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O'Donohue MP, Amir Hamzah K, Nichols D, Ney LJ. Trauma film viewing and intrusive memories: Relationship between salivary alpha amylase, endocannabinoids, and cortisol. Psychoneuroendocrinology 2024; 164:107007. [PMID: 38503195 DOI: 10.1016/j.psyneuen.2024.107007] [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: 11/13/2023] [Revised: 01/14/2024] [Accepted: 02/26/2024] [Indexed: 03/21/2024]
Abstract
The endogenous cannabinoid (ECB) system is a small molecule lipid signalling system that is involved in stress response activation and is associated with PTSD, but it is unclear whether salivary ECBs are part of the sympathetic nervous system response to stress. We conducted an adapted trauma film paradigm, where participants completed a cold pressor test (or control) while watching a 10-minute trauma film. We also collected saliva and hair samples and tested them for ECBs, cortisol, and salivary alpha amylase (sAA). As hypothesised, there were significant positive correlations between sAA activity and salivary ECB levels, particularly 2-arachidonoyl glycerol (2-AG), though ECBs were not correlated with sAA stress reactivity. Participants who had a significant cortisol response to the trauma film/stressor reported less intrusive memories, which were also less distressing and less vivid. This effect was moderated by arachidonoyl ethanolamide (AEA), where decreases in AEA post-stress were associated with more intrusive memories in cortisol non-responders only. This study provides new evidence for the role of ECBs in the sympathetic nervous system.
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Affiliation(s)
- Matthew P O'Donohue
- School of Psychology and Counselling, Queensland University of Technology, Australia
| | - Khalisa Amir Hamzah
- School of Psychology and Counselling, Queensland University of Technology, Australia
| | - David Nichols
- Central Science Laboratory, University of Tasmania, Australia
| | - Luke J Ney
- School of Psychology and Counselling, Queensland University of Technology, Australia.
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Yount G, Taddeo S, Stumbrys T, Kriegsman M, Wahbeh H. Trends in waking salivary alpha-amylase levels following healing lucid dreams. Front Psychol 2024; 15:1347499. [PMID: 38298517 PMCID: PMC10828844 DOI: 10.3389/fpsyg.2024.1347499] [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: 11/30/2023] [Accepted: 01/04/2024] [Indexed: 02/02/2024] Open
Abstract
Introduction Salivary alpha-amylase (sAA) is considered a marker of autonomic nervous system activity in stress research, and atypical waking sAA responses have been reported for traumatized individuals. Lucid dreams, characterized by a dreamer's awareness of their dream state while remaining asleep, have shown promising preliminary evidence of their potential to enhance mental health. This study's objective was to evaluate sAA in relation to healing lucid dreams. Methods Participants experiencing PTSD symptoms attended a six-day workshop delivered via live video designed to teach techniques for transforming trauma through dreamwork and dream lucidity. Participants (n = 20) collected saliva samples each morning, immediately upon awakening (Time 1) and 30 min afterward (Time 2). sAA levels were determined by enzymatic assay, and the waking sAA slope was calculated as the difference of Time 2 minus Time 1. Participants completed dream reports each morning, with a dream classified as a 'healing lucid dream' when they reported attaining lucidity and remembered their intention to manifest a healing experience within the dreamscape. Results Of eight participants experiencing healing lucid dreams, four were able to provide usable saliva samples. Statistical tests on these four participants were not significant because of low power. However, nonsignificant positive associations were observed between experiencing more healing lucid dreams and increased waking sAA slope. Conclusion The results did not reveal a consistent effect of healing lucid dreams on waking sAA slope. Identifying meaningful patterns in this relationship will require larger samples and more stringent control over saliva collection procedures in future studies.
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Affiliation(s)
- Garret Yount
- Institute of Noetic Sciences, Novato, CA, United States
| | - Sitara Taddeo
- Institute of Noetic Sciences, Novato, CA, United States
| | - Tadas Stumbrys
- Institute of Psychology, Vilnius University, Vilnius, Lithuania
| | | | - Helané Wahbeh
- Institute of Noetic Sciences, Novato, CA, United States
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Govindula A, Ranadive N, Nampoothiri M, Rao CM, Arora D, Mudgal J. Emphasizing the Crosstalk Between Inflammatory and Neural Signaling in Post-traumatic Stress Disorder (PTSD). J Neuroimmune Pharmacol 2023; 18:248-266. [PMID: 37097603 PMCID: PMC10577110 DOI: 10.1007/s11481-023-10064-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 04/16/2023] [Indexed: 04/26/2023]
Abstract
Post-traumatic stress disorder (PTSD) is a chronic incapacitating condition with recurrent experience of trauma-related memories, negative mood, altered cognition, and hypervigilance. Agglomeration of preclinical and clinical evidence in recent years specified that alterations in neural networks favor certain characteristics of PTSD. Besides the disruption of hypothalamus-pituitary-axis (HPA) axis, intensified immune status with elevated pro-inflammatory cytokines and arachidonic metabolites of COX-2 such as PGE2 creates a putative scenario in worsening the neurobehavioral facet of PTSD. This review aims to link the Diagnostic and Statistical Manual of mental disorders (DSM-V) symptomology to major neural mechanisms that are supposed to underpin the transition from acute stress reactions to the development of PTSD. Also, to demonstrate how these intertwined processes can be applied to probable early intervention strategies followed by a description of the evidence supporting the proposed mechanisms. Hence in this review, several neural network mechanisms were postulated concerning the HPA axis, COX-2, PGE2, NLRP3, and sirtuins to unravel possible complex neuroinflammatory mechanisms that are obscured in PTSD condition.
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Affiliation(s)
- Anusha Govindula
- Department of Pharmacology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Niraja Ranadive
- Department of Pharmacology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Madhavan Nampoothiri
- Department of Pharmacology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - C Mallikarjuna Rao
- Department of Pharmacology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Devinder Arora
- Department of Pharmacology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India.
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast campus, Gold Coast, Queensland, 4222, Australia.
| | - Jayesh Mudgal
- Department of Pharmacology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India.
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Kinney KL, Rao U, Bailey B, Hellman N, Kelly C, McAfee NW, Morris MC. Dynamics of diurnal cortisol and alpha-amylase secretion and their associations with PTSD onset in recent interpersonal trauma survivors. Psychol Med 2023; 53:2263-2273. [PMID: 37310311 PMCID: PMC10264829 DOI: 10.1017/s0033291721004050] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Dysfunction in major stress response systems during the acute aftermath of trauma may contribute to risk for developing posttraumatic stress disorder (PTSD). The current study investigated how PTSD diagnosis and symptom severity, depressive symptoms, and childhood trauma uniquely relate to diurnal neuroendocrine secretion (cortisol and alpha-amylase rhythms) in women who recently experienced interpersonal trauma compared to non-traumatized controls (NTCs). METHOD Using a longitudinal design, we examined diurnal cortisol and alpha-amylase rhythms in 98 young women (n = 57 exposed to recent interpersonal trauma, n = 41 NTCs). Participants provided saliva samples and completed symptom measures at baseline and 1-, 3-, and 6-month follow-up. RESULTS Multilevel models (MLMs) revealed lower waking cortisol predicted the development of PTSD in trauma survivors and distinguished at-risk women from NTCs. Women with greater childhood trauma exposure exhibited flatter diurnal cortisol slopes. Among trauma-exposed individuals, lower waking cortisol levels were associated with higher concurrent PTSD symptom severity. Regarding alpha-amylase, MLMs revealed women with greater childhood trauma exposure exhibited higher waking alpha-amylase and slower diurnal alpha-amylase increase. CONCLUSIONS Results suggest lower waking cortisol in the acute aftermath of trauma may be implicated in PTSD onset and maintenance. Findings also suggest childhood trauma may predict a different pattern of dysfunction in stress response systems following subsequent trauma exposure than the stress system dynamics associated with PTSD risk; childhood trauma appears to be associated with flattened diurnal cortisol and alpha-amylase slopes, as well as higher waking alpha-amylase.
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Affiliation(s)
- Kerry L. Kinney
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Uma Rao
- Departments of Psychiatry & Human Behavior, Pediatrics and Psychological Science, and Center for the Neurobiology of Learning and Memory, University of California – Irvine, California, USA
- Children’s Hospital of Orange County, Orange, CA, USA
| | - Brooklynn Bailey
- Department of Psychology, the Ohio State University, Columbus, Ohio, USA
| | - Natalie Hellman
- Department of Psychology, University of Tulsa, Tulsa, Oklahoma, USA
| | - Chris Kelly
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Nicholas W. McAfee
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Matthew C. Morris
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi, USA
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Bryant RA. Attachment processes in posttraumatic stress disorder: A review of mechanisms to advance theories and treatments. Clin Psychol Rev 2023; 99:102228. [PMID: 36493729 DOI: 10.1016/j.cpr.2022.102228] [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: 07/21/2022] [Revised: 10/31/2022] [Accepted: 11/22/2022] [Indexed: 11/29/2022]
Abstract
Current conceptualisations of posttraumatic stress disorder (PTSD) are driven by biological, learning, and cognitive models that have shaped current treatments of the disorder. The strong influence of these models has resulted in a relative neglect of social mechanisms that can influence traumatic stress. There is abundant evidence from experimental, observational, and clinical studies that social factors can moderate many of the mechanisms articulated in prevailing models of PTSD. In this review it is proposed that attachment theory provides a useful framework to complement existing models of PTSD because it provides explanatory value for social factors can interact with biological, learning, and cognitive processes that shape traumatic stress response. The review provides an overview of attachment theory in the context of traumatic stress, outlines the evidence for how attachment factors can moderate stress responses and PTSD, and considers how harnessing attachment processes may augment recovery from and treatment of PTSD. This review emphasizes that rather than conceptualizing attachment theory as an independent theory of traumatic stress, there is much to gain by integrating attachment mechanisms into existing models of PTSD to accommodate the interactions between cognitive, biological, and attachment processes.
