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Lorkiewicz SA, Modiano YA, Miller BI, Van Cott AC, Haneef Z, Sullivan-Baca E. The neuropsychological presentation of women with epilepsy: Clinical considerations and future directions. Clin Neuropsychol 2024; 38:1382-1408. [PMID: 37993977 DOI: 10.1080/13854046.2023.2283937] [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: 07/07/2023] [Accepted: 11/09/2023] [Indexed: 11/24/2023]
Abstract
Objective: Cognitive, mood, and behavioral changes are common among persons with epilepsy (PWE), resulting in a complex neuropsychological presentation. Women with epilepsy (WWE) represent a distinct cohort within the broader epilepsy population due to sex and gender-specific factors impacting epilepsy semiology and treatment. However, unique neuropsychological profiles among WWE have not been established. This narrative review aims to further define neuropsychological correlates in WWE and promote meaningful discussion related to enhancing the provision of neuropsychological care within this clinical population. Method: Current literature in PWE examining differences in cognitive function, mental health, and quality of life (QoL) between women and men was critically reviewed, emphasizing considerations for neuropsychological practice. Results: WWE demonstrate a preservation of verbal learning and memory compared to men both pre- and post-surgically, with sex-based, neurobiological mechanisms likely contributing to this association. WWE also have elevated risk for affective disorder psychopathology, suicidality, and traumatic experiences. Epidemiology related to psychotic and bipolar spectrum disorders is less clear, and findings are mixed regarding sex-specific behavioral side effects of antiseizure and psychotropic medication. Finally, hormonal and obstetric factors are highlighted as important contributors to neuropsychological symptoms in WWE, with elevated risk for low QoL and increased stigma associated with greater medical and psychiatric comorbidities compared to men. Conclusions: While emerging literature has begun to characterize the neuropsychological presentation of WWE, future research is needed to define sex and gender differences in neuropsychological sequalae among PWE to ensure consistency and quality of care for WWE.
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Affiliation(s)
| | - Yosefa A Modiano
- Neurosciences, McGovern Medical School at UT Health Houston, Houston, TX, USA
| | - Brian I Miller
- Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Anne C Van Cott
- Neurology Division, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Zulfi Haneef
- Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
- Epilepsy Centers of Excellence, Veteran's Health Administration, USA
| | - Erin Sullivan-Baca
- Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
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Scherrer JF, Salas J, Wang W, Freedland KE, Lustman PJ, Schnurr PP, Cohen BE, Jaffe AS, Friedman MJ. Posttraumatic Stress Disorder and Type 2 Diabetes Outcomes in Veterans. JAMA Netw Open 2024; 7:e2427569. [PMID: 39136942 PMCID: PMC11322846 DOI: 10.1001/jamanetworkopen.2024.27569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 06/17/2024] [Indexed: 08/15/2024] Open
Abstract
Importance Posttraumatic stress disorder (PTSD) symptom reduction is linked with lower risk of incident type 2 diabetes (T2D), but little is known about the association between PTSD and comorbid T2D outcomes. Whether PTSD is a modifiable risk factor for adverse T2D outcomes is unknown. Objective To determine whether patients with PTSD who improved and no longer met diagnostic criteria for PTSD had a lower risk of adverse T2D outcomes compared with patients with persistent PTSD. Design, Setting, and Participants This retrospective cohort study used deidentified data from US Veterans Health Administration (VHA) historical medical records (from October 1, 2011, to September 30, 2022) to create a cohort of patients aged 18 to 80 years with comorbid PTSD and T2D. Data analysis was performed from March 1 to June 1, 2024. Exposures Diagnoses of PTSD and T2D. Main Outcomes and Measures The main outcomes were insulin initiation, poor glycemic control, any microvascular complication, and all-cause mortality. Improvement of PTSD was defined as no longer meeting PTSD diagnostic criteria, per a PTSD Checklist score of less than 33. Entropy balancing controlled for confounding. Survival and competing risk models estimated the association between meeting PTSD criteria and T2D outcomes. Subgroup analyses examined variation by age, sex, race, PTSD severity, and comorbid depression status. Results The study cohort included 10 002 veterans. More than half of patients (65.3%) were aged older than 50 years and most (87.2%) were men. Patients identified as Black (31.6%), White (62.7%), or other race (5.7%). Before controlling for confounding with entropy balancing, patients who no longer met PTSD diagnostic criteria had similar incidence rates for starting insulin (22.4 vs 24.4 per 1000 person-years), poor glycemic control (137.1 vs 133.7 per 1000 person-years), any microvascular complication (108.4 vs 104.8 per 1000 person-years), and all-cause mortality (11.2 vs 11.0 per 1000 person-years) compared with patients with persistent PTSD. After controlling for confounding, no longer meeting PTSD criteria was associated with a lower risk of microvascular complications (hazard ratio [HR], 0.92 [95% CI, 0.85-0.99]). Among veterans aged 18 to 49 years, no longer meeting PTSD criteria was associated with a lower risk of insulin initiation (HR, 0.69 [95% CI, 0.53-0.88]) and all-cause mortality (HR, 0.39 [95% CI, 0.19-0.83]). Among patients without depression, no longer meeting PTSD criteria was associated with a lower risk of insulin initiation (HR, 0.73 [95% CI, 0.55-0.97]). Conclusions and Relevance The findings of this cohort study of patients with comorbid PTSD and T2D suggest that PTSD is a modifiable risk factor associated with a modest reduction in microvascular complications. Further research is needed to determine whether findings are similar in non-VHA health care settings.
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Affiliation(s)
- Jeffrey F. Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St Louis, Missouri
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, St Louis, Missouri
- Advanced Health Data Research Institute, Saint Louis University School of Medicine, St Louis, Missouri
- Harry S. Truman Memorial Veterans’ Hospital, Columbia, Missouri
| | - Joanne Salas
- Advanced Health Data Research Institute, Saint Louis University School of Medicine, St Louis, Missouri
- Harry S. Truman Memorial Veterans’ Hospital, Columbia, Missouri
| | - Wenjin Wang
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St Louis, Missouri
| | - Kenneth E. Freedland
- Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri
| | - Patrick J. Lustman
- Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri
| | - Paula P. Schnurr
- National Center for PTSD, White River Junction, Vermont
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Beth E. Cohen
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco
- San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Allan S. Jaffe
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Matthew J. Friedman
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
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3
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Arnold R, Brown DJ, McLoughlin E. An examination of the relationship between sport performers' organizational stressor dimensions, physical health, and well-being. J Sports Sci 2024:1-11. [PMID: 39087581 DOI: 10.1080/02640414.2024.2382561] [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: 11/03/2023] [Accepted: 07/13/2024] [Indexed: 08/02/2024]
Abstract
Whilst research has assessed the multidimensionality of organizational stressors, severity has been overlooked. This study aimed to develop and validate a severity response scale, before examining the relationship between organizational stressor severity, physical health, and well-being, and if severity mediated the relationship between stressor occurrence and outcomes. 403 sport performers (186 male; Mage = 21.43) completed a questionnaire assessing study variables and data were analysed using structural equation modelling. Organizational stressor severity had a significant, negative relationship with physical health (r = -.374, p < .001), but notwith hedonic or eudaimonic well-being (p = .624 and .203). Direct effects were found for neuroticism (β = -0.632, p < .001) and stressor frequency (β = -0.226, p = .016) on physical health; however, when adding severity as a mediator, stressor frequency positively predicted stressor severity (β = 1.025, p < .001); however, the indirect effect of stressor frequency on physical health via stressor severity (β = -0.018, p = .885) and the direct effect between stressor frequency and physical health (β = -0.191, p = .204) were non-significant. These novel findings highlight that higher stressor severity is associated with higher physical health complaints, and that repeated exposure to stressors may heighten an vulnerability to future stressors.
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Affiliation(s)
- Rachel Arnold
- Department for Health, University of Bath, Bath, England
| | - Daniel J Brown
- School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, England
| | - Ella McLoughlin
- School of Science and Technology, Nottingham Trent University, Nottingham, England
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4
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Rhein C, Apelt I, Werner F, Schäflein E, Adler W, Reichel M, Schug C, Morawa E, Erim Y. Paradoxical effect of anti-inflammatory drugs on IL-6 mRNA expression in patients with PTSD during treatment. J Neural Transm (Vienna) 2024; 131:813-821. [PMID: 38613673 PMCID: PMC11199235 DOI: 10.1007/s00702-024-02770-6] [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: 08/07/2023] [Accepted: 03/23/2024] [Indexed: 04/15/2024]
Abstract
The pathophysiology of posttraumatic stress disorder (PTSD) is associated with the activation of the innate immune system, including cytokines like interleukin 6 (IL-6). However, the role of IL-6 in the etiology and treatment of PTSD still remains elusive. We conducted a prospective controlled trial to investigate the development of IL-6 during psychosomatic treatment in individuals with PTSD in comparison with individuals without PTSD. We assessed IL-6 mRNA expression before and after 2 months of psychosomatic treatment in individuals with and without PTSD. Severities of PTSD and depressive symptoms were assessed in parallel. Linear mixed regression was applied for statistical analysis, including the factors diagnosis PTSD and pre-post treatment after subgrouping for intake of anti-inflammatory drugs. The development of IL-6 mRNA expression during treatment was affected by the use of anti-inflammatory drugs. In the subgroup without intake of anti-inflammatory drugs, no significant statistical treatment effect in individuals with and without PTSD emerged. In the subgroup of individuals taking anti-inflammatory drugs, a significant interaction effect of the factors pre-post treatment and diagnosis PTSD was observed. Whereas IL-6 mRNA expression in individuals without PTSD decreased according to amelioration of symptoms, IL-6 mRNA expression in individuals with PTSD increased significantly during treatment, in opposite direction to symptom severity. Anti-inflammatory drugs might affect IL-6 mRNA expression in individuals with PTSD in a paradoxical way. This study offers a further piece of evidence that IL-6 could be involved in the pathophysiology of PTSD and PTSD-specific immunologic molecular mechanisms.
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Affiliation(s)
- Cosima Rhein
- Department of Psychosomatic Medicine and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Hartmannstr. 14, 91054, Erlangen, Germany.
| | - Isabella Apelt
- Department of Psychosomatic Medicine and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Hartmannstr. 14, 91054, Erlangen, Germany
| | - Franziska Werner
- Department of Psychosomatic Medicine and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Hartmannstr. 14, 91054, Erlangen, Germany
| | - Eva Schäflein
- Department of Psychosomatic Medicine and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Hartmannstr. 14, 91054, Erlangen, Germany
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden (TUD), Dresden, Germany
| | - Werner Adler
- Department of Psychosomatic Medicine and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Hartmannstr. 14, 91054, Erlangen, Germany
- Institute of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Martin Reichel
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Caterina Schug
- Department of Psychosomatic Medicine and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Hartmannstr. 14, 91054, Erlangen, Germany
| | - Eva Morawa
- Department of Psychosomatic Medicine and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Hartmannstr. 14, 91054, Erlangen, Germany
| | - Yesim Erim
- Department of Psychosomatic Medicine and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Hartmannstr. 14, 91054, Erlangen, Germany
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Navarra-Ventura G, Riera-Serra P, Roca M, Gili M, García-Toro M, Vilagut G, Alayo I, Ballester L, Blasco MJ, Castellví P, Colom J, Casajuana C, Gabilondo A, Lagares C, Almenara J, Miranda-Mendizabal A, Mortier P, Piqueras JA, Soto-Sanz V, Alonso J. Factors associated with high and low mental well-being in Spanish university students. J Affect Disord 2024; 356:424-435. [PMID: 38631424 DOI: 10.1016/j.jad.2024.04.056] [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: 11/02/2023] [Revised: 03/27/2024] [Accepted: 04/14/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Previous studies conducted in various nationally representative samples of the general population show that positive mental health is related to social prosperity. However, specific studies in university populations are scarce. In this study, we set out to explore factors associated with mental well-being (MWB) in a representative sample of first-year university students in Spain. METHODS MWB was assessed with the short version of the Warwick-Edinburgh Mental Well-Being Scale. Multinomial logistic regressions were performed to explore the association between different blocks of factors, including relational, adversity, stress, lifestyle, spiritual, health, and self-perceived health variables with high and low MWB, controlling for sociodemographic and university-related variables. RESULTS Data from 2082 students (18.6 ± 1.2 years; 56.6 % females) were analysed. Being male, being born in a foreign country, "high" self-perceived support, and "high" self-perceived mental health increased the odds of high MWB. Growing up in the suburbs, stressful experiences, and anxiety disorders reduced the odds of high MWB. Mood and anxiety disorders increased the odds of low MWB. "Middle" self-perceived support, sleeping ≥8 h per day, and "high" self-perceived mental health reduced the odds of low MWB. LIMITATIONS The cross-sectional design precludes establishing causal relationships. Data were collected in the 2014-15 academic year using self-reported online surveys. CONCLUSION The factors associated with high and low MWB do not always mirror each other, so specific plans are needed to successfully address each of the two poles. Interventions and policies targeting these factors for health promotion and disease prevention would improve the MWB of university students.
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Affiliation(s)
- Guillem Navarra-Ventura
- Department of Medicine, University of the Balearic Islands (UIB), Palma (Mallorca), Spain; Research Institute of Health Sciences (IUNICS), University of the Balearic Islands (UIB), Palma (Mallorca), Spain; Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitario Son Espases, Palma (Mallorca), Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Pau Riera-Serra
- Research Institute of Health Sciences (IUNICS), University of the Balearic Islands (UIB), Palma (Mallorca), Spain; Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitario Son Espases, Palma (Mallorca), Spain
| | - Miquel Roca
- Department of Medicine, University of the Balearic Islands (UIB), Palma (Mallorca), Spain; Research Institute of Health Sciences (IUNICS), University of the Balearic Islands (UIB), Palma (Mallorca), Spain; Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitario Son Espases, Palma (Mallorca), Spain
| | - Margalida Gili
- Research Institute of Health Sciences (IUNICS), University of the Balearic Islands (UIB), Palma (Mallorca), Spain; Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitario Son Espases, Palma (Mallorca), Spain; Department of Psychology, University of the Balearic Islands (UIB), Palma (Mallorca), Spain.
| | - Mauro García-Toro
- Department of Medicine, University of the Balearic Islands (UIB), Palma (Mallorca), Spain; Research Institute of Health Sciences (IUNICS), University of the Balearic Islands (UIB), Palma (Mallorca), Spain; Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitario Son Espases, Palma (Mallorca), Spain
| | - Gemma Vilagut
- Health Services Research Group, Hospital del Mar Research Institute, Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Itxaso Alayo
- Health Services Research Group, Hospital del Mar Research Institute, Barcelona, Spain; Biosistemak Institute for Health Systems Research, Basque Country, Spain
| | - Laura Ballester
- Health Services Research Group, Hospital del Mar Research Institute, Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Pere Castellví
- Department of Medicine, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Joan Colom
- Agència de Salut Pública de Catalunya (ASPCat), Barcelona, Spain
| | | | - Andrea Gabilondo
- Outpatient Mental Health Care Network, Osakidetza-Basque Health Service, Biodonosti Health Research Institute, San Sebastian, Spain
| | - Carolina Lagares
- Departamento de Estadística e Investigación Operativa, Universidad de Cádiz, Cádiz, Spain
| | - José Almenara
- Departamento de Biomedicina, Biotecnología y Salud Pública, Universidad de Cádiz, Cádiz, Spain
| | - Andrea Miranda-Mendizabal
- Teaching, Research & Innovation Unit, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Philippe Mortier
- Health Services Research Group, Hospital del Mar Research Institute, Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - José Antonio Piqueras
- Department of Health Psychology, Miguel Hernández University of Elche (UMH), Alicante, Spain
| | - Victoria Soto-Sanz
- Department of Health Psychology, Miguel Hernández University of Elche (UMH), Alicante, Spain
| | - Jordi Alonso
- Health Services Research Group, Hospital del Mar Research Institute, Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain; Department of Medicine and Life Science, Universitat Pompeu Fabra (UPF), Barcelona, Spain
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Lauten TH, Elkhatib SK, Natour T, Reed EC, Jojo CN, Case AJ. Beta-adrenergic signaling and T-lymphocyte-produced catecholamines are necessary for interleukin 17A synthesis. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.06.05.597633. [PMID: 38895227 PMCID: PMC11185643 DOI: 10.1101/2024.06.05.597633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
Background Post-traumatic stress disorder (PTSD) is a debilitating psychological disorder that also presents with neuroimmune irregularities. Patients display elevated sympathetic tone and are at an increased risk of developing secondary autoimmune diseases. Previously, using a preclinical model of PTSD, we demonstrated that elimination of sympathetic signaling to T-lymphocytes specifically limited their ability to produce pro-inflammatory interleukin 17A (IL-17A); a cytokine implicated in the development of many autoimmune disorders. However, the mechanism linking sympathetic signaling to T-lymphocyte IL-17A production remained unclear. Methods Using a modified version of repeated social defeat stress (RSDS) that allows for both males and females, we assessed the impact of adrenergic receptor blockade (genetically and pharmacologically) and catecholamine depletion on T-lymphocyte IL-17A generation. Additionally, we explored the impact of adrenergic signaling and T-lymphocyte-produced catecholamines on both CD4+ and CD8+ T-lymphocytes polarized to IL-17A-producing phenotypes ex vivo. Results Only pharmacological inhibition of the beta 1 and 2 adrenergic receptors (β1/2) significantly decreased circulating IL-17A levels after RSDS, but did not impact other pro-inflammatory cytokines (e.g., IL-6, TNF-α, and IL-10). This finding was confirmed using RSDS with both global β1/2 receptor knock-out mice, as well as by adoptively transferring β1/2 knock-out T-lymphocytes into immunodeficient hosts. Furthermore, ex vivo polarized T-lymphocytes produced significantly less IL-17A with the blockade of β1/2 signaling, even in the absence of exogenous sympathetic neurotransmitter supplementation, which suggested T-lymphocyte-produced catecholamines may be involved in IL-17A production. Indeed, pharmacological depletion of catecholamines both in vivo and ex vivo abrogated T-lymphocyte IL-17A production demonstrating the importance of immune-generated neurotransmission in pro-inflammatory cytokine generation. Conclusions Our data depict a novel role for β1/2 adrenergic receptors and autologous catecholamine signaling during T-lymphocyte IL-17A production. These findings provide a new target for pharmacological therapy in both psychiatric and autoimmune diseases associated with IL-17A-related pathology.
