and social memory are used to construct legitimate images of self and justify past actions. The Uruguayan military as an institution was interested in constructing its own memory of the controversial period of the dictatorship to establish their new identity as political actors and to respond to outside critiques. As a result, the institution produced a wealth of documents to explain and justify its actions before holding power. This paper investigates how the Armed Forces represented their actions during this period, how they positioned themselves and other social actors, and how they evaluated themselves, others and their practices during that traumatic period. The critical discourse analysis focuses on the configuration of lexico-grammatical and discursive choices that construct the institution's shifting identity and its memory of the dictatorship. The analysis demonstrates how the military used discursive practices to legitimate its deviant actions through the construction of a narrative of the past that presented the situation as chaotic and requiring extreme measures.

Recalling War Trauma of the Pacific War and the Japanese Occupation in the Oral History of Malaysia and Singapore

The Pacific War and the Japanese Occupation were traumatic periods in the lives of people now over seventy years old in Malaysia and Singapore. This study traces why individuals interviewed for oral history of the Pacific War and the Japanese Occupation have often been able to tell stories of trauma without being overwhelmed by their reminiscences. It emphasizes that memories of traumatic experiences of the Pacific War and Japanese Occupation in Malaysia and Singapore are mediated and eased by supportive social networks that are part of the interview subject's community. The individual's personal memories of traumatic war experiences are positioned in the context of the collective memory of the group and, thus, are made easier to recall. However, for individuals whose personal memories are at variance with the collective memory of the group they belong to, recalling traumatic experiences is more difficult and alienating as they do not have the support of their community. The act of recalling traumatic memories in the context of the collective memory of a group is particularly relevant in Malaysia and Singapore. These countries have a long history of being plural societies, where although the major ethnic groups—the Malays, Chinese, and Indians—have lived side by side peacefully, they have lived in culturally and socially separate worlds, not interacting much with the other groups. The self—identity of many older people who lived through the Pacific War and the Japanese Occupation is inextricably bound up with their ethnicity. Oral history on war trauma strongly reflects these identities.

The role of gap-junction in suspended animation for hemorrhagic shock with brain injury: experiment with rats

To investigate the role of gap-junction in suspended animation for hemorrhagic shock with brain injury. Twenty-four SD rats were made into models of uncontrolled hemorrhagic shock and occlusion of bilateral common carotid arteries and randomly divided into 3 equal groups: traditional resuscitation group (Group I) undergoing traditional resuscitation, hypothermy resuscitation group (Group II) undergoing temperature lowering by ice-cap, and carbenoxolone resuscitation group (Group III) undergoing injection of carbenoxolone 50 microg/200 g. The process was divided into 3 periods: traumatic hemorrhagic period (30 min), pre-hospital treatment period (60 min), and in-hospital cardiopulmonary resuscitation period (60 min). The levels of left ventricular systolic pressure (LVSP), maximum change rate of left ventricular pressure rise and fall (+/- dp/dt(max)), mean arterial pressure (MAP), heart rate (HR), and respiratory rate (RR) were recorded at the beginning and the end of traumatic hemorrhagic period (T1 and T2), the end of pre-hospital treatment period (T3), and the end of in-hospital cardiopulmonary resuscitation period (T4). The survival time was recorded after in-hospital cardiopulmonary resuscitation period. Then the left brain was taken out and the hippocampal neurons apoptosis was observed by flow cytometry, chemiluminescence was used to detect the ATP, and IL-6 and tumor necrosis factor (TNF)-alpha were detected by enzyme linked immunosorbent assay (ELISA). The survival time of Groups II and III were (2.9 +/- 0.6) h and (2.6 +/- 1.0) h respectively, both significantly longer than that of Group I [(1.4 +/- 0.3) h, both P < 0.01]. The apoptotic rates of hippocampal neurons of Groups II and III were (72 +/- 6)% and (75 +/- 9)% respectively, both significantly lower than that of Group [83 +/- 5)% P < 0.05]. The ATP levels in hippocampus of Groups II and III were (2.0 +/- 0.3) and (1.9 +/- 0.4) pg/g respectively, both significantly higher than that of Group I [(1.4 +/- 0.5 pg/g, both P < 0.05). The TNF-alpha and IL-6 levels of Groups II were (1.7 +/- 0.3) pg/g and (19 +/- 3) pg/g respectively, both significantly lower than those of Group I [(2.2 +/- 0.6) and (24 +/- 3) pg/g respectively, both P < 0.05]. The IL-6 level of Group III was (26 +/- 4) pg/g, significantly higher than that of Group II (P < 0. 01). There were no significant difference between Groups II and III in the values of survival time, hippocampal neuron apoptosis, dissipation of ATP, and liberation of TNF-alpha (all P > 0.05), but there was significant difference in IL-6 (P < 0.01). Both hypothermy resuscitation and carbenoxolone resuscitation protect the brain of cerebral ischemia on hemorrhagic shock with brain injury, and suggest that Gap junctions play an important role in suspended animation to treat hemorrhagic shock with brain injury.

