Clinician-Administered PTSD Scale Scores Research Articles

Re‐experiencing Symptoms and Sleep Disturbances in Women with PTSD

Individuals with post-traumatic stress disorder (PTSD) are at significantly higher risk of developing cardiovascular disease. While there is accumulating evidence that insufficient sleep independently contributes to adverse cardiovascular conditions, the specific associations between PTSD symptoms, cardiovascular variables and sleep disturbances (i.e. disruptive nighttime behaviors) are still unclear. In a group of trauma-exposed civilian women, we assessed the predictive value of the PTSD diagnostic clusters of re-experiencing, arousal and avoidance/numbing on blood pressure (BP), heart rate (HR) and sleep disturbances. We hypothesized that BP, HR and sleep will be differentially linked to specific diagnostic clusters. PTSD status was assessed using the gold-standard clinician administered PTSD scale (CAPS) and PTSD symptom severity via the PTSD Symptom Scale (PSS). We measured baseline BP, HR and quantified sleep disturbances via the Pittsburgh Sleep Quality Index Addendum for PTSD (PSQI-A). Of the 49 women included in the analysis, a subset of 43 (age, 49±12 years old; body mass index (BMI), 37±7 kg/m2) also presented with comorbid depression as per Beck Depression Inventory (BDI). Our analysis yielded no significant correlations between resting BP and CAPS or PSS scores. However, we found a modest correlation between HR and CAPS score (r=.210, p=.074), solely driven by avoidance symptoms (r=.344, p=.009). PSQI-A was correlated with CAPS (r=.536, P<.001) and PSS total scores (r=.685, P<.001). Interestingly, the correlation with PSS appeared to be mainly driven by hyperarousal (r=.621, p<.001) and re-experiencing (r=.704, p<.001) symptoms than avoidance/numbing symptoms (r=.442, p=.001). PSQI-A was also correlated with depression (r=.589, P<.001). To further determine the predictive value of the PTSD diagnostic clusters, we conducted two hierarchical linear regression models predicting HR and PSQI-A by relevant covariates of age, BMI, and BDI total score in step 1, and re-experiencing, hyperarousal, and avoidance symptoms scores in step 2. The final model with age, BMI, depression, and all three PTSD symptom clusters was significant (R2=.607, p=.016), and those clusters explained 21.3% of the variance beyond other predictors in PSQI-A score; the re-experiencing cluster was the strongest predictor (b =.535, p<.001). On the other hand, the final model predicting HR (R2=.205, p=.035) included age, BMI, and avoidance symptoms as significant predictors (p<.05). In summary, the current results show that while avoidance/numbing symptoms might partly contribute to resting HR in PTSD, the disruptive nighttime behaviors described in PTSD are strongly predicted by symptoms of re-experiencing (i.e. intrusive thoughts, flashbacks), even when controlling for the common comorbid depression. This suggests that the level of sleep dysfunction reported in PTSD could depend on the presence of specific symptoms which can serve to identify at-risk individuals who may benefit from targeted sleep interventions.

A personalized index to inform selection of a trauma-focused or non-trauma-focused treatment for PTSD

PTSD treatment guidelines recommend several treatments with extensive empirical support, including Prolonged Exposure (PE), a trauma-focused treatment and Present-Centered Therapy (PCT), a non-trauma-focused therapy. Research to inform treatment selection has yielded inconsistent findings with single prognostic variables that are difficult to integrate into clinical decision-making. We examined whether a combination of prognostic factors can predict different benefits in a trauma-focused vs. a non-trauma-focused psychotherapy. We applied a multi-method variable selection procedure and developed a prognostic index (PI) with a sample of 267 female veterans and active-duty service members (mean age 45; SD = 9.37; 53% White) with current PTSD who began treatment in a randomized clinical trial comparing PE and PCT. We conducted linear regressions predicting outcomes (Clinician-Administered PTSD Scale score) with treatment condition, the PI, and the interaction between the PI and treatment condition. The interaction between treatment type and PI moderated treatment response, moderated post-treatment symptom severity, b = 0.30, SEb = 0.15 [95% CI: 0.01, 0.60], p = .049. For the 64% of participants with the best prognoses, PE resulted in better post-treatment outcomes; for the remainder, there was no difference. Use of a PI may lead to optimized patient outcomes and greater confidence when selecting trauma-focused treatments.

Evaluating the Relationship Between Post Traumatic Stress Disorder Symptoms and Psychological Resilience in a Sample of Turkoman Refugees in Turkey.

Turkey has witnessed an increase in migration of people belonging to neighboring countries due to civil war. Traumatic life events experienced by refugees bring along mental problems. Their psychological resilience enables them to cope with these difficulties. In this study, 101 Iraqi Turkoman refugees who migrated to Turkey following the increasing civil war events in their country were evaluated psychologically. Sociodemographic data form Resilience Scale for Adults (RSA) and Clinician-Administered Post-Traumatic Stress Disorder Scale (CAPS) were used for psychological evaluation. The prevalence of lifetime post-traumatic stress disorder (PTSD) among the refugees was 25.7%. There was no significant difference between the psychological resilience of the patients who developed PTSD and those who did not (p = 0.709). As the severity of trauma decreased, psychological resilience increased in the people who developed PTSD (p = 0.001, r = -0.622). Considering the psychological resilience of refugees, the area with the highest resilience is access to social resources, while the area with the lowest is the planned future. It was observed that the basic needs of refugees after migration could not be met clearly compared to the ones before migration. It was noteworthy that in cases diagnosed with PTSD, CAPS scores increased (p = 0.011, r: 0.251) and resilience decreased (p < 0.001, r: -0.376) as the inability to reach basic needs increased. Our study is very important in terms of defining how refugees are mentally affected after settling in another country and what determines their psychological resilience.

