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Nuechterlein KH, Nasrallah H, Velligan D. Measuring Cognitive Impairments Associated With Schizophrenia in Clinical Practice: Overview of Current Challenges and Future Opportunities. Schizophr Bull 2024:sbae051. [PMID: 39088730 DOI: 10.1093/schbul/sbae051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/03/2024]
Abstract
BACKGROUND Cognitive impairment associated with schizophrenia (CIAS) negatively impacts daily functioning, quality of life, and recovery, yet effective pharmacotherapies and practical assessments for clinical practice are lacking. Despite the pivotal progress made with establishment of the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Consensus Cognitive Battery (MCCB) for clinical research, implementation of the full MCCB is too time-consuming and cost-ineffective for most clinicians in clinical practice. STUDY DESIGN Here we discuss current assessments in relation to delivery format (interview-based and performance-based), validity, ease of use for clinicians and patients, reliability/reproducibility, cost-effectiveness, and suitability for clinical implementation. Key challenges and future opportunities for improving cognitive assessments are also presented. STUDY RESULTS Current assessments that require 30 min to complete would have value in clinical settings, but the associated staff training and time required might preclude their application in most clinical settings. Initial profiling of cognitive deficits may require about 30 min to assist in the selection of evidence-based treatments; follow-up monitoring with brief assessments (10-15 min in duration) to detect treatment-related effects on global cognition may complement this approach. Guidance on validated brief cognitive tests for the strategic monitoring of treatment effects on CIAS is necessary. CONCLUSIONS With increased advancements in technology-based and remote assessments, development of validated formats of remote and in-person assessment, and the necessary training models and infrastructure required for implementation, are likely to be of increasing clinical relevance for future clinical practice.
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Affiliation(s)
- Keith H Nuechterlein
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA
| | - Henry Nasrallah
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati School of Medicine, Cincinnati, OH
| | - Dawn Velligan
- Division of Schizophrenia and Related Disorders, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, San Antonio, TX
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2
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Molero-Zafra M, Fernández-García O, Mitjans-Lafont MT, Pérez-Marín M, Hernández-Jiménez MJ. Psychological intervention in women victims of childhood sexual abuse: a randomized controlled clinical trial comparing EMDR psychotherapy and trauma-focused cognitive behavioral therapy. Front Psychiatry 2024; 15:1360388. [PMID: 38868491 PMCID: PMC11167727 DOI: 10.3389/fpsyt.2024.1360388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 05/03/2024] [Indexed: 06/14/2024] Open
Abstract
Introduction Childhood sexual abuse persists as a painful societal reality, necessitating responses from institutions and healthcare professionals to prevent and address its severe long-term consequences in victims. This study implements an intervention comprising two psychotherapeutic approaches recommended by the WHO and international clinical guidelines for addressing short-, medium-, and long-term posttraumatic symptomatology: Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) and Eye Movement Desensitization and Reprocessing (EMDR). Both approaches are adapted from group formats for implementation in small online groups via Zoom. Methods The impact of both therapeutic approaches on trauma improvement was assessed in a sample of 19 women who were victims of childhood sexual abuse through a Randomized Clinical Trial comparing EMDR Psychotherapy and Trauma-Focused Cognitive Behavioral Therapy after a baseline period. Intra and inter comparison were made using statistics appropriate to the sample. Results Both therapeutic approaches significantly reduced symptomatology across various evaluated variables, suggesting their efficacy in improving the quality of life for these individuals. Following CBT-FT treatment, patients exhibited enhanced emotional regulation, reduced reexperiencing, and avoidance. The EMDR group, utilizing the G-TEP group protocol, significantly improved dissociation, along with other crucial clinical variables and the perception of quality of life. Discussion Although the limitations of this study must be taken into account due to the size of the sample and the lack of long-term follow-up, the results align with existing scientific literature, underscoring the benefits of trauma-focused psychological treatments. The online group format appears promising for enhancing the accessibility of psychological treatment for these women. Furthermore, the differential outcomes of each treatment support recent research advocating for the inclusion of both approaches for individuals with trauma-related symptomatology. Ethics and dissemination The study has been approved by the Ethics Committee of the Valencian International University (VIU) (Valencia, Spain) (Ref. CEID2021_07). The results will be submitted for publication in peer-reviewed journals and disseminated to the scientific community. Clinical trial registration https://clinicaltrials.gov/ct2/show/NCT04813224, identifier NCT04813224.
