Risk factors for postpartum posttraumatic stress disorder after emergency admission

BACKGROUND:Postpartum posttraumatic stress disorder(PTSD)can occur in women who give birth after emergency admission.The identification of risk factors for this condition is crucial for developing effective preventive measures.This retrospective study aimed to explore the incidence and risk factors for postpartum PTSD in women who give birth after emergency admission.METHODS:Medical records of women who gave birth after emergency admission were collected between March 2021 and April 2023.The patients’general conditions and perinatal clinical indicators were recorded.The puerperae were divided into PTSD group and control group based on symptom occurrence at six weeks postpartum.Multivariate logistic regression analysis was performed to identify risk factors.RESULTS:A total of 276 puerperae were included,with a PTSD incidence of 20.3% at six weeks postpartum.Multivariate logistic regression analysis identified emergency cesarean section(odds ratio[OR]=2.102;95%confidence interval[CI]:1.114-3.966,P=0.022),admission to the emergency department after midnight(12:00 AM)(OR=2.245;95%CI:1.170-4.305,P<0.001),and cervical dilation(OR=3.203;95%CI:1.670–6.141,P=0.039)as independent risk factors for postpartum PTSD.Analgesia pump use(OR=0.500;95%CI:0.259–0.966,P=0.015)was found to be a protective factor against postpartum PTSD.CONCLUSION:Emergency cesarean section,admission to the emergency department after midnight,and cervical dilation were identified as independent risk factors for postpartum PTSD,while analgesic pump use was a protective factor.These findings provide insights for developing more effective preventive measures for women who give birth after emergency admission.

Comparison of posttraumatic growth and posttraumatic stress of nurses with physicians and medical students after caring of COVID‑19 patients

Objectives:The present study compared the prevalence and psychosocial factors affecting posttraumatic growth(PTG),posttraumatic stress disorder(PTSD),and psychological distress in nurses,physicians,and medical students.Materials and Methods:In a cross‑sectional study,three groups of medical staff including nurses(n=57),physicians(n=40),and medical students(n=34)who were responsible for the care/treatment of COVID‑19 patients admitted to a general hospital for 4 months responded to Posttraumatic Growth Inventory,Brief Symptom Inventory‑18,Resilience Questionnaire,PTSD Screen,and Social Capital‑Integrated Questionnaire.Results:After the exposure of medical staff to at least 4 months of treatment/care of COVID‑19 patients,PTG prevalence was higher than PTSD(38.2%vs.14.6%),but they experienced some degrees of psychological distress(65.5%).The nurses had 8.33(confidence interval[CI]:2.5–26.7)times higher PTG rate than medical students(P<0.001).Physicists also experienced 5.00(CI:1.4–26.7)times higher PTG than medical students(P<0.001).PTG was aided by age,married status,strong resilience,and high social capital,but gender had no influence.Resilience played an important protective role to prevent the incidence of psychological distress in nurses,medical students,and physicians.Conclusion:Despite the fact that the PTSD and psychological distress were same in the three groups of medical staff,the nurses had a greater rate of PTG than physicians and medical students.

Psychological trauma,posttraumatic stress disorder and traumarelated depression:A mini-review

There are various types of traumatic stimuli,such as catastrophic events like wars,natural calamities like earthquakes,and personal trauma from physical and psychological neglect or abuse and sexual abuse.Traumatic events can be divided into type I and type II trauma,and their impacts on individuals depend not only on the severity and duration of the traumas but also on individuals’self-evaluation of the traumatic events.Individual stress reactions to trauma include posttraumatic stress disorder(PTSD),complex PTSD and trauma-related depression.Trauma-related depression is a reactive depression with unclear pathology,and depression occurring due to trauma in the childhood has gained increasing attention,because it has persisted for a long time and does not respond to conventional antidepressants but shows good or partial response to psychotherapy,which is similar to the pattern observed for PTSD.Because trauma-related depression is associated with high risk of suicide and is chronic with a propensity to relapse,it is necessary to explore its pathogenesis and therapeutic strategy.

