Long-term effects of trauma: psychosocial functioning of the second and third generation of Holocaust survivors

The long-term effects of extreme war-related trauma on the second and the third generation of Holocaust survivors (HS) were examined in 88 middle-class families. Differences in functioning between adult offspring of HS (HSO) and a comparison group, as well as the psychosocial functioning of adolescent grandchildren of HS, were studied. Degree of presence of Holocaust in the family was examined in families in which both parents were HSO, either mother or father was HSO, and neither parent was HSO. Mothers' Holocaust background was associated with higher levels of psychological distress and less positive parenting representations. In line with synergic (multiplicative) models of risk, adolescents in families where both parents were HSO perceived their mothers as less accepting and less encouraging independence, and reported less positive self-perceptions than their counterparts. They also perceived their fathers as less accepting and less encouraging independence, showed higher levels of ambivalent attachment style, and according to their peers, demonstrated poorer adjustment during military basic training than their fellow recruits from the one-parent HSO group. Parents and adolescents in the one-parent HSO group functioned similarly to others with no Holocaust background. Parenting variables mediated the association across generations between degree of Holocaust experience in the family of origin of the parents and ambivalent attachment style and self-perception of the adolescents. It is recommended that researchers and clinicians develop awareness of the possible traces of trauma in the second and the third generation despite their sound functioning in their daily lives.

[Sonography of the optical nerve -- experience in 483 children]

INTRODUCTION

In case of increased intracranial pressure (IICP), the inflow of cerebrospinal fluid widens the space between the optic nerve (ON) itself and the surrounding dura mater leading to the sonographic appearance of increased diameter of the ON. The purpose of the study was to gain clinical experience in children and to determine (a) the mean values for patients without proven IICP and (b) pathologic values of those with proven IICP.

MATERIALS AND METHODS

Ultrasound of the optic nerve was performed in 483 children with symptoms consistent with IICP, comprising 287 males and 196 females at an age ranging from 4 days to 24 years with a mean age of 7.5 + 5.1 years. The measured diameter of the ON of both eyes and the morphologic criteria concerning nerve sheath and papilla were evaluated retrospectively.

RESULTS

Most of the investigated patients (n = 466) had no IICP as confirmed by neurological examination, EEG, sometimes CCT and/or MRI and clinical follow-up. The typical morphological findings in patients with normal intracranial pressure (ICP) were a clear and longitudinally extended demarcation of the ON with a well-delimited nerve sheath and without prominent papilla. The mean diameter of the ON in patients with normal ICP was 3.4 mm + 0.7 mm. In 17 patients with proven IICP, the mean diameter of the ON increased to 5.6 mm + 0.9 mm. Typically, the nerve sheath was indistinguishable from the hypoechoic ON, often but not invariably associated with a prominent papilla. In patients with IICP, the diameter of the ON alone matches the diameter of the ON plus nerve sheath in patients with normal ICP.

CONCLUSION

IICP was detected with a high sensitivity by ultrasound using the diameter and the morphological criteria of an indistinguishable nerve sheath. A diameter of more than 4.5 mm is definitely pathologic and requires further investigation. Prominence of the papilla is an unreliable criterion for acute IICP.

Adolescents' Attachment Representations and Developmental Tasks in Emerging Adulthood

The association between attachment representations and adolescents' coping with 3 developmental tasks of emerging adulthood-leaving home, advancing in the capacity for mature intimacy, and developing individuation-was examined. Israeli male adolescents (N = 88) were administered the Adult Attachment Interview during their high-school senior year. A year later, they and their friends reported on the adolescents' adjustment to mandatory military service. Three years later, participants and their parents reported on the adolescents' capacity for intimacy using an in-depth interview and on their individuation. An autonomous state of mind was associated with better coping with basic training and with a higher capacity for mature intimacy but was not associated with markers of individuation. The results highlight the importance of attachment representations in shaping an individual's developmental trajectory.

Attachment and traumatic stress in female holocaust child survivors and their daughters

OBJECTIVE

During the Holocaust, extreme trauma was inflicted on children who experienced it. Two questions were central to the current investigation. First, do survivors of the Holocaust still show marks of their traumatic experiences, even after more than 50 years? Second, was the trauma passed on to the next generation?

METHOD

Careful matching of Holocaust survivors and comparison subjects was employed to form a research study design with three generations, including 98 families with a grandmother, a mother, and an infant, who engaged in attachment- and trauma-related interviews, questionnaires, and observational procedures.

