Treating traumatic stress: conducting imaginal exposure in PTSD (clinician manual & DVD, new edition)
The Australian Centre for Posttraumatic Mental Health (ACPMH) has released a new edition of our internationally endorsed training package, Treating traumatic stress: conducting imaginal exposure in PTSD. This package is used in the training program of the National Center for PTSD, US Department of Veterans' Affairs. Now with an easier-to-use manual and accompanying DVD, the training package provides health practitioners with the knowledge and skills they need to confidently use imaginal exposure. The manual includes key learning activities and the DVD includes therapy demonstrations. More information: http://www.acpmh.unimelb.edu.au »

Australian Guidelines for the Treatment of Adults with Acute Stress Disorder and Posttraumatic Stress Disorder
The Australian Centre for Posttraumatic Mental Health (ACPMH) published the Guidelines in 2007. Approved by the National Medical Health and Research Council, these new Guidelines assist health practitioners to determine when is the right time for professional intervention and what is the best approach for helping people affected by trauma.
More information: http://www.acpmh.unimelb.edu.au »

J. P. Wilson, C. C. So-Kum Tang
Cross-Cultural Assessment of Psychological Trauma and PTSD
2007. 410 p.; GEB; Englisch
Springer, Berlin, 2007 »

Michael Linden, Max Rotter, Kai Baumann et al.
Posttraumatic Embitterment Disorder Definition, Evidence, Diagnosis, Treatment
2007. 155 p. 24 cm; GEB; Englisch
Hogrefe-Verlag, 2007 »

Waldrop AE, Back SE, Brady KT, Upadhyaya HP, McRae AL, Saladin MEDepartment of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, Box 250861, Charleston, SC 29425, United States.
Daily stressor sensitivity, abuse effects, and cocaine use in cocaine dependence. Addictive Behaviors 2007 Dec;32(12):3015-25. Epub 2007 Jul 19
This study highlights respondent sensitivity to daily hassles as it relates to situational cocaine use and perceived long-term effects of adverse events in childhood. Data were drawn from a larger study on stress reactivity in cocaine dependent individuals. In use and frequency no gender differences were found. Overall, there were some associations in the patterns of cocaine use and sensitivity to daily hassles, particularly the use in response to conflict with others. Early negative life events were positively related to response to daily hassles, but current triggers were more relevant.
PMID: 17706887 [PubMed - in process] (subscribers only).
http://www.ncbi.nlm.nih.gov/
November 2007

Testa M, Livingston JA, Hoffman JH. University at Buffalo, Research Institute on Addictions, 1021 Main Street, Buffalo, NY 14203, United States.
Does sexual victimization predict subsequent alcohol consumption? A prospective study among a community sample of women. Addictive Behaviors 2007 Dec;32(12):2926-39. Epub 2007 Jun 9
The prospective study examined whether sexual victimization contributes to subsequent heavy drinking among a community sample of women, 18-30 years of age (n=927). Using three waves of data, 12 months apart, an examination of the impact of T1 sexual victimization on T2 heavy drinking, and of T2 sexual victimization on T3 heavy drinking was done. There were significant bivariate differences between sexually victimized and non-victimized women on heavy drinking both concurrently and prospectively. Also tested was the hypothesis that Post-Traumatic Stress Disorder (PTSD) Symptoms would mediate the relationship between T2 sexual victimization and T3 heavy drinking. PTSD did not contribute to subsequent heavy drinking. Findings suggest that heavy drinking is relatively stable over time and that sexual victimization does not make a substantial independent contribution to heavy drinking among women in the general population.
PMID: 17597304 [PubMed - in process] (subscribers only).
http://www.ncbi.nlm.nih.gov/
November 2007

Beckham JC, Dennis MF, McClernon FJ, Mozley SL, Collie CF, Vrana SR. Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States; Psychology Service, Durham Veterans Affairs Medical Center, Durham, NC, United States.
The effects of cigarette smoking on script-driven imagery in smokers with and without posttraumatic stress disorder. Addictive Behaviors 2007 Dec;32(12):2900-15. Epub 2007 May 3
The effects of smoking a nicotinized or denicotinized cigarette on craving, affect and posttraumatic stress disorder (PTSD) symptoms while recalling neutral, stressful and traumatic events in smokers with and without PTSD were investigated. Smokers completed laboratory sessions during which they were presented with audiotapes of personalized scripts followed by smoking a cigarette. The main effect was for script type across groups for smoking craving, negative affect and PTSD symptoms, with increased symptoms in trauma and stressful conditions. Responses were significantly higher in PTSD smokers. Smoking either cigarette type resulted in decreased craving, negative affect and PTSD symptoms in both groups.The results support that context and non-pharmacologic effects of smoking are important variables in smoking craving and mood, particularly in smokers with PTSD.
PMID: 17544226 [PubMed - in process] (subscribers only).
http://www.ncbi.nlm.nih.gov/
November 2007

