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Marx BP, Rothbaum BO, Vermetten E. What I was thinking/what I would do differently: Technology-enabled traumatic stress support. J Trauma Stress 2024. [PMID: 39137153 DOI: 10.1002/jts.23095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Revised: 07/08/2024] [Accepted: 07/08/2024] [Indexed: 08/15/2024]
Abstract
At the 39th meeting of the International Society of Traumatic Stress Studies, three leading researchers and clinicians in technology-enabled traumatic stress support were invited to reflect on their careers and contributions to the field. Dr. Brian P. Marx has led the development of large-scale technologies to screen, assess, and treat traumatic stress pathology across diverse etiologies and needs. Dr. Barbara O. Rothbaum, a pioneer in the development of virtual reality for exposure therapy, has demonstrated the efficacy and scalability of digital treatment for traumatic stress. Retired Col. Dr. Eric Vermetten has worked extensively on the intersection of basic mechanisms, novel psychological and biological treatment, and technology for scalable assessment and treatment, primarily in military and mass casualty contexts. The panelists were asked to reflect on their initial ambitions, concerns, unexpected challenges, and the influence of their work on new research trajectories. Their insights provide valuable lessons about the process and content of their work, and their pioneering efforts have significantly advanced the field of technology-enabled traumatic stress support.
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Affiliation(s)
- Brian P Marx
- National Center for PTSD at VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Barabara O Rothbaum
- Department of Psychiatry and Behavioral Sciences, Emory School of Medicine, Atlanta, Georgia, USA
- Atlanta VA Medical Center, Atlanta, Georgia, USA
| | - Eric Vermetten
- Department of Psychiatry, Leiden University, Leiden, the Netherlands
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2
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Norred MA, Zuschlag ZD, Hamner MB. A Neuroanatomic and Pathophysiologic Framework for Novel Pharmacological Approaches to the Treatment of Post-traumatic Stress Disorder. Drugs 2024; 84:149-164. [PMID: 38413493 DOI: 10.1007/s40265-023-01983-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 02/29/2024]
Abstract
Post-traumatic stress disorder (PTSD) is a debilitating disorder inflicting high degrees of symptomatic and socioeconomic burdens. The development of PTSD results from a cascade of events with contributions from multiple processes and the underlying pathophysiology is complex, involving neurotransmitters, neurocircuitry, and neuroanatomical pathways. Presently, only two medications are US FDA-approved for the treatment of PTSD, both selective serotonin reuptake inhibitors (SSRIs). However, the complex underlying pathophysiology suggests a number of alternative pathways and mechanisms that may be targets for potential drug development. Indeed, investigations and drug development are proceeding in a number of these alternative, non-serotonergic pathways in an effort to improve the management of PTSD. In this manuscript, the authors introduce novel and emerging treatments for PTSD, including drugs in various stages of development and clinical testing (BI 1358894, BNC-210, PRAX-114, JZP-150, LU AG06466, NYV-783, PH-94B, SRX246, TNX-102), established agents and known compounds being investigated for their utility in PTSD (brexpiprazole, cannabidiol, doxasoin, ganaxolone, intranasal neuropeptide Y, intranasal oxytocin, tianeptine oxalate, verucerfont), and emerging psychedelic interventions (ketamine, MDMA-assisted psychotherapy, psilocybin-assisted psychotherapy), with an aim to examine and integrate these agents into the underlying pathophysiological frameworks of trauma-related disorders.
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Affiliation(s)
- Michael A Norred
- Mental Health and Behavioral Sciences Service, James A. Haley Veterans Hospital, Tampa, FL, USA
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA
| | - Zachary D Zuschlag
- Mental Health and Behavioral Sciences Service, James A. Haley Veterans Hospital, Tampa, FL, USA
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA
| | - Mark B Hamner
- Behavioral Health Service, Ralph H. Johnson VA Medical Center, 109 Bee Street, Charleston, SC, 29401, USA.
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.
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3
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Liberati AS, Perrotta G. Neuroanatomical and functional correlates in post-traumatic stress disorder: A narrative review. IBRAIN 2024; 10:46-58. [PMID: 38682011 PMCID: PMC11045199 DOI: 10.1002/ibra.12147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 12/27/2023] [Accepted: 01/03/2024] [Indexed: 05/01/2024]
Abstract
Post-traumatic stress disorder (PTSD), currently included by the Diagnostic and Statistical of Mental Disorders, Fifth Edition, Text Revision in the macro-category "disorders related to traumatic and stressful events", is a severe mental distress that arises acutely as a result of direct or indirect exposure to severely stressful and traumatic events. A large body of literature is available on the psychological and behavioral manifestations of PTSD; however, with regard to the more purely neuropsychological aspects of the disorder, they are still the subject of research and need greater clarity, although the roles of the thalamus, hypothalamus, amygdala, cingulate gyrus, cerebellum, locus coeruleus, and hippocampus in the onset of the disorder's characteristic symptoms have already been elucidated.
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Affiliation(s)
- Anna S. Liberati
- Faculty of PsychologyInternational Telematic University “Uninettuno”RomeItaly
- Department of the Psychological SciencesForensic Science Academy (F.S.A.)SalernoItaly
| | - Giulio Perrotta
- Department of the Psychological SciencesForensic Science Academy (F.S.A.)SalernoItaly
- Department of the Strategic PsychotherapyInstitute for the Study of Psychotherapies (I.S.P.)RomeItaly
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4
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Gonda X, Dome P, Erdelyi-Hamza B, Krause S, Elek LP, Sharma SR, Tarazi FI. Invisible wounds: Suturing the gap between the neurobiology, conventional and emerging therapies for posttraumatic stress disorder. Eur Neuropsychopharmacol 2022; 61:17-29. [PMID: 35716404 DOI: 10.1016/j.euroneuro.2022.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 05/19/2022] [Accepted: 05/20/2022] [Indexed: 11/26/2022]
Abstract
A sharp increase in the prevalence of neuropsychiatric disorders, including major depression, anxiety, substance use disorders and posttraumatic stress disorder (PTSD) has occurred due to the traumatic nature of the persisting COVID-19 global pandemic. PTSD is estimated to occur in up to 25% of individuals following exposure to acute or chronic trauma, and the pandemic has inflicted both forms of trauma on much of the population through both direct physiological attack as well as an inherent upheaval to our sense of safety. However, despite significant advances in our ability to define and apprehend the effects of traumatic events, the neurobiology and neuroanatomical circuitry of PTSD, one of the most severe consequences of traumatic exposure, remains poorly understood. Furthermore, the current psychotherapies or pharmacological options for treatment have limited efficacy, durability, and low adherence rates. Consequently, there is a great need to better understand the neurobiology and neuroanatomy of PTSD and develop novel therapies that extend beyond the current limited treatments. This review summarizes the neurobiological and neuroanatomical underpinnings of PTSD and discusses the conventional and emerging psychotherapies, pharmacological and combined psychopharmacological therapies, including the use of psychedelic-assisted psychotherapies and neuromodulatory interventions, for the improved treatment of PTSD and the potential for their wider applications in other neuropsychiatric disorders resulting from traumatic exposure.
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Affiliation(s)
- Xenia Gonda
- Department of Psychiatry and Psychotherapy, Semmelweis University, Hungary; NAP-2-SE New Antidepressant Target Research Group, Semmelweis University, Hungary; International Centre for Education and Research in Neuropsychiatry, Samara State Medical University, Russia.
| | - Peter Dome
- Department of Psychiatry and Psychotherapy, Semmelweis University, Hungary; National Institute of Mental Health, Neurology and Neurosurgery - Nyiro Gyula Hospital, Hungary
| | - Berta Erdelyi-Hamza
- Department of Psychiatry and Psychotherapy, Semmelweis University, Hungary; Doctoral School of Mental Health Sciences, Semmelweis University, Hungary
| | - Sandor Krause
- National Institute of Mental Health, Neurology and Neurosurgery - Nyiro Gyula Hospital, Hungary; Doctoral School of Mental Health Sciences, Semmelweis University, Hungary; Department of Pharmacodynamics, Semmelweis University, Hungary
| | - Livia Priyanka Elek
- Department of Psychiatry and Psychotherapy, Semmelweis University, Hungary; Department of Clinical Psychology, Semmelweis University, Hungary
| | - Samata R Sharma
- Department of Psychiatry, Harvard Medical School, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Frank I Tarazi
- Department of Psychiatry and Neuroscience, Harvard Medical School, McLean Hospital, Belmont, MA 02478, USA
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5
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Ventura R, Cabib S, Babicola L, Andolina D, Di Segni M, Orsini C. Interactions Between Experience, Genotype and Sex in the Development of Individual Coping Strategies. Front Behav Neurosci 2022; 15:785739. [PMID: 34987364 PMCID: PMC8721137 DOI: 10.3389/fnbeh.2021.785739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 11/29/2021] [Indexed: 02/01/2023] Open
Abstract
Coping strategies, the first line of defense against adversities, develop through experience. There is consistent evidence that both genotype and sex contribute to the development of dysfunctional coping, leading to maladaptive outcomes of adverse experiences or to adaptive coping that fosters rapid recovery even from severe stress. However, how these factors interact to influence the development of individual coping strategies is just starting to be investigated. In the following review, we will consider evidence that experience, sex, and genotype influence the brain circuits and neurobiological processes involved in coping with adversities and discuss recent results pointing to the specific effects of the interaction between early experiences, genotype, and stress in the development of functional and dysfunctional coping styles.
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Affiliation(s)
- Rossella Ventura
- Department of Psychology and Centre for Research in Neurobiology D. Bovet, Sapienza University of Rome, Rome, Italy.,Department of Experimental Neurosciences, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Simona Cabib
- Department of Psychology and Centre for Research in Neurobiology D. Bovet, Sapienza University of Rome, Rome, Italy.,Department of Experimental Neurosciences, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Lucy Babicola
- Department of Psychology and Centre for Research in Neurobiology D. Bovet, Sapienza University of Rome, Rome, Italy.,Department of Experimental Neurosciences, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Diego Andolina
- Department of Psychology and Centre for Research in Neurobiology D. Bovet, Sapienza University of Rome, Rome, Italy.,Department of Experimental Neurosciences, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Matteo Di Segni
- Department of Experimental Neurosciences, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Cristina Orsini
- Department of Psychology and Centre for Research in Neurobiology D. Bovet, Sapienza University of Rome, Rome, Italy
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6
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Increased risk of health professionals to feel traumatized during the COVID-19 pandemic. Sci Rep 2021; 11:18286. [PMID: 34521958 PMCID: PMC8440540 DOI: 10.1038/s41598-021-97783-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 08/23/2021] [Indexed: 01/08/2023] Open
Abstract
Health professionals may be a vulnerable group to posttraumatic stress symptoms (PTSS) during the Coronavirus disease 2019 (COVID-19) pandemic. To investigate how health professionals who experienced a traumatic event are expressing PTSS and factors related to risk for higher PTSS symptomatology can inform how health professionals are facing their role in this crisis. This was an Internet cross-sectional survey. Participants were 49,767 Brazilian health professionals who have ever faced a traumatic event, which was about 25.9% of an initial sample of health professionals. PTSS symptoms were assessed using the Impact of Event Scale-Revised (IES-R) and latent profile analysis (LPA) explored subpopulations within participants based on their scores. Distinct profiles were compared for psychological distress (e.g., depression and anxiety) and quality of life. Multinomial logistic regression analysis was conducted to investigate the relationship between IES-R profiles and COVID-19 related experiences, thoughts, and perceptions. A two-profile model was the most appropriate for the IES-R data pointing out a group with a high level of PTSS (named high-PTSS; n = 10,401, 20.9%) and another expressing a low level of symptoms (named low-PTSS; n = 39,366, 79.1%). The high-PTSS profile demonstrated worse psychological scores (global psychological distress, somatization, depression, and anxiety) and worse quality of life (physical, psychological, social, and environmental) with moderate magnitudes. Small but significant predictors of the high-PTSS profile included sociodemographic characteristics and COVID-19 related experiences, thoughts, and perceptions. Most individuals who experienced a traumatic event were not in the high-PTSS profile. For those who were, however, psychological and quality of life measures were much worse. During the initial phase of the COVID-19 pandemic, several characteristics emerged as risks to report trauma.
