Traumatic events and posttraumatic stress disorder in an urban population of young adults

Trauma exposure and undetected posttraumatic stress disorder among adults with a mental disorder

BACKGROUND

Trauma exposure and posttraumatic stress disorder (PTSD) are common among individuals with a mental disorder, but symptoms often go undetected and untreated.

METHODS

The aim of this study was to determine the prevalence of PTSD among a large sample of adults with psychiatric diagnoses and to establish factors associated with symptoms going undetected. Participants were 1,946 adults recruited by the National Centre for Mental Health. Structured interviews and validated self-report questionnaires were used to ascertain clinical and demographic information for analysis.

RESULTS

The prevalence of participants screening positive for PTSD that had not been detected by clinical services was 13.9% [12.4-15.5%, 95% confidence interval]). Factors associated with undetected PTSD were female gender, younger age of first contact with psychiatric services, and lower household income. Especially, poor rates of detection were observed after traumatic events, such as child abuse and sexual assault.

CONCLUSIONS

Our findings demonstrate the need for routine assessment of trauma histories and symptoms of PTSD among individuals with anymental disorder.

The impact of resilience and subsequent stressful life events on MDD and GAD

BACKGROUND

There remains a dearth of research examining the "buffering" effect of resilience, wherein resilience at one point in time would be expected to protect an individual against development of psychopathology following future adverse life events.

METHODS

Using longitudinal data from an epidemiological twin sample (N = 7463), this study tested whether resilience would act as a buffer for stressful life events (SLEs) against risk for major depressive disorder (MDD) and generalized anxiety disorder (GAD). Resilience, demographics, and psychopathology were measured at Time 1 and recent SLEs and current MDD and GAD were measured at Time 2.

RESULTS

Final models, controlling for demographic covariates and Time 1 diagnosis, examined the impact of Time 1 resilience, recent SLEs, their interaction, and a three-way interaction adding sex on MDD and GAD.

CONCLUSIONS

The pattern of findings was the same for MDD and GAD, wherein main effects and two-way interactions of resilience and SLEs were significant, such that greater resilience was protective even in the context of high numbers of past-year SLEs. The three-way interaction was not significant, suggesting that the relationship between SLEs and resilience on psychopathology was the same for both men and women. Findings support the conceptualization of resilience as a buffer against the impact of future life stressors on common internalizing psychopathology. Longitudinal designs and trajectory-based studies that include recurring measures of SLEs could inform conceptualizations of resilience in the context of ongoing adversity and aid in developing interventions aimed at fostering healthy adaptation in the face of stressors.

Treatment of victims of trauma

The psychiatric sequelae of trauma have been most often discussed in relation to disasters, both natural and man-made, and military conflict. This may sometimes lead psychiatrists to think of posttraumatic stress disorder (PTSD) and other posttraumatic mental illnesses as being somewhat exotic and unusual in general psychiatric practice. In this paper, I propose that PTSD and related disorders are actually common psychiatric problems which require treatment.

Personality characteristics and individual factors associated with PTSD in firefighters one month after extended wildfires

BACKGROUND

Firefighters participate in activities with intense physical and psychological stress and are constantly at risk to develop various psychopathological reactions.

AIMS

To investigate psychological reactions in firefighters one month after devastating wildfires in Greece, during August 2007, which lead to the devastation of large areas and the death of 43 people among whom three were firefighters.

METHODS

One month after the wildfires, a joint task force of mental health clinicians was organized in order to provide psychological support and to investigate the psychological consequences of wildfires to firefighters. One hundred and two firefighters, living within the fire-devastated area, who were on duty for the whole period of wildfires were interviewed and assessed with the use of several questionnaires and inventories.

RESULTS

Post-traumatic stress disorder (PTSD) was detected in 18.6% of firefighters. Multiple logistic regression found that existence of fear of dying during firefighting, insomnia and increased scores in neuroticism, as well as in depression subscale of the SCL-90, were significantly associated with greater likelihood for having PTSD. Additionally those firefighters who worked permanently had 70% lower probability of having PTSD vs. those seasonally employed.

CONCLUSIONS

Insomnia, depressive symptoms, as well as personality characteristics as neuroticism and the perception of fear of imminent death during firefighting operations may precipitate the development of PTSD in firefighters. Within this context, mental health clinicians should be aware that the early detection of these predisposing factors may facilitate the prevention and mitigation of PTSD in firefighters particularly those who are seasonally employed.

Psychiatric comorbidities in adult survivors of major trauma: findings from the Midland Trauma Registry

ABSTRACT INTRODUCTION Information for primary care providers about the outcomes of adult survivors of major medical trauma in the first year of recovery is not widely available. In particular, risks of impairment across multiple domains of functioning are poorly understood. AIM To determine the extent to which adults’ experience impaired health-related quality of life (QoL), symptoms of post-traumatic stress disorder, depression, chronic pain and harmful alcohol use during the year following major trauma, and to identify factors associated with outcomes. METHODS Adults (aged ≥16 years) admitted to Waikato Hospital following major trauma sustained in Waikato District between 1 June 2010 and 1 July 2011 were sent a questionnaire in their first year of recovery. They were asked about their QoL, mental health, experiences of pain, post-traumatic stress disorder symptoms and use of alcohol. RESULTS Sixty-five questionnaires were completed (40% response rate). In the year following major trauma, trauma survivors met criteria for post-traumatic stress disorder (45%), harmful alcohol use (26%), moderate to severe chronic pain (23%) and depression (18%). Reports of poor health-related QoL were common, ranging from self-care difficulties (31%) to pain and discomfort (72%). Younger age, previous psychiatric illness, substance use, intensive care unit admission and length of hospitalisation were associated with symptoms. Thirty-seven adults (57%) reported symptoms in at least two domains. DISCUSSION A significant proportion of adults experience adverse psychosocial outcomes in the first year following major trauma. Screening and management of potentially comorbid psychosocial needs could improve care and outcomes for survivors.

Peritraumatic distress fully mediates the relationship between posttraumatic stress symptoms preoperative and three months postoperative in patients undergoing spine surgery

Background: Growing evidence shows the significance of illness and surgical procedures as traumatizing stressors. Risk factors are widely investigated in various settings and samples, using numerous measures of posttraumatic stress and posttraumatic stress disorder (PTSD). While pretrauma psychological distress is acknowledged as an influential factor, peritraumatic experiences are controversially still being discussed as relevant to the development of PTSD. Objective: In a group of patients consecutively undergoing elective spine surgery (N = 89) in a German hospital, this longitudinal study addressed the question of how pretrauma PTSD symptoms and peritrauma distress interact with one another in regard to the amount of posttrauma symptoms of PTSD. Methods: Pre- and posttrauma symptoms of PTSD as well as peritrauma distress were assessed through questionnaires one week before, one week after or three months after surgery. Results: Even though all three variables showed significant correlations with one another, mediation analysis revealed that peritrauma distress fully mediated the relationship between pre- and posttrauma PTSD symptoms. Conclusions: These results add new insights to the controversial discussion on the role peritraumatic experiences play in the development of PTSD, especially in medical settings.

