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Ressler KJ, Berretta S, Bolshakov VY, Rosso IM, Meloni EG, Rauch SL, Carlezon WA. Post-traumatic stress disorder: clinical and translational neuroscience from cells to circuits. Nat Rev Neurol 2022; 18:273-288. [PMID: 35352034 PMCID: PMC9682920 DOI: 10.1038/s41582-022-00635-8] [Citation(s) in RCA: 110] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2022] [Indexed: 01/16/2023]
Abstract
Post-traumatic stress disorder (PTSD) is a maladaptive and debilitating psychiatric disorder, characterized by re-experiencing, avoidance, negative emotions and thoughts, and hyperarousal in the months and years following exposure to severe trauma. PTSD has a prevalence of approximately 6-8% in the general population, although this can increase to 25% among groups who have experienced severe psychological trauma, such as combat veterans, refugees and victims of assault. The risk of developing PTSD in the aftermath of severe trauma is determined by multiple factors, including genetics - at least 30-40% of the risk of PTSD is heritable - and past history, for example, prior adult and childhood trauma. Many of the primary symptoms of PTSD, including hyperarousal and sleep dysregulation, are increasingly understood through translational neuroscience. In addition, a large amount of evidence suggests that PTSD can be viewed, at least in part, as a disorder that involves dysregulation of normal fear processes. The neural circuitry underlying fear and threat-related behaviour and learning in mammals, including the amygdala-hippocampus-medial prefrontal cortex circuit, is among the most well-understood in behavioural neuroscience. Furthermore, the study of threat-responding and its underlying circuitry has led to rapid progress in understanding learning and memory processes. By combining molecular-genetic approaches with a translational, mechanistic knowledge of fear circuitry, transformational advances in the conceptual framework, diagnosis and treatment of PTSD are possible. In this Review, we describe the clinical features and current treatments for PTSD, examine the neurobiology of symptom domains, highlight genomic advances and discuss translational approaches to understanding mechanisms and identifying new treatments and interventions for this devastating syndrome.
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Affiliation(s)
- Kerry J Ressler
- SPARED Center, Department of Psychiatry, McLean Hospital, Harvard Medical School, Boston, MA, USA.
| | - Sabina Berretta
- SPARED Center, Department of Psychiatry, McLean Hospital, Harvard Medical School, Boston, MA, USA
| | - Vadim Y Bolshakov
- SPARED Center, Department of Psychiatry, McLean Hospital, Harvard Medical School, Boston, MA, USA
| | - Isabelle M Rosso
- SPARED Center, Department of Psychiatry, McLean Hospital, Harvard Medical School, Boston, MA, USA
| | - Edward G Meloni
- SPARED Center, Department of Psychiatry, McLean Hospital, Harvard Medical School, Boston, MA, USA
| | - Scott L Rauch
- SPARED Center, Department of Psychiatry, McLean Hospital, Harvard Medical School, Boston, MA, USA
| | - William A Carlezon
- SPARED Center, Department of Psychiatry, McLean Hospital, Harvard Medical School, Boston, MA, USA
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2
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Intranasal oxytocin administration impacts the acquisition and consolidation of trauma-associated memories: a double-blind randomized placebo-controlled experimental study in healthy women. Neuropsychopharmacology 2022; 47:1046-1054. [PMID: 34887528 PMCID: PMC8938422 DOI: 10.1038/s41386-021-01247-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 10/06/2021] [Accepted: 11/19/2021] [Indexed: 11/08/2022]
Abstract
Intrusive memories are a hallmark symptom of post-traumatic stress disorder (PTSD) and oxytocin has been implicated in the formation of intrusive memories. This study investigates how oxytocin influences the acquisition and consolidation of trauma-associated memories and whether these effects are influenced by individual neurobiological and genetic differences. In this randomized, double-blind, placebo-controlled study, 220 healthy women received either a single dose of intranasal 24IU oxytocin or a placebo before exposure to a trauma film paradigm that solicits intrusive memories. We used a "general random forest" machine learning approach to examine whether differences in the noradrenergic and hypothalamic-pituitary-adrenal axis activity, polygenic risk for psychiatric disorders, and genetic polymorphism of the oxytocin receptor influence the effect of oxytocin on the acquisition and consolidation of intrusive memories. Oxytocin induced significantly more intrusive memories than placebo did (t(188.33) = 2.12, p = 0.035, Cohen's d = 0.30, 95% CI 0.16-0.44). As hypothesized, we found that the effect of oxytocin on intrusive memories was influenced by biological covariates, such as salivary cortisol, heart rate variability, and PTSD polygenic risk scores. The five factors that were most relevant to the oxytocin effect on intrusive memories were included in a Poisson regression, which showed that, besides oxytocin administration, higher polygenic loadings for PTSD and major depressive disorder were directly associated with a higher number of reported intrusions after exposure to the trauma film stressor. These results suggest that intranasal oxytocin amplifies the acquisition and consolidation of intrusive memories and that this effect is modulated by neurobiological and genetic factors. Trial registration: NCT03031405.
