Two-dimensional correlated spectroscopy records reduced neurotransmission in blast-exposed artillery soldiers after live fire training.

There is a requirement for an objective method to determine a safe level of low-level military occupational blast, having recognised it can lead to neurological damage. The purpose of the current study was to evaluate the effect of artillery firing training on the neurochemistry of frontline soldiers using two-dimensional (2D) COrrelated SpectroscopY (2D COSY) in a 3-T clinical MR scanner. Ten men considered to be of sound health were evaluated before and after a week-long live firing exercise in two ways. Prior to the live fire exercise, all participants were screened by a clinical psychologist using a combination of clinical interviews and psychometric tests, and were then scanned with 3-T MRI. The protocols included T1- and T2-weighted images for diagnostic reporting and anatomical localisation and 2D COSY to record any neurochemical effects from the firing. No changes to the structural MRI were recorded. Nine substantive and statistically significant changes in the neurochemistry were recorded as a consequence of firing training. Glutamine and glutamate, glutathione, and two of the seven fucose-α (1-2)-glycans were significantly increased. N-acetyl aspartate, myo-inositol + creatine, and glycerol were also increased. Significant decreases were recorded for the glutathione cysteine moiety and tentatively assigned glycan with a 1-6 linkage (F2: 4.00, F1: 1.31 ppm). These molecules are part of three neurochemical pathways at the terminus of the neurons providing evidence of early markers of disruption to neurotransmission. Using this technology, the extent of deregulation can now be monitored for each frontline defender on a personalised basis. The capacity to monitor early a disruption in neurotransmitters, using the 2D COSY protocol, can observe the effect of firing and may be used to prevent or limit these events.

Development of the motivational thought frequency scale for alcohol abstinence (MTF-A).

BACKGROUND AND AIMS: For most treatment-seeking patients with severe Alcohol Use Disorder (AUD), abstinence is the clinically indicated goal. Existing AUD motivation scales are non-specific about treatment consumption goals, which limit their effectiveness. Desires and mental imagery are relevant in the motivation for AUD treatment engagement. The Motivational Thought Frequency Scale for an abstinence goal (MTF-A) was adapted from the MTF for controlled drinking (MTF-CD). This study psychometrically evaluated the MTF-A in an alcohol-dependent sample engaged in treatment with a goal of abstinence. To enhance the clinical utility of the scale, a secondary aim was to evaluate a psychometrically equivalent short version of the MTF-A. METHOD: A sample N of 329 treatment-seeking patients with AUD (mean age of 44.44 years, SD = 11.89 years, 72% male) who were undertaking a cognitive behavioral treatment (CBT) program for abstinence completed the Motivational Thought Frequency Scale for Abstinence (MTF-A) and the Severity of Alcohol Dependence Questionnaire (SADQ). The MTF-A measured motivation for abstinence through four factors: intensity, self-efficacy imagery, incentives imagery, and availability. Confirmatory factor analyses (CFAs) were conducted to examine factor structure and model fit. Cronbach's alpha assessed internal consistency. Predictive validity was determined by logistic regression predicting first-session treatment non-attendance and alcohol consumption between baseline assessment and commencement of treatment, controlling for potential confounds. RESULTS: A four-factor structure provided the best fit for the MTF-A, compared with one- and three-factor models. A shortened 9-item MTF-A scale (S-MTF-A) provided better fit than the 13-item MTF-A scale. Both MTF-A and S-MTF-A displayed good internal consistency. Although both MTF-A and S-MTF-A successfully predicted first-session treatment non-attendance, neither predicted alcohol consumption between the baseline assessment and commencement of treatment. CONCLUSIONS: The model fit of the four-factor, 9-item S-MTF-A was superior to the original 13-item MTF-A. Both scales were predictive of participation of AUD treatment. Desires and mental imagery play an important role in AUD treatment motivation.

Direction of the relationship between methamphetamine use and positive psychotic symptoms in regular methamphetamine users: evidence from a prospective cohort study.

