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.     

Comparison of MMPI-2 profiles of Gulf War veterans with epileptic and nonepileptic seizure patients

As part of a larger study of illnesses related to service in the Gulf War, MMPI-2 profiles of epileptic seizure (ES) patients; nonepileptic seizure (NES) patients; Gulf War veterans with unexplained cognitive, psychological, musculoskeletal, fatigue, or dermatologic symptoms; and asymptomatic Gulf War veterans (Controls) were analyzed. There were 70 people in each group. Seizure diagnosis was based upon intensive EEG monitoring. Gulf War cases were mildly abnormal on MMPI-2 Scales Hs and D and significantly higher than controls on 8 of 10 MMPI-2 clinical scales, but they were significantly lower than NES patients on several scales including Hs and Hy.     

Self-reported changes in subjective health and anthrax vaccination as reported by over 900 Persian Gulf War era veterans

A 1999 study of United Kingdom servicemembers by Unwin, et al. recently found significant relationships between anthrax and other vaccinations, reactions to those vaccines, and later health problems for male current or former active military Gulf War veterans. Likewise, in 2000 Steele and in 1998 Gilroy found possible adverse effects of vaccinations on Gulf War veterans. However, the role of such vaccinations remains controversial; more recent government reports continue to dispute the existence of any data that might reflect adversely on the role of vaccinations on the health of Gulf War veterans. To address this controversy, the current study assessed similar relationships for over 900 Reserve Component Gulf War Era veterans from Ohio and nearby states. Gulf War veterans were more likely to report poorer health than non-Gulf veterans. Female veterans were more likely to report mild or severe reactions to vaccines than male veterans. Those veterans who received anthrax vaccine reported more reactions to vaccines than those who did not receive anthrax vaccine. Declines in long-term subjective health were associated with receipt of anthrax vaccine by Gulf War veterans but not for those who did not deploy to the Gulf, although few of the latter received anthrax vaccine. Regardless of deployment status, veterans who reported more severe reactions to vaccines were more likely to report declines in subjective health. Female veterans reported poorer health during the Gulf War than did male veterans, but sex was not related to veterans' reports of subjective health at subsequent times. It is recommended that servicemembers who experience severe reactions to anthrax vaccine be medically reevaluated before receiving further anthrax vaccine and that careful follow-ups be conducted of those receiving the vaccine currently, in accordance with Nass's 1999 recommendations. We also recommend that safer alternatives to thimerosal (a mercury sodium salt, 50% mercury) be used to preserve all vaccines.     

The Effect of War Stressors and Life Events on Gulf War Veterans With Chronic Fatigue Syndrome Symptoms

This study examines the association of life stressors and the period when they occur, with the development of chronic fatigue syndrome (CFS) symptoms in Gulf War veterans. Of data collected from Gulf War Health Registry veterans, 113 met CFS criteria and 441were controls. After hierarchical multiple regression, several negative life stressors were associated with CFS group membership: being wounded, experiencing a traumatic war experience, frequent battle experiences, demotion, and unable to work within 2 years of returning from the Gulf. The positive life stressor of buying a house more than 2 years after returning protected against being in the CFS group. The findings are consistent with etiological hypotheses of CFS incorporating a psychosocial component and are useful in developing programs for veterans returning from war.     

Spirituality,Forgiveness, and Quality of Life: Testing a Mediational Model with Military Veterans with PTSD

Combat-related posttraumatic stress disorder (PTSD) can be a debilitating condition that has been linked with problems with forgiveness and impaired quality of life (QOL) in physical, psychological, social, and environmental domains. However, an amassing base of research studies also suggests that spirituality can be a vital resource for veterans exposed to severe traumas. Drawing on multidimensional assessments of spirituality and QOL, this study therefore tested direct/indirect associations between spirituality, forgiveness, and QOL among 678 military veterans with PTSD. When controlling for demographic risk factors, combat exposure, and PTSD symptom severity, structural equation modeling results revealed (a) an overall positive effect for spirituality on QOL and (b) that forgiveness fully mediated this link. These findings align with contemporary models of military trauma and suggest that forgiveness could be a critical pathway for promoting QOL as veterans attempt to recover from their posttraumatic symptomatology in treatment settings. Implications for clinical practice and future research are discussed in the article.     

