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1.
Nat Neurosci ; 24(1): 24-33, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33349712

RESUMO

Despite extensive study of the neurobiological correlates of post-traumatic stress disorder (PTSD), little is known about its molecular determinants. Here, differential gene expression and network analyses of four prefrontal cortex subregions from postmortem tissue of people with PTSD demonstrate extensive remodeling of the transcriptomic landscape. A highly connected downregulated set of interneuron transcripts is present in the most significant gene network associated with PTSD. Integration of this dataset with genotype data from the largest PTSD genome-wide association study identified the interneuron synaptic gene ELFN1 as conferring significant genetic liability for PTSD. We also identified marked transcriptomic sexual dimorphism that could contribute to higher rates of PTSD in women. Comparison with a matched major depressive disorder cohort revealed significant divergence between the molecular profiles of individuals with PTSD and major depressive disorder despite their high comorbidity. Our analysis provides convergent systems-level evidence of genomic networks within the prefrontal cortex that contribute to the pathophysiology of PTSD in humans.


Assuntos
Química Encefálica/genética , Transtornos de Estresse Pós-Traumáticos/genética , Transtornos de Estresse Pós-Traumáticos/fisiopatologia , Transcriptoma , Adulto , Autopsia , Estudos de Coortes , Transtorno Depressivo Maior/genética , Feminino , Regulação da Expressão Gênica/genética , Redes Reguladoras de Genes , Predisposição Genética para Doença/genética , Estudo de Associação Genômica Ampla , Humanos , Interneurônios/metabolismo , Masculino , Pessoa de Meia-Idade , Proteínas do Tecido Nervoso/genética , Caracteres Sexuais , Adulto Jovem
2.
PLoS One ; 15(10): e0239969, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33017408

RESUMO

BACKGROUND: Traumatized refugees often suffer from diverse psychosomatic symptoms. Female Yazidi refugees from Northern Iraq who survived attacks of the so-called "Islamic State" were brought to Germany to receive special medical and psychotherapeutic treatment in a unique worldwide humanitarian admission program (HAP). Here, we report on their psychosomatic symptoms and helpful strategies from the perspective of care providers. METHODS: Care providers (N = 84) in this HAP were interviewed in an individual setting as well as in focus groups to gather information about the HAP beneficiaries' psychosomatic symptoms. Data analysis followed Qualitative Content Analysis by Mayring. RESULTS: The care providers reported five main psychological burdens of the Yazidis: 1) insecurity regarding loss, 2) worries about family members, 3) ambivalence about staying in Germany or returning to Iraq, 4) life between two worlds and 5) re-actualization of the traumatic experiences. The predominant psychological symptoms the care providers noticed were fear, depressive symptoms, feelings of guilt, and sleep and eating disorders. Regarding somatic symptoms, the care providers mainly received complaints about pain in the head, back, chest and stomach. Helpful strategies for providing adequate health care were care providers' cooperating with physicians, precise documentation of beneficiaries' symptoms, and additional support in directing the beneficiaries through the health care system. Regarding psychotherapy, interpreters help to overcome language barriers, onsite psychotherapy, flexible therapy appointments, psychoeducational methods, time for stabilization, and support in coping with daily life aspects. In the care providers' experience, psychotherapists have to build a relationship of trust. After grief therapy, a trauma-specific therapy in a culturally adapted way is possible. CONCLUSION: The HAP is a unique model health care program to offer highly traumatized refugees medical and psychological help. Care providers reported on several (psycho-)somatic symptoms of the traumatized women. The strategies the HAP care providers perceived as helpful can be recommended for similar projects in the future.


Assuntos
Pessoal de Saúde , Trauma Psicológico/fisiopatologia , Transtornos Psicofisiológicos/fisiopatologia , Refugiados/psicologia , Transtornos de Estresse Pós-Traumáticos/fisiopatologia , Adulto , Idoso , Feminino , Alemanha , Humanos , Iraque/etnologia , Islamismo , Masculino , Pessoa de Meia-Idade , Trauma Psicológico/etnologia , Transtornos Psicofisiológicos/etnologia , Pesquisa Qualitativa , Transtornos de Estresse Pós-Traumáticos/etnologia , Inquéritos e Questionários , Adulto Jovem
3.
Artigo em Inglês | MEDLINE | ID: mdl-32898346

