Support for relationship between serum cholinesterase and post-traumatic stress disorder; 5-year follow-ups of victims of the Tokyo subway sarin poisoning

Military exposures and Gulf War illness in veterans with and without posttraumatic stress disorder

Gulf War illness (GWI) is a chronic multisymptom disorder of unknown etiology that is believed to be caused by neurotoxicant exposure experienced during deployment to the Gulf War. Posttraumatic stress disorder (PTSD) covaries with GWI and is believed to play a role in GWI symptoms. The present study examined the association between self-reported military exposures and GWI, stratified by PTSD status, in veterans from the Gulf War Era Cohort and Biorepository who were deployed to the Persian Gulf during the war. Participants self-reported current GWI and PTSD symptoms as well as military exposures (e.g., pyridostigmine [PB] pills, pesticides/insecticides, combat, chemical attacks, and oil well fires) experienced during the Gulf War. Deployed veterans' (N = 921) GWI status was ascertained using the Centers for Disease Control and Prevention definition. Individuals who met the GWI criteria were stratified by PTSD status, yielding three groups: GWI-, GWI+/PTSD-, and GWI+/PTSD+. Multivariable logistic regression, adjusted for covariates, was used to examine associations between GWI/PTSD groups and military exposures. Apart from insect bait use, the GWI+/PTSD+ group had higher odds of reporting military exposures than the GWI+/PTSD- group, adjusted odds ratio (aOR) = 2.15, 95% CI [1.30, 3.56]-aOR = 6.91, 95% CI [3.39, 14.08]. Except for PB pills, the GWI+/PTSD- group had a higher likelihood of reporting military exposures than the GWI- group, aOR = 2.03, 95% CI [1.26, 3.26]-aOR = 4.01, 95% CI [1.57, 10.25]. These findings are consistent with roles for both PTSD and military exposures in the etiology of GWI.

The impact of neurotoxicant exposures on posttraumatic stress disorder trajectories: The Ft. Devens Gulf War Veterans Cohort

Gulf War veterans (GWVs) were exposed to neurotoxicants, including sarin nerve gas, anti-nerve agent pills, pesticides, oil well fires, and fumes from unvented tent heaters, all of which have been associated with subsequent adverse health. Posttraumatic stress disorder (PTSD) symptoms have also been associated with GW deployment; however, associations between exposures and PTSD symptoms have not been investigated. We assessed PTSD symptom trajectories and associations with neurotoxicant exposures in Ft. Devens Cohort (FDC) veterans (N = 259) who endorsed trauma exposure during deployment and completed the PTSD Checklist at three follow-ups (1992-1993, 1997-1998, 2013-2017). Results indicate that among veterans with more severe initial PTSD symptoms, symptoms remained significantly higher across follow-ups, Bs = -1.489-1.028, whereas among those with low initial PTSD symptoms, symptom severity increased significantly over time, Bs = 1.043-10.304. Additionally, neurotoxicant exposure was associated with a significant increase in PTSD symptoms, Bs = -1.870-9.003. Significant interactions between time and exposures were observed for PTSD symptom clusters, suggesting that among participants with high initial PTSD symptom, unexposed veterans experienced symptom alleviation, whereas exposed veterans' PTSD symptoms remained high. In GWVs with low initial PTSD symptoms, both unexposed and exposed veterans experienced PTSD symptom exacerbations over time; however, this occurred at a faster rate among exposed veterans. These findings suggest that in the years following deployment, GWVs who were exposed to both traumatic events and neurotoxicants may experience more severe and chronic PTSD symptoms than those without neurotoxicant exposures.

Plasma lipoproteins in posttraumatic stress disorder patients compared to healthy controls and their associations with the HPA- and HPT-axis

BACKGROUND

Based on studies among primarily male veteran subjects, lipoproteins are thought to mediate the association of posttraumatic stress disorder (PTSD) with cardiovascular disease (CVD). However, recent civilian studies with female samples or samples with both sexes represented provide little evidence for this association. Gender, diet and sex-specific effects of stress hormones on lipoproteins may explain this dissociation in findings.

METHOD

Cross-sectional analysis of plasma concentrations of total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL) and triglycerides (TG) in a male and female sample of 49 PTSD-patients due to civilian trauma and 45 healthy controls. Second, we related these lipoproteins to several stress hormones (prolactin, cortisol, DHEA(S), TSH, T4).

RESULTS

Patients showed lower LDL (p=0.033) and LDL:HDL ratio (p=0.038) compared to controls, also when adjusting for diet. Sex influenced the effect of having PTSD on LDL with only male patients having lower values than male controls (p=0.012). All stress hormones were associated with several lipoproteins, mostly in a sex-dependent manner. For LDL, a significant sex-by-cortisol effect (p<0.001), having PTSD-by-sex-by-DHEA (p<0.001), having PTSD-by-sex-by-DHEAS (p=0.016) and having PTSD-by-sex-by-prolactin (p=0.003) was found.