Caring for abandoned street children in La Paz, Bolivia

UNICEF reported in 1986 that the number of street children ranged from 30 to 170 million worldwide.1 Despite the large number, there is a relatively small amount of literature on...

L’enseignement de la lecture et de l’écriture, livres scolaires et culture politique en Argentine: les années les plus sombres (1976–1983)

Argentine society underwent one of its most traumatic periods when a new Military Dictatorship took over power between 1976 and 1983. The military groups claimed that they would end a crisis that resulted from a society that ran out of control. The instruments to correct and discipline the population were part of a political project based on the state of siege, generalized repression, power abuse, the submission of judicial power and State terrorism. Of course, the educational field was not exempted from these movements. This paper analyzes the impact of its political tenets on school textbooks. In particular, it deals with two aspects: the censorship on books and other writings that could be used in schools, and the methods for teaching literacy in the first grades of elementary schools. It concludes by linking these policies to the formation of political cultures.

Survivors of Childhood Trauma: Possible Approaches to Therapy

TO THE EDITOR: The clinical case conference by Andreea L. Seritan, M.D., Glen O. Gabbard, M.D., and Lloyd Benjamin, M.D., published in the Oct. 2006 issue of the Journal (1), is much appreciated. Several aspects of the case conference deserve comment. “Ms. A” is a child survivor of the Holocaust (2, 3) who was hidden with her family, not separated from them. She did not have to assume a gentile identity nor was she adopted. Furthermore, she is not a death camp survivor, one of the “living skeletons” liberated from such places as Auschwitz, Buchenwald, and Dachau. Nevertheless, the deaths of her mother and brother were incalculable losses, sustained while she lived in constant danger of being caught and killed by Nazis. She was also suspected of being sexually abused, possibly as part of the “cost” of being protected. The indelible impact of such genocidal persecution could not be ameliorated in short-term therapy, and while I do not believe any such claims were made, this point was not clearly delineated. Furthermore, there was no posttermination follow-up to determine whether the patient’s trauma was “worked through” (1, p. 1705) as opposed to “opening up more than the patient can handle”(1, p. 1708). Despite Dr. Seritan’s sensitivity, did she inadvertently get drawn into a masochistic enactment that could have re-traumatized the patient by inflicting another loss upon her? Ms. A was appropriately informed that Dr. Seritan was moving in 6 months and had reservations about the treatment. But was Dr. Seritan so impressed by the patient that she proceeded nonetheless? Perhaps the wish to write about the patient also influenced her. Nonetheless, the patient’s resilience, ego, strength, and presentation were positive factors not to be minimized. However, Ms. A’s persona and idealizing maternal transference not only recreated the long-lost mother who suddenly disappeared, but also concealed the terrified child who had to be invisible to the Nazis, invisible to her stepmother, and perhaps somewhat invisible to her lovely therapist with a European accent. In the patient’s unconscious mind, the therapist could have been a Nazi also. Dr. Seritan read about the Holocaust and consulted knowledgeable supervisors. While Dr. Gabbard correctly points out that empathic attunement is more important than factual knowledge, our research (2, 3) suggests that clinicians working with survivors of historical trauma are well-served by knowing about the actual circumstances that their patients’ endured. The reconstruction of the traumatic period and the opportunity to develop a coherent narrative—often for the first time—may be one of the important achievements in therapy. Perhaps Dr. Seritan alluded to this when she states, “I pointed out to Ms. A how much work she had done and how much she had accomplished.”

