Managing Menopause: The Evolving Role of Estrogens, Selective Serotonin Reuptake Inhibitors, and Phytoestrogens in Balancing Hormonal Fluctuations.

Menopause is characterized by the cessation of menstruation for 12 consecutive months. In this narrative review, we describe the transitional stages of menopause, clinical presentation, pharmacological management of symptoms, and effects on fluctuating hormone levels. To standardize the stages of menopause, the Stages of Reproductive Aging Workshop + 10 (STRAW+10) system was designed with five distinct categories corresponding to symptom presentation and numerical years.

Risdiplam for the Use of Spinal Muscular Atrophy.

Spinal muscular atrophy (SMA) is one of the leading causes of death in infants related to the degeneration of neurons. Currently, there are no curative treatment options for SMA, and many options available may not be feasible. This review presents the background, clinical studies, and indications for the use of Risdiplam in treating SMA.

Using an implicit memory task to estimate premorbid memory.

Clinicians are often asked to determine if significant memory loss has occurred. Clinical judgment figures prominently in making these determinations, because there is no accepted, objective method for estimating premorbid memory. Two studies were designed to explore the utility of an implicit memory task, Anagrams Solutions, for estimating premorbid memory ability.

Utility of the RBANS in detecting cognitive impairment associated with Alzheimer's disease: sensitivity, specificity, and positive and negative predictive powers.

Although initially developed as a brief dementia battery, the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) has not yet demonstrated its sensitivity, specificity, and positive and negative predictive powers in detecting cognitive impairment in patients with Alzheimer's disease (AD). Therefore, the current study examined the clinical utility of the RBANS by comparing two age-, education-, and gender-matched groups: patients with AD (n=69) and comparators (n=69). Significant differences (p<0.

Early symptom predictors of chronic distress in Gulf War veterans.

Although there is evidence that specific early hyperarousal, avoidance, and emotional numbing symptoms are associated with later posttraumatic stress disorder (PTSD) symptomatology among veterans, little is known about predictors of later non-PTSD-related psychological symptoms. One and 2 years after serving in the Gulf War, 348 military reservists were assessed for severity of war zone stress, PTSD, psychological distress, and stress-mediated physical complaints. Overall PTSD symptomatology and emotional numbing and hyperarousal symptom clusters increased over time, whereas re-experiencing and avoidance symptoms showed no change.

Olfactory functioning in Gulf War-era veterans: relationships to war-zone duty, self-reported hazards exposures, and psychological distress.

To explore possible neurotoxic sequelae of Gulf War (GW) participation, olfactory identification performance, neurocognitive functioning, health perceptions, and emotional distress were assessed in 72 veterans deployed to the GW and 33 military personnel activated during the GW but not deployed to the war zone. Findings revealed that war-zone-exposed veterans reported more concerns about health, cognitive functioning, and depression than did their counterparts who did not see war-zone duty. There was no evidence that performances on olfactory or neurocognitive measures were related to war-zone duty or to self-reported exposure to GW toxicants.

Attention, learning, and memory performances and intellectual resources in Vietnam veterans: PTSD and no disorder comparisons.

Attention, learning, memory, and estimated intellectual potential were examined in 26 Vietnam veterans diagnosed with posttraumatic stress disorder (PTSD) and in 21 Vietnam veterans without mental disorders. Results revealed PTSD-associated cognitive deficits on tasks of sustained attention, working memory, initial learning, and estimated premorbid intelligence but not on measures of focus of attention, shift of attention, or memory savings. Cognitive task performances adjusted for estimated native intelligence remained negatively correlated with PTSD severity.

Neuropsychological function in Gulf War veterans: relationships to self-reported toxicant exposures.

Background: The present study was aimed at (1) exploring evidence of central nervous system (CNS) dysfunction among Gulf War (GW) veterans on neuropsychological tests and (2) examining whether performance on neuropsychological tests was related to specific neurotoxicant exposures experienced in the Gulf.

Methods: The GW-deployed groups were selected using stratified random sampling methods from two distinct cohorts of GW veterans. A comparison group that had been called up for GW service but deployed to Germany rather than the Gulf also was examined.

War zone stress, personal and environmental resources, and PTSD symptoms in Gulf War veterans: a longitudinal perspective.

Cross-sectional research has demonstrated a link between personal and environmental resources and development of emotional distress after war zone service. Less is known about the longitudinal relationship between resources and distress. The authors addressed this issue in a study of 348 Gulf War returnees tested at 2 time points.

Olfactory identification in combat-related posttraumatic stress disorder.

