Obesity Links PTSD and Diabetes Risk

Posted on August 9, 2018 by Marie Benz MD FAAD

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MedicalResearch.com Interview with:

Jeff Scherrer, Ph.D. Associate professor; Research director Department of Family and Community Medicine Saint Louis University Center for Health Outcomes Research

Dr. Scherrer

Jeff Scherrer, Ph.D.
Associate professor; Research director
Department of Family and Community Medicine
Saint Louis University Center for Health Outcomes Research

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The rationale for this study comes from evidence that patients with PTSD are more likely to be obese than persons without PTSD and have more difficulty losing weight.

Given the obesity epidemic and substantial role of obesity in risk of type 2 diabetes, we sought to determine if obesity accounted for the existing evidence that PTSD is a risk factor for incident type 2 diabetes. Other studies have adjusted for obesity or BMI in models that control for obesity/BMI and other confounders simultaneously which prohibits measuring the independent role of obesity on the ass Continue reading →

Stress Disorders Linked to Increase Risk of Autoimmune Disease

Posted on June 21, 2018 by Marie Benz MD FAAD

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MedicalResearch.com Interview with:

Huan Song Associated Department of Medical Epidemiology and Biostatistics Karolinska Institutet

Huan Song

Huan Song
Associated
Department of Medical Epidemiology and Biostatistics
Karolinska Institutet

MedicalResearch.com: What is the background for this study?

Response: Earlier findings from our group (e.g. Fang et al., NEJM 2012; Arnberg et al., Lancet Psychiatry 2015; Lu et al., JAMA Oncol 2016; Shen et al., BMJ 2016; Zhu et al., Ann Oncol 2017) have identified pathways through which stressful events contribute to deterioration in human health. With strong animal models and human data supporting a role of stress in immune dysregulation, the hypothesis linking mental distress with autoimmune is indeed plausible. However, the evidence is as yet limited to clinical observations and a few larger observational studies on US veterans, most of them on men only, and some of which have cross-sectional designs and various other methodological shortcomings.

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Focusing On Employment Early Improves Success In Veterans with PTSD

Posted on March 2, 2018 by Marie Benz MD FAAD

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MedicalResearch.com Interview with:

Dr. Lori Davis, MD Research and Development Service, Tuscaloosa Veterans Affairs (VA) Medical Center, Department of Psychiatry, School of Medicine, University of Alabama, Tuscaloosa Tuscaloosa, Alabama

Dr. Davis

Dr. Lori Davis, MD
Research and Development Service, Tuscaloosa Veterans Affairs (VA) Medical Center,
Department of Psychiatry, School of Medicine, University of Alabama, Tuscaloosa
Tuscaloosa, Alabama

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Symptoms of posttraumatic stress disorder (PTSD) interfere with a person’s ability to function at work, making it harder to stay employed and establish oneself in a career. Veterans with PTSD are uniquely challenged given their motivation to serve others, be leaders and not be generally receptive to reaching out for help.

Conventional wisdom about PTSD and employment has traditionally been to first commit to treatment, learn coping skills, manage one’s symptoms and then reintegrate into mainstream employment. However, this view is being transformed by our research that suggests a more assertive recovery-oriented approach to the treatment of PTSD that involves returning to meaningful competitive employment as soon as possible.

This study compared Evidence-based Supported Employment (also known as Individual Placement and Support or IPS) integrated within PTSD treatment teams to the treatment as usual Transitional Work model offered within the VA. This multisite trial demonstrated significantly greater effectiveness of the IPS-supported employment over stepwise, transitional work vocational rehabilitation for Veterans living with chronic PTSD.

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Short-Term Prolonged Exposure Therapy Found Effective in PTSD Trial

Posted on January 23, 2018 by Marie Benz MD FAAD

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MedicalResearch.com Interview with:
, PhD
Professor of Psychiatry
Director, Center for the Treatment and Study of Anxiety
University of Pennsylvania
Philadelphia, Pa 19104

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: As much as 10 to 20 percent of military members deployed to Iraq and Afghanistan following the September 11th attacks suffer from PTSD, which is often chronic and incapacitating. A constant increase in the number of individuals suffering from PTSD as a result of massive natural disasters, terror attacks, and the wars in Iraq and Afghanistan, has prompted an urgent need for effective and efficient evidence-based treatments for PTSD.

