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Morrison M, Pettus C, Drake B, Roth K, Renn T. Trauma and Incarceration: A Latent Class Analysis of Lifetime Trauma Exposures for Individuals in Prison. J Trauma Dissociation 2024; 25:168-184. [PMID: 38083864 DOI: 10.1080/15299732.2023.2289189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 06/12/2023] [Indexed: 01/30/2024]
Abstract
This paper aims to contribute to the knowledge base about the lives of individuals who experience incarceration in the U.S. in order to advance post-release intervention services. Research has shown that among the millions of Americans who cycle through prisons and jails each year, the majority are poor, in poor health, living in contexts of chronic violence, often with mental illness, and more than half are people of color. Of particular concern for this population are high rates of trauma exposure and PTSD, though the research in this area is underdeveloped, particularly for men. Using survey data gathered during a large (n = 1,516, 90% male) multi-state randomized control trial of a reentry intervention, this study used latent class analysis (LCA) to explore types and timing of trauma exposures across the life course. LCA has been found to be an effective statistical tool in intervention research for identifying high-risk groups and for informing the tailoring of interventions. This study found three latent classes: 1) Lifetime Interpersonal Polyvictimization, 2) Lifetime Environmental Exposures, and 3) Low Exposure. About one third of the sample fell within each class. Study findings indicate that not only should trauma-informed and trauma-specific interventions be the norm in reentry services, including for men, but that these interventions should target both individual and environmental factors.
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Affiliation(s)
- Maria Morrison
- School of Social Work, Saint Louis University, St. Louis, MO, USA
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2
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Montgomery KR, Bridi MS, Folts LM, Marx-Rattner R, Zierden HC, Wulff AB, Kodjo EA, Thompson SM, Bale TL. Chemogenetic activation of CRF neurons as a model of chronic stress produces sex-specific physiological and behavioral effects. Neuropsychopharmacology 2024; 49:443-454. [PMID: 37833589 PMCID: PMC10724197 DOI: 10.1038/s41386-023-01739-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/29/2023] [Accepted: 09/07/2023] [Indexed: 10/15/2023]
Abstract
Trauma and chronic stress exposure are the strongest predictors of lifetime neuropsychiatric disease presentation. These disorders often have significant sex biases, with females having higher incidences of affective disorders such as major depression, anxiety, and PTSD. Understanding the mechanisms by which stress exposure heightens disease vulnerability is essential for developing novel interventions. Current rodent stress models consist of a battery of sensory, homeostatic, and psychological stressors that are ultimately integrated by corticotropin-releasing factor (CRF) neurons to trigger corticosteroid release. These stress paradigms, however, often differ between research groups in the type, timing, and duration of stressors utilized. These inconsistencies, along with the variability of individual animals' perception and response to each stressor, present challenges for reproducibility and translational relevance. Here, we hypothesized that a more direct approach using chemogenetic activation of CRF neurons would recapitulate the effects of traditional stress paradigms and provide a high-throughput method for examining stress-relevant phenotypes. Using a transgenic approach to express the Gq-coupled Designer Receptor Exclusively Activated by Designer Drugs (DREADD) receptor hM3Dq in CRF-neurons, we found that the DREADD ligand clozapine-N-oxide (CNO) produced an acute and robust activation of the hypothalamic-pituitary-adrenal (HPA) axis, as predicted. Interestingly, chronic treatment with this method of direct CRF activation uncovered a novel sex-specific dissociation of glucocorticoid levels with stress-related outcomes. Despite hM3Dq-expressing females producing greater corticosterone levels in response to CNO than males, hM3Dq-expressing males showed significant typical physiological stress sensitivity with reductions in body and thymus weights. hM3Dq-expressing females while resistant to the physiological effects of chronic CRF activation, showed significant increases in baseline and fear-conditioned freezing behaviors. These data establish a novel mouse model for interrogating stress-relevant phenotypes and highlight sex-specific stress circuitry distinct for physiological and limbic control that may underlie disease risk.
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Affiliation(s)
- Kristen R Montgomery
- Department of Pharmacology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
- Center for Epigenetic Research in Child Health and Brain Development, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
- Neuroscience Graduate Program, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Morgan S Bridi
- Department of Pharmacology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
- Center for Epigenetic Research in Child Health and Brain Development, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Lillian M Folts
- Department of Pharmacology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
- Center for Epigenetic Research in Child Health and Brain Development, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Ruth Marx-Rattner
- Department of Pharmacology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
- Center for Epigenetic Research in Child Health and Brain Development, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Hannah C Zierden
- Department of Pharmacology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
- Center for Epigenetic Research in Child Health and Brain Development, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Andreas B Wulff
- Department of Physiology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Emmanuela A Kodjo
- Department of Physiology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Scott M Thompson
- Department of Physiology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Tracy L Bale
- Department of Pharmacology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.
- Center for Epigenetic Research in Child Health and Brain Development, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA.
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On making (and turning adaptive to) maladaptive aversive memories in laboratory rodents. Neurosci Biobehav Rev 2023; 147:105101. [PMID: 36804263 DOI: 10.1016/j.neubiorev.2023.105101] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 02/03/2023] [Accepted: 02/14/2023] [Indexed: 02/18/2023]
Abstract
Fear conditioning and avoidance tasks usually elicit adaptive aversive memories. Traumatic memories are more intense, generalized, inflexible, and resistant to attenuation via extinction- and reconsolidation-based strategies. Inducing and assessing these dysfunctional, maladaptive features in the laboratory are crucial to interrogating posttraumatic stress disorder's neurobiology and exploring innovative treatments. Here we analyze over 350 studies addressing this question in adult rats and mice. There is a growing interest in modeling several qualitative and quantitative memory changes by exposing already stressed animals to freezing- and avoidance-related tests or using a relatively high aversive training magnitude. Other options combine aversive/fearful tasks with post-acquisition or post-retrieval administration of one or more drugs provoking neurochemical or epigenetic alterations reported in the trauma aftermath. It is potentially instructive to integrate these procedures and incorporate the measurement of autonomic and endocrine parameters. Factors to consider when defining the organismic and procedural variables, partially neglected aspects (sex-dependent differences and recent vs. remote data comparison) and suggestions for future research (identifying reliable individual risk and treatment-response predictors) are discussed.
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Occean JR, Wani AH, Donglasan J, Aiello AE, Galea S, Koenen KC, Qu A, Wildman DE, Uddin M. DNA methylation of Nuclear Factor of Activated T Cells 1 mediates the prospective relation between exposure to different traumatic event types and post-traumatic stress disorder. Psychiatry Res 2022; 311:114510. [PMID: 35349860 PMCID: PMC9018623 DOI: 10.1016/j.psychres.2022.114510] [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: 09/07/2021] [Revised: 02/26/2022] [Accepted: 03/12/2022] [Indexed: 11/25/2022]
Abstract
The mechanisms through which exposure to differing trauma types become biologically embedded to shape the risk for post-traumatic stress disorder (PTSD) is unclear. DNA methylation (5-mC), particularly in stress-relevant genes, may play a role in this relationship. Here, we conducted path analysis using generalized structural equation modeling to investigate whether blood-derived 5-mC in Nuclear Factor of Activated T Cells 1 (NFATC1) mediates the prospective association between each of five different trauma types ("assaultive violence", "other injury or shocking experience", "learning of trauma to loved one", "sudden, unexpected death of a close friend or relative", and "other") and lifetime PTSD. All five trauma types were significantly associated with reduced methylation at NFATC1 CpG site, cg17057218. Two of the five trauma types were significantly associated with increased methylation at NFATC1 CpG site, cg22324981. Moreover, methylation at cg17057218 significantly mediated 21-32% of the total effect for four of the five trauma types, while methylation at cg22324981 mediated 27-40% of the total effect for two of the five trauma types. These CpG sites were differentially associated with transcription factor binding sites and chromatin state signatures. NFATC1 5-mC may be a potential mechanism in the relationship between some trauma types and prospective risk for PTSD.
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Affiliation(s)
- James R. Occean
- Genomics Program, College of Public Health, University of South Florida, Tampa, FL, USA,Present address: Laboratory of Genetics and Genomics, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
| | - Agaz H. Wani
- Genomics Program, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Janelle Donglasan
- Genomics Program, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Allison E. Aiello
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sandro Galea
- Boston University School of Public Health, Boston University, Boston, MA, USA
| | - Karestan C. Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA,Psychiatric and Neurodevelopmental Genetics Unit & Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Annie Qu
- Department of Statistics, University of California Irvine, Irvine, CA, USA
| | - Derek E. Wildman
- Genomics Program, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Monica Uddin
- Genomics Program, College of Public Health, University of South Florida, Tampa, FL, USA.
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Erickson SJ, Dinces S, Kubinec N, Annett RD. Pediatric Cancer Survivorship: Impact Upon Hair Cortisol Concentration and Family Functioning. J Clin Psychol Med Settings 2022; 29:943-953. [PMID: 35150359 DOI: 10.1007/s10880-022-09858-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2022] [Indexed: 12/30/2022]
Abstract
A clearer understanding of the association between a biomarker of long-term stress reactivity and family functioning among pediatric cancer survivors may guide both survivorship research and clinical practice. The current study examined the relationship between a long-term measure of hypothalamic-pituitary-adrenal (HPA) activity (cortisol concentration; CORTHAIR) and parent-reported family functioning (Family Environment Scale; FES) in a cross-sectional sample of survivors (n = 26) and controls (n = 53). Child CORTHAIR was not different in survivors and controls, though treatment severity was significantly related to child survivor CORTHAIR. Child CORTHAIR and parent CORTHAIR were positively correlated. Cancer survivor parents reported greater FES Organization. Child CORTHAIR was inversely associated with FES Independence, while parent CORTHAIR was inversely correlated with FES Organization. Parent CORTHAIR and FES Independence were significant and unique predictors of child CORTHAIR. Our results provide preliminary evidence for a relationship between a stress biomarker, child CORTHAIR, and family functioning among pediatric cancer survivors and controls.
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Affiliation(s)
- Sarah J Erickson
- Department of Psychology, Logan Hall, University of New Mexico, MSC03 2220, Albuquerque, NM, 87131, USA.
| | | | - Nicole Kubinec
- Department of Psychology, Logan Hall, University of New Mexico, MSC03 2220, Albuquerque, NM, 87131, USA
| | - Robert D Annett
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS, USA
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Wang H, van Leeuwen JMC, de Voogd LD, Verkes RJ, Roozendaal B, Fernández G, Hermans EJ. Mild early-life stress exaggerates the impact of acute stress on corticolimbic resting-state functional connectivity. Eur J Neurosci 2021; 55:2122-2141. [PMID: 34812558 PMCID: PMC9299814 DOI: 10.1111/ejn.15538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 11/15/2021] [Indexed: 01/09/2023]
Abstract
Abundant evidence shows that early‐life stress (ELS) predisposes for the development of stress‐related psychopathology when exposed to stressors later in life, but the underlying mechanisms remain unclear. To study predisposing effects of mild ELS on stress sensitivity, we examined in a healthy human population the impact of a history of ELS on acute stress‐related changes in corticolimbic circuits involved in emotional processing (i.e., amygdala, hippocampus and ventromedial prefrontal cortex [vmPFC]). Healthy young male participants (n = 120) underwent resting‐state functional magnetic resonance imaging (fMRI) in two separate sessions (stress induction vs. control). The Childhood Trauma Questionnaire (CTQ) was administered to index self‐reported ELS, and stress induction was verified using salivary cortisol, blood pressure, heart rate and subjective affect. Our findings show that self‐reported ELS was negatively associated with baseline cortisol, but not with the acute stress‐induced cortisol response. Critically, individuals with more self‐reported ELS exhibited an exaggerated reduction of functional connectivity in corticolimbic circuits under acute stress. A mediation analysis showed that the association between ELS and stress‐induced changes in amygdala–hippocampal connectivity became stronger when controlling for basal cortisol. Our findings show, in a healthy sample, that the effects of mild ELS on functioning of corticolimbic circuits only become apparent when exposed to an acute stressor and may be buffered by adaptations in hypothalamic–pituitary–adrenal axis function. Overall, our findings might reveal a potential mechanism whereby even mild ELS might confer vulnerability to exposure to stressors later in adulthood.
