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Lin C, King PH, Richman JS, Davis LL. Association of Posttraumatic Stress Disorder and Race on Readmissions After Stroke. Stroke 2024; 55:983-989. [PMID: 38482715 PMCID: PMC10994194 DOI: 10.1161/strokeaha.123.044795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 01/03/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND There is limited research on outcomes of patients with posttraumatic stress disorder (PTSD) who also develop stroke, particularly regarding racial disparities. Our goal was to determine whether PTSD is associated with the risk of hospital readmission after stroke and whether racial disparities existed. METHODS The analytical sample consisted of all veterans receiving care in the Veterans Health Administration who were identified as having a new stroke requiring inpatient admission based on the International Classification of Diseases codes. PTSD and comorbidities were identified using the International Classification of Diseases codes and given the date of first occurrence. The retrospective cohort data were obtained from the Veterans Affairs Corporate Data Warehouse. The main outcome was any readmission to Veterans Health Administration with a stroke diagnosis. The hypothesis that PTSD is associated with readmission after stroke was tested using Cox regression adjusted for patient characteristics including age, sex, race, PTSD, smoking status, alcohol use, and comorbidities treated as time-varying covariates. RESULTS Our final cohort consisted of 93 651 patients with inpatient stroke diagnosis and no prior Veterans Health Administration codes for stroke starting from 1999 with follow-up through August 6, 2022. Of these patients, 12 916 (13.8%) had comorbid PTSD. Of the final cohort, 16 896 patients (18.0%) with stroke were readmitted. Our fully adjusted model for readmission found an interaction between African American veterans and PTSD with a hazard ratio of 1.09 ([95% CI, 1.00-1.20] P=0.047). In stratified models, PTSD has a significant hazard ratio of 1.10 ([95% CI, 1.02-1.18] P=0.01) for African American but not White veterans (1.05 [95% CI, 0.99-1.11]; P=0.10). CONCLUSIONS Among African American veterans who experienced stroke, preexisting PTSD was associated with increased risk of readmission, which was not significant among White veterans. This study highlights the need to focus on high-risk groups to reduce readmissions after stroke.
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Affiliation(s)
- Chen Lin
- Departments of Neurology (C.L., P.H.K.), University of Alabama at Birmingham
- Birmingham VA Medical Center, AL (C.L., P.H.K., J.S.R.)
| | - Peter H King
- Departments of Neurology (C.L., P.H.K.), University of Alabama at Birmingham
- Birmingham VA Medical Center, AL (C.L., P.H.K., J.S.R.)
| | - Joshua S Richman
- Surgery (J.S.R.), University of Alabama at Birmingham
- Birmingham VA Medical Center, AL (C.L., P.H.K., J.S.R.)
| | - Lori L Davis
- Psychiatry (L.L.D.), University of Alabama at Birmingham
- Tuscaloosa VA Medical Center, AL (L.L.D.)
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Sadeghi MA, Hemmati S, Yousefi-Manesh H, Foroutani L, Nassireslami E, Yousefi Zoshk M, Hosseini Y, Abbasian K, Dehpour AR, Chamanara M. Cilostazol pretreatment prevents PTSD-related anxiety behavior through reduction of hippocampal neuroinflammation. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2024; 397:133-144. [PMID: 37382600 DOI: 10.1007/s00210-023-02578-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 06/13/2023] [Indexed: 06/30/2023]
Abstract
Current pharmacological treatments against post-traumatic stress disorder (PTSD) lack adequate efficacy. As a result, intense research has focused on identifying other molecular pathways mediating the pathogenesis of this condition. One such pathway is neuroinflammation, which has demonstrated a role in PTSD pathogenesis by causing synaptic dysfunction, neuronal death, and functional impairment in the hippocampus. Phosphodiesterase (PDE) inhibitors (PDEIs) have emerged as promising therapeutic agents against neuroinflammation in other neurological conditions. Furthermore, PDEIs have shown some promise in animal models of PTSD. However, the current model of PTSD pathogenesis, which is based on dysregulated fear learning, implies that PDE inhibition in neurons should enhance the acquisition of fear memory from the traumatic event. As a result, we hypothesized that PDEIs may improve PTSD symptoms through inhibiting neuroinflammation rather than long-term potentiation-related mechanisms. To this end, we tested the therapeutic efficacy of cilostazol, a selective inhibitor of PDE3, on PTSD-related anxiety symptoms in the underwater trauma model of PTSD. PDE3 is expressed much more richly in microglia and astrocytes compared to neurons in the murine brain. Furthermore, we used hippocampal indolamine 2,3-dioxygenase 1 (IDO) expression and interleukin 1 beta (IL-1β) concentration as indicators of neuroinflammation. We observed that cilostazol pretreatment prevented the development of anxiety symptoms and the increase in hippocampal IDO and IL-1β following PTSD induction. As a result, PDE3 inhibition ameliorated the neuroinflammatory processes involved in the development of PTSD symptoms. Therefore, cilostazol and other PDEIs may be promising candidates for further investigation as pharmacological therapies against PTSD.
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Affiliation(s)
- Mohammad Amin Sadeghi
- Toxicology Research Center, AJA University of Medical Sciences, Tehran, Iran
- Department of Pharmacology, School of Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Sara Hemmati
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Hasan Yousefi-Manesh
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Laleh Foroutani
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Ehsan Nassireslami
- Toxicology Research Center, AJA University of Medical Sciences, Tehran, Iran
- Department of Pharmacology, School of Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Mojtaba Yousefi Zoshk
- Trauma Research Center, AJA University of Medical Sciences, Tehran, Iran
- Department of Pediatrics, AJA University of Medical Sciences, Tehran, Iran
| | - Yasaman Hosseini
- Cognitive Neuroscience Center, School of Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Kourosh Abbasian
- Management and Health Economics Department, AJA University of Medical Sciences, Tehran, Iran
| | - Ahmad Reza Dehpour
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Chamanara
- Toxicology Research Center, AJA University of Medical Sciences, Tehran, Iran.
- Department of Pharmacology, School of Medicine, AJA University of Medical Sciences, Tehran, Iran.
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Griffin TT, Bhave V, McNulty J, Christophe BR, Garton AL, Sander Connolly E. Delirium and Previous Psychiatric History Independently Predict Poststroke Posttraumatic Stress Disorder. Neurologist 2023; 28:362-366. [PMID: 37083500 PMCID: PMC10627542 DOI: 10.1097/nrl.0000000000000495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
OBJECTIVES Delirium is an acute brain dysfunction that has been correlated with adverse mental health outcomes, such as depression and posttraumatic stress disorder (PTSD). However, delirium has not been studied in relation to mental health outcomes after cerebrovascular events. This study aimed to examine the incidence of PTSD after nontraumatic intracerebral hemorrhage (ICH) and identify new predictors of poststroke PTSD symptoms. METHODS Clinical data were collected from 205 patients diagnosed with nontraumatic ICH. Demographics and hospital course data were examined. Univariate and multivariable correlational analyses were performed to determine predictors of PTSD symptoms. PTSD symptoms were assessed using PTSD checklist-civilian version (PCL-C) scores. RESULTS Diagnostic criteria for a positive PTSD screen (PCL-C score ≥44) were met by 13.7%, 20.2%, and 11.6% of nontraumatic patients with ICH at 3, 6, and 12 months, respectively. On univariate analysis, younger age, female sex, unemployed, and in-hospital delirium were correlated with higher PCL-C scores. In multivariable models, younger age, female sex, unemployed, in-hospital delirium, and a previous anxiety or depression diagnosis were associated with higher PCL-C scores at different follow-up times. Modified Rankin Scale scores were also positively correlated with PCL-C scores at each time point. CONCLUSIONS Delirium, previous psychiatric history, younger age, female sex, and unemployment status were found to be associated with a greater degree of posthemorrhagic stroke PTSD symptoms. More significant PTSD symptoms were also correlated with greater functional impairment. A better understanding of patient susceptibility to PTSD symptoms may help providers coordinate earlier interventions.
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Affiliation(s)
- Tian T. Griffin
- Department of Neurosurgery, Columbia University, College of Physicians and Surgeons
| | | | - Jack McNulty
- Columbia Vagelos College of Physicians and Surgeons
| | | | - Andrew L.A. Garton
- Department of Neurological Surgery, Weill Cornell Medical Center, New York, NY
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Singh J, Carleton RN, Neary JP. Cardiac function and posttraumatic stress disorder: a review of the literature and case report. Health Promot Chronic Dis Prev Can 2023; 43:472-480. [PMID: 37991890 PMCID: PMC10753899 DOI: 10.24095/hpcdp.43.10/11.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
INTRODUCTION Posttraumatic stress disorder (PTSD) can induce an elevation in sympathetic tone; however, research pertaining to the cardiac cycle in patients with PTSD is limited. METHODS A literature review was conducted with PubMed, MEDLINE and Web of Science. Articles discussing changes and associations in echocardiography and PTSD or related symptoms were synthesized for the current review. We have also included data from a case report of a male participant aged 33 years experiencing potentially psychologically traumatic events, who wore a noninvasive cardiac sensor to assess the timing intervals and contractility parameters of the cardiac cycle using seismocardiography. The intervals included systolic time, isovolumic contraction time (IVCT) and isovolumic relaxation time (IVRT). Calculations of systolic (IVCT/systole), diastolic (IVRT/systole) and myocardial [(IVCT+IVRT)/systole] performance indices were completed. RESULTS The review identified 55 articles, 14 of which assessed cardiac function using echocardiography in patients with PTSD symptoms. Cardiac dysfunction varied across studies, with diastolic and systolic impairments found in patients with PTSD. Our case study showed that occupational stress elevated cardiac performance indices, suggesting increased ventricular stress and supporting results in the existing literature. CONCLUSIONS The literature review results suggest that a controlled approach to assessing cardiac function in patients with PTSD is required. The case study results further suggest that acute bouts of stress can alter cardiac function, with potential for sustained occupational stress to induce changes in cardiac function. Cardiac monitoring can be used prospectively to identify changes induced by potentially psychologically traumatic event exposures that can lead to the development of PTSD symptoms.
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Affiliation(s)
- Jyotpal Singh
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, Saskatchewan, Canada
| | - R Nicholas Carleton
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
| | - J Patrick Neary
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, Saskatchewan, Canada
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Koraishy FM, Cohen BE, Scherrer JF, Whooley M, Hajagos J, Robinson-Cohen C, Hou W. The association of post-traumatic stress disorder with glomerular filtration rate decline. Nephrology (Carlton) 2023; 28:181-186. [PMID: 36594760 PMCID: PMC9974752 DOI: 10.1111/nep.14140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 12/23/2022] [Accepted: 12/27/2022] [Indexed: 01/04/2023]
Abstract
While major depression is known to be associated with glomerular filtration rate (GFR) decline, there is a lack of data on the association of other mental illnesses like posttraumatic stress disorder (PTSD) with kidney disease. In 640 adult participants of the Heart and Soul Study (mean baseline age of 66.2 years) with a high prevalence cardiovascular disease, hypertension and diabetes, we examined the association of PTSD with GFR decline over a 5-year follow-up. We observed a significantly greater estimated (e) GFR decline over time in those with PTSD compared to those without (2.97 vs. 2.11 ml/min/1.73 m2 /year; p = .022). PTSD was associated with 91% (95% CI 12%-225%) higher odds of 'rapid' versus 'mild' (>3.0 vs. <3.0 ml/min/1.73 m2 /per year) eGFR decline. These associations remained consistent despite controlling for demographics, medical comorbidities, other mental disorders and psychiatric medications. In conclusion, our study provides evidence that PTSD is independently associated with GFR decline in middle-aged adults with a high comorbidity burden. This association needs to be examined in larger cohorts with longer follow-ups.
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Affiliation(s)
- Farrukh M. Koraishy
- Division of Nephrology, Department of Medicine, Stony Brook University, NY
- Northport VA Medical Center, Northport, NY
| | - Beth E. Cohen
- Department of Medicine, University of California, San Francisco
- San Francisco VA Health Care System, San Francisco
| | | | - Mary Whooley
- Department of Medicine, University of California, San Francisco
- San Francisco VA Health Care System, San Francisco
| | - Janos Hajagos
- Department of Medical Bioinformatics, Stony Brook University, NY
| | | | - Wei Hou
- Department of Family, Population, and Preventive Medicine, Program in Public Health, Stony Brook University
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Screening for PTSD and TBI in Veterans using Routine Clinical Laboratory Blood Tests. Transl Psychiatry 2023; 13:64. [PMID: 36810280 PMCID: PMC9944218 DOI: 10.1038/s41398-022-02298-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/16/2022] [Accepted: 12/21/2022] [Indexed: 02/24/2023] Open
Abstract
Post-traumatic stress disorder (PTSD) is a mental disorder diagnosed by clinical interviews, self-report measures and neuropsychological testing. Traumatic brain injury (TBI) can have neuropsychiatric symptoms similar to PTSD. Diagnosing PTSD and TBI is challenging and more so for providers lacking specialized training facing time pressures in primary care and other general medical settings. Diagnosis relies heavily on patient self-report and patients frequently under-report or over-report their symptoms due to stigma or seeking compensation. We aimed to create objective diagnostic screening tests utilizing Clinical Laboratory Improvement Amendments (CLIA) blood tests available in most clinical settings. CLIA blood test results were ascertained in 475 male veterans with and without PTSD and TBI following warzone exposure in Iraq or Afghanistan. Using random forest (RF) methods, four classification models were derived to predict PTSD and TBI status. CLIA features were selected utilizing a stepwise forward variable selection RF procedure. The AUC, accuracy, sensitivity, and specificity were 0.730, 0.706, 0.659, and 0.715, respectively for differentiating PTSD and healthy controls (HC), 0.704, 0.677, 0.671, and 0.681 for TBI vs. HC, 0.739, 0.742, 0.635, and 0.766 for PTSD comorbid with TBI vs HC, and 0.726, 0.723, 0.636, and 0.747 for PTSD vs. TBI. Comorbid alcohol abuse, major depressive disorder, and BMI are not confounders in these RF models. Markers of glucose metabolism and inflammation are among the most significant CLIA features in our models. Routine CLIA blood tests have the potential for discriminating PTSD and TBI cases from healthy controls and from each other. These findings hold promise for the development of accessible and low-cost biomarker tests as screening measures for PTSD and TBI in primary care and specialty settings.
