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1.
Occup Med (Lond) ; 69(8-9): 625-631, 2019 Dec 31.
Artigo em Inglês | MEDLINE | ID: mdl-32025738

RESUMO

BACKGROUND: Limited research suggests that female firefighters report problem drinking at higher rates than the general population. AIMS: To identify longitudinal drinking patterns in female firefighters, make comparisons to male firefighters and examine problem drinking in relation to post-traumatic stress disorder (PTSD) and depression. METHODS: Study participants included 33 female and 289 male firefighter recruits, who were assessed over their first 3 years of fire service. RESULTS: Female firefighters consumed increasing numbers of drinks per week, with a median of 0.90 drinks per week at baseline, and 1.27 drinks in year 3. Female firefighters reported binge drinking at high rates, with nearly half binging at least once per year across all time points (44-74%). The percentage that reported binge drinking three or more times per month doubled over the course of the study (from 9% to 18%). Overall, males reported higher rates of binge drinking and a greater number of drinks per week; however, binge drinking rates among females increased over time and became comparable to rates of binge drinking among males. A greater percentage of female than male firefighters met the criteria for problem drinking by year 1. Problem drinking was associated with screening positive for PTSD at year 1 and depression at year 2, but not with occupational injury. CONCLUSIONS: Over time, female firefighters reported increasing amounts of drinking, more frequent binge drinking and more negative consequences from drinking. These findings along with existing literature indicate female firefighters change their drinking in the direction of their male counterparts.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Depressão/epidemiologia , Bombeiros/psicologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Adulto , Consumo Excessivo de Bebidas Alcoólicas/epidemiologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Caracteres Sexuais , Estados Unidos/epidemiologia
2.
Psychol Med ; 46(10): 2215-26, 2016 07.
Artigo em Inglês | MEDLINE | ID: mdl-27087657

RESUMO

BACKGROUND: Post-traumatic stress disorder (PTSD) is associated with elevated risk for metabolic syndrome (MetS). However, the direction of this association is not yet established, as most prior studies employed cross-sectional designs. The primary goal of this study was to evaluate bidirectional associations between PTSD and MetS using a longitudinal design. METHOD: A total of 1355 male and female veterans of the conflicts in Iraq and Afghanistan underwent PTSD diagnostic assessments and their biometric profiles pertaining to MetS were extracted from the electronic medical record at two time points (spanning ~2.5 years, n = 971 at time 2). RESULTS: The prevalence of MetS among veterans with PTSD was just under 40% at both time points and was significantly greater than that for veterans without PTSD; the prevalence of MetS among those with PTSD was also elevated relative to age-matched population estimates. Cross-lagged panel models revealed that PTSD severity predicted subsequent increases in MetS severity (ß = 0.08, p = 0.002), after controlling for initial MetS severity, but MetS did not predict later PTSD symptoms. Logistic regression results suggested that for every 10 PTSD symptoms endorsed at time 1, the odds of a subsequent MetS diagnosis increased by 56%. CONCLUSIONS: Results highlight the substantial cardiometabolic concerns of young veterans with PTSD and raise the possibility that PTSD may predispose individuals to accelerated aging, in part, manifested clinically as MetS. This demonstrates the need to identify those with PTSD at greatest risk for MetS and to develop interventions that improve both conditions.


Assuntos
Síndrome Metabólica/epidemiologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Veteranos/estatística & dados numéricos , Adulto , Campanha Afegã de 2001- , Idoso , Comorbidade , Feminino , Humanos , Guerra do Iraque 2003-2011 , Estudos Longitudinais , Masculino , Síndrome Metabólica/fisiopatologia , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Adulto Jovem
3.
Oncogene ; 32(3): 397-402, 2013 Jan 17.
Artigo em Inglês | MEDLINE | ID: mdl-22370638

RESUMO

We performed a genetic screen in mice to identify candidate genes that are associated with leukaemogenesis in the context of Trp53 heterozygosity. To do this we generated Trp53 heterozygous mice carrying the T2/Onc transposon and SB11 transposase alleles to allow transposon-mediated insertional mutagenesis to occur. From the resulting leukaemias/lymphomas that developed in these mice, we identified nine loci that are potentially associated with tumour formation in the context of Trp53 heterozygosity, including AB041803 and the Jun dimerization protein 2 (Jdp2). We show that Jdp2 transcriptionally regulates the Trp53 promoter, via an atypical AP-1 site, and that Jdp2 expression negatively regulates Trp53 expression levels. This study is the first to identify a genetic mechanism for tumour formation in the context of Trp53 heterozygosity.


