Faculty Bibliography

Most available research on MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) scores in combat veterans suffering from posttraumatic stress disorder (PTSD) has focused on Vietnam veterans. No data are available from peacekeepers suffering from PTSD. The aim of this study was to investigate the relationship between PTSD and the MMPI-2 in a sample of 120 treatment seeking peacekeeping veterans. Results show that relative to a non-PTSD reference group, veterans who screened positive for PTSD scored higher on Scales F, 2 (D), 4 (Pd), 6 (Pa), 7 (Pt), 8 (Sc), and 0 (Si) of the MMPI-2. Scales 2 (D), 7 (Pt), and 8 (Sc) were highest in the mean PTSD profile but no 2- or 3-point code type could be defined. Moderate correlations were found between a self-report measure for PTSD symptoms and scores on MMPI-2 clinical scales 1 (Hs), 2 (D), 6 (Pa), 7 (Pt), and 8 (Sc). The MMPI-2 proved to be useful in assessing the broad range of symptoms typically present in trauma populations as well as the severity of posttraumatic morbidity.

To account for individual differences in vulnerability for stress-related disorders, studies have examined the relationship between hypothalamic-pituitary-adrenal (HPA) axis functioning and personality. The present study examined the relationship between the free fraction of cortisol in saliva after awakening and personality as measured with Cloninger's Temperament and Character Inventory [Cloninger, C.R., Przybeck, T.R., Svrakic, D.M., Wetzel, R.D., 1994. The Temperament and Character Inventory (TCI): A Guide to its Development and Use. Washington University, Center for Psychobiology of Personality, St. Louis, MO] in 107 healthy male soldiers. Harm avoidance explained 9% of variance in cortisol levels after awakening (AUCG), and harm avoidance and self-directedness predicted 10% of variance in mean cortisol increase. The cortisol awakening response (CAR) was lower in participants with low scores on harm avoidance, and mean cortisol increase after awakening was higher in soldiers high on self-directedness and harm avoidance. These results show that the CAR is related to personality and that it can be used to examine individual differences in HPA (re)activity.

BACKGROUND: Several studies have investigated volumetric brain changes in patients with posttraumatic stress disorder (PTSD) and borderline personality disorder (BPD). Both groups exhibit volume reductions of the hippocampus and amygdala. Our aim was to investigate the influence of comorbid PTSD on hippocampus and amygdala volumes in patients with BPD. METHODS: We compared 2 groups of unmedicated female patients with BPD (10 with and 15 without comorbid PTSD) and 25 healthy female controls. We used T(1)- and T(2)-weighted magnetic resonance images for manual tracing and 3-dimensional reconstruction of the hippocampus and amygdala. RESULTS: Hippocampus volumes of patients with BPD and PTSD were smaller than those of healthy controls. However, there was no significant difference between patients with BPD but without PTSD and controls. Impulsiveness was positively correlated with hippocampus volumes in patients with BPD. LIMITATIONS: Our study did not allow for disentangling the effects of PTSD and traumatization. Another limitation was the relatively small sample size. CONCLUSION: Our findings highlight the importance of classifying subgroups of patients with BPD. Comorbid PTSD may be related to volumetric alterations in brain regions that are of central importance to our understanding of borderline psychopathology.

Although posttraumatic stress disorder (PTSD) is associated with chronic pain, preliminary evidence suggests reduced experimental pain sensitivity in this disorder. The questions addressed in the present study were whether pain perception would also be reduced in PTSD patients who are not suffering from chronic pain symptoms, and whether a reduction in pain sensitivity would also be present in combat veterans who did not develop PTSD. For this, we determined thermal detection and pain thresholds in 10 male combat-related PTSD patients, 10 combat control subjects (no PTSD) and 10 healthy controls without combat experience. All subjects were pain free. First, we measured thermal sensory thresholds with ramped heat and cold stimuli using the method of limits. Ramped thermal sensory stimulation revealed no deficits for the detection of (non-noxious) f2.1thermal stimuli between groups. In contrast, heat and cold pain thresholds in both combat groups (PTSD and combat controls) were significantly increased compared to healthy controls. However, these stimuli could not distinguish between the two groups due to ceiling effects. When using longer-lasting heat stimulation at different temperatures (30s duration; method of fixed stimuli), we found significantly lower frequency of pain reports in PTSD patients compared with both combat and healthy controls, as well as significantly lower pain ratings. Our results suggest an association of PTSD with reduced pain sensitivity, which could be related to PTSD-related (neuro-)psychological alterations or to a pre-existing risk factor for the disorder.

