1
|
Strigo IA, Craig ADB, Simmons AN. Expectation of pain and relief: a dynamical model of the neural basis for pain-trauma co-morbidity. Neurosci Biobehav Rev 2024:105750. [PMID: 38849067 DOI: 10.1016/j.neubiorev.2024.105750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 05/30/2024] [Accepted: 06/02/2024] [Indexed: 06/09/2024]
Abstract
Posttraumatic Stress Disorder (PTSD) is highly co-morbid with chronic pain conditions. When present, PTSD significantly worsens chronic pain outcomes. Likewise, pain contributes to a more severe PTSD as evidenced by greater disability, more frequent use of harmful opioid analgesics and increased pain severity. The biomechanism behind this comorbidity is incompletely understood, however recent work strongly supports the widely-accepted role of expectation, in the entanglement of chronic pain and trauma symptoms. This work has shown that those with trauma have a maladaptive brain response while expecting stress and pain, whereas those with chronic pain may have a notable impairment in brain response while expecting pain relief. This dynamical expectation model of the interaction between neural systems underlying expectation of pain onset (traumatic stress) and pain offset (chronic pain) is biologically viable and may provide a biomechanistic insight into pain-trauma comorbidity. These predictive mechanisms work through interoceptive pathways in the brain critically the insula cortex. Here we highlight how the neural expectation-related mechanisms augment the existing models of pain and trauma to better understand the dynamics of pain and trauma comorbidity. These ideas will point to targeted complementary clinical approaches, based on mechanistically separable neural biophenotypes for the entanglement of chronic pain and trauma symptoms.
Collapse
Affiliation(s)
- Irina A Strigo
- Emotion and Pain Laboratory, San Francisco Veterans Affairs Health Care Center, 4150 Clement Street, San Francisco, CA 94121, USA; Department of Psychiatry, University of California San Francisco, 401 Parnassus Ave, San Francisco, CA 94143, USA
| | - A D Bud Craig
- Emotion and Pain Laboratory, San Francisco Veterans Affairs Health Care Center, 4150 Clement Street, San Francisco, CA 94121, USA; Department of Psychiatry, University of California San Francisco, 401 Parnassus Ave, San Francisco, CA 94143, USA; Center of Excellence in Stress and Mental Health, San Diego Veterans Affairs Health Care Center, 3350 La Jolla Village Dr, San Diego, CA 92161, USA; Stress and Neuroimaging Laboratory, San Diego Veterans Affairs Health Care Center, 3350 La Jolla Village Drive, MC 151-B, San Diego, CA 92161, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA
| | - Alan N Simmons
- Center of Excellence in Stress and Mental Health, San Diego Veterans Affairs Health Care Center, 3350 La Jolla Village Dr, San Diego, CA 92161, USA; Stress and Neuroimaging Laboratory, San Diego Veterans Affairs Health Care Center, 3350 La Jolla Village Drive, MC 151-B, San Diego, CA 92161, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA
| |
Collapse
|
2
|
van den Heuvel LL, Assim A, Koning M, Nöthling J, Seedat S. Childhood maltreatment and internalizing/externalizing disorders in trauma-exposed adolescents: Does posttraumatic stress disorder (PTSD) severity have a mediating role? Dev Psychopathol 2023:1-13. [PMID: 38017689 DOI: 10.1017/s0954579423001414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
Childhood maltreatment is associated with wide-ranging psychopathology at all stages of life. In the current study, we investigated whether posttraumatic stress disorder (PTSD) severity mediated the association between childhood maltreatment and internalizing and externalizing disorders among 262 South African trauma-exposed adolescents (aged 12-18 years). Childhood maltreatment and PTSD symptom severity were assessed using the Childhood Trauma Questionnaire and the Child PTSD Checklist, respectively. Psychiatric disorders were assessed utilizing the Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime version and were grouped into internalizing or externalizing disorders. Hierarchal logistic regression was used to assess the association of childhood maltreatment subtype with internalizing and externalizing disorders, controlling for age and gender, with PTSD symptom severity added to the final model. We found that sexual abuse was significantly associated with internalizing disorders, although this effect was no longer significant when PTSD was added to the model demonstrating that PTSD mediated the association between sexual abuse and internalizing disorders. Physical abuse, but not PTSD, was associated with externalizing disorders. Physical abuse, emotional neglect, and PTSD were associated with comorbid internalizing and externalizing disorders. These findings have implications for intervention and prevention strategies targeted at trauma-exposed adolescents with a history of childhood maltreatment.
Collapse
Affiliation(s)
- Leigh Luella van den Heuvel
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Genomics of Brain Disorders, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Ayesha Assim
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Milo Koning
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Jani Nöthling
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Genomics of Brain Disorders, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| |
Collapse
|
3
|
Feng J, Liang Y, Yu T. MM-GANN-DDI: Multimodal Graph-Agnostic Neural Networks for Predicting Drug-Drug Interaction Events. Comput Biol Med 2023; 166:107492. [PMID: 37820558 DOI: 10.1016/j.compbiomed.2023.107492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 08/15/2023] [Accepted: 09/15/2023] [Indexed: 10/13/2023]
Abstract
Personalized treatment of complex diseases relies on combined medication. However, the occurrence of unexpected drug-drug interactions (DDIs) in these combinations can lead to adverse effects or even fatalities. Although recent computational methods exhibit promising performance in DDI screening, their practical implementation faces two significant challenges: (i) the availability of comprehensive datasets to support clinical application, and (ii) the ability to infer DDI types for new drugs beyond the existing dataset coverage. To mitigate these challenges, we propose MM-GANN-DDI: a Multimodal Graph-Agnostic Neural Network for Predicting Drug-Drug Interaction Events. We first mine six drug modalities and incorporate a graph attention (GAT) mechanism to fuse these modalities with the topological features of the DDI graph. We further propose a novel graph neural network training mechanism called graph-agnostic meta-training (GAMT), which effectively leverages topological information from the DDI graph and efficiently predicts DDI types for new drugs beyond the available dataset. Specifically, GAMT samples meta-graphs from the original DDI graph, splitting them into support and query sets to simulate seen and unseen drugs. Two-level optimizations are applied to enhance the model's generalization capability. We evaluate our model on two datasets (DB-v1 and DB-v2) across three tasks. Our MM-GANN-DDI demonstrates competitive performance on all three tasks. Notably, in Task 2, which focuses on predicting DDI types for drugs outside the dataset, our proposed model outperforms other methods, exhibiting an improvement of 4.6 percentage points in AUPR on DB-v1 and 5.9 percentage points on DB-v2. Additionally, our model surpasses state-of-the-art methods and classic approaches in terms of accuracy, F1 score, precision, and recall. Ablation experiments provide further validation of the effectiveness of the proposed model design. Importantly, our model exhibits the potential to discover unobserved DDIs, demonstrating its practical application in clinical medication.
Collapse
Affiliation(s)
- Junning Feng
- Faculty of Innovation Engineering, Macau University of Science and Technology, 999078, Macao Special Administrative Region of China; School of Data Science, The Chinese University of Hong Kong-Shenzhen, Shenzhen, 518055, China
| | - Yong Liang
- Peng Cheng Laboratory, Shenzhen, 518055, China.
| | - Tianwei Yu
- School of Data Science, The Chinese University of Hong Kong-Shenzhen, Shenzhen, 518055, China
| |
Collapse
|
4
|
Sanghvi DE, Rackoff GN, Newman MG. Latent class analysis of post-traumatic stress disorder symptoms following exposure to Hurricane Ike. Soc Sci Med 2023; 327:115942. [PMID: 37210980 PMCID: PMC10519432 DOI: 10.1016/j.socscimed.2023.115942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 03/05/2023] [Accepted: 04/30/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND There is substantial heterogeneity in how people react to potentially traumatic events (PTEs). Although some literature has explored this heterogeneity, there are only a few studies identifying factors associated with it within the disaster literature. OBJECTIVE The current investigation identified latent classes of post-traumatic stress disorder (PTSD) symptoms and differences between these classes after exposure to Hurricane Ike. METHODS Adults living in Galveston and Chambers County, Texas, (n = 658) completed a battery of measures during an interview conducted two to five months after Hurricane Ike. Latent class analysis (LCA) was performed to identify latent classes of PTSD symptoms. Additionally, gender, age, racial or ethnic minority status, depression severity, anxiety severity, quality of life, perceived need for services, and disaster exposure were examined to explore class differences. RESULTS LCA supported a 3-class model with low (n = 407, 61.9%), moderate (n = 191, 29.0%), and high PTSD symptoms (n = 60, 9.1%). Women appeared most at-risk for a moderate-severity presentation as compared to a low-severity presentation. Further, racial or ethnic minority groups appeared most at-risk for a high-severity presentation as compared to a moderate-severity presentation. Overall, the high symptom class had the poorest well-being, the most perceived need for services, and the highest exposure to the disaster, followed by the moderate symptom class, and finally the low symptom class. CONCLUSIONS PTSD symptom classes appeared to be differentiated primarily by overall severity as well as important psychological, contextual, and demographic dimensions.
Collapse
|
5
|
Moser DA, Graf S, Glaus J, Urben S, Jouabli S, Pointet Perrizolo V, Suardi F, Robinson J, Rusconi Serpa S, Plessen KJ, Schechter DS. On the complex and dimensional relationship of maternal posttraumatic stress disorder during early childhood and child outcomes at school-age. Eur Psychiatry 2023; 66:e20. [PMID: 36734250 PMCID: PMC9970153 DOI: 10.1192/j.eurpsy.2023.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Several studies have shown associations between maternal interpersonal violence-related posttraumatic stress disorder (PTSD), child mental health problems, and impaired socioemotional development. However, the existing literature lacks evidence linking constellations of risk factors such as maternal interpersonal-violence-related PTSD, psychopathology, and interactive behavior with toddlers and outcome measures at school-age. METHODS This study involved a prospective, longitudinal investigation of 62 mothers and examined the relationship between maternal variables measured when children were in early childhood (mean age 27 months), and child outcomes when children were school-age (age mean = 83.2 months) while retaining a focus on the context of maternal PTSD. To identify and weigh associated dimensions comparatively, we employed sparse canonical correlation analysis (sCCA) aimed at associating dimensions of a dataset of 20 maternal variables in early childhood with that of more than 20 child outcome variables (i.e., child psychopathology, life-events, and socioemotional skills) at school-age. RESULTS Phase 1 variables with the highest weights were those of maternal psychopathology: PTSD, depressive and dissociative symptoms, and self-report of parental stress. The highest weighted Phase 2 child outcome measures were those of child psychopathology: PTSD, anxiety, and depressive symptoms as well as peer bullying and victimization. CONCLUSIONS sCCA revealed that trauma-related concepts in mothers were significantly and reliably associated with child psychopathology and other indicators of risk for intergenerational transmission of violence and victimization. The results highlight the dimensional and multifaceted nature-both for mothers as well as children-of the intergenerational transmission of violence and associated psychopathology.
