Posttraumatic Stress Disorder in the Elderly

The Role of Defence Mechanisms in Coping with Stress in PTSD Patients

In the context of the war in Ukraine, the risk of post-traumatic stress disorders increases, which in critical cases cause the development of chronic mental illnesses and a decline in physiological functions. In connection with the emergence of a feeling of helplessness due to the inability to act effectively in a dangerous situation, various psychological defence mechanisms are formed to overcome intrapsychic conflicts. The purpose of this stud was to investigate the dominant mechanisms in individuals with post-traumatic stress disorder who had been in regions with different scenarios for the development of hostilities since the beginning of the war, using the PlutchikKellerman-Conte methodology. The information was collected from people of different age categories, types of employment, educational qualification levels, and gender who were in Kyiv, Kharkiv, and Lviv during the first two months of the full-scale war and periodically moved through the territory of Central and Western Ukraine. Cases of short-term residence abroad were also considered during the study. The results of the tension of psychological defence indicate that in individuals with post-traumatic stress disorder that stayed in different regions of Central and Western Ukraine since the beginning of the war, the projection mechanism dominated (75%), and the substitution mechanisms (12.5%) and denial mechanisms (12.5%) were equally distributed. The dominance of the projection may indicate the transfer of intrapsychic conflict to the outside. In this case, the external world is perceived by the individual as the main carrier of the threat from which they need to protect themselves. Instead, denial may indicate ignoring certain aspects of reality. Respondents who are prone to substitution use the approach of transferring repressed emotions, which can be expressed in the form of anger, fear, and hostility towards more accessible objects that are no less dangerous than those that led to frustrating experiences. It was determined that the total sample tension does not exceed 50%. This may indicate the ability of patients with post-traumatic stress disorder to resolve intrapsychic conflicts that have developed at the moment. The results of the study may be of practical interest to specialists investigating the identification and generation of methods for the prevention and treatment of post-traumatic stress disorder

Feasibility of EMDR in Older Adults with PTSD to Reduce Frailty and Improve Quality of Life

OBJECTIVES

Posttraumatic stress disorder (PTSD) after exposure to multiple (childhood) trauma's is strongly associated with accelerated aging and high psychiatric and somatic comorbidity, influencing frailty and Quality of Life (QoL) in older adults. Eye Movement Desensitization therapy (EMDR) addresses psychological and physiologic symptoms stemming from adverse life events and therefore could influence frailty and QoL in older adults.

METHODS

We conducted a multi-center feasibility study (two psychiatric hospitals) in Dutch older outpatients (N = 24; ≥60 years) with PTSD. Participants received weekly EMDR-treatment during the course of the trial (3 months to a maximum of 9 months). Frailty (Groninger Frailty Indicator) and QoL (EuroQol 5D-3L), were assessed pre- and posttreatment.

RESULTS

A linear mixed-model approach showed significant reduction of frailty (F(1,23) = 9.019, p = .006) and improvement of QoL (F(1,23) = 13.787, p = .001). For both frailty and QoL, there was no significant influence of Clinician-Administered PTSD Scale (CAPS-5) pre-treatment score, therapy duration, and neither an interaction effect of therapy duration x CAPS-5 pre-treatment score.

CONCLUSIONS

EMDR with older adults with PTSD showed a significant reduction of frailty and improvement of QoL. Randomized controlled studies are needed to more precisely study the impact of trauma-focused treatment in older adults on frailty and QoL and the implications this might have for lessening disease burden.

CLINICAL IMPLICATIONS

Screening for PTSD in older frail adults is important to treat PTSD as a possible way to reduce frailty and improve QoL.

L-Carnitine prevents memory impairment induced by post-traumatic stress disorder

BACKGROUND

Post-traumatic stress disorder (PTSD) is a genuine obstructing mental disorder. As indicated by the name, it is related to the patients' stress augmented by life-threatening conditions or accidents. The PTSD has linked to oxidative stress that can result in neurodegeneration. L-carnitine (L-CAR) is known for its antioxidant properties, which can protect against neuronal damage.

OBJECTIVE

In the current study, we investigated the beneficial effects of L-CAR on the memory impairment induced by PTSD using a rat model.

METHODS

A model of single-prolonged stress (a cycle of restraining, forced swimming, rest, and finally diethyl ether exposure for 2 h, 20 min, 15 min, and 1-2 min, respectively) was used to induce PTSD-like behavior. Intraperitoneal L-CAR treatment (300 mg/kg/day) was introduced for four weeks. Both memory and special learning were evaluated utilizing the radial arm water maze (RAWM). Moreover, the levels of glutathione peroxidase (GPx), glutathione reduced (GSH), and glutathione oxidized (GSSG) were assessed as biomarkers oxidative stress in the hippocampus.

RESULTS

The results demonstrated that both the short and long-term memories were impaired by PTSD/SPS model (P <  0.05), while L-CAR treatment prevented this memory impairment in PTSD rats. Besides, L-CAR prevented the reduction in GPx activity and increase in GSSG, which were altered in the hippocampus of the PTSD/SPS rats (P <  0.05). Levels of GSH were not changed in PTSD and/or L-CAR rats.

CONCLUSIONS

L-CAR administration prevented short- and long-term memories' impairments induced in the PTSD/SPS rat model. This is probably related to its antioxidant effects in the hippocampus.