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Affiliation(s)
- Tatlock H. Lauten
- Department of Psychiatry and Behavioral Sciences, Texas A&M University, Bryan, TX, United States
- Department of Medical Physiology, Texas A&M University, Bryan, TX, United States
| | - Safwan K. Elkhatib
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Tamara Natour
- Department of Psychiatry and Behavioral Sciences, Texas A&M University, Bryan, TX, United States
- Department of Medical Physiology, Texas A&M University, Bryan, TX, United States
| | - Emily C. Reed
- Department of Psychiatry and Behavioral Sciences, Texas A&M University, Bryan, TX, United States
- Department of Medical Physiology, Texas A&M University, Bryan, TX, United States
| | - Caroline N. Jojo
- Department of Psychiatry and Behavioral Sciences, Texas A&M University, Bryan, TX, United States
- Department of Medical Physiology, Texas A&M University, Bryan, TX, United States
| | - Adam J. Case
- Department of Psychiatry and Behavioral Sciences, Texas A&M University, Bryan, TX, United States
- Department of Medical Physiology, Texas A&M University, Bryan, TX, United States
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7
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Karsberg S, Elklit A, Pedersen MM, Pedersen MU, Vang ML. A nationally representative survey of ICD-11 PTSD among Danish adolescents and young adults aged 15-29. Scand J Psychol 2024. [PMID: 38812284 DOI: 10.1111/sjop.13032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 04/03/2024] [Accepted: 05/14/2024] [Indexed: 05/31/2024]
Abstract
Posttraumatic stress disorder (PTSD) is recognized as a debilitating psychiatric disorder affecting populations worldwide. This has inspired many countries to estimate the national prevalence rates of PTSD in Europe and beyond. At present, there are no published representative studies that have assessed the occurrence of trauma exposure and PTSD in Denmark using a valid measurement based on ICD-11 criteria. A national sample of the general population of young Danish residents, ranging in age between 15 to 29 years (n = 2,434), was surveyed cross-sectionally from April to October 2022. Data weights were applied to ensure representativity of the sample. Multiple regression was used to study the relationship between trauma exposure, sex, age, and PTSD. Accidents and violence were the most common types of trauma exposure with females being more likely to experience sexual violence. A total of 7.7% endorsed probable PTSD with women reporting higher rates of clinical and subclinical PTSD (12.3% and 12.7%, respectively) than men (3.5% and 7.3%, respectively). Findings from the multiple regression showed that female gender was associated with higher PTSD-severity, although the strongest predictor was trauma-type with other types of traumas, and sexual violence displaying the strongest relationship to PTSD-severity overall. A dose-response relationship between the number of trauma types and PTSD symptomatology was found. This is the first study of PTSD in a nationally representative Danish sample using a valid measure of ICD-11 PTSD. The identified PTSD rates were higher than Danish official estimates in a representative sample of the Danish adolescent and young adult population (7.7% weighted compared to 1%). The study replicated international findings of sex differences in probable PTSD endorsement.
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Affiliation(s)
- Sidsel Karsberg
- Centre for Alcohol and Drug Research, Department of Psychology, Aarhus University, Aarhus, Denmark
| | - Ask Elklit
- National Centre for Psychotraumatology, Department of Psychology, University of Southern Denmark, Odense, Denmark
| | | | - Mads U Pedersen
- Centre for Alcohol and Drug Research, Department of Psychology, Aarhus University, Aarhus, Denmark
| | - Maria L Vang
- National Centre for Psychotraumatology, Department of Psychology, University of Southern Denmark, Odense, Denmark
- Department for Occupational and Environmental Health, Odense University Hospital, Odense, Denmark
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8
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Laskowski M, Schiöler L, Åberg M, Abuabara K, Wennberg AM, Gustafsson H, Torén K. Influence of stress resilience in adolescence on long-term risk of psoriasis and psoriatic arthritis among men: A prospective register-based cohort study in Sweden. J Eur Acad Dermatol Venereol 2024. [PMID: 38767960 DOI: 10.1111/jdv.20069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 04/06/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Although stress is considered to be a negative factor for psoriasis, no convincing scientific evidence of this association exists, largely because of difficulties in measuring stress. Stress resilience is the ability to cope with and adapt to stressful events. Stress resilience can be measured in a standardized way and used as a marker for chronic stress. OBJECTIVES The objective of this study is to investigate whether low stress resilience in adolescence increases the risk for onset of psoriasis and psoriatic arthritis later in life. METHODS A cohort of Swedish men (mean age 18.3 years), enrolled in compulsory military service between 1968 and 2005, was created using data from the Swedish Military Service Conscription Register (n = 1,669,422). Stress resilience at conscription was estimated using standardized semi-structured interviews, and was divided into three categories: low, medium and high. The men were followed from conscription until new-onset psoriasis or psoriatic arthritis, death or emigration or at the latest until 31 December 2019. Cox regression models adjusted for confounders at conscription were used to obtain hazard ratios (HRs) with 95% confidence intervals (CIs) for incident psoriasis and psoriatic arthritis. RESULTS Men in the lowest stress resilience category had an increased risk of psoriasis and psoriatic arthritis (HR 1.31 (95% CI 1.26-1.36) and 1.23 (95% CI 1.15-1.32), respectively), compared with those in the highest stress resilience category. When including only hospitalized patients the HRs for psoriasis and psoriatic arthritis in the lowest stress resilience group were 1.79 (1.63-1.98) and 1.53 (1.32-1.77), respectively. CONCLUSIONS This large, prospective register study suggests that low stress resilience in adolescence is associated with an increased risk of incident psoriasis among men. The results indicate that patients with psoriasis have an inherent psychological vulnerability, and highlight the importance of addressing psychological well-being in the management of psoriasis.
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Affiliation(s)
- M Laskowski
- Department of Dermatology and Venereology, Institute of Clinical Sciences, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Dermatology and Venereology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - L Schiöler
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - M Åberg
- School of Public Health and Community Medicine/Primary Health Care, Institute of Medicine, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Regionhälsan, Gothenburg, Sweden
| | - K Abuabara
- Department of Dermatology, University of California, San Francisco, California, USA
| | - A-M Wennberg
- Department of Dermatology and Venereology, Institute of Clinical Sciences, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Dermatology and Venereology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - H Gustafsson
- Department of Physiology, Institute of Neuroscience and Physiology, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - K Torén
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Hsu TW, Bai YM, Tsai SJ, Chen TJ, Chen MH, Liang CS. Risk of autoimmune diseases after post-traumatic stress disorder: a nationwide cohort study. Eur Arch Psychiatry Clin Neurosci 2024; 274:487-495. [PMID: 37322294 DOI: 10.1007/s00406-023-01639-1] [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: 11/03/2022] [Accepted: 06/03/2023] [Indexed: 06/17/2023]
Abstract
This longitudinal study aimed to investigate the risk of subsequent autoimmune disease in patients with post-traumatic stress disorder (PTSD) in Asian population. Between 2002 and 2009, we enrolled 5273 patients with PTSD and 1:4 matched controls from the National Health Insurance Database of Taiwan, and followed up the patients until December 31, 2011, or death. The investigated autoimmune diseases included thyroiditis, lupus, rheumatic arthritis, inflammatory bowel disease, Sjogren's syndrome, dermatomyositis, and polymyositis. The Cox regression model was used to estimate the risk of developing autoimmune diseases, with adjustment for demographics and psychiatric and medical comorbidities. Furthermore, we examined the psychiatric clinics utility of patients with PTSD indicating the severity of PTSD in association with autoimmune diseases. After adjusting for confounders, patients with PTSD had a 2.26-fold higher risk of developing any autoimmune diseases (reported as hazard ratios with 95% confidence intervals: 1.82-2.80) than the controls. For specific autoimmune diseases, patients with PTSD had a 2.70-fold higher risk (1.98-3.68) of thyroiditis, a 2.95-fold higher risk (1.20-7.30) of lupus, and a 6.32-fold higher risk (3.44-11.60) of Sjogren's syndrome. Moreover, the PTSD severity was associated with the risk of autoimmune diseases in a dose-dependent manner. The patient with the highest psychiatric clinics utility was associated with an 8.23-fold higher risk (6.21-10.90) of any autoimmune diseases than the controls. Patients with PTSD had an increased risk of autoimmune diseases, and such risk was associated with the severity of PTSD in a dose-dependent manner. However, the present study did not provide a direct effect between PTSD and autoimmune diseases, but rather an association. Further studies are warranted to examine the underlying pathophysiological mechanisms.
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Affiliation(s)
- Tien-Wei Hsu
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Ya-Mei Bai
- Department of Psychiatry, Taipei Veterans General Hospital, No. 201, Sec. 2, Shihpai Road, Beitou District, Taipei, 11217, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Jen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, No. 201, Sec. 2, Shihpai Road, Beitou District, Taipei, 11217, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan
| | - Mu-Hong Chen
- Department of Psychiatry, Taipei Veterans General Hospital, No. 201, Sec. 2, Shihpai Road, Beitou District, Taipei, 11217, Taiwan.
- Department of Psychiatry, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan.
| | - Chih-Sung Liang
- Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, National Defense Medical Center, No. 60, Xinmin Road, Beitou District, Taipei, 11243, Taiwan.
- Department of Psychiatry, National Defense Medical Center, Taipei, Taiwan.
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Hibbs CA. Predicting comorbid mental health difficulties in people with autoimmune arthritis. Rheumatol Int 2024; 44:459-468. [PMID: 38236426 PMCID: PMC10866777 DOI: 10.1007/s00296-023-05519-8] [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: 10/30/2023] [Accepted: 12/06/2023] [Indexed: 01/19/2024]
Abstract
Little is known about variables impacting the association between mental health difficulties and autoimmune conditions. This study investigates whether, age of onset, adverse childhood experiences (ACEs), and 'illness invisibility' predict comorbid mental health difficulties in people with autoimmune arthritis. Participants with autoimmune arthritis (N = 209) were recruited via social media platforms. Age of onset of arthritis and the temporal order of mental health difficulties (if applicable) were collected alongside a measure of personality and ACEs. A novel measure of illness invisibility was developed for this study. A cross-sectional mixed-subject design was utilised. 53.5% of the sample endorsed lifetime mental health difficulties. Logistic regression analyses revealed participants with a younger age of onset of arthritis had significantly higher odds of developing a mental health problem (OR 0.93, 95% CI 0.90-0.96). Independently, Illness Invisibility, endorsed by 89.9% of participants, significantly predicted postmorbid mental health difficulties (OR 1.08, 95% CI 1.01-1.19). Adverse Childhood Experiences were frequently endorsed within the sample with 37.8% reporting ≥ 3 cumulative ACEs. Every unit increase in ACEs increased the odds of having comorbid mental health difficulties (OR 1.27, 95% CI 1.09-1.47). Young people who are diagnosed with autoimmune arthritis maybe more likely to experience subsequent mental health difficulties. The 'invisibility' of their illness and exposure to ACEs also is associated with their risk for mental health complications. These findings highlight the importance of mental health screening for young people being investigated for arthritis and interdisciplinary care, especially for young people.
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11
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Shi H. The effect of social support on home isolation anxiety and depression among college students in the post-pandemic era: the mediating effect of perceived loss of control and the moderating role of family socioeconomic status. Front Public Health 2024; 12:1288848. [PMID: 38406501 PMCID: PMC10884108 DOI: 10.3389/fpubh.2024.1288848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 01/30/2024] [Indexed: 02/27/2024] Open
Abstract
Background There is an escalating concern about the rising levels of anxiety and depression among college students, especially during the post-pandemic era. A thorough examination of the various dimensions of social support and their impact on these negative emotions in college students is imperative. Aim This study aimed to determine if a perceived loss of control mediates the relationship between social support and levels of anxiety and depression among college students during the post-pandemic era. Additionally, it examined whether family socioeconomic status moderates this mediated relationship. Methods We administered an online cross-sectional survey in China, securing responses from 502 participants. The sample comprised home-isolated college students impacted by COVID-19. Established scales were employed to assess social support, anxiety, depression, perceived loss of control, and family socioeconomic status. Analytical techniques included descriptive statistics, correlation analysis, and a bootstrap method to investigate mediating and moderating effects. Results Social support was found to negatively affect anxiety and depression in college students, with perceived loss of control partially mediating this relationship. In addition, family socio-economic status was shown to moderate this moderating process. Furthermore, family socioeconomic status influenced this mediation, with higher socioeconomic families exhibiting a stronger moderating effect on perceived loss of control across different dimensions of social support. Conclusion This study may help to develop strategies to mitigate the impact of anxiety and depression in the lives and studies of university students during unexpected public health crises, and to promote better mental health among college students.
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Affiliation(s)
- Hui Shi
- School of Media and Communication, Shanghai Jiao Tong University, Shanghai, China
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12
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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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Vasileva AV. [Posttraumatic stress disorder clinical guidelines and treatment standards: focus on the symptoms of the psychophysiological arousal]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:58-68. [PMID: 38884431 DOI: 10.17116/jnevro202412405158] [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] [Indexed: 06/18/2024]
Abstract
The article describes the main diagnostic criteria and principles of posttraumatic stress disorder (PTSD) diagnostic with the consideration of risk factors and specific clinical features. The main biomarkers search trends and existing limitations are considered. The role of the psychophysiological arousal symptoms claster is highlighted in the clinical picture of PTSD as well as in connection with the main cluster of re-experiencing symptoms activation and slowing of sanogenesis process. The necessity of PTSD detection in somatic medicine is thoroughly described. The article presents therapeutic algorithms of the latest international and Russian PTSD treatment clinical guidelines based on the individual combination of psychotherapy and psychopharmacotherapy treatment choice. Additionally the accumulated during the last decades national clinical experience of the anxiety disorders treatment, including the symptoms of psychophysiological arousal is highlighted that determined the list of the recommended drugs indicating the evidence level, in the PTSD treatment standards and guidelines. The treatment choices possibilities with the consideration of different PTSD symptoms cluster expression and comorbid states and individual case distress level specific are presented. Main evidence based psychotherapeutic methods are described.
