Cross-validation of a minnesota multiphasic personality inventory (MMPI) subscale for the assessment of combat-related post-traumatic stress disorder

We have examined the Minnesota Multiphasic Personality Inventory (MMPI) scores of 80 carefully diagnosed veterans with post-traumatic stress disorder (PTSD) in an attempt to cross-validate the PTSD subscale and three-point MMPI code of Keane, Malloy, and Fairbank (1984). In general, although we replicated Keane and co-workers'cutoff scores, our hit rates were slightly lower than those reported originally.This research was supported in part by NIMH Grant MH-37839 to Dr. Kolb.     

机器学习在儿童创伤后应激障碍识别及转归预测中的应用

创伤后应激障碍(PTSD)会给儿童发展带来负面效应,其影响甚至延续至成年期。然而传统诊断方式难以做到快速、客观、准确的识别和诊断儿童PTSD,机器学习作为一种处理大量变量和数据的新兴方法,逐渐被应用到儿童PTSD的早期预测、识别及辅助诊断等研究中。机器学习凭借其性能、原理等方面的优势,可被应用在儿童PTSD的识别与转归领域。相比自我报告式的诊断,通过机器学习辅助识别和诊断儿童PTSD的过程具有效率高、客观准确、节约资源等独特优势。然而,机器学习也在硬件成本、算法选择和预测准确度等方面存在局限性。未来研究人员需要进一步提高机器学习诊断识别儿童PTSD的准确率,并将机器学习算法同传统诊断方法结合进行更多的探索和应用。     

Exposure therapy for post-traumatic stress disorder: Its relative efficacy,limitations and optimal application

Abstract

Post-traumatic stress disorder (PTSD) is a very debilitating psychological disturbance that follows the experience of traumatic events. Exposure therapy has shown good treatment efficacy in earlier treatment outcome studies on PTSD. Only a few other behavioral treatments have shown equal effectiveness, and exposure is usually a necessary treatment component in the others. This paper presents a short review of controlled treatment outcome studies on PTSD. The relative efficacy of exposure therapy compared to other treatments is discussed and factors that can hinder and enhance its effectiveness are reviewed. In the discussion section some methodological pitfalls in the treatment outcome studies are discussed.     

创伤后应激障碍的组蛋白修饰机制

创伤后应激障碍是一种具有复杂病因学的精神疾病,多发生于个体受到重大创伤事件后。创伤后应激障碍的发生发展过程受到环境和遗传易感性的共同作用,存在着较大的个体差异;而表观遗传学作为一门研究多变环境因素调控基因表达的可遗传变化的学科,近年来在创伤后应激障碍的研究中受到越来越多的重视。表观遗传机制之一——组蛋白修饰机制在创伤后应激障碍的发生中起着重要作用,并且由于组蛋白修饰可以受到多种酶的调控,其灵活的可逆化和精细调控为相应的药物研发提供了可能性和便利。因此,深入探讨创伤后应激障碍的组蛋白修饰机制,对于相关疾病的临床治疗及药物研发具有十分重要的意义。当前创伤后应激障碍的组蛋白修饰研究主要使用动物模型,临床研究较少;组蛋白的类型则主要关注组蛋白H3和H4乙酰化;此外,同以往的研究结果一致,组蛋白修饰水平的变化主要发生在前额叶、海马体和杏仁核区域,参与免疫系统、血清素系统和神经肽Y能系统等相关通路的调节。当前PTSD组蛋白修饰的研究结果间还存在较大的异质性,未来的研究应采用更加一致和实用的分析和报道方法,以最大限度地发挥研究的影响。     

Emotional working memory capacity in posttraumatic stress disorder (PTSD)

Participants with a lifetime history of posttraumatic stress disorder (PTSD) and trauma-exposed controls with no PTSD history completed an emotional working memory capacity (eWMC) task. The task required them to remember lists of neutral words over short intervals while simultaneously processing sentences describing dysfunctional trauma-related thoughts (relative to neutral control sentences). The task was designed to operationalise an everyday cognitive challenge for those with mental health problems such as PTSD; namely, the ability to carry out simple, routine tasks with emotionally benign material, while at the same time tackling emotional laden intrusive thoughts and feelings. eWMC performance, indexed as the ability to remember the word lists in the context of trauma sentences, relative to neutral sentences, was poorer overall in the PTSD group compared with controls, suggestive of a particular difficulty employing working memory in emotion-related contexts in those with a history of PTSD. The possible implications for developing affective working memory training as an adjunctive treatment for PTSD are explored.     

