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Zaretsky TG, Jagodnik KM, Barsic R, Antonio JH, Bonanno PA, MacLeod C, Pierce C, Carney H, Morrison MT, Saylor C, Danias G, Lepow L, Yehuda R. The Psychedelic Future of Post-Traumatic Stress Disorder Treatment. Curr Neuropharmacol 2024; 22:636-735. [PMID: 38284341 PMCID: PMC10845102 DOI: 10.2174/1570159x22666231027111147] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 09/11/2023] [Accepted: 09/13/2023] [Indexed: 01/30/2024] Open
Abstract
Post-traumatic stress disorder (PTSD) is a mental health condition that can occur following exposure to a traumatic experience. An estimated 12 million U.S. adults are presently affected by this disorder. Current treatments include psychological therapies (e.g., exposure-based interventions) and pharmacological treatments (e.g., selective serotonin reuptake inhibitors (SSRIs)). However, a significant proportion of patients receiving standard-of-care therapies for PTSD remain symptomatic, and new approaches for this and other trauma-related mental health conditions are greatly needed. Psychedelic compounds that alter cognition, perception, and mood are currently being examined for their efficacy in treating PTSD despite their current status as Drug Enforcement Administration (DEA)- scheduled substances. Initial clinical trials have demonstrated the potential value of psychedelicassisted therapy to treat PTSD and other psychiatric disorders. In this comprehensive review, we summarize the state of the science of PTSD clinical care, including current treatments and their shortcomings. We review clinical studies of psychedelic interventions to treat PTSD, trauma-related disorders, and common comorbidities. The classic psychedelics psilocybin, lysergic acid diethylamide (LSD), and N,N-dimethyltryptamine (DMT) and DMT-containing ayahuasca, as well as the entactogen 3,4-methylenedioxymethamphetamine (MDMA) and the dissociative anesthetic ketamine, are reviewed. For each drug, we present the history of use, psychological and somatic effects, pharmacology, and safety profile. The rationale and proposed mechanisms for use in treating PTSD and traumarelated disorders are discussed. This review concludes with an in-depth consideration of future directions for the psychiatric applications of psychedelics to maximize therapeutic benefit and minimize risk in individuals and communities impacted by trauma-related conditions.
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Affiliation(s)
- Tamar Glatman Zaretsky
- James J. Peters Veterans Affairs Medical Center, New York, NY, USA
- The Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kathleen M. Jagodnik
- The Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Robert Barsic
- James J. Peters Veterans Affairs Medical Center, New York, NY, USA
- The Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Josimar Hernandez Antonio
- The Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Philip A. Bonanno
- The Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Carolyn MacLeod
- The Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Charlotte Pierce
- The Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Hunter Carney
- The Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Morgan T. Morrison
- James J. Peters Veterans Affairs Medical Center, New York, NY, USA
- The Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Charles Saylor
- The Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - George Danias
- The Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lauren Lepow
- The Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rachel Yehuda
- James J. Peters Veterans Affairs Medical Center, New York, NY, USA
- The Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Yang J, Jiang W. A meta-analysis of the association between post-traumatic stress disorder and cancer risk. Front Psychiatry 2023; 14:1281606. [PMID: 37965365 PMCID: PMC10642749 DOI: 10.3389/fpsyt.2023.1281606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/16/2023] [Indexed: 11/16/2023] Open
Abstract
Background Several studies have investigated the link between post-traumatic stress disorder (PTSD) and cancer risk but reported mixed results. The objective of our study was to investigate the association between PTSD and cancer risk. Methods Studies published in English about the relationship between PTSD and cancer incidence were systematically searched. We performed a meta-analysis to estimate the relative risks (RR) and 95% confidence intervals (CI) for cancer incidence. Result A total of 3,129 articles were screened. Finally, 8 articles and 11 studies were included in the meta-analysis. We found that PTSD was not associated with cancer risk compared with controls. For site-specific cancer, our results showed that women with PTSD were associated with higher risk of ovarian cancer than controls. However, PTSD was not associated with the risk of gastrointestinal cancer, breast cancer and lung cancer. Conclusion These analyzes based on studies published in English suggest that PTSD is associated with ovarian cancer risk, although the evidence base is very limited. Future studies are needed to investigate the mechanisms that PTSD diagnosis influenced cancer incidence depending on types of cancer.
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Affiliation(s)
- Juanjuan Yang
- Department of Health Management, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Wei Jiang
- Department of Oncology, The Second Affiliated Hospital of Xi’ an Jiaotong University, Xi’an, Shaanxi, China
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Moshfegh CM, Elkhatib SK, Watson GF, Drake J, Taylor ZN, Reed EC, Lauten TH, Clopp AJ, Vladimirov VI, Case AJ. S100a9 Protects Against the Effects of Repeated Social Defeat Stress. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2023; 3:919-929. [PMID: 37881565 PMCID: PMC10593888 DOI: 10.1016/j.bpsgos.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 11/07/2022] [Accepted: 12/01/2022] [Indexed: 12/15/2022] Open
Abstract
Background Posttraumatic stress disorder, a consequence of psychological trauma, is associated with increased inflammation and an elevated risk of developing comorbid inflammatory diseases. However, the mechanistic link between this mental health disorder and inflammation remains elusive. We previously found that S100a8 and S100a9 messenger RNA, genes that encode the protein calprotectin, were significantly upregulated in T lymphocytes and positively correlated with inflammatory gene expression and the mitochondrial redox environment in these cells. Therefore, we hypothesized that genetic deletion of calprotectin would attenuate the inflammatory and redox phenotype displayed after psychological trauma. Methods We used a preclinical mouse model of posttraumatic stress disorder known as repeated social defeat stress (RSDS) combined with pharmacological and genetic manipulation of S100a9 (which functionally eliminates calprotectin). A total of 186 animals (93 control, 93 RSDS) were used in these studies. Results Unexpectedly, we observed worsening of behavioral pathology, inflammation, and the mitochondrial redox environment in mice after RSDS compared with wild-type animals. Furthermore, loss of calprotectin significantly enhanced the metabolic demand on T lymphocytes, suggesting that this protein may play an undescribed role in mitochondrial regulation. This was further supported by single-cell RNA sequencing analysis demonstrating that RSDS and loss of S100a9 primarily altered genes associated with mitochondrial function and oxidative phosphorylation. Conclusions These data demonstrate that the loss of calprotectin potentiates the RSDS-induced phenotype, which suggests that its observed upregulation after psychological trauma may provide previously unexplored protective functions.
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Affiliation(s)
- Cassandra M. Moshfegh
- Department of Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Safwan K. Elkhatib
- Department of Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Gabrielle F. Watson
- Department of Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha, Nebraska
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - John Drake
- Department of Psychiatry and Behavioral Sciences, Texas A&M University, Bryan, Texas
| | - Zachary N. Taylor
- Department of Psychiatry and Behavioral Sciences, Texas A&M University, Bryan, Texas
| | - Emily C. Reed
- Department of Psychiatry and Behavioral Sciences, Texas A&M University, Bryan, Texas
- Department of Medical Physiology, Texas A&M University, Bryan, Texas
| | - Tatlock H. Lauten
- Department of Psychiatry and Behavioral Sciences, Texas A&M University, Bryan, Texas
- Department of Medical Physiology, Texas A&M University, Bryan, Texas
| | - Amelia J. Clopp
- Department of Psychiatry and Behavioral Sciences, Texas A&M University, Bryan, Texas
- Department of Medical Physiology, Texas A&M University, Bryan, Texas
| | - Vladimir I. Vladimirov
- Department of Psychiatry and Behavioral Sciences, Texas A&M University, Bryan, Texas
- Department of Psychiatry, University of Arizona, Phoenix, Arizona
- Lieber Institute for Brain Development, Johns Hopkins University, Baltimore, Maryland
| | - Adam J. Case
- Department of Psychiatry and Behavioral Sciences, Texas A&M University, Bryan, Texas
- Department of Medical Physiology, Texas A&M University, Bryan, Texas
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Makale MT, Abbasi S, Nybo C, Keifer J, Christman L, Fairchild JK, Yesavage J, Blum K, Gold MS, Baron D, Cadet JL, Elman I, Dennen CA, Murphy KT. Personalized repetitive transcranial magnetic stimulation (prtms®) for post-traumatic stress disorder (ptsd) in military combat veterans. Heliyon 2023; 9:e18943. [PMID: 37609394 PMCID: PMC10440537 DOI: 10.1016/j.heliyon.2023.e18943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 07/31/2023] [Accepted: 08/03/2023] [Indexed: 08/24/2023] Open
Abstract
Emerging data suggest that post-traumatic stress disorder (PTSD) arises from disrupted brain default mode network (DMN) activity manifested by dysregulated encephalogram (EEG) alpha oscillations. Hence, we pursued the treatment of combat veterans with PTSD (n = 185) using an expanded form of repetitive transcranial magnetic stimulation (rTMS) termed personalized-rTMS (PrTMS). In this treatment methodology spectral EEG based guidance is used to iteratively optimize symptom resolution via (1) stimulation of multiple motor sensory and frontal cortical sites at reduced power, and (2) adjustments of cortical treatment loci and stimulus frequency during treatment progression based on a proprietary frequency algorithm (PeakLogic, Inc. San Diego) identifying stimulation frequency in the DMN elements of the alpha oscillatory band. Following 4 - 6 weeks of PrTMS® therapy in addition to routine PTSD therapy, veterans exhibited significant clinical improvement accompanied by increased cortical alpha center frequency and alpha oscillatory synchronization. Full resolution of PTSD symptoms was attained in over 50% of patients. These data support DMN involvement in PTSD pathophysiology and suggest a role in therapeutic outcomes. Prospective, sham controlled PrTMS® trials may be warranted to validate our clinical findings and to examine the contribution of DMN targeting for novel preventive, diagnostic, and therapeutic strategies tailored to the unique needs of individual patients with both combat and non-combat PTSD.
