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Clancy KJ, Devignes Q, Ren B, Pollmann Y, Nielsen SR, Howell K, Kumar P, Belleau EL, Rosso IM. Spatiotemporal dynamics of hippocampal-cortical networks underlying the unique phenomenological properties of trauma-related intrusive memories. Mol Psychiatry 2024; 29:2161-2169. [PMID: 38454081 PMCID: PMC11408261 DOI: 10.1038/s41380-024-02486-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 02/07/2024] [Accepted: 02/12/2024] [Indexed: 03/09/2024]
Abstract
Trauma-related intrusive memories (TR-IMs) possess unique phenomenological properties that contribute to adverse post-traumatic outcomes, positioning them as critical intervention targets. However, transdiagnostic treatments for TR-IMs are scarce, as their underlying mechanisms have been investigated separate from their unique phenomenological properties. Extant models of more general episodic memory highlight dynamic hippocampal-cortical interactions that vary along the anterior-posterior axis of the hippocampus (HPC) to support different cognitive-affective and sensory-perceptual features of memory. Extending this work into the unique properties of TR-IMs, we conducted a study of eighty-four trauma-exposed adults who completed daily ecological momentary assessments of TR-IM properties followed by resting-state functional magnetic resonance imaging (rs-fMRI). Spatiotemporal dynamics of anterior and posterior hippocampal (a/pHPC)-cortical networks were assessed using co-activation pattern analysis to investigate their associations with different properties of TR-IMs. Emotional intensity of TR-IMs was inversely associated with the frequency and persistence of an aHPC-default mode network co-activation pattern. Conversely, sensory features of TR-IMs were associated with more frequent co-activation of the HPC with sensory cortices and the ventral attention network, and the reliving of TR-IMs in the "here-and-now" was associated with more persistent co-activation of the pHPC and the visual cortex. Notably, no associations were found between HPC-cortical network dynamics and conventional symptom measures, including TR-IM frequency or retrospective recall, underscoring the utility of ecological assessments of memory properties in identifying their neural substrates. These findings provide novel insights into the neural correlates of the unique features of TR-IMs that are critical for the development of individualized, transdiagnostic treatments for this pervasive, difficult-to-treat symptom.
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Affiliation(s)
- Kevin J Clancy
- Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont, MA, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Quentin Devignes
- Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Boyu Ren
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Laboratory for Psychiatric Biostatistics, McLean Hospital, Belmont, MA, USA
| | - Yara Pollmann
- Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont, MA, USA
| | - Sienna R Nielsen
- Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont, MA, USA
| | - Kristin Howell
- Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont, MA, USA
| | - Poornima Kumar
- Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Emily L Belleau
- Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Isabelle M Rosso
- Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Oga K, Fuchikami M, Kobayashi H, Miyagi T, Fujita S, Fujita S, Okada S, Morinobu S. Involvement of dysregulated hippocampal histone H3K9 methylation at the promoter of the BDNF gene in impaired memory extinction. Psychopharmacology (Berl) 2024:10.1007/s00213-024-06640-7. [PMID: 38940908 DOI: 10.1007/s00213-024-06640-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 06/17/2024] [Indexed: 06/29/2024]
Abstract
RATIONALE Since the precise mechanisms of posttraumatic stress disorder (PTSD) remain unknown, effective treatment interventions have not yet been established. Impaired extinction of fear memory (EFM) is one of the core symptoms of PTSD and is associated with stress-induced epigenetic change in gene expression. OBJECTIVES In this study, we examined whether the involvement of histone H3 lysine 9 dimethylation (H3K9me2) in EFM is mediated through brain-derived neurotrophic factor (BDNF) expression in the hippocampus, and whether BIX01294, a selective G9a and GLP histone methyltransferase inhibitor, could be treatment for impaired EFM in an animal model of PTSD. METHODS The single prolonged stress (SPS) paradigm was used to model PTSD. We measured BDNF mRNA levels by RT-PCR, and H3K9me2 levels in the BDNF gene promoters by chromatin immunoprecipitation-qPCR. After undergoing contextual fear conditioning and hippocampal injection of BIX01294, male rats were subjected to extinction training and extinction testing and their freezing times and BDNF mRNA levels were measured. RESULTS Compared to sham rats, SPS rats showed decreased BDNF mRNA levels 2 h after extinction training, no significant changes in levels of global H3K9me2 prior to extinction training, and increased levels of H3K9me2 in BDNF gene promoter IV, but not in BDNF gene promoter I. Administration of BIX01294 ameliorated the decrease in BDNF mRNA levels 2 h after extinction training and subsequently alleviated impaired EFM in extinction tests in SPS rats. CONCLUSION We conclude that reduced hippocampal levels of BDNF mRNA due to increase in H3K9me2 levels may play a role in PTSD-associated EFM impairment, and BIX01294 could be a PTSD treatment option.
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Affiliation(s)
- Kenichi Oga
- Department of Psychiatry and Neuroscience, Division of Graduate School of Biomedical and Health Sciences, Hiroshima University, Minami-Ku, Kasumi 1-2-3, Hiroshima City, Hiroshima, Japan
| | - Manabu Fuchikami
- Department of Psychiatry and Neuroscience, Division of Graduate School of Biomedical and Health Sciences, Hiroshima University, Minami-Ku, Kasumi 1-2-3, Hiroshima City, Hiroshima, Japan.
