Mental health and psychosocial support in humanitarian settings: linking practice and research.

Lancet. 2011 Oct 14;

Authors: Tol WA, Barbui C, Galappatti A, Silove D, Betancourt TS, Souza R, Golaz A, van Ommeren M

Abstract
This review links practice, funding, and evidence for interventions for mental health and psychosocial wellbeing in humanitarian settings. We studied practice by reviewing reports of mental health and psychosocial support activities (2007-10); funding by analysis of the financial tracking service and the creditor reporting system (2007-09); and interventions by systematic review and meta-analysis. In 160 reports, the five most commonly reported activities were basic counselling for individuals (39%); facilitation of community support of vulnerable individuals (23%); provision of child-friendly spaces (21%); support of community-initiated social support (21%); and basic counselling for groups and families (20%). Most interventions took place and were funded outside national mental health and protection systems. 32 controlled studies of interventions were identified, 13 of which were randomised controlled trials (RCTs) that met the criteria for meta-analysis. Two studies showed promising effects for strengthening community and family supports. Psychosocial wellbeing was not included as an outcome in the meta-analysis, because its definition varied across studies. In adults with symptoms of post-traumatic stress disorder (PTSD), meta-analysis of seven RCTs showed beneficial effects for several interventions (psychotherapy and psychosocial supports) compared with usual care or waiting list (standardised mean difference [SMD] -0·38, 95% CI -0·55 to -0·20). In children, meta-analysis of four RCTs failed to show an effect for symptoms of PTSD (-0·36, -0·83 to 0·10), but showed a beneficial effect of interventions (group psychotherapy, school-based support, and other psychosocial support) for internalising symptoms (six RCTs; SMD -0·24, -0·40 to -0·09). Overall, research and evidence focuses on interventions that are infrequently implemented, whereas the most commonly used interventions have had little rigorous scrutiny.

PMID: 22008428 [PubMed - as supplied by publisher]

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Neural correlates of self-reflection in post-traumatic stress disorder.

Acta Psychiatr Scand. 2011 Oct 18;

Authors: Bluhm RL, Frewen PA, Coupland NC, Densmore M, Schore AN, Lanius RA

Abstract
Bluhm RL, Frewen PA, Coupland NC, Densmore M, Schore AN, Lanius RA. Neural correlates of self-reflection in post-traumatic stress disorder. Objective:  Disturbances in self-referential processing (SRP) are increasingly recognized in post-traumatic stress disorder (PTSD). In healthy adults, SRP tasks engage the medial prefrontal cortex (MPFC) and posterior cingulate cortex (PCC) brain regions that have shown altered function in PTSD. We hypothesized that individuals with PTSD would differ from controls in functional activation of the MPFC and PCC during SRP. Method:  We compared neural activation in healthy controls (n = 15) and participants with PTSD (n = 20) during a SRP task, using fMRI at 4.0T. Results:  Controls made faster responses to the self-relevance of personal characteristics than to the accuracy of general facts, whereas response times did not differ between these conditions in PTSD. Controls also demonstrated greater MPFC (dorsal and ventral) and PCC response when considering the self-relevance of personal characteristics in comparison with the accuracy of general facts. Individuals with PTSD demonstrated less MPFC response than did healthy controls for the contrast of self-relevance of personal characteristics relative to general facts. Conclusions:  These results implicate MPFC in SRP disturbances associated with PTSD. These findings are relevant to current proposals for including symptoms of negative self-referential cognition and identity-existential disturbance as diagnostically relevant to PTSD.

PMID: 22007877 [PubMed - as supplied by publisher]

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Prolonged exposure for the treatment of Spanish-speaking Puerto Ricans with posttraumatic stress disorder: a feasibility study.

BMC Res Notes. 2011 Oct 17;4(1):415

Authors: Vera M, Reyes-Rabanillo ML, Juarbe D, Perez-Pedrogo C, Olmo A, Kichic R, Chaplin WF

Abstract
ABSTRACT: BACKGROUND: Most of the empirical studies that support the efficacy of prolonged exposure (PE) for treating posttraumatic stress disorder (PTSD) have been conducted on white mainstream English-speaking populations. Although high PTSD rates have been reported for Puerto Ricans, the appropriateness of PE for this population remains unclear. The purpose of this study was to examine the feasibility of providing PE to Spanish speaking Puerto Ricans with PTSD. Particular attention was also focused on identifying challenges faced by clinicians with limited experience in PE. This information is relevant to help inform practice implications for training Spanish-speaking clinicians in PE. RESULTS: Fourteen patients with PTSD were randomly assigned to receive PE (n = 7) or usual care (UC) (n = 7). PE therapy consisted of 15 weekly sessions focused on gradually confronting and emotionally processing distressing trauma-related memories and reminders. Five patients completed PE treatment; all patients attended the 15 sessions available to them. In UC, patients received mental health services available within the health care setting where they were recruited. They also had the option of self-referring to a mental health provider outside the study setting. The Clinician-Administered PTSD Scale (CAPS) was administered at baseline, mid-treatment, and post-treatment to assess PTSD symptom severity. Treatment completers in the PE group demonstrated significantly greater reductions in PTSD symptoms than the UC group. Forty percent of the PE patients showed clinically meaningful reductions in PTSD symptoms from pre- to post-treatment. CONCLUSIONS: PE appears to be viable for treating Puerto Rican Spanish-speaking patients with PTSD. This therapy had good patient acceptability and led to improvements in PTSD symptoms. Attention to the clinicians’ training process contributed strongly to helping them overcome the challenges posed by the intervention and increased their acceptance of PE.

PMID: 22005187 [PubMed - as supplied by publisher]

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Original Research: Documentation of Screening for Perpetration of Intimate Partner Violence in Male Veterans with PTSD.

Am J Nurs. 2011 Oct 14;

Authors: Gerlock AA, Grimesey JL, Pisciotta AK, Harel O

Abstract
A retrospective cohort study finds that screening was documented for only a quarter of the veterans seeking treatment for posttraumatic stress disorder. BACKGROUND: Men seeking care for posttraumatic stress disorder (PTSD) are believed to have high rates of relationship conflict and intimate partner violence (IPV). But little is known about screening for IPV perpetration in this population. OBJECTIVE: In phase one of a two-phase study of male veterans treated for PTSD, the primary objective was to determine how many veterans’ records showed documentation that they’d been screened for IPV perpetration. The secondary objective was to count the total number of screenings and to determine whether an initial screening affected future screenings. METHODS: For this retrospective cohort study, a stratified random sample of 10% (N = 507) of all male veterans receiving treatment for PTSD at a U.S. Department of Veterans Affairs health care facility in a five-year period (November 2002 to November 2007) was selected and more than 70,000 progress notes were reviewed. The presence or absence of a documented screening for IPV perpetration in each record was noted and a Spearman rank correlation test to determine the relationship between the documentation of a first screening and future screenings was performed. RESULTS: Of the 507 records examined, 120 (24%) showed documentation of screening for IPV perpetration. Of those, 73 (61%) showed positive results for IPV perpetration, and 61 (51%) showed more than one screening. Documentation of screening was most likely to have occurred at the veteran’s initial appointment (71%) and in an outpatient mental health setting (72%); IPV perpetration was determined most often as the result of a provider’s inquiry (45%). There was a total of 415 screenings, including 356 in records in which there was more than one screening. The documentation of a single screening for IPV perpetration was significantly correlated with the documentation of subsequent screenings and with IPV perpetration determination (Spearman rank correlation = 0.611, P < 0.001). Also, veterans with documented IPV perpetration and high rates of relationship conflict accessed the health care system twice as often as those without such documentation. CONCLUSIONS: In the sample analyzed, fewer than a quarter of male veterans with PTSD had a documented screening for IPV perpetration. Also, because those identified as IPV perpetrators accessed the health care system at a higher rate than those not so identified and repeated screenings were associated with a higher rate of IPV perpetrator determinations, health care providers should be made more aware of opportunities for screening for IPV in this population.

PMID: 22005050 [PubMed - as supplied by publisher]

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Behavioral Health and Social Normative Influence: Correlates of Concurrent Sexual Partnering Among Heterosexually-Active Homeless Men.

AIDS Behav. 2011 Oct 15;

Authors: Wenzel SL, Rhoades H, Hsu HT, Golinelli D, Tucker JS, Kennedy DP, Green HD, Ewing B

Abstract
Sexual concurrency poses significant HIV/STI transmission risk. The correlates of concurrency have not been examined among homeless men. A representative sample of 305 heterosexually active homeless men utilizing meal programs in the Skid Row area of Los Angeles reported on their mental health, substance use, and social network characteristics. Nearly 40% of men reported concurrency with one of their four most recent sex partners. Results indicated that HIV seropositivity (OR = 4.39, CI: 1.10, 17.46; P = 0.04), PTSD (OR = 2.29, CI: 1.05, 5.01; P = 0.04), hard drug use (OR = 2.45, CI: 1.07, 5.58; P = 0.03), and the perception that network alters engage in risky sex (OR = 3.72, CI: 1.49, 9.30; P = 0.01) were associated with increased odds of concurrency. Programs aimed at reducing HIV/STI transmission in this vulnerable population must take into account the roles that behavioral health and social networks may play in sexual concurrency.

PMID: 22001933 [PubMed - as supplied by publisher]

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Psychological adjustment one year after the diagnosis of breast cancer: A prototype study of delayed post-traumatic stress disorder.

Br J Clin Psychol. 2011 Nov;50(4):350-63

Authors: Elklit A, Blum A

Abstract
Objective. The utilization of a post-traumatic stress disorder (PTSD) diagnostic framework for categorizing the psychological adjustment of breast cancer (BC) patients has been debated. We wanted to study the prevalence of PTSD and predictors for PTSD. Design. The current study is a one-year follow-up of 64 early BC patients. Methods. PTSD, subclinical PTSD, delayed onset PTSD and several theory-driven predictive variables were examined. Results. Thirteen per cent of the patients showed full symptoms of disease-related PTSD compared with 7% at the initial study (6 weeks after diagnosis). Considerable changes were observed in all PTSD clusters (intrusion, avoidance, and arousal), in most cases representing a decrease in symptom level. Immature defence style, emotional coping, avoidant behaviour, and negative affectivity were all implicated as predicting variables in a hierarchical multiple regression analysis which explained 65% of the variability of PTSD severity one year after diagnosis. Conclusions. This study highlights the PTSD diagnosis as being highly relevant in oncology settings. Early screening for the above-mentioned four variables may help early identification of the patients most at risk of developing PTSD.

PMID: 22003946 [PubMed - in process]

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Altered salivary alpha-amylase awakening response in Bosnian War refugees with posttraumatic stress disorder.

Psychoneuroendocrinology. 2011 Oct 14;

Authors: Thoma MV, Joksimovic L, Kirschbaum C, Wolf JM, Rohleder N

Abstract
In posttraumatic stress disorder (PTSD), chronic activation of the sympathetic nervous system (SNS) has been suggested. No study so far has investigated diurnal secretion patterns of salivary alpha-amylase (sAA) in PTSD, a promising candidate for non-invasive assessment of SNS activity. We compared sAA diurnal profiles between a group of Bosnian War refugees with PTSD and a healthy control group, and further analyzed for associations with psychiatric symptoms and glucocorticoid (GC) sensitivity of inflammatory regulation. PTSD patients showed a sAA awakening response profile that was opposite to those seen in healthy controls, i.e. an increase instead of a sharp decrease. Patterns of sAA secretion were further positively associated with psychiatric symptoms of PTSD. Finally, higher sAA awakening responses were associated with higher GC sensitivity of inflammatory cytokine production. These findings are in line with altered SNS function in PTSD, and lend further support for employing assessment of diurnal sAA profiles as non-invasive biomarkers in stress-related disease.

PMID: 22001009 [PubMed - as supplied by publisher]

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Unit cohesion and mental health in the UK armed forces.

