Possible new weapon against PTSD

September 1, 2015

Science Daily/Massachusetts Institute of Technology

Blocking a newly identified memory pathway could prevent the disorder

Animals who underwent chronic stress prior to a traumatic experience engaged a distinctive brain pathway that encodes traumatic memories more strongly than in unstressed animals, new research shows.


About 8 million Americans suffer from nightmares and flashbacks to a traumatic event. This condition, known as post-traumatic stress disorder (PTSD), is particularly common among soldiers who have been in combat, though it can also be triggered by physical attack or natural disaster.


Studies have shown that trauma victims are more likely to develop PTSD if they have previously experienced chronic stress, and a new study from MIT may explain why. The researchers found that animals who underwent chronic stress prior to a traumatic experience engaged a distinctive brain pathway that encodes traumatic memories more strongly than in unstressed animals.


Blocking this type of memory formation may offer a new way to prevent PTSD, says Ki Goosens, the senior author of the study, which appears in the journal Biological Psychiatry.


"The idea is not to make people amnesic but to reduce the impact of the trauma in the brain by making the traumatic memory more like a 'normal,' unintrusive memory," says Goosens, an assistant professor of neuroscience and investigator in MIT's McGovern Institute for Brain Research.


The paper's lead author is former MIT postdoc Michael Baratta.


Strong memories


Goosens' lab has sought for several years to find out why chronic stress is so strongly linked with PTSD. "It's a very potent risk factor, so it must have a profound change on the underlying biology of the brain," she says.


To investigate this, the researchers focused on the amygdala, an almond-sized brain structure whose functions include encoding fearful memories. They found that in animals that developed PTSD symptoms following chronic stress and a traumatic event, serotonin promotes the process of memory consolidation. When the researchers blocked amygdala cells' interactions with serotonin after trauma, the stressed animals did not develop PTSD symptoms. Blocking serotonin in unstressed animals after trauma had no effect.


"That was really surprising to us," Baratta says. "It seems like stress is enabling a serotonergic memory consolidation process that is not present in an unstressed animal."


Memory consolidation is the process by which short-term memories are converted into long-term memories and stored in the brain. Some memories are consolidated more strongly than others. For example, "flashbulb" memories, formed in response to a highly emotional experience, are usually much more vivid and easier to recall than typical memories.


Goosens and colleagues further discovered that chronic stress causes cells in the amygdala to express many more 5-HT2C receptors, which bind to serotonin. Then, when a traumatic experience occurs, this heightened sensitivity to serotonin causes the memory to be encoded more strongly, which Goosens believes contributes to the strong flashbacks that often occur in patients with PTSD.


"It's strengthening the consolidation process so the memory that's generated from a traumatic or fearful event is stronger than it would be if you don't have this serotonergic consolidation engaged," Baratta says.


Drug intervention


This memory consolidation process can take hours to days to complete, but once a memory is consolidated, it is very difficult to erase. However, the findings suggest that it may be possible to either prevent traumatic memories from forming so strongly in the first place, or to weaken them after consolidation, using drugs that interfere with serotonin.


"The consolidation process gives us a window in which we can possibly intervene and prevent the development of PTSD. If you give a drug or intervention that can block fear memory consolidation, that's a great way to think about treating PTSD," Goosens says. "Such an intervention won't cause people to forget the experience of the trauma, but they might not have the intrusive memory that is ultimately going to cause them to have nightmares or be afraid of things that are similar to the traumatic experience."


The Food and Drug Administration has already approved a drug called agomelatine that blocks this type of serotonin receptor and is used as an antidepressant.


Such a drug might also be useful to treat patients who already suffer from PTSD. These patients' traumatic memories are already consolidated, but some research has shown that when memories are recalled, there is a window of time during which they can be altered and reconsolidated. It may be possible to weaken these memories by using serotonin-blocking drugs to interfere with the reconsolidation process, says Goosens, who plans to begin testing that possibility in animals.


The findings also suggest that the antidepressant Prozac and other selective serotonin reuptake inhibitors (SSRIs), which are commonly given to PTSD patients, likely do not help and may actually worsen their symptoms. Prozac enhances the effects of serotonin by prolonging its exposure to brain cells. While this often helps those suffering from depression, "There's no biological evidence to support the use of SSRIs for PTSD," Goosens says.


"The consolidation of traumatic memories requires this serotonergic cascade and we want to block it, not enhance it," she adds. "This study suggests we should rethink the use of SSRIs in PTSD and also be very careful about how they are used, particularly when somebody is recently traumatized and their memories are still being consolidated, or when a patient is undergoing cognitive behavior therapy where they're recalling the memory of the trauma and the memory is going through the process of reconsolidation."



How exposure to brief trauma and sudden sounds form lasting memories

Study may speed improved treatments for hearing loss and symptoms of PTSD

August 24, 2015

Science Daily/NYU Langone Medical Center / New York University School of Medicine

Researchers have found how even brief exposure to sudden sounds or mild trauma can form permanent, long-term brain connections, or memories, in a specific region of the brain.


The NYU team says their new study, summarized in the cover article in the journal Nature Neuroscience online Aug. 24, is believed to be the first to explore an apparent connection between hearing and memory formation in the locus coeruleus as well as the first to successfully improve hearing in rats by manipulating the centrally located brain region whose neural network projects throughout the body.


"Our study gives us deeper insight into the functions of the locus coeruleus as a powerful amplifier in the brain, controlling how and where the brain stores and transforms sudden, traumatizing sounds and events into memories," says senior study investigator and neuroscientist Robert C. Froemke, PhD, an assistant professor at NYU Langone and its Skirball Institute of Biomolecular Medicine. "Our findings, if confirmed by future studies in animals and people, should help us better understand how to improve hearing and memory abilities in those suffering from hearing loss or possibly even Alzheimer's disease, as well as how to alter or minimize memories involved in disorders like post-traumatic stress disorder."


According to the investigators, their findings provide insight into how and where traumatizing events stick in our minds and may possibly explain why it may take years to learn dates in history class but only seconds to develop post-traumatic stress disorder, or PTSD, from a shock or sudden event. They also say these study results may help explain how electrical impulses, such as those produced by cochlear implants for the hearing impaired, can better be used to improve hearing, and how traumatizing memories can be reshaped or dampened to lessen symptoms of PTSD.


As part of the Froemke team's four-year investigation, led by Ana Raquel O. Martins, PhD, PharmD, the researchers chemically stimulated the locus coeruleus in rats while simultaneously playing them a sound paired with a food reward. After a two-week training period to ensure that the rats associated the sound with food, the same sound was played much more quietly. The researchers recorded activity in the same regions of their brain, as well as in the auditory cortex area responsible for interpreting sounds. They found that the locus coeruleus and auditory cortex still responded to the sound, even at nearly imperceptible levels, for the subsequent and remaining two weeks of the experiments.