Assuntos
Transformação Celular Neoplásica/genética , Regulação para Baixo , Heterozigoto , Leucemia/genética , Leucemia/patologia , Proteínas Repressoras/metabolismo , Transcrição Gênica , Proteína Supressora de Tumor p53/genética , Animais , Células HEK293 , Humanos , Linfoma/genética , Linfoma/patologia , Camundongos , Células NIH 3T3
4.
AIDS Care ; 17(8): 1013-21, 2005 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-16176897

RESUMO

Considerable literature reflects the range of HIV-related neurocognitive complications, including relatively poor performance on tests of: movement and coordination; attention and concentration; reaction time; and mental flexibility. Efforts to develop appropriate screening techniques include the HIV Dementia Scale (HDS), a brief measure that has demonstrated promise but is lacking extensive independent evaluation. The present study examines the utility of the HDS in a sample of HIV-seropositive adults with a co-morbid history of psychiatric and substance use disorders. Forty subjects (65% male; mean age 41 years; mean education 12.2 years; 55% African American, 30% Caucasian) recruited for a study of the impact of brief psychotherapy on adherence to medications and medical appointments, relapse prevention, and/or enhancement of mental health functioning completed a battery of neuropsychological measures, including the HDS. Forty percent were identified as at high risk for significant cognitive-motor disorder (HDS total score < or =10). After controlling for age, education, illness (absolute CD4), and depressed mood, high-risk participants performed significantly worse on measures of simple and sustained divided attention, psychomotor speed, and working memory. However, only 25 of 40 (63%) were correctly classified based on their performance on traditional tests of neuropsychological functioning. Implications and limitations of the study are discussed.


Assuntos
Complexo AIDS Demência/diagnóstico , Transtornos Cognitivos/diagnóstico , Transtornos Psicomotores/diagnóstico , Adulto , Transtornos Cognitivos/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Transtornos Psicomotores/etiologia , Sensibilidade e Especificidade
5.
Bioinformatics ; 21(8): 1705-6, 2005 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-15564297

RESUMO

UNLABELLED: We present a distributed and fully cross-platform database search program that allows the user to utilize the idle clock cycles of machines to perform large searches using the most sensitive algorithms. For those in an academic or corporate environment with hundreds of idle desktop machines, DSEARCH can deliver a 'free' database search supercomputer. AVAILABILITY: The software is publicly available under the GNU general public licence from http://www.cs.may.ie/distributed CONTACT: tom.naughton@may.ie SUPPLEMENTARY INFORMATION: Full documentation and a user manual is available from http://www.cs.may.ie/distributed.


Assuntos
Redes de Comunicação de Computadores , Metodologias Computacionais , Sistemas de Gerenciamento de Base de Dados , Bases de Dados Genéticas , Armazenamento e Recuperação da Informação/métodos , Software , Algoritmos
6.
Bioinformatics ; 21(7): 969-74, 2005 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-15513992

RESUMO

MOTIVATION: In recent years there has been increased interest in producing large and accurate phylogenetic trees using statistical approaches. However for a large number of taxa, it is not feasible to construct large and accurate trees using only a single processor. A number of specialized parallel programs have been produced in an attempt to address the huge computational requirements of maximum likelihood. We express a number of concerns about the current set of parallel phylogenetic programs which are currently severely limiting the widespread availability and use of parallel computing in maximum likelihood-based phylogenetic analysis. RESULTS: We have identified the suitability of phylogenetic analysis to large-scale heterogeneous distributed computing. We have completed a distributed and fully cross-platform phylogenetic tree building program called distributed phylogeny reconstruction by maximum likelihood. It uses an already proven maximum likelihood-based tree building algorithm and a popular phylogenetic analysis library for all its likelihood calculations. It offers one of the most extensive sets of DNA substitution models currently available. We are the first, to our knowledge, to report the completion of a distributed phylogenetic tree building program that can achieve near-linear speedup while only using the idle clock cycles of machines. For those in an academic or corporate environment with hundreds of idle desktop machines, we have shown how distributed computing can deliver a 'free' ML supercomputer.