Prevalence of posttraumatic stress disorder following acute coronary syndrome and clinical characteristics of patients referred to cardiac rehabilitation

BACKGROUND Studies have demonstrated that patients who have experienced acute coronary syndrome(ACS)have an increased risk of developing posttraumatic stress disorder(PTSD)and experiencing worse survival outcomes than those who do not develop PTSD.Nevertheless,the prevalence rates of PTSD following ACS vary widely across studies,and it is noteworthy that in most cases,the diagnosis of PTSD was based on self-report symptom questionnaires,rather than being established by psychiatrists.Additionally,the individual characteristics of patients who develop PTSD after ACS can differ widely,making it difficult to identify any consistent patterns or predictors of the disorder.AIM To investigate the prevalence of PTSD among a large sample of patients undergoing cardiac rehabilitation(CR)after ACS,as well as their characteristics in comparison to a control group.METHODS The participants of this study are patients who have experienced ACS with or without undergoing percutaneous coronary intervention and are enrolled in a 3-wk CR program at the largest CR center in Croatia,the Special Hospital for Medical Rehabilitation Krapinske Toplice.Patient recruitment for the study took place over the course of one year,from January 1,2022,to December 31,2022,with a total of 504 participants.The expected average follow-up period for patients included in the study is about 18 mo,and currently ongoing.Using self-assessment questionnaire for PTSD criteria and clinical psychiatric interview,a group of patients with a PTSD diagnosis was identified.From the participants who do not have a PTSD diagnosis,patients who would match those with a PTSD diagnosis in terms of relevant clinical and medical stratification variables and during the same rehabilitation period were selected to enable comparability of the two groups.RESULTS A total of 507 patients who were enrolled in the CR program were approached to participate in the study.Three patients declined to participate in the study.The screening PTSD Checklist-Civilian Version questionnaire was completed by 504 patients.Out of the total sample of 504 patients,74.2%were men(n=374)and 25.8%were women(n=130).The mean age of all participants was 56.7 years(55.8 for men and 59.1 for women).Among the 504 participants who completed the screening questionnaire,80 met the cutoff criteria for the PTSD and qualified for further evaluation(15.9%).All 80 patients agreed to a psychiatric interview.Among them,51 patients(10.1%)were diagnosed with clinical PTSD by a psychiatrist according to Diagnostic and Statistical Manual of Mental Disorders criteria.Among the variables analyzed,there was a noticeable difference in the percentage of theoretical maximum achieved on exercise testing between the PTSD and non-PTSD groups.Non-PTSD group achieved a significantly higher percentage of their maximum compared to the PTSD group(P=0.035).CONCLUSION The preliminary results of the study indicate that a significant proportion of patients with PTSD induced by ACS are not receiving adequate treatment.Furthermore,the data suggest that these patients may exhibit reduced physical activity levels,which could be one of the possible underlying mechanisms in observed poor cardiovascular outcomes in this population.Identifying cardiac biomarkers is crucial for identifying patients at risk of developing PTSD and may derive benefits from personalized interventions based on the principles of precision medicine in multidisciplinary CR programs.

Self-compassion and resilience mediate the relationship between childhood exposure to domestic violence and posttraumatic growth/stress disorder during COVID-19 pandemic

BACKGROUND Studies have indicated that childhood exposure to domestic violence is a common factor in posttraumatic growth(PTG)and posttraumatic stress disorder(PTSD),but it is unclear whether PTG and PTSD share a common/different underlying mechanism.AIM To explore the common/different underlying mechanism of PTG and PTSD.METHODS Between February 12 and 17,2020,a nationwide cross-sectional online survey was conducted in China among 2038 university students,and a self-administered questionnaire was used for the data collection.The data included demographic characteristics,such as age,gender,and subjective social economic status,and childhood exposure to domestic violence scale that was selected from the Chinese version of revised Adverse Childhood Experiences Question,Self-compassion Scale,Connor–Davidson Resilience Scale,Posttraumatic Growth Inventory,and the Abbreviated PTSD Checklist-Civilian version.A structural equation model was used to test the hypotheses.RESULTS Exposure to domestic violence was significantly associated with PTG and PTSD via a 1-step indirect path of self-compassion(PTG:β=-0.023,95%CI:-0.44 to-0.007;PTSD:β=0.008,95%CI:0.002,0.014)and via a 2-step indirect path from self-compassion to resilience(PTG:β=-0.008,95%CI:-0.018 to-0.002;PTSD:β=0.013,95%CI:0.004-0.024).However,resilience did not mediate the relationship between exposure to domestic violence and PTG and PTSD.CONCLUSION PTG and PTSD are common results of childhood exposure to domestic violence,which may be influenced by self-compassion and resilience.

