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Marital quality and relationship satisfaction in war veterans and their wives in Bosnia and Herzegovina
Miro Klaric,Tanja Franciskovic,Aleksandra Stevanovic,Bozo Petrov
European Journal of Psychotraumatology , 2011, DOI: 10.3402/ejpt.v2i0.8077
Abstract: Posttraumatic stress disorder (PTSD) in war veterans and its complex emotional and behavioral characteristics affect veterans’ partners and the quality of their relationships. Although most research focuses on the effects of veterans’ PTSD on their partners/wives and their relationships, not many findings have been established on partner adjustment and marriage quality when wives suffer from PTSD as well.The aim of the research was to examine the relationship between war-related posttraumatic stress symptoms and partner's marital satisfaction in couples where one or both partners suffer from PTSD.The Harvard Trauma Questionnaire and Dyadic Adjustment Scale encompassed 154 war veterans and their wives who had been treated at Mostar Clinical Hospital in Bosnia and Herzegovina for combat-related PTSD as well as 77 veterans who did not suffer from PTSD and their wives.Veterans’ PTSD is related to lower levels of marital adjustment of their wives. Marital adjustment was significantly lower in couples where both partners had PTSD compared with couples where only the veteran had PTSD or neither partner had PTSD. Female partner's marital adjustment is best explained by his avoidance symptoms and her own level of depressiveness and re-experiencing symptoms.The results highlight the importance of recognizing PTSD in wives of traumatized veterans as well as the importance of family approach in the treatment of PTSD.For the abstract or full text in other languages, please see Supplementary files under Reading Tools online
A Pilot Study of Mifepristone in Combat-Related PTSD  [PDF]
Julia A. Golier,Kimberly Caramanica,Rebecca DeMaria,Rachel Yehuda
Depression Research and Treatment , 2012, DOI: 10.1155/2012/393251
Abstract: Background. We obtained pilot data to examine the clinical and neuroendocrine effects of short-term mifepristone treatment in male veterans with PTSD. Methods. Eight male veterans with military-related PTSD completed a randomized, double-blind trial of one week of treatment with mifepristone (600?mg/day) or placebo. The primary clinical outcome measures were improvement in PTSD symptoms and dichotomously defined clinical responder status as measured by the CAPS at one-month follow-up. Additional outcome measures included self-reported measures of PTSD symptom severity, CAPS-2 symptom subscale scores, and morning plasma cortisol and ACTH levels. Results. Mifepristone was associated with significant improvements in total CAPS-2 score. At one-month follow-up, all four veterans in the mifepristone group and one of four veterans in the placebo group achieved clinical response; three of four veterans in the mifepristone group and one of four veterans in the mifepristone group remitted. Mifepristone treatment was associated with acute increases in cortisol and ACTH levels and decreases in cytosolic glucocorticoid receptor number in lymphocytes. Conclusions. Further controlled trials of the effects of mifepristone and their durability are indicated in PTSD. If effective, a short-term pharmacological treatment in PTSD could have myriad uses. 1. Introduction Within the last decade, two selective serotonin reuptake inhibitors (SSRIs), sertraline and paroxetine, have been approved by the FDA for the treatment of posttraumatic stress disorder (PTSD). In studies of civilian trauma survivors, each has been superior to placebo in achieving clinical response and reducing core PTSD symptoms, which represents a significant advance. However, their use as PTSD monotherapy has significant limitations. Even in the most favorable studies, some key symptoms are resistant to treatment (e.g., sleep disturbance), remission is uncommon, and continuous treatment is often necessary to prevent relapse. Additionally, SSRIs have been shown to be largely ineffective in combat veterans with PTSD. There is a need to develop better pharmacological treatments that specifically target PTSD symptoms and/or pathophysiology. Given the abundant evidence for hypothalamic-pituitary adrenal (HPA) axis dysregulation in PTSD, we performed a preliminary study to examine whether mifepristone—which recalibrates the HPA axis through peripheral and central mechanisms—could be of therapeutic benefit. Mifepristone is a selective antagonist of glucocorticoid receptors (GRs) that induces increases in cortisol
Disruption of bradycardia associated with discriminative conditioning in combat veterans with PTSD  [cached]
Jay P Ginsberg,Edwin Ayers,Louisa Burriss,Donald A Powell
Neuropsychiatric Disease and Treatment , 2008,
