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Walsh K, Short N, Ji YY, An XM, Witkemper KD, Lechner M, Bell K, Black J, Buchanan J, Ho J, Reed G, Platt M, Riviello R, Martin SL, Liberzon I, Rauch SAM, Bollen K, McLean SA. Development of a brief bedside tool to screen women sexual assault survivors for risk of persistent posttraumatic stress six months after sexual assault. J Psychiatr Res 2024; 174:54-61. [PMID: 38615545 PMCID: PMC11151166 DOI: 10.1016/j.jpsychires.2024.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/31/2024] [Accepted: 04/03/2024] [Indexed: 04/16/2024]
Abstract
This study aims to develop and validate a brief bedside tool to screen women survivors presenting for emergency care following sexual assault for risk of persistent elevated posttraumatic stress symptoms (PTSS) six months after assault. Participants were 547 cisgender women sexual assault survivors who presented to one of 13 sexual assault nurse examiner (SANE) programs for medical care within 72 h of a sexual assault and completed surveys one week and six months after the assault. Data on 222 potential predictors from the SANE visit and the week one survey spanning seven broadly-defined risk factor domains were candidates for inclusion in the screening tool. Elevated PTSS six months after assault were defined as PCL-5 > 38. LASSO logistic regression was applied to 20 randomly selected bootstrapped samples to evaluate variable importance. Logistic regression models comprised of the top 10, 20, and 30 candidate predictors were tested in 10 cross-validation samples drawn from 80% of the sample. The resulting instrument was validated in the remaining 20% of the sample. AUC of the finalized eight-item prediction tool was 0.77 and the Brier Score was 0.19. A raw score of 41 on the screener corresponds to a 70% risk of elevated PTSS at 6 months. Similar performance was observed for elevated PTSS at one year. This brief, eight-item risk stratification tool consists of easy-to-collect information and, if validated, may be useful for clinical trial enrichment and/or patient screening.
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Affiliation(s)
- Kate Walsh
- Department of Psychology, University of Wisconsin-Madison, Madison, WI, USA; Department of Gender & Women's Studies, University of Wisconsin-Madison, Madison, WI, USA
| | - Nicole Short
- Institute for Trauma Recovery, University of North Carolina at Chapel Hill, North Carolina, USA; Department of Anesthesiology, University of North Carolina at Chapel Hill, North Carolina, USA; Department of Psychology, University of Nevada, Las Vegas, NV, USA
| | - Yin Yao Ji
- Institute for Trauma Recovery, University of North Carolina at Chapel Hill, North Carolina, USA; Department of Psychiatry, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Xin Ming An
- Institute for Trauma Recovery, University of North Carolina at Chapel Hill, North Carolina, USA; Department of Anesthesiology, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Kristen D Witkemper
- Institute for Trauma Recovery, University of North Carolina at Chapel Hill, North Carolina, USA; Department of Psychiatry, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Megan Lechner
- University of Colorado Health Memorial Hospital, Colorado Springs, CO, USA
| | - Kathy Bell
- Tulsa Forensic Nursing, Tulsa Police Department, Tulsa, OK, USA
| | | | | | - Jeffrey Ho
- Hennepin Assault Response Team (HART), Hennepin Healthcare, Minneapolis, MN, USA
| | | | | | | | - Sandra L Martin
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Israel Liberzon
- Department of Psychiatry and Behavioral Sciences Texas A&M University, Bryan, TX, USA
| | - Sheila A M Rauch
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA; Veterans Affairs Atlanta Healthcare System, Atlanta, GA, USA
| | - Kenneth Bollen
- Department of Psychology and Neuroscience, Department of Sociology, University of North Carolina at Chapel Hill, North Carolina, USA; Department of Sociology, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Samuel A McLean
- Institute for Trauma Recovery, University of North Carolina at Chapel Hill, North Carolina, USA; Department of Psychiatry, University of North Carolina at Chapel Hill, North Carolina, USA; Department of Emergency Medicine, University of North Carolina at Chapel Hill, North Carolina, USA.
