Psychotic symptoms in post-traumatic stress disorder

The mouse has become the leading animal model for studying biological processes in mammals. Creation of additional genomic and genetic resources will make the mouse an even more useful model for the research community. On the basis of recommendations from the scientific community, the National Institutes of Health (NIH) plans to support grants to generate a 'working draft' sequence of the mouse genome by 2003, systematic mutagenesis and phenotyping centres, repositories for mouse strain maintenance, distribution and cryopreservation and training fellowships in mouse pathobiology.     

Pseudoneurologic symptoms in post-traumatic stress disorder

We report a case of documented transient segmental aperistalsis of the distal esophagus following an accidental electrical injury. There are no other reports in the literature demonstrating this phenomenon. A review of gastrointestinal injury secondary to electrical injury is presented.     

Lateral preference in post-traumatic stress disorder

Two sets of experiments on the role of tea in azoxymethane (AOM) induced colon cancer were performed. The first test involved male F344 rats given 1.25% solutions of black tea beginning at 5 weeks of age and ending at 51 days of age. At 6 and 7 weeks of age, they received 15 mg/kg AOM and were held for 50 weeks. Another group received the AOM dosage at 6 and 7 weeks and were placed on the tea solutions 2 days after the last AOM dosage, at 51 days of age, and held for the 50-week period. The end point was the occurrence and multiplicity of colon cancer, classified as in situ, exophytic, invasive and Peyer's patch carcinomas. Tea failed to affect the incidence and multiplicity of colon cancers when given during or after the AOM administration, but tea after AOM increased the multiplicity of exophytic carcinomas. In a second series of tests, solutions of 0.6, 1.25, 1.75 or 2.5% tea were given, beginning 1 week prior to the two AOM doses and extending for 42 weeks. Also, one group received 1.25% tea and 1.85% whole milk. The incidence of exophytic or invasive colon cancer and tumor multiplicity were similar in all treatment groups, although the incidence of exophytic neoplasms was higher with 2.5% tea. Thus, chronic administration failed to significantly change the incidence and multiplicity of the AOM-induced colon cancers. These findings are accounted for by the underlying mechanism, namely the fact that tea solutions do not alter the amount of cytochrome P-4502E1 required for the metabolic activation of AOM.     

Psychobiologic research in post-traumatic stress disorder

PTSD can be a chronic, devastating disorder for which treatment is only partially effective. For some, this disorder progressively worsens over time and appears to affect nearly every aspect of life, including work, interpersonal relationships, physical health, and view of self. Although generally understood as a psychological disorder, PTSD also may be viewed from a biologic perspective. There is now accumulating evidence to suggest that severe psychological trauma can cause alterations in the organism's neurobiologic response to stress even years after the original insult. Long-standing alterations in the biologic response to stress may contribute to a number of complaints commonly expressed by patients with PTSD. For example, increased sensitivity and sensitization of the noradrenergic system may leave the individual in a hyperaroused, vigilant, sleep-deprived, and, at times, explosive state that worsens over time. Being irritable and on edge makes it difficult to interact with family members, friends, coworkers, and employers. To quiet these symptoms of hyperarousal, PTSD patients often withdraw and use substances, particularly central nervous system depressants, that suppress peripheral and central catecholamine function. Alterations in other neurobiologic systems may further contribute to multiple symptoms, such as intrusive memories, dissociation phenomena, and even numbing. Characterization of the biologic underpinnings of PTSD relies to a large degree on available neurobiologic technology. Much of what has been discussed in this article has grown out of advances in physiologic, hormone, and receptor assay methodology. With further advances in neurobiologic technology, in areas such as brain imaging, it soon will be possible to better delineate acute and long-term stress-induced changes in central and peripheral nervous system functioning. Undoubtedly a far richer, more complex understanding of neurobiologic responses and alterations will emerge in the near future. It is believed that an improved neurobiologic understanding will facilitate the development of more specific, effective treatments for individuals who have been severely traumatized.     

