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Ben-Azu B, Oritsemuelebi B, Oghorodi AM, Adebesin A, Isibor H, Eduviere AT, Otuacha OS, Akudo M, Ekereya S, Maidoh IF, Iyayi JO, Uzochukwu-Godfrey FC. Psychopharmacological interaction of alcohol and posttraumatic stress disorder: Effective action of naringin. Eur J Pharmacol 2024; 978:176791. [PMID: 38944175 DOI: 10.1016/j.ejphar.2024.176791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 06/09/2024] [Accepted: 06/26/2024] [Indexed: 07/01/2024]
Abstract
Posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) are prevalently co-occurring, important risk factors for a broad array of neuropsychiatric diseases. To date, how these two contrastive concomitant pairs increase the risk of neuropsychiatric states, notably exacerbating PTSD-related symptoms, remains unknown. Moreover, pharmacological interventions with agents that could reverse PTSD-AUD comorbidity, however, remained limited. Hence, we investigated the neuroprotective actions of naringin in mice comorbidly exposed to PTSD followed by repeated ethanol (EtOH)-induced AUD. Following a 7-day single-prolong-stress (SPS)-induced PTSD in mice, binge/heavy drinking, notably related to AUD, was induced in the PTSD mice with every-other-day ethanol (2 g/kg, p.o.) administration, followed by daily treatments with naringin (25 and 50 mg/kg) or fluoxetine (10 mg/kg), from days 8-21. PTSD-AUD-related behavioral changes, alcohol preference, hypothalamic-pituitary-adrenal (HPA)-axis dysfunction-induced neurochemical alterations, oxidative/nitrergic stress, and inflammation were examined in the prefrontal-cortex, striatum, and hippocampus. PTSD-AUD mice showed aggravated anxiety, spatial-cognitive, social impairments and EtOH intake, which were abated by naringin, similar to fluoxetine. Our assays on the HPA-axis showed exacerbated increased corticosterone release and adrenal hypertrophy, accompanied by marked dopamine and serotonin increase, with depleted glutamic acid decarboxylase enzyme in the three brain regions, which naringin, however, reversed, respectively. PTSD-AUD mice also showed increased TNF-α, IL-6, malondialdehyde and nitrite levels, with decreased antioxidant elements in the prefrontal-cortex, striatum, and hippocampus compared to SPS-EtOH-mice, mainly exacerbating catalase and glutathione decrease in the hippocampus relative SPS-mice. These findings suggest that AUD exacerbates PTSD pathologies in different brain regions, notably comprising neurochemical dysregulations, oxidative/nitrergic and cytokine-mediated inflammation, with HPA dysfunction, which were, however, revocable by naringin.
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Affiliation(s)
- Benneth Ben-Azu
- DELSU Joint Canada-Israel Neuroscience and Biopsychiatry Laboratory, Department of Pharmacology, Faculty of Basic Medical Sciences, Delta State University, Abraka, Nigeria.
| | - Benjamin Oritsemuelebi
- DELSU Joint Canada-Israel Neuroscience and Biopsychiatry Laboratory, Department of Pharmacology, Faculty of Basic Medical Sciences, Delta State University, Abraka, Nigeria
| | - Akpobo M Oghorodi
- DELSU Joint Canada-Israel Neuroscience and Biopsychiatry Laboratory, Department of Pharmacology, Faculty of Basic Medical Sciences, Delta State University, Abraka, Nigeria; Department of Biomedical Engineering, Faculty of Technology, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Adaeze Adebesin
- Department of Pharmacology and Therapeutics, Faculty of Basic Medical Sciences, Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University, Sagamu Campus, Sagamu, Ogun State, Nigeria
| | - Happy Isibor
- DELSU Joint Canada-Israel Neuroscience and Biopsychiatry Laboratory, Department of Pharmacology, Faculty of Basic Medical Sciences, Delta State University, Abraka, Nigeria
| | - Anthony T Eduviere
- DELSU Joint Canada-Israel Neuroscience and Biopsychiatry Laboratory, Department of Pharmacology, Faculty of Basic Medical Sciences, Delta State University, Abraka, Nigeria
| | - Oghenemine S Otuacha
- DELSU Joint Canada-Israel Neuroscience and Biopsychiatry Laboratory, Department of Pharmacology, Faculty of Basic Medical Sciences, Delta State University, Abraka, Nigeria
| | - Moses Akudo
- DELSU Joint Canada-Israel Neuroscience and Biopsychiatry Laboratory, Department of Pharmacology, Faculty of Basic Medical Sciences, Delta State University, Abraka, Nigeria
| | - Surhirime Ekereya
- DELSU Joint Canada-Israel Neuroscience and Biopsychiatry Laboratory, Department of Pharmacology, Faculty of Basic Medical Sciences, Delta State University, Abraka, Nigeria
| | - Isioma F Maidoh
- DELSU Joint Canada-Israel Neuroscience and Biopsychiatry Laboratory, Department of Pharmacology, Faculty of Basic Medical Sciences, Delta State University, Abraka, Nigeria
| | - Joy O Iyayi
- DELSU Joint Canada-Israel Neuroscience and Biopsychiatry Laboratory, Department of Pharmacology, Faculty of Basic Medical Sciences, Delta State University, Abraka, Nigeria
| | - Faith C Uzochukwu-Godfrey
- DELSU Joint Canada-Israel Neuroscience and Biopsychiatry Laboratory, Department of Pharmacology, Faculty of Basic Medical Sciences, Delta State University, Abraka, Nigeria
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Gasik RE, Madkour AS, Skeen SJ, Clum G, Francis T, Felker-Kantor E, Ferguson T, Welsh DA, Molina PE, Theall KP. The Impact of Childhood Adversity on Life Course Alcohol Use Patterns and Health Status Among People Living with HIV. AIDS Behav 2024:10.1007/s10461-024-04368-1. [PMID: 38907764 DOI: 10.1007/s10461-024-04368-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2024] [Indexed: 06/24/2024]
Abstract
Adverse childhood experiences (ACEs) and financial hardship are associated with increased likelihood of heavier alcohol use and health challenges in adulthood among persons living with HIV (PWH). We examined whether retrospectively captured lifetime drinking trajectories are a pathway through which childhood hardships affect current health in a sample of 365 adult PWH. Childhood economic hardship and ACEs were used as main predictors. Measures of alcohol use included age at first drink and lifetime drinking trajectories. Health indicators included health-related quality of life, frailty, number of comorbidities, and symptoms of anxiety, depression, and post-traumatic stress disorder (PTSD). Structural equation modeling (SEM) was applied to estimate both direct and indirect pathways between childhood hardship and physical and mental health. Participants were mostly male; Black (84%); and averaged 48 years of age. SEM results supported both direct and indirect pathways between childhood experiences and adult health. ACEs were connected to physical health directly and mental health both directly and indirectly through age at first drink and drinking heaviness during ages 10-20. Childhood economic hardship related to mental health indirectly through higher drinking levels during ages 10-20. Childhood adverse experiences, economic hardship, and early drinking patterns appear to accumulate, resulting in later life physical and mental health concerns for PWH. Findings support taking a life course approach to health. This includes considering individual trauma histories in HIV care engagement and taking preventative approaches which support the economic and social well-being of vulnerable children to improve health in subsequent decades.
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Affiliation(s)
- Rayna E Gasik
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA.
| | | | - Simone J Skeen
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
- Department of Psychology, Hunter College, City University of New York, New York, NY, USA
| | - Gretchen Clum
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | | | - Erica Felker-Kantor
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Tekeda Ferguson
- Department of Epidemiology, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, USA
- Department of Physiology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
- Comprehensive Alcohol Research Center, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - David A Welsh
- Section of Pulmonary/Critical Care, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
- Comprehensive Alcohol Research Center, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Patricia E Molina
- Department of Physiology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
- Comprehensive Alcohol Research Center, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Katherine P Theall
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
- Department of Epidemiology, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, USA
- Comprehensive Alcohol Research Center, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
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3
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Back SE, Jarnecke AM, Norman SB, Zaur AJ, Hien DA. State of the Science: Treatment of comorbid posttraumatic stress disorder and substance use disorders. J Trauma Stress 2024. [PMID: 38857125 DOI: 10.1002/jts.23049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 03/12/2024] [Accepted: 03/14/2024] [Indexed: 06/12/2024]
Abstract
Posttraumatic stress disorder (PTSD) and substance use disorders (SUDs) co-occur at high rates, with research showing that up to nearly 60% of individuals with PTSD also suffer from an alcohol and/or drug use disorder. PTSD/SUD is complex; associated with adverse health, social, and economic outcomes; and can be challenging to treat. Over the past decade, the landscape of treatment research addressing PTSD/SUD has significantly expanded. Ongoing efforts aimed at developing and evaluating novel treatments for PTSD/SUD, encompassing both psychotherapy and pharmacotherapy approaches, are steadily advancing. As such, this State of the Science paper reviews the literature on the latest scientific advances in treating PTSD/SUD. Clinical practice guidelines for the treatment of PTSD/SUD are discussed, along with evidence-based psychotherapies and emerging interventions. Rigorously conducted clinical trials demonstrate that individual, manualized, trauma-focused treatments are the most efficacious psychotherapies to use among individuals with PTSD/SUD. Moreover, patients do not need to be abstinent to initiate or benefit from evidence-based PTSD treatment. To date, no medications have been established for this comorbidity. We highlight ongoing research on novel treatments for PTSD/SUD, such as new forms of integrated trauma-focused psychotherapies, pharmacological augmentation strategies, and technology-based enhancements. Finally, promising future directions for the field are discussed.
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Affiliation(s)
- Sudie E Back
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Ralph H. Johnson VA Healthcare System, Charleston, South Carolina, USA
| | - Amber M Jarnecke
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Sonya B Norman
- Department of Psychiatry, University of California San Diego School of Medicine, San Diego, California, USA
| | - Angela J Zaur
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Denise A Hien
- Center of Alcohol and Substance Use Studies, Rutgers University-New Brunswick, New Brunswick, New Jersey, USA
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Hammock JA, López-Castro T, Fox AD. Prior incarceration, restrictive housing, and posttraumatic stress disorder symptoms in a community sample of persons who use drugs. HEALTH & JUSTICE 2024; 12:20. [PMID: 38668954 PMCID: PMC11046833 DOI: 10.1186/s40352-024-00276-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 04/22/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Criminalization of drugs in the United States (US) has extensive consequences for people who use drugs (PWUD). Incarceration and substance use overlap with 65% of the US prison population meeting substance use disorder (SUD) criteria. Exposure to the criminal-legal system negatively impacts the health of PWUD. PTSD is commonly comorbid with SUDs, and exposure to restrictive housing (RH) during incarceration may worsen mental health. Because PWUD are disproportionately incarcerated, experiences occurring during incarceration, such as RH, may contribute to the development or exacerbation of PTSD and SUDs. This study of PWUD investigated prior criminal-legal system exposure and its association with PTSD symptoms in community-dwelling PWUD. METHODS This cross-sectional study recruited PWUD from syringe service programs (SSP). Inclusion criteria were: age 18+, current or past opioid use disorder, and SSP enrollment. Data collected included: sociodemographics; incarceration, substance use, SUD treatment history, and PTSD assessments (Life Events Checklist for DSM-5 and the PTSD Checklist for DSM-5). Bivariate testing and multivariate logistic regression analyses, with probable PTSD as the dependent variable and a three-level variable for criminal legal history as the independent variable, were conducted to determine whether incarceration and RH were associated with probable PTSD. RESULTS Of 139 participants, 78% had an incarceration history with 57% of these having a history of RH. 57% of participants screened positive for probable PTSD, and physical assault was the most common traumatic exposure. Any history of incarceration was not associated with probable PTSD diagnosis; however, in multivariate testing, adjusting for age, sex, and substance use, a history of RH (adjusted odds ratio [aOR]: 3.76, 95% CI 1.27-11.11) was significantly associated with probable PTSD. CONCLUSIONS RH and PTSD were both exceptionally common in a sample of SSP participants. RH can be detrimental to physical and mental health. Clinicians and policy makers may not consider incarceration as a traumatic experience for PWUD; however, our data suggest that among highly marginalized PWUD, prior exposure to incarceration and RH may add an additional burden to their daily struggles, namely PTSD.
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Affiliation(s)
- James A Hammock
- Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY, 10461, USA
| | - Teresa López-Castro
- The City College of New York, City University of New York, 160 Convent Ave, New York, NY, 10031, USA
| | - Aaron D Fox
- Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY, 10461, USA.
- Montefiore Medical Center, 111 E 210th St, Bronx, NY, 10467, USA.
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Fearon D, Perlman CM, Leatherdale S, Hirdes JP, Dubin J. Classification of traumatic life events and substance use among persons admitted to inpatient psychiatry in Ontario, Canada. J Psychiatr Res 2024; 172:236-243. [PMID: 38412786 DOI: 10.1016/j.jpsychires.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/09/2024] [Accepted: 02/01/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Trauma is commonly overlooked or undiagnosed in clinical care settings. Undetected trauma has been associated with elevated substance use highlighting the need to prioritize identifying individuals with undetected trauma through common characteristics. OBJECTIVE The purpose of this study is to identify classifications of traumatic life experiences and substance use among persons admitted to inpatient psychiatry in Ontario and to identify covariates associated with classification membership. STUDY DESIGN A population-based retrospective cohort study was conducted using interRAI Mental Health (MH) assessment data. Individuals were included who experienced traumatic life events (N = 10,125), in Ontario, Canada between January 1, 2015, to December 31, 2019. RESULTS Eight latent classes were identified that ranged from low (i.e., Class 1: Interpersonal Issues, Without Substance use) to high (i.e., Class 8: Widespread Trauma, Alcohol & Cannabis Addiction) complexity patterns of traumatic life events and substance use indicators. Classifications with similar trauma profiles were differentiated by patterns of substance use. For example, individuals in Class 2: Safety & Relationship Issues, Without Substance use and Class 3: Safety & Relationship Issues, Alcohol & Cannabis both had many estimates centered around the experience of victimization (e.g., victim of sexual assault, victim of physical assault, victim of emotional abuse). Multinomial logistic regression models highlighted additional factors associated with classifications such as homelessness, where those who were homeless were 2.09-4.02 times more likely to be in Class 6: Widespread Trauma & Substance Addiction. INTERPRETATION Trauma exposures are complex and varied among persons in inpatient psychiatry and can be further differentiated by substance use patterns. These findings provide a population-based estimate of the trauma experiences of persons in inpatient settings in Ontario, Canada. Findings demonstrate the importance of using comprehensive assessment to support clinical decision making in relation to trauma and substance.
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Affiliation(s)
- Danielle Fearon
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada.
| | | | - Scott Leatherdale
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - John P Hirdes
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Joel Dubin
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada; Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada
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6
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Livne O, Malte CA, Olfson M, Wall MM, Keyes KM, Maynard C, Gradus JL, Saxon AJ, Martins SS, Keyhani S, McDowell Y, Fink DS, Mannes ZL, Gutkind S, Hasin DS. Trends in Prevalence of Cannabis Use Disorder Among U.S. Veterans With and Without Psychiatric Disorders Between 2005 and 2019. Am J Psychiatry 2024; 181:144-152. [PMID: 38018141 PMCID: PMC10843609 DOI: 10.1176/appi.ajp.20230168] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
OBJECTIVE Cannabis use disorder diagnoses are increasing among U.S. adults and are more prevalent among people with comorbid psychiatric disorders. Recent changes in cannabis laws, increasing cannabis availability, and higher-potency cannabis may have placed people with cannabis use and psychiatric disorders at disproportionately increasing risk for cannabis use disorder. The authors used Veterans Health Administration (VHA) data to examine whether trends in cannabis use disorder prevalence among VHA patients differ by whether they have psychiatric disorders. METHODS VHA electronic health records from 2005 to 2019 (N range, 4,332,165-5,657,277) were used to identify overall and age-group-specific (<35, 35-64, and ≥65 years) trends in prevalence of cannabis use disorder diagnoses among patients with depressive, anxiety, posttraumatic stress, bipolar, or psychotic spectrum disorders and to compare these to corresponding trends among patients without any of these disorders. Given transitions in ICD coding, differences in trends were tested within two periods: 2005-2014 (ICD-9-CM) and 2016-2019 (ICD-10-CM). RESULTS Greater increases in prevalence of cannabis use disorder diagnoses were observed among patients with psychiatric disorders compared to those without (difference in prevalence change, 2005-2014: 1.91%, 95% CI=1.87-1.96; 2016-2019: 0.34%, 95% CI=0.29-0.38). Disproportionate increases in cannabis use disorder prevalence among patients with psychiatric disorders were greatest among those under age 35 between 2005 and 2014, and among those age 65 or older between 2016 and 2019. Among patients with psychiatric disorders, the greatest increases in cannabis use disorder prevalences were observed among those with bipolar and psychotic spectrum disorders. CONCLUSIONS The findings highlight disproportionately increasing disparities in risk of cannabis use disorder among VHA patients with common psychiatric disorders. Greater public health and clinical efforts are needed to monitor, prevent, and treat cannabis use disorder in this population.
