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Natraj N, Neylan TC, Yack LM, Metzler TJ, Woodward SH, Hubachek SQ, Dukes C, Udupa NS, Mathalon DH, Richards A. Sleep Spindles Favor Emotion Regulation Over Memory Consolidation of Stressors in Posttraumatic Stress Disorder. Biol Psychiatry Cogn Neurosci Neuroimaging 2023; 8:899-908. [PMID: 36889539 DOI: 10.1016/j.bpsc.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is a trauma-induced condition, characterized by intrusive memories and trauma-associated anxiety. Non-rapid eye movement (NREM) sleep spindles might play a crucial role in learning and consolidating declarative stressor information. However, sleep and possibly sleep spindles are also known to regulate anxiety, suggestive of a dual role for sleep spindles in the processing of stressors. Specifically, in individuals with high PTSD symptom burden, spindles might fail to regulate anxiety levels after exposure and instead might maladaptively consolidate stressor information. METHODS To disentangle the role of spindles in declarative memory versus anxiety regulation after stressor exposure and to examine the role of PTSD in these processes, we measured nap sleep after a cohort of 45 trauma-exposed participants were exposed to laboratory stress. Participants (high vs. low PTSD symptoms) completed 2 visits: a stress visit involving exposure to negatively valent images before nap and a control visit. In both visits, sleep was monitored via electroencephalography. A stressor recall session occurred after the nap in the stress visit. RESULTS Stage 2 NREM (NREM2) spindle rates were higher in stress versus control sleep, indicative of stress-induced changes in spindles. In participants with high PTSD symptoms, NREM2 spindle rates in stress sleep predicted poorer recall accuracy of stressor images relative to participants with low PTSD symptoms, while correlating with greater reduction in stressor-induced anxiety levels after sleep. CONCLUSIONS Contrary to our expectations, although spindles are known to play a role in declarative memory processes, our findings highlight an important role for spindles in sleep-dependent anxiety regulation in PTSD.
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Affiliation(s)
- Nikhilesh Natraj
- Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California; Department of Veterans Affairs San Francisco Health Care System, San Francisco, California
| | - Thomas C Neylan
- Department of Veterans Affairs San Francisco Health Care System, San Francisco, California; Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California
| | - Leslie M Yack
- Department of Veterans Affairs San Francisco Health Care System, San Francisco, California; Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California
| | - Thomas J Metzler
- Department of Veterans Affairs San Francisco Health Care System, San Francisco, California
| | - Steven H Woodward
- Veterans Administration National Center for PTSD, Department of Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Samantha Q Hubachek
- Department of Veterans Affairs San Francisco Health Care System, San Francisco, California; Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California
| | - Cassandra Dukes
- Department of Veterans Affairs San Francisco Health Care System, San Francisco, California; Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California
| | - Nikhila S Udupa
- Department of Veterans Affairs San Francisco Health Care System, San Francisco, California; Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California
| | - Daniel H Mathalon
- Department of Veterans Affairs San Francisco Health Care System, San Francisco, California; Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California
| | - Anne Richards
- Department of Veterans Affairs San Francisco Health Care System, San Francisco, California; Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California.
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Richards A, Woodward SH, Baquirin DPG, Yack LM, Metzler TJ, Udupa NS, Staggs EJ, Neylan TC. The sleep physiology of nightmares in veterans with psychological trauma: Evaluation of a dominant model using participant-applied electroencephalography in the home environment. J Sleep Res 2023; 32:e13639. [PMID: 35644523 DOI: 10.1111/jsr.13639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/25/2022] [Accepted: 05/02/2022] [Indexed: 11/27/2022]
Abstract
Nightmares are a core feature of posttraumatic stress disorder, are poorly understood, and are associated with serious negative outcomes. Their biology has been difficult to study, and the feasibility of capturing them in the naturalistic home environment has been poor. This said, the published research and dominant scientific model has focused on nightmares as a manifestation of noradrenergic hyperarousal during rapid eye movement sleep. The current study used at-home, participant-applied devices to measure nightmare physiology in posttraumatic stress disorder treatment-seeking veterans, by examining heartrate measures as indicators of noradrenergic tone, and sleep-stage characteristics and stability in the sleep preceding time-stamped nightmare awakenings. Our data indicate the high feasibility of participant-administered, at-home measurement, and showed an unexpected stability of -rapid eye movement sleep along with no evidence of heartrate elevations in sleep preceding nightmare awakenings. Altogether, these data highlight new opportunities for the study of nightmares while questioning the sufficiency of dominant models, which to date are largely theoretically based.
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Affiliation(s)
- Anne Richards
- University of California San Francisco, and San Francisco VA Healthcare System, San Francisco, California, USA
| | - Steven H Woodward
- University of California San Francisco, and San Francisco VA Healthcare System, San Francisco, California, USA
| | - David Paul G Baquirin
- University of California San Francisco, and San Francisco VA Healthcare System, San Francisco, California, USA
| | - Leslie M Yack
- University of California San Francisco, and San Francisco VA Healthcare System, San Francisco, California, USA
| | - Thomas J Metzler
- University of California San Francisco, and San Francisco VA Healthcare System, San Francisco, California, USA
| | - Nikhila S Udupa
- University of California San Francisco, and San Francisco VA Healthcare System, San Francisco, California, USA
| | - Emily J Staggs
- University of California San Francisco, and San Francisco VA Healthcare System, San Francisco, California, USA
| | - Thomas C Neylan
- University of California San Francisco, and San Francisco VA Healthcare System, San Francisco, California, USA
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Bartholomew ME, Rozalski V, Richards A, Gurdock J, Thornton M, Fee C, Lipshitz SL, Metzler TJ, Neylan TC, Inslicht SS. Impact of hormonal contraceptives on sex differences in fear conditioning and fear extinction in PTSD. Learn Mem 2022; 29:332-339. [PMID: 36206397 PMCID: PMC9488024 DOI: 10.1101/lm.053597.122] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/19/2022] [Indexed: 11/29/2022]
Abstract
Sex differences in the neurobiological mechanisms involved in fear conditioning and extinction have been suggested to contribute to differential vulnerability for the development of posttraumatic stress disorder (PTSD) in women compared with men. Reproductive hormones, such as estradiol, have been shown to facilitate fear conditioning and extinction learning and may explain some of these differences. However, the effect of commonly used hormonal contraceptives on the neurobiological mechanisms of fear conditioning and extinction is poorly understood. A laboratory study was conducted in trauma-exposed men and women with and without full or partial PTSD to examine effects of sex and use of hormonal birth control on fear conditioning, fear extinction learning, and extinction retention. Participants underwent fear conditioning with stimuli that were paired (CS+) or unpaired (CS−) with shock. Extinction learning occurred 72 h later, and extinction retention was tested 1 wk after extinction. Women on hormonal contraceptives (HCs) demonstrated enhanced acquisition of fear conditioning and enhanced extinction of fear as compared with women off hormonal birth control and men. While clinical implications have yet to be determined, these results suggest that hormonal contraceptives may facilitate learning during both fear acquisition and extinction. Understanding the impact of sex and hormones on fear conditioning and extinction processes may lead to new insights into the pathophysiology of PTSD and result in advancements in treatment that may vary by sex.
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Ranney RM, Gloria R, Metzler TJ, Huggins J, Neylan TC, Maguen S. Brief behavioral treatment for insomnia decreases trauma-related nightmare frequency in veterans. J Clin Sleep Med 2022; 18:1831-1839. [PMID: 35393934 DOI: 10.5664/jcsm.10002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Trauma-related nightmares are highly prevalent among veterans and are associated with higher severity insomnia and PTSD. Cognitive behavioral therapy for insomnia (CBT-I, typically 6-8 sessions) has been shown to reduce trauma-related nightmares. Brief behavioral treatment for insomnia (BBTI, 4 sessions) has been found to be comparable to CBT-I in decreasing insomnia severity; however, the effects of BBTI on nightmares have not been investigated. The current study tested the effects of BBTI on both trauma-related nightmares and non-trauma-related bad dreams using an active control group, progressive muscle relaxation therapy (PMRT). Additionally, we tested whether baseline trauma-related nightmare frequency and baseline non-trauma-related bad dream frequency moderated changes in insomnia severity. METHODS Participants were 91 military veterans with insomnia disorder randomized to BBTI or PMRT. Participants reported insomnia severity on the Insomnia Severity Index and reported trauma-related nightmare frequency and non-trauma-related bad dream frequency on the Pittsburgh Sleep Quality Index--PTSD Addendum. RESULTS We found that BBTI significantly reduced trauma-related nightmares from baseline to post-treatment while PMRT did not. However, reductions in trauma-related nightmares were not maintained at six month follow up. Neither BBTI nor PMRT reduced non-trauma-related bad dreams from baseline to post-treatment. We also found that neither baseline trauma-related nightmare frequency nor baseline non-trauma-related bad dream frequency moderated changes in insomnia symptom severity. CONCLUSIONS Findings from the current study suggest that BBTI may help to reduce trauma-related nightmares. Further research is needed to better understand potential mechanisms underlying how improved sleep may reduce trauma-related nightmares. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: Brief Behavioral Insomnia Treatment Study (BBTI); Identifier: NCT02571452; URL: https://clinicaltrials.gov/ct2/show/NCT02571452.
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Affiliation(s)
- Rachel M Ranney
- Veterans Affairs San Francisco Health Care System, San Francisco, CA.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco School of Medicine, San Francisco, CA.,Sierra Pacific Mental Illness Research Education, and Clinical Center, San Francisco, CA
| | - Rebecca Gloria
- Veterans Affairs San Francisco Health Care System, San Francisco, CA
| | - Thomas J Metzler
- Veterans Affairs San Francisco Health Care System, San Francisco, CA.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco School of Medicine, San Francisco, CA.,Sierra Pacific Mental Illness Research Education, and Clinical Center, San Francisco, CA
| | - Joy Huggins
- Veterans Affairs San Francisco Health Care System, San Francisco, CA
| | - Thomas C Neylan
- Veterans Affairs San Francisco Health Care System, San Francisco, CA.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco School of Medicine, San Francisco, CA.,Sierra Pacific Mental Illness Research Education, and Clinical Center, San Francisco, CA
| | - Shira Maguen
- Veterans Affairs San Francisco Health Care System, San Francisco, CA.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco School of Medicine, San Francisco, CA.,Sierra Pacific Mental Illness Research Education, and Clinical Center, San Francisco, CA
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Richards A, Inslicht SS, Yack LM, Metzler TJ, Huie JR, Straus LD, Dukes C, Hubachek SQ, Felmingham KL, Mathalon DH, Woodward SH, Neylan TC. The Relationship of Fear-Potentiated Startle and Polysomnography-Measured Sleep in Trauma-Exposed Men and Women with and without PTSD: Testing REM Sleep Effects and Exploring the Roles of an Integrative Measure of Sleep, PTSD Symptoms, and Biological Sex. Sleep 2021; 45:6430783. [PMID: 34792165 DOI: 10.1093/sleep/zsab271] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 10/06/2021] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES Published research indicates that sleep is involved in emotional information processing. Using a fear-potentiated startle (FPS) and nap sleep protocol, we examined the relationship of emotional learning with REM sleep (REMS) in trauma-exposed participants. We also explored the roles of PTSD symptoms, biological sex, and an integrative measure of polysomnography-measured (PSG) sleep in the learning-sleep relationship. METHODS After an adaptation nap, participants (N=46) completed 2 more visits (counterbalanced): a stress-condition visit, which included FPS conditioning procedures prior to a nap and assessment of learning retention and fear extinction training after the nap, and a control visit, which included a nap opportunity without stressful procedures. FPS conditioning included a "fear" visual stimulus paired with an air blast to the neck and a "safety" visual stimulus never paired with an air blast. Retention and extinction involved presentation of the visual stimuli without the air blast. Primary analyses examined the relationship between FPS responses pre- and post- sleep with stress-condition REMS duration, controlling for control-nap REMS duration. RESULTS Higher safety learning predicted increased REMS and increased REMS predicted more rapid extinction learning. Similar relationships were observed with an integrative PSG sleep measure. They also showed unexpected effects of PTSD symptoms on learning and showed biological sex effects on learning-sleep relationships. CONCLUSIONS Findings support evidence of a relationship between adaptive emotional learning and REMS. They underscore the importance of examining sex effects in sleep-learning relationships. They introduce an integrative PSG sleep measure with potential relevance to studies of sleep and subjective and biological outcomes.
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Affiliation(s)
- Anne Richards
- University of California, San Francisco, and San Francisco VA Medical Center (SFVAMC), San Francisco, CA, 94121, USA
| | - Sabra S Inslicht
- University of California, San Francisco, and San Francisco VA Medical Center (SFVAMC), San Francisco, CA, 94121, USA
| | - Leslie M Yack
- San Francisco VA Medical Center, San Francisco, CA, 94121, USA
| | | | - J Russell Huie
- University of California, San Francisco, and San Francisco VA Medical Center (SFVAMC), San Francisco, CA, 94121, USA
| | - Laura D Straus
- San Francisco VA Medical Center, San Francisco, CA, 94121, USA
| | - Cassandra Dukes
- San Francisco VA Medical Center, San Francisco, CA, 94121, USA
| | | | | | - Daniel H Mathalon
- University of California, San Francisco, and San Francisco VA Medical Center (SFVAMC), San Francisco, CA, 94121, USA
| | - Steven H Woodward
- National Center for PTSD and VA Palo Alto Health Care System, Palo Alto, CA 94304, USA
| | - Thomas C Neylan
- University of California, San Francisco, and San Francisco VA Medical Center (SFVAMC), San Francisco, CA, 94121, USA
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Cakmak AS, Alday EAP, Da Poian G, Rad AB, Metzler TJ, Neylan TC, House SL, Beaudoin FL, An X, Stevens JS, Zeng D, Linnstaedt SD, Jovanovic T, Germine LT, Bollen KA, Rauch SL, Lewandowski CA, Hendry PL, Sheikh S, Storrow AB, Musey PI, Haran JP, Jones CW, Punches BE, Swor RA, Gentile NT, McGrath ME, Seamon MJ, Mohiuddin K, Chang AM, Pearson C, Domeier RM, Bruce SE, O'Neil BJ, Rathlev NK, Sanchez LD, Pietrzak RH, Joormann J, Barch DM, Pizzagalli DA, Harte SE, Elliott JM, Kessler RC, Koenen KC, Ressler KJ, Mclean SA, Li Q, Clifford GD. Classification and Prediction of Post-Trauma Outcomes Related to PTSD Using Circadian Rhythm Changes Measured via Wrist-Worn Research Watch in a Large Longitudinal Cohort. IEEE J Biomed Health Inform 2021; 25:2866-2876. [PMID: 33481725 PMCID: PMC8395207 DOI: 10.1109/jbhi.2021.3053909] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Post-Traumatic Stress Disorder (PTSD) is a psychiatric condition resulting from threatening or horrifying events. We hypothesized that circadian rhythm changes, measured by a wrist-worn research watch are predictive of post-trauma outcomes. APPROACH 1618 post-trauma patients were enrolled after admission to emergency departments (ED). Three standardized questionnaires were administered at week eight to measure post-trauma outcomes related to PTSD, sleep disturbance, and pain interference with daily life. Pulse activity and movement data were captured from a research watch for eight weeks. Standard and novel movement and cardiovascular metrics that reflect circadian rhythms were derived using this data. These features were used to train different classifiers to predict the three outcomes derived from week-eight surveys. Clinical surveys administered at ED were also used as features in the baseline models. RESULTS The highest cross-validated performance of research watch-based features was achieved for classifying participants with pain interference by a logistic regression model, with an area under the receiver operating characteristic curve (AUC) of 0.70. The ED survey-based model achieved an AUC of 0.77, and the fusion of research watch and ED survey metrics improved the AUC to 0.79. SIGNIFICANCE This work represents the first attempt to predict and classify post-trauma symptoms from passive wearable data using machine learning approaches that leverage the circadian desynchrony in a potential PTSD population.
