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Enhanced anxiolytic and analgesic effectiveness or a better safety profile of morphine and tramadol combination in cholestatic and addicted mice. Neuroreport 2022; 33:681-689. [DOI: 10.1097/wnr.0000000000001834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Leconte C, Mongeau R, Noble F. Traumatic Stress-Induced Vulnerability to Addiction: Critical Role of the Dynorphin/Kappa Opioid Receptor System. Front Pharmacol 2022; 13:856672. [PMID: 35571111 PMCID: PMC9091501 DOI: 10.3389/fphar.2022.856672] [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: 01/17/2022] [Accepted: 04/07/2022] [Indexed: 11/13/2022] Open
Abstract
Substance use disorders (SUD) may emerge from an individual’s attempt to limit negative affective states and symptoms linked to stress. Indeed, SUD is highly comorbid with chronic stress, traumatic stress, or post-traumatic stress disorder (PTSD), and treatments approved for each pathology individually often failed to have a therapeutic efficiency in such comorbid patients. The kappa-opioid receptor (KOR) and its endogenous ligand dynorphin (DYN), seem to play a key role in the occurrence of this comorbidity. The DYN/KOR function is increased either in traumatic stress or during drug use, dependence acquisition and DYN is released during stress. The behavioural effects of stress related to the DYN/KOR system include anxiety, dissociative and depressive symptoms, as well as increased conditioned fear response. Furthermore, the DYN/KOR system is implicated in negative reinforcement after the euphoric effects of a drug of abuse ends. During chronic drug consumption DYN/KOR functions increase and facilitate tolerance and dependence. The drug-seeking behaviour induced by KOR activation can be retrieved either during the development of an addictive behaviour, or during relapse after withdrawal. DYN is known to be one of the most powerful negative modulators of dopamine signalling, notably in brain structures implicated in both reward and fear circuitries. KOR are also acting as inhibitory heteroreceptors on serotonin neurons. Moreover, the DYN/KOR system cross-regulate with corticotropin-releasing factor in the brain. The sexual dimorphism of the DYN/KOR system could be the cause of the gender differences observed in patients with SUD or/and traumatic stress-related pathologies. This review underlies experimental and clinical results emphasizing the DYN/KOR system as common mechanisms shared by SUD or/and traumatic stress-related pathologies, and suggests KOR antagonist as a new pharmacological strategy to treat this comorbidity.
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Siciliano RE, Anderson AS, Compas BE. Autonomic nervous system correlates of posttraumatic stress symptoms in youth: Meta-analysis and qualitative review. Clin Psychol Rev 2022; 92:102125. [PMID: 35078039 PMCID: PMC8858870 DOI: 10.1016/j.cpr.2022.102125] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 11/25/2021] [Accepted: 01/09/2022] [Indexed: 11/17/2022]
Abstract
Physiological dysregulation is a key diagnostic criterion for posttraumatic stress disorder (PTSD). While PTSD is defined by trauma exposure, symptom presentations are varied. Similarly, findings of autonomic nervous system (ANS), including parasympathetic (PNS) and sympathetic nervous system (SNS), function in youth exposed to trauma are mixed (e.g., hyporeactivity and hyperreactivity). The present meta-analysis quantitatively assesses the relation between ANS measures broadly, and PNS- and SNS-specific measures, and posttraumatic stress symptoms (PTSS) in youth (ages 4.98 to 19.55 years) across 38 cross-sectional and longitudinal studies (N = 3488). Findings demonstrate that heightened ANS activity is related to increased PTSS during stress tasks (r = 0.07), while decreased SNS activity at rest corresponded to increased PTSS (r = -0.09). The correlation between PNS measures and PTSS was non-significant. The moderation effect of age on the relation between PNS activity measured during stress tasks and PTSS approached significance, such that younger children showed a stronger negative relation between symptoms and PNS activity compared to older youth. Qualitative review of included studies revealed significant variability across sample and stressor characteristics and study methodology. Findings indicate the importance of autonomic dysregulation in youth with PTSS. Additional considerations for future research are discussed.
