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Pinto R, Albuquerque S, de Castro MV, Levendosky AA, Fonseca M, Jongenelen I, Maia Â, Gamito P. A Virtual Reality Simulation to Examine the Relationship Between Post-Traumatic Stress Symptoms and Decision-Making in First Responders. J Trauma Dissociation 2024:1-16. [PMID: 38978229 DOI: 10.1080/15299732.2024.2374370] [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: 01/27/2024] [Accepted: 05/21/2024] [Indexed: 07/10/2024]
Abstract
First responders (FRs) are continuously exposed to critical incidents, considered traumatic events (TEs). This cumulative exposure increases the risk for post-traumatic stress disorder (PTSD). However, there is no evidence about the relationship between PTSD symptoms and emergency decision-making (EDM). The objective of this study was to examine the EDM of FRs during a virtual reality through the simulation of two emergency scenarios to collect data on the reaction time and the number of incorrect decisions. We also assessed PTSD symptoms, TE, and sociodemographics. The sample included 368 Portuguese FRs, were 295 (80.20%) males and 73 (19.80%) females, with a mean age of 33.96 (SD = 9.38). Considering the probable PTSD diagnosis according to the DSM-5, 85 (23.10%) of the FRs met the criteria. These individuals who meet the criteria exhibited higher EDM scores (M = 19.60, SD = 5.99) compared to those without probable PTSD (M = 17.87, SD = .5.66) (F(1, 360) = 5.32, p = .02, partial η2 = .015). We found that TEs had a direct effect on EDM, β = -.16, Z = -3.74, p < .001), and the pathway of trauma-PTSD symptoms-decision-making an indirect effect, β = .02, Z = 3.10, p = .002). Individuals exposed to more TEs demonstrated faster and more accurate decision-making in the context of EDM. However, when these individuals developed PTSD symptoms, their decision-making became slower and less accurate. The inclusion of a trauma-informed approach for FRs to prevent individual and job-related consequences is discussed.
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Affiliation(s)
- Ricardo Pinto
- HEI-Lab: Digital Human-Environment Interaction Labs, Lusófona University, Lisbon, Portugal
| | - Sara Albuquerque
- HEI-Lab: Digital Human-Environment Interaction Labs, Lusófona University, Lisbon, Portugal
| | - Maria Vieira de Castro
- HEI-Lab: Digital Human-Environment Interaction Labs, Lusófona University, Lisbon, Portugal
| | - Alytia A Levendosky
- Department of Psychology, Michigan State University, East Lansing, Michigan, USA
| | - Micaela Fonseca
- HEI-Lab: Digital Human-Environment Interaction Labs, Lusófona University, Lisbon, Portugal
| | - Inês Jongenelen
- HEI-Lab: Digital Human-Environment Interaction Labs, Lusófona University, Lisbon, Portugal
| | - Ângela Maia
- School of Psychology, University of Minho, Braga, Portugal
| | - Pedro Gamito
- HEI-Lab: Digital Human-Environment Interaction Labs, Lusófona University, Lisbon, Portugal
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Back SE, Jarnecke AM, Norman SB, Zaur AJ, Hien DA. State of the Science: Treatment of comorbid posttraumatic stress disorder and substance use disorders. J Trauma Stress 2024. [PMID: 38857125 DOI: 10.1002/jts.23049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 03/12/2024] [Accepted: 03/14/2024] [Indexed: 06/12/2024]
Abstract
Posttraumatic stress disorder (PTSD) and substance use disorders (SUDs) co-occur at high rates, with research showing that up to nearly 60% of individuals with PTSD also suffer from an alcohol and/or drug use disorder. PTSD/SUD is complex; associated with adverse health, social, and economic outcomes; and can be challenging to treat. Over the past decade, the landscape of treatment research addressing PTSD/SUD has significantly expanded. Ongoing efforts aimed at developing and evaluating novel treatments for PTSD/SUD, encompassing both psychotherapy and pharmacotherapy approaches, are steadily advancing. As such, this State of the Science paper reviews the literature on the latest scientific advances in treating PTSD/SUD. Clinical practice guidelines for the treatment of PTSD/SUD are discussed, along with evidence-based psychotherapies and emerging interventions. Rigorously conducted clinical trials demonstrate that individual, manualized, trauma-focused treatments are the most efficacious psychotherapies to use among individuals with PTSD/SUD. Moreover, patients do not need to be abstinent to initiate or benefit from evidence-based PTSD treatment. To date, no medications have been established for this comorbidity. We highlight ongoing research on novel treatments for PTSD/SUD, such as new forms of integrated trauma-focused psychotherapies, pharmacological augmentation strategies, and technology-based enhancements. Finally, promising future directions for the field are discussed.
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Affiliation(s)
- Sudie E Back
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Ralph H. Johnson VA Healthcare System, Charleston, South Carolina, USA
| | - Amber M Jarnecke
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Sonya B Norman
- Department of Psychiatry, University of California San Diego School of Medicine, San Diego, California, USA
| | - Angela J Zaur
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Denise A Hien
- Center of Alcohol and Substance Use Studies, Rutgers University-New Brunswick, New Brunswick, New Jersey, USA
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Agarwal I, Draheim AA. Seeking Safety for women in incarceration: a systematic review. Arch Womens Ment Health 2024; 27:317-327. [PMID: 38147147 DOI: 10.1007/s00737-023-01411-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 12/06/2023] [Indexed: 12/27/2023]
Abstract
PURPOSE Seeking Safety is an evidence-based treatment for individuals with comorbid posttraumatic stress disorder and substance use disorder. This treatment shows promise to address the unique, unmet needs of women in prison. The current systematic literature review aims to highlight several critical gaps in research on Seeking Safety in forensic settings that need to be filled before Seeking Safety can be implemented in a widespread manner. METHODS PsycINFO, PubMed and Google scholar databases were used to identify studies that were published in English, included women in forensic settings, and incorporated Seeking Safety treatment. A total of seven studies met review criteria. The quality of studies was assessed with the mixed methods appraisal tool. RESULTS High risk of contamination, inclusion of small, predominantly White samples, high attrition rates, need for dose-response testing, and lack of follow-up data currently limit the ability to assess the efficacy of Seeking Safety in forensic settings. In addition, there is a lack of research on Seeking Safety's ability to reduce symptoms of substance use disorder for incarcerated women and further cultural adaptation may be needed. CONCLUSION Seeking Safety has the potential to address the underlying causes of incarceration for justice-involved women, but additional research addressing these identified gaps is needed to facilitate more widespread implementation.