Posttraumatic stress symptom trajectories of Chinese university students during the first eight months of the COVID-19 pandemic and their association with cognitive reappraisal,expressive suppression,and posttraumatic growth

Objective: To identify the moderating effects of cognitive reappraisal(CR) and expressive suppression(ES) on the relationship between posttraumatic stress(PTS) symptoms and posttraumatic growth(PTG) in university students. Methods: The survey included 1 987 Chinese university students who completed questionnaires on PTS symptoms in February 2020, with three follow-up surveys at two-month intervals until August 2020. We assessed CR and ES at February 2020 and PTG at August 2020. Growth mixture modeling was used to classify the PTS symptom trajectories. Multinomial logistic regression was used to recognize the predictors of class membership. The relationships among PTS symptoms, CR, ES, and PTG were examined using multi-group path analysis.Results: Sex, SARS-Co V-2 infection of a family member or friend, number of siblings, CR, and ES were significantly associated with PTS symptoms. Three latent classes were identified: ‘Increasing PTS’(n=205, 10.0%) who had rapid deterioration of PTS symptoms, ‘Moderate PTS’(n=149, 8.0%) who had a high level of PTS symptoms at the beginning and slightly increasing, and ‘Persistent Minimal PTS’(n=1 633, 82.0%), who had slow resolution of PTS symptoms over time. Male, SARS-Co V-2 infection of a family member or friend, and having a lower CR and a higher ES, were more likely to have ‘Increasing PTS’. PTS at February 2020 predicted PTG only in ‘Increasing PTS’ class, and both CR and ES had moderating effects on the conversion between them.Conclusions: Most students recovered from posttraumatic stress of COVID-19 pandemic, but a small proportion expeienced increasing PTS symptoms, and those with this condition may benefit from emotional regulation intervention.

Study on serum cytokine levels in posttraumatic stress disorder patients

Objective:To evaluate serum IL-2,IL-4,IL-6.IL-8,TL-10 and TNF-αlevels in posttraumatic stress disorder(PTSD) patients.Methods:We utilized ELISA technology to examine cytokines such as IL-2,IL-4.IL-6.IL-8,IL-10 and TNF-αin serum from 50 well-characterized individuals with a primary DSM-1V PTSD diagnosis,and 50 age- and gender-matched healthy controls.We conservatively employed a Mann-Whitney U testing.Results:Individuals with primary PTSD had significantly elevated peripheral cytokine levels for all 6 different cytokines compared to age- and gender-matched healthy controls(allP【0.01).Conclusions:These findings suggest that a generalized inflammatory state may be present in individuals with PTSD.

Transcranial magnetic stimulation: potential treatment for co-occurring alcohol, traumatic brain injury and posttraumatic stress disorders

Alcohol use disorder （AUD）, mild traumatic brain injury （mTBI）, and posttraumatic stress disorder （PTSD） commonly co-occur （AUD ＋ mTBI ＋ PTSD）. These conditions have overlapping symptoms which are, in part, reflective of overlapping neuropathology. These conditions become problematic because their co-occurrence can exacerbate symptoms. Therefore, treatments must be developed that are inclusive to all three conditions. Repetitive transcranial magnetic stimulation （rTMS） is non-invasive and may be an ideal treatment for co-occurring AUD ＋ mTBI ＋ PTSD. There is accumulating evidence on rTMS as a treatment for people with AUD, mTBI, and PTSD each alone. However, there are no published studies to date on rTMS as a treatment for co-occurring AUD ＋ mTBI ＋ PTSD. This review article advances the knowledge base for rTMS as a treatment for AUD ＋ mTBI ＋ PTSD. This review provides background information about these co-occurring conditions as well as rTMS. The existing literature on rTMS as a treatment for people with AUD, TBI, and PTSD each alone is reviewed. Finally, neurobiological findings in support of a theoretical model are discussed to inform TMS as a treatment for co-occurring AUD ＋ mTBI ＋ PTSD. The peer-reviewed literature was identified by targeted literature searches using PubMed and supplemented by cross-referencing the bibliographies of relevant review articles. The existing evidence on rTMS as a treatment for these conditions in isolation, coupled with the overlapping neuropathology and symptomology of these conditions, suggests that rTMS may be well suited for the treatment of these conditions together.

