Life-Review Technique in the Treatment of PTSD in Elderly Patients: Rationale and Three Single Case Studies

Persons exposed to traumatic events in childhood and adolescence may suffer from the symptoms of posttraumatic stress disorder (PTSD) well into old age. The aim of this paper is to introduce a structured life-review technique for the treatment of elderly PTSD patients. This technique centers on the discussion and evaluation of each consecutive stage of life. The therapist encourages the patient to reminisce on both positive and negative experiences; positive coping experiences are reinforced. A single session on the traumatic event is integrated into the discussion of the stages of life, which are dealt with in chronological order. In the following, 3 case studies (e.g., survivors of the 1945 Dresden bombing) are presented. Psychometric measures (PTSS-10, IES-R) for the case studies are reported. Finally, the potential and limitations of the pilot study and the new approach are discussed.     

Personality Dysfunction and the Management of Chronic Medical Illness: A Community Health Sample

The purpose of this study was to determine the influence of personality disorders on perceived health status, self-efficacy for management of the chronic illness, and physician perception of patient health. A total of 607 patients with self-identified chronicillness(es) volunteered to participate in the study. Out of this sample, 147 had collaborative physician data indicating a chronic illness. The final sample was 143 due to incomplete data. Results suggested that maladaptive personality characteristics, as measured by the Short-Form of the Coolidge Axis II Inventory (SCATI), were related to a number of important factors that influence self-management of chronic illnesses. When the personality constellations were broken into 3 groups (normal, subclinical, and clinical) significant differences were found on the 3 groups of dependent variables (Subjective Health, Self-Efficacy, Physician Appraisal) for the different personality disorders. These data provide useful information on several factors that influence effective disease management. Clinical implications and directions for future research are provided.     

Crisis Support and Coping as Mediators of Well-Being in Persons with Spinal Cord Lesion

This study aims to investigate whether crisis support and coping mediate symptoms of posttraumatic stress disorder (PTSD) in individuals with spinal cord lesions (SCL). PTSD, crisis support, and coping were assessed an average of 83 days after the injury (T1), at discharge from the rehabilitation center (T2), and an average of 121 days following discharge (T3). Sixty-nine newly injured paraplegics and tetraplegics completed the questionnaire at T1, 40 (58%) at T2, and 38 (55%) at T3. Individuals with PTSD experienced significantly lower levels of social support, and used more emotional coping than did those without PTSD. On the basis of logistic regression analyses, emotional coping and the interaction between negative response and emotional coping predicted PTSD. Emotional coping is a strong predictor of PTSD in persons with new SCL.     

A linear growth curve analysis of inpatient treatment response by conduct‐disordered,ADHD, and comorbid preadolescents

Conduct disorder (CD) comorbid with attention deficit hyperactivity disorder (ADHD) is widely reputed to be treatment refractory, particularly when accompanied by aggression and early‐onset symptoms. Few studies, however, have assessed inpatient treatment response among early onset CD/ADHD children in detail. In the present investigation, behavioral and rating scale data were compared among CD (n=13), ADHD (n=20), and CD/ADHD (n=45) preadolescents during one‐month of multimodal inpatient treatment that included methylphenidate administration. As expected, linear growth curve analyses revealed that CD/ADHD children were the most symptomatic of the three groups. However, all groups benefited from hospitalization, with few differences in treatment responsiveness observed. Analyses of residualized symptoms suggested that methylphenidate administration was effective in curbing impulsive but not aggressive behaviors. Aggr. Behav. 29:440–456, 2003. © 2003 Wiley‐Liss, Inc.     

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.     

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.     