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Affiliation(s)
- Ishita Agarwal
- Department of Psychology, Lawrence University, Appleton, WI, USA
| | - Amanda A Draheim
- Department of Psychology, Lawrence University, Appleton, WI, USA.
- Department of Psychology, Goucher College, 1021 Dulaney Valley Road, Baltimore, MD, 21204, USA.
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Fearon D, Perlman CM, Leatherdale S, Hirdes JP, Dubin J. Classification of traumatic life events and substance use among persons admitted to inpatient psychiatry in Ontario, Canada. J Psychiatr Res 2024; 172:236-243. [PMID: 38412786 DOI: 10.1016/j.jpsychires.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/09/2024] [Accepted: 02/01/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Trauma is commonly overlooked or undiagnosed in clinical care settings. Undetected trauma has been associated with elevated substance use highlighting the need to prioritize identifying individuals with undetected trauma through common characteristics. OBJECTIVE The purpose of this study is to identify classifications of traumatic life experiences and substance use among persons admitted to inpatient psychiatry in Ontario and to identify covariates associated with classification membership. STUDY DESIGN A population-based retrospective cohort study was conducted using interRAI Mental Health (MH) assessment data. Individuals were included who experienced traumatic life events (N = 10,125), in Ontario, Canada between January 1, 2015, to December 31, 2019. RESULTS Eight latent classes were identified that ranged from low (i.e., Class 1: Interpersonal Issues, Without Substance use) to high (i.e., Class 8: Widespread Trauma, Alcohol & Cannabis Addiction) complexity patterns of traumatic life events and substance use indicators. Classifications with similar trauma profiles were differentiated by patterns of substance use. For example, individuals in Class 2: Safety & Relationship Issues, Without Substance use and Class 3: Safety & Relationship Issues, Alcohol & Cannabis both had many estimates centered around the experience of victimization (e.g., victim of sexual assault, victim of physical assault, victim of emotional abuse). Multinomial logistic regression models highlighted additional factors associated with classifications such as homelessness, where those who were homeless were 2.09-4.02 times more likely to be in Class 6: Widespread Trauma & Substance Addiction. INTERPRETATION Trauma exposures are complex and varied among persons in inpatient psychiatry and can be further differentiated by substance use patterns. These findings provide a population-based estimate of the trauma experiences of persons in inpatient settings in Ontario, Canada. Findings demonstrate the importance of using comprehensive assessment to support clinical decision making in relation to trauma and substance.
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Affiliation(s)
- Danielle Fearon
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada.
| | | | - Scott Leatherdale
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - John P Hirdes
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Joel Dubin
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada; Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada
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Halladay J, Georgiades K, MacKillop J, Lipman E, Pires P, Duncan L. Identifying patterns of substance use and mental health concerns among adolescents in an outpatient mental health program using latent profile analysis. Eur Child Adolesc Psychiatry 2024; 33:739-747. [PMID: 36947251 PMCID: PMC10031175 DOI: 10.1007/s00787-023-02188-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 03/08/2023] [Indexed: 03/23/2023]
Abstract
Though mental health and substance use concerns often co-occur, few studies have characterized patterns of co-occurrence among adolescents in clinical settings. The current investigation identifies and characterizes these patterns among adolescents presenting to an outpatient mental health service in Ontario, Canada. Data come from cross-sectional standardized patient intake assessments from 916 adolescents attending an outpatient mental health program (January 2019-March 2021). Latent profile analysis identified patterns of substance use (alcohol, cannabis, (e-) cigarettes) and emotional and behavioral disorder symptoms. Sociodemographic and clinical correlates of these patterns were examined using multinomial regression. Three profiles were identified including: 1) low substance use and lower frequency and/or severity (relative to other patients in the sample) emotional and behavioral disorder symptoms (26.2%), 2) low substance use with higher emotional and behavioral disorder symptoms (48.2%), and 3) high in both (25.6%). Profiles differed in sociodemographic and clinical indicators related to age, gender, trauma, harm to self, harm to others, and service use. Experiences of trauma, suicide attempts, and thoughts of hurting others increased the odds of adolescents being in the profile high in both substance use and symptoms compared to other profiles. These findings further document the high rates of substance use in adolescents in mental health treatment and the profiles generally map onto three out of four quadrants in the adapted four-quadrant model of concurrent disorders, indicating the importance of assessing and addressing substance use in these settings.
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Affiliation(s)
- Jillian Halladay
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Australia Level 6, Jane Foss Russell Building, G02, Camperdown, NSW, 2006, Australia.
- The Peter Boris Centre for Addictions Research, McMaster University/St. Joseph's Healthcare Hamilton, 100 West 5Th St, Hamilton, ON, L8N 3K7, Canada.
| | - Katholiki Georgiades
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4S4, Canada
- Offord Centre for Child Studies, McMaster University, Hamilton, Canada
| | - James MacKillop
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4S4, Canada
- The Peter Boris Centre for Addictions Research, McMaster University/St. Joseph's Healthcare Hamilton, 100 West 5Th St, Hamilton, ON, L8N 3K7, Canada
| | - Ellen Lipman
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4S4, Canada
- Offord Centre for Child Studies, McMaster University, Hamilton, Canada
| | - Paulo Pires
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4S4, Canada
- Offord Centre for Child Studies, McMaster University, Hamilton, Canada
| | - Laura Duncan
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4S4, Canada
- Offord Centre for Child Studies, McMaster University, Hamilton, Canada
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Hinojosa CA, Sitar SI, Zhao JC, Barbosa JD, Hien DA, Welsh JW, Fani N, van Rooij SJ. Functional Domains of Substance Use and their Implications to Trauma: A Systematic Review of Neuroimaging Studies. CHRONIC STRESS (THOUSAND OAKS, CALIF.) 2024; 8:24705470241258752. [PMID: 38846598 PMCID: PMC11155333 DOI: 10.1177/24705470241258752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 05/16/2024] [Indexed: 06/09/2024]
Abstract
Substance use disorder (SUD) is a significant health problem, and trauma exposure is a known risk factor for the escalation of substance use. However, the shared neural mechanisms through which trauma is associated with substance use are still unknown. Therefore, we systematically review neuroimaging studies focusing on three domains that may contribute to the overlapping mechanisms of SUD and trauma-reward salience, negative emotionality, and inhibition. Using PRISMA guidelines, we identified 45 studies utilizing tasks measuring these domains in alcohol, tobacco, and cannabis use groups. Greater reward, lesser regulation of inhibitory processes, and mixed findings of negative emotionality processes in individuals who use substances versus controls were found. Specifically, greater orbitofrontal cortex, ventral tegmental area, striatum, amygdala, and hippocampal activation was found in response to reward-related tasks, and reduced activation was found in the inferior frontal gyrus and hippocampus in response to inhibition-related tasks. Importantly, no studies in trauma-exposed individuals met our review criteria. Future studies examining the role of trauma-related factors are needed, and more studies should explore inhibition- and negative-emotionality domains in individuals who use substances to uncover clinically significant alterations in these domains that place an individual at greater risk for developing a SUD.
