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Isaksson J, Nyman S, Schwab-Stone M, Stickley A, Ruchkin V. The severity of perceived stress associated with community violence exposure and its role in future posttraumatic stress: findings from a longitudinal study of U.S. adolescents. Child Adolesc Psychiatry Ment Health 2024; 18:121. [PMID: 39322966 PMCID: PMC11423508 DOI: 10.1186/s13034-024-00813-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Accepted: 09/10/2024] [Indexed: 09/27/2024] Open
Abstract
BACKGROUND Community violence exposure (CVE) in adolescence is associated with poorer mental health although the situational factors that may impact on this relationship remain relatively unexplored. The present study aimed to investigate if the degree of perceived stress during CVE has an effect on future posttraumatic stress disorder (PTSD) symptoms in youth, and if this association differs between females and males. METHODS Data were analyzed from 760 U.S. adolescents (mean age = 14.00 years), who participated in two surveys, one year apart. Information about CVE (witnessing violence and violence victimization) and the stress severity associated with it was collected in the first survey, whereas data on PTSD symptoms were obtained in the second survey. Generalized Linear Models were used to examine the associations that were also adjusted for ethnicity, age and socioeconomic status. RESULTS The results showed a longitudinal association between CVE-related stress and future PTSD symptoms, with students who had higher levels of perceived stress during CVE (witnessing or victimization) reporting higher PTSD symptom levels subsequently. There was no interaction between sex and CVE-related stress and PTSD symptoms, although females reported more PTSD symptoms. CONCLUSIONS The severity of the perceived stress associated with CVE should be regarded as a potentially important prognostic factor for identifying those who might develop PTSD symptoms after CVE and this may facilitate early intervention and treatment for those exposed to community violence.
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Affiliation(s)
- Johan Isaksson
- Department of Medical Sciences, Child and Adolescent Psychiatry Unit, Uppsala University, Uppsala, Sweden
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Sweden
| | - Sara Nyman
- Department of Medical Sciences, Child and Adolescent Psychiatry Unit, Uppsala University, Uppsala, Sweden
| | - Mary Schwab-Stone
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Andrew Stickley
- Stockholm Centre for Health and Social Change (SCOHOST), Sodertorn University, Huddinge, Sweden
- Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Vladislav Ruchkin
- Department of Medical Sciences, Child and Adolescent Psychiatry Unit, Uppsala University, Uppsala, Sweden.
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut, USA.
- Sala Forensic Psychiatric Clinic, Sala, Sweden.
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Ben-Azu B, Oritsemuelebi B, Oghorodi AM, Adebesin A, Isibor H, Eduviere AT, Otuacha OS, Akudo M, Ekereya S, Maidoh IF, Iyayi JO, Uzochukwu-Godfrey FC. Psychopharmacological interaction of alcohol and posttraumatic stress disorder: Effective action of naringin. Eur J Pharmacol 2024; 978:176791. [PMID: 38944175 DOI: 10.1016/j.ejphar.2024.176791] [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: 05/01/2024] [Revised: 06/09/2024] [Accepted: 06/26/2024] [Indexed: 07/01/2024]
Abstract
Posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) are prevalently co-occurring, important risk factors for a broad array of neuropsychiatric diseases. To date, how these two contrastive concomitant pairs increase the risk of neuropsychiatric states, notably exacerbating PTSD-related symptoms, remains unknown. Moreover, pharmacological interventions with agents that could reverse PTSD-AUD comorbidity, however, remained limited. Hence, we investigated the neuroprotective actions of naringin in mice comorbidly exposed to PTSD followed by repeated ethanol (EtOH)-induced AUD. Following a 7-day single-prolong-stress (SPS)-induced PTSD in mice, binge/heavy drinking, notably related to AUD, was induced in the PTSD mice with every-other-day ethanol (2 g/kg, p.o.) administration, followed by daily treatments with naringin (25 and 50 mg/kg) or fluoxetine (10 mg/kg), from days 8-21. PTSD-AUD-related behavioral changes, alcohol preference, hypothalamic-pituitary-adrenal (HPA)-axis dysfunction-induced neurochemical alterations, oxidative/nitrergic stress, and inflammation were examined in the prefrontal-cortex, striatum, and hippocampus. PTSD-AUD mice showed aggravated anxiety, spatial-cognitive, social impairments and EtOH intake, which were abated by naringin, similar to fluoxetine. Our assays on the HPA-axis showed exacerbated increased corticosterone release and adrenal hypertrophy, accompanied by marked dopamine and serotonin increase, with depleted glutamic acid decarboxylase enzyme in the three brain regions, which naringin, however, reversed, respectively. PTSD-AUD mice also showed increased TNF-α, IL-6, malondialdehyde and nitrite levels, with decreased antioxidant elements in the prefrontal-cortex, striatum, and hippocampus compared to SPS-EtOH-mice, mainly exacerbating catalase and glutathione decrease in the hippocampus relative SPS-mice. These findings suggest that AUD exacerbates PTSD pathologies in different brain regions, notably comprising neurochemical dysregulations, oxidative/nitrergic and cytokine-mediated inflammation, with HPA dysfunction, which were, however, revocable by naringin.
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Affiliation(s)
- Benneth Ben-Azu
- DELSU Joint Canada-Israel Neuroscience and Biopsychiatry Laboratory, Department of Pharmacology, Faculty of Basic Medical Sciences, Delta State University, Abraka, Nigeria.
| | - Benjamin Oritsemuelebi
- DELSU Joint Canada-Israel Neuroscience and Biopsychiatry Laboratory, Department of Pharmacology, Faculty of Basic Medical Sciences, Delta State University, Abraka, Nigeria
| | - Akpobo M Oghorodi
- DELSU Joint Canada-Israel Neuroscience and Biopsychiatry Laboratory, Department of Pharmacology, Faculty of Basic Medical Sciences, Delta State University, Abraka, Nigeria; Department of Biomedical Engineering, Faculty of Technology, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Adaeze Adebesin
- Department of Pharmacology and Therapeutics, Faculty of Basic Medical Sciences, Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University, Sagamu Campus, Sagamu, Ogun State, Nigeria
| | - Happy Isibor
- DELSU Joint Canada-Israel Neuroscience and Biopsychiatry Laboratory, Department of Pharmacology, Faculty of Basic Medical Sciences, Delta State University, Abraka, Nigeria
| | - Anthony T Eduviere
- DELSU Joint Canada-Israel Neuroscience and Biopsychiatry Laboratory, Department of Pharmacology, Faculty of Basic Medical Sciences, Delta State University, Abraka, Nigeria
| | - Oghenemine S Otuacha
- DELSU Joint Canada-Israel Neuroscience and Biopsychiatry Laboratory, Department of Pharmacology, Faculty of Basic Medical Sciences, Delta State University, Abraka, Nigeria
| | - Moses Akudo
- DELSU Joint Canada-Israel Neuroscience and Biopsychiatry Laboratory, Department of Pharmacology, Faculty of Basic Medical Sciences, Delta State University, Abraka, Nigeria
| | - Surhirime Ekereya
- DELSU Joint Canada-Israel Neuroscience and Biopsychiatry Laboratory, Department of Pharmacology, Faculty of Basic Medical Sciences, Delta State University, Abraka, Nigeria
| | - Isioma F Maidoh
- DELSU Joint Canada-Israel Neuroscience and Biopsychiatry Laboratory, Department of Pharmacology, Faculty of Basic Medical Sciences, Delta State University, Abraka, Nigeria
| | - Joy O Iyayi
- DELSU Joint Canada-Israel Neuroscience and Biopsychiatry Laboratory, Department of Pharmacology, Faculty of Basic Medical Sciences, Delta State University, Abraka, Nigeria
| | - Faith C Uzochukwu-Godfrey
- DELSU Joint Canada-Israel Neuroscience and Biopsychiatry Laboratory, Department of Pharmacology, Faculty of Basic Medical Sciences, Delta State University, Abraka, Nigeria
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Melese M, Maru L, Esubalew D. Posttraumatic stress disorder and its associated factors among people living in Dabat district, northwest Ethiopia. Front Psychiatry 2024; 15:1359382. [PMID: 39140107 PMCID: PMC11320060 DOI: 10.3389/fpsyt.2024.1359382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 07/10/2024] [Indexed: 08/15/2024] Open
Abstract
Background The conflict between the Ethiopian government and the Tigray People's Liberation Front (TPLF) in the Dabat district of Ethiopia has led to significant civilian casualties, instances of rape, sexual abuse, and property theft. These traumatic events contribute to the development of post-traumatic stress disorder (PTSD) among local residents. However, there is currently no available data on the prevalence of PTSD and its associated factors in this region. This study seeks to fill this gap by assessing PTSD prevalence and identifying related factors among residents of the war-affected Dabat district in northwest Ethiopia. Method A community-based correctional study was conducted in the Woken and China kebeles of Dabat district, northwest Ethiopia, spanning from July 13 to September 19, 2023. A total of 410 participants were selected using systematic random sampling, making a 100% response rate. The study utilized an interviewer-administered questionnaire, which included the Post-Traumatic Stress Disorder Checklist (PCL-5) to assess PTSD. The research investigated the association between PTSD and various demographic and psychosocial characteristics using both bivariate and multivariable binary logistic regression analyses. Statistical significance was set at a P-value of 0.05. Results The majority of participants in the study were male (62%) with a mean age of 33 ( ± 1.67) years. The overall prevalence of PTSD was 30.7% (95% CI: 26.6-35.10). Multivariable logistic regression analysis identified several factors significantly associated with PTSD: symptoms of depression (AOR=3.5; 95% CI: 1.13-6.89), age between 45 and 67 years (AOR=1.68; 95% CI: 1.04-5.78), experiencing stressful life events (AOR=1.63; 95% CI: 1.05-7.86), experiencing sexual abuse or rape (AOR=1.53; 95% CI: 1.07-6.75), chewing khat (AOR=1.48; 95% CI: 1.08-4.56), being female (AOR=1.43; 95% CI: 1.13-3.67), and having an income of 34.6 USD (AOR=1.28; 95% CI: 1.07-4.67). Conclusion and recommendation This study reported that the prevalence of PTSD was high. As a result, the study suggested that governments and other stakeholders should be involved in implementing efficient interventions and quick measures to mitigate the effects of war on mental health following the conflict. The government and nongovernmental organizations were also advised by these studies to continue providing humanitarian assistance, which should include access to food, clean water, clothing, shelter, and education. This study also suggested that people living in conflict zones should be legally protected from rape, sexual abuse, arson, detention without cause, and kidnapping.
