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Anderson D, Jones V. Psychological interventions for cancer-related post-traumatic stress disorder: narrative review. BJPsych Bull 2024; 48:100-109. [PMID: 37288666 PMCID: PMC10985725 DOI: 10.1192/bjb.2023.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 03/31/2023] [Accepted: 04/23/2023] [Indexed: 06/09/2023] Open
Abstract
AIMS AND METHOD This narrative review updates the evidence base for cancer-related post-traumatic stress disorder (PTSD). Databases were searched in December 2021, and included EMBASE, Medline, PsycINFO and PubMed. Adults diagnosed with cancer who had symptoms of PTSD were included. RESULTS The initial search identified 182 records, and 11 studies were included in the final review. Psychological interventions were varied, and cognitive-behavioural therapy and eye movement desensitisation and reprocessing were perceived to be most efficacious. The studies were also independently rated for methodological quality, which was found to be hugely variable. CLINICAL IMPLICATIONS There remains a lack of high-quality intervention studies for PTSD in cancer, and there is a wide range of approaches to managing these conditions, with a large heterogeneity in the cancer populations examined and methodologies used. Specific studies designed with patient and public engagement and that tailor the PTSD intervention to particular cancer populations under investigation are required.
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Affiliation(s)
| | - Victoria Jones
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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2
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Childhood maltreatment, traumatic experiences, and posttraumatic stress disorder in pathological skin picking: An online case-control study. Gen Hosp Psychiatry 2022; 78:9-13. [PMID: 35752025 DOI: 10.1016/j.genhosppsych.2022.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 06/07/2022] [Accepted: 06/10/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Although traumatic stress including childhood maltreatment (CM) has a profound impact on mental health, its relation to pathological skin picking (PSP) has been understudied and results remain inconclusive. Likewise, posttraumatic stress disorder (PTSD) as the most typical sequelae of traumatic stress has hardly been investigated in those with PSP. The objective of our online case-control study was to shed further light on this issue. METHODS Using an anonymous online survey, 325 adult participants with PSP defined by Skin Picking Scale-Revised (SPS-R) scores ≥ 7 as well as Skin Picking Impact Scale (SPIS) scores ≥ 7 were administered the Childhood Trauma Questionnaire (CTQ), the Short Screening Scale for DSM-IV PTSD (PTSD-7) including a list of traumatic events, and a brief measure of psychopathological distress. They were compared to an age-, sex-, and education-matched control group recruited online by means of analyses of variance (ANOVA). RESULTS The PSP sample scored significantly higher on the CTQ dimensions of sexual and emotional abuse as well as emotional neglect with small to moderate effect sizes (d between 0.27 and 0.49). Accounting for psychological distress, the only significant difference related to emotional abuse with a small effect (d = 0.23). Participants with PSP reported significantly more traumatic experiences in adulthood than the control group (59.1% vs. 38.2%; χ2(1; N=638) = 28.02, p < .001). Among those with PSP, a probable diagnosis of PTSD was found in 44 (13.5%) compared to zero cases in the control group. CONCLUSIONS Our findings indicate that emotional abuse in childhood may be of relevance in skin picking. Since exposure to traumatic events in adulthood as well as PTSD seem to be more frequent in those with PSP compared to a control group, it might be worthwhile to consider these factors in the assessment of patients with skin picking.
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Núñez-Rios DL, Martínez-Magaña JJ, Nagamatsu ST, Andrade-Brito DE, Forero DA, Orozco-Castaño CA, Montalvo-Ortiz JL. Central and Peripheral Immune Dysregulation in Posttraumatic Stress Disorder: Convergent Multi-Omics Evidence. Biomedicines 2022; 10:biomedicines10051107. [PMID: 35625844 PMCID: PMC9138536 DOI: 10.3390/biomedicines10051107] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 04/29/2022] [Accepted: 05/04/2022] [Indexed: 11/16/2022] Open
Abstract
Posttraumatic stress disorder (PTSD) is a chronic and multifactorial disorder with a prevalence ranging between 6–10% in the general population and ~35% in individuals with high lifetime trauma exposure. Growing evidence indicates that the immune system may contribute to the etiology of PTSD, suggesting the inflammatory dysregulation as a hallmark feature of PTSD. However, the potential interplay between the central and peripheral immune system, as well as the biological mechanisms underlying this dysregulation remain poorly understood. The activation of the HPA axis after trauma exposure and the subsequent activation of the inflammatory system mediated by glucocorticoids is the most common mechanism that orchestrates an exacerbated immunological response in PTSD. Recent high-throughput analyses in peripheral and brain tissue from both humans with and animal models of PTSD have found that changes in gene regulation via epigenetic alterations may participate in the impaired inflammatory signaling in PTSD. The goal of this review is to assess the role of the inflammatory system in PTSD across tissue and species, with a particular focus on the genomics, transcriptomics, epigenomics, and proteomics domains. We conducted an integrative multi-omics approach identifying TNF (Tumor Necrosis Factor) signaling, interleukins, chemokines, Toll-like receptors and glucocorticoids among the common dysregulated pathways in both central and peripheral immune systems in PTSD and propose potential novel drug targets for PTSD treatment.
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Affiliation(s)
- Diana L. Núñez-Rios
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, USA; (D.L.N.-R.); (J.J.M.-M.); (S.T.N.); (D.E.A.-B.)
- VA CT Healthcare Center, West Haven, CT 06516, USA
| | - José J. Martínez-Magaña
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, USA; (D.L.N.-R.); (J.J.M.-M.); (S.T.N.); (D.E.A.-B.)
- VA CT Healthcare Center, West Haven, CT 06516, USA
| | - Sheila T. Nagamatsu
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, USA; (D.L.N.-R.); (J.J.M.-M.); (S.T.N.); (D.E.A.-B.)
- VA CT Healthcare Center, West Haven, CT 06516, USA
| | - Diego E. Andrade-Brito
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, USA; (D.L.N.-R.); (J.J.M.-M.); (S.T.N.); (D.E.A.-B.)
- VA CT Healthcare Center, West Haven, CT 06516, USA
| | - Diego A. Forero
- Health and Sport Sciences Research Group, School of Health and Sport Sciences, Fundación Universitaria del Área Andina, Bogotá 110231, Colombia; (D.A.F.); (C.A.O.-C.)
| | - Carlos A. Orozco-Castaño
- Health and Sport Sciences Research Group, School of Health and Sport Sciences, Fundación Universitaria del Área Andina, Bogotá 110231, Colombia; (D.A.F.); (C.A.O.-C.)
| | - Janitza L. Montalvo-Ortiz
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, USA; (D.L.N.-R.); (J.J.M.-M.); (S.T.N.); (D.E.A.-B.)
