ABSTRACT
Among Cambodian refugees attending a psychiatric clinic, we assessed psychopathology associated with gastrointestinal panic (GIP), and investigated possible causal mechanisms, including "fear of fear" and GIP-associated flashbacks and catastrophic cognitions. GIP (n=46) patients had greater psychopathology (Clinician-Administered PTSD Scale [CAPS] and Symptom Checklist-90-R [SCL]) and "fear of fear" (Anxiety Sensitivity Index [ASI]) than did non-GIP patients (n=84). Logistic regression revealed that general psychopathology (SCL; odds ratio=4.1) and fear of anxiety-related sensations (ASI; odds ratio=2.4) predicted the presence of GIP. Among GIP patients, a hierarchical regression revealed that GIP-associated trauma recall and catastrophic cognitions explained variance in GIP severity beyond a measure of general psychopathology (SCL). A mediational analysis indicated that SCL's effect on GIP severity was mediated by GIP-associated flashbacks and catastrophic cognitions.
Subject(s)
Cognition , Disasters , Gastrointestinal Diseases/ethnology , Gastrointestinal Diseases/etiology , Memory , Panic Disorder/ethnology , Panic Disorder/psychology , Refugees/psychology , Refugees/statistics & numerical data , Stress Disorders, Post-Traumatic/ethnology , Stress Disorders, Post-Traumatic/psychology , Adolescent , Adult , Agoraphobia/diagnosis , Agoraphobia/ethnology , Agoraphobia/psychology , Cambodia/ethnology , Child , Female , Gastrointestinal Diseases/diagnosis , Humans , Male , Metaphor , Nausea/epidemiology , Panic Disorder/diagnosis , Severity of Illness Index , Somatoform Disorders/epidemiology , Somatoform Disorders/psychology , Starvation/epidemiology , Starvation/psychology , Stress Disorders, Post-Traumatic/diagnosis , Surveys and Questionnaires , United States/epidemiologyABSTRACT
Consecutive Cambodian refugees attending a psychiatric clinic were assessed for the presence and severity of current tinnitus (i.e., at least one episode in the last month). Fifty percent (52/104) of surveyed patients had tinnitus. Among the tinnitus patients, posttraumatic stress disorder (PTSD) rates were significantly more elevated than among nontinnitus patients (OR=13.5; 95% CI=5.8 to 39.4), as were Clinician-Administered PTSD Scale (CAPS) scores. In a hierarchical regression among tinnitus patients (n=52), tinnitus-related trauma associations and catastrophic cognitions accounted for variability in CAPS severity beyond a measure of tinnitus severity. Among tinnitus patients, tinnitus-related trauma associations and catastrophic cognitions mediated the effect of tinnitus severity on CAPS severity.
Subject(s)
Somatoform Disorders/psychology , Stress Disorders, Post-Traumatic/psychology , Tinnitus/psychology , Cambodia/ethnology , Case-Control Studies , Cognition , Cross-Sectional Studies , Female , Humans , Male , Massachusetts , Middle Aged , Regression Analysis , Severity of Illness Index , Stress Disorders, Post-Traumatic/diagnosisABSTRACT
Posttraumatic stress disorder (PTSD) symptoms were assessed by using the Clinician-Administered PTSD Scale (CAPS) in a consecutive sample of Cambodian refugees attending a psychiatric clinic in the United States. Psychometric properties of the translated CAPS and severity of PTSD-related symptoms were examined. The CAPS demonstrated adequate psychometric properties, including coefficient alpha (.92) and item-total correlations (.48-.85). Of the sample 56% (101/179) met Diagnostic and Statistical Manual of Mental Disorders, fourth edition, criteria for current PTSD. Those patients who met criteria for current PTSD had significantly higher CAPS total scores (M = 65.3, SD = 18.1) than those who did not meet the criteria (M = 13.9, SD = 16.7).