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Miranda O, Fan P, Qi X, Wang H, Brannock MD, Kosten T, Ryan ND, Kirisci L, Wang L. Prediction of adverse events risk in patients with comorbid post-traumatic stress disorder and alcohol use disorder using electronic medical records by deep learning models. Drug Alcohol Depend 2024; 255:111066. [PMID: 38217979 PMCID: PMC10853953 DOI: 10.1016/j.drugalcdep.2023.111066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/15/2023] [Accepted: 12/15/2023] [Indexed: 01/15/2024]
Abstract
BACKGROUND Identifying co-occurring mental disorders and elevated risk is vital for optimization of healthcare processes. In this study, we will use DeepBiomarker2, an updated version of our deep learning model to predict the adverse events among patients with comorbid post-traumatic stress disorder (PTSD) and alcohol use disorder (AUD), a high-risk population. METHODS We analyzed electronic medical records of 5565 patients from University of Pittsburgh Medical Center to predict adverse events (opioid use disorder, suicide related events, depression, and death) within 3 months at any encounter after the diagnosis of PTSD+AUD by using DeepBiomarker2. We integrated multimodal information including: lab tests, medications, co-morbidities, individual and neighborhood level social determinants of health (SDoH), psychotherapy and veteran data. RESULTS DeepBiomarker2 achieved an area under the receiver operator curve (AUROC) of 0.94 on the prediction of adverse events among those PTSD+AUD patients. Medications such as vilazodone, dronabinol, tenofovir, suvorexant, modafinil, and lamivudine showed potential for risk reduction. SDoH parameters such as cognitive behavioral therapy and trauma focused psychotherapy lowered risk while active veteran status, income segregation, limited access to parks and greenery, low Gini index, limited English-speaking capacity, and younger patients increased risk. CONCLUSIONS Our improved version of DeepBiomarker2 demonstrated its capability of predicting multiple adverse event risk with high accuracy and identifying potential risk and beneficial factors.
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Affiliation(s)
- Oshin Miranda
- Computational Chemical Genomics Screening Center, Department of Pharmaceutical Sciences/School of Pharmacy, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Peihao Fan
- Computational Chemical Genomics Screening Center, Department of Pharmaceutical Sciences/School of Pharmacy, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Xiguang Qi
- Computational Chemical Genomics Screening Center, Department of Pharmaceutical Sciences/School of Pharmacy, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Haohan Wang
- School of Information Sciences at the University of Illinois Urbana-Champaign, Champaign, IL 61820, USA
| | | | - Thomas Kosten
- Menninger Department of Psychiatry, Baylor College of Medicine, Houston, TX 77030, USA
| | - Neal David Ryan
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Levent Kirisci
- University of Pittsburgh School of Pharmacy, Pittsburgh, PA 15213, USA
| | - LiRong Wang
- Computational Chemical Genomics Screening Center, Department of Pharmaceutical Sciences/School of Pharmacy, University of Pittsburgh, Pittsburgh, PA 15213, USA.
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Ravi M, Powers A, Rothbaum BO, Stevens JS, Michopoulos V. Neighborhood Poverty Prospectively Predicts PTSD Symptoms Six-Months Following Trauma Exposure. MENTAL HEALTH SCIENCE 2023; 1:213-221. [PMID: 38406565 PMCID: PMC10888169 DOI: 10.1002/mhs2.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 08/06/2023] [Indexed: 02/27/2024]
Abstract
Introduction Individuals living in areas with high rates of poverty are disproportionately affected by posttraumatic stress disorder (PTSD). Despite this association, little is known about how neighborhood poverty rates impact risk for PTSD development. In the current prospective study, we determined the relationship between neighborhood poverty rate and PTSD symptoms six-months after experiencing a traumatic event in a sample of varied race, gender, and socioeconomic status. Methods Participants (N=252) were enrolled in a hospital emergency department after experiencing a traumatic event. Demographic information (including zip code of residence), baseline PTSD symptoms, and baseline trauma history was assessed in the emergency department. PTSD symptoms were again assessed six-months post-trauma. Neighborhood poverty rate was determined using the American Community Survey. Results Correlation analyses revealed that neighborhood poverty was significantly associated with baseline PTSD symptoms (r=.181, p=.004) and PTSD symptoms six-months post-trauma (r=.163, p=.009). A regression analysis controlling for baseline trauma exposure, clinician-rated trauma severity, and individual socioeconomic status demonstrated that neighborhood poverty predicted PTSD symptoms six-months post-trauma (R2= 0.099, B= 0.15, p=0.04), but this relationship was no longer significant when baseline PTSD symptoms was added as an additional covariate (R2=.304, B= 0.07, p>0.05). Conclusion Overall, results suggest that neighborhood poverty generally increases PTSD symptom severity, and the context in which an individual lives should be considered when conceptualizing risk for PTSD.
