The Austin and Repatriation Medical Centre in conjunction with the National Centre for War-related Post Traumatic Stress Disorder (PTSD) and the University of Melbourne has been conducting a series of research programs on Post-Traumatic Stress Disorder. The following is an update on the progress of research so far.

Dot probe study

A recent study conducted at the National Centre for PTSD investigated the way in which people pay attention to things around them. We thought that veterans with PTSD would he unable to ignore words associated with Vietnam. Even when asked to focus on something else, we thought that their attention would be drawn to Vietnam words. This is like walking down the street and seeing something out of the comer of your eye that reminds you of Vietnam - many veterans report that it is very hard to ignore something like that; their attention is drawn to the reminder. This is important, as it helps to explain why it is so hard to stop the memories from coming back.
To test this hypothesis1 veterans with and without PTSD were asked to look at a computer screen on which two words were displayed. One of these words was Vietnam-related and the other was neutral. The words then disappeared and were replaced by a dot where one of the words had been. Participants were asked to press a button as soon as they saw the dot. We thought that they would respond faster if the dot appeared in place of the word they were looking at. So1 if their attention was focussed on the Vietnam word, they would be faster if the dot appeared there than if it appeared in place of the neutral word.
As expected, we found that veterans with PTSD (as compared with those without (PTSD) were more likely to focus on Vietnam words than neutral words. Interestingly, however, it was not just Vietnam words; any threatening or frightening word showed the same effect for veterans with PTSD. This suggests that they were unable to prevent their attention being drawn to those words even when they were asked to do something else. It seems that this tendency to be always on the look-out for danger (which was very sensible in Vietnam) has persisted ever since and generalised to anything that might be dangerous. This is important, as it helps to explain why people with PTSD find it so difficult to block out memories of the trauma. It also helps us begin to understand some of 'the complex' mechanisms that may maintain the disorder.
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The Dissociation study

The term 'dissociation' refers to a range of experiences that people may have when they are slightly out of touch with present reality. Everyone has these in mild forms from time to time. Being totally engrossed in a film or book, or driving a familiar road and being unable to remember covering the last few miles, are common examples. Some people have these experiences more often and more severely than others. In such cases, there may he gaps in memory, distortions of time (passing very quickly or very slowly), feelings of unreality, the sensation of watching oneself from outside, and a range of other unusual experiences. Some people have suggested that there may be a link between dissociation and PTSD, while others disagree. We thought that there might be two types of PTSD, one characterised by high levels of dissociation (but lower anxiety) and the other by low dissociation and high anxiety.
To test this idea, we asked a group of veterans with and without PTSD to take part in a structured interview covering the symptoms of PTSD and dissociation, and to complete some questionnaires. We found that them was an association between some symptoms of PT'SD (intrusive memories and avoidance) and dissociation, but not between the anxiety symptoms of PTSD and dissociation. This provided partial support for our suggestion of two subtypes. However, we found also that a general tendency towards dissociation, as well as reported dissociation during Vietnam, were strong predictors of current PTSD. Thus, it may be that those individuals who have a tendency to dissociate are more vulnerable to the development of PTSD when they am exposed to trauma.
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Treatment study

Investigators: Mark Creamer, Tony McHugh, Glen Bates, John Reeves and Jackie Marcina Commencement Date: July 1996 Completion Date: May 1997 Participants: 33
Many relatively brief approaches to the treatment of PTSD are currently being proposed as potentially useful. We investigated three of these in a group of veterans with PTSD, and compared them to a group who received no treatment (waiting list control, or WLC). The three treatments were:
a) EMDR, individual sessions in which the veteran is asked to focus on the trauma and the thoughts that accompany it; eye movements are used to help "process" or modify the painful memories; b) Stress Management, administered in a group format, designed to help veterans control the unpleasant symptoms of PTSD directly; and c) writing therapy, also conducted in groups, in which veterans am asked to write about significant experiences before, during and after Vietnam to help come to tern's with what happened and to put their traumatic experiences into a more balanced perspective.
This research is still in progress and results are not available at this stage. However, preliminary data suggest that some people in each group improved, while others were not helped at all. If these trends are maintained in the final analysis, it will have important implications. That is, we will need to try to identify predictors - which type of treatment will work best for which veteran? We will then need to tailor treatment to the individual needs of each veteran, rather than providing the same treatment package to all. This is a very complex and difficult question that will take many years of research around the world, but perhaps this study will be an important contribution to the overall picture.
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PET study

One of the most disabling symptoms of PTSD, which also appears to be particularly resistant to treatment, is the disturbance of memory and concentration. There has been extensive investigation of the phenomenology and neurophysiology of traumatic memories in PTSD. To date, much of the work has focused on the evidence that people with PTSD have an abnormal pattern of response to reminders of the trauma. However, there has been relatively little investigation of how people with PTSD deal with everyday (neutral) environmental stimuli.
To gather information about the brain activity involved in attention and memory processing in PTSD, a number of sophisticated brain imaging techniques were employed. At the Austin Hospital in Melbourne, volunteers had a Positron Emission Tomography (PET) scan and a Magnetic Resonance Imaging (MRI) scan. The PET scan measures the changes in cerebral blood flow and the MRI scan looks at the anatomy of the brain. Whilst having the PET scan the volunteers were asked to complete a number of tasks involving memory and concentration. A computer screen placed in front of them flashed a sequence of blue and red coloured words. The participants indicated their responses by clicking a computer mouse placed under their right hand. The second part of the study involved flying to Adelaide and having an electroencephalogram (EEG) at Flinders University. Participants completed the same task done previously in Melbourne, with the EEG measuring changes in brain electrical activity.
At present, we have some preliminary information about the brain regions involved in attention and memory in a group of 10 PTSD subjects and another 8 controls. However, we are not in a position to formulate any conclusions about the study, as we are in the process of complicated data analyses. We hope to complete our analyses and publish our results to the international scientific community later this year.
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Naltrexone in the Treatment of Alcohol Dependence