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Affiliation(s)
- Cecilia A. Hinojosa
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Siara I. Sitar
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Joshua C. Zhao
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Joshua D. Barbosa
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Denise A. Hien
- Center of Alcohol and Substance Use Studies, Graduate School of Applied and Professional Psychology, Rutgers University-New Brunswick, Piscataway, NJ, USA
| | - Justine W. Welsh
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Negar Fani
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Sanne J.H. van Rooij
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
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Israel BS, Belcher AM, Ford JD. A Harm Reduction Framework for Integrated Treatment of Co-Occurring Opioid Use Disorder and Trauma-Related Disorders. J Dual Diagn 2024; 20:52-85. [PMID: 38165922 DOI: 10.1080/15504263.2023.2295416] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
The opioid epidemic has exposed a gulf in mental health research, treatment, and policy: Most patients with comorbid trauma-related disorder (TRD) and opioid use disorder (OUD) (TRD + OUD) remain undiagnosed or unsuccessfully treated for the combination of TRD symptoms and opioid use. TRD treatments tend to be psychotherapies that are not accessible or practical for many individuals with TRD + OUD, due to TRD treatment models not systematically incorporating principles of harm reduction (HR). HR practices prioritize flexibility and unequivocally improve outcomes and save lives in the treatment of OUD. Considering the urgent need to improve TRD + OUD treatment and outcomes, we propose that the OUD and TRD fields can be meaningfully reconciled by integrating HR principles with classic phasic treatment for TRD. Adding a "prestabilization" phase of treatment for TRD - largely analogous to the precontemplation Stage of Change - creates opportunities to advance research, clinical practice, and policies and potentially improve patient outcomes.
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Affiliation(s)
- Benjamin S Israel
- Division of Addiction Research and Treatment, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Annabelle M Belcher
- Division of Addiction Research and Treatment, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Julian D Ford
- Department of Psychiatry, University of Connecticut Health Center, Farmington, Connecticut, USA
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8
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Dyar C, Kaysen D. Event-level positive and negative reinforcement risk factors for alcohol use: Moderation by individual-level alcohol consequences and post-traumatic stress disorder symptom severity. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:2068-2080. [PMID: 38226757 PMCID: PMC10794026 DOI: 10.1111/acer.15188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/30/2023] [Accepted: 08/30/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND The multistage model of drug addiction posits that risk processes contributing to alcohol use change as individuals develop alcohol use disorders. However, few studies have tested this theory outside of the lab or at the event level. We assessed whether event-level associations between positive reinforcement (e.g., positive affect, sociability expectancies) and negative reinforcement risk factors (e.g., negative affect, tension reduction expectancies) and same-/next-day alcohol consumption varied as a function of an individual's level of alcohol consequences. Given elevated alcohol use consequences among individuals with post-traumatic stress disorder (PTSD) and disruptions in reward processing that affect this population, we also tested whether these processes differed based on the presence and severity of PTSD. METHODS We used data from a 30-day ecological momentary assessment study with 174 undergraduate women who regularly engaged in heavy episodic drinking. A majority (78%) of the sample had experienced sexual assault and 44% had current PTSD. Analyses used Bayesian multilevel structural equation modeling with diffuse (non-informative) priors. We used markov chain monte carlo (MCMC) algorithms to generate a series of 10,000 random draws from the multivariate posterior distribution of our sample for each model. RESULTS Results partially supported the multistage model. Event-level negative reinforcement risk factors only predicted more alcohol consumption among individuals who experienced more alcohol consequences. Findings for positive reinforcement risk factors were partially consistent with hypotheses. Overall, findings appear to operate similarly across PTSD symptom severity. CONCLUSIONS Results suggest that interventions for heavy episodic drinking could benefit from attending to an individual's level of alcohol consequences. For example, preventive interventions for individuals who tend to experience few consequences may benefit more from addressing positive reinforcement risk factors, while treatment interventions for those who experience more consequences may benefit from attending to both positive and negative reinforcement.
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Affiliation(s)
| | - Debra Kaysen
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
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Amstadter AB, Lönn S, Sundquist J, Sundquist K, Kendler KS. Post-traumatic stress disorder and drug use disorder: examination of aetiological models in a Swedish population-based cohort. Eur J Psychotraumatol 2023; 14:2258312. [PMID: 37800551 PMCID: PMC10561571 DOI: 10.1080/20008066.2023.2258312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 07/24/2023] [Indexed: 10/07/2023] Open
Abstract
Background: There are two primary phenotypic models of comorbidity between post-traumatic stress disorder (PTSD) and drug use disorder (DUD), i.e. self-medication (PTSD precedes and causes DUD) and susceptibility (DUD precedes and causes PTSD). We sought to clarify the longitudinal relationship between PTSD and DUD, while examining sex differences.Method: We used approximately 23 years of longitudinal data from Swedish population registries to conduct two complementary statistical models: Cox proportional hazard models (N ≈ 1.5 million) and a cross-lagged panel model (N ≈ 3.8 million).Results: Cox proportional hazards models, adjusting for cohort and socioeconomic status, found strong evidence for the self-medication hypothesis, as PTSD predicted increased risk for DUD among both women [hazard ratio (HR) = 5.34, 95% confidence interval (CI) 5.18, 5.51] and men (HR = 3.65, 95% CI 3.54, 3.77), and moreover, that the PTSD to DUD association was significantly higher among women (interaction term 0.68, 95% CI 0.65, 0.71). The results of the susceptibility model were significant, but not as strong as the self-medication model. DUD predicted risk for PTSD among both women (HR = 2.43, 95% CI 2.38, 2.50) and men (HR = 2.55, 95% CI 2.50, 2.60), and HR was significantly higher in men (interaction term 1.05, 95% CI 1.02, 1.08). Investigating the pathways simultaneously in the cross-lagged model yielded support for both pathways of risk. The cross-paths instantiating the susceptibility model (0.10-0.22 in females, 0.12-0.19 in males) were mostly larger than those capturing the self-medication model (0.01-0.16 in females, 0.04-0.22 in males).Conclusions: We demonstrate that the relationship between PTSD and DUD is bidirectional, with evidence that future research should prioritize examining specific pathways of risk that may differ between men and women.