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Affiliation(s)
- Milan T. Makale
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, 92093, USA
| | - Shaghayegh Abbasi
- Department of Electrical Engineering, University of Portland, Portland, OR, 97203, USA
| | - Chad Nybo
- CrossTx Inc., Bozeman, MT, 59715, USA
| | | | | | - J. Kaci Fairchild
- Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA
- Sierra Pacific Mental Illness Research, Education, and Clinical Center, VA Medical Center, Palo Alto, CA, 94304, USA
| | - Jerome Yesavage
- Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA
| | - Kenneth Blum
- Division of Addiction Research & Education, Center for Sports, Exercise & Global Mental Health, Western University Health Sciences, Pomona, USA
- Department of Clinical Psychology and Addiction, Institute of Psychology, Faculty of Education and Psychology, Eötvös Loránd University, Hungary
- Department of Psychiatry, Wright University, Boonshoft School of Medicine, Dayton, OH, USA
- Department of Molecular Biology and Adelson School of Medicine, Ariel University, Ariel, Israel
| | - Mark S. Gold
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - David Baron
- Division of Addiction Research & Education, Center for Sports, Exercise & Global Mental Health, Western University Health Sciences, Pomona, USA
| | - Jean Lud Cadet
- Molecular Neuropsychiatry Research Branch, National Institute on Drug Abuse, Intramural Research Program, National Institutes of Health, Baltimore, MD, USA
| | - Igor Elman
- Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA
| | - Catherine A. Dennen
- Department of Family Medicine, Jefferson Health Northeast, Philadelphia, PA, USA
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Rajkumar RP. Biomarkers of Neurodegeneration in Post-Traumatic Stress Disorder: An Integrative Review. Biomedicines 2023; 11:biomedicines11051465. [PMID: 37239136 DOI: 10.3390/biomedicines11051465] [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: 04/10/2023] [Revised: 05/11/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023] Open
Abstract
Post-Traumatic Stress Disorder (PTSD) is a chronic psychiatric disorder that occurs following exposure to traumatic events. Recent evidence suggests that PTSD may be a risk factor for the development of subsequent neurodegenerative disorders, including Alzheimer's dementia and Parkinson's disease. Identification of biomarkers known to be associated with neurodegeneration in patients with PTSD would shed light on the pathophysiological mechanisms linking these disorders and would also help in the development of preventive strategies for neurodegenerative disorders in PTSD. With this background, the PubMed and Scopus databases were searched for studies designed to identify biomarkers that could be associated with an increased risk of neurodegenerative disorders in patients with PTSD. Out of a total of 342 citations retrieved, 29 studies were identified for inclusion in the review. The results of these studies suggest that biomarkers such as cerebral cortical thinning, disrupted white matter integrity, specific genetic polymorphisms, immune-inflammatory alterations, vitamin D deficiency, metabolic syndrome, and objectively documented parasomnias are significantly associated with PTSD and may predict an increased risk of subsequent neurodegenerative disorders. The biological mechanisms underlying these changes, and the interactions between them, are also explored. Though requiring replication, these findings highlight a number of biological pathways that plausibly link PTSD with neurodegenerative disorders and suggest potentially valuable avenues for prevention and early intervention.
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Affiliation(s)
- Ravi Philip Rajkumar
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry 605006, India
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Eades ND, Kauffman BY, Bakhshaie J, Cardoso JB, Zvolensky MJ. Eating expectancies among trauma-exposed Latinx college students: The role of mindful attention. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023; 71:790-797. [PMID: 33830868 PMCID: PMC8809199 DOI: 10.1080/07448481.2021.1908304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 06/23/2020] [Accepted: 03/21/2021] [Indexed: 05/05/2023]
Abstract
Objective: Emergent research suggests that trauma-exposed Latinx college students are a particularly at-risk group for eating-related problems. For this reason, there is a need to further understand the cognitive processes that may underpin maladaptive eating among this vulnerable segment of the population. Participants: Participants included 304 trauma exposed Latinx college students (84.5% females; Mage = 22.8 years, SD = 5.79). Methods: The current study examined the role of mindful attention in relation to several distinct expectancies related to eating. Results: Results indicated that lower reported levels of mindful attention were associated with greater levels of expectancies of eating to help manage negative affect, expectancies that eating will alleviate boredom, and expectancies that eating will lead to feeling out of control. Conclusions: These findings suggest that it may be beneficial to assess for mindful attention among Latinx college students with a history of trauma exposure presenting with problematic eating behaviors.
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Affiliation(s)
- Natasha D. Eades
- Department of Psychology, University of Houston, Houston, United States
| | | | - Jafar Bakhshaie
- Menninger Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, United States
| | - Jodi Berger Cardoso
- Graduate College of Social Work, University of Houston, Houston, United States
- Health Institute, University of Houston, Houston, Texas, United States
| | - Michael J. Zvolensky
- Department of Psychology, University of Houston, Houston, United States
- Department of Behavioral Sciences, University of Texas MD Anderson Cancer Center, Houston, Texas, United States
- Health Institute, University of Houston, Houston, Texas, United States
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Tudor L, Nedic Erjavec G, Nikolac Perkovic M, Konjevod M, Uzun S, Kozumplik O, Mimica N, Lauc G, Svob Strac D, Pivac N. The Association of the Polymorphisms in the FUT8-Related Locus with the Plasma Glycosylation in Post-Traumatic Stress Disorder. Int J Mol Sci 2023; 24:ijms24065706. [PMID: 36982780 PMCID: PMC10056189 DOI: 10.3390/ijms24065706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/04/2023] [Accepted: 03/11/2023] [Indexed: 03/19/2023] Open
Abstract
The molecular underpinnings of post-traumatic stress disorder (PTSD) are still unclear due to the complex interactions of genetic, psychological, and environmental factors. Glycosylation is a common post-translational modification of proteins, and different pathophysiological states, such as inflammation, autoimmune diseases, and mental disorders including PTSD, show altered N-glycome. Fucosyltransferase 8 (FUT8) is the enzyme that catalyzes the addition of core fucose on glycoproteins, and mutations in the FUT8 gene are associated with defects in glycosylation and functional abnormalities. This is the first study that investigated the associations of plasma N-glycan levels with FUT8-related rs6573604, rs11621121, rs10483776, and rs4073416 polymorphisms and their haplotypes in 541 PTSD patients and control participants. The results demonstrated that the rs6573604 T allele was more frequent in the PTSD than in the control participants. Significant associations of plasma N-glycan levels with PTSD and FUT8-related polymorphisms were observed. We also detected associations of rs11621121 and rs10483776 polymorphisms and their haplotypes with plasma levels of specific N-glycan species in both the control and PTSD groups. In carriers of different rs6573604 and rs4073416 genotypes and alleles, differences in plasma N-glycan levels were only found in the control group. These molecular findings suggest a possible regulatory role of FUT8-related polymorphisms in glycosylation, the alternations of which could partially explain the development and clinical manifestation of PTSD.
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Affiliation(s)
- Lucija Tudor
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Rudjer Boskovic Institute, 10000 Zagreb, Croatia; (L.T.); (G.N.E.); (M.N.P.); (M.K.)
| | - Gordana Nedic Erjavec
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Rudjer Boskovic Institute, 10000 Zagreb, Croatia; (L.T.); (G.N.E.); (M.N.P.); (M.K.)
| | - Matea Nikolac Perkovic
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Rudjer Boskovic Institute, 10000 Zagreb, Croatia; (L.T.); (G.N.E.); (M.N.P.); (M.K.)
| | - Marcela Konjevod
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Rudjer Boskovic Institute, 10000 Zagreb, Croatia; (L.T.); (G.N.E.); (M.N.P.); (M.K.)
| | - Suzana Uzun
- Department for Biological Psychiatry and Psychogeriatrics, University Hospital Vrapce, 10000 Zagreb, Croatia; (S.U.); (O.K.); (N.M.)
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Faculty of Education and Rehabilitation Sciences, University of Zagreb, 10000 Zagreb, Croatia
| | - Oliver Kozumplik
- Department for Biological Psychiatry and Psychogeriatrics, University Hospital Vrapce, 10000 Zagreb, Croatia; (S.U.); (O.K.); (N.M.)
- Faculty of Education and Rehabilitation Sciences, University of Zagreb, 10000 Zagreb, Croatia
| | - Ninoslav Mimica
- Department for Biological Psychiatry and Psychogeriatrics, University Hospital Vrapce, 10000 Zagreb, Croatia; (S.U.); (O.K.); (N.M.)
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Gordan Lauc
- Glycobiology Laboratory, Genos Ltd., 10000 Zagreb, Croatia;
| | - Dubravka Svob Strac
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Rudjer Boskovic Institute, 10000 Zagreb, Croatia; (L.T.); (G.N.E.); (M.N.P.); (M.K.)
- Correspondence: (D.S.S.); (N.P.)
| | - Nela Pivac
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Rudjer Boskovic Institute, 10000 Zagreb, Croatia; (L.T.); (G.N.E.); (M.N.P.); (M.K.)
- University of Applied Sciences Hrvatsko Zagorje Krapina, 49000 Krapina, Croatia
- Correspondence: (D.S.S.); (N.P.)
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Pivac N, Vuic B, Sagud M, Nedic Erjavec G, Nikolac Perkovic M, Konjevod M, Tudor L, Svob Strac D, Uzun S, Kozumplik O, Uzun S, Mimica N. PTSD, Immune System, and Inflammation. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1411:225-262. [PMID: 36949313 DOI: 10.1007/978-981-19-7376-5_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
Posttraumatic stress disorder (PTSD) is a severe trauma and stress-related disorder associated with different somatic comorbidities, especially cardiovascular and metabolic disorders, and with chronic low-grade inflammation. Altered balance of the hypothalamic-pituitary-adrenal (HPA) axis, cytokines and chemokines, C-reactive protein, oxidative stress markers, kynurenine pathways, and gut microbiota might be involved in the alterations of certain brain regions regulating fear conditioning and memory processes, that are all altered in PTSD. In addition to the HPA axis, the gut microbiota maintains the balance and interaction of the immune, CNS, and endocrine pathways forming the gut-brain axis. Disbalance in the HPA axis, gut-brain axis, oxidative stress pathways and kynurenine pathways, altered immune signaling and disrupted homeostasis, as well as the association of the PTSD with the inflammation and disrupted cognition support the search for novel strategies for treatment of PTSD. Besides potential anti-inflammatory treatment, dietary interventions or the use of beneficial bacteria, such as probiotics, can potentially improve the composition and the function of the bacterial community in the gut. Therefore, bacterial supplements and controlled dietary changes, with exercise, might have beneficial effects on the psychological and cognitive functions in patients with PTSD. These new treatments should be aimed to attenuate inflammatory processes and consequently to reduce PTSD symptoms but also to improve cognition and reduce cardio-metabolic disorders associated so frequently with PTSD.
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Affiliation(s)
- Nela Pivac
- Division of Molecular Medicine, Laboratory for Molecular Neuropsychiatry, Rudjer Boskovic Institute, Zagreb, Croatia.