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Olff M, Amstadter A, Armour C, Birkeland MS, Bui E, Cloitre M, Ehlers A, Ford JD, Greene T, Hansen M, Lanius R, Roberts N, Rosner R, Thoresen S. A decennial review of psychotraumatology: what did we learn and where are we going? Eur J Psychotraumatol 2019; 10:1672948. [PMID: 31897268 PMCID: PMC6924542 DOI: 10.1080/20008198.2019.1672948] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
On 6 December 2019 we start the 10th year of the European Journal of Psychotraumatogy (EJPT), a full Open Access journal on psychotrauma. This editorial is part of a special issue/collection celebrating the 10 years anniversary of the journal where we will acknowledge some of our most impactful articles of the past decade (also discussed below and marked with * in the reference list). In this editorial the editors present a decennial review of the field addressing a range of topics that are core to both the journal and to psychotraumatology as a discipline. These include neurobiological developments (genomics, neuroimaging and neuroendocrine research), forms of trauma exposure and impact across the lifespan, mass trauma and early interventions, work-related trauma, trauma in refugee populations, and the potential consequences of trauma such as PTSD or Complex PTSD, but also resilience. We address innovations in psychological, medication (enhanced) and technology-assisted treatments, mediators and moderators like social support and finally how new research methods help us to gain insights in symptom structures or to better predict symptom development or treatment success. We aimed to answer three questions 1. Where did we stand in 2010? 2. What did we learn in the past 10 years? 3. What are our knowledge gaps? We conclude with a number of recommendations concerning top priorities for the future direction of the field of psychotraumatology and correspondingly the journal.
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Affiliation(s)
- Miranda Olff
- Department of Psychiatry, Amsterdam
University Medical Centers (location AMC), University of Amsterdam, Amsterdam
Neuroscience, Amsterdam, The Netherlands
- ARQ National Psychotrauma
Centre, Diemen, The Netherlands
| | - Ananda Amstadter
- Departemnts of Psychiatry, Psychology, &
Human and Molecular Genetics, Virginia Commonwealth University, Richmond,
USA
| | - Cherie Armour
- School of Psychology, Queens University
Belfast, Belfast, Northern Ireland, UK
| | - Marianne S. Birkeland
- Section for implementation and treatment
research, Norwegian Centre for Violence and Traumatic Stress Studies, Oslo
Norway
| | - Eric Bui
- Department of Psychiatry, Massachusetts
General Hospital & Harvard Medical School, Boston, MA,
USA
| | - Marylene Cloitre
- National Center for PTSD Dissemination and
Training Division, Palo Alto, CA, USA
- Department of Psychiatry and Behavioral
Sciences, Stanford University, Palo Alto, CA, USA
| | - Anke Ehlers
- Department of Experimental Psychology,
University of Oxford, Oxford, UK
| | - Julian D. Ford
- Department of Psychiatry, University of
Connecticut Health Center, Farmington, USA
| | - Talya Greene
- Department of Community Mental Health,
University of Haifa, Haifa, Israel
| | - Maj Hansen
- Department of Psychology,
Odense, Denmark
| | - Ruth Lanius
- Posttraumatic Stress Disorder (PTSD) Research
Unit, Western University of Canada, London, ON,
Canada
| | - Neil Roberts
- Psychology and Psychological Therapies
Directorate, Cardiff & Vale University Health Board, Cardiff,
UK
- Division of Psychological Medicine &
Clinical Neurosciences, Cardiff University, Cardiff,
UK
| | - Rita Rosner
- Department of Clinical and Biological
Psychology, KU Eichstaett-Ingolstadt, Eichstaett,
Germany
| | - Siri Thoresen
- Section for trauma, catastrophes and forced
migration – children and youth, Norwegian Centre for Violence and Traumatic Stress
Studies, Oslo, Norway
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DePierro J, Lepow L, Feder A, Yehuda R. Translating Molecular and Neuroendocrine Findings in Posttraumatic Stress Disorder and Resilience to Novel Therapies. Biol Psychiatry 2019; 86:454-463. [PMID: 31466562 PMCID: PMC6907400 DOI: 10.1016/j.biopsych.2019.07.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 07/08/2019] [Accepted: 07/16/2019] [Indexed: 12/13/2022]
Abstract
Many biological systems are altered in association with posttraumatic stress disorder (PTSD) and resilience. However, there are only few approved pharmacological treatments for PTSD, and no approved medications to enhance resilience. This article provides a critical review of select neurobiological findings in PTSD and resilience, and also of pharmacologic approaches that have emerged from this work. The medications summarized involve engagement with targets in the adrenergic, hypothalamic-pituitary-adrenal axis, and neuropeptide Y systems. Other highlighted approaches involve the use of ketamine and 3,4-methylenedioxymethamphetamine-assisted psychotherapy, which recently surfaced as promising strategies for PTSD, though the neurobiological mechanisms underlying their actions, including for promoting resilience, are not yet fully understood. The former approaches fall within the broad concept of "rational pharmacotherapy," in that they attempt to directly target dysregulated systems known to be associated with posttraumatic symptoms. To the extent that use of ketamine and 3,4-methylenedioxymethamphetamine promotes symptom improvement and resilience in PTSD, this provides an opportunity for reverse translation and identification of relevant targets and mechanisms of action through careful study of biological changes resulting from these interventions. Promoting resilience in trauma-exposed individuals may involve more than pharmacologically manipulating dysregulated molecules and pathways associated with developing and sustaining PTSD symptom severity, but also producing a substantial change in mental state that increases the ability to engage with traumatic material in psychotherapy. Neurobiological examination in the context of treatment studies may yield novel targets and promote a greater understanding of mechanisms of recovery from trauma.