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Affiliation(s)
- Ofir Livne
- New York State Psychiatric Institute, New York (Livne, Olfson, Wall, Fink, Hasin); Department of Psychiatry (Livne, Olfson, Wall, Hasin) and Department of Emergency Medicine (Mannes), Columbia University Irving Medical Center, New York; Health Services Research and Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care (Malte, Saxon, McDowell) and Center of Excellence in Substance Addiction Treatment and Education (Malte, Saxon), VA Puget Sound Health Care System, Seattle; Department of Epidemiology, Columbia University Mailman School of Public Health, New York (Keyes, Martins, Mannes, Gutkind, Hasin); Department of Health Systems and Population Health, School of Public Health and Community Medicine, University of Washington, Seattle (Maynard); Department of Epidemiology, Boston University School of Public Health, and Department of Psychiatry, Boston University School of Medicine, Boston (Gradus); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Saxon); San Francisco VA Medical Center and Department of Medicine, University of California, San Francisco (Keyhani)
| | - Carol A Malte
- New York State Psychiatric Institute, New York (Livne, Olfson, Wall, Fink, Hasin); Department of Psychiatry (Livne, Olfson, Wall, Hasin) and Department of Emergency Medicine (Mannes), Columbia University Irving Medical Center, New York; Health Services Research and Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care (Malte, Saxon, McDowell) and Center of Excellence in Substance Addiction Treatment and Education (Malte, Saxon), VA Puget Sound Health Care System, Seattle; Department of Epidemiology, Columbia University Mailman School of Public Health, New York (Keyes, Martins, Mannes, Gutkind, Hasin); Department of Health Systems and Population Health, School of Public Health and Community Medicine, University of Washington, Seattle (Maynard); Department of Epidemiology, Boston University School of Public Health, and Department of Psychiatry, Boston University School of Medicine, Boston (Gradus); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Saxon); San Francisco VA Medical Center and Department of Medicine, University of California, San Francisco (Keyhani)
| | - Mark Olfson
- New York State Psychiatric Institute, New York (Livne, Olfson, Wall, Fink, Hasin); Department of Psychiatry (Livne, Olfson, Wall, Hasin) and Department of Emergency Medicine (Mannes), Columbia University Irving Medical Center, New York; Health Services Research and Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care (Malte, Saxon, McDowell) and Center of Excellence in Substance Addiction Treatment and Education (Malte, Saxon), VA Puget Sound Health Care System, Seattle; Department of Epidemiology, Columbia University Mailman School of Public Health, New York (Keyes, Martins, Mannes, Gutkind, Hasin); Department of Health Systems and Population Health, School of Public Health and Community Medicine, University of Washington, Seattle (Maynard); Department of Epidemiology, Boston University School of Public Health, and Department of Psychiatry, Boston University School of Medicine, Boston (Gradus); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Saxon); San Francisco VA Medical Center and Department of Medicine, University of California, San Francisco (Keyhani)
| | - Melanie M Wall
- New York State Psychiatric Institute, New York (Livne, Olfson, Wall, Fink, Hasin); Department of Psychiatry (Livne, Olfson, Wall, Hasin) and Department of Emergency Medicine (Mannes), Columbia University Irving Medical Center, New York; Health Services Research and Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care (Malte, Saxon, McDowell) and Center of Excellence in Substance Addiction Treatment and Education (Malte, Saxon), VA Puget Sound Health Care System, Seattle; Department of Epidemiology, Columbia University Mailman School of Public Health, New York (Keyes, Martins, Mannes, Gutkind, Hasin); Department of Health Systems and Population Health, School of Public Health and Community Medicine, University of Washington, Seattle (Maynard); Department of Epidemiology, Boston University School of Public Health, and Department of Psychiatry, Boston University School of Medicine, Boston (Gradus); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Saxon); San Francisco VA Medical Center and Department of Medicine, University of California, San Francisco (Keyhani)
| | - Katherine M Keyes
- New York State Psychiatric Institute, New York (Livne, Olfson, Wall, Fink, Hasin); Department of Psychiatry (Livne, Olfson, Wall, Hasin) and Department of Emergency Medicine (Mannes), Columbia University Irving Medical Center, New York; Health Services Research and Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care (Malte, Saxon, McDowell) and Center of Excellence in Substance Addiction Treatment and Education (Malte, Saxon), VA Puget Sound Health Care System, Seattle; Department of Epidemiology, Columbia University Mailman School of Public Health, New York (Keyes, Martins, Mannes, Gutkind, Hasin); Department of Health Systems and Population Health, School of Public Health and Community Medicine, University of Washington, Seattle (Maynard); Department of Epidemiology, Boston University School of Public Health, and Department of Psychiatry, Boston University School of Medicine, Boston (Gradus); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Saxon); San Francisco VA Medical Center and Department of Medicine, University of California, San Francisco (Keyhani)
| | - Charles Maynard
- New York State Psychiatric Institute, New York (Livne, Olfson, Wall, Fink, Hasin); Department of Psychiatry (Livne, Olfson, Wall, Hasin) and Department of Emergency Medicine (Mannes), Columbia University Irving Medical Center, New York; Health Services Research and Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care (Malte, Saxon, McDowell) and Center of Excellence in Substance Addiction Treatment and Education (Malte, Saxon), VA Puget Sound Health Care System, Seattle; Department of Epidemiology, Columbia University Mailman School of Public Health, New York (Keyes, Martins, Mannes, Gutkind, Hasin); Department of Health Systems and Population Health, School of Public Health and Community Medicine, University of Washington, Seattle (Maynard); Department of Epidemiology, Boston University School of Public Health, and Department of Psychiatry, Boston University School of Medicine, Boston (Gradus); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Saxon); San Francisco VA Medical Center and Department of Medicine, University of California, San Francisco (Keyhani)
| | - Jaimie L Gradus
- New York State Psychiatric Institute, New York (Livne, Olfson, Wall, Fink, Hasin); Department of Psychiatry (Livne, Olfson, Wall, Hasin) and Department of Emergency Medicine (Mannes), Columbia University Irving Medical Center, New York; Health Services Research and Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care (Malte, Saxon, McDowell) and Center of Excellence in Substance Addiction Treatment and Education (Malte, Saxon), VA Puget Sound Health Care System, Seattle; Department of Epidemiology, Columbia University Mailman School of Public Health, New York (Keyes, Martins, Mannes, Gutkind, Hasin); Department of Health Systems and Population Health, School of Public Health and Community Medicine, University of Washington, Seattle (Maynard); Department of Epidemiology, Boston University School of Public Health, and Department of Psychiatry, Boston University School of Medicine, Boston (Gradus); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Saxon); San Francisco VA Medical Center and Department of Medicine, University of California, San Francisco (Keyhani)
| | - Andrew J Saxon
- New York State Psychiatric Institute, New York (Livne, Olfson, Wall, Fink, Hasin); Department of Psychiatry (Livne, Olfson, Wall, Hasin) and Department of Emergency Medicine (Mannes), Columbia University Irving Medical Center, New York; Health Services Research and Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care (Malte, Saxon, McDowell) and Center of Excellence in Substance Addiction Treatment and Education (Malte, Saxon), VA Puget Sound Health Care System, Seattle; Department of Epidemiology, Columbia University Mailman School of Public Health, New York (Keyes, Martins, Mannes, Gutkind, Hasin); Department of Health Systems and Population Health, School of Public Health and Community Medicine, University of Washington, Seattle (Maynard); Department of Epidemiology, Boston University School of Public Health, and Department of Psychiatry, Boston University School of Medicine, Boston (Gradus); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Saxon); San Francisco VA Medical Center and Department of Medicine, University of California, San Francisco (Keyhani)
| | - Silvia S Martins
- New York State Psychiatric Institute, New York (Livne, Olfson, Wall, Fink, Hasin); Department of Psychiatry (Livne, Olfson, Wall, Hasin) and Department of Emergency Medicine (Mannes), Columbia University Irving Medical Center, New York; Health Services Research and Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care (Malte, Saxon, McDowell) and Center of Excellence in Substance Addiction Treatment and Education (Malte, Saxon), VA Puget Sound Health Care System, Seattle; Department of Epidemiology, Columbia University Mailman School of Public Health, New York (Keyes, Martins, Mannes, Gutkind, Hasin); Department of Health Systems and Population Health, School of Public Health and Community Medicine, University of Washington, Seattle (Maynard); Department of Epidemiology, Boston University School of Public Health, and Department of Psychiatry, Boston University School of Medicine, Boston (Gradus); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Saxon); San Francisco VA Medical Center and Department of Medicine, University of California, San Francisco (Keyhani)
| | - Salomeh Keyhani
- New York State Psychiatric Institute, New York (Livne, Olfson, Wall, Fink, Hasin); Department of Psychiatry (Livne, Olfson, Wall, Hasin) and Department of Emergency Medicine (Mannes), Columbia University Irving Medical Center, New York; Health Services Research and Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care (Malte, Saxon, McDowell) and Center of Excellence in Substance Addiction Treatment and Education (Malte, Saxon), VA Puget Sound Health Care System, Seattle; Department of Epidemiology, Columbia University Mailman School of Public Health, New York (Keyes, Martins, Mannes, Gutkind, Hasin); Department of Health Systems and Population Health, School of Public Health and Community Medicine, University of Washington, Seattle (Maynard); Department of Epidemiology, Boston University School of Public Health, and Department of Psychiatry, Boston University School of Medicine, Boston (Gradus); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Saxon); San Francisco VA Medical Center and Department of Medicine, University of California, San Francisco (Keyhani)
| | - Yoanna McDowell
- New York State Psychiatric Institute, New York (Livne, Olfson, Wall, Fink, Hasin); Department of Psychiatry (Livne, Olfson, Wall, Hasin) and Department of Emergency Medicine (Mannes), Columbia University Irving Medical Center, New York; Health Services Research and Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care (Malte, Saxon, McDowell) and Center of Excellence in Substance Addiction Treatment and Education (Malte, Saxon), VA Puget Sound Health Care System, Seattle; Department of Epidemiology, Columbia University Mailman School of Public Health, New York (Keyes, Martins, Mannes, Gutkind, Hasin); Department of Health Systems and Population Health, School of Public Health and Community Medicine, University of Washington, Seattle (Maynard); Department of Epidemiology, Boston University School of Public Health, and Department of Psychiatry, Boston University School of Medicine, Boston (Gradus); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Saxon); San Francisco VA Medical Center and Department of Medicine, University of California, San Francisco (Keyhani)
| | - David S Fink
- New York State Psychiatric Institute, New York (Livne, Olfson, Wall, Fink, Hasin); Department of Psychiatry (Livne, Olfson, Wall, Hasin) and Department of Emergency Medicine (Mannes), Columbia University Irving Medical Center, New York; Health Services Research and Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care (Malte, Saxon, McDowell) and Center of Excellence in Substance Addiction Treatment and Education (Malte, Saxon), VA Puget Sound Health Care System, Seattle; Department of Epidemiology, Columbia University Mailman School of Public Health, New York (Keyes, Martins, Mannes, Gutkind, Hasin); Department of Health Systems and Population Health, School of Public Health and Community Medicine, University of Washington, Seattle (Maynard); Department of Epidemiology, Boston University School of Public Health, and Department of Psychiatry, Boston University School of Medicine, Boston (Gradus); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Saxon); San Francisco VA Medical Center and Department of Medicine, University of California, San Francisco (Keyhani)
| | - Zachary L Mannes
- New York State Psychiatric Institute, New York (Livne, Olfson, Wall, Fink, Hasin); Department of Psychiatry (Livne, Olfson, Wall, Hasin) and Department of Emergency Medicine (Mannes), Columbia University Irving Medical Center, New York; Health Services Research and Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care (Malte, Saxon, McDowell) and Center of Excellence in Substance Addiction Treatment and Education (Malte, Saxon), VA Puget Sound Health Care System, Seattle; Department of Epidemiology, Columbia University Mailman School of Public Health, New York (Keyes, Martins, Mannes, Gutkind, Hasin); Department of Health Systems and Population Health, School of Public Health and Community Medicine, University of Washington, Seattle (Maynard); Department of Epidemiology, Boston University School of Public Health, and Department of Psychiatry, Boston University School of Medicine, Boston (Gradus); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Saxon); San Francisco VA Medical Center and Department of Medicine, University of California, San Francisco (Keyhani)
| | - Sarah Gutkind
- New York State Psychiatric Institute, New York (Livne, Olfson, Wall, Fink, Hasin); Department of Psychiatry (Livne, Olfson, Wall, Hasin) and Department of Emergency Medicine (Mannes), Columbia University Irving Medical Center, New York; Health Services Research and Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care (Malte, Saxon, McDowell) and Center of Excellence in Substance Addiction Treatment and Education (Malte, Saxon), VA Puget Sound Health Care System, Seattle; Department of Epidemiology, Columbia University Mailman School of Public Health, New York (Keyes, Martins, Mannes, Gutkind, Hasin); Department of Health Systems and Population Health, School of Public Health and Community Medicine, University of Washington, Seattle (Maynard); Department of Epidemiology, Boston University School of Public Health, and Department of Psychiatry, Boston University School of Medicine, Boston (Gradus); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Saxon); San Francisco VA Medical Center and Department of Medicine, University of California, San Francisco (Keyhani)
| | - Deborah S Hasin
- New York State Psychiatric Institute, New York (Livne, Olfson, Wall, Fink, Hasin); Department of Psychiatry (Livne, Olfson, Wall, Hasin) and Department of Emergency Medicine (Mannes), Columbia University Irving Medical Center, New York; Health Services Research and Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care (Malte, Saxon, McDowell) and Center of Excellence in Substance Addiction Treatment and Education (Malte, Saxon), VA Puget Sound Health Care System, Seattle; Department of Epidemiology, Columbia University Mailman School of Public Health, New York (Keyes, Martins, Mannes, Gutkind, Hasin); Department of Health Systems and Population Health, School of Public Health and Community Medicine, University of Washington, Seattle (Maynard); Department of Epidemiology, Boston University School of Public Health, and Department of Psychiatry, Boston University School of Medicine, Boston (Gradus); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Saxon); San Francisco VA Medical Center and Department of Medicine, University of California, San Francisco (Keyhani)
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7
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Ahmed Z, Tahmin CI, Tahsin CT, Michopoulos V, Mohamed A, Wattero R, Albott S, Cullen KR, Lowe DA, Osborn J, Fonkoue IT. Higher arterial stiffness and blunted vagal control of the heart in young women with compared to without a clinical diagnosis of PTSD. Clin Auton Res 2024; 34:165-175. [PMID: 38324188 PMCID: PMC10947824 DOI: 10.1007/s10286-024-01014-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 01/08/2024] [Indexed: 02/08/2024]
Abstract
PURPOSE Young women are typically thought to be protected from cardiovascular disease (CVD) before menopause. However, posttraumatic stress disorder (PTSD) increases CVD risk in women by up to threefold. Data in predominantly male cohorts point to physiological mechanisms such as vascular and autonomic derangements as contributing to increased CVD risk. The purpose of the study reported here was to determine whether young women diagnosed with PTSD, compared to those without, present with arterial stiffness and impaired autonomic control of the heart. METHODS A total of 73 healthy young women, ranging in age from 18 to 40 years, with a history of trauma exposure were included in this study, 32 with and 41 without a clinical PTSD diagnosis. We measured resting pulse wave velocity (PWV), central hemodynamics, augmentation pressure and augmentation index (AI) via pulse wave analysis using applanation tonometry. Heart rate variability was also assessed via peripheral arterial tone. RESULTS In comparison to controls, women with PTSD showed higher central arterial pressure (mean ± standard deviation: systolic blood pressure 104 ± 8 vs. 97 ± 8 mmHg, p < 0.001; diastolic blood pressure 72 ± 7 vs. 67 ± 7 mmHg, p = 0.003), PWV (6 ± 0.3 vs. 5 ± 0.6 m/s, p < 0.001) and AI (22 ± 13 vs. 15 ± 12%, p = 0.007) but lower standard deviation of normal-to-normal intervals (SDNN; 44 ± 17 vs. 54 ± 18 ms, p = 0.005) and root mean square of successive differences between normal heartbeats (RMSSD; 37 ± 17 vs. 51 ± 22 ms, p = 0.002). CONCLUSION PTSD in young women is associated with higher brachial and central pressures, increased arterial stiffness and blunted parasympathetic control of the heart. These findings illustrate potential mechanisms underlying high risk for CVD in young women with PTSD, suggesting possible treatment targets for this at-risk group.
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Affiliation(s)
- Zynab Ahmed
- Divisions of Physical Therapy and Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota Medical School, 420 Delaware St. SE (MMC 388), Minneapolis, MN, USA
- Division of Health Policy and Management, School of Public Health, Minneapolis, MN, USA
| | - Chowdhury Ibtida Tahmin
- Divisions of Physical Therapy and Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota Medical School, 420 Delaware St. SE (MMC 388), Minneapolis, MN, USA
| | - Chowdhury Tasnova Tahsin
- Divisions of Physical Therapy and Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota Medical School, 420 Delaware St. SE (MMC 388), Minneapolis, MN, USA
| | - Vasiliki Michopoulos
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Azhaar Mohamed
- Divisions of Physical Therapy and Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota Medical School, 420 Delaware St. SE (MMC 388), Minneapolis, MN, USA
| | - Redeat Wattero
- Divisions of Physical Therapy and Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota Medical School, 420 Delaware St. SE (MMC 388), Minneapolis, MN, USA
| | - Sophia Albott
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA
- Mental Health Service Line, Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Kathryn R Cullen
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Dawn A Lowe
- Divisions of Physical Therapy and Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota Medical School, 420 Delaware St. SE (MMC 388), Minneapolis, MN, USA
| | - John Osborn
- Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Ida T Fonkoue
- Divisions of Physical Therapy and Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota Medical School, 420 Delaware St. SE (MMC 388), Minneapolis, MN, USA.
