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JAMA Network Open Dec 2020Posttraumatic stress disorder (PTSD) has been associated with impaired educational performance. Previous studies on the disorder could not control for important measured...
IMPORTANCE
Posttraumatic stress disorder (PTSD) has been associated with impaired educational performance. Previous studies on the disorder could not control for important measured and unmeasured confounders.
OBJECTIVE
To prospectively investigate the association between PTSD and objective indicators of educational attainment across the life span, controlling for familial factors shared by full siblings, psychiatric comorbidity, and general cognitive ability.
DESIGN, SETTING, AND PARTICIPANTS
This population-based cohort study included 2 244 193 individuals born in Sweden between January 1, 1973, and December 31, 1997, who were followed-up until December 31, 2013. Clusters of full siblings were used to account for familial factors. Data analyses were conducted between December 2018 and May 2020.
EXPOSURE
International Classification of Diseases, Ninth Revision and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnoses of PTSD in the Swedish National Patient Register.
MAIN OUTCOMES AND MEASURES
Eligibility to access upper secondary education after finishing compulsory education, finishing upper secondary education, starting a university degree, and finishing a university degree.
RESULTS
Of the final cohort of 2 244 193 individuals (1 151 414 [51.3%] men) included in the analysis, 1 425 326 were assessed for finishing compulsory education (919 with PTSD), 2 001 944 for finishing upper secondary education (2013 with PTSD), and 1 796 407 and 1 356 741 for starting and finishing a university degree (2243 and 2254 with PTSD, respectively). Posttraumatic stress disorder was associated with lower odds of achieving each of the educational milestones during the study period, including 82% lower odds of finishing compulsory education (adjusted odds ratio [aOR], 0.18; 95% CI, 0.15-0.20), 87% lower odds of finishing upper secondary education (aOR, 0.13; 95% CI, 0.12-0.14), 68% lower odds of starting a university degree (aOR, 0.32; 95% CI, 0.28-0.35), and 73% lower odds of finishing a university degree (aOR, 0.27; 95% CI, 0.23-0.31). Estimates in the sibling comparison were attenuated (aOR range, 0.22-0.53) but remained statistically significant. Overall, excluding psychiatric comorbidities and adjusting for the successful completion of the previous milestone and general cognitive ability did not statistically significantly alter the magnitude of the associations.
CONCLUSIONS AND RELEVANCE
Posttraumatic stress disorder was associated with educational impairment across the life span, and the associations were not entirely explained by shared familial factors, psychiatric comorbidity, or general cognitive ability. This finding highlights the importance of implementing early trauma-informed interventions in schools and universities to minimize the long-term socioeconomic consequences of academic failure in individuals with PTSD.
Topics: Adult; Cognition; Educational Status; Female; Humans; International Classification of Diseases; Male; Medical History Taking; Mental Health; Needs Assessment; Risk Factors; Siblings; Stress Disorders, Post-Traumatic; Sweden
PubMed: 33289847
DOI: 10.1001/jamanetworkopen.2020.28477 -
Biological Psychiatry Sep 2019Many biological systems are altered in association with posttraumatic stress disorder (PTSD) and resilience. However, there are only few approved pharmacological... (Review)
Review
Many biological systems are altered in association with posttraumatic stress disorder (PTSD) and resilience. However, there are only few approved pharmacological treatments for PTSD, and no approved medications to enhance resilience. This article provides a critical review of select neurobiological findings in PTSD and resilience, and also of pharmacologic approaches that have emerged from this work. The medications summarized involve engagement with targets in the adrenergic, hypothalamic-pituitary-adrenal axis, and neuropeptide Y systems. Other highlighted approaches involve the use of ketamine and 3,4-methylenedioxymethamphetamine-assisted psychotherapy, which recently surfaced as promising strategies for PTSD, though the neurobiological mechanisms underlying their actions, including for promoting resilience, are not yet fully understood. The former approaches fall within the broad concept of "rational pharmacotherapy," in that they attempt to directly target dysregulated systems known to be associated with posttraumatic symptoms. To the extent that use of ketamine and 3,4-methylenedioxymethamphetamine promotes symptom improvement and resilience in PTSD, this provides an opportunity for reverse translation and identification of relevant targets and mechanisms of action through careful study of biological changes resulting from these interventions. Promoting resilience in trauma-exposed individuals may involve more than pharmacologically manipulating dysregulated molecules and pathways associated with developing and sustaining PTSD symptom severity, but also producing a substantial change in mental state that increases the ability to engage with traumatic material in psychotherapy. Neurobiological examination in the context of treatment studies may yield novel targets and promote a greater understanding of mechanisms of recovery from trauma.