| | - Barbara Vuic
- Division of Molecular Medicine, Laboratory for Molecular Neuropsychiatry, Rudjer Boskovic Institute, Zagreb, Croatia
| | - Marina Sagud
- Department of Psychiatry, University Hospital Center Zagreb, Zagreb, Croatia
- University of Zagreb School of Medicine, Zagreb, Croatia
| | - Gordana Nedic Erjavec
- Division of Molecular Medicine, Laboratory for Molecular Neuropsychiatry, Rudjer Boskovic Institute, Zagreb, Croatia
| | - Matea Nikolac Perkovic
- Division of Molecular Medicine, Laboratory for Molecular Neuropsychiatry, Rudjer Boskovic Institute, Zagreb, Croatia
| | - Marcela Konjevod
- Division of Molecular Medicine, Laboratory for Molecular Neuropsychiatry, Rudjer Boskovic Institute, Zagreb, Croatia
| | - Lucija Tudor
- Division of Molecular Medicine, Laboratory for Molecular Neuropsychiatry, Rudjer Boskovic Institute, Zagreb, Croatia
| | - Dubravka Svob Strac
- Division of Molecular Medicine, Laboratory for Molecular Neuropsychiatry, Rudjer Boskovic Institute, Zagreb, Croatia
| | - Suzana Uzun
- University of Zagreb School of Medicine, Zagreb, Croatia
- University Psychiatric Hospital Vrapce, Zagreb, Croatia
| | | | - Sandra Uzun
- Department for Anesthesiology, Reanimatology, and Intensive Care, University Hospital Center Zagreb, Zagreb, Croatia
| | - Ninoslav Mimica
- University of Zagreb School of Medicine, Zagreb, Croatia
- University Psychiatric Hospital Vrapce, Zagreb, Croatia
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9
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Konjevod M, Sáiz J, Nikolac Perkovic M, Nedic Erjavec G, Tudor L, Uzun S, Kozumplik O, Barbas C, Zarkovic N, Pivac N, Strac DS. Plasma lipidomics in subjects with combat posttraumatic stress disorder. Free Radic Biol Med 2022; 189:169-177. [PMID: 35918015 DOI: 10.1016/j.freeradbiomed.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/18/2022] [Indexed: 11/18/2022]
Abstract
Posttraumatic stress disorder (PTSD) is complex neuropsychiatric disorder triggered by a traumatic event and characterized by the symptoms that represent large burden to patients, as well as to society. Lipidomic approach can be applied as a useful tool for discovery of novel diagnostic, prognostic and therapeutic lipid biomarkers of various disorders, whose etiology is complex and still unknown, including PTSD. Since changes in the levels of lipid metabolites might indicate impairments in various metabolic pathways and cellular processes, the aim of this lipidomic study was to determine altered levels of lipid compounds in PTSD. The study enrolled 235 male patients with combat PTSD and 241 healthy male control subjects. Targeted lipidomic analysis of plasma samples was conducted using reverse-phase liquid chromatography coupled with mass spectrometry. Lipids that have been analyzed belong to the group of ceramides, cholesterol esters, diacylglycerols, lysophosphatidylcholines, lysophosphatidylethanolamines, phosphatidylcholines, phosphatidylethanolamines, sphingomyelins and triglycerides. The levels of fifteen lipid compounds were found to be significantly different between PTSD patients and healthy control subjects, including four phosphatidylcholines, two phosphatidylethanolamines, five sphingomyelins, two cholesterol esters and two ceramides. The lipid metabolites whose levels significantly differed between patients with PTSD and control subjects are associated with various biological processes, including impairments of membrane integrity and function, mitochondrial dysfunction, inflammation and oxidative stress. As these processes might be associated with development and progression of PTSD, altered lipid compounds represent potential biomarkers that could facilitate the diagnosis of PTSD, prediction of the disease, as well as identification of novel treatment approaches in PTSD.
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Affiliation(s)
- Marcela Konjevod
- Ruder Boskovic Institute, Division of Molecular Medicine, Bijenicka Cesta 54, 10000, Zagreb, Croatia; Centro de Metabolómica y Bioanálisis (CEMBIO), Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Urbanizacion Monteprincipe, 28660, Boadilla del Monte, Spain
| | - Jorge Sáiz
- Centro de Metabolómica y Bioanálisis (CEMBIO), Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Urbanizacion Monteprincipe, 28660, Boadilla del Monte, Spain.
| | - Matea Nikolac Perkovic
- Ruder Boskovic Institute, Division of Molecular Medicine, Bijenicka Cesta 54, 10000, Zagreb, Croatia
| | - Gordana Nedic Erjavec
- Ruder Boskovic Institute, Division of Molecular Medicine, Bijenicka Cesta 54, 10000, Zagreb, Croatia
| | - Lucija Tudor
- Ruder Boskovic Institute, Division of Molecular Medicine, Bijenicka Cesta 54, 10000, Zagreb, Croatia
| | - Suzana Uzun
- Department for Biological Psychiatry and Psychogeriatrics, University Psychiatric Hospital Vrapce, Bolnicka Cesta 32, 10000, Zagreb, Croatia; School of Medicine, University of Zagreb, Salata 2, 10 000, Zagreb, Croatia; Faculty of Education and Rehabilitation Studies, University of Zagreb, University Campus Borongaj, Borongajska Cesta 83f, 10000, Zagreb, Croatia
| | - Oliver Kozumplik
- Department for Biological Psychiatry and Psychogeriatrics, University Psychiatric Hospital Vrapce, Bolnicka Cesta 32, 10000, Zagreb, Croatia; Faculty of Education and Rehabilitation Studies, University of Zagreb, University Campus Borongaj, Borongajska Cesta 83f, 10000, Zagreb, Croatia
| | - Coral Barbas
- Centro de Metabolómica y Bioanálisis (CEMBIO), Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Urbanizacion Monteprincipe, 28660, Boadilla del Monte, Spain
| | - Neven Zarkovic
- Ruder Boskovic Institute, Division of Molecular Medicine, Bijenicka Cesta 54, 10000, Zagreb, Croatia
| | - Nela Pivac
- Ruder Boskovic Institute, Division of Molecular Medicine, Bijenicka Cesta 54, 10000, Zagreb, Croatia.
| | - Dubravka Svob Strac
- Ruder Boskovic Institute, Division of Molecular Medicine, Bijenicka Cesta 54, 10000, Zagreb, Croatia.
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10
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Vučić Peitl M, Palaić D, Habibović F, Šešo B. THE INCIDENCE OF COMORBID MENTAL AND PHYSICAL CONDITIONS IN PATIENTS WITH POST-TRAUMATIC STRESS DISORDER. Acta Clin Croat 2022; 61:295-302. [PMID: 36818934 PMCID: PMC9934051 DOI: 10.20471/acc.2022.61.02.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/22/2021] [Indexed: 02/10/2023] Open
Abstract
There is a small body of research about mental and physical comorbidity in post-traumatic stress disorder (PTSD) patients despite the fact that some psychiatric disorders and physical conditions are commonly comorbid with PTSD. In this study, we researched the relationship between PTSD and its mental and physical comorbidities by comparing the number of patient hospitalizations across two ten-year periods. Our sample consisted of 2761 patients with warfare PTSD hospitalized during the 20-year period (1999-2018). The results confirmed a higher number of hospitalizations in the 2009-2018 period than in the 1999-2008 period for the group of PTSD patients with both mental and physical comorbidity. Furthermore, no significant difference was found in the number of hospitalizations between the two ten-year periods for the group of PTSD patients with mental comorbidity. We argued that both mental and physical comorbidities along with PTSD are needed to induce a significantly higher level of distress in patients, resulting in a higher number of hospitalizations after a longer period of time. Patients with the most severe conditions and comorbidity have a greater need to seek help from mental health professionals as their mental and physical state deteriorates to a higher degree when not in the treatment of any kind.
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Affiliation(s)
- Marija Vučić Peitl
- Department of Psychiatry, Rijeka University Hospital Center, Rijeka, Croatia;,Department of Psychiatry and Psychological Medicine, School of Medicine, University of Rijeka, Rijeka, Croatia
| | - Diana Palaić
- Department of Psychiatry, Rijeka University Hospital Center, Rijeka, Croatia
| | - Fadil Habibović
- Department of Psychiatry, Rijeka University Hospital Center, Rijeka, Croatia
| | - Bernard Šešo
- Society for Research and Support, Rijeka, Croatia
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11
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Genetic and Epigenetic Association of Hepatocyte Nuclear Factor-1α with Glycosylation in Post-Traumatic Stress Disorder. Genes (Basel) 2022; 13:genes13061063. [PMID: 35741825 PMCID: PMC9223288 DOI: 10.3390/genes13061063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/05/2022] [Accepted: 06/13/2022] [Indexed: 01/25/2023] Open
Abstract
Post-traumatic stress disorder (PTSD) is a complex trauma-related disorder, the etiology and underlying molecular mechanisms of which are still unclear and probably involve different (epi)genetic and environmental factors. Protein N-glycosylation is a common post-translational modification that has been associated with several pathophysiological states, including inflammation and PTSD. Hepatocyte nuclear factor-1α (HNF1A) is a transcriptional regulator of many genes involved in the inflammatory processes, and it has been identified as master regulator of plasma protein glycosylation. The aim of this study was to determine the association between N-glycan levels in plasma and immunoglobulin G, methylation at four CpG positions in the HNF1A gene, HNF1A antisense RNA 1 (HNF1A-AS1), rs7953249 and HNF1A rs735396 polymorphisms in a total of 555 PTSD and control subjects. We found significant association of rs7953249 and rs735396 polymorphisms, as well as HNF1A gene methylation at the CpG3 site, with highly branched, galactosylated and sialyated plasma N-glycans, mostly in patients with PTSD. HNF1A-AS1 rs7953249 polymorphism was also associated with PTSD; however, none of the polymorphisms were associated with HNF1A gene methylation. These results indicate a possible regulatory role of the investigated HNF1A polymorphisms with respect to the abundance of complex plasma N-glycans previously associated with proinflammatory response, which could contribute to the clinical manifestation of PTSD and its comorbidities.
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12
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Mengin AC, Rolling JM, Palacio C, Mastelli D, Berna F, Schroder CM, Vidailhet P. Hiding from danger, not from fear: Lockdown as a risk factor of probable PTSD among civilians after Strasbourg Christmas market terror attack. J Psychiatr Res 2021; 144:262-268. [PMID: 34710662 DOI: 10.1016/j.jpsychires.2021.10.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 09/25/2021] [Accepted: 10/19/2021] [Indexed: 11/19/2022]
Abstract
On December 11, 2018, five people were killed and 11 injured during a terrorist attack on Strasbourg's Christmas market. As the attacker was on the run during the night, part of the population was locked down for several hours. Our study aimed at assessing factors associated with the development of PTSD and health services use among the victims. Four hundred and twelve victims were followed up from 6 to 11 months after the attacks through phone calls by psychologists. The presence of probable PTSD was assessed with the Trauma Screening Questionnaire. In addition, we evaluated the type and level of exposure, and health services use after the attacks. Two hundred and twelve participants completed the phone interview. The prevalence of probable PTSD was 26.4%. Being locked down during the attack and the level of exposure were associated with probable PTSD (OR = 2.32 [1.17-4.59], p = 0.016 and OR = 1.49 [1.10-2.03], p = 0.010 respectively). Lockdown was especially associated with symptoms suggesting adrenergic hyperactivation (startle at surprise, dreams about the event). General and mental health services use was frequent among our sample (83% consulted either their GP or a mental health professional), but people living alone tend to use these health services more infrequently than these living with others. Though necessary, measures taken to protect victims, such as lockdown, may foster PTSD. Victims of terror attacks having been subjected to lockdown may have experienced powerlessness, fostering prolonged stress and fear. These victims may benefit from mental health support over the following months.