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Affiliation(s)
- Jonathan DePierro
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Lauren Lepow
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Adriana Feder
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Rachel Yehuda
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Psychiatry, James J. Peters Veterans Affairs Medical Center, Bronx, New York.
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Misganaw B, Guffanti G, Lori A, Abu-Amara D, Flory JD, Mueller S, Yehuda R, Jett M, Marmar CR, Ressler KJ, Doyle FJ. Polygenic risk associated with post-traumatic stress disorder onset and severity. Transl Psychiatry 2019; 9:165. [PMID: 31175274 PMCID: PMC6555815 DOI: 10.1038/s41398-019-0497-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 05/07/2019] [Indexed: 01/14/2023] Open
Abstract
Post-traumatic stress disorder (PTSD) is a psychiatric illness with a highly polygenic architecture without large effect-size common single-nucleotide polymorphisms (SNPs). Thus, to capture a substantial portion of the genetic contribution, effects from many variants need to be aggregated. We investigated various aspects of one such approach that has been successfully applied to many traits, polygenic risk score (PRS) for PTSD. Theoretical analyses indicate the potential prediction ability of PRS. We used the latest summary statistics from the largest published genome-wide association study (GWAS) conducted by Psychiatric Genomics Consortium for PTSD (PGC-PTSD). We found that the PRS constructed for a cohort comprising veterans of recent wars (n = 244) explains a considerable proportion of PTSD onset (Nagelkerke R2 = 4.68%, P = 0.003) and severity (R2 = 4.35%, P = 0.0008) variances. However, the performance on an African ancestry sub-cohort was minimal. A PRS constructed with schizophrenia GWAS also explained a significant fraction of PTSD diagnosis variance (Nagelkerke R2 = 2.96%, P = 0.0175), confirming previously reported genetic correlation between the two psychiatric ailments. Overall, these findings demonstrate the important role polygenic analyses of PTSD will play in risk prediction models as well as in elucidating the biology of the disorder.
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Affiliation(s)
- Burook Misganaw
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Guia Guffanti
- Department of Psychiatry, Harvard Medical School and McLean Hospital, Belmont, MA, USA
| | - Adriana Lori
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Duna Abu-Amara
- Steven and Alexandra Cohen Veterans Center for the Study of Posttraumatic Stress and Traumatic Brain Injury; and Department of Psychiatry, NYU School of Medicine, New York, NY, USA
| | - Janine D Flory
- Department of Psychiatry, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
- The Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Susanne Mueller
- Center for Imaging of Neurodegenerative Diseases, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Rachel Yehuda
- Department of Psychiatry, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
- The Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Marti Jett
- Integrative Systems Biology, United States Army Medical Research and Material Command, United States Army Center for Environmental Health Research, Frederick, MD, USA
| | - Charles R Marmar
- Steven and Alexandra Cohen Veterans Center for the Study of Posttraumatic Stress and Traumatic Brain Injury; and Department of Psychiatry, NYU School of Medicine, New York, NY, USA
| | - Kerry J Ressler
- Department of Psychiatry, Harvard Medical School and McLean Hospital, Belmont, MA, USA
| | - Francis J Doyle
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA.
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Modelling posttraumatic stress disorders in animals. Prog Neuropsychopharmacol Biol Psychiatry 2019; 90:117-133. [PMID: 30468906 DOI: 10.1016/j.pnpbp.2018.11.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 11/19/2018] [Accepted: 11/19/2018] [Indexed: 01/07/2023]
Abstract
Animal models of posttraumatic stress disorder are useful tools to reveal the neurobiological basis of the vulnerability to traumatic events, and to develop new treatment strategies, as well as predicting treatment response contributing to personalized medicine approach. Different models have different construct, face and predictive validity and they model different symptoms of the disease. The most prevalent models are the single prolonged stress, electric foot-shock and predator odor. Freezing as 're-experiencing' in cluster B and startle as 'arousal' in cluster E according to DSM-5 are the most frequently studied parameters; however, several other symptoms related to mood, cognitive and social skills are part of the examinations. Beside behavioral characteristics, symptoms of exaggerated sympathetic activity and hypothalamic-pituitary-adrenocortical axis as well as signs of sleep disturbances are also warranted. Test battery rather than a single test is required to describe a model properly and the results should be interpreted in a comprehensive way, e.g. creating a z-score. Research is shifting to study larger populations and identifying the features of the resilient and vulnerable individuals, which cannot be easily done in humans. Incorporation of the "three hit theory" in animal models may lead to a better animal model of vulnerability and resilience. As women are twice as vulnerable as men, more emphasize should be taken to include female animals. Moreover, hypothesis free testing and big data analysis may help to identify an array of biomarkers instead of a single variable for identification of vulnerability and for the purpose of personalized medicine.
