Treatment Of Posttraumatic Stress Disorder Research Articles

Protocol for remote Tai Chi and wellness for PTSD and pain in veterans

ABSTRACT Background: Posttraumatic stress disorder (PTSD) is a debilitating psychological disorder that is associated with a host of psychosocial and health ailments, including chronic pain. Although evidence-based psychological therapies are recommended as first-line PTSD treatments, a large proportion of individuals either drop out and/or do not achieve a therapeutic response. PTSD is increasingly recognized as a systemic disorder that impacts both physical and mental health, and mind-body approaches, such as Tai Chi, have shown promise. However, to date there have been no randomized clinical trials examining Tai Chi as a treatment for PTSD. Objective: To conduct a fully remote two-phased study designed to adapt, refine, and standardize two group treatments, Tai Chi and a Wellness comparison, for Veterans diagnosed with PTSD and chronic pain. Method: We deploy the project in two phases. In Phase One, we adapt both interventions for delivery via a videoconferencing platform. We then pilot the interventions in a ‘dry run’ with non-random assignment of 12 participants to Tai Chi or a Wellness comparison group. In Phase Two, we randomize 36 participants to one of the two group interventions. The feasibility and acceptability of the two remotely delivered interventions and assessment protocols are evaluated. Conclusions: This is the first study to our knowledge to evaluate the feasibility, acceptability, adherence, and participant burden of the Tai Chi and Wellness comparison interventions for PTSD and chronic pain in Veterans. This information will facilitate the development of a future large, randomized control trial to evaluate the efficacy of Tai Chi to address PTSD and chronic pain in Veterans.

How Psychedelics Modulate Multiple Memory Mechanisms in Posttraumatic Stress Disorder.

Posttraumatic stress disorder (PTSD) is a psychiatric disorder with defining abnormalities in memory, and psychedelics may be promising candidates for the treatment of PTSD given their effects on multiple memory systems. Most PTSD and psychedelic research has investigated memory with fear conditioning and extinction. While fruitful, conditioning and extinction provide a limited model of the complexity of PTSD and phenomenology of psychedelics, thereby limiting the refinement of therapies. In this review, we discuss abnormalities in fear conditioning and extinction in PTSD and review 25 studies testing psychedelics on these forms of memory. Perhaps the most reliable effect is that the acute effects of psychedelics can enhance extinction learning, which is impaired in PTSD. However, the post-acute effects may also enhance extinction learning, and the acute effects can also enhance fear conditioning. We then discuss abnormalities in episodic and semantic memory in PTSD and review current knowledge on how psychedelics impact these memory systems. Although PTSD and psychedelics acutely impair the formation of hippocampal-dependent episodic memories, psychedelics may acutely enhance cortical-dependent learning of semantic memories that could facilitate the integration of trauma memories and disrupt maladaptive beliefs. More research is needed on the acute effects of psychedelics on episodic memory consolidation, retrieval, and reconsolidation and post-acute effects of psychedelics on all phases of episodic memory. We conclude by discussing how targeting multiple memory mechanisms could improve upon the current psychedelic therapy paradigm for PTSD, thereby necessitating a greater emphasis on assessing diverse measures of memory in translational PTSD and psychedelic research.

(Why?) Evidence-Based Treatments for War-Related Posttraumatic Stress Disorder

Any war increases at least twice the prevalence of post-traumatic stress disorder (PTSD) in its victims. Post-traumatic stress disorder (PTSD) affects about 10% of car accident victims, half of the people who have experienced rape or war, and victims of violence. PTSD negatively affects the quality of life. It is associated with direct and indirect health costs. Any effort to treat and prevent PTSD with evidence-based methods is our obligation toward trauma victims and to professionals at an increased risk of job-related traumatization. In the paper, we will focus on three aspects. First – a rationale of decision making – the role of evidence in elaborating the intervention guidelines will be described. Second, an overview of evidence-based guidelines for the psychological help and for the diagnosis and treatment of PTSD will be presented, according to current NICE (National Institute of Care Excellence) and APA (American Psychological Association) and meta-analyses focusing on war-related trauma. The third part of the paper will be devoted to the prevention of PTSD in people who are exposed to professional, duty-related trauma – the data on the efficacy of preventive interventions together with a short description of the programs (on the example of “Effective performance under stress” program designed to prevent PTSD in firefighters and other professions).

What's in a treatment name? How people with posttraumatic stress disorder (PTSD) symptoms interpret and react to PTSD treatment names.