Assuntos
Algoritmos , Evolução Molecular , Modelos Genéticos , Filogenia , Alinhamento de Sequência/métodos , Análise de Sequência de DNA/métodos , Simulação por Computador , Funções Verossimilhança , Modelos Estatísticos , Software
7.
AIDS Care ; 16 Suppl 1: S97-120, 2004.
Artigo em Inglês | MEDLINE | ID: mdl-15736824

RESUMO

Many individuals living with HIV have been exposed to some type of traumatic event during their lives and may be living with symptoms of post-traumatic stress disorder (PTSD). A substantial number of these individuals are also likely to show evidence of a co-morbid substance use disorder (SUD). There is reason to believe that the co-occurrence of HIV and PTSD or co-morbid PTSD and SUD (PTSD/SUD) may predict poorer health outcomes. There are several pathways through which PTSD or PTSD/SUD might adversely impact the health of individuals living with HIV, including participation in negative health behaviours, low levels of adherence to antiretroviral medications, and/or a direct, deleterious effect on immune function. Psychological interventions are needed to treat PTSD and PTSD/SUD in HIV-positive individuals, and reduce the negative impact of these conditions on health outcomes. This article will explore data on the prevalence of trauma exposure, PTSD, and PTSD/SUD among individuals living with HIV, the pathways through which these conditions might affect health, possible interventions for PTSD and PTSD/SUD for individuals living with HIV, and methods for integrating care for individuals with these disorders. Future directions for research related to HIV, PTSD, and PTSD/SUD will also be discussed.


Assuntos
Atitude Frente a Saúde , Infecções por HIV/psicologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Ferimentos e Lesões/psicologia , Prestação Integrada de Cuidados de Saúde/organização & administração , Feminino , Infecções por HIV/terapia , Humanos , Masculino , Cooperação do Paciente , Transtornos Relacionados ao Uso de Substâncias/terapia
8.
Gen Hosp Psychiatry ; 23(4): 198-204, 2001.
Artigo em Inglês | MEDLINE | ID: mdl-11543846

RESUMO

Failure of general anesthesia to render a patient insensate, termed "awareness," is estimated to affect between 40,000 and 140,000 patients in the US each year. This study investigated the occurrence of post-traumatic stress disorder (PTSD) in subjects who reported a past episode of intraoperative awareness. We inquired about intraoperative and postoperative experiences and studied the relationship between various surgical experiences and currently meeting the diagnosis of PTSD. Sixteen postawareness subjects and 10 postgeneral anesthesia controls completed the Clinician Administered PTSD Scale (CAPS), a standardized clinical rating scale for PTSD, and a questionnaire about peri-operative experiences. Nine of 16 subjects (56.3%), a mean of 17.9 postoperative years, and no controls met diagnostic criteria for current PTSD (X(2)= 8.6, df = 1, P<.01). Common intraoperative experiences included an inability to communicate, helplessness, terror, and pain. Postawareness patients had significant postoperative distress related to feeling unable to communicate, unsafe, terrified, abandoned and betrayed. Perioperative dissociative experiences predicted having current PTSD. Being conscious during surgery is a traumatic event that may result in developing chronic PTSD. Further studies should include prospective designs of prevalence and long-term psychological, social, and overall health effects, and ways of preventing and treating awareness-induced PTSD.


Assuntos
Anestesia Geral/efeitos adversos , Conscientização , Transtornos de Estresse Pós-Traumáticos/psicologia , Transtornos de Estresse Pós-Traumáticos/terapia , Adulto , Doença Crônica , Transtornos Dissociativos/diagnóstico , Feminino , Humanos , Cuidados Intraoperatórios , Masculino , Índice de Gravidade de Doença , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Inquéritos e Questionários
9.
Psychosom Med ; 63(5): 835-41, 2001.
Artigo em Inglês | MEDLINE | ID: mdl-11573033

