References: Post Traumatic Stress Disorder 1998

Article References & Abstracts
POST TRAUMATIC STRESS DISORDER 1998

1. Author Mirza KA; Bhadrinath BR; Goodyer IM; Gilmour C
Institution Developmental Psychiatry Section, University of Cambridge, UK.
Title Post-traumatic stress disorder in children and adolescents following road traffic accidents.
Source Br J Psychiatry 1998 May;172:443-7
ISSN 0007-1250
Abstract

BACKGROUND: Post-traumatic stress disorder (PTSD) can be a persistent and disabling psychiatric disorder. There is little systematic research into the psychiatric consequences of road traffic accidents (RTAs) in children and adolescents.
METHOD: A consecutive sample of 8-16-year-olds attending an accident and emergency department following RTAs were screened for PTSD. Potential cases and their parent(s) were interviewed with semi-structured research instruments about six weeks and six months after the accident.
RESULTS: Fifty-three (45%) of the 119 subjects fell above PTSD cut-off on the Frederick's Reaction Index. Thirty-three (75%) of the 44 cases met DSM-IV criteria for PTSD. In half of these other psychiatric disorders were present, including major depressive disorder and anxiety disorders. Being female, involvement in car accidents and pre-existing depression and anxiety were associated with developing PTSD. Seventeen per cent of the sample continued to be symptomatic six months after the accident.
CONCLUSIONS: PTSD is a common consequence of RTAs. Liaison with accident and emergency departments would enhance the early detection and follow-up of children at risk of developing PTSD.

2. Author Ellis A; Stores G; Mayou R
Institution University of Oxford, Park Hospital for Children, United Kingdom.
Title Psychological consequences of road traffic accidents in children.
Source Eur Child Adolesc Psychiatry 1998 Jun;7(2): p61-8
ISSN 1018-8827
Abstract

Questionnaire information about possible psychological changes in the months following their accident was obtained for 45 school age children who had attended an Accident and Emergency Department because of their involvement in road traffic accidents. Central nervous system involvement was rare in this group. Short-term psychological consequences were common, but even after 4-7 months 33% were considered by their parents to still have a moderate reaction and a further 11% were considered to be severely affected. The children had high levels of post-traumatic stress symptoms, particularly avoidance in over 50%. Travel anxiety was described in 39%, 23% were depressed and 14% highly anxious--features which were considered by parents to have appeared following the accident, often with increasing disturbance over time. Other apparent repercussions were nightmares and other sleep difficulties in 17%, accident related fears, irritability, anger and emotionally regressed behaviour. As head injury was very uncommon in this series, such psychological consequences were attributable to non-neurological factors. Parents had become more protective of their children and placed greater restrictions on their travel, causing conflict. Younger children, those who had not fully recovered from their accident injuries, and children who also had a parent involved in the same accident, were most at risk. Greater awareness of these psychological consequences of road traffic accidents is required on the part of parents and professionals. Prospective studies are also needed to delineate more precisely those at greatest risk and to assess the effectiveness of treatment approaches.

3. Author Yehuda R
Institution Posttraumatic Stress Disorder Program, Mount Sinai School of Medicine, Bronx Veterans Affairs, New York, New York, USA.
Title Psychoneuroendocrinology of post-traumatic stress disorder.
Source Psychiatr Clin North Am 1998 Jun;21(2): p359-79
ISSN 0193-953X
Abstract

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.

4. Author Maes M; Lin A; Bonaccorso S; van Hunsel F; Van Gastel A; Delmeire L; Biondi M; Bosmans E; Kenis G; Scharpe S
Institution Clinical Research Center for Mental Health, Antwerp, Belgium.
Title Increased 24-hour urinary cortisol excretion in patients with post-traumatic stress disorder and patients with major depression, but not in patients with fibromyalgia.
Source Acta Psychiatr Scand 1998 Oct;98(4): p328-35
ISSN 0001-690X
Abstract