However, chemically stimulating the locus coeruleus led to 100 percent neural activity in the auditory cortex, even in the absence of the same triggering sounds. Neural activity in the auditory cortex in response to the sounds was at least 10 times greater than when activity in the locus coeruleus was chemically suppressed.


According to Froemke, the results clearly demonstrate that the memory of the sound and its associated reward was encoded by the locus coeruleus, which helped improve the rats' ability to perceive the sound.


In another set of experiments, the investigators paired a specific sound with a series of mild shocks to the animals and found that when the shocks stopped, but the sound continued to play, their locus coeruleus response remained the same, at 20 neuron spikes per second.


Froemke says he next plans to investigate how information is encoded within the locus coeruleus and to identify which cells are activated by cochlear implants and in animal models of PTSD. He is also planning experiments to identify patterns formed in the locus coerelus during other behavioral events involving hearing, such as mothers responding to the cries and calls of their offspring.


Impact of sleep disturbance on recovery in veterans with PTSD and TBI

August 21, 2015

Science Daily/Boston University Medical Center

Poor sleep may impact treatment and recovery in veterans with Post-Traumatic Stress Disorder (PTSD) and Traumatic Brain Injury (TBI). A review of extensive research on sleep in TBI and PTSD has found that sleep-focused interventions can improve treatment outcomes in veterans.


Led by researchers at Boston University School of Medicine (BUSM) and VA Boston Healthcare System, the review article currently appears online in the journal of Clinical Psychology Review.


Sleep difficulty is a primary symptom of both PTSD and TBI and has been found to affect the severity of both conditions. TBI patients can suffer from permanent sleep problems regardless of the severity of their initial injury. Approximately 40 to 65 percent of individuals have insomnia after mild TBI, while patients with sleep difficulties are at a higher risk of developing PTSD. Despite recent attention, sleep has been understudied in the veteran population.


The review found that poor sleep often persists in veterans after resolution of their PTSD and mild TBI symptoms, but few treatments and rehabilitation protocols target sleep specifically. "In these veterans, sleep disturbances continue to adversely impact daily functioning and quality of life. "PTSD, TBI, and sleep problems significantly affect functional status and quality of life in veterans returning from combat," explains lead author Yelena Bogdanova, PhD, assistant professor of psychiatry at BUSM add VA title.


According to the researchers sleep is critical for restorative processes and evaluation of sleep problems should be integral to the clinical management of PTSD and TBI. "Understanding sleep problems and their role in the development and maintenance of PTSD and TBI symptoms may lead to improvement in overall treatment outcomes," added Bogdanova. "Future research efforts," she proposes, "should target the development of sleep-focused interventions."



Study finds association between people who have had a traumatic brain injury, ADHD

Findings suggest it may be useful to assess TBI history during screening, assessment of ADHD

August 20, 2015

Science Daily/St. Michael's Hospital

A new study has found a 'significant association' between adults who have suffered a traumatic brain injury at some point in their lives and who also have attention deficit hyperactive disorder.


The study, published in the Journal of Psychiatric Research, supports research that found a similar association in children, said Dr. Gabriela Ilie, lead author of the study and a post-doctoral fellow at St. Michael's Hospital.


The data used in the adult study was collected by the Centre for Addiction and Mental Health's Monitor, a continuous, cross-sectional telephone survey of almost 4,000 Ontario residents age 18 and older. Traumatic brain injury was described as any injury to the head that resulted in loss of consciousness for at least five minutes or overnight hospitalization. ADHD was measured by self-reported history of an ADHD diagnosis or the Adult ADHD Self-Report Scale known as the ASRS.


Among adults with a history of TBI, 5.9 per cent reported having been diagnosed with ADHD in their lifetime and another 6.6 per cent screened positive for ADHD when the self-report scale was conducted during the phone survey.


Recent clinical studies have suggested a relationship between ADHD and TBI that were experienced in childhood.


"This is not be surprising because some of the most persistent consequences of TBI include ADHD-like symptoms, such as memory and attention impairment, deficits in executive functions such as planning and organization, processing consonants and vowels and impulsive behaviour," Dr. Ilie said.


Other studies have suggested that TBI may lead to psycho-neurological changes that facilitate ADHD or ADHD may increase the probability that a person may fall or have another accident that will result in a TBI.


"Therefore it may be useful to assess TBI history during screening and assessment of ADHD in the adult population," Dr. Ilie said.


Dr. Robert Mann, senior scientist at CAMH and co-principal investigator said this latest study extends previous findings from the research team about the association between TBI and mental health and addiction issues.


"These new data suggest a significant association between ADHD and TBI," Dr. Mann said. "We see that adults with TBI are more than twice as likely than those without to report symptoms of ADHD."


Traumatic brain injuries are increasing in developed countries. The World Health Organization has predicted that by 2020 TBI will become the third largest contributor of disease and disability in the world, following heart disease and depressions.


Injuries from team sports such as hockey and football have been identified as the main source of TBI among youth, while falls and motor vehicle collisions are the main causes among adults.


Traumatic events take toll on the heart

New study links traumatic experiences with increased risk of heart disease, especially after the menopause transition

October 11, 2017

Science Daily/The North American Menopause Society (NAMS)

Today it seems about everything has been shown to lead to heart disease. Of course, smoking is bad for you, as is high blood pressure. There's even mounting evidence that psychosocial factors can cause heart problems. A new study demonstrates how traumatic experiences can affect vascular health and, ultimately, heart disease.


Heart disease is a leading cause of death in women. According to the American Heart Association, every minute in the US someone's mother, wife, daughter, or sister dies from a form a heart disease. To date, little research has been done to study the impact of traumatic experiences on vascular health as a precursor to heart disease. Even less work has focused on this relationship during the menopause transition when the risk of heart disease is naturally increasing, along with deteriorating endothelial function. (The endothelium is the inner lining of the heart and blood vessels.)


In this study of 272 peri- and postmenopausal nonsmoking women, researchers tested whether a greater number of lifetime traumatic experiences was related to poorer endothelial function, independent of demographic characteristics, other heart disease risk factors, estradiol, and childhood abuse history. The result was that women reporting a higher number of traumatic experiences (three or more) had poorer endothelial function which can make them more susceptible to a cardiac incident. For purposes of this study, traumatic experiences were defined as events such as sexual harassment, death of a child, being in a car accident, experiencing a natural disaster, or being beaten or mugged.


"These findings underscore the importance of psychosocial factors, such as trauma exposure, in the development of heart disease risk in midlife women," says Dr. Rebecca Thurston, lead author of the study from the University of Pittsburgh, School of Medicine.


