Cardiovascular correlates of motor vehicle accident related posttraumatic stress disorder and its successful treatment

Springer Open Choice ArticlePersons with posttraumatic stress disorder (PTSD) have been shown to display elevated baseline cardiovascular activity and a heightened physiological reactivity to trauma-related stimuli. Study 1 examined differences in baseline heart rate (HR) and HR reactivity in 68 survivors of motor vehicle accidents (MVAs) and healthy controls without MVA. MVA survivors with PTSD (n=26), subsyndromal PTSD (n=22), traumatized controls without PTSD (non-PTSD with MVA, n=20) and healthy controls without MVA (HC, n=27) underwent measurement of HR during baseline and exposure to a neutral, positive, negative, and trauma-related picture. PTSD patients showed elevated baseline HR and increased HR reactivity only during exposure to the trauma-related picture. Study 2 investigated whether the elevated physiological responses observed in Study 1 normalized after cognitive behavioral therapy (CBT). We conducted a randomized, controlled treatment trial comparing CBT (n=17) to a Wait-list condition (WLC, n=18). Results showed a greater decrease in HR reactivity for CBT than for WLC. The change in HR reactivity was associated with clinical improvement.This study was supported by the Deutsche Forschungsgemeinschaft (KA 1476/3

Post- and peritraumatic stress in disaster survivors: An explorative study about the influence of individual and event characteristics across different types of disasters

Background: Examination of existing research on posttraumatic adjustment after disasters suggests that survivors’ posttraumatic stress levels might be better understood by investigating the influence of the characteristics of the event experienced on how people thought and felt, during the event as well as afterwards. Objective: To compare survivors’ perceived post- and peritraumatic emotional and cognitive reactions across different types of disasters. Additionally, to investigate individual and event characteristics. Design: In a European multi-centre study, 102 survivors of different disasters terror attack, flood, fire and collapse of a building were interviewed about their responses during the event. Survivors’ perceived posttraumatic stress levels were assessed with the Impact of Event Scale-Revised (IES-R). Peritraumatic emotional stress and risk perception were rated retrospectively. Influences of individual characteristics, such as socio-demographic data, and event characteristics, such as time and exposure factors, on post- and peritraumatic outcomes were analyzed. Results: Levels of reported post- and peritraumatic outcomes differed significantly between types of disasters. Type of disaster was a significant predictor of all three outcome variables but the factors gender, education, time since event, injuries and fatalities were only significant for certain outcomes. Conclusion: Results support the hypothesis that there are differences in perceived post- and peritraumatic emotional and cognitive reactions after experiencing different types of disasters. However, it should be noted that these findings were not only explained by the type of disaster itself but also by individual and event characteristics. As the study followed an explorative approach, further research paths are discussed to better understand the relationships between variables

HD101584: Circumstellar characteristics and evolutionary status

We have performed a study of the characteristics of the circumstellar environment of the binary object HD101584, that provides information on a likely evolutionary scenario. We have obtained and analysed ALMA observations, complemented with observations using APEX, of a large number of molecular lines. An analysis of the spectral energy distribution has also been performed. Emissions from 12 molecular species (not counting isotopologues) have been observed, and most of them mapped with angular resolutions in the range 0.1" to 0.6". Four circumstellar components are identified: i) a central compact source of size 0.15", ii) an expanding equatorial density enhancement (a flattened density distribution in the plane of the orbit) of size 3", iii) a bipolar high-velocity outflow (150 km/s), and iv) an hourglass structure. The outflow is directed almost along the line of sight. There is evidence of a second bipolar outflow. The mass of the circumstellar gas is 0.5[D/1 kpc]^2 Msun, about half of it lies in the equatorial density enhancement. The dust mass is 0.01[D/1 kpc]^2 Msun, and a substantial fraction of this is in the form of large-sized, up to 1 mm, grains. The estimated kinetic age of the outflow is 770[D/1 kpc] yr. The kinetic energy and the scalar momentum of the accelerated gas are estimated to be 7x10^(45)[D/1 kpc]^2 erg and 10^(39)[D/1 kpc]^2 g cm/s, respectively. We provide good evidence that the binary system HD101584 is in a post-common-envelope-evolution phase, that ended before a stellar merger. Isotope ratios combined with stellar mass estimates suggest that the primary star's evolution was terminated already on the first red giant branch (RGB). Most of the energy required to drive the outflowing gas was probably released when material fell towards the companion.Comment: Accepted for publication in A&

