Patricia B. Sutker

Attention and memory dysfunction in posttraumatic stress disorder

Attention and memory performances were studied in Persian Gulf War veterans with and without posttraumatic stress disorder (PTSD) diagnoses. Veterans diagnosed with PTSD showed relative performance deficiencies on tasks of sustained attention, mental manipulation, initial acquisition of information, and retroactive interference. Their performances were also characterized by errors of commission and intrusion. The tendency toward response disinhibition and intrusion on cognitive tasks was correlated positively with reexperiencing symptoms and negatively with avoidance-numbing symptoms. These cognitive deficit patterns are consistent with models of PTSD that emphasize the role of hyperarousal and implicate dysfunction of frontal-subcortical systems. Results suggest that intrusion of traumatic memories in PTSD may not be limited to trauma-related cognitions but instead reflects a more general pattern of disinhibition.

Attention, Learning, and Memory Performances and Intellectual Resources in Vietnam Veterans: PTSD and No Disorder Comparisons

Attention, learning, memory, and estimated intellectual potential were examined in 26 Vietnam veterans diagnosed with posttraumatic stress disorder (PTSD) and in 21 Vietnam veterans without mental disorders. Results revealed PTSD-associated cognitive deficits on tasks of sustained attention, working memory, initial learning, and estimated premorbid intelligence but not on measures of focus of attention, shift of attention, or memory savings. Cognitive task performances adjusted for estimated native intelligence remained negatively correlated with PTSD severity. An intellectual measure adjusted for cognitive task performances was negatively correlated with PTSD severity, even after the authors statistically controlled the level of combat exposure. Results suggested that although intellectual resources may constitute a vulnerability-protective factor for PTSD development, PTSD was associated with cognitive impairment independent of intellectual functioning.

Memory and attention in combat-related post-traumatic stress disorder (PTSD)

Vietnam combat veterans assigned diagnoses of PTSD were compared on measures of attention/concentration, new learning, and memory with Army National Guard enlistees who reported no unusual traumatic events or stress-related symptoms. Results showed that PTSD veterans performed more poorly than the comparison sample on a measure of verbal learning, exhibiting less proficient cumulative acquisition across repeated exposures, greater sensitivity to proactive interference, and more perseverative errors. Veterans with PTSD diagnoses also evidenced impairments in word fluency and visual attention/tracking abilities. These preliminary findings suggest that diagnoses of chronic PTSD in combat veterans are associated with cognitive performance deficits, when comparisons are made with military troops judged to be free of stress-related psychopathology. Results are consistent with self-reported complaints of concentration and memory impairments among PTSD-diagnosed clinical samples, thus highlighting the need for continued investigation of the neuropsychologlcal sequelae of prolonged stress exposure.

War Zone stress, personal and environmental resources, and PTSD symptoms in Gulf War Veterans: A longitudinal perspective.

Cross-sectional research has demonstrated a link between personal and environmental resources and development of emotional distress after war zone service. Less is known about the longitudinal relationship between resources and distress. The authors addressed this issue in a study of 348 Gulf War returnees tested at 2 time points. Resources decreased and posttraumatic stress disorder (PTSD) symptoms increased over time. Time 1 avoidance and family cohesion predicted PTSD symptoms at Time 2. Regression analyses revealed a bidirectional relationship over time between resources and PTSD symptoms. Time 1 resources predicted Time 2 psychopathology after accounting for Time 1 emotional distress. PTSD symptoms at Time 1 also predicted changes in coping and family relationships, even after accounting for Time 1 resources. Findings are consistent with the concept of a loss spiral (Hobfoll, 1989), in which resource factors and emotional sequelae to war stress exert reciprocal effects.

War zone stress, personal resources, and PTSD in Persian Gulf War returnees.

Posttraumatic stress disorder (PTSD) can occur subsequent to war stress, but not all troops are negatively affected. A discriminant function model was used to study associations between personal and environmental resources and psychological outcomes subsequent to war zone stress. Among 775 Persian Gulf War exposed troops, 2 subsets were identified: 97 with PTSD diagnoses and 484 who had no psychological distress. A discriminant function, double cross-validated in random subsamples, classified 87% of troops, and demographic and stress severity variables did not alter results significantly. Personality hardiness commitment, avoidance coping, and perceived family cohesion emerged as consistent predictors of PTSD diagnosis. Findings suggest personal characteristics and environmental factors may alter vulnerability to negative war stress outcomes. Work is needed to identify mechanisms and causal pathways by which resource factors enhance or lower stress resistance.

