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Breen MS, Maihofer AX, Glatt SJ, Tylee DS, Chandler SD, Tsuang MT, Risbrough VB, Baker DG, O’Connor DT, Nievergelt CM, Woelk CH. Gene networks specific for innate immunity define post-traumatic stress disorder. Mol Psychiatry 2015; 20:1538-45. [PMID: 25754082 PMCID: PMC4565790 DOI: 10.1038/mp.2015.9] [Citation(s) in RCA: 145] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 11/25/2014] [Accepted: 12/19/2014] [Indexed: 12/17/2022]
Abstract
The molecular factors involved in the development of Post-Traumatic Stress Disorder (PTSD) remain poorly understood. Previous transcriptomic studies investigating the mechanisms of PTSD apply targeted approaches to identify individual genes under a cross-sectional framework lack a holistic view of the behaviours and properties of these genes at the system-level. Here we sought to apply an unsupervised gene-network based approach to a prospective experimental design using whole-transcriptome RNA-Seq gene expression from peripheral blood leukocytes of U.S. Marines (N=188), obtained both pre- and post-deployment to conflict zones. We identified discrete groups of co-regulated genes (i.e., co-expression modules) and tested them for association to PTSD. We identified one module at both pre- and post-deployment containing putative causal signatures for PTSD development displaying an over-expression of genes enriched for functions of innate-immune response and interferon signalling (Type-I and Type-II). Importantly, these results were replicated in a second non-overlapping independent dataset of U.S. Marines (N=96), further outlining the role of innate immune and interferon signalling genes within co-expression modules to explain at least part of the causal pathophysiology for PTSD development. A second module, consequential of trauma exposure, contained PTSD resiliency signatures and an over-expression of genes involved in hemostasis and wound responsiveness suggesting that chronic levels of stress impair proper wound healing during/after exposure to the battlefield while highlighting the role of the hemostatic system as a clinical indicator of chronic-based stress. These findings provide novel insights for early preventative measures and advanced PTSD detection, which may lead to interventions that delay or perhaps abrogate the development of PTSD.
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Affiliation(s)
- Michael S. Breen
- Clinical and Experimental Sciences, Faculty of Medicine,
University of Southampton, UK
| | - Adam X. Maihofer
- Department of Psychiatry, University of California San
Diego, California, USA
| | - Stephen J. Glatt
- Psychiatric Genetic Epidemiology and Neurobiology
Laboratory (PsychGENe Lab), Departments of Psychiatry and Behavioral Sciences and
Neuroscience and Physiology, Medical Genetics Research Center, SUNY Upstate Medical
University, Syracuse, New York, USA
| | - Daniel S. Tylee
- Psychiatric Genetic Epidemiology and Neurobiology
Laboratory (PsychGENe Lab), Departments of Psychiatry and Behavioral Sciences and
Neuroscience and Physiology, Medical Genetics Research Center, SUNY Upstate Medical
University, Syracuse, New York, USA
| | - Sharon D. Chandler
- Department of Psychiatry, University of California San
Diego, California, USA
| | - Ming T. Tsuang
- Department of Psychiatry, University of California San
Diego, California, USA,Veterans Affairs Center of Excellence for Stress and Mental
Health, San Diego, California, USA,Veterans Affairs San Diego Healthcare System, San Diego,
California, USA,Institute of Genomic Medicine, University of California,
San Diego, La Jolla, California USA,Center for Behavioral Genomics, Department of Psychiatry,
University of California San Diego, California, USA
| | - Victoria B. Risbrough
- Department of Psychiatry, University of California San
Diego, California, USA,Veterans Affairs Center of Excellence for Stress and Mental
Health, San Diego, California, USA
| | - Dewleen G. Baker
- Department of Psychiatry, University of California San
Diego, California, USA,Veterans Affairs Center of Excellence for Stress and Mental
Health, San Diego, California, USA
| | - Daniel T. O’Connor
- Institute of Genomic Medicine, University of California,
San Diego, La Jolla, California USA,Departments of Medicine and Pharmacology, University of
California San Diego, California, USA
| | - Caroline M. Nievergelt
- Department of Psychiatry, University of California San
Diego, California, USA,Veterans Affairs Center of Excellence for Stress and Mental
Health, San Diego, California, USA
| | - Christopher H. Woelk