Subject(s)
Interview, Psychological , Refugees/psychology , Stress Disorders, Post-Traumatic/diagnosis , Cambodia/ethnology , Female , Humans , Incidence , Male , Massachusetts/epidemiology , Middle Aged , Observer Variation , Psychometrics , Reproducibility of Results , Severity of Illness Index , Stress Disorders, Post-Traumatic/ethnology , Stress Disorders, Post-Traumatic/psychology , TranslatingABSTRACT
Consecutive Cambodian refugees attending a psychiatric clinic were assessed for the presence and severity of current--i.e., at least one episode in the last month--neck-focused panic. Among the whole sample (N=130), in a logistic regression analysis, the Anxiety Sensitivity Index (ASI; odds ratio=3.70) and the Clinician-Administered PTSD Scale (CAPS; odds ratio=2.61) significantly predicted the presence of current neck panic (NP). Among the neck panic patients (N=60), in the linear regression analysis, NP severity was significantly predicted by NP-associated flashbacks (beta=.42), NP-associated catastrophic cognitions (beta=.22), and CAPS score (beta=.28). Further analysis revealed the effect of the CAPS score to be significantly mediated (Sobel test [Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1173-1182]) by both NP-associated flashbacks and catastrophic cognitions. In the care of traumatized Cambodian refugees, NP severity, as well as NP-associated flashbacks and catastrophic cognitions, should be specifically assessed and treated.
Subject(s)
Asian People/psychology , Fear , Neck , Panic Disorder/diagnosis , Refugees/psychology , Somatoform Disorders/diagnosis , Adult , Cambodia/ethnology , Cognition , Cross-Sectional Studies , Cultural Characteristics , Female , Homicide/psychology , Humans , Male , Mental Recall , Middle Aged , Panic Disorder/epidemiology , Panic Disorder/ethnology , Personality Inventory/statistics & numerical data , Psychometrics , Regression Analysis , Somatoform Disorders/epidemiology , Somatoform Disorders/ethnology , Statistics as Topic , Stress Disorders, Post-Traumatic/diagnosis , Stress Disorders, Post-Traumatic/epidemiology , Stress Disorders, Post-Traumatic/ethnology , United StatesABSTRACT
The authors outline six steps to develop culturally sensitive treatment for traumatized refugees, which focus on somatic symptoms. Among Cambodian refugees with posttraumatic stress disorder, the authors describe a somatic presentation (viz., neck-focused panic attacks) that forms a key aspect of trauma-related disorder, how those panic attacks are generated, and a treatment that specifically targets those panic attacks. Evidence of treatment efficacy is provided through a multiple-baseline, across-subjects design (N = 3), and one treatment case is described to illustrate clinical presentation and treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved).
ABSTRACT
We examined the therapeutic efficacy of a culturally adapted cognitive-behavior therapy for Cambodian refugees with treatment-resistant posttraumatic stress disorder (PTSD) and comordid panic attacks. We used a cross-over design, with 20 patients in the initial treatment (IT) condition and 20 in delayed treatment (DT). Repeated measures MANOVA, Group & times; Time ANOVAs, and planned contrasts indicated significantly greater improvement in the IT condition, with large effect sizes (Cohen's d) for all outcome measures: Anxiety Sensitivity Index (d = 3.78), Clinician-Administered PTSD Scale (d = 2.17), and Symptom Checklist 90-R subscales (d = 2.77). Likewise, the severity of (culturally related) neck-focused and orthostasis-cued panic attacks, including flashbacks associated with these subtypes, improved across treatment.
Subject(s)
Cognitive Behavioral Therapy/methods , Panic Disorder/therapy , Refugees/psychology , Stress Disorders, Post-Traumatic/therapy , Cambodia/ethnology , Conditioning, Psychological , Cross-Over Studies , Female , Humans , Hypotension, Orthostatic/psychology , Male , Middle Aged , Models, Psychological , Neck , Panic Disorder/ethnology , Panic Disorder/physiopathology , Panic Disorder/psychology , Stress Disorders, Post-Traumatic/ethnology , Stress Disorders, Post-Traumatic/psychology , United StatesABSTRACT
Among Cambodian refugees attending a psychiatric clinic (n=100), 49% (49/100) had at least one episode of sleep paralysis (SP) in the previous 12 months. The annual and monthly SP prevalences were much higher in posttraumatic stress disorder (PTSD) than in non-PTSD patients. Among the PTSD patients, 65% (30/46) had monthly episodes of SP versus 14.85% (8/54) among non-PTSD patients (chi2[2, n=100]=26.78, P<.001). Moreover, patients with SP in the last month (n=30) versus those without SP had much higher PTSD severity scores. In the entire sample (n=100), the PTSD severity scores correlated significantly with the rate of SP in the last month. During SP, Cambodian refugees usually hallucinated an approaching figure (90%, 44/49). The rate of SP-associated and post-SP panic attacks was high, indicating the great distress caused by the phenomenon. SP seems to be a core aspect of the Cambodian refugee's response to trauma. When treating Cambodian refugees, and traumatized refugees in general, clinicians should assess for its presence.
