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Hicks EM, Niarchou M, Goleva S, Kabir D, Johnson J, Johnston KJ, Ciarcia J, Pathak GA, Smoller JW, Davis LK, Nievergelt CM, Koenen KC, Huckins LM, Choi KW. Comorbidity Profiles of Posttraumatic Stress Disorder Across the Medical Phenome. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2024; 4:100337. [PMID: 39050781 PMCID: PMC11268109 DOI: 10.1016/j.bpsgos.2024.100337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 04/09/2024] [Accepted: 04/19/2024] [Indexed: 07/27/2024] Open
Abstract
Background Previous epidemiological research has linked posttraumatic stress disorder (PTSD) with specific physical health problems, but the comprehensive landscape of medical conditions associated with PTSD remains uncharacterized. Electronic health records provide an opportunity to overcome clinical knowledge gaps and uncover associations with biological relevance that potentially vary by sex. Methods PTSD was defined among biobank participants (N = 145,959) in 3 major healthcare systems using 2 ICD code-based definitions: broad (≥1 PTSD or acute stress codes vs. 0; n cases = 16,706) and narrow (≥2 PTSD codes vs. 0; n cases = 3325). Using a phenome-wide association study design, we tested associations between each PTSD definition and all prevalent disease umbrella categories, i.e., phecodes. We also conducted sex-stratified phenome-wide association study analyses including a sex × diagnosis interaction term in each logistic regression. Results A substantial number of phecodes were significantly associated with PTSDNarrow (61%) and PTSDBroad (83%). While the strongest associations were shared between the 2 definitions, PTSDBroad captured 334 additional phecodes not significantly associated with PTSDNarrow and exhibited a wider range of significantly associated phecodes across various categories, including respiratory, genitourinary, and circulatory conditions. Sex differences were observed in that PTSDBroad was more strongly associated with osteoporosis, respiratory failure, hemorrhage, and pulmonary heart disease among male patients and with urinary tract infection, acute pharyngitis, respiratory infections, and overweight among female patients. Conclusions This study provides valuable insights into a diverse range of comorbidities associated with PTSD, including both known and novel associations, while highlighting the influence of sex differences and the impact of defining PTSD using electronic health records.
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Affiliation(s)
- Emily M. Hicks
- Pamela Sklar Division of Psychiatric Genetics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Maria Niarchou
- Vanderbilt University Medical Center, Vanderbilt Genetics Institute, Nashville, Tennessee
| | - Slavina Goleva
- Vanderbilt University Medical Center, Vanderbilt Genetics Institute, Nashville, Tennessee
| | - Dia Kabir
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Jessica Johnson
- Pamela Sklar Division of Psychiatric Genetics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Keira J.A. Johnston
- Department of Psychiatry, Division of Molecular Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Julia Ciarcia
- Department of Psychiatry, Division of Molecular Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Gita A. Pathak
- Department of Psychiatry, Division of Molecular Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Jordan W. Smoller
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Broad Institute of MIT and Harvard, Stanley Center for Psychiatric Research, Cambridge, Massachusetts
- Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, Massachusetts
| | - Lea K. Davis
- Vanderbilt University Medical Center, Vanderbilt Genetics Institute, Nashville, Tennessee
| | - Caroline M. Nievergelt
- Department of Psychiatry, University of California San Diego, La Jolla, California
- Veterans Affairs San Diego Healthcare System, Center of Excellence for Stress and Mental Health, San Diego, California
- Veterans Affairs San Diego Healthcare System, Research Service, San Diego, California
| | - Karestan C. Koenen
- Broad Institute of MIT and Harvard, Stanley Center for Psychiatric Research, Cambridge, Massachusetts
- Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Laura M. Huckins
- Department of Psychiatry, Division of Molecular Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Karmel W. Choi
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - PGC/PsycheMERGE PTSD & Trauma EHR Working Group
- Pamela Sklar Division of Psychiatric Genetics, Icahn School of Medicine at Mount Sinai, New York, New York
- Vanderbilt University Medical Center, Vanderbilt Genetics Institute, Nashville, Tennessee
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Department of Psychiatry, Division of Molecular Psychiatry, Yale University School of Medicine, New Haven, Connecticut
- Broad Institute of MIT and Harvard, Stanley Center for Psychiatric Research, Cambridge, Massachusetts
- Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, Massachusetts
- Department of Psychiatry, University of California San Diego, La Jolla, California
- Veterans Affairs San Diego Healthcare System, Center of Excellence for Stress and Mental Health, San Diego, California
- Veterans Affairs San Diego Healthcare System, Research Service, San Diego, California
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Ertan D, Mezouar N, Tarrada A, Maillard L, El-Hage W, Hingray C. Post-epileptic seizure posttraumatic stress Disorder: A mediation analysis. Epilepsy Behav 2024; 157:109863. [PMID: 38824749 DOI: 10.1016/j.yebeh.2024.109863] [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: 03/11/2024] [Revised: 05/20/2024] [Accepted: 05/21/2024] [Indexed: 06/04/2024]
Abstract
OBJECTIVE Previous studies investigated the varying prevalence of post-epileptic seizure posttraumatic stress disorder (PS-PTSD). The current study aimed first to compare the profiles of patients with and without PS-PTSD and, second, to study the interaction between other past traumatic experiences, subjective ictal anxiety, psychiatric comorbidities, and PS-PTSD in people with epilepsy (PWE). METHODS We conducted an observational study, investigating past traumatic experiences and PS-PTSD through standardized scales (CTQ-28, LEC-5 and PCL-5). We used semi-structured interviews and validated psychometric scales (NDDIE for depression and GAD-7 for anxiety) to collect data on general psychiatric comorbidities. We also assessed epilepsy specific psychiatric symptoms (interictal and peri-ictal). We performed a mediation analysis through PROCESS for SPSS to evaluate the effect of history of past trauma and subjective ictal anxiety on PS-PTSD through interictal depression and anxiety symptoms. RESULTS We enrolled 135 PWE, including 35 patients with PS-PTSD (29.5 %). Patients with PS-PTSD had significantly higher depression (12.87 vs 10; p = 0.005) and anxiety (7.74 vs 5.01; p = 0.027) scores and higher prevalence of peri-ictal psychiatric symptoms, compared to patients without PS-PTSD. The relationship between other past traumatic experiences and PS-PTSD was totally mediated by interictal depression and anxiety. We found a significant indirect effect of interictal anxiety symptoms on the path between subjective ictal anxiety and PS-PTSD. SIGNIFICANCE Our results showed that patients with PS-PTSD have a more severe psychopathological profile (more peri ictal and inter ictal depressive and anxiety symptoms). Both inter ictal and subjective ictal anxiety appear to have a significant role in PS-PTSD.
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Affiliation(s)
- Deniz Ertan
- Institut La Teppe Tain l'Hermitage, France; CHRU de Nancy, Département de Neurologie, Nancy, France
| | | | | | | | - Wissam El-Hage
- CHU de Tours, Tours, France; UMR 1253, iBraiN, Université de Tours, INSERM, Tours, France
| | - Coraline Hingray
- CHRU de Nancy, Département de Neurologie, Nancy, France; Pôle Hospitalo-Universitaire de Psychiatrie D'Adultes Du Grand Nancy, Centre Psychothérapique de Nancy, Laxou, France.
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3
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Mulder M, Kok R, Aben B, de Wind A. Incidence Rates and Predictors of Recurrent Long-Term Mental Sickness Absence Due to Common Mental Disorders. JOURNAL OF OCCUPATIONAL REHABILITATION 2024:10.1007/s10926-024-10226-7. [PMID: 39066861 DOI: 10.1007/s10926-024-10226-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/12/2024] [Indexed: 07/30/2024]
Abstract
PURPOSE Several predictors have been identified for mental sickness absence, but those for recurrences are not well-understood. This study assesses recurrence rates for long-term mental sickness absence (LTMSA) within subgroups of common mental disorders (CMDs) and identifies predictors of recurrent LTMSA. METHODS This historical prospective cohort study used routinely collected data from 16,310 employees obtained from a nationally operating Dutch occupational health service (ArboNed). Total follow-up duration was 23,334 person-years. Overall recurrence rates were assessed using Kaplan-Meier estimators. Recurrence rates within subgroups of CMDs were calculated using person-years. Univariable and multivariable Cox proportional hazards models were used to identify predictors. RESULTS 15.6% of employees experienced a recurrent LTMSA episode within three years after fully returning to work after a previous LTMSA episode. Highest recurrence rates for LTMSA were observed after a previous LTMSA episode due to mood or anxiety disorders. Mood or anxiety disorders and shorter previous episode duration were predictors of recurrent LTMSA. No associations were found for age, gender, company size, full-time equivalent and job tenure. CONCLUSION Employees should be monitored adequately after they fully returned to work after LTMSA. It is recommended to monitor high-risk employees (i.e. employees with mood or anxiety disorders and short LTMSA episode) more intensively, also beyond full return to work. Moreover, diagnosis of anxiety and depressive symptoms should be given a higher priority in occupational healthcare.
