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McCall A, Forouhandehpour R, Celebi S, Richard-Malenfant C, Hamati R, Guimond S, Tuominen L, Weinshenker D, Jaworska N, McQuaid RJ, Shlik J, Robillard R, Kaminsky Z, Cassidy CM. Evidence for Locus Coeruleus-Norepinephrine System Abnormality in Military Posttraumatic Stress Disorder Revealed by Neuromelanin-Sensitive Magnetic Resonance Imaging. Biol Psychiatry 2024; 96:268-277. [PMID: 38296219 DOI: 10.1016/j.biopsych.2024.01.013] [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: 08/15/2023] [Revised: 01/04/2024] [Accepted: 01/22/2024] [Indexed: 07/26/2024]
Abstract
BACKGROUND The complex neurobiology of posttraumatic stress disorder (PTSD) calls for the characterization of specific disruptions in brain functions that require targeted treatment. One such alteration could be an overactive locus coeruleus (LC)-norepinephrine system, which may be linked to hyperarousal symptoms, a characteristic and burdensome aspect of the disorder. METHODS Study participants were Canadian Armed Forces veterans with PTSD related to deployment to combat zones (n = 34) and age- and sex-matched healthy control participants (n = 32). Clinical measures included the Clinician-Administered PTSD Scale for DSM-5, and neuroimaging measures included a neuromelanin-sensitive magnetic resonance imaging scan to measure the LC signal. Robust linear regression analyses related the LC signal to clinical measures. RESULTS Compared with control participants, the LC signal was significantly elevated in the PTSD group (t62 = 2.64, p = .010), and this group difference was most pronounced in the caudal LC (t56 = 2.70, Cohen's d = 0.72). The caudal LC signal was also positively correlated with the severity of Clinician-Administered PTSD Scale for DSM-5 hyperarousal symptoms in the PTSD group (t26 = 2.16, p = .040). CONCLUSIONS These findings are consistent with a growing body of evidence indicative of elevated LC-norepinephrine system function in PTSD. Furthermore, they indicate the promise of neuromelanin-sensitive magnetic resonance imaging as a noninvasive method to probe the LC-norepinephrine system that has the potential to support subtyping and treatment of PTSD or other neuropsychiatric conditions.
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Affiliation(s)
- Adelina McCall
- University of Ottawa Institute of Mental Health Research at the Royal, Ottawa, Ontario, Canada
| | | | - Seyda Celebi
- University of Ottawa Institute of Mental Health Research at the Royal, Ottawa, Ontario, Canada
| | | | - Rami Hamati
- University of Ottawa Institute of Mental Health Research at the Royal, Ottawa, Ontario, Canada
| | - Synthia Guimond
- University of Ottawa Institute of Mental Health Research at the Royal, Ottawa, Ontario, Canada; Department of Neuroscience, Carleton University, Ottawa, Ontario, Canada; Département de psychoéducation et de psychologie, Université du Québec en Outaouais, Gatineau, Quebec, Canada
| | - Lauri Tuominen
- University of Ottawa Institute of Mental Health Research at the Royal, Ottawa, Ontario, Canada; Department of Neuroscience, Carleton University, Ottawa, Ontario, Canada
| | - David Weinshenker
- Department of Human Genetics, Emory University School of Medicine, Atlanta, Georgia
| | - Natalia Jaworska
- University of Ottawa Institute of Mental Health Research at the Royal, Ottawa, Ontario, Canada; Department of Neuroscience, Carleton University, Ottawa, Ontario, Canada
| | - Robyn J McQuaid
- University of Ottawa Institute of Mental Health Research at the Royal, Ottawa, Ontario, Canada; Department of Neuroscience, Carleton University, Ottawa, Ontario, Canada
| | - Jakov Shlik
- University of Ottawa Institute of Mental Health Research at the Royal, Ottawa, Ontario, Canada
| | - Rebecca Robillard
- University of Ottawa Institute of Mental Health Research at the Royal, Ottawa, Ontario, Canada
| | - Zachary Kaminsky
- University of Ottawa Institute of Mental Health Research at the Royal, Ottawa, Ontario, Canada
| | - Clifford M Cassidy
- University of Ottawa Institute of Mental Health Research at the Royal, Ottawa, Ontario, Canada; Department of Neuroscience, Carleton University, Ottawa, Ontario, Canada; Renaissance School of Medicine at Stony Brook University, Stony Brook, New York.