RESUMO

Objective: To investigate the impact of reminder-focused positive psychiatry (RFPP) on attention-deficit/hyperactive disorder (ADHD) and posttraumatic stress disorder (PTSD) symptoms, vascular-function, inflammation and well-being of adolescents with comorbid ADHD and PTSD. Methods: After obtaining informed-consent, 11 adolescents were randomized to RFPP (n = 5) or trauma-focused cognitive-behavioral therapy (TF-CBT) (n = 6). Eight participants (RFPP: n = 4, TF-CBT: n = 4) completed the twice-weekly intervention for a 6-week trial. The RFPP intervention was inclusive of positive psychiatry interventions on (1) traumatic reminders and (2) avoidance and negative cognition. Vascular function measured as temperature rebound, C-reactive protein, homocysteine, ADHD Swanson, Nolan, and Pelham (SNAP) Questionnaire, Clinician-Administered PTSD Scale for DSM-5-Child/Adolescent Version (CAPS-CA), and neuropsychiatric-measures were measured at baseline and 6 weeks. Subjects were followed for 12 months. The study was conducted from September 2016 to June 2018. Results: A significant improvement in CAPS-CA, SNAP scores, and vascular function of both RFPP and TF-CBT groups was noted at follow-up, but was more-robust in the RFPP group (P < .05). At the sixth week, a significant increase in PERMA, gratitude, resilience, and Posttraumatic Growth Inventory scores and a significant decrease in homocysteine and C-reactive protein levels in the RFPP group, but not the TF-CBT group, were noted (P < .05). At 12-month follow-up, there was no psychiatry hospitalization or suicide ideation reported in either group. A continuation of significant improvement in CAPS-CA and SNAP scores in both groups was noted but was more robust in the RFPP group (P < .05). Similarly, a continuation of significant increase in PERMA, gratitude, resilience and Posttraumatic Growth Inventory scores was noted in the RFPP group but not in the TF-CBT group (P < .05). Conclusions: RFPP is associated with improvement in core PTSD and ADHD symptoms, decrease in inflammation, and increase in well-being, vascular function, and posttraumatic growth, as well as a favorable long-term clinical outcome. This finding highlights the importance of the dual role of RFPP in addressing vulnerability symptoms as well as enhancing well-being in youth with comorbid ADHD and PTSD. Trial Registration: ClinicalTrials.gov identifier: NCT04336072.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/complicações , Transtorno do Deficit de Atenção com Hiperatividade/terapia , Psicoterapia , Transtornos de Estresse Pós-Traumáticos/complicações , Transtornos de Estresse Pós-Traumáticos/terapia , Adolescente , Transtorno do Deficit de Atenção com Hiperatividade/fisiopatologia , Criança , Comorbidade , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Masculino , Transtornos de Estresse Pós-Traumáticos/fisiopatologia , Resultado do Tratamento
4.
Nat Commun ; 11(1): 4220, 2020 08 24.
Artigo em Inglês | MEDLINE | ID: mdl-32839437

RESUMO

Post-traumatic stress disorder (PTSD) is characterized by emotional hypermnesia on which preclinical studies focus so far. While this hypermnesia relates to salient traumatic cues, partial amnesia for the traumatic context can also be observed. Here, we show in mice that contextual amnesia is causally involved in PTSD-like memory formation, and that treating the amnesia by re-exposure to all trauma-related cues cures PTSD-like hypermnesia. These findings open a therapeutic perspective based on trauma contextualization and the underlying hippocampal mechanisms.


Assuntos
Amnésia/prevenção & controle , Amnésia/terapia , Condicionamento Psicológico/fisiologia , Memória/fisiologia , Transtornos de Estresse Pós-Traumáticos/prevenção & controle , Transtornos de Estresse Pós-Traumáticos/terapia , Amnésia/fisiopatologia , Animais , Aprendizagem da Esquiva/fisiologia , Sinais (Psicologia) , Emoções , Hipocampo/fisiopatologia , Humanos , Masculino , Camundongos Endogâmicos C57BL , Transtornos de Estresse Pós-Traumáticos/fisiopatologia
5.
Am J Physiol Regul Integr Comp Physiol ; 319(4): R466-R475, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-32847397