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Sperl MFJ, Panitz C, Skoluda N, Nater UM, Pizzagalli DA, Hermann C, Mueller EM. Alpha-2 Adrenoreceptor Antagonist Yohimbine Potentiates Consolidation of Conditioned Fear. Int J Neuropsychopharmacol 2022; 25:759-773. [PMID: 35748393 PMCID: PMC9515133 DOI: 10.1093/ijnp/pyac038] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 05/26/2022] [Accepted: 06/21/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Hyperconsolidation of aversive associations and poor extinction learning have been hypothesized to be crucial in the acquisition of pathological fear. Previous animal and human research points to the potential role of the catecholaminergic system, particularly noradrenaline and dopamine, in acquiring emotional memories. Here, we investigated in a between-participants design with 3 groups whether the noradrenergic alpha-2 adrenoreceptor antagonist yohimbine and the dopaminergic D2-receptor antagonist sulpiride modulate long-term fear conditioning and extinction in humans. METHODS Fifty-five healthy male students were recruited. The final sample consisted of n = 51 participants who were explicitly aware of the contingencies between conditioned stimuli (CS) and unconditioned stimuli after fear acquisition. The participants were then randomly assigned to 1 of the 3 groups and received either yohimbine (10 mg, n = 17), sulpiride (200 mg, n = 16), or placebo (n = 18) between fear acquisition and extinction. Recall of conditioned (non-extinguished CS+ vs CS-) and extinguished fear (extinguished CS+ vs CS-) was assessed 1 day later, and a 64-channel electroencephalogram was recorded. RESULTS The yohimbine group showed increased salivary alpha-amylase activity, confirming a successful manipulation of central noradrenergic release. Elevated fear-conditioned bradycardia and larger differential amplitudes of the N170 and late positive potential components in the event-related brain potential indicated that yohimbine treatment (compared with a placebo and sulpiride) enhanced fear recall during day 2. CONCLUSIONS These results suggest that yohimbine potentiates cardiac and central electrophysiological signatures of fear memory consolidation. They thereby elucidate the key role of noradrenaline in strengthening the consolidation of conditioned fear associations, which may be a key mechanism in the etiology of fear-related disorders.
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Affiliation(s)
- Matthias F J Sperl
- Correspondence: Matthias F. J. Sperl, Justus Liebig University Giessen, Department of Psychology, Otto-Behaghel-Str. 10F, 35394 Giessen, Germany ()
| | - Christian Panitz
- Department of Psychology, Personality Psychology and Assessment, University of Marburg, Marburg, Germany,Department of Psychology, Experimental Psychology and Methods, University of Leipzig, Leipzig, Germany,Center for the Study of Emotion and Attention, University of Florida, Gainesville, Florida, USA
| | - Nadine Skoluda
- Department of Clinical and Health Psychology, University of Vienna, Vienna, Austria
| | - Urs M Nater
- Department of Clinical and Health Psychology, University of Vienna, Vienna, Austria
| | - Diego A Pizzagalli
- Department of Psychiatry, Harvard Medical School, & Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, Massachusetts, USA
| | - Christiane Hermann
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Giessen, Giessen, Germany
| | - Erik M Mueller
- Department of Psychology, Personality Psychology and Assessment, University of Marburg, Marburg, Germany
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Combining the trauma film and fear conditioning paradigms: A theoretical review and meta-analysis with relevance to PTSD. Behav Res Ther 2022; 152:104081. [DOI: 10.1016/j.brat.2022.104081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 03/09/2022] [Accepted: 03/15/2022] [Indexed: 01/01/2023]
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Feemster JC, Steele TA, Palermo KP, Ralston CL, Tao Y, Bauer DA, Edgar L, Rivera S, Walters-Smith M, Gossard TR, Teigen LN, Timm PC, Richardson JW, Robert Auger R, Kolla B, McCarter SJ, Boeve BF, Silber MH, St. Louis EK. Abnormal rapid eye movement sleep atonia control in chronic post-traumatic stress disorder. Sleep 2021; 45:6484914. [PMID: 34958372 PMCID: PMC8919203 DOI: 10.1093/sleep/zsab259] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 10/12/2021] [Indexed: 12/30/2022] Open
Abstract
STUDY OBJECTIVES Post-traumatic stress disorder (PTSD) and rapid eye movement (REM) sleep behavior disorder (RBD) share some common features including prominent nightmares and sleep disturbances. We aimed to comparatively analyze REM sleep without atonia (RSWA) between patients with chronic PTSD with and without dream enactment behavior (DEB), isolated RBD (iRBD), and controls. METHODS In this retrospective study, we comparatively analyzed 18 PTSD with DEB (PTSD+DEB), 18 PTSD without DEB, 15 iRBD, and 51 controls matched for age and sex. We reviewed medical records to determine PTSD clinical features and quantitatively analyzed RSWA. We used nonparametric analyses to compare clinical and polysomnographic features. RESULTS PTSD patients, both with and without DEB, had significantly higher RSWA than controls (all p < .025, excepting submentalis phasic duration in PTSD+DEB). Most RSWA measures were also higher in PTSD+DEB than in PTSD without DEB patients (all p < .025). CONCLUSIONS PTSD patients have higher RSWA than controls, whether DEB is present or not, indicating that REM sleep atonia control is abnormal in chronic PTSD. Further prospective studies are needed to determine whether neurodegenerative risk and disease markers similar to RBD might occur in PTSD patients.
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Affiliation(s)
- John C Feemster
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Division of Pulmonary and Critical Care Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Neurology, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Tyler A Steele
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Division of Pulmonary and Critical Care Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Neurology, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Kyle P Palermo
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,St. Olaf College, Northfield, MN, USA
| | - Christy L Ralston
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Cornell College, Mount Vernon, IA, USA
| | - Yumeng Tao
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Cornell College, Mount Vernon, IA, USA
| | - David A Bauer
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,St. Olaf College, Northfield, MN, USA
| | - Liam Edgar
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,St. Olaf College, Northfield, MN, USA
| | - Sonia Rivera
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Maxwell Walters-Smith
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Thomas R Gossard
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Division of Pulmonary and Critical Care Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Medicine, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Luke N Teigen
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Division of Pulmonary and Critical Care Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Medicine, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Paul C Timm
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Division of Pulmonary and Critical Care Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Medicine, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Jarrett W Richardson
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Division of Pulmonary and Critical Care Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Psychiatry, Mayo Clinic and Foundation, Rochester, MN, USA
| | - R Robert Auger
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Division of Pulmonary and Critical Care Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Psychiatry, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Bhanuprakash Kolla
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Division of Pulmonary and Critical Care Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Psychiatry, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Stuart J McCarter
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Division of Pulmonary and Critical Care Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Neurology, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Bradley F Boeve
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Division of Pulmonary and Critical Care Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Neurology, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Michael H Silber
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Division of Pulmonary and Critical Care Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Neurology, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Erik K St. Louis
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Division of Pulmonary and Critical Care Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Neurology, Mayo Clinic and Foundation, Rochester, MN, USA,Mayo Clinic Health System Southwest Wisconsin, La Crosse, WI, USA,Corresponding author. Erik K. St. Louis, Mayo Center for Sleep Medicine, Departments of Medicine and Neurology, Mayo Clinic College of Medicine, 200 First Street Southwest, Rochester, MN 55905, USA.
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Ney LJ, Crombie KM, Mayo LM, Felmingham KL, Bowser T, Matthews A. Translation of animal endocannabinoid models of PTSD mechanisms to humans: Where to next? Neurosci Biobehav Rev 2021; 132:76-91. [PMID: 34838529 DOI: 10.1016/j.neubiorev.2021.11.040] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 11/21/2021] [Accepted: 11/22/2021] [Indexed: 12/11/2022]
Abstract
The endocannabinoid system is known to be involved in mechanisms relevant to PTSD aetiology and maintenance, though this understanding is mostly based on animal models of the disorder. Here we review how human paradigms can successfully translate animal findings to human subjects, with the view that substantially increased insight into the effect of endocannabinoid signalling on stress responding, emotional and intrusive memories, and fear extinction can be gained using modern paradigms and methods for assessing the state of the endocannabinoid system in PTSD.