- Clinical and Experimental Sciences, Faculty of Medicine,
University of Southampton, UK
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2
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Rifai MA, Indest D, Loftis J, Hauser P. Psychiatric management of the hepatitis C patient. ACTA ACUST UNITED AC 2012; 9:508-19. [PMID: 17081484 DOI: 10.1007/s11938-006-0007-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Patients with hepatitis C virus (HCV) infection have a higher prevalence of psychiatric illness compared with the general US population, and the prevalence of HCV infection in patients with severe mental illness ranges between 8% and 19%, which is four to nine times that of the general US population (1.8%). Given the association between HCV infection and psychiatric illness, gastroenterologists are on the front line of identifying comorbid psychiatric and substance use disorders and conducting a psychosocial pretreatment risk-benefit assessment for HCV infection. The use of interferon-alpha (IFN)-based therapies in combination with ribavirin (RBV) to eradicate HCV has been associated with frequent neuropsychiatric adverse effects (eg, affective, anxiety, cognitive, and psychotic symptoms) that compromise the management of both HCV patients with and those without a preexisting history of psychiatric illness. Consequently, gastroenterologists have been reluctant to engage patients with HCV and comorbid psychiatric illness in antiviral treatment due to concerns about exacerbating or precipitating neuropsychiatric symptoms. Despite the clinical challenge that HCV treatment of patients with comorbid HCV and psychiatric illness presents, recent research indicates that HCV treatments can be safely administered to patients with psychiatric illness provided that there is a comprehensive pretreatment assessment, a risk-benefit analysis, and ongoing follow-up of neuropsychiatric symptoms during antiviral therapy. The process of pretreatment assessment involves screening patients for psychiatric and substance use disorders, educating patients about the treatment process, and addressing available psychosocial support. Most psychotropic medications (antidepressants, mood stabilizers, antipsychotics, and neuroleptics) are thought to be safe to use in the management of patients with HCV and psychiatric illness and for the management of IFN- and RBV-induced neuropsychiatric adverse effects. Nonetheless, the prophylactic use of psychotropic medications to prevent IFN- and RBV-induced neuropsychiatric adverse effects remains a controversial topic. The use of IFN and RBV in patients with HCV and severe mental illness can be done safely with expert psychiatric follow-up. In this review, we discuss the process of pretreatment assessment of patients with HCV and psychiatric illness and specifically address IFN- and RBV-induced depression in patients receiving HCV treatment.
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Affiliation(s)
- Muhamad Aly Rifai
- Northwest Hepatitis C Resource Center, Portland VA Medical Center, Behavioral Health and Clinical Neurosciences Division, PO Box 1034 (P3MHADM), Portland, OR 97239, USA.
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Inder D, Rehan HS, Yadav M, Manak S, Kumar P. IFN-α-2a (Interferon) and ribavirin induced suicidal attempt in a patient of chronic HCV: A rare case report. Indian J Pharmacol 2011; 43:210-1. [PMID: 21572662 PMCID: PMC3081466 DOI: 10.4103/0253-7613.77375] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Revised: 09/14/2010] [Accepted: 12/30/2010] [Indexed: 11/24/2022] Open
Abstract
Interferons (IFNs) are proteins produced by cells, fibroblasts and macrophages, in response to viral invasion, and mediates immune response. IFN-α and ribavirin are the approved treatment for HCV infection, but also carries a risk of neuropsychiatric adverse effects, viz. insomnia, irritability, mood changes, and depression. We present a case report of depression induced by IFN-α and ribavirin, leading to attempted suicide. Following the episode, antidepressant paroxetine (20 mg o.d.) and zolpidem (10 mg h.s) were added with psychotherapy. No significant improvement was observed. Patient was given a drug dechallenge (IFN-α and ribavirin). Dramatic improvement was seen over 1 month. Following rechallenge with combination, patient again experienced depressive symptoms with suicidal ideation. IFN-α and ribavirin were promptly stopped. Naranjo causality assessment scale revealed probable association with IFN-α and ribavirin. The report intends to improve awareness among clinicians to facilitate early diagnosis and intervention of similar cases.