The effect of trauma type on the severity of Post-Traumatic Stress Disorder (PTSD) symptoms

Abstract Objective: The high prevalence of trauma exposure calls for detailed research on how trauma type affects the development of Post-Traumatic Stress Disorder (PTSD). Therefore, the aim of our study was to investigate the effects of the type of trauma on the severity of symptoms, anxiety, depression, and dissociative experiences in the PTSD patient population. Method: The sample of the study consists of 80 volunteer PTSD patients (20 sexual trauma, 20 work accidents, 20 traffic accidents and 20 combat related trauma). Once the severity of symptoms was determined in all subjects by the Clinician-Administered PTSD Scale (CAPS), Beck Depression Inventory, Beck Anxiety Inventory and Dissociative Experiences Scale (DES) were applied. Results: A statistically significant difference were found between trauma types with regard to age, time without treatment, and the total and subscale scores obtained in DES and CAPS. It was found that in the group that has PTSD diagnosis related to sexual trauma, the length of the time without treatment, DES and CAPS scores. Conclusion: The study we conducted showed that PTSD continued more severe and resistant after a sexual trauma. Moreover, specific type of trauma was significant in PTSD patients.

Composite contributions of cerebrospinal fluid GABAergic neurosteroids, neuropeptide Y and interleukin-6 to PTSD symptom severity in men with PTSD

Given that multiple neurobiological systems, as well as components within these systems are impacted by stress, and may interact in additive, compensatory and synergistic ways to promote or mitigate PTSD risk, severity, and recovery, we thought that it would be important to consider the collective, as well as separate effects of these neurobiological systems on PTSD risk. With this goal in mind, we conducted a proof-of-concept study utilizing cerebrospinal fluid (CSF) collected from unmedicated, tobacco- and illicit substance-free men with PTSD (n = 13) and trauma-exposed healthy controls (TC) (n = 17). Thirteen neurobiological factors thought to contribute to PTSD risk or severity based on previous studies were assayed. As the small but typical sample size of this lumbar puncture study limited the number of factors that could be considered in a hierarchical regression model, we included only those five factors with at least a moderate correlation (Spearman rho > 0.30) with total Clinician-Administered PTSD Scale (CAPS-IV) scores, and that did not violate multicollinearity criteria. Three of the five factors meeting these criteria—CSF allopregnanolone and pregnanolone (Allo + PA: equipotent GABAergic metabolites of progesterone), neuropeptide Y (NPY), and interleukin-6 (IL-6)—were found to account for over 75% of the variance in the CAPS-IV scores (R2 = 0.766, F = 8.75, p = 0.007). CSF Allo + PA levels were negatively associated with PTSD severity (β = −0.523, p = 0.02) and accounted for 47% of the variance in CAPS-IV scores. CSF NPY was positively associated with PTSD severity (β = 0.410, p = 0.04) and accounted for 14.7% of the CAPS-IV variance. There was a trend for a positive association between PTSD severity and CSF IL-6 levels, which accounted for 15.3% of the variance in PTSD severity (β = 0.423, p = 0.05). Z-scores were then computed for each of the three predictive factors and used to depict the varying relative degrees to which each contributed to PTSD severity at the individual PTSD patient level. This first of its kind, proof-of-concept study bears replication in larger samples. However, it highlights the collective effects of dysregulated neurobiological systems on PTSD symptom severity and the heterogeneity of potential biological treatment targets across individual PTSD patients—thus supporting the need for precision medicine approaches to treatment development and prescribing in PTSD.

Autonomic Reactivity to Acute Mental Stress Differs Between Women and Men with Post Traumatic Stress Disorder (PTSD)

