Acute stress disorder: a critical review of diagnostic issues

Pulse Wave Velocity, a Predictor of Major Adverse Cardiovascular Events, and Its Correlation with the General Stress Level of Health Care Workers during the COVID-19 Pandemic

Background and Objectives: In the COVID-19 epidemiological context, the health care workers who were treating patients with COVID-19 were exposed daily to additional stress. Pulse wave velocity (PWV) is a predictive parameter for possible major adverse cardiovascular events. The present study aimed to evaluate the correlation between the general stress levels and PWVs of medical workers during the COVID-19 pandemic. Materials and Methods: The study group was heterogeneous in terms of the medical profession. PWV was measured using a TendioMed arteriograph. Assessment of stress level was performed using a general stress questionnaire with questions grouped on the areas that contribute to stress: lifestyle, environment, symptoms, job, relationships and personality. PWV measurements and stress assessment were performed both during the period with many patients with COVID-19 and during the period with few patients with COVID-19. Results: The stress levels and PWVs of subjects were higher in the period when they cared for patients with COVID-19 than in the period when they did not have patients with COVID-19. Conclusions: The study shows a positive correlation between the PWV of each subject and his/her stress score (the higher the stress score, the higher the PWV).

DSM-5-Based ASD Models: Assessing the Latent Structural Relations with Functionality in War-Exposed Individuals

There is a dearth of studies investigating the latent structure of Acute Stress Disorder (ASD) following the changes in the fifth edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5). To date, there is no consensus on the best representation of ASD. This study addressed this gap by examining four latent ASD models in a sample of war-exposed individuals (N = 424). Investigation on the relationship of the best-fitting model to functionality in the latent level was also conducted. The five-factor model, composed of intrusion, avoidance, numbing, dysphoric arousal, and anxious arousal factors, yielded the best-fitting model. Latent associations between the factors of the model and functionality suggest that symptoms of functionality do not significantly affect the factor structure of ASD. These findings have implications for understanding the underlying mechanism of ASD and can inform the development of more nuanced trauma-related interventions, particularly addressing ASD symptoms and functionality separately.

Post-traumatic stress disorder: a state-of-the-art review of evidence and challenges

Post-traumatic stress disorder (PTSD) is arguably the most common psychiatric disorder to arise after exposure to a traumatic event. Since its formal introduction in the DSM-III in 1980, knowledge has grown significantly regarding its causes, maintaining mechanisms and treatments. Despite this increased understanding, however, the actual definition of the disorder remains controversial. The DSM-5 and ICD-11 define the disorder differently, reflecting disagreements in the field about whether the construct of PTSD should encompass a broad array of psychological manifestations that arise after trauma or should be focused more specifically on trauma memory phenomena. This controversy over clarifying the phenotype of PTSD has limited the capacity to identify biomarkers and specific mechanisms of traumatic stress. This review provides an up-to-date outline of the current definitions of PTSD, its known prevalence and risk factors, the main models to explain the disorder, and evidence-supported treatments. A major conclusion is that, although trauma-focused cognitive behavior therapy is the best-validated treatment for PTSD, it has stagnated over recent decades, and only two-thirds of PTSD patients respond adequately to this intervention. Moreover, most people with PTSD do not access evidence-based treatment, and this situation is much worse in low- and middle-income countries. Identifying processes that can overcome these major barriers to better management of people with PTSD remains an outstanding challenge.

Trajectories of PTSD symptoms among children who survived the Lushan earthquake: A four-year longitudinal study

BACKGROUND

This study aimed to explore the trajectories of posttraumatic stress disorder (PTSD) symptoms among child survivors of the Lushan earthquake by using latent category growth analysis.

METHODS

In total, 304 students from a school located in Lushan County were assessed by UCLA PTSD-RI at 1.5, 6, 12, 24 and 48 months after the earthquake. The children ages ranged from 9 to 17 years old at the time of the first assessment, and the sample included 140 males and 164 females.

RESULTS

Four trajectories of PTSD symptoms were found, namely, resilience (53.8%), low symptoms (32.6%), recovery (7.0%), and chronic dysfunction (6.6%). Then, a logistic regression analysis that controlled for gender and grade showed that compared with the resilience group, children with an injury or probable acute stress disorder (ASD) were likely to be in the recovery group, children with probable ASD were more likely to be in the low-symptoms group, and children with a bad relationship with their father were more likely to be in the chronic group.

LIMITATIONS

The participants were selected by convenience principle. All children received an intervention after the earthquake.

CONCLUSIONS

These findings suggest that increasing children's social support may relieve children's PTSD symptoms. We should consider both perceived threat and object exposure in future studies. The posttraumatic stress response was very high and was unstable during the first month after the earthquake, which suggests that psychological first aid is necessary in posttraumatic events.