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Affiliation(s)
- Matthew Mulder
- Department of Research and Development, HumanTotalCare B.V., Zwarte Woud 10, Utrecht, 3524 SJ, The Netherlands.
| | - Robin Kok
- Department of Research and Development, HumanTotalCare B.V., Zwarte Woud 10, Utrecht, 3524 SJ, The Netherlands
| | - Bart Aben
- Department of Research and Development, HumanTotalCare B.V., Zwarte Woud 10, Utrecht, 3524 SJ, The Netherlands
| | - Astrid de Wind
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Societal Participation & Health, Amsterdam, The Netherlands
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Martalek A, Dubertret C, Fovet T, Le Strat Y, Tebeka S. Distressing memories: A continuum from wellness to PTSD. J Affect Disord 2024; 363:198-205. [PMID: 39029679 DOI: 10.1016/j.jad.2024.07.076] [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: 03/08/2024] [Revised: 07/09/2024] [Accepted: 07/14/2024] [Indexed: 07/21/2024]
Abstract
BACKGROUND Exposure to traumatic events is a frequent source of distress, provoking isolated symptoms such as distressing memories (DM) to full-blown post-traumatic stress disorder (PTSD). We aimed to assess the continuum theory using DM as an isolated symptom, and to examine trauma consequences in a exposed to traumatic events. METHODS Using data from the National Epidemiologic Study of Alcohol and Related Conditions III, we assessed the prevalence of DM in a trauma exposed sample, and examined their sociodemographic and lifetime psychiatric correlates, comparing three groups: (i) controls (no DM, no PTSD); (ii) participants with isolated DM without PTSD; (iii) participants with PTSD. We estimated the sensitivity and specificity of DM for PTSD diagnosis. RESULTS In our sample of 17,505 participants exposed to trauma, 13 % had PTSD and 42 % had DM without PTSD. The sensitivity of DM for the diagnosis of PTSD was 95.14 %, specificity was 51.91 %. Participants with DM and those with PTSD shared the same socio-demographic correlates. Participants with DM reported more lifetime psychiatric disorders (mood disorders - mainly depressive disorders and bipolar type 1 disorder; anxiety disorders - mainly social anxiety disorder, substance use disorders - mainly opioid use disorder and cannabis disorder; eating disorders - mainly binge eating disorder; personality disorders - mainly borderline personality disorder- and suicidality) than controls, but less than participants with PTSD. CONCLUSION DM represent an intermediate state between well-being and post-traumatic stress disorder; DM is also associated with other psychiatric disorders. It should be considered as a transdiagnostic psychiatric symptom useful for clinicians in identifying psychiatric vulnerability.
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Affiliation(s)
- Alexandra Martalek
- Department of Psychiatry, Louis-Mourier Hospital, AP-HP, 92700 Colombes, France; Université Paris cité, Faculty of Medicine, Paris, France
| | - Caroline Dubertret
- Department of Psychiatry, Louis-Mourier Hospital, AP-HP, 92700 Colombes, France; Université Paris cité, Faculty of Medicine, Paris, France; INSERM U1266, Centre for Psychiatry and Neurosciences, 102 rue de la Santé, 75014 Paris, France
| | - Thomas Fovet
- Univ. Lille, Inserm, CHU Lille, U1172 - Lille Neuroscience & Cognition, F-59000 Lille, France
| | - Yann Le Strat
- Department of Psychiatry, Louis-Mourier Hospital, AP-HP, 92700 Colombes, France; Université Paris cité, Faculty of Medicine, Paris, France; INSERM U1266, Centre for Psychiatry and Neurosciences, 102 rue de la Santé, 75014 Paris, France
| | - Sarah Tebeka
- Department of Psychiatry, Louis-Mourier Hospital, AP-HP, 92700 Colombes, France; Université Paris cité, Faculty of Medicine, Paris, France.
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Primasari I, Hoeboer CM, Bakker A, Olff M. Adaptation and validation study of the Indonesian version of the Global Psychotrauma Screen in an undergraduate student population. Compr Psychiatry 2024; 132:152485. [PMID: 38653061 DOI: 10.1016/j.comppsych.2024.152485] [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: 05/31/2023] [Revised: 04/05/2024] [Accepted: 04/13/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND The high incidence of potentially traumatic events (PTEs) in Indonesia warrants early identification of those with probable trauma-related disorders in order to tailor prevention and intervention for trauma-related symptoms. OBJECTIVES This study aims to adapt and validate a novel brief transdiagnostic screener, the Global Psychotrauma Screen (GPS), in Indonesian undergraduate students. METHODS An online survey was administered among Indonesian undergraduate students (N = 322). Exploratory factor analysis, reliability analyses, clinical validity analyses, and correlational analyses were performed to evaluate the construct validity, reliability, clinical validity, and convergent-divergent validity of the Indonesian GPS. Hierarchical multiple regression was conducted to assess the relationship between risk factors and trauma-related symptoms. The relationship between four categories of trauma-related symptom severity and social/work functioning was measured using Analysis of Covariance. RESULTS Exploratory factor analysis yielded a single-factor solution. The Indonesian GPS demonstrated good internal consistency, test-retest correlation, and absolute agreement, indicating good reliability. The Indonesian GPS also had an acceptable area under the curve, sensitivity, and specificity for a probable diagnosis of Post-Traumatic Stress Disorder (PTSD), Complex-PTSD (CPTSD), depression, and generalized anxiety disorder (GAD). We also established evidence for the convergent and divergent validity of GPS. The GPS risk factors (low psychological resilience, other stressful events, history of mental illness, and low social support) contributed to predicting trauma-related symptoms after controlling for gender, age, employment status, and faculty background. Additionally, in comparison to participants from the mild and low categories of GPS symptoms scores, participants from the severe and moderate category reported impaired lowered social/work functioning. CONCLUSION The current findings indicate that the Indonesian GPS is a valid and reliable transdiagnostic trauma screener for Indonesian undergraduate students. This first comprehensive validation of the GPS in Indonesia calls for more research in Lower-middle Income Countries (LMICs) as a way towards prevention and early intervention for trauma-related symptoms.
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Affiliation(s)
- Indira Primasari
- Amsterdam UMC location University of Amsterdam, Psychiatry, Amsterdam Public Health, Amsterdam, the Netherlands; Faculty of Psychology, Universitas Indonesia, Depok, Indonesia.
| | - Chris M Hoeboer
- Amsterdam UMC location University of Amsterdam, Psychiatry, Amsterdam Public Health, Amsterdam, the Netherlands
| | - Anne Bakker
- Amsterdam UMC location University of Amsterdam, Psychiatry, Amsterdam Public Health, Amsterdam, the Netherlands; Department of Trauma Care, OLVG, Amsterdam, the Netherlands
| | - Miranda Olff
- Amsterdam UMC location University of Amsterdam, Psychiatry, Amsterdam Public Health, Amsterdam, the Netherlands; ARQ National Psychotrauma Centre, Diemen, the Netherlands
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Lappas AS, Glarou E, Polyzopoulou ZA, Goss G, Huhn M, Samara MT, Christodoulou NG. Pharmacotherapy for sleep disturbances in post-traumatic stress disorder (PTSD): A network meta-analysis. Sleep Med 2024; 119:467-479. [PMID: 38795401 DOI: 10.1016/j.sleep.2024.05.032] [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: 03/12/2024] [Revised: 05/13/2024] [Accepted: 05/14/2024] [Indexed: 05/27/2024]
Abstract
BACKGROUND Sleep disturbances are an important symptom dimension of post-traumatic-stress-disorder (PTSD). There is no meta-analytic evidence examining the effects of all types of pharmacotherapy on sleep outcomes among patients with PTSD. METHODS Medline/Embase/PsychInfo/CENTRAL/clinicaltrials.gov/ICTRP, reference lists of published reviews and all included studies were searched for Randomised Controlled Trials (RCTs) examining any pharmacotherapy vs. placebo or any other drug among patients with PTSD. PRIMARY OUTCOMES total sleep time, nightmares, sleep quality. SECONDARY OUTCOMES sleep onset latency, number of nocturnal awakenings, time spent awake following sleep onset, dropouts due to sleep-related adverse-effects, insomnia/somnolence/vivid-dreams as adverse-effects. Pairwise and network meta-analyses were performed. RESULTS 99 RCTs with 10,481 participants were included. Prazosin may be the most effective treatment for insomnia (SMD = -0.88, 95%CI = [-1.22;-0.54], nightmares (SMD = -0.44, 95%CI = [-0.84;-0.04]) and poor sleep quality (SMD = -0.55, 95%CI = [-1.01;-0.10]). Evidence is scarce and indicates lack of efficacy for SSRIs, Mirtazapine, z-drugs and benzodiazepines, which are widely used in daily practice. Risperidone and Quetiapine carry a high risk of causing somnolence without having a clear therapeutic benefit. Hydroxyzine, Trazodone, Nabilone, Paroxetine and MDMA-assisted psychotherapy may be promising options, but more research is needed. CONCLUSIONS Underpowered individual comparisons and very-low to moderate confidence in effect estimates hinder the generalisability of the results. More RCTs, specifically reporting on sleep-related outcomes, are urgently needed.