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8
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Gully BJ, Eaton E, Capone C, Haass-Koffler CL. Treating posttraumatic stress disorder and alcohol use disorder comorbidity: Current pharmacological therapies and the future of MDMA-integrated psychotherapy. J Psychopharmacol 2023; 37:1182-1189. [PMID: 38009477 DOI: 10.1177/02698811231200880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) frequently co-occur in patients who have experienced trauma. This comorbidity leads to a vicious cycle where PTSD symptoms beget heavy drinking and vice versa. There are no FDA-approved medications to treat PTSD-AUD; therefore, individuals suffering from this comorbidity are treated with medication approved to treat the disorders separately or with off-label pharmacological interventions. However, these medications are limited in their efficacy for treating PTSD-AUD comorbidity. Emerging research on the nonclassical psychedelic drug 3,4-methylenedioxymethamphetamine (MDMA) suggests that it may be an effective drug used in conjunction with psychotherapy. The following reviews the current research for clinical pharmacotherapies, as well as MDMA-integrative psychotherapy as they pertain to PTSD and AUD in isolation and co-occurrence. Future directions for the role of psychedelic-integrative therapy for the treatment of this comorbidity are discussed.
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Affiliation(s)
- Brian J Gully
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, USA
| | - Erica Eaton
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA
- Providence Veterans Affairs Medical Center, Providence, RI, USA
| | - Christy Capone
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA
- Providence Veterans Affairs Medical Center, Providence, RI, USA
| | - Carolina L Haass-Koffler
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA
- Carney Institute for Brain Science, Brown University, Providence, RI, USA
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9
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Dyar C, Kaysen D. Event-level positive and negative reinforcement risk factors for alcohol use: Moderation by individual-level alcohol consequences and post-traumatic stress disorder symptom severity. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:2068-2080. [PMID: 38226757 PMCID: PMC10794026 DOI: 10.1111/acer.15188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/30/2023] [Accepted: 08/30/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND The multistage model of drug addiction posits that risk processes contributing to alcohol use change as individuals develop alcohol use disorders. However, few studies have tested this theory outside of the lab or at the event level. We assessed whether event-level associations between positive reinforcement (e.g., positive affect, sociability expectancies) and negative reinforcement risk factors (e.g., negative affect, tension reduction expectancies) and same-/next-day alcohol consumption varied as a function of an individual's level of alcohol consequences. Given elevated alcohol use consequences among individuals with post-traumatic stress disorder (PTSD) and disruptions in reward processing that affect this population, we also tested whether these processes differed based on the presence and severity of PTSD. METHODS We used data from a 30-day ecological momentary assessment study with 174 undergraduate women who regularly engaged in heavy episodic drinking. A majority (78%) of the sample had experienced sexual assault and 44% had current PTSD. Analyses used Bayesian multilevel structural equation modeling with diffuse (non-informative) priors. We used markov chain monte carlo (MCMC) algorithms to generate a series of 10,000 random draws from the multivariate posterior distribution of our sample for each model. RESULTS Results partially supported the multistage model. Event-level negative reinforcement risk factors only predicted more alcohol consumption among individuals who experienced more alcohol consequences. Findings for positive reinforcement risk factors were partially consistent with hypotheses. Overall, findings appear to operate similarly across PTSD symptom severity. CONCLUSIONS Results suggest that interventions for heavy episodic drinking could benefit from attending to an individual's level of alcohol consequences. For example, preventive interventions for individuals who tend to experience few consequences may benefit more from addressing positive reinforcement risk factors, while treatment interventions for those who experience more consequences may benefit from attending to both positive and negative reinforcement.
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Affiliation(s)
| | - Debra Kaysen
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
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10
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Amstadter AB, Lönn S, Sundquist J, Sundquist K, Kendler KS. Post-traumatic stress disorder and drug use disorder: examination of aetiological models in a Swedish population-based cohort. Eur J Psychotraumatol 2023; 14:2258312. [PMID: 37800551 PMCID: PMC10561571 DOI: 10.1080/20008066.2023.2258312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 07/24/2023] [Indexed: 10/07/2023] Open
Abstract
Background: There are two primary phenotypic models of comorbidity between post-traumatic stress disorder (PTSD) and drug use disorder (DUD), i.e. self-medication (PTSD precedes and causes DUD) and susceptibility (DUD precedes and causes PTSD). We sought to clarify the longitudinal relationship between PTSD and DUD, while examining sex differences.Method: We used approximately 23 years of longitudinal data from Swedish population registries to conduct two complementary statistical models: Cox proportional hazard models (N ≈ 1.5 million) and a cross-lagged panel model (N ≈ 3.8 million).Results: Cox proportional hazards models, adjusting for cohort and socioeconomic status, found strong evidence for the self-medication hypothesis, as PTSD predicted increased risk for DUD among both women [hazard ratio (HR) = 5.34, 95% confidence interval (CI) 5.18, 5.51] and men (HR = 3.65, 95% CI 3.54, 3.77), and moreover, that the PTSD to DUD association was significantly higher among women (interaction term 0.68, 95% CI 0.65, 0.71). The results of the susceptibility model were significant, but not as strong as the self-medication model. DUD predicted risk for PTSD among both women (HR = 2.43, 95% CI 2.38, 2.50) and men (HR = 2.55, 95% CI 2.50, 2.60), and HR was significantly higher in men (interaction term 1.05, 95% CI 1.02, 1.08). Investigating the pathways simultaneously in the cross-lagged model yielded support for both pathways of risk. The cross-paths instantiating the susceptibility model (0.10-0.22 in females, 0.12-0.19 in males) were mostly larger than those capturing the self-medication model (0.01-0.16 in females, 0.04-0.22 in males).Conclusions: We demonstrate that the relationship between PTSD and DUD is bidirectional, with evidence that future research should prioritize examining specific pathways of risk that may differ between men and women.
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Affiliation(s)
- Ananda B. Amstadter
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
| | - Sara Lönn
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
- Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
- Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Kenneth S. Kendler
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
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11
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Giovanniello JR, Paredes N, Wiener A, Ramírez-Armenta K, Oragwam C, Uwadia HO, Lim K, Nnamdi G, Wang A, Sehgal M, Reis FM, Sias AC, Silva AJ, Adhikari A, Malvaez M, Wassum KM. A dual-pathway architecture enables chronic stress to promote habit formation. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.10.03.560731. [PMID: 37873076 PMCID: PMC10592885 DOI: 10.1101/2023.10.03.560731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Chronic stress can change how we learn and, thus, how we make decisions by promoting the formation of inflexible, potentially maladaptive, habits. Here we investigated the neuronal circuit mechanisms that enable this. Using a multifaceted approach in male and female mice, we reveal a dual pathway, amygdala-striatal, neuronal circuit architecture by which a recent history of chronic stress shapes learning to disrupt flexible goal-directed behavior in favor of inflexible habits. Chronic stress inhibits activity of basolateral amygdala projections to the dorsomedial striatum to impede the action-outcome learning that supports flexible, goal-directed decisions. Stress also increases activity in direct central amygdala projections to the dorsomedial striatum to promote the formation of rigid, inflexible habits. Thus, stress exerts opposing effects on two amygdala-striatal pathways to promote premature habit formation. These data provide neuronal circuit insights into how chronic stress shapes learning and decision making, and help understand how stress can lead to the disrupted decision making and pathological habits that characterize substance use disorders and other psychiatric conditions.
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Affiliation(s)
| | | | - Anna Wiener
- Dept. of Psychology, UCLA, Los Angeles, CA 90095
| | | | | | | | - Kayla Lim
- Dept. of Biological Chemistry, UCLA, Los Angeles, CA 90095
| | - Gift Nnamdi
- Dept. of Psychology, UCLA, Los Angeles, CA 90095
| | - Alicia Wang
- Dept. of Psychology, UCLA, Los Angeles, CA 90095
| | - Megha Sehgal
- Dept. of Psychology, UCLA, Los Angeles, CA 90095
| | | | - Ana C Sias
- Dept. of Psychology, UCLA, Los Angeles, CA 90095
| | - Alcino J Silva
- Dept. of Psychology, UCLA, Los Angeles, CA 90095
- Brain Research Institute, UCLA, Los Angeles, CA 90095, USA
- Integrative Center for Learning and Memory, University of California Los Angeles, Los Angeles, CA, USA
| | - Avishek Adhikari
- Dept. of Psychology, UCLA, Los Angeles, CA 90095
- Brain Research Institute, UCLA, Los Angeles, CA 90095, USA
- Integrative Center for Learning and Memory, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Kate M Wassum
- Dept. of Psychology, UCLA, Los Angeles, CA 90095
- Brain Research Institute, UCLA, Los Angeles, CA 90095, USA
- Integrative Center for Learning and Memory, University of California Los Angeles, Los Angeles, CA, USA
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12
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Tahsin CT, Michopoulos V, Powers A, Park J, Ahmed Z, Cullen K, Jenkins NDM, Keller-Ross M, Fonkoue IT. Sleep efficiency and PTSD symptom severity predict microvascular endothelial function and arterial stiffness in young, trauma-exposed women. Am J Physiol Heart Circ Physiol 2023; 325:H739-H750. [PMID: 37505472 PMCID: PMC10642999 DOI: 10.1152/ajpheart.00169.2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 07/13/2023] [Accepted: 07/28/2023] [Indexed: 07/29/2023]
Abstract
Posttraumatic stress disorder (PTSD) is linked to sleep disturbances and significantly higher risk of developing cardiovascular disease (CVD). Furthermore, vascular dysfunction and sleep are independently associated with CVD. Uncovering the link between PTSD symptom severity, sleep disturbances, and vascular function could shine a light on mechanisms of CVD risk in trauma-exposed young women. The purpose of the present study was to investigate the individual and combined effects of sleep efficiency and PTSD symptom severity on vascular function. We recruited 60 otherwise healthy women [age, 26 ± 7 yr and body mass index (BMI), 27.7 ± 6.5 kg/m2] who had been exposed to trauma. We objectively quantified sleep efficiency (SE) using actigraphy, microvascular endothelial function via Framingham reactive hyperemia index (fRHI), and arterial stiffness via pulse-wave velocity (PWV). PTSD symptom severity was assessed using the PTSD checklist for fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (PCL5). PWV was correlated with age (r = 0.490, P < 0.001) and BMI (r = 0.484, P < 0.001). In addition, fRHI was positively correlated with SE (r = 0.409, P = 0.001) and negatively correlated with PTSD symptoms (r = -0.382, P = 0.002). To explore the predictive value of SE and PTSD symptoms on PWV and fRHI, we conducted two multivariate linear regression models. The model predicting PWV was significant (R2 = 0.584, P < 0.001) with age, BMI, blood pressure, and SE emerging as predictors. Likewise, the model predicting fRHI was significant (R2 = 0.360, P < 0.001) with both PTSD symptoms and SE as significant predictors. Our results suggest that although PTSD symptoms mainly impact microvascular endothelial function, sleep efficiency is additionally associated with arterial stiffness in young trauma-exposed women, after controlling for age and BMI.NEW & NOTEWORTHY This is the first study to investigate the individual and combined impacts of objective sleep and PTSD symptoms severity on arterial stiffness and microvascular endothelial function in young premenopausal women. We report that in young trauma-exposed women, although low sleep efficiency is associated with overall vascular function (i.e., microvascular endothelial function and arterial stiffness), the severity of PTSD symptoms is specifically associated with microvascular endothelial function, after accounting for age and body mass index.
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Affiliation(s)
- Chowdhury Tasnova Tahsin
- Division of Physical Therapy, Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, United States
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, United States
| | - Vasiliki Michopoulos
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, United States
| | - Abigail Powers
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, United States
| | - Jeanie Park
- Division of Renal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States
- Department of Veterans Affairs, Research Service Line, Atlanta Veterans Affairs Healthcare Systems, Decatur, Georgia, United States
| | - Zynab Ahmed
- Division of Physical Therapy, Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, United States
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, United States
| | - Kathryn Cullen
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota, United States
| | - Nathaniel D M Jenkins
- Department of Health and Human Physiology, University of Iowa, Iowa City, Iowa, United States
- Abboud Cardiovascular Research Center, University of Iowa, Iowa City, Iowa, United States
| | - Manda Keller-Ross
- Division of Physical Therapy, Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, United States
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, United States
| | - Ida T Fonkoue
- Division of Physical Therapy, Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, United States
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, United States
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13
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Garrey SK, Locke S, Pollari C, Li J, Takemoto E. Post-traumatic stress disorder and risk of first-time and repeated opioid-related hospitalizations among World Trade Center Health Registry enrollees. Psychiatry Res 2023; 328:115462. [PMID: 37734242 DOI: 10.1016/j.psychres.2023.115462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 09/01/2023] [Accepted: 09/03/2023] [Indexed: 09/23/2023]
Abstract
In 2021, and average of 220 deaths from opioid-related overdoses occurred daily in the US. Recent evidence suggests there is an association between post-traumatic stress disorder (PTSD) and increased opioid misuse, while little is known about opioid-related hospitalizations. This study used data from the World Trade Center Health Registry (WTCHR), a longitudinal cohort consisting of individuals directly exposed to the September 11th terrorist attacks with a high prevalence of resulting PTSD (3.8-29.6%). We linked WTCHR data to New York State hospitalization data to examine the question: do opioid-related hospitalizations (first time and repeated) differ by PTSD status. In a study sample of 37,968 adults, 145 experienced at least one episode of opioid-related hospitalization and 64 had repeated episodes during the study period. We found that in the 13-years post-9/11, individuals with PTSD had a significantly higher risk of a first-time opioid-related hospitalization (Hazard Ratio: 3.6, 95% CI: 2.7, 5.0) and repeated opioid-related hospitalizations (Hazard Ratio: 3.9, 95% CI: 2.7, 5.8) than those who did not have PTSD. Improved treatment of and increased screenings for PTSD may reduce the likelihood of opioid misuse in this population and consequently overdoses, hospitalizations, and healthcare costs.
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Affiliation(s)
- Sascha K Garrey
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, 42-09 28th Street, CN-6W, Long Island City, NY 11101, United States
| | - Sean Locke
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, 42-09 28th Street, CN-6W, Long Island City, NY 11101, United States
| | - Cristina Pollari
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, 42-09 28th Street, CN-6W, Long Island City, NY 11101, United States
| | - Jiehui Li
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, 42-09 28th Street, CN-6W, Long Island City, NY 11101, United States.
| | - Erin Takemoto
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, 42-09 28th Street, CN-6W, Long Island City, NY 11101, United States
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14
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Houghton DC, Spratt HM, Keyser-Marcus L, Bjork JM, Neigh GN, Cunningham KA, Ramey T, Moeller FG. Behavioral and neurocognitive factors distinguishing post-traumatic stress comorbidity in substance use disorders. Transl Psychiatry 2023; 13:296. [PMID: 37709748 PMCID: PMC10502088 DOI: 10.1038/s41398-023-02591-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 08/08/2023] [Accepted: 08/25/2023] [Indexed: 09/16/2023] Open
Abstract
Significant trauma histories and post-traumatic stress disorder (PTSD) are common in persons with substance use disorders (SUD) and often associate with increased SUD severity and poorer response to SUD treatment. As such, this sub-population has been associated with unique risk factors and treatment needs. Understanding the distinct etiological profile of persons with co-occurring SUD and PTSD is therefore crucial for advancing our knowledge of underlying mechanisms and the development of precision treatments. To this end, we employed supervised machine learning algorithms to interrogate the responses of 160 participants with SUD on the multidimensional NIDA Phenotyping Assessment Battery. Significant PTSD symptomatology was correctly predicted in 75% of participants (sensitivity: 80%; specificity: 72.22%) using a classification-based model based on anxiety and depressive symptoms, perseverative thinking styles, and interoceptive awareness. A regression-based machine learning model also utilized similar predictors, but failed to accurately predict severity of PTSD symptoms. These data indicate that even in a population already characterized by elevated negative affect (individuals with SUD), especially severe negative affect was predictive of PTSD symptomatology. In a follow-up analysis of a subset of 102 participants who also completed neurocognitive tasks, comorbidity status was correctly predicted in 86.67% of participants (sensitivity: 91.67%; specificity: 66.67%) based on depressive symptoms and fear-related attentional bias. However, a regression-based analysis did not identify fear-related attentional bias as a splitting factor, but instead split and categorized the sample based on indices of aggression, metacognition, distress tolerance, and interoceptive awareness. These data indicate that within a population of individuals with SUD, aberrations in tolerating and regulating aversive internal experiences may also characterize those with significant trauma histories, akin to findings in persons with anxiety without SUD. The results also highlight the need for further research on PTSD-SUD comorbidity that includes additional comparison groups (i.e., persons with only PTSD), captures additional comorbid diagnoses that may influence the PTSD-SUD relationship, examines additional types of SUDs (e.g., alcohol use disorder), and differentiates between subtypes of PTSD.
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Affiliation(s)
- David C Houghton
- Center for Addiction Sciences and Therapeutics, University of Texas Medical Branch, Galveston, TX, USA.
- Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch, Galveston, TX, USA.
| | - Heidi M Spratt
- Center for Addiction Sciences and Therapeutics, University of Texas Medical Branch, Galveston, TX, USA
- Department of Biostatistics and Data Science, University of Texas Medical Branch, Galveston, TX, USA
| | - Lori Keyser-Marcus
- Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA, USA
| | - James M Bjork
- Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA, USA
| | - Gretchen N Neigh
- Department of Anatomy and Neurobiology, Virginia Commonwealth University, Richmond, VA, USA
| | - Kathryn A Cunningham
- Center for Addiction Sciences and Therapeutics, University of Texas Medical Branch, Galveston, TX, USA
- Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch, Galveston, TX, USA
- Department of Pharmacology and Toxicology, University of Texas Medical Branch, Galveston, TX, USA
| | - Tatiana Ramey
- Division of Therapeutics and Medical Consequences, National Institute of Drug Abuse, National Institutes of Health, Rockville, MD, USA
| | - F Gerard Moeller
- Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA, USA
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15
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Rypicz Ł, Gawłowski P, Witczak I, Humeńczuk-Skrzypek A, Salehi HP, Kołcz A. Psychosocial ergonomics of the workplace of medical staff during the COVID-19 pandemic in three risk's dimensions: working hours, violence and the use of psychoactive drugs-a prospective pilot study. Front Public Health 2023; 11:1199695. [PMID: 37469688 PMCID: PMC10353535 DOI: 10.3389/fpubh.2023.1199695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/21/2023] [Indexed: 07/21/2023] Open
Abstract
Introduction Workplace ergonomics should also be considered in the context of psychosocial factors affecting the worker, which have a real impact on occupational risk. The present study examined psychosocial risk factors in medical personnel in three domains: working hours, violence and substance abuse. Methods The purpose of the present study is to assess the current state of psychosocial ergonomics of medical personnels by measuring occupational risks in the domains of: working hours, violence and psychoactive substance abuse. The survey is consisted of two parts: socio-demographic information of participants and participants' assements of psychosocial risk factors. Results In more than half of the respondents (52%), increased risk was identified in the domain of working hours. Nearly half of the respondents (49.6%) have an identified high risk in the domain of violence, and more than half of the respondents (52%) are at high risk in the domain of psychoactive substance abuse. Discussion Our findings show that the present psychosocial ergonomics of the Polish health system must be improved. The COVID-19 pandemic has been a compelling test to assess the current state. Our findings highlighted the fact that HCWs often worked overtime and that many cases of workplace violence and substance abuse were reported.
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Affiliation(s)
- Łukasz Rypicz
- Division of Public Health, Department of Population Health, Faculty of Health Sciences, Wrocław Medical University, Wrocław, Poland
| | - Paweł Gawłowski
- Center for Medical Simulation, Wrocław Medical University, Wrocław, Poland
| | - Izabela Witczak
- Division of Public Health, Department of Population Health, Faculty of Health Sciences, Wrocław Medical University, Wrocław, Poland
| | | | - Hugh Pierre Salehi
- Department of Industrial Engineering, The Ohio State University, Columbus, OH, United States
| | - Anna Kołcz
- Ergonomics and Biomedical Monitoring Laboratory, Department of Physiotherapy, Faculty of Health Sciences, Wrocław Medical University, Wrocław, Poland
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16
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Gette JA, Nosen E, Schumacher JA. Predicting Reasons for Drinking in a Dually-Diagnosed Sample with PTSD and Substance Use Disorders. Subst Use Misuse 2023; 58:1438-1446. [PMID: 37331791 DOI: 10.1080/10826084.2023.2223300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Objective: Using the negative reinforcement and common factors frameworks, this work assessed whether and how anxiety sensitivity, distress tolerance, and impulsivity relate to reasons for drinking (RFD) in a residential treatment sample with co-occurring alcohol use disorder and posttraumatic stress disorder (AUD-PTSD). Demographic differences were also examined. Method: Participants were 75 (52.0% male, 78.7% white) adults at a residential substance use treatment facility who met criteria for AUD-PTSD with 98.67% meeting criteria for one or more substance use disorders in addition to AUD. Participants completed measures of anxiety sensitivity, distress tolerance, impulsivity, RFD, and AUD-PTSD symptoms. Univariate and multivariate linear regression was used with and without controlling for demographic variables (i.e., age, race, and sex). Results: The positive and negative urgency facets of impulsivity were positively related to both negative affect and cue/craving response RFD with relations maintained after controlling for demographic variables and including PTSD symptom severity (βs .30-.51). There were no significant relations between impulsivity and social RFD. No facets of anxiety sensitivity or distress tolerance were significantly related to RFD domains. Conclusions: Findings suggest that the urgency facets of impulsivity are crucial in understanding negative affect and cue/craving RFD. However, anxiety sensitivity and distress tolerance are not related to RFD in this dually diagnosed AUD-PTSD sample. Treatment considerations and future directions are discussed.
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Affiliation(s)
- J A Gette
- Center of Alcohol and Substance Use Studies, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - E Nosen
- G.V. (Sonny) Montgomery Veterans Affairs Medical Center, Jackson, Mississippi, USA
| | - J A Schumacher
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi, USA
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17
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Dickins KA, Reed M, Paun O, Swanson B, Karnik NS. Biopsychosocial Model of Traumatic Stress Symptoms in Women Experiencing Homelessness: A Qualitative Descriptive Study. Issues Ment Health Nurs 2023:1-12. [PMID: 37267047 DOI: 10.1080/01612840.2023.2205522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Trauma is nearly ubiquitous among women experiencing homelessness (WEH). WEH develop post-traumatic stress disorder (PTSD) at rates far exceeding the general population. The consequences of untreated PTSD can cascade, exacerbating existing physical, mental, and social health inequities, placing this population at risk for disproportionate biopsychosocial health adversity. Despite the outsized impact of PTSD, WEH are less likely to access or receive appropriate trauma-focused services. Understanding the unique and intersecting factors that contribute to the disproportionate PTSD toll on WEH may elucidate risk and protective factors, as well as possible intervention pathways to address the disparate trauma burden. This study employed a qualitative descriptive approach to develop understanding of the determinants of trauma risk, exposure, and outcomes among WEH. Semi-structured interviews were completed with 10 WEH, six shelter staff, four mental health professionals. Six deductively biopsychosocial model-derived themes were identified, alongside supporting categories. Themes/categories highlighted the role of biological, psychological, and socio-environmental determinants in shaping risk for and actualization of traumatic events and adverse outcomes. Trauma played an outsized role in shaping the health of WEH participants in this study, and the need for and interest in tailored trauma screening, treatment, psychoeducation options was highlighted. Recursive relationships between biopsychosocial determinants and trauma impact were identified. Participants emphasized population tailored trauma-focused interventions, specifically brief co-designed and community partner implemented interventions that address substance use behaviors, while leveraging the strengths of WEH. Addressing the marked trauma burden in WEH shows promise in promoting measurable biopsychosocial health improvements in this resilient yet overlooked population.
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Affiliation(s)
- Kirsten A Dickins
- Department of Community, Systems and Mental Health Nursing, Rush University, Chicago, Illinois, USA
| | - Monique Reed
- Department of Community, Systems and Mental Health Nursing, Rush University, Chicago, Illinois, USA
| | - Olimpia Paun
- Department of Community, Systems and Mental Health Nursing, Rush University, Chicago, Illinois, USA
| | - Barbara Swanson
- Department of Adult Health and Gerontologic Nursing, Rush University, Chicago, Illinois, USA
| | - Niranjan S Karnik
- Department of Psychiatry, Institute for Juvenile Research, College of Medicine, University of Illinois Chicago, Chicago, Illinois, USA
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18
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Rajkumar RP. Biomarkers of Neurodegeneration in Post-Traumatic Stress Disorder: An Integrative Review. Biomedicines 2023; 11:biomedicines11051465. [PMID: 37239136 DOI: 10.3390/biomedicines11051465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/11/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023] Open
Abstract
Post-Traumatic Stress Disorder (PTSD) is a chronic psychiatric disorder that occurs following exposure to traumatic events. Recent evidence suggests that PTSD may be a risk factor for the development of subsequent neurodegenerative disorders, including Alzheimer's dementia and Parkinson's disease. Identification of biomarkers known to be associated with neurodegeneration in patients with PTSD would shed light on the pathophysiological mechanisms linking these disorders and would also help in the development of preventive strategies for neurodegenerative disorders in PTSD. With this background, the PubMed and Scopus databases were searched for studies designed to identify biomarkers that could be associated with an increased risk of neurodegenerative disorders in patients with PTSD. Out of a total of 342 citations retrieved, 29 studies were identified for inclusion in the review. The results of these studies suggest that biomarkers such as cerebral cortical thinning, disrupted white matter integrity, specific genetic polymorphisms, immune-inflammatory alterations, vitamin D deficiency, metabolic syndrome, and objectively documented parasomnias are significantly associated with PTSD and may predict an increased risk of subsequent neurodegenerative disorders. The biological mechanisms underlying these changes, and the interactions between them, are also explored. Though requiring replication, these findings highlight a number of biological pathways that plausibly link PTSD with neurodegenerative disorders and suggest potentially valuable avenues for prevention and early intervention.
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Affiliation(s)
- Ravi Philip Rajkumar
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry 605006, India
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19
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Baskin BM, Logsdon AF, Janet Lee S, Foresi BD, Peskind E, Banks WA, Cook DG, Schindler AG. Timing matters: Sex differences in inflammatory and behavioral outcomes following repetitive blast mild traumatic brain injury. Brain Behav Immun 2023; 110:222-236. [PMID: 36907289 PMCID: PMC10106404 DOI: 10.1016/j.bbi.2023.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 02/25/2023] [Accepted: 03/01/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Repetitive blast-related mild traumatic brain injury (mTBI) caused by exposure to high explosives is increasingly common among warfighters as well as civilians. While women have been serving in military positions with increased risk of blast exposure since 2016, there are few published reports examining sex as a biological variable in models of blast mTBI, greatly limiting diagnosis and treatment capabilities. As such, here we examined outcomes of repetitive blast trauma in female and male mice in relation to potential behavioral, inflammatory, microbiome, and vascular dysfunction at multiple timepoints. METHODS In this study we utilized a well-established blast overpressure model to induce repetitive (3x) blast-mTBI in both female and male mice. Acutely following repetitive exposure, we measured serum and brain cytokine levels, blood-brain barrier (BBB) disruption, fecal microbial abundance, and locomotion and anxiety-like behavior in the open field assay. At the one-month timepoint, in female and male mice we assessed behavioral correlates of mTBI and PTSD-related symptoms commonly reported by Veterans with a history of blast-mTBI using the elevated zero maze, acoustic startle, and conditioned odorant aversion paradigms. RESULTS Repetitive blast exposure resulted in both similar (e.g., increased IL-6), and disparate (e.g., IL-10 increase only in females) patterns of acute serum and brain cytokine as well as gut microbiome changes in female and male mice. Acute BBB disruption following repetitive blast exposure was apparent in both sexes. While female and male blast mice both exhibited acute locomotor and anxiety-like deficits in the open field assay, only male mice exhibited adverse behavioral outcomes that lasted at least one-month. DISCUSSION Representing a novel survey of potential sex differences following repetitive blast trauma, our results demonstrate unique similar yet divergent patterns of blast-induced dysfunction in female vs. male mice and highlight novel targets for future diagnosis and therapeutic development.
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Affiliation(s)
- Britahny M Baskin
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195, USA; Graduate Program in Neuroscience, University of Washington, Seattle, WA 98195, USA; Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA 98108, USA
| | - Aric F Logsdon
- Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA 98108, USA; Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Suhjung Janet Lee
- Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA 98108, USA
| | - Brian D Foresi
- Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA 98195, USA; Department of Pharmaceutical Sciences, Northeast Ohio Medical University, Rootstown, OH 44272, USA
| | - Elaine Peskind
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195, USA; VA Northwest Mental Illness Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, WA 98108, USA
| | - William A Banks
- Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA 98108, USA; Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - David G Cook
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195, USA; Graduate Program in Neuroscience, University of Washington, Seattle, WA 98195, USA; Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA 98108, USA; Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA 98195, USA; VA Northwest Mental Illness Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, WA 98108, USA; Department of Pharmacology, University of Washington, Seattle, WA 98195, USA
| | - Abigail G Schindler
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195, USA; Graduate Program in Neuroscience, University of Washington, Seattle, WA 98195, USA; Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA 98108, USA; Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA 98195, USA; VA Northwest Mental Illness Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, WA 98108, USA.
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20
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Colaizzi JM, Flagel SB, Gearhardt AN, Borowitz MA, Kuplicki R, Zotev V, Clark G, Coronado J, Abbott T, Paulus MP. The propensity to sign-track is associated with externalizing behavior and distinct patterns of reward-related brain activation in youth. Sci Rep 2023; 13:4402. [PMID: 36928057 PMCID: PMC10020483 DOI: 10.1038/s41598-023-30906-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 03/03/2023] [Indexed: 03/18/2023] Open
Abstract
Externalizing behaviors in childhood often predict impulse control disorders in adulthood; however, the underlying bio-behavioral risk factors are incompletely understood. In animals, the propensity to sign-track, or the degree to which incentive motivational value is attributed to reward cues, is associated with externalizing-type behaviors and deficits in executive control. Using a Pavlovian conditioned approach paradigm, we quantified sign-tracking in 40 healthy 9-12-year-olds. We also measured parent-reported externalizing behaviors and anticipatory neural activations to outcome-predicting cues using the monetary incentive delay fMRI task. Sign-tracking was associated with attentional and inhibitory control deficits and the degree of amygdala, but not cortical, activation during reward anticipation. These findings support the hypothesis that youth with a propensity to sign-track are prone to externalizing tendencies, with an over-reliance on subcortical cue-reactive brain systems. This research highlights sign-tracking as a promising experimental approach delineating the behavioral and neural circuitry of individuals at risk for externalizing disorders.
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Affiliation(s)
- Janna M Colaizzi
- Laureate Institute for Brain Research, 6655 S Yale Ave, Tulsa, OK, USA.
| | - Shelly B Flagel
- Michigan Neuroscience Institute and Department of Psychiatry, University of Michigan, 205 Zina Pitcher Pl, Ann Arbor, MI, 48109, USA
| | - Ashley N Gearhardt
- Department of Psychology, University of Michigan, 530 Church St, Ann Arbor, MI, 48109, USA
| | - Michelle A Borowitz
- Department of Psychology, University of Michigan, 530 Church St, Ann Arbor, MI, 48109, USA
| | - Rayus Kuplicki
- Laureate Institute for Brain Research, 6655 S Yale Ave, Tulsa, OK, USA
| | - Vadim Zotev
- Laureate Institute for Brain Research, 6655 S Yale Ave, Tulsa, OK, USA
| | - Grace Clark
- Laureate Institute for Brain Research, 6655 S Yale Ave, Tulsa, OK, USA
| | - Jennifer Coronado
- Laureate Institute for Brain Research, 6655 S Yale Ave, Tulsa, OK, USA
| | - Talia Abbott
- Laureate Institute for Brain Research, 6655 S Yale Ave, Tulsa, OK, USA
| | - Martin P Paulus
- Laureate Institute for Brain Research, 6655 S Yale Ave, Tulsa, OK, USA
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21
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Sex differences in serotonergic control of rat social behaviour. Pharmacol Biochem Behav 2023; 223:173533. [PMID: 36858181 DOI: 10.1016/j.pbb.2023.173533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 03/02/2023]
Abstract
RATIONALE There is increasing evidence that enhancement of the salience of social stimuli can have a beneficial effect in managing many psychiatric conditions. There are, however, clear sex-related differences in social behaviour, including the neural mechanisms responsible for different aspects of social functions. OBJECTIVES We explored the role of the serotonergic system on rat social behaviour under baseline and under stressful conditions in female and male rats. METHODS Rats were treated with the selective serotonin transporter (SERT) inhibitor escitalopram postnatally; a procedure known to cause a long-lasting reduction of serotonergic activity. In adulthood, social behaviour was tested in a social interaction test and in ultrasonic vocalisation (USVs) recording sessions before and after yohimbine-induced stress-like state. RESULTS Our data demonstrated that both female and, to a lesser extent, male escitalopram treated rats, exposed to a novel social situation, had fewer social exploration events and emitted fewer frequency-modulated calls with trills, trills and step calls, suggesting that an impaired function of the serotonergic system reduced the positive valence of social interaction. In a stress-like state, 50 kHz flat calls were increased only in female rats, indicating an increased seeking of social contact. However, the number of flat calls in escitalopram treated female rats was significantly lower compared with control rats. CONCLUSIONS These data suggest that females may respond differently to serotonergic pharmacotherapy with respect to enhancement of beneficial effects of social support, especially in stress-related situations.
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Coffman DL, Ayer L, Schuler MS, Godley MD, Griffin BA. The Role of Pre-Treatment Traumatic Stress Symptoms in Adolescent Substance Use Treatment Outcomes. Subst Use Misuse 2023; 58:551-559. [PMID: 36762441 DOI: 10.1080/10826084.2023.2177960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Background: Prominent theories suggest that individuals with co-occurring traumatic stress symptoms (TSS) and substance use (SU) may be less responsive to SU treatment compared to those with SU only. However, empirical findings in adult samples are mixed, and there has been limited work among adolescents. This study assesses the association between TSS and SU treatment outcomes among trauma-exposed adolescents, using statistical methods to reduce potential confounding from important factors such as baseline SU severity. Method: 2,963 adolescents with lifetime history of victimization received evidence-based SU treatment in outpatient community settings. At baseline, 3- and 6-months, youth were assessed using the Global Appraisal of Individual Needs Traumatic Stress Scale and the Substance Frequency Scale. Propensity score weighting was used to mitigate potential confounding due to baseline differences in sociodemographic characteristics and SU across youth with varying levels of TSS. Results: Propensity score weighting successfully balanced baseline differences in sociodemographic factors and baseline SU across youth. Among all youth, mean SU was lower at both 3- and 6- month follow-up relative to baseline, indicating declining use. After adjusting for potential confounders, we observed no statistically significant relationship between TSS and SU at either 3- or 6-month follow-up. Conclusions: Based on this investigation, conducted among a large sample of trauma-exposed youth receiving evidence-based outpatient SU treatment, baseline TSS do not appear to be negatively associated with SU treatment outcomes. However, future research should examine whether youth with TSS achieve better outcomes through integrative treatment for both SU and TSS.