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Affiliation(s)
- Huan Wang
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Radboud University, Nijmegen, The Netherlands
| | - Judith M C van Leeuwen
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Radboud University, Nijmegen, The Netherlands
| | - Lycia D de Voogd
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Radboud University, Nijmegen, The Netherlands
| | - Robbert-Jan Verkes
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Radboud University, Nijmegen, The Netherlands
| | - Benno Roozendaal
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Radboud University, Nijmegen, The Netherlands
| | - Guillén Fernández
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Radboud University, Nijmegen, The Netherlands
| | - Erno J Hermans
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Radboud University, Nijmegen, The Netherlands
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Gazarini L, Stern CA, Takahashi RN, Bertoglio LJ. Interactions of Noradrenergic, Glucocorticoid and Endocannabinoid Systems Intensify and Generalize Fear Memory Traces. Neuroscience 2021; 497:118-133. [PMID: 34560200 DOI: 10.1016/j.neuroscience.2021.09.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 09/09/2021] [Accepted: 09/13/2021] [Indexed: 12/13/2022]
Abstract
Systemic administration of drugs that activate the noradrenergic or glucocorticoid system potentiates aversive memory consolidation and reconsolidation. The opposite happens with the stimulation of endocannabinoid signaling under certain conditions. An unbalance of these interacting neurotransmitters can lead to the formation and maintenance of traumatic memories, whose strength and specificity attributes are often maladaptive. Here we aimed to investigate whether originally low-intensity and precise contextual fear memories would turn similar to traumatic ones in rats systemically administered with adrenaline, corticosterone, and/or the cannabinoid type-1 receptor antagonist/inverse agonist AM251 during consolidation or reconsolidation. The high dose of each pharmacological agent evaluated significantly increased freezing times at test in the conditioning context one and nine days later when given alone post-acquisition or post-retrieval. Their respective low dose produced no relative changes when given separately, but co-treatment of adrenaline with corticosterone or AM251 and the three drugs combined, but not corticosterone with AM251, produced results equivalent to those mentioned initially. Neither the high nor the low dose of adrenaline, corticosterone, or AM251 altered freezing times at test in a novel, neutral context two and ten days later. In contrast, animals receiving the association of their low dose exhibited significantly higher freezing times than controls. Together, the results indicate that newly acquired and destabilized threat memory traces become more intense and generalized after a combined interference acting synergistically and mimicking that reported in patients presenting stress-related psychiatric conditions.
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Affiliation(s)
- Lucas Gazarini
- Departamento de Farmacologia, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil; Universidade Federal de Mato Grosso do Sul, Três Lagoas, MS, Brazil.
| | - Cristina A Stern
- Departamento de Farmacologia, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil; Departamento de Farmacologia, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | - Reinaldo N Takahashi
- Departamento de Farmacologia, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Leandro J Bertoglio
- Departamento de Farmacologia, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil.
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Filatova EV, Shadrina MI, Slominsky PA. Major Depression: One Brain, One Disease, One Set of Intertwined Processes. Cells 2021; 10:cells10061283. [PMID: 34064233 PMCID: PMC8224372 DOI: 10.3390/cells10061283] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/17/2021] [Accepted: 05/19/2021] [Indexed: 01/18/2023] Open
Abstract
Major depressive disorder (MDD) is a heterogeneous disease affecting one out of five individuals and is the leading cause of disability worldwide. Presently, MDD is considered a multifactorial disease with various causes such as genetic susceptibility, stress, and other pathological processes. Multiple studies allowed the formulation of several theories attempting to describe the development of MDD. However, none of these hypotheses are comprehensive because none of them can explain all cases, mechanisms, and symptoms of MDD. Nevertheless, all of these theories share some common pathways, which lead us to believe that these hypotheses depict several pieces of the same big puzzle. Therefore, in this review, we provide a brief description of these theories and their strengths and weaknesses in an attempt to highlight the common mechanisms and relationships of all major theories of depression and combine them together to present the current overall picture. The analysis of all hypotheses suggests that there is interdependence between all the brain structures and various substances involved in the pathogenesis of MDD, which could be not entirely universal, but can affect all of the brain regions, to one degree or another, depending on the triggering factor, which, in turn, could explain the different subtypes of MDD.
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Wani AH, Aiello AE, Kim GS, Xue F, Martin CL, Ratanatharathorn A, Qu A, Koenen K, Galea S, Wildman DE, Uddin M. The impact of psychopathology, social adversity and stress-relevant DNA methylation on prospective risk for post-traumatic stress: A machine learning approach. J Affect Disord 2021; 282:894-905. [PMID: 33601733 PMCID: PMC7942200 DOI: 10.1016/j.jad.2020.12.076] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/18/2020] [Accepted: 12/21/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND A range of factors have been identified that contribute to greater incidence, severity, and prolonged course of post-traumatic stress disorder (PTSD), including: comorbid and/or prior psychopathology; social adversity such as low socioeconomic position, perceived discrimination, and isolation; and biological factors such as genomic variation at glucocorticoid receptor regulatory network (GRRN) genes. This complex etiology and clinical course make identification of people at higher risk of PTSD challenging. Here we leverage machine learning (ML) approaches to identify a core set of factors that may together predispose persons to PTSD. METHODS We used multiple ML approaches to assess the relationship among DNA methylation (DNAm) at GRRN genes, prior psychopathology, social adversity, and prospective risk for PTS severity (PTSS). RESULTS ML models predicted prospective risk of PTSS with high accuracy. The Gradient Boost approach was the top-performing model with mean absolute error of 0.135, mean square error of 0.047, root mean square error of 0.217, and R2 of 95.29%. Prior PTSS ranked highest in predicting the prospective risk of PTSS, accounting for >88% of the prediction. The top ranked GRRN CpG site was cg05616442, in AKT1, and the top ranked social adversity feature was loneliness. CONCLUSION Multiple factors including prior PTSS, social adversity, and DNAm play a role in predicting prospective risk of PTSS. ML models identified factors accounting for increased PTSS risk with high accuracy, which may help to target risk factors that reduce the likelihood or course of PTSD, potentially pointing to approaches that can lead to early intervention. LIMITATION One of the limitations of this study is small sample size.
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Affiliation(s)
- Agaz H Wani
- Genomics Program, College of Public Health, University of South Florida, Tampa, FL, United States
| | - Allison E Aiello
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill and Carolina Population Center, University of North Carolina at Chapel Hill, United States
| | - Grace S Kim
- Medical Scholars Program, University of Illinois College of Medicine, United States
| | - Fei Xue
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, United States
| | - Chantel L Martin
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill and Carolina Population Center, University of North Carolina at Chapel Hill, United States
| | | | - Annie Qu
- Department of Statistics, University of California Irvine, United States
| | - Karestan Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, United States; Psychiatric and Neurodevelopmental Genetics Unit & Department of Psychiatry, Massachusetts General Hospital, United States
| | - Sandro Galea
- Boston University School of Public Health, United States
| | - Derek E Wildman
- Genomics Program, College of Public Health, University of South Florida, Tampa, FL, United States
| | - Monica Uddin
- Genomics Program, College of Public Health, University of South Florida, Tampa, FL, United States.
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Cannabis use and posttraumatic stress disorder comorbidity: Epidemiology, biology and the potential for novel treatment approaches. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2021; 157:143-193. [PMID: 33648669 DOI: 10.1016/bs.irn.2020.09.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Cannabis use is increasing among some demographics in the United States and is tightly linked to anxiety, trauma, and stress reactivity at the epidemiological and biological level. Stress-coping motives are highly cited reasons for cannabis use. However, with increased cannabis use comes the increased susceptibility for cannabis use disorder (CUD). Indeed, CUD is highly comorbid with posttraumatic stress disorder (PTSD). Importantly, endogenous cannabinoid signaling systems play a key role in the regulation of stress reactivity and anxiety regulation, and preclinical data suggest deficiencies in this signaling system could contribute to the development of stress-related psychopathology. Furthermore, endocannabinoid deficiency states, either pre-existing or induced by trauma exposure, could provide explanatory insights into the high rates of comorbid cannabis use in patients with PTSD. Here we review clinical and preclinical literature related to the cannabis use-PTSD comorbidity, the role of endocannabinoids in the regulation of stress reactivity, and potential therapeutic implications of recent work in this area.
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11
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Allende S, Medina JL, Spiegel D, Zeitzer JM. Evening salivary cortisol as a single stress marker in women with metastatic breast cancer. Psychoneuroendocrinology 2020; 115:104648. [PMID: 32171899 DOI: 10.1016/j.psyneuen.2020.104648] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 03/03/2020] [Accepted: 03/04/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Flattened diurnal salivary cortisol patterns predict shorter subsequent survival with breast, lung, and renal cell carcinomas. The underlying cause of this flattened slope is undetermined, though it has been hypothesized to be secondary to a deficit in the amplitude of the circadian clock. To gain greater insight into the portions of the diurnal salivary curve that are associated with cancer survival, we examined (1) which points in the diurnal curve are predictive of the slope of the curve and (2) whether elevated evening cortisol levels alone are associated with reduced HPA-axis feedback inhibition (i.e., decreased sensitivity to the dexamethasone suppression test). METHOD We examined study hypotheses on adult women with advanced breast cancer (age = 54.3 ± 9.58 years; n = 99) using non-parametric Wilcoxon's rank-sum tests, Spearman correlation coefficients and an accuracy formula based on a confusion matrix. Cortisol was sampled five times per day for three consecutive days, with dexamethasone administered late on the second day. RESULTS Salivary cortisol concentrations did not vary between those with flat and steep slopes during the morning (p's > .05), but did vary in the evening (p's < 0.05). Furthermore, the concentration of the 2100h alone was 86% accurate in discriminating between individuals classified as having "flat" or "steep" slopes. Dexamethasone suppression was only associated with diurnal salivary cortisol slope (p = .0042). CONCLUSIONS Evening cortisol levels are a sensitive indicator flattened diurnal cortisol slope, suggesting evening cortisol may also be a useful predictor of breast cancer survival. Future research should focus on determining the causes of abnormally increased evening cortisol.
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Affiliation(s)
- Santiago Allende
- PGSP-Stanford Psy.D. Consortium, Palo Alto University, 1791 Arastradero Road, Palo Alto, CA 94304, United States.
| | - Johnna L Medina
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road Stanford, CA 94305-5717, United States
| | - David Spiegel
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road Stanford, CA 94305-5717, United States
| | - Jamie M Zeitzer
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road Stanford, CA 94305-5717, United States
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12
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Sbarski B, Akirav I. Cannabinoids as therapeutics for PTSD. Pharmacol Ther 2020; 211:107551. [PMID: 32311373 DOI: 10.1016/j.pharmthera.2020.107551] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 03/08/2020] [Indexed: 02/09/2023]
Abstract
Post-traumatic stress disorder (PTSD) is a complex disorder that involves dysregulation of multiple neurobiological systems. The traumatic stressor plays a causal role in producing psychological dysfunction and the pattern of findings suggests that the hypothalamic-pituitary-adrenal (HPA) axis, which is instrumental for stress adaptation, is critically dysfunctional in PTSD. Given the lack of understanding of the basic mechanisms and underlying pathways that cause the disorder and its heterogeneity, PTSD poses challenges for treatment. Targeting the endocannabinoid (ECB) system to treat mental disorders, and PTSD in particular, has been the focus of research and interest in recent years. The ECB system modulates multiple functions, and drugs enhancing ECB signaling have shown promise as potential therapeutic agents in stress effects and other psychiatric and medical conditions. In this review, we focus on the interaction between the ECB-HPA systems in animal models for PTSD and in patients with PTSD. We summarize evidence supporting the use of cannabinoids in preventing and treating PTSD in preclinical and clinical studies. As the HPA system plays a key role in the mediation of the stress response and the pathophysiology of PTSD, we describe preclinical studies suggesting that enhancing ECB signaling is consistent with decreasing PTSD symptoms and dysfunction of the HPA axis. Overall, we suggest that a pharmacological treatment targeted at one system (e.g., HPA) may not be very effective because of the heterogeneity of the disorder. There are abnormalities across different neurotransmitter systems in the pathophysiology of PTSD and none of these systems function uniformly among all patients with PTSD. Hence, conceptually, enhancing ECB signaling may be a more effective avenue for pharmacological treatment.