Aproximación a las Relaciones internacionales de España, 1834-1874

In the second third of the xix th century, Spain was a small peripheral state, whose limited international role was determined by its own weakness, its political instability and the extra-European character of its basic interests (that is, the remains of the scattered colonial dominions of its lost empire located in the Antilles —Cuba in particular—, Asian Southeastern and Pacific). Between 1833 and 1868 (reign of Isabel II) Spain made a relatively successful effort to improve as a small nation, subordinated to France and Great Britain. But such achievement did finally fade away during the traumatic period of 1868-1874, in which the country underwent a triple civil war (Carlist, Cuban and cantonal) and a practically complete international isolation.

Whiplash and Concussion: Similar Acute Changes in Middle-Latency SEPs

Middle-latency somatosensory evoked potentials (SEPs) following median nerve stimulation can provide a sensitive measure of cortical function. We sought to determine whether the mechanical forces of whiplash injury or concussion alter normal processing of middle-latency SEPs. In a cross-sectional pilot study 20 subjects with whiplash were investigated (50% between 0.5-2 months and 50% between 6-41 months post injury) and compared to 83 healthy subjects using a standard middle-latency SEP procedure. In a subsequent prospective study subjects with either acute whiplash (n=13) or Grade 3 concussion (n=16) were investigated within 48 hours and again three months post injury. In the pilot study the middle-latency SEP component N60 was significantly increased in the ten subjects investigated within two months after whiplash. In contrast, the ten subjects examined more than six months after injury showed normal latencies. In the prospective study N60 latencies were increased after whiplash and concussion when tested within 48 hours of injury. At three months, latencies were improved though still significantly different from controls post whiplash and concussion. Both whiplash injury and concussion alter processing of the middle-latency SEP component N60 in the acute post traumatic period. The acute changes appear to normalize between three-six months post injury. The SEP similarities suggest that the overlapping clinical symptomatology post whiplash and concussion may reflect a similar underlying mechanism of rotational mild traumatic brain injury.

“Invitation to the Journey”: The Consolations of Organisational Excess

“Poetry is the first and last of all knowledge” according to William Wordsworth. This article uses poetry as a lens through which to examine an organisational phenomenon: the opulent decoration of a company's headquarters. As an alternative to more conventional research methods, the aesthetic qualities of poetry are particularly helpful in understanding the deep emotions of shame, guilt and remorse that the article centres on. The article works with two case examples: a large hierarchical organisation recovering from a traumatic period in its history, and a love poem by the nineteenth‐century French poet, Charles Baudelaire.

Downsizing Masculinity: Gender, Family, and Fatherhood in Post-Industrial America

This paper employs interviewing of and participant observation among laid-off and soon to be laid-off industrial workers to explore how conceptions of masculinity, fatherhood, and family are negotiated during the traumatic and transitory period of a plant closing. As economic globalization erodes the industrial base of the Rust Belt, traditional ideas about masculinity, fatherhood and family—including the notion of a sole provider or “breadwinner”—become increasingly impracticable. This study finds that industrial workers adapt to the realities of downward mobility by discarding elements of the “breadwinner ideal”while clinging to others, including beliefs about the American dream and fatherhood.