Collapse
Affiliation(s)
- Dominik Andreas Moser
- Child and Adolescent Psychiatry Service, Lausanne University Hospital, Lausanne, Switzerland.,Institute of Psychology, University of Bern, Bern, Switzerland
| | - Shannen Graf
- Child and Adolescent Psychiatry Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Jennifer Glaus
- Child and Adolescent Psychiatry Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Sébastien Urben
- Child and Adolescent Psychiatry Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Sondes Jouabli
- Child and Adolescent Psychiatry Service, Lausanne University Hospital, Lausanne, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | | | - Francesca Suardi
- Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
| | - JoAnn Robinson
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Sandra Rusconi Serpa
- Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
| | - Kerstin Jessica Plessen
- Child and Adolescent Psychiatry Service, Lausanne University Hospital, Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Daniel Scott Schechter
- Child and Adolescent Psychiatry Service, Lausanne University Hospital, Lausanne, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.,Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, New York, USA
| |
Collapse
|
6
|
[Latent posttraumatic stress disorder in psychiatry at the Mohammed VI university hospital in Oujda]. L'ENCEPHALE 2023; 49:50-56. [PMID: 34887079 DOI: 10.1016/j.encep.2021.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 09/20/2021] [Accepted: 09/30/2021] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Posttraumatic stress disorder (PTSD) is a severe psychiatric disorder following exposure to a traumatic event. It is rarely diagnosed alone. High comorbidity has been observed between PTSD and other psychiatric disorders. OBJECTIVES The purpose of this work is to evaluate the prevalence of latent PTSD in a population followed in a service of psychiatry and to describe the associated factors. MATERIALS AND METHODS It is a descriptive cross-sectional study of 300 patients treated for psychiatric disorders, using a hetero-questionnaire containing sociodemographic data, personal and family history, clinical and therapeutic data, and characteristics of the traumatic event. The MINI was used to screen for PTSD and assess suicidal risk. RESULTS Exposure to a traumatic event is reported by 46.7% of patients, and PTSD by 19.7%. The suicidal risk is 47.7% in the presence of this comorbidity. An ESPT is significantly associated with a schizoaffective disorder and significant suicidal risk. The recentness of the traumatic event, the presence of a state of acute stress and the absence of family psychological support are significantly associated with the occurrence of PTSD. CONCLUSION A significant number of patients with a psychiatric disorder have undiagnosed PTSD, thus explaining their clinical deterioration. Screening and treatment of the underlying PTSD would help to improve their management.
Collapse
|
7
|
Marfoli A, Viglia F, Di Consiglio M, Merola S, Sdoia S, Couyoumdjian A. Anaclitic-sociotropic and introjective-autonomic personality dimensions and depressive symptoms: a systematic review. Ann Gen Psychiatry 2021; 20:53. [PMID: 34915926 PMCID: PMC8680331 DOI: 10.1186/s12991-021-00373-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 11/25/2021] [Indexed: 11/10/2022] Open
Abstract
Sociotropy (anaclitic) and autonomy (introjective) are conceptualised as two personality dimensions that confer vulnerability to depression. According to Blatt and Beck's theories, sociotropic individuals exhibit distinctive patterns of symptoms such as prominent anxiety, depressed mood, helplessness, crying and somatic concerns, while self-critical ones seem to exhibit a pattern of symptoms including prominent guilt, hopelessness, feelings of failure and worthlessness and other cognitive symptoms.This systematic review was performed with the aim of investigating whether and to what extent psychological dimensions of anaclitic-sociotropic and introjective-autonomy are related to a specific core of depressive symptoms. The search was conducted in three databases (PubMed, PsycINFO and Scopus) and 27 articles were selected.Results showed a weak association between somatic symptoms and dependent personality traits, while the relationship between self-criticism and cognitive symptomatology was significantly higher. These findings are discussed in the context of future research, necessary to corroborate the existence of a form of depression characterised by somatic features usually ignored by diagnostic criteria, essential to direct psychological treatments to these depressive personality differences.
Collapse
Affiliation(s)
- Angelica Marfoli
- Dipartimento di Psicologia, Sapienza Università di Roma, Via dei Marsi 78, 00185, Roma, Italy
| | - Federica Viglia
- Dipartimento di Psicologia, Sapienza Università di Roma, Via dei Marsi 78, 00185, Roma, Italy
| | - Micaela Di Consiglio
- Dipartimento di Psicologia, Sapienza Università di Roma, Via dei Marsi 78, 00185, Roma, Italy
| | - Sheila Merola
- Dipartimento di Psicologia, Sapienza Università di Roma, Via dei Marsi 78, 00185, Roma, Italy
| | - Stefano Sdoia
- Dipartimento di Psicologia, Sapienza Università di Roma, Via dei Marsi 78, 00185, Roma, Italy
| | - Alessandro Couyoumdjian
- Dipartimento di Psicologia, Sapienza Università di Roma, Via dei Marsi 78, 00185, Roma, Italy.
| |
Collapse
|
8
|
Minhas M, Belisario K, Gonzalez-Roz A, Halladay J, Morris V, Keough M, Murphy J, MacKillop J. Is talk cheap? Correspondence between self-attributions about changes in drinking and longitudinal changes in drinking during the coronavirus disease 2019 pandemic. Alcohol Clin Exp Res 2021; 45:2560-2568. [PMID: 34590313 PMCID: PMC8653375 DOI: 10.1111/acer.14724] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/22/2021] [Accepted: 09/23/2021] [Indexed: 11/28/2022]
Abstract
Background There are concerns that the coronavirus disease 2019 (COVID‐19) pandemic may increase drinking, but most accounts to date are cross‐sectional studies of self‐attributions about alcohol‐related impacts and the accuracy of those perceptions has not been investigated. The current study examined the correspondence between self‐attributions of pandemic‐related changes in drinking and longitudinally‐measured changes in drinking and alcohol‐related consequences in a sample of emerging adults. Methods In an existing ongoing longitudinal study on alcohol misuse (≥1 heavy episodic drinking day/month) in emerging adults, 473 individuals (Mage = 23.8; 41.7% male) received a supplemental assessment from June 17th to July 1st, 2020, during public health restrictions in Ontario, Canada. These intrapandemic data were matched to the most recent assessment prior to the pandemic (~8 months earlier). Self‐attributions about changes in drinking were assessed globally (i.e., increases/decreases/no change) and with higher resolution questions clarifying the magnitude of changes. Results Global self‐attributions about changes in drinking substantively paralleled longitudinal changes in weekly drinking days (DD). In the longitudinal data, individuals’ who self‐reported increases in drinking exhibited significant increases; individuals’ who self‐reported decreases exhibited significant decreases; and individuals who self‐reported no change exhibited nonsignificant changes. Higher resolution items likewise revealed longitudinal patterns of weekly drinking that were substantively consistent with self‐attributions. Heavy DD and alcohol‐related consequences exhibited similar patterns, but only individuals who self‐reported large increases in drinking exhibited increases on these outcomes. Individuals who reported large increases in drinking also exhibited significant increases in depression and posttraumatic stress disorder symptoms. Conclusions Self‐attributions about drinking closely corresponded to longitudinal changes in drinking, supporting the validity of self‐attributions in population‐level surveys, particularly in young adults. Notably, a subgroup was identified that exhibited pronounced increases for all alcohol‐related outcomes and concurrent increases in internalizing psychopathology.
Collapse
Affiliation(s)
- Meenu Minhas
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, McMaster University, Hamilton, Ontario, Canada
| | - Kyla Belisario
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, McMaster University, Hamilton, Ontario, Canada
| | - Alba Gonzalez-Roz
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, McMaster University, Hamilton, Ontario, Canada.,Department of Psychology/IUNICS, University of the Balearic Islands, Majorca, Spain
| | - Jillian Halladay
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, McMaster University, Hamilton, Ontario, Canada.,Department of Health Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Vanessa Morris
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - Matthew Keough
- Department of Psychology, York University, Toronto, Ontario, Canada
| | | | - James MacKillop
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, McMaster University, Hamilton, Ontario, Canada.,Homewood Research Institute, Guelph, Ontario, Canada
| |
Collapse
|
9
|
Lekkas D, Jacobson NC. Using artificial intelligence and longitudinal location data to differentiate persons who develop posttraumatic stress disorder following childhood trauma. Sci Rep 2021; 11:10303. [PMID: 33986445 PMCID: PMC8119967 DOI: 10.1038/s41598-021-89768-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 04/30/2021] [Indexed: 11/09/2022] Open
Abstract
Post-traumatic stress disorder (PTSD) is characterized by complex, heterogeneous symptomology, thus detection outside traditional clinical contexts is difficult. Fortunately, advances in mobile technology, passive sensing, and analytics offer promising avenues for research and development. The present study examined the ability to utilize Global Positioning System (GPS) data, derived passively from a smartphone across seven days, to detect PTSD diagnostic status among a cohort (N = 185) of high-risk, previously traumatized women. Using daily time spent away and maximum distance traveled from home as a basis for model feature engineering, the results suggested that diagnostic group status can be predicted out-of-fold with high performance (AUC = 0.816, balanced sensitivity = 0.743, balanced specificity = 0.8, balanced accuracy = 0.771). Results further implicate the potential utility of GPS information as a digital biomarker of the PTSD behavioral repertoire. Future PTSD research will benefit from application of GPS data within larger, more diverse populations.
Collapse
Affiliation(s)
- Damien Lekkas
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, 46 Centerra Parkway, Suite 300, Lebanon, NH, 03766, USA. .,Quantitative Biomedical Sciences Program, Dartmouth College, Lebanon, NH, 03766, USA.
| | - Nicholas C Jacobson
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, 46 Centerra Parkway, Suite 300, Lebanon, NH, 03766, USA.,Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Lebanon, NH, 03766, USA.,Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, NH, 03766, USA.,Quantitative Biomedical Sciences Program, Dartmouth College, Lebanon, NH, 03766, USA
| |
Collapse
|
10
|
Levin-Aspenson HF, Watson D, Ellickson-Larew S, Stanton K, Stasik-O'Brien SM. Beyond Distress and Fear: Differential Psychopathology Correlates of PTSD Symptom Clusters. J Affect Disord 2021; 284:9-17. [PMID: 33581490 DOI: 10.1016/j.jad.2021.01.090] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 01/12/2021] [Accepted: 01/31/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Research suggests that re-experiencing and avoidance are "core" PTSD symptoms, but there has been little research explicating their unique connections to psychopathology other than internalizing conditions such as depression and anxiety. We aim to unpack symptom heterogeneity within PTSD by exploring associations between re-experiencing and avoidance clusters and major psychopathology domains in a dimensional metastructural framework (e.g., the Hierarchical Taxonomy of Psychopathology, or HiTOP). METHOD We used a trauma-exposed community sample (n = 233, 66.1% female, mean age = 45 years) to compare re-experiencing and avoidance's associations with factor-analytically derived dimensions generally corresponding to HiTOP structure: Distress, Fear, Detachment, Antagonism, Disinhibition, Thought Disorder, and Compulsivity. RESULTS Both re-experiencing and avoidance were robustly related to Fear. Re-experiencing was particularly related to Distress and Thought Disorder, whereas avoidance was related to domains involving overinhibition (e.g., Compulsivity). Relative to avoidance, re-experiencing had broader and more substantial associations with psychopathology, partly as a function of its greater saturation with dysphoria. LIMITATIONS Coverage of PTSD symptoms was limited to questionnaire measurement of re-experiencing and avoidance clusters. Results need to be replicated in samples selected for posttraumatic psychopathology. CONCLUSION Although they are strongly intercorrelated and both are robustly related to Fear, re-experiencing and avoidance differ substantially in their unique relations with other forms of psychopathology, and re-experiencing may be less specific to PTSD than previously thought. These differences can be used to understand the etiology and phenomenology of re-experiencing and avoidance in greater depth to inform more targeted and effective interventions for posttraumatic psychopathology.
