Offer a holistic package of care including: medical, psychological and occupational health services. Medical screenings, travel health clinics and pharmacy. Pre-, during and post-deployment resilience briefings. Trauma, burnout and stress specialist support services. Training in stress and trauma awareness, resilience building, psychological first aid and peer support programmes.

Objective: Studies in nonhuman primates suggest that high levels of cortisol associated with stress have neurotoxic effects on the hippocampus, a brain structure involved in memory. The authors previously showed that patients with combat-related posttraumatic stress disorder (PTSD) had deficits in short-term memory. The purpose of this study was to compare the hippocampal volume of patients with PTSD to that of subjects without psychiatric disorder. Method: Magnetic resonance imaging was used to measure the volume of the hippocampus in 26 Vietnam combat veterans with PTSD and 22 comparison subjects selected to be similar to the patients in age, sex, race, years of education, socioeconomic status, body size, and years of alcohol abuse. Results: The PTSD patients had a statistically significant 8% smaller right hippocampal volume relative to that of the comparison subjects, but there was no difference in the volume of other brain regions (caudate and temporal lobe). Deficits in short-term verbal memory as measured with the Wechsler Memory Scale were associated with smaller right hippocampal volume in the PTSD patients only. Conclusions: These findings are consistent with a smaller right hippocampal volume in PTSD that is associated with functional deficits in verbal memory.

Exposure to stress has been associated with alterations in memory function, and we have previously shown deficits in short-term verbal memory in patients with a history of exposure to the stress of combat and the diagnosis of posttraumatic stress disorder (PTSD). Few studies of any kind have focused on adult survivors of childhood physical and sexual abuse. The purpose of this study was to investigate short-term memory function in adult survivors of childhood abuse. Adult survivors of severe childhood physical and sexual abuse (n = 21), as defined by specific criteria derived from the Early Trauma Inventory (ETI), who were presenting for psychiatric treatment were compared with healthy subjects (n = 20) matched for several variables including age, alcohol abuse, and years of education. All subjects were assessed with the Wechsler Memory Scale (WMS) Logical (verbal memory) and Figural (visual memory) components, the Verbal and Visual Selective Reminding Tests (SRT), and the Wechsler Adult Intelligence Scale-Revised (WAIS-R). Adult survivors of childhood abuse had significantly lower scores on the WMS Logical component for immediate and delayed recall in comparison to normal subjects, with no difference in visual memory, as measured by the WMS or the SRT, or IQ, as measured by the WAIS-R. Deficits in verbal memory, as measured by the WMS, were associated with the severity of abuse, as measured by a composite score on the ETI. Our findings suggest that childhood physical and sexual abuse is associated with long-term deficits in verbal short-term memory. These findings of specific deficits in verbal (and not visual) memory, with no change in IQ, are similar to the pattern of deficits that we have previously found in patients with combat-related PTSD.

OBJECTIVE:The purpose of this study was to compare the memory function of patients with posttraumatic stress disorder (PTSD) to that of matched comparison subjects.METHOD:Vietnam veterans with combat-related PTSD (N = 26) were compared to physically healthy comparison subjects (N = 15) matched for age, race, sex, years of education, handedness, socioeconomic status, and alcohol abuse. Memory and intelligence were assessed with a battery of neuropsychological tests, including the Russell revision of the Wechsler Memory Scale, the Selective Reminding Test, and subtests of the Wechsler Adult Intelligence Scale-Revised (WAIS-R).RESULTS:The PTSD patients scored significantly lower than the comparison subjects on the Wechsler Memory Scale logical memory measures for immediate recall (mean = 11.6, SD = 3.3 versus mean = 20.9, SD = 6.6) and delayed recall (mean = 8.0, SD = 3.3 versus mean = 17.8, SD = 6.4). The PTSD patients also scored significantly lower on the total recall, long-term storage, long-term retrieval, and delayed recall measures for the verbal component of the Selective Reminding Test and on the recall, long-term storage, long-term retrieval, and continuous long-term retrieval measures for the visual component of the Selective Reminding Test. There was no significant difference between the PTSD patients and comparison subjects in prorated full-scale IQ as measured by the WAIS-R.CONCLUSIONS:Patients with PTSD may have deficits in short-term memory. Counseling and rehabilitation that address these deficits may be of value for PTSD patients.

Magnetic resonance images (MRIs) were obtained from 25 patients with medically refractory epilepsy of temporal lobe origin (12 on the left, 13 on the right) and 14 right-handed control subjects. The hippocampi and temporal lobes were traced by computer on successive coronal images and the resulting measurements of area were summed for each region. The left and right hippocampi were symmetrical in the control subjects; however, for patients the hippocampus was smaller on the side of the seizure focus. Moreover, the left-right hippocampal ratio significantly differentiated the control subjects from each patient group. The left temporal lobe was significantly smaller than the right in control subjects. The epileptics' temporal lobes were smaller on the side of the seizure focus, compared to the temporal lobes in the control subjects. MRI hippocampal measurements were compared to hippocampal neuronal densities obtained postoperatively. Significant correlations were obtained between the ratio (side ipsilateral to focus/side contralateral to focus) of MRI hippocampal measurements and neuronal densities in all hippocampal subfields except CA2. Prior to surgery, patients were administered the Wechsler Memory Scale and the verbal Selective Reminding Test. Significant correlations existed between MRI measurements of the left hippocampus and the Wechsler logical memory percent retention scores and between the left temporal lobe measurements and the verbal Selective Reminding Test scores for patients with seizure foci in the left temporal lobe.