Psychiatry - Research Publications

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    The relationship between early life stress and microstructural integrity of the corpus callosum in a non-clinical population.
    Paul, R ; Henry, L ; Grieve, SM ; Guilmette, TJ ; Niaura, R ; Bryant, R ; Bruce, S ; Williams, LM ; Richard, CC ; Cohen, RA ; Gordon, E (Informa UK Limited, 2008-02)
    BACKGROUND: Previous studies have examined the impact of early life stress (ELS) on the gross morphometry of brain regions, including the corpus callosum. However, studies have not examined the relationship between ELS and the microstructural integrity of the brain. METHODS: In the present study we evaluated this relationship in healthy non-clinical participants using diffusion tensor imaging (DTI) and self-reported history of ELS. RESULTS: Regression analyses revealed significant reductions in fractional anisotropy (FA) within the genu of the corpus callosum among those exposed to the greatest number of early life stressors, suggesting reduced microstructural integrity associated with increased ELS. These effects were most pronounced in the genu of the corpus callosum compared to the body and splenium, and were evident for females rather than males despite no differences in total ELS exposure between the sexes. In addition, a further comparison of those participants who were exposed to no ELS vs. three or more ELS events revealed lower FA in the genu of the corpus callosum among the ELS-exposed group, with trends of FA reduction in the body and the whole corpus callosum. By contrast, there were no relationships between ELS and volumetric analysis of the CC regions. The two group did not differ significantly on measures of current depression, stress or anxiety. CONCLUSION: Our results reveal that greater exposure to ELS is associated with microstructural alterations in the white matter in the absence of significant volumetric changes. Importantly, our results indicate that exposure to ELS is associated with abnormalities on DTI despite the absence of clinically significant psychiatric symptoms. Future studies are needed to determine whether specific types of ELS are more likely to impact brain structure and function.
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    The latent structure of the Peritraumatic Dissociative Experiences Questionnaire.
    Brooks, R ; Bryant, RA ; Silove, D ; Creamer, M ; O'Donnell, M ; McFarlane, AC ; Marmar, CR (Wiley, 2009-04)
    This paper has been retracted due to a publisher's error: the order of the authors was incorrect. The Editor and Publisher of the Journal of Traumatic Stress apologize to the authors and our readership. The Peritraumatic Dissociative Experiences Questionnaire (PDEQ) is a widely used measure of peritraumatic dissociation, and is presumably a unidimensional construct. Two hundred forty-seven individuals admitted to five hospitals after traumatic injury were administered the Clinician Administered PTSD Scale, the Hospital Anxiety and Depression Scale, and the PDEQ. Factor analysis indicated that the PDEQ involved two factors containing four items each: one factor (altered awareness) indexes alterations in awareness and the other (derealization) reflects distortions in perceptions of the self and the world. Only the derealization factor was associated with acute stress, anxiety, and depression symptoms. Cross-validation with independent data provided only partial support for the 2-factor structure model. These data indicate that peritraumatic dissociation may involve two distinct constructs.
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    Distant Memories: A Prospective Study of Vantage Point of Trauma Memories
    Kenny, LM ; Bryant, RA ; Silove, D ; Creamer, M ; O'Donnell, M ; McFarlane, AC (SAGE PUBLICATIONS INC, 2009-09-01)
    Adopting an observer perspective to recall trauma memories may function as a form of avoidance that maintains posttraumatic stress disorder (PTSD). We conducted a prospective study to analyze the relationship between memory vantage point and PTSD symptoms. Participants (N= 947) identified the vantage point of their trauma memory and reported PTSD symptoms within 4 weeks of the trauma; 730 participants repeated this process 12 months later. Initially recalling the trauma from an observer vantage point was related to more severe PTSD symptoms at that time and 12 months later. Shifting from a field to an observer perspective a year after trauma was associated with greater PTSD severity at 12 months. These results suggest that remembering trauma from an observer vantage point is related to both immediate and ongoing PTSD symptoms.