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Richter-Levin G, Stork O, Schmidt MV. Animal models of PTSD: a challenge to be met. Mol Psychiatry 2019; 24:1135-1156. [PMID: 30816289 PMCID: PMC6756084 DOI: 10.1038/s41380-018-0272-5] [Citation(s) in RCA: 111] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 08/13/2018] [Accepted: 09/11/2018] [Indexed: 02/07/2023]
Abstract
Recent years have seen increased interest in psychopathologies related to trauma exposure. Specifically, there has been a growing awareness to posttraumatic stress disorder (PTSD) in part due to terrorism, climate change-associated natural disasters, the global refugee crisis, and increased violence in overpopulated urban areas. However, notwithstanding the increased awareness to the disorder, the increasing number of patients, and the devastating impact on the lives of patients and their families, the efficacy of available treatments remains limited and highly unsatisfactory. A major scientific effort is therefore devoted to unravel the neural mechanisms underlying PTSD with the aim of paving the way to developing novel or improved treatment approaches and drugs to treat PTSD. One of the major scientific tools used to gain insight into understanding physiological and neuronal mechanisms underlying diseases and for treatment development is the use of animal models of human diseases. While much progress has been made using these models in understanding mechanisms of conditioned fear and fear memory, the gained knowledge has not yet led to better treatment options for PTSD patients. This poor translational outcome has already led some scientists and pharmaceutical companies, who do not in general hold opinions against animal models, to propose that those models should be abandoned. Here, we critically examine aspects of animal models of PTSD that may have contributed to the relative lack of translatability, including the focus on the exposure to trauma, overlooking individual and sex differences, and the contribution of risk factors. Based on findings from recent years, we propose research-based modifications that we believe are required in order to overcome some of the shortcomings of previous practice. These modifications include the usage of animal models of PTSD which incorporate risk factors and of the behavioral profiling analysis of individuals in a sample. These modifications are aimed to address factors such as individual predisposition and resilience, thus taking into consideration the fact that only a fraction of individuals exposed to trauma develop PTSD. We suggest that with an appropriate shift of practice, animal models are not only a valuable tool to enhance our understanding of fear and memory processes, but could serve as effective platforms for understanding PTSD, for PTSD drug development and drug testing.
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Affiliation(s)
- Gal Richter-Levin
- Sagol Department of Neurobiology, University of Haifa, Haifa, Israel. .,The Integrated Brain and Behavior Research Center (IBBR), University of Haifa, Haifa, Israel. .,Psychology Department, University of Haifa, Haifa, Israel.
| | - Oliver Stork
- 0000 0001 1018 4307grid.5807.aDepartment of Genetics & Molecular Neurobiology, Institute of Biology, Otto-von-Guericke-University Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany ,grid.452320.2Center for Behavioral Brain Sciences, Universitätsplatz 2, 39106 Magdeburg, Germany
| | - Mathias V. Schmidt
- 0000 0000 9497 5095grid.419548.5Department of Stress Neurobiology and Neurogenetics, Max Planck Institute of Psychiatry, Munich, Germany
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Paul MA, Love RJ, Jetly R, Richardson JD, Lanius RA, Miller JC, MacDonald M, Rhind SG. Blunted Nocturnal Salivary Melatonin Secretion Profiles in Military-Related Posttraumatic Stress Disorder. Front Psychiatry 2019; 10:882. [PMID: 31866882 PMCID: PMC6910089 DOI: 10.3389/fpsyt.2019.00882] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 11/08/2019] [Indexed: 12/16/2022] Open
Abstract
Background: Sleep disturbances are a hallmark of posttraumatic stress disorder (PTSD), yet few studies have evaluated the role of dysregulated endogenous melatonin secretion in this condition. Methods: This study compared the sleep quality and nocturnal salivary melatonin profiles of Canadian Armed Forces (CAF) personnel diagnosed with PTSD, using the Clinician Administered PTSD Scale (CAPS score ≥50), with two healthy CAF control groups; comprising, a "light control" (LC) group with standardized evening light exposure and "normal control" (NC) group without light restriction. Participants were monitored for 1-week using wrist actigraphy to assess sleep quality, and 24-h salivary melatonin levels were measured (every 2h) by immunoassay on the penultimate day in a dim-light (< 5 lux) laboratory environment. Results: A repeated measures design showed that mean nocturnal melatonin concentrations for LC were higher than both NC (p = .03) and PTSD (p = .003) with no difference between PTSD and NC. Relative to PTSD, NC had significantly higher melatonin levels over a 4-h period (01 to 05 h), whereas the LC group had higher melatonin levels over an 8-h period (23 to 07 h). Actigraphic sleep quality parameters were not different between healthy controls and PTSD patients, likely due to the use of prescription sleep medications in the PTSD group. Conclusions: These results indicate that PTSD is associated with blunted nocturnal melatonin secretion, which is consistent with previous findings showing lower melatonin after exposure to trauma and suggestive of severe chronodisruption. Future studies targeting the melatonergic system for therapeutic intervention may be beneficial for treatment-resistant PTSD.
