1
|
Skolariki K, Vrahatis AG, Krokidis MG, Exarchos TP, Vlamos P. Assessing and Modelling of Post-Traumatic Stress Disorder Using Molecular and Functional Biomarkers. BIOLOGY 2023; 12:1050. [PMID: 37626936 PMCID: PMC10451531 DOI: 10.3390/biology12081050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 07/03/2023] [Accepted: 07/24/2023] [Indexed: 08/27/2023]
Abstract
Post-traumatic stress disorder (PTSD) is a complex psychological disorder that develops following exposure to traumatic events. PTSD is influenced by catalytic factors such as dysregulated hypothalamic-pituitary-adrenal (HPA) axis, neurotransmitter imbalances, and oxidative stress. Genetic variations may act as important catalysts, impacting neurochemical signaling, synaptic plasticity, and stress response systems. Understanding the intricate gene networks and their interactions is vital for comprehending the underlying mechanisms of PTSD. Focusing on the catalytic factors of PTSD is essential because they provide valuable insights into the underlying mechanisms of the disorder. By understanding these factors and their interplay, researchers may uncover potential targets for interventions and therapies, leading to more effective and personalized treatments for individuals with PTSD. The aforementioned gene networks, composed of specific genes associated with the disorder, provide a comprehensive view of the molecular pathways and regulatory mechanisms involved in PTSD. Through this study valuable insights into the disorder's underlying mechanisms and opening avenues for effective treatments, personalized interventions, and the development of biomarkers for early detection and monitoring are provided.
Collapse
Affiliation(s)
| | | | - Marios G. Krokidis
- Bioinformatics and Human Electrophysiology Laboratory, Department of Informatics, Ionian University, 49100 Corfu, Greece; (K.S.); (A.G.V.); (T.P.E.); (P.V.)
| | | | | |
Collapse
|
2
|
Mavrenkova PV, Khlebnikova NN, Alchinova IB, Demorzhi MS, Shoibonov BB, Karganov MY. Effects of Maternal Separation and Subsequent Stress on Behaviors and Brain Monoamines in Rats. Brain Sci 2023; 13:956. [PMID: 37371434 DOI: 10.3390/brainsci13060956] [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: 05/06/2023] [Revised: 06/04/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
Childhood adversity can induce maladaptive behaviors and increase risk for affective disorders, post-traumatic stress disorder, personality disorders, and vulnerability to stress in adulthood. Deprivation of maternal care interrupts brain development through the disturbance of various neurotransmitters, however, the details remain unclear. The features of the symptoms of disorders are largely determined by early stress protocol, genetic characteristics (line), and the sex of the animals. The purpose of current study was (1) to assess behavioral changes in adult Wistar rats of both sexes after early life stress; (2) to determine the levels of monoamines in brain structures involved in the motor, emotional, and social reactions in rats aged 1 and 2 months; and (3) to determine the level of monoamines after physical or emotional stress in adult rats. The rat pups were separated from their dams and isolated from siblings in tight boxes at a temperature of 22-23 °C for 6 h during postnatal days 2-18. The data were processed predominantly using two-way analysis of variance and the Newman-Keys test as the post hoc analysis. The adult rats demonstrated an increase in motor activity and aggressiveness and a decrease in levels of anxiety and sociability. Behavioral disturbances were accompanied by region-, sex-, and age-dependent changes in the levels of monoamines and their metabolites. The dopaminergic and noradrenergic systems were found to be sensitive to psycho-emotional stress.
Collapse
Affiliation(s)
- Polina V Mavrenkova
- Institute of General Pathology and Pathophysiology, 8 Baltiyskaya St., 125315 Moscow, Russia
| | - Nadezhda N Khlebnikova
- Institute of General Pathology and Pathophysiology, 8 Baltiyskaya St., 125315 Moscow, Russia
| | - Irina B Alchinova
- Institute of General Pathology and Pathophysiology, 8 Baltiyskaya St., 125315 Moscow, Russia
| | - Marina S Demorzhi
- Institute of General Pathology and Pathophysiology, 8 Baltiyskaya St., 125315 Moscow, Russia
| | - Batozhab B Shoibonov
- P. K. Anokhin Institute of Normal Physiology, 8 Baltiyskaya St., 125315 Moscow, Russia
| | - Mikhail Yu Karganov
- Institute of General Pathology and Pathophysiology, 8 Baltiyskaya St., 125315 Moscow, Russia
| |
Collapse
|
3
|
Huang J, Xu F, Yang L, Tuolihong L, Wang X, Du Z, Zhang Y, Yin X, Li Y, Lu K, Wang W. Involvement of the GABAergic system in PTSD and its therapeutic significance. Front Mol Neurosci 2023; 16:1052288. [PMID: 36818657 PMCID: PMC9928765 DOI: 10.3389/fnmol.2023.1052288] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 01/16/2023] [Indexed: 02/04/2023] Open
Abstract
The neurobiological mechanism of post-traumatic stress disorder (PTSD) is poorly understood. The inhibition of GABA neurons, especially in the amygdala, is crucial for the precise regulation of the consolidation, expression, and extinction of fear conditioning. The GABAergic system is involved in the pathophysiological process of PTSD, with several studies demonstrating that the function of the GABAergic system decreases in PTSD patients. This paper reviews the preclinical and clinical studies, neuroimaging techniques, and pharmacological studies of the GABAergic system in PTSD and summarizes the role of the GABAergic system in PTSD. Understanding the role of the GABAergic system in PTSD and searching for new drug targets will be helpful in the treatment of PTSD.
Collapse
Affiliation(s)
| | - Fei Xu
- Department of Psychiatry of School of Public Health, Southern Medical University, Guangzhou, China
| | - Liping Yang
- Department of Applied Psychology of School of Public Health, Southern Medical University, Guangzhou, China
| | - Lina Tuolihong
- Department of Basic Medical of Basic Medical College, Southern Medical University, Guangzhou, China
| | - Xiaoyu Wang
- Eight-Year Master's and Doctoral Program in Clinical Medicine of the First Clinical Medical College, Southern Medical University, Guangzhou, China
| | - Zibo Du
- Eight-Year Master's and Doctoral Program in Clinical Medicine of the First Clinical Medical College, Southern Medical University, Guangzhou, China
| | - Yiqi Zhang
- Eight-Year Master's and Doctoral Program in Clinical Medicine of the First Clinical Medical College, Southern Medical University, Guangzhou, China
| | - Xuanlin Yin
- Department of Basic Medical of Basic Medical College, Southern Medical University, Guangzhou, China
| | - Yingjun Li
- Department of Medical Laboratory Science, School of Laboratory Medicine and Biotechnology, Southern Medical University, Guangzhou, China
| | - Kangrong Lu
- Guangdong Provincial Key Laboratory of Construction and Detection in Tissue Engineering, Southern Medical University, Guangzhou, China
| | - Wanshan Wang
- Department of Laboratory Animal Center, Southern Medical University, Guangzhou, China
| |
Collapse
|
4
|
Brewerton TD. Mechanisms by which adverse childhood experiences, other traumas and PTSD influence the health and well-being of individuals with eating disorders throughout the life span. J Eat Disord 2022; 10:162. [PMID: 36372878 PMCID: PMC9661783 DOI: 10.1186/s40337-022-00696-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 11/09/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Multiple published sources from around the world have confirmed an association between an array of adverse childhood experiences (ACEs) and other traumatic events with eating disorders (EDs) and related adverse outcomes, including higher morbidity and mortality. METHODS In keeping with this Special Issue's goals, this narrative review focuses on the ACEs pyramid and its purported mechanisms through which child maltreatment and other forms of violence toward human beings influence the health and well-being of individuals who develop EDs throughout the life span. Relevant literature on posttraumatic stress disorder (PTSD) is highlighted when applicable. RESULTS At every level of the pyramid, it is shown that EDs interact with each of these proclaimed escalating mechanisms in a bidirectional manner that contributes to the predisposition, precipitation and perpetuation of EDs and related medical and psychiatric comorbidities, which then predispose to early death. The levels and their interactions that are discussed include the contribution of generational embodiment (genetics) and historical trauma (epigenetics), social conditions and local context, the ACEs and other traumas themselves, the resultant disrupted neurodevelopment, subsequent social, emotional and cognitive impairment, the adoption of health risk behaviors, and the development of disease, disability and social problems, all resulting in premature mortality by means of fatal complications and/or suicide. CONCLUSIONS The implications of these cascading, evolving, and intertwined perspectives have important implications for the assessment and treatment of EDs using trauma-informed care and trauma-focused integrated treatment approaches. This overview offers multiple opportunities at every level for the palliation and prevention of EDs and other associated trauma-related conditions, including PTSD.
Collapse
Affiliation(s)
- Timothy D Brewerton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.
| |
Collapse
|
5
|
D'Elia ATD, Juruena MF, Coimbra BM, Mello MF, Mello AF. Increased immuno-inflammatory mediators in women with post-traumatic stress disorder after sexual assault: 1-Year follow-up. J Psychiatr Res 2022; 155:241-251. [PMID: 36113394 DOI: 10.1016/j.jpsychires.2022.08.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 08/21/2022] [Accepted: 08/31/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Sexual violence is a traumatic event that can trigger post-traumatic stress disorder (PTSD) and generate biological responses to stress characterized by inhibiting the hypothalamic-pituitary axis (HPA), altering immune activity, and changing the structure and function of the brain. PTSD is associated with increased levels of inflammatory markers. This study aimed to measure differences in inflammatory markers and HPA hormone levels between women with PTSD due to sexual violence and controls at baseline and after 1-year follow-up. METHODS Fifty-eight women with PTSD resulting from sexual assault occurring up to 6 months prior were compared to 41 female controls. The patients were followed for 1 year. At baseline (T1), we measured inflammatory biomarkers. We also applied the Mini International Neuropsychiatric Interview (MINI), the Clinician-Administered Post-Traumatic Stress Disorder Scale-5, the Beck Depression Inventory, the Beck Anxiety Inventory, and the Childhood Trauma Questionnaire. The patients were randomized to receive treatment with sertraline or interpersonal psychotherapy for 14 weeks (T2) and then continued the usual treatment if deemed necessary for 1 year. The same interviews and examinations were repeated after 1 year (T3). RESULTS At baseline, the patients had significantly higher adrenocorticotropic hormone levels, compared to controls; however, there was no baseline difference in inflammatory markers or cortisol. After 1 year, there were significantly higher levels of interleukin-1β (p < 0.0001), monocyte chemoattractant protein-1 (p < 0.0001), tumor necrosis factor-α (p < 0.0001), c-reactive protein (p < 0.0001), and cortisol (p = 0.046) in the patient group. In addition to PTSD, 56 patients presented with a major depressive episode at T1 (according to the MINI). At the end of 1 year, there was a significant improvement in depressive (p < 0.001), anxiety (p = 0.03), and PTSD symptoms (p < 0.001) regardless of the treatment received. DISCUSSION The increase of the inflammatory markers after 1 year, even with symptomatic improvement, may indicate that PTSD following sexual violence is associated with high depressive symptoms. This association may have a different pattern of immunoendocrine alterations than PTSD only. Furthermore, these alterations may persist in the long term, even with the improvement of the symptoms, probably generating an immunological imprint that can lead to future clinical consequences. This study adds to the current knowledge of PTSD neurobiology and contributes to broadening approaches to this disorder.