Utility of the RBANS in detecting cognitive impairment associated with Alzheimer's disease : Sensitivity, specificity, and positive and negative predictive powers

Although initially developed as a brief dementia battery, the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) has not yet demonstrated its sensitivity, specificity, and positive and negative predictive powers in detecting cognitive impairment in patients with Alzheimers disease (AD). Therefore, the current study examined the clinical utility of the RBANS by comparing two age-, education-, and gender-matched groups: patients with AD (n=69) and comparators (n=69). Significant differences (p<0.001) were observed on the RBANS Total score, all 5 Indexes, and all 12 subtests, with patients performing worse than the comparison participants. An optimal balance between sensitivity and specificity on RBANS scores was obtained when cutoffs of one and one and a half standard deviations below the mean of the comparison sample were implemented. Areas under the Receiver Operating Characteristic curves for all RBANS Indexes were impressive though Immediate and Delayed Memory Indexes were excellent (0.96 and 0.98, respectively). Results suggest that RBANS scores yield excellent estimates of diagnostic accuracy and that the RBANS is a useful screening tool in detection of cognitive deficits associated with AD.

Acute alcohol intoxication and body composition in women and men.

The present study was a direct experimental comparison of administering equivalent alcohol doses based on body weight and estimated total body water to 12 women and 12 men. Each subject participated in two experimental sessions separated by at least three days. Two doses of 95% ethanol were administered in a randomized, counterbalanced order: 0.66 ml/kg of body weight, and 1.2 ml/l of total body water. Women were tested during the midfollicular phase of their menstrual cycle when plasma concentrations of estrogen and progesterone have been found to be lower than other phases of the cycle. When given doses equated for body weight, women reached significantly higher peak blood alcohol concentrations than men. No sex differences were found when equivalent doses based on total body water were administered. This differential effect of dose determination was not reflected in self-reported levels of alcohol intoxication. The anthropometric equations used to estimate total body water provided a practical, reliable method for equating alcohol doses.

Relationship of psychiatric status to Gulf War veterans' health problems.

OBJECTIVE A growing body of research has shown that there are important links between certain psychiatric disorders and health symptom reporting. Two disorders in particular (posttraumatic stress disorder (PTSD) and major depression) have been the most widely implicated to date, and this association has sometimes been used to explain the occurrence of ill-defined medical problems and increased somatic symptoms in certain groups, most recently Gulf War veterans. METHODS Structured psychiatric diagnostic interviews were used to examine the presence of major psychiatric (axis I) disorders and their relation to health symptom reporting in a well-characterized, stratified subset of Gulf War veterans and a non-Gulf-deployed veteran comparison group. RESULTS Rates of most psychiatric disorders were substantially lower than national comorbidity estimates, consistent with prior studies showing heightened physical and emotional well-being among active-duty military personnel. Rates of PTSD and major depression, however, were significantly elevated relative to the veteran comparison group. The diagnosis of PTSD showed a small but significant association with increased health symptom reports. However, nearly two-thirds of Gulf participants reporting moderate to high health symptoms had no axis I psychiatric diagnosis. CONCLUSIONS Results suggest that rates of psychiatric illness were generally low with the exception of PTSD and major depression. Although PTSD was associated with higher rates of reported health problems, this disorder did not entirely account for symptoms reported by participants. Factors other than psychiatric status may play a role in Gulf War health problems.

Acute alcohol intoxication, mood states and alcohol metabolism in women and men.

The course of alcohol absorption and elimination was investigated in seven women and nine men administered a moderate (0.66 ml/kg) dose of 95% ethanol. Women were tested during the postmenstrual phase (Day 6-7), when levels of estrogen and progesterone were estimated to be relatively low. Data reflecting alterations in physical sensations, perceived levels of intoxication, and positive and negative mood states were also collected. Women reached significantly higher peak blood alcohol concentrations (BACs) than men (p less than 0.01). However, differences in peak BACs between men and women could be explained by differences in body water content between the sexes. When the raw data on BACs were corrected for differences in body water content between men and women, no difference in the amount of alcohol metabolized, or in the length of time necessary to metabolize that amount of alcohol, could be found between the sexes. Although women attained higher blood and, presumably, brain levels of ethanol, men did not differ from women in perceived levels of intoxication, physical sensations and mood states. Acute alcohol intoxication appeared to elevate positive mood states during the ascending limb of the BAC curve, but was associated with increased negative affect during the descending limb.

Personality Disorders Classification and Symptoms in Cocaine and Opioid Addicts.

: The extent to which personality disorders (PDs) and associated symptom criteria were found among 117 cocaine- and opioid-dependent men selected from 350 consecutive inpatient admissions to a Veterans Administration Drug Dependence Treatment Unit over a 30-month period was examined using structured interview methodology. Drug groups were distinguished by higher rates of antisocial and borderline symptomatology rather than by features associated with other PDs. Cocaine users showed lower rates of borderline and adult antisocial features and reported less subjective distress than opioid addicts, and different constellations of target problem features emerged for the two groups.