RESULTS

Holocaust survivors (now grandmothers) showed more signs of traumatic stress and more often lack of resolution of trauma than comparison subjects, but they were not impaired in general adaptation. Also, the traumatic effects did not appear to transmit across generations.

CONCLUSIONS

Holocaust survivors may have been able to protect their daughters from their war experiences, although they themselves still suffer from the effects of the Holocaust.

Differential expression and induction of two Drosophila cytochrome P450 genes near the Rst(2)DDT locus

Previous studies have shown that the major metabolic resistance locus in the insecticide-resistant Drosophila line Rst(2)DDT(Wisconsin) maps between the markers cn and vg on chromosome 2. Six cytochrome P450 genes exist in this region. We investigated the expression levels of these P450 genes in DDT-resistant and -susceptible fly lines. We report: (i) DDT resistance is significant (> 30-fold) and dominant, (ii) resistance is reduced by the cytochrome P450 inhibitor PBO, (iii) there is constitutive over-expression relative to susceptible flies of two genes encoding cytochrome P450 enzymes within the cn-vg region (CYP6G1 = 4.3-fold; CYP12D1 = 6.0-fold), and (iv) exposure to DDT results in an increased expression of only one of these two P450 genes (CYP12D1 > or = 6-fold above constitutive resistant fly baselines).

Disorganized reasoning in Holocaust survivors

In 2 related studies of nonclinical Israeli samples, the long-term sequelae of traumatic Holocaust experiences were investigated from an attachment perspective. In each study, Holocaust survivors were compared with participants who had not experienced the Holocaust, and their attachment style and state of mind with regard to past and present attachment experiences as well as their state of mind regarding unresolved loss were assessed. In both studies, the Holocaust groups were found to be significantly more inclined to show disoriented thought processes around trauma than were the groups without Holocaust background. From an attachment perspective, the authors showed that even after 50 years, traumatic traces of Holocaust experiences are present in the survivors.

Parental divorce and young adult children's romantic relationships: resolution of the divorce experience

Fifty-one romantically involved young Israeli adults, whose parents were divorced, were questioned about their romantic relationship, parents' conflict, and current feelings about and reconstruction of the divorce. An integrative perception of the divorce was found to be related to fewer problems and to higher levels of friendship, enjoyment, and intimacy in the relationship. Implications for research and intervention with young adults are discussed.

Radiobiological hypoxia, oxygen tension, interstitial fluid pressure and relative viable tumour area in two human squamous cell carcinomas in nude mice during fractionated radiotherapy

Very little is known about the correlation between the radiobiological hypoxic fraction (rHF) and other measures of tumour oxygenation during fractionated irradiation. In the present study the rHF is determined in untreated human FaDu and GL squamous cell carcinoma in nude mice and in tumours irradiated with 10 fractions in 2 weeks and 20 fractions in 4 weeks, using tumour control as the experimental endpoint. The results were compared with measurements of the pO2, the interstitial fluid pressure (IFP) and the relative viable tumour area. In FaDu tumours the radiobiological hypoxic fractions (rHFs) before and during irradiation were not statistically different from 100%. Depending on the assumptions made for D0, the rHFs of GL tumours were between 0.2 and 4% or 30 and 53%. The median pO2 values were 2.8 mmHg for untreated FaDu tumours and 0.2 mmHg for GL tumours (p < 0.001). The median IFP values were 2.6 mmHg in FaDu and 5.3 mmHg in GL tumours (p = 0.01). No important changes in the pO2 and IFP values were observed during fractionated irradiation. The relative viable tumour area during irradiation decreased by 83% in FaDu tumours (p = 0.002) and by 54% in GL tumours (p = 0.003). It is concluded that differences in rHF exist between FaDu and GL tumours before and during fractionated irradiation and that these differences are not reflected by pO2 and IFP values and the relative viable tumour area.

