Two studies of reported pretraumatic stressors' effect on posttraumatic stress disorder severity.

We contrasted in two studies the effects of military trauma on Vietnam veterans who reported high and low premilitary stress. In the first, we administered the Posttraumatic Stress Disorder Interview (PTSD-I), a premilitary modification of the Social Readjustment Rating Scale, and the Military Stress Scale to hospitalized veterans. Premilitary stress appeared to reduce the impact of combat on several trauma-reexperiencing ratings, although the relevant evidence was inconsistent. In the second study, the premilitary stress main effects and the premilitary stress/combat interactions on four PTSD-I factors were nonsignificant. Thus, the severities of most PTSD symptoms increased with trauma intensity, but not with milder premilitary stress. The inconsistent data on the impact of pretraumatic stress on the trauma severity/PTSD relationships suggest further study.

The PTSD interview: rationale, description, reliability, and concurrent validity of a DSM-III-based technique.

This paper describes the PTSD Interview (PTSD-I). It was developed to meet four specifications: (a) close correspondence to DSM-III standards; (b) binary present/absent and continuous severity/frequency outputs on each symptom and the entire syndrome; (c) administrable by trained subprofessionals; and (d) substantial reliability and validity. It was written to meet the first three criteria. It demonstrated very high internal consistency (alpha = .92) and test-retest reliability (Total score r = .95; diagnostic agreement = 87%). It correlated strongly with parallel DIS criteria (Total score vs. DIS diagnosis rbis = .94, sensitivity = .89, specificity = .94, overall hit rate = .92, and kappa = .84). Earlier studies revealed correlations with a military stress scale and Keane et al.'s MMPI PTSD subscale. It is apparently the only PTSD instrument that meets all of the above criteria.

A factor analysis of the DSM-III post-traumatic stress disorder criteria.

The authors factor analyzed DSM-III-based post-traumatic stress disorder symptom ratings made on 131 Vietnam-veteran PTSD patients. Five factors--termed Intrusive Thoughts and Their Effects, Increased Arousal, Impoverished Relationships, Guilt, and Cognitive Interference--emerged. The factor structure gave more support to Laufer, Brett and Gallops' conceptualization of PTSD than to the Horowitz, DSM-III, or DSM-III-R systems. It also generated suggestions for future editions of the diagnostic manual.

Childhood stress disorder behaviors in veterans who do and do not develop posttraumatic stress disorder.

The purpose of this study was to test a variation of the stress-evaporation theory, which maintains that posttraumatic stress disorder (PTSD) symptoms are simply exacerbations of behaviors present before the trauma. Retrospective childhood self-ratings were made by 63 PTSD patients, 53 psychiatric controls, and 28 normals on 13 PTSD-like symptoms. The results did not support the hypothesis, and they give more support to the residual-stress model than to the stress-evaporation theory.

Differences between posttraumatic stress disorder patients with delayed and undelayed onsets.

In an effort to determine whether they differ from one another in important ways, the authors compared posttraumatic stress disorder (PTSD) victims who reported delayed onsets with those who claimed undelayed onsets of PTSD symptom self-ratings, MMPI clinical and validity scale scores, stress histories, and repression measures. The number and the sizes of the differences did not exceed chance expectations and did not support the establishment of separate delayed- and undelayed-onset PTSD categories in the diagnostic manual, nor did they support the hypotheses that the delay, when it appears, is attributable to the magnitude of the trauma, the severity of the symptoms, repression, or a limited stress history.

Perceptual distraction in schizophrenia.

The purpose of this project was to determine whether a distractibility deficit at the stimulus-identification level could be identified in schizophrenics after distractor and non-distractor conditions had been matched for difficulty (N = 110). Process schizophrenics, reactive schizophrenics, and psychiatric controls were asked to identify tachistoscopically presented stimuli shown with and without distractors. The distractor and non-distractor tasks were matched for difficulty beforehand by manipulating presentation intervals. The schizophrenics did not show more deficit under the distractor conditions than did the nonschizophrenic patients. Moreover, compared to psychiatric controls, the schizophrenics' performances were no more deficient under distractor conditions than under non-distractor conditions, even before the tasks were matched for difficulty. These findings suggest that perceptual distractibility at the stimulus identification level is no more pronounced in schizophrenics than in nonschizophrenics, especially after difficulty is controlled.