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Affiliation(s)
- Meghna Ravi
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, Georgia
| | - Abigail Powers
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, Georgia
| | - Barbara O Rothbaum
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, Georgia
| | - Jennifer S Stevens
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, Georgia
| | - Vasiliki Michopoulos
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, Georgia
- Emory National Primate Research Center, Atlanta, Georgia
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Gould F, Jones MT, Harvey PD, Reidy LJ, Hodgins G, Michopoulos V, Maples-Keller J, Rothbaum BO, Rothbaum A, Ressler KJ, Nemeroff CB. The relationship between substance use, prior trauma history, and risk of developing post-traumatic stress disorder in the immediate aftermath of civilian trauma. J Psychiatr Res 2021; 144:345-352. [PMID: 34735838 DOI: 10.1016/j.jpsychires.2021.10.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 10/16/2021] [Accepted: 10/19/2021] [Indexed: 10/20/2022]
Abstract
Many reports have documented the relationship between post-traumatic stress disorder (PTSD) and substance use. Substance use is commonly comorbid with PTSD and is a risk factor for trauma exposure. The aim of this study was to prospectively examine how recent substance use, abuse, or dependence influenced the development of PTSD in the context of a prior trauma history, including child abuse, and the severity of initial trauma reactions. Participants (N = 81) were recruited and assessed at the emergency department of a large urban hospital in Miami and serum levels of common drugs of abuse were measured. Although substance use appeared to be a risk factor for trauma exposure, neither self-reported nor blood toxicology influenced the development of PTSD. Positive toxicology screens were more likely to be associated with a diagnosis of substance abuse or dependence, χ2 (1) = 4.11, p = .04. Participants with a history of physical abuse were more likely to have a positive toxicology screen, χ2 (1) = 4.03, p = .05. The majority of our trauma-exposed subjects (66%) were found to be positive for one or more illicit substances at presentation at the ED. The current findings provide support for the "high risk" hypothesis in which substance use is associated with increased trauma exposure.
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Affiliation(s)
- Felicia Gould
- University of Miami Miller School of Medicine, Department of Psychiatry and Behavioral Sciences, Miami, FL, USA.
| | - Mackenzie T Jones
- University of Miami Miller School of Medicine, Department of Psychiatry and Behavioral Sciences, Miami, FL, USA
| | - Philip D Harvey
- University of Miami Miller School of Medicine, Department of Psychiatry and Behavioral Sciences, Miami, FL, USA; Research Service, Bruce W. Carter Miami VA Medical Center, Miami, FL, USA
| | - Lisa J Reidy
- University of Miami Miller School of Medicine, Department of Pathology and Laboratory Medicine, Miami, FL, USA
| | - Gabrielle Hodgins
- University of Miami Miller School of Medicine, Department of Psychiatry and Behavioral Sciences, Miami, FL, USA; Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Vasiliki Michopoulos
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, USA; Yerkes National Primate Research Center, Emory University, USA
| | - Jessica Maples-Keller
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, USA
| | - Barbara O Rothbaum
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, USA
| | - Alex Rothbaum
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, USA; Department of Psychological Services, Case Western Reserve University, Cleveland, OH, USA
| | - Kerry J Ressler
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, USA; Mclean Hospital, Harvard Medical School, Belmont, MA, USA
| | - Charles B Nemeroff
- University of Miami Miller School of Medicine, Department of Psychiatry and Behavioral Sciences, Miami, FL, USA; Department of Psychiatry, University of Texas at Austin, Dell Medical School, Austin, TX, USA; Institute for Early Life Adversity Research, University of Texas at Austin, Austin, TX,, USA