There is now firm evidence that major depression is accompanied by increased baseline activity of the hypothalamic-pituitary-adrenal (HPA) axis, as assessed by means of 24-h urinary cortisol (UC) excretion. Recently, there were some reports that fibromyalgia and post-traumatic stress disorder (PTSD), two disorders which show a significant amplitude of depressive symptoms, are associated with changes in the baseline activity of the HPA axis, such as low 24-h UC excretion. The aim of the present study was to examine 24-h UC excretion in fibromyalgia and PTSD patients compared to normal controls and patients with major depression. In the three patient groups, severity of depressive symptoms was measured by means of the Hamilton Depression Rating Scale (HDRS) score. Severity of fibromyalgia was measured using a dolorimetrically obtained myalgic score, and severity of PTSD was assessed by means of factor analytical scores computed on the items of the Composite International Diagnostic Interview (CIDI), PTSD Module. Patients with PTSD and major depression had significantly higher 24-h UC excretion than normal controls and fibromyalgia patients. At a threshold value of > or = 240 micrograms/24 h, 80% of PTSD patients and 80% of depressed patients had increased 24 h UC excretion with a specificity of 100%. There were no significant differences in 24-h UC excretion either between fibromyalgia patients and normal controls, or between patients with major depression and PTSD patients. In the three patient groups, no significant correlations were found between 24-h UC excretion and the HDRS score. In fibromyalgia, no significant correlations were found between 24-h UC excretion and the myalgic score. In PTSD, no significant correlations were found between 24-h UC excretion and severity of either depression-avoidance or anxiety-arousal symptoms. In conclusion, this study found increased 24-h UC excretion in patients with PTSD comparable to that in patients with major depression, whereas in fibromyalgia no significant changes in 24-h UC were found.

5. Author Golier J; Yehuda R
Institution Mount Sinai School of Medicine and the Bronx Veterans Affairs Medical Center, NY 10468, USA. golier.julia@bronx.va.gov.
Title Neuroendocrine activity and memory-related impairments in posttraumatic stress disorder.
Source Dev Psychopathol 1998 Fall;10(4): p857-69
ISSN 0954-5794
Abstract

This article reviews memory-related impairments in trauma survivors with posttraumatic stress disorder and their possible association to neuroendocrine alterations seen in this disorder. The neuroendocrine profile in PTSD first described in chronically ill combat veterans is characterized by lower basal cortisol levels, higher glucocorticoid receptor number, enhanced sensitivity to exogenous steroids, and increased variation in basal cortisol levels over the diurnal cycle. The generalizability and time course of these neuroendocrine alterations are explored in longitudinal studies and studies in other traumatized populations. These studies suggest that at least some aspects of this neuroendocrine profile can also be seen in other populations, including women, children, and victims of childhood trauma. Additionally, the alterations may be present early in the course of illness, perhaps even in the immediate aftermath of trauma, and may continue to be manifest in elderly trauma survivors. The mechanisms by which these neuroendocrine alterations may influence the formation and processing of traumatic memories are discussed.

6. Author Berthier ML; Kulisevsky J; Fernandez Benitez JA; Gironell A
Institution Neurology Service, Clinic University Hospital, University of Malaga, Spain.
Title Reactivation of posttraumatic stress disorder after minor head injury.
Source Depress Anxiety 1998;8(1): p43-7
ISSN 1091-4269
Abstract

This report describes the reactivation of a posttraumatic stress disorder (PTSD) after a minor head injury in two young women who had recovered from extreme stress caused by sexual abuse during adolescence. Intrusive thoughts, images, dreams, and phobic avoidance bear a direct relationship to the specific circumstances of both head injury and sexual abuse, and were associated with obsessive-compulsive symptoms, generalized anxiety with panic, and depression. These findings suggest that in some individuals minor head injuries may induce not only extreme stress reactions, but also cause the reactivation of symptoms related to previous traumatic experiences.