The relationships of post-traumatic stress disorder to adolescent illegal activities, drinking, and employment.

The authors compared the self-reported incidences of adolescent legal problems, drinking, employment, and church attendance in psychiatric patients (N = 116) with and without post-traumatic stress disorder (PTSD) and normals (N = 28). The differences did not exceed chance expectations. The data raise doubts about the validity of the theory that PTSD is at least partially a result of pre-traumatic personality maladjustment.

Intellectual deterioration and personality decompensation in schizophrenia.

The Army General Classification Test (AGCT) and the MMPI were administered to schizophrenic inpatients (N = 50) with initially high (mean standard score = 115) and low (77) intelligence at two timepoints separated by an average of 14 years. The Arithmetic scores of the more intelligent group declined significantly with time, but significant changes did not appear on the Vocabulary or Spatial Aptitude scores of that group. No significant mean changes appeared in the low-IQ sample. The high-IQ group's Arithmetic section deterioration resulted from an increased error rate, not a drop in speed. No changes beyond those attributable to chance appeared on the MMPI scales. The results suggest that an intellectual decline limited to certain skills and to a subset of subjects occurs in schizophrenia and that the deterioration is not attributable to personality decompensation as defined by the MMPI. Because these findings appear to contrast with most previous research in this area, they should be considered tentative until confirmed by independent studies.

The comparative validities of six MMPI repression scales.

The validities of six MMPI repression scales were compared using each of the other five and an independent measure as criteria (N = 190). The data gave little support to the Eichman, Welsh, and Haan Repression scales as operational definitions of this construct. The results for the Little-Fisher Denial, Byrne et al. R-S, and Haan Denial scales showed more promise.

Performance asymptotes in schizophrenia: a further test of the Broen-Storms theory.

Broen and Storms have developed a theory that attributes schizophrenic cognitive deficit to the combination of high drive levels and low response strength ceiling. The authors tested four hypotheses drawn from the theory in a multiple-choice paired associates learning study (N = 90). The hypotheses were that schizophrenics would demonstrate faster acquisition of reinforced (dominant) responses, lower peak performances, and greater declines in post-peak performance than would two comparison groups. They also hypothesized that all three groups would manifest declines in number of dominant responses after peak performance levels were reached. None of the hypotheses was supported. These results, and the majority of the earlier research on the Broen-Storms hypothesis, cast doubt on the utility of the theory.

The relationships of anhedonia and the process-reactive dimension to season of birth and infectious disease incidence in schizophrenia.

This project was designed to test two hypotheses drawn from a new formulation explaining the exaggerated winter birthrate among hospitalized schizophrenics. The first is that the supposed exaggerated winter birthrate among process schizophrenics actually represents a reduction in spring-fall births caused by prenatal exposure to infectious diseases during the preceding winter--i.e., a high prenatal death rate in process preschizophrenic fetuses. The second is that the level of negative symptoms in survivors at risk for schizophrenia who were born after winters with high infectious disease rates is exaggerated. The findings provided some tentative support for this formulation. Compared with counterparts born after low-disease winters, schizophrenics born after winters with high disease incidences tended to show lower (more reactive) scores on a measure of the process-reaction dimension but higher anhedonia scores.

A cross-validation of the Keane and Penk MMPI scales as measures of post-traumatic stress disorder.

The scores of DSM-III-diagnosed post-traumatic stress disorder (PTSD) patients (N = 116), psychiatric patients who did not meet the criteria, and normals (N = 19) on the Keane, Malloy, and Fairbank (1984) PTSD and Penk Combat scales for the MMPI were compared. The Keane scale discriminated PTSD-positive patients from normals at a substantial level of accuracy (omega 2 = .23; mean hit rate = 80.5%) and PTSD-positive from PTSD-negative patients at a more modest level (omega 2 = .09; mean hit rate = 64%). The scores of the PTSD-positive and PTSD-negative patients were considerably lower than those of Keane et al.'s (1984) samples, which suggests that local norms may be needed to facilitate their interpretation. The Penk Combat Intensity scale, which was correlated highly with the Keane scale, differentiated the PTSD-positive patients from both the normals and the PTSD-negative patients, but with less differentiating power (omega 2'S = .07 and .08). The Penk Combat Exposure scale did not separate the groups.