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Affiliation(s)
- Ananda B. Amstadter
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
| | - Sara Lönn
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
- Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
- Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Kenneth S. Kendler
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
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10
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Grace E, Rogers R, Usher R, Rivera IM, Elbakry H, Sotilleo S, Doe R, Toribio M, Coreas N, Olff M. Psychometric properties of the Global Psychotrauma Screen in the United States. Health Psychol Behav Med 2023; 11:2266215. [PMID: 37811317 PMCID: PMC10557551 DOI: 10.1080/21642850.2023.2266215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 09/26/2023] [Indexed: 10/10/2023] Open
Abstract
Background Prior research assessing the psychometric properties of the Global Psychotrauma Screen provided support for its internal consistency reliability, construct validity, convergent validity, and divergent validity in several international samples, but not specifically in a U.S. subsample. Objective The purpose of this study was to assess psychometric properties of the GPS in the U.S. Method This observational study included a convenience sample of individually recruited participants (N = 231) who completed an initial study with 126-item online questionnaire and a two-week follow-up study with GPS alone through the weblinks provided by the research team. Data analyzes included measuring internal consistency and test-retest reliability, exploratory and confirmatory factor analyzes (EFA and CFA), convergent and divergent validity, sensitivity, specificity, and severity of the GPS symptom items. Additional CFA was conducted with data (N = 947) from the GPS multinational research project, U.S. subsample. Results The results showed acceptable internal consistency and test-retest reliability, convergent validity, and divergent validity of the GPS. The construct validity results supported a three-factor structure of the GPS symptoms. The GPS domains showed acceptable sensitivity and specificity with the cut-off scores of 3 for PTSD and 5 for CPTSD domains; and the scores of 1 for the anxiety, depression, and insomnia domains respectively. The GPS risk factors predicted the GPS symptom severity. Conclusions This study provides new and additional evidence on the psychometric properties of the GPS which may help health care providers with the selection of an appropriate screening instrument for trauma-related transdiagnostic symptoms. The study limitations should be addressed in future research through the replication of EFA and CFA internationally with larger samples, and the inclusion of a reference standard for dissociation.
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Affiliation(s)
- Emma Grace
- Department of International Psychology, The Chicago School of Professional Psychology, Washington, DC, USA
| | - Rosalind Rogers
- Department of International Psychology, The Chicago School of Professional Psychology, Washington, DC, USA
| | - Robin Usher
- Department of International Psychology, The Chicago School of Professional Psychology, Washington, DC, USA
| | - Iris Margarita Rivera
- Department of International Psychology, The Chicago School of Professional Psychology, Washington, DC, USA
| | - Hanan Elbakry
- Department of International Psychology, The Chicago School of Professional Psychology, Washington, DC, USA
| | - Shanelle Sotilleo
- Department of International Psychology, The Chicago School of Professional Psychology, Washington, DC, USA
| | - Renee Doe
- Department of International Psychology, The Chicago School of Professional Psychology, Washington, DC, USA
| | - Mariella Toribio
- Department of International Psychology, The Chicago School of Professional Psychology, Washington, DC, USA
| | - Narda Coreas
- Department of International Psychology, The Chicago School of Professional Psychology, Washington, DC, USA
| | - Miranda Olff
- Department of Psychiatry, Amsterdam Neuroscience & Public Health, Amsterdam UMC, Amsterdam, The Netherlands
- ARQ National Psychotrauma Centre, Diemen, The Netherlands
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Bennett MM, Davis KE, Fitzgerald JM. Neural Correlates of Reward Processing in the Onset, Maintenance, and Treatment of Posttraumatic Stress Disorder. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2023; 8:884-890. [PMID: 37263417 DOI: 10.1016/j.bpsc.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 06/03/2023]
Abstract
Posttraumatic stress disorder (PTSD) is a prevalent, debilitating, and heterogeneous psychiatric condition marked by both exaggerated threat responding and diminished positive affect. While symptom profiles of PTSD differ across individuals, symptoms also vary within individuals over the course of illness. Functional magnetic resonance imaging studies have provided crucial insights into the neurobiology of heightened threat responsivity in PTSD, which has aided in identifying neurobiological risk factors and treatment targets for this disorder. Despite this demonstrated utility, the application of functional magnetic resonance imaging to understanding deficits in reward responsivity in PTSD remains underexplored. Significantly, over 60% of individuals with PTSD experience anhedonia, or an inability to feel pleasure, which may reflect reward processing deficits. To better understand the neural underpinnings of reward deficits and their relevance to the onset, maintenance, and treatment of PTSD, we reviewed the functional magnetic resonance imaging literature through the framework of disease prognosis. Here, we provide insights on whether reward deficits are central to PTSD or are better explained by comorbid major depressive disorder, and we clarify how reward-related deficiencies in PTSD fit into the context of more intensely studied threat-related deficits.
