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Robles TF, Rünger D, Sumner JA, Elashoff D, Shetty V. Salivary inflammatory biomarkers as a predictor of post-traumatic stress disorder and depressive symptom severity in trauma patients: A prospective study. Brain Behav Immun 2024; 119:792-800. [PMID: 38714269 DOI: 10.1016/j.bbi.2024.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 04/24/2024] [Accepted: 05/04/2024] [Indexed: 05/09/2024] Open
Abstract
BACKGROUND Although post-traumatic stress disorder (PTSD) and depression screening are recommended for traumatic injury patients, routine screening is still uncommon. Salivary inflammatory biomarkers have biological plausibility and potential feasibility and acceptability for screening. This study tested prospective associations between several salivary inflammatory biomarkers (proinflammatory cytokines interleukin-1β, interleukin-6, tumor necrosis factor-α; and C-reactive protein), collected during hospitalization and PTSD and depressive symptoms at 5-month follow-up. METHODS Adult traumatic injury patients (N = 696) at a major urban Level 1 trauma center provided salivary samples and completed PTSD and depressive symptom measures during days 0-13 of inpatient hospitalization. At 5-month follow-up, 368 patients (77 % male, 23 % female) completed the Clinician-Administered PTSD Scale for DSM-IV and the Self-rated Inventory of Depressive Symptomatology. Analyses focused on a latent inflammatory cytokine factor and C-reactive protein at baseline predicting 5-month PTSD and depression symptom outcomes and included baseline symptom levels as covariates. RESULTS A latent factor representing proinflammatory cytokines was not related to 5-month PTSD or depressive symptom severity. Higher salivary CRP was related to greater PTSD symptom severity (β = .10, p = .03) at 5-month follow-up and more severity in the following depressive symptoms: changes in weight and appetite, bodily complaints, and constipation/diarrhea (β's from .14 to .16, p's from .004 -.03). CONCLUSION In a primarily Latine and Black trauma patient sample, salivary CRP measured after traumatic injury was related to greater PTSD symptom severity and severity in several depressive symptom clusters. Our preliminary findings suggest that salivary or systemic CRP may be useful to include in models predicting post-trauma psychopathology.
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Affiliation(s)
- Theodore F Robles
- Department of Psychology, University of California, Los Angeles, United States.
| | - Dennis Rünger
- Department of Medicine Statistics Core, David Geffen School of Medicine at University of California, Los Angeles, United States
| | - Jennifer A Sumner
- Department of Psychology, University of California, Los Angeles, United States
| | - David Elashoff
- Department of Medicine Statistics Core, David Geffen School of Medicine at University of California, Los Angeles, United States
| | - Vivek Shetty
- School of Dentistry, University of California, Los Angeles, United States
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Park SM, Lee JY, Choi JS, Jung HY. A prospective study on EEG default mode network associated with subsequent posttraumatic stress disorder following sexual assault. J Psychiatr Res 2024; 174:181-191. [PMID: 38642455 DOI: 10.1016/j.jpsychires.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/06/2024] [Accepted: 04/03/2024] [Indexed: 04/22/2024]
Abstract
This study aimed to explore the predictors of posttraumatic stress disorder (PTSD) in women who have recently experienced sexual assault, by examining psychological and neurophysiological factors using a prospective design with resting-state electroencephalogram (EEG) functional connectivity. The study enrolled 33 women who had been recently traumatized by sexual assault and conducted assessments within a month of the trauma. These survivors were evaluated for PTSD three months later and were classified into two groups: PTSD positive (n = 12) and PTSD negative (n = 21). They were compared to two control groups comprising women who had not experienced any extremely traumatic events: 25 with depression and 25 healthy controls. The evaluation focused on resting-state EEG functional connectivity within default mode network (DMN) using small-worldness (SW), based on graph theory. We also assessed self-reported levels of depression, anxiety, anger, and executive functions. The findings indicated that survivors who developed PTSD three months post-trauma exhibited higher anxiety levels and reduced DMN SW in the beta 3 frequency, compared to those who did not develop PTSD. Contrary to expectations, survivors without PTSD showed decreased executive functioning and lower prefrontal centrality compared to those with PTSD. This study underscores the importance of early assessment and intervention for sexual assault survivors at risk of developing PTSD.
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Affiliation(s)
- Su Mi Park
- Department of Counseling Psychology, Hannam University, Daejoen, Republic of Korea.
| | - Jun-Young Lee
- Department of Psychiatry, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea; Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Jung-Seok Choi
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Hee Yeon Jung
- Department of Psychiatry, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea; Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea; Institute of Human Behavioral Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea.
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Rankins EM, Quinn A, McKeever KH, Malinowski K. Ground-based adaptive horsemanship lessons for veterans with post-traumatic stress disorder: a randomized controlled pilot study. Front Psychiatry 2024; 15:1390212. [PMID: 38863605 PMCID: PMC11165701 DOI: 10.3389/fpsyt.2024.1390212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 05/10/2024] [Indexed: 06/13/2024] Open
Abstract
Introduction Equine-assisted services (EAS) has received attention as a potential treatment strategy for post-traumatic stress disorder (PTSD), as existing literature indicates that symptoms may decrease following EAS. Relatively little is known about the mechanisms at play during lessons and if physiological measures are impacted. The objectives of this pilot study were to 1) explore the effects of adaptive horsemanship (AH) lessons on symptoms of PTSD, hormone concentrations, and social motor synchrony; 2) determine if physiological changes occur as veterans interact with horses; and 3) explore if the interaction between veteran and horse changes over the 8-week session. Methods Veterans with PTSD were randomly assigned to control (CON, n = 3) or AH (n = 6) groups for an 8-week period (clinical trial; NCT04850573; clinicaltrials.gov). Veterans completed the PTSD Checklist (PCL-5) and Brief Symptom Inventory (BSI) at pre-, post-, and 2- and 6-month follow-up time points. They also completed a social motor synchrony test (pendulum swinging) and blood draw at pre- and post-time points. In weeks 1, 4, and 8, blood samples were drawn at 0 min, 3 min, 5 min, 25 min, and 30 min during the 30-min AH lessons. Veterans completed the Human-Animal Interaction Scale (HAIS) after each lesson. Blood samples were assayed for plasma cortisol, epinephrine, norepinephrine, and oxytocin. Data were analyzed with repeated measure ANOVAs. Changes in PTSD symptoms from pre- to post-time point were analyzed with paired t-tests. Results Changes in PCL-5 scores tended to differ (p = 0.0989), and global BSI scores differed (p = 0.0266) between AH (-11.5 ± 5.5, mean ± SE; -0.5 ± 0.2) and CON (5.3 ± 5.4; 0.4 ± 0.2) groups. Social motor synchrony and hormone concentrations did not differ between groups or time points (p > 0.05). Cortisol, norepinephrine, and oxytocin concentrations did not differ across sessions (p > 0.05). Epinephrine concentrations tended (p = 0.0744) to decrease from week 1 to 4 of sessions. HAIS scores increased (p ≥ 0.0437) in week 3 and remained elevated as compared to week 1. Discussion Participant recruitment was the greatest challenge. These preliminary results agree with the literature suggesting that EAS can reduce symptoms of PTSD.
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Affiliation(s)
- Ellen M. Rankins
- Equine Science Center, Department of Animal Sciences, Rutgers University, New Brunswick, NJ, United States
| | - Andrea Quinn
- Center for Psychological Services, Rutgers University, New Brunswick, NJ, United States
| | - Kenneth H. McKeever
- Equine Science Center, Department of Animal Sciences, Rutgers University, New Brunswick, NJ, United States
| | - Karyn Malinowski
- Equine Science Center, Department of Animal Sciences, Rutgers University, New Brunswick, NJ, United States
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Bertolini F, Robertson L, Bisson JI, Meader N, Churchill R, Ostuzzi G, Stein DJ, Williams T, Barbui C. Early pharmacological interventions for prevention of post-traumatic stress disorder (PTSD) in individuals experiencing acute traumatic stress symptoms. Cochrane Database Syst Rev 2024; 5:CD013613. [PMID: 38767196 PMCID: PMC11103774 DOI: 10.1002/14651858.cd013613.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
BACKGROUND Acute traumatic stress symptoms may develop in people who have been exposed to a traumatic event. Although they are usually self-limiting in time, some people develop post-traumatic stress disorder (PTSD), a severe and debilitating condition. Pharmacological interventions have been proposed for acute symptoms to act as an indicated prevention measure for PTSD development. As many individuals will spontaneously remit, these interventions should balance efficacy and tolerability. OBJECTIVES To assess the efficacy and acceptability of early pharmacological interventions for prevention of PTSD in adults experiencing acute traumatic stress symptoms. SEARCH METHODS We searched the Cochrane Common Mental Disorders Controlled Trial Register (CCMDCTR), CENTRAL, MEDLINE, Embase and two other databases. We checked the reference lists of all included studies and relevant systematic reviews. The search was last updated on 23 January 2023. SELECTION CRITERIA We included randomised controlled trials on adults exposed to any kind of traumatic event and presenting acute traumatic stress symptoms, without restriction on their severity. We considered comparisons of any medication with placebo, or with another medication. We excluded trials that investigated medications as an augmentation to psychotherapy. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodological procedures. Using a random-effects model, we analysed dichotomous data as risk ratios (RR) and calculated the number needed to treat for an additional beneficial/harmful outcome (NNTB/NNTH). We analysed continuous data as mean differences (MD) or standardised mean differences (SMD). Our primary outcomes were PTSD severity and dropouts due to adverse events. Secondary outcomes included PTSD rate, functional disability and quality of life. MAIN RESULTS We included eight studies that considered four interventions (escitalopram, hydrocortisone, intranasal oxytocin, temazepam) and involved a total of 779 participants. The largest trial contributed 353 participants and the next largest, 120 and 118 participants respectively. The trials enrolled participants admitted to trauma centres or emergency departments. The risk of bias in the included studies was generally low except for attrition rate, which we rated as high-risk. We could meta-analyse data for two comparisons: escitalopram versus placebo (but limited to secondary outcomes) and hydrocortisone versus placebo. One study compared escitalopram to placebo at our primary time point of three months after the traumatic event. There was inconclusive evidence of any difference in terms of PTSD severity (mean difference (MD) on the Clinician-Administered PTSD Scale (CAPS, score range 0 to 136) -11.35, 95% confidence interval (CI) -24.56 to 1.86; 1 study, 23 participants; very low-certainty evidence), dropouts due to adverse events (no participant left the study early due to adverse events; 1 study, 31 participants; very low-certainty evidence) and PTSD rates (RR 0.59, 95% CI 0.03 to 13.08; NNTB 37, 95% CI NNTB 15 to NNTH 1; 1 study, 23 participants; very low-certainty evidence). The study did not assess functional disability or quality of life. Three studies compared hydrocortisone to placebo at our primary time point of three months after the traumatic event. We found inconclusive evidence on whether hydrocortisone was more effective in reducing the severity of PTSD symptoms compared to placebo (MD on CAPS -7.53, 95% CI -25.20 to 10.13; I2 = 85%; 3 studies, 136 participants; very low-certainty evidence) and whether it reduced the risk of developing PTSD (RR 0.47, 95% CI 0.09 to 2.38; NNTB 14, 95% CI NNTB 8 to NNTH 5; I2 = 36%; 3 studies, 136 participants; very low-certainty evidence). Evidence on the risk of dropping out due to adverse events is inconclusive (RR 3.19, 95% CI 0.13 to 75.43; 2 studies, 182 participants; low-certainty evidence) and it is unclear whether hydrocortisone might improve quality of life (MD on the SF-36 (score range 0 to 136, higher is better) 19.70, 95% CI -1.10 to 40.50; 1 study, 43 participants; very low-certainty evidence). No study assessed functional disability. AUTHORS' CONCLUSIONS This review provides uncertain evidence regarding the use of escitalopram, hydrocortisone, intranasal oxytocin and temazepam for people with acute stress symptoms. It is therefore unclear whether these pharmacological interventions exert a positive or negative effect in this population. It is important to note that acute traumatic stress symptoms are often limited in time, and that the lack of data prevents the careful assessment of expected benefits against side effects that is therefore required. To yield stronger conclusions regarding both positive and negative outcomes, larger sample sizes are required. A common operational framework of criteria for inclusion and baseline assessment might help in better understanding who, if anyone, benefits from an intervention. As symptom severity alone does not provide the full picture of the impact of exposure to trauma, assessment of quality of life and functional impairment would provide a more comprehensive picture of the effects of the interventions. The assessment and reporting of side effects may facilitate a more comprehensive understanding of tolerability.
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Affiliation(s)
- Federico Bertolini
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Lindsay Robertson
- Cochrane Common Mental Disorders, University of York, York, UK
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Jonathan I Bisson
- Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Nicholas Meader
- Cochrane Common Mental Disorders, University of York, York, UK
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Rachel Churchill
- Cochrane Common Mental Disorders, University of York, York, UK
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Giovanni Ostuzzi
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Dan J Stein
- SAMRC Unit on Risk & Resilience in Mental Disorders, Dept of Psychiatry & Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Taryn Williams
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Corrado Barbui
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
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Baldo BA. The entactogen 3,4-methylenedioxymethamphetamine (MDMA; ecstasy) as a treatment aid in psychotherapy and its safety concerns. Arch Toxicol 2024:10.1007/s00204-024-03765-8. [PMID: 38743292 DOI: 10.1007/s00204-024-03765-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 04/24/2024] [Indexed: 05/16/2024]
Abstract
The phenylethylamine, 3,4-methylenedioxymethamphetamine (MDMA, 'ecstasy'), is the prototypical example of an entactogen. Its original placement in highly restrictive drug usage categories in the US and UK, led to an inevitable restriction on MDMA neuroscience research and treatment. The dominant pharmacological effects of MDMA are its properties of release and inhibition of reuptake of amine neurotransmitter transporters for dopamine, norepinephrine, and serotonin. MDMA is an agonist of a wide range of receptors; its mood-altering effects are mediated via 5-HT2A receptors; this receptor may also mediate its effects on body temperature, analgesia, and anxiolytic properties. The mechanisms underlying MDMA's entactogenic properties of sociability and interpersonal closeness are not known but release and involvement of oxytocin, a peptide thought by some to be involved in social bonding, has been suggested. Adverse effects of MDMA are mostly transient; acute multiorgan adverse effects occurring during raves or crowded dance gatherings include dehydration, hyperthermia, seizures, rhabdomyolysis, disseminated intravascular coagulation, and acute renal failure. Deaths following MDMA taken by itself are rare compared to fatalities following coadministration with other drugs. A recent FDA-approved phase 3 clinical trial of MDMA for post-traumatic stress disorder (PTSD) led to the conclusion that MDMA-assisted therapy represents a potential breakthrough treatment meriting expedited clinical evaluation. Despite the ongoing deliberations by the FDA and EMA for approval of MDMA treatment of PTSD, the Australian Therapeutic Goods Administration (TGA) recently announced that after an evaluation of the therapeutic value, benefits, and risks of MDMA, it will permit its prescribing for the treatment of PTSD. Further examples of regulatory relaxation toward MDMA-assisted psychotherapy are underway. These include the FDA's recently approved clinical trial to assess MDMA's efficacy in the treatment of "asociality" in patients with schizophrenia and an open trial of MDMA treatment for alcohol-use disorder which showed decreased alcohol consumption. There are also ongoing studies on the little understood startle response, anxiety associated with life-threatening illness, and social anxiety in autistic adults.
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Affiliation(s)
- Brian A Baldo
- Kolling Institute of Medical Research, Royal North Shore Hospital of Sydney, Sydney, NSW, 2065, Australia.
- Department of Medicine, University of Sydney, Sydney, NSW, 2000, Australia.
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Hatfield O, Bresin K, Mekawi Y, Michopoulos V, Fani N, Bradley B, Powers A. Predicting aggressive behaviors: Examining unique and interactive roles of PTSD and emotion dysregulation in a minority sample. Aggress Behav 2024; 50:e22149. [PMID: 38757986 DOI: 10.1002/ab.22149] [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: 12/07/2023] [Revised: 04/29/2024] [Accepted: 05/08/2024] [Indexed: 05/18/2024]
Abstract
Aggression is a costly public health problem with severe and multi-faceted negative consequences and thus, identifying factors that contribute to aggression, particularly in understudied populations, is necessary to develop more effective interventions to reduce the public health cost of aggression. The goal this study was to test whether difficulties regulating emotions moderated the association between posttraumatic stress disorder (PTSD) symptoms and aggression in a community sample of predominantly Black females with high levels of trauma exposure. Furthermore, we explored unique relations between PTSD symptom clusters and distinct subscales of difficulties regulating emotions and aggression. The sample included 601 community participants recruited from an urban public hospital. Symptoms were assessed using self-report measures including the Difficulties in Emotion Regulation Scale (DERS) and Behavioral Questionnaire-Short. Regression analyses were conducted using PTSD symptoms and total DERS to test their interaction as predictors for aggression (using BQ-Short). We found that higher levels of PTSD arousal symptoms and difficulty controlling impulses when upset were positively related to aggression. We also conducted an exploratory analysis to examine the association between PTSD symptom clusters using the Alternative Symptom Clusters hybrid model. The results suggest that some PTSD symptoms (externalizing behavior) and some emotion dysregulation processes (difficulties controlling impulses when upset), relate to aggression in independent, rather than multiplicative ways. These results offer insights for new directions of research that focuses on the independent association between specific emotion dysregulation processes and PTSD symptoms on aggression.
