RESUMEN
Post-traumatic stress disorder (PTSD) is an anxiety disorder that can occur after exposure to extreme traumatic experience such as war trauma, and is accompanied by fear, helplessness or horror. Exposure to trauma can result in immune dysregulation and influence susceptibility to infectious disease as well as vaccine efficacy. The aim of the study was to determine the relation of psychological stress and the immune response to influenza vaccination in combat-related PTSD patients (n = 28). Detection of anti-viral antibody titre was performed by inhibition of haemagglutination assay. Ex vivo tetramer staining of CD8(+) T lymphocytes was used to monitor T cells specific for human leucocyte antigen (HLA)-A*0201-restricted influenza A haemagglutinin antigens before and after vaccination. Twenty patients showed a fourfold antibody titre increase to one or both influenza A viral strains, and 18 of them showed the same response for both influenza B viral strains. Ten of 15 healthy controls showed a fourfold rise in antibody titre to both influenza A viral strains and eight of them showed the same response for both influenza B viral strains. HLA-A*0201(+) PTSD patients (n = 10) showed a significant increase of influenza-specific CD8 T cells after vaccination. Although those PTSD patients had a lower number of influenza-specific CD8(+) T cells before vaccination compared to HLA-A*0201(+) healthy controls (n = 6), there was no difference in influenza A antibody titre between PTSD patients and control subjects before vaccination. The generated humoral and cellular immune response in PTSD patients argues against the hypothesis that combat-related PTSD in war veterans might affect protection following influenza vaccination.
Asunto(s)
Vacunas contra la Influenza/inmunología , Trastornos por Estrés Postraumático/inmunología , Adulto , Anticuerpos Antivirales/biosíntesis , Anticuerpos Antivirales/sangre , Linfocitos T CD8-positivos/inmunología , Femenino , Antígenos HLA-A/análisis , Antígeno HLA-A2 , Humanos , Inmunidad Celular , Virus de la Influenza A/inmunología , Virus de la Influenza B/inmunología , Masculino , Persona de Mediana Edad , Linfocitos T Citotóxicos/inmunología , Vacunación , VeteranosRESUMEN
AIM: To compare psychological, medical, and trauma-related variables in veterans with combat-related post-traumatic stress disorder (CR-PTSD) comorbid with depression and veterans with CR-PTSD only. METHOD: Out of 402 Croatian veterans recruited during expert evaluation for war-related compensation claims, 346 met the criteria for CR-PTSD: 97 for CR-PTSD only and 249 for PTSD comorbid with other diagnoses (77 comorbid with depression). To reach diagnosis, psychiatrists used clinical interview based on DSM-IV criteria, interview with family and friends, previous medical documentation, and Hamilton Rating Scales for Depression and Anxiety. An independent psychologist used a structured psychological interview, Mississippi CR-PTSD scale, Watson's PTSD criteria, Minnesota Multiphasic Personality Inventory-version 201, and trauma questionnaire based on the Harvard Questionnaire. RESULTS: Out of 402 soldiers, 13.9% did not meet the criteria for PTSD or other psychiatric diagnosis, 61.9% met the criteria for comorbid diagnoses, and 24.2% for PTSD only. The PTSD group with depression did not differ from PTSD-only group in combat experience, number of traumatic events, age, length of employment, sick leave, education, or marital status (chi-square test, p = 0.121-0.672). The two groups differed in pre-trauma factors, such as mental disturbances before combat experiences (p = 0.003), positive family history of psychiatric illness (p = 0.008), primary major depression (p = 0.012), and the number of hospital admissions (p = 0.002). CONCLUSION: Different assessment methods in expert examination of combat-experienced soldiers with PTSD for compensation-related purposes are needed to establish the final diagnosis and avoid possibility of factitious disorder or malingering. Combat ability assessment should include assessment of previous psychiatric disturbances of soldiers and their families.
Asunto(s)
Trastorno Depresivo/epidemiología , Trastornos por Estrés Postraumático/epidemiología , Veteranos/estadística & datos numéricos , Guerra , Adulto , Distribución por Edad , Comorbilidad , Croacia/epidemiología , Trastorno Depresivo/diagnóstico , Evaluación de la Discapacidad , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Probabilidad , Factores de Riesgo , Índice de Severidad de la Enfermedad , Trastornos por Estrés Postraumático/diagnósticoRESUMEN
AIM: To investigate the basic personality dimensions of the wives of alcoholics in comparison to the wives of non-alcoholics, and to compare these two groups according to psychiatric treatment frequency. METHOD: The group of alcoholics' wives (N=100) was compared to a group of non-alcoholics' wives (N=90). The groups were identical with respect to their age, working and marital status. Eysenck Personality Questionnaire was used for measuring the main personality dimensions. A structured psychiatric interview based on ICD-10 and DSM-III-R, and self-assessment of behavior before marriage (extraverted vs. introverted) were also used. RESULTS: The wives of alcoholics were less extraverted than the wives of non-alcoholics. There were no differences in neuroticism and psychoticism. According to the self-assessment of their behavior before marriage, wives of alcoholics also manifested less extraverted behavior before marriage. The wives of alcoholics were psychiatrically treated more often during their marriage than the wives of non-alcoholics. Moreover, the group of the wives of non-alcoholics had fewer psychiatric treatments during than before marriage. CONCLUSION: The wives of alcoholics were less extraverted than the wives of non-alcoholics, but they did not differ in two other main personality dimensions, neuroticism and psychoticism. More psychiatric treatments during marriage of the wives of alcoholics can be interpreted in accordance with the "stressed wife" theory.