1
|
Liu S, Zeng Z, Qi Q, Yang Q, Hu Y. The Effect of Peer Relationships on Adolescent Loneliness: The Role of Psychological Resilience and the OXTR Gene. Psychol Res Behav Manag 2024; 17:2477-2489. [PMID: 38933337 PMCID: PMC11204807 DOI: 10.2147/prbm.s460393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024] Open
Abstract
Background Based on the gene-environment interaction paradigm, this study explored the effect of peer relationships on adolescent loneliness and the role of psychological resilience and the oxytocin receptor gene (OXTR). Methods A survey was conducted in a sample of 619 adolescents, and their oral cells were collected for DNA extraction and genotyping. Results The results showed that (1) both peer relationships and psychological resilience significantly affected adolescent loneliness; (2) psychological resilience partially mediated the relationship between peer relationships and loneliness in adolescents; (3) OXTR gene rs53576 polymorphism moderated both the first and second half of the indirect pathway of the mediation model. Specifically, carriers of the rs53576 polymorphism A/A genotype showed a significantly enhanced effect of peer relationships on adolescent psychological resilience, while carriers of the rs53576 polymorphism G/G genotype showed a significantly enhanced effect of psychological resilience on adolescent loneliness. Conclusion These findings helped elucidate the developmental mechanisms of adolescent loneliness in terms of peer relationships, psychological resilience, and OXTR gene polymorphisms.
Collapse
Affiliation(s)
- Shuangjin Liu
- School of Educational Science, Hunan Normal University, Changsha, 410006, People’s Republic of China
| | - Zihao Zeng
- School of Educational Science, Hunan Normal University, Changsha, 410006, People’s Republic of China
| | - Qi Qi
- School of Educational Science, Hunan Normal University, Changsha, 410006, People’s Republic of China
| | - Qin Yang
- School of Educational Science, Hunan Normal University, Changsha, 410006, People’s Republic of China
| | - Yiqiu Hu
- School of Educational Science, Hunan Normal University, Changsha, 410006, People’s Republic of China
| |
Collapse
|
2
|
Marazziti D, Fantasia S, Palermo S, Arone A, Massa L, Gambini M, Carmassi C. Main Biological Models of Resilience. CLINICAL NEUROPSYCHIATRY 2024; 21:115-134. [PMID: 38807984 PMCID: PMC11129343 DOI: 10.36131/cnfioritieditore20240201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
Objective Resilience is a complex process of adaptation to new conditions that would permit a positive outcome after adversities, traumas or other sources of stress. However, despite the growing interest in this topic, there is no universally accepted definition and no comprehensive bio-behavioural model. This systematic review aims to provide an overview of the main biological models that have been theorized to date, with a focus on new alternative theories to improve our understanding of the mechanisms underlying the development and strengthening of resilience, with potential implications for the prevention of some psychopathological disorders. Method This review was conducted according to PRISMA guidelines and includes 185 studies published in English in PubMed and Embase up to December 2023. Results Most studies use the stress-related model, which conceptualizes resilience as the absence of symptoms after the stressful event and mainly deal with the differences between stress-prone and resilient phenotypes in animals exposed to stress. However, the results of this search seem to suggest that resilience might be an independent construct with biological bases rooted in the stress system and the social brain, and widely sculptured by individual and environmental factors, especially early life events and affiliation. Conclusions This work contributes to ongoing efforts to understand the intricate mechanisms of resilience, while highlighting the potential of improving social relationships since our birth to promote coping strategies towards stress and traumas, and even a peaceful world.
Collapse
Affiliation(s)
- Donatella Marazziti
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
- Saint Camillus International University of Health and Medical Sciences, Rome, Italy
| | - Sara Fantasia
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Stefania Palermo
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Alessandro Arone
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Lucia Massa
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Matteo Gambini
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Claudia Carmassi
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| |
Collapse
|
3
|
Burback L, Brémault-Phillips S, Nijdam MJ, McFarlane A, Vermetten E. Treatment of Posttraumatic Stress Disorder: A State-of-the-art Review. Curr Neuropharmacol 2024; 22:557-635. [PMID: 37132142 PMCID: PMC10845104 DOI: 10.2174/1570159x21666230428091433] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 02/19/2023] [Accepted: 02/23/2023] [Indexed: 05/04/2023] Open
Abstract
This narrative state-of-the-art review paper describes the progress in the understanding and treatment of Posttraumatic Stress Disorder (PTSD). Over the last four decades, the scientific landscape has matured, with many interdisciplinary contributions to understanding its diagnosis, etiology, and epidemiology. Advances in genetics, neurobiology, stress pathophysiology, and brain imaging have made it apparent that chronic PTSD is a systemic disorder with high allostatic load. The current state of PTSD treatment includes a wide variety of pharmacological and psychotherapeutic approaches, of which many are evidence-based. However, the myriad challenges inherent in the disorder, such as individual and systemic barriers to good treatment outcome, comorbidity, emotional dysregulation, suicidality, dissociation, substance use, and trauma-related guilt and shame, often render treatment response suboptimal. These challenges are discussed as drivers for emerging novel treatment approaches, including early interventions in the Golden Hours, pharmacological and psychotherapeutic interventions, medication augmentation interventions, the use of psychedelics, as well as interventions targeting the brain and nervous system. All of this aims to improve symptom relief and clinical outcomes. Finally, a phase orientation to treatment is recognized as a tool to strategize treatment of the disorder, and position interventions in step with the progression of the pathophysiology. Revisions to guidelines and systems of care will be needed to incorporate innovative treatments as evidence emerges and they become mainstream. This generation is well-positioned to address the devastating and often chronic disabling impact of traumatic stress events through holistic, cutting-edge clinical efforts and interdisciplinary research.
Collapse
Affiliation(s)
- Lisa Burback
- Department of Psychiatry, University of Alberta, Edmonton, Canada
| | | | - Mirjam J. Nijdam
- ARQ National Psychotrauma Center, Diemen, The Netherlands
- Department of Psychiatry, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | | | - Eric Vermetten
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
- Department of Psychiatry, New York University Grossman School of Medicine, New York, USA
| |
Collapse
|
4
|
Quiroga Méndez MP. [Old age and attachment theory, a systematic review of attachment typology, continuity, prevalence and association with psychological and health variables in older adults]. Rev Esp Geriatr Gerontol 2023; 58:101421. [PMID: 37922612 DOI: 10.1016/j.regg.2023.101421] [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] [Received: 09/15/2021] [Revised: 09/20/2023] [Accepted: 09/25/2023] [Indexed: 11/07/2023]
Abstract
The aim of this paper is to review the research on attachment theory during old age in the last 10 years, in order to obtain: a) the prevalence of different types of attachment, b) the assessment of attachment methods, c) the relationship established between attachment and other psychosocial and health variables in the aging process. A systematic search of PsycINFO, PsycArticles, WOS, and Scopus identified 17 studies, in which attachment had been assessed in a population of 7118 older adults. The results of this research present a clear evolution and some differences, with respect to the previous systematic 2010 review. Regarding the prevalence of the different types of attachment, it is confirmed that secure attachment and avoidant attachment are more abundant in old age than in adulthood or youth people. There is no consensus on the instruments used for the evaluation, and results are presented that associate insecure attachment with depression, life satisfaction, physical illness and loneliness. The attachment construct appears as an explanatory and mediating variable, directly involved in the psychology and psychopathology of old age.
Collapse
|
5
|
Liu S, Huang R, Li A, Yu S, Yao S, Xu J, Tang L, Li W, Gan C, Cheng H. The role of the oxytocin system in the resilience of patients with breast cancer. Front Oncol 2023; 13:1187477. [PMID: 37781188 PMCID: PMC10534028 DOI: 10.3389/fonc.2023.1187477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 08/29/2023] [Indexed: 10/03/2023] Open
Abstract
Breast cancer is a grave traumatic experience that can profoundly compromise patients' psychological resilience, impacting their overall quality of life. The oxytocin system represents one of the essential neurobiological bases of psychological resilience and plays a critical role in regulating resilience in response to social or traumatic events during adulthood. Oxytocin, through its direct interaction with peripheral or central oxytocin receptors, has been found to have a significant impact on regulating social behavior. However, the precise mechanism by which the activation of peripheral oxytocin receptors leads to improved social is still not completely comprehended and requires additional research. Its activation can modulate psychological resilience by influencing estrogen and its receptors, the hypothalamic-pituitary-adrenal axis, thyroid function, 5-hydroxytryptamine metabolism levels, and arginine pressure release in breast cancer patients. Various interventions, including psychotherapy and behavioral measures, have been employed to improve the psychological resilience of breast cancer patients. The potential effectiveness of such interventions may be underpinned by their ability to modulate oxytocin release levels. This review provides an overview of the oxytocin system and resilience in breast cancer patients and identifies possible future research directions and interventions.
Collapse
Affiliation(s)
- Shaochun Liu
- Department of Oncology, The Second Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Runze Huang
- Department of Oncology, The Second Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Anlong Li
- Department of Oncology, The Second Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Sheng Yu
- Department of Oncology, The Second Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Senbang Yao
- Department of Oncology, The Second Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Jian Xu
- Department of Oncology, The Second Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Lingxue Tang
- Department of Oncology, The Second Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Wen Li
- Department of Oncology, The Second Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Chen Gan
- Department of Oncology, The Second Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Huaidong Cheng
- Department of Oncology, The Second Hospital of Anhui Medical University, Hefei, Anhui, China
- Shenzhen Clinical Medical School of Southern Medical University, Guangzhou, China
- Department of Oncology, Shenzhen Hospital of Southern Medical University, Shenzhen, Guangdong, China
| |
Collapse
|
6
|
Skolariki K, Vrahatis AG, Krokidis MG, Exarchos TP, Vlamos P. Assessing and Modelling of Post-Traumatic Stress Disorder Using Molecular and Functional Biomarkers. BIOLOGY 2023; 12:1050. [PMID: 37626936 PMCID: PMC10451531 DOI: 10.3390/biology12081050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 07/03/2023] [Accepted: 07/24/2023] [Indexed: 08/27/2023]
Abstract
Post-traumatic stress disorder (PTSD) is a complex psychological disorder that develops following exposure to traumatic events. PTSD is influenced by catalytic factors such as dysregulated hypothalamic-pituitary-adrenal (HPA) axis, neurotransmitter imbalances, and oxidative stress. Genetic variations may act as important catalysts, impacting neurochemical signaling, synaptic plasticity, and stress response systems. Understanding the intricate gene networks and their interactions is vital for comprehending the underlying mechanisms of PTSD. Focusing on the catalytic factors of PTSD is essential because they provide valuable insights into the underlying mechanisms of the disorder. By understanding these factors and their interplay, researchers may uncover potential targets for interventions and therapies, leading to more effective and personalized treatments for individuals with PTSD. The aforementioned gene networks, composed of specific genes associated with the disorder, provide a comprehensive view of the molecular pathways and regulatory mechanisms involved in PTSD. Through this study valuable insights into the disorder's underlying mechanisms and opening avenues for effective treatments, personalized interventions, and the development of biomarkers for early detection and monitoring are provided.