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Affiliation(s)
- Brenda Sbarski
- School of Psychological Sciences, Integrated Brain and Behavior Research Center, University of Haifa, Haifa 3498838, Israel
| | - Irit Akirav
- School of Psychological Sciences, Integrated Brain and Behavior Research Center, University of Haifa, Haifa 3498838, Israel.
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13
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Flux MC, Lowry CA. Finding intestinal fortitude: Integrating the microbiome into a holistic view of depression mechanisms, treatment, and resilience. Neurobiol Dis 2020; 135:104578. [PMID: 31454550 PMCID: PMC6995775 DOI: 10.1016/j.nbd.2019.104578] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 06/27/2019] [Accepted: 08/14/2019] [Indexed: 02/07/2023] Open
Abstract
Depression affects at least 322 million people globally, or approximately 4.4% of the world's population. While the earnestness of researchers and clinicians to understand and treat depression is not waning, the number of individuals suffering from depression continues to increase over and above the rate of global population growth. There is a sincere need for a paradigm shift. Research in the past decade is beginning to take a more holistic approach to understanding depression etiology and treatment, integrating multiple body systems into whole-body conceptualizations of this mental health affliction. Evidence supports the hypothesis that the gut microbiome, or the collective trillions of microbes inhabiting the gastrointestinal tract, is an important factor determining both the risk of development of depression and persistence of depressive symptoms. This review discusses recent advances in both rodent and human research that explore bidirectional communication between the gut microbiome and the immune, endocrine, and central nervous systems implicated in the etiology and pathophysiology of depression. Through interactions with circulating inflammatory markers and hormones, afferent and efferent neural systems, and other, more niche, pathways, the gut microbiome can affect behavior to facilitate the development of depression, exacerbate current symptoms, or contribute to treatment and resilience. While the challenge of depression may be the direst mental health crisis of our age, new discoveries in the gut microbiome, when integrated into a holistic perspective, hold great promise for the future of positive mental health.
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Affiliation(s)
- M C Flux
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO 80309, USA.
| | - Christopher A Lowry
- Department of Integrative Physiology, Center for Neuroscience, and Center for Microbial Exploration, University of Colorado Boulder, Boulder, CO 80309, USA; Department of Physical Medicine & Rehabilitation and Center for Neuroscience, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; Veterans Health Administration, Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional Veterans Affairs Medical Center (RMRVAMC), Aurora, CO 80045, USA; Military and Veteran Microbiome: Consortium for Research and Education (MVM-CoRE), Aurora, CO 80045, USA; Senior Fellow, VIVO Planetary Health, Worldwide Universities Network (WUN), West New York, NJ 07093, USA.
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14
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Bhattacharya S, Fontaine A, MacCallum PE, Drover J, Blundell J. Stress Across Generations: DNA Methylation as a Potential Mechanism Underlying Intergenerational Effects of Stress in Both Post-traumatic Stress Disorder and Pre-clinical Predator Stress Rodent Models. Front Behav Neurosci 2019; 13:113. [PMID: 31191267 PMCID: PMC6547031 DOI: 10.3389/fnbeh.2019.00113] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 05/07/2019] [Indexed: 12/12/2022] Open
Abstract
Although most humans will experience some type of traumatic event in their lifetime only a small set of individuals will go on to develop post-traumatic stress disorder (PTSD). Differences in sex, age, trauma type, and comorbidity, along with many other elements, contribute to the heterogenous manifestation of this disorder. Nonetheless, aberrant hypothalamus-pituitary-adrenal (HPA) axis activity, especially in terms of cortisol and glucocorticoid receptor (GR) alterations, has been postulated as a tenable factor in the etiology and pathophysiology of PTSD. Moreover, emerging data suggests that the harmful effects of traumatic stress to the HPA axis in PTSD can also propagate into future generations, making offspring more prone to psychopathologies. Predator stress models provide an ethical and ethologically relevant way to investigate tentative mechanisms that are thought to underlie this phenomenon. In this review article, we discuss findings from human and laboratory predator stress studies that suggest changes to DNA methylation germane to GRs may underlie the generational effects of trauma transmission. Understanding mechanisms that promote stress-induced psychopathology will represent a major advance in the field and may lead to novel treatments for such devastating, and often treatment-resistant trauma and stress-disorders.
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Affiliation(s)
- Sriya Bhattacharya
- Department of Psychology, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Audrey Fontaine
- Department of Psychology, Memorial University of Newfoundland, St. John's, NL, Canada.,Institut des Systèmes Intelligents et de Robotique (ISIR), Université Pierre et Marie Curie, Sorbonne Universités, Paris, France
| | - Phillip E MacCallum
- Department of Psychology, Memorial University of Newfoundland, St. John's, NL, Canada
| | - James Drover
- Department of Psychology, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Jacqueline Blundell
- Department of Psychology, Memorial University of Newfoundland, St. John's, NL, Canada
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15
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Salminen LE, Morey RA, Riedel BC, Jahanshad N, Dennis EL, Thompson PM. Adaptive Identification of Cortical and Subcortical Imaging Markers of Early Life Stress and Posttraumatic Stress Disorder. J Neuroimaging 2019; 29:335-343. [PMID: 30714246 PMCID: PMC6571150 DOI: 10.1111/jon.12600] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 01/13/2019] [Accepted: 01/16/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND PURPOSE Posttraumatic stress disorder (PTSD) is a heterogeneous condition associated with a range of brain imaging abnormalities. Early life stress (ELS) contributes to this heterogeneity, but we do not know how a history of ELS influences traditionally defined brain signatures of PTSD. Here, we used a novel machine learning method - evolving partitions to improve classification (EPIC) - to identify shared and unique structural neuroimaging markers of ELS and PTSD in 97 combat-exposed military veterans. METHODS We used EPIC with repeated cross-validation (CV) to determine how combinations of cortical thickness, surface area, and subcortical brain volumes could contribute to classification of PTSD (n = 40) versus controls (n = 57), and classification of ELS within the PTSD (ELS+ n = 16; ELS- n = 24) and control groups (ELS+ n = 16; ELS- n = 41). Additional inputs included intracranial volume, age, sex, adult trauma, and depression. RESULTS On average, EPIC classified PTSD with 69% accuracy (SD = 5%), and ELS with 64% accuracy in the PTSD group (SD = 10%), and 62% accuracy in controls (SD = 6%). EPIC selected unique sets of individual features that classified each group with 75-85% accuracy in post hoc analyses; combinations of regions marginally improved classification from the individual atlas-defined brain regions. Across analyses, surface area in the right posterior cingulate was the only variable that was repeatedly selected as an important feature for classification of PTSD and ELS. CONCLUSIONS EPIC revealed unique patterns of features that distinguished PTSD and ELS in this sample of combat-exposed military veterans, which may represent distinct biotypes of stress-related neuropathology.
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Affiliation(s)
- Lauren E Salminen
- Imaging Genetics Center of the Mark and Mary Stevens Institute for Neuroimaging & Informatics, Keck School of Medicine, University of Southern California, Marina del Rey, CA
| | - Rajendra A Morey
- Durham VA Medical Center, Durham, NC
- Duke University Medical Center, Durham, NC
| | - Brandalyn C Riedel
- Imaging Genetics Center of the Mark and Mary Stevens Institute for Neuroimaging & Informatics, Keck School of Medicine, University of Southern California, Marina del Rey, CA
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN
| | - Neda Jahanshad
- Imaging Genetics Center of the Mark and Mary Stevens Institute for Neuroimaging & Informatics, Keck School of Medicine, University of Southern California, Marina del Rey, CA
| | - Emily L Dennis
- Imaging Genetics Center of the Mark and Mary Stevens Institute for Neuroimaging & Informatics, Keck School of Medicine, University of Southern California, Marina del Rey, CA
- Psychiatry Neuroimaging Laboratory, Harvard Medical School, Boston, MA
- Stanford Neurodevelopment, Affect, and Psychopathology Laboratory, Stanford, CA
| | - Paul M Thompson
- Imaging Genetics Center of the Mark and Mary Stevens Institute for Neuroimaging & Informatics, Keck School of Medicine, University of Southern California, Marina del Rey, CA
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16
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Abstract
This review examines the putative link between glucocorticoid and hippocampal abnormalities in posttraumatic stress disorder (PTSD). Increased glucocorticoid receptor (GR) sensitivity in PTSD may permit enhanced negative feedback inhibition of cortisol at the pituitary, hypothalamus, or other brain regions comprising the hypothalamic-pituitary-adrenal (HPA) axis and would be expected to affect other physiological systems that are regulated by glucocorticoids. Molecular and transcriptional studies of cortisol are consistent with the hypothesis that cortisol actions may be amplified in PTSD as a result of enhanced GR sensitivity in monocytes and some brain regions, although cortisol levels themselves are unchanged and oftentimes lower than normal. Concurrently, magnetic resonance imaging studies have demonstrated that individuals with PTSD have smaller hippocampal volume than individuals without PTSD. Initial hypotheses regarding the mechanism underlying hippocampal alterations in PTSD focused on elevated glucocorticoid levels in combination with extreme stress as the primary cause, but this explanation has not been well supported in human studies. Lack of data from neuroimaging studies preclude a firm link between PTSD onset and hippocampal volume changes. Rather, the available evidence is consistent with the possibility that smaller hippocampal volume (like reduced cortisol levels and enhanced GR sensitivity) may be a vulnerability factor for developing the disorder; limitations of hippocampal-based models of PTSD are described. We further review neuroimaging studies examining hippocampal structure and function following manipulation of glucocorticoid levels and also examining changes in the hippocampus in relationship to other brain regions. Evidence that the GR may be an important therapeutic target for the treatment of PTSD, especially for functions subserved by the hippocampus, is discussed. Implications of the current review for future research are described, with an emphasis on the need to integrate findings of glucocorticoid abnormalities with functional-imaging paradigms to formulate a comprehensive model of HPA-axis functioning in PTSD.
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17
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Morrison FG, Miller MW, Logue MW, Assef M, Wolf EJ. DNA methylation correlates of PTSD: Recent findings and technical challenges. Prog Neuropsychopharmacol Biol Psychiatry 2019; 90:223-234. [PMID: 30503303 PMCID: PMC6314898 DOI: 10.1016/j.pnpbp.2018.11.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 11/14/2018] [Accepted: 11/16/2018] [Indexed: 12/22/2022]
Abstract
There is increasing evidence that epigenetic factors play a critical role in posttraumatic stress disorder (PTSD), by mediating the impact of environmental exposures to trauma on the regulation of gene expression. DNA methylation is one epigenetic process that has been highly studied in PTSD. This review will begin by providing an overview of DNA methylation (DNAm) methods, and will then highlight two major biological systems that have been identified in the epigenetic regulation in PTSD: (a) the immune system and (b) the stress response system. In addition to candidate gene approaches, we will review novel strategies to study epigenome-wide PTSD-related effects, including epigenome-wide algorithms that distill information from many loci into a single summary score (e.g., measures of "epigenetic age" which have been associated with PTSD). This review will also cover recent epigenome wide association studies (EWAS) of PTSD, and biological pathway models used to identify gene sets enriched in PTSD. Finally, we address technical and methodological advances and challenges to the field, and highlight exciting directions for future research.