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Maguen S, Gloria R, Huggins J, Goldstein LA, Kanady JC, Straus LD, Metzler TJ, Lujan C, Neylan TC. Brief behavioral treatment for insomnia improves psychosocial functioning in veterans: results from a randomized controlled trial. Sleep 2021; 44:5918478. [PMID: 33022048 DOI: 10.1093/sleep/zsaa205] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/28/2020] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES Our goal was to compare brief behavioral treatment for insomnia (BBTI) to a progressive muscle relaxation training (PMRT) control condition among veterans with insomnia, examining psychosocial functioning as a primary outcome and sleep-related outcomes, mood, cognition, and pain as secondary outcomes. METHODS Veterans were randomly assigned to either BBTI or PMRT (N = 91; 24-74 years; M = 49 years). BBTI consisted of two in-person (60-min and 30-min sessions) and two telephone sessions (20-min each), and the PMRT control condition was matched to BBTI for session duration and type. Veterans were assessed through clinical interview at baseline and self-report measures at pre-, mid-, and posttreatment, as well as 6-month follow-up for the BBTI condition to assess sustained response. Measures also included continuous sleep monitoring with sleep diary. RESULTS Intent-to-treat analyses demonstrated that individuals who completed BBTI versus PMRT reported greater improvements in work, home, social and cognitive functioning, insomnia symptom severity, mood, and energy. Improvements in psychosocial functioning, insomnia symptoms, and mood were maintained 6-months following BBTI treatment completion. CONCLUSIONS Veterans who received BBTI improved and maintained gains in psychosocial functioning, insomnia, and mood. BBTI is a treatment that can be implemented in primary care, mental health, or integrated care settings and provide symptom relief and improved functioning among those with insomnia, one of the most commonly reported mental health problems among veterans. CLINICAL TRIAL REGISTRATION NCT02571452.
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Affiliation(s)
- Shira Maguen
- San Francisco Veterans Affairs Health Care System, San Francisco, CA.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA.,Sierra Pacific Mental Illness Research Education, and Clinical Center, San Francisco, CA
| | - Rebecca Gloria
- San Francisco Veterans Affairs Health Care System, San Francisco, CA
| | - Joy Huggins
- San Francisco Veterans Affairs Health Care System, San Francisco, CA
| | - Lizabeth A Goldstein
- San Francisco Veterans Affairs Health Care System, San Francisco, CA.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA.,Sierra Pacific Mental Illness Research Education, and Clinical Center, San Francisco, CA
| | - Jennifer C Kanady
- San Francisco Veterans Affairs Health Care System, San Francisco, CA.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA.,Sierra Pacific Mental Illness Research Education, and Clinical Center, San Francisco, CA
| | - Laura D Straus
- San Francisco Veterans Affairs Health Care System, San Francisco, CA.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA.,Sierra Pacific Mental Illness Research Education, and Clinical Center, San Francisco, CA
| | - Thomas J Metzler
- San Francisco Veterans Affairs Health Care System, San Francisco, CA.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA.,Sierra Pacific Mental Illness Research Education, and Clinical Center, San Francisco, CA
| | - Callan Lujan
- San Francisco Veterans Affairs Health Care System, San Francisco, CA.,Department of Psychology, Washington State University, Pullman, WA
| | - Thomas C Neylan
- San Francisco Veterans Affairs Health Care System, San Francisco, CA.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA.,Sierra Pacific Mental Illness Research Education, and Clinical Center, San Francisco, CA
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Chao LL, Kanady JC, Crocker N, Straus LD, Hlavin J, Metzler TJ, Maguen S, Neylan TC. Cognitive behavioral therapy for insomnia in veterans with gulf war illness: Results from a randomized controlled trial. Life Sci 2021; 279:119147. [PMID: 33549595 PMCID: PMC8217272 DOI: 10.1016/j.lfs.2021.119147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/15/2021] [Accepted: 01/24/2021] [Indexed: 01/08/2023]
Abstract
Aims: To examine whether cognitive behavioral therapy for insomnia (CBT-I), delivered by telephone, improves sleep and non-sleep symptoms of Gulf War Illness (GWI). Main methods: Eighty-five Gulf War veterans (21 women, mean age: 54 years, range 46–72 years) who met the Kansas GWI case definition, the Centers for Disease Control and Prevention (CDC) case definition for Chronic Multisymptom Illness (CMI), and research diagnostic criteria for insomnia disorder were randomly assigned to CBT-I or monitor-only wait list control. Eight weekly sessions of individual CBT-I were administered via telephone by Ph.D. level psychologists to study participants. Outcome measures included pre-, mid-, and post-treatment assessments of GWI and insomnia symptoms, subjective sleep quality, and continuous sleep monitoring with diary. Outcomes were re-assessed 6-months post-treatment in participants randomized to CBT-I. Key findings: Compared to wait list, CBT-I produced significant improvements in overall GWI symptom severity, individual measures of fatigue, cognitive dysfunction, depression and anxiety, insomnia severity, subjective sleep quality, and sleep diary outcome measures. The beneficial effects of CBT-I on overall GWI symptom severity and most individual GWI symptom measures were maintained 6-months after treatment. Significance: GWI symptoms have historically been difficult to treat. Because CBT-I, which is associated with low stigma and is increasingly readily available to veterans, improved both sleep and non-sleep symptoms of GWI, these results suggest that a comprehensive approach to the treatment of GWI should include behavioral sleep interventions.
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Affiliation(s)
- Linda L Chao
- San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, USA; University of California, San Francisco, CA 94143, USA.
| | | | - Nicole Crocker
- San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, USA
| | - Laura D Straus
- San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, USA; University of California, San Francisco, CA 94143, USA; Sierra Pacific Mental Illness Research, Education, and Clinical Center, San Francisco, CA 94121, USA
| | - Jennifer Hlavin
- San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, USA
| | - Thomas J Metzler
- San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, USA; University of California, San Francisco, CA 94143, USA; Sierra Pacific Mental Illness Research, Education, and Clinical Center, San Francisco, CA 94121, USA
| | - Shira Maguen
- San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, USA; University of California, San Francisco, CA 94143, USA; Sierra Pacific Mental Illness Research, Education, and Clinical Center, San Francisco, CA 94121, USA
| | - Thomas C Neylan
- San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, USA; University of California, San Francisco, CA 94143, USA; Sierra Pacific Mental Illness Research, Education, and Clinical Center, San Francisco, CA 94121, USA
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Neylan TC, Richards A, Metzler TJ, Ruoff LM, Varbel J, O’Donovan A, Sivasubramanian M, Motraghi T, Hlavin J, Batki SL, Inslicht SS, Samuelson K, Morairty SR, Kilduff TS. Acute cognitive effects of the hypocretin receptor antagonist almorexant relative to zolpidem and placebo: a randomized clinical trial. Sleep 2020; 43:zsaa080. [PMID: 32303763 PMCID: PMC7551303 DOI: 10.1093/sleep/zsaa080] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 03/06/2020] [Indexed: 12/18/2022] Open
Abstract
STUDY OBJECTIVES Hypnotic medications can adversely affect behavior during unanticipated awakenings during the night. Animals treated with the hypocretin (Hcrt) receptor antagonist almorexant (ALM) have less acute cognitive impairment compared to the GABAA receptor modulator zolpidem (ZOL). This study aimed to determine whether ALM produces less acute cognitive impairment than ZOL in human subjects. METHODS Healthy, young adult, unmedicated male and female subjects participated in a controlled trial of a single dose of ALM 100 mg (N = 48), ALM 200 mg (N = 53), ZOL 10 mg (N = 49), and placebo (PBO, N = 52). RESULTS ZOL and both doses of ALM produced similar levels of subjective sleepiness and impaired the ability of subjects to remain awake in a dark, low-stimulus setting relative to PBO. For most cognitive measures, performance under ZOL was significantly worse than ALM or PBO. For tasks involving verbal memory or visual-motor coordination, ZOL impaired performance, whereas the two doses of ALM were no different than PBO. For tasks involving higher-order executive function, ZOL produced impairment in processing speed and inhibitory control, whereas the two doses of ALM were no different than PBO. Performance decrements for ALM were less than ZOL but greater than PBO for some reaction time measures. CONCLUSIONS The data provide support for the hypothesis that Hcrt receptor antagonists produce less functional impairment than a benzodiazepine receptor agonist (BzRA). These observations are particularly relevant to patients treated with sedative-hypnotics who are at elevated risk for falls and other untoward events during the intended hours for sleep.
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Affiliation(s)
- Thomas C Neylan
- Department of Psychiatry, University of California San Francisco, San Francisco, CA
- San Francisco Veterans Affairs Medical Center, San Francisco, CA
- Sierra-Pacific Mental Illness Research Educational and Clinical Center, Department of Veterans Affairs, Palo Alto, CA
- Department of Neurology, University of California San Francisco, San Francisco, CA
| | - Anne Richards
- Department of Psychiatry, University of California San Francisco, San Francisco, CA
- San Francisco Veterans Affairs Medical Center, San Francisco, CA
- Sierra-Pacific Mental Illness Research Educational and Clinical Center, Department of Veterans Affairs, Palo Alto, CA
| | - Thomas J Metzler
- Department of Psychiatry, University of California San Francisco, San Francisco, CA
- San Francisco Veterans Affairs Medical Center, San Francisco, CA
- Sierra-Pacific Mental Illness Research Educational and Clinical Center, Department of Veterans Affairs, Palo Alto, CA
| | - Leslie M Ruoff
- Department of Psychiatry, University of California San Francisco, San Francisco, CA
- San Francisco Veterans Affairs Medical Center, San Francisco, CA
- Sierra-Pacific Mental Illness Research Educational and Clinical Center, Department of Veterans Affairs, Palo Alto, CA
| | - Jonathan Varbel
- Department of Psychiatry, University of California San Francisco, San Francisco, CA
- San Francisco Veterans Affairs Medical Center, San Francisco, CA
- Sierra-Pacific Mental Illness Research Educational and Clinical Center, Department of Veterans Affairs, Palo Alto, CA
| | - Aoife O’Donovan
- Department of Psychiatry, University of California San Francisco, San Francisco, CA
- San Francisco Veterans Affairs Medical Center, San Francisco, CA
- Sierra-Pacific Mental Illness Research Educational and Clinical Center, Department of Veterans Affairs, Palo Alto, CA
| | - Melinda Sivasubramanian
- Department of Psychiatry, University of California San Francisco, San Francisco, CA
- San Francisco Veterans Affairs Medical Center, San Francisco, CA
- Sierra-Pacific Mental Illness Research Educational and Clinical Center, Department of Veterans Affairs, Palo Alto, CA
| | - Terri Motraghi
- Department of Psychiatry, University of California San Francisco, San Francisco, CA
- San Francisco Veterans Affairs Medical Center, San Francisco, CA
- Sierra-Pacific Mental Illness Research Educational and Clinical Center, Department of Veterans Affairs, Palo Alto, CA
| | - Jennifer Hlavin
- Department of Psychiatry, University of California San Francisco, San Francisco, CA
- San Francisco Veterans Affairs Medical Center, San Francisco, CA
- Sierra-Pacific Mental Illness Research Educational and Clinical Center, Department of Veterans Affairs, Palo Alto, CA
| | - Steven L Batki
- Department of Psychiatry, University of California San Francisco, San Francisco, CA
- San Francisco Veterans Affairs Medical Center, San Francisco, CA
- Sierra-Pacific Mental Illness Research Educational and Clinical Center, Department of Veterans Affairs, Palo Alto, CA
| | - Sabra S Inslicht
- Department of Psychiatry, University of California San Francisco, San Francisco, CA
- San Francisco Veterans Affairs Medical Center, San Francisco, CA
- Sierra-Pacific Mental Illness Research Educational and Clinical Center, Department of Veterans Affairs, Palo Alto, CA
| | - Kristin Samuelson
- Department of Psychiatry, University of California San Francisco, San Francisco, CA
- San Francisco Veterans Affairs Medical Center, San Francisco, CA
- Sierra-Pacific Mental Illness Research Educational and Clinical Center, Department of Veterans Affairs, Palo Alto, CA
- Department of Psychology, University of Colorado, Colorado Springs, CO
| | - Stephen R Morairty
- Center for Neuroscience, Biosciences Division, SRI International, Menlo Park, CA
| | - Thomas S Kilduff
- Center for Neuroscience, Biosciences Division, SRI International, Menlo Park, CA
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10
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Armstrong K, Underhill J, Epstein K, Metzler TJ, Sendowski TD, O'Connor A, Norona JC, Ihle EC. Looking into the One-way Mirror: A Pilot Study on the Impact of Reflecting Teams on Family Members. Fam Process 2019; 58:819-831. [PMID: 30152013 DOI: 10.1111/famp.12386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Reflecting Teams (RTs) are an internationally recognized clinical consultation methodology, first developed by Tom Andersen in 1985. Over the last three decades, family therapists around the world have used RTs to enhance treatment. However, this innovation to family therapy practice is not well-standardized nor evaluated. The pilot study described in this article is an attempt to expand on the previous studies on RTs, and quantitatively examines RTs conducted with family therapy participants at a university medical center psychiatric institute. Preliminary analyses indicate that after participating in a single RT, family members may feel more hopeful, believe they can better support each other in times of stress, have more confidence in working together, and resolve conflicts. Additionally, the analyses suggest that family members may feel better understood and have more ideas about how to have a conversation with their family members, even though, after the RT, they may not view their family differently. These preliminary results suggest that further studies should explore the influence of RTs on family functioning.