Prior research has rarely examined how people understand or react to the names of psychological treatments. In the case of evidence-based psychotherapies for posttraumatic stress disorder (PTSD), such reactions may be relevant to the low rates of uptake of such treatments. Participants who screened positive for PTSD (n = 887) completed questions assessing their initial reactions to PTSD treatment names as well as how a different name would affect their openness to treatment. In addition, they gave brief responses to open-ended questions about the reason for their initial reactions, and content analysis was used to better understand these reasons. The results indicated that among the treatment name options, cognitive processing therapy (CPT) and present-centered therapy (PCT) were viewed most positively. Approximately 40% of the sample preferred plain language alternatives for treatment names. Content analyses focused on descriptions of the treatments-which could be accurate or inaccurate-as well as whether respondents evaluated a treatment name itself as positive or negative. Some names conveyed treatments more accurately (e.g., CPT and written exposure therapy) than others (e.g., eye movement desensitization and reprocessing and prolonged exposure [PE]). Some names were also evaluated more positively (e.g., PCT) than others (e.g., PE). The general term "trauma-focused therapy" was seen as positive and clear. Addressing the ways patients react to psychological terms and treatment names could help clarify misperceptions about evidence-based psychotherapies and promote more widespread uptake of effective treatments for PTSD.

Traumatic brain injury rehabilitation for warfighters with post-traumatic stress.

While there is extensive empirical support and clinical guidance for the treatment of mild traumatic brain injury (mTBI) and post-traumatic stress disorder (PTSD) individually, less is known about treating the comorbid presentation of both conditions. The purpose of this review article is to provide information on the mental health treatment needs of service members (SMs) engaged in traumatic brain injury (TBI) rehabilitation. It also aims to offer a framework for an integrated treatment approach to address the cognitive and psychological health needs of warfighters. We review the prevalence and outcomes associated with comorbid TBI and PTSD and present relevant access to care considerations. Additionally, we identify an integrated approach to TBI treatment which takes psychological trauma into consideration. We introduce a trauma-informed care (TIC) model with specified diagnostic and treatment considerations for the service member and veteran (SM/V) communities. TIC is a strengths-based framework that raises the system-wide awareness of treatment facilities to the impact of psychological trauma on behavioral health. A comprehensive diagnostic approach is recommended with considerations for symptom etiology. Clinical considerations derived from available guidelines are identified to meet critical treatment needs for SM/Vs presenting for TBI treatment with a remote history of mTBI and psychological trauma or known PTSD. Clinical practice guidelines are used to inform an integrated TBI treatment model and maximize rehabilitation efforts for warfighters. Given the prevalence of comorbid TBI and PTSD among SM/Vs and its impact on outcomes, this review presents the integration of appropriate diagnostics and treatment practices, including the incorporation of CPGs into TBI rehabilitation.

Posttraumatic Stress Disorder and Substance Use Disorder Screening, Assessment, and Treatment.

We review prevalence, etiology, impact on treatment, and best practices for treatment of posttraumatic stress disorder (PTSD) in a substance use disorder (SUD) treatment setting. Recommendations are given related to screening, assessment, and symptom monitoring. PTSD and SUDs are highly comorbid. This comorbidity is associated with higher acuity, more difficulty completing treatment, and worse prognosis. Integrated treatment is recommended, and trauma-focused psychotherapies combined with pharmacotherapy show particular promise. PTSD is highly prevalent in substance using samples, negatively impacting treatment course and worsening prognosis. This comorbidity has been explained by a variety of models, with self-medication having garnered the most support. Trauma-focused psychotherapies combined with pharmacotherapy demonstrate the most efficacy and are recommended when treating co-occurring SUDs and PTSD. Specifically, prolonged exposure (PE), concurrent treatment of PTSD and SUDs using PE (COPE), and cognitive processing therapy (CPT) have been seen as promising trauma-focused treatments. Investigations into ways to best augment therapy are also underway, both through treatment format and neuromodulation. Several recommendations are given.

A Pilot Study Exploring the Feasibility of Virtual Written Exposure Therapy with Underserved Black Perinatal Women.

