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      El trastorno por estrés post-traumático relacionado con el combate entre los veteranos croatas: modelos causales para grupos (clusters) de síntomas

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          Abstract

          Objetivos: Este estudio investiga el papel etiológico de los factores de riesgo premilitares, las condiciones de entrada en el ejército, las experiencias en zona de guerra, reacciones disociativas y el recibimiento al regreso al hogar en el desarrollo de grupos (clusters) de síntomas de trastorno por estrés postraumático (TEP) crónico entre los veteranos croatas. Métodos: Se seleccionó una muestra de 150 veteranos de guerra croatas con diagnóstico de TEP crónico relacionado con el combate que solicitaron tratamiento en el Departamento de Psiquiatría del Hospital Universitario de Osijek, Croacia, que proporcionaron los datos completos, para realizar este estudio entre los ex-soldados que solicitaron tratamiento (N = 192). Se utilizaron modelos de ecuaciones estructurales para desarrollar un modelo etiológico que estudiase las relaciones entre factores de riesgo premilitar, condiciones de entrada en el ejercito, experiencias en zona de guerra, reacciones disociativas, recibimiento al regreso al hogar y los grupos ("clusters") de síntomas presentes de TEP. Resultados: Se desarrollaron los modelos causales con satisfactorios ajuste y dimensiones. El análisis de resultados sugiere que, en los tres modelos estudiados, hay un diferente efecto etiológico de las variables estudiadas sobre los clusters de síntomas TEP. En los tres modelos estudiados, las experiencias en zona de guerra, la disociación peritraumática y el recibimiento al regreso al hogar, tienen un mayor efecto etiológico primario que el derivado de los factores de riesgo premilitares y las condiciones de entrada en el ejército. En ocasiones, se observa un mayor efecto etiológico de los factores de riesgo premilitares en los modelos causales para los síntomas de evitación y las condiciones de entrada en el ejército en los modelos causales para el cluster de activación. Conclusiones: Los resultados pueden apoyar la hipótesis del estudio de que todos los síntomas de TEP no tienen la misma etiología, y que existe una jerarquización de influencia etiológica diferente entre las variables estudiadas en los tres modelos desarrollados de clusters de síntomas de TEP.

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          Peritraumatic dissociation and posttraumatic stress in male Vietnam theater veterans.

          The aim of this study was to determine the reliability and validity of a proposed measure of peritraumatic dissociation and, as part of that effort, to determine the relationship between dissociative experiences during disturbing combat trauma and the subsequent development of posttraumatic stress disorder (PTSD). A total of 251 male Vietnam theater veterans from the Clinical Examination Component of the National Vietnam Veterans Readjustment Study were examined to determine the relationship of war zone stress exposure, retrospective reports of dissociation during the most disturbing combat trauma events, and general dissociative tendencies with PTSD case determination. The total score on the Peritraumatic Dissociation Experiences Questionnaire--Rater Version was strongly associated with level of posttraumatic stress symptoms, level of stress exposure, and general dissociative tendencies and weakly associated with general psychopathology scales from the MMPI-2. Logistic regression analyses supported the incremental value of dissociation during trauma, over and above the contributions of level of war zone stress exposure and general dissociative tendencies, in accounting for PTSD case determination. These results provide support for the reliability and validity of the Peritraumatic Dissociation Experiences Questionnaire--Rater Version and for a trauma-dissociation linkage hypothesis: the greater the dissociation during traumatic stress exposure, the greater the likelihood of meeting criteria for current PTSD.
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            Disintegrated experience: the dissociative disorders revisited.

            We present proposed changes to the dissociative disorders section of the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders and review the concept of pathological and nonpathological dissociation, including empirical findings on the relations between trauma and dissociative phenomenology and between dissociation and hypnosis. The most important proposals include the creation of two new diagnostic entities, brief reactive dissociative disorder and transient dissociative disturbance, and the readoption of the criterion of amnesia for a multiple personality disorder diagnosis. We conclude that further work on dissociative processes will provide an important link between clinical and experimental approaches to human cognition, emotion, and personality.
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              The dose-effect relationships between torture and psychiatric symptoms in Vietnamese ex-political detainees and a comparison group.

              The purpose of this study was to determine in Vietnamese ex-political detainees newly arrived into the United States a) the prevalence of torture and psychiatric symptoms and b) the dose-effect relationships between cumulative torture experience and the psychiatric symptoms of posttraumatic stress disorder (PTSD) and major depression. The study population included Vietnamese ex-political detainees (N = 51) and a comparison group (N = 22). All respondents received culturally validated instruments with known psychometric properties including Vietnamese versions of the Hopkins Symptom Checklist-25 and the Harvard Trauma Questionnaire. The ex-political detainees, in contrast to the comparison group, had experienced more torture events (12.2 SD = 4.2 vs. 2.6 SD = 3.1) and had higher rates of PTSD (90% vs. 79%) and depression (49% vs. 15%). Dose-effect relationships between cumulative torture experience and psychiatric symptoms were positive with the PTSD subcategory of "increased arousal" revealing the strongest association. These findings provide evidence that torture is associated with psychiatric morbidity in Vietnamese refugees. The demonstration of significant dose-effect responses supports the hypothesis that torture is a major risk factor in the etiology of major depression and PTSD. The generalizability of these results to other torture survivor groups is unknown. The interaction between torture and other pre- and post-migration risk factors over time in different cultural settings still needs to be examined.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                ejp
                The European journal of psychiatry (edición en español)
                Eur. J. Psychiat. (Ed. esp.)
                Universidad de Zaragoza (, , Spain )
                1579-699X
                December 2004
                : 18
                : 4
                : 197-209
                Affiliations
                [01] orgnameUniversity Hospital Osijek
                [02] orgnameUniversity School of Medicine orgdiv1Department of Psychiatry CROATIA
                Article
                S1579-699X2004000400001
                63b6dd13-9330-45e6-bc9c-29d2089e0824

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

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                Figures: 0, Tables: 0, Equations: 0, References: 40, Pages: 13
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                SciELO Spain


                Grupos (clusters) de síntomas del TEP,Etiología,Modelos causales,Veteranos de guerra croatas

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