Physiological arousal and attention in veterans with posttraumatic stress disorder

Psychophysiological reactivity has been well documented in WWII, Korean Conflict, and Vietnam veterans with posttraumatic stress disorder (PTSD). In addition, these individuals have demonstrated cognitive impairments within the domains of attention, concentration, new learning, and memory. However, there has been no research examining the impact of physiological arousal on attention in individuals with PTSD. This study documents the level of physiological arousal and associated disruption of attentional abilities in 28 Persian Gulf War veterans (18 without PTSD or other psychopathology and 10 with PTSD). This population represents a group of combat trauma victims who experienced a relatively acute onset of PTSD, thus providing a unique opportunity to compare prior psychophysiological and cognitive results with a group of veterans who manifested a recent onset of PTSD. Results indicated relatively comparable psychophysiological reactivity and arousal between Persian Gulf War veterans with PTSD and Persian Gulf War veterans without PTSD. Furthermore, attentional processes of veterans with PTSD were not more disrupted than in comparison soldiers. Results suggest that the intensity and chronicity of the disorder may impact physiological arousal and disruption of cognitive functioning. Following Persian Gulf War veterans with PTSD over time may reveal that psychophysiological arousal becomes more pronounced with chronicity, perhaps as memory networks become strengthened and/or neuroendocrine systems become increasingly disrupted.     

Sustained attention in combat-related posttraumatic stress disorder

There is substantial evidence that PTSD patients have information processing abnormalities for stimuli that are highly relevant to the traumas they have endured. The goal of the present study was to examine whether this extends to neutral stimuli as well. Twenty-four male Vietnam combat veterans with PTSD were compared to fifteen normal male comparison subjects on their performance on a sensitive measure of sustained attention, the Continuous Performance Test-Identical Pairs version (CPT-IP). PTSD subjects did not differ from controls in their ability to discriminate target stimuli from background noise on the CPT. Additionally they performed as well as controls, even in the presence of external distraction. Thus, this study did not find a generalized deficit in attention associated with PTSD on the CPT-IP. Nevertheless, further clarification of the nature of the information processing disturbance in PTSD is warranted.     

Attention training normalises combat-related post-traumatic stress disorder effects on emotional Stroop performance using lexically matched word lists

We examined two groups of combat veterans, one with post-traumatic stress disorder (PTSD) (n?=?27) and another without PTSD (n?=?16), using an emotional Stroop task (EST) with word lists matched across a series of lexical variables (e.g. length, frequency, neighbourhood size, etc.). Participants with PTSD exhibited a strong EST effect (longer colour-naming latencies for combat-relevant words as compared to neutral words). Veterans without PTSD produced no such effect, t?p?>?.37. Participants with PTSD then completed eight sessions of attention training (Attention Control Training or Attention Bias Modification Training) with a dot-probe task utilising threatening and neutral faces. After training, participants—especially those undergoing Attention Control Training—no longer produced longer colour-naming latencies for combat-related words as compared to other words, indicating normalised attention allocation processes after treatment.     

注意和记忆对孤独症儿童词汇发展滞后的影响

孤独症语言障碍的表现之一是词汇发展滞后, 可能与其注意和记忆损伤有关。当前研究结果表明, 孤独症儿童在学习词汇时难以利用社会注意提供的有效信息, 且其注意易受到无关刺激干扰, 这可能导致其形成的物体-词汇的联结不稳定, 影响其进一步将这种联结整合到心理词典并保存在记忆中。未来研究应探究联合注意影响孤独症儿童词汇学习的发展轨迹和机制, 儿童的词汇知识对其词汇记忆的影响, 并关注自然场景中孤独症儿童的词汇学习过程和个体差异。     

Memory Bias for Faces that are Perceived as Hostile by Crime Victims with Acute Post-traumatic Stress Disorder

The present study tested, and found support for, the hypotheses that crime victims with acute post-traumatic stress disorder have: (i) a general memory impairment for faces; and (ii) a memory bias for faces that they perceive as hostile, even when these faces are not arranged to show any hostile face expressions. It is suggested that crime victims with acute post-traumatic stress disorder perform worse on recognition memory due to impaired concentration, and that they allocate their limited attentional resources to the detection of hostility in others in order to avoid being victimized again. This produces a memory bias for perceived hostility even in relatively innocuous everyday interactions with others, which contributes to maintaining the sense of serious current threat that characterizes post-traumatic stress disorder.     