Posttraumatic stress disorder after liver transplantation

BACKGROUND: Liver transplantation can lead to the development of posttraumatic stress disorder (PTSD), but the risk factors associated with this progression are not well understood. To study this syndrome in adult liver transplant recipients, a cross-sectional investigation of 296 recipients at our hospital was carried out between January and June 2010. METHODS: Study participants completed two questionnaires [a PTSD self-rating scale (PTSD-SS) and a validated Chinese version of the Medical Outcomes Study Short Form-36 (SF-36)]. Clinical and demographic data were collected from the records of the Chinese Liver Transplant Registry and via questionnaires. RESULTS: The prevalence of full PTSD and partial PTSD (that met the criteria for 2 of the 3 symptom clusters) was 3.7% and 5.4%, respectively, for all transplant recipients. Significant differences between the recipients with no PTSD, partial PTSD, and full PTSD were found in all SF-36 domains except for physical functioning (P=0.466). In general, domain scores were the highest in the recipients who did not meet the criteria for PTSD and the lowest in the recipients who met the criteria for full PTSD. Greater severity of posttraumatic stress symptoms was correlated with poorer quality of life, especially in the bodily pain (P=0.004), social functioning (P=0.001), role-emotional (P=0.048), and mental health (P<0.001) domains. The model for end-stage liver disease (MELD) scores, complications, and educational status were identified by multiple regression analysis as risk factors for developing PTSD. CONCLUSIONS: PTSD occurred after liver transplantation and was significantly associated with decreased quality of life. Higher MELD scores and complications after transplantation were risk factors that contributed to PTSD, and higher education was a protective factor.

Carbenoxolone pretreatment and treatment of posttraumatic epilepsy

Gap junction blocking agents can inhibit spontaneous discharge frequency in cells. We established a rat model of posttraumatic epilepsy induced using ferric ions. Rats were intraperitoneally injected with carbenoxolone, 20 mg/kg, prior to and 30 minutes after model establishment, once a day for 14 consecutive days. Immunohistochemistry showed glial cell proliferation around a cortical focus and significantly increased connexin expression in posttraumatic epilepsy. However, carbenoxolone pretreatment or treatment significantly reduced connexin expression in the cortex, inhibited glial fibdllary acidic protein expression and ameliorated seizure degree in rats. These findings indicate that large amounts of glial cell proliferation and abnormal gap junction generation play a role in posttraumatic epilepsy, and that carbenoxolone may prevent and treat this disease.

Metabolic,autonomic and immune markers for cardiovascular disease in posttraumatic stress disorder

Posttraumatic stress disorder(PTSD) has been associated with significantly greater incidence of heart disease.Numerous studies have indicated that health problems for individuals with PTSD occur earlier in life than in the general population. Multiple mechanistic pathways have been suggested to explain cardiovascular disese(CVD)risk in PTSD,including neurochemical,behavioral,and immunological changes. The present paper is a review of recent research that examines cardiovascular and immune risk profiles of individuals with PTSD. First,we address the relatively new evidence that the constellation of risk factors commonly experienced in PTSD fits the profile of metabolic syndrome. Next we examine the findings concerning hypertension/blood pressure in particular. The literature on sympathetic and parasympathetic responsivity in PTSD is reviewed. Last,we discuss recent findings concerning immune functioning in PTSD that may have a bearing on the high rates of CVD and other illnesses. Our primary goal is to synthesize the existing literature by examining factors that overlap mechanistically to increase the risk of developing CVD in PTSD.