RESUMO

Posttraumatic stress disorder (PTSD) is characterized by increased risk for developing hypertension and cardiovascular disease. We recently showed that device-guided slow breathing (DGB) acutely lowers blood pressure (BP) and muscle sympathetic activity (MSNA) and improves baroreflex sensitivity (BRS) in PTSD. The aim of this study was to assess the long-term benefits of DGB on autonomic function at rest and during stress. We hypothesized that long-term DGB improves arterial BRS and lowers BP and MSNA in PTSD. Twenty-five veterans with PTSD were studied and randomized to either 8 wk of daily DGB (n = 12) or 8 wk of sham device (Sham; n = 13). BP, heart rate (HR), and MSNA were measured at rest and during mental math. Arterial BRS was assessed using the modified Oxford technique. Resting MSNA, BP, and heart rate (HR) remained comparable before and after 8 wk in both groups (DGB and Sham). Likewise, the change in sympathetic and cardiovagal BRS was not different between the groups. Interestingly, DGB significantly decreased MSNA reactivity to mental math when expressed as burst frequency (P = 0.012) or burst incidence (P = 0.008) compared with Sham, suggesting a sustained effect of DGB on sympathetic reactivity to stress in PTSD. Contrary to our hypothesis, long-term DGB did not lower systolic BP, diastolic BP, or HR responses to stress compared with Sham. Likewise, pulse pressure reactivity after 8 wk (P = 0.121) was also comparable. In summary, these data suggest that long-term use of DGB may lead to a sustained dampening of sympathetic reactivity to mental stress in PTSD.


Assuntos
Barorreflexo/fisiologia , Respiração , Transtornos de Estresse Pós-Traumáticos/fisiopatologia , Estresse Psicológico/fisiopatologia , Sistema Nervoso Simpático/fisiopatologia , Adulto , Pressão Sanguínea/fisiologia , Método Duplo-Cego , Feminino , Frequência Cardíaca/fisiologia , Hemodinâmica/fisiologia , Humanos , Masculino , Taxa Respiratória , Veteranos
6.
Life Sci ; 256: 118014, 2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-32593712

RESUMO

The age and strength of fear memory are two potential parameters that can be influenced by the impairing effects of pharmacological agents on reconsolidation of fear memory. In reconsolidation, stored information is rendered labile again after being reactivated. Pharmacological manipulations at this stage result in an inability to retrieve the fear memories, suggesting that they are erased or persistently inhibited. This fear memory impairment phenomenon can be valuable to treat post-traumatic stress disorders (PTSD). Previously ß-adrenergic antagonist propranolol has been repeatedly reported to impair fear memory in the treatment of PTSD. Atropine has also shown to disrupt memory formation. The present study was therefore designed to compare the effects of atropine and propranolol on reconsolidation of older fear memory in rat model of PTSD using Pavlovian fear conditioning apparatus. For this purpose 18 rats were taken and divided into control, atropine and propranolol groups and subjected to Pavlovian fear conditioning trials in order to develop animal model of PTSD. To evaluate the reconsolidation impairment of fear memory by atropine and propranolol, short term and long term memory was tested after reactivation of fear memory in rats. The present findings demonstrate that atropine significantly decreases fear expression. These results suggest that atropine significantly reduces the strength of fear memories and may be effective in the treatment of psychiatric disorders especially in PTSD.


Assuntos
Atropina/farmacologia , Medo/efeitos dos fármacos , Propranolol/farmacologia , Transtornos de Estresse Pós-Traumáticos/tratamento farmacológico , Antagonistas Adrenérgicos beta/farmacologia , Animais , Condicionamento Clássico/efeitos dos fármacos , Modelos Animais de Doenças , Masculino , Memória/efeitos dos fármacos , Antagonistas Muscarínicos/farmacologia , Ratos , Ratos Wistar , Receptores Muscarínicos/efeitos dos fármacos , Receptores Muscarínicos/metabolismo , Transtornos de Estresse Pós-Traumáticos/fisiopatologia
7.
Psychol Trauma ; 12(S1): S71-S72, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32551771

RESUMO

The COVID-19 pandemic has demonstrated itself to be a considerable stressor, especially for those individuals coping with a preexisting mental health disorder. This article contains clinical observations and reflections from two practicing psychologists regarding the impact of the COVID-19 pandemic and associated social conditions on clients with posttraumatic stress disorder. Observations include changes in trauma-related symptom manifestations and therapeutic process issues, particularly in response to social isolation. The authors encourage specific therapeutic considerations and offer suggestions for adapting treatment with regard to these early observations. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Assuntos
Infecções por Coronavirus , Serviços de Saúde Mental , Pandemias , Pneumonia Viral , Trauma Psicológico , Psicoterapia , Isolamento Social , Transtornos de Estresse Pós-Traumáticos , Telemedicina , Adulto , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/psicologia , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/psicologia , Trauma Psicológico/fisiopatologia , Trauma Psicológico/psicologia , Trauma Psicológico/terapia , Transtornos de Estresse Pós-Traumáticos/fisiopatologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Transtornos de Estresse Pós-Traumáticos/terapia
8.
Cardiovasc Ther ; 2020: 2478781, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32426035

