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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 -
Surgery For Obesity and Related... Aug 2022After bariatric surgery, some patients experience adverse psychiatric outcomes, including substance use, suicidality, and self-harm. These factors are commonly...
BACKGROUND
After bariatric surgery, some patients experience adverse psychiatric outcomes, including substance use, suicidality, and self-harm. These factors are commonly associated with posttraumatic stress disorder (PTSD) and related symptoms (PTSD-S) that develop following adverse childhood experiences (ACEs) and traumatic events. However, emerging evidence suggests that chronic discrimination also may contribute to PTSD-S. Weight-based discrimination is salient for people with obesity but has received little attention in relation to PTSD-S.
OBJECTIVE
Our study examined factors that may contribute to the link between experienced weight stigma (WS), which is common in individuals seeking bariatric surgery, and PTSD-S.
SETTING
Teaching hospital and surgical weight loss center in the United States.
METHODS
A total of 217 participants completed self-report surveys of experienced and internalized WS, ACEs, and PTSD-S. Demographics and trauma history were obtained from patient medical records. A stepwise multiple regression examined associations between experienced WS and internalized WS with PTSD-S, co-varying demographics, ACEs, and trauma, followed by examination of whether findings held co-varying anxiety/depressive symptoms in a participant subset (n = 189).
RESULTS
After accounting for covariates in step 1 and ACEs and trauma in step 2 (ΔR = .14), experienced WS and internalized WS accounted for substantial PTSD-S variance in steps 2 and 3 (ΔR = .12 and .13, respectively; overall model R =.44; P < .001). Findings held after co-varying anxiety/depressive symptoms.
CONCLUSIONS
Over and above ACEs and trauma, experienced WS and internalized WS may contribute to PTSD-S. Longitudinal research is needed to better elucidate the pathways underlying these associations.
Topics: Bariatric Surgery; Humans; Stress Disorders, Post-Traumatic; Substance-Related Disorders; Surveys and Questionnaires; Weight Prejudice
PubMed: 35811291
DOI: 10.1016/j.soard.2022.05.011 -
Neuropsychopharmacology : Official... Jan 2022Posttraumatic stress disorder can be viewed as a disorder of fear dysregulation. An abundance of research suggests that the prefrontal cortex is central to fear... (Review)
Review
Posttraumatic stress disorder can be viewed as a disorder of fear dysregulation. An abundance of research suggests that the prefrontal cortex is central to fear processing-that is, how fears are acquired and strategies to regulate or diminish fear responses. The current review covers foundational research on threat or fear acquisition and extinction in nonhuman animals, healthy humans, and patients with posttraumatic stress disorder, through the lens of the involvement of the prefrontal cortex in these processes. Research harnessing advances in technology to further probe the role of the prefrontal cortex in these processes, such as the use of optogenetics in rodents and brain stimulation in humans, will be highlighted, as well other fear regulation approaches that are relevant to the treatment of posttraumatic stress disorder and involve the prefrontal cortex, namely cognitive regulation and avoidance/active coping. Despite the large body of translational research, many questions remain unanswered and posttraumatic stress disorder remains difficult to treat. We conclude by outlining future research directions related to the role of the prefrontal cortex in fear processing and implications for the treatment of posttraumatic stress disorder.
Topics: Amygdala; Animals; Extinction, Psychological; Fear; Humans; Prefrontal Cortex; Stress Disorders, Post-Traumatic
PubMed: 34545196
DOI: 10.1038/s41386-021-01155-7 -
Cancer Jul 2021Patients with acute myeloid leukemia (AML) receiving intensive chemotherapy face a life-threatening illness, isolating hospitalization, and substantial physical and... (Clinical Trial)
Clinical Trial
BACKGROUND
Patients with acute myeloid leukemia (AML) receiving intensive chemotherapy face a life-threatening illness, isolating hospitalization, and substantial physical and psychological symptoms. However, data are limited regarding risk factors of posttraumatic stress disorder (PTSD) symptoms in this population.
METHODS
The authors conducted a secondary analysis of data from 160 patients with high-risk AML who were enrolled in a supportive care trial. The PTSD Checklist-Civilian Version was used to assess PTSD symptoms at 1 month after AML diagnosis. The Brief COPE and the Functional Assessment of Cancer Therapy-Leukemia were to assess coping and quality of life (QOL), respectively. In addition, multivariate regression models were constructed to assess the relation between PTSD symptoms and baseline sociodemographic factors, coping, and QOL.
RESULTS
Twenty-eight percent of patients reported PTSD symptoms, describing high rates of intrusion, avoidance, and hypervigiliance. Baseline sociodemographic factors significantly associated with PTSD symptoms were age (B = -0.26; P = .002), race (B = -8.78; P = .004), and postgraduate education (B = -6.30; P = .029). Higher baseline QOL (B = -0.37; P ≤ .001) and less decline in QOL during hospitalization (B = -0.05; P = .224) were associated with fewer PTSD symptoms. Approach-oriented coping (B = -0.92; P = .001) was associated with fewer PTSD symptoms, whereas avoidant coping (B = 2.42; P ≤ .001) was associated with higher PTSD symptoms.
