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Mendoza C, Barreto GE, Iarkov A, Tarasov VV, Aliev G, Echeverria V. Cotinine: A Therapy for Memory Extinction in Post-traumatic Stress Disorder. Mol Neurobiol 2018; 55:6700-6711. [PMID: 29335846 DOI: 10.1007/s12035-018-0869-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 01/07/2018] [Indexed: 12/14/2022]
Abstract
Post-traumatic stress disorder (PTSD) is a mental disorder that may develop after exposure to exceptionally threatening or unescapable horrifying events. Actual therapies fail to alleviate the emotional suffering and cognitive impairment associated with this disorder, mostly because they are ineffective in treating the failure to extinguish trauma memories in a great percentage of those affected. In this review, current behavioral, cellular, and molecular evidence supporting the use of cotinine for treating PTSD are reviewed. The role of the positive modulation by cotinine of the nicotinic acetylcholine receptors (nAChRs) and their downstream effectors, the protection of astroglia, and the inhibition of microglia in the PTSD brain are also discussed.
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Affiliation(s)
- Cristhian Mendoza
- Facultad de Ciencias de la Salud, Universidad San Sebastián, Lientur 1457, 4030000, Concepción, Chile
| | - George E Barreto
- Departamento de Nutrición y Bioquímica, Facultad de Ciencias, Pontificia Universidad Javeriana, Bogotá D.C., Colombia.,Instituto de Ciencias Biomédicas, Universidad Autónoma de Chile, Santiago, Chile
| | - Alexandre Iarkov
- Facultad de Ciencias de la Salud, Universidad San Sebastián, Lientur 1457, 4030000, Concepción, Chile
| | - Vadim V Tarasov
- Institute of Pharmacy and Translational Medicine, Sechenov First Moscow State Medical University, 119991, Moscow, Russia
| | - Gjumrakch Aliev
- Institute of Physiologically Active Compounds of the Russian Academy of Sciences, Severniy Proezd, Chernogolovka, Moscow Region, 1142432, Russia. .,"GALLY" International Biomedical Research Consulting LLC, San Antonio, TX, 78229, USA. .,School of Health Sciences and Healthcare Administration, University of Atlanta, Johns Creek, GA, 30097, USA.
| | - Valentina Echeverria
- Facultad de Ciencias de la Salud, Universidad San Sebastián, Lientur 1457, 4030000, Concepción, Chile. .,Bay Pines VA Healthcare System, Research and Development, Bay Pines, FL, 33744, USA.
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Abstract
The term translational research is typically used to refer both to "bench to bedside" research, in which preclinical research findings inform the development of novel therapeutics, and to the dissemination of new treatments to the community to encourage the use of the new health practices and treatments. Both definitions are germane to understanding the evidence base for treatment of post-traumatic stress disorder (PTSD) today. This article offers (a) an overview of evidence-based treatments for PTSD, (b) a description of a translational model of PTSD, and (c) a discussion of common barriers to dissemination and implementation of the empirically validated treatments. Recent studies in the field are discussed with a focus on pharmacotherapies, psychotherapies, and combined treatments.
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Affiliation(s)
- JoAnn Difede
- Department of Psychiatry, Weill Cornell Medical College, New York, New York 10065; , ,
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Rutledge T, Nidich S, Schneider RH, Mills PJ, Salerno J, Heppner P, Gomez MA, Gaylord-King C, Rainforth M. Design and rationale of a comparative effectiveness trial evaluating transcendental meditation against established therapies for PTSD. Contemp Clin Trials 2014; 39:50-6. [PMID: 25066921 DOI: 10.1016/j.cct.2014.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 07/13/2014] [Accepted: 07/16/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although meditation therapies such as the Transcendental Meditation (TM) technique are commonly used to assist with stress and stress-related diseases, there remains a lack of rigorous clinical trial research establishing the relative efficacy of these treatments overall and for populations with psychiatric illness. This study uses a comparative effectiveness design to assess the relative benefits of TM to those obtained from a gold-standard cognitive behavioral therapy for posttraumatic stress disorder (PTSD) in a Veteran population. METHODS AND DESIGN This paper describes the rationale and design of an in progress randomized controlled trial comparing TM to an established cognitive behavioral treatment - Prolonged Exposure (PE) - and an active control condition (health education [HE]) for PTSD. This trial will recruit 210 Veterans meeting DSM-IV criteria for PTSD, with testing conducted at 0 and 3 months for PTSD symptoms, depression, mood disturbance, quality of life, behavioral factors, and physiological/biochemical and gene expression mechanisms using validated measures. The study hypothesis is that TM will be noninferior to PE and superior to HE on changes in PTSD symptoms, using the Clinician Administered PTSD Scale (CAPS). DISCUSSION The described study represents a methodologically rigorous protocol evaluating the benefits of TM for PTSD. The projected results will help to establish the overall efficacy of TM for PTSD among Veterans, identify bio-behavioral mechanisms through which TM and PE may improve PTSD symptoms, and will permit conclusions regarding the relative value of TM against currently established therapies for PTSD.