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Affiliation(s)
- Rachel E. Siciliano
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee, USA
| | - Allegra S. Anderson
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee, USA
| | - Bruce E. Compas
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee, USA
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Abstract
OBJECTIVES After injury, many children experience posttraumatic stress symptoms (PTSS) that negatively impact recovery. Acute pain and PTSS share neurobiological pathways, and acute dosage of morphine has been linked to reduced PTSS in naturalistic studies. However, the complex interactions between pain, morphine and other opioid use, and PTSS have yet to be investigated in robust pediatric samples.This prospective, longitudinal study examined relationships between acute pain, opioid medications, and PTSS after pediatric injury. METHODS Ninety-six children aged 8 to 13 years (mean = 10.60, SD = 1.71), hospitalized for unintentional injury, completed assessments at baseline (T1) and 12 weeks (T2) later. Pain ratings and opioid administration data were obtained via chart review. RESULTS Structural equation modeling revealed that worst pain endorsed during hospitalization was positively associated with concurrent and later PTSS when controlling for evidence-based risk factors (ie, age, sex, prior trauma history, traumatic appraisals of injury event, heart rate). Neither opioid medications overall nor morphine specifically (milligram/kilogram/day) administered during hospitalization mediated the relationship between pain and T2 PTSS. CONCLUSIONS Pain during hospitalization may increase susceptibility for persistent PTSS above and beyond the influence of other empirical risk factors. Findings suggest that pain assessment may be a useful addition to pediatric PTSS screening tools and highlight the need for additional research on pharmacological secondary prevention approaches. Given that inadequate pain control and persistent PTSS each hinder recovery and long-term functioning, better understanding of interactions between acute pain and PTSS after injury is essential for improving screening, prevention, and early intervention efforts.
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Paredes Molina CS, Berry S, Nielsen A, Winfield R. PTSD in civilian populations after hospitalization following traumatic injury: A comprehensive review. Am J Surg 2018; 216:745-753. [PMID: 30103902 DOI: 10.1016/j.amjsurg.2018.07.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 06/01/2018] [Accepted: 07/17/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Injuries and their comorbidities affect victims far beyond their physical recovery period. Some study-measures show that more than half of patients hospitalized for a traumatic injury suffer from Acute Stress Disorder, alcohol dependence, and recurrent trauma. Overall, this literature review serves to review risk factors for PTSD, screening tools, follow-up strategies, and gaps in the literature for achieving feasible patient-centered interventions for the prevention of PTSD after a traumatic injury. DATA SOURCES A literature review was performed from August 1, 2017 to March 19, 2018, from 3 Databases: PubMed, CINAHL and Cochrane, with keywords: "PTSD", "Post-traumatic Stress Disorder", "Civilians", "Traumatic", "Injury", "Follow-up", "Treatment", "Referral", "surgery", "surgical", "Intervention", and "Insured", "underinsured". CONCLUSIONS Reported risk factors for PTSD were: prior psychiatric disorder, gunshots, and lack of social support. Most articles use the Posttraumatic Stress Disorder Checklist - Civilian version. Follow-up strategies mainly focus on multidisciplinary intervention protocols, including social workers, behavioral health specialists, and psychiatrists. Finally, gaps in the literature show the need for bilingual/bicultural patient-centered care for elderly, diverse ethnic backgrounds, and insured vs. uninsured patients.
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Affiliation(s)
| | - Stepheny Berry
- The University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS, 66160, USA
| | - Alexandra Nielsen
- The University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS, 66160, USA
| | - Robert Winfield
- The University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS, 66160, USA.