A study of a new treatment for patients suffering from alcohol problems is being conducted at the National Centre for War-Related PTSD. The study involves testing how well a new drug treatment (Naltrexone) compares against placebo (an inactive tablet) in treating alcohol dependence. Naltrexone is a drug that acts as an opiate antagonist and has been used for many years in the treatment of narcotic addiction. It stops the action of drugs such as morphine and heroin by blocking the receptors for these drugs in the brain. By blocking these receptors, Naltrexone also blocks the effect of natural morphine like substances released by the brain when alcohol is consumed. These morphine like substances are thought to cause the pleasurable effects of alcohol. Therefore, Naltrexone works to reduce the pleasurable effects of alcohol and to cut down on alcohol craving. Research studies in the United States have shown that when Naltrexone was added to traditional alcohol rehabilitation treatment there were lower rates of alcohol craving, fewer drinking days and lower rates of alcohol relapse.
Since the study started at the National Centre in July 1996, more than 50 patients have been enrolled in the study and 25 have completed. A number of patients are still presently ongoing.
If you would like to know more about this treatment study, please contact Elizabeth Drummond, study co-ordinator at the National Centre for War-related PTSD on (03) 9 4964341 who would be very keen to discuss the details with you.
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Sleep study 1

Difficulty sleeping is one of the most common problems reported by veterans, yet surprisingly little is known about it. This study is the first stage of an extended program of research looking in detail of problems in veterans. Sleep questionnaires were distributed to VVAA sub-branches in Victoria and interstate.
Although this research is still in progress, preliminary analysis of the data suggests a relationship between the severity of PTSD and sleep disturbance. This study will have direct implications for our ability to provide effective treatment for sleeping difficulties.
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Sleep study 2

Little is known about the relationship between sleep and other PTSD symptoms. A preliminary postal survey has shown that 36% of Vietnam Veterans with PTSD sleep less than five hours a night. This would suggest that they are chronically sleep deprived.
One major distressing set of symptoms in PTSD consists of intrusive memories, sensations, and images, reliving of events and nightmares. Little is known about the relationship between these different sorts of re-experiencing phenomena or whether they are affected by sleep.
This study aims to verify the lack of sleep in 100 Vietnam Veterans with PTSD using a Sleep and Intrusive Log over a two week period. We also aim to examine the relationship between sleep length and daytime intrusive events and the relationship between different intrusive events.
We are currently refining our Sleep and Intrusive Log and will be starting the study in the next month.
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Sleep study 3

Disturbed sleep is a cardinal symptom of PTSD and there is some evidence that a reduction in sleep disturbance is associated with primary symptom reduction.
This study aims to assess the efficacy of two interventions for improving sleep among veterans with PTSD; namely1 I) a commercially available sleep retraining package that has shown some promise; and 2) a recently developed dream reprocessing therapy intervention which has been trailed with some success among US veterans with PTSD.
Both treatments are to be mn in groups and due to commence after completion of pre-treatment and further pre-treatment trial mg of the dream reprocessing therapy. The study is expected to start within the next 3 months
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Neuroendocrine Study of Chronic PTSD

In this study a number of blood collection, were taken over a period of a week. Participants were recruited from the PTSD inpatient program at the Repatriation campus of the Austin Repatriation Medical Centre, the Vietnam Veterans Association, the Vietnam Veterans Counseling, Service and the Returned Servicemen a League. Average age was 49 years, with 79% married and 57% employed. Fifty-eight percent experienced moderate or greater combat exposure.
Preliminary analysis of the data shows that the growth hormone response to clonidine is blunted in subjects with current high levels of PTSD symptoms. The prolactin response to d-fenfluramine is no different between veterans with and without chronic PTSD. All subjects showed suppression of cortisol by the 0.5 mg dose of dexamethasone. The patients with chronic PTSD suppressed cortisol as much but no more than non-PTSD) subjects.
The results suggest that central alpha adrenergic receptors are down-regulated in PTSD. The results do not support previous findings of dexamethasone super-suppression of cortisol in PTSD, thus questioning the presence of HPA axis dysregulation in this condition. Further analysis of the data is underway and publications based on these findings are planned.
Research publications are being prepared using the findings of each of the neuroendocrine tests and will be submitted by mid 1997.

A personal message from Jackie, affectionately (I think) known to some as "Vampire", or "Piglet"

I would like to take this opportunity of thanking all of those veterans who have helped by being a part of or actively recruiting for the above studies. It is very important to understand more about these complex disorders only by doing research will we be able 10 improve our strategies to help veterans of previous conflicts as well as those who are currently (and in the future) members of our armed forces
Research also has important implications for other populations who may be exposed to trauma such as emergency services workers and survivors of violent crime.
The National Centre for War-related PTSD is committed towards future research and would like to establish a register of people interested in being involved in future research.
Once again I would like to thank all the veterans who took part in the above studies. If you require any further information or clarification please do not hesitate to contact me on (03)94964330.
Jacqueline A Marcina (Soda) Research Coordinator

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