"Given the large percentage of postmenopausal women affected by heart disease, this is an important study that should remind healthcare providers of the need to thoroughly discuss a woman's history beyond simply asking about her physical health," says Dr. JoAnn Pinkerton, NAMS executive director."


Women warriors at no greater risk for PTSD than men

August 20, 2015

Science Daily/Veterans Affairs Research Communications

While past research on the question has been mixed, a new study suggests that women in the military are at no greater risk than men for developing posttraumatic stress disorder, given similar experiences -- including combat.


The findings are in the September 2015 Journal of Psychiatric Research.


The study involved active-duty troops and veterans who are part of the Millennium Cohort Study. That effort has more than 200,000 participants in all.


The new PTSD study included more than 2,300 pairs of men and women who were matched based on an array of variables--including combat exposure--and followed about seven years, on average.


"This is the first study to prospectively investigate the development of PTSD in male and female service members who were matched on multiple important characteristics that could explain some of the differences in PTSD, including military sexual trauma," says one of the authors, Dr. Shira Maguen. "We found no gender differences in the development of PTSD. Consequently, our focus should be on the types of traumatic experiences that people have been exposed to, rather than any inherent gender differences in the development of PTSD."


Maguen is the mental health director of the OEF/OIF Integrated Care Clinic and a staff psychologist at the San Francisco VA Medical Center. She's also an associate professor at UCSF Medical School.


Lead author on the study was Dr. Isabel Jacobson of the Naval Health Research Center in San Diego.


All the men and women in the study were free of PTSD at the outset of the research, and they all deployed to Iraq or Afghanistan at least once. They completed a baseline survey in 2001 -- 2003, and follow-up surveys in 2004 -- 2006 and 2007 -- 2008.


While female troops in general are less likely to see combat, the researchers selected the study sample so there would be equal numbers of men and women with combat experiences. This was in addition to the pairs of men and women in the study being matched on factors such as age, race, education, marital status, service branch, and military occupation and pay grade.


The researchers also sought to match them on various health characteristics, including alcohol misuse, anxiety, and depression. Another factor the researchers took into account was stressful life events: divorce, a violent assault, or the death of a family member.


The matching technique helped ensure like-to-like comparisons. For example, while women service members are far more likely than men to experience sexual assault, the study matched men and women on this basis too, ensuring equal numbers of such events in each matched pair. The study also took into account sexual assaults that may have occurred over the follow-up period, during or after military service.


During the course of the study, 6.7 percent of women and 6.1 percent of men developed PTSD. The researchers say the difference was not statistically significant. Likewise, for those who did develop PTSD, there was no difference in severity between men and women.


Maguen points out that these rates of PTSD are lower than the commonly cited rates of 11 to 20 percent among returning Iraq and Afghanistan veterans because the study excluded men and women who had PTSD at the outset.


"Generally, when studies look at PTSD rates among returning veterans, they look at everyone, regardless of whether they had PTSD in the past from pre-military traumas or prior deployments. Here we were only looking at new cases," she explains.


In contrast to the new study, past research on civilians has found that women are at higher risk than men for PTSD. That body of literature, though, is not based on comparisons of men and women with similar trauma exposures.


Maguen: "I do think military women are extremely resilient, but I think the differences in rates in the civilian literature actually have to do with a number of factors, including women having much higher rates of interpersonal traumas, which we know put people at high risk for PTSD."


Maguen and her colleagues point to several limitations of their study. For example, while they tried to match men and women on the basis of military occupation--among all the other factors--they acknowledge that members with the same occupational code could have performed different duties while overseas.


Also, the survey questions about combat exposure may not have distinguished adequately between those who saw dead or wounded troops or civilians, and those who actively took part in the fighting.


Despite these and other limitations, the researchers say the study is the first to be able to answer the question: "If a man and woman are equivalent on all other factors, including history of sexual assault, which is more likely to develop PTSD in a deployed environment with or without experiencing combat?"


The researchers say the findings support Department of Defense efforts to integrate women into combat roles. Gender alone is not an indicator of PTSD risk, they say.


"This study supports the positive direction being taken by the expansion of women's occupations into combat arms roles, and suggests continued support from the [Department of Defense] for women seeking occupational equality in the military setting," write the authors.


Dr. Dawne Vogt, acting deputy director of the Women's Health Sciences Division of VA's National Center for PTSD, says, "These findings are important because of their focus on new-onset PTSD." She points out that they are consistent with those from "several other recent studies that have shown that U.S. female service members are no more vulnerable than male service members to the negative mental health consequences of warfare exposure."


Children of military parents, caregivers at greater risk for adverse outcomes

August 17, 2015

Science Daily/The JAMA Network Journals

Children with parents or caregivers currently serving in the military had a higher prevalence of substance use, violence, harassment and weapon-carrying than their nonmilitary peers in a study of California school children, according to an article.


While most young people whose families are connected to the military demonstrate resilience, war-related stressors, including separation from parents because of deployment, frequent relocation and the worry about future deployments, can contribute to struggles for some of them, according to the study background.


Kathrine Sullivan, M.S.W., of the University of Southern California School of Social Work, Los Angeles, and coauthors analyzed data collected in 2013 that included 54,679 military-connected and 634,034 nonmilitary-connected secondary school students from public civilian schools in every county and almost all the school districts in California. Students were defined as military connected if they had a parent or caregiver currently serving in the military. Latino students were the largest percentage of the sample (51.4 percent) and 7.9 percent of students indicated having a parent in the military, according to the results.


·      45.2 percent of military-connected youth reported lifetime alcohol use compared with 39.2 percent of their nonmilitary-connected peers

·      12.2 percent of military-connected youth reported recently smoking cigarettes in the previous 30 days compared with about 8.4 percent of their nonmilitary peers

·      62.5 percent of military-connected students reported any physical violence compared with 51.6 percent of nonmilitary-connected students

·      17.7 percent of military-connected youth reported carrying a weapon at school compared with 9.9 percent of nonmilitary students

·      11.9 percent of military-connected students reported recent other drug use (e.g., cocaine and lysergic acid diethylamide [LSD]) compared with 7.3 percent of nonmilitary peers


The authors note the data they used were cross-sectional and therefore cannot infer causality. The data also come from a self-report survey and students may have been reluctant to report risky behavior.


"Based on the totality of findings from this study and others, further efforts are needed to promote resilience among military children who are struggling. More efforts in social contexts, including civilian schools and communities, to support military families during times of war are likely needed," the study concludes.



Mindfulness-based stress reduction therapy decreases PTSD symptom severity among veterans

August 4, 2015

Science Daily/The JAMA Network Journals

In a randomized trial that included veterans with posttraumatic stress disorder (PTSD), those who received mindfulness-based stress reduction therapy showed greater improvement in self-reported PTSD symptom severity, although the average improvement appears to have been modest, according to a study.