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Affiliation(s)
- Keith Armstrong
- San Francisco Department of Veterans Affairs Health Care System, San Francisco, CA
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, CA
| | - Justine Underhill
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, CA
- Edgewood Center for Families and Children, San Francisco, CA
| | - Ken Epstein
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, CA
| | - Thomas J Metzler
- San Francisco Department of Veterans Affairs Health Care System, San Francisco, CA
| | | | - Ashley O'Connor
- Iowa City Department of Veterans Affairs Health Care System, Iowa City, IA
| | - Jerika C Norona
- San Francisco Department of Veterans Affairs Health Care System, San Francisco, CA
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, CA
| | - Eva C Ihle
- Departments of Psychiatry and Pediatrics, University of California, San Francisco, CA
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11
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Richards A, Kanady JC, Huie JR, Straus LD, Inslicht SS, Levihn-Coon A, Metzler TJ, Neylan TC. Work by day and sleep by night, do not sleep too little or too much: Effects of sleep duration, time of day and circadian synchrony on flanker-task performance in internet brain-game users from teens to advanced age. J Sleep Res 2019; 29:e12919. [PMID: 31631467 DOI: 10.1111/jsr.12919] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 07/20/2019] [Accepted: 08/18/2019] [Indexed: 11/28/2022]
Abstract
Research elucidating the effects of sleep and circadian rhythm on cognitive performance is advancing, yet many important questions remain. Using flanker-task performance scores from a large internet sample (N = 48,881) with repeated measures of cognitive performance and linked prior-night self-reported sleep duration, we analysed the relationship between sleep duration, time of day of task performance, and chronotype synchrony with performance in participants aged 15-80 years. Results indicate a performance peak at 7 hr habitual sleep duration, and point to a variable effect of deviation from habitual sleep duration depending on users' habitual sleep duration and age. Time-of-day effects were notable for a steady decline in performance up until 01:00 hours-02:00 hours for the group as a whole, which was accounted for by nighttime deterioration on trials requiring inhibitory executive functioning, particularly in older subjects. Analyses did not demonstrate an advantage for playing in synchrony with self-identified chronotype. Results strengthen findings indicating an inverted U-shaped relationship between sleep duration and cognitive performance across a broad spectrum of age groups. These findings underscore the importance of daytime task performance for tasks requiring inhibitory function, especially in elderly people. Findings highlight the utility of large-scale internet data in contributing to sleep and circadian science.
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Affiliation(s)
- Anne Richards
- University of California, San Francisco, San Francisco, CA, USA.,San Francisco VA Medical Center, San Francisco, CA, USA
| | - Jennifer C Kanady
- University of California, San Francisco, San Francisco, CA, USA.,San Francisco VA Medical Center, San Francisco, CA, USA
| | - John Russell Huie
- University of California, San Francisco, San Francisco, CA, USA.,San Francisco VA Medical Center, San Francisco, CA, USA
| | - Laura D Straus
- University of California, San Francisco, San Francisco, CA, USA.,San Francisco VA Medical Center, San Francisco, CA, USA
| | - Sabra S Inslicht
- University of California, San Francisco, San Francisco, CA, USA.,San Francisco VA Medical Center, San Francisco, CA, USA
| | | | | | - Thomas C Neylan
- University of California, San Francisco, San Francisco, CA, USA.,San Francisco VA Medical Center, San Francisco, CA, USA
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12
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Young DA, Neylan TC, Chao LL, O’Donovan A, Metzler TJ, Inslicht SS. Child abuse interacts with hippocampal and corpus callosum volume on psychophysiological response to startling auditory stimuli in a sample of veterans. J Psychiatr Res 2019; 111:16-23. [PMID: 30660809 PMCID: PMC6467732 DOI: 10.1016/j.jpsychires.2019.01.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 01/05/2019] [Accepted: 01/10/2019] [Indexed: 12/21/2022]
Abstract
Child abuse (CA), which is linked to posttraumatic stress disorder (PTSD), has been associated with a reduction in both hippocampal and corpus callosum (CC) volume. However, few studies have explored these relationships on psychophysiological variables related to trauma exposure. Therefore, we assessed whether the interaction between CA and hippocampal and CC volume were associated with enhanced fear potentiated psychophysiological response patterns in a sample of Veterans. 147 Veteran participants who were part of a larger study of Gulf War Illness were exposed to startling sounds in no, ambiguous, and high threat conditions and also provided MRI data. The Clinician Administered PTSD Scale and Trauma History Questionnaire were used to measure PTSD and CA respectively. Psychophysiological response was measured by EMG, SCR, and heart rate. Repeated-measures mixed linear models were used to assess the significance of CA by neural structure interactions. CA interacted with both hippocampal and CC volume on psychophysiological response magnitudes, where participants with CA and smaller hippocampal volume had greater EMG (p < 0.01) and SCR (p < 0.05) magnitudes across trials and over threat conditions. Participants with CA and smaller CC volume had greater SCR magnitudes across trials and over threat conditions (p < 0.01). Hippocampal and genu volume mediated CA and psychophysiological response magnitude. CA may impact psychophysiological response via a reduction in hippocampal and CC volume. Volumetric reduction in these structures may indicate a neurofunctional, CA-related increase in threat sensitivity, which could portend increased PTSD susceptibility and adverse interpersonal and social consequences across the lifespan.
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Affiliation(s)
- Dmitri A. Young
- San Francisco VA Health Care System, 4150 Clement St. (116P), San Francisco, CA, 94121,
USA,Northern California Institute for Research and Education (NCIRE), The Veterans Health Research
Institute, San Francisco, CA, 94121, USA,Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco,
San Francisco, CA, 94143, USA,Corresponding author. San Francisco Veterans Affairs Medical Center, 4150 Clement St., San
Francisco, CA, 94121, USA.
| | - Thomas C. Neylan
- San Francisco VA Health Care System, 4150 Clement St. (116P), San Francisco, CA, 94121,
USA,Northern California Institute for Research and Education (NCIRE), The Veterans Health Research
Institute, San Francisco, CA, 94121, USA,Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco,
San Francisco, CA, 94143, USA
| | - Linda L. Chao
- San Francisco VA Health Care System, 4150 Clement St. (116P), San Francisco, CA, 94121,
USA,Northern California Institute for Research and Education (NCIRE), The Veterans Health Research
Institute, San Francisco, CA, 94121, USA,Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco,
San Francisco, CA, 94143, USA,Department of Radiology & Biomedical Imaging, University of California San Francisco, San
Francisco, CA, 94143, USA
| | - Aoife O’Donovan
- San Francisco VA Health Care System, 4150 Clement St. (116P), San Francisco, CA, 94121,
USA,Northern California Institute for Research and Education (NCIRE), The Veterans Health Research
Institute, San Francisco, CA, 94121, USA,Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco,
San Francisco, CA, 94143, USA
| | - Thomas J. Metzler
- San Francisco VA Health Care System, 4150 Clement St. (116P), San Francisco, CA, 94121,
USA,Northern California Institute for Research and Education (NCIRE), The Veterans Health Research
Institute, San Francisco, CA, 94121, USA,Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco,
San Francisco, CA, 94143, USA
| | - Sabra S. Inslicht
- San Francisco VA Health Care System, 4150 Clement St. (116P), San Francisco, CA, 94121,
USA,Northern California Institute for Research and Education (NCIRE), The Veterans Health Research
Institute, San Francisco, CA, 94121, USA,Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco,
San Francisco, CA, 94143, USA
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13
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Küffer A, Straus LD, Prather AA, Inslicht SS, Richards A, Shigenaga JK, Madden E, Metzler TJ, Neylan TC, O'Donovan A. Altered overnight levels of pro-inflammatory cytokines in men and women with posttraumatic stress disorder. Psychoneuroendocrinology 2019; 102:114-120. [PMID: 30544002 PMCID: PMC6420348 DOI: 10.1016/j.psyneuen.2018.12.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 11/26/2018] [Accepted: 12/04/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is associated with disturbed sleep and elevated levels of pro-inflammatory cytokines, including interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α). Studies in animals and healthy humans have also shown that disrupted sleep elevates pro-inflammatory cytokines, including IL-6 and TNF-α. A better understanding of overnight cytokine levels and sleep might shed light on possible mechanisms for elevated inflammation in PTSD. Thus, we investigated overnight levels of IL-6 and TNF-α in individuals with and without PTSD while recording sleep polysomnography (PSG). METHOD Serum samples were collected from otherwise healthy, medication-free participants with chronic PTSD (n = 44; 50% female; M age = 30.34 ± 8.11) and matched controls (n = 49; 53% female; M age = 30.53 ± 6.57) during laboratory PSG. Levels of IL-6 and TNF-α were measured at hours 0, 2, 4, 6, and 8 after typical sleep onset time using serial serum samples. Plasma IL-6 and TNF-α levels were quantified using enzyme-linked immunosorbent assays. RESULTS Growth model analysis indicated a significantgroup by time interaction for IL-6 (t[247] = -2.92, p = .005) and a significant group by sex by time interaction for TNF-α (t[275] = 2.02, p = .04). PTSD positive men and women initially had higher IL-6 and TNF-α at sleep onset, but not at the end of their sleep cycle. Men with PTSD showed a peak of TNF-α at the end of the sleep cycle, whereas male control subjects demonstrated an inverted U-shaped profile. There were no significant differences in TNF-α levels overnight between women with and without PTSD. CONCLUSION To our knowledge, this is the largest study to examine IL-6 overnight in a PTSD sample and the first study to examine overnight TNF-α in PTSD. Overnight IL-6 and TNF-α levels may be altered in individuals with PTSD compared to those without PTSD, and TNF-α trajectories also differed by sex. The current findings highlight the need to consider sex, sleep, time of day, and circadian variation when examining inflammation in PTSD. Additional research in broader study samples will be necessary to clarify associations between disrupted sleep, cytokines, and increased risk for disease in PTSD.
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Affiliation(s)
- Andreas Küffer
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA; Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Laura D Straus
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA; Department of Psychiatry, University of California, San Francisco, CA, USA; Mental Illness Research Education and Clinical Centers, San Francisco VA Healthcare System, San Francisco, CA, USA.
| | - Aric A Prather
- Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Sabra S Inslicht
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA; Department of Psychiatry, University of California, San Francisco, CA, USA; Northern California Institute for Research and Education, San Francisco, CA, USA
| | - Anne Richards
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA; Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Judy K Shigenaga
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA; Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Erin Madden
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Thomas J Metzler
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Thomas C Neylan
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA; Department of Psychiatry, University of California, San Francisco, CA, USA; Northern California Institute for Research and Education, San Francisco, CA, USA
| | - Aoife O'Donovan
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA; Department of Psychiatry, University of California, San Francisco, CA, USA; Northern California Institute for Research and Education, San Francisco, CA, USA
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14
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Eswarappa M, Neylan TC, Whooley MA, Metzler TJ, Cohen BE. Inflammation as a predictor of disease course in posttraumatic stress disorder and depression: A prospective analysis from the Mind Your Heart Study. Brain Behav Immun 2019; 75:220-227. [PMID: 30389462 DOI: 10.1016/j.bbi.2018.10.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 10/01/2018] [Accepted: 10/29/2018] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Prior research has focused largely on the pro-inflammatory states of PTSD and depression, with few studies evaluating the direction of inflammation's association with these disorders. To clarify whether inflammation plays a role in the development of PTSD or depression, we assessed the predictive value of inflammatory biomarkers on the courses of these conditions in a cohort of Veterans. METHODS This research was part of the Mind Your Heart Study, a prospective cohort study designed to examine PTSD-related health outcomes. Between 2008 and 2010, 746 San Francisco area Veterans Administration patients were enrolled. At baseline, inflammatory biomarkers were measured from fasting morning venous blood draws, and cortisol and catecholamine levels were measured from 24-hour urine samples. PTSD was diagnosed using the PTSD Checklist at baseline and annual follow-up. Depression was evaluated using the 9-item Patient Health Questionnaire at baseline and follow-up. Ordinal logistic regression models were used to assess the predictive value of baseline biomarker levels on clinically relevant courses of PTSD and depression categorized and ordered as none, resolved, developed, and chronic. RESULTS After adjustment for age and sex, elevated levels of white blood cell count (OR = 1.27(1.10-1.47), p = 0.001), C-reactive protein (OR = 1.20(1.04-1.39), p = 0.02), fibrinogen (OR = 1.19(1.03-1.38), p = 0.02), and ESR (OR = 1.17(1.00-1.36, p = 0.05), and decreased levels of urine cortisol (OR = 0.84(0.71-0.99), p = 0.04) were significant predictors of poorer courses of PTSD. Elevated levels of WBC count (OR = 1.31(1.14-1.50), p < 0.001), CRP (OR = 1.24(1.07-1.43), p = 0.003), fibrinogen (OR = 1.26(1.09-1.46), p = 0.002), and catecholamines (OR = 1.17(1.01-1.36), p = 0.04) were significant predictors of poorer courses of depression. After additionally controlling for physical activity, elevated WBC count (p = 0.002) and decreased levels of urine cortisol (p = 0.05) remained significant predictors of PTSD course, and elevated WBC count (p = 0.001), CRP (p = 0.03), and fibrinogen (p = 0.02) remained significant predictors of depression course. After adjusting for all significant variables, elevated WBC count (p = 0.02) was a significant predictor of a poorer course of PTSD, and elevated WBC count (p = 0.04) and platelet count (p = 0.03) were significant predictors of a poorer course of depression. CONCLUSIONS Increased levels of several inflammatory biomarkers were associated with significantly increased odds of clinically worse courses of PTSD and depression. Inflammation may be a target for prevention and treatment of these mental health disorders.
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Affiliation(s)
| | - Thomas C Neylan
- Department of Psychiatry, University of California, San Francisco, CA, USA; Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Mary A Whooley
- Department of Medicine, University of California, San Francisco, CA, USA; Veterans Affairs Medical Center, San Francisco, CA, USA
| | | | - Beth E Cohen
- Department of Medicine, University of California, San Francisco, CA, USA; Veterans Affairs Medical Center, San Francisco, CA, USA.
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15
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Young DA, Inslicht SS, Metzler TJ, Neylan TC, Ross JA. The effects of early trauma and the FKBP5 gene on PTSD and the HPA axis in a clinical sample of Gulf War veterans. Psychiatry Res 2018; 270:961-966. [PMID: 29576410 DOI: 10.1016/j.psychres.2018.03.037] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 02/01/2018] [Accepted: 03/11/2018] [Indexed: 12/21/2022]
Abstract
Previous research indicates that interactions between FKBP5 single nucleotide polymorphisms (SNPs) and child abuse are associated with posttraumatic stress disorder (PTSD) in adulthood. We examined the relationship between the T-allele of the rs1360780 FKBP5 SNP and child abuse on PTSD and the HPA axis in a clinical sample of Gulf War veterans. Genotyping was completed on 266 veterans and 174 veterans additionally participated in a low dose dexamethasone suppression test (DST). The CAPS was used to determine PTSD status and the THQ was used to determine child abuse operationalized as either childhood physical or sexual abuse. Hierarchical regression models were used to assess FKBP5 × child abuse interactions on PTSD, basal cortisol levels, and post DST cortisol levels. The FKBP5 risk allele and child abuse were separately associated with PTSD diagnosis. The risk allele was also associated with significantly lower cortisol levels at baseline. However, no significant FKBP5 × child abuse interaction on PTSD diagnosis, basal cortisol levels, or greater cortisol suppression was observed. Our results suggest that FKBP5 may be a viable biomarker for PTSD. Nonetheless, further work will be required to reconcile our findings with previous reports of an FKBP5 × child abuse interaction on posttraumatic stress response.