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Maples-Keller JL, Hyatt CS, Sleep CE, Stevens JS, Fenlon EE, Jovanovic T, Rothbaum BO, Ressler KJ, Carter S, Bradley B, Fani N, Powers A, Michopoulos V. DSM-5 alternative model for personality disorders trait domains and PTSD symptoms in a sample of highly traumatized African American women and a prospective sample of trauma center patients. Personal Disord 2021; 12:491-502. [PMID: 33444034 PMCID: PMC8277882 DOI: 10.1037/per0000477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Posttraumatic stress disorder (PTSD) has a specified precipitant (i.e., trauma), and thus, is particularly well-suited to examine risk and maintenance factors for the development of the disorder. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) alternative model of personality disorder (AMPD) is based, in part, on a dimensional trait model; previous research suggests that personality traits are related to PTSD symptoms. To date, there is little research examining this model with regard to PTSD symptoms, and such research could elucidate new strategies for identification and prevention. The present study investigates associations between AMPD traits and PTSD symptoms in a cross-sectional high-risk sample (N = 490; 100% female; 97.8% African American) and in a prospective, longitudinal sample of Level 1 trauma center patients (N = 185; 46.8% female; 72.5% African American). The Personality Inventory for DSM-5 Brief Form domains were significantly associated with PTSD total symptom severity and symptom clusters across both self-report and clinical interview measures. Personality Inventory for DSM-5 Negative Affectivity and Psychoticism emerged as significant predictors of concurrent PTSD. When prospectively predicting PTSD symptoms in the longitudinal cohort, Negative Affectivity and Psychoticism were significant predictors of PTSD symptom severity. These findings indicate how the DSM-5 AMPD pathological traits are associated with risk for stress-related disorders cross-sectionally and prospectively. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
| | | | | | - Jennifer S. Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
| | - Emily E. Fenlon
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
| | - Barbara O. Rothbaum
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
| | - Kerry J. Ressler
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
- Department of Psychiatry, Mclean Hospital, Harvard Medical School
| | - Sierra Carter
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
- Department of Psychology, Georgia State University
| | - Bekh Bradley
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
| | - Negar Fani
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
| | - Abigail Powers
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
| | - Vasiliki Michopoulos
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
- Yerkes National Primate Research Center, Atlanta, Georgia, United States
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Epigenetic prediction of 17β-estradiol and relationship to trauma-related outcomes in women. COMPREHENSIVE PSYCHONEUROENDOCRINOLOGY 2021; 6:100045. [PMID: 35757356 PMCID: PMC9216622 DOI: 10.1016/j.cpnec.2021.100045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 03/03/2021] [Indexed: 11/30/2022] Open
Abstract
17β-estradiol (E2) levels in women correlate with multiple neuropsychiatric symptoms, including those that are stress-related. Furthermore, prior work from our group has demonstrated that E2 status influences DNA methylation (DNAm) across the genome. We developed and validated a DNAm-based predictor of E2 (one of four naturally occurring estrogens) using a training set of 183 females and a test set of 79 females from the same traumatized cohort. We showed that predicted E2 levels were highly correlated with measured E2 concentrations in our testing set (r = 0.75, p = 1.8e-15). We further demonstrated that predicted E2 concentrations, in combination with measured values, negatively correlated with current post-traumatic stress disorder (PTSD) (β = −0.38, p = 0.01) and major depressive disorder (MDD) diagnoses (β = −0.45, p = 0.02), as well as a continuous measure of PTSD symptom severity (β = −2.3, p = 0.007) in females. Finally, we tested our predictor in an independent data set (n = 85) also comprised of recently traumatized female subjects to determine if the predictor would generalize to a different population than the one on which it was developed. We found that the correlation between predicted and actual E2 concentrations in the external validation data set was also high (r = 0.48, p = 3.0e-6). While further validation is warranted, a DNAm predictor of E2 concentrations will advance our understanding of hormone-epigenetic interactions. Furthermore, such a DNAm predictor may serve as an epigenetic proxy for E2 concentrations and thus provide an important biomarker to better evaluate the contribution of E2 to current and potentially future psychiatric symptoms in samples for which E2 is not measured. Neuropsychiatric symptoms correlate with estradiol (E2) levels in females. We developed a DNA methylation-based E2 predictor using machine learning approach. Our predictor performed well in an external validation cohort of traumatized women. Predicted E2 concentrations correlated with stress-related phenotypes. Our model may serve as an epigenetic biomarker of E2 status in women.
