Category: PTSD

In life, we're told, we must take the good with the bad, and how we view these life events determines our well-being and ability to adjust. But according to Prof. Dov Shmotkin of Tel Aviv University's Department of Psychology, you need more than the right attitude to successfully negotiate the vicissitudes of life.

As recently reported in Aging and Mental Health, Prof. Shmotkin's research reveals that people's well-being and their adaptation can be ascertained by their "time trajectory" — their concept of how they have evolved through their remembered past, currently perceived present, and anticipated future. A close study of how patients compartmentalize their life into these periods can help clinical psychologists treat them more effectively, he says.

From trauma to everyday life

Prof. Shmotkin says that the theory emerged from the study of patients who had experienced traumatic events. "We discovered that overcoming trauma was related to how people organized the memory of their trauma on the larger time continuum of their life course," he explains.

In a study of Holocaust survivors, Prof. Shmotkin separated these survivors into those who considered the "Holocaust as past" and those who conceived of the "Holocaust as present." Those in the "Holocaust as past" category were able to draw an effective line between the present day and the past trauma, thus allowing themselves to move forward. Those in the "Holocaust as present" category considered their traumatic experience as still existing, which indicated a difficulty in containing the trauma within a specific time limit.

But Prof. Shmotkin quickly saw that these coping mechanisms were not exclusive to those who had experienced trauma. Instead, he theorized, these mechanisms are a part of the normal aging process. When young, he explains, our wishes for self improvement and growth lie in an anticipated future. But as we get older, our longer perspective can help or hinder in confronting the present challenges of aging.

A time line to improve patient care

Prof. Shmotkin tested his thesis in collaboration with his former PhD students, Drs. Yuval Palgi and Amit Shrira. They studied participants with an average age of 92 who described their personal time trajectories in terms of their satisfaction with the recent past, the present, and near future.

The best-functioning participants were those whose time trajectory appeared stable rather than "descending," as was expected to occur is very old age, or "ascending," as is normal for youth and adults. Participants at this advanced age also revealed higher well-being when they managed to contrast their present with the suffering they endured in miserable periods of their life. Notably, Holocaust survivors were less able to make this break between the present and the trauma of their past.

This information, says Prof. Shmotkin, is crucial for improving therapeutic care, although it is often overlooked by clinical psychologists. "A person's subjective time frame is key to the formulation of that person's life story and well-being," he explains. Prof. Shmotkin urges psychologists to try to better understand their patients' personal time trajectories, using these as a tool to help patients reconcile their traumatic pasts and the present challenges of aging.

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Journal Reference:

1. Yuval Palgi, Dov Shmotkin. The predicament of time near the end of life: Time perspective trajectories of life satisfaction among the old-old. Aging & Mental Health, 2010; 14 (5): 577 DOI: 10.1080/13607860903483086

A new study on the behavior of the zebrafish by researchers at the RIKEN Brain Science Institute has uncovered a key role for a region of the brain called the habenula nucleus in the development of fear responses. The discovery provides valuable insights applicable to the treatment of post-traumatic stress disorder (PTSD) and other mental illnesses.

The survival of any living organism is crucially dependent on the actions it takes when faced with fearful situations. Fear responses are likewise important to the social well-being of human beings, where its malfunction has been linked to a variety of mental disorders. Yet while numerous brain regions have been connected to the memory of fearful experiences, the neural pathways governing how such experiences are translated into the selection of behavior remain a mystery.

To unravel this mystery, the researchers analyzed neural pathways of the zebrafish, a model organism with a simple brain, focusing on an evolutionarily-conserved region called the habenula nucleus present in all vertebrate species. Using fluorescent tracers, they identified a specific pathway connecting the lateral nuclei of the habenula (HbL), via the dorsal interpeduncular nucleus (dIPN), to a structure likely to correspond to regions in the mammalian brain implicated in the modulation of fear behaviors. Transgenic zebrafish with this pathway silenced were then subject to fear-conditioning tasks and compared to a control population.

To their surprise, the researchers found a dramatic difference between the groups: while normal zebrafish learned to invoke a flight response at the sight of a stimulus (red light, conditioned stimulus) associated with a fearful stimulus (electric shock, unconditioned stimulus), the transgenic fish responded by freezing, indicating an impaired response strategy. Published in Nature Neuroscience, the findings for the first time connect the experience-dependent selection of fear responses to a specific region of the brain, opening new paths for research and promising insights into related mental disorders such as PTSD.

