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Holder N, Ranney RM, Bernhard PA, Holliday R, Vogt D, Hoffmire CA, Blosnich JR, Schneiderman AI, Maguen S. Which veterans with PTSD are most likely to report being told of their diagnosis? J Psychiatr Res 2024; 170:158-166. [PMID: 38147692 DOI: 10.1016/j.jpsychires.2023.12.026] [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: 08/29/2023] [Revised: 12/11/2023] [Accepted: 12/13/2023] [Indexed: 12/28/2023]
Abstract
Veterans who do not know about their posttraumatic stress disorder (PTSD) diagnosis experience a fundamental barrier to accessing effective treatment. Little is known about the characteristics that influence veterans' PTSD diagnosis knowledge (i.e., report of being told they have a PTSD diagnosis by a healthcare provider). Veterans who met probable and provisional criteria for PTSD on the self-report PTSD checklist for DSM-5 were identified from the Comparative Health Assessment Interview Research Study (n = 2335). Weighted logistic regression was performed to identify demographic variables, clinical characteristics, and social determinants of health (e.g., economic instability, homelessness, healthcare coverage) associated with PTSD diagnosis knowledge among post-9/11 veterans. Approximately 62% of veterans with probable and provisional PTSD had PTSD diagnosis knowledge. Predictors with the strongest associations included another mental health diagnosis (OR = 6.10, CI95:4.58,8.12) and having Veterans Affairs (VA) healthcare coverage (OR = 2.63, CI95:1.97,3.51). Veterans with combat or sexual trauma were more likely to have PTSD diagnosis knowledge than those with different trauma types. Results suggest veterans with VA healthcare coverage and military-related trauma are more likely to be informed by a healthcare professional about a PTSD diagnosis. Further research is needed to improve PTSD diagnosis knowledge for those with non-military-related trauma and those without VA healthcare coverage.
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Affiliation(s)
- Nicholas Holder
- San Francisco Veterans Affairs Health Care System, United States; University of California, San Francisco School of Medicine, United States.
| | - Rachel M Ranney
- San Francisco Veterans Affairs Health Care System, United States; University of California, San Francisco School of Medicine, United States; Sierra Pacific Mental Illness Research, Education, and Clinical Center, United States
| | - Paul A Bernhard
- Health Outcomes Military Exposures Epidemiology Program, Patient Care Services, U.S. Department of Veterans Affairs, United States
| | - Ryan Holliday
- Department of Veterans Affairs Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention, United States; University of Colorado Anschutz Medical Campus, Department of Psychiatry, United States
| | - Dawne Vogt
- Women's Health Sciences Division, National Center for Posttraumatic Stress Disorder, VA Boston Healthcare System, United States; Boston University School of Medicine, United States
| | - Claire A Hoffmire
- Department of Veterans Affairs Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention, United States; University of Colorado Anschutz Medical Campus, Department of Physical Medicine and Rehabilitation, United States
| | - John R Blosnich
- Suzanne Dworak-Peck School of Social Work, University of Southern California, United States; Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, United States
| | - Aaron I Schneiderman
- Health Outcomes Military Exposures Epidemiology Program, Patient Care Services, U.S. Department of Veterans Affairs, United States
| | - Shira Maguen
- San Francisco Veterans Affairs Health Care System, United States; University of California, San Francisco School of Medicine, United States; Sierra Pacific Mental Illness Research, Education, and Clinical Center, United States
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2
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Bogolepova AN. [Cognitive impairment in post-traumatic stress disorder]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:69-74. [PMID: 38884432 DOI: 10.17116/jnevro202412405169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Post-traumatic stress disorder (PTSD) is a common mental health disorder, with an incidence of up to 12.5% among primary care patients. Most often, PTSD is detected in combat veterans, victims of terrorist attacks and terror, but it can also be a consequence of traumatic brain injury and medical interventions. Impaired cognitive functioning is a key feature of PTSD, including attention deficits and reduced processing speed, executive dysfunction, and impairments in verbal learning and memory. Cognitive impairments in PTSD are significantly persistent and are largely similar in nature to neuropsychological impairments in neurodegenerative pathology. Possible pathogenetic mechanisms underlying PTSD are the development of neuroinflammation, oxidative stress and decreased production of neurotrophic factors. One of the promising areas of treatment is the use of Cerebrolysin, which has powerful neurotrophic and anti-inflammatory activity.