Jogems-Kosterman BJ, de Knijff DW, Kusters R, van Hoof JJ. Institute of Mental Health Care, GGZ Oost Brabant, P.O. Box 632, 5340 AP Oss, The Netherlands.
Basal cortisol and DHEA levels in women with borderline personality disorder. Journal of Psychiatr Research 2007 Dec;41(12):1019-26. Epub 2006 Oct 9
Research suggests that in borderline personality disorder (BPD) normal stress regulation, with a main role for cortisol, is disturbed. Relevant patient characteristics such as depression, childhood abuse, posttraumatic stress disorder (PTSD) and copying styles were not systematically examined. Moreover, none of the studies incorporated dehydroepiandrosterone (DHEA), a hormone that can antagonize the effects of cortisol. The pilot study investigates the basic levels of cortisol and DHEA and the ratio (CDR) between the two hormones in BPD patients. Overall cortisol levels were not significantly increased in the patient group as a whole but only in those patients diagnosed with co-morbid PTSD and a history of childhood abuse. The patients' cortisol secretions decreased relatively less steep during the day than it did in the controls. The current findings underline the relevance of cortisol and DHEA assessments and the need for further scrutiny of their interplay to foster our understanding of the biological basis of stress regulation in BPD.
PMID: 17028025 [PubMed - in process] (subscribers only).
http://www.ncbi.nlm.nih.gov/
November 2007

Frueh BC, Monnier J, Grubaugh AL, Elhai JD, Yim E, Knapp R. University of Hawai'i at Hilo. frueh@hawaii.edu.
Therapist Adherence and Competence With Manualized Cognitive-Behavioral Therapy for PTSD Delivered via Videoconferencing Technology. Behavior Modification 2007 Nov;31(6):856-66.
In this Study a secondary analyses from a randomized trial comparing the effectiveness of manualized cognitive-behavioral therapy for posttraumatic stress disorder was used. The Authors compared ratings of therapist competency and adherence between two service delivery modes: telepsychiatry (TP) and same room (SR). Patients were 38 male treatment-seeking veterans recruited from a veterans affairs medical center. Domains of therapist competence and adherence included several domains. Only one difference emerged between the two treatment conditions, with more favorable ratings on this item in the TP condition. Findings suggest that therapist competence and adherence to cognitive-behavioral therapy is similar whether the treatment is delivered via TP or by traditional means, and TP does not compromise therapists' ability to effectively structure sessions or build rapport with patients. These data further support the use of TP to address shortages in access to mental health care.
PMID: 17932240 [PubMed - in process] (subscribers only).
http://www.ncbi.nlm.nih.gov/
November 2007

Scholes C, Turpin G, Mason S. Clinical Psychology Unit, Department of Psychology, Western Bank, University of Sheffield, Sheffield S10 2TP, UK.
A randomised controlled trial to assess the effectiveness of providing self-help information to people with symptoms of acute stress disorder following a traumatic injury. Behaviour Research and Therapy 2007 Nov;45(11):2527-36. Epub 2007 Jun 23
Patients attending accident and emergency (A&E) may develop long-term psychological difficulties. Psycho-education has been suggested to reduce the risk of post-injury disorders. The Study group tested the efficacy of providing self-help information to a high-risk sample by screening attenders for acute stress disorder and randomised to two groups: patients (n=116) receiving a self-help booklet and those who did not (n=111). A sample of 'low' scorers was also included (n=120); they did not receive a booklet. Psychological assessments were completed at baseline (within 1 month post-injury) and 3 and 6 months post-injury. Post-traumatic stress disorder (PTSD), anxiety and depression decreased (p<0.001) across time but there were no group differences in these measures or quality of life. However, subjective ratings of the usefulness of the self-help booklet were very high.
PMID: 17662689 [PubMed - in process] (subscribers only).
http://www.ncbi.nlm.nih.gov/
November 2007

Lubman DI, Allen NB, Rogers N, Cementon E, Bonomo Y. ORYGEN Research Centre, Department of Psychiatry, University of Melbourne, Australia.
The impact of co-occurring mood and anxiety disorders among substance-abusing youth. Journal of Affective Disorders 2007 Nov;103(1-3):105-12. Epub 2007 Feb 8.
Comorbid mood and anxiety disorders are highly prevalent amongst substance-using young adolescents, and have been associated with a range of adverse outcomes. One hundred young people (mean age 19.4 years) were recruited from two youth drug treatment services in Melbourne, Australia. They were screened with a structured interview and questionnaires assessing drug use, psychopathology, risk-taking behaviours and quality of life. Fifty percent of the sample met criteria for at least one current mental health disorder. 49% met criteria for a current mood or anxiety disorder, with 68% reporting a lifetime history. There were high rates of current Major Depressive Disorder (MDD; 27%) and Post-traumatic Stress Disorder (PTSD; 26%) within the sample. Participants with these disorders were more likely to have a higher number of comorbid disorders, report more substance-related problems and a poorer quality of life.In older adolescence and emerging adulthood, young drug users with comorbid affective disorders have greater mental health and substance use morbidity than those with substance use problems alone.
PMID: 17291589 [PubMed - in process] (subscribers only).
http://www.ncbi.nlm.nih.gov/
November 2007