Collapse
Affiliation(s)
| | | | - Marios G. Krokidis
- Bioinformatics and Human Electrophysiology Laboratory, Department of Informatics, Ionian University, 49100 Corfu, Greece; (K.S.); (A.G.V.); (T.P.E.); (P.V.)
| | | | | |
Collapse
|
7
|
Marazziti D, Diep PT, Carter S, Carbone MG. Oxytocin: An Old Hormone, A Novel Psychotropic Drug And Possible Use In Treating Psychiatric Disorders. Curr Med Chem 2022; 29:5615-5687. [PMID: 35894453 DOI: 10.2174/0929867329666220727120646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 03/17/2022] [Accepted: 04/19/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Oxytocin is a nonapeptide synthesized in the paraventricular and supraoptic nuclei of the hypothalamus. Historically, this molecule has been involved as a key factor in the formation of infant attachment, maternal behavior and pair bonding and, more generally, in linking social signals with cognition, behaviors and reward. In the last decades, the whole oxytocin system has gained a growing interest as it was proposed to be implicated in etiopathogenesis of several neurodevelopmental and neuropsychiatric disorders. METHODS With the main goal of an in-depth understanding of the oxytocin role in the regulation of different functions and complex behaviors as well as its intriguing implications in different neuropsychiatric disorders, we performed a critical review of the current state of art. We carried out this work through PubMed database up to June 2021 with the search terms: 1) "oxytocin and neuropsychiatric disorders"; 2) "oxytocin and neurodevelopmental disorders"; 3) "oxytocin and anorexia"; 4) "oxytocin and eating disorders"; 5) "oxytocin and obsessive-compulsive disorder"; 6) "oxytocin and schizophrenia"; 7) "oxytocin and depression"; 8) "oxytocin and bipolar disorder"; 9) "oxytocin and psychosis"; 10) "oxytocin and anxiety"; 11) "oxytocin and personality disorder"; 12) "oxytocin and PTSD". RESULTS Biological, genetic, and epigenetic studies highlighted quality and quantity modifications in the expression of oxytocin peptide or in oxytocin receptor isoforms. These alterations would seem to be correlated with a higher risk of presenting several neuropsychiatric disorders belonging to different psychopathological spectra. Collaterally, the exogenous oxytocin administration has shown to ameliorate many neuropsychiatric clinical conditions. CONCLUSION Finally, we briefly analyzed the potential pharmacological use of oxytocin in patient with severe symptomatic SARS-CoV-2 infection due to its anti-inflammatory, anti-oxidative and immunoregulatory properties.
Collapse
Affiliation(s)
- Donatella Marazziti
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Italy.,Saint Camillus International University of Health and Medical Sciences, Rome, Italy
| | - Phuoc-Tan Diep
- Department of Histopathology, Royal Lancaster Infirmary, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, United Kingdom
| | - Sue Carter
- Director Kinsey Institute, Indiana University, Bloomington, IN, USA
| | - Manuel G Carbone
- Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, 21100 Varese, Italy
| |
Collapse
|
8
|
Oxytocin receptor genes moderate BDNF epigenetic methylation by childhood trauma. J Affect Disord 2022; 306:167-173. [PMID: 35314247 DOI: 10.1016/j.jad.2022.03.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 12/24/2021] [Accepted: 03/10/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Gene-Environment (G × E) interaction is of increasing importance in understanding the pathophysiology of posttraumatic stress disorder (PTSD). This study investigated the interaction effect of childhood traumatic experience and epigenetic methylation of brain-derived neurotrophic factor (BDNF) and a possible moderating effect of oxytocin receptor (OXTR) gene rs53576. METHODS Ninety-nine patients with PTSD and 81 healthy controls (HCs) were recruited. Clinical assessments, including the childhood trauma questionnaire (CTQ) and posttraumatic stress disorder Checklist (PCL) were performed. BDNF methylation and OXTR genotyping (A vs. G allele) were conducted through blood sampling. A two-way multivariate analysis and a moderated regression analysis were conducted to investigate the moderating effect of the OXTR gene on the relationship between CTQ and BDNF methylation. RESULTS As for the HC group, the interaction effect of the CTQ and OXTR genotype was significant on BDNF methylation, and the moderation model showed that CTQ and OXTR group are significant predictors of BDNF methylation. In the G-OXTR type, the high CTQ group showed a greater BDNF methylation level. As for the PTSD group, no interaction or moderation effects were found. LIMITATIONS The present study did not control the dosage, duration of medications, and different trauma types and the assessment of childhood trauma was based on self-report. CONCLUSIONS These results suggested that childhood traumatic experience showed a significant impact on BDNF methylation, and OXTR genes have a moderating effect on this epigenetic mechanism in people who have experienced the childhood traumatic episodes.
Collapse
|
9
|
Bell K, McMillin K, Ethridge LE. Bereft and Left: The interplay between insecure attachment, isolation, and neurobiology. DEVELOPMENTAL REVIEW 2022. [DOI: 10.1016/j.dr.2022.101020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
10
|
Tamman AJF, Wendt FR, Pathak GA, Krystal JH, Southwick SM, Sippel LM, Gelernter J, Polimanti R, Pietrzak RH. Attachment Style Moderates Polygenic Risk for Incident Posttraumatic Stress in U.S. Military Veterans: A 7-Year, Nationally Representative, Prospective Cohort Study. Biol Psychiatry 2022; 91:637-646. [PMID: 34955171 DOI: 10.1016/j.biopsych.2021.09.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/11/2021] [Accepted: 09/26/2021] [Indexed: 11/02/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) develops consequent to complex gene-by-environment interactions beyond the precipitating trauma. To date, however, no known study has used a prospective design to examine how polygenic risk scores (PRSs) interact with social-environmental factors such as attachment style to predict PTSD development. METHODS PRSs were derived from a genome-wide association study of PTSD symptoms (N = 186,689; Million Veteran Program cohort). We evaluated combined effects of PRS and attachment style in predicting incident PTSD in a 7-year, nationally representative cohort of trauma-exposed, European-American U.S. military veterans without PTSD (N = 1083). We also conducted multivariate gene-by-environment interaction and drug repositioning analyses to identify loci that interact with multiple environmental factors and potential pharmacotherapies that may be repurposed for this disorder. RESULTS Veterans with higher PTSD PRS were more likely to have an incident-positive screen for PTSD over 7 years. A gene-by-environment interaction was also observed, such that higher PRS only predicted incident PTSD in veterans with an insecure attachment style and not those with a secure attachment style. At an individual locus level, the strongest gene-by-environment interaction was observed for the rs4702 variant of the FURIN gene with cumulative lifetime trauma burden. Drug repositioning revealed that genes implicated in PRS are perturbated by the drug doxylamine. CONCLUSIONS Attachment style moderates polygenic risk for the development of PTSD in European-American veterans. These findings may inform PTSD prevention and treatment for veterans with high polygenic risk for PTSD and suggest a potential pharmacotherapeutic target for risk genes moderated by social-environmental factors.
Collapse
Affiliation(s)
- Amanda J F Tamman
- Department of Psychology, St John's University, Queens, New York; Mood and Anxiety Disorders Program, Baylor College of Medicine, Houston, Texas.
| | - Frank R Wendt
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut; VA Connecticut Healthcare System, West Haven, Connecticut
| | - Gita A Pathak
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut; VA Connecticut Healthcare System, West Haven, Connecticut
| | - John H Krystal
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut; Clinical Neurosciences Division, National Center for PTSD, West Haven, Connecticut
| | - Steven M Southwick
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Lauren M Sippel
- Executive Division, National Center for PTSD, White River Junction, Vermont; Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Joel Gelernter
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut; VA Connecticut Healthcare System, West Haven, Connecticut
| | - Renato Polimanti
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut; VA Connecticut Healthcare System, West Haven, Connecticut
| | - Robert H Pietrzak
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut; Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut; Clinical Neurosciences Division, National Center for PTSD, West Haven, Connecticut
| |
Collapse
|
11
|
Intranasal oxytocin administration impacts the acquisition and consolidation of trauma-associated memories: a double-blind randomized placebo-controlled experimental study in healthy women. Neuropsychopharmacology 2022; 47:1046-1054. [PMID: 34887528 PMCID: PMC8938422 DOI: 10.1038/s41386-021-01247-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 10/06/2021] [Accepted: 11/19/2021] [Indexed: 11/08/2022]
Abstract
Intrusive memories are a hallmark symptom of post-traumatic stress disorder (PTSD) and oxytocin has been implicated in the formation of intrusive memories. This study investigates how oxytocin influences the acquisition and consolidation of trauma-associated memories and whether these effects are influenced by individual neurobiological and genetic differences. In this randomized, double-blind, placebo-controlled study, 220 healthy women received either a single dose of intranasal 24IU oxytocin or a placebo before exposure to a trauma film paradigm that solicits intrusive memories. We used a "general random forest" machine learning approach to examine whether differences in the noradrenergic and hypothalamic-pituitary-adrenal axis activity, polygenic risk for psychiatric disorders, and genetic polymorphism of the oxytocin receptor influence the effect of oxytocin on the acquisition and consolidation of intrusive memories. Oxytocin induced significantly more intrusive memories than placebo did (t(188.33) = 2.12, p = 0.035, Cohen's d = 0.30, 95% CI 0.16-0.44). As hypothesized, we found that the effect of oxytocin on intrusive memories was influenced by biological covariates, such as salivary cortisol, heart rate variability, and PTSD polygenic risk scores. The five factors that were most relevant to the oxytocin effect on intrusive memories were included in a Poisson regression, which showed that, besides oxytocin administration, higher polygenic loadings for PTSD and major depressive disorder were directly associated with a higher number of reported intrusions after exposure to the trauma film stressor. These results suggest that intranasal oxytocin amplifies the acquisition and consolidation of intrusive memories and that this effect is modulated by neurobiological and genetic factors. Trial registration: NCT03031405.