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Affiliation(s)
- Luke J Ney
- School of Psychological Sciences, University of Tasmania, Australia; School of Psychology and Counselling, Queensland University of Technology, Australia.
| | - Kevin M Crombie
- Department of Psychiatry and Behavioral Sciences, University of Texas at Austin, United States
| | - Leah M Mayo
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Science, Linköping University, Sweden
| | - Kim L Felmingham
- Department of Psychological Sciences, University of Melbourne, Australia
| | | | - Allison Matthews
- School of Psychological Sciences, University of Tasmania, Australia
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10
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Bhatt S, Hillmer AT, Rusowicz A, Nabulsi N, Matuskey D, Angarita GA, Najafzadeh S, Kapinos M, Southwick SM, Krystal JH, Carson RE, Huang Y, Cosgrove KP. Imaging brain cortisol regulation in PTSD with a target for 11β-hydroxysteroid dehydrogenase type 1. J Clin Invest 2021; 131:150452. [PMID: 34651587 DOI: 10.1172/jci150452] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 08/31/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUNDInvestigations of stress dysregulation in posttraumatic stress disorder (PTSD) have focused on peripheral cortisol, but none have examined cortisol in the human brain. This study used positron emission tomography (PET) to image 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1), a cortisol-producing enzyme, as a putative brain cortisol marker in PTSD.METHODSSixteen individuals with PTSD and 17 healthy, trauma-exposed controls (TCs) underwent PET imaging with [18F]AS2471907, a radioligand for 11β-HSD1.RESULTSPrefrontal-limbic 11β-HSD1 availability, estimated as [18F]AS2471907 volume of distribution (VT), was significantly higher in the PTSD group compared with the TC group (β = 1.16, P = 0.0057). Lower prefrontal-limbic 11β-HSD1 availability was related to greater overall PTSD severity (R2 = 0.27, P = 0.038) in the PTSD group. 11β-HSD1 availability was not related to plasma cortisol levels (R2 = 0.026, P = 0.37). In a PTSD subset (n = 10), higher 11β-HSD1 availability was associated with higher availability of translocator protein (TSPO), a microglial marker (β = 4.40, P = 0.039).CONCLUSIONHigher brain cortisol-producing 11β-HSD1 in the PTSD group may represent a resilience-promoting neuroadaptation resulting in lower PTSD symptoms. Along with preliminary associations between 11β-HSD1 and TSPO, corroborating previous evidence of immune suppression in PTSD, these findings collectively challenge previous hypotheses of the deleterious effects of both excessive brain glucocorticoid and brain immune signaling in PTSD.FUNDINGBrain and Behavior Research Foundation Independent Investigator Grant, National Institute of Mental Health grants F30MH116607 and R01MH110674, the Veterans Affairs National Center for PTSD, the Gustavus and Louise Pfeiffer Foundation Fellowship, Clinical and Translational Science Awards grant UL1 TR000142 from the NIH National Center for Advancing Translational Science.
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Affiliation(s)
- Shivani Bhatt
- Interdepartmental Neuroscience Program, Yale University, New Haven, Connecticut, USA
| | - Ansel T Hillmer
- Department of Radiology and Biomedical Imaging.,Department of Psychiatry, and.,Yale PET Center, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Nabeel Nabulsi
- Department of Radiology and Biomedical Imaging.,Yale PET Center, Yale School of Medicine, New Haven, Connecticut, USA
| | - David Matuskey
- Department of Radiology and Biomedical Imaging.,Department of Psychiatry, and.,Yale PET Center, Yale School of Medicine, New Haven, Connecticut, USA
| | - Gustavo A Angarita
- Department of Psychiatry, and.,Yale PET Center, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Michael Kapinos
- Yale PET Center, Yale School of Medicine, New Haven, Connecticut, USA
| | - Steven M Southwick
- Department of Psychiatry, and.,US Department of Veterans Affairs, National Center for Posttraumatic Stress Disorder, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - John H Krystal
- Department of Psychiatry, and.,US Department of Veterans Affairs, National Center for Posttraumatic Stress Disorder, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Richard E Carson
- Department of Psychiatry, and.,Yale PET Center, Yale School of Medicine, New Haven, Connecticut, USA
| | - Yiyun Huang
- Department of Radiology and Biomedical Imaging.,Yale PET Center, Yale School of Medicine, New Haven, Connecticut, USA
| | - Kelly P Cosgrove
- Interdepartmental Neuroscience Program, Yale University, New Haven, Connecticut, USA.,Department of Radiology and Biomedical Imaging.,Department of Psychiatry, and.,Yale PET Center, Yale School of Medicine, New Haven, Connecticut, USA.,US Department of Veterans Affairs, National Center for Posttraumatic Stress Disorder, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, Connecticut, USA
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11
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Blekić W, Rossignol M, Wauthia E, Felmingham KL. Influence of acute stress on attentional bias toward threat: How a previous trauma exposure disrupts threat apprehension. Int J Psychophysiol 2021; 170:20-29. [PMID: 34597728 DOI: 10.1016/j.ijpsycho.2021.09.009] [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: 10/14/2020] [Revised: 09/08/2021] [Accepted: 09/24/2021] [Indexed: 11/18/2022]
Abstract
While previous trauma exposure is known to be a risk factor for the development and maintenance of many psychological disorders, it remains unclear how it increases individual risk for prospective psychopathology in the aftermath of a new trauma exposure. The aim of this study was to investigate how a prior exposure to trauma affects attentional processing of threat before and after an acute stress task. Specifically, we assessed attentional biases to threat before and after a cold pressor task in 17 individuals who have been exposed to trauma (TE) compared to 18 individuals without trauma exposure (NTE). Behavioral results showed difficulties to disengage from threat in TE but not in the control group prior to stress induction, as well as a switch to an attentional bias toward threat after the cold pressor task in the TE group. For the ERPs, we highlighted (1) decreased N1 negativity in response to threatening stimuli after an acute stress in both groups, and (2) a parallel increase in P1 for such stimuli only in the TE group. Those results suggest a vulnerability presented by previously traumatized individuals when dealing with threats as well as an acute responsitity toward stress. Those results are interpreted in regards with the theorical models of stress and anxiety.
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Affiliation(s)
- Wivine Blekić
- Laboratory of Cognitive Psychology and Neuropsychology, University of Mons, Belgium.
| | - Mandy Rossignol
- Laboratory of Cognitive Psychology and Neuropsychology, University of Mons, Belgium
| | - Erika Wauthia
- Laboratory of Cognitive Psychology and Neuropsychology, University of Mons, Belgium
| | - Kim L Felmingham
- School of Psychological Sciences, University of Melbourne, Australia
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12
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Hsu CMK, Ney LJ, Honan C, Felmingham KL. Gonadal steroid hormones and emotional memory consolidation: A systematic review and meta-analysis. Neurosci Biobehav Rev 2021; 130:529-542. [PMID: 34517034 DOI: 10.1016/j.neubiorev.2021.09.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/19/2021] [Accepted: 09/06/2021] [Indexed: 10/20/2022]
Abstract
Anxiety and stress-related disorders are more prevalent in women and associated with negative emotional memory consolidation as well as impaired fear extinction recall. Recent research has identified a role of gonadal steroid hormones in influencing emotional memories and fear extinction, however most individual studies have small samples and employed various protocols. A systematic review and meta-analysis were conducted on studies that examined sex hormones (estrogen, progesterone, testosterone, allopregnanolone, dehydroepiandrosterone) on four aspects of memory, namely, intentional recall (k = 13), recognition memory (k = 7), intrusive memories (k = 9), and extinction recall (k = 11). The meta-analysis on natural cycling women revealed that progesterone level was positively associated with negative recall and negative intrusive memories, and this effect on intentional recall was enhanced under stress induction. Estradiol level was positively associated with extinction recall. This study reveals an important role of progesterone and estradiol in influencing emotional memory consolidation. It highlights the need to control for these hormonal effects and examine progesterone and estradiol concurrently across all menstrual phases in future emotional memory paradigms.
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Affiliation(s)
- Chia-Ming K Hsu
- School of Psychological Sciences, University of Tasmania, Australia.
| | - Luke J Ney
- School of Psychological Sciences, University of Tasmania, Australia
| | - Cynthia Honan
- School of Psychological Sciences, University of Tasmania, Australia
| | - Kim L Felmingham
- School of Psychological Sciences, University of Melbourne, Australia
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13
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Karl A, Carnelley KB, Arikan G, Baldwin DS, Heinrichs M, Stopa L. The effect of attachment security priming and oxytocin on physiological responses to trauma films and subsequent intrusions. Behav Res Ther 2021; 141:103845. [PMID: 33780748 DOI: 10.1016/j.brat.2021.103845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 02/19/2021] [Accepted: 03/08/2021] [Indexed: 10/21/2022]
Abstract
To further understand protective mechanisms to prevent post-traumatic stress disorder or assist recovery from psychological trauma, this study investigated whether pharmacological and psychological activation of a secure attachment representation elicits higher felt-security and a related response pattern of reduced physiological arousal and increased parasympathetic activation; and whether it protects individuals from developing intrusions and experiencing distress in the week following exposure to a trauma film. Using a double-blind, experimental mixed factorial design, 101 volunteers received either oxytocin or placebo and either secure attachment or neutral priming before watching a trauma film. We measured felt security as an indicator of the strength of activation of a secure attachment representation, skin conductance and heart rate as indicators of physiological arousal, and high frequency heart rate variability as an indicator of parasympathetic activation during the priming and the film. Participants then completed a seven-day intrusion diary. Secure attachment priming, but not oxytocin administration or the combination of both, was associated with reduced physiological arousal and increased parasympathetic activity during priming. Although secure attachment priming was not related to the absolute number of intrusions or to less perceived distress or physiological arousal during the trauma film, it was associated with lower intrusion-related distress in the 7-days post-testing. Our findings extend previous research that suggests the importance of interventions that address intrusion-related distress for recovery from trauma, and suggest a promising role for secure attachment priming in trauma-focused psychological therapies. We contribute to the growing literature that finds that higher subjective distress during a trauma is associated with higher intrusion-related distress. We discuss theoretical implications and possible mechanisms through which secure attachment priming may exert potential beneficial effects.