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Affiliation(s)
- Mihret Melese
- Department of Human Physiology, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Lemlemu Maru
- Department of Human Physiology, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Dereje Esubalew
- Department of Human Physiology, College of Medicine and Health Sciences, Ambo University, Ambo, Oromia Region, Ethiopia
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Cusack SE, Maihofer AX, Bustamante D, Amstadter AB, Duncan LE. Genetic influences on testosterone and PTSD. J Psychiatr Res 2024; 174:8-11. [PMID: 38598976 PMCID: PMC11102285 DOI: 10.1016/j.jpsychires.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 02/25/2024] [Accepted: 04/02/2024] [Indexed: 04/12/2024]
Abstract
Females are twice as likely to experience PTSD as compared to males. Although sex differences in prevalence are well-established, little is known about why such sex differences occur. Biological factors that vary with sex, including sex hormone production, may contribute to these differences. Considerable evidence links sex hormones, such as testosterone, to PTSD risk though less is known about the shared genetic underpinnings. The objective of the present study was to test for genetic relationships between testosterone and PTSD. To do so, we used summary statistics from large, publicly available genetic consortia to conduct linkage disequilibrium score regression to estimate the genetic correlations between PTSD and testosterone in males and females, and two-sample, bi-directional Mendelian randomization to examine potential causal relationships of testosterone on PTSD and the reverse. Heritability estimates of testosterone were significantly higher in males (0.17, SE = 0.02) than females (0.11, SE = 0.01; z = 2.46, p = 00.01). The correlation between testosterone and PTSD was negative in males (rg = -0.11, SE = 0.02, p = 6.7 x 10-6), but not significant in females (rg = 0.002, SE = 0.03, p = 0.95). MR analyses found no evidence of a causal effect of testosterone on PTSD or the reverse. Findings are consistent with phenotypic literature suggesting a relationship between testosterone and PTSD that may be sex-specific. This work provides early evidence of a relationship between testosterone and PTSD genotypically and suggests an avenue for future research that will enable a better understanding of disparities in PTSD.
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Affiliation(s)
- Shannon E Cusack
- Virginia Institute of Psychiatric and Behavioral Genetics, Virginia Commonwealth University, USA.
| | - Adam X Maihofer
- University of California San Diego, Department of Psychiatry, La Jolla, CA, USA; Veterans Affairs San Diego Healthcare System, Research Service, San Diego, CA, USA
| | - Daniel Bustamante
- Virginia Institute of Psychiatric and Behavioral Genetics, Virginia Commonwealth University, USA
| | - Ananda B Amstadter
- Virginia Institute of Psychiatric and Behavioral Genetics, Virginia Commonwealth University, USA
| | - Laramie E Duncan
- Stanford University, Department of Psychiatry and Behavioral Sciences, USA
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Schmidt KFR, Gensichen JS, Schroevers M, Kaufmann M, Mueller F, Schelling G, Gehrke-Beck S, Boede M, Heintze C, Wensing M, Schwarzkopf D. Trajectories of post-traumatic stress in sepsis survivors two years after ICU discharge: a secondary analysis of a randomized controlled trial. Crit Care 2024; 28:35. [PMID: 38287438 PMCID: PMC10823628 DOI: 10.1186/s13054-024-04815-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 01/18/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Post-traumatic stress has been identified as a frequent long-term complication in survivors of critical illnesses after sepsis. Little is known about long-term trajectories of post-traumatic stress and potentially modifiable risk factors following the ICU stay. Study objective was to explore and compare different clinical trajectories of post-traumatic stress symptoms in sepsis survivors up to two years after discharge from ICU. METHODS Data on post-traumatic stress symptoms by means of the Post-traumatic Symptom Scale (PTSS-10) were collected in sepsis survivors at one, six, 12 and 24 months after discharge from ICU. Data on chronic psychiatric diagnoses prior ICU were derived from the primary care provider's health records, and data on intensive care treatment from ICU documentation. Trajectories of post-traumatic symptoms were identified ex post, discriminating patterns of change and k-means clustering. Assignment to the trajectories was predicted in multinomial log-linear models. RESULTS At 24 months, all follow-up measurements of the PTSS-10 were completed in N = 175 patients. Three clusters could be identified regarding clinical trajectories of PTSS levels: stable low symptoms (N = 104 patients [59%]), increasing symptoms (N = 45 patients [26%]), and recovering from symptoms (N = 26 patients [15%]). Patients with initially high post-traumatic symptoms were more likely to show a decrease (OR with 95% CI: 1.1 [1.05, 1.16]). Females (OR = 2.45 [1.11, 5.41]) and patients reporting early traumatic memories of the ICU (OR = 4.04 [1.63, 10]) were at higher risk for increasing PTSS levels. CONCLUSION Post-traumatic stress is a relevant long-term burden for sepsis patients after ICU stay. Identification of three different trajectories within two years after ICU discharge highlights the importance of long-term observation, as a quarter of patients reports few symptoms at discharge yet an increase in symptoms in the two years following. Regular screening of ICU survivors on post-traumatic stress should be considered even in patients with few symptoms and in particular in females and patients reporting traumatic memories of the ICU.
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Affiliation(s)
- Konrad F R Schmidt
- Institute of General Practice and Family Medicine, Charité University Medicine, Charitéplatz 1, D-10117, Berlin, Germany.
- Institute of General Practice and Family Medicine, Jena University Hospital, D-07743, Jena, Germany.
- Center of Sepsis Control and Care (CSCC), Jena University Hospital, D-07747, Jena, Germany.
| | - Jochen S Gensichen
- Center of Sepsis Control and Care (CSCC), Jena University Hospital, D-07747, Jena, Germany
- Institute of General Practice and Family Medicine, University Hospital of the Ludwig-Maximilians-University Munich, D-80336, Munich, Germany
| | - Maya Schroevers
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, NL-9700 AB, Groningen, The Netherlands
| | - Martina Kaufmann
- Office of Good Scientific Practice, Charité University Medicine, D-10117, Berlin, Germany
| | - Friederike Mueller
- Center of Sepsis Control and Care (CSCC), Jena University Hospital, D-07747, Jena, Germany
- Department of Child and Youth Psychiatry, Psychosomatics and Psychotherapy, Asklepios Hospital Luebben, D-15907, Luebben, Germany
| | - Gustav Schelling
- Department of Anesthesiology, University Hospital of the Ludwig-Maximilians-University Munich, D-80336, Munich, Germany
| | - Sabine Gehrke-Beck
- Institute of General Practice and Family Medicine, Charité University Medicine, Charitéplatz 1, D-10117, Berlin, Germany
| | - Monique Boede
- Institute of General Practice and Family Medicine, Jena University Hospital, D-07743, Jena, Germany
| | - Christoph Heintze
- Institute of General Practice and Family Medicine, Charité University Medicine, Charitéplatz 1, D-10117, Berlin, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, University Hospital Heidelberg, D-69120, Heidelberg, Germany
| | - Daniel Schwarzkopf
- Center of Sepsis Control and Care (CSCC), Jena University Hospital, D-07747, Jena, Germany
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Am Klinikum 1, D-07747, Jena, Germany
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D'Souza AW, Yoo JK, Bhai S, Sarma S, Anderson EH, Levine BD, Fu Q. Attenuated peripheral oxygen extraction and greater cardiac output in women with posttraumatic stress disorder during exercise. J Appl Physiol (1985) 2024; 136:141-150. [PMID: 38031720 PMCID: PMC11219012 DOI: 10.1152/japplphysiol.00161.2023] [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: 03/15/2023] [Revised: 11/20/2023] [Accepted: 11/20/2023] [Indexed: 12/01/2023] Open
Abstract
Posttraumatic stress disorder (PTSD) is associated with an increased risk of developing cardiovascular disease, especially in women. Evidence indicates that men with PTSD exhibit lower maximal oxygen uptake (V̇o2max) relative to controls; however, whether V̇o2max is blunted in women with PTSD remains unknown. Furthermore, it is unclear what determinants (i.e., central and/or peripheral) of V̇o2max are impacted by PTSD. Therefore, we evaluated the central (i.e., cardiac output; Q̇c) and peripheral (i.e., arteriovenous oxygen difference) determinants of V̇o2max in women with PTSD; hypothesizing that V̇o2max would be lower in women with PTSD compared with women without PTSD (controls), primarily due to smaller increases in stroke volume (SV), and therefore Q̇c. Oxygen uptake (V̇o2), heart rate (HR), Q̇c, SV, and arteriovenous oxygen difference were measured in women with PTSD (n = 14; mean [SD]: 43 [11] yr,) and controls (n = 17; 45 [11] yr) at rest, and during an incremental maximal treadmill exercise test, and the Q̇c/V̇o2 slope was calculated. V̇o2max was not different between women with and without PTSD (24.3 [5.6] vs. 26.4 [5.0] mL/kg/min; P = 0.265). However, women with PTSD had higher Q̇c [P = 0.002; primarily due to greater SV (P = 0.069), not HR (P = 0.285)], and lower arteriovenous oxygen difference (P = 0.002) throughout exercise compared with controls. Furthermore, the Q̇c/V̇o2 slope was steeper in women with PTSD relative to controls (6.6 [1.4] vs. 5.7 [1.0] AU; P = 0.033). Following maximal exercise, women with PTSD exhibited slower HR recovery than controls (P = 0.046). Thus, despite attenuated peripheral oxygen extraction, V̇o2max is not reduced in women with PTSD, likely due to larger increases in Q̇c.NEW & NOTEWORTHY The current study indicates that V̇o2max is not different between women with and without PTSD; however, women with PTSD exhibit blunted peripheral extraction of oxygen, thus requiring an increase in Q̇c to meet metabolic demand during exercise. Furthermore, following exercise, women with PTSD demonstrate impaired autonomic cardiovascular control relative to sedentary controls. We interpret these data to indicate that women with PTSD demonstrate aberrant cardiovascular responses during and immediately following fatiguing exercise.
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Affiliation(s)
- Andrew W D'Souza
- Neurovascular Research Laboratory, School of Kinesiology, Western University, London, Ontario, Canada
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States
- Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Jeung-Ki Yoo
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States
- Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Salman Bhai
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States
- Department of Neurology, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Satyam Sarma
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States
- Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Elizabeth H Anderson
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
- Veterans Affairs North Texas Health Care System, Dallas, Texas, United States
| | - Benjamin D Levine
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States
- Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Qi Fu
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States
- Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
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Saraiya TC, Back SE, Jarnecke AM, Blakey SM, Bauer AG, Brown DG, Ruglass LM, Killeen T, Hien DA. Sex and Gender Differences in Co-Occurring Alcohol Use Disorder and PTSD. CURRENT ADDICTION REPORTS 2023; 10:617-627. [PMID: 39026610 PMCID: PMC11257080 DOI: 10.1007/s40429-023-00511-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2023] [Indexed: 07/20/2024]
Abstract
Purpose of Review Research demonstrates a strong association between alcohol use disorder (AUD) and posttraumatic stress disorder (PTSD). However, less is known about sex- and gender-based differences among individuals with AUD + PTSD. This narrative review examines recent literature in this area and aims to be a reference for future research endeavors. Recent Findings Extant literature shows that intertwining biological systems increase females' risk of developing PTSD and experiencing more adverse effects from AUD compared to males. Sex-based physiological differences further interact with gendered sociocultural environments to influence the risk of AUD + PTSD. Emerging research suggests potential gender-specific pathways between PTSD, coping, and AUD which may inform prevention and treatment. However, barriers to care are often gender-specific and tailored approaches are needed to improve reach and uptake. Summary Additional research is needed to examine intersectional and contextual factors that synergistically influence sex/gender differences in AUD + PTSD, particularly beyond cisgender identities, and mechanisms of action.