Collapse
Affiliation(s)
- Ana Teresa D D'Elia
- Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
| | - Mario F Juruena
- Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil; Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neurosciences, Kings College London, London, United Kingdom
| | - Bruno M Coimbra
- Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil; Amsterdam UMC, location University of Amsterdam, Department of Psychiatry, Amsterdam Public Health Research Institute and Amsterdam Neuroscience Research Institute, Amsterdam, the Netherlands
| | - Marcelo F Mello
- Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Andrea F Mello
- Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| |
Collapse
|
6
|
Rasmusson AM, Novikov O, Brown KD, Pinna G, Pineles SL. Pleiotropic endophenotypic and phenotype effects of GABAergic neurosteroid synthesis deficiency in posttraumatic stress disorder. CURRENT OPINION IN ENDOCRINE AND METABOLIC RESEARCH 2022; 25:100359. [PMID: 36909842 PMCID: PMC10004350 DOI: 10.1016/j.coemr.2022.100359] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PTSD is associated with deficits in synthesis of progesterone metabolites such as allopregnanolone and pregnanolone that potently facilitate gamma-amino-butyric acid (GABA) effects at GABAA receptors. These neurosteroids modulate neuronal firing rate, regional brain connectivity, and activation of amygdala-mediated autonomic nervous system, hypothalamic-pituitary-adrenal axis, and behavioral reactions to unconditioned and conditioned threat. They also play critical roles in learning and memory processes such as extinction and extinction retention and inhibit toll-like receptor activation of intracellular pro-inflammatory pathways. Deficient synthesis of these neurosteroids thus may contribute to individually variable PTSD clinical phenotypes encompassing symptom severity, capacity for PTSD recovery, and vulnerability to common PTSD-comorbidities such as major depression, chronic pain, alcohol and nicotine dependence, cardiovascular disease, metabolic syndrome, reproductive disorders, and autoimmune conditions.
Collapse
Affiliation(s)
- Ann M Rasmusson
- VA National Center for PTSD, Women's Health Science Division, VA Boston Healthcare System, Boston, MA 02130, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Olga Novikov
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, 02118, USA.,Boston University School of Medicine, Psychiatry Residency Program, Boston, MA 02118, USA
| | - Kayla D Brown
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, 02118, USA.,Behavioral Neurosciences Ph.D. Program, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Graziano Pinna
- The Psychiatric Institute, Department of Psychiatry, College of Medicine, University of Illinois at Chicago, Chicago, IL, 60612, USA
| | - Suzanne L Pineles
- VA National Center for PTSD, Women's Health Science Division, VA Boston Healthcare System, Boston, MA 02130, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, MA, 02118, USA
| |
Collapse
|
7
|
Nishimi K, Thurston RC, Chibnik LB, Roberts AL, Sumner JA, Lawn RB, Tworoger SS, Kim Y, Koenen KC, Kubzansky LD. Posttraumatic stress disorder symptoms and timing of menopause and gynecological surgery in the Nurses' Health Study II. J Psychosom Res 2022; 159:110947. [PMID: 35644086 PMCID: PMC9197996 DOI: 10.1016/j.jpsychores.2022.110947] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Earlier menopause, either natural or through gynecologic surgeries, has been associated with various negative health sequelae. While posttraumatic stress disorder (PTSD) has been linked to dysregulated biological processes, including reproductive system changes that could alter menopausal timing, little work has examined whether trauma and PTSD are associated with greater risk of early cessation of menses. METHODS Data are from 46,639 women in the Nurses' Health Study II, a prospective cohort study of women followed for up to 26 years. Lifetime trauma and PTSD symptoms were assessed with the Brief Trauma Questionnaire and a PTSD symptom screener in 2008. Age at cessation of menses and reason for cessation of menses (i.e., natural menopause, gynecologic surgery including hysterectomy and/or bilateral salpingo-oophorectomy [BSO]) were assessed. Cox proportional hazards models estimated hazards ratios (HR) of cessation of menses (separately for naturally or surgically) associated with trauma alone or PTSD symptoms, relative to no trauma, adjusting for covariates. RESULTS Trauma/PTSD status was associated with earlier cessation of menses due to surgery, but not natural menopause. Women with trauma exposure, low, and high PTSD symptoms had higher hazard of cessation of menses due to surgery relative to those with no trauma exposure (HRtrauma = 1.16, 95%CI 1.07-1.26; HRlow PTSD = 1.25, 95%CI 1.15-1.36; HRhigh PTSD = 1.29, 95%CI 1.17-1.42). Trauma exposure and PTSD symptoms were associated with similarly increased risk of hysterectomy and BSO surgeries. CONCLUSIONS Women who experienced trauma and PTSD may be at elevated risk for common gynecological surgeries premenopausally, potentially due to increased clinical indications or gynecological conditions.
Collapse
Affiliation(s)
- Kristen Nishimi
- Mental Health Service, San Francisco Veterans Affairs Healthcare System, San Francisco, CA, USA; Department of Psychiatry and Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA.
| | - Rebecca C Thurston
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA; Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA; Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lori B Chibnik
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Andrea L Roberts
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jennifer A Sumner
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Rebecca B Lawn
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Shelley S Tworoger
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Yongjoo Kim
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA; College of Korean Medicine, Sangji University, Wonju, Republic of Korea
| | - Karestan C Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Laura D Kubzansky
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| |
Collapse
|
8
|
Du J, Diao H, Zhou X, Zhang C, Chen Y, Gao Y, Wang Y. Post-traumatic stress disorder: a psychiatric disorder requiring urgent attention. MEDICAL REVIEW (BERLIN, GERMANY) 2022; 2:219-243. [PMID: 37724188 PMCID: PMC10388753 DOI: 10.1515/mr-2022-0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 06/21/2022] [Indexed: 09/20/2023]
Abstract
Post-traumatic stress disorder (PTSD) is a severe and heterogenous psychiatric disorder that was first defined as a mental disorder in 1980. Currently, the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) and the International Classification of Diseases 11th Edition (ICD-11) offer the most widely accepted diagnostic guidelines for PTSD. In both diagnostic categories, experiencing a traumatic event (TE) is the necessary criterion for diagnosing PTSD. The TEs described in the DSM-5 include actual or threatened death, serious injury, sexual violence, and other extreme stressors, either directly or indirectly. More than 70% of adults worldwide are exposed to a TE at least once in their lifetime, and approximately 10% of individuals develop PTSD after experiencing a TE. The important features of PTSD are intrusion or re-experiencing fear memories, pervasive sense of threat, active avoidance, hyperarousal symptoms, and negative alterations of cognition and mood. Individuals with PTSD have high comorbidities with other psychiatric diseases, including major depressive disorder, generalized anxiety disorder, and substance use disorder. Multiple lines of evidence suggest that the pathophysiology of PTSD is complex, involving abnormal neural circuits, molecular mechanisms, and genetic mechanisms. A combination of both psychotherapy and pharmacotherapy is used to treat PTSD, but has limited efficacy in patients with refractory PTSD. Because of the high prevalence, heavy burden, and limited treatments, PTSD is a psychiatric disorder that requires urgent attention. In this review, we summarize and discuss the diagnosis, prevalence, TEs, pathophysiology, and treatments of PTSD and draw attention to its prevention.
Collapse
Affiliation(s)
- Jun Du
- The Brain Science Center, Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Huapeng Diao
- The Brain Science Center, Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Xiaojuan Zhou
- The Brain Science Center, Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Chunkui Zhang
- The Brain Science Center, Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Yifei Chen
- The Brain Science Center, Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Yan Gao
- The Brain Science Center, Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Yizheng Wang
- The Brain Science Center, Beijing Institute of Basic Medical Sciences, Beijing, China
| |
Collapse
|
9
|
The Molecular Genetics of Dissociative Symptomatology: A Transdiagnostic Literature Review. Genes (Basel) 2022; 13:genes13050843. [PMID: 35627228 PMCID: PMC9141026 DOI: 10.3390/genes13050843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 05/05/2022] [Accepted: 05/06/2022] [Indexed: 12/04/2022] Open
Abstract
Dissociative disorders are a common and frequently undiagnosed group of psychiatric disorders, characterized by disruptions in the normal integration of awareness, personality, emotion and behavior. The available evidence suggests that these disorders arise from an interaction between genetic vulnerability and stress, particularly traumatic stress, but the attention paid to the underlying genetic diatheses has been sparse. In this paper, the existing literature on the molecular genetics of dissociative disorders, as well as of clinically significant dissociative symptoms not reaching the threshold of a disorder, is reviewed comprehensively across clinical and non-clinical samples. Association studies suggest a link between dissociative symptoms and genes related to serotonergic, dopaminergic and peptidergic transmission, neural plasticity and cortisol receptor sensitivity, particularly following exposure to childhood trauma. Genome-wide association studies have identified loci of interest related to second messenger signaling and synaptic integration. Though these findings are inconsistent, they suggest biologically plausible mechanisms through which traumatic stress can lead to pathological dissociation. However, methodological concerns related to phenotype definition, study power, and correction for the confounding factors limit the value of these findings, and they require replication and extension in studies with better design.
