Posttraumatic Stress Disorder Symptoms In Patients Research Articles

The Prevalence of Post-Traumatic Stress Disorder Symptoms in Chronic Pain Patients in a Tertiary Care Setting: A Cross-Sectional Study

There is limited research regarding the prevalence of post-traumatic stress disorder (PTSD) in civilian multidisciplinary pain clinics. Controlled studies have only examined specific patient populations, such as those with motor vehicle accidents, war veterans, work-related injuries, back pain, and headache. The purpose of this study was to estimate the prevalence of PTSD symptoms in patients with chronic pain at a large multidisciplinary pain clinic. Three hundred consecutive new or newly referred patients with a self-reported history of chronic pain were recruited to complete an in-person screen for PTSD symptoms, which included the Brief Trauma Questionnaire and the PTSD Symptom-Scale Self-Report. Two hundred and sixty-five were eligible for the study. Seventy-four (28%) screened positive for PTSD symptoms, a value higher than the lifetime prevalence of PTSD in the general population (6.8%). Those who screened positive for PTSD symptoms were significantly younger (p = 0.007) and had higher levels of pain intensity (p = 0.0005) compared to those who screened negative for PTSD symptoms. The prevalence of PTSD symptoms in our chronic pain population (28%) exceeded the prevalence of PTSD in the general population (7%). Patients with chronic pain who screened positive for PTSD reported higher pain severity and were younger. This emphasizes the need for PTSD screening in the chronic pain population, as early identification and treatment may be effective in reducing the mounting health care costs and disease burden of comorbid chronic pain and PTSD.

Number and Type of Post-Traumatic Stress Disorder Symptom Domains Are Associated With Patient-Reported Outcomes in Patients With Chronic Pain

Post-traumatic stress disorder (PTSD) commonly accompanies complex chronic pain, yet PTSD is often overlooked in chronic pain management. Using the 4-item Primary Care (PC)-PTSD screening tool, we evaluated the relationship between the number and type of PC-PTSD symptoms endorsed and a set of patient-reported outcomes, including: pain intensity and interference, function, mood, quality of life, and substance abuse risk in a consecutive sample of patients with chronic pain (n = 4,402). Patients completed PainTracker, a Web-based patient-reported outcome tool that provides a multidimensional evaluation of chronic pain, as part of their intake evaluation at a specialty pain clinic in a community setting. Twenty-seven percent of the sample met PC-PTSD screening criteria for PTSD by endorsing 3 of the 4 symptom domains. Significant ordinal trends were observed between increasing number of PTSD symptoms and all outcomes evaluated. The occurrence of even 1 PTSD symptom was associated with overall poorer outcomes, suggesting that subsyndromal PTSD is clinically significant in the context of chronic pain. Among the 4 PTSD domains assessed, “numbness/detachment” was most strongly associated with negative pain outcomes in relative weight analysis. Results from this cross-sectional study suggest that a range of pain-related outcomes may be significantly related to comorbid PTSD. PerspectiveWe present evidence that PTSD symptoms are significantly related to a broad set of pain-related patient-reported outcomes. These findings highlight the need to evaluate for PTSD symptoms in patients with chronic pain, especially feelings of numbness or detachment from others, to improve understanding and management of chronic pain.

Disability from posttraumatic headache is compounded by coexisting posttraumatic stress disorder.

BackgroundPosttraumatic headache (PTH) occurs in up to 82% of patients with traumatic brain injury (TBI). Posttraumatic stress disorder (PTSD) occurs in 39% of those with PTH. This study evaluates whether PTSD affects PTH disability.MethodsEighty-six patients with TBI were prospectively evaluated in a secondary care trauma center. Headache disability was assessed using the Headache Impact Test version 6 and signs indicative of PTSD using the PTSD Check List Civilian version.ResultsIncreased PTSD-type symptoms were significantly associated with increased headache disability (p<0.001), as were employment status and loss of consciousness (p=0.049 and 0.016, respectively). Age was negatively correlated with headache disability (Spearman’s correlation rho=0.361, p=0.001).ConclusionIncreased severity of PTSD-type symptoms is significantly associated with increased headache disability in patients with chronic PTH. Managing PTSD symptoms in patients with chronic PTH may facilitate headache management.

Reduced Consolidation, Reinstatement, and Renewal of Conditioned Fear Memory by Repetitive Treatment of Radix Polygalae in Mice.

