Neural correlates of exposure to traumatic pictures and sound in Vietnam combat veterans with and without posttraumatic stress disorder: a positron emission tomography study.
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BACKGROUND: Patients with posttraumatic stress disorder (PTSD) show a reliable increase in PTSD symptoms and physiological reactivity following exposure to traumatic pictures and sounds. In this study neural correlates of exposure to traumatic pictures and sounds were measured in PTSD. METHODS: Positron emission tomography and H2[15O] were used to measure cerebral blood flow during exposure to combat-related and neutral pictures and sounds in Vietnam combat veterans with and without PTSD. RESULTS: Exposure to traumatic material in PTSD (but not non-PTSD) subjects resulted in a decrease in blood flow in medial prefrontal cortex (area 25), an area postulated to play a role in emotion through inhibition of amygdala responsiveness. Non-PTSD subjects activated anterior cingulate (area 24) to a greater degree than PTSD patients. There were also differences in cerebral blood flow response in areas involved in memory and visuospatial processing (and by extension response to threat), including posterior cingulate (area 23), precentral (motor) and inferior parietal cortex, and lingual gyrus. There was a pattern of increases in PTSD and decreases in non-PTSD subjects in these areas. CONCLUSIONS: The findings suggest that functional alternations in specific cortical and subcortical brain areas involved in memory, visuospatial processing, and emotion underlie the symptoms of patients with PTSD. (+info)
Countertransference and limits of therapy in war situation.
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Psychotherapy of war traumas and their specific emotional and psychological experiences is a challenge for the therapist. The two partners of the therapeutic dyad may undergo the same difficulties and suffer from the same anxieties, and be affected by the transference and countertransference processes. The conditions of neutrality that should be maintained in the treatment are thus prone to changes. The therapist may protect himself/herself from unconscious guilt, omnipotent fantasies and feelings of being overwhelmed by different modes of defenses. The historical and social context of the trauma have to be taken into account. A chronology to be introduced in the narrative is the first step in the process of reindividuation as the victim's identity has been attacked by the trauma as well as his/her physical integrity. The therapist may find in this intervention a reflection of his/her own needs. The aims of psychotherapy in war situations may be close to those of crisis intervention and at the same time deal with the reactivation of previous infantile traumas. The past plays a significant part in the readaptative process as much as it is relevant to the present. The therapeutic intervention is in essence a message of hope as it implies a potential future to be created. (+info)
Complexity of therapist's feelings in the work with war-traumatized patients.
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AIM: To present the complexity of therapist's feelings and emotions in the work with war-traumatized persons and the importance of psychological mechanisms taking place in such circumstances. METHODS: The method of psychoanalytical psychotherapy was used, adapted to the work with war-traumatized persons. The therapy sessions were held once a week and lasted for 50 minutes. The patients were given transference interpretations differing from customary transference interpretations. They were modified to provide support, aiming at overcoming of the feelings overwhelming each patient. RESULTS: The diversity of the therapist's feelings amalgamated into countertransference was one of the most important psychological mechanisms in the therapy procedures, and served as an indicator of the patient's feelings in the procedure. It was related to the processes of projective identification as a framework of the complex patient-therapist relationship CONCLUSION: + In the work with a war-traumatized patient, it is inevitable that the patient's feelings are partly shared by the therapist through projective identification. This can lead to the "burnout" syndrome and threaten the boundaries of the therapist's psychological system. The role of the therapist includes not only knowledge but also the personal experience of work on himself. Through the process of therapy and by using interpretations as the powerful tool, the therapist is capable to accept such traumatic feelings and help the patient overcome them, but also to remain within the framework of his role. (+info)
Psychiatric battle casualties: an intra- and interwar comparison.
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BACKGROUND: Psychiatric casualties are recognised as an important and inevitable feature of modern warfare. At the beginning of the 20th century they were scarcely acknowledged and still less treated. Today, as a result of lessons learned in the First and Second World Wars, numbers can be predicted on the basis of battle intensity and effective clinical interventions applied. AIMS: To discover more about the factors that cause psychiatric casualties and their relationship to total battle casualties. METHOD: A survey of historical War Office reports and the papers of Royal Army Medical Corps psychiatrists has provided both statistics and treatment strategies. RESULTS: Reported psychiatric casualties were low in the Boer War, influenced, in part, by the misdiagnosis of psychosomatic disorders. Their incidence rose appreciably in the First World War with the identification of shell-shock and neurasthenia. The Second World War saw the collection of accurate data, and combat stress was treated efficiently, although few soldiers returned to fighting units. CONCLUSIONS: A constant relationship exists between the incidence of the total killed and wounded and the number of psychiatric casualties, mediated by the nature of the fighting and quality of the troops involved. (+info)
Population attributable fractions of psychiatric disorders and behavioral outcomes associated with combat exposure among US men.