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Affiliation(s)
- Anke Karl
- Psychology, University of Exeter, Exeter, UK.
| | | | - Gizem Arikan
- Department of Psychology, Ozyegin University, Istanbul, Turkey
| | - David S Baldwin
- Faculty of Medicine, University of Southampton, UK; Department of Psychiatry and Mental Health, University of Cape Town, South Africa
| | | | - Lusia Stopa
- School of Psychology, University of Southampton, Southampton, UK
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14
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Ney LJ, Hsu CMK, Nicholson E, Zuj DV, Clark L, Kleim B, Felmingham KL. The Effect of Self-Reported REM Behavior Disorder Symptomology on Intrusive Memories in Post-Traumatic Stress Disorder. Behav Sleep Med 2021; 19:178-191. [PMID: 31986908 DOI: 10.1080/15402002.2020.1722127] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background: PTSD is characterised by severe sleep disturbances, which is increasingly recognised to in many cases consist of similar symptomology to sleep disorders such as REM Behaviour Disorder (RBD). The present study aimed to investigate whether different aspects of sleep quality influence intrusive memory development and whether PTSD status moderates this relationship. Participants and Methods: 34 PTSD, 52 trauma-exposed (TE) and 42 non-trauma exposed (NTE) participants completed an emotional memory task, where they viewed 60 images (20 positive, 20 negative and 20 neutral) and, two days later, reported how many intrusive memories they had of each valence category. Participants also completed three measures of sleep quality: the Pittsburgh Sleep Quality Index, the REM Behaviour Disorder Screening Questionnaire and total hours slept before each session. Results: The PTSD group reported poorer sleep quality than both TE and NTE groups on all three measures, and significantly more negative intrusive memories than the NTE group. Mediation analyses revealed that self-reported RBD symptomology before the second session mediated the relationship between PTSD status and intrusive memories. Follow-up moderation analyses revealed that self-reported RBD symptomology before the second session was only a significant predictor of intrusion in the PTSD group, though with a small effect size. Conclusions: These findings suggest that RBD symptomology is an indicator of consolidation of intrusive memories in PTSD but not trauma-exposed or healthy participants, which supports the relevance of characterising RBD in PTSD.
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Affiliation(s)
- Luke J Ney
- School of Psychology, University of Tasmania , Hobart, Australia
| | - Chia Ming K Hsu
- School of Psychology, University of Tasmania , Hobart, Australia
| | - Emma Nicholson
- School of Psychology, University of Tasmania , Hobart, Australia.,School of Psychological Sciences, University of Melbourne , Melbourne, Australia
| | - Daniel V Zuj
- School of Psychology, University of Tasmania , Hobart, Australia.,Department of Psychology, Swansea University , Swansea, UK
| | - L Clark
- School of Psychology, University of Tasmania , Hobart, Australia
| | - Birgit Kleim
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich , Zurich, Switzerland
| | - Kim L Felmingham
- School of Psychological Sciences, University of Melbourne , Melbourne, Australia
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15
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Carmassi C, Dell'Oste V, Bertelloni CA, Foghi C, Diadema E, Mucci F, Massimetti G, Rossi A, Dell'Osso L. Disrupted Rhythmicity and Vegetative Functions Relate to PTSD and Gender in Earthquake Survivors. Front Psychiatry 2020; 11:492006. [PMID: 33304278 PMCID: PMC7701044 DOI: 10.3389/fpsyt.2020.492006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 09/14/2020] [Indexed: 01/11/2023] Open
Abstract
Background: Increasing evidence indicates that survivors to traumatic events may show disruption of sleep pattern, eating and sexual behaviors, and somatic symptoms suggestive of alterations of biorhythmicity and vegetative functions. Therefore, the aim of this study was to investigate these possible alterations in a sample of survivors in the aftermath of earthquake exposure, with particular attention to gender differences and impact of post-traumatic stress disorder (PTSD). Methods: High school senior students, who had been exposed to the 2009 L'Aquila earthquake, were enrolled 21 months after the traumatic event and evaluated by the Trauma and Loss Spectrum Self-Report to investigate PTSD rates and by a domain of the Mood Spectrum Self-Report-Lifetime Version (MOODS-SR), to explore alterations in circadian/seasonal rhythms and vegetative functions. Results: The rates of endorsement of MOODS-SR rhythmicity and vegetative functions domain and subdomain scores were significantly higher in survivors with PTSD with respect to those without it. Among all earthquake survivors, women reported higher scores than men on the rhythmicity and vegetative functions domain and subdomain scores, except for the rhythmicity and sexual functions ones. Female survivors without PTSD showed significantly higher scores than men in the rhythmicity and vegetative functions total scores and the sleep and weight and appetite subdomains. Potentially traumatic events burden predicted rhythmicity and vegetative functions impairment, with a moderation effect of re-experiencing symptoms. Conclusions: We report impairments in rhythmicity, sleep, eating, and sexual and somatic health in survivors to a massive earthquake, particularly among subjects with PTSD and higher re-experiencing symptoms, with specific gender-related differences. Evaluating symptoms of impaired rhythmicity and vegetative functions seems essential for a more accurate assessment and clinical management of survivors to a mass trauma.
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Affiliation(s)
- Claudia Carmassi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Valerio Dell'Oste
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,Department of Biotechnology Chemistry and Pharmacy, University of Siena, Siena, Italy
| | | | - Claudia Foghi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Elisa Diadema
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,Department of Biotechnology Chemistry and Pharmacy, University of Siena, Siena, Italy
| | - Federico Mucci
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,Department of Biotechnology Chemistry and Pharmacy, University of Siena, Siena, Italy
| | - Gabriele Massimetti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alessandro Rossi
- Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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16
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An alternative theory for hormone effects on sex differences in PTSD: The role of heightened sex hormones during trauma. Psychoneuroendocrinology 2019; 109:104416. [PMID: 31472433 DOI: 10.1016/j.psyneuen.2019.104416] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/05/2019] [Accepted: 08/22/2019] [Indexed: 02/08/2023]
Abstract
Women are at least twice as susceptible to developing post-traumatic stress disorder (PTSD) compared to men. Although most research seeking to explain this discrepancy has focussed on the role of oestradiol during fear extinction learning, the role of progesterone has been overlooked, despite relatively consistent findings being reported concerning the role of progesterone during consolidation of emotional and intrusive memories. In this review article, we outline literature supporting the role of progesterone on memory formation, with particular emphasis on potential memory-enhancing properties of progesterone when subjects are placed under stress. It is possible that progesterone directly and indirectly exerts memory-enhancing effects at the time of trauma, which is an effect that may not be necessarily captured during non-stressful paradigms. We propose a model whereby progesterone's steroidogenic relationship to cortisol and brain-derived neurotrophic factor in combination with elevated oestradiol may enhance emotional memory consolidation during trauma and therefore present a specific vulnerability to PTSD formation in women, particularly during the mid-luteal phase of the menstrual cycle.
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17
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Ney LJ, Matthews A, Bruno R, Felmingham KL. Cannabinoid interventions for PTSD: Where to next? Prog Neuropsychopharmacol Biol Psychiatry 2019; 93:124-140. [PMID: 30946942 DOI: 10.1016/j.pnpbp.2019.03.017] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 03/20/2019] [Accepted: 03/29/2019] [Indexed: 01/18/2023]
Abstract
Cannabinoids are a promising method for pharmacological treatment of post-traumatic stress disorder (PTSD). Despite considerable research devoted to the effect of cannabinoid modulation on PTSD symptomology, there is not a currently agreed way by which the cannabinoid system should be targeted in humans. In this review, we present an overview of recent research identifying neurological pathways by which different cannabinoid-based treatments may exert their effects on PTSD symptomology. We evaluate the strengths and weaknesses of each of these different approaches, including recent challenges presented to favourable options such as fatty acid amide hydrolase (FAAH) inhibitors. This article makes the strengths and challenges of different potential cannabinoid treatments accessible to psychological researchers interested in cannabinoid therapeutics and aims to aid selection of appropriate tools for future clinical trials.
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Affiliation(s)
- Luke J Ney
- School of Psychology, University of Tasmania, Australia.
| | | | | | - Kim L Felmingham
- School of Psychological Sciences, University of Melbourne, Australia
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18
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McCall WV, Pillai A, Pandya CD, McCloud L, Moraczewski JA, Tauhidul L, Youssef NA, Case D, Rosenquist PB. Bedtime doses of prazosin do not affect daytime salivary amylase markers in PTSD. Heliyon 2019; 5:e01709. [PMID: 31193114 PMCID: PMC6517516 DOI: 10.1016/j.heliyon.2019.e01709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 04/05/2019] [Accepted: 05/08/2019] [Indexed: 11/30/2022] Open
Abstract
Overactivity of the noradrenergic (NE) system within the central nervous system (CNS) has been postulated as a key pathophysiology of posttraumatic stress disorder (PTSD). The activity of the enzyme salivary α-amylase (sAA) has been proposed as an indirect measure of CNS NE activity, and sAA is elevated in PTSD. As an antagonist of the α-1 NE receptor, prazosin would be expected to alter sAA values in PTSD patients. However, given its short half-life, it is not clear whether bedtime doses would have an effect on daytime sAA. In the present study, we assayed daytime sAA in 20 suicidal PTSD patients who were randomized to prazosin versus placebo at bedtime-only, and found no effect in daytime sAA. These findings are consistent with studies showing an advantage for twice daily dosing of prazosin in PTSD.
