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Al Jowf GI, Ahmed ZT, Reijnders RA, de Nijs L, Eijssen LMT. To Predict, Prevent, and Manage Post-Traumatic Stress Disorder (PTSD): A Review of Pathophysiology, Treatment, and Biomarkers. Int J Mol Sci 2023; 24:ijms24065238. [PMID: 36982313 PMCID: PMC10049301 DOI: 10.3390/ijms24065238] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/28/2023] [Accepted: 03/07/2023] [Indexed: 03/11/2023] Open
Abstract
Post-traumatic stress disorder (PTSD) can become a chronic and severely disabling condition resulting in a reduced quality of life and increased economic burden. The disorder is directly related to exposure to a traumatic event, e.g., a real or threatened injury, death, or sexual assault. Extensive research has been done on the neurobiological alterations underlying the disorder and its related phenotypes, revealing brain circuit disruption, neurotransmitter dysregulation, and hypothalamic–pituitary–adrenal (HPA) axis dysfunction. Psychotherapy remains the first-line treatment option for PTSD given its good efficacy, although pharmacotherapy can also be used as a stand-alone or in combination with psychotherapy. In order to reduce the prevalence and burden of the disorder, multilevel models of prevention have been developed to detect the disorder as early as possible and to reduce morbidity in those with established diseases. Despite the clinical grounds of diagnosis, attention is increasing to the discovery of reliable biomarkers that can predict susceptibility, aid diagnosis, or monitor treatment. Several potential biomarkers have been linked with pathophysiological changes related to PTSD, encouraging further research to identify actionable targets. This review highlights the current literature regarding the pathophysiology, disease development models, treatment modalities, and preventive models from a public health perspective, and discusses the current state of biomarker research.
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Affiliation(s)
- Ghazi I. Al Jowf
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, 6200 MD Maastricht, The Netherlands
- Department of Public Health, College of Applied Medical Sciences, King Faisal University, Al-Ahsa 31982, Saudi Arabia
- European Graduate School of Neuroscience, Maastricht University, 6200 MD Maastricht, The Netherlands
- Correspondence: (G.I.A.J.); (L.M.T.E.)
| | - Ziyad T. Ahmed
- College of Medicine, Sulaiman Al Rajhi University, Al-Bukairyah 52726, Saudi Arabia
| | - Rick A. Reijnders
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, 6200 MD Maastricht, The Netherlands
- European Graduate School of Neuroscience, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Laurence de Nijs
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, 6200 MD Maastricht, The Netherlands
- European Graduate School of Neuroscience, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Lars M. T. Eijssen
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, 6200 MD Maastricht, The Netherlands
- European Graduate School of Neuroscience, Maastricht University, 6200 MD Maastricht, The Netherlands
- Department of Bioinformatics—BiGCaT, School of Nutrition and Translational Research in Metabolism (NUTRIM), Faculty of Health, Medicine and Life Sciences, Maastricht University, 6200 MD Maastricht, The Netherlands
- Correspondence: (G.I.A.J.); (L.M.T.E.)
