-
Journal of Psychiatric Research Aug 2023Accumulating evidence suggests that post-traumatic stress disorder (PTSD) may increase the risk of various types of dementia. Despite the large number of studies linking... (Review)
Review
BACKGROUND
Accumulating evidence suggests that post-traumatic stress disorder (PTSD) may increase the risk of various types of dementia. Despite the large number of studies linking these critical conditions, the underlying mechanisms remain unclear. The past decade has witnessed an exponential increase in interest on brain imaging research to assess the neuroanatomical underpinnings of PTSD. This systematic review provides a critical assessment of available evidence of neuroimaging correlates linking PTSD to a higher risk of dementia.
METHODS
The EMBASE, PubMed/MEDLINE, and SCOPUS electronic databases were systematically searched from 1980 to May 22, 2021 for original references on neuroimaging correlates of PTSD and risk of dementia. Literature search, screening of references, methodological quality appraisal of included articles as well as data extractions were independently conducted by at least two investigators. Eligibility criteria included: 1) a clear PTSD definition; 2) a subset of included participants must have developed dementia or cognitive impairment at any time point after the diagnosis of PTSD through any diagnostic criteria; and 3) brain imaging protocols [structural, molecular or functional], including whole-brain morphologic and functional MRI, and PET imaging studies linking PTSD to a higher risk of cognitive impairment/dementia.
RESULTS
Overall, seven articles met eligibility criteria, comprising findings from 366 participants with PTSD. Spatially convergent structural abnormalities in individuals with PTSD and co-occurring cognitive dysfunction involved primarily the bilateral frontal (e.g., prefrontal, orbitofrontal, cingulate cortices), temporal (particularly in those with damage to the hippocampi), and parietal (e.g., superior and precuneus) regions.
LIMITATIONS
A meta-analysis could not be performed due to heterogeneity and paucity of measurable data in the eligible studies.
CONCLUSIONS
Our systematic review provides putative neuroimaging correlates associated with PTSD and co-occurring dementia/cognitive impairment particularly involving the hippocampi. Further research examining neuroimaging features linking PTSD to dementia are clearly an unmet need of the field. Future imaging studies should provide a better control for relevant confounders, such as the selection of more homogeneous samples (e.g., age, race, education), a proper control for co-occurring disorders (e.g., co-occurring major depressive and anxiety disorders) as well as the putative effects of psychotropic medication use. Furthermore, prospective studies examining imaging biomarkers associated with a higher rate of conversion from PTSD to dementia could aid in the stratification of people with PTSD at higher risk for developing dementia for whom putative preventative interventions could be especially beneficial.
Topics: Humans; Stress Disorders, Post-Traumatic; Depressive Disorder, Major; Prospective Studies; Cognitive Dysfunction; Neuroimaging; Dementia
PubMed: 37390621
DOI: 10.1016/j.jpsychires.2023.06.016 -
Journal of Affective Disorders Sep 2023Patients with Post-traumatic stress disorder (PTSD) exposed to traumatic reminders show hyperreactivity in brain areas (e.g., amygdala) belonging or related to the... (Meta-Analysis)
Meta-Analysis Review
Patients with Post-traumatic stress disorder (PTSD) exposed to traumatic reminders show hyperreactivity in brain areas (e.g., amygdala) belonging or related to the Innate Alarm System (IAS), allowing the rapid processing of salient stimuli. Evidence that IAS is activated by subliminal trauma-reminders could shed a new light on the factors precipitating and perpetuating PTSD symptomatology. Thus, we systematically reviewed studies investigating neuroimaging correlates of subliminal stimulation in PTSD. Twenty-three studies were selected from the MEDLINE and Scopus® databases for a qualitative synthesis, 5 of which allowed a further meta-analysis of fMRI data. The intensity of IAS responses to subliminal trauma-related reminders ranged from a minimum in healthy controls to a maximum in the PTSD patients with the most severe (e.g., dissociative) symptoms or the least responsiveness to treatment. Comparisons with other disorders (e.g., phobias) revealed contrasting results. Our findings demonstrate the hyperactivation of areas belonging or related to IAS in response to unconscious threats that should be integrated in diagnostic as well as in therapeutic protocols.