| | - Hironori Kobayashi
- Department of Psychiatry and Neuroscience, Division of Graduate School of Biomedical and Health Sciences, Hiroshima University, Minami-Ku, Kasumi 1-2-3, Hiroshima City, Hiroshima, Japan
| | - Tatsuhiro Miyagi
- Department of Psychiatry and Neuroscience, Division of Graduate School of Biomedical and Health Sciences, Hiroshima University, Minami-Ku, Kasumi 1-2-3, Hiroshima City, Hiroshima, Japan
| | - Sho Fujita
- Department of Psychiatry and Neuroscience, Division of Graduate School of Biomedical and Health Sciences, Hiroshima University, Minami-Ku, Kasumi 1-2-3, Hiroshima City, Hiroshima, Japan
| | - Satoshi Fujita
- Department of Psychiatry and Neuroscience, Division of Graduate School of Biomedical and Health Sciences, Hiroshima University, Minami-Ku, Kasumi 1-2-3, Hiroshima City, Hiroshima, Japan
| | - Satoshi Okada
- Department of Psychiatry and Neuroscience, Division of Graduate School of Biomedical and Health Sciences, Hiroshima University, Minami-Ku, Kasumi 1-2-3, Hiroshima City, Hiroshima, Japan
| | - Shigeru Morinobu
- Department of Psychology, School of Faculty of Health and Wellness Sciences, Hiroshima International University, Kure, Japan
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Pollmann Y, Clancy KJ, Devignes Q, Ren B, Kaufman M, Rosso IM. Ecological Momentary Assessments of Trauma-Related Intrusive Memories: Potential Clinical Utility. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.15.24307377. [PMID: 38798682 PMCID: PMC11118638 DOI: 10.1101/2024.05.15.24307377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
As the global prevalence of trauma rises, there is a growing need for accessible and scalable treatments for trauma-related disorders like posttraumatic stress disorder (PTSD). Trauma-related intrusive memories (TR-IMs) are a central PTSD symptom and a target of exposure-based therapies, gold-standard treatments that are effective but resource-intensive. This study examined whether a brief ecological momentary assessment (EMA) protocol assessing the phenomenology of TR-IMs could reduce intrusion symptoms in trauma-exposed adults. Participants (N=131) experiencing at least 2 TR-IMs per week related to a DSM-5 criterion A trauma completed a 2-week EMA protocol during which they reported on TR-IM properties three times per day, and on posttraumatic stress symptoms at the end of each day. Longitudinal symptom measurements were entered into linear mixed-effects models to test the effect of Time on TR-IMs. Over the 2-week EMA protocol, intrusion symptom severity (cluster B scores) significantly declined (t = -2.78, p = 0.006), while other symptom cluster scores did not significantly change. Follow-up analyses demonstrated that this effect was specific to TR-IMs (t = -4.02, p < 0.001), and was not moderated by survey completion rate, total PTSD symptom severity, or ongoing treatment. Our findings indicate that implementing an EMA protocol assessing intrusive memories could be an effective trauma intervention. Despite study limitations like its quasi-experimental design and absence of a control group, the specificity of findings to intrusive memories argues against a mere regression to the mean. Overall, an EMA approach could provide a cost-effective and scalable treatment option targeting intrusive memory symptoms.
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Azmoun S, Diaz YF, Tang CY, Horton M, Clouston SA, Luft BJ, Bromet EJ, Gandy S, Placidi D, Ambrosi C, Mascaro L, Rodella C, Paghera B, Gasparotti R, Chambers JW, Tieu K, Corbo D, Lucchini RG. Cognitive impact of exposure to airborne particles captured by brain imaging. ADVANCES IN NEUROTOXICOLOGY 2022; 7:29-45. [PMID: 37663650 PMCID: PMC10473881 DOI: 10.1016/bs.ant.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Affiliation(s)
| | | | - Cheuk Y. Tang
- Icahn School of Medicine at Mount Sinai, New York, United States
| | - Megan Horton
- Icahn School of Medicine at Mount Sinai, New York, United States
| | | | - Ben J. Luft
- Stony Brook University, New York, United States
| | | | - Sam Gandy
- Icahn School of Medicine at Mount Sinai, New York, United States
- James J. Peters VA Medical Center, Bronx, New York, United States
| | - Donatella Placidi
- University of Brescia, Brescia, Italy
- Spedali Civili of Brescia, Brescia, Italy
| | - Claudia Ambrosi
- University of Brescia, Brescia, Italy
- Spedali Civili of Brescia, Brescia, Italy
| | | | - Carlo Rodella
- University of Brescia, Brescia, Italy
- Spedali Civili of Brescia, Brescia, Italy
| | - Barbara Paghera
- University of Brescia, Brescia, Italy
- Spedali Civili of Brescia, Brescia, Italy
| | - Roberto Gasparotti
- University of Brescia, Brescia, Italy
- Spedali Civili of Brescia, Brescia, Italy
| | | | - Kim Tieu
- Florida International University, Miami, United States
| | - Daniele Corbo
- University of Brescia, Brescia, Italy
- Spedali Civili of Brescia, Brescia, Italy
| | - Roberto G. Lucchini
- Florida International University, Miami, United States
- University of Brescia, Brescia, Italy
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Morr M, Noell J, Sassin D, Daniels J, Philipsen A, Becker B, Stoffel‐Wagner B, Hurlemann R, Scheele D. Lonely in the Dark: Trauma Memory and Sex-Specific Dysregulation of Amygdala Reactivity to Fear Signals. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2022; 9:e2105336. [PMID: 35343102 PMCID: PMC9131432 DOI: 10.1002/advs.202105336] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 02/18/2022] [Indexed: 06/14/2023]
Abstract
Loneliness exacerbates psychological distress and increases the risk of psychopathology after trauma exposure. However, it is still unclear whether a lack of social connectedness affects trauma-related intrusions and the neural processing of fear signals. Moreover, it is uncertain, whether loneliness plays a different role in women and men. A prestratification strategy is used and n = 47 (n = 20 women) healthy lonely individuals and n = 35 controls (n = 18 women) are recruited. Participants are exposed to an experimental trauma and evoked intrusive thoughts in daily life are monitored for three consecutive days. Functional magnetic resonance imaging is used to assess neural habituation to fearful faces and fear learning (conditioning and extinction) prior to trauma exposure. The results reveal a significant interaction between loneliness and sex such that loneliness is associated with more intrusions in men, but not in women. A similar pattern emerges at the neural level, with both reduced amygdala habituation to repeated fearful faces and amygdala hyperreactivity during the conditioning of fear signals in lonely men. The findings indicate that loneliness may confer vulnerability to intrusive memories after trauma exposure in healthy men and that this phenotype relates to altered limbic processing of fear signals.
