Lutz Wittmann

Exposure to pulsed high-frequency electromagnetic field during waking affects human sleep EEG.

The aim of the study was to investigate whether the electro-magnetic field (EMF) emitted by digital radiotelephone handsets affects brain physiology. Healthy, young male subjects were exposed for 30 min to EMF (900 MHz; spatial peak specific absorption rate 1 W/kg) during the waking period preceding sleep. Compared with the control condition with sham exposure, spectral power of the EEG in non-rapid eye movement sleep was increased. The maximum rise occurred in the 9.75–11.25 Hz and 12.5–13.25 Hz band during the initial part of sleep. These changes correspond to those obtained in a previous study where EMF was intermittently applied during sleep. Unilateral exposure induced no hemispheric asymmetry of EEG power. The present results demonstrate that exposure during waking modifies the EEG during subsequent sleep. Thus the changes of brain function induced by pulsed high-frequency EMF outlast the exposure period.

Dreaming in Posttraumatic Stress Disorder: A Critical Review of Phenomenology, Psychophysiology and Treatment

This review summarizes the available knowledge on the phenomenology of posttraumatic dreams. Posttraumatic nightmares are reported by up to 70% of individuals suffering from posttraumatic stress disorder (PTSD). An extensive review of polysomnographic studies suggests that neither this high incidence nor the occurrence of posttraumatic nightmares throughout the sleep cycle can be explained by altered REM sleep parameters. The assumption that a reduction of dream recall may serve as a coping mechanism in PTSD patients is questionable. About 50% of posttraumatic dreams comprise exact replications of the traumatic events. Therefore dreams in PTSD do not have stereotypical content. Data characterizing non-replicative posttraumatic dreams and indicating a change in dream content over time must be considered preliminary. Occurrence of posttraumatic dreams is associated with psychopathological developments. Imagery Rehearsal Therapy has repeatedly been proven to be a valuable tool in treating patients suffering from posttraumatic dream disturbance. A deeper knowledge of posttraumatic dreams is essential for any theory of PTSD as well as for a better understanding of the overall function of dreaming.

Factors of home dream recall: a structural equation model

Previous research has indicated that personality factors such as openness to experience, creativity, visual memory, attitude toward dreams, and sleep behavior is related to home dream recall frequency (DRF). However, a study investigating all areas simultaneously within one sample in order to determine the percentage of variance explained by all variables and to take intercorrelations between the influencing factors into account has not been performed till now. The present study with 444 participants fills this gap. Using several indicators for each of the variables mentioned above, a structural equation model was tested. Although the model fit was satisfying, the four factors which were significantly related to DRF: personality (openness to experience, thin boundaries, absorption), creativity, nocturnal awakenings, and attitude toward dreams, explained only 8.4% of the total variance. As this value is considerably lower than those of studies investigating a single influencing factor and using similar measurement instruments in similar samples, one might speculate about possible expectancy effects in these previous studies, an effect which has been demonstrated for DRF in the laboratory setting. In addition, the small percentage of explained variance of each single factors (<3%) may indicate that other, in this study unmeasured, variables such as sleep duration (state aspect), introspection, and cognitive functioning immediately upon awakening (sleep inertia) show substantial covariance with the interindividual differences in DRF. Future studies should focus on longitudinal aspects in order to differentiate between state versus trait factors (although methodologic issues, e.g. the effect of the measurement technique on DRF itself, have to be clarified) and investigate additional variables which might be associated with DRF (see above).

Development of chronic pain following severe accidental injury. Results of a 3-year follow-up study.