Over 7 million Americans are affected by post‐traumatic stress disorder (PTSD), a debilitating mental illness that is associated with significant cardiovascular disease risk. Women are twice as likely as men to develop PTSD after a traumatic event. A prior study from our laboratory showed that sympathetic nervous system reactivity during combat related and non‐combat related stress is heightened in PTSD; however, this study was conducted in a predominantly male cohort and did not consider the potential influence of sex on neural cardiovascular function in PTSD. The aim of the current study was to determine if women with PTSD have heightened blood pressure (BP), heart rate (HR), and sympathetic reactivity to acute mental stress than men with PTSD. We recruited 15 women and 18 men clinically diagnosed with PTSD and confirmed using the Clinician Administered PTSD Scale (CAPS) and PTSD Checklist‐Military (PCL‐M) surveys. We measured muscle sympathetic nerve activity (MSNA), continuous BP, HR and heart rate variability (HRV) at baseline and during 3 minutes of mental arithmetic. Women and men were matched for race, age (41±2 vs 38±2 years, p=0.191), body mass index (31±2 vs 29±2 kg/m2, p=0.368), CAPS (71 ±9 vs 74 ±4, p=0.732) and PCLM (57 ±5 vs 68 ±4, p=0.129) scores. Likewise, baseline systolic BP (131±5 vs 128±4 mmHg), diastolic BP (76±4 vs 74±2 mmHg) and HR (70±3 vs 64±2 beats/min) were comparable (P&gt;0.05) between women and men. Although resting HRV measures were not different between groups (p&gt;0.05), resting MSNA was higher (p=0.008) in women compared to men (27±3 vs 16±3 bursts/min). In response to mental arithmetic, systolic BP reactivity was higher in women compared to men (Δ+5.1±1 versus Δ+2.2±1 mm Hg, p&lt;0.001). Diastolic BP (p=0.366) and HR (p=0.170) responses were not different. However, MSNA reactivity was higher (p=0.04) in women compared to men (Δ15.2±5 versus Δ6.4±3 bursts/min), suggesting an exaggerated sympathetic response to acute stress. Although RMSSD reactivity was similar between both groups (p=0.347), HF response to mental stress was blunted (p=0.05) in women compared to men, suggesting a greater withdrawal of parasympathetic control of the heart during acute stress. In summary, women with PTSD show an exaggerated blood pressure and sympathetic response to acute mental stress coupled with a blunted parasympathetic control of the heart. These results provide important insight into the physiological mechanisms linking the high risk of PTSD in women and the associated cardiovascular disease and hypertension risk.Support or Funding InformationThis work was supported by National Institutes of Health (NIH) Grant R01 HL135183; NIH R61 AT010457, VA Merit I01CX001065, the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Decatur, Georgia, and the APS STRIDE Undergraduate Summer Research Fellowship, grant program number NHLBI; 1 R25 HL115473‐01.

Evaluating a screener to quantify PTSD risk using emergency care information: a proof of concept study

BackgroundPrevious work has indicated that post-traumatic stress disorder (PTSD) symptoms, measured by the Clinician-Administered PTSD Scale (CAPS) within 60 days of trauma exposure, can reliably produce likelihood estimates of chronic PTSD among trauma survivors admitted to acute care centers. Administering the CAPS is burdensome, requires skilled professionals, and relies on symptoms that are not fully expressed upon acute care admission. Predicting chronic PTSD from peritraumatic responses, which are obtainable upon acute care admission, has yielded conflicting results, hence the rationale for a stepwise screening-and-prediction practice. This work explores the ability of peritraumatic responses to produce risk likelihood estimates of early CAPS-based PTSD symptoms indicative of chronic PTSD risk. It specifically evaluates the Peritraumatic Dissociative Experiences Questionnaire (PDEQ) as a risk-likelihood estimator.MethodsWe used individual participant data (IPD) from five acute care studies that used both the PDEQ and the CAPS (n = 647). Logistic regression calculated the probability of having CAPS scores ≥ 40 between 30 and 60 days after trauma exposure across the range of initial PDEQ scores, and evaluated the added contribution of age, sex, trauma type, and prior trauma exposure. Brier scores, area under the receiver-operating characteristic curve (AUC), and the mean slope of the calibration line evaluated the accuracy and precision of the predicted probabilities.ResultsTwenty percent of the sample had CAPS ≥ 40. PDEQ severity significantly predicted having CAPS ≥ 40 symptoms (p < 0.001). Incremental PDEQ scores produced a reliable estimator of CAPS ≥ 40 likelihood. An individual risk estimation tool incorporating PDEQ and other significant risk indicators is provided.ConclusionPeritraumatic reactions, measured here by the PDEQ, can reliably quantify the likelihood of acute PTSD symptoms predictive of chronic PTSD and requiring clinical attention. Using them as a screener in a stepwise chronic PTSD prediction strategy may reduce the burden of later CAPS-based assessments. Other peritraumatic metrics may perform similarly and their use requires similar validation.Trial registrationJerusalem Trauma Outreach and Prevention Study (J-TOPS): NCT00146900.

The resting-state functional connectivity of amygdala subregions associated with post-traumatic stress symptom and sleep quality in trauma survivors.

Neuroimaging findings suggest that the amygdala plays a primary role in both the psychopathology of posttraumatic stress disorder (PTSD) and poor sleep quality, which are common in trauma survivors. However, the neural mechanisms of these two problems in trauma survivors associated with amygdala remain unclear. In the current study, we aimed to explore the role of functional connectivity of amygdala subregions in both PTSD symptoms and poor sleep quality. A total of 94 trauma-exposed subjects were scanned on a 3T MR system using resting-state functional magnetic resonance imaging. Both Pittsburgh Sleep Quality Index and Clinician-Administered PTSD Scale scores were negatively correlated with the resting-state functional connectivity between the left basolateral amygdala-left medial prefrontal cortex and the right basolateral amygdala-right medial prefrontal cortex. Our findings suggest a shared amygdala subregional neural circuitry underlying the neuropathological mechanisms of PTSD symptoms and poor sleep quality in trauma survivors.