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Zolfa R, Moradi A, Mahdavi M, Parhoon H, Parhoon K, Jobson L. Feasibility and acceptability of written exposure therapy in addressing posttraumatic stress disorder in Iranian patients with breast cancer. Psychooncology 2023; 32:68-76. [PMID: 36116086 DOI: 10.1002/pon.6037] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 07/18/2022] [Accepted: 07/26/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE This study examined the feasibility and acceptability of written exposure therapy (WET) in reducing symptoms of posttraumatic stress disorder (PTSD) in Iranian women with breast cancer. Secondary aims included examining the influence of WET on quality of life (QoL), overgeneral memory and illness perceptions. METHOD Forty-six females with breast cancer and clinical symptoms of PTSD referred to the Razi Hospital in Rasht, Iran were randomly assigned to either WET (n = 23) or control (n = 23) groups. WET is a 5-session low-intensity exposure-based intervention for treating PTSD. The control group had no additional contact. Measures assessing PTSD, illness perceptions, overgeneral memory, and QoL were administered at baseline, post-intervention and 3-month follow-up. RESULTS Acceptability of WET was high; all participants completed all WET sessions. At post-intervention, 95.65% of the WET group met criteria for reliable change and 100% met criteria for minimal clinically important difference (MCID) and clinically significant change in PTSD symptom improvement. At follow-up, all WET participants met criteria for reliable change, MCID and clinically significant change in PTSD symptom improvement. No participants in the control group met reliable change, MCID or clinically significant change. The WET group had improved QoL and memory specificity and decreased threatening illness perceptions at post-intervention and follow-up when compared to controls. CONCLUSION WET may be a useful intervention for use with breast cancer patients with PTSD symptoms and may be an important adjunct to medical and pharmacological treatments, particularly in low- and middle-income countries. This study indicates further research in this area is warranted.
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Affiliation(s)
- Reihane Zolfa
- Department of Clinical Psychology, Kharazmi University, Tehran, Iran
| | - Alireza Moradi
- Kharazmi University and Institute for Cognitive Science Studies, Tehran, Iran
| | - Mohammad Mahdavi
- Kharazmi University and Institute for Cognitive Science Studies, Tehran, Iran
| | - Hadi Parhoon
- Department of Psychology, Razi University, Kermanshah, Iran
| | - Kamal Parhoon
- Postdoc Researcher in Cognitive Psychology, Kharazmi University, Tehran, Iran
| | - Laura Jobson
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
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Stigma Affects the Health-Related Quality of Life of People Living with HIV by Activating Posttraumatic Stress Symptoms. J Clin Psychol Med Settings 2022:10.1007/s10880-022-09928-y. [PMID: 36414787 DOI: 10.1007/s10880-022-09928-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2022] [Indexed: 11/23/2022]
Abstract
Stigma is a strong concern in the effort to manage the impact of many chronic diseases on patients and affects the quality of life (QoL) of patients, but little is understood regarding how this happens. We explored the perspective that stigma reduces health-related QoL (HRQoL) by evoking the traumatic experiences associated with HIV diagnosis. Outpatients (n = 250) receiving HIV-related care were recruited from 2 hospitals in the southeastern region of Nigeria. Participants completed measures of stigma, posttraumatic stress symptoms, and HRQoL. Mediation analyses were conducted using Hayes PROCESS Macro for SPSS. Result showed that stigma was negatively associated with HRQoL; patients who reported more traumatic symptoms also reported poorer HRQoL. Traumatic stress symptoms mediated the path between stigma and all the dimensions of HRQoL. Findings suggest that recognizing and addressing trauma symptoms are important in the management of PLWH. Perhaps addressing trauma would reduce the impact of stigma on HRQoL.
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Javanbakht A, Grasser LR, Kim S, Arfken CL, Nugent N. Perceived health, adversity, and posttraumatic stress disorder in Syrian and Iraqi refugees. Int J Soc Psychiatry 2022; 68:118-128. [PMID: 33269642 PMCID: PMC9678010 DOI: 10.1177/0020764020978274] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Exposure to armed conflict and fleeing country of origin for refugees has been associated with poorer psychological health. METHODS Within the first month following their arrival in the United States, 152 Syrian and Iraqi refugees were screened in a primary care setting for posttraumatic stress disorder (PTSD), anxiety, and depression and rated their perceived health, and perceived level of adversity of violence, armed conflict/flight. The moderating effects of psychiatric symptoms on the relation between perceived adversity and perceived health were assessed. RESULTS Three models based on diagnosis (PTSD, anxiety, and depression) were tested. While significant effects were found on perceived adversity negatively influencing perceived health across diagnoses, slightly different patterns emerged based on diagnosis. DISCUSSION Findings suggest that refugees' perception regarding adversity of violence, armed conflict, and flight may contribute to perceived health, with a moderating role of clinically significant symptoms of PTSD, anxiety, and depression.
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Affiliation(s)
- Arash Javanbakht
- Stress, Trauma, and Anxiety Research Clinic, Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | - Lana Ruvolo Grasser
- Stress, Trauma, and Anxiety Research Clinic, Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | - Soyeong Kim
- Department of Psychiatry, Brown University, Providence, RI, USA
| | - Cynthia L Arfken
- Stress, Trauma, and Anxiety Research Clinic, Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | - Nicole Nugent
- Department of Psychiatry, Brown University, Providence, RI, USA
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Alzahrani A, Alqahtani A, Saleh A, Aloqalaa M, Abdulmajeed A, Nadhrah A, Alhazmi N. Quality of life of cardiac outpatients with and without psychiatric disorders: a cross-sectional study. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2022. [DOI: 10.1186/s41983-021-00444-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The study aims to measure the quality of life (QOL) for cardiac outpatients with psychiatric disorders (CPP) in comparison to cardiac outpatients without psychiatric disorders (CPOP). A semi-structured interview was performed for consecutive cardiac outpatients. Psychiatric diagnoses were confirmed using the mini-international neuropsychiatric interview (MINI). The QOL was measured by the World Health Organization quality of life (WHOQOL-BREF).
Results
Out of the 343 enrolled patients, 93 (27.1%) patients were found to have psychiatric disorders. The WHO-BREF score of QOL was 4.25 ± 0.85. The CPP were found to have statistically significant lower scores in QOL than CPOP in all the WHOQOL-BREF domains. Particularly, the domain of psychological health showed the highest difference between the two groups (76.9 vs. 87.8, P < 0.001), whereas the environment domain showed the lowest difference between them (80.2 vs. 87.9, P < 0.001). Within each QOL domain, patients with congestive heart failure and psychiatric disorders showed the lowest QOL in both the physical domain (51.4 vs. 71.3, P < 0.02) and the social domain (64.7 vs. 81.9, P < 0.05), while patients with vulvular heart disease and psychiatric disorders showed the lowest QOL in the psychological domain (74.6 vs. 85.7, P < 0.001) and patients with arrhythmias and psychiatric disorders in the environment domain (80 vs. 86.2, P < 0.02).
Conclusions
The QOL of CPP were found to have poorer QOL than CPOP. The magnitude of difference in QOL was the highest in the psychological health domain and the lowest in the environment domain.
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Meeres J, Hariz M. Deep Brain Stimulation for Post-Traumatic Stress Disorder: A Review of the Experimental and Clinical Literature. Stereotact Funct Neurosurg 2022; 100:143-155. [PMID: 34979516 DOI: 10.1159/000521130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/12/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Up to 30% of patients with post-traumatic stress disorder (PTSD), especially combat veterans, remain refractory to conventional treatment. For them, deep brain stimulation (DBS) has been suggested. Here, we review the literature on animal models of PTSD in which DBS has been used to treat PTSD-type behavior, and we review and discuss patient reports of DBS for PTSD. METHODS A broad search was performed to find experimental animal articles and clinical reports on PubMed, Ovid MEDLINE, Cochrane Library, and PsycINFO, using combinations and variations of search words pertinent to DBS and PTSD. RESULTS The search yielded 30 articles, 24 on DBS in rat models of PTSD, and 6 publications between 2016 and 2020 reporting on a total of 3 patients. DBS in rat models targeted 4 brain areas: medial prefrontal cortex (mPFC), ventral striatum, amygdala, and hippocampus. Clinical publications reported on 2 male combat veterans who received DBS in basolateral amygdala, and 1 female with PTSD due to domestic abuse, who received DBS of mPFC. All 3 patients benefitted to various extents from DBS, at follow-ups of 4 years, 6 months, and 7 months, respectively. CONCLUSIONS PTSD is the only potential clinical indication for DBS that shows extensive animal research prior to human applications. Nevertheless, DBS for PTSD remains highly investigational. Despite several years of government funding of DBS research in view of treating severe PTSD in combat veterans, ethical dilemmas, recruitment difficulties, and issues related to use of DBS in such a complex and heterogenous disorder remain prevalent.
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Affiliation(s)
- Jennifer Meeres
- Unit of Functional Neurosurgery, UCL Institute of Neurology, London, United Kingdom
| | - Marwan Hariz
- Unit of Functional Neurosurgery, UCL Institute of Neurology, London, United Kingdom.,Department of Clinical Neuroscience, Umeå University, Umeå, Sweden
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Onu DU. Adherence to antiretroviral therapy mediates the link between posttraumatic stress disorder symptoms and health-related quality of life. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2021. [DOI: 10.1177/00812463211048122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Human immunodeficiency virus is one of the trauma-inducing chronic illnesses with attendant-negative impact on health-related quality of life. Substantial literature exists on the association of posttraumatic stress disorder symptoms and health-related quality of life among people living with human immunodeficiency virus, but little is known about the pathways explaining this link. This study therefore examined the mediating role of adherence to antiretroviral therapy in the association between posttraumatic stress disorder symptoms and health-related quality of life among people living with human immunodeficiency virus. Nine hundred and sixty-nine people living with human immunodeficiency virus in Nigeria who were on antiretroviral therapy completed measures of posttraumatic stress disorder symptoms, adherence to antiretroviral therapy, and health-related quality of life. Hayes PROCESS macro for SPSS was used to analyse the data. Adherence to antiretroviral therapy mediated the association between posttraumatic stress disorder symptoms and health-related quality of life in the relationship and treatment impact domains, implying that poor adherence to antiretroviral therapy is a pathway through which posttraumatic stress disorder symptoms exert negative influence on health-related quality of life of people living with human immunodeficiency virus. Interventions aimed at reducing the impact of posttraumatic stress disorder symptoms on quality of life of people living with human immunodeficiency virus should focus on improving clients’ level of adherence to antiretroviral therapy treatment.
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Allabadi H, Alkaiyat A, Zahdeh T, Assadi A, Ghanayim A, Hasan S, Abu Al Haj D, Allabadi L, Haj-Yahia S, Schindler C, Kwiatkowski M, Zemp E, Probst-Hensch N. Posttraumatic stress disorder predicts poor health-related quality of life in cardiac patients in Palestine. PLoS One 2021; 16:e0255077. [PMID: 34314470 PMCID: PMC8315523 DOI: 10.1371/journal.pone.0255077] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/09/2021] [Indexed: 11/20/2022] Open
Abstract
Background The longitudinal association of posttraumatic stress disorder (PTSD) with health-related quality of life (HRQL) in cardiac patients’ remains poorly studied, particularly in conflict-affected settings. Materials and methods For this cohort study, we used baseline and one-year follow-up data collected from patients 30 to 80 years old consecutively admitted with a cardiac diagnosis to four major hospitals in Nablus, Palestine. All subjects were screened for PTSD and HRQL using the PTSD Checklist Specific and the HeartQoL questionnaire. We used a generalized structural equation model (GSEM) to examine the independent predictive association of PTSD at baseline with HRQL at follow-up. We also examined the mediating roles of depression, anxiety, and stress at baseline. Results The prevalence of moderate-to-high PTSD symptoms among 1022 patients at baseline was 27∙0%. Patients with PTSD symptoms reported an approximate 20∙0% lower HRQL at follow-up. The PTSD and HRQL relationship was largely mediated by depressive and anxiety symptoms. It was not materially altered by adjustment for socio-demographic, clinical, and lifestyle factors. Discussion Our findings suggest that individuals with a combination of PTSD and depression, or anxiety are potentially faced with poor HRQL as a longer-term outcome of their cardiac disease. In Palestine, psychological disorders are often stigmatized; however, integration of mental health care with cardiac care may offer an entry door for addressing psychological problems in the population. Further studies need to assess the effective mental health interventions for improving quality of life in cardiac patients.