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Affiliation(s)
- Olivia Hatfield
- Department of Counseling and Human Development, University of Louisville, Louisville, Kentucky, USA
| | - Konrad Bresin
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky, USA
| | - Yara Mekawi
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky, USA
| | - Vasiliki Michopoulos
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia, USA
| | - Negar Fani
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia, USA
| | - Bekh Bradley
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia, USA
- Atlanta VA Health Care System, Decatur, Georgia, USA
| | - Abigail Powers
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia, USA
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7
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Wigard I, Meyerbröker K, Ehring T, Topper M, Arntz A, Emmelkamp P. Skills training followed by either EMDR or narrative therapy for posttraumatic stress disorder in adult survivors of childhood abuse: a randomized controlled trial. Eur J Psychotraumatol 2024; 15:2332104. [PMID: 38629403 PMCID: PMC11025408 DOI: 10.1080/20008066.2024.2332104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 03/06/2024] [Indexed: 04/19/2024] Open
Abstract
Background: Individuals suffering from PTSD following childhood abuse represent a large subgroup of patients attending mental health services. The aim of phase-based treatment is to tailor treatment to the specific needs to childhood abuse survivors with PTSD with a Skills Training in Affective and Interpersonal Regulation (STAIR) phase, in which emotion dysregulation and interpersonal problems are targeted, and a trauma-focused phase.Objective: The purpose of this study was to compare STAIR + Eye Movement Desensitization and Reprocessing (EMDR) vs. STAIR + Narrative Therapy (NT) as treatments for PTSD following childhood-onset trauma in a routine clinical setting.Method: Sixty-eight adults were randomly assigned to STAIR/EMDR (8 STAIR-sessions followed by 12 EMDR-sessions) or STAIR/NT (8 STAIR-sessions followed by 12 NT-sessions). Assessments took place at pre-treatment, after each treatment phase and at 3 and 12 months post-intervention follow-up. Primary outcomes were interviewer-rated and self-reported symptom levels of PTSD. Secondary outcomes included symptom levels of depression and disturbances in emotion regulation and interpersonal skills.Results: Multilevel analyses in the intent-to-treat sample indicated that patients in both treatments improved substantially on PTSD symptom severity (CAPS: d = 0.81 to 1.29; PDS: d = 1.68 to 2.15), as well as on symptom levels of depression, anxiety, emotion regulation, dissociation and interpersonal skills. Effects increased or were maintained until 12-month follow-up. At mid-treatment, after STAIR, patients in both treatments improved moderately on PTSD symptom severity (PDS: d = 1.68 to 2.15), as well as on symptom levels of depression (BDI: d = .32 to .31). Symptoms of anxiety, emotion dysregulation, interpersonal problems and dissociation were not decreased after STAIR. There were no significant differences between the two conditions on any outcome.Conclusion: PTSD in adult survivors of childhood interpersonal trauma can effectively be treated by phase-based interventions using either EMDR or NT in the trauma-processing phase.Trial registration: ClinicalTrials.gov identifier: NCT01443182..
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Affiliation(s)
- I. Wigard
- Parnassiagroep, Amsterdam, the Netherlands
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - K. Meyerbröker
- Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands
- Altrecht Academic Anxiety Centre, Utrecht, the Netherlands
| | - T. Ehring
- Department of Psychology, LMU Munich, Munich, Germany
| | - M. Topper
- GGZ-Noord-Holland-Noord, Alkmaar, the Netherlands
| | - A. Arntz
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - P. Emmelkamp
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands
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8
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Grifoni J, Crispiatico V, Castagna A, Quartarone A, Converti RM, Ramella M, Granata G, Di Iorio R, Brancucci A, Bevacqua G, Pagani M, L'Abbate T, Armonaite K, Paulon L, Tecchio F. Musician's dystonia: an opinion on novel treatment strategies. Front Neurosci 2024; 18:1393767. [PMID: 38660229 PMCID: PMC11041626 DOI: 10.3389/fnins.2024.1393767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 03/18/2024] [Indexed: 04/26/2024] Open
Affiliation(s)
- Joy Grifoni
- Uninettuno International University, Rome, Italy
- Laboratory of Electrophysiology for Translational neuroScience LET'S, Institute of Cognitive Sciences and Technologies ISTC, Consiglio Nazionale delle Ricerche CNR, Rome, Italy
| | | | | | | | | | | | - Giuseppe Granata
- Neurology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Riccardo Di Iorio
- Neurology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Alfredo Brancucci
- Dipartimento di Scienze Motorie, Umane e della Salute, Università di Roma “Foro Italico”, Rome, Italy
| | | | - Marco Pagani
- Laboratory of Electrophysiology for Translational neuroScience LET'S, Institute of Cognitive Sciences and Technologies ISTC, Consiglio Nazionale delle Ricerche CNR, Rome, Italy
| | - Teresa L'Abbate
- Uninettuno International University, Rome, Italy
- Laboratory of Electrophysiology for Translational neuroScience LET'S, Institute of Cognitive Sciences and Technologies ISTC, Consiglio Nazionale delle Ricerche CNR, Rome, Italy
| | - Karolina Armonaite
- Uninettuno International University, Rome, Italy
- Laboratory of Electrophysiology for Translational neuroScience LET'S, Institute of Cognitive Sciences and Technologies ISTC, Consiglio Nazionale delle Ricerche CNR, Rome, Italy
| | - Luca Paulon
- Laboratory of Electrophysiology for Translational neuroScience LET'S, Institute of Cognitive Sciences and Technologies ISTC, Consiglio Nazionale delle Ricerche CNR, Rome, Italy
- Independent Researcher, Rome, Italy
| | - Franca Tecchio
- Laboratory of Electrophysiology for Translational neuroScience LET'S, Institute of Cognitive Sciences and Technologies ISTC, Consiglio Nazionale delle Ricerche CNR, Rome, Italy
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9
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Cisler JM, Dunsmoor JE, Privratsky AA, James GA. Decoding neural reactivation of threat during fear learning, extinction, and recall in a randomized clinical trial of L-DOPA among women with PTSD. Psychol Med 2024; 54:1091-1101. [PMID: 37807886 DOI: 10.1017/s0033291723002891] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
BACKGROUND Laboratory paradigms are widely used to study fear learning in posttraumatic stress disorder (PTSD). Recent basic science models demonstrate that, during fear learning, patterns of activity in large neuronal ensembles for the conditioned stimuli (CS) begin to reinstate neural activity patterns for the unconditioned stimuli (US), suggesting a direct way of quantifying fear memory strength for the CS. Here, we translate this concept to human neuroimaging and test the impact of post-learning dopaminergic neurotransmission on fear memory strength during fear acquisition, extinction, and recall among women with PTSD in a re-analysis of previously reported data. METHODS Participants (N = 79) completed a context-dependent fear acquisition and extinction task on day 1 and extinction recall tests 24 h later. We decoded activity patterns in large-scale functional networks for the US, then applied this decoder to activity patterns toward the CS on day 1 and day 2. RESULTS US decoder output for the CS+ increased during acquisition and decreased during extinction in networks traditionally implicated in human fear learning. The strength of US neural reactivation also predicted individuals skin conductance responses. Participants randomized to receive L-DOPA (n = 43) following extinction on day 1 demonstrated less US neural reactivation on day 2 relative to the placebo group (n = 28). CONCLUSION These results support neural reactivation as a measure of memory strength between competing memories of threat and safety and further demonstrate the role of dopaminergic neurotransmission in the consolidation of fear extinction memories.
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Affiliation(s)
- Josh M Cisler
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, University of Texas at Austin, Austin, TX, USA
- Institute for Early Life Adversity Research, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Joseph E Dunsmoor
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, University of Texas at Austin, Austin, TX, USA
- Institute for Early Life Adversity Research, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | | | - G Andrew James
- Brain Imaging Research Center, Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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10
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Zaccari B, Sherman ADF, Higgins M, Ann Kelly U. Trauma Center Trauma-Sensitive Yoga Versus Cognitive Processing Therapy for Women Veterans With PTSD Who Experienced Military Sexual Trauma: A Feasibility Study. J Am Psychiatr Nurses Assoc 2024; 30:343-354. [PMID: 35833676 PMCID: PMC9839891 DOI: 10.1177/10783903221108765] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is a common sequela to military sexual trauma (MST) among women veterans. Yoga has shown promise in research examining its benefit for symptoms and sequela of PTSD. AIMS The objective of this study was to evaluate the feasibility of a randomized controlled trial (RCT) of Trauma Center Trauma-Sensitive Yoga (TCTSY) for women veterans with PTSD related to MST. METHOD In this feasibility study, the final sample included women veterans (n = 41) with PTSD related to MST accessing health care in a Veterans Affairs Health Care System in the southeast United States; the majority were African American (n = 33; 80.5%). Interventions used established protocols of 10 weekly sessions of group TCTSY versus 12 weekly sessions of group Cognitive Processing Therapy (CPT). PTSD was assessed via clinical interview and participant report. Additional data collection included multiple participant-reported outcomes commonly associated with PTSD and psychophysiological measures. We also collected data regarding participant satisfaction and feasibility-related feedback from participants and providers. RESULTS Feasibility and acceptability were evaluated via demand, practicality, fidelity, and acceptability. This was measured by expressed interest, attendance, program completion, barriers to care and satisfaction with treatment, and satisfaction with interventions and data collection. CONCLUSIONS Results indicate the RCT design and TCTSY implementation were feasible; a full-scale RCT was subsequently conducted to determine efficacy of the experimental intervention. Recommendations for successful research strategies are provided.
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Affiliation(s)
- Belle Zaccari
- Belle Zaccari, PsyD, Veterans Affairs Portland Health Care System, Portland, OR, USA
- Belle Zaccari, PsyD, Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Athena D F Sherman
- Athena D. F. Sherman, PhD, PHN, RN, CNE, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Melinda Higgins
- Melinda Higgins, PhD, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Ursula Ann Kelly
- Ursula Ann Kelly, PhD, APRN, ANP-BC, PMHNP-BC, FAANP, FAAN, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
- Ursula Ann Kelly, PhD, APRN, ANP-BC, PMHNP-BC, FAANP, FAAN, Atlanta VA Health Care System, Atlanta, GA, USA
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11
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Yurgil KA, Ricca H, Baker DG. Resilience after combat: A prospective, longitudinal study of Marines and Navy Corpsmen. J Health Psychol 2024:13591053241236539. [PMID: 38494607 DOI: 10.1177/13591053241236539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024] Open
Abstract
Resilience is common, yet our understanding of key biopsychosocial and environmental correlates is limited. Additionally, perceived resilience is often conflated with absence of psychiatric symptoms. Here we leverage prospective, longitudinal data from 1835 Marines and Navy Corpsmen to examine predictors of perceived resilience 3 months after a combat deployment, while controlling for pre-deployment and concurrent psychiatric symptoms. Marines and Corpsmen did not differ significantly on psychosocial or clinical factors, and 50.4% reported high perceived resilience after deployment. Across groups, the strongest predictors of post-deployment perceived resilience were pre-deployment perceived resilience, positive emotions, and social support. Concurrent depression was the only clinical symptom negatively associated with perceived resilience. Our findings suggest that perceived resilience is a multi-dimensional construct that involves both psychosocial and personality factors, including but not limited to low psychopathology. Notably, establishing strong social support networks and encouraging positive emotions may help promote resilience following deployment.
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Affiliation(s)
- Kate A Yurgil
- Loyola University New Orleans, USA
- VA San Diego Healthcare System, USA
- Center of Excellence for Stress and Mental Health, USA
| | | | - Dewleen G Baker
- VA San Diego Healthcare System, USA
- Center of Excellence for Stress and Mental Health, USA
- University of California San Diego School of Medicine, USA
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12
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O'Brien MC, Disner SG, Davenport ND, Sponheim SR. The relationship between blast-related mild traumatic brain injury and executive function is moderated by white matter integrity. Brain Imaging Behav 2024:10.1007/s11682-024-00864-z. [PMID: 38448704 DOI: 10.1007/s11682-024-00864-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2024] [Indexed: 03/08/2024]
Abstract
Blast-related mild traumatic brain injury (BR mTBI) is a critical research area in recent combat veterans due to increased prevalence of survived blasts. Post-BR mTBI outcomes are highly heterogeneous and defining neurological differences may help in discrimination and prediction of cognitive outcomes. This study investigates whether white matter integrity, measured with diffusion tensor imaging (DTI), could influence how remote BR mTBI history is associated with executive control. The sample included 151 Veterans from the Minneapolis Veterans Affairs Medical Center who were administered a clinical/TBI assessment, neuropsychological battery, and DTI scan as part of a larger battery. From previous research, six white matter tracts were identified as having a putative relationship with blast severity: the cingulum, hippocampal cingulum, corticospinal tract, inferior fronto-occipital fasciculus, superior longitudinal fasciculus and uncinate. Fractional anisotropy (FA) of the a priori selected white matter tracts and report of BR mTBI were used as predictors of Trail-Making Test B (TMT-B) performance in a multiple linear regression model. Statistical analysis revealed that FA of the hippocampal cingulum moderated the association between report of at least one BR mTBI and poorer TMT-B performance (p < 0.008), such that lower FA value was associated with worse TMT-B outcomes in individuals with BR mTBI. No significant moderation existed for other selected tracts, and the effect was not observed with predictors aside from history of BR mTBI. Investigation at the individual-tract level may lead to a deeper understanding of neurological differences between blast-related and non-blast related injuries.
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Affiliation(s)
- Molly C O'Brien
- Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA.
- University of Minnesota, Twin Cities, Minneapolis, MN, USA.
| | - Seth G Disner
- Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
- University of Minnesota, Twin Cities, Minneapolis, MN, USA
| | - Nicholas D Davenport
- Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
- University of Minnesota, Twin Cities, Minneapolis, MN, USA
| | - Scott R Sponheim
- Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
- University of Minnesota, Twin Cities, Minneapolis, MN, USA
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13
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Beck JG, Griffith EL, Majeed R, Beyer MS, Bowen ME, Free BL. Social problem-solving in intimate partner violence victims: Exploring the relative contributions of shame and PTSD symptoms. J Clin Psychol 2024. [PMID: 38447035 DOI: 10.1002/jclp.23675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 12/29/2023] [Accepted: 02/26/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVE This study examined the contributions of shame and posttraumatic stress disorder (PTSD) symptoms to two dimensions of social problem-solving. METHOD A sample of 426 women who were seeking mental health assistance following experiences of intimate partner violence completed self-report and clinician measures. Separate path analyses were conducted for problem orientation and problem-solving styles. RESULTS In the model examining problem orientation, higher levels of shame were significantly associated with lower levels of positive problem orientation (f2 = 0.32) and higher levels of negative problem orientation (f2 = 0.92), with large effects noted. PTSD symptoms were significantly, positively associated with negative problem orientation (f2 = 0.3, large effect). When examining problem-solving styles, shame showed a significant negative association with rational style (f2 = 0.08, small effect) and significant positive associations with impulsive style (f2 = 0.45, large effect) and avoidant style (f2 = 0.48, large effect). PTSD symptoms did not return significant associations with any of the three problem-solving styles. CONCLUSION Results indicate that shame holds notable associations with both dimensions of social problem-solving, relative to PTSD symptoms, and are discussed in light of current models of post-trauma functioning. Implications for clinical care and early intervention efforts are highlighted.