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7
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Michaels TI, Stone E, Singal S, Novakovic V, Barkin RL, Barkin S. Brain reward circuitry: The overlapping neurobiology of trauma and substance use disorders. World J Psychiatry 2021; 11:222-231. [PMID: 34168969 PMCID: PMC8209534 DOI: 10.5498/wjp.v11.i6.222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/14/2021] [Accepted: 05/20/2021] [Indexed: 02/06/2023] Open
Abstract
Mental health symptoms secondary to trauma exposure and substance use disorders (SUDs) co-occur frequently in both clinical and community samples. The possibility of a shared aetiology remains an important question in translational neuroscience. Advancements in genetics, basic science, and neuroimaging have led to an improved understanding of the neural basis of these disorders, their frequent comorbidity and high rates of relapse remain a clinical challenge. This project aimed to conduct a review of the field's current understanding regarding the neural circuitry underlying posttraumatic stress disorder and SUD. A comprehensive review was conducted of available published literature regarding the shared neurobiology of these disorders, and is summarized in detail, including evidence from both animal and clinical studies. Upon summarizing the relevant literature, this review puts forth a hypothesis related to their shared neurobiology within the context of fear processing and reward cues. It provides an overview of brain reward circuitry and its relation to the neurobiology, symptomology, and phenomenology of trauma and substance use. This review provides clinical insights and implications of the proposed theory, including the potential development of novel pharmacological and therapeutic treatments to address this shared neurobiology. Limitations and extensions of this theory are discussed to provide future directions and insights for this shared phenomena.
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Affiliation(s)
- Timothy I Michaels
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY 11004, United States
- Department of Psychiatry, The Donald and Barbara Zucker School of Medicine, Hofstra/Northwell, Glen Oaks, NY 11004, United States
| | - Emily Stone
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY 11004, United States
| | - Sonali Singal
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY 11004, United States
| | - Vladan Novakovic
- Department of Psychiatry, The Donald and Barbara Zucker School of Medicine, Hofstra/Northwell, Glen Oaks, NY 11004, United States
| | - Robert L Barkin
- Department of Anesthesiology, Rush University Medical College, Chicago, IL 60612, United States
| | - Stacy Barkin
- Private Practice, Scottsdale, AZ 85250, United States
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8
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Laban G, Ben-Zion Z, Cross ES. Social Robots for Supporting Post-traumatic Stress Disorder Diagnosis and Treatment. Front Psychiatry 2021; 12:752874. [PMID: 35185629 PMCID: PMC8854768 DOI: 10.3389/fpsyt.2021.752874] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 12/27/2021] [Indexed: 12/13/2022] Open
Abstract
Post-Traumatic Stress Disorder (PTSD) is a severe psychiatric disorder with profound public health impact due to its high prevalence, chronic nature, accompanying functional impairment, and frequently occurring comorbidities. Early PTSD symptoms, often observed shortly after trauma exposure, abate with time in the majority of those who initially express them, yet leave a significant minority with chronic PTSD. While the past several decades of PTSD research have produced substantial knowledge regarding the mechanisms and consequences of this debilitating disorder, the diagnosis of and available treatments for PTSD still face significant challenges. Here, we discuss how novel therapeutic interventions involving social robots can potentially offer meaningful opportunities for overcoming some of the present challenges. As the application of social robotics-based interventions in the treatment of mental disorders is only in its infancy, it is vital that careful, well-controlled research is conducted to evaluate their efficacy, safety, and ethics. Nevertheless, we are hopeful that robotics-based solutions could advance the quality, availability, specificity and scalability of care for PTSD.
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Affiliation(s)
- Guy Laban
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, United Kingdom
| | - Ziv Ben-Zion
- Tel-Aviv Sourasky Medical Center, Sagol Brain Institute Tel-Aviv, Wohl Institute for Advanced Imaging, Tel-Aviv, Israel.,Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel.,Departments of Comparative Medicine and Psychiatry, Yale School of Medicine, Yale University, New Haven, CT, United States.,The Clinical Neurosciences Division, VA Connecticut Healthcare System, United States Department of Veterans Affairs, National Center for Posttraumatic Stress Disorder, West Haven, CT, United States
| | - Emily S Cross
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, United Kingdom.,Department of Cognitive Science, Macquarie University, Sydney, NSW, Australia
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9
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Chen K, Hollunder B, Garbusow M, Sebold M, Heinz A. The physiological responses to acute stress in alcohol-dependent patients: A systematic review. Eur Neuropsychopharmacol 2020; 41:1-15. [PMID: 32994116 DOI: 10.1016/j.euroneuro.2020.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/22/2020] [Accepted: 09/14/2020] [Indexed: 10/23/2022]
Abstract
Dysregulation of physiological stress reactivity plays a key role in the development and relapse risk of alcohol dependence. This article reviews studies investigating physiological responses to experimentally induced acute stress in patients with alcohol dependence. A systematic search from electronic databases resulted in 3641 articles found and after screening 62 articles were included in our review. Studies are analyzed based on stress types (i.e., social stress tasks and nonsocial stress tasks) and physiological markers (i.e., the nervous system, the endocrine system, somatic responses and the immune system). In studies applying nonsocial stress tasks, alcohol-dependent patients were reported to show a blunted stress response compared with healthy controls in the majority of studies applying markers of adrenocorticotropic hormone and cortisol. In studies applying social stress tasks, findings are inconsistent, with less than half of the studies reporting altered physiological stress responses in patients. We discuss the impact of duration of abstinence, comorbidities, baseline physiological arousal and intervention on the discrepancy of study findings. Furthermore, we review evidence for an association between blunted physiological stress responses and the relapse risk among patients with alcohol dependence.
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Affiliation(s)
- Ke Chen
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany.
| | - Barbara Hollunder
- Charité Universitätsmedizin Berlin, Einstein Center for Neurosciences Berlin, Berlin, Germany; Movement Disorder & Neuromodulation Unit, Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany; Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Maria Garbusow
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Miriam Sebold
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany; Department for Social and Preventive Medicine, University of Potsdam, Potsdam, Germany
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany
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Dietrich JW, Hoermann R, Midgley JEM, Bergen F, Müller P. The Two Faces of Janus: Why Thyrotropin as a Cardiovascular Risk Factor May Be an Ambiguous Target. Front Endocrinol (Lausanne) 2020; 11:542710. [PMID: 33193077 PMCID: PMC7649136 DOI: 10.3389/fendo.2020.542710] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 10/02/2020] [Indexed: 12/12/2022] Open
Abstract
Elevated concentrations of free thyroid hormones are established cardiovascular risk factors, but the association of thyrotropin (TSH) levels to hard endpoints is less clear. This may, at least in part, ensue from the fact that TSH secretion depends not only on the supply with thyroid hormones but on multiple confounders including genetic traits, medication and allostatic load. Especially psychosocial stress is a still underappreciated factor that is able to adjust the set point of thyroid function. In order to improve our understanding of thyroid allostasis, we undertook a systematic meta-analysis of published studies on thyroid function in post-traumatic stress disorder (PTSD). Studies were identified via MEDLINE/PubMed search and available references, and eligible were reports that included TSH or free thyroid hormone measurements in subjects with and without PTSD. Additionally, we re-analyzed data from the NHANES 2007/2008 cohort for a potential correlation of allostatic load and thyroid homeostasis. The available evidence from 13 included studies and 3386 euthyroid subjects supports a strong association of both PTSD and allostatic load to markers of thyroid function. Therefore, psychosocial stress may contribute to cardiovascular risk via an increased set point of thyroid homeostasis, so that TSH concentrations may be increased for reasons other than subclinical hypothyroidism. This provides a strong perspective for a previously understudied psychoendocrine axis, and future studies should address this connection by incorporating indices of allostatic load, peripheral thyroid hormones and calculated parameters of thyroid homeostasis.
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Affiliation(s)
- Johannes Wolfgang Dietrich
- Endocrinology and Diabetes Department, Medical Hospital I, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, Germany
- Ruhr Center for Rare Diseases (CeSER), Ruhr University of Bochum and Witten/Herdecke University, Bochum, Germany
| | - Rudolf Hoermann
- Private Consultancy, Research and Development, Yandina, QLD, Australia
| | | | - Friederike Bergen
- Department of Psychiatry and Psychotherapy, LVR-Klinikum Düsseldorf, Düsseldorf, Germany
| | - Patrick Müller
- Department of Cardiology II, Münster University Hospitals, University of Münster, Münster, Germany
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Malgaroli M, Schultebraucks K. Artificial Intelligence and Posttraumatic Stress Disorder (PTSD). EUROPEAN PSYCHOLOGIST 2020. [DOI: 10.1027/1016-9040/a000423] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract. Posttraumatic stress disorder (PTSD) is a debilitating disease that can occur after experiencing a traumatic event. Despite recent progress in computational research, it has not yet been possible to identify precise and reliable risk factors that enable predictive models of individual risk for posttraumatic stress after trauma. In this overview, we discuss recent advances in the use of Machine Learning (ML) and Artificial Intelligence (AI) for risk stratification and targeted treatment allocation in the context of stress pathologies and we critically review the benefits and challenges of emerging approaches. The vast heterogeneity in the manifestation and the etiology of PTSD is discussed as one major reason for the need to deploy ML-based computational models to better account for individual differences between patients. Striving for personalized medicine is one of the most important goals of current clinical research and is of great potential for the field of posttraumatic stress research. The use of ML is a promising and necessary approach for reaching more personalized treatments and to make further progress in the field of precision psychiatry.
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Affiliation(s)
- Matteo Malgaroli
- Department of Psychiatry, NYU Grossman School of Medicine, New York, NY, USA
| | - Katharina Schultebraucks
- Department of Emergency Medicine, Vagelos School of Physicians and Surgeon, Columbia University Irving Medical Center, New York, NY, USA
- Data Science Institute, Columbia University, New York, NY, USA
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12
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Diet, Stress and Mental Health. Nutrients 2020; 12:nu12082428. [PMID: 32823562 PMCID: PMC7468813 DOI: 10.3390/nu12082428] [Citation(s) in RCA: 133] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/25/2020] [Accepted: 08/04/2020] [Indexed: 12/14/2022] Open
Abstract
Introduction: There has long been an interest in the effects of diet on mental health, and the interaction of the two with stress; however, the nature of these relationships is not well understood. Although associations between diet, obesity and the related metabolic syndrome (MetS), stress, and mental disorders exist, causal pathways have not been established. Methods: We reviewed the literature on the relationship between diet, stress, obesity and psychiatric disorders related to stress. Results: Diet and obesity can affect mood through direct effects, or stress-related mental disorders could lead to changes in diet habits that affect weight. Alternatively, common factors such as stress or predisposition could lead to both obesity and stress-related mental disorders, such as depression and posttraumatic stress disorder (PTSD). Specific aspects of diet can lead to acute changes in mood as well as stimulate inflammation, which has led to efforts to assess polyunsaturated fats (PUFA) as a treatment for depression. Bidirectional relationships between these different factors are also likely. Finally, there has been increased attention recently on the relationship between the gut and the brain, with the realization that the gut microbiome has an influence on brain function and probably also mood and behavior, introducing another way diet can influence mental health and disorders. Brain areas and neurotransmitters and neuropeptides that are involved in both mood and appetite likely play a role in mediating this relationship. Conclusions: Understanding the relationship between diet, stress and mood and behavior could have important implications for the treatment of both stress-related mental disorders and obesity.