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Journal Reference:

1. Masakazu Agetsuma, Hidenori Aizawa, Tazu Aoki, Ryoko Nakayama, Mikako Takahoko, Midori Goto, Takayuki Sassa, Ryunosuke Amo, Toshiyuki Shiraki, Koichi Kawakami, Toshihiko Hosoya, Shin-ichi Higashijima, Hitoshi Okamoto. The habenula is crucial for experience-dependent modification of fear responses in zebrafish. Nature Neuroscience, 2010; DOI: 10.1038/nn.2654

 The trauma from hard combat can devastate veterans until old age, even as it influences others to be wiser, gentler and more accepting in their twilight years, a new University of Florida study finds.

The findings are ominous with the exposure of today's men and women to heavy combat in the ongoing Iraq and Afghanistan wars on terror at a rate that probably exceeds the length of time for U.S. veterans during World War II, said UF sociologist Monika Ardelt.

"The study shows that we really need to take care of our veterans when they arrive home, because if we don't, they may have problems for the rest of their lives," she said. "Yet veterans report they are facing long waiting lines at mental health clinics and struggling to get the services they need."

The 60-year study, co-authored with UF graduate student Scott Landes and George Vaillant, a psychiatry professor at Harvard Medical School, compared 50 World War II veterans with high combat exposure with 110 veterans without any combat experiences. Results showed that heavy combat exposure at a young age had a detrimental effect on physical health and psychological well-being for about half of the men well into their 80s, she said. The findings were published in the latest issue of the journal Research in Human Development.

Getting treatment not only prevents serious health problems but it can boost the mental well-being of veterans with heavy combat exposure to higher levels than their comrades who saw little battle action, Ardelt said.

The study found that about half of the veterans who experienced a high level of combat showed signs of stress-related growth at mid-life, leading to greater wisdom and well-being in old age than among veterans who witnessed no combat, she said.

Firing at the enemy, killing people and watching others die is enormously stressful, but it can result in personal growth as with survivors of cancer and sexual assault, Ardelt said.

"You can either conclude that God has abandoned you, the world is an unfair place and there is nothing else to do but close yourself off from it all or you can manage to open yourself up and develop compassion for the suffering of others realizing that you have now become a part of it," she said.

Participants were veterans who had been members of Harvard's undergraduate class between 1940 and 1944. In 1946, a year after the war ended, the men filled out an extensive questionnaire and participated in an in-depth interview. They took part in additional in-depth interviews at about 30, 50 and 65, answered follow-up questionnaires every two years, took personality tests and received physical examinations every five years starting at age 45.

The study found that some veterans experienced stress-related growth, the ability to press on with life in a purposeful manner after hardship or adversity. This was measured by whether or not they reached "generativity" in middle age, a life stage identified by psychologist Erik Erikson that is characterized by a desire to mentor the next generation and give back to the community.

Veterans in the high combat group who experienced stress-related growth or reached "generativity" reported significantly less anxiety and depression than other veterans who did not attain this stage of development, either in the high or low combat group, the study found.

In addition, veterans with high combat exposure who experienced this type of growth were less likely than those who did not attain it to abuse alcohol in their early 50s, while the difference in alcohol consumption in the no combat group between veterans who reached "generativity" and those who did not was statistically insignificant, Ardelt said. Among veterans who failed to reach "generativity," those exposed to heavy combat tended to drink significantly larger amounts of alcohol in midlife than veterans with no combat experience, she said.

"In some ways, it was probably easier for World War II veterans because that was a war supported by all the American people and the men were celebrated as liberators when they came home," she said. "Although not as bad as Vietnam, Afghanistan and Iran are wars that we just want to forget."

Even though effects from heavy combat could be long lasting, the Ivy League-educated World War II veterans studied were probably much better off than today's veterans, Ardelt said. Their educational background may have let them serve in better positions than the average soldier, she said.

"Because this was a very privileged sample, I would be even more concerned about the people who are coming home now, who are not necessarily privileged and joined the army for economic reasons," she said.