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Affiliation(s)
- Filomene G. Morrison
- National Center for PTSD at VA Boston Healthcare System,Department of Psychiatry, Boston University School of Medicine
| | - Mark W. Miller
- National Center for PTSD at VA Boston Healthcare System,Department of Psychiatry, Boston University School of Medicine
| | - Mark W. Logue
- National Center for PTSD at VA Boston Healthcare System,Department of Psychiatry, Boston University School of Medicine,Biomedical Genetics, Boston University School of Medicine,Department of Biostatistics, Boston University School of Public Health
| | - Michele Assef
- Boston University College of Health & Rehabilitation Sciences: Sargent College
| | - Erika J. Wolf
- National Center for PTSD at VA Boston Healthcare System,Department of Psychiatry, Boston University School of Medicine
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18
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Vandeleest J, Capitanio J, Hamel A, Meyer J, Novak M, Mendoza S, McCowan B. Social stability influences the association between adrenal responsiveness and hair cortisol concentrations in rhesus macaques. Psychoneuroendocrinology 2019; 100:164-171. [PMID: 30342315 PMCID: PMC6333515 DOI: 10.1016/j.psyneuen.2018.10.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 08/27/2018] [Accepted: 10/11/2018] [Indexed: 12/14/2022]
Abstract
Hair cortisol concentrations are increasingly being used in both humans and nonhuman animals as a biomarker of chronic stress. However, many details regarding how hair cortisol concentrations relate to the dynamic activity and regulation of the HPA axis are still unknown. The current study explores 1) how the regulation of the HPA axis in infancy relates to hair cortisol concentrations (HCC) in infancy 2) whether this relationship persists into adulthood under conditions of social stability, and 3) how social instability impacts these relationships. All subjects were rhesus monkeys housed in large social groups at the California National Primate Research Center, and all had participated in a 25-hr. long BioBehavioral Assessment (BBA) at 3-4 months of age when four plasma samples were taken to assess HPA regulation, in particular cortisol responses to 1) 2-hour social separation and relocation, 2) sustained challenge, 3) dexamethasone and 4) ACTH administration. In Study 1, hair samples were collected at the end of the BBA testing from 25 infant rhesus monkeys from 2 different stable social groups. In Study 2, hair samples were obtained at three timepoints from 108 adults from 3 different stable social groups (1 in the Spring/Summer and 2 in the Fall/Winter) to examine the temporal stability of the relationship between HCC and HPA axis regulation. In Study 3, subjects included 31 infants and 33 adults from a single social group experiencing social instability following the same procedures as in Studies 1 and 2. Generalized linear models were used to determine if infants' HPA axis activity and regulation predicted HCC in infancy (Study 1), in adulthood with animals living in stable social conditions (Study 2) or in animals living in an unstable social group (Study 3). Results indicated that for both infants and adults living in stable social groups, HCC are associated with the adrenal response to ACTH in infancy. Samples collected in the winter also had higher HCC than those collected in summer. In the unstable social group, adult hair cortisol levels were higher than in the stable social groups. Additionally, there were no consistent relationships between HCC and infant HPA axis regulation among adults or infants living in a group experiencing social instability. These results suggest that the aspects of the HPA axis that drive HCC may differ depending on context. Under stable, non-stressed conditions there seems to be a trait-like association between adrenal responsivity and HCC in infancy and adulthood. However, this association may be reduced or eliminated under conditions of social stress.
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Affiliation(s)
- J.J. Vandeleest
- California National Primate Research Center, University of California-Davis, One Shields Avenue, Davis, CA, 95616, USA,Corresponding author: California National Primate Research Center, University of California-Davis, One Shields Avenue, Davis, CA 956167, USA, Phone: 1-530-752-1506, Fax: 1-530-752-2880,
| | - J.P. Capitanio
- California National Primate Research Center, University of California-Davis, One Shields Avenue, Davis, CA, 95616, USA
| | - A. Hamel
- Department of Psychology and Brain Sciences, 441 Tobin Hall, University of Massachusetts, Amherst, MA, 01003 USA
| | - J. Meyer
- Department of Psychology and Brain Sciences, 441 Tobin Hall, University of Massachusetts, Amherst, MA, 01003 USA
| | - M. Novak
- Department of Psychology and Brain Sciences, 441 Tobin Hall, University of Massachusetts, Amherst, MA, 01003 USA
| | - S.P. Mendoza
- California National Primate Research Center, University of California-Davis, One Shields Avenue, Davis, CA, 95616, USA
| | - B McCowan
- California National Primate Research Center, University of California-Davis, One Shields Avenue, Davis, CA, 95616, USA,Department of Population Health & Reproduction, School of Veterinary Medicine, University of California-Davis, One Shields Avenue, Davis, CA, 95616, USA
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19
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Maples-Keller JL, Jovanovic T, Dunlop BW, Rauch S, Yasinski C, Michopoulos V, Coghlan C, Norrholm S, Rizzo AS, Ressler K, Rothbaum BO. When translational neuroscience fails in the clinic: Dexamethasone prior to virtual reality exposure therapy increases drop-out rates. J Anxiety Disord 2019; 61:89-97. [PMID: 30502903 DOI: 10.1016/j.janxdis.2018.10.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 10/11/2018] [Accepted: 10/24/2018] [Indexed: 10/28/2022]
Abstract
Posttraumatic stress disorder (PTSD) is characterized by exaggerated expression of fear responses to danger and safety cues. Translational research suggests that dexamethasone facilitates fear extinction in animal and human fear conditioning models. For this randomized, placebo-controlled trial (N = 27), we aimed to translate these findings to the clinic by using virtual reality exposure (VRE) therapy for OEF/OIF/OND veterans with PTSD to determine whether dexamethasone will increase the efficacy of exposure therapy for VRE relative to placebo. VRE sessions involved imaginal exposure to the most traumatic war memories while viewing a computer-generated view of virtual Iraq or Afghanistan with multisensory stimulus options used to match patient's description of the trauma. VRE was effective in reducing PTSD symptoms but there was no interaction with dexamethasone. Drop-out rate was significantly higher in the dexamethasone group, with 10 of 13 (76.9%) participants in this group discontinuing, compared to only 4 of 14 (28.5%) in the placebo group, χ2 = 6.31, p = 0.02. Results indicate that the dexamethasone group may have experienced an increase in PTSD symptoms, particularly re-experiencing, at session 2 following first drug administration. Contrary to study hypotheses, dexamethasone did not enhance exposure therapy outcomes and was associated with increased drop-out. This demonstrates potential pitfalls in translating neuroscience models to the clinic; future research carefully examining glucocorticoid mechanisms involved in therapy augmentation is warranted.
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Affiliation(s)
- Jessica L Maples-Keller
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, United States.
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, United States
| | - Boadie W Dunlop
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, United States
| | - Sheila Rauch
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, United States
| | - Carly Yasinski
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, United States
| | - Vasiliki Michopoulos
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, United States
| | - Callan Coghlan
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, United States
| | - Seth Norrholm
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, United States
| | - Albert Skip Rizzo
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, United States; Department of Psychiatry and Behavioral Sciences, University of Southern California, United States; Department of Psychiatry, McLean Hospital/Harvard Medical School, United States
| | - Kerry Ressler
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, United States; Department of Psychiatry and Behavioral Sciences, University of Southern California, United States; Department of Psychiatry, McLean Hospital/Harvard Medical School, United States
| | - Barbara O Rothbaum
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, United States
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20
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Alterations in Systemic and Cognitive Glucocorticoid Sensitivity in Depression. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2018; 4:310-320. [PMID: 30686583 DOI: 10.1016/j.bpsc.2018.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 11/21/2018] [Accepted: 11/27/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND Decades of research point to cortisol insensitivity as a biomarker of depression. Despite a vast literature on cortisol's effects on memory, the role of cortisol insensitivity in core psychological features of depression, such as emotional memory biases, is unknown. METHODS Sixty-five premenopausal women with varying levels of depression completed this study involving an at-home low-dose dexamethasone suppression test and four experimental sessions (i.e., two visits for memory encoding of emotionally arousing pictures, each of which was followed 48 hours later by a recall test). Participants received 20 mg of oral cortisol (CORT) or placebo prior to encoding. We tested whether systemic cortisol insensitivity measured with the dexamethasone suppression test predicted cognitive sensitivity to CORT, which was operationalized as the change in negatively biased memory formation for pictures encoded following CORT versus placebo administration. RESULTS Cortisol insensitivity was associated with more severe depression and flatter diurnal cortisol levels. Cortisol insensitivity predicted negative memory bias for pictures encoded during the placebo session and reduction in negative memory bias for pictures encoded during the CORT (compared with placebo) session, even after accounting for psychiatric symptomatology. CONCLUSIONS Our findings replicate research showing that cortisol insensitivity predicts depression severity and flatter diurnal cortisol levels. The results further suggest that systemic cortisol insensitivity is related to negative memory bias and its alleviation by cortisol administration. These novel cognitive findings tie together knowledge regarding endocrine and psychological dysfunction in depression and suggest that boosting cortisol signal may cognitively benefit individuals with cortisol insensitivity.
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21
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Drews E, Fertuck EA, Koenig J, Kaess M, Arntz A. Hypothalamic-pituitary-adrenal axis functioning in borderline personality disorder: A meta-analysis. Neurosci Biobehav Rev 2018; 96:316-334. [PMID: 30500331 DOI: 10.1016/j.neubiorev.2018.11.008] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 11/15/2018] [Accepted: 11/18/2018] [Indexed: 12/29/2022]
Abstract
Borderline Personality Disorder (BPD) has been associated with altered hypothalamic-pituitary-adrenal (HPA) axis functioning. However, evidence is inconsistent. Therefore, the present series of meta-analyses aimed to quantify HPA axis functioning in BPD patients based on singular and continuous cortisol assessments and measures of reactivity to pharmacological and psychosocial stress. Case-control studies comparing adult BPD patients and healthy and clinical controls were considered for inclusion. The search resulted in 804 publications, of which 37 studies (k = 81; BPD n = 803, controls n = 1092) were included. Analyses were based on random effect models using standardized mean differences. BPD patients displayed elevated continuous cortisol output and blunted cortisol following psychosocial challenges. Singular cortisol assessments and cortisol after pharmacological challenges were not significantly different. Meta-analyses were limited by inconsistent reporting in individual studies and small samples for some comparisons. Due to the debilitating nature of stress-related symptoms in BPD, more research on elevated continuous cortisol output and blunted cortisol responses to psychosocial stress is warranted.
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Affiliation(s)
- Elisa Drews
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany; Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands; New York State Psychiatric Institute, Columbia University, College of Physicians and Surgeons, New York, United States.
| | - Eric A Fertuck
- The City College and Graduate Center of the City University of New York, New York, United States; New York State Psychiatric Institute, Columbia University, College of Physicians and Surgeons, New York, United States
| | - Julian Koenig
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Michael Kaess
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands
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22
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Abstract
PURPOSE OF REVIEW Traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) can result from similar injuries and can result in similar symptoms, such as problems with sleep, concentration, memory, and mood. Although PTSD and persistent sequelae due to a TBI (PST) have generally been viewed as pragmatically confounded but conceptually separable entities, we examine emerging evidence emphasizing the breadth of overlap in both clinical presentation and underlying pathophysiology between PST and PTSD. RECENT FINDINGS New evidence underscores the poor specificity of symptoms to etiology and emphasizes the potential, after both physical brain injury and traumatic stress, for changes in each of the three interacting systems that coordinate the body's response to the experience or expectation of major injury-the immune, endocrine, and neuromodulatory neurotransmitter systems. A view of PTSD and PST sharing common pathophysiologic elements related to the CNS response to acute injury or threat carries important implications for research and clinical care.
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23
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Kok L, Hillegers MH, Veldhuijzen DS, Boks MP, Dieleman JM, van Dijk D, Joëls M, Vinkers CH. Genetic variation in the glucocorticoid receptor and psychopathology after dexamethasone administration in cardiac surgery patients. J Psychiatr Res 2018; 103:167-172. [PMID: 29879676 DOI: 10.1016/j.jpsychires.2018.05.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 05/14/2018] [Accepted: 05/20/2018] [Indexed: 10/16/2022]
Abstract
The glucocorticoid receptor (GR) agonist dexamethasone is frequently used for its anti-inflammatory properties. We recently showed that a single high-dose of dexamethasone had long-lasting protective effects on the development of psychopathology after cardiac surgery and postoperative intensive care unit stay. In this study, we investigated whether common genetic variation in the hypothalamic-pituitary-adrenal (HPA)-axis would influence the susceptibility for PTSD and depression after dexamethasone administration. Participants (n = 996) of the Dexamethasone for Cardiac Surgery (DECS) randomized clinical trial were followed after receiving a single high intraoperative dose of dexamethasone (1 mg/kg), a GR agonist, or placebo. PTSD and depressive symptoms were assessed up to four years after cardiac surgery. We focused primarily on five common single nucleotide polymorphisms (SNPs) in the glucocorticoid receptor (GR). Secondarily, we comprehensively assessed common genetic variation in the FK506 binding protein (FKBP5) and the mineralocorticoid receptor (MR). The protective effects of dexamethasone on postoperative PTSD symptoms were dependent on the GR polymorphisms rs41423247 (p = .009), rs10052957 (p = .003), and rs6189 (p = .002), but not on rs6195 (p = .025) or rs6198, (p = .026) after Bonferroni correction. No genotype-dependent effects were found for postoperative depressive symptoms. Also, no associations of FKBP5 and MR polymorphisms were found on PTSD and depression outcomes. Protective effects of dexamethasone on PTSD symptoms after cardiac surgery and ICU stay seem to depend on common genetic variation in its target receptor, the GR. These effects indicate that pre-operative genetic screening could potentially help in stratifying patients for their vulnerability for developing PTSD symptoms after surgery.