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Affiliation(s)
- Michel A Paul
- Defence Research & Development Canada, Toronto Research Centre, Operational Health and Performance Section, Toronto, ON, Canada
| | - Ryan J Love
- Defence Research & Development Canada, Toronto Research Centre, Operational Health and Performance Section, Toronto, ON, Canada
| | - Rakesh Jetly
- Directorate of Mental Health, Canadian Forces Health Services, Ottawa, ON, Canada
| | - J Donald Richardson
- Department of Psychiatry, Western University, London, ON, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.,Operational Stress Injury Clinic, Parkwood Institute, London, ON, Canada.,MacDonald Franklin Operational Stress Injury Research Centre, Lawson Research Institute, London, ON, Canada
| | - Ruth A Lanius
- Department of Psychiatry, Western University, London, ON, Canada.,Department of Neuroscience, Western University, London, ON, Canada
| | - James C Miller
- Department of Life Sciences, Texas A&M University Corpus Christi, Corpus Christi, TX, United States
| | - Michael MacDonald
- Directorate of Mental Health, Canadian Forces Health Services, Ottawa, ON, Canada
| | - Shawn G Rhind
- Defence Research & Development Canada, Toronto Research Centre, Operational Health and Performance Section, Toronto, ON, Canada
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Wang M, Duan F, Wu J, Min Q, Huang Q, Luo M, He Z. Effect of cyclooxygenase‑2 inhibition on the development of post‑traumatic stress disorder in rats. Mol Med Rep 2018; 17:4925-4932. [PMID: 29393449 PMCID: PMC5865951 DOI: 10.3892/mmr.2018.8525] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 09/18/2017] [Indexed: 12/25/2022] Open
Abstract
Post‑traumatic stress disorder (PTSD) is characterized by re‑experiencing of a traumatic event, avoidance of trauma‑associated stimulation, general changes in mood and cognition, and hyper arousal symptoms. Cyclooxygenase is involved in the production of prostaglandins and thromboxanes, and its inducible form cyclooxygenase‑2(COX‑2), an important mediator of cell injury in inflammation, is primarily expressed in leukocytes and brain cells. The present study investigated the expression of COX‑2 in the hippocampi of rats with PTSD and evaluated the effect of COX‑2 inhibition on PTSD. Adult male Wistar rats were randomly divided into three groups: Control (n=20), PTSD (n=20) and intervention group (PTSD+COX‑2 inhibitor treatment, n=20). The expression of COX‑2 was detected by immunohistochemistry, reverse transcription‑quantitative polymerase chain reaction and western blotting. Terminal deoxynucleotidyl transferase mediated dUTP nick end labeling staining was used to observe the apoptosis of rat hippocampal neurons. Tumor necrosis factor α (TNF‑α), interleukin (IL)‑6 and prostaglandin E2 (PGE2) levels were analyzed by ELISA. Nitric oxide (NO) was detected using the Griess test. The behavioral and cognitive function of rats in the PTSD group was significantly decreased compared with the control group, while the behavioral and cognitive function of rats in the intervention group were improved. The COX‑2 mRNA and protein expression levels in hippocampi of rats in the PTSD group were higher than in the control and intervention group. The apoptosis of hippocampus in rats with PTSD was significantly increased compared with the control group and following treatment with COX‑2 inhibitor, apoptosis was decreased. In addition, compared with the control group and intervention group, the levels of TNF‑α, IL‑6, PGE2 and NO in hippocampi of rats were increased in the PTSD group. The present study indicated that COX‑2 may be involved in the pathogenesis of PTSD, and inhibition of its expression serves a neuroprotective role in hippocampi of PTSD rats.
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Affiliation(s)
- Mengyang Wang
- Department of Neurosurgery, Wuhan No. 1 Hospital, Wuhan, Hubei 430022, P.R. China
| | - Faliang Duan
- Department of Neurosurgery, Wuhan No. 1 Hospital, Wuhan, Hubei 430022, P.R. China
| | - Jinglei Wu
- Department of Neurosurgery, Wuhan No. 1 Hospital, Wuhan, Hubei 430022, P.R. China
| | - Qiang Min
- Department of Neurosurgery, Wuhan No. 1 Hospital, Wuhan, Hubei 430022, P.R. China
| | - Qiaochun Huang
- Department of Neurosurgery, Wuhan No. 1 Hospital, Wuhan, Hubei 430022, P.R. China
| | - Ming Luo
- Department of Neurosurgery, Wuhan No. 1 Hospital, Wuhan, Hubei 430022, P.R. China
| | - Zhuqiang He
- Department of Neurosurgery, Wuhan No. 1 Hospital, Wuhan, Hubei 430022, P.R. China
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An overview of posttraumatic stress disorder genetic studies by analyzing and integrating genetic data into genetic database PTSDgene. Neurosci Biobehav Rev 2017; 83:647-656. [DOI: 10.1016/j.neubiorev.2017.08.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 07/08/2017] [Accepted: 08/30/2017] [Indexed: 01/08/2023]
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11
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van de Schoot R, Schalken N, Olff M. Systematic search of Bayesian statistics in the field of psychotraumatology. Eur J Psychotraumatol 2017; 8:1375339. [PMID: 29152158 PMCID: PMC5678372 DOI: 10.1080/20008198.2017.1375339] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Rens van de Schoot
- Department of Methods and Statistics, Utrecht University, The Netherlands
- Optentia Research Program, Faculty of Humanities, North-West University, South Africa
| | - Naomi Schalken
- Department of Methods and Statistics, Utrecht University, The Netherlands
| | - Miranda Olff
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, The Netherlands
- Arq Psychotrauma Expert Group, Diemen, The Netherlands
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12
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Parnell N, Rye K, Greenberg N. Health and well-being management in the military: a systematic review of genetic studies. J ROY ARMY MED CORPS 2017; 164:302-308. [PMID: 28939699 DOI: 10.1136/jramc-2017-000765] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 07/04/2017] [Accepted: 07/04/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Genetic research may have therapeutic value for mental and physical disorders and could have an indicative or preventative capacity. Little is known about the extent, form and utility of military-specific genetic research. METHOD A systematic review was conducted to evaluate existing genetic well-being studies of service personnel. The review specifically aimed to ascertain the current state of knowledge and feasibility of using genetics to aid recruitment and health management within military populations. Databases searched included MEDLINE, Embase, PsycINFO and Web of Science for relevant studies. Papers were rated using a genetics-specific quality assessment framework. RESULTS Ten papers were included within the final review, with seven mental-health-focused and three physical-health-focused genetic studies found within military populations. Eight papers considered candidate genes, one gene expression and one study was an outline of a future study of significant interest. Genetic commonalties were derived to yield shared physiological pathways. The 10 reviewed papers revealed moderate quality based on quality assessment. CONCLUSIONS Current genetic research within military populations is limited. Further studies on genetics, cost effectiveness, ethics and continual monitoring need to be explored before considering any movement toward clinical translation.