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Affiliation(s)
- Deep Inder
- Department of Pharmacology, Lady Hardinge Medical College and Associated, Hospitals, New Delhi - 110 001, India
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Silberbogen AK, Ulloa EW, Janke EA, Mori DL. Psychosocial issues and mental health treatment recommendations for patients with hepatitis C. PSYCHOSOMATICS 2009; 50:114-22. [PMID: 19377019 DOI: 10.1176/appi.psy.50.2.114] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Mental health needs of patients with HCV are increasingly being addressed in medical contexts. OBJECTIVE The authors review the psychosocial issues relevant to patients with hepatitis C and provide mental health treatment recommendations. FINDINGS Patients with HCV are faced with a number of challenges, including adjustment to a chronic medical illness, management of symptoms and treatment side effects, and making and maintaining lifestyle changes. Given these issues, mental health clinicians have the opportunity to make a significant contribution to patient care. CONCLUSION After reviewing the relevant research on these psychosocial issues, the authors have identified areas in which clinicians can intervene; these include adjustment to having a chronic medical illness, coping with stigma and relationship changes, management of side effects, and implementing healthy lifestyle changes.
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Affiliation(s)
- Amy K Silberbogen
- VA Boston Healthcare System, Psychology Service (116B), 150 South Huntington Ave., Boston, MA 02130, USA.
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Dieperink E, Leskela J, Dieperink ME, Evans B, Thuras P, Ho SB. The effect of pegylated interferon-alpha2b and ribavirin on posttraumatic stress disorder symptoms. PSYCHOSOMATICS 2008; 49:225-9. [PMID: 18448777 DOI: 10.1176/appi.psy.49.3.225] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Patients with chronic psychiatric diagnoses have a prevalence of chronic hepatitis C (HCV) approximately 11 times higher than the general American population. Posttraumatic stress disorder (PTSD) is particularly common among HCV patients. OBJECTIVE The authors describe the effect of treatment with pegylated-interferon-alpha(2b) (IFN) and ribavirin for patients with HCV on their posttraumatic stress disorder (PTSD) symptoms. METHOD Sixteen patients with HCV and combat-related PTSD were followed for 24 weeks and assessed with self-report measures of PTSD, hostility, and depression. RESULTS Depression and Resentment scores significantly increased in five patients treated with IFN and ribavirin, but no significant differences were found in PTSD scores when compared with 11 control patients. CONCLUSION The results suggest that patients with PTSD and HCV can be safely treated with anti-viral therapies when they are given appropriate psychiatric care.
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Affiliation(s)
- Eric Dieperink
- Dept. of Psychiatry and the Hepatitis C Resource Center at the VA Medical Center, Minneapolis, MN 55417, USA.
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Körner H, Treloar C. Representations of people with HIV and hepatitis C in editorials of medical journals: discourses and interdiscursive relations. Commun Med 2006; 3:15-25. [PMID: 16808422 DOI: 10.1515/cam.2006.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
HIV and hepatitis C are blood-borne viruses that cause chronic diseases and affect (in parts of the developed world) predominantly groups that are marginalized and discriminated against: gay men and injecting drug users, respectively. This paper compares the representation of people with HIV and hepatitis C in editorials of medical journals between 1989 and 2001. Analysis is informed by critical discourse analysis and systemic functional linguistics. Hepatitis C editorials draw almost exclusively on the discourse of biomedicine, and patients are either absent or objects in medical procedures. In HIV editorials, a variety of other discourses are integrated into the discourse of biomedicine, thereby creating multidimensional representations of people with HIV as patients and agents in medical procedures, involved in decision making, affected by economic factors, social and cultural issues. The paper discusses the role of the gay community in discursive change and argues that discursive diversity in the representation of people infected with HIV and hepatitis C in medical journals is necessary for health policy, the professional development of healthcare providers, and media reporting to the general public.