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Affiliation(s)
- J Gayle Beck
- Department of Psychology, University of Memphis, Memphis, Tennessee, USA
| | | | - Rimsha Majeed
- Department of Psychology, University of Memphis, Memphis, Tennessee, USA
| | - Melissa S Beyer
- Department of Psychology, University of Memphis, Memphis, Tennessee, USA
| | - Mya E Bowen
- Department of Psychology, University of Memphis, Memphis, Tennessee, USA
| | - Bre'Anna L Free
- Department of Psychology, University of Memphis, Memphis, Tennessee, USA
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14
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Yetter MA, Fitzgerald TR, Philippi CL, Bruce SE. Pro-inflammatory markers are related to cortical network connectivity in women exposed to interpersonal trauma with PTSD. Behav Brain Res 2024:114942. [PMID: 38447761 DOI: 10.1016/j.bbr.2024.114942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 03/03/2024] [Indexed: 03/08/2024]
Abstract
Exposure to interpersonal violence affects a significant number of individuals each year and further increases the risk for developing Posttraumatic Stress Disorder (PTSD). A growing body of research suggests that immune system dysfunction, in particular elevated inflammation, may contribute to the pathophysiology of PTSD. However, few studies have examined the neurobiological correlates of inflammation in women with PTSD using resting-state fMRI. The present study explored the relationship between pro-inflammatory cytokine levels, C-reactive protein (CRP), tumor necrosis factor alpha TNF-alpha), and interleukin-6 (IL-6), and resting-state functional connectivity patterns in three major cortical networks (default mode network (DMN), central executive network (CEN), and salience network (SN)) in a sample of women (N=18) exposed to interpersonal violence with PTSD. Results indicated that higher CRP levels were associated with stronger functional connectivity between the SN and visual areas, but weaker functional connectivity between the CEN and visual areas. These findings suggest that pro-inflammatory markers are related to connectivity of task-positive networks in women with PTSD. Further, our results provide evidence for potential neurobiological markers of inflammation in PTSD.
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Affiliation(s)
- Marissa A Yetter
- Department of Psychological Sciences, University of Missouri-St. Louis, 1 University Blvd., St. Louis, Missouri, 63121, USA; University of Missouri - St. Louis
| | - Taryn R Fitzgerald
- Department of Psychological Sciences, University of Missouri-St. Louis, 1 University Blvd., St. Louis, Missouri, 63121, USA; University of Missouri - St. Louis
| | - Carissa L Philippi
- Department of Psychological Sciences, University of Missouri-St. Louis, 1 University Blvd., St. Louis, Missouri, 63121, USA; University of Missouri - St. Louis
| | - Steven E Bruce
- Department of Psychological Sciences, University of Missouri-St. Louis, 1 University Blvd., St. Louis, Missouri, 63121, USA; University of Missouri - St. Louis
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15
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Beucke JC, Diez I, Sepulcre J, Mundorf A, Kaufmann C, Orr SP, Pitman RK, Shin LM. A late-life neurogenetic signature of exposure to combat stress - A monozygotic discordant twin study. J Psychiatr Res 2024; 171:230-237. [PMID: 38316103 PMCID: PMC11113072 DOI: 10.1016/j.jpsychires.2024.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 01/09/2024] [Accepted: 01/15/2024] [Indexed: 02/07/2024]
Abstract
Animal models suggest that experiencing high-stress levels induces changes in amygdalar circuitry and gene expression. In humans, combat exposure has been shown to alter amygdalar responsivity and connectivity, but abnormalities have been indicated to normalize at least partially upon the termination of stress exposure. In contrast, other evidence suggests that combat exposure continues to exert influence on exposed individuals well beyond deployment and homecoming, as indicated by longitudinal psychosocial evidence from veterans, and observation of greater health decline in veterans late in life. Accordingly, the experience of combat stress early in life may affect amygdalar responsivity late in life, a possibility requiring careful consideration of the confounding effects of aging, genetic factors, and symptoms of post-traumatic stress disorder. Here, we investigated amygdalar responsivity in a unique sample of 16 male monozygotic (MZ) twin pairs in their sixties, where one but not the other sibling had been exposed to combat stress in early adulthood. Forty years after combat experience, a generally blunted amygdalar response was observed in combat-exposed veterans compared to their non-exposed twin siblings. Spatial associations between these phenotypical changes and patterns of gene expression in the brain were found for genes involved in the synaptic organization and chromatin structure. Protein-protein interactions among the set of identified genes pointed to histone modification mechanisms. We conclude that exposure to combat stress early in life continues to impact brain function beyond the termination of acute stress and appears to exert prolonged effects on amygdalar function later in life via neurogenetic mechanisms.
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Affiliation(s)
- Jan C Beucke
- Institute for Systems Medicine, Department of Human Medicine, MSH Medical School Hamburg, Hamburg, Germany; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany.
| | - Ibai Diez
- Gordon Center for Medical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Jorge Sepulcre
- Gordon Center for Medical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Annakarina Mundorf
- Institute for Systems Medicine, Department of Human Medicine, MSH Medical School Hamburg, Hamburg, Germany
| | - Christian Kaufmann
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Scott P Orr
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Roger K Pitman
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Lisa M Shin
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Tufts University, Medford, MA, USA
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16
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Abdelaziz HA, Dean YE, Elshafie AMA. Effect of three modalities on emergence agitation among post-traumatic stress disorder patients undergoing laparoscopy: a randomized controlled study. BMC Psychiatry 2024; 24:78. [PMID: 38281929 PMCID: PMC10823645 DOI: 10.1186/s12888-024-05525-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 01/16/2024] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND AND AIM Emergence agitation (EA) after general anesthesia is common in patients with post-traumatic stress disorder (PTSD). Due to the recent worldwide events such as the Covid-19 pandemic and wars, PTSD is not rare. Accordingly, a reliable, cost-effective anesthetic protocol to lower the incidence of EA is crucial. Therefore, we aimed to compare three different interventions for avoiding EA in PTSD patients undergoing gynecological laparoscopic surgery. Participants were divided into four groups: 1: performing pre-operative relaxation techniques (deep breathing exercise and progressive muscle relaxation [PMR]); 2: administrating intra-operative Ketamine; 3: applying both previously mentioned strategies and 4 as controls. METHODS This study was carried out on 144 adult women scheduled for gynecological laparoscopy, randomly allocated into four groups: three intervention groups and a control group (36 each). Women aged 18-45 years old, with a diagnosis of PTSD were included in the study. Patients with a positive history of major neurological, cardiovascular, metabolic, respiratory, or renal disease were excluded. Any patient who reported the use of psychiatric drugs were also excluded from the study. Data was analyzed using IBM SPSS Statistics software version 26. Kolmogorov- Smirnov was used to verify the normality of the distribution of variables. Odds ratio was calculated to clarify the strength and direction of the association between intervention groups and control. Data was deemed significant at a p-value ≤0.05. RESULTS Heart rate (HR) and Mean Arterial Blood Pressure (MABP) intra-operative and post-operative till 24 hours were significantly lower in groups 1, 2, and 3 compared to group 4 (p<0.001). There was a significant statistical difference in the intraoperative HR percentage decrease. MABP percentage decrease post-operative was higher in all the intervention groups with no statistically significant difference, except for group 1 compared to group 4, which was statistically significant (12.28 ± 11.77 and 6.10 ± 7.24, p=0.025). Visual Analogue Scale measurements were significantly less in the intervention groups 1, 2, and 3 compared to group 4. On Riker sedation-agitation scores, group 1 was 85 times more likely to be non-agitated (85 (15.938 - 453.307), p<0.001), group 2 was 175 times more likely to be non-agitated (175 (19.932-1536.448), p<0.001) and group 3 was protected against agitation. CONCLUSION Pre-operative relaxation techniques (breathing exercises and PMR) significantly lowered HR, MABP, VAS score, and EA than controls. These effects were not significantly different from intra-operative ketamine injection or the combination of both (relaxation techniques and ketamine). We recommend routine pre-operative screening for PTSD and the application of relaxation techniques (breathing exercises and PMR) in the pre-operative preparation protocol of PTSD-positive cases as well as routine practical application of preoperative relaxation techniques. Further studies on using pre-operative relaxation techniques in general could be cost-effective.
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Affiliation(s)
- Heba Ahmed Abdelaziz
- Lecturer of Mental Health, Department of Family Health, Alexandria High Institute of Public Health, Alexandria, Egypt
| | - Yomna E Dean
- Lecturer of Anesthesia and Surgical Intensive Care, Department of Anesthesia and Surgical Intensive Care, Alexandria University, Faculty of Medicine, Alexandria, Egypt.
- Alexandria Medical Center (AMC), Alexandria, Egypt.
| | - Ahmed Mohamed Ahmed Elshafie
- Lecturer of Anesthesia and Surgical Intensive Care, Department of Anesthesia and Surgical Intensive Care, Alexandria University, Faculty of Medicine, Alexandria, Egypt
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17
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Chen HJ, Guo Y, Ke J, Qiu J, Zhang L, Xu Q, Zhong Y, Lu GM, Qin H, Qi R, Chen F. Characterizing Typhoon-related Posttraumatic Stress Disorder Based on Multimodal Fusion of Structural, Diffusion, and Functional Magnetic Resonance Imaging. Neuroscience 2024; 537:141-150. [PMID: 38042250 DOI: 10.1016/j.neuroscience.2023.11.018] [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] [Received: 06/05/2023] [Revised: 11/09/2023] [Accepted: 11/15/2023] [Indexed: 12/04/2023]
Abstract
Diagnosing posttraumatic stress disorder (PTSD) using only single-modality images is controversial. We aimed to use multimodal magnetic resonance imaging (MRI) combining structural, diffusion, and functional MRI to possibly provide a more comprehensive viewpoint on the decisive characteristics of PTSD patients. Typhoon-exposed individuals with (n = 26) and without PTSD (n = 32) and healthy volunteers (n = 30) were enrolled. Five MRI features from three modalities, including two resting-state functional MRI (rs-fMRI) features (amplitude of low-frequency fluctuation, ALFF; and regional homogeneity, ReHo), one structural MRI feature (gray matter density, GM), and two diffusion tensor imaging (DTI) features (fractional anisotropy, FA; and mean diffusivity, MD) were investigated simultaneously with a multimodal canonical correlation analysis + joint independent component analysis model to identify abnormalities in the PTSD brain. We identified statistical differences between PTSD patients and healthy controls in terms of 1 rs-fMRI (ALFF, ReHo) alterations in the superior frontal gyrus, precuneus, inferior parietal lobule (IPL), anterior cingulate cortex (ACC), and posterior cingulate cortex (PCC), 2 DTI (FA, MD) changes in the pons, genu, and splenium of the corpus callosum, and 3 Structural MRI abnormalities in the precuneus, IPL, ACC, and PCC. A novel ReHo component was found to distinguish PTSD and trauma-exposed controls, including the precuneus, IPL, middle frontal gyrus, middle occipital gyrus, and cerebellum. This study reveals that PTSD individuals exhibit intertwined functional and structural anomalies within the default mode network. Some alterations within this network may serve as a potential marker to distinguish between PTSD patients and trauma-exposed controls.
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Affiliation(s)
- Hui Juan Chen
- Department of Radiology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), No. 19, Xiuhua St, Xiuying Dis, Haikou, Hainan 570311, PR China
| | - Yihao Guo
- Department of Radiology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), No. 19, Xiuhua St, Xiuying Dis, Haikou, Hainan 570311, PR China
| | - Jun Ke
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, PR China; Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province 215006, PR China
| | - Jie Qiu
- Department of Ultrasound, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), No. 19, Xiuhua St, Xiuying Dis, Haikou, Hainan 570311, PR China
| | - Li Zhang
- Mental Health Institute, The Second Xiangya Hospital, National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Central South University, Changsha, China
| | - Qiang Xu
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, PR China
| | - Yuan Zhong
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, PR China
| | - Guang Ming Lu
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, PR China
| | - Haodong Qin
- MR Collaboration, Siemens Healthineers Ltd., Guangzhou, PR China
| | - Rongfeng Qi
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, PR China
| | - Feng Chen
- Department of Radiology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), No. 19, Xiuhua St, Xiuying Dis, Haikou, Hainan 570311, PR China.
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18
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Blalock ZN, Wu GWY, Lindqvist D, Trumpff C, Flory JD, Lin J, Reus VI, Rampersaud R, Hammamieh R, Gautam A, Doyle FJ, Marmar CR, Jett M, Yehuda R, Wolkowitz OM, Mellon SH. Circulating cell-free mitochondrial DNA levels and glucocorticoid sensitivity in a cohort of male veterans with and without combat-related PTSD. Transl Psychiatry 2024; 14:22. [PMID: 38200001 PMCID: PMC10781666 DOI: 10.1038/s41398-023-02721-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 12/05/2023] [Accepted: 12/15/2023] [Indexed: 01/12/2024] Open
Abstract
Circulating cell-free mitochondrial DNA (ccf-mtDNA) is a biomarker of cellular injury or cellular stress and is a potential novel biomarker of psychological stress and of various brain, somatic, and psychiatric disorders. No studies have yet analyzed ccf-mtDNA levels in post-traumatic stress disorder (PTSD), despite evidence of mitochondrial dysfunction in this condition. In the current study, we compared plasma ccf-mtDNA levels in combat trauma-exposed male veterans with PTSD (n = 111) with those who did not develop PTSD (n = 121) and also investigated the relationship between ccf mt-DNA levels and glucocorticoid sensitivity. In unadjusted analyses, ccf-mtDNA levels did not differ significantly between the PTSD and non-PTSD groups (t = 1.312, p = 0.191, Cohen's d = 0.172). In a sensitivity analysis excluding participants with diabetes and those using antidepressant medication and controlling for age, the PTSD group had lower ccf-mtDNA levels than did the non-PTSD group (F(1, 179) = 5.971, p = 0.016, partial η2 = 0.033). Across the entire sample, ccf-mtDNA levels were negatively correlated with post-dexamethasone adrenocorticotropic hormone (ACTH) decline (r = -0.171, p = 0.020) and cortisol decline (r = -0.149, p = 0.034) (viz., greater ACTH and cortisol suppression was associated with lower ccf-mtDNA levels) both with and without controlling for age, antidepressant status and diabetes status. Ccf-mtDNA levels were also significantly positively associated with IC50-DEX (the concentration of dexamethasone at which 50% of lysozyme activity is inhibited), a measure of lymphocyte glucocorticoid sensitivity, after controlling for age, antidepressant status, and diabetes status (β = 0.142, p = 0.038), suggesting that increased lymphocyte glucocorticoid sensitivity is associated with lower ccf-mtDNA levels. Although no overall group differences were found in unadjusted analyses, excluding subjects with diabetes and those taking antidepressants, which may affect ccf-mtDNA levels, as well as controlling for age, revealed decreased ccf-mtDNA levels in PTSD. In both adjusted and unadjusted analyses, low ccf-mtDNA levels were associated with relatively increased glucocorticoid sensitivity, often reported in PTSD, suggesting a link between mitochondrial and glucocorticoid-related abnormalities in PTSD.
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Affiliation(s)
- Zachary N Blalock
- Department of Psychiatry and Behavioral Sciences and Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Gwyneth W Y Wu
- Department of Psychiatry and Behavioral Sciences and Weill Institute for Neurosciences, University of California, San Francisco, CA, USA.
| | - Daniel Lindqvist
- Unit for Biological and Precision Psychiatry, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Caroline Trumpff
- Department of Psychiatry, Division of Behavioral Medicine, Columbia University Medical Center, New York, USA
| | - Janine D Flory
- James J. Peters VA Medical Center, Bronx, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jue Lin
- Department of Biochemistry and Biophysics, University of California, San Francisco, CA, USA
| | - Victor I Reus
- Department of Psychiatry and Behavioral Sciences and Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Ryan Rampersaud
- Department of Psychiatry and Behavioral Sciences and Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Rasha Hammamieh
- Integrative Systems Biology, US Army Medical Research and Materiel Command, USACEHR, Fort Detrick, Frederick, MD, USA
| | - Aarti Gautam
- Integrative Systems Biology, US Army Medical Research and Materiel Command, USACEHR, Fort Detrick, Frederick, MD, USA
| | - Francis J Doyle
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Charles R Marmar
- Department of Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
| | - Marti Jett
- Integrative Systems Biology, US Army Medical Research and Materiel Command, USACEHR, Fort Detrick, Frederick, MD, USA
| | - Rachel Yehuda
- James J. Peters VA Medical Center, Bronx, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Owen M Wolkowitz
- Department of Psychiatry and Behavioral Sciences and Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Synthia H Mellon
- Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, CA, USA
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19
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Zeifman RJ, Kettner H, Ross S, Weiss B, Mithoefer MC, Mithoefer AT, Wagner AC. Preliminary evidence for the importance of therapeutic alliance in MDMA-assisted psychotherapy for posttraumatic stress disorder. Eur J Psychotraumatol 2024; 15:2297536. [PMID: 38174611 PMCID: PMC10769553 DOI: 10.1080/20008066.2023.2297536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 12/14/2023] [Indexed: 01/05/2024] Open
Abstract
Background: MDMA-assisted psychotherapy (MDMA-AP) is a combined psychotherapeutic and pharmacologic intervention that shows promise in the treatment of posttraumatic stress disorder (PTSD). Although therapeutic alliance has been established as a key predictor across psychotherapies and is emphasised within MDMA-AP treatment manuals, research has not yet examined the relationship between therapeutic alliance and MDMA-AP treatment outcomes.Objective: Examine whether therapeutic alliance predicts changes in PTSD symptoms following MDMA-AP.Method: Twenty-three individuals with chronic PTSD participated in a MDMA-AP clinical trial that included a randomised (MDMA vs. placebo) and open-label phase. The present analyses focused on participants who were administered MDMA over the course of the randomised and open-label phases (n = 22). Therapeutic alliance was assessed using the Working Alliance Inventory at sessions baseline (pre-session 3) and sessions 4 and 9. PTSD symptoms were assessed using the Clinician Administered PTSD Scale and the Impact of Events Scale-Revised.Results: Controlling for baseline clinician-assessed PTSD severity, therapeutic alliance at sessions 4 and 9 (but not baseline) significantly predicted post-MDMA-AP clinician-assessed PTSD severity. Controlling for baseline self-reported PTSD severity, therapeutic alliance at baseline (although this did not survive correction for multiple comparisons) and sessions 4 and 9 predicted post-MDMA-AP self-reported PTSD severity.Conclusions: The present results provide the first preliminary evidence for the relationship between the therapeutic alliance and treatment outcomes within MDMA-AP for PTSD. These findings highlight the important role of psychotherapy, and common psychotherapeutic factors, within MDMA-AP. Replication in studies with larger and more diverse clinical samples remain necessary.Trial registration: ClinicalTrials.gov identifier: NCT00090064.