The capacity for romantic intimacy: exploring the contribution of best friend and marital and parental relationships

This study examined, in a longitudinal design, the contributions of three different relationships, namely marital, parent-child and best friend, to the capacity for intimacy in romantic relationships of Israeli male adolescents, as well as the mediating role of socio-emotional capacities. Eighty-four 17-year-old adolescents and their parents filled out questionnaires concerning the quality of these relational contexts. Four years later the Intimacy Status Interview was administered to the adolescents at the conclusion of their mandatory military service to examine closeness, separateness, and commitment within their romantic relationships. Results showed that all relational contexts were related to capacity for intimacy (directly or indirectly), with higher relational qualities associated with better capability for intimacy. The marital relationship was associated with intimacy through its effect on the parent-child relationships. The effects of the parent-child relationships on the capacity for intimacy were mediated through the adolescents' socio-emotional capabilities. The contribution of the parent-adolescent relationships to the capacity for closeness and commitment was further mediated through relationships with the best friend, whereas the contribution to the capacity for separateness was not. A substantial number of our participants showed high capability for intimacy although in the military service context the circumstances for the development of intimacy were quite limited and non-optimal. Exploration of the separateness and closeness facets of intimacy in romantic relationships in the two sexes and in other contexts is recommended.

A "natural experiment" in childrearing ecologies and adolescents' attachment and separation representations

Employing a quasi-experimental design, this study explored the long-term effects of different childrearing ecological contexts. Participants were 131 adolescents (aged 16-18) from four groups: some who lived in a city, some from a kibbutz familial setting, some from a kibbutz communal setting, and a transitional group that included adolescents raised in a communal setting as young children who moved to a familial sleeping arrangement before the age of six. Adolescents' state of mind with regard to attachment and representations regarding separation were examined. Participants were administered the Adult Attachment Interview, the Separation Anxiety Test, and background questionnaires. The group raised in a communal setting in the kibbutz showed a higher incidence of nonautonomous attachment representations and less competent coping with imagined separations than did the other groups. By contrast, the transitional group was comparable to the city and the kibbutz familial groups. These results are discussed in light of the plasticity and adaptability of children to changed circumstances.

Eight weeks of non-nightly use of zolpidem for primary insomnia

CONTEXT

Intermittent use (i.e., a few nights per week) of hypnotic medication is often recommended for the treatment of chronic insomnia despite an absence of efficacy and safety data using this regimen.

STUDY OBJECTIVES

To evaluate the clinical efficacy and safety of intermittent pharmacotherapy for chronic insomnia.

DESIGN AND SETTING

Randomized, double-blind, placebo-controlled, parallel groups, clinical trial at six sleep research sites.

PATIENTS

One hundred-sixty-three (115 women, 48 men; mean age 44.1+ SE. 0.9 years), DSM-IV-defined primary insomnia patients were randomized, 134 patients completed the study.

INTERVENTIONS

Eight weeks of treatment with either zolpidem 10 mg or placebo. Patients were instructed to take medication when they felt they needed it, but at least three and no more than five times per week.

MAIN OUTCOME MEASURES

Investigator and Patient Global Ratings were the primary outcome variables. Secondary measures from daily questionnaires to assess efficacy, rebound insomnia and drug taking behavior.

RESULTS

The Investigator's Global Rating indicated that intermittent use of zolpidem produced a significantly better therapeutic effect and significantly reduced insomnia severity throughout the 8-week study relative to placebo. Zolpidem was found to be effective in initiating and maintaining sleep on nights taken, as compared to placebo, based upon the Patient's Global Ratings and all subjective sleep variables. No evidence of rebound insomnia was found on nights that zolpidem was not taken. The number of nights a pill was taken did not differ between groups, nor did frequency of pill taking change in either group across the duration of the study. There were no significant effects of treatment upon quality of life or neurocognitive measures.

CONCLUSIONS

Zolpidem 10 mg is effective in treating insomnia when used intermittently, without evidence of discontinuation effects or increased frequency of pill taking.

Close relationships and social competence of hospitalized and nonhospitalized adolescents

This study was designed to examine the social relationships of adolescents with severe disorders. The study sample consisted of 33 adolescent inpatients in a psychiatric unit, as well as 33 nonhospitalized adolescents. Participants completed the Network of Relationship Inventory for an assessment of the quality of their relationships with mother, father, close friend, and other significant adults. In addition, friendship intimacy was assessed. Results showed nonhospitalized adolescents describing a close relationship with their parents, as well as with their close friends. Their relationships with their friends were mature. Hospitalized adolescents described a less close relationship with their parents, whereas they were close to and valued their relationships with their friends and other significant adults. Though both groups described similar levels of emotional closeness, hospitalized adolescents tended more to exert control or to evince a penchant for similarity to the other in their friendships. Results are discussed within the framework of adolescent social tasks.