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Belge JB, Mulders P, Van Diermen L, Sienaert P, Sabbe B, Abbott CC, Tendolkar I, Schrijvers D, van Eijndhoven P. Reviewing the neurobiology of electroconvulsive therapy on a micro- meso- and macro-level. Prog Neuropsychopharmacol Biol Psychiatry 2023; 127:110809. [PMID: 37331685 DOI: 10.1016/j.pnpbp.2023.110809] [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: 01/22/2023] [Revised: 05/27/2023] [Accepted: 06/07/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Electroconvulsive therapy (ECT) remains the one of the most effective of biological antidepressant interventions. However, the exact neurobiological mechanisms underlying the efficacy of ECT remain unclear. A gap in the literature is the lack of multimodal research that attempts to integrate findings at different biological levels of analysis METHODS: We searched the PubMed database for relevant studies. We review biological studies of ECT in depression on a micro- (molecular), meso- (structural) and macro- (network) level. RESULTS ECT impacts both peripheral and central inflammatory processes, triggers neuroplastic mechanisms and modulates large scale neural network connectivity. CONCLUSIONS Integrating this vast body of existing evidence, we are tempted to speculate that ECT may have neuroplastic effects resulting in the modulation of connectivity between and among specific large-scale networks that are altered in depression. These effects could be mediated by the immunomodulatory properties of the treatment. A better understanding of the complex interactions between the micro-, meso- and macro- level might further specify the mechanisms of action of ECT.
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Affiliation(s)
- Jean-Baptiste Belge
- Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Department of Psychiatry, Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
| | - Peter Mulders
- Department of Psychiatry, Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behavior, Centre for Neuroscience, P.O. Box 9010, 6500 GL Nijmegen, The Netherlands
| | - Linda Van Diermen
- Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Psychiatric Center Bethanië, Andreas Vesaliuslaan 39, Zoersel 2980, Belgium
| | - Pascal Sienaert
- KU Leuven - University of Leuven, University Psychiatric Center KU Leuven, Academic Center for ECT and Neuromodulation (AcCENT), Leuvensesteenweg 517, Kortenberg 3010, Belgium
| | - Bernard Sabbe
- Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | | | - Indira Tendolkar
- Department of Psychiatry, Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behavior, Centre for Neuroscience, P.O. Box 9010, 6500 GL Nijmegen, The Netherlands
| | - Didier Schrijvers
- Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Department of Psychiatry, University Psychiatric Center Duffel, Stationstraat 22, Duffel 2570, Belgium
| | - Philip van Eijndhoven
- Department of Psychiatry, Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behavior, Centre for Neuroscience, P.O. Box 9010, 6500 GL Nijmegen, The Netherlands
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Sala-Hamrick KJ, Braciszewski JM, Yeh HH, Zelenak L, Westphal J, Beebani G, Frank C, Simon GE, Owen-Smith AA, Rossom RC, Lynch F, Lu CY, Waring SC, Harry ML, Beck A, Daida YG, Ahmedani BK. Diagnosed Posttraumatic Stress Disorder and Other Trauma-Associated Stress Disorders and Risk for Suicide Mortality. Psychiatr Serv 2023; 74:936-942. [PMID: 37143334 PMCID: PMC10497061 DOI: 10.1176/appi.ps.202100244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
OBJECTIVE Strong evidence exists for posttraumatic stress disorder (PTSD) as a risk factor for suicidal thoughts and behaviors across diverse populations. However, few empirical studies have examined PTSD and other trauma-associated stress disorders as risk factors for suicide mortality among health system populations. This study aimed to assess trauma-associated stress diagnoses as risk factors for suicide mortality in a U.S. health system population. METHODS This case-control, matched-design study examined individuals who died by suicide between 2000 and 2015 and had received care from nine U.S. health systems affiliated with the Mental Health Research Network (N=3,330). Individuals who died by suicide were matched with individuals from the general health system population (N=333,000): 120 individuals with PTSD who died by suicide were matched with 1,592 control group members, 84 with acute reaction to stress were matched with 2,218 control individuals, and 331 with other stress reactions were matched with 8,174 control individuals. RESULTS After analyses were adjusted for age and sex, individuals with any trauma-associated stress condition were more likely to have died by suicide. Risk was highest among individuals with PTSD (adjusted OR [AOR]=10.10, 95% CI=8.31-12.27), followed by those with other stress reactions (AOR=5.38, 95% CI=4.78-6.06) and those with acute reaction to stress (AOR=4.49, 95% CI=3.58-5.62). Patterns of risk remained the same when the analyses were adjusted for any comorbid psychiatric condition. CONCLUSIONS All trauma-associated stress disorders are risk factors for suicide mortality, highlighting the importance of health system suicide prevention protocols that consider the full spectrum of traumatic stress diagnoses.