RESUMO

OBJECTIVE: Prior research has demonstrated increased use of medical services among persons with anxiety and depression. This investigation examined the possible association of posttraumatic stress disorder (PTSD) with the use of nonmental health services. METHOD: A case-comparison design enrolled 102 high users of health services and 54 low users who were assessed for PTSD diagnosis and severity of PTSD symptoms. Subjects were male veterans receiving services from the primary care clinics of the VA Boston Healthcare System during an 18-month period. Data were collected by interview by use of standardized instruments including the Clinician Administered PTSD Scale for DSM-IV, the Life Events Checklist, and the Beck Depression Inventory. Data analysis employed odds ratios, linear and logistic regression, and path analyses. RESULTS: High users of health care were almost twice as likely as low users (27.5% vs. 14.8%) to meet diagnostic criteria for current PTSD. The two groups differed significantly on both symptom frequency and intensity. Path analyses showed an indirect positive association between PTSD and health services use, with physician-diagnosed health conditions as a mediating variable. Auxiliary analysis demonstrated that the combined mental health burden of PTSD and depression symptoms also is positively associated with number of health conditions. CONCLUSIONS: The findings indicate that PTSD, alone and in combination with depression, has a direct negative relationship with physical health that, in turn, is associated with more frequent use of primary health care services. These results do not suggest that PTSD leads to inappropriate (eg, distress-motivated) use of services.


Assuntos
Nível de Saúde , Ambulatório Hospitalar/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Transtornos de Estresse Pós-Traumáticos/economia , Veteranos/estatística & dados numéricos , Adulto , Idoso , Boston/epidemiologia , Hospitais de Veteranos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Revisão da Utilização de Recursos de Saúde , Veteranos/psicologia
10.
Depress Anxiety ; 13(3): 132-56, 2001.
Artigo em Inglês | MEDLINE | ID: mdl-11387733

RESUMO

The Clinician-Administered PTSD Scale (CAPS) is a structured interview for assessing posttraumatic stress disorder (PTSD) diagnostic status and symptom severity. In the 10 years since it was developed, the CAPS has become a standard criterion measure in the field of traumatic stress and has now been used in more than 200 studies. In this paper, we first trace the history of the CAPS and provide an update on recent developments. Then we review the empirical literature, summarizing and evaluating the findings regarding the psychometric properties of the CAPS. The research evidence indicates that the CAPS has excellent reliability, yielding consistent scores across items, raters, and testing occasions. There is also strong evidence of validity: The CAPS has excellent convergent and discriminant validity, diagnostic utility, and sensitivity to clinical change. Finally, we address several concerns about the CAPS and offer recommendations for optimizing the CAPS for various clinical research applications.


Assuntos
Escalas de Graduação Psiquiátrica/normas , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Estudos de Casos e Controles , Humanos , Psicometria , Reprodutibilidade dos Testes
11.
J Trauma Stress ; 13(4): 611-8, 2000 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-11109234

RESUMO

Litz et al. (1997), theorizing that emotional numbing (EN) is the result of emotional depletion caused by chronic hyperarousal, demonstrated that a cluster of hyperarousal symptoms was a robust predictor of EN symptoms. In the present study, these findings were replicated and extended in two multiple regression analyses of data from a large, multisite investigation (T. M. Keane et al., 1998) of psychophysiological responding by male combat veterans. The arousal (D) cluster of symptoms was again the most robust predictor of EN symptoms, whereas physiological indices of arousal and reactivity accounted for negligible amounts of variance in both regression equations. These findings underscore the possible link between disturbances related to arousal and the capacity of traumatized individuals to express and experience pleasant feelings.


Assuntos
Afeto , Nível de Alerta/fisiologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Frequência Cardíaca/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Veteranos/psicologia
12.
J Abnorm Psychol ; 108(1): 164-70, 1999 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-10067002

RESUMO

Relationships among pretrauma risk factors (e.g., family instability, childhood antisocial behavior), war-zone stressors (e.g., combat, perceived threat), posttrauma resilience-recovery variables (e.g., hardiness, social support), and posttraumatic stress disorder (PTSD) symptom severity were examined. Data from a national sample of 432 female and 1,200 male veterans were analyzed using structural equation modeling. For both genders, direct links to PTSD from pretrauma, war-zone, and posttrauma variable categories were found; several direct associations between pretrauma and posttrauma variables were documented. Although war-zone stressors appeared preeminent for PTSD in men, posttrauma resilience-recovery variables were more salient for women. Researchers, policymakers, and clinicians are urged to take a broad view on trauma and its sequelae, especially regarding possible multiple exposures over time and the depletion and availability of important resources.