OBJECTIVE Motor vehicle accidents (MVA) and work-related injuries are two of the more common causes of chronic pain. Nevertheless, there is little evidence on predicting factors regarding the development of chronic pain following physical injury. METHODS The present study investigated temporal associations between accident-related factors, psychological factors [symptoms of posttraumatic stress disorder (PTSD), anxiety, depression, coping], and the development of chronic pain in a sample of individuals who had sustained severe accidental injuries (N=90). Assessments were performed within 1 month of the accident, and at 6, 12, and 36 months post trauma. RESULTS A total of 40 individuals (44%) reported accident-related pain 3 years after the accident. Individuals with chronic pain showed significantly more symptoms of PTSD, depression, and anxiety, more disability, and more days off work. Analysis of temporal associations between psychological variables and the development of chronic pain indicated that the separation of the pain from the nonpain group mostly occurred between 6 (T2) and 12 months (T3). Differences were much less pronounced at T1. CONCLUSION The prevalence of chronic pain in severely injured patients 3 years after the accident is considerably high. The development of chronic pain is more related to psychological factors, particularly PTSD symptoms, in the aftermath of the accident, as compared to sociodemographic and accident-related variables at the time of the accident. These findings may be helpful to elucidate the problems in predicting chronic pain conditions in injured subjects and to recognize the onset of a chronic pain condition more reliably.

Mutual influence of posttraumatic stress disorder symptoms and chronic pain among injured accident survivors: A longitudinal study

The relationship between acute stress disorder (ASD), posttraumatic stress disorder symptoms (PTSD), and chronic pain was investigated in a longitudinal study of injured accident victims (N = 323, 64.7% men). Assessments took place 5 days (T1), 6 (T2) months, and 12 (T3) months postaccident. Relations between pain and posttraumatic stress symptoms were tested by structural equation modeling. Subjects diagnosed with full or subsyndromal PTSD at T2 and at T3 (14 and 19%) reported significantly higher pain intensity. Cross-lagged panel analysis yielded a mutual maintenance of pain intensity and ASD or PTSD symptoms across T2. Across the second half year, PTSD symptoms impacted significantly on pain but not vice versa. Clinicians need to pay careful attention to PTSD symptoms in accident survivors suffering from chronic pain.

Psychological and psychosocial interventions after attempted suicide: an overview of treatment studies.

A literature search was conducted to collect randomized controlled studies evaluating the outcome of psychological and psychosocial interventions after attempted suicide and deliberate self-harm. Twenty-five studies meeting the inclusion criteria were identified. The studies are grouped according to the psychological approach chosen for the intervention. They are discussed with regard to both the various therapeutic strategies and models used, and the repetition of self-harming behavior as the main outcome.

Psychopathology and resident status – comparing asylum seekers, refugees, illegal migrants, labor migrants, and residents

PURPOSE This study aimed to describe, compare, and predict mental health outcomes of different migrant groups and native residents in Switzerland. SUBJECTS AND METHODS Asylum seekers (n=65); refugees holding permanent protection visas (n=34); illegal migrants (n=21); labor migrants (n=26); and residents (n=56) completed an assessment by questionnaire. Main outcome variables were symptoms of posttraumatic stress, anxiety and depression. It was tested whether resident status predicted psychopathology over and above the influence of control variables including social desirability, traumatic event types and post-migration resources. RESULTS Asylum seekers (54.0%) and refugees (41.4%) fulfilled criteria of PTSD most frequently. Clinically relevant symptoms of anxiety and depression were most frequently reported by asylum seekers (84.6% and 63.1%, resp.) and illegal migrants (both 47.6%). Resident status contributed to psychopathology over and above the influence of control variables. CONCLUSIONS Overall, asylum seekers, refugees, and illegal migrants showed high psychiatric morbidity. Differences in resident status appear to be specifically associated with mental health outcomes. This association persists even when controlling for social desirability, post-migration resources and traumatic events. This emphasizes the importance of current socio-political living conditions for mental health, even with respect to the psychopathological sequelae of past traumatic experiences.