Differences in posttraumatic stress characteristics by duration of exposure to trauma

Ongoing exposure of civilian populations to war and terror is associated with adverse responses beyond those specified in DSM-5 for PTSD. Current PTSD assessment practices are not fully sensitive to the complex symptomatic picture observed among individuals exposed to ongoing stress and are therefore limited for use in these situations. The current survey aimed to portray the posttraumatic characteristics most salient to ongoing exposure to political conflict. A questionnaire enquiring about various aspects of the posttraumatic consequences of ongoing exposure to political conflict as compared with those associated with a single exposure to trauma was disseminated to therapists throughout the country. Participants were asked to rank 75 posttraumatic characteristics for their relevance to each trauma type (about the symptom frequency and severity) and item mean scores were compared. The sample consisted of 66 responses valid for analysis. Our findings pinpoint some of the posttraumatic characteristics most salient to ongoing exposure to political conflict and highlight the complexity of the posttraumatic picture observed in these situations. Incorporating these in post trauma assessment tools will allow for the development of standardized, reliable definitions, which in turn will allow for more accurate diagnosis and more effective treatment protocols.

Binge-pattern cocaine administration causes long-lasting behavioral hyperarousal but does not enhance vulnerability to single prolonged stress in rats

Cocaine use disorder and post-traumatic stress disorder (PTSD) commonly co-occur. This could be due to vulnerability to post-traumatic symptoms conferred by previous exposure to cocaine. Therefore, we combined chronic binge-pattern cocaine with a model of psychological trauma (single prolonged stress) to determine whether the behavioral effects of psychological trauma are enhanced in cocaine-sensitized individuals. Adult male Sprague Dawley rats received 14 days of cocaine (15mg/kg/injection) or saline in a binge pattern (3 injections per day, 1h apart). Seven days after the last injection animals were exposed to traumatic stress or a control procedure. Seven days after stress, activity and anxiety-like behaviors were measured. Binge-pattern cocaine increased locomotor activity in the open field and elevated plus maze, and both cocaine and SPS exposure increased the rapidity with which rats moved through grooming sequences. Neither binge-pattern cocaine nor SPS increased anxiety-like behaviors, and no interactions were found between binge-pattern cocaine exposure and SPS exposure. A behavioral phenotype categorization approach demonstrated that cocaine-exposed groups expressed a high incidence of hyperactivity-like symptoms. These results suggest that binge-pattern cocaine exposure causes a long-lasting hyper-exploratory phenotype but does not make individuals more vulnerable to a later traumatic stress exposure.

Trajectories of post-traumatic stress and externalizing psychopathology among maltreated foster care youth: A parallel process latent growth curve model

Few longitudinal studies have analyzed how violence exposure (e.g. child maltreatment, witnessing community violence) influence both externalizing and Post-Traumatic Stress (PTS) symptoms among children in foster care. Data from three waves of the National Survey of Child and Adolescent Well-Being (1999-2007) (NSCAW; National Data Archive on Child Abuse and Neglect, 2002) were analyzed to investigate the change trajectories of both externalizing and PTS symptomatology among children with a substantiated report of child maltreatment by Child Protective Services (CPS) between October 1999 and December 2000. This study uses data collected at three time points: baseline and approximately 18 (Wave 3) and 36 (Wave 4) months post-baseline. The Child Behavior Checklist (CBCL) scale measured externalizing symptoms and the Post Traumatic Stress Disorder section of a version of the Trauma Symptom Checklist for Children (TSCC) provided the measure of current trauma-related symptoms or distress. Analyses were conducted using a parallel process growth curve model with a sample of n=280 maltreated youth between the ages of 8 and 15 following home removal. Findings revealed that initial levels of externalizing and PTS symptomatology were both significantly and positively related and co-develop over time. Externalizing symptom severity remained in the borderline range during the first two years in out-of-home care. Both direct and indirect forms of interpersonal violence exposure were associated with initial level of externalizing symptom and PTS symptom severity, respectively. Taken together, our results suggest an underlying process that links early violence exposure to the co-development and cumulative impact of PTS on externalizing behavior above and beyond experiences of maltreatment. We conclude by discussing the key points of intervention that result from a more nuanced understanding of the longitudinal relationship between PTS and externalizing symptoms and the effect of complex trauma on growth in these symptoms over time.

A confirmatory factor analysis of the PTSD checklist 5 in veteran and college student samples

An important change in the conceptualization of posttraumatic stress disorder (PTSD) has been the shift from a three-factor model used in the DSM-IV-TR to the current four-factor model used in DSM-5. Early research initially supported the three-factor model, but most recent data suggest a four-factor model provides the best fit. Still other research has examined evidence for a five-factor model that would include depression sequelae. By way of a confirmatory factor analysis, we demonstrate the reliability of DSM-5 PTSD criteria clustering in a sample of 124 OEF/OIF/OND Veterans treated at a VAMC (49% white, 89% men) and a sample of 737 college students (48% white, 78% women). All participants were trauma-exposed, and completed the PTSD Checklist for DSM-5. The current study shows both samples best support a five-factor model over two four factor models considered for the DSM-5, though none provided better than moderate fit. Implications of the current findings regarding the reliability of the new DSM-5 criteria of PTSD will be discussed.

Prevalence and correlates of symptoms of post-traumatic stress disorder among Chinese healthcare workers exposed to physical violence: a cross-sectional study

OBJECTIVES

Post-traumatic stress disorder (PTSD) is a common psychological maladjustment to undergoing a traumatic event. Our aim was to measure the prevalence of PTSD among Chinese healthcare workers exposed to physical violence' and explore the associations of their demographic characteristics, social support, personality traits' and coping styles with their PTSD symptoms.

METHODS

A cross-sectional study was conducted using the Workplace Violence Scale, Posttraumatic Stress Disorder Checklist-Civilian Version (PCL-C), Social Support Rating Scale (SSRS), Eysenck Personality Questionnaire-Revised Short Scale and Trait Coping Style Questionnaire. We used convenience sampling method to collect data from March 2015 to September 2016. Healthcare workers (n=2706) from 39 public hospitals located in Heilongjiang, Hebei and Beijing provinces of China completed the questionnaires (effective response rate=84.25%).

RESULTS

Overall, the prevalence of physical violence in the previous 12 months was 13.60% (n=2706). The prevalence of PTSD among the healthcare workers who experienced physical violence was 28.0% (n=368). Most of the victims of physical violence (50.80%) did not exhibit PTSD symptoms based on their PCL-C scores, and 47.0% did not manifest the diagnostic criteria for PTSD after experiencing physical violence. The level of PTSD symptoms was negatively correlated with their scores on the SSRS (r=-0.188, p<0.001). The hierarchical regression analysis (block 3) revealed that, in women, positive coping was significantly associated with PTSD symptoms (β=-0.376, p=0.001). However, the effect of positive coping was not significant in men.