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23
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Mengin AC, Rolling J, Porche C, Durpoix A, Lalanne L. The Intertwining of Posttraumatic Stress Symptoms, Alcohol, Tobacco or Nicotine Use, and the COVID-19 Pandemic: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14546. [PMID: 36361425 PMCID: PMC9658659 DOI: 10.3390/ijerph192114546] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/30/2022] [Accepted: 11/02/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Posttraumatic stress symptoms (PTSSs) and alcohol, tobacco, or nicotine use are frequently associated conditions. The COVID-19 pandemic has been a stressful situation globally and has worsened mental health conditions and addictions in the population. Our systematic review explores the links between PTSSs and (1) alcohol use and (2) tobacco or nicotine use during the COVID-19 pandemic. METHODS We searched the PubMed, PsycINFO, and Web of Science databases for studies published between January 2020 and 16 December 2021. We included studies published in English concerning adults or adolescents. Included articles dealt simultaneously with the COVID-19 pandemic, PTSSs, and alcohol, tobacco, or nicotine use. The reports included were cross-sectional, longitudinal, or cohort studies. We categorized the reports according to the population explored. Our main outcomes are the impacts of PTSSs on (1) alcohol use and (2) tobacco and nicotine use and their relation to COVID-19-related stressors (worries, exposure, lockdown, and infection, either of self or relatives). RESULTS Of the 503 reports identified, 44 were assessed for eligibility, and 16 were included in our review, encompassing 34,408 participants. The populations explored were the general population, healthcare workers, war veterans, patients with substance use disorders, and other vulnerable populations. Most studies were online surveys (14) with cross-sectional designs (11). Every study explored alcohol use, while only two assessed tobacco use. In most populations explored, a high level of PTSSs was associated with alcohol use increase. COVID-19-related stress was frequently correlated with either high PTSSs or alcohol use. In healthcare workers, PTSSs and alcohol use were not associated, while COVID-19 worries were related to both PTSSs and alcohol use. DISCUSSION 1. PTSSs and increased alcohol use are frequently associated, while COVID-19 worries might trigger both conditions and worsen their association. Alcohol use increase may represent either an inadequate way of coping with PTSSs or a vulnerability amid the COVID-19 pandemic, leading to PTSSs. As most studies were cross-sectional online surveys, longitudinal prospective studies are needed to ascertain the direction of the associations between these conditions. These studies need to be sufficiently powered and control for potential bias and confounders. 2. Our review highlighted that research about PTSSs and tobacco or nicotine use is scarce.
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Affiliation(s)
- Amaury C. Mengin
- Psychiatry, Mental Health and Addictology Department, Strasbourg University Hospital, 67000 Strasbourg, France
- Regional Center for Psychotrauma Great East, 67000 Strasbourg, France
- Institut National de la Santé et de la Recherche Médiale, Unité de Recherche 1114 (INSERM U1114), Cognitive Neuropsychology, and Pathophysiology of Schizophrenia, 67000 Strasbourg, France
| | - Julie Rolling
- Psychiatry, Mental Health and Addictology Department, Strasbourg University Hospital, 67000 Strasbourg, France
- Regional Center for Psychotrauma Great East, 67000 Strasbourg, France
- Centre National de la Recherche Scientifique Unité Propre de Recherche 3212 (CNRS UPR 3212), Institute for Cellular and Integrative Neurosciences (INCI), 67000 Strasbourg, France
| | - Christelle Porche
- Psychiatry, Mental Health and Addictology Department, Strasbourg University Hospital, 67000 Strasbourg, France
- Institut National de la Santé et de la Recherche Médiale, Unité de Recherche 1114 (INSERM U1114), Cognitive Neuropsychology, and Pathophysiology of Schizophrenia, 67000 Strasbourg, France
| | - Amaury Durpoix
- Psychiatry, Mental Health and Addictology Department, Strasbourg University Hospital, 67000 Strasbourg, France
- Faculty of Medicine, Strasbourg University, 67000 Strasbourg, France
| | - Laurence Lalanne
- Psychiatry, Mental Health and Addictology Department, Strasbourg University Hospital, 67000 Strasbourg, France
- Institut National de la Santé et de la Recherche Médiale, Unité de Recherche 1114 (INSERM U1114), Cognitive Neuropsychology, and Pathophysiology of Schizophrenia, 67000 Strasbourg, France
- Faculty of Medicine, Strasbourg University, 67000 Strasbourg, France
- Fédération de Médecine Translationnelle de Strasbourg, 67000 Strasbourg, France
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Degenhardt L, Bharat C, Glantz MD, Bromet EJ, Alonso J, Bruffaerts R, Bunting B, de Girolamo G, de Jonge P, Florescu S, Gureje O, Haro JM, Harris MG, Hinkov H, Karam EG, Karam G, Kovess-Masfety V, Lee S, Makanjuola V, Medina-Mora ME, Navarro-Mateu F, Piazza M, Posada-Villa J, Scott KM, Stein DJ, Tachimori H, Tintle N, Torres Y, Viana MC, Kessler RC, Al-Hamzawi A, Al-Kaisy MS, Alonso J, Altwaijri Y, Helena Andrade L, Atwoli L, Benjet C, Borges G, Bromet EJ, Bruffaerts R, Bunting B, Caldas-de-Almeida JM, Cardoso G, Chatterji S, Cia AH, Degenhardt L, Demyttenaere K, Florescu S, Girolamo GD, Gureje O, Haro JM, Harris MG, Hinkov H, Hu CY, de Jonge P, Karam AN, Karam EG, Kawakami N, Kessler RC, Kiejna A, Kovess-Masfety V, Lee S, Lepine JP, McGrath J, Medina-Mora ME, Mneimneh Z, Moskalewicz J, Navarro-Mateu F, Piazza M, Posada-Villa J, Scott KM, Slade T, Stagnaro JC, Stein DJ, ten Have M, Torres Y, Viana MC, Vigo DV, Whiteford H, Williams DR, Wojtyniak B. The associations between traumatic experiences and subsequent onset of a substance use disorder: Findings from the World Health Organization World Mental Health surveys. Drug Alcohol Depend 2022; 240:109574. [PMID: 36150948 DOI: 10.1016/j.drugalcdep.2022.109574] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 07/06/2022] [Accepted: 07/11/2022] [Indexed: 01/06/2023]
Abstract
AIM Exposure to traumatic events (TEs) is associated with substance use disorders (SUDs). However, most studies focus on a single TE, and are limited to single countries, rather than across countries with variation in economic, social and cultural characteristics. We used cross-national data to examine associations of diverse TEs with SUD onset, and variation in associations over time. METHODS Data come from World Mental Health surveys across 22 countries. Adults (n = 65,165) retrospectively reported exposure to 29 TEs in six categories: "exposure to organised violence"; "participation in organised violence"; "interpersonal violence"; "sexual-relationship violence"; "other life-threatening events"; and those involving loved ones ("network traumas"). Discrete-time survival analyses were used to examine associations with subsequent first SUD onset. RESULTS Most (71.0%) reported experiencing at least one TE, with network traumas (38.8%) most common and exposure to organised violence (9.5%) least. One in five (20.3%) had been exposed to sexual-relationship violence and 26.6% to interpersonal violence. Among the TE exposed, lifetime SUD prevalence was 14.5% compared to 5.1% with no trauma exposure. Most TE categories (except organised violence) were associated with increased odds of SUD. Increased odds of SUD were also found following interpersonal violence exposure across all age ranges (ORs from 1.56 to 1.78), and sexual-relationship violence exposure during adulthood (ORs from 1.33 to 1.44), with associations persisting even after >11 years. CONCLUSION Sexual and interpersonal violence have the most consistent associations with progression to SUD; increased risk remains for many years post-exposure. These need to be considered when working with people exposed to such traumas.
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Affiliation(s)
- Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.
| | - Chrianna Bharat
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Meyer D Glantz
- Department of Epidemiology, Services, and Prevention Research (DESPR), National Institute on Drug Abuse (NIDA), National Institute of Health (NIH), Bethesda, MD, USA
| | - Evelyn J Bromet
- Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - Jordi Alonso
- Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Spain; Pompeu Fabra University (UPF), Barcelona, Spain
| | - Ronny Bruffaerts
- Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium
| | - Brendan Bunting
- School of Psychology, Ulster University, Londonderry, United Kingdom
| | | | - Peter de Jonge
- Department of Developmental Psychology, University of Groningen, Groningen, the Netherlands; Interdisciplinary Center Psychopathology and Emotion Regulation, University Medical Center Groningen, Groningen, the Netherlands
| | - Silvia Florescu
- National School of Public Health, Management and Development, Bucharest, Romania
| | - Oye Gureje
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain
| | - Meredith G Harris
- School of Public Health, The University of Queensland, Herston, Queensland, Australia; Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Queensland, Australia
| | - Hristo Hinkov
- National Center of Public Health and Analyses, Sofia, Bulgaria
| | - Elie G Karam
- Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon; Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon; Balamand University, Faculty of Medicine, Beirut, Lebanon
| | - Georges Karam
- Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon; Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon; Balamand University, Faculty of Medicine, Beirut, Lebanon
| | - Viviane Kovess-Masfety
- Ecole des Hautes Etudes en Santé Publique (EHESP), EA 4057, Paris Descartes University, Paris, France
| | - Sing Lee
- Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong
| | - Victor Makanjuola
- Department of Psychiatry, College of Medicine, University of Ibadan; University College Hospital, Ibadan, Nigeria
| | | | - Fernando Navarro-Mateu
- Unidad de Docencia, Investigacion y Formación en Salud Mental, Servicio Murciano de Salud, Murcia, Spain; Instituto Murciano de Investigación Biosanitaria Virgen de la Arrixaca, Spain; Centro de Investigación Biomédica en ERed en Epidemíologia y Salud Pública, Murcia, Spain
| | - Marina Piazza
- Instituto Nacional de Salud, Universidad Cayetano Heredia, Lima, Peru
| | - José Posada-Villa
- Colegio Mayor de Cundinamarca University, Faculty of Social Sciences, Bogota, Colombia
| | - Kate M Scott
- Department of Psychological Medicine, University of Otago, Dunedin, Otago, New Zealand
| | - Dan J Stein
- Dept of Psychiatry & Mental Health and South African Medical Council Research Unit on Risk and Resilience in Mental Disorders, University of Cape Town and Groote Schuur Hospital, Cape Town, Republic of South Africa
| | - Hisateru Tachimori
- National Institute of Mental Health, National Center for Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Nathan Tintle
- Department of Mathematics, Statistics and Computer Science, Dordt College, Sioux Center, IA, USA
| | - Yolanda Torres
- Center for Excellence on Research in Mental Health, CES University, Medellin, Colombia
| | - Maria Carmen Viana
- Department of Social Medicine, Postgraduate Program in Public Health, Federal University of Espírito Santo, Vitoria, Brazil
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
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Alcohol Addiction in War Veterans Treated in a In-patient Psychiatric Facility: Incidence, Comorbidity with PTSD Symptoms, Association with Combat Stressors. CONSORTIUM PSYCHIATRICUM 2022. [DOI: 10.17816/cp188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND: The dearth of and inconsistency in the data on the prevalence, risks of occurrence, comorbidity, and causation of stress-related disorders and alcohol use disorders in Russian veterans of local wars constituted the background for this study.
AIM: To study the psychopathological structure, clinical changes, and the reasons for the mental disorders suffered by Russian veterans of local wars; in particular, to study the prevalence, pathogenic factors, comorbidity of alcohol addiction and alcohol abuse, together with symptoms of stress disorders, in Russian veterans undergoing inpatient treatment.
METHODS: Our observational case-control study included 685 patients who were undergoing treatment in the psychiatric department of a military hospital: the Main group (veterans) consisted of 264 veterans of armed conflicts who had undergone inpatient treatment from 1992 to 2010; the Control group, 1, 296 patients, all servicemen and military pensioners who had undergone inpatient treatment during a calendar year and had never taken part in combat operations in the past; Control group 2, 125 military personnel (regular and reserve) who had not taken part in combat operations and corresponded to the patients of the main group in terms of the mean age and age distribution curve. We performed a clinical and psychopathological analysis of the symptoms identified in patients from the compared samples and, then, compared them with the ICD-10 criteria of post-traumatic stress disorder (PTSD) and alcohol-related disorders. This allowed us to establish the significance of the difference in their frequency and degree of association at the stage of the data analysis.
RESULTS: We uncovered no difference in the prevalence of symptoms of alcohol addiction and alcohol abuse among veterans and other servicemen and military pensioners who had not taken part in combat operations. However, there was a tendency to underdiagnose alcohol addiction in veterans in general and those with symptoms of PTSD, in particular. That is, alcohol addiction was not diagnosed in most cases when the veterans displayed symptoms of stress or other mental disorders, in addition to the signs of alcohol addiction. In most such cases, a stress-related mental disorder or another mental disorder with identified signs was diagnosed and alcohol abuse was described as a concomitant disorder or a complication. There was no significant association between any form of alcohol addiction or abuse and the presence of stress disorder symptoms in our sample of veterans; on the contrary, symptoms of re-experience of trauma were more often observed in veterans who were not prone to frequent drinking. The incidence of combat stressors traced in the medical history did not differ in veterans with any form of alcohol abuse and veterans who were not prone to frequent drinking. However, the main group subjects with alcohol addiction more often displayed cases of addictive behavior during combat operations. Therefore, alcohol abuse during combat operations requires additional research to better establish its prognostic significance.
CONCLUSION: This Study found no difference in the incidence of alcohol dependence and alcohol abuse among veterans and other officers. In the sample of veterans, there was no significant association between alcoholism and the presence of PTSD symptoms or a history of combat stressors. It is possible that the same risk of alcohol addiction in different categories of military officers is due to a compact of social stressors that equally had a more significant adverse effect on the entire population of Russian military personnel in the 90s of the last century and the first years of this century, as well as the massive abuse of alcohol, which could also equalize the risks of developing alcohol dependence in all groups of militaries.
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Inactivation of the Basolateral Amygdala to Insular Cortex Pathway Makes Sign-Tracking Sensitive to Outcome Devaluation. eNeuro 2022; 9:ENEURO.0156-22.2022. [PMID: 36127135 PMCID: PMC9522321 DOI: 10.1523/eneuro.0156-22.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 08/26/2022] [Accepted: 09/11/2022] [Indexed: 12/15/2022] Open
Abstract
Goal-tracking (GT) rats are sensitive to Pavlovian outcome devaluation while sign-tracking (ST) rats are devaluation insensitive. During outcome devaluation, GT rats flexibly modify responding to cues based on the current value of the associated outcome. However, ST rats rigidly respond to cues regardless of the current outcome value. Prior work demonstrated disconnection of the basolateral amygdala (BLA) and anterior insular cortex (aIC) decreased both GT and ST behaviors. Given the role of these regions in appetitive motivation and behavioral flexibility, we predicted that disrupting BLA to aIC pathway during outcome devaluation would reduce flexibility in GT rats and reduce rigid appetitive motivation in ST rats. We inhibited the BLA to aIC pathway by infusing inhibitory DREADDs (hM4Di-mcherry) or control (mCherry) virus into the BLA and implanted cannulae into the aIC to inhibit BLA terminals using intracranial injections of clozapine N-oxide (CNO). After training, we used a within-subject satiety-induced outcome devaluation procedure in which we sated rats on training pellets (devalued condition) or homecage chow (valued condition). All rats received bilateral CNO infusions into the aIC before brief nonreinforced test sessions. Contrary to our hypothesis, BLA-IC inhibition did not interfere with devaluation sensitivity in GT rats but did make ST behaviors sensitive to devaluation. Intermediate rats showed the opposite effect, showing rigid responding to cues with BLA-aIC pathway inactivation. Together, these results demonstrate BLA-IC projections mediate tracking-specific Pavlovian devaluation sensitivity and highlights the importance of considering individual differences in Pavlovian approach when evaluating circuitry contributions to behavioral flexibility.
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Posttraumatic Stress Symptoms, Physical Illness, and Social Adjustment Among Disaster Victims. Disaster Med Public Health Prep 2022; 17:e195. [PMID: 35593424 DOI: 10.1017/dmp.2022.89] [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: 02/08/2023]
Abstract
OBJECTIVE Posttraumatic stress disorder is one of the most studied outcomes after a disaster. Posttraumatic stress symptoms (PTSS) are maladaptive and disabling and can severely impair affected individuals' psychosocial functioning and quality of life. Consequently, the objective of this research is to investigate the prevalence of PTSS and physical illness among disaster victims. METHODS We analyzed disaster victims' survey data in South Korea 1 year after a natural disaster (n = 1659). Then, we performed multivariable comparisons of social and work adjustments between individuals with PTSS and individuals with physical illness to examine the association between PTSS and functional impairment. RESULTS Individuals with PTSS had a significant association with work and social maladjustments whether or not they had a physical illness; PTSS (+) physical illness (-) group (OR: 1.18, CI: 1.12-1.26, P < 0.001) and PTSS (+) physical illness (+) group (OR: 1.16, CI: 1.08-1.23, P < 0.001). Interestingly, this association was not significant in the group that exclusively presented physical illness. CONCLUSIONS Our results suggest that PTSS might be a critical factor in social maladjustment during the post-disaster period. Subsequently, an assessment of disaster victims' PTSS would help ensure effective medical and governmental approaches to assist disaster victims.
