History of Post-traumatic Stress Disorder Is Associated With Impaired Neuropsychometric Performance After Coronary Artery Surgery

Post-traumatic Stress Disorder as an Independent Risk Factor for Increased Opioid Use Following Carpal Tunnel Surgery

BACKGROUND

Carpal tunnel release (CTR) is one of the most common hand surgeries. Studies have highlighted a mental-physical connection to hand pathologies and psychological connections to postoperative pain burden. Post-traumatic stress disorder (PTSD) has been identified as a medical-psychological comorbidity like other mental health disorders such as generalized anxiety disorder (GAD). There remains a gap in the literature regarding PTSD as a comorbidity for hand surgeries, where there is this mental-physical connection. We hypothesize PTSD will be associated with increased risk of postoperative pain, evidenced by greater prevalence of opioid usage.

METHODS

The authors performed a retrospective analysis using the TriNetX Research Database. Patients who underwent elective CTR were identified within the database. Two groups were created and compared against individual controls: the first was identified based on the diagnosis of PTSD, and the second was identified based on the diagnosis of GAD. Cohorts were matched and opioid usage was compared postoperatively.

RESULTS

Patients with PTSD who underwent CTR were found to be at significantly increased risk of postoperative opioid use (P = .033) and more likely to present to the emergency department (ED) (P = .001). Patients with GAD were found to be significantly less likely to require postoperative opioids (P = .040).

CONCLUSIONS

We found patients with PTSD to be at increased risk of opioid use and more likely to present to ED following CTR. Patients with GAD were found to be at decreased risk of opioid use after CTR. Owing to the independent significant risks not found in GAD, further research of postoperative pain in patients with PTSD is needed.

Posttraumatic stress disorder symptom severity is associated with reduced Montreal Cognitive Assessment scores in a sample of Vietnam War Veterans

The goal of the present study was to examine associations between posttraumatic stress disorder (PTSD) symptom severity, the number of stressors experienced, and cognitive outcomes in a sample of U.S. Vietnam War Veterans (N = 274). Adults between 60 and 85 years of age completed a Vietnam Veterans Alzheimer's Disease Neuroimaging Initiative Project visit. A modified version of the Life Stressor Checklist-Revised (LSC-R) was used to assess the number of stressful experiences participants experienced, current PTSD severity scores were measured via the Clinician-Administered PTSD Scale for DSM-IV (CAPS-IV), and cognition was assessed using the Montreal Cognitive Assessment (MoCA). Linear regressions were conducted to examine the effect of CAPS-IV and LSC-R scores on cognitive performance. Higher CAPS-IV scores were associated with worse cognitive outcomes on the MoCA, ΔF(1, 264) = 12.686, p < .001, R² = .142. In contrast, the number of reported stressful experiences was not associated with cognitive outcomes. After accounting for multiple comparisons, findings indicated that CAPS-IV severity scores were significantly associated with the MoCA memory index. In a sample of older Veterans, PTSD symptom severity, but not the number of reported stressors, was associated with poorer performance on a well-established cognitive function screening tool. Analyses of specific MoCA domains indicated that memory may be driving this association. These findings suggest that highly arousing stressors characteristic of PTSD, rather than stressful experiences more broadly, contribute to this association. Future work can use these findings to explore whether treating PTSD symptoms may help maintain cognitive function during the aging process.

Predictors of cognitive dysfunction after cardiac surgery: a systematic review

AIMS

Postoperative cognitive dysfunction (POCD) is often experienced by cardiac surgery patients; however, it is not known if some groups of patients experience this more frequently or severely than others.The aim of this systematic review was to identify preoperative and postoperative predictors of cognitive dysfunction in adults following cardiac surgery.

METHODS AND RESULTS

Eight bibliographic databases were searched (January 2005 to March 2021) in relation to cardiac surgery and cognition. Studies including adult patients who had undergone open cardiac surgery and using a validated measurement of cognitive function were included. Full-text review for inclusion, quality assessment, and data extraction were undertaken independently by two authors.A total of 2870 papers were identified, of which 36 papers met the inclusion criteria and were included in the review. The majority were prospective observational studies [n = 28 (75.7%)]. In total, 61 independent predictors (45 preoperative and 16 postoperative) were identified as significant in at least one study; advancing age and education level appear important. Age has emerged as the most common predictor of cognitive outcome.

CONCLUSION

Although a number of predictors of POCD have been identified, they have inconsistently been reported as significantly affecting cognitive outcome. Consistent with previous research, our findings indicate that older patients and those with lower educational levels should be prioritized when developing and trialling interventions to improve cognitive function. These findings are less than surprising if we consider the methodological shortcomings of included studies. It is evident that further high-quality research exploring predictors of POCD is required.

Enhancing Hospital Well-being and Minimizing Intensive Care Unit Trauma: Cushioning Effects of Psychosocial Care

CONTEXT

Hospitalization has the potential to induce hospital anxiety, while admission in the Intensive Care Unit (ICU) is found to surpass the anxiety and result in what is termed as "ICU Trauma."

AIMS

This study aimed to determine the impact of psychosocial care and quality of ICU on ICU trauma and hospital well-being in patients who underwent coronary artery bypass grafting (CABG).

SETTINGS AND DESIGN

This correlational study involved 250 CABG patients, who were recruited from five major corporate hospitals.

PARTICIPANTS AND METHODS

The ICU Psychosocial Care Scale, Hospital Wellbeing Scale, and ICU Trauma Scale were used. Each of the participants was assessed individually. The ICU Practices Checklist was used to assess the environment of the ICU in the hospital.