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Comparative Data for the Morel Emotional Numbing Test: High False-Positive Rate in Older Bona-Fide Neurological Patients. PSYCHOLOGICAL INJURY & LAW 2023. [DOI: 10.1007/s12207-023-09470-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Pachet AK, Malcolm DN, Liu I, Brown C, Vanderveen S, Tan A. Classification of performance validity and symptom validity using the Trauma Symptom Inventory-2. APPLIED NEUROPSYCHOLOGY. ADULT 2022:1-8. [PMID: 36377630 DOI: 10.1080/23279095.2022.2141632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Trauma Symptom Inventory-Second Edition (TSI-2) is garnering research interest as a symptom validity test in the evaluation of trauma-related disorders. However, there has been limited empirical validation of its validity scales in clinical and forensic real-world settings. This study evaluated the ability of the TSI-2 Atypical Response (ATR) scale to discriminate response bias in cognitive performance and symptom reporting in a large sample of disability and compensation-seeking claimants. This retrospective chart review included 296 adults with a known history of trauma exposure or claimed trauma-related psychological injury who underwent neuropsychological and/or comprehensive psychological assessment in a private neuropsychology clinic. The discriminability of the ATR scale to classify credible versus non-credible cognitive profiles and symptom reporting were analyzed by AUC-ROCs. Overall, the ATR scale demonstrated poor discriminability of assessment validity based on the Word Memory Test, Victoria Symptom Validity Test, and Minnesota Multiphasic Personality Inventory-2-Restructured Form. The ATR scale had fair discriminatory ability of only one of the over-reporting scales (F-r), with an ROC area of .73, p = .001. However, the test publisher's proposed ATR cut-offs of ≥8 for screening, research, and normal groups, and ≥15 in forensic and clinical settings revealed significant issues with sensitivity and specificity. These results suggest that the TSI-2 should be paired with other established performance validity and symptom validity tests in clinical assessments and not be used as the primary or sole indicator of assessment validity.
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Affiliation(s)
- Arlin K Pachet
- Pachet Assessment and Rehabilitation, Calgary, Canada
- University of Calgary, Calgary, Canada
| | | | - Irene Liu
- Pachet Assessment and Rehabilitation, Calgary, Canada
- Alberta Health Services, Calgary, Canada
| | | | | | - Aiko Tan
- Pachet Assessment and Rehabilitation, Calgary, Canada
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Kertzman S, Vainder M, Spivak B, Goclaw Y, Markman U, Weizman A, Kupchik M. Over-Reporting of Somatic and Psychiatric PTSD Symptoms Among People Who Experienced Motor Vehicle Accidents and Did Not Seek Psychiatric Help in a Primary Care Setting. Psychol Res Behav Manag 2022; 15:1347-1357. [PMID: 35669110 PMCID: PMC9165651 DOI: 10.2147/prbm.s340965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 04/20/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Semion Kertzman
- The Beer-Ya’akov/Ness Ziona Mental Health Center, Beer-Ya’akov, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Correspondence: Semion Kertzman, Forensic Psychiatry Department, Beer-Yakov Mental Health Center, P.O. Box 1, Beer-Yakov, 70350, Israel, Tel +972-8-9776151, Fax +972-8-9776142, Email
| | | | - Baruch Spivak
- The Beer-Ya’akov/Ness Ziona Mental Health Center, Beer-Ya’akov, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yosi Goclaw
- The Beer-Ya’akov/Ness Ziona Mental Health Center, Beer-Ya’akov, Israel
| | - Uri Markman
- The Abarbanel Mental Health Center, Bat Yam, Israel
| | - Abraham Weizman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Research Unit, Geha Mental Health Center, Petach Tikva, Israel
- Felsenstein Medical Research Center, Petach Tikva, Israel
| | - Marina Kupchik
- The Beer-Ya’akov/Ness Ziona Mental Health Center, Beer-Ya’akov, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Abstract
Psychological trauma has developed into a very common concept in the scientific community, in mental health care, as well as in popular language and mass media. The purpose of this article is to show the relevance of the discipline of traumatic stress studies to the field of public mental health by examining central concepts and findings concerning trauma and its aftermath and examining implications for public mental health. Attention is paid to the diagnosis of posttraumatic stress disorder (PTSD) and the construct of resilience as well as to specific areas of public mental health activities. A public mental health perspective will help to develop preventive approaches to trauma and extend the impact of various forms of interventions. It will also make clear that trauma care will have to consider the community and the society at large.