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Affiliation(s)
- Tanya C. Saraiya
- Center of Alcohol & Substance Use Studies, Rutgers University-New Brunswick, 607 Allison Road, Piscataway, NJ 08854, USA
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, 125 Doughty Street, Suite 300, Charleston, SC 29425, USA
| | - Sudie E. Back
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, 125 Doughty Street, Suite 300, Charleston, SC 29425, USA
- Ralph H. Johnson Veterans Affairs Healthcare System, Charleston, SC, USA
| | - Amber M. Jarnecke
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, 125 Doughty Street, Suite 300, Charleston, SC 29425, USA
| | | | - Alexandria G. Bauer
- Center of Alcohol & Substance Use Studies, Rutgers University-New Brunswick, 607 Allison Road, Piscataway, NJ 08854, USA
| | - Delisa G. Brown
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, 125 Doughty Street, Suite 300, Charleston, SC 29425, USA
| | - Lesia M. Ruglass
- Center of Alcohol & Substance Use Studies, Rutgers University-New Brunswick, 607 Allison Road, Piscataway, NJ 08854, USA
- Department of Psychology, City College of New York, New York, NY, USA
| | - Therese Killeen
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, 125 Doughty Street, Suite 300, Charleston, SC 29425, USA
| | - Denise A. Hien
- Center of Alcohol & Substance Use Studies, Rutgers University-New Brunswick, 607 Allison Road, Piscataway, NJ 08854, USA
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Marchese S, Huckins LM. Trauma Matters: Integrating Genetic and Environmental Components of PTSD. ADVANCED GENETICS (HOBOKEN, N.J.) 2023; 4:2200017. [PMID: 37766803 PMCID: PMC10520418 DOI: 10.1002/ggn2.202200017] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/28/2022] [Indexed: 09/29/2023]
Abstract
Trauma is ubiquitous, but only a subset of those who experience trauma will develop posttraumatic stress disorder (PTSD). In this review, it is argued that to determine who is at risk of developing PTSD, it is critical to examine the genetic etiology of the disorder and individual trauma profiles of those who are susceptible. First, the state of current PTSD genetic research is described, with a particular focus on studies that present evidence for trauma type specificity, or for differential genetic etiology according to gender or race. Next, approaches that leverage non-traditional phenotyping approaches are reviewed to identify PTSD-associated variants and biology, and the relative advantages and limitations inherent in these studies are reflected on. Finally, it is discussed how trauma might influence the heritability of PTSD, through type, risk factors, genetics, and associations with PTSD symptomology.
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Affiliation(s)
- Shelby Marchese
- Pamela Sklar Division of Psychiatric GenomicsIcahn School of Medicine at Mount SinaiNew YorkNY10029USA
- Department of Genetics and Genomic SciencesIcahn School of Medicine at Mount SinaiNew YorkNY10029USA
| | - Laura M. Huckins
- Pamela Sklar Division of Psychiatric GenomicsIcahn School of Medicine at Mount SinaiNew YorkNY10029USA
- Department of Genetics and Genomic SciencesIcahn School of Medicine at Mount SinaiNew YorkNY10029USA
- Department of PsychiatryIcahn School of Medicine at Mount SinaiNew YorkNY10029USA
- Seaver Autism Center for Research and TreatmentIcahn School of Medicine at Mount SinaiNew YorkNY10029USA
- Present address:
Department of PsychiatryYale University School of MedicineNew HavenCT06511USA
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9
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Zoladz PR, Cordes CN, Weiser JN, Reneau KE, Boaz KM, Helwig SJ, Virden EM, Thebeault CK, Pfister CL, Getnet BA, Niese TD, Parker SL, Stanek ML, Long KE, Norrholm SD, Rorabaugh BR. Pre-Learning Stress That Is Temporally Removed from Acquisition Impairs Fear Learning. BIOLOGY 2023; 12:775. [PMID: 37372060 DOI: 10.3390/biology12060775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/19/2023] [Accepted: 05/23/2023] [Indexed: 06/29/2023]
Abstract
Few studies have examined the time-dependent effects of stress on fear learning. Previously, we found that stress immediately before fear conditioning enhanced fear learning. Here, we aimed to extend these findings by assessing the effects of stress 30 min prior to fear conditioning on fear learning and fear generalization. Two hundred and twenty-one healthy adults underwent stress (socially evaluated cold pressor test) or a control manipulation 30 min before completing differential fear conditioning in a fear-potentiated startle paradigm. One visual stimulus (CS+), but not another (CS-), was associated with an aversive airblast to the throat (US) during acquisition. The next day, participants were tested for their fear responses to the CS+, CS-, and several generalization stimuli. Stress impaired the acquisition of fear on Day 1 but had no significant impact on fear generalization. The stress-induced impairment of fear learning was particularly evident in participants who exhibited a robust cortisol response to the stressor. These findings are consistent with the notion that stress administered 30 min before learning impairs memory formation via corticosteroid-related mechanisms and may help us understand how fear memories are altered in stress-related psychological disorders.
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Affiliation(s)
- Phillip R Zoladz
- Psychology Program, The School of Health and Behavioral Sciences, Ohio Northern University, Ada, OH 45810, USA
| | - Chloe N Cordes
- Psychology Program, The School of Health and Behavioral Sciences, Ohio Northern University, Ada, OH 45810, USA
| | - Jordan N Weiser
- Psychology Program, The School of Health and Behavioral Sciences, Ohio Northern University, Ada, OH 45810, USA
| | - Kassidy E Reneau
- Psychology Program, The School of Health and Behavioral Sciences, Ohio Northern University, Ada, OH 45810, USA
| | - Kayla M Boaz
- Psychology Program, The School of Health and Behavioral Sciences, Ohio Northern University, Ada, OH 45810, USA
| | - Sara J Helwig
- Psychology Program, The School of Health and Behavioral Sciences, Ohio Northern University, Ada, OH 45810, USA
| | - Emma M Virden
- Psychology Program, The School of Health and Behavioral Sciences, Ohio Northern University, Ada, OH 45810, USA
| | - Caitlin K Thebeault
- Psychology Program, The School of Health and Behavioral Sciences, Ohio Northern University, Ada, OH 45810, USA
| | - Cassidy L Pfister
- Psychology Program, The School of Health and Behavioral Sciences, Ohio Northern University, Ada, OH 45810, USA
| | - Bruktawit A Getnet
- Psychology Program, The School of Health and Behavioral Sciences, Ohio Northern University, Ada, OH 45810, USA
| | - Taylor D Niese
- Psychology Program, The School of Health and Behavioral Sciences, Ohio Northern University, Ada, OH 45810, USA
| | - Sydney L Parker
- Psychology Program, The School of Health and Behavioral Sciences, Ohio Northern University, Ada, OH 45810, USA
| | - Mercedes L Stanek
- Psychology Program, The School of Health and Behavioral Sciences, Ohio Northern University, Ada, OH 45810, USA
| | - Kristen E Long
- Psychology Program, The School of Health and Behavioral Sciences, Ohio Northern University, Ada, OH 45810, USA
| | - Seth D Norrholm
- Department of Psychiatry and Behavioral Neurosciences, School of Medicine, Wayne State University, Detroit, MI 48202, USA
| | - Boyd R Rorabaugh
- Department of Pharmaceutical Sciences, School of Pharmacy, Marshall University, Huntington, WV 25755, USA
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10
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Cawley E, Piazza G, Das RK, Kamboj SK. A systematic review of the pharmacological modulation of autobiographical memory specificity. Front Psychol 2022; 13:1045217. [PMID: 36452391 PMCID: PMC9703074 DOI: 10.3389/fpsyg.2022.1045217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 10/27/2022] [Indexed: 08/31/2023] Open
Abstract
Background Over-general autobiographical memory (AM) retrieval is proposed to have a causal role in the maintenance of psychological disorders like depression and PTSD. As such, the identification of drugs that modulate AM specificity may open up new avenues of research on pharmacological modeling and treatment of psychological disorders. Aim The current review summarizes randomized, placebo-controlled studies of acute pharmacological modulation of AM specificity. Method A systematic search was conducted of studies that examined the acute effects of pharmacological interventions on AM specificity in human volunteers (healthy and clinical participants) measured using the Autobiographical Memory Test. Results Seventeen studies were identified (986 total participants), of which 16 were judged to have low risk of bias. The presence and direction of effects varied across drugs and diagnostic status of participants (clinical vs. healthy volunteers). The most commonly studied drug-hydrocortisone-produced an overall impairment in AM specificity in healthy volunteers [g = -0.28, CI (-0.53, -0.03), p = 0.03], although improvements were reported in two studies of clinical participants. In general, studies of monoamine modulators reported no effect on specificity. Conclusion Pharmacological enhancement of AM specificity is inconsistent, although monaminergic modulators show little promise in this regard. Drugs that reduce AM specificity in healthy volunteers may be useful experimental-pharmacological tools that mimic an important transdiagnostic impairment in psychological disorders. Systematic review registration PROSPERO, identifier CRD42020199076, https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020199076.
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Affiliation(s)
- Emma Cawley
- Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
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11
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Farhane-Medina NZ, Luque B, Tabernero C, Castillo-Mayén R. Factors associated with gender and sex differences in anxiety prevalence and comorbidity: A systematic review. Sci Prog 2022; 105:368504221135469. [PMID: 36373774 PMCID: PMC10450496 DOI: 10.1177/00368504221135469] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023]
Abstract
Background: The prevalence and comorbidity of anxiety disorders are significantly different between women and men, with research showing a greater impact on women. The aim of this review was to identify the psychosocial and biological factors that have been considered to explain this gender and sex difference in prevalence and determine whether these factors are related to any anxiety comorbidity differences between men and women. Methods: Following the PRISMA guidelines, we carried out a systematic review of studies published between 2008 and 2021 in PsycINFO and PubMed databases. Empirical and review studies evaluating psychosocial and biological factors that could influence the difference in prevalence and comorbidity between men and women were included. A qualitative narrative synthesis was performed to describe the results. Results: From 1012 studies, 44 studies were included. Retrieved articles were categorized depending on their object of study: psychosocial factors (n = 21), biological factors (n = 16), or comorbidity (n = 7). Results showed that differences in anxiety between women and men have been analyzed by psychosocial and biological factors but rarely together. Among the psychosocial factors analyzed, masculinity may be a protective factor for anxiety development, while femininity can be a risk factor. In the studies that took biological factors into account, the potential influence of brain structures, genetic factors, and fluctuations in sexual hormones are pointed out as causes of greater anxiety in women. Concerning comorbidity, the results noted that women tend to develop other internalizing disorders (e.g. depression), while men tend to develop externalizing disorders (e.g. substance abuse). Conclusions: For an accurate understanding of differences between women and men in anxiety, both biological and psychosocial factors should be considered. This review highlights the need to apply the biopsychosocial model of health and the gender perspective to address differences in anxiety between sexes.