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Affiliation(s)
- Kelsey J Sala-Hamrick
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Jordan M Braciszewski
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Hsueh-Han Yeh
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Logan Zelenak
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Joslyn Westphal
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Ganj Beebani
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Cathrine Frank
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Gregory E Simon
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Ashli A Owen-Smith
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Rebecca C Rossom
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Frances Lynch
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Christine Y Lu
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Stephen C Waring
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Melissa L Harry
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Arne Beck
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Yihe G Daida
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Brian K Ahmedani
- Center for Health Policy and Health Services Research (Sala-Hamrick, Braciszewski, Yeh, Zelenak, Westphal, Ahmedani) and Department of Psychiatry (Braciszewski, Beebani, Frank, Ahmedani), Henry Ford Health System, Detroit; Kaiser Permanente Washington, Seattle (Simon); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta (Owen-Smith); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring, Harry); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Kaiser Permanente Hawaii, Honolulu (Daida)
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Dammen LV, Finseth TT, McCurdy BH, Barnett NP, Conrady RA, Leach AG, Deick AF, Van Steenis AL, Gardner R, Smith BL, Kay A, Shirtcliff EA. Evoking stress reactivity in virtual reality: A systematic review and meta-analysis. Neurosci Biobehav Rev 2022; 138:104709. [PMID: 35644278 DOI: 10.1016/j.neubiorev.2022.104709] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 04/08/2022] [Accepted: 05/21/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Virtual reality (VR) research probes stress environments that are infeasible to create in the real world. However, because research simulations are applied to narrow populations, it remains unclear if VR simulations can stimulate a broadly applicable stress-response. This systematic review and meta-analysis was conducted on studies using VR stress tasks and biomarkers. METHODS Included papers (N = 52) measured cortisol, heart rate (HR), galvanic skin response (GSR), systolic blood pressure (SBP), diastolic blood pressure (DBP), respiratory sinus arrhythmia (RSA), parasympathetic activity (RMSSD), sympathovagal balance (LF/HF), and/or salivary alpha-amylase (sAA). Effect sizes (ES) and confidence intervals (CI) were calculated based on standardized mean change of baseline-to-peak biomarker levels. RESULTS From baseline-to-peak (ES, CI), analyses showed a statistically significant change in cortisol (0.56, 0.28-0.83), HR (0.68, 0.53-0.82), GSR (0.59, 0.36-0.82), SBP (.55, 0.19-0.90), DBP (.64, 0.23-1.05), RSA (-0.59, -0.88 to -0.30), and sAA (0.27, 0.092-0.45). There was no effect for RMSSD and LF/HF. CONCLUSION VR stress tasks elicited a varied magnitude of physiological stress reactivity. VR may be an effective tool in stress research.
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Affiliation(s)
- Lotte van Dammen
- Iowa State University, Virtual Reality Applications Center, Ames, IA, USA
| | - Tor T Finseth
- Iowa State University, Virtual Reality Applications Center, Ames, IA, USA.
| | - Bethany H McCurdy
- Iowa State University, Virtual Reality Applications Center, Ames, IA, USA
| | - Neil P Barnett
- Iowa State University, Virtual Reality Applications Center, Ames, IA, USA
| | - Roselynn A Conrady
- Iowa State University, Virtual Reality Applications Center, Ames, IA, USA
| | - Alexis G Leach
- Iowa State University, Virtual Reality Applications Center, Ames, IA, USA
| | - Andrew F Deick
- Iowa State University, Virtual Reality Applications Center, Ames, IA, USA
| | | | - Reece Gardner
- Iowa State University, Virtual Reality Applications Center, Ames, IA, USA
| | - Brandon L Smith
- Iowa State University, Virtual Reality Applications Center, Ames, IA, USA
| | - Anita Kay
- Iowa State University, Virtual Reality Applications Center, Ames, IA, USA
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5
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Kaplan GB, Lakis GA, Zhoba H. Sleep-Wake and Arousal Dysfunctions in Post-Traumatic Stress Disorder:Role of Orexin Systems. Brain Res Bull 2022; 186:106-122. [PMID: 35618150 DOI: 10.1016/j.brainresbull.2022.05.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 04/20/2022] [Accepted: 05/10/2022] [Indexed: 12/15/2022]
Abstract
Post-traumatic stress disorder (PTSD) is a trauma-related condition that produces distressing fear memory intrusions, avoidance behaviors, hyperarousal/startle, stress responses and insomnia. This review focuses on the importance of the orexin neural system as a novel mechanism related to the pathophysiology of PTSD. Orexinergic neurons originate in the lateral hypothalamus and project widely to key neurotransmitter system neurons, autonomic neurons, the hypothalamic-pituitaryadrenal (HPA) axis, and fear-related neural circuits. After trauma or stress, the basolateral amygdala (BLA) transmits sensory information to the central nucleus of the amygdala (CeA) and in turn to the hypothalamus and other subcortical and brainstem regions to promote fear and threat. Orexin receptors have a prominent role in this circuit as fear conditioned orexin receptor knockout mice show decreased fear expression while dual orexin receptor antagonists (DORAs) inhibit fear acquisition and expression. Orexin activation of an infralimbic-amygdala circuit impedes fear extinction while DORA treatments enhance it. Increased orexin signaling to the amygdalocortical- hippocampal circuit promotes avoidance behaviors. Orexin has an important role in activating sympathetic nervous system (SNS) activity and the HPA axis stress responses. Blockade of orexin receptors reduces fear-conditioned startle responses. In PTSD models, individuals demonstrate sleep disturbances such as increased sleep latency and more transitions to wakefulness. Increased orexin activity impairs sleep by promoting wakefulness and reducing total sleep time while DORA treatments enhance sleep onset and maintenance. The orexinergic neural system provides important mechanisms for understanding multiple PTSD behaviors and provides new medication targets to treat this often persistent and debilitating illness.