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Dai W, Kaminga AC, Tan H, Wang J, Lai Z, Wu X, Xiong Y, Deng J, Liu A. Comorbidity of post-traumatic stress disorder and anxiety in flood survivors: Prevalence and shared risk factors. Medicine (Baltimore) 2017; 96:e7994. [PMID: 28885358 PMCID: PMC6393105 DOI: 10.1097/md.0000000000007994] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Post-traumatic stress disorder (PTSD) and anxiety are both prevalent in trauma-related populations. However, comorbidity of these 2 psychiatric disorders has not been investigated in flood survivors. This study aimed to estimate the extent to which PTSD and anxiety co-occur in flood survivors, and identify shared risk factors for PTSD only and comorbidity of PTSD and anxiety.Individuals who experienced Dongting Lake flood in 1998 were enrolled in this study using stratified and systematic random sampling method. Information on social support, personality traits, PTSD, and anxiety was collected using self-report questionnaires. The intensity of exposure to the flood was measured by some questions. Logistic regression analyses were used to identify factors associated with PTSD only and comorbidity of PTSD and anxiety.In all, 325 participants were enrolled in this study. The prevalence of PTSD, anxiety, and comorbidity of PTSD and anxiety among survivors of the 1998 Dongting Lake flood at 17-year follow-up was 9.54%, 9.23%, and 6.15%, respectively. Furthermore, 64.52% of those with PTSD had anxiety and 66.67% of those with anxiety had PTSD. Loss of relative, injury of body, damage of house, and emotional instability were shared risk factors for PTSD only and comorbidity of PTSD and anxiety, in comparison with neither PTSD nor anxiety.Post-traumatic stress disorder only and comorbidity of PTSD and anxiety are prevalent in flood survivors, and are both related to the intensity of exposure to the flood and personality traits, indicating that integrated intervention strategies of PTSD and anxiety for flood survivors are needed.
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Affiliation(s)
- Wenjie Dai
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Hunan, China
| | - Atipatsa C. Kaminga
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Hunan, China
- Department of Mathematics, Mzuzu University, Mzuzu, Malawi
| | - Hongzhuan Tan
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Hunan, China
| | - Jieru Wang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Hunan, China
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Zhiwei Lai
- Hunan Provincial Center for Disease Control and Prevention, Hunan, China
| | - Xin Wu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Hunan, China
| | - Yuan Xiong
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Hunan, China
| | - Jing Deng
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Hunan, China
| | - Aizhong Liu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Hunan, China
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Haag AC, Landolt MA. Young Children’s Acute Stress After a Burn Injury: Disentangling the Role of Injury Severity and Parental Acute Stress. J Pediatr Psychol 2017; 42:861-870. [DOI: 10.1093/jpepsy/jsx059] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 02/11/2017] [Indexed: 11/12/2022] Open
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Saxe GN, Statnikov A, Fenyo D, Ren J, Li Z, Prasad M, Wall D, Bergman N, Briggs EC, Aliferis C. A Complex Systems Approach to Causal Discovery in Psychiatry. PLoS One 2016; 11:e0151174. [PMID: 27028297 PMCID: PMC4814084 DOI: 10.1371/journal.pone.0151174] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 02/24/2016] [Indexed: 11/19/2022] Open
Abstract
Conventional research methodologies and data analytic approaches in psychiatric research are unable to reliably infer causal relations without experimental designs, or to make inferences about the functional properties of the complex systems in which psychiatric disorders are embedded. This article describes a series of studies to validate a novel hybrid computational approach–the Complex Systems-Causal Network (CS-CN) method–designed to integrate causal discovery within a complex systems framework for psychiatric research. The CS-CN method was first applied to an existing dataset on psychopathology in 163 children hospitalized with injuries (validation study). Next, it was applied to a much larger dataset of traumatized children (replication study). Finally, the CS-CN method was applied in a controlled experiment using a ‘gold standard’ dataset for causal discovery and compared with other methods for accurately detecting causal variables (resimulation controlled experiment). The CS-CN method successfully detected a causal network of 111 variables and 167 bivariate relations in the initial validation study. This causal network had well-defined adaptive properties and a set of variables was found that disproportionally contributed to these properties. Modeling the removal of these variables resulted in significant loss of adaptive properties. The CS-CN method was successfully applied in the replication study and performed better than traditional statistical methods, and similarly to state-of-the-art causal discovery algorithms in the causal detection experiment. The CS-CN method was validated, replicated, and yielded both novel and previously validated findings related to risk factors and potential treatments of psychiatric disorders. The novel approach yields both fine-grain (micro) and high-level (macro) insights and thus represents a promising approach for complex systems-oriented research in psychiatry.