Distance to threat and risk of acute and posttraumatic stress disorder following bank robbery: A longitudinal study

Identifying pathways through which environmental risk factors influence PTSD is important for understanding PTSD etiology. Here, we hypothesized that the physical proximity to threat influences PTSD risk by increasing ASD following trauma. One hundred six bank employees who had experienced a bank robbery participated in the study. A longitudinal design assessing ASD at day 2 and PTSD at day 30 was used to test the hypothesis. Participants also indicated their location in the bank at the time of the robbery. ASD was identified in 40 (38%) and PTSD in 16 (15%) of the robbery victims. Distance to the robber had a strong effect on ASD (OR 3.51, 95% CI 1.94-6.34) and a somewhat lesser effect on PTSD (OR 2.15, 95% CI 1.04-4.46), indicating that the effect of proximity to threat on PTSD 1 month following trauma could be mediated by its effect on ASD 2 days following trauma. Using structural equation modeling, we confirmed that the effect of distance on PTSD was fully mediated by ASD. These findings suggest that proximity to threat may increase PTSD risk by enhancing the acute stress response following trauma.

[Development and validation of the Subclinical Stress Symptom Questionnaire SSQ-25]

BACKGROUND

Stress symptoms are widespread in the general population and often occur in the early course of mental disorders. However, no validated instrument was available for the study of subclinical stress symptoms and their relevance in the study of psychopathological trajectories. In order to advance and systematize the study of the etiology and pathogenesis of diseases in subclinical populations, the Subclinical Stress Symptom Questionnaire (SSQ-25) was developed in the present study.

METHODS

In the course of three online studies, a total of 1174 subjects were recruited. The first study included item selection and the development of the questionnaire based on the analysis of item parameters, reliability, and exploratory factor analysis. To validate the factor structure, confirmatory factor analysis was used. Validation analyses were applied to distinguish the SSQ-25 from three clinical measures: Beck's Anxiety and Depression Inventory (BAI and BDI), and the Posttraumatic Stress Diagnostic Scale (PDS). In the third study the subclinical property of the instrument was investigated.

RESULTS

Exploratory and confirmatory factor analyses revealed and confirmed a two-factor model (psychological and physiological stress symptoms). Cronbach's alpha was 0.95. The subclinical property of the SSQ-25 was confirmed by means of item information functions, scatter plots, residuals, and Koenker-Bassett tests as opposed to established clinical measures.

DISCUSSION

The SSQ-25 is a comprehensive, reliable, and valid instrument that allows a valid assessment and differentiation of subclinical stress symptoms.

Post-traumatic stress disorder and traumatic brain injury

Disentangling the effects of "organic" neurologic damage and psychological distress after a traumatic brain injury poses a significant challenge to researchers and clinicians. Establishing a link between traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) has been particularly contentious, reflecting difficulties in establishing a unique diagnosis for conditions with overlapping and sometimes contradictory symptom profiles. However, each disorder is linked to a variety of adverse health outcomes, underscoring the need to better understand how neurologic and psychiatric risk factors interact following trauma. Here, we present data showing that individuals with a TBI are more likely to develop PTSD, and that individuals with PTSD are more likely to develop persistent cognitive sequelae related to TBI. Further, we describe neurobiological models of PTSD, highlighting how patterns of neurologic damage typical in TBI may promote or protect against the development of PTSD in brain-injured populations. These data highlight the unique course of PTSD following a TBI and have important diagnostic, prognostic, and treatment implications for individuals with a dual diagnosis.

How to help women at risk for acute stress disorder after childbirth

For some women, childbirth is a traumatic experience that results in significant mental and emotional distress. Whether owing to birth complications, postpartum events such as hemorrhage or pre-existing risk factors such as past history of sexual abuse or rape, the emotional effects of childbirth trauma can lead to acute stress disorder (ASD). To provide the best care for women after childbirth, it's imperative that nurses be able to identify signs of ASD and intervene appropriately. There are many things nurses can do to help women in what could be the most vulnerable time of their lives.