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Affiliation(s)
- Gary B Kaplan
- Mental Health Service, VA Boston Healthcare System, West Roxbury, MA, 02132 USA; Department of Psychiatry, Boston University School of Medicine, Boston, MA, 02118 USA; Department of Pharmacology and Experimental Therapeutics, Boston University School of Medicine, Boston, MA, 02118 USA.
| | - Gabrielle A Lakis
- Research Service, VA Boston Healthcare System, West Roxbury, MA, 02132 USA; Undergraduate Program in Neuroscience, Boston University, Boston, MA, 02215 USA
| | - Hryhoriy Zhoba
- Research Service, VA Boston Healthcare System, West Roxbury, MA, 02132 USA
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6
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Kustov G, Zinchuk M, Rider F, Pashnin E, Voinova N, Avedisova A, Guekht A. Comorbidity of psychogenic non-epileptic seizures with mental disorders. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:28-35. [DOI: 10.17116/jnevro202212202128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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7
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Elkhatib SK, Moshfegh CM, Watson GF, Schwab AD, Katsurada K, Patel KP, Case AJ. Splenic denervation attenuates repeated social defeat stress-induced T-lymphocyte inflammation. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2021; 1:190-200. [PMID: 35330608 PMCID: PMC8941638 DOI: 10.1016/j.bpsgos.2021.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/12/2021] [Accepted: 05/06/2021] [Indexed: 11/28/2022] Open
Abstract
Background Post-traumatic stress disorder (PTSD) is a devastating psychological disorder. Patients with PTSD canonically demonstrate an increased risk for inflammatory diseases, as well as increased sympathetic tone and norepinephrine (NE) outflow. Yet, the exact etiology and causal nature of these physiologic changes remain unclear. Previously, we demonstrated that exogenous NE alters mitochondrial superoxide in T-lymphocytes to produce a pro-inflammatory T-helper 17 (TH17) phenotype, and observed similar TH17 polarization in a preclinical model of PTSD. Therefore, we hypothesized sympathetic-driven neuroimmune interactions could mediate psychological trauma-induced T-lymphocyte inflammation. Methods Repeated social defeat stress (RSDS) is a preclinical murine model that recapitulates the behavioral, autonomic, and inflammatory aspects of PTSD. Targeted splenic denervation (Dnx) was performed to deduce the contribution of splenic sympathetic nerves to RSDS-induced inflammation. Eighty-five C57BL/6J mice underwent Dnx or sham-operation, followed by RSDS or control paradigms. Animals were assessed for behavioral, autonomic, inflammatory, and redox profiles. Results Dnx did not alter the antisocial or anxiety-like behavior induced by RSDS. In circulation, RSDS Dnx animals exhibited diminished levels of T-lymphocyte-specific cytokines (IL-2, IL-17A, and IL-22) compared to intact animals, whereas other non-specific inflammatory cytokines (e.g., IL-6, TNF-α, and IL-10) were unaffected by Dnx. Importantly, Dnx specifically ameliorated the increases in RSDS-induced T-lymphocyte mitochondrial superoxide, TH17 polarization, and pro-inflammatory gene expression with minimal impact to non-T-lymphocyte immune populations. Conclusions Overall, our data suggest that sympathetic nerves regulate RSDS-induced splenic T-lymphocyte inflammation, but play less of a role in the behavioral and non-T-lymphocyte inflammatory phenotypes induced by this psychological trauma paradigm.