Pivac N, Knezevic J, Kozaric-Kovacic D, Dezeljin M, Mustapic M, Rak D, Matijevic T, Pavelic J, Muck-Seler D. Rudjer Boskovic Institute, Division of Molecular Medicine, POBox 180, HR-10002 Zagreb, Croatia.
Monoamine oxidase (MAO) intron 13 polymorphism and platelet MAO-B activity in combat-related posttraumatic stress disorder. Journal of Affective Disorders 2007 Nov;103(1-3):131-8. Epub 2007 Feb 7
Neurobiology of posttraumatic stress disorder (PTSD) involves alterations in multiple neuroendocrine and neurotransmitter systems. Platelet monoamine oxidase (MAO-B) has been associated with susceptibility to various psychiatric disorders, personality traits and behaviors. Platelet MAO-B activity and MAO-B intron 13 polymorphism (a G/A substitution) were determined in male war veterans (n=106) with DSM-IV diagnosed current and chronic PTSD, combat exposed veterans (n=41) who did not develop PTSD, and healthy control men (n=242). A two-way ANOVA revealed a significant effect of diagnosis and smoking, a significant effect of smoking, no significant effect of genotype, and no significant interaction between genotype, smoking or diagnosis, on platelet MAO-B activity. One-way ANOVAs showed significantly lower platelet MAO-B activity in smokers than in nonsmokers. After controlling for smoking, veterans with psychotic PTSD had significantly higher platelet MAO-B activity than veterans with or without PTSD, or healthy subjects. The MAO-B intron 13 polymorphism was not functional, and did not affect platelet MAO-B activity. The allele frequencies of the MAO-B genotype were similarly distributed among healthy controls and veterans with or without PTSD and/or psychotic symptoms.
PMID: 17289152 [PubMed - in process] (subscribers only).
http://www.ncbi.nlm.nih.gov/
November 2007

Siegmund A, Wotjak CT. Max-Planck-Institut für Psychiatrie, AG Neuronale Plastizität, Kraepelinstr. 2, D-80804 Munich, Germany.
A mouse model of posttraumatic stress disorder that distinguishes between conditioned and sensitised fear. Journal of Psychiatric Research 2007 Nov;41(10):848-60. Epub 2006 Oct 5
The pathomechanisms of posttraumatic stress disorder (PTSD) are widely unknown. Fear conditioning and stress sensitisation are supposed to play a crucial role. Hence, valid animal models that model both associative and non-associative components of fear will facilitate elucidation of the biological substrates of the illness, and to develop novel and specific approaches for its prevention and therapy. The author applied a single electroc footshock on mice and recorded the conditioned response to contextual trauma reminders (associative fear), the sensitised reaction to a neutral tone in a novel environment (non-associative fear, hyperarousal), social interaction and various emotional behaviours using diverse methods. Freezing generally increased as a function of shock intensity. This mouse model fulfils common criteria for face and predictive validity and can be used to investigate the biological correlates of individual fear susceptibility, as well as the impact and interrelationship of associative and non-associative fear components in the development and maintenance of PTSD.
PMID: 17027033 [PubMed - indexed for MEDLINE] (subscribers only).
http://www.ncbi.nlm.nih.gov/
November 2007

von Känel R, Hepp U, Kraemer B, Traber R, Keel M, Mica L, Schnyder U. Department of General Internal Medicine, Division of Psychosomatic Medicine, University Hospital/INSELSPITAL, Freiburgstrasse 4, CH-3010 Berne, Switzerland. roland.vonkaenel@insel.ch
Evidence for low-grade systemic proinflammatory activity in patients with posttraumatic stress disorder. Journal of Psychiatric Research 2007 Nov;41(9):744-52. Epub 2006 Aug 9
Posttraumatic stress disorder (PTSD) may increase cardiovascular risk. The psychophysiological mechanisms involved are elusive. The authors hypothesized that proinflammatory activity is elevated in patients with PTSD. Plasma levels of proinflammatory C-reactive protein (CRP), interleukin (IL)-1beta, IL-6, and tumor necrosis factor (TNF)-alpha, and of anti-inflammatory IL-4 and IL-10 were measured in 14 otherwise healthy PTSD patients and in 14 age- and gender-matched healthy non-PTSD controls. Levels of TNF-alpha and of IL-1beta were higher in patients than in controls. CRP and IL-10 were not significantly different between groups. Controlling for traditional cardiovascular risk factors, mood, and time since trauma revealed lower IL-4 in patients than in controls and rendered group differences in TNF-alpha and IL-1beta insignificant. In all subjects, TNF-alpha correlated with total (frequency and intensity) PTSD symptom cluster of re-experiencing avoidance and hyperarousal and with PTSD total symptom score Controlling for time since trauma attenuated these associations. PTSD patients showed a low-grade systemic proinflammatory state, which, moreover, was related to PTSD symptom levels suggesting one mechanism by which PTSD could contribute to atherosclerotic disease.
PMID: 16901505 [PubMed - indexed for MEDLINE] (subscribers only).
http://www.ncbi.nlm.nih.gov/
November 2007