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Affiliation(s)
- Lotte Kok
- Department of Anesthesiology and Intensive Care, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Translational Neuroscience, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Manon H Hillegers
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Dieuwke S Veldhuijzen
- Department of Anesthesiology and Intensive Care, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands; Leiden Institute for Brain and Cognition, Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, the Netherlands
| | - Marco Pm Boks
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jan M Dieleman
- Department of Anesthesiology and Intensive Care, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Diederik van Dijk
- Department of Anesthesiology and Intensive Care, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marian Joëls
- Department of Translational Neuroscience, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands; University of Groningen, Groningen, The Netherlands
| | - Christiaan H Vinkers
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
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24
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Hacimusalar Y, Eşel E. Suggested Biomarkers for Major Depressive Disorder. ACTA ACUST UNITED AC 2018; 55:280-290. [PMID: 30224877 DOI: 10.5152/npa.2017.19482] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 06/08/2017] [Indexed: 12/21/2022]
Abstract
Currently, the diagnosis of major depressive disorder (MDD) mainly relies on clinical examination and subjective evaluation of depressive symptoms. There is no non-invasive, quantitative test available today for the diagnosis of MDD. In MDD, exploration of biomarkers will be helpful in diagnosing the disorder as well as in choosing a treatment, and predicting the treatment response. In this article, it is aimed to review the findings of suggested biomarkers such as growth factors, cytokines and other inflammatory markers, oxidative stress markers, endocrine markers, energy balance hormones, genetic and epigenetic features, and neuroimaging in MDD and to evaluate how these findings contribute to the pathophysiology of MDD, the prediction of treatment response, severity of the disorder, and identification of subtypes. Among these, the findings related to the brain-derived neurotrophic factor, the hypothalamo-pituitary-adrenal axis, cytokines, and neuroimaging may be strong candidates for being biomarkers MDD, and may provide critical information in understanding biological etiology of depression. Although the findings are not sufficient yet, we think that the results of epigenetic studies will also provide very important contributions to the biomarker research in MDD. The availability of biomarkers in MDD will be an advancement that will facilitate the diagnosis of the disorder, treatment choices in the early stages, and prediction of the course of the disorder.
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Affiliation(s)
- Yunus Hacimusalar
- Department of Psychiatry, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Ertuğrul Eşel
- Department of Psychiatry, Erciyes University Faculty of Medicine, Kayseri, Turkey
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Leistner C, Menke A. How to measure glucocorticoid receptor's sensitivity in patients with stress-related psychiatric disorders. Psychoneuroendocrinology 2018; 91:235-260. [PMID: 29449045 DOI: 10.1016/j.psyneuen.2018.01.023] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 12/07/2017] [Accepted: 01/28/2018] [Indexed: 12/31/2022]
Abstract
Stress is a state of derailed homeostasis and a main environmental risk factor for psychiatric diseases. Chronic or uncontrollable stress may lead to a dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, which is a common feature of stress-related psychiatric disorders. One of the key mechanisms underlying a disturbed HPA axis is an impaired function of the glucocorticoid receptor (GR) with an enhanced or reduced feedback sensitivity for glucocorticoids and subsequently altered concentrations of peripheral cortisol. GR function is regulated by a multiprotein complex including the different expression of the hsp90 co-chaperone FK 506 binding protein 51 (FKBP5) that may be genetically determined or acquired in response to stressful stimuli. Specific patterns of a dysregulation of the HPA axis and GR function are found in different stress-related psychiatric entities e.g. major depression, job-related exhaustion or posttraumatic stress disorder. GR challenge tests like the dexamethasone-suppression test (DST), the dexamethasone-corticotropin-releasing hormone (dex-CRH) test or most recently the analysis of the dexamethasone-induced gene expression are employed to sensitively measure HPA axis activity in these disorders. They provide information for a stratification of phenotypic similar but neurobiological diverse psychiatric disorders. In this review we present a synopsis of GR challenge tests with a focus on the application of the DST, the CRH test and the dex-CRH test as well as the dexamethasone-induced gene expression in stress-related psychiatric entities.
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Affiliation(s)
- Carolin Leistner
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Wuerzburg, Margarete-Hoeppel-Platz 1, Wuerzburg, 97080, Germany
| | - Andreas Menke
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Wuerzburg, Margarete-Hoeppel-Platz 1, Wuerzburg, 97080, Germany; Comprehensive Heart Failure Center, University Hospital of Wuerzburg, Am Schwarzenberg 15, Wuerzburg, 97080, Germany.
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Lisieski MJ, Eagle AL, Conti AC, Liberzon I, Perrine SA. Single-Prolonged Stress: A Review of Two Decades of Progress in a Rodent Model of Post-traumatic Stress Disorder. Front Psychiatry 2018; 9:196. [PMID: 29867615 PMCID: PMC5962709 DOI: 10.3389/fpsyt.2018.00196] [Citation(s) in RCA: 127] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 04/25/2018] [Indexed: 12/21/2022] Open
Abstract
Post-traumatic stress disorder (PTSD) is a common, costly, and often debilitating psychiatric condition. However, the biological mechanisms underlying this disease are still largely unknown or poorly understood. Considerable evidence indicates that PTSD results from dysfunction in highly-conserved brain systems involved in stress, anxiety, fear, and reward. Pre-clinical models of traumatic stress exposure are critical in defining the neurobiological mechanisms of PTSD, which will ultimately aid in the development of new treatments for PTSD. Single prolonged stress (SPS) is a pre-clinical model that displays behavioral, molecular, and physiological alterations that recapitulate many of the same alterations observed in PTSD, illustrating its validity and giving it utility as a model for investigating post-traumatic adaptations and pre-trauma risk and protective factors. In this manuscript, we review the present state of research using the SPS model, with the goals of (1) describing the utility of the SPS model as a tool for investigating post-trauma adaptations, (2) relating findings using the SPS model to findings in patients with PTSD, and (3) indicating research gaps and strategies to address them in order to improve our understanding of the pathophysiology of PTSD.
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Affiliation(s)
- Michael J Lisieski
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, United States
| | - Andrew L Eagle
- Department of Physiology, Michigan State University, East Lansing, MI, United States
| | - Alana C Conti
- Research and Development Service, John D. Dingell Veterans Affairs Medical Center, Detroit, MI, United States.,Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, United States
| | - Israel Liberzon
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States.,Mental Health Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, United States
| | - Shane A Perrine
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, United States
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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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28
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The association of serotonin receptor 3A methylation with maternal violence exposure, neural activity, and child aggression. Behav Brain Res 2017; 325:268-277. [DOI: 10.1016/j.bbr.2016.10.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 10/04/2016] [Accepted: 10/05/2016] [Indexed: 01/05/2023]
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Banerjee SB, Morrison FG, Ressler KJ. Genetic approaches for the study of PTSD: Advances and challenges. Neurosci Lett 2017; 649:139-146. [PMID: 28242325 DOI: 10.1016/j.neulet.2017.02.058] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 02/15/2017] [Accepted: 02/21/2017] [Indexed: 12/31/2022]
Abstract
Post-traumatic stress disorder (PTSD) is a highly debilitating stress and anxiety-related disorder that occurs in response to specific trauma or abuse. Genetic risk factors may account for up to 30-40% of the heritability of PTSD. Understanding the gene pathways that are associated with PTSD, and how those genes interact with the fear and stress circuitry to mediate risk and resilience for PTSD will enable the development of targeted therapies to prevent the occurrence of or decrease the severity of this complex multi-gene disorder. This review will summarize recent research on genetic approaches to understanding PTSD risk and resilience in human populations, including candidate genes and their epigenetic modifications, genome-wide association studies and neural imaging genetics approaches. Despite challenges faced within this field of study such as inconsistent results and replications, genetic approaches still offer exciting opportunities for the identification and development of novel therapeutic targets and therapies in the future.
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Affiliation(s)
- Sunayana B Banerjee
- Behavioral Neuroscience and Psychiatric Disorders, Emory University, Atlanta, GA 30329, USA
| | - Filomene G Morrison
- Behavioral Neuroscience and Psychiatric Disorders, Emory University, Atlanta, GA 30329, USA; McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA
| | - Kerry J Ressler
- Behavioral Neuroscience and Psychiatric Disorders, Emory University, Atlanta, GA 30329, USA; McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA.
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Easter A, Taborelli E, Bye A, Zunszain PA, Pariante CM, Treasure J, Schmidt U, Micali N. Perinatal hypothalamic-pituitary-adrenal axis regulation among women with eating disorders and their infants. Psychoneuroendocrinology 2017; 76:127-134. [PMID: 27914245 DOI: 10.1016/j.psyneuen.2016.11.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 10/31/2016] [Accepted: 11/04/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Psychiatric illness is associated with heightened hypothalamic-pituitary-adrenal (HPA) axis activity during pregnancy which may have long term effects on infant stress regulation. HPA axis regulation has not previously been investigated in women with eating disorders (ED) or their infants during the perinatal period. METHODS Women were recruited to a prospective longitudinal study in three groups: 1) current or active ED (C-ED=31), 2) past ED (P-ED=29) and healthy control (HC=57). Maternal psychopathology, diurnal cortisol levels, corticotropin-releasing hormone (CRH) and CRH binding protein (CRH-BP) were measured during the third trimester of pregnancy. At eight weeks postpartum infant cortisol was obtained before and after routine immunisations to determine infant hormonal response to a stressful situation. RESULTS Women with current ED had a significantly lower cortisol decline throughout the day compared to HC, in both adjusted and unadjusted analyses. Lower cortisol decline among women with a current ED were associated with higher levels of psychopathology during pregnancy. Women's cortisol awakening response, CRH and CRH-BP levels did not differ across the three groups. Infants' stress response was also significantly higher among those in the C-ED group, although this effect was attenuated after controlling for confounders. CONCLUSIONS During pregnancy women with ED have lower cortisol declines, suggestive of blunted diurnal cortisol rhythms. Postnatally, their infants also have a heightened response to stress. This is the first study to identify HPA axis dysfunction in pregnancy in women with ED, and to show an intergenerational effect. Since dysfunctions in HPA activity during childhood may represent a risk factor for psychological and physical health problems later in life, further investigation of the potential long-term implications of these findings is crucial.