Occup Med (Lond). 2011 Oct 14;

Authors: Du Preez J, Sundin J, Wessely S, Fear NT

Abstract
BACKGROUND: Unit cohesion is recognized as a potentially modifiable factor in the aetiology of mental illness among military personnel. AIMS: To examine the association between unit cohesion and probable post-traumatic stress disorder (PTSD), common mental disorder and alcohol misuse, in UK armed forces personnel deployed to Iraq. METHODS: A sample of 4901 male UK armed forces personnel who had deployed to Iraq was drawn from a cohort of personnel who participated in a cross-sectional postal questionnaire study between June 2004 and March 2006. Information was collected on socio-demographic and military characteristics, deployment experiences and information on current health. RESULTS: Perceived interest from seniors was associated with less probable PTSD [odds ratio (OR) 0.42, 95% confidence interval (CI) 0.26-0.67] and common mental disorder (OR 0.68, 95% CI 0.53-0.87). Among regular personnel, feeling well informed was associated with less common mental disorder (OR 0.74, 95% CI 0.58-0.95) and comradeship was associated with greater alcohol misuse (OR 1.98, 95% CI 1.19-3.28). Feeling able to talk about personal problems was associated with less alcohol misuse among reserve personnel (OR 0.31, 95% CI 0.16-0.60). The general construct of unit cohesion was predictive of less probable PTSD (OR 0.69, 95% CI 0.58-0.81) and common mental disorder (OR 0.80, 95% CI 0.73-0.87). CONCLUSIONS: Unit cohesion had a linear association with less probable PTSD and common mental disorder. Of the individual items, perception of leadership was associated with less probable PTSD and common mental disorder. Comradeship was associated with greater alcohol misuse among regular personnel, while feeling able to talk about personal problems was associated with less alcohol misuse for reserve personnel.

PMID: 22003060 [PubMed - as supplied by publisher]

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Periaqueductal gray c-Fos expression varies relative to the method of conditioned taste aversion extinction employed.

Brain Res. 2011 Sep 22;

Authors: Mickley GA, Wilson GN, Remus JL, Ramos L, Ketchesin KD, Biesan OR, Luchsinger JR, Prodan S

Abstract
A conditioned taste aversion (CTA) is acquired when an animal consumes a novel taste (CS) and then experiences the symptoms of poisoning (US). Following CTA training, animals will avoid the taste that was previously associated with malaise. This defensive reaction to a learned fear can be extinguished by repeated exposure to the CS alone (CS-only; CSO-EXT). However, following a latency period in which the CS is not presented, the CTA will spontaneously recover (SR). Through the use of an explicitly unpaired extinction procedure (EU-EXT) we have shown that we can speed up extinction and attenuate SR of the CTA. Here we compared and contrasted the ability of CSO and EU extinction procedures to affect c-Fos expression in the periaqueductal gray (PAG). Fluid-deprived Sprague-Dawley rats acquired a strong CTA [via 3 pairings of 0.3% oral saccharin (SAC; the CS) and 81mg/kg i.p. lithium chloride (LiCl; the US)] followed by extinction trials consisting of multiple exposures to either, (a) the CS every-other day (CSO-EXT), or (b) CS and US on alternate days (EU-EXT). A different group of rats did not receive multiple CS exposures and served as a “no extinction” (NE) control. Both extinction procedures resulted in ≥90% reacceptance of SAC (achieving asymptotic extinction). Some of the animals were sacrificed for c-Fos immunohistochemical analysis following asymptotic extinction. Other rats entered a 30-day latency period where they drank water only. These remaining animals were then tested for SR with a final exposure to SAC before being sacrificed for c-Fos immunohistochemistry. As reported previously, rats in the CS-only group exhibited a significant SR of the CTA. However, animals in the EU extinction group reached asymptotic extinction more rapidly than did CSO rats and they did not show SR of the CTA. As compared to rats that retained their CTA, both groups of extinguished rats showed suppression in the number of c-Fos-labeled neurons in all 4 longitudinal columns of the PAG. The number of c-Fos-labeled cells in the PAG was generally low but there was a reliable increase in c-Fos expression in dorsolateral PAG (dlPAG) following the SR test in the brains of rats that went through the EU-EXT procedure as compared with those that either went through the more-traditional CSO extinction procedure or experienced no extinction at all. The number of c-Fos-labeled neurons in the dlPAG was significantly correlated with the amount of SAC consumed at the SR test. Surprisingly, the brains of EU-extinguished rats and CSO extinguished rats did not differ in the number of c-Fos-labeled neurons in gustatory neocortex, medial prefrontal cortex, basolateral amygdala, or the central nucleus of the amygdala. Thus, behavioral differences in SR between the EU and CSO extinction animals were not represented by corresponding changes in the neural activity of several brain nuclei classically associated with extinction learning. However a detailed analysis of PAG c-Fos expression provided hints about some of the physiological changes evoked by these 2 extinction paradigms that produce very different behavioral outcomes. The findings are clinically relevant as we seek the development of treatments for deficits in fear extinction (e.g. PTSD, phobias).

PMID: 22000083 [PubMed - as supplied by publisher]

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Chronic Pain and Marijuana Use among a Nationally Representative Sample of Adults.

Am J Addict. 2011 Nov;20(6):538-542

Authors: Zvolensky MJ, Cougle JR, Bonn-Miller MO, Norberg MM, Johnson K, Kosiba J, Asmundson GJ

Abstract
This study sought to examine the relations between chronic pain and marijuana use in a large nationally representative survey of adults (n = 5,672; 53% female; M(age) = 45.05, SD = 17.9) conducted in the United States. After controlling for sociodemographic variables, lifetime history of depression, and alcohol abuse/dependence, there was a significant association between lifetime chronic pain and lifetime and current marijuana use. Moreover, current chronic pain was significantly associated with lifetime marijuana use. There was no significant association between current chronic pain and current marijuana use, possibly owing to limited statistical power. Results suggest that there are generally consistent statistically significant relations between chronic pain and marijuana use. Future work is needed to explicate the developmental patterning between chronic pain and marijuana use. This paper presents the potential linkage between chronic pain and marijuana use. Results from this study suggest that it may be beneficial for clinicians to assess for marijuana use among patients suffering from chronic pain. Such patients may be using marijuana as a maladaptive coping strategy. (Am J Addict 2011;20:538-542).

PMID: 21999500 [PubMed - as supplied by publisher]

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PTSD treatment of African American adults in primary care: the gap between current practice and evidence-based treatment guidelines.

J Natl Med Assoc. 2011 Jul;103(7):585-93

Authors: Graves RE, Freedy JR, Aigbogun NU, Lawson WB, Mellman TA, Alim TN

Abstract
BACKGROUND: Posttraumatic stress disorder (PTSD) is a common, potentially disabling, underdiagnosed, and under-treated illness. Primary care physicians assume a critical role in the diagnosis, treatment, and referral of African Americans with PTSD since mental health access is limited for this population. This study is an examination of PTSD treatment of African Americans in the primary care setting. Actual treatment provision is contrasted with existing evidence-based PTSD treatment guidelines.
METHOD: Researchers screened 738 consenting, mostly African American, adults in 4 academically affiliated primary care offices for both trauma exposure and mental health symptoms, including PTSD.
RESULTS: Employing criteria from the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision) (DSM-IV), investigators diagnosed 91 of the participants with current PTSD using the Structured Clinical Interview for DSM and the clinician-administered of PTSD Scale for DSM-IV. Treatment statistics include: 69.2% (n=63) had never received treatment from a mental health provider: 18.6% (n=17) were currently seeing a mental health practitioner; nearly half (47.9%, n=24) of a subsample had never discussed traumatic event exposure or mental health symptoms with their primary care doctor; 32% (n=29) were prescribed psychotropic medication and only 18.6% (n=17) were participating in any form of psychotherapy. Concurrent psychiatric disorders were found in 46.2% (n = 42) of the participants with PTSD.
CONCLUSION: Most African American adult primary care patients with PTSD were either undiagnosed or undertreated in this inner-city setting. These results demonstrate a clear need to improve screening and treatment services. Both individual (provider and patient) and system-based changes will be required to meet the demonstrated clinical need.

PMID: 21999033 [PubMed - in process]

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The effect of resilience on posttraumatic stress disorder in trauma-exposed inner-city primary care patients.

J Natl Med Assoc. 2011 Jul;103(7):560-6

Authors: Wrenn GL, Wingo AP, Moore R, Pelletier T, Gutman AR, Bradley B, Ressler KJ

Abstract
Posttraumatic stress disorder (PTSD) has previously been associated with increased risk for a variety of chronic medical conditions and it is often underdiagnosed in minority civilian populations. The current study examined the effects of resilience on the likelihood of having a diagnosis of PTSD in an inner-city sample of primary care patients (n=767). We measured resilience with the Connor-Davidson Resilience Scale, trauma with the Childhood Trauma Questionnaire and Trauma Events Inventory, and assessed for PTSD with the modified PTSD symptom scale. Multiple logistic regression model with presence/absence of PTSD as the outcome yielded 3 significant factors: childhood abuse, nonchild abuse trauma, and resilience. One type of childhood abuse in moderate to severe range (OR, 2.01; p = .0001), 2 or more types of childhood abuse in moderate to severe range (OR, 4.00; p < or = .0001), and 2 or more types of nonchildhood abuse trauma exposure (OR, 3.33; p < or = .0001), were significantly associated with an increased likelihood of PTSD, while resilience was robustly and significantly associated with a decreased likelihood of PTSD (OR, 0.93; p < or = .0001). By understanding the role of resilience in recovery from adverse experiences, improved treatment and interventional methods may be developed. Furthermore, these results suggest a role for assessing resilience in highly traumatized primary care populations as a way to better characterize risk for PTSD and direct screening/psychiatric referral efforts.

PMID: 21999030 [PubMed - in process]

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Translation and adaptation of the life stressor checklist-revised with Colombian women.

Health Care Women Int. 2011 Jul;32(7):599-612

Authors: Humphreys JC, Bernal De Pheils P, Slaughter RE, Uribe T, Jaramillo D, Tiwari A, Canaval GE, Amaya P, Mendoza Flores ME, Belknap RA

Abstract
We undertook the translation and adaptation of an instrument developed to measure women’s lifetime trauma exposure, the Life Stressor Checklist-Revised (LSC-R), in order to determine its utility and cultural appropriateness with Colombian Spanish-speaking women. The LSC-R was forward and backward translated and administered to a sample (N = 217) of community-based women volunteers in Medellín, Colombia. Open-ended questions were included to assess the construct validity and cultural appropriateness of the LSC-R. The LSC-R was found to be valid and easily understood. Trauma exposure was common, but its assessment was not overly distressing to Colombian women.

PMID: 21728882 [PubMed - indexed for MEDLINE]

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Cognitive-behavior therapy for disaster-exposed youth with posttraumatic stress: results from a multiple-baseline examination.

Behav Ther. 2011 Sep;42(3):349-63

Authors: Taylor LK, Weems CF

Abstract
Youth traumatized by natural disasters report high levels of posttraumatic stress such as symptoms of posttraumatic stress disorder, other anxiety disorders, and depression. Research suggests that cognitive behavioral therapies are promising interventions for symptom reduction; however, few cognitive behavioral treatments have been systematically tested in youth hurricane survivors. The current study provides an examination of the efficacy of an intervention manual designed specifically for hurricane-exposed youth (i.e., the StArT manual) using a partially nonconcurrent multiple baseline design. Youth ages 8-13 (n = 6) who met diagnostic criteria for posttraumatic stress disorder were provided the individual StArT treatment in their school. Youth were assessed at pretreatment, weekly during treatment, and at posttreatment. Results provide initial evidence for the efficacy of the StArT manual and suggest the feasibility of conducting the StArT manual in a school setting. The importance of large-scale tests of effectiveness and implementation of cognitive behavioral treatments in the wake of disaster among youth are discussed.

PMID: 21658519 [PubMed - indexed for MEDLINE]

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Teacher-delivered resilience-focused intervention in schools with traumatized children following the second Lebanon War.