Abstract: Jay P Ginsberg1,2, Edwin Ayers3, Louisa Burriss1, Donald A Powell1,41Shirley L. Buchanan Neuroscience Laboratory, Dorn VA Medical Center, Columbia, SC, USA; 2Department of Pharmacology, Physiology, and Neuroscience, School of Medicine, 4Department of Psychology, University of South Carolina, Columbia, SC, USA; 3Department of Psychology, South Carolina State University, Orangeburg, SC, USAAbstract: The effects of combat-related posttraumatic stress disorder (PTSD) on heart rate (HR) responding associated with a discriminative delay eyeblink (EB) conditioning paradigm are reported. Combat PTSD+, Combat PTSD , and Noncombat PTSD veterans were assessed with psychometric self-report measures, and baseline heart rate variability (HRV) was measured before receiving a 72-trial session of discriminative EB classical conditioning. Two types (red or green light) of conditioned stimuli (CS) were used: one (CS+) predicted a tone, followed immediately by an aversive stimulus (corneal airpuff); the other (CS ) predicted a tone alone, not followed by the airpuff. The light signal was presented for 5 seconds, during which HR was measured. On all psychometric measures, the PTSD+ subgroup was significantly different from the PTSD subgroups (Combat + Noncombat), and the PTSD subgroups did not significantly differ from each other. A linear deceleration in HR to CS+ and CS signals was found in the combined PTSD subgroup and on CS trials in the PTSD+ subgroup, but was not present on CS+ trials in the PTSD+ subgroup. Results are interpreted with respect to a behavioral stages model of conditioned bradycardia and in terms of neural substrates which are both critical to HR conditioning and known to be abnormal in PTSD.Keywords: bradycardia, PTSD, combat veterans, classical conditioning
Psychiatric diagnoses and punishment for misconduct: the effects of PTSD in combat-deployed Marines
Robyn M Highfill-McRoy, Gerald E Larson, Stephanie Booth-Kewley, Cedric F Garland
BMC Psychiatry , 2010, DOI: 10.1186/1471-244x-10-88
Abstract: A population-based study was conducted on all U.S. Marines who entered the military between October 1, 2001, and September 30, 2006, and deployed outside of the United States before the end of the study period, September 30, 2007. Demographic, psychiatric, deployment, and personnel information was collected from military records. Cox proportional hazards regression analysis was conducted to investigate associations between the independent variables and the three types of misconduct in war-deployed (n = 77 998) and non-war-deployed (n = 13 944) Marines.Marines in both the war-deployed and non-war-deployed cohorts with a non-PTSD psychiatric diagnosis had an elevated risk for all three misconduct outcomes (hazard ratios ranged from 3.93 to 5.65). PTSD was a significant predictor of drug-related discharges in both the war-deployed and non-war-deployed cohorts. In the war-deployed cohort only, a specific diagnosis of PTSD was associated with an increased risk for both demotions (hazard ratio, 8.60; 95% confidence interval, 6.95 to 10.64) and punitive discharges (HR, 11.06; 95% CI, 8.06 to 15.16).These results provide evidence of an association between PTSD and behavior problems in Marines deployed to war. Moreover, because misconduct can lead to disqualification for some Veterans Administration benefits, personnel with the most serious manifestations of PTSD may face additional barriers to care.Numerous studies have demonstrated that exposure to combat or other traumatic events is associated with an increase in psychiatric problems, including depression, substance abuse, anxiety disorders, and posttraumatic stress disorder (PTSD) [1-3]. Another area of concern is the relationship between combat exposure and antisocial behavior. The media have keenly focused on this topic, as evidenced by the publicity surrounding military misconduct both during and after deployment [4-7].Research on Vietnam War veterans strongly suggests an association between combat exposure and antiso
A Comparative Analysis of MMPI and Rorschach Findings Assessing Combat-Related PTSD in Vietnam Veterans—Analysis of MMPI and Rorschach Findings Assessing PTSD  [PDF]
Ioanna Katsounari, Jordan Jacobowitz
Psychology (PSYCH) , 2011, DOI: 10.4236/psych.2011.24053
Abstract: There has been a proliferation of assessment research on Post-traumatic Stress Disorder (PTSD) over the past twenty years. In spite of recent advances in the PTSD assessment research, there continues to be a controversy as to whether the MMPI or Rorschach is more useful in determining the presence of PTSD. The present comparative analysis of the research literature will carefully evaluate controlled empirical studies, which utilized psychometric measures such as the MMPI/2 and Rorschach to identify PTSD in Vietnam Veterans. This analysis is guided by the paucity of comparative data for standardized objective and projective instruments to assess combat-related PTSD. The analysis indicated that the MMPI as an assessment instrument focuses on symptom recognition of PTSD while the Rorschach seems to be more likely to identify chronic adaptations to trauma. The significance of pre-combat factors, such as preexisting personality, and their impact on the way individuals make meaning and express traumatic experiences needs to be further addressed in future research. The need for reliable and valid measures to assess combat-related PTSD is urgent as an increasing number of soldiers return from war zones.
