Suchergebnisse

FrontMatter -- Reviewers -- Acknowledgments -- Contents -- Summary -- 1 Introduction -- 2 Background-Disability Compensation -- 3 Background-PTSD and Impairment -- 4 The PTSD Compensation and Pension Examination -- 5 The Evaluation of PTSD Disability Claims -- 6 Other PTSD Compensation Issues -- 7 General Observations -- APPENDIXES -- Appendix A: Committee on Veterans' Compensation for Posttraumatic Stress Disorder Public Meeting Agendas -- Appendix B: Federal Regulations Related to VA Compensation of PTSD and Other Mental Disorders -- Appendix C: Automated Medical Information Exchange (AMIE) Worksheets for Initial and Review Examinations for PTSD -- Appendix D: Acronyms and Abbreviations -- Appendix E: Biographical Sketches of Committee Members, Consultants, and Staff.

According to the Diagnostic and Statistical Manual of Mental Disorders, delayed posttraumatic stress disorder (PTSD) must be diagnosed in individuals fulfilling criteria for PTSD if the onset of symptoms is at least six months after the trauma. The purpose of this thesis was to establish the prevalence of delayed PTSD and to examine factors that may explain its occurrence. We conducted a meta-analysis and examined prospective data from disaster survivors, unaccompanied refugee minors, and armed forces deployed to Afghanistan. Delayed PTSD occurred in about one quarter of all PTSD cases. The risk of delayed PTSD did not decrease between 9 and 25 months after the traumatic event, and when traumatized populations were followed up for longer periods of time, more delayed PTSD cases were found. These findings suggest ongoing potential risk to some individuals. Delayed PTSD occurred most often in individuals already reporting subthreshold symptoms. Prodromal symptoms included intrusive memories and avoidance of reminders as well as feelings of depression and anxiety. We found a high likelihood of mental health services utilization in participants endorsing delayed PTSD 4 years after a disaster. Two thirds of disaster survivors endorsing delayed PTSD used or continued using mental health services. This finding strongly suggests that symptom progression in delayed PTSD is clinically relevant. We found the severity of traumatic event exposure to be related to PTSD progression after a disaster in individuals reporting total home destruction and after military deployment. We also found that cognitive ability as indicated by higher education was associated with PTSD progression after a disaster, presumably by mitigating initial distress. Lack of perceived social support as well as new stressful life events increased the risk of delayed PTSD after a disaster. In unaccompanied refugee minors, increasing age emerged as a risk marker for delayed PTSD. This highlights the importance of the stressful transitions for these youths ...

Posttraumatic stress disorder (PTSD) is associated with changes in cognitive functions. The aim of the study was to investigate differences in cognitive abilities between PTSD patients and healthy controls. As PTSD is often accompanied by comorbidity, the PTSD patients with comorbid diagnoses were also included in our study. The study participants in¬cluded 254 Croatian combat veterans (60 PTSD and 194 PTSD plus comorbidity) and control group of 125 healthy Cro¬atian military and civilian pilots. The diagnosis of PTSD was made by clinical scale for PTSD assessment (CAPS), while cognitive abilities were measured by Wechsler intelligence scale (WAIS-III-R) and Rey test (ROCFT). The study results have confirmed that there is a significant difference in cognitive functions between the PTSD patients and healthy controls regarding age and education. The PTSD patients (PTSD only and PTSD with comorbidity) have shown lower general intellectual abilities, reduced capacity of working, numerical and visual memory, and decreased executive functions when compared to healthy controls. These results are an additional contribution to a better understanding and determination of changes in cognitive functions that occur in combat PTSD as a result of traumatic stress.

Posttraumatic stress disorder (PTSD) involves the onset of psychiatric symptoms after exposure to a traumatic event. PTSD has an estimated lifetime prevalence of 7.8% among adult Americans, and about 15.2% of the men and 8.5% of the women who served in Vietnam suffered from posttraumatic stress disorder (PTSD) > or =15 years after their military service. Physiological responses (increase in heart rate, blood pressure, tremor and other symptoms of autonomic arousal) to reminders of the trauma are a part of the DSM-IV definition of PTSD. Multiple studies have shown that patients suffering from PTSD have increased resting heart rate, increased startle reaction, and increased heart rate and blood pressure as responses to traumatic slides, sounds and scripts. Some researchers have studied the sympathetic nervous system even further by looking at plasma norepinephrine and 24-hour urinary norepinephrine and found them to be elevated in veterans with PTSD as compared to those without PTSD. PTSD is associated with hyperfunctioning of the central noradrenergic system. Hyperactivity of the sympathoadrenal axis might contribute to cardiovascular disease through the effects of the catecholamines on the heart, the vasculature and platelet function. A psychobiological model based on allostatic load has also been proposed and states that chronic stressors over long durations of time lead to increased neuroendocrine responses, which have adverse effects on the body. PTSD has also been shown to be associated with an increased prevalence of substance abuse. With this review, we have discussed the effects of PTSD on the cardiovascular system.