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Affiliation(s)
- Hala Allabadi
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Abdulsalam Alkaiyat
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Tamer Zahdeh
- Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Alaa Assadi
- Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Aya Ghanayim
- Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Shaden Hasan
- Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Dalia Abu Al Haj
- Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Liana Allabadi
- Faculty of Graduate Studies, Arab American University, Ramallah, Palestine
| | - Salim Haj-Yahia
- School of Clinical Sciences, University of Bristol, Bristol, United Kingdom
- Institute of Cardiovascular and Medical Sciences, Glasgow University, 126 University Place, Glasgow, United Kingdom
| | - Christian Schindler
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Marek Kwiatkowski
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Elisabeth Zemp
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Nicole Probst-Hensch
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- * E-mail:
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14
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Madel MB, Elefteriou F. Mechanisms Supporting the Use of Beta-Blockers for the Management of Breast Cancer Bone Metastasis. Cancers (Basel) 2021; 13:cancers13122887. [PMID: 34207620 PMCID: PMC8228198 DOI: 10.3390/cancers13122887] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 06/06/2021] [Accepted: 06/08/2021] [Indexed: 12/22/2022] Open
Abstract
Simple Summary Bone represents the most common site of metastasis for breast cancer and the establishment and growth of metastatic cancer cells within the skeleton significantly reduces the quality of life of patients and their survival. The interplay between sympathetic nerves and bone cells, and its influence on the process of breast cancer bone metastasis is increasingly being recognized. Several mechanisms, all dependent on β-adrenergic receptor signaling in stromal bone cells, were shown to promote the establishment of disseminated cancer cells into the skeleton. This review provides a summary of these mechanisms in support of the therapeutic potential of β-blockers for the early management of breast cancer metastasis. Abstract The skeleton is heavily innervated by sympathetic nerves and represents a common site for breast cancer metastases, the latter being the main cause of morbidity and mortality in breast cancer patients. Progression and recurrence of breast cancer, as well as decreased overall survival in breast cancer patients, are associated with chronic stress, a condition known to stimulate sympathetic nerve outflow. Preclinical studies have demonstrated that sympathetic stimulation of β-adrenergic receptors in osteoblasts increases bone vascular density, adhesion of metastatic cancer cells to blood vessels, and their colonization of the bone microenvironment, whereas β-blockade prevented these events in mice with high endogenous sympathetic activity. These findings in preclinical models, along with clinical data from breast cancer patients receiving β-blockers, support the pathophysiological role of excess sympathetic nervous system activity in the formation of bone metastases, and the potential of commonly used, safe, and low-cost β-blockers as adjuvant therapy to improve the prognosis of bone metastases.
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Affiliation(s)
| | - Florent Elefteriou
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX 77030, USA;
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA
- Correspondence:
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15
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Wooldridge JS, Herbert MS, Dochat C, Afari N. Understanding relationships between posttraumatic stress disorder symptoms, binge-eating symptoms, and obesity-related quality of life: the role of experiential avoidance. Eat Disord 2021; 29:260-275. [PMID: 33459212 PMCID: PMC8285449 DOI: 10.1080/10640266.2020.1868062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Obesity, binge-eating symptoms, and PTSD symptoms commonly co-occur. Avoidance, a key feature of PTSD and proposed mechanism of binge-eating, is one potential mechanism for explaining this clinical overlap. The purpose of the current study was to: 1) examine the associations between PTSD symptoms (PTSD Checklist-Civilian; PCL-C) and measures of bingeeating symptoms (Binge Eating Scale; BES) and obesity-related quality of life (Obesity Related Well-Being Questionnaire-97; ORWELL-97) in a sample of veterans with overweight or obesity (N = 89), and 2) determine whether experiential avoidance (The Acceptance and Action Questionnaire-II; AAQ-II) explains the relationship between PTSD symptoms and binge-eating symptoms, and PTSD symptoms and obesity-related quality of life, respectively. Scores on the PCL-C, BES, ORWELL-97, and AAQ-II were all significantly correlated. Linear regression analyses indicated that higher PCL-C scores were related to higher scores on the BES and ORWELL-97 after controlling for potentially confounding factors (BMI and race). Effect sizes were in the medium-large range. Further, AAQ-II mediated the relationship between PCL-C and ORWELL-97, but did not mediate the relationship between PCL-C and BES. These findings suggest that experiential avoidance should be considered in interventions addressing co-occurring PTSD, binge-eating, and poor obesity-related well-being. Longitudinal research is needed to better understand directionality of these relationships and changes over time.
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Affiliation(s)
- Jennalee S Wooldridge
- VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, California, USA.,Center of Excellence for Stress and Mental Health (CESAMH), San Diego, California, USA
| | - Matthew S Herbert
- VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, California, USA.,Center of Excellence for Stress and Mental Health (CESAMH), San Diego, California, USA
| | - Cara Dochat
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, California, San Diego, USA
| | - Niloofar Afari
- VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, California, USA.,Center of Excellence for Stress and Mental Health (CESAMH), San Diego, California, USA
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16
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Rahmat S, Velez J, Farooqi M, Smiley A, Prabhakaran K, Rhee P, Khan M, Dornbush R, Ferrando S, Smolin Y. Post-traumatic stress disorder can be predicted in hospitalized blunt trauma patients using a simple screening tool. Trauma Surg Acute Care Open 2021; 6:e000623. [PMID: 33880413 PMCID: PMC7993304 DOI: 10.1136/tsaco-2020-000623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) has debilitating psychiatric and medical consequences. The purpose of this study was to identify whether PTSD diagnosis and PTSD symptom scale score (PTSD severity) could be predicted by assessing peritraumatic experiences using a single question or screening tools at different time points in patients hospitalized after admission to the hospital after significant physical trauma, but with stable vitals (level II trauma). METHODS Patients completed the 'initial question' and the National Stressful Events Survey Acute Stress Disorder Scale (NSESSS) at 3 days to 5 days after trauma (NSESSS-1). The same scale was administered 2 weeks to 4 weeks after trauma (NSESSS-2). The Posttraumatic Stress Disorder Symptoms Scale Interview for DSM-5 (PSSI-5) was administered 2 months after trauma. PTSD diagnosis and PTSD severity were extracted from the PSSI-5. Linear multivariate regression analyses were used to establish whether scores for NSESSS-1 or NSESSS-2 predicted PTSD diagnosis/PTSD severity. Non-linear multivariate regression analyses were performed to better understand the relationship between NSESSS-1/NSESSS-2 and PTSD diagnosis/PTSD severity. RESULTS A single question assessing the experience of fear, helplessness, or horror was not an effective tool for determining the diagnosis of PTSD (p=0.114) but can be a predictor of PTSD severity (p=0.039). We demonstrate that administering the NSESSS after either 3 days to 5 days (p=0.008, p<0.001) or 2 weeks to 4 weeks (p=0.039; p<0.001) can predict the diagnosis of PTSD and PTSD severity. Scoring an NSESSS above 14/28 (50%) increases the chance of experiencing a higher PTSD severity substantially and linearly. DISCUSSION Our initial question was not an effective predictor of PTSD diagnosis. However, using the NSESSS at both 3 days to 5 days and 2 weeks to 4 weeks after trauma is an effective method for predicting PTSD diagnosis and PTSD severity. Additionally, we show that patients who score higher than 14 on the NSESSS for acute stress symptoms may need closer follow-up. LEVEL OF EVIDENCE Level III, prognostic.
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Affiliation(s)
- Saad Rahmat
- Department of Psychiatry and Behavioral Sciences, Westchester Medical Center, Valahlla, NY, USA
| | - Jessica Velez
- Department of Surgery, Westchester Medical Center Health Network, Valhalla, New York, USA
| | - Muhammad Farooqi
- Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, New York, USA
| | - Abbas Smiley
- Department of Surgery, New York Medical College, Valhalla, New York, USA
| | - Kartik Prabhakaran
- Department of Surgery, Westchester Medical Center Health Network, Valhalla, New York, USA
- Department of Surgery, New York Medical College, Valhalla, New York, USA
| | - Peter Rhee
- Department of Surgery, Westchester Medical Center Health Network, Valhalla, New York, USA
- Department of Surgery, New York Medical College, Valhalla, New York, USA
| | - Maria Khan
- New York Medical College, St. Vincent's Medical Center, Yonkers, New York, USA
| | - Rhea Dornbush
- Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, New York, USA
| | - Stephen Ferrando
- Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, New York, USA
| | - Yvette Smolin
- Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, New York, USA
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17
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Howard JT, Janak JC, Santos-Lozada AR, McEvilla S, Ansley SD, Walker LE, Spiro A, Stewart IJ. Telomere Shortening and Accelerated Aging in US Military Veterans. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041743. [PMID: 33670145 PMCID: PMC7916830 DOI: 10.3390/ijerph18041743] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 01/24/2023]
Abstract
A growing body of literature on military personnel and veterans’ health suggests that prior military service may be associated with exposures that increase the risk of cardiovascular disease (CVD), which may differ by race/ethnicity. This study examined the hypothesis that differential telomere shortening, a measure of cellular aging, by race/ethnicity may explain prior findings of differential CVD risk in racial/ethnic groups with military service. Data from the first two continuous waves of the National Health and Nutrition Examination Survey (NHANES), administered from 1999–2002 were analyzed. Mean telomere length in base pairs was analyzed with multivariable adjusted linear regression with complex sample design, stratified by sex. The unadjusted mean telomere length was 225.8 base shorter for individuals with prior military service. The mean telomere length for men was 47.2 (95% CI: −92.9, −1.5; p < 0.05) base pairs shorter for men with military service after adjustment for demographic, socioeconomic, and behavioral variables, but did not differ significantly in women with and without prior military service. The interaction between military service and race/ethnicity was not significant for men or women. The results suggest that military service may contribute to accelerated aging as a result of health damaging exposures, such as combat, injury, and environmental contaminants, though other unmeasured confounders could also potentially explain the results.
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Affiliation(s)
- Jeffrey T. Howard
- Department of Public Health, University of Texas at San Antonio, One UTSA Circle, San Antonio, TX 78249, USA; (S.M.); (S.D.A.)
- Consequences of Trauma Working Group, the Center for Community-Based and Applied Health Research, University of Texas at San Antonio, One UTSA Circle, San Antonio, TX 78249, USA
- Correspondence: ; Tel.: +1-210-458-2987
| | | | - Alexis R. Santos-Lozada
- Department of Human Development and Family Studies, Pennsylvania State University, 119 Health and Human Development Building, University Park, PA 16802, USA;
| | - Sarah McEvilla
- Department of Public Health, University of Texas at San Antonio, One UTSA Circle, San Antonio, TX 78249, USA; (S.M.); (S.D.A.)
| | - Stephanie D. Ansley
- Department of Public Health, University of Texas at San Antonio, One UTSA Circle, San Antonio, TX 78249, USA; (S.M.); (S.D.A.)
- Consequences of Trauma Working Group, the Center for Community-Based and Applied Health Research, University of Texas at San Antonio, One UTSA Circle, San Antonio, TX 78249, USA
| | - Lauren E. Walker
- David Grant USAF Medical Center, Travis Air Force Base, Fairfield, CA 94535, USA;
| | - Avron Spiro
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA 02130, USA;
- Departments of Epidemiology and Psychiatry, Boston University Schools of Public Health and Medicine, Boston, MA 02118, USA
| | - Ian J. Stewart
- Uniformed Services University of Health Sciences, Bethesda, MD 20814, USA;
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18
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Khan A, O’Donovan A, Neylan T, Gross J, Cohen B. Suppression, but not reappraisal, is associated with inflammation in trauma-exposed veterans. Psychoneuroendocrinology 2020; 122:104871. [PMID: 33010600 PMCID: PMC8425342 DOI: 10.1016/j.psyneuen.2020.104871] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/10/2020] [Accepted: 09/11/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Emotion dysregulation can elicit inflammatory activity. The current study examined whether specific maladaptive and adaptive emotion regulation strategies were associated with inflammatory markers in trauma-exposed veterans, above and beyond PTSD. METHODS In a cohort study, 606 participants exposed to a Criterion A trauma and recruited from Veteran Health Administration facilities completed fasting blood draws, the Emotion Regulation Questionnaire, and the Clinician Administered PTSD Scale-IV. Inflammation was assessed with high sensitivity C-reactive protein (hsCRP), white blood cell count (WBC), and fibrinogen levels. An inflammation index was created by summing standardized log-transformed levels of the three biomarkers. Our primary linear regression models were adjusted for sex, age, race, education, income, creatinine, and PTSD. RESULTS Suppression, but not cognitive reappraisal, was significantly associated with higher levels of the inflammatory index (β = 0.14, p = 0.001). Parallel analyses for the individual inflammatory markers also showed suppression, but not reappraisal, was significantly associated with higher hsCRP (β = 0.11, p = 0.01), WBC (β = 0.11, p = 0.01), and fibrinogen (β = 0.10, p = 0.02). CONCLUSIONS Emotional suppression is related to elevated systemic inflammation independent of PTSD. Cognitive reappraisal is unrelated to inflammation. Findings suggest over-utilization of maladaptive, rather than under-utilization of adaptive, emotion regulation strategies may be associated with systemic inflammation in trauma-exposed veterans.
