PTSD psychiatric patients exhibit a deficit in remembering

Neurocognitive difficulties in trauma-exposed adults with metabolic syndrome: no influence of PTSD status or PTSD and metabolic syndrome comorbidity

BACKGROUND

Metabolic syndrome (MetS) and posttraumatic stress disorder (PTSD) often co-occur and both may compromise cognition, owing in part to common underlying mechanisms. Few studies have investigated the additive effects of these disorders on cognitive performance. Our aims were to compare cognitive performance between patients with PTSD and trauma-exposed controls (TEC) and investigate the additive effects of MetS factors on cognition.

METHODS

In this case-control study, we included 474 adult participants, 236 with PTSD and 238 TEC. Demographic, neuropsychiatric, metabolic-related, and neurocognitive assessments were undertaken and MANCOVAs performed controlling for age. Cognitive domains (immediate and delayed memory, attention, language, visuospatial performance, working memory and global cognition) were the dependent variables in the analysis. Patient status and presence/absence of MetS or MetS components were independent variables, in each model.

RESULTS

Patients with PTSD did not demonstrate worse cognitive performance than TEC on the neurocognitive domains assessed, and the presence of MetS in patients with PTSD did not alter this finding. Individuals with MetS also did not demonstrate worse cognition when compared to those without MetS. When we looked at individual MetS features, higher BMI was associated with poorer visuospatial performance, CONCLUSIONS: These findings contrast with many previous studies showing worse neurocognitive performance related to both PTSD and MetS. Further investigation is required to establish the contribution of MetS to cognitive deficits in those with PTSD. Generalisability and inferences regarding the directionality of associations are limited.

Posttraumatic Stress Symptoms Increase the Efficiency of Memory Functioning for Trauma-Related Information

OBJECTIVE

The present study explored the resources reallocation explanation for memory biases in posttraumatic stress disorder (PTSD), whereby a preferential allocation of cognitive resources to the processing of threatening stimuli could result in both improvements in their memorization and deficits for other types of information.

METHOD

To this end, 25 participants presenting significant symptoms of PTSD (i.e., total PCL-5 score ≥33) and 32 participants presenting low levels of symptoms (i.e., total PCL-5 score <20) took part in a Remember/Know recognition procedure associated with a dual-task encoding of positive, neutral, negative, and trauma-related words. In order to manipulate the availability of cognitive resources, the encoding of each word was associated with a simultaneous encoding of series of letters and numbers.

RESULTS

Results replicated the increased production of Remember recognitions for trauma-related words in participants with significant PTSD symptoms. However, the dual-task load only impaired remember recognitions for non-trauma-related words.

CONCLUSIONS

Contrary to expectations, these findings suggest that the encoding of trauma-related information in PTSD is relatively independent from the availability of cognitive resources. Thus, rather than reflecting an increased allocation of cognitive resources to the processing of threatening information, memory biases in PTSD appeared to be supported by an enhanced efficiency of their processing.

The experience of Basic Body Awareness Therapy and its transfer to daily life amongst Danish military veterans with PTSD

INTRODUCTION

The prevalence of Post-Traumatic Stress Disorder (PTSD) among Danish military veterans is estimated to be around 10%, and treatment primarily consists of recommended psychological trauma-focused therapy.

AIM

The aim of the study was to explore veterans' experiences of their body and its potential transfer of that experience in their daily life after BBAT.

METHODS

A hermeneutic-phenomenological qualitative study using semi-structured individual interviews was used. A slightly modified Interpretive Phenomenological Analysis was applied in the data analysis. The participants were four Danish military veterans with PTSD who had completed 12 individual sessions of BBAT in addition to psychological trauma-focused therapy.

RESULTS

All participants found the BBAT treatment sessions calming and reported the overall treatment was a positive experience. Three participants experienced increased body awareness and were able to apply the exercises and principles of BBAT in their daily lives to varying degrees. All participants estimated the benefits would have been greater with more sessions.

CONCLUSION

BBAT showed potential for enhancing the bodily awareness of military veterans with PTSD experience and their ability to apply that awareness in their daily life. The degree of transfer of this skill to everyday life appeared to be dependent on the participants' mentalizing capacity.

IMPLICATIONS OF THIS STUDY

The results indicate a benefit in using body-oriented therapies such as BBAT in the treatment of military veterans with PTSD, as a supplement to trauma-focused treatment although it is hard to distinguish which treatment had which effect or if the combination of psychotherapy and BBAT had a joint effect. Future studies are needed due to the limited research in this field.

