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Li Q, Zhang X, Yang X, Pan N, He M, Suo X, Li X, Gong Q, Wang S. Pre-COVID resting-state brain activity in the fusiform gyrus prospectively predicts social anxiety alterations during the pandemic. J Affect Disord 2024; 344:380-388. [PMID: 37838273 DOI: 10.1016/j.jad.2023.10.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 09/24/2023] [Accepted: 10/09/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND Social anxiety (SA) has been linked to the coronavirus disease 2019 (COVID-19) pandemic, but the neurobiopsychological mechanisms underlying this relationship remain unclear. This study aimed to elucidate the neurofunctional markers for COVID-induced SA development and the potential role of COVID-related posttraumatic stress symptoms (PTSS) in the brain-SA alterations link. METHODS Before the COVID-19 pandemic (T1), 100 general college students underwent resting-state magnetic resonance imaging and behavioral tests. During the period of community-level outbreaks (T2), these students were re-contacted to undergo follow-up behavioral assessments. RESULTS Whole-brain correlation and prediction analyses found that pre-pandemic spontaneous neural activity (measured by fractional amplitude of low-frequency fluctuations) in the right fusiform gyrus (FG) was positively correlated to SA alterations (T2 - T1). Mediation analyses revealed that COVID-specific PTSS mediated the effects of right FG on SA alterations. LIMITATIONS The results should be interpreted carefully because only one-session neuroimaging data in a sample of normal adults were included. CONCLUSIONS The results provide evidence for neurofunctional markers of COVID-induced SA and may help develop targeted brain-based interventions that reduce SA.
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Affiliation(s)
- Qingyuan Li
- Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China; Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xun Zhang
- Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China
| | - Xun Yang
- School of Public Affairs, Chongqing University, Chongqing, China
| | - Nanfang Pan
- Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China
| | - Min He
- Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China
| | - Xueling Suo
- Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China
| | - Xiao Li
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qiyong Gong
- Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China; Department of Radiology, West China Xiamen Hospital of Sichuan University, Xiamen, China.
| | - Song Wang
- Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China.
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Han D, Shi Y, Han F. The effects of orexin-A and orexin receptors on anxiety- and depression-related behaviors in a male rat model of post-traumatic stress disorder. J Comp Neurol 2021; 530:592-606. [PMID: 34387361 DOI: 10.1002/cne.25231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 08/08/2021] [Accepted: 08/09/2021] [Indexed: 12/14/2022]
Abstract
Orexin neurons play an important role in stress-related mental disorders including post-traumatic stress disorder (PTSD). Anxiety- and depression-related symptoms commonly occur in combination with PTSD. However, the role of the orexin system in mediating alterations in these affective symptoms remains unclear. The medial prefrontal cortex (mPFC) is implicated in both cognitive and emotional processing. In the present study, we investigated anxiety- and depression-related behavioral changes using the elevated plus maze, the sucrose preference test, and the open field test in male rats with single prolonged stress (SPS) induced-PTSD. The expression of orexin-A in the hypothalamus and orexin receptors (OX1R and OX2R) in the mPFC was detected and quantified by immunohistochemistry, western blotting, and real-time polymerase chain reaction. We found that the SPS rats exhibited enhanced levels of anxiety, reduced exploratory activities, and anhedonia. Furthermore, SPS resulted in reductions in the expression of orexin-A in the hypothalamus and the increased the expression of OX1R in the mPFC. The intracerebroventricular administration of orexin-A alleviated behavioral changes in SPS rats and partly restored the increased levels of OX1R in the mPFC. These results suggest that the orexin system plays a role in the anxiety- and depression-related symptoms observed in PTSD.