Prolong exposure (PE) is a form of cognitive-behavioral therapy that involves exposure to trauma memories and daily life trauma reminders. Previous studies have proven PE is quite effective for treating civilians and veterans with PTSD. In this five-year study, the researchers sought to determine whether PE could have similar success with active-duty military personnel. The researchers examined the benefit of various methods for delivering PE including Massed-PE, (10 therapy sessions administered over two weeks) and Spaced-PE (10 sessions administered over 8 weeks), as well as Present Centered Therapy (PCT), a non-trauma-focused therapy that involves identifying and discussing daily stressors in 10 sessions over eight weeks, and Minimal Contact Control (MCC), which included supportive phone calls from therapists once weekly for four weeks.

Patients who received Massed-PE therapy, delivered over two weeks, saw a greater reduction in PTSD symptoms than those who received MCC. Importantly, Massed-PE therapy was found to be equally effective to Spaced-PE in reducing PTSD symptom severity. The researchers also found that PCT might be an effective treatment option for PTSD in active military personnel although it was less effective than PE in veteran and civilian PTSD sufferers. Continue reading →

Virtual Human Interviewers May Help Armed Services Members Open Up About PTSD

Posted on October 17, 2017 by Marie Benz MD FAAD

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MedicalResearch.com Interview with:

Dr. Gale Lucas, PhD Director of Research USC Institute for Creative Technologies Playa Vista, CA

Dr. Lucas

Dr. Gale Lucas, PhD
Director of Research
USC Institute for Creative Technologies
Playa Vista, CA

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: A common barrier to healthcare for psychiatric conditions is the stigma associated with these disorders. Perceived stigma prevents many from reporting their symptoms. Stigma is a particularly pervasive problem among military service members, preventing them from reporting symptoms of combat-related conditions like posttraumatic stress disorder (PTSD).

This put them at risk for having their symptoms go untreated, with possible disastrous outcomes including suicide attempts. We envisioned a technology system – a virtual human interviewer – whereby military service members can get feedback about their risk for PTSD in a safe place without stigma. Indeed, our prior research has shown that, because its “just a computer” (therefore safe and anonymous), this virtual human interviewer helps people to feel safe discussing sensitive issues like mental health symptoms. In this follow-up research project (published in Frontiers), we sought to demonstrate the value of this kind of virtual human interviewer specifically for encouraging reporting of PTSD symptoms among service members.

Specifically, we were interested in comparing the willingness of service members to report symptoms of PTSD to our virtual human interviewer, compared to the gold standard of the Post Deployment Health Assessment (PDHA). We wanted to isolate the effect of anonymity, separating it from “relational factors” that the virtual human interviewer uses to encourage service members to open up. Indeed, before asking these same questions as on the PDHA to capture PTSD symptoms, the system engages in social dialogue, which build rapport with users. The system asks “get to know you questions,” and throughout the interview, engage in active listening with responses such as nods, smiles, saying “uh huh,” and other encouraging phrases like “that’s great.”

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Stepped Care Case-Finding Intervention Can Provide Cost Effective Care For PTSD After a Disaster

Posted on October 6, 2017 by Marie Benz MD FAAD

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MedicalResearch.com Interview with:

Dr. Cohen

Gregory H. Cohen, MPhil, MSW
Statistical Analyst
Department of Epidemiology
School of Public Health
Boston University

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We simulated a stepped care case-finding approach to the treatment of posttraumatic stress in New York City, in the aftermath of Hurricane Sandy.

Stepped care includes an initial triage screening step which identifies whether a presenting individual is in need of Cognitive Behavioral Therapy, or can be adequately treated at a lower level of care.

Our simulation suggests that a stepped care approach to treating symptoms of posttraumatic stress in the aftermath of a hurricane is superior to care as usual in terms of reach and treatment-effectiveness, while being cost-effective. Continue reading →

Weakening Neural Connections Can Eliminate Fearful Memories

Posted on August 17, 2017 by Marie Benz MD FAAD

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MedicalResearch.com Interview with:

Jun-Hyeong Cho MD PhD Department of Molecular, Cell and Systems Biology University of California, Riverside Riverside, CA 92521

Dr. Jun-Hyeong Cho

Jun-Hyeong Cho MD PhD
Department of Molecular, Cell and Systems Biology
University of California, Riverside
Riverside, CA 92521

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: To survive in a dynamic environment, animals develop fear responses to dangerous situations. For these adaptive fear responses to be developed, the brain must discriminate between different sensory cues and associate only relevant stimuli with aversive events.

In our current study, we investigated the neural mechanism how the brain does this, using a mouse model of fear learning and memory. Our study demonstrates that the formation of fear memory associated with an auditory cue requires selective synaptic strengthening in neural pathways that convey the auditory signals to the amygdala, an essential brain area for fear learning and memory.