Psychoneuroendocrinology of post-traumatic stress disorder

In 1980, the diagnosis of post-traumatic stress disorder (PTSD) was established to describe the long-lasting symptoms that can occur following exposure to extremely stressful life events. This article reviews the findings of neuroendocrinologic alterations in PTSD and summarizes the finding of hypothalamic-pituitary-adrenal (HPA), catecholamine, hypothalamic-pituitary-thyroid (HPT) and hypothalamic-pituitary-gonadal (HPG) systems. These are the neuroendocrine systems that have been studied in PTSD. Also included is a review of the basic facts about PTSD and biologic data.     

Myocardial infarction and post-traumatic stress disorder

Currently, we recommend varicocele repair in adolescents when (1) the results of semen analysis are abnormal, (2) the volume of the left testis is at least 3 mL less than that of the right, (3) the response of either luteinizing hormone or FSH to Gn-RH stimulation is supranormal, (4) bilaterally palpable varicoceles are detected, or (5) a large symptomatic varicocele is present. When surgery is necessary, the Palomo approach significantly decreases the risk of operative failure and has facilitated "catch-up" growth of the left testis that is comparable to that after artery-sparing procedures. It is important to note that there is potential for impaired fertility whenever a palpable varicocele is present. Unfortunately, no test or group of tests can predict with absolute certainty whether an adolescent with a varicocele will be fertile or infertile. Therefore, it is important to observe untreated patients until they complete their families. Patients who are unwilling or unable to adhere to the follow-up protocol may be candidates for surgical intervention.     

Subtle presentations of post-traumatic stress disorder. Diagnostic issues

The authors present a set of diagnostic procedures designed to detect subtle presentations of post-traumatic stress disorder (PTSD). Defined as a Type II diagnostic error (a false negative), the authors examine several sources of subtle presentations of PTSD. These include imperfect diagnostic instruments, high base rates, imperfect memory of critical events, imperfect reporting of signs and symptoms, imperfect interpretation of presented signs and symptoms, and diagnostic decisions based on informal clinical judgment. The authors believe that a multistage diagnostic procedure, using instruments with known psychometric properties while simultaneously looking for converging evidence is the best safeguard against missing an appropriate diagnosis of post-traumatic stress disorder.     

Uncontrollability and unpredictability in post-traumatic stress disorder: An animal model.

The disturbances observed in animals subjected to unpredictable and uncontrollable aversive events resemble posttraumatic stress disorder (PTSD) symptoms and thus may constitute an animal model of this disorder. It is argued that the similarity between animals' symptoms and those of trauma victims may reflect common etiological factors. Relevant experiments in which animals exhibit generalized fear and arousal, discrete fear of a CS, analgesia, and avoidance are reviewed with the view that these manifestations may be analogous to the PTSD symptom clusters of persistent arousal, reexperiencing, numbing, and avoidance, respectively. Finally, animal paradigms are suggested to test the validity of the model, and specific hypotheses are derived from the animal literature regarding trauma variables that are predictive of particular PTSD symptom clusters. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Civilian post-traumatic stress disorder: Clinical syndromes and psychotherapeutic strategies.

Reviews the clinical features of the major classes of civilian PTSD that psychotherapists are most likely to encounter including medical procedures, pain, crime and the social environment, traffic accidents, traumatic brain injury, and the toxic stress syndrome. Psychotherapeutic strategies that clinicians can productively employ to treat civilian PTSD are discussed including supportive therapy, behavioral approaches, and psychodynamic psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social medicine expert assessment of post-traumatic stress disorder

The concept of a posttraumatic stress disorder (PTSD) has become important for psychiatric diagnosis and research, particularly following US-american studies on Vietnam war veterans. Recently, studies on traindrivers involved in suicide accidents have shown symptoms of anxiety and depression in more than 30% of concerned drivers and typical symptoms of a PTSD in 15%. Here, we present the case of a traindriver who was involved in 6 suicide accidents within 17 years of traindriving (the average is 2 suicide accidents). Following the 3rd accident, the driver developed increasingly symptoms like anxiety, sleep disturbances, flashbacks and irritability. Following the 6th accident, he has been unable to work. A former expert opinion saw no relationship between the symptoms of the driver and the suicide accidents. Therefore, further information about the concept of a PTSD seems necessary to ensure early psychotherapeutic and pharmacological treatment of patients with such a disorder.     