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Affiliation(s)
- Mitjan Morr
- Research Section Medical PsychologyDepartment of Psychiatry and PsychotherapyUniversity Hospital BonnBonn53127Germany
| | - Jeanine Noell
- Research Section Medical PsychologyDepartment of Psychiatry and PsychotherapyUniversity Hospital BonnBonn53127Germany
| | - Daphne Sassin
- Research Section Medical PsychologyDepartment of Psychiatry and PsychotherapyUniversity Hospital BonnBonn53127Germany
| | - Jule Daniels
- Research Section Medical PsychologyDepartment of Psychiatry and PsychotherapyUniversity Hospital BonnBonn53127Germany
| | - Alexandra Philipsen
- Department of Psychiatry and PsychotherapyUniversity Hospital BonnBonn53127Germany
| | - Benjamin Becker
- Clinical Hospital of Chengdu Brain Science InstituteSchool of Life Science and TechnologyUniversity of Electronic Science and Technology of ChinaChengdu610054China
| | - Birgit Stoffel‐Wagner
- Institute of Clinical Chemistry and Clinical PharmacologyUniversity Hospital BonnBonn53127Germany
| | - René Hurlemann
- Department of PsychiatrySchool of Medicine and Health SciencesUniversity of OldenburgOldenburg26129Germany
- Research Center Neurosensory ScienceUniversity of OldenburgOldenburg26129Germany
| | - Dirk Scheele
- Research Section Medical PsychologyDepartment of Psychiatry and PsychotherapyUniversity Hospital BonnBonn53127Germany
- Department of PsychiatrySchool of Medicine and Health SciencesUniversity of OldenburgOldenburg26129Germany
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Metrik J, Stevens AK, Gunn RL, Borsari B, Jackson KM. Cannabis use and posttraumatic stress disorder: prospective evidence from a longitudinal study of veterans. Psychol Med 2022; 52:446-456. [PMID: 32546286 PMCID: PMC9882422 DOI: 10.1017/s003329172000197x] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is the most highly co-occurring psychiatric disorder among veterans with cannabis use disorder (CUD). Despite some evidence that cannabis use prospectively exacerbates the course of PTSD, which in turn increases the risk for CUD, the causal nature of the relationship between cannabis and psychiatric comorbidity is debated. The longitudinal relationship between PTSD diagnosis and traumatic intrusion symptoms with cannabis use and CUD was examined using cross-lagged panel model (CLPM) analysis. METHODS Prospective data from a longitudinal observational study of 361 veterans deployed post-9/11/2001 included PTSD and CUD diagnoses, cannabis use, and PTSD-related traumatic intrusion symptoms from the Inventory of Depression and Anxiety Symptoms. RESULTS A random intercept CLPM analysis that leveraged three waves (baseline, 6 months and 12 months) of cannabis use and PTSD-related intrusion symptoms to account for between-person differences found that baseline cannabis use was significantly positively associated with 6-month intrusion symptoms; the converse association was significant but reduced in magnitude (baseline use to 6-month intrusions: β = 0.46, 95% CI 0.155-0.765; baseline intrusions to 6-month use: β = 0.22, 95% CI -0.003 to 0.444). Results from the two-wave CLPM reveal a significant effect from baseline PTSD to 12-month CUD (β = 0.15, 95% CI 0.028-0.272) but not from baseline CUD to 12-month PTSD (β = 0.12, 95% CI -0.022 to 0.262). CONCLUSIONS Strong prospective associations capturing within-person changes suggest that cannabis use is linked with greater severity of trauma-related intrusion symptoms over time. A strong person-level directional association between PTSD and CUD was evident. Findings have significant clinical implications for the long-term effects of cannabis use among individuals with PTSD.
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Affiliation(s)
- Jane Metrik
- Providence VA Medical Center, Providence, RI 02908, USA
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI 02903, USA
| | - Angela K. Stevens
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI 02903, USA
| | - Rachel L. Gunn
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI 02903, USA
| | - Brian Borsari
- San Francisco VA Health Care System, San Francisco, CA 94121, USA
- Department of Psychiatry, University of California – San Francisco, San Francisco, CA 94103, USA
| | - Kristina M. Jackson
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI 02903, USA
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Zhang Y, Workman A, Russell MA, Williamson M, Pan H, Reifels L. The long-term impact of bushfires on the mental health of Australians: a systematic review and meta-analysis. Eur J Psychotraumatol 2022; 13:2087980. [PMID: 35957633 PMCID: PMC9359172 DOI: 10.1080/20008198.2022.2087980] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The long-term health effects of bushfires include the potential to trigger new and exacerbate existing mental health problems. OBJECTIVE This review aimed to determine the prevalence of long-term mental health issues in Australian populations exposed to bushfires. METHOD A systematic search was conducted in five databases (Embase, Medline, PsycINFO, Scopus, and Web of Science) to identify studies focusing on Australian populations impacted by bushfires with the prevalence of mental health issues reported at 2+ years after bushfire. The Joanna Briggs Institute prevalence critical appraisal tool was utilised. We conducted meta-analyses to determine the prevalence of general psychological distress in the general population, and a narrative synthesis. RESULTS We included 21 articles based on 5 studies and conducted on 3 bushfire events. Meta-analyses showed a pooled prevalence of 14% (95% CI 12%-16%) for psychological distress in the general population at 2-4 years post bushfire. The overall prevalence of long-term psychological problems in firefighters at 2-7 years ranged from 28% to 47.6%. The prevalence of some psychological issues decreased with time and was directly proportional to the level of bushfire impact. CONCLUSIONS As the magnitude of long-term bushfire-related mental health impacts in Australia is severe, it is important to monitor psychological problems and assist communities in future. Future research needs include: (a) more studies on the full range of long-term psychological impacts of bushfires, and (b) consensus on instruments and diagnostic criteria to define mental health issues. HIGHLIGHTS First systematic review of long-term bushfire mental health issues in Australia.Indicating substantial mental health problems among affected populations.Long-term issues were linked to bushfire impact and elevated among firefighters.Highlighting need for further rigorous research on long-term disaster sequalae.
