Author Interviews, Critical Care - Intensive Care - ICUs, PTSD, Vanderbilt / 07.01.2016

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.  (more…)
Anesthesiology, Author Interviews, CHEST, Critical Care - Intensive Care - ICUs, PTSD, Pulmonary Disease / 24.10.2015

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. This is why many veterans are trying to claim disability benefits using va benefits and disability lawyer Tennessee to help them fight their case. (more…)
Author Interviews, JAMA, PTSD / 08.10.2015

Kathryn Magruder, Ph.D., M.P.H. Johnson Veterans Affairs Medical Center Charleston, S.C.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. (more…)
Author Interviews, Nature, NYU / 25.08.2015

Robert C. Froemke, PhD, Assistant professor NYU Langone and Skirball Institute of Biomolecular Medicine New York MedicalResearch.com Interview with: Robert C. Froemke, PhD, Assistant professor NYU Langone and Skirball Institute of Biomolecular Medicine New York Medical Research: What is the background for this study? What are the main findings? Dr. Froemke: We studied how a brain area called the ‘locus coeruleus’ is involved in hearing. The locus coeruleus is the brain’s alarm clock, it’s a small region deep in the brainstem that is responsible for arousal and wakefulness, activated by surprising or potentially dangerous events. The locus coeruleus releases the neurochemical noradrenalin (similar to adrenalin) throughout the brain to greatly increase brain activity, and so might convey the significance of sounds related to past events that were very important or startling in some way (like the sound of an alarm, a baby crying, or other sounds that require immediate attention). We found that sounds related to surprising events can come to directly activate the locus coeruleus, meaning that this brain area can learn from past experience. This learning happens quickly (within seconds to minutes) and can be incredibly long-lasting, up to weeks as measured in our study, and we suspect indefinitely or all life-long. We studied this by training lab rats to respond to sounds, poking their nose in a hole to get a food reward whenever they heard a certain sound. We activated the locus coeruleus briefly in some of these animals, and observed that they were much more sensitive to this sound and learned much faster than other unstimulated animals. We made recordings of electrical activity in the locus coeruleus and the auditory cortex, one of the major ‘hearing’ parts of the brain. In stimulated animals, sounds activated the locus coeruleus within tens of milliseconds, releasing noradrenalin into the auditory cortex to greatly boost the audio processing there- making almost every neuron respond very vigorously to that special sound. (more…)
Author Interviews, JAMA, PTSD / 05.08.2015

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 (B68-2) One Veterans Drive Minneapolis, MN 5541MedicalResearch.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%). (more…)
Author Interviews, PTSD / 14.07.2015

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. (more…)
Author Interviews, Columbia, JACC, PTSD, Women's Heart Health / 30.06.2015

Jennifer A. Sumner, Ph.D.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. (more…)
Author Interviews, JAMA, Mental Health Research / 23.01.2015

MedicalResearch.com Interview with: David P.G. van den Berg PhD student Clinical Psychologist Cognitive behavioural therapist Parnassia Psychiatric Institute Early Detection and Intervention Team (EDIT) Zoutkeetsingel, The Netherlands Medical Research: What is the background for this study? What are the main findings? Response: The last decade it has become clear that many people with psychotic disorders suffered severe childhood trauma. These experiences enhance chances of developing psychosis, but also result in comorbid posttraumatic stress disorder (PTSD). PTSD is highly prevalent in patients with psychotic disorders and negatively influences prognosis and wellbeing. Prolonged Exposure (PE) and Eye Movement Desensitization and Reprocessing (EMDR) are highly effective treatments and recommended as first choice treatments in PTSD guidelines worldwide. Although there is no evidence to support this, patients with psychosis are excluded from PTSD treatment due to fear of destabilization or psychotic decompensation. Moreover, psychosis is the most used exclusion criterion in PTSD trials. This is the first randomized clinical trial (RCT) of the efficacy of PTSD treatment in psychosis. In this RCT 155 patients with a psychotic disorder and comorbid PTSD were randomly assigned to PE, EMDR or Waiting List (WL). In the treatment conditions participants received 8 sessions of 90-minutes therapy. Standard protocols were used. Treatment was not preceded by stabilizing psychotherapeutic interventions or skills training. The first session comprised psycho-education about PTSD and target selection. In sessions 2 to 8 traumas were treated, starting with the most distressing experience. Baseline, post-treatment and 6-month follow-up assessments were made. Participants in both PE and EMDR showed greater reduction of PTSD symptoms than those in WL. Between group effect sizes were large. About sixty percent of the participants in the treatment groups achieved loss of diagnosis. Treatment effects were maintained at six-month follow-up for both PE and EMDR. Treatments did not result in serious adversities. (more…)
Author Interviews, Genetic Research, PTSD, UCLA / 15.01.2015

