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Brain Imaging and Behavior Apr 2024Post-traumatic stress disorder (PTSD) is a debilitating condition which has been related to problems in emotional regulation, memory and cognitive control. Psychotherapy... (Meta-Analysis)
Meta-Analysis Review
Post-traumatic stress disorder (PTSD) is a debilitating condition which has been related to problems in emotional regulation, memory and cognitive control. Psychotherapy has a non-response rate of around 50% and understanding the neurobiological working mechanisms might help improve treatment. To integrate findings from multiple smaller studies, we performed the first meta-analysis of changes in brain activation with a specific focus on emotional processing after psychotherapy in PTSD patients. We performed a meta-analysis of brain activation changes after treatment during emotional processing for PTSD with seed-based d mapping using a pre-registered protocol (PROSPERO CRD42020211039). We analyzed twelve studies with 191 PTSD patients after screening 3700 studies. We performed systematic quality assessment both for the therapeutic interventions and neuroimaging methods. Analyses were done in the full sample and in a subset of studies that reported whole-brain results. We found decreased activation after psychotherapy in the left amygdala, (para)hippocampus, medial temporal lobe, inferior frontal gyrus, ventrolateral prefrontal cortex, right pallidum, anterior cingulate cortex, bilateral putamen, and insula. Decreased activation in the left amygdala and left ventrolateral PFC was also found in eight studies that reported whole-brain findings. Results did not survive correction for multiple comparisons. There is tentative support for decreased activation in the fear and cognitive control networks during emotional processing after psychotherapy for PTSD. Future studies would benefit from adopting a larger sample size, using designs that control for confounding variables, and investigating heterogeneity in symptom profiles and treatment response.
Topics: Humans; Stress Disorders, Post-Traumatic; Brain; Emotions; Psychotherapy; Brain Mapping; Magnetic Resonance Imaging
PubMed: 38049598
DOI: 10.1007/s11682-023-00831-0 -
European Journal of Psychotraumatology 2024Posttraumatic stress disorder (PTSD) is considered an independent risk factor for dementia. Despite the (clinical) evidence that PTSD is associated with...
Posttraumatic stress disorder (PTSD) is considered an independent risk factor for dementia. Despite the (clinical) evidence that PTSD is associated with neuropsychiatric symptoms in people with dementia, studies on its prevalence and clinical manifestation are limited, and their quality is affected by the lack of a structured method to diagnose PTSD in this population. The primary aim of the current study is to validate the 'TRAuma and DEmentia' interview as a diagnostic tool for PTSD in people with dementia and to test feasibility of EMDR treatment for people with PTSD and dementia. This prospective multi-centre study is divided into two parts. In study A, 90 participants with dementia will be included to test the criterion validity, inter-rater reliability and feasibility of the 'TRAuma and DEmentia' interview. In study B, 29 participants with dementia and PTSD will receive eye movement desensitisation and reprocessing therapy by a trained psychologist, and 29 participants with dementia and PTSD will be placed on the waiting list control group. This study aims to improve the diagnostic process of PTSD and to assess the effects of eye movement desensitisation and reprocessing treatment in people with dementia living in Dutch care facilities. NL70479.068.20 / METC 20-063 / OSF registration: https://doi.org/10.17605/OSF.IO/AKW4F.
Topics: Humans; Stress Disorders, Post-Traumatic; Prospective Studies; Reproducibility of Results; Eye Movement Desensitization Reprocessing; Dementia; Multicenter Studies as Topic
PubMed: 38488137
DOI: 10.1080/20008066.2024.2320040 -
Psychiatric Services (Washington, D.C.) Oct 2023Preliminary empirical evidence suggests that self-stigma may be a significant problem for those with posttraumatic stress disorder (PTSD). Although research on...
