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Longo MSDC, Vilete LMP, Figueira I, Quintana MI, Mello MF, Bressan RA, Mari JDJ, Ribeiro WS, Andreoli SB, Coutinho ESF. Comorbidity in post-traumatic stress disorder: A population-based study from the two largest cities in Brazil. J Affect Disord 2020; 263:715-721. [PMID: 31780134 DOI: 10.1016/j.jad.2019.11.051] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 05/07/2019] [Accepted: 11/10/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND This study investigated the patterns of comorbidity between PTSD and depression, other anxiety disorders, alcohol-related disorders using the DSM-IV and ICD-10 criteria. The temporal sequence of the comorbid diagnoses was also investigated. METHODS We used data from a large population-based survey carried out between 2007 and 2008 in the two largest cities in Brazil: São Paulo and Rio de Janeiro. RESULTS Diagnoses of depression, other anxiety disorders, and alcohol-related disorder were more prevalent in the people with PTSD than in those without PTSD. Using the DSM-IV criteria, approximately 67% of cases presenting PTSD were also diagnosed with another mental disorder. The diagnosis category of other anxiety disorders presented the highest proportion of comorbidity (53%). Depression was found in 34% person with PTSD whilst alcohol-related disorders were observed in 7%. Considering the temporal relationship, the onset of comorbid depression was uniformly distributed through the periods before, within the same year and after PTSD's onset. When other anxiety disorders were comorbid with PTSD, in almost 90% of the cases the other anxiety disorders preceded PTSD. For comorbidity between of alcohol-related disorders and PTSD, in 50% of the cases alcohol-related disorders preceded the diagnosis of PTSD. LIMITATIONS The cross-sectional design imposes limitations on establishing a temporal relationship between the onset of psychiatric disorders due to memory bias. CONCLUSIONS Our findings indicate that among individuals presenting comorbid PTSD and other anxiety disorders, this diagnosis tend to precede PTSD. Comorbid cases are more frequent and more severe, and this should be taken into account in therapeutic research and clinical practice.
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Affiliation(s)
| | | | - Ivan Figueira
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Maria Inês Quintana
- Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Marcelo Feijó Mello
- Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Rodrigo A Bressan
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience King's College London, UK
| | - Jair de Jesus Mari
- Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Wagner Silva Ribeiro
- Personal Social Services Research Unit, London School of Economics and Political Science, London, UK
| | | | - Evandro Silva Freire Coutinho
- Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública, Rio de Janeiro, Brazil; Instituto de Medicina Social da Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
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Lipsky S, Kernic MA, Qiu Q, Hasin DS. Traumatic Events Associated With Posttraumatic Stress Disorder: The Role of Race/Ethnicity and Depression. Violence Against Women 2016; 22:1055-74. [PMID: 26620827 PMCID: PMC4884659 DOI: 10.1177/1077801215617553] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study sought to examine specific types of potentially traumatic experiences as predictors of posttraumatic stress disorder (PTSD) and the moderating effect of race/ethnicity and major depressive disorder (MDD) among non-Hispanic White, non-Hispanic Black, and Hispanic U.S. women. The study sample was drawn from two waves of the National Epidemiologic Surveys of Alcohol and Related Conditions. Sexual assault, intimate partner violence, and childhood trauma were the strongest predictors of PTSD compared with the reference group (indirect/witnessed trauma). Similar patterns were revealed across racial/ethnic groups, although the estimates were most robust among White women. Findings also suggest that MDD moderates the effect of traumatic experiences on PTSD.
