ABSTRACT
Declarative memory impairment is a frequent complaint of patients suffering from posttraumatic stress disorder (PTSD). We assessed memory, attention, visual spatial skills, and executive function in Vietnam combat veterans with (n = 19) and without (n = 13) PTSD. Although PTSD subjects demonstrated a "generalized impairment" relative to non-PTSD subjects on a majority of tasks, only attention and memory provided unique and independent prediction of PTSD versus non-PTSD status. Our findings suggest that memory functioning represents a neurocognitive domain of specific relevance to the development of PTSD in trauma-exposed individuals, which can be distinguished from generalized attentional impairment as well as the effects of trauma exposure severity, IQ, comorbid depression, history of alcohol use, and history of developmental learning problems.
Subject(s)
Attention , Combat Disorders/complications , Combat Disorders/psychology , Memory Disorders/etiology , Memory Disorders/psychology , Veterans/psychology , Alcoholism/complications , Alcoholism/psychology , Case-Control Studies , Comorbidity , Depression/complications , Depression/psychology , Humans , Interview, Psychological , Learning Disabilities/complications , Learning Disabilities/psychology , Male , Memory Disorders/diagnosis , Middle Aged , Multivariate Analysis , Neuropsychological Tests , New Hampshire , Risk Factors , Severity of Illness Index , Vietnam , WarfareABSTRACT
BACKGROUND: Subtle neurologic impairment has been reported in several mental disorders. The goals of the present study were to evaluate neurologic status in patients of both sexes with chronic posttraumatic stress disorder (PTSD) from different traumatic experiences. METHODS: Twenty-one adult women who were sexually abused as children (12 with PTSD, 9 without) and 38 male Vietnam War combat veterans (23 with PTSD, 15 without) underwent examination for 41 neurologic soft signs, which were scored by the examiner as well as a blind rater observing videotapes. Subject history was obtained with special attention to neurodevelopmental problems. Psychometrics included the Wender Utah Rating Scale for symptoms of childhood attention-deficit/hyperactivity disorder and the Michigan Alcoholism Screening Test. Veterans also completed the Combat Exposure Scale and subtests of the Wechsler Adult Intelligence Scale-Revised. RESULTS: Average neurologic soft sign scores (interrater reliability = 0.74) of women with PTSD owing to sexual abuse in childhood (mean [SD], 0.77 [0.32]) and veteran men (0.72 [0.20]) with combat-related PTSD were comparable and significantly (P<.001) higher than those of women sexually abused as children (0.42 [0.10]) and combat veteran men (0.43 [0.17]) without PTSD. This effect could not be explained by a history of alcoholism or head injury. Subjects with PTSD reported more neurodevelopmental problems and more childhood attention-deficit/hyperactivity disorder symptoms and had lower IQs, all of which were significantly correlated with neurologic soft signs. CONCLUSION: Neurologic compromise is evident from subject history and findings from physical examination in both women and men with chronic PTSD who had experienced different kinds of traumatic events in childhood and adulthood.
Subject(s)
Nervous System Diseases/diagnosis , Stress Disorders, Post-Traumatic/diagnosis , Adolescent , Adult , Attention Deficit Disorder with Hyperactivity/diagnosis , Attention Deficit Disorder with Hyperactivity/epidemiology , Child , Child Abuse, Sexual/diagnosis , Child Abuse, Sexual/psychology , Child Abuse, Sexual/statistics & numerical data , Combat Disorders/diagnosis , Combat Disorders/epidemiology , Combat Disorders/psychology , Comorbidity , Female , Humans , Intellectual Disability/diagnosis , Intellectual Disability/epidemiology , Life Change Events , Male , Nervous System Diseases/epidemiology , Neurologic Examination , Psychological Tests , Sex Factors , Stress Disorders, Post-Traumatic/epidemiology , Stress Disorders, Post-Traumatic/psychologyABSTRACT
We found higher levels of positive soft neurological signs in PTSD participants than in participants who also experienced similar trauma but did not develop PTSD. This finding was replicated in two samples, that is, Vietnam combat veterans and adult female survivors of childhood sexual abuse, despite differences in gender, age, nature of trauma, and period of life when the trauma occurred. Past developmental history of participants and a substance abuse history of first-degree relatives also differentiated PTSD from non-PTSD groups in both combat and sexual abuse samples. Evidence for neurological impairment and compromised developmental history raises the possibility of pretrauma impairment as a risk factor for the development of PTSD.