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Journal Reference:

1. Monika Ardelt, Scott Landes, George Vaillant. The Long-Term Effects of World War II Combat Exposure on Later Life Well-Being Moderated by Generativity. Research in Human Development, 2010; 7 (3): 202 DOI: 10.1080/15427609.2010.504505

Researchers in the Midwest are developing microelectronic circuitry to guide the growth of axons in a brain damaged by an exploding bomb, car crash or stroke. The goal is to rewire the brain connectivity and bypass the region damaged by trauma, in order to restore normal behavior and movement.

Pedram Mohseni, a professor of electrical engineering and computer science at Case Western Reserve University, and Randolph J. Nudo, a professor of molecular and integrative physiology at Kansas University Medical Center, believe repeated communications between distant neurons in the weeks after injury may spark long-reaching axons to form and connect.

Their work is inspired by the traumatic brain injuries suffered by ground troops in Afghanistan and Iraq. Despite improvements in helmets and armor, brain trauma continues to be the signature injury of these wars.

Brain damage carries a heavy toll that may include loss of coordination, balance, mobility, memory and problem-solving skills, with soldiers suffering from mood swings, depression, anxiety, aggression, social inappropriateness and emotional outbursts.

Scientists believe that as the brain develops, it naturally establishes and solidifies communication pathways between neurons that repeatedly fire together.

Nudo and others have found that during the month following injury the brain is redeveloping, with fibers that connect different parts of the brain undergoing extensive rewiring.

"The month following injury is a window of opportunity," Mohseni said. "We believe we can do this with an injured brain, which is very malleable."

Mohseni has been building a multichannel microelectronic device to bypass the gap left by injury. The device, which he calls a brain-machine-brain interface, includes a microchip on a circuit board smaller than a quarter. The microchip amplifies signals, called neural action potentials, produced by the neurons in one part of the brain and uses an algorithm to separate these signals — brain spike activity — from noise and other artifacts. Upon spike discrimination, the microchip sends a current pulse to stimulate neurons in another part of the brain, artificially connecting the two brain regions.

The miniature device currently remains outside the body, connecting to microelectrodes implanted in two regions of the brain.

Nudo has been studying and mapping brain connectivity in a rat model and developing a traumatic brain injury model to test the device and the neuroanatomical rewiring theory.

The researchers began collaborating in 2007. This month they received a $1.44 million grant from the Department of Defense Congressionally Directed Medical Research Program to continue their work and begin testing and improving the device.

During the next four years, they expect to understand the ability to rewire the brain in a rat model and to determine whether the technology is safe enough to test in non-human primates. If tests show the treatment is successful in helping recovery from traumatic brain injury, the researchers foresee the possibility of using the approach in patients 10 years from now.

Holocaust survivors show remarkable resilience in their day-to-day lives, but they still manifest the pain of their traumatic past in the form of various psychiatric symptoms, according to an analysis of 44 years of global psychological research.

Jewish Holocaust survivors living in Israel also have higher psychological well-being than those who live in other countries, which suggests living in that country could serve as a protective factor, according to researchers in Israel and the Netherlands. Their findings are reported in Psychological Bulletin, which is published by the American Psychological Association. The studies chosen for this analysis focused on Holocaust survivors of Jewish ancestry.

"Six decades after the end of World War II and we are still learning how a mass genocide like the Holocaust is affecting its victims," said the study's lead author, Efrat Barel, PhD, a psychology professor at the Max Stern Academic College of Emek Yezreel in Israel. "What we've found is that they have the ability to overcome their traumatic experiences and even to flourish and gain psychological growth, but it may not be as easy as it seems."

The central question of this analysis was how the Holocaust affected survivors' general adjustment, according to Barel. General adjustment levels were determined by examining the participants' psychological well-being, post-traumatic stress symptoms, cognitive functioning, physical health, stress-related symptoms and psychopathological symptoms. The researchers analyzed findings from 71 different research samples, which included 12,746 people from around the world. The researchers searched for studies with samples of Holocaust survivors in addition to control groups of people who were not Holocaust survivors. The nature of these control groups varied across studies. For example, some studies matched on background characteristics, except for the Holocaust experience; other studies compared Holocaust survivors to other European-born Jews who did not undergo the Holocaust. All the studies were published between 1964 and 2008.

As the researchers examined the findings, they were able to see some interesting differences and similarities between Holocaust survivors and the control groups:

• Holocaust survivors had poorer psychological well-being, more post-traumatic stress symptoms and more psychopathological symptoms.
• There were no significant differences in cognitive functioning or physical health.
• Holocaust survivors who lived in Israel showed better psychological well-being and social adjustment than survivors who lived in other countries.