The effect of trauma type on the severity of Post-Traumatic Stress Disorder (PTSD) symptoms

Abstract Objective: The high prevalence of trauma exposure calls for detailed research on how trauma type affects the development of Post-Traumatic Stress Disorder (PTSD). Therefore, the aim of our study was to investigate the effects of the type of trauma on the severity of symptoms, anxiety, depression, and dissociative experiences in the PTSD patient population. Method: The sample of the study consists of 80 volunteer PTSD patients (20 sexual trauma, 20 work accidents, 20 traffic accidents and 20 combat related trauma). Once the severity of symptoms was determined in all subjects by the Clinician-Administered PTSD Scale (CAPS), Beck Depression Inventory, Beck Anxiety Inventory and Dissociative Experiences Scale (DES) were applied. Results: A statistically significant difference were found between trauma types with regard to age, time without treatment, and the total and subscale scores obtained in DES and CAPS. It was found that in the group that has PTSD diagnosis related to sexual trauma, the length of the time without treatment, DES and CAPS scores. Conclusion: The study we conducted showed that PTSD continued more severe and resistant after a sexual trauma. Moreover, specific type of trauma was significant in PTSD patients.

Traumatic Life Events and Severity of Posttraumatic Stress Disorder Among Syrian Refugees Residing in a Camp in Turkey

The aim of this study was to identify types and number of traumatic experiences and to determine the predictors of severity of posttraumatic stress disorder (PTSD) in Syrian refugees who were residing in a camp in Turkey. Face-to-face psychiatric interviews were carried out with 342 participants to make a diagnosis of PTSD according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM-IV-TR) diagnostic criteria. A traumatic events list was administered to screen Criterion A traumatic experiences, and the Clinician-Administered PTSD Scale (CAPS) was administered to assess the severity of PTSD. The prevalence of PTSD was 31.0% (n = 106). Among 86.8% of the refugees with PTSD, the CAPS score was at the level of severe and above. Female gender, total number of traumatic events, and age predicted the PTSD symptom severity. Married young women were the most affected group and violent loss of family members was the most frequent type of trauma among them. Given that the vast majority of Syrian refugees have already settled down in various towns of the country, those who were residing in camps possibly constituted an especially fragile subgroup. The participants represented a group with an extreme level of mass traumatization. Both future research and psychosocial services should address those with broken families as a potentially fragile subgroup among refugees.

Genetic Susceptibility to Posttraumatic Stress Disorder: Analyses of the Oxytocin Receptor, Retinoic Acid Receptor-Related Orphan Receptor A and Cannabinoid Receptor 1 Genes.

Exposure to life-threatening events is common and everyone will most likely experience this type of trauma during their lifetime. Reactions to these events are highly heterogeneous and seems to be influenced by genes as well. Some individuals will develop posttraumatic stress disorder (PTSD), while others will not. In this study, our aim was to analyze the correlation between single nucleotide polymorphisms (SNPs) within the oxytocin receptor (OXTR) gene (rs53576 and rs2254298), the RAR-related orphan receptor A (RORA) gene (rs8042149) and the cannabinoid receptor 1 (CNR1) gene (rs1049353) and PTSD. All candidate genes have been previously associated with stress related disorders and the reaction to traumatic events. Participants (N=719) have been exposed to war-related trauma during the war in South-Eastern Europe (Bosnia and Herzegovina, Croatia and Kosovo). We correlated the presence and absence of current and lifetime PTSD as well as PTSD severity (Clinician Administered PTSD scale (CAPS)) and current psychopathology (Brief Symptom Inventory (BSI) score) with the mentioned SNPs. DNA was isolated from whole blood and genotyped for OXTR rs2254298 and rs53576 following previously published protocols, for RORA rs8042149 via PCR-RFLP and CNR1 rs1049353 via KASP. Nominally significant results were found for OXTR rs53576 in connection with the CAPS and BSI scores within lifetime PTSD patients. The additive allelic model indicated that G allele carriers achieved lower CAPS (p=0.0090) and BSI (p=0.0408) scores than participants carrying one or two copies of the A allele. These results did not withstand correction for multiple tests. No significant results were observed for OXTR rs2254298, RORA rs8042149 and CNR1 rs1049353 although the results for RORA showed a slight tendency that rs8042149 may influence the level of BSI scores in current PTSD patients. This study points to a role of the OXTR gene in PTSD and the related psychopathology following war related trauma.

Associations of Gene Variations in Neuropeptide Y and Brain Derived Neurotrophic Factor Genes with Posttraumatic Stress Disorder.