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Affiliation(s)
- A N Bogolepova
- Pirogov Russian National Research Medical University, Moscow, Russia
- Federal Center of Brain Research and Neurotechnologies, Moscow, Russia
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3
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Hamblen JL, Szafranski S, Ranney RM, Grubaugh AL. Development and feasibility pilot of Considering PTSD Treatment: An online intervention with peer support. Internet Interv 2023; 34:100684. [PMID: 37920732 PMCID: PMC10618498 DOI: 10.1016/j.invent.2023.100684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 10/09/2023] [Accepted: 10/18/2023] [Indexed: 11/04/2023] Open
Abstract
Considering PTSD Treatment is an online program adapted from the National Center for PTSD's AboutFace website. Developed to help veterans overcome barriers to seeking treatment for posttraumatic stress disorder (PTSD), the program features videos of veterans describing PTSD and what treatment was like. Peer specialists are available at the beginning and end to chat with participants. We describe initial pilot feasibility data in 50 veterans recruited through online ads who screened positive for PTSD and were not currently in treatment. Eighty percent of participants who consented enrolled in the program and 64.0 % completed all modules. On average, participants rated the program at least "moderately" helpful and over 90 % reported feeling more knowledgeable about PTSD and PTSD treatment. Of the 21 participants who completed the one month follow-up, 52.4 % said they had talked to or were assessed by a provider and 61.9 % said they started treatment. There was not a significant change in stigma scores from baseline to follow-up. Results provide initial support for the feasibility, acceptability, and effectiveness of Considering PTSD Treatment for increasing treatment seeking readiness and support the need for a larger randomized controlled trial.
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Affiliation(s)
- Jessica L. Hamblen
- National Center for PTSD, VA Medical Center (166D), 215 North Main Street, White River Junction, VT 05059, USA
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, NH 03755, USA
| | - Sarah Szafranski
- Ralph H. Johnson VA Health Care System, Charleston, SC 29401, USA
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Rachel M. Ranney
- San Francisco VA Health Care System, 4150 Clement St, San Francisco, CA 94121, USA
- University of California – San Francisco, 401 Parnassus Ave, San Francisco, CA 94143, USA
- Sierra Pacific Mental Illness Research Education, and Clinical Center, 150 Clement St, San Francisco, CA 94121, USA
| | - Anouk L. Grubaugh
- Ralph H. Johnson VA Health Care System, Charleston, SC 29401, USA
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC 29425, USA
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Morse JL, Fischer IC, Na PJ, Afari N, Pietrzak RH. Functional decline during the COVID-19 pandemic among U.S. military veterans: Results from the National Health and Resilience in Veterans Study. Int J Geriatr Psychiatry 2023; 38:e6040. [PMID: 38072628 DOI: 10.1002/gps.6040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 11/28/2023] [Indexed: 12/18/2023]
Abstract
OBJECTIVES The coronavirus disease-2019 pandemic has contributed to widespread social and economic stressors, along with substantial health problems, including loss of life. To date, however, relatively few studies have examined the prevalence and correlates of declines in mental and physical functioning in U.S. military veterans, an older and potentially vulnerable segment of the U.S. adult population. METHODS Data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study, a nationally representative, longitudinal study of 3078 veterans. Veterans were surveyed prior to the pandemic (pre-pandemic) and 1 year later during the height of the pandemic (peri-pandemic). Multivariable analyses were conducted to identify risk and protective variables associated with pre-to-peri pandemic declines in self-reported physical and mental functioning. RESULTS The prevalence of veterans who experienced functional decline (≥0.5 standard deviation reductions) pre-to-peri-pandemic was 18.1% (N = 541) for physical functioning and 18.3% (N = 547) for mental functioning. Older age, greater adverse childhood experiences (ACEs), and pandemic-related posttraumatic stress symptoms were the strongest correlates of physical functional decline, while greater ACEs, loneliness, pandemic-related posttraumatic and social restriction stress symptoms, and lower protective psychosocial characteristics were the strongest correlates of mental functional decline. CONCLUSIONS Although the majority of U.S. Veterans showed functional maintenance or improvement 1 year into the pandemic, nearly one-in-five experienced a decline in physical or mental functioning. Results could help inform identification of veterans who may be at risk for functional decline during large-magnitude stressors, such as national or global pandemics.