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13
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Ketenci S, Acet NG, Sarıdoğan GE, Aydın B, Cabadak H, Gören MZ. The Neurochemical Effects of Prazosin Treatment on Fear Circuitry in a Rat Traumatic Stress Model. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2020; 18:219-230. [PMID: 32329303 PMCID: PMC7242110 DOI: 10.9758/cpn.2020.18.2.219] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 09/03/2019] [Accepted: 09/06/2019] [Indexed: 02/04/2023]
Abstract
Objective The timing of administration of pharmacologic agents is crucial in traumatic stress since they can either potentiate the original fear memory or may cause fear extinction depending on the phase of fear conditioning. Brain noradrenergic system has a role in fear conditioning. Data regarding the role of prazosin in traumatic stress are controversial. Methods In this study, we examined the effects of prazosin and the noradrenergic system in fear conditioning in a predator stress rat model. We evaluated the direct or indirect effects of stress and prazosin on noradrenaline (NA), gamma-aminobuytyric acid (GABA), glutamate, glycine levels and choline esterase activity in the amygdaloid complex, the dorsal hippocampus, the prefrontal cortex and the rostral pons. Results Our results demonstrated that prazosin might alleviate defensive behaviors and traumatic stress symptoms when given during the traumatic cue presentation in the stressed rats. However prazosin administration resulted in higher anxiety levels in non stressed rats when the neutral cue was presented. Conclusion Prazosin should be used in PTSD with caution because prazosin might exacerbate anxiety in non-traumatized subjects. However prazosin might as well alleviate stress responses very effectively. Stress induced changes included increased NA and GABA levels in the amygdaloid complex in our study, attributing noradrenaline a possible inhibitory role on fear acquisition. Acetylcholine also has a role in memory modulation in the brain. We also demonstrated increased choline esterase acitivity. Cholinergic modulation might be another target for indirect prazosin action which needs to be further studied.
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Affiliation(s)
- Sema Ketenci
- Department of Medical Pharmacology, Marmara University School of Medicine, Istanbul, Turkey
| | - Nazife Gökçe Acet
- Department of Medical Pharmacology, Medeniyet University, Faculty of Medicine, Istanbul, Turkey
| | - Gökçe Elif Sarıdoğan
- Department of Medical Pharmacology, Marmara University School of Medicine, Istanbul, Turkey.,Department of Psychiatry, Erenköy Mental Health and Research Hospital, Istanbul, Turkey
| | - Banu Aydın
- Department of Biophysics, Marmara University, Faculty of Medicine, Istanbul, Turkey
| | - Hülya Cabadak
- Department of Biophysics, Marmara University, Faculty of Medicine, Istanbul, Turkey
| | - Mehmet Zafer Gören
- Department of Medical Pharmacology, Marmara University School of Medicine, Istanbul, Turkey
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Faria MP, Laverde CF, Nunes-de-Souza RL. Anxiogenesis induced by social defeat in male mice: Role of nitric oxide, NMDA, and CRF 1 receptors in the medial prefrontal cortex and BNST. Neuropharmacology 2020; 166:107973. [PMID: 32006904 DOI: 10.1016/j.neuropharm.2020.107973] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 11/14/2019] [Accepted: 01/19/2020] [Indexed: 10/25/2022]
Abstract
Nitric oxide (NO) release in the right medial prefrontal cortex (RmPFC) produces anxiogenesis. In the bed nucleus of the stria terminalis (BNST), a region that receives neuronal projections from the mPFC, NO provokes anxiety, an effect that is blocked by local injections of corticotrophin-releasing factor type 1 receptor (CRF1) or n-methyl-d-aspartate receptor (NMDAr) antagonist. Anxiety is also enhanced by social defeat stress, and chronic stress impairs and facilitates, respectively, PFC and BNST roles in modulating behavioral responses to aversive situations. This study investigated whether the (i) chronic social defeat stress (CSDS) increases NO signaling in the mPFC; and/or (ii) anxiogenic effects provoked by the intra-RmPFC injection of NOC-9 (an NO donor) or by CSDS are prevented by intra-BNST injections of AP-7 (0.05 nmol) or CP 376395 (3.0 nmol), respectively, NMDAr and CRF1 antagonists, in male Swiss-Webster mice exposed to the elevated plus-maze (EPM). Results showed that (a) CSDS increased anxiety (i.e., reduced open-arm exploration) and repeatedly activated nNOS-containing neurons, as measured by ΔFosB (a stable nonspecific marker of neural activity) + nNOS double-labeling, in the right (but not left) mPFC, (b) NOC-9 in the RmPFC also increased anxiety, and (c) both CSDS and NOC-9 effects were reversed by injections of AP-7 or CP 376395 into the BNST. These results suggest that NMDA and CRF1 receptors located in BNST play an important role in the modulation of anxiety provoked by NO in the RmPFC, as well as by chronic social defeat in mice.
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Affiliation(s)
- M P Faria
- Joint Graduate Program of Physiological Sciences (PIPGCF) UFSCar-UNESP, 14800-903, Araraquara, SP, Brazil; São Paulo State University (Unesp), School of Pharmaceutical Sciences, Lab. Pharmacology, Araraquara, SP, Brazil
| | - C F Laverde
- Joint Graduate Program of Physiological Sciences (PIPGCF) UFSCar-UNESP, 14800-903, Araraquara, SP, Brazil; São Paulo State University (Unesp), School of Pharmaceutical Sciences, Lab. Pharmacology, Araraquara, SP, Brazil
| | - R L Nunes-de-Souza
- Joint Graduate Program of Physiological Sciences (PIPGCF) UFSCar-UNESP, 14800-903, Araraquara, SP, Brazil; São Paulo State University (Unesp), School of Pharmaceutical Sciences, Lab. Pharmacology, Araraquara, SP, Brazil.
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The behavioral and neurochemical effects of methylprednisolone or metyrapone in a post-traumatic stress disorder rat model. North Clin Istanb 2020; 6:327-333. [PMID: 31909376 PMCID: PMC6936935 DOI: 10.14744/nci.2019.69345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 05/21/2019] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE: Mechanisms contributing to the post-traumatic stress disorder (PTSD) that involve several physiological systems, and the activation of the hypothalamic-pituitary-adrenal axis (HPA) is one of the most known systems in the PTSD pathophysiology. The present study investigates the potential effects of methylprednisolone, metyrapone and their association with the noradrenergic system within the rostral pons, a region containing the locus coeruleus (LC) in a rat model of PTSD induced with predator scent. METHODS: In this study, Sprague-Dawley rats were exposed to the stress by exposure to the scent of dirty cat litter, which is a natural stressor of a predator. One week later, the rats were re-exposed to a situational reminder (clean cat litter). The rats were treated using either methylprednisolone, metyrapone or physiological saline before exposure to a situational reminder (n=8 in each group). Noradrenaline (NA) levels in the rostral pons homogenates were analysed using ELISA. RESULTS: The anxiety indices of the rats exposed to the trauma were found to be significantly higher than the anxiety indices of the control rats. Metyrapone produced a significant increase in the anxiety indices of the non-stressed rats, and methylprednisolone did not produce a change in the anxiety indices of the non-stressed rats. Methylprednisolone treatment suppressed the anxiety in the stressed rats. Metyrapone treatment increased the anxiety indices in the stressed rats but still being lower than that of the saline-treated stressed rats. Significant decrease in the freezing time was observed following the methylprednisolone treatment both in the stressed and non-stressed rats. NA content in the rostral pons of the stressed rats was significantly higher than that of the non-stressed rats. Methylprednisolone or metyrapone treatments decreased the NA content in the non-stressed rats as compared to the saline treatment. However, these decreases were not significant. CONCLUSION: In this study, findings suggest that stress may give rise to endocrine, autonomic and behavioural responses. The anxiety indices and NA levels in the rostral pons increased with the traumatic event. The methylprednisolone treatment may suppress anxiety through interactions between the LC and the HPA axis.
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Zhang K, Wang L, Li G, Cao C, Fang R, Liu P, Luo S, Zhang X. Correlation between hypothalamic-pituitary-adrenal axis gene polymorphisms and posttraumatic stress disorder symptoms. Horm Behav 2020; 117:104604. [PMID: 31655035 DOI: 10.1016/j.yhbeh.2019.104604] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 09/20/2019] [Accepted: 09/21/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND The hypothalamic-pituitary-adrenal (HPA) axis is the main neuroendocrine system that controls stress responses, including fear learning. To further understand the correlation between the HPA axis and stress- and fear-related symptoms in humans, the current study investigated the relationship between HPA axis gene polymorphisms and a stress- and fear-related disorder, posttraumatic stress disorder (PTSD). This is the first study that systematically investigates the correlations between HPA axis genes and distinct PTSD symptom clusters. METHODS Participants included 1132 Chinese earthquake survivors (772 women and 360 men). PTSD symptoms were measured by the PTSD Checklist for DSM-5 (PCL-5), and the severity (total symptoms) and symptom clusters were calculated according to the hybrid seven-factor model of DSM-5 PTSD. We genotyped eight single nucleotide polymorphisms (SNPs) of three HPA axis genes, including FKBP5, CRHR1 and CRHR2. RESULTS The main effects of the CRHR2 SNP rs2267715 were associated with PTSD severity (P = 0.0035) and all PTSD symptom clusters except dysphoric arousal (P ranging from 0.0011 to 0.048). In women, a gene-environment interaction (G × E) effect of FKBP5 (rs3800373 × trauma exposure) was correlated with PTSD severity (P = 0.038), externalizing behaviors, anxious arousal and dysphoric arousal symptoms (P ranging from 0.014 to 0.028); the G × E effect of CRHR1 (rs4458044 × trauma exposure) was associated with anxious arousal symptoms (P = 0.016). In men, a gene-gene interaction (G × G) effect of FKBP5-CRHR1 (rs9470080 × rs4458044) was associated with PTSD severity (P = 0.0091), intrusion, negative affect, externalizing behaviors and anxious arousal (P ranging 0.012-0.049). CONCLUSION Our results systematically revealed that the main effects and G × E and G × G effects of some genetic polymorphisms of HPA axis genes are involved in the severity and distinct symptom clusters of PTSD.