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Affiliation(s)
- Sherry Lipsky
- University of Washington School of Medicine at Harborview Medical Center, Seattle, USA
| | - Mary A Kernic
- University of Washington School of Public Health, Seattle, USA
| | - Qian Qiu
- University of Washington School of Medicine at Harborview Medical Center, Seattle, USA
| | - Deborah S Hasin
- Columbia University/New York State Psychiatric Institute, USA
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3
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Balan S, Widner G, Shroff M, van den Berk-Clark C, Scherrer J, Price RK. Drug use disorders and post-traumatic stress disorder over 25 adult years: role of psychopathology in relational networks. Drug Alcohol Depend 2013; 133:228-34. [PMID: 23726975 PMCID: PMC3786051 DOI: 10.1016/j.drugalcdep.2013.04.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Revised: 04/16/2013] [Accepted: 04/24/2013] [Indexed: 12/25/2022]
Abstract
BACKGROUND In traumatized populations, drug use disorders and post-traumatic stress disorder (PTSD) persist for many years. Relational factors that mediate this persistence have rarely been systematically examined. Our aim is to examine the relative effects of psychopathology in familial and non-familial networks on the persistence of both disorders over adulthood. METHODS We utilized longitudinal data from an epidemiologically ascertained sample of male Vietnam veterans (n=642). Measures included DSM-IV drug use disorders, other psychiatric disorders, network problem history and time-varying marital and employment characteristics. Longitudinal measures of veterans' psychopathology and social functioning were retrospectively obtained for each year over a 25 year period. We used generalized estimating equations (GEE) to estimate the relative effects of network problems on veteran's drug use disorders and PTSD after adjusting for covariates. RESULTS Veterans' mean age was 47 years in 1996. Prevalence of illicit drug disorders declined from 29.8% in 1972 to 8.3% in 1996, but PTSD remained at 11.7% from 13.2% in 1972. While 17.0% of veterans reported a familial drug use problem, 24.9% reported a non-familial drug use problem. In full GEE models, a non-familial drug problem was a significant predictor of illicit drug use disorders over 25 years (OR=2.21, CI=1.59-3.09), while both familial depression (OR=1.69, CI=1.07-2.68) and non-familial drinking problem (OR=1.66, CI=1.08-2.54) were significant predictors of PTSD over 25 years. CONCLUSIONS Familial and non-familial problems in networks differentially affect the persistence of drug use disorders and PTSD in traumatized male adults.
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Affiliation(s)
- Sundari Balan
- Department of Psychiatry, Washington University School of Medicine, Medical Box 8134, St. Louis, MO 63110, United States
| | - Greg Widner
- Department of Psychiatry, Washington University School of Medicine, Medical Box 8134, St. Louis, MO 63110, United States
| | - Manan Shroff
- Department of Psychiatry, Washington University School of Medicine, Medical Box 8134, St. Louis, MO 63110, United States
| | - Carissa van den Berk-Clark
- Department of Psychiatry, Washington University School of Medicine, Medical Box 8134, St. Louis, MO 63110, United States
| | - Jeffrey Scherrer
- Department of Psychiatry, Washington University School of Medicine, Medical Box 8134, St. Louis, MO 63110, United States
,Research Service, VA St. Louis Health Care System, 915 North Grand Blvd. St. Louis MO 63106, United States
,Department of Family and Community Medicine, Saint Louis University School of Medicine, 1402 S. Grand Blvd, St. Louis MO 63104, United States
| | - Rumi Kato Price
- Department of Psychiatry, Washington University School of Medicine, Medical Box 8134, St. Louis, MO 63110, United States
,Research Service, VA St. Louis Health Care System, 915 North Grand Blvd. St. Louis MO 63106, United States
,Corresponding author. Tel.: +1 314-286-2282; fax +1 314 286 2285. (R.K. Price)
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Leen-Feldner EW, Feldner MT, Knapp A, Bunaciu L, Blumenthal H, Amstadter AB. Offspring psychological and biological correlates of parental posttraumatic stress: review of the literature and research agenda. Clin Psychol Rev 2013; 33:1106-33. [PMID: 24100080 DOI: 10.1016/j.cpr.2013.09.001] [Citation(s) in RCA: 135] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 09/06/2013] [Accepted: 09/06/2013] [Indexed: 11/16/2022]
Abstract
Millions of individuals with posttraumatic stress disorder (PTSD) are parents. A burgeoning literature suggests that offspring of parents with this condition may be at increased risk for psychological problems. The current paper provides an integrative and comprehensive review of the diverse research literature examining the sequelae of parental posttraumatic stress among offspring. Over 100 studies that evaluated psychological and/or biological variables among children of parents with PTSD are reviewed. Findings suggest parental symptoms of posttraumatic stress are uniquely related to an array of offspring outcomes, including internalizing-type problems, general behavioral problems, and altered hypothalamic-pituitary-adrenal axis functioning. Although very little work has directly evaluated mechanisms of transmission, there is increasing support for genetic and epigenetic effects as well as parenting behaviors. These and other mechanisms are discussed; drawing upon findings from other literatures to consider how parental PTSD may impart psychobiological vulnerability upon offspring. We conclude with a detailed discussion of the methodological strengths and challenges of the extant research, along with a recommended agenda for future research in this important area of study.