RESUMO

It was indeed a Don Quixote-like pursuit of the mechanism of essential hypertension when we serendipitously discovered α 2-adrenoceptors (α 2-ARs) in skin-lightening experiments in the frog. Now α 2-ARs lurk on the horizon involving hypertension causality, renal denervation for hypertension, injury from falling in the elderly and prazosin's mechanism of action in anxiety states such as posttraumatic stress disorder (PTSD). Our goal here is to focus on this horizon and bring into clear view the role of α 2-AR-mediated mechanisms in these seemingly unrelated conditions. Our narrative begins with an explanation of how experiments in isolated perfused kidneys led to the discovery of a sodium-retaining process, a fundamental mechanism of hypertension, mediated by α 2-ARs. In this model system and in the setting of furosemide-induced sodium excretion, α 2-AR activation inhibited adenylate cyclase, suppressed cAMP formation, and caused sodium retention. Further investigations led to the realization that renal α 2-AR expression in hypertensive animals is elevated, thus supporting a key role for kidney α 2-ARs in the pathophysiology of essential hypertension. Subsequent studies clarified the molecular pathways by which α 2-ARs activate prohypertensive biochemical systems. While investigating the role of α 1-adrenoceptors (α 1-ARs) versus α 2-ARs in renal sympathetic neurotransmission, we noted an astonishing result: in the kidney α 1-ARs suppress the postjunctional expression of α 2-ARs. Here, we describe how this finding relates to a broader understanding of the role of α 2-ARs in diverse disease states. Because of the capacity for qualitative and quantitative monitoring of α 2-AR-induced regulatory mechanisms in the kidney, we looked to the kidney and found enlightenment.


Assuntos
Pressão Sanguínea , Hipertensão Essencial/metabolismo , Rim/metabolismo , Receptores Adrenérgicos alfa 2/metabolismo , Acidentes por Quedas , Antagonistas de Receptores Adrenérgicos alfa 2/uso terapêutico , Animais , Anti-Hipertensivos/uso terapêutico , Ansiedade/metabolismo , Ansiedade/fisiopatologia , Ansiedade/psicologia , Denervação Autônoma , Pressão Sanguínea/efeitos dos fármacos , Diuréticos/uso terapêutico , Hipertensão Essencial/fisiopatologia , Hipertensão Essencial/terapia , Humanos , Hipotensão Ortostática/metabolismo , Hipotensão Ortostática/fisiopatologia , Rim/efeitos dos fármacos , Rim/fisiopatologia , Receptores Adrenérgicos alfa 1/metabolismo , Receptores Adrenérgicos alfa 2/efeitos dos fármacos , Eliminação Renal , Reabsorção Renal , Transdução de Sinais , Sódio/metabolismo , Transtornos de Estresse Pós-Traumáticos/metabolismo , Transtornos de Estresse Pós-Traumáticos/fisiopatologia , Transtornos de Estresse Pós-Traumáticos/psicologia
9.
PLoS One ; 15(5): e0233172, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32396568

RESUMO

In 2005, a random sample of 200 people were assessed in Camerino, Italy, eight years after an earthquake. Psychological symptom levels were low and only one person had current Post-Traumatic Stress Disorder (PTSD). In 2016 a new earthquake occurred in Camerino. The study aims to assess the impact of the second exposure in the same cohort. A longitudinal study was conducted, 130 participants were re-interviewed between July and December 2017. Psychological symptoms were self-rated on the Brief Symptom Inventory (BSI) and the Global Severity Index (GSI) was analysed. Post-traumatic stress symptoms were self-rated on the Impact of Event Scale-Revised (IES-R). Subjective quality of life (SQOL) was assessed on the Manchester Short Assessment of Quality of Life (MANSA). Mean scores of GSI and IES-R were significantly higher than in 2005 (p<0.01 and p<0.001), whilst SQOL remained almost unchanged (p = 0.163). In 2017, 16.9% of the sample had reached the PTSD threshold whilst in 2005 only the 0.5% had reached it. Despite low symptom levels several years after an earthquake, people can show psychological distress after a new exposure, whilst average quality of life levels are not affected.