CONCLUSION

In this male and female civilian sample we found a somewhat more favorable lipoprotein profile in PTSD-patients in contrast to evidence from strictly male veteran samples exhibiting a less favorable lipoprotein profile. Male patients did not exhibit a worse lipoprotein profile than female patients and therefore gender cannot explain the contradiction in evidence. Additionally, we found that PTSD-related stress hormones are associated with lipoproteins levels in patients in a sex-specific manner. Specific configurations of stress hormones may contribute to CVD in male patients or protect in female patients. Further research on these configurations could indicate which PTSD-patients are especially at risk for CVD and which are not. This could guide future precision medicine efforts to prevent and treat the still growing burden of CVD morbidity and mortality in PTSD.

Effect of Rivastigmine Augmentation in Treatment of Male Patients With Combat-Related Chronic Posttraumatic Stress Disorder: A Randomized Controlled Trial

BACKGROUND

Posttraumatic stress disorder (PTSD) is one of the chronic and disabling psychiatric disorders, particularly in combat veterans. In a case series, rivastigmine was suggested to be an effective augmentation in treatment of PTSD. The aim of the present study was to evaluate this finding in a randomized controlled trial.

METHOD

A 12-week, double-blind, placebo-controlled clinical trial was performed on 36 male patients (aged 42-60 years) diagnosed with chronic, combat-related PTSD. Subjects were screened for apparent cognitive deficits by means of Mini-Mental State Examination. All patients received selective serotonin reuptake inhibitors plus sodium valproate for 4 weeks and then reevaluated. Subjects who did not show adequate response were randomly assigned into 3 groups receiving rivastigmine (up to 6 mg/d), placebo, or the prior treatment regimen. Efficacy of medication was measured by administering PTSD Check List-Military Version at baseline and weeks 2, 4, 8, and 12. Collected data were analyzed by analysis of variance and repeated measurement. Reported differences were considered significant at the level of 0.05 or less.

RESULTS

The 3 groups showed statistically significant reductions in the total PTSD Check List-Military Version, avoidance subscale, and the reexperience subscale but not in the hyperarousal subscale. No significant differences were found between the 3 groups.

CONCLUSIONS

In contrast to the previous case series, findings of the current study did not support the efficacy of adjunctive rivastigmine in treatment of PTSD. This hypothetically could be due to the fact that all the study's subjects scored higher than 25 on Mini-Mental State Examination.

Abnormal serum lipid profile in Brazilian police officers with post-traumatic stress disorder

BACKGROUND

To measure the serum lipid composition of a sample of Brazilian police officers with and without PTSD regularly exposed to potentially traumatic situations.

METHODS

A cross-sectional survey was conducted with 118 active duty male police officers. Serum concentrations for total cholesterol, LDL-C, HDL-C, and triglycerides were enzymatically determined. Body mass index (BMI) was obtained for each participant.

RESULTS

Officers with PTSD exhibited significantly higher serum total cholesterol, LDL-C and triglycerides levels than those without PTSD. Total cholesterol and triglycerides, but not LDL-C, remained associated with PTSD diagnosis after controlling for confounding influences (i.e. socio-demographics, BMI, and tobacco, alcohol and medication use).

LIMITATIONS

The sample size was small. A nutritional interview was employed instead of established scales to assess alimentary habits, tobacco or alcohol consumption. A self-report screening tool was used to assess the prevalence of PTSD.

CONCLUSIONS

The association between PTSD and abnormal serum lipid profile and a tendency to exhibit higher BMI suggests that individuals with PTSD may be at increased risk for developing metabolic syndrome, a condition that by itself could account for many of the most serious PTSD-related physical health problems.

Our recent experiences with sarin poisoning cases in Japan and pesticide users with references to some selected chemicals

Attention has been paid to neurobehavioral effects of occupational and environmental exposures to chemicals such as pesticides, heavy metals and organic solvents. The area of research that includes neurobehavioral methods and effects in occupational and environmental health has been called "Occupational and Environmental Neurology and Behavioral Medicine." The methods, by which early changes in neurological, cognitive and behavioral function can be assessed, include neurobehavioral test battery, neurophysiological methods, questionnaires and structured interview, biochemical markers and imaging techniques. The author presents his observations of neurobehavioral and neurophysiological effects in Tokyo subway sarin poisoning cases as well as in pesticide users (tobacco farmers) in Malaysia in relation to Green Tobacco Sickness (GTS). In sarin cases, a variety effects were observed 6-8 months after exposure, suggesting delayed neurological effects. Studies on pesticide users revealed that organophosphorus and dithiocarbamate affected peripheral nerve conduction and postural balance; subjective symptoms related to GTS were also observed, indicating the effects of nicotine absorbed from wet tobacco leaves. In addition, non-neurological effects of pesticides and other chemicals are presented, in relation to genetic polymorphism and oxidative stress.