Collapse
|
11
|
Valentine SE. Gender differences in exposure to potentially traumatic events and diagnosis of posttraumatic stress disorder (PTSD) by racial and ethnic group-Author Reply. Gen Hosp Psychiatry 2020; 67:167. [PMID: 32571588 DOI: 10.1016/j.genhosppsych.2020.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 06/11/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Sarah E Valentine
- Boston University School of Medicine, Boston Medical Center, United States of America.
| |
Collapse
|
12
|
Multi-domain potential biomarkers for post-traumatic stress disorder (PTSD) severity in recent trauma survivors. Transl Psychiatry 2020; 10:208. [PMID: 32594097 PMCID: PMC7320966 DOI: 10.1038/s41398-020-00898-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 05/28/2020] [Accepted: 06/02/2020] [Indexed: 12/02/2022] Open
Abstract
Contemporary symptom-based diagnosis of post-traumatic stress disorder (PTSD) largely overlooks related neurobehavioral mechanisms and relies entirely on subjective interpersonal reporting. Previous studies associating biomarkers with PTSD have mostly used symptom-based diagnosis as the main outcome measure, disregarding the wide variability and richness of PTSD phenotypical features. Here, we aimed to computationally derive potential biomarkers that could efficiently differentiate PTSD subtypes among recent trauma survivors. A three-staged semi-unsupervised method ("3C") was used to firstly categorize individuals by current PTSD symptom severity, then derive clusters based on clinical features related to PTSD (e.g. anxiety and depression), and finally to classify participants' cluster membership using objective multi-domain features. A total of 256 features were extracted from psychometrics, cognitive functioning, and both structural and functional MRI data, obtained from 101 adult civilians (age = 34.80 ± 11.95; 51 females) evaluated within 1 month of trauma exposure. The features that best differentiated cluster membership were assessed by importance analysis, classification tree, and ANOVA. Results revealed that entorhinal and rostral anterior cingulate cortices volumes (structural MRI domain), in-task amygdala's functional connectivity with the insula and thalamus (functional MRI domain), executive function and cognitive flexibility (cognitive testing domain) best differentiated between two clusters associated with PTSD severity. Cross-validation established the results' robustness and consistency within this sample. The neural and cognitive potential biomarkers revealed by the 3C analytics offer objective classifiers of post-traumatic morbidity shortly following trauma. They also map onto previously documented neurobehavioral mechanisms associated with PTSD and demonstrate the usefulness of standardized and objective measurements as differentiating clinical sub-classes shortly after trauma.
Collapse
|
13
|
Koirala R, Søegaard EGI, Ojha SP, Hauff E, Thapa SB. Trauma related psychiatric disorders and their correlates in a clinical sample: A cross-sectional study in trauma affected patients visiting a psychiatric clinic in Nepal. PLoS One 2020; 15:e0234203. [PMID: 32541999 PMCID: PMC7295578 DOI: 10.1371/journal.pone.0234203] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 05/20/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Nepal, like many other low-income countries, has a great burden of mental health issues but few resources to meet them. In addition, Nepal has endured several traumatic events in recent decades but the impact on mental health has not been studied in clinical settings. This study explores trauma-related psychiatric disorders and their correlates. METHODS 100 patients with a history of trauma who visited the outpatient psychiatry clinic at a University hospital in Kathmandu were assessed. The Composite International Diagnostic Interview 2.1 (CIDI) was used to evaluate lifetime and current depressive disorder, generalized anxiety disorder (GAD) and lifetime post-traumatic stress disorder (PTSD). Current PTSD was evaluated using PSTD Checklist-Civilian Version (PCL-C). RESULTS The median number of lifetime traumatic events was two. Natural disaster was the most common trauma type (84%) compared to other types of trauma. Rape was reported as the most traumatizing. Current PTSD was found in 15%, depression in 33% and GAD in 38% of the patients. The lifetime rates were PTSD 83%, depression 45% and GAD 40%. There was high comorbidity between the disorders. The 31 to 45 years age group, above high school education level and trauma types other than earthquake were independently associated with current PTSD. Marital status and upper socioeconomic status (SES) compared to upper-middle SES were independently associated with lifetime PTSD. Both lifetime and current depression rates were independently associated with the upper SES compared to upper-middle SES. Place of living, education above high school and lower-middle SES were significantly associated with lifetime and current GAD. CONCLUSION PTSD, depression and GAD were prevalent in a trauma exposed patient population visiting a psychiatric clinic in Nepal. High rates of comorbidities and several risk factors were identified. Our findings highlight the need for addressing trauma related disorders in clinical settings in developing countries.
Collapse
Affiliation(s)
- Rishav Koirala
- Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Brain and Neuroscience Center, Kathmandu, Nepal
- * E-mail:
| | - Erik Ganesh Iyer Søegaard
- Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Saroj Prasad Ojha
- Department of Psychiatry and Mental Health, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Edvard Hauff
- Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Suraj B. Thapa
- Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Department of Psychiatry and Mental Health, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| |
Collapse
|
14
|
TAN MAKBULENESLISAH, MEVSIM VILDAN, TOPAL İSMAIL, ALKAN ÇIGDEM. Long-term posttraumatic stress disorder in mine workers after a coalmining disaster. ARCH CLIN PSYCHIAT 2020. [DOI: 10.1590/0101-60830000000223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | | | - İSMAIL TOPAL
- Tek Ilke Iş Sağliği ve Güvenliği Eğitim Kurumu, Turkey
| | | |
Collapse
|
15
|
Lotzin A, Grundmann J, Hiller P, Pawils S, Schäfer I. Profiles of Childhood Trauma in Women With Substance Use Disorders and Comorbid Posttraumatic Stress Disorders. Front Psychiatry 2019; 10:674. [PMID: 31681026 PMCID: PMC6813657 DOI: 10.3389/fpsyt.2019.00674] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 08/20/2019] [Indexed: 12/25/2022] Open
Abstract
Background: It is increasingly becoming accepted that substance use disorders, including substance abuse and substance dependence, are closely related to childhood trauma and posttraumatic stress disorders. Among women with substance use disorders, the majority report sexual, physical or emotional abuse, or neglect. However, it is poorly understood which types of childhood trauma co-occur in women with substance use disorders and how combinations of different types and severities of childhood trauma are related to clinical characteristics. This information is important to inform treatment of substance use disorders. Aim: The first aim of this research was to investigate profiles of childhood trauma in female patients with substance use disorders and posttraumatic stress disorders. The second aim was to examine relationships between these childhood trauma profiles and addiction characteristics or current clinical symptoms. Methods: We includeda 343 treatment-seeking women with substance use disorders and comorbid posttraumatic stress disorders according to DSM-IV. Five types of childhood trauma (sexual abuse, physical abuse, emotional abuse) were measured using the Childhood Trauma Questionnaire. Addiction characteristics were assessed by using the Addiction Severity Index-lite. Current severity of clinical symptoms was determined by the Symptom-Checklist-27. Latent profile analysis was conducted to distinguish profiles of childhood trauma. Analysis of variance was applied to examine the relationship between childhood trauma profiles and addiction characteristics or severity of clinical symptoms. Results: Nine out of ten women reported at least one type of childhood abuse or neglect. Four different childhood trauma profiles could be distinguished that characterized different types and severities of childhood trauma: 'Low trauma'; 'Moderate sexual abuse and emotional abuse'; 'Severe sexual abuse and emotional abuse'; and 'Severe levels of all types of trauma'. Profiles with more severe levels of childhood trauma showed an earlier age at initiation and escalation of substance use. Furthermore, childhood trauma profiles were related to current severity of depressive symptoms, dysthymic symptoms, sociophobic symptoms, and distrust. Conclusion: In women with substance use disorders and posttraumatic stress disorders, childhood trauma profiles can inform about addiction characteristics and severity of a wide range of clinical symptoms. This information is essential to understand current treatment needs and should be systematically assessed in women with substance use disorders and trauma exposure.
Collapse
Affiliation(s)
- Annett Lotzin
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Center for Interdisciplinary Addiction Research, University of Hamburg, Hamburg, Germany
| | - Johanna Grundmann
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Center for Interdisciplinary Addiction Research, University of Hamburg, Hamburg, Germany
| | - Philipp Hiller
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Center for Interdisciplinary Addiction Research, University of Hamburg, Hamburg, Germany
| | - Silke Pawils
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ingo Schäfer
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Center for Interdisciplinary Addiction Research, University of Hamburg, Hamburg, Germany
| |
Collapse
|
16
|
da Silva HC, Furtado da Rosa MM, Berger W, Luz MP, Mendlowicz M, Coutinho ESF, Portella CM, Marques PIS, Mograbi DC, Figueira I, Ventura P. PTSD in mental health outpatient settings: highly prevalent and under-recognized. ACTA ACUST UNITED AC 2018; 41:213-217. [PMID: 30328959 PMCID: PMC6794137 DOI: 10.1590/1516-4446-2017-0025] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 04/03/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To estimate the current prevalence of posttraumatic stress disorder (PTSD) and the diagnosis rate of this disorder ascertained by psychiatrists in training. METHODS We interviewed 200 adults under treatment in a university mental health outpatient clinic. The PTSD diagnoses obtained using the Structured Clinical Interview for DSM-IV (SCID-IV) were compared with the patients' medical records. RESULTS Forty-one patients (20.5%) were diagnosed with current PTSD, but only one of them (2.4%) had previously received this diagnosis. This study confirms that although PTSD is highly prevalent among mental health outpatients, it is remarkably underdiagnosed in teaching hospitals. CONCLUSIONS These findings suggest that psychiatrists in training may be failing to investigate traumatic events and their consequences and strongly indicate that trauma-related issues should be given more prominence in psychiatry curricula and psychiatrist training.
