Posttraumatic Stress Disorder Syndrome Research Articles

Posttraumatic Stress Disorder (PTSD): Level 4 – Efficacious

Posttraumatic stress disorder (PTSD) is a psychophysiological disorder characterized by chronic sympathetic nervous system activation, persisting perceptual/sensory vigilance for threats, and recurrent distressing memories of a traumatic event. Persons with PTSD frequently experience intrusive memories, nightmares, and flashbacks lived as if in the present moment. Many also exhibit a persisting negative emotional state, including fear, anger, guilt, and shame (Badour et al., 2017; Moss, 2017). PTSD often produces significant disability, lowered quality of life, and functional impairment (Alonso et al., 2004). The syndrome and symptoms of PTSD have been reported since the early 1800s and described under various diagnostic labels as exhaustion, irritable heart, Da Costa syndrome, and shell shock. Kardiner (1941) described the condition as a physioneurosis, a disorder that is both physiological and psychological. The psychophysiological basis of PTSD calls for psychophysiologically based interventions. Bessel van der Kolk has highlighted the problems in PTSD with affect regulation and called for mind–body interventions such as yoga and neurofeedback (NF) to enhance affective self-regulation (van der Kolk, 2014; van der Kolk et al., 2014, 2016). The purpose of this article is to review the published research on applications of biofeedback (BFB) and NF treatment of PTSD. Much of the research on this topic is still exploratory; several studies were conducted to show the viability of specific protocols. Accordingly, the review will include pilot studies, quasi-experimental studies, and randomized controlled studies. There is an emerging body of research on whether BFB or NF training before combat deployment or before childbirth can prevent the development of PTSD (Hourani et al., 2016; Pyne et al., 2019; Schlesinger et al., 2020). This important research will not be reviewed here.

Differential diagnosis of states of operability in young people who have had COVID-19 infection

AIM: to assess the peculiarity of the state of working capacity in the process of rehabilitation in young people after suffering COVID-19 infection.
 MATERIALS AND METHODS: We examined 62 convalescents who underwent COVID-19 (men aged 22.83 0.37 years) 90 days after discharge from the hospital. The main clinical forms (CF) of COVID-19 in this study were inapparent form (20 people 32.25%), acute respiratory viral infection (22 people 35.49%), pneumonia without respiratory failure (20 people 32.25%). The diagnostics of all clinical cases of COVID-19, examination, treatment and discharge of patients from the hospital were carried out in accordance with the regulatory documents. The psychodiagnostic study was carried out according to the Questionnaire Differential Diagnosis of Conditions of Decreased Performance by A.B. Leonova and S.B. Velichkovskaya. All surveyed received voluntary informed consent to participate in the study.
 RESULTS: In most cases, in all groups, the degree of severity of states of working capacity is regarded as low, which is probably due to asthenic syndrome after a previous illness, and psychological fatigue, due, in particular, to the presence of post-traumatic stress disorder syndrome.
 CONCLUSION: The states of reduced working capacity and the effectiveness of professional activity are very diverse, therefore, the peculiarities of the mental state can be understood only on the basis of identifying really acting motives of activity, which are manifested in reflexive assessments of the real situation and the behavior of the individual, taking into account their emotional coloring. Therefore, in order to substantiate corrective and rehabilitation measures in the case of a state of reduced working capacity and the effectiveness of professional activity, a differentiated assessment of these conditions is required, which requires the work of a multidisciplinary rehabilitation team (2 tables, bibliography: 32 refs).

Genome-wide association analyses of post-traumatic stress disorder and its symptom subdomains in the Million Veteran Program.

We conducted genome-wide association analyses in over 250,000 participants of European and African ancestry from the Million Veteran Program using electronic health record-validated posttraumatic stress disorder (PTSD) diagnosis and quantitative symptom phenotypes. Applying genome-wide multiple testing correction, we identified three significant loci in European case-control analyses and 15 loci in quantitative symptom analyses. Genomic structural equation modeling indicated tight coherence of a PTSD symptom factor that shares genetic variance with a distinct internalizing (mood-anxiety-neuroticism) factor. Partitioned heritability indicated enrichment in several cortical and subcortical regions, and imputed genetically regulated gene expression in these regions was used to identify potential drug repositioning candidates. These results validate the biological coherence of the PTSD syndrome, inform its relationship to comorbid anxiety and depressive disorders, and provide new considerations for treatment.