Kolassa IT, Eckart C, Ruf M, Neuner F, de Quervain DJ, Elbert T.
Lack of cortisol response in patients with posttraumatic stress disorder (PTSD) undergoing a diagnostic interview. Bio Med Central Psychiatry. 2007 Oct 4;7(1):54
The diagnosis of posttraumatic stress disorder (PTSD) requires the experience of a traumatic event during which the person's response involved intense fear, helplessness, or horror. In order to diagnose PTSD, clinicians must interview the person in depth and determine whether the individual has been traumatized by a specific event or events. However, asking questions about traumatic experiences can be stressful for the traumatized individual and it has been cautioned that subsequent "re-traumatization" could occur. This study investigated the cortisol response in traumatized refugees with PTSD during a detailed and standardized interview about their personal war and torture experiences. 17 male refugee patients were administered the Vivo Checklist of War, Detention, and Torture Events, 16 subjects were interviewed about absorption behavior. Self-reported measures of affect and arousal, as well as saliva cortisol were collected at four points. Before and after the experimental intervention, subjects performed a Delayed Matching-to-Sample (DMS) task for distraction. They also rated the severity of selected PTSD symptoms, as well as the level of intrusiveness of traumatic memories at that time. Cortisol excretion diminished in the course of the interview and showed the same pattern for both groups. No specific response was detectable after the supposed stressor. Correspondingly, ratings of subjective well-being, memories of the most traumatic event(s) and PTSD symptoms did not show any significant difference between groups. A comprehensive diagnostic interview including questions about traumatic events does not trigger an HPA-axis based alarm response or changes in psychological measures, even for persons with severe PTSD, such as survivors of torture. Thus, addressing traumatic experiences within a safe and empathic environment appears to impose no unacceptable additional load to the patient.
PMID: 17916253 [PubMed - as supplied by publisher] (subscribers only).
http://www.ncbi.nlm.nih.gov/
November 2007

Yehuda R, Ledoux J. Division of Traumatic Stress Studies, Mount Sinai School of Medicine, James J. Peters Veteran Affairs, New York, NY 10468, USA.
Response Variation following Trauma: A Translational Neuroscience Approach to Understanding PTSD. Neuron. 2007 Oct 4;56(1):19-32
Exposure to traumatic stress is a requirement for the development of posttraumatic stress disorder (PTSD). The majority of trauma-exposed persons do not develop PTSD. Examination of the typical effects of a stressor will not identify the critical components of PTSD risk or pathogenesis. Rather, PTSD represents a specific phenotype associated with a failure to recover from the normal effects of trauma. Research must focus on identifying pre- and posttraumatic risk factors that explain the development of the disorder and the failure to reinstate physiological homeostasis. In this review, the authors summarize what is known about the clinical and biological characteristics of PTSD and articulate some of the gaps in knowledge. Emphasize was given on how knowledge about individual differences related to genetic and epigenetic factors in behavioural and brain responses to stress offers the hope of a deeper understanding of PTSD.
PMID: 17920012 [PubMed - in process] (subscribers only).
http://www.ncbi.nlm.nih.gov/
November 2007

Gracie A, Freeman D, Green S, Garety PA, Kuipers E, Hardy A, Ray K, Dunn G, Bebbington P, Fowler D. King's College London, Department of Psychology, Institute of Psychiatry, London, and South London and Maudsley NHS Trust, London, UK.
The association between traumatic experience, paranoia and hallucinations: a test of the predictions of psychological models. Acta Psychiatrica Scandinavica 2007 Oct;116(4):280-9
The study investigated the relation between trauma and predisposition to hallucinations and to paranoia in a non-clinical sample. 228 students completed online measures of trauma, post traumatic stress disorder (PTSD), schematic beliefs, perceptual anomalies, and predisposition to hallucinations and paranoia. As results associations were found between negative schematic beliefs, PTSD and predisposition to both paranoia and hallucinations. PTSD reexperiencing-symptoms were most strongly associated with a predisposition to hallucinations. Negative beliefs about self and others were most strongly associated with a predisposition to paranoia. The results provide support for the prediction that there may be two routes between trauma and predisposition to psychosis. Clear support was found for a link between trauma and psychosis mediated by negative beliefs about self and others.
PMID: 17803758 [PubMed - in process] (subscribers only).
http://www.ncbi.nlm.nih.gov/
November 2007

Tagay S, Kribben A, Hohenstein A, Mewes R, Senf W. Department of Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, Essen, Germany. sefik.tagay@uni-due.de
Posttraumatic stress disorder in hemodialysis patients. American Journal of Kidney Diseases 2007 Oct;50(4):594-601
The study aimed to assess the prevalence and severity of posttraumatic stress disorder (PTSD) in patients who receive long-term hemodialysis (HD) and investigate its correlation with depression, anxiety, health-related quality of life, and service utilization. With cross-sectional study, 144 HD patients were screened with diverse instruments. 77.8% of HD patients reported at least 1 traumatic event. The lifetime prevalence for PTSD, independent from trauma type, was 17%. PTSD prevalence only with regard to HD as a potential traumatic event was 10.4%. Women reported more helplessness and more intensive experiences of fear or horror than men with respect to the stressor A criterion. Patients with PTSD showed substantial decreases in mental health in comparison to patients without PTSD (P < 0.01). Additionally, greater depression, anxiety, less life satisfaction, and more service utilization were associated with greater posttraumatic symptoms. There was no correlation of physical health with posttraumatic symptoms. In partial correlation analyses adjusting for depression, associations between posttraumatic symptoms, mental health, and anxiety remained robust. Thus PTSD is common in HD patients, but little work has been done to explore the variables associated with PTSD. Data suggest that PTSD is underdiagnosed and undertreated in HD patients.
PMID: 17900459 [PubMed - in process (subscribers only).
http://www.ncbi.nlm.nih.gov/
November 2007