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Nickerson A, Steenkamp M, Aerka IM, Salters-Pedneault K, Carper TL, Barnes JB, Litz BT. Prospective investigation of mental health following sexual assault. Depress Anxiety 2013; 30:444-50. [PMID: 23165889 DOI: 10.1002/da.22023] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Revised: 08/30/2012] [Accepted: 10/16/2012] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Comorbidity in psychological disorders is common following exposure to a traumatic event. Relatively little is known about the manner in which changes in the symptoms of a given type of psychological disorder in the acute period following a trauma impact changes in symptoms of another disorder. This study investigated the relationship between changes in posttraumatic stress disorder (PTSD), depression, and anxiety symptoms in the first 12 weeks following sexual assault. METHODS Participants were 126 women who had been sexually assaulted in the previous 4 weeks. RESULTS Lower level mediation analyses revealed that changes in PTSD symptoms had a greater impact on changes in depression and anxiety than vice versa. CONCLUSIONS The finding highlights the role of PTSD symptoms in influencing subsequent change in other psychological symptoms. These findings are discussed in the context of models detailing the trajectory of psychological disorders following trauma, and clinical implications are considered.
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Affiliation(s)
- Angela Nickerson
- School of Psychology, University of New South Wales, Sydney, Australia.
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Posttraumatic and depressive symptoms in victims of occupational accidents. DEPRESSION RESEARCH AND TREATMENT 2012; 2012:184572. [PMID: 22690334 PMCID: PMC3368301 DOI: 10.1155/2012/184572] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Revised: 01/12/2012] [Accepted: 03/24/2012] [Indexed: 11/17/2022]
Abstract
The present descriptive study was aimed at evaluating posttraumatic and depressive symptoms and their cooccurrence, in a sample of victims of workplace accidents. Also, posttraumatic negative cognitions were assessed. Eighty-five injured workers were evaluated, using the PTSD Symptom Scale, the Beck Depression Inventory II, and the posttraumatic Cognitions Inventory. 49.4% of injured workers reported both depressive and posttraumatic symptoms of clinical relevance. 20% only reported posttraumatic, but not depressive, symptoms, and 30.6% did not report either type of symptoms. The group with both posttraumatic and depressive symptoms displayed greater symptom severity and more negative cognitions about the self and about the world than the other two groups. The obtained findings indicate that workplace accidents can have a major impact upon the mental health of victims. Early interventions should be focused not only on the prevention or reduction of posttraumatic and depressive symptoms but also on restructuring specific maladaptive trauma-related cognitions.
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DNA methylation in vulnerability to post-traumatic stress in rats: evidence for the role of the post-synaptic density protein Dlgap2. Int J Neuropsychopharmacol 2010; 13:347-59. [PMID: 19793403 DOI: 10.1017/s146114570999071x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Post-traumatic stress disorder (PTSD) is unique among psychiatric disorders since there is an explicit requirement for the presence of a well-defined precipitating environmental event. This suggests the participation of adaptable molecular processes such as epigenetic modifications, including acetylation and methylation of histones and DNA methylation. In the present study we investigated whether changes in DNA methylation are associated with the effects of traumatic stressor, using a validated PTSD rat model. Screening of genomic DNA methylation patterns revealed that maladaptation to traumatic stress is associated with numerous changes in the methylation pattern of rat hippocampus. Of the differentially methylated genes revealed by this global screening, Disks Large-Associated Protein (Dlgap2) was of special interest, demonstrating an increase in a specific methylation site which was associated with a reduction in its gene expression in PTSD-like compared to non-PTSD-like rats. The association between the methylation rate and Dlgap2 expression was further substantiated by re-dividing the rats according to their methylation state. A significantly higher expression was observed in the non-methylated compared to methylated rats. In addition, taking all rats as one group revealed a significant correlation between their behavioural stress responses and Dlgap2 transcript levels. These results suggest that alterations in global methylation pattern are involved in behavioural adaptation to environmental stress and pinpoint Dlgap2 as a possible target in PTSD.