CONCLUSIONS

The results suggest that the aftermath of physical violence contributes to the current prevalence of PTSD. The positive effects of social support on PTSD symptoms suggest that it has practical implications for interventions to promote psychological health. The healthcare workers' coping styles influenced the development of PTSD symptoms. Therefore, adopting effective coping styles and receiving social support have potential roles in the recovery from trauma after experiencing physical violence.

Factors associated with posttraumatic stress disorder symptoms among community volunteers during the Sewol ferry disaster in Korea

BACKGROUND

The aim of this study was to investigate the characteristics associated with volunteerism and identify the factors that contributed to posttraumatic stress disorder symptoms among community volunteers following the Sewol ferry disaster in Korea.

METHODS

In total, 2,298 adults (aged 30-70 years) from the Jin-do area, where the Sewol ferry disaster occurred, participated in this study. A cross-sectional survey was conducted 1 month after the disaster. Posttraumatic stress disorder (PTSD), depression, and anxiety symptoms were assessed using the Impact of Events Scale Revised (IES-R), Center for Epidemiologic Studies Depression Scale (CES-D), and Beck Anxiety Inventory (BAI).

RESULTS

Clinically relevant PTSD symptoms were observed in 151 (19.7%) community volunteers. Age, education, socioeconomic status, religion, and lifetime experiences of natural disasters were associated with volunteering following the disaster. Logistic regression analysis revealed that volunteering was a significant risk factor for the development of PTSD symptoms in this sample. Personal experience with property damage associated with a traumatic event, depression, and anxiety were also significantly associated with the PTSD symptoms of community volunteers.

CONCLUSIONS

Our results suggest the need for assessment and mental health programs for community volunteers performing rescue work to prevent posttraumatic stress symptoms following a community disaster.

Sexual assault victimization and psychopathology: A review and meta-analysis

Sexual assault (SA) is a common and deleterious form of trauma. Over 40years of research on its impact has suggested that SA has particularly severe effects on a variety of forms of psychopathology, and has highlighted unique aspects of SA as a form of trauma that contribute to these outcomes. The goal of this meta-analytic review was to synthesize the empirical literature from 1970 to 2014 (reflecting 497 effect sizes) to understand the degree to which (a) SA confers general risk for psychological dysfunction rather than specific risk for posttraumatic stress, and (b) differences in studies and samples account for variation in observed effects. Results indicate that people who have been sexually assaulted report significantly worse psychopathology than unassaulted comparisons (average Hedges' g=0.61). SA was associated with increased risk for all forms of psychopathology assessed, and relatively stronger associations were observed for posttraumatic stress and suicidality. Effects endured across differences in sample demographics. The use of broader SA operationalizations (e.g., including incapacitated, coerced, or nonpenetrative SA) was not associated with differences in effects, although including attempted SA in operationalizations resulted in lower effects. Larger effects were observed in samples with more assaults involving stranger perpetrators, weapons, or physical injury. In the context of the broader literature, our findings provide evidence that experiencing SA is major risk factor for multiple forms of psychological dysfunction across populations and assault types.

Traumatic Brain Injuries during Development: Implications for Alcohol Abuse

Traumatic brain injuries are strongly related to alcohol intoxication as by some estimates half or more of all brain injuries involve at least one intoxicated individual. Additionally, there is mounting evidence that traumatic brain injuries can themselves serve as independent risk factors for the development of alcohol use disorders, particularly when injury occurs during juvenile or adolescent development. Here, we will review the epidemiological and experimental evidence for this phenomenon and discuss potential psychosocial mediators including attenuation of negative affect and impaired decision making as well as neurochemical mediators including disruption in the glutamatergic, GABAergic, and dopaminergic signaling pathways and increases in inflammation.

Validating Multidimensional Outcome Assessment Using the TBI Common Data Elements: An Analysis of the TRACK-TBI Pilot Sample

The Glasgow Outcome Scale-Extended (GOSE) is often the primary outcome measure in clinical trials for traumatic brain injury (TBI). Although the GOSE's capture of global function outcome has several strengths, concerns have been raised about its limited ability to identify mild disability and failure to capture the full scope of problems patients exhibit after TBI. This analysis examined the convergence of disability ratings across a multidimensional set of outcome domains in the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) Pilot study. The study collected measures recommended by the TBI Common Data Elements (CDE) Workgroup. Patients presenting to 3 emergency departments with a TBI of any severity enrolled in TRACK-TBI prospectively after injury; outcome measures were collected at 3 and six months postinjury. Analyses examined frequency of impairment and overlap between impairment status across the CDE outcome domains of Global Level of Functioning (GOSE), Neuropsychological (cognitive) Impairment, Psychological Status, TBI Symptoms, and Quality of Life. GOSE score correlated in the expected direction with other outcomes (M Spearman's rho = .21 and .49 with neurocognitive and self-report outcomes, respectively). The subsample in the Upper Good Recovery (GOSE 8) category appeared quite healthy across most other outcomes, although 19.0% had impaired executive functioning (Trail Making Test Part B). A significant minority of participants in the Lower Good Recovery subgroup (GOSE 7) met criteria for impairment across numerous other outcome measures. The findings highlight the multidimensional nature of TBI recovery and the limitations of applying only a single outcome measure.

Nonparametric Regression Method for Broad Sense Agreement

Characterizing the correspondence between an ordinal measurement and a continuous measurement is often of interest in mental health studies. To this end, Peng, Li, Guo, and Manatunga (2011) introduced the concept of broad sense agreement (BSA) and developed nonparametric estimation and inference for a BSA measure. In this work, we propose a non-parametric regression framework for BSA, which provides a robust tool to further investigate population heterogeneity in BSA. We develop inferential procedures including regression function estimation and hypothesis testing. Extensive simulation studies demonstrate satisfactory performance of the proposed method. We also apply the new method to a recent Grady Trauma Study and reveal an interesting impact of depression severity on the alignment between a self-reported symptom instrument and clinician diagnosis in posttraumatic stress disorder (PSTD) patients.

PTSD in Court III: Malingering, assessment, and the law

This journal's third article on PTSD in Court focuses especially on the topic's "court" component. It first considers the topic of malingering, including in terms of its definition, certainties, and uncertainties. As with other areas of the study of psychological injury and law, generally, and PTSD (posttraumatic stress disorder), specifically, malingering is a contentious area not only definitionally but also empirically, in terms of establishing its base rate in the index populations assessed in the field. Both current research and re-analysis of past research indicates that the malingering prevalence rate at issue is more like 15±15% as opposed to 40±10%. As for psychological tests used to assess PTSD, some of the better ones include the TSI-2 (Trauma Symptom Inventory, Second Edition; Briere, 2011), the MMPI-2-RF (Minnesota Multiphasic Personality Inventory, Second Edition, Restructured Form; Ben-Porath & Tellegen, 2008/2011), and the CAPS-5 (The Clinician-Administered PTSD Scale for DSM-5; Weathers, Blake, Schnurr, Kaloupek, Marx, & Keane, 2013b). Assessors need to know their own possible biases, the applicable laws (e.g., the Daubert trilogy), and how to write court-admissible reports. Overall conclusions reflect a moderate approach that navigates the territory between the extreme plaintiff or defense allegiances one frequently encounters in this area of forensic practice.