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Affiliation(s)
- Naima Z. Farhane-Medina
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain
- Department of Psychology, University of Cordoba, Cordoba, Spain
| | - Bárbara Luque
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain
- Department of Psychology, University of Cordoba, Cordoba, Spain
| | - Carmen Tabernero
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain
- Institute of Neuroscience of Castilla y León (INCYL), University of Salamanca, Salamanca, Spain
| | - Rosario Castillo-Mayén
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain
- Department of Psychology, University of Cordoba, Cordoba, Spain
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12
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Torales J, O’Higgins M, Barrios I, Amarilla D, Figueredo P, Almirón-Santacruz J, Ruiz-Díaz N, Melgarejo O, Castaldelli-Maia JM, Ventriglio A. The International Trauma Questionnaire: An assessment of the psychometric properties of its Spanish version. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2022. [DOI: 10.29333/ejgm/12389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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13
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Ressler KJ, Berretta S, Bolshakov VY, Rosso IM, Meloni EG, Rauch SL, Carlezon WA. Post-traumatic stress disorder: clinical and translational neuroscience from cells to circuits. Nat Rev Neurol 2022; 18:273-288. [PMID: 35352034 PMCID: PMC9682920 DOI: 10.1038/s41582-022-00635-8] [Citation(s) in RCA: 116] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2022] [Indexed: 01/16/2023]
Abstract
Post-traumatic stress disorder (PTSD) is a maladaptive and debilitating psychiatric disorder, characterized by re-experiencing, avoidance, negative emotions and thoughts, and hyperarousal in the months and years following exposure to severe trauma. PTSD has a prevalence of approximately 6-8% in the general population, although this can increase to 25% among groups who have experienced severe psychological trauma, such as combat veterans, refugees and victims of assault. The risk of developing PTSD in the aftermath of severe trauma is determined by multiple factors, including genetics - at least 30-40% of the risk of PTSD is heritable - and past history, for example, prior adult and childhood trauma. Many of the primary symptoms of PTSD, including hyperarousal and sleep dysregulation, are increasingly understood through translational neuroscience. In addition, a large amount of evidence suggests that PTSD can be viewed, at least in part, as a disorder that involves dysregulation of normal fear processes. The neural circuitry underlying fear and threat-related behaviour and learning in mammals, including the amygdala-hippocampus-medial prefrontal cortex circuit, is among the most well-understood in behavioural neuroscience. Furthermore, the study of threat-responding and its underlying circuitry has led to rapid progress in understanding learning and memory processes. By combining molecular-genetic approaches with a translational, mechanistic knowledge of fear circuitry, transformational advances in the conceptual framework, diagnosis and treatment of PTSD are possible. In this Review, we describe the clinical features and current treatments for PTSD, examine the neurobiology of symptom domains, highlight genomic advances and discuss translational approaches to understanding mechanisms and identifying new treatments and interventions for this devastating syndrome.
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Affiliation(s)
- Kerry J Ressler
- SPARED Center, Department of Psychiatry, McLean Hospital, Harvard Medical School, Boston, MA, USA.
| | - Sabina Berretta
- SPARED Center, Department of Psychiatry, McLean Hospital, Harvard Medical School, Boston, MA, USA
| | - Vadim Y Bolshakov
- SPARED Center, Department of Psychiatry, McLean Hospital, Harvard Medical School, Boston, MA, USA
| | - Isabelle M Rosso
- SPARED Center, Department of Psychiatry, McLean Hospital, Harvard Medical School, Boston, MA, USA
| | - Edward G Meloni
- SPARED Center, Department of Psychiatry, McLean Hospital, Harvard Medical School, Boston, MA, USA
| | - Scott L Rauch
- SPARED Center, Department of Psychiatry, McLean Hospital, Harvard Medical School, Boston, MA, USA
| | - William A Carlezon
- SPARED Center, Department of Psychiatry, McLean Hospital, Harvard Medical School, Boston, MA, USA
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14
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Al Yacoub ON, Awwad HO, Zhang Y, Standifer KM. Therapeutic potential of nociceptin/orphanin FQ peptide (NOP) receptor modulators for treatment of traumatic brain injury, traumatic stress, and their co-morbidities. Pharmacol Ther 2022; 231:107982. [PMID: 34480968 DOI: 10.1016/j.pharmthera.2021.107982] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/12/2021] [Accepted: 08/12/2021] [Indexed: 12/22/2022]
Abstract
The nociceptin/orphanin FQ (N/OFQ) peptide (NOP) receptor is a member of the opioid receptor superfamily with N/OFQ as its endogenous agonist. Wide expression of the NOP receptor and N/OFQ, both centrally and peripherally, and their ability to modulate several biological functions has led to development of NOP receptor modulators by pharmaceutical companies as therapeutics, based upon their efficacy in preclinical models of pain, anxiety, depression, Parkinson's disease, and substance abuse. Both posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) are debilitating conditions that significantly affect the quality of life of millions of people around the world. PTSD is often a consequence of TBI, and, especially for those deployed to, working and/or living in a war zone or are first responders, they are comorbid. PTSD and TBI share common symptoms, and negatively influence outcomes as comorbidities of the other. Unfortunately, a lack of effective therapies or therapeutic agents limits the long term quality of life for either TBI or PTSD patients. Ours, and other groups, demonstrated that PTSD and TBI preclinical models elicit changes in the N/OFQ-NOP receptor system, and that administration of NOP receptor ligands alleviated some of the neurobiological and behavioral changes induced by brain injury and/or traumatic stress exposure. Here we review the past and most recent progress on understanding the role of the N/OFQ-NOP receptor system in PTSD and TBI neurological and behavioral sequelae. There is still more to understand about this neuropeptide system in both PTSD and TBI, but current findings warrant further examination of the potential utility of NOP modulators as therapeutics for these disorders and their co-morbidities. We advocate the development of standards for common data elements (CDE) reporting for preclinical PTSD studies, similar to current preclinical TBI CDEs. That would provide for more standardized data collection and reporting to improve reproducibility, interpretation and data sharing across studies.
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Affiliation(s)
- Omar N Al Yacoub
- Department of Pharmaceutical Sciences, University of Oklahoma College of Pharmacy, OUHSC, Oklahoma City, OK 73117, United States of America
| | - Hibah O Awwad
- Department of Pharmaceutical Sciences, University of Oklahoma College of Pharmacy, OUHSC, Oklahoma City, OK 73117, United States of America
| | - Yong Zhang
- Department of Pharmaceutical Sciences, University of Oklahoma College of Pharmacy, OUHSC, Oklahoma City, OK 73117, United States of America
| | - Kelly M Standifer
- Department of Pharmaceutical Sciences, University of Oklahoma College of Pharmacy, OUHSC, Oklahoma City, OK 73117, United States of America.
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15
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Musumeci MD, Cunningham CM, White TL. Disgustingly perfect: An examination of disgust, perfectionism, and gender. MOTIVATION AND EMOTION 2022; 46:336-349. [PMID: 35669938 PMCID: PMC9136022 DOI: 10.1007/s11031-022-09931-8] [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] [Accepted: 01/25/2022] [Indexed: 11/25/2022]
Abstract
High levels of disgust and perfectionism co-exist in some clinical disorders raising questions about the relationship between the two. This research evaluated socially-related and physically-related disgust in people with varying levels of perfectionism. In Study 1, 120 college students participated in a state emotion-eliciting scenario task, then completed both the Almost Perfect Scale-Revised and the Three Dimensions of Disgust Survey (TDDS). In Study 2, 380 Qualtrics users completed the scenarios, along with the TDDS and Multidimensional Perfectionist Scale. Both studies showed that state emotions differed from each other in ways that were unrelated to perfectionism. Gender differences were seen in the perfectionist groups, state disgust responses, and trait sexual disgust. However, Study 2 also showed relationships between trait perfectionism and disgust. The differing state emotional responses show that contextual interpersonal factors are highly important in disgust behaviors. Additionally, the findings suggest that gender could be important in the relationship between disgust and perfectionism.
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Affiliation(s)
- M. D. Musumeci
- Le Moyne College, Syracuse, USA
- University of Dayton, Dayton, USA
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16
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Tronson NC. Puberty reverses sex differences in learning. Nat Neurosci 2022; 25:134-135. [PMID: 35087247 DOI: 10.1038/s41593-021-00986-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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17
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Phytoestrogen genistein modulates neuron-microglia signaling in a mouse model of chronic social defeat stress. Neuropharmacology 2022; 206:108941. [PMID: 34990615 DOI: 10.1016/j.neuropharm.2021.108941] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 12/26/2021] [Accepted: 12/29/2021] [Indexed: 01/20/2023]
Abstract
Microglia, resident immune cells in the brain, are shown to mediate the crosstalk between psychological stress and depression. Interestingly, increasing evidence indicates that sex hormones, particularly estrogen, are involved in the regulation of immune system. In this study, we aimed to understand the potential effects of chronic social defeat stress (CSDS) and genistein (GEN), an estrogenic compound of the plant origin, on neuron-microglia interactions in the mouse hippocampus. The time spent in the avoidance zone in the social interaction test was increased by CSDS 1 day after the exposure, while the avoidance behavior returned to control levels 14 days after the CSDS exposure. Similar results were obtained from the elevated plus-maze test. However, the immobility time in the forced swim test was increased by CSDS 14 days after the exposure, and the depression-related behavior was in part alleviated by GEN. The numerical densities of microglia in the hippocampus were increased by CSDS, and they were decreased by GEN. The voxel densities of synaptic structures and synaptic puncta colocalized with microglia were decreased by CSDS, and they were increased by GEN. Neither CSDS nor GEN affected the gene expressions of major pro-inflammatory cytokines. Conversely, the expression levels of genes related to neurotrophic factors were decreased by CSDS, and they were partially reversed by GEN. These findings show that GEN may in part alleviate stress-related symptoms, and the effects of GEN may be associated with the modulation of neuron-microglia signaling via chemokines and neurotrophic factors in the hippocampus.
