Hallmark Of Posttraumatic Stress Disorder Research Articles

Vulnerability Imposed by Diet and Brain Trauma for Anxiety-Like Phenotype: Implications for Post-Traumatic Stress Disorders

Mild traumatic brain injury (mTBI, cerebral concussion) is a risk factor for the development of psychiatric illness such as posttraumatic stress disorder (PTSD). We sought to evaluate how omega-3 fatty acids during brain maturation can influence challenges incurred during adulthood (transitioning to unhealthy diet and mTBI) and predispose the brain to a PTSD-like pathobiology. Rats exposed to diets enriched or deficient in omega-3 fatty acids (n-3) during their brain maturation period, were transitioned to a western diet (WD) when becoming adult and then subjected to mTBI. TBI resulted in an increase in anxiety-like behavior and its molecular counterpart NPY1R, a hallmark of PTSD, but these effects were more pronounced in the animals exposed to n-3 deficient diet and switched to WD. The n-3 deficiency followed by WD disrupted BDNF signaling and the activation of elements of BDNF signaling pathway (TrkB, CaMKII, Akt and CREB) in frontal cortex. TBI worsened these effects and more prominently in combination with the n-3 deficiency condition. Moreover, the n-3 deficiency primed the immune system to the challenges imposed by the WD and brain trauma as evidenced by results showing that the WD or mTBI affected brain IL1β levels and peripheral Th17 and Treg subsets only in animals previously conditioned to the n-3 deficient diet. These results provide novel evidence for the capacity of maladaptive dietary habits to lower the threshold for neurological disorders in response to challenges.

The Impact of Posttraumatic Stress Disorder on Blood Pressure and Heart Rate in a Veteran Population

Hyperarousal is a hallmark of posttraumatic stress disorder (PTSD). PTSD has been associated with increased blood pressure (BP) and heart rate (HR) in veteran populations. We retrospectively identified male patients consulted to outpatient psychiatry at the Iowa City Veterans Affairs Healthcare System. Patients were divided into PTSD (n = 88) and non-PTSD (n = 98) groups. All PTSD patients and a subset of non-PTSD patients had documented blast exposure during service. The study investigated whether patients with PTSD had higher systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) than patients without PTSD. The effect of trauma exposure on BP was also examined. Mean SBP (133.8 vs. 122.3 mm Hg; p < .001), DBP (87.6 vs. 78.6 mm Hg; p < .001), and HR (78.9 vs. 73.1 bpm; p < .001) were all significantly higher in the PTSD group. Trauma-exposed patients without PTSD had significantly higher BP than nonexposed patients. The prevalence of hypertension (HTN) was 34.1% (diagnosed and undiagnosed) among PTSD patients. Patients with PTSD had higher BP and HR compared to patients without PTSD. Trauma exposure may increase BP in this population. These findings will increase awareness about the cardiovascular implications of PTSD.

Reducing analogue trauma symptoms by computerized reappraisal training – Considering a cognitive prophylaxis?

Background and objectivesDistressing intrusions are a hallmark of posttraumatic stress disorder (PTSD). Dysfunctional appraisal of these symptoms may exacerbate the disorder, and conversely may lead to further intrusive memories. This raises the intriguing possibility that learning to ‘reappraise’ potential symptoms more functionally may protect against such symptoms. Woud, Holmes, Postma, Dalgleish, and Mackintosh (2012) found that ‘reappraisal training’ when delivered after an analogue stressful event reduced later intrusive memories and other posttraumatic symptoms. The present study aimed to investigate whether reappraisal training administered before a stressful event is also beneficial. MethodsParticipants first received positive or negative reappraisal training (CBM-App training) using a series of scripted vignettes. Subsequently, participants were exposed to a film with traumatic content. Effects of the CBM-App training procedure were assessed via three distinct outcome measures, namely: (a) post-training appraisals of novel ambiguous vignettes, (b) change scores on the Post Traumatic Cognitions Inventory (PTCI), and (c) intrusive symptom diary. ResultsCBM-App training successfully induced training-congruent appraisal styles. Moreover, those trained positively reported less distress arising from their intrusive memories of the trauma film during the subsequent week than those trained negatively. However, the induced appraisal bias only partly affected PTCI scores. LimitationsParticipants used their own negative event as a reference for the PTCI assessments. The events may have differed regarding their emotional impact. There was no control group. ConclusionsCBM-App training has also some beneficial effects when applied before a stressful event and may serve as a cognitive prophylaxis against trauma-related symptomatology.

