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Esopenko C, Jain D, Adhikari SP, Dams-O'Connor K, Ellis M, Haag HL, Hovenden ES, Keleher F, Koerte IK, Lindsey HM, Marshall AD, Mason K, McNally JS, Menefee DS, Merkley TL, Read EN, Rojcyk P, Shultz SR, Sun M, Toccalino D, Valera EM, van Donkelaar P, Wellington C, Wilde EA. Intimate Partner Violence-Related Brain Injury: Unmasking and Addressing the Gaps. J Neurotrauma 2024. [PMID: 38323539 DOI: 10.1089/neu.2023.0543] [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: 02/08/2024] Open
Abstract
Intimate partner violence (IPV) is a significant, global public health concern. Women, individuals with historically underrepresented identities, and disabilities are at high risk for IPV and tend to experience severe injuries. There has been growing concern about the risk of exposure to IPV-related head trauma, resulting in IPV-related brain injury (IPV-BI), and its health consequences. Past work suggests that a significant proportion of women exposed to IPV experience IPV-BI, likely representing a distinct phenotype compared with BI of other etiologies. An IPV-BI often co-occurs with psychological trauma and mental health complaints, leading to unique issues related to identifying, prognosticating, and managing IPV-BI outcomes. The goal of this review is to identify important gaps in research and clinical practice in IPV-BI and suggest potential solutions to address them. We summarize IPV research in five key priority areas: (1) unique considerations for IPV-BI study design; (2) understanding non-fatal strangulation as a form of BI; (3) identifying objective biomarkers of IPV-BI; (4) consideration of the chronicity, cumulative and late effects of IPV-BI; and (5) BI as a risk factor for IPV engagement. Our review concludes with a call to action to help investigators develop ecologically valid research studies addressing the identified clinical-research knowledge gaps and strategies to improve care in individuals exposed to IPV-BI. By reducing the current gaps and answering these calls to action, we will approach IPV-BI in a trauma-informed manner, ultimately improving outcomes and quality of life for those impacted by IPV-BI.
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Affiliation(s)
- Carrie Esopenko
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Divya Jain
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Shambhu Prasad Adhikari
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | - Kristen Dams-O'Connor
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Michael Ellis
- Department of Surgery, Section of Neurosurgery, University of Manitoba, Pan Am Clinic, Winnipeg, Manitoba, Canada
| | - Halina Lin Haag
- Faculty of Social Work, Wilfrid Laurier University, Ontario, Canada
- Acquired Brain Injury Research Lab, University of Toronto, Toronto, Canada
| | - Elizabeth S Hovenden
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Finian Keleher
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Inga K Koerte
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Mass General Brigham, Harvard Medical School, Somerville, Massachusetts, USA
| | - Hannah M Lindsey
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Amy D Marshall
- Department of Psychology, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Karen Mason
- Supporting Survivors of Abuse and Brain Injury through Research (SOAR), Kelowna, British Columbia, Canada
| | - J Scott McNally
- Department of Radiology and Imaging Sciences, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Deleene S Menefee
- Michael E. DeBakey VA Medical Center, The Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Tricia L Merkley
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Department of Psychology and Neuroscience Center, Brigham Young University, Provo, Utah, USA
| | - Emma N Read
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Philine Rojcyk
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Mass General Brigham, Harvard Medical School, Somerville, Massachusetts, USA
| | - Sandy R Shultz
- Health Sciences, Vancouver Island University, Nanaimo, Canada
- Department of Neuroscience, Monash University, Alfred Centre, Melbourne, Australia
| | - Mujun Sun
- Department of Neuroscience, Monash University, Alfred Centre, Melbourne, Australia
| | - Danielle Toccalino
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Eve M Valera
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Paul van Donkelaar
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | - Cheryl Wellington
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, Canada
- School of Biomedical Engineering, University of British Columbia, Vancouver, Canada
| | - Elisabeth A Wilde
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Department of Radiology and Imaging Sciences, University of Utah School of Medicine, Salt Lake City, Utah, USA
- George E. Wahlen ,VA Salt Lake City Heathcare System, Salt Lake City, Utah, USA
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2
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Lesmana CBJ, Suryani LK, Tiliopoulos N. The biobehavioural effectiveness of spiritual-hypnosis-assisted therapy in PTSD with childhood trauma. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2022. [DOI: 10.1186/s41983-022-00475-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Posttraumatic Stress Disorder (PTSD) is a serious psychological trauma disorder. Treatment of psychological trauma tends to focus on patients' memory. Clinical Spiritual-Hypnosis Assisted Therapy is a culturally sensitive treatment that combines elements of psychodynamic hypnosis, cognitive–behavioral and humanistic therapies.
Methods
The current interventional single-blind randomized control study assessed the biobehavioural effectiveness of spiritual-hypnosis on cortisol and PTSD symptomatology in adults with childhood trauma. Participants were divided into spiritual hypnosis (n = 15) and a control group (n = 14) that received fluoxetine. This study used PCL-C & CTQ to screen the presence and severity of PTSD symptoms.
Results
Spiritual hypnosis was significantly better than fluoxetine at reducing PTSD symptoms, while both treatments had similar effects on cortisol modification.
Conclusions
Spiritual-Hypnosis Assisted Therapy for PTSD patients with childhood trauma appears to have a noteworthy effect in reducing PTSD clinical symptoms and results in a comparable to the pharmacological treatment modification of the HPA axis cortisol markers.