"The psychological scars of Holocaust survivors are evident in their continued experience of post-traumatic symptoms, but these experiences have not necessarily prevented their ability to adapt to day-to-day life," said co-author Abraham Sagi-Schwartz, a dean of social sciences at Haifa University, Israel. "It's possible these survivors repressed a lot of these traumatic memories in the immediate aftermath of the war and instead focused on rebuilding their lives and raising new families."

This research is particularly relevant for survivors who were children during the Holocaust, the authors added. "Most survivors alive today were children during World War II and the current findings call for special attention to the care of these survivors," said co-author Marinus Van IJzendoorn of Leiden University in the Netherlands. "As they approach old age, they face new challenges, including retirement, declining health and losing a spouse, and this may reactivate their extreme early stresses."

Approximately half of the samples included participants selected randomly from different populations around the world, the researchers noted. In the other studies, participants were recruited through Holocaust survivor meetings or advertisements. There were some differences in the findings but in their conclusions of this meta-analysis, the psychologists focused on the randomly selected samples since these types of studies are more scientifically sound than studies that are more select in their recruiting methods. They outline their findings for each sample type within the published article.

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Journal Reference:

1. Efrat Barel, Marinus H. Van IJzendoorn, Abraham Sagi-Schwartz, Marian J. Bakermans-Kranenburg. Surviving the Holocaust: A meta-analysis of the long-term sequelae of a genocide. Psychological Bulletin, 2010; 136 (5): 677 DOI: 10.1037/a0020339

Traumatic brain injury (TBI) is a serious public health problem in the United States. Recent data show that approximately 1.7 million people sustain a traumatic brain injury annually. While the majority of TBIs are concussions or other mild forms, traumatic brain injuries contribute to a substantial number of deaths and cases of permanent disability.

Currently, there are no drugs available to treat TBI: a variety of single drugs have failed clinical trials, suggesting a possible role for drug combinations. Testing this hypothesis in an animal model, researchers at SUNY Downstate Medical Center tested five drugs in various combinations.

Their observations, published recently in the journal PLoS ONE, suggest a potentially valuable role for minocycline plus N-acetylcysteine to treat TBI. The Congressionally Directed Medical Research Programs recently cited this work, funded by the Psychological Health and Traumatic Brain Injury Research Program, as an outstanding example of research.

Peter J. Bergold, PhD, associate professor of physiology and pharmacology at SUNY Downstate, and the article's corresponding author, said: "There is great need for drugs to treat TBI. Perhaps the fastest way to get treatments to the clinic is to combine drugs already known to be both safe and effective. The combination of minocycline and N-acetylcysteine showed a large, synergistic improvement of cognition and memory after experimental traumatic brain injury. We are continuing these studies to get this combination in a clinical trial."

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Journal Reference:

1. Abdel Baki SG, Schwab B, Haber M, Fenton AA, Bergold PJ. Minocycline Synergizes with N-Acetylcysteine and Improves Cognition and Memory Following Traumatic Brain Injury in Rats. PLoS ONE, 2010; 5 (8): e12490 DOI: 10.1371/journal.pone.0012490

Some intensive care patients develop post-traumatic stress syndrome (PTSD) after the trauma of a difficult hospital stay, and this is thought to be exacerbated by delusional or fragmentary memories of their time in the intensive care unit. Now researchers writing in BioMed Central's open access journal Critical Care have found that if staff and close relatives make a diary for patients, featuring information about their stay and accompanied by photographs, PTSD rates can be significantly reduced.

Professor Richard Griffiths and Christina Jones from the University of Liverpool, UK, worked with an international team of researchers to conduct a randomized controlled trial into the effectiveness of the diaries in 352 patients from 12 hospitals in 6 different European countries. Griffiths said, "On average 1 in 10 patients who stay more than 48 hours in intensive care will develop PTSD. It is likely that the fragmentary nature of their memories and the high proportion of delusional memories, such as nightmares and hallucinations, make it difficult for patients to make sense of what has happened to them. These memories are frequently described as vivid, realistic and frightening and may even involve patients thinking that nurses or doctors tried to kill them. Hard evidence of what really happened, in the form of a diary filled out by the treatment staff, may help to allay these fears."