BACKGROUND: Methamphetamine has been consistently associated with positive psychotic symptoms, but little is known about whether the reverse also occurs. AIMS: This study determined whether the relationship between methamphetamine use and positive psychotic symptoms is bidirectional over 12 months. The impact of lifetime psychotic disorders and methamphetamine dependence on these relationships was also examined. METHOD: A total of 201 regular (at least monthly) primary methamphetamine users were recruited from free needle and syringe programmes in three Australian cities. Data on the frequency of methamphetamine and other drug use (from Timeline Followback inteviews) and the severity of positive psychotic symptoms (using the Brief Psychiatric Rating Scale) in the past 2 weeks were collected in 12 contiguous monthly face-to-face interviews (mean of 9.14/11 (s.d. = 3.16) follow-ups completed). Diagnoses were derived using the Psychiatric Research Interview for DSM-IV Substance and Mental Disorders. RESULTS: The mean age of participants was 31.71 years (s.d. = 8.19) and 39% (n = 77) were women. At baseline 55% (n = 110) were dependent on methamphetamine and 51% (n = 102) had a lifetime psychotic disorder. Cross-lagged dynamic panel models found a significant bidirectional relationship between psychotic symptoms and methamphetamine use (Comparative Fit Index (CFI) = 0.94, standardised root mean square residual (SRMR) = 0.05, root mean square error of approximation (RMSEA) = 0.05, 95% CI 0.04-0.06). The magnitude of the relationship in each direction was similar, and the presence of methamphetamine dependence or a lifetime psychotic disorder did not have an impact on results. CONCLUSIONS: A dynamic, bidirectional relationship between methamphetamine and psychotic symptoms of similar magnitude in each direction was found over 1 year. This suggests integrated treatments that target methamphetamine, psychotic symptoms and their interrelationship may be of most benefit.

Binge drinking among male medical students in Viet Nam: a qualitative exploration of norms.

Alcohol is a commonly used substance among Vietnamese medical students, especially males. Vietnamese male medical students drink more alcohol, report more intentions to binge drink, and experience more alcohol-related problems than females. As medical students' alcohol consumption may influence their attitudes and medical practice relating to alcohol counseling and prevention, research about the cultural and drinking norms underlying the drinking behavior of Vietnamese male medical students is warranted. This study aims to explore the norms underlying drinking behavior of Vietnamese male medical students. A qualitative study including 32 in-depth interviews with Vietnamese male medical students at a medical university. Thematic analysis was used to analyze the data. This study found Vietnamese male medical students considered alcohol consumption as a way to show their masculinity and become accepted by groups. Given these beliefs and adherence to norms, they followed rules to force others to consume more alcohol or be intoxicated in drinking occasions among medical students. This study showed the importance of gender and group norms in influencing Vietnamese male medical students' alcohol consumption. These norms should be considered in future research and interventions addressing alcohol use among this target population.

Stimulant expectancy questionnaire for men who have sex with men: A measure of substance-related beliefs.

ISSUE ADDRESSED: Stimulant use has been identified as a key risk factor for sexual behaviours leading to HIV transmission. Substance-related expectancies are associated with substance use and postsubstance use thoughts, feelings and behaviours. Expectancies held by specific cultural subgroups have rarely been investigated, particularly regarding a range of commonly used stimulants. METHOD: The Stimulant Expectancy Questionnaire for Men who have Sex with Men (SEQ-MSM) was initially generated through consumer panel and interviews regarding the most commonly used stimulants among MSM in Australia (methamphetamine, amphetamines and ecstasy), with initial administration among 98 MSM to facilitate item reduction. A community sample of 427 MSM was used to validate the SEQ-MSM, with exploratory factor analysis (EFA; n = 202) and confirmatory factor analysis (CFA; n = 225). RESULTS: EFA revealed three distinct substance reinforcement domains ('Enhanced sexual experience', 'Sexual communication and negotiation' and 'Cognitive impairment'). The scale was associated with stimulant consumption patterns (including greater expectancies regarding sexual enhancement among methamphetamine users), and the factor structure, comprising a final form of the MSM-SEQ, was confirmed through CFA. CONCLUSIONS: The SEQ-MSM represents a reliable measure of outcome expectancies related to the range of commonly used stimulants among Australian MSM. Development of applied validation studies with the SEQ-MSM is a key next step in advancing health promotion, clinical interventions and research efforts to reduce harm (eg, HIV transmission) associated with stimulant use (particularly methamphetamine) among MSM. SO WHAT?: Objectives: This research maps expectancies specific among gay and men who have sex with men (MSM), and relationships between expectancies and stimulant use patterns and behaviours postuse - including sexual activity (eg, condomless anal sex).