Collapse
|
10
|
Rasmusson AM, Pineles SL, Brown KD, Pinna G. A role for deficits in GABAergic neurosteroids and their metabolites with NMDA receptor antagonist activity in the pathophysiology of posttraumatic stress disorder. J Neuroendocrinol 2022; 34:e13062. [PMID: 34962690 PMCID: PMC9233411 DOI: 10.1111/jne.13062] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 10/15/2021] [Accepted: 10/29/2021] [Indexed: 02/03/2023]
Abstract
Trauma-focused psychotherapies show general efficacy in post-traumatic stress disorder (PTSD), although outcomes vary substantially among individuals with PTSD and many patients do not achieve clinically meaningful symptom improvement. Several factors may contribute to poor treatment response, including genetic or environmental (e.g., stress) effects on neurobiological factors involved in learning and memory processes critical to PTSD recovery. In this review, we discuss the relationship between deficient GABAergic neurosteroid metabolites of progesterone, allopregnanolone (Allo) and pregnanolone (PA), and PTSD symptoms in men and women or PTSD-like behavioral abnormalities observed in male rodent models of PTSD. We also review the role and molecular underpinnings of learning and memory processes relevant to PTSD recovery, including extinction, extinction retention, reconsolidation of reactivated aversive memories and episodic non-aversive memory. We then discuss preclinical and clinical research that supports a role in these learning and memory processes for GABAergic neurosteroids and sulfated metabolites of Allo and PA that allosterically antagonize NMDA receptor function. Studies supporting the possible therapeutic impact of appropriately timed, acutely administered Allo or Allo analogs to facilitate extinction retention and/or block reconsolidation of aversive memories are also reviewed. Finally, we discuss important future directions for research in this area. Examining the varied and composite effects in PTSD of these metabolites of progesterone, as well as neuroactive derivatives of other parent steroids produced in the brain and the periphery, will likely enable a broadening of targets for treatment development. Defining contributions of these neuroactive steroids to common PTSD-comorbid psychiatric and medical conditions, as well as subpopulation-specific underlying dysfunctional physiological processes such as hypothalamic-pituitary-adrenal axis and immune system dysregulation, may also enable development of more effective multisystem precision medicines to prevent and treat the broader, polymorbid sequelae of extreme and chronic stress.
Collapse
Affiliation(s)
- Ann M. Rasmusson
- VA National Center for PTSD, Women’s Health Science Division, Department of Veterans Affairs, Boston, MA 02130, U.S.A
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, 02118
| | - Suzanne L. Pineles
- VA National Center for PTSD, Women’s Health Science Division, Department of Veterans Affairs, Boston, MA 02130, U.S.A
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, 02118
| | - Kayla D. Brown
- Behavioral Neurosciences PhD Program, Boston University Medical Campus, Boston, MA, 02118, U.S.A
| | - Graziano Pinna
- The Psychiatric Institute, Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois, 60612, U.S.A
| |
Collapse
|
11
|
Scott E, May M, Silva G, Taylor R, Fenlon N, Lowery-Gionta E, Matson L. Variation in trauma-related behavioral effects using a preclinical rat model of three predator exposure stress. Stress 2022; 25:276-290. [PMID: 35920240 DOI: 10.1080/10253890.2022.2105647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
The underlying mechanisms of trauma-related disorders are challenging to discover and the disorders are difficult to treat, in part due to the complex and varied expressions of response to traumatic stress. These challenges will be easier to overcome as more is understood about the variability in response to trauma. Incorporating assessment of variability into animal models of traumatic stress may allow better translation to clinical research and treatment development. In this study, we characterized variability in behavioral responses following traumatic stress exposure using a predator exposure (PE) animal model. Elevated plus maze (EPM) and acoustic startle response (SR) were used to study avoidance and arousal symptoms in male Sprague-Dawley rats. Behavioral data were compared between control (n = 31) and predator-exposed (n = 30) rats. PE behavior was clustered using k-means principal components analysis. Four clusters and three distinct subgroups were identified and were characterized as avoidant (Cluster 4, 30%), moderately avoidant (Clusters 2 and 3, 49%), and unaffected (Cluster 1, 17%). These results demonstrate that rodent responses to PE are varied, similar to human presentations following traumatic stress, suggesting it may be possible to develop treatment strategies for varied symptom presentations using a preclinical animal model.
Collapse
Affiliation(s)
- Emily Scott
- Behavioral Biology Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Spring, MD, USA
| | - Matthew May
- Behavioral Biology Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Spring, MD, USA
| | - Gabriella Silva
- Behavioral Biology Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Spring, MD, USA
| | - Rachel Taylor
- Behavioral Biology Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Spring, MD, USA
| | - Nicole Fenlon
- Behavioral Biology Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Spring, MD, USA
| | - Emily Lowery-Gionta
- Behavioral Biology Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Spring, MD, USA
| | - Liana Matson
- Behavioral Biology Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Spring, MD, USA
| |
Collapse
|
12
|
Sukhareva EV. The role of the corticotropin-releasing hormone and its receptors in the regulation of stress response. Vavilovskii Zhurnal Genet Selektsii 2021; 25:216-223. [PMID: 34901719 PMCID: PMC8627883 DOI: 10.18699/vj21.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/19/2020] [Accepted: 10/06/2020] [Indexed: 11/19/2022] Open
Abstract
Stress is an essential part of everyday life. The neuropeptide corticotropin-releasing hormone (CRH, also
called CRF and corticoliberin) plays a key role in the integration of neuroendocrine, autonomic and behavioral
responses to stress. The activation of the hypothalamic-pituitary-adrenal axis (HPA axis) by neurons of the paraventricular hypothalamic nucleus (PVN), the primary site of synthesis CRH, triggers stress reactions. In addition to the
hypothalamus, CRH is widespread in extrahypothalamic brain structures, where it functions as a neuromodulator
for coordination and interaction between the humoral and behavioral aspects of a stress response. The axons of
neurons expressing CRH are directed to various structures of the brain, where the neuropeptide interacts with
specific receptors (CRHR1, CRHR2) and can affect various mediator systems that work together to transmit signals
to different brain regions to cause many reactions to stress. Moreover, the effect of stress on brain functions varies
from behavioral adaptation to increased survival and increased risk of developing mental disorders. Disturbances
of the CRH system regulation are directly related to such disorders: mental pathologies (depression, anxiety, addictions), deviations of neuroendocrinological functions, inflammation, as well as the onset and development of
neurodegenerative diseases such as Alzheimer’s disease. In addition, the role of CRH as a regulator of the neurons
structure in the areas of the developing and mature brain has been established. To date, studies have been conducted in which CRHR1 is a target for antidepressants, which are, in fact, antagonists of this receptor. In this regard,
the study of the participation of the CRH system and its receptors in negative effects on hormone-dependent
systems, as well as the possibility of preventing them, is a promising task of modern physiological genetics. In this
review, attention will be paid to the role of CRH in the regulation of response to stress, as well as to the involvement
of extrahypothalamic CRH in pathophysiology and the correction of mental disorders.
Collapse
Affiliation(s)
- E V Sukhareva
- Institute of Cytology and Genetics of the Siberian Branch of the Russian Academy of Sciences, Novosibirsk, Russia
| |
Collapse
|
13
|
Carter JS, Kearns AM, Reichel CM. Complex Interactions Between Sex and Stress on Heroin Seeking. Front Neurosci 2021; 15:784365. [PMID: 34955731 PMCID: PMC8702641 DOI: 10.3389/fnins.2021.784365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/22/2021] [Indexed: 11/13/2022] Open
Abstract
Rationale: Stress plays a dual role in substance use disorders as a precursor to drug intake and a relapse precipitant. With heroin use at epidemic proportions in the United States, understanding interactions between stress disorders and opioid use disorder is vital and will aid in treatment of these frequently comorbid conditions. Objectives: Here, we combine assays of stress and contingent heroin self-administration (SA) to study behavioral adaptations in response to stress and heroin associated cues in male and female rats. Methods: Rats underwent acute restraint stress paired with an odor stimulus and heroin SA for subsequent analysis of stress and heroin cue reactivity. Lofexidine was administered during heroin SA and reinstatement testing to evaluate its therapeutic potential. Rats also underwent tests on the elevated plus maze, locomotor activity in a novel environment, and object recognition memory following stress and/or heroin. Results: A history of stress and heroin resulted in disrupted behavior on multiple levels. Stress rats avoided the stress conditioned stimulus and reinstated heroin seeking in response to it, with males reinstating to a greater extent than females. Lofexidine decreased heroin intake, reinstatement, and motor activity. Previous heroin exposure increased time spent in the closed arms of an elevated plus maze, activity in a round novel field, and resulted in object recognition memory deficits. Discussion: These studies report that a history of stress and heroin results in maladaptive coping strategies and suggests a need for future studies seeking to understand circuits recruited in this pathology and eventually help develop therapeutic approaches.
Collapse
Affiliation(s)
| | | | - Carmela M. Reichel
- Reichel Laboratory, Department of Neuroscience, Medical University of South Carolina, Charleston, SC, United States
| |
Collapse
|
14
|
Radell ML, Hamza EA, Moustafa AA. Depression in post-traumatic stress disorder. Rev Neurosci 2021; 31:703-722. [PMID: 32866132 DOI: 10.1515/revneuro-2020-0006] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 05/31/2020] [Indexed: 12/12/2022]
Abstract
Major depressive disorder (MDD) symptoms commonly occur after trauma-exposure, both alone and in combination with post-traumatic stress disorder (PTSD). This article reviews recent research on comorbidity between these disorders, including its implications for symptom severity and response to treatment. Despite considerable symptom overlap, the two disorders represent distinct constructs and depend, at least in part, on separate biological mechanisms. Both, however, are also clearly related to stress psychopathology. We recommend that more research focus specifically on the study of individual differences in symptom expression in order to identify distinct subgroups of individuals and develop targeted treatments. However, a barrier to this line of inquiry is the trend of excluding particular patients from clinical trials of new interventions based on symptom severity or comorbidity. Another obstacle is the overreliance on self-report measures in human research. We argue that developing computer-based behavioral measures in order to supplement self-report can help address this challenge. Furthermore, we propose that these measures can help tie findings from human and non-human animal research. A number of paradigms have been used to model MDD-and PTSD-like behavior in animals. These models remain valuable for understanding the biological basis of these disorders in humans and for identifying potential interventions, but they have been underused for the study of comorbidity. Although the interpretation of animal behavior remains a concern, we propose that this can also be overcome through the development of close human analogs to animal paradigms.