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Affiliation(s)
- A.J. Khan
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, United States,Department of Psychiatry, University of California, San Francisco, CA, United States,Corresponding author at: San Francisco VA Health Care System 4150 Clement Street, San Francisco, CA, 94121, United States. (A.J. Khan)
| | - A. O’Donovan
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, United States,Department of Psychiatry, University of California, San Francisco, CA, United States
| | - T.C. Neylan
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, United States,School of Medicine, University of California, San Francisco, CA, United States
| | - J.J. Gross
- Department of Psychology, Stanford University, Stanford, CA, United States
| | - B.E. Cohen
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, United States,School of Medicine, University of California, San Francisco, CA, United States
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19
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Ahmadian AJ, Lin JE, Neylan TC, Woolley JD, O'Donovan A, Cohen BE. Social integration and inflammation in individuals with and without posttraumatic stress disorder. Brain Behav Immun 2020; 89:168-174. [PMID: 32534985 PMCID: PMC8388310 DOI: 10.1016/j.bbi.2020.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 06/04/2020] [Accepted: 06/06/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is associated with increased risk for morbidity and mortality, which may be mediated through elevated inflammation. In contrast, social support appears to protect against morbidity and mortality, reduce levels of inflammation, and improve PTSD outcomes. METHODS We examined relationships among social isolation, perceived social support, and inflammation in Veterans Affairs (VA) patients with and without PTSD. Our sample included 735 (35% PTSD+) participants from the Mind Your Heart Study (mean age = 58 ± 11; 94% male). Social isolation was assessed with the Berkman Syme Social Network Index; perceived social support with the Multidimensional Scale of Perceived Social Support; and PTSD with the Clinician Administered PTSD Scale. Inflammation was indexed by high sensitivity C-reactive protein, white blood cell count, and fibrinogen. Hierarchical linear regression was used to examine associations between social measures and inflammation. PROCESS was used to examine the interactive effects of social relationships and PTSD on inflammation. RESULTS Social isolation, but not low perceived social support, trended towards an association with elevated inflammation in the full sample. However, considering groups with and without PTSD separately, social isolation was significantly associated with all inflammatory markers among individuals without PTSD, but not among those with PTSD. CONCLUSIONS Social integration is associated with reduced inflammation in individuals without, but not with, PTSD. Socially integrated individuals with PTSD did not have lower levels of inflammatory markers than socially isolated individuals with PTSD.
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Affiliation(s)
- Ashkan J Ahmadian
- San Francisco Veterans Affairs Medical Center and Mental Illness Research, Education and Clinical Center, San Francisco, CA, USA; Department of Internal Medicine, St. Mary's Medical Center, San Francisco, CA, USA
| | - Joy E Lin
- San Francisco Veterans Affairs Medical Center and Mental Illness Research, Education and Clinical Center, San Francisco, CA, USA; Department of Neurology, Stanford University, Palo Alto, CA, USA
| | - Thomas C Neylan
- San Francisco Veterans Affairs Medical Center and Mental Illness Research, Education and Clinical Center, San Francisco, CA, USA; Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Joshua D Woolley
- San Francisco Veterans Affairs Medical Center and Mental Illness Research, Education and Clinical Center, San Francisco, CA, USA; Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Aoife O'Donovan
- San Francisco Veterans Affairs Medical Center and Mental Illness Research, Education and Clinical Center, San Francisco, CA, USA; Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Beth E Cohen
- San Francisco Veterans Affairs Medical Center and Mental Illness Research, Education and Clinical Center, San Francisco, CA, USA; Department of Internal Medicine, University of California, San Francisco, CA, USA.
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20
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Shih CH, Thalla PR, Elhai JD, Mathews J, Brickman KR, Redfern RE, Xie H, Wang X. Preliminary study examining the mediational link between mild traumatic brain injury, acute stress, and post-traumatic stress symptoms following trauma. Eur J Psychotraumatol 2020; 11:1815279. [PMID: 33133419 PMCID: PMC7580736 DOI: 10.1080/20008198.2020.1815279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background: The presence of mild traumatic brain injury (mTBI) increases post-traumatic stress disorder (PTSD) symptoms in the months following injury. However, factors that link mTBI and PTSD development are still unclear. Acute stress responses after trauma have been associated with PTSD development. mTBI may impair cognitive functions and increase anxiety immediately after trauma. Objective: This research aimed to test the possibility that mTBI increases acute stress symptoms rapidly, which in turn results in PTSD development in the subsequent months. Method: Fifty-nine patients were recruited from the emergency rooms of local hospitals. Post-mTBI, acute stress, and PTSD symptom severity were measured using the Rivermead Post-Concussion Symptoms Questionnaire (RPQ), Acute Stress Disorder Scale (ASDS), and PTSD Checklist for DSM-5 (PCL-5), respectively. Results: Moderated mediation analysis indicated that ASDS, at 2 weeks post-trauma, mediated the relationship between RPQ scores at 2 weeks and PCL-5 scores at 3 months post-trauma, only for patients who met mTBI diagnostic criteria. Conclusions: These findings present preliminary evidence suggesting that acute stress disorder symptoms may be one of the mechanisms involved in the development of PTSD among trauma survivors who have experienced mTBI, which provides a theoretical basis for early intervention of PTSD prevention after mTBI.
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Affiliation(s)
- Chia-Hao Shih
- Department of Psychiatry, University of Toledo, Toledo, OH, USA
| | | | - Jon D Elhai
- Department of Psychiatry, University of Toledo, Toledo, OH, USA.,Department of Psychology, University of Toledo, Toledo, OH, USA
| | - Jeremy Mathews
- Department of Psychiatry, University of Toledo, Toledo, OH, USA
| | | | | | - Hong Xie
- Department of Neurosciences, University of Toledo, Toledo, OH, USA
| | - Xin Wang
- Department of Psychiatry, University of Toledo, Toledo, OH, USA.,Department of Neurosciences, University of Toledo, Toledo, OH, USA
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21
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Bukhbinder AS, Wang AC, Qureshi SU, Arora G, Jawaid A, Kalkonde YV, Petersen NJ, Yu HJ, Kimbrell T, Pyne JM, Magruder KM, Hudson TJ, Bush RL, Kunik ME, Schulz PE. Increased Vascular Pathology in Older Veterans With a Purple Heart Commendation or Chronic Post-Traumatic Stress Disorder. J Geriatr Psychiatry Neurol 2020; 33:195-206. [PMID: 31426715 DOI: 10.1177/0891988719868308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The goal of this retrospective cohort study was to determine whether stressors related to military service, determined by a diagnosis of chronic post-traumatic stress disorder (cPTSD) or receiving a Purple Heart (PH), are associated with an increased risk of vascular risk factors and disease, which are of great concern for veterans, who constitute a significant portion of the aging US population. The Veterans Integrated Service Network (VISN) 16 administrative database was searched for individuals 65 years or older between October 1, 1997 to September 30, 1999 who either received a PH but did not have cPTSD (PH+/cPTSD-; n = 1499), had cPTSD without a PH (PH-/cPTSD+; n = 3593), had neither (PH-/cPTSD-; n = 5010), or had both (PH+/cPTSD+; n = 153). In comparison to the control group (PH-/cPTSD-), the PH+/cPTSD- group had increased odds ratios for incidence and prevalence of diabetes mellitus, hypertension, and hyperlipidemia. The PH-/cPTSD+ group had increased odds ratios for prevalence of diabetes mellitus and for the incidence and prevalence of hyperlipidemia. The PH-/cPTSD+ and PH+/cPTSD- groups were associated with ischemic heart disease and cerebrovascular disease, but not independently of the other risk factors. The PH+/cPTSD+ group was associated only with an increase in the incidence and prevalence of hyperlipidemia, though this group's much smaller sample size may limit the reliability of this finding. We conclude that certain physical and psychological stressors related to military service are associated with a greater incidence of several vascular risk factors in veterans aged 65 years or older, which in turn are associated with greater rates of ischemic heart disease and cerebrovascular disease.
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Affiliation(s)
- Avram S Bukhbinder
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.,Mischer Neuroscience Institute, McGovern Medical School at UTHealth and Memorial Hermann-Texas Medical Center, Houston, TX, USA
| | - Austin C Wang
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.,Mischer Neuroscience Institute, McGovern Medical School at UTHealth and Memorial Hermann-Texas Medical Center, Houston, TX, USA
| | - Salah U Qureshi
- Houston Veterans Affairs Health Services Research and Development Service Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.,Baylor College of Medicine, Houston, TX, USA.,Veterans Affairs South Central Mental Illness Research, Education and Clinical Center, Little Rock, AR, USA
| | - Garima Arora
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.,Mischer Neuroscience Institute, McGovern Medical School at UTHealth and Memorial Hermann-Texas Medical Center, Houston, TX, USA
| | - Ali Jawaid
- Laboratory of Neuroepigenetics, Brain Research Institute, University of Zurich, Zurich, Switzerland
| | | | - Nancy J Petersen
- Houston Veterans Affairs Health Services Research and Development Service Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.,Baylor College of Medicine, Houston, TX, USA
| | - Hong-Jen Yu
- Houston Veterans Affairs Health Services Research and Development Service Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Timothy Kimbrell
- Veterans Affairs South Central Mental Illness Research, Education and Clinical Center, Little Rock, AR, USA.,Center for Mental Health and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock, AR, USA.,Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jeffrey M Pyne
- Veterans Affairs South Central Mental Illness Research, Education and Clinical Center, Little Rock, AR, USA.,Center for Mental Health and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock, AR, USA.,Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Kathy M Magruder
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Teresa J Hudson
- Veterans Affairs South Central Mental Illness Research, Education and Clinical Center, Little Rock, AR, USA.,Center for Mental Health and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock, AR, USA.,Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ruth L Bush
- Baylor College of Medicine, Houston, TX, USA
| | - Mark E Kunik
- Houston Veterans Affairs Health Services Research and Development Service Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.,Baylor College of Medicine, Houston, TX, USA.,Veterans Affairs South Central Mental Illness Research, Education and Clinical Center, Little Rock, AR, USA
| | - Paul E Schulz
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.,Mischer Neuroscience Institute, McGovern Medical School at UTHealth and Memorial Hermann-Texas Medical Center, Houston, TX, USA
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22
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Goreis A, Felnhofer A, Kafka JX, Probst T, Kothgassner OD. Efficacy of Self-Management Smartphone-Based Apps for Post-traumatic Stress Disorder Symptoms: A Systematic Review and Meta-Analysis. Front Neurosci 2020; 14:3. [PMID: 32038153 PMCID: PMC6992648 DOI: 10.3389/fnins.2020.00003] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 01/06/2020] [Indexed: 02/06/2023] Open
Abstract
Post-traumatic stress disorder (PTSD) symptoms are prevalent in both civilian and military service members. As the number of smartphone-based applications (apps) grows rapidly in health care, apps are also increasingly used to help individuals with subthreshold PTSD or full PTSD. Yet, if the apps are self-managed, the feasibility and efficacy of such interventions are still rather unclear in these two populations with PTSD symptoms. Hence, the present meta-analysis set out to evaluate the effect of self-management smartphone-based apps on PTSD and depressive symptoms in populations with subthreshold PTSD or full PTSD. Studies were included if they conducted randomized controlled trials or pre-post comparisons. Six studies (n = 2 randomized controlled trials) were identified for meta-analysis. In pre-post comparisons, N = 209 participants were included in the analyses. In randomized controlled trials, N = 87 participants received smartphone-based self-management interventions and N = 82 participants were in waitlist control conditions. Meta-analysis for pre-post comparisons concluded an effect of g = 0.55 (p < 0.001) regarding the overall reduction in PTSD symptoms (n = 6) and g = 0.45 (p < 0.001) for reduction in depressive symptoms (n = 5). Yet, in randomized controlled trials, no significant difference was found between app-based treatment and waitlist control groups (g = 0.09, p = 0.574). The duration of the interventions did not significantly influence the results. Overall, despite positive pre-post effects, current results indicate that smartphone-apps for PTSD patients are not significantly more effective than waitlist control conditions. Nevertheless, a combined smartphone and standard therapy approach may be a fruitful field for future research.
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Affiliation(s)
- Andreas Goreis
- Department for Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria.,Outpatient Unit for Research, Teaching and Practice, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Anna Felnhofer
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Johanna Xenia Kafka
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Thomas Probst
- Department for Psychotherapy and Biopsychosocial Health, Danube University Krems, Krems, Austria
| | - Oswald D Kothgassner
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
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Musey PI, Schultebraucks K, Chang BP. Stressing Out About the Heart: A Narrative Review of the Role of Psychological Stress in Acute Cardiovascular Events. Acad Emerg Med 2020; 27:71-79. [PMID: 31675448 DOI: 10.1111/acem.13882] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 10/29/2019] [Accepted: 10/31/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Survivors of acute cardiovascular disease (CVD) events, such as acute coronary syndrome (ACS) and stroke, may experience significant psychological distress during and following the acute event. Long-term adverse effects may follow, including the development of posttraumatic stress disorder (PTSD), increased overall all-cause mortality, and recurrent cardiac events. The goal of this concepts paper is to describe and summarize the rates of adverse psychological outcomes, such as PTSD, following cardiovascular emergencies, to review how these psychological factors are associated with increased risk of future events and long-term health and to provide a theoretical framework for future work. METHODS A panel of two board-certified emergency physicians, one with a doctorate in experimental psychology, along with one PhD clinical psychologist with expertise in psychoneuroendocrinology were co-authors involved in the paper. Each author used various search strategies (e.g., PubMed, Psycinfo, Cochrane, and Google Scholar) for primary research and reviewed articles related to their section. The references were reviewed and evaluated for relevancy and included based on review by the lead authors RESULTS: A meta-analysis of 24 studies (N > 2,300) found the prevalence of ACS-induced PTSD at nearly 12%, while a meta-analysis of nine studies (N = 1,138) found that 25% of survivors of transient ischemic attack and stroke report PTSD symptoms. The presence of PTSD doubles 3-year risk of CVD/mortality risk in ACS survivors. Cardiac patients treated during periods of ED overcrowding, hallway care, and perceived poor clinician-patient communication appear at greater risk for subsequent PTSD. CONCLUSIONS Psychological stress is often present in patients undergoing evaluation for acute CVD events. Understanding such associations provides a foundation to appreciate the potential contribution of psychological variables on acute and long-term cardiovascular recovery, while also stimulating future areas of research and discovery.