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Leconte C, Mongeau R, Noble F. Traumatic Stress-Induced Vulnerability to Addiction: Critical Role of the Dynorphin/Kappa Opioid Receptor System. Front Pharmacol 2022; 13:856672. [PMID: 35571111 PMCID: PMC9091501 DOI: 10.3389/fphar.2022.856672] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 04/07/2022] [Indexed: 11/13/2022] Open
Abstract
Substance use disorders (SUD) may emerge from an individual’s attempt to limit negative affective states and symptoms linked to stress. Indeed, SUD is highly comorbid with chronic stress, traumatic stress, or post-traumatic stress disorder (PTSD), and treatments approved for each pathology individually often failed to have a therapeutic efficiency in such comorbid patients. The kappa-opioid receptor (KOR) and its endogenous ligand dynorphin (DYN), seem to play a key role in the occurrence of this comorbidity. The DYN/KOR function is increased either in traumatic stress or during drug use, dependence acquisition and DYN is released during stress. The behavioural effects of stress related to the DYN/KOR system include anxiety, dissociative and depressive symptoms, as well as increased conditioned fear response. Furthermore, the DYN/KOR system is implicated in negative reinforcement after the euphoric effects of a drug of abuse ends. During chronic drug consumption DYN/KOR functions increase and facilitate tolerance and dependence. The drug-seeking behaviour induced by KOR activation can be retrieved either during the development of an addictive behaviour, or during relapse after withdrawal. DYN is known to be one of the most powerful negative modulators of dopamine signalling, notably in brain structures implicated in both reward and fear circuitries. KOR are also acting as inhibitory heteroreceptors on serotonin neurons. Moreover, the DYN/KOR system cross-regulate with corticotropin-releasing factor in the brain. The sexual dimorphism of the DYN/KOR system could be the cause of the gender differences observed in patients with SUD or/and traumatic stress-related pathologies. This review underlies experimental and clinical results emphasizing the DYN/KOR system as common mechanisms shared by SUD or/and traumatic stress-related pathologies, and suggests KOR antagonist as a new pharmacological strategy to treat this comorbidity.
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29
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Bountress KE, Brick LA, Sheerin C, Grotzinger A, Bustamante D, Hawn SE, Gillespie N, Kirkpatrick RM, Kranzler H, Morey R, Edenberg HJ, Maihofer AX, Disner S, Ashley-Koch A, Peterson R, Lori A, Stein DJ, Kimbrel N, Nievergelt C, Andreassen OA, Luykx J, Javanbakht A, Youssef NA, Amstadter AB. Alcohol use and alcohol use disorder differ in their genetic relationships with PTSD: A genomic structural equation modelling approach. Drug Alcohol Depend 2022; 234:109430. [PMID: 35367939 PMCID: PMC9018560 DOI: 10.1016/j.drugalcdep.2022.109430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/09/2022] [Accepted: 03/21/2022] [Indexed: 11/20/2022]
Abstract
PURPOSE Posttraumatic Stress Disorder (PTSD) is associated with increased alcohol use and alcohol use disorder (AUD), which are all moderately heritable. Studies suggest the genetic association between PTSD and alcohol use differs from that of PTSD and AUD, but further analysis is needed. BASIC PROCEDURES We used genomic Structural Equation Modeling (genomicSEM) to analyze summary statistics from large-scale genome-wide association studies (GWAS) of European Ancestry participants to investigate the genetic relationships between PTSD (both diagnosis and re-experiencing symptom severity) and a range of alcohol use and AUD phenotypes. MAIN FINDINGS When we differentiated genetic factors for alcohol use and AUD we observed improved model fit relative to models with all alcohol-related indicators loading onto a single factor. The genetic correlations (rG) of PTSD were quite discrepant for the alcohol use and AUD factors. This was true when modeled as a three-correlated-factor model (PTSD-AUD rG:.36, p < .001; PTSD-alcohol use rG: -0.17, p < .001) and as a Bifactor model, in which the common and unique portions of alcohol phenotypes were pulled out into an AUD-specific factor (rG with PTSD:.40, p < .001), AU-specific factor (rG with PTSD: -0.57, p < .001), and a common alcohol factor (rG with PTSD:.16, NS). PRINCIPAL CONCLUSIONS These results indicate the genetic architecture of alcohol use and AUD are differentially associated with PTSD. When the portions of variance unique to alcohol use and AUD are extracted, their genetic associations with PTSD vary substantially, suggesting different genetic architectures of alcohol phenotypes in people with PTSD.
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Affiliation(s)
- Kaitlin E Bountress
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, USA.
| | - Leslie A Brick
- Department of Psychiatry and Human Behavior, Quantitative Sciences Program, Alpert Medical School at Brown University, USA
| | - Christina Sheerin
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, USA
| | - Andrew Grotzinger
- Behavioral, Psychiatric, and Statistical Genetics, Institute for Behavior Genetics, University of Colorado Boulder, USA
| | - Daniel Bustamante
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, USA; Integrative Life Sciences Doctoral Program, Virginia Commonwealth University, USA
| | - Sage E Hawn
- National Center for PTSD at VA Boston Healthcare System, Boston, MA, USA; Boston University School of Medicine, Department of Psychiatry, Boston, MA, USA
| | - Nathan Gillespie
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, USA
| | - Robert M Kirkpatrick
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, USA
| | - Henry Kranzler
- University of Pennsylvania Perelman School of Medicine, Department of Psychiatry, Philadelphia, PA, USA; Mental Illness Research, Education and Clinical Center, Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Rajendra Morey
- VA Mid-Atlantic Mental Illness Research Education and Clinical Center, Durham VAMC, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA; Duke-UNC Brain Imaging and Analysis Center, Duke University, Durham, NC, USA
| | - Howard J Edenberg
- Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, USA; Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, USA
| | - Adam X Maihofer
- Department of Psychiatry, University of California, San Diego, USA; Center of Excellence for Stress and Mental Health, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Seth Disner
- Minneapolis VA Health Care System, Minneapolis, MN, USA; Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Allison Ashley-Koch
- Duke Molecular Physiology Institute, Duke University Medical Center, Durham, NC, USA
| | - Roseann Peterson
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, USA
| | - Adriana Lori
- Department of Psychiatry and Behavioral Sciences, Emory University, USA
| | - Dan J Stein
- Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Nathan Kimbrel
- VA Mid-Atlantic Mental Illness Research Education and Clinical Center, Durham VAMC, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Caroline Nievergelt
- Department of Psychiatry, University of California, San Diego, USA; Center of Excellence for Stress and Mental Health, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Ole A Andreassen
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Jurjen Luykx
- School for Mental Health and Neuroscience, Maastricht University Medical Centre, Department of Psychiatry and Neuropsychology Maastricht, The Netherlands; UMC Utrecht Brain Center, University Medical Center Utrecht, Department of Psychiatry Utrecht, University, Utrecht, The Netherlands; Outpatient second opinion clinic, GGNet Mental Health, Warnsveld, The Netherlands
| | - Arash Javanbakht
- Stress, Trauma, and Anxiety Research Clinic (STARC), Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | - Nagy A Youssef
- Department of Psychiatry and Behavioral Health, Ohio State University, Columbus, OH, USA
| | - Ananda B Amstadter
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, USA
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Xue B, Xue J, Yu Y, Wei SG, Beltz TG, Felder RB, Johnson AK. Predator Scent-Induced Sensitization of Hypertension and Anxiety-like Behaviors. Cell Mol Neurobiol 2022; 42:1141-1152. [PMID: 33201417 PMCID: PMC8126575 DOI: 10.1007/s10571-020-01005-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 11/11/2020] [Indexed: 12/15/2022]
Abstract
Post-traumatic stress disorder (PTSD), an anxiety-related syndrome, is associated with increased risk for cardiovascular diseases. The present study investigated whether predator scent (PS) stress, a model of PTSD, induces sensitization of hypertension and anxiety-like behaviors and underlying mechanisms related to renin-angiotensin systems (RAS) and inflammation. Coyote urine, as a PS stressor, was used to model PTSD. After PS exposures, separate cohorts of rats were studied for hypertensive response sensitization (HTRS), anxiety-like behaviors, and changes in plasma levels and mRNA expression of several components of the RAS and proinflammatory cytokines (PICs) in the lamina terminalis (LT), paraventricular nucleus (PVN), and amygdala (AMY). Rats exposed to PS as compared to control animals exhibited (1) a significantly greater hypertensive response (i.e., HTRS) when challenged with a slow-pressor dose of angiotensin (ANG) II, (2) significant decrease in locomotor activity and increase in time spent in the closed arms of a plus maze as well as general immobility (i.e., behavioral signs of increased anxiety), (3) upregulated plasma levels of ANG II and interleukin-6, and (4) increased expression of message for components of the RAS and PICs in key brain nuclei. All the PS-induced adverse effects were blocked by pretreatment with either an angiotensin-converting enzyme antagonist or a tumor necrosis factor-α inhibitor. The results suggest that PS, used as an experimental model of PTSD, sensitizes ANG II-induced hypertension and produces behavioral signs of anxiety, probably through upregulation of RAS components and inflammatory markers in plasma and brain areas associated with anxiety and blood pressure control.
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Affiliation(s)
- Baojian Xue
- Department of Psychological and Brain Sciences, University of Iowa, PBSB, 340 Iowa Ave, Iowa City, IA, 52242, USA.
| | - Jiarui Xue
- Department of Psychological and Brain Sciences, University of Iowa, PBSB, 340 Iowa Ave, Iowa City, IA, 52242, USA
| | - Yang Yu
- Internal Medicine, University of Iowa, Iowa City, IA, 52242, USA
| | - Shun-Guang Wei
- Internal Medicine, University of Iowa, Iowa City, IA, 52242, USA
- The Franҫois M. Abboud Cardiovascular Research Center University of Iowa, Iowa City, IA, 52242, USA
| | - Terry G Beltz
- Department of Psychological and Brain Sciences, University of Iowa, PBSB, 340 Iowa Ave, Iowa City, IA, 52242, USA
| | - Robert B Felder
- Internal Medicine, University of Iowa, Iowa City, IA, 52242, USA
- The Franҫois M. Abboud Cardiovascular Research Center University of Iowa, Iowa City, IA, 52242, USA
| | - Alan Kim Johnson
- Department of Psychological and Brain Sciences, University of Iowa, PBSB, 340 Iowa Ave, Iowa City, IA, 52242, USA
- Health and Human Physiology, University of Iowa, Iowa City, IA, 52242, USA
- Neuroscience and Pharmacology, University of Iowa, Iowa City, IA, 52242, USA
- The Franҫois M. Abboud Cardiovascular Research Center University of Iowa, Iowa City, IA, 52242, USA
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31
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Badour CL, Flanagan JC, Allan NP, Gilmore AK, Gros DF, Killeen T, Korte KJ, Brown DG, Kolnogorova K, Back SE. Temporal dynamics of symptom change among veterans receiving an integrated treatment for posttraumatic stress disorder and substance use disorders. J Trauma Stress 2022; 35:546-558. [PMID: 34773928 PMCID: PMC9035042 DOI: 10.1002/jts.22769] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 07/30/2021] [Accepted: 08/09/2021] [Indexed: 11/07/2022]
Abstract
The present study examined temporal patterns of symptom change during treatment for comorbid posttraumatic stress disorders (PTSD) and substance use disorders (SUDs). We hypothesized that PTSD symptom severity would predict subsequent-session substance use and that this association would be particularly strong among patients who received an integrated treatment versus SUD-only treatment. Participants were 81 United States military veterans with current PTSD and an SUD who were enrolled in a 12-week, randomized controlled trial examining the efficacy of an integrated treatment called Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure (COPE) compared with cognitive behavioral relapse prevention therapy (RP). Lagged multilevel models indicated that PTSD symptom improvement did not significantly predict the likelihood of next-session substance use (likelihood of use: B = 0.03, SE = 0.02, p = .141; percentage of days using B = -0.02, SE = 0.01, p = .172. Neither substance use, B = 1.53, SE = 1.79, p = .391, nor frequency of use, B = 0.26, SE = 0.50, p = .612, predicted next-session PTSD symptom severity in either treatment condition. Stronger associations between PTSD symptoms and next-session substance use were expected given the self-medication hypothesis. Additional research is needed to better understand the temporal dynamics of symptom change as well as the specific mediators and mechanisms underlying symptom change.
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Affiliation(s)
- Christal L. Badour
- Department of Psychology, University of Kentucky, Lexington, Kentucky, USA
| | - Julianne C. Flanagan
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Mental Health Service Line, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina, USA
| | - Nicholas P. Allan
- Department of Psychology, Ohio University, Athens, Ohio, USA
- VA Center of Excellence for Suicide Prevention, VA Finger Lakes Health Care System, Canandaigua, New York, USA
| | - Amanda K. Gilmore
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - Daniel F. Gros
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Mental Health Service Line, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina, USA
| | - Therese Killeen
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kristina J. Korte
- Psychiatry Department, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Delisa G. Brown
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | | | - Sudie E. Back
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Mental Health Service Line, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina, USA
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32
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Kapfhammer HP. [Comorbidity of posttraumatic stress disorder and addiction from a biopsychosocial perspective]. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT OSTERREICHISCHER NERVENARZTE UND PSYCHIATER 2022; 36:1-18. [PMID: 33439473 PMCID: PMC8916999 DOI: 10.1007/s40211-020-00384-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 12/16/2020] [Indexed: 11/18/2022]
Abstract
Posttraumatic stress disorder and substance use disorder often co-occur within the health care system. Their comorbidity is associated with more serious acute clinical symptomatology, more frequent hospital admissions in state of emergency and significantly lower chances of improvement by psychological and pharmacological treatment. Their comorbidity contributes to dramatically unfavourable courses of illness as regards all biopsychosocial levels. The survey presented will discuss empirical findings from various perspectives: general epidemiology, substance use disorder as risk factor of trauma and PTSD, trauma and PTSD as risk factor of SUD, neurobiological effects of SUD converging towards neurobiology of PTSD, shared common factors of genetics/epigenetics, personality traits, and early developmental stress and trauma. The main focus of analysis will be put on processes that are intrinsically linked to the development and course of both disorders.
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Affiliation(s)
- Hans-Peter Kapfhammer
- Universitätsklinik für Psychiatrie und Psychotherapeutische Medizin, Medizinische Universität Graz, Auenbruggerplatz 31, 8036, Graz, Österreich.
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Bautista TG, Amaro H. Dispositional mindfulness and trauma symptom severity associated with uptake of mindfulness practice among women in treatment for substance use disorder. JOURNAL OF SUBSTANCE USE 2022. [DOI: 10.1080/14659891.2022.2039970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Tara G. Bautista
- Yale Stress Center, School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Hortensia Amaro
- Wertheim College of Medicine and Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
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Baskin B, Lee SJ, Skillen E, Wong K, Rau H, Hendrickson RC, Pagulayan K, Raskind MA, Peskind ER, Phillips PEM, Cook DG, Schindler AG. Repetitive Blast Exposure Increases Appetitive Motivation and Behavioral Inflexibility in Male Mice. Front Behav Neurosci 2022; 15:792648. [PMID: 35002648 PMCID: PMC8727531 DOI: 10.3389/fnbeh.2021.792648] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 11/25/2021] [Indexed: 12/02/2022] Open
Abstract
Blast exposure (via detonation of high explosives) represents a major potential trauma source for Servicemembers and Veterans, often resulting in mild traumatic brain injury (mTBI). Executive dysfunction (e.g., alterations in memory, deficits in mental flexibility, difficulty with adaptability) is commonly reported by Veterans with a history of blast-related mTBI, leading to impaired daily functioning and decreased quality of life, but underlying mechanisms are not fully understood and have not been well studied in animal models of blast. To investigate potential underlying behavioral mechanisms contributing to deficits in executive functioning post-blast mTBI, here we examined how a history of repetitive blast exposure in male mice affects anxiety/compulsivity-like outcomes and appetitive goal-directed behavior using an established mouse model of blast mTBI. We hypothesized that repetitive blast exposure in male mice would result in anxiety/compulsivity-like outcomes and corresponding performance deficits in operant-based reward learning and behavioral flexibility paradigms. Instead, results demonstrate an increase in reward-seeking and goal-directed behavior and a congruent decrease in behavioral flexibility. We also report chronic adverse behavioral changes related to anxiety, compulsivity, and hyperarousal. In combination, these data suggest that potential deficits in executive function following blast mTBI are at least in part related to enhanced compulsivity/hyperreactivity and behavioral inflexibility and not simply due to a lack of motivation or inability to acquire task parameters, with important implications for subsequent diagnosis and treatment management.