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3
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Fu Q. Autonomic dysfunction and cardiovascular risk in post-traumatic stress disorder. Auton Neurosci 2021; 237:102923. [PMID: 34844132 DOI: 10.1016/j.autneu.2021.102923] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 09/28/2021] [Accepted: 11/13/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND Patients with post-traumatic stress disorder (PTSD) have an increased risk for cardiovascular disease. The underlying mechanisms are unclear but impaired autonomic function may contribute. However, research in this field has shown contradictory results and the causal links between PTSD, autonomic dysfunction, and cardiovascular risk remain unknown. This brief review summarizes the current knowledge on alterations in autonomic function and cardiovascular risk in patients with PTSD. LITERATURE SEARCH STRATEGY A PubMed search of the literature was performed using the following keywords: autonomic function, heart rate variability, blood pressure variability, sympathetic activity, baroreflex function, and cardiovascular risk in combination with PTSD. Evidence-based studies conducted between 2000 and 2021 were selected. RESULTS In total 1221 articles were identified and of these, 61 (48 original research papers, 13 review articles) were included in this review. Many, though not all, studies have reported increased activity of the sympathetic nervous system and decreased activity of the parasympathetic nervous system (namely, autonomic imbalance) in PTSD patients. There seems to be enough evidence to suggest impairments in baroreflex function in PTSD, leading to blood pressure dysregulation. It appears that the chronicity of PTSD diagnosis and symptom severity are independent risk factors for cardiovascular disease, which may be linked with impaired autonomic function. CONCLUSIONS Increased cardiovascular risk may be associated with autonomic dysfunction in PTSD. Whether autonomic dysfunction can serve as a biomarker for the onset and progression of PTSD remains to be determined. It also needs to determine if autonomic imbalance increases the risk of developing PTSD.
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Affiliation(s)
- Qi Fu
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States of America.
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4
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Non-communicable diseases among women survivors of intimate partner violence: Critical review from a chronic stress framework. Neurosci Biobehav Rev 2021; 128:720-734. [PMID: 34252471 DOI: 10.1016/j.neubiorev.2021.06.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 06/24/2021] [Accepted: 06/26/2021] [Indexed: 01/02/2023]
Abstract
A neurobiological framework of chronic stress proposes that the stress-response system can be functionally altered by the repeated presentation of highly stressful situations over time. These functional alterations mainly affect brain processing and include the dysregulation of the hypothalamic-pituitary-adrenal axis and associated processes. In the present critical review, we translate these results to inform the clinical presentation of women survivors of intimate partner violence (IPV). We approach IPV as a scenario of chronic stress where women are repetitively exposed to threat and coping behaviours that progressively shape their neurobiological response to stress. The changes at the central and peripheral levels in turn correlate with the phenotypes of non-communicable diseases. The reviewed studies clarify the extent of the impact of IPV on women's health in large (N > 10,000) population-based designs, and provide observations on experimental neuroendocrine, immune, neurocognitive and neuroimaging research linking alterations of the stress-response system and disease. This evidence supports the prevention of violence against women as a fundamental action to reduce the prevalence of non-communicable diseases.
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González-Vives S, Díaz-Marsá M, De la Vega I, Palomares N, Vázquez S, López-Villatoro JM, Palomo T, Carrasco JL. Hypothalamic-pituitary axis response to a 0.25-MG dexamethasone test in women with fibromyalgia. Stress 2020; 23:284-289. [PMID: 31591938 DOI: 10.1080/10253890.2019.1678024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Fibromyalgia has been reported as having some clinical overlap with both depression and emotionally-unstable disorders, although both types of disorders present different cortisol suppression response to dexamethasone. In this study we investigated the hypothalamic-pituitary-adrenal system (HPA) in the fibromyalgic syndrome (FMS) using a dexamethasone suppression test (DST) of 0.25 mg designed to specifically detect cortisol hypersuppression. We studied 59 women (20 patients and 39 healthy controls) to whom the DST was administered together with a battery of psychometric tests. In our results, patients with FMS had significant lower levels of basal cortisol pre- and post-DST compared with control subjects. However, cortisol suppression rate in patients after DST was not significantly different than in controls. As other syndromes like post-traumatic stress disorder or emotionally unstable personality disorders, also related with high incidence of severe trauma, FMS patients presented significant low basal cortisol. However, they did not have cortisol hypersuppression as is commonly found in the mentioned disorders. The relation of FMS with lifetime traumas and with emotional instability should be further investigated in order to improve psychological treatment approaches for these patients.LAY SUMMARYPatients with fibromyalgic syndrome have basal hypocortisoism but no cortisol hypersuppression after dexamethasone infusion compared to control subjects, as other trauma-related syndromes.
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Affiliation(s)
- Sara González-Vives
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Marina Díaz-Marsá
- Department of Psychiatry and Medical Psychology, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- Centro de Investigación en Red de Salud Mental (CIBERSAM), Hospital Gregorio Marañón, Madrid, Spain
| | - Irene De la Vega
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Nerea Palomares
- Centro de Investigación en Red de Salud Mental (CIBERSAM), Hospital Gregorio Marañón, Madrid, Spain
- Department of Personality, Evaluation and Clinical Psychology, Faculty of Psychology, Universidad Complutense de Madrid, Madrid, Spain
| | - Susana Vázquez
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | | | - Tomás Palomo
- Department of Psychiatry and Medical Psychology, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- Centro de Investigación en Red de Salud Mental (CIBERSAM), Hospital Gregorio Marañón, Madrid, Spain
| | - José Luis Carrasco
- Department of Psychiatry and Medical Psychology, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- Centro de Investigación en Red de Salud Mental (CIBERSAM), Hospital Gregorio Marañón, Madrid, Spain
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6
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Costache A, Riza AL, Ioana M, Glavan DG, Dinca ME, Vladu IM, Popescu M, Udristoiu I. Circulating Cortisol in a Cohort of Depressive Patients. CURRENT HEALTH SCIENCES JOURNAL 2020; 46:11-15. [PMID: 32637160 PMCID: PMC7323722 DOI: 10.12865/chsj.46.01.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 02/02/2020] [Indexed: 01/21/2023]
Abstract
It has long been suspected that the hypothalamic pituitary adrenal (HPA) axis plays a role in the pathophysiology of depression. Whether this association exists or not, and if it does, the degree of its significance, remain highly disputed. The issue is further complicated as no consensus currently exists on cortisol sampling timepoints or methods. Our study aimed to evaluate HPA functionality by evaluating plasma cortisol levels in a cohort of patients diagnosed with Major Depressive Disorder (MDD). We enrolled 96 subjects admitted for a major depressive episode and tested serum cortisol levels for 80 of them. We found that only 15 (12%) had values that were outside the normal reference range, with 14 of these being below the normal threshold. We also interviewed the patients and obtained self-reported information regarding previous depressive episodes, treatment administration, anxiety, suicidal ideas and suicidal gestures. Our study did not find a significant association between cortisol levels and the number of previous depressive episodes, the presence of feelings of anxiety, suicidal ideas or suicidal gestures. While our cohort did not find an association between cortisol levels and depression other authors have reported significantly different results and as such, more research is needed in order to establish or infirm this hypothesis.
