Problems in families of male Vietnam veterans with posttraumatic stress disorder.

Interviews were conducted with a nationally representative sample of 1,200 male Vietnam veterans and the spouses or coresident partners of 376 of these veterans. The veteran interview contained questions to determine the presence of posttraumatic stress disorder (PTSD) and items tapping family and marital adjustment, parenting problems, and violence. The spouse or partner (S/P) interview assessed the S/P's view of these items, as well as her view of her own mental health, drug, and alcohol problems and behavioral problems of school-aged children living at home. Compared with families of male veterans without current PTSD, families of male veterans with current PTSD showed markedly elevated levels of severe and diffuse problems in marital and family adjustment, in parenting skills, and in violent behavior. Clinical implications of these findings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Physiologic responses to loud tones in Vietnam veterans with posttraumatic stress disorder.

The authors evaluated eyeblink and autonomic components of the acoustic startle response in combat-related posttraumatic stress disorder (PTSD). Thirty-seven Vietnam combat veterans with current PTSD and 19 combat veterans without PTSD were exposed to 15 consecutive 95-dB, 500-ms, 1000-Hz tones with 0-ms rise and fall times, while orbicularis oculi electromyogram, skin conductance, and heart rate responses were measured. PTSD veterans produced larger averaged electromyographic and heart rate responses, and a slower decline in skin conductance responses, across the 15 tone presentations compared to non-PTSD veterans. Results of this study provide laboratory support for an exaggerated startle response in PTSD and replicate and extend previous findings of increased autonomic responses to loud tone stimuli in this disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessment of posttraumatic stress disorder in World War II veterans.

Four posttraumatic stress disorder (PTSD) scales were compared in a community sample of 330 American former prisoners of war and combat veterans of World War II. The Mississippi Scale for Combat-Related PTSD (M-PTSD), the MMPI-2 Pk PTSD scale, and the Impact of Event Scale (IES) all demonstrated moderate relationships with PTSD as defined by the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-III-Revised (DSM-III-R). Comparative validities were similar to those observed in Vietnam veteran samples. Confirmatory factor analysis indicated that the 3 scales loaded significantly on 1 factor. The impact of Diagnostic and Statistical Manual of Mental Disorders (4th ed.) PTSD criteria changes was examined and found to be minimal. Implications for the use of the M-PTSD, Pk, and IES in combat-related PTSD assessment are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interpersonal problems of Vietnam combat veterans with symptoms of posttraumatic stress disorder.

274 male veterans seeking treatment for substance abuse were divided on the basis of combat experience and DSM-III criteria of posttraumatic stress disorder (PTSD). Ss with evidence of PTSD were compared with a non-PTSD group of Vietnam combat veterans and a noncombat group of Vietnam-era veterans on measures of specific interpersonal problems using the Horowitz Interpersonal Problem Inventory, traditional measures of family and social adjustment, and the MMPI. The PTSD group scored significantly higher on clusters of problems dealing with intimacy and sociability than did either of the comparison groups. PTSD Ss also scored higher on the MMPI scales of Paranoia, Psychopathic Deviate, Social Introversion, Social Maladjustment, Family Problems, and Manifest Hostility, but did not differ from other groups on Family Environment Scale variables. Results, which were not attributable to premilitary adjustment differences or to confounding demographic variables, are compared to previous studies, and research questions that remain outstanding are discussed. (11 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health status, somatization, and severity of posttraumatic stress disorder in Vietnam combat veterans with posttraumatic stress disorder