Effectiveness of a theory-based sun-safe randomised behavioural change trial among Australian adolescents.

OBJECTIVE: Sun safety is crucial for preventing skin cancer. This study evaluated a school-based intervention based on the theory of planned behaviour (TPB), which aimed to encourage sun-protective behaviour among adolescents. METHODS: Secondary school students (N = 382; 61.1% female; Mage  = 13.73 y) in Queensland, Australia, participated in the study. Schools were randomly allocated to an intervention or control group. The intervention focussed on fostering positive attitudes, increasing perceptions of normative support, and strengthening control perceptions. Participants completed questionnaires assessing the TPB variables and sun-protective behaviour (weekday and weekend) 1 week before intervention (time 1), 1 week after intervention (time 2), and 4 weeks after intervention (time 3). RESULTS: With baseline between-group differences in TPB variables matched, repeated-measures multivariate analysis of variance was used to evaluate the Time × Condition effects across time. Multigroup comparisons using path models traced the intervariable changes. From times 1 to 3, a significant improvement in weekend sun-protective behaviour was identified in the intervention group (but not the control group), whereas cognitions showed no significant changes across time for either conditions. Multigroup comparisons on path coefficients between the intervention and control group participants indicated that the intervention group members formed stronger positive associations between perceived behavioural control and intention at time 2 and between perceived control and behaviour at time 3. CONCLUSION: The significant behavioural change on weekends highlights the value of targeting control perceptions, which may encourage adolescents' sun-protective behaviour. Further studies are needed to understand the absence of significant changes in weekday sun-safe behaviour among this at-risk cohort.

Patterns of drinking alcohol and intentions to binge drink among medical students in Vietnam.

Alcohol use is common among Vietnamese students. Previous qualitative findings showed Vietnamese medical students believed they were not binge drinkers while reporting many binge drinking occasions they participated in or witnessed. This dichotomy warrants examination. This study aims to establish drinking patterns and examine the factors underlying Vietnamese medical students' binge drinking intention and behaviour. This study used a prospective-correlational design, with two waves of data collection, drawing from established health behaviour models. At Time 1, 206 students completed the Alcohol Use Disorder Identification Test, the standard Theory of Planned Behaviour measures (attitude, subjective norm and perceived behavioural control) and their underlying beliefs, as well as group norm, role identity, drinking culture and past binge drinking behaviour. At Time 2, 156 medical students reported their binge drinking behaviour 2 weeks later. Only 6.8% of participants were classified as problematic drinkers and few participants reported binge drinking occasions at the 2-week follow-up. Perceived behavioural control, friends' group norms, role identity as future doctors, and past behaviour significantly predicted binge drinking intentions and key beliefs were identified. This study indicated Vietnamese medical students' limited engagement with binge drinking and identified key factors to address for those with risky drinking behaviour intentions.

Future Smoking Intentions at Critical Ages among Students in Two Chinese High Schools.

BACKGROUND: China is the world's largest tobacco consumer. Smoking initiation dramatically increases from teenage to adulthood. In this study, we investigated adolescents' future smoking intention at critical ages and its associated predictors. METHODS: Using a longitudinal design (3 waves) across 6 months in 2016, data from 156 10th graders in two high schools in China were examined. We used latent class growth modelling to explore the heterogeneous trajectories of smoking intentions for two future age groups. Logistic regression was then used to estimate the predictors of trajectories. RESULTS: Two trajectories and three trajectories were identified for future smoking intention in their twenties and forties, respectively. Gender, current smoking status, and mothers' and friends' smoking status all played distinct roles in future smoking intentions. CONCLUSIONS: Chinese adolescents' future intentions at critical ages are of concern. Future tobacco control should target the critical ages as well as incorporate social and cultural meanings of smoking in China. As important factors related to future smoking trajectories, gender and mothers' smoking status should also be considered in anti-smoking prevention efforts. Meanings associated with smoking status in the future should also be explored especially for female adolescents.