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Affiliation(s)
- Andreas S Lappas
- Department of Psychiatry, Faculty of Medicine, University of Thessaly, Larisa, Greece; Aneurin Bevan University Health Board, Wales, United Kingdom.
| | - Eleni Glarou
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom; Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Zoi A Polyzopoulou
- Department of Psychology, University of Western Macedonia, Florina, Greece
| | - Grace Goss
- Cwm Taf Morgannwg University Health Board, Wales, United Kingdom
| | - Maximillian Huhn
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen, Germany; Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, District Hospital Bayreuth/Psychiatric Health Care Facilities of Upper Franconia, Bayreuth, Germany
| | - Myrto T Samara
- Department of Psychiatry, Faculty of Medicine, University of Thessaly, Larisa, Greece; Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Nikos G Christodoulou
- Department of Psychiatry, Faculty of Medicine, University of Thessaly, Larisa, Greece
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Guidetti C, Feeney A, Hock RS, Iovieno N, Hernández Ortiz JM, Fava M, Papakostas GI. Antidepressants in the acute treatment of post-traumatic stress disorder in adults: a systematic review and meta-analysis. Int Clin Psychopharmacol 2024:00004850-990000000-00142. [PMID: 38869978 DOI: 10.1097/yic.0000000000000554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
Currently, there are few pharmacotherapy options for clinicians treating post-traumatic stress disorder (PTSD), and antidepressants are usually the medication of choice. This meta-analysis aimed to review the efficacy of antidepressants in the acute treatment of PTSD in adults while investigating the contribution of study design and placebo response to the findings of these studies. Randomized, double-blind, placebo-controlled clinical trials that compared antidepressants with placebo for acute treatment of PTSD were selected. Standardized mean difference (SMD) in change in Clinician-Administered PTSD Scale scores were pooled after examining for heterogeneity. A random-effects meta-analysis was performed. Twenty-nine antidepressant-placebo comparisons, involving 4575 subjects, were analyzed. The SMD among all studies was 0.25, a small to medium effect size, lower than that in studies of antidepressants in adult major depressive disorder. The SMDs for low and high mean placebo responses, were 0.27 and 0.22, respectively. The overall SMD for paroxetine studies was in the moderate range (0.43) and that for sertraline studies was in the small range (0.12). Our findings suggest that antidepressants have modest efficacy in alleviating PTSD symptoms. Patient-level meta-analyses are required to further explore the potential clinical relevance of sertraline for PTSD.
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Affiliation(s)
- Clotilde Guidetti
- Department of Psychiatry, Clinical Trials Network and Institute, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children's hopsital, IRCCS, Rome, Italy
| | - Anna Feeney
- Department of Psychiatry, Clinical Trials Network and Institute, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Rebecca S Hock
- Department of Psychiatry, Clinical Trials Network and Institute, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Nadia Iovieno
- Department of Psychiatry, Clinical Trials Network and Institute, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jesús M Hernández Ortiz
- Department of Psychiatry, Clinical Trials Network and Institute, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Maurizio Fava
- Department of Psychiatry, Clinical Trials Network and Institute, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - George I Papakostas
- Department of Psychiatry, Clinical Trials Network and Institute, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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8
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Bainter SA, Goodman ZT, Kupis LB, Timpano KR, Uddin LQ. Neural and psychological correlates of post-traumatic stress symptoms in a community adult sample. Cereb Cortex 2024; 34:bhae214. [PMID: 38813966 DOI: 10.1093/cercor/bhae214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 04/30/2024] [Accepted: 05/07/2024] [Indexed: 05/31/2024] Open
Abstract
A multitude of factors are associated with the symptoms of post-traumatic stress disorder. However, establishing which predictors are most strongly associated with post-traumatic stress disorder symptoms is complicated because few studies are able to consider multiple factors simultaneously across the biopsychosocial domains that are implicated by existing theoretical models. Further, post-traumatic stress disorder is heterogeneous, and studies using case-control designs may obscure which factors relate uniquely to symptom dimensions. Here we used Bayesian variable selection to identify the most important predictors for overall post-traumatic stress disorder symptoms and individual symptom dimensions in a community sample of 569 adults (18 to 85 yr of age). Candidate predictors were selected from previously established risk factors relevant for post-traumatic stress disorder and included psychological measures, behavioral measures, and resting state functional connectivity among brain regions. In a follow-up analysis, we compared results controlling for current depression symptoms in order to examine specificity. Poor sleep quality and dimensions of temperament and impulsivity were consistently associated with greater post-traumatic stress disorder symptom severity. In addition to self-report measures, brain functional connectivity among regions commonly ascribed to the default mode network, central executive network, and salience network explained the unique variability of post-traumatic stress disorder symptoms. This study demonstrates the unique contributions of psychological measures and neural substrates to post-traumatic stress disorder symptoms.
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Affiliation(s)
- Sierra A Bainter
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Coral Gables, FL 33146, United States
| | - Zachary T Goodman
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Coral Gables, FL 33146, United States
| | - Lauren B Kupis
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, 760 Westwood Plaza, Los Angeles, CA 90095, United States
| | - Kiara R Timpano
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Coral Gables, FL 33146, United States
| | - Lucina Q Uddin
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, 760 Westwood Plaza, Los Angeles, CA 90095, United States
- Department of Psychology, University of California Los Angeles, 1285 Psychology Building, Box 951563, Los Angeles, CA 90095-1563, United States
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9
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Song Y, Zhao Y, Baranova A, Cao H, Yue W, Zhang F. Causal association of attention-deficit/hyperactivity disorder and autism spectrum disorder with post-traumatic stress disorder. Psychiatr Genet 2024; 34:37-42. [PMID: 38288984 PMCID: PMC10919267 DOI: 10.1097/ypg.0000000000000357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 10/16/2023] [Indexed: 03/09/2024]
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) are two neurodevelopmental disorders that often result in individuals experiencing traumatic events. However, little is known about the connection between ADHD/ASD and post-traumatic stress disorder (PTSD). This study aimed to investigate the genetic associations between these disorders. METHODS Genetic correlation analysis was used to examine the genetic components shared between ADHD (38 691 cases and 275 986 controls), ASD (18 381 cases and 27 969 controls) and PTSD (23 212 cases and 151 447 controls). Two-sample Mendelian randomization analyses were employed to explore the bidirectional causal relationships between ADHD/ASD and PTSD. RESULTS The results of the genetic correlation analysis revealed significant positive correlations of PTSD with ADHD(r g = 0.70) and ASD (r g = 0.34). Furthermore, the Mendelian randomization analysis revealed that genetic liabilities to ADHD [odds ratio (OR) = 1.14; 95% confidence interval (CI), 1.06-1.24; P = 7.88 × 10 -4 ] and ASD (OR = 1.04; CI, 1.01-1.08; P = 0.014) were associated with an increased risk of developing PTSD later in life. However, no evidence supported that genetic liability to PTSD could elevate the risk of ADHD or ASD. CONCLUSION The findings of this study supported that ADHD and ASD may increase the risk of PTSD, but not vice versa.
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Affiliation(s)
- Yuqing Song
- Peking University Sixth Hospital/Institute of Mental Health, Beijing
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing
| | - Yi Zhao
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Ancha Baranova
- School of Systems Biology, George Mason University, Manassas, USA
- Research Centre for Medical Genetics, Moscow, Russia
| | - Hongbao Cao
- School of Systems Biology, George Mason University, Manassas, USA
| | - Weihua Yue
- Peking University Sixth Hospital/Institute of Mental Health, Beijing
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing
- PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing
- Chinese Institute for Brain Research, Beijing
| | - Fuquan Zhang
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
- Institute of Neuropsychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
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10
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Paiva JM, Dos Santos Melani M, Marques ESN, Arcosy CV, Coutinho ESF, Ventura P, Berger W. The efficacy of internet-delivered cognitive-behavioral therapy for posttraumatic stress disorder according to the mean age of patients: a systematic review and meta-analysis. PSYCHOL HEALTH MED 2024; 29:683-697. [PMID: 38083873 DOI: 10.1080/13548506.2023.2292478] [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: 04/30/2023] [Accepted: 12/04/2023] [Indexed: 03/26/2024]
Abstract
Internet-delivered cognitive-behavioral therapy (I-CBT) is effective in treating post-traumatic stress disorder (PTSD) symptoms, offering enhanced accessibility and cost-effectiveness. However, it's important to note that these technologies may not be suitable for all age groups. Therefore, we conducted a systematic review and meta-analysis to determine if the effectiveness of I-CBT in treating PTSD varies based on the patients' mean age. We conducted a systematic review of the literature, focusing on randomized controlled trials (RCTs) in the ISI Web of Science, PubMed/MEDLINE, and PsycINFO databases. Following this, we performed a meta-analysis and evaluated the risk of bias using the Cochrane risk of bias quality assessment tool. In this study, we examined patient-related factors (civil or military status, age, and gender), clinical characteristics (baseline PTSD severity and type of trauma), and treatment characteristics (type of intervention, synchronous or asynchronous delivery, and the number of sessions) as independent variables. The dependent variable was the reduction in mean PTSD symptoms. Five RCTs out of 1,552 screened studies were included in this review, all of which showed some level of concern regarding potential bias. Our meta-analysis indicates that I-CBT is equally effective regardless of patients' mean age. Since all RCTs included only provide the mean age of the patients, further randomized controlled trials should address the effectiveness of I-CBT among different age groups.