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Affiliation(s)
- Glenn N. Saxe
- Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, New York, United States of America
- * E-mail:
| | - Alexander Statnikov
- Center for Health Informatics and Bioinformatics, New York University School of Medicine, New York, New York, United States of America
| | - David Fenyo
- Center for Health Informatics and Bioinformatics, New York University School of Medicine, New York, New York, United States of America
| | - Jiwen Ren
- Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, New York, United States of America
- Center for Health Informatics and Bioinformatics, New York University School of Medicine, New York, New York, United States of America
| | - Zhiguo Li
- Center for Health Informatics and Bioinformatics, New York University School of Medicine, New York, New York, United States of America
| | - Meera Prasad
- Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Dennis Wall
- Systems Medicine in the Department of Pediatrics, Stanford University School of Medicine, Stanford, California, United States of America
| | - Nora Bergman
- Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, New York, United States of America
| | - Ernestine C. Briggs
- Department of Psychiatry, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Constantin Aliferis
- Institute for Health Informatics, University of Minnesota, Minneapolis, Minnesota, United States of America
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, United States of America
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Manjoch H, Vainer E, Matar M, Ifergane G, Zohar J, Kaplan Z, Cohen H. Predator-scent stress, ethanol consumption and the opioid system in an animal model of PTSD. Behav Brain Res 2016; 306:91-105. [PMID: 26965572 DOI: 10.1016/j.bbr.2016.03.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 03/02/2016] [Accepted: 03/04/2016] [Indexed: 12/20/2022]
Abstract
Emerging literature points to stress exposure as a potential contributor to the development of alcohol abuse, but animal models have yielded inconsistent results. Converging experimental data indicate that the endogenous opioid system modulates alcohol consumption and stress regulation. The aim of the present study is to examine the interplay between stress exposure, behavioral stress responses, ethanol (EtOH) consumption and the endogenous opioid system in an animal model of posttraumatic stress disorder. Rats were exposed to stress and then tested in a two-bottle free choice (TBC) assay or in a conditioned place preference paradigm. In some experiments, the endogenous opioid system was pharmacologically manipulated prior to stress exposure. The behavioral outcomes of stress exposure were assessed in an elevated plus-maze, with the acoustic startle response, and by monitoring the freezing response to trauma reminder. Immunoreactivity of phosphorylated opioid receptors in hippocampal subregions was also measured. Stress significantly increased the consumption of EtOH in the TBC assay. The severity of the behavioral response to stress was associated with EtOH consumption, cue-triggered freezing response to a trauma reminder, and endogenous levels of phosphorylated opioid receptors in the hippocampus. Pharmacologically manipulating the endogenous opioid system prior to stress exposure attenuated trauma cue-triggered freezing responses and blocked predator scent stress-induced potentiation of EtOH consumption. These data demonstrate a stress-induced potentiation of EtOH self-administration and reveal a clear association between individual patterns of the behavioral response to stress and alcohol preference, while indicating a role for the endogenous opioid system in the neurobiological response to stress.
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Affiliation(s)
- Hadar Manjoch
- Ben-Gurion University of the Negev, Department of Psychology, Beer Sheva, Israel; Beer-Sheva Mental Health Center, Anxiety and Stress Research Unit, Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel
| | - Ella Vainer
- Beer-Sheva Mental Health Center, Anxiety and Stress Research Unit, Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel
| | - Michael Matar
- Beer-Sheva Mental Health Center, Anxiety and Stress Research Unit, Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel
| | - Gal Ifergane
- Headache Clinic, Department of Neurology, Soroka Medical Center, Ben-Gurion University of the Negev Beer- Sheva, Israel
| | - Joseph Zohar
- Division of Psychiatry, The State of Israel Ministry of Health, The Chaim Sheba Medical Center, Sackler Medical School, Tel-Aviv University, Tel Hashomer, Israel
| | - Zeev Kaplan
- Beer-Sheva Mental Health Center, Anxiety and Stress Research Unit, Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel
| | - Hagit Cohen
- Ben-Gurion University of the Negev, Department of Psychology, Beer Sheva, Israel; Beer-Sheva Mental Health Center, Anxiety and Stress Research Unit, Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel.