Posttraumatic stress disorder affects 23 percent of veterans returning from Afghanistan and Iraq. Left untreated, PTSD is associated with high rates of other disorders, disability, and poor quality of life. Evidence suggests that mindfulness-based stress reduction, an intervention that teaches individuals to attend to the present moment in a nonjudgmental, accepting manner, can result in reduced symptoms of depression and anxiety. By encouraging acceptance of thoughts, feelings, and experiences without avoidance, mindfulness-based interventions target experiential avoidance, a key factor in the development and maintenance of PTSD, and may be an acceptable type of intervention for veterans who have poor adherence to existing treatments for PTSD, according to background information in the article.


Melissa A. Polusny, Ph.D., of the Minneapolis Veterans Affairs Health Care System, and colleagues randomly assigned 116 veterans with PTSD to receive nine sessions of mindfulness-based stress reduction therapy (n = 58) or present-centered group therapy (n = 58), an active-control condition consisting of nine weekly group sessions focused on current life problems. Outcomes were assessed before, during, and after treatment and at 2-month follow-up.


Participants in the mindfulness-based stress reduction group demonstrated greater improvement in self-reported PTSD symptom severity during treatment and at 2-month follow-up. Although participants in the mindfulness-based stress reduction group were more likely to show clinically significant improvement in self-reported PTSD symptom severity (49 percent vs 28 percent with present-centered group therapy) at 2-month follow-up, there was no difference in rates of loss of PTSD diagnosis at posttreatment (42 percent vs 44 percent) or at 2-month follow-up (53 percent vs 47 percent).


"Findings from the present study provide support for the efficacy of mindfulness-based stress reduction for the treatment of PTSD among veterans," the researchers write. "However, the magnitude of the average improvement suggests a modest effect."


Cures for PTSD often remain elusive for war veterans

August 4, 2015

Science Daily/NYU Langone Medical Center / New York University School of Medicine

New light shed on the 'invisible wounds of war'

Our nation's veterans continue to suffer emotional and psychological effects of war -- some for decades. And while there has been greater attention directed recently toward post-traumatic stress disorder, and more veterans are seeking help, current psychotherapy treatments are less than optimal, according to a new narrative review.


In a review of medical literature over a 35-year period, researchers from the Steven and Alexandra Cohen Center for Post-Traumatic Stress and Traumatic Brain Injury -- a program in the Department of Psychiatry at NYU Langone Medical Center -- and other institutions found that non-medical approaches to treat PTSD were effective in some patients but not in others, suggesting a need for broader, more personalized approaches to care.


The researchers looked at randomized clinical trials of psychotherapy for military-related PTSD to examine which psychotherapies improve symptoms. This included, in particular, a review of trials of two commonly-used, evidence-based treatment models: cognitive processing therapy (CPT) and prolonged exposure (PE) therapy.


Searches were conducted via PubMED, PsycINFO, and PILOTS for randomized clinical trials of individual and group psychotherapies for PTSD in military personnel and veterans published from January 1980 to March 2015. Of 891 publications initially identified, 36 were included in the JAMA Narrative review, representing 2,083 participants.


"Our findings showed that PE and CPT are not as broadly effective as we might have once thought or hoped," says Maria M. Steenkamp, PhD, assistant professor of psychiatry at NYU Langone and lead author of the study. "As many as two-thirds of veterans receiving CPT or PE keep their PTSD diagnosis after treatment, even if their symptoms improve. So there is room for improvement."


"The emotional effects of war are gaining attention," says Charles R. Marmar, MD, the Lucius Littauer Professor and chair of psychiatry at NYU Langone, director of its Cohen Veterans Center, and the senior author of the JAMA study. "And there are veterans from all wars who are struggling, not just those who most recently served in the wars in Iraq and Afghanistan."


In fact, recently released findings from another study led by Dr. Marmar and published July 22, 2015 in JAMA Psychiatry --the National Vietnam Veterans Longitudinal Study--found that over 270,000 Vietnam veterans -- 40 years since the end of that war -- are still suffering from clinically important levels of PTSD symptoms, and one-third of those have a current, major depressive disorder.


"There is a pressing need for innovation in treatments for PTSD and TBI to protect a new generation of veterans," adds Dr. Marmar.


Dr. Steenkamp suggests that the JAMA study indicates there is still much to learn about how to optimize PTSD treatments of veterans. "It is clear that there is no one-size-fits-all approach," she says. "Ideally, we have to move toward clinical options that match patients to treatments, based on their preferences and their comfort with talking about their trauma. One thing we do know is that veterans are unlikely to benefit unless they complete a full course of treatment. Finding ways to develop treatments that align with patient needs and preferences is important."


The U.S. Veterans Administration and the U.S. Department of Defense have been funding such approaches to treatment, Dr. Marmar says. "There are encouraging findings that while therapies that focus on processing trauma are generally effective for veterans who complete that course of treatment, there are alternatives for veterans who are emotionally unprepared to confront their war-zone experiences," he adds.


Understanding the underlying mechanisms that occur in specific patients is key. A novel five-year multicenter study led by NYU Langone's Cohen Veterans Center is looking into objective biological markers of PTSD and TBI in returning soldiers of the wars in Iraq and Afghanistan. The goal is to transform the way mental health disorders are diagnosed by identifying specific brain imaging and blood and other biological markers that can tell clinicians definitively that a person is suffering from PTSD or TBI or a combination. Presently, there is no single valid diagnostic test that can independently confirm either diagnosis. Stanford University, Emory University and the U.S. Department of Defense Systems Biology Program at Fort Detrick, Maryland are partners in this research.


"Collectively, these studies may bring us one-step further in tailoring treatment to the individual, monitoring progress, and measuring long-term effectiveness," Dr. Marmar says.


New insights into the circuitry of PTSD, mild traumatic brain injury

July 23, 2015

Science Daily/Elsevier

Posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) can have devastating consequences. Both are associated with high rates of disability and suicide, and although they are separate conditions, they commonly co-occur. For example, a soldier who has developed PTSD as a result of a traumatic experience may have also sustained a brain injury during that experience.


Significant research has been conducted to understand the brain mechanisms underlying PTSD and TBI, but there has still been a lack of knowledge regarding exactly which brain networks are disturbed in these disorders.


To fill this gap, Dr. Jeffrey Spielberg and his colleagues at the VA Boston Healthcare System examined brain networks in veterans with trauma exposure using functional magnetic resonance imaging and graph theory tools. As the authors explain, graph theory is a sophisticated analysis that allows us to understand brain networks at a level of complexity that was previously impossible. It permits examination of the patterns of brain connections, as opposed to examining individual connections.


The researchers recruited 208 veterans of Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn, all of whom had experienced a traumatic event. They found that veterans who had more severe PTSD re-experiencing symptoms (e.g., flashbacks or reliving the event) showed weaker connectivity in two networks.