STATISTICAL ANALYSIS USED

Descriptive statistics, correlation, and simple and multiple linear regression analyses were done.

RESULTS

The results revealed the significant contribution of psychosocial care in ICU in enhancing hospital well-being as well as minimizing ICU trauma of patients who underwent CABG. The results of multiple regressions clearly indicated that psychosocial care was a powerful predictor of hospital well-being and ICU trauma.

CONCLUSIONS

Although psychosocial care was not a component of hospital well-being and had a negative correlation with ICU trauma, it contributed significantly with a cushioning effect to minimize trauma and helped enhance the feelings and experiences of well-being among patients in ICU.

Elevated rates of memory impairment in military service-members and veterans with posttraumatic stress disorder

INTRODUCTION

Studies investigating the neurocognitive effects of posttraumatic stress disorder (PTSD) routinely find "deficits" in various cognitive domains. However, the rate of cognitive impairment in individuals with PTSD remains unclear, as studies have focused on null hypothesis testing (NHT) and inferring patterns of impairment rather than empirically determining the rate of cognitive impairment in this sample.

METHOD

This study examined rates of cognitive impairment using a domain-specific approach in non-treatment-seeking Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn service members and veterans with (n = 92) and without (n = 79) PTSD and without substance abuse/dependence who passed a performance validity measure and were matched on age, education, estimated IQ, and ethnicity. Chi-square analyses were used to compare the rate of cognitive impairment across groups based on normative scores using three cutoffs (-1, -1.5, and -2 SDs). NHT was also used to compare performances across groups.

RESULTS

Individuals with PTSD showed higher rates of impairment in memory (-1-SD cutoff) than controls, but equivalent rates of impairment in attention, processing speed, and executive functioning; no significant differences were found on NHT. Impairment in any domain was also more prevalent in PTSD (-1-, -1.5-, and -2-SD cutoffs). No differences were found on NHT or rates of impairment in individuals with PTSD with (n = 34) and without (n = 58) depression.

CONCLUSIONS

Patients with PTSD were more likely to meet criteria for memory impairment and to show impairment in any domain than controls. Patients with PTSD and comorbid depression were no more likely to be impaired in any cognitive domain or to have lower scores on individual cognitive tasks than patients with PTSD alone. Clinicians noting cognitive impairment in individuals with PTSD should exercise caution before ascribing that impairment to another etiology if deficits are limited to memory.

Postoperative pain and subsequent PTSD-related symptoms in patients undergoing lung resection for suspected cancer

BACKGROUND

Because lung cancer resection is at the crossroad between cancer and high-risk surgery, we hypothesized that the patients undergoing lung resection for cancer are exposed to develop a post-traumatic stress disorder (PTSD) syndrome-related symptoms.

METHODS

Forty-seven adult patients were included in the study. Patients were eligible for inclusion if they underwent lung resection for suspected cancer, if they were able to speak and read French, and if they agreed to be reached for a telephone interview. We assessed before, immediately after, and 3 months after surgery the presence of symptoms of anxiety and depression (Hospital Anxiety and Depression Scale) and PTSD-related symptoms (impact of events scale revised [IES-R]). At the 3-month assessment, an IES-R score > 22 was used as criteria for predicting the patients at risk of PTSD-related symptoms.

RESULTS

We identified an IES-R score higher than 22 in 24 participants (51%). Patients with a preoperatory Hospital Anxiety and Depression Scale(anxiety) score more than 7 (T0) and a maximal visual analogic scale score more than 40 during the first 24 hours after surgery were more likely to develop PTSD-related symptoms at 3-months with odd ratios at 4.61 [1.20-17.73] (p = 0.03) and 1.34 [1.05-1.75] (p = 0.02).

CONCLUSION

The prevalence of PTSD-related symptoms after lung cancer resection is high, showing that lung cancer patients undergoing surgical resection are at high risk of postprocedure burden. The presence of preoperative symptoms of anxiety and acute procedural pain during the early postoperative period are strong predictors for developing PTSD-related symptoms after lung cancer surgery.

The Impact of Stress Hormones on Post-traumatic Stress Disorders Symptoms and Memory in Cardiac Surgery Patients

The relationship and interactions between stress hormones and post-traumatic stress disorder (PTSD) are well established from both animal and human research studies. This interaction is especially important in the post-operative phase of cardiac surgery where the development of PTSD symptoms will result in increased morbidity and mortality and prolong length of stay for critically ill cardiac surgery patients. Cardiopulmonary bypass itself will independently result in massive inflammation response and release of stress hormones in the perioperative period. Glucocorticoid may reduce this response and result in reduction of PTSD symptom clusters and therefore improve health outcome. In this review, we plan to conduct a systemic review and analysis of the literatures on this topic.

A meta-analysis of cognitive functioning in older adults with PTSD

A meta-analysis was conducted to summarize and integrate the literature on the cognitive functioning of older adults with posttraumatic stress disorder (PTSD). We hypothesized that those with PTSD would exhibit worse performance in each of the cognitive domains studied when compared to older adults without PTSD. Major databases were queried and eleven articles met criteria for review. As predicted, there was evidence of worse performance across cognitive measures in older adult samples with PTSD relative to older samples without PTSD. The strongest effect across samples was found for lower test scores in the broad domain of memory among older adults with PTSD, and there was evidence that trauma exposure is uniquely associated with worse performance on tests specific to learning. We outline factors thought to contribute to the interactions among PTSD, cognitive deficits, and the aging process. These findings highlight the need for thorough evaluation of cognitive functioning in older adults with PTSD, particularly in the areas of processing speed, learning, memory, and executive functioning.