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Biazus Soares G, Mahmoud O, Yosipovitch G, Mochizuki H. The mind-skin connection: A narrative review exploring the link between inflammatory skin diseases and psychological stress. J Eur Acad Dermatol Venereol 2024; 38:821-834. [PMID: 38311707 DOI: 10.1111/jdv.19813] [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: 05/03/2023] [Accepted: 11/16/2023] [Indexed: 02/06/2024]
Abstract
Inflammatory skin diseases are known to negatively impact patient psychology, with individuals experiencing higher rates of stress and subsequent diminished quality of life, as well as mental health issues including anxiety and depression. Moreover, increased psychological stress has been found to exacerbate existing inflammatory skin diseases. The association between inflammatory skin diseases and psychological stress is a timely topic, and a framework to better understand the relationship between the two that integrates available literature is needed. In this narrative review article, we discuss potential neurobiological mechanisms behind psychological stress due to inflammatory skin diseases, focusing mainly on proinflammatory cytokines in the circulating system (the brain-gut-skin communications) and the default mode network in the brain. We also discuss potential descending pathways from the brain that lead to aggravation of inflammatory skin diseases due to psychological stress, including the central and peripheral hypothalamic-pituitary-adrenal axes, peripheral nerves and the skin barrier function.
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Affiliation(s)
- G Biazus Soares
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miami Itch Center, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - O Mahmoud
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miami Itch Center, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - G Yosipovitch
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miami Itch Center, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - H Mochizuki
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miami Itch Center, University of Miami Miller School of Medicine, Miami, Florida, USA
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2
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Mukadam AA, Chester JA. Line- and sex-dependent effects of juvenile stress on contextual fear- and anxiety-related behavior in high- and low-alcohol-preferring mouse lines. Behav Brain Res 2024; 463:114899. [PMID: 38342379 PMCID: PMC10954351 DOI: 10.1016/j.bbr.2024.114899] [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: 07/28/2023] [Revised: 01/16/2024] [Accepted: 02/05/2024] [Indexed: 02/13/2024]
Abstract
Juvenile stress (JS) is a known risk factor for the development of alcohol use disorder (AUD) and post-traumatic stress disorder (PTSD), both of which are frequently co-morbid. Data suggest there may be common, genetically-influenced biological responses to stress that contribute to the development of both AUD and PTSD. The present study investigated the impact of JS on contextual fear learning and extinction, as well as corticosterone (CORT) responses before and after JS, before and after contextual fear conditioning (CFC), and after fear extinction in male and female high-alcohol-preferring (HAP2) and low-alcohol-preferring (LAP2) mouse lines. We also measured unconditioned anxiety-related behavior in the light-dark-transition test before CFC. HAP2 and LAP2 mice did not differ in fear acquisition, but HAP2 mice showed faster fear extinction compared to LAP2 mice. No effects of JS were seen in HAP2 mice, whereas in LAP2 mice, JS reduced fear acquisition in males and facilitated fear extinction in females. Females showed greater fear-related behavior relative to males, regardless of subgroup. HAP2 males demonstrated more anxiolytic-like responses than LAP2 males and LAP2 females demonstrated more anxiolytic-like responses than LAP2 males in the light-dark transition test. HAP2 and LAP2 mice did not differ in CORT during the juvenile stage; however, adult LAP2 mice showed greater CORT levels than HAP2 mice at baseline and after CFC and extinction testing. These findings build upon prior work in these unique mouse lines that differ in genetic propensity toward alcohol preference and provide new information regarding contextual fear learning and extinction mechanisms theorized to contribute to co-morbid AUD and PTSD.
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Affiliation(s)
- Arbaaz A Mukadam
- Department of Psychological Sciences, Purdue University, West Lafayette, IN, USA.
| | - Julia A Chester
- Department of Psychological Sciences, Purdue University, West Lafayette, IN, USA; Purdue Institute for Integrative Neuroscience, Purdue University, West Lafayette, IN, USA.
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3
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Murray SL, Holton KF. Effects of a diet low in excitotoxins on PTSD symptoms and related biomarkers. Nutr Neurosci 2024; 27:1-11. [PMID: 36484432 DOI: 10.1080/1028415x.2022.2152932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Post-traumatic stress disorder (PTSD) develops after trauma exposure and involves symptoms of avoidance, intrusive re-experiencing, mood and cognitive dysfunction, and hypervigilance. PTSD is often comorbid with Gulf War Illness (GWI), a neurological condition involving widespread pain, cognitive dysfunction, digestive problems, and other symptoms, in Gulf War veterans. PTSD tends to be more severe when comorbid with GWI. Low cortisol and elevated homocysteine levels have been found in PTSD, making them potential PTSD biomarkers. The low-glutamate diet, which aims to reduce excitotoxicity by eliminating the consumption of free glutamate and aspartate, has been shown to significantly reduce GWI and PTSD symptoms. This study examined whether changes in serum cortisol and homocysteine are associated with reduced PTSD severity in veterans with GWI after one month on the low-glutamate diet, and whether reducing the consumption of dietary excitotoxins was associated changes in PTSD and serum biomarkers. Data were analyzed for 33 veterans. No serum biomarkers significantly changed post-diet; however, cortisol increased as dietary excitotoxin consumption decreased, which held in a multivariable linear regression after adjustment for sex. Reduced dietary excitotoxin consumption was also associated with reduced hyperarousal symptoms, which held in a multivariable linear regression after adjustment for sex. Cortisol increase was associated with reduced avoidance symptoms after adjustment for change in BMI, and was marginally associated with overall PTSD reduction. Change in homocysteine was not significantly related to dietary adherence nor change in PTSD. Results suggest that reducing the consumption of dietary excitotoxins may normalize cortisol levels, which has been associated with alleviating PTSD.
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Affiliation(s)
- Sidney L Murray
- Department of Neuroscience, American University, Washington, DC, USA
| | - Kathleen F Holton
- Department of Neuroscience, American University, Washington, DC, USA
- Department of Health Studies, American University, Washington, DC, USA
- Center for Neuroscience and Behaviour, American University, Washington, DC, USA
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4
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Swanberg KM, Campos L, Abdallah CG, Juchem C. Proton Magnetic Resonance Spectroscopy in Post-Traumatic Stress Disorder-Updated Systematic Review and Meta-Analysis. CHRONIC STRESS (THOUSAND OAKS, CALIF.) 2022; 6:24705470221128004. [PMID: 36237981 PMCID: PMC9551353 DOI: 10.1177/24705470221128004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 09/06/2022] [Indexed: 11/06/2022]
Abstract
A stressor-related disorder wherein traumatic experience precipitates protracted
disruptions to mood and cognition, post-traumatic stress disorder (PTSD) is
associated with wide-ranging abnormalities across the body. While various
methods have investigated these deviations, only proton magnetic resonance
spectroscopy (1H MRS) enables noninvasive measurement of
small-molecule metabolites in the living human. 1H MRS has
correspondingly been employed to test hypotheses about the composition and
function of multiple brain regions putatively involved in PTSD. Here we
systematically review methodological considerations and reported findings, both
positive and negative, of the current 1H-MRS literature in PTSD
(N = 32 studies) to communicate the brain regional metabolite alterations
heretofore observed, providing random-effects model meta-analyses for those most
extensively studied. Our review suggests significant PTSD-associated decreases
in N-acetyl aspartate in bilateral hippocampus and anterior cingulate cortex
with less evident effect in other metabolites and regions. Model heterogeneities
diverged widely by analysis (I2 < 0.01% to 90.1%) and suggested
regional dependence on quantification reference (creatine or otherwise). While
observed variabilities in methods and reported findings suggest that
1H-MRS explorations of PTSD could benefit from methodological
standardization, informing this standardization by quantitative assessment of
the existing literature is currently hampered by its small size and limited
scope.
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Affiliation(s)
- Kelley M. Swanberg
- Department of Biomedical Engineering,
Columbia
University Fu Foundation School of Engineering and Applied
Science, New York, NY, USA
- Kelley M. Swanberg, Department of
Biomedical Engineering, Columbia University Fu Foundation School of Engineering
and Applied Science, 351 Engineering Terrace, 1210 Amsterdam Avenue, New York,
NY 10027, USA.
| | - Leonardo Campos
- Department of Biomedical Engineering,
Columbia
University Fu Foundation School of Engineering and Applied
Science, New York, NY, USA
| | - Chadi G. Abdallah
- Department of Psychiatry, Yale University School of
Medicine, New Haven, CT, USA
- Clinical Neuroscience Division, Department of Veterans Affairs
National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut
Healthcare System, West Haven, CT, USA
- Psychiatry and Behavioral Sciences,
Baylor College
of Medicine, Houston, TX, USA
| | - Christoph Juchem
- Department of Biomedical Engineering,
Columbia
University Fu Foundation School of Engineering and Applied
Science, New York, NY, USA
- Department of Radiology, Columbia University College of Physicians and
Surgeons, New York, NY, USA
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5
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Randomized controlled experimental study of hydrocortisone and D-cycloserine effects on fear extinction in PTSD. Neuropsychopharmacology 2022; 47:1945-1952. [PMID: 34799682 PMCID: PMC9485259 DOI: 10.1038/s41386-021-01222-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/30/2021] [Accepted: 10/22/2021] [Indexed: 12/11/2022]
Abstract
Fear extinction underlies prolonged exposure, one of the most well-studied treatments for posttraumatic stress disorder (PTSD). There has been increased interest in exploring pharmacological agents to enhance fear extinction learning in humans and their potential as adjuncts to PE. The objective of such adjuncts is to augment the clinical impact of PE on the durability and magnitude of symptom reduction. In this study, we examined whether hydrocortisone (HC), a corticosteroid, and D-Cycloserine (DCS), an N-methyl-D-aspartate receptor partial agonist, enhance fear extinction learning and consolidation in individuals with PTSD. In a double-blind placebo-controlled 3-group experimental design, 90 individuals with full or subsyndromal PTSD underwent fear conditioning with stimuli that were paired (CS+) or unpaired (CS-) with shock. Extinction learning occurred 72 h later and extinction retention was tested one week after extinction. HC 25 mg, DCS 50 mg or placebo was administered one hour prior to extinction learning. During extinction learning, the DCS and HC groups showed a reduced differential CS+/CS- skin conductance response (SCR) compared to placebo (b = -0.19, CI = -0.01 to -37, p = 0.042 and b = -0.25, CI = -08 to -0.43, p = 0.005, respectively). A nonsignificant trend for a lower differential CS+/CS- SCR in the DCS group, compared to placebo, (b = -0.25, CI = 0.04 to -0.55, p = 0.089) was observed at retention testing, one week later. A single dose of HC and DCS facilitated fear extinction learning in participants with PTSD symptoms. While clinical implications have yet to be determined, our findings suggest that glucocorticoids and NMDA agonists hold promise for facilitating extinction learning in PTSD.
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Gonda X, Dome P, Erdelyi-Hamza B, Krause S, Elek LP, Sharma SR, Tarazi FI. Invisible wounds: Suturing the gap between the neurobiology, conventional and emerging therapies for posttraumatic stress disorder. Eur Neuropsychopharmacol 2022; 61:17-29. [PMID: 35716404 DOI: 10.1016/j.euroneuro.2022.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 05/19/2022] [Accepted: 05/20/2022] [Indexed: 11/26/2022]
Abstract
A sharp increase in the prevalence of neuropsychiatric disorders, including major depression, anxiety, substance use disorders and posttraumatic stress disorder (PTSD) has occurred due to the traumatic nature of the persisting COVID-19 global pandemic. PTSD is estimated to occur in up to 25% of individuals following exposure to acute or chronic trauma, and the pandemic has inflicted both forms of trauma on much of the population through both direct physiological attack as well as an inherent upheaval to our sense of safety. However, despite significant advances in our ability to define and apprehend the effects of traumatic events, the neurobiology and neuroanatomical circuitry of PTSD, one of the most severe consequences of traumatic exposure, remains poorly understood. Furthermore, the current psychotherapies or pharmacological options for treatment have limited efficacy, durability, and low adherence rates. Consequently, there is a great need to better understand the neurobiology and neuroanatomy of PTSD and develop novel therapies that extend beyond the current limited treatments. This review summarizes the neurobiological and neuroanatomical underpinnings of PTSD and discusses the conventional and emerging psychotherapies, pharmacological and combined psychopharmacological therapies, including the use of psychedelic-assisted psychotherapies and neuromodulatory interventions, for the improved treatment of PTSD and the potential for their wider applications in other neuropsychiatric disorders resulting from traumatic exposure.