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Affiliation(s)
- Paul I. Musey
- Department of Emergency Medicine Indiana University School of Medicine Indianapolis IN
| | | | - Bernard P. Chang
- Department of Emergency Medicine Columbia University Medical Center New York NY
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24
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Impact of Wartime Stress Exposures and Mental Health on Later-Life Functioning and Disability in Vietnam-Era Women Veterans: Findings From the Health of Vietnam-Era Women's Study. Psychosom Med 2020; 82:147-157. [PMID: 31714370 PMCID: PMC8845064 DOI: 10.1097/psy.0000000000000762] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE The effect of stress exposures and mental health sequelae on health-related outcomes is understudied among older women veterans. We examined a) the impact of wartime stress exposures on later-life functioning and disability in Vietnam-era women veterans and b) the extent to which mental health conditions known to be associated with stress-posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and generalized anxiety disorder (GAD)-are associated with additional later-life functioning and disability. METHODS Data were collected in 2011 to 2012 using a mail survey and telephone interview of 4219 women veterans who were active duty during the Vietnam Era. Health functioning was assessed using the Veterans RAND 36-Item Health Survey, and disability was assessed using the World Health Organization Disability Assessment Schedule 2.0. Wartime exposures were assessed using the Women's War-Zone Stressor Scale-Revised; the Composite International Diagnostic Interview, version 3.0 was used to assess PTSD, MDD, and GAD. RESULTS Several wartime stress exposures-including job-related pressures, dealing with death, and sexual discrimination and harassment-were associated with worse later-life health (β ranges, -0.04 to -0.26 for functioning, 0.05 to 0.30 for disability). Current PTSD was linked with lower health functioning (physical, β = -0.06; mental, β = -0.15) and greater disability (β = 0.14). Current MDD and GAD were also associated with lower mental health functioning (MDD, β = -0.29; GAD, β = -0.10) and greater disability (MDD, β = 0.16; GAD, β = 0.06). CONCLUSIONS Results underscore the importance of detection and treatment of the potential long-term effects of wartime stressors and mental health conditions among women veterans.
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25
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Meli L, Birk J, Edmondson D, Bonanno GA. Trajectories of posttraumatic stress in patients with confirmed and rule-out acute coronary syndrome. Gen Hosp Psychiatry 2020; 62:37-42. [PMID: 31775067 PMCID: PMC9255559 DOI: 10.1016/j.genhosppsych.2019.11.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 11/06/2019] [Accepted: 11/13/2019] [Indexed: 12/13/2022]
Abstract
Many patients evaluated in the emergency department (ED) for acute coronary syndrome (ACS) develop posttraumatic stress symptoms (PTSS), but little is known about symptom trajectories over time. We estimated longitudinal trajectories of PTSS from ED to 1 year after evaluation for suspected ACS (N = 1000), and the effect of threat perceptions and discharge diagnosis. Participants reported on threat perceptions in the ED, ongoing cardiac threat at 1 month, and PTSS at 1, 6, and 12 months. Latent growth mixture modeling identified 3 PTSS trajectories over 1 year: Resilient (81.75%), Chronic-Worsening (13.69%), and Acute-Recovering (4.56%). Chronic-Worsening and Acute-Recovering classes reported significantly higher ED and cardiac threat perceptions than Resilient class. Discharge diagnosis did not differ (χ2(2) = 2.93, p = .231). PTSS are common following evaluation for suspected ACS, and trajectories vary, but targeting threat perceptions may reduce PTSS and improve clinical course, whether or not patients are ultimately diagnosed with ACS.
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Affiliation(s)
- Laura Meli
- Columbia University, Teachers College, 525 West 120(th) Street, HM330, New York, NY, USA; Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 West 168(th) Street, PH-9(th) Floor, New York, NY, USA.
| | - Jeffrey Birk
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 West 168(th) Street, PH-9(th) Floor, New York, NY, USA.
| | - Donald Edmondson
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 West 168(th) Street, PH-9(th) Floor, New York, NY, USA.
| | - George A. Bonanno
- Columbia University, Teachers College, 525 West 120th Street, HM330, New York, NY, USA
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26
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Multi-omic biomarker identification and validation for diagnosing warzone-related post-traumatic stress disorder. Mol Psychiatry 2020; 25:3337-3349. [PMID: 31501510 PMCID: PMC7714692 DOI: 10.1038/s41380-019-0496-z] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 05/15/2019] [Accepted: 06/24/2019] [Indexed: 01/01/2023]
Abstract
Post-traumatic stress disorder (PTSD) impacts many veterans and active duty soldiers, but diagnosis can be problematic due to biases in self-disclosure of symptoms, stigma within military populations, and limitations identifying those at risk. Prior studies suggest that PTSD may be a systemic illness, affecting not just the brain, but the entire body. Therefore, disease signals likely span multiple biological domains, including genes, proteins, cells, tissues, and organism-level physiological changes. Identification of these signals could aid in diagnostics, treatment decision-making, and risk evaluation. In the search for PTSD diagnostic biomarkers, we ascertained over one million molecular, cellular, physiological, and clinical features from three cohorts of male veterans. In a discovery cohort of 83 warzone-related PTSD cases and 82 warzone-exposed controls, we identified a set of 343 candidate biomarkers. These candidate biomarkers were selected from an integrated approach using (1) data-driven methods, including Support Vector Machine with Recursive Feature Elimination and other standard or published methodologies, and (2) hypothesis-driven approaches, using previous genetic studies for polygenic risk, or other PTSD-related literature. After reassessment of ~30% of these participants, we refined this set of markers from 343 to 28, based on their performance and ability to track changes in phenotype over time. The final diagnostic panel of 28 features was validated in an independent cohort (26 cases, 26 controls) with good performance (AUC = 0.80, 81% accuracy, 85% sensitivity, and 77% specificity). The identification and validation of this diverse diagnostic panel represents a powerful and novel approach to improve accuracy and reduce bias in diagnosing combat-related PTSD.
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27
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Li X, Aida J, Hikichi H, Kondo K, Kawachi I. Association of Postdisaster Depression and Posttraumatic Stress Disorder With Mortality Among Older Disaster Survivors of the 2011 Great East Japan Earthquake and Tsunami. JAMA Netw Open 2019; 2:e1917550. [PMID: 31834397 PMCID: PMC6991206 DOI: 10.1001/jamanetworkopen.2019.17550] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
IMPORTANCE Depression and posttraumatic stress disorder (PTSD) represent 2 common mental health sequelae of natural disasters. However, to date, no studies have examined whether postdisaster depression and PTSD are associated with increased risk of mortality among community-dwelling survivors of natural disasters. OBJECTIVE To assess whether postdisaster depression and PTSD were associated with mortality in older disaster survivors. DESIGN, SETTING, AND PARTICIPANTS In this cohort study, prospective data were retrieved from older Japanese adults in Iwanuma City, Miyagi Prefecture, which was directly affected by the 2011 Great East Japan Earthquake and Tsunami. The baseline was established 7 months before the disaster (August 2010), and follow-up surveys were conducted approximately 2.5 years afterward (October 1, 2013, to January 31, 2014). Invitations were mailed to every citizen 65 years or older in Iwanuma City. Mortality data were obtained through March 4, 2017. Data analysis was performed from December 1, 2018, to June 30, 2019. EXPOSURES Postdisaster depression (Geriatric Depression Scale Short Form score ≥5) and PTSD (Screening Questionnaire for Disaster Mental Health PTSD subscale score ≥4) were measured in 2013. MAIN OUTCOMES AND MEASURES Mortality data were obtained by linkage to the national long-term care insurance database. Cox proportional hazards regression models were adjusted for predisaster sociodemographic characteristics, health behaviors, social cohesion, predisaster depression, and disaster experiences. RESULTS The response rate for the baseline survey was 59.0% (5058 of 8567 individuals), and the follow-up rate was 82.1% (3594 of 4380 eligible respondents). A total of 2965 individuals (mean [SD] age, 73.4 [6.2] years; 1621 [54.7%] female) participated in the study. The mean (SD) follow-up since the 2013 survey was 3.3 (0.5) years. Overall, 974 (32.8%) reported postdisaster depression and 747 (25.2%) reported PTSD. In adjusted models, depression was associated with more than double the risk of mortality (hazard ratio, 2.29; 95% CI, 1.54-3.42); PTSD was not associated with increased risk of mortality (hazard ratio, 1.10; 95% CI, 0.73-1.64). When evaluating the association of the 4-category comorbid depression and PTSD variable with mortality, survivors with depression only (HR, 2.24; 95% CI, 1.43-3.49) as well as those with comorbid depression and PTSD (HR, 2.54; 95% CI, 1.50-4.27) were at increased risk of death during the follow-up period compared with those with neither depression nor PTSD. CONCLUSIONS AND RELEVANCE Depression, but not PTSD, was associated with mortality during 3.3 years of follow-up among older disaster survivors. These findings suggest that long-term mental health consequences of natural disasters may exist and that treating depression in older survivors of disasters may be beneficial.
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Affiliation(s)
- Xiaoyu Li
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Jun Aida
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Miyagi Prefecture, Japan
| | - Hiroyuki Hikichi
- Division of Community Medicine and Public Health Practice, School of Public Health, University of Hong Kong, Hong Kong
| | - Katsunori Kondo
- Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
- Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Ahmadian AJ, Neylan TC, Metzler T, Cohen BE. Longitudinal association of PTSD symptoms and self-reported physical functioning among Veterans. J Affect Disord 2019; 250:1-8. [PMID: 30818050 DOI: 10.1016/j.jad.2019.02.048] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 02/13/2019] [Accepted: 02/17/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND Few longitudinal studies have investigated the potentially dynamic relationship between Posttraumatic Stress Disorder (PTSD) and physical functioning, and the number of follow-up timepoints have been limited. We evaluated whether PTSD symptoms predicted future physical functioning and vice versa using five assessments over four years. METHODS Data was used from a longitudinal cohort of 695 participants recruited from Veteran Affairs medical outpatient clinics who experienced a traumatic event. PTSD symptom severity was assessed annually with the PTSD Checklist (PCL). Physical functioning was measured with the 10-item subscale of the SF-36. An autoregressive cross-lagged panel model was used to determine the temporal associations between PTSD and physical functioning, adjusting for age, sex, ethnicity, education and employment. Comorbidities and health behaviors were added to assess their roles in the relationship. RESULTS Greater PTSD symptom severity predicted worse physical functioning the following year (average β = -0.10, P <0.001), where a 10-point increase in PCL score predicted a 0.3-point decline in physical function score over one year. Similarly, better physical functioning also predicted reduced PTSD severity the following year, but to a smaller magnitude (average β = -0.04, P = .003). The pattern of effects was similar after controlling for comorbidities and health behaviors. LIMITATIONS Both primary variables relied on self-report, and generalizability may be limited by the mostly male Veteran sample. CONCLUSIONS Our results support a bidirectional, but unequal, relationship between PTSD and physical functioning over time. They also highlight the importance of long-term control of PTSD symptoms in preventing functional decline.
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Affiliation(s)
- Ashkan J Ahmadian
- San Francisco Veteran Affairs Medical Center and Mental Illness Research, Education and Clinical Center, San Francisco, CA, USA; School of Medicine, University of California, San Francisco, CA, USA.
| | - Thomas C Neylan
- San Francisco Veteran Affairs Medical Center and Mental Illness Research, Education and Clinical Center, San Francisco, CA, USA; Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Thomas Metzler
- San Francisco Veteran Affairs Medical Center and Mental Illness Research, Education and Clinical Center, San Francisco, CA, USA
| | - Beth E Cohen
- San Francisco Veteran Affairs Medical Center and Mental Illness Research, Education and Clinical Center, San Francisco, CA, USA; Department of Internal Medicine, University of California, San Francisco, CA, USA
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29
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Koek RJ, Luong TN. Theranostic pharmacology in PTSD: Neurobiology and timing. Prog Neuropsychopharmacol Biol Psychiatry 2019; 90:245-263. [PMID: 30529001 DOI: 10.1016/j.pnpbp.2018.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 11/17/2018] [Accepted: 12/05/2018] [Indexed: 02/06/2023]
Abstract
Recent reviews and treatment guidelines regard trauma-focused cognitive-behavior therapies as the treatments of choice for chronic post-traumatic stress disorder (PTSD). However, many patients do not engage in this treatment when it is available, drop out before completion, or do not respond. Medications remain widely used, alone and in conjunction with psychotherapy, although the limitations of traditional monoamine-based pharmacotherapy are increasingly recognized. This article will review recent developments in psychopharmacology for PTSD, with a focus on current clinical data that apply putative neurobiologic mechanisms to medication use-i.e., a theranostic approach. A theranostic approach however, also requires consideration of timing, pre, peri or post trauma in conjunction with underlying dynamic processes affecting synaptic plasticity, the HPA axis, hippocampal activation, PFC-amygdala circuitry and fear memory.