Assuntos
Terremotos , Qualidade de Vida , Transtornos de Estresse Pós-Traumáticos , Inquéritos e Questionários , Adulto , Feminino , Humanos , Itália/epidemiologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/fisiopatologia , Transtornos de Estresse Pós-Traumáticos/psicologia
10.
Nat Commun ; 11(1): 1898, 2020 04 20.
Artigo em Inglês | MEDLINE | ID: mdl-32313055

RESUMO

Growing evidence indicates a reciprocal relationship between low-grade systemic inflammation and stress exposure towards increased vulnerability to neuropsychiatric disorders, including posttraumatic stress disorder (PTSD). However, the neural correlates of this reciprocity and their influence on the subsequent development of PTSD are largely unknown. Here we investigated alterations in functional connectivity among brain networks related to low-grade inflammation and stress exposure using two large independent data sets. Functional couplings among the higher-order cognitive network system including the salience, default mode, and central executive networks were reduced in association with low-grade inflammation and stress exposure. This reduced functional coupling may also be related to subsequent posttraumatic stress symptom severity. The current findings propose functional couplings among the higher-order cognitive network system as neural correlates of low-grade inflammation and stress exposure, and suggest that low-grade inflammation, alongside with stress, may render individuals more vulnerable to PTSD.


Assuntos
Encéfalo/fisiopatologia , Inflamação/fisiopatologia , Redes Neurais de Computação , Transtornos de Estresse Pós-Traumáticos/fisiopatologia , Adulto , Citocinas/sangue , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Rede Nervosa/fisiopatologia , Vias Neurais/fisiopatologia , República da Coreia , Transtornos de Estresse Pós-Traumáticos/psicologia , Adulto Jovem
11.
Am J Physiol Heart Circ Physiol ; 318(5): H1198-H1207, 2020 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-32243771

RESUMO

Posttraumatic stress disorder (PTSD) is more prevalent in women and associated with greater risk of major forms of cardiovascular disease, but physiological mechanisms underlying this association remain unknown. We hypothesized that abnormal sympathetic responses to sympathoexcitatory stimuli might predispose PTSD patients to a greater risk of cardiovascular disease. We examined changes in integrated muscle sympathetic nerve activity (MSNA) burst and multiunit action potential (AP) recruitment patterns as well as hemodynamic responses during cold pressor test (CPT) in 14 women with PTSD and 14 healthy control subjects. Data were collected during 1-min baseline, 2-min CPT, and 3-min recovery. At baseline, blood pressure (BP) was not different between groups; however, heart rate and sympathetic neural activity were greater in women with PTSD [MSNA burst frequency (BF): 27 ± 13 vs. 18 ± 14 bursts/min (P = 0.04); AP frequency: 272 ± 152 vs. 174 ± 146 spikes/min (P = 0.03)]. In response to CPT, BP responses exhibited a significant group × time interaction (P = 0.01) highlighted by a significant diastolic BP main group effect (P = 0.048) despite the finding that increases in integrated MSNA burst responses were not different between groups (P > 0.05). However, compared with control subjects, AP firing frequency (group × time interaction P = 0.0001, group P = 0.02) and AP per burst (group × time interaction P = 0.03, group P = 0.03) were augmented in women with PTSD. Collectively, women with PTSD exhibited a greater pressor response and an exaggerated sympathetic neural recruitment pattern during sympathoexcitatory stimuli that may, in part, explain the propensity toward developing hypertension and cardiovascular disease later in life.NEW & NOTEWORTHY The novel findings of the present study are that women with posttraumatic stress disorder (PTSD) have an augmented pressor response to the sympathoexcitatory stimulus of a cold pressor test (CPT) compared with healthy control subjects. Although integrated muscle sympathetic nerve activity burst responses were not significantly different between groups, total sympathetic action potential discharge in response to the CPT was markedly elevated in women with PTSD exhibiting increased firing of low-threshold axons as well as the recruitment of latent subpopulations of larger-sized axons that are otherwise silent at baseline. Aberrant autonomic circulatory control in response to sympathoexcitatory stimulus may in part explain the propensity toward developing hypertension and cardiovascular disease in this population.


Assuntos
Pressão Sanguínea , Recrutamento Neurofisiológico , Reflexo , Transtornos de Estresse Pós-Traumáticos/fisiopatologia , Sistema Nervoso Simpático/fisiopatologia , Potenciais de Ação , Adulto , Temperatura Baixa , Feminino , Humanos , Pessoa de Meia-Idade
12.
Psychiatry Res Neuroimaging ; 299: 111062, 2020 05 30.
Artigo em Inglês | MEDLINE | ID: mdl-32278278