The therapeutic goal for the treatment of posttraumatic stress disorder (PTSD) is to promote extinction and to prevent the relapse of fearful memories. Research has identified pharmacological treatments that may regulate the formation and extinction of fear memories, but not many reagents that block the relapse of extinguished fear are known. Radix Polygalae (RP) is an Asian herb used for sedation, and its ingredients have anxiolytic and antidepressant properties. As various neurological effects have been identified, we tested whether RP affects the relapse of fear. Freezing in response to a conditioned context and cues was used to measure the effects of RP in mice. In cohort 1 (n = 30), consolidation, extinction, and reinstatement were tested during the course of 18 days of treatment. In cohort 2 (n = 30), consolidation, extinction, and renewal were tested during 10 days of treatment. The consolidation, extinction, reinstatement, and possibly the renewal of context-induced freezing were inhibited due to the administration of RP in animal subjects. However, the effects of RP on the freezing responses of subjects elicited by conditioned auditory cues were less obvious. Because it effectively suppresses the consolidation of fear memories, RP may be used for primary and secondary prevention of symptoms in PTSD patients. Additionally, because it effectively suppresses the reinstatement and renewal of fear memories, RP may be applied for the prevention of fear relapse in PTSD patients who have undergone exposure therapy.

Association between social support and post-traumatic stress disorder symptoms among Chinese patients with ovarian cancer: A multiple mediation model.

Post-traumatic stress disorder (PTSD) symptoms can develop after person experiences one or more traumatic events. Little research, however, has been done on PTSD symptoms of patients with ovarian cancer. The present study aimed to estimate the prevalence of PTSD symptoms in patients with ovarian cancer in China; the effects of demographic and clinical variables on PTSD symptoms; multiple mediation roles in the association between social support and PTSD symptoms in patients with ovarian cancer in China. We collected demographic and clinical information of patients with ovarian cancer in the first and second hospitals of China Medical University between January 1, 2014 and December 31, 2015. Qualified patients were asked to complete the Posttraumatic Stress Disorder Checklist-Civilian Version (PCL-C), Duke-UNC Functional Social Support Questionnaire, Herth Hope Index (HHI), and Resilience Scale-14 (RS-14). 201 patients provided responses. We performed hierarchical linear regression to assess the correlation between social support and PTSD symptoms and bootstrapping to test the mediating role of hope and resilience as potential mediators. After controlling demographic and clinical characteristics, social support negatively correlated with PTSD symptoms (β = -0.406, P < 0.01). Social support explained 14.7% of the variance in PTSD symptoms. Hope and resilience explained 17.0% of the variance in PTSD symptoms. The proportion of the hope mediating effect was 43.37% for social support and the proportion of the resilience mediating effect was 10.64% for social support. Hope and resilience partly mediated the correlation between social support and PTSD symptoms despite accounting for different proportions of the mediating effect. Future intervention plans should pay more attention to social support as well as hope and resilience to prevent, relieve and treat PTSD symptoms.

Residual sleep disturbance in Tunisian military patients with post-traumatic stress disorder

IntroductionSleep disorders such as nightmares and insomnia are among the most frequently reported symptoms in patients with post-traumatic stress disorder (PTSD).ObjectiveTo assess the prevalence of residual sleep disorders in military personnel with PTSD.MethodsA cross-sectional study was conducted and included 25 military consultants meeting the criteria of DSM-5 for PTSD. Sleep disorders were assessed using the insomnia severity index (ISI).ResultsThe mean score of the ISI was 14. Fourteen percent of the participants (n = 21) reported difficulty falling asleep. All patients reported difficulties staying asleep. Nightmares were reported by 48% of the sample (n = 12). All patients were under hydroxyzine at dosages ranging from 25 to 50 mg per day. More than half of the sample (n = 18) was under a combination of benzodiazepine and hydroxyzine. Seventy-one percent of patients (n = 15) considered that their sleep difficulties significantly disrupted their daily lives.ConclusionInsomnia is one of the most frequent and persistent symptoms in PTSD patients. These sleep disorders can impede remission and may be due in part to co-morbid depression.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Cognitive-Behavioral Treatment of Posttraumatic Stress in Patients With Implantable Cardioverter Defibrillators: Results From a Randomized Controlled Trial.