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Griffiths C, Armstrong-James L, White P, Rumsey N, Pleat J, Harcourt D. A systematic review of patient reported outcome measures (PROMs) used in child and adolescent burn research. Burns 2014; 41:212-24. [PMID: 25300756 DOI: 10.1016/j.burns.2014.07.018] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 07/21/2014] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Patient reported outcome measures (PROMs) can identify important information about patient needs and therapeutic progress. The aim of this review was to identify the PROMs that are being used in child and adolescent burn care and to determine the quality of such scales. METHODS Computerised and manual bibliographic searches of Medline, Social Sciences Index, Cinahl, Psychinfo, Psycharticles, AMED, and HAPI, were used to identify English-language articles using English-language PROMs from January 2001 to March 2013. The psychometric quality of the PROMs was assessed. RESULTS 23 studies met the entry criteria and identified 32 different PROMs (31 generic, 1 burns-specific). Overall, the psychometric quality of the PROMs was low; only two generic scales (the Perceived Stigmatisation Questionnaire and the Social Comfort Scale) and only one burns-specific scale (the Children Burn Outcomes Questionnaire for children aged 5-18) had psychometric evidence relevant to this population. CONCLUSIONS The majority of PROMs did not have psychometric evidence for their use with child or adolescent burn patients. To appropriately identify the needs and treatment progress of child and adolescent burn patients, new burns-specific PROMs need to be developed and validated to reflect issues that are of importance to this population.
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Affiliation(s)
- C Griffiths
- Centre for Appearance Research (CAR), University of the West of England, Bristol, United Kingdom.
| | - L Armstrong-James
- Centre for Appearance Research (CAR), University of the West of England, Bristol, United Kingdom.
| | - P White
- Department of Engineering Design and Mathematics, University of the West of England, Bristol, United Kingdom.
| | - N Rumsey
- Centre for Appearance Research (CAR), University of the West of England, Bristol, United Kingdom.
| | - J Pleat
- Department of Plastic Surgery, Southmead Hospital, Bristol, United Kingdom.
| | - D Harcourt
- Centre for Appearance Research (CAR), University of the West of England, Bristol, United Kingdom.
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Pfefferbaum B, Shaw JA. Practice parameter on disaster preparedness. J Am Acad Child Adolesc Psychiatry 2013; 52:1224-38. [PMID: 24157398 DOI: 10.1016/j.jaac.2013.08.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 08/10/2013] [Indexed: 12/01/2022]
Abstract
This Practice Parameter identifies best approaches to the assessment and management of children and adolescents across all phases of a disaster. Delivered within a disaster system of care, many interventions are appropriate for implementation in the weeks and months after a disaster. These include psychological first aid, family outreach, psychoeducation, social support, screening, and anxiety reduction techniques. The clinician should assess and monitor risk and protective factors across all phases of a disaster. Schools are a natural site for conducting assessments and delivering services to children. Multimodal approaches using social support, psychoeducation, and cognitive behavioral techniques have the strongest evidence base. Psychopharmacologic interventions are not generally used but may be necessary as an adjunct to other interventions for children with severe reactions or coexisting psychiatric conditions.
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Differential mechanisms of opioidergic and dopaminergic systems of the ventral hippocampus (CA3) in anxiolytic-like behaviors induced by cholestasis in mice. Eur J Pharmacol 2013; 714:352-8. [DOI: 10.1016/j.ejphar.2013.07.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 07/09/2013] [Accepted: 07/16/2013] [Indexed: 11/20/2022]
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OPRM1 and diagnosis-related posttraumatic stress disorder in binge-drinking patients living with HIV. AIDS Behav 2012; 16:2171-80. [PMID: 22143634 DOI: 10.1007/s10461-011-0095-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Posttraumatic stress disorder (PTSD) has been linked to numerous negative outcomes in persons living with HIV (PLH) and there is evidence that PTSD symptoms may play a role in maintaining alcohol use problems. The opioid receptor mu-1 (OPRM1) gene may play a role in both PTSD and alcohol use. We examined the association between PTSD and drinking motives as well as variation in the OPRM1 as a predictor of both PTSD and drinking motives in a sample of 201 PLH reporting recent binge drinking. Self-reported PTSD symptom severity was significantly associated with drinking motives for coping, enhancement, and socialization. OPRM1 variation was associated with decreased PTSD symptom severity as well as enhancement motives for drinking.