PTSD modifies performance on a task of affective executive control among deployed OEF/OIF veterans with mild traumatic brain injury

Individuals with post-traumatic stress disorder (PTSD) show a cognitive bias for threatening information, reflecting dysregulated executive control for affective stimuli. This study examined whether comorbid mild Traumatic Brain Injury (mTBI) with PTSD exacerbates this bias. A computer-administered Affective Go/No-Go task measured reaction times (RTs) and errors of omission and commission to words with a non-combat-related positive or negative valence in 72 deployed United States service members from the wars in Iraq and Afghanistan. Incidents of military-related mTBI were measured with the Boston Assessment of Traumatic Brain Injury-Lifetime. PTSD symptoms were measured with the Clinician-Administered PTSD Scale. Participants were divided into those with (mTBI+, n = 34) and without a history of military-related mTBI (mTBI-, n = 38). Valence of the target stimuli differentially impacted errors of commission and decision bias (criterion) in the mTBI+ and mTBI- groups. Specifically, within the mTBI+ group, increasing severity of PTSD symptoms was associated with an increasingly liberal response pattern (defined as more commission errors to negative distractors and greater hit rate for positive stimuli) in the positive compared to the negative blocks. This association was not observed in the mTBI- group. This study underscores the importance of considering the impact of a military-related mTBI and PTSD severity upon affective executive control.

Predictors of acute stress disorder severity

BACKGROUND

The DSM-IV diagnosis of acute stress disorder (ASD) describes a posttraumatic reaction that occurs two to twenty-eight days following a trauma and involves symptoms of intrusion, avoidance, hyper-arousal and dissociation. A better understanding of ASD and its pathogenesis could lead to improved post-trauma health care interventions. The aim of this study was to determine prospectively whether a combination of clinical, cognitive and demographic variables were predictive of ASD severity in an acutely traumatized sample.

METHODS

We assessed demographic (e.g. age, gender, education), clinical (e.g. sleep quality, trait anxiety, previous psychiatric diagnoses), and cognitive (e.g. negative cognitions following trauma) variables in a sample of 125 adult motor vehicle accident survivors (age: 32.26±9.99; gender: 56.6% male) approximately 10 days after the accident. Univariate analyes and stepwise linear regression were performed to identify variables predictive of ASD severity.

RESULTS

Although a number of factors were individually associated with ASD severity, in a regression model only 3 factors, trait anxiety, suicide risk and post-traumatic cognitions, emerged as predictive of the severity of the disorder.

LIMITATIONS

The cross-sectional nature of the study and use of self-report measures are important to bear in mind.

CONCLUSIONS

Higher levels of trait anxiety, risk for suicide and negative appraisals of the traumatic event were predictive of ASD severity. As these factors may help to identify those who may be at risk of more severe responses after a traumatic event, and who may benefit from secondary prevention strategies, they should be assessed for in acute trauma survivors.

Acute stress disorder versus chronic posttraumatic stress disorder: inhibition of fear as a function of time since trauma

BACKGROUND

Previous work has shown that inhibition of fear is impaired in posttraumatic stress disorder (PTSD) resulting from both civilian and combat trauma. The purpose of the present study was to investigate the inhibition of learned fear in traumatized individuals diagnosed with either acute stress disorder (ASD) or PTSD. This is the first study to use a conditioned inhibition paradigm with traumatized individuals within a month of trauma exposure. We hypothesized that impaired fear inhibition would be evident in PTSD, but not ASD.

METHOD

Using established translational, psychophysiological methods including fear-potentiated startle, and skin conductance, we examined fear acquisition, stimulus discrimination, and the transfer of learned safety in a Croatian population with ASD or PTSD. This cross-sectional study included three age-matched groups: healthy nontrauma controls (n = 27), a group with chronic PTSD (10 or more years since trauma exposure, n = 24), and a group with ASD (30 days or less since trauma exposure, n = 27).

RESULTS

The presence of trauma-related psychopathology, whether acute or chronic, was associated with an impaired ability to transfer learned safety based on fear-potentiated startle measures, while healthy control subjects showed significant fear inhibition in the presence of the safety cue compared to the danger cue, F(1,26) = 12.64, P = .001.

CONCLUSIONS

These data expand our previously observed findings of PTSD-associated fear inhibition deficits by demonstrating that trauma-related impairments in safety learning are evident within 30 days of trauma exposure.

Does acute stress disorder predict posttraumatic stress disorder following bank robbery?

Unfortunately, the number of bank robberies is increasing and little is known about the subsequent risk of posttraumatic stress disorder (PTSD). Several studies have investigated the prediction of PTSD through the presence of acute stress disorder (ASD). However, there have only been a few studies following nonsexual assault. The present study investigated the predictive power of different aspects of the ASD diagnosis and symptom severity on PTSD prevalence and symptom severity in 132 bank employees. The PTSD diagnosis, based on the three core symptom clusters, was best identified using cutoff scores on the Acute Stress Disorder scale. ASD severity accounted for 40% and the inclusion of other risk factors accounted for 50% of the PTSD severity variance. In conclusion, results indicated that ASD appears to predict PTSD differently following nonsexual assault than other trauma types. ASD severity was a stronger predictor of PTSD than ASD diagnosis.

The structure of acute stress disorder among Chinese adults exposed to an earthquake: is dysphoric arousal a unique construct of acute posttraumatic responses?

