Neuropsychological Performance in Gulf War Era Veterans: Neuropsychological Symptom Reporting

Relationships between broad-based health symptoms and neuropsychological performance have been investigated previously in Gulf War (GW) veterans. However, very little has been done to assess relationships between severity of neuropsychological symptom complaints and performance on objective neuropsychological tests. In this study, relationships between level of self-reported neuropsychological symptom severity and objective neuropsychological performance measures were investigated. Participants included 240 veterans from three GW-era cohorts: GW-deployed veterans recruited from Ft. Devens, MA, (n = 142) and from New Orleans, LA (n = 51), and veterans deployed to Germany from a Maine National Guard unit (n = 47). Findings suggest that level of subjective neuropsychological complaints was associated primarily with mood symptoms in GW-era veterans. Among GW-deployed troops, high neuropsychological symptom reporters endorsed more tension, fatigue, and confusion and less vigor than those reporting fewer cognitive complaints. Current findings emphasize the importance of independent assessment of subjective symptoms and objective neuropsychological performance.     

Cognitive Functioning in Treatment-Seeking Gulf War Veterans: Pyridostigmine Bromide Use and PTSD

Gulf War (GW) deployed veterans have reported health symptoms since returning from the war that suggest dysfunction of the central nervous system (CNS). These symptoms include memory and concentration difficulties, fatigue, and headaches. Leading hypotheses for the etiology of these cognitive complaints include psychological factors and/or exposures to chemicals with neurotoxic properties. In this study, cognitive functioning was compared in treatment-seeking GW-deployed veterans and a treatment-seeking non–GW-deployed veteran control group. Results indicated that GW-deployed veterans performed significantly worse than the comparison group on tests of attention, visuospatial skills, visual memory, and mood. GW-deployed veterans who reported taking pyridostigmine bromide (PB) performed worse than GW-deployed veterans without PB use on executive system tasks. Treatment-seeking GW-deployed veterans with diagnoses of posttraumatic stress disorder (PTSD) did not differ on cognitive test measures compared with GW-deployed veterans without PTSD. No interaction effect of PTSD and PB use was found.     

Neuropsychological Performance in Gulf War Era Veterans: Motivational Factors and Effort

Assuming that the underlying etiology of unexplained health-related symptoms in returning Gulf War (GW) veterans is multifactorial, the possible role of feigning or exaggeration of symptoms is worth consideration as a contributing factor. The present study assessed the relationship between motivation to perform well during neuropsychological assessment and objective neuropsychological test performance. Motivation was measured as the score on a visual memory task (Test of Memory Malingering, TOMM) of low difficulty. Participants included 77 veterans from the cohorts of GW- (n = 58) and Germany-deployed (n = 19) GW-era veterans described in two other papers in this issue who were administered the TOMM. Most veterans earned perfect or near-perfect scores on the TOMM (48–50/50). Scores 47 were associated with lower scores on neuropsychological tasks assessing attention, executive functions, and memory. Variability in test performance within and between tasks measuring similar functions was also found in participants with lower TOMM scores.     

Service in the Gulf War and Significant Health Problems: Focus on the Central Nervous System

The consensus of several studies on health among Gulf War (GW)-deployed veterans is that they have elevated symptom complaints. Central nervous system (CNS) symptoms among these veterans have been assessed in several investigations. Studies have disagreed as to whether there are neuropsychological deficits in GW-deployed veterans relative to controls. When differences between these groups have been found, they have often been attributed to stress or psychiatric factors, although exposures to neurotoxic substances present in the GW theatre have also been indicted as possible explanations. A review of the existing literature as well as the 5 papers contained in this issue of Journal of Psychopathology and Behavioral Assessment suggests that the neuropsychological and health symptom sequelae of GW zone service are multidetermined and cannot easily be explained on the basis of simplistic models of causation. Psychological, historical, and exposure parameters must be considered in the scientific evaluation of this problem.     

Characteristics of Calls to Israeli Hotlines During the Gulf War

The current study presents results of a survey of 3,215 calls received at seven centers of telephone emergency services (TES) in Israel during the Gulf War, when citizens of Israel experienced severe stress resulting from SCUD missile attacks. Whereas former surveys have shown that characteristics of calls to TES in Israel are generally not affected by external stressogenic events, a remarkable change was recorded in both the quantity and quality of calls received in TES centers in Israel during the Gulf War. The relative frequencies of problem categories presented by callers during the Gulf War revealed a significant increase in environmental pressures, a category that reflected the stressful situation of the war, as opposed to intra- or interpersonal problems typical of peacetime calls. A comparison between this group of war calls and a control group of nonwar calls, revealed that the two groups represented populations of callers differing in sociodemographic characteristics, expectations, and benefits from the calls. Results are discussed in reference to the unique role of TES as a source of psychological first-aid in a community crisis situation.     