In the USA, Black pregnant women are at the highest risk for maternal morbidity. They also experience the highest rates of trauma exposure and posttraumatic stress disorder (PTSD). PTSD takes a toll on Black women's mental and physical health, placing them at risk for maternal morbidity. It increases several mental health symptoms such as suicidality, anxiety, re-living the trauma, and numbness. These mental health conditions adversely affect health behaviors, including those essential for maternal health, such as attending prenatal and postpartum appointments. Furthermore, untreated PTSD is associated with higher blood pressure, increasing Black mothers' risk of pre-eclampsia. For a variety of reasons including cultural mistrust, stigma, transportation, time constraints, and access to care, PTSD is frequently underassessed and undertreated among Black perinatal women. Written exposure therapy (WET) is a state-of-the-art brief treatment for PTSD. In this study, we explored the initial feasibility of the virtual delivery of WET to reduce PTSD symptoms among Black perinatal women. Results found the virtual delivery of WET to be feasible. Symptom reduction for PTSD in participants was 50-100% during follow-up, suggesting potential effectiveness of the intervention. Implications for virtual delivery of WET in reducing risk for Black maternal morbidity are discussed.

Rapid and sustained reduction of treatment-resistant PTSD symptoms after intravenous ketamine in a real-world, psychedelic paradigm.

Traditional treatments for post-traumatic stress disorder (PTSD) often show limited success with high dropout. Ketamine, an N-methyl-D-aspartate antagonist known for rapid antidepressant effects, has decreased PTSD symptoms in some studies but not in others. Administering ketamine in ways that parallel psychedelic-assisted treatments-including preparatory, integration, sensory immersion, and psychotherapy sessions-could decrease PTSD symptoms meaningfully. A retrospective sample of 117 screened outpatients with elevated PTSD Checklist for DSM-5 (PCL-5) scores received intravenous ketamine in supportive environments. The protocol included preparation, intention-setting, and integration sessions accompanying at least six administrations. Administration sessions included eye shades and evocative music paralleling typical psychedelic therapy trials. Mean PCL scores decreased from 52.54 (SD = 12.01) to 28.78 (SD = 16.61), d = 1.64. Patients tolerated treatment well, with no serious adverse events. Covariates, including age, gender, days between PCL assessments, number of psychiatric medications, and suicidal ideation were not significant moderators; concomitant psychotherapy did reach significance, d = 0.51. Of the 117 patients' final PCL scores, 88 (75.21%) measures suggested clinically meaningful improvement and 72 (61.54%) suggested remission of PTSD symptoms. Intravenous ketamine in supportive environments, with hallmarks of psychedelic therapy, preceded large reductions in PTSD symptoms. These results highlight ketamine's potential when delivered in this manner, suggesting environmental factors might account for some variation seen in previous work. Given the molecule's cost, minimal interaction with other psychiatric medications, and legal status, intravenous ketamine in a psychedelic paradigm may be a promising option for PTSD unresponsive to other treatments.

Digital transformation of mental health therapy by integrating digitalized cognitive behavioral therapy and eye movement desensitization and reprocessing.

Digital therapy has gained popularity in the mental health field because of its convenience and accessibility. One major benefit of digital therapy is its ability to address therapist shortages. Posttraumatic stress disorder (PTSD) is a debilitating mental health condition that can develop after an individual experiences or witnesses a traumatic event. Digital therapy is an important resource for individuals with PTSD who may not have access to traditional in-person therapy. Cognitive behavioral therapy (CBT) and eye movement desensitization and reprocessing (EMDR) are two evidence-based psychotherapies that have shown efficacy in treating PTSD. This paper examines the mechanisms and clinical symptoms of PTSD as well as the principles and applications of CBT and EMDR. Additionally, the potential of digital therapy, including internet-based CBT, video conferencing-based therapy, and exposure therapy using augmented and virtual reality, is explored. This paper also discusses the engineering techniques employed in digital psychotherapy, such as emotion detection models and text analysis, for assessing patients' emotional states. Furthermore, it addresses the challenges faced in digital therapy, including regulatory issues, hardware limitations, privacy and security concerns, and effectiveness considerations. Overall, this paper provides a comprehensive overview of the current state of digital psychotherapy for PTSD treatment and highlights the opportunities and challenges in this rapidly evolving field.

Effectiveness of telehealth-delivered massed trauma-focused psychotherapy among veterans with posttraumatic stress disorder.

