Posttraumatic Stress Disorder Participants Research Articles

An investigation of laboratory-based positive and negative emotional suppression in relation to posttraumatic stress disorder symptom clusters.

Emotional suppression is a clinically significant aspect of emotion regulation with robust associations to psychopathology, including posttraumatic stress disorder (PTSD). Despite the fast-growing body of literature highlighting the role of positive emotion regulation difficulties in the development and maintenance of PTSD, extant work on emotional suppression and PTSD has almost exclusively focused on the role of negative emotions. The present study aimed to advance this literature by examining the associations between PTSD symptom clusters and participants' use of state emotional suppression during a laboratory task designed to elicit negative or positive emotions. Participants were 108 community women (Mage = 39.55; 33% Black/African American) currently experiencing intimate partner violence (IPV) by a male partner and using substances. Participants were interviewed using a structured diagnostic assessment for PTSD and reported on state emotional intensity and emotional suppression following idiographic negative or positive emotion inductions. Results of the moderation analyses showed that, when controlling for state emotional intensity, women experiencing clinical levels of PTSD symptom Clusters B (intrusive recollections), D (negative alterations in cognitions and mood), and E (alterations in arousal and reactivity) were significantly more likely to utilize emotional suppression, but only in the context of positive-not negative-emotions. Findings provide evidence for a link between PTSD and positive emotional suppression among women currently experiencing IPV by a male partner and using substances, highlighting positive emotional suppression as a potential target in PTSD treatment for IPV populations with comorbid substance use concerns. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Structural covariance, topological organization, and volumetric features of amygdala subnuclei in posttraumatic stress disorder

The amygdala is divided into functional subnuclei which have been challenging to investigate due to functional magnetic resonance imaging (MRI) limitations in mapping small neural structures. Hence their role in the neurobiology of posttraumatic stress disorder (PTSD) remains poorly understood. Examination of covariance of structural MRI measures could be an alternate approach to circumvent this issue. T1-weighted anatomical scans from a 3 T scanner from non-trauma-exposed controls (NEC; n = 71, 75 % female) and PTSD participants (n = 67, 69 % female) were parcellated into 105 brain regions. Pearson’s r partial correlations were computed for three and nine bilateral amygdala subnuclei and every other brain region, corrected for age, sex, and total brain volume. Pairwise correlation comparisons were performed to examine subnuclei covariance profiles between-groups. Graph theory was employed to investigate subnuclei network topology. Volumetric measures were compared to investigate structural changes.We found differences between amygdala subnuclei in covariance with the hippocampus for both groups, and additionally with temporal brain regions for the PTSD group. Network topology demonstrated the importance of the right basal nucleus in facilitating network communication only in PTSD. There were no between-group differences for any of the three structural metrics. These findings are in line with previous work that has failed to find structural differences for amygdala subnuclei between PTSD and controls. However, differences between amygdala subnuclei covariance profiles observed in our study highlight the need to investigate amygdala subnuclei functional connectivity in PTSD using higher field strength fMRI for better spatial resolution.

A tale of two targets: examining the differential effects of posterior cingulate cortex- and amygdala-targeted fMRI-neurofeedback in a PTSD pilot study

IntroductionReal-time fMRI-based neurofeedback (rt-fMRI-NFB) is a non-invasive technology that enables individuals to self-regulate brain activity linked to neuropsychiatric symptoms, including those associated with post-traumatic stress disorder (PTSD). Selecting the target brain region for neurofeedback-mediated regulation is primarily informed by the neurobiological characteristics of the participant population. There is a strong link between PTSD symptoms and multiple functional disruptions in the brain, including hyperactivity within both the amygdala and posterior cingulate cortex (PCC) during trauma-related processing. As such, previous rt-fMRI-NFB studies have focused on these two target regions when training individuals with PTSD to regulate neural activity. However, the differential effects of neurofeedback target selection on PTSD-related neural activity and clinical outcomes have not previously been investigated.MethodsHere, we compared whole-brain activation and changes in PTSD symptoms between PTSD participants (n = 28) that trained to downregulate activity within either the amygdala (n = 14) or the PCC (n = 14) while viewing personalized trauma words.ResultsFor the PCC as compared to the amygdala group, we observed decreased neural activity in several regions implicated in PTSD psychopathology – namely, the bilateral cuneus/precuneus/primary visual cortex, the left superior parietal lobule, the left occipital pole, and the right superior temporal gyrus/temporoparietal junction (TPJ) – during target region downregulation using rt-fMRI-NFB. Conversely, for the amygdala as compared to the PCC group, there were no unique (i.e., over and above that of the PCC group) decreases in neural activity. Importantly, amygdala downregulation was not associated with significantly improved PTSD symptoms, whereas PCC downregulation was associated with reduced reliving and distress symptoms over the course of this single training session. In this pilot analysis, we did not detect significant between-group differences in state PTSD symptoms during neurofeedback. As a critical control, the PCC and amygdala groups did not differ in their ability to downregulate activity within their respective target brain regions. This indicates that subsequent whole-brain neural activation results can be attributed to the effects of the neurofeedback target region selection in terms of neurophysiological function, rather than as a result of group differences in regulatory success.ConclusionIn this study, neurofeedback-mediated downregulation of the PCC was differentially associated with reduced state PTSD symptoms and simultaneous decreases in PTSD-associated brain activity during a single training session. This novel analysis may guide researchers in choosing a neurofeedback target region in future rt-fMRI-NFB studies and help to establish the clinical efficacy of specific neurofeedback targets for PTSD. A future multi-session clinical trial of rt-fMRI-NFB that directly compares between PCC and amygdala target regions is warranted.