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Affiliation(s)
- Jessica L Morse
- VA San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Ian C Fischer
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
- U.S. Department of Veterans Affairs National Center for PTSD, VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Peter J Na
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Niloofar Afari
- VA San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, California, USA
- VA Center of Excellence for Stress and Mental Health, San Diego, California, USA
| | - Robert H Pietrzak
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
- U.S. Department of Veterans Affairs National Center for PTSD, VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
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5
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Ely SL, Zundel CG, Gowatch LC, Evanski JM, Bhogal A, Carpenter C, Shampine M, Marusak H. Attention, attention! Posttraumatic stress disorder is associated with altered attention-related brain function. Front Behav Neurosci 2023; 17:1244685. [PMID: 37670803 PMCID: PMC10476007 DOI: 10.3389/fnbeh.2023.1244685] [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: 06/22/2023] [Accepted: 08/01/2023] [Indexed: 09/07/2023] Open
Abstract
Posttraumatic stress disorder (PTSD) is a debilitating condition characterized by altered arousal, mood, and cognition. Studies report attentional alterations such as threat bias in individuals with PTSD, though this work has largely been conducted within emotionally-charged contexts (e.g., threatening stimuli). Emerging behavioral evidence suggests that PTSD-related attention deficits exist even in the absence of threatening cues or anxiety triggers. However, the role and functioning of attention brain circuits as they relate to PTSD remains underexplored. In this mini review, we highlight recent work using non-emotional stimuli to investigate the neurobiology of attention and disruptions to attention-related brain function among individuals with PTSD. We then discuss gaps in the current literature, including questions pertaining to the neural circuitry of attentional alterations in PTSD, as well as the contributions that trauma exposure, PTSD symptoms, comorbidities, and pre-existing vulnerabilities may have in this relationship. Finally, we suggest future directions for this emerging area of research, which may further inform knowledge surrounding the neurobiological underpinnings of PTSD and potential treatments.
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Affiliation(s)
- Samantha L. Ely
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, United States
- Translational Neuroscience PhD Program, Wayne State University School of Medicine, Detroit, MI, United States
| | - Clara G. Zundel
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, United States
| | - Leah C. Gowatch
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, United States
| | - Julia M. Evanski
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, United States
- Neuroscience Graduate Program, University of Michigan, Ann Arbor, MI, United States
| | - Amanpreet Bhogal
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, United States
| | - Carmen Carpenter
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, United States
| | - MacKenna Shampine
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, United States
| | - Hilary Marusak
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, United States
- Translational Neuroscience PhD Program, Wayne State University School of Medicine, Detroit, MI, United States
- Department of Pharmacology, Wayne State University School of Medicine, Detroit, MI, United States
- Merrill Palmer Skillman Institute, Wayne State University, Detroit, MI, United States
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6
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Choi JJ, Martins JS, Hwang S, Sinha R, Seo D. Neural correlates linking trauma and physical symptoms. Psychiatry Res Neuroimaging 2022; 327:111560. [PMID: 36327865 PMCID: PMC9757618 DOI: 10.1016/j.pscychresns.2022.111560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 10/13/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022]
Abstract
Trauma and chronic pain frequently co-occur, but the underlying neurological mechanisms are poorly understood. The current study investigated the neural correlates of stress and physical symptoms in trauma patients using functional magnetic resonance imaging (fMRI) and follow-up smartphone surveys. Participants were 10 patients diagnosed with Trauma- and Stressor-Related Disorders and 18 demographically-matched healthy controls who completed a fMRI stress provocation task in which they viewed stressful and neutral-relaxing images. Subsequently, participants completed daily smartphone surveys which prospectively monitored their stress and physical symptoms for 30 days. The trauma group experienced a significantly higher frequency of physical symptoms than controls during the follow-up period. During stress, trauma patients exhibited increased activity in the hippocampus, insula, and sensorimotor areas, but decreased activity in the ventromedial prefrontal cortex (vmPFC), lateral prefrontal cortex (LPFC), and dorsal striatum relative to controls. In all participants, higher physical symptom frequency was significantly associated with a hyperactive left hippocampal response to stress. The current study reports that trauma is characterized by greater physical symptoms and decreased prefrontal but increased limbic responses to stress. Our findings suggest that trauma may increase physical health symptoms by compromising hippocampal function, which could also increase vulnerability to stress- and pain-related disorders.