Trauma-focused psychotherapies can be effectively delivered using a massed delivery format. Telehealth treatment for posttraumatic stress disorder (PTSD) using evidence-based interventions has been shown to be as effective as in-person treatment. However, the effectiveness of evidence-based treatments for PTSD over telehealth using the massed delivery format requires further examination. To examine the effectiveness of telehealth massed PTSD treatment, we report on a quality improvement study of 33 veterans (75.8% male; MAge = 42.3, SD = 11.0) who participated in a virtual 4-week massed PTSD program at a Department of Veterans Affairs (VA) medical center. Twenty-seven (81.8%) veterans completed the treatment and reported large reductions in PTSD (d = 1.48) and depressive symptoms (d = 1.08) at Week 4 and at 1-month follow-up (PTSD, d = 1.34; depression, d = 0.70). Results suggested that evidence-based treatment for PTSD can be effectively delivered in a massed format over telehealth in a VA medical setting. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

MDMA-assisted psychotherapy for the treatment of PTSD: A systematic review and meta-analysis of randomized controlled trials (RCTs).

Post-traumatic stress disorder (PTSD) is a mental health disorder resulting from exposure to traumatic events, manifesting in various debilitating symptoms. Despite available treatments, many individuals experience inadequate response or significant side effects. Previous reviews suggest promising outcomes with MDMA-assisted psychotherapy (MDMA-AT), but limitations prompt the need for a comprehensive evaluation. We searched various online databases and registries such as MEDLINE (via PubMed), Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov to retrieve RCTs that fit our inclusion criteria. We performed meta-analyses using Review Manager by applying a random-effects model. Dichotomous and continuous outcomes were pooled as risk ratios (RR) and standard mean difference (SMD), respectively. Nine studies with a total of 297 participants with PTSD were included in our meta-analysis. The control group consisted of inactive doses of MDMA (25-40 mg) or placebo. Our meta-analysis showed that MDMA-AT led to a significant reduction in the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) severity scores as compared to the control group (SMD -1.10, 95% CI: -1.62 to -0.59). More patients in the MDMA-AT group exhibited significant response (RR 1.59, 95% CI: 1.22, 2.08) and remission (RR 2.32, 95% CI: 1.47 to 3.66) as compared to patients in the control group. There was no significant difference regarding the incidence of ≥1 treatment-emergent adverse events (TEAE), ≥1 severe TEAE, and suicidal ideation between the two groups. MDMA-AT demonstrates significant efficacy in improving PTSD symptoms, enhancing both response and remission rates in individuals with chronic, treatment-resistant PTSD, while maintaining a favorable safety profile.

Cortical morphological changes and associated transcriptional signatures in post-traumatic stress disorder and psychological resilience.

Individuals who have experienced severe traumatic events are estimated to have a post-traumatic stress disorder (PTSD) prevalence rate ranging from 10 to 50%, while those not affected by trauma exposure are often considered to possess psychological resilience. However, the neural mechanisms underlying the development of PTSD, especially resilience after trauma, remain unclear. This study aims to investigate changes of cortical morphometric similarity network (MSN) in PTSD and trauma-exposed healthy individuals (TEHI), as well as the associated molecular alterations in gene expression, providing potential targets for the prevention and intervention of PTSD. We recruited PTSD patients and TEHI who had experienced severe earthquakes, and healthy controls who had not experienced earthquakes. We identified alterations in the whole-brain MSN changes in PTSD and TEHI, and established associations between these changes and brain-wide gene expression patterns from the Allen Human Brain Atlas microarray dataset using partial least squares regression. At the neuroimaging level, we found not only trauma-susceptible changes in TEHI same as those in PTSD, but also unique neurobiological alterations to counteract the deleterious impact of severe trauma. We identified 1444 and 2214 genes transcriptionally related to MSN changes in PTSD and TEHI, respectively. Functional enrichment analysis of weighted gene expression for PTSD and TEHI revealed distinct enrichments in Gene Ontology biological processes and Kyoto Encyclopedia of Genes and Genomes pathways. Furthermore, gene expression profiles of astrocytes, excitatory neurons, and microglial cells are highly related to MSN abnormalities in PTSD. The formation of resilience may be by an active compensatory process of the brain. The combination of macroscopic neuroimaging changes and microscopic human brain transcriptomics could offer a more direct and in-depth understanding of the pathogenesis of PTSD and psychological resilience, shedding light on new targets for the prevention and treatment of PTSD.

When the attention control condition works: A systematic review of attention control training for posttraumatic stress disorder.