CONCLUSIONS
A substantial proportion of patients with AML report clinically significant PTSD symptoms 1 month after initiating intensive chemotherapy. Patients' baseline QOL, coping strategies, and extent of QOL decline during hospitalization emerge as important risk factors for PTSD, underscoring the need for supportive oncology interventions to reduce the risk of PTSD in this population.
Topics: Adaptation, Psychological; Hospitalization; Humans; Leukemia, Myeloid, Acute; Quality of Life; Stress Disorders, Post-Traumatic
PubMed: 33764526
DOI: 10.1002/cncr.33524 -
Journal of Sleep Research Aug 2021Emotion processing abnormalities and sleep pathology are central to the phenomenology of paediatric posttraumatic stress disorder, and sleep disturbance has been linked...
Emotion processing abnormalities and sleep pathology are central to the phenomenology of paediatric posttraumatic stress disorder, and sleep disturbance has been linked to the development, maintenance and severity of the disorder. Given emerging evidence indicating a role for sleep in emotional brain function, it has been proposed that dysfunctional processing of emotional experiences during sleep may play a significant role in affective disorders, including posttraumatic stress disorder. Here we sought to examine the relationship between sleep and emotion processing in typically developing youth, and youth with a diagnosis of posttraumatic stress disorder . We use high-density electroencephalogram to compare baseline sleep with sleep following performance on a task designed to assess both memory for and reactivity to negative and neutral imagery in 10 youths with posttraumatic stress disorder, and 10 age- and sex-matched non-traumatized typically developing youths. Subjective ratings of arousal to negative imagery (ΔArousal = post-sleep minus pre-sleep arousal ratings) remain unchanged in youth with posttraumatic stress disorder following sleep (mean increase 0.15, CI -0.28 to +0.58), but decreased in TD youth (mean decrease -1.0, 95% CI -1.44 to -0.58). ΔArousal, or affective habituation, was negatively correlated with global change in slow-wave activity power (ρ = -0.58, p = .008). When considered topographically, the correlation between Δslow-wave activity power and affective habituation was most significant in a frontal cluster of 27 electrodes (Spearman, ρ = -0.51, p = .021). Our results highlight the importance of slow-wave sleep for adaptive emotional processing in youth, and have implications for symptom persistence in paediatric posttraumatic stress disorder. Impairments in slow-wave activity may represent a modifiable risk factor in paediatric posttraumatic stress disorder.
Topics: Adolescent; Child; Emotions; Female; Humans; Male; Pilot Projects; Sleep; Stress Disorders, Post-Traumatic
PubMed: 33442931
DOI: 10.1111/jsr.13261 -
American Journal of Transplantation :... Mar 2022Adolescent transplant recipients may encounter a range of potentially traumatic events (PTEs) pre- and posttransplant, yet little is known about the relationship between...
Adolescent transplant recipients may encounter a range of potentially traumatic events (PTEs) pre- and posttransplant, yet little is known about the relationship between posttraumatic stress symptoms (PTSS) and medication adherence in this population. In the present study, adolescent recipients and caregivers completed psychosocial questionnaires at enrollment. Outpatient tacrolimus trough level data were collected over 1 year to calculate the Medication Level Variability Index (MLVI), a measure of medication adherence. Nonadherence (MLVI ≥2) was identified in 34.8% of patients, and most (80.7%) reported ≥1 PTE exposure. Levels of PTSS indicating likely posttraumatic stress disorder (PTSD) were endorsed by 9.2% of patients and 43.7% of caregivers. PTSS and MLVI were significantly correlated in the liver subgroup (r = .30, p = .04). Hierarchical multivariable linear regression analyses revealed overall patient PTSS were significantly associated with QoL (p < .001). PTEs are common in adolescent recipients; a minority may meet criteria for PTSD. PTSS screening to identify nonadherence risk requires further investigation and addressing PTSS may improve QoL. Caregivers appear at greater risk for PTSD and may require their own supports. The study was approved by each participating center's Institutional Review Board.
Topics: Adolescent; Child; Humans; Medication Adherence; Quality of Life; Stress Disorders, Post-Traumatic; Surveys and Questionnaires; Transplant Recipients
PubMed: 34837457
DOI: 10.1111/ajt.16896 -
Air Medical Journal 2022Emergency medical personnel are exposed to multiple stressors, including those of psychological etiologies. The aim of this study was to report the prevalence of...
OBJECTIVE
Emergency medical personnel are exposed to multiple stressors, including those of psychological etiologies. The aim of this study was to report the prevalence of anxiety, depression, and posttraumatic stress symptoms in Norwegian medical helicopter personnel and to determine to what degree they report personal growth or deprecation due to exposure to work-related events.
METHODS
This was a web-based, cross-sectional survey performed among rescue paramedics and physicians staffing helicopter emergency medical services and search and rescue helicopters between May 5, 2021, and July 5, 2021. Questions included demographic data, the traumatic events exposure index, the Generalized Anxiety Disorder 7 scale, the Patient Health Questionnaire 9 (Depression), the posttraumatic change scale, and the posttraumatic symptom scale.
