Thomas A. Mellman

Evaluation of dream content in combat-related PTSD

Nightmares that replicate traumatic events are among the criteria that define posttraumatic stress disorder (PTSD); however, there has been limited systematic assessment of the content of dreams in PTSD. A PTSD dream rating instrument was developed to ope rationalize features attributed to dreams associated with combat-related PTSD that incorporated dimensions from the dream content analysis literature, and its reliability was assessed. Then the instrument was used to characterize dream reports in 18 Vietnam combat veterans diagnosed with PTSD. Approximately half of the groups target dreams contained features characteristic of combat, and all but 3 (17%) were moderately to highly threatening. Fifty-three percent were set at least partially in the present and 79% contained distorted elements. We therefore conclude that target dreams of combat veterans with PTSD vary with regard to replication of trauma and elements normally associated with dreaming, but typically are threatening.

Psychobiology of Sleep Disturbances in Posttraumatic Stress Disorder

Sleep disturbances are prominent complaints of PTSD patients. Some, but not all, of the polysomnographic studies support the occurrence of sleep disruption. The main dimensions of sleep disturbance in the disorder relate to arousal regulation and REM-related functions of dreaming and memory processing. Both of these issues are relevant to the pathogenesis of PTSD and manifestations of the disorder during wake states. Studies elucidating the effects of treatment on sleep parameters are an important direction for future research.

Pilot evaluation of hypnotic medication during acute traumatic stress response

Early intervention aimed at secondary prevention is a high priority for posttraumatic stress disorder (PTSD) research. Disrupted sleep may have a role in the initiation and maintenance of PTSD. Three of the participants were recruited from a surgical trauma service, and one had sought treatment in a psychiatric setting. All were within 1-3 weeks of trauma exposure and had acute PTSD symptoms that included disturbed sleep. Temazepam, a benzodiazepine hypnotic, was administered for 5 nights, tapered for 2 nights, and then discontinued. Evaluations 1-week after the medication had been discontinued revealed improved sleep and reduced PTSD severity. These observations suggest an approach that may be clinically useful and a need for more systematic trials.

A Simplified HPLC-ECD Technique for Measurement of Urinary Free Catecholamines

Abstract A simplified HPLC assay is described for quantification of free urinary catecholamines. The procedure involves exraction of catecholamines, (norepinephrine, epinephrine and dopamine) from urine, using columns filled with Biorex-70. The catecholamines from the extract were separated on a high performance liquid chromatographic system using reverse phase C18, 5 u column and determined by electrochemical detection. Integration and calculations are achieved by a data module using area ratio method with dihydroxybenzylamine as internal standard. Recovery of more than 90% was achieved for each catecholamine. A linear relationship between a wide range of concentrations and ratio of the area of amines to that of internal standard was observed. The method is simple and rapid and therefore can be used to analyze a large number of samples in one day and should prove useful in studies involving the role of catecholamines in different psychiatric disorders.

Divergence of PTSD and narcolepsy associated with military trauma

Abstract The occurrence of vivid dreams and hallucinatory-like visualizations in PTSD, has suggested a hypothesis of pathological involvement of REM sleep mechanisms. The pathophysiology of narcolepsy, which features vivid dreaming and hypnagogic hallucinations, involves REM intrusion and dysfunction. From a referral population of combat veterans and former prisoners of war, two patients were identified with laboratory-confirmed narcolepsy, which emerged during military combat or captivity. Although exogenous factors appeared to have a role in precipitating the condition, a genetic marker for narcolepsy was present in both cases. The content of PTSD and narcolepsy symptoms tended to be dissociated, and PTSD remitted while narcolepsy persisted and progressed. These observations are discussed in the context of a REM hypothesis for PTSD.