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    Prior Trauma and Psychiatric History as Risk Factors for Intentional and Unintentional Injury in Australia
    O'Donnell, ML ; Creamer, M ; Elliott, P ; Bilant, R ; McFarlane, A ; Silove, D (LIPPINCOTT WILLIAMS & WILKINS, 2009-02-01)
    BACKGROUND: Preliminary evidence suggests that injury survivors are at increased risk for having experienced traumatic events before their injury or having a lifetime psychiatric history. We aimed to extend the previous research by examining in the same sample whether trauma history or lifetime psychiatric history represented risk pathways to injury for intentional or unintentional injury survivors. We also aimed to describe the co-occurrence between trauma history and psychiatric history in unintentionally injured survivors. METHODS: In this multisited study, randomly selected injury survivors admitted to five trauma services in three states of Australia (April 2004 to February 2006) completed two structured clinical interviews that assessed their history of traumatic life events and lifetime psychiatric disorder (n = 1,167). chi analyses were conducted to compare the lifetime prevalence of traumatic events and psychiatric history for intentional and unintentional injury with population norms. RESULTS: Both intentional and unintentional injury survivors were at increased risk for reporting all types of trauma and reporting all measured psychiatric diagnoses compared with population norms. The majority of unintentional injury survivors with a psychiatric history were likely to have a trauma history. CONCLUSIONS: In this study, we identified that prior trauma or prior psychiatric illness may represent risk for injury in both intentionally and unintentionally injured survivors. The results highlight the need for injury-care services to address mental health issues in injury patients as part of routine care.
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    Post-traumatic amnesia and the nature of post-traumatic stress disorder after mild traumatic brain injury
    Bryant, RA ; Creamer, M ; O'Donnell, M ; Silove, D ; Clark, CR ; McFarlane, AC (CAMBRIDGE UNIV PRESS, 2009-11-01)
    The prevalence and nature of post-traumatic stress disorder (PTSD) following mild traumatic brain injury (MTBI) is controversial because of the apparent paradox of suffering PTSD with impaired memory for the traumatic event. In this study, 1167 survivors of traumatic injury (MTBI: 459, No TBI: 708) were assessed for PTSD symptoms and post-traumatic amnesia during hospitalization, and were subsequently assessed for PTSD 3 months later (N = 920). At the follow-up assessment, 90 (9.4%) patients met criteria for PTSD (MTBI: 50, 11.8%; No-TBI: 40, 7.5%); MTBI patients were more likely to develop PTSD than no-TBI patients, after controlling for injury severity (adjusted odds ratio: 1.86; 95% confidence interval, 1.78-2.94). Longer post-traumatic amnesia was associated with less severe intrusive memories at the acute assessment. These findings indicate that PTSD may be more likely following MTBI, however, longer post-traumatic amnesia appears to be protective against selected re-experiencing symptoms.
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    The role of post-traumatic stress disorder and depression in predicting disability after injury
    O'Donnell, ML ; Holmes, AC ; Creamer, MC ; Ellen, S ; Judson, R ; McFarlane, AC ; Silove, DM ; Bryant, RA (AUSTRALASIAN MED PUBL CO LTD, 2009-04-06)
    OBJECTIVES: To examine the relationship between psychological response to injury at 1 week and 3 months, and disability at 12 months. DESIGN: Multisite, longitudinal study. PARTICIPANTS AND SETTING: 802 adult patients admitted to trauma services at four Australian hospitals from 13 March 2004 to 21 February 2006 were assessed before discharge and followed up at 3 and 12 months. MAIN OUTCOME MEASURE: Disability, measured with the 12-item version of the World Health Organization Disability Assessment Schedule II. RESULTS: Logistic regression identified the degree to which high levels of depression and post-traumatic stress disorder (PTSD) at 1 week and at 3 months predicted disability at 12 months. After controlling for demographic variables and characteristics of the injury, patients with PTSD or subsyndromal PTSD at 1 week were 2.4 times more likely, and those with depression at 1 week were 1.9 times more likely to have high disability levels at 12 months. PTSD at 3 months was associated with 3.7 times, and depression at 3 months with 3.4 times the risk of high disability at 12 months. CONCLUSIONS: PTSD and depression at 1 week and at 3 months after injury significantly increased the risk of disability at 12 months. Routine assessment of symptoms of depression and PTSD in patients who have been physically injured may facilitate triage to evidence-based treatments, leading to improvement in both physical and psychological outcomes.
