Faculty Bibliography

OBJECTIVE: Meeting criterion A2 for the diagnosis of posttraumatic stress disorder (PTSD) in DSM-IV requires that an individual have high levels of distress during or after the traumatic event. Because of the paucity of valid and reliable instruments for assessing such responses, the authors developed a 13-item self-report measure, the Peritraumatic Distress Inventory, to obtain a quantitative measure of the level of distress experienced during and immediately after a traumatic event. METHOD: The cross-sectional study group comprised 702 police officers and 301 matched nonpolice comparison subjects varying in ethnicity and gender who were exposed to a wide range of critical incidents. RESULTS: The Peritraumatic Distress Inventory was found to be internally consistent, with good test-retest reliability and good convergent and divergent validity. Even after controlling for peritraumatic dissociation and for general psychopathology, the authors found that Peritraumatic Distress Inventory scores correlated with two measures of posttraumatic stress symptoms. CONCLUSIONS: The Peritraumatic Distress Inventory holds promise as a measure of PTSD criterion A2. Future studies should prospectively examine the ability of the Peritraumatic Distress Inventory to predict PTSD and its associated biological and cognitive correlates in other trauma-exposed groups

This study assesses the efficacy of fluvoxamine treatment on different domains of subjective sleep quality in Vietnam combat veterans with chronic posttraumatic stress disorder (PTSD). Medically healthy male Vietnam theater combat veterans (N = 21) completed a 10-week open label trial. Fluvoxamine treatment led to improvements in PTSD symptoms and all domains of subjective sleep quality. The largest effect was for dreams linked to the traumatic experience in combat. In contrast, generic unpleasant dreams showed only a modest response to treatment. Sleep maintenance insomnia and the item 'troubled sleep' showed a large treatment response, whereas sleep onset insomnia improved less substantially. These therapeutic benefits contrast with published reports that have found activating effects of Selective Serotonin Reuptake Inhibitors on the sleep electroencephalogram

Background: Anecdotal reports from space and results from simulation studies on Earth have suggested that space crewmembers may experience decrements in their interpersonal environment over time and may displace tension and dysphoria to mission control personnel. Methods: To evaluate these issues, we studied 5 American astronauts, 8 Russian cosmonauts, and 42 American and 16 Russian mission control personnel who participated in the Shuttle/Mir space program. Subjects completed questions from subscales of the Profile of Mood States, the Group Environment Scale, and the Work Environment Scale on a weekly basis before, during, and after the missions. Results: Among the crewmembers, there was little evidence for significant time effects based on triphasic (U-shaped) or linear models for the 21 subscales tested, although the presence of an initial novelty effect that declined over time was found in three subscales for the astronauts. Compared with work groups on Earth, the crewmembers reported less dysphoria and perceived their crew environment as more constraining, cohesive, and guided by leadership. There was no change in ratings of mood and interpersonal environment before, during, and after the missions. Conclusions: There was little support for the presence of a moderate to strong time effect that influenced the space crews. Crewmembers perceived their work environment differently from people on Earth, and they demonstrated equanimity in mood and group perceptions, both in space and on the ground. Grant numbers: NAS9-19411

OBJECTIVE: First popularized as neurasthenia in the late 1800s by American George Beard, asthenia has been viewed by Russian psychologists and flight surgeons as a major problem that affects cosmonauts participating in long-duration space missions. However, there is some controversy about whether this syndrome exists in space; this controversy is attributable in part to the fact that it is not recognized in the current American psychiatric diagnostic system. METHODS: To address this issue empirically, we retrospectively examined the data from our 4 1/2-year, NASA-funded study of crew member and mission control interactions during the Shuttle/Mir space program. Three of the authors identified eight items of stage 1 asthenia from one of our measures, the Profile of Mood States (POMS). Scores on these items from 13 Russian and American crew members were compared with scores derived from the opinions of six Russian space experts. RESULTS: Crew members' scores in space were significantly lower than the experts' scores on seven of the eight items, and they generally were in the 'not at all' to 'a little' range of the item scales. There were no differences in mean scores before and after launch or across the four quarters of the missions. There were no differences in response between Russian and American crew members. CONCLUSIONS: We could not demonstrate the presence of asthenia in space as operationally defined using the POMS. However, the POMS addresses only emotional and not physiological aspects of the syndrome, and the subject responses in our study generally were skewed toward the positive end of the scales. Further research on this syndrome needs to be done and should include physiological measures and measures that are specific to asthenia