Are impairments in emotion recognition a core feature of callous-unemotional traits? Testing the primary versus secondary variants model in children

The role of environmental adversity in the development of high callous-unemotional (CU) traits in children is controversial. Evidence speaks to the traits being largely independent of adversity; however, recent data shows that those with high CU traits and high adversity and/or high anxiety might differ in important ways from those with no such history. We tested this using emotion recognition (ER) skills. We tested whether maltreatment history and anxiety levels moderated the relationship between level of CU traits and ER skills in N = 364 children with behavioral problems who were 3 to 16 years old. As hypothesised, in the full sample, the relationship between CU traits and ER differed according to maltreatment history, such that CU traits were associated with poorer recognition for those with zero or negligible history of maltreatment. This moderation of the CU-ER relationship by maltreatment was inconsistent across subgroups, however, and for the cohort utilizing youth self-report of maltreatment, high CU traits were associated with poor ER in those with lower anxiety levels. Maltreatment history and/or anxiety levels can identify different emotional impairments associated with high CU traits, and the impairments might be characteristic of "primary" high CU traits defined as occurring independently of maltreatment and/or high anxiety.

Low lifetime stress exposure is associated with reduced stimulus-response memory

Exposure to stress throughout life can cumulatively influence later health, even among young adults. The negative effects of high cumulative stress exposure are well-known, and a shift from episodic to stimulus–response memory has been proposed to underlie forms of psychopathology that are related to high lifetime stress. At the other extreme, effects of very low stress exposure are mixed, with some studies reporting that low stress leads to better outcomes, while others demonstrate that low stress is associated with diminished resilience and negative outcomes. However, the influence of very low lifetime stress exposure on episodic and stimulus–response memory is unknown. Here we use a lifetime stress assessment system (STRAIN) to assess cumulative lifetime stress exposure and measure memory performance in young adults reporting very low and moderate levels of lifetime stress exposure. Relative to moderate levels of stress, very low levels of lifetime stress were associated with reduced use and retention (24 h later) of stimulus–response (SR) associations, and a higher likelihood of using context memory. Further, computational modeling revealed that participants with low levels of stress exhibited worse expression of memory for SR associations than those with moderate stress. These results demonstrate that very low levels of stress exposure can have negative effects on cognition.

Association Between Lifetime Posttraumatic Stress Disorder and Past Year Alcohol Use Disorder Among American Indians/Alaska Natives and Non-Hispanic Whites

BACKGROUND

Posttraumatic stress disorder (PTSD) and alcohol use disorder disproportionately impact certain populations including American Indians/Alaska Natives (AIAN). While PTSD and alcohol use disorder have been studied both separately and in tandem, less is known about the association in AIAN. The objective was to examine the association between lifetime PTSD and past year alcohol use disorder among AIAN and non-Hispanic Whites (NHW).

METHODS

Data come from the 2012 to 2013 U.S. National Epidemiologic Survey on Alcohol and Related Conditions-III. We used logistic regression to estimate odds of AUD among adults with and without PTSD by race.

RESULTS

A total of 19,705 participants, of whom 511 were AIAN and 19,194 were NHW, were included in this study. The percentage of PTSD among AIAN was 22.9% (n = 117) compared to 11.7% (n = 2,251) in NHW (p-value <0.0001). The percentage of past year alcohol use disorder among AIAN was 20.2% (n = 103) compared to 14.2% (n = 2,725) in NHW (p-value <0.0001). The percentage of comorbid past year alcohol use disorder with lifetime PTSD among AIAN was 6.5% (n = 33) compared to 2.4% (n = 457) in NHW (p-value <0.0001). Regarding the joint distribution of PTSD and AUD, AIAN men have greater than 3 times the percentage compared to NHW men (9.5% vs. 3.1%). When stratifying by race (after adjusting for age, sex, depression, and education), among AIAN, the odds of past year alcohol use disorder with (vs. without) lifetime PTSD were 1.76 (95% CI 1.07, 2.90) and among NHW, the odds were 1.59 (95% CI 1.41, 1.80).

CONCLUSIONS

PTSD is significantly associated with alcohol use disorder in the study populations. Despite a lack of pre-PTSD measures of alcohol use disorder, these findings show a trend indicating that AIAN exposed to PTSD are more burdened with alcohol use disorder compared to NHW in the general U.S.

POPULATION

Treatment of Post-Traumatic Stress Disorders with the Alpha-1 Adrenergic Antagonist Prazosin

OBJECTIVE

The present review aims to assess the clinical efficacy and safety of the α-1-adrenergic antagonist prazosin as primary pharmacologic treatment for post-traumatic stress disorder (PTSD).

METHOD

A systematic review was performed using keywords (i.e., prazosin, α-1-adrenergic antagonist, α-1-blocker, post-traumatic stress disorder) in the databases PubMed/Medline (1966-May 2016), Embase (1966-May 2016), ScienceDirect (1823-May 2016), OvidSP (1946-May 2016) and Nature (1845-May 2016). To be considered for inclusion, studies had to test the efficacy of prazosin either alone or added to ongoing treatment in adults with PTSD, use validated tools to assess and monitor the disorders, allow comparisons on the basis of univariate analyses (i.e., p-values of t-tests and effect sizes) and list the identified adverse reactions.

RESULTS

12 studies were included: 5 randomized controlled trials, 4 open-label prospective trials and 3 retrospective file reviews. The evaluation concerned 276 patients exposed to civilian trauma (19%) or war trauma (81%). Prazosin significantly decreases trauma nightmares, avoidance, hypervigilance and improves patient status in all studies. No significant difference of blood pressure was observed at the end of trials.

CONCLUSIONS

Beyond the methodological and clinical biases of these studies, the present review not only confirms the effectiveness and good tolerability of prazosin, but also suggests its possible use as primary pharmacologic treatment for PTSD. Uncertainties remain, however, regarding the prescription modalities and dosages.

Severe Mental Illness and Acute Stress: A Study of Service Utilization in a Conflict Zone

Patients suffering from severe mental illness (SMI) are considered especially vulnerable to stress. In this study, their use of acute stress services in a military context affecting civilian populations was assessed, using naturally occurring data. The proportion of patients with a previously known SMI, defined as any chronic psychotic disorder or bipolar disorder, among all civilians examined at a center for treatment of stress during a military conflict versus at the ER in usual times, was compared, using the Chi square statistical test. Among 354 subjects examined at the center for treatment of stress, 12 had a SMI diagnosis. Among 404 subjects examined at the ER in usual times, 16 had a SMI diagnosis. Patients with SMI were under-represented, but not in a statistically significant manner, at the center for treatment of stress (χ² = 0.31, p = ns). Although these results may imply that patients with SMI are not more vulnerable to external stress than the general population, we believe that they may have difficulties in seeking immediate help in such traumatogenic contexts. In order to reduce the occurrence of PTSD and gain efficacy in the treatment of the primary disorder, psychiatric services should perhaps make a reaching out effort to identify and examine these patients in the community. .