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18
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van Zuiden M, Engel S, Karchoud JF, Wise TJ, Sijbrandij M, Mouthaan J, Olff M, van de Schoot R. Sex-differential PTSD symptom trajectories across one year following suspected serious injury. Eur J Psychotraumatol 2022; 13:2031593. [PMID: 35186216 PMCID: PMC8856115 DOI: 10.1080/20008198.2022.2031593] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Recent years have shown an increased application of prospective trajectory-oriented approaches to posttraumatic stress disorder (PTSD). Although women are generally considered at increased PTSD risk, sex and gender differences in PTSD symptom trajectories have not yet been extensively studied. OBJECTIVE To perform an in-depth investigation of differences in PTSD symptom trajectories across one-year post-trauma between men and women, by interpreting the general trends of trajectories observed in sex-disaggregated samples, and comparing within-trajectory symptom course and prevalence rates. METHOD We included N = 554 participants (62.5% men, 37.5% women) from a multi-centre prospective cohort of emergency department patients with suspected severe injury. PTSD symptom severity was assessed at 1, 3, 6, and 12 months post-trauma, using the Clinician-Administered PTSD Scale for DSM-IV. Latent growth mixture modelling on longitudinal PTSD symptoms was performed within the sex-disaggregated whole samples. Bayesian modelling with informative priors was applied for reliable model estimation, considering the imbalanced prevalence of the expected latent trajectories. RESULTS In terms of general trends, the same trajectories were observed for men and women, i.e. resilient, recovery, chronic symptoms and delayed onset. Within-trajectory symptom courses were largely comparable, but resilient women had higher symptoms than resilient men. Sex differences in prevalence rates were observed for the recovery (higher in women) and delayed onset (higher in men) trajectories. Model fit for the sex-disaggregated samples was better than for the whole sample, indicating preferred application of sex-disaggregation. Analyses within the whole sample led to biased estimates of overall and sex-specific trajectory prevalence rates. CONCLUSIONS Sex-disaggregated trajectory analyses revealed limited sex differences in PTSD symptom trajectories within one-year post-trauma in terms of general trends, courses and prevalence rates. The observed biased trajectory prevalence rates in the whole sample emphasize the necessity to apply appropriate statistical techniques when conducting sex-sensitive research.
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Affiliation(s)
- Mirjam van Zuiden
- Department of Psychiatry, Amsterdam University Medical Centers, Location Amsterdam Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute and Amsterdam Neuroscience Research Institute, Amsterdam, The Netherlands
| | - Sinha Engel
- Division of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Jeanet F Karchoud
- Department of Psychiatry, Amsterdam University Medical Centers, Location Amsterdam Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Thomas J Wise
- Department of Psychiatry, Amsterdam University Medical Centers, Location Amsterdam Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Marit Sijbrandij
- Vrije Universiteit, Department of Clinical, Neuro- and Developmental Psychology; Amsterdam Public Health Research Institute, World Health Organization Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam, The Netherlands
| | - Joanne Mouthaan
- Department of Clinical Psychology, Institute of Psychology, Faculty of Social and Behavioural Sciences, Leiden University, AK Leiden, Netherlands
| | - Miranda Olff
- Department of Psychiatry, Amsterdam University Medical Centers, Location Amsterdam Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute and Amsterdam Neuroscience Research Institute, Amsterdam, the Netherlands & Arq National Psychotrauma Centre, Amsterdam, The Netherlands
| | - Rens van de Schoot
- Department of Methodology and Statistics, Faculty of Social and Behavioral Sciences, Utrecht University, Utrecht, The Netherlands
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19
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Saltzman LY. Sex Differences in the Relationship Between Child Maltreatment, Recent Bereavement, and Average Heart Rate. OMEGA-JOURNAL OF DEATH AND DYING 2021; 84:459-473. [PMID: 31865859 PMCID: PMC7306425 DOI: 10.1177/0030222819894139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The study explores the sex differences in cardiovascular outcomes among bereaved individuals. In addition, the study differentiates the impact of child maltreatment and recent loss on the physical health of adult men and women. This study conducted a secondary analysis of data drawn from the Biomarker Subproject of the National Survey of Midlife Development in the United States (n = 1,255). Analysis included a series of regression models estimated in Stata version 15.1. A main effect for both sex and loss was observed. Both male and female respondents with loss had higher average heart rates as compared to male respondents without loss. Interestingly, being a female without loss was also associated with a higher average heart rate as compared to males without loss. The findings suggest that sex differences in cardiovascular functioning do occur and that these differences may be exacerbated by experiences of trauma and loss, and this relationship has implications for assessment and intervention.
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Affiliation(s)
- Leia Y Saltzman
- School of Social Work, Tulane University, New Orleans, LA, USA
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20
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Sexually Dimorphic Expression of Fear-conditioned Analgesia in Rats and Associated Alterations in the Endocannabinoid System in the Periaqueductal Grey. Neuroscience 2021; 480:117-130. [PMID: 34774710 DOI: 10.1016/j.neuroscience.2021.11.005] [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: 06/18/2021] [Revised: 10/16/2021] [Accepted: 11/02/2021] [Indexed: 11/20/2022]
Abstract
The endocannabinoid system within the periaqueductal grey (PAG) has been implicated in fear-conditioned analgesia (FCA), the profound suppression of pain upon re-exposure to a context previously paired with an aversive stimulus. Since the endocannabinoid and nociceptive systems exhibit sexual dimorphism, the aim of the present study was to assess possible sex differences in the expression of FCA, fear in the presence of nociceptive tone, and associated sex-dependent alterations in the endocannabinoid system within the PAG. Male and female Sprague-Dawley rats received footshock (10 × 1s; 0.4 mA; every 60 s) or no-footshock in a conditioning arena and 23.5 h later received intraplantar injection of formalin (2.5%) under brief isoflourane anaesthetic into the right hind paw. Nociceptive and fear-related behaviours were assessed 30 min later. Levels of endocannabinoids, N-acylethanolamines and neurotransmitters in the PAG were assessed by LC-MS/MS and expression of endocannabinoid system-related proteins by Western immunoblotting. Male, but not female, rats exhibited robust FCA and greater expression of fear-related behaviours than females. Fear-conditioned formalin-treated males, but not females, had higher levels of N-oleoylethanolamine (OEA) and γ-aminobutyric acid (GABA) in the PAG, compared with non-fear-conditioned controls. There was no effect of fear conditioning on the levels of FAAH or CB1 receptor expression (CB1R) in the PAG of male or female formalin-treated rats. Non-fear-conditioned females had higher levels of CB1R and PPARγ expression than non-fear-conditioned male counterparts. In summary, our results provide evidence of sexual dimorphism in the expression of FCA and fear-related behaviours, and associated alterations in components of the endocannabinoid system and GABA within the PAG.
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21
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Psychiatric admission as a risk factor for posttraumatic stress disorder. Psychiatry Res 2021; 305:114176. [PMID: 34455217 DOI: 10.1016/j.psychres.2021.114176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/01/2021] [Accepted: 08/14/2021] [Indexed: 11/21/2022]
Abstract
Psychiatric hospitalization poses a risk for Posttraumatic Stress Disorder (PTSD), partly because of coercion. However, the role of legal status is less clear, while factors like insight, exposure to violence and affective disorders have not been addressed adequately. The present study aims at assessing PTSD rates after hospitalization and evaluating the potential role of these factors. 98 inpatients were assessed for PTSD, insight, main diagnosis, adverse events during hospitalization and legal status. Assessment took place at discharge (T1) and three months later (T2). Three months after discharge, 74.2% of patients with affective disorders met symptom-criteria for PTSD. Voluntarily hospitalized patients had more severe PTSD-symptoms. This relation vanished after controlling for affective disorders. The latter, as well as exposure to violence were the most significant risk factors at T2. Female gender, marital status (not married) and employment status (not employed), were additional risk factors at T1, while involuntary medication had a negative effect on PTSD-symptoms. Voluntarily hospitalized patients are more vulnerable to PTSD, due to higher rates of affective disorders. Females suffering from affective disorders who are not married and not employed should be monitored for PTSD symptoms during and after hospitalization, especially if exposed to violence.
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22
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Zante B, Erne K, Grossenbacher J, Camenisch SA, Schefold JC, Jeitziner MM. Symptoms of post-traumatic stress disorder (PTSD) in next of kin during suspension of ICU visits during the COVID-19 pandemic: a prospective observational study. BMC Psychiatry 2021; 21:477. [PMID: 34587929 PMCID: PMC8480126 DOI: 10.1186/s12888-021-03468-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 09/09/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND During the COVID-19 pandemic, suspension of visits by next of kin to patients in intensive care units (ICU), to prevent spread of the SARS-CoV-2 virus, has been a common practice. This could impede established family-centered care and may affect the mental health of the next of kin. The aim of this study was to explore symptoms of post-traumatic stress syndrome (PTSD) in the next of kin of ICU patients. METHODS In this prospective observational single-center study, next of kin of ICU patients were interviewed by telephone, using the Impact of Event Scale-Revised (IES-R), to assess symptoms of acute stress disorder during the ICU stay and PTSD symptoms at 3 months after the ICU stay. The primary outcome was the prevalence of severe PTSD symptoms (IES-R score ≥ 33) at 3 months. The secondary outcomes comprised the IES-R scores during the ICU stay, at 3 months, and the prevalence of severe symptoms of acute stress disorder during ICU stay. An inductive content analysis was performed of the next of kin's comments regarding satisfaction with patient care and the information they were given. RESULTS Of the 411 ICU patients admitted during the study period, 62 patients were included together with their next of kin. An IES-R score > 33 was observed in 90.3% (56/62) of next of kin during the ICU stay and in 69.4% (43/62) 3 months later. The median IES-R score was 49 (IQR 40-61) during the ICU stay and 41 (IQR 30-55) at 3 months. The inductive content analysis showed that communication/information (55%), support (40%), distressing emotions (32%), and suspension of ICU visits (24%) were mentioned as relevant aspects by the next of kin. CONCLUSIONS During the suspension of ICU visits in the COVID-19 pandemic, high prevalence and severity of both symptoms of acute stress disorder during the ICU stay and PTSD symptoms 3 months later were observed in the next of kin of ICU patients.