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Affiliation(s)
- Meghan M Bennett
- Department of Psychology, Marquette University, Milwaukee, Wisconsin.
| | - Kaley E Davis
- Department of Psychology, Marquette University, Milwaukee, Wisconsin
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Hoover LV, Yu HP, Duval ER, Gearhardt AN. Investigating gender differences in the co-occurrence of PTSD and food addiction. Appetite 2023; 187:106605. [PMID: 37236363 DOI: 10.1016/j.appet.2023.106605] [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: 02/02/2023] [Revised: 05/12/2023] [Accepted: 05/13/2023] [Indexed: 05/28/2023]
Abstract
OBJECTIVE Post-traumatic stress disorder (PTSD) commonly co-occurs with substance use disorders (SUDs). Past studies suggest PTSD is also associated with food addiction (compulsive intake of highly processed foods containing refined carbohydrates and/or added fat). However, research investigating gender differences has been limited (e.g., restricted samples) and mixed. We aim to investigate the risk of co-occurring PTSD and food addiction in a community sample for all participants and stratified by gender. Additionally, we conducted risk ratios for problematic substance use and obesity to allow for within-sample comparisons. METHOD We utilized a sample of 318 participants recruited from Amazon Mechanical Turk (mean age = 41.2, 47.8% men, 78.0% white) to address existing gaps in the literature on PTSD and food addiction. We calculated risk ratios (adjusted for sociodemographic covariates) using modified Poisson regression with 95% confidence intervals. Results were also gender stratified. RESULTS Risk of food addiction (Risk Ratio (RR) = 6.42, 95% CI [4.10, 10.07], problematic alcohol use (RR) = 3.86, 95% CI [2.25,6.62], problematic smoking (RR) = 3.93, 95% CI [2.22, 6.97], and problematic nicotine vaping (RR) = 5.41, 95% CI [2.41, 11.14] were higher for those meeting criteria for PTSD. Risk of problematic cannabis use, and risk of obesity were not significantly higher for those meeting criteria for PTSD. Gender-stratified results suggest risk of food addiction may be higher for men (RR) = 8.54, 95% CI [4.49, 16.25] compared to women (RR) = 4.32, 95% CI [2.16, 8.62]. DISCUSSION Food addiction, but not obesity, appears to co-occur with PTSD more strongly than other types of problematic substance use (alcohol, cannabis, cigarettes, nicotine vaping). This risk appears to be particularly high for men compared to women. Assessing for food addiction in those with PTSD, particularly in men, may assist in identifying high-risk groups.
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Affiliation(s)
- Lindzey V Hoover
- Department of Psychology, University of Michigan, Ann Arbor, USA.
| | - Hayley P Yu
- Department of Psychology, University of Michigan, Ann Arbor, USA
| | - Elizabeth R Duval
- Department of Psychology, University of Michigan, Ann Arbor, USA; Department of Psychiatry, University of Michigan, Ann Arbor, USA
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Papini S, Norman SB, Campbell-Sills L, Sun X, He F, Kessler RC, Ursano RJ, Jain S, Stein MB. Development and Validation of a Machine Learning Prediction Model of Posttraumatic Stress Disorder After Military Deployment. JAMA Netw Open 2023; 6:e2321273. [PMID: 37389870 PMCID: PMC10314304 DOI: 10.1001/jamanetworkopen.2023.21273] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 05/16/2023] [Indexed: 07/01/2023] Open
Abstract
Importance Military deployment involves significant risk for life-threatening experiences that can lead to posttraumatic stress disorder (PTSD). Accurate predeployment prediction of PTSD risk may facilitate the development of targeted intervention strategies to enhance resilience. Objective To develop and validate a machine learning (ML) model to predict postdeployment PTSD. Design, Setting, and Participants This diagnostic/prognostic study included 4771 soldiers from 3 US Army brigade combat teams who completed assessments between January 9, 2012, and May 1, 2014. Predeployment assessments occurred 1 to 2 months before deployment to Afghanistan, and follow-up assessments occurred approximately 3 and 9 months post deployment. Machine learning models to predict postdeployment PTSD were developed in the first 2 recruited cohorts using as many as 801 predeployment predictors from comprehensive self-report assessments. In the development phase, cross-validated performance metrics and predictor parsimony were considered to select an optimal model. Next, the selected model's performance was evaluated with area under the receiver operating characteristics curve and expected calibration error in a temporally and geographically distinct cohort. Data analyses were performed from August 1 to November 30, 2022. Main Outcomes and Measures Posttraumatic stress disorder diagnosis was assessed by clinically calibrated self-report measures. Participants were weighted in all analyses to address potential biases related to cohort selection and follow-up nonresponse. Results This study included 4771 participants (mean [SD] age, 26.9 [6.2] years), 4440 (94.7%) of whom were men. In terms of race and ethnicity, 144 participants (2.8%) identified as American Indian or Alaska Native, 242 (4.8%) as Asian, 556 (13.3%) as Black or African American, 885 (18.3%) as Hispanic, 106 (2.1%) as Native Hawaiian or other Pacific Islander, 3474 (72.2%) as White, and 430 (8.9%) as other or unknown race or ethnicity; participants could identify as of more than 1 race or ethnicity. A total of 746 participants (15.4%) met PTSD criteria post deployment. In the development phase, models had comparable performance (log loss range, 0.372-0.375; area under the curve range, 0.75-0.76). A gradient-boosting machine with 58 core predictors was selected over an elastic net with 196 predictors and a stacked ensemble of ML models with 801 predictors. In the independent test cohort, the gradient-boosting machine had an area under the curve of 0.74 (95% CI, 0.71-0.77) and low expected calibration error of 0.032 (95% CI, 0.020-0.046). Approximately one-third of participants with the highest risk accounted for 62.4% (95% CI, 56.5%-67.9%) of the PTSD cases. Core predictors cut across 17 distinct domains: stressful experiences, social network, substance use, childhood or adolescence, unit experiences, health, injuries, irritability or anger, personality, emotional problems, resilience, treatment, anxiety, attention or concentration, family history, mood, and religion. Conclusions and Relevance In this diagnostic/prognostic study of US Army soldiers, an ML model was developed to predict postdeployment PTSD risk with self-reported information collected before deployment. The optimal model showed good performance in a temporally and geographically distinct validation sample. These results indicate that predeployment stratification of PTSD risk is feasible and may facilitate the development of targeted prevention and early intervention strategies.