The prediction of intrusions following an analogue traumatic event: Peritraumatic cognitive processes and anxiety-focused rumination versus rumination in response to intrusions

Intrusions are often considered the hallmark of posttraumatic stress disorder (PTSD). Despite this, relatively little is known about factors that give rise to intrusions. Cognitive models of PTSD highlight the importance of pre-existing cognitive vulnerabilities, cognitive processing and anxiety during a traumatic event, as well as negative responses to trauma sequelae. However, few studies have examined multiple forms of peritraumatic processes, and rumination in response to trauma intrusions using analogue trauma tasks, and none have examined whether broader anxious ruminative processes contribute to intrusion development. In addition, little work has investigated the role of post-state anxiety in intrusions, and anxiety may be related to both peritraumatic processing and rumination. The current study employed a distressing film paradigm to examine key tenets of cognitive models of PTSD. Ninety-one female university students completed measures of anxiety, rumination in response to anxious symptoms, peritraumatic dissociation, data driven processing, lack of self referent processing, intrusions, and rumination in response to intrusions of the distressing film. Results revealed that peritraumatic dissociation, data driven processing, and self referent processing were associated with intrusion development, with lack of self referent processing being a strong predictor of intrusion development. Post-state anxiety and rumination in response to intrusions also predicted intrusion development. Discussion focuses on implications of cognitive processes and anxiety in theories of intrusion development.

Heightened muscle tension and diurnal hyper-vigilance following exposure to a social defeat-conditioned odor cue in rats

Patients with post-traumatic stress disorder (PTSD) exhibit exaggerated daytime muscle tension as well as nocturnal sleep disturbances. Yet, these physiological and behavioral features of the disorder are little studied in animal models of PTSD. Accordingly, the present studies were designed to assess alterations in muscle tension and diurnal hyper-vigilance resulting from exposure to a social defeat stressor paired with an olfactory stimulus, which was then used as a reminder of stressor exposure. In the first series of experiments, rats presented with an olfactory cue paired previously with a single social defeat exhibited a significant increase in muscle tension 4 weeks following defeat. In the second series of experiments, an olfactory cue paired previously with a single social defeat induced a significant increase in locomotor activity among quiescent rats 4 weeks following stressor exposure. The present results thus support the a priori hypotheses that novel physiological and behavioral hallmarks of PTSD can be documented in an animal model of the disorder and that the present overt signs of reactive hyper-vigilance can be triggered by reintroduction of an olfactory stimulus present at the time of initial trauma exposure.

A combined group treatment for nightmares and insomnia in combat veterans: A pilot study

Insomnia and nightmares are hallmarks of posttraumatic stress disorder (PTSD). Sleep disturbances in PTSD negatively impact clinical course and functioning. In this open clinical trial, the preliminary effects of a combined treatment for insomnia and nightmares in combat veterans with PTSD were assessed. Ten combat veterans participated in a 10-session group treatment combining cognitive-behavioral therapy for insomnia with exposure, rescripting, and relaxation therapy. Participants maintained daily sleep and dream diaries and completed self-report measures of sleep quality and PTSD symptoms pre- and posttreatment. Participants reported improvements in sleep and nightmares following treatment. Future research using controlled designs to evaluate this treatment is warranted.