A TPB-Based Smoking Intervention among Chinese High School Students.

OBJECTIVES: China is the world's largest tobacco consumer and its adolescent smoking rate is increasing. Smoking interventions among high school students are limited. The aim of this study was to deliver and evaluate a brief theory-based smoking intervention in China, with a focus on anti-smoking cognitions. METHODS: The intervention was based on the constructs of an extended theory of planned behavior and life skills training. Using class-level randomization sampling, 106 tenth graders from two high schools in Kunming, China received a four-session intervention; 101 students were assigned as control group members. Surveys were conducted at three time-points (1 week before the intervention, 1 week post-intervention, and 6 months post-intervention). MANOVA and latent class analysis were used to test the intervention's effectiveness and personal change trajectories over time. RESULTS: The intervention failed to change smoking behavior, intention or willingness, but improved anti-smoking attitudes and perceived control over smoking. Skills showed a general enhancement, consistent with participants' qualitative feedback. Trajectories of smoking behavior, intention, and willingness all assumed two distinct but constant latent classes independent of the intervention. CONCLUSIONS: This study suggests that addressing attitudinal and control beliefs among adolescents and building on assertiveness via additional strategies in life skills such as appropriate refusal skills may be beneficial. The absence of a successful change in subjective norm should be a focus for future anti-smoking programs in China.

Alexithymia and Alcohol Dependence: The Roles of Negative Mood and Alcohol Craving.

Background: Alexithymia is a personality trait associated with emotion regulation difficulties. Up to 67% of alcohol-dependent patients in treatment have alexithymia. Objectives: The objective of this study was to investigate the direct and indirect effects of alexithymia, negative mood (stress, anxiety, and depression) and alcohol craving on alcohol dependence severity. Methods: Three hundred and fifty-five outpatients (mean age = 38.70, SD = 11.00, 244 males, range 18-71 years) undergoing Cognitive-Behavioral Therapy for alcohol dependence completed the Toronto Alexithymia Scale (TAS-20), Depression Anxiety Stress Scales (DASS-21), Obsessive Compulsive Drinking Scale (OCDS), and Alcohol Use Disorders Identification Test (AUDIT) prior to the first treatment session. Results: Alexithymia had an indirect effect on alcohol dependence severity, via both negative mood and alcohol craving (b = 0.03, seb = 0.008, 95% CI: 0.02-0.05). An indirect effect of negative mood on alcohol dependence via alcohol craving was also observed (b = 0.12, seb = 0.03, 95% CI: 0.07-0.16). Conclusions/importance: Alexithymia worked through negative mood and alcohol craving leading to increased alcohol dependence severity, indicating that craving had an indirect effect on the relationship between alexithymia and alcohol dependence severity. Targeting alcohol craving and negative mood for alcohol-dependent patients with alexithymia seems warranted.

Transcriptome analysis reveals novel genes and immune networks dysregulated in veterans with PTSD.

BACKGROUND: Posttraumatic stress disorder (PTSD) is a serious condition that emerges following trauma exposure and involves long-lasting psychological suffering and health-issues. Uncovering critical genes and molecular networks is essential to understanding the biology of the disorder. We performed a genome-wide scan to identify transcriptome signatures of PTSD. METHODS: Genome-wide peripheral blood transcriptomic data from 380 service personnel were investigated. This included a discovery sample of 96 Australian Vietnam War veterans and two independent pre and post-deployment replication samples of U.S. Marines (N = 188 and N = 96). RESULTS: A total of 60 transcripts were differentially expressed between veterans with and without PTSD, surviving Bonferroni multiple testing correction. Genes within the cytokine-cytokine receptor interaction, Jak-STAT signaling and Toll-like receptor signaling pathways were enriched. For 49% of the genes, gene expression changes were also accompanied by DNA methylation changes. Using replication data from two U.S. Marine cohorts, we observed that of the differentially expressed genes, 71% genes also showed significant gene expression changes between pre and post-deployment. Weighted gene co-expression networks revealed two modules of genes associated with PTSD. The first module (67 genes, p-value = 6e-4) was enriched for genes within the 11p13 locus including BDNF. The second module (266 genes, p-value = 0.01) was enriched for genes in 17q11 including SLC6A4, STAT5A and STAT5B. CONCLUSIONS: We identified novel transcriptomic loci and biological pathways for PTSD in service personnel. Network analysis revealed enrichment of loci harboring key candidate genes in PTSD. These findings highlight the role of transcriptional biomarkers in the molecular etiology of PTSD.