Collapse
|
12
|
Ryan M, Ryznar R. The Molecular Basis of Resilience: A Narrative Review. Front Psychiatry 2022; 13:856998. [PMID: 35599764 PMCID: PMC9120427 DOI: 10.3389/fpsyt.2022.856998] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/14/2022] [Indexed: 12/12/2022] Open
Abstract
Resilience refers to the adaptability of a person - an ability to "bounce-back" from stressors. We question if resilience can be strengthened, potentially to decrease the risk of stress-related disorders. Unfortunately, the molecular origins of resilience are complicated and not yet well understood. In this review, we examine the various physiological biomarkers of resilience, including the associated genes, epigenetic changes, and protein biomarkers associated with resilient phenotypes. In addition to assessing biomarkers that may indicate higher levels of resilience, we also review at length the many biomarkers that confer lower levels of resilience and may lead to disorders of low resilience, such as anxiety and depression. This large and encompassing review may help to identify the possible therapeutic targets of resilience. Hopefully these studies will lead to a future where stress-related disorders can be prevented, rather than treated.
Collapse
Affiliation(s)
- Megan Ryan
- College of Osteopathic Medicine, Rocky Vista University, Parker, CO, United States
| | - Rebecca Ryznar
- Molecular Biology, Department of Biomedical Sciences, Rocky Vista University, Parker, CO, United States
| |
Collapse
|
13
|
Cahill S, Chandola T, Hager R. Genetic Variants Associated With Resilience in Human and Animal Studies. Front Psychiatry 2022; 13:840120. [PMID: 35669264 PMCID: PMC9163442 DOI: 10.3389/fpsyt.2022.840120] [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: 12/20/2021] [Accepted: 04/19/2022] [Indexed: 11/15/2022] Open
Abstract
Resilience is broadly defined as the ability to maintain or regain functioning in the face of adversity and is influenced by both environmental and genetic factors. The identification of specific genetic factors and their biological pathways underpinning resilient functioning can help in the identification of common key factors, but heterogeneities in the operationalisation of resilience have hampered advances. We conducted a systematic review of genetic variants associated with resilience to enable the identification of general resilience mechanisms. We adopted broad inclusion criteria for the definition of resilience to capture both human and animal model studies, which use a wide range of resilience definitions and measure very different outcomes. Analyzing 158 studies, we found 71 candidate genes associated with resilience. OPRM1 (Opioid receptor mu 1), NPY (neuropeptide Y), CACNA1C (calcium voltage-gated channel subunit alpha1 C), DCC (deleted in colorectal carcinoma), and FKBP5 (FKBP prolyl isomerase 5) had both animal and human variants associated with resilience, supporting the idea of shared biological pathways. Further, for OPRM1, OXTR (oxytocin receptor), CRHR1 (corticotropin-releasing hormone receptor 1), COMT (catechol-O-methyltransferase), BDNF (brain-derived neurotrophic factor), APOE (apolipoprotein E), and SLC6A4 (solute carrier family 6 member 4), the same allele was associated with resilience across divergent resilience definitions, which suggests these genes may therefore provide a starting point for further research examining commonality in resilience pathways.
Collapse
Affiliation(s)
- Stephanie Cahill
- Evolution, Infection and Genomics, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom.,Faculty of Humanities, Cathie Marsh Institute for Social Research, The University of Manchester, Manchester, United Kingdom
| | - Tarani Chandola
- Faculty of Humanities, Cathie Marsh Institute for Social Research, The University of Manchester, Manchester, United Kingdom.,Methods Hub, Department of Sociology, Faculty of Social Sciences, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Reinmar Hager
- Evolution, Infection and Genomics, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| |
Collapse
|
14
|
Takayanagi Y, Onaka T. Roles of Oxytocin in Stress Responses, Allostasis and Resilience. Int J Mol Sci 2021; 23:ijms23010150. [PMID: 35008574 PMCID: PMC8745417 DOI: 10.3390/ijms23010150] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/17/2021] [Accepted: 12/19/2021] [Indexed: 02/06/2023] Open
Abstract
Oxytocin has been revealed to work for anxiety suppression and anti-stress as well as for psychosocial behavior and reproductive functions. Oxytocin neurons are activated by various stressful stimuli. The oxytocin receptor is widely distributed within the brain, and oxytocin that is released or diffused affects behavioral and neuroendocrine stress responses. On the other hand, there has been an increasing number of reports on the role of oxytocin in allostasis and resilience. It has been shown that oxytocin maintains homeostasis, shifts the set point for adaptation to a changing environment (allostasis) and contributes to recovery from the shifted set point by inducing active coping responses to stressful stimuli (resilience). Recent studies have suggested that oxytocin is also involved in stress-related disorders, and it has been shown in clinical trials that oxytocin provides therapeutic benefits for patients diagnosed with stress-related disorders. This review includes the latest information on the role of oxytocin in stress responses and adaptation.
Collapse
|
15
|
Crow TM, Levy KN, Bradley B, Fani N, Powers A. The roles of attachment and emotion dysregulation in the association between childhood maltreatment and PTSD in an inner-city sample. CHILD ABUSE & NEGLECT 2021; 118:105139. [PMID: 34091237 PMCID: PMC8292198 DOI: 10.1016/j.chiabu.2021.105139] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 04/01/2021] [Accepted: 05/23/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Most people will experience a traumatic event in their lifetime, but only a subset (<10%) will develop posttraumatic stress disorder (PTSD). OBJECTIVE To facilitate prevention and intervention of PTSD, it is important to understand how risk and resilience factors interact with one another to explain individual differences in risk for PTSD, especially in underprivileged groups, who often experience greater burden of trauma and PTSD. METHOD The current study utilized multiple and moderated regression to examine the relation between childhood maltreatment and adulthood PTSD risk in the context of various attachment patterns and emotion dysregulation in a sample (n = 856) of mostly low-income, African American participants. RESULTS Moderation analysis indicated that the strongest association between self-reported childhood maltreatment and PTSD symptoms was manifest in participants reporting the highest levels of both attachment anxiety and attachment avoidance (b = 0.22, 95% CI [0.15, 0.29], p < .001), whereas, among those low on both these dimensions (i.e., more securely attached participants), there was no significant association between childhood maltreatment and current PTSD (b = 0.07, 95% CI [-0.01, 0.14], p = .07). Separately, multiple regression predicting current PTSD symptoms revealed an effect size for the two attachment dimensions similar to that of emotion dysregulation, while controlling for childhood maltreatment. CONCLUSIONS These findings suggest more secure attachment may buffer against the deleterious effects of childhood maltreatment, and both attachment difficulties and emotion dysregulation serve as robust correlates of adulthood PTSD.
Collapse
Affiliation(s)
- Thomas M Crow
- Department of Psychology, Pennsylvania State University, USA
| | - Kenneth N Levy
- Department of Psychology, Pennsylvania State University, USA
| | - Bekh Bradley
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, USA; Atlanta VA Medical Center, Mental Health Services, USA
| | - Negar Fani
- Emory University School of Medicine, USA
| | - Abigail Powers
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, USA.
| |
Collapse
|
16
|
Zhou YG, Shang ZL, Zhang F, Wu LL, Sun LN, Jia YP, Yu HB, Liu WZ. PTSD: Past, present and future implications for China. Chin J Traumatol 2021; 24:187-208. [PMID: 33994278 PMCID: PMC8343811 DOI: 10.1016/j.cjtee.2021.04.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 03/30/2021] [Accepted: 04/18/2021] [Indexed: 02/04/2023] Open
Abstract
There has been a long history since human beings began to realize the existence of post-traumatic symptoms. Posttraumatic stress disorder (PTSD), a diagnostic category adopted in 1980 in the Diagnostic and Statistical Manual of Mental Disorders-Ⅲ, described typical clusters of psychiatric symptoms occurring after traumatic events. Abundant researches have helped deepen the understanding of PTSD in terms of epidemiological features, biological mechanisms, and treatment options. The prevalence of PTSD in general population ranged from 6.4% to 7.8% and was significantly higher among groups who underwent major public traumatic events. There has been a long way in the studies of animal models and genetic characteristics of PTSD. However, the high comorbidity with other stress-related psychiatric disorders and complexity in the pathogenesis of PTSD hindered the effort to find specific biological targets for PTSD. Neuroimage was widely used to elucidate the underlying neurophysiological mechanisms of PTSD. Functional MRI studies have showed that PTSD was linked to medial prefrontal cortex, anterior cingulate cortex and sub-cortical structures like amygdala and hippocampus, and to explore the functional connectivity among these brain areas which might reveal the possible neurobiological mechanism related to PTSD symptoms. For now, cognitive behavior therapy-based psychotherapy, including combination with adjunctive medication, showed evident treatment effects on PTSD. The emergence of more effective PTSD pharmacotherapies awaits novel biomarkers from further fundamental research. Several natural disasters and emergencies have inevitably increased the possibility of suffering from PTSD in the last two decades, making it critical to strengthen PTSD research in China. To boost PTSD study in China, the following suggestions might be helpful: (1) establishing a national psychological trauma recover project, and (2) exploring the mechanisms of PTSD with joint effort and strengthening the indigenized treatment of PTSD.
Collapse
Affiliation(s)
- Yao-Guang Zhou
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China
| | - Zhi-Lei Shang
- The Emotion & Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China
| | - Fan Zhang
- Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China
| | - Li-Li Wu
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China,The Emotion & Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China
| | - Lu-Na Sun
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China,The Emotion & Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China
| | - Yan-Pu Jia
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China,The Emotion & Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China
| | - Hai-Bo Yu
- Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China,Corresponding author.
| | - Wei-Zhi Liu
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China,The Emotion & Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China,Corresponding author. Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China.
| |
Collapse
|
17
|
Carmassi C, Marazziti D, Mucci F, Della Vecchia A, Barberi FM, Baroni S, Giannaccini G, Palego L, Massimetti G, Dell'Osso L. Decreased Plasma Oxytocin Levels in Patients With PTSD. Front Psychol 2021; 12:612338. [PMID: 34276462 PMCID: PMC8280334 DOI: 10.3389/fpsyg.2021.612338] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 03/24/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction Although the pathophysiology of post-traumatic stress disorder (PTSD) is still unclear, growing preclinical evidences suggest that oxytocin (OT), a pleiotropic hormone, is possibly involved. However, direct studies on OT levels or clinical trials with this exogenous hormone in patients with PTSD led to inconsistent findings. Therefore, the aim of the present study was at exploring and comparing the plasma OT levels in a group of patients with PTSD and matched healthy subjects as the control group. Materials and Methods Twenty-six outpatients (13 men, 13 women, mean age: 40.3 ± 11.5 years) suffering from PTSD, according to the Diagnostic and Statistical Manual for Mental Disorders, fifth edition (DSM-5), and 26 healthy subjects (13 men, 13 women, mean age: 43.8 ± 12.7 years) were included. The patients were assessed through the structured clinical interview for DSM-5 research version, patient edition (SCID-I/P), and the Impact for Event Scale revised (IES-R). All fasting subjects underwent three venous blood samples for the subsequent oxytocin radioimmunoassay. We used unpaired Student’s t-test to assess OT levels and the intergroup difference of demographic characteristics, while anxiety, avoidance, and hyperarousal scores were compared among groups adjusting for the effect of gender and age by means of analysis of covariance (ANCOVA). The correlations between different variables were investigated by Pearson’s method. Results The most common traumatic events of patients with PTSD were the following: severe car accident, physical violence, sexual violence, sudden death of a loved one, and natural disaster. The IES total score was 55 ± 15. Student’s t-test revealed that the patients showed significantly lower OT levels (mean ± SD, pg/ml) than healthy control subjects (4.37 ± 1.61 vs 5.64 ± 2.17, p < 0.001). We detected no correlation between the IES total score, subscales, or single items and OT plasma levels. Again, no difference between men and women was detected in the patients’ group, while healthy control women showed higher OT levels than men. Discussion Our study, while reporting the presence of decreased plasma OT levels in outpatients with PTSD of both sexes, as compared with healthy control subjects, would support the possible involvement of OT in the pathophysiology of PTSD. However, given the complexity of the clinical picture, future investigations are necessary to better deepen the role and level of OT in PTSD.