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Affiliation(s)
- Richard J. Zeifman
- Department of Psychiatry, NYU Grossman School of Medicine, NYU Langone Centre for Psychedelic Medicine, New York, NY, USA
| | - Hannes Kettner
- Centre for Psychedelic Research, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Stephen Ross
- Department of Psychiatry, NYU Grossman School of Medicine, NYU Langone Centre for Psychedelic Medicine, New York, NY, USA
| | - Brandon Weiss
- Centre for Psychedelic Research, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
| | | | | | - Anne C. Wagner
- Department of Psychology, Toronto Metropolitan University, Toronto, Canada
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Wen A, Rao U, Kinney KL, Yoon KL, Morris M. Diversity in emotion regulation strategy use: Resilience against posttraumatic stress disorder. Behav Res Ther 2024; 172:104441. [PMID: 38091721 DOI: 10.1016/j.brat.2023.104441] [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: 07/21/2022] [Revised: 11/14/2023] [Accepted: 11/23/2023] [Indexed: 12/26/2023]
Abstract
Posttraumatic stress disorder (PTSD) is associated with impaired emotion regulation (ER). ER diversity, the variety, prevalence, and relative abundance of ER strategy use, may provide resilience against PTSD. This study examined the prospective relation between ER diversity and PTSD, while accounting for negative and positive life events, in interpersonal violence (IPV) survivors. IPV-exposed women with PTSD onset (PTSD; n = 22), without PTSD onset (IPV; n = 37), and non-traumatized control participants (NTC; n = 41) rated their ER strategy use and experience of negative and positive life events. The ER diversity index differentiated the participant groups. Importantly, group differences in ER diversity depended on the experience of life events. When experiencing fewer positive life events and more negative life events, the IPV and NTC groups, but not the PTSD group, demonstrated higher ER diversity. Thus, greater ER diversity during periods with more negative life events and fewer positive life events may play a protective role against PTSD onset for IPV survivors.
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Affiliation(s)
- Alainna Wen
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, 760 Westwood Plaza, Los Angeles, CA, 90095, USA; Department of Psychology, University of Notre Dame, 390 Corbett Family Hall, Notre Dame, IN 46556, USA.
| | - Uma Rao
- Department of Psychiatry and Human Behavior, University of California Irvine, 5251 California Avenue, Irvine, CA, 92617, USA; Children's Hospital of Orange County, 1201 West La Veta Ave, Orange, CA, 92868, USA.
| | - Kerry L Kinney
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA; Department of Psychological Sciences, Vanderbilt University, 2301 Vanderbilt Place, Nashville, TN, 37240, USA.
| | - K Lira Yoon
- Department of Psychology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD, 21250, USA.
| | - Matthew Morris
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA; Department of Anesthesiology, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN, 37232, USA.
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21
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Woodward MJ, Griffith EL, Free BL, Bowen ME, Majeed R, Beyer MS, Beck JG. Do latent profiles of self-reported anxiety, depression, and PTSD map onto clinician ratings? An examination with intimate partner violence survivors. J Anxiety Disord 2024; 101:102806. [PMID: 38061324 DOI: 10.1016/j.janxdis.2023.102806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/10/2023] [Accepted: 12/01/2023] [Indexed: 01/17/2024]
Abstract
OBJECTIVE Studies exploring latent profiles of mental health in trauma survivors have largely relied on self-report, making it unclear whether these patterns correspond with clinician-assessed psychopathology. The purpose of the current study was to examine latent profiles of self-reported PTSD, depression, and anxiety in a sample of 387 women who had experienced intimate partner violence (IPV) and investigate whether profiles mapped onto clinician-rated measures of the same outcomes. METHOD Participants completed a series of semi-structured interviews and self-report measures assessing PTSD, depression, and anxiety. RESULTS Latent profile analyses revealed a 3-profile solution characterized by Low (22.48 %), Moderate (37.98 %), and High (39.53 %) self-reported symptomology. Clinician ratings were significant predictors of membership in the low vs. moderate vs. high symptomology profiles. However, normalized means showed discrepancies between self-report and clinician assessment regarding which issue was rated most severe. CONCLUSIONS Results suggest that while latent modeling approaches relying on self-report may adequately approximate common underlying patterns of psychopathology, they have limitations in identifying which disorders are most salient for clinical intervention.
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22
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Fine NB, Helpman L, Armon DB, Gurevitch G, Sheppes G, Seligman Z, Hendler T, Bloch M. Amygdala-related electroencephalogram neurofeedback as add-on therapy for treatment-resistant childhood sexual abuse posttraumatic stress disorder: feasibility study. Psychiatry Clin Neurosci 2024; 78:19-28. [PMID: 37615935 DOI: 10.1111/pcn.13591] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 08/14/2023] [Accepted: 08/21/2023] [Indexed: 08/25/2023]
Abstract
AIM Childhood sexual abuse (CSA) among women is an alarmingly prevalent traumatic experience that often leads to debilitating and treatment-refractory posttraumatic stress disorder (PTSD), raising the need for novel adjunctive therapies. Neuroimaging investigations systematically report that amygdala hyperactivity is the most consistent and reliable neural abnormality in PTSD and following childhood abuse, raising the potential of implementing volitional neural modulation using neurofeedback (NF) aimed at down-regulating amygdala activity. This study aimed to reliably probe limbic activity but overcome the limited applicability of functional magnetic resonance imaging (fMRI) NF by using a scalable electroencephalogram NF probe of amygdala-related activity, termed amygdala electrical-finger-print (amyg-EFP) in a randomized controlled trial. METHOD Fifty-five women with CSA-PTSD who were in ongoing intensive trauma-focused psychotherapy for a minimum of 1 year but still met Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) PTSD criteria were randomized to either 10 add-on sessions of amyg-EFP-NF training (test group) or continuing psychotherapy (control group). Participants were blindly assessed for PTSD symptoms before and after the NF training period, followed by self-reported clinical follow-up at 1, 3, and 6 months, as well as one session of amygdala real-time fMRI-NF before and after NF training period. RESULTS Participants in the test group compared with the control group demonstrated a marginally significant immediate reduction in PTSD symptoms, which progressively improved during the follow-up period. In addition, successful neuromodulation during NF training was demonstrated. CONCLUSION This feasibility study for patients with treatment-resistant CSA-PTSD indicates that amyg-EFP-NF is a viable and efficient intervention.
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Affiliation(s)
- Naomi B Fine
- School of Psychological Sciences, Faculty of Social Sciences, Tel-Aviv University, Tel Aviv, Israel
- Sagol Brain Institute Tel-Aviv, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Liat Helpman
- Womens' Reproductive Mental Health research Unit, Psychiatric Department, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Department of Counseling and Human Development, University of Haifa, Haifa, Israel
| | - Daphna Bardin Armon
- Lotem Center for Treatment of Sexual Trauma, Department of Psychiatry, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Guy Gurevitch
- Sagol Brain Institute Tel-Aviv, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gal Sheppes
- School of Psychological Sciences, Faculty of Social Sciences, Tel-Aviv University, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | - Zivya Seligman
- Lotem Center for Treatment of Sexual Trauma, Department of Psychiatry, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Talma Hendler
- School of Psychological Sciences, Faculty of Social Sciences, Tel-Aviv University, Tel Aviv, Israel
- Sagol Brain Institute Tel-Aviv, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | - Miki Bloch
- Womens' Reproductive Mental Health research Unit, Psychiatric Department, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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23
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Ceroni TL, Holmes SC, Alshabani N, Silver KE, Johnson DM. The Role of Race, Social Support, Empowerment, and Posttraumatic Cognitions in Survivors of Intimate Partner Violence Symptoms of Posttraumatic Stress Disorder. Violence Against Women 2023:10778012231214773. [PMID: 38128921 DOI: 10.1177/10778012231214773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Black women experience more frequent and severe intimate partner violence (IPV), but there are mixed findings on their posttraumatic stress disorder (PTSD) symptom severity. This may be explained by cultural-salient factors which are associated with fewer posttraumatic cognitions. We hypothesized an indirect effect of race on PTSD symptoms via social support, empowerment, and posttraumatic cognitions, serially. Path analysis revealed Black women reported increased social support, which was associated with higher levels of empowerment, which was associated with lower levels of posttraumatic cognitions. Decreased posttraumatic cognitions were associated with less severe PTSD symptoms. Results increase understanding of culturally-salient factors that may impact PTSD symptoms in Black women.
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Affiliation(s)
- Taylor L Ceroni
- Southeast Louisiana Veterans Health Care System (SLVHCS), New Orleans, LA, USA
- South Central Mental Illness Research, Education and Clinical Center (MIRECC), New Orleans, LA, USA
| | - Samantha C Holmes
- College of Staten Island, City University of New York, Staten Island, NY, USA
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24
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Rawls E, Marquardt CA, Fix ST, Bernat E, Sponheim SR. Posttraumatic reexperiencing and alcohol use: mediofrontal theta as a neural mechanism for negative reinforcement. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.07.12.547253. [PMID: 37502872 PMCID: PMC10370024 DOI: 10.1101/2023.07.12.547253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Objective Over half of US military veterans with posttraumatic stress disorder (PTSD) use alcohol heavily, potentially to cope with their symptoms. This study investigated the neural underpinnings of PTSD symptoms and heavy drinking in veterans. We focused on brain responses to salient outcomes within predictive coding theory. This framework suggests the brain generates prediction errors (PEs) when outcomes deviate from expectations. Alcohol use might provide negative reinforcement by reducing the salience of negatively-valenced PEs and dampening experiences like loss. Methods We analyzed electroencephalography (EEG) responses to unpredictable gain/loss feedback in veterans of Operations Enduring and Iraqi Freedom. We used time-frequency principal components analysis of event-related potentials to isolate neural responses indicative of PEs, identifying mediofrontal theta linked to losses (feedback-related negativity, FRN) and central delta associated with gains (reward positivity, RewP). Results Intrusive reexperiencing symptoms of PTSD were associated with intensified mediofrontal theta signaling during losses, suggesting heightened negative PE sensitivity. Conversely, increased hazardous alcohol use was associated with reduced theta responses, implying a dampening of these negative PEs. The separate delta-RewP component showed associations with alcohol use but not PTSD symptoms. Conclusions Findings suggest a common neural component of PTSD and hazardous alcohol use involving altered PE processing. We suggest that reexperiencing enhances the intensity of salient negative PEs, while chronic alcohol use may reduce their intensity, thereby providing negative reinforcement by muting emotional disruption from reexperienced trauma. Modifying the mediofrontal theta response could address the intertwined nature of PTSD symptoms and alcohol use, providing new avenues for treatment.
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Affiliation(s)
- Eric Rawls
- Department of Psychiatry and Behavioral Sciences, University of Minnesota
| | - Craig A Marquardt
- Minneapolis Veterans Affairs Health Care System
- Department of Psychiatry and Behavioral Sciences, University of Minnesota
| | - Spencer T Fix
- Department of Psychology, University of Maryland College Park
| | - Edward Bernat
- Department of Psychology, University of Maryland College Park
| | - Scott R Sponheim
- Minneapolis Veterans Affairs Health Care System
- Department of Psychiatry and Behavioral Sciences, University of Minnesota
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25
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Elinger G, Hasson-Ohayon I, Bar-Shachar Y, Peri T. A quasi-experimental trial of narrative reconstruction for prolonged grief disorder: Symptomatic improvement and enhanced memory integration. J Clin Psychol 2023; 79:2849-2868. [PMID: 37590286 DOI: 10.1002/jclp.23583] [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] [Received: 01/29/2023] [Revised: 06/27/2023] [Accepted: 08/08/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Prolonged grief disorder (PGD) was recently approved as a formal diagnosis in the DSM-5-TR. The implementation of bereavement interventions is frequently requested, but their effectiveness has been controversial. Narrative reconstruction (NR) is a time-limited integrative therapy, originally developed for the treatment of post-traumatic stress disorder (PTSD) and adapted for the treatment of PGD. NR consists of exposure to the loss memory, a detailed written reconstruction of the loss memory narrative, and an elaboration of the personal significance of that memory for the bereaved. OBJECTIVES In this study we evaluated the efficacy of NR for PGD. METHOD In this study, 33 participants with PGD were quasi-randomized-that is, assigned to an immediate (n = 20) or delayed (n = 13) 16-session NR intervention. PGD, intrusion, avoidance and depression symptoms, as well as levels of the loss memory integration, were assessed at pretreatment, post-treatment, and at a 3-month follow-up. RESULTS Mixed linear models showed significant intervention effects for PGD and intrusive symptomatology. Results also showed an increase in integration of the loss memory, and improvements remained stable for all outcomes at follow-up. CONCLUSION In this study we established NR as an effective intervention for PGD and call for further validation in future studies. Integrating this intervention into the routine care of people with PGD seems important and beneficial.
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Affiliation(s)
- Gali Elinger
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
| | | | - Yael Bar-Shachar
- Department of Psychology, Ben-Gurion University, Beer Sheva, Israel
| | - Tuvia Peri
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
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26
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Pyne JM, Constans JI, Wiederhold BK, Jegley S, Rabalais A, Hu B, Weber MC, Hinkson KD, Wiederhold MD. Predicting Post-Traumatic Stress Disorder Treatment Response Using Heart Rate Variability to Virtual Reality Environment and Modified Stroop Task: An Exploratory Study. CYBERPSYCHOLOGY, BEHAVIOR AND SOCIAL NETWORKING 2023; 26:896-903. [PMID: 38032955 DOI: 10.1089/cyber.2023.0164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
Predicting treatment response can inform treatment decisions, expectations, and optimize use of mental health treatment resources. This study examined heart rate (HR), heart rate variability (HRV), and a modified Stroop task (mStroop) to predict post-traumatic stress disorder (PTSD) treatment response. We report on an observational, longitudinal study with 45 U.S. veterans in outpatient PTSD care, who had deployed to Iraq or Afghanistan. HR and HRV were collected before, during, and after virtual reality (VR) combat and civilian scenes. HRV recovery was defined as HRV after a 3-minute VR simulation minus HRV during a VR scene. mStroop threat variables included index scores for combat and general threat. Self-report data were collected at baseline and 6 months later. The outcome variable was the 17-item Clinician Administered PTSD Scale (CAPS). Controlling for baseline CAPS and number of combat experiences, the following baseline HRV recovery variables were significant predictors of 6-month CAPS: standard deviation of normal beat to beat interval (SDNN) after combat scene minus SDNN during combat scene and low-frequency (LF HRV) after civilian scene minus LF during civilian scene. HRV at rest, HR reactivity, HR recovery, and mStroop scores did not predict treatment response. In conclusion, HRV recovery variables in the context of a standardized VR stressor were significant predictors of PTSD treatment response after controlling for baseline CAPS and number of combat experiences. The direction of this relationship indicates that greater baseline HRV recovery predicts lower 6-month PTSD symptom severity. This was an exploratory study in need of replication.