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Affiliation(s)
- Safwan K. Elkhatib
- Department of Cellular and Integrative Physiology, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Cassandra M. Moshfegh
- Department of Cellular and Integrative Physiology, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Gabrielle F. Watson
- Department of Cellular and Integrative Physiology, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Aaron D. Schwab
- Department of Cellular and Integrative Physiology, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Kenichi Katsurada
- Department of Cellular and Integrative Physiology, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
- School of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Kaushik P. Patel
- Department of Cellular and Integrative Physiology, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Adam J. Case
- Department of Cellular and Integrative Physiology, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Texas A&M Health Science Center, Bryan, Texas
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8
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Elkhatib SK, Moshfegh CM, Watson GF, Case AJ. Peripheral inflammation is strongly linked to elevated zero maze behavior in repeated social defeat stress. Brain Behav Immun 2020; 90:279-285. [PMID: 32890698 PMCID: PMC7568442 DOI: 10.1016/j.bbi.2020.08.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 08/21/2020] [Accepted: 08/28/2020] [Indexed: 12/25/2022] Open
Abstract
Post-traumatic stress disorder (PTSD) is a psychiatric illness that results in an increased risk for a variety of inflammatory diseases. The exact etiology of this increased risk is unknown, and thus several animal models have been developed to investigate the neuroimmune interactions of PTSD. Repeated social defeat stress (RSDS) is an established preclinical model of psychological trauma that recapitulates certain behavioral and inflammatory aspects of human PTSD. Furthermore, RSDS has been utilized to subgroup animals into susceptible and resilient populations based on one specific behavioral phenotype (i.e., social interaction). Herein, we conducted an extensive investigation of circulating inflammatory proteins after RSDS and found significant elevations in various cytokines and chemokines after exposure to RSDS. When categorizing animals into either susceptible or resilient populations based on social interaction, we found no inflammatory or other behavioral differences between these subgroups. Furthermore, correlative analyses found no significant correlation between social interaction parameters and inflammation. In contrast, parameters from the elevated zero maze (EZM) demonstrated significant associations and clustering to five circulating cytokines. When animals were subdivided into susceptible and resilient populations solely based upon combined EZM performance, significant inflammatory differences were evident between these groups. Strikingly, these circulating inflammatory proteins displayed a stronger predictive ability of EZM performance compared to social interaction test performance. These findings provide new insights into inflammatory markers associated with RSDS, and the utility of EZM to effectively group RSDS-exposed mice into populations with differential levels of peripheral inflammation.
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Affiliation(s)
- Safwan K Elkhatib
- Department of Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha, NE, United States
| | - Cassandra M Moshfegh
- Department of Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha, NE, United States
| | - Gabrielle F Watson
- Department of Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha, NE, United States
| | - Adam J Case
- Department of Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha, NE, United States.
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9
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Cochran AL, Pingeton BC, Goodman SH, Laurent H, Rathouz PJ, Newport DJ, Stowe ZN. A transdiagnostic approach to conceptualizing depression across the perinatal period in a high-risk sample. JOURNAL OF ABNORMAL PSYCHOLOGY 2020; 129:689-700. [PMID: 32852962 PMCID: PMC7541773 DOI: 10.1037/abn0000612] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Clinical guidelines recommend assessing depression during pregnancy and postpartum but often overlook potential changes in symptoms across this developmental period. Such changes contribute to difficulties in conceptualizing maternal depression. This study aimed to situate depressive symptoms and related concerns (anxiety, stress, sleep) across the perinatal period within a transdiagnostic framework and to use this framework to better understand how depressive symptoms change across the perinatal period. First, items from seven symptom scales were a priori categorized into six transdiagnostic factors: four based on Research Domain Criteria (loss, potential threat, frustrative nonreward, and sleep-wakefulness) and two based on the depression literature (somatic and coping symptoms). Second, using prospective data from women with a history of an affective disorder (n = 657) in an observational study of neuropsychiatric illness, factor analyses were performed in seven periods (three trimesters of pregnancy and four quarters of first year postpartum). For each period, a bifactor model with six transdiagnostic factors and a general factor fit data better than models that combined or dropped a factor (p < .003). Except around delivery, item loadings and intercepts could be fixed between consecutive periods and still adequately fit data from both periods. Means of sleep-wakefulness and somatic factors increased significantly from second to third trimester (p < .01), with trends reversing early postpartum. In conclusion, depressive symptoms and related concerns exhibit factor structures that are only partly congruent across the perinatal period. This conclusion suggests that greater attention to specific life phases is warranted in the conceptualization of depression during this time in women's lives. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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10
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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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11
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Zoladz PR. Animal models for the discovery of novel drugs for post-traumatic stress disorder. Expert Opin Drug Discov 2020; 16:135-146. [PMID: 32921163 DOI: 10.1080/17460441.2020.1820982] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Existing pharmacological treatments for PTSD are limited and have been used primarily because of their effectiveness in other psychiatric conditions. To generate novel, PTSD specific pharmacotherapy, researchers must utilize animal models to assess the efficacy of experimental drugs. AREAS COVERED This review includes a discussion of factors that should be considered when developing an animal model of PTSD, as well as descriptions of the most commonly used models. Researchers have utilized physical stressors, psychological stressors, or a combination of the two to induce PTSD-like physiological and behavioral sequelae in animals. Such models have provided researchers with a valuable tool to examine the neurobiological mechanisms underlying the condition. EXPERT OPINION PTSD is a heterogeneous disorder that manifests as different symptom clusters in different individuals. Thus, there cannot be a one-size-fits-all approach to modeling the disorder in animals. Preclinical investigators must adopt a concentrated effort aimed at modeling specific PTSD subtypes and the distinct symptom profiles that result from specific types of human trauma. Moreover, researchers have focused so much on modeling a single PTSD syndrome in animals that studies examining only specific facets of the disorder are largely ignored. Future research employing animal models of PTSD requires greater focus on the nuances of PTSD.