Approximately 20% of patients with implantable cardioverter defibrillators (ICDs) suffer from posttraumatic stress disorder (PTSD) due to a history of cardiac arrest, device implantation, and ICD shock. There has been very little examination of treatment of PTSD symptoms in these patients. This study evaluated the effect of a specific cognitive-behavioral therapy (CBT) intervention for ICD patients with high levels of PTSD symptoms: a manualized program consisting of 8 telephone sessions with a trained counselor, a patient education book, and a stress management procedure on compact disc. Participants were 193 ICD patients, who were randomized to CBT or usual cardiac care (UCC) who completed self-report surveys at the time of recruitment and 6 and 12 months after initial measurement. Previous publication on the primary research evaluation questions reported that the CBT condition resulted in greater improvement on PTSD and depression symptoms than the UCC for the general population of ICD patients, but did not evaluate the effect on those with elevated symptoms of PTSD. The authors conducted secondary analyses of the effect of treatment on high and low PTSD symptom groups based on a cutoff for the Impact of Event Scale-Revised (Weiss & Marmar, 1997). Participants in the CBT group who had high symptoms experienced significantly greater symptom reduction from baseline to 12 months (d = 2.44, p = .021) than the UCC group (d = 1.12). Participants with low symptoms had small reductions regardless of group assignment (d = 0.16, p = .031). ICD-focused CBT was sufficient to produce a large, statistically significant reduction in PTSD symptoms in ICD patients with indications for treatment.

(221) Associations between post-traumatic stress disorder symptoms and mental health in fibromyalgia

Research suggests that many patients who suffer from post-traumatic stress disorder (PTSD) frequently also have fibromyalgia and vice versa. Patients with PTSD with concurrent fibromyalgia reported more pain, greater tenderness, lower quality of life, greater functional impairment, and more psychological distress as compared to patients with PTSD without concurrent fibromyalgia. However, it is unknown how PTSD may contribute to the mental health impairment in fibromyalgia. The purpose of this study was to evaluate symptoms of PTSD in patients with fibromyalgia and determine if PTSD symptoms could mediate differences in mental health between patients with fibromyalgia and healthy controls. Thirty patients and 30 healthy controls completed questionnaires assessing anxiety, depression, affect, and symptoms of PTSD. Multiple regression was used to assess the association between group (fibromyalgia versus healthy control) and mental health symptoms while controlling confounding influences of age and BMI and considering the mediating effect of trauma symptoms. On average, patients with fibromyalgia were 47.0 years of age (SD 10.4), white (96.7%) and non-Hispanic (100%). As expected, patients with fibromyalgia had poorer mental health than healthy controls. Patient-control differences in mental health were fully or partially mediated by differences in PTSD symptoms. Patients with fibromyalgia differed most greatly from healthy controls on the arousal subscale of trauma symptoms. This high degree of arousal symptoms might suggest that central sensitization may bear some relevance to understanding fibromyalgia and PTSD connections. Clinicians who care for patients with fibromyalgia should be aware of the role of trauma as management of trauma symptoms may be one strategy for improving mental health.

Observational Evidence for Buprenorphine's Impact on Posttraumatic Stress Symptoms in Veterans With Chronic Pain and Opioid Use Disorder.

Posttraumatic stress disorder (PTSD), chronic pain, and substance use disorders are prevalent co-occurring conditions that are challenging to treat individually, and there is no evidence-based treatment for all 3. Buprenorphine, used to treat opioid use disorder and chronic pain, is a partial nociceptin opioid receptor agonist. In preclinical studies, a nociceptin opioid receptor agonist was shown to mitigate PTSD symptoms in acute trauma. We compared buprenorphine to other opioid medications in its impact on PTSD symptoms in patients with chronic pain and opioid and/or other substance use disorders. We assembled a retrospective cohort of 382 Iraq and Afghanistan veterans in US Department of Veterans Affairs health care from October 1, 2007, to July 29, 2013, with ICD-9-CM diagnoses of PTSD, chronic pain, and substance use disorders. We used time-varying general estimating equation models to assess the primary outcome, which was change in PTSD symptoms (measured using the PTSD Checklist and the Primary Care PTSD Screen) among veterans initiated on sublingual buprenorphine versus those maintained on moderately high-dose opioid therapy. Twice as many veterans in the buprenorphine group (23.7%) compared to those in the opioid therapy group (11.7%) experienced improvement in PTSD symptoms (P = .001). Compared to veterans in the opioid therapy group, veterans receiving buprenorphine showed significant improvement in PTSD symptoms after 8 months, with increasing improvement up to 24 months (incidence rate ratio = 1.79; 95% CI, 1.16-2.77; P = .009). There were no differences in the longitudinal course of pain ratings between groups. This observational study is the first to report an incidental effect of buprenorphine compared to opioid therapy in improving PTSD symptoms in veterans.

