PTSD symptoms and comorbid mental disorders in Israeli war veterans

BACKGROUND: The purpose of this study was to investigate patterns of mental disorders co-morbid with PTSD symptoms in young Israeli men exposed to combat. METHOD: Six hundred and seventeen subjects were selected via a general population sample and evaluated in a two-phase case-identification procedure, culminating in a modified SADS-L interview, administered by psychiatrists. RESULTS: Major depressive disorder (OR = 3.2), substance use disorders (OR = 1.9) and personality disorders (OR = 3.0) occurred more frequently in men reporting symptoms of PTSD than in men who had been under fire who did not report symptoms. With the possible exception of personality disorders, comorbid disorders did not constitute risk factors for PTSD. Comorbid PTSD and RDC disorders were associated with increased help-seeking. CONCLUSIONS: The results suggest similar rates and types of PTSD comorbidity in Israeli war veterans as in veterans in the US assessed in general population studies, and are consistent with shared risk factors for PTSD and comorbid disorders.     

Clonazepam-related sexual dysfunction in male veterans with PTSD

Medication-induced sexual dysfunction can significantly interfere with patients' quality of life and lead to poor compliance. This retrospective study examined the records of 100 male veterans with post-traumatic stress disorder (PTSD) selected in alphabetical order from an active treatment file of 230 patients. Forty-two patients had received clonazepam (mean maximum dose: 3.4 +/- 1.6 mg/day) at some point during their treatment. Of these, 18 (42.9%) complained of significant sexual dysfunction (primarily erectile dysfunction). Eighty-four patients received diazepam (mean maximum dose: 52.1 +/- 29.7 mg/day), nine received alprazolam (mean maximum dose: 5.2 +/- 2.8 mg/day) and eight received lorazepam (mean maximum dose: 3.8 +/- 2.4 mg/day). None of these patients complained of sexual dysfunction during treatment with these three other benzodiazepines. Our findings suggest that benzodiazepines, particularly clonazepam in the current study, can be a cause of sexual dysfunction in many male patients. Prospective studies comparing the overall clinical utility of various benzodiazepines are indicated in this and other clinic populations.     

Heterogeneity in the latent structure of PTSD symptoms among Canadian veterans.

The current study used factor mixture modeling to identify heterogeneity (i.e., latent classes) in 2 well-supported models of posttraumatic stress disorder's (PTSD) factor structure. Data were analyzed from a clinical sample of 405 Canadian veterans evaluated for PTSD. Results were consistent with our hypotheses. Each PTSD factor model was best represented by 2 latent classes of participants, differing with respect to PTSD symptom severity. Furthermore, classes were most strongly distinguished by factor scores related to emotional numbing or dysphoria. For both factor models, class membership was significantly predicted by age and depression diagnosis. Implications of these findings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A clinician's guide to PTSD treatments for returning veterans.

What options are available to mental health providers helping clients with posttraumatic stress disorder (PTSD)? In this paper we review many of the current pharmacological and psychological interventions available to help prevent and treat PTSD with an emphasis on combat-related traumas and veteran populations. There is strong evidence supporting the use of several therapies including prolonged exposure (PE), eye movement desensitization and reprocessing (EMDR), and cognitive processing therapies (CPT), with PE possessing the most empirical evidence in favor of its efficacy. There have been relatively fewer studies of nonexposure based modalities (e.g., psychodynamic, interpersonal, and dialectical behavior therapy perspectives), but there is no evidence that these treatments are less effective. Pharmacotherapy is promising (especially paroxetine, sertraline, and venlafaxine), but more research comparing the relative merits of medication vs. psychotherapy and the efficacy of combined treatments is needed. Given the recent influx of combat-related traumas due to ongoing conflicts in Iraq and Afghanistan, there is clearly an urgent need to conduct more randomized clinical trials research and effectiveness studies in military and Department of Veterans Affairs PTSD samples. Finally, we provide references to a number of PTSD treatment manuals and propose several recommendations to help guide clinicians' treatment selections. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Social relationships and PTSD symptomatology in combat veterans.

