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Boyd JE, Kanas NA, Salnitskiy VP, Gushin VI, Saylor SA, Weiss DS, Marmar CR. Cultural differences in crewmembers and mission control personnel during two space station programs. ACTA ACUST UNITED AC 2009; 80:532-40. [PMID: 19522363 DOI: 10.3357/asem.2430.2009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Cultural differences among crewmembers and mission control personnel can affect long-duration space missions. We examine three cultural contrasts: national (American vs. Russian); occupational (crewmembers vs. mission control personnel); and organizational [Mir space station vs. International Space Station (ISS)]. METHODS The Mir sample included 5 American astronauts, 8 Russian cosmonauts, and 42 American and 16 Russian mission control personnel. The ISS sample included 8 astronauts, 9 cosmonauts, and 108 American and 20 Russian mission control personnel. Subjects responded to mood and group climate questions on a weekly basis. The ISS sample also completed a culture and language questionnaire. RESULTS Crewmembers had higher scores on cultural sophistication than mission control personnel, especially American mission control. Cultural sophistication was not related to mood or social climate. Russian subjects reported greater language flexibility than Americans. Crewmembers reported better mood states than mission control, but both were in the healthy range. There were several Russian-American differences in social climate, with the most robust being higher work pressure among Americans. Russian-American social climate differences were also found in analyses of crew only. Analyses showed Mir-ISS differences in social climate among crew but not in the full sample. DISCUSSION We found evidence for national, occupational, and organizational cultural differences. The findings from the Mir space station were essentially replicated on the ISS. Alterations to the ISS to make it a more user-friendly environment have still not resolved the issue of high levels of work pressure among the American crew.
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Seal KH, Metzler TJ, Gima KS, Bertenthal D, Maguen S, Marmar CR. Trends and risk factors for mental health diagnoses among Iraq and Afghanistan veterans using Department of Veterans Affairs health care, 2002-2008. Am J Public Health 2009; 99:1651-8. [PMID: 19608954 DOI: 10.2105/ajph.2008.150284] [Citation(s) in RCA: 461] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We sought to investigate longitudinal trends and risk factors for mental health diagnoses among Iraq and Afghanistan veterans. METHODS We determined the prevalence and predictors of mental health diagnoses among 289,328 Iraq and Afghanistan veterans entering Veterans Affairs (VA) health care from 2002 to 2008 using national VA data. RESULTS Of 289,328 Iraq and Afghanistan veterans, 106,726 (36.9%) received mental health diagnoses; 62,929 (21.8%) were diagnosed with posttraumatic stress disorder (PTSD) and 50 432 (17.4%) with depression. Adjusted 2-year prevalence rates of PTSD increased 4 to 7 times after the invasion of Iraq. Active duty veterans younger than 25 years had higher rates of PTSD and alcohol and drug use disorder diagnoses compared with active duty veterans older than 40 years (adjusted relative risk = 2.0 and 4.9, respectively). Women were at higher risk for depression than were men, but men had over twice the risk for drug use disorders. Greater combat exposure was associated with higher risk for PTSD. CONCLUSIONS Mental health diagnoses increased substantially after the start of the Iraq War among specific subgroups of returned veterans entering VA health care. Early targeted interventions may prevent chronic mental illness.
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Wang Z, Xiao Z, Inslicht SS, Tong H, Jiang W, Wang X, Metzler T, Marmar CR, Jiang S. Low expression of catecholamine-O-methyl-transferase gene in obsessive-compulsive disorder. J Anxiety Disord 2009; 23:660-4. [PMID: 19269131 DOI: 10.1016/j.janxdis.2009.02.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2008] [Revised: 01/27/2009] [Accepted: 02/04/2009] [Indexed: 01/03/2023]
Abstract
This study examined peripheral catecholamine-O-methyl-transferase (COMT) gene expression in obsessive-compulsive disorder (OCD) patients and healthy controls. Participants included 35 first episode OCD patients and 31 age- and sex-matched healthy controls. Relative COMT gene expression levels were examined by real-time quantitative reverse transcription polymerase chain reaction (RT-PCR) in peripheral blood of all the subjects. COMT gene expression levels, normalized by glyceraldehyde-3-phosphate dehydrogenase (GAPDH), were significantly decreased in the OCD group compared with healthy controls (F=6.244, p=0.015). OCD patients showed a 32% down-regulation. We also found lower COMT gene expression levels in female in comparison to male participants (F=5.366, p=0.024) in the sample as a whole. COMT gene expression down-regulation of male OCD patients relative to male controls is 38%, and that of female OCD patients relative to female controls is 27%. These results suggest that COMT gene expression down-regulation might play an important role in the development of OCD and that there may be gender differences in this alteration.