Topics: Drug Therapy; Humans; Hypothalamo-Hypophyseal System; Neurobiology; Pituitary-Adrenal System; Psychotherapy; Resilience, Psychological; Stress Disorders, Post-Traumatic
PubMed: 31466562
DOI: 10.1016/j.biopsych.2019.07.009 -
Canadian Journal of Psychiatry. Revue... Sep 2014During the last 30 years, there has been a substantial increase in the study of posttraumatic stress disorder (PTSD). Several high-profile traumatic events, such as the... (Review)
Review
During the last 30 years, there has been a substantial increase in the study of posttraumatic stress disorder (PTSD). Several high-profile traumatic events, such as the wars in Afghanistan and Iraq, and the terrorist attacks of September 11 on the World Trade Center, have led to a greater public interest in the risk and protective factors for PTSD. In this In Review paper, I discuss some of the important advances in PTSD. The paper provides a concise review of the evolution of PTSD diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, impact of PTSD in the community, an overview of the established risk factors for developing PTSD, and assessment and treatment. Throughout the paper, controversies and clinical implications are discussed.
Topics: Adult; Brain Injuries; Cognitive Behavioral Therapy; Comorbidity; Diagnostic and Statistical Manual of Mental Disorders; Female; Humans; Life Change Events; Male; Mental Health; Outcome Assessment, Health Care; Prevalence; Psychotropic Drugs; Risk Factors; Sex Offenses; Social Problems; Stress Disorders, Post-Traumatic; Warfare
PubMed: 25565692
DOI: 10.1177/070674371405900902 -
Behavioural Brain Research Jan 2015Post-traumatic stress disorder is an anxiety disorder that can develop following one or more traumatic events that threaten one's safety or make the victim feel... (Review)
Review
Post-traumatic stress disorder is an anxiety disorder that can develop following one or more traumatic events that threaten one's safety or make the victim feel helpless. Currently there are an increasing number of cases in the population in part due to the number of soldiers returning from combat. The disorder is characterized by symptoms that include hypervigilance, sleep disturbances, social and cognitive degradation, and memory flashbacks. Most of the research has been centered on the human and rodent as subjects but recently another viable contender has emerged - the zebrafish (Danio rerio). The zebrafish is a strong comparative model with the ability to exhibit a wide variety of behaviors, complex learning, and neurobiological changes that can be extrapolated to the human condition. The zebrafish is an ideal organism to study pharmacological treatments as well as the neurological underpinnings of the disorder. Here we review a sampling of the human and rodent model literature on post-traumatic stress disorder focusing on symptomology, current treatments, and stress paradigms. We also make the argument for the inclusion of the zebrafish model in future studies investigating the causes, symptoms, and treatments of post-traumatic stress disorder.
Topics: Animals; Disease Models, Animal; Humans; Stress Disorders, Post-Traumatic; Zebrafish
PubMed: 24821404
DOI: 10.1016/j.bbr.2014.05.005 -
Current Psychiatry Reports Nov 2016Psychological mechanisms can be defined as processes or events that are responsible for specific changes in psychological outcomes. In psychotherapy research, mechanisms... (Review)
Review
Psychological mechanisms can be defined as processes or events that are responsible for specific changes in psychological outcomes. In psychotherapy research, mechanisms are the factors through which interventions produce change. In this article, we explain the importance of identifying psychological mechanisms, describe methods for identifying them, and analyze recent literature on the psychological mechanisms underlying the development and treatment of posttraumatic stress disorder (PTSD). Based on the findings of recent investigations (from 2013 to present), we focus on four putative mechanisms: emotional engagement, extinction and contextualization, distress tolerance, and negative posttraumatic cognitions. Future directions for psychological mechanism research are also outlined, including possible opportunities for capitalizing on the most promising mechanisms identified to date.