J Trauma Stress. 2011 Jun;24(3):309-16

Authors: Wolmer L, Hamiel D, Barchas JD, Slone M, Laor N

Abstract
The 2006 Lebanon War exposed children in the north of Israel to daily rocket attacks. To cope with the massive psychological needs, a teacher-delivered protocol focusing on enhancing personal resilience was implemented. Children were assessed for risk factors, symptoms, and adaptation before the 16-week program (Time 1; n = 983) and after its completion (Time 2; n = 563). At a 3-month follow-up (Time 3; n = 754) children were assessed together with a waiting-list comparison group (n = 1,152). Participating children showed a significant symptom decrease at Time 2 and significantly fewer symptoms than the control group at Time 3. Six or more risk factors were associated with greater symptoms and parental concern about the child’s adaptive functioning. Teachers are valuable cost-effective providers for clinically informed interventions after mass trauma and disaster.

PMID: 21618288 [PubMed - indexed for MEDLINE]

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An assessment of secondary traumatic stress in juvenile justice education workers.

J Correct Health Care. 2011 Jul;17(3):208-17

Authors: Smith Hatcher S, Bride BE, Oh H, Moultrie King D, Franklin Catrett J

Abstract
Given the frequency and violent character of the traumas encountered by juvenile offenders, staff members who regularly interact with juveniles in custody are at risk of developing secondary traumatic stress. Juvenile justice teachers and staff (N = 118) were administered a cross-sectional survey, including the Secondary Traumatic Stress Scale. Respondents said the students were moderately traumatized (47%), severely traumatized (27%), and very severely traumatized (7%). Regarding STS, the most frequently reported symptom was intrusive thoughts related to work with the students, mentioned by 61% of respondents. Additionally, 81% met at least one, 55% met two, and 39% met all three core diagnostic criteria for posttraumatic stress disorder. Recommendations for juvenile justice staff members and for the organization are provided to address practice and policy implications.

PMID: 21571748 [PubMed - indexed for MEDLINE]

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Body awareness in preschool children with psychiatric disorder.

Res Dev Disabil. 2011 Sep-Oct;32(5):1623-30

Authors: Simons J, Leitschuh C, Raymaekers A, Vandenbussche I

Abstract
The purpose of this study was to investigate the body awareness of preschool children with a psychiatric disorder as measured by the test imitation of gestures (Bergès & Lézine, 1978), using the subsections for pointing to body parts (passive vocabulary) and naming body parts (active vocabulary). Seventy-seven children from 37 to 72 months of age with psychiatric disorders and 67 children without psychiatric disorders were matched for age and sex. A MANOVA indicated no significant interaction effects on the results between the sexes in the psychiatric group and the control group for passive vocabulary (F(1,150)=.59, p≥0.05) or for active vocabulary (F(1,150)=.61, p≥0.05). An ANOVA was conducted to determine the differences between the boys and girls for passive and active vocabulary, and the differences between the psychiatric group and the control group for passive and active vocabulary. No significant differences between the boys and girls for passive vocabulary (F(1,150)=1.968, p≥0.05) and active vocabulary (F(1,150)=1.57, p≥0.05) were found. There was a significant difference between the psychiatric and the control group for passive vocabulary (F(1,150)=9.511, p=0.002) and active vocabulary (F(1,150)=16.18, p=0.00009). The study provides support for the presence of language disorders associated with active and passive body awareness in children with psychiatric disorders compared to typically developing children.

PMID: 21435833 [PubMed - indexed for MEDLINE]

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Lessons from the 2004 Asian tsunami: Epidemiological and nosological debates in the diagnosis of post-traumatic stress disorder in non-Western post-disaster communities.

Int J Soc Psychiatry. 2011 Oct 13;

Authors: Rajkumar AP, Mohan TS, Tharyan P

Abstract
BACKGROUND: The nosological validity of post-traumatic stress disorder (PTSD) remains controversial in non-Western communities. After natural disasters, epidemiological studies often overlook these conceptual debates and assess post-traumatic stress symptoms (PTSS) by short screening instruments. Such PTSS estimates are reported as inflated prevalence rates of PTSD in post-disaster settings. AIMS: To discuss the prevalence and determinants of PTSS within the context of pertinent epidemiological and nosological debates. METHODS: We assessed PTSS and grief symptoms of 643 survivors from five Indian villages struck by the Asian tsunami using the Impact of Events Scale – Revised and Complicated Grief Assessment Scale. We adopted a case control design and employed complex sample multiple logistic regression statistics to study the determinants of PTSS. RESULTS: The prevalence of PTSS was 15.1% (95% CI 12.3%-17.9%). PTSS was significantly associated with traumatic grief, female gender, physical injury, death of children and financial losses, but not with functional disability (p = .91). CONCLUSIONS: Although PTSS were common in this population, elevating them to a psychiatric construct of PTSD is questionable, when functional impairment and avoidance behaviours were absent. Grief reactions, socio-economic burden, and poor support systems contribute towards PTSS. We highlight the important issues regarding the nosological validity and epidemiology of PTSD in non-Western communities.

PMID: 21997766 [PubMed - as supplied by publisher]

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Central functions of neuropeptide Y in mood and anxiety disorders.

Expert Opin Ther Targets. 2011 Nov;15(11):1317-31

Authors: Wu G, Feder A, Wegener G, Bailey C, Saxena S, Charney D, Mathé AA

Abstract
Introduction: Neuropeptide Y (NPY) is a highly conserved neuropeptide belonging to the pancreatic polypeptide family. Its potential role in the etiology and pathophysiology of mood and anxiety disorders has been extensively studied. NPY also has effects on feeding behavior, ethanol intake, sleep regulation, tissue growth and remodeling. Findings from animal studies have delineated the physiological and behavioral effects mediated by specific NPY receptor subtypes, of which Y1 and Y2 are the best understood. Areas covered: Physiological roles and alterations of the NPYergic system in anxiety disorders, depression, posttraumatic stress disorder (PTSD), alcohol dependence and epilepsy. For each disorder, studies in animal models and human investigations are outlined and discussed, focusing on behavior, neurophysiology, genetics and potential for novel treatment targets. Expert opinion: The wide implications of NPY in psychiatric disorders such as depression and PTSD make the NPYergic system a promising target for the development of novel therapeutic interventions. These include intranasal NPY administration, currently under study, and the development of agonists and antagonists targeting NPY receptors. Therefore, we are proposing that via this mode of administration, NPY might exert CNS therapeutic actions without untoward systemic effects. Future work will show if this is a feasible approach.

PMID: 21995655 [PubMed - in process]

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Recognition of mental disorders and beliefs about treatment and outcome: findings from an Australian National Survey of Mental Health Literacy and Stigma.

Aust N Z J Psychiatry. 2011 Oct 13;

Authors: Reavley NJ, Jorm AF

Abstract
Objective: The aim of the study was to carry out a national survey in order to assess recognition and beliefs about treatment for affective disorders, anxiety disorders and schizophrenia/psychosis. Method: In 2011, telephone interviews were carried out with 6019 Australians aged 15 or over. Participants were presented with a case vignette describing either depression, depression with suicidal thoughts, early schizophrenia, chronic schizophrenia, social phobia or post-traumatic stress disorder (PTSD). Questions were asked about what was wrong with the person, the likely helpfulness of a broad range of interventions and the likely outcomes for the person with and without appropriate treatment. Results: Rates of recognition of depression were relatively high, with almost 75% of respondents using the correct label. Rates of recognition for the schizophrenia vignettes and PTSD were similar, with around one third of respondents using the correct labels. Only 9.2% of respondents were able to correctly label social phobia. Respondents gave the highest helpfulness ratings to GPs, counsellors, antidepressants, antipsychotics (for schizophrenia) and lifestyle interventions such as physical activity, relaxation and getting out more. Respondents were generally optimistic about recovery following treatment, although relapse was seen as likely. Conclusions: While Australians’ beliefs about effective medications and interventions for mental disorders have moved closer to those of health professionals since surveys conducted in 1995 and 2003/4, there is still potential for mental health literacy gains in the areas of recognition and treatment beliefs for mental disorders. This is particularly the case for schizophrenia and anxiety disorders, which are less well recognized and, in the case of social phobia, generally perceived as having less need for professional help.

PMID: 21995330 [PubMed - as supplied by publisher]

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Self-study assisted Cognitive Therapy for PTSD: A case study.

Eur J Psychotraumatol. 2010 Dec;1

Authors:

Abstract
Research has demonstrated that Cognitive Therapy for PTSD (CT-PTSD), a version of trauma-focused cognitive-behavioural therapy developed by Ehlers and Clark’s group (2000), is effective and feasible when offered in weekly and intensive daily formats. It is unknown whether patients with posttraumatic stress disorder (PTSD) could engage in and benefit from self-study assisted cognitive therapy, which would reduce therapist contact time. This case report aims to illustrate this possibility. A patient with PTSD and comorbid major depression, who developed these problems following a road traffic accident, was treated in six sessions of cognitive therapy with six self-study modules completed in-between sessions. The patient made a complete recovery on measures of PTSD, anxiety, and depression as assessed by self-report and independent assessment. Self-study assisted cognitive CT-PTSD reduced the therapist contact time to half of that normally required in standard CT-PTSD. This highlights the potential feasibility and therapeutic benefits of self-study modules in the brief treatment of PTSD. Further research is required to systematically evaluate the acceptability and efficacy of brief self-study assisted CT-PTSD.

PMID: 21994807 [PubMed - as supplied by publisher]

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Search for a curvilinear relationship between the sense of coherence and the intensity of PTSD in MVA survivors.

Anxiety Stress Coping. 2011 Sep 6;

Authors: Kaźmierczak IE, Strelau J, Zawadzki B

Abstract
Abstract The relationship between the sense of coherence (SOC) and the intensity of posttraumatic stress disorder (PTSD) was examined in order to determine its nature and to resolve the inconsistencies between (1) a growing body of empirical research that indicates a linear relationship between these variables, and (2) the schema-based theories of PTSD that suggest a curvilinear relationship between cognitions and the intensity of PTSD. In this cross-sectional study an attempt was also made to identify some psychological factors that moderate this relationship. Participants were a sample of 1132 motor vehicle accident (MVA) survivors. The results showed that gender and temperamental predisposition to PTSD constituted moderator variables of the relationship between SOC and the intensity of PTSD. This supported both the empirical evidence on the linear and negative relationship between SOC and the intensity of PTSD and the theories that postulated the curvilinear relationship.

PMID: 21992182 [PubMed - as supplied by publisher]

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Hypercoagulation in chronic post-traumatic stress disorder.

Isr Med Assoc J. 2011 Sep;13(9):548-52

Authors: Robicsek O, Makhoul B, Klein E, Brenner B, Sarig G

Abstract
BACKGROUND: Whereas procoagulation abnormalities in acute stress are well established, little is known about the mechanism of hypercoagulation in chronic stress, such as post-traumatic stress disorder (PTSD). This is crucial, given the fact that chronic coagulation disturbances have been associated with increased morbidity and premature mortality due to thromboembolism and cardiovascular disorders, complications recently described in PTSD patients.
OBJECTIVES: To explore the mechanisms of hypercoagulation in chronic PTSD.
METHODS: Thirty patients diagnosed with chronic PTSD were enrolled and compared with a control group matched for age, gender and ethnicity. Hypercoagulation state was evaluated by levels of fibrinogen, D-dimer, prothrombin fragment F 1+2, von Willebrand factor (vWF) antigen, factor VIII activity, activated protein C resistance, ProC Global assay, and tissue factor antigen. Psychiatric evaluation was performed using the Mini-International Neuropsychiatric Interview and Clinician Administered PTSD Scale (CAPS).
RESULTS: vWF antigen levels were significantly higher in patients with chronic PTSD compared with the controls (121.3 +/- 42 vs. 99.7 +/- 23, respectively, P = 0.034). Higher levels of vWF antigen and factor VIII activity were found in patients with severe chronic PTSD (CAPS > 80), compared to controls and patients with chronic PTSD and less severe symptoms (CAPS < or = 80). However, no differences were observed in any other studied coagulation parameters between patients and controls.
CONCLUSIONS: Increased levels of vWF antigen and factor VIII activity were documented in severe chronic PTSD. These findings suggest that the higher risk of arterial and venous thromboembolic events in PTSD patients could be related to endothelial damage or endothelial activation.