Topics: Humans; Stress Disorders, Post-Traumatic; Subliminal Stimulation; Brain; Amygdala; Brain Mapping; Magnetic Resonance Imaging
PubMed: 37236272
DOI: 10.1016/j.jad.2023.05.047 -
Social Psychiatry and Psychiatric... Apr 2015There is growing evidence in the literature that a diagnosis of Posttraumatic Stress Disorder (PTSD) is an important contributory factor to suicidality in adolescents.... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
There is growing evidence in the literature that a diagnosis of Posttraumatic Stress Disorder (PTSD) is an important contributory factor to suicidality in adolescents. However, there is no existing review of the literature examining the relationship between PTSD and suicidality in adolescents. This study aims to provide the first systematic review and meta-analysis of the association between PTSD and suicidality in adolescents.
METHODS
Five bibliographic databases (Medline, EMBASE, PsycINFO, Web of Science and PILOT) were screened for suitable articles. Twenty-eight studies (which provided 28 independent samples) were included in the review. The overall meta-analyses of the association between PTSD and suicidality were followed by subgroup and meta-regression analyses.
RESULTS
A highly significant positive association was found between PTSD and suicidality (d = 0.701, 95% CI 0.555-0.848). The subgroup and meta-regression analyses showed that the association between PTSD and suicidality persisted whilst adjusting for various sources of between-study heterogeneity, such as, different levels of severity of suicidality, target groups, and methodological quality of the studies.
CONCLUSIONS
Suicidality in adolescents with PTSD is a major problem which requires further research effort. The implications of these results are discussed.
Topics: Adolescent; Female; Humans; Male; Stress Disorders, Post-Traumatic; Suicidal Ideation; Suicide
PubMed: 25398198
DOI: 10.1007/s00127-014-0978-x -
Psicothema Nov 2023In recent years, eye movement desensitization and reprocessing (EMDR) has spread, in both the number of publications and professionals who use this technique in the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
In recent years, eye movement desensitization and reprocessing (EMDR) has spread, in both the number of publications and professionals who use this technique in the clinical setting. The objective of this meta-analysis was to verify the efficacy of EMDR in treatment of post-traumatic stress disorder.
METHOD
Based on the inclusion/exclusion criteria, 18 articles were selected ( n = 1213 subjects), published between 1991-2022.
RESULTS
The effect sizes found in the meta-analysis were small in the reduction of symptoms associated with PTSD, anxiety and depression, both in post-treatment and in maintenance. The analysis of the moderating variables revealed that both intervention time, the number and duration of the sessions, the experience of the therapist, and the type of therapist in charge of the intervention play an important role in the size of the final effect. No statistically significant data were found in the meta-regression analysis.
CONCLUSIONS
Although the study had restrictive criteria for study selection, there is a certain risk of bias in the selected articles, which lack sufficient methodological quality to be extrapolated to the clinical field.
Topics: Humans; Stress Disorders, Post-Traumatic; Eye Movement Desensitization Reprocessing; Randomized Controlled Trials as Topic; Anxiety; Anxiety Disorders; Treatment Outcome
PubMed: 37882423
DOI: 10.7334/psicothema2022.309 -
Clinical Neuropharmacology 2017The aim of this study was to review the safety and efficacy of aripiprazole as monotherapy and adjunct therapy for the treatment of post-traumatic stress disorder (PTSD). (Review)
Review
OBJECTIVE
The aim of this study was to review the safety and efficacy of aripiprazole as monotherapy and adjunct therapy for the treatment of post-traumatic stress disorder (PTSD).
METHODS
A search of both MEDLINE (1956 to May 2017) and EMBASE (1957 to May 2017) was conducted using the terms "aripiprazole" and "post-traumatic stress disorder," "posttraumatic stress disorder," or "PTSD." Studies evaluating the primary endpoint of PTSD in patients taking aripiprazole as monotherapy or adjunct therapy were analyzed for relevance. Those that met the objective of this study were included for evaluation: 1 placebo-controlled trial; 4 open-label trials; and 1 retrospective chart review.
RESULTS
In patients with a history of PTSD, aripiprazole resulted in significant improvements in the primary outcome, including Clinician-Administered PTSD Symptom Scale or PTSD Checklist-Military scores, in all but 1 study analyzed. Study durations ranged from 10 to 16 weeks. Initial doses of aripiprazole ranged from 2 to 15 mg daily that could be titrated up or down in the range of 2 to 30 mg daily based on efficacy and tolerability. Overall, aripiprazole was well tolerated with the most common treatment-related study discontinuations attributed to the adverse events of anxiety, insomnia, akathisia, asthenia, restlessness, and somnolence.
CONCLUSIONS
Based on the reviewed literature, aripiprazole is a reasonable therapy option as monotherapy or adjunct therapy in patients with PTSD. Larger randomized controlled trials are needed to better understand the role of this atypical antipsychotic in patients with PTSD.