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Affiliation(s)
- William Vaughn McCall
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, 997 St Sebastian Way, Augusta, GA, 30912, USA
| | - Anilkumar Pillai
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, 997 St Sebastian Way, Augusta, GA, 30912, USA
| | - Chirayu D Pandya
- Medical Laboratory, Imaging, and Radiologic Sciences Department, College of Allied Health Sciences, Augusta University, Augusta, GA, USA
| | - Laryssa McCloud
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, 997 St Sebastian Way, Augusta, GA, 30912, USA
| | | | - Liniya Tauhidul
- Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Nagy A Youssef
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, 997 St Sebastian Way, Augusta, GA, 30912, USA
| | - Doug Case
- Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, USA
| | - Peter B Rosenquist
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, 997 St Sebastian Way, Augusta, GA, 30912, USA
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19
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Durand F, Isaac C, Januel D. Emotional Memory in Post-traumatic Stress Disorder: A Systematic PRISMA Review of Controlled Studies. Front Psychol 2019; 10:303. [PMID: 30890976 PMCID: PMC6411692 DOI: 10.3389/fpsyg.2019.00303] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 01/30/2019] [Indexed: 01/28/2023] Open
Abstract
Background: Emotional memory is an adaptive process that improves the memorization of emotional events or stimuli. In Post-Traumatic Stress Disorder (PTSD), emotional memory may be altered, which in turn may affect symptoms. Having a clearer view of the processes of interaction between memory and emotional stimuli in PTSD may improve our knowledge of this disorder, and could create new therapeutic management tools. Thus, we performed a systematic review of the evidence of specific emotional memory in PTSD patients. Method: Following PRISMA guidelines, a systematic review of MEDLINE, PsycInfo, and ScienceDirect was undertaken to identify controlled studies on emotional memory that used cognitive tasks on PTSD patients. The initial research was conducted from June 2017 to July 2017, and search terms included: Post-Traumatic Stress Disorder; PTSD; emotional memory; emotion; emotional; memory; and episodic memory. Results: Eighteen studies reporting on 387 PTSD patients met the eligibility criteria. Among the studies selected, 11 observed specific memory processing in PTSD patients, such as a greater memorization of negative information, or a trend to false recognition of negative information. In addition, attentional and inhibition processing seem to play an important role in emotional memory in PTSD sufferers. Furthermore, other studies that did not find behavioral differences between PTSD and control groups nevertheless showed differences in both specific cerebral activities and neurohormone levels during emotional memory tasks. Conclusion: This review has several limitations, including a limited number of controlled studies, small sample sizes, different tasks and methods. Nevertheless, the results of this systematic review provide interesting information on emotional memory for clinicians and researchers, as they seem to highlight facilitated memory processing for negative information in PTSD patients. This topic needs further controlled studies with sensitive behavioral tasks. Also, future studies may evaluate emotional memory after symptom amelioration.
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Affiliation(s)
- Florence Durand
- Unité de Recherche Clinique (URC), EPS Ville Evrard, Neuilly-sur-Marne, France
- Laboratory of Neuropsychology and Psychopathology, University of Paris, Saint-Denis, France
| | - Clémence Isaac
- Unité de Recherche Clinique (URC), EPS Ville Evrard, Neuilly-sur-Marne, France
- Laboratory of Neuropsychology and Psychopathology, University of Paris, Saint-Denis, France
| | - Dominique Januel
- Unité de Recherche Clinique (URC), EPS Ville Evrard, Neuilly-sur-Marne, France
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20
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Hsu CMK, Kleim B, Nicholson EL, Zuj DV, Cushing PJ, Gray KE, Clark L, Felmingham KL. Sex differences in intrusive memories following trauma. PLoS One 2018; 13:e0208575. [PMID: 30521618 PMCID: PMC6283557 DOI: 10.1371/journal.pone.0208575] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 11/20/2018] [Indexed: 11/21/2022] Open
Abstract
Background A key mechanism thought to underlie Posttraumatic Stress Disorder (PTSD) is enhanced emotional memory consolidation. Recent evidence in healthy controls revealed that women have greater negative memory consolidation following stress relative to men. This study examined emotional memory consolidation in women and men with PTSD, and in trauma-exposed and non-trauma controls to test the hypothesis that emotionally negative memory consolidation would be greater in women with PTSD. Method One hundred and forty-seven men and women (47 with PTSD, 49 trauma-exposed controls, and 51 non-trauma controls) completed an emotional memory task where they looked at negative, neutral and positive images from the International Affective Picture System (IAPS). Delayed recall and an intrusive memory diary were completed two days later. Results Women displayed greater recall, and reported more negative intrusive memories than men. A gender x group interaction effect showed that both women with PTSD and trauma-exposed women reported more intrusive memories than women without trauma exposure or men. Conclusion This study provided preliminary evidence of sex differences in intrusive memories in those with PTSD as well as those with a history of trauma exposure. Future research should include measures of sex hormones to further examine sex differences on memory consolidation in the context of trauma exposure and PTSD.
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Affiliation(s)
- Chia-Ming K. Hsu
- Division of Psychology, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
- * E-mail:
| | - Birgit Kleim
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital Zurich, Zurich, Switzerland
| | - Emma L. Nicholson
- Division of Psychology, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Daniel V. Zuj
- Division of Psychology, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
- Department of Psychology, Swansea University, Singleton Park, Wales, United Kingdom
| | - Pippa J. Cushing
- Division of Psychology, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Kate E. Gray
- Division of Psychology, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Latifa Clark
- Division of Psychology, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Kim L. Felmingham
- School of Psychological Sciences, University of Melbourne, Parkville, Victoria, Australia
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21
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Modulation of the endocannabinoid system by sex hormones: Implications for posttraumatic stress disorder. Neurosci Biobehav Rev 2018; 94:302-320. [DOI: 10.1016/j.neubiorev.2018.07.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 07/10/2018] [Accepted: 07/10/2018] [Indexed: 12/11/2022]
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22
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Rombold-Bruehl F, Otte C, Renneberg B, Hellmann-Regen J, Bruch L, Wingenfeld K, Roepke S. Impact of stress response systems on forced choice recognition in an experimental trauma film paradigm. Neurobiol Learn Mem 2018; 156:45-52. [PMID: 30352264 DOI: 10.1016/j.nlm.2018.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 08/31/2018] [Accepted: 10/20/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Traumatic events are often followed by memory impairments of key features of the trauma. Stress hormones are involved in emotional memory formation. However, little is known about their influence during trauma on subsequent recognition memory. MATERIAL AND METHODS A pooled analysis of two double-blind, placebo-controlled studies (N = 175) was performed to assess the influence of the noradrenergic system and the hypothalamus-pituitaryadrenal (HPA) axis on intrusion formation. Participants received either 10 mg yohimbine (stimulating noradrenergic activity), 0.15 mg clonidine (inhibiting noradrenergic activity), or placebo (noradrenergic manipulation study) or 20 mg hydrocortisone or placebo (hydrocortisone manipulation study), each 60 min before watching a distressing film depicting severe sexual and physical violence. After seven days, the participants performed a 24-item forced choice recognition test. Memory was assessed for pre-, peri-, and post-trauma film scenes. RESULTS A significant film scene by intervention interaction indicated a differential influence of drug intervention on the number of correct pre-, peri-, and post-trauma film scene memories one week after the distressing film. Post hoc tests revealed that clonidine led to significantly fewer correct peri-trauma film scene memories compared to placebo and, on a trend level, to yohimbine. DISCUSSION Pharmacological inhibition of noradrenaline during a distressing film leads to impaired emotional recognition memory for the peri-trauma film scene.
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Affiliation(s)
- Felicitas Rombold-Bruehl
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Germany; Department of Psychology, Freie Universität Berlin, Germany.
| | - Christian Otte
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Germany
| | | | - Julian Hellmann-Regen
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Germany
| | - Linda Bruch
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Germany
| | - Katja Wingenfeld
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Germany
| | - Stefan Roepke
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Germany
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23
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Marks EH, Franklin AR, Zoellner LA. Can't get it out of my mind: A systematic review of predictors of intrusive memories of distressing events. Psychol Bull 2018; 144:584-640. [PMID: 29553763 PMCID: PMC5938103 DOI: 10.1037/bul0000132] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Intrusive memories, when persistent and distressing, are theorized to underlie a range of transdiagnostic psychological symptoms and associated impairment. However, little is known about factors predicting the development and persistence of intrusive memories. The aim of this systematic review is to evaluate the literature on pre-event, event-based, and post-event predictors of intrusive memories. A systematic review was conducted, searching for studies that examined intrusive, event-based memories. One hundred and six articles were identified from PsycInfo, PubMed, and Medline databases. Experimental and prospective studies with clinical (N = 14) and nonclinical (N = 92) samples were critically reviewed, provided the inclusion of an analogue stressor with nonclinical samples, and that intrusive memories frequency and/or distress were assessed as primary dependent variables. Pre-existing psychopathology and pre-event appraisal style appear to predict intrusive memories (small to medium effects), whereas trait dissociation did not predict intrusive memories. Of studies examining event-based predictors, higher data-driven processing appears to predict intrusive memories with generally large effects. Post-event negative appraisals consistently predicted intrusive memories (medium to large effects), and preliminary evidence suggests higher post-event conceptual processing predicting fewer intrusive memories. This review synthesizes findings regarding a broad range of pre-event, event-based, and post-event factors that may influence the development of intrusive memories. Methodological issues of current paradigms and the lack of emphasis on memory retrieval processes limit our understanding of what predicts intrusive memory persistence. These limitations are particularly important given that individuals typically seek treatment for distressing intrusive memories once a memory has been fully consolidated, where retrieval processes are of utmost importance. (PsycINFO Database Record
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Zuj DV, Palmer MA, Malhi GS, Bryant RA, Felmingham KL. Endogenous salivary α-amylase does not interact with skin conductance response during fear extinction in posttraumatic stress disorder. Psychiatry Res 2018; 262:316-322. [PMID: 29494868 DOI: 10.1016/j.psychres.2018.02.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 01/28/2018] [Accepted: 02/02/2018] [Indexed: 12/14/2022]
Abstract
Posttraumatic Stress Disorder (PTSD) is associated with elevated noradrenergic signaling, which has an impact on emotional learning and memory. Fear extinction is thought to underlie the processes of exposure therapy, however the relationship between noradrenaline and extinction in PTSD is unclear. Participants with PTSD (n = 21), trauma-exposure without PTSD (TC; n = 36), and non-trauma-exposed controls (NTC; n = 27) completed a fear conditioning and extinction paradigm, and conditioned fear was indexed by skin conductance response (SCR). Salivary α-amylase (sAA) collected at baseline and immediately post-fear acquisition was used as an index of noradrenaline, and we examined whether sAA in response to fear acquisition was a moderator between fear extinction and PTSD symptoms. While there was a significant increase in sAA from baseline to post-fear acquisition, this was not modulated by group. Compared to TC and NTC, the PTSD group displayed a slower decline in SCRs during early extinction, which generalized across stimulus type, and was not moderated by sAA. These findings suggest that the relationship between fear extinction and PTSD symptoms does not change as a function of sAA levels; however previous research suggests other processes of fear learning may be associated with noradrenergic activity in PTSD.