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Affiliation(s)
- Dmitri A Young
- Department of Mental Health, San Francisco Veterans Affairs Medical Center, 4150 Clement St. Bldg. 8., San Francisco, CA 94121, USA; School of Medicine, Department of Psychiatry, University of California, San Francisco, 401 Parnassus Ave. San Francisco, CA 94143, USA.
| | - Sabra S Inslicht
- Department of Mental Health, San Francisco Veterans Affairs Medical Center, 4150 Clement St. Bldg. 8., San Francisco, CA 94121, USA; School of Medicine, Department of Psychiatry, University of California, San Francisco, 401 Parnassus Ave. San Francisco, CA 94143, USA
| | - Thomas J Metzler
- School of Medicine, Department of Psychiatry, University of California, San Francisco, 401 Parnassus Ave. San Francisco, CA 94143, USA
| | - Thomas C Neylan
- Department of Mental Health, San Francisco Veterans Affairs Medical Center, 4150 Clement St. Bldg. 8., San Francisco, CA 94121, USA; School of Medicine, Department of Psychiatry, University of California, San Francisco, 401 Parnassus Ave. San Francisco, CA 94143, USA
| | - Jessica A Ross
- Department of Mental Health, San Francisco Veterans Affairs Medical Center, 4150 Clement St. Bldg. 8., San Francisco, CA 94121, USA
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16
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Young DA, Chao L, Neylan TC, O'Donovan A, Metzler TJ, Inslicht SS. Association among anterior cingulate cortex volume, psychophysiological response, and PTSD diagnosis in a Veteran sample. Neurobiol Learn Mem 2018; 155:189-196. [PMID: 30086395 DOI: 10.1016/j.nlm.2018.08.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 07/11/2018] [Accepted: 08/03/2018] [Indexed: 11/30/2022]
Abstract
Posttraumatic stress disorder (PTSD) is associated with fear response system dysregulation. Research has shown that the anterior cingulate cortex (ACC) may modulate the fear response and that individuals with PTSD have abnormalities in ACC structure and functioning. Our objective was to assess whether ACC volume moderates the relationship between PTSD and fear-potentiated psychophysiological response in a sample of Gulf War Veterans. 142 Veteran participants who were associated with a larger study associated with Gulf War Illness were exposed to no threat, ambiguous threat, and high threat conditions in a fear conditioned startle response paradigm and also provided MRI imaging data. PTSD was assessed using the Clinician Administered PTSD Scale (CAPS). Decreased caudal ACC volume predicted greater psychophysiological responses with a slower habituation of psychophysiological magnitudes across trials (p < 0.001). PTSD diagnosis interacted significantly with both caudal and rostral ACC volumes on psychophysiological response magnitudes, where participants with PTSD and smaller rostral and caudal ACC volumes had greater psychophysiological magnitudes across trials (p < 0.05 and p < 0.001, respectively) and threat conditions (p < 0.05 and p < 0.005). Our results suggest that ACC volume may moderate both threat sensitivity and threat response via impaired habituation in individuals who have been exposed to traumatic events. More research is needed to assess whether ACC size and these associated response patterns are due to neurological processes resulting from trauma exposure or if they are indicative of a premorbid risk for PTSD subsequent to trauma exposure.
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Affiliation(s)
- Dmitri A Young
- San Francisco VA Health Care System, 4150 Clement St. (116P), San Francisco, CA 94121, United States; Northern California Institute for Research and Education (NCIRE), The Veterans Health Research Institute, San Francisco, CA 94121, United States; Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA 94143, United States.
| | - Linda Chao
- San Francisco VA Health Care System, 4150 Clement St. (116P), San Francisco, CA 94121, United States; Northern California Institute for Research and Education (NCIRE), The Veterans Health Research Institute, San Francisco, CA 94121, United States; Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA 94143, United States; Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA 94143, United States
| | - Thomas C Neylan
- San Francisco VA Health Care System, 4150 Clement St. (116P), San Francisco, CA 94121, United States; Northern California Institute for Research and Education (NCIRE), The Veterans Health Research Institute, San Francisco, CA 94121, United States; Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA 94143, United States
| | - Aoife O'Donovan
- San Francisco VA Health Care System, 4150 Clement St. (116P), San Francisco, CA 94121, United States; Northern California Institute for Research and Education (NCIRE), The Veterans Health Research Institute, San Francisco, CA 94121, United States; Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA 94143, United States
| | - Thomas J Metzler
- San Francisco VA Health Care System, 4150 Clement St. (116P), San Francisco, CA 94121, United States; Northern California Institute for Research and Education (NCIRE), The Veterans Health Research Institute, San Francisco, CA 94121, United States; Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA 94143, United States
| | - Sabra S Inslicht
- San Francisco VA Health Care System, 4150 Clement St. (116P), San Francisco, CA 94121, United States; Northern California Institute for Research and Education (NCIRE), The Veterans Health Research Institute, San Francisco, CA 94121, United States; Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA 94143, United States
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17
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Niles AN, Luxenberg A, Neylan TC, Inslicht SS, Richards A, Metzler TJ, Hlavin J, Deng J, O’Donovan A. Effects of Threat Context, Trauma History, and Posttraumatic Stress Disorder Status on Physiological Startle Reactivity in Gulf War Veterans. J Trauma Stress 2018; 31:579-590. [PMID: 30058728 PMCID: PMC6415744 DOI: 10.1002/jts.22302] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 03/21/2018] [Accepted: 03/27/2018] [Indexed: 01/22/2023]
Abstract
In the current study, we explored exaggerated physiological startle responses in posttraumatic stress disorder (PTSD) and examined startle reactivity as a biomarker of PTSD in a large veteran sample. We assessed heart rate (HR), skin conductance (SC), and electromyographic (EMG) startle responses to acoustic stimuli under low-, ambiguous-, and high-threat conditions in Gulf War veterans with current (n = 48), past (n = 42), and no history of PTSD (control group; n = 152). We evaluated PTSD status using the Clinician-Administered PTSD Scale and trauma exposure using the Trauma History Questionnaire. Participants with current PTSD had higher HR, ds = 0.28-0.53; SC, d = 0.37; and startle responses than those with past or no history of PTSD. The HR startle response under ambiguous threat best differentiated current PTSD; however, sensitivity and specificity analyses revealed it to be an imprecise indicator of PTSD status, ROC AUC = .66. Participants with high levels of trauma exposure only showed elevated HR and SC startle reactivity if they had current PTSD. Results indicate that startle is particularly elevated in PTSD when safety signals are available but a possibility of danger remains and when trauma exposure is high. However, startle reactivity alone is unlikely to be a sufficient biomarker of PTSD.
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Affiliation(s)
- Andrea N. Niles
- San Francisco Veterans Affairs Medical Center, San Francisco, California, USA,Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA
| | - Adam Luxenberg
- San Francisco Veterans Affairs Medical Center, San Francisco, California, USA,Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA
| | - Thomas C. Neylan
- San Francisco Veterans Affairs Medical Center, San Francisco, California, USA,Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA
| | - Sabra S. Inslicht
- San Francisco Veterans Affairs Medical Center, San Francisco, California, USA,Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA
| | - Anne Richards
- San Francisco Veterans Affairs Medical Center, San Francisco, California, USA,Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA
| | - Thomas J. Metzler
- San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Jennifer Hlavin
- San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Jersey Deng
- San Francisco Veterans Affairs Medical Center, San Francisco, California, USA,Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA
| | - Aoife O’Donovan
- San Francisco Veterans Affairs Medical Center, San Francisco, California, USA,Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA
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18
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Kanady JC, Talbot LS, Maguen S, Straus LD, Richards A, Ruoff L, Metzler TJ, Neylan TC. Cognitive Behavioral Therapy for Insomnia Reduces Fear of Sleep in Individuals With Posttraumatic Stress Disorder. J Clin Sleep Med 2018; 14:1193-1203. [PMID: 29991428 DOI: 10.5664/jcsm.7224] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 04/12/2018] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Our study aims were to examine (1) the association between fear of sleep and posttraumatic stress disorder (PTSD) symptoms, (2) the association between fear of sleep and subjective and objective insomnia symptoms and disruptive behaviors during sleep, and (3) whether fear of sleep decreases following cognitive behavioral therapy for insomnia (CBT-I). METHODS Forty-five adults with PTSD and insomnia participated in the study. Fear of sleep was assessed using the Fear of Sleep Inventory; PTSD symptoms were assessed using the Clinician Administered PTSD Scale; and sleep disturbance symptoms were assessed using the Insomnia Severity Index, polysomnography, sleep diaries, and the Pittsburgh Sleep Quality Index Addendum for PTSD. Participants were randomly assigned to 8 weeks of CBT-I (n = 29) or a waitlist control condition (n = 16). RESULTS Greater fear of sleep was associated with greater PTSD symptom severity, greater nightmare frequency, and greater hypervigilance intensity. Greater fear of sleep was associated with decreased wake after sleep onset (WASO), reduced total sleep time, and greater disruptive nocturnal behaviors. Following CBT-I, there was a significant reduction in fear of sleep compared to the waitlist condition. These improvements persisted 6 months later. CONCLUSIONS Fear of sleep was related to sleep disturbances specific to trauma rather than "classic" insomnia symptoms. Unexpectedly, greater fear of sleep was associated with reduced WASO. These results may be related to having a truncated sleep period and thus more consolidated sleep. Fear of sleep deceased following CBT-I despite not being a permissible target for this research protocol and not being related to insomnia symptoms. CLINICAL TRIAL REGISTRATION Registry: CinicalTrials.gov; Name: Treating People with Post-traumatic Stress Disorder with Cognitive Behavioral Therapy for Insomnia; Identifier: NCT00881647; URL: https://clinicaltrials.gov/ct2/show/NCT00881647.
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Affiliation(s)
- Jennifer C Kanady
- San Francisco VA Health Care System, San Francisco, California.,Department of Psychiatry, University of California, San Francisco, California.,Mental Illness, Research, Education, and Clinical Center, San Francisco, California
| | - Lisa S Talbot
- San Francisco VA Health Care System, San Francisco, California.,Department of Psychiatry, University of California, San Francisco, California
| | - Shira Maguen
- San Francisco VA Health Care System, San Francisco, California.,Department of Psychiatry, University of California, San Francisco, California
| | - Laura D Straus
- San Francisco VA Health Care System, San Francisco, California.,Department of Psychiatry, University of California, San Francisco, California.,Mental Illness, Research, Education, and Clinical Center, San Francisco, California
| | - Anne Richards
- San Francisco VA Health Care System, San Francisco, California.,Department of Psychiatry, University of California, San Francisco, California
| | - Leslie Ruoff
- San Francisco VA Health Care System, San Francisco, California
| | | | - Thomas C Neylan
- San Francisco VA Health Care System, San Francisco, California.,Department of Psychiatry, University of California, San Francisco, California
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Arenson MB, Whooley MA, Neylan TC, Maguen S, Metzler TJ, Cohen BE. Posttraumatic stress disorder, depression, and suicidal ideation in veterans: Results from the mind your heart study. Psychiatry Res 2018; 265:224-230. [PMID: 29753254 DOI: 10.1016/j.psychres.2018.04.046] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 04/12/2018] [Accepted: 04/12/2018] [Indexed: 01/14/2023]
Abstract
Veterans with PTSD or depression are at increased risk for suicidal ideation. However, few studies have examined that risk in those with comorbid PTSD and depression, instead focusing on these disorders individually. This study investigates the association of suicidal ideation with comorbid PTSD and depression and examines the role of military and psychosocial covariates. We evaluated 746 veterans using the CAPS to assess PTSD and the PHQ-9 to measure depression and suicidal ideation. Covariates were assessed via validated self-report measures. 49% of veterans with comorbid PTSD and depression endorsed suicidal ideation, making them more likely to do so than those with depression alone (34%), PTSD alone (11%), or neither (2%). In multivariate logistic regression models, this association remained significant after controlling for demographics and symptom severity. Anger, hostility, anxiety, alcohol use, optimism and social support did not explain the elevated risk of suicidal ideation in the comorbid group in fully adjusted models. As suicidal ideation is a known risk factor for suicide attempts and completions, veterans with comorbid PTSD and depression represent a vulnerable group who may need more intensive monitoring and treatment to reduce risk of suicide.
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Affiliation(s)
- Melanie B Arenson
- San Francisco VA Medical Center, San Francisco, CA, USA; University of California, San Francisco, San Francisco, CA, USA.
| | - Mary A Whooley
- San Francisco VA Medical Center, San Francisco, CA, USA; University of California, San Francisco, San Francisco, CA, USA
| | - Thomas C Neylan
- San Francisco VA Medical Center, San Francisco, CA, USA; University of California, San Francisco, San Francisco, CA, USA
| | - Shira Maguen
- San Francisco VA Medical Center, San Francisco, CA, USA; University of California, San Francisco, San Francisco, CA, USA
| | - Thomas J Metzler
- San Francisco VA Medical Center, San Francisco, CA, USA; University of California, San Francisco, San Francisco, CA, USA
| | - Beth E Cohen
- San Francisco VA Medical Center, San Francisco, CA, USA; University of California, San Francisco, San Francisco, CA, USA.
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20
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Goldstein LA, Mehling WE, Metzler TJ, Cohen BE, Barnes DE, Choucroun GJ, Silver A, Talbot LS, Maguen S, Hlavin JA, Chesney MA, Neylan TC. Veterans Group Exercise: A randomized pilot trial of an Integrative Exercise program for veterans with posttraumatic stress. J Affect Disord 2018; 227:345-352. [PMID: 29145076 DOI: 10.1016/j.jad.2017.11.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 08/30/2017] [Accepted: 11/02/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is prevalent among military veterans and is associated with significant negative health outcomes. However, stigma and other barriers to care prevent many veterans from pursuing traditional mental health treatment. We developed a group-based Integrative Exercise (IE) program combining aerobic and resistance exercise, which is familiar to veterans, with mindfulness-based practices suited to veterans with PTSD. This study aimed to evaluate the effects of IE on PTSD symptom severity and quality of life, as well as assess the feasibility and acceptability of IE. METHODS Veterans (N = 47) were randomized to either IE or waitlist control (WL). Veterans in IE were asked to attend three 1-h group exercise sessions for 12 weeks. RESULTS Compared with WL, veterans randomized to IE demonstrated a greater reduction in PTSD symptom severity (d = -.90), a greater improvement in psychological quality of life (d = .53) and a smaller relative improvement in physical quality of life (d = .30) Veterans' ratings of IE indicated high feasibility and acceptability. LIMITATIONS The sample was relatively small and recruited from one site. The comparison condition was an inactive control. CONCLUSIONS This initial study suggests that IE is an innovative approach to treating veterans with symptoms of PTSD that reduces symptoms of posttraumatic stress and improves psychological quality of life. This approach to recovery may expand the reach of PTSD treatment into non-traditional settings and to veterans who may prefer a familiar activity, such as exercise, over medication or psychotherapy.