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Affiliation(s)
- Justin J Choi
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States of America.
| | - Jorge S Martins
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States of America; William James Center for Research, ISPA-Instituto Universitário, Lisbon, Portugal
| | - Seungju Hwang
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States of America
| | - Rajita Sinha
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States of America; Department of Neuroscience, Yale University School of Medicine, New Haven, CT, United States of America
| | - Dongju Seo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States of America.
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7
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Analysis of the bidirectional relationships between posttraumatic stress and depression symptoms with physical health functioning in post-9/11 veteran men and women deployed to a war zone. J Psychosom Res 2022; 162:111034. [PMID: 36099750 DOI: 10.1016/j.jpsychores.2022.111034] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Many war-zone deployed post-9/11 veterans report negative mental health symptoms related to their military service, which can have consequences for physical health symptoms and the impact of physical health on functioning. The current study examined the longitudinal, bidirectional relationships between mental health symptoms and physical health functioning in veteran men and women, allowing for exploration of gender differences. METHODS A sample of 1032 post-9/11 veterans (women: n = 554; men: n = 478) who recently returned from a war-zone deployment completed self-report measures of posttraumatic stress disorder (PTSD) symptoms, depression symptoms, and physical health functioning at 3 time points spanning approximately 7 years. Gender-stratified longitudinal cross-lagged panel analyses were used to examine bidirectional relationships. RESULTS PTSD symptom severity was negatively associated with physical health functioning across time. For women, associations were reciprocal, such that those reporting poorer physical health functioning reported more severe PTSD symptoms at later time points. Men with greater PTSD symptom severity reported poorer physical health functioning at later time points, but there was no evidence of bidirectionality. Men and women with more severe depression symptoms reported worse later physical health functioning, which further exacerbated depression symptoms across time. CONCLUSIONS Findings showed that individual differences in mental health symptoms both set the stage for and were impacted by physical health functioning in post-9/11 veterans. Although additional research is needed, the current study suggests that healthcare approaches that consider the whole person, such as through integration of mental and physical health treatments, may be particularly relevant for post-9/11 veterans.
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8
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Smith DL, Kovacevic M, Montes M, Pridgen S, Held P. Improving mental, physical, and social functioning through participation in a 3-week cognitive processing therapy-based intensive PTSD treatment. J Anxiety Disord 2022; 88:102560. [PMID: 35367875 DOI: 10.1016/j.janxdis.2022.102560] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/07/2022] [Accepted: 03/19/2022] [Indexed: 11/16/2022]
Abstract
Research has supported the utility of brief intensive treatment programs (ITPs) which utilize interventions, such as Cognitive Processing Therapy (CPT), for reducing severity of symptoms among veterans with posttraumatic stress disorder (PTSD). These treatments have produced large overall reductions in PTSD severity and demonstrated the persistence of these gains following treatment. However, the potential effects of ITPs on mental, physical, and social functioning following treatment completion has been largely unexplored. We utilized data from 204 veterans and 5 service members who completed a 3-week CPT-based ITP and 3-month follow-up assessments. We used a two-stage mixed effects location-scale model approach to initially model each participant's amount of PTSD change over time and used these estimates to predict mental, physical, and social functioning three months following treatment. Veterans reported moderate improvements in mental, physical, and social functioning from pre-treatment to 3-month follow-up (ds = 0.52,.42,.55, and.47, respectively). Results indicated that reductions in PTSD severity during treatment, rather than fluctuation in symptom reporting from one assessment to the next, significantly predicted improved mental, physical, and social functioning at follow-up. This study supports the ability of ITPs to enact meaningful improvement in functioning among veterans with PTSD in a short timeframe.
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Affiliation(s)
- Dale L Smith
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA; Behavioral Sciences, Olivet Nazarene University, Bourbonnais, IL, USA.