Prevalence and Correlates of Post-traumatic Stress Disorder in Adults With Congenital Heart Disease

Post-traumatic stress disorder (PTSD) is associated with adverse outcomes and increased mortality in cardiac patients. No studies have examined PTSD in the adult congenital heart disease (ACHD) population. The objectives of this study were to assess the prevalence of self-reported symptoms of PTSD in patients with ACHD and explore potential associated factors. Patients were enrolled from an outpatient ACHD clinic and completed several validated measures including the Impact of Event Scale-Revised, PTSD Checklist-Civilian Version, and the Hospital Anxiety and Depression Scale. Clinical data were abstracted through medical data review. A total of 134 participants (mean age 34.6 ± 10.6; 46% men) were enrolled. Of the 127 participants who completed the Impact of Event Scale-Revised, 14 (11%) met criteria for elevated PTSD symptoms specifically related to their congenital heart disease or treatment. Of the 134 patients who completed PTSD Checklist-Civilian Version, 27 (21%) met criteria for global PTSD symptoms. In univariate analyses, patients with congenital heart disease-specific PTSD had their most recent cardiac surgery at an earlier year (p = 0.008), were less likely to have attended college (p = 0.04), had higher rates of stroke or transient ischemic attack (p = 0.03), and reported greater depressive symptoms on the Hospital Anxiety and Depression Scale (7 vs 2, p <0.001). In multivariable analysis, the 2 factors most strongly associated with PTSD were depressive symptoms (p <0.001) and year of most recent cardiac surgery (p <0.03). In conclusion, PTSD is present in 11% to 21% of subjects seen at a tertiary referral center for ACHD. The high prevalence of PTSD in this complex group of patients has important implications for the medical and psychosocial management of this growing population.

A rodent model of traumatic stress induces lasting sleep and quantitative electroencephalographic disturbances.

Hyperarousal and sleep disturbances are common, debilitating symptoms of post-traumatic stress disorder (PTSD). PTSD patients also exhibit abnormalities in quantitative electroencephalography (qEEG) power spectra during wake as well as rapid eye movement (REM) and non-REM (NREM) sleep. Selective serotonin reuptake inhibitors (SSRIs), the first-line pharmacological treatment for PTSD, provide modest remediation of the hyperarousal symptoms in PTSD patients, but have little to no effect on the sleep-wake architecture deficits. Development of novel therapeutics for these sleep-wake architecture deficits is limited by a lack of relevant animal models. Thus, the present study investigated whether single prolonged stress (SPS), a rodent model of traumatic stress, induces PTSD-like sleep-wake and qEEG spectral power abnormalities that correlate with changes in central serotonin (5-HT) and neuropeptide Y (NPY) signaling in rats. Rats were implanted with telemetric recording devices to continuously measure EEG before and after SPS treatment. A second cohort of rats was used to measure SPS-induced changes in plasma corticosterone, 5-HT utilization, and NPY expression in brain regions that comprise the neural fear circuitry. SPS caused sustained dysregulation of NREM and REM sleep, accompanied by state-dependent alterations in qEEG power spectra indicative of cortical hyperarousal. These changes corresponded with acute induction of the corticosterone receptor co-chaperone FK506-binding protein 51 and delayed reductions in 5-HT utilization and NPY expression in the amygdala. SPS represents a preclinical model of PTSD-related sleep-wake and qEEG disturbances with underlying alterations in neurotransmitter systems known to modulate both sleep-wake architecture and the neural fear circuitry.