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Affiliation(s)
- Lizabeth A Goldstein
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States; Department of Psychiatry, University of California, San Francisco, CA, United States.
| | - Wolf E Mehling
- Department of Family and Community Medicine, University of California, San Francisco, CA, United States; Osher Center for Integrative Medicine, University of California, San Francisco, CA, United States
| | - Thomas J Metzler
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States; Northern California Institute for Research and Education, San Francisco, CA, United States
| | - Beth E Cohen
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States; Northern California Institute for Research and Education, San Francisco, CA, United States; Department of Medicine, University of California, San Francisco, CA, United States
| | - Deborah E Barnes
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States; Department of Psychiatry, University of California, San Francisco, CA, United States; Northern California Institute for Research and Education, San Francisco, CA, United States; Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, United States
| | - Gerard J Choucroun
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States; Northern California Institute for Research and Education, San Francisco, CA, United States
| | - Aliza Silver
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States; Northern California Institute for Research and Education, San Francisco, CA, United States
| | - Lisa S Talbot
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States; Department of Psychiatry, University of California, San Francisco, CA, United States
| | - Shira Maguen
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States; Department of Psychiatry, University of California, San Francisco, CA, United States; Northern California Institute for Research and Education, San Francisco, CA, United States
| | - Jennifer A Hlavin
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States; Northern California Institute for Research and Education, San Francisco, CA, United States
| | - Margaret A Chesney
- Osher Center for Integrative Medicine, University of California, San Francisco, CA, United States
| | - Thomas C Neylan
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States; Department of Psychiatry, University of California, San Francisco, CA, United States; Northern California Institute for Research and Education, San Francisco, CA, United States
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Inslicht SS, Rao MN, Richards A, O'Donovan A, Gibson CJ, Baum T, Metzler TJ, Neylan TC. Sleep and hypothalamic pituitary adrenal axis responses to metyrapone in posttraumatic stress disorder. Psychoneuroendocrinology 2018; 88:136-143. [PMID: 29268182 PMCID: PMC6170159 DOI: 10.1016/j.psyneuen.2017.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 12/05/2017] [Accepted: 12/05/2017] [Indexed: 11/19/2022]
Abstract
Disturbed sleep is a core feature of posttraumatic stress disorder (PTSD), characterized in part by decreased delta power sleep that may result from stress-related alterations in corticotropin releasing factor (CRF), hypothalamic pituitary adrenal axis (HPA) regulation and glucocorticoid signaling. Overnight HPA axis response mediating sleep disturbances in men and women with PTSD was examined using a metyrapone challenge. Metyrapone blocks cortisol synthesis, removing negative feedback, and increases the release of hypothalamic CRF and pituitary adrenocorticotropic hormone (ACTH). Laboratory-based polysomnography was used to monitor the sleep of 66 medically healthy, medication-free men and pre-menopausal follicular phase women including 33 with chronic PTSD (16 women and 17 men) and 33 age- and sex-matched controls (14 women and 19 men) over 3 consecutive nights. Participants completed an overnight metyrapone challenge after an adaptation and baseline night of sleep and ACTH was obtained by repeated blood sampling. Metyrapone resulted in a greater increase in ACTH and greater decreases in cortisol and delta spectral power sleep in PTSD subjects compared to controls, and a greater increase in ACTH in women compared to men. There was no sex difference in metyrapone effects on delta power sleep, and no significant metyrapone by PTSD by sex interactions with either ACTH or delta power sleep. Regression analyses indicated that a greater increase in ACTH response was associated with a greater decrease in delta power sleep response in PTSD subjects, but no such relationship was found in controls. The PTSD group difference was similar in men and women. These results suggest that stress-related alterations of the HPA axis in PTSD may contribute to sleep difficulties. Therapeutics that target the HPA axis may offer promise as a potential future treatment for PTSD and related sleep difficulties.
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Affiliation(s)
- Sabra S Inslicht
- San Francisco VA Healthcare System, 4150 Clement St. (116P), San Francisco, CA 94121, United States; Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA 94143, United States; Northern California Institute for Research and Education (NCIRE), The Veterans Health Research Institute, San Francisco, CA 94121, United States.
| | - Madhu N Rao
- Department of Medicine, University of California, San Francisco, San Francisco, CA 94143, United States
| | - Anne Richards
- San Francisco VA Healthcare System, 4150 Clement St. (116P), San Francisco, CA 94121, United States; Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA 94143, United States; Northern California Institute for Research and Education (NCIRE), The Veterans Health Research Institute, San Francisco, CA 94121, United States
| | - Aoife O'Donovan
- San Francisco VA Healthcare System, 4150 Clement St. (116P), San Francisco, CA 94121, United States; Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA 94143, United States; Northern California Institute for Research and Education (NCIRE), The Veterans Health Research Institute, San Francisco, CA 94121, United States
| | - Carolyn J Gibson
- San Francisco VA Healthcare System, 4150 Clement St. (116P), San Francisco, CA 94121, United States; Department of Medicine, University of California, San Francisco, San Francisco, CA 94143, United States
| | - Tierney Baum
- Institute of Neurodegenerative Disease, University of California, San Francisco, San Francisco, CA 94158, United States
| | - Thomas J Metzler
- San Francisco VA Healthcare System, 4150 Clement St. (116P), San Francisco, CA 94121, United States; Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA 94143, United States; Northern California Institute for Research and Education (NCIRE), The Veterans Health Research Institute, San Francisco, CA 94121, United States
| | - Thomas C Neylan
- San Francisco VA Healthcare System, 4150 Clement St. (116P), San Francisco, CA 94121, United States; Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA 94143, United States; Northern California Institute for Research and Education (NCIRE), The Veterans Health Research Institute, San Francisco, CA 94121, United States
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Richards A, Inslicht SS, Metzler TJ, Mohlenhoff BS, Rao MN, O'Donovan A, Neylan TC. Sleep and Cognitive Performance From Teens To Old Age: More Is Not Better. Sleep 2017; 40:2972132. [PMID: 28364476 DOI: 10.1093/sleep/zsw029] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2017] [Indexed: 11/14/2022] Open
Abstract
Objectives To determine the interaction of age and habitual sleep duration in predicting cognitive performance in a large sample of participants aged 15 to 89 years. Methods This study is a cross-sectional analysis of performance data gathered between January 2012 and September 2013. First-time players (N = 512823) of three internet cognitive training games measuring processing speed, working memory, visuospatial memory, and arithmetic participated in the study. Results Performance was based on a measure of speed and accuracy for each game. The relationship between performance and self-reported habitual sleep duration was examined in the sample as a whole and across 10-year age groups starting at age 15 and ending at 75 and older. Performance peaked at 7 h of sleep duration for all three games in the sample as a whole, and the decrements in performance for sleep durations greater than 7 h were either comparable or greater in the youngest as compared to the oldest age groups. Conclusions These findings challenge the hypothesis that deteriorating cognitive performance with long sleep duration is driven by medical comorbidities associated with aging. Further, these data are consistent with an optimal dose model of sleep and suggest that the model for the homeostatic recovery of cognitive function as a function of sleep duration should incorporate a curvilinear decline with longer duration sleep, indicating that there may be a cost to increased sleep. Replication and further research is essential for clarifying the sleep duration-cognition relationship in youth and adults of all ages.
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Affiliation(s)
- Anne Richards
- University of California, San Francisco, CA.,San Francisco VA Medical Center, San Francisco, CA
| | - Sabra S Inslicht
- University of California, San Francisco, CA.,San Francisco VA Medical Center, San Francisco, CA
| | | | - Brian S Mohlenhoff
- University of California, San Francisco, CA.,San Francisco VA Medical Center, San Francisco, CA
| | | | - Aoife O'Donovan
- University of California, San Francisco, CA.,San Francisco VA Medical Center, San Francisco, CA
| | - Thomas C Neylan
- University of California, San Francisco, CA.,San Francisco VA Medical Center, San Francisco, CA
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Mehling WE, Chesney MA, Metzler TJ, Goldstein LA, Maguen S, Geronimo C, Agcaoili G, Barnes DE, Hlavin JA, Neylan TC. A 12-week integrative exercise program improves self-reported mindfulness and interoceptive awareness in war veterans with posttraumatic stress symptoms. J Clin Psychol 2017; 74:554-565. [DOI: 10.1002/jclp.22549] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 08/20/2017] [Accepted: 09/01/2017] [Indexed: 11/12/2022]
Affiliation(s)
- Wolf E. Mehling
- University of California; San Francisco USA
- San Francisco Veterans Affairs Medical Center
| | - Margaret A. Chesney
- University of California; San Francisco USA
- San Francisco Veterans Affairs Medical Center
| | - Thomas J. Metzler
- University of California; San Francisco USA
- San Francisco Veterans Affairs Medical Center
| | - Lizabeth A. Goldstein
- University of California; San Francisco USA
- San Francisco Veterans Affairs Medical Center
| | - Shira Maguen
- University of California; San Francisco USA
- San Francisco Veterans Affairs Medical Center
| | | | | | - Deborah E. Barnes
- University of California; San Francisco USA
- San Francisco Veterans Affairs Medical Center
| | | | - Thomas C. Neylan
- University of California; San Francisco USA
- San Francisco Veterans Affairs Medical Center
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Talbot LS, Neylan TC, Metzler TJ, Cohen BE. The mediating effect of sleep quality on the relationship between PTSD and physical activity. J Clin Sleep Med 2014; 10:795-801. [PMID: 25024659 DOI: 10.5664/jcsm.3878] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
STUDY OBJECTIVES Physical inactivity is linked to health outcomes such as obesity, diabetes, and psychiatric disorders. Sleep disturbance has been linked to the same adverse outcomes. We examine the influence of sleep on physical activity as a novel approach to understand these relationships. Specifically, our objective was to determine whether low sleep quality predicts low physical activity in posttraumatic stress disorder (PTSD), a disorder associated with sleep disturbance, physical inactivity, and poor health outcomes. METHODS We used data from the Mind Your Heart Study, a prospective cohort study of 736 outpatients recruited from two Department of Veterans Affairs (VA) medical centers. We assessed PTSD with the Clinician Administered PTSD Scale, sleep quality using an item from the Pittsburgh Sleep Quality Index, and physical activity by self-report at baseline and again one year later. Hierarchical multiple regression models and structural equation modeling were used to examine the relationships among PTSD, sleep, and physical activity. RESULTS Sleep quality but not PTSD status was prospectively associated with lower physical activity in a model adjusting for age, sex, apnea probability, depression, body mass index, and baseline physical activity (β = 0.129, SE = 0.072, p < 0.01). Structural equation modeling indicated that the results were consistent with sleep quality statistically mediating the relationship between PTSD status at baseline and physical activity one year later. CONCLUSIONS Worse sleep quality predicts lower physical activity in PTSD, providing possible evidence for a behavioral pathway from disturbed sleep to poor physical health outcomes.
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Affiliation(s)
- Lisa S Talbot
- San Francisco VA Medical Center, San Francisco, CA ; Department of Psychiatry, University of California, San Francisco, CA
| | - Thomas C Neylan
- San Francisco VA Medical Center, San Francisco, CA ; Department of Psychiatry, University of California, San Francisco, CA
| | | | - Beth E Cohen
- San Francisco VA Medical Center, San Francisco, CA ; Department of Medicine, University of California, San Francisco, CA
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25
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Meffert SM, Henn-Haase C, Metzler TJ, Qian M, Best S, Hirschfeld A, McCaslin S, Inslicht S, Neylan TC, Marmar CR. Prospective study of police officer spouse/partners: a new pathway to secondary trauma and relationship violence? PLoS One 2014; 9:e100663. [PMID: 24987848 PMCID: PMC4079247 DOI: 10.1371/journal.pone.0100663] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 05/29/2014] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION It has been reported that posttraumatic stress disorder (PTSD) is associated with secondary spouse/partner (S/P) emotional distress and relationship violence. OBJECTIVE To investigate the relationships between PTSD, S/P emotional distress and relationship violence among police recruits using a prospective design. METHODS Two hypotheses were tested in 71 S/Ps: (1) Police officer reports of greater PTSD symptoms after 12 months of police service will be associated with greater secondary trauma symptoms among S/Ps; (2) Greater secondary trauma symptoms among S/Ps at 12 months will be associated with S/P reports of greater relationship violence. METHODS 71 police recruits and their S/Ps were assessed at baseline and 12 months after the start of police officer duty. Using linear and logistic regression, we analyzed explanatory variables for 12 month S/P secondary traumatic stress symptoms and couple violence, including baseline S/P variables and couple violence, as well as exposure and PTSD reports from both S/P and officer. RESULTS S/P perception of officer PTSD symptoms predicted S/P secondary traumatic stress. OS/P secondary trauma was significantly associated with both total couple violence (.34, p = .004) and S/P to officer violence (.35, p = .003). CONCLUSIONS Although results from this relatively small study of young police officers and their S/Ps must be confirmed by larger studies in general populations, findings suggest that S/P perception of PTSD symptoms may play a key role in the spread of traumatic stress symptoms across intimate partner relationships and intimate partner violence in the context of PTSD.