Resnick H, Acierno R, Waldrop AE, King L, King D, Danielson C, Ruggiero KJ, Kilpatrick D. Medical University of South Carolina, Charleston, SC 29425, USA.
Randomized controlled evaluation of an early intervention to prevent post-rape psychopathology. Behaviour Research and Therapy 2007 Oct;45(10):2432-47. Epub 2007 May 13.
A randomized between-group design was used to evaluate the efficacy of a video intervention to reduce post-traumatic stress disorder (PTSD) and other mental health problems, implemented prior to the forensic medical examination conducted within 72h post-sexual assault. Participants were 140 female victims of sexual assault aged 15 years or older. Assessments were targeted for 6 weeks (Time 1) and 6 months (Time 2) post-assault. At Time 1, the intervention was associated with lower scores on measures of PTSD and depression among women with a prior rape history relative to scores among women with a prior rape history in the standard care condition. At Time 2, depression scores were also lower among those with a prior rape history who were in the video relative to the standard care condition, small effects indicating higher PTSD. Higher scores in Anxiety among women without a prior rape history in the video condition were observed at Time 1. Accelerated longitudinal growth curve analysis indicated a videoxprior rape history interaction for PTSD, yielding four patterns of symptom trajectory over time. Women with a prior rape history in the video condition generally maintained the lowest level of symptoms.
PMID: 17585872 [PubMed - in process] (subscribers only).
http://www.ncbi.nlm.nih.gov/
November 2007

Bryant RA, Salmon K, Sinclair E, Davidson P. University of New South Wales, Sydney, NSW 2052, Australia.
A prospective study of appraisals in childhood posttraumatic stress disorder. Behaviour Research and Therapy 2007 Oct;45(10):2502-7. Epub 2007 May 4.
The predictors of posttraumatic stress disorder (PTSD) in children following a diagnosis of traumatic injury were investigated. Children (N=76) aged between 7 and 13 who were admitted to hospital following injury were assessed within a month of trauma for acute stress disorder (ASD), negative appraisals, as well as parental stress reactions. Children (N=62) were re-assessed 6-months later for PTSD and negative appraisals. The majority of the variance of chronic posttraumatic stress was accounted for by negative appraisals about future harm. This study supports cognitive models of PTSD, and suggests that younger children who exaggerate their vulnerability after trauma exposure are high risk for PTSD after trauma.
PMID: 17560541 [PubMed - in process] (subscribers only).
http://www.ncbi.nlm.nih.gov/
November 2007

Abram KM, Washburn JJ, Teplin LA, Emanuel KM, Romero EG, McClelland GM. the Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 710 North Lake Shore Dr., Suite 900, Chicago, IL 60611. psycho-legal@northwestern.edu.
Posttraumatic stress disorder and psychiatric comorbidity among detained youths. Psychiatric Services 2007 Oct;58(10):1311-6.
This study examined the prevalence of posttraumatic stress disorder (PTSD) and comorbid psychiatric disorders among juvenile detainees. The sample consisted of a stratified random sample of 898 youths aged ten to 18 years who were arrested and detained in Chicago. Among participants with PTSD, 93% had at least one comorbid psychiatric disorder; however, among those without PTSD, 64% had at least one comorbid psychiatric disorder. Over half (54%) of the participants with PTSD had two or more types of comorbid disorders-that is, affective, anxiety, behavioral, or substance use disorders-and 11% had all four types of comorbid disorders. Among males, having any psychiatric diagnosis significantly increased the odds of having comorbid PTSD. Among females, alcohol use disorder and both alcohol and drug use disorders significantly increased the odds of having PTSD is often missed because traumatic experiences are rarely included in standard screens or volunteered by patients.
PMID: 17914008 [PubMed - in process] (subscribers only).
http://www.ncbi.nlm.nih.gov/
November 2007

Zatzick DF, Rivara FP, Nathens AB, Jurkovich GJ, Wang J, Fan MY, Russo J, Salkever DS, Mackenzie EJ. Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA.
A nationwide US study of post-traumatic stress after hospitalization for physical injury. Psychological Medicine 2007 Oct;37(10):1469-80.
Few studies have screened PTSD after injury in large samples across diverse acute care hospital settings. A total of 2931 injured trauma survivors aged 18-84 who were representative of 9983 in-patients were recruited from 69 hospitals across the USA. In-patient medical records were abstracted, and hospitalized patients were interviewed at 3 and 12 months after injury. 23% of injury survivors had symptoms consistent with a diagnosis of PTSD 12 months after their hospitalization. Greater levels of early post-injury emotional distress and physical pain were associated with an increased risk of symptoms consistent with a PTSD diagnosis. Pre-injury, intensive care unit (ICU) admission were independently associated with an increased risk of symptoms consistent with a PTSD diagnosis. White injury survivors without insurance demonstrated approximately twice the rate of symptoms consistent with a diagnosis of PTSD when compared to white individuals with private insurance. More than 20% of injured trauma survivors have symptoms consistent with a diagnosis of PTSD 12 months after acute care in-patient hospitalization. Coordinated investigative and policy efforts could target mandates for high-quality PTSD screening and intervention in acute care medical settings.
PMID: 17559704 [PubMed - in process] (subscribers only).
http://www.ncbi.nlm.nih.gov/
November 2007