The first altered network includes the hippocampus and prefrontal cortex, and is involved in providing contextual information. This suggests that perhaps the hippocampus may be overgeneralizing trauma-related memories, and therefore, fails to correctly classify non-threatening cues as "safe."


The second network, which was identified only in veterans with comorbid mild TBI, includes the basal ganglia and prefrontal cortex, and plays a role in working memory.


Because the veterans studied here had already experienced a traumatic event, this research cannot identify with certainty whether the observed brain network disturbances were present in these individuals before the trauma occurred, or whether they occurred as a result of the trauma exposure. Future research of at-risk individuals, perhaps examining soldiers before and after military deployment, will be necessary to clarify this point.


"It may never be possible to fully distinguish the role of the severity of stress, the capacity for resilience to stress effects, and the presence of mild TBI in PTSD-related distress and disability because these factors are so complex and intimately entwined," said Dr. John Krystal, Editor of Biological Psychiatry.


"However, this study suggests that there are subtle but important differences in brain circuit functional connectivity related to the impact of traumatic stress among individuals with and without TBI. These data provide additional evidence that TBI may complicate the capacity for recovery from traumatic stress-related symptoms."


Some Vietnam vets currently have PTSD 40 years after war ended

July 22, 2015

Science Daily/The JAMA Network Journals

While it has been 40 years since the Vietnam War ended, about 271,000 veterans who served in the war zone are estimated to have current full posttraumatic stress disorder (PTSD) plus subthreshold war-zone PTSD and more than one-third have current major depressive disorder, according to an article.


The study by Charles R. Marmar, M.D., of the New York University Langone Medical Center, and colleagues builds on the National Vietnam Veterans Readjustment Study (NVVRS), which was implemented from 1984 through 1988 (about 10 years after the war ended). The authors' National Vietnam Veterans Longitudinal Study (NVVLS) is the first follow-up to NVVRS. There were 1,839 veterans from the original study still living at the time of the NVVLS from July 2012 to May 2013 and 78.8 percent (n=1,450) of the veterans participated in at least one phase of the study.


The authors estimate a prevalence among male war zone veterans of 4.5 percent for a current PTSD diagnosis based on the Clinician-Administered PTSD Scale for DSM-5; 10.8 percent based on that assessment plus subthreshold PTSD; and 11.2 percent based on the PTSD Checklist for DSM-5 items for current war-zone PTSD. Among female veterans, the estimates were 6.1 percent, 8.7 percent and 6.6 percent, respectively.


The study also found coexisting major depression in 36.7 percent of veterans with current war-zone PTSD.


About 16 percent of war zone Vietnam veterans reported an increase of more than 20 points on a PTSD symptom scale while 7.6 percent reported a decrease of greater than 20 points on the symptom scale. "An important minority of Vietnam veterans are symptomatic after four decades, with more than twice as many deteriorating as improving," the study notes.


The authors conclude: "Policy implications include the need for greater access to evidence-based mental health services; the importance of integrating mental health treatment into primary care in light of the nearly 20 percent mortality; attention to the stresses of aging, including retirement, chronic illness, declining social support and cognitive changes that create difficulties with the management of unwanted memories; and anticipating challenges that lie ahead for Iraq and Afghanistan veterans," the study concludes.


Editorial: Measuring the Long-Term Impact of War Zone Military Service


In a related editorial, Charles W. Hoge, M.D., of the Walter Reed Army Institute of Research, Silver Spring, Md., writes: "This methodologically superb follow-up of the original NVVRS cohort offers a unique window into the psychiatric health of these veterans 40 years after the war's end. No other study has achieved this quality of longitudinal information, and the sobering findings tell us as much about the Vietnam generation as about the lifelong impact of combat service in general, relevant to all generations."


Why does PTSD increase the risk of cardiovascular disease?

July 15, 2015

Science Daily/American Physiological Society (APS)

A new review article finds that post-traumatic stress disorder (PTSD) leads to overactive nerve activity, dysfunctional immune response and activation of the hormone system that controls blood pressure. These changes can ultimately increase risk of cardiovascular disease.


The authors found evidence that PTSD leads to overactive nerve activity, dysfunctional immune response and activation of the hormone system that controls blood pressure (the renin-angiotensin system). "These changes ultimately contribute to the culmination of increased cardiovascular disease risk," the authors wrote. Cardiovascular events, including stroke and heart attack, also can be stressful enough to cause PTSD symptoms, "putting these individuals at greater risk for future adverse cardiovascular events," the authors noted.



People over 65 with traumatic brain injuries hospitalized four times as often as younger people

July 6, 2015

Science Daily/St. Michael's Hospital

Rate of seniors being hospitalized with TBI increased 24 percent from 2006-07 to 2010-11

A disproportionate number of people hospitalized in Canada with traumatic brain injuries are 65 years or older, a new study has found. While that age group represents only 14 per cent of the Canadian population, it accounted for 38 per cent of hospitalizations for TBI between 2006-07 and 2010-11.


While that age group represents only 14 per cent of the Canadian population, it accounted for 38 per cent of hospitalizations for TBI between 2006-07 and 2010-11, according to the study published in the Journal of Trauma. That's 3.8 times greater than for people under 65.


Furthermore, the rate of seniors being hospitalized with TBI increased 24 per cent from 2006-07 to 2010-11. In contrast, hospitalization rates declined 8 per cent among those under 65 and there was a significant decrease in those in the 15-24 age group. Together, these trends resulted in an increase in the median age of hospitalized TBI patients from 48 to 56 years.


The researchers looked at data from the Hospital Morbidity Database to examine nationwide trends in TBI hospitalizations and deaths. There were 116,614 TBI-related hospitalizations in Canada during the study period, resulting in 10,185 deaths.


"During this study period, hospitalization rates remained steady for children and young adults, but increased significantly among adults ages 65 and older," said author Terence Fu, a medical student with the Injury Prevention Research Office of St. Michael's Hospital.


"Elderly adults were most vulnerable to falls and experienced the greatest increase, 29 per cent, in fall-related hospitalization rates. Young adults were most at risk for motor vehicle collisions, but experienced the greatest decline in MVC-related admissions."


Falls and motor vehicle collisions were the most commons causes of TBI, representing 51 per cent and 27 per cent of hospitalizations. However, TBI hospitalizations due to falls were on the rise -- increasing 24 per cent over the study period -- while hospitalizations due to motor vehicle collisions dropped 18 per cent. People over 65 were most vulnerable to fall-related TBIs, with 61 per cent of all falls occurring in that age group. Falls accounted for 82 per cent of hospitalizations among the elderly but only 32 per cent of hospitalizations among those under age 65.