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Affiliation(s)
- Jeffrey M Pyne
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, USA
- South Central Mental Illness Research, Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, USA
- Division of Health Services Research, Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Joseph I Constans
- Office of Research and Development, Veterans Health Administration, Washington, District of Columbia, USA
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
- School of Medicine, Tulane University, New Orleans, Louisiana, USA
| | | | - Susan Jegley
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, USA
- South Central Mental Illness Research, Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, USA
| | | | - Bo Hu
- Division of Health Services Research, Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Marcela C Weber
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, USA
- South Central Mental Illness Research, Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, USA
| | - Kent D Hinkson
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, USA
- South Central Mental Illness Research, Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, USA
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Fonkoue IT, Tahsin CT, Jones TN, King KN, Tahmin CI, Jeong J, Dixon D, DaCosta DR, Park J. Sex differences in Black Veterans with PTSD: women versus men have higher sympathetic activity, inflammation, and blunted cardiovagal baroreflex sensitivity. Clin Auton Res 2023; 33:757-766. [PMID: 37898568 DOI: 10.1007/s10286-023-00995-1] [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: 06/26/2023] [Accepted: 10/14/2023] [Indexed: 10/30/2023]
Abstract
PURPOSE Post-traumatic stress disorder (PTSD) is associated with greater risk of incident hypertension and cardiovascular disease (CVD). Inflammation and autonomic derangements are suggested as contributing mechanisms. Women and Black adults have higher CVD risk associated with stress; however, whether there is a sex difference in autonomic and inflammatory mechanisms among Black individuals with PTSD is not known. We hypothesized that Black women with PTSD have higher inflammation, sympathetic nervous system (SNS) activity and impaired baroreflex sensitivity (BRS). METHODS In 42 Black Veterans with PTSD (Women, N = 18 and Men, N = 24), we measured inflammatory biomarkers, continuous blood pressure (BP), heart rate (HR) and muscle sympathetic nerve activity (MSNA) at rest and during arterial BRS testing via the modified Oxford technique. RESULTS Groups were matched for age and body mass index (BMI). Resting BP was similar between groups, but HR was higher (76 ± 12 vs. 68 ± 9 beats/min, p = 0.021) in women compared to men. Although women had lower PTSD symptoms severity (57 ± 17 vs. 68 ± 12 a.u.), resting MSNA (27 ± 13 vs. 16 ± 5 bursts/min, p = 0.003) was higher in women compared to men, respectively. Likewise, cardiovagal BRS was blunted (p = 0.002) in women (7.6 ± 4.3 ms/mmHg) compared to men (15.5 ± 8.4 ms/mmHg) while sympathetic BRS was not different between groups (p = 0.381). Black women also had higher (p = 0.020) plasma levels of interleukin-2 (IL-2). CONCLUSION Black women with PTSD have higher resting HR and MSNA, greater impairment of cardiovagal BRS and possibly higher inflammation. These findings suggest a higher burden of autonomic and inflammatory derangements in Black women compared to Black men with PTSD.
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Affiliation(s)
- Ida T Fonkoue
- Physical Therapy Division, Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
- Rehabilitation Science Division, Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Chowdhury Tasnova Tahsin
- Rehabilitation Science Division, Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Toure N Jones
- Division of Renal Medicine, Department of Medicine, Emory University School of Medicine, 101 Woodruff Circle, WMB 3300, Atlanta, GA, 30322, USA
- Research Service Line, Atlanta VA Healthcare System, Decatur, GA, USA
| | - Keyona N King
- Division of Renal Medicine, Department of Medicine, Emory University School of Medicine, 101 Woodruff Circle, WMB 3300, Atlanta, GA, 30322, USA
- Research Service Line, Atlanta VA Healthcare System, Decatur, GA, USA
| | - Chowdhury Ibtida Tahmin
- Rehabilitation Science Division, Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Jinhee Jeong
- Division of Renal Medicine, Department of Medicine, Emory University School of Medicine, 101 Woodruff Circle, WMB 3300, Atlanta, GA, 30322, USA
- Research Service Line, Atlanta VA Healthcare System, Decatur, GA, USA
| | - Deirdre Dixon
- Division of Renal Medicine, Department of Medicine, Emory University School of Medicine, 101 Woodruff Circle, WMB 3300, Atlanta, GA, 30322, USA
- Research Service Line, Atlanta VA Healthcare System, Decatur, GA, USA
| | - Dana R DaCosta
- Division of Renal Medicine, Department of Medicine, Emory University School of Medicine, 101 Woodruff Circle, WMB 3300, Atlanta, GA, 30322, USA
- Research Service Line, Atlanta VA Healthcare System, Decatur, GA, USA
| | - Jeanie Park
- Division of Renal Medicine, Department of Medicine, Emory University School of Medicine, 101 Woodruff Circle, WMB 3300, Atlanta, GA, 30322, USA.
- Research Service Line, Atlanta VA Healthcare System, Decatur, GA, USA.
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28
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Blain RC, Martin CE, Ehlinger CC, Chard KM. Evidence-based treatment for posttraumatic stress disorder decreases suicidal ideation by reducing perceived burdensomeness among veterans in an outpatient program. J Trauma Stress 2023; 36:1138-1150. [PMID: 38057998 DOI: 10.1002/jts.23004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 09/25/2023] [Accepted: 09/25/2023] [Indexed: 12/08/2023]
Abstract
Evidenced-based posttraumatic stress disorder (PTSD) treatments generally reduce suicidal ideation (SI), and the interpersonal theory of suicide (ITS) may theoretically account for this finding. The ITS posits that SI stems from feeling like a burden (i.e., perceived burdensomeness) and a lack of belonging (i.e., thwarted belongingness). Previous research suggests that change in PTSD severity has a significant indirect effect on change in SI through changes in perceived burdensomeness, but not thwarted belongingness, among patients receiving residential PTSD treatment in a Veterans Affairs (VA) medical center; however, no research has investigated these associations in an outpatient VA setting with fewer confounding factors that might affect ITS constructs. Therefore, the current sample included veterans (N = 126) who completed PTSD treatment and pre- and posttreatment assessments in a VA outpatient clinic. Results from parallel models of multiple indirect effects suggest that change in PTSD severity was indirectly associated with change in SI through changes in perceived burdensomeness, B = 0.35, p < .001; β = .36, p < .001, SE = .10, 95% CI [.15, .54], but not thwarted belongingness, B = 0.14, p = .146; β = .14, p = .161, SE = .10, 95% CI [-.05, .33]. Additional models were examined using PTSD cluster scores for exploratory purposes. The results indicate that PTSD treatment reduces the perceived and objective burden of PTSD to decrease SI. Study findings support the importance of access to evidence-based care to treat PTSD and alleviate burdensomeness for suicide prevention.
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Affiliation(s)
- Rachel C Blain
- Cincinnati VA Medical Center, Trauma Recovery Center, Cincinnati, Ohio, USA
| | - Colleen E Martin
- Cincinnati VA Medical Center, Trauma Recovery Center, Cincinnati, Ohio, USA
| | | | - Kathleen M Chard
- Cincinnati VA Medical Center, Trauma Recovery Center, Cincinnati, Ohio, USA
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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29
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Foss S, Petty CR, Howell C, Mendonca J, Bosse A, Waber DP, Wright RJ, Enlow MB. Associations among maternal lifetime trauma, psychological symptoms in pregnancy, and infant stress reactivity and regulation. Dev Psychopathol 2023; 35:1714-1731. [PMID: 35678173 PMCID: PMC9732151 DOI: 10.1017/s0954579422000402] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Maternal trauma has intergenerational implications, including worse birth outcomes, altered brain morphology, and poorer mental health. Research investigating intergenerational effects of maternal trauma on infant stress reactivity and regulation is limited. Maternal mental health during pregnancy may be a contributor: psychopathology is a sequela of trauma exposure and predictor of altered self-regulatory capacity in offspring of affected mothers. We assessed associations among maternal lifetime trauma and infant stress responsivity, mediated by psychological symptoms in pregnancy. Mothers reported lifetime trauma history and anxiety, depressive, and posttraumatic stress symptoms during pregnancy. At infant age 6 months, stress reactivity and regulation were assessed via maternal behavior ratings (Infant Behavior Questionnaire-Revised, IBQ-R) and behavioral (negative mood) and physiological (respiratory sinus arrhythmia, RSA) markers during a laboratory stressor (Still-Face Paradigm). Maternal trauma was directly associated with lower infant physiological regulation and indirectly associated with lower levels of both infant behavioral and physiological regulation via higher maternal anxiety during pregnancy. Maternal trauma was also indirectly associated with higher infant reactivity via higher maternal anxiety during pregnancy. Post hoc analyses indicated differential contributions of maternal prenatal versus postnatal anxiety to infant outcomes. Findings highlight potential contributory mechanisms toward maladaptive child stress response, which has been associated with poor behavioral, cognitive, and academic outcomes.
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Affiliation(s)
- Sophie Foss
- Department of Psychiatry, Boston Children’s Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Carter R. Petty
- Institutional Centers for Clinical and Translational Research, Boston Children’s Hospital, Boston, MA, USA
| | - Caroline Howell
- Department of Psychiatry, Boston Children’s Hospital, Boston, MA, USA
| | - Juliana Mendonca
- Department of Psychiatry, Boston Children’s Hospital, Boston, MA, USA
| | - Abigail Bosse
- Department of Psychiatry, Boston Children’s Hospital, Boston, MA, USA
| | - Deborah P. Waber
- Department of Psychiatry, Boston Children’s Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Rosalind J. Wright
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Kravis Children’s Hospital, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michelle Bosquet Enlow
- Department of Psychiatry, Boston Children’s Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Macia KS, Carlson EB, Palmieri PA, Smith SR, Anglin DM, Ghosh Ippen C, Lieberman AF, Wong EC, Schell TL, Waelde LC. Development of a Brief Version of the Dissociative Symptoms Scale and the Reliability and Validity of DSS-B Scores in Diverse Clinical and Community Samples. Assessment 2023; 30:2058-2073. [PMID: 37653563 PMCID: PMC10478338 DOI: 10.1177/10731911221133317] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
The Dissociative Symptoms Scale (DSS) was developed to assess moderately severe types of dissociation (depersonalization, derealization, gaps in awareness and memory, and dissociative reexperiencing) that would be relevant to a range of clinical populations, including those experiencing trauma-related dissociation. The current study used data from 10 ethnically and racially diverse clinical and community samples (N = 3,879) to develop a brief version of the DSS (DSS-B). Item information curves were examined to identify items with the most precision in measuring above average levels of the latent trait within each subscale. Analyses revealed that the DSS-B preserved the factor structure and content domains of the full scale, and its scores had strong reliability and validity that were comparable to those of scores on the full measure. DSS-B scores showed high levels of measurement invariance across ethnoracial groups. Results indicate that DSS-B scores are reliable and valid in the populations studied.
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Affiliation(s)
- Kathryn S. Macia
- National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, CA, USA
- Stanford University School of Medicine, Palo Alto, CA, USA
| | - Eve B. Carlson
- National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, CA, USA
- Stanford University School of Medicine, Palo Alto, CA, USA
| | | | | | | | | | | | | | | | - Lynn C. Waelde
- Stanford University School of Medicine, Palo Alto, CA, USA
- Palo Alto University, CA, USA
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Liu SR, Moore TM, Gur RC, Nievergelt C, Baker DG, Risbrough V, Acheson DT. High executive functioning is associated with reduced posttraumatic stress after trauma exposure among male U.S. military personnel. Front Psychol 2023; 14:1181055. [PMID: 37818418 PMCID: PMC10560729 DOI: 10.3389/fpsyg.2023.1181055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 08/31/2023] [Indexed: 10/12/2023] Open
Abstract
Introduction Evidence suggests that executive function (EF) may play a key role in development of PTSD, possibly influenced by factors such as trauma type and timing. Since EF can be improved through intervention, it may be an important target for promoting resilience to trauma exposure. However, more research is needed to understand the relation between trauma exposure, EF, and PTSD. The goal of this study was to improve understanding of EF as a potential antecedent or protective factor for the development of PTSD among military personnel. Method In a cohort of U.S. Marines and Navy personnel (N = 1,373), the current study tested the association between exposure to traumatic events (pre-deployment and during deployment) and PTSD severity, and whether EF moderated these associations. Three types of pre-deployment trauma exposure were examined: cumulative exposure, which included total number of events participants endorsed as having happened to them, witnessed, or learned about; direct exposure, which included total number of events participants endorsed as having happened to them; and interpersonal exposure, which included total number of interpersonally traumatic events participants' endorsed. EF was measured using the Penn Computerized Neurocognitive Battery. Results EF was associated with less PTSD symptom severity at pre-deployment, even when adjusting for trauma exposure, alcohol use, traumatic brain injury, and number of years in the military. EF also moderated the relation between cumulative trauma exposure and interpersonal trauma exposure and PTSD, with higher EF linked to a 20 and 33% reduction in expected point increase in PTSD symptoms with cumulative and interpersonal trauma exposure, respectively. Finally, higher pre-deployment EF was associated with reduced PTSD symptom severity at post-deployment, independent of deployment-related trauma exposure and adjusting for pre-deployment PTSD. Conclusion Our results suggest that EF plays a significant, if small role in the development of PTSD symptoms after trauma exposure among military personnel. These findings provide important considerations for future research and intervention and prevention, specifically, incorporating a focus on improving EF in PTSD treatment.
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Affiliation(s)
- Sabrina R. Liu
- Department of Human Development, California State University San Marcos, San Marcos, CA, United States
| | - Tyler M. Moore
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States
| | - Ruben C. Gur
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States
| | - Caroline Nievergelt
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, La Jolla, CA, United States
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Dewleen G. Baker
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, La Jolla, CA, United States
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Victoria Risbrough
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, La Jolla, CA, United States
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Dean T. Acheson
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, La Jolla, CA, United States
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
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Veerapa E, Grandgenevre P, Vaiva G, Duhem S, Fayoumi ME, Vinnac B, Szaffarczyk S, Wathelet M, Fovet T, D'Hondt F. Attentional bias toward negative stimuli in PTSD: an eye-tracking study. Psychol Med 2023; 53:5809-5817. [PMID: 36259422 DOI: 10.1017/s0033291722003063] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Research on biased processing of aversive stimuli in posttraumatic stress disorder (PTSD) has produced inconsistent results between response time (RT) and eye-tracking studies. Recent RT-based results of dot-probe studies showed no attentional bias (AB) for threat while eye-tracking research suggested heightened sustained attention for this information. Here, we used both RT-based and eye-tracking measures to explore the dynamics of AB to negative stimuli in PTSD. METHODS Twenty-three individuals diagnosed with PTSD, 23 trauma-exposed healthy controls, and 23 healthy controls performed an emotional dot-probe task with pairs of negative and neutral scenes presented for either 1 or 2 s. Analyses included eye movements during the presentation of the scenes and RT associated with target localization. RESULTS There was no evidence for an AB toward negative stimuli in PTSD from RT measures. However, the main eye-tracking results revealed that all three groups showed longer dwell times on negative pictures than neutral pictures at 1 s and that this AB was stronger for individuals with PTSD. Moreover, although AB disappeared for the two groups of healthy controls with prolonged exposure, it persisted for individuals with PTSD. CONCLUSION PTSD is associated with an AB toward negative stimuli, characterized by heightened sustained attention toward negative scenes once detected. This study sheds light on the dynamics of AB to negative stimuli in PTSD and encourages us to consider optimized therapeutic interventions targeting abnormal AB patterns.
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Affiliation(s)
- Emilie Veerapa
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, F-59000 Lille, France
- Department of Psychiatry, CHU Lille, F-59000 Lille, France
| | - Pierre Grandgenevre
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, F-59000 Lille, France
- Department of Psychiatry, CHU Lille, F-59000 Lille, France
| | - Guillaume Vaiva
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, F-59000 Lille, France
- Department of Psychiatry, CHU Lille, F-59000 Lille, France
- Centre national de ressources et de résilience Lille-Paris (CN2R), F-59000 Lille, France
| | - Stéphane Duhem
- Department of Psychiatry, CHU Lille, F-59000 Lille, France
- Centre national de ressources et de résilience Lille-Paris (CN2R), F-59000 Lille, France
- Fédération de Recherche en Psychiatrie et Santé Mentale des Hauts-de-France, F-59000 Lille, France
- Univ. Lille, Inserm, CHU Lille, CIC1403 - Clinical Investigation Center, F-59000 Lille, France
| | - Mohamed El Fayoumi
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, F-59000 Lille, France
| | - Benjamin Vinnac
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, F-59000 Lille, France
- Department of Psychiatry, CHU Lille, F-59000 Lille, France
| | - Sébastien Szaffarczyk
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, F-59000 Lille, France
| | - Marielle Wathelet
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, F-59000 Lille, France
- Department of Psychiatry, CHU Lille, F-59000 Lille, France
- Centre national de ressources et de résilience Lille-Paris (CN2R), F-59000 Lille, France
- Fédération de Recherche en Psychiatrie et Santé Mentale des Hauts-de-France, F-59000 Lille, France
| | - Thomas Fovet
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, F-59000 Lille, France
- Department of Psychiatry, CHU Lille, F-59000 Lille, France
- Centre national de ressources et de résilience Lille-Paris (CN2R), F-59000 Lille, France
| | - Fabien D'Hondt
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, F-59000 Lille, France
- Department of Psychiatry, CHU Lille, F-59000 Lille, France
- Centre national de ressources et de résilience Lille-Paris (CN2R), F-59000 Lille, France
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Carmi L, Zohar J, Juven-Wetzler A, Desarnaud F, Makotkine L, Bierer LM, Cohen H, Yehuda R. Promoter methylation of the glucocorticoid receptor following trauma may be associated with subsequent development of PTSD. World J Biol Psychiatry 2023; 24:578-586. [PMID: 36748398 PMCID: PMC10440098 DOI: 10.1080/15622975.2023.2177342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 01/22/2023] [Accepted: 02/02/2023] [Indexed: 02/08/2023]
Abstract
OBJECTIVES The ability to identify persons at elevated risk for post-traumatic stress disorder (PTSD) soon after exposure to trauma, could aid clinical decision-making and treatment. In this study, we explored whether cytosine methylation of the 1 F promoter of the NR3C1 (glucocorticoid receptor [GR]) gene obtained immediately following a trauma could predict PTSD. METHODS Our sample comprised 52 trauma survivors (28 women, 24 men), presenting to the Emergency Department (ED) within six hours of a traumatic event and followed for 13 months. Blood samples were taken at intake (n = 42) and again at the end of the study (13 months later, n = 27) to determine NR3C1-1F promoter methylation as well as plasma levels of cortisol, adrenocorticotropic-hormone (ACTH), and neuropeptide-Y (NPY). RESULTS At the 13-month follow-up, participants who met the PTSD criteria (n = 4) showed significantly lower NR3C1-1F promoter sum percent methylation compared to the non-PTSD group (n = 38). Further, NR3C1-1F methylation at ED intake was inversely correlated with PTSD severity 13 months later, indicating that lower NR3C1-1F promoter methylation in the immediate aftermath of trauma was associated with the development of PTSD. CONCLUSION To the extent that reduced promoter methylation is associated with greater GR expression and responsivity, this finding is consistent with the hypothalamic-pituitary-adrenal dysregulation previously described for PTSD.