7. Author Breslau N; Kessler RC; Chilcoat HD; Schultz LR; Davis GC; Andreski P
Institution Department of Psychiatry, Henry Ford Health System, Detroit, Mich 48202- 450, USA. nbresla1@hfhs.org.
Title Trauma and posttraumatic stress disorder in the community: the 1996 Detroit Area Survey of Trauma.
Source Arch Gen Psychiatry 1998 Jul;55(7): p626-32
ISSN 0003-990X
Abstract

BACKGROUND: The study estimates the relative importance of specific types of traumas experienced in the community in terms of their prevalence and risk of leading to posttraumatic stress disorder (PTSD).
METHODS: A representative sample of 2181 persons in the Detroit area aged 18 to 45 years were interviewed by telephone to assess the lifetime history of traumatic events and PTSD, according to DSM-IV. Posttraumatic stress disorder was assessed with respect to a randomly selected trauma from the list of traumas reported by each respondent, using a modified version of the Diagnostic Interview Schedule, Version IV, and the World Health Organization Composite International Diagnostic Interview. RESULTS: The conditional risk of PTSD following exposure to trauma was 9.2%. The highest risk of PTSD was associated with assaultive violence (20.9%). The trauma most often reported as the precipitating event among persons with PTSD (31% of all PTSD cases) was sudden unexpected death of a loved one, an event experienced by 60% of the sample, and with a moderate risk of PTSD (14.3%). Women were at higher risk of PTSD than men, controlling for type of trauma. CONCLUSIONS: The risk of PTSD associated with a representative sample of traumas is less than previously estimated. Previous studies have overestimated the conditional risk of PTSD by focusing on the worst events the respondents had ever experienced. Although recent research has focused on combat, rape, and other assaultive violence as causes of PTSD, sudden unexpected death of a loved one is a far more important cause of PTSD in the community, accounting for nearly one third of PTSD cases.

8. Author Shalev AY; Sahar T; Freedman S; Peri T; Glick N; Brandes D; Orr SP; Pitman RK
Institution The Center for Traumatic Stress, Department of Psychiatry, Hadassah University Hospital, Jerusalem, Israel.
Title A prospective study of heart rate response following trauma and the subsequent development of posttraumatic stress disorder.
Source Arch Gen Psychiatry 1998 Jun;55(6): p553-9
ISSN 0003-990X
Abstract

BACKGROUND: Physiological arousal during traumatic events may trigger the neurobiological processes that lead to posttraumatic stress disorder (PTSD). This study prospectively examined the relationship between heart rate and blood pressure recorded immediately following a traumatic event and the subsequent development of PTSD.
METHODS: Eighty-six trauma survivors who presented at the emergency department of a general hospital were followed up for 4 months. Heart rate and blood pressure were recorded on arrival at the emergency department. Heart rate, anxiety, depression, and PTSD symptoms were assessed 1 week, 1 month, and 4 months later. The clinician-administered PTSD scale defined PTSD status at 4 months. RESULTS: twenty subjects (23%) met PTSD diagnostic criteria at the 4-month assessment (PTSD group), and 66 (77%) did not (non-PTSD group). Subjects who developed PTSD had higher heart rates at the emergency department (95.5+/-13.9 vs 83.3+/-10.9 beats per minute, t=4.4, P<.001) and 1 week later (77.8+/-11.9 vs 72.0+/-9.5 beats per minute, t=2.25, P<.03), but not after 1 and 4 months. The groups did not differ in initial blood pressure measurement. Repeated-measures analysis of variance (ANOVA) for heart rate showed a significant group effect (P<.02), time effect (P<.001), and group x time interaction (P<.001). The time effect and group x time interaction remained significant when adjusted for sex, age, trauma severity, immediate response, and dissociation during the traumatic event.
CONCLUSION: Elevated heart rate shortly after trauma is associated with the later development of PTSD.

9. Author Harvey AG; Bryant RA
Institution School of Psychology, University of New South Wales, Sydney, Australia.
Title The relationship between acute stress disorder and posttraumatic stress disorder: a prospective evaluation of motor vehicle accident survivors.
Source J Consult Clin Psychol 1998 Jun;66(3): p507-12
ISSN 0022-006X
Abstract

Motor vehicle accident survivors (n = 92) were assessed for acute stress disorder (ASD) within 1 month of the trauma and reassessed (n = 71) for posttraumatic stress disorder (PTSD) 6 months posttrauma. ASD was diagnosed in 13% of participants, and a further 21% had subclinical levels of ASD. At follow-up, 78% of ASD participants and 60% of subclinical ASD participants met criteria for PTSD. The strong predictive power of acute numbing, depersonalization, a sense of relieving the trauma, and motor restlessness, in contrast to the low to moderate predictive power of other symptoms, indicates that only a subset of ASD symptoms is strongly related to the development of chronic PTSD. Although these findings support the use of the ASD diagnosis, they suggest that the dissociative and arousal clusters may require revision.