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Brooks R, Bryant RA, Silove D, Creamer M, O'Donnell M, McFarlane AC, Marmar CR. The latent structure of the Peritraumatic Dissociative Experiences Questionnaire. J Trauma Stress 2009; 22:153-7. [PMID: 19370700 DOI: 10.1002/jts.20414] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
This paper has been retracted due to a publisher's error: the order of the authors was incorrect. The Editor and Publisher of the Journal of Traumatic Stress apologize to the authors and our readership. The Peritraumatic Dissociative Experiences Questionnaire (PDEQ) is a widely used measure of peritraumatic dissociation, and is presumably a unidimensional construct. Two hundred forty-seven individuals admitted to five hospitals after traumatic injury were administered the Clinician Administered PTSD Scale, the Hospital Anxiety and Depression Scale, and the PDEQ. Factor analysis indicated that the PDEQ involved two factors containing four items each: one factor (altered awareness) indexes alterations in awareness and the other (derealization) reflects distortions in perceptions of the self and the world. Only the derealization factor was associated with acute stress, anxiety, and depression symptoms. Cross-validation with independent data provided only partial support for the 2-factor structure model. These data indicate that peritraumatic dissociation may involve two distinct constructs.
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Berger W, Mendlowicz MV, Marques-Portella C, Kinrys G, Fontenelle LF, Marmar CR, Figueira I. Pharmacologic alternatives to antidepressants in posttraumatic stress disorder: a systematic review. Prog Neuropsychopharmacol Biol Psychiatry 2009; 33:169-80. [PMID: 19141307 PMCID: PMC2720612 DOI: 10.1016/j.pnpbp.2008.12.004] [Citation(s) in RCA: 205] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2008] [Revised: 12/15/2008] [Accepted: 12/15/2008] [Indexed: 12/17/2022]
Abstract
The selective serotonin reuptake inhibitors (SSRIs) are considered the first-line pharmacological treatment for PTSD. However, even when treated with this class of drugs, response rates rarely exceed 60% and less than 20-30% of the patients achieve full remission. The aim of this study was to address this limitation by systematically reviewing the options left for the treatment of PTSD when patients do not respond satisfactorily to or tolerate SSRIs. A systematic review covering all original articles, letters and brief reports published in any language until October 2008 was conducted through searches in the ISI/Web of Science, PubMed and PILOTS databases. The search terms included the pharmacological class of each agent or its generic name plus "PTSD" or "stress disorder" in the title, in the abstract or as a keyword. Sixty-three articles were selected, covering the following categories: antipsychotics, anticonvulsants, adrenergic-inhibiting agents, opioid antagonists, benzodiazepines and other agents. None of the identified agents reached the level A of scientific evidence, 5 reached level B, 7 level C and 13 level D. The non-antidepressant agent with the strongest scientific evidence supporting its use in PTSD is risperidone, which can be envisaged as an effective add-on therapy when patients did not fully benefit from previous treatment with SSRIs. Prazosin, an adrenergic-inhibiting agent, is a promising alternative for cases of PTSD where nightmares and insomnia are prominent symptoms. So far, there is no consistent empirical support for using benzodiazepines in the prevention or in the treatment of PTSD, although these drugs could alleviate some associated non-specific symptoms, such as insomnia or anxiety. Further controlled clinical trials and meta-analysis are needed to guide clinicians in their search of effective pharmacological alternatives to antidepressants in PTSD.