- VA CT Healthcare Center, West Haven, CT 06516, USA
- Correspondence: ; Tel.: +1-(203)-9325711 (ext. 7491)
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4
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Renner V, Schellong J, Bornstein S, Petrowski K. Stress-induced pro- and anti-inflammatory cytokine concentrations in female PTSD and depressive patients. Transl Psychiatry 2022; 12:158. [PMID: 35422029 PMCID: PMC9010431 DOI: 10.1038/s41398-022-01921-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 03/22/2022] [Accepted: 03/25/2022] [Indexed: 12/31/2022] Open
Abstract
Alterations of the hypothalamus pituitary-axis on one hand and heightened rates of somatic diseases and mortality on the other hand are consistently found for PTSD and MDD patients. A possible link between these factors might be the immune system, in particular pro- and anti-inflammatory cytokines. A 'low-grade inflammation' in PTSD and MDD patients was found, whereas the influence of acute stress and the role of anti-inflammatory cytokines was rarely examined. In this study, 17 female PTSD patients participated in the Trier social stress test while serum cytokine levels (IL-6, IL-10) were assessed. Cytokine levels of PTSD patients were compared with levels of female depressive patients (n = 18) and female healthy controls (n = 18). Group differences were assessed using a 3 (group) x 8 (time: -15, -1, +1, +10, +20, +30, +45, +60 min) ANCOVA for repeated measures with baseline values as covariates. There was no group difference regarding IL-6 levels (p = 0.920) but PTSD patients showed significantly higher levels of IL-10 compared with depressive patients (p < 0.001, d = 0.16) and healthy controls (p = 0.001, d = 0.38). Under acute stress, PTSD patients did not show the widely found elevated IL-6 levels but showed an increase of anti-inflammatory IL-10. Therefore, acute stress seems to promote an imbalance of pro- and anti-inflammatory cytokine levels in PTSD and might indicate a hyperreactive immune response. This should be considered in future studies to further understand the role of the immune system as a link between stress response and somatic diseases.
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Affiliation(s)
- Vanessa Renner
- Medical Psychology & Medical Sociology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
| | - Julia Schellong
- grid.4488.00000 0001 2111 7257University Medical Center Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Stefan Bornstein
- grid.4488.00000 0001 2111 7257University Medical Center Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Katja Petrowski
- grid.410607.4Medical Psychology & Medical Sociology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany ,grid.4488.00000 0001 2111 7257University Medical Center Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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5
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Womersley JS, Nothling J, Toikumo S, Malan-Müller S, van den Heuvel LL, McGregor NW, Seedat S, Hemmings SMJ. Childhood trauma, the stress response and metabolic syndrome: A focus on DNA methylation. Eur J Neurosci 2021; 55:2253-2296. [PMID: 34169602 DOI: 10.1111/ejn.15370] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 05/13/2021] [Accepted: 06/12/2021] [Indexed: 12/12/2022]
Abstract
Childhood trauma (CT) is well established as a potent risk factor for the development of mental disorders. However, the potential of adverse early experiences to exert chronic and profound effects on physical health, including aberrant metabolic phenotypes, has only been more recently explored. Among these consequences is metabolic syndrome (MetS), which is characterised by at least three of five related cardiometabolic traits: hypertension, insulin resistance/hyperglycaemia, raised triglycerides, low high-density lipoprotein and central obesity. The deleterious effects of CT on health outcomes may be partially attributable to dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, which coordinates the response to stress, and the consequent fostering of a pro-inflammatory environment. Epigenetic tags, such as DNA methylation, which are sensitive to environmental influences provide a means whereby the effects of CT can be biologically embedded and persist into adulthood to affect health and well-being. The methylome regulates the transcription of genes involved in the stress response, metabolism and inflammation. This narrative review examines the evidence for DNA methylation in CT and MetS in order to identify shared neuroendocrine and immune correlates that may mediate the increased risk of MetS following CT exposure. Our review specifically highlights differential methylation of FKBP5, the gene that encodes FK506-binding protein 51 and has pleiotropic effects on stress responding, inflammation and energy metabolism, as a central candidate to understand the molecular aetiology underlying CT-associated MetS risk.
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Affiliation(s)
- Jacqueline S Womersley
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,South African Medical Research Council/Stellenbosch University Genomics of Brain Disorders Research Unit, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Jani Nothling
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,South African Medical Research Council/Stellenbosch University Genomics of Brain Disorders Research Unit, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,Gender and Health Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Sylvanus Toikumo
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Stefanie Malan-Müller
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Leigh L van den Heuvel
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,South African Medical Research Council/Stellenbosch University Genomics of Brain Disorders Research Unit, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Nathaniel W McGregor
- Systems Genetics Working Group, Department of Genetics, Faculty of Agriculture, Stellenbosch University, Stellenbosch, South Africa
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,South African Medical Research Council/Stellenbosch University Genomics of Brain Disorders Research Unit, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Sîan M J Hemmings
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,South African Medical Research Council/Stellenbosch University Genomics of Brain Disorders Research Unit, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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6
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Baig MR, Ouyang S, Mata-Galán E, Dawes MA, Roache JD. A Comparison of Cognitive Processing Therapy and Seeking Safety for the Treatment of Posttraumatic Stress Disorder in Veterans. Psychiatr Q 2021; 92:735-750. [PMID: 32964375 DOI: 10.1007/s11126-020-09850-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/17/2020] [Indexed: 11/30/2022]
Abstract
To compare the outcomes of Seeking Safety (SS) and cognitive processing therapy (CPT) in veterans with PTSD in a specialty clinic of an urban VA medical center. Retrospective chart review of electronic medical records was conducted for 420 veterans with PTSD who received treatment with either CPT (n = 227) or SS (n = 193) in group setting. 1) treatment completion rate, 2) self-reported PTSD symptom severity measured by PTSD checklist (PCL), and 3) additional mental health services received within 12 months after treatment. Data were analyzed for the 160 who had both a pre and post PCL documented in their charts. The final analysis sample included n = 94 for CPT and n = 66 for SS veterans with a mean age of 49.71[SD = 14] years, 24 women [15%]; mean baseline PCL score was 68.41 [9]. Significantly more veterans completed SS treatment (SS, 59 [89%] than CPT, 47 [50%] (p = <.001). However, PCL score decreases were significantly greater for patients who completed CPT treatment than those in SS (treatment x time interaction, 9.60 vs.4.98, respectively; difference, 4.62; t84 = 2.16; p = .02). The patients who received SS used significantly more mental health services of the PTSD clinical team than patients who completed CPT treatment (p = .01). The results of this study demonstrate the need for alternative approaches where dually diagnosed patients would not be delayed in their receipt of trauma-focused care - i.e., where treatment is initiated concurrently rather than sequentially to substance abuse treatment.
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Affiliation(s)
- Muhammad R Baig
- Mental Health, South Texas Veterans Healthcare System, 116 A, 7400 Merton Minter Blvd, San Antonio, TX, USA. .,Polytrauma Rehabilitation Center, South Texas Veterans Healthcare System, San Antonio, TX, USA. .,Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
| | - Shuang Ouyang
- Pharmacy Service, South Texas Veterans Healthcare System, San Antonio, TX, USA
| | - Emma Mata-Galán
- Mental Health, South Texas Veterans Healthcare System, 116 A, 7400 Merton Minter Blvd, San Antonio, TX, USA
| | - Michael A Dawes
- Department of Psychiatry, Boston University Medical Campus, Boston, MA, USA.,VA Boston Healthcare System-Brockton Campus, Boston, MA, USA
| | - John D Roache
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,Department of Pharmacology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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7
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Moni MA, Lin PI, Quinn JMW, Eapen V. COVID-19 patient transcriptomic and genomic profiling reveals comorbidity interactions with psychiatric disorders. Transl Psychiatry 2021; 11:160. [PMID: 33723208 PMCID: PMC7957287 DOI: 10.1038/s41398-020-01151-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 11/28/2020] [Accepted: 12/07/2020] [Indexed: 12/16/2022] Open
Abstract
Psychiatric symptoms are seen in some COVID-19 patients, as direct or indirect sequelae, but it is unclear whether SARS-CoV-2 infection interacts with underlying neuronal or psychiatric susceptibilities. Such interactions might arise from COVID-19 immune responses, from infection of neurons themselves or may reflect social-psychological causes. To clarify this we sought the key gene expression pathways altered in COVID-19 also affected in bipolar disorder, post-traumatic stress disorder (PTSD) and schizophrenia, since this may identify pathways of interaction that could be treatment targets. We performed large scale comparisons of whole transcriptome data and immune factor transcript data in peripheral blood mononuclear cells (PBMC) from COVID-19 patients and patients with psychiatric disorders. We also analysed genome-wide association study (GWAS) data for symptomatic COVID-19 patients, comparing GWAS and whole-genome sequence data from patients with bipolar disorder, PTSD and schizophrenia patients. These studies revealed altered signalling and ontology pathways shared by COVID-19 patients and the three psychiatric disorders. Finally, co-expression and network analyses identified gene clusters common to the conditions. COVID-19 patients had peripheral blood immune system profiles that overlapped with those of patients with psychiatric conditions. From the pathways identified, PTSD profiles were the most highly correlated with COVID-19, perhaps consistent with stress-immune system interactions seen in PTSD. We also revealed common inflammatory pathways that may exacerbate psychiatric disorders, which may support the usage of anti-inflammatory medications in these patients. It also highlights the potential clinical application of multi-level dataset studies in difficult-to-treat psychiatric disorders in this COVID-19 pandemic.