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Affiliation(s)
- Phillip R Zoladz
- Psychology Program, the School of Health and Behavioral Sciences, Ohio Northern University , Ada, OH, USA
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12
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Rab SL, Admon R. Parsing inter- and intra-individual variability in key nervous system mechanisms of stress responsivity and across functional domains. Neurosci Biobehav Rev 2020; 120:550-564. [PMID: 32941963 DOI: 10.1016/j.neubiorev.2020.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 08/21/2020] [Accepted: 09/03/2020] [Indexed: 12/16/2022]
Abstract
Exposure to stressful events is omnipresent in modern human life, yet people show considerable heterogeneity in the impact of stress exposure(s) on their functionality and overall health. Encounter with stressor(s) is counteracted by an intricate repertoire of nervous-system responses. This narrative review starts with a brief summary of the vast evidence that supports heart rate variability, cortisol secretion, and large-scale cortical network interactions as kay physiological, endocrinological, and neural mechanisms of stress responsivity, respectively. The second section highlights potential sources for inter-individual variability in these mechanisms, by focusing on biological, environmental, social, habitual, and psychological factors that may influence stress responsivity patterns and thus contribute to heterogeneity in the impact of stress exposure on functionality and health. The third section introduces intra-individually variability in stress responsivity across functional domains as a novel putative source for heterogeneity in the impact of stress exposure. Challenges and future directions are further discussed. Parsing inter- and intra-individual variability in nervous-system mechanisms of stress responsivity and across functional domains is critical towards potential clinical translation.
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Affiliation(s)
- Sharona L Rab
- Department of Psychology, University of Haifa, Haifa, Israel
| | - Roee Admon
- Department of Psychology, University of Haifa, Haifa, Israel; The Integrated Brain and Behavior Research Center (IBBRC), University of Haifa, Haifa, Israel.
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13
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Verbitsky A, Dopfel D, Zhang N. Rodent models of post-traumatic stress disorder: behavioral assessment. Transl Psychiatry 2020; 10:132. [PMID: 32376819 PMCID: PMC7203017 DOI: 10.1038/s41398-020-0806-x] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 03/17/2020] [Accepted: 04/08/2020] [Indexed: 12/29/2022] Open
Abstract
Although the etiology and expression of psychiatric disorders are complex, mammals show biologically preserved behavioral and neurobiological responses to valent stimuli which underlie the use of rodent models of post-traumatic stress disorder (PTSD). PTSD is a complex phenotype that is difficult to model in rodents because it is diagnosed by patient interview and influenced by both environmental and genetic factors. However, given that PTSD results from traumatic experiences, rodent models can simulate stress induction and disorder development. By manipulating stress type, intensity, duration, and frequency, preclinical models reflect core PTSD phenotypes, measured through various behavioral assays. Paradigms precipitate the disorder by applying physical, social, and psychological stressors individually or in combination. This review discusses the methods used to trigger and evaluate PTSD-like phenotypes. It highlights studies employing each stress model and evaluates their translational efficacies against DSM-5, validity criteria, and criteria proposed by Yehuda and Antelman's commentary in 1993. This is intended to aid in paradigm selection by informing readers about rodent models, their benefits to the clinical community, challenges associated with the translational models, and opportunities for future work. To inform PTSD model validity and relevance to human psychopathology, we propose that models incorporate behavioral test batteries, individual differences, sex differences, strain and stock differences, early life stress effects, biomarkers, stringent success criteria for drug development, Research Domain Criteria, technological advances, and cross-species comparisons. We conclude that, despite the challenges, animal studies will be pivotal to advances in understanding PTSD and the neurobiology of stress.
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Affiliation(s)
- Alexander Verbitsky
- Department of Engineering Science and Mechanics, The Pennsylvania State University, University Park, PA, 16802, USA
| | - David Dopfel
- Department of Biomedical Engineering, The Pennsylvania State University, University Park, PA, 16802, USA
| | - Nanyin Zhang
- Department of Biomedical Engineering, The Pennsylvania State University, University Park, PA, 16802, USA.
- The Huck Institutes of Life Sciences, The Pennsylvania State University, University Park, PA, 16802, USA.
