Neuropsychiatric Disturbances, Self-Mutilation and Malingering in the French Armies during World War I: War Strain or Cowardice?

Between 1914 and 1918, war strain appeared under a number of guises and affected, to varying extents, the majority of French soldiers. The most frequent form of war strain was war psychoneurosis, but war strain also induced more paroxystic disorders, such as acute episodes of terror, self-mutilation, induced illnesses and even suicide. Fear was the constant companion of soldiers of the Great War: soldiers were either able to tame it or overwhelmed by an uncontrollable fear. Nonetheless, over the course of the war, some aspects of fear were recognised as syndromes. 

The French health service poorly anticipated the major consequences of war strain, as with many other types of injuries. After the establishment of wartime neuropsychiatric centres, two main medical stances emerged: listening to soldiers empathetically on the one hand and applying more repressive management on the other. For many physicians, the psychological consequences of this first modern war were synonymous with malingering or cowardice in the face of duty. 

The stance of French military physicians in relation to their command was not unequivocal and remained ambivalent, swaying between medico-military collusion and empathy towards soldiers experiencing psychological distress. The ubiquity of suspected malingering modified the already porous borders between neuropsychiatric disorders and disobedience. 

Several war psychoneurotic soldiers were sentenced by councils of war for deserting their posts in the face of the enemy and were shot. Many soldiers suspected of self-mutilation or suffering from induced illnesses were also sentenced and executed without an expert assessment of their wound or their psychological state.

Purchase full article at:   http://goo.gl/wZ2GLx

By:  Tatu L, Bogousslavsky J.

Front Neurol Neurosci. 2016 Apr 1;38:143-154

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Factors Associated with Follow-Up Attendance among Rape Victims Seen in Acute Medical Care

Objective

Rape is associated with Posttraumatic Stress Disorder and related comorbidities. Most victims do not obtain treatment for these conditions. Acute care medical settings are well-positioned to link patients to services; however, difficulty engaging victims and low attendance at provided follow-up appointments is well documented. Identifying factors associated with follow-up can inform engagement and linkage strategies.

Method

Administrative, patient self-report, and provider observational data from Harborview Medical Center were combined for the analysis. Using logistic regression, we examined factors associated with follow-up health service utilization after seeking services for rape in the emergency department.

Results

Of the 521 diverse female (n=476) and male (n=45) rape victims, 28% attended the recommended medical/counseling follow-up appointment. In the final (adjusted) logistic regression model, having a developmental or other disability, having a current mental illness, and being assaulted in public were uniquely associated with reduced odds of attending the follow-up. Having a prior mental health condition, a completed SANE examination, and social support available to help cope with the assault were associated with an increased odds of attending the follow-up.

Conclusions

Findings point to relevant characteristics ascertained at the acute care medical visit for rape that may be used to identify victims less likely to obtain posttraumatic medical and mental health services. Efforts to improve service linkage among these patients is warranted and may require alternative models to engage these patients to support posttraumatic recovery.

…In our analysis, routine pre-scheduling of follow-ups in the ED did not appear to result in better follow-up rates than pre-scheduling follow-ups based on provider judgment or patient request. It may actually be more important who schedules the follow-up. At Harborview, ED social workers schedule the follow-up appointments; however, it is possible that appointments scheduled by SANEs who spend 2-4 hours with the patient at this vulnerable time would result in greater follow-up. Brown and colleagues (2013) were able to achieve a 50% follow-up rate after sexual assault using SANEs to schedule follow-ups and contact patients to remind them of the appointment. Although not tested in this study, it is likely that having the same providers who saw the patient in the ED see the patient at follow-up could improve follow-up attendance by capitalizing on the rapport developed in the ED.