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Affiliation(s)
- Jéssica Meirelles Paiva
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marina Dos Santos Melani
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Elisa Schoenche Nunes Marques
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Cheyenne von Arcosy
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Paula Ventura
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - William Berger
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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11
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Tiet QQ, Tiet TN. Diagnostic Accuracy of the Primary Care PTSD for DSM-5 Screen (PC-PTSD-5) in Demographic and Diagnostic Subgroups of Veterans. J Gen Intern Med 2024:10.1007/s11606-024-08719-5. [PMID: 38506961 DOI: 10.1007/s11606-024-08719-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 03/01/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5) is a screening instrument designed to identify patients with probable PTSD and is mandated to be used in VA primary care settings. However, validation of the diagnostic accuracy of the instrument is lacking in various demographic and diagnostic groups. OBJECTIVE To evaluate the diagnostic accuracy of the PC-PTSD-5 in demographically and diagnostically stratified groups of VA primary care patients. DESIGN, SETTING, AND PARTICIPANTS Based on a sample of 519 VA primary care patients (40.61% response rate), the PC-PTSD-5 was evaluated against a criterion measure, examining its sensitivity, specificity, and other diagnostic properties. Evaluations were conducted in demographically stratified patient groups, including gender, age, race/ethnicity, marital status, and education, as well as diagnostically stratified groups, in patients with and without a depression, alcohol use, and drug use disorder. MAIN MEASURES The MINI-International Neuropsychiatric Interview was the criterion measure against which the PC-PTSD-5 was evaluated. KEY RESULTS Among the 10 demographically stratified groups of patients, the PC-PTSD-5 demonstrated a sensitivity between 81.25% (95% C.I.: 54.35 - 05.95) and 100% (95% C.I.: 63.06 - 1000) and its specificity ranged from 80.54% (95% C.I.: 74.70 - 85.55) to 88.31% (95% C.I.: 83.45 - 92.15). Among the 6 diagnostically stratified groups of patients (with and without depression, alcohol use, and drug use disorders), the PC-PTSD-5 exhibited a sensitivity between 88.89% (95% C.I.: 65.29 - 98.62) and 95.92% (95% C.I.: 86.02 - 99.50), and its specificity varied from 60.00% (95% C.I.: 40.60 - 77.34) to 88.14% (95% C.I.: 84.50 - 91.19). CONCLUSIONS The PC-PTSD-5, suitable for a diverse range of VA primary care patients, shows satisfactory sensitivity and specificity across various demographic and diagnostic groups. Healthcare providers should be cautious of false positives in patients with depression or substance use disorders, given the potential symptom overlap with PTSD.
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Affiliation(s)
- Quyen Q Tiet
- California School of Professional Psychology at Alliant International University, PhD Clinical Psychology Program, San Francisco Bay Area Campus, Emeryville, CA, USA.
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System, Menlo Park, CA, USA.
| | - Thien-Nha Tiet
- Department of Psychology, University of California, San Diego, CA, USA
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12
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Guo J, Orgeta V, Olivé I, Hoff E, Huntley J, Olff M, Sobczak S. Biomarkers associated with cognitive impairment in post-traumatic stress disorder: A systematic review of current evidence. Ageing Res Rev 2024; 95:102198. [PMID: 38237700 DOI: 10.1016/j.arr.2024.102198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVE This systematic review aimed at synthesizing current evidence on biomarkers associated with cognitive impairment (CI) in Post-Traumatic Stress Disorder (PTSD). METHODS A systematic literature search was conducted for studies assessing biomarkers associated with CI in PTSD. RESULTS Of the 10,149 titles screened, 8 studies met our inclusion criteria. In a single longitudinal study, MRI volumes, Aβ and tau accumulation were not associated with CI in PTSD. Studies on structural imaging reported no significant association between morphological changes and CI. Two studies on diffusion neuroimaging showed abnormalities in white matter tracts which were cross-sectionally associated with CI in PTSD. Similarly, lower resting-state functional connectivity in neocortical networks, and elevated tau in the neocortex were also cross sectionally associated with CI. Two single studies on biochemical biomarkers showed that sixteen novel plasma proteins and lower BDNF, indicative of genetic vulnerabilities associated with neural and synaptic dysfunctions commonly observed in neurodegeneration, were cross-sectionally associated with CI in PTSD. Overall, evidence is of low quality. CONCLUSIONS Longitudinal research utilizing large representative samples of trauma exposed populations are needed to establish the utility of specific biomarkers in monitoring cognitive decline in PTSD.
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Affiliation(s)
- Junling Guo
- Division of Psychiatry, University College London, London, United Kingdom
| | - Vasiliki Orgeta
- Division of Psychiatry, University College London, London, United Kingdom.
| | - Isadora Olivé
- Division of Psychiatry, University College London, London, United Kingdom
| | - Erik Hoff
- Department of Neurology, Zuyderland Medical Center, Heerlen, Sittard, the Netherlands
| | - Jonathan Huntley
- Division of Psychiatry, University College London, London, United Kingdom
| | - Miranda Olff
- Department of Psychiatry, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Neuroscience, & Amsterdam Public Health, Amsterdam, the Netherlands; ARQ National Psychotrauma Centre, Diemen, the Netherlands
| | - Sjacko Sobczak
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands; Mondriaan Mental Health Center, Heerlen, Maastricht, the Netherlands; Rotterdam University of Applied Sciences (RUAS), Research Center Innovations in Care, Rotterdam, the Netherlands
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13
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Deahl M, Andreassen M. Psychiatric colonialism, PTSD and the Western psychiatric diagnostic tradition . . . is one man's food another man's poison? Int J Soc Psychiatry 2024; 70:36-39. [PMID: 37638706 PMCID: PMC10860350 DOI: 10.1177/00207640231193286] [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: 08/29/2023]
Abstract
Sadly, much of the world is no stranger to Psychological Trauma, particularly in poorer areas with poor health infrastructure. Western Aid Organisations frequently deploy to such areas bringing with them a western psychiatric tradition of nosology and therapy which may not be appropriate in other cultures. We argue that imposing a western system of diagnosis and treatment may not only undermine local culture but may also be bad for the patient. We discuss this with reference to the WHO's Mental Health Gap initiative (MHGap).
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Affiliation(s)
- Martin Deahl
- Centre for Affective Disorders, Kings College London, London, UK
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14
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Davis LL, Urganus A, Gagnon-Sanschagrin P, Maitland J, Qu W, Cloutier M, Guérin A, Aggarwal J. Patient journey before and after a formal post-traumatic stress disorder diagnosis in adults in the United States - a retrospective claims study. Curr Med Res Opin 2023; 39:1523-1532. [PMID: 37817472 DOI: 10.1080/03007995.2023.2269839] [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: 09/08/2023] [Accepted: 10/09/2023] [Indexed: 10/12/2023]
Abstract
OBJECTIVE To describe post-traumatic stress disorder (PTSD)-related symptoms and frequent psychiatric comorbidities, treatments received, healthcare resource utilization (HRU), and healthcare costs pre- and post-PTSD diagnosis among adults in the United States. METHODS Adults with PTSD who received a PTSD-related pharmacological treatment (selective serotonin reuptake inhibitor [SSRI], serotonin-norepinephrine reuptake inhibitor [SNRI], atypical antipsychotic [AA]) within 24 months of the first observed PTSD diagnosis (index date) were identified using MarketScan Commercial Database (2015-2020). Study outcomes were assessed during the 6-month pre-diagnosis and 24-month post-diagnosis periods. Subgroup analyses included patients treated or not treated with AAs post-PTSD diagnosis. RESULTS Of the overall patients (N = 26,306; mean age at diagnosis 39.5 years; 73.3% female), 85.9% had PTSD-related symptoms and frequent psychiatric comorbidities during the 6 months pre-diagnosis. Patients treated with AAs post-PTSD diagnosis (N = 9,298) tended to have higher rates of PTSD-related symptoms and comorbidities at diagnosis than those not treated with AAs (N = 7,011). Following diagnosis, the most commonly observed first-line treatments were SSRI (67.4%), AA (23.4%), and SNRI (22.6%). The rate of PTSD-related symptoms and comorbidities, psychotherapy and pharmacological treatments received, HRU, and healthcare costs increased during the 6 months post-diagnosis relative to the 6 months pre-diagnosis and then declined over time during the 24 months post-diagnosis. CONCLUSIONS The PTSD diagnosis was associated with increased rates of symptoms and frequent psychiatric comorbidities, psychotherapy and pharmacological treatments received, HRU, and healthcare costs, pointing to increased patient monitoring. Within 6 to 12 months after the PTSD diagnosis, these outcomes tended to reduce, perhaps as patients were obtaining targeted and effective care.