Collapse
Affiliation(s)
- Herika C da Silva
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Maísa M Furtado da Rosa
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - William Berger
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Mariana P Luz
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Mauro Mendlowicz
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.,Departamento de Psiquiatria e Saúde Mental, Universidade Federal Fluminense (UFF), Niterói, RJ, Brazil
| | - Evandro S F Coutinho
- Departamento de Epidemiologia e Métodos Quantitativos em Saúde (DEMQS), Escola Nacional de Saúde Pública (ENSP), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Carla M Portella
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Pamela I S Marques
- Departamento de Psicologia, Pontifícia Universidade Católica do Rio de Janeiro (PUC-Rio), Rio de Janeiro, RJ, Brazil
| | - Daniel C Mograbi
- Departamento de Psicologia, Pontifícia Universidade Católica do Rio de Janeiro (PUC-Rio), Rio de Janeiro, RJ, Brazil
| | - Ivan Figueira
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Paula Ventura
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.,Instituto de Psicologia, UFRJ, Rio de Janeiro, RJ, Brazil
| |
Collapse
|
17
|
Poulsen DV, Stigsdotter UK, Davidsen AS. "That Guy, Is He Really Sick at All?" An Analysis of How Veterans with PTSD Experience Nature-Based Therapy. Healthcare (Basel) 2018; 6:E64. [PMID: 29904038 PMCID: PMC6023361 DOI: 10.3390/healthcare6020064] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 06/02/2018] [Accepted: 06/08/2018] [Indexed: 11/17/2022] Open
Abstract
Serving in the military leads to mental diseases, such as post-traumatic stress disorder (PTSD), for a percentage of soldiers globally. The number of veterans with PTSD is increasing and, although medication and psychological treatments are offered, treatment results could be improved. Historically, different forms of nature-based therapy have been used for this target group. However, in spite of anecdotally good results, studies measuring the effect of this form of therapy are still lacking. The aim of this study is to explore how veterans with PTSD manage their everyday lives during and after a ten-week nature-based intervention in a therapy garden. METHODS Eight veterans participated in qualitative interviews, which were conducted during a one-year period and were analyzed using interpretative phenomenological analysis (IPA). RESULTS Five themes emerged from the IPA analysis: Bodily symptoms; relationships; building new identities; the future; and lessons learned. All the participating veterans gained a greater insight into and mastering of their condition, achieved better control of their lives, and developed tools to handle life situations more appropriately and to build a new identity. This improved their ability to participate in social activities and employment. CONCLUSION The results should be considered in the future treatment of veterans with PTSD.
Collapse
Affiliation(s)
- Dorthe Varning Poulsen
- Department of Geosciences and Natural Resource Management, University of Copenhagen, Rolighedsvej 23, 1958 Frederiksberg C, Denmark.
| | - Ulrika K Stigsdotter
- Department of Geosciences and Natural Resource Management, University of Copenhagen, Rolighedsvej 23, 1958 Frederiksberg C, Denmark.
| | - Annette Sofie Davidsen
- The Research Unit for General Practice, University of Copenhagen, Øster Farimagsgade 5, 1014 København K, Denmark.
| |
Collapse
|
18
|
Cook N, Ayers S, Horsch A. Maternal posttraumatic stress disorder during the perinatal period and child outcomes: A systematic review. J Affect Disord 2018; 225:18-31. [PMID: 28777972 DOI: 10.1016/j.jad.2017.07.045] [Citation(s) in RCA: 218] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 07/20/2017] [Accepted: 07/24/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Approximately 3.3% of women in pregnancy have posttraumatic stress disorder (PTSD) and 4% of women postpartum PTSD. The impact of maternal PTSD during the perinatal period (from conception until one year postpartum) on child outcomes has not been systematically examined. METHOD A systematic review was conducted to synthesize and critically evaluate quantitative research investigating the association between perinatal PTSD and child outcomes. Databases EMBASE, BNI, Medline, PsycInfo and CINAHL were searched using specific inclusion and exclusion criteria. RESULTS 26 papers reporting 21 studies were identified that examined associations between perinatal PTSD and postpartum birth outcomes, child development, and mother-infant relationship. Studies reviewed were heterogeneous, with poor-to-medium scores of methodological quality. Results showed that maternal postpartum PTSD is associated with low birth weight and lower rates of breastfeeding. Evidence for an association between maternal PTSD and preterm birth, fetal growth, head circumference, mother-infant interaction, the mother-infant relationship or child development is contradictory. Associations between maternal PTSD and infant salivary cortisol levels, and eating/sleeping difficulties are based on single studies, so require replication. LIMITATIONS Methodological weaknesses of the studies included insufficient sample size, use of invalidated measures, and limited external validity. CONCLUSION Findings suggest that perinatal PTSD is linked with some negative child outcomes. Early screening for PTSD during the perinatal period may be advisable and onward referral for effective treatment, if appropriate. Future research using larger sample sizes, validated and reliable clinical interviews to assess PTSD, and validated measures to assess a range of child outcomes, is needed.
Collapse
Affiliation(s)
- Natalie Cook
- The Oxford Institute of Clinical Psychology Training, Isis Education Centre, Warneford Hospital, Oxford OX3 7JX, United Kingdom.
| | - Susan Ayers
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, Northampton Square, London EC1V 0HB, United Kingdom.
| | - Antje Horsch
- Department Woman-Mother-Child, Lausanne University Hospital, Avenue Pierre-Decker 2, CH-1011 Lausanne, Switzerland.
| |
Collapse
|
19
|
Yang Z, Oathes DJ, Linn KA, Bruce SE, Satterthwaite TD, Cook PA, Satchell EK, Shou H, Sheline YI. Cognitive Behavioral Therapy Is Associated With Enhanced Cognitive Control Network Activity in Major Depression and Posttraumatic Stress Disorder. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2017; 3:311-319. [PMID: 29628063 PMCID: PMC5908226 DOI: 10.1016/j.bpsc.2017.12.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 12/15/2017] [Accepted: 12/18/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Both major depressive disorder (MDD) and posttraumatic stress disorder (PTSD) are characterized by depressive symptoms, abnormalities in brain regions important for cognitive control, and response to cognitive behavioral therapy (CBT). However, whether a common neural mechanism underlies CBT response across diagnoses is unknown. METHODS Brain activity during a cognitive control task was measured using functional magnetic resonance imaging in 104 participants: 28 patients with MDD, 53 patients with PTSD, and 23 healthy control subjects; depression and anxiety symptoms were determined on the same day. A patient subset (n = 31) entered manualized CBT and, along with controls (n = 19), was rescanned at 12 weeks. Linear mixed effects models assessed the relationship between depression and anxiety symptoms and brain activity before and after CBT. RESULTS At baseline, activation of the left dorsolateral prefrontal cortex was negatively correlated with Montgomery–Åsberg Depression Rating Scale scores across all participants; this brain–symptom association did not differ between MDD and PTSD. Following CBT treatment of patients, regions within the cognitive control network, including ventrolateral prefrontal cortex and dorsolateral prefrontal cortex, showed a significant increase in activity. CONCLUSIONS Our results suggest that dimensional abnormalities in the activation of cognitive control regions were associated primarily with symptoms of depression (with or without controlling for anxious arousal). Furthermore, following treatment with CBT, activation of cognitive control regions was similarly increased in both MDD and PTSD. These results accord with the Research Domain Criteria conceptualization of mental disorders and implicate improved cognitive control activation as a transdiagnostic mechanism for CBT treatment outcome.
Collapse
Affiliation(s)
- Zhen Yang
- Center for Neuromodulation in Depression and Stress, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Desmond J Oathes
- Center for Neuromodulation in Depression and Stress, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kristin A Linn
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Steven E Bruce
- Department of Psychological Sciences, Center for Trauma Recovery, University of Missouri, St. Louis, Missouri
| | - Theodore D Satterthwaite
- Center for Neuromodulation in Depression and Stress, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania; Brain and Behavior Laboratory, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Philip A Cook
- Center for Neuromodulation in Depression and Stress, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Emma K Satchell
- Center for Neuromodulation in Depression and Stress, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Haochang Shou
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Yvette I Sheline
- Center for Neuromodulation in Depression and Stress, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania.
| |
Collapse
|
20
|
Dasse MN, Juback SK, Morissette SB, Dolan SL, Weaver CA. False Memory Susceptibility in OEF/OIF Veterans With and Without PTSD. MILITARY PSYCHOLOGY 2017. [DOI: 10.1037/mil0000094] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | - Sara K. Juback
- Department of Psychology and Neuroscience, Baylor University
| | - Sandra B. Morissette
- VA VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, Texas, and Texas A&M Health Science Center
| | - Sara L. Dolan
- Department of Psychology and Neuroscience, Baylor University
| | | |
Collapse
|
21
|
Javdani S, Sadeh N, Donenberg GR, Emerson E, Houck C, Brown LK. Affect recognition among adolescents in therapeutic schools: relationships with posttraumatic stress disorder and conduct disorder symptoms. Child Adolesc Ment Health 2017; 22:42-48. [PMID: 28503096 PMCID: PMC5424813 DOI: 10.1111/camh.12198] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) and conduct disorder (CD) symptoms often co-occur in adolescence, but little is known about whether they show common or distinct emotional processing deficits. METHOD We examined the effects of PTSD and CD symptoms on facial affect processing in youth with emotional and behavior problems. Teens enrolled in therapeutic day schools (N = 371; ages 13-19) completed a structured diagnostic assessment and the Diagnostic Analysis of Nonverbal Accuracy-2 facial affect recognition task. RESULTS PTSD symptoms were associated with deficits in the recognition of angry facial expressions, specifically the false identification of angry faces as fearful. CD symptoms were associated with greater difficulty correctly identifying sadness. CONCLUSIONS Findings suggest specificity in the relationships of PTSD and CD symptoms with emotional processing.
Collapse
Affiliation(s)
- Shabnam Javdani
- New York University Steinhardt School of Culture, Education, and Human Development. New York, NY, USA
| | - Naomi Sadeh
- University of Delaware, Department of Psychological and Brain Sciences. Newark, DE
| | - Geri R Donenberg
- University of Illinois at Chicago School of Public Health; Department of Medicine. Chicago, IL
| | - Erin Emerson
- University of Illinois at Chicago School of Public Health; Department of Medicine. Chicago, IL
| | - Christopher Houck
- Bradley Hasbro Children's Research Center, Rhode Island Hospital, Warren Alpert Medical School of Brown University. Providence, RI, USA
| | - Larry K Brown
- Bradley Hasbro Children's Research Center, Rhode Island Hospital, Warren Alpert Medical School of Brown University. Providence, RI, USA
| |
Collapse
|
22
|
Chakraborty N, Meyerhoff J, Jett M, Hammamieh R. Genome to Phenome: A Systems Biology Approach to PTSD Using an Animal Model. Methods Mol Biol 2017; 1598:117-154. [PMID: 28508360 DOI: 10.1007/978-1-4939-6952-4_6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Post-traumatic stress disorder (PTSD) is a debilitating illness that imposes significant emotional and financial burdens on military families. The understanding of PTSD etiology remains elusive; nonetheless, it is clear that PTSD is manifested by a cluster of symptoms including hyperarousal, reexperiencing of traumatic events, and avoidance of trauma reminders. With these characteristics in mind, several rodent models have been developed eliciting PTSD-like features. Animal models with social dimensions are of particular interest, since the social context plays a major role in the development and manifestation of PTSD.For civilians, a core trauma that elicits PTSD might be characterized by a singular life-threatening event such as a car accident. In contrast, among war veterans, PTSD might be triggered by repeated threats and a cumulative psychological burden that coalesced in the combat zone. In capturing this fundamental difference, the aggressor-exposed social stress (Agg-E SS) model imposes highly threatening conspecific trauma on naïve mice repeatedly and randomly.There is abundant evidence that suggests the potential role of genetic contributions to risk factors for PTSD. Specific observations include putatively heritable attributes of the disorder, the cited cases of atypical brain morphology, and the observed neuroendocrine shifts away from normative. Taken together, these features underscore the importance of multi-omics investigations to develop a comprehensive picture. More daunting will be the task of downstream analysis with integration of these heterogeneous genotypic and phenotypic data types to deliver putative clinical biomarkers. Researchers are advocating for a systems biology approach, which has demonstrated an increasingly robust potential for integrating multidisciplinary data. By applying a systems biology approach here, we have connected the tissue-specific molecular perturbations to the behaviors displayed by mice subjected to Agg-E SS. A molecular pattern that links the atypical fear plasticity to energy deficiency was thereby identified to be causally associated with many behavioral shifts and transformations.PTSD is a multifactorial illness sensitive to environmental influence. Accordingly, it is essential to employ the optimal animal model approximating the environmental condition that elicits PTSD-like symptoms. Integration of an optimal animal model with a systems biology approach can contribute to a more knowledge-driven and efficient next-generation care management system and, potentially, prevention of PTSD.