Also of interest are observations that some of our factors were unrelated to post-rape medical/counseling appointment follow-up. We did not observe a relationship between gender and follow-up, which is in contrast to other research indicating men are less likely to seek services after traumatic events more generally (Elhai, et al., 2005). Although this finding may be an artifact of the small sample size of males in our study (8.6%), it is also possible that men who choose to seek acute medical services for rape, are as likely to pursue additional services as women who pursue these acute medical services. We also did not observe a relationship between the relationship to the primary offender and follow-up. Prior research indicates that being raped by a stranger results in women being more likely to seek acute care medical/forensic services (Resnick et al., 2000; Starzynski, Ullman, Filipas, Townsend, 2005); however, our findings suggest that among those who do seek acute services, being assault by a stranger is not related to obtaining the recommended follow-up care…

Full article at:   http://goo.gl/ydvpof

By:  Doyanne Darnell, PhD,1 Roselyn Peterson, BA,1 Lucy Berliner, MSW,2 Terri Stewart, RN, BSN,2 Joan Russo, PhD,1Lauren Whiteside, MD,3 and Douglas Zatzick, MD1

¹Department of Psychiatry & Behavioral Sciences, University of Washington

²Harborview Center for Sexual Assault and Traumatic Stress, Seattle, Washington

³Division of Emergency Medicine, University of Washington

Address correspondence to Doyanne Darnell, PhD, Department of Psychiatry & Behavioral Sciences, University of Washington, Box 359911, 325 Ninth Avenue, Seattle, WA 98104-2499

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Posttraumatic Stress Disorder Symptom Severity and Relationship Functioning among Partnered Heterosexual and Lesbian Women Veterans

PURPOSE:

Few studies have examined associations of posttraumatic stress disorder (PTSD) and relationship satisfaction among women Veterans, and no research has explored these factors in lesbian women Veterans, a large subgroup that may have unique concerns. This study examined the link between PTSD and relationship satisfaction in partnered heterosexual and lesbian women Veterans and evaluated potential moderation by sexual orientation, partner support, and conflict.

METHODS:

Women Veterans (heterosexual n = 260; lesbian n = 128) were recruited nationally to complete a cross-sectional online survey. Multiple linear regression models were used to evaluate moderation, using two- and three-way interactions.

RESULTS:

Partner support moderated the association between PTSD symptoms and relationship satisfaction to a different degree for heterosexual and lesbian women Veterans, playing a more prominent role in this association for lesbian women. Specifically, for lesbians with low partner support, as PTSD symptoms worsened, relationship satisfaction decreased at a steeper rate than for heterosexual women with low partner support. On the other hand, for lesbians with high partner support, as PTSD symptoms worsened, relationship satisfaction decreased less sharply than for heterosexual women with high partner support. Degree of conflict was highly correlated with relationship satisfaction and also appeared to moderate these relations differently by sexual orientation.

CONCLUSION:

These findings suggest that women Veterans with PTSD experience impairments in their romantic relationships, which vary by sexual orientation, partner support, and conflict. Partner support and conflict may be important targets in assessment and therapy for women Veterans with PTSD, and especially so for sexual minorities.

Purchase full article at:   http://goo.gl/MZ2qPH

By:  Caska-Wallace CM1,2, Katon JG3,4,5, Lehavot K2,3,4,6, McGinn MM1,2, Simpson TL2,6,7.

• 1 Mental Health Service, VA Puget Sound Health Care System , Seattle, Washington.
• 2 Department of Psychiatry and Behavioral Sciences, University of Washington , Seattle, Washington.
• 3 Health Services Research and Development (HSR&D), VA Puget Sound Health Care System , Seattle, Washington.
• 4 Department of Health Services, University of Washington , Seattle, Washington.
• 5 US Department of Veterans Affairs (VA), Office of Patient Care Services , Women's Health Services, Washington, DC.
• 6 Mental Illness Research, Education, and Clinical Center (MIRECC) , VA Puget Sound Health Care System, Seattle, Washington.
• 7 Center of Excellence in Substance Abuse Treatment and Education (CESATE) , VA Puget Sound Health Care System, Seattle, Washington. 
• LGBT Health. 2016 Feb 19. 