Fighting for Survival: The 1980s Campaign to Save Ravenscraig Steelworks

The story of the former Ravenscraig steelworks in Motherwell, Lanarkshire, interweaves economics, politics, trade unionism and, above all, the life of a community. From its inception in the 1950s, Ravenscraig took on symbolic status in Scotland, encapsulating hopes for industrial renewal, whilst demonstrating the British state’s commitment to depressed regions. During the economic restructuring and dislocation of the Thatcher years between 1979 and 1990,Ravenscraig’s rundown characterised the Conservatives’ abandonment of this strategy. The plant’s eventual closure in 1992 signalled the death of Scottish heavy industry, sparking widespread anger and bitterness, and touching a raw nerve that still precludes academic analysis of this traumatic period. Of historians who have considered the subject, Peter Payne has tended to focus on the industrial history of Scottish steel-making, whilst Robert Duncan has charted the steel industry’s impact on Motherwell. Keith Aitken’s history of the Scottish Trades Union Congress (STUC) contains the only detailed coverage of Ravenscraig’s fortunes during Thatcher’s premiership. 2 This paper aims to redress the balance by charting the 1980s campaign to save Ravenscraig, placing it within the context of steel nationalisation, the ‘post-war consensus’ in British politics and the privatisation programme. It disentangles the mythology surrounding Ravenscraig by highlighting the role played by the Conservatives in bringing the strip mill to Motherwell, and pointing to Scottish Conservative collusion in prolonging the steelworks’ existence throughout the 1980s.The paper also outlines the changing nature of Conservatism between the 1950s and 1980s, and the impact of this on attitudes to regional development. Finally, consideration is given to the role played by the European Economic Community in the rundown of the Scottish steel industry, a little known aspect of the Ravenscraig story.

Exploring the conditions leading to stoma-forming surgery

The most common disease leading to the formation of a stoma is cancer. However, there are many other diseases that affect the gastrointestinal or urinary system that may also require either a temporary or permanent stoma to be formed (a colostomy, ileostomy or urostomy). Stoma-forming surgery may be undertaken for a number of reasons, such as to eradicate a disease or improve the patient's quality of life. Cancer, inflammatory bowel disease and diverticular disease are the most common conditions that lead to stoma formation. However, faecal incontinence, familial adenomatous polyposis, Hirschsprung's disease, spina bifida and Ehlers-Danlos syndrome may also require a stoma to be formed. The nurse's role in caring for these patients at a potentially traumatic period of their life is discussed.

Communication at the Core of Effective Public Health

Years from now, we may remember the fall of 2001 as the traumatic period in our country’s history when public health became visible throughout society. While the dust was still settling from the terrorist attacks and the country grappled with fears of anthrax in our mail, the American public learned what professionals have known for years: the health and security of our nation depend heavily on a robust public health system. An additional revelation from this turbulent time was the critical role of strategic, timely, and effective communication in public health. The realization that both science and communication are essential to promoting and protecting the health of the public was a major milestone in the emerging discipline of public health communication, reinforcing its vital role as a new core component of public health.

Attitude of Adolescents Towards Family Life Education (FLE): A Comparative Study of Jammu and Palampur

Adolescents are growing up in the world in which they will have to make more decisions for themselves than any previous generation. They experiment more make choices and risks and learn by their own experiences rather than by those of others many are able to face change and confidence and with the vision of better life in future which they can build with their own efforts. Yet for others the result is confusion despair and risk taking of a kind which is ultimately self destructive considering the adolescent stage as a traumatic period. Early pregnancy increased pre-marital sexual activity and limited knowledge regarding reproductive health all results in increased risks of STD infections including HIV/AIDS maternal morbidity and mortality unwanted pregnancies and unsafe abortion thus endangering the physical and reproductive health and productivity of adolescent. As per results revealed by Registrar General of India and National Family Health Survey for 1992-1993 in India 38% girls get married at 19.5 years. In 1991 26.1% of the total fertility in India is attributed to women in the age group of 15-19 years 8% of India 26-27 million annual birth are to mothers under 19 years of age; 7.1% of currently married women in the age group 15-19 years were practicing contraception; the infant mortality rate among live births of adolescent women is about 30% higher compared to those of older women aged 20-24 years. (excerpt)