Primary prevention of posttraumatic stress disorder: drugs and implications

Because posttraumatic stress disorder(PTSD) is a highly debilitating condition, prevention is an important research topic. This article reviews possible prevention approaches that involve the administration of drugs before the traumatic event takes place. The considered approaches include drugs that address the sympathetic nervous system, drugs interfere with the hypothalamic-pituitary-adrenal(HPA) axis, narcotics and other psychoactive drugs, as well as modulators of protein synthesis. Furthermore, some thoughts on potential ethical implications of the use of drugs for the primary prevention of PTDS are presented. While there are many barriers to overcome in this field of study, this paper concludes with a call for additional research, as there are currently no approaches that are well-suited for regular daily use.

Neural stem cell activation and glial proliferation in the hippocampal CA3 region of posttraumatic epileptic rats

The present study observed the dynamic expression of CD133, nuclear factor-κB and glial fibrUlary acidic protein in the hippocampal CA3 area of the experimental posttraumatic epilepsy rats to investigate whether gliosis occurs after posttraumatic epilepsy. CD133 and nuclear factor-κB expression was increased at 1 day after posttraumatic epilepsy, peaked at 7 days, and gradually decreased up to 14 days, as seen by double-irnmunohistochemical staining. Glial fibrillary acidic protein/nuclear factor-EB double-labeled cells increased with time and peaked at 14 days after posttraumatic epilepsy. Results show that activation of hippocampal neural stem cells and glial proliferation after posttraumatic epilepsy-induced oxidative stress increases hippocampal glial cell density.

A conceptual model of posttraumatic growth of nursing students with a disabled parent

Objectives: To examine a conceptual model of posttraumatic growth (PTG) with the inclusion of family resilience as a mediator,and social support,individual resilience,maternal care,and family members' intimacy after trauma as protective factors.Methods: A cross-sectional questionnaire survey was carried out in a sample of 134 college nursing students who had a parent with a non-congenital disability.The Socio-demographic Information Questionnaire,the Chinese version of Perceived Social Support Scale (PSSS),10-item Connor-Davidson Resilience Scale (CD-RISC10),Parental Bonding Instrument (PBI),Family Resilience Assessment Scale (FRAS) and the Posttraumatic Growth Inventory (PTGI) were used to collect data.Results: Results showed that social support,individual resilience,maternal care,and family members' intimacy after trauma positively predicted family resilience (β=0.41,0.20,0.20,0.22,all P<0.01),respectively,and indirectly predicted PTG through family resilience.Family resilience positively predicted PTG (β =0.25,P < 0.01).Moreover,individual resilience directly positively predicted PTG (β =0.25,P < 0.001).Conclusions: Family resilience could facilitate PTG in nursing students in the face of parental disability.Interventions to promote PTG among college nursing students who have experienced parental disability should consider individual or family resilience-based intervention.

Association of Bax and Bcl-2 Functional Polymorphisms and Protein Levels with Posttraumatic Stress Disorder

Background: Posttraumatic stress disorder (PTSD) is an anxiety disease influenced by both environmental and genetic factors, which affects a patient’s quality of life and social stability. Recent studies have shown that the pathogenesis of PTSD is associated with apoptosis;however, the molecular mechanisms that cause such damage are not well-understood. Also it is unclear whether these pathologic alterations are genetically determined or caused by other factors. The aim of this study was to investigate the genetic association of functional polymorphisms in genes coding for apoptosis-related Bcl-2 and Bax proteins with PTSD as well as proteins levels in the blood of affected subjects. Methods: The study groups consisted of 200 combat veterans with PTSD and an equal number of healthy subjects with no family- or past-history of any psychiatric disorders. Bax and Bcl-2 proteins levels in blood were measured by ELISA. DNA samples were genotyped for SNPs using PCR-SSP. Results: According to our results, PTSD patients are characterized by increased levels of apoptotic proteins and the imbalance in the Bax/Bcl-2 ratio compared to healthy subjects. Our results also demonstrate that rs956572*A minor allele of the BCL2 gene was overrepresented in patients with PTSD compared to healthy subjects. Conclusions: The results implicate Bcl-2 and Bax in pathogenesis of PTSD on genetic and protein levels, though further studies on enlarged cohort and in different populations are required.