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Affiliation(s)
| | - Anca-Lelia Riza
- University of Medicine and Pharmacy of Craiova, Romania
- Regional Center of Medical Genetics Craiova, County Emergency Hospital, Craiova, Romania
| | - Mihai Ioana
- University of Medicine and Pharmacy of Craiova, Romania
- Regional Center of Medical Genetics Craiova, County Emergency Hospital, Craiova, Romania
| | - Daniela Gabriela Glavan
- University of Medicine and Pharmacy of Craiova, Romania
- Clinical Hospital of Neuropsychiatry, Craiova, Romania
| | - Mihaela-Eugenia Dinca
- University of Medicine and Pharmacy of Craiova, Romania
- Filantropia Hospital, Craiova, Romania
| | - Ionela-Mihaela Vladu
- University of Medicine and Pharmacy of Craiova, Romania
- Filantropia Hospital, Craiova, Romania
| | - Mihaela Popescu
- University of Medicine and Pharmacy of Craiova, Romania
- Filantropia Hospital, Craiova, Romania
| | - Ion Udristoiu
- University of Medicine and Pharmacy of Craiova, Romania
- Clinical Hospital of Neuropsychiatry, Craiova, Romania
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7
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Godoy LD, Rossignoli MT, Delfino-Pereira P, Garcia-Cairasco N, de Lima Umeoka EH. A Comprehensive Overview on Stress Neurobiology: Basic Concepts and Clinical Implications. Front Behav Neurosci 2018; 12:127. [PMID: 30034327 PMCID: PMC6043787 DOI: 10.3389/fnbeh.2018.00127] [Citation(s) in RCA: 334] [Impact Index Per Article: 55.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 06/06/2018] [Indexed: 12/20/2022] Open
Abstract
Stress is recognized as an important issue in basic and clinical neuroscience research, based upon the founding historical studies by Walter Canon and Hans Selye in the past century, when the concept of stress emerged in a biological and adaptive perspective. A lot of research after that period has expanded the knowledge in the stress field. Since then, it was discovered that the response to stressful stimuli is elaborated and triggered by the, now known, stress system, which integrates a wide diversity of brain structures that, collectively, are able to detect events and interpret them as real or potential threats. However, different types of stressors engage different brain networks, requiring a fine-tuned functional neuroanatomical processing. This integration of information from the stressor itself may result in a rapid activation of the Sympathetic-Adreno-Medullar (SAM) axis and the Hypothalamus-Pituitary-Adrenal (HPA) axis, the two major components involved in the stress response. The complexity of the stress response is not restricted to neuroanatomy or to SAM and HPA axes mediators, but also diverge according to timing and duration of stressor exposure, as well as its short- and/or long-term consequences. The identification of neuronal circuits of stress, as well as their interaction with mediator molecules over time is critical, not only for understanding the physiological stress responses, but also to understand their implications on mental health.
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Affiliation(s)
- Lívea Dornela Godoy
- Physiology Department, Ribeirão Preto School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Matheus Teixeira Rossignoli
- Department of Neuroscience and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Polianna Delfino-Pereira
- Department of Neuroscience and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Norberto Garcia-Cairasco
- Physiology Department, Ribeirão Preto School of Medicine, University of São Paulo, São Paulo, Brazil
- Department of Neuroscience and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Eduardo Henrique de Lima Umeoka
- Department of Neuroscience and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
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8
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Krystal JH, Abdallah CG, Averill LA, Kelmendi B, Harpaz-Rotem I, Sanacora G, Southwick SM, Duman RS. Synaptic Loss and the Pathophysiology of PTSD: Implications for Ketamine as a Prototype Novel Therapeutic. Curr Psychiatry Rep 2017; 19:74. [PMID: 28844076 PMCID: PMC5904792 DOI: 10.1007/s11920-017-0829-z] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Studies of the neurobiology and treatment of PTSD have highlighted many aspects of the pathophysiology of this disorder that might be relevant to treatment. The purpose of this review is to highlight the potential clinical importance of an often-neglected consequence of stress models in animals that may be relevant to PTSD: the stress-related loss of synaptic connectivity. RECENT FINDINGS Here, we will briefly review evidence that PTSD might be a "synaptic disconnection syndrome" and highlight the importance of this perspective for the emerging therapeutic application of ketamine as a potential rapid-acting treatment for this disorder that may work, in part, by restoring synaptic connectivity. Synaptic disconnection may contribute to the profile of PTSD symptoms that may be targeted by novel pharmacotherapeutics.
