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Current concepts - Post-traumatic stress disorder

Division of Traumatic Stress Studies and Department of Psychiatry, Mount Sinai School of Medicine and Bronx Veterans Affairs Medical Center, New York 10468, USA.
New England Journal of Medicine (Impact Factor: 54.42). 02/2002; 346(2):108-14. DOI: 10.1056/NEJMra012941
Source: PubMed
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    • "The hypothalamic-pituitary-adrenal (HPA) axis and the autonomic nervous system (ANS) have been examined extensively as mediators between psychosocial factors and health (Hemingway et al., 2005). Cortisol reactivity and regulation have long been related to helplessness and depression (Anisman & Zacharko, 1982) and to long-lasting effects of trauma ( " post-traumatic stress disorder " (Yehuda, 2002). We constructed a new short questionnaire, " Stress in Children " , (SiC) and in this study our aim was to assess the magnitude of stress in children of both sexes, and to validate this questionnaire against established psychometric measures for closely related states such as depression, anxiety, anger, disruptive behavior, and self-perception (Beck Youth Inventories) (Beck, Beck, & Jolly, 2001). "
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    ABSTRACT: We constructed a test to assess stress in children and compared it with established measures of depression, anxiety, angel; disruptive behavior, and negative self-perception. A total of 181 children aged between 9 and 12 years were enrolled at various stages of the construction of a new short questionnaire; Stress in Children (SiC). Baseline data, completed questionnaires, salivary cortisol (SC)five times during (1 day), and 24-h urinary catecholamines were collected during an ordinary school week. The SiC was validated using the Beck Youth Inventories of Emotional andnt (BYI). Associations with self-reported psychosomatic symptoms for urinary catecholamines and cortisol concentrations were assessed. Cronbach's 6 used in this study for the entire SiC questionnaire is 0.86. Statistically significant associations were found between the SiC Global Mean Score (GMS) and all of the five BYI subscales. Spearman's rho coefficient for the association of SiC GMS with the first SC sample is 0.30 (p = 0.01). When stratified by sex, the magnitude of the association between SC and SiC was higher in girls, while there was no significant association among boys. No significant associations with catecholamine levels were observed for self-rating scores from the SiC or BYI. This study demonstrated that the SiC questionnaire has satisfactory reliability and its ratings are associated with those generated by the BYI. The SiC GMS was associated with higher morning saliva cortisol in girls. Our results demonstrate that it is possible to screen for stress in schoolchildren using an easily administered self-rating instrument.
    International Journal of Behavioral Medicine 02/2007; 14(2):108-17. DOI:10.1007/BF03004176 · 2.63 Impact Factor
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    • "Chronic destabilization of neuronal networks in the hippocampus or cerebral cortex, combined with enhanced fear circuits in the amygdala (e.g., Bauer, Ledoux, & Nader, 2001; Huang & Herbert, 2006; Phan, Fitzgerald, Nathan, & Tancer, 2006; Schafe et al., 2005), however, could result in apparently pathological conditions, such as PTSD (Yehuda, 2002) and some types of depression (McEwen, 2005; Preussner et al., 2005; Young, Haskett, Murphy-Weinberg, Watson, & Akil, 1991). Even normal (but rather novel) everyday stressors in modern societies, such as social discordance between what we desire and what we have (Dressler, 1999), might generate maladaptive HPA response. "
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    ABSTRACT: The stress response systems of the human child are highly sensitive to social challenges. Because stress hormones can have negative developmental and health consequences, this presents an evolutionary paradox: Why would natural selection have favored mechanisms that elevate stress hormone levels in response to psychosocial stimuli? Two complementary hypotheses are considered: (a) maladaptation to the novelty of chronic stress in social environments, and (b) adaptive neural reorganization that facilitates the ontogeny of social competencies. Data on salivary cortisol, morbidity, and social environment from an 18 year study of child health in a rural community on the island of Dominica are examined from the perspective of these alternative hypotheses. Results indicate that difficult family environments and traumatic events are associated with elevated cortisol levels and higher morbidity. The long-term effects of traumatic early experiences on cortisol profiles are complex and indicate domain-specific effects, with normal recovery from physical stressors, but heightened response to negative-affect social challenges.
    Developmental Review 06/2006; DOI:10.1016/j.dr.2006.02.003 · 3.23 Impact Factor
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    • "Chronic destabilization of neuronal networks in the hippocampus or cerebral cortex , combined with enhanced fear circuits in the amygdala (e.g., Bauer, LeDoux, & Nader, 2001; Phan, Fitzgerald, Nathan, & Tancer, 2006), however, could result in apparently pathological conditions such as PTSD (Tupler & DeBellis, 2006; Yehuda, 2002) and some types of depression (Preussner, Baldwin, Dedovic, Renwick, Khalili Mahani, Lord, Meaney, & Lupien, 2005). Even normal (but rather novel) everyday stressors in modern societies, such as social discordance between what we desire and what we have (Dressler & Bindon, 2000), might generate maladaptive HPA response. "
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    ABSTRACT: Loss of a parent by death or divorce is among the most traumatic experiences faced by a human child. Exposure to early family trauma (EFT) can have long-term effects on the limbic hypothalamic-anterior pituitary-adrenal cortex (HPA) axis and other compo- nents of neuroendocrine stress response. Because the HPA system has important immuno- modulatory functions, children that have endured difficult family social conditions during development may be at higher risk for immune dysfunction and other health problems. Here we investigate the mediating effects of grandparental relationships, mostly maternal grandmothers, on the ontogeny of HPA stress response among EFT children. Sample and methods: A longitudinal eighteen-year study (1988-2006) of child health in a rural community on the island of Dominica provides sequential biyearly data on salivary cortisol, morbidity, growth, and social environment (N= 282 children, 26,738 saliva sam- ples from children + 5,470 saliva samples from their parents and other kin, 89,109 health observations, 46,788 anthropometric measurements, 42 months of residence in the com- munity studying social environment). Patterns of cortisol response, extent of care from grandparents, morbidity, growth, and immune function are examined for associations with trauma at different periods during development. Results: Grandparents are a common and important mediator of child wellbeing in this community. EFT children with extensive grandparental care are more likely to recover nor- mal HPA function than are EFT children with little or no grandparental care. Lengthy infor- mal discussions with children and their caregivers over the past 18 years suggest that grand- parents are important components of their social worlds, including roles as temporary and permanent replacements for parents. EFT children with low contact rates with grandparents have more erratic cortisol profiles, higher morbidity, more growth disruptions, and more be- havioral problems than EFT children with extensive grandparental care.
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