Salcioğlu E, Basoğlu M, Livanou M. Section of Trauma Studies, Division of Psychological Medicine, Institute of Psychiatry, King's College London, University of London, London SE5 8AF, UK. Ebru.Salcioglu@iop.kcl.ac.uk
Effects of live exposure on symptoms of posttraumatic stress disorder: The role of reduced behavioral avoidance in improvement. Behaviour Research and Therapy 2007 Oct;45(10):2268-2279.
Few studies examined the effects of cognitive behavioural therapy on individual PTSD symptoms and possible mechanisms of improvement in symptoms. In a previous randomized controlled study a single session of behavioural treatment involving self-exposure instructions was highly effective in reducing earthquake-related PTSD. In the present study the effects of treatment on each PTSD symptom and which symptoms improved early in treatment were examined. Because the intervention focused solely on behavioral avoidance, the authors hypothesized that avoidance would be the first symptom to change and that reduction in avoidance would generalize to all other symptoms. The results showed significant between-groups treatment effect on only behavioral avoidance early in treatment (week 6). At 6 months post-treatment recovery rates ranged from 60% to 89% for 15 PTSD symptoms, including the numbing symptoms. Lack of improvement in avoidance was associated with lack of improvement in 12 symptoms. The critical process in recovery thus appeared to be increased sense of control associated with reduction in avoidance.
PMID: 17570342 [PubMed - in process] (subscribers only).
http://www.ncbi.nlm.nih.gov/
November 2007

Ford JD, Hawke J, Alessi S, Ledgerwood D, Petry N. University of Connecticut School of Medicine Psychiatry, MC1410 263 Farmington Avenue, Farmington, CT 06030, USA.
Psychological trauma and PTSD symptoms as predictors of substance dependence treatment outcomes. Behaviour Research and Therapy 2007 Oct;45(10):2417-31. Epub 2007 Apr 19.
The effectiveness of treatment for substance use disorders (SUDs). may complicated and reduced by psychological trauma and post-traumatic stress disorder (PTSD) This study assessed trauma history and symptoms of simple and complex PTSD at baseline in a randomized trial of contingency management (CM) compared to standard treatment with cocaine- or heroin-dependent outpatients. History of exposure to each of eight types of psychological trauma was unrelated to treatment outcome, except for witnessed assaults and emotional abuse. Complex PTSD symptoms were inversely associated with short-term treatment outcomes, and PTSD symptoms were positively related to long-term outcome, independent of the effects of demographics, psychological distress, baseline substance use status, and treatment modality. Complex PTSD symptoms warrant further study as a potential negative prognostic factor in SUD interventions.
PMID: 17531193 [PubMed - in process] (subscribers only).
http://www.ncbi.nlm.nih.gov/
November 2007

Kleim B, Ehlers A, Glucksman E. Institute of Psychiatry, Department of Psychology, King's College London, London, UK.
Early predictors of chronic post-traumatic stress disorder in assault survivors. Psychological Medicine 2007 Oct;37(10):1457-67. Epub 2007 Jun 22
Some studies suggest that early psychological treatment is effective in preventing chronic post-traumatic stress disorder (PTSD). Yet it is unclear how best to identify trauma survivors who need such intervention. This study investigated the prognostic validity of acute stress disorder (ASD), of variables derived from a meta-analysis of risk factors for PTSD, and of candidate cognitive and biological variables in predicting chronic PTSD following assault. Assault survivors who had been treated for their injuries at a metropolitan Accident and Emergency (A&E) Department were assessed with structured clinical interviews to establish diagnoses of ASD at 2 weeks (n=222) and PTSD at 6 months (n=205) after the assault. Candidate predictors were assessed at 2 weeks. Most predictors significantly predicted PTSD status at follow-up. Multivariate logistic regressions showed that a set of four theory-derived cognitive variables predicted When all predictors were considered simultaneously, mental defeat, rumination and prior problems with anxiety or depression were chosen as the best combination of predictors (Nagelkerke R2=0.47).ConclusionQuestionnaires measuring mental defeat, rumination and pre-trauma psychological problems may help to identify assault survivors at risk of chronic PTSD.
PMID: 17588274 [PubMed - in process] (subscribers only).
http://www.ncbi.nlm.nih.gov/
November 2007

While the ESTSS is preparing to set up a new task force dedicated to human rights and trauma, we see a crop of interesting new articles and research into a subject that is of increasing political and clinical urgency. In particular, a series of four articles in The Lancet tackles the health implications of the human rights agenda from three perspectives - the impact on health and the way human rights are implemented; the effect of health issues on what it terms the delivery of human rights; and the effect of public health policies and programmes on human rights.&nbsp;&raquo;
September 2007

