The Psychological Characteristics and Functional Magnetic Resonance Imaging Findings in Firefighters with Partial Posttraumatic Stress Disorder and the Effect of Treatment by Using Eye Movement Desensitization and Reprocessing

Yongho Chung; Nam Hee Kim; Daeho Kim; Jae Hyun Bae; Jun Soo Kwon; Joon Hwan Jang; Wi Hoon Jung; Seok Hyeon Kim; Jun Ki Kim; Dong Hoon Oh; Da-Jung Shin; Kang-Ik Cho

doi:10.4306/jknpa.2014.53.2.122

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Chung, Kim, Kim, Bae, Kwon, Jang, Jung, Kim, Kim, Oh, Shin, and Cho: The Psychological Characteristics and Functional Magnetic Resonance Imaging Findings in Firefighters with Partial Posttraumatic Stress Disorder and the Effect of Treatment by Using Eye Movement Desensitization and Reprocessing

Original Article

Journal of Korean Neuropsychiatric Association 2014; 53(2): 122-133.

Published online: 31 March 2014

DOI: https://doi.org/10.4306/jknpa.2014.53.2.122

The Psychological Characteristics and Functional Magnetic Resonance Imaging Findings in Firefighters with Partial Posttraumatic Stress Disorder and the Effect of Treatment by Using Eye Movement Desensitization and Reprocessing

Yongho Chung, MD¹, Nam Hee Kim, MD, PhD², Daeho Kim, MD, PhD³, Jae Hyun Bae, MA⁴, Jun Soo Kwon, MD, PhD⁵, Joon Hwan Jang, MD, PhD⁵, Wi Hoon Jung, PhD⁶, Seok Hyeon Kim, MD, PhD³, Jun Ki Kim, MD⁴, Dong Hoon Oh, MD, PhD³, Da-Jung Shin, BS⁷, Kang-Ik Cho, BS⁷

¹Department of Psychiatry, Seoul Metropolitan Eunpyeong Hospital, Seoul, Korea.

²Department of Psychiatry and Behavioral Sciences, Ajou University School of Medicine, Suwon, Korea.

³Department of Psychiatry, College of Medicine and Institute of Mental Health, Hanyang University, Seoul, Korea.

⁴Seoul EMDR Institute, Seoul, Korea.

⁵Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea.

⁶Clinical Cognitive Neuroscience Center, Neuroscience Institute, Seoul National University-Medical Research Center, Seoul, Korea.

⁷Department of Brain and Cognitive Sciences, College of Natural Sciences, Seoul National University, Seoul, Korea.

Address for correspondence: Nam Hee Kim, MD, PhD. Department of Psychiatry and Behavioral Sciences, Ajou University School of Medicine, 164 World cup-ro, Yeongtong-gu, Suwon 443-380, Korea. Tel +82-31-219-5180, Fax +82-31-219-5179, nadianam@gmail.com

Received 31 October 2013 Revised 16 January 2014 Accepted 29 January 2014

Abstract

Objectives

This study investigated the clinical characteristics and functional magnetic resonance imaging (fMRI) findings of firefighters suffering from partial posttraumatic stress disorder (partial PTSD). They were treated by eye movement desensitization and reprocessing (EMDR) and the treatment effect was evaluated.

Methods

A total of 116 firefighters were screened and 15 of them were diagnosed as partial PTSD. 1) We compared sociodemographic and psychological characteristics between the firefighter partial PTSD group and the firefighter control group. 2) Subjects in the firefighter partial PTSD group (n=10), firefighter control group (n=8), and general control group (n=12) underwent fMRI with traumatic, negative, positive, and neutral picture stimuli. We compared clinical characteristics and fMRI findings among these three groups. 3) Seven firefighters in the partial PTSD group were treated by EMDR and the treatment effect was evaluated according to psychological scales.

Results

In fMRI analysis, there was a left middle temporal/occipital activation in the order of the general control group, firefighter control group, than the firefighter partial PTSD group for the Traumatic-Baseline contrast. For the Negative-Baseline contrast, there was an increased left middle temporal/occipital activation in the general control group versus decreased activation in the firefighter control group and the firefighter partial PTSD group. All firefighters in the partial PTSD group treated by EMDR showed significant improvement of Clinician-Administered PTSD Scale scores.

Conclusion

These results show high incidence rate of partial PTSD in firefighters. In addition, partial PTSD firefighters exhibited distinct clinical characteristics and fMRI findings and showed significant improvement by EMDR treatment.

Keywords: Firefighters, Partial posttraumatic stress disorder, Functional magnetic resonance imaging, Occipital lobe, Temporal lobe, Eye movement desensitization and reprocessing

Figures and Tables

Fig. 1

Flow chart of firefighter control group, partial PTSD group, and general control group. LEC : Life Events Checklist, IES-R : Impact of Event Scale-Revise, PTSD : Posttraumatic stress disorder, fMRI : Functional magnetic resonance imaging, CAPS : Clinician-Administered PTSD Scale.

Fig. 2

The visual stimulation paradigm.

Fig. 3

A : Left middle occipital/temporal activation in the order of general control group, firefighter control group, than firefighter partial PTSD group for the Traumatic-Baseline contrast. B : Left middle temporal/occipital activation in the order of general control group, firefighter control group, than firefighter partial PTSD group for the Negative-Baseline contrast. ANOVA test. Statistical threshold, p<0.005 uncorrected and voxel threshold was 20. PTSD : Posttraumatic stress disorder, ANOVA : Analysis of variance.

Fig. 4

A : Regions demonstrating significantly greater activity in general control group than firefighter control group and firefighter partial PTSD group for the Traumatic-Baseline contrast. B : Regions demonstrating significantly greater activity in general control group than firefighter control group and firefighter partial PTSD group for the Negative-Baseline contrast. Post-hoc t-test. PTSD : Posttraumatic stress disorder.

Table 1

Sociodemographic and psychological characteristics of firefighters

IES-R : Impact of Event Scale-Revised

Table 2

Demographic and clinical characteristics of firefighter control and firefighter partial PTSD groups

Values are mean (±standard deviation). ^*: p<0.05. IES-R : Impact of Event Scale-Revised, LEC : Life Events Checklist, BDI : Beck Depression Inventory, DES-K : Dissociative Experiences Scale-Korean version, PTSD : Posttraumatic stress disorder

Table 3

Demographic and clinical characteristics of firefighter partial PTSD group, firefighter control group, and general control group

Values are mean (±standard deviation) or (number). ^*: p<0.05. IES-R : Impact of Event Scale-Revised, LEC : Life Events Checklist, BDI : Beck Depression Inventory, DES-K : Dissociative Experiences Scale-Korean version, PTSD : Posttraumatic stress disorder

Table 4

Regions demonstrating significantly greater activity in general control group than firefighter control group and firefighter partial PTSD group at post-hoc t-test

Statistical threshold, p<0.005 uncorrected and voxel threshold was 20. Each contrast inclusively masked with its ANOVA analysis. MNI : Montreal Neurological Institute, PTSD : Posttraumatic stress disorder, ANOVA : Analysis of variance

Notes

The authors have no financial conflicts of interest.

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