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3
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Gielkens EMJ, Rossi G, van Alphen SPJ, Sobczak S. A First Exploration: Can Eye Movement Desensitization and Reprocessing Improve Cognition in Older Adults With Posttraumatic Stress Disorder? J Geriatr Psychiatry Neurol 2024; 37:206-221. [PMID: 37869986 DOI: 10.1177/08919887231207639] [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] [Indexed: 10/24/2023]
Abstract
OBJECTIVES In older adults, PTSD is associated with decreased verbal learning and executive dysfunction. Therefore, feasibility of EMDR-treatment to improve cognitive performance in older adults with PTSD was examined. Additionally, we investigated pre-treatment correlation with often co-occurring risk factors for cognitive decline (sleep problems, depressive disorder, physical inactivity, childhood traumatic events). DESIGN Multicenter design with pre-post measurements. SETTING Psychiatric Dutch hospitals Mondriaan Mental Health Center and Altrecht. PARTICIPANTS 22 treatment-seeking PTSD-outpatients (60-84 years). INTERVENTION Weekly one-hour EMDR session during 3, 6, or 9 months. MEASUREMENTS PTSD was assessed with Clinician-Administered PTSD-scale for DSM-5 (CAPS-5). Verbal learning memory was measured with Auditory Verbal Learning Test (RAVLT), interference with Stroop Colour-Word Test (SCWT) and working memory with Wechsler Adult Intelligence Scale-Digit Span (WAIS-IV-DS). RESULTS A Linear mixed-model showed significant improvement on RAVLT immediate-recall (F (1, 21) = 15.928, P = .001, 95% CI -6.98-2.20), delayed-recall (F (1, 21) = 7.095, P = .015, 95% CI -2.43-.30), recognition (F (21) = 8.885, P = .007, 95% CI -1.70- -.30), and SCWT (F (1 ,21) = 5.504, P = .029, 95% CI 4.38-72.78) but not on WAIS-IV-DS (F (20) = -1.237, P = .230, 95% CI -3.07-.78). There was no significant influence of therapy duration and CAPS-5 pre-treatment scores. There were small-medium nonsignificant correlations between CAPS-5 and cognitive performance pre-post differences, and between most cognitive measures and sleep problems, depressive disorder, and physical inactivity. CONCLUSIONS Cognitive functioning on memory and attention possible increased in older adults with PTSD after EMDR treatment. Further research is needed with a larger sample and a control condition to corroborate these findings and to identify the possible mediating role of modifiable risk factors.
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Affiliation(s)
- Ellen M J Gielkens
- Department Clinical Center of Excellence for Older Adults with Personality Disorders, Mondriaan Mental Health Center, Heerlen-Maastricht, the Netherlands
- Psychology Department, Personality and Psychopathology Research Group (PEPS), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Gina Rossi
- Psychology Department, Personality and Psychopathology Research Group (PEPS), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Sebastiaan P J van Alphen
- Department Clinical Center of Excellence for Older Adults with Personality Disorders, Mondriaan Mental Health Center, Heerlen-Maastricht, the Netherlands
- Psychology Department, Personality and Psychopathology Research Group (PEPS), Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
| | - Sjacko Sobczak
- Department Clinical Center of Excellence for Older Adults with Personality Disorders, Mondriaan Mental Health Center, Heerlen-Maastricht, the Netherlands
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
- Research Center Innovations in Care, Rotterdam University of Applied Sciences (RUAS), Rotterdam, The Netherlands
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Aupperle RL, Berg H. Arriving at One Goal Is the Starting Point to Another: Identification of Prognostic Biomarkers for Posttraumatic Stress Disorder Starts a Long Journey Toward Translation. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2024; 9:3-5. [PMID: 38185485 DOI: 10.1016/j.bpsc.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 11/20/2023] [Indexed: 01/09/2024]
Affiliation(s)
- Robin L Aupperle
- Laureate Institute for Brain Research, Tulsa, Oklahoma; School of Community Medicine, The University of Tulsa, Tulsa, Oklahoma
| | - Hannah Berg
- Laureate Institute for Brain Research, Tulsa, Oklahoma; School of Community Medicine, The University of Tulsa, Tulsa, Oklahoma.