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Affiliation(s)
- Thomas Rutledge
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, United States; University of California, 9500 Gilman Dr, La Jolla, CA 92093, United States.
| | - Sanford Nidich
- Maharishi University of Management Research Institute, 1000 North Fourth Street Fairfield, IA 52557, United States.
| | - Robert H Schneider
- Maharishi University of Management Research Institute, 1000 North Fourth Street Fairfield, IA 52557, United States.
| | - Paul J Mills
- University of California, 9500 Gilman Dr, La Jolla, CA 92093, United States.
| | - John Salerno
- Maharishi University of Management Research Institute, 1000 North Fourth Street Fairfield, IA 52557, United States.
| | - Pia Heppner
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, United States; University of California, 9500 Gilman Dr, La Jolla, CA 92093, United States.
| | - Mayra A Gomez
- Veterans Medical Research Foundation, 3350 La Jolla Village Drive, Building 13, San Diego, CA 92161, United States.
| | - Carolyn Gaylord-King
- Maharishi University of Management Research Institute, 1000 North Fourth Street Fairfield, IA 52557, United States.
| | - Maxwell Rainforth
- Maharishi University of Management Research Institute, 1000 North Fourth Street Fairfield, IA 52557, United States.
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Simmons AN, Norman SB, Spadoni AD, Strigo IA. Neurosubstrates of remission following prolonged exposure therapy in veterans with posttraumatic stress disorder. PSYCHOTHERAPY AND PSYCHOSOMATICS 2014; 82:382-9. [PMID: 24061484 DOI: 10.1159/000348867] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 04/16/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Prolonged exposure (PE) therapy is the first-line treatment for posttraumatic stress disorder (PTSD) in combat veterans. The underlying brain changes of treatment effect in PTSD are currently unknown. METHODS A total of 31 veterans with PTSD completed an fMRI scan performing an affective anticipation task at baseline and were enrolled in PE therapy. Of these, 7 prematurely terminated therapy, while 24 individuals completed PE therapy and an identical follow-up fMRI scan. At follow-up, 15 of the 24 completers still had diagnosable PTSD (NR-PTSD) and 9 of the 24 completers showed complete remission from PTSD (R-PTSD), i.e. they did not meet diagnostic criteria for PTSD. RESULTS The left anterior insula showed a significant group by scan session interaction. Specifically, the R-PTSD group showed decreased activation during anticipation of negative images from pre- to posttreatment scans, while the NR-PTSD group showed increased activation during anticipation of positive images in this region. Furthermore, the change in functional activation in the insula co-occurred with increased connectivity between this insular region and the right cingulate and right mid-posterior insular region in R-PTSD. CONCLUSIONS These findings suggest that the capacity to effectively remit from PTSD symptoms after PE treatment requires the ability to connect with physiological signals and moderate the discomfort of anticipatory anxiety of exposure therapy. These processes appear to be controlled by a network where the anterior insula is connected with the cingulate and the mid-posterior insula.
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Affiliation(s)
- Alan N Simmons
- VA San Diego Healthcare System, University of California San Diego, La Jolla, Calif., USA
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5
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McLean CP, Foa EB. The use of prolonged exposure therapy to help patients with post-traumatic stress disorder. ACTA ACUST UNITED AC 2014. [DOI: 10.2217/cpr.13.96] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Intensive Outpatient Prolonged Exposure for Combat-Related PTSD: A Case Study. COGNITIVE AND BEHAVIORAL PRACTICE 2014. [DOI: 10.1016/j.cbpra.2013.05.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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McLean CP, Foa EB. Prolonged exposure therapy for post-traumatic stress disorder: a review of evidence and dissemination. Expert Rev Neurother 2014; 11:1151-63. [DOI: 10.1586/ern.11.94] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Peterson AL, Luethcke CA, Borah EV, Borah AM, Young-McCaughan S. Assessment and Treatment of Combat-Related PTSD in Returning War Veterans. J Clin Psychol Med Settings 2011; 18:164-75. [DOI: 10.1007/s10880-011-9238-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Renshaw KD. Working With the New Generation of Service Members/Veterans From Operations Enduring and Iraqi Freedom. COGNITIVE AND BEHAVIORAL PRACTICE 2011. [DOI: 10.1016/j.cbpra.2010.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Karlin BE, Ruzek JI, Chard KM, Eftekhari A, Monson CM, Hembree EA, Resick PA, Foa EB. Dissemination of evidence-based psychological treatments for posttraumatic stress disorder in the Veterans Health Administration. J Trauma Stress 2010; 23:663-73. [PMID: 21171126 DOI: 10.1002/jts.20588] [Citation(s) in RCA: 275] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Unlike the post-Vietnam era, effective, specialized treatments for posttraumatic stress disorder (PTSD) now exist, although these treatments have not been widely available in clinical settings. The U.S. Department of Veterans Affairs (VA) is nationally disseminating 2 evidence-based psychotherapies for PTSD throughout the VA health care system. The VA has developed national initiatives to train mental health staff in the delivery of Cognitive Processing Therapy (CPT) and Prolonged Exposure therapy (PE) and has implemented a variety of strategies to promote local implementation. In this article, the authors examine VA's national CPT and PE training initiatives and report initial patient, therapist, and system-level program evaluation results. Key issues, lessons learned, and next steps for maximizing impact and sustainability are also addressed.