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OBJECTIVES: This study determined the percentage of adverse outcomes in US men attributable to combat exposure. METHODS: Standardized psychiatric interviews (modified Diagnostic Interview Schedule and Composite International Diagnostic Interview assessments) were administered to a representative national sample of 2583 men aged 18 to 54 in the National Comorbidity Survey part II subsample. RESULTS: Adjusted attributable fraction estimates indicated that the following were significantly attributable to combat exposure: 27.8% of 12-month posttraumatic stress disorder, 7.4% of 12-month major depressive disorder, 8% of 12-month substance abuse disorder, 11.7% of 12-month job loss, 8.9% of current unemployment, 7.8% of current divorce or separation, and 21% of current spouse or partner abuse. CONCLUSIONS: Combat exposure results in substantial morbidity lasting decades and accounts for significant and multifarious forms of dysfunction at the national level. (+info)
War pensions (1900-1945): changing models of psychological understanding.
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BACKGROUND: War pensions are used to examine different models of psychological understanding. The First World War is said to have been the first conflict for which pensions were widely granted for psychological disorders as distinct from functional, somatic syndromes. In 1939 official attitudes hardened and it is commonly stated that few pensions were awarded for post-combat syndromes. AIMS: To re-evaluate the recognition of psychiatric disorders by the war pension authorities. METHOD: Official statistics were compared with samples of war pension files from the Boer War and the First and Second World Wars. RESULTS: Official reports tended to overestimate the number of awards. Although government figures suggested that the proportion of neurological and psychiatric pensions was higher after the Second World War, our analysis suggests that the rates may not have been significantly different. CONCLUSIONS: The acceptance of psychological disorders was a response to cultural shifts, advances in psychiatric knowledge and the exigencies of war. Changing explanations were both a consequence of these forces and themselves agents of change. (+info)
Smaller hippocampal volume predicts pathologic vulnerability to psychological trauma.
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In animals, exposure to severe stress can damage the hippocampus. Recent human studies show smaller hippocampal volume in individuals with the stress-related psychiatric condition posttraumatic stress disorder (PTSD). Does this represent the neurotoxic effect of trauma, or is smaller hippocampal volume a pre-existing condition that renders the brain more vulnerable to the development of pathological stress responses? In monozygotic twins discordant for trauma exposure, we found evidence that smaller hippocampi indeed constitute a risk factor for the development of stress-related psychopathology. Disorder severity in PTSD patients who were exposed to trauma was negatively correlated with the hippocampal volume of both the patients and the patients' trauma-unexposed identical co-twin. Furthermore, severe PTSD twin pairs-both the trauma-exposed and unexposed members-had significantly smaller hippocampi than non-PTSD pairs. (+info)
Elevated serum lipids in veterans with combat-related chronic posttraumatic stress disorder.
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AIM: To assess possible differences in serum cholesterol, low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), triglycerides, arteriosclerosis index, established risk factor (ERF) of arteriosclerosis, and 10-year risk for coronary disease according to the Adult Treatment Panel III (ATP-III) between veterans with combat-related posttraumatic stress disorder (PTSD) and a control group consisting of patients with major depressive disorder. METHOD: We determined serum cholesterol, LDL-C, HDL-C, and triglycerides in the patients with PTSD (n = 103) and patients with major depressive disorder (n = 92), using the enzyme-assay method. AI, ERF, and ATP-III were calculated from cholesterol, LDL-C, and HDL-C levels. The groups were matched in age and body mass index (BMI). Patients with major depressive disorder were chosen as a control group because they do not have changes in serum lipids. RESULTS: Patients with combat-related PTSD had higher mean concentration of cholesterol (6.2+/-1.1 mmol/L vs 5.3+/-0.9 mmol/L; p<0.001), LDL-C (3.9+/-0.7 mmol/L vs 3.5+/-1.0 mmol/L; p = 0.005), and triglycerides (2.9+/-2.3 mmol/L vs 1.5+/-0.5 mmol/L; p<0.001), and lower HDL-C (1.0+/-0.3 mmol/L vs 1.3+/-0.2 mmol/L; p<0.001) than the control group. Arteriosclerosis index (4.2+/-1.2 vs 3.7+/-1.7; p = 0.050), ERF (6.4+/-1.9 vs 5.5+/-2.4; p = 0.010), and ATP-III (12.1+/-3.3 vs 10.2+/-3.8; p<0.001) were higher in PTSD than in the control group. CONCLUSION: Elevated concentrations of serum lipids are associated with combat-related PTSD. This may imply that patients with combat-related PTSD are under a higher risk for arteriosclerosis. (+info)