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Affiliation(s)
- Ralph J Koek
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Sepulveda Ambulatory Care Center, VA Greater Los Angeles Healthcare System, North Hills, CA, USA.
| | - Tinh N Luong
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Olive View Medical Center, Sylmar, CA, USA
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30
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The Impact of Cardiac-induced Post-traumatic Stress Disorder Symptoms on Cardiovascular Outcomes: Design and Rationale of the Prospective Observational Reactions to Acute Care and Hospitalizations (ReACH) Study. HEALTH PSYCHOLOGY BULLETIN 2019; 3:10-20. [PMID: 31903438 PMCID: PMC6941797 DOI: 10.5334/hpb.16] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Aims: As many as 1 in 8 acute coronary syndrome (ACS) patients develop posttraumatic stress disorder (PTSD) due to the ACS, and ACS-induced PTSD may increase secondary cardiovascular disease (CVD) risk. However, prior studies have been small and underpowered to test plausible behavioral or biological mechanisms of the hypothesized PTSD-secondary CVD risk association. In this paper, we describe the design and methods of a large prospective observational cohort study to estimate the prognostic significance of ACS-induced PTSD, mechanisms for its association with CVD risk, and emergency department (ED) factors that may increase PTSD risk, in a cohort of patients evaluated for acute coronary syndrome (ACS) in the ED of a large, urban academic medical center. Methods: The Reactions to Acute Care and Hospitalization (ReACH) study follows 1,741 racially, ethnically, and socioeconomically diverse patients initially presenting to the ED with ACS symptoms. Psychosocial factors are assessed at baseline. Medication adherence is monitored by electronic pill bottle (eCAP). Participants are contacted by phone at 1-, 6-, and 12-months post-hospitalization to assess PTSD symptoms, hospital readmission, and recurrent CVD events/mortality (proactively searched and confirmed by medical records). Conclusion: This study will provide the most accurate estimates to date of PTSD’s association with recurrent CVD events and mortality and will test whether medication adherence mediates that association. Further, it will provide estimates of the contribution of ED and hospital factors to PTSD risk in ACS patients. If our hypotheses are supported, we will have identified PTSD as a novel target for secondary risk reduction.
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31
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Agorastos A, Nicolaides NC, Bozikas VP, Chrousos GP, Pervanidou P. Multilevel Interactions of Stress and Circadian System: Implications for Traumatic Stress. Front Psychiatry 2019; 10:1003. [PMID: 32047446 PMCID: PMC6997541 DOI: 10.3389/fpsyt.2019.01003] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 12/19/2019] [Indexed: 12/11/2022] Open
Abstract
The dramatic fluctuations in energy demands by the rhythmic succession of night and day on our planet has prompted a geophysical evolutionary need for biological temporal organization across phylogeny. The intrinsic circadian timing system (CS) represents a highly conserved and sophisticated internal "clock," adjusted to the 24-h rotation period of the earth, enabling a nyctohemeral coordination of numerous physiologic processes, from gene expression to behavior. The human CS is tightly and bidirectionally interconnected to the stress system (SS). Both systems are fundamental for survival and regulate each other's activity in order to prepare the organism for the anticipated cyclic challenges. Thereby, the understanding of the temporal relationship between stressors and stress responses is critical for the comprehension of the molecular basis of physiology and pathogenesis of disease. A critical loss of the harmonious timed order at different organizational levels may affect the fundamental properties of neuroendocrine, immune, and autonomic systems, leading to a breakdown of biobehavioral adaptative mechanisms with increased stress sensitivity and vulnerability. In this review, following an overview of the functional components of the SS and CS, we present their multilevel interactions and discuss how traumatic stress can alter the interplay between the two systems. Circadian dysregulation after traumatic stress exposure may represent a core feature of trauma-related disorders mediating enduring neurobiological correlates of trauma through maladaptive stress regulation. Understanding the mechanisms susceptible to circadian dysregulation and their role in stress-related disorders could provide new insights into disease mechanisms, advancing psychochronobiological treatment possibilities and preventive strategies in stress-exposed populations.
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Affiliation(s)
- Agorastos Agorastos
- Department of Psychiatry, Division of Neurosciences, Faculty of Medical Sciences, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.,VA Center of Excellence for Stress and Mental Health (CESAMH), VA San Diego Healthcare System, San Diego, CA, United States
| | - Nicolas C Nicolaides
- First Department of Pediatrics, Division of Endocrinology, Metabolism and Diabetes, School of Medicine, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Vasilios P Bozikas
- Department of Psychiatry, Division of Neurosciences, Faculty of Medical Sciences, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George P Chrousos
- First Department of Pediatrics, Division of Endocrinology, Metabolism and Diabetes, School of Medicine, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Athens, Greece.,Unit of Developmental & Behavioral Pediatrics, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Panagiota Pervanidou
- Unit of Developmental & Behavioral Pediatrics, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Athens, Greece
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32
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Cohn E, Lurie I, Yang YX, Bilker WB, Haynes K, Mamtani R, Shacham-Shmueli E, Margalit O, Boursi B. Posttraumatic Stress Disorder and Cancer Risk: A Nested Case-Control Study. J Trauma Stress 2018; 31:919-926. [PMID: 30520529 DOI: 10.1002/jts.22345] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 08/19/2018] [Accepted: 08/20/2018] [Indexed: 11/08/2022]
Abstract
Data regarding cancer risk for individuals who were exposed to traumatic and stressful life events are conflicting. We sought to evaluate the association between posttraumatic stress disorder (PTSD) and the risk of the four most common solid tumors: lung, breast, prostate, and colorectal cancers. We conducted four nested case-control studies using a large UK population-based database. Cases were defined as individuals with any medical code for the specific malignancy. For every case, we used incidence-density sampling to match four controls by age, sex, practice site, and both duration and calendar time of follow-up. Exposure of interest was any diagnosis of PTSD prior to cancer diagnosis. The odds ratios (ORs) and 95% confidence intervals (CIs) for cancer risk associated with PTSD were estimated using multivariable conditional logistic regression and were adjusted for smoking status, obesity, and antidepressant use. The study population included four case groups according to cancer type. There were 19,143 cases with lung cancer (74,473 matched controls), 22,163 cases with colorectal cancer (86,538 matched controls), 31,352 cases with breast cancer (123,285 matched controls), and 27,212 cases with prostate cancer (105,940 matched controls). There was no statistically significant association between PTSD and cancer risk among any of the cancer types: lung, OR = 0.73, 95% CI [0.43, 1.23]; breast, OR = 0.73, 95% CI [0.52, 1.01]; prostate, OR = 1.24, 95% CI [0.87, 1.77]; and colorectal, OR = 1.05, 95% CI [0.68, 1.62]. Our findings indicated that participants in our study with PTSD were not at increased risk of lung, breast, prostate, and colorectal cancers.
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Affiliation(s)
- Elana Cohn
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ido Lurie
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Shalvata Mental Health Center, Hod Hasharon, Israel
| | - Yu-Xiao Yang
- Division of Gastroenterology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Warren B Bilker
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kevin Haynes
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ronac Mamtani
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Einat Shacham-Shmueli
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Oncology, Sheba Medical Center, Tel Hashomer, Israel
| | - Ofer Margalit
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Oncology, Sheba Medical Center, Tel Hashomer, Israel
| | - Ben Boursi
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Oncology, Sheba Medical Center, Tel Hashomer, Israel
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Seib C, Porter-Steele J, Ng SK, Turner J, McGuire A, McDonald N, Balaam S, Yates P, McCarthy A, Anderson D. Life stress and symptoms of anxiety and depression in women after cancer: The mediating effect of stress appraisal and coping. Psychooncology 2018; 27:1787-1794. [DOI: 10.1002/pon.4728] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 03/27/2018] [Accepted: 03/28/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Charrlotte Seib
- Menzies Health Institute Queensland; Griffith University; Southport Queensland Australia
| | - Janine Porter-Steele
- Menzies Health Institute Queensland; Griffith University; Southport Queensland Australia
- Institute of Health and Biomedical Innovation and School of Nursing; Queensland University of Technology; Brisbane Queensland Australia
- Choices Cancer Support Program, Wesley Hospital; Brisbane Queensland Australia
| | - Shu-Kay Ng
- Menzies Health Institute Queensland; Griffith University; Southport Queensland Australia
| | - Jane Turner
- Royal Brisbane Clinical Unit, Faculty of Medicine; University of Queensland; Brisbane Queensland Australia
| | - Amanda McGuire
- Institute of Health and Biomedical Innovation and School of Nursing; Queensland University of Technology; Brisbane Queensland Australia
| | - Nicole McDonald
- Menzies Health Institute Queensland; Griffith University; Southport Queensland Australia
| | - Sarah Balaam
- Institute of Health and Biomedical Innovation and School of Nursing; Queensland University of Technology; Brisbane Queensland Australia
| | - Patsy Yates
- Institute of Health and Biomedical Innovation and School of Nursing; Queensland University of Technology; Brisbane Queensland Australia
| | - Alexandra McCarthy
- Menzies Health Institute Queensland; Griffith University; Southport Queensland Australia
- Institute of Health and Biomedical Innovation and School of Nursing; Queensland University of Technology; Brisbane Queensland Australia
- Division of Cancer Services, Princess Alexandra Hospital; Brisbane Queensland Australia
- School of Nursing, University of Auckland; Auckland New Zealand
| | - Debra Anderson
- Menzies Health Institute Queensland; Griffith University; Southport Queensland Australia
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Jiang C. Posttraumatic stress disorder after a first-ever intracerebral hemorrhage in the Chinese population: A pilot study. APPLIED NEUROPSYCHOLOGY-ADULT 2018; 27:1-8. [PMID: 29617165 DOI: 10.1080/23279095.2018.1451334] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Che Jiang
- Department of Neurology, Guangzhou Military General Hospital, Guangzhou, China
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Wang M, Duan F, Wu J, Min Q, Huang Q, Luo M, He Z. Effect of cyclooxygenase‑2 inhibition on the development of post‑traumatic stress disorder in rats. Mol Med Rep 2018; 17:4925-4932. [PMID: 29393449 PMCID: PMC5865951 DOI: 10.3892/mmr.2018.8525] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 09/18/2017] [Indexed: 12/25/2022] Open
Abstract
Post‑traumatic stress disorder (PTSD) is characterized by re‑experiencing of a traumatic event, avoidance of trauma‑associated stimulation, general changes in mood and cognition, and hyper arousal symptoms. Cyclooxygenase is involved in the production of prostaglandins and thromboxanes, and its inducible form cyclooxygenase‑2(COX‑2), an important mediator of cell injury in inflammation, is primarily expressed in leukocytes and brain cells. The present study investigated the expression of COX‑2 in the hippocampi of rats with PTSD and evaluated the effect of COX‑2 inhibition on PTSD. Adult male Wistar rats were randomly divided into three groups: Control (n=20), PTSD (n=20) and intervention group (PTSD+COX‑2 inhibitor treatment, n=20). The expression of COX‑2 was detected by immunohistochemistry, reverse transcription‑quantitative polymerase chain reaction and western blotting. Terminal deoxynucleotidyl transferase mediated dUTP nick end labeling staining was used to observe the apoptosis of rat hippocampal neurons. Tumor necrosis factor α (TNF‑α), interleukin (IL)‑6 and prostaglandin E2 (PGE2) levels were analyzed by ELISA. Nitric oxide (NO) was detected using the Griess test. The behavioral and cognitive function of rats in the PTSD group was significantly decreased compared with the control group, while the behavioral and cognitive function of rats in the intervention group were improved. The COX‑2 mRNA and protein expression levels in hippocampi of rats in the PTSD group were higher than in the control and intervention group. The apoptosis of hippocampus in rats with PTSD was significantly increased compared with the control group and following treatment with COX‑2 inhibitor, apoptosis was decreased. In addition, compared with the control group and intervention group, the levels of TNF‑α, IL‑6, PGE2 and NO in hippocampi of rats were increased in the PTSD group. The present study indicated that COX‑2 may be involved in the pathogenesis of PTSD, and inhibition of its expression serves a neuroprotective role in hippocampi of PTSD rats.