Collapse
Affiliation(s)
- Nabarun Chakraborty
- Integrative Systems Biology, Geneva Foundation, USACEHR, 568 Doughten Drive, Fredrick, MD, 21702-5010, USA
| | - James Meyerhoff
- Integrative Systems Biology, Geneva Foundation, USACEHR, 568 Doughten Drive, Fredrick, MD, 21702-5010, USA
| | - Marti Jett
- Integrative Systems Biology, US Army Center for Environmental Health Research, USACEHR, 568 Doughten Drive, Frederick, MD, 21702-5010, USA
| | - Rasha Hammamieh
- Integrative Systems Biology, US Army Center for Environmental Health Research, USACEHR, 568 Doughten Drive, Frederick, MD, 21702-5010, USA.
| |
Collapse
|
23
|
DiLeo A, Wright KM, McDannald MA. Subsecond fear discrimination in rats: adult impairment in adolescent heavy alcohol drinkers. ACTA ACUST UNITED AC 2016; 23:618-622. [PMID: 27918281 PMCID: PMC5066601 DOI: 10.1101/lm.043257.116] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 07/28/2016] [Indexed: 12/17/2022]
Abstract
Discriminating safety from danger must be accurate and rapid. Yet, the rapidity with which fear discrimination emerges remains unknown. Rapid fear discrimination in adulthood may be susceptible to impairment by adolescent heavy alcohol drinking, which increases incidence of anxiety disorders. Rats were given voluntary, adolescent alcohol access, and heavy drinkers were identified. In adulthood, rapid fear discrimination of safety, uncertainty, and danger cues was assessed. Normal rats, but not heavy drinkers, showed discriminative fear <1 sec following cue onset. This provides the first demonstration of subsecond fear discrimination and its adult impairment in adolescent heavy alcohol drinkers.
Collapse
Affiliation(s)
- Alyssa DiLeo
- Department of Psychology, Boston College, Chestnut Hill, Massachusetts 02467, USA
| | - Kristina M Wright
- Department of Psychology, Boston College, Chestnut Hill, Massachusetts 02467, USA
| | - Michael A McDannald
- Department of Psychology, Boston College, Chestnut Hill, Massachusetts 02467, USA
| |
Collapse
|
24
|
Herz N, Reuveni I, Goldstein A, Peri T, Schreiber S, Harpaz Y, Bonne O. Neural correlates of attention bias in posttraumatic stress disorder. Clin Neurophysiol 2016; 127:3268-76. [DOI: 10.1016/j.clinph.2016.07.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Revised: 05/29/2016] [Accepted: 07/29/2016] [Indexed: 10/21/2022]
|
25
|
Dimensional depression severity in women with major depression and post-traumatic stress disorder correlates with fronto-amygdalar hypoconnectivty. Mol Psychiatry 2016; 21:894-902. [PMID: 26416545 PMCID: PMC4840084 DOI: 10.1038/mp.2015.149] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 07/26/2015] [Accepted: 08/17/2015] [Indexed: 01/17/2023]
Abstract
Depressive symptoms are common in multiple psychiatric disorders and are frequent sequelae of trauma. A dimensional conceptualization of depression suggests that symptoms should be associated with a continuum of deficits in specific neural circuits. However, most prior investigations of abnormalities in functional connectivity have typically focused on a single diagnostic category using hypothesis-driven seed-based analyses. Here, using a sample of 105 adult female participants from three diagnostic groups (healthy controls, n=17; major depression, n=38; and post-traumatic stress disorder, n=50), we examine the dimensional relationship between resting-state functional dysconnectivity and severity of depressive symptoms across diagnostic categories using a data-driven analysis (multivariate distance-based matrix regression). This connectome-wide analysis identified foci of dysconnectivity associated with depression severity in the bilateral amygdala. Follow-up seed analyses using subject-specific amygdala segmentations revealed that depression severity was associated with amygdalo-frontal hypo-connectivity in a network of regions including bilateral dorsolateral prefrontal cortex, anterior cingulate and anterior insula. In contrast, anxiety was associated with elevated connectivity between the amygdala and the ventromedial prefrontal cortex. Taken together, these results emphasize the centrality of the amygdala in the pathophysiology of depressive symptoms, and suggest that dissociable patterns of amygdalo-frontal dysconnectivity are a critical neurobiological feature across clinical diagnostic categories.
Collapse
|
26
|
Vulnerable, But Why? Post-Traumatic Stress Symptoms in Older Adults Exposed to Hurricane Sandy. Disaster Med Public Health Prep 2016; 10:362-70. [PMID: 27019107 DOI: 10.1017/dmp.2016.15] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Drawing on pre-disaster, peri-disaster, and post-disaster data, this study examined factors associated with the development of post-traumatic stress disorder (PTSD) symptoms in older adults exposed to Hurricane Sandy. METHODS We used a sample of older participants matched by gender, exposure, and geographic region (N=88, mean age=59.83 years) in which one group reported clinically significant levels of PTSD symptoms and the other did not. We conducted t-tests, chi-square tests, and exact logistic regressions to examine differences in pre-disaster characteristics and peri-disaster experiences. RESULTS Older adults who experienced PTSD symptoms reported lower levels of income, positive affect, subjective health, and social support and were less likely to be working 4 to 6 years before Hurricane Sandy than were people not experiencing PTSD symptoms. Those developing PTSD symptoms reported more depressive symptoms, negative affect, functional disability, chronic health conditions, and pain before Sandy and greater distress and feelings of danger during Hurricane Sandy. Exact logistic regression revealed independent effects of preexisting chronic health conditions and feelings of distress during Hurricane Sandy in predicting PTSD group status. CONCLUSIONS Our findings indicated that because vulnerable adults can be identified before disaster strikes, the opportunity to mitigate disaster-related PTSD exists through identification and resource programs that target population subgroups. (Disaster Med Public Health Preparedness. 2016;10:362-370).
Collapse
|
27
|
Prevalence, Detection and Correlates of PTSD in the Primary Care Setting: A Systematic Review. J Clin Psychol Med Settings 2016; 23:160-80. [DOI: 10.1007/s10880-016-9449-8] [Citation(s) in RCA: 129] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
|
28
|
Zerach G, Kanat-Maymon Y, Aloni R, Solomon Z. The role of fathers' psychopathology in the intergenerational transmission of captivity trauma: A twenty three-year longitudinal study. J Affect Disord 2016; 190:84-92. [PMID: 26480215 DOI: 10.1016/j.jad.2015.09.072] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 09/02/2015] [Accepted: 09/15/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND The aversive impact of combat and parents' combat-induced posttraumatic stress disorder (PTSD) on young children has been examined in a few studies. However, the long-term toll of war captivity on the secondary traumatization (ST) of adult offspring remains unknown. This study aimed to assess the longitudinal associations between former prisoners of war (ex-POWs), PTSD, depressive symptoms and their adult offsprings ST. METHOD A sample of 134 Israeli father-child dyads (80 ex-POWs dyads and a comparison group of 44 veterans'dyads) completed self-report measures. The fathers participated in three waves of measurements following the Yom Kippur War (T1: 1991, T2: 2003, and T3: 2008), while the offspring took part in T4 (2013). RESULTS Offspring of ex-POWs with PTSD at T3 reported more ST symptoms than offspring of ex-POWs without PTSD and controls. Ex-POWs' PTSD hyper-arousal symptom cluster at T3 was positively related to offsprings ST avoidance symptom cluster. Offspring of ex-POWs with chronic and delayed PTSD trajectories reported more ST symptoms than offspring of ex-POWS and controls with resilient trajectories. Ex-POWs' PTSD and depression symptoms at T1, T2 and T3 mediated the link between war captivity (groups) and offsprings ST in T4. LIMITATIONS The use of self-report measures that did not cover the entire span of 40 years since the war, might may bias the results. CONCLUSIONS The intergenerational transmission of captivity related trauma following the Yom Kippur War was exemplified. ST symptoms among ex-POWs' adult offspring are closely related to their father' PTSD and related depressive symptom comorbidity.
Collapse
Affiliation(s)
- Gadi Zerach
- Department of Behavioral Sciences, Ariel University, Ariel, Israel.
| | - Yaniv Kanat-Maymon
- The School of Psychology, Interdisciplinary Center Herzliya, Herzliya, Israel
| | - Roy Aloni
- Bob Shapell School of Social Work, Tel Aviv University, I-Core Research Center for Mass Trauma, Tel Aviv, Israel
| | - Zahava Solomon
- Bob Shapell School of Social Work, Tel Aviv University, I-Core Research Center for Mass Trauma, Tel Aviv, Israel
| |
Collapse
|
29
|
Evaluation of a hybrid treatment for Veterans with comorbid traumatic brain injury and posttraumatic stress disorder: Study protocol for a randomized controlled trial. Contemp Clin Trials 2015; 45:210-216. [DOI: 10.1016/j.cct.2015.10.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 10/14/2015] [Accepted: 10/17/2015] [Indexed: 11/23/2022]
|
30
|
Özdemir O, Boysan M, Güzel Özdemir P, Yilmaz E. Relations between Post-traumatic Stress Disorder, Dissociation and Attention-Deficit/Hyperactivity Disorder among Earthquake Survivors. Noro Psikiyatr Ars 2015; 52:252-257. [PMID: 28360719 DOI: 10.5152/npa.2015.7616] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 03/04/2014] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION There is a burgeoning interest in relations between post-traumatic stress disorder (PTSD) and attention-deficit/hyperactivity disorder (ADHD). Although few studies were conducted, weak evidence was found supporting the hypothesis that ADHD may be a risk factor for the development of PTSD. In addition, there is a paucity of research addressing the relations between dissociation and ADHD. In this study, our aim was to examine the relations between PTSD and ADHD combined with the mediating effect of dissociative psychopathology. METHODS The participants were 317 undergraduate students, a greater proportion of whom experienced the 2011 Van earthquake (66%). The participants were administered the Posttraumatic Diagnostic Scale, Dissociative Experiences Scale, Adult ADHD Self-Report Scale, Beck Depression Inventory and Beck Anxiety Inventory. RESULTS We found that ADHD symptoms and dissociation were significantly associated with PTSD. Considering the multivariate relations between ADHD, PTSD and dissociation, significant associations between PTSD and ADHD resulted from symptom overlaps. However, pathological dissociation mediated the relations between PTSD and ADHD. CONCLUSION We concluded that ADHD comorbidity was not a predominant vulnerability factor for the development of post-traumatic stress response but may be an exacerbating factor after the development of PTSD.