Many unemployed Vietnam veterans may be sufferers of posttraumatic stress disorder (PTSD). Symptoms and behaviors of PTSD are reviewed to assist employment counselors in identifying such individuals, and suggestions for referral are made.

Posttraumatic stress disorder (PTSD) is a psychiatric disorder characterised by an acute emotional response to a traumatic event or situation involving severe environmental stress (natural disasters, wars, epidemics, rape, assaults, physical torture, catastrophic illness or accident), which may be identified in cognitive, affective or sensory motor activities. The objective was to perform a pilot clinical trial designed to compare the effects of older (tricyclic) and newer "second-generation" (selective inhibitors of serotonin uptake) antidepressants in the treatment of PTSD. A total of 20 hospitalised chronic military combat Bosnian veterans with PTSD symptoms were randomly assigned into two groups of 10 patients each. One group was treated with amitriptyline hydrochloride (AMYZOL®) 75 mg/day as a representative of older antidepressants and the other with fluoxetine hydrochloride 60 mg/day (OXETIN®) as a representative of newer antidepressants. Those drugs were administered by mouth two or three times-a-day in equally divided doses for at least 8 weeks. Favourable response was achieved in 70% of patients treated with amitriptyline hydrochloride and 60% of patients treated with fluoxetine hydrochloride. Amitriptyline hydrochloride was more effective in the treatment of acute PTSD symptoms (emotional numbing, startle reaction, nightmares, flashbacks, intrusive thoughts, vulnerability, poor impulse control or irritability and explosiveness). Fluoxetine hydrochloride showed a greater efficacy in the treatment of chronic PTSD symptoms (avoidance and numbing symptoms, hyperarousal, nightmares and a feeling of guilt).

Increased excitotoxity in response to stressors leads to oxidative stress (OS) due to accumulation of excess reactive oxygen/nitrogen species. Neuronal membrane phospholipids are especially susceptible to oxidative damage, which alters signal transduction mechanisms. The Contingent of International Operations (CIO) has been subjected to various extreme stressors that could cause Posttraumatic Stress Disorder (PTSD). Former studies suggest that heterogeneity due to gender, race, age, nutritional condition and variable deployment factors and stressors produce challenges in studying these processes. The research aim was to assess OS levels in the PTSD risk group in CIO. In a prospective study, 143 participants who were Latvian CIO, regular personnel, males, Europeans, average age of 27.4, with the same tasks during the mission, were examined two months before and immediately after a six-month Peace Support Mission (PSM) in Afghanistan. PCL-M questionnaire, valid Latvian language "Military" version was used for PTSD evaluation. Glutathione peroxidase (GPx), superoxide dismutase (SOD) and lipid peroxidation intensity and malondialdehyde (MDA) as OS indicators in blood were determined. Data were processed using SPSS 20.0. The MDA baseline was 2.5582 μM, which after PSM increased by 24.36% (3.1815 μM). The GPx baseline was 8061.98 U/L, which after PSM decreased by 9.35% (7308.31 U/L). The SOD baseline was 1449.20 U/gHB, which after PSM increased by 2.89% (1491.03 U/gHB). The PTSD symptom severity (total PCL-M score) baseline was 22.90 points, which after PSM increased by 14.45% (26.21 points). The PTSD Prevalence rate (PR) baseline was 0.0357, which after PSM increased by 147.06% (0.0882). We conclude that there is positive correlation between increase of OS, PTSD symptoms severity level, and PTSD PR in a group of patients with risk of PTSD - CIO. PTSD PR depends on MDA intensity and OS severity. OS and increased free radical level beyond excitotoxity, is a possible causal factor for clinical manifestation of PTSD