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Affiliation(s)
- Xenia Gonda
- Department of Psychiatry and Psychotherapy, Semmelweis University, Hungary; NAP-2-SE New Antidepressant Target Research Group, Semmelweis University, Hungary; International Centre for Education and Research in Neuropsychiatry, Samara State Medical University, Russia.
| | - Peter Dome
- Department of Psychiatry and Psychotherapy, Semmelweis University, Hungary; National Institute of Mental Health, Neurology and Neurosurgery - Nyiro Gyula Hospital, Hungary
| | - Berta Erdelyi-Hamza
- Department of Psychiatry and Psychotherapy, Semmelweis University, Hungary; Doctoral School of Mental Health Sciences, Semmelweis University, Hungary
| | - Sandor Krause
- National Institute of Mental Health, Neurology and Neurosurgery - Nyiro Gyula Hospital, Hungary; Doctoral School of Mental Health Sciences, Semmelweis University, Hungary; Department of Pharmacodynamics, Semmelweis University, Hungary
| | - Livia Priyanka Elek
- Department of Psychiatry and Psychotherapy, Semmelweis University, Hungary; Department of Clinical Psychology, Semmelweis University, Hungary
| | - Samata R Sharma
- Department of Psychiatry, Harvard Medical School, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Frank I Tarazi
- Department of Psychiatry and Neuroscience, Harvard Medical School, McLean Hospital, Belmont, MA 02478, USA
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Ramos-Cejudo J, Genfi A, Abu-Amara D, Debure L, Qian M, Laska E, Siegel C, Milton N, Newman J, Blessing E, Li M, Etkin A, Marmar CR, Fossati S. CRF serum levels differentiate PTSD from healthy controls and TBI in military veterans. PSYCHIATRIC RESEARCH AND CLINICAL PRACTICE 2022; 3:153-162. [PMID: 35211666 PMCID: PMC8764614 DOI: 10.1176/appi.prcp.20210017] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background and Objective Posttraumatic stress disorder (PTSD) is a serious and frequently debilitating psychiatric condition that can occur in people who have experienced traumatic stressors, such as war, violence, sexual assault and other life‐threatening events. Treatment of PTSD and traumatic brain injury (TBI) in veterans is challenged by diagnostic complexity, partially due to PTSD and TBI symptoms overlap and to the fact that subjective self‐report assessments may be influenced by a patient's willingness to share their traumatic experiences and resulting symptoms. Corticotropin‐releasing factor (CRF) is one of the main mediators of hypothalamic pituitary adrenal (HPA)‐axis responses in stress and anxiety. Methods and Results We analyzed serum CRF levels in 230 participants including heathy controls (64), and individuals with PTSD (53), TBI (70) or PTSD + TBI (43) by enzyme immunoassay (EIA). Significantly lower CRF levels were found in both the PTSD and PTSD + TBI groups compared to healthy control (PTSD vs. Controls: P = 0.0014, PTSD + TBI vs. Controls: P = 0.0011) and chronic TBI participants (PTSD vs. TBI: P < 0.0001, PTSD + TBI vs. TBI: P < 0.0001), suggesting a PTSD‐related mechanism independent from TBI and associated with CRF reduction. CRF levels negatively correlated with PTSD severity on the Clinically Administered PTSD Scale (CAPS‐5) scale in the whole study group. Conclusions Hyperactivation of the HPA axis has been classically identified in acute stress. However, the recognized enhanced feedback inhibition of the HPA axis in chronic stress supports our findings of lower CRF in PTSD patients. This study suggests that reduced serum CRF in PTSD should be further investigated. Future validation studies will establish if CRF is a possible blood biomarker for PTSD and/or for differentiating PTSD and chronic TBI symptomatology. The HPA axis is activated under acute stress conditions, but an enhanced feedback inhibition may be prevalent in chronic stress conditions such as PTSD. We observed a reduction in serum CRF levels in veterans with PTSD and PTSD + TBI, but not in veterans with chronic TBI alone. A serum CRF reduction may be indicative of CNS mechanisms specific to PTSD and should be further evaluated as a possible peripheral biomarker.
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Affiliation(s)
- Jaime Ramos-Cejudo
- Center for Alcohol Use Disorder and PTSD, Department of Psychiatry, New York University Grossman School of Medicine, NY, USA.,Steven and Alexandra Cohen Veterans Center for the Study of PTSD and TBI, Department of Psychiatry, New York University Grossman School of Medicine, NY, USA
| | - Afia Genfi
- Center for Alcohol Use Disorder and PTSD, Department of Psychiatry, New York University Grossman School of Medicine, NY, USA.,Steven and Alexandra Cohen Veterans Center for the Study of PTSD and TBI, Department of Psychiatry, New York University Grossman School of Medicine, NY, USA
| | - Duna Abu-Amara
- Center for Alcohol Use Disorder and PTSD, Department of Psychiatry, New York University Grossman School of Medicine, NY, USA.,Steven and Alexandra Cohen Veterans Center for the Study of PTSD and TBI, Department of Psychiatry, New York University Grossman School of Medicine, NY, USA
| | - Ludovic Debure
- Center for Alcohol Use Disorder and PTSD, Department of Psychiatry, New York University Grossman School of Medicine, NY, USA.,New York University, School of Medicine, Department of Neurology, New York, NY, USA
| | - Meng Qian
- Center for Alcohol Use Disorder and PTSD, Department of Psychiatry, New York University Grossman School of Medicine, NY, USA.,Steven and Alexandra Cohen Veterans Center for the Study of PTSD and TBI, Department of Psychiatry, New York University Grossman School of Medicine, NY, USA
| | - Eugene Laska
- Center for Alcohol Use Disorder and PTSD, Department of Psychiatry, New York University Grossman School of Medicine, NY, USA.,Steven and Alexandra Cohen Veterans Center for the Study of PTSD and TBI, Department of Psychiatry, New York University Grossman School of Medicine, NY, USA
| | - Carole Siegel
- Center for Alcohol Use Disorder and PTSD, Department of Psychiatry, New York University Grossman School of Medicine, NY, USA.,Steven and Alexandra Cohen Veterans Center for the Study of PTSD and TBI, Department of Psychiatry, New York University Grossman School of Medicine, NY, USA
| | - Nicholas Milton
- Center for Alcohol Use Disorder and PTSD, Department of Psychiatry, New York University Grossman School of Medicine, NY, USA.,Steven and Alexandra Cohen Veterans Center for the Study of PTSD and TBI, Department of Psychiatry, New York University Grossman School of Medicine, NY, USA
| | - Jennifer Newman
- Center for Alcohol Use Disorder and PTSD, Department of Psychiatry, New York University Grossman School of Medicine, NY, USA.,Steven and Alexandra Cohen Veterans Center for the Study of PTSD and TBI, Department of Psychiatry, New York University Grossman School of Medicine, NY, USA
| | - Esther Blessing
- Center for Alcohol Use Disorder and PTSD, Department of Psychiatry, New York University Grossman School of Medicine, NY, USA.,Steven and Alexandra Cohen Veterans Center for the Study of PTSD and TBI, Department of Psychiatry, New York University Grossman School of Medicine, NY, USA
| | - Meng Li
- Center for Alcohol Use Disorder and PTSD, Department of Psychiatry, New York University Grossman School of Medicine, NY, USA.,Steven and Alexandra Cohen Veterans Center for the Study of PTSD and TBI, Department of Psychiatry, New York University Grossman School of Medicine, NY, USA
| | - Amit Etkin
- Stanford University, Department of Psychiatry and Behavioral Sciences, Stanford, CA USA.,Stanford University, Stanford Neurosciences Institute, Stanford, CA, USA.,VA Palo Alto Health Care System, Sierra-Pacific Mental Illness Research, Education and Clinical Center (MIRECC), Palo Alto, CA, USA
| | - Charles R Marmar
- Center for Alcohol Use Disorder and PTSD, Department of Psychiatry, New York University Grossman School of Medicine, NY, USA.,Steven and Alexandra Cohen Veterans Center for the Study of PTSD and TBI, Department of Psychiatry, New York University Grossman School of Medicine, NY, USA
| | - Silvia Fossati
- Center for Alcohol Use Disorder and PTSD, Department of Psychiatry, New York University Grossman School of Medicine, NY, USA.,Steven and Alexandra Cohen Veterans Center for the Study of PTSD and TBI, Department of Psychiatry, New York University Grossman School of Medicine, NY, USA.,New York University, School of Medicine, Department of Neurology, New York, NY, USA.,Current Affiliation: Alzheimer's center at Temple, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
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Serum Corticotrophin Releasing Factor (CRF) and its correlation with stress and craving in detoxified opioid-dependent subjects. Asian J Psychiatr 2022; 68:102964. [PMID: 34923378 DOI: 10.1016/j.ajp.2021.102964] [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: 10/13/2021] [Revised: 11/19/2021] [Accepted: 12/13/2021] [Indexed: 11/21/2022]
Abstract
Corticotrophin Releasing Factor (CRF) might be suitable as biological measure of stress as it is implicated directly in both central neurological and endocrine stress-response. The study aims to compare serum CRF levels and perceived stress in opioid-dependent subjects (n = 53) with non-using controls (n = 47) and to correlate them with general and instantaneous craving (in cases only). Perceived stress score and serum CRF levels were significantly higher among the users. No significant correlation with craving was found. The significant difference in serum CRF levels indicate feasibility of measuring CRF levels in peripheral fluids and asserts its role as biochemical measure of stress.
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Ibrahim C, Le Foll B, Hassan AN. The effect of nicotine dependence on the risk of developing post-traumatic stress disorder: Results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Nicotine Tob Res 2021; 24:719-727. [PMID: 34734244 DOI: 10.1093/ntr/ntab229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 10/04/2021] [Accepted: 11/01/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND It is evident that an association between smoking and post-traumatic stress disorder (PTSD) exists, but research is lacking in establishing the directionality of the relationship. METHODS We used longitudinal data from wave I (2001-2002) and II (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Individuals with nicotine dependence (ND) were matched to individuals without ND using propensity score matching to estimate the risk of developing PTSD after trauma. We also matched smokers (with or without ND) to lifetime non-smokers to estimate their risk of developing PTSD after trauma. Lastly, we conducted a mediation analysis on the effect of ND severity on PTSD symptoms. RESULTS Individuals with ND (n = 1,514) were more likely to develop PTSD (OR: 1.59; 95%CI: 1.09-2.32; p = 0.017) compared to individuals without ND (n = 6,047). Smokers (regardless of ND status) (n = 2,335) compared to non-smokers (n = 5,226) had no significant effect on risk of PTSD (p = 0.26). Withdrawal was found to be a mediator of the effect of ND severity on PTSD symptoms. CONCLUSION ND, but not smoking status, increases a smoker's risk of developing PTSD. This provides information that could aid in preventive strategies for individuals with ND who are exposed to trauma. IMPLICATIONS This study provides evidence in a national representative sample of adults in the U.S. that nicotine dependence may increase one's risk of developing PTSD after exposure to trauma. It also shows the directionality of the association between smoking and PTSD. Lastly, it demonstrates that withdrawal may be the link to the association between nicotine dependence and PTSD. We hope that with these findings, preventative strategies are put in place for smokers who are dependent and are exposed to trauma, such that they do not develop PTSD.
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Affiliation(s)
- Christine Ibrahim
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Pharmacology and Toxicology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Bernard Le Foll
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Pharmacology and Toxicology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Addictions Division, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Ahmed N Hassan
- Department of Pharmacology and Toxicology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Addictions Division, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Santana-Gomez CE, Medel-Matus JS, Rundle BK. Animal models of post-traumatic epilepsy and their neurobehavioral comorbidities. Seizure 2021; 90:9-16. [DOI: 10.1016/j.seizure.2021.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 05/07/2021] [Accepted: 05/09/2021] [Indexed: 12/30/2022] Open
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West GL, Kurdi V, Fouquet C, Schachar R, Boivin M, Hastings P, Robaey P, Bohbot VD. Differential stress response to psychological and physical stressors in children using spatial versus response-dependent navigation strategies. COMPREHENSIVE PSYCHONEUROENDOCRINOLOGY 2021; 6:100043. [PMID: 35757366 PMCID: PMC9216353 DOI: 10.1016/j.cpnec.2021.100043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/10/2021] [Accepted: 02/27/2021] [Indexed: 11/13/2022] Open
Abstract
Previous work from our lab has shown that basal cortisol levels are different between healthy young adults who spontaneously use caudate nucleus-dependent response strategies compared to young adults who use hippocampus-dependent spatial navigation strategies. Young adults who use caudate nucleus dependent strategies display lower basal cortisol levels compared to those who use hippocampus-dependent strategies. In the current study, we assessed navigation strategies in children using a virtual navigation task and measured cortisol at baseline as well as cortisol reactivity to both a psychological and to a physical stressor. Replicating what is observed in adults, we found that children who used caudate nucleus-dependent navigation strategies displayed lower cortisol levels at baseline compared to those who used hippocampus-dependent strategies. The psychological stressor, knowledge that a blood draw would be performed by a nurse, caused a significant increase in cortisol uniquely in response learners. The physical stressor, the actual blood draw, produced a significant increase in cortisol amongst spatial learners that was then comparable to levels observed in response learners. Lower baseline cortisol and higher cortisol psychological stress response observed amongst children who used response strategies may therefore reflect early biological changes during development which may have an impact later in life when considering risk for neuropsychiatric disorders. Both adults and children rely of different navigation strategies to learn new environments. Cortisol levels differ between people dependent on spontaneous navigation strategy. We show a differential cortisol stress response in children dependent on navigational strategy.