Intrusive Traumatic Re-Experiencing Domain: Functional Connectivity Feature Classification by the ENIGMA PTSD Consortium

BackgroundIntrusive traumatic re-experiencing domain (ITRED) was recently introduced as a novel perspective on posttraumatic psychopathology, proposing to focus research of posttraumatic stress disorder (PTSD) on the unique symptoms of intrusive and involuntary re-experiencing of the trauma, namely, intrusive memories, nightmares, and flashbacks. The aim of the present study was to explore ITRED from a neural network connectivity perspective. MethodsData were collected from 9 sites taking part in the ENIGMA (Enhancing Neuro Imaging Genetics through Meta Analysis) PTSD Consortium (n= 584) and included itemized PTSD symptom scores and resting-state functional connectivity (rsFC) data. We assessed the utility of rsFC in classifying PTSD, ITRED-only (no PTSD diagnosis), and trauma-exposed (TE)–only (no PTSD or ITRED) groups using a machine learning approach, examining well-known networks implicated in PTSD. A random forest classification model was built on a training set using cross-validation, and the averaged cross-validation model performance for classification was evaluated using the area under the curve. The model was tested using a fully independent portion of the data (test dataset), and the test area under the curve was evaluated. ResultsrsFC signatures differentiated TE-only participants from PTSD and ITRED-only participants at about 60% accuracy. Conversely, rsFC signatures did not differentiate PTSD from ITRED-only individuals (45% accuracy). Common features differentiating TE-only participants from PTSD and ITRED-only participants mainly involved default mode network–related pathways. Some unique features, such as connectivity within the frontoparietal network, differentiated TE-only participants from one group (PTSD or ITRED-only) but to a lesser extent from the other group. ConclusionsNeural network connectivity supports ITRED as a novel neurobiologically based approach to classifying posttrauma psychopathology.

Habituation of distress during exposure and its relationship to treatment outcome in post-traumatic stress disorder and prolonged grief disorder

ABSTRACT Background: Reliving distressing memories is a core component of treatments for post-traumatic stress disorder (PTSD) and prolonged grief disorder (PGD). There is little understanding of how reliving these memories functions in the treatment of these disorders. Objective: This study investigated whether reliving functions comparably in the treatment of PTSD and PGD, and whether it is comparably related to treatment outcome. Method: This study conducted a reanalysis of patients with either PTSD (n = 55) or PGD (n = 45) who underwent treatments that comprised at least four sessions of reliving memories of either their traumatic experience or the loss of the deceased person. Results: PTSD participants displayed greater habituation of distress across sessions during reliving than PGD participants. Between-session reduction in distress during reliving was associated with symptom remission in PTSD, but this pattern was not observed in PGD. Conclusion: This pattern of findings indicates that although reliving appears to be a useful strategy for treating both PTSD and PGD, this strategy does not function comparably in the two conditions and may involve distinct mechanisms.