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Affiliation(s)
- Mengyang Wang
- Department of Neurosurgery, Wuhan No. 1 Hospital, Wuhan, Hubei 430022, P.R. China
| | - Faliang Duan
- Department of Neurosurgery, Wuhan No. 1 Hospital, Wuhan, Hubei 430022, P.R. China
| | - Jinglei Wu
- Department of Neurosurgery, Wuhan No. 1 Hospital, Wuhan, Hubei 430022, P.R. China
| | - Qiang Min
- Department of Neurosurgery, Wuhan No. 1 Hospital, Wuhan, Hubei 430022, P.R. China
| | - Qiaochun Huang
- Department of Neurosurgery, Wuhan No. 1 Hospital, Wuhan, Hubei 430022, P.R. China
| | - Ming Luo
- Department of Neurosurgery, Wuhan No. 1 Hospital, Wuhan, Hubei 430022, P.R. China
| | - Zhuqiang He
- Department of Neurosurgery, Wuhan No. 1 Hospital, Wuhan, Hubei 430022, P.R. China
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Li X, Wang J, Zhou J, Huang P, Li J. The association between post-traumatic stress disorder and shorter telomere length: A systematic review and meta-analysis. J Affect Disord 2017; 218:322-326. [PMID: 28486180 DOI: 10.1016/j.jad.2017.03.048] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 03/19/2017] [Accepted: 03/24/2017] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Post-traumatic stress disorder (PTSD) is a common psychiatric disorder, which may accelerate aging. Many study have investigated the association between telomeres length and PTSD, but results from published studies are contradictory. Therefore, Meta-analysis approaches were conducted to give more precise estimate of relationship between telomere length and PTSD. METHOD We systematically reviewed the databases of PUBMED, PsycINFO, Medline(Ovid SP) and EMBASE for all articles on the association between telomere length and PTSD. Data were summarized by using random-effects in the meta-analysis. The heterogeneity among studies were examined by using Cochrane's Q statistic and I-squared. RESULTS Five eligible studies containing 3851 participants were included in our meta-analysis. Shorten telomere length was significantly associated with PTSD with mean difference of -0.19( 95% CI: -0.27, -0.01; P<0.001) with I-square of 96%. The results from subgroup analysis demonstrated that shorter telomere length was significantly associated with PTSD across all gender groups, with mean difference of -0.15( 95% CI: -0.29, -0.01; P=0.04) for female, mean difference of -0.17( 95% CI: -0.19, -0.15; P<0.001) for male. Meanwhile, shorten telomere length was significantly associated with sexual assault(mean difference =-0.15, 95% CI: -0.29, -0.01), childhood trauma (mean difference =-0.08, 95% CI: -0.19, -0.07), but not combat (mean difference =-0.39, 95% CI: -0.83, 0.05). CONCLUSION Compared to the individuals without PTSD, individuals with PTSD have shorter telomere length, which has implications for early intervention and timely treatment to prevent future adverse health outcomes.
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Affiliation(s)
- Xuemei Li
- West China Hospital, Sichuan University, Chengdu, China; The First people's Hospital of Neijiang, Neijiang, Sichuan, China
| | - Jiang Wang
- College of Nursing, Jinggangshan University, Jian, China
| | - Jianghua Zhou
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Pan Huang
- West China Second University Hospital, Sichuan University, Chengdu, China
| | - Jiping Li
- West China Hospital, Sichuan University, Chengdu, China.
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Habibović M, Denollet J, Pedersen SS. Posttraumatic stress and anxiety in patients with an implantable cardioverter defibrillator: Trajectories and vulnerability factors. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 40:817-823. [DOI: 10.1111/pace.13090] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 02/11/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Mirela Habibović
- Department of Medical and Clinical Psychology; Tilburg University; Tilburg The Netherlands
- Department of Cardiology; Elisabeth-TweeSteden Hospital; Tilburg The Netherlands
| | - Johan Denollet
- Department of Medical and Clinical Psychology; Tilburg University; Tilburg The Netherlands
| | - Susanne S. Pedersen
- Department of Psychology; University of Southern Denmark; Odense Denmark
- Department of Cardiology; Odense University Hospital; Odense Denmark
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Exposure to stress across the life course and its association with anxiety and depressive symptoms: Results from the Australian Women's Wellness After Cancer Program (WWACP). Maturitas 2017; 105:107-112. [PMID: 28551081 DOI: 10.1016/j.maturitas.2017.05.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 05/10/2017] [Accepted: 05/15/2017] [Indexed: 01/23/2023]
Abstract
OBJECTIVES Earlier life stressors can increase the risk of persistent anxiety and depressive symptoms in women after cancer, though our understanding of the underlying mechanisms is limited. In this study, we tested alternative life course models to determine which best described associations between exposure to stressors in childhood, adolescence, and adulthood, and self-reported health in women previously treated for breast, gynaecological, and blood cancer. STUDY DESIGN Data were drawn from 351 Australian women within 2 years of completing active cancer treatment who were participating in the Women's Wellness After Cancer Program (WWACP) randomised controlled trial. A model-building framework compared "accumulative risk" and "sensitive period" stress exposure hypotheses with the saturated model to determine best fit. MAIN OUTCOME MEASURES Symptoms of anxiety and depression were measured using the Center for Epidemiologic Studies Depression Scale (CES-D) and the Zung Self-rating Anxiety Scale (SAS). RESULTS Participants with the greatest number of stressful life events (SLEs) reported higher anxiety scores and more depressive symptoms. Alternative life course models for psychological distress (measured through the CES-D and SAS) and stress were compared with the saturated model (i.e., the accumulative risk). The more restrictive "sensitive period" models were the best fit for depressive symptoms though none was significantly better than another. In contrast, an "early sensitive" model provided the best fit for anxiety data. CONCLUSIONS Anxiety scores were higher in women with early life stressors. This study highlights the need for whole-of-life supportive care approaches for women previously treated for cancer, which should include targeted strategies for effective management of stress, anxiety and depression.
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Chaturvedi S, Clancy M, Schaefer N, Oluwole O, McCrae KR. Depression and post-traumatic stress disorder in individuals with hereditary hemorrhagic telangiectasia: A cross-sectional survey. Thromb Res 2017; 153:14-18. [PMID: 28314138 DOI: 10.1016/j.thromres.2017.03.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 03/01/2017] [Accepted: 03/06/2017] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Hereditary hemorrhagic telangiectasia (HHT) is characterized by frequent severe bleeding, particularly epistaxis, and life-threatening complications including stroke, brain abscess and heart failure. The psychological impact of HHT is not known. We conducted this cross sectional study to determine the prevalence of depression and post-traumatic stress disorder (PTSD) related to HHT. METHODS A survey tool comprising demographic and clinical information and two validated self-administered questionnaires, the PTSD checklist for DSM-5 (PCL-5) and Beck Depression Inventory-II (BDI-II), was distributed to individuals with HHT. Associations with clinical and demographic variables with depression and PTSD were evaluated in a logistic regression model. RESULTS A total of 222 individuals responded to the survey. Of these, 185 completed either the BDI II or PCL-5 and were included in the analysis. Median age was 54years and 142 (76.8%) were female. An existing diagnosis of depression, anxiety disorder and PTSD was present in 81 (43.8%), 59 (31.9%) and 16(8.6%) respondents, respectively. BDI-II scores>13 indicating at least mild depressive symptoms were present in 142 (88.7%) patients and 52 (28.1%) patients had a positive screen for PTSD (PCL-5 score≥38). On multivariable analysis, depression [OR 2.17 (95% CI 1.045-4.489), p=0.038], anxiety disorder [OR 2.232 (95% CI 1.066-4.676), p=0.033], and being unemployed [OR 2.234 (95% CI 1.46-4.714), p=0.019) were associated with PTSD. CONCLUSION We report a high prevalence of depressive and PTSD symptoms in individuals with HHT. While selection bias may lead to overestimation of prevalence in this study, our results are concerning and clinicians should remain vigilant for signs of psychological distress and consider screening for these disorders.
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Affiliation(s)
- Shruti Chaturvedi
- Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | | | | | - Olalekan Oluwole
- Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Keith R McCrae
- Department of Cellular and Molecular Medicine, Cleveland Clinic, United States; Hematologic Oncology and Blood Disorders, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, United States.
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Chaturvedi S, Oluwole O, Cataland S, McCrae KR. Post-traumatic stress disorder and depression in survivors of thrombotic thrombocytopenic purpura. Thromb Res 2017; 151:51-56. [DOI: 10.1016/j.thromres.2017.01.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 12/19/2016] [Accepted: 01/05/2017] [Indexed: 12/21/2022]
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Eslami B. Correlates of posttraumatic stress disorder in adults with congenital heart disease. CONGENIT HEART DIS 2017; 12:357-363. [PMID: 28217850 DOI: 10.1111/chd.12452] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 12/12/2016] [Accepted: 01/16/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aims of this study were to compare the level of posttraumatic stress disorder between adults with and without congenital heart disease, and to examine the correlates of posttraumatic stress disorder (e.g., sociodemographics). DESIGN Cross-sectional. SETTING Two university-affiliated heart hospitals in Tehran, Iran. PATIENTS A sample of 347 adults with congenital heart disease aged 18-64 years (52% women), and 353 adults without congenital heart disease matched by sex and age (±2 years) was recruited. OUTCOME MEASURES The PTSD Scale: Self-report version was used to assess the diagnosis and severity of posttraumatic stress disorder. Hierarchical multivariate logistic regression analyses were performed to explore correlates of likely posttraumatic stress disorder diagnosis among each group of participants. RESULTS The posttraumatic stress disorder in the patients was comparable to those of the control group, except for increased arousal (P = .027) which was scored higher among the patients. Over 52% of adults with congenital heart disease met the criteria for a likely posttraumatic stress disorder diagnosis compared with 48% of adults without congenital heart disease. The regression analyses among patients revealed that elevated depressive symptoms (OR = 1.27) and a positive history of cardiac surgery (OR = 2.02) were significantly associated with posttraumatic stress disorder. The model could explain 29% of the variance in posttraumatic stress disorder. CONCLUSIONS The high and comparable prevalence of posttraumatic stress disorder among patients and nonpatients highlight the significance of the context in which adults with congenital heart disease may face other/additional stressors than disease-related ones, an issue that clinicians need also take into account. Furthermore, the association of posttraumatic stress disorder with elevated depressive symptoms warrant a comprehensive psychological assessment and management of adults with congenital heart disease, in particular among those with a history of invasive procedures.
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Affiliation(s)
- Bahareh Eslami
- Division of Public Health Science, Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.,Department of Research, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
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O'Donovan A, Ahmadian AJ, Neylan TC, Pacult MA, Edmondson D, Cohen BE. Current posttraumatic stress disorder and exaggerated threat sensitivity associated with elevated inflammation in the Mind Your Heart Study. Brain Behav Immun 2017; 60:198-205. [PMID: 27765647 PMCID: PMC5279867 DOI: 10.1016/j.bbi.2016.10.014] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 09/29/2016] [Accepted: 10/15/2016] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE Elevated inflammation has been repeatedly observed in posttraumatic stress disorder (PTSD), and it may drive the development of both psychiatric symptoms and physical comorbidities. However, it is not clear if elevated inflammation is a feature of both remitted and current PTSD, and little is known about relationships between specific clusters of PTSD symptoms and inflammation. Exaggerated threat sensitivity, as indexed by threat reactivity and avoidance of perceived threats, may be particularly closely associated with inflammation. METHODS We assessed PTSD symptoms and threat sensitivity using the Clinician Administered PTSD Scale in 735 Veterans Affairs patients (35% current PTSD; 16% remitted PTSD) who participated in the Mind Your Heart Study (mean age=59±11; 94% male). High sensitivity C-reactive protein (hsCRP), white blood cell count (WBC), and fibrinogen were used as indices of inflammation. Analysis of covariance models with planned contrasts were used to examine differences in inflammation by PTSD status, adjusting for age, sex, race, kidney function and socioeconomic status. RESULTS Individuals with current PTSD had significantly higher hsCRP and WBC than patients with no history of PTSD, but there were no significant differences in inflammatory markers between those with remitted versus no history of PTSD. Within patients with current PTSD, higher threat reactivity was independently associated with higher hsCRP (β=0.16, p=0.01) and WBC count (β=0.24, <0.001), and higher effortful avoidance was associated with higher fibrinogen (β=0.13, p=0.04). CONCLUSION Our data indicate that elevated inflammation may be a feature of current, but not remitted, PTSD. Within patients with PTSD, higher threat reactivity was also associated with elevated inflammation. A better understanding of the relationship between threat sensitivity and inflammation may inform interventions for patients with PTSD.