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Affiliation(s)
- John H. Krystal
- Department of Psychiatry, Yale University School of Medicine, 300 George St., Suite #901, New Haven, CT 06511, USA,Clinical Neuroscience Division, VA National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA,Department of Neuroscience, Yale University School of Medicine, New Haven, CT, USA,Psychiatry Services, Yale-New Haven Hospital, New Haven, CT, USA
| | - Chadi G. Abdallah
- Department of Psychiatry, Yale University School of Medicine, 300 George St., Suite #901, New Haven, CT 06511, USA,Clinical Neuroscience Division, VA National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Lynette A. Averill
- Department of Psychiatry, Yale University School of Medicine, 300 George St., Suite #901, New Haven, CT 06511, USA,Clinical Neuroscience Division, VA National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Benjamin Kelmendi
- Department of Psychiatry, Yale University School of Medicine, 300 George St., Suite #901, New Haven, CT 06511, USA,Clinical Neuroscience Division, VA National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Ilan Harpaz-Rotem
- Department of Psychiatry, Yale University School of Medicine, 300 George St., Suite #901, New Haven, CT 06511, USA,Clinical Neuroscience Division, VA National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Gerard Sanacora
- Department of Psychiatry, Yale University School of Medicine, 300 George St., Suite #901, New Haven, CT 06511, USA,Department of Neuroscience, Yale University School of Medicine, New Haven, CT, USA,Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, CT, USA
| | - Steven M. Southwick
- Department of Psychiatry, Yale University School of Medicine, 300 George St., Suite #901, New Haven, CT 06511, USA,Clinical Neuroscience Division, VA National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA,Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, CT, USA
| | - Ronald S. Duman
- Department of Psychiatry, Yale University School of Medicine, 300 George St., Suite #901, New Haven, CT 06511, USA,Clinical Neuroscience Division, VA National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA,Department of Neuroscience, Yale University School of Medicine, New Haven, CT, USA,Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, New Haven, CT, USA
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9
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Boeckel MG, Viola TW, Daruy-Filho L, Martinez M, Grassi-Oliveira R. Intimate partner violence is associated with increased maternal hair cortisol in mother-child dyads. Compr Psychiatry 2017; 72:18-24. [PMID: 27693887 DOI: 10.1016/j.comppsych.2016.09.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Revised: 08/25/2016] [Accepted: 09/15/2016] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The chronic consequences of intimate partner violence (IPV) on HPA activation are a topic of debate. The current study investigated hair cortisol concentrations in female victims of IPV and their children. METHODS A total of 52 mother-child dyads were divided into two groups depending on exposure to IPV: IPV group (n=27 dyads) and control group (n=25 dyads). Hair cortisol concentration was measured in 1-cm-long hair strands, representing 30days of exposure before assessment. PTSD and depression symptoms were assessed in the mother and child. RESULTS Women reporting IPV presented with higher hair cortisol levels, depression and PTSD symptoms severity in comparison to control women. Children who witnessed IPV reported more severe PTSD symptoms, but depressive symptoms and hair cortisol were not statistically different than those in control children. Correlation analyses revealed a positive association between the number of injury events and the level of hair cortisol in children. No associations between the hair cortisol levels in mothers and those in their children were found. CONCLUSION Higher hair cortisol levels detected in women exposed to IPV reflected long-lasting changes in HPA axis functioning associated with chronic stress exposure. Children whose parents recurrently engage in violent conflicts with intimate partners may often feel threatened and consequently reporting more PTSD-related symptoms. Given that experiencing and witnessing violence during childhood and adolescence are predictive of intimate partner violence in adulthood, the need of early interventions is crucial.
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Affiliation(s)
- Mariana G Boeckel
- Developmental Cognitive Neuroscience Lab (DCNL), Pontifical Catholic University of Rio Grande do Sul, Av. Ipiranga, 6681 Prédio 11 Sala 936, Porto Alegre, RS 90619-900, Brazil
| | - Thiago Wendt Viola
- Developmental Cognitive Neuroscience Lab (DCNL), Pontifical Catholic University of Rio Grande do Sul, Av. Ipiranga, 6681 Prédio 11 Sala 936, Porto Alegre, RS 90619-900, Brazil
| | - Ledo Daruy-Filho
- Developmental Cognitive Neuroscience Lab (DCNL), Pontifical Catholic University of Rio Grande do Sul, Av. Ipiranga, 6681 Prédio 11 Sala 936, Porto Alegre, RS 90619-900, Brazil
| | - Manuela Martinez
- Department of Psychobiology, Faculty of Psychology, University of Valencia, Avda Blasco Ibañez, Valencia 2146010, Spain
| | - Rodrigo Grassi-Oliveira
- Developmental Cognitive Neuroscience Lab (DCNL), Pontifical Catholic University of Rio Grande do Sul, Av. Ipiranga, 6681 Prédio 11 Sala 936, Porto Alegre, RS 90619-900, Brazil.
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10
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Steudte-Schmiedgen S, Kirschbaum C, Alexander N, Stalder T. An integrative model linking traumatization, cortisol dysregulation and posttraumatic stress disorder: Insight from recent hair cortisol findings. Neurosci Biobehav Rev 2016; 69:124-35. [PMID: 27443960 DOI: 10.1016/j.neubiorev.2016.07.015] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 07/15/2016] [Accepted: 07/15/2016] [Indexed: 12/11/2022]
Abstract
Abundant evidence suggests links between trauma exposure, altered secretion of the glucocorticoid cortisol and the development/maintenance of posttraumatic stress disorder (PTSD), albeit with some inconsistency in findings. Further insight into the complex relations underlying this process may be derived from an increasing number of studies using hair cortisol analysis, a novel assessment strategy assumed to retrospectively capture long-term integrated cortisol secretion. Here, we evaluate the utility of hair cortisol analysis as a method in trauma/PTSD research and review current findings in this context. We compare hair cortisol data on the complex links between trauma, cortisol dysregulation and PTSD against the main findings obtained using traditional cortisol assessment methods. Finally, we integrate these data into a model which proposes that traumatization leads to dose and time-dependent changes in long-term cortisol output (initial post-traumatic increase, subsequent chronic attenuation) and that such dysregulation may partly mediate the link between traumatic load and the risk of PTSD development upon additional trauma exposure ("building block effect").