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Affiliation(s)
- Kunlin Zhang
- Laboratory for Traumatic Stress Studies and Center for Genetics and BioMedical Informatics Research, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing 100101, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Li Wang
- Laboratory for Traumatic Stress Studies and Center for Genetics and BioMedical Informatics Research, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing 100101, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing 100049, China.
| | - Gen Li
- Laboratory for Traumatic Stress Studies and Center for Genetics and BioMedical Informatics Research, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing 100101, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Chengqi Cao
- Laboratory for Traumatic Stress Studies and Center for Genetics and BioMedical Informatics Research, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing 100101, China; Shenzhen Key Laboratory of Affective and Social Cognitive Science, Shenzhen University, Shenzhen 518060, China
| | - Ruojiao Fang
- Laboratory for Traumatic Stress Studies and Center for Genetics and BioMedical Informatics Research, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing 100101, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Ping Liu
- People's Hospital of Deyang City, Deyang, Sichuan 618000, China
| | - Shu Luo
- People's Hospital of Deyang City, Deyang, Sichuan 618000, China
| | - Xiangyang Zhang
- Laboratory for Traumatic Stress Studies and Center for Genetics and BioMedical Informatics Research, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing 100101, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing 100049, China
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Gurel NZ, Huang M, Wittbrodt MT, Jung H, Ladd SL, Shandhi MMH, Ko YA, Shallenberger L, Nye JA, Pearce B, Vaccarino V, Shah AJ, Bremner JD, Inan OT. Quantifying acute physiological biomarkers of transcutaneous cervical vagal nerve stimulation in the context of psychological stress. Brain Stimul 2020; 13:47-59. [PMID: 31439323 PMCID: PMC8252146 DOI: 10.1016/j.brs.2019.08.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 07/24/2019] [Accepted: 08/04/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Stress is associated with activation of the sympathetic nervous system, and can lead to lasting alterations in autonomic function and in extreme cases symptoms of posttraumatic stress disorder (PTSD). Vagal nerve stimulation (VNS) is a potentially useful tool as a modulator of autonomic nervous system function, however currently available implantable devices are limited by cost and inconvenience. OBJECTIVE The purpose of this study was to assess the effects of transcutaneous cervical VNS (tcVNS) on autonomic responses to stress. METHODS Using a double-blind approach, we investigated the effects of active or sham tcVNS on peripheral cardiovascular and autonomic responses to stress using wearable sensing devices in 24 healthy human participants with a history of exposure to psychological trauma. Participants were exposed to acute stressors over a three-day period, including personalized scripts of traumatic events, public speech, and mental arithmetic tasks. RESULTS tcVNS relative to sham applied immediately after traumatic stress resulted in a decrease in sympathetic function and modulated parasympathetic/sympathetic autonomic tone as measured by increased pre-ejection period (PEP) of the heart (a marker of cardiac sympathetic function) of 4.2 ms (95% CI 1.6-6.8 ms, p < 0.01), decreased peripheral sympathetic function as measured by increased photoplethysmogram (PPG) amplitude (decreased vasoconstriction) by 47.9% (1.4-94.5%, p < 0.05), a 9% decrease in respiratory rate (-14.3 to -3.7%, p < 0.01). Similar effects were seen when tcVNS was applied after other stressors and in the absence of a stressor. CONCLUSION Wearable sensing modalities are feasible to use in experiments in human participants, and tcVNS modulates cardiovascular and peripheral autonomic responses to stress.
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Affiliation(s)
- Nil Z Gurel
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, USA.
| | - Minxuan Huang
- Department of Epidemiology, Rollins School of Public Health, Atlanta, GA, USA
| | - Matthew T Wittbrodt
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Hewon Jung
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Stacy L Ladd
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA; Department of Radiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Md Mobashir H Shandhi
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Yi-An Ko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Atlanta, GA, USA
| | - Lucy Shallenberger
- Department of Epidemiology, Rollins School of Public Health, Atlanta, GA, USA
| | - Jonathon A Nye
- Department of Radiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Bradley Pearce
- Department of Epidemiology, Rollins School of Public Health, Atlanta, GA, USA
| | - Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Atlanta, GA, USA; Department of Internal Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Amit J Shah
- Department of Epidemiology, Rollins School of Public Health, Atlanta, GA, USA; Department of Internal Medicine, Emory University School of Medicine, Atlanta, GA, USA; Atlanta VA Medical Center, Decatur, GA, USA
| | - J Douglas Bremner
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA; Department of Radiology, Emory University School of Medicine, Atlanta, GA, USA; Atlanta VA Medical Center, Decatur, GA, USA
| | - Omer T Inan
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, USA; Coulter Department of Bioengineering, Georgia Institute of Technology, Atlanta, GA, USA
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Ahmadizadeh MJ, Rezaei M, Fitzgerald PB. Transcranial direct current stimulation (tDCS) for post-traumatic stress disorder (PTSD): A randomized, double-blinded, controlled trial. Brain Res Bull 2019; 153:273-278. [DOI: 10.1016/j.brainresbull.2019.09.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 09/19/2019] [Indexed: 12/12/2022]
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Mikolajewski AJ, Scheeringa MS. Examining the Prospective Relationship between Pre-Disaster Respiratory Sinus Arrhythmia and Post-Disaster Posttraumatic Stress Disorder Symptoms in Children. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2019; 46:1535-1545. [PMID: 29327312 DOI: 10.1007/s10802-017-0396-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Previous studies have examined the concurrent relationship between posttraumatic stress disorder (PTSD) and a range of psychophysiological variables, including respiratory sinus arrhythmia (RSA). However, there is a lack of research examining the prospective development of trauma symptomatology, and the directionality of the association between RSA level and PTSD has yet to be determined. The current study is the first prospective study to examine whether RSA level and RSA reactivity are risk factors for PTSD symptoms in children. Assessments were conducted both prior to (Time 1) and following (Time 2) a natural disaster (i.e., Hurricane Katrina). Participants were 36 children who were 3-6 years-old during the Time 1 assessment. Structured diagnostic interviews were used to assess PTSD symptoms at both Time 1 and Time 2. RSA level during a neutral stimulus, RSA reactivity to emotional video stimuli (distress, joy, and trauma videos) and RSA reactivity to memory stimuli (remote happy memory, trauma memory, mother's recall of the trauma memory) were also collected at both time points. Time 1 RSA level during a neutral stimulus was a significant predictor of Time 2 PTSD symptoms (controlling for age, Time 1 PTSD symptoms, Time 2 neutral RSA level), such that lower RSA during a neutral condition was related to higher PTSD symptoms. Also, Time 1 RSA reactivity in response to memory (but not video) stimuli, in the form of relatively less vagal withdrawal, was a significant predictor of more Time 2 PTSD symptoms (controlling for age, Time 1 PTSD symptoms, Time 2 RSA reactivity). This unique prospective study provides evidence for level of RSA and RSA reactivity as pre-existing clinical markers of stress sensitivity that predict psychopathology following a trauma.
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Affiliation(s)
- Amy J Mikolajewski
- Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, 1430 Tulane Ave. #8448, New Orleans, LA, 70112, USA.
| | - Michael S Scheeringa
- Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, 1430 Tulane Ave. #8448, New Orleans, LA, 70112, USA
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Schmidt U, Vermetten E. Integrating NIMH Research Domain Criteria (RDoC) into PTSD Research. Curr Top Behav Neurosci 2019; 38:69-91. [PMID: 28341942 DOI: 10.1007/7854_2017_1] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Three and a half decades of research on posttraumatic stress disorder (PTSD) has produced substantial knowledge on the pathobiology of this frequent and debilitating disease. However, despite all research efforts, so far no drug that has specifically targeted PTSD core symptoms progressed to clinical use. Instead, although not overly efficient, serotonin re-uptake inhibitors continue to be considered the gold standard of PTSD pharmacotherapy. The psychotherapeutic treatment and symptom-oriented drug therapy options available for PTSD treatment today show some efficacy, although not in all PTSD patients, in particular not in a substantial percent of those suffering from the detrimental sequelae of repeated childhood trauma or in veterans with combat related PTSD. PTSD has this in common with other psychiatric disorders - in particular effective treatment for incapacitating conditions such as resistant major depression, chronic schizophrenia, and frequently relapsing obsessive-compulsive disorder as well as dementia has not yet been developed through modern neuropsychiatric research.In response to this conundrum, the National Institute of Mental Health launched the Research Domain Criteria (RDoC) framework which aims to leave diagnosis-oriented psychiatric research behind and to move on to the use of research domains overarching the traditional diagnosis systems. To the best of our knowledge, the paper at hand is the first that has systematically assessed the utility of the RDoC system for PTSD research. Here, we review core findings in neurobiological PTSD research and match them to the RDoC research domains and units of analysis. Our synthesis reveals that several core findings in PTSD such as amygdala overactivity have been linked to all RDoC domains without further specification of their distinct role in the pathophysiological pathways associated with these domains. This circumstance indicates that the elucidation of the cellular and molecular processes ultimately decisive for regulation of psychic processes and for the expression of psychopathological symptoms is still grossly incomplete. All in all, we find the RDoC research domains to be useful but not sufficient for PTSD research. Hence, we suggest adding two novel domains, namely stress and emotional regulation and maintenance of consciousness. As both of these domains play a role in various if not in all psychiatric diseases, we judge them to be useful not only for PTSD research but also for psychiatric research in general.
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Affiliation(s)
- Ulrike Schmidt
- Trauma Outpatient Unit and RG Molecular Psychotraumatology, Clinical Department, Max Planck Institute of Psychiatry, Kraepelinstrasse 10, Munich, 80804, Germany
| | - Eric Vermetten
- Department Psychiatry, Leiden University Medical Center Utrecht, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands.
- Arq Psychotruama Research Group, Diemen, The Netherlands.
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Weckmann K, Deery MJ, Howard JA, Feret R, Asara JM, Dethloff F, Filiou MD, Labermaier C, Maccarrone G, Lilley KS, Mueller M, Turck CW. Ketamine's Effects on the Glutamatergic and GABAergic Systems: A Proteomics and Metabolomics Study in Mice. MOLECULAR NEUROPSYCHIATRY 2018; 5:42-51. [PMID: 31019917 DOI: 10.1159/000493425] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 08/31/2018] [Indexed: 12/15/2022]
Abstract
Ketamine, a noncompetitive, voltage-dependent N-Methyl-D-aspartate receptor (NMDAR) antagonist, has been shown to have a rapid antidepressant effect and is used for patients experiencing treatment-resistant depression. We carried out a time-dependent targeted mass spectrometry-based metabolomics profiling analysis combined with a quantitative based on in vivo 15N metabolic labeling proteome comparison of ketamine- and vehicle-treated mice. The metabolomics and proteomics datasets were used to further elucidate ketamine's mode of action on the gamma-aminobutyric acid (GABA)ergic and glutamatergic systems. In addition, myelin basic protein levels were analyzed by Western Blot. We found altered GABA, glutamate and glutamine metabolite levels and ratios as well as increased levels of putrescine and serine - 2 positive modulators of the NMDAR. In addition, GABA receptor (GABAR) protein levels were reduced, whereas the alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPAR) subunit Gria2 protein levels were increased upon ketamine treatment. The significantly altered metabolite and protein levels further significantly correlated with the antidepressant-like behavior, which was assessed using the forced swim test. In conclusion and in line with previous research, our data indicate that ketamine impacts the AMPAR subunit Gria2 and results in decreased GABAergic inhibitory neurotransmission leading to increased excitatory neuronal activity.