Beyond Clinical Outcomes: Posttraumatic Stress Symptoms Favor Attentional and Memory Control Abilities for Trauma-Related Words

Memory alterations and biases are core features of posttraumatic stress symptoms (PTSS). Although a large number of studies have investigated memory biases associated with PTSS, some inconsistencies remain regarding the nature of the mechanisms behind the threat-related biases observed in prior findings. The present study explored the extent to which inhibitory deficits, both for automatic and controlled processes, can account for these biases. Participants (N = 64) took part in a remember/know recognition procedure for positive, neutral, negative, and trauma-related words associated with negative priming and directed forgetting encoding. Half of the participants had high levels of PTSS (i.e., PCL-5 score > 40) and half had low levels (i.e., total PCL-5 score < 20). As both negative priming and directed forgetting effects are posited to depend on inhibitory abilities, we expected these effects to be absent for trauma-related words in participants with more severe PTSS. Replicating classic memory biases, participants with high levels of PTSS produced more "remember" recognition responses for trauma-related words, η_p ² = .10. However, contrary to our expectations, directed forgetting, η_p ² = .26; and negative priming effects were observed for trauma-related words but not for words of other valences, η_p ² = .07 and .06, respectively. Hence, rather than the expected inhibitory deficits, our results suggest that PTSS preserve the ability to inhibit trauma-related information in both attentional and memory processes. As it appears to occur at the expense of other information, this preserved cognitive functioning for trauma-related stimuli is discussed with regard to resource reallocation theories.

Inhibitory control of threat remembering in PTSD

Intrusive traumatic recollections suggest an inability in Posttraumatic Stress Disorder (PTSD) to control and notably to inhibit memories for trauma-related information. Supported by inhibitory deficits found on experimental settings in PTSD, memory functioning and memory biases in the disorder were usually explained through inhibitory and control deficits in the processing of trauma-related information. The present study aimed to directly assess this hypothesis by investigating memory control abilities for emotional information in PTSD. For this purpose, 34 patients diagnosed with PTSD were compared to 37 non-PTSD controls on an item-cued directed forgetting paradigm for emotional words combined with a Remember/Know recognition procedure. Results revealed enhanced amounts of Remember recognitions for trauma-related words in PTSD. Moreover, we replicated findings of memory control impairments in the disorder. However, such impairments only occurred for non-trauma-related words. Accordingly, it appeared that PTSD patients presented preserved memory control abilities for trauma-related words, at the expenses of other emotional valences. Surprisingly, PTSD patients presented a preserved ability to control and notably to inhibit their memory functioning for trauma-related material. In addition to potential theoretical and clinical relevance, these results are discussed in the light of resource reallocation hypotheses and vigilant-avoidant theories of information processing in PTSD.

Cotinine: Beyond that Expected, More than a Biomarker of Tobacco Consumption

A greater incidence of tobacco consumption occurs among individuals with psychiatric conditions including post-traumatic stress disorder (PTSD), bipolar disorder, major depression, and schizophrenia, compared with the general population. Even when still controversial, it has been postulated that smoking is a form of self-medication that reduces psychiatric symptoms among individuals with these disorders. To better understand the component(s) of tobacco-inducing smoking behavior, greater attention has been directed toward nicotine. However, in recent years, new evidence has shown that cotinine, the main metabolite of nicotine, exhibits beneficial effects over psychiatric symptoms and may therefore promote smoking within this population. Some of the behavioral effects of cotinine compared to nicotine are discussed here. Cotinine, which accumulates in the body as a result of tobacco exposure, crosses the blood-brain barrier and has different pharmacological properties compared with nicotine. Cotinine has a longer plasma half-life than nicotine and showed no addictive or cardiovascular effects in humans. In addition, at the preclinical level, cotinine facilitated the extinction of fear memory and anxiety after fear conditioning, improved working memory in a mouse model of Alzheimer’s disease (AD) and in a monkey model of schizophrenia. Altogether, the new evidence suggests that the pharmacological and behavioral effects of cotinine may play a key role in promoting tobacco smoking in individuals that suffer from psychiatric conditions and represents a new potential therapeutic agent against psychiatric conditions such as AD and PTSD.

The Effects of Expressive and Experiential Suppression on Memory Accuracy and Memory Distortion in Women with and Without PTSD

Specific emotion regulation strategies impinge on cognitive resources, impairing memory accuracy; however, their effects on memory distortion have been largely unexamined. Further, little is known about the effects of emotion regulation on memory in individuals with posttraumatic stress disorder (PTSD), who exhibit both emotion regulation and memory difficulties. We examined the effects of expressive suppression (i.e., concealing visible signs of emotion), experiential suppression (i.e., suppressing the subjective emotional experience), and control instructions on memory accuracy and distortion in trauma-exposed individuals with PTSD, those without PTSD, and psychologically healthy controls. Expressive and, to a lesser degree, experiential suppression led to poorer memory accuracy and both expressive and experiential suppression led to less memory distortion compared to control instructions. Participants with and without PTSD did not significantly differ. Under high cognitive load, irrelevant details may receive more processing, potentially leading to lower accuracy but improved processing of source information, preventing memory distortion.

Working memory processing of traumatic material in women with posttraumatic stress disorder

BACKGROUND

Posttraumatic stress disorder (PTSD) is associated with medial frontal and amygdala functional alterations during the processing of traumatic material and frontoparietal dysfunctions during working memory tasks. This functional magnetic resonance imaging (fMRI) study investigated the effects of trauma-related words processing on working memory in patients with PTSD.