Genetic Polymorphisms of Nervous System Development and the Risk of Posttraumatic Stress Disorder

Background: Posttraumatic stress disorder (PTSD) is a complex severe polygenic psychiatric disease, influenced by environmental and genetic factors. PTSD development and progression is characterized by cognitive impairment, which may result in altered processes of nervous system development and synaptic plasticity, where a number of growth factors and their receptors were shown to play important role. Since neurotrophins play an essential role in the development of central nervous system, it is widely implicated in psychiatric disorders. The aim of this study is to investigate the potential association functional polymorphisms of genes encoding netrin G1 (NTNG1), brain-derived neurotrophic factor (BDNF), nerve growth factor (NGF) and its receptor (NGFR) with PTSD. Methods: Study groups consisted of 200 combat veterans with PTSD and an equal number of controls with no family or past history of any psychiatric disorders. The DNA samples were genotyped for NTNG1 rs62811;BDNF rs6265;NGF rs6330, rs4839435;NGFR rs11466155, rs734194 SNPs using polymerase chain reaction with sequence specific primers. Results: According to the results, NGF rs6330 was overrepresented in patients with PTSD compared to controls. Furthermore, negative association for BDNF rs6265, NGF rs4839435 and NGFR rs734194 was observed in PTSD patients. Conclusions: In summary, BDNF rs6265, NGF rs6330, rs4839435 and NGFR rs734194 are implicated in PTSD in Armenian population. However, further research is required to provide the definitive evidence of selected polymorphism association with gene expression.

Is There Growth in Grief: Measuring Posttraumatic Growth in the Grief Response

Introduction: Grief is considered to be negative manifestations of affect, cognition, and behavior. However, persons who experience grief have also reported enduring positive outcomes in such domains as interpersonal relationships, personal strengths, and life perspectives. This review evaluated current measures of grief to determine if such positive outcomes can be adequately assessed. Methods: The Texas Revised Inventory of Grief, Grief Experience Inventory, Bereavement Phenomenology Questionnaire, Core Bereavement Items, Continuing Bonds Scale, and Hogan Grief Reaction Checklist (currently the most common measures of grief) are reviewed. Results: Only one of the reviewed measures assessed posttraumatic growth as a component of grief (i.e., Hogan Grief Reaction Checklist). Conclusion: Since posttraumatic growth and negative psychological adjustment after traumatic events can coexist, it is important that measures of grief used in both clinical and research domains allow an assessment of positive response.

Changes in insomnia severity with advanced PAP therapy in patients with posttraumatic stress symptoms and comorbid sleep apnea:A retrospective,nonrandomized controlled study