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5
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Ouhmad N, Combalbert N, El Hage W. The association between post-traumatic stress disorder (PTSD) and executive functioning. Cogn Neuropsychiatry 2024; 29:29-40. [PMID: 38308862 DOI: 10.1080/13546805.2024.2313461] [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: 11/03/2021] [Accepted: 11/24/2023] [Indexed: 02/05/2024]
Abstract
Introduction: Post-Traumatic Stress Disorder (PTSD) is a condition characterised by several disturbances in an individual's executive functioning. We were interested in the link between executive functions and the presence of anxiety and depression in a clinical population with post-traumatic stress disorder.Methods: Our sample comprised 180 participants divided into three groups: 60 with PTSD, 60 trauma-exposed without PTSD, and 60 controls. All participants were assessed on the following dimensions: PTSD, dissociation, executive functions, anxiety, and depression.Results: Consistent with the literature, the results of our study suggest that individuals with PTSD have difficulties in executive functioning. These disturbances are related to levels of anxiety and depression.Conclusion: The severity of PTSD is positively correlated with executive function disturbances, but the observed disturbances, especially in working memory updating, can be explained mainly by the high level of depression, rather than by PTSD alone.
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Affiliation(s)
- Nawal Ouhmad
- EA 2114, laboratoire PAVeA, Université de Tours, Tours, France
| | | | - Wissam El Hage
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France
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6
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Sep MSC, Geuze E, Joëls M. Impaired learning, memory, and extinction in posttraumatic stress disorder: translational meta-analysis of clinical and preclinical studies. Transl Psychiatry 2023; 13:376. [PMID: 38062029 PMCID: PMC10703817 DOI: 10.1038/s41398-023-02660-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 10/28/2023] [Accepted: 11/09/2023] [Indexed: 12/18/2023] Open
Abstract
Current evidence-based treatments for post-traumatic stress disorder (PTSD) are efficacious in only part of PTSD patients. Therefore, novel neurobiologically informed approaches are urgently needed. Clinical and translational neuroscience point to altered learning and memory processes as key in (models of) PTSD psychopathology. We extended this notion by clarifying at a meta-level (i) the role of information valence, i.e. neutral versus emotional/fearful, and (ii) comparability, as far as applicable, between clinical and preclinical phenotypes. We hypothesized that cross-species, neutral versus emotional/fearful information processing is, respectively, impaired and enhanced in PTSD. This preregistered meta-analysis involved a literature search on PTSD+Learning/Memory+Behavior, performed in PubMed. First, the effect of information valence was estimated with a random-effects meta-regression. The sources of variation were explored with a random forest-based analysis. The analyses included 92 clinical (N = 6732 humans) and 182 preclinical (N = 6834 animals) studies. A general impairment of learning, memory and extinction processes was observed in PTSD patients, regardless of information valence. Impaired neutral learning/memory and fear extinction were also present in animal models of PTSD. Yet, PTSD models enhanced fear/trauma memory in preclinical studies and PTSD impaired emotional memory in patients. Clinical data on fear/trauma memory was limited. Mnemonic phase and valence explained most variation in rodents but not humans. Impaired neutral learning/memory and fear extinction show stable cross-species PTSD phenotypes. These could be targeted for novel PTSD treatments, using information gained from neurobiological animal studies. We argue that apparent cross-species discrepancies in emotional/fearful memory deserve further in-depth study; until then, animal models targeting this phenotype should be applied with utmost care.
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Affiliation(s)
- Milou S C Sep
- Brain Research and Innovation Centre, Ministry of Defence, Utrecht, the Netherlands.
- Department of Translational Neuroscience, UMC Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands.