Collapse
Affiliation(s)
- Milen L Radell
- Department of Psychology, Niagara University, Lewiston, NY, USA
| | - Eid Abo Hamza
- Department of Mental Health, Faculty of Education, Tanta University, Tanta, Egypt
| | - Ahmed A Moustafa
- School of Psychology, Western Sydney University, Sydney, NSW, Australia.,Marcs Institute for Brain, Behaviour and Development, Western Sydney University, Sydney, NSW, Australia.,Department of Human Anatomy and Physiology, The Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| |
Collapse
|
15
|
Helpman L, Zhu X, Zilcha-Mano S, Suarez-Jimenez B, Lazarov A, Rutherford B, Neria Y. Reversed patterns of resting state functional connectivity for females vs. males in posttraumatic stress disorder. Neurobiol Stress 2021; 15:100389. [PMID: 34527793 PMCID: PMC8433283 DOI: 10.1016/j.ynstr.2021.100389] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 08/29/2021] [Accepted: 08/31/2021] [Indexed: 02/06/2023] Open
Abstract
Background Posttraumatic stress disorder (PTSD) is twice as prevalent among females as compared to males following potentially traumatic events. While there is evidence for aberrant functional connectivity between hubs of the central executive network (CEN), salience network (SN), and the default mode network (DMN) in PTSD, little is known regarding sex-specificity of this connectivity. The current study aims to directly examine sex-specific resting-state functional connectivity (rs-FC) in trauma exposed males and females, with and without PTSD. Methods One hundred and seventy-eight individuals underwent functional magnetic resonance imaging (fMRI) at rest, of them 85 females (45 with PTSD) and 93 males (57 with PTSD). We conducted whole-brain seed-based analysis using CEN (lateral prefrontal cortex [lPFC]), SN (anterior cingulate cortex [ACC], insula, amygdala [AMG]), and DMN (medial prefrontal cortex [mPFC], posterior parietal cortex [PCC], and hippocampus [HIP]) hubs as seed regions. Group-by-Sex ANOVA was conducted. Results The amygdala-precuneus, ACC-precuneus, and hippocampus-precuneus pathways exhibited significant group-by-sex interaction effects, with females with PTSD consistently differing in connectivity patterns from males with PTSD and from trauma-exposed healthy females. Conclusions Sex-specific neural connectivity patterns were found within and between key nodes of the CEN, DMN, and the SN, suggesting opposite patterns of connectivity in PTSD and trauma-exposed controls as a function of sex as a biological variable (SABV). This may point to mechanistic sex differences in adaptation following trauma and may inform differential neural targets for treatment of females and males with PTSD.
Collapse
Affiliation(s)
- Liat Helpman
- University of Haifa, 199 Aba Hushi St. Mt. Carmel, Haifa, Israel
- Tel Aviv Sourasky Medical Center, 6 Weizmann St., Tel Aviv, Israel
- Department of Psychiatry and the New York State Psychiatric Institute, Columbia University Medical Center, 1071 Riverside Dr., New York, NY, USA
- Corresponding author. Dept. of Counseling and Human Development, University of Haifa, 199 Aba Hushi St. Mt. Carmel, Haifa, Israel.
| | - Xi Zhu
- Department of Psychiatry and the New York State Psychiatric Institute, Columbia University Medical Center, 1071 Riverside Dr., New York, NY, USA
| | | | | | - Amit Lazarov
- Department of Psychiatry and the New York State Psychiatric Institute, Columbia University Medical Center, 1071 Riverside Dr., New York, NY, USA
- School of Psychological Sciences, Tel Aviv University, P.O. Box 39040, Tel Aviv, Israel
| | - Bret Rutherford
- Department of Psychiatry and the New York State Psychiatric Institute, Columbia University Medical Center, 1071 Riverside Dr., New York, NY, USA
| | - Yuval Neria
- Department of Psychiatry and the New York State Psychiatric Institute, Columbia University Medical Center, 1071 Riverside Dr., New York, NY, USA
| |
Collapse
|
16
|
Arditte Hall KA, DeLane SE, Anderson GM, Lago TR, Shor R, Wang W, Rasmusson AM, Pineles SL. Plasma gamma-aminobutyric acid (GABA) levels and posttraumatic stress disorder symptoms in trauma-exposed women: a preliminary report. Psychopharmacology (Berl) 2021; 238:1541-1552. [PMID: 33620549 DOI: 10.1007/s00213-021-05785-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 02/04/2021] [Indexed: 12/16/2022]
Abstract
RATIONALE Aberrations in the stress response are associated with posttraumatic stress disorder (PTSD) symptom development, maintenance, and severity. Gamma-aminobutyric acid (GABA), the brain's primary inhibitory neurotransmitter, may play a key role in stress recovery. OBJECTIVES In this preliminary study, we examined whether plasma GABA levels differed between women with PTSD and trauma-exposed healthy controls. METHODS Thirty participants provided plasma samples during two phases of the menstrual cycle: the early follicular phase and the mid-luteal phase. During each phase, blood was drawn after 45 min of rest, and after mild and moderately stressful psychophysiological tasks. Plasma GABA levels were measured using HPLC-mass spectrometry (LC-MS/MS). RESULTS In analyses using PTSD diagnosis as a categorical group variable, women with and without a diagnosis of PTSD did not differ in plasma GABA levels (ps > .18). However, in analyses examining PTSD symptom severity as a continuous variable, there was a trend-level positive association between more severe PTSD symptoms and higher plasma GABA levels across the four blood draws (p = .06). In analyses examining DSM-IV PTSD symptom clusters separately, dysphoria symptoms were positively and significantly associated with plasma GABA levels (p = .03). Similarly, there was a trend-level positive association between avoidance cluster symptoms and plasma GABA levels (p = .06). Plasma GABA levels were not modulated by experimentally induced stress or menstrual cycle phase. CONCLUSIONS Dysregulation in GABA may be a neurobiological marker and/or potential treatment target for women with PTSD symptom profiles characterized by prominent dysphoria and avoidance cluster symptoms.
Collapse
Affiliation(s)
- Kimberly A Arditte Hall
- Department of Psychology & Philosophy, Framingham State University, 100 State Street, Framingham, MA, 01701, USA.
| | - Sumaiya E DeLane
- National Center for PTSD Women's Health Sciences Division at VA Boston Healthcare System, Boston, MA, 02130, USA
| | - George M Anderson
- Child Study Center, Yale University School of Medicine, New Haven, CT, 06519, USA
| | | | - Rachel Shor
- National Center for PTSD Women's Health Sciences Division at VA Boston Healthcare System, Boston, MA, 02130, USA
| | - Weiwei Wang
- MEDKEC Keck Biotechnology Services, Yale University School of Medicine, New Haven, CT, 06519, USA
| | - Ann M Rasmusson
- National Center for PTSD Women's Health Sciences Division at VA Boston Healthcare System, Boston, MA, 02130, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Suzanne L Pineles
- National Center for PTSD Women's Health Sciences Division at VA Boston Healthcare System, Boston, MA, 02130, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, MA, 02118, USA
| |
Collapse
|
17
|
Dysregulation of miR-15a-5p, miR-497a-5p and miR-511-5p Is Associated with Modulation of BDNF and FKBP5 in Brain Areas of PTSD-Related Susceptible and Resilient Mice. Int J Mol Sci 2021; 22:ijms22105157. [PMID: 34068160 PMCID: PMC8153003 DOI: 10.3390/ijms22105157] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/06/2021] [Accepted: 05/10/2021] [Indexed: 12/21/2022] Open
Abstract
Post-traumatic stress disorder (PTSD) is a neuropsychiatric disorder occurring in susceptible individuals following a traumatic event. Understanding the mechanisms subserving trauma susceptibility/resilience is essential to develop new effective treatments. Increasing evidence suggests that non-coding RNAs, such as microRNAs (miRNAs), may play a prominent role in mediating trauma susceptibility/resilience. In this study, we evaluated the transcriptional expression of two key PTSD-related genes (FKBP5 and BDNF) and the relative targeting miRNAs (miR-15a-5p, miR-497a-5p, miR-511-5p, let-7d-5p) in brain areas of PTSD-related susceptible and resilient mice identified through our recently developed mouse model of PTSD (arousal-based individual screening (AIS) model). We observed lower transcript levels of miR-15a-5p, miR-497a-5p, and miR-511a-5p in the hippocampus and hypothalamus of susceptible mice compared to resilient mice, suggesting that the expression of these miRNAs could discriminate the two different phenotypes of stress-exposed mice. These miRNA variations could contribute, individually or synergically, to the inversely correlated transcript levels of FKBP5 and BDNF. Conversely, in the medial prefrontal cortex, downregulation of miR-15a-5p, miR-511-5p, and let-7d-5p was observed both in susceptible and resilient mice, and not accompanied by changes in their mRNA targets. Furthermore, miRNA expression in the different brain areas correlated to stress-induced behavioral scores (arousal score, avoidance-like score, social memory score and PTSD-like score), suggesting a linear connection between miRNA-based epigenetic modulation and stress-induced phenotypes. Pathway analysis of a miRNA network showed a statistically significant enrichment of molecular processes related to PTSD and stress. In conclusion, our results indicate that PTSD susceptibility/resilience might be shaped by brain-area-dependent modulation of miRNAs targeting FKBP5, BDNF, and other stress-related genes.
Collapse
|
18
|
Ponomareva OY, Ressler KJ. Genomic factors underlying sex differences in trauma-related disorders. Neurobiol Stress 2021; 14:100330. [PMID: 33997155 PMCID: PMC8102626 DOI: 10.1016/j.ynstr.2021.100330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 04/11/2021] [Accepted: 04/17/2021] [Indexed: 12/26/2022] Open
Abstract
Post-traumatic stress disorder (PTSD) is a devastating illness with treatment that is effective in only approximately half of the population. This limited rate of response highlights the necessity for research into underlying individual biological mechanisms that mediate development and progression of this disease, allowing for identification of patient-specific treatments. PTSD has clear sex differences in both risk and symptom patterns. Thus, one approach is to characterize trauma-related changes between men and women who exhibit differences in treatment efficacy and response to trauma. Recent technological advances in sequencing have identified several genomic loci and transcriptional changes that are associated with post-trauma symptomatology. However, although the diagnosis of PTSD is more prevalent in women, the genetic factors underlying sex differences remain poorly understood. Here, we review recent work that highlights current understanding and limitations in the field of sex differences in PTSD and related symptomatology.