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Affiliation(s)
- Dan Han
- PTSD Laboratory, Department of Histology and Embryology, Basic Medical Sciences College, China Medical University, Shenyang, China.,Department of Neonatology, The First Hospital of China Medical University, Shenyang, China
| | - Yuxiu Shi
- PTSD Laboratory, Department of Histology and Embryology, Basic Medical Sciences College, China Medical University, Shenyang, China
| | - Fang Han
- PTSD Laboratory, Department of Histology and Embryology, Basic Medical Sciences College, China Medical University, Shenyang, China
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The hidden burden of social anxiety disorder in U.S. military veterans: Results from the National Health and Resilience in Veterans Study. J Affect Disord 2021; 291:9-14. [PMID: 34022553 DOI: 10.1016/j.jad.2021.04.088] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 02/08/2021] [Accepted: 04/25/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Social anxiety disorder (SAD) is a chronic and disabling psychiatric disorder associated with low levels of help-seeking. To date, however, scarce research has examined the epidemiology of SAD in veterans. This study examined the prevalence, comorbidities and incremental burden of SAD in relation to suicidality and functioning in a representative sample of U.S. military veterans. METHODS A nationally representative sample of 3,157 U.S. veterans completed a web survey containing measures of SAD symptoms, trauma history, psychiatric history and functioning. Multivariable analyses were conducted to examine associations between SAD and psychiatric comorbidities, suicidality and functioning. RESULTS A total 9.5% (n = 272) of the sample screened positive for lifetime SAD. Veterans with SAD were more likely than those without SAD to be younger, female, single, racial/ethnic minorities and to have experienced childhood abuse. They also had substantially elevated rates of comorbid psychiatric disorders, particularly lifetime major depression (odds ratio [OR]=5.8) and posttraumatic stress disorder (OR=3.1), as well as current suicidal ideation (OR=3.3). Veterans with SAD scored lower on measures of functioning, particularly social, emotional and mental health functioning (d's=0.21-0.34). LIMITATIONS Data were collected cross-sectionally using self-report. CONCLUSIONS SAD in U.S. veterans is prevalent and associated with psychiatric comorbidities, functional impairment and a more than 3-fold greater risk for suicidal ideation . Given that SAD is associated with low treatment seeking and engagement, it may be undetected and undertreated relative to other psychiatric morbidities. These results underscore the importance of screening, monitoring and treating SAD in this population along with other prevalent mental disorders.
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Meyer MAA, Anstötz M, Ren LY, Fiske MP, Guedea AL, Grayson VS, Schroth SL, Cicvaric A, Nishimori K, Maccaferri G, Radulovic J. Stress-related memories disrupt sociability and associated patterning of hippocampal activity: a role of hilar oxytocin receptor-positive interneurons. Transl Psychiatry 2020; 10:428. [PMID: 33311459 PMCID: PMC7733596 DOI: 10.1038/s41398-020-01091-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 10/17/2020] [Accepted: 10/29/2020] [Indexed: 02/07/2023] Open
Abstract
In susceptible individuals, memories of stressful experiences can give rise to debilitating socio-affective symptoms. This occurs even when the ability to retrieve such memories is limited, as seen in patients suffering from traumatic amnesia. We therefore hypothesized that the encoding, rather than retrieval, mechanisms of stress-related memories underlie their impact on social and emotional behavior. To test this hypothesis, we used combinations of stress-enhanced and state-dependent fear conditioning, which engage different encoding mechanisms for the formation of stress-related memories. We found that the encoding of stress-enhanced state-dependent memories robustly and sex specifically impairs sociability in male mice and disrupts the asymmetry of dentate gyrus (DG)/CA3 activity accompanying social interactions. These deficits were restored by chemogenetic inactivation of oxytocin receptor-positive interneurons localized in the hilus (Oxtr-HI), and by inactivation of dorsohippocampal efferents to the caudal lateral septum. Together, our data suggest that disrupted patterning of dorsohippocampal DG/CA3 activity underlies stress-induced sociability deficits, and that Oxtr-HI can be a cellular target for improving these deficits.