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Affiliation(s)
- Lior Carmi
- Post Trauma Center, Chaim Sheba Medical Center, Ramat Gan, Israel
- The Data Science Institution, Reichman University, Herzliya, Israel
| | - Joseph Zohar
- Post Trauma Center, Chaim Sheba Medical Center, Ramat Gan, Israel
- Tel Aviv University, Tel Aviv, Israel
| | | | - Frank Desarnaud
- Traumatic Stress Studies Division, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, Mental Health Care Center, PTSD Clinical Research Program & Laboratory of Clinical Neuroendocrinology and Neurochemistry, James J. Peters Veterans Affairs Medical Center, Bronx, New York
| | - Louri Makotkine
- Traumatic Stress Studies Division, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, Mental Health Care Center, PTSD Clinical Research Program & Laboratory of Clinical Neuroendocrinology and Neurochemistry, James J. Peters Veterans Affairs Medical Center, Bronx, New York
| | - Linda M Bierer
- Traumatic Stress Studies Division, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, Mental Health Care Center, PTSD Clinical Research Program & Laboratory of Clinical Neuroendocrinology and Neurochemistry, James J. Peters Veterans Affairs Medical Center, Bronx, New York
| | - Hagit Cohen
- Beer-Sheva Mental Health Center, Ministry of Health, Anxiety and Stress Research Unit, Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel
| | - Rachel Yehuda
- Traumatic Stress Studies Division, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, Mental Health Care Center, PTSD Clinical Research Program & Laboratory of Clinical Neuroendocrinology and Neurochemistry, James J. Peters Veterans Affairs Medical Center, Bronx, New York
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López-Castro T, Martin L, Nickley S, Saraiya TC, Melara RD. Frontal Alpha Asymmetry in Posttraumatic Stress Disorder: Group Differences Among Individuals With and Without PTSD During an Inhibitory Control Task. Clin EEG Neurosci 2023; 54:472-482. [PMID: 34657474 PMCID: PMC9022109 DOI: 10.1177/15500594211046703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The current study examined frontal alpha asymmetry (FAA) as a marker of approach- and avoidance-related prefrontal activity in participants with and without trauma exposure and posttraumatic stress disorder (PTSD). We investigated FAA in an inhibitory control paradigm (threatening vs nonthreatening cues) under 2 levels of cognitive demand (baseline: images constant within a block of trials; vs filtering: images varied randomly within a block) in 3 groups of participants: individuals with PTSD (n = 16), exposed to trauma but without PTSD (n = 14), and a control group without PTSD or trauma exposure (n = 15). Under low demand (baseline), both PTSD and trauma-exposed participants exhibited significantly greater relative left than right frontal brain activity (approach) to threatening than to nonthreatening images. Under high demand (filtering), no FAA differences were found between threatening and nonthreatening images, but PTSD participants revealed more relative left than right FAA, whereas trauma-exposed participants showed reduced left relative right FAA. In all conditions, healthy controls exhibited reduced left relative to right FAA and no differences between threatening and nonthreatening images. Study findings suggest dysfunctional prefrontal mechanisms of emotion regulation in PTSD, but adaptive prefrontal regulation in trauma-exposed individuals without PTSD.
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Affiliation(s)
- Teresa López-Castro
- Psychology Department, The City College of New York, The City University of New York, 160 Convent Avenue, New York, NY 10032
| | - Laura Martin
- George Mason University, 4400 University Drive, Fairfax, VA, 22030
| | - Sean Nickley
- Psychology Department, Long Island University, 1 University Plaza, H811, Brooklyn, NY 11201
| | - Tanya C. Saraiya
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Robert D. Melara
- Psychology Department, The City College of New York, The City University of New York, 160 Convent Avenue, New York, NY 10032
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Lendvai D, Whittemore R, Womack JA, Fortier CB, Milberg WP, Fonda JR. The Impact of Blast Exposure-With or Without Traumatic Brain Injury-on Metabolic Abnormalities in Post-9/11 Veterans. J Head Trauma Rehabil 2023; 38:380-390. [PMID: 36951458 PMCID: PMC10514232 DOI: 10.1097/htr.0000000000000874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
OBJECTIVE The primary aim included explorations of: (1) the associations between the history of blast exposure (BE), close blast exposure (CBE), and blast-related traumatic brain injury (bTBI) and metabolic abnormality; and (2) the potential mediating effect of comorbid psychological and somatic conditions on these associations. The secondary aim explored the association of dose-response impact of BE, CBE, and bTBI and metabolic abnormality. SETTING Data were collected by the Translational Research Center for TBI and Stress Disorders (TRACTS). PARTICIPANTS Post-9/11 veterans from the TRACTS baseline sample who had conflict-zone deployment experience ( N = 734). DESIGN Cross-sectional secondary data analysis. We computed relative risks (RRs) and 95% CI using modified Poisson regression. We quantified the impact of co-occurring psychological and somatic conditions on this association using mediation analyses. MAIN MEASURES Exposures included BE (<100 m), CBE (<10 m), and bTBI. Metabolic abnormality outcomes included (1) overweight/obesity (defined by abnormal waist-hip ratio [WHR] and abnormal waist circumference [WC]); (2) glucose dysregulation; and (3) meeting criteria for cardiometabolic syndrome (defined by guidelines). RESULTS The sample was majority male (91%) and White (68%), with a mean age of 34.6 years (SD = 8.99). Most participants had 1 or more BE (83%); 48% experienced 1 or more CBE. Overweight/obesity was highly prevalent in the sample (51% had abnormal WHR and 60% abnormal WC). There was no significant direct or indirect association between BE, CBE, and bTBI and metabolic abnormalities (RRs: 0.70-1.51; P 's > .05). CONCLUSION Future research is needed to investigate the association of BE with metabolic abnormalities with larger, more targeted sample selection, and longer follow-up. Effective and sustainable weight management and metabolic health prevention interventions for this veteran cohort are needed.
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Affiliation(s)
- Dora Lendvai
- VA Connecticut Healthcare System, West Haven, Connecticut
- Yale University, School of Nursing, Orange, Connecticut
| | | | - Julie A. Womack
- VA Connecticut Healthcare System, West Haven, Connecticut
- Yale University, School of Nursing, Orange, Connecticut
| | - Catherine B. Fortier
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Healthcare System, Boston, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - William P. Milberg
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Healthcare System, Boston, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Jennifer R. Fonda
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education and Clinical Center (GRECC), VA Boston Healthcare System, Boston, Massachusetts
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
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MacDonald HZ, Franz MR, Kaiser AP, Lee LO, Lawrence AE, Fairbank JA, Vasterling JJ. Associations of Warzone Veteran and Intimate Partner PTSD Symptoms with Child Depression, Anxiety, Hyperactivity, and Conduct Problems. MILITARY BEHAVIORAL HEALTH 2023; 11:236-243. [PMID: 38859978 PMCID: PMC11164550 DOI: 10.1080/21635781.2023.2246894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
Warzone deployment increases risk for posttraumatic stress disorder symptoms (PTSS), including among service members who have children. Parental PTSS are associated with child depression, anxiety, hyperactivity, and conduct problems, yet few studies of child behavioral health outcomes in military populations have accounted for PTSS in both warzone veterans and their partners. Fewer still incorporate non-clinically-recruited samples of nationally dispersed warzone veterans and their families. The current research examines whether children whose parent(s) have higher levels of PTSS exhibit more behavioral health symptoms. One hundred and thirty-three Iraq and Afghanistan War veterans and their cohabitating partners completed clinical interviews and self-report questionnaires. Higher intimate partner PTSS, more extensive child exposure to stressful life events, and being an adolescent were significantly associated with child depression after adjusting for warzone veteran PTSS, demographics, and recent warzone veteran absence from the household. Greater child exposure to stressful life events was also associated with child conduct problems. Treatment of PTSD symptoms experienced by warzone veterans' intimate partners, and preventative interventions aimed at helping the children of warzone veterans cope with stress, may ultimately yield positive benefits for the behavioral health of children in military families.
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Affiliation(s)
- Helen Z. MacDonald
- Department of Psychology and Neuroscience, Emmanuel College, Boston, MA, USA
- Psychology Service, VA Boston Healthcare System, Boston, MA, USA
| | - Molly R. Franz
- Department of Psychology, University of Maryland Baltimore County, Baltimore, MD, USA
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Anica Pless Kaiser
- Psychology Service, VA Boston Healthcare System, Boston, MA, USA
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Lewina O. Lee
- Psychology Service, VA Boston Healthcare System, Boston, MA, USA
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Amy E. Lawrence
- Psychology Service, VA Boston Healthcare System, Boston, MA, USA
| | - John A. Fairbank
- National Center for Child Traumatic Stress, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- Mid-Atlantic (VISN 6) Mental Illness Research, Education and Clinical Center, Durham VA Health Care System, Durham, NC, USA
| | - Jennifer J. Vasterling
- Psychology Service, VA Boston Healthcare System, Boston, MA, USA
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
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Nguyen E, Meadley B, Harris R, Rajaratnam SMW, Williams B, Smith K, Bowles KA, Dobbie ML, Drummond SPA, Wolkow AP. Sleep and mental health in recruit paramedics: a 6-month longitudinal study. Sleep 2023; 46:zsad050. [PMID: 36861384 PMCID: PMC10424174 DOI: 10.1093/sleep/zsad050] [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: 07/07/2022] [Revised: 01/11/2023] [Indexed: 03/03/2023] Open
Abstract
STUDY OBJECTIVES To explore potential relationships and longitudinal changes in sleep and mental health in recruit paramedics over the first 6 months of work, and whether sleep disturbances pre-emergency work predict future mental health outcomes. METHODS Participants (N = 101, 52% female, Mage = 26 years) completed questionnaires prior to (baseline), and after 6 months of emergency work to assess for symptoms of insomnia, obstructive sleep apnea, post-traumatic stress disorder (PTSD), depression, anxiety, and trauma exposure. At each timepoint, participants also completed a sleep diary and wore an actigraph for 14 days to assess sleep patterns. Correlations between baseline sleep and mental health were conducted and changes in these variables across timepoints were examined using linear mixed models. Hierarchical regressions assessed whether sleep at baseline predicted mental health at follow-up. RESULTS Insomnia and depression symptoms, and total sleep time increased while sleep onset latency decreased across the first 6 months of emergency work. Participants experienced an average of 1 potentially traumatic event during the 6-month period. Baseline insomnia predicted increased depression symptoms at the 6-month follow-up, while baseline wake after sleep onset predicted follow-up PTSD symptoms. CONCLUSION Results highlight an increase in insomnia and depression across the initial months of emergency work, while sleep disturbances before emergency work were identified as potential risk factors for the development of depression and PTSD among paramedics in their early career. Screening and early interventions targeting poor sleep at the beginning of emergency employment may assist in reducing the risk of future mental health outcomes in this high-risk occupation.
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Affiliation(s)
- Elle Nguyen
- Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria 3800, Australia
| | - Ben Meadley
- Paramedic Health and Well-being Research Unit, Monash University, Frankston, Victoria 3199, Australia
- Department of Paramedicine, Monash University, Frankston, Victoria 3199, Australia
- Ambulance Victoria, Doncaster, Victoria 3108, Australia
| | - Rachael Harris
- Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria 3800, Australia
| | - Shantha M W Rajaratnam
- Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria 3800, Australia
- Paramedic Health and Well-being Research Unit, Monash University, Frankston, Victoria 3199, Australia
| | - Brett Williams
- Paramedic Health and Well-being Research Unit, Monash University, Frankston, Victoria 3199, Australia
- Department of Paramedicine, Monash University, Frankston, Victoria 3199, Australia
| | - Karen Smith
- Paramedic Health and Well-being Research Unit, Monash University, Frankston, Victoria 3199, Australia
- Department of Paramedicine, Monash University, Frankston, Victoria 3199, Australia
- Department of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3000, Australia
| | - Kelly-Ann Bowles
- Paramedic Health and Well-being Research Unit, Monash University, Frankston, Victoria 3199, Australia
- Department of Paramedicine, Monash University, Frankston, Victoria 3199, Australia
| | | | - Sean P A Drummond
- Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria 3800, Australia
| | - Alexander P Wolkow
- Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria 3800, Australia
- Paramedic Health and Well-being Research Unit, Monash University, Frankston, Victoria 3199, Australia
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Shah N, Goodwin AJ, Verdin R, Clark JT, Rheingold AA, Ruggiero KJ, Simpson AN, Ford DW. Evaluation of a Telehealth-Enabled Pilot Program to Address Intensive Care Unit Health Care Worker Mental Health Distress. TELEMEDICINE REPORTS 2023; 4:249-258. [PMID: 37637378 PMCID: PMC10457649 DOI: 10.1089/tmr.2023.0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/01/2023] [Indexed: 08/29/2023]
Abstract
Introduction Health care workers (HCWs) are at heightened risk of adverse mental health events (AMHEs) and burnout with resultant impact on health care staffing, outcomes, and costs. We piloted a telehealth-enabled mental health screening and support platform among HCWs in the intensive care unit (ICU) setting at a tertiary care center. Methods A survey consisting of validated screening tools was electronically disseminated to a potential cohort of 178 ICU HCWs. Participants were given real-time feedback on their results and those at risk were provided invitations to meet with resiliency clinicians. Participants were further invited to engage in a 3-month longitudinal assessment of their well-being through repeat surveys and a weekly text-based check-in coupled with self-help tips. Programmatic engagement was evaluated and associations between at-risk scores and engagement were assessed. Qualitative input regarding programmatic uptake and acceptance was gathered through key informant interviews. Results Fifty (28%) HCWs participated in the program. Half of the participants identified as female, and most participants were white (74%) and under the age of 50 years (93%). Nurses (38%), physicians-in-training (24%), and faculty-level physicians (20%) engaged most frequently. There were 19 (38%) requests for an appointment with a resiliency clinician. The incidence of clinically significant symptoms of AMHEs and burnout was high but not clearly associated with engagement. Additional programmatic tailoring was encouraged by key informants while time was identified as a barrier to program engagement. Discussion A telehealth-enabled platform is a feasible approach to screening at-risk HCWs for AMHEs and can facilitate engagement with support services.