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Gould F, Harvey PD, Hodgins G, Jones MT, Michopoulos V, Maples-Keller J, Rothbaum BO, Rothbaum AO, Ressler KJ, Nemeroff CB. Prior trauma-related experiences predict the development of posttraumatic stress disorder after a new traumatic event. Depress Anxiety 2021; 38:40-47. [PMID: 32789992 DOI: 10.1002/da.23084] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/25/2020] [Accepted: 07/12/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Many reports have documented the relationship between previous traumatic experiences, including childhood trauma, and the development of later life psychopathology, including posttraumatic stress disorder (PTSD). Identification of individuals at greatest risk for the development of PTSD could lead to preventative interventions. The present study examined the developmental course of PTSD after trauma exposure, using histories of previous traumatic experiences and the severity of the reaction to the trauma as predictors. METHODS Participants (N = 713) were recruited from Emergency Departments in Miami and Atlanta immediately following a traumatic experience. Histories of previous traumatic experiences and the immediate reaction to the new trauma were examined at baseline. Follow-up assessments of PTSD severity were conducted at 1, 3, and 6 months. RESULTS Histories of child abuse and pre-existing trauma symptoms predicted the immediate response to stress (R2 = .21, p < .001) and the initial trauma reaction (p < .005).) A mixed-model repeated-measures analysis of variance found that immediate stress response and a history of prior trauma (p < .001) significantly predicted the course of PTSD symptoms. Area under the curve (AUC) analyses suggested that the presence of PTSD at each successive assessment was predicted most substantially by the severity of PTSD at the immediately prior follow-up assessment (AUC > 0.86). CONCLUSIONS The current findings suggest that previous traumatic experiences lead to a greater immediate reaction to trauma and combine to predict the development of PTSD, the maintenance of which is not moderated by these earlier experiences. The identification of people likely to develop PTSD may be aided by the assessment of prior experiences and immediate reactions.
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Affiliation(s)
- Felicia Gould
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Philip D Harvey
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida.,Research Service, Bruce W. Carter Miami VA Medical Center, Miami, Florida
| | - Gabrielle Hodgins
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida.,Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - Mackenzie T Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Vasiliki Michopoulos
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Jessica Maples-Keller
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Barbara O Rothbaum
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Alex O Rothbaum
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia.,Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio
| | - Kerry J Ressler
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia.,Mclean Hospital, Harvard Medical School, Belmont, Massachusetts
| | - Charles B Nemeroff
- Department of Psychiatry, Dell Medical School, University of Texas at Austin, Austin, Texas.,Institute for Early Life Adversity Research, University of Texas at Austin, Austin, Texas
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Maples-Keller JL, Post LM, Price M, Goodnight JM, Burton MS, Yasinski CW, Michopoulos V, Stevens JS, Hinrichs R, Rothbaum AO, Hudak L, Houry D, Jovanovic T, Ressler K, Rothbaum BO. Investigation of optimal dose of early intervention to prevent posttraumatic stress disorder: A multiarm randomized trial of one and three sessions of modified prolonged exposure. Depress Anxiety 2020; 37:429-437. [PMID: 32248637 PMCID: PMC7347250 DOI: 10.1002/da.23015] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 12/04/2019] [Accepted: 01/03/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is linked to a specific event, providing the opportunity to intervene in the immediate aftermath of trauma to prevent the development of this disorder. A previous trial demonstrated that trauma survivors who received three sessions of modified prolonged exposure therapy demonstrated decreased PTSD and depression prospectively compared to assessment only. The present study investigated the optimal dosing of this early intervention to test one versus three sessions of exposure therapy in the immediate aftermath of trauma. METHODS Participants (n = 95) recruited from a Level 1 Trauma Center were randomly assigned in a 1.5:1.5:1 ratio in a parallel-group design to the three conditions: one-session exposure therapy, three-session exposure therapy, and assessment only. Follow-up assessments were conducted by study assessors blind to study condition. RESULTS Mixed-effects model results found no significant differences in PTSD or depression symptoms between the control condition and those who received one or three exposure therapy sessions across 1-12-month follow-up assessment. Results indicate that the intervention did not interfere with natural recovery. Receiver operating characteristic curve analyses on the screening measure used for study inclusion (Predicting PTSD Questionnaire; PPQ) in the larger sample from which the treatment sample was drawn (n = 481) found that the PPQ was a poor predictor of likely PTSD at all follow-up time points (Area under the curve's = 0.55-0.62). CONCLUSIONS This likely impacted study results as many participants demonstrated natural recovery. Recommendations for future early intervention research are reviewed, including strategies to identify more accurately those at risk for PTSD and oversampling more severe trauma types.