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Pole N, Neylan TC, Otte C, Henn-Hasse C, Metzler TJ, Marmar CR. Prospective prediction of posttraumatic stress disorder symptoms using fear potentiated auditory startle responses. Biol Psychiatry 2009; 65:235-40. [PMID: 18722593 PMCID: PMC2647968 DOI: 10.1016/j.biopsych.2008.07.015] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2007] [Revised: 07/10/2008] [Accepted: 07/10/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) has been most consistently associated with exaggerated physiologic reactivity to startling sounds when such sounds occur in threatening contexts. There is conflicting evidence about whether startle hyperreactivity is a preexisting vulnerability factor for PTSD or an acquired result of posttrauma neural sensitization. Until now, there have been no prospective studies of physiologic reactivity to startling sounds in threatening contexts as predictors of PTSD symptoms. METHODS One hundred and thirty-eight police academy cadets without current psychopathology were exposed to repeated 106-dB startling sounds under increasing (low, medium, or high) threat of mild electric shock while their eye-blink electromyogram, skin conductance, heart rate, and subjective fear responses were recorded. Measures of response habituation were also calculated. Following 1 year of exposure to police-related trauma, these participants were assessed for PTSD symptom severity. RESULTS After accounting for other baseline variables that were predictive of PTSD symptom severity (age and general psychiatric distress), more severe PTSD symptoms were prospectively and independently predicted by the following startle measures: greater subjective fear under low threat, greater skin conductance under high threat, and slower skin conductance habituation. CONCLUSIONS These results imply that hypersensitivity to contextual threat (indexed by greater fear under low threat), elevated sympathetic nervous system reactivity to explicit threat (indexed by larger responses under high threat), and failure to adapt to repeated aversive stimuli (evidenced by slower habituation) are all unique preexisting vulnerability factors for greater PTSD symptom severity following traumatic stress exposure. These measures may eventually prove useful for preventing PTSD.
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Bryant RA, Brooks R, Silove D, Creamer M, O'Donnell M, McFarlane AC, Marmar CR. The latent structure of the Peritraumatic Dissociative Experiences Questionnaire. J Trauma Stress 2009; 22:69-73. [PMID: 19189282 DOI: 10.1002/jts.20388] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The Peritraumatic Dissociative Experiences Questionnaire (PDEQ) is a widely used measure of peritraumatic dissociation, and is presumably a unidimensional construct. Two hundred forty-seven individuals admitted to five hospitals after traumatic injury were administered the Clinician Administered PTSD Scale, the Hospital Anxiety and Depression Scale, and the PDEQ. Factor analysis indicated that the PDEQ involved two factors containing four items each: one factor (altered awareness) indexes alterations in awareness and the other (derealization) reflects distortions in perceptions of the self and the world. Only the derealization factor was associated with acute stress, anxiety, and depression symptoms. Cross-validation with independent data provided only partial support for the 2-factor structure model. These data indicate that peritraumatic dissociation may involve two distinct constructs.
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Seal KH, Maguen S, Bertenthal D, Gima K, Marmar CR. SEAL ET AL. RESPOND. Am J Public Health 2008. [DOI: 10.2105/ajph.2008.141333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Meffert SM, Metzler TJ, Henn-Haase C, McCaslin S, Inslicht S, Chemtob C, Neylan T, Marmar CR. A prospective study of trait anger and PTSD symptoms in police. J Trauma Stress 2008; 21:410-6. [PMID: 18720397 PMCID: PMC3974928 DOI: 10.1002/jts.20350] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
It is unknown whether anger is a risk factor for the development of posttraumatic stress disorder ( PTSD) symptoms, arises as a consequence of PTSD, or both. Two hypotheses were tested in 180 police recruits: Greater trait anger during training will predict greater PTSD symptoms at one year; greater PTSD symptoms at one year will predict greater state anger at one year. Both hypotheses were confirmed, suggesting that trait anger is a risk factor for PTSD symptoms, but that PTSD symptoms are also associated with an increase of state anger. Increased anger is important not only because of the impact it has on individual distress and physical health, but also because of its potential public health impact.
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Maia DB, Marmar CR, Mendlowicz MV, Metzler T, Nóbrega A, Peres MC, Coutinho ES, Volchan E, Figueira I. Abnormal serum lipid profile in Brazilian police officers with post-traumatic stress disorder. J Affect Disord 2008; 107:259-63. [PMID: 17888517 PMCID: PMC3974924 DOI: 10.1016/j.jad.2007.08.013] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2007] [Revised: 08/15/2007] [Accepted: 08/20/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND To measure the serum lipid composition of a sample of Brazilian police officers with and without PTSD regularly exposed to potentially traumatic situations. METHODS A cross-sectional survey was conducted with 118 active duty male police officers. Serum concentrations for total cholesterol, LDL-C, HDL-C, and triglycerides were enzymatically determined. Body mass index (BMI) was obtained for each participant. RESULTS Officers with PTSD exhibited significantly higher serum total cholesterol, LDL-C and triglycerides levels than those without PTSD. Total cholesterol and triglycerides, but not LDL-C, remained associated with PTSD diagnosis after controlling for confounding influences (i.e. socio-demographics, BMI, and tobacco, alcohol and medication use). LIMITATIONS The sample size was small. A nutritional interview was employed instead of established scales to assess alimentary habits, tobacco or alcohol consumption. A self-report screening tool was used to assess the prevalence of PTSD. CONCLUSIONS The association between PTSD and abnormal serum lipid profile and a tendency to exhibit higher BMI suggests that individuals with PTSD may be at increased risk for developing metabolic syndrome, a condition that by itself could account for many of the most serious PTSD-related physical health problems.