Post-Traumatic Stress Disorder (PTSD) Among Landslide Survivors: a Descriptive Study

Introduction: Natural disasters cause many problems for survivors. Trauma, one such outcome of disasters, may result in the development of post traumatic stress disorder (PTSD). This study aimed to identify the level of post traumatic stress disorder (PTSD) and also its predictor factors among survivors of a landslide disaster at Donorati Village community, Purworejo, Indonesia Method: This was a descriptive cross-sectional design research using a quantitative approach. The population of this study were the landslide survivors in Purworejo district. While this research sample was 100 survivors who live in Donorati village. Cluster and consecutive sampling techniques was applied for this study. The variables of this study were PTSD, gender, age, education level, socio-economic status based on occupation, marriage status, severity of natural disaster, exposure to previous disaster events, landslide disaster impact (house damage, injured family members, and death of family members) and evacuation record. The instruments of this research were demographic form and The Impact of Event Scale-Revised (IES-R). Bivariate analysis was performed using Chi-squared test and Fisher’s test, followed by multivariate analysis using logistic regression. Results: The prevalence of probability of PTSD participants was 27%. Bivariate analysis revealed significant differences in PTSD levels based on sex (p-value = 0,02), age (p-value = 0,009), occupation (p-value = 0,02), severity of disaster (p-value = 0,008), the presence of injured family members (p-value = 0,018), and evacuation history (p-value = 0,001). The multivariate analysis revealed the factors related to PTSD after the landslide as gender and severity of the disaster impact. Conclusions: The level of PTSD was significantly different based on gender, age, occupation, severity of the disaster, the presence of injured family members, and a history of evacuation. Mental health and psychosocial support services need to be developed to help reduce the impact of disasters and to assist survivors to cope better with the outcomes of those events.

Investigating TSPO levels in occupation-related posttraumatic stress disorder

Microglia are immune brain cells implicated in stress-related mental illnesses including posttraumatic stress disorder (PTSD). Their role in the pathophysiology of PTSD, and on neurobiological systems that regulate stress, is not completely understood. We tested the hypothesis that microglia activation, in fronto-limbic brain regions involved in PTSD, would be elevated in participants with occupation-related PTSD. We also explored the relationship between cortisol and microglia activation. Twenty participants with PTSD and 23 healthy controls (HC) completed positron emission tomography (PET) scanning of the 18-kDa translocator protein (TSPO), a putative biomarker of microglia activation using the probe [18F]FEPPA, and blood samples for measurement of cortisol. [18F]FEPPA VT was non-significantly elevated (6.5–30%) in fronto-limbic regions in PTSD participants. [18F]FEPPA VT was significantly higher in PTSD participants reporting frequent cannabis use compared to PTSD non-users (44%, p = 0.047). Male participants with PTSD (21%, p = 0.094) and a history of early childhood trauma (33%, p = 0.116) had non-significantly higher [18F]FEPPA VT. Average fronto-limbic [18F]FEPPA VT was positively related to cortisol (r = 0.530, p = 0.028) in the PTSD group only. Although we did not find a significant abnormality in TSPO binding in PTSD, findings suggest microglial activation might have occurred in a subgroup who reported frequent cannabis use. The relationship between cortisol and TSPO binding suggests a potential link between hypothalamic–pituitary–adrenal-axis dysregulation and central immune response to trauma which warrants further study.

Posterior cingulate cortex targeted real-time fMRI neurofeedback recalibrates functional connectivity with the amygdala, posterior insula, and default-mode network in PTSD.

Alterations within large-scale brain networks-namely, the default mode (DMN) and salience networks (SN)-are present among individuals with posttraumatic stress disorder (PTSD). Previous real-timefunctional magnetic resonance imaging (fMRI) and electroencephalographyneurofeedback studies suggest that regulating posterior cingulate cortex (PCC; the primary hub of the posterior DMN) activity may reduce PTSD symptoms and recalibrate altered network dynamics. However, PCC connectivity to the DMN and SN during PCC-targeted fMRI neurofeedback remains unexamined and may help to elucidate neurophysiological mechanisms through which these symptom improvements may occur. Using a trauma/emotion provocation paradigm, we investigated psychophysiological interactions over a single session of neurofeedback among PTSD (n=14) and healthy control (n=15) participants. We compared PCC functional connectivity between regulate (in which participants downregulated PCC activity) and view (in which participants did not exert regulatory control) conditions across the whole-brain as well as in a priori specified regions-of-interest. During regulate as compared to view conditions, only the PTSD group showed significant PCC connectivity with anterior DMN (dmPFC, vmPFC) and SN (posterior insula) regions, whereas both groups displayed PCC connectivity with other posterior DMN areas (precuneus/cuneus). Additionally, as compared with controls, the PTSD group showed significantly greater PCC connectivity with the SN (amygdala) during regulate as compared to view conditions. Moreover, linear regression analyses revealed that during regulate as compared to view conditions, PCC connectivity to DMN and SN regions was positively correlated to psychiatric symptoms across all participants. In summary,observations of PCC connectivity to the DMN and SN provide emerging evidence ofneural mechanisms underlying PCC-targeted fMRI neurofeedback among individuals with PTSD. This supports the use of PCC-targeted neurofeedback as a means by which to recalibrate PTSD-associated alterations in neural connectivity within the DMN and SN, which together, may help to facilitate improved emotion regulation abilities in PTSD.