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Affiliation(s)
- Jessica L. Maples-Keller
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, Georgia
| | - Loren M. Post
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, Georgia
| | - Matthew Price
- Department of Psychological Science, University of Vermont, Burlington, Vermont
| | - Jessica M. Goodnight
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, Georgia
| | - Mark S. Burton
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, Georgia
| | - Carly W. Yasinski
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, Georgia
| | - Vasiliki Michopoulos
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, Georgia,Developmental and Cognitie Neuroscience, Yerkes National Primate Research Center, Atlanta, Georgia
| | - Jennifer S. Stevens
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, Georgia
| | - Rebecca Hinrichs
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, Georgia
| | - Alex O. Rothbaum
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio
| | - Lauren Hudak
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, Georgia
| | - Debra Houry
- Division of Injury Prevention, National Center for Injury Control and Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, Georgia
| | - Kerry Ressler
- Department of Psychiatry, Mclean Hospital, Harvard Medical School, Belmont, Massachusetts
| | - Barbara O. Rothbaum
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, Georgia
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Pavlov D, Gorlova A, Bettendorff L, Kalueff AA, Umriukhin A, Proshin A, Lysko A, Landgraf R, Anthony DC, Strekalova T. Enhanced conditioning of adverse memories in the mouse modified swim test is associated with neuroinflammatory changes - Effects that are susceptible to antidepressants. Neurobiol Learn Mem 2020; 172:107227. [PMID: 32325189 DOI: 10.1016/j.nlm.2020.107227] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 03/09/2020] [Accepted: 03/29/2020] [Indexed: 01/08/2023]
Abstract
Deficient learning and memory are well-established pathophysiologic features of depression, however, mechanisms of the enhanced learning of aversive experiences associated with this disorder are poorly understood. Currently, neurobiological mechanisms of enhanced retention of aversive memories during depression, and, in particular, their relation to neuroinflammation are unclear. As the association between major depressive disorder and inflammation has been recognized for some time, we aimed to address whether neuroinflammatory changes are involved in enhanced learning of adversity in a depressive state. To study this question, we used a recently described mouse model of enhanced contextual conditioning of aversive memories, the modified forced swim model (modFST). In this model, the classic two-day forced swim is followed by an additional delayed session on Day 5, where increased floating behaviour and upregulated glycogen synthase kinase-3 (GSK-3) are context-dependent. Here, increased time spent floating on Day 5, a parameter of enhanced learning of the adverse context, was accompanied by hypercorticosteronemia, increased gene expression of GSK-3α, GSK-3β, c-Fos, cyclooxygenase-1 (COX-1) and pro-inflammatory cytokines interleukin-1 beta (IL-1β), tumor necrosis factor (TNF), and elevated concentrations of protein carbonyl, a marker of oxidative stress, in the prefrontal cortex and hippocampus. There were significant correlations between cytokine levels and GSK-3β gene expression. Two-week administration of compounds with antidepressant properties, imipramine (7 mg/kg/day) or thiamine (vitamin B1; 200 mg/kg/day) ameliorated most of the modFST-induced changes. Thus, enhanced learning of adverse memories is associated with pro-inflammatory changes that should be considered for optimizing pharmacotherapy of depression associated with enhanced learning of aversive memories.