Individuals who are exposed to traumatic events are at an increased risk of developing posttraumatic stress disorder (PTSD), a condition during which an individual's ability to function is impaired by emotional responses to memories of those events. The gene coding for neuropeptide Y (NPY) and the gene coding for brain-derived neurotrophic factor (BDNF) are among the number of candidate gene variants that have been identified as potential contributors to PTSD. The aim of this study was to investigate the association between NPY and BDNF and PTSD in individuals who experienced war-related trauma in the South Eastern Europe (SEE) conflicts (1991-1999). This study included participants with current and remitted PTSD and healthy volunteers (N=719, 232 females, 487 males), who were recruited between 2013 and 2015 within the framework of the South Eastern Europe (SEE) - PTSD Study. Psychometric methods comprised the Mini International Neuropsychiatric Interview (M.I.N.I.), the Clinician Administered PTSD Scale (CAPS), and the Brief Symptom Inventory (BSI). DNA was isolated from whole blood and genotyped for NPY rs5574 via PCR - RFLP and NPY rs16147 and BDNF rs6265 using the KASP assay. Tests for deviation from Hardy-Weinberg equilibrium showed no significant results. Analyses at the categorical level yielded no associations between the affected individuals and all three SNPs when compared to controls. Within lifetime PTSD patients, the major alleles of both NPY variants showed a nominally significant association with higher CAPS scores (p=0.007 and p=0.02, respectively). Also, the major allele of rs5574C>T was associated with higher BSI scores with a nominal significance among current PTSD patients (p=0.047). The results did not withstand a Bonferroni adjustment (α=0.002). Nominally significant associations between NPY polymorphisms and PTSD susceptibility were found that did not withstand Bonferroni correction.

Videoconferencing psychotherapy for veterans with PTSD: Results from a randomized controlled non-inferiority trial

Introduction Veterans with post-traumatic stress disorder (PTSD) face significant barriers that make it less likely for them to pursue treatment. A randomized controlled non-inferiority trial was used to determine if providing psychotherapy for PTSD via videoconference (VC) is as effective as in-person (IP) psychotherapy. Methods All eligible veterans (n = 207) received cognitive processing therapy (CPT) to treat PTSD symptoms in one of the two treatment modalities. Participant symptoms were collected at baseline, post-treatment, and six months after treatment completion. The primary outcome measure, the Clinician-Administered PTSD Scale (CAPS), was used to assess PTSD diagnosis and symptom severity. Secondary outcomes included two self-report measures of symptom severity, the Post-traumatic Stress Disorder Checklist – Specific (PCL–S) for PTSD and the Patient Health Questionnaire – 9 (PHQ–9) for depressive symptoms. A linear mixed-effects model was used to assess non-inferiority for participants who completed treatment (completers) and those who were randomized to treatment (intention-to-treat (ITT)). Results Both completer and ITT analyses showed that improvement in CAPS scores in the VC condition was non-inferior to that in the IP condition at six-month follow-up, but VC was inferior to IP for improvement in CAPS at post-treatment. Non-inferiority was supported by completer analyses for PCL–S and PHQ–9 in both post-treatment change and six-month follow-up change, and the ITT analysis supported the significant non-inferiority for PCL at post-treatment change. Discussion These findings generally suggest that CPT delivered via VC can be as effective as IP for reducing the severity of PTSD symptoms.

Sympathetic and Cardiovascular Response to Device Guided Slow Breathing Acutely Depends on Post‐Traumatic Stress Disorder (PTSD) Severity

Post‐traumatic stress disorder (PTSD) is associated with an increased risk for developing hypertension and cardiovascular disease. We previously showed that device guided slow breathing (DGB) using the RESPeRATE device acutely lowers muscle sympathetic nerve activity (MSNA) and improves baroreflex sensitivity and hemodynamics in patients with PTSD. However, it remains unclear whether the physiological responses to DGB depend on the severity of the disorder. We hypothesized that neural and cardiovascular response to acute DGB will be heightened in PTSD participants with a greater severity of PTSD symptoms. To test our hypothesis, we recruited 25 veterans (age 36 ± 2 years; BMI 29 ± 2 kg/m2) with PTSD. The clinician‐administered PTSD scale (CAPS) was used to confirm the diagnosis of PTSD (CAPS score ≥45) and the severity of PTSD symptoms. The CAPS scores in our sample ranged from 45 to 95 with a median score of 70 that was used to separate our study participants into two groups (group effect): Moderate (CAPS ≤70, n=13) and Severe (CAPS &gt;70, n=12). Within each group, participants were randomized to either breathing with the DGB device (at a rate of 5–6 breaths/min) or breathing with an identical Sham device (at 12–14 breaths/min) (device effect) for 15 minutes. In the Moderate group, 5 participants used DGB and 8 used Sham; while in the Severe group, 6 used DGB and 6 used Sham. Beat‐to‐beat blood pressure (BP) via finger plethysmography, heart rate (HR) via EKG, heart rate variability (HRV) and muscle sympathetic nerve activity (MSNA) using microneurography were measured continuously at baseline and after 10 minutes of breathing (time effect). Age, BMI, resting BP and HR (all p&gt;0.05) were similar between groups. In response to the breathing intervention, systolic BP (time*group*device, p=0.352) and diastolic BP (time*group*device, p=0.552) responses to DGB compared to Sham were comparable between the Moderate and Severe groups. However, as we hypothesized, HR decreased more with DGB (75 ± 4 to 62 ± 3 beats/min) than Sham (73 ± 6 to 75 ± 5 beats/min) in the Severe group when compared to the Moderate group (time*group*device, p=0.049). Likewise, MSNA decreased more (time*group*device, p=0.025) with DGB (38 ± 7 to 24 ± 4 bursts/min) compared to Sham (17 ± 2 to 14 ± 2 bursts/min) in the Severe group compared to the Moderate group. Unlike MSNA, HRV responses were not different between the groups. In summary, we found that DGB decreases HR and MSNA more in participants with a higher CAPS score, i.e. more severe PTSD. These results suggest that DGB may have greater beneficial effects on sympathetic overactivity and hemodynamics in PTSD patients with severe symptoms. Whether DGB leads to long‐term benefits on neural and cardiovascular function in severe PTSD should be studied in the future.Support or Funding InformationSupported by NIH HL‐098744, NIH DK‐00756, VA Merit I01CX001065, AHA 15CSA24340001This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Symptom Severity Impacts Inflammation and Sympathetic Over‐activity in Post‐Traumatic Stress Disorder (PTSD)