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Affiliation(s)
- A V Vasileva
- Bekhterev National Medical Research Center for Psychiatry and Neurology, St. Petersburg, Russia
- Mechnikov North-Western State Medical University, St. Petersburg, Russia
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Parks CG, Pettinger M, de Roos AJ, Tindle HA, Walitt BT, Howard BV. Life Events, Caregiving, and Risk of Autoimmune Rheumatic Diseases in the Women's Health Initiative Observational Study. Arthritis Care Res (Hoboken) 2023; 75:2519-2528. [PMID: 37230960 PMCID: PMC10798355 DOI: 10.1002/acr.25164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 05/15/2023] [Accepted: 05/23/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVE Growing evidence suggests psychosocial stressors may increase risk of developing autoimmune disease. We examined stressful life events and caregiving in relation to incident rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) in the Women's Health Initiative Observational Study cohort. METHODS The sample of postmenopausal women included 211 incident RA or SLE cases reported within 3 years after enrollment, confirmed by use of disease-modifying antirheumatic drugs (i.e., probable RA/SLE), and 76,648 noncases. Baseline questionnaires asked about life events in the past year, caregiving, and social support. We used Cox regression models to calculate hazard ratios (HR) and 95% confidence intervals (95% CIs), adjusting for age, race/ethnicity, occupational class, education, pack-years of smoking and BMI. RESULTS Incident RA/SLE was associated with reporting 3 or more life events (e.g., age-adjusted HR 1.70 [95% CI 1.14, 2.53]; P for trend = 0.0026). Elevated HRs were noted for physical (HR 2.48 [95% CI 1.02, 6.04]) and verbal (HR 1.34 [0.89, 2.02]) abuse (P for trend = 0.0614), 2 or more interpersonal events (HR 1.23 [95% CI 0.87, 1.73]; P for trend = 0.2403), financial stress (HR 1.22 [95% CI 0.90, 1.64]), and caregiving 3 or more days per week (HR 1.25 [95% CI 0.87, 1.81]; P for trend = 0.2571). Results were similar, excluding women with baseline symptoms of depression or moderate-to-severe joint pain in the absence of diagnosed arthritis. CONCLUSION Our findings support the idea that diverse stressors may increase risk of developing probable RA or SLE in postmenopausal women, supporting the need for further studies in autoimmune rheumatic diseases, including childhood adverse events, life event trajectories, and modifying psychosocial and socioeconomic factors.
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Affiliation(s)
- Christine G. Parks
- National Institute of Environmental Health Sciences, National Institute of Health, Research Triangle Park, NC
| | - Mary Pettinger
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA
| | - Anneclaire J. de Roos
- Department of Environmental & Occupational Health, Drexel University Dornsife School of Public Health, Philadelphia, PA
| | - Hilary A. Tindle
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN
- Geriatric Research Education and Clinical Centers, Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN
| | - Brian T. Walitt
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD
| | - Barbara V. Howard
- Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, DC, USA; MedStar Health Research Institute, Hyattsville, MD, USA
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Riggs BJ, Carpenter JL. Pediatric Neurocritical Care: Maximizing Neurodevelopmental Outcomes Through Specialty Care. Pediatr Neurol 2023; 149:187-198. [PMID: 37748977 DOI: 10.1016/j.pediatrneurol.2023.08.006] [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: 03/01/2023] [Revised: 07/27/2023] [Accepted: 08/04/2023] [Indexed: 09/27/2023]
Abstract
The field of pediatric neurocritical care (PNCC) has expanded and evolved over the last three decades. As mortality from pediatric critical care illness has declined, morbidity from neurodevelopmental disorders has expanded. PNCC clinicians have adopted a multidisciplinary approach to rapidly identify neurological injury, implement neuroprotective therapies, minimize secondary neurological insults, and establish transitions of care, all with the goal of improving neurocognitive outcomes for their patients. Although there are many aspects of PNCC and adult neurocritical care (NCC) medicine that are similar, elemental difference between adult and pediatric medicine has contributed to a divergent evolution of the respective fields. The low incidence of pediatric critical care illness, the heterogeneity of neurological insults, and the limited availability of resources all shape the need for a PNCC clinical care model that is distinct from the established paradigm adopted by the adult neurocritical care community at large. Considerations of neurodevelopment are fundamental in pediatrics. When neurological injury occurs in a child, the neurodevelopmental stage at the time of insult alters the impact of the neurological disease. Developmental variables contribute to a range of outcomes for seemingly similar injuries. Despite the relative infancy of the field of PNCC, early reports have shown that implementation of a specialized PNCC service elevates the quality and safety of care, promotes education and communication, and improves outcomes for children with acute neurological injuries. The multidisciplinary approach of PNCC clinicians and researchers also promotes a culture that emphasizes the importance of quality improvement and education initiatives, as well as development of and adherence to evidence-based guidelines and family-focused care models.
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Affiliation(s)
- Becky J Riggs
- Division of Pediatric Critical Care Medicine, Oregon Health & Science University, Portland, Oregon.
| | - Jessica L Carpenter
- Division of Pediatric Neurology, University of Maryland Medical Center, Baltimore, Maryland
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Ke S, Hartmann J, Ressler KJ, Liu YY, Koenen KC. The emerging role of the gut microbiome in posttraumatic stress disorder. Brain Behav Immun 2023; 114:360-370. [PMID: 37689277 PMCID: PMC10591863 DOI: 10.1016/j.bbi.2023.09.005] [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: 04/15/2023] [Revised: 08/28/2023] [Accepted: 09/06/2023] [Indexed: 09/11/2023] Open
Abstract
Posttraumatic stress disorder (PTSD) occurs in some people following exposure to a terrifying or catastrophic event involving actual/threatened death, serious injury, or sexual violence. PTSD is a common and debilitating mental disorder that imposes a significant burden on individuals, their families, health services, and society. Moreover, PTSD is a risk factor for chronic diseases such as coronary heart disease, stroke, diabetes, as well as premature mortality. Furthermore, PTSD is associated with dysregulated immune function. Despite the high prevalence of PTSD, the mechanisms underlying its etiology and manifestations remain poorly understood. Compelling evidence indicates that the human gut microbiome, a complex community of microorganisms living in the gastrointestinal tract, plays a crucial role in the development and function of the host nervous system, complex behaviors, and brain circuits. The gut microbiome may contribute to PTSD by influencing inflammation, stress responses, and neurotransmitter signaling, while bidirectional communication between the gut and brain involves mechanisms such as microbial metabolites, immune system activation, and the vagus nerve. In this literature review, we summarize recent findings on the role of the gut microbiome in PTSD in both human and animal studies. We discuss the methodological limitations of existing studies and suggest future research directions to further understand the role of the gut microbiome in PTSD.
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Affiliation(s)
- Shanlin Ke
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Jakob Hartmann
- Department of Psychiatry, Harvard Medical School, McLean Hospital, Belmont, MA 02478, USA
| | - Kerry J Ressler
- Department of Psychiatry, Harvard Medical School, McLean Hospital, Belmont, MA 02478, USA
| | - Yang-Yu Liu
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA; Center for Artificial Intelligence and Modeling, The Carl R. WoeseInstitute for Genomic Biology, University of Illinois at Urbana-Champaign, Champaign, IL, USA.
| | - Karestan C Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
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Moshfegh CM, Elkhatib SK, Watson GF, Drake J, Taylor ZN, Reed EC, Lauten TH, Clopp AJ, Vladimirov VI, Case AJ. S100a9 Protects Against the Effects of Repeated Social Defeat Stress. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2023; 3:919-929. [PMID: 37881565 PMCID: PMC10593888 DOI: 10.1016/j.bpsgos.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 11/07/2022] [Accepted: 12/01/2022] [Indexed: 12/15/2022] Open
Abstract
Background Posttraumatic stress disorder, a consequence of psychological trauma, is associated with increased inflammation and an elevated risk of developing comorbid inflammatory diseases. However, the mechanistic link between this mental health disorder and inflammation remains elusive. We previously found that S100a8 and S100a9 messenger RNA, genes that encode the protein calprotectin, were significantly upregulated in T lymphocytes and positively correlated with inflammatory gene expression and the mitochondrial redox environment in these cells. Therefore, we hypothesized that genetic deletion of calprotectin would attenuate the inflammatory and redox phenotype displayed after psychological trauma. Methods We used a preclinical mouse model of posttraumatic stress disorder known as repeated social defeat stress (RSDS) combined with pharmacological and genetic manipulation of S100a9 (which functionally eliminates calprotectin). A total of 186 animals (93 control, 93 RSDS) were used in these studies. Results Unexpectedly, we observed worsening of behavioral pathology, inflammation, and the mitochondrial redox environment in mice after RSDS compared with wild-type animals. Furthermore, loss of calprotectin significantly enhanced the metabolic demand on T lymphocytes, suggesting that this protein may play an undescribed role in mitochondrial regulation. This was further supported by single-cell RNA sequencing analysis demonstrating that RSDS and loss of S100a9 primarily altered genes associated with mitochondrial function and oxidative phosphorylation. Conclusions These data demonstrate that the loss of calprotectin potentiates the RSDS-induced phenotype, which suggests that its observed upregulation after psychological trauma may provide previously unexplored protective functions.
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Affiliation(s)
- Cassandra M. Moshfegh
- Department of Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Safwan K. Elkhatib
- Department of Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Gabrielle F. Watson
- Department of Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha, Nebraska
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - John Drake
- Department of Psychiatry and Behavioral Sciences, Texas A&M University, Bryan, Texas
| | - Zachary N. Taylor
- Department of Psychiatry and Behavioral Sciences, Texas A&M University, Bryan, Texas
| | - Emily C. Reed
- Department of Psychiatry and Behavioral Sciences, Texas A&M University, Bryan, Texas
- Department of Medical Physiology, Texas A&M University, Bryan, Texas
| | - Tatlock H. Lauten
- Department of Psychiatry and Behavioral Sciences, Texas A&M University, Bryan, Texas
- Department of Medical Physiology, Texas A&M University, Bryan, Texas
| | - Amelia J. Clopp
- Department of Psychiatry and Behavioral Sciences, Texas A&M University, Bryan, Texas
- Department of Medical Physiology, Texas A&M University, Bryan, Texas
| | - Vladimir I. Vladimirov
- Department of Psychiatry and Behavioral Sciences, Texas A&M University, Bryan, Texas
- Department of Psychiatry, University of Arizona, Phoenix, Arizona
- Lieber Institute for Brain Development, Johns Hopkins University, Baltimore, Maryland
| | - Adam J. Case
- Department of Psychiatry and Behavioral Sciences, Texas A&M University, Bryan, Texas
- Department of Medical Physiology, Texas A&M University, Bryan, Texas
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Raeder R, Clayton NS, Boeckle M. Narrative-based autobiographical memory interventions for PTSD: a meta-analysis of randomized controlled trials. Front Psychol 2023; 14:1215225. [PMID: 37829075 PMCID: PMC10565228 DOI: 10.3389/fpsyg.2023.1215225] [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: 05/01/2023] [Accepted: 08/25/2023] [Indexed: 10/14/2023] Open
Abstract
Introduction The aim of this systematic review and meta-analysis is to evaluate the efficacy of narrative-based interventions (NBIs) for individuals with post-traumatic stress disorder (PTSD). Investigating the efficacy of NBIs should yield insight on autobiographical memory (AM) phenomena implicated in PTSD onset and recovery, leading to improved intervention protocols. Furthermore, by analyzing how NBIs influence maladaptive AM distortions, we hope to shed light on the theorized narrative architecture of AM more generally. Methods A systematic literature search was conducted according to PRISMA and Cochrane guidelines in MEDLINE, EMBASE, PsychINFO, and PubMed. Additional studies were then also identified from the reference lists of other relevant literature and considered for inclusion. Studies were then evaluated for adherence to the inclusion/exclusion criteria and assessed for risk of bias. Various meta-analyses were performed on included studies to understand how NBIs may or may not influence the overall effect size of treatment. Results The results of the meta-analysis of 35 studies, involving 2,596 participants, suggest that NBIs are a viable and effective treatment option for PTSD, yielding a statistically significant within-group effect size and decrease in PTSD symptomatology at both post-treatment [g = 1.73, 95% CI (1.23-2.22)] and 3-9 month follow-up assessments [g = 2.33, 95% CI (1.41-3.26)]. Furthermore, the difference in effect sizes between NBIs compared to active and waitlist controls was statistically significant, suggesting that NBIs are superior. Sub-analyses showed that NET provided a stronger effect size than FORNET, which may be due to the nature of the traumatic event itself and not the treatment protocol. While evidence of small study and publication bias was present, a weight-function model and trim-and-fill method suggested it was not influencing the overall results. Discussion This meta-analysis presents strong evidence supporting the use of NBIs in the treatment of PTSD. Clear similarities can be identified between NBIs included in this analysis that make them distinct from non-NBI interventions, which are reviewed in the discussion. Controlled comparisons between NBIs and non-NBIs would help to further understand AM mechanisms of action implicated in recovery and how various interventions facilitate them. Future research should also aim to elucidate the full range of AM impairment in individuals with PTSD to gain insight on how other memory capabilities, such as the ability to mentally simulate the future, are implicated in the pathogenesis of PTSD.
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Affiliation(s)
- Robert Raeder
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom
| | - Nicola S. Clayton
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom
| | - Markus Boeckle
- Scientific Working Group, Karl Landsteiner University of Health Sciences, Krems, Austria
- Department of Transitory Psychiatry, University Hospital Tulln, Tulln, Austria
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19
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Nieto-Quero A, Infantes-López MI, Zambrana-Infantes E, Chaves-Peña P, Gavito AL, Munoz-Martin J, Tabbai S, Márquez J, Rodríguez de Fonseca F, García-Fernández MI, Santín LJ, Pedraza C, Pérez-Martín M. Unveiling the Secrets of the Stressed Hippocampus: Exploring Proteomic Changes and Neurobiology of Posttraumatic Stress Disorder. Cells 2023; 12:2290. [PMID: 37759512 PMCID: PMC10527244 DOI: 10.3390/cells12182290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/28/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
Intense stress, especially traumatic stress, can trigger disabling responses and in some cases even lead to the development of posttraumatic stress disorder (PTSD). PTSD is heterogeneous, accompanied by a range of distress symptoms and treatment-resistant disorders that may be associated with a number of other psychopathologies. PTSD is a very heterogeneous disorder with different subtypes that depend on, among other factors, the type of stressor that provokes it. However, the neurobiological mechanisms are poorly understood. The study of early stress responses may hint at the way PTSD develops and improve the understanding of the neurobiological mechanisms involved in its onset, opening the opportunity for possible preventive treatments. Proteomics is a promising strategy for characterizing these early mechanisms underlying the development of PTSD. The aim of the work was to understand how exposure to acute and intense stress using water immersion restraint stress (WIRS), which could be reminiscent of natural disaster, may induce several PTSD-associated symptoms and changes in the hippocampal proteomic profile. The results showed that exposure to WIRS induced behavioural symptoms and corticosterone levels reminiscent of PTSD. Moreover, the expression profiles of hippocampal proteins at 1 h and 24 h after stress were deregulated in favour of increased inflammation and reduced neuroplasticity, which was validated by histological studies and cytokine determination. Taken together, these results suggest that neuroplastic and inflammatory dysregulation may be a therapeutic target for the treatment of post-traumatic stress disorders.
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Affiliation(s)
- Andrea Nieto-Quero
- Departamento de Psicobiología y Metodología de las Ciencias del Comportamiento, Universidad de Málaga, 29010 Malaga, Spain; (A.N.-Q.); (E.Z.-I.); (S.T.); (L.J.S.)
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma Bionand, 29590 Malaga, Spain; (M.I.I.-L.); (A.L.G.); (J.M.); (F.R.d.F.); (M.I.G.-F.)
| | - María Inmaculada Infantes-López
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma Bionand, 29590 Malaga, Spain; (M.I.I.-L.); (A.L.G.); (J.M.); (F.R.d.F.); (M.I.G.-F.)
- Departamento de Biología Celular, Genética y Fisiología, Universidad de Málaga, 29010 Malaga, Spain; (P.C.-P.); (J.M.-M.)
| | - Emma Zambrana-Infantes
- Departamento de Psicobiología y Metodología de las Ciencias del Comportamiento, Universidad de Málaga, 29010 Malaga, Spain; (A.N.-Q.); (E.Z.-I.); (S.T.); (L.J.S.)