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Affiliation(s)
- Nathan Parnell
- King's Centre for Military Health Research, King's College London, London, UK
| | - K Rye
- King's Centre for Military Health Research, King's College London, London, UK
| | - N Greenberg
- Academic Department for Military Mental Health, King's College London, London, UK
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13
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Nedic Erjavec G, Konjevod M, Nikolac Perkovic M, Svob Strac D, Tudor L, Barbas C, Grune T, Zarkovic N, Pivac N. Short overview on metabolomic approach and redox changes in psychiatric disorders. Redox Biol 2017; 14:178-186. [PMID: 28942195 PMCID: PMC5609866 DOI: 10.1016/j.redox.2017.09.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 08/30/2017] [Accepted: 09/05/2017] [Indexed: 12/12/2022] Open
Abstract
Schizophrenia, depression and posttraumatic stress disorder (PTSD) are severe mental disorders and complicated diagnostic entities, due to their phenotypic, biological and genetic heterogeneity, unknown etiology, and poorly understood alterations in biological pathways and biological mechanisms. Disturbed homeostasis between overproduction of oxidant species, overcoming redox regulation and a lack of cellular antioxidant defenses, resulting in free radical-mediated pathology and subsequent neurotoxicity contributes to development of depression, schizophrenia and PTSD, their heterogeneous clinical presentation and resistance to treatment. Metabolomics is a discipline that combines different strategies with the aim to extract, detect, identify and quantify all metabolites that are present in a biological sample and might provide mechanistic insights into the etiology of various psychiatric disorders. Therefore, oxidative stress research combined with metabolomics might offer a novel approach in dissecting psychiatric disorders, since these data-driven but not necessarily hypothesis-driven methods might identify new targets, molecules and pathways responsible for development of schizophrenia, depression or PTSD. Findings from the oxidative research in psychiatry together with metabolomics data might facilitate development of specific and validated prognostic, therapeutic and clinical biomarkers. These methods might reveal bio-signatures of individual patients, leading to individualized treatment approach. In reviewing findings related to oxidative stress and metabolomics in selected psychiatric disorders, we have highlighted how these novel approaches might make a unique contribution to deeper understanding of psychopathological alterations underlying schizophrenia, depression and PTSD.
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Affiliation(s)
- Gordana Nedic Erjavec
- Rudjer Boskovic Institute, Division of Molecular Medicine, Laborattory for Molecular Neuropsychiatry, Zagreb, Croatia; The Centre of Metabolomics and Bioanalysis (CEMBIO) at thte Pharmacy Faculty, University San Pablo CEU, Madrid, Spain
| | - Marcela Konjevod
- Rudjer Boskovic Institute, Division of Molecular Medicine, Laborattory for Molecular Neuropsychiatry, Zagreb, Croatia
| | - Matea Nikolac Perkovic
- Rudjer Boskovic Institute, Division of Molecular Medicine, Laborattory for Molecular Neuropsychiatry, Zagreb, Croatia
| | - Dubravka Svob Strac
- Rudjer Boskovic Institute, Division of Molecular Medicine, Laborattory for Molecular Neuropsychiatry, Zagreb, Croatia
| | - Lucija Tudor
- Rudjer Boskovic Institute, Division of Molecular Medicine, Laborattory for Molecular Neuropsychiatry, Zagreb, Croatia
| | - Coral Barbas
- The Centre of Metabolomics and Bioanalysis (CEMBIO) at thte Pharmacy Faculty, University San Pablo CEU, Madrid, Spain
| | - Tilman Grune
- German Institute of Human Nutrition, Potsdam-Rehbruecke, Nuthetal, Germany
| | - Neven Zarkovic
- Rudjer Boskovic Institute, Division of Molecular Medicine, Laboratory for Oxidative Stress, Zagreb, Croatia
| | - Nela Pivac
- Rudjer Boskovic Institute, Division of Molecular Medicine, Laborattory for Molecular Neuropsychiatry, Zagreb, Croatia.
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14
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DiGangi JA, Burkhouse KL, Aase DM, Babione JM, Schroth C, Kennedy AE, Greenstein JE, Proescher E, Phan KL. An electrocortical investigation of emotional face processing in military-related posttraumatic stress disorder. J Psychiatr Res 2017; 92:132-138. [PMID: 28433950 DOI: 10.1016/j.jpsychires.2017.03.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 03/09/2017] [Accepted: 03/17/2017] [Indexed: 01/01/2023]
Abstract
PTSD is a disorder of emotion dysregulation. Although much work has intended to elucidate the neural underpinnings of the disorder, much remains unknown about the neurobiological substrates of emotion dysregulation in PTSD. In order to assess the relationship between a neural measure of attention to emotion (i.e. the late positive potential; LPP) and PTSD symptoms, EEG was recorded and examined as a potential predictor of military-related PTSD symptoms in a sample of 73 OEF/OIF/OND veterans. Results revealed that higher PTSD symptoms were related to an attenuated LPP response to angry facial expressions. This finding was not observed for happy or fearful faces. The current study provides initial evidence that, in a relatively young, mostly male sample of OEF/OIF/OND veterans, hyporeactivity to angry faces at the neural level may provide phenotypic data to characterize individual differences in PTSD symptom severity. This work may assist in future studies that seek to examine useful psychophysiologic targets for treatment and early interventions.