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Affiliation(s)
- Henrike Körner
- National Centre in HIV Social Research, University of New South Wales, Sydney NSW 2052, Australia.
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Geppert CMA, Dettmer E, Jakiche A. Ethical challenges in the care of persons with hepatitis C infection: a pilot study to enhance informed consent with veterans. PSYCHOSOMATICS 2005; 46:392-401. [PMID: 16145183 DOI: 10.1176/appi.psy.46.5.392] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Psychiatric and addictive disorders are often considered contraindications to hepatitis C virus (HCV) treatment. In this pilot study, the ability of 30 veterans to provide informed consent for combined antiviral HCV therapy was examined with a mental health assessment protocol specifically geared to evaluate capacity in this area. The results showed that subjects lacked essential knowledge regarding the course of the disease and the nature of antiviral treatment despite receiving prior counseling. Informed consent assessments of candidates for HCV treatment may identify deficits that are responsive to intervention, thereby allowing patients with comorbid psychiatric and addictive disorders to receive effective HCV treatment.
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Affiliation(s)
- Cynthia M A Geppert
- Department of Psychiatry, University of New Mexico School of Medicine, NM, USA.
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Clifford DB, Evans SR, Yang Y, Gulick RM. The neuropsychological and neurological impact of hepatitis C virus co-infection in HIV-infected subjects. AIDS 2005; 19 Suppl 3:S64-71. [PMID: 16251830 DOI: 10.1097/01.aids.0000192072.80572.43] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To evaluate the effect of hepatitis C virus (HCV)/HIV co-infection on neuropsychological performance and neurological status in HIV/HCV treatment-naive HIV-1-infected individuals we conducted a cross-sectional study using baseline data from an HIV therapy trial. METHODS HCV status was determined by the presence of anti-HCV antibodies. Neuropsychological function was evaluated by Trailmaking tests, and the Digit Symbol Task. Depression was assessed using the Center for Epidemiologic Studies--Depression Scale. Sleep quality was evaluated by the Pittsburgh Sleep Quality Index and anxiety by the State-Trait Anxiety Inventory for Adults. A questionnaire was designed grading the severity of a variety of symptoms. RESULTS Of 264 patients with HCV status data, 30 were HCV positive and 234 were HCV negative. Both groups were comparable except that HCV-positive individuals had a higher prevalence of intravenous drug use and lower educational level. The HCV-positive group had a significantly lower neuropsychological performance overall. Multivariate modeling supported an association between HCV infection status with test performance in the Digit Symbol Task and mood parameters even when controlling for potentially confounding variables. Marginal differences were noted with respect to symptom questionnaire scores and global sleep. No differences were noted with respect to anxiety. CONCLUSION The findings suggest that HCV/HIV co-infection has an adverse impact on neuropsychological function. HCV may also be associated with depressed mood, particularly somatic depressive symptoms. Although confounding contributors to neuropsychological performance are difficult to exclude, exploratory modeling supports the association between HCV infection status and some impairment of neuropsychological performance and depressed mood.
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Affiliation(s)
- David B Clifford
- Washington University School of Medicine, St Louis, MO 63110, USA.
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Lehman CL, Cheung RC. Depression, anxiety, post-traumatic stress, and alcohol-related problems among veterans with chronic hepatitis C. Am J Gastroenterol 2002; 97:2640-6. [PMID: 12385453 DOI: 10.1111/j.1572-0241.2002.06042.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The aim of this study was to determine the incidence of psychiatric comorbidities among veterans with chronic hepatitis C. METHODS Depression, anxiety sensitivity, post-traumatic stress symptoms, and alcohol use were assessed using standardized questionnaires in 120 consecutive veterans with chronic hepatitis C referred to the Liver Clinic. RESULTS Using well-established scoring criteria of the questionnaires, clinically significant levels of depression (44.2%), anxiety (38.1%), post-traumatic stress disorder (20.8%), and alcohol-related problems (26.7%) were observed. The majority of patients had a clinically significant score for at least one questionnaire, whereas 37.2% had significant scores in two or more questionnaires. Positive correlations were found between post-traumatic symptoms and depressive symptoms, anxiety sensitivity, and alcohol use problems. Depressive symptoms were also correlated with anxiety. Responses to the questionnaires, in general, correlated poorly with psychiatric histories documented in the medical record. Overall, 79 (65.8%) patients had one or more possible contraindications to antiviral therapy: coexisting unstable psychiatric disorders and/or recent substance use was found in 73.4% of these patients. CONCLUSIONS Psychiatric comorbidities were very common among veterans with chronic hepatitis C and correlated poorly with diagnoses documented in the medical record. We recommend a multidisciplinary approach that includes psychological assessment using standardized questionnaires in the evaluation of these patients for antiviral therapy.