Patients with post‐traumatic stress disorder (PTSD) are at significantly higher risk of developing hypertension and cardiovascular disease. Low‐grade inflammation and overactive sympathetic nervous system (SNS) activity are suggested as contributing mechanisms. Our prior studies showed that while SNS reactivity during stress is heightened in PTSD, resting MSNA and inflammation was not elevated in young combat Veterans with PTSD as a group; however, prior results did not take into account the potential influence of PTSD symptom severity on neural cardiovascular function. The aim of the current study was to determine if PTSD patients with greater PTSD symptoms measured via the gold‐standard clinician administered PTSD scale (CAPS) have higher SNS activity and inflammation compared to PTSD patients with less severe symptoms. To answer this question, we recruited 21 veterans clinically diagnosed with PTSD (mean CAPS score, 68±4). We measured muscle sympathetic nerve activity (MSNA) via microneurography and blood pressure using standard technique. We collected blood samples to measure serum levels of two inflammatory biomarkers: highly sensitive C‐reactive protein (hsCRP) and interleukin‐6 (IL‐6). For data analysis, the participants were grouped based on the median CAPS score of 70, with the low CAPS group (L‐CAPS) having a score ≤ 70 and the high CAPS group (H‐CAPS) having a score &gt; 70. The two groups (L‐CAPS, n=11; H‐CAPS, n=10) were matched for age, body mass index (BMI) and selective serotonin reuptake inhibitor (SSRI) prescription. Resting blood pressure and heart rate were similar between the two groups. However, the H‐CAPS group had a significantly greater MSNA at baseline when quantified as both burst frequency (26±5 vs 13±2 bursts/min, p= 0.011) and burst incidence (35±6 vs 21±3 bursts/100hb, p= 0.022) compared to the L‐CAPS group. Similarly, hsCRP (2.02±0.71 vs 0.74±0.18, p= 0.036) and IL‐6 (5.44±1.86 vs 2.35±0.73, p= 0.055) levels were higher in the H‐CAPS group compared to the L‐CAPS group. Furthermore, the levels of hsCRP (r= 0.766, p&lt; 0.001) and IL‐6 (r= 0.594, p=0.007) were positively correlated with MSNA. When the groups were analyzed separately, the correlation between MSNA and hsCRP was stronger in the H‐CAPS group (r=0.822, p=0.012) than the L‐CAPS group (r=0.604, p=0.065). These results suggest that the severity of PTSD is associated with chronically increased MSNA and inflammation, and SNS overactivity may be mechanistically linked to inflammation in severe PTSD.Support or Funding InformationSupported by NIH HL‐098744, NIH DK‐00756, VA Merit I01CX001065, AHA 15CSA24340001This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

A randomized controlled trial of prolonged exposure therapy versus relaxation training for older veterans with military-related PTSD

ObjectiveAlthough prolonged exposure (PE) has strong support for treating posttraumatic stress disorder (PTSD), there is little research on PE for older adults. Likewise, Relaxation Training (RT) has shown some benefit for PTSD, but has not been adequately tested in this population. MethodThis study represents the first randomized controlled trial of two active psychotherapies for PTSD among older adults. Male combat veterans (N = 87; mean age = 65 years) were randomly assigned to 12 sessions of PE (n = 41) or RT (n = 46). Clinician-administered and self-report assessments were conducted at pre-treatment, post-treatment, and six-month follow-up; self-reported symptoms were also measured at each treatment session. ResultsMulti-level modeling indicated that Clinician-Administered PTSD Scale scores significantly decreased from pre-treatment to follow-up, but the time by treatment condition interaction was not significant. Pre- to post-treatment change was large in PE and moderate in RT, but many gains were lost at follow-up. For self-reported PTSD symptoms, a significant time by treatment condition interaction emerged, suggesting that participants who received PE had both greater decreases in symptoms and a greater rebound in self-reported PTSD symptoms than those who received RT. Unlike PTSD symptoms, depression symptoms neither changed nor were moderated by treatment condition from pre-treatment to follow-up. For self-reported PTSD and depression symptoms assessed at each session, time significantly predicted symptom reductions across psychotherapy sessions. ConclusionsPE and RT are well-tolerated, feasible, and effective for older adults, though treatment gains were not maintained at follow-up. Trial registrationclinicaltrials.gov Identifier: NCT00539279.

Alcohol Abstainer Status and Prazosin Treatment in Association with Changes in Posttraumatic Stress Disorder Symptoms in Veterans with Comorbid Alcohol Use Disorder and Posttraumatic Stress Disorder.