Collapse
Affiliation(s)
- Claudia Carmassi
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Donatella Marazziti
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy.,Unicamillus-Saint Camillus International University of Medical and Health Sciences, Rome, Italy
| | - Federico Mucci
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, Siena, Italy.,Department of Psychiatry, North-Western Tuscany Region, NHS Local Health Unit, Viareggio, Italy
| | - Alessandra Della Vecchia
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Filippo Maria Barberi
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Stefano Baroni
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | | | | | - Gabriele Massimetti
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| |
Collapse
|
18
|
Oxytocin receptor variant rs53576 genotype is associated with dysphoric arousal symptoms of DSM-5 posttraumatic stress disorder in Chinese earthquake survivors. Chin J Traumatol 2021; 24:209-213. [PMID: 33863620 PMCID: PMC8343244 DOI: 10.1016/j.cjtee.2021.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 02/27/2021] [Accepted: 03/20/2021] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Evidence suggests that the oxytocin receptor (OXTR) gene may be involved in the psychopathology of posttraumatic stress disorder (PTSD). This study aimed to investigate the effects of OXTR rs53576 genotype on PTSD symptoms introduced in the Diagnostic and Statistical Manual, Fifth Edition (DSM-5). METHODS This study was a cross-sectional study conducted among 1140 adults who had personally experienced the Wenchuan earthquake. PTSD symptoms were measured with the PTSD checklist for DSM-5. A custom-by-design 2 × 48-Plex SNPscanTM Kit were used to determine the OXTR rs53576. Multiple regression models were used to analyze the independent and interactive effects of OXTR rs53576 genotype and earthquake exposure on the severity of total PTSD symptoms and different dimensions of PTSD symptoms. RESULTS The results revealed that the rs53576 genotype could significantly predict PTSD symptoms (β = 0.055, p = 0.045). Further analysis showed that the rs53576 genotype was only significantly associated with dysphoric arousal symptoms of PTSD (β = 0.080, p = 0.005). The rs53576 genotype × earthquake exposure interaction had no significant effect on different symptom clusters (p > 0.05). CONCLUSION This study showed that the rs53576 genotype was only associated with the dysphoric arousal symptoms but not with other symptom clusters of PTSD. These findings support the role of the OXTR on the psychopathology of PTSD and help us to understand the genetic basis of PTSD.
Collapse
|
19
|
Tamman AJF, Wendt FR, Pathak GA, Krystal JH, Montalvo-Ortiz JL, Southwick SM, Sippel LM, Gelernter J, Polimanti R, Pietrzak RH. Attachment Style Moderates Polygenic Risk for Posttraumatic Stress in United States Military Veterans: Results From the National Health and Resilience in Veterans Study. Biol Psychiatry 2021; 89:878-887. [PMID: 33276944 DOI: 10.1016/j.biopsych.2020.09.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/15/2020] [Accepted: 09/15/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND A polygenic risk score (PRS) derived from genome-wide association studies of posttraumatic stress disorder (PTSD) may inform risk for this disorder. To date, however, no known study has examined whether social environmental factors such as attachment style may moderate the relation between PRS and PTSD. METHODS We evaluated main and interactive effects of PRS and attachment style on PTSD symptoms in a nationally representative sample of trauma-exposed European-American U.S. military veterans (N = 2030). PRS was derived from a genome-wide association study of PTSD re-experiencing symptoms (N = 146,660) in the Million Veteran Program cohort. Using one-sample Mendelian randomization with data from the UK Biobank (N = 115,099), we evaluated the effects of re-experiencing PRS and attachment style on PTSD symptoms. RESULTS Higher re-experiencing PRS and secure attachment style were independently associated with PTSD symptoms. A significant PRS-by-attachment style interaction was also observed (β = -.11, p = .006), with a positive association between re-experiencing PRS and PTSD symptoms observed only among veterans with an insecure attachment style. One-sample Mendelian randomization analyses suggested that the association between PTSD symptoms and attachment style is bidirectional. PRS enrichment analyses revealed a significant interaction between attachment style and a variant mapping to the IGSF11 gene (rs151177743, p = 2.1 × 10-7), which is implicated in regulating excitatory synaptic transmission and plasticity. CONCLUSIONS Attachment style may moderate polygenic risk for PTSD symptoms, and a novel locus implicated in synaptic transmission and plasticity may serve as a possible biological mediator of this association. These findings may help inform interpersonally oriented treatments for PTSD for individuals with high polygenic risk for this disorder.
Collapse
Affiliation(s)
| | - Frank R Wendt
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Gita A Pathak
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - John H Krystal
- Clinical Neurosciences Division, U.S. Department of Veterans Affairs National Center for PTSD, VA Connecticut Healthcare System, New Haven, Connecticut; Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | | | - Steven M Southwick
- Clinical Neurosciences Division, U.S. Department of Veterans Affairs National Center for PTSD, VA Connecticut Healthcare System, New Haven, Connecticut; Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Lauren M Sippel
- Executive Division, National Center for PTSD, White River Junction, Vermont; Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Joel Gelernter
- Clinical Neurosciences Division, U.S. Department of Veterans Affairs National Center for PTSD, VA Connecticut Healthcare System, New Haven, Connecticut; Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Renato Polimanti
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Robert H Pietrzak
- Clinical Neurosciences Division, U.S. Department of Veterans Affairs National Center for PTSD, VA Connecticut Healthcare System, New Haven, Connecticut; Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| |
Collapse
|
20
|
Rajkumar RP. Harnessing the Neurobiology of Resilience to Protect the Mental Well-Being of Healthcare Workers During the COVID-19 Pandemic. Front Psychol 2021; 12:621853. [PMID: 33815205 PMCID: PMC8012770 DOI: 10.3389/fpsyg.2021.621853] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 02/22/2021] [Indexed: 01/26/2023] Open
Abstract
Healthcare workers are at a high risk of psychological morbidity in the face of the COVID-19 pandemic. However, there is significant variability in the impact of this crisis on individual healthcare workers, which can be best explained through an appreciation of the construct of resilience. Broadly speaking, resilience refers to the ability to successfully adapt to stressful or traumatic events, and thus plays a key role in determining mental health outcomes following exposure to such events. A proper understanding of resilience is vital in enabling a shift from a reactive to a proactive approach for protecting and promoting the mental well-being of healthcare workers. Research in the past decade has identified six areas that provide promising leads in understanding the biological basis of individual variations in resilience. These are: (1) the key role played by the monoamines noradrenaline and serotonin, (2) the centrality of the hypothalamic-pituitary-adrenal axis in influencing stress vulnerability and resilience, (3) the intimate links between the immune system and stress sensitivity, (4) the role of epigenetic modulation of gene expression in influencing the stress response, (5) the role played by certain neuropeptides as a natural “brake” mechanism in the face of stress, and (6) the neurobiological mechanisms by which environmental factors, such as exercise, diet, and social support, influence resilience to subsequent life events. Though much of this research is still in its early stages, it has already provided valuable information on which strategies – including dietary changes, lifestyle modification, environmental modification, psychosocial interventions, and even pharmacological treatments – may prove to be useful in fostering resilience in individuals and groups. This paper examines the above evidence more closely, with a specific focus on the challenges faced by healthcare workers during the COVID-19 pandemic, and provides suggestions regarding how it may be translated into real-world interventions, as well as how the more tentative hypotheses advanced in this field may be tested during this critical period.
Collapse
Affiliation(s)
- Ravi Philip Rajkumar
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| |
Collapse
|
21
|
Written exposure therapy and app-delivered mindfulness-based meditation for PTSD and subthreshold PTSD in China: Design of a randomized controlled trial. Contemp Clin Trials Commun 2021; 22:100729. [PMID: 34007950 PMCID: PMC8111261 DOI: 10.1016/j.conctc.2021.100729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/16/2020] [Accepted: 01/15/2021] [Indexed: 11/22/2022] Open
Abstract
Background Posttraumatic stress disorder (PTSD) and subthreshold PTSD are still major global concerns, especially in developing areas short of mental health resources. Written exposure therapy (WET), a brief 5-session treatment, has been found to be effective in reducing PTSD symptoms, but no studies have examined it in an Eastern context. Mindfulness-based meditation mobile application may be a promising approach to reduce insomnia comorbid with PTSD. The current study aims to: 1) examine the effectiveness of WET for Chinese PTSD and subthreshold PTSD patients, and 2) examine the effectiveness of adding a mindfulness-based application (MBA) to WET for reducing comorbid insomnia. Methods The randomized controlled trial will enroll 150 adults with subthreshold/full PTSD and comorbid insomnia. Participants will be randomly assigned to written exposure therapy plus mindfulness-based application condition (WET + MBA, n = 50), written exposure therapy alone (WET, n = 50), or minimal contact control (MMC, n = 50). Clinical interview of the primary outcome (PTSD symptoms) will be administrated at baseline, posttreatment, 3- and 6- month follow-up, while self-reported PTSD symptoms and secondary outcomes (insomnia severity) will be administrated at baseline, every week and all follow-ups. Discussion This is the first study applying WET in Chinese PTSD patients, as well as examining a mindfulness-based mobile application as a treatment add-on for comorbid insomnia. Study findings will contribute to the knowledge of the effectiveness of WET and a mindfulness-based mobile application, and the development of a culture-adapted treatment protocol. Trial registration ChiCTR, ChiCTR2000034119. Registered 24 June 2020, http://www.chictr.org.cn/showproj.aspx?proj=55,467.