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Affiliation(s)
- Mariah A. A. Meyer
- grid.16753.360000 0001 2299 3507Department of Psychiatry and Behavioral Sciences, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611 USA
| | - Max Anstötz
- grid.16753.360000 0001 2299 3507Department of Physiology, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611 USA
| | - Lynn Y. Ren
- grid.16753.360000 0001 2299 3507Department of Psychiatry and Behavioral Sciences, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611 USA
| | - Michael P. Fiske
- grid.16753.360000 0001 2299 3507Department of Physiology, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611 USA
| | - Anita L. Guedea
- grid.16753.360000 0001 2299 3507Department of Psychiatry and Behavioral Sciences, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611 USA
| | - Viktoriya S. Grayson
- grid.16753.360000 0001 2299 3507Department of Psychiatry and Behavioral Sciences, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611 USA
| | - Samantha L. Schroth
- grid.16753.360000 0001 2299 3507Department of Psychiatry and Behavioral Sciences, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611 USA
| | - Ana Cicvaric
- grid.16753.360000 0001 2299 3507Department of Psychiatry and Behavioral Sciences, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611 USA
| | - Katsuhiko Nishimori
- grid.411582.b0000 0001 1017 9540Department of Obesity and Internal Inflammation, Fukushima Medical University, Fukushima, 960-1295 Japan
| | - Gianmaria Maccaferri
- grid.16753.360000 0001 2299 3507Department of Physiology, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611 USA
| | - Jelena Radulovic
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Feinberg School of Medicine, Chicago, IL, 60611, USA. .,Department of Physiology, Northwestern University, Feinberg School of Medicine, Chicago, IL, 60611, USA. .,Department of Neuroscience and Department of Psychiatry, Albert Einstein College of Medicine, The Bronx, NY, 10461, USA.
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Social anxiety among unaccompanied minor refugees in Norway.The association with pre-migration trauma and post-migration acculturation related factors. J Psychosom Res 2020; 136:110175. [PMID: 32652372 DOI: 10.1016/j.jpsychores.2020.110175] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 05/30/2020] [Accepted: 06/14/2020] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Unaccompanied refugee minors (URMs), are at high risk for mental health problems, yet there is a lack of knowledge about social anxiety among these youths. The aim of this study was to investigate symptoms of social anxiety among URMs resettled in Norway, and the combined effects of pre-migration traumatic events, post-migration acculturation related factors (perceived discrimination and culture competence in relation both to the heritage and majority cultures) and demographic background variables, over and above the effect of concurrent depressive symptoms. METHODS Cross-sectional self-report questionnaire data were collected from 557 URMs from 31 different countries, mainly from Afghanistan (49,6%), Somalia (11,1%), and Iraq (7,0%). RESULTS The findings from structural equation model (SEM) showed that the effect of pre-migration traumatic events on social anxiety was non-significant (β = 0.001, p = .09), while perceived discrimination and majority culture competence had unique effects on social anxiety (β = 0.39, p < .001 and β = -0.12, p = .008, respectively) over and above depressive symptoms (β = 0.30, p < .001). CONCLUSIONS The findings show that factors of the current socio-cultural developmental context rather than pre-migration war-related traumatic events the youths experienced before migration accounts for variation in social anxiety. Potential practical implications of the findings for social workers, educational staff and clinicians are discussed.
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Bjornsson AS, Hardarson JP, Valdimarsdottir AG, Gudmundsdottir K, Tryggvadottir A, Thorarinsdottir K, Wessman I, Sigurjonsdottir Ó, Davidsdottir S, Thorisdottir AS. Social trauma and its association with posttraumatic stress disorder and social anxiety disorder. J Anxiety Disord 2020; 72:102228. [PMID: 32361167 DOI: 10.1016/j.janxdis.2020.102228] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 04/14/2020] [Accepted: 04/14/2020] [Indexed: 11/26/2022]
Abstract
The key characteristic of a traumatic event as defined by the Diagnostic and Mental Manual of Mental Disorders (DSM) seems to be a threat to life. However, evidence suggests that other types of threats may play a role in the development of PTSD and other disorders such as social anxiety disorder (SAD). One such threat is social trauma, which involves humiliation and rejection in social situations. In this study, we explored whether there were differences in the frequency, type and severity of social trauma endured by individuals with a primary diagnosis of SAD (n = 60) compared to a clinical control group of individuals with a primary diagnosis of obsessive compulsive disorder (OCD, n = 19) and a control group of individuals with no psychiatric disorders (n = 60). The results showed that most participants in this study had experienced social trauma. There were no clear differences in the types of experiences between the groups. However, one third of participants in the SAD group (but none in the other groups) met criteria for PTSD or suffered from clinically significant PTSD symptoms in response to their most significant social trauma. This group of SAD patients described more severe social trauma than other participants. This line of research could have implications for theoretical models of both PTSD and SAD, and for the treatment of individuals with SAD suffering from PTSD after social trauma.