Therapeutic and Economic Benefits of Service Dogs Versus Emotional Support Dogs for Veterans With PTSD.

This work aimed to assess the therapeutic and economic benefits of service dogs versus emotional support dogs for veterans with posttraumatic stress disorder (PTSD). Veterans with PTSD (N=227) participating in a multicenter trial were randomly assigned to receive a service or emotional support dog; 181 veterans received a dog and were followed up for 18 months. Primary outcomes included overall functioning (assessed with World Health Organization Disability Assessment Scale II [WHODAS 2.0]) and quality of life (Veterans RAND 12-Item Health Survey [VR-12]). Secondary outcomes included PTSD symptoms (PTSD Checklist for DSM-5), suicidal ideation, depression, sleep quality, health care costs and utilization, medication adherence, employment, and productivity. Participants paired with a dog had a mean±SD age of 50.6±13.6 years (range 22-79), and most were male (80%), White (66%), and non-Hispanic (91%). Adjusted linear mixed repeated-measures models indicated no difference between the two groups on WHODAS 2.0 or VR-12 scores. Participants with service dogs had a 3.7-point greater reduction in PTSD symptoms versus participants with emotional support dogs (p=0.036). No reduced health care utilization or cost was associated with receiving a service dog. Veterans with service dogs had an increase of 10 percentage points in antidepressant adherence compared with those with emotional support dogs (p<0.01). Both groups appeared to benefit from having a service or emotional support dog. No significant differences in improved functioning or quality of life were observed between the groups. Those in the service dog group had a greater reduction in PTSD symptoms and better antidepressant adherence, improvements that should be explored further.

Hyperarousal Symptom Severity in Women with Posttraumatic Stress Disorder Might Be Associated with LINE-1 Hypomethylation in Childhood Sexual Abuse Victims

Introduction: Sexual assault and a history of childhood sexual abuse (CSA) are related to posttraumatic stress disorder (PTSD) development. Long interspersed nuclear elements (LINE-1) are transposable elements, and their methylation is used to infer DNA global methylation. DNA methylation can be affected by trauma exposition which in turn would be associated with PTSD. Thus, we investigated if the LINE-1 methylation pattern is related to PTSD symptoms in females with a history of CSA. Methods: This is a case-control study that examined, at baseline (W1), 64 women victims of sexual assault diagnosed with PTSD and 31 patients with PTSD who completed the 1-year follow-up (W2). Participants were categorized into two groups according to the presence of CSA (PTSDCSA+: NW1 = 19, NW2 = 10; PTSDCSA-: NW1 = 45, NW2 = 21). PTSD symptoms (re-experiencing, avoidance, hyperarousal, alterations in cognition/mood) were assessed using the Clinician-Administered PTSD Scale, and the history of CSA was assessed by the Childhood Trauma Questionnaire. LINE-1 methylation was measured in three sites (CpG1, CpG2, CpG3) located in the 5’UTR region using bisulfite conversion followed by pyrosequencing. Linear regression models were performed to test the relation between LINE-1 CpG sites methylation and PTSD symptoms. Results: We found a negative association between CpG2 methylation and hyperarousal symptoms among those in the PTSDCSA+ group in W1 (adjusted p = 0.003) compared to the PTSDCSA- group (p > 0.05). Still, no association was observed between other PTSD symptoms and other CpG sites. Further, in the longitudinal analysis, LINE-1 hypomethylation was no longer observed in PTSD participants exposed to CSA. Conclusion: Our findings suggest that LINE-1 methylation may help understand the relationship between trauma and PTSD. However, more studies are needed to investigate LINE-1 as an epigenetic marker of psychiatric disorders.