Collapse
Key Words
- BAI, Beck Anxiety Inventory
- BDI-II, Beck Depression Inventory-II
- CAPS5, Clinician-Administered PTSD Scale for DSM-5
- CBT-i, cognitive behavioral therapy-insomnia
- CERQ, Cognitive Emotion Regulation Questionnaire
- CPT, cognitive processing therapy
- Chinese
- CiOQ-S, Short Form of the Changes in Outlook Questionnaire
- DSM-5, Diagnostic and Statistical Manual of Mental Disorders-5
- GHS, General Happiness Scale
- GQ-5, Gratitude Questionnaire-5
- HFS, Heartland Forgiveness Scale
- HPA-axis, hypothalamic–pituitary–adrenal axis
- ISI, Insomnia Severity Index
- MBA, mindfulness-based application
- MCC, minimal contact control
- MHApp, mental health application
- MLMs, Multilevel models
- MLQ, Meaning in Life Questionnaire
- MM, mindfulness-based meditation
- Mindfulness
- PCL-5, PTSD CheckList-DSM5
- PE, prolonged exposure
- PSSI-5, PTSD
- PTCI, Posttraumatic Cognitions Inventory
- PTG, posttraumatic growth
- PTGI, Post Traumatic Growth Inventory
- PTSD
- PTSD, Post-traumatic stress disorder
- RCT, randomized controlled trial
- SUDs, Subjective Units of Distress Scale
- Symptom Scale, Interview Version for DSM-5
- WET, written exposure therapy
- WET + MBA, written exposure therapy plus mindfulness-based App
- Written exposure therapy
- app, application
- mHealth
- sIgA, secretory Immunoglobulin A
Collapse
|
22
|
Fogle BM, Tsai J, Mota N, Harpaz-Rotem I, Krystal JH, Southwick SM, Pietrzak RH. The National Health and Resilience in Veterans Study: A Narrative Review and Future Directions. Front Psychiatry 2020; 11:538218. [PMID: 33362593 PMCID: PMC7755975 DOI: 10.3389/fpsyt.2020.538218] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 10/27/2020] [Indexed: 12/26/2022] Open
Abstract
United States (U.S.) veterans are substantially older than their non-veteran counterparts. However, nationally representative, population-based data on the unique health needs of this population are lacking. Such data are critical to informing the design of large-scale outreach initiatives, and to ensure the effectiveness of service care delivery both within and outside of the Veterans Affairs healthcare system. The National Health and Resilience in Veterans Study (NHRVS) is a contemporary, nationally representative, prospective study of two independent cohorts (n = 3,157 and n = 1,484) of U.S. veterans, which is examining longitudinal changes, and key risk and protective factors for several health outcomes. In this narrative review, we summarize the main findings of all NHRVS studies (n = 82) published as of June 2020, and discuss the clinical implications, limitations, and future directions of this study. Review of these articles was organized into six major topic areas: post-traumatic stress disorder, suicidality, aging, resilience and post-traumatic growth, special topics relevant to veterans, and genetics and epigenetics. Collectively, results of these studies suggest that while a significant minority of veterans screen positive for mental disorders, the majority are psychologically resilient. They further suggest that prevention and treatment efforts designed to promote protective psychosocial characteristics (i.e., resilience, gratitude, purpose in life), and social connectedness (i.e., secure attachment, community integration, social engagement) help mitigate risk for mental disorders, and promote psychological resilience and post-traumatic growth in this population.
Collapse
Affiliation(s)
- Brienna M. Fogle
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, United States
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| | - Jack Tsai
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, United States
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| | - Natalie Mota
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, United States
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| | - Ilan Harpaz-Rotem
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, United States
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| | - John H. Krystal
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, United States
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| | - Steven M. Southwick
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, United States
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| | - Robert H. Pietrzak
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, United States
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, United States
| |
Collapse
|
23
|
Lim BH, Hodges MA, Lilly MM. The Differential Effects of Insecure Attachment on Post-Traumatic Stress: A Systematic Review of Extant Findings and Explanatory Mechanisms. TRAUMA, VIOLENCE & ABUSE 2020; 21:1044-1060. [PMID: 30599805 DOI: 10.1177/1524838018815136] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
It is well-documented that insecure attachment poses substantial risks to post-trauma recovery. Although attachment anxiety reliably predicts and is associated with elevated post-traumatic stress symptoms (PTSS), the attachment avoidance-PTSS link has been far less consistent. This suggests both attenuating and enhancing connections between attachment difficulties and post-trauma outcomes. The goal of this study is 2-fold: (a) to review and summarize extant evidence concerning the relation between insecure attachment and PTSS and (b) to review mechanism(s) underlying attachment anxiety and attachment avoidance that may explain the development of PTSS. Following a systematic review of the empirical literature investigating attachment, trauma, and post-trauma reactions, a total of 138 studies were identified and summarized. The review further identifies explanatory mechanisms underlying the association between insecure attachment and PTSS, including stress appraisals, cognitive factors, self-esteem, emotion regulation strategies, social factors, and trauma-specific factors (i.e., type of trauma, extreme stress). Implications for practice, policy, and research are discussed.
Collapse
Affiliation(s)
- Ban Hong Lim
- University of California, Los Angeles, Los Angeles, CA, USA
| | | | | |
Collapse
|
24
|
Gong P, Wang Q, Liu J, Xi S, Yang X, Fang P, Wang B, He L, Guo W, Zhang M. The OXTR polymorphisms are not associated with attachment dimensions: A three-approach study. Psychoneuroendocrinology 2020; 120:104780. [PMID: 32634747 DOI: 10.1016/j.psyneuen.2020.104780] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/15/2020] [Accepted: 06/19/2020] [Indexed: 12/15/2022]
Abstract
Inspired by the roles of oxytocin in social behaviors, scientists have devoted considerable efforts to examine the association between the oxytocin receptor gene (OXTR) and human attachment, a personality of seek and receiving comfort from intimate figures. However, there are still a lot of controversies on the association. To clarify the relationship, this research integrated three studies: (1) A cross-sectional study indicated that the OXTR polymorphisms (i.e., rs53576 and rs2254298) were not significantly associated with attachment dimensions in a college student sample (N = 1193); (2) A three-wave study showed that the polymorphisms were not associated with the individual differences and changes of attachment dimensions in a freshmen sample (N = 657); and (3) Meta-analysis indicated that attachment dimensions were not associated with the polymorphisms of rs53576 (Anxiety: 14 samples, N = 5053; Avoidance: ten samples, N = 4273) and rs2254298 (Anxiety: ten samples, N = 3670; Avoidance: ten samples, N = 3698). Taken together, these findings provide strong evidence that the OXTR polymorphisms are not related to attachment dimensions.
Collapse
Affiliation(s)
- Pingyuan Gong
- Shaanxi Key Laboratory for Animal Conservation, Northwest University, Xi'an, 710069, China; College of Life Science, Northwest University, Xi'an, 710069, China; College of Medicine, Northwest University, Xi'an, 710069, China.
| | - Quanhe Wang
- College of Life Science, Northwest University, Xi'an, 710069, China
| | - Jinting Liu
- Research Center of Brain Function and Psychological Science, Shenzhen University, Shenzhen, 518060, China
| | - Shoumin Xi
- College of Medicine, Henan University of Science and Technology, Luoyang, 471003, China
| | - Xing Yang
- College of Life Science, Northwest University, Xi'an, 710069, China; College of Life Science, Yulin University, Yulin, 719000, China
| | - Pengpeng Fang
- College of Life Science, Northwest University, Xi'an, 710069, China
| | - Bei Wang
- College of Life Science, Northwest University, Xi'an, 710069, China
| | - Linlin He
- College of Life Science, Northwest University, Xi'an, 710069, China
| | - Wenxuan Guo
- College of Life Science, Northwest University, Xi'an, 710069, China
| | - Mengfei Zhang
- College of Life Science, Northwest University, Xi'an, 710069, China
| |
Collapse
|
25
|
Wang J, Zhang P, Li W, Wen Q, Liu F, Xu J, Xu Q, Zhu D, Ye Z, Yu C. Right Posterior Insula and Putamen Volume Mediate the Effect of Oxytocin Receptor Polygenic Risk for Autism Spectrum Disorders on Reward Dependence in Healthy Adults. Cereb Cortex 2020; 31:746-756. [PMID: 32710107 DOI: 10.1093/cercor/bhaa198] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 06/29/2020] [Accepted: 06/29/2020] [Indexed: 12/24/2022] Open
Abstract
Much evidence indicates the influence of the oxytocin receptor (OXTR) gene on autism spectrum disorders (ASDs), a set of disorders characterized by a range of deficits in prosocial behaviors, which are closely related to the personality trait of reward dependence (RD). However, we do not know the effect of the OXTR polygenic risk score for ASDs (OXTR-PRSASDs) on RD and its underlying neuroanatomical substrate. Here, we aimed to investigate associations among the OXTR-PRSASDs, gray matter volume (GMV), and RD in two independent datasets of healthy young adults (n = 450 and 540). We found that the individuals with higher OXTR-PRSASDs had lower RD and significantly smaller GMV in the right posterior insula and putamen. The GMV of this region showed a positive correlation with RD and a mediation effect on the association between OXTR-PRSASDs and RD. Moreover, the correlation map between OXTR-PRSASDs and GMV showed spatial correlation with OXTR gene expression. All results were highly consistent between the two datasets. These findings highlight a possible neural pathway by which the common variants in the OXTR gene associated with ASDs may jointly impact the GMV of the right posterior insula and putamen and further affect the personality trait of RD.