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Affiliation(s)
- Nihar Shah
- Division of Pulmonary Critical Care Allergy and Sleep Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Andrew J. Goodwin
- Division of Pulmonary Critical Care Allergy and Sleep Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Rebecca Verdin
- Telehealth Center of Excellence; Leadership and Management; Medical University of South Carolina, Charleston, South Carolina, USA
| | - John T. Clark
- Biomedical Informatics Center; Leadership and Management; Medical University of South Carolina, Charleston, South Carolina, USA
| | - Alyssa A. Rheingold
- Department of Psychiatry and Behavioral Sciences; Leadership and Management; Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kenneth J. Ruggiero
- College of Nursing, Leadership and Management; Medical University of South Carolina, Charleston, South Carolina, USA
| | - Annie N. Simpson
- Department of Healthcare, Leadership and Management; Medical University of South Carolina, Charleston, South Carolina, USA
| | - Dee W. Ford
- Division of Pulmonary Critical Care Allergy and Sleep Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
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Yetter M, Philippi CL, Bruce SE. Altered functional connectivity between cortical networks associated with inhibitory control in trauma-exposed females. Psychiatry Res Neuroimaging 2023; 333:111671. [PMID: 37348291 PMCID: PMC10330570 DOI: 10.1016/j.pscychresns.2023.111671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 04/18/2023] [Accepted: 06/01/2023] [Indexed: 06/24/2023]
Abstract
Post-traumatic stress disorder (PTSD) is associated with impaired inhibitory control and alterations in large-scale brain network connectivity. However, few studies to date have examined the construct of inhibitory control as it relates to resting-state functional connectivity (rsFC) in a population with PTSD or trauma-exposure. The present study investigated the relationship between impaired inhibitory control and rsFC within the default mode network (DMN), central executive network (CEN), and salience network (SN) in a sample of females exposed to interpersonal trauma with and without PTSD (n = 67). Participants completed a classic Color-Word Stroop task as a measure of inhibitory control and two resting-state fMRI scans. We conducted voxelwise rsFC analyses with seed regions in the DMN, CEN, and SN and voxelwise linear regression analyses to examine the relationship between inhibitory control and rsFC of these networks across the sample. Better Stroop performance was negatively associated with total self-reported PTSD symptoms. An analysis of PTSD symptom clusters indicated that better Stroop performance was also associated with re-experiencing and hyperarousal symptoms, but not avoidance PTSD symptoms. Decreased coupling between the CEN and the DMN was associated with better inhibitory control in this sample of trauma-exposed females. These findings lend support to the hypothesis that efficient switching between these networks may contribute to better performance on cognitive and attentional tasks in trauma-exposed individuals.
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Affiliation(s)
- Marissa Yetter
- Department of Psychological Sciences, University of Missouri-St. Louis, 1 University Blvd., St. Louis, MO, 63121, USA, University of Missouri - St. Louis
| | - Carissa L Philippi
- Department of Psychological Sciences, University of Missouri-St. Louis, 1 University Blvd., St. Louis, MO, 63121, USA, University of Missouri - St. Louis
| | - Steven E Bruce
- Department of Psychological Sciences, University of Missouri-St. Louis, 1 University Blvd., St. Louis, MO, 63121, USA, University of Missouri - St. Louis.
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Choi Y, Kim Y, Choi S, Choi YE, Kwon O, Kwon DH, Lee SH, Cho SH, Kim H. Emotional freedom technique versus written exposure therapy versus waiting list for post-traumatic stress disorder: protocol for a randomised clinical MRI study. BMJ Open 2023; 13:e070389. [PMID: 37349095 PMCID: PMC10314485 DOI: 10.1136/bmjopen-2022-070389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 05/31/2023] [Indexed: 06/24/2023] Open
Abstract
INTRODUCTION The emotional freedom technique (EFT) is an acupuncture-based psychotherapy that combines tapping on acupoints with cognitive reframing. EFT has been previously shown to have potential for treating post-traumatic stress disorder (PTSD). However, further clinical evidence and underlying mechanisms of EFT are yet to be fully explored. This proposed clinical trial aims to examine the effect of EFT on patients with PTSD compared with the waitlist (WL) and active controls. METHODS AND ANALYSIS This study was designed as a randomised, assessor-blinded, three-arm clinical MRI study. A total of 120 eligible patients with PTSD will be recruited and randomised into EFT, written exposure therapy (WET) or WL groups. EFT and WET will be applied once a week for 5 weeks. For patients in the WL group, EFT will be performed after 12 weeks. PTSD symptoms, depression, anxiety, somatic symptoms and quality of life will be evaluated. Assessments will be conducted at baseline (week 0), post-treatment (week 6) and follow-up (week 12). Structural and functional brain images and recording videos of facial expressions to emotional stimuli will be obtained before and after treatment. Sixty participants without lifetime traumatic experiences will be enrolled as healthy controls. The primary objective of the study is to compare the change from baseline in the Clinician-Administered PTSD Scale after treatment (week 6) between EFT and WL groups and between EFT and WET groups. ETHICS AND DISSEMINATION Ethical approval was obtained from the Institutional Review Board of the Kyung Hee University Korean Medicine Hospital. The research findings will be shared at national and international conferences and will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER Clinical Research Information Service KCT0007360 https://cris.nih.go.kr/cris/search/detailSearch.do/21974.
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Affiliation(s)
- Yujin Choi
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Yunna Kim
- Department of Neuropsychiatry, College of Korean Medicine, Kyung Hee University Medical Center, Kyung Hee University, Seoul, Republic of Korea
- Research Group of Neuroscience, East-West Medical Research Institute, WHO Collaborating Center, Kyung Hee University, Seoul, Republic of Korea
| | - Sunyoung Choi
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Young-Eun Choi
- R&D Strategy Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Ojin Kwon
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Do-Hyung Kwon
- Department of Neuropsychiatry, College of Korean Medicine, Kyung Hee University Medical Center, Kyung Hee University, Seoul, Republic of Korea
- Research Group of Neuroscience, East-West Medical Research Institute, WHO Collaborating Center, Kyung Hee University, Seoul, Republic of Korea
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Seung-Ho Lee
- Department of Neuropsychiatry, College of Korean Medicine, Kyung Hee University Medical Center, Kyung Hee University, Seoul, Republic of Korea
- Research Group of Neuroscience, East-West Medical Research Institute, WHO Collaborating Center, Kyung Hee University, Seoul, Republic of Korea
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Seung-Hun Cho
- Department of Neuropsychiatry, College of Korean Medicine, Kyung Hee University Medical Center, Kyung Hee University, Seoul, Republic of Korea
- Research Group of Neuroscience, East-West Medical Research Institute, WHO Collaborating Center, Kyung Hee University, Seoul, Republic of Korea
| | - Hyungjun Kim
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
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Chen HJ, Ke J, Qiu J, Xu Q, Zhong Y, Lu GM, Wu Y, Qi R, Chen F. Altered whole-brain resting-state functional connectivity and brain network topology in typhoon-related post-traumatic stress disorder. Ther Adv Psychopharmacol 2023; 13:20451253231175302. [PMID: 37342156 PMCID: PMC10278414 DOI: 10.1177/20451253231175302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 04/24/2023] [Indexed: 06/22/2023] Open
Abstract
Background Altered resting-state functional connectivity has been found in patients with post-traumatic stress disorder (PTSD). However, the alteration of resting-state functional connectivity at whole-brain level in typhoon-traumatized individuals with PTSD remains largely unknown. Objectives To investigate changes in whole-brain resting-state functional connectivity and brain network topology in typhoon-traumatized subjects with and without PTSD. Design Cross-sectional study. Methods Twenty-seven patients with typhoon-related PTSD, 33 trauma-exposed controls (TEC), and 30 healthy controls (HC) underwent resting-state functional MRI scanning. The whole brain resting-state functional connectivity network was constructed based on the automated anatomical labeling atlas. The graph theory method was used to analyze the topological properties of the large-scale resting-state functional connectivity network. Whole-brain resting-state functional connectivity and the topological network property were compared by analyzing the variance. Results There was no significant difference in the area under the curve of γ, λ, σ, global efficiency, and local efficiency among the three groups. The PTSD group showed increased dorsal cingulate cortex (dACC) resting-state functional connectivity with the postcentral gyrus (PoCG) and paracentral lobe and increased nodal betweenness centrality in the precuneus relative to both control groups. Compared with the PTSD and HC groups, the TEC group showed increased resting-state functional connectivity between the hippocampus and PoCG and increased connectivity strength in the putamen. In addition, compared with the HC group, both the PTSD and TEC groups showed increased connectivity strength and nodal efficiency in the insula. Conclusion Aberrant resting-state functional connectivity and topology were found in all trauma-exposed individuals. These findings broaden our knowledge of the neuropathological mechanisms of PTSD.
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Affiliation(s)
- Hui Juan Chen
- Department of Radiology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, China
| | - Jun Ke
- Department of Medical Imaging, Jinling Hospital, Medical School, Nanjing University, Nanjing, China
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jie Qiu
- Department of Ultrasound, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, China
| | - Qiang Xu
- Department of Medical Imaging, Jinling Hospital, Medical School, Nanjing University, Nanjing, China
| | - Yuan Zhong
- Department of Medical Imaging, Jinling Hospital, Medical School, Nanjing University, Nanjing, China
| | - Guang Ming Lu
- Department of Medical Imaging, Jinling Hospital, Medical School, Nanjing University, Nanjing, China
| | - Yanglei Wu
- MR Collaboration, Siemens Healthineers Ltd., Beijing, China
| | - Rongfeng Qi
- Department of Medical Imaging, Jinling Hospital, Medical School, Nanjing University, Nanjing 210002, Jiangsu, China
| | - Feng Chen
- Department of Radiology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), No. 19, Xiuhua Street, Xiuying District, Haikou 570311, Hainan, China
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Muhie S, Gautam A, Yang R, Misganaw B, Daigle BJ, Mellon SH, Flory JD, Abu-Amara D, Lee I, Wang K, Rampersaud R, Hood L, Yehuda R, Marmar CR, Wolkowitz OM, Ressler KJ, Doyle FJ, Hammamieh R, Jett M. Molecular signatures of post-traumatic stress disorder in war-zone-exposed veteran and active-duty soldiers. Cell Rep Med 2023; 4:101045. [PMID: 37196634 DOI: 10.1016/j.xcrm.2023.101045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 11/23/2022] [Accepted: 04/18/2023] [Indexed: 05/19/2023]
Abstract
Post-traumatic stress disorder (PTSD) is a multisystem syndrome. Integration of systems-level multi-modal datasets can provide a molecular understanding of PTSD. Proteomic, metabolomic, and epigenomic assays are conducted on blood samples of two cohorts of well-characterized PTSD cases and controls: 340 veterans and 180 active-duty soldiers. All participants had been deployed to Iraq and/or Afghanistan and exposed to military-service-related criterion A trauma. Molecular signatures are identified from a discovery cohort of 218 veterans (109/109 PTSD+/-). Identified molecular signatures are tested in 122 separate veterans (62/60 PTSD+/-) and in 180 active-duty soldiers (PTSD+/-). Molecular profiles are computationally integrated with upstream regulators (genetic/methylation/microRNAs) and functional units (mRNAs/proteins/metabolites). Reproducible molecular features of PTSD are identified, including activated inflammation, oxidative stress, metabolic dysregulation, and impaired angiogenesis. These processes may play a role in psychiatric and physical comorbidities, including impaired repair/wound healing mechanisms and cardiovascular, metabolic, and psychiatric diseases.
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Affiliation(s)
- Seid Muhie
- Medical Readiness Systems Biology, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA; The Geneva Foundation, Silver Spring, MD 20910, USA.
| | - Aarti Gautam
- Medical Readiness Systems Biology, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - Ruoting Yang
- Medical Readiness Systems Biology, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - Burook Misganaw
- Medical Readiness Systems Biology, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA; Vysnova Inc., Landover, MD 20785, USA
| | - Bernie J Daigle
- Departments of Biological Sciences and Computer Science, The University of Memphis, Memphis, TN 38152, USA
| | - Synthia H Mellon
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Janine D Flory
- Office of Mental Health, James J. Peters VA Medical Center, Bronx, NY 10468, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10468, USA
| | - Duna Abu-Amara
- Department of Psychiatry, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Inyoul Lee
- Institute for Systems Biology, Seattle, WA 98109, USA
| | - Kai Wang
- Institute for Systems Biology, Seattle, WA 98109, USA
| | - Ryan Rampersaud
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Leroy Hood
- Institute for Systems Biology, Seattle, WA 98109, USA
| | - Rachel Yehuda
- Office of Mental Health, James J. Peters VA Medical Center, Bronx, NY 10468, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10468, USA
| | - Charles R Marmar
- Department of Psychiatry, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Owen M Wolkowitz
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Kerry J Ressler
- McLean Hospital, Belmont, MA 02478, USA; Harvard Medical School, Boston, MA 02115, USA
| | - Francis J Doyle
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA 02134, USA
| | - Rasha Hammamieh
- Medical Readiness Systems Biology, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA
| | - Marti Jett
- US Army Medical Research and Development Command, HQ, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA.
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Galatzer-Levy IR, Onnela JP. Machine Learning and the Digital Measurement of Psychological Health. Annu Rev Clin Psychol 2023; 19:133-154. [PMID: 37159287 DOI: 10.1146/annurev-clinpsy-080921-073212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Since its inception, the discipline of psychology has utilized empirical epistemology and mathematical methodologies to infer psychological functioning from direct observation. As new challenges and technological opportunities emerge, scientists are once again challenged to define measurement paradigms for psychological health and illness that solve novel problems and capitalize on new technological opportunities. In this review, we discuss the theoretical foundations of and scientific advances in remote sensor technology and machine learning models as they are applied to quantify psychological functioning, draw clinical inferences, and chart new directions in treatment.
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Affiliation(s)
- Isaac R Galatzer-Levy
- Department of Psychiatry, New York University Grossman School of Medicine, New York, NY, USA;
- Current affiliation: Google LLC, Mountain View, California, USA
| | - Jukka-Pekka Onnela
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Fine NB, Ben-Aharon N, Armon DB, Seligman Z, Helpman L, Bloch M, Hendler T, Sheppes G. Reduced emotion regulatory selection flexibility in post-traumatic stress disorder: converging performance-based evidence from two PTSD populations. Psychol Med 2023; 53:2758-2767. [PMID: 37449489 PMCID: PMC10244008 DOI: 10.1017/s0033291721004670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 10/20/2021] [Accepted: 10/26/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Contemporary views of emotion dysregulation in post-traumatic stress disorder (PTSD) highlight reduced ability to flexibly select regulatory strategies according to differing situational demands. However, empirical evidence of reduced regulatory selection flexibility in PTSD is lacking. Multiple studies show that healthy individuals demonstrate regulatory selection flexibility manifested in selecting attentional disengagement regulatory strategies (e.g. distraction) in high-intensity emotional contexts and selecting engagement meaning change strategies (e.g. reappraisal) in low-intensity contexts. Accordingly, we hypothesized that PTSD populations will show reduced regulatory selection flexibility manifested in diminished increase in distraction (over reappraisal) preference as intensity increases from low to high intensity. METHODS Study 1 compared student participants with high (N = 22) post-traumatic symptoms (PTS, meeting the clinical cutoff for PTSD) and participants with low (N = 22) post-traumatic symptoms. Study 2 compared PTSD diagnosed women (N = 31) due to childhood sexual abuse and matched non-clinical women (N = 31). In both studies, participants completed a well-established regulatory selection flexibility performance-based paradigm that involves selecting between distraction and reappraisal to regulate negative emotional words of low and high intensity. RESULTS Beyond demonstrating adequate psychometric properties, Study 1 confirmed that relative to the low PTS group, the high PTS group presented reduced regulatory selection flexibility (p = 0.01, ŋ²ₚ= 0.14). Study 2 critically extended findings of Study 1, in showing similar reduced regulatory selection flexibility in a diagnosed PTSD population, relative to a non-clinical population (p = 0.002, ŋ²ₚ= 0.114). CONCLUSIONS Two studies provide converging evidence for reduced emotion regulatory selection flexibility in two PTSD populations.
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Affiliation(s)
- Naomi B. Fine
- Faculty of Social Sciences, School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel
- Sagol Brain Institute Tel-Aviv, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Noa Ben-Aharon
- Faculty of Social Sciences, School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Daphna Bardin Armon
- Department of Psychiatry, Lotem Center for Treatment of Sexual Trauma, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Zivya Seligman
- Department of Psychiatry, Lotem Center for Treatment of Sexual Trauma, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Liat Helpman
- Psychiatric Department, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Department of Counseling and Human Development, University of Haifa, Haifa, Israel
| | - Miki Bloch
- Psychiatric Department, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Talma Hendler
- Faculty of Social Sciences, School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel
- Sagol Brain Institute Tel-Aviv, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | - Gal Sheppes
- Faculty of Social Sciences, School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel
- Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
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Xiao Y, Chen F, Lei W, Ke J, Dai Y, Qi R, Lu G, Zhong Y. Transcriptional signal and cell specificity of genes related to cortical structural differences of post-traumatic stress disorder. J Psychiatr Res 2023; 160:28-37. [PMID: 36773345 DOI: 10.1016/j.jpsychires.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/09/2023] [Accepted: 02/04/2023] [Indexed: 02/09/2023]
Abstract
Due to the diversity of traumatic events, the diagnosis of Post-traumatic Stress Disorder is heterogeneous. The pathogenesis has been explored in the fields of brain imaging and genomics separately, but the results are inconsistent. Previous research evidenced that there existed structural differences between PTSD and healthy controls in multiple brain regions. This study further looked into the differences of brain structure in PTSD at the whole brain level and analyzed the difference-related genomes. The brain structure imaging data of 36 patients and 32 healthy controls were taken as morphological indexes. Partial least squares regression and transcriptome data were used to extract genomes related to structural differences. Additional data sets were used to study transcription characteristics of genome. Morphological differences were found in cingulate gyrus between patients and control group. Differentially expressed genes related to Morphometric similarity networks difference space were also observed. The obtained genes (i.e., RORA, PRKG1 and FKBP5) were proved to be related to the disorder with no significant correlation with other mental illnesses. In the subsequent cell type analysis, astrocytes, excitatory neurons and inhibitory neurons were evidenced to have the most significant correlation with these genes. This study found morphologically different brain regions related to PTSD. The related genome transcription analysis connects the structural differences and molecular mechanisms.