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Functional Brain Markers Can Suggest Susceptibility to PTSD

Posted on June 9, 2017 by Marie Benz MD FAAD

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MedicalResearch.com Interview with:

Jennifer Stevens, PhD Director, Neuroscience of Memory, Emotion, and Stress Laboratory Instructor, Dept of Psychiatry & Behavioral Sciences Emory University School of Medicine

Dr. Stevens

Jennifer Stevens, PhD
Director, Neuroscience of Memory, Emotion, and Stress Laboratory
Instructor, Dept of Psychiatry & Behavioral Sciences
Emory University School of Medicine

MedicalResearch.com: What is the background for this study?

Response: Post-traumatic stress disorder (PTSD) was once thought to be a disorder of combat veterans, however, we now know that more than 60% of Americans experience a traumatic event during their lifetimes, and that this can have negative consequences for mental and physical health. Many people recover from the psychological effects of trauma without any intervention, but a significant proportion have long-lasting debilitating symptoms.

Supported by the NIH, the cutting edge of PTSD research includes new strategies for preventing the disease, rather than treating PTSD after patients have been living with symptoms for months to years. In order to prevent the disease, it is critical that we are able to quickly identify people who will be at risk for the disease following a trauma, so that preventive strategies can be deployed bedside in the emergency room or in the battlefield. In the current study, we used functional MRI to predict which individuals would recover from trauma, and which individuals would have long-lasting symptoms of PTSD.

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How and Where Does the Brain Encode Fearful Memories

Posted on May 21, 2017 by Marie Benz MD FAAD

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MedicalResearch.com Interview with:

Jun-Hyeong Cho, M.D., Ph.D. Assistant Professor Department of Cell Biology & Neuroscience University of California, Riverside Riverside, CA 92521

Dr. Jun-Hyeong Cho

Jun-Hyeong Cho, M.D., Ph.D.
Assistant Professor
Department of Cell Biology & Neuroscience
University of California, Riverside
Riverside, CA 92521

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: In order to survive in a dynamic environment, animals develop adaptive fear responses to dangerous situations, which requires coordinated neural activity in the hippocampus, medial prefrontal cortex (mPFC), and amygdala. Dysregulation of this process leads to maladaptive generalized fear in post-traumatic stress disorder (PTSD), which affects 7 percent of the U.S. population.

In this study, we found that a population of hippocampal neurons project to both amygdala and medical prefrontal cortex (mPFC). We also found neural mechanisms how these double-projecting neurons efficiently convey contextual information to the amygdala and mPFC to encode and retrieve fear memory for a context associated with an aversive event.

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Genetic Factors Raise Risk of PTSD After Trauma, Especially in Women

Posted on April 25, 2017 by Marie Benz MD FAAD

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MedicalResearch.com Interview with:

Laramie E Duncan, PhD</strong> Stanford University

Dr. Duncan

Laramie E Duncan, PhD
Stanford University

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Posttraumatic stress disorder (PTSD) is a mental health condition that some people experience after a traumatic event, like a terrorist attack, military conflict, or violence in the home. When people have PTSD, they may experience flashbacks to the traumatic event, nightmares, and other recollections of the event that can interfere with their day-to-day lives.

Before this study, not everyone was convinced that genetic factors make some people more prone to developing PTSD than others. Using a study of over 20,000 people and analyzing over two hundred billion (200,000,000,000) pieces of genetic information, we demonstrated that developing PTSD is partly genetic. We also found that genetic factors seem to play a stronger role for women than men, though for everyone, experiencing trauma is still the most important factor.

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Doxycycline May Mute Painful Memories Associated With PTSD

Posted on April 5, 2017 by Marie Benz MD FAAD

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MedicalResearch.com Interview with:
Dominik R Bach, PhD, MD
University of Zurich

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Posttraumatic stress disorder (PTSD) can occur after a psychological trauma such as physical violence, abuse, or natural disaster. It is characterised by increased arousal, flashbacks, and nightmares that reflect memories of the trauma. Current therapies include talking therapy, but it is costly and does not work in everybody. This is why we were looking for ways of reducing aversive memories with a drug. In the current study, we found that the antibiotic doxycycline impairs the formation of negative memories in healthy volunteers.

To form memories, the brain needs to strengthen connections between neurons. It has recently emerged that for strengthening such connections particular proteins are required that sit between nerve cells, so-called MMPs. They are involved in many disorders outside the brain, such as certain cancers and heart disease. This is how we already know that doxycycline suppresses the activity of MMPs. Since doxycycline is relatively safe and readily accessible, our research was relatively straightforward.

76 healthy volunteers – half women, half men – came to the laboratory and received either placebo (a sugar pill) or 200 mg doxycycline. They then took part in a computer test in which one screen color was often followed by a mildly painful electric shock and another color was not.