Assuntos
Transtornos de Estresse Pós-Traumáticos/epidemiologia , Veteranos/estatística & dados numéricos , Adulto , Bases de Dados Factuais/estatística & dados numéricos , Feminino , Humanos , Relações Interpessoais , Acontecimentos que Mudam a Vida , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Sistema de Registros , Indução de Remissão , Fatores de Risco , Estudos de Amostragem , Apoio Social , Transtornos de Estresse Pós-Traumáticos/etiologia , Estados Unidos , Veteranos/psicologia , Vietnã , Guerra
13.
J Nerv Ment Dis ; 186(11): 701-8, 1998 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-9824173

RESUMO

Given the association of injury and posttraumatic stress disorder (PTSD), we examined whether head injury might be associated with increased frequency and severity of PTSD. Using a mail survey, we queried 143 male combat veterans with and without PTSD, who had previously participated in PTSD research in our laboratory, about their history of head injury. Respondents with a PTSD diagnosis were significantly more likely to report a history of head injury than those without. Patients with a history of head injury also reported more severe symptoms of PTSD compared with PTSD patients without head injury. The association of head injury and PTSD was not due to greater combat exposure in the head-injured group. Head injury is associated with a greater likelihood of developing combat-related PTSD and with more severe PTSD symptoms. This retrospective study did not address mechanisms that could account for this finding. The results indicate head injury should be systematically assessed by both nonpsychiatric and psychiatric physicians concerned with the psychological sequelae of exposure to victimizing experiences.


Assuntos
Distúrbios de Guerra/epidemiologia , Traumatismos Craniocerebrais/epidemiologia , Distúrbios de Guerra/diagnóstico , Comorbidade , Traumatismos Craniocerebrais/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença , Veteranos/psicologia , Veteranos/estatística & dados numéricos
14.
J Pers Soc Psychol ; 74(2): 420-34, 1998 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-9491585

RESUMO

Structural equation modeling procedures were used to examine relationships among several war zone stressor dimensions, resilience-recovery factors, and post-traumatic stress disorder symptoms in a national sample of 1,632 Vietnam veterans (26% women and 74% men). A 9-factor measurement model was specified on a mixed-gender subsample of the data and then replicated on separate subsamples of female and male veterans. For both genders, the structural models supported strong mediation effects for the intrapersonal resource characteristic of hardiness, postwar structural and functional social support, and additional negative life events in the postwar period. Support for moderator effects or buffering in terms of interactions between war zone stressor level and resilience-recovery factors was minimal.


Assuntos
Adaptação Psicológica , Transtornos de Estresse Pós-Traumáticos/reabilitação , Veteranos/psicologia , Guerra , Análise Fatorial , Feminino , Humanos , Acontecimentos que Mudam a Vida , Masculino , Modelos Psicológicos , Análise de Regressão , Fatores Sexuais , Apoio Social , Transtornos de Estresse Pós-Traumáticos/psicologia , Estresse Psicológico/psicologia , Temperamento , Estados Unidos , Vietnã
15.
J Consult Clin Psychol ; 66(6): 914-23, 1998 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-9874904

RESUMO

This multisite study tested the ability of psychophysiological responding to predict posttraumatic stress disorder (PTSD) diagnosis (current, lifetime, or never) in a large sample of male Vietnam veterans. Predictor variables for a logistic regression equation were drawn from a challenge task involving scenes of combat. The equation was tested and cross-validated demonstrating correct classification of approximately 2/3 of the current and never PTSD participants. Results replicate the finding of heightened psychophysiological responding to trauma-related cues by individuals with current PTSD, as well as differences in a variety of other domains between groups with and without the disorder. Follow-up analyses indicate that veterans with current PTSD who do not react physiologically to the challenge task manifest less reexperiencing symptoms, depression, and guilt. Discussion addresses the value of psychophysiological measures for assessment of PTSD.