Collapse
Affiliation(s)
- Olga Y Ponomareva
- Neuropsychiatry Translational Research Fellowship Program, Boston VA Healthcare System, Boston, MA, USA.,McLean Hospital, Harvard Medical School, Belmont, MA, USA
| | | |
Collapse
|
19
|
D'Elia ATD, Juruena MF, Coimbra BM, Mello MF, Mello AF. Posttraumatic stress disorder (PTSD) and depression severity in sexually assaulted women: hypothalamic-pituitary-adrenal (HPA) axis alterations. BMC Psychiatry 2021; 21:174. [PMID: 33789596 PMCID: PMC8010966 DOI: 10.1186/s12888-021-03170-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 03/17/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Sexual assault is implicated in several adverse psychological and physical health outcomes, including posttraumatic stress disorder (PTSD) and depression. Neurobiological research has shown variations related to the hypothalamic-pituitary-adrenal (HPA) axis, immune alterations, metabolic function, and brain circuitry. Although these mechanisms have been extensively studied, the results have demonstrated different outcomes in PTSD. METHODS We compared the plasma adrenocorticotropin (ACTH) and salivary cortisol levels of fifty-eight women with PTSD developed after sexual assault to those of forty-four female controls with no history of trauma. We also evaluated the psychiatric diagnosis and symptom severity of PTSD and depression. The participants' clinical conditions were associated with their hormonal levels to assess whether symptom severity was related to hormonal imbalance. RESULTS A large percentage of sexually assaulted women had PTSD and comorbid depression. The ACTH levels were higher in the PTSD group than the control group and increased as PTSD severity increased, considering depressive symptoms, measured by the Beck Depression Inventory (BDI) (p < 0.0001), as well as PTSD symptoms, measured by subscale D of the Clinician-Administered PTSD Scale (CAPS-5) (p = 0.045) and the CAPS-5 total scale (p = 0.026). Cortisol levels measured at 10 pm were higher for the PTSD group than the control group (p = 0.045, p = 0.037, respectively), and the cortisol awakening response showed elevated cortisol levels for the PTSD group. CONCLUSIONS These results show a correlation between symptom severity and HPA axis imbalance in patients with PTSD. Elevated ACTH and an elevated cortisol response in patients with comorbid depressive symptoms were the opposite of the expected response for patients with PTSD only. This association leads to the hypothesis that the neurobiological alterations of PTSD are related to the type of symptoms presented and their severity. These manifestations likely influence the disease course, prognosis and response to treatment. These outcomes highlight the need to discuss particular neurobiological alterations in patients with PTSD developed after sexual assault, mainly those with severe depressive symptoms.
Collapse
Affiliation(s)
- Ana Teresa D D'Elia
- Department of Psychiatry, Federal University of São Paulo (UNIFESP), Rua Major Maragliano, 241, Vila Mariana, São Paulo, SP, CEP 04017-030, Brazil.
| | - Mario F Juruena
- Department of Psychiatry, Federal University of São Paulo (UNIFESP), Rua Major Maragliano, 241, Vila Mariana, São Paulo, SP, CEP 04017-030, Brazil
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neurosciences, Kings College London, London, UK
| | - Bruno M Coimbra
- Department of Psychiatry, Federal University of São Paulo (UNIFESP), Rua Major Maragliano, 241, Vila Mariana, São Paulo, SP, CEP 04017-030, Brazil
| | - Marcelo F Mello
- Department of Psychiatry, Federal University of São Paulo (UNIFESP), Rua Major Maragliano, 241, Vila Mariana, São Paulo, SP, CEP 04017-030, Brazil
| | - Andrea F Mello
- Department of Psychiatry, Federal University of São Paulo (UNIFESP), Rua Major Maragliano, 241, Vila Mariana, São Paulo, SP, CEP 04017-030, Brazil
| |
Collapse
|
20
|
Galovski TE, Werner KB, Iverson KM, Kaplan S, Fortier CB, Fonda JR, Currao A, Salat D, McGlinchey RE. A Multi-Method Approach to a Comprehensive Examination of the Psychiatric and Neurological Consequences of Intimate Partner Violence in Women: A Methodology Protocol. Front Psychiatry 2021; 12:569335. [PMID: 33679466 PMCID: PMC7933589 DOI: 10.3389/fpsyt.2021.569335] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 01/21/2021] [Indexed: 01/07/2023] Open
Abstract
The number of women in the United States that experience blows to the head during assaults by intimate partners is substantial. The number of head blows that result in a traumatic brain injury (TBI) is virtually unknown, but estimates far exceed numbers of TBI in parallel populations (e.g., blast exposure, accidents, sports) combined. Research on the impact of TBI on post-traumatic stress disorder (PTSD) in survivors of intimate partner violence (IPV) is sparse. This methodology paper describes the comprehensive, multi-method approach used by a multi-disciplinary team of investigators from several different fields of expertise to assess the interaction of psychiatric, cognitive, psychological, and physical conditions that result from IPV. Using state-of-the-art instruments, a comprehensive assessment of lifetime trauma exposure, lifetime history of TBI, psychiatric history, and a full assessment of current cognitive, neuropsychological and biomedical function was conducted with 51 female survivors of IPV who screened positive for PTSD. This multi-method assessment included clinician-administered diagnostic interviews modified to specifically assess the sequelae of IPV, standardized self-report surveys, neuropsychological tests, structural, diffusion, and functional neuroimaging and blood-based biomarkers. The specific details and full report of the results of the full study are beyond the scope of this methodology paper. Descriptive characteristics of the complex clinical presentation observed in this unique sample are described. The sample reported high rates of trauma exposure across the lifespan and 80% met full criteria for current PTSD. Women also reported high rates of lifetime subconcussive head injury (88.2%) and TBI (52.9%) from various etiologies (35.3% secondary to IPV). Descriptive findings from the methodological protocol described here have begun to reveal information that will advance our understanding of the impact of subconcussive head injury and TBI on recovery from mental injury among IPV survivors.
Collapse
Affiliation(s)
- Tara E. Galovski
- Women's Health Sciences Division, National Center for Posttraumatic Stress Disorder, Veterans Affairs Boston Healthcare System, Boston, MA, United States
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States
| | - Kimberly B. Werner
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, MA, United States
| | - Katherine M. Iverson
- Women's Health Sciences Division, National Center for Posttraumatic Stress Disorder, Veterans Affairs Boston Healthcare System, Boston, MA, United States
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States
| | - Stephanie Kaplan
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, MA, United States
| | - Catherine B. Fortier
- The Translational Research Center for Traumatic Brain Injury and Stress Disorders and the Geriatric Research, Education and Clinical Center, Veterans Affairs Boston Healthcare System, Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Cambridge, MA, United States
| | - Jennifer R. Fonda
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States
- The Translational Research Center for Traumatic Brain Injury and Stress Disorders and the Geriatric Research, Education and Clinical Center, Veterans Affairs Boston Healthcare System, Boston, MA, United States
| | - Alyssa Currao
- The Translational Research Center for Traumatic Brain Injury and Stress Disorders and the Geriatric Research, Education and Clinical Center, Veterans Affairs Boston Healthcare System, Boston, MA, United States
| | - David Salat
- The Translational Research Center for Traumatic Brain Injury and Stress Disorders and the Geriatric Research, Education and Clinical Center, Veterans Affairs Boston Healthcare System, Boston, MA, United States
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, United States
| | - Regina E. McGlinchey
- The Translational Research Center for Traumatic Brain Injury and Stress Disorders and the Geriatric Research, Education and Clinical Center, Veterans Affairs Boston Healthcare System, Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Cambridge, MA, United States
| |
Collapse
|
21
|
The Impact of the Menstrual Cycle and Underlying Hormones in Anxiety and PTSD: What Do We Know and Where Do We Go From Here? Curr Psychiatry Rep 2021; 23:8. [PMID: 33404887 PMCID: PMC8819663 DOI: 10.1007/s11920-020-01221-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/16/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW This paper reviews the recent literature on menstrual cycle phase effects on outcomes relevant to anxiety and PTSD, discusses potential neurobiological mechanisms underlying these effects, and highlights methodological limitations impeding scientific advancement. RECENT FINDINGS The menstrual cycle and its underlying hormones impact symptom expression among women with anxiety and PTSD, as well as psychophysiological and biological processes relevant to anxiety and PTSD. The most consistent findings are retrospective self-report of premenstrual exacerbation of anxiety symptoms and the protective effect of estradiol on recall of extinction learning among healthy women. Lack of rigorous methodology for assessing menstrual cycle phase and inconsistent menstrual cycle phase definitions likely contribute to other conflicting results. Further investigations that address these limitations and integrate complex interactions between menstrual cycle phase-related hormones, genetics, and psychological vulnerabilities are needed to inform personalized prevention and intervention efforts for women.
Collapse
|
22
|
Stone LA, Harmatz ES, Goosens KA. Ghrelin as a Stress Hormone: Implications for Psychiatric Illness. Biol Psychiatry 2020; 88:531-540. [PMID: 32912426 DOI: 10.1016/j.biopsych.2020.05.013] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 05/11/2020] [Accepted: 05/11/2020] [Indexed: 12/28/2022]
Abstract
The stress response is an adaptive means of maintaining physiological homeostasis in the face of changing environmental conditions. However, protracted recruitment of stress systems can precipitate wear and tear on the body and may lead to many forms of disease. The mechanisms underlying the connection between chronic stress and disease are not fully understood and are likely multifactorial. In this review, we evaluate the possibility that the hormone ghrelin may contribute to the pathophysiology that follows chronic stress. Since ghrelin was discovered as a pro-hunger hormone, many additional roles for it have been identified, including in learning, memory, reward, and stress. We describe the beneficial effects that ghrelin exerts in healthy mammals and discuss that prolonged exposure to ghrelin has been linked to maladaptive responses and behaviors in the realm of psychiatric disease. In addition, we consider whether chronic stress-associated altered ghrelin signaling may enhance susceptibility to posttraumatic stress disorder and comorbid conditions such as major depressive disorder and alcohol use disorder. Finally, we explore the possibility that ghrelin-based therapeutics could eventually form the basis of a treatment strategy for illnesses that are linked to chronic stress and potentially also ghrelin dysregulation, and we identify critical avenues for future research in this regard.