BACKGROUND: Previous magnetic resonance imaging studies of posttraumatic stress disorder reported hippocampal volume loss. The goals of this study were 1) to determine the relationship between hippocampal atrophy and posttraumatic stress disorder in the absence of alcohol abuse, and 2) to test if loss of N-acetylaspartate (a neuron marker) in the hippocampus of posttraumatic stress disorder occurs separate from atrophy. In addition, volume changes in the entorhinal cortex were also explored. METHODS: Eighteen male patients with combat-related posttraumatic stress disorder (mean age 51.2 +/- 2.5 years) and 19 male control subjects (mean age 51.8 +/- 3.2 years) were studied using magnetic resonance imaging and Proton magnetic resonance spectroscopic imaging. Both groups had no alcohol and drug abuse during the past 5 years. RESULTS: Posttraumatic stress disorder and control subjects had similar volumes of hippocampus and entorhinal cortex. In contrast to volume, N-acetylaspartate was significantly reduced by about 23% bilaterally in the hippocampus of posttraumatic stress disorder when compared with control subjects, and creatine-containing compounds were reduced by 26% in the right hippocampus of posttraumatic stress disorder. CONCLUSIONS: N-acetyl asparate and creatine reductions imply that there are hippocampal abnormalities in posttraumatic stress disorder. Furthermore, these metabolite changes seem to be better indicators of posttraumatic stress disorder pathology than volume losses

To improve the interpersonal climate of crewmembers involved with long-duration space missions, it is important to understand the factors affecting their interactions with each other and with members of mission control. This paper will present findings from a recently completed NASA-funded study during the Shuttle/Mir program which evaluated in-group/out-group displacement of negative emotions; changes in tension, cohesion, and leader support over time; and cultural differences. In-flight data were collected from 5 astronauts, 8 cosmonauts, and 42 American and 16 Russian mission control personnel who signed informed consent. Subjects completed a weekly questionnaire that assessed their mood and perception of their work group's interpersonal climate using questions from well-known, standardized measures (Profile of Mood States, Group and Work Environment Scales) and a critical incident log. There was strong evidence for the displacement of tension and dysphoric emotions from crewmembers to mission control personnel and from mission control personnel to management. There was a perceived decrease in commander support during the 2nd half of the missions, and for American crewmembers a novelty effect was found on several subscales during the first few months on-orbit. There were a number of differences between American and Russian responses which suggested that the former were less happy with their interpersonal environment than the latter. Mission control personnel reported more tension and dysphoria than crewmembers, although both groups scored better than other work groups on Earth. Nearly all reported critical incidents came from ground subjects, with Americans and Russians showing important differences in response frequencies

Important psychosocial issues involving tension, cohesion, leader support, and displacement of negative emotions were evaluated in a 4 1/2-year study involving five U.S. and four Russian Shuttle/Mir space missions. Weekly mood and group climate questionnaires were completed by five U.S. astronauts, eight Russian cosmonauts, and 42 U.S. and 16 Russian mission control subjects. There were few findings that supported our hypothesized changes in tension, cohesion, and leader support in crew and ground subjects using various time models, although crewmembers reported decreasing leader support in the 2nd half of the missions, and astronauts showed some evidence of a novelty effect in the first few weeks. There was no evidence suggesting a 3rd quarter effect among crewmembers on any of the 21 subscales evaluated. In contrast, there was strong evidence to support the hypothesized displacement of tension and negative emotions from crewmembers to mission control personnel and from mission control personnel to management. There were several significant differences in response between Americans vs. Russians, crewmembers vs. mission control personnel, and subjects in this study vs. people in comparable groups on Earth. Subject responses before, during, and after the missions were similar, and we did not find evidence for asthenia in space. Critical incidents that were reported generally dealt with events on-board the Mir and interpersonal conflicts, although most of the responses were from a relatively small number of subjects. Our findings have implications for future training and lead to a number of countermeasures

We explored the physical and psychological distress of sheltered battered women. A convenience sample of 50 ethnically diverse women was obtained from women who had resided in two shelters for at least 21 days. Participants had experienced multiple traumatic events (8.1+/-4.6); however, only 19 (38.8%) of the participants were diagnosed with posttraumatic stress disorder (PTSD). When we analyzed biopsychosocial variables, we saw beneficial effects of support (financial, social, spiritual). These findings reinforce the need to enhance the resources of battered women, to help them identify existing opportunities, and to fortify self-caring strategies that give them strength

The effect of initial trauma on the symptomatic response to a subsequent trauma was investigated in a cross-sectional study of urban bus drivers. Comparisons were made among 175 drivers (mean age 42.2 yrs) who had developed either high or low symptoms of posttraumatic stress disorder (PTSD) as a result of the initial trauma, and a third group exposed to only a single trauma. The group with high levels Of PTSD symptoms after the initial trauma reported high PTSD symptoms for a subsequent trauma (75%) significantly more often than the other two groups who did not differ from each other (Low PTSD symptoms group 49%, No prior trauma group 41 %). These results suggest that unless trauma exposure leads to significant PTSD symptoms, it is not a risk factor for high PTSD symptoms after exposure to a subsequent traumatic event.