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Affiliation(s)
| | | | | | | | | | | | - Inga Wessman
- Department of Psychology, University of Iceland, Iceland
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Goode TD, Acca GM, Maren S. Threat imminence dictates the role of the bed nucleus of the stria terminalis in contextual fear. Neurobiol Learn Mem 2020; 167:107116. [PMID: 31740383 PMCID: PMC6980749 DOI: 10.1016/j.nlm.2019.107116] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 11/09/2019] [Accepted: 11/13/2019] [Indexed: 12/24/2022]
Abstract
Recent work indicates that the bed nucleus of the stria terminalis (BNST) is critically involved in the regulation of conditioned fear responses to unpredictable threats. Here we examined whether the involvement of the BNST in contextual fear conditioning in male rats depends on the imminence of shock after placement in the conditioning chamber. Specifically, we hypothesized that the BNST supports contextual freezing after conditioning with delayed, but not imminent, footshock (relative to placement in the context). Rats were implanted with cannulae targeting the BNST and underwent a contextual fear conditioning procedure in which a single footshock unconditioned stimulus (US) was delivered either 1 min or 9 min after the rat was placed in the context; the rats received a total of four identical conditioning sessions over two days, all with equivalent exposure to the context. Contexts associated with either imminent or delayed US onsets produced distinct patterns of freezing and shock-induced activity but freezing in each case was context-dependent. Reversible inactivation of the BNST reduced the expression of contextual freezing in the context paired with delayed (9 min), but not imminent (1 min), footshock onset. Implications of these data are discussed in the light of recent conceptualizations of BNST function, as well as for anxiety behaviors.
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Affiliation(s)
- Travis D Goode
- Department of Psychological and Brain Sciences and Institute for Neuroscience, Texas A&M University, College Station, TX 77843-3474, USA
| | - Gillian M Acca
- Department of Psychological and Brain Sciences and Institute for Neuroscience, Texas A&M University, College Station, TX 77843-3474, USA
| | - Stephen Maren
- Department of Psychological and Brain Sciences and Institute for Neuroscience, Texas A&M University, College Station, TX 77843-3474, USA.
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Tribble JE, Fanselow MS. Pair-housing rats does not protect from behavioral consequences of an acute traumatic experience. Behav Neurosci 2019; 133:232-239. [PMID: 30628802 DOI: 10.1037/bne0000295] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Posttraumatic stress disorder (PTSD) is an extremely debilitating disease with a broad array of associated symptoms, making the disorder difficult to diagnose and treat. In humans, patients seem to benefit from group therapy or other means of promoting social behavior. To test these effects on our rodent model of PTSD, adult, male rats were housed in either single or pair conditions prior to and during an acute stressor to induce PTSD-like behaviors in these rats. Subsequently, rats were assessed for PTSD-like symptoms to determine the effect of social housing on stress-induced phenotypes. Posttrauma phenotypes, including enhanced fear conditioning and anxiety-related behavior, persisted regardless of the animal's housing condition. It is possible that any housing driven improvements to stress-induced phenotypes would require longer periods of pair housing than were used in these experiments. Although PTSD patients show improved health outcomes following social interaction or group therapy, the fear and anxiety phenotypes seen following an acute stressor in an animal model of the disease endured despite an animal's housing condition. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Lenz AS, Luo Y. Differential Estimation of Treatment Effect Between Clinician-Administered and Self-Reported PTSD Assessments. JOURNAL OF COUNSELING AND DEVELOPMENT 2019. [DOI: 10.1002/jcad.12230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- A. Stephen Lenz
- Department of Counseling and Educational Psychology, Texas A&M University-Corpus Christi
| | - Ye Luo
- Department of Counseling and Educational Psychology, Texas A&M University-Corpus Christi