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Affiliation(s)
- Mohammad Ali Moni
- Faculty of Medicine, School of Psychiatry, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Ping-I Lin
- Faculty of Medicine, School of Psychiatry, University of New South Wales, Sydney, NSW, 2052, Australia
- South Western Sydney Area Health Service, Sydney, NSW, 2170, Australia
| | - Julian M W Quinn
- The Garvan Institute of Medical Research, Healthy Ageing Theme, Darlinghurst, NSW, 2010, Australia
- Division of Surgery and Anesthesia, Royal North Shore Hospital SERT Institute, St Leonards, NSW, 2065, Australia
| | - Valsamma Eapen
- Faculty of Medicine, School of Psychiatry, University of New South Wales, Sydney, NSW, 2052, Australia.
- South Western Sydney Area Health Service, Sydney, NSW, 2170, Australia.
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8
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Dhungana S, Koirala R, Ojha SP, Thapa SB. Quality of life and its association with psychiatric disorders in outpatients with trauma history in a tertiary hospital in Kathmandu, Nepal: a cross-sectional study. BMC Psychiatry 2021; 21:98. [PMID: 33593325 PMCID: PMC7885479 DOI: 10.1186/s12888-021-03104-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 12/16/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Quality of life is an important indicator of health and has multiple dimensions. It is adversely affected in patients with trauma history, and psychiatric disorders play an important role therein. Studies in trauma-affected populations focus mainly on the development of psychiatric disorders. Our study explored various aspects of quality of life in trauma patients in a clinical setting, mainly focusing on the association of psychiatric disorders on various domains of quality of life. METHODS One hundred patients seeking help at the psychiatry outpatient of a tertiary hospital in Kathmandu, Nepal, and with history of trauma were interviewed using the World Health Organization Composite International Diagnostic Interview version 2.1 for trauma categorization. Post-traumatic stress disorder symptoms were assessed using the Post-Traumatic Stress Disorder Checklist-Civilian Version; while the level of anxiety and depression symptoms was assessed using the 25-item Hopkins Symptom Checklist-25. Quality of life was assessed using the World Health Organization Quality Of Life-Brief Version measure. Information on sociodemographic and trauma-related variables was collected using a semi-structured interview schedule. The associations between psychiatric disorders and quality of life domains were explored using bivariate analyses followed by multiple regressions. RESULTS The mean scores (standard deviations) for overall quality of life and health status perception were 2.79 (.87) and 2.35 (1.11), respectively. The mean scores for the physical, psychological, social and environmental domains were 12.31 (2.96), 11.46 (2.84), 12.79 (2.89), and 13.36 (1.79), respectively. Natural disaster was the only trauma variable significantly associated with overall quality of life, but not with other domains. Anxiety, depression and post-traumatic stress disorder were all significantly associated with various quality of life domains, where anxiety had the greatest number of associations. CONCLUSION Quality of life, overall and across domains, was affected in various ways based on the presence of psychiatric disorders such as anxiety, depression and post-traumatic stress disorder in patients with trauma. Our findings therefore emphasize the need to address these disorders in a systematic way to improve the patients' quality of life.
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Affiliation(s)
- Saraswati Dhungana
- Department of Psychiatry and Mental Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal. .,Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Rishav Koirala
- grid.5510.10000 0004 1936 8921Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo, Norway ,Brain and Neuroscience Center, Kathmandu, Nepal
| | - Saroj Prasad Ojha
- grid.80817.360000 0001 2114 6728Department of Psychiatry and Mental Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Suraj Bahadur Thapa
- grid.80817.360000 0001 2114 6728Department of Psychiatry and Mental Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal ,grid.5510.10000 0004 1936 8921Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo, Norway ,grid.55325.340000 0004 0389 8485Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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9
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Goyal NG, Maddocks KJ, Johnson AJ, Byrd JC, Westbrook TD, Andersen BL. Cancer-Specific Stress and Trajectories of Psychological and Physical Functioning in Patients With Relapsed/Refractory Chronic Lymphocytic Leukemia. Ann Behav Med 2019; 52:287-298. [PMID: 30084895 DOI: 10.1093/abm/kax004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background Chronic lymphocytic leukemia is the most prevalent adult leukemia. The disease is incurable with a cycling of treatment and relapse common. Little is known about the psychological and physical functioning of patients with relapsed/refractory chronic lymphocytic leukemia. Cancer-specific stress is an important individual difference variable that predicts psychological and physical outcomes. Purpose To examine cancer-specific stress at treatment initiation as a predictor of psychological and physical functioning trajectories in patients with relapsed/refractory chronic lymphocytic leukemia during the first 5 months of treatment. Methods Patients with relapsed/refractory chronic lymphocytic leukemia (N = 152) enrolled in a phase II clinical trial completed self-report measures at treatment initiation (baseline), 1, 2, and 5 months of treatment. Cancer-specific stress at baseline was examined as a predictor of psychological (cognitive-affective depressive symptoms, negative mood, mental health quality of life) and physical functioning (fatigue interference, sleep problems, physical health quality of life), controlling for demographic and treatment variables. Results Using multilevel modeling, higher baseline cancer-specific stress was related to worse psychological (cognitive-affective depressive symptoms, negative mood, mental health quality of life) and physical functioning (fatigue interference, sleep problems) at baseline and more rapid improvements during the next 5 months. Despite these improvements, higher baseline cancer-specific stress remained associated with poorer 5-month psychological, though not physical, functioning. Conclusions Findings suggest cancer-specific stress at treatment initiation may be a risk factor for poorer psychological functioning during treatment for patients with relapsed/refractory chronic lymphocytic leukemia.
