Prevalence of posttraumatic stress disorder in Veterans Affairs primary care clinics.

We examined whether combat-related PTSD was differentially associated with particular dimensions of anger on two multi-index, psychometric instruments and whether the proportion of variation in PTSD scores explained by anger was significantly greater than that by demographic and exposure variables. We also examined the reliability and validity of a subset of Mississippi Scale items as an anger measure. Participants were 143 Vietnam combat veterans. Anger accounted for over 40% of the variance in Mississippi PTSD scores (minus the anger items) above that associated with age, education, and combat exposure. Veterans with structured-interview–diagnosed PTSD were significantly differentiated from those without PTSD on all anger indices. The results point to anger treatment as a high priority for combat-related PTSD.

Anger and combat-related posttraumatic stress disorder

Apparent Symptom Overreporting in Combat Veterans Evaluated for PTSD

With a randomized group design, a 12-session anger treatment was evaluated with severely angry Vietnam War veterans suffering combat-related posttraumatic stress disorder (PTSD). Eight participants in anger treatment and 7 in a routine clinical care control condition completed multiple measures of anger control, anger reaction, and anger disposition, as well as measures of anxiety, depression, and PTSD at pre- and posttreatment. Controlling for pretreatment scores, significant effects were found on anger reaction and anger control measures but not on anger disposition or physiological measures. Eighteen-months follow-up (for both completers and dropouts) supported the posttreatment anger control findings. The challenges of treatment research with this refractory population are discussed.

Cognitive-behavioral treatment for severe anger in posttraumatic stress disorder

The authors examined interrelationships among posttraumatic stress disorder (PTSD) symptomatology, anger, and partner abuse perpetration among a sample of 60 combat veterans. Compared with PTSD-negative participants, PTSD-positive participants reported higher state anger across time and neutral and trauma prime conditions and higher anger reactivity during the trauma prime condition. PTSD-positive participants also exhibited more anger reactivity during the trauma prime than during the neutral condition. The same pattern of results was not found for anxiety reactivity during trauma memory activation. PTSD symptoms were associated with physical assault and psychological aggression perpetration, and trait anger mediated these relationships. Findings indicate a heightened anger response among PTSD-positive veterans and suggest the salience of dispositional components of anger in abuse perpetration in this population.

Posttraumatic Stress Disorder, Anger, and Partner Abuse Among Vietnam Combat Veterans

A needs assessment was conducted to determine the existence and extent of differences between Vietnam-era veterans and other veterans residing within the catchment area of the Northport Veterans Ad...

An assessment of the treatment needs of Vietnam-era veterans.

Basic eye care has been available at the Veterans Administration Medical Center (VAMC), Northport, NY, for the past 20 years. The demand for these services increased as the mission of this medical center was broadened to include major medical and surgery services. Increased migration of veterans to Long Island and their subsequent aging further increased the demand for eye-vision care. Originally, primary eye-vision care was provided independently by optometry and ophthalmology services. There was unnecessary duplication of equipment and inappropriate utilization of providers. Consequently, the services provided were quite limited in scope and sophistication. Both patients and providers became disenchanted with this practice mode. In December 1983, the administration of the Northport VAMC approved the establishment of a coordinated eye-vision care program that integrates ophthalmological and optometric services in a matrix structure. Since the program became operational in April 1984, patient satisfaction has increased, the working relationships between optometrists and ophthalmologists have improved, the ophthalmology residency program has been upgraded, and the combined staff productivity has increased.

Integrating ophthalmological and optometric services in a VA hospital program.

As an essential element of the comprehensive rehabilitation efforts at Northport VA Medical Center, and as a service whose demand is projected to increase substantially with the expanding proportion of aging veterans, eye/vision care has become increasingly important. As a result, the administration of the Medical Center decided to heed the suggestions of Congress and the Director of Optometry in VA Central Office and reorganize the delivery of eye/vision services so the ever-increasing demand could be met more rationally, efficiently and effectively. In this paper, the Northport VA Medical Center's Comprehensive Eye/Vision Program, including the residency program in rehabilitative optometry, will be described and the benefits of the reorganization will be discussed.

W. L. Hodson

Papers

An assessment of the treatment needs of Vietnam-era veterans.

Integrating ophthalmological and optometric services in a VA hospital program.

A comprehensive eye/vision program.

Marcel Proust 4: Proust au tournant des siècles, vol. 1, by Bernard Brun, Juliette Hassine (review)