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Affiliation(s)
- Amaury C Mengin
- Hôpitaux Universitaires de Strasbourg, Pôle de Psychiatrie, Santé Mentale et Addictologie, Strasbourg, 1 Place de L'Hôpital, 67091, Strasbourg, France; Centre Régional Du Psychotraumatisme Grand Est, Strasbourg, France; INSERM U1114 Neuropsychologie Cognitive et Physiopathologie de La Schizophrénie, Strasbourg, France.
| | - Julie M Rolling
- Centre Régional Du Psychotraumatisme Grand Est, Strasbourg, France; Department of Child and Adolescent Psychiatry, Strasbourg University Hospitals, Strasbourg, France; CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, Strasbourg, France
| | - Cédric Palacio
- Hôpitaux Universitaires de Strasbourg, Pôle de Psychiatrie, Santé Mentale et Addictologie, Strasbourg, 1 Place de L'Hôpital, 67091, Strasbourg, France; Centre Régional Du Psychotraumatisme Grand Est, Strasbourg, France; Cellule D'Urgence Médico-Psychologique 67, Strasbourg, France
| | - Dominique Mastelli
- Hôpitaux Universitaires de Strasbourg, Pôle de Psychiatrie, Santé Mentale et Addictologie, Strasbourg, 1 Place de L'Hôpital, 67091, Strasbourg, France; Centre Régional Du Psychotraumatisme Grand Est, Strasbourg, France; Cellule D'Urgence Médico-Psychologique 67, Strasbourg, France
| | - Fabrice Berna
- Hôpitaux Universitaires de Strasbourg, Pôle de Psychiatrie, Santé Mentale et Addictologie, Strasbourg, 1 Place de L'Hôpital, 67091, Strasbourg, France; INSERM U1114 Neuropsychologie Cognitive et Physiopathologie de La Schizophrénie, Strasbourg, France; Strasbourg University, Faculty of Medicine, Strasbourg, France; Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - Carmen M Schroder
- Department of Child and Adolescent Psychiatry, Strasbourg University Hospitals, Strasbourg, France; CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, Strasbourg, France; Strasbourg University, Faculty of Medicine, Strasbourg, France; Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - Pierre Vidailhet
- Hôpitaux Universitaires de Strasbourg, Pôle de Psychiatrie, Santé Mentale et Addictologie, Strasbourg, 1 Place de L'Hôpital, 67091, Strasbourg, France; Centre Régional Du Psychotraumatisme Grand Est, Strasbourg, France; INSERM U1114 Neuropsychologie Cognitive et Physiopathologie de La Schizophrénie, Strasbourg, France; Cellule D'Urgence Médico-Psychologique 67, Strasbourg, France; Strasbourg University, Faculty of Medicine, Strasbourg, France; Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
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13
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Perković MN, Milković L, Uzun S, Mimica N, Pivac N, Waeg G, Žarković N. Association of Lipid Peroxidation Product 4-Hydroxynonenal with Post-Traumatic Stress Disorder. Biomolecules 2021; 11:1365. [PMID: 34572578 PMCID: PMC8469760 DOI: 10.3390/biom11091365] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/03/2021] [Accepted: 09/11/2021] [Indexed: 12/23/2022] Open
Abstract
Repeated activation of the hypothalamic-pituitary-adrenal axis system, sleep disturbances, and other symptoms related to posttraumatic stress disorder (PTSD) elevate reactive oxygen species, increase inflammation, and accelerate cellular aging, leading to neuroprogression and cognitive decline. However, there is no information about possible involvement of 4-hydroxynonenal (4-HNE), the product of lipid peroxidation associated with stress-associated diseases, in the complex etiology of PTSD. Therefore, the aim of this study was to compare the plasma levels of 4-HNE between war veterans with PTSD (n = 62) and age-, sex- and ethnicity- matched healthy control subjects (n = 58) in order to evaluate the potential of HNE-modified proteins as blood-based biomarker of PTSD. The genuine 4-HNE-Enzyme-Linked Immunosorbent Assay (HNE-ELISA), based on monoclonal antibody specific for HNE-histidine (HNE-His) adducts, was used to determine plasma HNE-protein conjugates. Our results revealed significantly elevated levels of 4-HNE in patients with PTSD. Moreover, the accumulation of plasma 4-HNE seems to increase with aging but in a negative correlation with BMI, showing specific pattern of change for individuals diagnosed with PTSD. These findings suggest that oxidative stress and altered lipid metabolism reflected by increase of 4-HNE might be associated with PTSD. If confirmed with further studies, elevated 4-HNE plasma levels might serve as a potential biomarker of PTSD.
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Affiliation(s)
- Matea Nikolac Perković
- Laboratory of Molecular Neuropsychiatry, Division of Molecular Medicine, Rudjer Boskovic Institute, Bijenička 54, 10000 Zagreb, Croatia; (M.N.P.); (N.P.)
| | - Lidija Milković
- Laboratory for Oxidative Stress (LabOS), Division of Molecular Medicine, Rudjer Boskovic Institute, Bijenička 54, 10000 Zagreb, Croatia;
| | - Suzana Uzun
- Department for Biological Psychiatry and Psychogeriatrics, University Psychiatric Hospital Vrapče, 10090 Zagreb, Croatia; (S.U.); (N.M.)
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Ninoslav Mimica
- Department for Biological Psychiatry and Psychogeriatrics, University Psychiatric Hospital Vrapče, 10090 Zagreb, Croatia; (S.U.); (N.M.)
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Nela Pivac
- Laboratory of Molecular Neuropsychiatry, Division of Molecular Medicine, Rudjer Boskovic Institute, Bijenička 54, 10000 Zagreb, Croatia; (M.N.P.); (N.P.)
| | - Georg Waeg
- Institute of Molecular Biosciences, Karl Franzens University of Graz, Heinrichstraße 31/II, 8010 Graz, Austria;
| | - Neven Žarković
- Laboratory for Oxidative Stress (LabOS), Division of Molecular Medicine, Rudjer Boskovic Institute, Bijenička 54, 10000 Zagreb, Croatia;
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14
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Sarajlić Vuković I, Jovanović N, Džubur Kulenović A, Britvić D, Mollica RF. Women health: Psychological and most prominent somatic problems in 3-year follow-up in Bosnian refugees. Int J Soc Psychiatry 2021; 67:770-778. [PMID: 33183154 DOI: 10.1177/0020764020972433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Little is known about gender differences among people exposed to war related trauma. Aim of this study is to explore gender differences in health status and comorbidity of mental and physical disorders in a cohort of Bosnian refugees followed up for 3 years (1996-1999). METHODS This longitudinal study included 534 subjects followed up for 3 years. The interviews were conducted in refugee camps in Varaždin, Croatia in Bosnian language. Data were collected using Harvard Trauma Questionnaire (Bosnian version) and Hopkins Checklist-25, respectively. Physical health disorders were self-reported. RESULTS In both assessments there was a statistically significant difference between men and women in the number of physical health disorders, even when results were controlled for educational status. Although there was no difference in total number of symptoms in both assessments (F = 0.32; df = 1; p > 0.05 and F = 1.15; df = 1; p > 0.05), important physical health disorders were significantly more frequent among women than in men in different educational groups, namely high blood pressure and cardiovascular diseases, arthritis, and anaemia. Asthma, tuberculosis, cirrhosis of the liver, ulcer and epilepsy were more frequent in men than in women. There were no differences in frequencies of psychiatric disorders at baseline, but frequency of psychiatric disorders in women was higher at endpoint for uneducated respondents. There was significant difference compared to men in group of respondents without formal education, but only in comorbidity of PTSD and depression which was more often present in females (22.1%) than in males (3.6%). CONCLUSION Our findings indicate the importance of gender and education on mental and physical health of people exposed to warrelated trauma. Long term health monitoring and programs, especially related to women's health are needed in order to avoid lasting consequences.
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15
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Konjevod M, Nedic Erjavec G, Nikolac Perkovic M, Sáiz J, Tudor L, Uzun S, Kozumplik O, Svob Strac D, Zarkovic N, Pivac N. Metabolomics in posttraumatic stress disorder: Untargeted metabolomic analysis of plasma samples from Croatian war veterans. Free Radic Biol Med 2021; 162:636-641. [PMID: 33249139 DOI: 10.1016/j.freeradbiomed.2020.11.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/19/2020] [Accepted: 11/21/2020] [Indexed: 12/12/2022]
Abstract
Posttraumatic stress disorder (PTSD) is a severe, multifactorial and debilitating neuropsychiatric disorder, which can develop in a subset of individuals as a result of the exposure to severe stress or trauma. Such traumatic experiences have a major impact on molecular, biochemical and cellular systems, causing psychological and somatic alterations that affect the whole organism. Although the etiology of PTSD is still unclear, it seems to involve complex interaction between various biological genetic and environmental factors. Metabolomics, as one of the rapidly developing "omics" techniques, might be a useful tool for determining altered metabolic pathways and stress-related metabolites as new potential biomarkers of PTSD. The aim of our study was to identify metabolites whose altered levels allow us to differentiate between patients with PTSD and healthy control individuals. The study included two cohorts. The first, exploratory, group included 50 Croatian veterans with PTSD and 50 healthy control subjects, whereas a validation group consisted of 52 veterans with PTSD and 52 control subjects. The metabolomic analysis of plasma samples was conducted using liquid chromatography coupled with mass spectrometry (LC-MS), as well as gas chromatography coupled with mass spectrometry (GC-MS). The LC-MS analysis determined significantly different levels of two glycerophospholipids, PE(18:1/0:0) and PC(18:1/0:0), between control subjects and PTSD patients in both cohorts. The altered metabolites might play a role in multiple cellular processes, including inflammation, mitochondrial dysfunction, membrane breakdown, oxidative stress and neurotoxicity, which could be associated with PTSD pathogenesis.
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Affiliation(s)
- Marcela Konjevod
- Rudjer Boskovic Institute, Division of Molecular Medicine, Bijenicka Cesta 54, 10000, Zagreb, Croatia; Centre for Metabolomics and Bioanalysis (CEMBIO), Department of Chemistry and Biochemistry, Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, 28660, Boadilla Del Monte, Madrid, Spain
| | - Gordana Nedic Erjavec
- Rudjer Boskovic Institute, Division of Molecular Medicine, Bijenicka Cesta 54, 10000, Zagreb, Croatia; Centre for Metabolomics and Bioanalysis (CEMBIO), Department of Chemistry and Biochemistry, Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, 28660, Boadilla Del Monte, Madrid, Spain
| | - Matea Nikolac Perkovic
- Rudjer Boskovic Institute, Division of Molecular Medicine, Bijenicka Cesta 54, 10000, Zagreb, Croatia; Centre for Metabolomics and Bioanalysis (CEMBIO), Department of Chemistry and Biochemistry, Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, 28660, Boadilla Del Monte, Madrid, Spain
| | - Jorge Sáiz
- Centre for Metabolomics and Bioanalysis (CEMBIO), Department of Chemistry and Biochemistry, Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, 28660, Boadilla Del Monte, Madrid, Spain
| | - Lucija Tudor
- Rudjer Boskovic Institute, Division of Molecular Medicine, Bijenicka Cesta 54, 10000, Zagreb, Croatia
| | - Suzana Uzun
- Department for Biological Psychiatry and Psychogeriatrics, University Psychiatric Hospital Vrapce, Bolnicka cesta 32, 10000, Zagreb, Croatia; University Josip Juraj Strossmayer Osijek, School of Medicine, Trg Svetog Trojstva 3, 31000, Osijek, Croatia
| | - Oliver Kozumplik
- Department for Biological Psychiatry and Psychogeriatrics, University Psychiatric Hospital Vrapce, Bolnicka cesta 32, 10000, Zagreb, Croatia; University Josip Juraj Strossmayer Osijek, School of Medicine, Trg Svetog Trojstva 3, 31000, Osijek, Croatia
| | - Dubravka Svob Strac
- Rudjer Boskovic Institute, Division of Molecular Medicine, Bijenicka Cesta 54, 10000, Zagreb, Croatia.
| | - Neven Zarkovic
- Rudjer Boskovic Institute, Division of Molecular Medicine, Bijenicka Cesta 54, 10000, Zagreb, Croatia.
| | - Nela Pivac
- Rudjer Boskovic Institute, Division of Molecular Medicine, Bijenicka Cesta 54, 10000, Zagreb, Croatia.