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Affiliation(s)
- Neha G Goyal
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC
| | - Kami J Maddocks
- Division of Hematology, Department of Internal Medicine, The Ohio State University Medical Center, Columbus, OH
| | - Amy J Johnson
- Division of Hematology, Department of Internal Medicine, The Ohio State University Medical Center, Columbus, OH
| | - John C Byrd
- Division of Hematology, Department of Internal Medicine, The Ohio State University Medical Center, Columbus, OH
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10
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Siwakoti A, Potukuchi PK, Thomas F, Gaipov A, Talwar M, Balaraman V, Cseprekal O, Yazawa M, Streja E, Eason JD, Kalantar-Zadeh K, Kovesdy CP, Molnar MZ. History of posttraumatic stress disorder and outcomes after kidney transplantation. Am J Transplant 2019; 19:2294-2305. [PMID: 30672107 PMCID: PMC6650381 DOI: 10.1111/ajt.15268] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 01/15/2019] [Accepted: 01/16/2019] [Indexed: 01/25/2023]
Abstract
A history of posttraumatic stress disorder (PTSD), if uncontrolled, represents a contraindication for kidney transplantation. However, no previous large study has assessed the association between pretransplant history of PTSD and posttransplantation outcomes. We examined 4479 US veterans who had undergone transplantation. The diagnosis of history of PTSD was based on a validated algorithm. Measured covariates were used to create a matched cohort (n = 560). Associations between pretransplant PTSD and death with functioning graft, all-cause death, and graft loss were examined in survival models. Posttransplant medication nonadherence was assessed using proportion of days covered (PDC). From among 4479 veterans, 282 (6.3%) had a history of PTSD. The mean age ± standard deviation (SD) of the cohort at baseline was 61 ± 11 years, 91% were male, and 66% and 28% of patients were white and African American, respectively. Compared to patients without a history of PTSD, patients with a history of PTSD had a similar risk of death with a functioning graft (subhazard ratio [SHR] 0.97, 95% confidence interval [CI] 0.61-1.54), all-cause death (1.05, 0.69-1.58), and graft loss (1.09, 0.53-2.26). Moreover, there was no difference in immunosuppressive drug PDC in patients with and without a history of PTSD (PDC: 98 ± 4% vs 99 ± 3%, P = .733 for tacrolimus; PDC: 99 ± 4% vs 98 ± 7%, P = .369 for mycophenolic acid). A history of PTSD in US veterans with end-stage renal disease should not on its own preclude a veteran from being considered for transplantation.
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Affiliation(s)
- Ashmita Siwakoti
- Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Praveen K. Potukuchi
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee,IHOP, College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Fridtjof Thomas
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Abduzhappar Gaipov
- Department of Medicine, Nazarbayev University School of Medicine, Astana, Kazakhstan
| | - Manish Talwar
- Methodist University Hospital Transplant Institute, Memphis, Tennessee,Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Vasanthi Balaraman
- Methodist University Hospital Transplant Institute, Memphis, Tennessee,Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Orsolya Cseprekal
- Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee,Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
| | - Masahiko Yazawa
- Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Elani Streja
- Division of Nephrology, University of California, Irvine, California
| | - James D. Eason
- Methodist University Hospital Transplant Institute, Memphis, Tennessee,Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | | | - Csaba P. Kovesdy
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee,Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis, Tennessee
| | - Miklos Z. Molnar
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee,Methodist University Hospital Transplant Institute, Memphis, Tennessee,Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee,Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
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11
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Chen Z, Wang G, Jiang C. Posttraumatic stress symptoms (PTSS) in patients with Cushing's disease before and after surgery: A prospective study. J Clin Neurosci 2019; 66:1-6. [PMID: 31178305 DOI: 10.1016/j.jocn.2019.05.059] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 04/13/2019] [Accepted: 05/27/2019] [Indexed: 12/19/2022]
Abstract
The aim of this study was to investigate the occurrence, correlated factors and prognosis of posttraumatic stress symptoms (PTSS) in patients with Cushing's disease (CD). A total of 49 patients who were newly diagnosed with CD and underwent transsphenoidal surgery in our hospital from April 2015 to August 2017 were asked to participate in this study. Another group of 49 age and sex matched healthy control participants were also included for comparison. PTSS (measured with Impact of Event Scale-Revised, IES-R), depression/anxiety (measured with Hospital Anxiety and Depression scale, HADS) and quality of life (QoL; measured with 36-item short-form, SF-36) were evaluated at pre-surgery, 6 months post-surgery and 12 months post-surgery. The results showed that at preoperative stage, 15 (30.6%) CD patients developed PTSS, and they had higher 24 h UFC, and presented worse levels of depression, anxiety and QoL compared with patients without PTSS. Although most of them recovered postoperatively, there were still 5/15 (33.3%) patients persisted with PTSS for over a year. Additionally, one patient with recurred CD developed PTSS between 6 and 12 months postoperatively. Among the whole group of CD patients, the PTSS severity showed consistent improvement after surgery, which was in accordance with the progressing trends of depression, anxiety and psychological aspects of SF-36. However, compared with healthy individuals, CD patients in remission still performed worse in physical/mental health. In conclusion, patients with CD can develop PTSS, and they may persist for over a year even after successful surgery. Combined psychological intervention is advised for these patients.
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Affiliation(s)
- Zhuang Chen
- Department of Neurology, General Hospital of Southern Theatre Command, Guangzhou, China
| | - Guoliang Wang
- Department of Neurology, General Hospital of Southern Theatre Command, Guangzhou, China
| | - Che Jiang
- Department of Neurology, General Hospital of Southern Theatre Command, Guangzhou, China.
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12
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Dimitrov L, Moschopoulou E, Korszun A. Interventions for the treatment of cancer-related traumatic stress symptoms: A systematic review of the literature. Psychooncology 2019; 28:970-979. [PMID: 30847978 DOI: 10.1002/pon.5055] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 02/25/2019] [Accepted: 03/04/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Cancer has been reported to trigger symptoms of post-traumatic stress disorder (PTSD) in a substantial proportion of individuals. Despite the significant burden associated with these symptoms, there are as yet no therapeutic guidelines. This systematic review aims to evaluate the effectiveness of interventions for cancer-related post-traumatic stress in order to provide an evidence base for developing appropriate clinical practice. METHODS Databases searched until April 2018 included Psych INFO, EMBASE, Medline, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL). No restrictions to study design were applied. Participants aged 18 years or older who received their cancer diagnosis in adulthood and had symptoms of cancer-related PTSD were included. Because of significant clinical heterogeneity, a meta-analysis was not performed. RESULTS Of 508 unique titles, eight studies met study inclusion criteria: five randomised controlled trials (RCTs), one before-and-after study, one case series, and one case study. Interventions were predominately psychological and were administered to patients with a range of cancer types. Eye movement desensitisation and reprocessing and cognitive behavioural therapy-based interventions were associated with reduced symptomatology; however, overall the methodological quality of studies had limitations. CONCLUSIONS At present, there is only weak evidence available for the effectiveness of psychological interventions in reducing symptoms of cancer-related PTSD. The majority of interventions were administered to all cancer patients regardless of whether they showed pretreatment levels of post-traumatic stress. Future studies would be better targeted towards patients with a diagnosis of cancer and who have significant levels of cancer-related post-traumatic symptoms. Higher quality trials are also needed before treatment recommendations can be made.
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Affiliation(s)
- Lilia Dimitrov
- ENT Department, St Mary's Hospital, Imperial College Healthcare NHS Trust, London
| | - Elisavet Moschopoulou
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London
| | - Ania Korszun
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London
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13
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Post-traumatic stress disorders in patients with low-grade glioma and its association with survival. J Neurooncol 2019; 142:385-392. [DOI: 10.1007/s11060-019-03112-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 01/24/2019] [Indexed: 12/13/2022]
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14
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Antidepressant adherence in United States active duty Army Soldiers: A small descriptive study. Arch Psychiatr Nurs 2018; 32:793-801. [PMID: 30454619 DOI: 10.1016/j.apnu.2018.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 05/09/2018] [Accepted: 06/02/2018] [Indexed: 11/22/2022]
Abstract
While much is known about depression and antidepressant adherence associations with illness perceptions, medication beliefs, social support, and stigma in the general population, there is a dearth of knowledge among United States active duty Army Soldiers. The study objective was to explore antidepressant adherence and correlations between antidepressant adherence and illness perceptions, medication beliefs, social support, stigma and select demographic variables among Army Soldiers with depression. Results indicated age and gender were significantly correlated with and predictive of adherence. Low adherence was found. Findings suggest Soldiers who are younger and those who are female are more likely to report higher levels of adherence.