RESUMO

Posttraumatic Stress Disorder (PTSD) is a debilitating condition often associated with difficulty in emotion regulation, including reappraising negative emotions. This study assessed neural mechanisms associated with emotion regulation in veterans prior to and following treatment for PTSD. Participants with PTSD and combat exposed controls (CC) completed diagnostic evaluation and underwent fMRI scanning while completing Emotion Regulation Task (ERT) and Emotional Faces Assessment Task (EFAT). Participants with PTSD were randomly assigned to Prolonged Exposure plus placebo (PE+PLB), Sertraline plus enhanced medication management (SERT+EMM), or PE plus SERT (PE+SERT) and repeated diagnostic evaluation and MRI scanning following treatment. The amygdala, dmPFC, and dlPFC were examined as regions of interest. On ERT, veterans with PTSD showed significantly less dmPFC activation than CCs during reappraisal vs emotional maintenance. Within the PTSD group, results demonstrated a significant association between less activation in the dmPFC during emotion reappraisal vs maintenance trials before treatment and greater reductions in symptoms from pre- to post-treatment. During the EFAT, there were no group differences between participants with PTSD and CCs in brain activation, and no relationships between brain function and PTSD symptoms. These findings suggest that less emotional reactivity might potentially reflect less need for recruitment of prefrontal regions when reappraising negative emotion, and is an individual factor associated with better treatment outcome.


Assuntos
Tonsila do Cerebelo/fisiopatologia , Emoções/fisiologia , Córtex Pré-Frontal/fisiopatologia , Transtornos de Estresse Pós-Traumáticos/fisiopatologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Adulto , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Sertralina/uso terapêutico , Resultado do Tratamento , Veteranos/psicologia
13.
J Womens Health (Larchmt) ; 29(3): 446-451, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32186966

RESUMO

We review findings and propose a model explaining why women's adaptation to traumatic stress might be different than men's, including the role of cycling hormones and sleep differences in the development of post-traumatic stress and other stress-related disorders. Women are diagnosed with stress-related mental health disorders at a higher frequency than men. Most mental health disorders involve sleep disturbances, which may contribute to these disorders. The mechanisms by which sleep contributes to the development of mental health disorders in women have not been addressed in basic research. Sleep features such as spindle density and rapid eye movement (REM) sleep theta power are important for the role of sleep in emotion and cognition. The effect of hormonal cycles on these and other critical sleep features is only beginning to be understood. We explore what sleep factors could confer resilience to mental health disorders and how they might be altered by hormonal cycles in women. We target a specific system at the nexus of arousal control, stress response, and memory consolidation processes that has not been explored at all in women or across the hormonal cycle in animal studies: the locus coeruleus noradrenergic (LC-NE) system.


Assuntos
Ciclo Menstrual/fisiologia , Transtornos do Sono-Vigília/fisiopatologia , Sono/fisiologia , Transtornos de Estresse Pós-Traumáticos/fisiopatologia , Animais , Cognição , Emoções , Feminino , Humanos , Locus Cerúleo/fisiologia , Memória/fisiologia
14.
Sci Rep ; 10(1): 3353, 2020 02 25.
Artigo em Inglês | MEDLINE | ID: mdl-32098997

RESUMO

The epigenetic regulation of microRNA (miRNA) expression related to the FK506-binding protein 5 (FKBP5) gene may contribute to the risk of stress-related disorders such as posttraumatic stress disorder (PTSD). Here, we identified candidate miRNAs derived from FKBP5 knockout mice as a potential diagnostic biomarker of PTSD. Using a translational approach, candidate miRNAs found to alter in expression within the medial prefrontal cortex of FKBP5 knockout mice were selected. Each candidate miRNA was examined in the serum of 48 recently traumatized individuals with PTSD and 47 healthy individuals. Multimodal imaging was also conducted to identify the neural correlates for the expression of candidate exosomal miRNAs in response to trauma exposure. Differential miRNA expression was found according to PTSD diagnosis in two composite marker groups. The differential miRNA expression between the composite marker groups contributed to PTSD symptom severity, which may be explained by differential recruitment of prefrontolimbic activity in brain imaging. The present study reveals that a set of circulating exosomal miRNAs showing altered expression in FKBP5 knockout mice play a potential role as epigenetic markers of PTSD. The corroborative evidence from multiple levels including molecular, brain, and behavioral indicates that these epigenetic biomarkers may serve as complementary measures for the diagnosis and prognosis prediction of PTSD in recently traumatized individuals.