INDIGENOUS VIDEO, DEVELOPMENT AND SHARED ANTHROPOLOGY: A COLLABORATIVE EXPERIENCE WITH MAYA Q'EQCHI'FILMMAKERS IN POSTWAR GUATEMALA

This article deals with the role of indigenous video, shared anthropology, and collaborative filmmaking among Maya‐Q'eqchi'communities in Alta Verapaz, Guatemala. The subjective and historical conditions that provided the context for collaborative video production between local filmmakers, communities and a visual anthropologist are analyzed, as are the implications these had both for the Q'eqchi'and for my own anthropological practice. I argue that this community‐based video project provided important ethnographic insights about an indigenous group and its transformations. It also provided the communities with new mechanisms for sociocultural reconstruction and awareness after an intensely traumatic and violent period of civil war. In this context, the video documents produced provided a space within a wider practice of shared anthropology where each party could advance its own goals through hybrid products. The project represented an opportunity to explore ways in which anthropology and ethnographic filmmaking could, simultaneously, be of use to the researcher and to the communities studied. It also highlighted the contradictions and complexities of collaborative or “shared” anthropological practice in the sphere of applied visual anthropology.

Transforming Labour: Work, Workers, Struggle and Change

weather made the conference even more pleasant. The range of papers was impressive. There were the traditional labour history concerns such as socialism, trade unions and labourism, plus papers on newer topics that included workers' education, the representation of labour, and labour heritage. The focus of the conference was largely on the twentieth century with very few papers exarriining the nineteenth-century experience, and this tends to be a trend in Australian labour historiography. There were also a number of papers that concentrated on important current industrial relations and work issues which all had their origins in the past. As Marcel Van Der Linden once noted in a seminar at the University of Sydney, a focus on the present may be termed 'contemporary labour history'. With the necessity of parallel sessions, it was impossible to attend all papers. Some interesting papers I attended included Julie Kimber's presentation on the impact of World War I on the country centre of Orange in NSW. Julie looked at a range of outsiders in the town, including a pacifist cleric, to emphasise issues such as patriotism and morality. Images of her subjects brought a touch of the personal to a presentation that examined one of the most traumatic periods in Australian history. Carol Corless, a union delegate, highlighted the struggles that workers have faced for the last 25 years at the margarine factory where she worked. Against the background of world markets and the Accord, this paper sheds light on the recent experience of workers at the point of production. There was a range of other activities that contributed to an excellent conference. Labour banners, which brought colour and important messages to the conference, were everywhere. Trish Nacey's film on the aftermath of the 1998 Maritime Union of Australia (MUA) dispute was compelling. One scene that particularly stands out was sight of MUA union officers handing out redundancy notices to their members. Debra Beattie's documentary 'Manufacturing Dissent' brought back the memories of the struggles during the period of the Bjelke-Peterson state government in Queensland. Terry Irving's excellent conference dinner address provided intriguing insights into the early history of the Australian Society for the Study of Labour History, particularly the role of ASIO, the Australian Security Intelligence Organisation. [This address has been published in the Sydney Branch publication, Hummer, vol. 4, no. 1, Summer 2003/04.]