| | - Merdijana Kovacevic
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Mauricio Montes
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Sarah Pridgen
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Philip Held
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
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9
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Holder N, Shiner B, Li Y, Madden E, Neylan TC, Seal KH, Lujan C, Patterson OV, DuVall SL, Maguen S. Determining the median effective dose of prolonged exposure therapy for veterans with posttraumatic stress disorder. Behav Res Ther 2020; 135:103756. [PMID: 33157475 DOI: 10.1016/j.brat.2020.103756] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 08/14/2020] [Accepted: 10/16/2020] [Indexed: 10/23/2022]
Abstract
Prolonged exposure therapy (PE) is an effective treatment for posttraumatic stress disorder (PTSD). Identifying metrics of treatment response can guide treatment delivery. The median effective dose represents the number of sessions at which there is a 50% probability of clinically meaningful improvement (i.e., 10-point reduction in PTSD checklist). The goal of the current study was to investigate the median effective dose of PE. We identified a cohort of Iraq and Afghanistan war veterans who received psychotherapy for PTSD in the Veterans Health Administration between 2001 and 2017. From this cohort, 10,234 veterans who received PE (as identified using natural language processing) and had ≥2 PTSD symptom measures were included in analyses. To determine how the number of PE sessions and covariates affected clinically meaningful improvement, we utilized a Cox proportional hazards regression, followed by Kaplan-Meier curves to determine the median effective dose. The median effective dose of PE was four sessions. Although some covariates were found to be statistically significant predictors of clinically meaningful improvement (e.g., age, gender, PTSD medications, and depressive disorder comorbidity), these effects were small. Clinicians and patients should consider evaluating treatment response after four sessions to determine preliminary effectiveness of PE.
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Affiliation(s)
- Nicholas Holder
- San Francisco Veterans Affairs Health Care System, United States; Sierra Pacific Mental Illness Research, Education, and Clinical Center, United States; University of California San Francisco School of Medicine, United States.
| | - Brian Shiner
- White River Junction Veterans Affairs Medical Center, United States; Geisel School of Medicine at Dartmouth, United States; National Center for Posttraumatic Stress Disorder, Executive Division, United States
| | - Yongmei Li
- San Francisco Veterans Affairs Health Care System, United States
| | - Erin Madden
- San Francisco Veterans Affairs Health Care System, United States
| | - Thomas C Neylan
- San Francisco Veterans Affairs Health Care System, United States; Sierra Pacific Mental Illness Research, Education, and Clinical Center, United States; University of California San Francisco School of Medicine, United States
| | - Karen H Seal
- San Francisco Veterans Affairs Health Care System, United States; University of California San Francisco School of Medicine, United States
| | - Callan Lujan
- San Francisco Veterans Affairs Health Care System, United States
| | - Olga V Patterson
- Department of Veterans Affairs Salt Lake City Health Care System, United States; University of Utah School of Medicine, United States
| | - Scott L DuVall
- Department of Veterans Affairs Salt Lake City Health Care System, United States; University of Utah School of Medicine, United States
| | - Shira Maguen
- San Francisco Veterans Affairs Health Care System, United States; Sierra Pacific Mental Illness Research, Education, and Clinical Center, United States; University of California San Francisco School of Medicine, United States
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10
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Lahav Y, Stein JY, Hasson R, Solomon Z. Impostorism, subjective age, and perceived health among aging veterans. Soc Sci Med 2020; 258:113082. [PMID: 32504914 DOI: 10.1016/j.socscimed.2020.113082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/15/2020] [Accepted: 05/22/2020] [Indexed: 11/19/2022]
Abstract
RATIONALE Aging veterans often suffer from increased vulnerability, manifested among other things in old subjective age and poor perceived health. Though research has documented the contribution of trauma related variables to these negative appraisals, their associations with impostorism (i.e., the subjective experience that one is less adequate than others perceive) remain unexamined. OBJECTIVE Filling this gap, this study explored the relations between impostorism and subjective age and perceived health among aging combat veterans. METHOD The study was conducted among 146 Israeli veterans of the 1973 Yom Kippur War. Participants were assessed for combat exposure, Posttraumatic Stress Disorder (PTSD) symptoms, and health-related behaviors during middle adulthood (1991; T1), and for subjective age, perceived health, impostorism, PTSD symptoms, and depressive symptoms during old age (2018; T2). RESULTS The veterans' impostorism was associated with relatively old subjective age and poor perceived health, above and beyond the effects of age, health-related behaviors, combat exposure, depressive symptoms, and PTSD symptoms. CONCLUSIONS The current results suggest that impostorism may contribute to veterans' stress and negatively affect their evaluations regarding age and health.