Family relationships, leaving home, and adjustment to military service

Associations between family relationships and individual adjustment were studied within a sample of 19-year-old soldiers during their first weeks of basic training. Results showed that family relationships partly explained soldiers' closeness to best friends, number of social nominations, and commanders' ratings of soldiers' military and social competence. In addition, family relations explained soldiers' perceived social competence as assessed via closeness to best friends and number of sociometric nominations. Together, the results reiterate the role played by the family and attitudes toward offspring leaving home and toward their adjustment to military service.

Zaleplon improves sleep without producing rebound effects in outpatients with insomnia. Zaleplon Clinical Study Group

The efficacy and safety of three doses of zaleplon, a novel non-benzodiazepine hypnotic, were compared with those of placebo in outpatients with insomnia in this 4-week study, using zolpidem 10 mg as active comparator. Postsleep questionnaires were used to determine treatment effects on the patient's perception of sleep, as well as any development of pharmacological tolerance during therapy or rebound insomnia or withdrawal symptoms upon discontinuation of therapy. During week 1, sleep latency was significantly shorter with zaleplon 5, 10, and 20 mg compared to placebo. The significant decrease in sleep latency persisted through week 4 with zaleplon 20 mg, and was again evident with zaleplon 10 mg at week 3. Zaleplon 20 mg also had significant effects on sleep duration, number of awakenings, and sleep quality compared to placebo. No pharmacological tolerance developed during treatment with zaleplon and there were no indications of rebound insomnia or withdrawal symptoms after treatment discontinuation. Zolpidem 10 mg had significant effects on sleep latency, sleep duration, and sleep quality compared to placebo. However, a significantly greater incidence of withdrawal symptoms and a suggestion of sleep difficulty after treatment discontinuation (rebound insomnia) for all sleep measures was seen with zolpidem compared to placebo. There was no significant difference in the frequency of adverse events with active treatment compared to placebo. These results show that zaleplon provides effective treatment of insomnia with a favourable safety profile.

Loratadine versus cetirizine: assessment of somnolence and motivation during the workday

OBJECTIVE

This parallel-group, double-blind study compared the somnolence and motivation profiles of 2 second-generation antihistamines, loratadine and cetirizine, in patients with allergic rhinitis.

BACKGROUND

Second-generation antihistamines were developed to provide symptomatic relief from allergic disorders without the unwanted side effects of first-generation antihistamines, including somnolence. Recent research has indicated that not all second-generation antihistamines are comparable with respect to somnolence and other cognitive processes.

METHODS

Patients aged > or = 12 years and actively exhibiting symptoms of allergic rhinitis were randomized to 2 treatment groups to receive 10 mg loratadine or 10 mg cetirizine daily at 8:00 AM for 1 week. After patients took the medication, their somnolence and degree of motivation to perform activities were recorded in an electronic diary using a visual analog scale 4 times during the workday (8:00 AM, 10:00 AM, noon, and 3:00 PM).

RESULTS

Sixty patients (31 men, 29 women) were randomized to treatment. Somnolence scores were similar for both groups at baseline and at the time of dosing (8:00 AM). However, there was a statistically significant difference in somnolence scores between the loratadine and cetirizine groups at 10:00 AM (P = 0.008), noon (P = 0.001), and 3:00 PM (P < 0.001), with the cetirizine group showing a greater degree of somnolence. The scores on motivation to perform activities were similar for both groups at the baseline and 8:00-AM measurements. In parallel with the somnolence scores, there were statistically significant differences in motivation scores between the loratadine and cetirizine groups at 10:00 AM (P = 0.014), noon (P = 0.001), and 3:00 PM (P < 0.001), indicating that patients taking loratadine were relatively more motivated during the workday.

CONCLUSION

The results of this study demonstrate that in patients aged > or = 12 years who had allergic rhinitis, cetirizine use promoted somnolence and decreased motivation to perform activities during the workday compared with loratadine.

Structure and dynamic properties of the single disulfide-deficient alpha-amylase inhibitor [C45A/C73A]tendamistat: an NMR study

Covalent linkages such as disulfide bonds are important for the stabilization of proteins. In the present NMR study we compare the structure and the dynamics of the single disulfide-deficient variant C45A/C73A of the alpha-amylase inhibitor tendamistat and the wild-type protein, which contains two disulfide bonds (C11-C27 and C45-C73). Complete proton assignment was achieved by standard homonuclear 2D techniques for the variant. Chemical shift differences, intra-strand NOE effects and protected amide proton were used to compare the connectivity of the secondary structure elements of variant and wild-type. Dynamic properties of the wild-type protein were studied by 13C(alpha) heteronuclear NOE experiments with carbon in natural abundance. 15N isotope labeling was necessary to obtain the relaxation parameters of the variant, because of sample degradation. The 15N resonance assignment was achieved by a 15N 3D-NOESY-HMQC. Removal of the C45-C73 bond by the C45A/C73A mutation has no influence upon the beta-barrel structure of tendamistat beside very local changes at the mutation site. The relaxation data revealed only subtle differences between variant and wild-type on a subnanosecond time scale. Only the N-terminus and G62 in the connecting loop between the anti-parallel beta-sheets showed an increased mobility. The results are discussed in respect to thermodynamic stability and the secretion efficiency of tendamistat.