Preliminary empirical evidence suggests that self-stigma may be a significant problem for those with posttraumatic stress disorder (PTSD). Although research on self-stigma for persons with PTSD is limited, some PTSD symptoms, such as negative thoughts about oneself, feelings of shame, and avoidance-particularly of social interactions-may be conceptually related to self-stigma, potentially explaining the co-occurrence and relevance of self-stigma in PTSD. This Open Forum reviews how the social cognitive model may explain the co-occurrence of self-stigma and PTSD, considers how this model may inform treatment approaches for self-stigma in PTSD, and identifies next steps to empirically test the proposed theory.
Topics: Humans; Stress Disorders, Post-Traumatic; Concept Formation; Social Stigma; Shame
PubMed: 36935625
DOI: 10.1176/appi.ps.20220397 -
Stroke Apr 2024There is limited research on outcomes of patients with posttraumatic stress disorder (PTSD) who also develop stroke, particularly regarding racial disparities. Our goal...
BACKGROUND
There is limited research on outcomes of patients with posttraumatic stress disorder (PTSD) who also develop stroke, particularly regarding racial disparities. Our goal was to determine whether PTSD is associated with the risk of hospital readmission after stroke and whether racial disparities existed.
METHODS
The analytical sample consisted of all veterans receiving care in the Veterans Health Administration who were identified as having a new stroke requiring inpatient admission based on the codes. PTSD and comorbidities were identified using the codes and given the date of first occurrence. The retrospective cohort data were obtained from the Veterans Affairs Corporate Data Warehouse. The main outcome was any readmission to Veterans Health Administration with a stroke diagnosis. The hypothesis that PTSD is associated with readmission after stroke was tested using Cox regression adjusted for patient characteristics including age, sex, race, PTSD, smoking status, alcohol use, and comorbidities treated as time-varying covariates.
RESULTS
Our final cohort consisted of 93 651 patients with inpatient stroke diagnosis and no prior Veterans Health Administration codes for stroke starting from 1999 with follow-up through August 6, 2022. Of these patients, 12 916 (13.8%) had comorbid PTSD. Of the final cohort, 16 896 patients (18.0%) with stroke were readmitted. Our fully adjusted model for readmission found an interaction between African American veterans and PTSD with a hazard ratio of 1.09 ([95% CI, 1.00-1.20] =0.047). In stratified models, PTSD has a significant hazard ratio of 1.10 ([95% CI, 1.02-1.18] =0.01) for African American but not White veterans (1.05 [95% CI, 0.99-1.11]; =0.10).
CONCLUSIONS
Among African American veterans who experienced stroke, preexisting PTSD was associated with increased risk of readmission, which was not significant among White veterans. This study highlights the need to focus on high-risk groups to reduce readmissions after stroke.
Topics: Humans; United States; Stress Disorders, Post-Traumatic; Retrospective Studies; Patient Readmission; Stroke; Comorbidity; Veterans
PubMed: 38482715
DOI: 10.1161/STROKEAHA.123.044795 -
Expert Review of Neurotherapeutics Feb 2024The focus on perinatal mental health has expanded recently, though there is less research on post-traumatic stress disorder (PTSD). Therefore, a review of the literature... (Review)
Review
INTRODUCTION
The focus on perinatal mental health has expanded recently, though there is less research on post-traumatic stress disorder (PTSD). Therefore, a review of the literature was undertaken and coupled with expert clinical insights to discuss current clinical practice recommendations for PTSD in the perinatal period.
AREAS COVERED
This review covers considerations for the assessment, prevention, and treatment of PTSD during the perinatal period. Within these sections, evidence-based and promising practices are outlined. Extra attention is afforded to treatment, which includes considerations from both psychotherapeutic and psychopharmacological perspectives. This review closes with coverage of three important and related areas of consideration, including bereavement, intimate partner violence, and childhood sexual abuse.