10. Author Classen C; Koopman C; Hales R; Spiegel D
Institution Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, CA 94305-5718, USA. classen@leland.stanford.edu.
Title Acute stress disorder as a predictor of posttraumatic stress symptoms.
Source Am J Psychiatry 1998 May;155(5): p620-4
ISSN 0002-953X
Abstract

OBJECTIVE: Using the DSM-IV diagnostic criteria for acute stress disorder, the authors examined whether the acute psychological effects of being a bystander to violence involving mass shootings in an office building predicted later posttraumatic stress symptoms.
METHOD: The participants in this study were 36 employees working in an office building where a gunman shot 14 persons (eight fatally). The acute stress symptoms were assessed within 8 days of the event, and posttraumatic stress symptoms of 32 employees were assessed 7 to 10 months later. RESULTS: According to the Stanford Acute Stress Reaction Questionnaire, 12 (33%) of the employees met criteria for the diagnosis of acute stress disorder. Acute stress symptoms were found to be an excellent predictor of the subjects' posttraumatic stress symptoms 7-10 months after the traumatic event.
CONCLUSIONS: These results suggest not only that being a bystander to violence is highly stressful in the short run, but that acute stress reactions to such an event further predict later posttraumatic stress symptoms.

11. Author Bryant RA; Harvey AG
Institution School of Psychology, University of New South Wales, Australia. r.bryant@unsw.edu.au.
Title Relationship between acute stress disorder and posttraumatic stress disorder following mild traumatic brain injury.
Source Am J Psychiatry 1998 May;155(5): p625-9
ISSN 0002-953X
Abstract

OBJECTIVE: The aim of this study was to index the frequency of occurrence of acute stress disorder following mild traumatic brain injury and to determine its utility in predicting posttraumatic stress disorder (PTSD).
METHOD: Consecutive adult patients who sustained a mild traumatic brain injury following a motor vehicle accident (N = 79) were assessed for acute stress disorder within 1 month of their trauma with the Acute Stress Disorder Inventory, a structured clinical interview based on DSM-IV criteria. Patients were followed up 6 months after the trauma (N = 63) and were administered the PTSD module of the Composite International Diagnostic Interview. RESULTS: Acute stress disorder was diagnosed in 14% of patients, and at follow-up 24% satisfied criteria for PTSD. Six months after the trauma PTSD was diagnosed in 82% of patients who had been diagnosed with acute stress disorder and in 11% of those who had not been diagnosed with acute stress disorder.
CONCLUSIONS: These findings point to the frequency of PTSD following mild traumatic brain injury. While the criteria for acute stress disorder are useful in identifying those individuals who are at risk of developing chronic PTSD, the findings suggest that current criteria require modification in order to optimally predict PTSD following mild traumatic brain injury.

12. Author Max JE; Castillo CS; Robin DA; Lindgren SD; Smith WL Jr; Sato Y; Arndt S
Institution Department of Psychiatry, University of Iowa, Iowa City, USA.
Title Posttraumatic stress symptomatology after childhood traumatic brain injury.
Source J Nerv Ment Dis 1998 Oct;186(10): p589-96
ISSN 0022-3018
Abstract

The purpose of this study was to quantify and to identify predictors of posttraumatic stress disorder (PTSD) symptomatology after traumatic brain injury (TBI). Fifty children aged 6 to 14 years, hospitalized after TBI, were assessed soon after TBI regarding injury severity and preinjury psychiatric, socioeconomic, family functioning, and family psychiatric history status; neuroimaging was also analyzed. Psychiatric assessments were repeated 3, 6, 12, and 24 months after TBI. Only 2 of 46 (4%) subjects with at least one follow-up assessment developed PTSD. However, the frequency with which subjects experienced at least one PTSD symptom ranged from 68% in the first 3 months to 12% at 2 years in assessed children. The presence of an internalizing disorder at time of injury followed by greater injury severity were the most consistent predictors of PTSD symptomatology. It is apparent, therefore, that PTSD and subsyndromal posttraumatic stress disturbances occur despite neurogenic amnesia. These problems should be treated, particularly if symptoms persist beyond 3 months.