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Breslau N. The epidemiology of trauma, PTSD, and other posttrauma disorders. TRAUMA, VIOLENCE & ABUSE 2009; 10:198-210. [PMID: 19406860 DOI: 10.1177/1524838009334448] [Citation(s) in RCA: 428] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Epidemiologic studies have reported that the majority of community residents in the United States have experienced posttraumatic stress disorder (PTSD)-level traumatic events, as defined in the DSM-IV. Only a small subset of trauma victims develops PTSD (<10%). Increased incidence of other disorders following trauma exposure occurs primarily among trauma victims with PTSD. Female victims of traumatic events are at higher risk for PTSD than male victims are. Direct evidence on the causes of the sex difference in the conditional risk of PTSD is unavailable. The available evidence suggests that the sex difference is not due to (a) the higher occurrence of sexual assault among females, (b) prior traumatic experiences, (c) preexisting depression or anxiety disorder, or (d) sex-related bias in reporting. Observed sex differences in anxiety, neuroticism, and depression, inducing effects of stressful experiences, might provide a theoretical context for further inquiry into the greater vulnerability of females to PTSD.
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Affiliation(s)
- Naomi Breslau
- Department of Epidemiology, Michigan State University College of Human Medicine, USA
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Cohen H, Geva AB, Matar MA, Zohar J, Kaplan Z. Post-traumatic stress behavioural responses in inbred mouse strains: can genetic predisposition explain phenotypic vulnerability? Int J Neuropsychopharmacol 2008; 11:331-49. [PMID: 17655807 DOI: 10.1017/s1461145707007912] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Clinical studies of twin pairs and families of post-traumatic stress disorder (PTSD) patients raise questions as to possible genetic predisposition to PTSD. Studies using isogenic animal populations exposed to a stress paradigm could elucidate the relative contributions of genotype and environment to endophenotypic expression. The prevalence of individuals displaying severely compromised behavioural responses to predator scent stress (PSS) was assessed in six inbred strains of mice in an animal model of PTSD that classifies individuals into groups according to the degree of their behavioural response. The choice of strains was based on the frequent use of these mice in transgenic research. The prevalence of extreme behavioural response in the elevated plus maze and the acoustic startle response paradigms, performed in sequence, was assessed at baseline and 7 d after PSS exposure between and within strains, and compared to differences in circulating corticosterone levels. Narrow-sense trait heritability was determined by comparing the between-strain variance to the total variance. Although strain-specific differences in anxiety-like behaviours were demonstrated, the results revealed a significant degree of individual variability in response patterns within each of the inbred strains, yielding a baseline heritability factor for anxiety-like behaviours of 30%, but only 10% for response to stress exposure. Baseline anxiety-like behaviours were found not to be predictive of post-exposure behavioural responses. The response of the individual to stress is multifactorial and environmental factors play a predominant role in characterizing the individual response to stress exposure, although there are significant genetic underpinnings.