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Affiliation(s)
| | - Clemens Kirschbaum
- Department of Psychology, Technische Universität Dresden, 01062 Dresden, Germany
| | - Nina Alexander
- Department of Psychology, Technische Universität Dresden, 01062 Dresden, Germany
| | - Tobias Stalder
- Department of Psychology, Technische Universität Dresden, 01062 Dresden, Germany
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11
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Romero-Martínez A, Lila M, Vitoria-Estruch S, Moya-Albiol L. High Immunoglobulin A Levels Mediate the Association Between High Anger Expression and Low Somatic Symptoms in Intimate Partner Violence Perpetrators. JOURNAL OF INTERPERSONAL VIOLENCE 2016; 31:732-742. [PMID: 25389190 DOI: 10.1177/0886260514556107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
It has been hypothesized that anger expression may be associated with increased salivary immunoglobulin A (sIgA) levels, which is associated with decreased somatic symptoms, and therefore anger expression may be associated with reduced somatic symptoms in intimate partner violence (IPV) perpetrators. This study tested the potential mediating effect of sIgA levels on the relationship between anger expression and respiratory and gastrointestinal symptoms in IPV perpetrators and non-violent controls. The sample consisted of IPV perpetrators (n = 19) and controls (n = 21). Saliva samples were collected for assessing sIgA levels. The State-Trait Anger Expression Inventory-2 was used to assess anger expression and the Revised version of the Somatic Symptoms Scale developed by Sandín and Chorot to measure somatic symptoms. High anger expression was associated with low levels of respiratory and gastrointestinal symptoms in IPV perpetrators mediated through high sIgA levels but the same was not true for non-violent controls. This finding supports the hypothesis that for IPV perpetrators, anger expression may be physiologically and psychologically rewarding. Future research examining other immunological parameters is needed to further test this hypothesis. Such effort may illuminate why some IPV perpetrators continue to use violence against their partners.
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Affiliation(s)
| | - M Lila
- Department of Social Psychology, Valencia University, Spain
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12
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van der Werff SJA, Pannekoek JN, Andela CD, Meijer OC, van Buchem MA, Rombouts SARB, van der Mast RC, Biermasz NR, Pereira AM, van der Wee NJA. Resting-State Functional Connectivity in Patients with Long-Term Remission of Cushing's Disease. Neuropsychopharmacology 2015; 40:1888-98. [PMID: 25652248 PMCID: PMC4839512 DOI: 10.1038/npp.2015.38] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 01/08/2015] [Accepted: 01/09/2015] [Indexed: 01/21/2023]
Abstract
Glucocorticoid disturbance can be a cause of psychiatric symptoms. Cushing's disease represents a unique model for examining the effects of prolonged exposure to high levels of endogenous cortisol on the human brain as well as for examining the relation between these effects and psychiatric symptomatology. This study aimed to investigate resting-state functional connectivity (RSFC) of the limbic network, the default mode network (DMN), and the executive control network in patients with long-term remission of Cushing's disease. RSFC of these three networks of interest was compared between patients in remission of Cushing's disease (n=24; 4 male, mean age=44.96 years) and matched healthy controls (n=24; 4 male, mean age=46.5 years), using probabilistic independent component analysis to extract the networks and a dual regression method to compare both groups. Psychological and cognitive functioning was assessed with validated questionnaires and interviews. In comparison with controls, patients with remission of Cushing's disease showed an increased RSFC between the limbic network and the subgenual subregion of the anterior cingulate cortex (ACC) as well as an increased RSFC of the DMN in the left lateral occipital cortex. However, these findings were not associated with psychiatric symptoms in the patient group. Our data indicate that previous exposure to hypercortisolism is related to persisting changes in brain function.