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Affiliation(s)
- Cassandra L Lehman
- Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, California 94304, USA
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Abstract
Exposure to trauma can result in immune dysregulation, and increasing evidence suggests that there are immune alterations associated with post-traumatic stress disorder (PTSD). However, the exact nature of these immune findings in PTSD has not been defined. The study of psychoneuroimmunology in PTSD is relevant not only for understanding the biological underpinnings of this disorder, but also for establishing the nature of the associations between PTSD and other medical and psychiatric illnesses.
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Affiliation(s)
- Cheryl M Wong
- Department of Psychiatry, Mount Sinai School of Medicine, Bronx VAMC, OOMH 130 West Kingsbridge Road, Bronx, NY 10468, USA.
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Ademmer K, Beutel M, Bretzel R, Jaeger C, Reimer C, Clemens J. Suicidal ideation with IFN-alpha and ribavirin in a patient with hepatitis C. PSYCHOSOMATICS 2001; 42:365-7. [PMID: 11496031 DOI: 10.1176/appi.psy.42.4.365] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- K Ademmer
- Department of Psychomatics and Psychotherapy, Justus Liebig University Hospital, Giessen, Germany.
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Ho SB, Nguyen H, Tetrick LL, Opitz GA, Basara ML, Dieperink E. Influence of psychiatric diagnoses on interferon-alpha treatment for chronic hepatitis C in a veteran population. Am J Gastroenterol 2001; 96:157-64. [PMID: 11197246 DOI: 10.1111/j.1572-0241.2001.03468.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The prevalence of psychiatric problems and substance abuse is high in the veteran population with hepatitis C. The purpose of this study was to retrospectively analyze the effect of preexisting psychiatric conditions in veteran patients undergoing treatment with interferon a-2b (IFN-alpha) with respect to adverse events, compliance, and treatment response. METHODS Thirty-three veterans with chronic hepatitis C were treated with IFN-alpha (5 million units three times weekly) for 6 months, followed by a tapering dose for an additional 6 months. All patients fulfilled standard criteria for treatment eligibility. Psychiatric diagnoses, adverse events, and virological and biochemical responses to therapy were determined. RESULTS Nineteen of 33 (58%) patients with hepatitis C had documented psychiatric conditions before starting IFN-alpha therapy. Of the patients with preexisting psychiatric diagnoses, 13/19 (68%) developed major adverse events requiring intervention or discontinuation of therapy. In contrast, 4/14 (29%) patients without psychiatric diagnoses developed major adverse events (p = 0.024) In the psychiatric group, 6/19 (32%) developed major neuropsychiatric side effects compared with 2/14 patients (14%) in the nonpsychiatric group (p = 0.25). Patients with and without psychiatric diagnoses had equivalent biochemical and virological responses to therapy. Overall, only 2/33 (6%) patients had a sustained virological response. CONCLUSIONS Veterans with chronic hepatitis C and psychiatric diagnoses experienced a significantly greater number of major adverse events during treatment with IFN-alpha. Veteran patients with hepatitis C should be carefully screened for psychiatric conditions and may require more intensive monitoring during IFN-alpha therapy.
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Affiliation(s)
- S B Ho
- Department of Medicine, Veterans Affairs Medical Center and University of Minnesota, Minneapolis 55417, USA
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