Collapse
Affiliation(s)
- Osman Özdemir
- Department of Psychiatry, Yüzüncü Yıl University Faculty of Medicine, Van, Turkey
| | - Murat Boysan
- Department of Psychology, Yüzüncü Yıl University Faculty of Arts, Van, Turkey
| | - Pınar Güzel Özdemir
- Department of Psychiatry, Yüzüncü Yıl University Faculty of Medicine, Van, Turkey
| | - Ekrem Yilmaz
- Department of Psychiatry, Yüzüncü Yıl University Faculty of Medicine, Van, Turkey
| |
Collapse
|
31
|
Elhai JD, Contractor AA, Tamburrino M, Fine TH, Cohen G, Shirley E, Chan PK, Liberzon I, Calabrese JR, Galea S. Structural relations between DSM-5 PTSD and major depression symptoms in military soldiers. J Affect Disord 2015; 175:373-8. [PMID: 25665497 DOI: 10.1016/j.jad.2015.01.034] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 01/15/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) are frequently comorbid. One explanation for this comorbidity is that PTSD has a constellation of "dysphoria" symptoms resembling depression. METHOD Using confirmatory factor analysis we tested the role of DSM-5 PTSD׳s dysphoria factor in relation to MDD symptom dimensions of somatic and non-somatic psychopathology. 672 Ohio National Guard soldiers completed DSM-5 measures of PTSD and MDD symptoms in an epidemiological study. RESULTS Results indicated that in contrast to other PTSD factors, PTSD׳s dysphoria factor was more related to MDD׳s somatic and non-somatic factors. LIMITATIONS Limitations include generalizability to the epidemiological population of trauma-exposed military veterans rather than civilians, and reliance on self-report measures. CONCLUSIONS Implications concerning clinical psychopathology and comorbidity of PTSD are discussed, including whether PTSD should be refined by removing its non-specific symptoms.
Collapse
Affiliation(s)
- Jon D Elhai
- Department of Psychology, University of Toledo, United States; Department of Psychiatry, University of Toledo, United States
| | | | | | - Thomas H Fine
- Department of Psychiatry, University of Toledo, United States
| | - Gregory Cohen
- Department of Epidemiology, Columbia University, United States
| | - Edwin Shirley
- Department of Psychiatry, Case Western Reserve University, United States; University Hospitals Case Medical Center, United States
| | - Philip K Chan
- Department of Psychiatry, Case Western Reserve University, United States; University Hospitals Case Medical Center, United States
| | - Israel Liberzon
- VA Ann Arbor Health System, Ann Arbor, Michigan, United States; Department of Psychiatry, University of Michigan, United States
| | - Joseph R Calabrese
- Department of Psychiatry, Case Western Reserve University, United States
| | - Sandro Galea
- School of Public Health, Boston University, United States
| |
Collapse
|
32
|
Elliott L, Golub A, Bennett A, Guarino H. PTSD and Cannabis-Related Coping Among Recent Veterans in New York City. ACTA ACUST UNITED AC 2015. [PMID: 28638168 DOI: 10.1177/0091450915570309] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article presents interview and focus group data from veterans of recent conflicts in Iraq and Afghanistan about their use of cannabis as a coping tool for dealing with posttraumatic stress disorder. Veterans' comparisons of cannabis, alcohol, and psychopharmaceuticals tended to highlight advantages to cannabis use as more effective and less complicated by side effects. Some participants suggested that cannabis can be part of an approach-based coping strategy that aids with introspection and direct confrontation of the sources of personal trauma. Others, however, held that cannabis use was part of a less productive, avoidant coping strategy. Some self-reports suggested the need for more nuanced theorizations of coping behaviors, as they indicated motivations for use that were grounded in symptom alleviation rather than any direct confrontation with (or avoidance of) sources of trauma.
Collapse
Affiliation(s)
- Luther Elliott
- National Development and Research Institutes, New York, NY, USA
| | - Andrew Golub
- National Development and Research Institutes, New York, NY, USA
| | | | - Honoria Guarino
- National Development and Research Institutes, New York, NY, USA
| |
Collapse
|
33
|
Reward functioning in PTSD: a systematic review exploring the mechanisms underlying anhedonia. Neurosci Biobehav Rev 2015; 51:189-204. [PMID: 25639225 DOI: 10.1016/j.neubiorev.2015.01.019] [Citation(s) in RCA: 167] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 01/20/2015] [Accepted: 01/21/2015] [Indexed: 01/04/2023]
Abstract
Post-traumatic stress disorder (PTSD) is a debilitating psychiatric disorder. An important diagnostic feature of PTSD is anhedonia, which may result from deficits in reward functioning. This has however never been studied systematically in PTSD. To determine if PTSD is associated with reward impairments, we conducted a systematic review of studies in which reward functioning was compared between PTSD patients and healthy control participants, or investigated in relation to PTSD symptom severity. A total of 29 studies were included, covering reward anticipation and approach ('wanting'), and hedonic responses to reward ('liking'). Overall, results were mixed, although decreased reward anticipation and approach and reduced hedonic responses were repeatedly observed in PTSD patients compared to healthy controls. Decreased reward functioning was seen more often in female than in male PTSD samples and most often in response to social positive stimuli. Though more research is needed, these findings are a first step in understanding the possible mechanisms underlying anhedonia in PTSD.
Collapse
|
34
|
Fragedakis TM, Toriello P. The Development and Experience of Combat-Related PTSD: A Demand for Neurofeedback as an Effective Form of Treatment. JOURNAL OF COUNSELING AND DEVELOPMENT 2014. [DOI: 10.1002/j.1556-6676.2014.00174.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Tami Maes Fragedakis
- Department of Addictions and Rehabilitation Studies, East Carolina University at Greenville
- Now at Capital Biofeedback, Inc., Raleigh, North Carolina
| | - Paul Toriello
- Department of Addictions and Rehabilitation Studies, East Carolina University at Greenville
| |
Collapse
|
35
|
Erickson J, Kinley DJ, Bolton JM, Zamorski MA, Enns MW, Sareen J. A sex-specific comparison of major depressive disorder symptomatology in the canadian forces and the general population. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2014; 59:393-8. [PMID: 25007423 PMCID: PMC4086316 DOI: 10.1177/070674371405900707] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Accepted: 03/01/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare major depressive disorder (MDD) symptomatology within men and women in a large, representative sample of Canadian military personnel and civilians. METHOD We used the Canadian Community Health Survey: Mental Health and Well-Being (Cycle 1.2 and Canadian Forces Supplement) (n = 36 984 and n = 8441, respectively) to compare past-year MDD symptomatology among military and civilian women, and military and civilian men. Logistic regression models were used to determine differences in the types of depressive symptoms endorsed in each group. RESULTS Men in the military with MDD were at lower odds than men in the general population to endorse numerous symptoms of depression, such as hopelessness (adjusted odds ratio [AOR] 0.44; 99% CI 0.23 to 0.83) and inability to cope (AOR 0.53; 99% CI 0.31 to 0.92). Military women with MDD were at lower odds of thinking about their death (AOR 0.52; 99% CI 0.32 to 0.86), relative to women with MDD in the general population. CONCLUSION Different MDD symptomatology among males and females in the military, compared with those in the general population, may reflect selection effects (for example, personality characteristics and patterns of comorbidity) or occupational experiences unique to military personnel. Future research examining the mechanisms behind MDD symptomatology in military personnel and civilians is required.
Collapse
Affiliation(s)
- Julie Erickson
- Student, Department of Psychology, University of Manitoba, Winnipeg, Manitoba
| | - D Jolene Kinley
- Student, Department of Psychology, University of Manitoba, Winnipeg, Manitoba
| | - James M Bolton
- Assistant Professor, Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba
| | - Mark A Zamorski
- Directorate of Mental Health, Canadian Forces Health Services Group Headquarters, Ottawa, Ontario
| | - Murray W Enns
- Professor, Departments of Psychiatry and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba
| | - Jitender Sareen
- Professor, Departments of Psychiatry, Psychology, and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba
| |
Collapse
|
36
|
Dekel S, Solomon Z, Horesh D, Ein-Dor T. Posttraumatic stress disorder and depressive symptoms: joined or independent sequelae of trauma? J Psychiatr Res 2014; 54:64-9. [PMID: 24703578 DOI: 10.1016/j.jpsychires.2014.03.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 03/06/2014] [Accepted: 03/07/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The nature of co-morbidity between posttraumatic stress disorder (PTSD) and depression has been the subject of much controversy. This study addresses this issue by investigating associations between probable PTSD and depressive symptoms in a prospective, longitudinal sample of combat veterans. METHOD Symptoms of PTSD and depression were assessed at 3 points of time (i.e., 1991, 2003, 2008) over a period of 17 years utilizing the PTSD Inventory and the SCL-90 (Derogatis, 1977). Two groups of combat veterans, 275 former prisoners of war (ex-POWs) and 219 matched combatants (controls), were assessed. Data were analyzed using descriptive statistics, latent variable modeling, and confirmatory factor analysis. RESULTS A series of χ(2) tests revealed that the prevalence proportions of depressive symptoms and probable PTSD were higher among ex-POWs compared to controls at all time points. The prevalence of depressive symptoms was higher than the prevalence of PTSD symptoms in both groups at the each of the times. Latent Trajectories Modeling (LTM) indicated that while ex-POWs' PTSD symptom severity increased over time, the severity of symptoms remained stable among controls. Parallel Process Latent Growth Modeling (PLGM) revealed a positive bi-directional relationship whereby PTSD symptoms mediated the affect of captivity on depressive symptoms and depressive symptoms mediated the affect of captivity on PTSD symptoms over time. Utilizing Confirmatory Factor Analysis (CFA), a single factor model emerged for depressive and PTSD symptoms. CONCLUSION The findings suggest that while depression and PTSD seem to be different long-term manifestations of traumatic stress, accounted for in part by the severity of the trauma, they both may be parts of a common general traumatic stress construct. Clinical and theoretical implications of these findings are discussed.
