Rudolf Gregurek

Smaller right hippocampus in war veterans with posttraumatic stress disorder

Chronic stress can putatively cause damage in the human hippocampus, but evidence of damage has not been consistently shown in studies on hippocampal morphology in posttraumatic stress disorder (PTSD). We compared hippocampal volumes in PTSD patients and normal subjects. Using a 3D T1-weighted GRE magnetic resonance imaging sequence, we measured hippocampal volumes in 15 war veterans with combat-related chronic PTSD and 15 case-matched normal controls. Although war veterans, our PTSD subjects were not professional soldiers and were mobilized shortly before they were exposed to a very specific combat-related trauma over a 3-day period. In our study, the period between traumatic exposure and imaging was considerably shorter, on average, 9 years, compared with at least two decades in previous studies on subjects with combat-related PTSD. Moreover, our subjects were free of any comorbidity, treatment or medication. The right hippocampus was significantly smaller in PTSD subjects than in healthy controls. The left hippocampus was also smaller in PTSD subjects than in controls, but the difference was not significant. In all PTSD subjects, the right hippocampus was smaller than the left (on average, 7.88%). Our results show smaller volume of the right hippocampus in PTSD patients than in normal subjects.

The Connection between Alexithymia and Somatic Morbidity in a Population of Combat Veterans with Chronic PTSD.

Purpose To investigate the connection between alexithymia and somatic illness, or, somatization, in veterans suffering from chronic combat-related post-traumatic stress disorder, PTSD. Methods Croatian combat veterans (N=127) were studied at the Department of Psychology, Zagreb Clinical Hospital Center. The diagnosis of PTSD was confirmed and verified according to the International Classification of Diseases (ICD-10). A version of the Mississippi Scale for Combat Related PTSD (M-PTSD) standardized for the Croatian population was used to assess the severity of PTSD. In addition to the clinical interview, the existence of alexithymia was confirmed by the score on the Toronto Alexithymia Scale (TA S-20). Results A statistically significant association was found between the total number of diagnosed physical illnesses and the scores on three subscales of an alexithymia questionnaire, the TA S-20, with a 1% risk (p<0.01, 0.487; 0.450; 0.335). Regression analysis confirmed the most statistically significant predictive value of the first item of the TA S-20, which refers to difficulty in identifying feelings (=0.408, p=0.019). The total score on the M-PTSD scale correlated significantly to the subscales for alexithymia. There was a statistically significant negative correlation of the total score on the M-PTSD scale with social support. Conclusion The total scores obtained in this study, particularly those related to alexithymia, indicate the importance of this construct in the etiopathogenesis of somatic morbidity in the study population and confirm that as in other countries the TA S-20 is a useful instrument in Croatia for the assessment of this phenomenon.

Special Section: Internal and External Boundaries of Supervision

This article proposes that supervision is an essential element of psychotherapy education and explains the relationship between internal and external boundaries of supervision. It is important that the boundary between the supervisory and the therapeutic relationship is clear. Each supervisor-supervisee negotiates the intimacy and content of the supervision according to their style and needs; there are clear differences between the tasks of the two relationships. It is important to understand any controversy as to the degree to which the supervision should serve as an exploration of the supervisees countertransference (internal boundaries) versus conflict inherent in the roles of supervisor in institutes where the supervisor is also the superior or older colleague of the supervisee (external boundaries).

1285 – Training of bosnia-herzegovina mental health professionals in group analysis as the factor of development of culture of dialogue in the aftermath ofthe 1992–1995 war

Aim The primary objective will focus the first of all on Group Analysis (GA) as the psychotherapy method and theory of group analysis applied particularly in post-war environments. It outlines in particular a Zagreb Institute for GA Training Programme that took place in Tuzla University Clinical Centre, Department of Psychiatry, in Bosnia-Herzegovina (BH) in response to 1992–1995 war, in helping to train mental health workers in GA to enable them to treat psychological trauma symptoms of war survivors. Method In the GA education in the period of 16 years mental health professionals employed in mental health services were involved as well as other care employees as General Practitioners, Family physicians, pediatricians, gynecologists and neurosurgeons, psychologists and special educators. Results Trainees in education were from greater part of BH, and from several towns from neighborhoods countries. In this way a new room for mutual exchanges of experiences and establishing of cooperation was created. Idea of group analytic treatment of persons with mental health problems spread out on the whole region of BH through this model of education. The future of GA application as a psychotherapy model in BH confirmed through established models of education which are employed inowadays in Tuzla, Sarajevo and Mostar. The future of GA is provided in activities focused on foundations of the Institute for Analysis in Tuzla. Conclusion Training of Bosnia-Herzegovina mental health workers to effectively use GA with enthusiastic help of GA trainers from Institute for GA Zagreb will develop dialogue culture in postwar BH.

P01-265 - Chronic low back pain in chronic combat related posttraumatic stress disorder

Objectives Chronic pain disorders have been accepted as one of major comorbid disorder in chronic posttraumatic stress disorder (PTSD). The main purpose of this research was to evaluate subjective processing of the pain in war veterans suffering from chronic PTSD and low back pain. Methods 227 Croatian war veterans participated in this study. Based on their personal history, psychiatric and surgical assessment they were divided in three groups: subjects suffering from PTSD and chronic low back pain (N=88), subjects suffering from chronic low back pain (N=50) and healthy controls (N=89). The following questionnaires were used in assessment of PTSD, depressive disorders and pain: Trauma Symptom Inventory, Hospital Anxiety and Depression Scale and the short-form McGill Pain Questionnaire. Results We have shown the significant differences between three groups. The group of PTSD patients experience the higher level of the intensity of pain and have an altered perception of pain complaining more of the affective and sensory pain than the group suffering from the chronic low back pain only. Both groups suffering from pain show depressive pattern rather than the the control group. We have shown that the affective and sensory pain is in the strong positive correlations with the specific PTSD symptoms and depression. Conclusion Patients suffering from PTSD seem to have an altered processing of the pain, especially the affective component of pain, probably because of functional pain disorders in many those patients. However, the neurobiological mechanism is needed to thoroughly understand the processing of pain in chronic PTSD.

PW01-197 - Social support in patients with chronic combat related PTSD in Croatia

Objective The main aim of this research is to evaluate the connection of various components of social support with chronic posttraumatic stress disorder (PTSD). We set up hypothesis that the level of the perceived social support mediates beneficial effects on various PTSD symptoms. Second hypothesis states that perceived social support is in positive connection with quality of life. Methods 246 outpatients with chronic combat related PTSD participated in this study. On the base of different questionnaires we examined social support, quality of life and PTSD symptomatology (Multidimensional Scale of Perceived Social Support- MSPSS, Trauma symptoms inventory -TSI-A, World Health Organization Quality Of Life-BREF). We tried to identify three main factors of social support by factor analysis of MSPSS. Those factors were used in logistic and multiple regression analysis in order to prove our hypothesis. Results In contrast to other researchers, we defined only two factors in MSPSS: “family support” explaining 52.9% of total variability and “peer support” explaining 18.5% of total variability. These factors used as predictors were not shown significant in multiple regression analysis predicting the PTSD symptoms defined by TSI-A. However, the levels of perceived social support were positively correlated with all four domains of quality of life. Conclusion Our research shows that role of social support in chronic course of PTSD is questionable, possibly due to personality changes and secondary traumatization, which is being supported by other researchers emphasizing its importance in the early course of PTSD.