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Knowles KA, Sripada RK, Defever M, Rauch SAM. Comorbid mood and anxiety disorders and severity of posttraumatic stress disorder symptoms in treatment-seeking veterans. PSYCHOLOGICAL TRAUMA-THEORY RESEARCH PRACTICE AND POLICY 2018; 11:451-458. [PMID: 29963890 DOI: 10.1037/tra0000383] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Comorbidity is the rule and not the exception among veterans with posttraumatic stress disorder (PTSD). Examining comorbidities in a veteran population allows us to better understand veterans' symptoms and recognize when mental health treatment may need to be tailored to other co-occurring issues. This article evaluates comorbid mood and anxiety disorders and PTSD symptom severity in a large sample of veterans from multiple eras of service, including the recent wars in Iraq and Afghanistan. METHOD The current study used data from veterans who sought treatment for PTSD at a VA PTSD Clinical Team from 2005 to 2013. Veterans were assessed for PTSD, mood, and anxiety disorders using a structured clinical interview and completed self-report symptom measures as part of the PTSD clinic intake procedure. A total of 2,460 veterans were evaluated, and 867 met diagnostic criteria for PTSD. RESULTS Veterans with PTSD were significantly more likely than those without PTSD to be diagnosed with social anxiety disorder and obsessive-compulsive disorder, but significantly less likely to be diagnosed with depression. In addition, veterans who had at least one comorbid diagnosis in addition to PTSD reported significantly higher PTSD symptom severity than veterans with PTSD alone. PTSD symptom severity also varied by era of service. CONCLUSION These results suggest that among veterans seeking treatment for PTSD, comorbid mood and anxiety disorders may be associated with greater severity of PTSD symptoms. Future work is needed to determine the impact of specific comorbidities on trauma-focused treatment outcomes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Klaric M, Lovric S, Kresic Coric M, Galic K, Coric S, Franciskovic T. Psychiatric comorbidity and PTSD-related health problems in war veterans: Cross-sectional study. THE EUROPEAN JOURNAL OF PSYCHIATRY 2017. [DOI: 10.1016/j.ejpsy.2017.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Johnson SU, Hoffart A, Nordahl HM, Wampold BE. Metacognitive therapy versus disorder-specific CBT for comorbid anxiety disorders: A randomized controlled trial. J Anxiety Disord 2017. [PMID: 28651207 DOI: 10.1016/j.janxdis.2017.06.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Few studies have compared the effects of Metacognitive therapy (MCT) and Cognitive behavioral therapy (CBT) for comorbid anxiety disorders. In the current study we compared CBT and MCT for heterogeneous anxiety disorders in a residential setting. Ninety patients with a primary diagnosis of Post Traumatic Stress Disorder, Social Phobia or Panic disorder, with and without Agoraphobia, were randomized to either CBT or MCT. Patients were assessed at pre-treatment, post-treatment and one-year follow-up. Primary outcome measures were Beck Anxiety Inventory and ADIS IV and secondary outcome measures were SCID II, Beck Depression Inventory, Penn State Worry Questionnaire, The Symptom Checklist-90 and the Inventory of Interpersonal Problems-64. Treatment fidelity was satisfactory and therapist credibility was equal in both treatments. There was a significant difference in the level of anxiety favouring MCT at post-treatment (d=0.7), but there were no differences at one-year follow-up, mainly due to a further improvement in the CBT group during the follow-up period. Both treatments were efficacious. No differences in effect on comorbid diagnoses and symptoms were found, but MCT produced larger change in personality problems. MCT seems to have a more rapid effect on anxiety symptoms, but there were no significant differences in the long term for patients with comorbid anxiety disorders.
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Affiliation(s)
- Sverre Urnes Johnson
- Modum Bad Psychiatric Center, Vikersund, Norway; University of Oslo, Department of Psychology, Norway.
| | - Asle Hoffart
- Modum Bad Psychiatric Center, Vikersund, Norway; University of Oslo, Department of Psychology, Norway.
| | - Hans M Nordahl
- Norwegian University of Science and Technology, Institute of Mental Health, Norway; St. Olavs Hospital, Div of Psychiatry, Nidaros DPS, 7006 Trondheim.
| | - Bruce E Wampold
- Modum Bad Psychiatric Center, Vikersund, Norway; University of Wisconsin-Madison, USA.