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Affiliation(s)
- Yael Lahav
- Department of Occupational Therapy, Sackler Faculty of Medicine, Tel Aviv University, Israel.
| | - Jacob Y Stein
- I-Core Research Center for Mass Trauma, Bob Shapell School of Social Work, Tel-Aviv University, Israel
| | - Rachel Hasson
- Bob Shapell School of Social Work, Tel-Aviv University, Israel
| | - Zahava Solomon
- I-Core Research Center for Mass Trauma, Bob Shapell School of Social Work, Tel-Aviv University, Israel
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11
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Huguenard CJC, Cseresznye A, Evans JE, Oberlin S, Langlois H, Ferguson S, Darcey T, Nkiliza A, Dretsch M, Mullan M, Crawford F, Abdullah L. Plasma Lipidomic Analyses in Cohorts With mTBI and/or PTSD Reveal Lipids Differentially Associated With Diagnosis and APOE ε4 Carrier Status. Front Physiol 2020; 11:12. [PMID: 32082186 PMCID: PMC7005602 DOI: 10.3389/fphys.2020.00012] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 01/13/2020] [Indexed: 01/05/2023] Open
Abstract
The differential diagnosis between mild Traumatic Brain Injury (mTBI) sequelae and Post-Traumatic Stress Disorder (PTSD) is challenging due to their symptomatic overlap and co-morbidity. As such, there is a need to develop biomarkers which can help with differential diagnosis of these two conditions. Studies from our group and others suggest that blood and brain lipids are chronically altered in both mTBI and PTSD. Therefore, examining blood lipids presents a minimally invasive and cost-effective approach to identify promising biomarkers of these conditions. Using liquid chromatography-mass spectrometry (LC-MS) we examined hundreds of lipid species in the blood of healthy active duty soldiers (n = 52) and soldiers with mTBI (n = 21), PTSD (n = 34) as well as co-morbid mTBI and PTSD (n = 13) to test whether lipid levels were differentially altered with each. We also examined if the apolipoprotein E (APOE) ε4 allele can affect the association between diagnosis and peripheral lipid levels in this cohort. We show that several lipid classes are altered with diagnosis and that there is an interaction between diagnosis and the ε4 carrier status on these lipids. Indeed, total lipid levels as well as both the degree of unsaturation and chain lengths are differentially altered with diagnosis and ε4 status, specifically long chain unsaturated triglycerides (TG) and both saturated and mono-unsaturated diglycerides (DG). Additionally, an examination of lipid species reveals distinct profiles in each diagnostic group stratified by ε4 status, mainly in TG, saturated DG species and polyunsaturated phosphatidylserines. In summary, we show that peripheral lipids are promising biomarker candidates to assist with the differential diagnosis of mTBI and PTSD. Further, ε4 carrier status alone and in interaction with diagnosis has a strong influence on peripheral lipid levels. Therefore, examining ε4 status along with peripheral lipid levels could help with differential diagnosis of mTBI and PTSD.
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Affiliation(s)
- Claire J C Huguenard
- The Roskamp Institute, Sarasota, FL, United States.,School of Life, Health and Chemical Sciences, The Open University, Milton Keynes, United Kingdom.,James A. Haley Veterans' Hospital, Tampa, FL, United States
| | - Adam Cseresznye
- The Roskamp Institute, Sarasota, FL, United States.,James A. Haley Veterans' Hospital, Tampa, FL, United States
| | - James E Evans
- The Roskamp Institute, Sarasota, FL, United States.,James A. Haley Veterans' Hospital, Tampa, FL, United States
| | - Sarah Oberlin
- The Roskamp Institute, Sarasota, FL, United States.,James A. Haley Veterans' Hospital, Tampa, FL, United States
| | - Heather Langlois
- The Roskamp Institute, Sarasota, FL, United States.,James A. Haley Veterans' Hospital, Tampa, FL, United States
| | - Scott Ferguson
- The Roskamp Institute, Sarasota, FL, United States.,School of Life, Health and Chemical Sciences, The Open University, Milton Keynes, United Kingdom.,James A. Haley Veterans' Hospital, Tampa, FL, United States
| | - Teresa Darcey
- The Roskamp Institute, Sarasota, FL, United States.,James A. Haley Veterans' Hospital, Tampa, FL, United States
| | - Aurore Nkiliza
- The Roskamp Institute, Sarasota, FL, United States.,James A. Haley Veterans' Hospital, Tampa, FL, United States
| | - Michael Dretsch
- US Army Medical Research Directorate-West, Walter Reed Army Institute of Research, Joint Base Lewis-McChord, Tacoma, WA, United States.,U.S. Army Aeromedical Research Laboratory, Fort Rucker, AL, United States
| | - Michael Mullan