Causal attribution,coping strategies,and combat-related post-traumatic stress disorder

The present study assesses the intervening role of ways of coping in mediating the effects of causal attribution for negative events on combat-related post-traumatic stress disorder (PTSD). The sample consisted of Israeli soldiers who suffered a combat stress reaction episode during the 1982 Lebanon War and were followed 2 and 3 years after their participation in combat. The results showed that an attribution of negative events to stable and uncontrollable causes was associated with both a more frequent use of emotion-focused coping and a less frequent use of problem-focused coping. It was also found that emotion-focused coping and problem-focused coping were more direct antecedents of combat-related PTSD than causal attribution. Finally, it was found that the association between causal attribution and combat-related PTSD was mediated by variations in emotion-focused coping. The discussion attempts to integrate theoretical notions derived from attributional models and Lazarus and Folkman's stress-coping model.     

PTSD个体对创伤相关刺激的情绪标识效应研究

采用三因素混合实验设计,结合情绪标识范式考察创伤后应激障碍（PTSD）个体对创伤相关图与负性情绪面孔的情绪标识效应。结果发现：PTSD组的情绪标识任务抑制了创伤相关图对之后奇偶判断任务的干扰,表现出显著的情绪标识效应;而对负性情绪面孔的情绪标识效应不显著。该研究表明将谈话疗法用于PTSD患者的心理危机干预是有效的。     

A thematic analysis of practitioners' understanding of domestic abuse in terms of post‐traumatic stress disorder (PTSD) and complex‐PTSD (C‐PTSD)

There is a growing body of evidence suggesting that domestic abuse (DA) should be conceptualised within the complex post‐traumatic stress disorder (C‐PTSD) model. Recently, in the draft of the International Classification of Diseases, Eleventh Revision, produced by the World Health Organization (WHO), C‐PTSD was included as a separate criterion in which DA is incorporated (ICD‐11, WHO, 2018). In this study, a thematic analysis was used to explore to what extent practitioners working with DA survivors are familiar with PTSD and C‐PTSD. Research into such a prevalent and detrimental problem as DA is important to understand whether the development of theoretical knowledge about DA and C‐PTSD is addressed in practice. In a Women's Centre in South London, six semi‐structured interviews with middle‐aged female practitioners were conducted to investigate each counsellor's experiences, knowledge and reflections. Six final themes were constructed to summarise the main results. The findings demonstrate limited practitioner understanding of DA in terms of C‐PTSD, which seems to impact not only the effectiveness of treatment plans with DA survivors, but also counsellors’ own psychological and physical states. It is also indicated that DA can be conceptualised within the C‐PTSD model that corresponds with previous literature indicating the complex nature of DA. The overall results of the current research acknowledge that DA sectors should not be neglected and better funding and effective psychoeducation in this field are needed.     

Effects of trazodone on sleep in patients diagnosed with post-traumatic stress disorder (PTSD)

Trauma victims frequently report nightmares with experiences of reliving the stressful event in catastrophic dreams. The following day there are exaggerated startle responses and psychic numbing, followed that evening by a reluctance to go to sleep and insomnia. This study found trazodone to be effective in veteran patients with a diagnosis or symptoms of PTSD including sleep disturbance. Among this group of veterans, 20 of the 21 under 60 and 24 out of 27 over 60 had positive responses to bedtime trazodone doses, in that they slept better, including going to sleep more quickly, having fewer nightmares,and had less anger the next day. These benefits may be due to deepened non-REM sleep early in the night as well as delayed REM-sleep onset.     

Social problem solving and autobiographical memory in posttraumatic stress disorder

This study investigated the relationship between overgeneral autobiographical memory and social problem solving in posttraumatic stress disorder (PTSD). Civilian trauma survivors with and without PTSD (N=41) provided autobiographical memories of events in response to positive and negative cue words. Participants also completed the means-end problem-solving (MEPS) procedure. PTSD participants reported more overgeneral memories, regardless of cue valence, than non-PTSD participants. Individuals with PTSD also displayed poorer problem solving than those without PTSD. Overgeneral autobiographical memory was strongly associated with deficits in problem solving. This study suggests that deficient problem solving in PTSD is associated with impaired retrieval of specific autobiographical memories.     