OBJECTIVE: Posttraumatic stress disorder (PTSD) increases cardiovascular disease and cardiovascular mortality risk. Neither the prospective relationship of PTSD to incident hypertension risk nor the effect of PTSD treatment on hypertension risk has been established. METHODS: Data from a nationally representative sample of 194,319 veterans were drawn from the Veterans Administration (VA) roster of United States service men and women. This included veterans whose end of last deployment was from September 2001 to July 2010 and whose first VA medical visit was from October 1, 2001 to January 1, 2009. Incident hypertension was modeled as 3 events: (1) a new diagnosis of hypertension and/or (2) a new prescription for antihypertensive medication, and/or (3) a clinic blood pressure reading in the hypertensive range (≥140/90 mm Hg, systolic/diastolic). Posttraumatic stress disorder diagnosis was the main predictor. Posttraumatic stress disorder treatment was defined as (1) at least 8 individual psychotherapy sessions of 50 minutes or longer during any consecutive 6 months and/or (2) a prescription for selective serotonin reuptake inhibitor medication. RESULTS: Over a median 2.4-year follow-up, the incident hypertension risk independently associated with PTSD ranged from hazard ratio (HR), 1.12 (95% confidence interval [CI], 1.08-1.17; p < .0001) to HR, 1.30 (95% CI, 1.26-1.34; p < .0001). The interaction of PTSD and treatment revealed that treatment reduced the PTSD-associated hypertension risk (e.g., from HR, 1.44 [95% CI, 1.38-1.50; p < .0001] for those untreated, to HR, 1.20 [95% CI, 1.15-1.25; p < .0001] for those treated). CONCLUSIONS: These results indicate that reducing the long-term health impact of PTSD and the associated costs may require very early surveillance and treatment.

The author's objective was to determine the amount of trauma, prevalence and diagnostic features of posttraumatic stress disorder (PTSD), and to study the relationship between PTSD and demographic variables, trauma experiences, coping style and post-migration stresses among adult Cambodian refugees in New Zealand. Information on basic sociodemographic data, trauma experiences, posttraumatic stress symptoms, General Health Questionnaire 28-item version (GHQ-28) scores, coping style, and post-migration stresses were gathered from 223 adult Cambodian refugees living in Dunedin, New Zealand. Most subjects had experienced multiple, severe traumas. The prevalence of PTSD was 12.1%. The most frequently reported posttraumatic stress symptom was recurrent intrusive recollection of trauma. There was a significant association between PTSD and amount of trauma, coping style, and post-migration stresses.

Despite the important role of behavioral avoidance in the maintenance of post-traumatic stress disorder (PTSD), little is known about the role of implicit or reflexive avoidance tendencies in PTSD. The current dissertation examined the role of reflexive avoidance tendencies in individuals with PTSD in a series of three studies. First, we examined avoidance tendencies of trauma-related stimuli in military veterans with PTSD, trauma-exposed military veterans without PTSD, and non-trauma-exposed civilians. Compared to non-trauma exposed civilians, both veterans with and without PTSD showed greater reflexive avoidance of low arousal combat images, but only veterans without PTSD showed heightened reflexive avoidance of high arousal images. Additionally, re-experiencing symptom severity, but not other clusters of PTSD symptoms, was associated with reflexive avoidance of high arousal images and marginally associated with reflexive avoidance of low arousal images among veterans with and without PTSD. The second study focused on the relationship between automatic avoidance tendencies and neural activity in veterans with and without posttraumatic stress disorder. We found that veterans with and without PTSD exhibited heightened bilateral amygdala, right ventrolateral prefrontal cortex, and medial prefrontal cortex activation in response to combat (versus neutral) images, but this neural reactivity was not associated with avoidance tendencies. Finally, the third study examined the effect of inhibitory regulation training on fear responding, PTSD symptoms, and reflexive avoidance tendencies. Compared to a waitlist control condition, veterans who completed the training experienced significant reductions in self-reported PTSD symptoms and reduced reflexive avoidance of trauma-related images, but did not exhibit changes in physiological reactivity to trauma-related images from pre- to post-training. Our findings suggest that trauma-exposed veterans, regardless of whether they meet criteria for PTSD, exhibit reflexive avoidance of trauma-related stimuli, perhaps representing a behavioral indicator of trauma exposure. Additionally, though reflexive avoidance was not associated with neural activity within regions of the brain involved in emotional responding and inhibitory regulation, our findings do provide evidence that inhibitory regulation-based training may reduce reflexive avoidance behavior. Future research on this topic may elucidate our understanding of how to better address avoidance behaviors in PTSD treatment.

Subjective cognitive complaints are frequently reported among individuals with Posttraumatic Stress Disorder (PTSD). However, attempts to empirically corroborate these complaints using objective, standardized neuropsychological measures have been inconsistent. Previous meta­analytic studies examining neuropsychological performances in PTSD have lacked sufficient moderator analyses, relied exclusively upon published studies, or focused primarily on memory function. In the current meta-analytic review, 41 published and unpublished studies (k = 704; N = 4793) examining neuropsychological outcomes between PTSD and comparison groups were identified from 1993 and 2011. Neuropsychological performances of 1282 PTSD cases and 3511 comparison cases (with or without prior trauma exposure) on standardized neuropsychological measures were examined. PTSD and comparison groups consisted of military service members, victims of sexual and physical assault, Holocaust survivors, police officers, and civilian war refugees. Results indicated an overall small composite effect size between PTSD and comparison groups (d= .30, 95% CI = .21 to .38), with small to moderate effect sizes observed across cognitive domains. Findings suggest that PTSD has a modest, though meaningful effect on cognitive function. Analyses also suggest that the relationship between PTSD and cognitive function may be moderated by several factors (diagnostic strategy, co-morbidity, substance misuse). Implications for clinical and counseling psychologists are discussed.