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Affiliation(s)
- Katja Weckmann
- Max Planck Institute of Psychiatry, Department of Translational Research in Psychiatry, Munich, Germany.,Institute for Pathobiochemistry, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Michael J Deery
- Cambridge Centre for Proteomics, Cambridge System Biology Centre, University of Cambridge, Cambridge, United Kingdom
| | - Julie A Howard
- Cambridge Centre for Proteomics, Cambridge System Biology Centre, University of Cambridge, Cambridge, United Kingdom
| | - Renata Feret
- Cambridge Centre for Proteomics, Cambridge System Biology Centre, University of Cambridge, Cambridge, United Kingdom
| | - John M Asara
- Division of Signal Transduction, Beth Israel Deaconess Medical Center and Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Frederik Dethloff
- Max Planck Institute of Psychiatry, Department of Translational Research in Psychiatry, Munich, Germany
| | - Michaela D Filiou
- Department of Biological Applications and Technology, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Christiana Labermaier
- Max Planck Institute of Psychiatry, Department of Translational Research in Psychiatry, Munich, Germany
| | - Giuseppina Maccarrone
- Max Planck Institute of Psychiatry, Department of Translational Research in Psychiatry, Munich, Germany
| | - Kathryn S Lilley
- Cambridge Centre for Proteomics, Cambridge System Biology Centre, University of Cambridge, Cambridge, United Kingdom
| | - Marianne Mueller
- Experimental Psychiatry, Department of Psychiatry and Psychotherapy and Focus Program Translational Neuroscience, Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Christoph W Turck
- Max Planck Institute of Psychiatry, Department of Translational Research in Psychiatry, Munich, Germany
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Danzi BA, La Greca AM. Genetic pathways to posttraumatic stress disorder and depression in children: Investigation of catechol-O-methyltransferase (COMT) Val158Met using different PTSD diagnostic models. J Psychiatr Res 2018; 102:81-86. [PMID: 29627597 DOI: 10.1016/j.jpsychires.2018.03.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 03/15/2018] [Accepted: 03/25/2018] [Indexed: 01/21/2023]
Abstract
The catechol-O-methyltransferase (COMT) Val158Met polymorphism has been linked to PTSD, although findings have been inconsistent. Recently, different diagnostic criteria for PTSD have been introduced by ICD-11 and DSM-5, including separate criteria for adults and for young children (i.e., the preschool criteria). The preschool criteria may be applicable to older children as well. This study is the first to examine COMT associations with depression and PTSD, using new diagnostic models, in school-age children (7-11 years) exposed to a natural disaster. Children (n = 115) provided saliva samples for genotyping and completed measures assessing disaster exposure, posttraumatic stress, and depressive symptoms. COMT Met allele carriers were at risk for PTSD, but only when using ICD-11 (OR = 6.99) or the preschool criteria (OR = 4.77); there was a trend for DSM-IV and no association for DSM-5 (adult criteria). However, all children agreed upon as having PTSD by both DSM-5 and ICD-11 were Met allele carriers. The genetic association between the COMT Met allele and PTSD seemed primarily driven by arousal symptoms, as a significant relationship emerged only for the PTSD arousal symptom cluster. In contrast, COMT Val allele homozygosity was associated with depression (OR = 4.34). Thus, findings suggest that opposing COMT genotypes increased vulnerability to depressive versus arousal-based clinical presentations following trauma exposure. As a result, the heterogeneity of the DSM-5 PTSD criteria and its inclusion of depressive symptoms may mask COMT associations with DSM-5 PTSD. Future research should consider how the use of different diagnostic models of PTSD may influence genetic findings.
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Affiliation(s)
- BreAnne A Danzi
- University of Miami, Department of Psychology, 5665 Ponce de Leon Boulevard, Coral Gables, FL, 33146, USA.
| | - Annette M La Greca
- University of Miami, Department of Psychology, 5665 Ponce de Leon Boulevard, Coral Gables, FL, 33146, USA.
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Posttraumatic stress disorder symptom severity is associated with left hippocampal volume reduction: a meta-analytic study. CNS Spectr 2017; 22:363-372. [PMID: 27989265 DOI: 10.1017/s1092852916000833] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Many studies have reported hippocampal volume reductions associated with posttraumatic stress disorder (PTSD), while others have not. Here we provide an updated meta-analysis of such reductions associated with PTSD and evaluate the association between symptom severity and hippocampal volume. METHODS A total of 37 studies met the criteria for inclusion in the meta-analysis. Mean effect sizes (Hedges' g) and 95% confidence intervals (CI 95%) were computed for each study and then averaged to obtain an overall mean effect size across studies. Meta-regression was employed to examine the relationship between PTSD symptom severity and hippocampal volume. RESULTS Results showed that PTSD is associated with significant bilateral reduction of the hippocampus (left hippocampus effect size=-0.400, p<0.001, 5.24% reduction; right hippocampus effect size=-0.462, p<0.001, 5.23% reduction). Symptom severity, as measured by the Clinician-Administered PTSD Scale (CAPS), was significantly associated with decreased left, but not right, hippocampal volume. CONCLUSIONS PTSD was associated with significant bilateral volume reduction of the hippocampus. Increased symptom severity was significantly associated with reduced left hippocampal volume. This finding is consistent with the hypothesis that PTSD is more neurotoxic to the left hippocampus than to the right. However, whether the association between PTSD and lower hippocampal volume reflects a consequence of or a predisposition to PTSD remains unclear. More prospective studies are needed in this area.
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Malan-Müller S, Hemmings S. The Big Role of Small RNAs in Anxiety and Stress-Related Disorders. ANXIETY 2017; 103:85-129. [DOI: 10.1016/bs.vh.2016.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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25
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Maeng LY, Milad MR. Post-Traumatic Stress Disorder: The Relationship Between the Fear Response and Chronic Stress. CHRONIC STRESS (THOUSAND OAKS, CALIF.) 2017; 1:2470547017713297. [PMID: 32440579 PMCID: PMC7219872 DOI: 10.1177/2470547017713297] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 05/09/2017] [Accepted: 05/09/2017] [Indexed: 11/15/2022]
Abstract
Post-traumatic stress disorder (PTSD) is a disabling psychiatric condition that can develop following a physical, psychological, or sexual trauma. Despite the growing body of literature examining the psychological and biological factors involved in PTSD psychopathology, specific biomarkers that may improve diagnosis and treatment of PTSD have yet to be identified and validated. This challenge may be attributed to the diverse array of symptoms that individuals with the disorder manifest. Examining the interrelated stress and fear systems allows for a more comprehensive study of these symptoms, and through this approach, which aligns with the research domain criteria (RDoC) framework, neural and psychophysiological measures of PTSD have emerged. In this review, we discuss PTSD neurobiology and treatment within the context of fear and stress network interactions and elucidate the advantages of using an RDoC approach to better understand PTSD with fear conditioning and extinction paradigms.
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Affiliation(s)
- Lisa Y Maeng
- Department of Psychiatry, Massachusetts
General Hospital, Charlestown, MA, USA
- Department of Psychiatry, Harvard
Medical School, Boston, MA, USA
| | - Mohammed R Milad
- Department of Psychiatry, Massachusetts
General Hospital, Charlestown, MA, USA
- Department of Psychiatry, Harvard
Medical School, Boston, MA, USA
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Barnabas K, Zhang L, Wang H, Kirouac G, Vrontakis M. Changes in Galanin Systems in a Rat Model of Post-Traumatic Stress Disorder (PTSD). PLoS One 2016; 11:e0167569. [PMID: 27907151 PMCID: PMC5131984 DOI: 10.1371/journal.pone.0167569] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 11/16/2016] [Indexed: 12/23/2022] Open
Abstract
Post-traumatic stress disorder (PTSD) is a chronic syndrome triggered by exposure to trauma and a failure to recover from a normal negative emotional reaction to traumatic stress. The neurobiology of PTSD and the participation of neuropeptides in the neural systems and circuits that control fear and anxiety are not fully understood. The long-term dysregulation of neuropeptide systems contributes to the development of anxiety disorders, including PTSD. The neuropeptide galanin (Gal) and its receptors participate in anxiety-like and depression-related behaviors via the modulation of neuroendocrine and monoaminergic systems. The objective of this research was to investigate how Gal expression changes in the brain of rats 2 weeks after exposure to footshock. Rats exposed to footshocks were subdivided into high responders (HR; immobility>60%) and low responders (LR; immobility<40%) based on immobility elicited by a novel tone one day after exposure. On day 14, rats were anesthetized, and the amygdala, hypothalamus, pituitary and adrenal glands were removed for analysis using real-time polymerase chain reaction (RT-PCR). Gal mRNA levels were increased in the amygdala and hypothalamus of HR compared with the control and LR. In contrast, Gal mRNA levels were decreased in the adrenal and pituitary glands of HR compared with the control and LR. Thus, the differential regulation (dysregulation) of the neuropeptide Gal in these tissues may contribute to anxiety and PTSD development.
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MESH Headings
- Adrenal Glands/metabolism
- Adrenal Glands/physiopathology
- Amygdala/metabolism
- Amygdala/physiopathology
- Animals
- Anxiety/genetics
- Anxiety/metabolism
- Anxiety/physiopathology
- Disease Models, Animal
- Electroshock
- Fear/psychology
- Galanin/genetics
- Galanin/metabolism
- Gene Expression Regulation
- Humans
- Hypothalamus/metabolism
- Hypothalamus/physiopathology
- Immobility Response, Tonic
- Male
- Organ Specificity
- Pituitary Gland/metabolism
- Pituitary Gland/physiopathology
- Protein Precursors/genetics
- Protein Precursors/metabolism
- RNA, Messenger/genetics
- RNA, Messenger/metabolism
- Rats
- Rats, Sprague-Dawley
- Signal Transduction
- Stress Disorders, Post-Traumatic/genetics
- Stress Disorders, Post-Traumatic/metabolism
- Stress Disorders, Post-Traumatic/physiopathology
- Stress, Psychological/genetics
- Stress, Psychological/metabolism
- Stress, Psychological/physiopathology
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Affiliation(s)
- Karen Barnabas
- Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lin Zhang
- Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Huiying Wang
- Faculty of Dentistry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Gilbert Kirouac
- Faculty of Dentistry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Maria Vrontakis
- Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- * E-mail:
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Clinard CT, Barnes AK, Adler SG, Cooper MA. Winning agonistic encounters increases testosterone and androgen receptor expression in Syrian hamsters. Horm Behav 2016; 86:27-35. [PMID: 27619945 PMCID: PMC5159211 DOI: 10.1016/j.yhbeh.2016.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 06/30/2016] [Accepted: 09/08/2016] [Indexed: 11/16/2022]
Abstract
Winning aggressive disputes is one of several experiences that can alter responses to future stressful events. We have previously tested dominant and subordinate male Syrian hamsters in a conditioned defeat model and found that dominant individuals show less change in behavior following social defeat stress compared to subordinates and controls, indicating a reduced conditioned defeat response. Resistance to the effects of social defeat in dominants is experience-dependent and requires the maintenance of dominance relationships for 14days. For this study we investigated whether winning aggressive interactions increases plasma testosterone and whether repeatedly winning increases androgen receptor expression. First, male hamsters were paired in daily 10-min aggressive encounters and blood samples were collected immediately before and 15min and 30min after the formation of dominance relationships. Dominants showed an increase in plasma testosterone at 15min post-interaction compared to their pre-interaction baseline, whereas subordinates and controls showed no change in plasma testosterone. Secondly, we investigated whether 14days of dominant social status increased androgen or estrogen alpha-receptor immunoreactivity in brain regions that regulate the conditioned defeat response. Dominants showed more androgen, but not estrogen alpha, receptor immuno-positive cells in the dorsal medial amygdala (dMeA) and ventral lateral septum (vLS) compared to subordinates and controls. Finally, we showed that one day of dominant social status was insufficient to increase androgen receptor immunoreactivity compared to subordinates. These results suggest that elevated testosterone signaling at androgen receptors in the dMeA and vLS might contribute to the reduced conditioned defeat response exhibited by dominant hamsters.