The primary purpose of this study is to determine if recent combat veterans discriminate between different sources of social support, and then preliminarily investigate the relationship of social support source on posttraumatic stress disorder (PTSD) symptomatology. Participants included 83 married male combat veterans. Principal-axis factor analysis with equamax rotation observed four distinct latent factors for each source of support examined. ANOVAs were performed to determine the relationship of each source of support from the distinct latent factors on the level of PTSD. Results indicate that the level of PTSD is related to support received from a significant other, F(1, 81) = 30.36, p F(1, 81) = 8.10, p = .006, and military peers, F(1, 81) = 6.70, p = .011, but not friends, F(1, 81) = 1.79, p = .18. In general, higher levels of support from each category were associated with lower levels of PTSD in combat veterans. The results suggest that combat veterans distinguish between specific sources of social support, which may have a protective effect on the level of PTSD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Compensation seeking, comorbidity, and apparent exaggeration of PTSD symptoms among Vietnam combat veterans.

Evaluated whether veterans who apparently exaggerate their symptoms are more likely to be (a) seeking disability compensation or (b) suffering from more comorbid pathology than nonexaggerating veterans. 54 of 145 (37%) veterans with posttraumatic stress disorder who completed the Minnesota Multiphasic Personality Inventory—2 (J. N. Butcher, W. G. Dalhstrom, J. R. Graham, A. Telegen, & B. Kaemmer, 1989) were identified as apparent exaggerators, with F (Frequency)– K (Correction) >13. These participants scored higher than nonexaggerators on self-report measures of various psychological symptoms but were no more likely to be seeking compensation or to have comorbid substance use or other anxiety disorders. Affective disorder was overrepresented among apparent exaggerators, however. Findings support the hypothesis of increased comorbidity among symptom exaggerators as measured by the F–K index but not the commonly held belief that symptom exaggerators are more likely to seek compensation. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The support system and amelioration of PTSD in Vietnam veterans.

Describes the nature of posttraumatic stress disorder (PTSD) suffered by Vietnam veterans and the need of a PTSD survivor to use the social healing process to defuse the influence of the traumatic material and to assimilate it. The healing process is considered to have 2 introspective dimensions—the mourning of losses and the examination of self. Each individual relies on a social context to accomplish the process. If patients do not feel approved of within their social context, then they are unable to assume an objective attitude of self-examination. The combined process of mourning and self-examination can enable the veteran to come to better terms with the identity issues of young adulthood, provided that there is a supportive social network available. It is suggested that every veteran with PTSD should receive some form of social-interaction-type treatment as a primary goal to overcome social isolation. Other forms of treatment should be used, according to the symptomatology and the veteran's suitability. (18 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Posttraumatic stress disorder symptoms, physiological reactivity, alcohol problems, and aggression among military veterans.

This study examined the association between posttraumatic stress disorder (PTSD) symptomatology and aggressive behavior among a sample of male Vietnam veterans (N = 1,328). Results indicated that the hyperarousal PTSD symptom cluster evidenced the strongest positive association with aggression at the bivariate level when compared with the other PTSD symptom clusters. When the PTSD symptom clusters were examined together as predictors, hyperarousal symptoms evidenced a significant positive relationship with aggression, and avoidance/numbing symptoms were negatively associated with aggression. Examination of potential mediators indicated that hyperarousal symptoms were directly associated with aggression and indirectly related to aggression via alcohol problems. Reexperiencing symptoms were associated with aggression only indirectly and through their positive association with physiological reactivity and negative association with alcohol problems. Study results highlight the complexity of the relationship between PTSD symptoms and aggression, and suggest possible mechanisms explaining this association. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessment of PTSD and other mental disorders in World War II and Korean Conflict POW survivors and combat veterans.

Mental disorders were assessed in 326 prisoners of war (POWs) of the World War II (WWII) European theater, WWII Pacific theater, and Korean Conflict (KC) and in combat veterans of both wars. Diagnoses were identified using a structured diagnostic interview including a posttraumatic stress disorder (PTSD) module. POW trauma severity was measured by a trauma events index, captivity weight loss, and captivity duration. KC and WWII Pacific former POWs reported the most extreme trauma and, as hypothesized, showed highest prevalences of lifetime and current mental disorders and PTSD. POW subgroups exhibited greater psychopathology than combat veterans. PTSD was frequently associated with other mental disorders and found in high prevalences in all subgroups, pointing to the persistent, far-reaching impact of combat and POW experiences on mental health. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The development of a couple-based treatment for PTSD in returning veterans.