The rise in fall-related TBI among the elderly likely relates to the rapid growth in this age group combined with the fact that people are living longer with more complex health issues and the likelihood of taking multiple medications. The oldest segment of the population is also most at risk of death following hospitalization for TBI, with a 1.4 to 2.0 fold higher risk of dying in-hospital compared to those ages 0-4.


Dr. Michael Cusimano, a neurosurgeon and the senior author on the work, said that the numbers also show that those who are admitted to hospital with TBI are sicker and more severely injured than they used to be so, hospitals and health care professionals should be prepared to manage more severe TBIs and older patients with more complex comorbidities. Declining rates of motor vehicle collisions, especially for children and young adults (ages 5-24) may be attributable to increased awareness and successful injury prevention policies. Over the past 15 years most Canadian provinces have introduced some form of graduated licensing programs, which includes requirements for adult supervision, lower demerit point thresholds and zero blood alcohol concentration limits for new and young drivers. Stricter federal impaired driving laws and improved enforcement over the study period could have further contributed to reduced motor vehicle collision rates. The increased use of child safety seats and recent introduction of federal child safety seat legislation could account for the decline in MVC rates among very young children.



Sleep deprivation could reduce intrusive memories of traumatic scenes

July 1, 2015

Science Daily/University of Oxford

A good night's sleep could be the wrong response to trauma

A good night's sleep has long been recommended to those who have experienced a traumatic event. But a new study provides preliminary experimental work suggesting it could actually be the wrong thing to do.


The research, conducted in Oxford's Wellcome Trust-funded Sleep and Circadian Neuroscience Institute (SCNi) and published in the journal Sleep, showed that sleep deprivation might prevent people from consolidating memories of experimental trauma (emotional film clips in the study), reducing their tendency to experience flashbacks.


Dr Kate Porcheret, from Oxford's Nuffield Department of Clinical Neurosciences, said: 'We wanted to see what effect sleep deprivation would have on the development of intrusive memories -- what in a clinical setting are called flashbacks. After showing participants a film of scenes with traumatic content, as an analogue to trauma, they were either kept in a sleep laboratory and deprived of sleep or sent home to have a normal night's sleep in their own bed.'


Each person then kept a diary in which they recorded any intrusive memories, however fleeting, recording as much information as possible so that the research team could check that the intrusive images were linked to the film.


Dr Katharina Wulff, from the SCNi, said: 'The sleep-deprived group experienced fewer intrusive memories than those who had been able to sleep normally. Both groups experienced more of these involuntary memories in the first two days and a reducing number in the following days. We know that sleep improves memory performance including emotional memory, but there may be a time when remembering in this way is unhelpful.'


The team stress that further research is needed as there is currently limited understanding of intrusive memories of emotional events as well as of the role of sleep in responding to real trauma, and that real-life trauma cannot be directly replicated in an laboratory study.


Dr Porcheret added: 'Finding out more how sleep and trauma interact means we can ensure people are well cared for after a traumatic event. These are really important research questions to pursue further. For example, it is still common for patients to receive sedatives after a traumatic event to help them sleep, even though we already know that for some very traumatised people this may be the wrong approach. That is why we need more research in both experimental and clinical settings into how our response to psychological trauma is affected by sleep -- and lack of sleep too.'



PTSD, traumatic experiences may raise heart attack, stroke risk in women

June 29, 2015

Science Daily/American Heart Association

Women with severe PTSD or traumatic events may have a 60 percent higher lifetime risk of cardiovascular disease. The study is the first to examine trauma exposure, PTSD, and onset of cardiovascular disease exclusively in women. Researchers suggest physicians ask women about traumatic events and PTSD symptoms and then monitor them for cardiovascular issues.


In the first major study of PTSD and onset of cardiovascular disease (both heart attacks and strokes) exclusively in women, researchers examined about 50,000 participants in the Nurses' Health Study II over 20 years.


PTSD occurs in some people after traumatic events (such as a natural disaster, unwanted sexual contact or physical assault). Patients may experience flashbacks of the trauma, insomnia, fatigue, trouble remembering or concentrating, and emotional numbing. Other symptoms include nightmares, irritability or being startled easily. PTSD is twice as common in women as in men.


In the study:


Women with four or more PTSD symptoms had 60 percent higher rates of cardiovascular disease compared to women who weren't exposed to traumatic events.


Women with no PTSD symptoms but who reported traumatic events had 45 percent higher rates of cardiovascular disease. Almost half of the association between elevated PTSD symptoms and cardiovascular disease was accounted for by unhealthy behaviors like smoking, obesity, lack of exercise and medical factors such as high blood pressure. "PTSD is generally considered a psychological problem, but the take-home message from our findings is that it also has a profound impact on physical health, especially cardiovascular risk," said Jennifer Sumner, Ph.D., lead author and an Epidemiology Merit Fellow at Columbia University's Mailman School of Public Health in New York City and a Visiting Scientist at the Harvard T.H. Chan School of Public Health in Boston. "This is not exclusively a mental problem -- it's a potentially deadly problem of the body as well."


Most studies of cardiovascular disease risk in PTSD patients have been conducted in men who have served in the military or among disaster survivors.


The current study, conducted by a team of researchers at Columbia and Harvard-Chan, is unique in that it examined women from the community who were exposed to a variety of traumatic events.


Our results provide further evidence that PTSD increases the risk of chronic disease," said. Karestan C. Koenen, the study's senior author and Professor of Epidemiology at Columbia University Mailman School of Public Health and Harvard T. H. Chan School of Public Health. "The medical system needs to stop treating the mind and the body as if they are separate. Patients need access to integrated mental and physical healthcare."


Researchers used a questionnaire to evaluate different types of traumatic experiences and PTSD symptoms. They also considered cardiovascular disease risk factors such as obesity, lack of exercise, diabetes, cigarette smoking, high blood pressure, and other contributors to cardiovascular health such as excessive alcohol use, and hormone replacement use.


PTSD emerged as a risk factor for cardiovascular disease in a sample of women under the age of 65. Physicians should be aware of this link and screen for cardiovascular disease risk, as well as monitor related health conditions and behaviors, including encouraging changes in lifestyle factors that may increase this risk, Sumner said.


More than half of the people in the United States who suffer from PTSD don't get treatment, especially minorities. Women need to get mental healthcare to treat symptoms as well as be monitored for signs of cardiovascular problems, she said.



Predictors of depression, PTSD among African-Americans, Latinos

June 25, 2015

Science Daily/University of California, Los Angeles (UCLA), Health Sciences

Chronic disease and mental health issues disproportionately affect low-income African-Americans, Latinos and Hispanics. Researchers have developed a screening tool that may provide better treatment.