Subject(s)
Child Abuse, Sexual , Nervous System/physiopathology , Stress Disorders, Post-Traumatic/etiology , Stress Disorders, Post-Traumatic/physiopathology , Veterans , Adult , Child , Child, Preschool , Female , Humans , Male , VietnamABSTRACT
This study used quantitative volumetric magnetic resonance imaging techniques to explore the neuroanatomic correlates of chronic, combat-related posttraumatic stress disorder (PTSD) in seven Vietnam veterans with PTSD compared with seven nonPTSD combat veterans and eight normal nonveterans. Both left and right hippocampi were significantly smaller in the PTSD subjects compared to the Combat Control and Normal subjects, even after adjusting for age, whole brain volume, and lifetime alcohol consumption. There were no statistically significant group differences in intracranial cavity, whole brain, ventricles, ventricle:brain ratio, or amygdala. Subarachnoidal cerebrospinal fluid was increased in both veteran groups. Our finding of decreased hippocampal volume in PTSD subjects is consistent with results of other investigations which utilized only trauma-unexposed control groups. Hippocampal volume was directly correlated with combat exposure, which suggests that traumatic stress may damage the hippocampus. Alternatively, smaller hippocampi volume may be a pre-existing risk factor for combat exposure and/or the development of PTSD upon combat exposure.
Subject(s)
Combat Disorders/pathology , Hippocampus/pathology , Stress Disorders, Post-Traumatic/pathology , Adult , Chronic Disease , Combat Disorders/psychology , Humans , Image Processing, Computer-Assisted , Magnetic Resonance Imaging , Male , Neuropsychological Tests , Psychiatric Status Rating Scales , Psychometrics , Risk Factors , Stress Disorders, Post-Traumatic/psychologyABSTRACT
This study measured self-reported aggression, hostility, and anger in Vietnam combat veterans with (n = 27) and without (n = 15) posttraumatic stress disorder (PTSD). On the Buss-Durkee Hostility Inventory, Past Feelings and Acts of Violence Scale, Episodic Dyscontrol Scale, and State-Trait Anger Expression Inventory (STAXI), PTSD subjects scored significantly higher than non-PTSD subjects, whose scores fell in the range reported for normative, noncombat populations. The PTSD versus non-PTSD group differences were not explained by combat exposure, which did not correlate significantly with the psychometric aggression measures. These findings suggest that increased aggression in war veterans is more appropriately regarded as a property of PTSD, rather than a direct consequence of military combat. The association between compromised neurologic and neuropsychologic status and the psychometric measures was modest and explained little of the group differences.
Subject(s)
Aggression/psychology , Combat Disorders/psychology , Veterans/psychology , Adult , Alcoholism/diagnosis , Alcoholism/psychology , Anger , Combat Disorders/diagnosis , Hostility , Humans , Irritable Mood , Male , Middle Aged , Personality Assessment/statistics & numerical data , Personality Inventory/statistics & numerical data , Psychometrics , Substance-Related Disorders/diagnosis , Substance-Related Disorders/psychology , VietnamABSTRACT
This study investigated neurological status in 27 medication-free outpatient Vietnam veterans meeting DSM-III-R criteria for posttraumatic stress disorder (PTSD) and 15 non-PTSD combat control subjects, all without alcohol or drug dependence or abuse during the past year. Subjects underwent neurological examination, neuropsychological testing, and sleep-deprived EEG. PTSD subjects showed significantly more neurological soft signs than non-PTSD subjects. Neither substance dependence/abuse nor the more frequent history of developmental problems in PTSD subjects accounted for this difference. There were no significant EEG or neuropsychological testing group differences; however, there were significant correlations between several neuropsychological test scores and total neurological soft signs.
