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Neurologic Soft Signs in Chronic Posttraumatic Stress Disorder
Tamara V. Gurvits, MD, PhD;
Mark W. Gilbertson, PhD;
Natasha B. Lasko, PhD;
Alexandra S. Tarhan, MD, PhD;
Daphne Simeon, MD;
Michael L. Macklin, BA;
Scott P. Orr, PhD;
Roger K. Pitman, MD
Arch Gen Psychiatry. 2000;57:181-186.
Background Subtle neurologic impairment has been reported in several mental disorders. The goals of the present study were to evaluate neurologic status in patients of both sexes with chronic posttraumatic stress disorder (PTSD) from different traumatic experiences.
Methods Twenty-one adult women who were sexually abused as children (12 with PTSD, 9 without) and 38 male Vietnam War combat veterans (23 with PTSD, 15 without) underwent examination for 41 neurologic soft signs, which were scored by the examiner as well as a blind rater observing videotapes. Subject history was obtained with special attention to neurodevelopmental problems. Psychometrics included the Wender Utah Rating Scale for symptoms of childhood attention-deficit/hyperactivity disorder and the Michigan Alcoholism Screening Test. Veterans also completed the Combat Exposure Scale and subtests of the Wechsler Adult Intelligence Scale–Revised.
Results Average neurologic soft sign scores (interrater reliability = 0.74) of women with PTSD owing to sexual abuse in childhood (mean [SD], 0.77 [0.32]) and veteran men (0.72 [0.20]) with combat-related PTSD were comparable and significantly (P<.001) higher than those of women sexually abused as children (0.42 [0.10]) and combat veteran men (0.43 [0.17]) without PTSD. This effect could not be explained by a history of alcoholism or head injury. Subjects with PTSD reported more neurodevelopmental problems and more childhood attention-deficit/hyperactivity disorder symptoms and had lower IQs, all of which were significantly correlated with neurologic soft signs.
Conclusion Neurologic compromise is evident from subject history and findings from physical examination in both women and men with chronic PTSD who had experienced different kinds of traumatic events in childhood and adulthood.
From the Veterans Affairs Medical Center, Manchester, NH, and the Department of Psychiatry, Harvard Medical School, Boston, Mass (Drs Gurvits, Gilbertson, Lasko, Orr, and Pitman and Mr Macklin); the Bekhterev Psychoneurological Research Institute, St Petersburg, Russia (Dr Tarhan); and the Department of Psychiatry, Mt Sinai School of Medicine, New York, NY (Dr Simeon).
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