During the study, 162 patients were randomly assigned to receive diaries, and they were found to be less than half as likely to develop PTSD as the control group. The diaries were completed daily by nursing staff and relatives using everyday language and accompanying photographs were taken. After discharge from intensive care, a nurse talked the patient through the diary entries.

According to Griffiths, "Diaries are not without cost; there has to be a commitment from the staff to write something in the diary every day and take photographs when important changes happen. In addition an experienced nurse is needed to go through the diary with the patient to ensure that they understand its contents, but this is not significantly more than might have been provided by an unstructured discussion in the past. Compared with providing formal therapy to all patients struggling to cope with their experiences, diaries are likely to be highly cost-effective."

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Journal Reference:

1. Christina Jones, Carl Backman, Maurizia Capuzzo, Ingrid Egerod, Hans Flaatten, Cristina Granja, Christian Rylander, Richard D Griffiths, The RACHEL group. Intensive care diaries reduce new onset post traumatic stress disorder following critical illness: a randomised, controlled trial. Critical Care, 2010; 14 (5): R168 DOI: 10.1186/cc9260

Cancer patients who die in the hospital or an intensive care unit have worse quality of life at the end-of-life, compared to patients who die at home with hospice services, and their caregivers are at higher risk for developing psychiatric illnesses during bereavement, according to a study by researchers at Dana-Farber Cancer Institute.

One striking finding of the study, reported in the September 13th issue of the Journal of Clinical Oncology, was that bereaved caregivers of patients who died in an intensive care unit (ICU) were five times more likely to be diagnosed with Posttraumatic Stress Disorder (PTSD), compared with caregivers of patients who died at home with hospice services.

"This is the first study to show that caregivers of patients who die in ICUs are at a heightened risk for developing PTSD," wrote the authors, led by Alexi Wright, MD, a medical oncologist and outcomes researcher at Dana-Farber. The American Medical Association Glossary defines PTSD as "feelings of anxiety experienced after a particularly frightening or stressful event, which include recurring dreams, difficulty sleeping, and a feeling of isolation."

In addition, families and loved ones of patients who died in the hospital, though not in an ICU, were at higher risk of developing Prolonged Grief Disorder (PGD), an intense and disabling form of grief which lasts more than 6 months.

The report comes at a time of growing concern over the appropriateness of aggressive, hospital-based end-of-life care for terminal cancer patients. The authors noted that although most cancer patients would prefer to spend their last days at home, 36 percent die in a hospital and 8 percent in an ICU and may be subjected to invasive and painful procedures at the end of life.

In contrast to home or hospice care that emphasizes alleviating pain and discomfort and providing a peaceful death, ICU care can be traumatic for patients and their family and caregivers, said Wright.

The report, whose senior author is Holly Prigerson, PhD, director of Dana-Farber's Center for Psycho-oncology & Palliative Care Research, contains findings from a prospective, longitudinal study of advanced cancer patients recruited at seven cancer centers from 2002 to 2008. Patients and caregivers — mainly family members — were interviewed at the beginning of the study. Their medical charts were reviewed at that point and after the patients died, on average 4.5 months later. Within two weeks of the death, researchers interviewed the caregiver most closely involved with the patient's care during the last week of life; they interviewed the caregiver again six months later.

In the interviews, the researchers asked the caregivers to assess the patients' quality of life and physical and psychological stress during the last week of life. The researchers also evaluated the caregivers' own mental health at the beginning of the study — to uncover any pre-existing psychiatric illnesses — and again six months after the patient's death.

After analyzing the data on 342 patient-caregiver pairs, the investigators found that patients who had died in the hospital or an ICU experienced more physical and emotional distress and worse quality of life than those dying at home. Among the caregivers, they determined that 4 of 19 caregivers (21 percent) of patients dying in an ICU developed PTSD, compared with 6 of 137 (4.4 percent) when death occurred in the home/hospice setting. A similar elevated risk of prolonged grief disorder was found in caregivers when patients died in the hospital, but not in an ICU.

These findings are important for both patients and physicians, said Wright. "If patients are aware that more-aggressive care may affect not only their quality of life, but also their loved ones after their death, they may make different choices."

In addition to Wright and Prigerson, the paper's other authors are Tracy Balboni, MD, Ursula Matulonis, MD, and Susan Block, MD, of Dana-Farber, and Nancy L. Keating, MD, of Harvard Medical School.

The research was supported by grants from the National Institute of Mental Health and the National Cancer Institute.