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Among Inpatients, Posttraumatic Stress Disorder Symptom Severity Is Negatively Associated with Time Spent Walking

This study aimed to determine whether posttraumatic stress disorder (PTSD) symptom severity and psychological and functional variables were associated with physical activity (PA) upon admission to an inpatient facility. 

PTSD symptoms, depression, anxiety and stress, sleep quality, and PA participation were assessed among 76 participants (age, 47.6 ± 11.9 years; 83% male). Backward stepwise regression analyses identified variables independently associated with time spent walking and engaging in moderate-vigorous PA (MVPA). No significant correlations were found between any of the variables and MVPA. Total PTSD symptoms (r = -0.39, p < 0.001), combined symptoms of depression, anxiety, and stress (r = -0.31, p < 0.01), and sleep behavior (r = -0.24, p < 0.05) were significantly and negatively associated with total walking time. Total PTSD symptoms were the only significant predictor of walking time (B = -0.03, SE = 0.008, β = -0.4; t = -3.4; p < 0.001). 

Results indicate that increased PTSD symptoms are associated with lower levels of walking. Results highlight the importance of considering symptoms when designing PA programs for people with PTSD.

Purchase full article at:   http://goo.gl/bYvzkZ

By:  Rosenbaum S1, Vancampfort D, Tiedemann A, Stubbs B, Steel Z, Ward PB, Berle D, Sherrington C.

• 1*School of Psychiatry, University of New South Wales; †South Eastern Sydney Local Health District, Bondi Early Psychosis Programme, Sydney, NSW; ‡Musculoskeletal Division, The George Institute for Global Health and Sydney Medical School, The University of Sydney, Sydney, Australia; §UPC KU Leuven, campus Kortenberg, Department of Neurosciences, KU Leuven-University of Leuven, Kortenberg; ∥Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Leuven, Belgium; ¶School of Health and Social Care, University of Greenwich, London, UK; #St John of God Health Care Richmond Hospital, North Richmond; **Black Dog Institute, NSW; and ††Schizophrenia Research Unit, South Western Sydney Local Health District, Sydney, Australia. 
• J Nerv Ment Dis. 2016 Jan;204(1):15-9. doi: 10.1097/NMD.0000000000000415.

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Torture and Long-Term Health Effects among Lebanese Female Political Prisoners

Lebanese prisoners during the Israeli occupation of Lebanon (1981-1999) were subject to regular torture. We examined the association between torture events and post-traumatic stress and cardiovascular diseases (CVDs) among former women political prisoners. 

We conducted a retrospective survey and performed health check-ups among 108 former women prisoners. Post-traumatic stress disorder (PTSD) was measured through the Clinician-Administered PTSD Scale (CAPS), and CVDs were assessed by physicians' diagnoses. The study was conducted between September 2008 and March 2010. All 67 participants in the study reported having been subjected to a variety of torture events. 

The prevalence of PTSD was 28.4% and that of CVD was 16.42%, respectively. PTSD and CVD were more likely to occur among women who had had longer imprisonment periods, and PTSD specifically was associated with exposure to torture (beating and threatening by rape). CVD was associated with asphyxia with water. Devoutness decreased the risk of PTSD. Torture had adverse long-term effects on prisoners' physiological and psychological health; devoutness played a significant protective role. 

This study highlights the importance of documenting torture events and identifying the indicators of associated morbidity among surviving political prisoners for the provision of additional resources to care.

Purchase full article at:   http://goo.gl/KSjLVn

By:  Ghaddar A1, Elsouri G2, Abboud Z3.

• 1Observatory of Public Policies and Health, Bonmarche Center, Beirut, Lebanon Lebanese International University, Beirut, Lebanon ali.ghaddar@liu.edu.lb.
• 2Observatory of Public Policies and Health, Bonmarche Center, Beirut, Lebanon Lebanese University, Beirut, Lebanon.
• 3Khiam Rehabilitation Center, Beirut, Lebanon.
• J Interpers Violence. 2016 Feb;31(3):500-14. doi: 10.1177/0886260514555865. Epub 2014 Nov 6. 