Topics: Humans; Psychotherapy; Stress Disorders, Post-Traumatic; Treatment Outcome
PubMed: 27671916
DOI: 10.1007/s11920-016-0735-9 -
Clinical Psychology & Psychotherapy Jan 2022Posttraumatic stress disorder (PTSD) includes changes in processes such as encoding and retrieval for both traumatic and positive memories. However, most work has... (Review)
Review
Posttraumatic stress disorder (PTSD) includes changes in processes such as encoding and retrieval for both traumatic and positive memories. However, most work has predominantly focused on traumatic memories. Thus, Contractor and colleagues proposed a Positive Memory-PTSD model, which highlighted potential benefits associated with and mechanisms underlying positive memory retrieval/processing among individuals reporting PTSD symptoms. To enhance research on and clinical impacts of this model, the current review provides critical considerations for the Positive Memory-PTSD model. Drawing from emerging research and clinical observations, we (i) clarify that the model addresses specific versus overgeneral positive memories; (ii) underscore the importance of considering the heterogeneity in, and transitionary nature of, affect processes following positive memory retrieval; and (iii) highlight the rationale for considering trauma type/count and co-occurring conditions, as potential moderators of relations between positive memory processing and PTSD. Hereby, we provide an updated Positive Memory-PTSD model and implications for positive memory interventions drawing from this model.
Topics: Cognition; Humans; Memory; Stress Disorders, Post-Traumatic
PubMed: 33870586
DOI: 10.1002/cpp.2599 -
Journal of Cognitive Psychotherapy Jul 2022Posttraumatic stress disorder (PTSD) co-occurs with obsessive-compulsive disorder (OCD) nearly 25% of the time, and rates of co-occurring OCD within PTSD populations are... (Review)
Review
Posttraumatic stress disorder (PTSD) co-occurs with obsessive-compulsive disorder (OCD) nearly 25% of the time, and rates of co-occurring OCD within PTSD populations are even higher. Several studies examining the impact of co-occurring OCD and PTSD with suggest attenuated treatment response, yet findings regarding symptom presentation in this population are mixed. Given phenotypic, functional, and sometimes etiological overlap in OCD and PTSD, differential diagnosis and specialized treatment can be a complex yet important undertaking. This paper reviews the current literature on co-occurring OCD and PTSD; describes the theoretical conceptualization for the intersection of OCD and PTSD; offers recommendations for differential assessment and cognitive behavioral treatment; and provides directions for future research on co-occurring OCD and PTSD.
Topics: Cognition; Cognitive Behavioral Therapy; Concept Formation; Humans; Obsessive-Compulsive Disorder; Stress Disorders, Post-Traumatic
PubMed: 35882536
DOI: 10.1891/jcp-2021-0007 -
Acta Psychiatrica Scandinavica Jan 2023Several medical and psychiatric disorders have stage-based treatment decision-making methods. However, international treatment guidelines for posttraumatic stress...
OBJECTIVES
Several medical and psychiatric disorders have stage-based treatment decision-making methods. However, international treatment guidelines for posttraumatic stress disorder (PTSD) fail to give specific treatment recommendations based on chronicity or stage of the disorder. There is convincing evidence of a finite range of PTSD symptom trajectories, implying that different phenotypes of the disorder can be distinguished, which are highly relevant for a staging typology of PTSD.
METHODS
State-of-the-art review building on prior work on staging models in other disorders as a mapping tool to identify and synthesize toward PTSD.