As a diagnosis organized mainly on the basis of theoretical conceptualization, acute stress disorder (ASD) has been widely criticized for lack of empirical support since it was introduced into the DSM system. To address this issue, the present study investigated the latent structure of ASD symptoms measured by the Acute Stress Disorder Scale (ASDS). A total of 350 adults with a mean age of 32.9 years (SD = 14.0, range: 16-85) took part in this study 12 to 15 days after an earthquake. The results of confirmatory factor analyses showed that a five-factor intercorrelated model (dissociation, reexperiencing, avoidance, dysphoric arousal, and anxious arousal) demonstrated the best data fit. The findings provide preliminary empirical evidence in favor of a new reconceptualization of ASD symptoms, and are informative for the impending DSM-5.

Evidence for a dissociative subtype of PTSD by latent profile and confirmatory factor analyses in a civilian sample

BACKGROUND

Dissociative symptoms are increasingly recognized in individuals with posttraumatic stress disorder (PTSD). The aim of this study was to investigate the prevalence of derealization and depersonalization symptoms via latent profile analyses (LPAs) in a civilian PTSD sample and examine the relationship between PTSD and dissociative symptoms via factor analytic methods.

METHODS

A civilian sample of individuals with PTSD predominantly related to childhood abuse (n = 134) completed a diagnostic interview for PTSD and comorbid psychiatric disorders. LPAs and confirmatory factor analyses (CFAs) were performed on the severity scores for PTSD, derealization, and depersonalization symptoms.

RESULTS

LPAs extracted three groups, one of which was uniquely characterized by high derealization and depersonalization symptoms, and accounted for 25% of the sample. Individuals in the dissociative subgroup also showed a higher number of comorbid Axis I disorders and a more significant history of childhood abuse and neglect. CFAs suggested the acceptance of a five factor solution in which dissociative symptoms are distinct from but correlate significantly with the core PTSD symptom clusters.

CONCLUSIONS

The results from LPAs and CFAs are concordant with the concept of a dissociative subtype in patients with PTSD and suggest that symptoms of derealization-depersonalization and the core symptoms of PTSD are positively correlated. Thought should be given to including a dissociative subtype of PTSD in the DSM-5.

A review of acute stress disorder in DSM-5

Acute stress disorder (ASD) was introduced into DSM-IV to describe acute stress reactions (ASRs) that occur in the initial month after exposure to a traumatic event and before the possibility of diagnosing posttraumatic stress disorder (PTSD), and to identify trauma survivors in the acute phase who are high risk for PTSD. This review considers ASD in relation to other diagnostic approaches to acute stress responses, critiques the evidence of the predictive power of ASD, and discusses ASD in relation to Adjustment Disorder. The evidence suggests that ASD does not adequately identify most people who develop PTSD. This review presents a number of options and preliminary considerations to be considered for DSM-5. It is proposed that ASD be limited to describing severe ASRs (that are not necessarily precursors of PTSD). The evidence suggests that the current emphasis on dissociation may be overly restrictive and does not recognize the heterogeneity of early posttraumatic stress responses. It is proposed that ASD may be better conceptualized as the severity of acute stress responses that does not require specific clusters to be present.

ASD and PTSD in rape victims

In recent years, a number of studies have investigated the prediction of posttraumatic stress disorder (PTSD) through the presence of acute stress disorder (ASD). The predictive power of ASD on PTSD was examined in a population of 148 female rape victims who visited a center for rape victims shortly after the rape or attempted rape. The PTSD diagnosis based solely on the three core symptom clusters was best identified by a subclinical ASD diagnosis based on all ASD criteria except dissociation. However, a full PTSD diagnosis including the A( 2) and F criteria was best identified by classifying victims according to a full ASD diagnosis. Regardless of whether cases were classified according to full PTSD status or according to meeting the criteria for the three PTSD core symptom clusters, the classification was correct only in approximately two thirds of the cases. A regression analysis based on ASD severity and sexual problems following the rape accounted for only 28% of the PTSD severity variance. In conclusion, the ASD diagnosis is not an optimal method for identifying those most at risk for PTSD. It remains to be seen whether a better way can be found.