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Affiliation(s)
- Lori L Davis
- Research Service, Tuscaloosa Veterans Affairs Medical Center, Tuscaloosa, AL, USA
| | | | | | | | - Wendi Qu
- Analysis Group, Inc, Montréal, Canada
| | | | | | - Jyoti Aggarwal
- Otsuka Pharmaceutical Development & Commercialization, Inc, Princeton, NJ, USA
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15
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Mordeno IG, Luzano JGC. Examining specific and non-specific symptoms of the best-fitting posttraumatic stress disorder model in conflict-exposed adolescents. BMC Psychol 2023; 11:353. [PMID: 37875987 PMCID: PMC10594924 DOI: 10.1186/s40359-023-01389-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 10/10/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND The 5th revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) construes PTSD symptoms into 4 clusters (intrusion, avoidance, negative alterations in cognitions and mood, alterations in arousal and reactivity; Model 1). However, recent literature has shown that this symptom structure does not best represent PTSD. Unfortunately, the findings of studies investigating the proposed alternative models are from consensus. Adding to the complexity of the issue of symptom-grouping models is the identification of specific and non-specific symptoms of PTSD. The present study aims to address these gaps by identifying the best-fitting PTSD model and subsequently examining what symptoms are considered specific and non-specific to PTSD in adolescent-survivors of armed political conflict and violence. METHODS The study utilized a sample of 641 adolescent victim survivors. We conducted CFA analyses and compared nested models through the scaled χ2 difference test, while comparison of non-nested models was done using the Bayesian information criterion (BIC). The best-fitted model was used in the consequent analysis, where we statistically controlled for the effect of non-specific psychological distress on PTSD by comparing the factor loadings and factor correlations before and after accounting for distress using the Aroian z-test. RESULTS The results provide support for the 7-factor hybrid model of PTSD over other proposed models for the current sample. Moreover, the data reveal that only 7 items could be construed as core symptoms, while the rest of the symptoms can be considered non-PTSD specific. CONCLUSIONS Overall, the findings provide support for the validity of the hybrid PTSD model among political conflict-exposed adolescents. The results also show that the DSM-5 PTSD has both specific and non-specific features in the present sample of conflict-exposed adolescents. This has potential implications for theory, practice, and treatment of the disorder.
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Affiliation(s)
- Imelu G Mordeno
- Mindanao State University - Iligan Institute of Technology, Iligan City, Philippines.
| | - Jelli Grace C Luzano
- Mindanao State University - Iligan Institute of Technology, Iligan City, Philippines
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16
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Russo JE, Dhruve DM, Oliveros AD. Childhood Trauma and PTSD Symptoms: Disentangling the Roles of Emotion Regulation and Distress Tolerance. Res Child Adolesc Psychopathol 2023; 51:1273-1287. [PMID: 37039922 DOI: 10.1007/s10802-023-01048-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 04/12/2023]
Abstract
Research documents that a history of childhood trauma increases risk for post-traumatic stress disorder (PTSD), greater emotion regulation difficulties (ERD), and reduced distress tolerance (DT). Independent lines of research implicate ERD and DT as transdiagnostic risk factors and link them to PTSD. To elucidate how such mechanisms may influence the etiology, maintenance, and treatment of PTSD, the current study investigates the distinct mediating roles of emotion regulation and DT, exploring which explains a larger indirect effect from childhood trauma to PTSD symptom severity. Participants (N = 385, aged 18-48) who endorsed a history of childhood trauma provided retrospective report of cumulative childhood trauma exposure, and of current ERD, DT, and PTSD symptom severity. Single and dual mediation analyses were used to assess indirect effects through ERD and DT in the relation between cumulative childhood trauma exposure and current PTSD symptom severity. ERD and DT were significantly and inversely related. Higher current self-ratings of PTSD symptom severity were explained by cumulative childhood trauma through ERD (B = 0.93, p < 0.001) and DT (B = 0.50, p < 0.05). The full model explained 36% of the variance in PTSD symptom severity. Current findings provide preliminary evidence of DT and emotion regulation (with specific facets identified) as distinct mechanisms in the development of PTSD. Of clinical relevance, current findings support post-trauma processing theories that contend individuals' recovery requires accepting and learning to modulate trauma-related emotional states. Implications for methods of treatment and prevention are discussed.
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Affiliation(s)
- Jenna E Russo
- Department of Psychology, Mississippi State University, 110 Magruder Hall, P.O. Box 6161, Mississippi State, MS, 39762, USA.
| | - Deepali M Dhruve
- Department of Psychology, Mississippi State University, 110 Magruder Hall, P.O. Box 6161, Mississippi State, MS, 39762, USA
| | - Arazais D Oliveros
- Department of Psychology, Mississippi State University, 110 Magruder Hall, P.O. Box 6161, Mississippi State, MS, 39762, USA
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17
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Hicks EM, Niarchou M, Goleva S, Kabir D, Ciarcia J, Smoller JW, Davis LK, Nievergelt CM, Koenen KC, Huckins LM, Choi KW. Comorbidity Profiles of Posttraumatic Stress Disorder Across the Medical Phenome. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.08.25.23294572. [PMID: 37693435 PMCID: PMC10491282 DOI: 10.1101/2023.08.25.23294572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Background Prior epidemiological research has linked PTSD with specific physical health problems, but the comprehensive landscape of medical conditions associated with PTSD remains uncharacterized. Electronic health records (EHR) provide an opportunity to overcome prior clinical knowledge gaps and uncover associations with biological relevance that potentially vary by sex. Methods PTSD was defined among biobank participants (total N=123,365) in a major healthcare system using two ICD code-based definitions: broad (1+ PTSD or acute stress codes versus 0; NCase=14,899) and narrow (2+ PTSD codes versus 0; NCase=3,026). Using a phenome-wide association (PheWAS) design, we tested associations between each PTSD definition and all prevalent disease umbrella categories, i.e., phecodes. We also conducted sex-stratified PheWAS analyses including a sex-by-diagnosis interaction term in each logistic regression. Results A substantial number of phecodes were significantly associated with PTSDNarrow (61%) and PTSDBroad (83%). While top associations were shared between the two definitions, PTSDBroad captured 334 additional phecodes not significantly associated with PTSDNarrow and exhibited a wider range of significantly associated phecodes across various categories, including respiratory, genitourinary, and circulatory conditions. Sex differences were observed, in that PTSDBroad was more strongly associated with osteoporosis, respiratory failure, hemorrhage, and pulmonary heart disease among male patients, and with urinary tract infection, acute pharyngitis, respiratory infections, and overweight among female patients. Conclusions This study provides valuable insights into a diverse range of comorbidities associated with PTSD, including both known and novel associations, while highlighting the influence of sex differences and the impact of defining PTSD using EHR.
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Affiliation(s)
- Emily M Hicks
- Pamela Sklar Division of Psychiatric Genetics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Maria Niarchou
- Vanderbilt University Medical Center, Vanderbilt Genetics Institute, Nashville, TN, USA
| | - Slavina Goleva
- Vanderbilt University Medical Center, Vanderbilt Genetics Institute, Nashville, TN, USA
| | - Dia Kabir
- Massachusetts General Hospital, Department of Psychiatry, Boston, MA, USA
| | - Julia Ciarcia
- Department of Psychiatry, Division of Molecular Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Jordan W Smoller
- Massachusetts General Hospital, Department of Psychiatry, Boston, MA, USA
- Broad Institute of MIT and Harvard, Stanley Center for Psychiatric Research, Cambridge, MA
- Massachusetts General Hospital, Psychiatric and Neurodevelopmental Genetics Unit (PNGU), Boston, MA
| | - Lea K Davis
- Vanderbilt University Medical Center, Vanderbilt Genetics Institute, Nashville, TN, USA
| | - Caroline M Nievergelt
- University of California San Diego, Department of Psychiatry, La Jolla, CA
- Veterans Affairs San Diego Healthcare System, Center of Excellence for Stress and Mental Health, San Diego, CA
- Veterans Affairs San Diego Healthcare System, Research Service, San Diego, CA
| | - Karestan C Koenen
- Broad Institute of MIT and Harvard, Stanley Center for Psychiatric Research, Cambridge, MA
- Massachusetts General Hospital, Psychiatric and Neurodevelopmental Genetics Unit (PNGU), Boston, MA
- Harvard T.H. Chan School of Public Health, Department of Epidemiology, Boston, MA, US
| | - Laura M Huckins
- Department of Psychiatry, Division of Molecular Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Karmel W Choi
- Massachusetts General Hospital, Department of Psychiatry, Boston, MA, USA
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18
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Hilberdink CE, van Zuiden M, Olff M, Roseboom TJ, de Rooij SR. The impact of adversities across the lifespan on psychological symptom profiles in late adulthood: a latent profile analysis. J Dev Orig Health Dis 2023; 14:508-522. [PMID: 37477375 DOI: 10.1017/s2040174423000181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
People commonly face adverse circumstances throughout life, which increases risk for psychiatric disorders, such as anxiety, depression, psychosis, and posttraumatic stress disorder (PTSD). Adversities may occur during different periods in life. Especially adversity during early periods has been suggested to put individuals at risk for adverse mental health outcomes. Here, we investigated whether timing of adversity during the prenatal period, childhood, or mid-to-late adulthood differentially impacted classification into late adulthood symptom profiles. We performed sex-stratified Latent Profile Analysis to identify latent profiles regarding anxious, depressive, psychotic, and PTSD symptoms in n = 568 Dutch famine birth cohort members (n = 294 women, n = 274 men, mean age(SD) = 72.9(0.8)). Cross-sectional late adulthood symptomatology, childhood traumatic maltreatment, and adulthood trauma were based on self-report questionnaires. Prenatal adversity was considered present when individuals were prenatally exposed to the 1944-45 Dutch famine. In both men and women we identified one anxious/depressive profile and three profiles with approximately equal severity of all symptom types within each profile, yet differentiating in overall severity (low, mild, high) between profiles. We additionally found a PTSD symptom profile in women. In men, logistic regression models showed significant associations between prenatal, childhood and adulthood adversity, and profile classification, with differential effects depending on timing and most profound effects of child maltreatment. In women, childhood and adulthood adversity significantly increased classification probability into almost all profiles, with no significant effect of prenatal adversity. These findings support a time-dependent and sex-specific impact of adversity during different periods across the lifespan on psychological health, with consequences into late adulthood.