The definition of posttraumatic stress disorder in alcoholic Vietnam veterans. Are the DSM-III criteria necessary and sufficient?

The authors evaluated the validities of the DSM-III elements defining posttraumatic stress disorder (PTSD) in alcoholic Vietnam veterans by studying the relationships of each to qualification for a PTSD diagnosis under DSM-III standards, the history of a major stressor (3 or more months of combat), and the presence/absence of enough other problems to meet the symptomatic DSM-III requirements for this diagnosis. Elements dealing with the reexperiencing of traumas, diminished pleasure, detachment from others, hyperalertness, sleep disturbance, guilt over behaviors required for survival, and avoidance of stimuli reminiscent of traumas showed substantial correlations with eligibility for a PTSD diagnosis. However, items dealing with emotional expressiveness, response to intimacy, survival guilt, impaired memory, and trouble concentrating either failed to correlate with qualification for a PTSD diagnosis or yielded marginal results. One ("lacking direction") of 10 additional symptoms sometimes termed as "post-Vietnam syndrome" behaviors correlated with eligibility for a PTSD diagnosis as well. The present results and those described in earlier studies suggest that several modifications in the DSM-III definition of PTSD are desirable.

The birth seasonality effect in nonschizophrenic psychiatric patients.

Several studies have suggested that patients with affective, neurotic, and personality disorders are particularly likely to have been born during the early months of the year. They suggest that seasonal factors may play a role in the etiologies of these disorders. However, Lewis and Griffin (1981) have suggested that the reported seasonal exaggerations in psychiatric patients' birthrates simply may reflect artifacts. We searched for seasonal trends in the birth patterns of neurotics (N = 989), alcoholics (N = 2,870), affective disorders (N = 320) and personality disorders (N = 713), both before and after controlling for these artifacts. No significant effect appeared.

Schizophrenic birth seasonality in relation to the incidence of infectious diseases and temperature extremes.

Previous research has indicated that schizophrenics are particularly likely to have been born during the winter months. In the present investigation, we studied the relationships of this birth-seasonality effect to year-to-year variations in the incidences of eight seasonal diseases and climatological temperature extremes in 3,246 schizophrenics. The winter birth-seasonality effect was greater in the years directly following those marked by high levels of infectious disorders than in years directly following those with low incidences of these diseases. Winter diseases (particularly diphtheria, pneumonia, and influenza) appeared to be more involved than others. These effects appeared among unmarried (presumably severe) schizophrenics but not among married patients, suggesting that the relationship is specific to process schizophrenia. The fact that most of the significant and near-significant relationships paired strength of birth seasonality to previous-year disease incidences suggested a prenatal rather than postnatal effect. Birth seasonality did not vary with winter or summer temperature extremes.

Prediction of the WAIS-scores from the 1973 Henmon-Nelson revision.

Administered the 1973 revision of the Henmon-Nelson and the WAIS to 100 psychiatric patients. The correlation of Henmon-Nelson raw scores with WAIS Full Scale scaled score was .83, which compared favorably with correlations run between several other short IQ tests and the WAIS in similar samples drawn from the same setting in earlier studies. However, the Henmon-Nelson did not appear able to estimate the WAIS IQs of low-intelligence Ss or aged persons with consistent accuracy. The validities of short IQ tests and current practices in the selection of WAIS surrogates were discussed.

A note on the pathology of anhedonia.

Tested the hypotheses that anhedonia afflicts only a minority of schizophrenics and is bimodally distributed among them by comparing the Anhedonia scale distributions of schizophrenic and psychiatric control samples (N = 90). Only 45% of the schizophrenics produced scores higher than those characteristic of the controls. While the schizophrenics' distribution appeared to be bimodal, its irregularity precluded a definitive assessment of the bimodality hypothesis. The correlation between age and Anehodina was positive for anhedonics but not for non-anhedonic schizpohrenics or controls; these findings suggest that anhedonia is a mildly progressive disorder among those schizophrenics who experience it.