The Relationship Between Perceived Probability of Personal Harm and Distressful Reactions During the Gulf War

This study investigated the relationship between threat appraisal, distressful reactions, and coping strategies of Israeli civilians under missile attack during the Gulf War. During the war, 66 subjects were asked about their perceived probability of being hurt by the missiles. Additionally, they completed a questionnaire that measured their fears and symptoms during the war, the State Anxiety scale of the Endler Multidimensional Anxiety Scales, and the Coping Inventory for Stressful Situations (CISS, Endler & Parker, 1990). The results showed an inverted U-shaped relationship between perceived probability of being hurt and the anxiety measures. A similar curvilinear relationship was found between perceived probability of being hurt and emotion coping strategy. Furthermore, it was found that those who appraised the possibility of being hurt as very high, more often used avoidance coping. The results are discussed within the framework of stress theories and are related to other inverted U-shape relationships found between threat appraisal and stressful reactions.     

The Effect of Masculinity on Community Reintegration Following TBI in Military Veterans

The present study examined the effect of level of traditional masculine gender role norms as well as the moderating effect of cognitive flexibility on community reintegration outcomes in a sample of 60 male military veterans who had sustained a traumatic brain injury during deployment. Data were collected through self-report measures and cognitive tests. Results suggested that greater endorsement of traditional masculine gender role beliefs, attitudes, and behaviors was significantly inversely related to the community integration domains of relationships and living skills and not significantly related to work and leisure. The effect of masculinity on healthy living skills was moderated by cognitive flexibility; the protective effect of low masculinity on living skills was only present if the veteran also had high cognitive flexibility skills. Results are discussed in the context of gender role strain, potential limiting aspects of stereotypy on recovery and reintegration, and the importance of cognitive flexibility in the recovery/reintegration process.     

Rorschach Measures of Posttraumatic Stress in Persian Gulf War Veterans

Imaginative stories written in response to either 6 or 10 different Thematic Apperception Test (TAT) pictures by over 1,500 college students in two studies were scored for intimacy motivation (McAdams, 1980), and a subset were scored for fear of intimacy (Pollack & Gilligan, 1982). The intimacy motive is a recurrent preference or readiness for experiences of warm, close, and communicative interaction with others, and it is assessed by coding the quality of the interpersonal interaction exhibited by characters in a TAT story. Fear of intimacy, on the other hand, is assumed to reveal itself through images of violence displayed in affiliative and intimate situations in TAT stories, for example, when one lover kills another. In both studies, women scored significantly higher than men on intimacy motivation, especially with respect to the intimacy themes of Relationship Produces Positive Affect, Relationship Transcends Space-Time Limitations, Surrender of Control in Relationships, and Connection to Outside World. This sex difference in intimacy motivation was most pronounced in stories written to pictures portraying possible heterosexual romance. Contrary to findings obtained by Pollack and Gilligan, however, men did not write more stories with themes of violence in intimate relationships than did women, providing little support for Consistent sex differences in a general fear of intimacy.     

Psychological Functioning of Partners of Australian Combat Veterans: Contribution of Veterans' PTSD Symptoms and Partners' Caregiving Distress

Previous research has found posttraumatic stress disorder (PTSD) symptoms in combat veterans to be associated with impaired psychological functioning in their partners. However, little is known about possible mediators of this association. The present study investigated the mediational properties of six dimensions of the revised Partners of Veterans' Distress Scale (MacDonell, Marsh, Hine, & Bhullar, 2010). Participants were 181 female partners of Australian combat veterans, age ranging from 43 and 83 years (M = 60.47, SD = 4.96), who completed measures assessing their caregiving distress levels, dyadic adjustment, mental health, and satisfaction with life. The combat veterans also completed a scale measuring their PTSD symptoms. Our results indicated that higher scores of veterans' PTSD were associated with lower levels of dyadic adjustment, mental health, and satisfaction with life in their partners. Partners reported that distress related to exhaustion and intimacy problems significantly mediated the relationship between veterans' PTSD symptoms and their partners' satisfaction with life, whereas partners' distress associated with intimacy problems was the sole significant mediator for their dyadic adjustment, and exhaustion was the only significant mediator for partners' mental health. Implications for programmes designed to address the significant needs of the partners of combat veterans are discussed.     