Collapse
Affiliation(s)
- Sharon Dekel
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, USA.
| | - Zahava Solomon
- Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
| | - Danny Horesh
- Department of Psychology, Bar Ilan University, Ramat Gan, Israel; Department of Psychiatry, New York University, NY, USA
| | - Tsachi Ein-Dor
- School of Psychology, Interdisciplinary Center Herzliya, Herzliya, Israel
| |
Collapse
|
37
|
Brancu M, Thompson NL, Beckham JC, Green KT, Calhoun PS, Elbogen EB, Robbins AT, Fairbank JA, Wagner HR. The impact of social support on psychological distress for U.S. Afghanistan/Iraq era veterans with PTSD and other psychiatric diagnoses. Psychiatry Res 2014; 217:86-92. [PMID: 24679515 DOI: 10.1016/j.psychres.2014.02.025] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 02/10/2014] [Accepted: 02/14/2014] [Indexed: 10/25/2022]
Abstract
This study aimed to examine the degree to which posttraumatic stress disorder (PTSD) affects the relationship between social support and psychological distress for U.S. Afghanistan/Iraq era veterans with and without co-occurring psychiatric disorders. Veterans (N=1825) were administered self-report questionnaires and a structured diagnostic interview as part of a multi-site study of post-deployment mental health through the Department of Veterans Affairs (VA) Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC). Main and interaction effects models assessed the association between psychological distress and social support for three comparisons conditions (Controls vs. PTSD-only, non-PTSD, and PTSD plus co-morbid diagnoses). Having PTSD was a critical factor in attenuating the strength of this association, more so than other diagnoses. Furthermore, those with PTSD plus co-morbid diagnoses did not demonstrate significantly larger attenuation in that association compared to the PTSD-only group, indicating that psychiatric comorbidity may be less important in considering the role of social support in PTSD. By understanding this relationship, new avenues for engaging and enhancing treatment outcomes related to social support for veterans of this cohort may be identified. Additional longitudinal research could help evaluate the effect of PTSD symptom clusters, social support type, and trauma exposure type on these relationships.
Collapse
Affiliation(s)
- Mira Brancu
- Mid-Atlantic VA Mental Illness Research, Education and Clinical Center (VISN 6 MIRECC), Durham, NC 27705, United States; Durham VA Medical Center, Durham, NC 27705, United States; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, United States.
| | - Nivonne L Thompson
- Hunter Holmes McGuire VA Medical Center, Richmond, VA 23224, United States; Virginia Commonwealth University, Department of Psychology, Richmond, VA 23284, United States
| | - Jean C Beckham
- Mid-Atlantic VA Mental Illness Research, Education and Clinical Center (VISN 6 MIRECC), Durham, NC 27705, United States; Durham VA Medical Center, Durham, NC 27705, United States; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, United States
| | - Kimberly T Green
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, United States
| | - Patrick S Calhoun
- Mid-Atlantic VA Mental Illness Research, Education and Clinical Center (VISN 6 MIRECC), Durham, NC 27705, United States; Durham VA Medical Center, Durham, NC 27705, United States; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, United States
| | - Eric B Elbogen
- Mid-Atlantic VA Mental Illness Research, Education and Clinical Center (VISN 6 MIRECC), Durham, NC 27705, United States; Durham VA Medical Center, Durham, NC 27705, United States; Department of Psychiatry, University of North Carolina, Chapel Hill, NC 27514, United States
| | - Allison T Robbins
- Mid-Atlantic VA Mental Illness Research, Education and Clinical Center (VISN 6 MIRECC), Durham, NC 27705, United States; Durham VA Medical Center, Durham, NC 27705, United States
| | - John A Fairbank
- Mid-Atlantic VA Mental Illness Research, Education and Clinical Center (VISN 6 MIRECC), Durham, NC 27705, United States; Durham VA Medical Center, Durham, NC 27705, United States; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, United States
| | | | - H Ryan Wagner
- Mid-Atlantic VA Mental Illness Research, Education and Clinical Center (VISN 6 MIRECC), Durham, NC 27705, United States; Durham VA Medical Center, Durham, NC 27705, United States; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, United States
| |
Collapse
|
38
|
Comparative safety of benzodiazepines and opioids among veterans affairs patients with posttraumatic stress disorder. J Addict Med 2014; 7:354-62. [PMID: 24091764 DOI: 10.1097/adm.0b013e31829e3957] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Although Veterans Affairs (VA) patients with posttraumatic stress disorder (PTSD) are prescribed benzodiazepines and opioids in addition to recommended pharmacotherapies, little is known about the safety of these medications. This study compared the 2-year incidence of adverse events among VA patients with PTSD exposed to combinations of selective serotonin reuptake inhibitors (SSRIs) or serotonin/norepinephrine reuptake inhibitors (SNRIs), benzodiazepines, and opioids. METHODS This retrospective cohort study used VA administrative data from 2004 to 2010 to identify and follow 5236 VA patients with PTSD with new episodes of (1) SSRIs/SNRIs only; (2) concurrent SSRIs/SNRIs and benzodiazepines; and (3) concurrent SSRIs/SNRIs, benzodiazepines, and opioids. Outcome measures were the 2-year incidence and adjusted hazard ratios (AHR) of mental health and medicine/surgery hospitalizations, emergency department visits, harmful events (eg, injuries and death), and any adverse event after adjustment for demographics, clinical covariates, and adverse event history. RESULTS Compared with SSRIs/SNRIs only, the adjusted risk of mental health hospitalizations (AHR: 1.87; 95% confidence interval [CI]: 1.37-2.53) was greater among patients prescribed SSRIs/SNRIs and benzodiazepines concurrently. The AHR of mental health hospitalizations (AHR: 2.00; 95% CI: 1.35-2.98), medicine/surgery hospitalizations (AHR: 4.86; 95% CI: 3.30-7.14), emergency department visits (AHR: 2.01; 95% CI: 1.53-2.65), any harmful event (2.92; 95% CI: 2.21-3.84), and any adverse event (AHR: 2.65; 95% CI: 2.18-3.23) were all significantly greater among patients prescribed SSRIs/SNRIs, benzodiazepines, and opioids than among those prescribed SSRIs/SNRIs only. CONCLUSIONS Concurrently prescribing SSRIs/SNRIs, benzodiazepines, and opioids among patients with PTSD is associated with adverse events. Although efforts are warranted to monitor patients who are prescribed combinations of these medications to prevent adverse events, these results should be interpreted with caution until they are replicated.
Collapse
|
39
|
Lehavot K, Stappenbeck CA, Luterek JA, Kaysen D, Simpson TL. Gender differences in relationships among PTSD severity, drinking motives, and alcohol use in a comorbid alcohol dependence and PTSD sample. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2013; 28:42-52. [PMID: 23647151 DOI: 10.1037/a0032266] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Alcohol dependence (AD) and posttraumatic stress disorder (PTSD) are highly prevalent and comorbid conditions associated with a significant level of impairment. Little systematic study has focused on gender differences specific to individuals with both AD and PTSD. The current study examined gender-specific associations between PTSD symptom severity, drinking to cope (i.e., reduce negative affect), drinking for enhancement (i.e., increase positive affect), and average alcohol use in a clinical sample of men (n = 46) and women (n = 46) with comorbid AD and PTSD. Results indicated that PTSD symptoms were highly associated with drinking-to-cope motives for both men and women, but with greater drinking for enhancement motives for men only. Enhancement motives were positively associated with average alcohol quantity for both men and women, but coping motives were significantly associated with average alcohol quantity for women only. These findings suggest that for individuals with comorbid AD and PTSD, interventions that focus on reducing PTSD symptoms are likely to lower coping motives for both genders, and targeting coping motives is likely to result in decreased drinking for women but not for men, whereas targeting enhancement motives is likely to lead to reduced drinking for both genders.
Collapse
Affiliation(s)
- Keren Lehavot
- Advanced Fellowship Program in Mental Illness Research and Treatment, VA Puget Sound Health Care System
| | | | | | - Debra Kaysen
- Department of Psychiatry and Behavioral Sciences, University of Washington
| | - Tracy L Simpson
- Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System
| |
Collapse
|
40
|
Zoladz PR, Diamond DM. Current status on behavioral and biological markers of PTSD: a search for clarity in a conflicting literature. Neurosci Biobehav Rev 2013; 37:860-95. [PMID: 23567521 DOI: 10.1016/j.neubiorev.2013.03.024] [Citation(s) in RCA: 188] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 03/23/2013] [Accepted: 03/27/2013] [Indexed: 12/24/2022]
Abstract
Extensive research has identified stereotypic behavioral and biological abnormalities in post-traumatic stress disorder (PTSD), such as heightened autonomic activity, an exaggerated startle response, reduced basal cortisol levels and cognitive impairments. We have reviewed primary research in this area, noting that factors involved in the susceptibility and expression of PTSD symptoms are more complex and heterogeneous than is commonly stated, with extensive findings which are inconsistent with the stereotypic behavioral and biological profile of the PTSD patient. A thorough assessment of the literature indicates that interactions among myriad susceptibility factors, including social support, early life stress, sex, age, peri- and post-traumatic dissociation, cognitive appraisal of trauma, neuroendocrine abnormalities and gene polymorphisms, in conjunction with the inconsistent expression of the disorder across studies, confounds attempts to characterize PTSD as a monolithic disorder. Overall, our assessment of the literature addresses the great challenge in developing a behavioral and biomarker-based diagnosis of PTSD.
Collapse
Affiliation(s)
- Phillip R Zoladz
- Department of Psychology, Sociology, & Criminal Justice, Ohio Northern University, 525 S. Main St., Ada, OH, 45810, USA
| | | |
Collapse
|
41
|
Biehn TL, Contractor A, Elhai JD, Tamburrino M, Fine TH, Prescott MR, Shirley E, Chan PK, Slembarski R, Liberzon I, Calabrese JR, Galea S. Relations between the underlying dimensions of PTSD and major depression using an epidemiological survey of deployed Ohio National Guard soldiers. J Affect Disord 2013; 144:106-11. [PMID: 22974471 DOI: 10.1016/j.jad.2012.06.013] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Accepted: 06/12/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND In the present study, the authors investigated the relationship between the underlying symptom dimensions of posttraumatic stress disorder (PTSD) and dimensions of major depressive disorder (MDD). METHOD A sample of 1266 Ohio National Guard soldiers with a history of overseas deployment participated and were administered the PTSD Checklist (assessing PTSD) and Patient Health Questionnaire-9 (assessing depression). RESULTS Using confirmatory factor analysis, results demonstrated that both PTSD's dysphoria and hyperarousal factors were more related to depression's somatic than non-somatic factor. Furthermore, depression's somatic factor was more related to PTSD's dysphoria than hyperarousal factor. LIMITATIONS Limitations of this study include the use of self-report measures and a predominately male military sample. CONCLUSIONS Results indicate that PTSD's dysphoria factor is related to depression specifically by way of depression's somatic construct. Given PTSD's substantial dysphoria/distress component, these results have implications for understanding the nature of PTSD's high comorbidity with depression.