Herschel/HIFI observations of O-rich AGB stars : molecular inventory

Spectra, taken with the heterodyne instrument, HIFI, aboard the Herschel Space Observatory, of O-rich asymptotic giant branch (AGB) stars which form part of the guaranteed time key program HIFISTARS are presented. The aim of this program is to study the dynamical structure, mass-loss driving mechanism, and chemistry of the outflows from AGB stars as a function of chemical composition and initial mass. We used the HIFI instrument to observe nine AGB stars, mainly in the H2O and high rotational CO lines We investigate the correlation between line luminosity, line ratio and mass-loss rate, line width and excitation energy. A total of nine different molecules, along with some of their isotopologues have been identified, covering a wide range of excitation temperature. Maser emission is detected in both the ortho- and para-H2O molecules. The line luminosities of ground state lines of ortho- and para-H2O, the high-J CO and NH3 lines show a clear correlation with mass-loss rate. The line ratios of H2O and NH3 relative to CO J=6-5 correlate with the mass-loss rate while ratios of higher CO lines to the 6-5 is independent of it. In most cases, the expansion velocity derived from the observed line width of highly excited transitions formed relatively close to the stellar photosphere is lower than that of lower excitation transitions, formed farther out, pointing to an accelerated outflow. In some objects, the vibrationally excited H2O and SiO which probe the acceleration zone suggests the wind reaches its terminal velocity already in the innermost part of the envelope, i.e., the acceleration is rapid. Interestingly, for R Dor we find indications of a deceleration of the outflow in the region where the material has already escaped from the star.Comment: 6 Figures in the main paper + 12 further figures in the appendix (to be printed in electronic form) Accepted for publication by A&

The wind of W Hya as seen by Herschel. II. The molecular envelope of W Hya

The evolution of low- and intermediate-mass stars on the asymptotic giant branch (AGB) is mainly controlled by the rate at which these stars lose mass in a stellar wind. Understanding the driving mechanism and strength of the stellar winds of AGB stars and the processes enriching their surfaces with products of nucleosynthesis are paramount to constraining AGB evolution and predicting the chemical evolution of galaxies. In a previous paper we have constrained the structure of the outflowing envelope of W Hya using spectral lines of the $^{12}$CO molecule. Here we broaden this study by modelling an extensive set of H$_{2}$O and $^{28}$SiO lines observed by the three instruments on board Herschel using a state-of-the-art molecular excitation and radiative transfer code. The oxygen isotopic ratios and the $^{28}$SiO abundance profile can be connected to the initial stellar mass and to crucial aspects of dust formation at the base of the stellar wind, respectively. The modelling of H$_{2}$O and $^{28}$SiO confirms the properties of the envelope model of W Hya derived from $^{12}$CO lines. We find an H$_2$O ortho-to-para ratio of 2.5\,$^{+2.5}_{-1.0}$, consistent with what is expected for an AGB wind. The O$^{16}$/O$^{17}$ ratio indicates that W Hya has an initial mass of about 1.5 M$_\odot$. Although the ortho- and para-H$_{2}$O lines observed by HIFI appear to trace gas of slightly different physical properties, a turbulence velocity of $0.7\pm0.1$ km s$^{-1}$ fits the HIFI lines of both spin isomers and those of $^{28}$SiO well. The ortho- and para-H$_2^{16}$O and $^{28}$SiO abundances relative to H$_{2}$ are $(6^{+3}_{-2}) \times 10^{-4}$, $(3^{+2}_{-1}) \times 10^{-4}$, and $(3.3\pm 0.8)\times 10^{-5}$, respectively. Assuming a solar silicon-to-carbon ratio, the $^{28}$SiO line emission model is consistent with about one-third of the silicon atoms being locked up in dust particles

Evidence of symptom profiles consistent with posttraumatic stress disorder and complex posttraumatic stress disorder in different trauma samples

Background: The International Classification of Diseases, 11th version (ICD-11), proposes two related stress and trauma-related disorders, posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD). A diagnosis of CPTSD requires that in addition to the PTSD symptoms, an individual must also endorse symptoms in three major domains: (1) affective dysregulation, (2) negative self-concepts, and (3) interpersonal problems. This study aimed to determine if the naturally occurring distribution of symptoms in three groups of traumatised individuals (bereavement, sexual victimisation, and physical assault) were consistent with the ICD-11, PTSD, and CPTSD specification. The study also investigated whether these groups differed on a range of other psychological problems. Methods and Results: Participants completed self-report measures of each symptom group and latent class analyses consistently found that a three class solution was best. The classes were “PTSD only,” “CPTSD,” and “low PTSD/CPTSD.” These classes differed significantly on measures of depression, anxiety, dissociation, sleep disturbances, somatisation, interpersonal sensitivity, and aggression. The “CPTSD” class in the three samples scored highest on all the variables, with the “PTSD only” class scoring lower and the “low PTSD/CPTSD” class the lowest. Conclusion: This study provides evidence to support the diagnostic structure of CPTSD and indicted that CPTSD is associated with a broad range of other psychological problems

The detached dust shells of AQ And, U Ant, and TT Cyg

Detached circumstellar dust shells are detected around three carbon variables using Herschel-PACS. Two of them are already known on the basis of their thermal CO emission and two are visible as extensions in IRAS imaging data. By model fits to the new data sets, physical sizes, expansion timescales, dust temperatures, and more are deduced. A comparison with existing molecular CO material shows a high degree of correlation for TT Cyg and U Ant but a few distinct differences with other observables are also found.Comment: Letter accepted for publication on the A&A Herschel Special Issu

Internet-based treatment for PTSD reduces distress and facilitates the development of a strong therapeutic alliance: a randomized controlled clinical trial