PTSD, emotion dysregulation, and dissociative symptoms in a highly traumatized sample

Exposure to multiple traumas has been shown to result in many negative mental health outcomes, including posttraumatic stress disorder (PTSD). Dissociation, which involves disruptions in memory, identity, and perceptions, may be a component of PTSD, particularly among individuals who have experienced childhood trauma. Emotion regulation difficulties are also strongly associated with childhood trauma and emotion dysregulation may be a particularly important factor to consider in the development and maintenance of dissociative symptoms.The goal of the present study was to determine whether emotion dysregulation mediated the relationship between PTSD symptoms and dissociation in a sample of 154 (80% female, 97% African-American) adults recruited from a public, urban hospital. PTSD was measured using the Clinician Administered PTSD Scale, emotion dysregulation was measured using the Difficulties in Emotion Regulation Scale, and dissociation was measured using the Multiscale Dissociation Inventory. A linear regression analysis showed that both PTSD and emotion dysregulation were statistically significant predictors of dissociation even after controlling for trauma exposure. Alexithymia and an inability to use emotion regulation strategies in particular were predictive of dissociation above and beyond other predictor variables. Using bootstrapping techniques, we found that overall emotion dyregulation partially mediated the effect of PTSD symptoms on dissociative symptoms. Our results suggest that emotion dysregulation may be important in understanding the relation between PTSD and dissociative symptoms. Treatment approaches may consider a focus on training in emotional understanding and the development of adaptive regulation strategies as a way to address dissociative symptoms in PTSD patients.

Posttraumatic stress disorder symptoms in newly diagnosed patients with head and neck cancer and their partners.

Head and neck cancer is a life-threatening illness requiring aversive treatments. Despite clear potential for posttraumatic stress disorder (PTSD) symptoms in both patients and their partners, research is scant. Newly diagnosed patients and partners (number of dyads = 42) completed questionnaires to assess symptoms of PTSD, anxiety, and depression, as well as demographic, medical, and attitudinal variables. Partners had higher average levels of PTSD symptoms than patients (p = .023). More partners (28.6%) met criteria for estimated PTSD caseness than did patients (11.9%). There were no significant differences in levels of other anxiety or depression symptoms. Perceived threat of disease appeared to be a stronger correlate of PTSD symptom levels than medical variables in patients and partners. A diagnosis of head and neck cancer elicits significant levels of PTSD symptoms in patients, and even higher levels among partners. Identified correlates of distress, including perceived threat of disease, are potential intervention targets.

Treatment of post traumatic stress disorder symptoms in emotionally distressed individuals

Older individuals with emotional distress and a history of psychologic trauma are at risk for post traumatic stress disorder (PTSD) and major depression. This study was an exploratory, secondary analysis of data from the study “Prevention of Depression in Older African Americans”. It examined whether Problem Solving Therapy-Primary Care (PST-PC) would lead to improvement in PTSD symptoms in patients with subsyndromal depression and a history of psychologic trauma. The control condition was dietary education (DIET). Participants (n=60) were age 50 or older with scores on the Center for Epidemiologic Studies -Depression scale of 11 or greater and history of psychologic trauma. Exclusions stipulated no major depression and substance dependence within a year. Participants were randomized to 6–8 sessions of either PST-PC or DIET and followed 2 years with booster sessions every 6 months; 29 participants were in the PST-PC group and 31 were in the DIET group. Mixed effects models showed that improvement of PTSD Check List scores was significantly greater in the DIET group over two years than in the PST-PC group (based on a group time interaction). We observed no intervention⁎time interactions in Beck Depression Inventory or Brief Symptom Inventory-Anxiety subscale scores.