Beyond fear: Patients with posttraumatic stress disorder fail to engage in safety cues

• We used brain reactivity as a proxy of engagement in safety cues. • Reactivity of supramarginal gyrus was modulated by context and group. • Safety cues attenuated brain reactivity in healthy participants. • Patients with PTSD present an inappropriate engagement in safety cues. For survival, it is crucial to continuously evaluate the presence or absence of risk in the environment. Previously, a safety cue for the observation of aversive pictures attenuated their aversiveness in healthy participants. Here, we investigated whether patients with Posttraumatic Stress Disorder (PTSD) would fail to engage in safety cues using brain reactivity to aversive pictures as a proxy. Patients with PTSD ( n = 20) and control participants ( n = 23) were exposed to neutral and mutilation pictures. Before the presentation of pictures, a text informed that those were fictitious (“safe context”) or real-life scenes (“real context”); appropriate images were also shown to increase the credibility of the text. A voxel-wise approach identified valence-responsive regions for further testing of an interaction pattern. A GROUPxCONTEXTxVALENCE interaction was found in the right supramarginal gyrus spreading anteriorly to the postcentral gyrus - a region involved in the processing of peripersonal space and defensive reactions. Control participants showed, in the real context, increased BOLD response in the right supramarginal gyrus for mutilation pictures compared to neutral ones and, in the safe context, no significant difference between those pictures, indicating an attenuation of brain reactivity. Patients with PTSD presented high brain reactivity in both real and safe contexts. Patients with PTSD were under pharmacological treatment, and the time posttrauma and comorbidities were not assessed. Differently from controls, patients with PTSD did not show attenuation of brain reactivity, reflected by supramarginal response in the safe context. This suggests an inappropriate engagement in safety cues.

A-194 Sustained Attention Differences Between Electrical Injury Patients and Combat Exposed Veterans with Post-Traumatic Stress Disorder

Abstract Objective: Electrical injury (EI) patients demonstrate heterogenous neuropsychological performance (NP), yet sustained attention (SA) has not been investigated. This study aimed to characterize differences in SA on the Conners’ Continuous Performance Test II (CPT-II) between patients with past EI and veterans with post-traumatic stress disorder (PTSD). Method: Participants included EI patients and veterans with PTSD receiving neuropsychological evaluations at affiliated academic medical centers. Inclusion criteria for veterans involved meeting criteria for PTSD per the Clinician-Administered PTSD Scale for DSM-IV. EI and PTSD participants were included if they completed the CPT-II and failed &amp;lt; 1 performance validity tests. The 50 EI participants were 80% male, ages 19-64 (M=42, SD=10.67), and 94% White. The 35 PTSD participants were 94% male, ages 25-49 (M=33, SD=5.55), and 31% White, 45% Black, 20% Hispanic, and 3% biracial. Results: Percentage of participants showing at least three atypical scores on the CPT-II was higher for EI (52%) compared with PTSD (20%) participants [χ^2 (1, N = 85) = 8.876, p &amp;lt; .003]. EI participants showed significantly greater SA difficulties on CPT-II overall standard error [F(1,84)=22.18, p&amp;lt; 0.001, ηp2=.21], variability of standard error [F(1,84)=7.70, p=0.028, ηp2=.09], reaction time by inter-stimulus interval (ISI) [F(1,84)=9.19, p=0.018, ηp2=.10], and standard error by ISI [F(1,84)=6.48, p=0.039, ηp2=.07]. All p-values were false discovery rate corrected. Conclusions: EI participants demonstrated overall greater inconsistency in response speed with slower and inconsistent reaction times during different ISIs. EI patients display a unique pattern of SA performance compared to veterans with PTSD, which may relate to the variability in EI NP.

A-275 Distinguishing Regional Cerebral Blood Flow between Posttraumatic Stress Disorder and Attention-Deficit/Hyperactivity Disorder in the Child Population

Abstract Objective: This study aimed to examine the regional cerebral blood flow (rCBF) of several brain regions to evaluate differences between Post-Traumatic Stress Disorder (PTSD) and Attention-Deficit/Hyperactivity Disorder (ADHD). Method: The sample consisted of PTSD patients (n=89) with a mean age of 12.10 years, SD=3.88, and ADHD patients (n=2568) with a mean age of 12.19 years, SD=3.39. To test the hypothesis that rCBF within these two disorders are distinguishable, one-way ANOVAs were run with all 17 brain regions in the SPECT Child Database. Results: Tests revealed statistical significance (increased rCBF (p&amp;lt;.001)) for PTSD bilaterally in the limbic system (baseline and concentration), bilaterally in the basal ganglia (baseline and concentration), and in the vermis (baseline and concentration). Statistical significance (p&amp;lt;.001) was indicated for ADHD bilaterally in the cerebellum (concentration), right-hemisphere parietal (baseline and concentration), and right-hemisphere temporal (baseline and concentration). Conclusions: While results indicated increased rCBF between various brain regions, this study also indicated two general regions that may significantly characterize each disorder to help us conceptualize neuropsychological functioning more meaningfully. Bilaterally, the limbic region generally produced greater rCBF in PTSD participants compared to ADHD; bilaterally, the cerebellum generally produced greater rCBF within ADHD participants. Literature correlates our limbic region with emotion, learning, memory, aggression and is particularly associated with anxiety disorders. The cerebellum is associated with refining fine movements initiated by the motor cortex. As impulsivity is a key criterion in ADHD, we may surmise that higher rCBF activity in the cerebellum results from increased efforts in controlling movements and coordination. Additional investigation is necessary.