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Affiliation(s)
- A Easter
- Behavioural and Brain Sciences Unit, Institute of Child Health, University College London, London, UK; Department of Psychological Medicine and Psychiatry, Section of Eating Disorders, Institute of Psychiatry, Kings College London, London, UK; Health Services Research Department, Institute of Psychiatry, Kings College London, London, UK.
| | - E Taborelli
- Behavioural and Brain Sciences Unit, Institute of Child Health, University College London, London, UK; Department of Psychological Medicine and Psychiatry, Section of Eating Disorders, Institute of Psychiatry, Kings College London, London, UK
| | - A Bye
- Behavioural and Brain Sciences Unit, Institute of Child Health, University College London, London, UK; Department of Psychological Medicine and Psychiatry, Section of Eating Disorders, Institute of Psychiatry, Kings College London, London, UK; Health Services Research Department, Institute of Psychiatry, Kings College London, London, UK
| | - P A Zunszain
- Department of Psychological Medicine, Institute of Psychiatry, Section of Perinatal Psychiatry and Stress, Psychiatry and Immunology (SPI-lab), King's College London, London, UK
| | - C M Pariante
- Department of Psychological Medicine, Institute of Psychiatry, Section of Perinatal Psychiatry and Stress, Psychiatry and Immunology (SPI-lab), King's College London, London, UK
| | - J Treasure
- Department of Psychological Medicine and Psychiatry, Section of Eating Disorders, Institute of Psychiatry, Kings College London, London, UK
| | - U Schmidt
- Department of Psychological Medicine and Psychiatry, Section of Eating Disorders, Institute of Psychiatry, Kings College London, London, UK
| | - N Micali
- Behavioural and Brain Sciences Unit, Institute of Child Health, University College London, London, UK; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, USA; Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, USA
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Cacciaglia R, Nees F, Grimm O, Ridder S, Pohlack ST, Diener SJ, Liebscher C, Flor H. Trauma exposure relates to heightened stress, altered amygdala morphology and deficient extinction learning: Implications for psychopathology. Psychoneuroendocrinology 2017; 76:19-28. [PMID: 27871027 DOI: 10.1016/j.psyneuen.2016.11.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 11/06/2016] [Accepted: 11/10/2016] [Indexed: 12/13/2022]
Abstract
Stress exposure causes a structural reorganization in neurons of the amygdala. In particular, animal models have repeatedly shown that both acute and chronic stress induce neuronal hypertrophy and volumetric increase in the lateral and basolateral nuclei of amygdala. These effects are visible on the behavioral level, where stress enhances anxiety behaviors and provokes greater fear learning. We assessed stress and anxiety levels in a group of 18 healthy human trauma-exposed individuals (TR group) compared to 18 non-exposed matched controls (HC group), and related these measurements to amygdala volume. Traumas included unexpected adverse experiences such as vehicle accidents or sudden loss of a loved one. As a measure of aversive learning, we implemented a cued fear conditioning paradigm. Additionally, to provide a biological marker of chronic stress, we measured the sensitivity of the hypothalamus-pituitary-adrenal (HPA) axis using a dexamethasone suppression test. Compared to the HC, the TR group showed significantly higher levels of chronic stress, current stress and trait anxiety, as well as increased volume of the left amygdala. Specifically, we observed a focal enlargement in its lateral portion, in line with previous animal data. Compared to HC, the TR group also showed enhanced late acquisition of conditioned fear and deficient extinction learning, as well as salivary cortisol hypo-suppression to dexamethasone. Left amygdala volumes positively correlated with suppressed morning salivary cortisol. Our results indicate differences in trauma-exposed individuals which resemble those previously reported in animals exposed to stress and in patients with post-traumatic stress disorder and depression. These data provide new insights into the mechanisms through which traumatic stress might prompt vulnerability for psychopathology.
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Affiliation(s)
- Raffaele Cacciaglia
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Square J5, 68159 Mannheim, Germany; Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Passeig de la vall d'Hebron 171, Barcelona, Catalonia, Spain.
| | - Frauke Nees
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Square J5, 68159 Mannheim, Germany
| | - Oliver Grimm
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital of Frankfurt, Frankfurt, Germany
| | - Stephanie Ridder
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Square J5, 68159 Mannheim, Germany
| | - Sebastian T Pohlack
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Square J5, 68159 Mannheim, Germany
| | - Slawomira J Diener
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Square J5, 68159 Mannheim, Germany
| | - Claudia Liebscher
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Square J5, 68159 Mannheim, Germany
| | - Herta Flor
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Square J5, 68159 Mannheim, Germany.
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Penney J, Mendell A, Zeng M, Tran K, Lymer J, Turner PV, Choleris E, MacLusky N, Lu R. LUMAN/CREB3 is a key regulator of glucocorticoid-mediated stress responses. Mol Cell Endocrinol 2017; 439:95-104. [PMID: 27789393 DOI: 10.1016/j.mce.2016.10.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 10/21/2016] [Accepted: 10/21/2016] [Indexed: 01/28/2023]
Abstract
Altered glucocorticoid sensitivity is believed to contribute to a number of human diseases, including inflammatory and autoimmune conditions as well as disorders characterized by abnormal hypothalamic-pituitary-adrenal axis (HPA) function. LUMAN (or CREB3), originally identified through its interaction with a cell cycle regulator HCFC1, is an endoplasmic reticulum membrane-bound transcription factor that is involved in the unfolded protein response. Here we demonstrate that LUMAN changes the glucocorticoid response by modulating the expression of the glucocorticoid receptor leading to an overall increase in GR activity. Luman-deficient mice exhibited a blunted stress response characterized by low levels of both anxiety and depressive-like behaviour in addition to low circulating corticosterone levels. These mice also have reduced dendritic branching in the CA3 region of the hippocampus, consistent with increased GR responses. These findings are consistent with the notion that elevated GR activities are the primary cause of the observed phenotype in these LUMAN-deficient mice. We thus postulate that LUMAN is a key regulator of GR-mediated signaling and modulates HPA axis reactivity.
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Affiliation(s)
- Jenna Penney
- Department of Molecular and Cellular Biology, University of Guelph, 488 Gordon Street, Guelph, Ontario, N1G 2W1, Canada
| | - Ari Mendell
- Department of Biomedical Sciences, University of Guelph, 488 Gordon Street, Guelph, Ontario, N1G 2W1, Canada
| | - Minghua Zeng
- Department of Molecular and Cellular Biology, University of Guelph, 488 Gordon Street, Guelph, Ontario, N1G 2W1, Canada
| | - Khoa Tran
- Department of Biomedical Sciences, University of Guelph, 488 Gordon Street, Guelph, Ontario, N1G 2W1, Canada
| | - Jennifer Lymer
- Department of Psychology, University of Guelph, 488 Gordon Street, Guelph, Ontario, N1G 2W1, Canada
| | - Patricia V Turner
- Department of Pathobiology, University of Guelph, 488 Gordon Street, Guelph, Ontario, N1G 2W1, Canada
| | - Elena Choleris
- Department of Psychology, University of Guelph, 488 Gordon Street, Guelph, Ontario, N1G 2W1, Canada
| | - Neil MacLusky
- Department of Biomedical Sciences, University of Guelph, 488 Gordon Street, Guelph, Ontario, N1G 2W1, Canada
| | - Ray Lu
- Department of Molecular and Cellular Biology, University of Guelph, 488 Gordon Street, Guelph, Ontario, N1G 2W1, Canada.
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Lindqvist D, Fernström J, Grudet C, Ljunggren L, Träskman-Bendz L, Ohlsson L, Westrin Å. Increased plasma levels of circulating cell-free mitochondrial DNA in suicide attempters: associations with HPA-axis hyperactivity. Transl Psychiatry 2016; 6:e971. [PMID: 27922635 PMCID: PMC5315562 DOI: 10.1038/tp.2016.236] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 10/05/2016] [Accepted: 10/15/2016] [Indexed: 12/29/2022] Open
Abstract
Preclinical data suggest that chronic stress may cause cellular damage and mitochondrial dysfunction, potentially leading to the release of mitochondrial DNA (mtDNA) into the bloodstream. Major depressive disorder has been associated with an increased amount of mtDNA in leukocytes from saliva samples and blood; however, no previous studies have measured plasma levels of free-circulating mtDNA in a clinical psychiatric sample. In this study, free circulating mtDNA was quantified in plasma samples from 37 suicide attempters, who had undergone a dexamethasone suppression test (DST), and 37 healthy controls. We hypothesized that free circulating mtDNA would be elevated in the suicide attempters and would be associated with hypothalamic-pituitary-adrenal (HPA)-axis hyperactivity. Suicide attempters had significantly higher plasma levels of free-circulating mtDNA compared with healthy controls at different time points (pre- and post-DST; all P-values<2.98E-12, Cohen's d ranging from 2.55 to 4.01). Pre-DST plasma levels of mtDNA were positively correlated with post-DST cortisol levels (rho=0.49, P<0.003). Suicide attempters may have elevated plasma levels of free-circulating mtDNA, which are related to impaired HPA-axis negative feedback. This peripheral index is consistent with an increased cellular or mitochondrial damage. The specific cells and tissues contributing to plasma levels of free-circulating mtDNA are not known, as is the specificity of this finding for suicide attempters. Future studies are needed in order to better understand the relevance of increased free-circulating mtDNA in relation to the pathophysiology underlying suicidal behavior and depression.
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Affiliation(s)
- D Lindqvist
- Department of Clinical Sciences Lund, Psychiatry, Lund University, Lund, Sweden,Department of Psychiatry, School of Medicine, University of California San Francisco, School of Medicine, San Francisco, CA, USA,Psychiatric Clinic, Lund, Division of Psychiatry, Lund, Sweden
| | - J Fernström
- Department of Clinical Sciences Lund, Psychiatry, Lund University, Lund, Sweden,Psychiatric Clinic, Lund, Division of Psychiatry, Lund, Sweden
| | - C Grudet
- Department of Clinical Sciences Lund, Psychiatry, Lund University, Lund, Sweden
| | - L Ljunggren
- Department of Biomedical Science, Malmö University,Health and Society, Malmö, Sweden
| | - L Träskman-Bendz
- Department of Clinical Sciences Lund, Psychiatry, Lund University, Lund, Sweden
| | - L Ohlsson
- Department of Biomedical Science, Malmö University,Health and Society, Malmö, Sweden,Department of Biomedical Science, Malmö University, Health and Society, Malmö 205 06, Sweden. E-mail:
| | - Å Westrin
- Department of Clinical Sciences Lund, Psychiatry, Lund University, Lund, Sweden,Psychiatric Clinic, Lund, Division of Psychiatry, Lund, Sweden
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The Very Low-Dose Dexamethasone Suppression Test in the General Population: A Cross-Sectional Study. PLoS One 2016; 11:e0164348. [PMID: 27736954 PMCID: PMC5063373 DOI: 10.1371/journal.pone.0164348] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 09/24/2016] [Indexed: 11/19/2022] Open
Abstract
Determinants of the hypothalamic-pituitary-adrenal (HPA) axis functioning are increasingly explored in population-based studies. However, functional tests measuring the negative feedback of the HPA axis cannot easily be implemented into large observational studies. Furthermore, high doses of dexamethasone often completely suppress the HPA axis in healthy persons. This study aimed to detect the effects of the health, lifestyle and sociodemographic factors, psychiatric problems and cognitive functions on the negative feedback of the HPA axis using a very low-dose (0.25 mg) dexamethasone suppression test (DST).We evaluated the associations of several determinants with the saliva cortisol concentrations after dexamethasone intake in a confounder-adjusted model also corrected for baseline saliva cortisol concentrations in the Rotterdam Study, a large population-based study (N = 1822). We found that female sex, low income, lack of exercise, instrumental disability and smoking were all independently associated with stronger suppression of the HPA axis. Even though there were no linear associations between psychiatric measures and cortisol suppression, we found that depressive symptoms and anxiety disorders were more common in persons with non-suppression of cortisol. Conversely, psychotropic medication use was related to enhanced suppression of cortisol after DST. In this large study, we found that female gender, low socioeconomic status and poor health were all related to suppression of the HPA axis. Non-linear associations were detected between the suppression of the HPA axis and common psychiatric disorders in community-dwelling persons.
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Abstract
The hypothalamo-pituitary-adrenal axis (HPA) is responsible for stimulation of adrenal corticosteroids in response to stress. Negative feedback control by corticosteroids limits pituitary secretion of corticotropin, ACTH, and hypothalamic secretion of corticotropin-releasing hormone, CRH, and vasopressin, AVP, resulting in regulation of both basal and stress-induced ACTH secretion. The negative feedback effect of corticosteroids occurs by action of corticosteroids at mineralocorticoid receptors (MR) and/or glucocorticoid receptors (GRs) located in multiple sites in the brain and in the pituitary. The mechanisms of negative feedback vary according to the receptor type and location within the brain-hypothalmo-pituitary axis. A very rapid nongenomic action has been demonstrated for GR action on CRH neurons in the hypothalamus, and somewhat slower nongenomic effects are observed in the pituitary or other brain sites mediated by GR and/or MR. Corticosteroids also have genomic actions, including repression of the pro-opiomelanocortin (POMC) gene in the pituitary and CRH and AVP genes in the hypothalamus. The rapid effect inhibits stimulated secretion, but requires a rapidly rising corticosteroid concentration. The more delayed inhibitory effect on stimulated secretion is dependent on the intensity of the stimulus and the magnitude of the corticosteroid feedback signal, but also the neuroanatomical pathways responsible for activating the HPA. The pathways for activation of some stressors may partially bypass hypothalamic feedback sites at the CRH neuron, whereas others may not involve forebrain sites; therefore, some physiological stressors may override or bypass negative feedback, and other psychological stressors may facilitate responses to subsequent stress.