Collapse
Affiliation(s)
- Junping Wang
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Peng Zhang
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, China
| | - Wei Li
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, China
| | - Qin Wen
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Feng Liu
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Jiayuan Xu
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Qiang Xu
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Dan Zhu
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Zhaoxiang Ye
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, China
| | - Chunshui Yu
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin 300052, China.,CAS Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai 200031, China
| |
Collapse
|
26
|
Berquist MD, Leth-Petersen S, Kristensen JL, Fantegrossi WE. In vivo effects of 3,4-methylenedioxymethamphetamine (MDMA) and its deuterated form in rodents: Drug discrimination and thermoregulation. Drug Alcohol Depend 2020; 208:107850. [PMID: 31954950 DOI: 10.1016/j.drugalcdep.2020.107850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Recent clinical studies support the use of 3,4-methylenedioxymethamphetamine (MDMA) as an adjunct treatment for posttraumatic stress disorder (PTSD). Despite these promising findings, MDMA administration in controlled settings can increase blood pressure, heart rate, and body temperature. Previous studies indicate thatO-demethylated metabolites of MDMA contribute to its adverse effects. As such, limiting the conversion of MDMA to reactive metabolites may mitigate some of its adverse effects and potentially improve its safety profile for therapeutic use. METHODS We compared the interoceptive and hyperthermic effects of a deuterium-substituted form of MDMA (d2-MDMA) to MDMA using rodent drug discrimination and biotelemetry procedures, respectively. RESULTS Compared to MDMA, d2-MDMA produced full substitution for a 1.5 mg/kg MDMA training stimulus with equal potency and effectiveness in the drug discrimination experiment. In addition, d2-MDMA produced increases in body temperature that were shorter-lasting and of lower magnitude compared to equivalent doses of MDMA. Last, d2-MDMA and MDMA were equally effective in reversing the hypothermic effects of the selective 5-HT2A/2C antagonist ketanserin. CONCLUSION These findings indicate that deuterium substitution of hydrogen at the methylenedioxy ring moiety does not impact MDMA's interoceptive effects, and compared to MDMA, d2-MDMA has less potential for producing hyperthermic effects and likely has similar pharmacodynamic properties. Given that d2-MDMA produces less adverse effects than MDMA, but retains similar desirable effects that are thought to relate to the effective treatment of PTSD, additional investigations into its effects on cardiovascular functioning and pharmacokinetic properties are warranted.
Collapse
Affiliation(s)
- Michael D Berquist
- Department of Pharmacology and Toxicology, College of Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham #611, Little Rock, AR, 72205, USA
| | - Sebastian Leth-Petersen
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Universitetsparken 2, 2100 København Ø, Denmark
| | - Jesper Langgaard Kristensen
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Universitetsparken 2, 2100 København Ø, Denmark
| | - William E Fantegrossi
- Department of Pharmacology and Toxicology, College of Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham #611, Little Rock, AR, 72205, USA.
| |
Collapse
|
27
|
A Preliminary Examination of Endogenous Peripheral Oxytocin in a Pilot Randomized Clinical Trial of Oxytocin-Enhanced Psychotherapy for Posttraumatic Stress Disorder. J Clin Psychopharmacol 2020; 40:401-404. [PMID: 32639293 PMCID: PMC7350551 DOI: 10.1097/jcp.0000000000001226] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Preclinical and clinical research suggests that the oxytocin system is implicated in the development and maintenance of stress and anxiety-related psychiatric conditions, such as posttraumatic stress disorder (PTSD). Recent research also suggests that intranasal oxytocin holds promise as a treatment for PTSD. However, little is known about the relationship between levels of peripheral oxytocin and PTSD symptom severity, PTSD treatment response, and repeated intranasal oxytocin administration. METHODS In the current study, we examined associations between PTSD symptom severity and peripheral oxytocin levels measured in plasma before and after a course of prolonged exposure (PE) for PTSD (n = 13); participants were randomized to adjunctive intranasal oxytocin (n = 6) or placebo (n = 7). RESULTS Baseline peripheral oxytocin levels were not associated with baseline PTSD symptom severity. Change in peripheral oxytocin levels did not differ by treatment condition and did not correspond to change in PTSD symptoms. CONCLUSIONS This proof-of-concept study illustrates the acceptability and feasibility of measuring peripheral oxytocin among individuals engaged in psychotherapy for PTSD and informs the utilization of these procedures in future adequately powered studies.
Collapse
|
28
|
Olson EA, Overbey TA, Ostrand CG, Pizzagalli DA, Rauch SL, Rosso IM. Childhood maltreatment experiences are associated with altered diffusion in occipito-temporal white matter pathways. Brain Behav 2020; 10:e01485. [PMID: 31773917 PMCID: PMC6955831 DOI: 10.1002/brb3.1485] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 08/27/2019] [Accepted: 11/09/2019] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Childhood maltreatment may contribute to brain alterations in posttraumatic stress disorder (PTSD). We previously found that PTSD was associated with white matter compromise, or lower fractional anisotropy (FA), in the left inferior longitudinal fasciculus (ILF). In this study, including non-PTSD controls, we examined whether ILF FA was associated with maltreatment exposures, including those that meet DSM-IV criterion A (physical abuse, sexual abuse) and those that typically do not (emotional abuse, emotional neglect, physical neglect). We hypothesized that lower FA would be associated with PTSD diagnosis and with both categories of maltreatment. METHODS Ninety-three participants (51 female), ages 20-50, were enrolled, including 32 with lifetime DSM-IV PTSD, 27 trauma-exposed non-PTSD controls, and 34 healthy controls. Participants completed structured interviews, the Childhood Trauma Questionnaire (CTQ), and diffusion-weighted imaging (36 directions). Probabilistic tractography (using FreeSurfer's TRACULA) was used to assess diffusion metrics in the ILF. RESULTS Contrary to our hypothesis, there was no significant effect of diagnostic group on FA. In contrast, higher CTQ scores were significantly associated with lower FA in the ILF bilaterally. This association of maltreatment with lower FA remained statistically significant after controlling for diagnostic group, and it was significant for both criterion-A-type and noncriterion-A-type maltreatment categories. CONCLUSIONS This work contributes to a growing body of literature indicating that different forms of childhood maltreatment are associated with altered white matter microstructure in the ILF, an association pathway involved in integrating visual information from occipital regions with emotion processing functions of the anterior temporal lobe.
Collapse
Affiliation(s)
- Elizabeth A Olson
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Tate A Overbey
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, Massachusetts
| | - Caroline G Ostrand
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, Massachusetts
| | - Diego A Pizzagalli
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.,McLean Imaging Center, McLean Hospital, Belmont, Massachusetts
| | - Scott L Rauch
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Isabelle M Rosso
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
29
|
An epistasis between dopaminergic and oxytocinergic systems confers risk of post-traumatic stress disorder in a traumatized Chinese cohort. Sci Rep 2019; 9:19252. [PMID: 31848444 PMCID: PMC6917732 DOI: 10.1038/s41598-019-55936-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 11/29/2019] [Indexed: 12/30/2022] Open
Abstract
Post-traumatic stress disorder (PTSD) is a psychiatric syndrome that occurs after trauma exposure. Neurotransmitters such as dopamine and oxytocin have been reported to be involved in neuropathology of PTSD. Previous studies indicated that the dopamine–oxytocin interaction may contribute to behavioral disorders. Thus, exploring the epistasis (gene–gene interaction) between oxytocinergic and dopaminergic systems might be useful to reveal the genetic basis of PTSD. In this study, we analyzed two functional single nucleotide polymorphisms (SNPs), rs2268498 for oxytocinergic gene OXTR and rs1801028 for dopaminergic gene DRD2 based on putative oxytocin receptor–dopamine receptor D2 (OTR–DR2) heterocomplex in a Chinese cohort exposed to the 2008 Wenchuan earthquake (156 PTSD cases and 978 controls). Statistical analyses did not find any single variant or gene–environment interaction (SNP × earthquake-related trauma exposure) associated with provisional PTSD diagnosis or symptoms. An OXTR–DRD2 interaction (rs2268498 × rs1801028) was identified to confer risk of provisional PTSD diagnosis (OR = 9.18, 95% CI = 3.07–27.46 and P = 7.37e-05) and further subset analysis indicated that rs2268498 genotypes controlled the association directions of rs1801028 and rs1801028 genotypes also controlled the association directions of rs2268498. Rs2268498 × rs1801028 is also associated with PTSD symptoms (P = 0.043). Our study uncovered a genetic and putative function-based contribution of dopaminergic–oxytocinergic system interaction to PTSD.
Collapse
|
30
|
Engel S, Klusmann H, Laufer S, Pfeifer AC, Ditzen B, van Zuiden M, Knaevelsrud C, Schumacher S. Trauma exposure, posttraumatic stress disorder and oxytocin: A meta-analytic investigation of endogenous concentrations and receptor genotype. Neurosci Biobehav Rev 2019; 107:560-601. [DOI: 10.1016/j.neubiorev.2019.08.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 07/02/2019] [Accepted: 08/07/2019] [Indexed: 01/06/2023]
|
31
|
Cao C, Wang L, Wu J, Li G, Fang R, Liu P, Luo S, Elhai JD. Association between the OXTR rs53576 genotype and latent profiles of post-traumatic stress disorder and depression symptoms in a representative sample of earthquake survivors. ANXIETY STRESS AND COPING 2019; 33:140-147. [PMID: 31771350 DOI: 10.1080/10615806.2019.1695604] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background and Objectives: Post-traumatic stress disorder (PTSD) and major depressive disorder are commonly experienced mental disorders among psychological trauma victims. Few studies have investigated the genetic basis for population heterogeneity of trauma-related psychopathology, including PTSD and depression. This study examined the main and interaction effects of the OXTR rs53576 genotype in distinguishing four subgroups identified by symptom profiles of PTSD and depression symptoms using latent profile analysis.Design: A cross-sectional design with a gene-environment interaction approach was adopted in the current study.Methods: This study was a secondary data analysis conducted on a sample of 1196 adult earthquake survivors. Participants completed assessments of earthquake exposure, PTSD symptoms, and depression symptoms. The rs53576 polymorphism of OXTR was genotyped using a custom-by-design 2×48-Plex SNPscanTMKit.Results: Multinomial logistic regression analyses revealed the main effects of the rs53576 genotype on symptom profiles. Specifically, G allele carriers were more likely in the combined PTSD-depression group than in the low symptom, predominantly depression, and predominantly PTSD groups. No significant interaction effects between this genotype and earthquake exposure on symptom profiles were found.Conclusions: Our findings support a genetic basis for trauma-related psychopathology heterogeneity. Furthermore, results provide preliminary evidence for the role of OXTR in PTSD/depression comorbidity.