PMID: 21991715 [PubMed - in process]

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Phantom Shocks as Markers of Underlying PTSD and Depression.

Cleve Clin J Med. 2011 Aug;78 Suppl 1:S88a

Authors: Bilanovic A, Irvine J, Kovacs A, Hill A, Cameron D, Katz J

PMID: 21972353 [PubMed - in process]

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Maltreated bodies and harrowed souls of the great war: the perpetration of psychiatry upon the war wounded.

Neuere Med Wiss Quellen Stud. 2011;26:97-111

Authors: Eckart WU

PMID: 21932477 [PubMed - indexed for MEDLINE]

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‘The nation’s leading whiner’: visions of the national community from the perspective of mentally traumatized veterans.

Neuere Med Wiss Quellen Stud. 2011;26:72-96

Authors: Crouthamel J

PMID: 21932476 [PubMed - indexed for MEDLINE]

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Reassessing war, trauma, and medicine in Germany and Central Europe (1914-1939).

Neuere Med Wiss Quellen Stud. 2011;26:7-29

Authors: Hofer HG, Prüll CR

PMID: 21932473 [PubMed - indexed for MEDLINE]

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Metaphors as contextual evidence for engaging Haitian clients in practice: a case study.

Am J Psychother. 2011;65(2):133-49

Authors: Rahill G, Jean-Gilles M, Thomlison B, Pinto-Lopez E

Abstract
Haitian immigrants remain underserved in the United States (U.S.), despite their large presence and their visibility, which increased after the January 12, 2010 earthquake. Employing cultural-specific practice strategies to engage Haitians in the U.S. who experienced loss in their social networks, requires understanding the context of their ecological culture and consideration of relevant linguistic and cultural elements. Through a case example, we describe the use of metaphors in cultural language as part of a strategy used to engage a Haitian immigrant with symptoms of posttraumatic stress disorder. Outcomes indicate that the use of storytelling and metaphors facilitate disclosure of clients’ worldviews, experiences, feelings and hopes in a safe environment while providing them with tools to determine progress. We identify four practice guidelines for intervention strategies with ethnic minority groups who share similar cultural contexts. Metaphors, which are a viable approach to practice, focus on cultural strengths and resiliencies over traditional models of deficit and can enhance access to needed effective services for underserved populations, such as Haitians in the United States.

PMID: 21847891 [PubMed - indexed for MEDLINE]

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Lifetime discrimination associated with greater likelihood of premenstrual dysphoric disorder.

J Womens Health (Larchmt). 2011 Jun;20(6):923-31

Authors: Pilver CE, Desai R, Kasl S, Levy BR

Abstract
OBJECTIVES: To evaluate whether the stressor of perceived discrimination was associated with premenstrual dysphoric disorder (PMDD) and premenstrual symptoms among minority women. This study builds on previous research that found perceived discrimination was positively associated with other psychiatric illnesses.
METHODS: Participants were 2718 Asian, Latina, and black premenopausal women aged 18-40 years who completed the World Mental Health Composite International Diagnostic Interview for the National Latino and Asian American Survey or the National Survey of American Life. Perceived discrimination was assessed with the Everyday Discrimination Scale. DSM-IV-based diagnostic algorithms generated a provisional lifetime diagnosis of PMDD.
RESULTS: Eighty-three percent of the participants reported experiencing discrimination (due to race, gender, age, height or weight, or other reasons) in their lifetimes. The frequency of perceived discrimination was positively associated with PMDD (odds ratio [OR] 1.08, 95% confidence interval [CI] 1.05-1.10) and premenstrual symptoms (OR 1.04, 95% CI 1.02-1.05), independent of demographic covariates and social desirability. Women reporting gender discrimination (OR 5.18, 95% CI 1.80-14.90), race discrimination (OR 4.14, 95% CI 1.54-11.11), and other forms of discrimination (OR 6.43, 95% CI 2.11-19.65) were significantly more likely than women without experiences of discrimination to have PMDD. Subtle discrimination was more strongly associated with PMDD (OR 1.12, 95% CI 1.01-1.23) than was blatant discrimination (OR 1.04, 95% CI 0.94-1.15).
CONCLUSIONS: This study is the first to demonstrate that perceived discrimination is associated with PMDD and premenstrual symptoms. These findings suggest that the prevalence of these conditions may be lessened by reducing discrimination in women’s lives.

PMID: 21671777 [PubMed - indexed for MEDLINE]

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Symptom attribution and presentation in general practice after an extreme life event.

Fam Pract. 2011 Jun;28(3):260-6

Authors: Nijrolder I, van der Velden PG, Grievink L, Yzermans CJ

Abstract
BACKGROUND: A serious life event is likely to shape attributions relating to symptoms experienced afterwards. While they may play an important role in prognosis and seeking care, such perceptions have hardly been studied among survivors of a disaster.
OBJECTIVE: To investigate the association between self-reported health problems that have been attributed to an extreme life event and the symptoms presented to GPs.
METHODS: A two-wave longitudinal survey (2-3 weeks and 18 months) among survivors of a fireworks disaster was combined with a continuous morbidity surveillance in general practice. Symptoms attributed to the disaster reported in an open-ended question in the two waves were analysed using descriptive statistics. Differences in presented symptoms over time were analysed using logistic multilevel analysis.
RESULTS: More than half of the respondents reported health problems, which were, in their opinion, related to the disaster. Psychological problems were most frequently reported in association with the disaster, and in contrast to physical attributed symptoms, presentation of these problems in general practice decreased over time. In the total sample, musculoskeletal symptoms were less frequently presented in the longer term. Survivors who attributed symptoms to the disaster at both waves or after 18 months only most often presented such symptoms to the GP.
CONCLUSION: Survivors attributed psychological problems and physical symptoms to the disaster at short-term and midterm post-disaster. Most of these survivors presented such symptoms to the GP. Attribution of symptoms to an extreme life event such as a disaster may therefore require special attention from the GP.

PMID: 21247957 [PubMed - indexed for MEDLINE]

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Looking for the hannibal behind the cannibal: current status of case research.

Int J Offender Ther Comp Criminol. 2011 May;55(3):350-69

Authors: Sundt Gullhaugen A, Aage Nøttestad J

Abstract
The character Hannibal “the Cannibal” Lecter, best known from the motion picture The Silence of the Lambs from 1991, has become a cultural icon and model for later portrayals of seriously disturbed offenders. He displays key characteristics of the Psychopathy Checklist-Revised, such as arrogance, manipulation, callousness, and lack of remorse. From a clinical point of view, one of the most fascinating aspects with Lecter is his display of a variety of capacities alternating between cold-blooded predatory behavior, affection toward FBI special agent Starling, and mourning of the loss of his sister Mischa. Many authors have described the ruthless characteristics of the psychopath. Through the lens of object relations theory, this review systematically examines case descriptions of severely psychopathic offenders published between 1980 and March 2009. In contrast to the prevalent opinion, case material ( n = 11) demonstrates that severely psychopathic offenders do suffer from psychological pain.

PMID: 20413645 [PubMed - indexed for MEDLINE]

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A randomized controlled effectiveness trial of cognitive behavior therapy for post-traumatic stress disorder in terrorist-affected people in Thailand.

World Psychiatry. 2011 Oct;10(3):205-9

Authors: Bryant RA, Ekasawin S, Chakrabhand S, Suwanmitri S, Duangchun O, Chantaluckwong T

Abstract
Although cognitive behaviour therapy (CBT) is the treatment of choice for post-traumatic stress disorder (PTSD), there is no evidence of its success with PTSD patients still under direct threat of terrorist attacks. This study reports the first randomized controlled trial of CBT for PTSD terrorist-affected people. Twenty-eight survivors of terrorist attacks in southern Thailand were randomized to 8 sessions of either CBT or treatment as usual (TAU). CBT was modified to accommodate the realistic threats facing patients. There were independent assessments conducted before, immediately after, and 3 months following treatment. Main outcome measures included symptoms of PTSD (PTSD Symptom Scale Interview), depression (Beck Depression Inventory) and complicated grief (Inventory of Complicated Grief). CBT resulted in significantly greater reduction in symptoms, including PTSD, depression, and complicated grief, at follow-up than TAU. Relative to TAU, CBT had stronger effect sizes at follow-up for PTSD, depression, and complicated grief. More patients in the CBT condition (75%) achieved high end-state functioning than participants in the TAU (33%). This preliminary evidence suggests that PTSD, depression, and complicated grief can be effectively treated despite ongoing threats of terrorism. Further, it demonstrates that non-specialist mental health workers in a non-western setting can be efficiently trained in using CBT, and this training can translate into successful treatment gains in trauma-affected individuals.

PMID: 21991280 [PubMed - in process]

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Post-Traumatic Stress Symptoms in Long-Term Non-Hodgkin’s Lymphoma Survivors: Does Time Heal?

J Clin Oncol. 2011 Oct 11;

Authors: Smith SK, Zimmerman S, Williams CS, Benecha H, Abernethy AP, Mayer DK, Edwards LJ, Ganz PA

Abstract
PURPOSELittle is known about the trajectory of post-traumatic stress disorder (PTSD) symptoms in cancer survivors, despite the fact that such knowledge can guide treatment. Therefore, this study examined changes in PTSD symptoms among long-term survivors of non-Hodgkin’s lymphoma (NHL) and identified demographic, clinical, and psychosocial predictors and correlates of PTSD symptomatology. PATIENTS AND METHODSSurveys were mailed to 682 NHL survivors who participated in an earlier survey and now were at least 7 years postdiagnosis. Information was obtained regarding PTSD symptoms, positive and negative perceptions of the cancer experience (ie, impact of cancer), and other potential correlates of PTSD.ResultsA total of 566 individuals participated (83% response rate) with a median of 12.9 years since diagnosis; respondents were 52% female and 87% white. Although half (51%) of the respondents reported no PTSD symptoms and 12% reported a resolution of symptoms, more than one-third (37%) reported persistence or worsening of symptoms over 5 years. Survivors who reported a low income, stage ≥ 2 at diagnosis, aggressive lymphoma, having received chemotherapy, and greater impact of cancer (both positive and negative) at the initial survey had more PTSD symptoms at follow-up. In multivariable analysis, income and negative impacts of cancer were independent predictors of PTSD symptoms. CONCLUSIONMore than one-third of long-term NHL survivors experience persisting or worsening PTSD symptoms. Providers should be aware of enduring risk; early identification of those at prolonged risk with standardized measures and treatments that target perceptions of the cancer experience might improve long-term outcomes.

PMID: 21990412 [PubMed - as supplied by publisher]

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The effect of repetitive transcranial magnetic stimulation on fear extinction in rats.

Neuroscience. 2011 Oct 1;

Authors: Baek K, Chae JH, Jeong J

Abstract
Facilitating fear extinction is clinically important to improve the efficacy of current exposure therapies for the treatment of anxiety disorders, such as post-traumatic stress disorder (PTSD). The aim of this study was to determine if repeated transcranial magnetic stimulation (rTMS) facilitates fear extinction in rats, especially when paired with exposure to a conditioned stimulus (CS). Thirty-five rats were conditioned to a tone CS by pairing the tone with an electric foot shock as an aversive unconditioned stimulus (US). We assessed the effects of 10 Hz rTMS before fear extinction (experiment 1) and rTMS paired with CS during extinction (experiment 2) on the following day. Fear responses of the rats were estimated using the level of freezing upon tone stimulus and were compared between the rTMS and corresponding sham groups. The rats treated with rTMS before fear extinction showed no difference in freezing time when compared with the sham group. However, the rats treated with rTMS paired with CS during extinction showed significantly less freezing behavior than the sham group, and this enhancement of fear extinction remained after 24 h without further stimulation. This finding suggests that high-frequency rTMS paired with trauma-reminding stimuli enhances fear extinction and that rTMS in conjunction with exposure therapy is potentially useful for facilitating extinction memory in the treatment of PTSD.