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16
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Korinek K, Young Y, Teerawichitchainan B, Kim Chuc NT, Kovnick M, Zimmer Z. Is war hard on the heart? Gender, wartime stress and late life cardiovascular conditions in a population of Vietnamese older adults. Soc Sci Med 2020; 265:113380. [PMID: 33096339 PMCID: PMC8114945 DOI: 10.1016/j.socscimed.2020.113380] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 08/01/2020] [Accepted: 09/15/2020] [Indexed: 12/19/2022]
Abstract
Populations in the global south are disproportionately exposed to the stressors of development, disaster and armed conflict, all of which heighten cardiovascular disease (CVD) risk. We consider how war-related stressors exert a lasting influence upon population health, in particular the cardiovascular health of war survivors now entering older adulthood. Data come from the 2018 Vietnam Health and Aging Study conducted among 2447 northern Vietnamese adults age 60 and older. We conduct survey-adjusted logistic regression analyses to examine the associations among respondents' wartime exposure to combat and physical threat, malevolent environment conditions, and four CVD conditions (hypertension, dyslipidemia, heart disease, and stroke). We examine posttraumatic stress disorder (PTSD) as it mediates the association between wartime stress exposures and late life CVD, and gender as it moderates the relationship between wartime stressors and CVD. We find that exposure to wartime combat and violence, as well as malevolent living conditions, exhibit significant, positive associations with cardiovascular conditions. These associations are mediated by the severity of recent PTSD symptoms. For certain CVD conditions, particularly hypertension, the associations between wartime stressors and late life cardiovascular conditions diverge across gender with women experiencing a greater penalty for their exposure to war-related stressors than their male counterparts. We conclude that the stressors of war and resultant PTSD, widespread in this cohort of Vietnamese older adults who endured myriad forms of war exposure during their young adulthood, exhibit modest, yet significant associations with late-life cardiovascular conditions. Women, especially those exposed to wartime violence and combat, bear this CVD burden alongside men.
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Affiliation(s)
- Kim Korinek
- Department of Sociology, University of Utah, Salt Lake City, UT, USA.
| | - Yvette Young
- Department of Sociology, University of Utah, Salt Lake City, UT, USA
| | | | | | - Miles Kovnick
- Department of Sociology, University of Utah, Salt Lake City, UT, USA
| | - Zachary Zimmer
- Department of Family Studies and Gerontology, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
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17
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Temperament, Character, and Subjective Well-Being in Croatian War Veterans Suffering From Posttraumatic Stress Disorder. J Nerv Ment Dis 2020; 208:340-343. [PMID: 32221189 DOI: 10.1097/nmd.0000000000001127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Subjective well-being is decreased in war-affected populations. However, no previous research has investigated the role of temperament and character dimensions in life satisfaction among war veterans with posttraumatic stress disorder (PTSD). This study enrolled 148 Croatian male war veterans being treated for combat-related PTSD. The participants completed the Beck Depression Inventory-Second Edition, Satisfaction with Life Scale, and Temperament and Character Inventory-Revised. Two multivariate regression analyses with life satisfaction as a dependent variable and temperament and character dimensions, respectively, as predictor variables, were performed. Temperament dimensions harm avoidance and novelty seeking as well as character dimensions self-directedness and cooperativeness were unique predictors of life satisfaction, while controlling for the influence of depressive symptoms, education level, and employment status. Given the influence of personality dimensions on life satisfaction, the routine assessment of these dimensions might help to establish the individually tailored treatment among war veterans with PTSD.
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18
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Liu M, Xie J, Sun Y. TLR4/MyD88/NF-κB-Mediated Inflammation Contributes to Cardiac Dysfunction in Rats of PTSD. Cell Mol Neurobiol 2020; 40:1029-1035. [PMID: 31939007 DOI: 10.1007/s10571-020-00791-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 01/07/2020] [Indexed: 12/20/2022]
Abstract
Post-traumatic stress disorder (PTSD) is related with myocardial injury and cardiac dysfunction, while the molecular mechanism has not been clear. This study investigated whether TLR4/MyD88/NF-κB-mediated inflammation involved in myocardial injury of PTSD. Adult male Wistar rats were exposed to single-prolonged stress (SPS), which was used broadly as a animal model of PTSD. Morris Water Maze (MWM) test and forced swimming test (FST) was carried out for behavioral testing. The protein expression of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) in the left ventricular of heart and TLR4/MyD88/NF-κB-mediated inflammation were examined. Our results showed that there were obvious increased in the protein expression of ANP and BNP in heart after exposure to SPS, SPS also significantly enhanced the serum level of IL-1β and TNF-α, and meanwhile, the TLR4/MyD88/NF-κB pathway were activated. These results demonstrated that the TLR4/MyD88/NF-κB pathway were involved in the myocardial injury of PTSD, which might be one of possible molecular mechanism contributed to the pathogenesis of cardiac dysfunction in PTSD.
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Affiliation(s)
- Moujie Liu
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, 110001, People's Republic of China
| | - Juhua Xie
- Department of Histology and Embryology, Basic Medical Sciences College, Shenyang Medical College, Shenyang, 110034, People's Republic of China.
| | - Yingxian Sun
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, 110001, People's Republic of China.
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19
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Ge F, Yuan M, Li Y, Zhang W. Posttraumatic Stress Disorder and Alterations in Resting Heart Rate Variability: A Systematic Review and Meta-Analysis. Psychiatry Investig 2020; 17:9-20. [PMID: 31995968 PMCID: PMC6992856 DOI: 10.30773/pi.2019.0112] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 10/14/2019] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE The functions of both the central and peripheral autonomic nervous system, indexed by heart rate variability (HRV), are affected by psychology and physiology. This review summarizes the results of studies comparing the evaluation of HRV parameters between individuals with posttraumatic stress disorder (PTSD) and healthy controls. METHODS Eligible studies (n=499) were identified through literature searches of the EMBASE, Medline, PubMed and Web of Science databases. Nineteen studies met our inclusion criteria. A random effects model was used, and standardized mean differences for highfrequency HRV(HF-HRV), low-frequency HRV(LF-HRV) and the root mean square of successive R-R interval differences (RMSSD) were calculated. RESULTS Significant effects were found for HF-HRV [p<0.0001, Z=4.18; Hedges'g=-1.58, 95% confidence interval (CI) (-2.32, -0.84); k=14] and RMSSD [p<0.00001, Z=4.80; Hedges'g=-1.96, 95% CI (-2.76, -1.16); k=9] relative to healthy controls. Considerable heterogeneity was revealed, but the main effects for HF-HRV and RMSSD were robust in subsequent meta-regression and subgroup analyses. CONCLUSION Given the relationships among low vagal state, inflammation, and alterations in brain structure and function, including executive function and emotion regulation, reduced HRV may be regarded as an endophenotype in PTSD research.
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Affiliation(s)
- Fenfen Ge
- Mental Health Center of West China Hospital, Sichuan University, Chengdu, China
| | - Minlan Yuan
- Mental Health Center of West China Hospital, Sichuan University, Chengdu, China
| | - Ying Li
- Embedded System and Intelligent Computing Laboratory, University of Electronic Science and Technology of China, Chengdu, China
| | - Wei Zhang
- Mental Health Center of West China Hospital, Sichuan University, Chengdu, China
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20
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The Relationship between Military Combat and Cardiovascular Risk: A Systematic Review and Meta-Analysis. Int J Vasc Med 2019; 2019:9849465. [PMID: 31934451 PMCID: PMC6942813 DOI: 10.1155/2019/9849465] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 06/18/2019] [Indexed: 12/31/2022] Open
Abstract
Background and Objectives Cardiovascular disease (CVD) is a leading cause of death among military veterans with several reports suggesting a link between combat and related traumatic injury (TI) to an increased CVD risk. The aim of this paper is to conduct a widespread systematic review and meta-analysis of the relationship between military combat ± TI to CVD and its associated risk factors. Methods PubMed, EmbaseProQuest, Cinahl databases and Cochrane Reviews were examined for all published observational studies (any language) reporting on CVD risk and outcomes, following military combat exposure ± TI versus a comparative nonexposed control population. Two investigators independently extracted data. Data quality was rated and rated using the 20-item AXIS Critical Appraisal Tool. The risk of bias (ROB using the ROBANS 6 item tool) and strength of evidence (SOE) were also critically appraised. Results From 4499 citations, 26 studies (14 cross sectional and 12 cohort; 78–100% male) met the inclusion criteria. The follow up period ranged from 1 to 43.6 years with a sample size ranging from 19 to 621901 participants in the combat group. Combat-related TI was associated with a significantly increased risk for CVD (RR 1.80: 95% CI 1.24–2.62; I2 = 59%, p = 0.002) and coronary heart disease (CHD)-related death (risk ratio 1.57: 95% CI 1.35–1.83; I2 = 0%, p = 0.77: p < 0.0001), although the SOE was low. Military combat (without TI) was linked to a marginal, yet significantly lower pooled risk (low SOE) of cardiovascular death in the active combat versus control population (RR 0.90: CI 0.83–0.98; I2 = 47%, p = 0.02). There was insufficient evidence linking combat ± TI to any other cardiovascular outcomes or risk factors. Conclusion There is low SOE to support a link between combat-related TI and both cardiovascular and CHD-related mortality. There is insufficient evidence to support a positive association between military combat ± any other adverse cardiovascular outcomes or risk factors. Data from well conducted prospective cohort studies following combat are needed.
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N-glycomic Profile in Combat Related Post-Traumatic Stress Disorder. Biomolecules 2019; 9:biom9120834. [PMID: 31817821 PMCID: PMC6995522 DOI: 10.3390/biom9120834] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 12/02/2019] [Accepted: 12/03/2019] [Indexed: 01/17/2023] Open
Abstract
Post-traumatic stress disorder (PTSD) develops in a portion of individuals exposed to extreme trauma. Glycosylation is a post-translational modification that affects protein functions and is altered in various pathophysiological states and aging. There are still no validated biomarkers of PTSD. The aim of this study was to evaluate the N-glycomic profile in 543 male Caucasian individuals (299 veterans with PTSD and 244 control subjects). The study included discovery (N = 233) and replication (N = 310) cohort. Hydrophilic interaction HPLC and ultra-performance liquid chromatography were used to separate and detect 39 plasma and 24 IgG N-glycan species, respectively. All results were corrected for the effects of age and multiple testing. Significant results included only significantly altered N-glycans in cases/controls in both cohorts, in the same direction. Results showed that six plasma N-glycans (four increased and two decreased) were altered in PTSD vs. controls in both cohorts, but IgG N-glycans were similar between groups. The severity of PTSD was not associated with different plasma N-glycans. This is the first study detecting alterations in plasma N-glycans in PTSD. These N-glycans are also associated with other neuropsychiatric disorders and inflammation, suggesting possible shared glycosylation mechanisms.