Assuntos
Imagens, Psicoterapia/métodos , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Veteranos/psicologia , Adolescente , Adulto , Pressão Sanguínea/fisiologia , Demografia , Eletromiografia , Resposta Galvânica da Pele/fisiologia , Frequência Cardíaca/fisiologia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Psicometria/métodos , Psicometria/normas , Viés de Seleção , Transtornos de Estresse Pós-Traumáticos/fisiopatologia , Estados Unidos , Vietnã
16.
Clin Psychol Rev ; 18(8): 983-1001, 1998 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-9885771

RESUMO

The aim of this article is to provide recommendations concerning the use of exposure-based therapy for reduction of emotional responding to traumatic memories. Background for these recommendations consists of a summary of the literature on traumatic stress and symptoms of posttraumatic stress disorder (PTSD); an overview of biological, cognitive, and behavioral models for traumatic memory; and a selective review of evidence for the effectiveness of therapeutic exposure as a treatment for trauma memories and PTSD. The recommendations themselves demonstrate how clinical decision making during the course of treatment might be informed by empirical evidence and theoretical models concerning human memory, as well as ethical and legal considerations that mark this topic.


Assuntos
Terapia Comportamental/métodos , Acontecimentos que Mudam a Vida , Memória , Transtornos de Estresse Pós-Traumáticos/terapia , Animais , Cognição , Terapia Cognitivo-Comportamental/métodos , Ética Profissional , Psiquiatria Legal , Humanos , Modelos Biológicos , Modelos Psicológicos , Psicologia Clínica , Ensaios Clínicos Controlados Aleatórios como Assunto , Ratos , Projetos de Pesquisa , Transtornos de Estresse Pós-Traumáticos/fisiopatologia , Transtornos de Estresse Pós-Traumáticos/psicologia
17.
Ann N Y Acad Sci ; 821: 24-34, 1997 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-9238191

RESUMO

It is clear from the existing data that PTSD often occurs in the context of other major psychological conditions. Evidence to support this comes from clinical studies, epidemiological studies, and studies of PTSD among substance abusers. Clearly, probably several different subgroups of PTSD patients exist including those who had psychological or behavioral problems before exposure to traumatic events (e.g., substance abuse), those who developed other problems concurrent with exposure to the traumatic events, and those who developed problems secondary to the development of PTSD, perhaps in efforts to cope with the intensely debilitating symptoms of PTSD. With this knowledge, research on PTSD must begin to contend with the comorbidity issue in systematic ways. The use of comparison groups that are carefully selected is one key way in which conclusions about PTSD can be most conservatively drawn. The use of statistical procedures to control for difference in levels of comorbidity is another responsible way in which to approach the problem. Finally, efforts to employ global measures of functioning such as the Global Assessment of Functioning to equate subjects within a study on minimally this characteristic may be the most economical method for trying to rule out the role of comorbidity and severity of condition in conclusions drawn in research studies. All these solutions presuppose the careful measurement of comorbidity in studies of PTSD, a recommendation that requires serious consideration for researchers operating in this field.


Assuntos
Transtornos Mentais/epidemiologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Comorbidade , Feminino , Humanos , Masculino , Transtornos Mentais/complicações , Pesquisa , Transtornos de Estresse Pós-Traumáticos/complicações , Estados Unidos/epidemiologia
18.
J Anxiety Disord ; 11(3): 317-28, 1997.
Artigo em Inglês | MEDLINE | ID: mdl-9220303

RESUMO

Questions about the differential diagnosis of Post-Traumatic Stress Disorder (PTSD) have been raised since this category was reformulated in DSM-III (APA, 1980). Clinicians have reported difficulties distinguishing PTSD from other categories, particularly from Major Depressive and Generalized Anxiety Disorders (MDD and GAD). Diagnostic validity can be established in several ways (e.g., through clinical descriptive studies, laboratory experiments, family history studies, etc.). In this paper, we describe one approach to validation thus far not applied to PTSD: This approach centers directly on whether clinicians can distinguish PTSD from other diagnostic categories. Experienced clinicians were asked to rate the extent to which a common set of 90 symptom items characterized PTSD, MDD, and GAD. Ratings were analyzed with multivariate and univariate analyses of variance and covariance, multiple discriminant function analysis, and factor analysis; moreover, characteristics of rates were examined for possible influences. Results indicated that clinicians readily distinguish PTSD from MDD and GAD as well as MDD from GAD. Findings are presented in terms of univariate analyses, 34 best discriminating items, and factors specifying dimensions differentiating the syndromes of PTSD, MDD, and GAD. Rater characteristics did not influence diagnostic accuracy, although significant differences in magnitude of symptom intensity were found.