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma Bionand, 29590 Malaga, Spain; (M.I.I.-L.); (A.L.G.); (J.M.); (F.R.d.F.); (M.I.G.-F.)
| | - Patricia Chaves-Peña
- Departamento de Biología Celular, Genética y Fisiología, Universidad de Málaga, 29010 Malaga, Spain; (P.C.-P.); (J.M.-M.)
| | - Ana L. Gavito
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma Bionand, 29590 Malaga, Spain; (M.I.I.-L.); (A.L.G.); (J.M.); (F.R.d.F.); (M.I.G.-F.)
| | - Jose Munoz-Martin
- Departamento de Biología Celular, Genética y Fisiología, Universidad de Málaga, 29010 Malaga, Spain; (P.C.-P.); (J.M.-M.)
| | - Sara Tabbai
- Departamento de Psicobiología y Metodología de las Ciencias del Comportamiento, Universidad de Málaga, 29010 Malaga, Spain; (A.N.-Q.); (E.Z.-I.); (S.T.); (L.J.S.)
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma Bionand, 29590 Malaga, Spain; (M.I.I.-L.); (A.L.G.); (J.M.); (F.R.d.F.); (M.I.G.-F.)
| | - Javier Márquez
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma Bionand, 29590 Malaga, Spain; (M.I.I.-L.); (A.L.G.); (J.M.); (F.R.d.F.); (M.I.G.-F.)
- Departamento de Biología Molecular y Bioquímica, Canceromics Lab, Universidad de Málaga, 29010 Malaga, Spain
| | - Fernando Rodríguez de Fonseca
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma Bionand, 29590 Malaga, Spain; (M.I.I.-L.); (A.L.G.); (J.M.); (F.R.d.F.); (M.I.G.-F.)
| | - María Inmaculada García-Fernández
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma Bionand, 29590 Malaga, Spain; (M.I.I.-L.); (A.L.G.); (J.M.); (F.R.d.F.); (M.I.G.-F.)
- Departamento de Fisiología Humana, Histología Humana, Anatomía Patológica y Educación Física y Deportiva, Universidad de Málaga, 29010 Malaga, Spain
| | - Luis J. Santín
- Departamento de Psicobiología y Metodología de las Ciencias del Comportamiento, Universidad de Málaga, 29010 Malaga, Spain; (A.N.-Q.); (E.Z.-I.); (S.T.); (L.J.S.)
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma Bionand, 29590 Malaga, Spain; (M.I.I.-L.); (A.L.G.); (J.M.); (F.R.d.F.); (M.I.G.-F.)
| | - Carmen Pedraza
- Departamento de Psicobiología y Metodología de las Ciencias del Comportamiento, Universidad de Málaga, 29010 Malaga, Spain; (A.N.-Q.); (E.Z.-I.); (S.T.); (L.J.S.)
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma Bionand, 29590 Malaga, Spain; (M.I.I.-L.); (A.L.G.); (J.M.); (F.R.d.F.); (M.I.G.-F.)
| | - Margarita Pérez-Martín
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma Bionand, 29590 Malaga, Spain; (M.I.I.-L.); (A.L.G.); (J.M.); (F.R.d.F.); (M.I.G.-F.)
- Departamento de Biología Celular, Genética y Fisiología, Universidad de Málaga, 29010 Malaga, Spain; (P.C.-P.); (J.M.-M.)
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Crawford DHG, Mellor R, Teo A, Duenow P, Connelly LB. Post-traumatic stress disorder is associated with a higher rate of polypectomy independent of an increased frequency of colonoscopy in Australian veterans: a retrospective review. Intern Med J 2023; 53:1423-1428. [PMID: 35559586 DOI: 10.1111/imj.15818] [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: 03/10/2022] [Accepted: 05/05/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) is associated with extensive physical comorbidities, including lower gastrointestinal symptoms. Diagnostic uncertainty and poor therapeutic responses may result in more frequent colonoscopies than clinically necessary. Polypectomy is standard practice when polyps are identified, and if PTSD is a risk factor for polyp formation, one would expect a higher rate of polyp detection and removal in veterans with PTSD than those without PTSD. AIM To determine the association between PTSD and the rate of colonoscopy and polypectomy in Australian veterans. METHODS Diagnostic and therapeutic colonoscopy rates in Australian male Veterans aged ≥50 years were examined by reviewing case records of veterans who accessed Department of Veterans' Affairs funded health services between 1 January 2013 and 31 December 2018. RESULTS A total of 138 471 veterans was included, of whom 28 018 had a diagnosis of PTSD; 56.4% were aged ≥65 years. Twenty-one percent of the entire cohort underwent at least one colonoscopy during the study period. Increased rates of diagnostic colonoscopy and polypectomy were associated with the presence of PTSD across all age brackets. The effect was empirically large as veterans with PTSD experience colonoscopy rates 76-81% greater than those without PTSD. Similarly, veterans with PTSD experienced polypectomy rates 76-81% greater than veterans without PTSD, and this increase persisted when controlling for the increased number of diagnostic colonoscopies they undergo. CONCLUSION The presence of PTSD has a marked impact on colonoscopy rates in Australian veterans. The increased polypectomy rate independent of increased colonoscopy rate suggests that PTSD is a risk factor for colonic polyp formation.
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Affiliation(s)
- Darrell H G Crawford
- Gallipoli Medical Research Foundation, Greenslopes Private Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Rebecca Mellor
- Gallipoli Medical Research Foundation, Greenslopes Private Hospital, Brisbane, Queensland, Australia
| | - Andrew Teo
- Gallipoli Medical Research Foundation, Greenslopes Private Hospital, Brisbane, Queensland, Australia
| | - Patrick Duenow
- Centre for the Business and Economics of Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Luke B Connelly
- Centre for the Business and Economics of Health, The University of Queensland, Brisbane, Queensland, Australia
- Department of Sociology and Business Law, The University of Bologna, Bologna, Italy
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21
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O'Connor V, Rowland JA, Naylor JC, Magnante AT, Craig KM, Miskey HM, Martindale SL. Time doesn't heal all: PTSD symptoms exacerbate the relationship between age and pain intensity. Front Psychiatry 2023; 14:1221762. [PMID: 37575582 PMCID: PMC10415104 DOI: 10.3389/fpsyt.2023.1221762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 07/17/2023] [Indexed: 08/15/2023] Open
Abstract
Objective Posttraumatic stress disorder (PTSD) symptoms and pain interfere with daily functioning and quality of life for many combat Veterans. As individuals age, pain symptoms tend to increase whereas PTSD symptoms tend to decrease. PTSD symptoms exacerbate pain, but the nature of this relationship across the aging process is unclear. The purpose of this study was to determine how PTSD symptoms affect the association between age and pain intensity. Methods Participants in this cross-sectional study included 450 Veterans (80% male) who served after September 11, 2001. PTSD and pain intensity ratings were assessed by the PTSD Checklist for DSM-5 (PCL-5) and the Brief Pain Inventory (BPI), respectively. Hierarchical multiple linear regression evaluated main and interaction effects between age, PTSD symptoms, and pain intensity. Results Age (B = 0.04, p < 0.001) and PTSD symptoms (B = 0.05, p < 0.001) were positively associated with pain intensity. Age and PTSD symptoms were inversely correlated (r = -0.16, p < 0.001). PTSD symptoms exacerbated the relationship between age and pain intensity (ΔR2 = 0.01, p = 0.036). Specifically, when greater PTSD symptoms were reported at older ages, pain intensity was significantly higher. Conclusion Results of these analyses suggests that age is important when considering the effects of PTSD symptoms on pain intensity ratings. Specifically, pain intensity ratings are higher in older Veterans with PTSD symptoms. These findings underscore the importance for clinical providers to evaluate trauma history and PTSD symptoms in older Veterans reporting pain symptoms.
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Affiliation(s)
- Victoria O'Connor
- W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC, United States
- Veterans Integrated Service Networks (VISN)-6 Mid-Atlantic Mental Illness, Research Education and Clinical Center (MIRECC), Durham, NC, United States
- Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Jared A Rowland
- W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC, United States
- Veterans Integrated Service Networks (VISN)-6 Mid-Atlantic Mental Illness, Research Education and Clinical Center (MIRECC), Durham, NC, United States
- Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Jennifer C Naylor
- Veterans Integrated Service Networks (VISN)-6 Mid-Atlantic Mental Illness, Research Education and Clinical Center (MIRECC), Durham, NC, United States
- Durham Veterans Affairs Health Care System, Durham, NC, United States
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Anna T Magnante
- W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC, United States
- Veterans Integrated Service Networks (VISN)-6 Mid-Atlantic Mental Illness, Research Education and Clinical Center (MIRECC), Durham, NC, United States
- Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Katherine M Craig
- W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC, United States
- Veterans Integrated Service Networks (VISN)-6 Mid-Atlantic Mental Illness, Research Education and Clinical Center (MIRECC), Durham, NC, United States
| | - Holly M Miskey
- W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC, United States
- Veterans Integrated Service Networks (VISN)-6 Mid-Atlantic Mental Illness, Research Education and Clinical Center (MIRECC), Durham, NC, United States
- Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Sarah L Martindale
- W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC, United States
- Veterans Integrated Service Networks (VISN)-6 Mid-Atlantic Mental Illness, Research Education and Clinical Center (MIRECC), Durham, NC, United States
- Wake Forest School of Medicine, Winston-Salem, NC, United States
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22
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Lee DW, Lee HS, Kim SG, Kim KJ, Jung SJ. The rocky road to freedom: number of countries transited during defection and risk of metabolic syndrome among North Korean Refugees in South Korea. Public Health 2023; 221:208-215. [PMID: 37490839 DOI: 10.1016/j.puhe.2023.06.019] [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: 11/24/2022] [Revised: 05/22/2023] [Accepted: 06/15/2023] [Indexed: 07/27/2023]
Abstract
OBJECTIVES North Korean Refugees (NKRs) undergo defection, and this has been shown to impact their current health status in South Korea. However, little is understood about how the defection process is related to metabolic syndrome (MetS). This study regarded the defection process to be a quasi-measurement of traumatic experience and investigated whether defection was a risk factor for MetS among NKRs living in South Korea. STUDY DESIGN This cross-sectional study obtained data from the Korea University Anam Hospital in Seoul. NKRs (N = 847) voluntarily completed questionnaires and underwent at least one medical examination between October 2008 and July 2021. METHODS Multivariable logistic regression models were used to evaluate whether the number of countries transited by NKRs was associated with MetS by controlling for covariates. RESULTS The prevalence of MetS among male and female NKRs in South Korea was 12.3% and 13.3%, respectively. The highest prevalence of MetS (33.4%) was among NKRs who had transited two countries. The number of months in transit countries (mean: 49.9 ± 51.7) and period of residence in South Korea (mean: 40.9 ± 40.9 months) were also considered. NKRs who transited three countries had a higher probability of MetS (odds ratio [OR] 2.660, 95% confidence interval [CI] 1.161-6.097) than those who travelled directly to South Korea. NKRs who transited three countries and had only resided in South Korea for a short period had a higher probability of MetS (OR 3.424, 95% CI 1.149-10.208) than those who have lived in South Korea for a longer period. CONCLUSIONS Considering the social vulnerability of NKRs and consequential health problems, there is an urgent need for appropriate support from the government and society.
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Affiliation(s)
- D W Lee
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea; Institute of Health Services Research, Yonsei University, Seoul, 03722, Republic of Korea
| | - H S Lee
- Research Investment for Global Health Technology Fund Foundation, Seoul, 03145, Republic of Korea
| | - S G Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, 02841, Republic of Korea; Department of Healthcare and Medicine for Unified Korea, Korea University College of Medicine, Seoul, 02842, Republic of Korea
| | - K J Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, 02841, Republic of Korea.
| | - S J Jung
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea; Department of Public Health, Graduate School, Yonsei University, Seoul, 03722, Republic of Korea; Center for Global Health, Massachusetts General Hospital, Boston, MA, 02114, USA; Harvard Center for Population and Developmental Studies, Cambridge, MA, 02138, USA.
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23
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Ismond KP, Spiers JA, Tandon P. Identifying opportunities for hepatic encephalopathy self-management: A mixed methods systematic review and synthesis. CANADIAN LIVER JOURNAL 2023; 6:215-233. [PMID: 37503524 PMCID: PMC10370725 DOI: 10.3138/canlivj-2022-0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 08/20/2022] [Indexed: 07/29/2023]
Abstract
Background Hepatic encephalopathy (HE) in cirrhosis is an extremely challenging complication for patients and care partners. To identify potentially modifiable factors to enhance HE self-management strategies, we conducted a synthesis of quantitative and qualitative research about real-world HE behaviours, knowledge, and experiences. Methods Using the EPPI-Centre's mixed methods synthesis procedure, a systematic literature search in five databases was completed; methods of selected articles underwent critical appraisal followed by descriptive analysis and coded line-by-line of content. Through refutational translation, the findings from the quantitative and qualitative syntheses were juxtaposed to highlight congruencies, incongruencies, or gaps. These findings informed generation of cross-analytical themes that were transformed into action statements. Results The quantitative narrative review of synthesis (n = 17) generated four themes (patients had low awareness of HE and low treatment adherence rates, physicians had a non-uniform approach to non-pharmaceutical therapies). Meta-aggregation of qualitative data from six articles yielded three themes (patients and care partners had low levels of HE awareness, were unfamiliar with HE self-management, and were adherent to treatments). Comparison of findings revealed three congruencies, two gaps, and one incongruency. The combined synthesis yielded two self-management themes: universal patient-oriented cirrhosis HE education and ensuring each health care encounter systematically addresses HE to guarantee health care is continuously modified to meet their needs. Conclusions By drawing on elements of Bloom's Taxonomy and distributed knowledge networks, deliberate patient-oriented HE messaging at all health care encounters is greatly needed to improve health outcomes and reduce care burdens related to HE.
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Affiliation(s)
- Kathleen P Ismond
- Division of Gastroenterology, Liver Unit, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Jude A Spiers
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Puneeta Tandon
- Division of Gastroenterology, Liver Unit, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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24
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Wang Z, Chen X, Zhou J, Loke AY, Li Q. Posttraumatic growth in colorectal cancer survivors: A systematic review. Clin Psychol Psychother 2023; 30:740-753. [PMID: 36734107 DOI: 10.1002/cpp.2838] [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: 08/27/2022] [Revised: 01/13/2023] [Accepted: 01/30/2023] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The diagnosis of cancer is an adverse event; nevertheless, it can also exert positive changes on survivors, such as posttraumatic growth (PTG). This review aims to integrate researches on PTG in colorectal cancer (CRC) survivors, including manifestations and prevalence of PTG, factors associated with PTG and interventions on PTG. METHODS A systematic search was implemented on six databases to identify studies on PTG in CRC survivors published in English or Chinese from October 1995 to May 2022. We also performed a manual search for additional studies from the article reference lists. RESULTS Thirty-one studies were included. The results were integrated based on the PTG theoretical framework and PTG affective-cognitive processing model. PTG manifests in CRC survivor-caregiver dyads in five domains, including personal growth, appreciation of life, relating to others, new possibilities and spiritual change. Factors correlated with PTG can be integrated into levels of personality, event cognitions, appraisal mechanisms, emotional states, coping and social environmental context. Elements of interventions can be integrated according to the affective-cognitive processing PTG model. Existing interventions are effective in promoting PTG in CRC survivors. CONCLUSION We provide a systematic perspective on studies targeting PTG in CRC survivors. PTG manifested in survivor-caregiver dyads. Factors associated with PTG in CRC survivors are significant, and the interventions are effective. An intervention programme based on the affective-cognitive processing model and focused on CRC survivor-caregiver dyads would be significant for the dyads facing cancer.
