Noradrenergic and serotonergic function in posttraumatic stress disorder.

BACKGROUND: Yohimbine hydrochloride produces marked behavioral and cardiovascular effects in combat veterans with posttraumatic stress disorder (PTSD). In the present study, yohimbine was used as a probe of noradrenergic activity, and meta-chlorophenylpiperazine (m-CPP) as a probe of serotonergic activity. To our knowledge, this is the first study to describe the behavioral and cardiovascular effects of meta-CPP in patients with PTSD, and to compare these effects with those of yohimbine. METHOD: Twenty-six patients with PTSD and 14 healthy subjects each received an intravenous infusion of yohimbine hydrochloride (0.4 mg/kg), m-CPP (1.0 mg/kg), or saline solution on 3 separate test days in a randomized balanced order and in double-blind fashion. Behavioral and cardiovascular measurements were determined at multiple times. RESULTS: Eleven (42%) of the patients with PTSD experienced yohimbine-induced panic attacks and had significantly greater increases compared with controls in anxiety, panic, and PTSD symptoms, but not in cardiovascular measurements. Eight patients (31%) with PTSD experienced m-CPP-induced panic attacks and had significantly greater increases compared with controls in anxiety, panic, and PTSD symptoms, and in standing diastolic blood pressure. Yohimbine-induced panic attacks tended to occur in different patients from m-CPP-induced panic attacks. CONCLUSION: These data suggest the presence of 2 neurobiological subgroups of patients with PTSD, one with a sensitized noradrenergic system, and the other with a sensitized serotonergic system.

Effects of the benzodiazepine antagonist flumazenil in PTSD.

OBJECTIVE: Evidence from preclinical and clinical studies suggests a role for alterations in the benzodiazepine/GABAA receptor complex in stress and anxiety. Flumazenil is a relatively pure benzodiazepine/GABAA antagonist with limited intrinsic activity. In panic disorder patients, but not healthy controls, flumazenil has been demonstrated to provoke panic attacks. METHOD: Vietnam combat veterans with PTSD (n = 14) received 90-second intravenous infusions of flumazenil 2 mg or placebo in a double-blind, crossover study design. PTSD symptomology was assessed using the PTSD Symptom Scale, and anxiety symptoms were measured with visual analogue rating scales. RESULTS: There was no significant difference in PTSD and anxiety symptoms between administration of flumazenil and placebo. CONCLUSION: Flumazenil administration does not produce an increase in anxiety and PTSD symptoms in patients with PTSD. This suggests that PTSD and panic disorder are dissimilar in terms of benzodiazepine/GABAA system function.

Consistency of memory for combat-related traumatic events in veterans of Operation Desert Storm.

OBJECTIVE: The nature of traumatic memories is currently the subject of intense scientific investigation. While some researchers have described traumatic memory as fixed and indelible, others have found it to be malleable and subject to substantial alteration. The current study is a prospective investigation of memory for serious combat-related traumatic events in veterans of Operation Desert Storm. METHOD: Fifty-nine National Guard reservists from two separate units completed a 19-item trauma questionnaire about their combat experiences 1 month and 2 years after their return from the Gulf War. Responses were compared for consistency between the two time points and correlated with level of symptoms of posttraumatic stress disorder (PTSD). RESULTS: There were many instances of inconsistent recall for events that were objective and highly traumatic in nature. Eighty-eight percent of subjects changed their responses on at least one of the 19 items, while 61% changed two or more items. There was a significant positive correlation between score on the Mississippi Scale for Combat-Related Posttraumatic Stress Disorder at 2 years and the number of responses on the trauma questionnaire changed from no at 1 month to yes at 2 years. CONCLUSIONS: These findings do not support the position that traumatic memories are fixed or indelible. Further, the data suggest that as PTSD symptoms increase, so does amplification of memory for traumatic events. This study raises questions about the accuracy of recall for traumatic events, as well as about the well-established but retrospectively determined relationship between level of exposure to trauma and degree of PTSD symptoms.

Trauma-related symptoms in veterans of Operation Desert Storm: a preliminary report.

OBJECTIVE: This study was designed to examine prospectively the development of trauma-related symptoms over time in two reserve units of Operation Desert Storm veterans. METHOD: One month and 6 months after returning from the Persian Gulf area, 84 National Guard reservists, from one medical unit and one military police unit, completed questionnaires on their exposure to combat and to specific stressors and rated the severity of their symptoms of posttraumatic stress disorder (PTSD) on two different scales. Differences in symptom severity at the two time points were analyzed. RESULTS: Scores on the Mississippi Scale for Combat-Related Post-Traumatic Stress Disorder, but not severity ratings on a symptom scale based on DSM-III-R PTSD criteria, increased significantly from the 1-month to the 6-month rating time. At both time points, symptoms of hyperarousal were more severe than symptoms of reexperiencing or avoiding trauma-related events. Level of exposure to combat, as reflected by the Combat Exposure Scale and a Desert Storm trauma questionnaire, was significantly associated with score on the Mississippi PTSD scale. There were no significant differences in combat exposure and PTSD symptoms between the male and female subjects or between the medical and police units. CONCLUSIONS: These preliminary findings suggest that a high percentage of Desert Storm veterans experienced some trauma-related symptoms after returning to the United States. Six months after the war, these symptoms, although relatively mild, had not significantly improved in this study group as a whole. For research on longer-term outcome, follow-up of these 84 reservists continues.