Teaching time-limited dynamic psychotherapy for post-traumatic stress disorder and pathological grief.

The authors' experience with a model of time-limited dynamic therapy for posttraumatic stress disorder (PTSD) and pathological grief has evolved over more than a decade of work that preceded formal manuals delineating treatment principles. Their accumulated experiences in training using this model suggests that a minimum of 2 yrs training in psychodynamics and psychopathology, supervised long-term dynamic psychotherapy experience, and some familiarity with brief therapy approaches is essential prerequisite knowledge. Because training needs to be sequential, they suggest the use of previous cases illustrating nuances of techniques with different personality styles, different levels of adaptive functioning, and implications of each of these factors for conducting treatment. They suggest liberal use of previously recorded cases in the context of ongoing tracking of adherence to a manual. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A general model for the treatment of post-traumatic stress disorder in war veterans.

Presents a general conceptual model of the recovery processes required for a successful therapeutic resolution of war-related PTSD. These processes involve relationship building, the development of emotional and cognitive connections with the trauma, recognition of the divergence between pre- and post-trauma values, modifying one's sense of self, establishing meaning for the trauma, and reestablishing appropriate self management and social skills. The authors emphasize the importance of the therapist–veteran relationship to client engagement in the recovery process. Case vignettes are included to illustrate model dynamics. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Are gender differences in post-traumatic stress disorder rates attenuated in substance use disorder patients?

We review 15 studies that examined rates of post-traumatic stress disorder (PTSD) in substance use disorder (SUD) patients to determine whether the typical female-greater-than- male gender difference in PTSD rates is attenuated in SUD samples. Since the majority of studies reviewed did not find a gender difference in PTSD rates, we critically examined methodological factors that might account for this attenuation, but none appeared to completely account for the variability in detection of gender differences across studies. Several factors may contribute to making rates of PTSD among SUD males equivalent to the high rates observed in SUD females: 1) the risky lifestyle associated with men's substance abuse may increase their exposure to traumatic events, 2) a history of more severe trauma characteristics may be apparent among men with SUDs, or 3) attenuated gender differences in rates of other comorbidities that increase PTSD risk (e.g., depression) may exist. Clinical implications are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prospective study of post-traumatic stress disorder in children involved in road traffic accidents

OBJECTIVE: To determine the prevalence of severe psychological trauma --that is, post-traumatic stress disorder--in children involved in everyday road traffic accidents. DESIGN: 12 month prospective study. SETTING: Accident and emergency department, Royal United Hospital, Bath. SUBJECTS: 119 children aged 5-18 years involved in road traffic accidents and 66 children who sustained sports injuries. MAIN OUTCOME MEASURE: Presence of appreciable psychological distress; fulfillment of diagnostic criteria for post-traumatic stress disorder. RESULTS: Post-traumatic stress disorder was found in 41 (34.5%) children involved in road traffic accidents but only two (3.0%) who sustained sports injuries. The presence of post-traumatic stress disorder was not related to the type of accident, age of the child, or the nature of injuries but was significantly associated with sex, previous experience of trauma, and subjective appraisal of threat to life. None of the children had received any psychological help at the time of assessment. CONCLUSIONS: One in three children involved in road traffic accidents was found to suffer from post-traumatic stress disorder when they were assessed 6 weeks after their accident. The psychological needs of such children after such accidents remain largely unrecognised.     