Assuntos
Predisposição Genética para Doença , MicroRNAs/genética , Transtornos de Estresse Pós-Traumáticos/genética , Proteínas de Ligação a Tacrolimo/genética , Adulto , Animais , Biomarcadores/metabolismo , Modelos Animais de Doenças , Epigênese Genética/genética , Feminino , Regulação da Expressão Gênica/efeitos dos fármacos , Genótipo , Humanos , Masculino , Camundongos , Camundongos Knockout , Polimorfismo de Nucleotídeo Único/genética , Córtex Pré-Frontal/diagnóstico por imagem , Córtex Pré-Frontal/fisiopatologia , Transtornos de Estresse Pós-Traumáticos/fisiopatologia , Tacrolimo/farmacologia
15.
J Nerv Ment Dis ; 208(3): 171-180, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32091470

RESUMO

Da Costa originally described Soldier's Heart in the 19th Century as a syndrome that occurred on the battlefield in soldiers of the American Civil War. Soldier's Heart involved symptoms similar to modern day posttraumatic stress disorder (PTSD) as well as exaggerated cardiovascular reactivity felt to be related to an abnormality of the heart. Interventions were appropriately focused on the cardiovascular system. With the advent of modern psychoanalysis, psychiatric symptoms became divorced from the body and were relegated to the unconscious. Later, the physiology of PTSD and other psychiatric disorders was conceived as solely residing in the brain. More recently, advances in psychosomatic medicine led to the recognition of mind-body relationships and the involvement of multiple physiological systems in the etiology of disorders, including stress, depression PTSD, and cardiovascular disease, has moved to the fore, and has renewed interest in the validity of the original model of the Soldier's Heart syndrome.


Assuntos
Guerra Civil Norte-Americana , Doenças Cardiovasculares/história , Militares/história , Transtornos de Estresse Pós-Traumáticos/história , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/fisiopatologia , Doenças Cardiovasculares/psicologia , História do Século XIX , Humanos , Militares/psicologia , Transtornos de Estresse Pós-Traumáticos/etiologia , Transtornos de Estresse Pós-Traumáticos/fisiopatologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Estados Unidos
16.
Brain Topogr ; 33(2): 208-220, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32034577

RESUMO

Inhibitory dysfunction is closely associated to post-traumatic stress disorder (PTSD). The present study investigated the neurophysiological evidence for and the brain regions related to inhibitory dysfunction in PTSD. Fifty patients with PTSD and 63 healthy controls (HCs) participated in a Go/Nogo task combined with electroencephalographic recordings. The N2-P3 complexes of event-related potentials (ERPs) elicited during the Nogo condition were compared between groups. Participants underwent structural magnetic resonance imaging to examine cortical volumes and completed questionnaires. Correlations between altered ERPs and cortical volumes of regions of interest as well as psychological symptoms were analysed. Nogo-N2 latencies at five electrode sites (Fz, FCz, Cz, CPz, and Pz) were significantly delayed in patients with PTSD compared to HCs. Nogo-N2 latency had a significant negative correlation with the volume of gyrus in the inferior frontal cortex, orbitofrontal cortex, amygdala, and medial prefrontal cortex. Nogo-N2 latency was significantly and positively correlated with catastrophizing, anxiety, and perceived threat. These findings show inhibitory dysfunction in patients with PTSD, reflected by the delay in Nogo-N2 latencies. They also indicate that Nogo-N2 latencies are associated with smaller cortical volumes responsible for inhibition as well as with major symptoms of PTSD.


Assuntos
Encéfalo/fisiopatologia , Potenciais Evocados , Inibição Psicológica , Transtornos de Estresse Pós-Traumáticos/fisiopatologia , Adulto , Mapeamento Encefálico , Eletroencefalografia , Feminino , Lobo Frontal/fisiopatologia , Humanos , Masculino , Tempo de Reação/fisiologia
17.
Psychol Addict Behav ; 34(4): 506-511, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32105112

RESUMO

Posttraumatic stress disorder (PTSD) and alcohol use disorder commonly co-occur. Little is known about how symptoms of one affect subsequent week symptoms of the other during the course of integrated treatment for both disorders. The sample included 107 veterans who were randomized to receive either Concurrent Treatment of PTSD and Substance Use Disorder Using Prolonged Exposure (COPE; an exposure-based trauma focused treatment) or Seeking Safety (SS; a present-focused coping skills-based treatment) and completed measures of PTSD and alcohol use at every other session. Multilevel models estimated the prospective associations between PTSD and alcohol use during treatment. Results indicated that greater PTSD symptom severity was associated with greater future alcohol use (b = 0.20, p = .024), and greater alcohol use was associated with greater future PTSD symptom severity (b = 0.13, p = .003). The effect size for PTSD symptoms to future alcohol use was larger than the reciprocal relationship. When using lagged PTSD severity to predict future drinking, results revealed that clinically significant differences in PTSD severity levels were associated with comparably large differences in drinking. Treatment condition did not moderate the effect of PTSD symptom severity on alcohol use (or the reciprocal relationship). Findings lend support to the mutual maintenance model of addiction. Integrated treatments that treat both PTSD and alcohol use may be preferential to sequential model of care where individuals are expected to achieve abstinence or reduced use prior to receiving trauma-focused treatment. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Assuntos
Adaptação Psicológica , Alcoolismo , Terapia Comportamental , Comorbidade , Transtornos de Estresse Pós-Traumáticos , Adaptação Psicológica/fisiologia , Adulto , Alcoolismo/epidemiologia , Alcoolismo/terapia , Humanos , Terapia Implosiva , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Índice de Gravidade de Doença , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/fisiopatologia , Transtornos de Estresse Pós-Traumáticos/terapia , Veteranos
18.
Jpn J Nurs Sci ; 17(3): e12320, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31957242