Re-examination of the Controversial Coexistence of Traumatic Brain Injury and Posttraumatic Stress Disorder: Misdiagnosis and Self-Report Measures

The coexistence of traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD) remains a controversial issue in the literature. To address this controversy, we focused primarily on the civilian-related literature of TBI and PTSD. Some investigators have argued that individuals who had been rendered unconscious or suffered amnesia due to a TBI are unable to develop PTSD because they would be unable to consciously experience the symptoms of fear, helplessness, and horror associated with the development of PTSD. Other investigators have reported that individuals who sustain TBI, regardless of its severity, can develop PTSD even in the context of prolonged unconsciousness. A careful review of the methodologies employed in these studies reveals that investigators who relied on clinical interviews of TBI patients to diagnose PTSD found little or no evidence of PTSD. In contrast, investigators who relied on PTSD questionnaires to diagnose PTSD found considerable evidence of PTSD. Further analysis revealed that many of the TBI patients who were initially diagnosed with PTSD according to self-report questionnaires did not meet the diagnostic criteria for PTSD upon completion of a clinical interview. In particular, patients with severe TBI were often misdiagnosed with PTSD. A number of investigators found that many of the severe TBI patients failed to follow the questionnaire instructions and erroneously endorsed PTSD symptoms because of their cognitive difficulties. Because PTSD questionnaires are not designed to discriminate between PTSD and TBI symptoms or determine whether a patient's responses are accurate or exaggerated, studies that rely on self-report questionnaires to evaluate PTSD in TBI patients are at risk of misdiagnosing PTSD. Further research should evaluate the degree to which misdiagnosis of PTSD occurs in individuals who have sustained mild TBI.

Avoidant encoding in acute stress disorder: a prospective study

This study investigated the relationship between ongoing posttraumatic adjustment and encoding style. Eleven acute stress disorder (ASD) participants and 14 non-traumatized controls completed the item method of directed forgetting and were retested 1 year later. Trauma-related, positive and neutral words were followed by a "remember" or "forget" instruction. At Time 1, ASD participants demonstrated directed forgetting for trauma and neutral words; controls showed directed forgetting for all word types. At Time 2, directed forgetting was replicated in controls for each word type, but only for neutral words in the ASD group. Directed forgetting effects were absent for positive words in the ASD group. The findings raise the possibility that individuals who develop ASD possess an encoding style for positive material that reflects a trait-like manner of information processing.

A confirmatory factor analysis of the acute stress disorder interview

Acute stress disorder (ASD) was introduced in 1994 to describe posttraumatic stress reactions that occur in the initial month after trauma exposure. Although it comprises the distinct symptom clusters of dissociation, reexperiencing, avoidance, and arousal, there have been no confirmatory factor analyses of the construct. In this study, 587 individuals admitted to five major hospitals after traumatic injury were administered the Acute Stress Disorder Interview. Forty-four participants met criteria for ASD. Confirmatory factor analysis based on the four symptom clusters described the Acute Stress Disorder Interview responses. These data provide the first confirmatory factor analysis of the ASD symptoms, and are discussed in terms of the 4-factor models repeatedly found in samples of chronic posttraumatic stress disorder.

Psychological factors associated with response to maxillofacial injury and its treatment

PURPOSE

This study evaluated symptoms of acute stress disorder (ASD), satisfaction with appearance postsurgery, and satisfaction with care in patients with maxillofacial injury at their first postsurgical physician visit. To determine the best predictors of patients' ASD symptoms and satisfaction, data also were obtained on the patients' strategies for coping with the stress of the injury, on the patients' and doctors' interpersonal appraisals of each other, and on the doctors' participatory behavior during the visits.

PATIENTS AND METHODS

A total of 47 patients who had sustained traumatic maxillofacial injury requiring emergency medical/surgical treatment were administered self-report measures immediately before and after their first postsurgical visit 10 to 12 days after trauma exposure. Doctors completed self-report measures after the visit and evaluated the patients' severity of injury.

RESULTS

Patients experienced high levels of ASD in the short-term period after surgery. Use of emotion-focused strategies by patients to cope with stress was associated with more ASD symptoms but better satisfaction with facial appearance. The more severely injured patients were less satisfied with their appearance and were viewed by their doctors as being more interpersonally controlling during the postsurgical visit.

CONCLUSIONS

Closer attention by doctors to patients' interpersonal behavior may aid in early identification of those patients with maxillofacial injury who may experience longer-term social problems related to their altered facial appearance.

PTSD: therapeutic interventions post-Katrina

August 29, 2006, brought the largest, most deadly hurricane ever to strike the Gulf Coast. According to reports, the storm killed more than 2000 people and destroyed billions of dollars of property, with winds clocked at 160 to 175 mph. More than a million residents were displaced, many requiring care for chronic conditions who suddenly also needed care for acute stress symptoms. Today, many individuals still struggle to cope with major psychiatric posttraumatic stress disorders (PTSD). Using a case study approach, this article discusses PTSD, including what it is, how it is manifested, how to diagnose it, patient education, and how it can be managed with therapeutic interventions. Special circumstances related to children are briefly presented.