Efficacy of Herbal Drugs in Human Diseases and Disorders

According to a ballpark figure by World Health Organization, more than three-quarters of population of the developing nations exploit herbal medicine for their primary health care. Herbal drugs and their constituents have advantageous effects on long-term fitness and can be used to efficiently treat human diseases or disorders. In veracity, herbs frequently include various active ingredients that imaginably have drug allying commotion in the body. Bringing into play, herbs are often more affordable than procuring expensive contemporary pharmaceuticals to take care of ailments. A large number of herbs have proved their usefulness in managing various illnesses. Latest advances in biology and medicine have introduced new technologies to study the biological significance of herbal drugs in various human diseases and disorders. Hence it is important to understand the mechanism(s) of herbal drug action for the knowledge and development of successful therapies. The current special issue brings together several exciting papers defining the efficacy of herbal drugs in an assortment of human diseases and disorders. J. Li et al. have tested the effects and mechanism of Bufei Yishen formula (BYF) in a rat chronic obstructive pulmonary disease (COPD) model and provided the basis for mechanisms of BYF on COPD and new therapeutic drug targets. X. Yu et al. have reported the treatment of Si-Jun-Zi decoction, a famous Chinese medicine that promotes the restoration of intestinal function after obstruction by regulating intestinal homeostasis. Tong xinluo (TXL), a Chinese herbal compound, has been used in China with traditional therapeutic efficacy in patients with diabetic nephropathy (DN). N. Zhang et al. demonstrated that TXL successfully inhibits TGF-β1-induced epithelial-to-mesenchymal transition in DN, which may account for the therapeutic efficacy in TXL-mediated renal protection. W. Zhang et al. explored the effects of Jian-Pi-Zhi-Dong decoction (JPZDD) on Tourette syndrome (TS) by investigating the expression of gamma-aminobutyric acid (GABA) and its type A receptor (GABAAR) in the striatum of a TS mice model induced by 3,3′-iminodipropionitrile (IDPN) treatment. It was revealed that JPZDD alleviates TS symptoms which may be associated with GABAAR expression downregulation in striatum thereby controlling GABA metabolism. TZQ-F has been traditionally used as a traditional Chinese medicine formula for the treatment of diabetes. H. Yuhong et al. compared the pharmacologic effects and gastrointestinal adverse events between TZQ-F and acarbose in Chinese healthy volunteers. T. Numata et al. reported the treatment of posttraumatic stress disorder (PTSD) using the traditional Japanese herbal medicine Saikokeishikankyoto in survivors of the great east Japan earthquake and tsunami. The traditional medicine may be a valid choice for the treatment of psychological and physical symptoms in PTSD patients. Y. Ewnetu et al. evaluated the synergetic antimicrobial effect of Ethiopian honey and ginger powder extract mixtures on standard and resistant clinical isolates of Staphylococcus aureus, Escherichia coli, and Klebsiella pneumoniae. The combination has the potential to serve as cheap source of antibacterial agents especially for the drug resistant strains. Herbs are now gaining much attention as the main source of effective drugs for lowering serum lipids and lipid peroxidation. M. Rafieian-kopaei et al. assessed the impact of Ferulago angulata on serum lipid profiles and on levels of lipid peroxidation in male Wistar rats. Administration of a hydroalcoholic extract reduces the serum levels of total cholesterol, triglycerides, and LDL comparable to atorvastatin (a standard lipid lowering drug). A-J. Lee et al. investigated the absolute counts and percentages of peripheral blood (PB) lymphocyte subtypes in end-stage cancer patients before and after localized radiotherapy (RT) and after oral administration of Bojungikki-tang water extract (BJITE) and to evaluate the changes mediated by RT and BJITE. It was observed that immune deterioration occurs after RT and administration of BJITE was found effective in its restoration. T. Shimizu provides a good overview of efficacy of Kampo medicine (KM) in treating atopic dermatitis (AD). KM is a traditional herbal medicine in Japan and has a long history and plays an important role in the prevention and treatment of various diseases including AD. Y. Ma et al. explored the efficacy of herb-partitioned moxibustion in patients with diarrhoea-predominant irritable bowel syndrome (DPIBS) and suggest it as a promising, efficacious, and well-tolerated treatment for patients. Melinjo (Gnetum gnemon L.) seed extract containing transresveratrol (3,5,4′-trihydroxy-trans-stilbene) and other derivatives exerts diverse beneficial effects. H. Konno et al. reported melinjo seed extract decreases serum uric acid levels in nonobese Japanese males regardless of insulin resistance and may improve lipid metabolism by increasing HDL cholesterol. We anticipate that readers and scientific fraternity working in the area of herbal drugs will find not only the updated review on the subject but also a compilation of precise data on the efficacy of herbal drugs in some lifestyle diseases and disorders with their suggested mechanism of action. Suaib Luqman Syed Ibrahim Rizvi Andre-Michael Beer Sunil Kumar Khare Pinar Atukeren

Treatment of posttraumatic stress disorder using the traditional Japanese herbal medicine saikokeishikankyoto: a randomized, observer-blinded, controlled trial in survivors of the great East Japan earthquake and tsunami.