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15
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Mining latent information in PTSD psychometrics with fuzziness for effective diagnoses. Sci Rep 2018; 8:16266. [PMID: 30389985 PMCID: PMC6214927 DOI: 10.1038/s41598-018-34573-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 10/19/2018] [Indexed: 02/05/2023] Open
Abstract
The options of traditional self-report rating-scale, like the PTSD Checklist Civilian (PCL-C) scale, have no clear boundaries which might cause considerable biases and low effectiveness. This research aimed to explore the feasibility of using fuzzy set in the data processing to promote the screening effectiveness of PCL-C in real-life practical settings. The sensitivity, specificity, Youden's index etc., of PCL-C at different cutoff lines (38, 44 and 50 respectively) were analyzed and compared with those of fuzzy set approach processing. In practice, no matter the cutoff line of the PCL-C was set at 50, 44 or 38, the PCL-C showed good specificity, but failed to exhibit good sensitivity and screening effectiveness. The highest sensitivity was at 65.22%, with Youden's index being 0.64. After fuzzy processing, the fuzzy-PCL-C's sensitivity increased to 91.30%, Youden's index rose to 0.91, having seen marked augmentation. In conclusion, this study indicates that fuzzy set can be used in the data processing of psychiatric scales which have no clear definition standard of the options to improve the effectiveness of the scales.
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16
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Abstract
OBJECTIVE Coronary Distensibility Index (CDI) impairments reflect endothelial-dependent process associated with vulnerable-plaque composition. This study investigated the relation of impaired CDI with posttraumatic stress disorder (PTSD) and their predictive value for major adverse cardiovascular events (MACE). METHODS This study involved 246 patients (age = 63 [10] years, 12% women) with (n = 50) and without (n = 196) PTSD, who underwent computed tomography angiography to determine coronary artery disease and CDI. Extent of coronary artery disease was defined as normal, nonobstructive (<50% luminal stenosis), and obstructive (>50%). Incidence of MACE, defined as myocardial infarction or cardiovascular death, was documented during a mean follow-up of 50 months. Survival regression was employed to assess the longitudinal association of impaired CDI and PTSD with MACE. RESULTS A significant inverse correlation between CDI and Clinical Global Impression Severity scale of PTSD symptoms was noted (r = .81, p = .001). CDI was significantly lower in patients with PTSD (3.3 [0.2]) compared with those without PTSD (4.5 [0.3]), a finding that was more robust in women (p < .05). Covariate-adjusted analyses revealed that the relative risk of MACE was higher in patients with PTSD (hazard ratio [HR] = 1.56, 95% CI = 1.34-3.14) and those with impaired CDI (HR = 1.95, 95% CI = 1.27-3.01, per standard deviation lower CDI value). There was also a significant interaction between PTSD and impaired CDI (HR = 3.24, 95% CI = 2.02-5.53). CONCLUSIONS Impaired CDI is strongly associated with the severity of PTSD symptoms. Both impaired CDI and PTSD were independently associated with an increased risk of MACE during follow-up, and evidence indicated an interaction between these two factors. These findings highlight the important role of CDI in identifying individuals with PTSD at risk for MACE.
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17
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Paslakis G, Beckmann M, Beckebaum S, Klein C, Gräf J, Erim Y. Posttraumatic Stress Disorder, Quality of Life, and the Subjective Experience in Liver Transplant Recipients. Prog Transplant 2017; 28:70-76. [DOI: 10.1177/1526924817746680] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: A high prevalence of posttraumatic stress disorder (PTSD) symptoms among transplant recipients has been associated with a low adherence to treatment and poor survival. It is crucial to detect and prevent the development of posttraumatic stress in transplant settings. Methods: We examined the prevalence of posttraumatic stress symptoms in 3 liver transplant recipients by means of the Essen Trauma Inventory (ETI), a self-report questionnaire. The Short Form-36 was used to assess the perceived health-related quality of life. Patients were asked to indicate the most traumatic events within the context of the liver transplantation procedure. Results: Five patients (4.9%) fulfilled the criteria for PTSD related to liver disease or transplantation (ETI score greater than 27). In these patients, diagnosis was confirmed by a structured clinical interview. Fourteen (13.6%) patients had a partial PTSD with the ETI score less than 27 and greater than 16. Posttraumatic stress symptoms were significantly associated with perceived poor physical and mental health-related quality of life. Patients reported that the physicians’ disclosure of diagnosis was experienced as traumatic, followed by treatment in an intensive care unit and the liver transplantation itself. Conclusions: The ETI resulted in prevalence rates for PTSD comparable to previous studies in liver transplantation settings. Medical professionals requested additional training in how to deliver severe diagnoses to patients.
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Affiliation(s)
- Georgios Paslakis
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Erlangen, Erlangen, Germany
| | - Mingo Beckmann
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Essen, Essen, Germany
| | - Susanne Beckebaum
- Department of Transplant Medicine, University Hospital Münster, Münster, Germany
| | - Christian Klein
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
| | - Jan Gräf
- Lukaskrankenhaus Neuss, HNO Klinik, Neuss, Germany
| | - Yesim Erim
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Erlangen, Erlangen, Germany
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18
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Meentken MG, van Beynum IM, Legerstee JS, Helbing WA, Utens EMWJ. Medically Related Post-traumatic Stress in Children and Adolescents with Congenital Heart Defects. Front Pediatr 2017; 5:20. [PMID: 28243582 PMCID: PMC5303720 DOI: 10.3389/fped.2017.00020] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 01/25/2017] [Indexed: 01/24/2023] Open
Abstract
Children and adolescents with a congenital heart defect (ConHD) frequently undergo painful or frightening medical procedures and hospitalizations. They often need multiple invasive procedures at a very young age and require regular checkups during their entire life. From other pediatric populations, it is known that these kinds of experiences can result in acute stress reactions and even in post-traumatic stress disorder (PTSD) in the long-term. PTSD and also subthreshold PTSD can lead to serious (psychosocial) impairment. However, limited information is available about PTSD in children with ConHD. Therefore, the aim of this review is to provide a summary of the current literature on post-traumatic stress (PTS) in children and adolescents with ConHD describing the prevalence of PTSD and its predictors/correlates. This review indicates that a range of 12-31% of children undergoing cardiac surgery develop PTSD. A range of 12-14% shows elevated post-traumatic stress symptoms (PTSS). These findings are comparable to those of hospitalized children without ConHD. Noteworthy, most studies used varying self-report questionnaires to measure PTSD and only one study used a semistructured interview. Although all studies point in the same direction of elevated PTSD and PTSS, systematic research is necessary to be able to draw firm conclusions. At present, as far as we know, in most clinics treating patients with ConHD, there is no regular screening for PTS in children with ConHD. In the reviewed literature, there is strong consensus that screening for PTSS and (preventive) psychological care for children and adolescents with ConHD is urgently needed.