Collapse
Affiliation(s)
- Tracey L Biehn
- Department of Psychology, University of Toledo, Mail Stop #948, 2801 West Bancroft Street, Toledo, OH 43606-3390, United States
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Abstract
Among both civilian and veteran populations, substance use disorders (SUDs) and anxiety disorders frequently co-occur. One of the most common comorbid anxiety disorder is posttraumatic stress disorder (PTSD), a condition which may develop after exposure to traumatic events, such as military combat. In comparison with the general population, rates of both SUDs and PTSD are elevated among veterans. Recent data show that soldiers returning from Iraq and Afghanistan demonstrate high rates of co-occurring SUDs, PTSD, and traumatic brain injury. Careful assessment of these conditions is critical and may be complicated by symptom overlap. More research targeting integrated interventions for these conditions is needed to establish optimal treatments.
Collapse
|
43
|
Aversa LH, Stoddard JA, Doran NM, Au S, Chow B, McFall M, Saxon A, Baker DG. PTSD and depression as predictors of physical health-related quality of life in tobacco-dependent veterans. J Psychosom Res 2012; 73:185-90. [PMID: 22850258 DOI: 10.1016/j.jpsychores.2012.06.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Revised: 06/25/2012] [Accepted: 06/25/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Smoking, depression and PTSD are related to poor physical health outcomes and health-related quality of life (HRQoL). Previous studies examining the effects of quitting smoking on HRQoL have been mixed. This study aimed to examine the effects of PTSD, depressive symptoms and smoking cessation on HRQoL in a sample receiving treatment for PTSD. METHOD This study utilized archival interview and self-report data from a clinical trial (VA Cooperative Study 519) that recruited tobacco dependent veterans with chronic PTSD (N=943). RESULTS Analyses were conducted using hierarchical linear modeling and indicated that PTSD and depressive symptoms differentially affected the various physical health status domains. Additionally, quitting smoking was associated with better self-perceived health status and social functioning. CONCLUSION Our findings further explain the interrelationships of PTSD, depression, and smoking in the prediction of physical HRQoL and advocate the importance of integrated care.
Collapse
Affiliation(s)
- Laura H Aversa
- Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Dr.151, San Diego, CA 92161, USA
| | | | | | | | | | | | | | | |
Collapse
|
44
|
Attention-deficit/hyperactivity disorder comorbidity in a sample of veterans with posttraumatic stress disorder. Compr Psychiatry 2012; 53:679-90. [PMID: 22305866 PMCID: PMC6519447 DOI: 10.1016/j.comppsych.2011.12.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Revised: 11/02/2011] [Accepted: 12/06/2011] [Indexed: 11/24/2022] Open
Abstract
This study examined attention-deficit/hyperactivity disorder (ADHD) comorbidity in military veterans with a high prevalence of posttraumatic stress disorder (PTSD) and evaluated the relationships between the 2 disorders and exposure to traumatic events. The sample included 222 male and female military veterans who were administered structured clinical interviews based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Results show that 54.5% met the criteria for current PTSD, 11.5% of whom also met the criteria for current adult ADHD. Level of trauma exposure and ADHD severity were significant predictors of current PTSD severity. Evaluation of the underlying structure of symptoms of PTSD and ADHD using confirmatory factor analysis yielded a best-fitting measurement model that comprised 4 PTSD factors and 3 ADHD factors. Standardized estimates of the correlations among PTSD and ADHD factors suggested that the largest proportion of shared variance underlying PTSD-ADHD comorbidity is related to problems with modulating arousal levels that are common to both disorders (ie, hyperarousal and hypoarousal).
Collapse
|
45
|
Pacella ML, Armelie A, Boarts J, Wagner G, Jones T, Feeny N, Delahanty DL. The impact of prolonged exposure on PTSD symptoms and associated psychopathology in people living with HIV: a randomized test of concept. AIDS Behav 2012; 16:1327-40. [PMID: 22012149 PMCID: PMC4391814 DOI: 10.1007/s10461-011-0076-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
People living with HIV (PLWH) report elevated levels of posttraumatic stress disorder symptoms (PTSS) and associated comorbidities. The present study tested the efficacy of prolonged exposure (PE) at reducing PTSS, depression, negative posttraumatic cognitions, and substance use in PLWH. Participants were randomly assigned to receive PE (n = 40) or to a weekly monitoring control group (n = 25). Assessments occurred at baseline, post-intervention and 3-months post-treatment. Following the 3-month assessment, controls were offered the intervention. All PE recipients (whether originally from the PE or control group) completed a 6-month assessment. Intent-to-treat mixed model repeated measures ANOVAs were conducted through 3-months post-treatment; within group analyses were conducted through 6-months. PE recipients reported fewer PTSS and negative posttraumatic cognitions and were more likely to achieve good end-state functioning; gains were maintained at 6-months. No between-group differences emerged for substance use. Overall, results support the efficacy of PE in PLWH.
Collapse
Affiliation(s)
| | - Aaron Armelie
- Kent State University, Department of Psychology, Kent, Ohio
| | - Jessica Boarts
- Kent State University, Department of Psychology, Kent, Ohio
| | | | - Tracy Jones
- The AIDS Taskforce of Greater Cleveland, Cleveland, Ohio
| | - Norah Feeny
- Case Western Reserve University, Cleveland, Ohio
| | - Douglas L. Delahanty
- Kent State University, Department of Psychology, Kent, Ohio
- Northeastern Ohio Universities College of Medicine (NEOUCOM), Department of Psychology in Psychiatry, Rootstown, Ohio
| |
Collapse
|
46
|
Hawkins EJ, Malte CA, Imel ZE, Saxon AJ, Kivlahan DR. Prevalence and trends of benzodiazepine use among Veterans Affairs patients with posttraumatic stress disorder, 2003-2010. Drug Alcohol Depend 2012; 124:154-61. [PMID: 22305658 DOI: 10.1016/j.drugalcdep.2012.01.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Revised: 01/04/2012] [Accepted: 01/07/2012] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although the Veterans Affairs and Department of Defense (VA/DoD) clinical guidelines for management of posttraumatic stress disorder (PTSD) recommend against routine benzodiazepine use, little is known about the trends and clinical and prescription profiles of benzodiazepine use since these guidelines were released in 2004. METHODS This retrospective study included 64,872 patients with a PTSD diagnosis received from care at facilities in VA Northwest Veterans Integrated Service Network (VISN 20) during 2003-2010. Annual prevalence of any use was defined as any prescription for benzodiazepines, and long-term use was defined as >90 days' supply, in a year. Gender-specific logistic regressions were fit to estimate any and long-term benzodiazepine use, test for linear trends over 8-years and explore factors associated with trends. RESULTS The trend of age-adjusted benzodiazepine use over 8-years rose significantly from 25.0 to 26.8% among men and 31.2 to 38.8% among women. Long-term use in men and women increased from 15.4 to 16.4% and 18.0 to 22.7%, respectively. Comorbid psychiatric and alcohol use disorders (AUD) were associated with a greater increase in long-term use of benzodiazepines. In 2010, 61% of benzodiazepine users received >90 days' supply. Among those prescribed benzodiazepines long-term, 11% had AUD and 47% were also prescribed opioids long-term. CONCLUSION Despite VA/DoD clinical guidelines recommending against routine use of benzodiazepines for PTSD, the adjusted prevalence of long-term use increased among men and women with PTSD in VISN 20. Widespread concomitant use of benzodiazepines and opioids suggests risk management systems and research on the efficacy and safety of these medications are needed.
Collapse
Affiliation(s)
- Eric J Hawkins
- Health Services Research and Development, VA Puget Sound Health Care System, Seattle, WA 98108, United States.
| | | | | | | | | |
Collapse
|
47
|
Coping strategies and beliefs about pain in veterans with comorbid chronic pain and significant levels of posttraumatic stress disorder symptoms. Eur J Pain 2012; 16:312-9. [DOI: 10.1016/j.ejpain.2011.06.010] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
48
|
Biological and clinical framework for posttraumatic stress disorder. HANDBOOK OF CLINICAL NEUROLOGY 2012; 106:291-342. [DOI: 10.1016/b978-0-444-52002-9.00018-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
49
|
Posttraumatic and depressive symptoms in victims of occupational accidents. DEPRESSION RESEARCH AND TREATMENT 2012; 2012:184572. [PMID: 22690334 PMCID: PMC3368301 DOI: 10.1155/2012/184572] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Revised: 01/12/2012] [Accepted: 03/24/2012] [Indexed: 11/17/2022]
Abstract
The present descriptive study was aimed at evaluating posttraumatic and depressive symptoms and their cooccurrence, in a sample of victims of workplace accidents. Also, posttraumatic negative cognitions were assessed. Eighty-five injured workers were evaluated, using the PTSD Symptom Scale, the Beck Depression Inventory II, and the posttraumatic Cognitions Inventory. 49.4% of injured workers reported both depressive and posttraumatic symptoms of clinical relevance. 20% only reported posttraumatic, but not depressive, symptoms, and 30.6% did not report either type of symptoms. The group with both posttraumatic and depressive symptoms displayed greater symptom severity and more negative cognitions about the self and about the world than the other two groups. The obtained findings indicate that workplace accidents can have a major impact upon the mental health of victims. Early interventions should be focused not only on the prevention or reduction of posttraumatic and depressive symptoms but also on restructuring specific maladaptive trauma-related cognitions.
Collapse
|
50
|
A chinese herbal formula to improve general psychological status in posttraumatic stress disorder: a randomized placebo-controlled trial on sichuan earthquake survivors. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2011; 2012:691258. [PMID: 22028733 PMCID: PMC3199055 DOI: 10.1155/2012/691258] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2011] [Revised: 07/26/2011] [Accepted: 07/29/2011] [Indexed: 11/28/2022]
Abstract
Introduction. Posttraumatic stress disorder (PTSD) is accompanied by poor general psychological status (GPS). In the present study, we investigated the effects of a Chinese herbal formula on GPS in earthquake survivors with PTSD. Methods. A randomized, double-blind, placebo-controlled trial compared a Chinese herbal formula, Xiao-Tan-Jie-Yu-Fang (XTJYF), to placebo in 2008 Sichuan earthquake survivors with PTSD. Patients were randomized into XTJYF (n = 123) and placebo (n = 122) groups. Baseline-to-end-point score changes in the three global indices of the Symptom Checklist-90-Revised (SCL-90-R) and rates of response in the SCL global severity index (GSI) were the primary endpoints. A subanalysis of the nine SCL factors and the sleep quality score were secondary endpoints. Results and Discussion. Compared to placebo, the XTJYF group was significantly improved in all three SCL global indices (P = 0.001~0.028). More patients in the XTJYF group reported “much improved” than the placebo group (P = 0.001). The XTJYF group performed significantly better than control in five out of nine SCL factors (somatization, obsessive-compulsive behavior, depression, anxiety, and hostility (P = 0.001~0.036)), and in sleep quality score (P < 0.001). XTJYF produced no serious adverse events. These findings suggest that XTJYF may be an effective and safe treatment option for improving GPS in patients with PTSD.
Collapse
|