The first study, published online by the journal Psychological Trauma, analyzed certain types of negative experiences that may affect low-income African-Americans and Latinos. It found five specific environmental factors, which the researchers call "domains," that can predict adult depression, anxiety and post-traumatic stress disorder.


In the second study, published online by the journal Psychological Assessment, researchers used the same five domains to develop a new screening tool for use in clinical settings. The UCLA Life Adversities Screener, or LADS, is a brief questionnaire that can help providers offer more accurate treatment for stress and trauma.


The five domains identified in the first study are:


• Experiences of discrimination due to racial, ethnic, gender or sexual orientation


• A history of sexual abuse


• A history of violence in the family or from an intimate partner


• A history of violence in an individuals' community


• A chronic fear of being killed or seriously injured


The researchers said the effects of these experiences are cumulative and their impact accrues over a person's lifetime.


"The costs to society of these life experiences are substantial," said Hector Myers, a former UCLA psychology professor and first author of the Psychological Trauma study. (Myers is now a professor at Vanderbilt University.) "We know there is a poorer overall quality of life, a loss of productivity, greater social dependency, disability, health and mental health care costs, and early mortality as a result of repeated experiences of stress and trauma."


In the first study, researchers asked 500 low-income African American and Hispanic men and women to self-report various measures of stress and mental health, including experiences of discrimination, childhood violence, poverty and trauma. Using structural equation modeling -- statistical methods designed to test a concept or theory -- they found a correlation between the cumulative burden of these adversities and the likelihood the subjects would later experience psychological distress. They also found that the greater people's overall burden of these experiences over their lifetime, the greater the likelihood that they would experience more severe symptoms of depression, anxiety and PTSD.


"Unfortunately, much of the psychological distress stemming from chronic life stress and trauma remains undetected and untreated," said Gail Wyatt, a professor of psychiatry at the UCLA Semel Institute for Neuroscience and Human Behavior and a senior author of both studies.


"Only a small proportion of individuals with psychological distress are identified in health care settings, and a smaller fraction of those ever receive appropriate treatment, especially for the experiences of discrimination," said Wyatt, who also is director of UCLA's Center for Culture, Trauma and Mental Health Disparities. "We talk about being discriminated against, but people don't learn how to cope with it effectively throughout their lives. If they don't manage it well enough, the consequences can be long-lasting and life-threatening."


The second study was led by first author Honghu Liu, a professor in the UCLA School of Dentistry. Working with the five domains, the researchers used regression modeling -- a statistical process for estimating relationships among variables -- to develop the LADS, a set of questions health care providers can use to screen patients for the effects of adversity and trauma.


"Given the utility and ease of use, LADS could be effective as a screening tool to identify ethnic and racial minority individuals in primary care settings who have a high trauma burden, and who need more extensive evaluation," said Liu, who is an expert in the design of research studies, data analysis and statistical modeling. "We feel it will capture experiences that could be missed with current screening approaches. This could optimize affordable care as it strives to improve prevention of mental health problems."


The Congressional Budget Office estimates that 16 million people have gained health insurance under the Patient Protection and Affordable Care Act. "The ACA provides a unique opportunity to identify those who have not been assessed for the adversities and trauma that can affect mental health needs. This research could provide the tools to make that assessment," Wyatt said.


"The next step is to offer individuals tools to more effectively cope with the adversities and trauma that they endure. One of the advantages of affordable primary care is that we will have the opportunity to offer skills for people who have not had mental health care for those experiences, one day soon. They will no longer have to manage on their own."



Impact of repetitive heading in soccer needs more research, say experts

February 10, 2014

Science Daily/St. Michael's Hospital

Soccer is the most-popular and fastest-growing sport in the world and, like many contact sports, players are at risk of suffering concussions from collisions on the field.


But researchers warned in a paper published today that not enough attention has been given to the unique aspect of soccer -- the purposeful use of the head to control the ball -- and the long-term consequences of repetitive heading.


The literature review by Dr. Tom Schweizer, director of the Neuroscience Research Program of St. Michael's Hospital, was published in the journal Brain Injury.


More than 265 million people play soccer worldwide, including 27 million in North America. Due to the nature of the sport, players are particularly vulnerable to head and neck injuries. Most are caused by unintentional or unexpected contact, such as when a player collides with teammates, opponents or the playing surface.


There is significant concern in the sporting and medical worlds about the potential long-term cognitive and behavioral consequences for athletes who suffer acute or repeat concussions or multiple "sub-concussive" head impacts -- blows to the head not causing symptoms of concussions.


"The practice of heading, which might occur thousands of times over a player's career, carries unknown risks, but may uniquely contribute to cognitive decline or impairment in the short- or long-term," said Dr. Schweizer, a neuroscientist. "Thus, soccer players present a unique opportunity to study whether cumulative sub-concussive impacts affect cognitive functioning, similar to that of concussions."


Examining research papers that studied the incidence of concussion in soccer, he found that concussions accounted for 5.8 per cent to 8.6 per cent of total injuries sustained during games. One study found that 62.7 per cent of varsity soccer players had suffered symptoms of a concussion during their playing careers, yet only 19.2 per cent realized it. Another found that 81.8 per cent of athletes who had suffered a concussion had experienced two or more and that players with a history of concussion had a 3.15 times greater odds of sustaining another one than those who had never had a concussion. One study found concussions sustained during soccer accounted for 15 per cent of the total number of concussions in all sports. In particular, girls' soccer accounted for 8.2 per cent of sports-related concussions, the second highest sport after football.


Research papers that looked at the mechanism of injury found 41.1 per cent of concussions resulted from contact by an elbow, arm or hand to the head. One found that 58.3 per cent of concussions occurred during a heading duel. More females suffered concussions from player-to-surface and player-to-ball contact than males who had more player-to-player contact than females.


Defensemen and goalkeepers are at greatest risk of suffering a concussion, the study found. Dr. Schweizer said that for goalkeepers, the risk decreases as they get older and become more aware of where they are at any given time in relation to the goal posts. He said padding goal posts might be one way to reduce concussions in younger players who don't have such a developed sense of spatial relations.


Studies on the long-term effects of heading found greater memory, planning and perceptual deficits in forwards and defenders, players who execute more headers. One study found professional players reporting the highest prevalence of heading during their careers did poorest in tests of verbal and visual memory as well as attention. Another found older or retired soccer players were significantly impaired in conceptual thinking, reaction time and concentration. The few studies that used advanced imaging techniques found physical changes to the brains in players who had concussions.


Monica Maher, a co-author and University of Toronto master's degree student in neuroscience, said the researchers wanted to emphasize possible injury prevention methods.


"Use of protective headgear, limiting heading exposure or stressing proper heading technique in younger children and increasing concussion education are all suggestions to perhaps decrease the incidence of head injury and their subsequent effects in the long run," she said.