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Affiliation(s)
- Zhiming Wang
- Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, China
| | - Xuan Chen
- Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, China
| | - Junrui Zhou
- Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, China
| | - Alice Yuen Loke
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hung Hom, Hong Kong, China
| | - Qiuping Li
- Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, China
- Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
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25
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Agorastos A, Mansueto AC, Hager T, Pappi E, Gardikioti A, Stiedl O. Heart Rate Variability as a Translational Dynamic Biomarker of Altered Autonomic Function in Health and Psychiatric Disease. Biomedicines 2023; 11:1591. [PMID: 37371686 DOI: 10.3390/biomedicines11061591] [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: 03/17/2023] [Revised: 04/13/2023] [Accepted: 05/24/2023] [Indexed: 06/29/2023] Open
Abstract
The autonomic nervous system (ANS) is responsible for the precise regulation of tissue functions and organs and, thus, is crucial for optimal stress reactivity, adaptive responses and health in basic and challenged states (survival). The fine-tuning of central ANS activity relies on the internal central autonomic regulation system of the central autonomic network (CAN), while the peripheral activity relies mainly on the two main and interdependent peripheral ANS tracts, the sympathetic nervous system (SNS) and the parasympathetic nervous system (PNS). In disease, autonomic imbalance is associated with decreased dynamic adaptability and increased morbidity and mortality. Acute or prolonged autonomic dysregulation, as observed in stress-related disorders, affects CAN core centers, thereby altering downstream peripheral ANS function. One of the best established and most widely used non-invasive methods for the quantitative assessment of ANS activity is the computerized analysis of heart rate variability (HRV). HRV, which is determined by different methods from those used to determine the fluctuation of instantaneous heart rate (HR), has been used in many studies as a powerful index of autonomic (re)activity and an indicator of cardiac risk and ageing. Psychiatric patients regularly show altered autonomic function with increased HR, reduced HRV and blunted diurnal/circadian changes compared to the healthy state. The aim of this article is to provide basic knowledge on ANS function and (re)activity assessment and, thus, to support a much broader use of HRV as a valid, transdiagnostic and fully translational dynamic biomarker of stress system sensitivity and vulnerability to stress-related disorders in neuroscience research and clinical psychiatric practice. In particular, we review the functional levels of central and peripheral ANS control, the main neurobiophysiologic theoretical models (e.g., polyvagal theory, neurovisceral integration model), the precise autonomic influence on cardiac function and the definition and main aspects of HRV and its different measures (i.e., time, frequency and nonlinear domains). We also provide recommendations for the proper use of electrocardiogram recordings for HRV assessment in clinical and research settings and highlight pathophysiological, clinical and research implications for a better functional understanding of the neural and molecular mechanisms underlying healthy and malfunctioning brain-heart interactions in individual stress reactivity and psychiatric disorders.
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Affiliation(s)
- Agorastos Agorastos
- II. Department of Psychiatry, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 56430 Thessaloniki, Greece
| | - Alessandra C Mansueto
- Center for Neurogenomics and Cognitive Research, Vrije Universiteit (VU) Amsterdam, 1081 HV Amsterdam, The Netherlands
- Centre for Urban Mental Health, University of Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Torben Hager
- Center for Neurogenomics and Cognitive Research, Vrije Universiteit (VU) Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Eleni Pappi
- Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Angeliki Gardikioti
- Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Oliver Stiedl
- Center for Neurogenomics and Cognitive Research, Vrije Universiteit (VU) Amsterdam, 1081 HV Amsterdam, The Netherlands
- Department of Health, Safety and Environment, Vrije Universiteit (VU) Amsterdam, 1081 HZ Amsterdam, The Netherlands
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26
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Kozlakidis Z, Shi P, Abarbanel G, Klein C, Sfera A. Recent Developments in Protein Lactylation in PTSD and CVD: Novel Strategies and Targets. BIOTECH 2023; 12:38. [PMID: 37218755 PMCID: PMC10204439 DOI: 10.3390/biotech12020038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 04/27/2023] [Accepted: 05/01/2023] [Indexed: 05/24/2023] Open
Abstract
In 1938, Corneille Heymans received the Nobel Prize in physiology for discovering that oxygen sensing in the aortic arch and carotid sinus was mediated by the nervous system. The genetics of this process remained unclear until 1991 when Gregg Semenza while studying erythropoietin, came upon hypoxia-inducible factor 1, for which he obtained the Nobel Prize in 2019. The same year, Yingming Zhao found protein lactylation, a posttranslational modification that can alter the function of hypoxia-inducible factor 1, the master regulator of cellular senescence, a pathology implicated in both post-traumatic stress disorder (PTSD) and cardiovascular disease (CVD). The genetic correlation between PTSD and CVD has been demonstrated by many studies, of which the most recent one utilizes large-scale genetics to estimate the risk factors for these conditions. This study focuses on the role of hypertension and dysfunctional interleukin 7 in PTSD and CVD, the former caused by stress-induced sympathetic arousal and elevated angiotensin II, while the latter links stress to premature endothelial cell senescence and early vascular aging. This review summarizes the recent developments and highlights several novel PTSD and CVD pharmacological targets. They include lactylation of histone and non-histone proteins, along with the related biomolecular actors such as hypoxia-inducible factor 1α, erythropoietin, acid-sensing ion channels, basigin, and Interleukin 7, as well as strategies to delay premature cellular senescence by telomere lengthening and resetting the epigenetic clock.
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Affiliation(s)
- Zisis Kozlakidis
- International Agency for Research on Cancer, World Health Organization (IARC/WHO), 69372 Lyon, France
| | - Patricia Shi
- Department of Psychiatry, Loma Linda University, Loma Linda, CA 92350, USA
| | - Ganna Abarbanel
- Patton State Hospital, University of California, Riverside, CA 92521, USA
| | | | - Adonis Sfera
- Patton State Hospital, University of California, Riverside, CA 92521, USA
- Department of Psychiatry, University of California, Riverside, CA 92521, USA
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27
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Gros DF, Allan NP, Koscinski B, Keller S, Acierno R. Influence of comorbid social anxiety disorder in PTSD treatment outcomes for Prolonged Exposure in female military sexual trauma survivors with PTSD. J Clin Psychol 2023; 79:1039-1050. [PMID: 36399326 DOI: 10.1002/jclp.23456] [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: 04/04/2022] [Revised: 09/14/2022] [Accepted: 11/01/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Posttraumatic stress disorder (PTSD) is a common psychiatric disorder that frequently presents alongside other comorbid diagnoses. Although several evidence-based psychotherapies have been well-studied for PTSD, limited research has focused on the influence of diagnostic comorbidity on their outcomes. The present study sought to investigate the influence of comorbid social anxiety disorder on treatment outcomes in patients with PTSD. METHODS One hundred and twelve treatment-seeking female veteran participants with PTSD completed baseline assessments and received 12-15 sessions of Prolonged Exposure. Symptom measures were completed biweekly as well as at immediate posttreatment, 3-month, and 6-month follow-ups. RESULTS Thirty (26.8%) participants seeking PTSD treatment also met diagnostic criteria for social anxiety disorder. Multilevel modeling was used to examine effects of social anxiety disorder diagnosis on post-intervention symptoms and revealed significantly worse outcomes for symptoms of PTSD and depression in participants with comorbid PTSD and social anxiety disorder. CONCLUSION Consistent with previous studies of co-occurring PTSD and depression, present findings suggest that comorbid diagnoses may adversely affect disorder-specific treatment outcomes. As such, the presence of diagnostic comorbidity may merit further consideration and potential adaptions to the traditional, disorder-specific assessment and treatment practices for PTSD.
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Affiliation(s)
- Daniel F Gros
- Mental Health Service, Ralph H. Johnson VA Healthcare System, Charleston, South Carolina, USA.,Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Nicholas P Allan
- Department of Psychiatry and Behavioral Health, Ohio State University, Columbus, Ohio, USA.,VA Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System Canandaigua, New York, USA
| | | | - Stephanie Keller
- Mental Health Service, Ralph H. Johnson VA Healthcare System, Charleston, South Carolina, USA.,Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ron Acierno
- Mental Health Service, Ralph H. Johnson VA Healthcare System, Charleston, South Carolina, USA.,Louis Faillace Department of Psychiatry, University of Texas Health Science Center at Houston, Houston, USA
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Cypel YS, Vogt D, Maguen S, Bernhard P, Lowery E, Culpepper WJ, Armand-Gibbs I, Schneiderman AI. Physical health of Post-9/11 U.S. Military veterans in the context of Healthy People 2020 targeted topic areas: Results from the Comparative Health Assessment Interview Research Study. Prev Med Rep 2023; 32:102122. [PMID: 36922958 PMCID: PMC10009290 DOI: 10.1016/j.pmedr.2023.102122] [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: 09/19/2022] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 02/04/2023] Open
Abstract
Large-scale epidemiological studies suggest that veterans may have poorer physical health than nonveterans, but this has been largely unexamined in post-9/11 veterans despite research indicating their high levels of disability and healthcare utilization. Additionally, little investigation has been conducted on sex-based differences and interactions by veteran status. Notably, few studies have explored veteran physical health in relation to national health guidelines. Self-reported, weighted data were analyzed on post-9/11 U.S. veterans and nonveterans (n = 19,693; 6,992 women, 12,701 men; 15,160 veterans, 4,533 nonveterans). Prevalence was estimated for 24 physical health conditions classified by Healthy People 2020 targeted topic areas. Associations between physical health outcomes and veteran status were evaluated using bivariable and multivariable analyses. Back/neck pain was most reported by veterans (49.3 %), twice that of nonveterans (22.8 %)(p < 0.001). Adjusted odds ratios (AORs) for musculoskeletal and hearing disorders, traumatic brain injury, and chronic fatigue syndrome (CFS) were 3-6 times higher in veterans versus nonveterans (p < 0.001). Women versus men had the greatest adjusted odds for bladder infections (males:females, AOR = 0.08, 95 % CI:0.04-0.18)(p < 0.001), and greater odds than men for multiple sclerosis, CFS, cancer, irritable bowel syndrome/colitis, respiratory disease, some musculoskeletal disorders, and vision loss (p < 0.05). Cardiovascular-related conditions were most prominent for men (p < 0.001). Veteran status by sex interactions were found for obesity (p < 0.03; greater for male veterans) and migraine (p < 0.01; greater for females). Healthy People 2020 targeted topic areas exclude some important physical health conditions that are associated with being a veteran. National health guidelines for Americans should provide greater consideration of veterans in their design.
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Affiliation(s)
- Yasmin S. Cypel
- Epidemiology Program, Health Outcomes Military Exposures (HOME) (12POP5), Office of Patient Care Services, U.S. Department of Veterans Affairs (VA), Washington, DC, USA
- Corresponding author at: Epidemiology Program, Health Outcomes Military Exposures (HOME) (12POP5), Office of Patient Care Services, U.S. Department of Veterans Affairs, 810 Vermont Avenue, N.W., Washington, DC 20420, USA.
| | - Dawne Vogt
- National Center for PTSD, VA Boston Health Care System, Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
| | - Shira Maguen
- San Francisco VA Health Care System, San Francisco, CA, USA
- University of California-San Francisco, San Francisco, CA, USA
| | - Paul Bernhard
- Epidemiology Program, Health Outcomes Military Exposures (HOME) (12POP5), Office of Patient Care Services, U.S. Department of Veterans Affairs (VA), Washington, DC, USA
| | - Elizabeth Lowery
- Epidemiology Program, Health Outcomes Military Exposures (HOME) (12POP5), Office of Patient Care Services, U.S. Department of Veterans Affairs (VA), Washington, DC, USA
| | - William J. Culpepper
- Epidemiology Program, Health Outcomes Military Exposures (HOME) (12POP5), Office of Patient Care Services, U.S. Department of Veterans Affairs (VA), Washington, DC, USA
| | - Irvine Armand-Gibbs
- Epidemiology Program, Health Outcomes Military Exposures (HOME) (12POP5), Office of Patient Care Services, U.S. Department of Veterans Affairs (VA), Washington, DC, USA
| | - Aaron I. Schneiderman
- Epidemiology Program, Health Outcomes Military Exposures (HOME) (12POP5), Office of Patient Care Services, U.S. Department of Veterans Affairs (VA), Washington, DC, USA
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Fan A, Glace B, Pereira B, Malochet-Guinamand S, Couderc M, Mathieu S, Tournadre A, Soubrier M, Dubost JJ. Post-traumatic stress disorder prior to diagnosis is as rare in spondyloarthritis as in non-inflammatory rheumatic conditions and rheumatoid arthritis. Joint Bone Spine 2023; 90:105500. [PMID: 36574573 DOI: 10.1016/j.jbspin.2022.105500] [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: 08/02/2022] [Revised: 10/18/2022] [Accepted: 11/16/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Post-traumatic stress disorder (PTSD) may be a risk factor for the development of rheumatoid arthritis (RA). No data are available in spondyloarthritis (SpA). The aim of the present study was to investigate the frequency of traumatic events and PTSD in patients with SpA and its different phenotypes and to compare the results to patients with non inflammatory rheumatic disease and RA patients. METHODS This was an observational, cross-sectional and bi-centric study. Participants were patients diagnosed with SpA, non-inflammatory rheumatic or autoimmune disease (controls), or RA. Traumatic events were identified by the brief trauma questionnaire (BTQ). PTSD was defined as the presence of a traumatic event and ≥4 symptoms on the short PTSD checklist scale. RESULTS Among 1389 participants, 510 patients were diagnosed with SpA (167 ankylosing spondylitis, 140 psoriatic arthritis, 130 non-radiographic-axial SpA, and 51 peripheral SpA), 365 with non-inflammatory rheumatic disease and 514 patients with RA. The frequency of trauma in SPA patients was 33.7%, of which 30.5% in AS, 30.7% in PsA, 37.7% in nr-axSpA and 41.2% in peripheral SpA (P=NS). The prevalence of PTSD in SPA patients was 4.9%, (of which 3.6% in AS, 2.9% in PsA, 6.2% in nr-axSpA and 7.8% in peripheral SpA [P=NS]) and was not significantly different from the controls (after IPTW 4.8% vs. 6.7%). The frequency of trauma and PTSD was also comparable between RA and controls and between SPA and RA. CONCLUSION Traumatic events and PTSD occurring prior to diagnosis is as rare in SpA as in non-inflammatory rheumatic diseases and RA.
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Affiliation(s)
- Angelique Fan
- Rheumatology department, CHU Clermont-Ferrand, 58, rue Montalembert, 63000 Clermont Ferrand, France.
| | - Baptiste Glace
- Rheumatology department, Centre Hospitalier de Vichy, Vichy, France
| | - Bruno Pereira
- Biostatistics Unit, CHU Clermont-Ferrand, Clermont Ferrand, France
| | | | - Marion Couderc
- Rheumatology department, CHU Clermont-Ferrand, 58, rue Montalembert, 63000 Clermont Ferrand, France
| | - Sylvain Mathieu
- Rheumatology department, CHU Clermont-Ferrand, 58, rue Montalembert, 63000 Clermont Ferrand, France
| | - Anne Tournadre
- Rheumatology department, CHU Clermont-Ferrand, 58, rue Montalembert, 63000 Clermont Ferrand, France
| | - Martin Soubrier
- Rheumatology department, CHU Clermont-Ferrand, 58, rue Montalembert, 63000 Clermont Ferrand, France
| | - Jean-Jacques Dubost
- Rheumatology department, CHU Clermont-Ferrand, 58, rue Montalembert, 63000 Clermont Ferrand, France
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30
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Mäder T, Oliver KI, Daffre C, Kim S, Orr SP, Lasko NB, Seo J, Kleim B, Pace-Schott EF. Autonomic activity, posttraumatic and nontraumatic nightmares, and PTSD after trauma exposure. Psychol Med 2023; 53:731-740. [PMID: 34127168 PMCID: PMC9121310 DOI: 10.1017/s0033291721002075] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Nightmares are a hallmark symptom of posttraumatic stress disorder (PTSD). This strong association may reflect a shared pathophysiology in the form of altered autonomic activity and increased reactivity. Using an acoustic startle paradigm, we investigated the interrelationships of psychophysiological measures during wakefulness and PTSD diagnosis, posttraumatic nightmares, and nontraumatic nightmares. METHODS A community sample of 122 trauma survivors were presented with a series of brief loud tones, while heart rate (HRR), skin conductance (SCR), and orbicularis oculi electromyogram (EMGR) responses were measured. Prior to the tone presentations, resting heart rate variability (HRV) was assessed. Nightmares were measured using nightmare logs. Three dichotomous groupings of participants were compared: (1) current PTSD diagnosis (n = 59), no PTSD diagnosis (n = 63), (2) those with (n = 26) or without (n = 96) frequent posttraumatic nightmares, and (3) those with (n = 22) or without (n = 100) frequent nontraumatic nightmares. RESULTS PTSD diagnosis was associated with posttraumatic but not with nontraumatic nightmares. Both PTSD and posttraumatic nightmares were associated with a larger mean HRR to loud tones, whereas nontraumatic nightmare frequency was associated with a larger SCR. EMGR and resting HRV were not associated with PTSD diagnosis or nightmares. CONCLUSIONS Our findings suggest a shared pathophysiology between PTSD and posttraumatic nightmares in the form of increased HR reactivity to startling tones, which might reflect reduced parasympathetic tone. This shared pathophysiology could explain why PTSD is more strongly related to posttraumatic than nontraumatic nightmares, which could have important clinical implications.