The Great East Japan earthquake and tsunami caused immense damage over a wide area of eastern Japan. Hence, many survivors are at high risk for posttraumatic stress disorder (PTSD). This randomized, observer-blinded, controlled trial examined the efficacy and safety of the traditional Japanese herbal formula saikokeishikankyoto (SKK) in the treatment of PTSD among survivors of this disaster. Forty-three participants with an Impact of Event Scale-Revised (IES-R) score ≥ 25 were randomized into SKK (n = 21) and control (n = 22) groups. The primary endpoint was the change in IES-R scores from baseline till after 2 weeks of treatment. Intergroup statistical comparisons were performed. The magnitude of changes in total IES-R scores differed significantly between the two groups (P < 0.001). Post hoc analysis showed that the total IES-R score improved significantly in the SKK group from 49.6 ± 11.9 to 25.5 ± 17.0 (P < 0.001). Subscale scores improved significantly in the SKK group (avoidance, P = 0.003; hyperarousal, P < 0.001; intrusion, P < 0.001). Two-week treatment with SKK significantly improved IES-R scores among PTSD patients. This traditional medicine may be a valid choice for the treatment of psychological and physical symptoms in PTSD patients.

Rivastigmine as an Effective Add-On to Standard Treatment of Veterans With Chronic Posttraumatic Stress Disorder

After 23 years of the end of the Iran-Iraq war, the country is left with many patients with chronic posttraumatic stress disorder (PTSD) who need close psychiatric services and are in need for recurrent hospitalization. So far, there are no reports of the rivastigmine use in PTSD patients. We report dramatic reduction of symptoms in 3 veterans with chronic PTSD, after rivastigmine augmentation. This report describes the efficacy of rivastigmine as an add-on to standard treatment of 3 Iranian male veterans with chronic PTSD (aged 52, 46, and 45 years) with severe active symptoms in all 3 dimensions of the disorder. Although they had gone through many approved drug treatments (selective serotonin reuptake inhibitors, tricyclic antidepressants, mood stabilizers, antipsychotics, benzodiazepines, β-blockers, and so on), from the beginning of the disorder, their recovery remained poor (PTSD Checklist-Military Version [PCL-M] scores were 67, 71, and 73 before rivastigmine add-on). Rivastigmine was added to the ongoing therapeutic regimens of the patients for 6 months.Evaluating their condition with PCL-M after 1 and 6 months of treatment showed a significant improvement in patients with PTSD (PCL-M scores were 37, 40, and 47 and dropped to 30, 27, and 31, respectively). Hyperarousal symptoms of PTSD in patients are noted to be the most improved. The rivastigmine add-on experience did not report any adverse effects. The present study showed that rivastigmine is an effective and safe add-on to treatment of patients with chronic PTSD. This effect could be due to improved cognitive status or cholinergic-adrenergic balance adjustment in patients.

A possible mechanism for PTSD symptoms in patients with traumatic brain injury: central autonomic network disruption

Patients with traumatic brain injuries (TBI) often develop post traumatic stress disorder (PTSD). This syndrome, defined and diagnosed by psychological and behavioral features, is associated with symptoms such as anxiety and anger with an increase of arousal and vigilance, as well as flashbacks and nightmares. Many of these features and symptoms observed in PTSD may be in part the result of altered autonomic nervous system (ANS) activity in response to psychological and physical challenges. Brain imaging has documented that TBI often induces white matter damage to pathways associated with the anterior limb of the internal capsule and uncinate fasciculus. Since these white matter structures link neocortical networks with subcortical and limbic structures that regulate autonomic control centers, injury to these pathways may induce a loss of inhibitory control of the ANS. In this review, the autonomic features associated with PTSD are discussed in the context of traumatic brain injury. We posit that TBI induced damage to networks that regulate the ANS increase vulnerability to PTSD. The means by which the vulnerability can be measured and tested are also discussed.