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Affiliation(s)
- Daniel V Zuj
- Division of Psychology, School of Medicine, University of Tasmania, Australia; Department of Psychology, Swansea University, United Kingdom.
| | - Matthew A Palmer
- Division of Psychology, School of Medicine, University of Tasmania, Australia
| | - Gin S Malhi
- Royal North Shore Hospital, Sydney, Australia; Sydney Medical School, University of Sydney, Australia
| | | | - Kim L Felmingham
- School of Psychological Sciences, University of Melbourne, Australia
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O'Connell CP, Goldstein-Piekarski AN, Nemeroff CB, Schatzberg AF, Debattista C, Carrillo-Roa T, Binder EB, Dunlop BW, Craighead WE, Mayberg HS, Williams LM. Antidepressant Outcomes Predicted by Genetic Variation in Corticotropin-Releasing Hormone Binding Protein. Am J Psychiatry 2018; 175:251-261. [PMID: 29241359 PMCID: PMC5832545 DOI: 10.1176/appi.ajp.2017.17020172] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Genetic variation within the hypothalamic-pituitary-adrenal (HPA) axis has been linked to risk for depression and antidepressant response. However, these associations have yet to produce clinical gains that inform treatment decisions. The authors investigated whether variation within HPA axis genes predicts antidepressant outcomes within two large clinical trials. METHOD The test sample comprised 636 patients from the International Study to Predict Optimized Treatment in Depression (iSPOT-D) who completed baseline and 8-week follow-up visits and for whom complete genotyping data were available. The authors tested the relationship between genotype at 16 candidate HPA axis single-nucleotide polymorphisms (SNPs) and treatment outcomes for three commonly used antidepressants (escitalopram, sertraline, and extended-release venlafaxine), using multivariable linear and logistic regression with Bonferroni correction. Response and remission were defined using the Hamilton Depression Rating Scale. Findings were then validated using the Predictors of Remission in Depression to Individual and Combined Treatments (PReDICT) study of outcome predictors in treatment-naive patients with major depression. RESULTS The authors found that the rs28365143 variant within the corticotropin-releasing hormone binding protein (CRHBP) gene predicted antidepressant outcomes for remission, response, and symptom change. Patients homozygous for the G allele of rs28365143 had greater remission rates, response rates, and symptom reductions. These effects were specific to drug class. Patients homozygous for the G allele responded significantly better to the selective serotonin reuptake inhibitors escitalopram and sertraline than did A allele carriers. In contrast, rs28365143 genotype was not associated with treatment outcomes for the serotonin norepinephrine reuptake inhibitor venlafaxine. When patients were stratified by race, the overall effect of genotype on treatment response remained. In the validation sample, the GG genotype was again associated with favorable antidepressant outcomes, with comparable effect sizes. CONCLUSIONS These findings suggest that a specific CRHBP SNP, rs28365143, may have a role in predicting which patients will improve with antidepressants and which type of antidepressant may be most effective. The results add to the foundational knowledge needed to advance a precision approach to personalized antidepressant choices.
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Affiliation(s)
- Chloe P. O'Connell
- School of Medicine, Stanford University, Stanford, CA 94305; Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305
| | - Andrea N. Goldstein-Piekarski
- Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305,Sierra-Pacific Mental Illness Research, Education, and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304
| | - Charles B. Nemeroff
- Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL 33136; Dept. of Translational Research in Psychiary, Max Planck Institute for Psychiatry, Munich, Germany
| | - Alan F. Schatzberg
- Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305
| | - Charles Debattista
- Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305
| | - Tania Carrillo-Roa
- Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL 33136; Dept. of Translational Research in Psychiary, Max Planck Institute for Psychiatry, Munich, Germany
| | - Elisabeth B. Binder
- Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL 33136; Dept. of Translational Research in Psychiary, Max Planck Institute for Psychiatry, Munich, Germany,Dept. of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30327; Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30327
| | - Boadie W. Dunlop
- Dept. of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30327; Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30327
| | - W. Edward Craighead
- Dept. of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30327; Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30327,Dept. of Psychology, Emory University, Atlanta, GA 30322
| | - Helen S. Mayberg
- Dept. of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30327; Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30327
| | - Leanne M. Williams
- Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305,Sierra-Pacific Mental Illness Research, Education, and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304
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Ehrenthal JC, Levy KN, Scott LN, Granger DA. Attachment-Related Regulatory Processes Moderate the Impact of Adverse Childhood Experiences on Stress Reaction in Borderline Personality Disorder. J Pers Disord 2018; 32:93-114. [PMID: 29388902 PMCID: PMC5798009 DOI: 10.1521/pedi.2018.32.supp.93] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
In this study, the authors explored whether attachment insecurity moderates the effects of adverse childhood experiences on stress reactivity in the context of borderline personality disorder (BPD). Participants were 113 women (39 with BPD, 15 with some BPD criteria present, 59 without any BPD symptoms) who participated in the Trier Social Stress Test. Saliva samples were collected before and after the stressor and assayed for salivary alpha-amylase (sAA) and cortisol. Adverse childhood experiences were measured using the Childhood Trauma Questionnaire, and attachment by the Experiences in Close Relationships-Revised questionnaire. Results revealed that attachment avoidance and a combination of more adverse childhood experiences and attachment insecurity resulted in higher sAA levels and differences in reactivity to the stressor. Interactions between attachment anxiety and adverse childhood experiences were related to blunted cortisol reactivity. The results suggest that the influence of adverse childhood experiences on stress regulation in BPD may be moderated by attachment-related regulatory processes.
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Affiliation(s)
- Johannes C. Ehrenthal
- Department of Psychology, Pennsylvania State University
- Department of Psychology, Klagenfurt University, Austria
| | | | - Lori N. Scott
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Douglas A. Granger
- Institute for Interdisciplinary Salivary Bioscience Research, University of California at Irvine
- Johns Hopkins University School of Medicine; Johns Hopkins University Bloomberg School of Public Health; Johns Hopkins University School of Nursing
- Department of Psychology and Salivary Bioscience Laboratory, University of Nebraska
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Activating attachment representations during memory retrieval modulates intrusive traumatic memories. Conscious Cogn 2017; 55:197-204. [DOI: 10.1016/j.concog.2017.08.010] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Revised: 08/12/2017] [Accepted: 08/22/2017] [Indexed: 11/17/2022]
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Dayan J, Rauchs G, Guillery-Girard B. Rhythms dysregulation: A new perspective for understanding PTSD? ACTA ACUST UNITED AC 2017; 110:453-460. [PMID: 28161453 DOI: 10.1016/j.jphysparis.2017.01.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 01/30/2017] [Indexed: 12/15/2022]
Abstract
Post-traumatic stress disorder (PTSD) is a complex syndrome that may occur after exposure to one or more traumatic events. It associates physiological, emotional, and cognitive changes Brain and hormonal modifications contribute to some impairments in learning, memory, and emotion regulation. Some of these biological dysfunctions may be analyzed in terms of rhythms dysregulation that would be expressed through endocrine rhythmicity, sleep organization, and temporal synchrony in brain activity. In the first part of this article, we report studies on endocrine rhythmicity revealing that some rhythms abnormalities are frequently observed, although not constantly, for both cortisol and sympathetic nervous system (SNS) activity. The most typical changes are a flattening of the diurnal secretion of cortisol and the hyperactivation of the SNS. These results may explain why cognitive functioning, in particular consolidation of emotional memories, attention, learning, vigilance and arousal, is altered in patients with PTSD. The second part of this article focuses on sleep disturbances, one of the core features of PTSD. Abnormal REM sleep reported in various studies may have a pathophysiological role in PTSD and may exacerbate some symptoms such as emotional regulation and memory. In addition, sleep disorders, such as paradoxical insomnia, increase the risk of developing PTSD. We also discuss the potential impact of sleep disturbances on cognition. Finally, temporal synchrony of brain activity and functional connectivity, explored using electroencephalography and functional magnetic resonance imaging, are addressed. Several studies reported abnormalities in alpha, beta and gamma frequency bands that may affect both attentional and memory processes. Other studies confirmed abnormalities in connectivity and recent fMRI data suggest that this could limit top-down control and may be associated with flashback intrusive memories. These data illustrate that a better knowledge of the different patterns of biological rhythms contributes to explain the heterogeneity of PTSD and shed new light on the association with some frequent medical disorders.