Armen K. Goenjian, M.D., L.D.F.A.P.A., F.A.C.G.S. Research Professor of Psychiatry Department of Psychiatry and Biobehavioral Sciences David Geffen School of Medicine at UCLAMedicalResearch.com Interview with: Armen K. Goenjian, M.D., L.D.F.A.P.A., F.A.C.G.S. Research Professor of Psychiatry Department of Psychiatry and Biobehavioral Sciences David Geffen School of Medicine at UCLA Medical Research: What is the background for this study? Response: Post-traumatic stress disorder (PTSD) is a psychiatric disorder that develops after exposure to a traumatic event such as rape, war, natural disaster, and accident. Symptoms include recurrent intrusive traumatic memories, flashbacks, nightmares, hyper-vigilance, jumpiness, and anxiety. Dopaminergic and serotonergic systems have been implicated in PTSD. Catechol-O-methyltransferase (COMT) is an enzyme that degrades dopamine, an important brain neuro-hormone that regulates human behavior, thoughts and emotions.  Tryptophan hydroxylase is the rate limiting step in the synthesis of serotonin, another important neuro-hormone that regulates arousal, sleep, anxiety, and mood. This study evaluated the association of four COMT gene loci, and the joint effect of COMT and tryptophan hydroxylase 2 (TPH-2) genes on PTSD symptoms. (more…)
Author Interviews, Brain Injury, PTSD / 05.12.2014

James L . Spira, PhD, MPH, ABPP Professor, Department of Psychiatry, John A Burns School of Medicine, University of Hawaii Director, National Center for PTSD, Department of Veterans Affairs, Pacific Islands DivisionMedicalResearch.com Interview with: James L . Spira, PhD, MPH, ABPP Professor, Department of Psychiatry, John A Burns School of Medicine, University of Hawaii Director, National Center for PTSD, Department of Veterans Affairs, Pacific Islands Division Medical Research: What is the background for this study? Dr. Spira:  Approximately 1.5 million Americans survive a traumatic brain injury (TBI) from traffic accidents, assaults, sports, and work injuries, with the vast majority of these being primarily mild (mTBI), otherwise known as concussion.1 Concussion, however, is uniquely problematic in the military given the new strategies of war encountered by service members when fighting an insurgency using improvised explosive devices. The rate of concussion experienced by United States (U.S.) service members engaging in combat during the wars in Afghanistan and Iraq has been estimated at between 15% and 22%.2–4There has been controversy in the area of neurotrauma as to whether persistent postconcussive symptoms (PPCSx) are due to neurological causes or solely due to the psychological sequelae of having been exposed to a traumatic event.  The recent wars in Iraq and Afghanistan have afforded an opportunity to examine these factors, although teasing them apart has proven difficult.  The most influential study of persistent effects of concussion in service members is that of Hoge and colleagues,5 in which they failed to find an independent effect of prior concussion on PPCSx, once depression and posttraumatic stress (PTSD) was taken into account.  They went so far as to recommend that assessment for concussion following deployment is unnecessary.  Others, however, have reported persistent cognitive, emotional, and physical symptoms following concussion. (more…)
General Medicine / 03.10.2014

MedicalResearch.com Interview with: Kathrin S. Utz, PhD Department of Neurology University of Erlangen-Nuremberg Erlangen, German Medical Research: What are the main findings of the study? Dr. Utz: A transient ischemic attack is caused when there is a temporary disruption in the blood supply to a person’s brain. It causes the person to experience symptoms, similar to those of a stroke, such as speech and visual disturbance and numbness or weakness in the arms and legs. A transient ischemic attack is only temporary and people make a full physical recovery from it. We found, however, that a TIA is not without cost. Specifically, we found that such persons are at a greater risk of going on to develop the psychiatric condition known as posttraumatic stress disorder (PTSD). We found 1 in 3 patients develop it. PTSD, which is perhaps better known as a problem found in survivors of war zones and natural, can develop when a person experiences a frightening event that poses a serious threat. It leads the person to experience symptoms such as worry, nightmares, flashbacks and social isolation. We found that TIA patients who develop PTSD are also more likely to suffer from depression and anxiety symptoms. Taken together these symptoms pose a significant psychological burden for the affected patients and it therefore comes as no surprise that we also found TIA patients with PTSD have a measurably lower sense of quality of life than TIA patients who do not develop PTSD. We could also identify some potential risk-factors for the development of PTSD following a TIA. Younger patients and patients who overestimate their future stroke risk are more likely to develop PTSD. Also important in this context are the strategies that patients typically adopt to deal with stressful situations. Those patients who use certain types of coping strategies, such as denying the problem, blaming themselves for any difficulties or turning to drugs for comfort, face a greater risk of developing PTSD after TIA. (more…)
Addiction, Author Interviews, JAMA, PTSD / 17.09.2014