Quality of life in patients before and after kidney transplantation

Abstract

The aim of the present study was to differentially determine quality of life (QOL) in patients with end-stage renal disease (ESRD) after successful kidney transplantation (RT, Group A) compared with ESRD patients on a waiting list for RT (Group B). and with healthy controls (Group C) because opinions vary as to which treatment modality can best assure ESRD patients a high QOL.

Groups A, B and C each consisted of 149 persons, matched for age and gender. The Munich Quality of Life Dimensions List (MLDL) was used to measure global aspects of QOL. Distinct aspects of QOL were investigated by the Brief Symptom Inventory (BSI) and the Questionnaire for Social Support (K-22).

Groups A and C reported similar QOL. Which was significantly higher than in group B (p < .0001). This was particularly true for the physical and psychological status and daily activities, but not for the social situation. Groups A and B reported similar social support, which was significantly, lower than in group C (p < 006). Both ESRD groups reported higher satisfaction with social support than healthy controls (p < .0001).

Successful RT nor only improved distinct aspects of QOL in patients with ESRD, but even put them on par with healthy controls regarding physical and psychological QOL.

Lower social support and higher satisfaction with social support in both groups of ESRD patients should be evaluated further. From a clinical viewpoint. the improvement of physical and psychological aspects of QOL in RT patients is impressive; but more attention should be paid to constantly low social support in this group of patients. International multi center longitudinal studies to investigate QOL in ESRD patients under different treatments am necessary.     

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.     

Quality-of-life assessment in HIV-infected psychiatric outpatients: Perceived health,functional status,symptoms, and preferences for cardiopulmonary resuscitation

Abstract

The current study had two purposes: (1) to describe the reliability and validity of a measure of quality of life (QOL) in HIV-infected psychiatric outpatients, and (2) to predict cardiopulmonary resuscitation (CPR) preferences from disease stage, depression, and other QOL factors. We studied 63 patients, who were seen in one year at an HIV/AIDS psychiatry clinic. The results provide evidence for the validity of our instrument as a measure of health status in an HIV-infected psychiatric population. Overall symptoms were the strongest associates of functional limitations. disability, and perceived health, but depression was also significantly associated with all measures of QOL. Twenty-two patients (35.5%) would not have wanted to be revived if their heart stopped beating the day of the study. Disease stage and poor mental health were independent predictors of this preference, but severity of depression, social support, fatigue, perceived health, functional limitations, and life satisfaction were not.     

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.     

Marital intimacy,family support,and secondary traumatization: A study of wives of veterans with combat stress reaction

Abstract

The main aim of the study was to assess the role of family variables in the process of secondary traumatization among wives of post-traumatic veterans. We compared a sample of 49 wives of Israeli veterans with combat stress reaction (CSR) from the 1982 Lebanon War with a sample of 31 wives of Israeli veterans who fought in the war without developing CSR. We assessed their psychological reactions to the war, their health status six years later, and their reported levels of marital intimacy and family support after the war. When compared with controls, wives of veterans with CSR reported more negative emotions and lower perceived intimacy after the war, and greater severity of psychiatric and somatic symptoms six years later. Results also indicate that the greater the perceived marital intimacy, the less the negative emotions wives of veterans with CSR felt after the war and the better their health status six years later. In addition, wives of veterans with CSR who reported having received more support from their families after the war reported more anxiety and hostility than wives who received less support. The roles of marital intimacy and family support in the process of secondary traumatization were discussed.     