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Posttraumatic Stress Disorder among Low-Income Women Exposed to Perinatal Intimate Partner Violence

Women exposed to intimate partner violence (IPV) and other forms of lifetime trauma may be at risk for negative mental health outcomes including posttraumatic stress disorder (PTSD). 

The purpose of this study was to examine potential predictors of PTSD among low-income women exposed to perinatal IPV. This study analyzed baseline cross-sectional data from 239 low-income pregnant women in the USA who participated in a nurse home visitation intervention between 2006 and 2012 after reporting recent IPV. PTSD was assessed with the Davidson Trauma Scale (DTS) in which participants answer questions about the most disturbing traumatic event (MDTE) in their lifetime that affected them the week before the interview. 

In total, 40 % of the women were identified as having PTSD (DTS ≥40). PTSD prevalence significantly increased with age to nearly 80 % of women ages 30 and older (n = 23). Age was also the strongest predictor of PTSD (p < 0.001). Most participants (65 %) identified non-IPV-related traumas as their MDTEs. Psychological (94 %), physical (82 %), and sexual (44 %) violence were not significantly associated with PTSD status. Despite recent exposure to IPV, most participants identified other traumatic events as more disturbing than IPV-related trauma. 

Further, the risk for PTSD increased with age, suggesting that the cumulative effect of trauma, which may include IPV, increases the risk for PTSD over a lifetime. 

Implementing comprehensive screening for trauma during prenatal care may lead to the early identification and treatment of PTSD during pregnancy in a community setting.

Purchase full article at:   http://goo.gl/nGqZeQ

By:   Kastello JC1, Jacobsen KH2, Gaffney KF3, Kodadek MP3, Bullock LC4, Sharps PW5.

• 1School of Nursing, University of Virginia, 202 Jeanette Lancaster Way, PO Box 800782, Charlottesville, VA, 222903, USA. jck9e@virginia.edu.
• 2Department of Global and Community Health, George Mason University, Fairfax, VA, USA.
• 3School of Nursing, George Mason University, Fairfax, VA, USA.
• 4School of Nursing, University of Virginia, 202 Jeanette Lancaster Way, PO Box 800782, Charlottesville, VA, 222903, USA.
• 5School of Nursing, Johns Hopkins University, Baltimore, MD, USA.  

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Intimate Partner Aggression-Related Shame & Posttraumatic Stress Disorder Symptoms: The Moderating Role of Substance Use Problems

A dearth of literature has examined the consequences of women's use of aggression in intimate relationships. Women's use of aggression against their intimate partners, regardless of their motivation (e.g., self-defense, retaliation), may elicit shame. Shame, in turn, may contribute to the maintenance and/or exacerbation of posttraumatic stress disorder (PTSD) symptoms, which are commonly experienced in this population. 

Further, emerging research suggests that emotionally avoidant coping strategies, such as substance use, may strengthen the relation between shame and PTSD symptoms. The goal of the present study was to examine whether women's shame concerning their use of intimate partner aggression is associated with their PTSD symptoms, and whether drug and alcohol use problems moderate this association. Participants were 369 community women who had used and been victimized by physical aggression in an intimate relationship with a male partner in the past six months. 

The intimate partner aggression-related shame × drug (but not alcohol) use problems interaction on PTSD symptom severity was significant. Analysis of simple slopes revealed that women's intimate partner aggression-related shame was positively associated with their PTSD symptoms when drug use problems were high, but not when drug use problems were low. 

Findings have implications for the potential utility of PTSD treatments targeting a reduction in shame and maladaptive shame regulation strategies (i.e., drug use) in this population.

Purchase full article at:   http://goo.gl/UQ4W5c

By:   Weiss NH1, Duke AA1, Overstreet NM2, Swan SC3, Sullivan TP1.

• 1Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.
• 2Department of Psychology, Clark University, Worcester, Massachusetts.
• 3Department of Psychology, University of South Carolina, Columbia, South Carolina. 