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Affiliation(s)
- Hagit Cohen
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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10
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Rasmussen DD, Crites NJ, Burke BL. Acoustic startle amplitude predicts vulnerability to develop post-traumatic stress hyper-responsivity and associated plasma corticosterone changes in rats. Psychoneuroendocrinology 2008; 33:282-91. [PMID: 18164825 PMCID: PMC2291512 DOI: 10.1016/j.psyneuen.2007.11.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2007] [Revised: 11/01/2007] [Accepted: 11/02/2007] [Indexed: 11/20/2022]
Abstract
Following exposure to trauma, a vulnerable sub-population of individuals develops post-traumatic stress disorder (PTSD) with characteristic persistent autonomic hyper-responsivity, associated increased startle response, and commonly altered hypothalamo-pituitary-adrenal regulation. A goal of this investigation was to identify a predictive marker for this vulnerability. Previous investigators have developed a model for PTSD in which male mice were exposed to a single brief episode of inescapable footshock followed by 1-min contextual reminders of this trauma at weekly intervals for 6 weeks. Exposure to these reminders induced a progressive and persistent increase in the amplitude of acoustic startle consistent with the persistently increased acoustic startle of individuals exhibiting PTSD. We adapted this model to adult male Wistar rats, with added characterization of initial (pre-trauma) startle response. After one episode of inescapable footshock (10 s, 2 mA) or control treatment followed by six weekly 1-min contextual reminders, acoustic startle was re-tested. Data were analyzed after dividing rats within each treatment into LOW vs MID vs HIGH (33% in each group) pre-treatment startle responders. Rats which exhibited pre-treatment LOW- and MID-range acoustic startle responses did not develop increased acoustic startle responses following subsequent traumatic stress+reminders ([TS+R]) treatment. However, rats which exhibited HIGH pre-treatment startle responses exhibited further significant (p<0.01) [TS+R]-induced persistent enhancement of this already elevated startle response. Furthermore, rats exhibiting HIGH pre-treatment startle responses were also the only subgroup which exhibited increased basal plasma corticosterone levels following [TS+R] treatment. These results suggest that initial pre-stress acoustic startle response can identify subgroups of rats which are predisposed to, or resistant to, developing a PTSD-like syndrome following subsequent trauma.
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Affiliation(s)
- Dennis D Rasmussen
- VA Puget Sound Health Care System, Mental Illness Research, Education and Clinical Center, Seattle, WA 98108, USA.
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Cavin S. World War II Never Ended in My House: Interviews of 12 Office of Strategic Services Veterans of Wartime Espionage on the 50th Anniversary of WW II. Ann N Y Acad Sci 2006; 1071:463-71. [PMID: 16891599 DOI: 10.1196/annals.1364.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The author conducted sociological interviews of 12 OSS spies (7 male, 5 female) who were operatives in France during World War II (WW II). The Office of Strategic Services (OSS) existed from 1941 to 1945 and was later renamed the CIA in 1947. This paper includes family studies of six close relatives of OSS vets and observation of 400 OSS veterans at the 50th anniversary of WW II. Three of the 12 OSS veterans who had been tortured by the Gestapo still suffered from PTSD-startle symptoms after 50 years; those three also suffered massive strokes in later life. The majority of OSS vets, regardless of gender, exhibited "war excitement" when talking about the war 50 years later. Most saw the war as the highpoint of their lives. War excitement needs more careful study within PTSD circles.
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Affiliation(s)
- Susan Cavin
- New York University-SCPS Division, 726 Broadway, 6th Floor, New York, NY 10012, USA.
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12
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Affiliation(s)
- Amy Deep-Soboslay
- Section on Neuropathology, Clinical Brain Disorders Branch, NIMH/NIH, Bethesda, Maryland 20892, USA
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Berlim MT, Perizzolo J, Fleck MPA. Transtorno de estresse pós-traumático e depressão maior. BRAZILIAN JOURNAL OF PSYCHIATRY 2003; 25 Suppl 1:51-4. [PMID: 14523512 DOI: 10.1590/s1516-44462003000500012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Estudos epidemiológicos indicam, claramente, que o transtorno de estresse pós-traumático (TEPT) está se tornando um importante problema de saúde em termos globais, ainda que continue sendo pouco diagnosticado e tratado de forma inapropriada. O TEPT comumente ocorre em comorbidade com outros transtornos psiquiátricos, especialmente com a depressão maior. Entretanto, a relação entre esses transtornos e o tratamento dessa complexa entidade clínica apenas recentemente passou a receber atenção da literatura especializada. Alguns autores argumentaram que elas são duas entidades distintas, enquanto outros defenderam a hipótese de que a alta prevalência dessa comorbidade pode representar um artefato derivado dos critérios diagnósticos atualmente utilizados. Com relação ao tratamento do TEPT comórbido com depressão maior, os dados disponíveis na literatura são insuficientes e não apontam para nenhuma abordagem específica, embora alguns ensaios clínicos pequenos tenham relatado a utilidade da combinação de inibidores seletivos da recaptação da serotonina com terapia cognitiva.
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Affiliation(s)
- Marcelo T Berlim
- Universidade Federal do Rio Grande do Sul (UFRGS). Porto Alegre, RS, Brasil.