Comorbid Depression and Other Predictors of PTSD Severity in Urban Public Transit Employees

The purpose of the study was to determine whether post traumatic stress disorder (PTSD) with Major Depressive Disorder (MDD) among urban public transit employees who were exposed to a workplace traumatic event is associated with greater PTSD severity over the 6-month follow-up period compared to PTSD without MDD, and also to identify predictors of PTSD severity among these employees. Information about Axis-I diagnosis and PTSD severity were collected from the SCID-I and the Modified PTSD Symptom Scale (MPSS) respectively. PTSD without MDD (N = 29) and PTSD with MDD (N = 37) groups were not significantly different in terms of PTSD severity. The severity of depression (p = 0.01), female (p = 0.01), non-Caucasian (p = 0.01), perceived high workplace related stress (p = 0.02), and history of lifetime trauma (p = 0.01) were significantly associated with greater PTSD severity after controlling other variables. This study highlights the importance of modifiable variables for reducing PTSD severity after a workplace traumatic event in transit employees.

Determinants of Light and Intermittent Smoking in the United States: Results from Three Pooled National Health Surveys

BACKGROUND

Light and/or intermittent smokers have been the fastest growing segment of cigarette smokers in the United States over the past two decades. Defining their behavioral characteristics is a critical public health priority.

METHODS

Our sample included 78,229 U.S. adults from three pooled contemporary population-based surveys: the 2012 NHIS, 2012 NSDUH, and 2011-2012 NHANES. We classified current smokers into four categories (light and intermittent [LITS], light-daily, heavier-intermittent, and heavier-daily) and assessed smoking behaviors, illicit drug use, and mental health indicators using weighted analyses.

RESULTS

Analyses associated smoking categories with nicotine dependence, age of smoking initiation, race/ethnicity, and other demographic and behavioral factors. Compared with heavier-daily smokers, smokers who were LITS were most likely to have mild or no nicotine dependence (weighted odds ratio [OR], 16.92; 95% confidence interval [CI], 13.10-21.85), to start smoking cigarettes regularly after age 21 (OR, 3.42; 95% CI, 2.84-4.12), and to be Hispanic (OR, 5.38; 95% CI, 4.38-6.61). Additional significant results were found for other categories of smokers.

CONCLUSIONS

Based on pooled data from three large national surveys, light and/or intermittent smokers differed in smoking, drug use, and mental health behaviors from heavier-daily, former, and never smokers. Notable differences by level of smoking frequency and intensity were observed for nicotine dependence, age of smoking initiation, and race/ethnicity.

IMPACT

Our results may help focus preventive measures and policies for the growing number of light and/or intermittent smokers in the United States because smoking patterns vary by behavioral and socioeconomic factors. Cancer Epidemiol Biomarkers Prev; 26(2); 228-39. ©2016 AACR.

Predictors and mental health outcomes of potentially traumatic event exposure

The aims were two-fold: to examine prevalence and correlates of lifetime potentially traumatic event (PTE) exposure and to explore the relationships between PTE exposure and mental health outcomes (i.e., trauma related distress, alcohol use quantity and frequency, depression symptoms, and anxiety symptoms) within a large sample of college freshmen. 6120 participants, consisting of three cohorts of incoming freshman at a large southeastern university, completed an online assessment battery measuring a multitude of factors including PTEs, personality, relationships (i.e., parental and peer), and mental health. The majority (81.8%) of participants endorsed experiencing at least one PTE within their lifetime and 39.0% reported at least one interpersonal trauma (i.e., physical assault, sexual assault, other unwanted or uncomfortable sexual situation). The average number of PTE categories endorsed was 1.71 (SD=1.30), and 8.7% of participants reported experiencing four or more separate PTE categories pre-college entry. Female gender and peer deviance were consistently associated with PTE exposure and symptoms of psychopathology. Furthermore, a history of interpersonal PTE exposure was associated with increased alcohol use (i.e., frequency and quantity), trauma related distress, depressive symptoms, and anxiety symptoms. The data demonstrate high prevalence PTE exposure among young adults and the clinical significance of a PTE history.

Exploring the Intersections of Trauma, Structural Adversity, and Psychosis among a Primarily African-American Sample: A Mixed-Methods Analysis

Traumatic life events (TLEs) have been associated with multiple psychiatric diagnoses, including anxiety disorders, major depression, PTSD, and psychosis. To advance our understanding of the complex interactions between forms of adversity as they manifest across the lifespan, psychosis, and symptom content, we undertook a mixed-methods investigation of TLEs and psychosis. Our research explored the association between cumulative exposures, type of TLE, and proximity to the traumatic event and psychosis; the association between TLEs and clinical symptomology including specific types of delusions and/or hallucinations; and how qualitative data further inform understanding of complex relationships and patterns of past trauma and symptoms as they unfold over time. There were a total of 97 participants in the quantitative study sample, 51 participants with present state psychosis and 46 non-clinical. There were a total of 34 qualitative study participants, all of whom were experiencing psychosis. The quantitative analysis showed that when comparing persons with psychosis to the non-clinical group, there were no group differences in the overall total score of TLEs. However, there was a significant difference in cumulative TLEs that "Happened," demonstrating that as the number of TLEs increased, the likelihood of clinical psychosis also increased. We also found a correlation between lifetime cumulative TLEs that "Happened" and PANSS five-factor analysis: positive, excitement, depression, thought disorder, activation, and paranoia scores. The qualitative analysis further built on these finding by providing rich narratives regarding the timing of trauma-related onset, relationships between trauma and both trauma-related and religious-spiritual content, and trauma and hallucinatory modality. Analysis of participant narratives suggests the central role of localized cultural and sociopolitical influences on onset, phenomenology, and coping and contributes to a growing literature calling for strengths-based, client-driven approaches to working with distressing voices and beliefs that centers the exploration of the personal and social meaning of such experiences including links to life narratives. Findings also underscore the clinical importance of trauma assessment and trauma-informed care.

Posttraumatic Stress Disorder: Perspectives for the Use of Deep Brain Stimulation

OBJECTIVES

Deep Brain Stimulation (DBS) has been either approved or is currently under investigation for a number of psychiatric disorders.

MATERIALS AND METHODS

We review clinical and preclinical concepts as well as the neurocircuitry that may be of relevance for the implementation of DBS in posttraumatic stress disorder (PTSD).