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Affiliation(s)
- Britahny Baskin
- VA Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, United States.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States.,Graduate Program in Neuroscience, University of Washington, Seattle, WA, United States
| | - Suhjung Janet Lee
- VA Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, United States
| | - Emma Skillen
- VA Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, United States.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Katrina Wong
- VA Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, United States.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Holly Rau
- VA Northwest Mental Illness Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, United States
| | - Rebecca C Hendrickson
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States.,VA Northwest Mental Illness Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, United States
| | - Kathleen Pagulayan
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States.,VA Northwest Mental Illness Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, United States
| | - Murray A Raskind
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States.,VA Northwest Mental Illness Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, United States
| | - Elaine R Peskind
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States.,VA Northwest Mental Illness Research, Education, and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, United States
| | - Paul E M Phillips
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States.,Graduate Program in Neuroscience, University of Washington, Seattle, WA, United States.,Department of Pharmacology, University of Washington, Seattle, WA, United States
| | - David G Cook
- VA Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, United States.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States.,Graduate Program in Neuroscience, University of Washington, Seattle, WA, United States.,Department of Pharmacology, University of Washington, Seattle, WA, United States.,Department of Medicine, University of Washington, Seattle, WA, United States
| | - Abigail G Schindler
- VA Northwest Geriatric Research Education and Clinical Center, VA Puget Sound Health Care System, Seattle, WA, United States.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States.,Graduate Program in Neuroscience, University of Washington, Seattle, WA, United States
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35
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Carvalho CM, Coimbra BM, Xavier G, Bugiga AVG, Fonseca T, Olff M, Polimanti R, Mello AF, Ota VK, Mello MF, Belangero SI. Shorter Telomeres Related to Posttraumatic Stress Disorder Re-experiencing Symptoms in Sexually Assaulted Civilian Women. Front Psychiatry 2022; 13:835783. [PMID: 35664481 PMCID: PMC9161278 DOI: 10.3389/fpsyt.2022.835783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 04/19/2022] [Indexed: 12/02/2022] Open
Abstract
Telomeres are short tandem repeats of "TTAGGG" that protect the chromosome ends from deterioration or fusion of chromosomes. Their repeat length shortens with cell division acting as a biomarker of cellular aging. Traumatic stress events during adulthood or childhood have been associated with posttraumatic stress disorder (PTSD) and short leukocyte telomere length (LTL). This study investigated whether LTL was associated with PTSD in a Brazilian sample of sexually assaulted civilian women at two time points: baseline and 1-year follow-up. At baseline, we assessed 64 women with PTSD following sexual assault (cases) and 60 women with no previous history of sexual trauma or mental disorders (healthy controls - HC). At follow-up visit, 13 persistent PTSD cases, 11 HCs, and 11 PTSD remitters patients were evaluated. PTSD diagnosis and severity were assessed using Mini International Neuropsychiatric Interview (Diagnostic and Statistical Manual of Mental Disorders III/IV criteria) and Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), respectively. LTL was measured using multiplex real-time polymerase chain reaction (PCR). In the baseline analysis, we observed that LTL was associated with re-experiencing symptoms (B = -0.16; confidence interval (CI) 95% = -0.027--0.005; Bonferroni-adjusted p-value = 0.02), but no association was observed between other PTSD symptoms and LTL. In the longitudinal analysis, telomere shortening was no longer observed in patients with PTSD and PTSD remitters. In conclusion, our findings indicate that shorter baseline LTL is associated with early stage of PTSD re-experiencing symptoms in recently sexually assaulted women.
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Affiliation(s)
- Carolina Muniz Carvalho
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil.,LiNC - Laboratory of Integrative Neuroscience, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Bruno Messina Coimbra
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil.,Department of Psychiatry, University of Amsterdam, Amsterdam Public Health Research Institute and Amsterdam Neuroscience Research Institute, Amsterdam, Netherlands
| | - Gabriela Xavier
- LiNC - Laboratory of Integrative Neuroscience, Universidade Federal de São Paulo, São Paulo, Brazil.,Genetics Division of Department of Morphology, Genetics of Universidade Federal de São Paulo, São Paulo, Brazil
| | - Amanda V G Bugiga
- LiNC - Laboratory of Integrative Neuroscience, Universidade Federal de São Paulo, São Paulo, Brazil.,Genetics Division of Department of Morphology, Genetics of Universidade Federal de São Paulo, São Paulo, Brazil
| | - Tamiris Fonseca
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil.,LiNC - Laboratory of Integrative Neuroscience, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Miranda Olff
- Department of Psychiatry, University of Amsterdam, Amsterdam Public Health Research Institute and Amsterdam Neuroscience Research Institute, Amsterdam, Netherlands.,ARQ National Psychotrauma Centre, Diemen, Netherlands
| | - Renato Polimanti
- Department of Psychiatry, Yale School of Medicine, VA CT Healthcare Center, West Haven, CT, United States
| | - Andrea Feijó Mello
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Vanessa Kiyomi Ota
- LiNC - Laboratory of Integrative Neuroscience, Universidade Federal de São Paulo, São Paulo, Brazil.,Genetics Division of Department of Morphology, Genetics of Universidade Federal de São Paulo, São Paulo, Brazil
| | - Marcelo Feijó Mello
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Sintia Iole Belangero
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil.,LiNC - Laboratory of Integrative Neuroscience, Universidade Federal de São Paulo, São Paulo, Brazil.,Genetics Division of Department of Morphology, Genetics of Universidade Federal de São Paulo, São Paulo, Brazil
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36
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Ferland F, Blanchette-Martin N, Plourde C, Rossi C, Savard AC, Bernier MA, Ehouarne G, Blais M, Genois R. Les enjeux liés à la victimisation dans le traitement de la dépendance aux substances : qu’en disent les cliniciens en dépendance ? SANTÉ MENTALE AU QUÉBEC 2022. [DOI: 10.7202/1094152ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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37
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Reyes ME, Rossi JS, Thomas ED, C Goldstein S, Weiss NH. Posttraumatic Stress Disorder and Substance Misuse Among Black Emerging Adults: The Influence of Social Support. J Dual Diagn 2022; 18:42-51. [PMID: 34970948 PMCID: PMC9128832 DOI: 10.1080/15504263.2021.2017221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objective: Black emerging adults are significantly impacted by substance misuse. Posttraumatic stress disorder (PTSD) is associated with heightened substance misuse among Black emerging adults. However, limited research has identified protective factors that may influence the strength of the relation between PTSD and substance misuse in this population. Addressing this important limitation, the present study examined the potential moderating role of perceived social support in the association between PTSD symptoms and substance (i.e., alcohol and drug) misuse. Methods: Participants were 182 trauma-exposed Black emerging adults (M age = 20.50; 71.3% women) who completed self-report measures assessing PTSD symptoms, alcohol and drug misuse, and perceived social support. Results: PTSD symptoms were significantly and positively correlated with both alcohol and drug misuse. Moderation analyses indicated that positive relations between PTSD symptoms and both alcohol and drug misuse were only significant among Black emerging adults with lower (but not higher) levels of perceived social support. Conclusions: These findings suggest the potential utility of addressing social support in the assessment and treatment of substance misuse in trauma-exposed Black emerging adults.
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Affiliation(s)
- Miranda E Reyes
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
| | - Joseph S Rossi
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
| | - Emmanuel D Thomas
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
| | - Silvi C Goldstein
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
| | - Nicole H Weiss
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
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38
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Borges G, Benjet C, Orozco R, Medina-Mora ME. Traumatic life-events and alcohol and drug use disorders among Mexican adolescents: Bidirectional associations over 8 years. Drug Alcohol Depend 2021; 228:109051. [PMID: 34607192 DOI: 10.1016/j.drugalcdep.2021.109051] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 08/04/2021] [Accepted: 08/31/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Most research linking type of traumatic events to the incidence of alcohol and drug use disorders among adolescents are cross-sectional and no longitudinal research exists in low/middle income countries where violence is common. Studies on bidirectional associations are infrequent. METHODS We estimated prospective associations of 7 types of events and new occurrence of DSM-IV alcohol use disorders (AUD) and drug use disorders (DUD), as well as prospective associations between DSM-IV AUD, DUD and the new onset of 7 types of traumatic events, from a follow-up conducted in 2013 (n = 1071; ages 19-26) of the original Mexican Adolescent Mental Health Survey conducted in 2005 (ages 12-17), by using Relative Ratios (RR) and Hazard Ratios (HR) estimates. RESULTS After adjustments for mental disorders and demographics, "any traumatic event" increased the RR and HR of a new AUD and any substance use disorder (SUD). In HR estimates, bidirectional associations were found between "Ever committed or witnessed violence" and "Ever beaten up by spouse…" and AUD, DUD and SUD. DUD disorder increased HR for several events. LIMITATIONS Our sample is representative of the largest metropolitan area in Mexico but does not include other cities and other age groups that may differ in risk factors. Corrections for multiple tests suggests caution. CONCLUSIONS We found partial support for the self-medication hypothesis and weaker support for the risky behavior hypothesis, and only two traumatic events ("Ever beaten up by spouse, partner…" and "Ever committed or witnessed violence") showed evidence of a bidirectional association.
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Affiliation(s)
- Guilherme Borges
- Instituto Nacional de Psiquiatría Ramon de la Fuente Muñiz, Calzada México Xochimilco No. 101, Col. San Lorenzo Huipulco, CP: 14370 Mexico City, Mexico.
| | - Corina Benjet
- Instituto Nacional de Psiquiatría Ramon de la Fuente Muñiz, Calzada México Xochimilco No. 101, Col. San Lorenzo Huipulco, CP: 14370 Mexico City, Mexico
| | - Ricardo Orozco
- Instituto Nacional de Psiquiatría Ramon de la Fuente Muñiz, Calzada México Xochimilco No. 101, Col. San Lorenzo Huipulco, CP: 14370 Mexico City, Mexico
| | - Maria Elena Medina-Mora
- Instituto Nacional de Psiquiatría Ramon de la Fuente Muñiz, Calzada México Xochimilco No. 101, Col. San Lorenzo Huipulco, CP: 14370 Mexico City, Mexico
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39
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Repeated cocaine exposure prior to fear conditioning induces persistency of PTSD-like symptoms and enhancement of hippocampal and amygdala cell density in male rats. Brain Struct Funct 2021; 226:2219-2241. [PMID: 34195855 DOI: 10.1007/s00429-021-02320-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 06/11/2021] [Indexed: 12/29/2022]
Abstract
Pre- and post-trauma drug use can interfere with recovery from post-traumatic stress disorder (PTSD). However, the biological underpinnings of this interference are poorly understood. Here we examined the effect of pre-fear conditioning cocaine self-administration on PTSD-like symptoms in male rats, and defined impairment of fear extinction as difficulty to recover from PTSD. We also examined cell density changes in brain regions suspected of being involved in resistance to PTSD recovery. Before footshock stress testing, rats were trained to self-administer cocaine during 20 consecutive days, after which they were exposed to footshocks, while other rats continued to self-administer cocaine until the end of the experiment. Upon assessment of three PTSD-like symptoms (fear during situational reminders, anxiety-like behavior, and impairment of recognition memory) and fear extinction learning and memory, changes in cell density were measured in the medial prefrontal cortex, hippocampus, and amygdala. Results show that pre-footshock cocaine exposure did not affect fear during situational reminders. Fear conditioning did not lead to an increase in cocaine consumption. However, in footshock stressed rats, cocaine induced a reduction of anxiety-like behavior, an aggravation of recognition memory decline, and an impairment of extinction memory. These behavioral alterations were associated with increased cell density in the hippocampal CA1, CA2, and CA3 regions and basolateral amygdala, but not in the medial prefrontal cortex. Our findings suggest that enhancement of cell density in the hippocampus and amygdala may be changes associated with drug use, interfering with PTSD recovery.
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40
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Michaels TI, Stone E, Singal S, Novakovic V, Barkin RL, Barkin S. Brain reward circuitry: The overlapping neurobiology of trauma and substance use disorders. World J Psychiatry 2021; 11:222-231. [PMID: 34168969 PMCID: PMC8209534 DOI: 10.5498/wjp.v11.i6.222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/14/2021] [Accepted: 05/20/2021] [Indexed: 02/06/2023] Open
Abstract
Mental health symptoms secondary to trauma exposure and substance use disorders (SUDs) co-occur frequently in both clinical and community samples. The possibility of a shared aetiology remains an important question in translational neuroscience. Advancements in genetics, basic science, and neuroimaging have led to an improved understanding of the neural basis of these disorders, their frequent comorbidity and high rates of relapse remain a clinical challenge. This project aimed to conduct a review of the field's current understanding regarding the neural circuitry underlying posttraumatic stress disorder and SUD. A comprehensive review was conducted of available published literature regarding the shared neurobiology of these disorders, and is summarized in detail, including evidence from both animal and clinical studies. Upon summarizing the relevant literature, this review puts forth a hypothesis related to their shared neurobiology within the context of fear processing and reward cues. It provides an overview of brain reward circuitry and its relation to the neurobiology, symptomology, and phenomenology of trauma and substance use. This review provides clinical insights and implications of the proposed theory, including the potential development of novel pharmacological and therapeutic treatments to address this shared neurobiology. Limitations and extensions of this theory are discussed to provide future directions and insights for this shared phenomena.
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Affiliation(s)
- Timothy I Michaels
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY 11004, United States
- Department of Psychiatry, The Donald and Barbara Zucker School of Medicine, Hofstra/Northwell, Glen Oaks, NY 11004, United States
| | - Emily Stone
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY 11004, United States
| | - Sonali Singal
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY 11004, United States
| | - Vladan Novakovic
- Department of Psychiatry, The Donald and Barbara Zucker School of Medicine, Hofstra/Northwell, Glen Oaks, NY 11004, United States
| | - Robert L Barkin
- Department of Anesthesiology, Rush University Medical College, Chicago, IL 60612, United States
| | - Stacy Barkin
- Private Practice, Scottsdale, AZ 85250, United States
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41
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Holland-Deguire C, Rabalais A, Soe K, Anderson E, Shivakumar G. Transitioning from the Battlefield: A Theoretical Model for the Development of Posttraumatic Stress Disorder (PTSD) in Gender Diverse Veterans. JOURNAL OF VETERANS STUDIES 2021. [DOI: 10.21061/jvs.v7i1.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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42
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Thakur A, Choudhary D, Kumar B, Chaudhary A. A review on post-traumatic stress disorder (PTSD): "Symptoms, Therapies and Recent Case Studies". Curr Mol Pharmacol 2021; 15:502-516. [PMID: 34036925 DOI: 10.2174/1874467214666210525160944] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/21/2021] [Accepted: 03/22/2021] [Indexed: 11/22/2022]
Abstract
Post-traumatic stress disorder (PTSD), previously known as battle fatigue syndrome or shell shock, is a severe mental disturbance condition that is normally triggered by the experience of some frightening/scary events or trauma where a person undergoes some serious physical or mental harm or threatened. PTSD is a long-life effect of the continuous occurrence of traumatic conditions which, leading the production of feelings of helplessness, intense fear, and horror in the person. There are various examples of events that can cause PTSD, such as physical, mental, or sexual assault at home or working place by others, unexpected death of a loved one, an accidental event, war, or some kind of natural disaster. Treatment of PTSD includes the removal or reduction of these emotional feelings or symptoms with the aim to improve the daily life functioning of a person. Problems which are needed to be considered in case of PTSD like ongoing trauma, abusive or bad relationships. Various drugs which are used for the treatment of PTSD include selective serotonin reuptake inhibitors (SSRIs) (citalopram, fluvoxamine, fluoxetine, etc.); tricyclic antidepressants (amitriptyline and isocarboxazid); mood stabilizers (Divalproex and lamotrigine); atypical antipsychotics (aripiprazole and quetiapine), etc. In this review, we have covered the different risk factors, case studies related to various treatment options with different age group peoples in PTSD and their effects on them. We have also covered the symptoms and associated disorders which can play a key role in the development of PTSD.
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Affiliation(s)
- Amandeep Thakur
- School of Pharmacy, College of Pharmacy, Taipei Medical University, 250 Wuxing Street, Taipei 11031. Taiwan
| | - Diksha Choudhary
- Department of School of Pharmacy, Abhilashi University, Chail Chowk, tehsil Chachyot, Mandi, Himachal Pradesh 175028, India
| | - Bhupinder Kumar
- Department of Pharmaceutical Chemistry, ISF College of Pharmacy, Ghal Kalan, G.T Road, Moga, Punjab, India
| | - Amit Chaudhary
- Department of School of Pharmacy, Abhilashi University, Chail Chowk, tehsil Chachyot, Mandi, Himachal Pradesh 175028, India
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43
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Alcohol to down-regulate negative and positive emotions: Extending our understanding of the functional role of alcohol in relation to posttraumatic stress disorder. Addict Behav 2021; 115:106777. [PMID: 33359633 DOI: 10.1016/j.addbeh.2020.106777] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Functional models of posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) underscore the role of internally-driven negative reinforcement. However, with the focus of these models being on negative emotions broadly, there is limited understanding of the effect of alcohol use to down-regulate specific forms of negative emotions or positive emotions generally. Among populations characterized by PTSD, there is growing evidence that positive emotions may elicit aversive reactions and thus be intentionally reduced, including via alcohol use. OBJECTIVE The current study examined the associations among PTSD symptom severity, alcohol use to down-regulate both negative (i.e., despondency and anger) and positive emotions, and alcohol misuse. METHOD Data were collected from 320 trauma-exposed, substance-using individuals in the community (M age = 35.78, 46.9% women). RESULTS Individuals with greater PTSD symptom severity reported significantly higher alcohol use to down-regulate despondency, anger, and positive emotions, which, in turn, were linked to greater alcohol misuse. CONCLUSIONS Alcohol use may serve to down-regulate both negative (i.e., despondency and anger) and positive emotions, and these functions may help to explain the association of PTSD symptom severity to alcohol misuse. PTSD-AUD models may benefit from specifying a negatively reinforcing function of alcohol use in the context of positive emotions.