PMID: 21989475 [PubMed - as supplied by publisher]

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Sleep Disturbances and Their Association With Mental Health Among Women Exposed to Intimate Partner Violence.

J Womens Health (Larchmt). 2011 Oct 11;

Authors: Pigeon WR, Cerulli C, Richards H, He H, Perlis M, Caine E

Abstract
Abstract Background: Intimate partner violence puts the victim at risk for substantial medical and psychiatric morbidity. As with other stress- and trauma-related experiences, intimate partner violence is associated with sleep disturbance, particularly insomnia and nightmares. This association, however, has not been well characterized in terms of general prevalence or its further relationship with depression, suicidality, and posttraumatic stress disorder (PTSD). Methods: The present study used validated instruments to characterize insomnia and nightmares among 121 women exposed to intimate partner violence. Participants with and without depression were compared on demographic, abuse, and sleep characteristics as were those with and without suicidality. Logistic regression models were constructed to test sleep variables as independent predictors of depression controlling for demographic factors, abuse severity, and PTSD severity. Results: Clinically significant insomnia and nightmares were observed in 46% and 32% of participants, respectively. Depressed women had more severe PTSD and were more likely to have insomnia and to have nightmares than nondepressed women. In models controlling for PTSD severity, the presence of insomnia was associated with an approximately eightfold greater risk of being depressed; nightmares were associated with a twofold increase in risk. Conclusions: Sleep disturbances were prevalent among women experiencing intimate partner violence, with both insomnia and nightmares predicting the presence of depression even after controlling for PTSD severity. In addition to the need to address common mental health issues such as depression, given that sleep problems are modifiable and potentially less stigmatizing than mental health problems, assessing and addressing insomnia and nightmares in survivors of interpersonal violence warrants strong clinical consideration and further investigation.

PMID: 21988551 [PubMed - as supplied by publisher]

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Associations between repeated deployments to Iraq (OIF/OND) and Afghanistan (OEF) and post-deployment illnesses and injuries, active component, U.S. Armed Forces, 2003-2010. Part II. Mental disorders, by gender, age group, military occupation, and “dwell times” prior to repeat (second through fifth) deployments.

MSMR. 2011 Sep;18(9):2-11

Authors:

Abstract
Since 2001, 1,347,731 active component U.S. military members deployed in support of operations in Afghanistan and Iraq. This report documents the percentages of deployers who were diagnosed with selected mental disorders in relation to the number (first through fifth) and lengths of “dwell times” prior to such deployments. In general, larger percentages of deployers were diagnosed with PTSD and anxiety-related disorders after second/third than first deployments. After first and repeat deployments, relatively more medical than other occupational group members were diagnosed with PTSD. In general, larger percentages of deployers were diagnosed with alcohol/drug disorders and psychosocial problems after first than repeat deployments; and among deployers younger than 25 years, in combat-specific occupations, and females, every disorder (except PTSD and anxiety-related) affected larger percentages after first than repeat deployments. For most disorders, the longer the “dwell times” prior to deployments, the larger the percentages diagnosed with the conditions after the deployments. The findings should be interpreted with consideration of limitations of the analysis.

PMID: 21988340 [PubMed - in process]

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Combat veterans’ symptoms of PTSD and partners’ distress: The role of partners’ perceptions of veterans’ deployment experiences.

J Fam Psychol. 2011 Oct 10;

Authors: Renshaw KD, Campbell SB

Abstract
Romantic partners of combat veterans with posttraumatic stress disorder (PTSD) report elevated relationship and psychological distress. One recent study suggests that this association may be weaker when partners perceive that veterans experienced higher levels of traumatic deployment events, but such results have not yet been replicated. We replicated and extended these findings in a sample of 206 National Guard service members who deployed overseas since 2001 and their partners. We used multivariate structural equation models to explore whether partners’ perceptions of service members’ deployment experiences moderated the associations of severity of service members’ overall PTSD and specific PTSD clusters with partners’ psychological and relationship distress. The significant association of overall PTSD symptom severity with partners’ distress was not moderated by partners’ perceptions. When examining PTSD symptoms at the cluster level, only the numbing/withdrawal cluster was significantly associated with distress. However, this association was moderated by partners’ perceptions of service members’ deployment experiences, such that the associations weakened as these perceptions increased. These results are in line with research indicating that the avoidance cluster of PTSD symptoms is particularly detrimental for partners of those with PTSD. Furthermore, they indicate that such symptoms are associated with less distress in partners who perceive that service members experienced high levels of potentially traumatic deployment events. Such perceptions may be linked with external attributions for symptoms, which suggests that psychoeducation regarding the causes of PTSD and the totality of PTSD symptoms may be useful in intervening with such partners. (PsycINFO Database Record (c) 2011 APA, all rights reserved).

PMID: 21988078 [PubMed - as supplied by publisher]

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Housing Instability Is as Strong a Predictor of Poor Health Outcomes as Level of Danger in an Abusive Relationship: Findings From the SHARE Study.

J Interpers Violence. 2011 Oct 10;

Authors: Rollins C, Glass NE, Perrin NA, Billhardt KA, Clough A, Barnes J, Hanson GC, Bloom TL

Abstract
Advocates, clinicians, policy makers, and survivors frequently cite intimate partner violence (IPV) as an immediate cause of or precursor to housing problems. Research has indicated an association between homelessness and IPV, yet few studies examine IPV and housing instability. Housing instability differs from homelessness, in that someone experiencing housing instability may currently have a place to live but faces difficulties with maintaining the residence. We present baseline findings from a longitudinal cohort study of 278 female IPV survivors with housing as a primary concern. Our analysis indicates the greater the number of housing instability risk factors (e.g., eviction notice, problems with landlord, moving multiple times), the more likely the abused woman reported symptoms consistent with PTSD (p < .001), depression (p < .001), reduced quality of life (p < .001), increased work/school absence (OR = 1.28, p < .004), and increased hospital/emergency department use (OR = 1.22, p < .001). These outcomes persist even when controlling for the level of danger in the abusive relationship and for survivors’ drug and alcohol use. Importantly, both housing instability and danger level had stronger associations with negative health outcomes than other factors such as age, alcohol, and drug use; both make unique contributions to negative health outcomes and could contribute in different ways. Housing instability is an important and understudied social determinant of health for IPV survivors. These findings begin to address the literature gap on the relationship between housing instability, IPV, and survivors’ health, employment, and utilization of medical care services.

PMID: 21987519 [PubMed - as supplied by publisher]

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Prevalence of lifetime DSM-IV affective disorders among older African Americans, Black Caribbeans, Latinos, Asians and Non-Hispanic White people.

Int J Geriatr Psychiatry. 2011 Oct 10;

Authors: Woodward AT, Taylor RJ, Bullard KM, Aranda MP, Lincoln KD, Chatters LM

Abstract
OBJECTIVES: The purpose of this study is to estimate lifetime prevalence of seven psychiatric affective disorders for older non-Hispanic White people, African Americans, Caribbean Black people, Latinos, and Asian Americans and examine demographic, socioeconomic, and immigration correlates of those disorders. DESIGN: Data are taken from the older sub-sample of the Collaborative Psychiatric Epidemiology Surveys. Selected measures of lifetime DSM-IV psychiatric disorders were examined (i.e., panic disorder, agoraphobia, social phobia, generalized anxiety disorder, post-traumatic stress disorder, major depressive disorder, and dysthymia). SETTING: Community epidemiologic survey. PARTICIPANTS: Nationally representative sample of adults 55 years and older (n = 3046). MEASUREMENTS: Disorders were assessed using the DSM-IV World Mental Health Composite International Diagnostic Interview. RESULTS: Major depressive disorder and social phobia were the two most prevalent disorders among the seven psychiatric conditions. Overall, non-Hispanic White people and Latinos consistently had higher prevalence rates of disorders, African Americans had lower prevalence of major depression and dysthymia, and Asian Americans were typically less likely to report affective disorders than those of their counterparts. There is variation across groups in the association of demographic, socioeconomic, and immigration variables with disorders. CONCLUSIONS: This study furthers our understanding of the racial and ethnic differences in the prevalence of DSM-IV disorders among older adults and the correlates of those disorders. It highlights the importance of examining both between-group and within-group differences in disorders and the complexity of the mechanisms associated with differences across groups. Findings from this study underscore the need for future research that more clearly delineates subgroup differences and similarities. Copyright © 2011 John Wiley & Sons, Ltd.

PMID: 21987438 [PubMed - as supplied by publisher]

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Teaching Trauma-Focused Exposure Therapy for PTSD: Critical Clinical Lessons for Novice Exposure Therapists.

Psychol Trauma. 2011 Sep 1;3(3):300-308

Authors: Zoellner LA, Feeny NC, Bittinger JN, Bedard-Gilligan MA, Slagle DM, Post LM, Chen JA

Abstract
Over the past 10 years, our experiences delivering exposure therapy and teaching clinicians to deliver exposure therapy for PTSD have taught us some important lessons. We will focus on lessons learned as we have attended to clinicians’ experiences as they begin to implement and apply the therapy. Specifically, we highlight common therapist expectations including the beliefs that the exposure therapy requires a new set of clinical skills, therapists themselves will experience a high level of distress hearing about traumatic events, and clients will become overly distressed. We then discuss common clinical challenges in the delivery of exposure therapy and illustrate them with case examples. The challenges addressed include finding the appropriate level of therapist involvement in session, handling client distress during treatment, targeting in-session covert avoidance, and helping the client shift from being trauma-focused to being more present and future oriented. Clinicians training exposure therapists and therapists new to the implementation of exposure therapy for PTSD should find this practical discussion of common expectations and initial clinical challenges reassuring and clinically useful.

PMID: 21984956 [PubMed - as supplied by publisher]

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Childhood trauma among individuals with co-morbid substance use and post traumatic stress disorder.

Ment Health Subst Use. 2011 Nov;4(4):314-326

Authors: Farrugia PL, Mills KL, Barrett E, Back SE, Teesson M, Baker A, Sannibale C, Hopwood S, Rosenfeld J, Merz S, Brady KT

Abstract
BACKGROUND: Little is known about the impact of childhood trauma (CT) on the clinical profile of individuals with co-occurring substance use disorder (SUD) and post traumatic stress disorder (PTSD). AIMS: To compare the clinical characteristics of individuals with SUD+PTSD who have a history of CT with SUD+PTSD individuals who have experienced trauma during adulthood only. METHOD: Data were collected on 103 individuals as part of a randomised controlled trial examining the efficacy of an integrated psychosocial treatment for SUD+PTSD. Participants were recruited from substance use treatment services, community referrals and advertising. Data were collected on demographic characteristics, substance use and treatment histories, lifetime trauma exposure, and current physical and mental health functioning. RESULTS: The vast majority (77%) of the sample had experienced at least one trauma before the age of 16, with 55% of those endorsing childhood sexual abuse. As expected individuals with a CT history, as compared to without, evidenced significantly longer duration of PTSD. Those with a CT history also had more extensive lifetime trauma exposure, an earlier age of first intoxication, and reported more severe substance use (e.g., a greater number of drug classes used in their lifetime, higher severity of dependence scores and greater number of drug treatment episodes). CONCLUSION: Individuals with co-morbid SUD+PTSD who have experienced CT present with a more severe and chronic clinical profile in relation to a number of trauma and substance use characteristics, when compared to individuals with adulthood only trauma histories. It is therefore important for SUD+PTSD treatment planning that CT be carefully assessed.

PMID: 21984884 [PubMed - as supplied by publisher]

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The Comorbidity of Psychotic Symptoms and Posttraumatic Stress Disorder: Evidence for a Specifier in DSM-5.