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Affiliation(s)
- Catherine T Clinard
- Department of Psychology, University of Tennessee, Knoxville, TN 37996, United States.
| | - Abigail K Barnes
- Department of Psychology, University of Tennessee, Knoxville, TN 37996, United States
| | - Samuel G Adler
- Department of Psychology, University of Tennessee, Knoxville, TN 37996, United States
| | - Matthew A Cooper
- Department of Psychology, University of Tennessee, Knoxville, TN 37996, United States
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Costa N, Vicente M, Cipriano A, Miguel T, Nunes-de-Souza R. Functional lateralization of the medial prefrontal cortex in the modulation of anxiety in mice: Left or right? Neuropharmacology 2016; 108:82-90. [DOI: 10.1016/j.neuropharm.2016.04.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 04/04/2016] [Accepted: 04/10/2016] [Indexed: 01/13/2023]
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Behavioral, emotional and neurobiological determinants of coronary heart disease risk in women. Neurosci Biobehav Rev 2016; 74:297-309. [PMID: 27496672 DOI: 10.1016/j.neubiorev.2016.04.023] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 04/15/2016] [Accepted: 04/20/2016] [Indexed: 02/08/2023]
Abstract
Women have more of the stress-related behavioral profile that has been linked to cardiovascular disease than men. For example, women double the rates of stress-related mental disorders such as depression and posttraumatic stress disorder (PTSD) than men, and have higher rates of exposure to adversity early in life. This profile may increase women's long-term risk of cardiometabolic conditions linked to stress, especially coronary heart disease (CHD). In addition to having a higher prevalence of psychosocial stressors, women may be more vulnerable to the adverse effects of these stressors on CHD, perhaps through altered neurobiological physiology. Emerging data suggest that young women are disproportionally susceptible to the adverse effects of stress on the risk of cardiovascular disease, both in terms of initiating the disease as well as worsening the prognosis in women who have already exhibited symptoms of the disease. Women's potential vulnerability to psychosocial stress could also help explain their higher propensity toward abnormal coronary vasomotion and microvascular disease compared with men.
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30
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Demir S, Bulut M, Atli A, Kaplan İ, Kaya MC, Bez Y, Özdemir PG, Sır A. Decreased Prolidase Activity in Patients with Posttraumatic Stress Disorder. Psychiatry Investig 2016; 13:420-6. [PMID: 27482243 PMCID: PMC4965652 DOI: 10.4306/pi.2016.13.4.420] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 09/06/2015] [Accepted: 09/17/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Many neurochemical systems have been implicated in the development of Posttraumatic Stress Disorder (PTSD). The prolidase enzyme is a cytosolic exopeptidase that detaches proline or hydroxyproline from the carboxyl terminal position of dipeptides. Prolidase has important biological effects, and to date, its role in the etiology of PTSD has not been studied. In the present study, we aimed to evaluate prolidase activity in patients with PTSD. METHODS The study group consisted of patients who were diagnosed with PTSD after the earthquake that occurred in the province of Van in Turkey in 2011 (n=25); the first control group consisted of patients who experienced the earthquake but did not show PTSD symptoms (n=26) and the second control group consisted of patients who have never been exposed to a traumatic event (n=25). Prolidase activities in the patients and the control groups were determined by the ELISA method using commercial kits. RESULTS Prolidase activity in the patient group was significantly lower when compared to the control groups. Prolidase activity was also significantly lower in the traumatized healthy subjects compared to the other healthy group (p<0.01). CONCLUSION The findings of the present study suggest that the decrease in prolidase activity may have neuroprotective effects in patients with PTSD.
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Affiliation(s)
- Süleyman Demir
- Department of Psychiatry, Dicle University, Diyarbakir, Turkey
| | - Mahmut Bulut
- Department of Psychiatry, Dicle University, Diyarbakir, Turkey
| | - Abdullah Atli
- Department of Psychiatry, Dicle University, Diyarbakir, Turkey
| | - İbrahim Kaplan
- Department of Biochemistry, Dicle University, Diyarbakir, Turkey
| | | | - Yasin Bez
- Department of Psychiatry, Marmara University, Istanbul, Turkey
| | | | - Aytekin Sır
- Department of Psychiatry, Dicle University, Diyarbakir, Turkey
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Atli A, Bulut M, Bez Y, Kaplan İ, Özdemir PG, Uysal C, Selçuk H, Sir A. Altered lipid peroxidation markers are related to post-traumatic stress disorder (PTSD) and not trauma itself in earthquake survivors. Eur Arch Psychiatry Clin Neurosci 2016; 266:329-36. [PMID: 26324882 DOI: 10.1007/s00406-015-0638-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 08/20/2015] [Indexed: 01/06/2023]
Abstract
The traumatic life events, including earthquakes, war, and interpersonal conflicts, cause a cascade of psychological and biological changes known as post-traumatic stress disorder (PTSD). Malondialdehyde (MDA) is a reliable marker of lipid peroxidation, and paraoxonase is a known antioxidant enzyme. The aims of this study were to investigate the relationship between earthquake trauma, PTSD effects on oxidative stress and the levels of serum paraoxonase 1 (PON1) enzyme activity, and levels of serum MDA. The study was carried out on three groups called: the PTSD group, the traumatized with earthquake exercise group, and healthy control group, which contained 32, 31, and 38 individuals, respectively. Serum MDA levels and PON1 enzyme activities from all participants were measured, and the results were compared across all groups. There were no significant differences between the PTSD patients and non-PTSD earthquake survivors in terms of the study variables. The mean PON1 enzyme activity from PTSD patients was significantly lower, while the mean MDA level was significantly higher than that of the healthy control group (p < 0.01 for both measurements). Similarly, earthquake survivors who did not develop PTSD showed higher MDA levels and lower PON1 activity when compared to healthy controls. However, the differences between these groups did not reach a statistically significant level. Increased MDA level and decreased PON1 activity measured in PTSD patients after earthquake and may suggest increased oxidative stress in these patients. The nonsignificant trends that are observed in lipid peroxidation markers of earthquake survivors may indicate higher impact of PTSD development on these markers than trauma itself. For example, PTSD diagnosis seems to add to the effect of trauma on serum MDA levels and PON1 enzyme activity. Thus, serum MDA levels and PON1 enzyme activity may serve as biochemical markers of PTSD diagnosis.
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Affiliation(s)
- Abdullah Atli
- Department of Psychiatry, Dicle University, 21280, Diyarbakir, Turkey.
| | - Mahmut Bulut
- Department of Psychiatry, Dicle University, 21280, Diyarbakir, Turkey
| | - Yasin Bez
- Department of Psychiatry, Marmara University, Istanbul, Turkey
| | - İbrahim Kaplan
- Department of Biochemistry, Dicle University, Diyarbakir, Turkey
| | | | - Cem Uysal
- Department of Forensic Medicine, Dicle University, Diyarbakir, Turkey
| | - Hilal Selçuk
- Department of Psychiatry, Selhaddin Eyyubi State Hospital, Diyarbakir, Turkey
| | - Aytekin Sir
- Department of Psychiatry, Dicle University, 21280, Diyarbakir, Turkey
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32
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Saar-Ashkenazy R, Shalev H, Kanthak MK, Guez J, Friedman A, Cohen JE. Altered processing of visual emotional stimuli in posttraumatic stress disorder: an event-related potential study. Psychiatry Res 2015; 233:165-74. [PMID: 26138281 DOI: 10.1016/j.pscychresns.2015.05.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 02/06/2015] [Accepted: 05/27/2015] [Indexed: 10/23/2022]
Abstract
Patients with posttraumatic stress disorder (PTSD) display abnormal emotional processing and bias towards emotional content. Most neurophysiological studies in PTSD found higher amplitudes of event-related potentials (ERPs) in response to trauma-related visual content. Here we aimed to characterize brain electrical activity in PTSD subjects in response to non-trauma-related emotion-laden pictures (positive, neutral and negative). A combined behavioral-ERP study was conducted in 14 severe PTSD patients and 14 controls. Response time in PTSD patients was slower compared with that in controls, irrespective to emotional valence. In both PTSD and controls, response time to negative pictures was slower compared with that to neutral or positive pictures. Upon ranking, both control and PTSD subjects similarly discriminated between pictures with different emotional valences. ERP analysis revealed three distinctive components (at ~300, ~600 and ~1000 ms post-stimulus onset) for emotional valence in control subjects. In contrast, PTSD patients displayed a similar brain response across all emotional categories, resembling the response of controls to negative stimuli. We interpret these findings as a brain-circuit response tendency towards negative overgeneralization in PTSD.
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Affiliation(s)
- Rotem Saar-Ashkenazy
- Department of Cognitive-Neuroscience and Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Department of Psychology and the School of Social-work, Ashkelon Academic College, Ashkelon, Israel; Department of Psychology, Achva Academic College, Beer-Tuvia regional council, Israel
| | - Hadar Shalev
- Department of Psychiatry, Soroka University Medical Center, Beer-Sheva, Israel
| | - Magdalena K Kanthak
- Department of Biological Psychology, Technical University of Dresden, Dresden, Germany
| | - Jonathan Guez
- Department of Psychology, Achva Academic College, Beer-Tuvia regional council, Israel; Beer-Sheva Mental Health Center, Beer-Sheva, Israel
| | - Alon Friedman
- Department of Cognitive-Neuroscience and Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Jonathan E Cohen
- Sharett Institute of Oncology, Hadassah Medical Organization, Kiryat-Hadassah, POB 12000, Jerusalem 91120, Israel.
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Activation of 5-HT2a receptors in the basolateral amygdala promotes defeat-induced anxiety and the acquisition of conditioned defeat in Syrian hamsters. Neuropharmacology 2014; 90:102-12. [PMID: 25458113 DOI: 10.1016/j.neuropharm.2014.11.016] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 11/11/2014] [Accepted: 11/22/2014] [Indexed: 01/14/2023]
Abstract
Conditioned defeat is a model in Syrian hamsters (Mesocricetus auratus) in which normal territorial aggression is replaced by increased submissive and defensive behavior following acute social defeat. The conditioned defeat response involves both a fear-related memory for a specific opponent as well as anxiety-like behavior indicated by avoidance of novel conspecifics. We have previously shown that systemic injection of a 5-HT2a receptor antagonist reduces the acquisition of conditioned defeat. Because neural activity in the basolateral amygdala (BLA) is critical for the acquisition of conditioned defeat and BLA 5-HT2a receptors can modulate anxiety but have a limited effect on emotional memories, we investigated whether 5-HT2a receptor modulation alters defeat-induced anxiety but not defeat-related memories. We injected the 5-HT2a receptor antagonist MDL 11,939 (0 mM, 1.7 mM or 17 mM) or the 5-HT2a receptor agonist TCB-2 (0 mM, 8 mM or 80 mM) into the BLA prior to social defeat. We found that injection of MDL 11,939 into the BLA impaired acquisition of the conditioned defeat response and blocked defeat-induced anxiety in the open field, but did not significantly impair avoidance of former opponents in the Y-maze. Furthermore, we found that injection of TCB-2 into the BLA increased the acquisition of conditioned defeat and increased anxiety-like behavior in the open field, but did not alter avoidance of former opponents. Our data suggest that 5-HT2a receptor signaling in the BLA is both necessary and sufficient for the development of conditioned defeat, likely via modulation of defeat-induced anxiety.