The independent predictive value of peritraumatic dissociation for PTSD symptomatology after type I trauma: a systematic review of prospective studies

We conducted a systematic review of prospective studies examining the independent predictive value of peritraumatic dissociation (PD) for posttraumatic stress disorder (PTSD) symptomatology following single traumatic events. Insight into the independent predictive value may help to identify victims at risk for PTSD symptomatology. For this purpose a literature search was carried out using the online databases PsycINFO, Medline/Pubmed, and PILOTS. Studies were included if they were published in peer-reviewed journals (before 2007), focused on more or less single traumatic events (Type I trauma), assessed PD within 1 month, had follow-ups 3 months or later, and which controlled for mental health problems at the time PD was assessed. The majority of the 17 identified studies showed no or only weak indications of an independent predictive value of PD for PTSD symptomatology following type I traumas. Only 3 of the 6 studies with positive results reported a strong independent predictive value of PD. Although bivariately associated with PTSD symptomatology, there is no general consensus across prospective Type I trauma studies that PD qualifies as an important independent predictor of PTSD symptomatology. Results indicate that initial mental health problems, among other factors, are better predictors of PTSD symptomatology than PD.

Clinical presentation and therapeutic interventions for posttraumatic stress disorder post-Katrina

It has been almost 2 years since Hurricane Katrina struck the Gulf Coast. These 2 years can be characterized by constant struggle and pain as the people try to reattain some semblance of life as they knew it before Katrina struck. Some have chosen to leave their ancestral homes, homes where they were raised and where they, in turn, raised their own families. Those who did leave are able, in some way, to reestablish some semblance of normality, but those who stayed showed manifestations of and dealt with psychological trauma. These manifestations include regression, inattentiveness, aggressiveness, somatic complaints, irritability, social withdrawal, nightmares, and crying. Longer lasting effects may include depression, anxiety, adjustment disorders, and interpersonal or academic difficulties. These postdisaster manifestations can linger or remain hidden until well after the traumatic event and could persist for years. This article presents issues about the effects of Katrina on the mental health of the people of New Orleans. It discusses the profile of posttraumatic stress disorder and presents evidence-based review of interventions the health care provider can implement to care for those who continue to suffer the effects of this horrific disaster.

Psychophysiological Response to Severe Sport Injury Among Competitive Male Athletes: A Preliminary Investigation

Features of posttraumatic distress have been associated with treatment noncompliance and delayed surgical recovery among general medical and trauma populations. Although cognitive-affective and behavioral features of posttraumatic distress have been demonstrated among adult and adolescent athletes with injuries, physiological responses associated with posttraumatic distress have not yet been examined in this population. The objective of this study was to examine psychophysiological stress reactivity to orthopedic trauma among male athletes who sustained a severe sport injury. Athletes with injuries (n= 7) and non-injured athlete controls (n= 5) completed self-report measures of psychological distress and were then shown injury video footage while heart rate and skin conductance measures were recorded. After exposure to orthopedic trauma-related video footage, athletes with injuries demonstrated significantly greater skin conductance reactivity and subjective distress compared to controls. As demonstrated among other medical and trauma populations, athletes with injuries exhibit exaggerated stress reactivity profiles when primed with orthopedic trauma stimuli.

Low predictive power of peritraumatic dissociation for PTSD symptoms in accident survivors

To test the predictive power of peritraumatic dissociation for the development of psychopathology, the authors assessed symptoms of peritraumatic dissociation (Peritraumatic Dissociative Experiences Questionnaire; PDEQ), posttraumatic stress disorder (Clinician-Administered PTSD Scale; CAPS), anxiety and depression (Hospital Anxiety and Depression Scale; HADS) in a sample of 214 accident victims 5 days postaccident (T1). Six months later (T2), CAPS and HADS were administered again. Acute stress disorder (ASD) and PTSD symptom levels were surprisingly low. In sequential regression analyses, initial reexperiencing and hyperarousal significantly predicted PTSD symptom level (T2) over several possibly confounding variables controlled for. Peritraumatic dissociation explained less than 3% of variance. For PTSD scores, 38% overall variance explanation was obtained; the variance for HADS scores was low. Possible explanations for the low-predictive power of peritraumatic dissociation for posttraumatic psychopathology in the sample are discussed.

Psychosocial interventions after tsunami in Tamil Nadu, India

Any response to the mental health needs of the affected community following any disaster depends upon a number of factors, including disaster preparedness, existence of mental health services, resources in human and financial terms, along with the magnitude, cause and suddenness of the event. In India, groups of islands in the Bay of Bengal and the coast of Tamil Nadu were very badly hit. The survivors needed basic physical and emotional support. The response by two non-governmental organizations (NGOs) is described in this paper. Normalization was seen as an important first step. Using a number of training materials, volunteers were trained to deal with the mental health needs of the survivors. A consistent well resourced and accessible mental health network is necessary for appropriate intervention.