Effective psychological therapy for PTSD changes the dynamics of specific large-scale brain networks.

In posttraumatic stress disorder (PTSD), re‐experiencing of the trauma is a hallmark symptom proposed to emerge from a de‐contextualised trauma memory. Cognitive therapy for PTSD (CT‐PTSD) addresses this de‐contextualisation through different strategies. At the brain level, recent research suggests that the dynamics of specific large‐scale brain networks play an essential role in both the healthy response to a threatening situation and the development of PTSD. However, very little is known about how these dynamics are altered in the disorder and rebalanced after treatment and successful recovery. Using a data‐driven approach and fMRI, we detected recurring large‐scale brain functional states with high temporal precision in a population of healthy trauma‐exposed and PTSD participants before and after successful CT‐PTSD. We estimated the total amount of time that each participant spent on each of the states while being exposed to trauma‐related and neutral pictures. We found that PTSD participants spent less time on two default mode subnetworks involved in different forms of self‐referential processing in contrast to PTSD participants after CT‐PTSD (mtDMN+ and dmDMN+) and healthy trauma‐exposed controls (only mtDMN+). Furthermore, re‐experiencing severity was related to decreased time spent on the default mode subnetwork involved in contextualised retrieval of autobiographical memories, and increased time spent on the salience and visual networks. Overall, our results support the hypothesis that PTSD involves an imbalance in the dynamics of specific large‐scale brain network states involved in self‐referential processes and threat detection, and suggest that successful CT‐PTSD might rebalance this dynamic aspect of brain function.

Influences of Aging on PTSD Prevalence, Neurobiology, and Clinical Course

Posttraumatic stress disorder (PTSD) affects 6.8% of adults in the United States and is associated with high rates of disability, comorbid medical and psychiatric disorders, and suicide. Recent studies report increasing prevalence rates of PTSD among older adults, and this pattern is anticipated to accelerate as the population skews older and Veterans from recent conflicts age. Most older adults suffer from chronic PTSD, which is associated with at least one disability in nearly 80% of cases. Compared to those without PTSD, individuals with chronic PTSD have exceedingly high rates of Major Depressive Disorder (MDD), triple the rates of drug abuse, and significant functional impairment. Prompt diagnosis and treatment of PTSD in later life is complicated by its differing phenomenology in older compared to younger adults and age-related changes in treatment seeking. Whereas overall symptom severity, intrusive thoughts, and avoidance behaviors are lower among older adults with PTSD, they more frequently report somatic problems (e.g., pain, insomnia, gastrointestinal upset) relative to emotional issues (e.g., specific aspects of the trauma). Older patients may not spontaneously report traumatic experiences or minimize their importance, use generic terms such as “stress”, and generally present to primary medical doctors rather than specialty mental health settings. In terms of treatment, few studies of exposure-based psychotherapies are randomized, older adults are rarely enrolled, and almost none evaluate the most evidence-based psychotherapy for PTSD, Prolonged Exposure therapy. Analyses of prescribing trends using Veterans Affairs (VA) databases suggest that only about half of veterans (all ages) with PTSD receive first-line pharmacotherapy agents such as selective serotonin reuptake inhibitors (SSRIs), with even lower medication prescription in older compared to younger adults.In this symposium the influence of age-related factors will be discussed on the prevalence, development of PTSD given a traumatic stimulus, clinical presentation in terms of symptom profiles, underlying neurobiology, treatment responsivity, and illness course. Speakers will engage the audience in a discussion of what makes PTSD different in older adults compared to younger adults and what are the implications of these differences on clinical evaluation and treatment. Dr. Joan Cook will present data comparing characteristics of younger vs. older sexual assault survivors in order to discuss clinical and research implications. Next, Dr. Vanessa Simiola will present electronic health record and utilization data and discuss age-based differences between diagnoses made in primary care versus specialty mental health, differences in mental health treatment receipt, as well as clinical characteristics of the samples. Then, Dr. Xi Zhu will delve into data suggesting higher rates of MDD in older adults with PTSD and present her analyses of network connectivity differences discriminating PTSD from comorbid PTSD/MDD. Finally, Dr. Bret Rutherford will present data from an ongoing NIMH study in which older adults with PTSD are compared to trauma-exposed healthy controls (TEHCs) on cognitive, physical functioning, and neuroimaging indices. Two-year follow up data will be reviewed to consider the differing cognitive and physical functioning trajectories experienced over time between PTSD and TEHC participants. Finally, an audience discussion synthesizing all three of the talks will be held, with ample opportunity for audience members to ask questions of each speaker.