EXPERT OPINION
Psychotherapeutic interventions for PTSD during pregnancy are limited, and no strong recommendations can be supported at this time while evidence points toward the effectiveness of cognitive behavioral therapies and eye movement desensitization therapy as first-line treatments postpartum though research evidence is also limited. Research on psychopharmacological interventions is similarly scarce, though selective serotonin reuptake inhibitors may be beneficial. Clinicians should also be mindful of additional considerations that may be needed for the treatment of PTSD in the context of bereavement, intimate partner violence, and history of sexual violence.
Topics: Pregnancy; Female; Humans; Child; Stress Disorders, Post-Traumatic; Cognitive Behavioral Therapy; Postpartum Period
PubMed: 38196397
DOI: 10.1080/14737175.2024.2303430 -
JAMA Network Open Aug 2023
Topics: Humans; Stress Disorders, Post-Traumatic; Cities; Risk Factors; Surveys and Questionnaires
PubMed: 37585205
DOI: 10.1001/jamanetworkopen.2023.29156 -
Journal of Traumatic Stress Jun 2024We examined transdiagnostic and posttraumatic stress disorder (PTSD)-specific associations with multiple forms of trauma exposure within a nationwide U.S. sample (N =...
We examined transdiagnostic and posttraumatic stress disorder (PTSD)-specific associations with multiple forms of trauma exposure within a nationwide U.S. sample (N = 1,649, 50.0% female) of military veterans overselected for PTSD. A higher-order Distress factor was estimated using PTSD, major depressive disorder (MDD), and generalized anxiety disorder (GAD) symptoms as indicators. A structural equation model spanning three assessment points over an average of 3.85 years was constructed to examine the unique roles of higher-order Distress and PTSD-specific variance in accounting for the associations between trauma exposure, measured using the Life Events Checklist (LEC) and Deployment Risk and Resiliency Inventory Combat subscale (DRRI-C), and psychosocial impairment. The results suggest the association between trauma exposure and PTSD symptoms was primarily mediated by higher-order distress (70.7% of LEC effect, 63.2% of DRRI-C effect), but PTSD severity retained a significant association with trauma exposure independent of distress, LEC: β = .10, 95% CI [.06, .13]; DRRI-C: β = .11, 95% CI [.07, .14]. Both higher-order distress, β = .31, and PTSD-specific variance, β = .36, were necessary to account for the association between trauma exposure and future impairment. Findings suggest that trauma exposure may contribute to comorbidity across a range of internalizing symptoms as well as to PTSD-specific presentations.
Topics: Humans; Female; Stress Disorders, Post-Traumatic; Male; Adult; Veterans; Depressive Disorder, Major; United States; Anxiety Disorders; Middle Aged; Life Change Events; Psychological Distress
PubMed: 38229407
DOI: 10.1002/jts.23009 -
Psychological Medicine Sep 2023Posttraumatic Stress Disorder (PTSD) tends to co-occur with greater alcohol consumption as well as alcohol use disorder (AUD). However, it is unknown whether the same...
BACKGROUND
Posttraumatic Stress Disorder (PTSD) tends to co-occur with greater alcohol consumption as well as alcohol use disorder (AUD). However, it is unknown whether the same etiologic factors that underlie PTSD-alcohol-related problems comorbidity also contribute to PTSD- alcohol consumption.
METHODS
We used summary statistics from large-scale genome-wide association studies (GWAS) of European-ancestry (EA) and African-ancestry (AA) participants to estimate genetic correlations between PTSD and a range of alcohol consumption-related and alcohol-related problems phenotypes.
RESULTS
In EAs, there were positive genetic correlations between PTSD phenotypes and alcohol-related problems phenotypes (e.g. Alcohol Use Disorders Identification Test (AUDIT) problem score) (rGs: 0.132-0.533, all FDR adjusted < 0.05). However, the genetic correlations between PTSD phenotypes and alcohol consumption -related phenotypes (e.g. drinks per week) were negatively associated or non-significant (rGs: -0.417 to -0.042, FDR adjusted : <0.05-NS). For AAs, the direction of correlations was sometimes consistent and sometimes inconsistent with that in EAs, and the ranges were larger (rGs for alcohol-related problems: -0.275 to 0.266, FDR adjusted : NS, alcohol consumption-related: 0.145-0.699, FDR adjusted : NS).