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Abstract
The opioid system plays a crucial role in the neural modulation of anxiety. The involvement of opioid ligands and receptors in physiological and dysfunctional forms of anxiety is supported by findings from a wide range of preclinical and clinical studies, including clinical trials, experimental research, and neuroimaging, genetic, and epidemiological data. In this review we provide a summary of studies from a variety of research disciplines to elucidate the role of the opioid system in the neurobiology of anxiety. First, we report data from preclinical studies using animal models to examine the modulatory role of central opioid system on defensive responses conducive to fear and anxiety. Second, we summarize the human literature providing evidence that clinical and experimental human studies are consistent with preclinical models. The implication of these data is that activation of the opioid system leads to anxiolytic responses both in healthy subjects and in patients suffering from anxiety disorders. The role of opioids in suppressing anxiety may serve as an adaptive mechanism, collocated in the general framework of opioid neurotransmission blunting acute negative and distressing affective responses.
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Affiliation(s)
- A Colasanti
- Neuropsychopharmacology Unit, Centre for Pharmacology and Therapeutics, Division of Experimental Medicine, Imperial College London, London, UK.
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Patterns of Medication Administration From 2001 to 2009 in the Treatment of Children With Acute Burn Injuries: A Multicenter Study. J Burn Care Res 2011; 32:519-28. [DOI: 10.1097/bcr.0b013e31822bef92] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Graf A, Schiestl C, Landolt MA. Posttraumatic Stress and Behavior Problems in Infants and Toddlers With Burns. J Pediatr Psychol 2011; 36:923-31. [DOI: 10.1093/jpepsy/jsr021] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Alisic E, Jongmans MJ, van Wesel F, Kleber RJ. Building child trauma theory from longitudinal studies: a meta-analysis. Clin Psychol Rev 2011; 31:736-47. [PMID: 21501581 DOI: 10.1016/j.cpr.2011.03.001] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2010] [Revised: 03/03/2011] [Accepted: 03/09/2011] [Indexed: 01/23/2023]
Abstract
Many children are exposed to traumatic events, with potentially serious psychological and developmental consequences. Therefore, understanding development of long-term posttraumatic stress in children is essential. We aimed to contribute to child trauma theory by focusing on theory use and theory validation in longitudinal studies. Forty studies measuring short-term predictors and long-term posttraumatic stress symptoms were identified and coded for theoretical grounding, sample characteristics, and correlational effect sizes. Explicit theoretical frameworks were present in a minority of the studies. Important predictors of long-term posttraumatic stress were symptoms of acute and short-term posttraumatic stress, depression, anxiety, and parental posttraumatic stress. Female gender, injury severity, duration of hospitalization, and elevated heart rate shortly after hospitalization yielded small effect sizes. Age, minority status, and socioeconomic status were not significantly related to long-term posttraumatic stress reactions. Since many other variables were not studied frequently enough to compute effect sizes, existing theoretical frameworks could only be partially confirmed or falsified. Child trauma theory-building can be facilitated by development of encouraging journal policies, the use of comparable methods, and more intense collaboration.
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Affiliation(s)
- Eva Alisic
- Psychotrauma Center for Children and Youth, University Medical Center Utrecht, The Netherlands.