MDMA-assisted therapy significantly reduces eating disorder symptoms in a randomized placebo-controlled trial of adults with severe PTSD

IntroductionEating disorders (EDs) and posttraumatic stress disorder (PTSD) are highly comorbid, yet there are no proven integrative treatment modalities for ED-PTSD. In clinical trials, MDMA-assisted therapy (MDMA-AT) has shown marked success in the treatment of PTSD and may be promising for ED-PTSD. MethodsNinety individuals with severe PTSD received treatment in a double-blind, placebo-controlled pivotal trial of MDMA-AT. In addition to the primary (Clinician-Administered PTSD Scale) and secondary (Sheehan Disability Scale) outcome measures, the Eating Attitudes Test 26 (EAT-26) was administered for pre-specified exploratory purposes at baseline and at study termination. ResultsThe study sample consisted of 58 females (placebo = 31, MDMA = 27) and 31 males (placebo = 12, MDMA = 19) (n = 89). Seven participants discontinued prior to study termination. At baseline, 13 (15%) of the 89 individuals with PTSD had total EAT-26 scores in the clinical range (≥20), and 28 (31.5%) had total EAT-26 scores in the high-risk range (≥11) despite the absence of active purging or low weight. In completers (n = 82), there was a significant reduction in total EAT-26 scores in the total group of PTSD participants following MDMA-AT versus placebo (p = .03). There were also significant reductions in total EAT-26 scores in women with high EAT-26 scores ≥11 and ≥ 20 following MDMA-AT versus placebo (p = .0012 and p = .0478, respectively). ConclusionsED psychopathology is common in individuals with PTSD even in the absence of EDs with active purging and low weight. MDMA-AT significantly reduced ED symptoms compared to therapy with placebo among participants with severe PTSD. MDMA-AT for ED-PTSD appears promising and requires further study.

Blood-Based Biomarkers for Alzheimer's Disease in Older Adults with Posttraumatic Stress Disorder.

Background:Posttraumatic stress disorder (PTSD) is associated with cognitive decline and risk for dementia, but the neuropathology involved is unclear.Objective:The aim of this study was to determine whether PTSD is associated with increased levels of Alzheimer’s disease (AD) blood-based biomarkers.Methods:Individuals aged 50 years and older with PTSD were compared to trauma-exposed healthy controls (TEHCs) at baseline on serum measures of amyloid-β (Aβ) 42 and 40 levels, the Aβ42/Aβ40 ratio, and total tau. Serum was analyzed using ultrasensitive Simoa Human Neurology 3-Plex A assay (N3PA). Linear regressions modeling each AD biomarker as a function of group were used to investigate between-group differences, controlling for age, sex, and educational attainment (years).Results:TEHC participants (N = 26) were 53.8% male with mean age 66.8±10.7, whereas PTSD participants (N = 44) were 47.7% male and aged 62.5±9.1 years. No between-group differences were noted on demographic characteristics or cognitive performance measured with the NIH Toolbox Cognition Battery. There were no significant between-group differences in serum Aβ40 (TEHC 105.8±51.6 versus PTSD 93.2±56.1, p = 0.46), Aβ42 (TEHC 8.1±4.6 versus PTSD 7.8±4.6, p = 0.63), Aβ42/Aβ40 (TEHC 0.08±0.03 versus PTSD 0.09±0.03, p = 0.27), or total tau (TEHC 0.5±0.3 versus PTSD 0.5±0.4, p = 0.77). Likewise, there were no significant interaction effects of amyloid or tau serum concentrations and PTSD group status on cognitive functioning.Conclusion:Findings from cognitive assessments and serum analyses do not support PTSD-induced neurodegeneration of the Alzheimer’s type as a pathway linking PTSD to increased incidence of dementia in older adults.

Differential mechanisms of posterior cingulate cortex downregulation and symptom decreases in posttraumatic stress disorder and healthy individuals using real-time fMRI neurofeedback.