Impulsive responses to positive mood and reward are related to mania risk

Bipolar disorder is characterised by impulsivity, and recent research suggests it is important to consider more specific forms of impulsivity. In two student samples, we examined associations of self-reported impulsivity with mania risk (Hypomanic Personality Scale, HPS). We hypothesised that mania risk would relate to impulsivity in the context of opportunities for rewarding activities (Delaying Gratification Inventory, DGI), reward pursuit (Fun-Seeking subscale of the Behavioural Activation Scale, BAS), and when experiencing positive affect (Positive Urgency Measure, PUM). In Study 1 (N=823), the HPS was uniquely related to Fun-Seeking and PUM scores. Study 2 (N=482) replicated the correlation of HPS scores with PUM while documenting positive associations between PUM and trait-like responses to positive affect. Findings across both studies stress the importance of considering the role of positive emotion in driving the impulsivity among persons at risk for mania. These findings have implications for refining our understanding of the aetiology of bipolar disorder and for treatment development.     

Clinical cut‐off point for the Distrust dimension of the Dimensional Clinical Personality Inventory 2 (IDCP‐2)

The Clinical Dimensional Personality Inventory 2 (IDCP ‐2) is a 206‐item self‐report tool developed for the assessment of 12 dimensions (divided into 47 factors) of personality pathology. One of the scales comprising the instrument, the Distrust scale, is intended to provide psychometric information on traits closely related to the Paranoid Personality Disorder (PPD ). In the present research, we used the Item Response Theory and the Receiver Operating Characteristic curve analysis to establish a clinical meaningful cutoff for the Distrust scale. Participants were 1,679 adults, among outpatients diagnosed with PPD , outpatients diagnosed with other PD s, and adults from the community. The Wright map revealed that outpatients were located at the very high levels on the latent continuum of the Distrust scale, with a very large effect size for the mean difference between patients and non‐patients. The ROC curve supported a cutoff at −1.00 score in theta standardization which yielded 0.87 of sensitivity and 0.54 of specificity. Findings from the present investigation suggest the IDCP ‐2 Distrust scale is useful as a screening tool of the core features of the PPD . We address potential clinical applications for the instrument and discuss limitations from the present study.     

The Yale-Brown Obsessive-Compulsive Scale: Confirmatory Factor Analytic Findings

The psychometric properties of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) have recently been heavily examined. Specifically, a number of researchers have been interested in determining the factor structure of this scale to find whether it best forms a one, two, or three factor model. The present study continued this examination by considering different scaling models using confirmatory factor analysis with a sample of individuals diagnosed with Obsessive-Compulsive Disorder (OCD). One hundred and forty-six individuals diagnosed with OCD participated and were administered the Y-BOCS and scales measuring depression (Hamilton Depression Rating Scale) and anxiety (Hamilton Anxiety Rating Scale). It was found that the Y-BOCS forms two different two-factor models. One model consisted of an obsessions and compulsions factor; the other composed of disturbance and symptom severity factors. It was likewise found that depression and anxiety were related to both factors in one model (disturbance and symptom severity). The finding that depression was related to obsessions and anxiety to compulsions was found, as in a previous factor analysis of the Y-BOCS. These findings suggest that OCD may be best characterized as a multidimensional syndrome that may not be adequately examined by a single unitary factor as described in the Y-BOCS.     

Intelligence, Callous-Unemotional Traits, and Antisocial Behavior

Research has consistently shown that children with severe conduct problems often exhibit intellectual deficits, especially in their verbal abilities. We investigated whether or not this finding only applies to certain subgroups of children with severe conduct problems. In a sample of 117 clinic-referred children between the ages of 6 and 13, we assessed for Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD) symptoms using a structured diagnostic interview with each child's parent and teacher, callous and unemotional traits using parent and teacher ratings, and intellectual functioning using a standard individually administered intelligence test. Children with an ODD or CD diagnosis who did not show callous and unemotional traits showed a deficit on subtests measuring verbal reasoning ability relative to a clinic control group. Children with an ODD or CD diagnosis who also showed callous and unemotional traits did not show a verbal deficit and, in fact, showed a trend toward having weaker nonverbal abilities. These results highlight the importance of recognizing distinct subgroups of children with severe conduct problems when studying potential intellectual deficits in these children.