Collapse
Affiliation(s)
- Chengqi Cao
- Center for Brain Disorder and Cognitive Science, Shenzhen University, Shenzhen, China.,Laboratory for Traumatic Stress Studies, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, People's Republic of China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, People's Republic of China
| | - Li Wang
- Laboratory for Traumatic Stress Studies, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, People's Republic of China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, People's Republic of China
| | - Jianhui Wu
- Center for Brain Disorder and Cognitive Science, Shenzhen University, Shenzhen, China
| | - Gen Li
- Laboratory for Traumatic Stress Studies, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, People's Republic of China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, People's Republic of China
| | - Ruojiao Fang
- Laboratory for Traumatic Stress Studies, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, People's Republic of China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, People's Republic of China
| | - Ping Liu
- People' s Hospital of Deyang City, Deyang, People's Republic of China
| | - Shu Luo
- People' s Hospital of Deyang City, Deyang, People's Republic of China
| | - Jon D Elhai
- Department of Psychology, University of Toledo, Toledo, OH, USA.,Department of Psychiatry, University of Toledo, Toledo, OH, USA
| |
Collapse
|
32
|
Abstract
PURPOSE OF REVIEW This article reviews recent evidence related to public health epidemiology and intervention for traumatic stress and PTSD. Recent evidence is presented regarding incidence of traumatic stress worldwide, as well as most frequent types of traumas, indicators of the public health burden of PTSD, and prevalence, predictors, and correlates of PTSD. Public health perspectives on intervention and treatment are delineated, and innovations in both psychosocial and psychopharmacological interventions are highlighted. RECENT FINDINGS PTSD has been associated with substantial medical and economic burden. Recent public health preventive innovations include integrated medical/behavioral health care, acute CBT and attention interventions, modifications to CBT protocols, use of novel and augmentative psychopharmacological agents, and use of technology. Recent research regarding the scope and impact of traumatic stress, as well as prevention strategies for PTSD, have resulted in an improved understanding of its impact and more effective public health interventions.
Collapse
Affiliation(s)
- Patricia Watson
- Department of Veterans Affairs (116D), National Center for PTSD, Executive Division, 215 N. Main ST, White River Junction, VT, 05009, USA.
| |
Collapse
|
33
|
Velasco ER, Florido A, Milad MR, Andero R. Sex differences in fear extinction. Neurosci Biobehav Rev 2019; 103:81-108. [PMID: 31129235 DOI: 10.1016/j.neubiorev.2019.05.020] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 03/08/2019] [Accepted: 05/19/2019] [Indexed: 12/18/2022]
Abstract
Despite the exponential increase in fear research during the last years, few studies have included female subjects in their design. The need to include females arises from the knowledge gap of mechanistic processes underlying the behavioral and neural differences observed in fear extinction. Moreover, the exact contribution of sex and hormones in relation to learning and behavior is still largely unknown. Insights from this field could be beneficial as fear-related disorders are twice as prevalent in women compared to men. Here, we review an up-to-date summary of animal and human studies in adulthood that report sex differences in fear extinction from a structural and functional approach. Furthermore, we describe how these factors could contribute to the observed sex differences in fear extinction during normal and pathological conditions.
Collapse
Affiliation(s)
- E R Velasco
- Institut de Neurociències, Universitat Autònoma de Barcelona, Spain
| | - A Florido
- Institut de Neurociències, Universitat Autònoma de Barcelona, Spain
| | - M R Milad
- Department of Psychiatry, University of Illinois at Chicago, USA
| | - R Andero
- Institut de Neurociències, Universitat Autònoma de Barcelona, Spain; CIBERSAM, Corporació Sanitaria Parc Taulí, Sabadell, Spain; Department of Psychobiology and Methodology of Health Sciences, Universitat Autònoma de Barcelona, Spain.
| |
Collapse
|
34
|
Flanagan JC, Mitchell JM. Augmenting Treatment for Posttraumatic Stress Disorder and Co-Occurring Conditions with Oxytocin. ACTA ACUST UNITED AC 2019; 6:132-142. [PMID: 31763133 DOI: 10.1007/s40501-019-00171-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Purpose of review The goal of this manuscript is to review the extant literature examining the neurobiological and behavioral mechanisms underlying the potential utility of intranasal oxytocin as a novel pharmacologic intervention for the treatment of posttraumatic stress disorder (PTSD), and for the treatment of co-morbid PTSD and alcohol and substance use disorders. Recent findings Research indicates that intranasal oxytocin is a low-cost and easily accessible medication with an excellent safety profile. Oxytocin holds promise for facilitating more effective PTSD treatment, particularly when used in combination with evidence-supported psychotherapy interventions. There is still a significant need to identify the mechanisms of action underlying oxytocin treatment of PTSD, and to maximize methods of nasal spray delivery, examine dose-response outcomes, and clarify the characteristics of individuals and populations that are most likely to benefit from adjunctive oxytocin treatment. Summary Collectively, preclinical and human laboratory research suggest that oxytocin may be an effective mechanism by which treatment outcomes for PTSD and common comorbidities can be enhanced. Adequately powered randomized controlled trials are needed to address efficacy, identify predictors of treatment outcome, and to assess the use of intranasal oxytocin within appropriate PTSD populations.
Collapse
Affiliation(s)
- Julianne C Flanagan
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC
| | - Jennifer M Mitchell
- Department of Neurology, University of California San Francisco, San Francisco, CA.,Department of Psychiatry, University of California San Francisco, San Francisco, CA
| |
Collapse
|
35
|
Tanaka M, Li H, Zhang X, Singh J, Dalgard CL, Wilkerson M, Zhang Y. Region- and time-dependent gene regulation in the amygdala and anterior cingulate cortex of a PTSD-like mouse model. Mol Brain 2019; 12:25. [PMID: 30922409 PMCID: PMC6438009 DOI: 10.1186/s13041-019-0449-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 03/15/2019] [Indexed: 01/07/2023] Open
Abstract
Posttraumatic stress disorder is developed by exposure to a threatening and/or a horrifying event and characterized by the presence of anxiety, hyperarousal, avoidance, and sleep abnormality for a prolonged period of time. To elucidate the potential molecular mechanisms, we constructed a mouse model by electric foot shock followed by situational reminders and performed transcriptome analysis in brain tissues. The stressed mice acquired anxiety-like behavior after 2 weeks and exaggerated startle response after 4 weeks. Avoidance latency and freezing behavior were sustained up to 5 weeks post stress and abnormal static behavior was observed during the sleep period. RNA sequencing was performed in two of the emotional regulatory regions, anterior cingulate cortex and amygdala, at 2 and 5 weeks post stress. More than 1000 differentially expressed genes were identified at 2 weeks in both regions. The number of the regulated genes remained constant in amygdala at 5 weeks post stress, whereas those in anterior cingulate cortex were plummeted. Although synaptic remodeling and endocrine system were the most enriched signaling pathways in both anterior cingulate cortex and amygdala, the individual gene expression profile was regulated in a region- and time-dependent manner. In addition, several genes associated with PTSD involved in Hypothalamic-Pituitary-Adrenal axis were differentially regulated. These findings suggested that global gene expression profile was dynamically regulated in accordance with the disease development stage, and therefore targeting the distinct signaling molecules in different region and development stage might be critical for effective treatment to PTSD.
Collapse
Affiliation(s)
- Mikiei Tanaka
- Department of Anatomy, Physiology and Genetics, Uniformed Services University of Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD, 20814, USA
| | - Hongyun Li
- Department of Anatomy, Physiology and Genetics, Uniformed Services University of Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD, 20814, USA
| | - Xijun Zhang
- Collaborative Health Initiative Research Program (CHIRP), Uniformed Services University of Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD, 20814, USA
| | - Jatinder Singh
- Collaborative Health Initiative Research Program (CHIRP), Uniformed Services University of Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD, 20814, USA
| | - Clifton L Dalgard
- Department of Anatomy, Physiology and Genetics, Uniformed Services University of Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD, 20814, USA.,Collaborative Health Initiative Research Program (CHIRP), Uniformed Services University of Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD, 20814, USA
| | - Matthew Wilkerson
- Department of Anatomy, Physiology and Genetics, Uniformed Services University of Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD, 20814, USA.,Collaborative Health Initiative Research Program (CHIRP), Uniformed Services University of Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD, 20814, USA
| | - Yumin Zhang
- Department of Anatomy, Physiology and Genetics, Uniformed Services University of Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD, 20814, USA. .,Collaborative Health Initiative Research Program (CHIRP), Uniformed Services University of Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD, 20814, USA.
| |
Collapse
|
36
|
Yoon S, Kim YK. Neuroendocrinological treatment targets for posttraumatic stress disorder. Prog Neuropsychopharmacol Biol Psychiatry 2019; 90:212-222. [PMID: 30502374 DOI: 10.1016/j.pnpbp.2018.11.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 11/16/2018] [Accepted: 11/27/2018] [Indexed: 10/27/2022]
Abstract
Posttraumatic stress disorder (PTSD) is prevalent, disabling, and frequently becomes chronic. Despite this, only two selective serotonergic reuptake inhibitors have been approved to date for its treatment by the United States Food and Drug Administration, and treatment results are often disappointing, with a remission rate of <30%. Certain neuroendocrinological systems are currently gaining attention with respect to their use for PTSD prevention and treatment as standalone options or medication-enhanced psychotherapy due to their involvement in physiological stress reactions, memory consolidation and extinction, cognitive appraisal to stress, and attachment and resilient coping strategies, which are important in the pathogenesis of PTSD. The hypothalamic-pituitary-adrenal axis system takes the most important role in stress reactions. Hydrocortisone has been studied for the prevention of PTSD, and some meta-analyses have suggested its possible efficacy; furthermore, it has been considered both as monotherapy and as an augmentation to psychotherapy in PTSD patients, with some positive results. Glucocorticoid receptor antagonists and corticotropin-releasing factor type 1 antagonists have also been considered for clinical use in PTSD treatment. Additionally, other neuroendocrinological systems have been studied in PTSD including the use of oxytocin for PTSD prevention and augmentation to psychotherapy, allopregnanolone, and neuropeptide Y (NPY) for PTSD treatment. For now, however, these studies offer only limited evidence of efficacy, thus it is prudent to study this issue more vigorously.
Collapse
Affiliation(s)
- Seoyoung Yoon
- Department of Psychiatry, Catholic University of Daegu school of Medicine, Daegu, Republic of Korea
| | - Yong-Ku Kim
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
37
|
Monin JK, Goktas SO, Kershaw T, DeWan A. Associations between spouses' oxytocin receptor gene polymorphism, attachment security, and marital satisfaction. PLoS One 2019; 14:e0213083. [PMID: 30818381 PMCID: PMC6395040 DOI: 10.1371/journal.pone.0213083] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 02/14/2019] [Indexed: 12/13/2022] Open
Abstract
OXTR rs53576, a polymorphism on the oxytocin receptor gene, has previously been linked to individual differences in social behaviors. That is, individuals with the GG genotype show greater empathy, sociability, and emotional stability. In the context of close relationships, such psychological resources are associated with better relationship outcomes. However, no studies to our knowledge have examined associations between spouses' OXTR polymorphisms, attachment security, and marital satisfaction. In the current study, 178 married couples (N = 356; ages 37-90) completed self-report measures of attachment security and marital satisfaction and provided saliva samples for genotyping. Results from Actor Partner Interdependence Models showed that individuals who had the GG genotype (actor effect) or had a spouse with the GG genotype (partner effect) reported greater marital satisfaction than individuals with AA or AG genotypes. Furthermore, greater attachment security mediated associations between GG genotype and marital satisfaction.