CONCLUSIONS
These findings illustrate that the genetic associations between consumption and problem alcohol phenotypes and PTSD differ in both strength and direction. Thus, the genetic factors that may lead someone to develop PTSD and high levels of alcohol consumption are not the same as those that lead someone to develop PTSD and alcohol-related problems. Discussion around needing improved methods to better estimate heritabilities and genetic correlations in diverse and admixed ancestry samples is provided.
Topics: Humans; Alcoholism; Stress Disorders, Post-Traumatic; Genome-Wide Association Study; Alcohol-Related Disorders; Alcohol Drinking; Phenotype
PubMed: 36177877
DOI: 10.1017/S0033291722002999 -
Journal of Affective Disorders Nov 2023A recent meta-analysis concluded to have found proof for both a social causation model, according to which social support protects against posttraumatic stress disorder... (Meta-Analysis)
Meta-Analysis Review
A recent meta-analysis concluded to have found proof for both a social causation model, according to which social support protects against posttraumatic stress disorder (PTSD), and a social selection model, which claims that PTSD erodes social support. However, the prospective cross-lagged effects were estimated while adjusting for a prior measurement of the outcome and this method is vulnerable for spurious findings due to correlations with residuals and regression toward the mean. The present re-analyses of the meta-analytic effects indicated that depending on used model one can choose to claim that social support has either a decreasing, an increasing, or no prospective effect on subsequent change in PTSD symptom severity, and vice versa. Therefore, claims over and above a negative cross-sectional correlation between social support and PTSD, including the social causation and social selection models, can be questioned. The findings were validated by analyses of simulated data, which indicated that prospective effects were not necessary for the observed meta-analytic associations.
Topics: Humans; Stress Disorders, Post-Traumatic; Cross-Sectional Studies; Social Support; Causality; Longitudinal Studies
PubMed: 37557992
DOI: 10.1016/j.jad.2023.08.014 -
Psychological Trauma : Theory,... Oct 2023The primary aim of this study was to examine the association between perceived discrimination and posttraumatic stress disorder (PTSD) outcomes among recently arrived...
OBJECTIVES
The primary aim of this study was to examine the association between perceived discrimination and posttraumatic stress disorder (PTSD) outcomes among recently arrived Venezuelan parents in Florida and Colombia. The secondary aim was to determine whether, given the existence of an association between perceived discrimination and PTSD, this association may have been moderated by gender or by country of relocation. This is the first study to examine perceived discrimination and PTSD in Venezuelan migrants.
METHOD
In October 2017, 647 Venezuelan migrant parents (62% female, average age 33) participated in an online survey in the United States (primarily Florida) and Colombia (Bogotá). The survey was cross-sectional and assessed mental health outcomes, perceived discrimination, and participant demographics.
RESULTS
There was a significant positive association between discrimination and PTSD outcomes when controlling for age, college completion, marital status, and recency of arrival (β = .25, < .001). Further, this relationship was moderated by gender, with the relationships of discrimination with PTSD symptom severity (β = .26, < .001) and likelihood of a positive PTSD screen ( = 1.07, 95% confidence interval [1.04, 1.09], < .001) both reaching significance for women but not for men.
CONCLUSIONS
Perceived discrimination is an important factor when considering mental health outcomes among Venezuelans in the United States and in Colombia. Further, our findings suggest the presence of gender differences in the relationship between discrimination and PTSD. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Topics: Male; Humans; Female; United States; Adult; Stress Disorders, Post-Traumatic; Colombia; Transients and Migrants; Cross-Sectional Studies; Perceived Discrimination
PubMed: 35549381
DOI: 10.1037/tra0001263