Kozaric-Kovacic, D and Pivac, N. (2007).
Quetiapine treatment in an open trial in combat-related post-traumatic stress disorder with psychotic features. International Journal of Neuropsychopharmacology, 10, 253-61.
Patients with combat-related post-traumatic stress disorder (PTSD) with psychotic features frequently fail to respond to antidepressants. Previous research has shown that these patients improve significantly after monotherapy with two atypical antipsychotics, olanzapine and risperidone. This study investigated the clinical outcome of another atypical antipsychotic, quetiapine, in war veterans with combat-related PTSD with psychotic features. 53 male war veterans with DSM-IV-diagnosed PTSD with psychotic symptoms completed 8 wk of in-patient treatment with quetiapine (25-400 mg/d). Two, 6 and 8 wk treatment with quetiapine significantly reduced total and the subscales scores on the CAPS, PANSS, and CGI-S scales, in patients with psychotic PTSD. The results indicate that 8 wk of monotherapy with quetiapine reduced the majority of the psychotic and PTSD symptoms in the patients. Our present and previous data suggest that treatment-resistant psychotic PTSD patients may improve after taking atypical antipsychotics. [Adapted from Abstract].
Full article available at The International Journal of Neuropsychopharmacology (subscribers only).
http://www.cambridge.org/journals/.
April 2007

Breslau, N. and Alvarado, G. F. (2007).
The clinical significance criterion in post- traumatic stress disorder. Psychological Medicine, 37, 1-8.
The DSM-IV definition of post-traumatic stress disorder (PTSD) requires that the syndrome cause clinically significant distress or impairment. The impact of the clinical significance criterion on the lifetime prevalence of PTSD among civilian victims of traumatic events has not been evaluated. Data from two community-based samples were examined, the 1996 Detroit Area Survey of Trauma (n=2181) and the Mid-Atlantic Urban Youth Study (n=1698). The World Health Organization Composite International Diagnostic Interview (WHO CIDI) was used to ascertain DSM-IV PTSD. The inclusion of the clinical significance criterion in DSM-IV reduces the conditional probability of PTSD given exposure to trauma by approximately 30%. Cases with clinically significant syndrome showed more pervasive and persistent disturbance and an excess in impaired activity days. The consistency of the findings between the two studies strengthens the evidence on the impact of the clinical significance criterion in the diagnosis of PTSD, and the construct validity of its measurement. There is a need for greater research effort on the definition and measurement of the clinical significance criterion.
Full article available at Psychological Medicine (subscribers only).
http://www.ovid.com/.
April 2007

Moore, S. A. and Zoellner, L. A. (2007).
Overgeneral autobiographical memory and traumatic events: An evaluative review. Psychological Bulletin,133, 419-437.
Does trauma exposure impair retrieval of autobiographical memories? Many theorists have suggested that the reduced ability to access specific memories of life events, termed overgenerality, is a protective mechanism helping attenuate painful emotions associated with trauma. The authors addressed this question by reviewing 24 studies that assessed trauma exposure and overgenerality, examining samples with posttraumatic stress disorder, acute stress disorder, depression, traumatic event exposure, and other clinical disorders. Limitations are discussed, including variations in assessment of events, depression, and overgenerality and the need for additional comparison groups. Across studies, there was no consistent association between trauma exposure and overgenerality, suggesting that trauma exposure is unlikely to be the primary mechanism leading to overgenerality. Instead, psychopathology factors such as depression and posttraumatic stress appear to be more consistently associated with overgenerality. Alternative overgenerality theories may help identify key overgenerality mechanisms, improving current understanding of autobiographical memory processes underlying psychopathology. [Adapted from Abstract].
Full article available at Psychological Bulletin | APA Journals (subscribers only).
http://www.apa.org/.
April 2007

Basoglu, M., Livanou, M. and Crnobaric, C. (2007).
Torture vs Other Cruel, Inhuman, and Degrading Treatment: Is the Distinction Real or Apparent? Archives of General Psychiatry, 64, 277-285.
After the reports of human rights abuses by the US military in Guantanamo Bay, Iraq, and Afghanistan, questions have been raised as to whether certain detention and interrogation procedures amount to torture. A cross-sectional survey was conducted with a population-based sample of survivors of torture in Bosnia and Herzegovina, Republica Srpska, Croatia, and Serbia to examine the distinction between various forms of ill treatment and torture during captivity in terms of their relative psychological impact. A total of 279 survivors of torture were assessed on the Semi-structured Interview for Survivors of War, Exposure to Torture Scale, Structured Clinical Interview for DSM-IV, and Clinician-Administered PTSD Scale for DSM-IV. Psychological manipulations, humiliating treatment, exposure to aversive environmental conditions, and forced stress positions showed considerable overlap with physical torture stressors in terms of associated distress and uncontrollability. In regression analyses, physical torture did not significantly relate to posttraumatic stress disorder or depression. The traumatic stress impact of torture (physical or nonphysical torture and ill treatment) seemed to be determined by perceived uncontrollability and distress associated with the stressors. Ill treatment during captivity, such as psychological manipulations, humiliating treatment, and forced stress positions, does not seem to be substantially different from physical torture in terms of the severity of mental suffering they cause, the underlying mechanism of traumatic stress, and their long-term psychological outcome. Thus, these procedures do amount to torture, thereby lending support to their prohibition by international law. [Adapted from Abstract].
Full article available at Archives of General Psychiatry (subscribers only).
http://archpsyc.ama-assn.org/.
March 2007