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Affiliation(s)
- C E Hilberdink
- Amsterdam UMC Location University of Amsterdam, Psychiatry, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Neuroscience Research Institute, Mood, Anxiety, Psychosis, Stress and Sleep, Amsterdam, The Netherlands
- Department of Epidemiology and Data Science, University of Amsterdam, Amsterdam, The Netherlands
| | - M van Zuiden
- Amsterdam UMC Location University of Amsterdam, Psychiatry, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Neuroscience Research Institute, Mood, Anxiety, Psychosis, Stress and Sleep, Amsterdam, The Netherlands
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
| | - M Olff
- Amsterdam UMC Location University of Amsterdam, Psychiatry, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Neuroscience Research Institute, Mood, Anxiety, Psychosis, Stress and Sleep, Amsterdam, The Netherlands
- ARQ, National Psychotrauma Centre, Diemen, The Netherlands
| | - T J Roseboom
- Department of Epidemiology and Data Science, University of Amsterdam, Amsterdam, The Netherlands
- Department of Obstetrics and Gynaecology, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
| | - S R de Rooij
- Department of Epidemiology and Data Science, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
- Amsterdam Public Health research institute, Aging and Later Life, Health Behaviors and Chronic Diseases, Amsterdam, The Netherlands
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19
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Öst LG, Enebrink P, Finnes A, Ghaderi A, Havnen A, Kvale G, Salomonsson S, Wergeland GJ. Cognitive behavior therapy for adult post-traumatic stress disorder in routine clinical care: A systematic review and meta-analysis. Behav Res Ther 2023; 166:104323. [PMID: 37257304 DOI: 10.1016/j.brat.2023.104323] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 03/25/2023] [Accepted: 04/26/2023] [Indexed: 06/02/2023]
Abstract
Although different cognitive behavioral therapies (CBT) have strong research support for treatment of adult post-traumatic stress disorder (PTSD) more knowledge is needed about the performance of CBT in routine clinical care. The present study is a systematic review and meta-analysis of CBT for PTSD in adults treated in routine clinical care. Ovid MEDLINE, Embase OVID, and PsycINFO were systematically searched for studies published until the end of May 2022. The effectiveness of CBT, methodological quality, and moderators of treatment outcome were examined, and benchmarked by meta-analytically comparing with efficacy studies for PTSD. Thirty-three studies, comprising 6482 participants, were included. The within-group effect sizes (ES) for PTSD-severity at post-treatment (1.75), and follow-up (1.70), on average 6 months post-treatment, were large. The effectiveness studies had very similar ESs as efficacy studies at post-treatment (1.75 vs. 1.72) and follow-up (1.70 vs. 2.02), based on the benchmarking analysis. As the heterogeneity was large, we can only cautiously consider CBT for PTSD an effective treatment when delivered in routine clinical care. The outcomes of effectiveness studies for PTSD seem to be comparable to the results obtained in efficacy studies. PROSPERO REGISTRATION ID: CRD42021228828.
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Affiliation(s)
- Lars-Göran Öst
- Department of Psychology, Stockholm University, Sweden; Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway; Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - Pia Enebrink
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Anna Finnes
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Academic Primary Care Center, Region Stockholm, Sweden
| | - Ata Ghaderi
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Audun Havnen
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway; Division of Psychiatry, St. Olavs Hospital, Trondheim, Norway
| | - Gerd Kvale
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway; Department of Clinical Psychology, University of Bergen, Norway
| | - Sigrid Salomonsson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Gro Janne Wergeland
- Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Norway
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20
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Brewerton TD, Gavidia I, Suro G, Perlman MM. Eating disorder patients with and without PTSD treated in residential care: discharge and 6-month follow-up results. J Eat Disord 2023; 11:48. [PMID: 36973828 PMCID: PMC10044735 DOI: 10.1186/s40337-023-00773-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/15/2023] [Indexed: 03/29/2023] Open
Abstract
INTRODUCTION We studied whether provisional posttraumatic stress disorder (PTSD) moderated discharge (DC) and 6-month follow-up (FU) outcomes of multi-modal, integrated eating disorder (ED) residential treatment (RT) based upon principles of cognitive processing therapy (CPT). METHODS ED patients [N = 609; 96% female; mean age (± SD) = 26.0 ± 8.8 years; 22% LGBTQ +] with and without PTSD completed validated assessments at admission (ADM), DC and 6-month FU to measure severity of ED, PTSD, major depressive disorder (MDD), state-trait anxiety (STA) symptoms, and eating disorder quality of life (EDQOL). We tested whether PTSD moderated the course of symptom change using mixed models analyses and if ED diagnosis, ADM BMI, age of ED onset and LGBTQ + orientation were significant covariates of change. Number of days between ADM and FU was used as a weighting measure. RESULTS Despite sustained improvements with RT in the total group, the PTSD group had significantly higher scores on all measures at all time points (p ≤ .001). Patients with (n = 261) and without PTSD (n = 348) showed similar symptom improvements from ADM to DC and outcomes remained statistically improved at 6-month FU compared to ADM. The only significant worsening observed between DC and FU was with MDD symptoms, yet all measures remained significantly lower than ADM at FU (p ≤ .001). There were no significant PTSD by time interactions for any of the measures. Age of ED onset was a significant covariate in the EDI-2, PHQ-9, STAI-T, and EDQOL models such that an earlier age of ED onset was associated with a worse outcome. ADM BMI was also a significant covariate in the EDE-Q, EDI-2, and EDQOL models, such that higher ADM BMI was associated with a worse ED and quality of life outcome. CONCLUSIONS Integrated treatment approaches that address PTSD comorbidity can be successfully delivered in RT and are associated with sustained improvements at FU. Improving strategies to prevent post-DC recurrence of MDD symptoms is an important and challenging area of future work.
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Affiliation(s)
- Timothy D Brewerton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.
- Timothy D. Brewerton, MD, LLC, Mount Pleasant, SC, USA.
- Monte Nido and Affiliates, Miami, FL, USA.
| | | | | | - Molly M Perlman
- Monte Nido and Affiliates, Miami, FL, USA
- Department of Psychiatry and Behavioral Health, Florida International University College of Medicine, Miami, FL, USA
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21
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Hilberdink CE, Bui E. The impact of trauma above and beyond its mental health consequences: An editorial. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2023. [DOI: 10.1080/00207411.2023.2180576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Affiliation(s)
- Charlotte E. Hilberdink
- Normandie University, UNICAEN, INSERM, U1237, PhIND “Physiopathology and Imaging of Neurological Disorders,” NEUROPRESAGE Team (Institut Blood and Brain at Caen-Normandie), GIP Cyceron, Caen, France
| | - Eric Bui
- Editor-in-Chief Normandie Univ, UNICAEN, INSERM, U1237, PhIND “Physiopathology and Imaging of Neurological Disorders”, NEUROPRESAGE Team, (Institut Blood and Brain @ Caen-Normandie), GIP Cyceron, Caen, France
- Centre Hospitalier Universitaire Caen Normandie, Caen, France
- Massachusetts General Hospital, Boston, MA, USA
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22
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Ragnhildstveit A, Roscoe J, Bass LC, Averill CL, Abdallah CG, Averill LA. The potential of ketamine for posttraumatic stress disorder: a review of clinical evidence. Ther Adv Psychopharmacol 2023; 13:20451253231154125. [PMID: 36895431 PMCID: PMC9989422 DOI: 10.1177/20451253231154125] [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: 08/26/2022] [Accepted: 01/13/2023] [Indexed: 03/08/2023] Open
Abstract
Posttraumatic stress disorder (PTSD) is a devastating condition, for which there are few pharmacological agents, often with a delayed onset of action and poor efficacy. Trauma-focused psychotherapies are further limited by few trained providers and low patient engagement. This frequently results in disease chronicity as well as psychiatric and medical comorbidity, with considerable negative impact on quality of life. As such, off-label interventions are commonly used for PTSD, particularly in chronic refractory cases. Ketamine, an N-methyl-D-aspartate (NDMA) receptor antagonist, has recently been indicated for major depression, exhibiting rapid and robust antidepressant effects. It also shows transdiagnostic potential for an array of psychiatric disorders. Here, we synthesize clinical evidence on ketamine in PTSD, spanning case reports, chart reviews, open-label studies, and randomized trials. Overall, there is high heterogeneity in clinical presentation and pharmacological approach, yet encouraging signals of therapeutic safety, efficacy, and durability. Avenues for future research are discussed.