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Weckmann K, Labermaier C, Asara JM, Müller MB, Turck CW. Time-dependent metabolomic profiling of Ketamine drug action reveals hippocampal pathway alterations and biomarker candidates. Transl Psychiatry 2014; 4:e481. [PMID: 25386958 PMCID: PMC4259990 DOI: 10.1038/tp.2014.119] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 09/12/2014] [Accepted: 09/28/2014] [Indexed: 12/17/2022] Open
Abstract
Ketamine, an N-methyl-D-aspartate receptor (NMDAR) antagonist, has fast-acting antidepressant activities and is used for major depressive disorder (MDD) patients who show treatment resistance towards drugs of the selective serotonin reuptake inhibitor (SSRI) type. In order to better understand Ketamine's mode of action, a prerequisite for improved drug development efforts, a detailed understanding of the molecular events elicited by the drug is mandatory. In the present study we have carried out a time-dependent hippocampal metabolite profiling analysis of mice treated with Ketamine. After a single injection of Ketamine, our metabolomics data indicate time-dependent metabolite level alterations starting already after 2 h reflecting the fast antidepressant effect of the drug. In silico pathway analyses revealed that several hippocampal pathways including glycolysis/gluconeogenesis, pentose phosphate pathway and citrate cycle are affected, apparent by changes not only in metabolite levels but also connected metabolite level ratios. The results show that a single injection of Ketamine has an impact on the major energy metabolism pathways. Furthermore, seven of the identified metabolites qualify as biomarkers for the Ketamine drug response.
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Affiliation(s)
- K Weckmann
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
| | - C Labermaier
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
| | - J M Asara
- Division of Signal Transduction, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - M B Müller
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
| | - C W Turck
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany,Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Kraepelinstrasse 2–10, Munich 80804, Germany. E-mail:
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35
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Maintenance of dominance status is necessary for resistance to social defeat stress in Syrian hamsters. Behav Brain Res 2014; 270:277-86. [PMID: 24875769 DOI: 10.1016/j.bbr.2014.05.041] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 05/16/2014] [Accepted: 05/19/2014] [Indexed: 01/15/2023]
Abstract
Resilience is an active process that involves a discrete set of neural substrates and cellular mechanisms and enables individuals to avoid some of the negative consequences of extreme stress. We have previously shown that dominant individuals show less stress-induced changes in behavior compared to subordinates using a conditioned defeat model in male Syrian hamsters (Mesocricetus auratus). To rule out pre-existing differences between dominants and subordinates, we examined whether 14 days of dominance experience is required to reduce the conditioned defeat response and whether the development of conditioned defeat resistance correlates with defeat-induced neural activation in select brain regions. We paired hamsters in daily 5-min aggressive encounters for 1, 7, or 14 days and then exposed animals to 3, 5-min social defeat episodes. The next day animals received conditioned defeat testing which involved a 5-min social interaction test with a non-aggressive intruder. In separate animals brains were collected after social defeat for c-Fos immunohistochemistry. We found that 14-day dominants showed a decreased conditioned defeat response compared to 14-day subordinates and controls, while 1-day and 7-day dominants did not differ from their subordinate counterparts. Also, the duration of dominance relationship was associated with distinct patterns of defeat-induced neural activation such that only 14-day dominants showed elevated c-Fos immunoreactivity in the ventral medial prefrontal cortex, medial amygdala, and lateral portions of the ventral medial hypothalamus. Our data suggest that resistance to social stress develops during the maintenance of dominance relationships and is associated with experience-dependent neural plasticity in select brain regions.
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36
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Asmundson GJG, Taylor S, Bovell CV, Collimore K. Strategies for managing symptoms of anxiety. Expert Rev Neurother 2014; 6:213-22. [PMID: 16466301 DOI: 10.1586/14737175.6.2.213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The purpose of this article is to summarize strategies for effectively managing the symptoms of anxiety. The distinction between the cognitive, physiological and behavioral components of fear and anxiety is explained and various treatment targets are outlined. Empirically-supported strategies that are effective in alleviating common symptoms of anxiety are reviewed. These include various forms of psychosocial intervention (i.e., cognitive and behavioral therapies), pharmacotherapy, in addition combined treatment approaches. Expert consensus guidelines, prognostic factors, patient preferences and accessibility issues are discussed with regard to treatment selection in addition to emerging challenges in the field and future research directions.
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Affiliation(s)
- Gordon J G Asmundson
- Department of Psychology, University of Regina, Regina, Saskatchewan, S4S 0A2, Canada.
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37
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Kip KE, Rosenzweig L, Hernandez DF, Shuman A, Diamond DM, Girling SA, Sullivan KL, Wittenberg T, Witt AM, Lengacher CA, Anderson B, McMillan SC. Accelerated Resolution Therapy for treatment of pain secondary to symptoms of combat-related posttraumatic stress disorder. Eur J Psychotraumatol 2014; 5:24066. [PMID: 24959325 PMCID: PMC4014659 DOI: 10.3402/ejpt.v5.24066] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 04/12/2014] [Accepted: 04/12/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND As many as 70% of veterans with chronic pain treated within the US Veterans Administration (VA) system may have posttraumatic stress disorder (PTSD), and conversely, up to 80% of those with PTSD may have pain. We describe pain experienced by US service members and veterans with symptoms of PTSD, and report on the effect of Accelerated Resolution Therapy (ART), a new, brief exposure-based therapy, on acute pain reduction secondary to treatment of symptoms of PTSD. METHODS A randomized controlled trial of ART versus an attention control (AC) regimen was conducted among 45 US service members/veterans with symptoms of combat-related PTSD. Participants received a mean of 3.7 sessions of ART. RESULTS Mean age was 41.0 + 12.4 years and 20% were female. Most veterans (93%) reported pain. The majority (78%) used descriptive terms indicative of neuropathic pain, with 29% reporting symptoms of a concussion or feeling dazed. Mean pre-/post-change on the Pain Outcomes Questionnaire (POQ) was -16.9±16.6 in the ART group versus -0.7±14.2 in the AC group (p=0.0006). Among POQ subscales, treatment effects with ART were reported for pain intensity (effect size = 1.81, p=0.006), pain-related impairment in mobility (effect size = 0.69, p=0.01), and negative affect (effect size = 1.01, p=0.001). CONCLUSIONS Veterans with symptoms of combat-related PTSD have a high prevalence of significant pain, including neuropathic pain. Brief treatment of symptoms of combat-related PTSD among veterans by use of ART appears to acutely reduce concomitant pain.
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Affiliation(s)
- Kevin E Kip
- College of Nursing, University of South Florida, Tampa, FL, USA
| | | | | | - Amy Shuman
- Western New England University, Springfield, MA, USA
| | - David M Diamond
- Department of Psychology, University of South Florida, Tampa, FL, USA ; Department of Molecular Pharmacology and Physiology, Center for Preclinical/Clinical Research on PTSD, University of South Florida, Tampa, FL, USA
| | - Sue Ann Girling
- College of Nursing, University of South Florida, Tampa, FL, USA
| | - Kelly L Sullivan
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | | | | | | | - Brian Anderson
- Pasco County Veterans Service Office, Port Richey, FL, USA
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Neuroimaging in children, adolescents and young adults with psychological trauma. Eur Child Adolesc Psychiatry 2013; 22:745-55. [PMID: 23553572 DOI: 10.1007/s00787-013-0410-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 03/23/2013] [Indexed: 12/17/2022]
Abstract
Childhood psychological trauma is a strong predictor of psychopathology. Preclinical research points to the influence of this type of trauma on brain development. However, the effects of psychological trauma on the developing human brain are less known and a challenging question is whether the effects can be reversed or even prevented. The aim of this review is to give an overview of neuroimaging studies in traumatized juveniles and young adults up till 2012. Neuroimaging studies in children and adolescents with traumatic experiences were found to be scarce. Most studies were performed by a small number of research groups in the United States and examined structural abnormalities. The reduction in hippocampal volume reported in adults with PTSD could not be confirmed in juveniles. The most consistent finding in children and adolescents, who experienced psychological trauma are structural abnormalities of the corpus callosum. We could not identify any studies investigating treatment effects. Neuroimaging studies in traumatized children and adolescents clearly lag behind studies in traumatized adults as well as studies on ADHD and autism.
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Malan-Müller S, Seedat S, Hemmings SMJ. Understanding posttraumatic stress disorder: insights from the methylome. GENES BRAIN AND BEHAVIOR 2013; 13:52-68. [DOI: 10.1111/gbb.12102] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 11/04/2013] [Accepted: 11/05/2013] [Indexed: 12/25/2022]
Affiliation(s)
- S. Malan-Müller
- Department of Psychiatry, Faculty of Medicine and Health Sciences; Stellenbosch University; Tygerberg South Africa
| | - S. Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences; Stellenbosch University; Tygerberg South Africa
| | - S. M. J. Hemmings
- Department of Psychiatry, Faculty of Medicine and Health Sciences; Stellenbosch University; Tygerberg South Africa
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40
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Ahmadizadeh M, Ahmadi K, Anisi J, Ahmadi AB. Assessment of Cognitive Behavioral Therapy on Quality of Life of Patients with Chronic War-related Post-traumatic Stress Disorder. Indian J Psychol Med 2013; 35:341-5. [PMID: 24379492 PMCID: PMC3868083 DOI: 10.4103/0253-7176.122222] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) is the one of the most commonly observed psychiatric disorder in veterans. The condition can lead to considerable social, occupational, and interpersonal dysfunction. PTSD occurring after combat injury appears to be strongly correlated with the extent of injury, and develops over several months. Present study was designed for assessing the cognitive behavioral therapy in the quality of life (QOL) of war-related PTSD in veterans compared to control group and compare applied treatments with each other. MATERIALS AND METHODS In the present study, we assessment effects of cognitive behavioral therapy such as problem solving, exposure therapy and their combination on QOL in 120 Iranian PTSD patients veterans after Iran-Iraq war. They were randomly allocated to one of four equal interventional groups: (a) Problem solving therapy (b) exposure therapy (c) combined therapy (exposure therapy plus problem solving) (d) control group. Before and after study intervention, patients were evaluated by short form-36 (SF-36) questionnaire. RESULTS Post-test and follow-up SF-36 scores were 55.6±4 and 55.1±3.6 in exposure therapy, 50±4.4 and 56.1±3.8 in problem solving, and 48.73±3.8 and 50.9±4.2 in combined therapy. In comparing to control group, all intervention showed significant improvement in QOL in PTSD patients. CONCLUSION According to the results of the present study, behavioral therapy can improve QOL in PTSD patients.
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Affiliation(s)
| | - Khodabakhsh Ahmadi
- Behavioral Sciences Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Jafar Anisi
- Behavioral Sciences Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Amir Bahrami Ahmadi
- Occupational Medicine Research Center, Iran University of Medical Sicences, Tehran, Iran
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van der Werff SJA, Pannekoek JN, Veer IM, van Tol MJ, Aleman A, Veltman DJ, Zitman FG, Rombouts SARB, Elzinga BM, van der Wee NJA. Resting-state functional connectivity in adults with childhood emotional maltreatment. Psychol Med 2013; 43:1825-1836. [PMID: 23254143 DOI: 10.1017/s0033291712002942] [Citation(s) in RCA: 104] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Childhood emotional maltreatment (CEM) has been associated with disturbances in emotional and behavioral functioning, and with changes in regional brain morphology. However, whether CEM has any effect on the intrinsic organization of the brain is not known. In this study, we investigated the effects of CEM on resting-state functional connectivity (RSFC) using seeds in the limbic network, the default-mode network (DMN) and the salience network, and the left dorsomedial prefrontal cortex (dmPFC). Method Using 3-T magnetic resonance imaging (MRI), resting-state functional MRI (RS-fMRI) scans were obtained. We defined seeds in the bilateral amygdala, the dorsal anterior cingulate cortex (dACC), the posterior cingulate cortex (PCC) and the left dmPFC, and used these to examine whether individuals reporting CEM (n=44) differed from individuals reporting no CEM (n=44) in RSFC with other brain regions. The two groups were matched for age, gender, handedness and the presence of psychopathology. RESULTS CEM was associated with decreased RSFC between the right amygdala and the bilateral precuneus and a cluster extending from the left insula to the hippocampus and putamen. In addition, CEM was associated with decreased RSFC between the dACC and the precuneus and also frontal regions of the brain. CONCLUSIONS We found that CEM has a profound effect on RSFC in the limbic network and the salience network. Regions that show aberrant connectivity are related to episodic memory encoding, retrieval and self-processing operations.