A week later, volunteers came back to the lab. They were shown the colors again , this time followed by a loud sound but never by shocks. The loud sounds made people blink their eyes – a reflexive response to sudden threat. This eye blink response was measured. Volunteers who had initially been under placebo had stronger eye blink after the color that predicted electric shock than after the other color. This “fear response” is a sensitive measure for memory of negative associations. Strikingly, the fear response was 60% lower in participants who had initially taken doxycycline.

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Ketamine Before Stressful Event May Reduce Risk of PTSD

Posted on February 14, 2017 by Marie Benz MD FAAD

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MedicalResearch.com Interview with:

Christine Ann Denny, Ph.D. Assistant Professor Department of Psychiatry Columbia University Division of Integrative Neuroscience Research Foundation for Mental Hygiene, Inc. New York, NY 10032-2695

Dr. Christine Ann Denny

Christine Ann Denny, Ph.D.
Assistant Professor
Department of Psychiatry
Columbia University
Division of Integrative Neuroscience
Research Foundation for Mental Hygiene, Inc.
New York, NY 10032-2695

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Post-traumatic stress disorder (PTSD) is one of the most common psychiatric illnesses, affecting about 8 million adult Americans, and an annual prevalence of about 3.5% worldwide. At-risk populations such as soldiers and veterans are at a higher risk to develop PTSD. Stress exposure is one of the major risk factors for PTSD and major depressive disorder (MDD), a disorder which is often co-morbid with PTSD.

There are currently very limited treatments for PTSD and MDD. In addition, these disorders are treated in a symptom-suppression approach, which only mitigate symptoms and work in only a small fraction of patients. Prevention is rarely an approach considered except in the form of behavioral intervention. However, pharmacological approaches to preventing psychiatric diseases has not yet been developed.

Our laboratory has previously found that ketamine, a general anesthetic and rapid-acting antidepressant, administered sub-anesthetically prior to stress can prevent against stress-induced depressive-like behaviors. We decided to delve into the literature to determine whether ketamine has any effects on PTSD in the clinic. We found numerous reports linking ketamine to PTSD, but the results were varied. We realized that the main difference in all of these studies was the timing of administration. We decided to systematically test the efficacy of ketamine in mice at various time points relative to a stressor to determine when would be the most effective window to buffer against heightened fear expression.

We found that ketamine administered 1 week, but not 1 month or 1 day, prior to a stressor was the most effective time point to administer the drug to buffer fear. This is critical, as it suggests that a pharmacological approach to enhance resilience can be more effective at protecting against PTSD symptoms than attempting to mitigate symptoms after it has already affected an individual.

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Cognitive Behavior Therapy Most Effective Treatment for OCD, Anxiety and PTSD

Posted on January 27, 2017 by Marie Benz MD FAAD

1

David Mataix-Cols

Prof. Mataix-Cols

MedicalResearch.com Interview with:
David Mataix-Cols PhD
Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Stockholm County Council
Stockholm, Sweden

MedicalResearch.com: What is the background for this study?

Response: Exposure-based Cognitive Behavior Therapy (CBT) is the treatment of choice for patients with anxiety, obsessive compulsive disorder (OCD) and post-traumatic stress disorders. Some patients do not respond sufficiently to such treatment. This has led researchers to find ways to augment (enhance) CBT with pharmacological agents, such as D-cycloserine (DCS).

Because CBT is such a powerful treatment for most patients, we suspected that the effects of DCS would probably be small. This means that very large samples of patients are needed to show statistically significant differences between groups. Previous studies and meta-analyses were underpowered to detect such small effects. Combining the raw data from all available studies to date gave us the power we needed to address the question of whether DCS is an efficacious augmenting strategy, over and above CBT.

We also had a second research question. Previous research from our group had suggested that there may be undesirable interactions between DCS and antidepressants, whereby patients taking both types of drugs would have significantly worse outcomes (see Andersson et al JAMA Psychiatry. 2015 Jul;72(7):659-67.
doi: 10.1001/jamapsychiatry.2015.0546).

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Veterans with PTSD Have High Prevalence of Sleep Disorders

Posted on July 19, 2016 by Marie Benz MD FAAD

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MedicalResearch.com Interview with:

Jim Burch, MS, PhD Associate Professor Dept. of Epidemiology & Biostatistics Cancer Prevention & Control Program Arnold School of Public Health University of South Carolina, Columbia, SC and Health Science Specialist WJB Dorn Department of Veterans Affairs Medical Center Columbia, SC

Dr. Jim Burch

Jim Burch, MS, PhD
Associate Professor
Dept. of Epidemiology & Biostatistics
Cancer Prevention & Control Program
Arnold School of Public Health
University of South Carolina, Columbia, SC and
Health Science Specialist
WJB Dorn Department of Veterans Affairs Medical Center
Columbia, SC

MedicalResearch.com: What is the background for this study?