- GGZ inGeest Mental Health Care, Amsterdam, The Netherlands.
- Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress Program, Amsterdam, The Netherlands.
- Amsterdam Public Health, Mental Health Program, Amsterdam, The Netherlands.
- Department of Psychiatry, Amsterdam University Medical Center location Vrije Universiteit, Amsterdam, The Netherlands.
| | - Elbert Geuze
- Brain Research and Innovation Centre, Ministry of Defence, Utrecht, the Netherlands
- Department of Psychiatry, UMC Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Marian Joëls
- Department of Translational Neuroscience, UMC Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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7
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Molina G, Whittaker A. Treatment of post-traumatic stress disorder and substance use disorder in adults with a history of adverse childhood experiences: A systematic review of psychological interventions. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 2:100028. [PMID: 36845903 PMCID: PMC9948894 DOI: 10.1016/j.dadr.2022.100028] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/12/2021] [Accepted: 01/17/2022] [Indexed: 11/18/2022]
Abstract
Background Adverse childhood experiences (ACEs) have long-term effects on adult health, including unresolved trauma and substance use disorder (SUD). There are hypotheses of a mediating role of emotion regulation. This systematic literature review and narrative synthesis assessed the effectiveness of psychological interventions on emotion regulation, PTSD and SUD symptoms. Methods Searches were conducted using the Cochrane Handbook for Systematic Reviews methodology. Eligible studies were randomised controlled trials (RCTs) and quasi-experimental psychological interventions published between 2009 and 2019. Study characteristics, results and methodological quality were systematically analysed. Results Thirteen studies, including nine RCTs, were selected. Integrated SUD and PTSD treatments consisted of Seeking Safety, exposure-based treatment, Trauma Recovery and Empowerment Model, and integrated cognitive behavioural therapy. Two studies reported emotion regulation. Five studies found a small to medium positive effect size of psychological interventions on PTSD outcomes. Two studies had a small positive effect size on SUD outcomes and two a small negative effect size. Attrition was high across most studies. Characteristics likely to affect the applicability of the review were described. Conclusion The review found some evidence of a small inconsistent positive effect of psychological interventions on PTSD outcomes, and no evidence of effect on SUD outcomes. The range of theoretical models was narrow. Overall quality was low with high clinical heterogeneity and missing key information, particularly on emotion regulation, an important transdiagnostic feature. Further research is required to establish interventions that can treat these multiple conditions with a focus on effectiveness, acceptability, and implementation in real life clinical practice.
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Key Words
- ACEs, adverse childhood experiences
- AEs, adverse events
- ATREM, Attachment-informed TREM
- CBT, Cognitive–Behavioural Therapy
- CI, confidence intervals
- CPTSD, complex PTSD
- DERS, Difficulties in Emotion Regulation Scale
- EMDR, eye movement desensitisation and reprocessing
- ER, emotion regulation
- FSP, family and social problems
- ICBT, Integrated CBT
- M, mean
- OR, odds ratio
- PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses
- PTSD, post-traumatic stress disorder
- RCT, randomised control trial
- SD, standard deviation
- SS, Seeking Safety
- SUD, substance use disorder
- SWiM, Synthesis Without Meta-Analysis
- TREM, Trauma Recovery and Empowerment Model
- adverse childhood experiences
- emotion regulation
- posttraumatic stress disorder
- psychological interventions
- substance use disorder
- systematic review
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Affiliation(s)
- Genevieve Molina
- CeGIDD, Pôle Santé Publique et Médecine Sociale, CHU Toulouse, Hôpital La Grave, TSA 60033, 31059 Toulouse Cedex 9, France
| | - Anne Whittaker
- NMAHP Research Unit, Faculty of Health Sciences and Sport, Pathfoot Building, University of Stirling, FK9 4LA, Stirling, Scotland, UK
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8