A New Heart and a New Soul: Ezekiel, the Exile and the Torah

A New Heart and a New Soul: Ezekiel, Exile and Torah, by Risa Levitt Kohn. JSOTSup 358. Sheffield: Sheffield Academic Press, 2002. Pp. xii + 148. $85.00 (cloth). ISBN 0826460577. Risa Levitt Kohn's interest in Ezekiel's message to exiles, during one of most traumatic periods in Israelite history (p. 1), brought her to study systematically lexical and thematic similarities between Ezekiel and P, and Ezekiel and D/Dtr. She poses questions regarding nature of relationship between Ezekiel and abovementioned sources. By considering implications of these literary connections on evolution of Torah, Levitt Kohn is able to place Ezekiel within context of Israelite history, theology, and literature. Levitt Kohn joins a gigantic controversy in biblical scholarship, with J. Wellhausen and Y. Kaufmann as major speakers. In a thorough introduction (ch. 2), she examines Wellhausen's thesis as well as counterthesis regarding evolution of Pentateuch and Ezekiel's contribution to this process. Studying idiomatic similarities between language of Ezekiel and P, on one hand, and D/Dtr phrases, on other, Levitt Kohn establishes (once again) improbability of assumption that Ezekiel preceded both and D/Dtr sources. She thus joins Kaufmann's school in this debate. In her study, Levitt Kohn strives to release Ezekiel from burden laid on him by Wellhausen, who considered prophet to be no less than the original spiritual of Judaism (thus Levitt Kohn [p. 110]). Levitt Kohn presents four major arguments regarding relationship between Ezekiel and Torah (ch. 6). First, though she argues that Ezekiel does not know entire Torah (p. 117), prophet is certainly aware of both and D/Dtr sources in their written form. Yet Ezekiel is not working furiously to preserve these traditions for posterity . . . Ezekiel is not safeguarding Israelite tradition from extinction (p. 111). Rather, uses both traditions, separately and in combination, as sources for his own pronouncements; he questions these traditions, comments upon them, and, ultimately, reformulates them (p. 111). Second, Levitt Kohn refutes moderate path that explains connections between Ezekiel and as resulting from common priestly concerns, ideology, vocabulary, or heritage in general. She rather emphasizes direct literary allusions to P in Ezekiel (p. 112, emphasis original). Third, Levitt Kohn illuminates Ezekiel's independence with respect to his sources and explains his position in accordance with his main motives in using them. The legal standards of both and D serve Ezekiel, on one hand, as theological arguments to explain 587 B.C.E. disaster and, on other, as potential standards for his contemporaries' improvement or as means to a future redemption. Yet, when neither nor D serves his purpose, Ezekiel paves his own new way, which oftentimes integrates both schools' ideologies (pp. 113-14). Finally, through a comparison with exilic and postexilic literary compositions, Levitt Kohn places Ezekiel at roots of a process of synthesizing pentateuchal literary sources, exemplified years later in redactor's work on Torah, in Ezra-Nehemiah, and in Chronicles. By articulating Ezekiel's combination of contradictory theologies of and D, then, Levitt Kohn gives prophet primacy as precursor of Torah redactor(s). Thus, she argues that Ezekiel anticipated restoration authors and redactors in constructing an inclusive ideology that intentionally combined rival streams of thought known to us as and D. Hence, while denying Wellhausen's appointment of Ezekiel as architect of Judaism, Levitt Kohn nevertheless awards prophet another major role: Ezekiel established an integrated ideology that went beyond preexilic separate Priestly and Deuteronomistic schools of thought. …

Low respiratory sinus arrhythmia and prolonged psychophysiological arousal in posttraumatic stress disorder: heart rate dynamics and individual differences in arousal regulation

Background There is extensive evidence that the parasympathetic branch of the autonomic nervous system can modulate psychophysiological arousal. To date, no studies have investigated associations between cardiac vagal tone and the time course of arousal during exposure to trauma-related stimuli in posttraumatic stress disorder (PTSD). Methods Thirty-one subjects, 29 with PTSD and 2 with partial PTSD, had electrocardiograms recorded during baseline and 2-minute traumatic and neutral script-driven imagery periods. Heart rate, respiratory sinus arrhythmia (RSA), and heart rate half-recovery to the trauma script were quantified, and subjects were divided into low and high baseline RSA groups. Results Across all participants, heart rate significantly increased from the neutral to the trauma script and RSA significantly decreased from baseline to trauma script ( p < .05). As predicted, low RSA subjects had more prolonged heart rate increases to the trauma script than high RSA subjects ( p < .001), and heart rate half-recovery was negatively correlated to baseline RSA ( r = −.50, p = .005). Conclusions This study is the first to find decreased RSA in response to a traumatic reminder and an association between low baseline RSA and sustained conditioned arousal in PTSD. Low vagal tone may account for deficient arousal and emotion regulation capacities often observed in PTSD.