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Affiliation(s)
- Julia A DiGangi
- Mental Health Service Line, Jesse Brown VA Medical Center, 820 S. Damen Ave., Chicago, IL 60612, United States; Department of Psychiatry, University of Illinois at Chicago, 1747 Roosevelt Road, Chicago, IL 60608, United States.
| | - Katie L Burkhouse
- Department of Psychiatry, University of Illinois at Chicago, 1747 Roosevelt Road, Chicago, IL 60608, United States
| | - Darrin M Aase
- Mental Health Service Line, Jesse Brown VA Medical Center, 820 S. Damen Ave., Chicago, IL 60612, United States; Department of Psychiatry, University of Illinois at Chicago, 1747 Roosevelt Road, Chicago, IL 60608, United States; College of Health & Human Services, Governors State University, 1 University Parkway, University Park, IL 60484, United States
| | - Joseph M Babione
- Mental Health Service Line, Jesse Brown VA Medical Center, 820 S. Damen Ave., Chicago, IL 60612, United States
| | - Christopher Schroth
- Mental Health Service Line, Jesse Brown VA Medical Center, 820 S. Damen Ave., Chicago, IL 60612, United States; Department of Psychiatry, University of Illinois at Chicago, 1747 Roosevelt Road, Chicago, IL 60608, United States
| | - Amy E Kennedy
- Mental Health Service Line, Jesse Brown VA Medical Center, 820 S. Damen Ave., Chicago, IL 60612, United States; Department of Psychiatry, University of Illinois at Chicago, 1747 Roosevelt Road, Chicago, IL 60608, United States
| | - Justin E Greenstein
- Mental Health Service Line, Jesse Brown VA Medical Center, 820 S. Damen Ave., Chicago, IL 60612, United States; Department of Psychiatry, University of Illinois at Chicago, 1747 Roosevelt Road, Chicago, IL 60608, United States
| | - Eric Proescher
- Mental Health Service Line, Jesse Brown VA Medical Center, 820 S. Damen Ave., Chicago, IL 60612, United States; Department of Psychiatry, University of Illinois at Chicago, 1747 Roosevelt Road, Chicago, IL 60608, United States
| | - K Luan Phan
- Mental Health Service Line, Jesse Brown VA Medical Center, 820 S. Damen Ave., Chicago, IL 60612, United States; Department of Psychiatry, University of Illinois at Chicago, 1747 Roosevelt Road, Chicago, IL 60608, United States; Departments of Psychology, Anatomy and Cell Biology, University of Illinois at Chicago, 808 S. Wood St., Chicago, IL 60612, United States
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15
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Martin CG, Kim H, Yun S, Livingston W, Fetta J, Mysliwiec V, Baxter T, Gill JM. Circulating miRNA associated with posttraumatic stress disorder in a cohort of military combat veterans. Psychiatry Res 2017; 251:261-265. [PMID: 28222310 PMCID: PMC6065100 DOI: 10.1016/j.psychres.2017.01.081] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 12/12/2016] [Accepted: 01/28/2017] [Indexed: 01/03/2023]
Abstract
Posttraumatic stress disorder (PTSD) affects many returning combat veterans, but underlying biological mechanisms remain unclear. In order to compare circulating micro RNA (miRNA) of combat veterans with and without PTSD, peripheral blood from 24 subjects was collected following deployment, and isolated miRNA was sequenced. PTSD was associated with 8 differentially expressed miRNA. Pathway analysis shows that PTSD is related to the axon guidance and Wnt signaling pathways, which work together to support neuronal development through regulation of growth cones. PTSD is associated with miRNAs that regulate biological functions including neuronal activities, suggesting that they play a role in PTSD symptomatology.
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Affiliation(s)
- Christiana G Martin
- National Institutes of Nursing Research, National Institutes of Health, 10 Center Drive, Bethesda, MD 20892, USA.
| | - Hyungsuk Kim
- National Institutes of Nursing Research, National Institutes of Health, 10 Center Drive, Bethesda, MD 20892, USA
| | | | - Whitney Livingston
- National Institutes of Nursing Research, National Institutes of Health, 10 Center Drive, Bethesda, MD 20892, USA
| | - Joseph Fetta
- National Institutes of Nursing Research, National Institutes of Health, 10 Center Drive, Bethesda, MD 20892, USA
| | - Vincent Mysliwiec
- Madigan Army Medical Center, 9040A Fitzsimmons Avenue, Tacoma, WA 98431, USA
| | - Tristin Baxter
- Madigan Army Medical Center, 9040A Fitzsimmons Avenue, Tacoma, WA 98431, USA
| | - Jessica M Gill
- National Institutes of Nursing Research, National Institutes of Health, 10 Center Drive, Bethesda, MD 20892, USA.