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Affiliation(s)
- Steven J A van der Werff
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands,Leiden Institute for Brain and Cognition, Leiden, The Netherlands,Department of Psychiatry, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands, Tel: +31 71 526 2281, Fax: +31 71 524 8156, E-mail:
| | - J Nienke Pannekoek
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands,Leiden Institute for Brain and Cognition, Leiden, The Netherlands
| | - Cornelie D Andela
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands,Department of Endocrinology and Metabolic Diseases and Center for Endocrine Tumors, Leiden University Medical Center, Leiden, The Netherlands
| | - Onno C Meijer
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands,Department of Endocrinology and Metabolic Diseases and Center for Endocrine Tumors, Leiden University Medical Center, Leiden, The Netherlands
| | - Mark A van Buchem
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands,Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Serge A R B Rombouts
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands,Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands,Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Roos C van der Mast
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - Nienke R Biermasz
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands,Department of Endocrinology and Metabolic Diseases and Center for Endocrine Tumors, Leiden University Medical Center, Leiden, The Netherlands
| | - Alberto M Pereira
- Leiden Institute for Brain and Cognition, Leiden, The Netherlands,Department of Endocrinology and Metabolic Diseases and Center for Endocrine Tumors, Leiden University Medical Center, Leiden, The Netherlands
| | - Nic J A van der Wee
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands,Leiden Institute for Brain and Cognition, Leiden, The Netherlands
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13
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Nicholson EL, Bryant RA, Felmingham KL. Interaction of noradrenaline and cortisol predicts negative intrusive memories in posttraumatic stress disorder. Neurobiol Learn Mem 2014; 112:204-11. [DOI: 10.1016/j.nlm.2013.11.018] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 10/31/2013] [Accepted: 11/24/2013] [Indexed: 11/27/2022]
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14
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Immunoglobulin A response to acute stress in intimate partner violence perpetrators: The role of anger expression-out and testosterone. Biol Psychol 2014; 96:66-71. [DOI: 10.1016/j.biopsycho.2013.11.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Revised: 11/25/2013] [Accepted: 11/25/2013] [Indexed: 11/19/2022]
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15
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Wieck A, Grassi-Oliveira R, Hartmann do Prado C, Teixeira AL, Bauer ME. Neuroimmunoendocrine interactions in post-traumatic stress disorder: focus on long-term implications of childhood maltreatment. Neuroimmunomodulation 2014; 21:145-51. [PMID: 24557048 DOI: 10.1159/000356552] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Childhood maltreatment has been linked to enhanced vulnerability to psychiatric pathologies in adult life, including post-traumatic stress disorder (PTSD). Previous works have reported cogent neuroendocrine and immune changes related to adult traumatic events (war survivors, refugees, etc.), but little information is known regarding the impact of early-life stress (ELS) in adult physiology. Here, we review the neuroendocrine and immunological changes commonly observed in PTSD, focusing on the long-term implications of ELS. Childhood maltreatment may lead to altered glucocorticoid (GC) secretion, resulting in hypo- or hypercortisolemia, and reciprocal changes in peripheral leukocyte sensitivity to GC. It is believed that these neuroendocrine changes are correlated with the immune imbalance phenomenon (low-grade inflammation), characterized by increased plasma levels of pro-inflammatory cytokines (TNF-α, IL-1β, IL-6) and C-reactive protein. Changes in peripheral lymphocyte subsets are also documented, such as a reduction in regulatory T cells and an expansion of activated T cells. The excess of circulating cytokines may thus interfere with key brain neurotransmitter pathways involved in depression and enhanced risk to cardiovascular, respiratory, gastrointestinal, inflammatory and autoimmune diseases. Recent gene-environment and epigenetic findings have indicated potential molecular mechanisms linking ELS, neuroendocrine and immunity in PTSD.
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Affiliation(s)
- Andréa Wieck
- Laboratory of Immunosenescence, Institute of Biomedical Research, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
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16
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Steudte S, Kirschbaum C, Gao W, Alexander N, Schönfeld S, Hoyer J, Stalder T. Hair cortisol as a biomarker of traumatization in healthy individuals and posttraumatic stress disorder patients. Biol Psychiatry 2013; 74:639-46. [PMID: 23623187 DOI: 10.1016/j.biopsych.2013.03.011] [Citation(s) in RCA: 149] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 03/18/2013] [Accepted: 03/19/2013] [Indexed: 01/22/2023]
Abstract
BACKGROUND Previous evidence on endocrine correlates of posttraumatic stress disorder (PTSD) has been rather inconsistent. The analysis of cortisol in hair is a recent methodological development that may increase the quality of long-term cortisol assessments in such research. Here, we use this method to closely assess hair cortisol relationships with trauma-related characteristics and PTSD symptom patterns. METHODS Hair cortisol concentrations (HCC), diurnal salivary cortisol, and relevant psychometric data were assessed in matched groups of 28 PTSD patients and 27 traumatized and 32 nontraumatized healthy control subjects. Cortisol levels were quantified by liquid chromatography tandem mass spectrometry. RESULTS Posttraumatic stress disorder patients and traumatized control subjects exhibited 59% and 51% lower HCC than nontraumatized control subjects, respectively. Hair cortisol concentrations were found to be negatively related to the severity of intrusion symptoms, the number of different lifetime traumatic events, the frequency of traumatization, and the time interval since traumatization. The overall pattern of HCC associations was not reflected in short-term salivary cortisol findings. CONCLUSIONS Our results indicate that trauma exposure per se, either in the absence or presence of PTSD, is a crucial correlate of long-term basal cortisol levels. Particularly, the experience of multiple events with a longer time since traumatization and an increased severity of intrusion symptoms may be related to hypocortisolism. The fact that HCC findings were not consistently seen in salivary cortisol data underscores the importance of the method of cortisol assessment and highlights the utility of hair cortisol analyses for future biological psychiatry research.
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Affiliation(s)
- Susann Steudte
- Institute of Biological Psychology, Technische Universität Dresden, Dresden, Germany
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17
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Romero-Martínez A, González-Bono E, Lila M, Moya-Albiol L. Testosterone/cortisol ratio in response to acute stress: a possible marker of risk for marital violence. Soc Neurosci 2013; 8:240-7. [PMID: 23428161 DOI: 10.1080/17470919.2013.772072] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Testosterone to cortisol (T/C) ratios could be associated with feelings and expression of anger as high testosterone and low cortisol levels indicate a predisposition to violence. The basal T/C ratio has recently been proposed as a marker for proneness to social aggression; so far, however, only its value as an indicator of state anger or violence has been investigated. Given this, we aimed to establish whether the T/C ratio response to acute stress was a specific psychobiological feature in individuals with a history of violence, namely, perpetrators of intimate partner violence (IPV). T/C ratio and anger responses were compared in men jailed for IPV and controls using the Trier Social Stress Test. IPV perpetrators had higher T/C ratios than controls, during the preparation period, and 15 and 30 minutes post-task. In IPV perpetrators, high T/C ratios were linked to better self-esteem and good mental health. An increase in anger may increase proneness to violence by altering hormones and, thereby, increasing T/C ratios. The basal T/C ratio together with acute stress responses and other indicators could serve as a marker to identify men at high risk of reacting violently to their partners.
