Racial differences in psychotic symptoms among combat veterans with PTSD

Emotional functioning in long COVID: Comparison to post-concussion syndrome using the Personality Assessment Inventory

Objective: Recent studies on Long COVID found that patients report prominent emotional distress and significant correlations between distress and cognitive performance have been identified, raising the question of how to manage or treat these issues. To understand psychological functioning in Long COVID further, this study examined personality responses on the Personality Assessment Inventory (PAI) to compare psychological functioning in a Long COVID group with a post-concussion syndrome (PCS) group, a syndrome with a significant psychological component. Participants and methods: Participants included 201 consecutive Long COVID outpatients (Mean age = 48.87 years, mean education = 14.82, 71.6% Female, 82.6% White) and a comparison group of 102 consecutively referred PCS outpatients (Mean age = 46.08, mean education = 14.17, 63.7% Female, 88.2% White). Effect sizes and t-tests were calculated using the PAI validity, clinical, interpersonal, and treatment consideration scales as well as clinical subscales. Results: The results replicated earlier findings on the PAI in Long COVID by demonstrating that both Long COVID and PCS groups had the highest mean elevations on SOM and DEP scales but no statistically significant between group differences in mean scale elevations. Results support similarities in psychological functioning between Long COVID and PCS patients emphasizing the importance of evaluating psychological functioning in neuropsychological evaluations for these populations. Further, results suggest that psychological treatment strategies for PCS patients may be helpful for Long COVID patients, but more research is needed.

[Psychotic disorders in the veterans of local wars]

OBJECTIVE

To determine the frequency of the key psychopathological syndromes, the dynamics and comorbidity of schizophrenia and other psychoses in Russian veterans of local wars receiving hospital treatment.

MATERIAL AND METHODS

The study included 685 patients of a psychiatric department of a military hospital, including 264 veterans of the local wars (the main group), 296 people (career military servicemen and retirees), who do not take part in combat actions (the first comparison group) and 125 people matched for the middle age and the age distribution curve with the main group (the second comparison group).

RESULTS AND CONCLUSION

The frequency of psychoses appeared to be slightly less in veterans (7.2%) compared to patients of comparison groups (14.5% and 8.8%, respectively). In all groups, most patients were diagnosed with schizophrenia (ICD-10 F20): 3.8% in the main group, 4.4% in the first comparison group and 4.0% in the second comparison group. Other acute and chronic psychotic disorders (F22-F23) were diagnosed in 0.8, 5.4 and 3.2% patients, respectively. Organic delusion disorders were diagnosed in 1.5% patients of the main group, 3.7% patients of the first comparison group and were not detected in the second comparison group. Comorbidity of posttraumatic stress disorder (PTSD) and psychosis was about 2% in the main group in whole and 26.3% in those with schizophrenia and other delusional disorders. The degree of incidence of symptoms of PTSD in veterans diagnosed with psychosis was significantly less than their frequency among all veterans (20% and 46.9%, respectively). Military stress factors do not influence the development of hallucinations and delusions in the main group. In the majority of veterans, psychotic symptoms manifested for the first time after stopping combat stress, the subsequent development and recurrence of psychotic symptoms happened regardless of the influence of combat stress factors.

Reductions in reported persecutory ideation and psychotic-like experiences during exposure therapy for posttraumatic stress disorder

While psychotic-like experiences (PLEs), including persecutory ideation and auditory or visual hallucinations, are common in PTSD, questions remain about their relationships to core PTSD symptoms and responsiveness to treatment. This study examined data from a waitlist (WL) controlled clinical study of the effect of virtual reality (VR) and prolonged exposure (PE) in a sample of active-duty service members with deployment-related trauma (n = 161). PLEs were assessed and examined with regard to their responsiveness to trauma focused treatment (combining conditions) relative to the WL, as well as their relationships to PTSD symptoms. Persecutory ideation symptoms, which were most closely related to PTSD Cluster C (avoidance and numbing) symptoms, were reduced post-treatment in the trauma-focused condition relative to WL. Auditory and visual hallucinations-which were most closely associated with PTSD re-experiencing-decreased from baseline to post-treatment assessments for WL and exposure therapy participants. The presence of PLEs at baseline did not predict a reduced PTSD symptom response to treatment. Trauma-focused treatments appear effective in addressing psychotic-like experiences that can emerge in individuals with PTSD.