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Affiliation(s)
- Yanqin Zhang
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
| | - Annabelle Workman
- Melbourne Climate Futures, Melbourne Law School, The University of Melbourne, Parkville, Australia
| | - Melissa A Russell
- Centre of Epidemiology and Biostatics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
| | - Michelle Williamson
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
| | - Haotai Pan
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
| | - Lennart Reifels
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
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Kritikos M, Clouston SAP, Huang C, Pellecchia AC, Mejia-Santiago S, Carr MA, Kotov R, Lucchini RG, Gandy SE, Bromet EJ, Luft BJ. Cortical complexity in world trade center responders with chronic posttraumatic stress disorder. Transl Psychiatry 2021; 11:597. [PMID: 34815383 PMCID: PMC8611009 DOI: 10.1038/s41398-021-01719-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 10/18/2021] [Accepted: 10/29/2021] [Indexed: 12/19/2022] Open
Abstract
Approximately 23% of World Trade Center (WTC) responders are experiencing chronic posttraumatic stress disorder (PTSD) associated with their exposures at the WTC following the terrorist attacks of 9/11/2001, which has been demonstrated to be a risk factor for cognitive impairment raising concerns regarding their brain health. Cortical complexity, as measured by analyzing Fractal Dimension (FD) from T1 MRI brain images, has been reported to be reduced in a variety of psychiatric and neurological conditions. In this report, we hypothesized that FD would be also reduced in a case-control sample of 99 WTC responders as a result of WTC-related PTSD. The results of our surface-based morphometry cluster analysis found alterations in vertex clusters of complexity in WTC responders with PTSD, with marked reductions in regions within the frontal, parietal, and temporal cortices, in addition to whole-brain absolute bilateral and unilateral complexity. Furthermore, region of interest analysis identified that the magnitude of changes in regional FD severity was associated with increased PTSD symptoms (reexperiencing, avoidance, hyperarousal, negative affect) severity. This study confirms prior findings on FD and psychiatric disorders and extends our understanding of FD associations with posttraumatic symptom severity. The complex and traumatic experiences that led to WTC-related PTSD were associated with reductions in cortical complexity. Future work is needed to determine whether reduced cortical complexity arose prior to, or concurrently with, onset of PTSD.
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Affiliation(s)
- Minos Kritikos
- Program in Public Health and Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Sean A P Clouston
- Program in Public Health and Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA.
| | - Chuan Huang
- Department of Radiology, Renaissance School of Medicine at Stony Brook, Stony Brook, NY, USA
- Department of Psychiatry, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Alison C Pellecchia
- World Trade Center Health and Wellness Program, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Stephanie Mejia-Santiago
- World Trade Center Health and Wellness Program, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Melissa A Carr
- World Trade Center Health and Wellness Program, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Roman Kotov
- Department of Psychiatry, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Roberto G Lucchini
- Department of Environmental Health Sciences, Robert Stempel School of Public Health, Florida International University, Miami, FL, USA
| | - Samuel E Gandy
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychiatry and Mount Sinai Alzheimer's Disease Research Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Evelyn J Bromet
- Department of Psychiatry, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Benjamin J Luft
- World Trade Center Health and Wellness Program, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
- Department of Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
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Kang E. Association between psychological morbidities and information provision, reliability, and satisfaction among disaster victims: A cross-sectional study. J Psychiatr Res 2020; 130:273-279. [PMID: 32861210 DOI: 10.1016/j.jpsychires.2020.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 08/08/2020] [Accepted: 08/11/2020] [Indexed: 11/19/2022]
Abstract
Providing information about disaster relief services and recovery processes reduces the damage from disasters and enables disaster victims to respond to disasters effectively. The present study aimed to clarify the associations between provision, reliability, satisfaction of information and satisfaction with media coverage and the risk of psychological morbidities (post-traumatic stress disorder [PTSD], depression, and anxiety). This was a cross-sectional survey - 1337 disaster victims who had experience of disasters within 2 years, such as earthquakes were enrolled in the 3rd Disaster Victims Panel Survey, 2018. Logistic regression analysis was used to investigate the associations between psychological morbidities and provision, reliability, and satisfaction of information. Reliability of information was assessed with a dichotomized variable and satisfaction with information or media was assessed 4 levels with 'neutral' by a single retrospective self-report item. The risks of depression (odds ratio [95% CI] = 1.478 [1.078-2.028]; p = 0.015) and anxiety (1.879 [1.262-2.798]; p = 0.002) were significantly higher in uninformed victims. Those who received reliable information were less likely to report depression (0.538 [0.381-0.758]; p < 0.001) and anxiety (0.362 [0.229-0.573]; p < 0.001), and those who received unreliable information were more likely to report PTSD (1.714 [1.045-2.810]; p = 0.033) and depression (1.742 [1.029-2.950]; p = 0.039). Satisfactory information was related to lower risks of depression (0.543 [0.380-0.778]; p = 0.001) and anxiety (0.352 [0.215-0.575]; p < 0.001). Disaster victims who were unsatisfied with media coverage had higher risks of PTSD (5.363 [3.672-7.833]; p < 0.001), depression (5.911 [3.377-10.347]; p < 0.001) and anxiety (5.840 [2.837-12.022]; p < 0.001). Providing information and providing reliable and satisfactory information might reduce the risk of psychological morbidities. Our results suggest that providing reliable and satisfactory information during disasters could reduce the psychiatric burden of disasters.