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12
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Notaras M, van den Buuse M. Neurobiology of BDNF in fear memory, sensitivity to stress, and stress-related disorders. Mol Psychiatry 2020; 25:2251-2274. [PMID: 31900428 DOI: 10.1038/s41380-019-0639-2] [Citation(s) in RCA: 183] [Impact Index Per Article: 45.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 12/01/2019] [Accepted: 12/12/2019] [Indexed: 01/17/2023]
Abstract
Brain-derived neurotrophic factor (BDNF) is widely accepted for its involvement in resilience and antidepressant drug action, is a common genetic locus of risk for mental illnesses, and remains one of the most prominently studied molecules within psychiatry. Stress, which arguably remains the "lowest common denominator" risk factor for several mental illnesses, targets BDNF in disease-implicated brain regions and circuits. Altered stress-related responses have also been observed in animal models of BDNF deficiency in vivo, and BDNF is a common downstream intermediary for environmental factors that potentiate anxiety- and depressive-like behavior. However, BDNF's broad functionality has manifested a heterogeneous literature; likely reflecting that BDNF plays a hitherto under-recognized multifactorial role as both a regulator and target of stress hormone signaling within the brain. The role of BDNF in vulnerability to stress and stress-related disorders, such as posttraumatic stress disorder (PTSD), is a prominent example where inconsistent effects have emerged across numerous models, labs, and disciplines. In the current review we provide a contemporary update on the neurobiology of BDNF including new data from the behavioral neuroscience and neuropsychiatry literature on fear memory consolidation and extinction, stress, and PTSD. First we present an overview of recent advances in knowledge on the role of BDNF within the fear circuitry, as well as address mounting evidence whereby stress hormones interact with endogenous BDNF-TrkB signaling to alter brain homeostasis. Glucocorticoid signaling also acutely recruits BDNF to enhance the expression of fear memory. We then include observations that the functional common BDNF Val66Met polymorphism modulates stress susceptibility as well as stress-related and stress-inducible neuropsychiatric endophenotypes in both man and mouse. We conclude by proposing a BDNF stress-sensitivity hypothesis, which posits that disruption of endogenous BDNF activity by common factors (such as the BDNF Val66Met variant) potentiates sensitivity to stress and, by extension, vulnerability to stress-inducible illnesses. Thus, BDNF may induce plasticity to deleteriously promote the encoding of fear and trauma but, conversely, also enable adaptive plasticity during extinction learning to suppress PTSD-like fear responses. Ergo regulators of BDNF availability, such as the Val66Met polymorphism, may orchestrate sensitivity to stress, trauma, and risk of stress-induced disorders such as PTSD. Given an increasing interest in personalized psychiatry and clinically complex cases, this model provides a framework from which to experimentally disentangle the causal actions of BDNF in stress responses, which likely interact to potentiate, produce, and impair treatment of, stress-related psychiatric disorders.
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Affiliation(s)
- Michael Notaras
- Center for Neurogenetics, Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, Cornell University, New York, NY, USA.
| | - Maarten van den Buuse
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia. .,College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia. .,Department of Pharmacology, University of Melbourne, Melbourne, VIC, Australia.
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Bremner JD, Wittbrodt MT, Shah AJ, Pearce BD, Gurel NZ, Inan OT, Raggi P, Lewis TT, Quyyumi AA, Vaccarino V. Confederates in the Attic: Posttraumatic Stress Disorder, Cardiovascular Disease, and the Return of Soldier's Heart. J Nerv Ment Dis 2020; 208:171-180. [PMID: 32091470 PMCID: PMC8214871 DOI: 10.1097/nmd.0000000000001100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Da Costa originally described Soldier's Heart in the 19th Century as a syndrome that occurred on the battlefield in soldiers of the American Civil War. Soldier's Heart involved symptoms similar to modern day posttraumatic stress disorder (PTSD) as well as exaggerated cardiovascular reactivity felt to be related to an abnormality of the heart. Interventions were appropriately focused on the cardiovascular system. With the advent of modern psychoanalysis, psychiatric symptoms became divorced from the body and were relegated to the unconscious. Later, the physiology of PTSD and other psychiatric disorders was conceived as solely residing in the brain. More recently, advances in psychosomatic medicine led to the recognition of mind-body relationships and the involvement of multiple physiological systems in the etiology of disorders, including stress, depression PTSD, and cardiovascular disease, has moved to the fore, and has renewed interest in the validity of the original model of the Soldier's Heart syndrome.
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Affiliation(s)
- J. Douglas Bremner
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Emory University, Atlanta
- Department of Radiology, Emory University School of Medicine, Emory University, Atlanta
- Atlanta VA Medical Center, Decatur
| | - Matthew T. Wittbrodt
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Emory University, Atlanta
| | - Amit J. Shah
- Atlanta VA Medical Center, Decatur
- Department of Medicine (Cardiology), Emory University School of Medicine, Emory University
| | - Bradley D. Pearce
- Department of Epidemiology, Rollins School of Public Health, Emory University
| | - Nil Z. Gurel
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, Georgia
| | - Omer T. Inan
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, Georgia
- Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia
| | - Paolo Raggi
- Mazankowski Alberta Heart Institute and Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Tené T. Lewis
- Department of Epidemiology, Rollins School of Public Health, Emory University
| | - Arshed A. Quyyumi
- Department of Medicine (Cardiology), Emory University School of Medicine, Emory University
| | - Viola Vaccarino
- Department of Medicine (Cardiology), Emory University School of Medicine, Emory University
- Department of Epidemiology, Rollins School of Public Health, Emory University
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Bremner JD, Wittbrodt MT. Stress, the brain, and trauma spectrum disorders. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2020; 152:1-22. [PMID: 32450992 PMCID: PMC8214870 DOI: 10.1016/bs.irn.2020.01.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
This chapter reviews the relationship between stress and brain function in patients with neuropsychiatric disorders, with an emphasis on disorders that have most clearly been linked to traumatic stress exposure. These disorders, which have been described as trauma spectrum disorders, include posttraumatic stress disorder (PTSD), a subgroup of major depression, borderline personality disorder (BPD) and dissociative disorders; they share in common a neurobiological footprint, including smaller hippocampal volume, and are distinguished from other disorders that may share symptom similarities, like some of the anxiety disorders, but are not as clearly linked to stress. The relationship between environmental events such as stressors, especially in early childhood, and their effects on brain and neurobiology is important to understand in approaching these disorders as well as the development of therapeutic interventions. Addressing patients with stress-related disorders from multiple developmental (age at onset of trauma) as well as levels of analysis (cognitive, cultural, neurobiological) approaches will provide the most complete picture and result in the most successful treatment outcomes.
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Affiliation(s)
- J Douglas Bremner
- Emory University School of Medicine, Atlanta, GA, United States; Atlanta Veterans Administration Medical Center, Decatur, GA, United States.
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Sukiasyan S, Soldatkin V, Snedkov E, Tadevosyan M, Kryuchkova M. Combat-related posttraumatic stress disorder: the historical evolution of concept from «irritable heart syndrome» to «psycho-organic disorder». Biological aspect. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:149-156. [DOI: 10.17116/jnevro2020120071149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Uniyal A, Singh R, Akhtar A, Dhaliwal J, Kuhad A, Sah SP. Pharmacological rewriting of fear memories: A beacon for post-traumatic stress disorder. Eur J Pharmacol 2019; 870:172824. [PMID: 31778672 DOI: 10.1016/j.ejphar.2019.172824] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 11/13/2019] [Accepted: 11/22/2019] [Indexed: 01/08/2023]
Abstract
Post-traumatic stress disorder (PTSD) is a psychopathological response that develops after exposure to an extreme life-threatening traumatic event. Its prevalence ranges from 0.5% to 14.5% worldwide. Due to the complex pathophysiology of PTSD, currently available treatment approaches are associated with high chances of failure, thus further research to identify better pharmacotherapeutic approaches is needed. The traumatic event associated with fear memories plays an important role in the development of PTSD and could be considered as the main culprit. PTSD patient feels frightened in a safe environment as the memories of the traumatic event are revisited. Neurocircuit involving normal processing of fear memories get disturbed in PTSD hence making a fear memory to remain to dominate even after years of trauma. Persistence of fear memories could be explained by acquisition, re-(consolidation) and extinction triad as all of these processes have been widely explored in preclinical as well as clinical studies and set a therapeutic platform for fear memory associated disorders. This review focuses on neurocircuit and pathophysiology of PTSD in context to fear memories and pharmacological targeting of fear memory for the management of PTSD.
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Affiliation(s)
- Ankit Uniyal
- Pharmacology Division, University Institute of Pharmaceutical Sciences, UGC-CAS, Panjab University, Chandigarh, 160014, India; Department of Pharmaceutical Engineering & Technology, Indian Institute of Technology (B.H.U.) Varanasi, 221005, Uttar Pradesh, India
| | - Raghunath Singh
- Pharmacology Division, University Institute of Pharmaceutical Sciences, UGC-CAS, Panjab University, Chandigarh, 160014, India
| | - Ansab Akhtar
- Pharmacology Division, University Institute of Pharmaceutical Sciences, UGC-CAS, Panjab University, Chandigarh, 160014, India
| | - Jatinder Dhaliwal
- Pharmacology Division, University Institute of Pharmaceutical Sciences, UGC-CAS, Panjab University, Chandigarh, 160014, India
| | - Anurag Kuhad
- Pharmacology Division, University Institute of Pharmaceutical Sciences, UGC-CAS, Panjab University, Chandigarh, 160014, India
| | - Sangeeta Pilkhwal Sah
- Pharmacology Division, University Institute of Pharmaceutical Sciences, UGC-CAS, Panjab University, Chandigarh, 160014, India.
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Ravi M, Stevens JS, Michopoulos V. Neuroendocrine pathways underlying risk and resilience to PTSD in women. Front Neuroendocrinol 2019; 55:100790. [PMID: 31542288 PMCID: PMC6876844 DOI: 10.1016/j.yfrne.2019.100790] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 08/26/2019] [Accepted: 09/18/2019] [Indexed: 01/23/2023]
Abstract
Women are twice as likely than men to suffer from posttraumatic stress disorder (PTSD). While women have increased exposure to traumatic events of many types and have greater prevalence of comorbid psychiatric disorders compared to men, these differences do not account for the overall sex difference in the prevalence of PTSD. The current review summarizes significant findings that implicate the role of estradiol, progesterone, and allopregnanolone in female risk for PTSD symptoms and dysregulation of fear psychophysiology that is cardinal to PTSD. We also discuss how these steroid hormones influence the stress axis and neural substrates critical for the regulation of fear responses. Understanding the role of ovarian steroid hormones in risk and resilience for trauma-related adverse mental health outcomes across the lifespan in women has important translational, clinical, and intergenerational implications for mitigating the consequences of trauma exposure.
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Affiliation(s)
- Meghna Ravi
- Emory University Graduate Program in Neuroscience, Atlanta, GA, United States
| | - Jennifer S Stevens
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, United States
| | - Vasiliki Michopoulos
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, United States; Yerkes National Primate Research Center, Atlanta, GA, United States.
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18
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Kim YK, Amidfar M, Won E. A review on inflammatory cytokine-induced alterations of the brain as potential neural biomarkers in post-traumatic stress disorder. Prog Neuropsychopharmacol Biol Psychiatry 2019; 91:103-112. [PMID: 29932946 DOI: 10.1016/j.pnpbp.2018.06.008] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 06/17/2018] [Accepted: 06/18/2018] [Indexed: 12/25/2022]
Abstract
The heterogeneity of post-traumatic stress disorder (PTSD) symptoms indicates that multiple neurobiological mechanisms underlie the pathophysiology of the condition. However, no generally accepted PTSD biomarkers in clinical practice currently exist. The sequential responses to recurrent and chronic stress by the hypothalamic-pituitary-adrenal (HPA) axis and the autonomic nervous system (ANS) system are considered to play a significant role in the onset and progression of PTSD. Decreased activity of the HPA axis and parasympathetic nervous system, along with increased activity of the sympathetic nervous system, have been observed in PTSD, which may lead to increased levels of proinflammatory cytokines. Such heightened activity of the immune system may cause alterations in the structure and function of brain regions-for example, the amygdala, hippocampus, medial prefrontal cortex, anterior cingulate cortex, and insula-through changes in levels of serotonin and kynurenine pathway metabolites, and direct neurotoxic effects of cytokines. Although chronic inflammation-induced alterations in brain regions critical in controlling emotional behavior and fear regulation may represent a strong candidate biomarker of PTSD, future studies are necessary to further elucidate inflammation-associated neural biomarkers of PTSD. Continued research on therapeutic methods that involve the normalization of the HPA axis, ANS, and immune system is expected to contribute to the development of novel ways to treat PTSD.
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Affiliation(s)
- Yong-Ku Kim
- Department of Psychiatry, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Meysam Amidfar
- Department of Neuroscience, Fasa University of Medical Sciences, Fasa, Iran
| | - Eunsoo Won
- Department of Psychiatry, College of Medicine, Korea University, Seoul, Republic of Korea.