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Fletcher S, Creamer M, Forbes D. Preventing post traumatic stress disorder: are drugs the answer? Aust N Z J Psychiatry 2010; 44:1064-71. [PMID: 21070102 DOI: 10.3109/00048674.2010.509858] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In the field of traumatic stress, chemoprophylaxis is a term that is often used but rarely well understood. There has been no shortage of debate on the issue, but few rigorous studies to ground the discussion. The purpose of the current paper is to explore the issues surrounding this contentious area. Databases including PubMed, PsychArticles and Web of Knowledge were searched using the key words 'chemo or pharmaco', 'prevention or prophylaxis', and 'PTSD or post-traumatic stress'. Relevant journals and reference lists of the papers obtained through this search were scanned for additional references. Studies that investigated the use of pharmacotherapy to prevent the onset of post-traumatic stress disorder were considered for this paper. Studies that examined the treatment of established PTSD were excluded. A total of 15 empirical studies were included in the review (including five randomized controlled trials), and twice as many non-data-driven papers. Evidence for the prophylactic use of alcohol, morphine, propranolol, and hydrocortisone is presented, followed by a discussion of the many challenges of using pharmacological interventions in this context. While attention to this issue has increased in recent times, the dearth of empirical data has done little to further the field. Larger studies are indicated following small trials with medications such as propranolol and hydrocortisone. There remain a number of ethical and practical questions to be answered before the widespread use of chemoprophylaxis can be recommended.
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Affiliation(s)
- Susan Fletcher
- Australian Centre for Post-traumatic Mental Health, Department of Psychiatry, University of Melbourne, East Melbourne, Victoria, Australia.
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Board R, Dai J. Effects of five parent-and-child risk factors on salivary cortisol levels and symptoms of posttraumatic stress disorder in school-age, critically ill children: pilot study. Heart Lung 2010; 40:236-46. [PMID: 20723987 DOI: 10.1016/j.hrtlng.2010.05.051] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2009] [Revised: 05/17/2010] [Accepted: 05/18/2010] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We examined the contributions of risk factors to the psychological and neuroendocrine status of children admitted to a pediatric intensive care unit (PICU), and explored the feasibility of a full-scale study of these risk factors. METHODS A prospective, correlational design was used. Risk factors included parental stress, parental anxiety, child anxiety, severity of the child's illness, and invasive procedures administered to the child. Outcomes variables were pediatric posttraumatic stress disorder (PTSD) symptoms and salivary cortisol levels. Measures were taken at 3 time points over 3 months. RESULTS The mothers' state anxiety significantly increased over time, whereas the children's PTSD symptoms decreased. Most children with average or high anxiety demonstrated varying degrees of PTSD symptomatology, whereas children with low anxiety exhibited doubtful or mild symptoms of PTSD. As the severity of PTSD symptoms increased over time, the level of salivary cortisol decreased at two weeks and three months after hospital discharge. CONCLUSIONS Predicted trends in data were found and warrant further investigation, using a similar methodology in a full-scale study with an emphasis on recruiting the most seriously ill children.
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Affiliation(s)
- Rhonda Board
- School of Nursing, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts 02115, USA.
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Stoddard FJ, Sorrentino EA, Ceranoglu TA, Saxe G, Murphy JM, Drake JE, Ronfeldt H, White GW, Kagan J, Snidman N, Sheridan RL, Tompkins RG. Preliminary Evidence for the Effects of Morphine on Posttraumatic Stress Disorder Symptoms in One- to Four-Year-Olds With Burns. J Burn Care Res 2009; 30:836-43. [DOI: 10.1097/bcr.0b013e3181b48102] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Amstadter AB, Nugent NR, Koenen KC. Genetics of PTSD: Fear Conditioning as a Model for Future Research. Psychiatr Ann 2009; 39:358-367. [PMID: 19779593 DOI: 10.3928/00485713-20090526-01] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In the last decade, the number of publications in psychiatric genetics has nearly tripled but little attention has been paid to the role of genetic factors in the etiology of posttraumatic stress disorder (PTSD). The present review summarizes the current state of genetic research on PTSD. First, we outline information regarding genetic influences provided by family investigations and by twin studies. Second, we propose the fear-conditioning model of PTSD as a framework for the nomination of candidate genes that may be related to the disorder. Third, we review lines of evidence from three neurobiological systems involved in fear conditioning, and we summarize published investigations of genetic variants studied in association with PTSD in these three systems. Finally, we review gene-by-environment interaction research, a promising novel approach to genetic research in PTSD.