Biomarkers in an Animal Model for Revealing Neural, Hematologic, and Behavioral Correlates of PTSD

Identification of biomarkers representing the evolution of the pathophysiology of Post Traumatic Stress Disorder (PTSD) is vitally important, not only for objective diagnosis but also for the evaluation of therapeutic efficacy and resilience to trauma. Ongoing research is directed at identifying molecular biomarkers for PTSD, including traumatic stress induced proteins, transcriptomes, genomic variances and genetic modulators, using biologic samples from subjects' blood, saliva, urine, and postmortem brain tissues. However, the correlation of these biomarker molecules in peripheral or postmortem samples to altered brain functions associated with psychiatric symptoms in PTSD remains unresolved. Here, we present an animal model of PTSD in which both peripheral blood and central brain biomarkers, as well as behavioral phenotype, can be collected and measured, thus providing the needed correlation of the central biomarkers of PTSD, which are mechanistic and pathognomonic but cannot be collected from people, with the peripheral biomarkers and behavioral phenotypes, which can.Our animal model of PTSD employs restraint and tail shocks repeated for three continuous days - the inescapable tail-shock model (ITS) in rats. This ITS model mimics the pathophysiology of PTSD 17, 7, 4, 10. We and others have verified that the ITS model induces behavioral and neurobiological alterations similar to those found in PTSD subjects 17, 7, 10, 9. Specifically, these stressed rats exhibit (1) a delayed and exaggerated startle response appearing several days after stressor cessation, which given the compressed time scale of the rat's life compared to a humans, corresponds to the one to three months delay of symptoms in PTSD patients (DSM-IV-TR PTSD Criterian D/E 13), (2) enhanced plasma corticosterone (CORT) for several days, indicating compromise of the hypothalamopituitary axis (HPA), and (3) retarded body weight gain after stressor cessation, indicating dysfunction of metabolic regulation.The experimental paradigms employed for this model are: (1) a learned helplessness paradigm in the rat assayed by measurement of acoustic startle response (ASR) and a charting of body mass; (2) microdissection of the rat brain into regions and nuclei; (3) enzyme-linked immunosorbent assay (ELISA) for blood levels of CORT; (4) a gene expression microarray plus related bioinformatics tools 18. This microarray, dubbed rMNChip, focuses on mitochondrial and mitochondria-related nuclear genes in the rat so as to specifically address the neuronal bioenergetics hypothesized to be involved in PTSD.

Biomarkers in an Animal Model for Revealing Neural, Hematologic, and Behavioral Correlates of PTSD

Identification of biomarkers representing the evolution of the pathophysiology of Post Traumatic Stress Disorder (PTSD) is vitally important, not only for objective diagnosis but also for the evaluation of therapeutic efficacy and resilience to trauma. Ongoing research is directed at identifying molecular biomarkers for PTSD, including traumatic stress induced proteins, transcriptomes, genomic variances and genetic modulators, using biologic samples from subjects' blood, saliva, urine, and postmortem brain tissues. However, the correlation of these biomarker molecules in peripheral or postmortem samples to altered brain functions associated with psychiatric symptoms in PTSD remains unresolved. Here, we present an animal model of PTSD in which both peripheral blood and central brain biomarkers, as well as behavioral phenotype, can be collected and measured, thus providing the needed correlation of the central biomarkers of PTSD, which are mechanistic and pathognomonic but cannot be collected from people, with the peripheral biomarkers and behavioral phenotypes, which can. Our animal model of PTSD employs restraint and tail shocks repeated for three continuous days - the inescapable tail-shock model (ITS) in rats. This ITS model mimics the pathophysiology of PTSD 17, 7, 4, 10. We and others have verified that the ITS model induces behavioral and neurobiological alterations similar to those found in PTSD subjects 17, 7, 10, 9. Specifically, these stressed rats exhibit (1) a delayed and exaggerated startle response appearing several days after stressor cessation, which given the compressed time scale of the rat's life compared to a humans, corresponds to the one to three months delay of symptoms in PTSD patients (DSM-IV-TR PTSD Criterian D/E 13), (2) enhanced plasma corticosterone (CORT) for several days, indicating compromise of the hypothalamopituitary axis (HPA), and (3) retarded body weight gain after stressor cessation, indicating dysfunction of metabolic regulation. The experimental paradigms employed for this model are: (1) a learned helplessness paradigm in the rat assayed by measurement of acoustic startle response (ASR) and a charting of body mass; (2) microdissection of the rat brain into regions and nuclei; (3) enzyme-linked immunosorbent assay (ELISA) for blood levels of CORT; (4) a gene expression microarray plus related bioinformatics tools 18. This microarray, dubbed rMNChip, focuses on mitochondrial and mitochondria-related nuclear genes in the rat so as to specifically address the neuronal bioenergetics hypothesized to be involved in PTSD.