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Dunlop BW, Wong A. The hypothalamic-pituitary-adrenal axis in PTSD: Pathophysiology and treatment interventions. Prog Neuropsychopharmacol Biol Psychiatry 2019; 89:361-379. [PMID: 30342071 DOI: 10.1016/j.pnpbp.2018.10.010] [Citation(s) in RCA: 115] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 10/15/2018] [Accepted: 10/16/2018] [Indexed: 12/26/2022]
Abstract
Questions of how altered functioning of the hypothalamic pituitary adrenal (HPA) axis contribute to the development and maintenance of posttraumatic stress disorder (PTSD) have been the focus of extensive animal and human research. As a rule, results have been inconsistent across studies, likely due to a variety of confounding variables that have received inadequate attention. Important confounding factors include the effects of early life stress, biological sex, and the glucocorticoid used for interventions. In this manuscript we review: 1) the literature on identified abnormalities of HPA axis function in PTSD, both in terms of basal functioning and as part of challenge paradigms; 2) the role of HPA axis function pre- and immediately post-trauma as a risk factor for PTSD development; 3) the impact of HPA axis genes' allelic variants and epigenetic modifications on PTSD risk; 4) the contributions of HPA axis components to fear learning and extinction; and 5) therapeutic manipulations of the HPA axis to both prevent and treat PTSD, including the role of glucocorticoids as part of medication enhanced psychotherapy.
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Affiliation(s)
- Boadie W Dunlop
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
| | - Andrea Wong
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
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20
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Jovanovic T, Duncan EJ, Kaye J, Garza K, Norrholm SD, Inslicht SS, Neylan TC, Mathew SJ, Iosifescu D, Rothbaum BO, Mayberg HS, Dunlop BW. Psychophysiological treatment outcomes: Corticotropin-releasing factor type 1 receptor antagonist increases inhibition of fear-potentiated startle in PTSD patients. Psychophysiology 2019; 57:e13356. [PMID: 30807663 DOI: 10.1111/psyp.13356] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 01/21/2019] [Accepted: 02/05/2019] [Indexed: 12/24/2022]
Abstract
After exposure to a traumatic event, a subset of people develop post-traumatic stress disorder (PTSD). One of the key deficits in PTSD is regulation of fear, and impaired inhibition of fear-potentiated startle (FPS) has been identified as a potential physiological biomarker specific to PTSD. As part of a larger clinical trial, this study investigated the effects of a CRF receptor 1 antagonist, GSK561679, on inhibition of fear-potentiated startle during a conditional discrimination fear-conditioning paradigm, termed AX+/BX-. Prior research using this paradigm has demonstrated deficits in inhibition of conditioned fear in several PTSD populations. The randomized, double-blind, placebo-controlled clinical trial compared fear inhibition between female PTSD participants taking 350 mg/day GSK561679 (n = 47 pre- and 29 post-treatment) and patients taking a placebo pill (n = 52 pre- and 30 post-treatment) daily for 6 weeks. There was no significant difference between the two groups in their acquisition of fear or discrimination between threat and safety cues, and no pre-post-treatment effect on these measures. However, there was a significant effect of treatment on inhibition of FPS during the AB trials in the AX+/BX- transfer test (p < 0.05). While all PTSD participants showed typical impairments in fear inhibition prior to treatment, GSK561679 enhanced fear inhibition post-treatment, independent of clinical effects. The current study suggests that CRF receptor 1 antagonism may have specific effects within neural circuitry mediating fear inhibition responses, but not overall symptom presentation, in PTSD.
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Affiliation(s)
- Tanja Jovanovic
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Erica J Duncan
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia.,Atlanta Veterans Affairs Medical Center, Atlanta, Georgia
| | - Joanna Kaye
- Department of Psychology, Drexel University, Philadelphia, Pennsylvania
| | - Kristie Garza
- Neuroscience Program, Graduate Division of Biological and Biomedical Sciences, Emory University, Atlanta, Georgia
| | - Seth D Norrholm
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia.,Atlanta Veterans Affairs Medical Center, Atlanta, Georgia
| | - Sabra S Inslicht
- Department of Psychiatry, University of California San Francisco and San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Thomas C Neylan
- Department of Psychiatry, University of California San Francisco and San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Sanjay J Mathew
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine and Michael E. Debakey Veterans Affairs Medical Center, Houston, Texas
| | - Dan Iosifescu
- Department of Psychiatry, NYU Langone School of Medicine, New York, New York
| | - Barbara O Rothbaum
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Helen S Mayberg
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia.,Icahn School of Medicine at Mount Sinai, New York, New York
| | - Boadie W Dunlop
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
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Malikowska-Racia N, Salat K. Recent advances in the neurobiology of posttraumatic stress disorder: A review of possible mechanisms underlying an effective pharmacotherapy. Pharmacol Res 2019; 142:30-49. [PMID: 30742899 DOI: 10.1016/j.phrs.2019.02.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 01/24/2019] [Accepted: 02/01/2019] [Indexed: 12/24/2022]
Abstract
Recent progress in the field of neurobiology supported by clinical evidence gradually reveals the mystery of human brain functioning. So far, many psychiatric disorders have been described in great detail, although there are still plenty of cases that are misunderstood. These include posttraumatic stress disorder (PTSD), which is a unique disease that combines a wide range of neurobiological changes, which involve disturbances of the hypothalamic-pituitary-adrenal gland axis, hyperactivation of the amygdala complex, and attenuation of some hippocampal and cortical functions. Such multiplicity results in differential symptomatology, including elevated anxiety, nightmares, fear retrieval episodes that may trigger delusions and hallucinations, sleep disturbances, and many others that strongly interfere with the quality of the patient's life. Because of widespread neurological changes and the disease manifestation, the pharmacotherapy of PTSD remains unclear and requires a multidimensional approach and involvement of polypharmacotherapy. Hopefully, more and more neuroscientists and clinicians will study PTSD, which will provide us with new information that would possibly accelerate establishment of well-tolerated and effective pharmacotherapy. In this review, we have focused on neurobiological changes regarding PTSD, addressing the most disturbed brain structures and neurotransmissions, as well as discussing in detail the recently taken and novel therapeutic paths.
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Affiliation(s)
- Natalia Malikowska-Racia
- Department of Pharmacodynamics, Chair of Pharmacodynamics, Jagiellonian University Medical College, 9 Medyczna St., 30-688 Krakow, Poland.
| | - Kinga Salat
- Department of Pharmacodynamics, Chair of Pharmacodynamics, Jagiellonian University Medical College, 9 Medyczna St., 30-688 Krakow, Poland
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Electroacupuncture and Moxibustion Improved Anxiety Behavior in DSS-Induced Colitis Mice. Gastroenterol Res Pract 2019; 2019:2345890. [PMID: 30881446 PMCID: PMC6383400 DOI: 10.1155/2019/2345890] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 09/18/2018] [Accepted: 10/31/2018] [Indexed: 12/19/2022] Open
Abstract
Background and Aims Psychological disorders are prevalent in patients with inflammatory bowel disease, but the underlying mechanisms remain unknown. The aim of this study was to study whether electroacupuncture (EA) and moxibustion (MB) can improve anxiety behavior in DSS-induced colitis mice and to investigate whether this effect is related to hypothalamic-pituitary-adrenocortical (HPA) axis. Methods The colitis model was established by drinking 2.5% dextran sodium sulfate (DSS). DSS-induced colitis mice were treated by EA or MB. Disease activity index (DAI) was scored; intestinal morphological and pathological structure was observed; anxiety behavior was tested by the elevated plus maze and open field. The concentration of corticotropin-releasing hormone (CRH) and cortisol (CORT) in serum was measured by enzyme-linked immunosorbent assay (ELISA). The protein expression of CRH in the colon and hypothalamus was detected by Western blot (WB). Results Both EA and MB treatments can improvethe morphology of their distal colonic mucosal epithelia, as well as the disease activity index. Meanwhile, anxiety behavior in colitis mice was improved slightly after EA and MB treatment. In addition, the levels of CRH and CORT in the serum were slightly improved after EA and MB treatment. These effects are further supported by WB results. The expression of CRH in the colon and hypothalamus was increased significantly after treatment, compared with the model group. Conclusion EA and MB were able to regulate the concentration of CRH in serum and protein expression in the peripheral and central at different levels and promote the recovery of the HPA axis that may be the basis for EA and MB to improve colonic pathology and alleviate anxiety behavior in DSS-induced colitis.
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Lima BB, Hammadah M, Wilmot K, Pearce BD, Shah A, Levantsevych O, Kaseer B, Obideen M, Gafeer MM, Kim JH, Sullivan S, Lewis TT, Weng L, Elon L, Li L, Bremner JD, Raggi P, Quyyumi A, Vaccarino V. Posttraumatic stress disorder is associated with enhanced interleukin-6 response to mental stress in subjects with a recent myocardial infarction. Brain Behav Immun 2019; 75:26-33. [PMID: 30172946 PMCID: PMC6279471 DOI: 10.1016/j.bbi.2018.08.015] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 08/08/2018] [Accepted: 08/28/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Posttraumatic Stress Disorder (PTSD) is prevalent among patients who survived an acute coronary syndrome, and is associated with adverse outcomes, but the mechanisms underlying these associations are unclear. Individuals with PTSD have enhanced sensitivity of the noradrenergic system to stress which may lead to immune activation. We hypothesized that survivors of a myocardial infarction (MI) who have PTSD would show an enhanced inflammatory response to acute psychological stress compared to those without PTSD. METHODS Individuals with a verified history of MI within 8 months and a clinical diagnosis of current PTSD underwent a mental stress speech task. Inflammatory biomarkers including interleukin-6 (IL-6), high-sensitivity C reactive protein (HsCRP), matrix metallopeptidase 9 (MMP-9), intercellular adhesion molecule (ICAM)-1, vascular cell adhesion molecule (VCAM)-1 and monocyte chemoattractant protein (MCP)-1 were measured at rest and 90 min after mental stress. RESULTS Among 271 patients in the study (mean age 51 ± 7 years, 50% female, 60% African-American), the prevalence of PTSD was 12%. Mental stress resulted in a significant increase in IL-6, but the increase was more marked in patients with PTSD (126% increase) than those without (63% increase) (p = 0.001). MCP-1 showed a modest increase with stress which was similar in patients with PTSD (9% increase) and without PTSD (6% increase) (p = 0.35). CRP did not increase with stress in either group. CONCLUSION MI patients with current PTSD exhibit enhanced IL-6 response to psychosocial stress, suggesting a mechanistic link between PTSD and adverse cardiovascular outcomes as well as other diseases associated with inflammation.
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Affiliation(s)
- Bruno B Lima
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States; Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Muhammad Hammadah
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Kobina Wilmot
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Brad D Pearce
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Amit Shah
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States; Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States; Atlanta VA Medical Center, Decatur, GA, United States
| | - Oleksiy Levantsevych
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Belal Kaseer
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Malik Obideen
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Mohamad Mazen Gafeer
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Jeong Hwan Kim
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Samaah Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Tené T Lewis
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Lei Weng
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Lisa Elon
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Lian Li
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - J Douglas Bremner
- Atlanta VA Medical Center, Decatur, GA, United States; Departments of Psychiatry and Behavioral Sciences and Radiology, Emory University School of Medicine, United States
| | - Paolo Raggi
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States; Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Arshed Quyyumi
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States; Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States.
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Stress-Related Memory Impairments Are Modulated by the Synergistic Action of Stress Hormones: Implications for PTSD. J Neurosci 2018; 37:4225-4227. [PMID: 28424298 DOI: 10.1523/jneurosci.3980-16.2017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 03/11/2017] [Accepted: 03/16/2017] [Indexed: 01/09/2023] Open
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Neurotransmitter, Peptide, and Steroid Hormone Abnormalities in PTSD: Biological Endophenotypes Relevant to Treatment. Curr Psychiatry Rep 2018; 20:52. [PMID: 30019147 DOI: 10.1007/s11920-018-0908-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE OF REVIEW This review summarizes neurotransmitter, peptide, and other neurohormone abnormalities associated with posttraumatic stress disorder (PTSD) and relevant to development of precision medicine therapeutics for PTSD. RECENT FINDINGS As the number of molecular abnormalities associated with PTSD across a variety of subpopulations continues to grow, it becomes clear that no single abnormality characterizes all individuals with PTSD. Instead, individually variable points of molecular dysfunction occur within several different stress-responsive systems that interact to produce the clinical PTSD phenotype. Future work should focus on critical interactions among the systems that influence PTSD risk, severity, chronicity, comorbidity, and response to treatment. Effort also should be directed toward development of clinical procedures by which points of molecular dysfunction within these systems can be identified in individual patients. Some molecular abnormalities are more common than others and may serve as subpopulation biological endophenotypes for targeting of currently available and novel treatments.
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Garcia AF, Wilborn K, Mangold DL. The Cortisol Awakening Response Mediates the Relationship Between Acculturative Stress and Self-Reported Health in Mexican Americans. Ann Behav Med 2018; 51:787-798. [PMID: 28337601 DOI: 10.1007/s12160-017-9901-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The assessment of acculturative stress as synonymous with acculturation level overlooks the dynamic, interactive, and developmental nature of the acculturation process. An individual's unique perception and response to a range of stressors at each stage of the dynamic process of acculturation may be associated with stress-induced alterations in important biological response systems that mediate health outcomes. Evidence suggests the cortisol awakening response (CAR) is a promising pre-clinical biomarker of stress exposure that may link acculturative stress to self-reported health in Mexican Americans. PURPOSE The aim of the current study was to examine whether alterations in the CAR mediate the relationship between acculturative stress and self-reported health in Mexican Americans. METHODS Salivary cortisol samples were collected at awakening, 30, 45, and 60 min thereafter, on two consecutive weekdays from a sample of adult Mexican Americans. Acculturative stress and self-reported health were assessed. Data were aggregated and analyzed (n = 89) using a mixed effects regression model and path analysis. RESULTS Poorer self-reported health was associated with attenuated CAR profiles (primarily due to a diminished post-awakening rise in cortisol) predicted by both moderate and high levels of exposure to acculturative stress. Stress-induced alterations in the CAR mediated the relationship between exposure to acculturative stressors and self-reported health. CONCLUSIONS Findings demonstrate that different levels of acculturative stress are associated with distinct CAR profiles and suggest the CAR is one possible biological pathway through which exposure to culturally unique stressors may be linked to health disparities.
