24 A look at the textbook of psychiatry published by Gurevich and Sereyskiy25 in Moscow immediately after the war in 1946, at the height of Stalin’s power, shows the existence of a specific diagnostic label to classify posttraumatic disorders. The authors describe the “affective shock reactions” (affeklivno-shokovye reaktsii), a subtype of psychogenic reactions, that are observed

after wartime events, earthquakes, or railway accidents; these are Inhibitors,research,lifescience,medical characterized by acute (a few days) and subchronic (a few months) symptoms. These Russian authors tended to emphasize cardiovascular and vasomotor symptoms, which reminds us of Da Costa’s “irritable heart” in American Civil War soldiers. The literature on Holocaust and concentration camp survivors is too abundant to be summarized here. The best known of all the early works studying concentration camp survivors is probably the article published by Eitinger.26 In contrast to WWI, the course of symptoms over TAE684 order decades and their chronic nature were extensively studied in WWII survivors. For instance, Inhibitors,research,lifescience,medical in 1988, we studied27 a group of French civilians living in the AlsaceLorraine region who were conscripted into the German army and later Inhibitors,research,lifescience,medical held in captivity

in Russia. This population of Alsace-Lorraine was interesting because it was bilingual, French and German, and had cultural roots in both heritages. The analysis of 525 questionnaires showed that, after over four decades, 82% still experienced intrusive recollections and nightmares of their wartime captivity; 73% actively attempted to avoid thoughts or feelings associated

Inhibitors,research,lifescience,medical with the trauma; 71% reported a foreshortened sense of the future; and nearly 40% reported survivor guilt. Beyond PTSD, these survivors from Alsace-Lorraine also suffered lasting personality changes. We believe that an aggravating factor Inhibitors,research,lifescience,medical was the fact that these individuals returned home uncelebrated, embittered, psychologically isolated, and that they were caught in a web of psychological ambiguity. They had fought in the German army against their will and under the threat of their families being deported, and were considered unreliable by the Germans. They were surprised to be treated as German soldiers upon their capture by the Soviet army. They were repatriated to a new also post-war social environment in a French society that was itself plagued by the guilt of its early surrender to the Nazis, and they felt misunderstood by some of their countrymen who criticized their incorporation into the German military as a form of treason. The Vietnam war During the Vietnam war, the principles of treating psychiatric casualties in the forward area were successfully applied, with a correspondingly low level of acute psychiatric casualties (11.5 per 1000 men per year). In contrast, the incidence of alcoholism and drug abuse was high.