Clin Schizophr Relat Psychoses. 2011 Oct;5(3):147-54

Authors: Bosson JV, Reuther ET, Cohen AS

Abstract
The comorbidity of posttraumatic stress disorder (PTSD) and psychotic symptoms is higher than what might be expected based on the prevalence of either disorder alone. Furthermore, the presence of psychotic symptoms is evident in PTSD patients who do not otherwise meet criteria for a psychotic spectrum disorder. The current paper discusses three existing hypotheses regarding the relation of PTSD and psychosis and presents a series of case studies that illustrates this phenomenon across a diverse group of patients and scenarios. Clinical implications in light of these case studies are offered, including the suggestion that the next edition of the Diagnostic and Statistical Manual of Mental Disorders includes a specifier of PTSD with psychotic features.

PMID: 21983499 [PubMed - in process]

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Upregulation of neurosteroid biosynthesis as a pharmacological strategy to improve behavioral deficits in a putative mouse model of PTSD.

J Neuroendocrinol. 2011 Oct 7;

Authors: Pinna G, Rasmusson AM

Abstract
Benzodiazepines remain the most frequently used psychotropic drugs for the treatment of anxiety spectrum disorders; however their use is associated with development of tolerance and dependence. Another major hindrance is represented by their lack of efficacy in many patients, including patients with posttraumatic stress disorder (PTSD). For these non-responders, the use of selective serotonin reuptake inhibitors (SSRIs) has been the therapy of choice. In the past decade, clinical studies have suggested that the pharmacological action of SSRIs may include the ability of these drugs to normalize decreased brain levels of neurosteroids in patients with depression and PTSD, in particular the progesterone derivative allopregnanolone, which potently and allosterically modulates the action of GABA at GABAA receptors. Preclinical studies using the socially isolated mouse as an animal model of PTSD have demonstrated that fluoxetine and congeners ameliorate anxiety-like behavior, fear responses, and aggressive behavior expressed by such mice by increasing corticolimbic levels of allopregnanolone. This is a novel and more selective mechanism than 5-HT reuptake inhibition, which for half a century has been thought to be the main molecular mechanism for the therapeutic action of SSRIs. Importantly, this finding may shed light on the high rates of SSRI resistance among patients with PTSD and depression, disorders in which there appears to be a block in allopregnanolone synthesis. There are several different mechanisms by which such a block may occur, and SSRIs may only be corrective under some conditions. Thus, upregulation of allopregnanolone biosynthesis in corticolimbic neurons may offer a novel non-traditional pharmacological target for a new generation of potent non-sedating, anxiolytic medications for the treatment of anxiety, depression, and PTSD: selective brain steroidogenic stimulants (SBSSs).

PMID: 21981145 [PubMed - as supplied by publisher]

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PTSD not an anxiety disorder? DSM committee proposal turns back the hands of time.

Depress Anxiety. 2011 Oct 3;28(10):853-6

Authors: Zoellner LA, Rothbaum BO, Feeny NC

PMID: 21976270 [PubMed - in process]

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The Neuropeptide Y (NPY)-ergic System is Associated with Behavioral Resilience to Stress Exposure in an Animal Model of Post-Traumatic Stress Disorder.

Neuropsychopharmacology. 2011 Oct 5;

Authors: Cohen H, Liu T, Kozlovsky N, Kaplan Z, Zohar J, Mathé AA

Abstract
Converging evidence implicates the regulatory neuropeptide Y (NPY) in anxiety- and depression-related behaviors. The present study sought to assess whether there is an association between the magnitude of behavioral responses to stress and patterns of NPY in selected brain areas, and subsequently, whether pharmacological manipulations of NPY levels affect behavior in an animal model of PTSD. Animals were exposed to predator-scent stress for 15 min. Behaviors were assessed with the elevated plus maze and acoustic startle response tests 7 days later. Preset cutoff criteria classified exposed animals according to their individual behavioral responses. NPY protein levels were assessed in specific brain regions 8 days after the exposure. The behavioral effects of NPY agonist, NPY-Y1-receptor antagonist, or placebo administered centrally 1 h post-exposure were evaluated in the same manner. Immunohistochemical technique was used to detect the expression of the NPY, NPY-Y1 receptor, brain-derived neurotrophic factor, and GR 1 day after the behavioral tests. Animals whose behavior was extremely disrupted (EBR) selectively displayed significant downregulation of NPY in the hippocampus, periaqueductal gray, and amygdala, compared with animals whose behavior was minimally (MBR) or partially (PBR) disrupted, and with unexposed controls. One-hour post-exposure treatment with NPY significantly reduced prevalence rates of EBR and reduced trauma-cue freezing responses, compared with vehicle controls. The distinctive pattern of NPY downregulation that correlated with EBR as well as the resounding behavioral effects of pharmacological manipulation of NPY indicates an intimate association between NPY and behavioral responses to stress, and potentially between molecular and psychopathological processes, which underlie the observed changes in behavior. The protective qualities attributed to NPY are supported by the extreme reduction of its expression in animals severely affected by the stressor and imply a role in promoting resilience and/or recovery.Neuropsychopharmacology advance online publication, 5 October 2011; doi:10.1038/npp.2011.230.

PMID: 21976046 [PubMed - as supplied by publisher]

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Yield of Practice-Based Depression Screening In VA Primary Care Settings.

J Gen Intern Med. 2011 Oct 6;

Authors: Yano EM, Chaney EF, Campbell DG, Klap R, Simon BF, Bonner LM, Lanto AB, Rubenstein LV

Abstract
BACKGROUND: Many patients who should be treated for depression are missed without effective routine screening in primary care (PC) settings. Yearly depression screening by PC staff is mandated in the VA, yet little is known about the expected yield from such screening when administered on a practice-wide basis. OBJECTIVE: We characterized the yield of practice-based screening in diverse PC settings, as well as the care needs of those assessed as having depression. DESIGN: Baseline enrollees in a group randomized trial of implementation of collaborative care for depression. PARTICIPANTS: Randomly sampled patients with a scheduled PC appointment in ten VA primary care clinics spanning five states. MEASUREMENTS: PHQ-2 screening followed by the full PHQ-9 for screen positives, with standardized sociodemographic and health status questions. RESULTS: Practice-based screening of 10,929 patients yielded 20.1% positive screens, 60% of whom were assessed as having probable major depression based on the PHQ-9 (11.8% of all screens) (n = 1,313). In total, 761 patients with probable major depression completed the baseline assessment. Comorbid mental illnesses (e.g., anxiety, PTSD) were highly prevalent. Medical comorbidities were substantial, including chronic lung disease, pneumonia, diabetes, heart attack, heart failure, cancer and stroke. Nearly one-third of the depressed PC patients reported recent suicidal ideation (based on the PHQ-9). Sexual dysfunction was also common (73.3%), being both longstanding (95.1% with onset >6 months) and frequently undiscussed and untreated (46.7% discussed with any health care provider in past 6 months). CONCLUSIONS: Practice-wide survey-based depression screening yielded more than twice the positive-screen rate demonstrated through chart-based VA performance measures. The substantial level of comorbid physical and mental illness among PC patients precludes solo management by either PC or mental health (MH) specialists. PC practice- and provider-level guideline adherence is problematic without systems-level solutions supporting adequate MH assessment, PC treatment and, when needed, appropriate MH referral.

PMID: 21975821 [PubMed - as supplied by publisher]

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Young people’s beliefs about preventive strategies for mental disorders: Findings from two Australian national surveys of youth.

J Affect Disord. 2011 Oct 3;

Authors: Yap MB, Reavley N, Jorm AF

Abstract
BACKGROUND: Political interest in prevention of mental illness has increased in recent years. However, relatively little is known about the public’s beliefs about prevention, and the predictors of these beliefs. Since many disorders start in the first decades of life, a focus on young people is warranted. METHODS: Young people’s prevention beliefs were assessed by a national telephone survey of 3746 Australian youths aged 12-25years in 2006. A similar survey was repeated in 2011 with 3021 youths aged 15-25. In both surveys, respondents were presented with a vignette portraying depression, psychosis, social phobia, or depression with alcohol abuse in a young person. The 2011 survey also included depression with suicidal thoughts and post-traumatic stress disorder. Respondents rated the helpfulness of seven potential prevention strategies, and reported on any experience of mental health problems and treatment in the past year, exposure to beyondblue and mental health information at school or work. RESULTS: Most respondents believed that regular contact with friends and family and regular physical activity would be helpful. Respondents who had recently experienced mental health problems, younger respondents, females, and those not exposed to beyondblue or mental health information were more likely to hold beliefs that differed from those of health professionals or available evidence. No significant changes were observed between surveys. LIMITATIONS: Actual preventive actions and reasons behind respondents’ beliefs were not assessed. CONCLUSIONS: Future prevention efforts should target subgroups with beliefs that differ from professionals’ and research evidence. Beyondblue and school and work settings may be promising avenues for these efforts.

PMID: 21975138 [PubMed - as supplied by publisher]

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Sociodemographic and psychopathological risk factors in repeated suicide attempts: Gender differences in a prospective study.

J Affect Disord. 2011 Oct 3;

Authors: Monnin J, Thiemard E, Vandel P, Nicolier M, Tio G, Courtet P, Bellivier F, Sechter D, Haffen E

Abstract
BACKGROUND: The prevention of the repetition of suicide attempts is an important feature of the care of attempters but current data fail to give actual predictors of repetition. The aim of this study was to characterize sociodemographic and psychopathological features and risk factors associated with future repetition of suicide attempts in two years. The study focused on differences between men and women. METHODS: 273 participants selected in psychiatric emergency units after their admission for a suicide attempt (index) were included in the study. Subsequent suicide attempts occurring within a two year follow-up were identified from the regional observatory of suicide attempts. At inclusion, sociodemographic variables and psychopathological data were collected. In particular, psychometric evaluations were performed using the following scales: BDI-SF, SIS, BIS and BDHI. The lifetime history of suicide attempt was also noted. RESULTS: Repetition of suicide attempt in 2years was associated with current follow up and treatment, a personal history of multiple suicide attempt, post traumatic stress disorder, current recurrent psychotic syndrome and substance misuse. Specific features of men and women repeaters have been identified. Men repeaters were characterized by substance use disorders whereas the re-attempt in women was associated with current follow up and treatment, post traumatic stress disorder and higher BDI-SF score. CONCLUSIONS: Repeaters must be considered as a specific population among suicide attempters and gender differences must be taken into account in this particular population in order to promote more personalized prevention programs for suicidal recurrence and completed suicide.

PMID: 21975134 [PubMed - as supplied by publisher]

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Lack of perceived social support among immigrants after a disaster: comparative study.

Br J Psychiatry. 2011 Apr;198:317-22

Authors: Drogendijk AN, van der Velden PG, Gersons BP, Kleber RJ

Abstract
BACKGROUND: Disaster research suggests that immigrant groups who are affected by a disaster receive less emotional support than their native counterparts. However, it is unclear to what extent these differences can be attributed to post-disaster mental health problems or whether they were present before the event.
AIMS: To examine the association between lack of social support, immigration status and victim status, as well as differences in support between immigrants and Dutch natives with disaster-related post-traumatic stress disorder (PTSD).
METHOD: Social support and psychological distress were assessed among immigrants and Dutch natives, among affected and non-affected individuals 4 years post disaster. Post-traumatic stress disorder was examined in the affected groups.
RESULTS: Affected immigrants more often lacked various kinds of perceived social support compared with affected Dutch natives. Remarkably, we found no differences in support between affected immigrants and non-affected immigrants. Immigrants with PTSD differ on only two out of six aspects of support from the Dutch natives with PTSD.
CONCLUSIONS: Results clearly indicate that differences in support between immigrants and Dutch natives are not so much a consequence of the disaster but were largely present before the disaster.

PMID: 21972280 [PubMed - in process]

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A comparison of activation patterns of cells in selected prefrontal cortical and amygdala areas of rats which are more or less anxious in response to predator exposure or submersion stress.