Smoking Beliefs Among Chinese Secondary School Students: A Theory-Based Qualitative Study.

Introduction: China has the world's greatest number of smokers but theory-based smoking interventions are rare. To develop an effective intervention, understanding the determinants of Chinese adolescent smoking is crucial. The Theory of Planned Behavior (TPB) is empirically supported to predict and assist in informing intervention strategies to change health-related behaviors. Based on the TPB, the elicitation of shared smoking beliefs among adolescents can inform future intervention designs among this at-risk population. Methods: We investigated the beliefs from six focus groups (N = 30) of one senior secondary school in Kunming, Yunnan Province, China. We used semi-structured questions based on the TPB framework, including prompts about behavioral (advantages and disadvantages), normative (important referents), and control (barriers and facilitators) beliefs. Following the Consensual Qualitative Research (CQR) methodology, data were discussed until consensus was reached. Auditing was undertaken by an external researcher. Results: Seven domains (advantages, disadvantages, approvers, disapprovers, facilitators, barriers, and smoker images) were examined. Smoking as a gendered behavior, smoking as influenced by cultural and environmental contexts, smoking as a strategy to cope with stress, and awareness of the harm of smoking, are highlighted themes across domains. Data suggested an extended-TPB framework as an appropriate approach to adopt when addressing smoking beliefs among the target population. Conclusions: These beliefs can be utilized to inform future school-based interventions and public health campaigns targeting smoking among Chinese adolescents. Implications: A modified TPB approach has potential for future smoking interventions among Chinese adolescents. Beliefs elicited in this study form a strong basis for designing a location- and population-specific antismoking programme.

The association between post-traumatic stress disorder and coronary artery disease: a meta-analysis.

OBJECTIVES: There are some psychosocial factors that have similar importance to biological factors in the genesis of coronary diseases. However, reasons for high rates of coronary heart disease in individuals with post-traumatic stress disorder (PTSD) are yet to be fully elucidated. Using a meta-analysis, we investigated the longitudinal relationship between PTSD and coronary heart disease (CHD) as an independent factor in the aetiology of CHD. METHODS: The databases of Medline, EBSCOhost and Psychoinfo were electronically searched for relevant articles. RESULTS: The pooled hazard ratio (HR) for the magnitude of the relationship between PTSD and CHD was an HR of 1.61, and p-value of p < 0.0005, 95% confidence interval (CI) [1.46-1.77] before adjustment for depression in nine studies ( N = 151,144) that met inclusion criteria. The HR estimates for the seven depression-adjusted estimates was 1.46, and a p-value of p < 0.0005, 95% CI[0.26-1.69]. CONCLUSIONS: This study demonstrates an association between CHD and PTSD.

PTSD symptoms associated with myocardial infarction: practical clinical implications.

OBJECTIVES: Several studies have demonstrated a link between post-traumatic stress disorder and myocardial infarction. We aim to determine what phenotypic features or symptom profile associated with cardiovascular disease may help with early detection and intervention. METHODS: This is a cross-sectional study. The study population comprises trauma-exposed Vietnam War veterans. RESULTS: Variables significantly associated with myocardial infarction from the bivariate analysis were avoidance memories, avoidance reminders and sleep disturbance. These variables were put into a logistic regression with known risk factors for myocardial infarction. Only sleep disturbance retained its effect, with a p-value of 0.015. CONCLUSIONS: It is concluded that sleep disturbance may be a modifiable risk factor in the treatment and prevention of myocardial infarction.