Background:Sleep disorders frequently occur in posttraumatic stress disorder(PTSD)patients.Chronic insomnia is a common feature of and criteria for the diagnosis of PTSD.Another sleep disorder,obstructive sleep apnea(OSA),also occurs frequently in PTSD,and emerging research indicates OSA fuels chronic insomnia.Scant research has investigated the impact of OSA treatment on insomnia outcomes(Insomnia Severity Index,ISI)in trauma survivors.Methods:OSA patients with moderately severe posttraumatic stress symptoms were studied in a retrospective chart review.Ninety-six patients who failed CPAP therapy due to expiratory pressure intolerance or complex sleep apnea or both underwent manual titration with advanced PAP modes[autobilevel(ABPAP);adaptive servo-ventilation(ASV)],which were subsequently prescribed.PAP use measured by objective data downloads divided the sample into three groups:compliant regular users(C-RU):n=68;subthreshold users(SC-RU):n=12;and noncompliant users(NC-MU):n=16.The average follow-up was 11.89±12.22 months.Baseline and posttreatment ISI scores were analyzed to assess residual insomnia symptoms as well as cure rates.Results:The C-RU group showed significant improvements in insomnia with very large effects compared to those in the NC-MU reference group(P=0.019).Insomnia severity significantly decreased in all three groups with large effects(C-RU,P=0.001;SC-RU,P=0.027;NC-MU,P=0.007).Hours of weekly PAP use and insomnia severity were inversely correlated(P=0.001,r=–0.321).However,residual insomnia symptoms based on established ISI cut-offs were quite common,even among the C-RU group.Post hoc analysis showed that several categories of sedating medications reported at baseline(hypnotics,anti-epileptic,opiates)as well as actual use of any sedating medication(prescription or nonprescription)were associated with smaller insomnia improvements than those in patients not using any sedating agents.Conclusions:In a retrospective,nonrandomized analysis of a select sample of sleep clinic patients with OSA and PTSD symptoms,advanced PAP therapy was associated with significant improvement in insomnia severity for both compliant and partial users.However,residual insomnia symptoms persisted,indicating that PAP therapy provides only limited treatment.RCTs are warranted to assess the effect of ABPAP and ASV modes of therapy on adherence and sleep outcomes,and their potential impact on posttraumatic stress symptoms.Treatment arms that combine PAP with CBT-I would be expected to yield the greatest potency.

Electrocardiographic features of patients with earthquake related posttraumatic stress disorder

AIM: To analyze electrocardiographic features of patients diagnosed with posttraumatic stress disorder (PTSD) after the Van-Erci earthquake, with a shock measuring 7.2 on the Richter scale that took place in Turkey in October 2011. METHODS: Surface electrocardiograms of 12 patients with PTSD admitted to Van Erci State Hospital (Van, Turkey) from February 2012 to May 2012 were examined. Psychiatric interviews of the sex and age matched control subjects, who had experienced the earthquake, confirmed the absence of any known diagnosable psychiatric conditions in the control group. RESULTS: A wide range of electrocardiogram (ECG) parameters, such as P-wave dispersion, QT dispersion, QT interval, Tpeak to Tend interval, intrinsicoid deflection durations and other traditional parameters were similar in both groups. There was no one with an abnormal P wave axis, short or long PR interval, longor short QT interval, negative T wave in lateral leads, abnormal T wave axis, abnormal left or right intrinsicoid deflection duration, low voltage, left bundle branch block, right bundle branch block, left posterior hemiblock, left or right axis deviation, left ventricular hypertrophy, right or left atrial enlargement and pathological q(Q) wave in either group. CONCLUSION: The study showed no direct effect of earthquake related PTSD on surface ECG in young patients. So, we propose that PTSD has no direct effect on surface ECG but may cause electrocardiographic changes indirectly by triggering atherosclerosis and/or contributing to the ongoing atherosclerotic process.

Complex posttraumatic stress disorder: The need to consolidate a distinct clinical syndrome or to reevaluate features of psychiatric disorders following interpersona trauma?

Complex posttraumatic stress disorder(Complex PTSD)has been recently proposed as a distinct clinical entity in the WHO International Classification of Diseases,11^(th) version, due to be published, two decades after its first initiation. It is described as an enhanced version of the current definition of PTSD, with clinical features of PTSD plus three additional clusters of symptoms namely emotional dysregulation, negative self-cognitions and interpersonal hardship, thus resembling the clinical features commonly encountered in borderline personality disorder(BPD). Complex PTSD is related to complex trauma which is defined by its threatening and entrapping context, generally interpersonal in nature. In this manuscript, we review the current findings related to traumatic events predisposing the above-mentioned disorders as well as the biological correlates surrounding them, along with their clinical features. Furthermore, we suggest that besides the present distinct clinical diagnoses(PTSD; Complex PTSD; BPD), there is a cluster of these comorbid disorders, that follow a continuum of trauma and biological severity on a spectrum of common or similar clinical features and should be treated as such. More studies are needed to confirm or reject this hypothesis, particularly in clinical terms and how they correlate to clinical entities' biological background, endorsing a shift from the phenomenologically only classification of psychiatric disorders towards a more biologically validated classification.