Military personnel deployed in Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) show high levels of emotional distress and posttraumatic stress disorder (PTSD), and these deployment-related problems may be expected to have a devastating impact on their relationships. It is urgent that researchers develop couple-based treatments to reduce PTSD in OEF/OIF veterans and to reduce PTSD-related relationship problems. This article describes the development of a novel couple-based treatment for PTSD, called Structured Approach Therapy (SAT), that uses empathic communication training and stress inoculation procedures to help couples improve their ability to cope with trauma-related anxiety and a multicomponent emotion activation program to help couples reduce emotional numbing. The theoretical basis of the SAT Treatment Model is described, and the various treatment components are presented. The authors recommend that couple-based interventions be used to provide OEF/OIF veterans and their partners with empathic communication skills to discuss their thoughts and feelings about deployment and with dyadic coping skills to confront trauma-related aversive emotions and emotional numbing and return intimacy to their lives. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Stress-disorder symptoms in Vietnam and Korean War veterans.

Compared the incidences of stress-disorder and non-stress-disorder "control" symptoms in the records of 58 Vietnam and Korean War veterans (mean age 25.15 yrs) hospitalized for psychiatric problems between 9 and 36 mo after return from their respective war zones. No significant difference in the percentages of symptoms observed in the 2 groups that fell into the stress-disorder category were found. The percentages of Vietnam veterans who qualified or nearly qualified for stress-disorder diagnoses under criteria from the DSM-III were not larger than the percentages of their Korean War counterparts. Results suggest that stress disorder is neither unique to nor inordinately common among Vietnam veteran psychiatric patients. (15 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Longitudinal changes in the contribution of genetic and environmental influences to symptoms of depression in older male twins.

Genetically informative longitudinal data on self-reported symptoms of depression allow for an investigation of the causes of stability and change in depression symptoms throughout adult life. In this report, the authors investigated the relative contribution of genetic and environmental influences to symptoms of depression in 83 monozygotic and 84 dizygotic male twin pairs from the National Heart, Lung, and Blood Institute (NHLBI) Twin Study. Participants first completed the Center for Epidemiologic Studies—Depression (CES—D) scale in 1985–1986 and again during 1995–1997. Mean age of twins at baseline was 63 years, range 59 to 70. From cross-sectional genetic analyses we estimated the heritability of CES—D to be 25% (95% confidence interval [CI], 11%–39%) at baseline and 55% (95% CI, 40%–71%) at follow-up. Fitting longitudinal genetic models to the two-wave data, we found that stability of symptoms over the 10-year follow-up was due primarily to continuity of genetic influences. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparison of immediate-onset and delayed-onset posttraumatic stress disorder in military veterans.

Differences in symptoms, trauma exposure, dissociative and emotional reactions to trauma, and subsequent life stress in war veterans reporting immediate-onset or delayed-onset posttraumatic stress disorder (PTSD) or no PTSD were investigated. The role of life stress in delayed-onset PTSD was also studied. Retrospective interviews were conducted with 142 United Kingdom veterans receiving a war pension for PTSD or physical disability. Immediate-onset and delayed-onset PTSD were similar in the number and type of symptoms reported at onset, but the delayed-onset group differed in showing a gradual accumulation of symptoms that began earlier and continued throughout their military career. They were more likely to report major depressive disorder and alcohol abuse prior to PTSD onset. Both groups described similar amounts of trauma exposure, but those in the delayed-onset group reported significantly less peritraumatic dissociation, anger, and shame. Veterans with delayed onsets were more likely than veterans with no PTSD to report the presence of a severe life stressor in the year before onset. In conclusion, the results suggest that delayed onsets involve a more general stress sensitivity and a progressive failure to adapt to continued stress exposure. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mindfulness in the treatment of posttraumatic stress disorder among military veterans.