RESULTS

PTSD is a chronic and debilitating illness associated with dysfunction in well-established neural circuits, including the amygdala and prefrontal cortex. Although most patients often improve with medications and/or psychotherapy, approximately 20-30% are considered to be refractory to conventional treatments. In other psychiatric disorders, DBS has been investigated in treatment-refractory patients. To date, preclinical work suggests that stimulation at high frequency delivered at particular timeframes to different targets, including the amygdala, ventral striatum, hippocampus, and prefrontal cortex may improve fear extinction and anxiety-like behavior in rodents. In the only clinical report published so far, a patient implanted with electrodes in the amygdala has shown striking improvements in PTSD symptoms.

CONCLUSIONS

Neuroimaging, preclinical, and preliminary clinical data suggest that the use of DBS for the treatment of PTSD may be practical but the field requires further investigation.

Post-traumatic stress disorder and depression co-occurrence: Structural relations among disorder constructs and trait and symptom dimensions

OBJECTIVES

Post-traumatic stress disorder (PTSD) and major depressive disorder (MDD) in response to trauma co-occur at high rates. A better understanding of the nature of this co-occurrence is critical to developing an accurate conceptualization of the disorders. This study examined structural relations among the PTSD and MDD constructs and trait and symptom dimensions within the framework of the integrative hierarchical model of anxiety and depression.

DESIGN

Study participants completed clinician-rated and self-report measures during a pre-treatment assessment.

METHODS

The sample consisted of 200 treatment-seeking individuals with a primary DSM-IV PTSD diagnosis. Structural equation modelling was used to examine the relationship between the constructs.

RESULTS

The trait negative affect/neuroticism construct had a direct effect on both PTSD and MDD. The trait positive affect/extraversion construct had a unique, negative direct effect on MDD, and PTSD had a unique, direct effect on the physical concerns symptoms construct. An alternative model with the PTSD and MDD constructs combined into an overall general traumatic stress construct produced a decrement in model fit.

CONCLUSIONS

These findings provide a clearer understanding of the relationship between co-occurring PTSD and MDD as disorders with shared trait negative affect/neuroticism contributing to the overlap between them and unique trait positive affect/extraversion and physical concerns differentiating them. Therefore, PTSD and MDD in response to trauma may be best represented as two distinct, yet strongly related constructs.

PRACTITIONER POINTS

In assessing individuals who have been exposed to trauma, practitioners should recognize that co-occurring PTSD and MDD appears to be best represented as two distinct, yet strongly related constructs. Negative affect may be the shared vulnerability directly influencing both PTSD and MDD; however, in the presence of both PTSD and MDD, low positive affect appears to be more specifically related to MDD and fear of physical sensations to PTSD, which is information that could be used by practitioners in the determination of treatment approach. Overall, these findings are clinically relevant in that they may inform assessment, treatment planning, and ultimately diagnostic classification.

Depression and PTSD in Survivors of Male Violence: Research and Training Initiatives to Facilitate Recovery

Male violence is an enduring feature of women's lives from childhood through old age. The review covers child sexual abuse, rape, and partner violence with emphasis on the prevalence of violence, its mental health consequences, the course of recovery, and mediators and moderators of traumatic impact. The primary focus is depression and posttraumatic stress disorder, the two major diagnostic entities through which postassault emotions and behaviors have been conceptualized and measured. The effects of psychiatric conceptualizations of victimization and patterns of individual recovery are critically reviewed. The PTSD paradigm as the sole foundation for most victimization research is also debated. Following the review, mental health services for victimized women are examined. The article concludes with public policy recommendations to improve the availability and accessibility of mental health services with emphasis on reaching those survivors who are less likely to consult the formal system.

Childhood Posttraumatic Stress Disorder and the Schools

There has been a growing research and clinical interest in children who meet the criteria for Posttraumatic Stress Disorder (PTSD). An increase in family violence, violence in schools, and a variety of other stressors is suspected of leading to the characteristic PTSD symptoms of reexperiencing the trauma, psychological numbing, and increased states of arousal. School psychologists and other school personnel can be of benefit to children and parents by being made aware of the nature of this disorder and by actively coordinating assessments and interventions. Research on childhood PTSD is presented along with methods of assessment and a review of individual and group interventions. Suggestions are made regarding the school psychologist's role in actively coordinating services through outside agencies, in the school, and at home.

PTSD in Court I: Introducing PTSD for Court

The first part of the series of three articles on posttraumatic stress disorder (PTSD) in Court to appear in the journal reviews the history of the construct of PTSD and its presentation in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; American Psychiatric Association, 2013) and the ICD-11 (International Classification of Diseases, 11th Edition; World Health Organization, 2018). There are 20 symptoms of PTSD in the DSM-5. PTSD symptoms are arranged into a four-cluster model, which has received partial support in the literature. Other four-factor models have been found that fit the data even better than that of the DSM-5. There is a five-factor dysphoria model and two six-factor models that have been found to fit better the DSM-5 PTSD symptoms. Finally, research is providing support for a hybrid seven-factor model. An eighth factor on dissociation seems applicable to the minority of people who express the dissociative subtype. At the epidemiological level, individuals can expect trauma exposure to take place about 70% over one's lifetime. Also, traumatic exposure leads to traumatic reactions in about 10% of cases, with PTSD being a primary diagnosis for trauma. Once initiated, PTSD becomes prolonged in about 10% of cases. Polytrauma and comorbidities complicate these prevalence statistics. Moreover, the possibility of malingered PTSD presents confounds. However, the estimate for malingered PTSD varies extensively, from 1 to 50%, so that the estimate is too imprecise for use in court without further research. This first article in the series of three articles appearing in the journal on PTSD in Court concludes with discussion of complications related to comorbidities and heterogeneities, in particular. For example, PTSD and its comorbidities can be expressed in over one quintillion ways. This complexity in its current structure in the DSM-5 speaks to the individual differences involved in its expression.

The association between post-traumatic stress disorder and lifetime DSM-5 psychiatric disorders among veterans: Data from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III)

This study examined the prevalence, correlates and psychiatric comorbidity of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) posttraumatic stress disorder (PTSD) in a nationally representative sample of U.S. veterans using data from the National Epidemiologic Survey on Alcohol and Related Conditions-III (n = 3119 veteran respondents). The overall prevalence of lifetime PTSD was 6.9%. Lifetime PTSD prevalence was higher among veterans who were female (13.2%), aged 18-29 years (15.3%), Native American (24.1%) or Black (11.0%), previously or never married (9.6% and 11.2, respectively), had incomes less than $70,000 (7.2%-10.1%) and had >2 traumatic events (5.2%-14.7%). After adjusting for sociodemographic characteristics, comorbidity between lifetime PTSD and other psychiatric disorders was highest for any personality disorder (adjusted odds ratio [AOR] = 11.1, 95% confidence interval [CI], 5.7, 21.5), any mood disorder (AOR = 9.7, 95% CI, 4.6, 20.4) and any anxiety disorder (AOR = 9.6, 95% CI, 5.1, 17.7), followed by nicotine, drug, and alcohol use disorders (AOR = 3.4, 95% CI, 1.8, 6.5; AOR = 3.1, 95% CI, 2.0, 5.9; 2.1, 95% CI, 1.5, 3.1, respectively). Associations remained with any mood, anxiety, and personality disorders after controlling for other psychiatric disorders (AOR = 3.7, 95% CI, 1.2, 10.9; AOR = 3.5, 95% CI, 1.6, 7.4; AOR = 4.5, 95% CI, 2.3, 8.7, respectively). Veterans who sought treatment for PTSD had more comorbid conditions, although treatment was only associated with comorbid drug use disorder (AOR = 2.4, 95% CI, 1.0, 5.7). In U.S. veterans, PTSD is highly comorbid with other psychiatric disorders. Although many veterans remain untreated, comorbidity may influence treatment seeking.