RESULTS
We propose a four-stage model of PTSD ranging from stage 0: trauma-exposed asymptomatic but at risk to stage 4: severe unremitting illness of increasing chronicity. We favor a symptom description in various chronological characteristics based on neurobiological markers, information processing systems, stress reactivity, and consciousness dimensions. We also advocate for a separate phenomenology of treatment resistance since this can yield treatment recommendations.
CONCLUSION
A staging perspective in the field of PTSD is highly needed. This can facilitate the selection of interventions that are proportionate to patients' current needs and risk of illness progression and can also contribute to an efficient framework to organize biomarker data and guide service delivery. Therefore, we propose that a neurobiologically driven trajectory-based typology of PTSD can help deduct several treatment recommendations leading to a more personalized and refined grid to strategize, plan and evaluate treatment interventions.
Topics: Humans; Stress Disorders, Post-Traumatic
PubMed: 36367112
DOI: 10.1111/acps.13520 -
Clinical Psychology Review Jul 2017The goal of the current systematic review was to provide an overview of the findings in the field of Cardiac-Disease-Induced Posttraumatic Stress Disorder (CDI-PTSD) in... (Review)
Review
The goal of the current systematic review was to provide an overview of the findings in the field of Cardiac-Disease-Induced Posttraumatic Stress Disorder (CDI-PTSD) in order to establish CDI-PTSD as a valid diagnostic entity for a wide spectrum of cardiac diseases and related medical procedures. In accordance with PRISMA guidelines, we conducted a systematic electronic literature search. Of the 3202 citations identified, 150 studies meeting the selection criteria were reviewed. Our main findings were that the prevalence of CDI-PTSD ranged between 0% and 38% (averaging at 12%) and was highly dependent on the assessment tool used. The most consistent risk factors are of a psychological nature (e.g., pre-morbid distress). The consequences of CDI-PTSD range from psychosocial difficulties to lack of adherence and heightened mortality rates. Much inconsistency in the field was found with regard to patients who present with diagnoses other than acute coronary syndrome (e.g., cardiac arrest) and who undergo potentially traumatic medical procedures (e.g., defibrillator implantation). Yet the current review seems to strengthen the conceptualization of CDI-PTSD as a valid diagnostic entity, at least with regard to acute cardiac events.
Topics: Heart Diseases; Humans; Stress Disorders, Post-Traumatic
PubMed: 28575815
DOI: 10.1016/j.cpr.2017.04.009 -
Clinical Psychology & Psychotherapy May 2020Self-compassion has emerged as an important construct in the mental health literature. Although conceptual links between self-compassion and trauma are apparent, a...
Self-compassion has emerged as an important construct in the mental health literature. Although conceptual links between self-compassion and trauma are apparent, a review has not been completed to examine whether this association is supported by empirical research findings. To systematically summarize knowledge on the association between trauma and/or posttraumatic stress disorder (PTSD) and self-compassion. Searches were conducted in PsycINFO, PubMed, Ovid Medline, Web of Science, Embase, and PILOTS databases, and papers reporting a direct analysis on the relationship between these constructs were identified. The search yielded 35 studies meeting inclusion criteria. Despite considerable heterogeneity in study design, sample, measurement, and trauma type, there was consistent evidence to suggest that increased self-compassion is associated with less PTSD symptomatology and some evidence to suggest that reduced fear of self-compassion is associated with less PTSD symptomatology. There was tentative evidence to suggest that interventions based, in part or whole, on a self-compassion model potentially reduce PTSD symptoms. Although findings are positive for the association between increased self-compassion and reduced PTSD symptoms, the precise mechanism of these protective effects is unknown. Prospective and longitudinal studies would be beneficial in clarifying this. The review also highlighted the variability in what is and should be referred to as trauma exposure, indicating the need for further research to clarify the concept.
Topics: Adaptation, Psychological; Diagnosis, Differential; Emotional Regulation; Empathy; Fear; Humans; Life Change Events; Prognosis; Prospective Studies; Psychotherapy; Self Concept; Stress Disorders, Post-Traumatic
PubMed: 31986553
DOI: 10.1002/cpp.2429