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Etingen B, Locatelli SM, Miskevics S, LaVela SL. Examining the relationship between post-traumatic stress disorder and social participation among Veterans with spinal cord injuries and disorders. Disabil Rehabil 2017; 40:2637-2643. [PMID: 28743195 DOI: 10.1080/09638288.2017.1355938] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE The objectives of this study were to examine differences in social participation among Veterans with spinal cord injuries/disorders with and without post-traumatic stress disorder, and determine if lower social participation was independently associated with having post-traumatic stress disorder. METHODS A cross-sectional mailed national survey was sent to a national sample of Veterans with spinal cord injuries/disorders who received prior-year Veterans Affairs healthcare. Surveys provided data on: demographics, health conditions, injury characteristics, and social participation. Analyses included bivariate comparisons, and multivariate logistic regression to determine if lower social participation was independently associated with post-traumatic stress disorder. RESULTS Veterans with (vs. without) post-traumatic stress disorder (n = 896) reported lower social participation (40.2 vs. 43.9, p < 0.0001). Multivariate analyses showed that longer duration of injury (OR = 0.98, 95% CI: 0.97-1.00, p = 0.04) and white race (OR = 0.62, 95% CI: 0.38-1.01, p = 0.05) were associated with lower odds of post-traumatic stress disorder, while a greater number of health conditions (OR = 1.43, 95% CI: 1.25-1.64, p < 0.0001) was associated with greater odds. When controlling for covariates, lower social participation was independently associated with post-traumatic stress disorder (OR = 0.94, 95% CI: 0.90-0.98, p = 0.003). CONCLUSIONS Results indicate post-traumatic stress disorder is associated with lower social participation in Veterans with spinal cord injuries/disorders, independent of other factors that may impact participation. Efforts to screen for and treat post-traumatic stress disorder among persons with spinal cord injuries/disorders, regardless of injury-specific factors, are needed to improve participation. Implications for Rehabilitation Individuals with spinal cord injuries/disorders often have post-traumatic stress disorder; in Veterans with spinal cord injuries/disorders this may be compounded by trauma incurred through military experiences. Social participation, an important aspect of rehabilitation and community integration following spinal cord injury or disorder, may be hindered by symptoms of post-traumatic stress disorder. Our data show that post-traumatic stress disorder is associated with lower social participation in Veterans with spinal cord injuries/disorders, independent of other factors that may impact participation. These results indicate that efforts to screen for and treat post-traumatic stress disorder among persons with spinal cord injuries/disorders, regardless of injury-specific factors, are needed to improve participation in this patient population.
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Affiliation(s)
- Bella Etingen
- a Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research and Development, Department of Veterans Affairs , Hines VA Hospital , Hines , IL , USA
| | - Sara M Locatelli
- a Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research and Development, Department of Veterans Affairs , Hines VA Hospital , Hines , IL , USA
| | - Scott Miskevics
- a Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research and Development, Department of Veterans Affairs , Hines VA Hospital , Hines , IL , USA
| | - Sherri L LaVela
- a Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research and Development, Department of Veterans Affairs , Hines VA Hospital , Hines , IL , USA.,b Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine , Northwestern University , Chicago , IL , USA
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Whealin JM, Jenchura EC, Wong AC, Zulman DM. How Veterans With Post-Traumatic Stress Disorder and Comorbid Health Conditions Utilize eHealth to Manage Their Health Care Needs: A Mixed-Methods Analysis. J Med Internet Res 2016; 18:e280. [PMID: 27784650 PMCID: PMC5103157 DOI: 10.2196/jmir.5594] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 03/29/2016] [Accepted: 04/13/2016] [Indexed: 11/30/2022] Open
Abstract