Physiol Behav. 2011 Sep 24;

Authors: Adamec R, Toth M, Haller J, Halasz J, Blundell J

Abstract
This study had two purposes. First: to compare predator and water submersion stress cFos activation in medial prefrontal cortices (mPFC) and the medial amygdala (MeA). Second: to identify markers of vulnerability to stressors within these areas. Rats were either predator or submersion stressed and tested 1.75h later for anxiety. Immediately thereafter, rats were sacrificed and cFos expression was examined. Predator and submersion stress equally increased anxiety-like behavior in the elevated plus maze (EPM) and hole board. To examine vulnerability, rats which were less anxious (LA) and more (highly) anxious (MA) in the EPM were selected from among handled control and stressed animals. LA stressed rats were considered stress non-responsive while MA stressed rats were considered stress responsive. Predator stress, but not submersion stress, activated MeA cFos. CFos expression of mPFC cells was elevated in LA rats and reduced in MA rats in predator stressed animals only, correlating negatively with anxiety. These findings are consistent with data implicating greater mPFC excitability in protection against the effects on affect of traumatic stress. The findings also suggest that this conclusion is stressor specific, applying to predator stress but not submersion stress. Both stressors have been suggested to model hyperarousal and comorbid anxiety aspects of PTSD in humans. Hence the use of these paradigms to identify brain bases of vulnerability and resilience to traumatic stress in PTSD has translation potential. On the other hand, our evidence of stressor specificity of vulnerability/resilience markers raises a caution. The data suggest that preclinical markers of vulnerability/resilience in a given stress paradigm are at best suggestive, and translational value must ultimately be confirmed in humans.

PMID: 21971366 [PubMed - as supplied by publisher]

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Working memory processing of traumatic material in women with posttraumatic stress disorder.

J Psychiatry Neurosci. 2011 Sep 1;36(5):100167

Authors: Landré L, Destrieux C, Andersson F, Barantin L, Quidé Y, Tapia G, Jaafari N, Clarys D, Gaillard P, Isingrini M, El-Hage W

Abstract
Background: Posttraumatic stress disorder (PTSD) is associated with medial frontal and amygdala functional alterations during the processing of traumatic material and frontoparietal dysfunctions during working memory tasks. This functional magnetic resonance imaging (fMRI) study investigated the effects of trauma-related words processing on working memory in patients with PTSD. Methods: We obtained fMRI scans during a 3-back task and an identity task on both neutral and trauma-related words in women with PTSD who had been sexually abused and in healthy, nonexposed pair-matched controls. Results: Seventeen women with PTSD and 17 controls participated in the study. We found no behavioural working memory deficit for the PTSD group. In both tasks, deactivation of posterior parietal midline regions was more pronounced in patients than controls. Additionally, patients with PTSD recruited the left dorsolateral frontal sites to a greater extent during the processing of trauma-related material than neutral material. Limitations: This study included only women and did not include a trauma-exposed non-PTSD control group; the results may, therefore, have been influenced by sex or by effects specific to trauma exposure. Conclusion: Our results broadly confirm frontal and parietal functional variations in women with PTSD and suggest a compensatory nature of these variations with regard to the retreival of traumatic memories and global attentional deficits, respectively, during cognitively challenging tasks.

PMID: 21971161 [PubMed - as supplied by publisher]

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Help a Buddy Take a Knee: Creating Persuasive Messages for Military Service Members to Encourage Others to Seek Mental Health Help.

Health Commun. 2011 Oct 4;

Authors: Clark-Hitt R, Smith SW, Broderick JS

Abstract
Helping service members returning from the wars in Iraq and Afghanistan who need mental health help is an important problem for the United States military. Tanielian and Jaycox (2008 ) estimated that approximately 14%, or 300,000, of the service members returning from the wars have posttraumatic stress disorder (PTSD), yet just over half of those needing psychological help seek it despite the availability of effective treatments. This article reports the focus group responses of military personnel about message factors associated with persuading individuals to encourage others to seek mental health help. The results have theoretical and practical implications for future message design for promoting increased usage of mental health services among members of this population. Responses are presented in terms of the communication variables of source, message, channel, and receiver factors.

PMID: 21970672 [PubMed - as supplied by publisher]

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Chronic psychological and functional sequelae after emergent hand surgery.

J Hand Surg Am. 2011 Oct;36(10):1663-8

Authors: Richards T, Garvert DW, McDade E, Carlson E, Curtin C

Abstract
PURPOSE: Several studies have shown that upper extremity trauma has serious, acute psychological effects after injury. This study’s goal was to assess the psychological outcomes, including symptoms of major depression, posttraumatic stress disorder (PTSD), and other psychosocial variables, as well as the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) results, after severe hand trauma. We hypothesized that hand trauma would have persistent psychological sequelae long after the physical injury.
METHODS: We performed a cross-sectional survey of 34 patients who had emergency hand surgery at a Level 1 trauma center an average of 16 months (range, 7-32 mo) earlier. The hand disability measure was the QuickDASH, and the psychological measures included the Center for Epidemiologic Studies Depression Scale, the Screen for Posttraumatic Stress Symptoms, the Medical Outcomes Study Social Support Survey Form, the Social Constraints Survey (to assess interpersonal stressors), and the Perceived Stress Scale.
RESULTS: The overall QuickDASH score was 27. The mean score for PTSD was 13 (above the clinical threshold for PTSD), and 29% of respondents had high levels of both depression and PTSD. High pain scores on the QuickDASH were strongly correlated with both depression and PTSD symptoms.
CONCLUSIONS: This study found high levels of psychological distress in patients after hand trauma. Hand disability was strongly related to pain, depression, and PTSD symptoms. This study shows that the psychological sequelae of hand trauma can persist long after the physical injury.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

PMID: 21862240 [PubMed - in process]

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Gender does not moderate hippocampal volume deficits in adults with posttraumatic stress disorder: A meta-analysis.

Hippocampus. 2011 Mar;21(3):243-52

Authors: Woon F, Hedges DW

Abstract
Epidemiological studies show a higher point prevalence of posttraumatic stress disorder (PTSD) in women than in men, and early evidence has suggested that gender may moderate hippocampal volume deficits in PTSD. Our objective was to use random-effects meta-regression to assess gender effects on hippocampal volume deficits in PTSD. Using the terms posttraumatic stress disorder, gender, MRI, hippocampus, trauma, and abuse, we searched electronic databases for peer-reviewed articles up to April 2009 containing data for hippocampal volume and gender composition in PTSD adults compared with controls. We identified 23 studies that met inclusion criteria and calculated effect sizes for differences in hippocampal mean volumes for each study and used the percentage of men with PTSD as a continuous moderating variable in meta-regression. Additionally, we did a subgroup analysis of hippocampal volume deficits between women and men with gender as a categorical moderating variable. Hippocampal volumes were significantly smaller in the PTSD group compared to the control group, but gender did not significantly moderate any effect sizes in the meta-regression or subgroup analyses. The lack of gender moderation on hippocampal volume deficits suggests that hippocampal volume deficits in PTSD are independent of gender. The higher prevalence of PTSD in females than in males does not correspond to increased hippocampal volume deficits in women with PTSD compared to men with PTSD, and neither gender appears protective against hippocampal volume deficits in adults with PTSD. © 2011 Wiley-Liss, Inc.

PMID: 20882539 [PubMed - in process]

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Long-term Outcomes of Disability Benefits in US Veterans With Posttraumatic Stress Disorder.

Arch Gen Psychiatry. 2011 Oct;68(10):1072-80

Authors: Murdoch M, Sayer NA, Spoont MR, Rosenheck R, Noorbaloochi S, Griffin JM, Arbisi PA, Hagel EM

Abstract
CONTEXT: Most studies examining the clinical impact of disability benefits have compared aid recipients with people who never applied for benefits. Such practices may bias findings against recipients because disability applicants tend to be much sicker than never-applicants. Furthermore, these studies ignore the outcomes of denied claimants.
OBJECTIVE: To examine long-term outcomes associated with receiving or not receiving Department of Veterans Affairs (VA) disability benefits for posttraumatic stress disorder (PTSD), the most common mental disorder for which veterans seek such benefits.
DESIGN: Comparison of outcomes between successful and unsuccessful applicants for VA disability payments. Because we could not randomize the receipt of benefits, we used exact matching by propensity scores to control for potential baseline differences. We examined clinical outcomes approximately 10 years later. Setting and
PARTICIPANTS: Stratified, nationally representative cohort of 3337 veterans who applied for VA PTSD disability benefits between January 1, 1994, and December 31, 1998.
MAIN OUTCOME MEASURES: Assessment on validated survey measures of PTSD; work, role, social, and physical functioning; employment; and poverty. We compared outcomes with earlier scores. Homelessness and mortality were assessed using administrative data.
RESULTS: Of still-living cohort members, 85.1% returned usable surveys. Symptoms of PTSD were elevated in both groups. After adjustment, awardees had more severe PTSD symptoms than denied claimants but were nonetheless more likely to have had a meaningful symptom reduction since their last assessment (-6.1 vs -4.4; SE, 0.1; P = .01). Both groups had meaningful improvements of similar magnitude in work, role, and social functioning (-0.15 vs -0.19; SE, 0.01; P = .94), but functioning remained poor nonetheless. Comparing awardees with denied claimants after adjustment, 13.2% vs 19.0% were employed (P = .11); 15.2% vs 44.8% reported poverty (P < .001); 12.0% vs 20.0% had been homeless (P = .02); and 10.4% vs 9.7% had died (P = .66).
CONCLUSIONS: Regardless of claim outcome, veterans who apply for PTSD disability benefits are highly impaired. However, receiving PTSD benefits was associated with clinically meaningful reductions in PTSD symptoms and less poverty and homelessness.

PMID: 21969464 [PubMed - in process]

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Importance of anonymity to encourage honest reporting in mental health screening after combat deployment.

Arch Gen Psychiatry. 2011 Oct;68(10):1065-71

Authors: Warner CH, Appenzeller GN, Grieger T, Belenkiy S, Breitbach J, Parker J, Warner CM, Hoge C

Abstract
CONTEXT: US soldiers are required to undergo screening for depression, posttraumatic stress disorder (PTSD), and other mental health problems on return from service in Iraq or Afghanistan as part of routine postdeployment health assessments.
OBJECTIVE: To assess the influence of the anonymity of screening processes on willingness of soldiers to report mental health problems after combat deployment.
DESIGN: Anonymous and nonanonymous surveys.
SETTING: US military. Patients  US infantry soldiers’ reporting of mental health problems on the routine Post-Deployment Health Assessment was compared with their reporting on an anonymous survey administered simultaneously.
MAIN OUTCOME MEASURES: The Primary Care PTSD Screen, the Patient Health Questionnaire-2 (modified), the suicidal ideation question from the Patient Health Questionnaire-9, and several other questions related to mental health were used on both surveys. Soldiers were also asked on the anonymous survey about perceptions of stigma and willingness to report honestly.
RESULTS: Of 3502 US Army soldiers from one infantry brigade combat team undergoing the routine Post-Deployment Health Assessment in 2008, a total of 2500 were invited to complete the anonymous survey, and 1712 of these participated (response rate, 68.5%). Reporting of depression, PTSD, suicidal ideation, and interest in receiving care were 2-fold to 4-fold higher on the anonymous survey compared with the routine Post-Deployment Health Assessment. Overall, 20.3% of soldiers who screened positive for depression or PTSD reported that they were uncomfortable reporting their answers honestly on the routine postdeployment screening.
CONCLUSIONS: Current postdeployment mental health screening tools are dependent on soldiers honestly reporting their symptoms. This study indicates that the Post-Deployment Health Assessment screening process misses most soldiers with significant mental health problems. Further efforts are required to reduce the stigma of reporting and improve willingness to receive care for mental health problems.

PMID: 21969463 [PubMed - in process]

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Prevention of Posttraumatic Stress Disorder by Early Treatment: Results From the Jerusalem Trauma Outreach and Prevention Study.