Topics: Antipsychotic Agents; Aripiprazole; Clinical Trials as Topic; Humans; Stress Disorders, Post-Traumatic
PubMed: 29059134
DOI: 10.1097/WNF.0000000000000251 -
Progress in Neuro-psychopharmacology &... Oct 2016Post-traumatic stress disorder (PTSD) is a serious psychiatric consequence of trauma that occurs in a proportion of individuals exposed to life-threatening events.... (Review)
Review
Post-traumatic stress disorder (PTSD) is a serious psychiatric consequence of trauma that occurs in a proportion of individuals exposed to life-threatening events. Trauma-focused psychotherapy is often recommended as first choice for those who do not recover spontaneously. But many individuals require medications. In the US, only paroxetine (PRX) and sertraline (SRT) are FDA approved for PTSD. But response and remission rates with these medications are low, so numerous other pharmacologic interventions have been tried. To date, there has not been a systematic review of the data on what are the best next-step pharmacologic strategies for individuals who fail standard treatments. To that end, we review 168 published trials of medications other than PRX or SRT and provide a detailed analysis of the 88/168 studies that describe alternative pharmacologic interventions in patients refractory to other treatment. We also review clinical factors relevant to treatment-refractory PTSD; the neurobiology of extinction, as well as evidence-based psychotherapy and neuromodulation strategies for this condition.
Topics: Animals; Drug Resistance; Extinction, Psychological; Humans; Stress Disorders, Post-Traumatic
PubMed: 26854815
DOI: 10.1016/j.pnpbp.2016.01.015 -
Health & Social Work Apr 2022Traumatic events may lead to the development of PTSD or PTSD symptomology that can negatively impact health outcomes. Allostatic load, which represents the cumulative... (Review)
Review
Traumatic events may lead to the development of PTSD or PTSD symptomology that can negatively impact health outcomes. Allostatic load, which represents the cumulative biological wear and tear of exposure to stress, can be employed to better understand the physiological etiology of PTSD. A scoping review, informed by the PRISMA Extension for Scoping Reviews, was completed to identify published and unpublished empirical studies that explored the relationship of allostatic load and PTSD. Eight databases were searched yielding four studies, with the results summarized narratively and in tabular form. Findings were mixed as to the association between allostatic load and PTSD. Allostatic load was positively associated with PTSD diagnosis; however, studies measuring only PTSD symptomatology found no relationship. Few PTSD researchers have tested the relationship of a comprehensive measure of allostatic load to PTSD. Among those who have, studies show that allostatic load can be a beneficial tool and applicable theoretical framework for understanding the biological changes associated with PTSD. Future research should focus on standardizing measures of both allostatic load and PTSD and identifying potential confounders. A better understanding of the physiological changes associated with PTSD could lead to more effective prevention and treatment efforts.
Topics: Allostasis; Humans; Stress Disorders, Post-Traumatic; Stress, Psychological
PubMed: 35244700
DOI: 10.1093/hsw/hlac001 -
Suicide & Life-threatening Behavior Feb 2023This study conducted a systematic review and meta-analysis of the association between posttraumatic stress disorder (PTSD) and (i) death by suicide, (ii) attempted... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
This study conducted a systematic review and meta-analysis of the association between posttraumatic stress disorder (PTSD) and (i) death by suicide, (ii) attempted suicide (AS), and (iii) suicidal ideation (SI).
METHODS
The systematic review identified seven studies on PTSD and suicide, 33 studies for AS, and 20 studies for SI. A series of stratified meta-analyses were conducted to estimate pooled effects, in addition to meta-regression to investigate sources of heterogeneity.
RESULTS
A higher relative risk of suicide was evident among those diagnosed with PTSD (RR = 2.09 [95% confidence interval (CI): 1.11-3.94]), with strongest associations among combat veterans (RR = 3.97, 95% CI 2.22-7.10). A lower relative risk of suicide among those with PTSD and co-morbid psychiatric conditions was evident (RR = 0.74, 95% CI 0.63-0.86). A strong association between PTSD and attempted suicide (RR = 4.05, 95% CI 3.14-5.23) and suicidal ideation (RR = 2.91, 95% CI 2.22-3.82) was also found, with a consistently strong association among those with co-morbid psychiatric conditions and non-clinical cohorts.
CONCLUSION
This review found a strong association between PTSD and death by suicide, attempted suicide, and suicidal ideation, and also suicide among veteran populations. Early identification and treatment of PTSD across both clinical and non-clinical cohorts should be a priority for suicide prevention.