Collapse
Affiliation(s)
| | | | - Ki A Goosens
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York.
| |
Collapse
|
23
|
Rauch SAM, Sripada R, Burton M, Michopoulos V, Kerley K, Marx CE, Kilts JD, Naylor JC, Rothbaum BO, McLean CP, Smith A, Norrholm SD, Jovanovic T, Liberzon I, Williamson DE, Yarvis CJS, Dondanville KA, Young-McCaughan S, Keane TM, Peterson AL. Neuroendocrine biomarkers of prolonged exposure treatment response in military-related PTSD. Psychoneuroendocrinology 2020; 119:104749. [PMID: 32554173 DOI: 10.1016/j.psyneuen.2020.104749] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 04/16/2020] [Accepted: 05/29/2020] [Indexed: 11/16/2022]
Abstract
Posttraumatic stress disorder (PTSD) is associated with dysregulation of the neuroendocrine system, including cortisol, allopregnanolone, and pregnanolone. Preliminary evidence from animal models suggests that baseline levels of these biomarkers may predict response to PTSD treatment. We report the change in biomarkers over the course of PTSD treatment. Biomarkers were sampled from individuals participating in (1) a randomized controlled trial comparing a web-version of Prolonged Exposure (Web-PE) therapy to in-person Present-Centered Therapy (PCT) and (2) from individuals participating in a nonrandomized effectiveness study testing PE delivered in-person as part of an intensive outpatient PTSD program. We found that higher cortisol reactivity during script-driven imagery was associated with higher baseline PTSD severity and that baseline allopregnanolone, pregnanolone, and cortisol reactivity were associated with PTSD treatment responder status over the course of intensive outpatient treatment. These findings demonstrate that peripherally assessed biomarkers are associated with PTSD severity and likelihood of successful treatment outcome of PE delivered daily over two weeks. These assessments could be used to determine which patients are likely to respond to treatment and which patients require augmentation to increase the likelihood of optimal response to PTSD treatment.
Collapse
Affiliation(s)
- Sheila A M Rauch
- Atlanta VA Medical Center, 1670 Clairmont Road, Decatur, GA, 30033, USA; Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, 12 Executive Park, 3rd Floor, Atlanta, GA, 30029, USA.
| | - Rebecca Sripada
- VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105, USA; University of Michigan, Department of Psychiatry, 4250 Plymouth Road, Ann Arbor, MI, 48109, USA.
| | - Mark Burton
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, 12 Executive Park, 3rd Floor, Atlanta, GA, 30029, USA.
| | - Vasiliki Michopoulos
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, 12 Executive Park, 3rd Floor, Atlanta, GA, 30029, USA.
| | - Kimberly Kerley
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, 12 Executive Park, 3rd Floor, Atlanta, GA, 30029, USA.
| | - Christine E Marx
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, 40 Duke Medicine Circle, Durham, NC, 27710, USA; Durham Veterans Administration Medical Center and VA Mid-Atlantic MIRECC, 508 Fulton Street, Durham, NC, 27705, USA.
| | - Jason D Kilts
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, 40 Duke Medicine Circle, Durham, NC, 27710, USA; Durham Veterans Administration Medical Center and VA Mid-Atlantic MIRECC, 508 Fulton Street, Durham, NC, 27705, USA.
| | - Jennifer C Naylor
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, 40 Duke Medicine Circle, Durham, NC, 27710, USA; Durham Veterans Administration Medical Center and VA Mid-Atlantic MIRECC, 508 Fulton Street, Durham, NC, 27705, USA.
| | - Barbara O Rothbaum
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, 12 Executive Park, 3rd Floor, Atlanta, GA, 30029, USA.
| | - Carmen P McLean
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System, 795 Willow Rd, Menlo Park, CA, 94025, USA; Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, 291 Campus Dr., Stanford, CA, 94305, USA.
| | - Alicia Smith
- Emory University School of Medicine, Department of Obstetrics and Gynecology, 101 Woodruff Circle NE, Ste 4217, Atlanta, 30322, USA.
| | - Seth D Norrholm
- Atlanta VA Medical Center, 1670 Clairmont Road, Decatur, GA, 30033, USA; Wayne State University, 3901 Chrysler Dr, Detroit, MI, 48201, USA.
| | - Tanja Jovanovic
- Wayne State University, 3901 Chrysler Dr, Detroit, MI, 48201, USA.
| | - Israel Liberzon
- Texas A&M University, 8447 Riverside Parkway, Bryan, TX, 77808-3260, USA.
| | - Douglas E Williamson
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, 40 Duke Medicine Circle, Durham, NC, 27710, USA; Durham Veterans Administration Medical Center and VA Mid-Atlantic MIRECC, 508 Fulton Street, Durham, NC, 27705, USA.
| | - Col Jeffrey S Yarvis
- Carl R. Darnall Army Medical Center, Department of Behavioral Health, 36065 Santa Fe Ave., Fort Hood, TX, 76544, USA.
| | - Katherine A Dondanville
- University of Texas Health Science Center at San Antonio, Department of Psychiatry and Behavioral Sciences, 7703 Floyd Curl Dr., San Antonio, TX, 78229, USA.
| | - Stacey Young-McCaughan
- University of Texas Health Science Center at San Antonio, Department of Psychiatry and Behavioral Sciences, 7703 Floyd Curl Dr., San Antonio, TX, 78229, USA.
| | - Terence M Keane
- VA Boston Healthcare System, National Center for PTSD (116B-2), 150 South Huntington Avenue, Boston, MA, 02130, USA; Boston University School of Medicine, Department of Psychiatry, 720 Harrison Avenue, Room 906, Boston, MA, 02118, USA.
| | - Alan L Peterson
- University of Texas Health Science Center at San Antonio, Department of Psychiatry and Behavioral Sciences, 7703 Floyd Curl Dr., San Antonio, TX, 78229, USA; South Texas Veterans Health Care System, Research and Development Service, 7400 Merton Minter, San Antonio, TX, 78229, USA; University of Texas at San Antonio, Department of Psychology, One UTSA Circle, San Antonio, TX, 78249, USA.
| | | |
Collapse
|
24
|
Pineles SL, Nillni YI, Pinna G, Webb A, Arditte Hall KA, Fonda JR, Irvine J, King MW, Hauger RL, Resick PA, Orr SP, Rasmusson AM. Associations between PTSD-Related extinction retention deficits in women and plasma steroids that modulate brain GABA A and NMDA receptor activity. Neurobiol Stress 2020; 13:100225. [PMID: 32490055 PMCID: PMC7256058 DOI: 10.1016/j.ynstr.2020.100225] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 04/14/2020] [Accepted: 04/25/2020] [Indexed: 12/25/2022] Open
Abstract
Several studies have demonstrated poor retention of extinction learning among individuals with posttraumatic stress disorder (PTSD). Gonadal hormone signaling in brain appears to influence the retention of extinction learning differently in women with and without PTSD. Women with PTSD, compared to trauma-exposed women without PTSD, show relative deficits in extinction retention during the mid-luteal phase (mLP) of the menstrual cycle, compared to the early follicular phase (eFP). A PTSD-related reduction in conversion of progesterone to its GABAergic metabolites allopregnanolone (Allo) and pregnanolone (PA) may contribute to these findings. The current study in trauma-exposed women with (n = 9) and without (n = 9) PTSD investigated associations between extinction retention and plasma Allo + PA levels, as well as the ratio of Allo + PA to 5α-dihydroprogesterone (5α-DHP), the immediate steroid precursor for Allo. The study also investigated the relationship between extinction retention and the ratio of Allo + PA to dehydroepiandrosterone (DHEA), an adrenally-derived GABAA receptor antagonist. Study participants completed differential fear-conditioning during both the eFP and mLP of the menstrual cycle. Analyses revealed a strong positive relationship between resting plasma Allo + PA levels and extinction retention during the mLP in the women with, but not without, PTSD (e.g., diagnosis X Allo + PA interaction controlling for early extinction: β = −.0008, p = .003). A similar pattern emerged for the Allo + PA to 5α-DHP ratio (β = -.165, p = .071), consistent with a PTSD-related block in production of Allo and PA at the enzyme 3α-hydroxysteroid dehydrogenase. The ratio of Allo + PA to DHEA appeared to influence extinction retention only during the eFP when Allo + PA and DHEA levels are comparable and thus may compete for effects on GABAA receptor function. This study aligns with male rodent PTSD models linking experimental reductions in brain Allo levels to deficits in extinction retention and suggests that targeting PTSD-related deficits in GABAergic neurosteroid synthesis may be therapeutic.
Collapse
Affiliation(s)
- Suzanne L Pineles
- National Center for PTSD Women's Health Sciences Division at VA Boston Healthcare System, Boston, MA, 02130, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Yael I Nillni
- National Center for PTSD Women's Health Sciences Division at VA Boston Healthcare System, Boston, MA, 02130, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Graziano Pinna
- The Psychiatric Institute, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, 60612, USA
| | - Andrea Webb
- The Charles Stark Draper Laboratory, Inc., Cambridge, MA, 02139, USA
| | | | - Jennifer R Fonda
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Healthcare System Boston, MA, 02130, USA.,Department of Epidemiology, Boston University School of Public Health, Boston, MA, 02118, USA
| | - John Irvine
- The MITRE Corporation, Bedford, MA, 01730, USA
| | - Matthew W King
- National Center for PTSD Women's Health Sciences Division at VA Boston Healthcare System, Boston, MA, 02130, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Richard L Hauger
- Center of Excellence for Stress and Mental Health, San Diego VA Healthcare System, San Diego, CA, 9216, USA.,Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA, 92093, USA
| | - Patricia A Resick
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, 27701, USA
| | - Scott P Orr
- Psychiatry Department, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, 02129, USA
| | - Ann M Rasmusson
- National Center for PTSD Women's Health Sciences Division at VA Boston Healthcare System, Boston, MA, 02130, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, MA, 02118, USA
| |
Collapse
|
25
|
Kim BK, Fonda JR, Hauger RL, Pinna G, Anderson GM, Valovski IT, Rasmusson AM. Composite contributions of cerebrospinal fluid GABAergic neurosteroids, neuropeptide Y and interleukin-6 to PTSD symptom severity in men with PTSD. Neurobiol Stress 2020; 12:100220. [PMID: 32435669 PMCID: PMC7231970 DOI: 10.1016/j.ynstr.2020.100220] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 03/31/2020] [Accepted: 04/04/2020] [Indexed: 02/06/2023] Open
Abstract
Given that multiple neurobiological systems, as well as components within these systems are impacted by stress, and may interact in additive, compensatory and synergistic ways to promote or mitigate PTSD risk, severity, and recovery, we thought that it would be important to consider the collective, as well as separate effects of these neurobiological systems on PTSD risk. With this goal in mind, we conducted a proof-of-concept study utilizing cerebrospinal fluid (CSF) collected from unmedicated, tobacco- and illicit substance-free men with PTSD (n = 13) and trauma-exposed healthy controls (TC) (n = 17). Thirteen neurobiological factors thought to contribute to PTSD risk or severity based on previous studies were assayed. As the small but typical sample size of this lumbar puncture study limited the number of factors that could be considered in a hierarchical regression model, we included only those five factors with at least a moderate correlation (Spearman rho > 0.30) with total Clinician-Administered PTSD Scale (CAPS-IV) scores, and that did not violate multicollinearity criteria. Three of the five factors meeting these criteria—CSF allopregnanolone and pregnanolone (Allo + PA: equipotent GABAergic metabolites of progesterone), neuropeptide Y (NPY), and interleukin-6 (IL-6)—were found to account for over 75% of the variance in the CAPS-IV scores (R2 = 0.766, F = 8.75, p = 0.007). CSF Allo + PA levels were negatively associated with PTSD severity (β = −0.523, p = 0.02) and accounted for 47% of the variance in CAPS-IV scores. CSF NPY was positively associated with PTSD severity (β = 0.410, p = 0.04) and accounted for 14.7% of the CAPS-IV variance. There was a trend for a positive association between PTSD severity and CSF IL-6 levels, which accounted for 15.3% of the variance in PTSD severity (β = 0.423, p = 0.05). Z-scores were then computed for each of the three predictive factors and used to depict the varying relative degrees to which each contributed to PTSD severity at the individual PTSD patient level. This first of its kind, proof-of-concept study bears replication in larger samples. However, it highlights the collective effects of dysregulated neurobiological systems on PTSD symptom severity and the heterogeneity of potential biological treatment targets across individual PTSD patients—thus supporting the need for precision medicine approaches to treatment development and prescribing in PTSD.
