Physical comorbidities of post-traumatic stress disorder in Australian Vietnam War veterans

OBJECTIVE

To determine whether the prevalence of physical comorbidities in Australian Vietnam War veterans with post-traumatic stress disorder (PTSD) is higher than in trauma-exposed veterans without PTSD.

DESIGN, SETTING AND PARTICIPANTS

Cross-sectional analysis of the health status (based on self-reported and objective clinical assessments) of 298 Australian Vietnam War veterans enrolled by the Gallipoli Medical Research Institute (Brisbane) during February 2014 - July 2015, of whom 108 were confirmed as having had PTSD and 106 served as trauma-exposed control participants.Main outcomes and measures: Diagnostic psychiatric interview and psychological assessments determined PTSD status, trauma exposure, and comorbid psychological symptoms. Demographic data, and medical and sleep history were collected; comprehensive clinical examination, electrocardiography, spirometry, liver transient elastography, and selected pathology assessments and diagnostic imaging were performed. Outcomes associated with PTSD were identified; regression analysis excluded the effects of potentially confounding demographic and risk factors and comorbid symptoms of depression and anxiety.

RESULTS

The mean total number of comorbidities was higher among those with PTSD (17.7; SD, 6.1) than in trauma-exposed controls (14.1; SD, 5.2; P < 0.001). For 24 of 171 assessed clinical outcomes, morbidity was greater in the PTSD group, including for conditions of the gastrointestinal, hepatic, cardiovascular, and respiratory systems, sleep disorders, and laboratory pathology measures. In regression analyses including demographic factors, PTSD remained positively associated with 17 adverse outcomes; after adjusting for the severity of depressive symptoms, it remained significantly associated with ten.

CONCLUSION

PTSD in Australian Vietnam veterans is associated with comorbidities in several organ systems, independent of trauma exposure. A comprehensive approach to the health care of veterans with PTSD is needed.

Temporal patterns of drug use by heroin addicts

Judgements were obtained from 26 subjects being treated for heroin use concerning the time of day they most commonly used heroin, marijuana, and alcohol. Heroin chipping, or occasional use, showed a peak time, 6 P.M. to 10 P.M., coinciding with the most common time for use of a variety of substances in several populations. However, the habitual use of heroin is most common upon awakening--apparently to ward off withdrawal symptoms. The results also suggest that the use of marijuana and alcohol does not deviate significantly from the recreational pattern of drug use demonstrated by other populations for other nonprescribed drugs.

Credibility of sources of information about drugs to heroin addicts

A small sample of black heroin addicts ( N = 23) was studied to determine their views of the credibility of a variety of sources of information about drugs. Addicts' own experience and that of ex-addicts and other users were the most trusted sources; and mental health professionals were significantly less credible than sources with personal drug experience. The findings support the use of paraprofessionals in drug education and drug counseling.

Credibility of sources of information about drugs

Several samples of youthful drug users and non-users were asked to rate the credibility of a variety of sources of information about drugs. For both users and non-users these sources can be scaled along dimensions of authority, drug experience, and friendship. The profile of credibility of these sources differed markedly for users and non-users. There are clear implications of these findings for drug education and drug counseling.

Sensitivity of the Experiential World Inventory to psychedelic drug states

The Experiential World Inventory (EWI) was administered under two conditions to each of 40 Ss who were drug abusers. The set oriented toward the recall of a psychedelic experience produced markedly elevated profiles, particularly on scales reflecting altered perceptions of the world and changes in the body image.

Marihuana--a psychedelic drug?

Dimensions of the drug experience derived from judgments by experienced drug users were combined to separate marihuana and psychedelic drugs into two classes. The marihuana substances were judged as calming as opposed to exciting, relatively safer, and less potent than psychedelic drugs. In this study and others it seems that marihuana may be more similar to sedative, depressant, and hypnotic drugs than to psychedelic drugs. Some superiority in correct classification was found for a non-linear discriminant function over a linear discriminant function.

Consistency of patterns of drug use

Although there is much descriptive research concerning frequency of drug use, few studies have reported quantitative data on patterns of drug use. 33 college students with experience with a variety of drugs were studied. Alcohol and some legal drugs were included as well as drugs of abuse. Guttman scalogram analyses yielded very high coefficients of reproducibility (.89 to .98). The pattern of drug use was cross-validated on a sample of young drug users in another setting. The relative frequency of drug use for our sample was also highly related to that reported in other studies of student populations. In order to identify the dimension underlying the pattern of drug use, ratings of the safety and availability of each of the 18 substances were obtained. Both availability and safety were highly related to the relative frequency of drug use, with availability being the more important variable.