Children with TBI have poorer sleep quality, more daytime sleepiness

June 8, 2015

American Academy of Sleep Medicine

Children with traumatic brain injuries have poorer sleep and more daytime sleepiness in comparison to healthy children, new research confirms. The children with TBI also had impaired emotional, physical and social functioning when compared to healthy children.


Results show that children with TBI were more likely to experience greater daytime sleepiness, sleep disturbances and a poorer overall sleep quality. The children with TBI also had impaired emotional, physical and social functioning when compared to healthy children.


"We were surprised that children with a TBI experienced persistent increases in daytime sleepiness and decreases in sleep quality compared to healthy children," said principal investigator Kimberly Allen, PhD, RN, assistant professor, Center for Narcolepsy, Sleep and Health Research, Department of Women Children and Family Health Science, at the University of Illinois-Chicago.


The research abstract was published recently in an online supplement of the journal Sleep and will be presented June 8, in Seattle, Washington, at SLEEP 2015, the 29th annual meeting of the Associated Professional Sleep Societies LLC.


The study group comprised 15 children with TBI and 15 healthy children, matched on age, race and maternal education level. Parents of children with TBI and parents of health children completed three surveys related to their child's sleep behaviors and sleep quality: Children's Sleep Habits Questionnaire (CSHQ), Child Sleep Wake Scale (CSWS), and th


Poor sleep quality linked to reduced resilience among veterans

June 8, 2015

Science Daily/American Academy of Sleep Medicine

Poor sleep quality is associated with reduced resilience among veterans and returning military personnel, a new study suggests. Findings suggest that appraisal of sleep quality may contribute to resilience scores more than self-reported sleep efficiency.


Results show that 63 percent of participants endorsed poor sleep quality, which was negatively associated with resilience. Longer sleep onset, lower sleep efficiency, shorter sleep duration, worse sleep quality, and greater daytime disturbance were each associated with lower resilience. Findings suggest that appraisal of sleep quality may contribute to resilience scores more than self-reported sleep efficiency.


'To our knowledge, this study is the first to examine the relationship between resilience, defined here as positive stress-coping ability, and self-reported sleep quality among veterans and active duty service-members of the Iraq and Afghanistan conflicts,' said lead author Jaime M. Hughes, MPH, MSW, research affiliate at Durham VA Medical Center and doctoral student at the University of North Carolina-Chapel Hill.


The research abstract was published recently in an online supplement of the journal Sleep and will be presented June 8 in Seattle, Wash., at SLEEP 2015, the 29th annual meeting of the Associated Professional Sleep Societies LLC.


The study group comprised 2,597 Iraq and Afghanistan military veterans. Eighty percent were male with a mean age of 37 years. An in-person assessment captured resilience (Connor-Davidson Resilience Scale), Post-Traumatic Stress Disorder (Davidson Trauma Scale), sleep quality (Pittsburgh Sleep Quality Index), and combat exposure (Combat Exposure Scale).

'These results support the need for additional research to better understand resilience as it relates sleep behaviors and sleep quality. Such findings may contribute to a better understanding of how chronic sleep disturbance impacts an individual's adaptive and functional capacities upon reintegration, and can help to inform the development of novel sleep interventions,' said Hughes.


High risk of sleep apnea in young veterans with PTSD

May 19, 2015

Science Daily/American Academy of Sleep Medicine

The probability of having a high risk of obstructive sleep apnea increased with increasing severity of post-traumatic stress disorder symptoms (PTSD), a new study of young US veterans shows. The study involved 195 Iraq and Afghanistan veterans who visited a Veterans' Affairs outpatient PTSD clinic for evaluation. Results show that 69.2 percent of participants had a high risk for sleep apnea, and this risk increased with PTSD symptom severity.


The study involved 195 Iraq and Afghanistan veterans who visited a VA outpatient PTSD clinic for evaluation. Results show that 69.2 percent of participants had a high risk for sleep apnea, and this risk increased with PTSD symptom severity. Every clinically significant increase in PTSD symptom severity was associated with a 40 percent increase in the probability of screening as high risk for sleep apnea.


"The implication is that veterans who come to PTSD treatment, even younger veterans, should be screened for obstructive sleep apnea so that they have the opportunity to be diagnosed and treated," said co-principal investigator Sonya Norman, PhD, researcher at the San Diego VA, director of the PTSD Consultation Program at the National Center for PTSD, and an associate professor of psychiatry at the University of California San Diego School of Medicine. "This is critical information because sleep apnea is a risk factor for a long list of health problems such as hypertension, cardiovascular disease and diabetes, and psychological problems including depression, worsening PTSD and anxiety."


The American Academy of Sleep Medicine reports that obstructive sleep apnea is a common sleep disease afflicting at least 25 million adults in the U.S. Sleep apnea warning signs include snoring and choking, gasping or silent breathing pauses during sleep. The AASM and other partners in the National Healthy Sleep Awareness Project, which is funded by the Centers for Disease Control and Prevention, urge anyone with symptoms of sleep apnea to visit http://www.stopsnoringpledge.org to pledge to "Stop the Snore" by talking to a doctor.


The study idea was initiated by Tonya Masino, MD, who was the first to recognize that a surprising number of younger veterans who were coming to the clinic for PTSD treatment also were presenting with sleep apnea symptoms. Study results are published in the May 15 issue of the Journal of Clinical Sleep Medicine.


Ninety-three percent of study participants were men, and their mean age was 33 years. Sleep apnea risk was evaluated using the Berlin Questionnaire, and PTSD was assessed using the PTSD Checklist Stressor Specific Version (PCL-S) questionnaire. Analyses controlled for potential confounders such as older age, smoking status, and use of central nervous system depressants.


According to the authors, younger veterans with PTSD are rarely screened for sleep apnea and frequently remain undiagnosed. They noted that the mechanism underlying the relationship between sleep apnea and PTSD in military veterans is unclear. However, potential factors that may connect the two disorders include disturbed sleep in combat, prolonged sleep deprivation, sleep fragmentation and hyperarousal due to the physical and psychological stressors of combat, the chronic stress from PTSD, or the sleep disturbances caused by OSA. Longitudinal studies are needed to examine the temporal relationship between sleep apnea and PTSD.


The study was led by Norman and co-principal investigator Abigail Angkaw, PhD. The lead author of the study is Peter Colvonen, PhD.


According to the National Center for PTSD of the U.S. Department of Veterans Affairs, PTSD symptoms such as nightmares or flashbacks usually start soon after a traumatic event, but they may not appear until months or years later. Symptoms that last longer than four weeks, cause great distress or interfere with daily life may be a sign of PTSD. To get help for PTSD, veterans can call the Veterans Crisis Line at 1-800-273-8255 and press 1, text 838255, contact a local VA Medical Center, or use the online PTSD program locator on the VA website.


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