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Zhang J, Buchanan GJR, Monn AR, Gewirtz AH. Inhibitory Control Moderates the Intervention Effects of a Preventive Parenting Program on Posttraumatic Stress Disorder Symptoms Among Male Service Members. J Trauma Stress 2022; 35:235-245. [PMID: 34388288 PMCID: PMC9707609 DOI: 10.1002/jts.22724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 05/11/2021] [Accepted: 06/13/2021] [Indexed: 02/03/2023]
Abstract
Military servicemembers face substantial challenges due to war-related trauma exposure, including posttraumatic stress disorder (PTSD). Individuals with deficits in inhibitory control (IC) may have an increased risk of developing PTSD due to a reduced ability to regulate their cognitive responses to and disengage from trauma-related stimuli. After Deployment, Adaptive Parenting Tools (ADAPT) is a mindfulness-infused parenting program for military families that has also been found to have crossover effects on parental mental health. The present study examined whether fathers' IC at baseline affected their response to this emotional skills-focused intervention and further influenced their PTSD symptoms 1 year later. The sample included 282 male National Guard and Reserve (NG/R) service members who had recently been deployed to Iraq or Afghanistan. Fathers were randomly assigned to either the ADAPT program or a control condition, with IC measured at baseline and PTSD symptoms measured at baseline and 1-year follow-up. Intent-to-treat analyses revealed no significant main effect of the intervention on fathers' PTSD symptoms. However, fathers' IC moderated intervention effects on PTSD symptoms, f2 = 0.03. The intervention had more beneficial effects on reducing fathers' PTSD symptoms for participants with low IC at baseline. These findings are consistent with compensatory effects in the risk moderation hypothesis, which suggests that prevention or intervention programs are more effective for high-risk subgroups.
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Affiliation(s)
- Jingchen Zhang
- Department of Family Social Science, University of Minnesota – Twin Cities, Minneapolis, Minnesota, USA
| | - Gretchen J. R. Buchanan
- Department of Family Social Science, University of Minnesota – Twin Cities, Minneapolis, Minnesota, USA
| | - Amy R. Monn
- Green Hills Family Psych, Nashville, Tennessee, USA
| | - Abigail H. Gewirtz
- Department of Family Social Science and Institute of Child Development, University of Minnesota – Twin Cities, Minneapolis, Minnesota, USA
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9
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Ranger V, Bedard M, Taler V. Social support, neurocognition, and posttraumatic stress disorder: Findings from the Canadian Longitudinal Study on Aging. J Clin Exp Neuropsychol 2022; 43:906-917. [PMID: 35098877 DOI: 10.1080/13803395.2022.2030304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Most research investigating neurocognitive changes in participants with PTSD has focused on young adults. Numerous studies have recognized the crucial role of social support in diminishing the likelihood of developing PTSD. The current study evaluates the cognitive performance of middle-aged and older adults with symptoms of PTSD, and examines if perceived social support can act as a cognitive reserve factor. METHOD The study was conducted using data from the Canadian Longitudinal Study on Aging, a nationwide study on health and aging. The current study included 1,096 participants in the PTSD group and 22,158 participants in the comparison group, all between the ages of 45 and 85. Participants completed the MOS (Medical Outcomes Study) Social Support Survey as well as neuropsychological tests in the domains of executive functioning, declarative memory, and prospective memory. RESULTS The PTSD group had worse performance in the domains of executive functioning and prospective memory than the comparison group. Furthermore, when examining global cognitive impairments (impairment was defined as scoring 1.5 or more standard deviations below age and education adjusted comparison group), the PTSD group demonstrated greater impairment rates than the comparison group on two or more tests. Moderation analyses revealed that greater social support was associated with better executive functioning for the comparison group, although this was not found to be true for the PTSD group. CONCLUSION The PTSD group experienced greater cognitive deficits compared to the comparison group. Higher levels of perceived social support were associated with better performance on neurocognitive measures for the comparison group. However, social support did not appear to moderate this relationship for the PTSD group.