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Affiliation(s)
- Anya Ragnhildstveit
- Integrated Research Literacy Group, Draper, UT, USA.,Department of Psychiatry, University of Cambridge, Cambridge, UK.,Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | - Jeremy Roscoe
- Integrated Research Literacy Group, Draper, UT, USA.,Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Lisa C Bass
- Integrated Research Literacy Group, Draper, UT, USA.,Neuroscience Interdepartmental Program, University of California, Los Angeles, Los Angeles, CA, USA
| | - Christopher L Averill
- Baylor College of Medicine, Houston, TX, USA.,Michael E. DeBakey VA Medical Center, Houston, TX, USA.,Yale School of Medicine, New Haven, CT, USA.,National Center for PTSD, West Haven, CT, USA
| | - Chadi G Abdallah
- Baylor College of Medicine, Houston, TX, USA.,Michael E. DeBakey VA Medical Center, Houston, TX, USA.,Yale School of Medicine, New Haven, CT, USA.,National Center for PTSD, West Haven, CT, USA
| | - Lynnette A Averill
- Baylor College of Medicine, 1977 Butler Avenue, 4-E-187, Houston, TX 77030, USA.,Yale School of Medicine, New Haven, CT, USA.,Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.,National Center for PTSD, West Haven, CT, USA
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23
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Use of Benzodiazepines and Z-Drugs in Inflammatory Bowel Disease. Am J Gastroenterol 2022; 117:2046-2054. [PMID: 36288107 DOI: 10.14309/ajg.0000000000001955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 07/29/2022] [Indexed: 12/11/2022]
Abstract
INTRODUCTION We estimated the incidence and prevalence of benzodiazepine and Z-drug (separately and jointly as BZD) use in the inflammatory bowel disease (IBD) population compared with matched controls without IBD and examined the association of mood/anxiety disorders (M/ADs) with the use of BZD from 1997 to 2017. METHODS Using administrative data from Manitoba, Canada, we identified 5,741 persons with incident IBD who were matched in a 1:5 ratio to controls on sex, birth year, and region. Validated case definitions were used to identify M/AD. Dispensations of BZD were identified. Multivariable generalized linear models were used to assess the association between IBD, M/AD, and BZD use. RESULTS In 2016, the incident age/sex-standardized benzodiazepine use rates per 1,000 were 28.06 (95% confidence interval [CI] 26.41-29.81) in the IBD cohort and 16.83 (95% CI 16.28-17.39) in controls (adjusted rate ratio = 1.69 [95% CI 1.56-1.79]). Benzodiazepine incidence rates were higher for women with IBD than men, but the RR between cases and controls were similar for men and women. The incident age/sex-standardized Z-drug use rate per 1,000 was 21.07 (95% CI 19.69-22.41) in the IBD cohort. This was 1.87-fold higher than in controls (95% CI 1.73-2.01). In 2017, approximately 20% of persons with IBD used benzodiazepines and 20% used Z-drugs. There was a subadditive effect of both benzodiazepine and Z-drug uses between IBD and M/AD after adjusting for covariates. DISCUSSION The use of BZD is more common in people with IBD than in population controls. Strategies to reduce the use of BZDs in persons with IBD and to offer alternative management strategies for M/ADs, sleep disorders, and other symptomatic concerns are needed.
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24
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Brewerton TD. Mechanisms by which adverse childhood experiences, other traumas and PTSD influence the health and well-being of individuals with eating disorders throughout the life span. J Eat Disord 2022; 10:162. [PMID: 36372878 PMCID: PMC9661783 DOI: 10.1186/s40337-022-00696-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 11/09/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Multiple published sources from around the world have confirmed an association between an array of adverse childhood experiences (ACEs) and other traumatic events with eating disorders (EDs) and related adverse outcomes, including higher morbidity and mortality. METHODS In keeping with this Special Issue's goals, this narrative review focuses on the ACEs pyramid and its purported mechanisms through which child maltreatment and other forms of violence toward human beings influence the health and well-being of individuals who develop EDs throughout the life span. Relevant literature on posttraumatic stress disorder (PTSD) is highlighted when applicable. RESULTS At every level of the pyramid, it is shown that EDs interact with each of these proclaimed escalating mechanisms in a bidirectional manner that contributes to the predisposition, precipitation and perpetuation of EDs and related medical and psychiatric comorbidities, which then predispose to early death. The levels and their interactions that are discussed include the contribution of generational embodiment (genetics) and historical trauma (epigenetics), social conditions and local context, the ACEs and other traumas themselves, the resultant disrupted neurodevelopment, subsequent social, emotional and cognitive impairment, the adoption of health risk behaviors, and the development of disease, disability and social problems, all resulting in premature mortality by means of fatal complications and/or suicide. CONCLUSIONS The implications of these cascading, evolving, and intertwined perspectives have important implications for the assessment and treatment of EDs using trauma-informed care and trauma-focused integrated treatment approaches. This overview offers multiple opportunities at every level for the palliation and prevention of EDs and other associated trauma-related conditions, including PTSD.
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Affiliation(s)
- Timothy D Brewerton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.
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25
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Gagnon-Sanschagrin P, Schein J, Urganus A, Serra E, Liang Y, Musingarimi P, Cloutier M, Guérin A, Davis LL. Identifying individuals with undiagnosed post-traumatic stress disorder in a large United States civilian population - a machine learning approach. BMC Psychiatry 2022; 22:630. [PMID: 36171558 PMCID: PMC9519190 DOI: 10.1186/s12888-022-04267-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 09/16/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The proportion of patients with post-traumatic stress disorder (PTSD) that remain undiagnosed may be substantial. Without an accurate diagnosis, these patients may lack PTSD-targeted treatments and experience adverse health outcomes. This study used a machine learning approach to identify and describe civilian patients likely to have undiagnosed PTSD in the US commercial population. METHODS The IBM® MarketScan® Commercial Subset (10/01/2015-12/31/2018) was used. A random forest machine learning model was developed and trained to differentiate between patients with and without PTSD using non-trauma-based features. The model was applied to patients for whom PTSD status could not be confirmed to identify individuals likely and unlikely to have undiagnosed PTSD. Patient characteristics, symptoms and complications potentially related to PTSD, treatments received, healthcare costs, and healthcare resource utilization were described separately for patients with PTSD (Actual Positive PTSD cohort), patients likely to have PTSD (Likely PTSD cohort), and patients without PTSD (Without PTSD cohort). RESULTS A total of 44,342 patients were classified in the Actual Positive PTSD cohort, 5683 in the Likely PTSD cohort, and 2,074,471 in the Without PTSD cohort. While several symptoms/comorbidities were similar between the Actual Positive and Likely PTSD cohorts, others, including depression and anxiety disorders, suicidal thoughts/actions, and substance use, were more common in the Likely PTSD cohort, suggesting that certain symptoms may be exacerbated among those without a formal diagnosis. Mean per-patient-per-6-month healthcare costs were similar between the Actual Positive and Likely PTSD cohorts ($11,156 and $11,723) and were higher than those of the Without PTSD cohort ($3616); however, cost drivers differed between cohorts, with the Likely PTSD cohort experiencing more inpatient admissions and less outpatient visits than the Actual Positive PTSD cohort. CONCLUSIONS These findings suggest that the lack of a PTSD diagnosis and targeted management of PTSD may result in a greater burden among undiagnosed patients and highlights the need for increased awareness of PTSD in clinical practice and among the civilian population.
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Affiliation(s)
- Patrick Gagnon-Sanschagrin
- Analysis Group, Inc., 1190 avenue des Canadiens-de-Montréal, 1190 avenue des Canadiens-de-Montréal, Tour Deloitte, Suite 1500, Montréal, QC, H3B 0G7, Canada.
| | - Jeff Schein
- grid.419943.20000 0004 0459 5953Otsuka Pharmaceutical Development & Commercialization, Inc., 508 Carnegie Center, Princeton, NJ 08540 USA
| | - Annette Urganus
- grid.419796.4Lundbeck LLC, 6 Parkway North, Deerfield, IL 60015 USA
| | - Elizabeth Serra
- Analysis Group, Inc., 1190 avenue des Canadiens-de-Montréal, 1190 avenue des Canadiens-de-Montréal, Tour Deloitte, Suite 1500, Montréal, QC H3B 0G7 Canada
| | - Yawen Liang
- Analysis Group, Inc., 1190 avenue des Canadiens-de-Montréal, 1190 avenue des Canadiens-de-Montréal, Tour Deloitte, Suite 1500, Montréal, QC H3B 0G7 Canada
| | - Primrose Musingarimi
- grid.424580.f0000 0004 0476 7612H. Lundbeck A/S, Ottiliavej 9, Valby, Copenhagen, Denmark
| | - Martin Cloutier
- Analysis Group, Inc., 1190 avenue des Canadiens-de-Montréal, 1190 avenue des Canadiens-de-Montréal, Tour Deloitte, Suite 1500, Montréal, QC H3B 0G7 Canada
| | - Annie Guérin
- Analysis Group, Inc., 1190 avenue des Canadiens-de-Montréal, 1190 avenue des Canadiens-de-Montréal, Tour Deloitte, Suite 1500, Montréal, QC H3B 0G7 Canada
| | - Lori L. Davis
- grid.416817.d0000 0001 0240 3901Research Service, Tuscaloosa Veterans Affairs Medical Center, 3701 Loop Rd East, Tuscaloosa, AL 35404 USA ,grid.265892.20000000106344187Department of Psychiatry and Behavioral Neurobiology, University of Alabama Heersink School of Medicine, 1720 7th Avenue South, Birmingham, AL 35233 USA
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26
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Male Sexual Health Related Complications Among Combat Veterans. Sex Med Rev 2022; 10:691-697. [PMID: 37051953 DOI: 10.1016/j.sxmr.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/06/2022] [Accepted: 06/09/2022] [Indexed: 11/21/2022]
Abstract
INTRODUCTION With improved armor and combat trauma care, more male service members in the 21st century are surviving devastating injuries to their genitourinary (GU) system. The impact of these injuries can have long lasting effect on their sexual function and fertility status. OBJECTIVES To review the current literature on sexual health-related complications and fertility implications among male service members sustaining combat related injuries. METHODS We performed a literature search that included male sexual health complications and combat injuries using PubMed and Google Scholar. We reviewed the impact of traumatic injuries to the pelvis and perineum on sexual function and fertility, and we also discuss sexual dysfunction from posttraumatic stress disorder (PTSD) and traumatic brain injuries (TBI). RESULTS Injuries sustained during combat are usually polytraumatic, especially in recent conflicts with improvised explosive devices. The majority of GU combat injuries involve the scrotum, testes, and penis resulting in lasting structural dysfunction. PTSD is associated with higher levels of erectile dysfunction, hypoactive sexual desire, and premature ejaculation. Overall, veterans diagnosed with PTSD had a higher risk of developing sexual dysfunction. Veterans with TBI experience sexual health complications, such as decreased libido, difficulties with arousal maintenance, and the ability to achieve orgasm. Combat related injuries can have significant fertility implications on service members as they typically serve in their peak fertility years. CONCLUSIONS Traumatic GU injuries, PTSD, TBI, and associated endocrine dysfunction can all contribute to sexual dysfunction among combat veterans. Given the complex nature of sexual dysfunction in this population, these patients are best managed by a multidisciplinary team. Castillo O, Chen IK, Amini E, et al. Male Sexual Health Related Complications Among Combat Veterans. Sex Med Rev 2022;XX:XXX-XXX.