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Affiliation(s)
- Santiago Papini
- Department of Psychiatry, University of California, San Diego, La Jolla
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Sonya B. Norman
- Department of Psychiatry, University of California, San Diego, La Jolla
- National Center for PTSD, White River Junction, Vermont
- Veterans Affairs Center of Excellence for Stress and Mental Health, San Diego, California
| | | | - Xiaoying Sun
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla
| | - Feng He
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Robert J. Ursano
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Sonia Jain
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla
| | - Murray B. Stein
- Department of Psychiatry, University of California, San Diego, La Jolla
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla
- Psychiatry Service, Veterans Affairs San Diego Healthcare System, San Diego, California
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Scheer JR, Helminen EC, Cascalheira CJ, Jaipuriyar V, Shaw TJ, Zabelski S, Behari K, Pirog S, Batchelder AW, Possemato K, Hughes TL, Sullivan TP. Probable PTSD, PTSD symptom severity, and comorbid PTSD and hazardous drinking among sexual minority women compared to heterosexual women: A meta-analysis. Clin Psychol Rev 2023; 102:102283. [PMID: 37150043 PMCID: PMC10205673 DOI: 10.1016/j.cpr.2023.102283] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 01/24/2023] [Accepted: 04/20/2023] [Indexed: 05/09/2023]
Abstract
Posttraumatic stress disorder (PTSD) is more prevalent among sexual minority women (SMW) than among heterosexual women. PTSD risk varies among SMW, but no meta-analysis has clarified sexual identity-related disparities in probable PTSD among women or SMW's heterogeneity in PTSD risk. SMW are also at pronounced risk of comorbid PTSD and hazardous drinking (HD). However, the difference in comorbid PTSD/HD between SMW and heterosexual women is understudied. This meta-analysis aimed to provide a comprehensive understanding of differences between SMW and heterosexual women and among SMW across demographic characteristics. Peer-reviewed publications that were written in English and reported quantitative data on PTSD specific to SMW were included. Eligible publications (n = 45) were identified through a systematic search of 11 electronic databases, supplemented by a search of reference lists of relevant papers. We found that probable PTSD, PTSD symptom severity, and probable comorbid PTSD/HD are highly prevalent among SMW, with SMW of color, transgender and gender diverse people, and bi+ women (e.g., bisexual, pansexual, queer) being at greatest risk. These results emphasize the need to improve accurate assessment of trauma-related sequelae among SMW and to develop, disseminate, and implement culturally sensitive treatments to reduce PTSD and comorbid PTSD/HD among at-risk SMW.
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Affiliation(s)
- Jillian R Scheer
- Department of Psychology, Syracuse University, 414 Huntington Hall, Syracuse, NY 13244, USA.
| | - Emily C Helminen
- Department of Psychology, Syracuse University, 414 Huntington Hall, Syracuse, NY 13244, USA; College of Health Science and Technology, Rochester Institute of Technology, USA
| | - Cory J Cascalheira
- Department of Psychology, Syracuse University, 414 Huntington Hall, Syracuse, NY 13244, USA; Department of Counseling & Educational Psychology, New Mexico State University, Las Cruces, NM, USA
| | - Virinca Jaipuriyar
- Department of Psychology, Syracuse University, 414 Huntington Hall, Syracuse, NY 13244, USA
| | - Thomas J Shaw
- Department of Psychology, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | - Sasha Zabelski
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Kriti Behari
- Department of Psychology, Syracuse University, 414 Huntington Hall, Syracuse, NY 13244, USA
| | - Sophia Pirog
- Department of Psychology, Syracuse University, 414 Huntington Hall, Syracuse, NY 13244, USA
| | - Abigail W Batchelder
- Harvard Medical School, Harvard University, Boston, MA, USA; Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Kyle Possemato
- VA Center for Integrated Healthcare, Syracuse Veterans Affairs Medical Center, Syracuse, NY, USA
| | - Tonda L Hughes
- School of Nursing and Department of Psychiatry, Columbia University, New York, NY, USA; Columbia University School of Nursing Center for Sexual and Gender Minority Research, New York, NY, USA
| | - Tami P Sullivan
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
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Thiol disulfide homeostasis in psychiatric disorders: A comprehensive review. Prog Neuropsychopharmacol Biol Psychiatry 2023; 123:110719. [PMID: 36634809 DOI: 10.1016/j.pnpbp.2023.110719] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 12/29/2022] [Accepted: 01/07/2023] [Indexed: 01/11/2023]
Abstract
Thiol-disulfide couple maintains an intracellular redox status. Dynamic thiol-disulfide homeostasis acts crucial parts in metabolic processes involving signal mechanisms, inflammation, antioxidant defense. Thiol-disulfide homeostasis have been implicated in numerous diseases. In this comprehensive review we identified the studies that examined the thiol-disulfide homeostasis in psychiatric disorders. Most cases demonstrated alterations in thiol-disulfide homeostasis and in most of them the thiol-disulfide balance tended to change direction to the disulfide side, that is, to the oxidative side. Currently, the fact that N-acetylcysteine, a thiol-containing compound, is of great interest as a new treatment approach in psychiatric disorders and the role of glutathione, the most abundant thiol, in the brain highlights the importance of evaluating the thiol-disulfide balance in psychiatric disorders.
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16
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López-Castro T, Papini S, Bauer A, Swarbrick M, Paul LK, Nizzi MC, Stanley D, Team CD, Hien D. Posttraumatic stress disorder symptom trajectories in a 16-month COVID-19 pandemic period. J Trauma Stress 2023; 36:180-192. [PMID: 36572985 PMCID: PMC9880687 DOI: 10.1002/jts.22899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 10/16/2022] [Accepted: 10/19/2022] [Indexed: 12/28/2022]
Abstract
COVID-19 pandemic presents an unheralded opportunity to better understand trajectories of posttraumatic stress disorder (PTSD) symptoms across a prolonged period of social disruption and stress. We tracked PTSD symptoms among trauma-exposed individuals in the United States and sought to identify population-based variability in PTSD symptom trajectories and understand what, if any, early pandemic experiences predicted membership in one trajectory versus others. As part of a longitudinal study of U.S. residents during the pandemic, participants who reported at least one potentially traumatic experience in their lifetime (N = 1,206) at Wave 1 (April 2020) were included in the current study. PTSD symptoms were assessed using the PCL-5 at four time points extending to July 2021. Latent growth mixture modeling was used to identify heterogeneous symptom trajectories. Trajectory membership was regressed on experiences from the early stage of the pandemic as measured using the Epidemic-Pandemic Impacts Inventory in a model that controlled for variables with documented associations to PTSD trajectories, including age, sex, income, and trauma history. Four trajectories were identified, categorized as resilient (73.0%), recurring (13.3%), recovering (8.3%), and chronic (5.5%). Emotional and physical health problems and positive changes associated with the early phase of the pandemic were each significant predictors of trajectory membership over and above all other variables in the model. Predictors primarily differentiated the resilient trajectory from each of the other three trajectories. Distinct PTSD symptom trajectories during the COVID-19 pandemic suggest a need for targeted efforts to help individuals at most risk for ongoing distress.