- The Roskamp Institute, Sarasota, FL, United States.,School of Life, Health and Chemical Sciences, The Open University, Milton Keynes, United Kingdom.,James A. Haley Veterans' Hospital, Tampa, FL, United States
| | - Fiona Crawford
- The Roskamp Institute, Sarasota, FL, United States.,School of Life, Health and Chemical Sciences, The Open University, Milton Keynes, United Kingdom.,James A. Haley Veterans' Hospital, Tampa, FL, United States
| | - Laila Abdullah
- The Roskamp Institute, Sarasota, FL, United States.,School of Life, Health and Chemical Sciences, The Open University, Milton Keynes, United Kingdom.,James A. Haley Veterans' Hospital, Tampa, FL, United States
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12
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Terock J, Hannemann A, Van der Auwera S, Janowitz D, Spitzer C, Bonk S, Völzke H, Grabe HJ. Posttraumatic stress disorder is associated with reduced vitamin D levels and functional polymorphisms of the vitamin D binding-protein in a population-based sample. Prog Neuropsychopharmacol Biol Psychiatry 2020; 96:109760. [PMID: 31518608 DOI: 10.1016/j.pnpbp.2019.109760] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/03/2019] [Accepted: 09/09/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Low levels of vitamin D were found to be associated with different mental disorders. However, the role of vitamin D in the pathogenesis of PTSD is unclear. In this study, we aimed at investigating whether PTSD is linked to reduced vitamin D levels and vitamin D deficiency. Moreover, we sought to investigate the role of the vitamin D-binding protein (also group-specific component or Gc) by testing if two functional polymorphisms (rs4588 and rs7041) were associated with vitamin D levels and PTSD. METHODS Serum levels of total 25(OH)D were measured in a general-population sample of the Study of Health in Pomerania (SHIP-1). The number of traumatic events and status of PTSD were assessed using the PTSD module of the Structured Clinical Interview for the DSM-IV. Study participants were genotyped for rs4588 and rs7041. Associations of 25(OH)D levels and the genotypes with PTSD were tested in subjects with at least one traumatic event (n = 1653). RESULTS 25(OH)D levels were inversely (OR: 0.96; p = 0.044) and vitamin D deficiency was positively (OR = 2.02; p = 0.028) associated with PTSD. Both polymorphisms of the Gc were associated with 25(OH)D levels and PTSD: Carriers of the CC-genotype of rs4588 showed significantly higher 25(OH)D levels (ß = 0.179, p < 0.001) and lower odds for PTSD (OR = 0.35; p = 0.023) compared to the AA-genotype. Likewise, carriers of the TT-allele of rs7041 showed lower 25(OH)D levels (-0.122; p < 0.001) and increased odds for PTSD (OR = 2.80; p = 0.015) compared to the GG-genotype. CONCLUSIONS Our results suggest that an altered vitamin D metabolism may be involved in the pathophysiology of PTSD. Also, genotypes of the Gc and thus Gc serum levels may impact on PTSD development over and above the effects of 25(OH)D. Our findings contribute to explain the associations of PTSD with different mental and physical disorders.
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Affiliation(s)
- Jan Terock
- Department of Psychiatry and Psychotherapy, HELIOS Hanseklinikum Stralsund, Rostocker Chaussee 70, 18437 Stralsund, Germany; Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Ellernholzstraße 1-2, 17475 Greifswald, Germany.
| | - Anke Hannemann
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, Greifswald, Germany; German Centre for Cardiovascular Research DZHK, Partner Site Greifswald, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany
| | - Sandra Van der Auwera
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Ellernholzstraße 1-2, 17475 Greifswald, Germany; German Center for Neurodegenerative Diseases DZNE, Site Rostock/Greifswald, Ellernholzstraße 1-2, 17475 Greifswald, Germany
| | - Deborah Janowitz
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Ellernholzstraße 1-2, 17475 Greifswald, Germany
| | - Carsten Spitzer
- Department of Psychosomatics and Psychotherapeutic Medicine, University Medicine Rostock, Gehlsheimer Straße 20, 18147 Rostock, Germany
| | - Sarah Bonk
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Ellernholzstraße 1-2, 17475 Greifswald, Germany
| | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Ellernholzstraße 1-2, Greifswald, Germany
| | - Hans Jörgen Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Ellernholzstraße 1-2, 17475 Greifswald, Germany; German Center for Neurodegenerative Diseases DZNE, Site Rostock/Greifswald, Ellernholzstraße 1-2, 17475 Greifswald, Germany
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