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Affiliation(s)
- Maya G Meentken
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children's Hospital , Rotterdam , Netherlands
| | - Ingrid M van Beynum
- Division of Cardiology, Department of Pediatrics, Erasmus MC - Sophia Children's Hospital , Rotterdam , Netherlands
| | - Jeroen S Legerstee
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children's Hospital , Rotterdam , Netherlands
| | - Willem A Helbing
- Division of Cardiology, Department of Pediatrics, Erasmus MC - Sophia Children's Hospital , Rotterdam , Netherlands
| | - Elisabeth M W J Utens
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children's Hospital, Rotterdam, Netherlands; Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, Netherlands; Academic Center for Child Psychiatry the Bascule/Department Child and Adolescent Psychiatry, Academic Medical Center, Amsterdam, Netherlands
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19
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Sun R, Zhang W, Bo J, Zhang Z, Lei Y, Huo W, Liu Y, Ma Z, Gu X. Spinal activation of alpha7-nicotinic acetylcholine receptor attenuates posttraumatic stress disorder-related chronic pain via suppression of glial activation. Neuroscience 2016; 344:243-254. [PMID: 28039041 DOI: 10.1016/j.neuroscience.2016.12.029] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 12/06/2016] [Accepted: 12/18/2016] [Indexed: 01/05/2023]
Abstract
The high prevalence of chronic pain in posttraumatic stress disorder (PTSD) individuals has been widely reported by clinical studies, which emphasized an urgent need to uncover the underlying mechanisms and identify potential therapeutic targets. Recent studies suggested that targeting activated glia and their pro-inflammatory products may provide a novel and effective therapy for the stress-related pain. In this study, we investigated whether activation of alpha-7 nicotinic acetylcholine receptor (α7 nAChR), a novel anti-inflammatory target, could attenuate PTSD-related chronic pain. The experiments were conducted in a rat model of single prolonged stress (SPS), an established model of PTSD-pain comorbidity. We found that SPS exposure produced persistent mechanical allodynia. Immunohistochemical and enzyme-linked immuno sorbent assay analysis showed that SPS also induced elevated activation of glia cells (including microglia and astrocytes) and accumulation of pro-inflammatory cytokines in spinal cord. In another experiment, we found that intrathecal injection of PHA-543613, a selective α7 nAchR agonist, attenuated the SPS-evoked allodynia in a dose dependent manner. However, this anti-hyperalgesic effect was blocked by pretreatment with methyllycaconitine (MLA), a selective α7 nAchR antagonist. Further analyses showed that PHA-543613 suppressed SPS-induced spinal glial activation and SPS-elevated spinal pro-inflammatory cytokines, and these were abolished by MLA. Taken together, the present study showed that spinal activation of α7 nAChR by PHA-543613 attenuated mechanical allodynia induced by PTSD-like stress, and the suppression of spinal glial activation may underlie this anti-hyperalgesic effect. Our study demonstrated the therapeutic potential of targeting α7 nAChR in the treatment of PTSD-related chronic pain.
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Affiliation(s)
- Rao Sun
- Department of Anesthesiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing 210008, China
| | - Wei Zhang
- Department of Anesthesiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing 210008, China
| | - Jinhua Bo
- Department of Anesthesiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing 210008, China
| | - Zuoxia Zhang
- Department of Anesthesiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing 210008, China
| | - Yishan Lei
- Department of Anesthesiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing 210008, China
| | - Wenwen Huo
- Department of Anesthesiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing 210008, China
| | - Yue Liu
- Department of Anesthesiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing 210008, China
| | - Zhengliang Ma
- Department of Anesthesiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing 210008, China.
| | - Xiaoping Gu
- Department of Anesthesiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing 210008, China.
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20
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Mindlis I, Morales-Raveendran E, Goodman E, Xu K, Vila-Castelar C, Keller K, Crawford G, James S, Katz CL, Crowley LE, de la Hoz RE, Markowitz S, Wisnivesky JP. Post-traumatic stress disorder dimensions and asthma morbidity in World Trade Center rescue and recovery workers. J Asthma 2016; 54:723-731. [PMID: 27905829 DOI: 10.1080/02770903.2016.1263650] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Using data from a cohort of World Trade Center (WTC) rescue and recovery workers with asthma, we assessed whether meeting criteria for post-traumatic stress disorder (PTSD), sub-threshold PTSD, and for specific PTSD symptom dimensions are associated with increased asthma morbidity. METHODS Participants underwent a Structured Clinical Interview for Diagnostic and Statistical Manual to assess the presence of PTSD following DSM-IV criteria during in-person interviews between December 2013 and April 2015. We defined sub-threshold PTSD as meeting criteria for two of three symptom dimensions: re-experiencing, avoidance, or hyper-arousal. Asthma control, acute asthma-related healthcare utilization, and asthma-related quality of life data were collected using validated scales. Unadjusted and multiple regression analyses were performed to assess the relationship between sub-threshold PTSD and PTSD symptom domains with asthma morbidity measures. RESULTS Of the 181 WTC workers with asthma recruited into the study, 28% had PTSD and 25% had sub-threshold PTSD. Patients with PTSD showed worse asthma control, higher rates of inpatient healthcare utilization, and poorer asthma quality of life than those with sub-threshold or no PTSD. After adjusting for potential confounders, among patients not meeting the criteria for full PTSD, those presenting symptoms of re-experiencing exhibited poorer quality of life (p = 0.003). Avoidance was associated with increased acute healthcare use (p = 0.05). Sub-threshold PTSD was not associated with asthma morbidity (p > 0.05 for all comparisons). CONCLUSIONS There may be benefit in assessing asthma control in patients with sub-threshold PTSD symptoms as well as those with full PTSD to more effectively identify ongoing asthma symptoms and target management strategies.
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Affiliation(s)
- I Mindlis
- a Division of General Internal Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - E Morales-Raveendran
- a Division of General Internal Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - E Goodman
- a Division of General Internal Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - K Xu
- a Division of General Internal Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - C Vila-Castelar
- b The Graduate Center, City University of New York , New York , NY , USA.,c Queens College, City University of New York , Flushing , NY , USA
| | - K Keller
- a Division of General Internal Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - G Crawford
- a Division of General Internal Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - S James
- a Division of General Internal Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - C L Katz
- d Department of Psychiatry , Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - L E Crowley
- e Department of Preventive Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - R E de la Hoz
- a Division of General Internal Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA.,f Division of Pulmonary , Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - S Markowitz
- c Queens College, City University of New York , Flushing , NY , USA
| | - J P Wisnivesky
- a Division of General Internal Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA.,f Division of Pulmonary , Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai , New York , NY , USA
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21
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Sun R, Zhang Z, Lei Y, Liu Y, Lu C, Rong H, Sun Y, Zhang W, Ma Z, Gu X. Hippocampal activation of microglia may underlie the shared neurobiology of comorbid posttraumatic stress disorder and chronic pain. Mol Pain 2016; 12:12/0/1744806916679166. [PMID: 27852966 PMCID: PMC5117253 DOI: 10.1177/1744806916679166] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 09/12/2016] [Accepted: 10/17/2016] [Indexed: 12/29/2022] Open
Abstract
The high comorbidity rates of posttraumatic stress disorder and chronic pain have been widely reported, but the underlying mechanisms remain unclear. Emerging evidence suggested that an excess of inflammatory immune activities in the hippocampus involved in the progression of both posttraumatic stress disorder and chronic pain. Considering that microglia are substrates underlying the initiation and propagation of the neuroimmune response, we hypothesized that stress-induced activation of hippocampal microglia may contribute to the pathogenesis of posttraumatic stress disorder-pain comorbidity. We showed that rats exposed to single prolonged stress, an established posttraumatic stress disorder model, exhibited persistent mechanical allodynia and anxiety-like behavior, which were accompanied by increased activation of microglia and secretion of pro-inflammatory cytokines in the hippocampus. Correlation analyses showed that hippocampal activation of microglia was significantly correlated with mechanical allodynia and anxiety-like behavior. Our data also showed that both intraperitoneal and intra-hippocampal injection of minocycline suppressed single prolonged stress-induced microglia activation and inflammatory cytokines accumulation in the hippocampus, and attenuated both single prolonged stress-induced mechanical allodynia and anxiety-like behavior. Taken together, the present study suggests that stress-induced microglia activation in the hippocampus may serve as a critical mechanistic link in the comorbid relationship between posttraumatic stress disorder and chronic pain. The novel concept introduces the possibility of cotreating chronic pain and posttraumatic stress disorder.