BACKGROUND: Several studies have reported deficits in both immediate and delayed recall of verbal memory in patients with posttraumatic stress disorder (PTSD). However, most of these studies had several methodological disadvantages. None of these studies assessed parameters related to social or occupational functioning. METHODS: Fifty Dutch veterans of UN peacekeeping missions (25 with PTSD and 25 without PTSD) were assessed with a comprehensive neuropsychological test battery consisting of four subtests of the Wechsler Adult Intelligence Scale-III, California Verbal-Learning Test, and the Rey Auditory Verbal-Learning Test. Veterans with PTSD were free of medication and substance abuse. RESULTS: Veterans with PTSD had similar total intelligence quotient scores compared to controls, but displayed deficits of figural and logical memory. Veterans with PTSD also performed significantly lower on measures of learning and immediate and delayed verbal memory. Memory performance accurately predicted current social and occupational functioning. CONCLUSIONS: Deficits of memory performance were displayed in a sample of medication- and substance abuse-free veterans with PTSD. Deficits in memory performance were not related to intelligence quotient, length of trauma exposure, or time since trauma exposure. This study showed that cognitive performance accurately predicted current social and occupational functioning in veterans with PTSD.

This paper provides a brief review of the developments in neurobiological research of posttraumatic stress disorder (ptsd), particularly into the link between the disorder and the central and peripheral stress-regulating processes. ptsd is an impairment of neuronal circuits and stress-regulating systems in the brain, where a critical note is played by limbic structures such as the hippocampus, the amygdala and the medial prefrontal cortex. In patients with ptsd the 'behaviour' of these neuronal circuits and systems is chronically disturbed. Characteristic symptoms are increased stress reactivity, reduction of declarative memory performance, high emotionality in response to trauma-related stimuli and over-representation of traumatic memory, all of which can be described as chronic dysregulated processes. Because of improvements in research designs and stratification of research populations, the specificity of research findings has improved and the developmental trajectories of specific ptsd parameters have been described more clearly. One of the most promising developments in the field of research designs is the current shift away from cross-sectional research designs to 'true prospective' research designs.

Group therapy can effectively reduce posttraumatic stress symptoms. However, the available literature on multifaceted programs for military samples is limited and available studies typically do not evaluate outcomes on a broad range of related problems. This study describes a retrospective evaluation of a multimodal, exposurebased group treatment program for posttraumatic stress disorder (PTSD) and associated symptoms in 22 peacekeeping veterans who successfully completed treatment. Treatment consisted of exposure-based CBT, case management, psycho-education, creative arts therapy, psychomotor therapy, psychodrama, and socio-therapy, which were provided one day a week for approximately 21 months. Analysis of pre- and posttreatment assessments showed that coping styles and professional and personality functioning had improved and that anxiety, somatic, depressive, and PTSD symptoms were reduced after treatment. Because significant improvement was observed on several parameters, the program may have successfully addressed a broad range of problems frequently reported by veterans with complex and chronic PTSD.

Hostility is a risk factor for adverse health outcomes as diverse as cardiovascular disease and post-traumatic stress disorder (PTSD). Cytokines have been suggested to mediate this relationship. We investigated whether in healthy men a relation existed between hostility and T-cell mitogen-induced cytokines and chemokines. Male Dutch military personnel (n=304) were included before deployment. Eleven cytokines and chemokines were measured in supernatants of T-cell mitogen-stimulated whole blood cultures by multiplex immunoassay. Factor analysis was used to identify clusters of cytokines and chemokines. In a regression analysis hostility was related to the cytokine/chemokine clusters, and the potential risk factors age, BMI, smoking, drinking, previous deployment, early life trauma and depression. Explorative factor analysis showed four functional clusters; a pro-inflammatory factor (IL-2, TNFalpha, IFNgamma), an anti-inflammatory factor (IL-4, IL-5, IL-10), IL-6/chemokine factor (IL-6, MCP-1, RANTES, IP-10), and MIF. Hostility was significantly related to decreased IL-6/chemokine secretion and increased pro- and anti-inflammatory cytokines. There was an inverse relation between age and hostility scores. Early life trauma and depression were positively and independently related to hostility as well. This study represents a novel way of investigating the relation between cytokines and psychological characteristics. Cytokines/chemokines clustered into functional factors, which were related to hostility in healthy males. Moreover this relation appeared to be independent of reported depression and early trauma.