OBJECTIVES: We provide a review of the literature on posttraumatic stress disorder (PTSD) in older adults, focusing largely on older U.S. military veterans in two primary areas: 1) assessment and diagnosis and 2) non-pharmacological treatment of PTSD in late life. METHODS: We performed a search using PubMed and Academic Search Premier (EBSCO) databases and reviewed reference sections of selected papers. We also drew on our own clinical perspectives and reflections of seven expert mental health practitioners. RESULTS: Rates of PTSD are lower in older compared with younger adults. The presence of sub-syndromal/partial PTSD is important and may impact patient functioning. Assessment requires awareness and adaptation for potential differences in PTSD experience and expression in older adults. Psychotherapies for late-life PTSD appear safe, acceptable and efficacious with cognitively intact older adults, although there are relatively few controlled studies. Treatment adaptations are likely warranted for older adults with PTSD and co-morbidities (e.g., chronic illness, pain, sensory, or cognitive changes). CONCLUSIONS: PTSD is an important clinical consideration in older adults, although the empirical database, particularly regarding psychotherapy, is limited. CLINICAL IMPLICATIONS: Assessment for trauma history and PTSD symptoms in older adults is essential, and may lead to increased recognition and treatment.

The rates of sexual dysfunctions among patients with PTSD are much higher than in the general population. An increasing body of scientific research has confirmed clinically relevant sexual problems (Letourneau et al. 1997, Kotler et al. 2000, Hossain et al. 2013, Yehuda et al. 2015, Tran et al. 2015), among which erectile dysfunction (ED) and premature ejaculation (PE) were the most frequent (Letourneau et al. 1997). It is important to underline that patients, particularly military veterans with PTSD, have an increased risk of sexual dysfunction independent of the use of psychiatric medications (Benjamin et al. 2014). Considering the utilization of pharmacotherapy, data indicate that over 80% of the veterans treated for PTSD in the USA have been receiving at least one of the psychotropic medications (Bernardy et al. 2012). A drug utilization study conducted in Croatia revealed that the annual frequency of drug use among pharmacologically treated PTSD patients was the highest for anxiolytics (75.83% patients), antidepressants (61.36%), hypnotics (35.68%) and antipsychotics (30.21%) in 2012 (LeticaCrepulja et al. 2015). In this context, it is very important to highlight that a variety of psychotropic medications recommended for the treatment of PTSD can induce sexual function disorders (Clayton & Shen 1998, Labbate 2008). Most practice guidelines for the treatment of PTSD highlight antidepressants as the first-line pharmacotherapeutic agents, particularly selective serotonin reuptake inhibitors (SSRIs) (Ballenger et al. 2000, American Psychiatric Association 2004, National Institute for Clinical Excellence (NICE) 2005, Baldwin et al. 2005, Forbes et al. 2007) and serotonin-norepinephrine reuptake inhibitors (SNRIs) (Bandelow et al. 2008, Benedek et al. 2009, Stein et al. 2009, Department of Veterans Affairs 2010, World Health Organization 2013, Baldwin et al. 2014). Since the introduction of these medications, increasing attention has been given to the side effects, such as sexual dysfunction (Labbate 2008, ...

A link between posttraumatic stress disorder and health behaviors, such as exercise, alcohol, smoking, and caffeine has been suggested. However, it is unknown whether veterans with combat-related PTSD differ from combat veterans without PTSD and whether health behaviors change over the course of exposure therapy for PTSD or differ based on PTSD severity. This study examined the relationship between health behaviors and PTSD. More specifically, combat veterans with and without PTSD were compared across self-reported levels of alcohol use, smoking, exercise, and caffeine. Health behaviors of combat veterans with PTSD were compared before and after a 17-week treatment for PTSD. Results showed a significant number of participants decreased alcohol use at post-treatment by an average of eight drinks over 30 days, regardless of their PTSD severity level or amount of improvement in PTSD symptoms. No significant differences were found for other health behaviors. ; 2017-12-01 ; M.S. ; Sciences, Psychology ; Masters ; This record was generated from author submitted information.