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Affiliation(s)
- Jacques Dayan
- Normandie Univ, UNICAEN, PSL Research University, EPHE, INSERM, U1077, CHU de Caen, Neuropsychologie et Imagerie de la Mémoire Humaine, 14000 Caen, France; CHGR Rennes-I, Pôle Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Rennes, France.
| | - Géraldine Rauchs
- Normandie Univ, UNICAEN, PSL Research University, EPHE, INSERM, U1077, CHU de Caen, Neuropsychologie et Imagerie de la Mémoire Humaine, 14000 Caen, France
| | - Bérengère Guillery-Girard
- Normandie Univ, UNICAEN, PSL Research University, EPHE, INSERM, U1077, CHU de Caen, Neuropsychologie et Imagerie de la Mémoire Humaine, 14000 Caen, France
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Rombold F, Wingenfeld K, Renneberg B, Schwarzkopf F, Hellmann-Regen J, Otte C, Roepke S. Impact of exogenous cortisol on the formation of intrusive memories in healthy women. J Psychiatr Res 2016; 83:71-78. [PMID: 27569651 DOI: 10.1016/j.jpsychires.2016.08.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 07/28/2016] [Accepted: 08/05/2016] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Stress hormones such as cortisol are involved in modulating emotional memory. However, little is known about the influence of cortisol on the formation of intrusive memories after a traumatic event. The aim of this study was to examine whether cortisol levels during encoding and consolidation of an intrusion-inducing trauma film paradigm would influence subsequent intrusion formation. MATERIAL AND METHODS In an experimental, double-blind, placebo-controlled study a trauma film paradigm was used to induce intrusions in 60 healthy women. Participants received a single dose of either 20 mg hydrocortisone or placebo before watching a trauma film. Salivary cortisol and alpha-amylase as well as blood pressure were measured during the experiment. The consecutive number of intrusions, the vividness of intrusions, and the degree of distress evoked by the intrusions resulting from the trauma film were assessed throughout the following seven days. RESULTS Hydrocortisone administration before the trauma film resulted in increased salivary cortisol levels but did not affect the consecutive number of intrusions, the vividness of intrusions, and the degree of distress evoked by the intrusions throughout the following week. CONCLUSIONS These results indicate that pharmacologically increased cortisol levels during an experimental trauma film paradigm do not influence consecutive intrusive memories. Current data do not support a prominent role of exogenous cortisol on intrusive memories, at least in healthy young women after a relatively mild trauma equivalent.
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Affiliation(s)
- Felicitas Rombold
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany; Department of Psychology, Freie Universität Berlin, Germany.
| | - Katja Wingenfeld
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | | | - Friederike Schwarzkopf
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Julian Hellmann-Regen
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Christian Otte
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Stefan Roepke
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
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Rombold F, Wingenfeld K, Renneberg B, Hellmann-Regen J, Otte C, Roepke S. Influence of the noradrenergic system on the formation of intrusive memories in women: an experimental approach with a trauma film paradigm. Psychol Med 2016; 46:2523-2534. [PMID: 27335220 DOI: 10.1017/s0033291716001379] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Intrusive memories of traumatic events are a core feature of post-traumatic stress disorder but little is known about the neurobiological formation of intrusions. The aim of this study was to determine whether the activity of the noradrenergic system during an intrusion-inducing stressor would influence subsequent intrusive memories. METHOD We conducted an experimental, double-blind, placebo-controlled study in 118 healthy women. Participants received a single dose of either 10 mg yohimbine, stimulating noradrenergic activity, or 0.15 mg clonidine, inhibiting noradrenergic activity, or placebo. Subsequently, they watched an established trauma film which induced intrusions. The number of consecutive intrusions resulting from the trauma film, the vividness of the intrusions, and the degree of distress evoked by the intrusions were assessed during the following 4 days. Salivary cortisol and α-amylase were collected before and after the trauma film. RESULTS A significant time × treatment interaction for the number of intrusions and the vividness of intrusions indicated a different time course of intrusions depending on treatment. Post-hoc tests revealed a delayed decrease of intrusions and a delayed decrease of intrusion vividness after the trauma film in the yohimbine group compared with the clonidine and placebo groups. Furthermore, after yohimbine administration, a significant increase in salivary cortisol levels was observed during the trauma film. CONCLUSIONS Our findings indicate that pharmacological activation of the noradrenergic system during an emotionally negative event makes an impact on consecutive intrusive memories and their vividness in healthy women. The noradrenergic system seems to be involved in the formation of intrusive memories.
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Affiliation(s)
- F Rombold
- Department of Psychiatry and Psychotherapy,Charité - Universitätsmedizin Berlin,Campus Benjamin Franklin,Berlin,Germany
| | - K Wingenfeld
- Department of Psychiatry and Psychotherapy,Charité - Universitätsmedizin Berlin,Campus Benjamin Franklin,Berlin,Germany
| | - B Renneberg
- Department of Psychology,Freie Universitaet Berlin,Berlin,Germany
| | - J Hellmann-Regen
- Department of Psychiatry and Psychotherapy,Charité - Universitätsmedizin Berlin,Campus Benjamin Franklin,Berlin,Germany
| | - C Otte
- Department of Psychiatry and Psychotherapy,Charité - Universitätsmedizin Berlin,Campus Benjamin Franklin,Berlin,Germany
| | - S Roepke
- Department of Psychiatry and Psychotherapy,Charité - Universitätsmedizin Berlin,Campus Benjamin Franklin,Berlin,Germany
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Zuj DV, Palmer MA, Lommen MJJ, Felmingham KL. The centrality of fear extinction in linking risk factors to PTSD: A narrative review. Neurosci Biobehav Rev 2016; 69:15-35. [PMID: 27461912 DOI: 10.1016/j.neubiorev.2016.07.014] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 07/13/2016] [Accepted: 07/14/2016] [Indexed: 02/08/2023]
Abstract
Recent prospective studies in emergency services have identified impaired fear extinction learning and memory to be a significant predictor of Posttraumatic Stress Disorder (PTSD), complementing a wealth of cross-sectional evidence of extinction deficits associated with the disorder. Additional fields of research show specific risk factors and biomarkers of the disorder, including candidate genotypes, stress and sex hormones, cognitive factors, and sleep disturbances. Studies in mostly nonclinical populations also reveal that the aforementioned factors are involved in fear extinction learning and memory. Here, we provide a comprehensive narrative review of the literature linking PTSD to these risk factors, and linking these risk factors to impaired fear extinction. On balance, the evidence suggests that fear extinction may play a role in the relationship between risk factors and PTSD. Should this notion hold true, this review carries important implications for the improvement of exposure-based treatments, as well as strategies for the implementation of treatment.
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Affiliation(s)
- Daniel V Zuj
- Division of Psychology, School of Medicine, University of Tasmania, Tasmania, Australia.
| | - Matthew A Palmer
- Division of Psychology, School of Medicine, University of Tasmania, Tasmania, Australia
| | - Miriam J J Lommen
- Department of Psychology, University of Groningen, Groningen, The Netherlands
| | - Kim L Felmingham
- Division of Psychology, School of Medicine, University of Tasmania, Tasmania, Australia
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Noradrenergic dysregulation in the pathophysiology of PTSD. Exp Neurol 2016; 284:181-195. [PMID: 27222130 DOI: 10.1016/j.expneurol.2016.05.014] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 05/07/2016] [Accepted: 05/09/2016] [Indexed: 12/17/2022]
Abstract
A central role for noradrenergic dysregulation in the pathophysiology of post-traumatic stress disorder (PTSD) is increasingly suggested by both clinical and basic neuroscience research. Here, we integrate recent findings from clinical and animal research with the earlier literature. We first review the evidence for net upregulation of the noradrenergic system and its responsivity to stress in individuals with PTSD. Next, we trace the evidence that the α1 noradrenergic receptor antagonist prazosin decreases many of the symptoms of PTSD from initial clinical observations, to case series, to randomized controlled trials. Finally, we review the basic science work that has begun to explain the mechanism for this efficacy, as well as to explore its possible limitations and areas for further advancement. We suggest a view of the noradrenergic system as a central, modifiable link in a network of interconnected stress-response systems, which also includes the amygdala and its modulation by medial prefrontal cortex. Particular attention is paid to the evidence for bidirectional signaling between noradrenaline and corticotropin-releasing factor (CRF) in coordinating these interconnected systems. The multiple different ways in which the sensitivity and reactivity of the noradrenergic system may be altered in PTSD are highlighted, as is the evidence for possible heterogeneity in the pathophysiology of PTSD between different individuals who appear clinically similar. We conclude by noting the importance moving forward of improved measures of noradrenergic functioning in clinical populations, which will allow better recognition of clinical heterogeneity and further assessment of the functional implications of different aspects of noradrenergic dysregulation.
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Abstract
AbstractThe glutamate amplifies noradrenergic effects (GANE) model emphasizes the role of focal glutamate–noradrenaline interactions in creating functional hotspots for prioritized processing of salient stimuli. Here, we briefly outline current evidence that synergistic action of noradrenaline and cortisol enables emotional stimuli to gain privileged access to amygdala–hippocampus circuits, eventually resulting in the formation of indelible memories and posttraumatic stress disorder (PTSD).
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Kao CY, Stalla G, Stalla J, Wotjak CT, Anderzhanova E. Norepinephrine and corticosterone in the medial prefrontal cortex and hippocampus predict PTSD-like symptoms in mice. Eur J Neurosci 2015; 41:1139-48. [PMID: 25720329 DOI: 10.1111/ejn.12860] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 01/26/2015] [Indexed: 12/24/2022]
Abstract
This study measured changes in brain extracellular norepinephrine (NE) and free corticosterone (CORT) levels in a mouse model of post-traumatic stress disorder and related them to hyperarousal and fear memory retention. To this end, microdialysis in the medial prefrontal cortex (mPFC) and the hippocampus (HPC) of male C57BL/6NCrl mice was performed during an acoustic startle response (ASR) and following an electric foot shock (FS), as well as during an ASR and recall of contextual fear (CF) 1 day later. Changes in ASR-stimulated NE levels in the mPFC corresponded to ASR 34 days after FS. Changes in basal and ASR-stimulated extracellular NE levels in the HPC, in contrast, were related to expression of early (day 2) and late (day 34) CF after FS. The increase in extracellular NE levels correlated in a U-shape manner with arousal levels and CF, thus suggesting a non-direct relationship. Stress of different modalities/strength (ASR, FS and CF) caused a similar relative increase in free CORT levels both in the mPFC and the HPC. One day after FS, ASR-induced increases in the CORT content in the mPFC tended to correlate with the FS-potentiated ASR in a U-shape manner. Taken together, these data show that the intracerebral increase in free CORT was likely related to an immediate response to stress, whereas NE neurotransmission in the forebrain predicted arousal and CF 1 month after trauma.