Attentional bias and deficits in attentional control are associated with posttraumatic stress disorder (PTSD) symptoms. Attention control training (ACT) may address these factors. We reviewed randomized controlled trials (RCTs) of ACT for PTSD to address unanswered questions about ACT's effectiveness, tolerability, and implementation. Studies were included if they were an RCT that used an adult sample, recruited participants with a PTSD diagnosis, and had ACT as at least one treatment arm. The PTSD Trials Standardized Data Repository (PTSD-Repository) and additional databases were searched to identify PTSD RCTs published through May 2024. Seven studies met the inclusion criteria (N = 407). The effect size for ACT versus a comparison condition on PTSD symptoms was large, but the confidence interval (CI) overlapped with 0, g = 0.75, 95% CI [-0.63, 2.12]. The same pattern was observed for attention bias variability, g = 1.04, 95% CI [-0.90, 2.98]. There was a significant within-group effect of ACT on self-reported PTSD symptoms, g = -1.43, 95% CI [-2.83, -0.03]. Risk of bias varied, with high risk of bias being primarily due to bias in the measurement of the outcome. These effects should be interpreted cautiously given the significant heterogeneity and wide confidence intervals observed. It remains unclear for whom and under what conditions ACT may be most effective. Future studies should move beyond response time measures, employ an inactive comparator, and examine the mechanism of action to determine whether ACT could be a viable intervention for PTSD.

Mechanisms of psilocybin on the treatment of posttraumatic stress disorder.

Posttraumatic stress disorder (PTSD) is a condition that can develop after a traumatic event, causing distressing symptoms, including intrusive re-experiencing symptoms, alterations in mood and cognition, and changes in arousal and reactivity. Few treatment options exist for patients who find conventional psychotherapy and pharmacotherapy to be inaccessible, ineffective, or intolerable. We explore psilocybin as a potential treatment option for PTSD by examining the neurobiology of PTSD as well as psilocybin's mechanism of action. Based on both pharmacodynamic and psychoanalytic principles, psilocybin may be an underexplored treatment option for patients with PTSD, though further research is required.

Secondary traumatization in refugee care—EMDR intervention for interpreters (STEIN): a study protocol for a quasi-randomized controlled trial

BackgroundBy the end of 2022, more than 100 million people worldwide fled their homes. Before, during and after their flight, refugees have high risk of experiencing traumatic events. Accordingly, around every third refugee is affected by posttraumatic stress disorder. For adequate mental health care, the service of interpreters is often urgently needed to overcome existing language barriers. However, repeated exposure with details of traumatic narratives, as experienced by interpreters, can be burdensome and can lead to trauma sequela symptoms in terms of secondary traumatic stress. Only few studies have examined the treatment of secondary traumatic stress to date. Based on the recommendations for the treatment of posttraumatic stress disorder with confrontational methods, this study was designed to evaluate the effectiveness of an eye movement desensitization and reprocessing (EMDR) intervention in a sample of interpreters working in refugee care suffering from secondary traumatic stress symptoms.MethodsTo evaluate the effectiveness of an EMDR intervention for the treatment of secondary traumatic stress symptoms, a quasi-randomized controlled trial using a waiting group design will be performed. Participants will be treated with a maximum of 6 sessions based on EMDR standard protocol. Primary outcome is the symptom load of secondary traumatic stress, assessed with the Questionnaire for Secondary Traumatization, while secondary outcomes comprise further symptom complexes such as PTSD due to self-experienced traumatic events, depression, anxiety, and somatization as well as quality of life, quality of professional life, and psychological wellbeing that will be assessed with the PDS, PHQ-9, GAD-7, SSD-12, SF-12, PROQOL-5, and WHO-5, respectively.DiscussionOur primary interest is to determine the efficacy of an EMDR intervention in interpreters affected by secondary traumatic stress, especially how many sessions are needed for significant symptom reduction. Change of associated symptom complexes and quality of life will be investigated. Reprocessing one’s own stressful experiences may also contribute to this, which is not the focus of the treatment but relevant to the EMDR protocol. This study aims to assess if EMDR could be an acceptable, effective, and time-efficient method for reducing work-related secondary traumatization.Trial registrationGerman Clinical Trials Register, DRKS00032092, registered 16 June 2023.

Health and wellbeing of survivors of sexual violence and abuse attending sexual assault referral centres in England: the MESARCH mixed-methods evaluation.