The Acute Stress Checklist for Children (ASC-Kids): development of a child self-report measure

This project aimed to develop and validate a brief, practical self-report measure of acute stress disorder (ASD) reactions (including ASD diagnostic criteria) in children and adolescents. A draft measure was reviewed for content validity by an expert panel, piloted with youth, and revised for clarity and coverage of key constructs. The new 29-item Acute Stress Checklist for Children (ASC-Kids) was administered to 176 youth age 8 to 17 who had a recent injury or intensive care unit admission. The ASC-Kids demonstrated strong test-retest reliability and internal consistency, as well as concurrent and predictive validity with other traumatic stress measures. Results of exploratory factor analyses were consistent with current conceptualizations of acute traumatic stress reactions. The ASC-Kids is a promising measure of child acute stress reactions.

Adaptação transcultural para o português do instrumento Peritraumatic Dissociative Experiences Questionnaire, Versão Auto-Aplicativa

INTRODUÇÃO: Este artigo apresenta a adaptação transcultural para o português do instrumento Peritraumatic Dissociative Experiences Questionnaire, Self-Report Version (PDEQ-SRV), para rastrear e quantificar os fenômenos dissociativos peritraumáticos. MÉTODOS: Fizeram-se duas traduções e suas respectivas retrotraduções, avaliação da equivalência semântica, elaboração da versão-síntese, pré-teste na população-alvo e realização da versão final. RESULTADOS: Observou-se um grau elevado de equivalência semântica entre o instrumento original e os dois pares de traduções/retrotraduções da perspectiva dos significados referencial e geral. O pré-teste na população-alvo conduziu a poucas modificações, que confirmaram a realização dos critérios de equivalência semântica. DISCUSSÃO: Este trabalho disponibiliza a primeira adaptação para o contexto brasileiro de um instrumento específico para a detecção e a quantificação de sintomas dissociativos peritraumáticos.

Optimism, Satisfaction With Needs Met, Interpersonal Perceptions of the Healthcare Team, and Emotional Distress in Patients’ Family Members During Critical Care Hospitalization

• Background Families of critical care patients experience high levels of emotional distress. Access to information about patients’ medical conditions and quality relationships with healthcare staff are high-priority needs for these families.

• Objectives To assess satisfaction with needs met, signs and symptoms of acute stress disorder, interpersonal perception of healthcare staff, level of optimism, and the relationships among these variables in patients’ family members.

• Methods Family representatives of 40 patients were administered a brief version of the Critical Care Family Needs Inventory, the Acute Stress Disorder Scale, the Brief Symptom Inventory, the Impact Message Inventory, and the Life Orientation Test shortly after admission of the patients to the intensive care unit and after discharge.

• Results Levels of dissociative symptoms associated with acute stress disorder were elevated in family members just after admission but decreased significantly after discharge. Needs the families thought were least satisfactorily cared for after admission involved lack of information. Interpersonally, attending physicians were viewed as more controlling than bedside nurses at admission; nurses were viewed as more affiliative than physicians both at admission and after discharge. At admission, higher optimism of the family members was strongly related to greater satisfaction with needs met, to perceptions of affiliation from physicians, and to perceptions of not being controlled by physicians.

• Conclusions More interpersonal contact with medical staff can help meet the information needs of patients’ families. Nurses may aid in families’ adjustment by fostering a sense of optimism in family members and encouraging them to participate in the patients’ care.

Psychopharmacological possibilities in the acute disaster setting

This article focuses on possible psychopharmacological interventions in the immediate post disaster setting. As there is little evidence for the efficacy or effectiveness of such interventions-given the difficulty in performing randomized, double-blind, placebo controlled studies with these populations-the article will delineate the neurobiological basis for pathological sequelae and theoretical drug interventions targeting putative disease mechanisms.

Prediction of Psychological Health After an Accidental Burn

BACKGROUND

Burn victims often display psychological symptoms that can impede recovery, but knowledge about risk factors for psychopathology is limited. This study aimed to predict psychological health 3 months after burn injury from coping and trauma-related factors assessed early in hospitalization.

METHODS

For this study, 34 burn patients were interviewed during hospitalization about their accident and coping. Questionnaires were administered during hospitalization and 3 months after the burn including the Impact of Event Scale-Revised for posttraumatic stress symptoms (intrusion, avoidance, arousal) and the Hospital Anxiety and Depression Scale for mood.

RESULTS

Anxiety, depressive, and avoidant symptoms at 3 months were highly predicted by baseline levels of these symptoms and avoidant coping. The life threat at the burn event predicted intrusive and arousal symptoms, and coping by self-control predicted less intrusive symptoms. Burn severity was not predictive of psychological health.