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Ferretti F, Pozza A, Bossini L, Desantis S, Olivola M, Del Matto L, Gualtieri G, Gusinu R, Bezzini D, Fagiolini A, Coluccia A. Post-traumatic stress disorder in Italy: a comprehensive evaluation of all the ICD comorbidities and gender-related differences. BMC Res Notes 2019; 12:747. [PMID: 31730479 PMCID: PMC6858635 DOI: 10.1186/s13104-019-4792-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 11/11/2019] [Indexed: 01/17/2023] Open
Abstract
Objectives The association between post-traumatic stress disorder (PTSD) and medical comorbidities is controversial since most studies focused on specific comorbidity and victim types. In Italy, data on this issue are scarce. A comprehensive evaluation of all the ICD medical categories co-occurring in PTSD may orient assessment and treatment during clinical and forensic practice. This is the first study evaluating all the ICD physical comorbidities and gender-related differences in Italian PTSD patients. Eighty-four PTSD patients (36 females, 48 males) were included. The Clinician-Administered PTSD Scale, Mini International Neuropsychiatric Interview and Davidson Trauma Scale were administered. Results Most patients had a PTSD consequent to an accident and half of them presented extreme symptom severity. No gender differences emerged on symptom severity/duration and age at the event. Metabolic (39.29%), circulatory (20.24%) and musculoskeletal systems/connective tissue diseases (17.86%) were the most frequent comorbidities. Metabolic/circulatory diseases were more frequent among males (p = 0.019 and p = 0.027, respectively) while females more frequently showed neoplasms (p = 0.039). Physical comorbidities represent a serious complication in PTSD patients and are more prevalent than in the Italian population. While gender is not associated with symptom presentation, it seems to play a key role in specific comorbidities including metabolic, circulatory and neoplastic diseases.
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Affiliation(s)
- Fabio Ferretti
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Viale Bracci 16, 53100, Siena, Italy
| | - Andrea Pozza
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Viale Bracci 16, 53100, Siena, Italy.
| | - Letizia Bossini
- Department of Molecular Medicine, University of Siena School of Medicine, Siena, Italy.,Department of Mental Health, University of Siena Medical Center (AOUS), Siena, Italy
| | - Serena Desantis
- Department of Molecular Medicine, University of Siena School of Medicine, Siena, Italy.,Department of Mental Health, University of Siena Medical Center (AOUS), Siena, Italy
| | - Miriam Olivola
- Department of Molecular Medicine, University of Siena School of Medicine, Siena, Italy.,Department of Mental Health, University of Siena Medical Center (AOUS), Siena, Italy
| | - Laura Del Matto
- Department of Molecular Medicine, University of Siena School of Medicine, Siena, Italy.,Department of Mental Health, University of Siena Medical Center (AOUS), Siena, Italy
| | - Giacomo Gualtieri
- Health Service Management Board, Santa Maria alle Scotte University Hospital of Siena, Siena, Italy
| | - Roberto Gusinu
- Health Service Management Board, Santa Maria alle Scotte University Hospital of Siena, Siena, Italy
| | - Daiana Bezzini
- Department of Life Sciences, University of Siena, Siena, Italy
| | - Andrea Fagiolini
- Department of Molecular Medicine, University of Siena School of Medicine, Siena, Italy.,Department of Mental Health, University of Siena Medical Center (AOUS), Siena, Italy
| | - Anna Coluccia
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Viale Bracci 16, 53100, Siena, Italy
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Moshfegh CM, Elkhatib SK, Collins CW, Kohl AJ, Case AJ. Autonomic and Redox Imbalance Correlates With T-Lymphocyte Inflammation in a Model of Chronic Social Defeat Stress. Front Behav Neurosci 2019; 13:103. [PMID: 31139062 PMCID: PMC6527882 DOI: 10.3389/fnbeh.2019.00103] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 04/25/2019] [Indexed: 11/13/2022] Open
Abstract
Patients diagnosed with post-traumatic stress disorder (PTSD) are at a significantly elevated risk of developing comorbid inflammatory conditions, but the mechanisms underlying this predilection remain unclear. Our previous work has shown that T-lymphocytes exposed to elevated levels of norepinephrine (NE) displayed a pro-inflammatory signature reminiscent of an autoreactive phenotype. With this, we hypothesized that the increased sympathetic tone observed during psychological trauma may be promoting pro-inflammatory T-lymphocytes, which causes a predisposition to comorbid inflammatory conditions. Here, we examined the consequences of psychological trauma on splenic T-lymphocytes using a mouse model of repeated social defeat stress. Social defeat led to anxiety-like and depression-like behavior as has been previously described. The spleens of socially-defeated mice showed significant elevations of NE, tyrosine hydroxylase (TH), and acetylcholinesterase (ACHE) levels, which appeared to be due in part to increased expression within T-lymphocytes. Additionally, T-lymphocytes from stressed animals showed higher levels of pro-inflammatory cytokines and mitochondrial superoxide. Interestingly, in this model system, close associations exist within splenic T-lymphocytes amid the autonomic, inflammatory, and redox environments, but these only weakly correlate with individual behavioral differences among animals suggesting the psychological and physiological manifestations of trauma may not be tightly coupled. Last, we describe, for the first time, elevations in calprotectin levels within T-lymphocytes and in circulation of psychologically stressed animals. Calprotectin correlated with both behavioral and physiological changes after social defeat, suggesting the potential for a new biological marker and/or therapeutic target for psychological trauma and its inflammatory comorbidities.
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Affiliation(s)
- Cassandra M Moshfegh
- Department of Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha, NE, United States
| | - Safwan K Elkhatib
- Department of Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha, NE, United States
| | - Christopher W Collins
- Department of Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha, NE, United States
| | - Allison J Kohl
- Department of Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha, NE, United States
| | - Adam J Case
- Department of Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha, NE, United States
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Abstract
A vast number of veterans with posttraumatic stress disorder (PTSD) have chronic somatic comorbidities. However, their relationship with quality of life (QoL) has received little attention. We aimed to compare QoL of veterans with similar intensity of PTSD but different number of chronic somatic disorders. Of 129 veterans, 78% had at least one somatic disorder, and they reported lower QoL across all domains than veterans without somatic comorbidities. The greatest effect size was observed on social relationship (d = 0.65), it was notable on environment (d = 0.4) and psychological health (d = 0.38), and it was not relevant on physical health (d = 0.05). There was a negative correlation between the number of somatic disorders and scores on psychological health (rs = -0.217, p = 0.014), social relationships (rs = -0.248, p = 0.005), and environment (rs = -0.279, p = 0.001). The QoL of war veterans decreases significantly with the number of comorbid somatic conditions, particularly on the nonphysical domains of QoL.
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Metabolomic and glycomic findings in posttraumatic stress disorder. Prog Neuropsychopharmacol Biol Psychiatry 2019; 88:181-193. [PMID: 30025792 DOI: 10.1016/j.pnpbp.2018.07.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 06/21/2018] [Accepted: 07/14/2018] [Indexed: 01/10/2023]
Abstract
Posttraumatic stress disorder (PTSD) is a stressor-related disorder that develops in a subset of individuals exposed to a traumatic experience. Factors associated with vulnerability to PTSD are still not fully understood. PTSD is frequently comorbid with various psychiatric and somatic disorders, moderate response to treatment and remission rates. The term "theranostics" combines diagnosis, prognosis, and therapy and offers targeted therapy based on specific analyses. Theranostics, combined with novel techniques and approaches called "omics", which integrate genomics, transcriptomic, proteomics and metabolomics, might improve knowledge about biological underpinning of PTSD, and offer novel therapeutic strategies. The focus of this review is on metabolomic and glycomic data in PTSD. Metabolomics evaluates changes in the metabolome of an organism by exploring the set of small molecules (metabolites), while glycomics studies the glycome, a complete repertoire of glycan structures with their functional roles in biological systems. Both metabolome and glycome reflect the physiological and pathological conditions in individuals. Only a few studies evaluated metabolic and glycomic changes in patients with PTSD. The metabolomics studies in PTSD patients uncovered different metabolites that might be associated with psychopathological alterations in PTSD. The glycomics study in PTSD patients determined nine N-glycan structures and found accelerated and premature aging in traumatized subjects and subjects with PTSD based on a GlycoAge index. Therefore, further larger studies and replications are needed. Better understanding of the biological basis of PTSD, including metabolomic and glycomic data, and their integration with other "omics" approaches, might identify new molecular targets and might provide improved therapeutic approaches.
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Munjiza J, Britvic D, Crawford MJ. Lasting personality pathology following exposure to severe trauma in adulthood: retrospective cohort study. BMC Psychiatry 2019; 19:3. [PMID: 30606154 PMCID: PMC6318845 DOI: 10.1186/s12888-018-1975-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 12/06/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Early exposure to trauma is a known risk factor for personality disorder (PD), but evidence for late-onset personality pathology following trauma in adults is much less clear. We set out to investigate whether exposure to war trauma can lead to lasting personality pathology in adults and to compare the mental health and social functioning of people with late-onset personality problems with those with PD. METHODS We recruited patients who scored positively on the International Personality Disorder Examination (IPDE) in southern Croatia 15 years after the Croatian war of independence and used a semi-structured interview to establish when the person's personality-related problems arose. All participants also completed Harvard Trauma Questionnaire, and measures of mental health and social functioning. RESULTS Among 182 participants with probable personality disorder, 65 (35.7%) reported that these problems started after exposure to war-trauma as adults. The most prevalent personality problems among those with late-onset pathology were borderline, avoidant, schizotypal, schizoid and paranoid. Participants with late-onset personality pathology were more likely to have schizotypal (75.4% vs. 47.3%) and schizoid traits (73.8% vs. 41.1%) compared to those with PD. Participants with late-onset personality pathology were three times more likely to have complex personality pathology across all three DSM-IV clusters compared to those with PD (OR = 2.96, 95% CI 1.54 to 5.67) after adjusted for gender and marital status. The prevalence of depression and social dysfunction were as high among those with late-onset personality pathology as among those with personality disorder. CONCLUSION Retrospective accounts of people with significant personality pathology indicate that some develop these problems following exposure to severe trauma in adulthood. Personality-related problems which start in adulthood may be as severe as those that have an earlier onset. These findings highlight the long term impact of war trauma on the mental health and have implications for the way that personality pathology is classified and treated.