One million people in England and Wales experience sexual violence and abuse each year, with nearly half experiencing serious sexual offences; around 30,000 survivors access sexual assault referral centres. This research was commissioned by National Institute for Health and Care Research to evaluate access, interventions and care pathways for survivors, especially those provided through sexual assault referral centres. The sexual assault referral centres care pathway was investigated through six sub-studies. There were two Cochrane Reviews (4274 participants). Seventy-two providers and 5 survivors were interviewed at eight sites; the children and young people study involved 12 participants from two sexual assault referral centres. A cohort study involving three-wave data collection over 1 year (21 sites; 2602 service users screened, 337 recruited) used a multilevel modelling framework to explore risk factors for burden of post-traumatic stress disorder symptoms at baseline and change at 1 year. We analysed costs and outcomes and conducted a narrative analysis (41 survivors). We worked closely with survivors and prioritised the safety/welfare of participants and researchers. Cochrane Reviews identified large effects from psychosocial interventions for post-traumatic stress disorder and depression. Sexual assault referral centres delivered a high-quality frontline service for survivors but groups experiencing domestic abuse and some ethnic and cultural minorities were under-represented. The qualitative research emphasised inter-agency collaboration for survivor benefit. The cohort study identified a risk 'triad' of adverse childhood experiences, poor mental health and economic deprivation, which was associated with baseline trauma burden. There were important improvements in trauma symptoms a year later. These improvements were unrelated to different sexual assault referral centre models. Costs and other outcomes were also similar across models. Harmful policing and justice practices/procedures were identified by 25% of participants. In this context, trauma-competent interviewing techniques, regular/timely updates and conveying case decisions with care signalled good practice. The cohort study lacked a comparison group, reducing confidence in the finding that access to sexual assault referral centres explained the reduction observed in post-traumatic stress disorder. Barriers to access call for concerted efforts to implement trauma-informed universal health services. The risk 'triad' underscores the value of holistic approaches to care at sexual assault referral centres and timely follow-on care. Poor mental health was the main barrier to service access beyond sexual assault referral centres. The persistence of trauma symptoms a year after accessing sexual assault referral centres signals urgent need for tackling counselling wait-lists, expanding support options and commitment to lifelong care. Multidisciplinary evaluation of sexual assault referral centres for better health provides a foundation for advancing trauma-informed practices in the context of sexual violence and abuse. This study is registered as ISRCTN30846825 https://doi.org/10.1186/ISRCTN30846825. This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 16/117/04) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 35. See the NIHR Funding and Awards website for further award information.

The Effects of Bioactive Compounds on PTSD Treatment.

Post-traumatic Stress Disorder (PTSD) is a psychiatric disease that arises in individuals who have experienced a traumatic event such as combat exposure, childhood physical abuse, sexual violence, physical assault, an accident, etc. Being difficult to diagnose and treat, PTSD is actively studied in areas of medicine, psychiatry, biochemistry, and rehabilitation. PTSD is characterized by significant comorbidity and is accompanied by depression and anxiety. Current treatment strategies for PTSD symptoms include psychotherapy and medications. Naturally derived compounds can offer therapeutic benefits for mood disorders without unpleasant side effects. Bioactive compounds found in food exhibit beneficial effects such as antioxidant, anti-inflammatory, and neuroprotective activities. Here, we describe the promising therapeutic benefits of a number of bioactive substances that have been evaluated in a variety of animal models and human experimental studies. Anxiolytic, antidepressant, and antidementia activities of bioactive compounds emphasize their potential for treating PTSD comorbidities. Hypothetical mechanisms of actions are also discussed, providing insights into their potential for human mental health.

A chromosome level reference genome of Diviner’s sage (Salvia divinorum) provides insight into salvinorin A biosynthesis

BackgroundDiviner’s sage (Salvia divinorum; Lamiaceae) is the source of the powerful hallucinogen salvinorin A (SalA). This neoclerodane diterpenoid is an agonist of the human Κ-opioid receptor with potential medical applications in the treatment of chronic pain, addiction, and post-traumatic stress disorder. Only two steps of the approximately twelve step biosynthetic sequence leading to SalA have been resolved to date.ResultsTo facilitate pathway elucidation in this ethnomedicinal plant species, here we report a chromosome level genome assembly. A high-quality genome sequence was assembled with an N50 value of 41.4 Mb and a BUSCO completeness score of 98.4%. The diploid (2n = 22) genome of ~ 541 Mb is comparable in size and ploidy to most other members of this genus. Two diterpene biosynthetic gene clusters were identified and are highly enriched in previously unidentified cytochrome P450s as well as crotonolide G synthase, which forms the dihydrofuran ring early in the SalA pathway. Coding sequences for other enzyme classes with likely involvement in downstream steps of the SalA pathway (BAHD acyl transferases, alcohol dehydrogenases, and O-methyl transferases) were scattered throughout the genome with no clear indication of clustering. Differential gene expression analysis suggests that most of these genes are not inducible by methyl jasmonate treatment.ConclusionsThis genome sequence and associated gene annotation are among the highest resolution in Salvia, a genus well known for the medicinal properties of its members. Here we have identified the cohort of genes responsible for the remaining steps in the SalA pathway. This genome sequence and associated candidate genes will facilitate the elucidation of SalA biosynthesis and enable an exploration of its full clinical potential.