ТРИВОЖНІСТЬ У СТРУКТУРІ ІНТЕГРАЛЬНОЇ ІНДИВІДУАЛЬНОСТІ ЖУРНАЛІСТА

The article considers the place of anxiety in the journalist's integral personality structure. Due to the difficulties and stress context of the journalist's profession with deadlines, permanent urgency and sometimes even life dangerous anxiety may rise and its place in integral personality structure has not researched yet. More often, we may find publications about post-traumatic stress disorder syndrome among journalists than researches dedicated to anxiety, especially to its connections with other psychological properties and traits. Our purpose is to find the place of anxiety in the journalist's integral personality structure. Reaching of purpose is reflected in the following tasks. The first task is establishing connections of anxiety with other individual psychological properties, the second, identifying predictors of anxiety and statistically prove their impact on the anxiety development, the third, establishing the links between anxiety and an integral characteristic of the individual which is professional self-esteem. The methods of this research are psychodiagnostic tests such as Structure of Temperament Questionnaire by Rusalov, Sixteen Personality Factor Questionnaire, Personality Value Orientations Questionnaire by Bubnova etc. The results of our research show anxiety has many links to temperament, psychological traits, and even values. Some of them are positive (emotionality, social emotionality, vigilance, tension, values of rest and respect), others are negative (ergic, plasticity, emotional stability, dominance, social boldness, perfectionism). Moreover, anxiety has causal relationships with other properties of psychological level (emotional stability, dominance, social boldness etc.). The influence of anxiety on personality was shown with an inverse statistically significant correlation between anxiety and professional self-esteem, which is an integral characteristic of individuality. This result reflects a need for socio-psychological or soft skills training that helps journalists to improve their professional self-esteem and to reduce the level of anxiety.

Mental and Physical Factors Influencing Wellbeing among South Korean Emergency Workers.

Emergency workers are frequently exposed to hazardous situations and such life patterns can influence their wellbeing. This study examined the relationships among South Korean emergency workers’ precedents and consequences of positive emotion, engagement, relationship, meaning, and achievement (PERMA), a wellbeing concept, and offered solutions. A total of 597 emergency workers in Daegu, South Korea, participated in a survey. This study measured post-traumatic stress disorder syndrome, burnout, depression, PERMA, quality of life, life satisfaction, and sleep quality to test the relationships. Results demonstrated that post-traumatic stress disorder syndrome and burnout predicted distracting sleep behavior and sleep health. Depression was significantly related to PERMA. The better the emergency workers’ PERMA was, the better their quality of life and life satisfaction were. PERMA significantly predicted sleep behavior, a portion of sleep quality. Depression had an indirect influence on quality of life mediated by PERMA. Post-traumatic stress disorder syndrome, burnout, and PERMA were significant predictors of low sleep health and sleep behavior. The results indicate that South Korean emergency workers struggle with depression and sleep quality. As the data were collected during the coronavirus disease 19 pandemic, individual efforts and relevant programs to improve South Korean emergency workers’ PERMA and sleep quality in a crisis are recommended. Possible solutions to improve the wellbeing of South Korean emergency workers are suggested.

Review of possible psychological impacts of COVID-19 on frontline medical staff and reduction strategies.

Like soldiers, frontline medical staff provide a first line of defense and have played a critical role in responses to the outbreak of coronavirus disease-2019 in December 2019. It is important to acknowledge the considerable pressure placed on frontline medical staff in the face of a new type of coronavirus that is highly infectious and for which no specific treatment is available. Here, we review the various kinds of psychological problems afflicting frontline medical staff who are combatting the severe acute respiratory syndrome epidemic. These include anxiety, insomnia, depression, interpersonal difficulties, and post-traumatic stress disorder syndrome. We further present a summary of countermeasures for alleviating these problems based on our findings. These countermeasures include ensuring the provision of adequate protective gear for frontline medical staff, developing timely and clear guidelines, strengthening social support, and providing clear criteria and additional training, focusing on the choice of frontline medical staff. An understanding of the psychological impacts of an epidemic situation and of relevant countermeasures will contribute to reducing the psychological pressures on frontline medical staff. Consequently, they will be able to cope better with outbreaks of infectious diseases in the future, to reduce the psychological pressure of the front-line medical staff, and to improve the treatment level.