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Castro-Vale I, van Rossum EF, Machado JC, Mota-Cardoso R, Carvalho D. Genetics of glucocorticoid regulation and posttraumatic stress disorder—What do we know? Neurosci Biobehav Rev 2016; 63:143-57. [DOI: 10.1016/j.neubiorev.2016.02.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Revised: 11/30/2015] [Accepted: 02/05/2016] [Indexed: 02/05/2023]
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Kunugi H, Hori H, Ogawa S. Biochemical markers subtyping major depressive disorder. Psychiatry Clin Neurosci 2015; 69:597-608. [PMID: 25825158 DOI: 10.1111/pcn.12299] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/27/2015] [Indexed: 01/07/2023]
Abstract
The pathophysiology of major depressive disorder (MDD) remains elusive, and there is no established biochemical marker used in the daily clinical setting. This situation may result in part from the heterogeneity of MDD, which might include heterogeneous subgroups with different biological mechanisms. In this review, we discuss three promising biological systems/markers to potentially subtype MDD: the dopamine system, the hypothalamic-pituitary-adrenal axis, and chronic inflammatory markers. Several lines of evidence suggest that a facet of MDD is a dopamine agonist-responsive subtype. Focusing on the hypothalamic-pituitary-adrenal axis, depressive spectrum disorders show hypercortisolism to hypocortisolism, which could be detected by hormonal challenge tests, such as the dexamethasone/corticotrophin-releasing hormone test. Finally, accumulating evidence suggests that at least some MDD patients show characteristics similar to those of chronic inflammatory diseases, including neuroinflammatory markers and reduced tryptophan due to the increased activation of the tryptophan-kynurenine pathway. Future studies should examine the inter-relations between these systems/markers to subtype and integrate the pathophysiology of MDD.
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Affiliation(s)
- Hiroshi Kunugi
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Hiroaki Hori
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Shintaro Ogawa
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
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An Overview of Translationally Informed Treatments for Posttraumatic Stress Disorder: Animal Models of Pavlovian Fear Conditioning to Human Clinical Trials. Biol Psychiatry 2015; 78:E15-27. [PMID: 26238379 PMCID: PMC4527085 DOI: 10.1016/j.biopsych.2015.06.008] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 05/07/2015] [Accepted: 06/02/2015] [Indexed: 01/13/2023]
Abstract
Posttraumatic stress disorder manifests after exposure to a traumatic event and is characterized by avoidance/numbing, intrusive symptoms and flashbacks, mood and cognitive disruptions, and hyperarousal/reactivity symptoms. These symptoms reflect dysregulation of the fear system likely caused by poor fear inhibition/extinction, increased generalization, and/or enhanced consolidation or acquisition of fear. These phenotypes can be modeled in animal subjects using Pavlovian fear conditioning, allowing investigation of the underlying neurobiology of normative and pathological fear. Preclinical studies reveal a number of neurotransmitter systems and circuits critical for aversive learning and memory that have informed the development of therapies used in human clinical trials. In this review, we discuss the evidence for a number of established and emerging pharmacotherapies and device-based treatments for posttraumatic stress disorder that have been developed via a bench to bedside translational model.
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Juster RP, Hatzenbuehler ML, Mendrek A, Pfaus JG, Smith NG, Johnson PJ, Lefebvre-Louis JP, Raymond C, Marin MF, Sindi S, Lupien SJ, Pruessner JC. Sexual orientation modulates endocrine stress reactivity. Biol Psychiatry 2015; 77:668-76. [PMID: 25444167 PMCID: PMC4434405 DOI: 10.1016/j.biopsych.2014.08.013] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 08/08/2014] [Accepted: 08/08/2014] [Indexed: 12/17/2022]
Abstract
BACKGROUND Biological sex differences and sociocultural gender diversity influence endocrine stress reactivity. Although numerous studies have shown that men typically activate stronger stress responses than women when exposed to laboratory-based psychosocial stressors, it is unclear whether sexual orientation further modulates stress reactivity. Given that lesbian, gay, and bisexual (LGB) individuals frequently report heightened distress secondary to stigma-related stressors, we investigated whether cortisol stress reactivity differs between LGB individuals and heterosexual individuals in response to a well-validated psychosocial stressor. METHODS The study population comprised 87 healthy adults (mean age, 25 years) who were grouped according to their biological sex and their gendered sexual orientation: lesbian/bisexual women (n = 20), heterosexual women (n = 21), gay/bisexual men (n = 26), and heterosexual men (n = 20). Investigators collected 10 salivary cortisol samples throughout a 2-hour afternoon visit involving exposure to the Trier Social Stress Test modified to maximize between-sex differences. RESULTS Relative to heterosexual women, lesbian/bisexual women showed higher cortisol stress reactivity 40 min after exposure to the stressor. In contrast, gay/bisexual men displayed lower overall cortisol concentrations throughout testing compared with heterosexual men. Main findings were significant while adjusting for sex hormones (estradiol-to-progesterone ratio in women and testosterone in men), age, self-esteem, and disclosure status (whether LGB participants had completed their "coming out"). CONCLUSIONS Our results provide novel evidence for gender-based modulation of cortisol stress reactivity based on sexual orientation that goes beyond well-established between-sex differences. This study raises several important avenues for future research related to the physiologic functioning of LGB populations and gender diversity more broadly.
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Affiliation(s)
- Robert-Paul Juster
- Centre for Studies on Human Stress, Fernand-Seguin Research Centre, Montreal, Quebec, Canada; Integrated Program in Neuroscience, McGill University, Montreal, Quebec, Canada.
| | - Mark L Hatzenbuehler
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York
| | - Adrianna Mendrek
- Department of Psychiatry, University of Montreal, Montreal; Department of Psychology, Bishop's University, Sherbrooke, Quebec, Canada
| | - James G Pfaus
- Department of Psychology, Concordia University, Montreal, Quebec, Canada
| | - Nathan Grant Smith
- Department of Educational Psychology, University of Houston, Houston, Texas
| | - Philip Jai Johnson
- Center for Sexual Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota
| | | | - Catherine Raymond
- Centre for Studies on Human Stress, Fernand-Seguin Research Centre, Montreal, Quebec, Canada; Department of Neuroscience, University of Montreal, Montreal
| | - Marie-France Marin
- Centre for Studies on Human Stress, Fernand-Seguin Research Centre, Montreal, Quebec, Canada; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Shireen Sindi
- Centre for Studies on Human Stress, Fernand-Seguin Research Centre, Montreal, Quebec, Canada; Integrated Program in Neuroscience, McGill University, Montreal, Quebec, Canada
| | - Sonia J Lupien
- Centre for Studies on Human Stress, Fernand-Seguin Research Centre, Montreal, Quebec, Canada; Department of Psychiatry, University of Montreal, Montreal
| | - Jens C Pruessner
- Integrated Program in Neuroscience, McGill University, Montreal, Quebec, Canada; Douglas Institute, Department of Psychiatry, McGill University, Montreal, Quebec, Canada
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Griebe M, Nees F, Gerber B, Ebert A, Flor H, Wolf OT, Gass A, Hennerici MG, Szabo K. Stronger pharmacological cortisol suppression and anticipatory cortisol stress response in transient global amnesia. Front Behav Neurosci 2015; 9:63. [PMID: 25805980 PMCID: PMC4353300 DOI: 10.3389/fnbeh.2015.00063] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 02/23/2015] [Indexed: 12/03/2022] Open
Abstract
Transient global amnesia (TGA) is a disorder characterized by a sudden attack of severe anterograde memory disturbance that is frequently preceded by emotional or physical stress and resolves within 24 h. By using MRI following the acute episode in TGA patients, small lesions in the hippocampus have been observed. Hence, it has been hypothesized that the disorder is caused by a stress-related transient inhibition of memory formation in the hippocampus. To study the factors that may link stress and TGA, we measured the cortisol day-profile, the dexamethasone feedback inhibition and the effect of experimental exposure to stress on cortisol levels (using the socially evaluated cold pressor test and a control procedure) in 20 patients with a recent history of TGA and in 20 healthy controls. We used self-report scales of depression, anxiety and stress, and a detailed neuropsychological assessment to characterize our collective. We did not observe differences in mean cortisol levels in the cortisol day-profile between the two groups. After administration of low-dose dexamethasone, TGA patients showed significantly stronger cortisol suppression in the daytime profile compared to the control group (p = 0.027). The mean salivary cortisol level was significantly higher in the TGA group prior to and after the experimental stress exposure (p = 0.008 and 0.010 respectively), as well as prior to and after the control condition (p = 0.022 and 0.024, respectively). The TGA group had higher scores of depressive symptomatology (p = 0.021) and anxiety (p = 0.007), but the groups did not differ in the neuropsychological assessment. Our findings of a stronger pharmacological suppression and higher cortisol levels in anticipation of experimental stress in participants with a previous TGA indicate a hypersensitivity of the HPA axis. This suggests that an individual stress sensitivity might play a role in the pathophysiology of TGA.
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Affiliation(s)
- Martin Griebe
- Department of Neurology, UniversitätsMedizin Mannheim, Heidelberg University , Mannheim , Germany
| | - Frauke Nees
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Heidelberg University , Mannheim , Germany
| | - Benjamin Gerber
- Department of Neurology, UniversitätsMedizin Mannheim, Heidelberg University , Mannheim , Germany
| | - Anne Ebert
- Department of Neurology, UniversitätsMedizin Mannheim, Heidelberg University , Mannheim , Germany
| | - Herta Flor
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Heidelberg University , Mannheim , Germany
| | - Oliver T Wolf
- Department of Cognitive Psychology, Institute of Cognitive Neuroscience, Ruhr-University Bochum , Bochum , Germany
| | - Achim Gass
- Department of Neurology, UniversitätsMedizin Mannheim, Heidelberg University , Mannheim , Germany
| | - Michael G Hennerici
- Department of Neurology, UniversitätsMedizin Mannheim, Heidelberg University , Mannheim , Germany
| | - Kristina Szabo
- Department of Neurology, UniversitätsMedizin Mannheim, Heidelberg University , Mannheim , Germany
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Karanikas E, Antoniadis D, Garyfallos GD. The role of cortisol in first episode of psychosis: a systematic review. Curr Psychiatry Rep 2014; 16:503. [PMID: 25200986 DOI: 10.1007/s11920-014-0503-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The stress diathesis hypothesis is currently one of the prevailing models of etiology of psychotic disorders. Cortisol is the most researched stress hormone; yet its role in first episode psychosis (FEP) was only recently investigated. The aim of the present study is to systematically review the evidence on the potential role of cortisol in FEP. Higher cortisol levels in blood samples have been consistently replicated, whereas saliva studies measuring baseline cortisol levels have exhibited divergent results. Moreover, longitudinal studies have revealed a cortisol upregulation in FEP with a subsequent decrease induced by antipsychotic treatment. The evidence suggests a role for cortisol in psychosis, although the association of cortisol with psychopathological symptoms is currently non-specific. Future research should focus on more pure diagnostic entities, clearly defined stages of the disorder and refined methods of hormonal measurement.
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Affiliation(s)
- Evangelos Karanikas
- 2nd Psychiatric Department, Aristotle University of Thessaloniki, Thessaloniki, Greece,
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Hatzenbuehler ML, McLaughlin KA. Structural stigma and hypothalamic-pituitary-adrenocortical axis reactivity in lesbian, gay, and bisexual young adults. Ann Behav Med 2014; 47:39-47. [PMID: 24154988 DOI: 10.1007/s12160-013-9556-9] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Youth exposed to extreme adverse life conditions have blunted cortisol responses to stress. PURPOSE This study aims to examine whether growing up in highly stigmatizing environments similarly shapes stigmatized individuals' physiological responses to identity-related stress. METHODS We recruited 74 lesbian, gay, and bisexual young adults (mean age = 23.68) from 24 states with varying levels of structural stigma surrounding homosexuality. State-level structural stigma was coded based on several dimensions, including policies that exclude sexual minorities from social institutions (e.g., same-sex marriage). Participants were exposed to a laboratory stressor, the Trier Social Stress Test (TSST), and neuroendocrine measures were collected. RESULTS Lesbian, gay, and bisexual young adults who were raised in highly stigmatizing environments as adolescents evidenced a blunted cortisol response following the TSST compared to those from low-stigma environments. CONCLUSIONS The stress of growing up in environments that target gays and lesbians for social exclusion may exert biological effects that are similar to traumatic life experiences.