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Affiliation(s)
- Antonio F Garcia
- Department of Psychology, The University of Texas at San Antonio, One UTSA Circle, San Antonio, TX, 78249, USA
| | | | - Deborah L Mangold
- Department of Psychology, The University of Texas at San Antonio, One UTSA Circle, San Antonio, TX, 78249, USA.
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Colvonen PJ, Straus LD, Stepnowsky C, McCarthy MJ, Goldstein LA, Norman SB. Recent Advancements in Treating Sleep Disorders in Co-Occurring PTSD. Curr Psychiatry Rep 2018; 20:48. [PMID: 29931537 PMCID: PMC6645398 DOI: 10.1007/s11920-018-0916-9] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE OF REVIEW Comorbidity of posttraumatic stress disorder (PTSD) and insomnia, nightmares, and obstructive sleep apnea (OSA) is high. We review recent research on psychotherapeutic and pharmacological interventions for sleep disorders in PTSD. RECENT FINDINGS PTSD treatments decrease PTSD severity and nightmare frequency, but do not resolve OSA or insomnia. Research on whether insomnia hinders PTSD treatment shows mixed results; untreated OSA does interfere with PTSD treatment. Cognitive behavioral therapy for insomnia is the recommended treatment for insomnia; however, optimal ordering with PTSD treatment is unclear. PTSD treatment may be most useful for PTSD-related nightmares. CPAP therapy is recommended for OSA but adherence can be low. Targeted treatment of sleep disorders in the context of PTSD offers a unique and underutilized opportunity to advance clinical care and research. Research is needed to create screening protocols, determine optimal order of treatment, and elucidate mechanisms between sleep and PTSD treatments.
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Affiliation(s)
- Peter J. Colvonen
- VA San Diego Healthcare System, University of California San Diego, 3350 La Jolla Village Dr. (116B), San Diego, CA 92161, USA,Center of Excellence for Stress and Mental Health, University of California San Diego, San Diego, CA, USA,Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Laura D. Straus
- Sierra Pacific Mental Illness Research Education and Clinical Centers, San Francisco VA Healthcare System, San Francisco, CA, USA,Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
| | - Carl Stepnowsky
- VA San Diego Healthcare System, University of California San Diego, 3350 La Jolla Village Dr. (116B), San Diego, CA 92161, USA,Department of Medicine, University of California, San Diego, San Diego, CA, USA
| | - Michael J. McCarthy
- VA San Diego Healthcare System, University of California San Diego, 3350 La Jolla Village Dr. (116B), San Diego, CA 92161, USA,Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Lizabeth A. Goldstein
- Sierra Pacific Mental Illness Research Education and Clinical Centers, San Francisco VA Healthcare System, San Francisco, CA, USA,Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
| | - Sonya B. Norman
- VA San Diego Healthcare System, University of California San Diego, 3350 La Jolla Village Dr. (116B), San Diego, CA 92161, USA,Center of Excellence for Stress and Mental Health, University of California San Diego, San Diego, CA, USA,Department of Psychiatry, University of California San Diego, San Diego, CA, USA,National Center for PTSD, Boston, MA, USA
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28
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Onton JA, Matthews SC, Kang DY, Coleman TP. In-Home Sleep Recordings in Military Veterans With Posttraumatic Stress Disorder Reveal Less REM and Deep Sleep <1 Hz. Front Hum Neurosci 2018; 12:196. [PMID: 29867419 PMCID: PMC5958207 DOI: 10.3389/fnhum.2018.00196] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 04/23/2018] [Indexed: 11/13/2022] Open
Abstract
Veterans with posttraumatic stress disorder (PTSD) often report suboptimal sleep quality, often described as lack of restfulness for unknown reasons. These experiences are sometimes difficult to objectively quantify in sleep lab assessments. Here, we used a streamlined sleep assessment tool to record in-home 2-channel electroencephalogram (EEG) with concurrent collection of electrodermal activity (EDA) and acceleration. Data from a single forehead channel were transformed into a whole-night spectrogram, and sleep stages were classified using a fully automated algorithm. For this study, 71 control subjects and 60 military-related PTSD subjects were analyzed for percentage of time spent in Light, Hi Deep (1-3 Hz), Lo Deep (<1 Hz), and rapid eye movement (REM) sleep stages, as well as sleep efficiency and fragmentation. The results showed a significant tendency for PTSD sleepers to spend a smaller percentage of the night in REM (p < 0.0001) and Lo Deep (p = 0.001) sleep, while spending a larger percentage of the night in Hi Deep (p < 0.0001) sleep. The percentage of combined Hi+Lo Deep sleep did not differ between groups. All sleepers usually showed EDA peaks during Lo, but not Hi, Deep sleep; however, PTSD sleepers were more likely to lack EDA peaks altogether, which usually coincided with a lack of Lo Deep sleep. Linear regressions with all subjects showed that a decreased percentage of REM sleep in PTSD sleepers was accounted for by age, prazosin, SSRIs and SNRIs (p < 0.02), while decreased Lo Deep and increased Hi Deep in the PTSD group could not be accounted for by any factor in this study (p < 0.005). Linear regression models with only the PTSD group showed that decreased REM correlated with self-reported depression, as measured with the Depression, Anxiety, and Stress Scales (DASS; p < 0.00001). DASS anxiety was associated with increased REM time (p < 0.0001). This study shows altered sleep patterns in sleepers with PTSD that can be partially accounted for by age and medication use; however, differences in deep sleep related to PTSD could not be linked to any known factor. With several medications [prazosin, selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs); p < 0.03], as well as SSRIs were associated with less sleep efficiency (b = -3.3 ± 0.95; p = 0.0005) and more sleep fragmentation (b = -1.7 ± 0.51; p = 0.0009). Anti-psychotics were associated with less sleep efficiency (b = -4.9 ± 1.4; p = 0.0004). Sleep efficiency was negatively impacted by SSRIs, antipsychotic medications, and depression (p < 0.008). Increased sleep fragmentation was associated with SSRIs, SNRIs, and anxiety (p < 0.009), while prazosin and antipsychotic medications correlated with decreased sleep fragmentation (p < 0.05).
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Affiliation(s)
- Julie A. Onton
- Institute for Neural Computation, University of California, San Diego, La Jolla, CA, United States
- Warfighter Performance, Naval Health Research Center, San Diego, CA, United States
| | - Scott C. Matthews
- Psychiatry, VA San Diego Healthcare System, San Diego, CA, United States
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Dae Y. Kang
- Department of Bioengineering, University of California, San Diego, La Jolla, CA, United States
| | - Todd P. Coleman
- Department of Bioengineering, University of California, San Diego, La Jolla, CA, United States
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Inslicht SS, Rao MN, Richards A, O'Donovan A, Gibson CJ, Baum T, Metzler TJ, Neylan TC. Sleep and hypothalamic pituitary adrenal axis responses to metyrapone in posttraumatic stress disorder. Psychoneuroendocrinology 2018; 88:136-143. [PMID: 29268182 PMCID: PMC6170159 DOI: 10.1016/j.psyneuen.2017.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 12/05/2017] [Accepted: 12/05/2017] [Indexed: 11/19/2022]
Abstract
Disturbed sleep is a core feature of posttraumatic stress disorder (PTSD), characterized in part by decreased delta power sleep that may result from stress-related alterations in corticotropin releasing factor (CRF), hypothalamic pituitary adrenal axis (HPA) regulation and glucocorticoid signaling. Overnight HPA axis response mediating sleep disturbances in men and women with PTSD was examined using a metyrapone challenge. Metyrapone blocks cortisol synthesis, removing negative feedback, and increases the release of hypothalamic CRF and pituitary adrenocorticotropic hormone (ACTH). Laboratory-based polysomnography was used to monitor the sleep of 66 medically healthy, medication-free men and pre-menopausal follicular phase women including 33 with chronic PTSD (16 women and 17 men) and 33 age- and sex-matched controls (14 women and 19 men) over 3 consecutive nights. Participants completed an overnight metyrapone challenge after an adaptation and baseline night of sleep and ACTH was obtained by repeated blood sampling. Metyrapone resulted in a greater increase in ACTH and greater decreases in cortisol and delta spectral power sleep in PTSD subjects compared to controls, and a greater increase in ACTH in women compared to men. There was no sex difference in metyrapone effects on delta power sleep, and no significant metyrapone by PTSD by sex interactions with either ACTH or delta power sleep. Regression analyses indicated that a greater increase in ACTH response was associated with a greater decrease in delta power sleep response in PTSD subjects, but no such relationship was found in controls. The PTSD group difference was similar in men and women. These results suggest that stress-related alterations of the HPA axis in PTSD may contribute to sleep difficulties. Therapeutics that target the HPA axis may offer promise as a potential future treatment for PTSD and related sleep difficulties.
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Affiliation(s)
- Sabra S Inslicht
- San Francisco VA Healthcare System, 4150 Clement St. (116P), San Francisco, CA 94121, United States; Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA 94143, United States; Northern California Institute for Research and Education (NCIRE), The Veterans Health Research Institute, San Francisco, CA 94121, United States.
| | - Madhu N Rao
- Department of Medicine, University of California, San Francisco, San Francisco, CA 94143, United States
| | - Anne Richards
- San Francisco VA Healthcare System, 4150 Clement St. (116P), San Francisco, CA 94121, United States; Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA 94143, United States; Northern California Institute for Research and Education (NCIRE), The Veterans Health Research Institute, San Francisco, CA 94121, United States
| | - Aoife O'Donovan
- San Francisco VA Healthcare System, 4150 Clement St. (116P), San Francisco, CA 94121, United States; Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA 94143, United States; Northern California Institute for Research and Education (NCIRE), The Veterans Health Research Institute, San Francisco, CA 94121, United States
| | - Carolyn J Gibson
- San Francisco VA Healthcare System, 4150 Clement St. (116P), San Francisco, CA 94121, United States; Department of Medicine, University of California, San Francisco, San Francisco, CA 94143, United States
| | - Tierney Baum
- Institute of Neurodegenerative Disease, University of California, San Francisco, San Francisco, CA 94158, United States
| | - Thomas J Metzler
- San Francisco VA Healthcare System, 4150 Clement St. (116P), San Francisco, CA 94121, United States; Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA 94143, United States; Northern California Institute for Research and Education (NCIRE), The Veterans Health Research Institute, San Francisco, CA 94121, United States
| | - Thomas C Neylan
- San Francisco VA Healthcare System, 4150 Clement St. (116P), San Francisco, CA 94121, United States; Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA 94143, United States; Northern California Institute for Research and Education (NCIRE), The Veterans Health Research Institute, San Francisco, CA 94121, United States
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Kempuraj D, Selvakumar GP, Thangavel R, Ahmed ME, Zaheer S, Raikwar SP, Iyer SS, Bhagavan SM, Beladakere-Ramaswamy S, Zaheer A. Mast Cell Activation in Brain Injury, Stress, and Post-traumatic Stress Disorder and Alzheimer's Disease Pathogenesis. Front Neurosci 2017; 11:703. [PMID: 29302258 PMCID: PMC5733004 DOI: 10.3389/fnins.2017.00703] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 11/30/2017] [Indexed: 12/30/2022] Open
Abstract
Mast cells are localized throughout the body and mediate allergic, immune, and inflammatory reactions. They are heterogeneous, tissue-resident, long-lived, and granulated cells. Mast cells increase their numbers in specific site in the body by proliferation, increased recruitment, increased survival, and increased rate of maturation from its progenitors. Mast cells are implicated in brain injuries, neuropsychiatric disorders, stress, neuroinflammation, and neurodegeneration. Brain mast cells are the first responders before microglia in the brain injuries since mast cells can release prestored mediators. Mast cells also can detect amyloid plaque formation during Alzheimer's disease (AD) pathogenesis. Stress conditions activate mast cells to release prestored and newly synthesized inflammatory mediators and induce increased blood-brain barrier permeability, recruitment of immune and inflammatory cells into the brain and neuroinflammation. Stress induces the release of corticotropin-releasing hormone (CRH) from paraventricular nucleus of hypothalamus and mast cells. CRH activates glial cells and mast cells through CRH receptors and releases neuroinflammatory mediators. Stress also increases proinflammatory mediator release in the peripheral systems that can induce and augment neuroinflammation. Post-traumatic stress disorder (PTSD) is a traumatic-chronic stress related mental dysfunction. Currently there is no specific therapy to treat PTSD since its disease mechanisms are not yet clearly understood. Moreover, recent reports indicate that PTSD could induce and augment neuroinflammation and neurodegeneration in the pathogenesis of neurodegenerative diseases. Mast cells play a crucial role in the peripheral inflammation as well as in neuroinflammation due to brain injuries, stress, depression, and PTSD. Therefore, mast cells activation in brain injury, stress, and PTSD may accelerate the pathogenesis of neuroinflammatory and neurodegenerative diseases including AD. This review focusses on how mast cells in brain injuries, stress, and PTSD may promote the pathogenesis of AD. We suggest that inhibition of mast cells activation and brain cells associated inflammatory pathways in the brain injuries, stress, and PTSD can be explored as a new therapeutic target to delay or prevent the pathogenesis and severity of AD.