Symptoms of post-traumatic stress disorder in abused women in a primary care setting

Abuse is a major source of trauma to women, and post-traumatic stress disorder (PTSD) results from exposure to extreme trauma. To describe the relationship between symptoms of PTSD and severity of abuse, an ethnically stratified cohort of 131 abused women in a primary care setting was interviewed. Symptoms of PTSD, both intrusion (i.e., trouble falling asleep, strong waves of feelings about the abuse) and avoidance (i.e., trying not to think or talk about the abuse, staying away from reminders of the abuse), were significantly (p < 0.01) correlated to severity of abuse, regardless of ethnicity. When asked about childhood physical or sexual abuse, women reporting physical abuse had significantly (p < 0.05) higher intrusion scores, whereas those reporting sexual abuse had significantly (p < 0.004) higher avoidance scores. Sixty-five percent of the women reported dreams, flashbacks, or terror attacks and had significantly (p < 0.001) higher mean results on both intrusion and avoidance. The need to offer abused women information about the connection between severity of abuse and symptoms of PTSD is discussed. We recommend that clinicians ask all abused women about dreams, flashbacks, or terror attacks to assess for further symptoms of PTSD.     

Theoretical and practical foundations of an inpatient post-traumatic stress disorder and alcoholism treatment program.

Describes the structure and process of an inpatient program for the treatment of posttraumatic stress disorder (PTSD) and alcoholism. The therapeutic community setting uses lifespan developmental and social learning models to provide patients with (1) a framework for understanding what has happened to them, (2) tools for more effective coping, (3) an arena to experience the discomfort of previous coping mechanisms, and (4) the anxiety/pleasure of creating and practicing a new and more effective repertoire of skills. The program is divided into 3 phases. Phase 1 focuses on solidifying motivation for change through assessment, education, and interpersonal work. Phase 2 represents the action stage, and incorporates exposure-based therapy in a developmental framework to address trauma issues. Phase 3 emphasizes maintenance and generalization of patients' learning via modified relapse prevention training. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Characteristics of veterans in Hawaii with and without diagnoses of post-traumatic stress disorder

A total of 118 combat veterans seeking services at the VA Medical Center in Honolulu were assessed on a variety of demographic and psychometric dimensions, permitting the first systematic comparison on the measured variables between veterans with and without PTSD in the multicultural population of veterans in Hawaii. The results have implications for medical interventions with this population.     

The two-factorial symptom structure of post-traumatic stress disorder: depression-avoidance and arousal-anxiety

BACKGROUND: Yeast pyruvate kinase (PK) catalyzes the final step in glycolysis. The enzyme therefore represents an important control point and is allosterically activated by fructose-1,6-bisphosphate (FBP). In mammals the enzyme is found as four different isozymes with different regulatory properties: two of these isozymes are produced by alternate splicing. The allosteric regulation of PK is directly related to proliferation of certain cell types, as demonstrated by the expression of an allosterically regulated isozyme in tumor cells. A model for the allosteric transition from the inactive (T) state to the active (R) state has been proposed previously, but until now the FBP-binding site had not been identified. RESULTS: We report here the structures of PK from yeast complexed with a substrate analog and catalytic metal ions in the presence and absence of bound FBP. The allosteric site is located 40 A from the active site and is entirely located in the enzyme regulatory (C) domain. A phosphate-binding site for the allosteric activator is created by residues encoded by a region of the gene corresponding to the alternately spliced exon of mammalian isozymes. FBP activation appears to induce several conformational changes among active-site sidechains through a mechanism that is most likely to involve significant domain motions, as previously hypothesized. CONCLUSIONS: The structure and location of the allosteric activator site agrees with the pattern of alternate genetic splicing of the PK gene in multicellular eukaryotes that distinguishes between a non-regulated isozyme and the regulated fetal isozymes. The conformational differences observed between the active sites of inactive and fully active PK enzymes is in agreement with the recently determined thermodynamic mechanism of allosteric activation through a 'metal relay' that increases the affinity of the enzyme for its natural phosphoenolpyruvate substrate.