Clinically proven drug targets differentially expressed in the prefrontal cortex of schizophrenia patients.

BACKGROUND: Due to the heterogeneous nature of schizophrenia, understanding the genetic risk for the disease is a complex task. Gene expression studies have proven to be more reliable than association studies as they are consistently replicated in a tissue specific manner. METHODS: Using RNA-Seq we analysed gene expression in the frontal cortex of 24 individuals with schizophrenia and 25 unaffected controls. RESULTS: We identified 1146 genes that were differentially expressed in schizophrenia, approximately 60% of which were up-regulated and 366 of 1146 (32%) also have aberrant DNA methylation (p=2.46×10-39). The differentially expressed genes were significantly overrepresented in several pathways including inflammatory (p=8.7×10-3) and nitric oxide pathways (p=9.2×10-4). Moreover, these genes were significantly enriched for those with a druggable genome (p=0.04). We identified a number of genes that are significantly up-regulated in schizophrenia as confirmed in other gene expression studies using different brain tissues. Of the 349 genes associated with schizophrenia from the Psychiatric Genomics Consortium we identified 16 genes that are significant from our list of differentially expressed genes. CONCLUSIONS: Our results identified biological functional genes that are differentially expressed in schizophrenia. A subset of these genes are clinically proven drug targets. We also found a strong pattern of differentially expressed immune response genes that may reflect an underlying defect in schizophrenia.

The Mini Alcohol Craving Experience Questionnaire: Development and Clinical Application.

BACKGROUND: Standardized alcohol craving scales are rarely used outside of research environments despite recognized clinical utility. Scale length is a key barrier to more widespread application. A brief measure of alcohol craving is needed to improve research and treatment of alcohol use disorders (AUDs). Grounded in the Elaborated Intrusion Theory of Desire, the Alcohol Craving Experience (ACE) Questionnaire comprises two 11-item self-report scales that assess past-week frequency and maximum strength of alcohol craving. This study aimed to create a brief version of the ACE while maintaining psychometric integrity and clinical utility. METHODS: Patients attending a university hospital alcohol and drug outpatient service for the treatment of AUD completed the ACE as part of a questionnaire battery. Three patient samples were utilized: 519 patients with pretreatment and outcome data, 228 patients with pretreatment data, and 66 patients who completed the ACE at treatment sessions 1 and 2. RESULTS: The Frequency scale of the ACE possessed greater clinical utility and predictive validity than the Strength scale. Revision of the Frequency measure produced a 5-item "Mini Alcohol Craving Experience" (MACE) Questionnaire. Satisfactory validity (construct, predictive, concurrent, convergent, and incremental) and reliability (internal and test-retest) were maintained. A 1 standard deviation increase in pretreatment MACE score was associated with a 54 percentage increase in the odds of patient lapse or dropout. CONCLUSIONS: The MACE provides a brief, theoretically, and psychometrically robust measure of alcohol craving suitable for use with AUD populations in time-limited clinical and research settings.

Physical comorbidities of post-traumatic stress disorder in Australian Vietnam War veterans.