Metabolic syndrome risk in relation to posttraumatic stress disorder among trauma-exposed civilians in Gansu Province, China.

This study included 1456 men and 1411 women who were trauma-exposed and underwent routine health examinations in a community epidemiological investigation. The participants completed the posttraumatic stress disorder (PTSD) Check List-Civilian Version (PCL-C) for PTSD and medical examinations to detect metabolic syndrome. Adjustments for age, marriage, exercise, education, cigarette smoking, cancer, stroke, angina, and thyroid disease were performed. The relationship between PTSD and metabolic syndrome and each of its components was analyzed by multiple logistic regression.In women, PTSD was associated with metabolic syndrome (OR = 1.53, 95% CI = 1.01–1.95, P = .047) and the high-density lipoprotein cholesterol component (OR = 1.98, 95% CI = 1.04–2.12, P = .002). In men, PTSD was related to the hypertension component of metabolic syndrome (OR = 0.54, 95% CI = 0.31–0.92, P = .023). There was also a relationship between PTSD severity and metabolism (OR = 1.141, 95% CI = 1.002–1.280, P = 0.037) in women, and PTSD was inversely associated with the hypertension component (OR = 0.54, 95% CI = 0.31–0.92, P = .023) in men.PTSD was related to metabolic syndrome only in women. We plan to further research the mechanism of sex differences and dyslipidemia.

Pretreatment Posttraumatic Stress Disorder Symptom Network Metrics Predict the Strength of the Association Between Node Change and Network Change During Treatment.

Network analysis has been increasingly applied in an effort to understand complex interactions among symptoms in posttraumatic stress disorder (PTSD). Although methods that initially focused on identifying central symptoms in cross-sectional networks have been extended to longitudinal data that can reveal the relative roles of acute symptoms in the emergence of the PTSD syndrome, the association between network metrics and symptom change during treatment have yet to be explored in PTSD. To address this gap, we estimated pretreatment PTSD symptom networks in a sample of patients from a multisite clinical trial for women with full or subthreshold PTSD and substance use. We tested the hypothesis that node metrics calculated in the pretreatment network would be predictive of the strength of the association between a symptom's change and the change in the severity of all other symptoms through the course of treatment. A symptom node's strength and predictability in the pretreatment network were each strongly correlated with the association between that symptom's change and overall change across the symptom network, r(15) = .79, p < .001 and r(15) = .75, p < .001, respectively, whereas a symptom's mean severity at pretreatment was not, r(15) = .27, p = .292. These findings suggest that a node's centrality prior to treatment engagement is a predictor of its association with overall symptom change throughout the treatment process.