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Affiliation(s)
- Valerie Ranger
- School of Psychology, University of Ottawa, Ottawa, Canada.,Clinical Psychology, Bruyère Research Institute, Ottawa, Canada
| | - Marc Bedard
- School of Psychology, University of Ottawa, Ottawa, Canada.,Clinical Psychology, Bruyère Research Institute, Ottawa, Canada
| | - Vanessa Taler
- School of Psychology, University of Ottawa, Ottawa, Canada.,Clinical Psychology, Bruyère Research Institute, Ottawa, Canada
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10
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Stress-induced generalization of negative memories is mediated by an extended hippocampal circuit. Neuropsychopharmacology 2022; 47:516-523. [PMID: 34493828 PMCID: PMC8674250 DOI: 10.1038/s41386-021-01174-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 08/20/2021] [Accepted: 08/29/2021] [Indexed: 02/08/2023]
Abstract
Memories of negative experiences exert important control of behavior in the face of actual or anticipated threat. Sometimes, however, this control extends to non-threatening situations, a phenomenon known as overgeneralization of negative memories. Overgeneralization is a reliable cognitive phenotype of major depressive disorder, generalized anxiety disorder, and post-traumatic stress disorder. We therefore sought to develop an animal model to study stress-induced generalization of negative memories (SIG) and determine its dependence on the episodic-like memory circuit. We found that male and female mice, which were trained to differentiate a threatening from neutral context, exhibited robust SIG in response to subsequent social stress. Using chemogenetic circuit manipulations during memory retrieval, we demonstrated that both excitatory afferents to the dorsal hippocampus (DH) from the ventral tegmental area (VTA), and excitatory efferents from the DH to the retrosplenial cortex (RSC) contribute to SIG. Based on the known roles of these projections, we suggest that (1) by targeting subcortical VTA circuits that provide valence signals to the DH, stress prioritizes the retrieval of negative over neutral memories, and (2) by forwarding such information to the RSC, stress engages cortical mechanisms that support the retrieval of general relative to specific memory features. Altogether, these results suggest that various components of the extended hippocampal circuit can serve as treatment targets for memory overgeneralization.
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12
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Korinek D, Resch ZJ, Soble JR, Aase DM, Schroth C, Phan KL. Forgetting to Remember: The Impact of Post-traumatic Stress Disorder on Prospective and Retrospective Memory Performance. Arch Clin Neuropsychol 2021; 37:210-216. [PMID: 34009244 DOI: 10.1093/arclin/acab028] [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: 12/21/2020] [Revised: 03/12/2021] [Accepted: 04/10/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE We examined the impact of post-traumatic stress disorder (PTSD) on both prospective (PM) and retrospective (RM) memory performance among a cross-sectional veteran sample. METHOD Data from tests of PM/RM memory and PTSD, anxiety, depression and sleep disturbance symptoms were examined among a prospectively recruited sample of 26 veterans with confirmed PTSD (PTSD+) and 26 well-matched, combat-exposed controls who did not meet criteria for PTSD (PTSD-). RESULTS Small-to-moderate negative correlations emerged between PTSD symptom severity, visuospatial RM and some aspects of PM; general anxiety correlated more strongly with memory. The PTSD+ group demonstrated significantly worse, but still average visuospatial RM; differences in PM were nonsignificant between groups. Regression analyses implicated generalized anxiety, but not other psychiatric symptomology, as significant contributors to all memory performances. CONCLUSIONS Minimal memory differences were found between veterans with and without PTSD. PM/RM memory performance was better explained by generalized anxiety rather that PTSD-specific symptoms.