BACKGROUND: The present study was designed to evaluate the efficacy of an internet-based therapy (Interapy) for Posttraumatic Stress Disorder (PTSD) in a German speaking population. Also, the quality of the online therapeutic relationship, its development and its relevance as potential moderator of the treatment effects was investigated. METHOD: Ninety-six patients with posttraumatic stress reactions were allocated at random to ten sessions of Internet-based cognitive behavioural therapy (CBT) conducted over a 5-week period or a waiting list control group. Severity of PTSD was the primary outcome. Secondary outcome variables were depression, anxiety, dissociation and physical health. Follow-up assessments were conducted at the end of treatment and 3 months after treatment. RESULTS: From baseline to post-treatment assessment, PTSD severity and other psychopathological symptoms were significantly improved for the treatment group (intent-to-treat group x time interaction effect size d = 1.40). Additionally, patients of the treatment condition showed significantly greater reduction of co-morbid depression and anxiety as compared to the waiting list condition. These effects were sustained during the 3-months follow-up period. High ratings of the therapeutic alliance and low drop-out rates indicated that a positive and stable therapeutic relationship could be established online. Significant improvement of the online working alliance in the course of treatment and a substantial correlation between the quality of the online relationship at the end of treatment and treatment outcome emerged. CONCLUSION: Interapy proved to be a viable treatment alternative for PTSD with large effect sizes and sustained treatment effects. A stable and positive online therapeutic relationship can be established through the Internet which improved during the treatment process. TRIAL REGISTRATION: Australian Clinical Trials Registry ACTRN012606000401550

DSM‐5 and ICD‐11 definitions of posttraumatic stress disorder: Investigating “narrow” and “broad” approaches

Background: The development of the Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5) and ICD-11 has led to reconsideration of diagnostic criteria for posttraumatic stress disorder (PTSD). The World Mental Health (WMH) Surveys allow investigation of the implications of the changing criteria compared to DSM-IV and ICD-10. Methods: WMH Surveys in 13 countries asked respondents to enumerate all their lifetime traumatic events (TEs) and randomly selected one TE per respondent for PTSD assessment. DSM-IV and ICD-10 PTSD were assessed for the 23,936 respondents who reported lifetime TEs in these surveys with the fully structured Composite International Diagnostic Interview (CIDI). DSM-5 and proposed ICD-11 criteria were approximated. Associations of the different criteria sets with indicators of clinical severity (distress-impairment, suicidality, comorbid fear-distress disorders, PTSD symptom duration) were examined to investigate the implications of using the different systems. Results: A total of 5.6% of respondents met criteria for broadly defined PTSD (i.e., full criteria in at least one diagnostic system), with prevalence ranging from 3.0% with DSM-5 to 4.4% with ICD-10. Only one-third of broadly defined cases met criteria in all four systems and another one third in only one system (narrowly defined cases). Between-system differences in indicators of clinical severity suggest that ICD-10 criteria are least strict and DSM-IV criteria most strict. The more striking result, though, is that significantly elevated indicators of clinical significance were found even for narrowly defined cases for each of the four diagnostic systems. Conclusions: These results argue for a broad definition of PTSD defined by any one of the different systems to capture all clinically significant cases of PTSD in future studies

VLT/NACO near-infrared imaging and spectroscopy of N88A in the SMC

We present near-infrared imaging and spectroscopic high spatial resolution observations of the SMC region N88 containing the bright, excited, extincted and compact H II region N88A of size ~ 1 pc. To investigate its stellar content and reddening, N88 was observed using spectroscopy and imagery in the JHKs- and L'-band at a spatial resolution of ~ 0.1-0.3", using the VLT UT4 equipped with the NAOS adaptive optics system. In order to attempt to establish if the origin of the infra-red (IR) excess is due to bright nebulosity, circumstellar material and/or local dust, we used Ks vs J-K colour-magnitude (CM) and JHK colour-colour (CC) diagrams, as well as L' imagery.Our IR-data reveal in the N88 area an IR-excess fraction of geq 30 per cent of the detected stars,as well as an unprecedently detailed morphology of N88A. It consists of an embedded cluster of ~3.5" (~ 1 pc) in diameter, of at least thirteen resolved stars superposed with an unusual bright continuum centered on a very bright star. The four brightest stars in this cluster lie red-ward of H-K geq 0.45 mag, and could be classified as young stellar object (YSO) candidates. Four other probable YSO candidates are also detected in N88 along a south-north bow-shaped thin H2 filament at ~ 7" east of the young central bright star. At 0.2" east of this star, a heavily embedded core is detected that could be a massive class I protostar candidate. The 2.12 mu H2 image of N88A resembles a shell of diameter ~ 3" ~ 0.9 pc) centered on the bright star. The line ratios of H2 2-1 S(1) and 1-0 S(0) relative to 1-0 S(1), as well as the presence of high v lines, are indicative of photodissociation regions, rather than shocks.Comment: 15 pages, 14 figures, accepted by Astronomy and Astrophysics, uses pdflatex, aa.cl