Collapse
Key Words
- 3α-HSD, 3α-hydroxysteroid dehydrogenase
- Allo + PA, sum of allopregnanolone and pregnanolone
- EIA, enzyme immunoassay
- GC-MS, gas chromatography-mass spectrometry
- HPLC, high pressure liquid chromatography
- LP, lumbar puncture
- PE, prolonged exposure therapy
- PFC, prefrontal cortex
- RIA, radioimmunoassay
- TC, trauma-exposed control
Collapse
Affiliation(s)
- Byung Kil Kim
- VA Boston Healthcare System, 150 South Huntington Ave., Boston, MA, 02130, USA
| | - Jennifer R Fonda
- VA Boston Healthcare System, 150 South Huntington Ave., Boston, MA, 02130, USA.,Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), 150 South Huntington Ave., Boston, MA, 02130, USA.,Boston University School of Medicine, 72 E. Concord Street, Boston, MA, 02118, USA
| | - Richard L Hauger
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA.,Center for Behavior Genetics of Aging, Department of Psychiatry, School of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Graziano Pinna
- The Psychiatric Institute, College of Medicine, University of Illinois at Chicago, 1601 W Taylor St. MC912 Chicago, IL, 60612, USA
| | - George M Anderson
- Child Study Center and Department of Laboratory Medicine, Yale University School of Medicine S. Frontage Rd. New Haven, CT, 06519, USA
| | - Ivan T Valovski
- VA Boston Healthcare System, 150 South Huntington Ave., Boston, MA, 02130, USA.,Harvard Medical School, 25 Shattuck St. Boston, MA, 02115, USA
| | - Ann M Rasmusson
- VA Boston Healthcare System, 150 South Huntington Ave., Boston, MA, 02130, USA.,Boston University School of Medicine, 72 E. Concord Street, Boston, MA, 02118, USA.,VA National Center for PTSD Women's Health Science Division, 150 South Huntington Ave., Boston, MA, 02130, USA
| |
Collapse
|
26
|
Sartori SB, Singewald N. Novel pharmacological targets in drug development for the treatment of anxiety and anxiety-related disorders. Pharmacol Ther 2019; 204:107402. [PMID: 31470029 DOI: 10.1016/j.pharmthera.2019.107402] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 08/19/2019] [Indexed: 12/24/2022]
Abstract
Current medication for anxiety disorders is suboptimal in terms of efficiency and tolerability, highlighting the need for improved drug treatments. In this review an overview of drugs being studied in different phases of clinical trials for their potential in the treatment of fear-, anxiety- and trauma-related disorders is presented. One strategy followed in drug development is refining and improving compounds interacting with existing anxiolytic drug targets, such as serotonergic and prototypical GABAergic benzodiazepines. A more innovative approach involves the search for compounds with novel mechanisms of anxiolytic action using the growing knowledge base concerning the relevant neurocircuitries and neurobiological mechanisms underlying pathological fear and anxiety. The target systems evaluated in clinical trials include glutamate, endocannabinoid and neuropeptide systems, as well as ion channels and targets derived from phytochemicals. Examples of promising novel candidates currently in clinical development for generalised anxiety disorder, social anxiety disorder, panic disorder, obsessive compulsive disorder or post-traumatic stress disorder include ketamine, riluzole, xenon with one common pharmacological action of modulation of glutamatergic neurotransmission, as well as the neurosteroid aloradine. Finally, compounds such as D-cycloserine, MDMA, L-DOPA and cannabinoids have shown efficacy in enhancing fear-extinction learning in humans. They are thus investigated in clinical trials as an augmentative strategy for speeding up and enhancing the long-term effectiveness of exposure-based psychotherapy, which could render chronic anxiolytic drug treatment dispensable for many patients. These efforts are indicative of a rekindled interest and renewed optimism in the anxiety drug discovery field, after decades of relative stagnation.
Collapse
Affiliation(s)
- Simone B Sartori
- Institute of Pharmacy, Department of Pharmacology and Toxicology, Center for Molecular Biosciences Innsbruck (CMBI), Leopold Franzens University Innsbruck, Innsbruck, Austria
| | - Nicolas Singewald
- Institute of Pharmacy, Department of Pharmacology and Toxicology, Center for Molecular Biosciences Innsbruck (CMBI), Leopold Franzens University Innsbruck, Innsbruck, Austria.
| |
Collapse
|
27
|
Abstract
PURPOSE OF REVIEW This article reviews recent evidence related to public health epidemiology and intervention for traumatic stress and PTSD. Recent evidence is presented regarding incidence of traumatic stress worldwide, as well as most frequent types of traumas, indicators of the public health burden of PTSD, and prevalence, predictors, and correlates of PTSD. Public health perspectives on intervention and treatment are delineated, and innovations in both psychosocial and psychopharmacological interventions are highlighted. RECENT FINDINGS PTSD has been associated with substantial medical and economic burden. Recent public health preventive innovations include integrated medical/behavioral health care, acute CBT and attention interventions, modifications to CBT protocols, use of novel and augmentative psychopharmacological agents, and use of technology. Recent research regarding the scope and impact of traumatic stress, as well as prevention strategies for PTSD, have resulted in an improved understanding of its impact and more effective public health interventions.
Collapse
Affiliation(s)
- Patricia Watson
- Department of Veterans Affairs (116D), National Center for PTSD, Executive Division, 215 N. Main ST, White River Junction, VT, 05009, USA.
| |
Collapse
|
28
|
Tobacco dependence is associated with increased risk for multi-morbid clustering of posttraumatic stress disorder, depressive disorder, and pain among post-9/11 deployed veterans. Psychopharmacology (Berl) 2019; 236:1729-1739. [PMID: 30617565 DOI: 10.1007/s00213-018-5155-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 12/17/2018] [Indexed: 10/27/2022]
Abstract
RATIONALE Tobacco use is highly prevalent among individuals with posttraumatic stress disorder (PTSD), depressive disorders, and pain. Research has revealed pairwise relationships among these conditions but has not examined more complex relationships that may influence symptom severity, chronicity, and treatment outcome. OBJECTIVE To examine the clustering of current PTSD, depressive disorders, and clinically significant pain according to current tobacco use and dependence among post-9/11 deployed veterans. METHODS Logistic regression was used to examine the clustering of these conditions in relationship to current tobacco use/dependence, while adjusting for age and total combat exposure, in 343 post-9/11 deployed veterans enrolled in the Translational Research Center for TBI and Stress Disorders (TRACTS) cohort (Mage = 32.1 + 8.3 years; 38% current tobacco use; 25% low and 12% moderate/high tobacco dependence). RESULTS A three-way clustering of PTSD, depressive disorder, and pain was more likely than any single or pairwise combination of these conditions in moderate/high tobacco-dependent veterans compared to tobacco non-users (adjusted ORs = 3.50 to 4.18). This multi-morbidity cluster also was associated with increased PTSD severity. CONCLUSIONS Moderate to high dependence on tobacco is associated with substantially increased clustering of PTSD, depression, and clinically significant pain in veterans. Research examining synergistic interactions among these conditions, biological vulnerabilities shared among them, and the direct impact of tobacco use on the pathophysiology of PTSD, depression, and pain is needed. The results of such work may spur development of more effective integrated treatments to reduce the negative impact of these multi-morbid conditions on veterans' wellbeing and long-term health.
Collapse
|
29
|
Rasmusson AM, King MW, Valovski I, Gregor K, Scioli-Salter E, Pineles SL, Hamouda M, Nillni YI, Anderson GM, Pinna G. Relationships between cerebrospinal fluid GABAergic neurosteroid levels and symptom severity in men with PTSD. Psychoneuroendocrinology 2019; 102:95-104. [PMID: 30529908 PMCID: PMC6584957 DOI: 10.1016/j.psyneuen.2018.11.027] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 11/02/2018] [Accepted: 11/21/2018] [Indexed: 12/21/2022]
Abstract
Allopregnanolone and pregnanolone (together termed allo + pregnan) are neurosteroid metabolites of progesterone that equipotently facilitate the action of gamma-amino-butyric acid (GABA) at GABAA receptors. The adrenal steroid dehydroepiandrosterone (DHEA) allosterically antagonizes GABAA receptors and facilitates N-methyl-D-aspartate (NMDA) receptor function. In prior research, premenopausal women with posttraumatic stress disorder (PTSD) displayed low cerebrospinal fluid (CSF) levels of allo + pregnan [undifferentiated by the gas chromatography-mass spectrometry (GC-MS) method used] that correlated strongly and negatively with PTSD reexperiencing and negative mood symptoms. A PTSD-related decrease in the ratio of allo + pregnan to 5α-dihydroprogesterone (5α-DHP: immediate precursor for allopregnanolone) suggested a block in synthesis of these neurosteroids at 3α-hydroxysteroid dehydrogenase (3α-HSD). In the current study, CSF was collected from unmedicated, tobacco-free men with PTSD (n = 13) and trauma-exposed healthy controls (n = 17) after an overnight fast. Individual CSF steroids were quantified separately by GC-MS. In the men with PTSD, allo + pregnan correlated negatively with Clinician-Administered PTSD Scale (CAPS-IV) total (ρ=-0.74, p = 0.006) and CAPS-IV derived Simms dysphoria cluster (ρ=-0.71, p = 0.01) scores. The allo+pregnan to DHEA ratio also was negatively correlated with total CAPS (ρ=-0.74, p = 0.006) and dysphoria cluster (ρ=-0.79, p = 0.002) scores. A PTSD-related decrease in the 5α-DHP to progesterone ratio indicated a block in allopregnanolone synthesis at 5α-reductase. This study suggests that CSF allo + pregnan levels correlate negatively with PTSD and negative mood symptoms in both men and women, but that the enzyme blocks in synthesis of these neurosteroids may be sex-specific. Consideration of sex, PTSD severity, and function of 5α-reductase and 3α-HSD thus may enable better targeting of neurosteroid-based PTSD treatments.