Recent neuropsychological conceptualizations of posttraumatic stress disorder (PTSD) implicate dysfunction of the fronto-limbic system, a brain system thought to be involved in the mediation of emotion. However, few studies have examined fronto-limbic subregions, such as the orbitofrontal cortex, in PTSD. As a measure of orbitofrontal integrity, olfactory identification was assessed in 26 Vietnam War veterans with PTSD, 25 Vietnam War veterans without mental disorders, and 17 Vietnam-era, non-war-zone veterans without mental disorders.

Relationship of psychiatric status to Gulf War veterans' health problems.

Objective: A growing body of research has shown that there are important links between certain psychiatric disorders and health symptom reporting. Two disorders in particular (posttraumatic stress disorder (PTSD) and major depression) have been the most widely implicated to date, and this association has sometimes been used to explain the occurrence of ill-defined medical problems and increased somatic symptoms in certain groups, most recently Gulf War veterans.

Methods: Structured psychiatric diagnostic interviews were used to examine the presence of major psychiatric (axis I) disorders and their relation to health symptom reporting in a well-characterized, stratified subset of Gulf War veterans and a non-Gulf-deployed veteran comparison group.

Health status of Persian Gulf War veterans: self-reported symptoms, environmental exposures and the effect of stress.

Background: Most US troops returned home from the Persian Gulf War (PGW) by Spring 1991 and many began reporting increased health symptoms and medical problems soon after. This investigation examines the relationships between several Gulf-service environmental exposures and health symptom reporting, and the role of traumatic psychological stress on the exposure-health symptom relationships.

Methods: Stratified, random samples of two cohorts of PGW veterans, from the New England area (n = 220) and from the New Orleans area (n = 71), were selected from larger cohorts being followed longitudinally since arrival home from the Gulf.

Attention and memory dysfunction in posttraumatic stress disorder.

Attention and memory performances were studied in Persian Gulf War veterans with and without posttraumatic stress disorder (PTSD) diagnoses. Veterans diagnosed with PTSD showed relative performance deficiencies on tasks of sustained attention, mental manipulation, initial acquisition of information, and retroactive interference. Their performances were also characterized by errors of commission and intrusion.

War zone stress, personal resources, and PTSD in Persian Gulf War returnees.

Posttraumatic stress disorder (PTSD) can occur subsequent to war stress, but not all troops are negatively affected. A discriminant function model was used to study associations between personal and environmental resources and psychological outcomes subsequent to war zone stress. Among 775 Persian Gulf War exposed troops, 2 subsets were identified: 97 with PTSD diagnoses and 484 who had no psychological distress.

Assessment of psychological distress in Persian Gulf troops: ethnicity and gender comparisons.

This study reports results of psychological assessment among military participants in Operation Desert Storm, a more diverse ethnic and gender mix of American troops than has been mobilized for previous military operations. Symptoms of current psychological distress, including negative mood states, somatic complaints, and posttraumatic stress disorder, in addition to personal and trauma characteristics, were measured in 653 Persian Gulf war-zone-exposed and 259 stateside-duty troops to test the hypothesis that ethnic minority status and female gender are associated with greater levels of psychological distress following war-zone duty. Findings point to potentially negative sequelae to war-zone stress in a portion of troops and suggest that ethnic minorities, but not necessarily women, may be more vulnerable to psychological risk.

Psychopathology in war-zone deployed and nondeployed Operation Desert Storm troops assigned graves registration duties.

Early psychopathology outcomes were compared in troops mobilized for Persian Gulf graves registration duty but differentiated by war-zone deployment. Constructs of interest were Axis I psychiatric disorders, particularly posttraumatic stress disorder (PTSD), negative affect states, and somatic complaints. Psychometric instruments, including the Structured Clinical Interview for DSM-III-R, were administered to troops attending drill exercises.

Psychological symptoms and psychiatric diagnoses in Operation Desert Storm troops serving Graves registration duty.

This clinical report describes symptoms of psychological and physical distress and psychiatric disorders in 24 Army Reservists who served war zone graves registration duty in support of Operation Desert Storm. Troops underwent comprehensive assessment for evidence of psychopathology that might be associated with war zone duty as one component of a debriefing protocol scheduled during regular drill exercises eight months after their return to the United States. Troops endorsed items suggestive of high war zone stress exposure, common symptoms of anxiety, anger, and depression, and multiple health and somatic concerns.

Psychopathy: traditional and clinical antisocial concepts.