The Relationship between Trauma, Arrest, and Incarceration History among Black Americans: Findings from the National Survey of American Life

Prior research indicates an association between exposure to trauma (e.g., being victimized) and perpetration of crime, especially in the context of chronic victimization. This study examines the relationship between trauma exposure, posttraumatic stress disorder (PTSD), and history of arrest and incarceration among a representative sample of black Americans from the National Survey of American Life (N = 5,189). One-third had a history of arrest, and 18 percent had a history of incarceration. Frequency of trauma exposure was associated with involvement with the criminal justice system. Relative to never experiencing trauma, experiencing ≥4 traumas was associated with elevated odds of arrest (odds ratio [OR] = 4.03), being jailed (OR = 5.15), and being imprisoned (OR = 4.41), all p <.01. PTSD was also associated with likelihood of incarceration among those with a history of trauma (OR = 2.18, p <.01). Both trauma exposure and trauma-associated psychopathology are associated with increased likelihood of arrest and incarceration in adulthood among black Americans.

Hippocampal and amygdala volumes in adults with posttraumatic stress disorder secondary to childhood abuse or maltreatment: A systematic review

We systematically reviewed differences in hippocampal and amygdala volumes between adults with childhood maltreatment-related posttraumatic stress disorder (PTSD) and healthy controls. Using the terms "adults", "MRI", "magnetic resonance imaging", with "posttraumatic stress disorder" "PTSD", "child abuse", and "child maltreatment", we conducted searches on several electronic databases. We identified 10 studies that met our inclusion criteria; 7 of which were included in a meta-analysis of hippocampal volume and 4 that were included in a meta-analysis of amygdala volume. Mean hippocampal and amygdala volumes were used to determine effect sizes. We found bilateral reduction of both the hippocampus and amygdala in the PTSD group compared to healthy controls, with effect sizes of -0.66 and -0.67 for the left and right hippocampus (p<0.00001 and p=0.002) and -1.08 and -1.15 for the left and right amygdala, (p=0.013 and p=0.003), respectively. Confidence intervals were -0.93,-0.39 and -1.26,-0.29 for the left and right hippocampus, respectively. For the amygdala, confidence intervals were -1.92,-0.23 and -1.19, -0.39 for the left and right amygdala. The relatively few studies available for analysis is a limitation. Additionally, sex diverse MRI studies in PTSD are needed to determine whether sex plays a significant role in the hippocampal effects associated with childhood-onset trauma.

The Impact of Interpersonal and Noninterpersonal Trauma on Psychological Symptoms in Refugees: The Moderating Role of Gender and Trauma Type

Research findings have documented a relationship between the number of types of traumatic events to which refugees were exposed and psychological disorders. It is unclear, however, if gender moderates the impact of trauma on refugee mental health. The participants in this study were 60 male and 31 female refugees and asylum-seekers resettled in Australia. Participants had a mean age of 34.54 years (SD = 9.70), and were from a variety of countries including Iraq, Iran, and Sri Lanka. We conducted a multigroup path analysis to test if the relationship between psychological outcomes of exposure to trauma (posttraumatic stress disorder [PTSD] symptoms, symptoms of anxiety, and symptoms of depression) was different as a function of the type of traumatic exposure (interpersonal vs. noninterpersonal) or as a function of gender. We found a significant relationship between interpersonal trauma exposure and PTSD symptoms (β = .77) and anxiety symptoms (β = .32) in women, and a significant association between noninterpersonal trauma exposure and PTSD symptoms (β = .59), anxiety (β =.49), and depression symptoms (β = .32) in men. For men, the effect sizes of the relationship between exposure to specific types of noninterpersonal trauma and psychological symptoms ranged from d = 0.14 to 1.01; for exposure to interpersonal trauma, they ranged from d = -0.53 to 0.43. For women, the effect sizes of the relationship between exposure to specific types of noninterpersonal trauma and psychological symptoms ranged from d = -0.79 to 0.67; for exposure to interpersonal trauma, they ranged from d = -0.09 to 1.46. These results suggested supporting refugees in their efforts to overcome the psychological impact of trauma, including the allocation of resources in clinical services to support the psychological recovery of refugees.

Emergence in extinction of enhanced and persistent responding to ambiguous aversive cues is associated with high MAOA activity in the prelimbic cortex

There is a great deal of individual variability in the emotional outcomes of potentially traumatic events, and the underlying mechanisms are only beginning to be understood. In order to further our understanding of individual trajectories to trauma, its vulnerability and resilience, we adapted a model of fear expression to ambiguous vs perfect cues in adult male rats, and examined long-term fear extinction, 2, 3, and 50 days from acquisition. After the final conditioned fear test, mitochondrial enzyme monoamine oxidase A (MAOA) function was examined. In order to identify associations between this function and behavioral expression, an a posteri median segregation approach was adopted, and animals were classified as high or low responding according to level of freezing to the ambiguous cue at remote testing, long after the initial extinction. Those individuals characterized by their higher response showed a freezing pattern that persisted from their previous extinction sessions, in spite of their acquisition levels being equivalent to the low-freezing group. Furthermore, unlike more adaptive individuals, freezing levels of high-freezing animals even increased at initial extinction, to almost double their acquisition session levels. Controlling for perfect cue response at remote extinction, greater ambiguous threat cue response was associated with enhanced prelimbic cortex MAOA functional activity. These findings underscore MAOA as a potential target for the development of interventions to mitigate the impact of traumatic experiences.

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Potentially traumatic event outcomes vary and mechanisms are poorly understood.

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We examined fear extinction of perfect or ambiguous cues in adult male rats.

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Higher freezing to ambiguous cue in extinction yet followed equivalent acquisition.

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Ambiguous cue response was associated with higher prelimbic cortex MAOA function.

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These findings support targeting MAOA to mitigate impact of traumatic experiences.