The noradrenergic system has been implicated in alcohol use disorder (AUD) and posttraumatic stress disorder (PTSD), with adrenergic agents reducing drinking in individuals with AUD and improving sleep disturbances in individuals with PTSD. In a recent clinical trial, prazosin, an α1-adrenergic antagonist, was not superior to placebo in reducing PTSD symptoms, sleep problems, or alcohol consumption in a comorbid population; however, patients in both treatment conditions improved in all symptom domains over the course of treatment. It remains unknown whether alcohol abstinence is related to changes in PTSD symptoms and medication effects in individuals with this comorbidity. Veterans with comorbid alcohol dependence and PTSD (n=96) were randomized to prazosin (16mg) or placebo in a 12-week outpatient, double-blind clinical trial. In this secondary data analysis, we examined main effects of alcohol abstainer status (abstainer vs. nonabstainer), treatment, and their interaction on changes in PTSD symptoms over time using linear mixed models. There was a main effect of alcohol abstainer status on symptoms of PTSD (p=0.03), such that nonabstainers had lower total Clinician-Administered PTSD Scale (CAPS) scores than abstainers. There was a significant treatment by alcohol abstainer status interaction (p=0.01); specifically, among placebo-treated individuals, those who did not abstain from alcohol had lower total CAPS scores compared to alcohol abstainers. Within the prazosin-treated group, abstainers and nonabstainers did not differ on total CAPS scores. Results were similar for the avoidance (p=0.02), reexperiencing (p=0.01), and hyperarousal (p=0.04) subscales, such that placebo-treated nonabstainers had lower CAPS scores overall. Overall, prazosin treatment was not significantly related to changes in PTSD symptoms over the course of the 12-week clinical trial in a comorbid population. Interestingly, placebo-treated alcohol nonabstainers had a significant reduction in PTSD symptoms. Whether placebo-treated individuals continued to use alcohol because of ongoing symptoms of PTSD is not known.

Transcendental Meditation May Be as Effective as Exposure Therapy for PTSD

Back to table of contents Previous article Next article Clinical and Research NewsFull AccessTranscendental Meditation May Be as Effective as Exposure Therapy for PTSDNick ZagorskiNick ZagorskiSearch for more papers by this authorPublished Online:3 Jan 2019https://doi.org/10.1176/appi.pn.2019.12b12AbstractVeterans with PTSD who participated in transcendental meditation sessions over a 12-week period showed symptom improvements similar to those who participated in prolonged exposure therapy sessions.Exposing people with posttraumatic stress disorder (PTSD) to their traumatic memories has been regarded as an important, if not essential, part of the therapeutic process. This is the basis of prolonged exposure therapy, in which people with PTSD relive their trauma in a safe environment, so that the memories are no longer associated with fear, distress, and other negative emotions.A study of veterans with PTSD now shows that transcendental meditation is comparable to prolonged exposure therapy—considered the gold standard psychotherapy for PTSD. Transcendental meditation involves the silent repetition of a personal mantra to achieve restful alertness and avoid distracting thoughts.The study findings were published November 15, 2018, in Lancet Psychiatry.“Our findings provide further evidence that PTSD treatments can be effective without an exposure component. Because trauma exposure can be difficult for patients, similarly effective treatments that do not require exposure could be appealing to veterans and other groups with PTSD,” wrote lead author Sanford Nidich, Ed.D., a professor of physiology and education at the Maharishi University of Management Research Institute in Iowa, and colleagues.Transcendental meditation might be an especially appealing alternative since it is a relatively effortless technique, Nidich said. “There is no intense concentration or contemplation needed; a person just learns to progressively experience a quieter and calmer state of mind.”Transcendental meditation is also consistent with military culture, noted Vernon Barnes, Ph.D., of Augusta University, in an editorial that accompanied the study: “Transcendental meditation is self-empowering, completely transportable, and inconspicuous. The technique can be practiced anywhere at any time, without specialized equipment or the need for personnel support.”The study by Nidich and colleagues included 203 veterans from the Veterans Administration San Diego Healthcare System who had a current diagnosis of PTSD resulting from an event during active military service. The participants were randomly assigned to receive 12 sessions of transcendental meditation, prolonged exposure therapy, or PTSD health education (which served as the control group) over 12 weeks. The meditation and health education sessions were provided in group settings, while the exposure therapy was given in one-on-one settings.The researchers used the clinician-administered PTSD scale (CAPS) and participant-administered PTSD Checklist–Military version (PCL-M) to assess PTSD symptoms at the start of the study and again after 12 weeks. The study participants were also asked about depressive symptoms using the nine-item Patient Health Questionnaire (PHQ-9).After 12 weeks, the veterans undergoing transcendental meditation and exposure therapy experienced comparable results in terms of reducing clinician- and patient-rated PTSD symptoms as well as depressive symptoms. Both treatments were superior to providing health education.Nidich noted that patients who received transcendental meditation had greater improvements on all three behavioral scales (CAPS, PCL-M, and PHQ-9) compared with those who received prolonged exposure, though these results were in the statistical margin of error. CAPS scores, for example, decreased by an average of 16 points in the meditation group, 11 points in the prolonged exposure group, and 2.5 points in the health education group. (A reduction of 10 points or more is considered clinically meaningful.)The goal of the study was not to prove one method is superior to the other, Nidich said. Rather, the goal was to examine whether these two treatments are on equal footing, so that veterans with PTSD would have another evidence-based option to choose from when considering treatment.It is also possible that transcendental meditation and exposure therapy can be used together for even greater PTSD improvements, he continued. “This approach hasn’t been tested yet, but I don’t see any reason why they can’t work together, even though one intervention is trauma focused and the other is not,” he said. Such an approach would just need to involve good communication between the psychotherapist and the certified meditation instructor to avoid any potential confusion on behalf of veterans as to when they should think about their trauma.This study was supported by grants from the U.S. Department of Defense. ■An abstract of “Non-Trauma-Focused Meditation Versus Exposure Therapy in Veterans With Posttraumatic Stress Disorder: A Randomised, Controlled Trial” can be accessed here. The accompanying commentary, “Transcendental Meditation and Treatment for Posttraumatic Stress Disorder,” is available here. ISSUES NewArchived