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

The Use of Medicinal Marijuana for Posttraumatic Stress Disorder: A Review of the Current Literature

Background:

Medicinal marijuana has already been legalized in over 23 states with more considering legalization. Despite the trend toward legalization, to date, there has been no systematic review of the existing literature for the efficacy of medicinal marijuana for many of the conditions for which it is proposed to treat. This study seeks to understand the current literature regarding the use of medicinal marijuana in the treatment of posttraumatic stress disorder (PTSD).

Data Sources:

PubMed and PsycINFO databases were searched until April 2014 for articles outlining outcomes of case files, control studies, and observational studies regarding the efficacy of medicinal marijuana in treating PTSD. Various combinations of the following search terms were used: marijuana, medicinal marijuana,cannabis, cannabinoid, PTSD, efficacy, trial, and neurobiology.

Study Selection:

Full text of each article was reviewed, and those directly addressing the question of efficacy of medicinal marijuana on PTSD symptomatology were included. Data were extracted from a total of 46 articles.

Results:

Analysis revealed that most reports are correlational and observational in basis with a notable lack of randomized, controlled studies. Many of the published studies suggest a decrease in PTSD symptoms with marijuana use. Though the directionality of cannabis use and PTSD could not be fully differentiated at this time, there appears to also be a correlation between PTSD and problematic cannabis use. Despite this finding, there is a growing amount of neurobiological evidence and animal studies suggesting potential neurologically based reasons for the reported efficacy.

Conclusions:

Posttraumatic stress disorder is one of the approved conditions for medicinal marijuana in some states. While the literature to date is suggestive of a potential decrease in PTSD symptomatology with the use of medicinal marijuana, there is a notable lack of large-scale trials, making any final conclusions difficult to confirm at this time.

Full article at:   http://goo.gl/ZUxkwe

By:   Department of Psychiatry, Yale University, New Haven, Connecticut

Corresponding author.

Corresponding author: Stephanie Yarnell, MD, PhD, Department of Psychiatry, Yale University, 300 George St, Ste 901, New Haven, CT 06510 (Email: ude.elay@llenray.einahpetS).

 

More at:  https://twitter.com/hiv_insight

And: http://twitter.com/Prison_Health

Dysfunctional or Hyperfunctional? The Amygdala in Posttraumatic Stress Disorder Is the Bull in the Evolutionary China Shop

Our motivation in writing this Review arose not only from the great value in contributing to this special issue of the Journal of Neuroscience Research but also from the desire to express our opinion that the description of the amygdala as "dysfunctional" in posttraumatic stress disorder (PTSD) might not be appropriate. We acknowledge that excessive activation of the amygdala contributes to the cluster of PTSD symptoms, including hypervigilance, intrusive memories, and impaired sleep, that underlies the devastating mental and physical outcomes in trauma victims. 

The issue that we address is whether the symptoms of PTSD represent an impaired (dysfunctional) or sensitized (hyperfunctional) amygdala status. We propose that the amygdala in PTSD is hyperfunctional rather than dysfunctional in recognition of the fact that the individual has already survived one life-threatening attack and that another may be forthcoming. We therefore consider PTSD to be a state in which the amygdala is functioning optimally if the goal is to ensure a person's survival. The misery caused by a hyperfunctional amygdala in PTSD is the cost of inheriting an evolutionarily primitive mechanism that considers survival more important than the quality of one's life.

Purchase full article at: http://goo.gl/qBRT6l

By: Diamond DM1,2,3,4, Zoladz PR5.

• 1Medical Research Service, Veterans Administration Hospital, Tampa, Florida.
• 2Department of Psychology, University of South Florida, Tampa, Florida.
• 3Department of Molecular Pharmacology and Physiology, University of South Florida, Tampa, Florida.
• 4Center for Preclinical and Clinical Research on PTSD, University of South Florida, Tampa, Florida.
• 5Department of Psychology, Sociology, and Criminal Justice, Ohio Northern University, Ada, Ohio.  

More at:  https://twitter.com/hiv_insight