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Affiliation(s)
- Jasna Munjiza
- Centre for Psychiatry, Faculty of Medicine, Imperial College London, Hammersmith Campus, 7th Floor Commonwealth Building, Du Cane Road, London, W12 0NN UK
- Central and North West London NHS Foundation Trust, London, UK
| | - Dolores Britvic
- Department of Psychiatry, School of Medicine Split, University of Split, Split, Croatia
| | - Mike J. Crawford
- Centre for Psychiatry, Faculty of Medicine, Imperial College London, Hammersmith Campus, 7th Floor Commonwealth Building, Du Cane Road, London, W12 0NN UK
- Central and North West London NHS Foundation Trust, London, UK
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Vidal C, Polo R, Alvarez K, Falgas-Bague I, Wang Y, Lê Cook B, Alegría M. Co-Occurrence of Posttraumatic Stress Disorder and Cardiovascular Disease Among Ethnic/Racial Groups in the United States. Psychosom Med 2018; 80:680-688. [PMID: 29781946 PMCID: PMC6113076 DOI: 10.1097/psy.0000000000000601] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Trauma and/or symptoms of posttraumatic stress disorder (PTSD) have been linked to the onset of cardiovascular disease (CVD), but the exact mechanism has not been determined. We examine whether the risk of CVD is different among those who have a history of trauma without PTSD symptoms, those who have experienced trauma and developed any symptoms of PTSD, and those with a PTSD diagnosis. Furthermore, we examine whether this association varies across ethnic/racial groups. METHODS We used two data sets that form part of the Collaborative Psychiatric Epidemiology Surveys - the National Latino and Asian American Study and the National Comorbidity Survey Replication. RESULTS We found an increased likelihood of cardiovascular events for those with a diagnosis of PTSD (odds ratio [OR] = 2.10, 95% CI = 1.32-3.33) when compared with those who had not experienced trauma. We did not find an increased risk for those who had experienced trauma without symptoms or with subclinical symptoms of PTSD. The higher likelihood of having a cardiovascular event in those with PTSD was significant for non-Latino whites (OR = 1.86, 95% CI = 1.08-3.11), Latinos (OR = 1.94, 95% CI = 1.04-3.62), and non-Latino blacks (OR = 3.73, 95% CI = 1.76-7.91), but not for Asian respondents. CONCLUSIONS The constellation of symptoms defining PTSD diagnosis reflect adverse reactions to traumatic events and indicate that complex responses to traumatic events may be a risk factor for CVD.
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Affiliation(s)
- Carmen Vidal
- From the Fundación Jiménez Díaz, Avda, Reyes Católicos, Madrid, Spain (Vidal, Polo); Disparities Research Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston (Alvarez, Falgas-Bague, Wang, Alegría); Health Equity Research Lab, Cambridge Health Alliance and Harvard Medical School, Cambridge, Massachusetts (Lê Cook); and Department of Psychiatry, Harvard Medical School (Lê Cook), Departments of Medicine and Psychiatry, Harvard Medical School, Boston, Massachusetts (Alegría)
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Abstract
BACKGROUND The Khyber Pakhtunkhwa province of North-West Pakistan has endured increased levels of violence in recent years. The psychological sequelae of such trauma including the presence of dissociative symptoms has been minimally investigated to date. The study examines psychopathology experienced including the presence of dissociative symptoms, and ascertain what factors are potentially predictive of these symptoms. METHOD Third-level students (n=303) completed psychometric instruments relating to their experience of traumatic events and assessed depression, anxiety and dissociative symptoms. RESULTS Symptoms suggestive of post-traumatic stress disorder were evident in 28% of individuals. Symptoms relating to intrusive experiences and alterations in reactivity predicted dissociative, depressive and anxiety symptoms (p<0.01). CONCLUSION Trauma related to violence in this study was associated with significant pathology including dissociative symptoms. Identification and subsequent treatment of dissociative symptoms in individuals who have experienced trauma, may have a significant ameliorating effect on levels of functioning and thus should be included in clinical assessment.
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Tudor L, Konjevod M, Nikolac Perkovic M, Svob Strac D, Nedic Erjavec G, Uzun S, Kozumplik O, Sagud M, Kovacic Petrovic Z, Pivac N. Genetic Variants of the Brain-Derived Neurotrophic Factor and Metabolic Indices in Veterans With Posttraumatic Stress Disorder. Front Psychiatry 2018; 9:637. [PMID: 30542302 PMCID: PMC6277864 DOI: 10.3389/fpsyt.2018.00637] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 11/08/2018] [Indexed: 12/12/2022] Open
Abstract
Posttraumatic stress disorder (PTSD) is a trauma and stressor related disorder that may develop after exposure to an event that involved the actual or possible threat of death, violence or serious injury. Its molecular underpinning is still not clear. Brain-derived neurotrophic factor (BDNF) modulates neuronal processes such as the response to stress, but also weight control, energy and glucose homeostasis. Plasma BDNF levels and a functional BDNF Val66Met (rs6265) polymorphism were reported to be associated with PTSD, as well as with increased body mass index (BMI) and dyslipidaemia in healthy subjects and patients with cardio-metabolic diseases, but these results are controversial. The other frequently studied BDNF polymorphism, C270T (rs56164415), has been associated with the development of different neuropsychiatric symptoms/disorders. As far as we are aware, there are no data on the association of BDNF Val66Met and C270T polymorphisms with metabolic indices in PTSD. Due to high rates of obesity and dyslipidaemia in PTSD, the aim of this study was to elucidate the association of BDNF Val66Met and C270T polymorphisms with BMI and lipid levels in veterans with PTSD. We hypothesized that BDNF variants contribute to susceptibility to metabolic disturbances in PTSD. The study included 333 Caucasian males with combat related PTSD, diagnosed according to DSM-5 criteria. Genotyping of the BDNF Val66Met and C270T polymorphisms was performed using the real-time PCR method. Results were analyzed using hierarchical multiple linear regression and the Mann-Whitney test, with p-value corrected to 0.005. The results showed that BDNF Val66Met and BDNF C270T polymorphisms were not significantly associated with BMI, total cholesterol, LDL-cholesterol, HDL-cholesterol or triglycerides. Although the BDNF C270T polymorphism was nominally associated only with HDL-cholesterol in veterans with PTSD, this significance disappeared after controlling for the effect of age. Namely, slightly higher plasma HDL values in T allele carriers, compared to CC homozygotes, were associated with differences in age. Our results, controlled for the critical covariates, revealed that BDNF Val66Met and C270T were not significantly associated with metabolic indices in veterans with PTSD and that these genetic variants do not contribute to susceptibility to metabolic disturbances in PTSD.
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Affiliation(s)
- Lucija Tudor
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Rudjer Boskovic Institute, Zagreb, Croatia
| | - Marcela Konjevod
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Rudjer Boskovic Institute, Zagreb, Croatia
| | - Matea Nikolac Perkovic
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Rudjer Boskovic Institute, Zagreb, Croatia
| | - Dubravka Svob Strac
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Rudjer Boskovic Institute, Zagreb, Croatia
| | - Gordana Nedic Erjavec
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Rudjer Boskovic Institute, Zagreb, Croatia
| | - Suzana Uzun
- Department of Biological Psychiatry and Psychogeriatry, University Psychiatric Hospital Vrapce, Zagreb, Croatia.,Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Oliver Kozumplik
- Department of Biological Psychiatry and Psychogeriatry, University Psychiatric Hospital Vrapce, Zagreb, Croatia.,Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Marina Sagud
- School of Medicine, University of Zagreb, Zagreb, Croatia.,Department of Psychiatry, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Zrnka Kovacic Petrovic
- Department of Biological Psychiatry and Psychogeriatry, University Psychiatric Hospital Vrapce, Zagreb, Croatia.,Department of Psychopharmacology, Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Nela Pivac
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Rudjer Boskovic Institute, Zagreb, Croatia
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Khodadadi-Hassankiadeh N, Dehghan Nayeri N, Shahsavari H, Yousefzadeh-Chabok S, Haghani H. Predictors of Post-Traumatic Stress Disorder among Victims of Serious Motor Vehicle Accidents. INTERNATIONAL JOURNAL OF COMMUNITY BASED NURSING AND MIDWIFERY 2017; 5:355-364. [PMID: 29043281 PMCID: PMC5635555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Revised: 03/26/2017] [Accepted: 04/04/2017] [Indexed: 12/03/2022]
Abstract
BACKGROUND Compelling evidence has shown that motor vehicle accidents have an enormous impact on mental health. Post-traumatic Stress Disorder (PTSD) is one of the most common psychological consequences in adult survivors of accidents, so it is important to understand the prevalence and predictors of this issue since delay causes damage to crucial daily functioning. This study aimed at investigating the prevalence and predictors of PTSD after motor vehicle accident. METHODS This cross-sectional study was conducted on 528 injured patients six weeks to six months after motor vehicle accident in Imam Reza Clinic of Poursina hospital, Rasht in 2015. Data collection tools were three questionnaires including post-traumatic stress-self report (PSS), Beck Depression Inventory (BDI-II), and the Numeric Rating Scale (NRS) for pain. The data were analyzed in SPSS (Version 19) using Chi-square, Fischer's exact test and multivariate logistic regression. Significance level was considered P≤0.05. RESULTS The prevalence of PTSD and depression was 30.49% and 19.89% in participants, respectively. Chi-square test indicated a significant relationship among age (P=0.02), sex (P<0.001), education level (P<0.001), work status (P<0.001) and PTSD. Participants who reported pain (P<0.001) and depression (P<0.001) were more likely to have high score of PTSD than the others. Multivariate logistic regression showed this significance in sex, depression, age, educational status and pain, as constant risk factors in developing PTSD after accident. CONCLUSION This study suggests that primary care setting should be readily prompted for diagnosis of these disorders in non-treatment seeking individuals in the community.
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Affiliation(s)
- Naema Khodadadi-Hassankiadeh
- Department of Community Health Nursing Group, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Nahid Dehghan Nayeri
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Hooman Shahsavari
- Department of Medical- surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahrokh Yousefzadeh-Chabok
- Department of Neurosurgery, Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Guilan, Iran
- Neuroscience Research Center, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Guilan, Iran
| | - Hamid Haghani
- Department of Biostatistics, School of Medical Sciences, Iran University of Medical Sciences, Tehran, Iran
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Nedic Erjavec G, Konjevod M, Nikolac Perkovic M, Svob Strac D, Tudor L, Barbas C, Grune T, Zarkovic N, Pivac N. Short overview on metabolomic approach and redox changes in psychiatric disorders. Redox Biol 2017; 14:178-186. [PMID: 28942195 PMCID: PMC5609866 DOI: 10.1016/j.redox.2017.09.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 08/30/2017] [Accepted: 09/05/2017] [Indexed: 12/12/2022] Open
Abstract
Schizophrenia, depression and posttraumatic stress disorder (PTSD) are severe mental disorders and complicated diagnostic entities, due to their phenotypic, biological and genetic heterogeneity, unknown etiology, and poorly understood alterations in biological pathways and biological mechanisms. Disturbed homeostasis between overproduction of oxidant species, overcoming redox regulation and a lack of cellular antioxidant defenses, resulting in free radical-mediated pathology and subsequent neurotoxicity contributes to development of depression, schizophrenia and PTSD, their heterogeneous clinical presentation and resistance to treatment. Metabolomics is a discipline that combines different strategies with the aim to extract, detect, identify and quantify all metabolites that are present in a biological sample and might provide mechanistic insights into the etiology of various psychiatric disorders. Therefore, oxidative stress research combined with metabolomics might offer a novel approach in dissecting psychiatric disorders, since these data-driven but not necessarily hypothesis-driven methods might identify new targets, molecules and pathways responsible for development of schizophrenia, depression or PTSD. Findings from the oxidative research in psychiatry together with metabolomics data might facilitate development of specific and validated prognostic, therapeutic and clinical biomarkers. These methods might reveal bio-signatures of individual patients, leading to individualized treatment approach. In reviewing findings related to oxidative stress and metabolomics in selected psychiatric disorders, we have highlighted how these novel approaches might make a unique contribution to deeper understanding of psychopathological alterations underlying schizophrenia, depression and PTSD.