Posttraumatic stress disorder with secondary psychotic features (PTSD-SP): Diagnostic and treatment challenges

Trauma exposure leads to various psychiatric disorders including depression, anxiety, bipolar disorders, personality disorders, psychotic disorders, and trauma related disorders, especially posttraumatic stress disorder (PTSD). There are some overlapping symptoms of both PTSD and psychosis that make diagnosis challenging. Despite this overlap, the evidence of PTSD with comorbid psychosis as a distinct entity lies in the research showing biologic, genetic and treatment management differences between psychotic PTSD, non-psychotic PTSD, psychotic disorders and healthy controls. There is emerging evidence that PTSD with secondary psychotic features (PTSD-SP) might be a discrete entity of PTSD with known risk factors that increase its prevalence. This review has presented evidence for individuals with PTSD-SP being distinct in genetics and neurobiological factors. Individuals with PTSD and comorbid psychosis can benefit from evidence based psychotherapy (EBT). There is not enough evidence to recommend second generation antipsychotics (SGA) for PTSD-SP given that risperidone and quetiapine are the only SGAs studied in randomized controlled trials. Hence, developing an operational diagnostic criteria and treatment framework for clinical and research use is critical.

Racism and Psychological and Emotional Injury

The purpose of this article is to discuss the psychological and emotional effects of racism on people of Color. Psychological models and research on racism, discrimination, stress, and trauma will be integrated to promote a model to be used to understand, recognize, and assess race-based traumatic stress to aid counseling and psychological assessment, research, and training.

Psychotic-like experiences, symptom expression, and cognitive performance in combat veterans with posttraumatic stress disorder

Apparent psychotic symptoms are often associated with posttraumatic stress disorder (PTSD), but these symptoms are poorly understood. In a sample of 30 male Vietnam combat veterans with severe and chronic PTSD, we conducted detailed assessments of psychotic symptom endorsement, insight, symptom severity, neurocognitive function, and feigning. Two thirds of the subjects endorsed a psychotic item but did not believe that the experiences were real. Those endorsing psychotic items were higher in PTSD severity, general psychopathology, and dissociation but not depression, functional health, cognitive function, or feigned effort. Severity of psychotic symptoms correlated with dissociation, combat exposure, and attention but not PTSD, depression, or functional health. Those endorsing psychotic items scored higher on a screen but not on a detailed structured interview for malingering. Endorsement of psychotic experiences by combat veterans with PTSD do not seem to reflect psychotic symptoms or outright malingering.

Hallucinations in nonpsychotic disorders: toward a differential diagnosis of "hearing voices"

While auditory hallucinations (AH) are prototypic psychotic symptoms whose clinical presence is often equated with a psychotic disorder, they are commonly found among those without mental illness as well as those with nonpsychotic disorders not typically associated with hallucinations in DSM-IV. This incongruity presents a significant challenge for clinical work and efforts to revise the next iteration of the DSM. Auditory hallucinations found among "normal" people suggest that either AH are not as pathologic as they are typically taken to be, or that less-than-hallucinatory experiences are routinely mischaracterized as AH. Such hallucinations in the context of conversion disorder, trauma, sensory deprivation, and certain cultural settings strengthen an association between AH and psychopathology but suggest limited diagnostic specificity and relevance. It may be useful to think of AH like coughs-common experiences that are often, but not always, symptoms of pathology associated with a larger illness. Although these issues have been known for many years, they are rarely discussed in American psychiatry and need to be addressed in future research and clinical work.

Validity of 'post-traumatic stress disorder with secondary psychotic features': a review of the evidence

OBJECTIVE

To review the evidence from empirical studies regarding the validity of 'post-traumatic stress disorder with secondary psychotic features' (PTSD-SP) as a separate diagnostic entity.

METHOD

The authors performed a review tracing publications between 1980 and January 2008.

RESULTS

Twenty-four comparative studies were included. These studies indicate that PTSD-SP is a syndrome that comprises PTSD-symptoms followed in time by the additional appearance of psychotic features. The psychotic features are not confined to episodes of re-experiencing, but remain present continuously. PTSD-SP seems to have some biological features differentiating it from schizophrenia and PTSD, e.g. there are differences in smooth pursuit eye movement patterns, concentrations of corticotropin-releasing factor and dopamine beta-hydroxylase activity.

CONCLUSION

There is currently not yet full support for PTSD-SP as a nosological entity. However, the delineation of PTSD-SP from other psychiatric syndromes is notable and biological studies seem to support the validity as a separate diagnostic entity.

Screening for major depression and posttraumatic stress disorder among asylum seekers: adapting a standardized instrument to the social and cultural context

OBJECTIVE

To adapt the PTSD and MDE sections of a validated psychiatric diagnostic instrument, we used the Mini International Neuropsychiatric Interview (MINI) during an initial health assessment into a primary care facility for asylum seekers.