13. Author Ehlers A; Mayou RA; Bryant B
Institution Department of Psychiatry, University of Oxford, United Kingdom. anke.ehlers@psychiatry.ox.ac.uk.
Title Psychological predictors of chronic posttraumatic stress disorder after motor vehicle accidents.
Source J Abnorm Psychol 1998 Aug;107(3): p508-19
ISSN 0021-843X
Abstract

A prospective longitudinal study assessed 967 consecutive patients who attended an emergency clinic shortly after a motor vehicle accident, again at 3 months, and at 1 year. The prevalence of posttraumatic stress disorder (PTSD) was 23.1% at 3 months and 16.5% at 1 year. Chronic PTSD was related to some objective measures of trauma severity, perceived threat, and dissociation during the accident, to female gender, to previous emotional problems, and to litigation. Maintaining psychological factors, that is, negative interpretation of intrusions, rumination, thought suppression, and anger cognitions, enhanced the accuracy of the prediction. Negative interpretation of intrusions, persistent medical problems, and rumination at 3 months were the most important predictors of PTSD symptoms at 1 year. Rumination, anger cognitions, injury severity, and prior emotional problems identified cases of delayed onset.

14. Author Ferrada-Noli M; Asberg M; Ormstad K; Lundin T; Sundbom E
Institution Department of Social Medicine, Harvard Medical School, Boston, Massachusetts 02115, USA.
Title Suicidal behavior after severe trauma. Part 1: PTSD diagnoses, psychiatric comorbidity, and assessments of suicidal behavior.
Source J Trauma Stress 1998 Jan;11(1): p103-12
ISSN 0894-9867
Abstract

The study comprises 149 refugees from various countries, reporting exposure to severe traumata, who were referred for psychiatric diagnosis and assessment of suicide risk. The stressors reported comprised both personal experience of and/or forced witnessing of combat atrocities (including explosions or missile impacts in urban areas), imprisonment (including isolation), torture and inflicted pain, sexual violence, witnessing others' suicide, and of summary and/or mock executions. Posttraumatic stress disorder (PTSD) was diagnosed in 79% of all cases, other psychiatric illness in 16% and no mental pathology in 5%. The prevalence of suicidal behavior was significantly greater among refugees with principal PTSD diagnoses than among the remainder. PTSD patients with depression comorbidity reported higher frequency of suicidal thoughts; PTSD nondepressive patients manifested increased frequency of suicide attempts.

http://home.mdconsult.com/das/journal/view/N/10461228?ja=131980&PAGE=1.html&sid=4338226&source=HS,MI

15. Author Chilcoat HD; Breslau N
Institution Department of Psychiatry, Henry Ford Health Sciences Center, Detroit, Mich 48202-3450, USA. hchilco1@hfhs.org.
Title Posttraumatic stress disorder and drug disorders: testing causal pathways.
Source Arch Gen Psychiatry 1998 Oct;55(10): p913-7
ISSN 0003-990X
Abstract