Universitas Psychologica , 2005,
Abstract: The results of cognitive-behavioral group interventions applied from 2002 to 2004 to 42 colombian combat veteranswith Post Traumatic Stress Disorder (PTSD) are presented. The goal of the study was to stablish the effectiveness ofthe group interventions based in Prolonged Exposition and Stress Inoculation treatment processes. Differencesbetween pre-in-post symptomatology scores of PTSD were measured by Foa Posttraumatic Stress Diagnostic Scale(PDS) and the Beck Depression Inventory. The statistical analysis was made by t test for paired samples, with alpha of0.05. Results show significant decrease in symptomatology and severity level after the intervention both in depressionand PTSD symptoms.
The relationship between Hippocampal asymmetry and working memory processing in combat-related PTSD – a monozygotic twin study
Hall Timothy,Galletly Cherrie,Clark C,Veltmeyer Melinda
Biology of Mood & Anxiety Disorders , 2012, DOI: 10.1186/2045-5380-2-21
Abstract: Background PTSD is associated with reduction in hippocampal volume and abnormalities in hippocampal function. Hippocampal asymmetry has received less attention, but potentially could indicate lateralised differences in vulnerability to trauma. The P300 event-related potential component reflects the immediate processing of significant environmental stimuli and has generators in several brain regions including the hippocampus. P300 amplitude is generally reduced in people with PTSD. Methods Our study examined hippocampal volume asymmetry and the relationship between hippocampal asymmetry and P300 amplitude in male monozygotic twins discordant for Vietnam combat exposure. Lateralised hippocampal volume and P300 data were obtained from 70 male participants, of whom 12 had PTSD. We were able to compare (1) combat veterans with current PTSD; (2) their non-combat-exposed co-twins; (3) combat veterans without current PTSD and (4) their non-combat-exposed co-twins. Results There were no significant differences between groups in hippocampal asymmetry. There were no group differences in performance of an auditory oddball target detection task or in P300 amplitude. There was a significant positive correlation between P300 amplitude and the magnitude of hippocampal asymmetry in participants with PTSD. Conclusions These findings suggest that greater hippocampal asymmetry in PTSD is associated with a need to allocate more attentional resources when processing significant environmental stimuli.
Epigenetic Biomarkers as Predictors and Correlates of Symptom Improvement Following Psychotherapy in Combat Veterans with PTSD  [PDF]
Rachel Yehuda,Nikolaos P. Daskalakis,Frank Desarnaud,Amy L. Lehrner,Janine D. Flory,Joseph D. Buxbaum,Michael J. Meaney
Frontiers in Psychiatry , 2013, DOI: 10.3389/fpsyt.2013.00118
Abstract: Epigenetic alterations offer promise as diagnostic or prognostic markers, but it is not known whether these measures associate with, or predict, clinical state. These questions were addressed in a pilot study with combat veterans with PTSD to determine whether cytosine methylation in promoter regions of the glucocorticoid related NR3C1 and FKBP51 genes would predict or associate with treatment outcome. Veterans with PTSD received prolonged exposure (PE) psychotherapy, yielding responders (n = 8), defined by no longer meeting diagnostic criteria for PTSD, and non-responders (n = 8). Blood samples were obtained at pre-treatment, after 12 weeks of psychotherapy (post-treatment), and after a 3-month follow-up. Methylation was examined in DNA extracted from lymphocytes. Measures reflecting glucocorticoid receptor (GR) activity were also obtained (i.e., plasma and 24 h-urinary cortisol, plasma ACTH, lymphocyte lysozyme IC50-DEX, and plasma neuropeptide-Y). Methylation of the GR gene (NR3C1) exon 1F promoter assessed at pre-treatment predicted treatment outcome, but was not significantly altered in responders or non-responders at post-treatment or follow-up. In contrast, methylation of the FKBP5 gene (FKBP51) exon 1 promoter region did not predict treatment response, but decreased in association with recovery. In a subset, a corresponding group difference in FKBP5 gene expression was observed, with responders showing higher gene expression at post-treatment than non-responders. Endocrine markers were also associated with the epigenetic markers. These preliminary observations require replication and validation. However, the results support research indicating that some glucocorticoid related genes are subject to environmental regulation throughout life. Moreover, psychotherapy constitutes a form of “environmental regulation” that may alter epigenetic state. Finally, the results further suggest that different genes may be associated with prognosis and symptom state, respectively.