Response: Over 21 million Veterans live in the U.S., and nearly 9 million of them receive healthcare through the Veterans Health Administration, which is the largest integrated healthcare system in the U.S. The military population is particularly vulnerable to sleep disturbances due to their work schedules, living conditions, and other physical and psychological factors that accompany their jobs. However, previous studies have not comprehensively described the scope and characteristics of sleep disorders among Veterans. Sleep is considered a physiological necessity. Inadequate sleep has been associated with a wide range of adverse health outcomes, including an increased risk of chronic diseases such as heart disease and cancer, psychiatric disorders, reduced quality of life, and increased mortality.

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Telehealth System Improved Mental Health and Depression in Army Study

Posted on July 1, 2016 by Marie Benz MD FAAD

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MedicalResearch.com Interview with:

Bradley E. Belsher, Ph.D. Chief of Research Translation and Integration, Deployment Health Clinical Center, Defense Center of Excellence for PH and TBI Research Assistant Professor, Department of Psychiatry Uniformed Services University of the Health Sciences

Dr. Bradley Belsher

Bradley E. Belsher, Ph.D.
Chief of Research Translation and Integration,
Deployment Health Clinical Center,
Defense Center of Excellence for PH
and TBI
Research Assistant Professor, Department of Psychiatry
Uniformed Services University of the Health Sciences

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: One out of five U.S. military service members returning from overseas military conflicts meets screening criteria for at least one mental health condition, yet fewer than half of service members will receive help from a mental health professional. The consequences of inadequate mental health treatment are considerable and can lead to significant social and functional problems for service members and their families. In response to these mounting concerns, the Military Health System (MHS) has increased efforts to expand and improve the identification and treatment of mental health disorders. Given that the average service member visits primary care three times each year, the MHS has invested considerable resources into the integration of mental health services into the primary care setting. Collaborative care is an effective model for integrating mental health services into primary care and has demonstrated effectiveness in treating different mental health conditions to include depression and anxiety disorders. However, no previous studies have examined whether the concept can work in the MHS.

Recently, the first large-scale, randomized effectiveness trial evaluating an integrated health care model in primary care for PTSD and depression in the DoD was conducted. This trial randomized 666 military members treated across six large Army bases to a centrally-assisted collaborative telecare (CACT) approach for PTSD and depression or to the existing standard of care (usual collaborative care). This effectiveness trial targeted a large population of service members as they came into primary care and minimized exclusion criteria to improve the generalizability of the findings and broaden the applicable reach of the intervention.

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Psychiatric Research Focuses On Major Hubs of Complex Brain Systems

Posted on April 6, 2016 by Marie Benz MD FAAD

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MedicalResearch.com Interview with:

Glenn Saxe, MD Arnold Simon Professor of Child and Adolescent Psychiatry and Chair, Department of Child and Adolescent Psychiatry NYU Langone’s Child Study Center

Dr. Glenn Saxe

Glenn Saxe, MD
Arnold Simon Professor of Child and Adolescent Psychiatry and
Chair, Department of Child and Adolescent Psychiatry
NYU Langone’s Child Study Center
Dr. Saxe’s bio page

MedicalResearch.com: What is the background for this approach? What are the main advantages and drawbacks to the CS-CN method in psychiatry research?

Dr. Saxe: Psychiatric disorders are complex and, in all likelihood, emerge and are sustained over time because they form what is called a complex system, involving the interaction between a great many variables of different types (e.g. molecules, neurons, brain circuits, developmental, social variables). There is a strong literature on complex systems in other fields that show remarkably similar properties between vastly different types of systems. Unfortunately, data methods used in research in psychiatry are not designed to ‘see’ the possible complex systems nature of a psychiatric disorder. Our method is designed to identify networks of variables related to psychiatric disorders that, together, have properties of complex systems. If such a system is identified, it may reveal new ways to treat these disorders.

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PTSD Linked To Worse Vascular Function in Veterans

Posted on March 27, 2016 by Marie Benz MD FAAD

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MedicalResearch.com Interview with:

S. Marlene Grenon, MDCM, MMSc, FRCSC Associate Professor of Surgery Division of Vascular and Endovascular Surgery University of California, San Francisco Veterans Affairs Medical Center- Surgical Services San Francisco, CA 94121

Dr Marlene Grenon

S. Marlene Grenon, MDCM, MMSc, FRCSC
Associate Professor of Surgery
Division of Vascular and Endovascular Surgery
University of California, San Francisco
Veterans Affairs Medical Center- Surgical Services
San Francisco, CA

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Grenon: In this study, we investigated the impact of PTSD on endothelial function using flow-mediated brachial artery vasodilation.