OBJECTIVE: A two-part study was conducted to examine the health status of Vietnam veterans with posttraumatic stress disorder (PTSD). In part 1, veterans with and without PTSD were compared on health behaviors and on self-reported and physician-rated health problems. Consistency of self-report with physician rating for health problems across the two groups was compared. In part 2, the association between health status and PTSD symptom severity, depression, somatization, and health behaviors in PTSD patients was evaluated. METHOD: In part 1, 276 combat veterans (225 with PTSD and 51 without PTSD) provided health status information, and medical records were reviewed. In part 2, 225 PTSD patients completed standardized PTSD severity, somatization, and depression measures. RESULTS: When analyses controlled for age, socioeconomic status, minority status, combat exposure, alcohol use, and pack-year history, veterans with PTSD reported and were rated as having a greater number of health problems than veterans without PTSD. Agreement between self-report and physician ratings for both groups ranged from low to moderate. Level of agreement between patient and physician was similar across groups. In the analysis of veterans with PTSD, somatization and PTSD symptom severity were significantly related to self-report of health problems, whereas only PTSD symptom severity was related to physician-rated health. Pack-year history was significantly related to self-reported health status in both groups. CONCLUSIONS: The presence and severity of PTSD in veterans were associated with greater physical health problems and conditions. Psychological variables (e.g., PTSD status, PTSD severity, somatization) and a behavioral variable (pack-year history) were related to health status.     

Social support in Vietnam veterans with posttraumatic stress disorder: A comparative analysis.

Conducted a comparative analysis of the social-support systems of 45 Vietnam-era veterans (mean age 36.69 yrs), including 15 Ss in a program designed to evaluate and treat combat-related posttraumatic stress disorder (PTSD), 15 well-adjusted Ss with no symptoms of PTSD, and 15 medical-service inpatients without combat exposure or PTSD. Retrospective reports of social support were obtained from each group for 3 life periods: 1–3 mo prior to entering the service, 1–3 mo following discharge from the service, and at the present time. Indexes of social support included social network size, material support, physical support, sharing, advice, and positive social interactions. Prior to Vietnam, all 3 groups reported comparable levels of support across all dimensions. For PTSD Ss, qualitative and quantitative measures of social support systematically declined over time to low levels at the present time period. For the remaining Ss, the social support was either stable or improved over time. (22 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ambulatory cardiovascular activity in Vietnam combat veterans with and without posttraumatic stress disorder.

The present study investigated the relationship between daily diary affect ratings and ambulatory cardiovascular activity in 117 male Vietnam combat veterans (61 with posttraumatic stress disorder [PTSD] and 56 without PTSD). Participants completed 12–14 hr of ambulatory monitoring and daily diary affect ratings. Compared with veterans without PTSD, veterans with PTSD reported higher negative affect and lower positive affect in daily diary ratings. No differences were detected for mean laboratory initial recordings or mean ambulatory heart rate (HR), systolic blood pressure (SBP), or diastolic blood pressure (DBP). However, compared with veterans without PTSD, veterans with PTSD demonstrated higher SBP and DBP variability and a higher proportion of HR activity (compared with initial recording values) during daily activity. There was a significant Time of Day × Group interaction for mean HR, with a trend for PTSD participants to maintain HR levels during evening hours. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interpersonal problem solving and coping reactions of Vietnam veterans with posttraumatic stress disorder.

In order to assess the relation between posttraumatic stress disorder (PTSD) and interpersonal problem solving and coping, 43 Vietnam veterans were assigned to the following four groups: (a) combat veterans with PTSD, (b) combat veterans with severe adjustment problems but not PTSD-diagnosable (AP), (c) combat veterans who were well adjusted (WA), and (d) veterans with little or no combat exposure who served during the Vietnam era (ERA). Multivariate analyses of variance indicated that both the PTSD and AP groups reported less effective coping reactions and poorer problem solving than both the WA and ERA groups. The PTSD subjects also reported less effective problem solving and less problem-focused coping reactions than the AP veterans. Implications of these results are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Chronic posttraumatic stress disorder and chronic pain in Vietnam combat veterans

A study was conducted to investigate chronic pain patterns in Vietnam veterans with posttraumatic stress disorder (PTSD). Combat veterans with PTSD completed standardized PTSD severity, pain, somatization, and depression measures. Of 129 consecutive out-patient combat veterans with PTSD, 80% reported chronic pain. In descending order were limb pain (83%), back pain (77%), torso pain (50%), and headache pain (32%). Compared to PTSD combat veterans without chronic pain, PTSD veterans who reported chronic pain reported significantly higher somatization as measured by the Minnesota Multiphasic Inventory 2 hypochondriasis and hysteria subscales. In the sample of 103 combat veterans with PTSD and chronic pain, MMPI 2 hypochondriasis scores and B PTSD symptoms (reexperiencing symptoms) were significantly related to pain disability, overall pain index, and current pain level MMPI 2 hypochondriasis and depression scores were also significantly related to percent body pain. These results are discussed in the context of current conceptualizations of PTSD.     

