Re-evaluating disability assessment in war veterans with posttraumatic stress disorder

Background/Aim. Sametimes war veterans may resort to such strategies as preducing exaggerated symptoms and malingerating in order to obtain material compensation rights. The aim of this study was to assess the accuracy of the diagnosis of posttraumatic stress disorder (PTSD) on the basis of which war veterans were entitled to a financial compensation due to their disability. Methods. The diagnoses of 259 war veterans were re-evaluated. Veterans were previously diagnosed by a psychiatrist on local level, while regional state medical commission determined the degree of disability and the right to a financial compensation. A team of experts, consisting of psychiatrists with research experience in the field of traumatic stress and who were trained to use a structured interview for PTSD, conducted the evaluation of medical data from veterans? military records. The diagnostic process was conducted using the standardized diagnostic interview (Clinician-Administered PTSD Scale ? CAPS), after which the diagnosis was reaffirmed or reviewed. This influenced disability status and consequential financial compensation. Results. There was a remarkable difference between the first diagnostic assessment of PTSD, conducted by the psychiatrists on local level, and the second evaluation conducted by the team of experts. In more than half of 259 veterans (52.1%) diagnosed with PTSD in the first assessment the diagnosis was not confirmed. The diagnosis was confirmed in 31.7% of veterans. Those veterans who were diagnosed with lifetime PTSD (7.3%) should also be treated as accuratelly diagnosed. This means that a total of 39% of the diagnoses were accurate. The rest (8.9%) were diagnosed with other diagnoses, but not PTSD, as was the case in the initial assessment. Conclusion. The possibility for war veterans to obtain the right to disability and financial compensation due to a diagnosis of PTSD might interfere with the proper diagnostic assessment and thus the treatment outcome. During the procedures for the obtention of these rights, exaggeration or simulation of symptoms are common. The quality of the diagnostic assessment of PTSD can be improved by applying evidence based standardized procedures.

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Co-morbidity of posttraumatic stress disorder, anxiety and depression: A 20-year longitudinal study of war veterans

PsycEXTRA Dataset ◽

10.1037/e717692011-011 ◽

2009 ◽

Author(s):

K. Ginzburg ◽

T. Ein-Dor ◽

Z. Solomon

Keyword(s):

Posttraumatic Stress Disorder ◽

Longitudinal Study ◽

Posttraumatic Stress ◽

Stress Disorder ◽

Anxiety And Depression ◽

War Veterans ◽

Co Morbidity

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Smaller right hippocampus in war veterans with posttraumatic stress disorder

Psychiatry Research Neuroimaging ◽

10.1016/j.pscychresns.2006.08.005 ◽

2007 ◽

Vol 154 (2) ◽

pp. 191-198 ◽

Cited By ~ 48

Author(s):

Ladislav Pavić ◽

Rudolf Gregurek ◽

Marko Radoš ◽

Boris Brkljačić ◽

Lovorka Brajković ◽

...

Keyword(s):

Posttraumatic Stress Disorder ◽

Posttraumatic Stress ◽

Stress Disorder ◽

War Veterans

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Embitterment in war veterans with posttraumatic stress disorder (PTSD)

European Psychiatry ◽

10.1016/j.eurpsy.2017.02.354 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S359-S360 ◽

Cited By ~ 1

Author(s):

D. Sabic ◽

A. Sabic

Keyword(s):

Posttraumatic Stress Disorder ◽

Posttraumatic Stress ◽

Health Center ◽

Rating Scale ◽

Stress Disorder ◽

World Health ◽

Control Group ◽

War Veterans ◽

Significant Difference ◽

And Control

The aim of this study was to analyse frequency of embitterment in war veterans with Posttraumatic stress disorder (PTSD) as well as the potential impact of embitterment on the development of chronic PTSD.Patients and methodsIt was analyzed 174 subjects (from Health Center Zivinice/mental health center) through a survey conducted in the period from March 2015 to June 2016, of which 87 war veterans with PTSD and control subjects 87 war veterans without PTSD. The primary outcome measure was the post-traumatic embitterment disorder self-rating scale (PTED Scale) who contains 19 items designed to assess features of embitterment reactions to negative life events. Secondary efficacy measures included the clinician-administered PTSD scale–V (CAPS), the PTSD checklist (PCL), the combat exposure scale (CES), the Hamilton depression rating scale (HAM-D), the Hamilton anxiety rating scale (HAM-A) and the World health organization quality of life scale (WHOQOL-Bref). All subjects were male. The average age of patients in the group war veterans with PTSD was 52.78 ± 5.99. In the control group, average age was 51.42 ± 5.98. Statistical data were analyzed in SPSS statistical program.ResultsComparing the results, t-tests revealed significant difference between group veterans with PTSD and control group (t = −21,21, P < 0.0001). War veterans group with PTSD (X = 51.41, SD = 8,91), control group (X = 14.39, SD = 13.61).ConclusionEmbitterment is frequent in war veterans with PTSD.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Embitterment in War Veterans with Posttraumatic Stress Disorder

Medical Archives ◽

10.5455/medarh.2018.72.125-130 ◽

2018 ◽

Vol 72 (2) ◽

pp. 125 ◽

Cited By ~ 3

Author(s):

Dzevad Sabic ◽

Adela Sabic ◽

Olivera BaticMujanovic

Keyword(s):

Posttraumatic Stress Disorder ◽

Posttraumatic Stress ◽

Stress Disorder ◽

War Veterans

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Comorbidity of posttraumatic stress disorder, anxiety and depression: A 20-year longitudinal study of war veterans

Journal of Affective Disorders ◽

10.1016/j.jad.2009.08.006 ◽

2010 ◽

Vol 123 (1-3) ◽

pp. 249-257 ◽

Cited By ~ 193

Author(s):