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Seal KH, Bertenthal D, Maguen S, Gima K, Chu A, Marmar CR. Getting beyond "Don't ask; don't tell": an evaluation of US Veterans Administration postdeployment mental health screening of veterans returning from Iraq and Afghanistan. Am J Public Health 2008; 98:714-20. [PMID: 18309130 DOI: 10.2105/ajph.2007.115519] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We sought to evaluate outcomes of the Veterans Administration (VA) Afghan and Iraq Post-Deployment Screen for mental health symptoms. METHODS Veterans Administration clinicians were encouraged to refer Iraq or Afghanistan veterans who screened positive for posttraumatic stress disorder, depression, or high-risk alcohol use to a VA mental health clinic. Multivariate methods were used to determine predictors of screening, the proportions who screened positive for particular mental health problems, and predictors of VA mental health clinic attendance. RESULTS Among 750 Iraq and Afghanistan veterans who were referred to a VA medical center and 5 associated community clinics, 338 underwent postdeployment screening; 233 (69%) screened positive for mental health problems. Having been seen in primary care (adjusted odd ratio [AOR]=13.3; 95% confidence interval [CI]=8.31, 21.3) and at a VA community clinic (AOR=3.28; 95% CI=2.03, 5.28) predicted screening. African American veterans were less likely to have been screened than were White veterans (AOR=0.45; 95% CI=0.22, 0.91). Of 233 veterans who screened positive, 170 (73%) completed a mental health follow-up visit. CONCLUSIONS A substantial proportion of veterans met screening criteria for co-occurring mental health problems, suggesting that the VA screens may help overcome a "don't ask, don't tell" climate that surrounds stigmatized mental illness. Based on data from 1 VA facility, VA postdeployment screening increases mental health clinic attendance among Iraq and Afghanistan veterans.
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Schuff N, Neylan TC, Fox-Bosetti S, Lenoci M, Samuelson KW, Studholme C, Kornak J, Marmar CR, Weiner MW. Abnormal N-acetylaspartate in hippocampus and anterior cingulate in posttraumatic stress disorder. Psychiatry Res 2008; 162:147-57. [PMID: 18201876 PMCID: PMC2443727 DOI: 10.1016/j.pscychresns.2007.04.011] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2006] [Revised: 04/23/2007] [Accepted: 04/24/2007] [Indexed: 12/15/2022]
Abstract
Magnetic resonance spectroscopic imaging (MRSI) studies suggest hippocampal abnormalities in posttraumatic stress disorder (PTSD), whereas findings of volume deficits in the hippocampus, as revealed with magnetic resonance imaging (MRI), have been inconsistent. Co-morbidities of PTSD, notably alcohol abuse, may have contributed to the inconsistency. The objective was to determine whether volumetric and metabolic abnormalities in the hippocampus and other brain regions are present in PTSD, independent of alcohol abuse. Four groups of subjects, PTSD patients with (n=28) and without (n=27) alcohol abuse and subjects negative for PTSD with (n=23) and without (n=26) alcohol abuse, were enrolled in this observational MRI and MRSI study of structural and metabolic brain abnormalities in PTSD. PTSD was associated with reduced N-acetylaspartate (NAA) in both the left and right hippocampus, though only when normalized to creatine levels in the absence of significant hippocampal volume reduction. Furthermore, PTSD was associated with reduced NAA in the right anterior cingulate cortex regardless of creatine. NAA appears to be a more sensitive marker for neuronal abnormality in PTSD than brain volume. The alteration in the anterior cingulate cortex in PTSD has implications for fear conditioning and extinction.