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Affiliation(s)
- Duraisamy Kempuraj
- Department of Neurology and Center for Translational Neuroscience, School of Medicine, University of Missouri, Columbia, MO, United States.,Harry S. Truman Memorial Veteran's Hospital, United States Department of Veterans Affairs, Columbia, MO, United States
| | - Govindhasamy P Selvakumar
- Department of Neurology and Center for Translational Neuroscience, School of Medicine, University of Missouri, Columbia, MO, United States.,Harry S. Truman Memorial Veteran's Hospital, United States Department of Veterans Affairs, Columbia, MO, United States
| | - Ramasamy Thangavel
- Department of Neurology and Center for Translational Neuroscience, School of Medicine, University of Missouri, Columbia, MO, United States.,Harry S. Truman Memorial Veteran's Hospital, United States Department of Veterans Affairs, Columbia, MO, United States
| | - Mohammad E Ahmed
- Department of Neurology and Center for Translational Neuroscience, School of Medicine, University of Missouri, Columbia, MO, United States.,Harry S. Truman Memorial Veteran's Hospital, United States Department of Veterans Affairs, Columbia, MO, United States
| | - Smita Zaheer
- Department of Neurology and Center for Translational Neuroscience, School of Medicine, University of Missouri, Columbia, MO, United States
| | - Sudhanshu P Raikwar
- Department of Neurology and Center for Translational Neuroscience, School of Medicine, University of Missouri, Columbia, MO, United States.,Harry S. Truman Memorial Veteran's Hospital, United States Department of Veterans Affairs, Columbia, MO, United States
| | - Shankar S Iyer
- Department of Neurology and Center for Translational Neuroscience, School of Medicine, University of Missouri, Columbia, MO, United States.,Harry S. Truman Memorial Veteran's Hospital, United States Department of Veterans Affairs, Columbia, MO, United States
| | - Sachin M Bhagavan
- Department of Neurology and Center for Translational Neuroscience, School of Medicine, University of Missouri, Columbia, MO, United States
| | - Swathi Beladakere-Ramaswamy
- Department of Neurology and Center for Translational Neuroscience, School of Medicine, University of Missouri, Columbia, MO, United States
| | - Asgar Zaheer
- Department of Neurology and Center for Translational Neuroscience, School of Medicine, University of Missouri, Columbia, MO, United States.,Harry S. Truman Memorial Veteran's Hospital, United States Department of Veterans Affairs, Columbia, MO, United States
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Albrechet-Souza L, Viola TW, Grassi-Oliveira R, Miczek KA, de Almeida RMM. Corticotropin Releasing Factor in the Bed Nucleus of the Stria Terminalis in Socially Defeated and Non-stressed Mice with a History of Chronic Alcohol Intake. Front Pharmacol 2017; 8:762. [PMID: 29118713 PMCID: PMC5660971 DOI: 10.3389/fphar.2017.00762] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 10/10/2017] [Indexed: 11/21/2022] Open
Abstract
Stress exposure has been identified as one risk factor for alcohol abuse that may facilitate the transition from social or regulated use to the development of alcohol dependence. Preclinical studies have shown that dysregulation of the corticotropin releasing factor (CRF) neurotransmission has been implicated in stress-related psychopathologies such as depression and anxiety, and may affect alcohol consumption. The bed nucleus of the stria terminalis (BNST) contains CRF-producing neurons which seem to be sensitive to stress. In this study, adult male C57BL/6 mice previously defeated in resident-intruder confrontations were evaluated in the elevated plus-maze and tail suspension test. Mice were also tested for sweet solution intake before and after social stress. After having had continuous access to ethanol (20% weight/volume) for 4 weeks, control and stressed mice had CRF type 1 (CRFR1) or type 2 (CRFR2) receptor antagonists infused into the BNST and then had access to ethanol for 24 h. In separate cohorts of control and stressed mice, we assessed mRNA levels of BNST CRF, CRFR1 and CRFR2. Stressed mice increased their intake of sweet solution after ten sessions of social defeat and showed reduced activity in the open arms of the elevated plus-maze. When tested for ethanol consumption, stressed mice persistently drank significantly more than controls during the 4 weeks of access. Also, social stress induced higher BNST CRF mRNA levels. The selective blockade of BNST CRFR1 with CP376,395 effectively reduced alcohol drinking in non-stressed mice, whereas the selective CRFR2 antagonist astressin2B produced a dose-dependent increase in ethanol consumption in both non-stressed controls and stressed mice. The 10-day episodic defeat stress used here elicited anxiety- but not depressive-like behaviors, and promoted an increase in ethanol drinking. CRF-CRFR1 signaling in the BNST seems to underlie ethanol intake in non-stressed mice, whereas CRFR2 modulates alcohol consumption in both socially defeated and non-stressed mice with a history of chronic intake.
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Affiliation(s)
- Lucas Albrechet-Souza
- Institute of Psychology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Thiago W Viola
- Developmental Cognitive Neuroscience Lab (DCNL) and Brain Institute (InsCer), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Rodrigo Grassi-Oliveira
- Developmental Cognitive Neuroscience Lab (DCNL) and Brain Institute (InsCer), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Klaus A Miczek
- Departments of Psychology and Neuroscience, Tufts University, Medford, MA, United States
| | - Rosa M M de Almeida
- Institute of Psychology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Michopoulos V, Norrholm SD, Stevens JS, Glover EM, Rothbaum BO, Gillespie CF, Schwartz AC, Ressler KJ, Jovanovic T. Dexamethasone facilitates fear extinction and safety discrimination in PTSD: A placebo-controlled, double-blind study. Psychoneuroendocrinology 2017; 83:65-71. [PMID: 28595089 PMCID: PMC5524593 DOI: 10.1016/j.psyneuen.2017.05.023] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 05/26/2017] [Accepted: 05/26/2017] [Indexed: 10/19/2022]
Abstract
Psychophysiological hallmarks of posttraumatic stress disorder (PTSD) include exaggerated fear responses, impaired inhibition and extinction of conditioned fear, and decreased discrimination between safety and fear cues. This increased fear load associated with PTSD can be a barrier to effective therapy thus indicating the need for new treatments to reduce fear expression in people with PTSD. One potential biological target for reducing fear expression in PTSD is the hypothalamic-pituitary-adrenal (HPA) axis, which is dysregulated in PTSD. Recent translational rodent studies and cross-sectional clinical studies have shown that dexamethasone administration and the resulting suppression of cortisol in individuals with PTSD leads to a decrease in the fear responses characteristic of PTSD. These data, taken together, suggest that dexamethasone may serve as a novel pharmacologic intervention for heightened fear responses in PTSD. We conducted a double-blind, placebo-controlled trial to test our hypothesis that dexamethasone administration and the concomitant suppression of HPA axis hyperactivity would attenuate fear expression and enhance fear extinction in individuals with PTSD. Study participants (n=62) were recruited from Grady Memorial Hospital in Atlanta, GA. Participants were randomized to receive dexamethasone or placebo prior to fear conditioning and extinction, in a counterbalanced design (treatments separated by a week). Both PTSD- (n=37) and PTSD+ (n=25) participants showed significant startle increases in the presence of the danger signal during placebo and dexamethasone treatments (all p<0.05). However, only PTSD- control participants showed decreases in fear-potentiated startle across extinction blocks during both conditions (p's≤0.001), with PTSD+ participants showing deficits in fear extinction and safety discrimination in the placebo condition. Notably, extinction and discrimination deficits in PTSD+ subjects were markedly reversed with dexamethasone (p<0.001). These data suggest that dexamethasone may serve as a pharmacological agent with which to facilitate fear extinction and discrimination in individuals with PTSD.
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Affiliation(s)
- Vasiliki Michopoulos
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia,Yerkes National Primate Research Center, Atlanta, Georgia
| | - Seth D. Norrholm
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia,Atlanta Veterans Affairs Medical Center, Mental Health Service Line, Decatur
| | - Jennifer S. Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Ebony M. Glover
- Department of Psychology, Kennesaw State University, Kennesaw, Georgia
| | - Barbara O. Rothbaum
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Charles F. Gillespie
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Ann C. Schwartz
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Kerry J Ressler
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia,Harvard/McLean Hospital, Boston, Massachusetts
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia.
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Juengst SB, Wagner AK, Ritter AC, Szaflarski JP, Walker WC, Zafonte RD, Brown AW, Hammond FM, Pugh MJ, Shea T, Krellman JW, Bushnik T, Arenth PM. Post-traumatic epilepsy associations with mental health outcomes in the first two years after moderate to severe TBI: A TBI Model Systems analysis. Epilepsy Behav 2017; 73:240-246. [PMID: 28658654 DOI: 10.1016/j.yebeh.2017.06.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 05/08/2017] [Accepted: 06/05/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Research suggests that there are reciprocal relationships between mental health (MH) disorders and epilepsy risk. However, MH relationships to post-traumatic epilepsy (PTE) have not been explored. Thus, the objective of this study was to assess associations between PTE and frequency of depression and/or anxiety in a cohort of individuals with moderate-to-severe TBI who received acute inpatient rehabilitation. METHODS Multivariate regression models were developed using a recent (2010-2012) cohort (n=867 unique participants) from the TBI Model Systems (TBIMS) National Database, a time frame during which self-reported seizures, depression [Patient Health Questionnaire (PHQ)-9], and anxiety [Generalized Anxiety Disorder (GAD-7)] follow-up measures were concurrently collected at year-1 and year-2 after injury. RESULTS PTE did not significantly contribute to depression status in either the year-1 or year-2 cohort, nor did it contribute significantly to anxiety status in the year-1 cohort, after controlling for other known depression and anxiety predictors. However, those with PTE in year-2 had 3.34 times the odds (p=.002) of having clinically significant anxiety, even after accounting for other relevant predictors. In this model, participants who self-identified as Black were also more likely to report clinical symptoms of anxiety than those who identified as White. PTE was the only significant predictor of comorbid depression and anxiety at year-2 (Odds Ratio 2.71; p=0.049). CONCLUSIONS Our data suggest that PTE is associated with MH outcomes 2years after TBI, findings whose significance may reflect reciprocal, biological, psychological, and/or experiential factors contributing to and resulting from both PTE and MH status post-TBI. Future work should consider temporal and reciprocal relationships between PTE and MH as well as if/how treatment of each condition influences biosusceptibility to the other condition.
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Affiliation(s)
- Shannon B Juengst
- Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA, United States
| | - Amy K Wagner
- Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA, United States; Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, United States; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA, United States; Department of Neuroscience, University of Pittsburgh, Pittsburgh, PA, United States; Center for Neuroscience at University of Pittsburgh, Pittsburgh, PA, United States.
| | - Anne C Ritter
- Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA, United States; Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Jerzy P Szaflarski
- University of Alabama at Birmingham Department of Neurology and UAB Epilepsy Center, Birmingham, AL, United States
| | - William C Walker
- Dept of Physical Medicine & Rehabilitation, Virginia Commonwealth University, Richmond, VA, United States
| | - Ross D Zafonte
- Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Allen W Brown
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, United States
| | - Flora M Hammond
- Carolinas Rehabilitation, Charlotte, NC, United States; Indiana University School of Medicine, Indianapolis, IN, United States
| | - Mary Jo Pugh
- South Texas Veterans Health Care System Polytrauma Rehabilitation Center, San Antonio, TX, United States; Department of Epidemiology and Biostatistics, University of Texas Health Science Center San Antonio, San Antonio, TX, United States
| | - Timothy Shea
- Department of Physical Medicine and Rehabilitation, Ohio State University, Columbus, OH, United States
| | - Jason W Krellman
- Department of Neurology, Columbia University Medical Center, New York, NY, United States
| | - Tamara Bushnik
- Rusk Rehabilitation, New York University School of Medicine, New York, NY, United States(1)
| | - Patricia M Arenth
- Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA, United States
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Galatzer-Levy IR, Andero R, Sawamura T, Jovanovic T, Papini S, Ressler KJ, Norrholm SD. A cross species study of heterogeneity in fear extinction learning in relation to FKBP5 variation and expression: Implications for the acute treatment of posttraumatic stress disorder. Neuropharmacology 2017; 116:188-195. [DOI: 10.1016/j.neuropharm.2016.12.023] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 12/01/2016] [Accepted: 12/21/2016] [Indexed: 02/03/2023]
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Inflammation in Fear- and Anxiety-Based Disorders: PTSD, GAD, and Beyond. Neuropsychopharmacology 2017; 42:254-270. [PMID: 27510423 PMCID: PMC5143487 DOI: 10.1038/npp.2016.146] [Citation(s) in RCA: 388] [Impact Index Per Article: 55.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 07/01/2016] [Accepted: 07/12/2016] [Indexed: 02/07/2023]
Abstract
The study of inflammation in fear- and anxiety-based disorders has gained interest as growing literature indicates that pro-inflammatory markers can directly modulate affective behavior. Indeed, heightened concentrations of inflammatory signals, including cytokines and C-reactive protein, have been described in posttraumatic stress disorder (PTSD), generalized anxiety disorder (GAD), panic disorder (PD), and phobias (agoraphobia, social phobia, etc.). However, not all reports indicate a positive association between inflammation and fear- and anxiety-based symptoms, suggesting that other factors are important in future assessments of inflammation's role in the maintenance of these disorders (ie, sex, co-morbid conditions, types of trauma exposure, and behavioral sources of inflammation). The most parsimonious explanation of increased inflammation in PTSD, GAD, PD, and phobias is via the activation of the stress response and central and peripheral immune cells to release cytokines. Dysregulation of the stress axis in the face of increased sympathetic tone and decreased parasympathetic activity characteristic of anxiety disorders could further augment inflammation and contribute to increased symptoms by having direct effects on brain regions critical for the regulation of fear and anxiety (such as the prefrontal cortex, insula, amygdala, and hippocampus). Taken together, the available data suggest that targeting inflammation may serve as a potential therapeutic target for treating these fear- and anxiety-based disorders in the future. However, the field must continue to characterize the specific role pro-inflammatory signaling in the maintenance of these unique psychiatric conditions.
