Malignant Post-Vietnam Stress Syndrome Revisited

Lambert, Monique; Hendrickse, William; Andrews, Rhys; Zelanko, J.; Fowler, D. Robert

doi:10.1097/00005053-199606000-00004

Cited by 9 publications

(8 citation statements)

References 18 publications

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“…The results of this study suggest that even within the population of help-seeking Vietnam combat veterans with PTSD, differences in symptom severity and adjustment are evident. These results provide partial support for the theoretical conceptualization of MPVSS, as outlined by Rosenheck (1984Rosenheck ( , 1985 and Lambert and his colleagues (Lambert et al, 1996). In particular, across subsamples, individuals in Cluster 2 differed from the other veterans with chronic PTSD in that they reported higher current levels of interpersonal violence and physical health problems.…”

Section: Discussionsupporting

confidence: 56%

“…

This study investigated whether a subgroup of veterans with malignant posttraumatic stress syndrome, as described by Rosenheck (1985) and Lambert et al (1996), could be identified via cluster analysis within two samples of Vietnam veterans with combat-related posttraumatic stress disorder (PTSD). In the initial subsample (n ϭ 157), four clusters were identified, including a subgroup that scored consistently higher on measures This study was supported by NCI P01-CA-81595.

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mentioning

confidence: 99%

“…Research investigating correlates of chronic PTSD in Vietnam veterans has typically presented mean scores across participants, and distinct clinical subgroups within this population have not been identified empirically. However, individual differences in veterans' responses to standard PTSD treatment have long been noted by clinicians (e.g., Lambert, Hendrickse, Andrews, Zelanko, & Fowler, 1996;Rosenheck, 1984Rosenheck, , 1985. Indeed, on the basis of his clinical experience with veterans, Rosenheck (1984Rosenheck ( , 1985 hypothesized that there was a subgroup of severely traumatized combat veterans who have a distinctly pathological clinical presentation, which he referred to as "malignant post-Vietnam stress syndrome" (MPVSS).…”

mentioning

confidence: 99%

“…Subsequently, Lambert and his colleagues (Lambert et al, 1996) updated Rosenheck's (1984Rosenheck's ( , 1985 theory by incorporating more recent clinical and research findings. Specifically, they noted that the concept of MPVSS overlaps with current conceptualizations of complex PTSD, as outlined by Herman (1992), in which PTSD symptoms, dissociation, and affect dysregulation are highly interrelated.…”

mentioning

confidence: 99%

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A cluster analysis of symptom patterns and adjustment in Vietnam combat veterans with chronic posttraumatic stress disorder

et al. 2002

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This study investigated whether a subgroup of veterans with malignant posttraumatic stress syndrome, as described by Rosenheck (1985) and Lambert et al. (1996), could be identified via cluster analysis within two samples of Vietnam veterans with combat-related posttraumatic stress disorder (PTSD). In the initial subsample (n = 157), four clusters were identified, including a subgroup that scored consistently higher on measures of interpersonal violence and current physical problems. Similar results were found in the cross-validation subsample (n = 156). These results provide support for the theoretical concept of malignant PTSD and suggest that veterans with chronic PTSD are not homogenous. Whereas some manifest extreme levels of both functional impairment and PTSD symptomatology, others exhibit markedly less functional impairment despite manifesting clinically significant levels of PTSD. Clinicians can consider this heterogeneity in their treatment decisions.

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Section: Discussionsupporting

confidence: 56%

“…

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mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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A cluster analysis of symptom patterns and adjustment in Vietnam combat veterans with chronic posttraumatic stress disorder

et al. 2002

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“…PTSD is a disorder that is notoriously difficult to treat 4,5,8 especially in the veteran population, 6,9 and treatment response in those with chronic PTSD is highly variable. In the last 10 years, several drug classes (ie, benzodiazepines, antidepressants, anticonvulsants, and antipsychotic agents) have been studied in the treatment of PTSD.…”

mentioning

confidence: 99%

A Placebo-Controlled Study of Nefazodone for the Treatment of Chronic Posttraumatic Stress Disorder

Davis¹,

Jewell²,

Ambrose³

et al. 2004

Journal of Clinical Psychopharmacology

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Nefazodone is a unique serotonergic antidepressant that acts as both a presynaptic serotonin reuptake inhibitor and a postsynaptic 5-hydroxytryptamine 2A receptor antagonist. Based on the positive results of open-label trials of nefazodone, including one from our group, we tested nefazodone's efficacy in the treatment of posttraumatic stress disorder (PTSD) under placebo-controlled conditions. Forty-one patients with chronic PTSD, predominantly male combat veterans, were enrolled in a randomized, double-blind, placebo-controlled 12-week trial of nefazodone. The primary outcome measure was the Clinician-Administered PTSD Scale. Fifteen patients were randomized to placebo and 26 were randomized to nefazodone. In a repeated-measures analysis of variance with last observation carried forward, patients on nefazodone showed a significant improvement in the percentage change of Clinician-Administered PTSD Scale Total score from baseline compared with those on placebo (P = 0.04; effect size = 0.6). Sample size was not powered to test group differences in the Clinician-Administered PTSD Scale criterion B, C, or D subscale. However, the criterion D subscale showed significant improvement in patients treated with nefazodone compared with those treated with placebo (P = 0.007). In addition, the Hamilton Rating Scale for Depression showed significant improvement compared with placebo (P = 0.008). The nefazodone group also reported an improvement on the PTSD Checklist (self-report scale; P = 0.08) and the Clinician-Administered Dissociative States Scale (P = 0.06). This pilot study supports the efficacy of nefazodone for the treatment of PTSD. However, larger placebo-controlled studies in more diverse patient population are warranted.

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Suicide risk factors among veterans: Risk management in the changing culture of the department of veterans affairs

Lambert

Fowler

1997

The Journal of Mental Health Administration

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Suicide risk management in the Department of Veterans Affairs (VA) health care system is particularly challenging because of both patient characteristics and aspects of the delivery system. The prototypical suicide-prone person is an older white male with alcoholism, depression, physical problems, and poor psychosocial support. This describes a large portion of the veteran patient population. Suicide risk factors that are common in VA patients include male gender, older age, diminished social environment support (exemplified by homelessness and unmarried status), availability and knowledge of firearms, and the prevalence of medical and psychiatric conditions associated with suicide. A variety of characteristics of the VA system complicate suicide management. Efforts under way to emphasize ambulatory care and decrease the VA culture of reliance on inpatient treatment heighten the importance of accurate suicide assessment. The authors recommend several strategies that VA administrators can consider for improving the assessment and management of veterans with long-term suicide risk factors.

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Malignant Post-Vietnam Stress Syndrome Revisited

Cited by 9 publications

References 18 publications

A cluster analysis of symptom patterns and adjustment in Vietnam combat veterans with chronic posttraumatic stress disorder

A cluster analysis of symptom patterns and adjustment in Vietnam combat veterans with chronic posttraumatic stress disorder

A Placebo-Controlled Study of Nefazodone for the Treatment of Chronic Posttraumatic Stress Disorder

Suicide risk factors among veterans: Risk management in the changing culture of the department of veterans affairs

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