Understanding posttraumatic stress disorder through fear conditioning, extinction and reconsolidation

Careaga MBL, Girardi CEN, Suchecki D. Understanding posttraumatic stress disorder through fear conditioning, extinction and reconsolidation. NEUROSCI BIOBEHAV REV -Posttraumatic stress disorder (PTSD) is a psychopathology characterized by exacerbation of fear response. A dysregulated fear response may be explained by dysfunctional learning and memory, a hypothesis that was proposed decades ago. A key component of PTSD is fear conditioning and the study of this phenomenon in laboratory has expanded the understanding of the underlying neurobiological changes in PTSD. Furthermore, traumatic memories are strongly present even years after the trauma and maintenance of this memory is usually related to behavioral and physiological maladaptive responses. Persistence of traumatic memory may be explained by a dysregulation of two memory processes: extinction and reconsolidation. The former may explain the over-expression of fear responses as an imbalance between traumatic and extinction memory. The latter, in turn, explains the maintenance of fear responses as a result of enhancing trauma-related memories. Thus, this review will discuss the importance of fear conditioning for the establishment of PTSD and how failure in extinction or abnormal reconsolidation may contribute to the maintenance of fear response overtime.

Trauma and Temporality

The authors argue that attention to the Freudian and Derridean concepts of Nachtr®aglichkeit and diff¥erance might challenge the implicit assumption of the linear development of traumatic stress from originary event to presenting symptoms. These concepts raise fundamental questions as to the origin of trauma and its ontological status. It is suggested that the psychical reality of retro-causality necessitates a reorientation of current thought about traumatic stress to reflect the paradoxical temporal dynamics of postmodernity.

Time-course of PTSD symptoms in the Australian Defence Force: a retrospective cohort study

AIMS

Understanding the time-course of post-traumatic stress disorder (PTSD), and the underlying events, may help to identify those most at risk, and anticipate the number of individuals likely to be diagnosed after exposure to traumatic events.

METHOD

Data from two health surveys were combined to create a cohort of 1119 Australian military personnel who deployed to the Middle East between 2000 and 2009. Changes in PTSD Checklist Civilian Version (PCL-C) scores and the reporting of stressful events between the two self-reported surveys were assessed. Logistic regression was used to examine the association between the number of stressful events reported and PTSD symptoms, and assess whether those who reported new stressful events between the two surveys, were also more likely to report older events. We also assessed, using linear regression, whether higher scores on the Kessler Psychological Distress Scale or the Alcohol Use Disorder Identification Test were associated with subsequent increases in the PCL-C in those who had experienced a stressful event, but who initially had few PTSD symptoms.

RESULTS

Overall, the mean PCL-C scores in the two surveys were similar, and 78% of responders stayed in the same PCL-C category. Only a small percentage moved from having few symptoms of PTSD (PCL-C < 30) in Survey 1 to meeting the criteria for PTSD (PCL-C ≥ 50) at Survey 2 (1% of all responders, 16% of those with PCL-C ≥ 50 at Survey 2). Personnel who reported more stressful lifetime events were more likely to score higher on the PCL-C. Only 51% reported the same stressful event on both surveys. People who reported events occurring between the two surveys were more likely to record events from before the first survey which they had not previously mentioned (OR 1.48, 95% CI (1.17, 1.88), p < 0.001), than those who did not. In people who initially had few PTSD symptoms, a higher level of psychological distress, was significantly associated with higher PCL-C scores a few years later.

CONCLUSIONS

The reporting of stressful events varied over time indicating that while the impact of some stressors endure, others may increase or decline in importance. When screening for PTSD, it is important to consider both traumatic experiences on deployment and other stressful life events, as well as other mental health problems among military personnel, even if individuals do not exhibit symptoms of PTSD on an initial assessment.

IRE1α pathway of endoplasmic reticulum stress induces neuronal apoptosis in the locus coeruleus of rats under single prolonged stress

Our previous studies have shown evidence of endoplasmic reticulum (ER) stress-induced apoptosis in the hippocampus and mPFC in an animal model of post- traumatic stress disorder (PTSD). Inositol-requiring enzyme 1α (IRE1α) and its downstream molecule X-box binding protein 1 (XBP1) play key roles in the ER-related apoptosis pathway. Dysregulation of the locus coeruleus (LC) has been reported to contribute to cognitive and/or arousal impairments associated with PTSD. The aim of the present study was to explore the role of IRE1α pathway in neuronal apoptosis in the LC of rat models of PTSD. We used an acute exposure to prolonged stress (single prolonged stress, SPS) to model PTSD in rats and examined the effects related to the IRE1α pathway. Neuronal apoptosis in LC was detected by transmission electron microscopy and TUNEL staining. The results showed that the level of LC neuronal apoptosis was markedly increased after SPS. SPS exposure triggered IRE1α pathway, as evidenced by the increased activity of IRE1α, specific splicing of XBP1, and up-regulated expression of binding immunoglobulin protein/78kDa glucose-regulated protein (BiP/GRP78), and C/EBP-homologous protein (CHOP). Treatment with STF-083010, an IRE1α RNase-specific inhibitor, successfully attenuated the above changes. These results indicate that excessive activation of the ER stress-associated IRE1α pathway is involved in LC neuronal apoptosis induced by SPS exposure; this may be a crucial mechanism of the pathogenesis of PTSD.

PTSD co-morbid with HIV: Separate but equal, or two parts of a whole?

Approximately 30 million people currently live with HIV worldwide and the incidence of stress-related disorders, such as post-traumatic stress disorder (PTSD), is elevated among people living with HIV as compared to those living without the virus. PTSD is a severely debilitating, stress-related psychiatric illness associated with trauma exposure. Patients with PTSD experience intrusive and fearful memories as well as flashbacks and nightmares of the traumatic event(s) for much of their lives, may avoid other people, and may be constantly on guard for new negative experiences. This review will delineate the information available to date regarding the comorbidity of PTSD and HIV and discuss the biological mechanisms which may contribute to the co-existence, and potential interaction of, these two disorders. Both HIV and PTSD are linked to altered neurobiology within areas of the brain involved in the startle response and altered function of the hypothalamic-pituitary-adrenal axis. Collectively, the data highlighted suggest that PTSD and HIV are more likely to actively interact than to simply co-exist within the same individual. Multi-faceted interactions between PTSD and HIV have the potential to alter response to treatment for either independent disorder. Therefore, it is of great importance to advance the understanding of the neurobiological substrates that are altered in comorbid PTSD and HIV such that the most efficacious treatments can be administered to improve both mental and physical health and reduce the spread of HIV.

Three Studies on the Reliability and Validity of a Self-Report Measure of Posttraumatic Stress Disorder

This paper describes three studies of the reliability and validity of a newly revised version of the Purdue Posttraumatic Stress Disorder scale (PPTSD-R). The PPTSD-R is a 17-item questionnaire that yields four scores: Reexperiencing, Avoidance, Arousal, and Total. It is highly internally consistent (α = .91), and the scores are relatively stable across time. The PPTSD-R is highly correlated with other measures of PTSD symptomatology and moderately correlated with measures of related psychopathology, providing preliminary support for the measure's convergent and discriminant validity. It reliably distinguishes between groups of people who were and were not traumatized, it is sensitive to the impact of different types of traumatic events, and (within a clinical sample) it discriminates between those who did and did not seek treatment for difficulty coping with the traumatic event being assessed. The PPTSD-R shows promise as a measure of PTSD symptoms in the college population.