RESUMO

AIM: Disturbance of urinary function is a common complication after rectal cancer surgery, and it may affect patients' psychological well-being, consequently may develop post-traumatic stress disorder. Personal resilience might increase people's ability to manage life's challenges. However, limited study to explore their relationships. This study examined the relationships among lower urinary symptoms, resilience, and post-traumatic stress symptoms (PTSS) in post-surgery patients with rectal cancer. METHODS: A cross-sectional study design was used and included 188 patients with diagnosed rectal cancer who had undergone surgery over 24 months and were recruited from a hospital in southern Taiwan. The outcome measurements included a resilience scale, International Prostate Symptom Score (IPSS), the Chinese Davidson Trauma Scale, personal characteristics, and disease-related variables. RESULTS: There were significant relationships among age at diagnosed, self-reported physical status, perceived satisfied with recovery, urinary tract symptoms, resilience, and overall PTSS. The stepwise regression demonstrated that five factors, self-reported physical status, resilience, urinary tract symptoms, age at diagnosed and gender, and together explained 27.7% of overall PTSS variance (10.7, 6.7, 3.7, 4.8 and 1.8% of variance, respectively). CONCLUSION: The study demonstrates that patients with diagnosed rectal cancers long-term outcomes of PTSS, urinary tract symptoms, and resilience after surgery; in addition, self-reported physical status, resilience, urinary tract symptoms, age at diagnosed and gender are the major predictors of PTSS. A better understanding of the long-term outcomes of post-surgery in rectal cancer patients and its related factors may help to decreasing the PTSS after surviving cancer.


Assuntos
Complicações Pós-Operatórias , Neoplasias Retais/cirurgia , Transtornos de Estresse Pós-Traumáticos/fisiopatologia , Sistema Urinário/fisiopatologia , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Retais/complicações , Transtornos de Estresse Pós-Traumáticos/etiologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Taiwan
19.
Am J Psychiatry ; 177(3): 233-243, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-31964161

RESUMO

OBJECTIVE: The authors sought to identify brain regions whose frequency-specific, orthogonalized resting-state EEG power envelope connectivity differs between combat veterans with posttraumatic stress disorder (PTSD) and healthy combat-exposed veterans, and to determine the behavioral correlates of connectomic differences. METHODS: The authors first conducted a connectivity method validation study in healthy control subjects (N=36). They then conducted a two-site case-control study of veterans with and without PTSD who were deployed to Iraq and/or Afghanistan. Healthy individuals (N=95) and those meeting full or subthreshold criteria for PTSD (N=106) underwent 64-channel resting EEG (eyes open and closed), which was then source-localized and orthogonalized to mitigate effects of volume conduction. Correlation coefficients between band-limited source-space power envelopes of different regions of interest were then calculated and corrected for multiple comparisons. Post hoc correlations of connectomic abnormalities with clinical features and performance on cognitive tasks were conducted to investigate the relevance of the dysconnectivity findings. RESULTS: Seventy-four brain region connections were significantly reduced in PTSD (all in the eyes-open condition and predominantly using the theta carrier frequency). Underconnectivity of the orbital and anterior middle frontal gyri were most prominent. Performance differences in the digit span task mapped onto connectivity between 25 of the 74 brain region pairs, including within-network connections in the dorsal attention, frontoparietal control, and ventral attention networks. CONCLUSIONS: Robust PTSD-related abnormalities were evident in theta-band source-space orthogonalized power envelope connectivity, which furthermore related to cognitive deficits in these patients. These findings establish a clinically relevant connectomic profile of PTSD using a tool that facilitates the lower-cost clinical translation of network connectivity research.


Assuntos
Encéfalo/fisiopatologia , Rede Nervosa/fisiopatologia , Transtornos de Estresse Pós-Traumáticos/fisiopatologia , Adulto , Estudos de Casos e Controles , Conectoma , Eletroencefalografia , Feminino , Humanos , Masculino , Veteranos , Adulto Jovem
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