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Schlenger WE, Kulka RA, Fairbank JA, Hough RL, Jordan BK, Marmar CR, Weiss DS. The psychological risks of Vietnam: the NVVRS perspective. J Trauma Stress 2007; 20:467-79. [PMID: 17721970 DOI: 10.1002/jts.20264] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
In recent years, controversy concerning the psychological consequences of service in the Vietnam war has rearisen. In this article, the Co-Principal Investigators of the National Vietnam Veterans Readjustment Study (NVVRS) provide a perspective on new findings reported by B. P. Dohrenwend et al. (2006) that addresses criticisms of the NVVRS PTSD (posttraumatic stress disorder) prevalence findings, and on a perspective that was provided by R. J. McNally (2006) in an accompanying commentary. They find that Dohrenwend et al.'s study, which evaluated empirically a variety of the critics' alternative explanations and found little support for any of them, represents a landmark contribution to the trauma field. However, they found that McNally's commentary misrepresented the history and context of the NVVRS, and then misinterpreted Dohrenwend et al.'s findings and their importance.
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Pole N, Neylan TC, Otte C, Metzler TJ, Best SR, Henn-Haase C, Marmar CR. Associations between childhood trauma and emotion-modulated psychophysiological responses to startling sounds: a study of police cadets. JOURNAL OF ABNORMAL PSYCHOLOGY 2007; 116:352-61. [PMID: 17516767 DOI: 10.1037/0021-843x.116.2.352] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Childhood trauma may confer risk for adult psychopathology by altering emotional and physiological responses to subsequent stressors. Few studies have distinguished effects of childhood trauma from effects of current Axis I psychopathology on adult psychophysiological reactivity. The authors exposed 90 psychiatrically healthy police cadets to startling sounds under increasing threat of shock while assessing their eyeblink electromyogram (EMG), skin conductance (SC), and heart rate responses. When compared with those who did not endorse early trauma (n = 65), cadets reporting childhood trauma (n = 25) reported less positive emotion and showed greater SC responses across all threat levels. They also showed threat-dependent elevations in reported negative emotions and EMG responses. Results suggest that childhood trauma may lead to long-lasting alterations in emotional and psychophysiological reactivity even in the absence of current Axis I psychopathology.
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Kanas NA, Salnitskiy VP, Boyd JE, Gushin VI, Weiss DS, Saylor SA, Kozerenko OP, Marmar CR. Crewmember and mission control personnel interactions during International Space Station missions. AVIATION, SPACE, AND ENVIRONMENTAL MEDICINE 2007; 78:601-7. [PMID: 17571662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
INTRODUCTION Reports from astronauts and cosmonauts, studies from space analogue environments on Earth, and our previous research on the Mir Space Station have identified a number of psychosocial issues that can lead to problems during long-duration space missions. Three of these issues (time effects, displacement, leader role) were studied during a series of long-duration missions to the International Space Station (ISS). METHODS As in our previous Mir study, mood and group climate questions from the Profile of Mood States or POMS, the Group Environment Scale or GES, and the Work Environment Scale or WES were completed weekly by 17 ISS crewmembers (15 men, 2 women) in space and 128 American and Russian personnel in mission control. RESULTS The results did not support the presence of decrements in mood and group cohesion during the 2nd half of the missions or in any specific quarter. The results did support the predicted displacement of negative feelings to outside supervisors in both crew and mission control subjects on all six questionnaire subscales tested. Crewmembers related cohesion in their group to the support role of their commander. For mission control personnel, greater cohesion was linked to the support role as well as to the task role of their leader. DISCUSSION The findings from our previous study on the Mir Space Station were essentially replicated on board the ISS. The findings suggest a number of countermeasures for future on-orbit missions, some of which may not be relevant for expeditionary missions (e.g., to Mars).
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Friedman MJ, Marmar CR, Baker DG, Sikes CR, Farfel GM. Randomized, double-blind comparison of sertraline and placebo for posttraumatic stress disorder in a Department of Veterans Affairs setting. J Clin Psychiatry 2007; 68:711-20. [PMID: 17503980 DOI: 10.4088/jcp.v68n0508] [Citation(s) in RCA: 152] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To evaluate the efficacy of sertraline in the treatment of posttraumatic stress disorder (PTSD) in a Veterans Affairs (VA) clinic setting involving patients with predominantly combat-related PTSD. METHOD 169 outpatient subjects with a DSM-III-R diagnosis of PTSD and who scored 50 or higher on Part 2 of the Clinician-Administered PTSD Scale (CAPS-2) at the end of a 1-week placebo run-in period participated. Patients recruited from 10 VA medical centers were randomly assigned to 12 weeks of flexibly dosed sertraline (25-200 mg/day) (N = 86; 70% with combat-related PTSD; 79% male) or placebo (N = 83; 72% combat-related PTSD; 81% male) between May 1994 and September 1996. The primary efficacy measures were the mean change in CAPS-2 total severity score from baseline to endpoint, in the total score from the Impact of Event Scale, and in the Clinical Global Impressions-Severity of Illness and Improvement scales. RESULTS There were no significant differences between sertraline and placebo on any of the primary or secondary efficacy measures at endpoint. In order to understand the results, gender, duration of illness, severity of illness, type of trauma, and history of alcohol/substance abuse were explored as potential moderators of outcome, but no consistent effects were uncovered. Sertraline was well tolerated, with 13% of patients discontinuing due to adverse events. CONCLUSION Sertraline was not demonstrated to be efficacious in the treatment of PTSD in the VA clinic settings studied.