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16
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Vermetten E, Baker DG, Jetly R, McFarlane AC. Concerns Over Divergent Approaches in the Diagnostics of Posttraumatic Stress Disorder. Psychiatr Ann 2016. [DOI: 10.3928/00485713-20160728-02] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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17
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Abstract
Post-traumatic stress disorder (PTSD) occurs in 5-10% of the population and is twice as common in women as in men. Although trauma exposure is the precipitating event for PTSD to develop, biological and psychosocial risk factors are increasingly viewed as predictors of symptom onset, severity and chronicity. PTSD affects multiple biological systems, such as brain circuitry and neurochemistry, and cellular, immune, endocrine and metabolic function. Treatment approaches involve a combination of medications and psychotherapy, with psychotherapy overall showing greatest efficacy. Studies of PTSD pathophysiology initially focused on the psychophysiology and neurobiology of stress responses, and the acquisition and the extinction of fear memories. However, increasing emphasis is being placed on identifying factors that explain individual differences in responses to trauma and promotion of resilience, such as genetic and social factors, brain developmental processes, cumulative biological and psychological effects of early childhood and other stressful lifetime events. The field of PTSD is currently challenged by fluctuations in diagnostic criteria, which have implications for epidemiological, biological, genetic and treatment studies. However, the advent of new biological methodologies offers the possibility of large-scale approaches to heterogeneous and genetically complex brain disorders, and provides optimism that individualized approaches to diagnosis and treatment will be discovered.
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18
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Michopoulos V, Norrholm SD, Jovanovic T. Diagnostic Biomarkers for Posttraumatic Stress Disorder: Promising Horizons from Translational Neuroscience Research. Biol Psychiatry 2015; 78:344-53. [PMID: 25727177 PMCID: PMC4520791 DOI: 10.1016/j.biopsych.2015.01.005] [Citation(s) in RCA: 135] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 01/07/2015] [Accepted: 01/15/2015] [Indexed: 02/07/2023]
Abstract
Posttraumatic stress disorder (PTSD) is a heterogeneous disorder that affects individuals exposed to trauma (e.g., combat, interpersonal violence, and natural disasters). Although its diagnostic features have been recently reclassified with the emergence of the Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition, the disorder remains characterized by hyperarousal, intrusive reminders of the trauma, avoidance of trauma-related cues, and negative cognition and mood. This heterogeneity indicates the presence of multiple neurobiological mechanisms underlying the etiology and maintenance of PTSD. Translational research spanning the past few decades has revealed several potential avenues for the identification of diagnostic biomarkers for PTSD. These include, but are not limited to, monoaminergic transmitter systems, the hypothalamic-pituitary-adrenal axis, metabolic hormonal pathways, inflammatory mechanisms, psychophysiological reactivity, and neural circuits. The current review provides an update to the literature with regard to the most promising putative PTSD biomarkers, with specific emphasis on the interaction between neurobiological influences on disease risk and symptom progression. Such biomarkers will most likely be identified by multi-dimensional models derived from comprehensive descriptions of molecular, neurobiological, behavioral, and clinical phenotypes.
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Affiliation(s)
- Vasiliki Michopoulos
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta; Yerkes National Primate Research Center, Atlanta
| | - Seth Davin Norrholm
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta; Atlanta Veterans Affairs Medical Center, Mental Health Service Line, Decatur, Georgia
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta.
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19
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Yehuda R, Vermetten E, McFarlane AC, Lehrner A. PTSD in the military: special considerations for understanding prevalence, pathophysiology and treatment following deployment. Eur J Psychotraumatol 2014; 5:25322. [PMID: 25206950 PMCID: PMC4138707 DOI: 10.3402/ejpt.v5.25322] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/29/2014] [Indexed: 11/29/2022] Open
Abstract
Given the unique context of warzone engagement, which may include chronic threat, multiple and lengthy deployments, and loss, there is a need to understand whether and to what extent knowledge about PTSD derived from studies of civilian trauma exposure is generalizeable to the military. This special issue on PTSD in the military addresses a range of issues and debates related to mental health in military personnel and combat veterans. This article provides an overview of the issues covered in selected contributions that have been assembled for a special volume to consider issues unique to the military. Several leading scholars and military experts have contributed papers regarding: 1) prevalence rates of PTSD and other post-deployment mental health problems in different NATO countries, 2) the search for biomarkers of PTSD and the potential applications of such findings, and 3) prevention and intervention approaches for service members and veterans. The volume includes studies that highlight the divergence in prevalence rates of PTSD and other post-deployment mental health problems across nations and that discuss potential causes and implications. Included studies also provide an overview of research conducted in military or Veteran's Affairs settings, and overarching reviews of military-wide approaches to research, promotion of resilience, and mental health interventions in the Unites States and across NATO and allied ISAF partners.
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Affiliation(s)
- Rachel Yehuda
- James. J. Peters Veterans Affairs Medical Center, New York, NY, USA ; Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Eric Vermetten
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands ; Arq Psychotrauma Expert Group, Diemen, The Netherlands ; Military Mental Health Research, Department of Defense, Utrecht, The Netherlands
| | - Alexander C McFarlane
- Centre for Traumatic Stress Studies, The University of Adelaide, Adelaide, South Australia, Australia
| | - Amy Lehrner
- James. J. Peters Veterans Affairs Medical Center, New York, NY, USA
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