RESULTS
Of the 245 eligible participants, 10 declined to take part and 74 failed to answer, producing a response rate of 66% (72 rescue paramedics and 89 physicians). Of the study population, 3.9 % reported manifest posttraumatic stress disorder symptoms, and 1.9% described moderate to severe depression and anxiety. The majority (76%) described posttraumatic emotional growth because of their work experience.
CONCLUSION
Despite exposure to several traumatic stressors, participants reported a lower prevalence of posttraumatic stress symptoms, depression, and anxiety compared with a Norwegian adult population.
Topics: Adult; Air Ambulances; Aircraft; Anxiety; Cross-Sectional Studies; Humans; Stress Disorders, Post-Traumatic
PubMed: 35595337
DOI: 10.1016/j.amj.2022.02.006 -
Neuropharmacology Mar 2023Psychiatric disorders associated with psychological trauma, stress and anxiety are a highly prevalent and increasing cause of morbidity worldwide. Current therapeutic... (Review)
Review
Psychiatric disorders associated with psychological trauma, stress and anxiety are a highly prevalent and increasing cause of morbidity worldwide. Current therapeutic approaches, including medication, are effective in alleviating symptoms of anxiety disorders and posttraumatic stress disorder (PTSD), at least in some individuals, but have unwanted side-effects and do not resolve underlying pathophysiology. After a period of stagnation, there is renewed enthusiasm from public, academic and commercial parties in designing and developing drug treatments for these disorders. Here, we aim to provide a snapshot of the current state of this field that is written for neuropharmacologists, but also practicing clinicians and the interested lay-reader. After introducing currently available drug treatments, we summarize recent/ongoing clinical assessment of novel medicines for anxiety and PTSD, grouped according to primary neurochemical targets and their potential to produce acute and/or enduring therapeutic effects. The evaluation of putative treatments targeting monoamine (including psychedelics), GABA, glutamate, cannabinoid, cholinergic and neuropeptide systems, amongst others, are discussed. We emphasize the importance of designing and clinically assessing new medications based on a firm understanding of the underlying neurobiology stemming from the rapid advances being made in neuroscience. This includes harnessing neuroplasticity to bring about lasting beneficial changes in the brain rather than - as many current medications do - produce a transient attenuation of symptoms, as exemplified by combining psychotropic/cognitive enhancing drugs with psychotherapeutic approaches. We conclude by noting some of the other emerging trends in this promising new phase of drug development.
Topics: Humans; Stress Disorders, Post-Traumatic; Anxiety Disorders; Anxiety
PubMed: 36623804
DOI: 10.1016/j.neuropharm.2023.109418 -
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 -
Journal of Psychiatric Practice Sep 2022Coronavirus disease 2019 (COVID-19) has taken a significant toll on people worldwide, and in particular, on the health care workers (HCWs) who have worked on the...
BACKGROUND
Coronavirus disease 2019 (COVID-19) has taken a significant toll on people worldwide, and in particular, on the health care workers (HCWs) who have worked on the frontlines in the fight against the pandemic. The goal of this study was to investigate the prevalence of posttraumatic stress disorder (PTSD) and related factors in HCWs in the era of COVID-19.
METHODS
This cross-sectional survey study was conducted between September 15, and October 15, 2020, among HCWs in Turkey. The survey consisted of self-administered questionnaires, which included questions about sociodemographic variables, experiences caring for patients with COVID-19, and the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5), a trauma screening tool. The online survey was completed by 1833 HCWs. Univariate and multivariate logistic regression analyses were used to identify independent predictors of PTSD.
RESULTS
The mean age of the participants was 32.7±7.0 years; 81.9% were physicians, and 56.5% were female. The rates of COVID-19 history in the respondents, a family member, or a coworker were 13.6%, 32.3%, and 12.6%, respectively. Among the HCWs who participated, 39.9% met the criteria for PTSD. Compared with the physicians, the nonphysician HCWs had a higher rate of PTSD (49.5% vs. 36%) (P<0.001) and higher PCL-5 scores (53.31±19.6 vs. 42.5±20.3) (P<0.001). In addition, 9.7% of the surveyed HCWs reported having suicidal ideation during the COVID-19 pandemic. Independent predictors of PTSD in HCWs were working on a COVID-19 unit, feeling isolated, suicidal ideation, being a nonphysician HCW, fear of spreading coronavirus to family, female sex, and a history of having COVID-19.
CONCLUSIONS
HCWs were at risk for impairment in mental well-being in the era of COVID-19, with a significant number experiencing PTSD as well as suicidal ideation. Therefore, HCWs, especially those who are working on a COVID-19 unit and are female, should be monitored regularly for PTSD.
Topics: Adult; COVID-19; Cross-Sectional Studies; Female; Health Personnel; Humans; Male; Pandemics; Stress Disorders, Post-Traumatic
PubMed: 36074104
DOI: 10.1097/PRA.0000000000000661