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Otte C, Lenoci M, Metzler T, Yehuda R, Marmar CR, Neylan TC. Effects of metyrapone on hypothalamic-pituitary-adrenal axis and sleep in women with post-traumatic stress disorder. Biol Psychiatry 2007; 61:952-6. [PMID: 17336940 DOI: 10.1016/j.biopsych.2006.08.018] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2005] [Revised: 08/02/2006] [Accepted: 08/07/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Metyrapone blocks cortisol synthesis which results in removal of negative feedback, a stimulation of hypothalamic corticotropin releasing factor (CRF) and a reduction in delta sleep. We previously reported a diminished delta sleep and hypothalamic-pituitary-adrenal (HPA) response to metyrapone in men with post-traumatic stress disorder (PTSD). In this study, we aimed to extend these findings to women. METHODS Three nights of polysomnography were obtained in 17 women with PTSD and 16 controls. On day 3, metyrapone was administered throughout the day up until bedtime. Plasma adrenocorticotropic hormone (ACTH), cortisol, and 11-deoxycortisol were obtained the morning following sleep recordings the day before and after metyrapone administration. RESULTS There were no significant between-group differences in hormone concentration and delta sleep at baseline. Relative to controls, women with PTSD had decreased ACTH and delta sleep responses to metyrapone. Decline in delta sleep was associated with the magnitude of increase in ACTH across groups. CONCLUSIONS Similar to our previous findings in men, the ACTH and sleep electroencephalogram response to metyrapone is attenuated in women with PTSD. These results are consistent with a model of downregulation of CRF receptors in an environment of chronically increased CRF activity or with enhanced negative feedback regulation in PTSD.
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Maia DB, Marmar CR, Metzler T, Nóbrega A, Berger W, Mendlowicz MV, Coutinho ESF, Figueira I. Post-traumatic stress symptoms in an elite unit of Brazilian police officers: prevalence and impact on psychosocial functioning and on physical and mental health. J Affect Disord 2007; 97:241-5. [PMID: 16859752 DOI: 10.1016/j.jad.2006.06.004] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2005] [Revised: 05/26/2006] [Accepted: 06/03/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Frequent exposure to traumatic situations put police officers under an increased risk for developing post-traumatic stress disorder (PTSD). The goals of this study were to determine the current prevalence of post-traumatic stress symptoms (PTSS) in Brazilian police officers and to compare groups with and without PTSS in terms of associated morbidity. METHODS Police officers from an elite unit (n=157) were asked to fill out a socio-demographic questionnaire, the 12-item General Health Questionnaire and the Post-Traumatic Stress Disorder Checklist-Civilian Version. The latter's scores were used to establish the diagnoses of "full PTSD" and of "partial PTSD". RESULTS Prevalence rates of "full PTSD" and "partial PTSD" were 8.9% and 16%, respectively. Compared with the "no PTSD" group, police officers with "full PTSD" were five times more likely to be divorced (21.6% vs. 4.3%, p=0.008), felt that their physical health was poorer (64.3% vs. 6%, p<0.001), had more medical consultations during the last 12 months [2.00 (+/-1.62) vs. 1.09 (+/-1.42), p=0.03] and reported more often lifetime suicidal ideation (35.7% vs. 5.2%, p=0.002). LIMITATIONS The sample was relatively small. A screening tool was employed instead of a semi-structured interview. The cross-sectional design is unsuitable for ascertaining cause-effect relations. CONCLUSIONS PTSD prevalence in our sample was comparable to those reported for North American and Dutch policemen. The presence of "full PTSD" was associated with evidences of considerable morbidity. These findings may contribute to the development of effective policies aimed at the prevention and treatment of PTSD in law enforcement agents.