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Affiliation(s)
- C-Y Kao
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany; Graduate School of Systemic Neurosciences, Ludwig-Maximilians-University Munich, Planegg-Martinsried, Germany
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Zoladz PR, Kalchik AE, Hoffman MM, Aufdenkampe RL, Lyle SM, Peters DM, Brown CM, Cadle CE, Scharf AR, Dailey AM, Wolters NE, Talbot JN, Rorabaugh BR. ADRA2B deletion variant selectively predicts stress-induced enhancement of long-term memory in females. Psychoneuroendocrinology 2014; 48:111-22. [PMID: 24997351 DOI: 10.1016/j.psyneuen.2014.06.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 06/13/2014] [Accepted: 06/14/2014] [Indexed: 10/25/2022]
Abstract
Clarifying the mechanisms that underlie stress-induced alterations of learning and memory may lend important insight into susceptibility factors governing the development of stress-related psychological disorders, such as post-traumatic stress disorder (PTSD). Previous work has shown that carriers of the ADRA2B Glu(301)-Glu(303) deletion variant exhibit enhanced emotional memory, greater amygdala responses to emotional stimuli and greater intrusiveness of traumatic memories. We speculated that carriers of this deletion variant might also be more vulnerable to stress-induced enhancements of long-term memory, which would implicate the variant as a possible susceptibility factor for traumatic memory formation. One hundred and twenty participants (72 males, 48 females) submerged their hand in ice cold (stress) or warm (no stress) water for 3min. Immediately afterwards, they studied a list of 42 words varying in emotional valence and arousal and then completed an immediate free recall test. Twenty-four hours later, participants' memory for the word list was examined via free recall and recognition assessments. Stressed participants exhibiting greater heart rate responses to the stressor had enhanced recall on the 24-h assessment. Importantly, this enhancement was independent of the emotional nature of the learned information. In contrast to previous work, we did not observe a general enhancement of memory for emotional information in ADRA2B deletion carriers. However, stressed female ADRA2B deletion carriers, particularly those exhibiting greater heart rate responses to the stressor, did demonstrate greater recognition memory than all other groups. Collectively, these findings implicate autonomic mechanisms in the pre-learning stress-induced enhancement of long-term memory and suggest that the ADRA2B deletion variant may selectively predict stress effects on memory in females. Such findings lend important insight into the physiological mechanisms underlying stress effects on learning and their sex-dependent nature.
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Affiliation(s)
- Phillip R Zoladz
- Department of Psychology, Sociology, & Criminal Justice, Ohio Northern University, Ada, OH 45810, USA.
| | - Andrea E Kalchik
- Department of Psychology, Sociology, & Criminal Justice, Ohio Northern University, Ada, OH 45810, USA
| | - Mackenzie M Hoffman
- Department of Psychology, Sociology, & Criminal Justice, Ohio Northern University, Ada, OH 45810, USA
| | - Rachael L Aufdenkampe
- Department of Psychology, Sociology, & Criminal Justice, Ohio Northern University, Ada, OH 45810, USA
| | - Sarah M Lyle
- Department of Psychology, Sociology, & Criminal Justice, Ohio Northern University, Ada, OH 45810, USA
| | - David M Peters
- Department of Psychology, Sociology, & Criminal Justice, Ohio Northern University, Ada, OH 45810, USA
| | - Callie M Brown
- Department of Psychology, Sociology, & Criminal Justice, Ohio Northern University, Ada, OH 45810, USA
| | - Chelsea E Cadle
- Department of Psychology, Sociology, & Criminal Justice, Ohio Northern University, Ada, OH 45810, USA
| | - Amanda R Scharf
- Department of Psychology, Sociology, & Criminal Justice, Ohio Northern University, Ada, OH 45810, USA
| | - Alison M Dailey
- Department of Psychology, Sociology, & Criminal Justice, Ohio Northern University, Ada, OH 45810, USA
| | - Nicholas E Wolters
- Department of Pharmaceutical & Biomedical Sciences, Raabe College of Pharmacy, Ohio Northern University, Ada, OH 45810, USA
| | - Jeffery N Talbot
- Research Center on Substance Abuse and Depression, Roseman University of Health Sciences, Henderson, NV 89014, USA
| | - Boyd R Rorabaugh
- Department of Pharmaceutical & Biomedical Sciences, Raabe College of Pharmacy, Ohio Northern University, Ada, OH 45810, USA
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Amos T, Stein DJ, Ipser JC. Pharmacological interventions for preventing post-traumatic stress disorder (PTSD). Cochrane Database Syst Rev 2014; 2014:CD006239. [PMID: 25001071 PMCID: PMC11064759 DOI: 10.1002/14651858.cd006239.pub2] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) is a debilitating disorder which, after a sufficient delay, may be diagnosed amongst individuals who respond with intense fear, helplessness or horror to traumatic events. There is some evidence that the use of pharmacological interventions immediately after exposure to trauma may reduce the risk of developing of PTSD. OBJECTIVES To assess the effects of pharmacological interventions for the prevention of PTSD in adults following exposure to a traumatic event. SEARCH METHODS We searched the Cochrane Depression, Anxiety and Neurosis Controlled Trials Register (CCDANCTR-Studies and CCDANCTR-References) (to 14 February 2014). This register contains relevant reports of randomised controlled trials from the following bibliographic databases: CENTRAL (all years); EMBASE (1974 to date); MEDLINE (1950 to date) and PsycINFO (1967 to date). We identified unpublished trials by searching the National Institute of Health (NIH) Reporter, the metaRegister of Controlled Trials database (mRCT) and the WHO International Clinical Trials Registry Platform (to December 2013). We scanned the reference lists of articles for additional studies. We placed no constraints on language and setting. SELECTION CRITERIA We restricted studies to randomised controlled trials (RCTs) of pharmacological interventions compared with placebo for the prevention of PTSD in adults. DATA COLLECTION AND ANALYSIS Two authors (TA and JI) independently assessed trials for eligibility and inclusion based on the review selection criteria. We independently extracted sample, methodological, outcome and 'Risk of bias' data, as well as the number of side effects, from each trial and entered these into a customised data extraction form. We contacted investigators for missing information. We calculated summary statistics for continuous and dichotomous variables (if provided). We did not undertake subgroup analyses due to the small number of included studies. MAIN RESULTS We included nine short-term RCTs (duration 12 weeks or less) in the analysis (345 participants; age range 18 to 76 years). Participants were exposed to a variety of traumas, ranging from assault, traffic accidents and work accidents to cardiac surgery and septic shock. Seven studies were conducted at single centres. The seven RCTs included four hydrocortisone studies, three propranolol studies (of which one study had a third arm investigating gabapentin), and single trials of escitalopram and temazepam. Outcome assessment measures included the Clinician-Administered PTSD Scale (CAPS), the 36-Item Short-Form Health Survey (SF-36) and the Center for Epidemiological Studies - Depression Scale (CES-D).In four trials with 165 participants there was moderate quality evidence for the efficacy of hydrocortisone in preventing the onset of PTSD (risk ratio (RR) 0.17; 95% confidence interval (CI) 0.05 to 0.56; P value = 0.004), indicating that between seven and 13 patients would need to be treated with this agent in order to prevent the onset of PTSD in one patient. There was low quality evidence for preventing the onset of PTSD in three trials with 118 participants treated with propranolol (RR 0.62; 95% CI 0.24 to 1.59; P value = 0.32). Drop-outs due to treatment-emergent side effects, where reported, were low for all of the agents tested. Three of the four RCTs of hydrocortisone reported that medication was more effective than placebo in reducing PTSD symptoms after a median of 4.5 months after the event. None of the single trials of escitalopram, temazepam and gabapentin demonstrated evidence that medication was superior to placebo in preventing the onset of PTSD.Seven of the included RCTs were at a high risk of bias. Differential drop-outs between groups undermined the results of three studies, while one study failed to describe how the allocation of medication was concealed. Other forms of bias that might have influenced study results included possible confounding through group differences in concurrent medication and termination of the study based on treatment response. AUTHORS' CONCLUSIONS There is moderate quality evidence for the efficacy of hydrocortisone for the prevention of PTSD development in adults. We found no evidence to support the efficacy of propranolol, escitalopram, temazepam and gabapentin in preventing PTSD onset. The findings, however, are based on a few small studies with multiple limitations. Further research is necessary in order to determine the efficacy of pharmacotherapy in preventing PTSD and to identify potential moderators of treatment effect.
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Affiliation(s)
- Taryn Amos
- University of Cape TownDepartment of Psychiatry and Mental HealthEducation Centre, Valkenberg HospitalPrivate Bage X1, ObservatoryCape TownSouth Africa7925
| | - Dan J Stein
- University of Cape TownDepartment of Psychiatry and Mental HealthEducation Centre, Valkenberg HospitalPrivate Bage X1, ObservatoryCape TownSouth Africa7925
| | - Jonathan C Ipser
- University of Cape TownDepartment of Psychiatry and Mental HealthEducation Centre, Valkenberg HospitalPrivate Bage X1, ObservatoryCape TownSouth Africa7925
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