Traumatic brain injury research opportunities: Results of Department of Veterans Affairs Consensus Conference

Traumatic brain injury (TBI) is one of the foremost medical problems resulting from the wars in Afghanistan and Iraq. In 2006, 13,969 active-duty servicemen and servicewomen with incident TBI were treated in the military medical system; of those, 7.6 percent were hospitalized [1]. While the consequences of moderate to severe TBI capture public and media attention, the majority of brain injuries are mild. Mild TBI (mTBI) represents 85 to 90 percent of civilians with TBI and a large majority with war-related TBI [2-5]. Our current ability to accurately diagnose war-related mTBI is greatly challenged because much of our knowledge of this injury is based on experience accrued from civilian patients, even though the conditions under which war-related injuries occur differ vastly from those of civilian injuries. TBIs of civilian patients typically result from falls or motor-vehicle or sports-related incidents, whereas war-related TBIs are more often sustained under emotionally traumatic circumstances. Furthermore, since a major portion of current war-related injuries result from blast exposure, inherently different mechanical processes are involved. Although the definition of mTBI varies, it typically refers to injuries that are associated with loss or alteration of consciousness for Postconcussive syndrome (PCS) is diagnosed when patients with mTBI present with ongoing symptomatic complaints. Those who experience multiple TBIs are more likely to have long-lasting symptoms [7]. PCS can occur with any level of head injury severity. According to recent reports, U.S. soldiers returning from Iraq have a high rate of coexistence of mTBI-related complaints and posttraumatic stress disorder (PTSD) [8]. PTSD is an anxiety disorder that may develop after exposure to a traumatic event in which grave harm occurred or was threatened [9]. PCS and PTSD have many symptoms in common, but a hallmark of PTSD is reexperiencing the traumatic event. As expected, PTSD is more prevalent than TBI in combat veterans. An important issue that complicates differentiating traumatic stress and TBI is the retrospective diagnosis of war-related mTBI. The diagnosis is difficult because it requires documenting the history of an injury that would typically have involved alteration of consciousness or amnesia for events before, during, or after injury in the midst of a battle. Despite their overlapping symptoms, PTSD and mTBI may be two distinct disease entities with differential responses to various treatment approaches. Patients who survive severe TBI commonly suffer cognitive impairments (e.g., memory, executive functions, and processing speed), language difficulties, emotional problems, sensory-motor losses, posttraumatic epilepsy, and a variety of other impairments and disabilities. Unlike the symptoms of a majority of patients with mTBI, these problems, in spite of some initial improvement, may persist and become chronic. These chronic cognitive, physical, and emotional impairments often interfere with individuals' abilities to function independently and resume their prior family, workplace, and social roles and responsibilities. Currently, no well-validated therapies exist to treat war-related TBI other than existing TBI rehabilitation programs and careful supportive care. …

Objective evidence of sleep disturbance in women with posttraumatic stress disorder

Although sleep disturbance is considered a hallmark of posttraumatic stress disorder (PTSD), objective evidence for sleep disturbance in patients with PTSD has been equivocal. The goal of the current investigation was to objectively examine sleep disturbance among women with PTSD in their home environment. Women with PTSD (n = 30) and a control group (n = 22) completed three nights of actigraphy monitoring. Results from actigraphy indicated that women with PTSD had poorer sleep efficiency, increased sleep latency, and more restless sleep. Actigraphy measures were moderately correlated with self-report sleep-log data, but were unrelated to scores on the Pittsburgh Sleep Quality Index. The current study provides evidence that women with PTSD have objectively measured sleep disturbance in their normal environment at home. Disturbed sleep may have important implications for the health and well-being of individuals with PTSD.

Intrusive images in PTSD and in traumatised and non-traumatised depressed patients: A cross-sectional clinical study

Although intrusive images are a hallmark of post-traumatic stress disorder (PTSD) and also occur in depression, little is known about the differences and similarities of such images in these conditions. Our study focuses on the qualities and triggers of intrusive images and responses to them in three groups—patients with PTSD, and depressed patients with and without trauma (n=65)—to highlight the diagnostic specificity of intrusive images for PTSD and depression. We distinguished intrusive images from verbal intrusive cognitions such as rumination and intrusive (brief) lexical thoughts. Consistent with the literature, the intrusive images of PTSD patients had a more “here-and-now quality” and were perceived more visually compared to those of both depressed groups. The groups showed a good deal of similarity concerning other image qualities. Most importantly, the intrusive images in PTSD and depressed patients with and without trauma were perceived as similarly distressing. Rumination and intrusive (brief) lexical thoughts were two of the five most named triggers of intrusive images. Limitations, such as the lack of a control group, and the clinical implications of these results are discussed, demonstrating the need to help non-PTSD patients with and without trauma to deal with intrusive images.