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Fikretoglu D, Brunet A, Best SR, Metzler TJ, Delucchi K, Weiss DS, Fagan J, Liberman A, Marmar CR. Peritraumatic fear, helplessness and horror and peritraumatic dissociation: Do physical and cognitive symptoms of panic mediate the relationship between the two? Behav Res Ther 2007; 45:39-47. [PMID: 16516845 DOI: 10.1016/j.brat.2006.01.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2005] [Revised: 12/30/2005] [Accepted: 01/19/2006] [Indexed: 11/22/2022]
Abstract
The goal of this study was to examine whether panic mediates the relationship between fear, helplessness, and horror (PTSD criterion A2) and dissociation at the time of trauma. The study sample included 709 police officers and 317 peer-nominated civilians who had been exposed to a variety of critical incidents. Participants filled out measures of critical incident exposure, PTSD criterion A2, panic, and dissociation. Results indicate that together, physical and cognitive symptoms of panic completely mediate the relationship between criterion A2 and dissociation in civilians, and partially mediate that relationship in police. These results provide support for the idea that panic mediates the relationship between fear, helplessness, and horror (criterion A2) and dissociation at the time of trauma. The results also raise the possibility, however, that the mediational role of panic may be further moderated by additional variables.
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Neylan TC, Lenoci M, Samuelson KW, Metzler TJ, Henn-Haase C, Hierholzer RW, Lindley SE, Otte C, Schoenfeld FB, Yesavage JA, Marmar CR. No improvement of posttraumatic stress disorder symptoms with guanfacine treatment. Am J Psychiatry 2006; 163:2186-8. [PMID: 17151174 DOI: 10.1176/appi.ajp.163.12.2186] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The authors report an 8-week, double-blind, randomized controlled trial of guanfacine versus placebo for posttraumatic stress disorder (PTSD). METHOD Veterans with chronic PTSD who were medication-free or receiving stable pharmacotherapy were randomly assigned to guanfacine (N=29) versus placebo (N=34). RESULTS Guanfacine had no effect on PTSD symptoms, subjective sleep quality, or general mood disturbances. Guanfacine was associated with a number of side effects. CONCLUSIONS These results do not support the use of alpha 2 agonists in veterans with chronic PTSD.
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Samuelson KW, Neylan TC, Metzler TJ, Lenoci M, Rothlind J, Henn-Haase C, Choucroun G, Weiner MW, Marmar CR. Neuropsychological functioning in posttraumatic stress disorder and alcohol abuse. Neuropsychology 2006; 20:716-726. [PMID: 17100516 PMCID: PMC2443729 DOI: 10.1037/0894-4105.20.6.716] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Studies have shown differences in neuropsychological functioning between groups with posttraumatic stress disorder (PTSD) and control participants. Because individuals with PTSD often have a history of comorbid alcohol abuse, the extent to which an alcohol confound is responsible for these differences remains a concern. The current study compares neuropsychological testing scores in 4 groups of veterans with and without PTSD (PTSD+ and PTSD-, respectively) and with and without a history of alcohol abuse (ETOH+ and ETOH-, respectively): n for PTSD+/ETOH- = 30, n for PTSD+/ETOH- = 37, n for PTSD-/ETOH+ = 30, and n for PTSD-/ETOH- = 31. Results showed that PTSD, when alcohol, educational level, vocabulary, and depression are controlled for, was associated with decreased verbal memory, attention, and processing speed performance. Alcohol abuse history was associated with decreased visual memory performance. By controlling for alcohol and depression, the authors can more conclusively demonstrate that verbal memory and attention differences are associated with PTSD.
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McCaslin SE, Rogers CE, Metzler TJ, Best SR, Weiss DS, Fagan JA, Liberman A, Marmar CR. The impact of personal threat on police officers' responses to critical incident stressors. J Nerv Ment Dis 2006; 194:591-7. [PMID: 16909067 DOI: 10.1097/01.nmd.0000230641.43013.68] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The relationship of type of critical incident (CI) stressor with peritraumatic responses and posttraumatic stress disorder symptoms was examined in police. Officers (N = 662) provided narratives of their most distressing CI experienced during police service and completed measures of related peritraumatic responses and posttraumatic stress disorder symptoms. Narratives were reliably rated (kappa = .80-1.0) on seven categories emerging from a series of factor analyses of a measure of critical incident stressors. Additional analysis revealed that the classification of primary narrative features required only five categories (personal life threat, duty-related violence, encountering physical or sexual assault victims, exposure to civilian death, other). When analyzed by further collapsing these five categories into high versus low personal threat, officers whose narratives contained high personal threat reported more peritraumatic dissociation, peritraumatic emotional distress, and current hyperarousal symptoms. Results suggest that greater personal threat during a CI may place an officer at greater risk for subsequent distress.