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Affiliation(s)
- Teresa López-Castro
- Psychology Department, Colin Powell School of Civic and Global Leadership, The City College of New York, New York, New York, USA
| | - Santiago Papini
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Alexandria Bauer
- Center of Alcohol & Substance Use Studies, Rutgers University, New Brunswick, New Jersey, USA
| | - Margaret Swarbrick
- Center of Alcohol & Substance Use Studies, Rutgers University, New Brunswick, New Jersey, USA
| | - Lynn K Paul
- Division of Humanities and Social Sciences, California Institute of Technology, Pasadena, California, USA
| | | | - Damian Stanley
- Division of Humanities and Social Sciences, California Institute of Technology, Pasadena, California, USA.,Gordon F. Derner School of Psychology, Adelphi University, Garden City, New York, USA
| | - Covid-Dynamic Team
- Center of Alcohol & Substance Use Studies, Rutgers University, New Brunswick, New Jersey, USA
| | - Denise Hien
- Center of Alcohol & Substance Use Studies, Rutgers University, New Brunswick, New Jersey, USA
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17
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Jiang W, Tian Y, Fan F, Fu F, Wei D, Tang S, Chen J, Li Y, Zhu R, Wang L, Shi Z, Wang D, Zhang XY. Effects of comorbid posttraumatic stress disorder on cognitive dysfunction in Chinese male methamphetamine patients. Prog Neuropsychopharmacol Biol Psychiatry 2022; 119:110611. [PMID: 35907518 DOI: 10.1016/j.pnpbp.2022.110611] [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: 05/22/2022] [Revised: 07/21/2022] [Accepted: 07/23/2022] [Indexed: 10/16/2022]
Abstract
OBJECTIVES Cognitive dysfunction and posttraumatic stress disorder (PTSD) are common in methamphetamine patients. However, few studies have investigated the cognitive performance of methamphetamine patients with PTSD. The purpose of this study was to investigate the impact of comorbid PTSD on cognitive function in Chinese male methamphetamine patients. METHODS We analyzed 464 methamphetamine patients and 156 healthy volunteers. The PTSD Screening Scale (PCL-5) was used to assess PTSD and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was used to assess cognitive function. RESULTS Compared with healthy controls, methamphetamine patients had more cognitive dysfunction in immediate memory, visuospatial/constructional, language, attention and delayed memory. Moreover, methamphetamine patients with PTSD had less cognitive dysfunction in immediate memory, attention, and delayed memory than methamphetamine patients without PTSD. Further stepwise regression analysis showed that PTSD alterations in arousal and reactivity cluster were risk predictors for language, and PTSD negative alteration in cognition and mood cluster were risk predictors for delayed memory. CONCLUSIONS Our results indicate that methamphetamine patients without PTSD have poorer cognitive dysfunction than those with PTSD. Some demographic and PTSD symptom clusters are protective or risk factors for cognitive dysfunction in methamphetamine patients.
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Affiliation(s)
- Wei Jiang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Yang Tian
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Fusheng Fan
- Xin Hua Drug Rehabilitation Center, Sichuan, China
| | - Fabing Fu
- Xin Hua Drug Rehabilitation Center, Sichuan, China
| | - Dejun Wei
- Xin Hua Drug Rehabilitation Center, Sichuan, China
| | | | - Jiajing Chen
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Yuqing Li
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Rongrong Zhu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Li Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Zhanbiao Shi
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
| | - Dongmei Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
| | - Xiang-Yang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
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18
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Javanbakht A, Grasser LR. Biological Psychiatry in Displaced Populations: What We Know, and What We Need to Begin to Learn. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2022; 7:1242-1250. [PMID: 35580738 PMCID: PMC9678009 DOI: 10.1016/j.bpsc.2022.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 04/05/2022] [Accepted: 05/02/2022] [Indexed: 12/16/2022]
Abstract
Conflict and climate change continue to displace millions of people, who experience unique trauma and stressors as they resettle in host countries. Both children and adults who are forcibly displaced, or choose to migrate, experience posttraumatic stress disorder, anxiety, depression, and other mental health conditions at higher rates than the general population. This may be attributed to severe, cumulative stress and trauma (largely interpersonal traumas); discrimination and harassment in host countries; and structural barriers to accessing and addressing mental health concerns, including clinician availability, language barriers, cultural differences, geographic accessibility, health care access, and stigma. Despite high exposure to and clinical impact of such experiences, and despite representing 1% of the world population, forcibly displaced people are underrepresented in neuroscientific research. The availability of such literature and research findings is significant in understanding the unique genetic and cultural aspects of trauma- and stress-related mental health, advocacy, reducing stigma, informing prevention, and treatment. The present work aimed to explore how the field of neuroscience can address mental health equity for individuals who have been uprooted in relation to land, with a focus on refugee populations. We offer practical suggestions on how to improve research in this area and narrow the gap in knowledge.
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Affiliation(s)
- Arash Javanbakht
- Stress, Trauma, and Anxiety Research Clinic, Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, Michigan.
| | - Lana Ruvolo Grasser
- Stress, Trauma, and Anxiety Research Clinic, Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, Michigan
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(2R,6R)-hydroxynorketamine acts through GluA1-induced synaptic plasticity to alleviate PTSD-like effects in rat models. Neurobiol Stress 2022; 21:100503. [DOI: 10.1016/j.ynstr.2022.100503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 11/30/2022] Open
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Leconte C, Mongeau R, Noble F. Traumatic Stress-Induced Vulnerability to Addiction: Critical Role of the Dynorphin/Kappa Opioid Receptor System. Front Pharmacol 2022; 13:856672. [PMID: 35571111 PMCID: PMC9091501 DOI: 10.3389/fphar.2022.856672] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 04/07/2022] [Indexed: 11/13/2022] Open
Abstract
Substance use disorders (SUD) may emerge from an individual’s attempt to limit negative affective states and symptoms linked to stress. Indeed, SUD is highly comorbid with chronic stress, traumatic stress, or post-traumatic stress disorder (PTSD), and treatments approved for each pathology individually often failed to have a therapeutic efficiency in such comorbid patients. The kappa-opioid receptor (KOR) and its endogenous ligand dynorphin (DYN), seem to play a key role in the occurrence of this comorbidity. The DYN/KOR function is increased either in traumatic stress or during drug use, dependence acquisition and DYN is released during stress. The behavioural effects of stress related to the DYN/KOR system include anxiety, dissociative and depressive symptoms, as well as increased conditioned fear response. Furthermore, the DYN/KOR system is implicated in negative reinforcement after the euphoric effects of a drug of abuse ends. During chronic drug consumption DYN/KOR functions increase and facilitate tolerance and dependence. The drug-seeking behaviour induced by KOR activation can be retrieved either during the development of an addictive behaviour, or during relapse after withdrawal. DYN is known to be one of the most powerful negative modulators of dopamine signalling, notably in brain structures implicated in both reward and fear circuitries. KOR are also acting as inhibitory heteroreceptors on serotonin neurons. Moreover, the DYN/KOR system cross-regulate with corticotropin-releasing factor in the brain. The sexual dimorphism of the DYN/KOR system could be the cause of the gender differences observed in patients with SUD or/and traumatic stress-related pathologies. This review underlies experimental and clinical results emphasizing the DYN/KOR system as common mechanisms shared by SUD or/and traumatic stress-related pathologies, and suggests KOR antagonist as a new pharmacological strategy to treat this comorbidity.