After adjustments for different risk factors and comorbidities, we found that patients with PTSD had worse endothelial function.

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Nightmares Linked to Increased Suicide Risk in PTSD

Posted on March 18, 2016 by Marie Benz MD FAAD

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MedicalResearch.com Interview with:
Donna L. Littlewood PhD Student
School of Psychological Sciences
University of Manchester, UK

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Every year over 800,000 people die by suicide, and for every individual’s death, it is estimated that another 20 people will make a suicide attempt. Therefore, to be able to prevent suicide, we need to understand the different factors that can combine to make an individual think about ending their own life.

Recent research indicates that nightmares are associated with suicidal thoughts and behaviours, and that this association is independent of other related suicide risk factors, such as, depression and PTSD. However, it is now important for research to examine the mechanisms that underpin this association, as this information will support the development of clinical interventions to prevent subsequent suicide attempts and deaths

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10% of ICU Patients At Risk of Developing PTSD

Posted on January 7, 2016 by Marie Benz MD FAAD

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Mayur Patel, MD, MPH, FACS Assistant Professor of Surgery & Neurosurgery Vanderbilt University Medical Center Staff Surgeon and Surgical Intensivist Nashville VA Medical Center

Dr. Mayur Patel

MedicalResearch.com Interview with:
Mayur Patel, MD, MPH, FACS
Assistant Professor of Surgery & Neurosurgery
Vanderbilt University Medical Center
Staff Surgeon and Surgical Intensivist
Nashville VA Medical Center

Medical Research: What is the background for this study?

Dr. Patel: Post-traumatic stress disorder (PTSD) can occur in patients after the traumatizing events of critical illness. Survivors of critical illness have reported PTSD symptoms months to even years after critical illness, possibly related to nightmare-like experiences, safety restraints creating communication barriers, and protective mechanical ventilation causing feelings of breathlessness and fear of imminent death. But, the epidemiology of PTSD after critical illness is unclear with wide ranging estimates (0-64%) and largely fails to distinguish past PTSD from new PTSD specifically resulting from the critical care experience.

Our study provides estimates on new cases of PTSD stemming specifically from the ICU experience. Pre-existing PTSD has rarely been systematically assessed in prior cohorts, and our work took extra effort to distinguish pre-existing PTSD from new PTSD cases. Civilian populations have dominated the literature of PTSD after critical illness, and this research is the first to also include the expanding and aging Veteran population. Continue reading →

Veterans with PTSD Require More Sedatives in Critical Care Units

Posted on October 24, 2015 by Marie Benz MD FAAD

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Jad Kebbe, MD Jacobs School of Medicine and Biomedical Sciences Department of Medicine University of Buffalo

Dr. Jad Kebbe

MedicalResearch.com Interview with:
Jad Kebbe, MD
Jacobs School of Medicine and Biomedical Sciences
Department of Medicine
University of Buffalo

Medical Research: What is the background for this study? What are the main findings?

Dr. Kebbe: This study proceeded after sensing that post-traumatic stress disorder (PTSD) was a major contributor to ill outcomes in Veterans who are hospitalized in general, and mechanically ventilated in the intensive care unit (ICU) in particular. There is plenty of data depicting the comorbid roles PTSD plays in other medical conditions, leading to an increase in the use of medical services. Furthermore, PTSD affects a Veteran’s adherence to both medical and psychiatric therapies. Having said this, the ICU course could itself negatively affect a pre-existing PTSD, or even lead to the inception of such a condition de novo. However, to date, there has been no study looking at the effect a pre-existing PTSD diagnosis may have on the ICU hospitalization and thereafter.

Our study confirmed that PTSD led to an increase in sedative requirements (opiates and benzodiazepines) for Veterans who were mechanically ventilated for more than 24h between 2003 and 2013, and revealed a trend towards an increase in mortality when compared to Veterans not suffering from PTSD.

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Female Vietnam War Vets Have High Prevalence of PTSD

Posted on October 8, 2015 by Marie Benz MD FAAD

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MedicalResearch.com Interview with:
Kathryn Magruder, Ph.D., M.P.H.
Johnson Veterans Affairs Medical Center
Charleston, S.C.

Medical Research: What is the background for this study? What are the main findings?