SU75 - ASSOCIATION OF PTSD WITH TELOMERE LENGTH IN FEMALE RAPE VICTIMS

Background Posttraumatic Stress Disorder (PTSD) is a clinical condition that occurs after experiencing a traumatic external stressful situation, such as exposure to sexual assault or rape. Previous studies suggested that PTSD may be associated with shortened Leukocyte Telomere Length (LTL), in war veterans. Telomeres are repetitive DNA sequences located at the ends of chromatids that become shorter after each cell division. Some findings proposed that stress induced by trauma is a probable cause of accelerated telomere shortening. We examined a cross-sectional association between LTL and PTSD or psychopathological measures in rape victims. Methods The study population consisted of 32 women rape victims with PTSD diagnosis (PTSD group) and 34 healthy controls women without history of sexual trauma and mental disorders (HC group), with ages between 18 and 43 years. All participants were evaluated using the Mini International Neuropsychiatric Interview (MINI) compatible with Diagnostic and Statistical Manual of Mental Disorder (DSM-V), Clinician-Administered PTSD Scale (CAPS), which assesses PTSD symptoms, and Life Events Checklist for DSM-V, which appraises the trauma exposure. DNA was extracted from peripheral blood leukocytes and telomere repeat copy number relative to single gene copy number (relative T/S ratio) was determined by quantitative real-time PCR telomere assay. We used logistic and linear regression models to assess associations between relative T/S ratio and PTSD or its symptoms, respectively. Results The relative T/S ratio was determined in all samples and we found that PTSD diagnosis was associated with longer LTL, after adjusting for age at blood draw (p=0.008; β=3.796; 95% confidence interval: 1.409 – 10.229), indicating elongation LTL in PTSD group (relative T/S ratio mean=0.336; Std Deviation=0.109) compared to HC control (relative T/S ratio mean=-0.316; Std Deviation=0.161). However, LTL was not associated to PTSD symptom severity, measured by CAPS (t=-0.993; p=329). Discussion Our study found evidence of longer telomere length in women with PTSD diagnosis compared to healthy controls. In contrast, only one study showed accelerated LTL shortening in women rape victims with PTSD diagnosis, although, this study must be interpreted with caution, as the sample size was very small (n=9). Nevertheless, the LTL was not significantly associated with CAPS scores, possibly due to our sample size. Only one study found PTSD symptoms were associated to shorter telomeres in women exposed to different traumas, include rape, interpersonal violence, sudden death of a loved one. The telomere dynamics in PTSD is unclear; few studies investigated the relationship between LTL and PTSD, in women rape victims. Different mechanisms may contribute to LTL in PTSD, including neuroprogression it was also associated with elongation of LTL in schizophrenia. Our results show that PTSD was associated to longer LTL in rape victims, perhaps, due to the action of neuroprogression in PTSD.

The relation of trauma type on the levels of plasma C-reactive protein in patients with post-traumatic stress disorder

Objective: Studies investigating the relationship between posttraumatic stress disorder (PTSD) that is chronic psychiatric disorder and C-reactive protein (CRP) have inconsistent results. However, to our knowledge, there is no study investigating the effect of PTSD-related trauma type on plasma CRP levels. This study was planned to determine the effect of PTSD and PTSD-related trauma type on plasma CRP levels. Methods: The sample of this cross-sectional study consisted of 73 PTSD patients and 69 healthy control subjects. After proper blood collection, Clinician-administered PTSD Scale (CAPS) was administered by the researchers and Sociodemographic Data Form, Beck Depression Inventory (BDI) and Dissociative Experiences Scale (DES) were requested. Results: CRP, BDI and DES scores of PTSD patients were statistically higher than healthy controls. There were statistically signifi-cant differences between plasma CRP level, CAPS and DES scores according to different trauma types. In the comparison of bilateral groups, plasma CRP levels of occupational accident-induced PTSD patients were statis-tically higher than patients with PTSD due to other types of trauma. Conclusion: As a result, there were differences in plasma CRP levels between PTSD patients and healthy control group and plasma CRP levels were found to vary with the type of trauma associated with PTSD.