Low-level visual attention and its relation to joint attention in autism spectrum disorder

Visual attention is integral to social interaction and is a critical building block for development in other domains (e.g., language). Furthermore, atypical attention (especially joint attention) is one of the earliest markers of autism spectrum disorder (ASD). The current study assesses low-level visual attention and its relation to social attentional processing in youth with ASD and typically developing (TD) youth, aged 7 to 18 years. The findings indicate difficulty overriding incorrect attentional cues in ASD, particularly with non-social (arrow) cues relative to social (face) cues. The findings also show reduced competition in ASD from cues that remain on-screen. Furthermore, social attention, autism severity, and age were all predictors of competing cue processing. The results suggest that individuals with ASD may be biased towards speeded rather than accurate responding, and further, that reduced engagement with visual information may impede responses to visual attentional cues. Once attention is engaged, individuals with ASD appear to interpret directional cues as meaningful. These findings from a controlled, experimental paradigm were mirrored in results from an ecologically valid measure of social attention. Attentional difficulties may be exacerbated during the complex and dynamic experience of actual social interaction. Implications for intervention are discussed.     

Autobiographical memory in posttraumatic stress disorder before and after treatment

Although overgeneral retrieval of autobiographical memories has been repeatedly demonstrated in posttraumatic stress disorder (PTSD), no studies have indexed overgeneral retrieval before and after treatment of PTSD. Autobiographical memory was assessed in PTSD participants (n=20) prior to commencing cognitive behaviour therapy and 6 months after therapy completion. Fifteen participants completed both assessments. Improvement in PTSD symptoms was significantly associated with improved retrieval of specific memories and decreased retrieval of categoric memories in response to positive cues. These data suggest that symptom reduction during treatment of PTSD leads to greater access to specific memories of positive experiences.     

Implicit learning, thought-focused attention and obsessive-compulsive disorder: a replication and extension

Although significant empirical support exists for both cognitive and neurobiological models of obsessive-compulsive disorder (OCD), there have been few efforts to integrate findings. In this investigation, we attempted to link models by examining relationships between performance on information processing tasks posited to be markers of OCD-related neuropathology and a self-report measure of excessive thought-focused attention (cognitive self-consciousness; CSC). Congruent with predictions and prior research, OCD patients' performance was impaired in comparison to an anxious control group on the Serial Reaction Time (SRT) Task, a measure of implicit procedural learning. Following completion of the SRT, participants' awareness of the embedded stimulus pattern was assessed. As predicted, participants with OCD demonstrated superior performance on this task. Scoring on a measure of CSC correlated with performance on both tasks, although the amount of variance accounted for was modest. Evaluation of OCD symptom subgroups revealed greater procedural learning impairment in a hoarding subgroup. Implications for theory and treatment are discussed.     

PTSD青少年对威胁图片注意偏向的时程特点及习惯化倾向

探讨创伤后应激障碍(post-traumatic stress disorder,PTSD)青少年(n=20)与创伤控制组(n=20)对威胁图片注意偏向的时间进程特点以及习惯化倾向.在线索提示任务中,图片的呈现时间为100ms、500ms和1250ms.研究表明:(1)在时间进程上,当图片呈现100ms时,创伤控制组对地震图存在注意警觉;当呈现时间为500ms时,两组被试对负性图和地震图存在注意回避;当呈现时间为1250ms时,PTSD组对负性图仍存在注意回避、对地震图的注意偏向消失,创伤控制组对负性图和地震图的注意偏向均消失.(2)在习惯化倾向上,当第六次呈现威胁图片时,PTSD组对负性图和地震图的注意偏向消失,而创伤控制组对负性图和地震图的注意回避仍未消失.     

Anxiety and selective attention in obsessive-compulsive disorder

Recently, there has been increasing evidence for information-processing deficits in individuals with obsessive-compulsive disorder (OCD). While impairments in selective attention have been identified to be central to the symptomatology of OCD, the role that situational anxiety plays in attentional processes has not been fully explored. Previous research findings were limited to tasks containing anxiety-relevant materials, only permitting for the evaluation of the impact of anxiety on simultaneous cognitive processing. Furthermore, it has not yet been determined whether the impact of anxiety is limited to selective attention or is indicative of a more general cognitive impairment. This study was designed to examine the role that situational anxiety plays in selective attention impairments. OCD participants and controls were presented with an anxiety producing statement and a neutral statement, followed by the Stroop Task. Results indicated that situational anxiety plays a significant role in the performance of tasks that require selective attention in OCD. A significant deterioration was detected in performance on selective attention tasks for the OCD participants after confronting anxiety-provoking scenarios, as compared to neutral scenarios. Anxiety did not impair performance on simple reading tasks. Possible explanations are discussed.