Overlap Between PTSD, TBI Symptoms Creates Challenges for Diagnosing Patients

Back to table of contents Previous article Next article Clinical and Research NewsFull AccessOverlap Between PTSD, TBI Symptoms Creates Challenges for Diagnosing PatientsAaron LevinAaron LevinSearch for more papers by this authorPublished Online:27 Jun 2019https://doi.org/10.1176/appi.pn.2019.6b20AbstractA patient’s symptoms and history of trauma are not enough for determining a diagnosis.Traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD) often overlap, both in their traumatic cause and in their symptoms; thus, differentiating between the two can be critical for treatment and determination of disability.Teasing out the symptomatic differences and similarities between PTSD and TBI―especially in patients diagnosed with both―requires great care, said panelists (from left) Elspeth Cameron Ritchie, M.D., M.P.H., Keith Caruso, M.D., Jeffrey Guina, M.D., and U.S. Air Force Capt. Brandon Withers.David HathcoxPeople with either condition may exhibit sleep problems, depression, flashbacks, avoidance, light or noise sensitivity, or irritability.Several physiological mechanisms come into play to produce those outcomes, said U.S. Air Force Capt. Brandon Withers, administrative chief resident in the Department of Psychiatry at Wright State University in Dayton, Ohio, during a session at APA’s 2019 Annual Meeting in San Francisco. The immune system is activated in the face of tissue damage and imminent threat, as are neuroendocrine and catecholaminergic mechanisms, he said.“It’s difficult to tease out which of these systems you’re dealing with based only on symptoms and a history of trauma,” said Withers. “Rating scales designed to measure PTSD versus postconcussion syndrome symptoms should not be presumed specific in the setting of potential comorbidity.”Application for disability status in the armed forces is diametrically opposite from the civilian world, said Jeffrey Guina, M.D., a former Air Force psychiatrist now at the Center for Forensic Psychiatry in Saline, Mich. In the U.S. military, the claimant gets the benefit of the doubt. Among civilians, the burden of proof is on the claimant.As a private disability consultant for the insurance company Lincoln Financial Group, Keith Caruso, M.D., of Brentwood, Tenn., is often called on to evaluate claims of disability by individuals with PTSD or TBI.“Neuropsychological findings found in both PTSD and TBI include deficits in attention, verbal memory, and response inhibition, although cognitive deficits in PTSD are typically less severe than in TBI,” said Caruso. Neuropsychological testing can reveal findings specific to TBI, such as changes in IQ or memory problems, processing speed, and executive function. Headaches, dizziness, tinnitus, and disequilibrium are also common. Comparing those symptoms with those of PTSD, even when there is some overlap, can help differentiate the two conditions and guide appropriate treatment.In military populations, the overlap is unsurprising, given the frequency of roadside bomb attacks during the recent conflicts in Iraq and Afghanistan, said former U.S. Army psychiatrist Elspeth Cameron Ritchie, M.D., M.P.H.“PTSD always has comorbidities,” said Ritchie. Soldiers who survive a bomb attack may have both concussive symptoms but also other physical wounds ranging from genital injuries to facial burns. They may already be sleep deprived and may develop depression or alcohol abuse.There are three types of treatment, said Ritchie: “Medications, psychotherapy, and everything else.”Only sertraline and paroxetine have been approved for use with PTSD but sometimes other medications are used, too. Ritchie has found success with bupropion because it does not induce weight gain and can reverse the sexual side effects of selective serotonin reuptake inhibitors, she said. Low doses of a second-generation antipsychotic like quetiapine may help with trauma-induced nightmares, although their use is controversial. Prazosin has also been used to reduce nightmares.Patients seen at the Veterans Health Administration seeking psychotherapy most commonly receive cognitive-behavioral therapy and cognitive processing therapy. Patients tend to benefit most from these therapies when informed in advance of treatment that it involves extended discussion of the traumatic episode.Patients with PTSD and TBI also may benefit from acupuncture, exercise, virtual reality technology, yoga, or working with dogs or horses—all based on the idea that the patients have some control over their therapy, Ritchie said. ■ ISSUES NewArchived

A Clinical Case Study of a 45 y/o Female Suffering with PTSD, Bipolar D/O, Depression, Anxiety and Chronic Pain Syndrome Taking 42-58 Pills Per Day and Weaned off of All Medications Using Medical Cannabis

Post-traumatic stress disorder (PTSD) is a prevalent, chronic, and disabling depression and anxiety disorder that may develop following exposure to a traumatic event. Although the use of Medical Cannabis for the treatment of physical and psychological disorders is controversial, medical marijuana is currently legal in Canada, 33 states in the United States and many countries around the world. Studies published in Molecular Psychiatry and Science Daily showed that treatment using particular compounds found in cannabis may benefit those with PTSD, and that “plant-derived cannabinoids [psychoactive chemicals] such as cannabis may possess some benefits in individuals with PTSD by helping relieve haunting nightmares and other symptoms of PTSD” and as a result of taking medical cannabis, participants reported a decrease in re-experiencing the trauma, less avoidance of situations that reminded them of the trauma, and a decline in hyper-arousal, respectively. There’s also convincing evidence from multiple studies for reduced endocannabinoid availability in PTSD, i.e., reduced levels of the endocannabinoid anandamide and compensatory increase of CB1 receptor availability in PTSD, and an association between increased CB1 receptor availability in the amygdala and abnormal threat processing, as well as increased severity of hyperarousal, but not dysphoric symptomatology, in trauma survivors. Other studies suggest that Medical Cannabis therapy, as an adjunct to a traditional analgesic therapy, can be an efficacious tool to make more effective the management of chronic pain and its consequences on functional and psychological dimensions. The patient in this case study had been treated for over 20 years with multiple opiates, Selective Serotonin Re-Uptake Inhibitors (SSRIs), Serotonin Norepinephrine Re-Uptake Inhibitors (SNRIs), typical and atypical antipsychotics, antiepileptics, etc. to manage her multiple medical conditions, i.e., migraine headaches, seizures/tremors, general anxiety disorder with panic attacks, major depressive disorder-moderate and recurrent, attention deficit disorder, fibromyalgia, hot flashes and generalized edema. We will review how she was weaned off of the majority of the pharmacological treatments solely using Medical Cannabis in less than one year