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Affiliation(s)
- Dale Korinek
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Zachary J Resch
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA.,Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA
| | - Jason R Soble
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA.,Department of Neurology, University of Illinois College of Medicine, Chicago, IL, USA
| | - Darrin M Aase
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
| | - Christopher Schroth
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA.,Cooperative Studies Program Coordinating Center, Edward Hines, Jr. VA Hospital, Hines, IL, USA
| | - K Luan Phan
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
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13
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Jak AJ, Jurick S, Crocker LD, Sanderson-Cimino M, Aupperle R, Rodgers CS, Thomas KR, Boyd B, Norman SB, Lang AJ, Keller AV, Schiehser DM, Twamley EW. SMART-CPT for veterans with comorbid post-traumatic stress disorder and history of traumatic brain injury: a randomised controlled trial. J Neurol Neurosurg Psychiatry 2019; 90:333-341. [PMID: 30554135 DOI: 10.1136/jnnp-2018-319315] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 10/19/2018] [Accepted: 11/18/2018] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To better concurrently address emotional and neuropsychological symptoms common in veterans with comorbid post-traumatic stress disorder (PTSD) and history of traumatic brain injury (TBI), we integrated components of compensatory cognitive training from the Cognitive Symptom Management and Rehabilitation Therapy (CogSMART) programme into cognitive processing therapy (CPT) for PTSD to create a hybrid treatment, SMART-CPT (CogSMART+CPT). This study compared the efficacy of standard CPT with SMART-CPT for treatment of veterans with comorbid PTSD and history of TBI reporting cognitive symptoms. METHODS One hundred veterans with PTSD, a history of mild to moderate TBI and current cognitive complaints were randomised and received individually delivered CPT or SMART-CPT for 12 weeks. Participants underwent psychological, neurobehavioural and neuropsychological assessments at baseline, on completion of treatment and 3 months after treatment. RESULTS Both CPT and SMART-CPT resulted in clinically significant reductions in PTSD and postconcussive symptomatology and improvements in quality of life. SMART-CPT resulted in additional improvements in the neuropsychological domains of attention/working memory, verbal learning/memory and novel problem solving. CONCLUSION SMART-CPT, a mental health intervention for PTSD, combined with compensatory cognitive training strategies, reduces PTSD and neurobehavioural symptoms and also provides added value by improving cognitive functioning.
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Affiliation(s)
- Amy J Jak
- Psychology Service, VA San Diego Healthcare System, San Diego, California, USA .,Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California, USA.,Research Service, VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, California, USA
| | - Sarah Jurick
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, California, USA
| | - Laura D Crocker
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California, USA.,Research Service, VA San Diego Healthcare System, San Diego, California, USA
| | | | - Robin Aupperle
- Laureate Institute for Brain Research, University of Tulsa, Tulsa, Oklahoma, USA
| | | | - Kelsey R Thomas
- Psychology Service, VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, California, USA
| | - Briana Boyd
- Research Service, VA San Diego Healthcare System, San Diego, California, USA
| | - Sonya B Norman
- Psychology Service, VA San Diego Healthcare System, San Diego, California, USA.,Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, California, USA.,National Center for PTSD, White River Junction, Vermont, USA
| | - Ariel J Lang
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, California, USA
| | - Amber V Keller
- Research Service, VA San Diego Healthcare System, San Diego, California, USA
| | - Dawn M Schiehser
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California, USA.,Research Service, VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, California, USA
| | - Elizabeth W Twamley
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, California, USA
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14
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Akter S, Sasaki H, Uddin KR, Ikeda Y, Miyakawa H, Shibata S. Anxiolytic effects of γ-oryzanol in chronically- stressed mice are related to monoamine levels in the brain. Life Sci 2018; 216:119-128. [PMID: 30468832 DOI: 10.1016/j.lfs.2018.11.042] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 11/19/2018] [Accepted: 11/19/2018] [Indexed: 02/08/2023]
Abstract
AIMS The present study was aimed to investigate the anxiolytic effect of γ-oryzanol (GORZ) during chronic restraint stress treatment (CRST), which is a well-documented model of stress-related disorders, like anxiety, and its potential molecular mechanisms. MATERIALS AND METHODS In this experiment, 5-week-old male ICR mice were used and the concentration of GORZ was fixed at 0.5% in the mouse standard diet (14% casein, AIN 93 M). Mice were immobilized daily for 3 h from ZT 2.5 to 5.5 (ZT0 was designated as light-on time) for 20 consecutive days, followed by behavioral testing, including the open field test (OFT) and elevated plus maze (EPM) test. The concentration of serum corticosterone (CORT) was measured. In addition, the expression of central monoamine neurotransmitters with their metabolites in the hippocampus, cerebral cortex, and amygdala of the brain were examined. KEY FINDINGS 0.5% GORZ partially blocked stress-induced reduction of body weight gain while stressed mice had significantly lower body weights during the entire experimental period. Further, 0.5% GORZ treatment could significantly improve the main behavioral parameters even in CRST situations. The significant increase in serum CORT levels indicated CRST-induced stress, which was almost unaffected by 0.5% GORZ treatment. Moreover, 0.5% GORZ also supported the anxiolytic mechanism with enhancement of 5-HIAA and NE levels in the amygdala of brain after CRST. SIGNIFICANCE Taken together, our studies suggested that 0.5% GORZ is a potential therapeutic drug candidate against anxiety under chronic stress conditions.