Background Mental health conditions are prevalent among US veterans and pose a number of self-management and health care navigation challenges. Post-Traumatic Stress Disorder (PTSD) with comorbid chronic medical conditions (CMCs) is especially common, in both returning Iraq or Afghanistan and earlier war-era veterans. Patient-facing electronic health (eHealth) technology may offer innovative strategies to support these individuals’ needs. Objective This study was designed to identify the types of eHealth tools that veterans with PTSD and comorbid CMCs use, understand how they currently use eHealth technology to self-manage their unique health care needs, and identify new eHealth resources that veterans feel would empower them to better manage their health care. Methods A total of 119 veterans with PTSD and at least one CMC who have used the electronic personal health record system of the US Department of Veterans Affairs (VA) responded to a mailed survey about their chronic conditions and preferences related to the use of technology. After the survey, 2 focus groups, stratified by sex, were conducted with a subgroup of patients to explore how veterans with PTSD and comorbid CMCs use eHealth technology to support their complex health care needs. Focus groups were transcribed verbatim and analyzed using standard content analysis methods for coding textual data, guided by the “Fit between Individual, Task, and Technology” framework. Results Survey respondents had a mean age of 64.0 (SD 12.0) years, 85.1% (97/114) were male, 72.4% (84/116) were white, and 63.1% (70/111) had an annual household income of < US $50,000. Mean score on a measure of eHealth literacy was 27.7 (SD 9.8). Of the respondents, 44.6% (50/112) used health-related technology 1 to 3 times per month and 21.4% (24/112) used technology less than once per month. Veterans reported using technology most often to search for health information (78.9%, 90/114), communicate with providers (71.1%, 81/114), and track medications (64.9%, 74/114). Five major themes emerged that describe how eHealth technology influences veterans with PTSD and comorbid CMCs: (1) interactions with social support, (2) condition management, (3) access to and communication with providers, (4) information access, and (5) coordination of care. Conclusions The “Fit between Individual, Task, and Technology” model provided a useful framework to examine the clinical tasks that arose for veterans and their resourceful adoption of eHealth tools. This study suggests that veterans who use the Web are eager to incorporate eHealth technology into their care and self-management activities. Findings illustrate a number of ways in which the VA and eHealth technology developers can refine existing applications, develop new resources, and better promote tools that address challenges experienced by veterans with PTSD and comorbid CMCs.
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Affiliation(s)
- Julia M Whealin
- Clinical Informatics Service, VA Pacific Island Health Care System, Honolulu, HI, United States.
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A single prolonged stress paradigm produces enduring impairments in social bonding in monogamous prairie voles. Behav Brain Res 2016; 315:83-93. [PMID: 27522019 DOI: 10.1016/j.bbr.2016.08.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 08/07/2016] [Accepted: 08/09/2016] [Indexed: 12/26/2022]
Abstract
Traumatic events such as natural disasters, violent crimes, tragic accidents, and war, can have devastating impacts on social relationships, including marital partnerships. We developed a single prolonged stress (SPS) paradigm, which consisted of restraint, forced swimming, and ether anesthesia, to establish an animal model relevant to post-traumatic stress disorder. We applied a SPS paradigm to a monogamous rodent, the prairie vole (Microtus ochrogaster) in order to determine whether a traumatic event affects the establishment of pair bonds. We did not detect effects of the SPS treatment on anhedonic or anxiety-like behavior. Sham-treated male voles huddled with their partner females, following a 6day cohabitation, for a longer duration than with a novel female, indicative of a pair bond. In contrast, SPS-treated voles indiscriminately huddled with the novel and partner females. Interestingly, the impairment of pair bonding was rescued by oral administration of paroxetine, a selective serotonin reuptake inhibitor (SSRI), after the SPS treatment. Immunohistochemical analyses revealed that oxytocin immunoreactivity (IR) was significantly decreased in the supraoptic nucleus (SON), but not in the paraventricular nucleus (PVN), 7days after SPS treatment, and recovered 14days after SPS treatment. After the presentation of a partner female, oxytocin neurons labeled with Fos IR was significantly increased in SPS-treated voles compared with sham-treated voles regardless of paroxetine administration. Our results suggest that traumatic events disturb the formation of pair bond possibly through an interaction with the serotonergic system, and that SSRIs are candidates for the treatment of social problems caused by traumatic events. Further, a vole SPS model may be useful for understanding mechanisms underlying the impairment of social bonding by traumatic events.
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