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Affiliation(s)
- Susan M. Meffert
- Department of Psychiatry, University of California San Francisco, San Francisco, California, United States of America
- * E-mail:
| | - Clare Henn-Haase
- Department of Psychiatry, New York University, New York, New York, United States of America
| | - Thomas J. Metzler
- Mental Health Service, San Francisco Veterans Administration Medical Center, San Francisco, California, United States of America
| | - Meng Qian
- Department of Psychiatry, New York University, New York, New York, United States of America
| | - Suzanne Best
- Graduate School of Education and Counseling, Lewis and Clark College, Portland, Oregon, United States of America
| | - Ayelet Hirschfeld
- Mental Health Service, San Francisco Veterans Administration Medical Center, San Francisco, California, United States of America
| | - Shannon McCaslin
- Dissemination and Training Division, National Center for PTSD, Palo Alto, California, United States of America
| | - Sabra Inslicht
- Department of Psychiatry, University of California San Francisco, San Francisco, California, United States of America
- Mental Health Service, San Francisco Veterans Administration Medical Center, San Francisco, California, United States of America
| | - Thomas C. Neylan
- Department of Psychiatry, University of California San Francisco, San Francisco, California, United States of America
- Mental Health Service, San Francisco Veterans Administration Medical Center, San Francisco, California, United States of America
| | - Charles R. Marmar
- Department of Psychiatry, New York University, New York, New York, United States of America
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Talbot LS, Maguen S, Metzler TJ, Schmitz M, McCaslin SE, Richards A, Perlis ML, Posner DA, Weiss B, Ruoff L, Varbel J, Neylan TC. Cognitive behavioral therapy for insomnia in posttraumatic stress disorder: a randomized controlled trial. Sleep 2014; 37:327-41. [PMID: 24497661 DOI: 10.5665/sleep.3408] [Citation(s) in RCA: 184] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES Examine whether cognitive behavioral therapy for insomnia (CBT-I) improves sleep in posttraumatic stress disorder (PTSD) as well as nightmares, nonsleep PTSD symptoms, depression symptoms, and psychosocial functioning. DESIGN RANDOMIZED CONTROLLED TRIAL WITH TWO ARMS: CBT-I and monitor-only waitlist control. SETTING Department of Veterans Affairs (VA) Medical Center. PARTICIPANTS Forty-five adults (31 females: [mean age 37 y (22-59 y)] with PTSD meeting research diagnostic criteria for insomnia, randomly assigned to CBT-I (n = 29; 22 females) or monitor-only waitlist control (n = 16; nine females). INTERVENTIONS Eight-session weekly individual CBT-I delivered by a licensed clinical psychologist or a board-certified psychiatrist. MEASUREMENTS AND RESULTS Measures included continuous monitoring of sleep with diary and actigraphy; prepolysomnography and postpolysomnography and Clinician-Administered PTSD Scale (CAPS); and pre, mid, and post self-report questionnaires, with follow-up of CBT-I participants 6 mo later. CBT-I was superior to the waitlist control condition in all sleep diary outcomes and in polysomnography-measured total sleep time. Compared to waitlist participants, CBT-I participants reported improved subjective sleep (41% full remission versus 0%), disruptive nocturnal behaviors (based on the Pittsburgh Sleep Quality Index-Addendum), and overall work and interpersonal functioning. These effects were maintained at 6-mo follow-up. Both CBT-I and waitlist control participants reported reductions in PTSD symptoms and CAPS-measured nightmares. CONCLUSIONS Cognitive behavioral therapy for insomnia (CBT-I) improved sleep in individuals with posttraumatic stress disorder, with durable gains at 6 mo. Overall psychosocial functioning improved following CBT-I. The initial evidence regarding CBT-I and nightmares is promising but further research is needed. Results suggest that a comprehensive approach to treatment of posttraumatic stress disorder should include behavioral sleep medicine. CLINICAL TRIAL INFORMATION TRIAL NAME: Cognitive Behavioral Treatment Of Insomnia In Posttraumatic Stress Disorder. URL: http://clinicaltrials.gov/ct2/show/NCT00881647. REGISTRATION NUMBER NCT00881647.
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Affiliation(s)
- Lisa S Talbot
- San Francisco VA Medical Center, San Francisco, CA ; Department of Psychiatry, University of California, San Francisco, CA
| | - Shira Maguen
- San Francisco VA Medical Center, San Francisco, CA ; Department of Psychiatry, University of California, San Francisco, CA
| | | | - Martha Schmitz
- San Francisco VA Medical Center, San Francisco, CA ; Department of Psychiatry, University of California, San Francisco, CA
| | - Shannon E McCaslin
- San Francisco VA Medical Center, San Francisco, CA ; Department of Psychiatry, University of California, San Francisco, CA ; National Center for PTSD, VA Palo Alto Health Care System, Palo Alto, CA
| | - Anne Richards
- San Francisco VA Medical Center, San Francisco, CA ; Department of Psychiatry, University of California, San Francisco, CA
| | - Michael L Perlis
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
| | - Donn A Posner
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI
| | | | - Leslie Ruoff
- San Francisco VA Medical Center, San Francisco, CA
| | | | - Thomas C Neylan
- San Francisco VA Medical Center, San Francisco, CA ; Department of Psychiatry, University of California, San Francisco, CA
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Meffert SM, Abdo AO, Alla OAA, Elmakki YOM, Omer AA, Yousif S, Metzler TJ, Marmar CR. A pilot randomized controlled trial of interpersonal psychotherapy for Sudanese refugees in Cairo, Egypt. ACTA ACUST UNITED AC 2014. [DOI: 10.1037/a0023540] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
The present study investigated the relationship between posttraumatic stress disorder (PTSD) and emotional eating in a sample of medically healthy and medication-free adults. Participants with PTSD (n = 44) and control participants free of lifetime psychiatric history (n = 49) completed a measure of emotional eating. Emotional eating is the tendency to eat or overeat in response to negative emotions. PTSD participants exhibited greater emotional eating than control participants (η(2) = .20) and emotional eating increased with higher PTSD symptom severity (R(2) = .11). Results supported the stress-eating-obesity model whereby emotional eating is a maladaptive response to stressors. Over time, this could lead to weight gain, particularly abdominal stores, and contribute to higher risk for comorbid medical disorders. Findings suggest the importance of future longitudinal research to understand whether emotional eating contributes to the high rates of obesity, diabetes, and heart disease in PTSD.
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Affiliation(s)
- Lisa S Talbot
- San Francisco VA Medical Center, San Francisco, California 94121, USA.
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Richards A, Metzler TJ, Ruoff LM, Inslicht SS, Rao M, Talbot LS, Neylan TC. Sex differences in objective measures of sleep in post-traumatic stress disorder and healthy control subjects. J Sleep Res 2013; 22:679-87. [PMID: 23763708 DOI: 10.1111/jsr.12064] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 04/28/2013] [Indexed: 01/30/2023]
Abstract
A growing literature shows prominent sex effects for risk for post-traumatic stress disorder and associated medical comorbid burden. Previous research indicates that post-traumatic stress disorder is associated with reduced slow wave sleep, which may have implications for overall health, and abnormalities in rapid eye movement sleep, which have been implicated in specific post-traumatic stress disorder symptoms, but most research has been conducted in male subjects. We therefore sought to compare objective measures of sleep in male and female post-traumatic stress disorder subjects with age- and sex-matched control subjects. We used a cross-sectional, 2 × 2 design (post-traumatic stress disorder/control × female/male) involving83 medically healthy, non-medicated adults aged 19-39 years in the inpatient sleep laboratory. Visual electroencephalographic analysis demonstrated that post-traumatic stress disorder was associated with lower slow wave sleep duration (F(3,82) = 7.63, P = 0.007) and slow wave sleep percentage (F(3,82) = 6.11, P = 0.016). There was also a group × sex interaction effect for rapid eye movement sleep duration (F(3,82) = 4.08, P = 0.047) and rapid eye movement sleep percentage (F(3,82) = 4.30, P = 0.041), explained by greater rapid eye movement sleep in post-traumatic stress disorder females compared to control females, a difference not seen in male subjects. Quantitative electroencephalography analysis demonstrated that post-traumatic stress disorder was associated with lower energy in the delta spectrum (F(3,82) = 6.79, P = 0.011) in non-rapid eye movement sleep. Slow wave sleep and delta findings were more pronounced in males. Removal of post-traumatic stress disorder subjects with comorbid major depressive disorder, who had greater post-traumatic stress disorder severity, strengthened delta effects but reduced rapid eye movement effects to non-significance. These findings support previous evidence that post-traumatic stress disorder is associated with impairment in the homeostatic function of sleep, especially in men with the disorder. These findings suggest that group × sex interaction effects on rapid eye movement may occur with more severe post-traumatic stress disorder or with post-traumatic stress disorder comorbid with major depressive disorder.
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Affiliation(s)
- Anne Richards
- University of California, San Francisco, CA, USA; San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
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Galatzer-Levy IR, Brown AD, Henn-Haase C, Metzler TJ, Neylan TC, Marmar CR. Positive and negative emotion prospectively predict trajectories of resilience and distress among high-exposure police officers. ACTA ACUST UNITED AC 2013; 13:545-53. [PMID: 23339621 DOI: 10.1037/a0031314] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Responses to both potentially traumatic events and other significant life stressors have been shown to conform to discrete patterns of response such as resilience, anticipatory stress, initial distress with gradual recovery, and chronic distress. The etiology of these trajectories is still unclear. Individual differences in levels of negative and positive emotion are believed to play a role in determining risk and resilience following traumatic exposure. In the current investigation, we followed police officers prospectively from academy training through 48 months of active duty, assessing levels of distress every 12 months. Using latent class growth analysis, we identified 4 trajectories closely conforming to prototypical patterns. Furthermore, we found that lower levels of self-reported negative emotion during academy training prospectively predicted membership in the resilient trajectory compared with the more symptomatic trajectories following the initiation of active duty, whereas higher levels of positive emotion during academy training differentiated resilience from a trajectory that was equivalently low on distress during academy training but consistently grew in distress through 4 years of active duty. These findings emerging from a prospective longitudinal design provide evidence that resilience is predicted by both lower levels of negative emotion and higher levels of positive emotion prior to active duty stressor exposure.
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Affiliation(s)
- Isaac R Galatzer-Levy
- Department of Psychiatry, New York University School of Medicine, New York, NY 10016, USA.
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Inslicht SS, Metzler TJ, Garcia NM, Pineles SL, Milad MR, Orr SP, Marmar CR, Neylan TC. Sex differences in fear conditioning in posttraumatic stress disorder. J Psychiatr Res 2013; 47:64-71. [PMID: 23107307 PMCID: PMC3806498 DOI: 10.1016/j.jpsychires.2012.08.027] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 08/28/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND Women are twice as likely as men to develop Posttraumatic Stress Disorder (PTSD). Abnormal acquisition of conditioned fear has been suggested as a mechanism for the development of PTSD. While some studies of healthy humans suggest that women are either no different or express less conditioned fear responses during conditioning relative to men, differences in the acquisition of conditioned fear between men and women diagnosed with PTSD has not been examined. METHODS Thirty-one participants (18 men; 13 women) with full or subsyndromal PTSD completed a fear conditioning task. Participants were shown computer-generated colored circles that were paired (CS+) or unpaired (CS-) with an aversive electrical stimulus and skin conductance levels were assessed throughout the task. RESULTS Repeated measures ANOVA indicated a significant sex by stimulus interaction during acquisition. Women had greater differential conditioned skin conductance responses (CS + trials compared to CS- trials) than did men, suggesting greater acquisition of conditioned fear in women with PTSD. CONCLUSIONS In contrast to studies of healthy individuals, we found enhanced acquisition of conditioned fear in women with PTSD. Greater fear conditioning in women may either be a pre-existing vulnerability trait or an acquired phenomenon that emerges in a sex-dependent manner after the development of PTSD. Characterizing the underlying mechanisms of these differences is needed to clarify sex-related differences in the pathophysiology of PTSD.
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Affiliation(s)
- Sabra S Inslicht
- University of California, San Francisco, San Francisco, CA 94121, United States.
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Maguen S, Metzler TJ, Bosch J, Marmar CR, Knight SJ, Neylan TC. Killing in combat may be independently associated with suicidal ideation. Depress Anxiety 2012; 29:918-23. [PMID: 22505038 PMCID: PMC3974930 DOI: 10.1002/da.21954] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Revised: 03/13/2012] [Accepted: 03/17/2012] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The United States military has lost more troops to suicide than to combat for the second year in a row and better understanding combat-related risk factors for suicide is critical. We examined the association of killing and suicide among war veterans after accounting for PTSD, depression, and substance use disorders. METHODS We utilized a cross-sectional, retrospective, nationally representative sample of Vietnam veterans from the National Vietnam Veterans Readjustment Study (NVVRS). In order to perform a more in depth analysis, we utilized a subsample of these data, the NVVRS Clinical Interview Sample (CIS), which is representative of 1.3 million veterans who were eligible for the clinical interview by virtue of living in proximity to an interview site, located within 28 standard metropolitan regions throughout the United States. RESULTS Veterans who had higher killing experiences had twice the odds of suicidal ideation, compared to those with lower or no killing experiences (OR = 1.99, 95% CI = 1.07-3.67), even after adjusting for demographic variables, PTSD, depression, substance use disorders, and adjusted combat exposure. PTSD (OR = 3.42, 95% CI = 1.09-10.73), depression (OR = 11.49, 95% CI = 2.12-62.38), and substance use disorders (OR = 3.98, 95% CI = 1.01-15.60) were each associated with higher odds of suicidal ideation. Endorsement of suicide attempts was most strongly associated with PTSD (OR = 5.52, 95% CI = 1.21-25.29). CONCLUSIONS Killing experiences are not routinely examined when assessing suicide risk. Our findings have important implications for conducting suicide risk assessments in veterans of war. Depression and Anxiety 00:1-6, 2012. © 2012 Wiley Periodicals, Inc.
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Affiliation(s)
- Shira Maguen
- San Francisco VA Medical Center, San Francisco, California 94121, USA.
| | - Thomas J. Metzler
- San Francisco VA Medical Center, San Francisco, California,University of California, San Francisco, California
| | - Jeane Bosch
- San Francisco VA Medical Center, San Francisco, California
| | | | - Sara J. Knight
- San Francisco VA Medical Center, San Francisco, California,University of California, San Francisco, California
| | - Thomas C. Neylan
- San Francisco VA Medical Center, San Francisco, California,University of California, San Francisco, California
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Komarovskaya I, Maguen S, McCaslin SE, Metzler TJ, Madan A, Brown AD, Galatzer-Levy IR, Henn-Haase C, Marmar CR. The impact of killing and injuring others on mental health symptoms among police officers. J Psychiatr Res 2011; 45:1332-6. [PMID: 21658717 PMCID: PMC3974970 DOI: 10.1016/j.jpsychires.2011.05.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Revised: 05/03/2011] [Accepted: 05/06/2011] [Indexed: 11/29/2022]
Abstract
This study examined the relationship between killing or seriously injuring someone in the line of duty and mental health symptoms in a sample of police officers (N = 400) who were first assessed during academy training and at five additional time points over three years. We found that nearly 10% of police officers reported having to kill or seriously injure someone in the line of duty in the first three years of police service. After controlling for demographics and exposure to life threat, killing or seriously injuring someone in the line of duty was significantly associated with PTSD symptoms (p < .01) and marginally associated with depression symptoms (p = .06). These results highlight the potential mental health impact of killing or seriously injuring someone in the line of duty. Greater attention to mental health services following these types of exposures can serve as a preventative measure for police officers who have been negatively impacted.