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    Early Stage Assessment and Course of Acute Stress Disorder After Mild Traumatic Brain Injury
    Broomhall, LGJ ; Clark, CR ; McFarlane, AC ; O'Donnell, M ; Bryant, R ; Creamer, M ; Silove, D (LIPPINCOTT WILLIAMS & WILKINS, 2009-03-01)
    Although it has been established that acute stress disorder (ASD) and posttraumatic stress disorder occur after mild traumatic brain injury (MTBI) the qualitative differences in symptom presentation between injury survivors with and without a MTBI have not been explored in depth. This study aimed to compare the ASD and posttraumatic stress disorder symptom presentation of injury survivors with and without MTBI. One thousand one hundred sixteen participants between the ages of 17 to 65 years (mean age: 38.97 years, SD: 14.23) were assessed in the acute hospital after a traumatic injury. Four hundred seventy-five individuals met the criteria for MTBI. Results showed a trend toward higher levels of ASD in the MTBI group compared with the non-MTBI group. Those with a MTBI and ASD had longer hospital admissions and higher levels of distress associated with their symptoms. Although many of the ASD symptoms that the MTBI group scored significantly higher were also part of a postconcussive syndrome, higher levels of avoidance symptoms may suggest that this group is at risk for longer term poor psychological adjustment. Mild TBI patients may represent a injury group at risk for poor psychological adjustment after traumatic injury.
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    A Study of the Protective Function of Acute Morphine Administration on Subsequent Posttraumatic Stress Disorder
    Bryant, RA ; Creamer, M ; O'Donnell, M ; Silove, D ; McFarlane, AC (ELSEVIER SCIENCE INC, 2009-03-01)
    BACKGROUND: To index the extent to which acute administration of morphine is protective against development of posttraumatic stress disorder (PTSD). METHODS: Consecutive patients admitted to hospital after traumatic injury (n=155) were assessed for current psychiatric disorder, pain, and morphine dose in the initial week after injury and were reassessed for PTSD and other psychiatric disorders 3 months later (n=120). RESULTS: Seventeen patients (14%) met criteria for PTSD at 3 months. Patients who met criteria for PTSD received significantly less morphine than those who did not develop PTSD; there was no difference in morphine levels in those who did and did not develop major depressive episode or another anxiety disorder. Hierarchical regression analysis indicated that PTSD severity at 3 months was significantly predicted by acute pain, mild traumatic brain injury, and elevated morphine dose in the initial 48 hours after trauma, after controlling for injury severity, gender, age, and type of injury. CONCLUSIONS: Acute administration of morphine may limit fear conditioning in the aftermath of traumatic injury and may serve as a secondary prevention strategy to reduce PTSD development.
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    A longitudinal analysis of alcohol consumption and the risk of posttraumatic symptoms
    McFarlane, AC ; Browne, D ; Bryant, RA ; O'Donnell, M ; Silove, D ; Creamer, M ; Horsley, K (ELSEVIER, 2009-11-01)
    BACKGROUND: Previous studies investigating the impact of alcohol ingestion on the emergence of posttraumatic psychological symptoms have generated contradictory findings. METHODS: One thousand forty-five patients, admitted to hospital following traumatic injury were assessed during hospitalisation for patterns of alcohol consumption prior to the injury and also during the month prior to reassessment at 3 months. Anxiety, depression and posttraumatic stress disorder (PTSD) were assessed post accident and at 3 months. In a sub sample (n=167), blood alcohol levels were measured at the time of admission to emergency departments. RESULTS: Moderate alcohol consumption prior to and following the accident predicted lower levels of psychological distress at 1 week and 3 months. No significant relationship was found between the blood alcohol level and psychiatric outcomes. PTSD predicted the emergence of alcohol abuse following the accident, suggesting self-medication in a subgroup of survivors. LIMITATIONS: The impact of alcohol consumption upon injury severity and the nature of injury was not controlled for and some non-participation may have been related to patterns of alcohol consumption. We relied on retrospective reports of alcohol use obtained shortly after the traumatic injury to index prior alcohol use and these reports may have been influenced by mood states at the time of recall. Our follow-up was limited to 3 months and there is a need for longer-term assessment of the relationship between prior alcohol use and subsequent posttraumatic adjustment. CONCLUSION: Given the potential impact of alcohol use on traumatic injury and post-injury recovery, we advocate active screening and early intervention strategies that focus on moderate alcohol usage.