Elevated awaking thresholds during sleep: characteristics of chronic war-related posttraumatic stress disorder patients

Background: Sleep disturbances are one of the hallmarks of posttraumatic stress disorder (PTSD); however, sleep laboratory studies have provided inconsistent evidence of the existence of objective sleep disturbances in PTSD patients. Reports that awaking thresholds from sleep in war-related PTSD patients were significantly elevated compared to normals are discordant with complaints of insomnia. The present study investigated the relationship between awaking threshold from REM sleep in war-related PTSD patients and their dream recall, dream content, and clinical condition. Methods: After informed consent was obtained from 12 PTSD patients and 12 controls, they were investigated by polysomnographic recordings for 4 nights. Awaking thresholds to clicks were determined during 1 night, and dreams were collected during 2 nights. Patients’ symptoms were assessed by the Zung and Beck depression scales, Impact of Events Scale, State and Trait Anxiety, and Symptom Check List questionnaires. Results: Although there were no significant differences between sleep data of patients and controls, PTSD patients had significantly higher awaking thresholds. Awaking thresholds were significantly positively related to depression and anxiety scores. Patients’ dreams were significantly more aggressive and hostile, and in 6 patients they included explicit war-related contents. The severity of the clinical picture was significantly related to the dreams’ scores of aggression–hostility, and to sleep quality variables. Conclusions: Elevated awaking thresholds from sleep are a characteristic finding in chronic war-related PTSD patients, which may help to explain the diverse sleep laboratory findings in this syndrome.

Increased Nocturnal Activity and Impaired Sleep Maintenance in Abused Children

Previous studies have suggested that sleep disturbance may be the "hallmark of posttraumatic stress disorder," although several investigations have failed to find evidence for sleep disruption. The purpose of this study was to determine whether intense averse stimulation during early development, in the form of physical and/or sexual abuse, led to disruption of sleep and nocturnal activity. Nineteen prepubertal children with documented abuse were compared with 15 nonabused normal controls and 10 depressed children. All subjects received a complete semistructured diagnostic interview. Ambulatory activity monitoring was used to evaluate sleep-related activity for three consecutive nights. Data were analyzed for nocturnal activity and algorithmic estimation of sleep initiation and continuity. Abused subjects were twice as active at night as normal and depressed children, and abused subjects emitted a greater percentage of their total daily activity during the night. Actigraph-derived sleep measures suggested that abused children had prolonged sleep latency and decreased sleep efficiency. Physically abused children had more impaired sleep efficiency than sexually abused children. Abused children have higher levels of nocturnal activity than normal controls or depressed children and appear to have more difficulty falling and staying asleep. Physical abuse appears to be the salient factor rather than posttraumatic stress disorder.

Traumatic intrusive imagery as an emotional memory phenomenon: A review of research and explanatory information processing theories

Intrusive imagery is both a common response to trauma and a hallmark of Posttraumatic Stress Disorder. However, its features and underlying mechanisms have not been reviewed systematically. This paper delineates the characteristics of intrusions and critically reviews the literature, conceptualizing intrusive imagery as an emotional memory phenomenon. This approach integrates otherwise separate research arenas in emotion and memory, psychobiology, pharmacology, and physiology, which converge to suggest that intrusive imagery is driven primarily by affective arousal and sympathetic nervous system reactivity. These basic and applied research findings are addressed directly by three information processing theories, which are reviewed and critiqued for their heuristic value in accounting for intrusions. Directions for research, treatment, and assessment are presented.

Sleep disturbance as the hallmark of posttraumatic stress disorder.

The reexperiencing of a traumatic event in the form of repetitive dreams, memories, or flashbacks is one of the cardinal manifestations of posttraumatic stress disorder (PTSD). The dream disturbance associated with PTSD may be relatively specific for this disorder, and dysfunctional REM sleep mechanisms may be involved in the pathogenesis of the posttraumatic anxiety dream. Furthermore, the results of neurophysiological studies in animals suggest that CNS processes generating REM sleep may participate in the control of the classical startle response, which may be akin to the startle behavior commonly described in PTSD patients. Speculating that PTSD may be fundamentally a disorder of REM sleep mechanisms, the authors suggest several strategies for future research.