DEVELOPMENT AND IMPLEMENTATION OF A NEW CONCEPT OF CRISIS SITUATIONS SYNDROME: "SYNDROME OF A HYBRID WAR"

The aim of our research was basis of the analysis and research of the current state and trends of emergence and development of crisis situations syndromes to identify their general and specific features inherent in specific crisis situations syndromes at the place where they occurred, factors that influenced their formation and the manifestations they characterized by. Materials and methods - analysis and systematization of data on the complex impact of stress factors and other manifestations of crisis situations on subjects who find themselves in a zone of military conflict / man-made or natural disaster; formulation of new concepts, strategies and tactics for work in crisis situations. Results. Common and specific features of the known syndromes of wars are found. It is proved that, by common characteristics, all syndromes of wars can be combined into a single basic category - crisis situations syndrome, which is divided by specific features into specific crisis situations syndromes at the place where they occurred, under what factors they were formed and the manifestations they characterize. A classification of post-traumatic stress disorders as a component of crisis situations syndromes by the mechanisms of their formation and a model of their formation are provided. Definitions are formulated; crisis syndrome and hybrid war syndrome are described. A working table has been developed for analysts for the differential diagnostic of “Crisis Situation Syndromes”. Conclusions. The technology of objective diagnostic, treatment and prevention of PTSD (post-traumatic stress disorder) and hybrid war syndrome is proposed, which includes the identification of possible etiological factors affecting the formation of crisis states syndromes with differentiation of impact factors, the actual identification with the formation of a differentiated approach to treatment, and prevention development of "coaching" techniques. The technology is based on a comprehensive psychological and ophthalmologic examination. It has been established that the “hybrid war syndrome” is formed both among combatants and non-combatants, for the first time in it the cognitive defeat, both of individual subjects and social groups is fully manifested. In addition, for the first time, in relation to other crisis syndromes, there are social group symptoms, the formation of migratory symptoms, the formation of specific PTSDs, etc.

Systematic review with meta-analysis: The association between post-traumatic stress disorder and irritable bowel syndrome.

Post-traumatic stress disorder (PTSD) is a psychiatric condition characterized by symptoms of hyperarousal and hypervigilance. Increasing research on the "gut-brain" axis (bidirectional signaling between the gut and the brain) has drawn links between PTSD and irritable bowel syndrome (IBS), an exceedingly common yet incompletely understood gastrointestinal condition. This meta-analysis thus aimed to examine the body of evidence and extent of association of PTSD with IBS. Using the keywords [early abuse OR childhood abuse OR violence OR trauma OR PTSD] AND [irritable bowel syndrome or IBS], a preliminary search on the PubMed, Medline, Embase, ScienceDirect, PsychINFO, Web of Science, and Google Scholar databases yielded 11,257 papers published in English between January 1, 1988, and May 1, 2018. Of these, only eight studies were included in the final meta-analysis. The eight studies (four cross-sectional and four cohort) contained a total of 648,375 subjects. Most studies were from the USA and conducted on army veterans. The funnel plot revealed a roughly symmetrical distribution of studies, and Egger test was not significant for publication bias (P=0.583). Random-effects meta-analysis found PTSD to be a significant risk factor for IBS (pooled odds ratio 2.80, 95% confidence interval: 2.06 to 3.54, P<0.001). Overall, PTSD is associated with an increased likelihood of IBS. This is the first meta-analysis to specifically examine the association between PTSD and IBS, and it provides insights into the probable (patho)physiology and management of IBS, supporting a holistic consideration of the psychosocial aspects of IBS and further research into effective multi-modal therapeutics.