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Affiliation(s)
- Rao Sun
- Department of Anesthesiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Zuoxia Zhang
- Department of Anesthesiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yishan Lei
- Department of Anesthesiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yue Liu
- Department of Anesthesiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Cui'e Lu
- Department of Anesthesiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Hui Rong
- Department of Anesthesiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yu'e Sun
- Department of Anesthesiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Wei Zhang
- Department of Anesthesiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Zhengliang Ma
- Department of Anesthesiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xiaoping Gu
- Department of Anesthesiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
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22
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Co-morbidity of PTSD and immune system dysfunction: opportunities for treatment. Curr Opin Pharmacol 2016; 29:104-10. [PMID: 27479489 DOI: 10.1016/j.coph.2016.07.011] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 07/12/2016] [Accepted: 07/15/2016] [Indexed: 12/27/2022]
Abstract
Posttraumatic stress disorder (PTSD) is defined as a psychiatric disorder; however, PTSD co-occurs with multiple somatic manifestations. People living with PTSD commonly manifest dysregulations in the systems that regulate the stress response, including the hypothalamic-pituitary-adrenal (HPA) axis, and development of a pro-inflammatory state. Additionally, somatic autoimmune and inflammatory diseases and disorders have a high rate of co-morbidity with PTSD. Recognition and understanding of the compounding effect that these disease states can have on each other, evidenced from poorer treatment outcomes and accelerated disease progression in patients suffering from co-morbid PTSD and/or other autoimmune and inflammatory diseases, has the potential to lead to additional treatment opportunities.
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23
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Coping strategies predict post-traumatic stress in patients with head and neck cancer. Eur Arch Otorhinolaryngol 2016; 273:3385-91. [DOI: 10.1007/s00405-016-3960-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 03/01/2016] [Indexed: 11/25/2022]
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Supelana C, Annunziato RA, Kaplan D, Helcer J, Stuber ML, Shemesh E. PTSD in solid organ transplant recipients: Current understanding and future implications. Pediatr Transplant 2016; 20:23-33. [PMID: 26648058 PMCID: PMC4769648 DOI: 10.1111/petr.12628] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/01/2015] [Indexed: 12/16/2022]
Abstract
PTSS are quite prevalent in transplant recipients, although full-scale PTSD may not be that common. Those symptoms have been linked to poor transplant outcomes, perhaps owing to non-adherence to medications and other recommendations, brought about by the avoidance dimension of the PTSD/PTSS construct (patients may avoid taking their medications because they serve as reminder of the emotionally traumatic event--the transplant). It is possible to treat PTSD via specific psychotherapeutic techniques, and the treatment has been shown to be safe and likely effective in other populations. Therefore, practitioners who treat transplant recipients should be familiar with the presentation and treatment of those symptoms. This manuscript provides a systematic literature review of the PTSD/PTSS presentation in the pediatric transplant setting, a synthesis of available research findings, and suggestions for current care and future research.
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Affiliation(s)
- C Supelana
- Icahn School of Medicine at Mount Sinai, Department of Pediatrics and Kravis Children's Hospital, New York, NY., Fordham University, Department of Psychology, Bronx, NY
| | - RA Annunziato
- Icahn School of Medicine at Mount Sinai, Department of Pediatrics and Kravis Children's Hospital, New York, NY., Fordham University, Department of Psychology, Bronx, NY
| | - D Kaplan
- Fordham University, Department of Psychology, Bronx, NY
| | - J Helcer
- Icahn School of Medicine at Mount Sinai, Department of Pediatrics and Kravis Children's Hospital, New York, NY., Fordham University, Department of Psychology, Bronx, NY
| | - ML Stuber
- UCLA Geffen School of Medicine, Los Angeles, CA
| | - E Shemesh
- Icahn School of Medicine at Mount Sinai, Department of Pediatrics and Kravis Children's Hospital, New York, NY
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Abrams TE, Blevins A, Weg MWV. Chronic obstructive lung disease and posttraumatic stress disorder: current perspectives. Int J Chron Obstruct Pulmon Dis 2015; 10:2219-33. [PMID: 26508851 PMCID: PMC4610806 DOI: 10.2147/copd.s71449] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background Several studies have reported on the co-occurrence of chronic obstructive pulmonary disease (COPD) and psychiatric conditions, with the most robust evidence base demonstrating an impact of comorbid anxiety and depression on COPD-related outcomes. In recent years, research has sought to determine if there is a co-occurrence between COPD and posttraumatic stress disorder (PTSD) as well as for associations between PTSD and COPD-related outcomes. To date, there have been no published reviews summarizing this emerging literature. Objectives The primary objective of this review was to determine if there is adequate evidence to support a co-occurrence between PTSD and COPD. Secondary objectives were to: 1) determine if there are important clinical considerations regarding the impact of PTSD on COPD management, and 2) identify targeted areas for further research. Methods A structured review was performed using a systematic search strategy limited to studies in English, addressing adults, and to articles that examined: 1) the co-occurrence of COPD and PTSD and 2) the impact of PTSD on COPD-related outcomes. To be included, articles must have addressed some type of nonreversible obstructive lung pathology. Results A total of 598 articles were identified for initial review. Upon applying the inclusion and exclusion criteria, n=19 articles or abstracts addressed our stated objectives. Overall, there is inconclusive evidence to support the co-occurrence between PTSD and COPD. Studies finding a significant co-occurrence generally had inferior methods of identifying COPD; in contrast, studies that utilized more robust COPD measures (such as a physician exam) generally failed to find a relationship. Among studies that examined the impact of PTSD on COPD-related outcomes, there was more consistent evidence that PTSD affects the perception of respiratory symptom burden and management. In addition, methods for measuring an important confounder (smoking) were generally lacking. Conclusion There is inconclusive evidence to support the co-occurrence of COPD and PTSD. There was stronger evidence implicating PTSD as an important comorbidity impacting COPD management. Further research is needed to: 1) determine whether or not COPD and PTSD are likely to be comorbid, and 2) further elucidate the mechanisms connecting PTSD and COPD-related outcomes.
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Affiliation(s)
- Thad E Abrams
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA ; Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City VA Health Care System, University of Iowa, Iowa City, IA, USA
| | - Amy Blevins
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA ; Hardin Health Sciences Library, University of Iowa, Iowa City, IA, USA
| | - Mark W Vander Weg
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA ; Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City VA Health Care System, University of Iowa, Iowa City, IA, USA ; Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA
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Morais-de-Jesus M, Daltro-Oliveira R, Pettersen KM, Dantas-Duarte A, Amaral LDD, Cavalcanti-Ribeiro P, Santos CT, Schinoni MI, Netto LR, Araújo-de-Freitas L, Paraná R, Miranda-Scippa Â, Koenen KC, Quarantini LC. Hepatitis C virus infection as a traumatic experience. PLoS One 2014; 9:e110529. [PMID: 25340574 PMCID: PMC4207714 DOI: 10.1371/journal.pone.0110529] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 09/23/2014] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate whether individuals consider their HCV infection to be a potentially traumatic experience. Additionally, we investigated its association with Post-Traumatic Stress Disorder (PTSD) and the impact of PTSD diagnosis on health-related quality of life (HRQoL) in HCV infected subjects. METHODS We conducted a cross-sectional survey of 127 HCV-infected outpatients recruited at a University Hospital in Salvador, Brazil. All subjects answered an orally-administered questionnaire to gather clinical and socio-demographic data. We investigated traumatic experiences and the subject's perception of the disease using the Trauma History Questionnaire. PTSD and other psychiatric diagnoses were assessed through the Mini International Neuropsychiatric Interview-Brazilian Version 5.0.0 (M.I.N.I. PLUS). HRQoL was assessed using Short-Form 36 (SF-36). RESULTS Approximately 38.6% of the patients considered hepatitis C to be a traumatic experience. Of these, 60.7% had a PTSD diagnosis. PTSD was associated with significant impairment in quality of life for individuals in seven SF-36 domains as shown bymultivariate analysis: Role-Physical (β: -24.85; 95% CI: -42.08; -7.61), Bodily Pain (β: -19.36; 95% CI: -31.28; -7.45), General Health (β: -20.79; 95% CI: -29.65; -11.92), Vitality (β: -11.92; 95% CI: -20.74; -3.1), Social Functioning (β: -34.73; 95% CI: -46.79; -22.68), Role-Emotional (β: -26.07; 95% CI: -44.61; -7.53), Mental Health (β: -17.46; 95% CI: -24.38; -10.54). CONCLUSION HCV is frequently a traumatic experience and it is strongly associated with PTSD diagnosis. PTSD significantly impaired HRQoL.