Olff, M., Langeland, W., Draijer, N. and Gersons, B (2007).
Gender Differences in Posttraumatic Stress Disorder. Psychological Bulletin, 133(2), 183-204.
One of the most consistent findings in the epidemiology of posttraumatic stress disorder (PTSD) is the higher risk of the disorder in women. Explanations reviewed within a psychobiological model of PTSD suggest that women's higher PTSD risk may be due to the type of trauma they experience, their younger age at the time of trauma exposure, their stronger perceptions of threat and loss of control, higher levels of peritraumatic dissociation, insufficient social support resources, and greater use of alcohol to manage trauma-related symptoms like intrusive memories and dissociation, as well as gender-specific acute psychobiological reactions to trauma. This review demonstrates the need for additional research of the gender differences in posttraumatic stress. Recommendations are made for clinical practice. [Adapted from Abstract].
Full article available at http://gateway.uk.ovid.com/ (subscribers only).
March 2007

Bodkin, J. A., Pope, H. G., Detke, M. J. and Hudson, J. I. (2007).
Is PTSD caused by traumatic stress? Journal of Anxiety Disorders, 21, 176-182.
Sequential subjects (N = 103) presenting for pharmacologic treatment of major depression were examined prior to treatment for history of traumatic experiences. Subjects were also examined for symptoms of posttraumatic stress disorder (PTSD). Two blinded raters subsequently judged whether subjects' experiences met DSM-IV criteria for trauma (criterion A of PTSD). Among 54 subjects scored by both raters as having experienced trauma, 42 (78%) met all other DSM-IV criteria for PTSD. Among 36 subjects scored by both raters as not having experienced trauma, 28 displayed all other DSM-IV criteria for PTSD-also a rate of 78%. This equivalence suggests that in a treatment-seeking population, caution should be exercised in attributing the PTSD to trauma. [Adapted from Abstract].
Full article available at Science Direct (subscribers only).
http://www.sciencedirect.com/
March 2007

Geuze, E., Westenberg, H. G. M., Jochims, A., Kloet, C. S., Bohus, M., Vermetten, E. and Schmahl, C. (2007).
Altered Pain Processing in Veterans With Posttraumatic Stress Disorder. Archives of General Psychiatry (64) 76-85.
Several brain areas related to pain processing are implicated in PTSD. To our knowledge, no functional imaging study has discussed whether patients with PTSD experience and process pain in a different way. Twelve male veterans with PTSD and 12 male veterans without PTSD were recruited. The experimental procedure consisted of psychophysical assessment and neuroimaging with functional magnetic resonance imaging (fMRI). Two conditions were assessed during fMRI in both experimental groups, one condition with administration of a fixed temperature of 43&ordm;C (fixed-temperature condition) and the other condition with an individual temperature for each subject but with a similar affective label equaling 40% of the subjective pain intensity (individual temperature condition). Changes in f MRI blood oxygenation level-dependent response to heat stimuli, reflecting increased and decreased activity of brain areas involved in pain processing. Patients with PTSD rated temperatures in the fixed-temperature assessment as less painful compared with controls. In the fixed-temperature condition, patients with PTSD revealed increased activation in the left hippocampus and decreased activation in the bilateral ventrolateral prefrontal cortex and the right amygdala. In the individual temperature condition, patients with PTSD showed increased activation in the right putamen and bilateral insula, as well as decreased activity in the right precentral gyrus and the right amygdala. These data provide evidence for reduced pain sensitivity in PTSD. [Adapted from Abstract].
Full article available at Archives of General Psychiatry (subscribers only).
http://archpsyc.ama-assn.org.
January 2007

Stein, D. J., Seedat, S., Iversen, A. and Wessely, S. (2007).
Post-traumatic stress disorder: medicine and politics. Lancet. 369(9556),139-44.
Regrettably, exposure to trauma is common worldwide, and can have serious adverse psychological results. The introduction of the notion of post-traumatic stress disorder has led to increasing medicalisation of the problem. This awareness has helped popular acceptance of the reality of post-traumatic psychiatric sequelae, which has boosted research into the pathogenesis of the disorder, leading to improved pharmacological and psychological management. The subjective experience of trauma and subsequent expression of symptoms vary considerably over space and time, and we emphasise that not all psychological distress or psychiatric disorders after trauma should be termed post-traumatic stress disorder. There are limits to the medicalisation of distress and there is value in focusing on adaptive coping during and after traumas. Striking a balance between a focus on heroism and resilience versus victimhood and pathological change is a crucial and constant issue after trauma for both clinicians and society. In this Review we discuss the advantages and disadvantages of medicalising trauma response, using examples from South Africa, the Armed Services, and post-disaster, to draw attention to our argument. Review Article. [Adapted from Abstract].
Full article in The Lancet.
http://www.thelancet.com/journals/lancet.
January 2007

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