Evidence for altered brain reactivity to norepinephrine in Veterans with a history of traumatic stress

BackgroundIncreases in the quantity or impact of noradrenergic signaling have been implicated in the pathophysiology of posttraumatic stress disorder (PTSD). This increased signaling may result from increased norepinephrine (NE) release, from altered brain responses to NE, or from a combination of both factors. Here, we tested the hypothesis that Veterans reporting a history of trauma exposure would show an increased association between brain NE and mental health symptoms commonly observed after trauma, as compared to Veterans who did not report a history of trauma exposure, consistent with the possibility of increased brain reactivity to NE after traumatic stress. MethodsUsing a convenience sample of 69 male Veterans with a history of combat-theater deployment, we examined the relationship between trauma-related mental health symptoms and the concentration of NE in cerebrospinal fluid (CSF). CSF NE levels were measured by HPLC in CSF from morning lumbar puncture. Behavioral symptoms associated with diagnoses of PTSD, depression, insomnia, or post-concussive syndrome (PCS), which together cover a wide variety of symptoms associated with alterations in arousal systems, such as sleep, mood, concentration, and anxiety, were assessed via self-report (PTSD Checklist [PCL] for PTSD, Patient Health Questionnaire 9 [PHQ9] for depression, Pittsburgh Sleep Quality Index [PSQI] for sleep problems including insomnia, and Neurobehavioral Symptom Inventory [NSI] for PCS) and structured clinical interview (Clinician-Administered PSTD Scale [CAPS]). Individuals meeting criterion A of the DSM-IV diagnostic criteria for PTSD were considered trauma-exposed. Linear regression models were used to quantify the association between CSF NE and symptom intensity in participants with and without a history of trauma exposure, as well as in participants with a history of trauma exposure who were currently taking the noradrenergic receptor antagonist prazosin. ResultsFifty-two Veterans met criteria for a history of trauma exposure; of these, 36 met criteria for PTSD. CSF NE levels were not significantly different in Veterans with a history of trauma compared to those without, nor in Veterans with PTSD as compared to those without. Veterans with a history of trauma and who were not using the medication prazosin demonstrated a significantly more positive correlation between CSF NE and behavioral symptom expression than Veterans who had not experienced traumatic stress. No relationship between CSF NE and behavioral symptom expression was found in Veterans who had experienced traumatic stress and were taking prazosin at the time of the assessments. ConclusionsThese results are consistent with increased central nervous system responsiveness to noradrenergic signaling in individuals with a history of traumatic exposure, raising the possibility that there may be long-lasting physiologic effects of trauma-exposure that exist independently of whether an individual meets criteria for PTSD at any given point in time. Exploration of the mechanism by which brain responsiveness to NE is modulated following trauma holds the possibility of finding new strategies for both preventing and treating PTSD.

CLINICAL PICTURE, DIAGNOSIS AND TREATMENT OF PATIENTS WITH REMOTE CONSEQUENCES OF FIGHTING CRANIO-CEREBRAL INJURY AND POSTTRAUMATIC STRESS DISORDER

We investigated 20 soldiers of antiterrorist operation, who had under one fighting cranio-cerebral injury mine-explosion trauma, and in the time of return on peaceful territory they developed syndrome of posttraumatic stress disorder (PTSD). They formed the basic group of our investigation. The control group was formed of 16 patients with remote consequences of fighting cranio-cerebral injury of peaceful time. The methods of investigation included neurological and psychological examination of the patients. Psychological test was conducted with the purpose of revealing syndrome of postraumatic stress disorder. To revealed clinical – pathogenetic peculiarities of the head pain in ATO soldiers with PTSD and in patients with remote consequences of fighting cranio-cerebral injury in peaceful time.

An intensive outpatient treatment program for combat-related PTSD: Trauma Management Therapy.

An estimated 18.5% of veterans returning from Operation Iraqi Freedom, Operation Enduring Freedom, and Operation New Dawn are suffering from posttraumatic stress or posttraumatic stress disorder (PTSD). The number of veterans and service duty personnel requesting VA health care services is increasing, and the VA's ability to handle requests is dwindling. Thus, both the content of interventions and the format by which these services are delivered need to be reconceptualized. The authors present a multicomponent intervention program known as Trauma Management Therapy (TMT), a comprehensive, empirically supported treatment that can be delivered in an intensive, 3-week outpatient format. TMT combines individual exposure therapy with group social and emotional rehabilitation skills training to address specific aspects of the combat-related PTSD syndrome. The authors present the format of this novel intensive outpatient program, describe the components, and address implementation factors such as treatment compliance, dropout rates, and administrative considerations.