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18
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Klaassens ER, Giltay EJ, Cuijpers P, van Veen T, Zitman FG. Adulthood trauma and HPA-axis functioning in healthy subjects and PTSD patients: a meta-analysis. Psychoneuroendocrinology 2012; 37:317-31. [PMID: 21802212 DOI: 10.1016/j.psyneuen.2011.07.003] [Citation(s) in RCA: 127] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2010] [Revised: 07/03/2011] [Accepted: 07/03/2011] [Indexed: 12/14/2022]
Abstract
BACKGROUND Hypothalamic-pituitary-adrenal (HPA)-axis dysregulation has inconsistently been associated with posttraumatic stress disorder (PTSD). Yet, trauma exposure rather than PTSD may be responsible for HPA-axis dysregulation. In two meta-analyses, we assessed the association of adulthood trauma exposure and HPA-axis functioning in healthy subjects with and without PTSD. METHOD A literature search in Pubmed and PsychInfo, using keywords and MeSH terms such as cortisol, emotional trauma, and PTSD, was performed. Only studies that included mentally healthy trauma-exposed (TE) individuals as well as non-exposed (NE) healthy individuals and/or PTSD patients (PTSD) were selected. This resulted in 1511 studies of which ultimately, 37 studies (21 TE versus NE and 34 TE versus PTSD, N=2468) were included. Methodological quality of all studies was assessed according to specific quality criteria. Pooled effect sizes (Hedges's g) on cortisol levels were compared. For all analyses, random effect models were used. RESULTS Cortisol levels were neither significantly different between TE versus NE subjects (-0.029; 95%CI: -0.145; 0.088) nor between TE subjects versus PTSD patients (0.175; 95%CI: -0.012; -0.362). Subgroup analyses showed an increased cortisol suppression after the low dose dexamethasone suppression test (DST) in TE versus NE subjects (-0.509; 95%CI: -0.871; -0.148). This meta-analysis was limited by the fact that lifetime psychiatric illness and childhood trauma were not an exclusion criterion in all 37 studies. CONCLUSION Neither adulthood trauma exposure nor PTSD were associated with differences in HPA-axis functioning, although adulthood trauma may augment cortisol suppression after the DST. More evidence on other dynamic tests of HPA-axis functioning in PTSD and adulthood trauma exposure is needed.
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Affiliation(s)
- Ellen R Klaassens
- Department of Psychiatry, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
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19
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The effect of trauma on stress reactivity in aggressive youth. Psychiatry Res 2011; 189:396-402. [PMID: 21684014 DOI: 10.1016/j.psychres.2011.05.046] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Revised: 02/28/2011] [Accepted: 05/29/2011] [Indexed: 11/23/2022]
Abstract
To address gaps in the literature related to the contribution of childhood trauma on aggression, we evaluated salivary cortisol and heart rate changes to psychological challenge in aggressive children with various degrees of trauma. We hypothesized that traumatized and aggressive youths will exhibit higher responsiveness to an active challenge (Violent film-VF) than aggressive youth with no trauma but will not differ when viewing a Non-Violent film (NVF). A total of 25 children (aged 9-12; M=15, F=9) with history of aggression were assessed for trauma exposure. Children viewed the two films in randomized order. Four salivary cortisol and pulse measurements were obtained before (T1), 15 min after the start (T2), at the end (T3), and 15 min following the end of the movie (T4). Repeated measures Analysis of Covariance (ANCOVA) using Film (VF/NVF), Cortisol/Time at T1-T4, Group (Trauma/Non-Trauma), and Film Order were performed with age and gender as covariates. There were significant main effects for Group and Cortisol/Time for the Trauma group showing greater cortisol responsiveness than the Non-Trauma group that was most pronounced during the NVF. These results suggest that aggressive youth with personal history of trauma may exhibit unique biological characteristics, which may have important implications for classification and treatment.
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20
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Increased cortisol concentrations in hair of severely traumatized Ugandan individuals with PTSD. Psychoneuroendocrinology 2011; 36:1193-200. [PMID: 21411229 DOI: 10.1016/j.psyneuen.2011.02.012] [Citation(s) in RCA: 125] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Revised: 02/16/2011] [Accepted: 02/16/2011] [Indexed: 11/21/2022]
Abstract
Previous research has mostly suggested general hypocortisolism in posttraumatic stress disorder (PTSD). However, PTSD is a complex disorder and opposite neuroendocrinological changes have also been reported. Amongst other things, heterogeneous results might be related to differences in sample characteristics as well as methodological factors associated with the assessment of cortisol. The current study used the novel method of hair cortisol analysis to examine cumulative long-term cortisol secretion in a severely traumatized PTSD sample. Hair samples of 10 traumatized individuals with PTSD and 17 traumatized controls without PTSD from a civil war area of Northern Uganda were analyzed. Results revealed that hair samples of PTSD participants contained higher cortisol levels than those of traumatized controls (p<.05). Furthermore, a positive association between hair cortisol levels and the number of lifetime traumatic events was found (p<.05). The current hair cortisol findings suggest that PTSD in severely traumatized individuals who continue to live under stressful conditions might be associated with general hypercortisolism. Future research examining participants after traumatic events at different follow-up periods is needed to determine the specific influence of time interval since traumatization.