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Affiliation(s)
- Rolf J. Kleber
- Utrecht University, Utrecht, Netherlands
- Arq Psychotrauma Expert Group, Diemen, Netherlands
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Brewin CR, Cloitre M, Hyland P, Shevlin M, Maercker A, Bryant RA, Humayun A, Jones LM, Kagee A, Rousseau C, Somasundaram D, Suzuki Y, Wessely S, van Ommeren M, Reed GM. A review of current evidence regarding the ICD-11 proposals for diagnosing PTSD and complex PTSD. Clin Psychol Rev 2017; 58:1-15. [PMID: 29029837 DOI: 10.1016/j.cpr.2017.09.001] [Citation(s) in RCA: 323] [Impact Index Per Article: 46.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 07/18/2017] [Accepted: 09/05/2017] [Indexed: 11/27/2022]
Abstract
The World Health Organization's proposals for posttraumatic stress disorder (PTSD) in the 11th edition of the International Classification of Diseases, scheduled for release in 2018, involve a very brief set of symptoms and a distinction between two sibling disorders, PTSD and Complex PTSD. This review of studies conducted to test the validity and implications of the diagnostic proposals generally supports the proposed 3-factor structure of PTSD symptoms, the 6-factor structure of Complex PTSD symptoms, and the distinction between PTSD and Complex PTSD. Estimates derived from DSM-based items suggest the likely prevalence of ICD-11 PTSD in adults is lower than ICD-10 PTSD and lower than DSM-IV or DSM-5 PTSD, but this may change with the development of items that directly measure the ICD-11 re-experiencing requirement. Preliminary evidence suggests the prevalence of ICD-11 PTSD in community samples of children and adolescents is similar to DSM-IV and DSM-5. ICD-11 PTSD detects some individuals with significant impairment who would not receive a diagnosis under DSM-IV or DSM-5. ICD-11 CPTSD identifies a distinct group who have more often experienced multiple and sustained traumas and have greater functional impairment than those with PTSD.
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Affiliation(s)
- Chris R Brewin
- Department of Clinical, Educational and Health Psychology, University College London, London, UK.
| | - Marylène Cloitre
- Division of Dissemination and Training, National Center for PTSD, Menlo Park, CA, USA
| | - Philip Hyland
- School of Business, National College of Ireland, Dublin, Ireland
| | - Mark Shevlin
- School of Psychology, University of Ulster, Coleraine, North Ireland
| | - Andreas Maercker
- Department of Psychology, Division of Psychopathology, University of Zurich, Switzerland
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, Australia
| | | | - Lynne M Jones
- FXB Center for Health and Human Rights, Harvard School of Public Health, Harvard University, Cambridge, MA, USA
| | - Ashraf Kagee
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Cécile Rousseau
- Department of Psychiatry, McGill University Health Center, Montreal, Canada
| | | | - Yuriko Suzuki
- National Center of Neurology and Psychiatry, National Institute of Mental Health, Tokyo, Japan
| | | | - Mark van Ommeren
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Geoffrey M Reed
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland; Global Mental Health Program, Columbia University Medical Center, New York, NY, USA
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Should Posttraumatic Stress Be a Disorder or a Specifier? Towards Improved Nosology Within the DSM Categorical Classification System. Curr Psychiatry Rep 2017; 19:66. [PMID: 28808897 DOI: 10.1007/s11920-017-0821-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE OF REVIEW Since 1980, posttraumatic stress (PTS) disorder has been controversial because of its origin as a social construct, its discriminating trauma definition, and the Procrustean array of symptoms/clusters chosen for inclusion/exclusion. This review summarizes the history of trauma-related nosology and proposed changes, within current categorical models (trauma definitions, symptoms/clusters, subtypes/specifiers, disorders) and new models. RECENT FINDINGS Considering that trauma is a risk factor for virtually all mental disorders (particularly depressive, anxiety, dissociative, personality), the multi-finality of trauma (some survivors are resilient, and some develop PTS and/or non-PTS symptoms), and the various symptoms that trauma survivors express (mood, cognitive, perceptual, somatic), it is difficult to classify PTS. Because the human mind best comprehends categories, reliable classification generally necessitates using a categorical nosology but PTS defies categories (internalizing and/or externalizing, fear-based and/or numbing symptoms), the authors conclude that PTS-like DSM-5's panic attacks specifier-is currently best conceptualized as a specifier for other mental disorders.