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Nicholas CR, Wang JB, Coker A, Mitchell JM, Klaire SS, Yazar-Klosinski B, Emerson A, Brown RT, Doblin R. The effects of MDMA-assisted therapy on alcohol and substance use in a phase 3 trial for treatment of severe PTSD. Drug Alcohol Depend 2022; 233:109356. [PMID: 35286849 PMCID: PMC9750500 DOI: 10.1016/j.drugalcdep.2022.109356] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/08/2022] [Accepted: 02/08/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) is commonly associated with alcohol and substance use disorders (ASUD). A randomized, placebo-controlled, phase 3 trial demonstrated the safety and efficacy of MDMA-assisted therapy (MDMA-AT) for the treatment of severe PTSD. This analysis explores patterns of alcohol and substance use in patients receiving MDMA-AT compared to placebo plus therapy (Placebo+Therapy). METHODS Adult participants with severe PTSD (n = 90) were randomized to three blinded trauma-focused therapy sessions with either MDMA-AT or Placebo+Therapy. Eligible participants met DSM-5 criteria for severe PTSD and could meet criteria for mild (current) or moderate (early remission) alcohol or cannabis use disorder; other SUDs were excluded. The current analyses examined outcomes on standardized measures of hazardous alcohol (i.e., Alcohol Use Disorder Identification Test; AUDIT) and drug (i.e., Drug Use Disorder Identification Test; DUDIT) use at baseline prior to randomization and at study termination. RESULTS There were no treatment group differences in AUDIT or DUDIT scores at baseline. Compared to Placebo+therapy, MDMA-AT was associated with a significantly greater reduction in mean (SD) AUDIT change scores (Δ = -1.02 (3.52) as compared to placebo (Δ = 0.40 (2.70), F (80, 1) = 4.20, p = 0.0436; Hedge's g= .45). Changes in DUDIT scores were not significantly different between treatment groups. CONCLUSIONS MDMA-AT for severe PTSD may also lead to subclinical improvements in alcohol use. MDMA-AT does not appear to increase risk of illicit drug use. These data provide preliminary evidence to support the development of MDMA-AT as an integrated treatment for co-occurring PTSD and ASUD.
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Affiliation(s)
- Christopher R. Nicholas
- University of Wisconsin-Madison, Department of Family Medicine and Community Health, Madison, WI, USA
| | - Julie B. Wang
- MAPS Public Benefit Corporation (MAPS PBC), San Jose, CA, USA
| | - Allison Coker
- MAPS Public Benefit Corporation (MAPS PBC), San Jose, CA, USA,University of California, San Francisco, Department of Neurology, San Francisco, CA, USA
| | - Jennifer M. Mitchell
- University of California, San Francisco, Department of Neurology, San Francisco, CA, USA,University of California, San Francisco, Department of Psychiatry and Behavioral Sciences, San Francisco, CA, USA
| | | | | | - Amy Emerson
- MAPS Public Benefit Corporation (MAPS PBC), San Jose, CA, USA
| | - Randy T. Brown
- University of Wisconsin-Madison, Department of Family Medicine and Community Health, Madison, WI, USA
| | - Rick Doblin
- Multidisciplinary Association for Psychedelic Studies (MAPS), San Jose, CA, USA
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Lawson K, Scarlata M, Cho C, Mangan C, Petersen D, Thompson H, Ehnstrom S, Mousley A, Bezek J, Bergstrom H. Adolescence alcohol exposure impairs fear extinction and alters medial prefrontal cortex plasticity. Neuropharmacology 2022; 211:109048. [DOI: 10.1016/j.neuropharm.2022.109048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 02/26/2022] [Accepted: 03/26/2022] [Indexed: 10/18/2022]
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Peak JM, Ingram V, Urbanoski K, Milligan K. Specifying the Relations among PTSD Symptom Clusters and Parenting Stress in Mothers Engaged in Substance Use Treatment. Subst Use Misuse 2022; 57:1552-1562. [PMID: 35819030 DOI: 10.1080/10826084.2022.2096236] [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] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Parenting stress is often heightened in mothers receiving treatment for substance use. Experiences of trauma are commonly seen in this population, which may give rise to Posttraumatic Stress Disorder (PTSD) symptoms, including intrusion, avoidance, negative cognition and mood, and affective arousal. While past research has demonstrated a significant relation between PTSD symptoms and parenting stress, no studies have examined the relative contributions of these symptoms to parenting stress in mothers engaged in substance use treatment. METHODS Seventy-four mothers attending outpatient substance use treatment who were parenting children aged 0-3 years completed measures of parenting stress, PTSD, substance use, and depression symptoms. RESULTS A canonical correlation analysis indicated two canonical variates accounting for significant variance between PTSD symptom clusters and parenting stress measures. The first canonical variate, primarily reflecting depressive and PTSD cognition and mood symptoms, was predominantly related to the parental distress aspect of parenting stress (40%). The second canonical variate, primarily reflecting intrusion and avoidance PTSD symptoms, was associated with increased parental perceptions of their child as difficult (10%). CONCLUSION Future research directions and clinical implications of these results are discussed for designing parenting interventions with mothers attending substance use treatment who present with PTSD symptoms.
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Affiliation(s)
- Julia Marie Peak
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | - Victoria Ingram
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | - Karen Urbanoski
- Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada
| | - Karen Milligan
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
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