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Journal Reference:

1. A. A. Wright, N. L. Keating, T. A. Balboni, U. A. Matulonis, S. D. Block, H. G. Prigerson. Place of Death: Correlations With Quality of Life of Patients With Cancer and Predictors of Bereaved Caregivers' Mental Health. Journal of Clinical Oncology, 2010; DOI: 10.1200/JCO.2009.26.3863

Traumatic brain injury, currently considered a singular event by the insurance industry and many health care providers, is instead the beginning of an ongoing process that impacts multiple organ systems and may cause or accelerate other diseases and disorders that can reduce life expectancy, according to research from the University of Texas Medical Branch at Galveston.

As such, traumatic brain injury should be defined and managed as a chronic disease to ensure that patients receive appropriate care and that future research is directed at discovering therapies that may interrupt the disease processes months or even years after the initiating injury, say co-authors Dr. Brent Masel, a clinical associate professor in UTMB's department of neurology and Dr. Douglas DeWitt, director of the Moody Center for Traumatic Brain & Spinal Cord Injury Research/Mission Connect and professor in the department of anesthesiology. Masel also serves as president and director of the Transitional Learning Center in Galveston, which for more than 25 years has provided survivors of brain injury with the special rehabilitation services they need to re-enter the community.

The literature review, which appears in the current issue of The Journal of Neurotrauma, examines 25 years of research on the effects of brain injury, including its impact on the central nervous system and on cognitive and motor functions.

Traumatic brain injury occurs when a sudden trauma causes damage to the brain and can be classified as mild, moderate or severe, depending on the extent of the damage. While many patients recover completely, more than 90,000 become disabled each year in the U.S. alone. It is estimated that more than 3.5 million Americans are presently disabled by brain injuries — suffering lifelong conditions as a result.

"Traumatic brain injury fits the World Health Organization's definition of a chronic disease, yet the U.S. health care system generally views it as a one-time injury that heals the way a broken bone does," says Masel. "Only by reimbursing and managing brain injuries on par with other chronic diseases will patients get the long-term treatment and support they need and deserve."

The researchers add that re-classifying traumatic brain injury as a chronic disease may help to provide brain injury researchers with the additional funding required to investigate a potential cure.

Masel and DeWitt's review compiled extensive evidence that brain trauma initiates a disease process that severely affects cognitive function, physiological processes and quality of life. These effects can prevent patients from fully reentering society post-injury and may ultimately contribute to death months or years later. Specifically, traumatic brain injury is strongly associated with:

• Neurological disorders that reduces life expectancy, including epilepsy — for which traumatic brain injury is the leading cause in young adults — and obstructive sleep apnea, which is associated with reduced cognition and severe cardiac arrhythmias during sleep.
• Neurodegenerative disorders that lead to gradual declines in cognitive function after injury, including Alzheimer's dementia, Parkinson's disease and chronic traumatic encephalopathy (also known as "punch drunk" and characterized by disturbed coordination, gait, slurred speech and tremors). However, research shows that those who receive more therapy in the early post-injury months, irrespective of severity of injury and level of neuropsychological impairment, were less likely to show decline over the long-term. Age is also a factor in cognitive outcome after brain injury, with older patients showing greater decline.
• A host of neuroendocrine disorders, possibly caused by complex hormonal responses in the hypothalamic-pituitary system that ultimately lead to acute and/or chronic post-traumatic hypopituitarism — the decreased secretion of hormones normally produced by the pituitary gland, which can result in several related conditions, including growth hormone deficiency and hypothyroidism.
• Psychiatric and psychological diseases, which are among the most disabling consequences of traumatic brain injury. Many individuals with mild brain trauma and the majority of those who survive moderate-to-severe brain injury are left with significant long-term neurobehavioral conditions. These range from aggression, confusion and agitation to obsessive-compulsive disorders, anxiety/mood/ psychotic disorders, major depression and substance abuse. It is also associated with high rates of suicide.
• Non-neurologic disorders, including sexual dysfunction, which affects 40-60 percent of patients; incontinence; musculoskeletal dysfunction, or spasticity that results in abnormal motor patterns that may limit mobility and independence; and metabolic dysfunction, as brain injury appears to impact the way the body absorbs, utilizes and converts amino acids, which play a critical role in brain function.