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Affiliation(s)
- Thomas Mäder
- Department of Psychology, University of Zurich, Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Katelyn I. Oliver
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
| | - Carolina Daffre
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
| | - Sophie Kim
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
| | - Scott P. Orr
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
- Department of Psychiatry, Harvard Medical School, Charlestown, MA, USA
| | - Natasha B. Lasko
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
- Department of Psychiatry, Harvard Medical School, Charlestown, MA, USA
| | - Jeehye Seo
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
- Department of Psychiatry, Harvard Medical School, Charlestown, MA, USA
- Department of Psychological & Brain Sciences, University of Massachusetts, Amherst, MA, USA
| | - Birgit Kleim
- Department of Psychology, University of Zurich, Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
- Neuroscience Centre Zurich, University of Zurich, Zurich, Switzerland
| | - Edward Franz Pace-Schott
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
- Department of Psychiatry, Harvard Medical School, Charlestown, MA, USA
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31
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Goldschen L, Ellrodt J, Amonoo HL, Feldman CH, Case SM, Koenen KC, Kubzansky LD, Costenbader KH. The link between post-traumatic stress disorder and systemic lupus erythematosus. Brain Behav Immun 2023; 108:292-301. [PMID: 36535611 PMCID: PMC10018810 DOI: 10.1016/j.bbi.2022.12.012] [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: 06/11/2022] [Revised: 12/03/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is a heterogeneous, multisystem autoimmune disorder characterized by unpredictable disease flares. Although the pathogenesis of SLE is complex, an epidemiologic link between posttraumatic stress disorder (PTSD) and the development of SLE has been identified, suggesting that stress-related disorders alter the susceptibility to SLE. Despite the strong epidemiologic evidence connecting PTSD and SLE, gaps remain in our understanding of how the two may be connected. Perturbations in the autonomic nervous system, neuroendocrine system, and at the genomic level may cause and sustain immune dysregulation that could lower the threshold for the development and propagation of SLE. We first describe shared risk factors for SLE and PTSD. We then describe potential biological pathways which may facilitate excessive inflammation in the context of PTSD. Among those genetically predisposed to SLE, systemic inflammation that accompanies chronic stress may fan the flames of smoldering SLE by priming immune pathways. Further studies on the connection between trauma and inflammation will provide important data on pathogenesis, risk factors, and novel treatments for SLE.
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Affiliation(s)
- Lauren Goldschen
- Department of Psychiatry, Brigham and Women's Hospital, 60 Fenwood Road, MA 02115, USA.
| | - Jack Ellrodt
- Division of Rheumatology, Inflammation and Immunity, Department of Medicine, Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA 02115, USA
| | - Hermioni L Amonoo
- Department of Psychiatry, Brigham and Women's Hospital, 60 Fenwood Road, MA 02115, USA; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA
| | - Candace H Feldman
- Division of Rheumatology, Inflammation and Immunity, Department of Medicine, Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA 02115, USA
| | - Siobhan M Case
- Division of Rheumatology, Inflammation and Immunity, Department of Medicine, Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA 02115, USA
| | - Karestan C Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA
| | - Laura D Kubzansky
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA
| | - Karen H Costenbader
- Division of Rheumatology, Inflammation and Immunity, Department of Medicine, Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA 02115, USA
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32
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Li J, Gao L, Bao R, Ji R, He Q, Tang X, Zhang W, Qu Z. Comparative efficacy for different age groups of psychological or psychosocial treatments on post-traumatic stress disorder: protocol for systematic review, meta-analysis and meta-regression analysis. BMJ Open 2023; 13:e066569. [PMID: 36639203 PMCID: PMC9843179 DOI: 10.1136/bmjopen-2022-066569] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION It remains unknown whether psychological or psychosocial treatments for post-traumatic stress disorder (PTSD) have comparable effects across the life span. This study aims at comparing the effects of psychological/psychosocial treatments for PTSD between different age groups of youth, early-middle adults and late adults. METHODS AND ANALYSIS A systematic search will be conducted among thirteen electronic databases, including Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PsycINFO, EMBASE, ERIC, PubMed, SCOPUS, Web of Science, Published International Literature on Traumatic Stress, China National Knowledge Infrastructure Database, the Wanfang database, the Chinese Scientific Journal Database (VIP Database) and ProQuest Dissertations and Theses, from inception to 15 May 2022. Electronic searches will be supplemented by a comprehensive grey literature search in Conference proceedings and trial registries. Randomised controlled trials (RCTs) comparing psychological or psychosocial treatments for PTSD with control conditions in all age groups will be included. The primary outcome is the between-treatments efficacy for PTSD that refers to the outcomes of the RCTs included in the meta-analysis. Effect sizes will be calculated for all comparisons and pooled with a fixed effects model or a random effects model. Differences in the efficacy of psychological/psychosocial therapies for PTSD across the age groups will be examined by stratified analyses and meta-regression analyses. ETHICS AND DISSEMINATION Data used in this study will be anonymised. These data will not be used for other purposes than research. Authors who supply the data will be acknowledged. The authors declare that no conflicts of interest exist. The findings of this study will be disseminated through briefing reports, publications and presentations. TRIAL REGISTRATION NUMBER CRD42022334305.
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Affiliation(s)
- Jia Li
- Center for Behavioral Health & School of Social Development and Public Policy, Beijing Normal University, Beijing, China
| | - Liru Gao
- Center for Behavioral Health & School of Social Development and Public Policy, Beijing Normal University, Beijing, China
| | - Ruiji Bao
- Center for Behavioral Health & School of Social Development and Public Policy, Beijing Normal University, Beijing, China
| | - Rui Ji
- Center for Behavioral Health & School of Social Development and Public Policy, Beijing Normal University, Beijing, China
| | - Qianyun He
- Center for Behavioral Health & School of Social Development and Public Policy, Beijing Normal University, Beijing, China
| | - Xinfeng Tang
- Department of Psychology, Renmin University, Beijing, China
| | - Weijun Zhang
- Center for Behavioral Health & School of Social Development and Public Policy, Beijing Normal University, Beijing, China
| | - Zhiyong Qu
- Center for Behavioral Health & School of Social Development and Public Policy, Beijing Normal University, Beijing, China
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33
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Kim SY, Soumoff AA, Raiciulescu S, Kemezis PA, Spinks EA, Brody DL, Capaldi VF, Ursano RJ, Benedek DM, Choi KH. Association of Traumatic Brain Injury Severity and Self-Reported Neuropsychiatric Symptoms in Wounded Military Service Members. Neurotrauma Rep 2023; 4:14-24. [PMID: 36726873 PMCID: PMC9886188 DOI: 10.1089/neur.2022.0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
The impact of traumatic brain injury (TBI) severity and loss of consciousness (LOC) on the development of neuropsychiatric symptoms was studied in injured service members (SMs; n = 1278) evacuated from combat settings between 2003 and 2012. TBI diagnoses of mild TBI (mTBI) or moderate-to-severe TBI (MS-TBI) along with LOC status were identified using International Classification of Diseases, Ninth Revision (ICD-9) codes and the Defense and Veterans Brain Injury Center Standard Surveillance Case Definition for TBI. Self-reported psychiatric symptoms were evaluated for post-traumatic stress disorder (PTSD) with the PTSD Checklist, Civilian Version for PTSD, the Patient Health Questionnaire-9 for major depressive disorder (MDD), and the Patient Health Questionnaire-15 for somatic symptom disorder (SSD) in two time periods post-injury: Assessment Period 1 (AP1, 0.0-2.5 months) and Assessment Period 2 (AP2, 3-12 months). mTBI, but not MS-TBI, was associated with increased neuropsychiatric symptoms: PTSD in AP1 and AP2; MDD in AP1; and SSD in AP2. A subgroup analysis of mTBI with and without LOC revealed that mTBI with LOC, but not mTBI without LOC, was associated with increased symptoms as compared to non-TBI: PTSD in AP1 and AP2; MDD in AP1; and SSD in AP1 and AP2. Moreover, mTBI with LOC was associated with increased MDD symptoms in AP2, and SSD symptoms in AP1 and AP2, compared to mTBI without LOC. These findings reinforce the need for the accurate characterization of TBI severity and a multi-disciplinary approach to address the devastating impacts of TBI in injured SMs.
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Affiliation(s)
- Sharon Y. Kim
- Program in Neuroscience, Uniformed Services University, Bethesda, Maryland, USA
| | - Alyssa A. Soumoff
- Department of Psychiatry, Uniformed Services University, Bethesda, Maryland, USA.,Behavioral Health Directorate, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Sorana Raiciulescu
- Department of Preventive Medicine and Biostatistics, Biostatistics Consulting Center, Uniformed Services University, Bethesda, Maryland, USA
| | - Patricia A. Kemezis
- Behavioral Health Directorate, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Elizabeth A. Spinks
- Behavioral Health Directorate, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - David L. Brody
- Center for Neuroscience and Regenerative Medicine, Uniformed Services University, Bethesda, Maryland, USA.,Department of Neurology, Uniformed Services University, Bethesda, Maryland, USA
| | - Vincent F. Capaldi
- Program in Neuroscience, Uniformed Services University, Bethesda, Maryland, USA.,Department of Psychiatry, Uniformed Services University, Bethesda, Maryland, USA.,Center for the Study of Traumatic Stress, Uniformed Services University, Bethesda, Maryland, USA
| | - Robert J. Ursano
- Program in Neuroscience, Uniformed Services University, Bethesda, Maryland, USA.,Department of Psychiatry, Uniformed Services University, Bethesda, Maryland, USA.,Center for the Study of Traumatic Stress, Uniformed Services University, Bethesda, Maryland, USA
| | - David M. Benedek
- Program in Neuroscience, Uniformed Services University, Bethesda, Maryland, USA.,Department of Psychiatry, Uniformed Services University, Bethesda, Maryland, USA.,Center for the Study of Traumatic Stress, Uniformed Services University, Bethesda, Maryland, USA
| | - Kwang H. Choi
- Program in Neuroscience, Uniformed Services University, Bethesda, Maryland, USA.,Department of Psychiatry, Uniformed Services University, Bethesda, Maryland, USA.,Center for the Study of Traumatic Stress, Uniformed Services University, Bethesda, Maryland, USA.,Address correspondence to: Kwang H. Choi, PhD, Department of Psychiatry, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
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Seligowski AV, Fonkoue IT, Noble NC, Dixon D, Gluck R, Kim YJ, Powers A, Pace TW, Jovanovic T, Umpierrez G, Ressler KJ, Quyyumi AA, Michopoulos V, Gillespie CF. Vagal control moderates the association between endothelial function and PTSD symptoms in women with T2DM. Brain Behav Immun Health 2022; 26:100527. [PMID: 36247837 PMCID: PMC9557816 DOI: 10.1016/j.bbih.2022.100527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 09/29/2022] [Accepted: 09/30/2022] [Indexed: 11/23/2022] Open
Abstract
Background Individuals with posttraumatic stress disorder (PTSD) are more likely to present with metabolic diseases such as type-2 diabetes mellitus (T2DM), and cardiovascular dysfunction has been implicated in this link. These diseases disproportionately affect women and individuals exposed to chronic environmental stressors (e.g., community violence, poverty). We examined associations among PTSD, cardiovascular indices, and metabolic function in highly trauma-exposed Black women with T2DM. Methods Participants (N = 80) were recruited for a follow-up study of stress and T2DM as part of the Grady Trauma Project. PTSD symptoms were assessed with the Clinician Administered PTSD Scale (CAPS-IV). Cardiovascular indices included heart rate (HR), blood pressure (BP), respiratory sinus arrhythmia (RSA), and endothelial function (assessed via flow-mediated dilation; FMD). An oral glucose tolerance test was used as an indicator of metabolic function. Results Of the cardiovascular indices, only FMD was significantly associated with PTSD symptoms (CAPS Avoidance symptoms; β = -0.37, p = .042), and glucose tolerance (β = -0.44, p = .019), controlling for age and body mass index. The association between FMD and PTSD Avoidance was moderated by RSA such that the effect of FMD was only significant at low levels of RSA (simple slopes β = -0.87, p = .004). Conclusions Our results indicate that endothelial function is significantly related to PTSD and glucose tolerance, over and above other cardiovascular measures (HR, BP, RSA). Further, our results suggest that low RSA may be a risk factor for the link between poor endothelial function and PTSD in women with T2DM.
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Affiliation(s)
- Antonia V. Seligowski
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- McLean Hospital, Belmont, MA, USA
| | - Ida T. Fonkoue
- Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | | | - Drew Dixon
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Rachel Gluck
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Ye Ji Kim
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Abigail Powers
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Thaddeus W.W. Pace
- College of Nursing and College of Medicine (Psychiatry), University of Arizona, Tucson, AZ, USA
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | - Guillermo Umpierrez
- Division of Endocrinology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Kerry J. Ressler
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- McLean Hospital, Belmont, MA, USA
| | - Arshed A. Quyyumi
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Vasiliki Michopoulos
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
- Yerkes National Primate Research Center, Atlanta, GA, USA
| | - Charles F. Gillespie
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
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35
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Immunogenetics of posttraumatic stress disorder (PTSD) in women veterans. Brain Behav Immun Health 2022; 26:100567. [DOI: 10.1016/j.bbih.2022.100567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/22/2022] [Accepted: 11/25/2022] [Indexed: 12/02/2022] Open
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Pro- and anti-inflammatory cytokines Interleukin-6 and Interleukin-10 predict therapy outcome of female patients with posttraumatic stress disorder. Transl Psychiatry 2022; 12:472. [PMID: 36351891 PMCID: PMC9646837 DOI: 10.1038/s41398-022-02230-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 10/18/2022] [Accepted: 10/20/2022] [Indexed: 11/11/2022] Open
Abstract
PTSD patients show alterations of the immune system, mainly a 'low-grade inflammation'. Psychotherapeutic treatments are meant to reduce symptom burden of PTSD patients but 30-50% of PTSD patients do not benefit from psychotherapy. Therefore, in this study, the predictive effect of cytokine levels on therapy outcome are investigated. Pro- (IL-6) and anti-inflammatory (IL-10) cytokines in female PTSD patients (N = 17) were assessed under acute stress during a Trier social stress test (TSST) before therapeutic treatment. The predictive effects of IL-6 and IL-10 on therapy outcome (SCL_GSI, BDI) after an inpatient psychotherapeutic treatment at the University Medical Center Carl Gustav Carus, Technische Universität Dresden was investigated. Areas under the curve with respect to ground (AUCG) and increase (AUCI) for IL-6 and IL-10 levels during the TSST were calculated and used as predictors in regression analyses with pre-treatment scores. Models including all three predictors show good model fits (R2 = 0.255 to 0.744). Models including AUCG and AUCI scores show superior fits compared with models including pre-treatment scores alone (ΔR2 = 0.196 to 0.444). IL-6 AUCG and AUCI scores are significant predictors for post-treatment SCL-GSI and BDI (β = -0.554 to 0.853), whereas IL-10 AUCG significantly predicts SCL-GSI and BDI (β = -0.449 to -0.509). Therefore, pro- and anti-inflammatory IL-6 and IL-10 levels under acute stress before therapy predict therapy outcome of female PTSD patients regarding general symptom burden and depressive symptoms. Future studies should further address the link between inflammation and therapy outcome, especially underlying mechanisms and influencing factors.