Magnetic resonance spectroscopy of hippocampal and striatal neurometabolites in experimental PTSD rat modeling

The spectrum of the metabolites in the dorsal region of the hippocampus and striatum was studied using the method of 1H magnetic resonance spectroscopy at experimental modeling of the posttraumatic stress disorder syndrome (PTSD) in rats. PTSD was reproduced by exposure of the cat cue to rats daily along 10 day by 10 minutes at once. The anxiety level of animals was estimated 12 days later after the end of the experimental series of stress. Based on the anxiety index, the rats were divided into 3 phenotypes. The animals with an anxiety index &gt; 0.8 (group 1) had lower plasma corticosterone compared with rats form the control group. In animals with an anxiety index in the range 0.7–0.8 (group 2), an elevated corticosterone level was noted. The rats with an anxiety index &lt; 0.7 (group 3) had a lower plasma corticosterone level compared with animals from the control group. Rats of group 2 were characterized by an increased level of GABA in the hippocampus compared with controls. In the remaining groups, the percentages of GABA in the hippocampus and striatum did not differ significantly from the control. The distribution of NAA differed form that of GABA. The highest level of NAA was found in the striatum for rats from group 1, whereas NAA in animals form groups 1 or 3 did not differ from the control. The NAA level in the hippocampus was similar between all groups, including the control. The results obtained indicate that multiple exposures to psychological stress associated with the sense of proximity of a natural enemy in some animals cause an anxiolytic reaction. These animals are characterized by a stable corticosterone level and a stable level of neurometabolites in the studied structures of the brain. For rats with the highest level of anxiety, a lowered level of corticosterone with a constant level of neurometabolites in the hippocampus and striatum is characteristic. And only in rats with an intermediate level of anxiety, synchronization was observed between the increase in plasma corticosterone and the increase in hippocampal GABA content. The results obtained are in good agreement with the ideas of the protective action of glucocorticoids under PTSD manifested in restraining violations of the psycho-physiological status. The mate rials allow the neurobiological mechanisms of the protective action of glucocorticoids to be detailed.

Acute and Chronic Posttraumatic Stress Symptoms in the Emergence of Posttraumatic Stress Disorder

Little is understood about how the symptoms of posttraumatic stress develop over time into the syndrome of posttraumatic stress disorder (PTSD). To use a network analysis approach to identify the nature of the association between PTSD symptoms in the acute phase after trauma and the chronic phase. A prospective cohort study enrolled 1138 patients recently admitted with traumatic injury to 1 of 4 major trauma hospitals across Australia from March 13, 2004, to February 26, 2006. Participants underwent assessment during hospital admission (n = 1388) and at 12 months after injury (n = 852). Networks of symptom associations were analyzed in the acute and chronic phases using partial correlations, relative importance estimates, and centrality measures of each symptom in terms of its association strengths, closeness to other symptoms, and importance in connecting other symptoms to each other. Data were analyzed from March 3 to September 5, 2016. Severity of PTSD was assessed at each assessment with the Clinician-Administered PTSD Scale. Of the 1138 patients undergoing assessment at admission (837 men [73.6%] and 301 women [26.4%]; mean [SD] age, 37.90 [13.62] years), strong connections were found in the acute phase. Reexperiencing symptoms were central to other symptoms in the acute phase, with intrusions and physiological reactivity among the most central symptoms in the networks in terms of the extent to which they occur between other symptoms (mean [SD], 1.2 [0.7] and 1.0 [0.9], respectively), closeness to other symptoms (mean [SD], 0.9 [0.3] and 1.1 [0.9], respectively), and strength of the associations (mean [SD], 1.6 [0.3] and 1.5 [0.3] respectively) among flashbacks, intrusions, and avoidance of thoughts, with moderately strong connections between intrusions and nightmares, being upset by reminders, and physiological reactivity. Intrusions and physiological reactivity were central in the acute phase. Among the 852 patients (73.6%) who completed the 12-month assessment, overall network connectivity was significantly stronger at 12 months than in the acute phase (global strength values, 6.57 vs 7.60; paired difference, 1.03; P < .001). The network associations among the reexperiencing symptoms were strengthened at 12 months, and physiological reactivity was strongly associated with the startle response, which was also associated with hypervigilance. Strong connectivity among emotional numbing, detachment from others, and disinterest in activities as well as moderately strong links among irritability (anger), concentration deficits, and sleep disturbance were found. As time elapses after trauma, fear circuitry and dysphoric PTSD symptoms appear to emerge as connected networks. Intrusive memories and reactivity are centrally associated with other symptoms in the acute phase, potentially pointing to the utility of addressing these symptoms in early intervention strategies.