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Michopoulos V, Vester A, Neigh G. Posttraumatic stress disorder: A metabolic disorder in disguise? Exp Neurol 2016; 284:220-229. [PMID: 27246996 PMCID: PMC5056806 DOI: 10.1016/j.expneurol.2016.05.038] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 05/24/2016] [Accepted: 05/26/2016] [Indexed: 12/30/2022]
Abstract
Posttraumatic stress disorder (PTSD) is a heterogeneous psychiatric disorder that affects individuals exposed to trauma and is highly co-morbid with other adverse health outcomes, including cardiovascular disease and obesity. The unique pathophysiological feature of PTSD is the inability to inhibit fear responses, such that individuals suffering from PTSD re-experience traumatic memories and are unable to control psychophysiological responses to trauma-associated stimuli. However, underlying alterations in sympathetic nervous system activity, neuroendocrine systems, and metabolism associated with PTSD are similar to those present in traditional metabolic disorders, such as obesity and diabetes. The current review highlights existing clinical, translational, and preclinical data that support the notion that underneath the primary indication of impaired fear inhibition, PTSD is itself also a metabolic disorder and proposes altered function of inflammatory responses as a common underlying mechanism. The therapeutic implications of treating PTSD as a whole-body condition are significant, as targeting any underlying biological system whose activity is altered in both PTSD and metabolic disorders, (i.e. HPA axis, sympathetic nervous systems, inflammation) may elicit symptomatic relief in individuals suffering from these whole-body adverse outcomes.
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Affiliation(s)
- Vasiliki Michopoulos
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States; Yerkes National Primate Research Center, Atlanta, GA, United States
| | - Aimee Vester
- Department of Environmental Health Sciences, Rollins School of Public Health, Atlanta, GA, United States
| | - Gretchen Neigh
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States; Yerkes National Primate Research Center, Atlanta, GA, United States; Department of Physiology, Emory University School of Medicine, Atlanta, GA, United States.
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Chaby LE. Why are there lasting effects from exposure to stress during development? An analysis of current models of early stress. Physiol Behav 2016; 164:164-81. [DOI: 10.1016/j.physbeh.2016.05.032] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 04/29/2016] [Accepted: 05/17/2016] [Indexed: 01/19/2023]
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Radahmadi M, Alaei H, Sharifi MR, Hosseini N. Stress biomarker responses to different protocols of forced exercise in chronically stressed rats. J Bodyw Mov Ther 2016; 21:63-68. [PMID: 28167192 DOI: 10.1016/j.jbmt.2016.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Revised: 05/02/2016] [Accepted: 05/14/2016] [Indexed: 11/26/2022]
Abstract
Stress is one of the most significant causes of major health problems on a global scale. The beneficial effects of exercise on combating stress, however, are well-established. The present study investigated the stress biomarker responses, such as serum corticosterone, interlukin-1β, and glucose levels, to different (preventive, therapeutic, protective, and continuous) protocols of forced exercise under stress. Male rats were randomly allocated to the following five groups: stressed, preventive, therapeutic, protective, and continuous (and/or pre-stress, post-stress, stress-accompanied, and both pre-stress and stress-accompanied exercise respectively) exercise groups. Stress was applied 6 h/day for 21 days and the treadmill running was employed at a speed of 20-21 m/min for 21 and 42 days. The findings showed that the therapeutic, protective, and continuous exercises led to reduced corticosterone and glucose levels. Whereas, the preventive exercise did not reverse the stress responses, and that the therapeutic exercise led to a significant decline in serum interlukin-1β. It is concluded that protective, therapeutic, and, particularly, continuous exercises lead to significant reductions in serum corticosterone and the associated stress-induced hyperglycemia. Moreover, it appears that the timing and duration of exercise are the two factors contributing to changes in stress biomarker responses.
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Affiliation(s)
- Maryam Radahmadi
- Department of Physiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Hojjatallah Alaei
- Department of Physiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Reza Sharifi
- Department of Physiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nasrin Hosseini
- Nursing Care Research Center, Iran University of Medical Sciences, Tehran, Iran
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Sasaki A, Sato N, Suzuki N, Kano M, Tanaka Y, Kanazawa M, Aoki M, Fukudo S. Associations between Single-Nucleotide Polymorphisms in Corticotropin-Releasing Hormone-Related Genes and Irritable Bowel Syndrome. PLoS One 2016; 11:e0149322. [PMID: 26882083 PMCID: PMC4755592 DOI: 10.1371/journal.pone.0149322] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 01/29/2016] [Indexed: 12/31/2022] Open
Abstract
UNLABELLED Irritable bowel syndrome (IBS) is a common functional disorder with distinct features of stress-related pathophysiology. A key mediator of the stress response is corticotropin-releasing hormone (CRH). Although some candidate genes have been identified in stress-related disorders, few studies have examined CRH-related gene polymorphisms. Therefore, we tested our hypothesis that single-nucleotide polymorphisms (SNPs) in CRH-related genes influence the features of IBS. METHODS In total, 253 individuals (123 men and 130 women) participated in this study. They comprised 111 IBS individuals and 142 healthy controls. The SNP genotypes in CRH (rs28364015 and rs6472258) and CRH-binding protein (CRH-BP) (rs10474485) were determined by direct sequencing and real-time polymerase chain reaction. The emotional states of the subjects were evaluated using the State-Trait Anxiety Inventory, Perceived Stress Scale, and the Self-rating Depression Scale. RESULTS Direct sequencing of the rs28364015 SNP of CRH revealed no genetic variation among the study subjects. There was no difference in the genotype distributions and allele frequencies of rs6472258 and rs10474485 between IBS individuals and controls. However, IBS subjects with diarrhea symptoms without the rs10474485 A allele showed a significantly higher emotional state score than carriers. CONCLUSIONS These results suggest that the CRH and CRH-BP genes have no direct effect on IBS status. However, the CRH-BP SNP rs10474485 has some effect on IBS-related emotional abnormalities and resistance to psychosocial stress.
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Affiliation(s)
- Ayaka Sasaki
- Department of Behavioral Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Naoko Sato
- Department of Behavioral Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Naoki Suzuki
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Michiko Kano
- Department of Behavioral Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
- Frontier Research Institute for Interdisciplinary Sciences, Tohoku University, Sendai, Japan
| | - Yukari Tanaka
- Department of Behavioral Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Motoyori Kanazawa
- Department of Behavioral Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masashi Aoki
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shin Fukudo
- Department of Behavioral Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
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Abstract
Post-traumatic stress disorder (PTSD) and sleep-disordered breathing (SDB) are shared by many patients. They both affect sleep and the quality of life of affected subjects. A critical review of the literature supports an association between the two disorders in both combat-related and non-combat-related PTSD. The exact mechanism linking PTSD and SDB is not fully understood. A complex interplay between sleep fragmentation and neuroendocrine pathways is suggested. The overlap of symptoms between PTSD and SDB raises diagnostic challenges that may require a novel approach in the methods used to diagnose the coexisting disorders. Similar therapeutic challenges face patients and providers when treating concomitant PTSD and SDB. Although continuous positive airway pressure therapy imparts a mitigating effect on PTSD symptomatology, lack of both acceptance and adherence are common. Future research should focus on ways to improve adherence to continuous positive airway pressure therapy and on the use of alternative therapeutic methods for treating SDB in patients with PTSD.
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Michopoulos V, Norrholm SD, Jovanovic T. Diagnostic Biomarkers for Posttraumatic Stress Disorder: Promising Horizons from Translational Neuroscience Research. Biol Psychiatry 2015; 78:344-53. [PMID: 25727177 PMCID: PMC4520791 DOI: 10.1016/j.biopsych.2015.01.005] [Citation(s) in RCA: 135] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 01/07/2015] [Accepted: 01/15/2015] [Indexed: 02/07/2023]
Abstract
Posttraumatic stress disorder (PTSD) is a heterogeneous disorder that affects individuals exposed to trauma (e.g., combat, interpersonal violence, and natural disasters). Although its diagnostic features have been recently reclassified with the emergence of the Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition, the disorder remains characterized by hyperarousal, intrusive reminders of the trauma, avoidance of trauma-related cues, and negative cognition and mood. This heterogeneity indicates the presence of multiple neurobiological mechanisms underlying the etiology and maintenance of PTSD. Translational research spanning the past few decades has revealed several potential avenues for the identification of diagnostic biomarkers for PTSD. These include, but are not limited to, monoaminergic transmitter systems, the hypothalamic-pituitary-adrenal axis, metabolic hormonal pathways, inflammatory mechanisms, psychophysiological reactivity, and neural circuits. The current review provides an update to the literature with regard to the most promising putative PTSD biomarkers, with specific emphasis on the interaction between neurobiological influences on disease risk and symptom progression. Such biomarkers will most likely be identified by multi-dimensional models derived from comprehensive descriptions of molecular, neurobiological, behavioral, and clinical phenotypes.
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Affiliation(s)
- Vasiliki Michopoulos
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta; Yerkes National Primate Research Center, Atlanta
| | - Seth Davin Norrholm
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta; Atlanta Veterans Affairs Medical Center, Mental Health Service Line, Decatur, Georgia
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta.
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Wellman LL, Yang L, Sanford LD. Effects of corticotropin releasing factor (CRF) on sleep and temperature following predictable controllable and uncontrollable stress in mice. Front Neurosci 2015; 9:258. [PMID: 26283899 PMCID: PMC4519684 DOI: 10.3389/fnins.2015.00258] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 07/10/2015] [Indexed: 02/05/2023] Open
Abstract
Corticotropin releasing factor (CRF) is a major mediator of central nervous system responses to stressors, including alterations in wakefulness and sleep. However, its role in mediating stress-induced alterations in sleep has not been fully delineated. In this study, we assessed the role of CRF and the non-specific CRF antagonist, astressin (AST), in regulating changes in sleep produced by signaled, escapable shock (SES) and signaled inescapable shock (SIS), two stressors that can increase or decrease sleep, respectively. Male BALB/cJ mice were surgically implanted with transmitters (DataSciences ETA10-F20) for recording EEG, activity and core body temperature by telemetry and a cannula for intracerebroventricular (ICV) microinjections. After baseline (Base) sleep recording, mice were presented tones (90 dB, 2 kHz) that started 5.0 s prior to and co-terminated with footshock (0.5 mA; 5.0 s maximum duration). SES mice (n = 9) always received shock but could terminate it by moving to the non-occupied chamber in a shuttlebox. Yoked SIS mice (n = 9) were treated identically, but could not alter shock duration. Training with SES or SIS was conducted over 2 days to stabilize responses. Afterwards, the mice received saline, CRF [0.4 μg (0.42 mM) or AST (1.0 μg (1.4 mM)] prior to SES or SIS. Sleep was analyzed over 20 h post-stress recordings. After administration of saline, REM was significantly greater in SES mice than in SIS mice whereas after CRF or AST, REM was similar in both groups. Total 20 h NREM did not vary across condition or group. However, after administration of saline and CRF, NREM episode duration was significantly decreased, and NREM episode number significantly increased, in SIS mice compared to SES animals. SES and SIS mice showed similar stress induced hyperthermia (SIH) across all conditions. These data demonstrate that CRF can mediate stress-induced changes in sleep independently of SIH, an index of hypothalamic-pituitary-adrenal axis activation.