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Affiliation(s)
- Bradley E Karlin
- Office of Mental Health Services, VA Central Office, Washington, DC 20420, USA.
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Impairment of contextual conditioned fear extinction after microinjection of alpha-1-adrenergic blocker prazosin into the medial prefrontal cortex. Behav Brain Res 2010; 211:89-95. [DOI: 10.1016/j.bbr.2010.03.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Revised: 03/01/2010] [Accepted: 03/05/2010] [Indexed: 11/22/2022]
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Wald J, Taylor S. Implementation and Outcome of Combining Interoceptive Exposure With Trauma-Related Exposure Therapy in a Patient With Combat-Related Posttraumatic Stress Disorder. Clin Case Stud 2010. [DOI: 10.1177/1534650110373387] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Theoretical considerations and several case studies suggest that trauma-related exposure therapy (TRE), which is one of the leading treatments for posttraumatic stress disorder (PTSD), may be augmented by adding interoceptive exposure (IE) therapy. The patient is a retired veteran with chronic PTSD as the primary (most severe) disorder and comorbid major depressive disorder. Treatment consisted of four sessions of IE followed by eight sessions of TRE. Structured interviews and self-report measures of psychopathology are administered pretreatment, midtreatment (after completing IE and before commencing TRE), posttreatment, and at 3-, 6-, and 12-month follow-ups. IE is associated with decreases in PTSD symptoms and anxiety sensitivity. At posttreatment, there are further reductions in PTSD symptoms and several associated symptoms. There are also further gradual improvements over the follow-up assessments. Implications of these findings are discussed, with an emphasis on identifying potential benefits and limitations of using IE+TRE for combat-related PTSD.
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Affiliation(s)
- Jaye Wald
- University of British Columbia, Vancouver, British Columbia, Canada,
| | - Steven Taylor
- University of British Columbia, Vancouver, British Columbia, Canada
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Freedman SA, Hoffman HG, Garcia-Palacios A, (Tamar) Weiss PL, Avitzour S, Josman N. Prolonged Exposure and Virtual Reality–Enhanced Imaginal Exposure for PTSD following a Terrorist Bulldozer Attack: A Case Study. CYBERPSYCHOLOGY BEHAVIOR AND SOCIAL NETWORKING 2010; 13:95-101. [DOI: 10.1089/cyber.2009.0271] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Sara A Freedman
- Department of Psychiatry, Hadassah University Hospital, Jerusalem, Israel
| | - Hunter G. Hoffman
- HITLab, Mechanical Engineering, University of Washington, Seattle, Washington
| | | | | | - Sara Avitzour
- Department of Psychiatry, Hadassah University Hospital, Jerusalem, Israel
| | - Naomi Josman
- Department of Occupational Therapy, University of Haifa, Mount Carmel, Haifa, Israel
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Koren D, Caspi Y, Leiba R, Bloch D, Vexler B, Klein E. Acute stress reactions among medical and non-medical personnel in a general hospital under missile attacks. Depress Anxiety 2009; 26:123-8. [PMID: 18800369 DOI: 10.1002/da.20509] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Recent mass level traumatic events further boosted the growing interest in understanding the effects of primary (direct) and secondary (indirect) traumatic exposure on "helping professionals." The objectives of this study are: (1) to assess the rates and severity of PTSD symptoms (PS) among hospital workers operating under fire while treating war-related injured patients, (2) to explore the effect of PS on level of functioning in real time, and (3) to estimate the added effect of secondary traumatization over and above that of primary traumatization. METHODS Rates of PS, level of psychological distress, and level of functioning were assessed in 412 medical and non-medical personnel working in a hospital that was under missile attacks during the Second Lebanon War in the summer of 2006. The Posttraumatic Stress Disorder Scale (PSS) was used to assess severity of PS, as well as to estimate probable DSM-IV diagnosis of PTSD. RESULTS The mean number of reported PS was 8.6 (SD=4.4). Forty-three (10.2%) of the participants met the symptom and severity threshold for a probable diagnosis of PTSD, however only 13 of these 43 reported impaired level of functioning. There were no significant differences between personnel who had direct exposure to injured or traumatized casualties of the war and those who were not on PS severity and frequency of probable PTSD. CONCLUSIONS These findings suggest that hospital workers operating under prolonged life-threatening conditions are at moderate risk for PTSD. However, they do not support an incremental effect of secondary traumatic exposure.
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Affiliation(s)
- Danny Koren
- Psychology Department, University of Haifa, Haifa, Israel
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