Exposure to a Predator Scent Induces Chronic Behavioral Changes in Rats Previously Exposed to Low-level Blast: Implications for the Relationship of Blast-Related TBI to PTSD.

Blast-related mild traumatic brain injury (mTBI) has been unfortunately common in veterans who served in the recent conflicts in Iraq and Afghanistan. The postconcussion syndrome associated with these mTBIs has frequently appeared in combination with post-traumatic stress disorder (PTSD). The presence of PTSD has complicated diagnosis, since clinically, PTSD and the postconcussion syndrome of mTBI have many overlapping symptoms. In particular, establishing how much of the symptom complex can be attributed to the psychological trauma associated with PTSD in contrast to the physical injury of traumatic brain injury has proven difficult. Indeed, some have suggested that much of what is now being called blast-related postconcussion syndrome is better explained by PTSD. The relationship between the postconcussion syndrome of mTBI and PTSD is complex. Association of the two disorders might be viewed as additive effects of independent psychological and physical traumas suffered in a war zone. However, we previously found that rats exposed to repetitive low-level blast exposure in the absence of a psychological stressor developed a variety of anxiety and PTSD-related behavioral traits that were present months following the last blast exposure. Here, we show that a single predator scent challenge delivered 8 months after the last blast exposure induces chronic anxiety related changes in blast-exposed rats that are still present 45 days later. These observations suggest that in addition to independently inducing PTSD-related traits, blast exposure sensitizes the brain to react abnormally to a subsequent psychological stressor. These studies have implications for conceptualizing the relationship between blast-related mTBI and PTSD and suggest that blast-related mTBI in humans may predispose to the later development of PTSD in reaction to subsequent psychological stressors.

Homogeneity of Severe Posttraumatic Stress Disorder Symptom Profiles in Children and Adolescents Across Gender, Age, and Traumatic Experiences Related to 9/11.

Patients with a posttraumatic stress disorder (PTSD) diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders (4th ed., DSM-IV; American Psychiatric Association, 1994) will very likely not share all of the same symptoms, a consequence of the polythetic approach used in the DSM. We examined heterogeneity in the latent structure of PTSD symptoms using data from a previously published sample of 8,236 youth a subset of which had been exposed to the September 11, 2001 attacks (N = 6,670; Hoven etal., 2005). Latent class analysis was applied (a) to PTSD symptoms alone, (b) to symptoms in combination with impairment indicators, and (c) to PTSD symptoms when stratified by age and gender, as well as by empirically defined classes of exposure. We identified 4 symptom classes: no disturbance (49.4%), intermediate disturbance (2 classes; 21.5% and 18.6%, respectively), and severe disturbance (10.5%). These classes varied not only in the severity of symptoms, but also in the configuration of symptoms. We observed a high probability of endorsing both PTSD symptoms and indicators of impairment only in the severe disturbance class. A similar 4-class structure was found when the data were stratified by age, gender, and exposure classes. There were no significant differences as a function of age, gender, or exposure in the presence of severe PTSD. Heterogeneity was observed at intermediate levels of PTSD symptom severity. The specific PTSD symptoms that defined the severe PTSD profile could constitute the pathogenic aspects of a largely invariant and clinically meaningful PTSD syndrome.

Balanced and less traumatized: Balanced time perspective mediates the relationship between temperament and severity of PTSD syndrome in motor vehicle accident survivor sample

Posttraumatic stress disorder (PTSD) symptoms describe a common chronic and disabling reaction of individuals exposed to extreme stress. The negative influence of PTSD on people's functioning justifies researchers' efforts to define predictors of the disorder and the factors that can prevent the development of PTSD. Existing research exposes a pronounced role of temperamental traits, in addition to the severity of trauma exposure. Experience of the traumatic event and subjective assessment of its consequences may also be influenced by individual differences in the time perspective profile, particularly the indicator of temporal adaptation referred to as balanced time perspective (BTP). The aim of the present research was to establish the relationship between time perspective, trauma exposure and temperament and its influence on the level of PTSD symptoms. The regression analyses showed that briskness, emotional reactivity, BTP and trauma severity were significant predictors of PTSD symptoms and that BTP mediated the relationship between temperament and PTSD. People exposed to more severe trauma who were prone to strong emotional reactions and were less flexible in coping with trauma revealed a negatively biased time perspective, which resulted in the development of PTSD symptoms.