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Affiliation(s)
- Bjoern Zante
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland.
| | - Katja Erne
- grid.5734.50000 0001 0726 5157Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland
| | - Julia Grossenbacher
- grid.5734.50000 0001 0726 5157Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland
| | - Sabine A. Camenisch
- grid.5734.50000 0001 0726 5157Department of Anesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Joerg C. Schefold
- grid.5734.50000 0001 0726 5157Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland
| | - Marie-Madlen Jeitziner
- grid.5734.50000 0001 0726 5157Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland ,grid.6612.30000 0004 1937 0642Department of Public Health, Nursing Science, Faculty of Medicine, University of Basel, Basel, Switzerland
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23
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Stevens NR, Miller ML, Puetz AK, Padin AC, Adams N, Meyer DJ. Psychological Intervention and Treatment for Posttraumatic Stress Disorder During Pregnancy: A Systematic Review and Call to Action. J Trauma Stress 2021; 34:575-585. [PMID: 33340151 DOI: 10.1002/jts.22641] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 10/07/2020] [Accepted: 11/24/2020] [Indexed: 11/07/2022]
Abstract
Posttraumatic stress disorder (PTSD) during pregnancy is a significant global mental health concern that affects up to 1 in 5 trauma-exposed pregnant women and is associated with an increased risk of adverse maternal and infant complications and health outcomes. This systematic literature review, conducted in accordance with PRISMA guidelines, examined findings from studies of psychological interventions and treatments for prenatal PTSD to inform recommendations for future research. Relevant evidence was identified from reference reviews and electronic databases (i.e., PubMed, Google Scholar, PsychInfo, and Scopus). Included studies reported on the effect of nonpharmacological intervention or treatment of PTSD symptomatology delivered during pregnancy, with at least one postintervention follow-up collected during pregnancy to assess prenatal treatment outcomes. The systematic review was augmented with a discussion of lower-level evidence. Of the 954 articles screened, six peer-reviewed, quantitative reports met the inclusion criteria and featured three empirically based interventions, including two randomized controlled trials: Two psychoeducation interventions for PTSD and one treatment study of interpersonal psychotherapy in trauma-exposed pregnant women. Effect sizes for PTSD symptom change ranged from small to large, Cohen's d/ηp 2 = 0.16-0.78. No studies examined evidence-based PTSD treatments (e.g., exposure therapy, cognitive processing therapy). A risk of bias assessment indicated variability in study quality. This review demonstrates that research on prenatal PTSD symptoms, diagnosis, and treatment is extremely limited despite a clear link between prenatal PTSD and perinatal complications. Early evidence supports further scientific inquiry into psychoeducation, psychotherapy treatments (e.g., exposure therapy), integrated prenatal care approaches, and community-based approaches.
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Affiliation(s)
- Natalie R Stevens
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Michelle L Miller
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Ann-Kathrin Puetz
- Department of Clinical and Neuropsychology, University of Konstanz, Konstanz, Germany
| | - Avelina C Padin
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Natasia Adams
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
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24
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Liu S, Yang L, Zhang C, Xu Y, Cai L, Ma S, Wang Y, Cai Z, Du H, Li R, Kang L, Zheng H, Liu Z, Zhang B. Gender differences in mental health problems of healthcare workers during the coronavirus disease 2019 outbreak. J Psychiatr Res 2021; 137:393-400. [PMID: 33765451 PMCID: PMC7962932 DOI: 10.1016/j.jpsychires.2021.03.014] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 01/10/2021] [Accepted: 03/08/2021] [Indexed: 12/29/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has imposed both physical and psychological burdens on healthcare workers (HCWs). What is more, few studies have focused on the gender differences in mental health problems (MHPs) among HCWs during such an outbreak. Thus, the current study investigated the prevalence and gender differences of various MHPs among HCWs in China during the COVID-19 outbreak. This nationwide survey was conducted online from January 29 to February 3, 2020. General information was collected by questions about socio-demographics, work-related factors, and living situations. Depressive, anxiety, stress, and insomnia symptoms were assessed by the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, the Impact of Event Scale-Revised, and the Insomnia Severity Index, respectively. Among the 2198 contacted HCWs, 1563 (71.1%) responded with valid data, of whom 1293 (82.7%) were females. The prevalences of depressive, anxiety, stress, and insomnia symptoms in participants were 50.7%, 44.7%, 52.5%, and 36.1%, respectively. Female HCWs had significantly higher scores in all four scales (p < 0.001) and higher prevalences in all MHPs involved (range, odds ratio [OR] 1.55-1.97). After adjusting for potential confounders, female HCWs still had higher risks for all MHPs involved than males (range, adjusted OR 1.36-1.96). HCWs present high prevalences of depressive, anxiety, stress, and insomnia symptoms during the COVID-19 outbreak. Furthermore, female HCWs are more vulnerable to all MHPs involved. These findings highlight the need for timely, special care and support for HCWs during the outbreak, especially for females.
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Affiliation(s)
- Shuai Liu
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China,Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, China,The Third People's Hospital of Qinghai Province, Xining, China
| | - Lulu Yang
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China,Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, China
| | - Chenxi Zhang
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China,Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, China
| | - Yan Xu
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China,Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, China
| | - Lidan Cai
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China,Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, China
| | - Simeng Ma
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ying Wang
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhongxiang Cai
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Hui Du
- Department of Psychiatry, Jingmen No. 2 People's Hospital, Jingmen, China
| | - Ruiting Li
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Lijun Kang
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Huirong Zheng
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Affiliated School of Medicine of South China University of Technology, Guangzhou, China
| | - Zhongchun Liu
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China.
| | - Bin Zhang
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China; Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, China.
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25
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Chowen JA, Garcia-Segura LM. Role of glial cells in the generation of sex differences in neurodegenerative diseases and brain aging. Mech Ageing Dev 2021; 196:111473. [PMID: 33766745 DOI: 10.1016/j.mad.2021.111473] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/14/2021] [Accepted: 03/16/2021] [Indexed: 12/11/2022]
Abstract
Diseases and aging-associated alterations of the nervous system often show sex-specific characteristics. Glial cells play a major role in the endogenous homeostatic response of neural tissue, and sex differences in the glial transcriptome and function have been described. Therefore, the possible role of these cells in the generation of sex differences in pathological alterations of the nervous system is reviewed here. Studies have shown that glia react to pathological insults with sex-specific neuroprotective and regenerative effects. At least three factors determine this sex-specific response of glia: sex chromosome genes, gonadal hormones and neuroactive steroid hormone metabolites. The sex chromosome complement determines differences in the transcriptional responses in glia after brain injury, while gonadal hormones and their metabolites activate sex-specific neuroprotective mechanisms in these cells. Since the sex-specific neuroprotective and regenerative activity of glial cells causes sex differences in the pathological alterations of the nervous system, glia may represent a relevant target for sex-specific therapeutic interventions.
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Affiliation(s)
- Julie A Chowen
- Department of Endocrinology, Hospital Infantil Universitario Niño Jesús, Instituto de Investigación la Princesa, Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutriciόn (CIBEROBN), Instituto de Salud Carlos III, and IMDEA Food Institute, CEIUAM+CSIC, Madrid, Spain.
| | - Luis M Garcia-Segura
- Instituto Cajal, Consejo Superior de Investigaciones Científicas (CSIC) and Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain.
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26
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Does Post-COVID-19 symptoms exist? A longitudinal study of COVID-19 sequelae in Wenzhou, China. ANNALES MEDICO-PSYCHOLOGIQUES 2021; 179:818-821. [PMID: 33688094 PMCID: PMC7934689 DOI: 10.1016/j.amp.2021.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 03/01/2021] [Indexed: 01/12/2023]
Abstract
Objective We conducted a cohort of tracing discharge patients of COVID-19. Materials and methods We used the Mann–Whitney U test, χ2 test, or Fisher's exact test to compare differences between age groups and gender groups where appropriate. Results Our study provides insights into the nature and severity of medical conditions specific to survivors of COVID-19. Conclusions It also highlights the potential mental health issues resulting from infectious disease outbreaks within communities.
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27
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Wilker S, Kolassa S, Ibrahim H, Rajan V, Pfeiffer A, Catani C, Kolassa IT. Sex differences in PTSD risk: evidence from post-conflict populations challenges the general assumption of increased vulnerability in females. Eur J Psychotraumatol 2021; 12:1930702. [PMID: 34531962 PMCID: PMC8439243 DOI: 10.1080/20008198.2021.1930702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Next to the dose-dependent effect of trauma load, female sex represents a well-established risk factor for PTSD. Exposure to particularly toxic traumatic event types, different coping styles, and biological risk factors are frequently listed as potential causes for the increased PTSD vulnerability in females. Nevertheless, sex differences have not been consistently observed in all study populations. Objective: To investigate sex differences in PTSD risk in post-conflict populations from different countries while considering trauma load. Method: In civilian post-conflict samples from Northern Uganda (N = 1665), Rwanda (N = 433), Syria (N = 974) and Sri Lanka (N = 165), we investigated sex differences in PTSD risk while taking trauma load into account. PTSD and trauma load were assessed using standardized diagnostic interviews. Potential sex differences in PTSD risk were analysed by logistic regression analyses considering trauma load. Results: Across all samples, males reported more traumatic events than females. Both sexes predominantly reported war-related traumatic events. Without considering trauma load, sex effects in PTSD risk were only detected in the Syrian sample. When taking trauma load into account, evidence for an increased PTSD vulnerability in females was found in the Syrian sample, and, to a much lesser extent, in the Northern Ugandan sample. Conclusion: In contrast to the literature, we did not find evidence for a general increased PTSD vulnerability in females. The dose-response effect of trauma load was a much stronger predictor of PTSD risk than sex across all samples.
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Affiliation(s)
- Sarah Wilker
- Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany.,vivo International e.V, Konstanz, Germany.,Clinical & Biological Psychology, Ulm University, Ulm, Germany
| | - Stephan Kolassa
- SAP S/4HANA CIC & Q2C, SAP Switzerland AG, Tägerwilen, Switzerland
| | - Hawkar Ibrahim
- Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany.,vivo International e.V, Konstanz, Germany.,Department of Clinical Psychology, Koya University, Koya, Iraq
| | - Vathsalan Rajan
- Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany.,vivo International e.V, Konstanz, Germany
| | | | - Claudia Catani
- Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany.,vivo International e.V, Konstanz, Germany
| | - Iris-Tatjana Kolassa
- vivo International e.V, Konstanz, Germany.,Clinical & Biological Psychology, Ulm University, Ulm, Germany
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28
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Castro-Vale I, Carvalho D. The Pathways between Cortisol-Related Regulation Genes and PTSD Psychotherapy. Healthcare (Basel) 2020; 8:healthcare8040376. [PMID: 33019527 PMCID: PMC7712185 DOI: 10.3390/healthcare8040376] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/24/2020] [Accepted: 09/24/2020] [Indexed: 01/30/2023] Open
Abstract
Post-traumatic stress disorder (PTSD) only develops after exposure to a traumatic event in some individuals. PTSD can be chronic and debilitating, and is associated with co-morbidities such as depression, substance use, and cardiometabolic disorders. One of the most important pathophysiological mechanisms underlying the development of PTSD and its subsequent maintenance is a dysfunctional hypothalamic-pituitary-adrenal (HPA) axis. The corticotrophin-releasing hormone, cortisol, glucocorticoid receptor (GR), and their respective genes are some of the mediators of PTSD's pathophysiology. Several treatments are available, including medication and psychotherapies, although their success rate is limited. Some pharmacological therapies based on the HPA axis are currently being tested in clinical trials and changes in HPA axis biomarkers have been found to occur in response not only to pharmacological treatments, but also to psychotherapy-including the epigenetic modification of the GR gene. Psychotherapies are considered to be the first line treatments for PTSD in some guidelines, even though they are effective for some, but not for all patients with PTSD. This review aims to address how knowledge of the HPA axis-related genetic makeup can inform and predict the outcomes of psychotherapeutic treatments.