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Affiliation(s)
- Mark L Hatzenbuehler
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 West 168th Street, Room 549.B, New York, NY, 10032, USA,
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Groer MW, Kane B, Williams SN, Duffy A. Relationship of PTSD Symptoms With Combat Exposure, Stress, and Inflammation in American Soldiers. Biol Res Nurs 2014; 17:303-10. [PMID: 25202037 DOI: 10.1177/1099800414544949] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Posttraumatic stress disorder (PTSD) is of great concern in veterans. PTSD usually occurs after a person is exposed to death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence. Active duty soldiers deployed to war zones are at risk for PTSD. Psychoneuroimmunological theory predicts that PTSD, depression, and stress can lead to low-grade, chronic inflammation. We asked whether there were relationships between PTSD symptoms and chronic stress, depression and inflammation in active duty U.S. soldiers. We enrolled 52 active duty enlisted and reservist soldiers in a cross-sectional study while they participated in a week of military training in fall 2011. They completed a demographic questionnaire, the Center for Epidemiological Studies-Depression Scale, the Combat Exposure Scale, and the PTSD symptom Checklist-Military version (PCL-M). Blood samples were taken for analysis of cytokines and C-reactive protein (CRP). Hair samples shaved from the forearm were measured for cortisol. Of the soldiers, 11 had PCL-M scores in the moderate to severe range. Regression analysis demonstrated that depression and war zone deployment were strong predictors of PTSD symptoms. CRP and hair cortisol were correlated with each other and with depression and PTSD symptoms. These results suggest relationships among war zone deployment, depression, and PTSD. Chronic stress associated with depression, PTSD, and war zone experiences may be related to inflammation in active duty soldiers.
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Affiliation(s)
- Maureen W Groer
- University of South Florida College of Nursing, Tampa, FL, USA
| | - Bradley Kane
- University of South Florida College of Nursing, Tampa, FL, USA
| | | | - Allyson Duffy
- University of South Florida College of Nursing, Tampa, FL, USA
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Sex differences in neurosteroid and hormonal responses to metyrapone in posttraumatic stress disorder. Psychopharmacology (Berl) 2014; 231:3581-95. [PMID: 24952092 DOI: 10.1007/s00213-014-3621-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 05/10/2014] [Indexed: 10/25/2022]
Abstract
RATIONALE Mechanisms contributing to sex differences in the regulation of acute stress responsivity and their effect on the increased incidence of posttraumatic stress disorder (PTSD) in women are poorly understood. The reproductive hormone, progesterone, through conversion to allopregnanolone (ALLO), suppresses the hypothalamic pituitary adrenal (HPA) axis and has potent anxiolytic effects. The potential that progesterone and allopregnanolone reactivity modulate HPA axis responses and account for sex differences in PTSD has not been previously examined. OBJECTIVE The present study examined the effects of sex and PTSD on adrenocorticotropic hormone (ACTH), progesterone, and allopregnanolone responses to metyrapone and whether progesterone and allopregnanolone reactivity could affect the ACTH response in PTSD. METHODS Healthy medication-free male and premenopausal follicular phase female participants with chronic PTSD (n = 43; 49 % female) and controls (n = 42; 50 % female) completed an overnight metyrapone challenge and ACTH, progesterone, and allopregnanolone were obtained by repeated blood sampling. RESULTS The increase in ACTH response to metyrapone was higher in PTSD subjects compared to controls and in women compared to men. Contrary to our initial prediction of an inverse relationship, progesterone and allopregnanolone were positively associated with ACTH. Progesterone and allopregnanolone partially mediated the relationship between PTSD and ACTH. CONCLUSIONS Our findings of increased ACTH to metyrapone in PTSD and in women may reflect heightened hypothalamic CRF hypersecretion. Progesterone and allopregnanolone partially mediated the ACTH response in PTSD. Further characterizing sex differences in these processes will advance our understanding of the pathophysiology of PTSD, and may ultimately lead to better-targeted, more effective treatment.
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Myers B, McKlveen JM, Herman JP. Glucocorticoid actions on synapses, circuits, and behavior: implications for the energetics of stress. Front Neuroendocrinol 2014; 35:180-196. [PMID: 24361584 PMCID: PMC4422101 DOI: 10.1016/j.yfrne.2013.12.003] [Citation(s) in RCA: 201] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Revised: 12/02/2013] [Accepted: 12/06/2013] [Indexed: 01/11/2023]
Abstract
Environmental stimuli that signal real or potential threats to homeostasis lead to glucocorticoid secretion by the hypothalamic-pituitary-adrenocortical (HPA) axis. Glucocorticoids promote energy redistribution and are critical for survival and adaptation. This adaptation requires the integration of multiple systems and engages key limbic-neuroendocrine circuits. Consequently, glucocorticoids have profound effects on synaptic physiology, circuit regulation of stress responsiveness, and, ultimately, behavior. While glucocorticoids initiate adaptive processes that generate energy for coping, prolonged or inappropriate glucocorticoid secretion becomes deleterious. Inappropriate processing of stressful information may lead to energetic drive that does not match environmental demand, resulting in risk factors for pathology. Thus, dysregulation of the HPA axis may promote stress-related illnesses (e.g. depression, PTSD). This review summarizes the latest developments in central glucocorticoid actions on synaptic, neuroendocrine, and behavioral regulation. Additionally, these findings will be discussed in terms of the energetic integration of stress and the importance of context-specific regulation of glucocorticoids.
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Affiliation(s)
- Brent Myers
- Department of Psychiatry and Behavioral Neuroscience University of Cincinnati, Cincinnati, OH
| | - Jessica M McKlveen
- Department of Psychiatry and Behavioral Neuroscience University of Cincinnati, Cincinnati, OH
| | - James P Herman
- Department of Psychiatry and Behavioral Neuroscience University of Cincinnati, Cincinnati, OH
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Starcevic A, Petricevic S, Djulejic V, Radojicic Z, Starcevic B, Filipovic B. Effects of Chronic Psychosocial Stress on Reduction of Basal Glucocorticoid Levels and Suppression of Glucocorticoid Levels Following Dexamethasone Administration in Animal Model of PTSD. Open Access Maced J Med Sci 2014. [DOI: 10.3889/oamjms.2014.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aim: To further examine the neurobiological mechanisms and their outcomes responsible for the PTSD sequelae induced by laboratory animal model and to explore the effects of chronic psychosocial paradigm. We tested the hypothesis that our animal model of PTSD would display abnormalities in glucocorticoid levels that are manifest in people with PTSD and that psychosocially stressed rats exhibit a significantly greater suppression of corticosterone levels than control rats following the administration of dexamethasone.Methods: Animals were divided into two groups. The experimental group was scheduled to exposure to two types of stressors: double exposure to acute immobilization stress, and combined predator-threat stress and daily social stress. There was also administration of dexamethasone in combination with stress exposure.Results: There was a statistical difference between masses of thymus in the stress group and stress group with dexamethasone appliance (p=0.024). We found statistical significance between baseline cortisol and stress induced levels of cortisol and between stress induced group and return to baseline group.Conclusion: Significant changes in HPA activity, reductions in basal glucocorticoid levels and enhanced dexamethasone induced inhibition of glucocorticoid levels have been manifested. All of this is manifested in PTSD patients also as many other stress induces changes.
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Lee RS, Sawa A. Environmental stressors and epigenetic control of the hypothalamic-pituitary-adrenal axis. Neuroendocrinology 2014; 100:278-87. [PMID: 25427939 PMCID: PMC4428760 DOI: 10.1159/000369585] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 11/05/2014] [Indexed: 02/05/2023]
Abstract
In this review, we provide a brief summary of several key studies that broaden our understanding of stress and its epigenetic control of the function and behavior of the hypothalamic-pituitary-adrenal (HPA) axis. Clinical and animal studies suggest a link among exposure to stress, dysregulation of the HPA axis, and susceptibility to neuropsychiatric illnesses. Recent studies have supported the notion that exposure to glucocorticoids and stress in various forms, durations, and intensities during different periods of development leads to long-lasting maladaptive HPA axis response in the brain. They demonstrate that this maladaptive response is comprised of persistent epigenetic changes in the function of HPA axis-associated genes that govern homeostatic levels of glucocorticoids. Stressors and/or disruption of glucocorticoid dynamics also target genes such as brain-derived neurotrophic factor(BDNF) and tyrosine hydroxylase(TH) that are important for neuronal function and behavior. While a definitive role for epigenetic mechanisms remains unclear, these emerging studies implicate glucocorticoid signaling and its ability to alter the epigenetic landscape as one of the key mechanisms that alter the function of the HPA axis and its associated cascades. We also suggest some of the requisite studies and techniques that are important, such as additional candidate gene approaches, genome-wide epigenomic screens, and innovative functional and behavioral studies, in order to further explore and define the relationship between epigenetics and HPA axis biology. Additional studies examining stress-induced epigenetic changes of HPA axis genes, aided by innovative techniques and methodologies, are needed to advance our understanding of this relationship and lead to better preventive, diagnostic, and corrective measures.
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Affiliation(s)
- Richard S Lee
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Md., USA
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Pinna KLM, Johnson DM, Delahanty DL. PTSD, comorbid depression, and the cortisol waking response in victims of intimate partner violence: preliminary evidence. ANXIETY STRESS AND COPING 2013; 27:253-69. [PMID: 24283327 DOI: 10.1080/10615806.2013.852185] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Posttraumatic Stress Disorder (PTSD) and Major Depressive Disorder (MDD) are two highly comorbid and debilitating disorders experienced by more than half of intimate partner violence victims (IPV). Hypothalamic-pituitary-adrenal (HPA) abnormalities are common in both disorders, though the direction of abnormalities often differs. The present study examined the relationship between comorbid PTSD and MDD, and the (salivary) cortisol waking response in 104 recently abused IPV victims. Waking cortisol levels, area under the waking curve with respect to ground (AUCg), and AUC with respect to increase (AUCi) were examined to determine the relation of HPA dynamics to comorbidity for basal versus more dynamic measures. Prior to accounting for comorbidity, women with PTSD or MDD showed significantly greater AUCi than women without the respective disorder. Accounting for comorbidity, PTSD only did not differ from other groups, while MDD only and PTSD + MDD showed greater AUCi than women with neither disorder. Results were nonsignificant for waking cortisol levels or AUCg. Results suggest that MDD drives elevated waking cortisol response, but not basal cortisol activity in recently abused IPV victims. Results demonstrate the importance of examining comorbid diagnoses and HPA activity from a dynamic perspective. Therapeutic implications are discussed.
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Affiliation(s)
- Keri L M Pinna
- a Family Social Science , University of Minnesota , 1985 Buford Avenue, St. Paul , MN 55108 , USA
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Structural stigma and hypothalamic-pituitary-adrenocortical axis reactivity in lesbian, gay, and bisexual young adults. ANNALS OF BEHAVIORAL MEDICINE : A PUBLICATION OF THE SOCIETY OF BEHAVIORAL MEDICINE 2013. [PMID: 24154988 DOI: 10.1007/s12160–013–9556–9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Youth exposed to extreme adverse life conditions have blunted cortisol responses to stress. PURPOSE This study aims to examine whether growing up in highly stigmatizing environments similarly shapes stigmatized individuals' physiological responses to identity-related stress. METHODS We recruited 74 lesbian, gay, and bisexual young adults (mean age = 23.68) from 24 states with varying levels of structural stigma surrounding homosexuality. State-level structural stigma was coded based on several dimensions, including policies that exclude sexual minorities from social institutions (e.g., same-sex marriage). Participants were exposed to a laboratory stressor, the Trier Social Stress Test (TSST), and neuroendocrine measures were collected. RESULTS Lesbian, gay, and bisexual young adults who were raised in highly stigmatizing environments as adolescents evidenced a blunted cortisol response following the TSST compared to those from low-stigma environments. CONCLUSIONS The stress of growing up in environments that target gays and lesbians for social exclusion may exert biological effects that are similar to traumatic life experiences.
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