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Hawn SE, Hawrilenko M, McDowell Y, Campbell S, Garcia NM, Simpson TL. An in-depth look at latent classes of DSM-5 psychiatric comorbidity among individuals with PTSD: Clinical indicators and treatment utilization. J Clin Psychol 2022; 78:2214-2244. [PMID: 35973077 PMCID: PMC9561047 DOI: 10.1002/jclp.23429] [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: 04/26/2021] [Revised: 04/25/2022] [Accepted: 07/26/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Posttraumatic stress disorder (PTSD) is associated with high comorbidity rates across the full range of psychiatric disorders. However, little is known about how psychiatric comorbidity manifests among people with PTSD, particularly with regard to concurrent diagnoses. METHOD Latent class analysis (LCA) was used to characterize discrete classes of PTSD comorbidity using past year DSM-5 diagnostic standards among a large nationally representative epidemiologic sample of U.S. adults. Follow-up analyses compared participant characteristics across latent classes. RESULTS The LCA was best characterized by five classes: low comorbidity, distress-fear, distress-externalizing, mania-fear-externalizing, and mania-externalizing. Excluding the low comorbidity class, proportions of borderline and schizotypal personality disorder were high across classes. CONCLUSION Participant characteristics across classes of past year PTSD comorbidity are explored through the lens of case conceptualization and treatment planning utility.
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Affiliation(s)
- Sage E. Hawn
- National Center for PTSD, Boston VA Healthcare System, Boston, MA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA
| | - Matthew Hawrilenko
- VA Puget Sound Healthcare System, Seattle, WA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
| | | | - Sarah Campbell
- VA Puget Sound Healthcare System, Seattle, WA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
| | | | - Tracy L. Simpson
- VA Puget Sound Healthcare System, Seattle, WA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
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The Genetic Basis for the Increased Prevalence of Metabolic Syndrome among Post-Traumatic Stress Disorder Patients. Int J Mol Sci 2022; 23:ijms232012504. [PMID: 36293361 PMCID: PMC9604263 DOI: 10.3390/ijms232012504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 10/13/2022] [Accepted: 10/14/2022] [Indexed: 11/23/2022] Open
Abstract
Post-traumatic stress disorder (PTSD) is a highly debilitating psychiatric disorder that can be triggered by exposure to extreme trauma. Even if PTSD is primarily a psychiatric condition, it is also characterized by adverse somatic comorbidities. One illness commonly co-occurring with PTSD is Metabolic syndrome (MetS), which is defined by a set of health risk/resilience factors including obesity, elevated blood pressure, lower high-density lipoprotein cholesterol, higher low-density lipoprotein cholesterol, higher triglycerides, higher fasting blood glucose and insulin resistance. Here, phenotypic association between PTSD and components of MetS are tested on a military veteran cohort comprising chronic PTSD presentation (n = 310, 47% cases, 83% male). Consistent with previous observations, we found significant phenotypic correlation between the various components of MetS and PTSD severity scores. To examine if this observed symptom correlations stem from a shared genetic background, we conducted genetic correlation analysis using summary statistics data from large-scale genetic studies. Our results show robust positive genetic correlation between PTSD and MetS (rg[SE] = 0.33 [0.056], p = 4.74E-09), and obesity-related components of MetS (rg = 0.25, SE = 0.05, p = 6.4E-08). Prioritizing genomic regions with larger local genetic correlation implicate three significant loci. Overall, these findings show significant genetic overlap between PTSD and MetS, which may in part account for the markedly increased occurrence of MetS among PTSD patients.
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Hoppen TH, Lindemann AS, Morina N. Safety of psychological interventions for adult post-traumatic stress disorder: meta-analysis on the incidence and relative risk of deterioration, adverse events and serious adverse events. Br J Psychiatry 2022; 221:1-10. [PMID: 35959698 DOI: 10.1192/bjp.2022.111] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Attention on harmful effects of psychological interventions for adult post-traumatic stress disorder (PTSD) has increased, yet a comprehensive meta-analysis is lacking. AIMS To summarise incidences and relative risks of deterioration, adverse events (AEs) and serious adverse events (SAEs) in trials of psychological interventions for adult PTSD. METHOD We searched MEDLINE, PsycInfo, Web of Science and PTSDpubs from inception to 21 April 2022 for sufficiently large (n ≥ 20) randomised controlled trials (RCTs) reporting on the incidence of harms. RESULTS We included 56 RCTs (4230 patients). Incidences of harms were generally low (0-5%). Psychological interventions were associated with decreased risk of deterioration relative to passive (RR = 0.21, 95% CI 0.15-0.28) and active control conditions (RR = 0.36, 95% CI 0.14-0.92). Decreased risk was even more pronounced in sensitivity analyses on trials exclusively delivering treatments face to face. When compared with other psychological interventions, trauma-focused cognitive-behavioural therapy (TF-CBT) was associated with decreased risk of SAEs (RR = 0.54, 95% CI 0.31-0.95) and with no differential risk of deterioration and AEs. CONCLUSIONS The current evidence base suggests that psychological interventions are safe for most adults with PTSD. In none of the analyses were psychological interventions associated with an increased risk of harm compared with control conditions. TF-CBT was found at least as safe as other psychological interventions. Individual face-to-face delivery might be the safest delivery format. However, more data are needed to draw firmer conclusions. We encourage research teams to routinely and thoroughly assess and report the incidence of harms and their causes.
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Katrinli S, Oliveira NCS, Felger JC, Michopoulos V, Smith AK. The role of the immune system in posttraumatic stress disorder. Transl Psychiatry 2022; 12:313. [PMID: 35927237 PMCID: PMC9352784 DOI: 10.1038/s41398-022-02094-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 07/20/2022] [Accepted: 07/22/2022] [Indexed: 12/14/2022] Open
Abstract
Posttraumatic stress disorder (PTSD) develops in a subset of individuals upon exposure to traumatic stress. In addition to well-defined psychological and behavioral symptoms, some individuals with PTSD also exhibit elevated concentrations of inflammatory markers, including C-reactive protein, interleukin-6, and tumor necrosis factor-α. Moreover, PTSD is often co-morbid with immune-related conditions, such as cardiometabolic and autoimmune disorders. Numerous factors, including lifetime trauma burden, biological sex, genetic background, metabolic conditions, and gut microbiota, may contribute to inflammation in PTSD. Importantly, inflammation can influence neural circuits and neurotransmitter signaling in regions of the brain relevant to fear, anxiety, and emotion regulation. Given the link between PTSD and the immune system, current studies are underway to evaluate the efficacy of anti-inflammatory treatments in those with PTSD. Understanding the complex interactions between PTSD and the immune system is essential for future discovery of diagnostic and therapeutic tools.
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Affiliation(s)
- Seyma Katrinli
- Department of Gynecology and Obstetrics, Emory University, Atlanta, GA, USA.
| | - Nayara C. S. Oliveira
- grid.189967.80000 0001 0941 6502Department of Gynecology and Obstetrics, Emory University, Atlanta, GA USA ,National Institute of Woman, Child, and Adolescence Health Fernandes Figueira, Rio de Janeiro, RJ Brazil ,grid.418068.30000 0001 0723 0931Department of Violence and Health Studies Jorge Careli, National School of Public Health, Fiocruz, Rio de Janeiro, RJ Brazil
| | - Jennifer C. Felger
- grid.189967.80000 0001 0941 6502Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA USA ,grid.189967.80000 0001 0941 6502The Winship Cancer Institute, Emory University, Atlanta, GA USA
| | - Vasiliki Michopoulos
- grid.189967.80000 0001 0941 6502Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA USA
| | - Alicia K. Smith
- grid.189967.80000 0001 0941 6502Department of Gynecology and Obstetrics, Emory University, Atlanta, GA USA ,grid.189967.80000 0001 0941 6502Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA USA
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Prevalence of Gastrointestinal Symptoms and Irritable Bowel Syndrome Among Individuals With Symptomatic Posttraumatic Stress Disorder. J Clin Gastroenterol 2022; 56:592-596. [PMID: 35089910 DOI: 10.1097/mcg.0000000000001670] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 12/16/2021] [Indexed: 12/12/2022]
Abstract
GOALS Our aim was to describe the prevalence of irritable bowel syndrome (IBS) and other gastrointestinal symptoms in a sample of veterans with posttraumatic stress disorder (PTSD) and to examine the relationship between gastrointestinal symptoms, PTSD severity, depression severity, and number of prior traumatic events reported. BACKGROUND IBS and PTSD can co-occur; yet, little research has focused on describing the gastrointestinal symptoms and prevalence of IBS among veterans with PTSD. MATERIALS AND METHODS We examined baseline data from a randomized clinical trial of behavioral interventions for veterans with PTSD. Veterans completed questionnaires assessing gastrointestinal symptoms (Gastrointestinal Patient-Reported Outcome Measures Information Systems; PROMIS) and lifetime traumatic events. Multivariable regression analyses were performed to examine associations between gastrointestinal symptoms and the number of prior traumas reported PTSD severity, and depression symptom severity. RESULTS One hundred eighty-four veterans with a diagnosis of PTSD were included. Twenty-five percent met the Rome III criteria for IBS. Veterans reported gastrointestinal symptoms including abdominal/belly pain (36%), diarrhea (21%), constipation (18%), and bloating/gas (17%). In multivariable analyses, greater PTSD severity was associated with worse constipation ( P =0.008), diarrhea ( P =0.005), and gas/bloating ( P =0.001) when controlling for age and sex. Higher levels of depressive symptoms severity were associated with greater abdominal/belly pain ( P =0.04). CONCLUSIONS Among a sample of veterans with PTSD, rates of IBS and abdominal/belly pain are greater than general US population reference values. Although levels of constipation and bloating/gas are lower than general US population reference values, increased severity of PTSD was associated with increased gastrointestinal symptoms.
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Spreyermann R. Case Report: Infra-Low-Frequency Neurofeedback for PTSD: A Therapist's Perspective. Front Hum Neurosci 2022; 16:893830. [PMID: 35685333 PMCID: PMC9170915 DOI: 10.3389/fnhum.2022.893830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 04/15/2022] [Indexed: 11/30/2022] Open
Abstract
The practical use of a combination of trauma psychotherapy and neurofeedback [infra-low-frequency (ILF) neurofeedback and alpha-theta training] is described for the treatment of patients diagnosed with complex post-traumatic stress disorder (C-PTSD). The indication for this combined treatment is the persistence of symptoms of a hyper-aroused state, anxiety, and sleep disorders even with adequate trauma-focused psychotherapy and supportive medication, according to the Guidelines of the German Society of Psycho-Traumatology (DeGPT). Another indication for a supplementary treatment with neurofeedback is the persistence of dissociative symptoms. Last but not least, the neurofeedback treatment after a trauma-focused psychotherapy session helps to calm the trauma-related reactions and to process the memories. The process of the combined therapy is described and illustrated using two representative case reports. Overall, a rather satisfying result of this outpatient treatment program can be seen in the qualitative appraisal of 7 years of practical application.
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Long non-coding RNA LINC00926 regulates WNT10B signaling pathway thereby altering inflammatory gene expression in PTSD. Transl Psychiatry 2022; 12:200. [PMID: 35551428 PMCID: PMC9098154 DOI: 10.1038/s41398-022-01971-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/17/2022] [Accepted: 02/21/2022] [Indexed: 11/29/2022] Open
Abstract
Post-traumatic stress disorder (PTSD), which frequently occurs in the aftermath of a psychologically traumatic event is characterized by heightened inflammation. People with PTSD also suffer from a number of comorbid clinical and behavioral disorders that are related to chronic inflammation. Thus, understanding the mechanisms of enhanced inflammation in PTSD can provide insights into the relationship between PTSD and associated comorbid disorders. In the current study, we investigated the role of large intervening non-coding RNAs (lincRNAs) in the regulation of inflammation in people diagnosed with PTSD. We observed that WNT ligand, WNT10B, was upregulated in the peripheral blood mononuclear cells (PBMCs) of PTSD patients. This observation was associated with higher H3K4me3 signals around WNT10B promotor in PTSD patients compared to those without PTSD. Increased H3K4me3 resulted from LINC00926, which we found to be upregulated in the PTSD sample, bringing in histone methyltransferase, MLL1, onto WNT10B promotor leading to the introduction of H3K4 trimethylation. The addition of recombinant human WNT10B to pre-activated peripheral blood mononuclear cells (PBMCs) led to increased expression of inflammatory genes such as IFNG and IL17A, suggesting that WNT10B is involved in their upregulation. Together, our data suggested that LINC00926 interacts physically with MLL1 and thereby controls the expression of IFNG and IL17A. This is the first time a long non-coding RNA is shown to regulate the expression of WNT10B and consequently inflammation. This observation has high relevance to our understanding of disease mechanisms of PTSD and comorbidities associated with PTSD.
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Renner V, Schellong J, Bornstein S, Petrowski K. Stress-induced pro- and anti-inflammatory cytokine concentrations in female PTSD and depressive patients. Transl Psychiatry 2022; 12:158. [PMID: 35422029 PMCID: PMC9010431 DOI: 10.1038/s41398-022-01921-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 03/22/2022] [Accepted: 03/25/2022] [Indexed: 12/31/2022] Open
Abstract
Alterations of the hypothalamus pituitary-axis on one hand and heightened rates of somatic diseases and mortality on the other hand are consistently found for PTSD and MDD patients. A possible link between these factors might be the immune system, in particular pro- and anti-inflammatory cytokines. A 'low-grade inflammation' in PTSD and MDD patients was found, whereas the influence of acute stress and the role of anti-inflammatory cytokines was rarely examined. In this study, 17 female PTSD patients participated in the Trier social stress test while serum cytokine levels (IL-6, IL-10) were assessed. Cytokine levels of PTSD patients were compared with levels of female depressive patients (n = 18) and female healthy controls (n = 18). Group differences were assessed using a 3 (group) x 8 (time: -15, -1, +1, +10, +20, +30, +45, +60 min) ANCOVA for repeated measures with baseline values as covariates. There was no group difference regarding IL-6 levels (p = 0.920) but PTSD patients showed significantly higher levels of IL-10 compared with depressive patients (p < 0.001, d = 0.16) and healthy controls (p = 0.001, d = 0.38). Under acute stress, PTSD patients did not show the widely found elevated IL-6 levels but showed an increase of anti-inflammatory IL-10. Therefore, acute stress seems to promote an imbalance of pro- and anti-inflammatory cytokine levels in PTSD and might indicate a hyperreactive immune response. This should be considered in future studies to further understand the role of the immune system as a link between stress response and somatic diseases.
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Affiliation(s)
- Vanessa Renner
- Medical Psychology & Medical Sociology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
| | - Julia Schellong
- grid.4488.00000 0001 2111 7257University Medical Center Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Stefan Bornstein
- grid.4488.00000 0001 2111 7257University Medical Center Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Katja Petrowski
- grid.410607.4Medical Psychology & Medical Sociology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany ,grid.4488.00000 0001 2111 7257University Medical Center Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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Sommer JL, Mota N, Thompson JM, Asmundson GJ, Sareen J, Bernstein CN, Marrie RA, El-Gabalawy R. Associations between courses of posttraumatic stress disorder and physical health conditions among Canadian military personnel. J Anxiety Disord 2022; 87:102543. [PMID: 35168002 DOI: 10.1016/j.janxdis.2022.102543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 10/15/2021] [Accepted: 01/14/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) and physical health conditions commonly co-occur and are both prevalent among military personnel. This study examined how courses of PTSD (no PTSD, remitted, new onset, persistent/recurrent) are associated with physical health conditions, among a population-based sample of Canadian military personnel. METHOD We analyzed data from the 2002 Canadian Community Health Survey-Mental Health and Well-being-Canadian Forces supplement (CCHS-CF) and the 2018 Canadian Armed Forces Members and Veterans Mental Health Follow-Up Survey (CAFVMHS; N = 2941). Multivariable logistic regressions examined associations between PTSD courses (reference = no PTSD) and physical health conditions. RESULTS In general, physical health conditions were more prevalent among symptomatic PTSD courses compared to no PTSD. After adjustment, new onset PTSD was associated with increased odds of all physical health conditions with the exception of ulcers and cancer (AOR range: 1.41-2.31) and remitted PTSD was associated with increased odds of diabetes (AOR = 2.31). CONCLUSION Results suggest that new onset PTSD may be most strongly associated with physical health conditions. Findings may inform targeted screening and intervention methods among military personnel with PTSD and physical health conditions.