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Affiliation(s)
- Ivone Castro-Vale
- Medical Psychology Unit, Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Al. Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
- i3S-Institute for Research and Innovation in Health, University of Porto, Rua Alfredo Allen, 208, 4200-135 Porto, Portugal
- Correspondence:
| | - Davide Carvalho
- Department of Endocrinology, Diabetes and Metabolism, São João Hospital University Centre, Faculty of Medicine, University of Porto, Al. Prof. Hernâni Monteiro, 4200-319 Porto, Portugal;
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29
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Taylor RM, Jeong IH, May MD, Bergman EM, Capaldi VF, Moore NLT, Matson LM, Lowery-Gionta EG. Fear expression is reduced after acute and repeated nociceptin/orphanin FQ (NOP) receptor antagonism in rats: therapeutic implications for traumatic stress exposure. Psychopharmacology (Berl) 2020; 237:2943-2958. [PMID: 32588078 DOI: 10.1007/s00213-020-05582-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 06/08/2020] [Indexed: 12/14/2022]
Abstract
RATIONALE Evaluation of pharmacotherapies for acute stress disorder (ASD) or post-traumatic stress disorder (PTSD) is challenging due to robust heterogeneity of trauma histories and limited efficacy of any single candidate to reduce all stress-induced effects. Pursuing novel mechanisms, such as the nociceptin/orphanin FQ (NOP) system, may be a viable path for therapeutic development and of interest as it is involved in regulation of relevant behaviors and recently implicated in PTSD and ASD. OBJECTIVES First, we evaluated NOP receptor antagonism on general behavioral performance and again following a three-species predator exposure model (Experiment 1). Then, we evaluated effects of NOP antagonism on fear memory expression (Experiment 2). METHODS Adult, male rats underwent daily administration of NOP antagonists (J-113397 or SB-612,111; 0-20 mg/kg, i.p.) and testing in acoustic startle, elevated plus maze, tail-flick, and open field tests. Effects of acute NOP antagonism on behavioral performance following predator exposure were then assessed. Separately, rats underwent fear conditioning and were later administered SB-612,111 (0-3 mg/kg, i.p.) prior to fear memory expression tests. RESULTS J-113397 and SB-612,111 did not significantly alter most general behavioral performance measures alone, suggesting minimal off-target behavioral effects of NOP antagonism. J-113397 and SB-612,111 restored performance in measures of exploratory behavior (basic movements on the elevated plus maze and total distance in the open field) following predator exposure. Additionally, SB-612,111 significantly reduced freezing behavior relative to control groups across repeated fear memory expression tests, suggesting NOP antagonism may be useful in dampening fear responses. Other measures of general behavioral performance were not significantly altered following predator exposure. CONCLUSIONS NOP antagonists may be useful as pharmacotherapeutics for dampening fear responses to trauma reminders, and the present results provide supporting evidence for the implication of the NOP system in the neuropathophysiology of dysregulations in fear learning and memory processes observed in trauma- and stress-related disorders.
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Affiliation(s)
- Rachel M Taylor
- Behavioral Biology Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, MD, 20910, USA.
| | - Isaac H Jeong
- Behavioral Biology Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, MD, 20910, USA
| | - Matthew D May
- Behavioral Biology Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, MD, 20910, USA
| | - Elizabeth M Bergman
- Behavioral Biology Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, MD, 20910, USA
| | - Vincent F Capaldi
- Behavioral Biology Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, MD, 20910, USA
| | - Nicole L T Moore
- Behavioral Biology Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, MD, 20910, USA
| | - Liana M Matson
- Behavioral Biology Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, MD, 20910, USA
| | - Emily G Lowery-Gionta
- Behavioral Biology Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, MD, 20910, USA.
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30
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Day HLL, Stevenson CW. The neurobiological basis of sex differences in learned fear and its inhibition. Eur J Neurosci 2020; 52:2466-2486. [PMID: 31631413 PMCID: PMC7496972 DOI: 10.1111/ejn.14602] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 10/07/2019] [Accepted: 10/15/2019] [Indexed: 12/16/2022]
Abstract
Learning that certain cues or environments predict threat enhances survival by promoting appropriate fear and the resulting defensive responses. Adapting to changing stimulus contingencies by learning that such cues no longer predict threat, or distinguishing between these threat-related and other innocuous stimuli, also enhances survival by limiting fear responding in an appropriate manner to conserve resources. Importantly, a failure to inhibit fear in response to harmless stimuli is a feature of certain anxiety and trauma-related disorders, which are also associated with dysfunction of the neural circuitry underlying learned fear and its inhibition. Interestingly, these disorders are up to twice as common in women, compared to men. Despite this striking sex difference in disease prevalence, the neurobiological factors involved remain poorly understood. This is due in part to the majority of relevant preclinical studies having neglected to include female subjects alongside males, which has greatly hindered progress in this field. However, more recent studies have begun to redress this imbalance and emerging evidence indicates that there are significant sex differences in the inhibition of learned fear and associated neural circuit function. This paper provides a narrative review on sex differences in learned fear and its inhibition through extinction and discrimination, along with the key gonadal hormone and brain mechanisms involved. Understanding the endocrine and neural basis of sex differences in learned fear inhibition may lead to novel insights on the neurobiological mechanisms underlying the enhanced vulnerability to develop anxiety-related disorders that are observed in women.
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Affiliation(s)
- Harriet L. L. Day
- School of BiosciencesUniversity of NottinghamLoughboroughUK
- Present address:
RenaSci LtdBioCity, Pennyfoot StreetNottinghamNG1 1GFUK
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31
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Engel S, van Zuiden M, Frijling JL, Koch SBJ, Nawijn L, Yildiz RLW, Schumacher S, Knaevelsrud C, Bosch JA, Veltman DJ, Olff M. Early posttraumatic autonomic and endocrine markers to predict posttraumatic stress symptoms after a preventive intervention with oxytocin. Eur J Psychotraumatol 2020; 11:1761622. [PMID: 32922686 PMCID: PMC7448939 DOI: 10.1080/20008198.2020.1761622] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Efficient prevention of posttraumatic stress disorder (PTSD) needs to target individuals with an increased risk for adverse outcome after trauma. Prognostic or prescriptive biological markers assessed early posttrauma may inform personalized treatment recommendations. OBJECTIVE To test prognostic and prescriptive effects of early (posttraumatic) autonomic and endocrine markers on PTSD symptom development. METHOD Autonomic and endocrine markers were assessed within 12 days posttrauma and before treatment initiation within a randomized placebo-controlled trial investigating repeated oxytocin administration as preventive intervention for PTSD. Linear mixed effects models were used to test the effects of heart rate (variability), resting cortisol, morning cortisol and cortisol awakening response (CAR), cortisol suppression by dexamethasone and resting oxytocin on PTSD symptoms 1.5, 3 and 6 months posttrauma in men (n = 54), women using hormonal contraception (n = 27) and cycling women (n = 19). RESULTS We found significant prognostic effects of resting oxytocin and cortisol suppression. In women using hormonal contraception, higher oxytocin was associated with higher PTSD symptoms across follow-up. Stronger cortisol suppression by dexamethasone, reflecting increased glucocorticoid receptor feedback sensitivity, was associated with lower PTSD symptoms across follow-up in men, but with higher symptoms at 1.5 months in women using hormonal contraception. These effects were independent of treatment condition. No further significant prognostic or prescriptive effects were detected. CONCLUSION Our exploratory study indicates that resting oxytocin and glucocorticoid receptor feedback sensitivity early posttrauma are associated with subsequent PTSD symptom severity. Notably, prognostic effects depended on sex and hormonal contraception use, emphasizing the necessity to consider these factors in biomedical PTSD research.
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Affiliation(s)
- Sinha Engel
- Amsterdam University Medical Centers, Location Academic Medical Center, Department of Psychiatry, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands.,Division of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Mirjam van Zuiden
- Amsterdam University Medical Centers, Location Academic Medical Center, Department of Psychiatry, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
| | - Jessie L Frijling
- Amsterdam University Medical Centers, Location Academic Medical Center, Department of Psychiatry, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
| | - Saskia B J Koch
- Amsterdam University Medical Centers, Location Academic Medical Center, Department of Psychiatry, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Laura Nawijn
- Amsterdam University Medical Centers, Location Academic Medical Center, Department of Psychiatry, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands.,Department of Psychiatry, Amsterdam University Medical Centers, Location VU University Medical Center, Amsterdam, The Netherlands
| | - Rinde L W Yildiz
- Amsterdam University Medical Centers, Location Academic Medical Center, Department of Psychiatry, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
| | - Sarah Schumacher
- Division of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Christine Knaevelsrud
- Division of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Jos A Bosch
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Dick J Veltman
- Department of Psychiatry, Amsterdam University Medical Centers, Location VU University Medical Center, Amsterdam, The Netherlands
| | - Miranda Olff
- Amsterdam University Medical Centers, Location Academic Medical Center, Department of Psychiatry, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands.,Arq Psychotrauma Expert Group, Diemen, The Netherlands
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Abstract
PURPOSE OF REVIEW To provide an update of recent or relevant studies on posttraumatic stress disorder (PTSD) in urban women, with a special focus on biopsychosocial risk factors. RECENT FINDINGS Urbanization itself can increase the risk for PTSD due to the concentration of poverty, substance use and crime. Women are usually at a greater social and economic disadvantage and are victims of collective and domestic violence more often than men. Accordingly, urban women are more exposed to traumatic events that increase the prevalence of PTSD than rural women and both rural and urban men, especially those with lack of social and family protection and support (including refugees) and/or with a history of interpersonal violence. This type of events has sensitizing effects on the PTSD response to other traumatic experiences even if they are of a lesser magnitude, which may reflect women's biological susceptibility to PTSD, and could explain their higher risk of developing chronic PTSD. SUMMARY A complex interaction of biopsychological factors may contribute to the ultra-high-risk for PTSD among urban women. The socially modifiable factors involved highlight the importance of strategies focused on women's social development that could reduce their social suffering and its negative mental health outcomes.