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Affiliation(s)
- Eunkyo Kang
- Public Healthcare Center, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
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10
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Cancio R. Experiences With Machismo and Pain: Latino Veterans. Am J Mens Health 2020; 14:1557988320976304. [PMID: 33256534 PMCID: PMC7711234 DOI: 10.1177/1557988320976304] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/30/2020] [Accepted: 11/03/2020] [Indexed: 11/18/2022] Open
Abstract
Physical and emotional pain from combat-related injuries and experiences are serious problems among Latino veterans. This study fleshes out existing cultural constructs and concepts (e.g., machismo and familism) from the participants' point of view and may serve as an important step in unraveling the influence of Latino culture on pain, providing a deeper and more critical theorization between masculinity, race/ethnicity, and the military. Using 26 interviews from U.S.-born Latino veterans, this study analyzes the meanings and experiences of pain from combat, masculinity, and how culture affects expressions of pain. The following themes emerged: (a) Latino culture and ethnicity, (b) machismo and pain, (c) the transforming self, and (d) feeling disconnected and dealing with pain. Overall, respondents were governed by strict gender standards influenced by their ethnic identity and exacerbated by military masculinity. Findings suggest that the study of race/ethnicity acts as a fundamental framework from which to understand the experiences and behaviors of pain.
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Affiliation(s)
- Roberto Cancio
- Department of Sociology, Loyola
Marymount University, Los Angeles, CA, USA
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Clouston SAP, Deri Y, Horton M, Tang C, Diminich E, DeLorenzo C, Kritikos M, Pellecchia AC, Santiago‐Michels S, Carr MA, Gandy S, Sano M, Bromet EJ, Lucchini RG, Luft BJ. Reduced cortical thickness in World Trade Center responders with cognitive impairment. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2020; 12:e12059. [PMID: 32695871 PMCID: PMC7364857 DOI: 10.1002/dad2.12059] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 06/02/2020] [Accepted: 06/04/2020] [Indexed: 12/31/2022]
Abstract
INTRODUCTION This study examined cortical thickness (CTX) in World Trade Center (WTC) responders with cognitive impairment (CI). METHODS WTC responders (N = 99) with/without CI, recruited from an epidemiologic study, completed a T1-MPRAGE protocol. CTX was automatically computed in 34 regions of interest. Region-based and surface-based morphometry examined CTX in CI versus unimpaired responders. CTX was automatically computed in 34 regions of interest. Region-based measures were also compared to published norms. RESULTS Participants were 55.8 (SD = 0.52) years old; 48 had CI. Compared to unimpaired responders, global mean CTX was reduced in CI and across 21/34 cortical subregions. Surface-based analyses revealed reduced CTX across frontal, temporal, and parietal lobes when adjusting for multiple comparisons. Both CI and unimpaired WTC groups had reduced CTX in the entorhinal and temporal cortices compared to published normative data. DISCUSSION Results from the first structural magnetic resonance imaging study in WTC responders identified reduced CTX consistent with a neurodegenerative disease of unknown etiology.
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Affiliation(s)
- Sean A. P. Clouston
- Program in Public Health Department of Family, Population, and Preventive MedicineRenaissance School of Medicine at Stony Brook UniversityStony BrookNew YorkUSA
| | - Yael Deri
- Department of MedicineRenaissance School of Medicine at Stony Brook UniversityStony BrookNew YorkUSA
| | - Megan Horton
- Department of Environmental Medicine and Public HealthIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Cheuk Tang
- Department of RadiologyIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
- Department of NeurologyIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Erica Diminich
- Program in Public Health Department of Family, Population, and Preventive MedicineRenaissance School of Medicine at Stony Brook UniversityStony BrookNew YorkUSA
| | - Christine DeLorenzo
- Department of PsychiatryRenaissance School of Medicine at Stony Brook UniversityStony BrookNew YorkUSA
| | - Minos Kritikos
- Program in Public Health Department of Family, Population, and Preventive MedicineRenaissance School of Medicine at Stony Brook UniversityStony BrookNew YorkUSA
| | - Alison C. Pellecchia
- Stony Brook World Trade Center Wellness ProgramRenaissance School of Medicine at Stony Brook UniversityStony BrookNew YorkUSA
| | - Stephanie Santiago‐Michels
- Stony Brook World Trade Center Wellness ProgramRenaissance School of Medicine at Stony Brook UniversityStony BrookNew YorkUSA
| | - Melissa A. Carr
- Stony Brook World Trade Center Wellness ProgramRenaissance School of Medicine at Stony Brook UniversityStony BrookNew YorkUSA
| | - Samuel Gandy
- Department of NeurologyIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
- Department of Psychiatry and Mount Sinai Alzheimer's Disease Research CenterIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Mary Sano
- Department of Psychiatry and Mount Sinai Alzheimer's Disease Research CenterIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Evelyn J. Bromet
- Department of PsychiatryRenaissance School of Medicine at Stony Brook UniversityStony BrookNew YorkUSA
| | - Roberto G. Lucchini
- Department of Environmental Medicine and Public HealthIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Benjamin J. Luft
- Department of MedicineRenaissance School of Medicine at Stony Brook UniversityStony BrookNew YorkUSA
- Stony Brook World Trade Center Wellness ProgramRenaissance School of Medicine at Stony Brook UniversityStony BrookNew YorkUSA