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Affiliation(s)
| | - Shira Maguen
- UCSF School of Medicine, SF VA Medical Center, San Francisco, CA, USA
| | | | | | - Anita Madan
- PTSD Research Program, NYU Langone Medical Center, 145 E. 32nd St., 14th Floor, New York, NY 10016, USA
| | - Adam D. Brown
- PTSD Research Program, NYU Langone Medical Center, 145 E. 32nd St., 14th Floor, New York, NY 10016, USA
| | - Isaac R. Galatzer-Levy
- PTSD Research Program, NYU Langone Medical Center, 145 E. 32nd St., 14th Floor, New York, NY 10016, USA
| | - Clare Henn-Haase
- PTSD Research Program, NYU Langone Medical Center, 145 E. 32nd St., 14th Floor, New York, NY 10016, USA
| | - Charles R. Marmar
- PTSD Research Program, NYU Langone Medical Center, 145 E. 32nd St., 14th Floor, New York, NY 10016, USA
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34
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Yuan C, Wang Z, Inslicht SS, McCaslin SE, Metzler TJ, Henn-Haase C, Apfel BA, Tong H, Neylan TC, Fang Y, Marmar CR. Protective factors for posttraumatic stress disorder symptoms in a prospective study of police officers. Psychiatry Res 2011; 188:45-50. [PMID: 21095622 PMCID: PMC3071439 DOI: 10.1016/j.psychres.2010.10.034] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2010] [Revised: 08/16/2010] [Accepted: 10/31/2010] [Indexed: 12/01/2022]
Abstract
Although police officers are frequently exposed to potentially traumatic incidents, only a minority will develop chronic posttraumatic stress disorder (PTSD). Identifying and understanding protective factors could inform the development of preventive interventions; however, few studies have examined this. In the present prospective study, 233 police officers were assessed during academy training and again following 2 years of police service. Caucasian race, less previous trauma exposure, and less critical incident exposure during police service as well as greater sense of self-worth, beliefs of greater benevolence of the world, greater social support and better social adjustment, all assessed during academy training, were associated with lower PTSD symptoms after 2 years of service. Positive personality attributes assessed during training with the NEO Five-Factor Personality Inventory were not associated with lower PTSD symptoms. In a hierarchical linear regression model, only Caucasian race, lower critical incident exposure during police service, greater assumptions of benevolence of the world and better social adjustment during training remained predictive of lower PTSD symptoms after 2 years of police service. These results suggest that positive world assumptions and better social functioning during training may protect police officers from critical incident related PTSD.
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Affiliation(s)
- Chengmei Yuan
- Division of Mood Disorder, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China, Department of Psychiatry, San Francisco VA Medical Center, San Francisco, CA, United States, Department of Psychiatry, University of California, San Francisco, CA, United States
| | - Zhen Wang
- Department of Psychiatry, San Francisco VA Medical Center, San Francisco, CA, United States, Department of Psychiatry, University of California, San Francisco, CA, United States, Department of Clinical Psychology, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Sabra S. Inslicht
- Department of Psychiatry, San Francisco VA Medical Center, San Francisco, CA, United States, Department of Psychiatry, University of California, San Francisco, CA, United States
| | - Shannon E. McCaslin
- Department of Psychiatry, San Francisco VA Medical Center, San Francisco, CA, United States, Department of Psychiatry, University of California, San Francisco, CA, United States
| | - Thomas J. Metzler
- Department of Psychiatry, San Francisco VA Medical Center, San Francisco, CA, United States, Department of Psychiatry, University of California, San Francisco, CA, United States
| | - Clare Henn-Haase
- Department of Psychiatry, New York University, New York, NY, United States
| | - Brigitte A. Apfel
- Department of Psychiatry, San Francisco VA Medical Center, San Francisco, CA, United States, Department of Psychiatry, University of California, San Francisco, CA, United States,Corresponding author: Brigitte Apfel, MD, Department of Psychiatry, Veterans Administration Medical Center, 4150 Clement St. (116P), San Francisco, CA 94121, Tel: (415) 221 4810, Fax: (415) 751-2297,
| | - Huiqi Tong
- Department of Psychiatry, San Francisco VA Medical Center, San Francisco, CA, United States
| | - Thomas C. Neylan
- Department of Psychiatry, San Francisco VA Medical Center, San Francisco, CA, United States, Department of Psychiatry, University of California, San Francisco, CA, United States
| | - Yiru Fang
- Division of Mood Disorder, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China,Co-corresponding author: Yiru Fang, MD, Division of Mood Disorder, Shanghai Mental Health Center, Jiao Tong University School of Medicine, 600 Wan Ping Nan Road, Shanghai, 200030, China, Tel: (8621) 3428 9888, Fax: (8621) 6438 7986,
| | - Charles R. Marmar
- Department of Psychiatry, New York University, New York, NY, United States
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35
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Herbst E, Metzler TJ, Lenoci M, McCaslin SE, Inslicht S, Marmar CR, Neylan TC. Adaptation effects to sleep studies in participants with and without chronic posttraumatic stress disorder. Psychophysiology 2011; 47:1127-33. [PMID: 20456661 DOI: 10.1111/j.1469-8986.2010.01030.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The "first night effect" (FNE) is the alteration of sleep architecture observed on the first night of polysomnographic (PSG) studies. It is unclear whether the FNE reflects adaptation to the equipment, sleeping environment, or both. Moreover, it is possible that certain patient populations, such as those with posttraumatic stress disorder (PTSD), demonstrate greater adaptation effects that are highly context dependent. We assessed FNE in participants with PTSD and healthy controls in a cross-sectional study consisting of PSG testing at home and in the hospital. Contrary to our expectations, the PTSD group showed no adaptation effects in either setting. Only the control group assigned to the "hospital first" condition showed significant decreases in total sleep time on night 1 versus night 2 of the study. The results suggest that the FNE is related to adaptation to the combination of the hospital environment and the recording equipment.
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Affiliation(s)
- Ellen Herbst
- Department of Psychiatry, University of California San Francisco, San Francisco, California, USA
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36
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Ballenger JF, Best SR, Metzler TJ, Wasserman DA, Mohr DC, Liberman A, Delucchi K, Weiss DS, Fagan JA, Waldrop AE, Marmar CR. Patterns and predictors of alcohol use in male and female urban police officers. Am J Addict 2011; 20:21-9. [PMID: 21175917 PMCID: PMC3592498 DOI: 10.1111/j.1521-0391.2010.00092.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
In a large sample of urban police officers, 18.1% of males and 15.9% of females reported experiencing adverse consequences from alcohol use and 7.8% of the sample met criteria for lifetime alcohol abuse or dependence. Female officers had patterns of alcohol use similar to male officers and substantially more than females in the general population. Critical incident exposure and posttraumatic stress disorder (PTSD) symptoms were not associated with level of alcohol use. Greater psychiatric symptoms were related to adverse consequences from alcohol use. There was a noteworthy gender by work stress interaction: greater routine work stress related to lower current alcohol use in female officers.
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Affiliation(s)
- James F Ballenger
- Mental Health Service, Department of Veterans Affairs Medical Center, San Francisco, California, USA
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37
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Neylan TC, Metzler TJ, Henn-Haase C, Blank Y, Tarasovsky G, McCaslin SE, Lenoci M, Marmar CR. Prior night sleep duration is associated with psychomotor vigilance in a healthy sample of police academy recruits. Chronobiol Int 2010; 27:1493-508. [PMID: 20795888 DOI: 10.3109/07420528.2010.504992] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Aviation, military, police, and health care personnel have been particularly interested in the operational impact of sleep restriction and work schedules given the potential severe consequences of making fatigue-related errors. Most studies examining the impact of sleep loss or circadian manipulations have been conducted in controlled laboratory settings using small sample sizes. This study examined whether the relationship between prior night sleep duration and performance on the psychomotor vigilance task could be reliably detected in a field study of healthy police academy recruits. Subjects (N = 189) were medically and psychiatrically healthy. Sleep-wake activity was assessed with wrist actigraphy for 7 days. Subjects performed the psychomotor vigilance task (PVT) for 5 min on a personal digital assistant (PDA) device before and after their police academy workday and on comparable times during their days off. Mixed-effects logistic regression was used to estimate the probability of having > or =1 lapse on the PVT as a function of the previous night sleep duration during the 7 days of field testing. Valid estimates of sleep duration were obtained for 1082 nights of sleep. The probability of a lapse decreased by 3.5%/h sleep the night prior to testing. The overall probability of having a lapse decreased by 0.9%/h since awakening, holding hours of sleep constant. Perceived stress was not associated with sleep duration or probability of performance lapse. These findings demonstrate the feasibility of detecting sleep and circadian effects on cognitive performance in large field studies. These findings have implications regarding the daytime functioning of police officers.
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Affiliation(s)
- Thomas C Neylan
- Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA.
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38
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Weiss DS, Brunet A, Best SR, Metzler TJ, Liberman A, Pole N, Fagan JA, Marmar CR. Frequency and severity approaches to indexing exposure to trauma: the Critical Incident History Questionnaire for police officers. J Trauma Stress 2010; 23:734-43. [PMID: 21171134 PMCID: PMC3974917 DOI: 10.1002/jts.20576] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The Critical Incident History Questionnaire indexes cumulative exposure to traumatic incidents in police by examining incident frequency and rated severity. In over 700 officers, event severity was negatively correlated (r(s) = -.61) with frequency of exposure. Cumulative exposure indices that varied emphasis on frequency and severity-using both nomothetic and idiographic methods-all showed satisfactory psychometric properties and similar correlates. All indices were only modestly related to posttraumatic stress disorder (PTSD) symptoms. Ratings of incident severity were not influenced by whether officers had ever experienced the incident. Because no index summarizing cumulative exposure to trauma had superior validity, our findings suggest that precision is not increased if frequency is weighted by severity.
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Affiliation(s)
- Daniel S. Weiss
- Department of Psychiatry, University of California, San Francisco
| | - Alain Brunet
- Department of Psychiatry, McGill University and Douglas Mental Health University Institute
| | | | - Thomas J. Metzler
- Mental Health Service, San Francisco Veterans Affairs Medical Center
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39
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Berger W, Mehra A, Lenoci M, Metzler TJ, Otte C, Tarasovsky G, Mellon SH, Wolkowitz OM, Marmar CR, Neylan TC. Serum brain-derived neurotrophic factor predicts responses to escitalopram in chronic posttraumatic stress disorder. Prog Neuropsychopharmacol Biol Psychiatry 2010; 34:1279-84. [PMID: 20643177 PMCID: PMC2939182 DOI: 10.1016/j.pnpbp.2010.07.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2010] [Revised: 07/03/2010] [Accepted: 07/12/2010] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Some studies have found that antidepressants increase serum brain-derived neurotrophic factor (BDNF) levels in patients with major depression and the expression of BDNF mRNA in limbic structures of rats. OBJECTIVES This study addressed whether the SSRI escitalopram increases serum BDNF levels in subjects with PTSD and whether BDNF levels are associated with treatment response. METHODS Medically healthy male subjects (N=16) with chronic PTSD completed a 12 week open-label trial of flexible dose (5-20 mg/day) escitalopram monotherapy. BDNF levels were obtained at baseline, and at weeks 4, 8 and 12. RESULTS PTSD symptoms significantly declined over the course of the 12 week escitalopram treatment. Despite a substantial improvement in PTSD symptoms, there was virtually no change in BDNF levels over time. Nevertheless, mean BDNF levels across the trial were strongly correlated with the slope of PTSD symptoms over the 12 weeks (r=0.58, p=0.018). Lower mean BDNF was associated with a greater decrease in PTSD symptoms over the course of the trial. CONCLUSIONS PTSD subjects with low BDNF levels demonstrated the largest treatment response from an agent with putative neurotrophic effects.
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Affiliation(s)
- William Berger
- Department of Psychiatry, University of California, San Francisco (UCSF), CA, USA, Psychiatry Service, San Francisco Department of Veterans Affairs Medical Center (DVAMC), San Francisco, USA, Department of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB-UFRJ), Rio de Janeiro, Brazil
| | - Akhil Mehra
- Department of Psychiatry, University of California, San Francisco (UCSF), CA, USA
| | - Maryann Lenoci
- Psychiatry Service, San Francisco Department of Veterans Affairs Medical Center (DVAMC), San Francisco, USA
| | - Thomas J. Metzler
- Department of Psychiatry, University of California, San Francisco (UCSF), CA, USA, Psychiatry Service, San Francisco Department of Veterans Affairs Medical Center (DVAMC), San Francisco, USA
| | - Christian Otte
- Department of Psychiatry, University of California, San Francisco (UCSF), CA, USA, Department of Psychiatry and Psychotherapy, University Hospital Hamburg-Eppendorf, Germany
| | - Gary Tarasovsky
- Psychiatry Service, San Francisco Department of Veterans Affairs Medical Center (DVAMC), San Francisco, USA
| | - Synthia H. Mellon
- Department of Obstetrics, Gynecology and Reproductive Endocrinology, University of California, San Francisco (UCSF), CA, USA
| | - Owen M. Wolkowitz
- Department of Psychiatry, University of California, San Francisco (UCSF), CA, USA
| | - Charles R. Marmar
- Department of Psychiatry, University of California, San Francisco (UCSF), CA, USA, Psychiatry Service, San Francisco Department of Veterans Affairs Medical Center (DVAMC), San Francisco, USA, Department of Psychiatry, New York University School of Medicine, New York, USA
| | - Thomas C. Neylan
- Department of Psychiatry, University of California, San Francisco (UCSF), CA, USA, Psychiatry Service, San Francisco Department of Veterans Affairs Medical Center (DVAMC), San Francisco, USA,Corresponding author: Dr. Thomas C. Neylan, UCSF and SFVAMC (116P), 4150 Clement Street, San Francisco, CA 94121. Phone: (415) 750-6961; Fax: (415) 751-2297.
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40
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Meffert SM, Musalo K, Abdo AO, Alla OAA, Elmakki YOM, Omer AA, Yousif S, Metzler TJ, Marmar CR. Feelings of betrayal by the United Nations High Commissioner for Refugees and emotionally distressed Sudanese refugees in Cairo. Med Confl Surviv 2010; 26:160-72. [PMID: 20718287 DOI: 10.1080/13623699.2010.491395] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Thousands of Sudanese refugees have fled to Cairo, Egypt in the wake of Sudanese civil conflicts. Sudanese refugees were evaluated with respect to symptoms of depression, post-traumatic stress disorder (PTSD) and social stress. Four respondents (22%) indicated that their interactions with the United Nations High Commissioner for Refugees (UNHCR) in Cairo, Egypt were the worst experiences since war-related atrocities. Fourteen participants (63.6%) felt 'extremely' betrayed by the UNHCR on a four point scale. Greater feelings of betrayal by the UNHCR were associated with greater avoidance and arousal symptoms of PTSD, symptoms of depression and trait anger. This is the first study of which we are aware that examines the relationship between sense of betrayal by the UNHCR and symptoms of PTSD, depression and anger among asylum seekers.
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Affiliation(s)
- Susan M Meffert
- Department of Psychiatry, University of California, San Francisco, California, USA.