Subject(s)
Panic Disorder/ethnology , Panic Disorder/psychology , Refugees/psychology , Sleep Paralysis/ethnology , Sleep Paralysis/epidemiology , Sleep Paralysis/psychology , Stress Disorders, Post-Traumatic/diagnosis , Stress Disorders, Post-Traumatic/epidemiology , Stress Disorders, Post-Traumatic/psychology , Surveys and Questionnaires , Adult , Cambodia/ethnology , Comorbidity , Female , Hallucinations/psychology , Humans , Male , Massachusetts/epidemiology , Middle Aged , SpiritualityABSTRACT
Among a psychiatric population of Cambodian refugees (N = 100), 42% had current--i.e. at least once in the last year--sleep paralysis (SP). Of those experiencing SP, 91% (38/42) had visual hallucinations of an approaching being, and 100% (42/42) had panic attacks. Among patients with post-traumatic stress disorder (PTSD; n = 45), 67% (30/45) had SP, whereas among those without PTSD, only 22.4% (11/45) had SP (chi2 = 20.4, p < .001). Of the patients with PTSD, 60% (27/45) had monthly episodes of SP. The Cambodian panic response to SP seems to be greatly heightened by elaborate cultural ideas--with SP generating concerns about physical status, 'good luck' status, 'bad luck' status, sorcery assault, and ghost assault--and by trauma associations to the figure seen in SP. Case vignettes illustrate cultural beliefs about, and trauma resonances of, SP. A model to explain the high rate of SP in this population is presented. SP is a core aspect of the Cambodian refugees response to trauma; when assessing Cambodian refugees, and traumatized refugees in general, clinicians should assess for its presence.
Subject(s)
Panic Disorder/ethnology , Panic Disorder/psychology , Refugees/psychology , Sleep Paralysis/ethnology , Sleep Paralysis/psychology , Spiritualism , Cambodia , Female , Humans , Male , Middle Aged , Surveys and QuestionnairesABSTRACT
Olfactory panic attacks have not been systematically assessed in a psychiatric population by any previous studies. Among Cambodian refugees attending a psychiatric clinic, the present investigation determines the following: (a) 1-month current prevalence of olfactory-triggered panic attacks, (b) associated psychopathology (Hopkins Symptom Checklist and the Structured Clinical Interview for DSM-IV-diagnosed posttraumatic stress disorder [PTSD]), and (c) frequency in events of olfactory panic of catastrophic cognitions (Panic Attack Cognitions Scale [PACQ]) and flashbacks (Clinician-Administered PTSD flashback scale). Forty-five percent of 100 consecutive psychiatric patients were found to have suffered an olfactory-triggered panic attack in the previous month; having current olfactory panic attacks was highly correlated with psychopathology (e.g., to PTSD diagnosis: and chi(2)=50.0; df=1; p<.001); and during olfactory-triggered panic attacks, catastrophic cognitions and flashbacks were common. Possible mechanisms for generation of high rates of olfactory-triggered panic attacks in this population are discussed (the "traumatic memory/catastrophic cognitions/interoceptive conditioning/escalating arousal" or "TCIE" model of panic generation) as are treatment implications.
Subject(s)
Life Change Events , Odorants , Panic Disorder/epidemiology , Refugees/psychology , Smell , Stress Disorders, Post-Traumatic/epidemiology , Adult , Association , Cambodia/ethnology , Comorbidity , Cross-Sectional Studies , Defense Mechanisms , Diagnostic and Statistical Manual of Mental Disorders , Female , Humans , Interview, Psychological , Male , Massachusetts , Mental Recall , Middle Aged , Panic Disorder/diagnosis , Panic Disorder/psychology , Psychopathology , Stress Disorders, Post-Traumatic/diagnosis , Stress Disorders, Post-Traumatic/psychologyABSTRACT
One hundred Khmer refugees attending a psychiatric clinic were surveyed to determine the prevalence of olfactory-triggered panic attacks as well as certain characteristics of the episodes, including trigger (i.e. type of odor), frequency, length, somatic symptoms, and the rate of associated flashbacks and catastrophic cognitions. Forty-five of the 100 patients had experienced an olfactory-triggered panic attack in the last month. Trauma associations and catastrophic cognitions (e.g. fears of a 'wind attack', 'weakness', and 'weak heart') were common during events of olfactory panic. Several case examples are presented. A multifactorial model of the generation of olfactory panic is adduced. The therapeutic implications of this model for the treatment of olfactory panic are discussed.