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Affiliation(s)
- Yiwen Xiao
- School of Psychology, Nanjing Normal University, Nanjing, 210097, Jiangsu, China; Jiangsu Key Laboratory of Mental Health and Cognitive Science, Nanjing Normal University, Nanjing, 210097, China
| | - Feng Chen
- Department of Radiology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), NO.19, XIUHUA ST, XIUYING DIC, Haikou, 570311, Hainan, China
| | - Wenkun Lei
- School of Psychology, Nanjing Normal University, Nanjing, 210097, Jiangsu, China; Jiangsu Key Laboratory of Mental Health and Cognitive Science, Nanjing Normal University, Nanjing, 210097, China
| | - Jun Ke
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, 14 215006, China
| | - Yingliang Dai
- School of Psychology, Nanjing Normal University, Nanjing, 210097, Jiangsu, China; Jiangsu Key Laboratory of Mental Health and Cognitive Science, Nanjing Normal University, Nanjing, 210097, China
| | - Rongfeng Qi
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 16 210002, China
| | - Guangming Lu
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 16 210002, China
| | - Yuan Zhong
- School of Psychology, Nanjing Normal University, Nanjing, 210097, Jiangsu, China; Jiangsu Key Laboratory of Mental Health and Cognitive Science, Nanjing Normal University, Nanjing, 210097, China.
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Tudor L, Nedic Erjavec G, Nikolac Perkovic M, Konjevod M, Uzun S, Kozumplik O, Mimica N, Lauc G, Svob Strac D, Pivac N. The Association of the Polymorphisms in the FUT8-Related Locus with the Plasma Glycosylation in Post-Traumatic Stress Disorder. Int J Mol Sci 2023; 24:ijms24065706. [PMID: 36982780 PMCID: PMC10056189 DOI: 10.3390/ijms24065706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/04/2023] [Accepted: 03/11/2023] [Indexed: 03/19/2023] Open
Abstract
The molecular underpinnings of post-traumatic stress disorder (PTSD) are still unclear due to the complex interactions of genetic, psychological, and environmental factors. Glycosylation is a common post-translational modification of proteins, and different pathophysiological states, such as inflammation, autoimmune diseases, and mental disorders including PTSD, show altered N-glycome. Fucosyltransferase 8 (FUT8) is the enzyme that catalyzes the addition of core fucose on glycoproteins, and mutations in the FUT8 gene are associated with defects in glycosylation and functional abnormalities. This is the first study that investigated the associations of plasma N-glycan levels with FUT8-related rs6573604, rs11621121, rs10483776, and rs4073416 polymorphisms and their haplotypes in 541 PTSD patients and control participants. The results demonstrated that the rs6573604 T allele was more frequent in the PTSD than in the control participants. Significant associations of plasma N-glycan levels with PTSD and FUT8-related polymorphisms were observed. We also detected associations of rs11621121 and rs10483776 polymorphisms and their haplotypes with plasma levels of specific N-glycan species in both the control and PTSD groups. In carriers of different rs6573604 and rs4073416 genotypes and alleles, differences in plasma N-glycan levels were only found in the control group. These molecular findings suggest a possible regulatory role of FUT8-related polymorphisms in glycosylation, the alternations of which could partially explain the development and clinical manifestation of PTSD.
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Affiliation(s)
- Lucija Tudor
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Rudjer Boskovic Institute, 10000 Zagreb, Croatia; (L.T.); (G.N.E.); (M.N.P.); (M.K.)
| | - Gordana Nedic Erjavec
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Rudjer Boskovic Institute, 10000 Zagreb, Croatia; (L.T.); (G.N.E.); (M.N.P.); (M.K.)
| | - Matea Nikolac Perkovic
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Rudjer Boskovic Institute, 10000 Zagreb, Croatia; (L.T.); (G.N.E.); (M.N.P.); (M.K.)
| | - Marcela Konjevod
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Rudjer Boskovic Institute, 10000 Zagreb, Croatia; (L.T.); (G.N.E.); (M.N.P.); (M.K.)
| | - Suzana Uzun
- Department for Biological Psychiatry and Psychogeriatrics, University Hospital Vrapce, 10000 Zagreb, Croatia; (S.U.); (O.K.); (N.M.)
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Faculty of Education and Rehabilitation Sciences, University of Zagreb, 10000 Zagreb, Croatia
| | - Oliver Kozumplik
- Department for Biological Psychiatry and Psychogeriatrics, University Hospital Vrapce, 10000 Zagreb, Croatia; (S.U.); (O.K.); (N.M.)
- Faculty of Education and Rehabilitation Sciences, University of Zagreb, 10000 Zagreb, Croatia
| | - Ninoslav Mimica
- Department for Biological Psychiatry and Psychogeriatrics, University Hospital Vrapce, 10000 Zagreb, Croatia; (S.U.); (O.K.); (N.M.)
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Gordan Lauc
- Glycobiology Laboratory, Genos Ltd., 10000 Zagreb, Croatia;
| | - Dubravka Svob Strac
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Rudjer Boskovic Institute, 10000 Zagreb, Croatia; (L.T.); (G.N.E.); (M.N.P.); (M.K.)
- Correspondence: (D.S.S.); (N.P.)
| | - Nela Pivac
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Rudjer Boskovic Institute, 10000 Zagreb, Croatia; (L.T.); (G.N.E.); (M.N.P.); (M.K.)
- University of Applied Sciences Hrvatsko Zagorje Krapina, 49000 Krapina, Croatia
- Correspondence: (D.S.S.); (N.P.)
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Shahidullah JD, Custer J, Widales-Benitez O, Aksan N, Hatchell C, Newport DJ, Wagner KD, Storch EA, Claassen C, Garrett A, Ugalde IT, Weber W, Nemeroff CB, Rathouz PJ. Establishing a training plan and estimating inter-rater reliability across the multi-site Texas childhood trauma research network. Psychiatry Res 2023; 323:115168. [PMID: 36931015 DOI: 10.1016/j.psychres.2023.115168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 03/09/2023] [Accepted: 03/11/2023] [Indexed: 03/19/2023]
Abstract
OBJECTIVE Minimal guidance is available in the literature to develop protocols for training non-clinician raters to administer semi-structured psychiatric interviews in large, multi-site studies. Previous work has not produced standardized methods for maintaining rater quality control or estimating interrater reliability (IRR) in such studies. Our objective is to describe the multi-site Texas Childhood Trauma Research Network (TX-CTRN) rater training protocol and activities used to maintain rater calibration and evaluate protocol effectiveness. METHODS Rater training utilized synchronous and asynchronous didactic learning modules, and certification involved critique of videotaped mock scale administration. Certified raters attended monthly review meetings and completed ongoing scoring exercises for quality assurance purposes. Training protocol effectiveness was evaluated using individual measure and pooled estimated IRRs for three key study measures (TESI-C, CAPS-CA-5, MINI-KID [Major Depressive Episodes - MDE & Posttraumatic Stress Disorder - PTSD modules]). A random selection of video-recorded administrations of these measures was evaluated by three certified raters to estimate agreement statistics, with jackknife (on the videos) used for confidence interval estimation. Kappa, weighted kappa and intraclass correlations were calculated for study measure ratings. RESULTS IRR agreement across all measures was strong (TESI-C median kappa 0.79, lower 95% CB 0.66; CAPS-CA-5 median weighted kappa 0.71 (0.62), MINI-MDE median kappa 0.71 (0.62), MINI-PTSD median kappa 0.91 (0.9). The combined estimated ICC was ≥0.86 (lower CBs ≥0.69). CONCLUSIONS The protocol developed by TX-CTRN may serve as a model for other multi-site studies that require comprehensive non-clinician rater training, quality assurance guidelines, and a system for assessing and estimating IRR.
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Affiliation(s)
- Jeffrey D Shahidullah
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA.
| | - James Custer
- Department of Population Health, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
| | - Oscar Widales-Benitez
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
| | - Nazan Aksan
- Department of Population Health, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
| | - Carly Hatchell
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
| | - D Jeffrey Newport
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA; Department of Women's Health, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
| | - Karen Dineen Wagner
- Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch, Galveston, Texas, USA
| | - Eric A Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | | | - Amy Garrett
- Department of Psychiatry, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
| | - Irma T Ugalde
- Department of Emergency Medicine, McGovern Medical School at UTHealth Houston, Houston, Texas, USA
| | - Wade Weber
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
| | - Charles B Nemeroff
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
| | - Paul J Rathouz
- Department of Population Health, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
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48
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Wheaton MG, Choo TH, Markowitz JC. Changes in avoidance and distress related to trauma reminders in PTSD psychotherapy. J Behav Ther Exp Psychiatry 2023; 78:101805. [PMID: 36435547 PMCID: PMC10029731 DOI: 10.1016/j.jbtep.2022.101805] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 11/02/2022] [Accepted: 11/11/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Research has examined reductions in patient distress recounting trauma narratives in Prolonged Exposure (PE) for posttraumatic stress disorder (PTSD). It remains unclear whether changes in distress and avoidance related to environmental trauma reminders matter in PE and other PTSD treatments, including non-exposure Interpersonal Psychotherapy (IPT). METHODS Data came from adults with chronic PTSD (N = 92) who completed a treatment trial comparing PE, IPT, and Relaxation Therapy (RT). We employed the Self-Initiated In-Vivo Exposure Scale (SIIVES), which measures patient distress from and avoidance of situational trauma reminders, to calculate reliable change in distress and avoidance. PTSD symptoms, depression, quality of life, and functioning assessments were collected before and after 14 weeks of treatment. RESULTS Overall, 48.1% of patients experienced reliable change in avoidance, while 51.9% showed reliable change in distress. Rates of reliable change did not differ by treatment group, although PE appeared to achieve reliable change earlier. Only one baseline characteristic predicted reliable change: patients with comorbid depression were less likely to reliably change in avoidance. At post-treatment, patients achieving reliable change had lower PTSD severity and depression and increased quality of life and social functioning. Statistical modeling revealed that changes in distress and avoidance related to subsequent reduction in PTSD symptoms in all three treatment groups, though this relationship appeared strongest in PE. LIMITATIONS The sample was relatively small. CONCLUSIONS Change in avoidance and distress associated with situational trauma reminders was associated with a range of clinical outcomes and may represent important factors in multiple PTSD psychotherapies.
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Affiliation(s)
- Michael G Wheaton
- Barnard College, Department of Psychology, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA.
| | - Tse-Hwei Choo
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City, NY, USA
| | - John C Markowitz
- New York State Psychiatric Institute, New York, NY, USA; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City, NY, USA
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49
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Dai Y, Zhou Z, Chen F, Zhang L, Ke J, Qi R, Lu G, Zhong Y. Altered dynamic functional connectivity associates with post-traumatic stress disorder. Brain Imaging Behav 2023; 17:294-305. [PMID: 36826627 DOI: 10.1007/s11682-023-00760-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2023] [Indexed: 02/25/2023]
Abstract
Research has been looking into neural pathophysiology of post-traumatic stress disorder (PTSD) and dynamic functioning connectivity (dFC) applying resting state functional magnetic resonance imaging (rs-fMRI). Previous studies showed that PTSD related impairments are associated with alterations distributed across different brain regions and disorganized functional connectivity, especially in Default Mode Network and the cerebellar area. In this study, we specifically looked into dFC on a whole brain level, and we focused on critical regions such as DMN and cerebellum. To explore the characteristics of dFC among patients with PTSD, we collected rs-fMRI data from 27 PTSD patients and 30 healthy controls. The study also added a control group of 33 trauma-exposed individuals to further look into trauma impact. Utilizing group spatial independent component analysis (ICA), the dynamic properties on whole brain level were detected with sliding time window approach, and k-means clustering. Two reoccurring FC "States" were identified, with connections being more concentrated on a within-network level in one state and more strongly inter-connected in the other state. Abnormalities in dFC were found within DMN, between DMN and cerebellum, and between DMN and visual network for PTSD patients. The findings were in accordance with the study hypothesis that the dFC alterations might point to deficits in emotional modulation and dysfunctional self-referential thought. Abnormalities in dFC among PTSD patients might also be indicators of PTSD symptoms including depression and anxiety, hypervigilance, impaired cognitive functioning and self-referential information processing.
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Affiliation(s)
- Yingliang Dai
- School of Psychology, Nanjing Normal University, Nanjing, 210097, Jiangsu, China.,Jiangsu Key Laboratory of Mental Health and Cognitive Science, Nanjing Normal University, Nanjing, 210097, People's Republic of China
| | - Zhou Zhou
- School of Psychology, Nanjing Normal University, Nanjing, 210097, Jiangsu, China.,Jiangsu Key Laboratory of Mental Health and Cognitive Science, Nanjing Normal University, Nanjing, 210097, People's Republic of China
| | - Feng Chen
- Department of Radiology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), No.19, Xiuhua St, Xiuying Dic, Haikou, 570311, Hainan, People's Republic of China
| | - Li Zhang
- Mental Health Institute, the Second Xiangya Hospital, National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Central South University, No.139 Middle Renmin Road, Changsha, 410011, Hunan Province, China
| | - Jun Ke
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, Jiangsu Province, China
| | - Rongfeng Qi
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Guangming Lu
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Yuan Zhong
- School of Psychology, Nanjing Normal University, Nanjing, 210097, Jiangsu, China. .,Jiangsu Key Laboratory of Mental Health and Cognitive Science, Nanjing Normal University, Nanjing, 210097, People's Republic of China.
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50
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Moser DA, Graf S, Glaus J, Urben S, Jouabli S, Pointet Perrizolo V, Suardi F, Robinson J, Rusconi Serpa S, Plessen KJ, Schechter DS. On the complex and dimensional relationship of maternal posttraumatic stress disorder during early childhood and child outcomes at school-age. Eur Psychiatry 2023; 66:e20. [PMID: 36734250 PMCID: PMC9970153 DOI: 10.1192/j.eurpsy.2023.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Several studies have shown associations between maternal interpersonal violence-related posttraumatic stress disorder (PTSD), child mental health problems, and impaired socioemotional development. However, the existing literature lacks evidence linking constellations of risk factors such as maternal interpersonal-violence-related PTSD, psychopathology, and interactive behavior with toddlers and outcome measures at school-age. METHODS This study involved a prospective, longitudinal investigation of 62 mothers and examined the relationship between maternal variables measured when children were in early childhood (mean age 27 months), and child outcomes when children were school-age (age mean = 83.2 months) while retaining a focus on the context of maternal PTSD. To identify and weigh associated dimensions comparatively, we employed sparse canonical correlation analysis (sCCA) aimed at associating dimensions of a dataset of 20 maternal variables in early childhood with that of more than 20 child outcome variables (i.e., child psychopathology, life-events, and socioemotional skills) at school-age. RESULTS Phase 1 variables with the highest weights were those of maternal psychopathology: PTSD, depressive and dissociative symptoms, and self-report of parental stress. The highest weighted Phase 2 child outcome measures were those of child psychopathology: PTSD, anxiety, and depressive symptoms as well as peer bullying and victimization. CONCLUSIONS sCCA revealed that trauma-related concepts in mothers were significantly and reliably associated with child psychopathology and other indicators of risk for intergenerational transmission of violence and victimization. The results highlight the dimensional and multifaceted nature-both for mothers as well as children-of the intergenerational transmission of violence and associated psychopathology.
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Affiliation(s)
- Dominik Andreas Moser
- Child and Adolescent Psychiatry Service, Lausanne University Hospital, Lausanne, Switzerland.,Institute of Psychology, University of Bern, Bern, Switzerland
| | - Shannen Graf
- Child and Adolescent Psychiatry Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Jennifer Glaus
- Child and Adolescent Psychiatry Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Sébastien Urben
- Child and Adolescent Psychiatry Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Sondes Jouabli
- Child and Adolescent Psychiatry Service, Lausanne University Hospital, Lausanne, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | | | - Francesca Suardi
- Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
| | - JoAnn Robinson
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Sandra Rusconi Serpa
- Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
| | - Kerstin Jessica Plessen
- Child and Adolescent Psychiatry Service, Lausanne University Hospital, Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Daniel Scott Schechter
- Child and Adolescent Psychiatry Service, Lausanne University Hospital, Lausanne, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.,Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, New York, USA
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