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14
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Lijffijt M, Green CE, Balderston N, Iqbal T, Atkinson M, Vo-Le B, Vo-Le B, O’Brien B, Grillon C, Swann AC, Mathew SJ. A Proof-of-Mechanism Study to Test Effects of the NMDA Receptor Antagonist Lanicemine on Behavioral Sensitization in Individuals With Symptoms of PTSD. Front Psychiatry 2019; 10:846. [PMID: 31920733 PMCID: PMC6923195 DOI: 10.3389/fpsyt.2019.00846] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 10/24/2019] [Indexed: 12/21/2022] Open
Abstract
Background: Individuals with post-traumatic stress disorder (PTSD) have a heightened sensitivity to subsequent stressors, addictive drugs, and symptom recurrence, a form of behavioral sensitization. N-methyl-D-aspartate receptors (NMDARs) are involved in the establishment and activation of sensitized behavior. Objective: We describe a protocol of a randomized placebo-controlled Phase 1b proof-of-mechanism trial to examine target engagement, safety, tolerability, and possible efficacy of the NMDAR antagonist lanicemine in individuals with symptoms of PTSD (Clinician Administered PTSD Scale [CAPS-5] score ≥ 25) and evidence of behavioral sensitization measured as enhanced anxiety-potentiated startle (APS; T-score ≥ 2.8). Methods: Subjects (n = 24; age range 21-65) receive three 60-min intravenous infusions of placebo or 100 mg lanicemine over 5 non-consecutive days. Primary endpoint is change in APS from pre-treatment baseline to after the third infusion. NMDAR engagement is probed with resting state EEG gamma band power, 40 Hz auditory steady state response, the mismatch negativity amplitude, and P50 sensory gating. Change in CAPS-5 scores is an exploratory clinical endpoint. Bayesian statistical methods will evaluate endpoints to determine suitability of this agent for further study. Conclusion: In contrast to traditional early-phase trials that use symptom severity to track treatment efficacy, this study tracks engagement of the study drug on expression of behavioral sensitization, a functional mechanism likely to cut across disorders. This experimental therapeutics design is consistent with recent NIMH-industry collaborative studies, and could serve as a template for testing novel pharmacological agents in psychiatry. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT03166501.
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Affiliation(s)
- Marijn Lijffijt
- Research Service Line, Michael E. DeBakey VA Medical Center, Houston, TX, United States
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Charles E. Green
- Department of Psychiatry and Behavioral Sciences, UTHealth McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
- Department of Pediatrics - Center for Evidence Based Medicine, UTHealth McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Nicholas Balderston
- Section on Neurobiology of Fear and Anxiety, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States
| | - Tabish Iqbal
- Research Service Line, Michael E. DeBakey VA Medical Center, Houston, TX, United States
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Megan Atkinson
- Department of Anesthesiology, Michael E. DeBakey VA Medical Center, Houston, TX, United States
- Department of Anesthesiology, Baylor College of Medicine, Houston, TX, United States
| | - Brittany Vo-Le
- Research Service Line, Michael E. DeBakey VA Medical Center, Houston, TX, United States
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Bylinda Vo-Le
- Research Service Line, Michael E. DeBakey VA Medical Center, Houston, TX, United States
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Brittany O’Brien
- Research Service Line, Michael E. DeBakey VA Medical Center, Houston, TX, United States
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Christian Grillon
- Department of Pediatrics - Center for Evidence Based Medicine, UTHealth McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Alan C. Swann
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
- Mental Health Care Line, Michael E. DeBakey VA Medical Center, Houston, TX, United States
| | - Sanjay J. Mathew
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
- Mental Health Care Line, Michael E. DeBakey VA Medical Center, Houston, TX, United States
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15
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Schultebraucks K, Galatzer-Levy IR. Machine Learning for Prediction of Posttraumatic Stress and Resilience Following Trauma: An Overview of Basic Concepts and Recent Advances. J Trauma Stress 2019; 32:215-225. [PMID: 30892723 DOI: 10.1002/jts.22384] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 11/23/2018] [Accepted: 12/02/2018] [Indexed: 12/23/2022]
Abstract
Posttraumatic stress responses are characterized by a heterogeneity in clinical appearance and etiology. This heterogeneity impacts the field's ability to characterize, predict, and remediate maladaptive responses to trauma. Machine learning (ML) approaches are increasingly utilized to overcome this foundational problem in characterization, prediction, and treatment selection across branches of medicine that have struggled with similar clinical realities of heterogeneity in etiology and outcome, such as oncology. In this article, we review and evaluate ML approaches and applications utilized in the areas of posttraumatic stress, stress pathology, and resilience research, and present didactic information and examples to aid researchers interested in the relevance of ML to their own research. The examined studies exemplify the high potential of ML approaches to build accurate predictive and diagnostic models of posttraumatic stress and stress pathology risk based on diverse sources of available information. The use of ML approaches to integrate high-dimensional data demonstrates substantial gains in risk prediction even when the sources of data are the same as those used in traditional predictive models. This area of research will greatly benefit from collaboration and data sharing among researchers of posttraumatic stress disorder, stress pathology, and resilience.
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Affiliation(s)
| | - Isaac R Galatzer-Levy
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA.,AiCure, New York, NY, USA
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16
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Koek RJ, Luong TN. Theranostic pharmacology in PTSD: Neurobiology and timing. Prog Neuropsychopharmacol Biol Psychiatry 2019; 90:245-263. [PMID: 30529001 DOI: 10.1016/j.pnpbp.2018.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 11/17/2018] [Accepted: 12/05/2018] [Indexed: 02/06/2023]
Abstract
Recent reviews and treatment guidelines regard trauma-focused cognitive-behavior therapies as the treatments of choice for chronic post-traumatic stress disorder (PTSD). However, many patients do not engage in this treatment when it is available, drop out before completion, or do not respond. Medications remain widely used, alone and in conjunction with psychotherapy, although the limitations of traditional monoamine-based pharmacotherapy are increasingly recognized. This article will review recent developments in psychopharmacology for PTSD, with a focus on current clinical data that apply putative neurobiologic mechanisms to medication use-i.e., a theranostic approach. A theranostic approach however, also requires consideration of timing, pre, peri or post trauma in conjunction with underlying dynamic processes affecting synaptic plasticity, the HPA axis, hippocampal activation, PFC-amygdala circuitry and fear memory.