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Clouston SAP, Kuan P, Kotov R, Mukherjee S, Thompson-Carino P, Bromet EJ, Luft BJ. Risk factors for incident prostate cancer in a cohort of world trade center responders. BMC Psychiatry 2019; 19:389. [PMID: 31822278 PMCID: PMC6902605 DOI: 10.1186/s12888-019-2383-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 11/29/2019] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Despite a relatively young average age and no routine screening, prostate cancer is one of the most common cancers in men who worked at the World Trade Center (WTC) following the 9/11/2001 disaster. This study evaluated whether re-experiencing stressful memories of a traumatic event was associated with prostate cancer incidence. METHODS Participants were males from one clinical center that monitors the health of first-responders (N = 6857). Monitoring began in July 2002 and occurs annually but does not include prostate cancer screening. Severity of physical exposures and of re-experiencing memories and stress responses were measured at study enrollment using standardized and validated methods in all participants. The outcome was incidence of diagnosed prostate cancer after enrollment (n = 68). Bivariate analyses provided age-adjusted incidence rates (aIR). Cox proportional hazards modeling was used to calculate incidence; hazards ratios (HR) were reported. RESULTS The mean age of responders on 9/11/2001 was 37.9 years. Prostate cancer incidence was lowest in responders with no re-experiencing stress (aIR = 250.83/100,000 person-years, [233.41-268.25]) and highest in responders with severe re-experiencing stress (aIR = 818.49/100,000 person-years, [801.07-835.91]). Cox proportional hazards regression revealed that re-experiencing the stressful events of 9/11/2001 was associated with increased prostate cancer incidence (HR = 1.96 [1.26-3.05], P = 0.003), even upon adjusting for confounders. CONCLUSIONS This is the first study to identify a positive association between re-experiencing a traumatic event and prostate cancer incidence. Our results are consistent with recent rodent model evidence demonstrating a direct biological link between stress pathways and prostate tumorigenesis and offer new hypotheses in the causality of prostate cancer.
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Affiliation(s)
- Sean A. P. Clouston
- 0000 0004 0437 5731grid.412695.dDepartment of Family, Population, and Preventive Medicine, Program in Public Health, Stony Brook Medicine, Health Sciences Center, #3-071, Nichols Rd., Stony Brook, NY 11794-8338 USA
| | - Peifen Kuan
- 0000 0001 2216 9681grid.36425.36Department of Applied Mathematics, Stony Brook University, Stony Brook, NY USA
| | - Roman Kotov
- grid.459987.eDepartment of Psychiatry, Stony Brook Medicine, Stony Brook, NY USA
| | - Soumyadeep Mukherjee
- grid.459987.eProgram in Public Health, Stony Brook Medicine, Stony Brook, NY USA
| | | | - Evelyn J. Bromet
- grid.459987.eDepartment of Psychiatry, Stony Brook Medicine, Stony Brook, NY USA
| | - Benjamin J. Luft
- grid.459987.eWorld Trade Center Health and Wellness Program, Department of Medicine, Stony Brook Medicine, Stony Brook, NY USA
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Mukherjee S, Clouston S, Kotov R, Bromet E, Luft B. Handgrip Strength of World Trade Center (WTC) Responders: The Role of Re-Experiencing Posttraumatic Stress Disorder (PTSD) Symptoms. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E1128. [PMID: 30934818 PMCID: PMC6480128 DOI: 10.3390/ijerph16071128] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 03/18/2019] [Accepted: 03/26/2019] [Indexed: 01/12/2023]
Abstract
Background: This study sought to examine whether handgrip strength (HGS), a measure of muscle strength and a biomarker of aging, was associated with post-traumatic stress disorder (PTSD) in a cohort of World Trade Center (WTC) responders at midlife. Methods: HGS was assessed utilizing a computer-assisted hand dynamometer administered to a consecutive sample of men and women (n = 2016) who participated in rescue and recovery efforts following the World Trade Center (WTC) attacks and subsequently attended monitoring appointments in Long Island, NY. PTSD symptom severity and depressive symptoms were assessed using the PTSD specific-trauma checklist (PCL-S) and the Patient Health Questionnaire (PHQ-9). General linear models were used to examine the association of WTC-related PTSD with HGS after adjusting for confounders. Results: The sample was at midlife (mean age = 53.3) when assessed, and 91.3% were men. Nearly 10% of the sample had probable PTSD (PCL ≥ 44) with concomitant depression (PHQ ≥ 10), while 5.1% had probable PTSD without depression. Average HGS was 57.4 lbs. (95% confidence interval (95% CI): 56.6⁻58.1) among men and 36.1 lbs. (95% CI = 33.8⁻38.5) among women. Mean HGS of those with probable PTSD with concomitant depression was lower (45.9 lbs., 95% CI = 43.6⁻48.2) than responders with only PTSD (49.1 lbs., 95% CI = 46.0⁻52.4) and those without PTSD or depression (57.5 lbs., 95% CI = 56.2⁻57.8). Subdomain analyses of PTSD symptoms revealed that re-experiencing symptoms at enrollment (p = 0.003) was associated with lower HGS after adjusting for depressive symptoms and other confounders. Discussion: Results suggested that higher WTC-related PTSD symptom severity was associated with lower HGS. Results support ongoing work suggesting that PTSD may be associated with more rapid physical aging. The potential for developing interventions that might simultaneously improve physical and mental health in the aftermath of trauma may be considered.
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Affiliation(s)
- Soumyadeep Mukherjee
- Community Health and Wellness, Health & Physical Education Department, Rhode Island College, Providence, RI 02908, USA.
| | - Sean Clouston
- Program in Public Health, Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY 11794, USA.
| | - Roman Kotov
- Department of Psychiatry, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY 11794, USA.
| | - Evelyn Bromet
- Department of Psychiatry, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY 11794, USA.
| | - Benjamin Luft
- World Trade Center Health and Wellness Program Director, Department of Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY 11794, USA.