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Kwako LE, Glass N, Campbell J, Melvin KC, Barr T, Gill JM. Traumatic brain injury in intimate partner violence: a critical review of outcomes and mechanisms. TRAUMA, VIOLENCE & ABUSE 2011; 12:115-126. [PMID: 21511686 DOI: 10.1177/1524838011404251] [Citation(s) in RCA: 138] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The prevalence of intimate partner violence (IPV) is striking, as are its consequences to the lives of women. The IPV often includes physical assault, which can include injuries to the head and attempted strangulation injuries. Both types of injuries can result in traumatic brain injury (TBI). The TBI sustained during IPV often occurs over time, which can increase the risk for health declines and postconcussive syndrome (PCS). Current studies have identified sequelae of cognitive dysfunction, posttraumatic stress disorder, and depression in women experiencing IPV, yet, most fail to determine the role of TBI in the onset and propagation of these disorders. Although imaging studies indicate functional differences in neuronal activation in IPV, they also have not considered the possibility of TBI contributing to these outcomes. This review highlights the significant gaps in current findings related to neuropsychological complications and medical and psychosocial symptoms that likely result in greater morbidity, as well as the societal costs of failing to acknowledge the association of IPV and TBI in women.
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Affiliation(s)
- Laura E Kwako
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA.
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Wroble‐Biglan MC, Dietz LJ, Pienkosky TV. Prediction of infant temperament from catecholamine and self‐report measures of maternal stress during pregnancy. J Reprod Infant Psychol 2009. [DOI: 10.1080/02646830903190912] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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23
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Zhang L, Li H, Benedek D, Li X, Ursano R. A strategy for the development of biomarker tests for PTSD. Med Hypotheses 2009; 73:404-9. [DOI: 10.1016/j.mehy.2009.02.038] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Revised: 02/09/2009] [Accepted: 02/12/2009] [Indexed: 10/20/2022]
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Handwerger K. Differential patterns of HPA activity and reactivity in adult posttraumatic stress disorder and major depressive disorder. Harv Rev Psychiatry 2009; 17:184-205. [PMID: 19499418 DOI: 10.1080/10673220902996775] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Despite a number of overlapping symptoms, individuals with posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) often display hypothalamic-pituitary-adrenal (HPA) profiles that appear quite different from one another. This review describes the patterns of HPA-axis activity and reactivity in healthy individuals compared to individuals with these two disorders. Measures of HPA-axis activity and reactivity include cortisol levels at rest, in response to the dexamethasone suppression test (DST), and in response to psychological stress. The research reviewed presents the possibility of diagnostic specificity with regard to HPA function. In particular, the differential response pattern to the DST suggests that, while it cannot be considered a pure diagnostic tool, it should be one measure taken into consideration during diagnosis.
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25
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Cruwys T, O'Kearney R. Implications of neuroscientific evidence for the cognitive models of post-traumatic stress disorder. CLIN PSYCHOL-UK 2008. [DOI: 10.1080/13284200802356820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Tegan Cruwys
- Department of Psychology, Australian National University , Canberra, Australian Capital Territory, Australia
| | - Richard O'Kearney
- Department of Psychology, Australian National University , Canberra, Australian Capital Territory, Australia
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Carpenter LL, Carvalho JP, Tyrka AR, Wier LM, Mello AF, Mello MF, Anderson GM, Wilkinson CW, Price LH. Decreased adrenocorticotropic hormone and cortisol responses to stress in healthy adults reporting significant childhood maltreatment. Biol Psychiatry 2007; 62:1080-7. [PMID: 17662255 PMCID: PMC2094109 DOI: 10.1016/j.biopsych.2007.05.002] [Citation(s) in RCA: 401] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2006] [Revised: 04/25/2007] [Accepted: 05/02/2007] [Indexed: 12/18/2022]
Abstract
BACKGROUND Preclinical research findings suggest that exposure to stress and concomitant hypothalamus-pituitary-adrenal (HPA) axis activation during early development can have permanent and potentially deleterious effects. A history of early-life abuse or neglect appears to increase risk for mood and anxiety disorders. Abnormal HPA response to stress challenge has been reported in adult patients with major depressive disorder and posttraumatic stress disorder. METHODS Plasma adrenocorticotropin hormone (ACTH) and cortisol reactivity to the Trier Social Stress Test were examined in healthy adults (n = 50) without current psychopathology. Subjects with a self-reported history of moderate to severe childhood maltreatment (MAL) (n = 23) as measured by the Childhood Trauma Questionnaire were compared with subjects without such a history (CTL) (n = 27). RESULTS Compared with CTLs, MAL subjects exhibited significantly lower cortisol and ACTH baseline-to-peak deltas. A significant group effect was seen in the (repeated measures) cortisol response to the stress challenge, reflecting lower concentrations among MAL subjects. A significant group x time effect characterized the relatively blunted ACTH response of the MAL group. Emotional neglect (-.34, p = .02) and sexual abuse (.31, p = .03) strongly predicted maximal cortisol release. CONCLUSIONS In adults without diagnosable psychopathology, childhood maltreatment is associated with diminished HPA axis response to a psychosocial stressor. Possible explanations for the finding are discussed.
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Affiliation(s)
- Linda L Carpenter
- Mood Disorders Research Program, Butler Hospital, Brown Medical School, Providence, Rhode Island 02906, USA
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Abstract
PURPOSE The purpose of this article is to describe the effects of traumatic stress on brain structure and function, and the relationship of these neurobiological changes to symptoms experienced after trauma. CONCLUSIONS Exposure to traumatic stress is associated with changes in the limbic system, the hypothalamic-pituitary-adrenal axis, and key monoamine neurotransmitters. Different neurobiological alterations can be linked to specific symptoms of hyperarousal, dissociation/numbing, and reexperiencing of the trauma. PRACTICE IMPLICATIONS Understanding what is happening in the brain can inform more targeted treatment for various symptoms that the individual may be experiencing.
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Affiliation(s)
- Sandra J Weiss
- Department of Community Health Systems, School of Nursing at the University of California, San Francisco, CA, USA.
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