Examining Relationships Among Ethnicity,PTSD, Life Functioning,and Comorbidity in Female OEF/OIF Veterans

There is much literature on posttraumatic stress disorder (PTSD) and male combat veterans, but little on PTSD by gender and ethnicity among women combat veterans. We examine ethnic differences in PTSD and comorbid disorders among 37 Hispanic, 27 White, and 15 Native female Operaton Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) combat veterans. Participants completed the Clinician-Administered PTSD Scale (CAPS), the Structured Clinical Interview for DSM-IV, Axis I (SCID-Axis I and II), Life Events Checklist (LEC), Military Stress Exposure Questionnaire (MSEQ), and the Medical Outcomes Study Short Form-36 (SF-36). Hispanics differed from Whites in having less education, more trauma exposure, higher levels of PTSD, mood disorder comorbidity, and poorer physical and emotional functioning. Natives differed from Whites with more trauma exposure, higher levels of PTSD, poorer emotional functioning, and higher rates of Cluster B PDs.     

Post-Traumatic Stress Disorder Nightmares and Sleep Disturbance in Iraq War Veterans: A Feasible and Promising Treatment Combination

A substantial proportion of returnees from the Iraq war have significant psychological symptoms related to war zone exposure, including high rates of post-traumatic stress disorder (PTSD), nightmares, and sleep disturbances. This pilot investigation examined the feasibility and efficacy of a promising cognitive-behavioral treatment (CBT) for nightmares, Imagery Rehearsal, combined with CBT for insomnia. Seven veterans completed treatment and showed promising pre-post effects regarding nightmare frequency, sleep quality, and PTSD. This report further examined the content of participants' nightmares, changes made during treatment, and potentially important modifying variables of treatment outcome. Those with redeployment fears, guilt due to perpetration issues, or traumatic brain injuries may receive some but not full benefits of the treatment.     

An Investigation into the Relationship Among ADHD Symptomatology,Creativity, and Neuropsychological Functioning in Children

This paper examined the relationship between creativity and ADHD symptomatology. First, the presence of ADHD symptomatology within a creative sample was explored. Secondly, the relationship between cognitive functioning and ADHD symptomatology was examined by comparing four groups, aged 10–12 years: 1) 29 ADHD children without creativity, 2) 12 creative children with ADHD symptomatology, 3) 18 creative children without ADHD symptomatology, and 4) 30 controls. Creativity, intelligence, processing speed, reaction time, working memory, and inhibitory control were measured. Results showed that 40% of the creative children displayed clinically elevated levels of ADHD symptomatology, but none met full criteria for ADHD. With regard to cognitive functioning, both ADHD and creative children with ADHD symptoms had deficits in naming speed, processing speed, and reaction time. For all other cognitive measures the creative group with ADHD symptoms outperformed the ADHD group. These findings have implications for the development and management of creative children.     

Creating hope: Assisting Veterans with Job Search Strategies using Cognitive Information Processing Theory

Providing effective employment services to today's veterans is essential. Given the high unemployment rate that currently exists for the veteran population, it is essential that career development professionals consider ways to effectively address their needs. This article highlights the complexities veterans experience in the job preparation and job search processes, as well as current efforts addressing the veteran unemployment concern. A clinical case study shows how cognitive information processing theory, a theory of career problem solving and decision making, can be used as a foundation for assisting veterans in the job search process.     

Neuropsychological Functioning in Chronic Lyme Disease

Lyme disease is currently the most common vector-borne illness in the United States. The disease is multisystemic, and chronic disease, in particular, may be associated with neuropsychological deficits. However, to date, only a few empirical studies exist, which examine the neuropsychological sequelae associated with chronic Lyme disease. A review of the literature shows that the deficits observed in adults with chronic Lyme disease are generally consistent with the deficits that can be seen in processes with primarily frontal systems involvement. These observations are generally consistent with neuroradiologic findings. The clinical presentation in chronic Lyme disease and the nature of the neuropsychological deficits are discussed, as are several central issues in understanding neuropsychological functioning in chronic Lyme disease, such as the impact of chronic illness, response to treatment, and the relationship between neuropsychological performance and depression, fatigue, and neurological indicators of disease.     

Workplace Perceptions of Veterans and Nonveterans in the Department of Veterans Affairs

Much has been written about veterans and their reintegration into civilian society, but little or no information is available about veterans’ workplace perceptions and how these might differ from those of nonveterans. The authors compared veterans’ and nonveterans’ attitudes about work (including job satisfaction aspects, perceptions of coworker interactions, supervisory support, and others) in the U.S. Department of Veterans Affairs (VA) based on responses to the organizational census, VA All Employee Survey (AES; N = 179,271). Based on differences in crude (unadjusted, but controlling for location) item odds ratios (range 0.65–1.08), compared to nonveterans, veterans scored modestly lower on most AES items. The authors show how controlling for demographics changes the relative size and, in some cases, the direction of the differences. This current study is 1 of only 2, to our knowledge, large-scale assessments of veterans’ workplace perceptions and the only 1 which controlled the results for demographic characteristics.     