Susan Mason, PhD, MPH Assistant Professor Division of Epidemiology and Community Health Minneapolis, MN 55454MedicalResearch.com Interview with: Susan Mason, PhD, MPH Assistant Professor Division of Epidemiology and Community Health Minneapolis, MN  55454   Medical Research: What are the main findings of the study? Dr. Mason: We examined 49,408 women enrolled in the Nurses' Health Study II to see if those who had experienced PTSD symptoms at some point in their lives were more likely than those without PTSD symptoms to meet the criteria for food addiction, a measure of perceived dependence on food. We found that the 8% of women with the most lifetime PTSD symptoms were about 2.7 times as likely to meet the criteria for food addiction as women with no lifetime PTSD symptoms. This translates to an elevation in food addiction prevalence from about 6% among women with no PTSD symptoms to about 16% in women with the most PTSD symptoms. (more…)
Author Interviews, Heart Disease, PTSD / 20.03.2014

Dr. Nancy Crum-Cianflone Deployment Health Research Department, Naval Health Research Center San Diego, CAMedicalResearch.com Interview with: Dr. Nancy Crum-Cianflone MD Deployment Health Research Department, Naval Health Research Center, San Diego, CA MedicalResearch.com: What are the main findings of the study? Dr. Nancy Crum-Cianflone: There have been several studies examining the health outcomes of service members who recently deployed to the conflicts in Iraq and Afghanistan.  However, none of these studies to date had examined the potential role of military deployment experiences and PTSD on coronary heart disease (CHD) among young US service members.  We believed that this would be an important study to undertake since these data would not only be useful to the US military, but may also have implications regarding job-related stressors on the health of young adults in the general population. After studying over 60,000 current and former US military personnel, we found that those who deployed and experienced combat were at a 60%-90% increased risk of subsequently developing CHD.  This finding was noted when we examined both self-reported CHD and medical record validated coronary heart disease.  These data suggest that experiences of intense stress may increase the risk for coronary heart disease over a relatively short period among young, previously healthy adults. (more…)
Author Interviews, Inflammation, JAMA, Mental Health Research, PTSD / 12.03.2014

Dr. Dewleen Baker MD Veterans Affairs (VA) San Diego Healthcare System, San Diego, California MedicalResearch.com Interview with: Dr. Dewleen Baker MD Veterans Affairs (VA) San Diego Healthcare System, San Diego, California MedicalResearch.com: What are the main findings of the study? Dr. Baker: The main finding of this study is that a marker of peripheral inflammation, plasma CRP may be prospectively associated with PTSD symptom emergence, suggesting that inflammation may predispose to PTSD. (more…)
Author Interviews, Brain Injury, JAMA, PTSD / 18.12.2013

Dewleen G. Baker, MD Department of Psychiatry School of Medicine, University of California, Veterans Affairs San Diego Healthcare System Veterans Affairs Center of Excellence for Stress and Mental Health San Diego, CaliforniaMedicalResearch.com Interview with: Dewleen G. Baker, MD Department of Psychiatry School of Medicine, University of California, Veterans Affairs San Diego Healthcare System Veterans Affairs Center of Excellence for Stress and Mental Health San Diego, California MedicalResearch.com: What are the main findings of the study? Dr. Baker: Pre-deployment psychiatric symptoms, combat intensity, and traumatic brain injury (TBI) were significant predictors of post-deployment PTSD symptom severity.  However, the strongest predictor was deployment-related TBI; mild TBI increased symptom scores by 23%, and moderate to severe injuries increased scores by 71%. (more…)
Author Interviews, JAMA, Mental Health Research / 03.12.2013

Ian Kronish, MD, MPHMedicalResearch.com Interview with: Ian Kronish, MD, MPH Assistant Professor of Medicine Center for Behavioral Cardiovascular Health Division of General Medicine Columbia University Medical Center MedicalResearch.com: What are the main findings of the study? Dr. Kronish: Among primary care patients with persistently uncontrolled blood pressure despite medication treatment, we found that medication non-adherence was more than twice as common in patients with PTSD (68%) as compared to patients without PTSD (26%). The association between PTSD and medication non-adherence remained present after adjustment for key covariates including regimen complexity and depression. Recent research shows that PTSD not only contributes to psychological distress, but is also associated with increased risk for incident and recurrent cardiovascular disease. The data from our study suggest that medication non-adherence may be an important mechanism by which PTSD increases risk for cardiovascular disease. (more…)