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Segman RH, Cooper-Kazaz R, Macciardi F, Goltser T, Halfon Y, Dobroborski T, Shalev AY. Association between the dopamine transporter gene and posttraumatic stress disorder. Mol Psychiatry 2003; 7:903-7. [PMID: 12232785 DOI: 10.1038/sj.mp.4001085] [Citation(s) in RCA: 131] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2001] [Revised: 07/21/2001] [Accepted: 09/24/2001] [Indexed: 11/09/2022]
Abstract
Posttraumatic stress disorder (PTSD) is a chronic anxiety disorder that follows exposure to extreme events. A large twin study of Vietnam veterans had demonstrated a significant genetic contribution to chronic PTSD upon exposure to combat.(1,2) The underlying genes, however, have not been described. Given previous findings of abnormal dopamine (DA) function in PTSD, and given the putative effect of dopamine neurotransmission in shaping the responses to stress in animals, this study examined the association of the dopamine transporter (DAT) SLC6A3 3' variable number tandem repeat (VNTR) polymorphism with PTSD. The study evaluated 102 chronic PTSD patients and 104 carefully-documented trauma survivors (TS) who did not develop PTSD. Significant excess of 9 repeat allele was observed among PTSD patients (43% vs 30.5% in TS controls; chi(2) = 6.3, df = 1, P = 0.012). An excess of 9 repeat homozygous genotype was also observed in PTSD (20.43% in PTSD vs 9.47% in TS controls; chi(2) = 6.11, df = 2, P < 0.047). These findings suggest that genetically determined changes in dopaminergic reactivity may contribute to the occurrence of PTSD among trauma survivors.
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Affiliation(s)
- R H Segman
- Department of Psychiatry, Hadassah-Hebrew University Medical Center, Hadassah University Hospital, PO Box 12000, Ein Karem, Jerusalem 91120, Israel.
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Breslau N. Epidemiologic studies of trauma, posttraumatic stress disorder, and other psychiatric disorders. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2002; 47:923-9. [PMID: 12553127 DOI: 10.1177/070674370204701003] [Citation(s) in RCA: 302] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This paper reviews recent epidemiologic studies of posttraumatic stress disorder (PTSD) in the general population. Estimates of the prevalence of exposure to traumatic events vary with the method used to ascertain trauma exposure and the definition of the stressor criterion. Changes in the DSM-IV definition of "stressor" have increased the number of traumatic events experienced in the community that can be used to diagnose PTSD and thus, the number of PTSD cases. Risk factors for PTSD in adults vary across studies. The 3 factors identified as having relatively uniform effects are 1) preexisting psychiatric disorders, 2) a family history of disorders, and 3) childhood trauma. In civilian populations, women are at a higher risk for PTSD than are men, following exposure to traumatic events. Most community residents have experienced 1 or more PTSD-level traumas in their lifetime, but only a few succumb to PTSD. Trauma victims who do not succumb to PTSD are not at an elevated risk for the subsequent onset of major depression or substance use disorders, compared with unexposed persons.
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Affiliation(s)
- Naomi Breslau
- Department of Psychiatry, Department of Biostatistics and Epidemiology, Henry Ford Health System, One Ford Place, 3A, Detroit, MI 48202-3450, USA.
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Yehuda R, Halligan SL, Bierer LM. Relationship of parental trauma exposure and PTSD to PTSD, depressive and anxiety disorders in offspring. J Psychiatr Res 2001; 35:261-70. [PMID: 11591428 DOI: 10.1016/s0022-3956(01)00032-2] [Citation(s) in RCA: 146] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study examined the relationship of parental trauma exposure and PTSD to the development of posttraumatic stress disorder (PTSD), depressive and anxiety disorders in the adult offspring of Holocaust survivors. One hundred and thirty-five subjects (55 men and 80 women) were divided into three groups according to parental trauma exposure and PTSD: 60 subjects were offspring of Holocaust survivors who endorsed having at least one parent with PTSD, 33 were offspring of Holocaust survivors who reported having no parent with PTSD, and 42 were demographically similar subjects with no parental Holocaust exposure. All subjects underwent a comprehensive psychiatric interview in which information about lifetime psychiatric diagnoses and exposure to traumatic events was obtained. Subjects also completed a checklist based on the 17 DSM-IV symptoms of PTSD, to estimate the symptom severity of PTSD in their parents. A presumptive diagnosis of parental PTSD was assigned according to DSM-IV criteria. Forward and forced entry stepwise logistic regression analyses were used to determine the effects of parental exposure, parental PTSD, and the subject's own history of trauma in the development of PTSD, depressive, and anxiety disorders in the offspring. The findings demonstrate a specific association between parental PTSD and the occurrence of PTSD in offspring. Additionally, parental trauma exposure, more than parental PTSD, was found to be significantly associated with lifetime depressive disorder. The identification of parental PTSD as a risk factor for PTSD in offspring of Holocaust survivors defines a sample in which the biological and psychological correlates of risk for PTSD can be further examined.