METHOD

A 3-step process was carried out. First, items of the original version of the MINI were adapted to the specific context of life of asylum seekers in the host country (by a multidisciplinary group that included public health nurses, a primary care physician, a psychologist, a psychiatrist, and an epidemiologist). Second, we submitted the reworded and original versions of the MINI to 14 interpreters' who tested for general and cultural acceptability. Each diagnostic criterion was rated according to interpreters' comments on a 4-point Likert scale (1 = an item good for translation and 4 = an unusable or completely inadequate item). In the third step, we rephrased the most problematic items identified by the interpreters.

RESULTS

Some original items were considered particularly ill-adapted for this context, and 4 had to be dropped. This final rewording took into account cultural inadequacies and lack of structure (including temporal organization) of the everyday life of newly arrived asylum seekers.

CONCLUSION

The reworded MINI was successfully tested, and its items are presented in the final part of the study.

Ethnicity and diagnostic patterns in veterans with psychoses

BACKGROUND

Differential diagnosis of schizophrenia and bipolar disorder is a challenging but important task. These conditions often exhibit overlapping clinical symptomatology, but have different prognoses and pharmacological management strategies. Factors other than clinical presentation may influence diagnosis. Past studies suggest that ethnicity is one such factor, with variations observed in diagnostic rates of serious mental illness (SMI). With increasing attention paid to provider cultural competency, we investigate current diagnostic practices within a veteran population.

METHOD

Controlling for patient need characteristics and illness severity, we examine whether ethnic differences in diagnosis continue to exist. If so, race may adversely enter the evaluation process. A national database of all SMI veterans explores the relationship between ethnicity and diagnosis. The role of symptomatology is also examined. Given minimal variation in veteran socioeconomic status, the Department of Veterans Affairs (VA) provides a natural setting to address this confounding factor. The 1999 National Psychosis Registry provides a sample of 134,523 veterans diagnosed with schizophrenia, schizoaffective disorder, or bipolar disorder. Multinomial logistic regression yielded odds ratios (OR) for being diagnosed with schizophrenia versus bipolar disorder; the schizoaffective versus bipolar risk was likewise assessed, exploring theoretical aspects of a psychosis-affective 'continuum'.

RESULTS

Small effects were observed for being male, single or rural resident. However, the demographic characteristic most strongly associated with a schizophrenia diagnosis was race. The OR for African Americans was 4.05, and 3.15 for Hispanics. Similar though less dramatic results were revealed for schizoaffective disorder.

CONCLUSIONS

This study confirms continued ethnic disparities in diagnostic patterns, and highlights the importance of recognizing ethnic differences in symptom presentation while emphasizing greater cultural competency.

Cancer and mental disorders in a national community sample: findings from the national comorbidity survey

OBJECTIVE

To determine the association between cancer (past 12 months) and mental disorders (past 12 months) among community-dwelling adults.

METHODS

Data were drawn from the National Comorbidity Survey (n = 5,877), a representative household sample of adults aged 15-54 years in the United States. Multiple logistic regression analyses were used to determine the association between cancer and mental disorders, adjusting for differences in sociodemographic characteristics.

RESULTS

Cancer was significantly associated with increased rates of major depression [odds ratio (OR) = 3.6, 95% confidence interval (CI) = 1.4-8.8], drug dependence (OR = 3.6, 95% CI = 1.3-9.8), simple phobia (OR = 2.5, 95% CI = 1.0-6.2) and agoraphobia (OR = 3.3, 95% CI = 1.0-10.4). These associations persisted after adjusting for major sociodemographic factors, and sex plays a significant role in the association between cancer diagnosis and mental disorder, with cancer diagnosis having a stronger influence on major depression and drug dependence in men than in women.

CONCLUSIONS

Clinicians and community health workers working with cancer survivors need to be not only alert for signs of clinical depression but also of co-occurring drug dependence and certain anxiety disorders so that appropriate referrals to mental health professionals can be made.

Linking posttraumatic stress disorder and psychosis: a look at epidemiology, phenomenology, and treatment

Several recent studies have provided direct evidence for the link between posttraumatic stress disorder (PTSD) and psychosis. Patients with psychotic disorders are known to be at a higher risk of traumatization and PTSD. Additionally, preclinical and clinical data suggest that the effects of trauma exposure on neural networks may provide a common diathesis for disorders like PTSD and schizophrenia. This article reviews evidence on a) the magnitude of association between PTSD and psychosis, b) the causal mechanisms implicated, and c) treatment considerations relevant to this association. A comprehensive MEDLINE search was conducted, and articles pertinent to epidemiological, clinical, and treatment aspects of comorbid PTSD and psychosis were identified. High rates of PTSD characterize patients with severe mental illness. Psychotic phenomena may also be a relatively common manifestation in patients with chronic PTSD. However, in clinical settings, the diagnosis is often missed, and few systematic guidelines exist for the identification and treatment of these comorbidities. Future neurobiological and treatment studies may be useful in better informing the clinical management of these subgroups.