Collapse
Affiliation(s)
- Ann M Rasmusson
- VA National Center for PTSD Women's Health Science Division, Boston, MA, 02130, United States; VA Boston Healthcare System, Boston, MA, 02130, United States; Boston University School of Medicine, Boston, MA, 02118, United States.
| | - Matthew W King
- VA National Center for PTSD Women's Health Science Division, Boston, MA, 02130, United States; VA Boston Healthcare System, Boston, MA, 02130, United States; Boston University School of Medicine, Boston, MA, 02118, United States
| | - Ivan Valovski
- VA Boston Healthcare System, Boston, MA, 02130, United States; Harvard Medical School, Boston, MA, 02115, United States
| | - Kristin Gregor
- VA Boston Healthcare System, Boston, MA, 02130, United States; Boston University School of Medicine, Boston, MA, 02118, United States
| | - Erica Scioli-Salter
- VA National Center for PTSD Women's Health Science Division, Boston, MA, 02130, United States; VA Boston Healthcare System, Boston, MA, 02130, United States; Boston University School of Medicine, Boston, MA, 02118, United States
| | - Suzanne L Pineles
- VA National Center for PTSD Women's Health Science Division, Boston, MA, 02130, United States; VA Boston Healthcare System, Boston, MA, 02130, United States; Boston University School of Medicine, Boston, MA, 02118, United States
| | - Mohamed Hamouda
- VA Boston Healthcare System, Boston, MA, 02130, United States; Harvard Medical School, Boston, MA, 02115, United States
| | - Yael I Nillni
- VA National Center for PTSD Women's Health Science Division, Boston, MA, 02130, United States; VA Boston Healthcare System, Boston, MA, 02130, United States; Boston University School of Medicine, Boston, MA, 02118, United States
| | - George M Anderson
- Child Study Center and Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, 06510, United States
| | - Graziano Pinna
- The Psychiatric Institute, College of Medicine, University of Illinois at Chicago, Chicago, IL, 60612, United States
| |
Collapse
|
30
|
Cruz DA, Glantz LA, McGaughey KD, Parke G, Shampine LJ, Kilts JD, Naylor JC, Marx CE, Williamson DE. Neurosteroid Levels in the Orbital Frontal Cortex of Subjects with PTSD and Controls: A Preliminary Report. CHRONIC STRESS (THOUSAND OAKS, CALIF.) 2019; 3:2470547019838570. [PMID: 31276078 PMCID: PMC6604657 DOI: 10.1177/2470547019838570] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 02/27/2019] [Indexed: 01/05/2023]
Abstract
Background Neurosteroids mediate stress signaling and have been implicated in the pathogenesis of post-traumatic stress disorder (PTSD) in both preclinical and clinical studies. Compared to controls, subjects with PTSD exhibit altered neurosteroid levels in peripheral blood and cerebrospinal fluid as well as hypoactivity in the medial orbital frontal cortex (mOFC). Therefore, the aim of this study was to compare neurosteroid levels in the mOFC of subjects with PTSD (n = 18) and controls (n = 35). Methods Gray matter was dissected from fresh-frozen mOFC, and levels of the neurosteroids pregnenolone, allopregnanolone, pregnanolone, epiallopregnanolone, epipregnanolone, tetrahydrodeoxycorticosterone, and androsterone were determined by gas chromatography - tandem mass spectrometry (GC/MS/MS). Results Analyses of unadjusted levels revealed that males with PTSD had significantly decreased levels of allopregnanolone (p = 0.03) compared to control males and females with PTSD had significantly increased levels of pregnenolone (p = 0.03) relative to control females. After controlling for age, postmortem interval, and smoking status, results showed that males with PTSD had significantly decreased levels of androsterone (t46 = 2.37, p = 0.02) compared to control males and females with PTSD had significantly increased levels of pregnanolone (t46 = -2.25, p = 0.03) relative to control females. Conclusions To our knowledge, this is the first report of neurosteroid levels in postmortem brain tissue of subjects with PTSD. Although replication is required in other brain regions and in a larger cohort of subjects, the results suggest a dysregulation of allopregnanolone and androsterone in males with PTSD and pregnanolone in females with PTSD in the mOFC.
Collapse
Affiliation(s)
- Dianne A. Cruz
- Department of Psychiatry and Behavioral
Sciences, Duke University Medical Center, Durham, NC, USA
| | - Leisa A. Glantz
- Department of Psychiatry and Behavioral
Sciences, Duke University Medical Center, Durham, NC, USA
| | - Kara D. McGaughey
- Department of Psychiatry and Behavioral
Sciences, Duke University Medical Center, Durham, NC, USA
| | - Gillian Parke
- Department of Psychiatry and Behavioral
Sciences, Duke University Medical Center, Durham, NC, USA
| | - Lawrence J. Shampine
- Department of Psychiatry and Behavioral
Sciences, Duke University Medical Center, Durham, NC, USA
| | - Jason D. Kilts
- Department of Psychiatry and Behavioral
Sciences, Duke University Medical Center, Durham, NC, USA
| | - Jennifer C. Naylor
- Department of Psychiatry and Behavioral
Sciences, Duke University Medical Center, Durham, NC, USA
| | - Christine E. Marx
- Department of Psychiatry and Behavioral
Sciences, Duke University Medical Center, Durham, NC, USA
- Durham
VA Medical Center, Durham, NC, USA
- VA Mid-Atlantic MIRECC, Durham, NC,
USA
| | - Douglas E. Williamson
- Department of Psychiatry and Behavioral
Sciences, Duke University Medical Center, Durham, NC, USA
- Durham
VA Medical Center, Durham, NC, USA
| |
Collapse
|
31
|
Abstract
PURPOSE OF REVIEW Traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) can result from similar injuries and can result in similar symptoms, such as problems with sleep, concentration, memory, and mood. Although PTSD and persistent sequelae due to a TBI (PST) have generally been viewed as pragmatically confounded but conceptually separable entities, we examine emerging evidence emphasizing the breadth of overlap in both clinical presentation and underlying pathophysiology between PST and PTSD. RECENT FINDINGS New evidence underscores the poor specificity of symptoms to etiology and emphasizes the potential, after both physical brain injury and traumatic stress, for changes in each of the three interacting systems that coordinate the body's response to the experience or expectation of major injury-the immune, endocrine, and neuromodulatory neurotransmitter systems. A view of PTSD and PST sharing common pathophysiologic elements related to the CNS response to acute injury or threat carries important implications for research and clinical care.
Collapse
|
32
|
Nisbett KE, Pinna G. Emerging Therapeutic Role of PPAR-α in Cognition and Emotions. Front Pharmacol 2018; 9:998. [PMID: 30356872 PMCID: PMC6190882 DOI: 10.3389/fphar.2018.00998] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 08/14/2018] [Indexed: 01/11/2023] Open
Affiliation(s)
- Khalin E Nisbett
- The Psychiatric Institute, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States
| | - Graziano Pinna
- The Psychiatric Institute, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States
| |
Collapse
|
33
|
Liang JJ, Rasmusson AM. Overview of the Molecular Steps in Steroidogenesis of the GABAergic Neurosteroids Allopregnanolone and Pregnanolone. CHRONIC STRESS (THOUSAND OAKS, CALIF.) 2018; 2:2470547018818555. [PMID: 32440589 PMCID: PMC7219929 DOI: 10.1177/2470547018818555] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 11/19/2018] [Indexed: 12/23/2022]
Abstract
Allopregnanolone and pregnanolone-neurosteroids synthesized from progesterone in the brain, adrenal gland, ovary and testis-have been implicated in a range of neuropsychiatric conditions including seizure disorders, post-traumatic stress disorder, major depression, post-partum depression, pre-menstrual dysphoric disorder, chronic pain, Parkinson's disease, Alzheimer's disease, neurotrauma, and stroke. Allopregnanolone and pregnanolone equipotently facilitate the effects of gamma-amino-butyric acid (GABA) at GABAA receptors, and when sulfated, antagonize N-methyl-D-aspartate receptors. They play myriad roles in neurophysiological homeostasis and adaptation to stress while exerting anxiolytic, antidepressant, anti-nociceptive, anticonvulsant, anti-inflammatory, sleep promoting, memory stabilizing, neuroprotective, pro-myelinating, and neurogenic effects. Given that these neurosteroids are synthesized de novo on demand, this review details the molecular steps involved in the biochemical conversion of cholesterol to allopregnanolone and pregnanolone within steroidogenic cells. Although much is known about the early steps in neurosteroidogenesis, less is known about transcriptional, translational, and post-translational processes in allopregnanolone- and pregnanolone-specific synthesis. Further research to elucidate these mechanisms as well as to optimize the timing and dose of interventions aimed at altering the synthesis or levels of these neurosteroids is much needed. This should include the development of novel therapeutics for the many neuropsychiatric conditions to which dysregulation of these neurosteroids contributes.
Collapse
Affiliation(s)
| | - Ann M. Rasmusson
- Boston
University School of Medicine, Boston, MA,
USA
- National Center for PTSD, Women’s Health
Science Division, Department of Veterans Affairs, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA,
USA
| |
Collapse
|