CONCLUSIONS

Coping style, life threat during the accident, and early symptoms are strong predictors of psychopathology after a burn.

The prevalence of post-traumatic stress disorder in chronic pain patients

Several of the more common causes of chronic pain include traumatic events such as motor vehicle accidents and work-related incidents. Therefore, it is not unusual for patients presenting with chronic pain to also describe significant levels of distress including post-traumatic symptomatology and, in the more severe cases, post-traumatic stress disorder (PTSD). Throughout the past few decades, the literature relating to chronic pain and PTSD has become progressively more sophisticated, resulting in well-supported theories and treatments for sufferers. However, only a handful of studies have specifically attended to the co-occurrence of these two disorders. This review presents a summary of the literature relating to the two disorders in terms of symptoms, prevalence, and comorbidity. It also briefly describes the main empirically supported psychologic theories of chronic pain and PTSD and briefly reviews the evidence regarding what factors maintain the disorders. Treatment implications and issues for future research are considered.

The relationship between acute stress disorder and posttraumatic stress disorder in severely injured trauma survivors

This prospective longitudinal study was designed to investigate the relationship between acute stress disorder (ASD) and the subsequent development of posttraumatic stress disorder (PTSD) in a population of severely injured hospitalised trauma survivors. Symptoms of ASD were assessed just prior to discharge in 307 consecutive admissions to a Level 1 Trauma Centre, with PTSD assessments completed at 3 and 12 months post-injury. A well-established structured clinical interview was adopted for both assessments. Only 1% of the sample met criteria for an ASD diagnosis (at a mean of 8 days post-injury), while the incidence of PTSD was 9% at 3 months and 10% at 12 months. Although all ASD symptom clusters contributed to the prediction of subsequent PTSD severity, logistic regression indicated that only re-experiencing and arousal predicted a categorical PTSD diagnosis. The dissociative symptoms that form the core of ASD were rarely endorsed and showed high specificity but low sensitivity, resulting in a high proportion of false negative diagnoses. Reducing the number of dissociative symptoms required for a diagnosis ameliorated, but did not resolve, the problem. In this particular population, the low sensitivity of the ASD diagnosis renders it a poor screening test for use in identifying high risk individuals for early intervention and prevention strategies.

Peritraumatic versus persistent dissociation in acute stress disorder

The DSM-IV definition of acute stress disorder (ASD) regards dissociation that occurs during a trauma (peritraumatic dissociation) comparably to persistent dissociation. This study investigated the relative contributions of peritraumatic dissociation and persistent dissociation to acute posttraumatic stress reactions. Civilian trauma (N = 53) survivors with either acute stress disorder (ASD), subclinical ASD, or no ASD were administered modified versions of the Peritraumatic Dissociative Experiences Questionnaire that indexed both dissociation during the trauma and dissociation at the time of assessment. Persistent dissociation was more strongly associated with ASD severity and intrusive symptoms than peritraumatic dissociation. These results are consistent with the proposition that persistent, rather than peritraumatic, dissociation is associated with posttraumatic psychopathology.

Are the dissociative criteria in ASD useful?

Acute stress disorder (ASD) is a new DSM-IV diagnostic category, characterized by dissociative, intrusive, avoidance, and hyperarousal symptoms in the first month after a traumatic experience. The goal of the present study was to examine the utility of this diagnosis. In a prospective study, 79 mixed trauma victims who met DSM-IV symptom criteria for PTSD within 1 month following a traumatic event were followed through three months post-event. Dissociative symptoms in ASD only partially captured distress and dysfunction during the first month. Participants with and without ASD showed similar patterns of recovery, with only small differences that disappeared at three months post-event. Interestingly, initial PTSD avoidance but not ASD dissociative symptoms predicted PTSD severity at 3 months.

Posttraumatic disorders following injury: an empirical and methodological review

Although there has been a marked increase in research on psychological disorders following physical injury in recent years, there are many discrepancies between the reported findings. This paper reviews the prevalence outcomes of recent studies of the mental health sequelae of physical injury with a focus on posttraumatic stress disorder (PTSD), acute stress disorder (ASD), and depression. The review critically outlines some of the methodological factors that may have contributed to these discrepancies. The phenomenological overlap between organic and psychogenic symptoms, the use of narcotic analgesia, the role of brain injury, the timing and content of assessments, and litigation are discussed in terms of their potential to confound findings with this population. Recommendations are proposed to clarify methodological approaches in this area. It is suggested that a clearer understanding of the psychological effects of physical injury will require the widespread adoption of more rigorous, standardized and transparent methodological procedures.