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Affiliation(s)
- Dmitrii Pavlov
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht University, Maastricht, Netherlands; Sechenov First Moscow State Medical University, Institute of Molecular Medicine Laboratory of Psychiatric Neurobiology and Department of Normal Physiology, Moscow, Russia; Laboratory of Neurophysiology, GIGA-Neurosciences, University of Liège, Liège, Belgium
| | - Anna Gorlova
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht University, Maastricht, Netherlands; Sechenov First Moscow State Medical University, Institute of Molecular Medicine Laboratory of Psychiatric Neurobiology and Department of Normal Physiology, Moscow, Russia
| | - Lucien Bettendorff
- Laboratory of Neurophysiology, GIGA-Neurosciences, University of Liège, Liège, Belgium
| | - Allan A Kalueff
- School of Pharmacy, Southwest University, Chongqing, China; Institute of Translational Biomedicine, St. Petersburg State University, St. Petersburg, Russia
| | - Aleksei Umriukhin
- Sechenov First Moscow State Medical University, Institute of Molecular Medicine Laboratory of Psychiatric Neurobiology and Department of Normal Physiology, Moscow, Russia; Federal State Budgetary Scientific Institution "P.K. Anokhin Research Institute of Normal Physiology", Moscow, Russia
| | - Andrey Proshin
- Federal State Budgetary Scientific Institution "P.K. Anokhin Research Institute of Normal Physiology", Moscow, Russia
| | - Alexander Lysko
- Laboratory of Cognitive Dysfunctions, Institute of General Pathology and Pathophysiology, Moscow, Russia
| | - Rainer Landgraf
- Sechenov First Moscow State Medical University, Institute of Molecular Medicine Laboratory of Psychiatric Neurobiology and Department of Normal Physiology, Moscow, Russia; Max Planck Institute of Psychiatry, Munich, Germany
| | - Daniel C Anthony
- Sechenov First Moscow State Medical University, Institute of Molecular Medicine Laboratory of Psychiatric Neurobiology and Department of Normal Physiology, Moscow, Russia; Department of Pharmacology, Oxford University, Oxford, UK
| | - Tatyana Strekalova
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht University, Maastricht, Netherlands; Sechenov First Moscow State Medical University, Institute of Molecular Medicine Laboratory of Psychiatric Neurobiology and Department of Normal Physiology, Moscow, Russia.
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Fani N, Jain J, Hudak LA, Rothbaum BO, Ressler KJ, Michopoulos V. Post-trauma anhedonia is associated with increased substance use in a recently-traumatized population. Psychiatry Res 2020; 285:112777. [PMID: 31991282 PMCID: PMC7544530 DOI: 10.1016/j.psychres.2020.112777] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 01/06/2020] [Accepted: 01/06/2020] [Indexed: 12/13/2022]
Abstract
Recreational substance use (SU) can emerge or worsen in the aftermath of psychological trauma. Anhedonia is one reason for this problematic SU. Symptoms of posttraumatic stress disorder (PTSD) that represent anhedonia (post-trauma anhedonia; PTA) have been consistently linked to SU disorders. However, no prospective studies have examined whether changes in PTA over time are associated with problematic SU in recently-traumatized people, which was the goal of this study. 165 men and women were recruited as part of a prospective PTSD study in the emergency department of a Level 1 trauma center. Clinical assessments of PTSD and SU were administered at three and six months post-trauma. Compared to participants with minimal SU at six months post-trauma, high substance users at six months post-trauma showed significant increases in PTA during the three to six month time period. This relationship was significant even after accounting for variance associated with other factors, including PTSD symptoms such as re-experiencing and hyperarousal. Participants who demonstrated increases in SU during this time also showed significant increases in PTA, unlike those who demonstrated consistently minimal/no SU during this time. These findings indicate that PTA may be a mechanism through which SU problems emerge in recently-traumatized individuals.
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Affiliation(s)
- Negar Fani
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, USA.
| | - Jahnvi Jain
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, USA
| | - Lauren A Hudak
- Emory University School of Medicine, Department of Emergency Medicine, USA
| | - Barbara O Rothbaum
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, USA
| | - Kerry J Ressler
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, USA; McLean Hospital, Harvard Medical School, USA
| | - Vasiliki Michopoulos
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, USA; Yerkes National Primate Research Center, Atlanta, GA, USA
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