Treating comorbid panic disorder in veterans with posttraumatic stress disorder.

This study compares the effectiveness of panic control treatment (PCT) with that of a psychoeducational supportive treatment (PE-SUP) in treating panic disorder among a veteran sample with a primary diagnosis of chronic posttraumatic stress disorder (PTSD). Thirty-five patients randomized to receive 10 individual sessions of either PCT or PE-SUP underwent assessments at pretreatment, at 1-week posttreatment, and at a 3-month follow-up. Intent-to-treat analyses of covariance showed that PCT participants significantly improved on panic severity at posttreatment and panic fear at the 3-month follow-up. The PCT group also showed significant reductions in anxiety sensitivity at posttreatment and follow-up compared with that of the PE-SUP group. A significantly higher proportion of persons (63%) in the PCT group was panic free by the follow-up period compared with that of the PE-SUP group (19%). Patient self-report and clinician ratings showed no changes in general anxiety, depression, and PTSD symptoms in either group. These findings indicated that PCT was superior to an active control therapy in reducing the frequency, severity, and distress associated with panic disorder and suggested that brief cognitive-behavioral therapy for panic is effective for persons with chronic PTSD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Trail making test performance in Vietnam combat veterans with and without posttraumatic stress disorder

The present study investigated variables associated with performance on the Trail Making Test from the Halstead-Reitan neuropsychological test battery in Vietnam combat veterans. There was a significant difference in performance between veterans with and without PTSD on both parts of the Trail Making Test. In subgroup analyses excluding participants on medications (antianxiety, antidepressant, and cardiac), comorbid diagnoses (history of alcohol or substance abuse, history of major depression and comorbid anxiety disorder) and compensation-seeking status, the group difference on Trails B remained significant. However, subgroup analyses suggested that poorer performance on Trails A was influenced by antianxiety and cardiac medications, as well as heavy combat exposure status.     

Polysomnographic sleep is not clinically impaired in Vietnam combat veterans with chronic posttraumatic stress disorder

BACKGROUND: Because sleep is typically disturbed in posttraumatic stress disorder (PTSD), this study was undertaken to evaluate a group of Vietnam combat veterans with the disorder using clinical polysomnographic techniques. METHODS: Eighteen Vietnam combat veterans with PTSD and 10 healthy non-combat-exposed Vietnam era veterans participated in 2 nights of polysomnographic study and a multiple sleep latency test. RESULTS: No significant differences between subjects and controls were noted except for greater sleep onset latency to stage 2 (p < .03), and lower arousals/hour from stages 3 & 4 (p < .04) on night 2, and lower subjectively estimated total sleep time on night 1 (p < .005) in the case of PTSD subjects. Otherwise, results from the second night served to replicate those from the first, and no significant differences appeared on 2 successive nights for any polysomnographic variable. No daytime hypersomnolence was detected. CONCLUSIONS: Polysomnographically recorded sleep was notably better than expected in the presence of clinically significant PTSD with typical histories of disrupted sleep. In these subjects, there is no clinically significant sleep disorder or typical pattern of sleep disturbance detectable by standard polysomnography.     

Magnitude and duration of cardiovascular response to anger in Vietnam veterans with and without posttraumatic stress disorder.

This study investigated the cardiovascular responses to a relived anger task in 118 male Vietnam combat veterans (62 with posttraumatic stress disorder [PTSD] and 56 without PTSD). Participants completed standardized diagnostic measures, hostility measures, and a laboratory session in which they relived a self-chosen anger memory while heart rate (HR), systolic blood pressure, and diastolic blood pressure (DBP) were measured continuously using an Ohmeda Finapres monitor. Compared with veterans without PTSD, PTSD veterans took less time to feel anger, had greater mean HR and DBP response during relived anger, and reported greater anger and anxiety during the task. There was a significant relationship between covert hostility and anger response during and after the anger task only in participants with PTSD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rorschach patterns of response in Vietnam veterans with posttraumatic stress disorder versus combat and normal controls