Effect of preformed correct tertiary interactions on rapid two-state tendamistat folding: evidence for hairpins as initiation sites for beta-sheet formation

The role of preformed correct side chain interactions, such as disulfide bonds, on protein folding kinetics is still not well understood. We investigated the effect of disulfide bond replacements on folding and stability of the small beta-sheet protein tendamistat. Tendamistat folds very fast (tau = 10 ms at pH 7 in water) and without detectable intermediates, which facilitates molecular interpretation of the kinetic data. Tendamistat contains two disulfide bonds, one between cysteines 11 and 27, which connects the ends of a beta-hairpin, and a second one between cysteines 45 and 73, which brings together the two outer strands of a three-stranded beta-sheet. Two single-disulfide variants of the protein were prepared by site-directed mutagenesis (tendamistat C11A/C27S and tendamistat C45A/C73A), and the effects on stability and on folding were monitored. Replacement of either disulfide bond leads to a large decrease in protein stability (DeltaDeltaG0 = 6.0 kcal/mol for the C11A/C27S variant and 5.1 kcal/mol for the C45A/C73A variant). This effect is caused both by entropic stabilization of the unfolded state and by enthalpic destabilization of the native structure. Kinetic experiments show that the main effect of fixed side chain contacts is on the unfolding rate. For both single-disulfide variants, unfolding is strongly accelerated (4250 times in the C11A/C27S variant and 250 times in the C45A/C73A variant) whereas the refolding rate constants are only slightly decreased. The activation parameters show that the observed small effect on the refolding reaction in the C11A/C27S variant is a consequence of large and compensating changes in the entropy and enthalpy of activation. Structural interpretation of the kinetic data suggests that formation of the beta-hairpin stabilized by the C11-C27 disulfide bond forms in the rate-limiting step of the refolding process. The interactions between the outer strands of the beta-sheet connected by the C45-C73 disulfide bond, in contrast, are made late in refolding. These results support the idea that beta-hairpins are initiation sites for beta-sheet formation and that additional strands are added late in the folding process.

Effect of beta-carboline-3-carboxoylate-t-butyl ester on ventilatory control

beta-carboline-3-carboxylate-t-butyl ester (beta CCT) is the most selective antagonist for the alpha 1 beta 2 gamma 2 benzodiazepine (BZ) receptor subtype which blocks anticonvulsant and antipunishment (anxiolytic) but not sedative and myorelaxant effects of diazepam. We sought to determine whether the alpha 1 beta 2 gamma 2 BZ receptor subtype modulates ventilation and whether beta CCT antagonizes respiratory depressant effects of BZ's. Room air (RA) ventilation and the ventilatory response to 6% & 12% CO2 were non-invasively assessed by barometric plethysmography in 30 gm mice, n = 11. Plethysmograph signal amplitude (AMP), respiratory rate (RR) and minute ventilatory effort (MVE = AMP*RR), were measured. Runs were performed pre-drug & after IP injection of saline, vehicle for beta CCT, beta CCT (60mg/kg), midazolam (10mg/kg), and midazolam followed by beta CCT. Compared with pre-drug value, midazolam depressed MVE during RA and CO2 stimulation (% of pre-drug value: RA:57.7 +/- 17.4%, 6% CO2:53.73 +/- 14.3%, 12% CO2:69.1 +/- 26.1%, p < .0001, ANOVA). Subsequent beta CCT partially reversed this depression during RA conditions (72.8 +/- 25.7% of pre-drug value, p < .03 compared with midazolam) and 6% CO2 stimulation (67.1 +/- 10.7% of pre-drug value, p < .006 compared with midazolam) but not with 12% CO2. Thus, the alpha 1 beta 2 gamma 2 BZ receptor subtype modulates ventilation and beta CCT partially antagonizes respiratory depressant effects of BZ's.