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Affiliation(s)
- Laurie L Wellman
- Sleep Research Laboratory, Department of Pathology and Anatomy, Eastern Virginia Medical School Norfolk, VA, USA
| | - Linghui Yang
- West China Hospital of Sichuan University Sichuan, China
| | - Larry D Sanford
- Sleep Research Laboratory, Department of Pathology and Anatomy, Eastern Virginia Medical School Norfolk, VA, USA
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Philbert J, Beeské S, Belzung C, Griebel G. The CRF₁ receptor antagonist SSR125543 prevents stress-induced long-lasting sleep disturbances in a mouse model of PTSD: comparison with paroxetine and d-cycloserine. Behav Brain Res 2014; 279:41-6. [PMID: 25446760 DOI: 10.1016/j.bbr.2014.11.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 10/30/2014] [Accepted: 11/04/2014] [Indexed: 01/02/2023]
Abstract
The selective CRF₁ (corticotropin releasing factor type 1) receptor antagonist SSR125543 has been previously shown to attenuate the long-term behavioral and electrophysiological effects produced by traumatic stress exposure in mice. Sleep disturbances are one of the most commonly reported symptoms by people with post-traumatic stress disorder (PTSD). The present study aims at investigating whether SSR125543 (10 mg/kg/day/i.p. for 2 weeks) is able to attenuate sleep/wakefulness impairment induced by traumatic stress exposure in a model of PTSD in mice using electroencephalographic (EEG) analysis. Effects of SSR125543 were compared to those of the 5-HT reuptake inhibitor, paroxetine (10 mg/kg/day/i.p.), and the partial N-methyl-d-aspartate (NMDA) receptor agonist, d-cycloserine (10 mg/kg/day/i.p.), two compounds which have demonstrated clinical efficacy against PTSD. Baseline EEG recording was performed in the home cage for 6h prior to the application of two electric foot-shocks of 1.5 mA. Drugs were administered from day 1 post-stress to the day preceding the second EEG recording session, performed 14 days later. Results showed that at day 14 post-stress, shocked mice displayed sleep fragmentation as shown by an increase in the occurrence of both non-rapid eye movement (NREM) sleep and wakefulness bouts. The duration of wakefulness, NREM and REM sleep were not significantly affected. The stress-induced effects were prevented by repeated administration of SSR125543, paroxetine and D-cycloserine. These findings confirm further that the CRF₁ receptor antagonist SSR125543 is able to attenuate the deleterious effects of traumatic stress exposure.
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Affiliation(s)
- Julie Philbert
- Sanofi, Translational Sciences Unit, Chilly-Mazarin, France
| | - Sandra Beeské
- Sanofi, Translational Sciences Unit, Chilly-Mazarin, France
| | - Catherine Belzung
- INSERM U-930, Université François Rabelais Tours, UFR Sciences et Techniques, Parc Grandmont, Tours, France
| | - Guy Griebel
- Sanofi, Translational Sciences Unit, Chilly-Mazarin, France.
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Laukova M, Alaluf LG, Serova LI, Arango V, Sabban EL. Early intervention with intranasal NPY prevents single prolonged stress-triggered impairments in hypothalamus and ventral hippocampus in male rats. Endocrinology 2014; 155:3920-33. [PMID: 25057792 DOI: 10.1210/en.2014-1192] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Intranasal administration of neuropeptide Y (NPY) is a promising treatment strategy to reduce traumatic stress-induced neuropsychiatric symptoms of posttraumatic stress disorder (PTSD). We evaluated the potential of intranasal NPY to prevent dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis, a core neuroendocrine feature of PTSD. Rats were exposed to single prolonged stress (SPS), a PTSD animal model, and infused intranasally with vehicle or NPY immediately after SPS stressors. After 7 days undisturbed, hypothalamus and hippocampus, 2 structures regulating the HPA axis activity, were examined for changes in glucocorticoid receptor (GR) and CRH expression. Plasma ACTH and corticosterone, and hypothalamic CRH mRNA, were significantly higher in the vehicle but not NPY-treated group, compared with unstressed controls. Although total GR levels were not altered in hypothalamus, a significant decrease of GR phosphorylated on Ser232 and increased FK506-binding protein 5 mRNA were observed with the vehicle but not in animals infused with intranasal NPY. In contrast, in the ventral hippocampus, only vehicle-treated animals demonstrated elevated GR protein expression and increased GR phosphorylation on Ser232, specifically in the nuclear fraction. Additionally, SPS-induced increase of CRH mRNA in the ventral hippocampus was accompanied by apparent decrease of CRH peptide particularly in the CA3 subfield, both prevented by NPY. The results show that early intervention with intranasal NPY can prevent traumatic stress-triggered dysregulation of the HPA axis likely by restoring HPA axis proper negative feedback inhibition via GR. Thus, intranasal NPY has a potential as a noninvasive therapy to prevent negative effects of traumatic stress.
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Affiliation(s)
- Marcela Laukova
- Department of Biochemistry and Molecular Biology (M.L., L.G.A., L.I.S., E.L.S.), New York Medical College, Valhalla, New York 10595; and Molecular Imaging and Neuropathology Division (V.A.), New York State Psychiatric Institute, New York, New York 10032
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Chester JA, Kirchhoff AM, Barrenha GD. Relation between corticosterone and fear-related behavior in mice selectively bred for high or low alcohol preference. Addict Biol 2014; 19:663-75. [PMID: 23331637 DOI: 10.1111/adb.12034] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Blunted cortisol responses to stress or trauma have been linked with genetic (familial) risk for both alcoholism and post-traumatic stress disorder (PTSD). Mouse lines selectively bred for high (HAP) or low (LAP) alcohol preference may be a relevant model of genetic risk for co-morbid alcoholism and PTSD in humans. HAP mice show greater fear-potentiated startle (FPS), a model used to study PTSD, than LAP mice. The relation between corticosterone (CORT) and FPS behavior was explored in four experiments. Naïve male and female HAP2 and LAP2 mice received fear-conditioning or control treatments, and CORT levels were measured before and immediately after fear-conditioning or FPS testing. In two other experiments, HAP2 mice received CORT (1.0, 5.0 or 10.0 mg/kg) or a glucocorticoid receptor antagonist (mifepristone; 25.0 and 50.0 mg/kg) 30 minutes before fear conditioning. HAP2 mice exposed to fear conditioning and to control foot shock exposures showed lower CORT after the fear-conditioning and FPS testing sessions than LAP2 mice. A trend toward higher FPS was seen in HAP2 mice pretreated with 10.0 mg/kg CORT, and CORT levels were the lowest in this group, suggesting negative feedback inhibition of CORT release. Mifepristone did not alter FPS. Overall, these results are consistent with data in humans and rodents indicating that lower cortisol/CORT levels after stress are associated with PTSD/PTSD-like behavior. These findings in HAP2 and LAP2 mice suggest that a blunted CORT response to stress may be a biological marker for greater susceptibility to develop PTSD in individuals with increased genetic risk for alcoholism.
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Affiliation(s)
- Julia A. Chester
- Department of Psychological Sciences; Purdue University; West Lafayette IN USA
| | - Aaron M. Kirchhoff
- Department of Psychological Sciences; Purdue University; West Lafayette IN USA
| | - Gustavo D. Barrenha
- Department of Psychological Sciences; Purdue University; West Lafayette IN USA
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46
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Neuroscience-driven discovery and development of sleep therapeutics. Pharmacol Ther 2014; 141:300-34. [DOI: 10.1016/j.pharmthera.2013.10.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 10/25/2013] [Indexed: 01/18/2023]
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47
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Connecting the pathology of posttraumatic stress and substance use disorders: monoamines and neuropeptides. Pharmacol Biochem Behav 2013; 117:61-9. [PMID: 24333548 DOI: 10.1016/j.pbb.2013.12.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 11/19/2013] [Accepted: 12/01/2013] [Indexed: 11/23/2022]
Abstract
Posttraumatic stress disorder (PTSD) co-occurs highly with substance use disorders (SUDs), yet the neurobiological basis for this comorbid relationship remains unclear. PTSD and SUDs result in similar pathological states including impulsive behavior, reward deficiency, and heightened stress sensitivity. Hence, PTSD and SUD may depend on overlapping dysfunctional neurocircuitry. Here we provide a short overview of the relationship between comorbid PTSD and SUD, as well as the potential role of select neurotransmitter systems that may underlie enhanced vulnerability to drug abuse in the context of PTSD.
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48
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Van't Veer A, Carlezon WA. Role of kappa-opioid receptors in stress and anxiety-related behavior. Psychopharmacology (Berl) 2013; 229:435-52. [PMID: 23836029 PMCID: PMC3770816 DOI: 10.1007/s00213-013-3195-5] [Citation(s) in RCA: 199] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 06/17/2013] [Indexed: 12/15/2022]
Abstract
RATIONALE Accumulating evidence indicates that brain kappa-opioid receptors (KORs) and dynorphin, the endogenous ligand that binds at these receptors, are involved in regulating states of motivation and emotion. These findings have stimulated interest in the development of KOR-targeted ligands as therapeutic agents. As one example, it has been suggested that KOR antagonists might have a wide range of indications, including the treatment of depressive, anxiety, and addictive disorders, as well as conditions characterized by co-morbidity of these disorders (e.g., post-traumatic stress disorder) A general effect of reducing the impact of stress may explain how KOR antagonists can have efficacy in such a variety of animal models that would appear to represent different disease states. OBJECTIVE Here, we review evidence that disruption of KOR function attenuates prominent effects of stress. We will describe behavioral and molecular endpoints including those from studies that characterize the effects of KOR antagonists and KOR ablation on the effects of stress itself, as well as on the effects of exogenously delivered corticotropin-releasing factor, a brain peptide that mediates key effects of stress. CONCLUSION Collectively, available data suggest that KOR disruption produces anti-stress effects and under some conditions can prevent the development of stress-induced adaptations. As such, KOR antagonists may have unique potential as therapeutic agents for the treatment and even prevention of stress-related psychiatric illness, a therapeutic niche that is currently unfilled.
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MESH Headings
- Animals
- Anti-Anxiety Agents/pharmacology
- Anti-Anxiety Agents/therapeutic use
- Anxiety Disorders/drug therapy
- Anxiety Disorders/metabolism
- Anxiety Disorders/psychology
- Behavior, Animal/drug effects
- Brain/drug effects
- Brain/metabolism
- Brain/physiopathology
- Corticotropin-Releasing Hormone/metabolism
- Dynorphins/genetics
- Dynorphins/metabolism
- Humans
- Ligands
- Receptors, Opioid, kappa/antagonists & inhibitors
- Receptors, Opioid, kappa/genetics
- Receptors, Opioid, kappa/metabolism
- Stress, Psychological/drug therapy
- Stress, Psychological/metabolism
- Stress, Psychological/psychology
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Affiliation(s)
- Ashlee Van't Veer
- Department of Psychiatry, Harvard Medical School, McLean Hospital, MRC 217, 115 Mill Street, Belmont, MA, 02478, USA
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49
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Daskalakis NP, Lehrner A, Yehuda R. Endocrine aspects of post-traumatic stress disorder and implications for diagnosis and treatment. Endocrinol Metab Clin North Am 2013; 42:503-13. [PMID: 24011883 DOI: 10.1016/j.ecl.2013.05.004] [Citation(s) in RCA: 139] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Post-traumatic stress disorder (PTSD) is a serious, multisystem disorder with multiple medical comorbidities. This article reviews the current literature on the endocrine aspects of PTSD, specifically hypothalamic-pituitary-adrenal axis alterations indicative of low cortisol and increased glucocorticoid sensitivity, and the proposed mechanisms whereby these alterations increase risk or reflect pathophysiology. Discussion includes novel treatment innovations and directions for future research.
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Affiliation(s)
- Nikolaos P Daskalakis
- Traumatic Stress Studies Division, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029-6574, USA.
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50
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Borelli KG, Albrechet-Souza L, Fedoce AG, Fabri DS, Resstel LB, Brandão ML. Conditioned fear is modulated by CRF mechanisms in the periaqueductal gray columns. Horm Behav 2013; 63:791-9. [PMID: 23603480 DOI: 10.1016/j.yhbeh.2013.04.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Revised: 04/05/2013] [Accepted: 04/10/2013] [Indexed: 12/27/2022]
Abstract
The periaqueductal gray (PAG) columns have been implicated in controlling stress responses through corticotropin-releasing factor (CRF), which is a neuropeptide with a prominent role in the etiology of fear- and anxiety-related psychopathologies. Several studies have investigated the involvement of dorsal PAG (dPAG) CRF mechanisms in models of unconditioned fear. However, less is known about the role of this neurotransmission in the expression of conditioned fear memories in the dPAG and ventrolateral PAG (vlPAG) columns. We assessed the effects of ovine CRF (oCRF 0.25 and 1.0 μg/0.2 μL) locally administered into the dPAG and vlPAG on behavioral (fear-potentiated startle and freezing) and autonomic (arterial pressure and heart rate) responses in rats subjected to contextual fear conditioning. The lower dose injected into the columns promoted proaversive effects, enhanced contextual freezing, increased the blood pressure and heart rate and decreased tail temperature. The lower dose of oCRF into the vlPAG, but not into the dPAG, produced a pronounced enhancement of the fear-potentiated startle response. The results imply that the PAG is a heterogeneous structure that is involved in the coordination of distinct behaviors and autonomic control, suggest PAG involvement in the expression of contextual fear memory as well as implicate the CRF as an important modulator of the neural substrates of fear in the PAG.
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Affiliation(s)
- Karina G Borelli
- Instituto de Neurociências e Comportamento, Ribeirão Preto, SP, Brazil.
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