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Affiliation(s)
- Jordana L Sommer
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, 671 William Avenue, Winnipeg, Manitoba, R3E 0Z2 Canada; Department of Psychology, University of Manitoba, 190 Dysart Road, Winnipeg, Manitoba, R3T 2N2 Canada
| | - Natalie Mota
- Department of Clinical Health Psychology, University of Manitoba, 771 Bannatyne Avenue, Winnipeg, Manitoba, R3E 3N4 Canada
| | - James M Thompson
- Veterans Affairs Canada, Charlottetown, Prince Edward Island, Canada
| | - Gordon Jg Asmundson
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, Saskatchewan, S4S 0A2 Canada
| | - Jitender Sareen
- Department of Psychiatry, University of Manitoba, 771 Bannatyne Avenue, Winnipeg, Manitoba, R3E 3N4 Canada
| | - Charles N Bernstein
- Department of Internal Medicine, University of Manitoba, 820 Sherbrook Street, Winnipeg, Manitoba, R3A 1R9 Canada
| | - Ruth Ann Marrie
- Department of Internal Medicine, University of Manitoba, 820 Sherbrook Street, Winnipeg, Manitoba, R3A 1R9 Canada
| | - Renée El-Gabalawy
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, 671 William Avenue, Winnipeg, Manitoba, R3E 0Z2 Canada; Department of Psychology, University of Manitoba, 190 Dysart Road, Winnipeg, Manitoba, R3T 2N2 Canada; Department of Clinical Health Psychology, University of Manitoba, 771 Bannatyne Avenue, Winnipeg, Manitoba, R3E 3N4 Canada; Department of Psychiatry, University of Manitoba, 771 Bannatyne Avenue, Winnipeg, Manitoba, R3E 3N4 Canada; CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, Manitoba, R3E 0V9 Canada.
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Busbee PB, Bam M, Yang X, Abdulla OA, Zhou J, Ginsberg JPJ, Aiello AE, Uddin M, Nagarkatti M, Nagarkatti PS. Dysregulated TP53 Among PTSD Patients Leads to Downregulation of miRNA let-7a and Promotes an Inflammatory Th17 Phenotype. Front Immunol 2022; 12:815840. [PMID: 35058939 PMCID: PMC8763839 DOI: 10.3389/fimmu.2021.815840] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 12/15/2021] [Indexed: 12/31/2022] Open
Abstract
Post-traumatic stress disorder (PTSD) is a psychiatric disorder and patients diagnosed with PTSD often express other comorbid health issues, particularly autoimmune and inflammatory disorders. Our previous reports investigating peripheral blood mononuclear cells (PBMCs) from PTSD patients showed that these patients exhibit an increased inflammatory T helper (Th) cell phenotype and widespread downregulation of microRNAs (miRNAs), key molecules involved in post-transcriptional gene regulation. A combination of analyzing prior datasets on gene and miRNA expression of PBMCs from PTSD and Control samples, as well as experiments using primary PBMCs collected from human PTSD and Controls blood, was used to evaluate TP53 expression, DNA methylation, and miRNA modulation on Th17 development. In the current report, we note several downregulated miRNAs were linked to tumor protein 53 (TP53), also known as p53. Expression data from PBMCs revealed that compared to Controls, PTSD patients exhibited decreased TP53 which correlated with an increased inflammatory Th17 phenotype. Decreased expression of TP53 in the PTSD population was shown to be associated with an increase in DNA methylation in the TP53 promotor region. Lastly, the most significantly downregulated TP53-associated miRNA, let-7a, was shown to negatively regulate Th17 T cells. Let-7a modulation in activated CD4+ T cells was shown to influence Th17 development and function, via alterations in IL-6 and IL-17 production, respectively. Collectively, these studies reveal that PTSD patients could be susceptible to inflammation by epigenetic dysregulation of TP53, which alters the miRNA profile to favor a proinflammatory Th17 phenotype.
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Affiliation(s)
- Philip B Busbee
- Department of Pathology, Microbiology, and Immunology, School of Medicine, University of South Carolina, Columbia, SC, United States
| | - Marpe Bam
- Department of Pathology, Microbiology, and Immunology, School of Medicine, University of South Carolina, Columbia, SC, United States
| | - Xiaoming Yang
- Department of Pathology, Microbiology, and Immunology, School of Medicine, University of South Carolina, Columbia, SC, United States
| | - Osama A Abdulla
- Department of Pathology, Microbiology, and Immunology, School of Medicine, University of South Carolina, Columbia, SC, United States
| | - Juhua Zhou
- Department of Pathology, Microbiology, and Immunology, School of Medicine, University of South Carolina, Columbia, SC, United States
| | - Jay Paul Jack Ginsberg
- Department of Pathology, Microbiology, and Immunology, School of Medicine, University of South Carolina, Columbia, SC, United States.,Departments of Psychophysiology, Clinical Psychology, and Research Office, Saybrook University, Pasadena, CA, United States
| | - Allison E Aiello
- Department of Epidemiology, University of North Carolina (UNC) Gillings School of Global Public Health, University of North Carolina, Mcgavran-Greenberg Hall, Chapel Hill, NC, United States
| | - Monica Uddin
- Genomics Program, University of South Florida College of Public Health, Tampa, FL, United States
| | - Mitzi Nagarkatti
- Department of Pathology, Microbiology, and Immunology, School of Medicine, University of South Carolina, Columbia, SC, United States
| | - Prakash S Nagarkatti
- Department of Pathology, Microbiology, and Immunology, School of Medicine, University of South Carolina, Columbia, SC, United States
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Associations between psoriasis and mental illness: an update for clinicians. Gen Hosp Psychiatry 2022; 75:30-37. [PMID: 35101785 DOI: 10.1016/j.genhosppsych.2022.01.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 01/03/2022] [Accepted: 01/18/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVE This review explores the association between psoriasis and mental illness and the potential underlying pathophysiologic explanations for this association. METHOD Using a search via the MEDLINE database in December 2020, eligible studies with a focus on systematic reviews, meta-analyses, and randomized control trials (RCTs) were retrieved and reviewed. RESULTS Psoriasis patients are 1.5 times more likely to show depressive symptoms and experience a higher prevalence of anxiety symptoms (20-50%) than individuals without psoriasis. Schizophrenia (2.82%) and suicidal ideation (12.7%) are found to be more prevalent among psoriasis patients than among the general population. Pro-inflammatory markers, which play an important role in the pathophysiology of psoriasis, have been shown to be elevated in patients with depression, anxiety, and schizophrenia; this suggests shared inflammatory pathways may be involved. CONCLUSIONS There is an elevated burden of psychiatric co-morbidity in psoriasis patients which may be explained by an inflammatory model. We recommend that clinicians conduct universal screening of depression, anxiety, and suicidality among their psoriasis patients and remain vigilant for any symptoms of severe psychiatric conditions such as schizophrenia. Collaboration between dermatologists, psychiatrists and primary care physicians is essential in supporting psychological wellbeing and clinical outcomes for psoriasis patients.
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Gill GK, Sommer JL, Mota N, Sareen J, El-Gabalawy R. Illness-induced post-traumatic stress disorder among Canadian Armed Forces Members and Veterans. J Anxiety Disord 2022; 86:102472. [PMID: 34531106 DOI: 10.1016/j.janxdis.2021.102472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 07/28/2021] [Accepted: 08/25/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES There is growing recognition of illness-induced post-traumatic stress disorder (PTSD), defined by illness being the index trauma that induces PTSD symptoms. This is the first study to examine 1) the lifetime prevalence of illness-induced PTSD among military personnel and veterans, and its 2) sociodemographic, military, trauma, and physical health condition correlates. METHODS Participants completed the 2002 Canadian Community Health Survey-Mental Health and Well-being - Canadian Forces (N = 5155) and the 2018 Canadian Armed Forces Members and Veterans Mental Health Survey follow-up (n = 2941). A semi-structured clinical interview assessed PTSD, which we categorized as "illness-induced" or "other trauma-induced" PTSD based on the index trauma in those participating in both timepoints. To ensure representativeness of our study sample, we used baseline weights created by Statistics Canada to report weighted prevalence estimates and inferential statistics. RESULTS The estimated lifetime prevalence of PTSD among the full sample was 22% and 1.5% had lifetime illness-induced PTSD. Among those with lifetime PTSD, the proportion of participants with illness-induced PTSD was 8.3% (91.7% met criteria for other trauma-induced PTSD). In an unadjusted model, the prevalence of illness-induced PTSD was greater for females (13.7%) than males (7.2%), and for those who were not deployed in both 2002 (5.7%) and 2018 (7.1%; unadjusted odds ratio (OR) range: 2.05-3.72). In a multinomial model adjusting for sociodemographic and military characteristics, compared to those with other trauma-induced PTSD, those with illness-induced PTSD had elevated rates of PTSD persistence (24.1% vs. 11.9%; RRR = 6.06, 95% CI [1.21-30.25]) and lower rates of remission (7.8% vs. 19.9%). CONCLUSION Results highlight differences between illness-induced PTSD and other trauma-induced PTSD, primarily the potential chronicity of this manifestation. This may have implications for assessment strategies and targeted interventions.
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Affiliation(s)
- Gagan K Gill
- Department of Psychology, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
| | - Jordana L Sommer
- Department of Psychology, University of Manitoba, Winnipeg, MB R3T 2N2, Canada; Department of Anesthesiology, Perioperative and Pain Medicine, Max Rady College of Medicine, University of Manitoba, 2nd Floor Harry Medovy House, 671 William Avenue, Winnipeg, MB R3E 0Z2, Canada
| | - Natalie Mota
- Department of Psychology, University of Manitoba, Winnipeg, MB R3T 2N2, Canada; Department of Psychiatry, Max Rady College of Medicine, University of Manitoba, PZ433-771 Bannatyne Avenue, Winnipeg, MB R3T 2N2, Canada; Department of Clinical Health Psychology, Max Rady College of Medicine, University of Manitoba, PZ350-771 Bannatyne Avenue, Winnipeg, MB R3E 3N4, Canada
| | - Jitender Sareen
- Department of Psychology, University of Manitoba, Winnipeg, MB R3T 2N2, Canada; Department of Psychiatry, Max Rady College of Medicine, University of Manitoba, PZ433-771 Bannatyne Avenue, Winnipeg, MB R3T 2N2, Canada
| | - Renée El-Gabalawy
- Department of Psychology, University of Manitoba, Winnipeg, MB R3T 2N2, Canada; Department of Anesthesiology, Perioperative and Pain Medicine, Max Rady College of Medicine, University of Manitoba, 2nd Floor Harry Medovy House, 671 William Avenue, Winnipeg, MB R3E 0Z2, Canada; Department of Psychiatry, Max Rady College of Medicine, University of Manitoba, PZ433-771 Bannatyne Avenue, Winnipeg, MB R3T 2N2, Canada; Department of Clinical Health Psychology, Max Rady College of Medicine, University of Manitoba, PZ350-771 Bannatyne Avenue, Winnipeg, MB R3E 3N4, Canada; CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada.
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Kelley DP, Venable K, Destouni A, Billac G, Ebenezer P, Stadler K, Nichols C, Barker S, Francis J. Pharmahuasca and DMT Rescue ROS Production and Differentially Expressed Genes Observed after Predator and Psychosocial Stress: Relevance to Human PTSD. ACS Chem Neurosci 2022; 13:257-274. [PMID: 34990116 DOI: 10.1021/acschemneuro.1c00660] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Post-traumatic stress disorder (PTSD) is associated with cognitive deficits, oxidative stress, and inflammation. Animal models have recapitulated features of PTSD, but no comparative RNA sequencing analysis of differentially expressed genes (DEGs) in the brain between PTSD and animal models of traumatic stress has been carried out. We compared DEGs from the prefrontal cortex (PFC) of an established stress model to DEGs from the dorsolateral PFC (dlPFC) of humans. We observed a significant enrichment of rat DEGs in human PTSD and identified 20 overlapping DEGs, of which 17 (85%) are directionally concordant. N,N-dimethyltryptamine (DMT) is a known indirect antioxidant, anti-inflammatory, and neuroprotective compound with antidepressant and plasticity-facilitating effects. We tested the capacity of DMT, the monoamine oxidase inhibitor (MAOI) harmaline, and "pharmahuasca" (DMT + harmaline) to reduce reactive oxygen species (ROS) production and inflammatory gene expression and to modulate neuroplasticity-related gene expression in the model. We administered DMT (2 mg/kg IP), harmaline (1.5 mg/kg IP), pharmahuasca, or vehicle every other day for 5 days, following a 30 day stress regiment. We measured ROS production in the PFC and hippocampus (HC) by electron paramagnetic resonance spectroscopy and sequenced total mRNA in the PFC. We also performed in vitro assays to measure the affinity and efficacy of DMT and harmaline at 5HT2AR compared to 5-HT. DMT and pharmahuasca reduced ROS production in the PFC and HC, while harmaline had mixed effects. Treatments normalized 9, 12, and 14 overlapping DEGs, and pathway analysis implicated that genes were involved in ROS production, inflammation, growth factor signaling, neurotransmission, and neuroplasticity.
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Affiliation(s)
- D. Parker Kelley
- Comparative Biomedical Sciences, Louisiana State University School of Veterinary Medicine, Baton Rouge, Louisiana 70803, United States
| | - Katy Venable
- Comparative Biomedical Sciences, Louisiana State University School of Veterinary Medicine, Baton Rouge, Louisiana 70803, United States
| | - Aspasia Destouni
- Comparative Biomedical Sciences, Louisiana State University School of Veterinary Medicine, Baton Rouge, Louisiana 70803, United States
| | - Gerald Billac
- Pharmacology and Experimental Therapeutics, Louisiana State University Health Sciences Center, New Orleans, Louisiana 70112, United States
| | - Philip Ebenezer
- Comparative Biomedical Sciences, Louisiana State University School of Veterinary Medicine, Baton Rouge, Louisiana 70803, United States
| | - Krisztian Stadler
- Pennington Biomedical Research Center, Baton Rouge, Louisiana 70808, United States
| | - Charles Nichols
- Pharmacology and Experimental Therapeutics, Louisiana State University Health Sciences Center, New Orleans, Louisiana 70112, United States
| | - Steven Barker
- Comparative Biomedical Sciences, Louisiana State University School of Veterinary Medicine, Baton Rouge, Louisiana 70803, United States
| | - Joseph Francis
- Comparative Biomedical Sciences, Louisiana State University School of Veterinary Medicine, Baton Rouge, Louisiana 70803, United States
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Pereira MA, Araújo A, Simões M, Costa C. Influence of Psychological Factors in Breast and Lung Cancer Risk - A Systematic Review. Front Psychol 2022; 12:769394. [PMID: 35046872 PMCID: PMC8762112 DOI: 10.3389/fpsyg.2021.769394] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/19/2021] [Indexed: 01/09/2023] Open
Abstract
Introduction: In 2020, according to the Global Cancer Observatory, nearly 10 million people died of cancer. Amongst all cancers, breast cancer had the highest number of new cases and lung cancer had the highest number of deaths. Even though the literatures suggest a possible connection between psychological factors and cancer risk, their association throughout studies remains inconclusive. The present systematic review studied the connection between psychological factors and the risk of breast and lung cancer, prior to a cancer diagnosis. The psychological factors of trauma, grief, and depression were studied. Methods: The current systematic review was carried out across multiple databases in two phases, an initial exploratory research in June 2020, refined with a second electronic research in December 2020. The inclusion criteria included studies describing the association between trauma, posttraumatic stress disorder (PTSD), grief, and depression with breast and lung cancer risk. The psychological data collection must have been carried out prior to a confirmed breast or lung cancer diagnosis, and accessed through self-report measures, questionnaires, clinical interviews, or clinical diagnoses. Study reports had to contain information about the incidence of cancer and effect size. The exclusion criteria were studies in which psychological factors were collected after cancer diagnosis. Results and Conclusion: A total of 26 studies were included. Although non-consensual, the findings from the present systematic review suggest that, in addition to the known risk factors, psychological factors may play an important role in the etiology of both breast and lung cancer. To include psychological factors as a variable that affects cancer development may be fundamental to opening new avenues for prevention and intervention. Systematic Review Registration: [www.ClinicalTrials.gov], identifier [CRD42020209161].
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Affiliation(s)
- Maria Angelina Pereira
- Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal,*Correspondence: Maria Angelina Pereira,
| | - António Araújo
- Department of Medical Oncology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Mário Simões
- Laboratory of Mind-Matter Interaction with Therapeutic Intention, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
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