Collapse
Affiliation(s)
- Joan K. Monin
- Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, United States of America
| | - Selin O. Goktas
- Psychiatry, Yale School of Medicine, New Haven, CT, United States of America
| | - Trace Kershaw
- Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, United States of America
| | - Andrew DeWan
- Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States of America
| |
Collapse
|
38
|
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: 111] [Impact Index Per Article: 22.2] [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.
Collapse
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
| |
Collapse
|
39
|
Abstract
BACKGROUND For a number of mental health disorders, including posttraumatic stress disorders (PTSD), there are not many available treatment options. Recently, there has been renewed interest in the potential of methylenedioxymethamphetamine (MDMA) to restore function for patients with these disorders. The primary hypothesis is that MDMA, via prosocial effects, increases the ability of patients to address the underlying psychopathology of the disorder. However, the use of MDMA poses potential problems of neurotoxicity, in addition to its own potential for misuse. METHODS In this article, the proposed potential of MDMA as an adjunct to psychotherapy for PTSD is evaluated. The rationale for the use of MDMA and the positive results of studies that have administered MDMA in the treatment of PTSD are provided (pros). A description of potential adverse effects of treatment is also presented (cons). An overview of MDMA pharmacology and pharmacokinetics and a description of potential adverse effects of treatments are also presented. Methylenedioxymethamphetamine-produced oxytocin release and decreased expression of fear conditioning as well as one of the MDMA enantiomers (the n R- entaniomer) are suggested as potential mechanisms for the beneficial effects of MDMA in PTSD (suggestions). RESULTS There is some evidence that MDMA facilitates recovery of PTSD. However, the significant adverse effects of MDMA raise concern for its adoption as a pharmacotherapy. Alternative potential treatments with less adverse effects and that are based on the ubiquitous pharmacology of MDMA are presented. CONCLUSIONS We suggest that additional research investigating the basis for the putative beneficial effects of MDMA might reveal an effective treatment with fewer adverse effects. Suggestions of alternative treatments based on the behavioral pharmacology and toxicology of MDMA and its enantiomers are presented.
Collapse
|
40
|
Londono Tobon A, Newport DJ, Nemeroff CB. The Role of Oxytocin in Early Life Adversity and Later Psychopathology: a Review of Preclinical and Clinical Studies. ACTA ACUST UNITED AC 2018. [DOI: 10.1007/s40501-018-0158-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
|
41
|
Stevens JS, Jovanovic T. Role of social cognition in post-traumatic stress disorder: A review and meta-analysis. GENES BRAIN AND BEHAVIOR 2018; 18:e12518. [PMID: 30221467 DOI: 10.1111/gbb.12518] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 09/11/2018] [Indexed: 12/31/2022]
Abstract
Social functioning is a key component of recovery after a potentially traumatic experience, and the buffering role of the social support in trauma resilience and recovery has been very well documented. Factors contributing to resilience and recovery are notable because although most people will experience a traumatic event during their lifetimes, only 6% to 10% are diagnosed with post-traumatic stress disorder (PTSD). The relationship between an individual and their social environment is determined both by the quality of the social environment itself, and by the individual's perception and understanding of information conveyed by the other people around them. However, little research has considered the contribution of these internal social cognitive processes to PTSD risk or resilience. The current review draws on the existing literature on social cognitive functioning in trauma exposure and PTSD, identifying key questions and themes for future research. We utilized a meta-analytic approach to assess the evidence for alterations in social cognition in PTSD, finding a consistent large deficit in social cognitive performance in PTSD groups relative to trauma-exposed and healthy controls. We then reviewed the literature on the interaction of genes and the social environment, supporting the hypothesis that social cognitive deficits are a preexisting risk factor for PTSD. Finally, we reviewed relevant neuroimaging findings, which suggest that alterations in social cognition affect the perception of threat cues in PTSD. Overall, research on social cognition and PTSD is still emerging, but existing findings suggest this is an important and understudied area for the understanding of PTSD.
Collapse
Affiliation(s)
- Jennifer S Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| |
Collapse
|
42
|
Yang S, Wynn GH, Ursano RJ. A Clinician's Guide to PTSD Biomarkers and Their Potential Future Use. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2018; 16:143-152. [PMID: 31975909 DOI: 10.1176/appi.focus.20170045] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
No clinically validated biomarkers have yet been found to assist in the diagnosis and treatment of posttraumatic stress disorder (PTSD). Innovation in clinical trial design, however, has led to the study of biomarkers as part of testing new medications and psychotherapies. There may soon be viable biomarkers to assist in diagnosis of PTSD and prediction of illness trajectory, severity, and functional outcomes; subtyping; and treatment selection. Processes for the identification and validation of biomarker findings are complex, involving several stages of clinical testing before use. The authors provide an overview of issues regarding the clinical use of PTSD biomarkers and examine a set of genetic, epigenetic, and other blood-based markers along with physiological markers currently proposed as candidate tests for PTSD. Studies that have identified candidate biomarkers with relevance to treatment selection in PTSD are discussed as a promising area of research that may lead to changes in clinical practice.
Collapse
Affiliation(s)
- Suzanne Yang
- The authors are with the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University, Bethesda, Maryland. Dr. Yang is also with the Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Gary H Wynn
- The authors are with the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University, Bethesda, Maryland. Dr. Yang is also with the Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Robert J Ursano
- The authors are with the Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University, Bethesda, Maryland. Dr. Yang is also with the Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| |
Collapse
|
43
|
Averill LA, Averill CL, Kelmendi B, Abdallah CG, Southwick SM. Stress Response Modulation Underlying the Psychobiology of Resilience. Curr Psychiatry Rep 2018; 20:27. [PMID: 29594808 DOI: 10.1007/s11920-018-0887-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW This review focuses on the relationship between resilience and the ability to effectively modulate the stress response. Neurobiological and behavioral responses to stress are highly variable. Exposure to a similar stressor can lead to heterogeneous outcomes-manifesting psychopathology in one individual, but having minimal effect, or even enhancing resilience, in another. We highlight aspects of stress response modulation related to early life development and epigenetics, selected neurobiological and neurochemical systems, and a number of emotional, cognitive, psychosocial, and behavioral factors important in resilience. We also briefly discuss interventions with potential to build and promote resilience. RECENT FINDINGS Throughout this review, we include evidence from recent preclinical and clinical studies relevant to the psychobiology of resilient stress response modulation. Effective modulation of the stress response is an essential component of resilience and is dependent on a complex interplay of neurobiological and behavioral factors.
Collapse
Affiliation(s)
- Lynnette A Averill
- Department of Veterans Affairs National Center for PTSD - Clinical Neurosciences Division, Department of Psychiatry, Yale School of Medicine, 950 Campbell Avenue, 151E, West Haven, CT, 06516, USA. .,Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, USA.
| | - Christopher L Averill
- Department of Veterans Affairs National Center for PTSD - Clinical Neurosciences Division, Department of Psychiatry, Yale School of Medicine, 950 Campbell Avenue, 151E, West Haven, CT, 06516, USA.,Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, USA
| | - Benjamin Kelmendi
- Department of Veterans Affairs National Center for PTSD - Clinical Neurosciences Division, Department of Psychiatry, Yale School of Medicine, 950 Campbell Avenue, 151E, West Haven, CT, 06516, USA.,Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, USA
| | - Chadi G Abdallah
- Department of Veterans Affairs National Center for PTSD - Clinical Neurosciences Division, Department of Psychiatry, Yale School of Medicine, 950 Campbell Avenue, 151E, West Haven, CT, 06516, USA.,Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, USA
| | - Steven M Southwick
- Department of Veterans Affairs National Center for PTSD - Clinical Neurosciences Division, Department of Psychiatry, Yale School of Medicine, 950 Campbell Avenue, 151E, West Haven, CT, 06516, USA.,Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, USA
| |
Collapse
|
44
|
Donadon MF, Martin-Santos R, Osório FDL. The Associations Between Oxytocin and Trauma in Humans: A Systematic Review. Front Pharmacol 2018; 9:154. [PMID: 29545749 PMCID: PMC5838009 DOI: 10.3389/fphar.2018.00154] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 02/13/2018] [Indexed: 01/01/2023] Open
Abstract
Studies have shown that traumatic experiences may affect hormonal systems mediated by the hypothalamic-pituitary-adrenal (HPA) axis and the oxytocinergic system. This effect is the result of long-term impairments in hypothalamic structures and negative feedback mechanisms within the HPA axis, structures that mediate the response to stress. This deregulation reduces the production and release of cortisol and oxytocin (OXT), which may alter stress responses and lead to increased vulnerability to impairments from stressful experiences. The presence of gene polymorphisms might also have an impact on the vulnerability to psychopathology. We made a systematic review of articles dealing with the relationship between OXT and traumatic emotional experiences in humans. Thirty-five studies were reviewed and significant associations between experiences of emotional trauma (ET) and OXT were found. The main results showed that the presence of ET and post-traumatic stress disorder (PTSD) is strongly associated with reductions in endogenous OXT, and also that the acute effects of OXT administrations in individuals with ET tend to be anxiolytic only in less severe forms. In victims of recent traumatic experiences (RTE), OXT increased the re-experience of traumas and restored the function of different neural networks associated with fear control/extinction in PTSD patients. The results available also suggest that gene receptor polymorphisms may have a protective function in different outcomes after the experience of traumatic events. We conclude that the relationship between ET and OXT is multifaceted, complex, and mediated by contextual and individual factors. Directions for future studies are suggested considering the gaps in the available literature.
Collapse
Affiliation(s)
- Mariana Fortunata Donadon
- Department of Neuroscience and Behavior, Medical School of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Rocio Martin-Santos
- Department of Psychiatry and Psychology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación en Red de Salud Mental (CIBERSAM), Barcelona, Spain.,Department of Medicine, University of Barcelona, Barcelona, Spain.,Technology Institute for Translational Medicine (INCT), National Council for Scientific and Technological Development (CNPq), Brasília, Brazil
| | - Flávia de Lima Osório
- Department of Neuroscience and Behavior, Medical School of Ribeirão Preto, University of São Paulo, São Paulo, Brazil.,Technology Institute for Translational Medicine (INCT), National Council for Scientific and Technological Development (CNPq), Brasília, Brazil
| |
Collapse
|