Karni Ginzburg ◽

Tsachi Ein-Dor ◽

Zahava Solomon

Keyword(s):

Posttraumatic Stress Disorder ◽

Longitudinal Study ◽

Posttraumatic Stress ◽

Stress Disorder ◽

Anxiety And Depression ◽

War Veterans

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Dysregulation of the Right Brain: A Fundamental Mechanism of Traumatic Attachment and the Psychopathogenesis of Posttraumatic Stress Disorder

Australian & New Zealand Journal of Psychiatry ◽

10.1046/j.1440-1614.2002.00996.x ◽

2002 ◽

Vol 36 (1) ◽

pp. 9-30 ◽

Cited By ~ 242

Author(s):

Allan N Schore

Keyword(s):

Posttraumatic Stress Disorder ◽

Posttraumatic Stress ◽

Stress Disorder ◽

Developmental Trajectory ◽

Stress Disorders ◽

Developmental Stress ◽

Posttraumatic Stress Disorders ◽

Autonomic Nervous ◽

Right Brain ◽

The Right

Objective: This review integrates recent advances in attachment theory, affective neuroscience, developmental stress research, and infant psychiatry in order to delineate the developmental precursors of posttraumatic stress disorder. Method: Existing attachment, stress physiology, trauma, and neuroscience literatures were collected using Index Medicus/Medline and Psychological Abstracts. This converging interdisciplinary data was used as a theoretical base for modelling the effects of early relational trauma on the developing central and autonomic nervous system activities that drive attachment functions. Results: Current trends that integrate neuropsychiatry, infant psychiatry, and clinical psychiatry are generating more powerful models of the early genesis of a predisposition to psychiatric disorders, including PTSD. Data are presented which suggest that traumatic attachments, expressed in episodes of hyperarousal and dissociation, are imprinted into the developing limbic and autonomic nervous systems of the early maturing right brain. These enduring structural changes lead to the inefficient stress coping mechanisms that lie at the core of infant, child, and adult posttraumatic stress disorders. Conclusions: Disorganised-disoriented insecure attachment, a pattern common in infants abused in the first 2 years of life, is psychologically manifest as an inability to generate a coherent strategy for coping with relational stress. Early abuse negatively impacts the developmental trajectory of the right brain, dominant for attachment, affect regulation, and stress modulation, thereby setting a template for the coping deficits of both mind and body that characterise PTSD symptomatology. These data suggest that early intervention programs can significantly alter the intergenerational transmission of posttraumatic stress disorders.

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Auditory Pseudohallucinations in United Kingdom War Veterans and Civilians With Posttraumatic Stress Disorder

The Journal of Clinical Psychiatry ◽

10.4088/jcp.09m05469blu ◽

2010 ◽

Vol 71 (04) ◽

pp. 419-425 ◽

Cited By ~ 55

Author(s):

Chris R. Brewin ◽

Trishna Patel

Keyword(s):

Posttraumatic Stress Disorder ◽

United Kingdom ◽

Posttraumatic Stress ◽

Stress Disorder ◽

War Veterans

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The Innate Alarm System and Subliminal Threat Presentation in Posttraumatic Stress Disorder: Neuroimaging of the Midbrain and Cerebellum

Chronic Stress ◽

10.1177/2470547018821496 ◽

2019 ◽

Vol 3 ◽

pp. 247054701882149 ◽

Cited By ~ 7

Author(s):

Braeden A. Terpou ◽

Maria Densmore ◽

Janine Thome ◽

Paul Frewen ◽

Margaret C. McKinnon ◽

...

Keyword(s):

Posttraumatic Stress Disorder ◽

Posttraumatic Stress ◽

Stress Disorder ◽

Brain Activation ◽

Stimulus Presentation ◽

Neutral Stimulus ◽

Alarm System ◽

Imaging Data ◽

The Right

Background The innate alarm system, a network of interconnected midbrain, other brainstem, and thalamic structures, serves to rapidly detect stimuli in the environment prior to the onset of conscious awareness. This system is sensitive to threatening stimuli and has evolved to process these stimuli subliminally for hastened responding. Despite the conscious unawareness, the presentation of subliminal threat stimuli generates increased activation of limbic structures, including the amygdala and insula, as well as emotionally evaluative structures, including the cerebellum and orbitofrontal cortex. Posttraumatic stress disorder (PTSD) is associated with an increased startle response and decreased extinction learning to conditioned threat. The role of the innate alarm system in the clinical presentation of PTSD, however, remains poorly understood. Methods Here, we compare midbrain, brainstem, and cerebellar activation in persons with PTSD (n = 26) and matched controls (n = 20) during subliminal threat presentation. Subjects were presented with masked trauma-related and neutral stimuli below conscious threshold. Contrasts of subliminal brain activation for the presentation of neutral stimuli were subtracted from trauma-related brain activation. Group differences in activation, as well as correlations between clinical scores and PTSD activation, were examined. Imaging data were preprocessed utilizing the spatially unbiased infratentorial template toolbox within SPM12. Results Analyses revealed increased midbrain activation in PTSD as compared to controls in the superior colliculus, periaqueductal gray, and midbrain reticular formation during subliminal threat as compared to neutral stimulus presentation. Controls showed increased activation in the right cerebellar lobule V during subliminal threat presentation as compared to PTSD. Finally, a negative correlation emerged between PTSD patient scores on the Multiscale Dissociation Inventory for the Depersonalization/Derealization subscale and activation in the right lobule V of the cerebellum during the presentation of subliminal threat as compared to neutral stimuli. Conclusion We interpret these findings as evidence of innate alarm system overactivation in PTSD and of the prominent role of the cerebellum in the undermodulation of emotion observed in PTSD.

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