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Affiliation(s)
- Aoife O'Donovan
- University of California, San Francisco, CA, USA; San Francisco Veteran's Affairs Medical Center and Northern California Institute for Research and Education, San Francisco, CA, USA.
| | - Ashkan J Ahmadian
- University of California, San Francisco, CA, USA; San Francisco Veteran's Affairs Medical Center and Northern California Institute for Research and Education, San Francisco, CA, USA
| | - Thomas C Neylan
- University of California, San Francisco, CA, USA; San Francisco Veteran's Affairs Medical Center and Northern California Institute for Research and Education, San Francisco, CA, USA
| | - Mark A Pacult
- University of California, San Francisco, CA, USA; San Francisco Veteran's Affairs Medical Center and Northern California Institute for Research and Education, San Francisco, CA, USA
| | | | - Beth E Cohen
- University of California, San Francisco, CA, USA; San Francisco Veteran's Affairs Medical Center and Northern California Institute for Research and Education, San Francisco, CA, USA
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Burg MM, Brandt C, Buta E, Schwartz J, Bathulapalli H, Dziura J, Edmondson DE, Haskell S. Risk for Incident Hypertension Associated With Posttraumatic Stress Disorder in Military Veterans and the Effect of Posttraumatic Stress Disorder Treatment. Psychosom Med 2017; 79:181-188. [PMID: 27490852 PMCID: PMC5285494 DOI: 10.1097/psy.0000000000000376] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Posttraumatic stress disorder (PTSD) increases cardiovascular disease and cardiovascular mortality risk. Neither the prospective relationship of PTSD to incident hypertension risk nor the effect of PTSD treatment on hypertension risk has been established. METHODS Data from a nationally representative sample of 194,319 veterans were drawn from the Veterans Administration (VA) roster of United States service men and women. This included veterans whose end of last deployment was from September 2001 to July 2010 and whose first VA medical visit was from October 1, 2001 to January 1, 2009. Incident hypertension was modeled as 3 events: (1) a new diagnosis of hypertension and/or (2) a new prescription for antihypertensive medication, and/or (3) a clinic blood pressure reading in the hypertensive range (≥140/90 mm Hg, systolic/diastolic). Posttraumatic stress disorder diagnosis was the main predictor. Posttraumatic stress disorder treatment was defined as (1) at least 8 individual psychotherapy sessions of 50 minutes or longer during any consecutive 6 months and/or (2) a prescription for selective serotonin reuptake inhibitor medication. RESULTS Over a median 2.4-year follow-up, the incident hypertension risk independently associated with PTSD ranged from hazard ratio (HR), 1.12 (95% confidence interval [CI], 1.08-1.17; p < .0001) to HR, 1.30 (95% CI, 1.26-1.34; p < .0001). The interaction of PTSD and treatment revealed that treatment reduced the PTSD-associated hypertension risk (e.g., from HR, 1.44 [95% CI, 1.38-1.50; p < .0001] for those untreated, to HR, 1.20 [95% CI, 1.15-1.25; p < .0001] for those treated). CONCLUSIONS These results indicate that reducing the long-term health impact of PTSD and the associated costs may require very early surveillance and treatment.
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Affiliation(s)
- Matthew M. Burg
- VA Connecticut Healthcare System, West Haven, CT,Yale University School of Medicine, New Haven, CT,Center for Behavioral Cardiovascular Health, Columbia University School of Medicine, New York, NY
| | - Cynthia Brandt
- VA Connecticut Healthcare System, West Haven, CT,Yale University School of Medicine, New Haven, CT
| | - Eugenia Buta
- VA Connecticut Healthcare System, West Haven, CT,Yale University School of Medicine, New Haven, CT
| | - Joseph Schwartz
- Center for Behavioral Cardiovascular Health, Columbia University School of Medicine, New York, NY
| | | | - James Dziura
- Yale University School of Medicine, New Haven, CT
| | - Donald E. Edmondson
- Center for Behavioral Cardiovascular Health, Columbia University School of Medicine, New York, NY
| | - Sally Haskell
- VA Connecticut Healthcare System, West Haven, CT,Yale University School of Medicine, New Haven, CT
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Malcolm L, Kibler JL, Ma M, Tursich M, Augustin D, Greenbarg R, Gold SN. Psychophysiological Reactivity and PTSD Symptom Severity among Young Women. INTERNATIONAL JOURNAL OF PSYCHOLOGY AND NEUROSCIENCE 2016; 2:17-34. [PMID: 30405999 PMCID: PMC6218170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Mixed findings with regard to cardiovascular reactivity (CVR) and posttraumatic stress disorder (PTSD) have suggested a need to further explore the nature of this relationship and factors that might explain differences in reactivity across and within samples. In the present study, the severity of PTSD symptoms was investigated in relation to CVR among young women. In addition, we examined whether severity within PTSD symptom clusters and level of dissociative symptoms were related to CVR. Heart rate, systolic and diastolic blood pressure, cardiac output (CO) and total peripheral resistance (TPR) reactivity in response to an oral speaking task were assessed for 58 young trauma-exposed civilian women with varying levels of PTSD symptomatology (from no symptoms to high severity of PTSD). The PTSD severity sub-scores for the DSM-V symptom clusters and total PTSD severity were based on structured interview (Clinician Administered PTSD Scale), and dissociative symptoms were assessed using the Dissociative Experiences Scale. Severity of total PTSD symptoms was associated with greater CO reactivity (r = .48, p < .01) and lower TPR reactivity (r = -.50, p < .01). Significant associations were not observed for heart rate or blood pressure. Results did not vary according to severity of symptoms within PTSD symptom cluster, with correlations for CO reactivity ranging from .40 to .49 and correlations for TPR reactivity ranging from -.40 to -.50 within symptom clusters. Dissociative symptoms were not significantly correlated with the CVR measures. Results partially supported the expectation that PTSD severity is one factor that would be associated with CVR, and suggest that reactivity for the underlying components of blood pressure (CO and TPR) provide additional information in probing stress reactivity in PTSD.
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Reber SO, Langgartner D, Foertsch S, Postolache TT, Brenner LA, Guendel H, Lowry CA. Chronic subordinate colony housing paradigm: A mouse model for mechanisms of PTSD vulnerability, targeted prevention, and treatment-2016 Curt Richter Award Paper. Psychoneuroendocrinology 2016; 74:221-230. [PMID: 27676359 DOI: 10.1016/j.psyneuen.2016.08.031] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 08/31/2016] [Indexed: 01/22/2023]
Abstract
There is considerable individual variability in vulnerability for developing posttraumatic stress disorder (PTSD); evidence suggests that this variability is related in part to genetic and environmental factors, including adverse early life experience. Interestingly, recent studies indicate that induction of chronic low-grade inflammation may be a common mechanism underlying gene and environment interactions that increase the risk for development of PTSD symptoms, and, therefore, may be a target for novel interventions for prevention or treatment of PTSD. Development of murine models with face, construct, and predictive validity would provide opportunities to investigate in detail complex genetic, environmental, endocrine, and immunologic factors that determine vulnerability to PTSD-like syndromes, and furthermore may provide mechanistic insight leading to development of novel interventions for both prevention and treatment of PTSD symptoms. Here we describe the potential use of the chronic subordinate colony housing (CSC) paradigm in mice as an adequate animal model for development of a PTSD-like syndrome and describe recent studies that suggest novel interventions for the prevention and treatment of PTSD.
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Affiliation(s)
- Stefan O Reber
- Laboratory for Molecular Psychosomatics, Clinic for Psychosomatic Medicine and Psychotherapy, University Ulm, 89081 Ulm, Germany.
| | - Dominik Langgartner
- Laboratory for Molecular Psychosomatics, Clinic for Psychosomatic Medicine and Psychotherapy, University Ulm, 89081 Ulm, Germany.
| | - Sandra Foertsch
- Laboratory for Molecular Psychosomatics, Clinic for Psychosomatic Medicine and Psychotherapy, University Ulm, 89081 Ulm, Germany.
| | - Teodor T Postolache
- University of Maryland School of Medicine, Baltimore MD, MD 21201, USA; Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), University of Colorado, Anschutz Medical Campus, Denver, CO 80220, USA; Military and Veteran Microbiome Consortium for Research and Education (MVM-CoRE), Denver, CO 80220, USA.
| | - Lisa A Brenner
- Department of Physical Medicine and Rehabilitation, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045, USA; Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), University of Colorado, Anschutz Medical Campus, Denver, CO 80220, USA; Military and Veteran Microbiome Consortium for Research and Education (MVM-CoRE), Denver, CO 80220, USA.
| | - Harald Guendel
- Laboratory for Molecular Psychosomatics, Clinic for Psychosomatic Medicine and Psychotherapy, University Ulm, 89081 Ulm, Germany.
| | - Christopher A Lowry
- Department of Physical Medicine and Rehabilitation, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045, USA; Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), University of Colorado, Anschutz Medical Campus, Denver, CO 80220, USA; Military and Veteran Microbiome Consortium for Research and Education (MVM-CoRE), Denver, CO 80220, USA; Department of Integrative Physiology and Center for Neuroscience, University of Colorado Boulder, Boulder, CO 80309, USA; Center for Neuroscience, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045, USA.
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Treatment-refractory posttraumatic stress disorder (TRPTSD): a review and framework for the future. Prog Neuropsychopharmacol Biol Psychiatry 2016; 70:170-218. [PMID: 26854815 DOI: 10.1016/j.pnpbp.2016.01.015] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 01/29/2016] [Accepted: 01/29/2016] [Indexed: 01/04/2023]
Abstract
Post-traumatic stress disorder (PTSD) is a serious psychiatric consequence of trauma that occurs in a proportion of individuals exposed to life-threatening events. Trauma-focused psychotherapy is often recommended as first choice for those who do not recover spontaneously. But many individuals require medications. In the US, only paroxetine (PRX) and sertraline (SRT) are FDA approved for PTSD. But response and remission rates with these medications are low, so numerous other pharmacologic interventions have been tried. To date, there has not been a systematic review of the data on what are the best next-step pharmacologic strategies for individuals who fail standard treatments. To that end, we review 168 published trials of medications other than PRX or SRT and provide a detailed analysis of the 88/168 studies that describe alternative pharmacologic interventions in patients refractory to other treatment. We also review clinical factors relevant to treatment-refractory PTSD; the neurobiology of extinction, as well as evidence-based psychotherapy and neuromodulation strategies for this condition.
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Agorastos A, Linthorst ACE. Potential pleiotropic beneficial effects of adjuvant melatonergic treatment in posttraumatic stress disorder. J Pineal Res 2016; 61:3-26. [PMID: 27061919 DOI: 10.1111/jpi.12330] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 04/05/2016] [Indexed: 12/21/2022]
Abstract
Loss of circadian rhythmicity fundamentally affects the neuroendocrine, immune, and autonomic system, similar to chronic stress and may play a central role in the development of stress-related disorders. Recent articles have focused on the role of sleep and circadian disruption in the pathophysiology of posttraumatic stress disorder (PTSD), suggesting that chronodisruption plays a causal role in PTSD development. Direct and indirect human and animal PTSD research suggests circadian system-linked neuroendocrine, immune, metabolic and autonomic dysregulation, linking circadian misalignment to PTSD pathophysiology. Recent experimental findings also support a specific role of the fundamental synchronizing pineal hormone melatonin in mechanisms of sleep, cognition and memory, metabolism, pain, neuroimmunomodulation, stress endocrinology and physiology, circadian gene expression, oxidative stress and epigenetics, all processes affected in PTSD. In the current paper, we review available literature underpinning a potentially beneficiary role of an add-on melatonergic treatment in PTSD pathophysiology and PTSD-related symptoms. The literature is presented as a narrative review, providing an overview on the most important and clinically relevant publications. We conclude that adjuvant melatonergic treatment could provide a potentially promising treatment strategy in the management of PTSD and especially PTSD-related syndromes and comorbidities. Rigorous preclinical and clinical studies are needed to validate this hypothesis.
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Affiliation(s)
- Agorastos Agorastos
- Department of Psychiatry and Psychotherapy, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Astrid C E Linthorst
- Faculty of Health Sciences, Neurobiology of Stress and Behaviour Research Group, School of Clinical Sciences, University of Bristol, Bristol, UK
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Langevin JP, Koek RJ, Schwartz HN, Chen JWY, Sultzer DL, Mandelkern MA, Kulick AD, Krahl SE. Deep Brain Stimulation of the Basolateral Amygdala for Treatment-Refractory Posttraumatic Stress Disorder. Biol Psychiatry 2016; 79:e82-e84. [PMID: 26475671 DOI: 10.1016/j.biopsych.2015.09.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 09/02/2015] [Accepted: 09/02/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Jean-Philippe Langevin
- Neurosurgery Service, Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California.
| | - Ralph J Koek
- Psychiatry and Mental Health Service, Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Holly N Schwartz
- Psychiatry and Mental Health Service, Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | - James W Y Chen
- Neurology Service, Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - David L Sultzer
- Psychiatry and Mental Health Service, Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Mark A Mandelkern
- Radiology Service, Nuclear Medicine, Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Alexis D Kulick
- Psychiatry and Mental Health Service, Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | - Scott E Krahl
- Research and Development Service, Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
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Telomere length and telomere repeating factors: Cellular markers for post-traumatic stress disorder-like model. J Affect Disord 2016; 195:156-62. [PMID: 26896808 DOI: 10.1016/j.jad.2016.02.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 11/08/2015] [Accepted: 02/07/2016] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The aim of the present study was to explore the telomere length of peripheral blood leukocytes from a rat model of post-traumatic stress disorder (PTSD), as well as the expression level of telomere-binding protein in the hippocampal CA1 region. METHODS The PTSD model was established with 42 adult male Wistar rats. The relative telomere length of the leukocytes was measured by real-time fluorescence quantitative polymerase chain reaction, and the expression levels of telomere repeating factor 1 (TRF1) and telomere repeating factor 2 (TRF2) in the hippocampal CA1 region of the PTSD rat model were determined by immunofluorescence technology. The covariance analysis of repeated measurements by the mixed model approach was used for the telomere length analysis. The comparison of averaged data among groups was performed using least significant difference and analysis of variance. The Student's t test or the Mann-Whitney U test was used for intragroup comparison. The association study among groups was conducted using the Spearman test. RESULTS The shortening speed of telomere length significantly accelerated in rats after Single Prolonged Stress (SPS) stimulation (P<0.05). The expression levels of TRF1 and TRF2 increased with the progress of PTSD, and the expression peak was shown in day 14, which was significantly different from the control group (P<0.05). CONCLUSION The shortening speed of the telomere length of peripheral blood leukocytes accelerated in PTSD rats, and the expression levels of TRF1 and TRF2 increased in hippocampus, both of which were closely associated with the pathological progress of the PTSD-like model and unfavorable prognosis.
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