BACKGROUND: Although there is a high degree of comorbidity between posttraumatic stress disorder (PTSD) and drug use disorders, little is known about causal relationships between PTSD, exposure to traumatic events, and drug use disorders.
METHODS: In a longitudinal study in southeast Michigan, 1007 adults aged 21 to 30 years were initially assessed in 1989 and were followed up 3 and 5 years later, in 1992 and 1994. Psychiatric disorders according to DSM-III-R criteria were measured by the National Institute of Mental Health Diagnostic Interview Schedule. To take into account temporal sequencing, the associations between PTSD, traumatic events, and drug use disorders were analyzed by using Cox proportional hazards models with time-dependent covariates.
RESULTS: Posttraumatic stress disorder signaled an increased risk of drug abuse or dependence (hazards ratio, 4.5; 95% confidence interval, 2.6-7.6, adjusted for sex), whereas exposure to traumatic events in the absence of PTSD did not increase the risk of drug abuse or dependence. The risk for abuse or dependence was the highest for prescribed psychoactive drugs (hazards ratio, 13.0; 95% confidence interval, 5.3-32.0). There was no evidence that preexisting drug abuse or dependence increased the risk of subsequent exposure to traumatic events or the risk of PTSD after traumatic exposure.
CONCLUSION: The results suggest that drug abuse or dependence in persons with PTSD might be the inadvertent result of efforts to medicate symptoms, although the possibility of shared vulnerability to PTSD and drug use disorders cannot be ruled out.

Deception and detection in psychiatric diagnosis.

16. Author Brady KT; Dansky BS; Sonne SC; Saladin ME
Institution Department of Psychiatry, Medical University of South Carolina, Charleston 29425, USA.
Title Posttraumatic stress disorder and cocaine dependence. Order of onset.
Source Am J Addict 1998 Spring;7(2): p128-35
ISSN 1055-0496
Abstract

To investigate differences between patients whose posttraumatic stress disorder (PTSD) preceded their cocaine dependence and vice versa, 33 patients with comorbid PTSD and cocaine dependence were divided into two groups: one in which the traum and PTSD occurred before onset of cocaine dependence (primary PTSD) and one in which the PTSD occurred after cocaine dependence was established (primary cocaine). In the primary-PTSD group, the trauma was generally childhood abuse. In the primary-cocaine group, the trauma was generally associated with the procurement and use of cocaine. In the primary PTSD group, there were significantly more women, more other Axis I diagnoses, more Cluster B and C Axis II diagnoses, and more benzodiazepine and opiate use. In the primary-cocaine group, there was a trend toward more cocaine use in the previous month. Significant clinical differences between these two groups may warrant different types of treatment or differing treatment emphasis.

17. Author Liljequist L; Kinder BN; Schinka JA
Institution Department of Psychology, Murray State University, USA.
Title An investigation of malingering posttraumatic stress disorder on the Personality Assessment Inventory.
Source J Pers Assess 1998 Dec;71(3): p322-36
ISSN 0022-3891
Abstract

Utilizing the Personality Assessment Inventory (PAI; Morey, 1991), this study aimed to isolate a pattern of responding that is indicative of an attempt to malinger posttraumatic stress disorder (PTSD). The PAI profiles of 116 male participants were examined. Profiles of a group of 29 alcohol-abusing veterans with a primary Axis I (American Psychiatric Association, 1994) diagnosis of PTSD and a group of 30 alcohol-abusing veterans with no other diagnoses were compared to those of 27 undergraduate men instructed to feign PTSD. Control data were obtained from another group of 30 undergraduates. The student malingerers produced PAI profiles that were significantly different from the veterans with PTSD. Seven scales distinguished the malingerers from the veterans with an actual diagnosis of PTSD. Malingerers tended to overexaggerate pathology, inflating their scores on many clinical scales greater than the mean of the PTSD sample. Malingerers also scored higher on Morey's (1993) 8-item Malingering Index than either group of veterans and the controls. Only 2 scales reliably differentiated alcohol-abusing veterans with PTSD from those without the disorder. The implications of these findings in the diagnosis of PTSD are discussed.

18. Author Blanchard EB; Hickling EJ; Taylor AE; Buckley TC; Loos WR; Walsh J
Institution Center for Stress and Anxiety Disorders, University at Albany-SUNY 12203, USA.
Title Effects of litigation settlements on posttraumatic stress symptoms in motor vehicle accident victims.
Source J Trauma Stress 1998 Apr;11(2): p337-54
ISSN 0894-9867
Abstract

In order to investigate the effects of the initiation of litigation and its settlement on victims of motor vehicle accidents (MVAs), we followed up 132 MVA victims from an initial assessment 1 to 4 months post-MVA for 1 year. Of the 67 who had initiated litigation, 18 (27%) settled within the 12 months, while 49 still had litigation pending; 65 never initiated litigation. Those who initiated litigation had more severe injuries and higher initial levels of posttraumatic stress (PTS) symptoms. All three groups improved in major role function and had reduced PTS symptoms over the 1 year follow-up. Those whose suits were still pending, as well as those whose suits had been settled, showed no reduction in measures of anxiety or depression, whereas the nonlitigants did show improvement on these measures.