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Affiliation(s)
- Salina Akter
- Laboratory of Physiology and Pharmacology, School of Advanced Science and Engineering, Waseda University, Tokyo, Japan
| | - Hiroyuki Sasaki
- Laboratory of Physiology and Pharmacology, School of Advanced Science and Engineering, Waseda University, Tokyo, Japan
| | - Kazi Rasel Uddin
- Laboratory of Physiology and Pharmacology, School of Advanced Science and Engineering, Waseda University, Tokyo, Japan
| | - Yuko Ikeda
- Laboratory of Physiology and Pharmacology, School of Advanced Science and Engineering, Waseda University, Tokyo, Japan
| | - Hiroki Miyakawa
- Laboratory of Physiology and Pharmacology, School of Advanced Science and Engineering, Waseda University, Tokyo, Japan
| | - Shigenobu Shibata
- Laboratory of Physiology and Pharmacology, School of Advanced Science and Engineering, Waseda University, Tokyo, Japan.
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15
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Wu ZM, Ni GL, Shao AM, Cui R. Genistein alleviates anxiety-like behaviors in post-traumatic stress disorder model through enhancing serotonergic transmission in the amygdala. Psychiatry Res 2017; 255:287-291. [PMID: 28600997 DOI: 10.1016/j.psychres.2017.05.051] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 03/31/2017] [Accepted: 05/31/2017] [Indexed: 11/27/2022]
Abstract
Post-traumatic stress disorder (PTSD) is a chronic psychiatric disorder, characterized by intense fear, and increased arousal and avoidance of traumatic events. The current available treatments for PTSD have limited therapeutic value. Genistein, a natural isoflavone, modulates a variety of cell functions. In this study, we tested anti-anxiety activity and underlying mechanisms of genistein in a PTSD rat model. The rats were trained to associate a tone with foot shock delivery on day 0, then fear conditioning was performed on day 7, 14 and 21. Genistein (2-8mg/kg) was injected intraperitoneally daily for 7 days. The anti-anxiety effects of genistein were measured by contextual freezing behavior and elevated plus maze. By the end of the experiments, the amygdala was extracted and subject to neurochemistry analysis. Genistein alleviated contextual freezing behavior and improved performance in elevated plus maze dose-dependently in PTSD rats. Furthermore, in these rats, genistein enhanced serotonergic transmission in the amygdala, including upregulation of tryptophan hydroxylase, serotonin, and phosphorylated (p)-CaMKII and p-CREB, as well. Genistein exerts anti-anxiety effects on a PTSD model probably through enhancing serotonergic system and CaMKII/CREB signaling pathway in the amygdala.
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Affiliation(s)
- Zhong-Min Wu
- Department of Anatomy, Medical College of Taizhou University, Taizhou 318000, China; Department of Neurology, First People's Hospital of Linhai City, Linhai 317000, China
| | - Gui-Lian Ni
- Department of Neurology, First People's Hospital of Linhai City, Linhai 317000, China
| | - Ai-Min Shao
- Department of Neurology, First People's Hospital of Linhai City, Linhai 317000, China
| | - Rong Cui
- Department of Neurology, First People's Hospital of Linhai City, Linhai 317000, China.
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16
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Perez-Urrutia N, Mendoza C, Alvarez-Ricartes N, Oliveros-Matus P, Echeverria F, Grizzell JA, Barreto GE, Iarkov A, Echeverria V. Intranasal cotinine improves memory, and reduces depressive-like behavior, and GFAP + cells loss induced by restraint stress in mice. Exp Neurol 2017. [DOI: 10.1016/j.expneurol.2017.06.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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