The Long-Term Effects of Operation Desert Storm on the Psychological Distress of U.S. Army Reserve and National Guard Veterans1

This study assessed factors related to the long-term psychological health of a sample of U.S. Army National Guard and Reserve Unit veterans who served during Operation Desert Storm (ODS). In the analysis, general distress symptom measures were obtained and comparisons made from soldiers who deployed to Germany, the Persian Gulf region, and throughout the United States, with soldiers who did not deploy. Elevated symptom levels were found for veterans of the Persian Gulf that could not be explained by variance attributed to demographics, or current life stress events. Reported exposure and the degree of current concern due to petrochemical fires in Kuwait were found to be significantly related to elevated symptom measures beyond the effect of combat-zone-related stresses. These findings suggest that a subset of Persian Gulf reserve veterans continue to have elevated levels of distress that are related to oil fire exposure.     

Psychological predictors for health-related quality of life and disability in persons with chronic obstructive pulmonary disease (COPD)

Objective: Individuals with chronic obstructive pulmonary disease (COPD) exhibit low physical and mental health-related quality of life (HRQL) and high susceptibility to disability. We investigated the influence of psychological factors on HRQL and disability in COPD individuals recruited from the general population. In line with Leventhal’s common sense model, we expected psychological factors to be associated with HRQL and disability even after controlling for medical status.

Methods: Individuals with COPD (n = 502; 59.7 years old; GOLD grades were I: 3%, II: 17%, III: 34%, IV: 46%) were assessed through an online survey administered via COPD patient organisations in Germany. Individuals filled in the Short Form Health Survey (SF-12), COPD Assessment Test, Patient Health Questionnaire (modules: GAD-2, PHQ-15, PHQ-9), Brief Illness Perception Questionnaire, a questionnaire that assesses causal illness attributions, and the internal illness-related locus of control scale of the ‘KKG questionnaire for the assessment of control beliefs about illness and health’. Multiple linear regressions were calculated.

Results: The investigated factors explained high variances (disability = 56%, physical HRQL = 28%, mental HRQL = 63%, p ≤ .001). Better mental health, more optimistic illness perceptions, attribution to psychological causes, and stronger internal locus of control were associated with lower disability and better HRQL. Comorbid somatic symptoms contributed to high disability and low quality of life.

Conclusion: Psychological factors, such as illness perception, attribution and internal locus of control, were associated with disability and HRQL. These factors should be considered when designing treatments for individuals with COPD, and adequate interventions should be provided to enhance illness understanding and self-management skills.     

心理干预对产褥期精神障碍患者生活质量的影响

探讨心理干预对产褥期精神障碍患者生活质量的影响。将85例产褥期精神障碍患者随机分为研究组45例和对照组40例,两组均给予精神科常规护理,研究组在此基础上根据患者的具体情况,实施有针对性的心理护理干预。于心理护理干预后采用Hamilton抑郁量表（HAMD）、Hamilton焦虑量表（HAMA）和生存质量量表（SF－36...     

Interpersonal styles of Vietnam Era veterans.

The study aims were to identify the interpersonal style characteristics of Vietnam Era veterans by comparison with World War II veterans. The sample included 3,075 veterans in treatment in 47 VA health care facilities. Patients were categorized as medical-surgical, psychiatric, and drug addicted, and divided by age into the 24 or less, and the 45 to 55 age groups. The measuring device was the Interpersonal Style Inventory. Group differences on the 17 scores were tested by discriminant function analyses. The Vietnam Era veterans were found to be more rebellious, mistrustful, adventure-seeking and expedient than the older veterans.     