METHODS

We obtained fMRI scans during a 3-back task and an identity task on both neutral and trauma-related words in women with PTSD who had been sexually abused and in healthy, nonexposed pair-matched controls.

RESULTS

Seventeen women with PTSD and 17 controls participated in the study. We found no behavioural working memory deficit for the PTSD group. In both tasks, deactivation of posterior parietal midline regions was more pronounced in patients than controls. Additionally, patients with PTSD recruited the left dorsolateral frontal sites to a greater extent during the processing of trauma-related material than neutral material.

LIMITATIONS

This study included only women and did not include a trauma-exposed non-PTSD control group; the results may, therefore, have been influenced by sex or by effects specific to trauma exposure.

CONCLUSION

Our results broadly confirm frontal and parietal functional variations in women with PTSD and suggest a compensatory nature of these variations with regard to the retreival of traumatic memories and global attentional deficits, respectively, during cognitively challenging tasks.

Recollection of negative information in posttraumatic stress disorder

The purpose of the present study was to investigate the effects of posttraumatic stress disorder (PTSD) associated with the effects of emotional valence on recall processes in recognition memory. Patients suffering from PTSD (n = 15) were compared with 15 nontraumatized patients with anxious and depressive symptoms and with 15 nontraumatized controls on the remember/know paradigm using negative, positive, and neutral words. The PTSD group remembered more negative words than the nontraumatized controls, F(1, 42) = 7.20, p = .01, but there was no difference between those with PTSD and those with anxiety or depression, F(1, 42) = 2.93, p = .09, or between the latter and controls, F(1, 42) < 1. This study did not allow us to determine whether this recollection bias for negative information was specific to the PTSD status or was triggered by the greater level of anxiety displayed in this group.

Source monitoring 15 years later: what have we learned from fMRI about the neural mechanisms of source memory?

Focusing primarily on functional magnetic resonance imaging (fMRI), this article reviews evidence regarding the roles of subregions of the medial temporal lobes, prefrontal cortex, posterior representational areas, and parietal cortex in source memory. In addition to evidence from standard episodic memory tasks assessing accuracy for neutral information, the article considers studies assessing the qualitative characteristics of memories, the encoding and remembering of emotional information, and false memories, as well as evidence from populations that show disrupted source memory (older adults, individuals with depression, posttraumatic stress disorder, or schizophrenia). Although there is still substantial work to be done, fMRI is advancing understanding of source memory and highlighting unresolved issues. A continued 2-way interaction between cognitive theory, as illustrated by the source monitoring framework (M. K. Johnson, S. Hashtroudi, & D. S. Lindsay, 1993), and evidence from cognitive neuroimaging studies should clarify conceptualization of cognitive processes (e.g., feature binding, retrieval, monitoring), prior knowledge (e.g., semantics, schemas), and specific features (e.g., perceptual and emotional information) and of how they combine to create true and false memories.

Cognitive abnormalities in posttraumatic stress disorder

PURPOSE OF REVIEW

The current review aims to describe and evaluate research on cognitive difficulties associated with posttraumatic stress disorder (PTSD) published between January 2007 and June 2008.

RECENT FINDINGS

The reviewed studies provide additional evidence that negative appraisals and decrements on verbal and autobiographical memory tasks are exhibited by individuals with PTSD relative to controls and may represent preexisting risk factors for PTSD rather than a result or concomitant of PTSD symptoms. In addition, the reviewed findings provide further evidence for source monitoring difficulties and attentional biases toward trauma-relevant information in PTSD. Recent research also provides evidence that, although memories of traumatic events differ in PTSD relative to other types of memories and memories of depressed individuals, they are likely on the same continuum as nontraumatic memories rather than qualitatively different.

SUMMARY

Individuals with PTSD experience cognitive alterations ranging from impairments in overall memory functioning to difficulties specific to trauma-related cues. These cognitive difficulties appear to be importantly related to the development and/or maintenance of the disorder. At this point, it is unclear whether common mechanisms may account for these diverse cognitive difficulties and whether cognitive impairments are attributable to comorbid depression.

An fMRI investigation of memory encoding in PTSD: influence of symptom severity

Previous studies have shown memory deficits in Post-Traumatic Stress Disorder (PTSD) patients, as well as abnormal patterns of brain activity, especially when retrieving trauma-related information. This study extended previous findings by investigating the neural correlates of successful memory encoding of trauma-unrelated stimuli and their relationship with PTSD symptom severity. We used the subsequent memory paradigm, in the context of event-related functional magnetic resonance imaging, in 27 PTSD patients to identify the brain regions involved in the encoding of fearful and neutral faces. Symptom severity was assessed by the Clinically Administered PTSD Scale (CAPS) scores. It was found that memory performance was negatively correlated with CAPS scores. Furthermore, a negative correlation was observed between CAPS scores and ventral medial prefrontal cortex (vmPFC) activity elicited by the subsequently forgotten faces. Finally, symptom severity predicted the contribution of the amygdala to the successful encoding of fearful faces. These results confirm the roles of the vmPFC and the amygdala in PTSD and highlight the importance of taking into account individual differences when assessing the behavioural and neural correlates of the disorder.