The aim of the present study was to determine whether maternal diabetes affects rat embryo and yolk sac apoptosis during the postimplantation period. Severely malformed and growth-retarded embryos of gestational day 12 from diabetic rats exhibited pronounced DNA laddering on agarose gels. On the other hand, no DNA laddering could be observed in any of the non-malformed embryos from control and diabetic rats, or in their corresponding yolk sacs. Analysis of embryos of gestational day 10 revealed only a few scattered TUNEL positive cells mainly located in the allantois, the foregut epithelium, the cranial neuroepithelium and in the cranial mesenchyme. Embryonic tissue of gestational day 12 showed numerous aggregates of TUNEL-positive cells, indicating developmental remodelling of multiple organs. Analysis of non-malformed embryos of day 10 and 12 revealed a distribution and frequency of TUNEL positive cells unaffected by the diabetic state of the mother on both days. In vitro incubation (2-8 hr) of normal day-12 yolk sacs resulted in strong DNA laddering, but not in the corresponding embryos. Dispersed yolk sac cells generated higher levels of reactive oxygen species than dispersed embryonic cells. Reactive oxygen species levels in both embryonic and yolk sac cells were unaffected by the diabetic state of the mother. Moreover, immunoblot analysis showed high Bcl-2 and undetectable caspase-1 levels in embryos from both normal and diabetic rats and low Bcl-2 and high caspase-1 levels in the corresponding yolk sacs. Immunohistochemical analysis of embryos demonstrated caspase-1-reactivity in a small subpopulation of cells located in proximity to TUNEL-positive cells. We conclude that the inherent capacity of embryonic cells to enter apoptosis in vitro is low as compared to yolk sac cells, and that wide-spread apoptosis is not likely to play a major role in diabetes-induced dysmorphogenesis but rather in early phases of resorption of severely malformed and developmentally retarded embryos.     

Fear-potentiated startle conditioning to explicit and contextual cues in Gulf War veterans with posttraumatic stress disorder.

Aversive conditioning to explicit and contextual cues was examined in Gulf War veterans with and without posttraumatic stress disorder (PTSD) by use of the startle reflex methodology. Veterans participated in a differential aversive conditioning experiment consisting of 2 sessions separated by 4 or 5 days. Each session comprised two startle habituation periods, a preconditioning phase, a conditioning phase, and a postconditioning extinction test. In contrast to the non-PTSD group, the PTSD group showed a lack of differential startle response in the presence of a conditioned stimulus with or without an unconditioned stimulus in Session 1 and an increase in the baseline startle response during Session 2. The PTSD group also exhibited normal differential conditioning following reconditioning in Session 2. These data suggest that individuals with PTSD tend to generalize fear across stimuli and are sensitized by stress. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A selected bibliography on posttraumatic stress disorders in Vietnam veterans.

Lists 171 references to the etiology, symptomatology, and treatment of posttraumatic stress disorders (PTSDs) in Vietnam veterans. Psychologically and medically oriented journals, books, and government publications were searched for research and clinical reports, as were published narratives of veterans' combat experiences and research on PTSDs from other conflicts (e.g., World War II, Korean conflict, and the Yom Kippur war). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive processing therapy for veterans with military-related posttraumatic stress disorder.

Sixty veterans (54 men, 6 women) with chronic military-related posttraumatic stress disorder (PTSD) participated in a wait-list controlled trial of cognitive processing therapy (CPT). The overall dropout rate was 16.6% (20% from CPT, 13% from waiting list). Random regression analyses of the intention-to-treat sample revealed significant improvements in PTSD and comorbid symptoms in the CPT condition compared with the wait-list condition. Forty percent of the intention-to-treat sample receiving CPT did not meet criteria for a PTSD diagnosis, and 50% had a reliable change in their PTSD symptoms at posttreatment assessment. There was no relationship between PTSD disability status and outcomes. This trial provides some of the most encouraging results of PTSD treatment for veterans with chronic PTSD and supports increased use of cognitive- behavioral treatments in this population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)