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- Citation Styles for "Neuropsychology of PTSD : biological, cognitive, and clinical perspectives"
- Neuropsychology of PTSD: Biological Cognitive and Clinical Perspectives by Chris R. Brewin
- History, the Posthuman, and the End of Trauma: Propranolol and Beyond
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The majority of participants were passengers in a car RTCs took place, on average, 9. Based on the Abbreviated Injury Scale, approximately half the sample Previous medical history ie, heart problems, tuberculosis was reported in At baseline, current major depressive disorder The participants had an average of 3.
Citation Styles for "Neuropsychology of PTSD : biological, cognitive, and clinical perspectives"
Descriptive statistics and the relationship of PTSD severity to individual neuropsychological measures are presented in Table 1. Variables that were included were age, education, ethnicity, medication use at the time of the accident, and IQ. Baseline clinical characteristics of the sample and their relationships to 3 and 6-month PTSD severity are displayed in Table 2.
The mean CAPS score at baseline was The mean CAPS score at the 3-month visit was This number dropped to Potential confounding variables included those that have previously been found to be associated with PTSD and are listed in Table 3. Again, as income and education were significantly related, income was excluded from the analyses. Notably, variables such as age and gender, which have been well established in previous studies as pre-trauma risk factors across trauma type, were not significantly associated with PTSD severity.
Variables that were controlled for, therefore, included education and ethnicity at 3 and 6 months. All clinical and neuropsychological predictors and potential confounders of PTSD were included in best subsets regression models to determine those that were most consistently predictive. All were significant and were most consistently predictive in the 20 best models too Table 4. The retained predictors also appeared to be the most consistently predictive variables in the 20 best models Table 5.
Neuropsychology of PTSD: Biological Cognitive and Clinical Perspectives by Chris R. Brewin
The objective of this study was to extend existing knowledge of early predictors of PTSD severity. In order to do this, we analyzed neuropsychological and clinical variables and their associated sociodemographic factors separately before combining them. We expected baseline sociodemographic, injury characteristics, neuropsychological, and clinical variables to influence vulnerability to PTSD.
Although numerous studies 3,5 have reported a relationship between PTSD severity and various patient characteristics, we mostly did not find this to be the case.
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We, however, did find that lower levels of education and ethnicity were associated with follow-up PTSD severity. Education also appears to be one of the most consistent predictors of PTSD severity. It may be that lower educational levels are associated with dysfunctional cognitive and coping styles. Although this finding is in contrast to a systematic review of factors that predict PTSD after RTCs, which found that ethnicity had no utility in predicting PTSD, 5 there are some studies that have found ethnicity to relate to the trauma response.
Cognitive changes resulting from trauma exposure or preexisting maladaptive cognitive styles may play a critical role in the development of PTSD. In line with our previous findings of an association between trait anxiety and ASD severity, 43 this suggests that individuals with a predisposition to anxiety problems are prone to developing clinically significant stress responses in relation to life stressors. In this study, it was the best and most consistent predictor of 3 and 6-month PTSD severity. Stress-related neurobiological activity is thought to alter the function, and potentially even the structure, of several brain regions mediating the stress response.
Accordingly, PTSD is associated with significant impairments in cognitive functioning. Poorer verbal learning and motor speed were also associated with 6-month PTSD severity. PTSD has been associated with poor speed, accuracy, and depth of information processing. Verbal and visual memory deficits, as well as immediate and delayed memory, have previously been found to be predictive of PTSD. Sustained attention 12 and working memory 13 have been found to predict PTSD. The primary aims were to identify whether neurocognitive factors are useful in the temporal prediction of PTSD severity and examine the predictive power afforded by their interaction with clinical, sociodemographic, and RTC-related variables.