OBJECTIVE: To determine whether the prevalence of physical comorbidities in Australian Vietnam War veterans with post-traumatic stress disorder (PTSD) is higher than in trauma-exposed veterans without PTSD. DESIGN, SETTING AND PARTICIPANTS: Cross-sectional analysis of the health status (based on self-reported and objective clinical assessments) of 298 Australian Vietnam War veterans enrolled by the Gallipoli Medical Research Institute (Brisbane) during February 2014 - July 2015, of whom 108 were confirmed as having had PTSD and 106 served as trauma-exposed control participants.Main outcomes and measures: Diagnostic psychiatric interview and psychological assessments determined PTSD status, trauma exposure, and comorbid psychological symptoms. Demographic data, and medical and sleep history were collected; comprehensive clinical examination, electrocardiography, spirometry, liver transient elastography, and selected pathology assessments and diagnostic imaging were performed. Outcomes associated with PTSD were identified; regression analysis excluded the effects of potentially confounding demographic and risk factors and comorbid symptoms of depression and anxiety. RESULTS: The mean total number of comorbidities was higher among those with PTSD (17.7; SD, 6.1) than in trauma-exposed controls (14.1; SD, 5.2; P < 0.001). For 24 of 171 assessed clinical outcomes, morbidity was greater in the PTSD group, including for conditions of the gastrointestinal, hepatic, cardiovascular, and respiratory systems, sleep disorders, and laboratory pathology measures. In regression analyses including demographic factors, PTSD remained positively associated with 17 adverse outcomes; after adjusting for the severity of depressive symptoms, it remained significantly associated with ten. CONCLUSION: PTSD in Australian Vietnam veterans is associated with comorbidities in several organ systems, independent of trauma exposure. A comprehensive approach to the health care of veterans with PTSD is needed.

Genetic and serum biomarker evidence for a relationship between TNFα and PTSD in Vietnam war combat veterans.

BACKGROUND: Posttraumatic stress disorder (PTSD) is associated with increased inflammation and comorbid medical conditions. However, study findings for individual inflammatory marker levels have been inconsistent. Some research suggests that resilience may play a role in decreased inflammation. A polymorphism in the promoter region of the tumor necrosis factor α gene (TNFα), TNFA -308 (rs1800629) is associated with psychiatric illness but its role in PTSD is yet to be elucidated. OBJECTIVE: This study investigates a key inflammatory marker, TNFα, for its role in PTSD severity. METHOD: In a cohort of trauma-exposed Vietnam War veterans (n=299; 159 cases, 140 controls) TNF α serum levels and TNFα polymorphism rs1800629 were correlated with PTSD severity and resilience scores. RESULTS: The polymorphism was associated with PTSD severity (p=0.045). There were significant group differences between cases and controls with regards to serum TNFα levels (p=0.036). Significant correlations were found between PTSD severity and elevated TNFα levels (r=0.153; p=0.009), and between resilience and decreased TNFα levels at a trend level (p=0.08) across the entire cohort. These relationships were non-significant after controlling for covariates. In the PTSD diagnostic group, a correlation of TNFα and PTSD severity was observed on a trend level (p=0.06), the relationship between TNFα and resilience remained non-significant. CONCLUSIONS: To our knowledge, this is the first time rs1800629 has been investigated in PTSD contributing to a growing body of literature that identifies the GG as a risk genotype for psychiatric disorders in Caucasian cohorts. However, more research is needed to replicate our results in larger, equally well-characterized cohorts. The relationship between serum TNFα levels and PTSD severity and resilience requires further investigation.

Craving Mediates Stress in Predicting Lapse During Alcohol Dependence Treatment.

BACKGROUND: Stress, craving, and depressed mood have all been implicated in alcohol use treatment lapses. Few studies have examined all 3 factors. Progress has been limited because of difficulties with craving assessment. The Alcohol Craving Experience Questionnaire (ACE) is a new measure of alcohol craving. It is both psychometrically sound and conceptually rigorous. This prospective study examines a stress-treatment response model that incorporates mediation by craving and moderation by depressed mood and pharmacotherapy. METHODS: Five hundred and thirty-nine consecutively treated alcohol-dependent patients voluntarily participated in an abstinence-based 12-week cognitive-behavioral therapy (CBT) program at a hospital alcohol and drug outpatient clinic. Measures of stress, craving, depressed mood, and alcohol dependence severity were administered prior to treatment. Treatment lapse and treatment dropout were assessed over the 12-week program duration. RESULTS: Patients reporting greater stress experienced stronger and more frequent cravings. Stronger alcohol craving predicted lapse, after controlling for dependence severity, stress, depression, and pharmacotherapy. Alcohol craving mediated stress to predict lapse. Depressed mood and anticraving medication were not significant moderators. CONCLUSIONS: Among treatment seeking, alcohol-dependent patients, craving mediated the relationship between stress and lapse. The effect was not moderated by depressed mood or anticraving medication.