Trauma-related symptoms in veterans of Operation Desert Storm: a 2-year follow-up.

OBJECTIVE: This study was a 2-year follow-up in an ongoing prospective examination of development of trauma-related symptoms over time in a community group of veterans of Operation Desert Storm. METHOD: Sixty-two National Guard reservists, from one medical and one military police unit, completed the Mississippi Scale for Combat-Related Posttraumatic Stress Disorder and a DSM-III-R-based posttraumatic stress disorder (PTSD) symptom scale 1 month, 6 months, and 2 years after returning from the Middle East. Differences in symptom severity over time were analyzed by using repeated measure analyses of variance. RESULTS: Scores on the Mississippi scale, but not the DSM-III-R PTSD scale, increased significantly over time. Symptoms of hyperarousal were more severe at all time points than were symptoms of reexperiencing or avoidance. Level of combat exposure, as reflected by the Desert Storm trauma questionnaire, was significantly associated with the score on the Mississippi scale at 2 years but not at 1 month or 6 months. All subjects who met the Mississippi scale's diagnostic criteria for PTSD at 1 or 6 months still met the criteria at 2 years. CONCLUSIONS: Although symptoms were relatively mild, there was an overall increase in PTSD symptoms over 2 years. The statistical relationship between level of combat exposure and PTSD symptoms at 2 years, and not before, suggests that it may take time for the consequences of traumatic exposure to become apparent. Moreover, degree of exposure may be important in predicting the eventual development of symptoms. Continued follow-up will address the evolution of PTSD symptoms in Gulf War veterans.

Nosocomial infection rates at an oncology center.

Nosocomial infection rates were computed for 5,031 patients at an oncology center during a 20-month period. Twelve percent of the patients developed nosocomial infections, accounting for a total of 802 infections. The overall incidence of nosocomial infections during this study period was 6.27 infections per 1,000 patient days. The highest incidence of nosocomial infections was found in patients having acute myelogenous leukemia (30.49 infections per 1,000 patient days); bone and joint cancer (27.27 infections per 1,000 patient days); and liver cancer (26.58 infections per 1,000 patient days). The respiratory tract was the most common site of infection, followed by bloodstream, surgical wound, and urinary tract infections. Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, and coagulase-negative staphylococci were most frequently implicated as pathogens. The distribution of specific types of infection according to underlying malignancy was also tabulated. These data provide nosocomial infection rates, common pathogens, and sites of infection for cancer patients, thus assisting in directing appropriate therapy for these patients.

Nosocomial infection rates at an oncology center.

Nosocomial infection rates were computed for 5,031 patients at an oncology center during a 20-month period. Twelve percent of the patients developed nosocomial infections, accounting for a total of 802 infections. The overall incidence of nosocomial infections during this study period was 6.27 infections per 1,000 patient days. The highest incidence of nosocomial infections was found in patients having acute myelogenous leukemia (30.49 infections per 1,000 patient days); bone and joint cancer (27.27 infections per 1,000 patient days); and liver cancer (26.58 infections per 1,000 patient days). The respiratory tract was the most common site of infection, followed by bloodstream, surgical wound, and urinary tract infections. Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, and coagulase-negative staphylococci were most frequently implicated as pathogens. The distribution of specific types of infection according to underlying malignancy was also tabulated. These data provide nosocomial infection rates, common pathogens, and sites of infection for cancer patients, thus assisting in directing appropriate therapy for these patients.

Perceived abuse and neglect as risk factors for suicidal behavior in adolescent inpatients.

The aim of this study was to assess relative risk of histories of different types of abuse (sexual, physical, and emotional) and neglect (physical and emotional) for suicidal behavior (attempts, ideation, and self-mutilation) in psychiatrically hospitalized adolescents. Seventy-one adolescent inpatients (34 boys, 37 girls) completed self-report measures of abuse and neglect, current suicidal ideation, and lifetime suicide and self-mutilation attempts. The prevalence of sexual and physical abuse was 37.5% and 43.7%, respectively, with 31.3% and 61% of youngsters reporting emotional and physical neglect. Fifty-one percent of youngsters had made suicide attempts, and 39% had self-mutilated. Suicide attempters were significantly more likely to be female, Latino, to report sexual, physical, and emotional abuse, and to endorse emotional neglect. In multivariate analyses, female gender, sexual abuse, and emotional neglect remained significant predictors of self-mutilation and suicidal ideation. Female gender and sexual abuse remained significant predictors of suicide attempts. These findings suggest that emotional neglect is an important and deleterious component of maltreatment experiences and may be a more powerful predictor of suicidal behavior in hospitalized adolescents than physical abuse, emotional abuse, and physical neglect.