According to Masel and DeWitt, research suggests that the progression of symptoms seen in chronic traumatic brain injury patients may be due, in part, to defective apoptotic cell death — a natural process in which cells die because they are genetically programmed to do so or because of injury or disease. It is possible that the abnormal apoptotic cell death is triggered by brain trauma, leading to an accelerated decline in cognitive function and development of disease.

"Media coverage of traumatic brain injury among soldiers and athletes, especially football players, has highlighted the serious health problems resulting from brain injury that are experienced later in life and helped raise awareness among the general public," says DeWitt. "But until traumatic brain injury is recognized as a chronic disease, research funding won't be adequate for the work that is needed to help patients minimize or avoid these outcomes."

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Journal Reference:

1. Brent E. Masel, Douglas S. DeWitt. Traumatic Brain Injury: A Disease Process, Not an Event. Journal of Neurotrauma, 2010; 27 (8): 1529 DOI: 10.1089/neu.2010.1358

A new national study not only has confirmed that children who have been exposed to disasters from earthquakes to fires are more prone to emotional problems, but many of those children may already have been experiencing maltreatment, domestic abuse or peer violence that could exacerbate those issues.

Researchers found that children who had experienced such victimization on top of exposure to disaster had more anxiety, depression, and aggression than children who only experienced a disaster. But, the authors say, these disasters can offer an opportunity for community organizations and first-responders to be in contact with children that might be suffering silently and need support.

"We have known for a long time that children who experience disasters have emotional and behavioral problems that seem to be related to the disaster. This study makes it clear that, for some children, those problems may also be related to other stress events in their lives," said lead author Kathryn Becker-Blease, a child development psychologist with Oregon State University.

Becker-Blease and colleagues at the University of New Hampshire looked at data from a nationally representative sample of 2,030 children aged two to 17 years. Their findings are in a special issue of the journal Child Development that focuses on disasters and their impact on children. The research was funded by the U.S. Department of Justice.

The study, taken from phone interviews with children and parents, shows that 4.1 percent of children had experienced a disaster in the past year and that 13.9 percent of the sample reported a lifetime exposure to a variety of disasters. In the study, disaster was defined to include both minor disasters, like home fires, and major disasters, like large earthquakes.

In the Child Development study, only two of the 70 children who experienced victimization in the past year received counseling for emotional or behavioral problems.

"It is a good time to screen children, to put them in contact with people who can help them because issues such as sexual abuse or neglect are still incredibly stigmatized," she said. "So a disaster like a fire or flood can put these children in contact with social services that can then identify other issues beyond the immediate trauma."

Children's reactions to disasters and other kinds of stressful events varied widely, especially for adolescents.

"After a disaster, we tell parents to remain calm, to resume a routine, and to assure children that adults will keep them safe. In reality, not all families provide calm, safe places with predicable routines. This study shows that children in those families are at higher risk for emotional and behavioral problems. We should be thinking about ways to help those families, while recognizing that most families cope with disasters well with less support."

Bob Porter is a retired licensed clinical social worker who volunteers as a Disaster Mental Health responder for the Oregon Trail Chapter of the American Red Cross. He has spent more than 30 years in the field of disaster mental health and post-trauma psychological intervention, including extensive work with victimized and traumatized children.

Volunteers like Porter who are part of the organization's disaster mental health team, assess what types of psychological support might be needed for survivors and victims following major disasters and traumatic events. They also train other Red Cross disaster and emergency responders on how to sensitively deal with disaster victims.

"We provide people with a variety of psychological supports, both in the immediate aftermath of disaster and in the short-term, connecting people with key resources and making referrals when there are more serious mental health issues involved," he said. "We provide a back-up to local mental health services and help people get additional psychological support, and appropriate treatment if indicated, that they may need."

Porter said the results of Becker-Blease's study are not surprising to him. It is consistent with his impressions over the years in working with disaster victims and survivors, especially children who may have had previous traumas in their life.

"One of the things we try to prepare disaster mental health and crisis responders for is that under the stress of a disaster, people can experience a wide range of reactions and behavior," he said. "We advise them to be aware that some of the reactions they are seeing in survivors may be related to other stressors and underlying issues, possibly even traumas, that children and other family members have experienced prior to the current event happening."

Porter is currently in the process of training Red Cross mental health teams who will be heading to the Gulf Coast in a few weeks to help with some of the ongoing psychological and mental health issues in communities affected by the Gulf Oil Spill disaster.