19. Author Fontana A; Rosenheck R
Institution Northeast Program Evaluation Center (182), VA National Center for PTSD, VA Connecticut Healthcare System, West Haven 06516, USA.
Title Effects of compensation-seeking on treatment outcomes among veterans with posttraumatic stress disorder.
Source J Nerv Ment Dis 1998 Apr;186(4): p223-30
ISSN 0022-3018
Abstract

The desire to acquire or increase financial compensation for a psychiatric disability is widely believed to introduce a response bias into patients' reports of their symptoms and their work performance. The hypothesized effects of compensation-seeking in inhibiting improvement from treatment are examined. Data from outpatient (N = 455) and inpatient (N = 553) programs for the treatment of posttraumatic stress disorder and associated disorders in the Department of Veterans Affairs were used to compare outcomes for veterans who were and were not seeking compensation. Outcome was measured as pre/post improvement in symptoms and work performance over the course of 1 year after the initiation of treatment. No compensation-seeking effect was observed among outpatients, but a significant effect was found for some inpatients. The effect for inpatients was manifested essentially by patients in a program type which was designed to have an extremely long length of stay, thus triggering a virtually automatic increase in payments. Like outpatients, inpatients in programs with a moderate length of stay did not manifest a compensation-seeking effect on improvement. Although not permitting a definitive explanation, the preponderance of the evidence favors the overstatement of symptoms rather than either the severity or the chronicity of the disorder as the most likely explanation for the compensation-seeking effect that was observed. For patients treated in standard outpatient and short-stay inpatient programs, compensation does not seem to affect clinical outcomes adversely.

20. Author Meek JK; Kablinger A
Institution Outpatient Psychiatry Clinic, Louisiana State University Medical Center, Shreveport, USA.
Title Antidepressants and posttraumatic stress disorder.
Source J La State Med Soc 1998 Oct;150(10): p487-9
ISSN 0024-6921
Abstract

This is a review of literature on the use of antidepressants in the symptomatic treatment of posttraumatic stress disorder. The use of tricyclic antidepressants, monoamine oxidase inhibitors, serotonin-selective reuptake inhibitors, and their effectiveness in treating the symptoms of posttraumatic stress disorder are discussed based on the most recent data available. In conclusion, it is clear that the use of antidepressants is effective in controlling the symptoms of posttraumatic stress disorder.

21. Author Sherman JJ
Institution University of Washington, College of Medicine, Department of Psychiatry and Behavioral Science, Seattle 98195-6560, USA.
Title Effects of psychotherapeutic treatments for PTSD: a meta-analysis of controlled clinical trials.
Source J Trauma Stress 1998 Jul;11(3): p413-35
ISSN 0894-9867
Abstract

This meta-analysis synthesized the results from controlled, clinical trials of psychotherapeutic treatments for posttraumatic stress disorder (PTSD). Psychotherapeutic modalities included behavioral, cognitive, and psychodynamic treatments, in group and individual settings. Participants in the studies included combat veterans from the Vietnam and Lebanon Wars, crime-related victims, and severe bereavement sufferers. The impact of psychotherapy on PTSD and psychiatric symptomatology was significant, d = .52, r = .25, when measured immediately after treatments were administered. Similarly, there was no decay in the effect of treatment at follow-up, d = .64, r = .31. Moreover, for target symptomes of PTSD and general psychological symptomes (intrusion, avoidance, hyperarousal, anxiety, and depression), effect sizes were significant, ranging from r's of .2-.49. Results suggest substantial promise for improving psychological health and decreasing related symptoms for those suffering from PTSD.