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Affiliation(s)
- Gordana Nedic Erjavec
- Rudjer Boskovic Institute, Division of Molecular Medicine, Laborattory for Molecular Neuropsychiatry, Zagreb, Croatia; The Centre of Metabolomics and Bioanalysis (CEMBIO) at thte Pharmacy Faculty, University San Pablo CEU, Madrid, Spain
| | - Marcela Konjevod
- Rudjer Boskovic Institute, Division of Molecular Medicine, Laborattory for Molecular Neuropsychiatry, Zagreb, Croatia
| | - Matea Nikolac Perkovic
- Rudjer Boskovic Institute, Division of Molecular Medicine, Laborattory for Molecular Neuropsychiatry, Zagreb, Croatia
| | - Dubravka Svob Strac
- Rudjer Boskovic Institute, Division of Molecular Medicine, Laborattory for Molecular Neuropsychiatry, Zagreb, Croatia
| | - Lucija Tudor
- Rudjer Boskovic Institute, Division of Molecular Medicine, Laborattory for Molecular Neuropsychiatry, Zagreb, Croatia
| | - Coral Barbas
- The Centre of Metabolomics and Bioanalysis (CEMBIO) at thte Pharmacy Faculty, University San Pablo CEU, Madrid, Spain
| | - Tilman Grune
- German Institute of Human Nutrition, Potsdam-Rehbruecke, Nuthetal, Germany
| | - Neven Zarkovic
- Rudjer Boskovic Institute, Division of Molecular Medicine, Laboratory for Oxidative Stress, Zagreb, Croatia
| | - Nela Pivac
- Rudjer Boskovic Institute, Division of Molecular Medicine, Laborattory for Molecular Neuropsychiatry, Zagreb, Croatia.
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Barrera-Valencia M, Calderón-Delgado L, Trejos-Castillo E, O’Boyle M. Cognitive profiles of Post-traumatic Stress Disorder and depression in children and adolescents. Int J Clin Health Psychol 2017; 17:242-250. [PMID: 30487899 PMCID: PMC6220903 DOI: 10.1016/j.ijchp.2017.05.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 05/11/2017] [Indexed: 11/23/2022] Open
Abstract
Background/Objective: Several diagnostic criteria of Post-traumatic Stress Disorder (PTSD) are remarkably similar to symptoms reported by individuals with depression, particularly as they manifest as cognitive processing deficits in children. Because of this overlap in profile and the high rate of comorbidity of PTSD and depression (48% to 69%), pinpointing similarities/differences in cognitive processes related to each of these disorders is essential to accurate diagnosis. This study aims to examine cognitive performance profiles of 23 children who have been victims of PTSD and to compare their results with 23 children with depression and 24 controls. Method: Empirical study, observational and descriptive methodologies were performed using several neuropsychological tests to assess IQ, attention, memory and executive function. Statistical comparisons between groups were made using the non-parametric Kruskall-Wallis test and post-hoc analyses were conducted using a Mann Whitney U test, as well as Quade's co-variance analysis. Results: Data show different profiles of cognitive performance in those with PTSD compared to those with depression and controls. Conclusions: The findings suggests that PTSD and depressed children differ somewhat in their cognitive profiles, and the differences in IQ found between those with PTSD and those without are not necessarily a confounding variable, but may rather be a consequence of their traumatic experience.
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Danzi BA, La Greca AM. Optimizing clinical thresholds for PTSD: Extending the DSM-5 preschool criteria to school-age children. Int J Clin Health Psychol 2017; 17:234-241. [PMID: 30487898 PMCID: PMC6220908 DOI: 10.1016/j.ijchp.2017.07.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 07/06/2017] [Indexed: 01/16/2023] Open
Abstract
Background/Objective: To examine the effect of using the DSM-5 preschool criteria to diagnose posttraumatic stress disorder (PTSD) in school-age children (ages 7-11). Method: Children exposed to Hurricane Ike (N = 327) were assessed for symptoms of PTSD and other trauma-related factors eight months post-disaster. Results: About twice as many children were identified as having PTSD using the DSM-5 preschool criteria compared to the DSM-5 adult criteria. The preschool criteria identified all children diagnosed by the adult criteria and many additional children. Although children who met both the adult and the preschool criteria reported the most functional impairment, children identified by the preschool criteria only reported greater impairment than children not diagnosed. The effect of including impairment in the diagnostic criteria was more marked for the preschool criteria than for the adult criteria. Additionally, PTSD defined by the preschool criteria was significantly associated with more PTSD risk factors than PTSD as defined by the adult criteria. Model fit was similar for both sets of criteria. Conclusions: The preschool criteria may be advantageous for screening for PTSD risk in school-age children. Further research is needed to optimize developmentally-appropriate PTSD criteria for school-age children.
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Child maltreatment, revictimization and Post-Traumatic Stress Disorder among adults in a community sample. Int J Clin Health Psychol 2017; 17:97-106. [PMID: 30487885 PMCID: PMC6220916 DOI: 10.1016/j.ijchp.2017.03.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 03/27/2017] [Indexed: 01/05/2023] Open
Abstract
Background/Objective: Childhood maltreatment (CM) has been associated with revictimization and post-traumatic stress disorder (PTSD). However, this relation is hardly examined in South European countries, and in community samples. We tested these associations in a convenience sample of 1,200 Portuguese adults in the community. Method: Data were collected using self-report questionnaires, the Post Traumatic Diagnostic Scale (PDS) and the Childhood Trauma Questionnaire–Short Form (CTQ-SF). Odds ratios, logistic and hierarchical regression were used to analyze the data. Results: Exposure to CM increased more than twofold the risk of being revictimized and threefold a PTSD diagnosis. Highly prevalent traumatic events such as accidents were associated with CM. More than 30% of adults with PTSD were exposed to emotional abuse. After adjusting for demographics, emotional abuse remained a significant predictor for revictimization and PTSD, having the largest effect on the prediction of PTSD severity (β = .24). Conclusions: Findings underline the injurious potential of emotional abuse during childhood in adults in the community. More knowledge is needed about the mechanisms linking CM with further traumatic exposure and PTSD across the lifespan to better inform preventive and therapeutic actions.
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Munjiza J, Britvic D, Radman M, Crawford MJ. Severe war-related trauma and personality pathology: a case-control study. BMC Psychiatry 2017; 17:100. [PMID: 28320355 PMCID: PMC5359945 DOI: 10.1186/s12888-017-1269-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 03/15/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Exposure to war-related trauma has long been recognised to have an adverse effect on mental health. We attempted to investigate whether people who have clinically significant personality-related problems 15 years after a war are more likely to have been exposed to severe war-related trauma than those who do not have significant personality difficulties. METHODS A case -control study was conducted in southern Croatia, fifteen years after the 1991-1995 war. We recruited 268 participants: 182 cases who scored positively on the International Personality Disorder Examination scale (IPDE), and 86 controls who were IPDE negative. Severity of war-related trauma was assessed according to the 17 items on the Harvard Trauma Questionnaire (HTQ) trauma event scale, which were considered to be of severe (catastrophic) nature based on the ICD-10 description of catastrophic trauma and the opinion of trauma experts. All participants also completed measures of mental health (depression, anxiety and PTSD), social functioning and current substance misuse. RESULTS Cases (IPDE positive) were eight times more likely to report exposure to severe war-related trauma than controls. This association increased after adjustments for demographic factors (OR = 10.1, 95% CI 5.0 to 20.4). The types of severe trauma most frequently reported were either the participants'own life being in direct danger or witnessing extreme violence inflicted on others or the result of violence towards others (murder, torture, seeing burned or disfigured bodies). Prevalences of depression, anxiety and PTSD were high among IPDE positive participants 15 years after exposure to war trauma. Their level of interpersonal dysfunction was considerably higher than that in controls (OR = 10.39, 95% CI 3.51 to 30.75). Alcohol consumption in cases was significantly higher with a mean of 14.24 units per week (sd = 11.03) when compared to controls whose mean number of alcohol units was 9.24 (sd = 7.25), t (73) = 2.16, p < 0.05, mean difference 4.99 (95% CI = 0.39 to 9.60). Similarly, a significantly higher number of cases reported current substance misuse (8.2% vs. 0.0%) X2 (1, n = 268) = 7.51, p < 0.05). CONCLUSION Exposure to severe war-related trauma is a risk factor for interpersonal dysfunction15 years after people were exposed to an armed conflict. These findings have implications for assessing and meeting the long-term mental health needs of people in war-affected regions. Further research needs to be done to increase our understanding about the relationship between severe war trauma and personality related problems.
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Affiliation(s)
- Jasna Munjiza
- Centre for Psychiatry, Faculty of Medicine, Imperial College London, Hammersmith Campus, 7th Floor Commonwealth Building, Du Cane Road, London, W12 0NN UK
- Central and North West London NHS Foundation Trust, London, UK
| | - Dolores Britvic
- Department of Psychiatry, School of Medicine Split, University of Split, Split, Croatia
| | - Maja Radman
- Department of Internal Medicine, School of Medicine Split, University of Split, Split, Croatia
| | - Mike J. Crawford
- Centre for Psychiatry, Faculty of Medicine, Imperial College London, Hammersmith Campus, 7th Floor Commonwealth Building, Du Cane Road, London, W12 0NN UK
- Central and North West London NHS Foundation Trust, London, UK
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Rzeszutek M, Oniszczenko W, Schier K, Biernat-Kałuża E, Gasik R. Temperament traits, social support, and trauma symptoms among HIV/AIDS and chronic pain patients. Int J Clin Health Psychol 2016; 16:137-146. [PMID: 30487857 PMCID: PMC6225014 DOI: 10.1016/j.ijchp.2015.10.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 10/14/2015] [Indexed: 01/28/2023] Open
Abstract
The main goal of our study was to investigate and compare the relationship between temperament traits postulated by the Regulative Theory of Temperament (RTT) and social support dimensions with the level of trauma symptoms, as appear in posttraumatic stress disorder (PTSD), in an HIV/AIDS patient sample [HIV+ (n=182) and AIDS (n=128)] and in patients suffering from chronic pain (rheumatoid arthritis; n=150). The level of trauma symptoms was assessed with the PTSD Factorial Version Inventory (PTSD-F), temperament was measured with the Formal Characteristics of Behaviour-Temperament Inventory (FCB-TI), and social support was tested with the Berlin Social Support Scales (BSSS). Significant predictors of trauma symptoms among participants were temperament traits (emotional reactivity, perseveration, and sensory sensitivity), and social support dimensions (perceived support, need for support, support seeking, and actually received support). We also noticed significant differences between the levels of trauma symptoms, temperament, and social support between HIV/AIDS and chronic pain patients. The importance of trauma symptoms, as well as temperament traits and social support, should be taken into account in planning the forms of psychological support that should accompany pharmacotherapy for HIV/AIDS and chronic pain patients.
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Affiliation(s)
- Marcin Rzeszutek
- University of Finance and Management, Poland
- Faculty of Management and Finance, University of Finance and Management, Poland
| | | | - Katarzyna Schier
- University of Warsaw, Poland
- Faculty of Psychology, University of Warsaw, Poland
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