When combat prevents PTSD symptoms—results from a survey with former child soldiers in Northern Uganda
Roland Weierstall, Inga Schalinski, Anselm Crombach, Tobias Hecker, Thomas Elbert
BMC Psychiatry , 2012, DOI: 10.1186/1471-244x-12-41
Abstract: We surveyed 42 former child soldiers in Northern Uganda that have all been abducted by the Lord Resistance Army (LRA) as well as 41 non-abducted controls.Linear regression analyses revealed a dose–response effect between the exposure to traumatic events and the Posttraumatic Diagnostic Scale (PDS) sum score. However, the vulnerability to develop trauma related symptoms was reduced in those with higher scores on the Appetitive Aggression Scale (AAS). This effect was more pronounced in the formerly abducted group.We conclude that attraction to aggression when being exposed to the victim’s struggling can lead to a substantial risk-reduction for developing PTSD.It is estimated that at any one time, 300.000 children under the age of 18 are used as soldiers in warfare [1]. Technological advantages like the development of lightweight automatic weapons have resulted in an increase of child soldiers in armed conflicts [2]. From the mid-90’s to 2006 the Lord Resistance Army (LRA) has been fighting in Northern Uganda and is responsible for the mutilation and mass execution of civilians and the abduction and recruitment of children as soldiers in the armed rebel force [3]. Since the LRA relocated its residence to southern Sudan and the Democratic Republic of Congo, several studies have investigated the impact of the war in Northern Uganda and reported devastating effects on the mental health of former child soldiers, especially because of the development of trauma-related symptoms [4-7]. Several studies reported a clear dose-effect relationship between the exposure to different stressful life events and the risk of development of post traumatic stress disorder (PTSD) in various especially war-affected populations [8-11]). Thus, the cumulative exposure to life-threatening events increases the risk of development of PTSD over time. The concept of perpetration-induced traumatic stress (PITS) was introduced to describe an observable phenomenon that former perpetrators show a higher
Validity of PTSD diagnoses in VA administrative data: Comparison of VA administrative PTSD diagnoses to self-reported PTSD Checklist scores  [PDF]
Amy A. Gravely, MA,Andrea Cutting, MA,Sean Nugent, BA,Joseph Grill, MS
Journal of Rehabilitation Research and Development , 2011,
Abstract: Little research has been done on the validity of posttraumatic stress disorder (PTSD) diagnoses that are found in Department of Veterans Affairs (VA) administrative data, even though they are often used in VA research. We compared PTSD diagnoses found in VA administrative data with PTSD Checklist (PCL) scores self-reported by 4,777 newly diagnosed participants in a national postal survey study. Using PCL scores of at least 50 as the gold standard, we compared positive predictive values (PPVs) for at least one versus at least two PTSD diagnoses (found within 4 months of the first) in VA administrative data overall and by subgroups of interest: age, sex, and clinic where first diagnosed. The overall PPV was 75% for at least one PTSD diagnosis and 82% for at least two PTSD diagnoses. Similarly, the PPV significantly increased for all subgroup analyses when at least two PTSD diagnoses were used. The increase in PPV was greatest for those first diagnosed in primary care and for those older than 65. To select a sample of veterans with more definitive PTSD from administrative data, researchers should select those veterans with at least two PTSD diagnoses as opposed to at least one.
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