Validation of scales from the Deployment Risk and Resilience Inventory in a sample of Operation Iraqi Freedom veterans

The Deployment Risk and Resilience Inventory (DRRI) is a suite of scales that can be used to assess deployment-related factors implicated in the health and well-being of military veterans. Although initial evidence for the reliability and validity of DRRI scales based on Gulf War veteran samples is encouraging, evidence with respect to a more contemporary cohort of Operation Iraqi Freedom (OIF) veterans is not available. Therefore, the primary goal of the present study was to validate scales from the DRRI in a large sample of OIF army personnel diversified in occupational and demographic characteristics. In general, results supported the use of these DRRI scales in this population. Internal consistency reliability estimates were quite strong. Additionally, support was obtained for criterion-related validity, as demonstrated by associations with mental and physical health measures, and discriminative validity, as demonstrated by differences between key military subgroups.     

A Test of the Factor Structure Equivalence of the 50-Item IPIP Five-Factor Model Measure Across Gender and Ethnic Groups

The study aims were to identify the interpersonal style characteristics of Vietnam Era veterans by comparison with World War II veterans. The sample included 3,075 veterans in treatment in 47 VA health care facilities. Patients were categorized as medical-surgical, psychiatric, and drug addicted, and divided by age into the 24 or less, and the 45 to 55 age groups. The measuring device was the Interpersonal Style Inventory. Group differences on the 17 scores were tested by discriminant function analyses. The Vietnam Era veterans were found to be more rebellious, mistrustful, adventure-seeking and expedient than the older veterans.     

Neuropsychological Performance in Gulf War Era Veterans: Traumatic Stress Symptomatology and Exposure to Chemical–Biological Warfare Agents

Because complaints of diminished concentration and memory are among the most common health symptoms reported by Gulf War (GW) veterans with unexplained illnesses, this study investigated neuropsychological functions among GW veterans and controls. Relationships between neuropsychological performance, severity of posttraumatic stress disorder (PTSD) symptomatology, and exposure to chemical–biological warfare agents (CBW) were assessed. Participants were 225 veterans recruited from three cohorts: GW-deployed veterans from Ft. Devens, MA ( n = 141) and New Orleans, LA (n = 37), and Germany-deployed veterans from a Maine National Guard unit (n = 47). A comprehensive evaluation was completed. Severity of subclinical PTSD symptomatology was significantly related to scores on specific neuropsychological tests. PTSD symptom severity in GW-deployed veterans was found to be greater and associated with a broader range of neuropsychological deficits than in Germany-deployed veterans. PTSD severity was associated with lower performance on a range of neuropsychological tasks, whereas CBW exposure contributed to performance deficits on specific cognitive tasks.     

Pyridostigmine bromide and the long-term subjective health status of a sample of female reserve component Gulf War veterans: a brief report

The role of pyridostigmine bromide (PB) pills in explaining the long-term subjective health status of a sample of over 100 female Reserve Component Gulf War veterans was examined through regression analysis. Results fell just short of significance (p < .06) for the prediction of subjective health approximately six years after the war and were clearly not significant for the prediction of subjective health at previous times. Results parallel Golomb's 1999 RAND report, which found suggestive but not conclusive evidence for the possible adverse effects of Gulf War veterans' consumption of pyridostigmine bromide pills. Our data suggest that use of more than 10 pills may have been especially risky with respect to long-term subjective health.     

Health,social comparisons,and psychological well-being: Their cross-time relationships

The purposes of this short-term longitudinal study were to investigate (a) stability and change in social comparisons across time; (b) the relationship between physical health and the use of social comparisons across time; (c) whether psychological well-being is best predicted by prior or concurrent social comparisons; and (d) the moderating effects of social comparisons. Community-dwelling elderly women (N=149) completed self-report instruments designed to measure social comparisons, psychological well-being, and physical health at two times, 2 years apart. Worse health at Time 1 predicted more frequent and less positive social comparisons at Time 2. Concurrent, but not prior, social comparisons contributed to a number of domains of psychological well-being. Further, the effects of prior health status on subsequent psychological functioning (Time 2) were moderated by social comparison processes. Women in poorest health who engaged in positive social comparisons showed less depression and anxiety and more positive relations with others at Time 2. Little support was found for the influence of prior psychological functioning on subsequent physical health.