How might a practice that has its roots in contemplative traditions, seeking heightened awareness through meditation, apply to trauma-related mental health struggles among military veterans? In recent years, clinicians and researchers have observed the increasing presence of mindfulness in Western mental health treatment programs. Mindfulness is about bringing an attitude of curiosity and compassion to present experience. This review addresses the above question in a detailed manner with an emphasis on the treatment of military veterans suffering from posttraumatic stress disorder (PTSD) and related psychopathology. In addition, the integration of mindfulness with current empirically supported treatments for PTSD is discussed with specific attention to directions for future research in this area. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Effect of a motivation enhancement intervention on veterans’ engagement in PTSD treatment.

This study is the first randomized controlled trial of the posttraumatic stress disorder (PTSD) motivation enhancement (PME) Group, a brief intervention based on Motivational Interviewing and designed to enhance combat veterans’ engagement in PTSD treatment by increasing awareness of the need to change PTSD-related problems. Outpatients in a year-long, group- and cognitive–behavioral therapy (CBT)–oriented Veterans Affairs PTSD treatment program were randomly assigned to 4 sessions of the PME Group (n = 60) or a Psychoeducation Group (n = 54) in the 2nd month of treatment. Hypotheses about the proposed impact of the PME Group on PTSD treatment engagement (i.e., readiness to change, perceived treatment relevance, and PTSD program attendance) were all supported, although predicted differences were not found on all measures. These results support the need to address readiness to change in combat-related PTSD treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Smoking behavior and readiness to change in male veterans with spinal cord injuries.

Objectives: Little is known about psychological factors associated with tobacco use in persons with spinal cord injuries and disorders (SCI&D). Method: Veterans with SCI&D who were current or past smokers were mailed survey questions about physical dependence on nicotine, motivation to smoke, readiness to quit, and use of tobacco cessation methods. Results: Of 684 respondents, 19% were current smokers. They were younger (Ms = 56.4 vs. 63.3 years; p     

Posttraumatic stress disorders in Vietnam veterans: An addendum to Fairbank et al.

J. A. Fairbank et al (see record 1982-12226-001) presented a selected bibliography on posttraumatic stress disorder, Vietnam veterans, and narratives about posttraumatic stress disorder and combat experiences from other wars. A 63-item bibliographic addendum is presented that includes references from nonprofessional sources as well as traditional mental health journals. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment of active-duty military with PTSD in primary care: Early findings.

The study presents early findings from an ongoing pilot study of a cognitive–behavioral treatment for assisting active-duty military members with deployment-related posttraumatic stress disorder (PTSD) designed for use by psychologists working in an integrated primary care clinic. Treatment protocol is based primarily on Prolonged Exposure but also includes elements of Cognitive Processing Therapy that were adapted for use in primary care. Individuals were recruited from the population of patients consulted to the psychologist by primary care providers during routine clinical care. The 15 participants include active-duty or activated reserve Operation Iraqi Freedom and Operation Enduring Freedom veterans seeking help for deployment-related PTSD symptoms, with a PTSD Checklist-Military Version score 32, and interest in treatment for PTSD in primary care. Baseline and 1-month posttreatment follow-up evaluations were conducted by an independent evaluator. Five participants (33%) dropped out of the intervention after one or two appointments. Using the last observation carried forward for intent-to-treat analyses, the results showed that PTSD severity, depression, and global mental health functioning all significantly improved with the intervention. Fifty percent of treatment completers no longer met criteria for PTSD. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Prior interpersonal trauma: The contribution to current PTSD symptoms in female rape victims.

The purpose of the current study was to disentangle the relationship of childhood sexual abuse and childhood physical abuse from prior adult sexual and physical victimization in predicting current posttraumatic stress disorder (PTSD) symptoms in recent rape victims. The participants were a community sample of 117 adult rape victims assessed within 1 month of a recent index rape for a history of child sexual abuse, child physical abuse, other adult sexual and physical victimization, and current PTSD symptoms. Results from path analyses showed that a history of child sexual abuse seems to increase vulnerability for adult sexual and physical victimization and appears to contribute to current PTSD symptoms within the cumulative context of other adult trauma. (PsycINFO Database Record (c) 2010 APA, all rights reserved)