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Affiliation(s)
- S J A van der Werff
- Department of Psychiatry, Leiden University Medical Center, The Netherlands.
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42
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Chang HA, Chang CC, Tzeng NS, Kuo TBJ, Lu RB, Huang SY. Decreased cardiac vagal control in drug-naïve patients with posttraumatic stress disorder. Psychiatry Investig 2013; 10:121-30. [PMID: 23798959 PMCID: PMC3687045 DOI: 10.4306/pi.2013.10.2.121] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Revised: 11/25/2012] [Accepted: 11/28/2012] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Decreased cardiac vagal control (CVC) has been proposed in posttraumatic stress disorder (PTSD), but the results are mixed. Analyses with larger sample sizes and better methodology are needed. METHODS Thirty-two drug-naïve survivors with current PTSD, 32 survivors without PTSD and 192 matched controls were recruited for a case-control analysis. We used the PTSD checklist-civilian version (PCL-C) to assess posttraumatic symptoms severity. Cardiac autonomic function was evaluated by measuring heart rate variability (HRV) parameters. Frequency-domain indices of HRV were obtained. The obtained results were evaluated in association with personality traits assessed by the Tridimensional Personality Questionnaire (TPQ). RESULTS PTSD patients exhibited decreased LF-HRV and HF-HRV as compared to survivors without PTSD and to matched controls. The PTSD symptoms severity was associated with reduced mean RR intervals, Var-HRV, LF-HRV and HF-HRV. The harm avoidance score (which has been suggested to be associated with serotonergic activity) was negatively correlated with Var-HRV, LF-HRV and HF-HRV. CONCLUSION These data suggest that PTSD is accompanied by decreased CVC, highlighting the importance of assessing HRV in PTSD patients. In view of the increased risk for cardiovascular diseases in these vulnerable individuals, one might consider the treatment to restore their autonomic function while reducing PTSD symptoms.
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Affiliation(s)
- Hsin-An Chang
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chuan-Chia Chang
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Nian-Sheng Tzeng
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Student Counseling Center, National Defense Medical Center, Taipei, Taiwan
| | - Terry BJ Kuo
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
| | - Ru-Band Lu
- Institute of Behavioral Medicine and Department of Psychiatry, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - San-Yuan Huang
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Increased Noradrenaline Levels in the Rostral Pons can be Reversed by M1 Antagonist in a Rat Model of Post-traumatic Stress Disorder. Neurochem Res 2013; 38:1726-33. [DOI: 10.1007/s11064-013-1076-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 05/09/2013] [Accepted: 05/11/2013] [Indexed: 10/26/2022]
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44
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Vermetten E, Olff M. Psychotraumatology in the Netherlands. Eur J Psychotraumatol 2013; 4:20832. [PMID: 23671764 PMCID: PMC3644061 DOI: 10.3402/ejpt.v4i0.20832] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 03/17/2013] [Accepted: 03/17/2013] [Indexed: 12/04/2022] Open
Abstract
The contribution to psychotrauma literature from Dutch authors has a long tradition. The relatively high lifetime prevalence of trauma and posttraumatic stress disorder (PTSD) is not unique for the Netherlands and does not fully explain the interest in trauma and its consequences. In this overview of psychotraumatology in the Netherlands, we will discuss some of the key events and processes that contribute to the current interest. We outlined the historical basis and development of the field in the Netherlands, including the impact of World War II, the effects of major man-made or natural disasters, engagement in military conflicts, as well as smaller scale traumatic events like sexual abuse and traffic accidents. The liberal and open culture may have reduced stigma to trauma, while other sociocultural aspects may have contributed to increased prevalence. Finally, we describe Dutch psychotraumatology today and how history and culture have shaped the current scientific basis.
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Affiliation(s)
- Eric Vermetten
- Military Mental Health Research Center, Ministery of Defence, Utrecht, The Netherlands
- Department of Psychiatry, University Medical Center, Utrecht, The Netherlands
| | - Miranda Olff
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, The Netherlands
- Arq Psychotrauma Expert Group, Diemen, The Netherlands
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Drury SS, Brett ZH, Henry C, Scheeringa M. The association of a novel haplotype in the dopamine transporter with preschool age posttraumatic stress disorder. J Child Adolesc Psychopharmacol 2013; 23:236-43. [PMID: 23647133 PMCID: PMC3657285 DOI: 10.1089/cap.2012.0072] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Significant evidence supports a genetic contribution to the development of posttraumatic stress disorder (PTSD). Three previous studies have demonstrated an association between PTSD and the nine repeat allele of the 3' untranslated region (3'UTR) variable number tandem repeat (VNTR) in the dopamine transporter (DAT, rs28363170). Recently a novel, functionally significant C/T single-nucleotide polymorphism (SNP) in the 3'UTR (rs27072) with putative interactions with the 3'VNTR, has been identified. To provide enhanced support for the role of DAT and striatal dopamine regulation in the development of PTSD, this study examined the impact of a haplotype defined by the C allele of rs27072 and the nine repeat allele of the 3'VNTR on PTSD diagnosis in young trauma-exposed children. METHODS DAT haplotypes were determined in 150 trauma-exposed 3-6 year-old children. PTSD was assessed with a semistructured interview. After excluding double heterozygotes, analysis was performed on 143 total subjects. Haplotype was examined in relation to categorical and continuous measures of PTSD, controlling for trauma type and race. Additional analysis within the two largest race categories was performed, as other means of controlling for ethnic stratification were not available. RESULTS The number of haplotypes (0, 1, or 2) defined by the presence of the nine repeat allele of rs28363170 (VNTR in the 3'UTR) and the C allele of rs27072 (SNP in the 3'UTR) was significantly associated with both the diagnosis of PTSD and total PTSD symptoms. Specifically, children with one or two copies of the haplotype had significantly more PTSD symptoms and were more likely to be diagnosed with PTSD than were children without this haplotype. CONCLUSIONS These findings extend previous findings associating genetic variation in the DAT with PTSD. The association of a haplotype in DAT with PTSD provides incremental traction for a model of genetic vulnerability to PTSD, a specific underlying mechanism implicating striatal dopamine regulation, and insight into potential future personalized interventions.
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Affiliation(s)
- Stacy S Drury
- Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans, LA 70112, USA.
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Fareed A, Eilender P, Haber M, Bremner J, Whitfield N, Drexler K. Comorbid Posttraumatic Stress Disorder and Opiate Addiction: A Literature Review. J Addict Dis 2013; 32:168-79. [DOI: 10.1080/10550887.2013.795467] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Covey TJ, Shucard JL, Violanti JM, Lee J, Shucard DW. The effects of exposure to traumatic stressors on inhibitory control in police officers: A dense electrode array study using a Go/NoGo continuous performance task. Int J Psychophysiol 2013; 87:363-75. [DOI: 10.1016/j.ijpsycho.2013.03.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 03/07/2013] [Accepted: 03/15/2013] [Indexed: 01/06/2023]
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Shucard JL, Cox J, Shucard DW, Fetter H, Chung C, Ramasamy D, Violanti J. Symptoms of posttraumatic stress disorder and exposure to traumatic stressors are related to brain structural volumes and behavioral measures of affective stimulus processing in police officers. Psychiatry Res 2012. [PMID: 23177923 DOI: 10.1016/j.pscychresns.2012.04.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Traumatic experiences and subsequent symptoms of posttraumatic stress disorder (PTSD) have been shown to affect brain structure and function. Although police officers are routinely exposed to traumatic events, the neurobehavioral effects of trauma in this population have rarely been studied. In this study, police officers with exposure to trauma-related stressors underwent structural magnetic resonance imaging (MRI). They also provided valence and arousal ratings of neutral and negative (trauma-related) picture stimuli. Relationships were examined among PTSD symptom scores (avoidance, reexperiencing, and hyperarousal), picture ratings, structural MRI measures, and number of trauma exposures. We hypothesized that greater PTSD symptomatology would be related to higher valence and arousal ratings of trauma-related stimuli and to decreased volume of limbic and Basal ganglia structures. Results revealed that officers with higher reexperiencing scores tended to have higher arousal ratings of negative pictures and reduced amygdala, thalamus, and globus pallidus volumes. There was a trend toward higher reexperiencing and reduced hippocampal volume. The frequency of traumatic exposures was also related to MRI measures of atrophy and to increased PTSD symptomatology. These findings suggest that chronic reexperiencing of traumatic events may result in volumetric reductions in brain structures associated with autonomic arousal and the acquisition of conditioned fear.
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Affiliation(s)
- Janet Louise Shucard
- Division of Cognitive and Behavioral Neurosciences, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14203, USA.
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Fani N, Jovanovic T, Ely TD, Bradley B, Gutman D, Tone EB, Ressler KJ. Neural correlates of attention bias to threat in post-traumatic stress disorder. Biol Psychol 2012; 90:134-42. [PMID: 22414937 PMCID: PMC3340884 DOI: 10.1016/j.biopsycho.2012.03.001] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Revised: 02/28/2012] [Accepted: 03/02/2012] [Indexed: 11/20/2022]
Abstract
Attentional biases have been proposed to contribute to symptom maintenance in posttraumatic stress disorder (PTSD), although the neural correlates of these processes have not been well defined; this was the goal of the present study. We administered an attention bias task, the dot probe, to a sample of 37 (19 control, 18 PTSD+) traumatized African-American adults during fMRI. Compared to controls, PTSD+ participants demonstrated increased activation in the dorsolateral prefrontal cortex (dlPFC) in response to threat cue trials. In addition, attentional avoidance of threat corresponded with increased ventrolateral prefrontal cortex (vlPFC) and dorsal anterior cingulate cortex (dACC) activation in the PTSD group, a pattern that was not observed in controls. These data provide evidence to suggest that relative increases in dlPFC, dACC and vlPFC activation represent neural markers of attentional bias for threat in individuals with PTSD, reflecting selective disruptions in attentional control and emotion processing networks in this disorder.
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Affiliation(s)
- Negar Fani
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30322, USA.
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50
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Olff M. Bonding after trauma: on the role of social support and the oxytocin system in traumatic stress. Eur J Psychotraumatol 2012; 3:EJPT-3-18597. [PMID: 22893838 PMCID: PMC3402118 DOI: 10.3402/ejpt.v3i0.18597] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This paper outlines the state of affairs in psychobiological research on psychotrauma and PTSD with a focus on the role of the oxytocin system in traumatic stress. With a high prevalence of trauma and PTSD in the Netherlands, new preventive and therapeutic interventions are needed. The focus is on the role of social support and bonding in coming to grips with psychological trauma, about the oxytocin system as a basis for reducing the stress response and creating a feeling of bonding, about binding words to painful emotions in psychotherapy, and about the bonds between researchers and clinicians.
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Affiliation(s)
- Miranda Olff
- Department of Psychiatry, Academic Medical Center, University of Amsterdam & Arq Psychotrauma Expert Group, Diemen, The Netherlands
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