We also expected participants with more severe PTSD at 3 and 6 months to significantly demonstrate more cognitive impairments than participants with fewer symptoms. Although not true of all neurocognitive tests, tests of information processing, executive functioning, verbal learning, and motor speed were related to PTSD severity on univariate analyses, as well as when neuropsychological, clinical, and sociodemographic factors were all taken into account with the exception of motor speed. Finally, we expected that participants with more severe PTSD at 3 and 6 months would have more psychiatric symptoms, such as those associated with anxiety, psychiatric disability, or ASD at 2 weeks post-trauma.
All clinical variables assessed ASD, PTSD symptoms, other psychiatric diagnoses, disability, trait anxiety, perceived stress, negative cognitions, and sleep were associated with 3 and 6-month PTSD severity on univariate analyses, with the exception of resilience, which was only associated with 3-month PTSD severity. Of these, trait anxiety was the only clinical variable found to be predictive of PTSD severity and was consistently the best predictor.
These findings are limited by a number of factors. These data were collected prior to the development of PTSD, but subsequent to a traumatic event, future studies would benefit from the inclusion of participants prior to trauma.
The sample consisted of individuals who had experienced a RTC. Although this avoids potential trauma-related confounders, the generalizability of findings is limited. The possibility that medical and surgical factors ie, physical injury and medication use may have influenced clinical and cognitive responses cannot be excluded. However, as we controlled for potential confounders where bivariate relationships were observed, these are unlikely to account for the relationships we did find. Furthermore, a larger sample size would have resulted in increased power to detect predictors.
These limitations notwithstanding, the present data offer preliminary evidence for the role of acute neuropsychological, clinical symptomatology and sociodemographic variables in the temporal prediction of PTSD, in a South African sample of RTC survivors. The strengths of the study include the longitudinal nature, reliable measures used in assessment of PTSD, ASD, and other psychiatric disorders, a wide range of possible predictors that were included, and potential confounders that were controlled for.
These findings will hopefully lead to a better understanding of the development and early maintenance of PTSD and serve as a starting point for the development of a screening measure to identify individuals at increased risk of PTSD. This would allow for targeted interventions to treat early negative symptoms and prevent the development of longer-term negative psychiatric sequelae. Furthermore, understanding the acute trauma response may aid in the development of more focused interventions that can reverse early PTSD or prevent the development of the disorder.
Recent research indicates that attention modification programs, for example, may be beneficial in anxiety disorders, 62,63 suggesting that research related to attention and working memory function may not only increase our understanding of PTSD but also lead to more effective treatments.
In conclusion, this study shows that a combination of neuropsychological, clinical, and sociodemographic characteristics have the best predictive value for PTSD severity in this sample, supporting the need for interventions that target these variables. Given that PTSD can have profound effects on patients and society, early, targeted profiling of this group of trauma survivors can inform early clinical interventions and policy. You may be trying to access this site from a secured browser on the server.
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History, the Posthuman, and the End of Trauma: Propranolol and Beyond
Your Name: optional. Your Email:. Colleague's Email:. Separate multiple e-mails with a ;. Thought you might appreciate this item s I saw at Medicine. Send a copy to your email. Some error has occurred while processing your request. Please try after some time. The authors have no conflicts of interest to disclose.
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TABLE 3. TABLE 4. TABLE 5. The expert consensus guideline series: treatment of posttraumatic stress disorder.
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J Clin Psychiatry. Cited Here Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. J Consult Clin Psychol. Predictors of posttraumatic stress disorder and symptoms in adults: a meta-analysis. Psychol Bull. Epidemiological and methodological issues in neuropsychological research on PTSD. A systematic review of predictors of posttraumatic stress disorder PTSD for adult road traffic crash survivors. The posttraumatic stress disorder project in Brazil: neuropsychological, structural and molecular neuroimaging studies in victims of urban violence.
BMC Psychiatry. Executive function and PTSD: disengaging from trauma. Memory for emotionally neutral information in posttraumatic stress disorder: a meta-analytic investigation. J Abnorm Psychol. Consistent impaired verbal memory in PTSD: a meta-analysis. J Affect Disord. Moore SA. Cognitive abnormalities in posttraumatic stress disorder.