Assuntos
Transtorno Depressivo/diagnóstico , Psiquiatria/normas , Psicologia Clínica/normas , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Terminologia como Assunto , Adulto , Análise de Variância , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/fisiopatologia , Transtorno Depressivo/fisiopatologia , Diagnóstico Diferencial , Análise Discriminante , Análise Fatorial , Feminino , Pesquisas sobre Atenção à Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Análise de Regressão , Transtornos de Estresse Pós-Traumáticos/fisiopatologia
19.
J Trauma Stress ; 9(3): 497-519, 1996 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-8827652

RESUMO

Vietnam combat veterans with current posttraumatic stress disorder (PTSD), with other Axis-I disorders, or with no Axis-I disorders completed a series of tasks designed to elucidate the psychophysiological parameters of information-processing in PTSD. These tasks included a modified Stroop procedure (MSP), a standard Stroop procedure, a recognition memory task, and a threat rating task. Physiological responses were recorded throughout the study. Our data supported several predictions derived from information-processing models of PTSD. PTSD subjects exhibited greater MSP interference to high threat words than both comparison groups, and a liberal response bias toward recognizing military-related words. PTSD symptoms and threat reactions contributed to MSP interference effects for high-threat words after controlling for medications, depression, and baseline physiological activity.


Assuntos
Nível de Alerta , Distúrbios de Guerra/psicologia , Rememoração Mental , Veteranos/psicologia , Adulto , Nível de Alerta/fisiologia , Percepção de Cores , Distúrbios de Guerra/fisiopatologia , Distúrbios de Guerra/reabilitação , Comorbidade , Aprendizagem por Discriminação/fisiologia , Humanos , Masculino , Rememoração Mental/fisiologia , Pessoa de Meia-Idade , Defesa Perceptiva , Psicofisiologia , Tempo de Reação , Semântica , Aprendizagem Verbal/fisiologia , Vietnã
20.
J Nerv Ment Dis ; 184(5): 307-13, 1996 May.
Artigo em Inglês | MEDLINE | ID: mdl-8627277

RESUMO

Previous research has found high rates of psychiatric disorders among veterans with war zone-related posttraumatic stress disorder (PTSD). However, many studies in this area are methodologically limited in ways that preclude unambiguous interpretation of their results. The purpose of this study was to address some of these limitations to clarify the relationship between war zone-related PTSD and other disorders. Participants were 311 male Vietnam theater veterans assessed at the National Center for PTSD at the Boston Veterans Affairs Medical Center. The Clinician-Administered PTSD Scale and the Structured Clinical Interview for DSM-III-R were used to derive current and lifetime diagnoses of PTSD, other axis I disorders (mood, anxiety, substance use, psychotic, and somatoform disorders), and two axis II disorders (borderline and antisocial personality disorders only). Participants also completed several self-report measures of PTSD and general psychopathology. Relative to veterans without PTSD, veterans with PTSD had significantly higher rates of current major depression, bipolar disorder, panic disorder, and social phobia, as well as significantly higher rates of lifetime major depression, panic disorder, social phobia, and obsessive-compulsive disorder. In addition, veterans with PTSD scored significantly higher on all self-report measures of PTSD and general psychopathology. These results provide further evidence that PTSD is associated with high rates of additional psychiatric disorders, particularly mood disorders and other anxiety disorders. The implications of these findings and suggestions about the direction of future research in this area are discussed.


Assuntos
Transtornos Mentais/epidemiologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Adulto , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/epidemiologia , Distúrbios de Guerra/diagnóstico , Distúrbios de Guerra/epidemiologia , Comorbidade , Humanos , MMPI , Masculino , Transtornos Mentais/diagnóstico , Pessoa de Meia-Idade , Transtornos da Personalidade/diagnóstico , Transtornos da Personalidade/epidemiologia , Inventário de Personalidade , Prevalência , Escalas de Graduação Psiquiátrica , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Veteranos/psicologia
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