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Affiliation(s)
- Ralph J Koek
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Sepulveda Ambulatory Care Center, VA Greater Los Angeles Healthcare System, North Hills, CA, USA.
| | - Tinh N Luong
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Olive View Medical Center, Sylmar, CA, USA
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17
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Richter-Levin G, Stork O, Schmidt MV. Animal models of PTSD: a challenge to be met. Mol Psychiatry 2019; 24:1135-1156. [PMID: 30816289 PMCID: PMC6756084 DOI: 10.1038/s41380-018-0272-5] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 08/13/2018] [Accepted: 09/11/2018] [Indexed: 02/07/2023]
Abstract
Recent years have seen increased interest in psychopathologies related to trauma exposure. Specifically, there has been a growing awareness to posttraumatic stress disorder (PTSD) in part due to terrorism, climate change-associated natural disasters, the global refugee crisis, and increased violence in overpopulated urban areas. However, notwithstanding the increased awareness to the disorder, the increasing number of patients, and the devastating impact on the lives of patients and their families, the efficacy of available treatments remains limited and highly unsatisfactory. A major scientific effort is therefore devoted to unravel the neural mechanisms underlying PTSD with the aim of paving the way to developing novel or improved treatment approaches and drugs to treat PTSD. One of the major scientific tools used to gain insight into understanding physiological and neuronal mechanisms underlying diseases and for treatment development is the use of animal models of human diseases. While much progress has been made using these models in understanding mechanisms of conditioned fear and fear memory, the gained knowledge has not yet led to better treatment options for PTSD patients. This poor translational outcome has already led some scientists and pharmaceutical companies, who do not in general hold opinions against animal models, to propose that those models should be abandoned. Here, we critically examine aspects of animal models of PTSD that may have contributed to the relative lack of translatability, including the focus on the exposure to trauma, overlooking individual and sex differences, and the contribution of risk factors. Based on findings from recent years, we propose research-based modifications that we believe are required in order to overcome some of the shortcomings of previous practice. These modifications include the usage of animal models of PTSD which incorporate risk factors and of the behavioral profiling analysis of individuals in a sample. These modifications are aimed to address factors such as individual predisposition and resilience, thus taking into consideration the fact that only a fraction of individuals exposed to trauma develop PTSD. We suggest that with an appropriate shift of practice, animal models are not only a valuable tool to enhance our understanding of fear and memory processes, but could serve as effective platforms for understanding PTSD, for PTSD drug development and drug testing.
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Affiliation(s)
- Gal Richter-Levin
- Sagol Department of Neurobiology, University of Haifa, Haifa, Israel. .,The Integrated Brain and Behavior Research Center (IBBR), University of Haifa, Haifa, Israel. .,Psychology Department, University of Haifa, Haifa, Israel.
| | - Oliver Stork
- 0000 0001 1018 4307grid.5807.aDepartment of Genetics & Molecular Neurobiology, Institute of Biology, Otto-von-Guericke-University Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany ,grid.452320.2Center for Behavioral Brain Sciences, Universitätsplatz 2, 39106 Magdeburg, Germany
| | - Mathias V. Schmidt
- 0000 0000 9497 5095grid.419548.5Department of Stress Neurobiology and Neurogenetics, Max Planck Institute of Psychiatry, Munich, Germany
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Carvajal C. Posttraumatic stress disorder as a diagnostic entity – clinical perspectives. DIALOGUES IN CLINICAL NEUROSCIENCE 2018. [PMID: 30581285 PMCID: PMC6296390 DOI: 10.31887/dcns.2018.20.3/ccarvajal] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Throughout history the consequences of psychological trauma and characteristic symptoms have involved clinical presentations that have had different names. Since the inclusion of the category of Posttraumatic Stress Disorder (PTSD) in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) with the symptomatic triad of re-experiencing the traumatic event, avoidance behaviors, and hypervigilance, this entity has been a source of controversy. Indeed, some authors have denied its existence, even considering it a diagnostic invention. In this article we review, from the clinician's perspective, historical aspects as well as the development of the nosological classifications and the contributions from the neurosciences that allow the consideration of the full validity of this diagnosis as a form of psychobiological reaction to psychological trauma.
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Affiliation(s)
- César Carvajal
- Clínica Universidad de los Andes, Santiago de Chile, Chile
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19
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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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