BackgroundIntrinsic connectivity networks, including the default mode network (DMN), are frequently disrupted in individuals with posttraumatic stress disorder (PTSD). The posterior cingulate cortex (PCC) is the main hub of the posterior DMN, where the therapeutic regulation of this region with real‐time fMRI neurofeedback (NFB) has yet to be explored.MethodsWe investigated PCC downregulation while processing trauma/stressful words over 3 NFB training runs and a transfer run without NFB (total n = 29, PTSD n = 14, healthy controls n = 15). We also examined the predictive accuracy of machine learning models in classifying PTSD versus healthy controls during NFB training.ResultsBoth the PTSD and healthy control groups demonstrated reduced reliving symptoms in response to trauma/stressful stimuli, where the PTSD group additionally showed reduced symptoms of distress. We found that both groups were able to downregulate the PCC with similar success over NFB training and in the transfer run, although downregulation was associated with unique within‐group decreases in activation within the bilateral dmPFC, bilateral postcentral gyrus, right amygdala/hippocampus, cingulate cortex, and bilateral temporal pole/gyri. By contrast, downregulation was associated with increased activation in the right dlPFC among healthy controls as compared to PTSD. During PCC downregulation, right dlPFC activation was negatively correlated to PTSD symptom severity scores and difficulties in emotion regulation. Finally, machine learning algorithms were able to classify PTSD versus healthy participants based on brain activation during NFB training with 80% accuracy.ConclusionsThis is the first study to investigate PCC downregulation with real‐time fMRI NFB in both PTSD and healthy controls. Our results reveal acute decreases in symptoms over training and provide converging evidence for EEG‐NFB targeting brain networks linked to the PCC.

Post-traumatic stress disorder: A biopsychosocial case-control study investigating peripheral blood protein biomarkers

Experiencing traumatic events is unfortunately commonplace and, in some cases, may lead to the onset of debilitating mental health disorders, such as post-traumatic stress disorder (PTSD). Current diagnostic criteria for PTSD results in high depression and anxiety comorbidity. Better understanding of biological mechanisms and pathways underlying PTSD could aid in more accurate case identification and stratification of treatments. Recent meta-analysis has identified chronic PTSD to be associated with increased expression of pro-inflammatory cytokines and alterations in neuronal structures which contribute to an overall reduction in brain volume. Despite this, there are currently no biological markers in clinical use to identify PTSD or monitor treatment. This case-control study (n = 40) aimed to identify differences in peripheral blood biomarkers, and biomarker combinations, able to distinguish PTSD participants from controls, and examine in a biopsychosocial framework. The levels of 5/37 biomarkers investigated were significantly altered in the serum of PTSD participants: HDL and LDL cholesterol, tPA, IL-8 and EGF. Biomarkers could be used in combination with psychological criteria, in a biopsychosocial model, to support clinical management decisions and ensure appropriate individual treatment pathways. • Overlapping symptomology of PTSD with depression and anxiety presents diagnostic challenges. • EGF, tPA and IL-8 were differentially expressed in PTSD vs. control participants. • Using a biopsychosocial approach may improve PTSD diagnosis and treatment management.

Using deep learning to classify pediatric posttraumatic stress disorder at the individual level

BackgroundChildren exposed to natural disasters are vulnerable to developing posttraumatic stress disorder (PTSD). Previous studies using resting-state functional neuroimaging have revealed alterations in graph-based brain topological network metrics in pediatric PTSD patients relative to healthy controls (HC). Here we aimed to apply deep learning (DL) models to neuroimaging markers of classification which may be of assistance in diagnosis of pediatric PTSD.MethodsWe studied 33 pediatric PTSD and 53 matched HC. Functional connectivity between 90 brain regions from the automated anatomical labeling atlas was established using partial correlation coefficients, and the whole-brain functional connectome was constructed by applying a threshold to the resultant 90 * 90 partial correlation matrix. Graph theory analysis was used to examine the topological properties of the functional connectome. A DL algorithm then used this measure to classify pediatric PTSD vs HC.ResultsGraphic topological measures using DL provide a potentially clinically useful classifier for differentiating pediatric PTSD and HC (overall accuracy 71.2%). Frontoparietal areas (central executive network), cingulate cortex, and amygdala contributed the most to the DL model’s performance.ConclusionsGraphic topological measures based on fMRI data could contribute to imaging models of clinical utility in distinguishing pediatric PTSD from HC. DL model may be a useful tool in the identification of brain mechanisms PTSD participants.