Attachment Patterns as Mediators of the Link Between Combat Exposure and Posttraumatic Symptoms: A Study Among Portuguese War Veterans

We analyzed the role of both attachment anxiety and attachment avoidance as a mediators of the effects of combat exposure on posttraumatic stress disorder (PTSD) symptoms. Participants were Portuguese veterans (N = 60) divided into 2 groups: 30 suffered from chronic PTSD (nonrecovered) and 30 had remission from PTSD (recovered). Combat exposure, attachment patterns, and PTSD symptoms were assessed through self-report measures. Mediation test was performed by conducting several hierarchical regression analyses. Results showed higher attachment anxiety among nonrecovered participants. We did not find statistically significant differences between groups for both attachment avoidance and combat exposure level scores. In mediation analysis, at first step, attachment avoidance was not a significant predictor of PTSD symptoms, and attachment avoidance did not enter in subsequent analysis. Attachment anxiety was a partial mediator of the effect of combat exposure on PTSD symptoms. Implications of the findings for both attachment theory and clinical intervention on trauma are discussed.     

Neuropsychological Functioning in Children with Posttraumatic Stress Disorder

Posttraumatic stress disorder (PTSD) has been associated with deficits in the areas of verbal memory and learning, executive functioning, working memory, and attention in adults. Findings have been less consistent in the few studies examining neuropsychological functioning in childhood PTSD, which are often limited by comparing children with PTSD to children without trauma histories, making it unclear whether observed neuropsychological deficits are related to trauma exposure or to PTSD symptomatology. In an ethnically diverse sample of 62 children who witnessed intimate partner violence (n = 27 PTSD+ and 35 PTSD?), children with PTSD exhibited slower and less effective learning, heightened sensitivity to interference, and impaired effect of rehearsal on memory acquisition on the California Verbal Learning Test – Children's Version, a word list learning task. Both groups performed in the below average range on measures of executive functioning, attention, and intellectual ability.     

Psychotherapeutic Interventions for Symptom Reduction in Veterans With PTSD: An Observational Study in a Residential Clinical Setting

Cognitive processing therapy (CPT) and eye movement desensitization and reprocessing (EMDR) therapy were compared for veterans in a posttraumatic stress disorder (PTSD) residential program (N = 51) who received individual EMDR and group CPT, individual CPT and group CPT, or trauma group exposure (TGE) therapy. Analyses revealed an overall significant difference on posttest measures of the PTSD Checklist for individual EMDR/group CPT and individual CPT/group CPT when compared to TGE, with no significant difference found between EMDR and CPT. Depression scores were significantly decreased between pre- and posttest for patients who received individual EMDR/group CPT. Results support EMDR and CPT as clinically effective and complementary treatments in residential PTSD treatment programs.     

Validation of the Warrior Identity Scale in the Chicagoland Veterans Study

The present study examined the psychometric properties of a measure of military identity in a sample of U.S. military members. Confirmatory factor analysis provided additional support for the multidimensional nature of military identity. Correlational analyses indicated that the domains of military identity were strongly related to postdeployment adjustment as well as other indicators of psychosocial health. Of importance, the relationships between the subscales of identity and the outcome variables differed in strength and direction depending on the form of identity, which supports a multidimensional structure of military identity. Additional research is necessary to identify the most salient domains of identity as well as the clinical and theoretical implications of identity in the functioning of veterans.     

Neuropsychological function and past exposure to metallic mercury in female dental workers

The aim of this study was to see if dental personnel with previous exposure to metallic mercury have later developed disturbances in cognitive function. Ninety-one female participants who had been selected from a previous health survey of dental personnel were investigated neuropsychologically within the following domains: motor function, short-term memory, working memory, executive function, mental flexibility, and visual and verbal long-term memory. The scores were mainly within normal ranges. Relationships between an exposure score, the duration of employment before 1990, and previously measured mercury in urine as independent variables and the neuropsychological findings as dependent variables, were analyzed by multiple linear regression controlling for age, general ability, length of education, alcohol consumption, and previous head injuries. The only relationship that was statistically significant in the hypothesized direction was between the previously measured urine mercury values and visual long-term memory, where the urine values explained 30% of the variability. As the study had a low statistical power and also some other methodological limitations, the results have to be interpreted with caution. Even so, we think it is right to conclude that neuropsychological findings indicative of subsequent cognitive injuries are difficult to find in groups of otherwise healthy dental personnel with previous occupational exposure to mercury.