Discrepancies in perceptions of PTSD symptoms among veteran couples: Links to poorer relationship and individual functioning.

Veteran and intimate partner perceptions of posttraumatic stress disorder (PTSD) may differ, and little is known about how agreement or disagreement on symptom severity is related to relationship satisfaction. Veterans and their partners (N = 199 couples) completed a baseline assessment for a clinical trial evaluating two couple-based PTSD interventions. Veterans completed the PTSD Checklist for DSM-5 (PCL-5). Partners completed the collateral PCL-5 (PCL-5-C), which asked them to rate the severity of the veteran's PTSD symptoms. Both partner and veteran completed the Couples Satisfaction Index (CSI-32). Intraclass correlations (ICC) assessed agreement between PCL-5 and PCL-5-C total and subscale scores, which was low for total PCL and for all subscales (ICC = 0.15-0.46). Actor-Partner Interdependence Models (APIMs; actor-only pattern) tested associations between relationship satisfaction and PTSD symptom severity (total PCL and subscales), and the magnitude and direction of difference between PCL-5 and PCL-5-C (total and subscales). For veterans, more severetotal PTSD and negative cognition/mood scores were associated with lower relationship satisfaction, and the direction of discrepancy for negative cognition/mood (i.e., higher veteran-rated PTSD symptoms relative to partner's collateral report) was also associated with lower satisfaction. For partners, more severe collateral-reported symptoms for total PTSD and all four subscales were associated with lower relationship satisfaction; further, a larger discrepancy between veterans' and partners' reports of total PTSD, negative cognition/mood, and hyperarousal were associated with lower satisfaction. These results suggest that partners may have different perceptions of PTSD symptoms, and support the potential of fostering a shared understanding of PTSD symptom severity in couples.

Causal Relationship Between Post-Traumatic Stress Disorder and Immune Cell Traits: A Mendelian Randomization Study.

Post-traumatic stress disorder (PTSD) is a debilitating psychological disorder that occurs after exposure to catastrophic-level experiences. Although alterations in immune function have been identified in individuals with PTSD, the causal relationship between the two remains unclear. To investigate the causal relationship between PTSD and immune function, we conducted the forward and backward two-sample Mendelian randomization (MR) analyses, based on summary-level genome-wide association studies (GWAS) data on PTSD and immune cell traits. For the forward MR analysis, PTSD was found to reduce the levels of CD62L- dendritic cell (DC) (beta=-0.254, FDR=0.01), CD86+ myeloid DC (beta=-0.238, FDR=0.014), CD62L- myeloid DC (beta=-0.26, FDR=0.01), CD62L- CD86+ myeloid DC absolute count (beta=-0.264, FDR=0.024), and CD62L- CD86+ myeloid DC (beta=-0.328, FDR=0.002). In contrast, PTSD was observed to increase the level of CD28- CD8dim T-cell absolute count (beta=0.27, FDR=0.029). For the backward MR analysis, the odds ratio (OR) for CD33 on CD33dim HLA DR+ CD11b- in relation to PTSD risk was found to be 1.045 (95% CI=1.021-1.069, FDR=0.008). The OR for FSC-A on HLA DR+ CD8br was 1.048 (95% CI=1.018-1.079, FDR=0.039) and for CCR2 on CD14- CD16+ monocyte was 1.059 (95% CI=1.027-1.092, FDR=0.008). No significant pleiotropy was detected in both forward and backward MR analyses. The bidirectional MR study shed light on the intricate interplay between immune function and PTSD. The identification of a bidirectional causal relationship between T cells and PTSD opens new avenues for considering innovative approaches to the prevention and early intervention of PTSD.