Dr. Magruder: There has been lots of attention and concern over PTSD in your younger veterans — both male and female — and in male Vietnam veterans. Too often the women who served during the Vietnam Era have been largely overlooked. We felt like we owed it to them to understand better their responses to their wartime experiences — even if 40 years later. It’s never too late to do the right thing!

Our main finding is that the women who served in Vietnam had high prevalence of PTSD (20% lifetime, 16% current) and this was not attributable to cases that had developed prior to entering the military. This was higher than the women who served near Vietnam or in the United States. When we looked at their reported experiences during the Vietnam Era, the women who were in Vietnam reported higher levels of exposure to all of the items on our scale. It was these experiences — especially sexual harassment, performance pressures, and experiences with triage and death — that explained their higher levels of PTSD.

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Mindfulness-Based Stress Therapy May Reduce PTSD Symptoms in Veterans

Posted on August 5, 2015 by Marie Benz MD FAAD

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MedicalResearch.com Interview with:
Melissa A. Polusny, PhD, LP
Staff Psychologist/Clinician Investigator
Core Investigator, Center for Chronic Disease Outcomes Research
Associate Professor, University of Minnesota Medical School
Minneapolis VA Health Care System
One Veterans Drive Minneapolis, MN 5541

Medical Research: What is the background for this study? What are the main findings?

Dr. Polusny: VA has invested heavily in the dissemination of prolonged exposure therapy and cognitive processing therapy as first-line treatments for PTSD; however, 30% to 50% of Veterans do not show clinically significant improvements and dropout rates are high. Evidence suggests that mindfulness-based stress reduction – an intervention that teaches individuals to attend to the present moment in a non-judgmental, accepting manner – can reduce symptoms of anxiety and depression. This randomized clinical trial compared mindfulness-based stress reduction with present-centered group therapy – sessions focused on current life problems. We randomly assigned 116 Veterans with PTSD to receive nine sessions of mindfulness-based stress reduction therapy (n=58) or nine sessions of present-centered group therapy (n=58). Outcomes were assessed before, during and after treatment, and at two-month follow-up. Exclusion criteria included: substance dependence (except nicotine), psychotic disorder, suicidal or homicidal ideation, and/or cognitive impairment or medical illness that could interfere with treatment. The primary outcome was a change in self-reported PTSD symptom severity over time. Secondary outcomes included interview-rated PTSD severity scores, self-reported depression symptoms, quality of life, and mindfulness skills.

Mindfulness-based stress reduction therapy – compared with present-centered group therapy – resulted in a greater decrease in self-reported PTSD symptom severity. Veterans in the mindfulness-based stress reduction group were more likely to show clinically significant improvement in self-reported PTSD symptom severity (49% vs. 28%) at two-month follow-up, but they were no more likely to have loss of PTSD diagnosis (53% vs. 47%). Veterans participating in mindfulness-based stress reduction therapy reported greater improvement in quality of life and depressive symptoms than those in present-centered group therapy; however improvement in depressive symptoms scores did not reach the level of significance. Improvements in quality of life made during treatment were maintained at 2-month follow-up for Veterans in the mindfulness-based stress reduction group, but reports of quality of life returned to baseline levels for those in present-centered group therapy. The dropout rate observed for mindfulness-based stress reduction therapy (22%) in this study was lower than dropout rates reported in previous studies for PE (28.1% to 44%) and CPT (26.8% to 35%).

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Over Quarter-Million Vietnam Vets Have Some Form of PTSD

Posted on July 24, 2015 by Marie Benz MD FAAD

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MedicalResearch.com Interview with:
Charles R. Marmar, MD
The Lucius Littauer Professor and Chair, Department of Psychiatry, NYU Langone Medical Center and
Director of the Steven and Alexandra Cohen Veterans Center at NYU Langone

MedicalResearch: What is the background for this study? What are the main findings?

Dr. Marmar: Approximately 2.7 million men and women served in Vietnam, and, for those who returned, many have suffered for decades from a variety of psychological problems resulting from their experiences and other injuries such as traumatic brain injury (TBI).

The 25-year National Vietnam Veterans Longitudinal Study (NVVLS) was a way we could determine at various points in time how veterans were faring emotionally four decades after their service. While the vast majority are resilient, there are still over 270,000 Vietnam veterans who still have some form of post-traumatic stress disorder (PTSD) and one-third of these veterans have depression.

We followed up with veterans who participated in the National Vietnam Veterans Readjustment Study (NVVRS) from 1984 to 1988 who were evaluated for PTSD. The NVVRS group represented a probability sample of those who served in Vietnam. Of the 1,839 participants still alive, 1,409 participated in at least one phase of the NVVLS, which involved a health questionnaire, health interview and clinical interview.