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Peyrot C, Brouillard A, Morand-Beaulieu S, Marin MF. A review on how stress modulates fear conditioning: Let's not forget the role of sex and sex hormones. Behav Res Ther 2020; 129:103615. [PMID: 32334278 DOI: 10.1016/j.brat.2020.103615] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 03/27/2020] [Accepted: 04/05/2020] [Indexed: 12/12/2022]
Abstract
Stress and fear are two fields of research that have evolved simultaneously. It was not until the eighties that these domains converged in order to better characterize the impact of stress on fear memory formation. Here, we reviewed the effects of stress occurring before fear acquisition on the main phases of fear conditioning protocols (acquisition training, extinction training, extinction retention test), with a specific focus on sex and sex hormones. We also paid close attention to methodological aspects in order to better understand and characterize discrepant findings across studies. In men, stress appears to potentiate fear acquisition at a physiological level but induces lower activations of fear-related brain regions. In women, results are inconsistent. Although some studies have shown that stress lowers physiological fear responses and heightens brain activations in women during fear acquisition, many studies report no significant effects. Irrespective of sex, pre-acquisition stress seems to induce fear extinction learning resistance. Overall, few studies have taken into account sex hormones, despite their impact on both the fear and stress brain networks. As methodological variability makes it complex to draw strong conclusions, several methodological aspects are discussed with the aim of orienting future research.
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Affiliation(s)
- Clémence Peyrot
- Research Center, Institut universitaire en santé mentale de Montréal, 7331 Hochelaga Street, Montreal, Quebec, Canada, H1N 3J4; Department of Psychiatry and Addictology, Université de Montréal, 2900 Édouard-Montpetit Boulevard, Montreal, Quebec, Canada, H3T 1J4.
| | - Alexandra Brouillard
- Research Center, Institut universitaire en santé mentale de Montréal, 7331 Hochelaga Street, Montreal, Quebec, Canada, H1N 3J4; Department of Psychology, Université du Québec à Montréal, 100 Sherbrooke Street W, Montreal, Quebec, Canada, H2X 2P3.
| | - Simon Morand-Beaulieu
- Research Center, Institut universitaire en santé mentale de Montréal, 7331 Hochelaga Street, Montreal, Quebec, Canada, H1N 3J4; Department of Neuroscience, Université de Montréal, 2960 de la Tour Rd, Montreal, Quebec, Canada, H3T 1J4; Currently with the Child Study Center, Yale University School of Medicine, 230 S Frontage Rd, New Haven, CT, 06519, USA.
| | - Marie-France Marin
- Research Center, Institut universitaire en santé mentale de Montréal, 7331 Hochelaga Street, Montreal, Quebec, Canada, H1N 3J4; Department of Psychiatry and Addictology, Université de Montréal, 2900 Édouard-Montpetit Boulevard, Montreal, Quebec, Canada, H3T 1J4; Department of Psychology, Université du Québec à Montréal, 100 Sherbrooke Street W, Montreal, Quebec, Canada, H2X 2P3.
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Engel S, Klusmann H, Laufer S, Pfeifer AC, Ditzen B, van Zuiden M, Knaevelsrud C, Schumacher S. Trauma exposure, posttraumatic stress disorder and oxytocin: A meta-analytic investigation of endogenous concentrations and receptor genotype. Neurosci Biobehav Rev 2019; 107:560-601. [DOI: 10.1016/j.neubiorev.2019.08.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 07/02/2019] [Accepted: 08/07/2019] [Indexed: 01/06/2023]
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Tronson NC, Keiser AA. A Dynamic Memory Systems Framework for Sex Differences in Fear Memory. Trends Neurosci 2019; 42:680-692. [PMID: 31473031 DOI: 10.1016/j.tins.2019.07.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 06/17/2019] [Accepted: 07/29/2019] [Indexed: 01/04/2023]
Abstract
Emerging research demonstrates that a pattern of overlapping but distinct molecular and circuit mechanisms are engaged by males and females during memory tasks. Importantly, sex differences in neural mechanisms and behavioral strategies are evident even when performance on a memory task is similar between females and males. We propose that sex differences in memory may be best understood within a dynamic memory systems framework. Specifically, sex differences in hormonal influences and neural circuit development result in biases in the circuits engaged and the information preferentially stored or retrieved in males and females. By using animal models to understand the neural networks and molecular mechanisms required for memory in both sexes, we can gain crucial insights into sex and gender biases in disorders including post-traumatic stress disorder (PTSD) in humans.
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Affiliation(s)
- Natalie C Tronson
- Psychology Department, University of Michigan, Ann Arbor, MI 48109, USA.
| | - Ashley A Keiser
- Department of Neurobiology and Behavior, University of California, Irvine, CA 92697, USA
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Engel S, van Zuiden M, Frijling JL, Koch SBJ, Nawijn L, Schumacher S, Knaevelsrud C, Veltman DJ, Olff M. Patterns of Recovery From Early Posttraumatic Stress Symptoms After a Preventive Intervention With Oxytocin: Hormonal Contraception Use Is a Prognostic Factor. Biol Psychiatry 2019; 85:e71-e73. [PMID: 30824111 DOI: 10.1016/j.biopsych.2019.01.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 01/18/2019] [Indexed: 01/22/2023]
Affiliation(s)
- Sinha Engel
- Department of Psychiatry, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Division of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Mirjam van Zuiden
- Department of Psychiatry, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
| | - Jessie L Frijling
- Department of Psychiatry, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Saskia B J Koch
- Department of Psychiatry, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Radboud University Nijmegen, Nijmegen, the Netherlands
| | - Laura Nawijn
- Department of Psychiatry, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Department of Psychiatry, Amsterdam University Medical Centers, Location VU University Medical Center, VU University, Amsterdam, the Netherlands
| | - Sarah Schumacher
- Division of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Christine Knaevelsrud
- Division of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Dick J Veltman
- Department of Psychiatry, Amsterdam University Medical Centers, Location VU University Medical Center, VU University, Amsterdam, the Netherlands
| | - Miranda Olff
- Department of Psychiatry, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Arq Psychotrauma Expert Group, Diemen, the Netherlands
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Dunlop BW, Wong A. The hypothalamic-pituitary-adrenal axis in PTSD: Pathophysiology and treatment interventions. Prog Neuropsychopharmacol Biol Psychiatry 2019; 89:361-379. [PMID: 30342071 DOI: 10.1016/j.pnpbp.2018.10.010] [Citation(s) in RCA: 118] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 10/15/2018] [Accepted: 10/16/2018] [Indexed: 12/26/2022]
Abstract
Questions of how altered functioning of the hypothalamic pituitary adrenal (HPA) axis contribute to the development and maintenance of posttraumatic stress disorder (PTSD) have been the focus of extensive animal and human research. As a rule, results have been inconsistent across studies, likely due to a variety of confounding variables that have received inadequate attention. Important confounding factors include the effects of early life stress, biological sex, and the glucocorticoid used for interventions. In this manuscript we review: 1) the literature on identified abnormalities of HPA axis function in PTSD, both in terms of basal functioning and as part of challenge paradigms; 2) the role of HPA axis function pre- and immediately post-trauma as a risk factor for PTSD development; 3) the impact of HPA axis genes' allelic variants and epigenetic modifications on PTSD risk; 4) the contributions of HPA axis components to fear learning and extinction; and 5) therapeutic manipulations of the HPA axis to both prevent and treat PTSD, including the role of glucocorticoids as part of medication enhanced psychotherapy.
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Affiliation(s)
- Boadie W Dunlop
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
| | - Andrea Wong
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
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Abstract
PURPOSE OF REVIEW This review highlights recent research on sex- and gender-related factors in the prevalence, symptom expression, and treatment of PTSD. Further discoveries about the underlying mechanisms of sex and gender effects have the potential to shape innovative directions for research. RECENT FINDINGS The prevalence of PTSD is substantially higher among women, but women show a modest advantage with respect to treatment response. There is evidence of greater heritability among females. Women are more likely to experience sexual and intimate violence, childhood trauma exposure, and repeated trauma exposures. Specific characteristics of social contexts act as gender-linked risks for PTSD. Among individuals diagnosed with PTSD, men and women are similar in phenotypic expression. Though research has yet to fully account for the factors that explain sex- and gender- related effects on PTSD, emerging research suggests these effects occur across multiple levels. Shared risk factors for trauma exposure and PTSD merit further investigation. Both social and biological contexts merit investigation to understand sex-linked differences in heritability.
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Affiliation(s)
- Rachel Kimerling
- National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, CA, USA.
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA.
| | - Monica C Allen
- National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, CA, USA
- Pacific Graduate School of Psychology-Stanford Psy.D. Consortium, Palo Alto, CA, USA
| | - Laramie E Duncan
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
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Zhang Y, Schalo I, Durand C, Standifer KM. Sex Differences in Nociceptin/Orphanin FQ Peptide Receptor-Mediated Pain and Anxiety Symptoms in a Preclinical Model of Post-traumatic Stress Disorder. Front Psychiatry 2018; 9:731. [PMID: 30670988 PMCID: PMC6331409 DOI: 10.3389/fpsyt.2018.00731] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 12/12/2018] [Indexed: 12/11/2022] Open
Abstract
Nociceptin/Orphanin FQ (N/OFQ) is a neuropeptide that modulates pain transmission, learning/memory, stress, anxiety, and fear responses via activation of the N/OFQ peptide (NOP or ORL1) receptor. Post-traumatic stress disorder (PTSD) is an anxiety disorder that may arise after exposure to a traumatic or fearful event, and often is co-morbid with chronic pain. Using an established animal model of PTSD, single-prolonged stress (SPS), we were the first to report that NOP receptor antagonist treatment reversed traumatic stress-induced allodynia, thermal hyperalgesia, and anxiety-like behaviors in male Sprague-Dawley rats. NOP antagonist treatment also reversed SPS-induced serum and CSF N/OFQ increase and circulating corticosterone decrease. The objective of this study was to examine the role of the NOP receptor in male and female rats subjected to traumatic stress using Wistar wild type (WT) and NOP receptor knockout (KO) rats. The severity of co-morbid allodynia was assessed as change in paw withdrawal threshold (PWT) to von Frey and paw withdrawal latency (PWL) to radiant heat stimuli, respectively. PWT and PWL decreased in male and female WT rats within 7 days after SPS, and remained decreased through day 28. Baseline sensitivity did not differ between genotypes. However, while male NOP receptor KO rats were protected from SPS-induced allodynia and thermal hypersensitivity, female NOP receptor KO rats exhibited tactile allodynia and thermal hypersensitivity to the same extent as WT rats. Male NOP receptor KO rats had a lower anxiety index (AI) than WT, but SPS did not increase AI in WT males. In contrast, SPS significantly increased AI in WT and NOP receptor KO female rats. SPS increased circulating N/OFQ levels in male WT, but not in male NOP receptor KO, or WT or KO female rats. These results indicate that the absence of the NOP receptor protects males from traumatic-stress-induced allodynia and hyperalgesia, consistent with our previous findings utilizing a NOP receptor antagonist. However, female NOP receptor KO rats experience allodynia, hyperalgesia and anxiety-like symptoms to the same extent as WT females following SPS. This suggests that endogenous N/OFQ-NOP receptor signaling plays an important, but distinct, role in males and females following exposure to traumatic stress.
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Affiliation(s)
- Yong Zhang
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Ian Schalo
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Cindy Durand
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Kelly M Standifer
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States.,Oklahoma Center for Neuroscience, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
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