Prevalence and predictors of posttraumatic stress disorder in patients with acute myocardial infarction

OBJECTIVE We estimated the prevalence of posttraumatic stress disorder (PTSD) and identified predictors of self-rated PTSD symptoms in patients post-myocardial infarction (MI). METHODS We recruited 400 patients (mean age 60 +/- 12 years, 79% were men) with a previous acute index MI who were referred to a tertiary cardiology clinic. PTSD was assessed by the Clinician-administered PTSD Scale, and self-rated severity of PTSD symptom levels were assessed by the Posttraumatic Diagnostic Scale. RESULTS Of the 190 patients who completed the Posttraumatic Diagnostic Scale, 34 met the cutoff for clinically significant PTSD symptomatology and 32 agreed to be interviewed. Among these patients, the Clinician-administered PTSD Scale interview yielded a prevalence of full and subsyndromal PTSD of 9.5% (95% confidence interval 7.4-11.6). Retrospectively rated feelings of helplessness (beta = .47, P < .001) and pain intensity during MI (beta = .15, P = .019) independently predicted PTSD symptom level. CONCLUSIONS Approximately 10% of patients post-MI had full or subsyndromal PTSD. Subjective perception of MI predicted self-rated PTSD symptom level.

Coping with Serious Accidental Injury: A One-Year Follow-Up Study

Background: The aim of this study was to analyze changes of coping strategies in severely injured accident victims over time and to compare patients with high and low posttraumatic stress disorder (PTSD) symptom levels with regard to their coping patterns and accident-related cognitions. Methods: 106 consecutive patients with severe accidental injuries admitted to a trauma surgery intensive care unit (ICU) were assessed within 1 month after the trauma and 6 and 12 months later. Assessments included a clinical interview, the Freiburg Questionnaire of Coping with Illness, the patients’ accident-related cognitions, the Clinician-Administered PTSD Scale, the 90-item revised Symptom Checklist (SCL-90-R), and the Sense of Coherence Questionnaire (SOC). Patients who met the criteria for either full or subsyndromal PTSD at least once over the observation period (36 subjects; 34.0%) were assigned to a highly symptomatic group (HSG), the remainder (70 subjects; 66.0%) to a less symptomatic group. Results: Overall, active problem-focused coping was predominant immediately after the accident and declined over time, with a stronger decrease in the HSG. Patients in the HSG scored higher on the SCL Global Severity Index and lower on the SOC. The patients’ subjective appraisal of accident severity was higher in the HSG, whereas there was no group difference with regard to accident-related variables such as type of accident, injury severity and mild to moderate traumatic brain injury. Conclusions: Active problem-focused coping, although utilized most frequently and often regarded as protective, might be an inadequate strategy in face of acute stress following a severe accident. Clinicians should not expect their patients to cope very actively in the acute ICU phase. In the subsequent rehabilitation, active coping seems to be more adaptive.

Posttraumatic Stress Disorder following Accidental Injury: Rule or Exception in Switzerland?

Background: There is still marked variability in the findings concerning psychiatric disorders associated with traumatic injury. The aim of this study was to determine the incidence of acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) following accidental injuries, and to predict the PTSD symptom level at 6 months, taking into particular consideration the role of pre-existing psychiatric morbidity and insufficient command of the local language. Method: A total of 255 accident survivors who were hospitalized for at least 2 consecutive nights at a Swiss university hospital for treatment of recently acquired physical injuries were interviewed within 2 weeks of the trauma and 6 months after the accident. Patients who did not have a good command of German but were fluent in Italian, Spanish, Portuguese, Serbo-Croatian or Albanian were assessed using interpreters. The main outcome measure was the Clinician-Administered PTSD Scale. Results: Ten patients (3.9%) were diagnosed as having ASD. At 6 months, 8 patients (3.1%) had PTSD. A regression model using 12 potential predictor variables explained 40% of the variance of PTSD symptoms; mild traumatic brain injury (p < 0.001), pain (p < 0.05), ASD symptom level (p < 0.001) and emotional coping (p = 0.001) predicted higher PTSD symptom levels, while high Sense of Coherence (p < 0.05) and perceived responsibility for the accident (p < 0.01) were associated with lower PTSD symptom levels at follow-up. Conclusions: ASD and PTSD seem to occur less frequently following accidental injuries than previously reported in the literature. Pre-existing psychiatric morbidity and lack of proficiency in the locally spoken language do not appear to play an important role in the development of PTSD.