The results showed that between 4.5 percent and 11.2 percent of male Vietnam veterans and 6.1 and 8.7 percent of the female veterans are currently experiencing some level of PTSD.

About 16 percent of veterans in the study reported an increase of more than 20 points on a PTSD symptom scale compared to 7.6 percent who reported a decrease of greater than 20 points.

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May Be Possible To Use Video Games To Block PTSD Intrusive Memories

Posted on July 14, 2015 by Marie Benz MD FAAD

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MedicalResearch.com interview with
Dr. Ella James, Post-Doctoral Investigator Scientist
Medical Research Council Cognition and Brain Sciences Unit
Cambridge, UK.

MedicalResearch: What is the background for this study?

Dr. James: Post-traumatic stress disorder (PTSD) is experienced by some people after a traumatic event. While many people who’ve been involved in traumatic events don’t experience PTSD, those who do typically have repeated visual intrusive memories of certain moments in vivid detail that pop back into mind, seemingly out of the blue. For example, with PTSD after a car crash might repeatedly ‘see’ the moment the other car crashed into them.

The recommended treatment for PTSD is cognitive behaviour therapy, a talking therapy that has been demonstrated to work well. But it is only delivered once intrusive memories have become established and PTSD is diagnosable – i.e. at least one month after the traumatic event occurred. At present, there is nothing readily available for use soon after trauma that has been shown to prevent symptoms building up and PTSD becoming established.

In previous laboratory work our research team showed that playing Tetris shortly after viewing events with traumatic content (e.g. film footage of road safety campaigns – what we call an experimental trauma) could reduce intrusive memories of those events in healthy volunteers over the following week [2, 3] when played in a 4-hour time window after viewing. We reasoned that this was because having to follow and track the shapes, colour and movement of the coloured blocks in Tetris soon after seeing the experimental trauma (the film) disrupted aspects of the visual memory of that event from being ‘laid down’ in the sensory part of the brain, whilst leaving memory for the narrative and meaning of the events unaffected.

However, it is hard to reach people so soon after a traumatic event in the real world and memories for events become ‘fixed’ in mind within hours after an event making them difficult to change. Therefore it was important to show whether we can change older, established memories of trauma.

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Women With PTSD At Higher Risk For Heart Disease

Posted on June 30, 2015 by Marie Benz MD FAAD

MedicalResearch.com Interview with:
Jennifer A. Sumner, Ph.D.
Columbia University Mailman School of Public Health
New York, NY 10032

Medical Research: What is the background for this study? What are the main findings?

Dr. Sumner: Cardiovascular disease, which includes conditions like heart attack and stroke, is the leading cause of death worldwide. Stress has long been thought to increase risk of cardiovascular disease, and posttraumatic stress disorder (PTSD) is the quintessential stress-related mental disorder. Some individuals who are exposed to traumatic events, such as unwanted sexual contact, the sudden unexpected death of a loved one, and physical assault, develop PTSD, which is characterized by symptoms of re-experiencing the trauma (e.g., nightmares), avoidance of trauma reminders (e.g., avoiding thinking about the trauma), changes in how one thinks and feels (e.g., feeling emotionally numb), and increased physiological arousal and reactivity (e.g., being easily startled). PTSD is twice as common in women as in men; approximately 1 in 10 women will develop PTSD in their lifetime. Research has begun to suggest that rates of cardiovascular disease are higher in people with PTSD. However, almost all research has been done in men.

My colleagues and I wanted to see whether PTSD was associated with the development of cardiovascular disease in a large sample of women from the general public. We looked at associations between PTSD symptoms and new onsets of heart attack and stroke among nearly 50,000 women in the Nurses’ Health Study II over 20 years, beginning in 1989. Women with the highest number of PTSD symptoms (those reporting 4+ symptoms on a 7-item screening questionnaire) had 60% higher rates of developing cardiovascular disease (both heart attack and stroke) compared to women who were not exposed to traumatic events. Unhealthy behaviors, including lack of exercise and obesity, and medical risk factors, including hypertension and hormone replacement use, accounted for almost 50% of the association between elevated PTSD symptoms and cardiovascular disease. We also found that trauma exposure alone (reporting no PTSD symptoms on the screening questionnaire) was associated with elevated cardiovascular disease risk compared to no trauma exposure.

Our study is the first to look at trauma exposure and PTSD symptoms and new cases of cardiovascular disease in a general population sample of women. These results add to a growing body of evidence suggesting that trauma and PTSD have profound effects on physical health as well as mental health.

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