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Affiliation(s)
- Ananda B Amstadter
- Departments of Psychiatry and Behavioral Science, Medical University of South Carolina
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Langeland W, Olff M. Psychobiology of posttraumatic stress disorder in pediatric injury patients: A review of the literature. Neurosci Biobehav Rev 2008; 32:161-74. [PMID: 17825911 DOI: 10.1016/j.neubiorev.2007.07.002] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2007] [Revised: 07/18/2007] [Accepted: 07/26/2007] [Indexed: 11/28/2022]
Abstract
Research suggests that about a quarter to a third of children with traffic-related injuries develop posttraumatic stress disorder (PTSD). Early symptoms of PTSD have been found to predict poor mental and physical outcome in studies of medically injured children. However, these symptoms are rarely recognized by physicians who provide emergency care for these children. In addition, there is insufficient knowledge about predictors of posttraumatic stress symptoms in this specific pediatric population. Early identification of those children at particular risk is needed to target preventive interventions appropriately. After some introducing remarks on the classification and the nature of posttraumatic stress reactions, current research findings on psychological and biological correlates of PTSD in pediatric injury patients are presented. The particular focus in this paper is on the neurobiological mechanisms that influence psychological responses to extreme stress and the development of PTSD. Continued study of the psychobiology of trauma and PTSD in pediatric injury patients, both in terms of neurobiology and treatment is needed.
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Affiliation(s)
- Willie Langeland
- Department of Psychiatry, Center for Psychological Trauma, University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam, The Netherlands.
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Landolt MA, Buehlmann C, Maag T, Schiestl C. Brief Report: Quality of Life Is Impaired in Pediatric Burn Survivors with Posttraumatic Stress Disorder. J Pediatr Psychol 2007; 34:14-21. [PMID: 17890286 DOI: 10.1093/jpepsy/jsm088] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This study assessed health-related quality of life (HRQOL) and posttraumatic stress disorder (PTSD) in pediatric burn survivors and examined associations between PTSD and HRQOL. METHODS Forty-three burn survivors, ages 7-16 years, were interviewed at an average of 4.4 years after their accident using the Clinician-Administered PTSD Scale for Children and Adolescents and the TNO-AZL Child Quality of Life Questionnaire. RESULTS Eight children (18.6%) met DSM-IV criteria for current PTSD. While most dimensions of HRQOL were within normal limits, social functioning was impaired. Severity of PTSD was significantly associated with physical, cognitive, and emotional dimensions of HRQOL. Children with PTSD reported an impaired overall HRQOL and limited physical (e.g., more bodily complaints) and emotional functioning (e.g., more feelings of sadness). CONCLUSIONS This study provides tentative evidence for a considerably high prevalence of PTSD in pediatric burn survivors and for a negative association between PTSD and HRQOL.
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Affiliation(s)
- Markus A Landolt
- Department of Psychosomatics and Psychiatry, University Children's Hospital, Zurich, Switzerland.
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Stein DJ, van Honk J, Ipser J, Solms M, Panksepp J. Opioids: from physical pain to the pain of social isolation. CNS Spectr 2007; 12:669-70, 672-4. [PMID: 17805212 DOI: 10.1017/s1092852900021490] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The opioid systems play an important role in mediating both physical pain and negative affects (eg, the pain of social isolation). From an evolutionary perspective, it is not surprising that the neurocircuitry and neurochemistry of physical pain would overlap with that involved in complex social emotions. Exposure to trauma as well as a range of gene variants in the opioid system may be associated with alterations in opioid systems function, with changes in reward processing, and with vulnerability to substance abuse. A role for interventions with opioid agents in depression and anxiety disorders has been suggested.
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Affiliation(s)
- Dan J Stein
- Department of Mental Health and Psychiatry, University of Cape Town, South Africa
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