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Affiliation(s)
- R Yehuda
- The Traumatic Stress Studies Program of the Mount Sinai School of Medicine and Bronx Veterans Affairs, New York, NY 10468, USA.
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Radant A, Tsuang D, Peskind ER, McFall M, Raskind W. Biological markers and diagnostic accuracy in the genetics of posttraumatic stress disorder. Psychiatry Res 2001; 102:203-15. [PMID: 11440771 DOI: 10.1016/s0165-1781(01)00252-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Family and twin studies suggest a substantial genetic contribution to the etiology of posttraumatic stress disorder (PTSD). Identification of the nature of this genetic contribution should enhance understanding of the pathophysiology of PTSD and suggest improved therapeutic strategies for its treatment. However, a broadly defined phenotype, specific requirement for an environmental exposure and high frequency of comorbid psychiatric illness all complicate genetic studies of PTSD. It is likely that genetic heterogeneity, incomplete penetrance, pleiotropy and the involvement of more than one gene all constitute formidable obstacles to the genetic analysis of PTSD. One way to circumvent these problems is to perform genetic analysis of traits associated with PTSD, rather than PTSD itself, an approach that has been fruitful for other diseases with complex modes of inheritance. Hypothalamic-pituitary-adrenal axis hypofunction, physiologic markers of increased arousal, and increased acoustic startle response are all potential PTSD-associated traits that might be susceptible to genetic analysis. However, the capacity of these traits to distinguish PTSD from non-PTSD patients and their familial pattern must be better defined before they can be employed in genetic studies.
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Affiliation(s)
- A Radant
- Veterans Affairs Northwest Network Mental Illness Research, Education and Clinical Center (MIRECC), VA Puget Sound (116), 1660 S. Columbian Way, Seattle, WA 98108, USA.
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Breslau N, Davis GC, Peterson EL, Schultz LR. A second look at comorbidity in victims of trauma: the posttraumatic stress disorder-major depression connection. Biol Psychiatry 2000; 48:902-9. [PMID: 11074228 DOI: 10.1016/s0006-3223(00)00933-1] [Citation(s) in RCA: 349] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND We examine whether traumatic events increase the risk for major depression independent of their effects on posttraumatic stress disorder (PTSD). METHODS Data come from the Epidemiologic Study of Young Adults in southeast Michigan (N = 1007). Retrospective and prospective data were used to estimate the risk of major depression in persons with PTSD and persons exposed to trauma with no PTSD, compared with persons who did not experience a trauma. National Comorbidity Survey data were used to evaluate the influence of trauma type. RESULTS In the retrospective lifetime data, hazard ratios were, for first-onset major depression in exposed persons with PTSD, 2.8 and, in exposed persons with no PTSD, 1.3 (not significant), as compared with persons who were not exposed. Corresponding estimates from the prospective data were 11.7 and 1.4 (not significant). The difference in the risk for depression associated with PTSD versus exposure without PTSD is unlikely to be due to differences in trauma type. CONCLUSIONS The findings of a markedly increased risk for major depression in persons with PTSD, but not in exposed persons without PTSD, do not support the hypothesis that PTSD and major depression in trauma victims are influenced by separate vulnerabilities.
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Affiliation(s)
- N Breslau
- Department of Psychiatry, Henry Ford Health System, (NB, GCD), Detroit, Michigan 48202-3450, USA
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