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41
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Neylan TC, Mueller SG, Wang Z, Metzler TJ, Lenoci M, Truran D, Marmar CR, Weiner MW, Schuff N. Insomnia severity is associated with a decreased volume of the CA3/dentate gyrus hippocampal subfield. Biol Psychiatry 2010; 68:494-6. [PMID: 20598672 PMCID: PMC2921477 DOI: 10.1016/j.biopsych.2010.04.035] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2009] [Revised: 04/14/2010] [Accepted: 04/26/2010] [Indexed: 02/05/2023]
Abstract
BACKGROUND Prolonged disruption of sleep in animal studies is associated with decreased neurogenesis in the dentate gyrus. Our objective was to determine whether insomnia severity in a sample of posttraumatic stress disorder (PTSD) patients and control subjects was associated with decreased volume in the CA3/dentate hippocampal subfield. METHODS Volumes of hippocampal subfields in 17 veteran men positive for PTSD (41 +/- 12 years) and 19 age-matched male veterans negative for PTSD were measured with 4-T magnetic resonance imaging. Subjective sleep quality was measured by the Insomnia Severity Index (ISI) and the Pittsburgh Sleep Quality Index. RESULTS Higher scores on the ISI, indicating worse insomnia, were associated with smaller volumes of the CA3/dentate subfields (r = -.48, p < .01) in the combined sample. Adding the ISI score as a predictor for CA3/dentate volume to a hierarchical linear regression model after first controlling for age and PTSD symptoms accounted for a 13% increase in incremental variance (t = -2.47, p = .02). CONCLUSIONS The findings indicate for the first time in humans that insomnia severity is associated with volume loss of the CA3/dentate subfields. This is consistent with animal studies showing that chronic sleep disruption is associated with decreased neurogenesis and dendritic branching in these structures.
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Affiliation(s)
- Thomas C. Neylan
- Mental Health Service, DVA Medical Center, San Francisco, CA, USA,Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Susanne G. Mueller
- Center for Imaging of Neurodegenerative Diseases, DVA Medical Center, San Francisco, CA, USA,Department of Radiology, University of California, San Francisco, CA, USA
| | - Zhen Wang
- Mental Health Service, DVA Medical Center, San Francisco, CA, USA,Department of Psychiatry, University of California, San Francisco, CA, USA,Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Thomas J. Metzler
- Mental Health Service, DVA Medical Center, San Francisco, CA, USA,Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Maryann Lenoci
- Mental Health Service, DVA Medical Center, San Francisco, CA, USA
| | - Diana Truran
- Center for Imaging of Neurodegenerative Diseases, DVA Medical Center, San Francisco, CA, USA
| | - Charles R. Marmar
- Mental Health Service, DVA Medical Center, San Francisco, CA, USA,Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Michael W. Weiner
- Center for Imaging of Neurodegenerative Diseases, DVA Medical Center, San Francisco, CA, USA,Department of Radiology, University of California, San Francisco, CA, USA
| | - Norbert Schuff
- Center for Imaging of Neurodegenerative Diseases, DVA Medical Center, San Francisco, CA, USA,Department of Radiology, University of California, San Francisco, CA, USA
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Wang Z, Inslicht SS, Metzler TJ, Henn-Haase C, McCaslin SE, Tong H, Neylan TC, Marmar CR. A prospective study of predictors of depression symptoms in police. Psychiatry Res 2010; 175:211-6. [PMID: 20044144 PMCID: PMC3974967 DOI: 10.1016/j.psychres.2008.11.010] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2008] [Revised: 10/31/2008] [Accepted: 11/19/2008] [Indexed: 11/29/2022]
Abstract
Police work is one of the most stressful occupations. Previous research has indicated that work stress and trauma exposure may place individuals at heightened risk for the development of depression symptomatology. This prospective longitudinal study was designed to examine predictors of depression symptoms in police service. Participants comprised 119 healthy police recruits from an ongoing prospective study. They completed baseline measures of depression symptoms, childhood trauma exposure, neuroticism, and self-worth during academy training. Follow-up measures of depression symptoms, PTSD symptoms, critical incident exposure, negative life events, and routine work environment stress were assessed after 12 months of police service. Hierarchical linear regression analysis was conducted to examine predictors of current levels of depression symptoms, controlling for baseline depression symptoms and current PTSD symptoms. Greater childhood trauma exposure, lower self-worth during training, and greater perceived work stress in the first year of police service predicted greater depression symptoms at 12 months. Depression symptoms at 1 year of police service were partly independent from PTSD symptoms at 12 months. Greater childhood trauma exposure and lower self-worth during training may be important variables to screen as risk factors for duty-related depression. Strategies to reduce routine work environment stress have the potential to decrease duty-related depression in law enforcement.
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Affiliation(s)
- Zhen Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University, Shanghei, China.
| | - Sabra S. Inslicht
- San Francisco VA Medical Center,University of California, San Francisco
| | - Thomas J. Metzler
- San Francisco VA Medical Center,University of California, San Francisco
| | - Clare Henn-Haase
- San Francisco VA Medical Center,University of California, San Francisco
| | | | | | - Thomas C. Neylan
- San Francisco VA Medical Center,University of California, San Francisco
| | - Charles R. Marmar
- San Francisco VA Medical Center,University of California, San Francisco
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Seal KH, Maguen S, Cohen B, Gima KS, Metzler TJ, Ren L, Bertenthal D, Marmar CR. VA mental health services utilization in Iraq and Afghanistan veterans in the first year of receiving new mental health diagnoses. J Trauma Stress 2010; 23:5-16. [PMID: 20146392 DOI: 10.1002/jts.20493] [Citation(s) in RCA: 224] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Little is known about mental health services utilization among Iraq and Afghanistan veterans receiving care at Department of Veterans Affairs (VA) facilities. Of 49,425 veterans with newly diagnosed posttraumatic stress disorder (PTSD), only 9.5% attended 9 or more VA mental health sessions in 15 weeks or less in the first year of diagnosis. In addition, engagement in 9 or more VA treatment sessions for PTSD within 15 weeks varied by predisposing variables (age and gender), enabling variables (clinic of first mental health diagnosis and distance from VA facility), and need (type and complexity of mental health diagnoses). Thus, only a minority of Iraq and Afghanistan veterans with new PTSD diagnoses received a recommended number and intensity of VA mental health treatment sessions within the first year of diagnosis.
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Affiliation(s)
- Karen H Seal
- Health Services Research and Development Research Enhancement Award Program, San Francisco VA Medical Center and the Department of Medicine, University of California, San Francisco, CA 94121, USA.
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44
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Inslicht SS, McCaslin SE, Metzler TJ, Henn-Haase C, Hart SL, Maguen S, Neylan TC, Marmar CR. Family psychiatric history, peritraumatic reactivity, and posttraumatic stress symptoms: a prospective study of police. J Psychiatr Res 2010; 44:22-31. [PMID: 19683259 PMCID: PMC2818084 DOI: 10.1016/j.jpsychires.2009.05.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2009] [Revised: 05/26/2009] [Accepted: 05/29/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Family history of psychiatric and substance use disorders has been associated with posttraumatic stress disorder (PTSD) in cross-sectional studies. METHOD Using a prospective design, we examined the relationships of family history of psychiatric and substance use disorders to posttraumatic stress symptoms in 278 healthy police recruits. During academy training, recruits were interviewed on family and personal psychopathology, prior cumulative civilian trauma exposure, and completed self-report questionnaires on nonspecific symptoms of distress and alcohol use. Twelve months after commencement of active duty, participants completed questionnaires on critical incident exposure over the previous year, peritraumatic distress to the worst critical incident during this time, and posttraumatic stress symptoms. RESULTS A path model indicated: (1) family loading for mood and anxiety disorders had an indirect effect on posttraumatic stress symptoms at 12 months that was mediated through peritraumatic distress to the officer's self-identified worst critical incident, (2) family loading for substance use disorders also predicted posttraumatic stress symptoms at 12 months and this relationship was mediated through peritraumatic distress. CONCLUSION These findings support a model in which family histories of psychopathology and substance abuse are pre-existing vulnerability factors for experiencing greater peritraumatic distress to critical incident exposure which, in turn, increases the risk for development of symptoms of posttraumatic stress disorder. Replication in other first responders, military and civilians will be important to determine generalizability of these findings.
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Abstract
This study examined the mental health and functional consequences associated with killing combatants and noncombatants. Using the National Vietnam Veterans Readjustment Study (NVVRS) survey data, the authors reported the percentage of male Vietnam theater veterans (N = 1200) who killed an enemy combatant, civilian, and/or prisoner of war. They next examined the relationship between killing in war and a number of mental health and functional outcomes using the clinical interview subsample of the NVVRS (n = 259). Controlling for demographic variables and exposure to general combat experiences, the authors found that killing was associated with posttraumatic stress disorder symptoms, dissociation, functional impairment, and violent behaviors. Experiences of killing in war are important to address in the evaluation and treatment of veterans.
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Affiliation(s)
- Shira Maguen
- San Francisco VA Medical Center, and Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA.
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46
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McCaslin SE, de Zoysa P, Butler LD, Hart S, Marmar CR, Metzler TJ, Koopman C. The relationship of posttraumatic growth to peritraumatic reactions and posttraumatic stress symptoms among Sri Lankan university students. J Trauma Stress 2009; 22:334-9. [PMID: 19588514 DOI: 10.1002/jts.20426] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The relationships of posttraumatic growth to peritraumatic reactions and posttraumatic stress symptoms were examined in 93 Sri Lankan university students who had experienced a traumatic life event. Posttraumatic growth was associated with peritraumatic dissociation and posttraumatic stress symptoms, but was not associated with peritraumatic emotional distress. Results indicated a curvilinear relationship between peritraumatic dissociation and posttraumatic growth and between posttraumatic stress symptoms and posttraumatic growth. In a regression model predicting posttraumatic growth scores, each of the quadratic relationships of peritraumatic dissociation and posttraumatic stress symptoms to posttraumatic growth were statistically significant, and combined accounted for 22% of the variance. Results suggest that moderate levels of peritraumatic dissociation and symptoms are most associated with the greatest levels of growth.
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Affiliation(s)
- Shannon E McCaslin
- San Francisco Veterans Administration Medical Center, Mental Health Service, San Francisco, CA 94121, USA.
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47
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Seal KH, Metzler TJ, Gima KS, Bertenthal D, Maguen S, Marmar CR. Trends and risk factors for mental health diagnoses among Iraq and Afghanistan veterans using Department of Veterans Affairs health care, 2002-2008. Am J Public Health 2009; 99:1651-8. [PMID: 19608954 DOI: 10.2105/ajph.2008.150284] [Citation(s) in RCA: 509] [Impact Index Per Article: 33.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We sought to investigate longitudinal trends and risk factors for mental health diagnoses among Iraq and Afghanistan veterans. METHODS We determined the prevalence and predictors of mental health diagnoses among 289,328 Iraq and Afghanistan veterans entering Veterans Affairs (VA) health care from 2002 to 2008 using national VA data. RESULTS Of 289,328 Iraq and Afghanistan veterans, 106,726 (36.9%) received mental health diagnoses; 62,929 (21.8%) were diagnosed with posttraumatic stress disorder (PTSD) and 50 432 (17.4%) with depression. Adjusted 2-year prevalence rates of PTSD increased 4 to 7 times after the invasion of Iraq. Active duty veterans younger than 25 years had higher rates of PTSD and alcohol and drug use disorder diagnoses compared with active duty veterans older than 40 years (adjusted relative risk = 2.0 and 4.9, respectively). Women were at higher risk for depression than were men, but men had over twice the risk for drug use disorders. Greater combat exposure was associated with higher risk for PTSD. CONCLUSIONS Mental health diagnoses increased substantially after the start of the Iraq War among specific subgroups of returned veterans entering VA health care. Early targeted interventions may prevent chronic mental illness.
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Affiliation(s)
- Karen H Seal
- San Francisco VA Medical Center, San Francisco, CA 94121, USA.
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Pole N, Neylan TC, Otte C, Henn-Hasse C, Metzler TJ, Marmar CR. Prospective prediction of posttraumatic stress disorder symptoms using fear potentiated auditory startle responses. Biol Psychiatry 2009; 65:235-40. [PMID: 18722593 PMCID: PMC2647968 DOI: 10.1016/j.biopsych.2008.07.015] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2007] [Revised: 07/10/2008] [Accepted: 07/10/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) has been most consistently associated with exaggerated physiologic reactivity to startling sounds when such sounds occur in threatening contexts. There is conflicting evidence about whether startle hyperreactivity is a preexisting vulnerability factor for PTSD or an acquired result of posttrauma neural sensitization. Until now, there have been no prospective studies of physiologic reactivity to startling sounds in threatening contexts as predictors of PTSD symptoms. METHODS One hundred and thirty-eight police academy cadets without current psychopathology were exposed to repeated 106-dB startling sounds under increasing (low, medium, or high) threat of mild electric shock while their eye-blink electromyogram, skin conductance, heart rate, and subjective fear responses were recorded. Measures of response habituation were also calculated. Following 1 year of exposure to police-related trauma, these participants were assessed for PTSD symptom severity. RESULTS After accounting for other baseline variables that were predictive of PTSD symptom severity (age and general psychiatric distress), more severe PTSD symptoms were prospectively and independently predicted by the following startle measures: greater subjective fear under low threat, greater skin conductance under high threat, and slower skin conductance habituation. CONCLUSIONS These results imply that hypersensitivity to contextual threat (indexed by greater fear under low threat), elevated sympathetic nervous system reactivity to explicit threat (indexed by larger responses under high threat), and failure to adapt to repeated aversive stimuli (evidenced by slower habituation) are all unique preexisting vulnerability factors for greater PTSD symptom severity following traumatic stress exposure. These measures may eventually prove useful for preventing PTSD.
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Affiliation(s)
- Nnamdi Pole
- Department of Psychology, Smith College, Northampton, Massachusetts, USA.
| | - Thomas C. Neylan
- Department of Psychiatry, University of California, San Francisco, Veterans Affairs Medical Center, San Francisco
| | | | - Clare Henn-Hasse
- Department of Psychiatry, University of California, San Francisco, Veterans Affairs Medical Center, San Francisco
| | - Thomas J. Metzler
- Department of Psychiatry, University of California, San Francisco, Veterans Affairs Medical Center, San Francisco
| | - Charles R. Marmar
- Department of Psychiatry, University of California, San Francisco, Veterans Affairs Medical Center, San Francisco
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Somer E, Maguen S, Moin V, Boehm A, Metzler TJ, Litz BT. The Effects of Perceived Community Cohesion on Stress Symptoms Following a Terrorist Attack. ACTA ACUST UNITED AC 2008. [DOI: 10.1080/19322880802231759] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
It is unknown whether anger is a risk factor for the development of posttraumatic stress disorder ( PTSD) symptoms, arises as a consequence of PTSD, or both. Two hypotheses were tested in 180 police recruits: Greater trait anger during training will predict greater PTSD symptoms at one year; greater PTSD symptoms at one year will predict greater state anger at one year. Both hypotheses were confirmed, suggesting that trait anger is a risk factor for PTSD symptoms, but that PTSD symptoms are also associated with an increase of state anger. Increased anger is important not only because of the impact it has on individual distress and physical health, but also because of its potential public health impact.
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Affiliation(s)
- Susan M Meffert
- Department of Psychiatry, University of California, San Francisco, CA 94143, USA.
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