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Gelkopf M, Lapid Pickman L, Carlson EB, Greene T. The Dynamic Relations Among Peritraumatic Posttraumatic Stress Symptoms: An Experience Sampling Study During Wartime. J Trauma Stress 2019; 32:119-129. [PMID: 30720893 DOI: 10.1002/jts.22374] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 09/20/2018] [Accepted: 09/23/2018] [Indexed: 12/18/2022]
Abstract
The associations among peritraumatic posttraumatic stress symptoms (P-PTSS) in the immediate aftermath of trauma exposure, including those in the posttraumatic stress disorder clusters of intrusions, avoidance, negative cognitions and mood (NCM), and arousal, might indicate mechanisms through which enduring PTSD develops. During a period of war, exposed participants (N = 181) were sent twice-daily questionnaires for 30 days via smartphone. We repeatedly assessed the predictive associations between the P-PTSS clusters over time. We performed a multilevel pathway analysis built of multiple triple sequence responses (6,221 cases) on each of the four P-PTSS clusters at a mean time lag of 12 hr (Model A) and 24 hr (Model B) for 181 participants, 85 of whom had been diagnosed with a serious mental illness. Arousal predicted intrusion in Models A and B, bA = 0.08, 95% CI [0.03, 0.12], p < .001 and bB = 0.03, 95% CI [0.00, 0.07], p = .051, respectively; and NCM in Models A and B, bA = 0.09, 95% CI [0.05, 0.12], p < .001 and bB = 0.06, 95% CI [0.03, 0.09], p < .001, respectively. Intrusion predicted arousal in Model B, bB = 0.05, 95% CI [0.01, 0.08], p = .010. NCM predicted arousal, bA = 0.10, 95% CI [0.05, 0.14], p < .001, and avoidance bA = 0.05, 95% CI [0.00, 0.11], p = .052, in Model A. Avoidance did not predict any other cluster. Arousal seemed to be acting as a hub, strengthening feedback loops to and from NCM and intrusion.
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Affiliation(s)
- Marc Gelkopf
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.,NATAL - Israel Trauma and Resiliency Center, Tel Aviv, Israel
| | - Liron Lapid Pickman
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.,NATAL - Israel Trauma and Resiliency Center, Tel Aviv, Israel
| | - Eve B Carlson
- National Center for PTSD and VA Palo Alto Health Care System, Dept. of Veterans Affairs, USA
| | - Talya Greene
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
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Richter-Levin G, Stork O, Schmidt MV. Animal models of PTSD: a challenge to be met. Mol Psychiatry 2019; 24:1135-1156. [PMID: 30816289 PMCID: PMC6756084 DOI: 10.1038/s41380-018-0272-5] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 08/13/2018] [Accepted: 09/11/2018] [Indexed: 02/07/2023]
Abstract
Recent years have seen increased interest in psychopathologies related to trauma exposure. Specifically, there has been a growing awareness to posttraumatic stress disorder (PTSD) in part due to terrorism, climate change-associated natural disasters, the global refugee crisis, and increased violence in overpopulated urban areas. However, notwithstanding the increased awareness to the disorder, the increasing number of patients, and the devastating impact on the lives of patients and their families, the efficacy of available treatments remains limited and highly unsatisfactory. A major scientific effort is therefore devoted to unravel the neural mechanisms underlying PTSD with the aim of paving the way to developing novel or improved treatment approaches and drugs to treat PTSD. One of the major scientific tools used to gain insight into understanding physiological and neuronal mechanisms underlying diseases and for treatment development is the use of animal models of human diseases. While much progress has been made using these models in understanding mechanisms of conditioned fear and fear memory, the gained knowledge has not yet led to better treatment options for PTSD patients. This poor translational outcome has already led some scientists and pharmaceutical companies, who do not in general hold opinions against animal models, to propose that those models should be abandoned. Here, we critically examine aspects of animal models of PTSD that may have contributed to the relative lack of translatability, including the focus on the exposure to trauma, overlooking individual and sex differences, and the contribution of risk factors. Based on findings from recent years, we propose research-based modifications that we believe are required in order to overcome some of the shortcomings of previous practice. These modifications include the usage of animal models of PTSD which incorporate risk factors and of the behavioral profiling analysis of individuals in a sample. These modifications are aimed to address factors such as individual predisposition and resilience, thus taking into consideration the fact that only a fraction of individuals exposed to trauma develop PTSD. We suggest that with an appropriate shift of practice, animal models are not only a valuable tool to enhance our understanding of fear and memory processes, but could serve as effective platforms for understanding PTSD, for PTSD drug development and drug testing.
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Affiliation(s)
- Gal Richter-Levin
- Sagol Department of Neurobiology, University of Haifa, Haifa, Israel. .,The Integrated Brain and Behavior Research Center (IBBR), University of Haifa, Haifa, Israel. .,Psychology Department, University of Haifa, Haifa, Israel.