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Inslicht SS, Marmar CR, Neylan TC, Metzler TJ, Hart SL, Otte C, McCaslin SE, Larkin GL, Hyman KB, Baum A. Increased cortisol in women with intimate partner violence-related posttraumatic stress disorder. Psychoneuroendocrinology 2006; 31:825-38. [PMID: 16716530 DOI: 10.1016/j.psyneuen.2006.03.007] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2005] [Revised: 03/13/2006] [Accepted: 03/28/2006] [Indexed: 12/01/2022]
Abstract
BACKGROUND Alterations of hypothalamic-pituitary-adrenal (HPA) axis function and sympathetic-adrenal activity have been proposed as key factors in biological models of posttraumatic stress disorder (PTSD). METHODS We examined neuroendocrine function in female survivors of intimate partner violence (IPV) with lifetime (current or remitted) PTSD (n=29) and in women who were exposed to IPV but never developed PTSD (n=20). Salivary cortisol was collected as a marker of HPA axis function at 1, 4, 9, and 11 h after awakening. Platelet epinephrine and norepinephrine were assayed as markers of sympathetic-adrenal activation. RESULTS Women with lifetime PTSD had significantly higher cortisol levels across the day compared to abuse-exposed participants without PTSD, after controlling for age, depression, severity, and latency of abuse. There were no significant group differences in levels of platelet catecholamines. CONCLUSIONS Elevated cortisol levels may be a biomarker of IPV-related lifetime PTSD, reflecting long-lasting changes associated with trauma-exposure or possibly a reflection of risk for PTSD in women.
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McCaslin SE, Inslicht SS, Neylan TC, Metzler TJ, Otte C, Lenoci M, Henn-Haase C, Best S, Yehuda R, Marmar CR. Association Between Alexithymia and Neuroendocrine Response to Psychological Stress in Police Academy Recruits. Ann N Y Acad Sci 2006; 1071:425-7. [PMID: 16891590 DOI: 10.1196/annals.1364.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Alexithymia has been associated with both posttraumatic stress disorder and neuroendocrine responses to stress. This study examined the relationship of alexithymia to salivary cortisol and 3-methoxy-4-hydroxy-phenylglycol (MHPG) in a sample of police academy recruits exposed to a video stress challenge. Alexithymia scores were negatively associated with catecholamine response to the video challenge but no association was found between alexithymia scores and cortisol reactivity.
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Marmar CR, McCaslin SE, Metzler TJ, Best S, Weiss DS, Fagan J, Liberman A, Pole N, Otte C, Yehuda R, Mohr D, Neylan T. Predictors of Posttraumatic Stress in Police and Other First Responders. Ann N Y Acad Sci 2006; 1071:1-18. [PMID: 16891557 DOI: 10.1196/annals.1364.001] [Citation(s) in RCA: 178] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We provide an overview of previous research conducted by our group on risk and resilience factors for PTSD symptoms in police and other first responders. Based on our work, the findings of other investigators on individual differences in risk for PTSD, and drawing on preclinical studies fear conditioning and extinction, we propose a conceptual model for the development of PTSD symptoms emphasizing the role of vulnerability and resilience to peritraumatic panic reactions. We tested this conceptual model in a cross-sectional sample of police officers (n = 715). Utilizing an hierarchical linear regression model we were able to explain 39.7% of the variance in PTSD symptoms. Five variables remained significant in the final model; greater peritraumatic distress (beta = 0.240, P < .001), greater peritraumatic dissociation (beta = 0.174, P < .001), greater problem-solving coping (beta = 0.103, P < .01), greater routine work environment stress (beta = 0.182, P < .001), and lower levels of social support (beta = -0.246, P < .001). These results were largely consistent with the proposed conceptual model. Next steps in this line of research will be to test this model prospectively in a sample of 400 police academy recruits assessed during training and currently being followed for the first 2 years of police service.
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