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A Public Health Perspective of Post-Traumatic Stress Disorder. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116474. [PMID: 35682057 PMCID: PMC9180718 DOI: 10.3390/ijerph19116474] [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: 04/20/2022] [Revised: 05/20/2022] [Accepted: 05/23/2022] [Indexed: 11/25/2022]
Abstract
Trauma exposure is one of the most important and prevalent risk factors for mental and physical ill-health. Prolonged or excessive stress exposure increases the risk of a wide variety of mental and physical symptoms, resulting in a condition known as post-traumatic stress disorder (PTSD). The diagnosis might be challenging due to the complex pathophysiology and co-existence with other mental disorders. The prime factor for PTSD development is exposure to a stressor, which variably, along with peritraumatic conditions, affects disease progression and severity. Additionally, many factors are thought to influence the response to the stressor, and hence reshape the natural history and course of the disease. With sufficient knowledge about the disease, preventive and intervenient methods can be implemented to improve the quality of life of the patients and to limit both the medical and economic burden of the disease. This literature review provides a highlight of up-to-date literature on traumatic stress, with a focus on causes or triggers of stress, factors that influence response to stress, disease burden, and the application of the social-ecological public health model of disease prevention. In addition, it addresses therapeutic aspects, ethnic differences in traumatic stress, and future perspectives, including potential biomarkers.
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Alexithymia and Emotional Deficits Related to Posttraumatic Stress Disorder: An Investigation of Content and Process Disturbances. Case Rep Psychiatry 2022; 2022:7760988. [PMID: 35103107 PMCID: PMC8800611 DOI: 10.1155/2022/7760988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 01/08/2022] [Indexed: 01/31/2023] Open
Abstract
Background Posttraumatic stress disorder (PTSD) is a debilitating mental disorder that develops in the aftermath of traumatic life experiences, especially those that occurred in childhood. PTSD is associated with intrusive memories, distressing dreams, dissociative reactions, avoidance of trauma-related stimuli, negative mood and sense of well-being, increased arousal and irritability, and clinically significant distress and impaired functioning. Case Presentation. The following case report presents a 42-year-old male displaying symptoms of PTSD, alexithymia, and depression. Conclusion Untreated alexithymia may aggravate the trauma and cause the development of PTSD and depression.
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Gala D, Gurusamy V, Patel K, Damodar S, Swaminath G, Ullal G. Stem Cell Therapy for Post-Traumatic Stress Disorder: A Novel Therapeutic Approach. Diseases 2021; 9:diseases9040077. [PMID: 34842629 PMCID: PMC8628773 DOI: 10.3390/diseases9040077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/11/2021] [Accepted: 10/25/2021] [Indexed: 12/04/2022] Open
Abstract
Stem cell therapy is a rapidly evolving field of regenerative medicine being employed for the management of various central nervous system disorders. The ability to self-renew, differentiate into specialized cells, and integrate into neuronal networks has positioned stem cells as an ideal mechanism for the treatment of epilepsy. Epilepsy is characterized by repetitive seizures caused by imbalance in the GABA and glutamate neurotransmission following neuronal damage. Stem cells provide benefit by reducing the glutamate excitotoxicity and strengthening the GABAergic inter-neuron connections. Similar to the abnormal neuroanatomic location in epilepsy, post-traumatic stress disorder (PTSD) is caused by hyperarousal in the amygdala and decreased activity of the hippocampus and medial prefrontal cortex. Thus, stem cells could be used to modulate neuronal interconnectivity. In this review, we provide a rationale for the use of stem cell therapy in the treatment of PTSD.
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Brewerton TD, Gavidia I, Suro G, Perlman MM, Genet J, Bunnell DW. Provisional posttraumatic stress disorder is associated with greater severity of eating disorder and comorbid symptoms in adolescents treated in residential care. EUROPEAN EATING DISORDERS REVIEW 2021; 29:910-923. [PMID: 34523192 DOI: 10.1002/erv.2864] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 08/21/2021] [Accepted: 09/02/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Past traumatic events, subsequent posttraumatic stress disorder (PTSD) and related psychiatric comorbidities are commonly associated with eating disorders (EDs) in adults but remain understudied in adolescents. METHODS Adolescent participants (mean [SD] age = 15.1 ± 1.5 years, 96.5% female) with EDs entering residential treatment (n = 647) at six sites in the United States completed validated self-report assessments of ED, PTSD, major depression, anxiety disorders and quality of life. Provisional DSM-5 PTSD diagnoses (PTSD+) were made via the Childhood Trauma Questionnaire, admission interviews and the PTSD Symptom Checklist for DSM-5. RESULTS PTSD+ occurred in 35.4% of participants, and those with ED-PTSD+ had significantly higher scores on all assessments (p ≤ 0.001), including measures of ED psychopathology, major depression, anxiety disorders and quality of life, as well as significantly higher rates of all forms of childhood trauma. Those with PTSD+ also exhibited a significantly higher percent median body mass index for age and sex and a lower propensity toward anorexia nervosa, restricting type. CONCLUSIONS Results confirm that adolescent patients in residential treatment with ED-PTSD+ are more symptomatic and have worse quality of life than their ED counterparts without PTSD. Integrated treatment approaches that effectively address ED-PTSD+ are greatly needed in ED programs that treat adolescents.
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Affiliation(s)
- Timothy D Brewerton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA.,LLC, Mt. Pleasant, South Carolina, USA.,Monte Nido and Affiliates, Miami, Florida, USA
| | | | - Giulia Suro
- Monte Nido and Affiliates, Miami, Florida, USA
| | - Molly M Perlman
- Monte Nido and Affiliates, Miami, Florida, USA.,Department of Psychiatry and Behavioral Health, Florida International University Herbert Wertheim College of Medicine, Miami, Florida, USA
| | | | - Douglas W Bunnell
- Monte Nido and Affiliates, Miami, Florida, USA.,Private Practice, Westport, Connecticut, USA
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Akhtar A, Pilkhwal Sah S. Advances in the pharmacotherapeutic management of post-traumatic stress disorder. Expert Opin Pharmacother 2021; 22:1919-1930. [PMID: 34124975 DOI: 10.1080/14656566.2021.1935871] [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: 10/21/2022]
Abstract
Introduction: Post-traumatic stress disorder (PTSD), a mental disorder, is associated with anxiety, depression, and social awkwardness resulting from past traumatic episodes like natural disasters, accidents, terrorist attacks, war, rape, and sexual violence. It affects primarily the amygdala, cortex, and hippocampus where neurochemical changes result in altered behavior. PTSD patients display impaired fear extinction, and past events keep haunting them. The topic presents relevant sections like PTSD pharmacotherapy, associated challenges, and the novel targets and drugs for future research and therapy.Areas covered: The authors discuss the current pharmacotherapy like SSRIs, NDRIs, SNRIs, anticonvulsants, antidepressants, and benzodiazepines, used to attenuate the associated symptoms. However, the primary focus being the novel and potential targets which can be explored better to understand possible future research and advanced therapy in PTSD. For the same, an account of both preclinical and clinical studies has been covered.Expert opinion: Excessive adverse effects, limited efficacy, and lower patient compliance are some of the major challenges with conventional drugs. Moreover, they correct only fewer symptoms without halting the disease progression. Several agents are investigated in different preclinical and clinical phases, which can potentially overcome the pitfalls and limitations associated with conventional therapies.
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Affiliation(s)
- Ansab Akhtar
- Pharmacology Division, University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, India
| | - Sangeeta Pilkhwal Sah
- Pharmacology Division, University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, India
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