| | - Oliver Stork
- 0000 0001 1018 4307grid.5807.aDepartment of Genetics & Molecular Neurobiology, Institute of Biology, Otto-von-Guericke-University Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany ,grid.452320.2Center for Behavioral Brain Sciences, Universitätsplatz 2, 39106 Magdeburg, Germany
| | - Mathias V. Schmidt
- 0000 0000 9497 5095grid.419548.5Department of Stress Neurobiology and Neurogenetics, Max Planck Institute of Psychiatry, Munich, Germany
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Mihailova S, Jobson L. Association between intrusive negative autobiographical memories and depression: A meta-analytic investigation. Clin Psychol Psychother 2018; 25:509-524. [PMID: 29473250 DOI: 10.1002/cpp.2184] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 01/18/2018] [Accepted: 01/19/2018] [Indexed: 01/01/2023]
Abstract
The study investigated several associations between depression and intrusive negative autobiographical memories. A systematic literature search identified 23 eligible studies (N = 2,582), which provided 59 effect sizes. Separate meta-analyses indicated that depression was moderately, positively associated with intrusive memory frequency, memory distress, maladaptive memory appraisals, memory avoidance, and memory rumination. Intrusive memory vividness was not significantly associated with depression. There were insufficient data to examine the relationship between depression and memory vantage perspective. Between-study heterogeneity was high for intrusive memory frequency and memory avoidance, and the percentage of females in studies significantly moderated the relationship between these variables and depression. An additional exploratory meta-analysis (3 studies; N = 257) indicated that intrusive memories were experienced more frequently by those with posttraumatic stress disorder than those with depression. Overall, the findings suggest that intrusive memories warrant clinical attention as they may contribute to the maintenance of depressive symptomatology.
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Affiliation(s)
- Stella Mihailova
- School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Laura Jobson
- School of Psychological Sciences, Monash University, Melbourne, Australia
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Correlates of Nonimprovement to Pharmacotherapy for Chronic, Antidepressant-Resistant, Military Service-Related Posttraumatic Stress Disorder: Insights From the Veterans Affairs Cooperative Study No. 504. J Clin Psychopharmacol 2017; 37:717-721. [PMID: 28945664 DOI: 10.1097/jcp.0000000000000777] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is a chronic and often difficult-to-treat condition that is prevalent among military veterans. First-line pharmacotherapy for this population typically involves antidepressants; however, veterans who do not improve are sometimes prescribed antipsychotics such as risperidone. A 2011 randomized controlled trial of adjunctive risperidone versus placebo for veterans with chronic, antidepressant-resistant, military service-related PTSD revealed no difference between groups. Hence, there is a need to examine predictors of nonimprovement for chronic, treatment-resistant PTSD. METHODS We examined correlates of nonimprovement and delayed improvement (ie, ≥12 weeks) using data from 267 veterans with chronic, antidepressant-resistant PTSD who were prescribed adjunctive risperidone or a placebo. Veterans received 1 to 4 mg adjunctive risperidone (n = 133; mean dose, 2.74 mg) or a placebo daily (n = 134) in addition to their original treatment regimen over the 24-week trial. RESULTS Greater severity of PTSD symptoms at baseline, specifically reexperiencing (ie, nightmares) and emotional numbing (ie, sense of foreshortened future), was independently associated with nonimprovement. Of the 194 veterans (72.7%) who did improve, 95 (49.0%) showed delayed improvement, taking 12 weeks or longer to demonstrate a 10-point reduction in Clinician-Administered PTSD Scale scores. Emotional difficulties affecting role functioning, as assessed using the Veterans RAND 36-item Health Survey, independently predicted nonimprovement. CONCLUSIONS While results are indicative of nonspecific pharmacotherapeutic effects, they suggest that specific PTSD symptom clusters and impairment are associated with variable improvement in veterans with antidepressant-resistant PTSD. They underscore the importance of developing more effective and targeted pharmacotherapies for specific symptom clusters in this population.
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Speth J, Schloerscheidt AM, Speth C. As we fall asleep we forget about the future: A quantitative linguistic analysis of mentation reports from hypnagogia. Conscious Cogn 2016; 45:235-244. [DOI: 10.1016/j.concog.2016.08.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 03/24/2016] [Accepted: 08/22/2016] [Indexed: 01/04/2023]
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Clouston SA, Kotov R, Pietrzak RH, Luft BJ, Gonzalez A, Richards M, Ruggero CJ, Spiro A, Bromet EJ. Cognitive impairment among World Trade Center responders: Long-term implications of re-experiencing the 9/11 terrorist attacks. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2016; 4:67-75. [PMID: 27626057 PMCID: PMC5011166 DOI: 10.1016/j.dadm.2016.08.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION During the World Trade Center (WTC) attacks, responders who helped in search, rescue, and recovery endured multiple traumatic and toxic exposures. One-fifth subsequently developed post-traumatic stress disorder (PTSD). PTSD has been linked to dementia in veterans. This study examined the association between WTC-related PTSD and cognitive impairment (CI) in WTC responders. METHODS A one-third sample of responders (N = 818) reporting for annual monitoring visits were screened for cognitive impairment and dementia using the Montreal Cognitive Assessment from January 2014-April 2015. Concurrent diagnoses of PTSD and major depressive disorder (MDD), as well as serial PTSD and depressive symptom inventories, collected since 2002, were examined in relation to current CI. RESULTS Approximately 12.8% and 1.2% of responders in this sample respectively had scores indicative of CI and possible dementia. Current PTSD and MDD were associated with CI. Longitudinal results revealed that re-experiencing symptoms were consistently associated with CI (aRR = 2.88, 95% confidence interval = 1.35-6.22), whereas longitudinal increases in other PTSD and depressive symptoms in the years before screening were evident only among those with CI. CONCLUSIONS Analyses replicated results from Veterans studies and further highlighted the importance of re-experiencing symptoms, a major component of PTSD that was consistently predictive of CI 14 years later. Clinicians should monitor CI when treating individuals with chronic PTSD.
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Affiliation(s)
- Sean A.P. Clouston
- Program in Public Health, Stony Brook University, Stony Brook, NY, USA
- Department of Family, Population, and Preventive Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Roman Kotov
- Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
| | | | - Benjamin J. Luft
- Department of Medicine, School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Adam Gonzalez
- Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
| | - Marcus Richards
- Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Camilo J. Ruggero
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Avron Spiro
- Department of Epidemiology and Biostatistics, School of Public Health, Boston University, Boston, MA, USA
| | - Evelyn J. Bromet
- Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
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