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van den Berg LJM, Tollenaar MS, Spinhoven P, Penninx BWJH, Elzinga BM. A new perspective on PTSD symptoms after traumatic vs stressful life events and the role of gender. Eur J Psychotraumatol 2017; 8:1380470. [PMID: 29435199 PMCID: PMC5800737 DOI: 10.1080/20008198.2017.1380470] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 07/17/2017] [Indexed: 11/13/2022] Open
Abstract
Background: There is an ongoing debate about the validity of the A1 criterion of PTSD. Whereas the DSM-5 has opted for a more stringent A1 criterion, the ICD-11 will leave it out as a key criterion. Objective: Here we investigated whether formal DSM-IV-TR traumatic (A1) and stressful (non-A1) events differ with regard to PTSD symptom profiles, and whether there is a gender difference in this respect. Method: This was examined in a large, mostly clinical sample from the Netherlands Study of Depression and Anxiety (n = 1433). Participants described their most bothersome (index) event and were assigned to either an A1 or non-A1 event group according to this index event. Results: Remarkably, in men PTSD symptoms were even more severe after non-A1 than A1 events, whereas in women symptoms were equally severe after non-A1 and A1 events. Moreover, while women showed significantly higher PTSD symptoms after A1 events than men (29.9 versus 15.4% met PTSD criteria), there was no gender difference after non-A1 events (women: 28.2%; men: 31.3%). Furthermore, anxiety and perceived impact were higher in women than men, which was associated with PTSD symptom severity. Conclusion: In sum, while women showed similar levels of PTSD symptoms after both event types, men reported even higher levels of PTSD symptoms after non-A1 than A1 events. These findings shed a new light on the role of gender in PTSD symptomatology and the clinical usefulness of the A1 criterion.
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Affiliation(s)
- Lisa J M van den Berg
- Institute of Psychology, Clinical Psychology Unit, Leiden University, Leiden, The Netherlands
| | - Marieke S Tollenaar
- Institute of Psychology, Clinical Psychology Unit, Leiden University, Leiden, The Netherlands
| | - Philip Spinhoven
- Institute of Psychology, Clinical Psychology Unit, Leiden University, Leiden, The Netherlands
| | - Brenda W J H Penninx
- Department of Psychiatry/EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Bernet M Elzinga
- Institute of Psychology, Clinical Psychology Unit, Leiden University, Leiden, The Netherlands
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Abstract
The first part of the series of three articles on posttraumatic stress disorder (PTSD) in Court to appear in the journal reviews the history of the construct of PTSD and its presentation in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; American Psychiatric Association, 2013) and the ICD-11 (International Classification of Diseases, 11th Edition; World Health Organization, 2018). There are 20 symptoms of PTSD in the DSM-5. PTSD symptoms are arranged into a four-cluster model, which has received partial support in the literature. Other four-factor models have been found that fit the data even better than that of the DSM-5. There is a five-factor dysphoria model and two six-factor models that have been found to fit better the DSM-5 PTSD symptoms. Finally, research is providing support for a hybrid seven-factor model. An eighth factor on dissociation seems applicable to the minority of people who express the dissociative subtype. At the epidemiological level, individuals can expect trauma exposure to take place about 70% over one's lifetime. Also, traumatic exposure leads to traumatic reactions in about 10% of cases, with PTSD being a primary diagnosis for trauma. Once initiated, PTSD becomes prolonged in about 10% of cases. Polytrauma and comorbidities complicate these prevalence statistics. Moreover, the possibility of malingered PTSD presents confounds. However, the estimate for malingered PTSD varies extensively, from 1 to 50%, so that the estimate is too imprecise for use in court without further research. This first article in the series of three articles appearing in the journal on PTSD in Court concludes with discussion of complications related to comorbidities and heterogeneities, in particular. For example, PTSD and its comorbidities can be expressed in over one quintillion ways. This complexity in its current structure in the DSM-5 speaks to the individual differences involved in its expression.
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Affiliation(s)
- Gerald Young
- Glendon Campus, York University, Toronto, Ontario, Canada.
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