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44
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Takemoto E, Giesinger I, Russell JS, Li J. Association between post-traumatic stress disorder and alcohol-related hospitalizations among World Trade Center Health Registry enrollees. Drug Alcohol Depend 2021; 221:108656. [PMID: 33689968 DOI: 10.1016/j.drugalcdep.2021.108656] [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] [Received: 10/27/2020] [Revised: 01/25/2021] [Accepted: 02/17/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND We examined both the impact of 9/11-related exposures and repeated assessments of post-traumatic stress disorder (PTSD) on the risk of alcohol-related hospitalizations (ARH) among individuals exposed to the World Trade Center (WTC) disaster. METHODS 9/11-related exposures (witnessing traumatic events, physical injuries, or both) were measured at baseline and PTSD symptoms were assessed at four time points (2003-2016) using the PTSD Checklist-17 among 53,174 enrollees in the WTC Health Registry. ICD-9-CM and ICD-10-CM codes were used to identify ARHs (2003-2016) through linked administrative data. For the effect of 9/11-related exposures on ARH, Cox proportional-hazards regression estimated hazard ratios (HR) and 95 % confidence intervals (CI); for time-varying PTSD, extended Cox proportional-hazards regression was used. Models were adjusted fora priori confounders and stratified by enrollee group (uniformed rescue and recovery worker (RRW), non-uniformed RRW, and community members). Person-time was calculated from baseline or 9/12/2001 to the earliest of ARH, withdrawal, death, or end of follow-up (12/31/2016). RESULTS Across all 9/11-related exposures, community members and non-uniformed RRWs were at increased risk of ARHs; uniformed RRWs were not. In adjusted models, PTSD was associated with an increased risk of hospitalization across all groups [HR, (95 % CI): uniformed RRWs: 2.6, (1.9, 3.6); non-uniformed RRWs: 2.1, (1.7, 2.7); and community members: 2.6, (2.1, 3.2)]. CONCLUSIONS Among certain enrollee groups, 9/11-related exposures are associated with an increased risk of ARH and that PTSD is strongly associated with ARHs among all enrollee groups. Findings may assist the clinical audience in improving screening and treatment.
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Affiliation(s)
- Erin Takemoto
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, 30-30 47th Ave, Long Island City, NY, 11101, USA
| | - Ingrid Giesinger
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, 30-30 47th Ave, Long Island City, NY, 11101, USA
| | - Jonathan S Russell
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, 30-30 47th Ave, Long Island City, NY, 11101, USA; Department of Epidemiology, Columbia University, Mailman School of Public Health, 722 West 168th Street, New York, NY, 10032, USA
| | - Jiehui Li
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, 30-30 47th Ave, Long Island City, NY, 11101, USA.
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Association of symptom severity, pain and other behavioral and medical comorbidities with diverse measures of functioning among adults with post-traumatic stress disorder. J Psychiatr Res 2021; 134:113-120. [PMID: 33383494 DOI: 10.1016/j.jpsychires.2020.12.063] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 12/17/2020] [Accepted: 12/21/2020] [Indexed: 12/23/2022]
Abstract
Post-traumatic stress disorder (PTSD) is an often disabling mental disorder whose management typically focuses on reducing PTSD symptoms. Chronic pain and other comorbidities that commonly accompany PTSD symptoms may also be independently associated with disability. Using data from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions, we examined the independent association of PTSD symptom severity, pain interference, non-PTSD psychiatric and substance use disorders (SUD), and medical illnesses with each of four domains of function: mental health-related quality of life and physical functioning assessed with the Mental Health Composite Score (MCS) and Physical Function Score (PFS) of the Short Form-12; perceived social support from the Interpersonal Support and Evaluation List-12 (ISEL-12); and self-reported past year employment. Among 1779 individuals representing 11 million U.S. adults who met the Diagnostic and Statistical Manual-5 (DSM-5) criteria for Past Year PTSD, the MCS (41.2; SD 12.5), PFS (44.8; SD 13.2) and ISEL-12 (33.6; SD 7.2) indicated substantial disability when compared to population norms, and only 63.6% were employed. Multiple regression showed the MCS had a modest negative association with PTSD symptoms, pain interference, psychiatric multimorbidity and medical comorbidity although not with SUD. PFS and employment had significant negative associations with pain interference and medical comorbidity. ISEL-12 had a weak negative association with PTSD symptoms and non-PTSD psychiatric comorbidity. Common comorbidities thus significantly influence disability associated with PTSD, often more strongly than PTSD symptoms. PTSD treatment may require integrative multimorbidity management beyond a focus on PTSD symptoms.
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Seidemann R, Duek O, Jia R, Levy I, Harpaz-Rotem I. The Reward System and Post-Traumatic Stress Disorder: Does Trauma Affect the Way We Interact With Positive Stimuli? CHRONIC STRESS (THOUSAND OAKS, CALIF.) 2021; 5:2470547021996006. [PMID: 33718742 PMCID: PMC7917421 DOI: 10.1177/2470547021996006] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 01/31/2021] [Indexed: 12/17/2022]
Abstract
Post-traumatic stress disorder (PTSD) is a highly prevalent disorder and a highly debilitating condition. Although anhedonia is an important construct of the disorder, the relationship between PTSD and reward functioning is still under-researched. To date, the majority of research on PTSD has focused on fear: fear learning, maintenance, and extinction. Here we review the relevant literature-including clinical observations, self-report data, neuroimaging research, and animal studies-in order to examine the potential effects of post-traumatic stress disorder on the reward system. Our current lack of sufficient insight into how trauma affects the reward system is one possible hindrance to clinical progress. The current review highlights the need for further investigation into the complex relationship between exposure to trauma and the reward system to further our understandings of the ethology of PTSD.
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Affiliation(s)
- Rebecca Seidemann
- Yale University School of Medicine, New Haven, CT, USA
- National Center for PTSD, West Haven, CT, USA
| | - Or Duek
- Yale University School of Medicine, New Haven, CT, USA
- National Center for PTSD, West Haven, CT, USA
| | - Ruonan Jia
- Yale University School of Medicine, New Haven, CT, USA
| | - Ifat Levy
- Yale University School of Medicine, New Haven, CT, USA
| | - Ilan Harpaz-Rotem
- Yale University School of Medicine, New Haven, CT, USA
- National Center for PTSD, West Haven, CT, USA
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Beerten-Duijkers JCLM, Vissers CTWM, Rinck M, Egger JIM. Inhibitory Control and Craving in Dual Disorders and Recurrent Substance Use. Preliminary Findings. Front Psychiatry 2021; 12:569817. [PMID: 33613336 PMCID: PMC7886692 DOI: 10.3389/fpsyt.2021.569817] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 01/04/2021] [Indexed: 11/23/2022] Open
Abstract
Objective: In Dual Disorders (DD), which involves the co-occurrence of a disorder in substance use and a mental disorder, recurrent struggles with addictive behavior are frequent. Neuropsychological knowledge concerning the profile of inhibitory control and the irresistible urge to use substances (craving) within the DD patient group may contribute to the prevention of this recurrent addictive behavior. Methods: Inhibitory control and craving were assessed in 25 patients with DD and 25 healthy controls (HC). Inhibitory control tasks (Go/No-go task and Stop Signal Task) were performed combined with brain measurements (Event Related Potentials) mapping inhibitory control. Moreover, implicit and explicit measures concerning craving were administered. Statistical DD and HC comparisons, correlational and regression analyses on exploratory base were conducted. Results: DD patients committed more inhibitory control errors than HC when confronted with (alcohol) consumption-related picture stimuli. Furthermore, patients with DD showed higher levels of implicit and explicit craving. The number of inhibitory control errors was positively related to levels of implicit and explicit craving. Moreover, explicit craving and impulsivity (as a dimension of inhibitory control) predicted the severity of addictive behavior. Event Related Potential analyses did not show differences in inhibitory control-associated brain activity between DD patients and HC; both groups showed reduction of P300 amplitudes in response to alcohol pictures. Conclusions: Impulsivity and craving are elevated in DD patients and show predictive value for the severity of addictive behavior. One's level of impulsive action tendency may trigger less effort to control (recurrent) substance use. The findings may contribute to existing DD treatment indications by the promotion of impulse control training via "stop-think-act" methods for DD patients.
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Affiliation(s)
- Judith C L M Beerten-Duijkers
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, Netherlands.,Centre of Excellence for Korsakoff and Alcohol Related Cognitive Dysfunctions/Addiction Care, Vincent van Gogh Institute for Psychiatry, Venray, Netherlands
| | - Constance Th W M Vissers
- Kentalis Academy, Royal Dutch Kentalis, Sint-Michielsgestel, Netherlands.,Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Mike Rinck
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Jos I M Egger
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, Netherlands.,Centre of Excellence for Korsakoff and Alcohol Related Cognitive Dysfunctions/Addiction Care, Vincent van Gogh Institute for Psychiatry, Venray, Netherlands.,Centre of Excellence for Neuropsychiatry, Vincent van Gogh Institute for Psychiatry, Venray, Netherlands.,Stevig Specialized and Forensic Care for People With Intellectual Disabilities, Dichterbij, Oostrum, Netherlands
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48
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Glynn TR, Mendez NA, Jones DL, Dale SK, Carrico AW, Feaster DJ, Rodriguez AE, Safren SA. Trauma exposure, PTSD, and suboptimal HIV medication adherence among marginalized individuals connected to public HIV care in Miami. J Behav Med 2020; 44:147-158. [PMID: 33098541 DOI: 10.1007/s10865-020-00191-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 10/08/2020] [Indexed: 11/25/2022]
Abstract
Individuals living with HIV report disproportionately high levels of trauma exposure and PTSD symptoms, both which have been associated with suboptimal ART adherence. Often conflated, the question arises as to which construct is driving subsequent HIV self-care behavior. Given the HIV disparities among Black and Hispanic/Latinx individuals, and that Miami is a geographic region with a high racial/ethnic minority make up and a unique socioeconomic environment, it is important to explore factors related to HIV outcomes in Miami to mitigate its uncontrolled epidemic. This study aimed to examine the association of trauma exposure, PTSD symptoms, and relevant additional key factors with adherence to ART among a sample of majority Black and Hispanic/Latinx individuals who are economically marginalized receiving public HIV care in Miami, FL (N = 1237) via a cross-sectional survey. Sequential linear regression was used to examine the study aim in four blocks: (1) trauma, (2) PTSD symptoms, and key covariates of ART adherence including (3) depression and substance use (potential psychological covariates), and (4) indicators of socioeconomic status (potential structural covariates). In the first block, trauma exposure was associated with worse adherence. However, in the second block, the association with trauma dropped and PTSD was significantly associated with worse adherence. Of note, for those experiencing high levels of trauma exposure, adherence was negatively impacted regardless of PTSD. When other key factors associated with adherence were entered in the third and fourth blocks, neither trauma exposure nor PTSD were uniquely significant. In this final model, depression, substance use, and unstable housing were uniquely associated with worse adherence. Trauma-informed models of HIV care that holistically address co-occurring factors are warranted to cater to communities with HIV health disparities and keep them from falling off the HIV care continuum.
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Affiliation(s)
- Tiffany R Glynn
- Department of Psychology, University of Miami Miller School of Medicine, Clinical Research Building, 1120 NW 14th St., Miami, FL, 33136, USA
| | - Noelle A Mendez
- Department of Psychology, University of Miami Miller School of Medicine, Clinical Research Building, 1120 NW 14th St., Miami, FL, 33136, USA
| | - Deborah L Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sannisha K Dale
- Department of Psychology, University of Miami Miller School of Medicine, Clinical Research Building, 1120 NW 14th St., Miami, FL, 33136, USA
| | - Adam W Carrico
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Daniel J Feaster
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Allan E Rodriguez
- Division of Infectious Disease, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Steven A Safren
- Department of Psychology, University of Miami Miller School of Medicine, Clinical Research Building, 1120 NW 14th St., Miami, FL, 33136, USA.
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Luteijn I, VanDerNagel JEL, van Duijvenbode N, de Haan HA, Poelen EAP, Didden R. Post-traumatic stress disorder and substance use disorder in individuals with mild intellectual disability or borderline intellectual functioning: A review of treatment studies. RESEARCH IN DEVELOPMENTAL DISABILITIES 2020; 105:103753. [PMID: 32763655 DOI: 10.1016/j.ridd.2020.103753] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/07/2020] [Accepted: 07/25/2020] [Indexed: 06/11/2023]
Abstract
Individuals with mild intellectual disability or borderline intellectual functioning (MID-BIF; IQ 50-85) are at high risk for developing post-traumatic stress disorder (PTSD) and substance use disorders (SUD). In individuals without MID-BIF, Seeking Safety (SeSa) is found to be effective in treating PTSD and SUD simultaneously. However, little is known about integrated treatment of PTSD and SUD in individuals with MID-BIF. This review aims to provide an overview of studies about this type of triple psychopathology, as well as PTSD or SUD in individuals with MID-BIF (i.e. dual diagnosis). No studies were found on integrated treatment of PTSD and SUD in individuals with MID-BIF. Thirty-two studies were found on treatment of either PTSD (mostly Eye Movement Desensitization and Reprocessing and cognitive behavior therapy) or SUD (mostly cognitive behavior therapy and mindfulness) in individuals with MID-BIF. Only 9.4 % of these studies mentioned the co-morbidity of PTSD and SUD. Suggestions for adapting treatment to individuals with MID-BIF were provided on communication, structure, non-verbal elements, network, coping skills, therapeutic relationship and use of suitable and reliable instruments to measure treatment progress. More research is needed on the effectivity of EMDR or Imaginary Exposure (IE) combined with SUD treatment (CBT and mindfulness), and on the adaption of SeSa tot individuals with MID-BIF, as well as on this type of triple psychopathology in general.
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Affiliation(s)
- Ilse Luteijn
- Tactus Verslavingszorg, P.O. Box 154, 7400 AD, Deventer, the Netherlands.
| | - Joanneke E L VanDerNagel
- Tactus Verslavingszorg, P.O. Box 154, 7400 AD, Deventer, the Netherlands; Radboud Universiteit Nijmegen, Nijmegen Institute for Scientist-Practitioners in Addiction, P.O Box 6909, 6503 GK Nijmegen, the Netherlands; Aveleijn, Grotestraat 260, 7622 GW Borne, the Netherlands; University of Twente, Faculty of Electrical Engineering, Mathematics, & Computer Science, Human Media Interaction, Drienerlolaan 5, 7522 NB Enschede, the Netherlands
| | - Neomi van Duijvenbode
- Tactus Verslavingszorg, P.O. Box 154, 7400 AD, Deventer, the Netherlands; Trajectum, Hanzeallee 2, 8017 KZ Zwolle, the Netherlands
| | - Hein A de Haan
- Tactus Verslavingszorg, P.O. Box 154, 7400 AD, Deventer, the Netherlands; Radboud Universiteit Nijmegen, Nijmegen Institute for Scientist-Practitioners in Addiction, P.O Box 6909, 6503 GK Nijmegen, the Netherlands
| | - Evelien A P Poelen
- Pluryn, Research & Development, Industrieweg 50, 6541 TW, Nijmegen, the Netherlands; Behavioral Science Institute, Radboud University, P.O. Box 9104, 6500 HE, Nijmegen, the Netherlands
| | - Robert Didden
- Trajectum, Hanzeallee 2, 8017 KZ Zwolle, the Netherlands; Behavioral Science Institute, Radboud University, P.O. Box 9104, 6500 HE, Nijmegen, the Netherlands
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50
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Vengeliene V, Foo JC, Kim J. Translational approach to understanding momentary factors associated with alcohol consumption. Br J Pharmacol 2020; 177:3878-3897. [PMID: 32608068 DOI: 10.1111/bph.15180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/17/2020] [Accepted: 06/22/2020] [Indexed: 01/23/2023] Open
Abstract
Multiple interindividual and intra-individual factors underlie variability in drinking motives, challenging clinical translatability of animal research and limiting treatment success of substance use-related problems. Intra-individual variability refers to time-dependent continuous and discrete changes within the individual and in substance use research is studied as momentary variation in the internal states (craving, stressed, anxious, impulsive and tired) and response to external triggers (stressors, drug-associated environmental cues and social encounters). These momentary stimuli have a direct impact on behavioural decisions and may be triggers and predictors of substance consumption. They also present potential targets for real-time behavioural and pharmacological interventions. In this review, we provide an overview of the studies demonstrating different momentary risk factors associated with increased probability of alcohol drinking in humans and changes in alcohol seeking and consumption in animals. The review also provides an overview of pharmacological interventions related to every individual risk factor.
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Affiliation(s)
- Valentina Vengeliene
- Department of Neurobiology and Biophysics, Institute of Biosciences, Life Sciences Center, Vilnius, Lithuania
| | - Jerome Clifford Foo
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Jinhyuk Kim
- Department of Informatics, Graduate School of Integrated Science and Technology, Shizuoka University, Shizuoka, Japan
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