Topics: Humans; Stress Disorders, Post-Traumatic; Suicidal Ideation; Suicide, Attempted; Veterans; Risk
PubMed: 36385705
DOI: 10.1111/sltb.12931 -
Clinical Psychology Review Feb 2017Parents who have lost an infant prior to, during, or following birth often interpret the event as highly traumatic. The present systematic review included 46 articles... (Review)
Review
Parents who have lost an infant prior to, during, or following birth often interpret the event as highly traumatic. The present systematic review included 46 articles based on 31 different studies of posttraumatic stress disorder (PTSD) in parents bereaved by infant death. The PTSD prevalence in mothers differed widely across studies with estimated rates at 0.6-39%. PTSD in fathers following infant loss has been less extensively studied but PTSD levels were generally much lower than in mothers with reported prevalence rates at 0-15.6% across studies. PTSD symptoms were not found to differ much depending on whether the death occurred prior to, during, or following birth and nor was gestational age consistently associated with PTSD severity. A number of risk and protective factors have been found to be associated with PTSD severity. Relevant focus areas for future research are presented along with considerations for future pregnancies and children. The suffering associated with PTSD following infant loss is overwhelming because of the rates at which such losses occur around the world. For this reason, it is problematic that not all types of infant loss resulting in sufficient symptoms of re-experiencing, avoidance, and arousal can elicit a DSM-5 PTSD diagnosis.
Topics: Bereavement; Female; Humans; Infant; Infant Death; Male; Parents; Prevalence; Stress Disorders, Post-Traumatic
PubMed: 27838460
DOI: 10.1016/j.cpr.2016.10.007 -
Critical Care Medicine May 2015To conduct a systematic review and metaanalysis of the prevalence, risk factors, and prevention/treatment strategies for posttraumatic stress disorder symptoms in... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To conduct a systematic review and metaanalysis of the prevalence, risk factors, and prevention/treatment strategies for posttraumatic stress disorder symptoms in critical illness survivors.
DATA SOURCES
PubMed, Embase, CINAHL, PsycINFO, and Cochrane Library from inception through March 5, 2014.
STUDY SELECTION
Eligible studies met the following criteria: 1) adult general/nonspecialty ICU, 2) validated posttraumatic stress disorder instrument greater than or equal to 1 month post-ICU, and 3) sample size greater than or equal to 10 patients.
DATA EXTRACTION
Duplicate independent review and data abstraction from all eligible titles/abstracts/full-text articles.
DATA SYNTHESIS
The search identified 2,817 titles/abstracts, with 40 eligible articles on 36 unique cohorts (n = 4,260 patients). The Impact of Event Scale was the most common posttraumatic stress disorder instrument. Between 1 and 6 months post-ICU (six studies; n = 456), the pooled mean (95% CI) Impact of Event Scale score was 20 (17-24), and the pooled prevalences of clinically important posttraumatic stress disorder symptoms (95% CI) were 25% (18-34%) and 44% (36-52%) using Impact of Event Scale thresholds greater than or equal to 35 and greater than or equal to 20, respectively. Between 7 and 12 months post-ICU (five studies; n = 698), the pooled mean Impact of Event Scale score was 17 (9-24), and pooled prevalences of posttraumatic stress disorder symptoms were 17% (10-26%) and 34% (22-50%), respectively. ICU risk factors for posttraumatic stress disorder symptoms included benzodiazepine administration and post-ICU memories of frightening ICU experiences. Posttraumatic stress disorder symptoms were associated with worse quality of life. In European-based studies: 1) an ICU diary was associated with a significant reduction in posttraumatic stress disorder symptoms, 2) a self-help rehabilitation manual was associated with significant posttraumatic stress disorder symptom reduction at 2 months, but not 6 months; and 3) a nurse-led ICU follow-up clinic did not reduce posttraumatic stress disorder symptoms.
CONCLUSIONS
Clinically important posttraumatic stress disorder symptoms occurred in one fifth of critical illness survivors at 1-year follow-up, with higher prevalence in those who had comorbid psychopathology, received benzodiazepines, and had early memories of frightening ICU experiences. In European studies, ICU diaries reduced posttraumatic stress disorder symptoms.
Topics: Critical Illness; Humans; Hypnotics and Sedatives; Intensive Care Units; Length of Stay; Mental Health; Respiration, Artificial; Risk Factors; Severity of Illness Index; Stress Disorders, Post-Traumatic; Survivors; Time Factors
PubMed: 25654178
DOI: 10.1097/CCM.0000000000000882