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Affiliation(s)
- Mychelle Morais-de-Jesus
- Programa de Pós-graduação em Medicina e Saúde, Faculdade de Medicina da Universidade Federal da Bahia, Salvador, BA, Brazil
| | | | - Karine Miranda Pettersen
- Programa de Pós-graduação em Medicina e Saúde, Faculdade de Medicina da Universidade Federal da Bahia, Salvador, BA, Brazil
| | - Adriana Dantas-Duarte
- Programa de Pós-graduação em Medicina e Saúde, Faculdade de Medicina da Universidade Federal da Bahia, Salvador, BA, Brazil
| | | | - Patrícia Cavalcanti-Ribeiro
- Programa de Pós-graduação em Medicina e Saúde, Faculdade de Medicina da Universidade Federal da Bahia, Salvador, BA, Brazil
| | - Carlos Teles Santos
- Departamento de Ciências Exatas, Universidade Estadual de Feira de Santana, Feira de Santana, BA, Brazil
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, BA, Brazil
| | - Maria Isabel Schinoni
- Programa de Pós-graduação em Medicina e Saúde, Faculdade de Medicina da Universidade Federal da Bahia, Salvador, BA, Brazil
| | - Liana R. Netto
- Programa de Pós-graduação em Medicina e Saúde, Faculdade de Medicina da Universidade Federal da Bahia, Salvador, BA, Brazil
| | - Lucas Araújo-de-Freitas
- Hospital Universitário e Departamento de Neurociências e Saúde Mental da Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, BA, Brazil
| | - Raymundo Paraná
- Programa de Pós-graduação em Medicina e Saúde, Faculdade de Medicina da Universidade Federal da Bahia, Salvador, BA, Brazil
- Faculdade de Medicina da Universidade Federal da Bahia, Salvador, BA, Brazil
| | - Ângela Miranda-Scippa
- Programa de Pós-graduação em Medicina e Saúde, Faculdade de Medicina da Universidade Federal da Bahia, Salvador, BA, Brazil
- Hospital Universitário e Departamento de Neurociências e Saúde Mental da Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, BA, Brazil
| | - Karestan C. Koenen
- Department of Epidemiology, Mailman School of Public Health - Columbia University, New York, New York, United States of America
| | - Lucas C. Quarantini
- Programa de Pós-graduação em Medicina e Saúde, Faculdade de Medicina da Universidade Federal da Bahia, Salvador, BA, Brazil
- Hospital Universitário e Departamento de Neurociências e Saúde Mental da Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, BA, Brazil
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Evan EE, Patel PA, Amegatcher A, Halnon N. Post-Traumatic Stress Symptoms in Pediatric Heart Transplant Recipients. Health Psychol Res 2014; 2:1549. [PMID: 26973937 PMCID: PMC4768549 DOI: 10.4081/hpr.2014.1549] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 04/12/2013] [Indexed: 12/24/2022] Open
Abstract
Traumatic experiences are not unusual in pediatric heart transplant (HT) recipients before and after transplantation. Post-traumatic stress symptoms (PTSS) present at the time of transplant evaluation and developing afterward occur with an unknown frequency. We sought to determine the burden of these symptoms in heart transplant patients. We reviewed 51 consecutive HTs between 2003-2007, including 40 primary transplants and 11 re-transplants. Symptoms were present in 17 of the 51 patients (34%) at the time of orthotopic heart transplantation evaluation. None met the criteria for full post traumatic stress disorder. Transplant complications were examined. Nineteen subjects of the total sample had rejection in the first year following transplant. Rejection rates in the first year was 41% for those with PTSS (7 of 17 patients) and 36% for those without (12 of 33 patients) (P=n.s). Of those patients presenting for a second heart transplant, 55% had PTSS at the time of transplant evaluation and/or the peritransplant period; whereas, (28%) undergoing a primary transplant had PTSS. In addition to symptoms resulting from the disease process leading to HT and other prior experiences, the HT itself seems to present a large psychiatric burden on patients. All patients need to be followed before and after HT for signs and symptoms related to PTSS. Future studies should be undertaken to determine if preventative detection and treatment of patients with these PTSS symptoms early can lead to better outcomes.
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Affiliation(s)
- Elana E Evan
- Department of Pediatric Cardiology, University of California , Los Angeles, CA, USA
| | - Payal A Patel
- Department of Pediatric Cardiology, University of California , Los Angeles, CA, USA
| | - Alison Amegatcher
- Department of Pediatric Cardiology, University of California , Los Angeles, CA, USA
| | - Nancy Halnon
- Department of Pediatric Cardiology, University of California , Los Angeles, CA, USA
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Posluszny DM, Dougall AL, Johnson JT, Argiris A, Ferris RL, Baum A, Bovbjerg DH, Dew MA. Posttraumatic stress disorder symptoms in newly diagnosed patients with head and neck cancer and their partners. Head Neck 2014; 37:1282-9. [PMID: 24817018 DOI: 10.1002/hed.23760] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 01/31/2014] [Accepted: 05/07/2014] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Head and neck cancer is a life-threatening illness requiring aversive treatments. Despite clear potential for posttraumatic stress disorder (PTSD) symptoms in both patients and their partners, research is scant. METHODS Newly diagnosed patients and partners (number of dyads = 42) completed questionnaires to assess symptoms of PTSD, anxiety, and depression, as well as demographic, medical, and attitudinal variables. RESULTS Partners had higher average levels of PTSD symptoms than patients (p = .023). More partners (28.6%) met criteria for estimated PTSD caseness than did patients (11.9%). There were no significant differences in levels of other anxiety or depression symptoms. Perceived threat of disease appeared to be a stronger correlate of PTSD symptom levels than medical variables in patients and partners. CONCLUSION A diagnosis of head and neck cancer elicits significant levels of PTSD symptoms in patients, and even higher levels among partners. Identified correlates of distress, including perceived threat of disease, are potential intervention targets.
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Affiliation(s)
- Donna M Posluszny
- Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.,Biobehavioral Medicine in Oncology Program, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | | | - Jonas T Johnson
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania.,Head and Neck Cancer Program, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | - Athanassios Argiris
- Division of Hematology/Oncology, Department of Medicine, University of Texas Health Center at San Antonio, Texas
| | - Robert L Ferris
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania.,Head and Neck Cancer Program, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania.,Department of Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Andrew Baum
- Department of Psychology, University of Texas at Arlington, Texas
| | - Dana H Bovbjerg
- Biobehavioral Medicine in Oncology Program, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania.,Departments of Psychiatry, Psychology, Behavioral, and Community Health Sciences, and Clinical and Translational Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Mary Amanda Dew
- Biobehavioral Medicine in Oncology Program, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania.,Departments of Psychiatry, Psychology, Epidemiology, and Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania
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