Arch Gen Psychiatry. 2011 Oct 3;

Authors: Shalev AY, Ankri Y, Israeli-Shalev Y, Peleg T, Adessky R, Freedman S

Abstract
CONTEXT: Preventing posttraumatic stress disorder (PTSD) is a pressing public health need. OBJECTIVES: To compare early and delayed exposure-based, cognitive, and pharmacological interventions for preventing PTSD. DESIGN: Equipoise-stratified randomized controlled study. SETTING: Hadassah Hospital unselectively receives trauma survivors from Jerusalem and vicinity. PARTICIPANTS: Consecutively admitted survivors of traumatic events were assessed by use of structured telephone interviews a mean (SD) 9.61 (3.91) days after the traumatic event. Survivors with symptoms of acute stress disorder were referred for clinical assessment. Survivors who met PTSD symptom criteria during the clinical assessment were invited to receive treatment. INTERVENTIONS: Twelve weekly sessions of prolonged exposure (PE; n = 63), or cognitive therapy (CT; n = 40), or double blind treatment with 2 daily tablets of either escitalopram (10 mg) or placebo (selective serotonin reuptake inhibitor/placebo; n = 46), or 12 weeks in a waiting list group (n = 93). Treatment started a mean (SD) 29.8 (5.7) days after the traumatic event. Waiting list participants with PTSD after 12 weeks received PE a mean (SD) 151.8 (42.4) days after the traumatic event (delayed PE). Main Outcome Measure  Proportion of participants with PTSD after treatment, as determined by the use of the Clinician-Administered PTSD Scale (CAPS) 5 and 9 months after the traumatic event. Treatment assignment and attendance were concealed from the clinicians who used the CAPS. RESULTS: At 5 months, 21.6% of participants who received PE and 57.1% of comparable participants on the waiting list had PTSD (odds ratio [OR], 0.21 [95% CI, 0.09-0.46]). At 5 months, 20.0% of participants who received CT and 58.7% of comparable participants on the waiting list had PTSD (OR, 0.18 [CI, 0.06-0.48]). The PE group did not differ from the CT group with regard to PTSD outcome (OR, 0.87 [95% CI, 0.29-2.62]). The PTSD prevalence rates did not differ between the escitalopram and placebo subgroups (61.9% vs 55.6%; OR, 0.77 [95% CI, 0.21-2.77]). At 9 months, 20.8% of participants who received PE and 21.4% of participants on the waiting list had PTSD (OR, 1.04 [95% CI, 0.40-2.67]). Participants with partial PTSD before treatment onset did similarly well with and without treatment. CONCLUSIONS: Prolonged exposure, CT, and delayed PE effectively prevent chronic PTSD in recent survivors. The lack of improvement from treatment with escitalopram requires further evaluation. Trauma-focused clinical interventions have no added benefit to survivors with subthreshold PTSD symptoms. Trial Registration  clinicaltrials.gov Identifier: NCT00146900.

PMID: 21969418 [PubMed - as supplied by publisher]

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Physician-Diagnosed Respiratory Conditions and Mental Health Symptoms Seven to Nine Years Following the World Trade Center Disaster.

Am J Ind Med. 2011 Sep 1;54(9):661-671

Authors: Webber MP, Glaser MS, Weakley J, Soo J, Ye F, Zeig-Owens R, Weiden MD, Nolan A, Aldrich TK, Kelly K, Prezant D

Abstract
BACKGROUND: This study examines the prevalence of physician-diagnosed respiratory conditions and mental health symptoms in firefighters and emergency medical service workers up to 9 years after rescue/recovery efforts at the World Trade Center (WTC). METHODS: We analyzed FDNY physician and self-reported diagnoses by WTC exposure and quintiles of pulmonary function (FEV1%predicted). We used screening instruments to assess probable PTSD and probable depression. RESULTS: FDNY physicians most commonly diagnosed asthma (8.8%) and sinusitis (9.7%). The highest prevalence of physician-diagnosed obstructive airway disease (OAD) was in the lowest FEV1%predicted quintile. Participants who arrived earliest on 9/11 were more likely to have physician-diagnosed asthma (OR=1.4). 7% had probable PTSD. 19.4% had probable depression. CONCLUSIONS: Self-reported and physician-diagnosed respiratory conditions remain common, especially among those who arrived earliest at the WTC site. OAD was associated with the lowest pulmonary function. Since respiratory and mental health conditions remain prevalent, ongoing monitoring and treatment is important.

PMID: 21966080 [PubMed - as supplied by publisher]

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The role of infant sleep in intergenerational transmission of trauma.

Sleep. 2011;34(10):1373-83

Authors: Hairston IS, Waxler E, Seng JS, Fezzey AG, Rosenblum KL, Muzik M

Abstract
INTRODUCTION: Children of parents who experienced trauma often present emotional and behavioral problems, a phenomenon named inter-generational transmission of trauma (IGTT). Combined with antenatal factors, parenting and the home environment contribute to the development and maintenance of sleep problems in children. In turn, infant sleep difficulty predicts behavioral and emotional problems later in life. The aim of this study was to investigate whether infant sleep problems predict early behavioral problems indicative of IGTT.
METHODS: 184 first-time mothers (ages 18-47) participated. N = 83 had a history of childhood abuse and posttraumatic stress disorder (PTSD+); 38 women reported childhood abuse but did not meet diagnostic criteria for PTSD (PTSD-); and the control group (N = 63) had neither a history of abuse nor psychopathology (CON). Depression, anxiety, and sleep difficulty were assessed in the mothers at 4 months postpartum. Infant sleep was assessed using the Child Behavior Sleep Questionnaire (CSHQ). Outcome measures included the Parent Bonding Questionnaire (PBQ) at 4 months and the Child Behavior Check List (CBCL) at 18 months.
RESULTS: Infants of PTSD+ mothers scored higher on the CSHQ and had more separation anxiety around bedtime than PTSD- and CON, and the severity of their symptoms was correlated with the degree of sleep disturbance. Maternal postpartum depression symptoms mediated impaired mother-infant bonding, while infant sleep disturbance contributed independently to impaired bonding. Mother-infant bonding at 4 months predicted more behavioral problems at 18 months.
CONCLUSIONS: Infant sleep difficulties and maternal mood play independent roles in infant-mother bonding disturbance, which in turn predicts behavioral problems at 18 months. CITATION: Hairston IS; Waxler E; Seng JS; Fezzey AG; Rosenblum KL; Muzik M. The role of infant sleep in intergenerational transmission of trauma. SLEEP 2011;34(10):1373-1383.

PMID: 21966069 [PubMed - in process]

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Treating trauma in psychosis with EMDR: A pilot study.

J Behav Ther Exp Psychiatry. 2011 Sep 17;43(1):664-671

Authors: van den Berg DP, van der Gaag M

Abstract
BACKGROUND: Initial studies have shown that posttraumatic stress disorder (PTSD) can be effectivelytreated in patients with a psychotic disorder. These studies however used adapted treatment protocols, avoided direct exposure to trauma related stimuli or preceded treatment with stabilizing techniques making treatment considerably longer in duration. METHOD: An open trial in which adult subjects with a psychotic disorder and a comorbid PTSD (n = 27) received a maximum of six Eye Movement Desensitization and Reprocessing (EMDR) therapy sessions. PTSD symptoms, psychotic symptoms and additional symptoms were assessed at baseline and end-of-treatment. RESULTS: The dropout rate was 18.5 percent (five subjects). Only five of the twenty-two completers (22.7%) still met criteria for PTSD after treatment. PTSD symptoms, auditory verbal hallucinations, delusions, anxiety, depression, and self-esteem all improved significantly. Paranoid ideation and feelings of hopelessness did not improve significantly. Treatment did not lead to symptom exacerbation in subjects. There were no adverse events, such as suicide attempts, self-mutilation, aggressive behavior or admission to a general or psychiatric hospital. CONCLUSIONS: This pilot study shows that a short EMDR therapy is effective and safe in the treatment of PTSD in subjects with a psychotic disorder. Treatment of PTSD has a positive effect on auditory verbal hallucinations, delusions, anxiety symptoms, depression symptoms, and self-esteem. EMDR can be applied to this group of patients without adapting the treatment protocol or delaying treatment by preceding it with stabilizing interventions.

PMID: 21963888 [PubMed - as supplied by publisher]

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Tianeptine in the combined treatment of combat related posttraumatic stress disorder.

Psychiatr Danub. 2011 Sep;23(3):257-63

Authors: Frančišković T, Suković Z, Janović S, Stevanović A, Nemčić-Moro I, Rončević-Gržeta I, Letica-Crepulja M

Abstract
BACKGROUND: The aim of this study was to evaluate the efficacy of tianeptine, an antidepressant that acts by increasing serotonin reuptake, in the treatment of posttraumatic stress disorder and to compare the effects of tianeptine and fluoxetine, an antidepressant from the selective serotonin reuptake inhibitors class.
SUBJECTS AND METHODS: 43 war veterans suffering from posttraumatic stress disorder were included in the study. During the 5.5 months of treatment 21 patients were receiving tianeptine and 22 were receiving fluoxetine. In addition, all patients took part in intensive trauma specific group psychotherapy. The effects of the two antidepressants on symptoms of PTSD, depression and anxiety after 5.5 months of treatment were assessed using the Harvard Trauma Questionnaire, Beck Depression Inventory, STAI and the List of Drug Use and Side Effects.
RESULTS: There was no significant difference between the two treatment groups regarding their effect on symptoms and severity of depression. The level of anxiety was the same in the first measurement but the difference became significant in other three measurements in favor of tianeptine. The anxiolytics and other co-prescribed drugs remain the same in both groups, the use of analgesics significantly increase in fluoxetine group during the course of treatment.
CONCLUSION: The study demonstrated that tianeptine is as effective as fluoxetine in the treatment of PTSD, with even stronger effect on anxiety and equal tolerance.

PMID: 21963693 [PubMed - in process]

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Association between serotonin transporter gene promoter-region polymorphism and 4- and 12-week treatment response to sertraline in posttraumatic stress disorder.

J Affect Disord. 2011 Sep 28;

Authors: Mushtaq D, Ali A, Margoob MA, Murtaza I, Andrade C

Abstract
BACKGROUND: We examined the association between serotonin transporter (5HTTLPR) genotype (SS vs SL vs LL) and sertraline treatment outcome in posttraumatic stress disorder (PTSD). METHODS: Outpatients (n=330) with PTSD underwent 5HTTLPR genotyping. All patients received sertraline (100mg/day) for 12weeks. Patients were assessed using the Clinician-Administered PTSD Scale (CAPS) and other instruments. Patients and rater were blind to the genotyping results. The primary outcome was completer sample CAPS improvement at 12weeks. Response was defined as ≥30% improvement in CAPS total score with a CGI-I score of 1 or 2. RESULTS: The discontinuation rate was 31.5%. Adverse events led to drop out in 18.1%, 15.3%, and 5.9% of SS, SL, and LL patients, respectively (P=0.038). Among completers, there were 95, 43, and 88 patients with the SS, SL, and LL genotypes, respectively. At endpoint, CAPS total scores improved by 26% vs 46%, respectively, in SS and SL vs LL patients (P<0.001); much of this improvement (15% vs 31% in SS and SL vs LL patients, respectively; P<0.001) was apparent by week 4. The findings were largely similar for the other outcome measures. The response rate was 0%, 0%, and 47.7% in the SS, SL, and LL groups, respectively (P<0.001). LIMITATIONS: We administered a fixed dose of sertraline. For sociopolitical reasons, we planned a completer analysis only. CONCLUSIONS: Relative to the SS and SL 5HTTLPR genotypes, the LL genotype is associated with greater responsiveness of PTSD to sertraline (100mg/day) and with lower drop out due to adverse events. The S allele is associated with a striking specificity for treatment nonresponse, as defined in this study.

PMID: 21962566 [PubMed - as supplied by publisher]

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