Advances in our knowledge about the concept of psychopathy and the repeated occurrence of antisocial behaviors in the face of adversity and punishment have been limited by a complex interplay of conceptual and methodological issues that have not yet been addressed adequately by psychosocial scientists. Foremost among the problems facing clinicians and researchers interested in this topic is the lack of agreement on the meaning and labelling of the construct. Scholars have not reached consensus in describing a category within a diagnostic system that distinguishes a relatively homogeneous group of individuals sharing a set of characteristics, or a class of persons that can be identified reliably from those who exhibit other perhaps closely related behavioral abnormalities and so-called normal individuals.

Psychopathology and psychiatric diagnoses of World War II Pacific theater prisoner of war survivors and combat veterans.

Objective: This study assessed current and long-term psychological and psychiatric sequelae of war trauma in World War II Pacific theater combat veterans, some of whom had been Japanese prisoners of war (POWs).

Method: A group of 36 POW survivors and a group of 29 combat veterans, all of whom had seen fierce fighting and heavy unit casualties, were compared approximately 40 years later on psychological instruments assessing psychopathology constructs, negative mood states, and symptoms of posttraumatic stress disorder (PTSD) and on the computer-administered National Institute of Mental Health Diagnostic Interview Schedule.

Results: Although similar in personal backgrounds and in having suffered catastrophic war trauma, the two groups differed in the severity and type of psychiatric symptoms and in the occurrence of psychiatric disorders.

Memory and learning performances in POW survivors with history of malnutrition and combat veteran controls.

Former prisoners of war (POWs) with histories of malnutrition and body wasting were compared on standardized measures of memory and learning with POW survivors who sustained less confinement body weight loss and combat veterans of similar ages and military assignments. Results showed that POWs who sustained the greatest degree of trauma-induced weight loss, or that exceeding 35% of their precaptivity body weights, performed significantly worse on four of the five Wechsler Memory Scale /3-Revised (WMS-R) indices, showed more rapid rates of forgetting on the Visual Reproduction test, and exhibited slower acquisition rates and less sophisticated mastery of the learning materials on a modified version of the Rey Auditory Verbal Learning Test (AVLT). Given their relatively intact performances on measures of general intelligence and attention-concentration, the POWs with a history of severe malnutrition appeared to evidence a pattern of cognitive limitations qualitatively similar to that associated with alcoholic Korsakoff's syndrome.

MMPI profiles of veterans of WWII and Korea: comparisons of former POWs and combat survivors.

MMPI profile patterns were compared between combat veteran groups of 168 POW survivors and 67 servicemen who were not war captives in WWII and the Korean Conflict. Results confirm previous reports that the scales, Hypochondriasis (Hs), Depression (D), and Hysteria (Hy), are characteristically elevated among former POWs. Findings also point to the contribution of scales, Psychasthenia (Pt), Paranoia (Pa), and Ego Strength (Es), in differentiating groups, suggesting that negative ruminations, heightened anxiety, interpersonal anger and suspiciousness, and low self-esteem contribute significantly to group differentiation.

Cognitive deficits and psychopathology among former prisoners of war and combat veterans of the Korean conflict.

Objective: This study was conducted to describe the long-term psychological and psychiatric sequelae of prisoner of war (POW) confinement against the backdrop of psychiatric evaluations of Korean conflict repatriates more than 35 years ago.

Method: A group of 22 POWs and a group of 22 combat veteran survivors of the Korean conflict were compared on measures of problem solving, personality characteristics, mood states, and psychiatric clinical diagnoses by means of a battery of psychometric instruments and structured clinical interviews.

Results: Although the two groups were similar in background and personal characteristics, they differed in reports of life adjustment problems, complaints of physical distress, proficiency on cognitive tests, objectively measured personality characteristics, and assigned psychiatric diagnoses.

Trauma-induced weight loss and cognitive deficits among former prisoners of war.

Former prisoners of war (POWs) from the Korean Conflict and WWII reporting confinement weight losses of greater than 35% (n = 60) and less than or equal to 35% (n = 113) and non-POW combat veterans (n = 50) were compared on WAIS-R and Wechsler Memory Scale (WMS) Logical Memory indices. High weight-loss POWs performed more poorly than combat veterans on Performance IQ, Arithmetic, Similarities, and Picture Completion subtests, Witkin-Goodenough Attention-Concentration Factor, and WMS Immediate and Delayed Recall and more poorly than low weight-loss POWs on Arithmetic, Attention-Concentration Factor, and the WMS immediate memory measure. Low weight-loss POWs and combat veterans differed only on WMS immediate memory.