Hope for veterans with an overlooked form of post-traumatic stress disorder
Clinical study finds excellent treatment response to standard psychotherapy in veterans with subclinical PTSD
March 17, 2016
Science Daily/Medical University of South Carolina
In an article published in the March 2016 issue of the Journal of Anxiety Disorders, investigators in the Department of Psychiatry and Behavioral Sciences at the Medical University of South Carolina (MUSC) report that veterans who fall just below the threshold for a diagnosis of post-traumatic stress disorder (PTSD) respond to a psychotherapy regimen better than those with full PTSD. The study highlights the need to recognize veterans suffering from an overlooked condition called subclinical PTSD. "The study shows not only that we can treat those experiencing subclinical presentations of PTSD, but also that those with subclinical PTSD may actually respond better to treatment than those with more severe forms of the disease," says MUSC investigator Kristina Korte, Ph.D., who is the first author on the article. MUSC co-authors include Ron Acierno, Ph.D., Daniel F. Gros, Ph.D., and Nicholas P. Allan, MS.
Just like patients with full PTSD, those with subclinical PTSD have experienced a traumatic event and are regularly re-experiencing it, often in nightmares or flashbacks. Patients with full PTSD also experience hyperarousal (i.e., they are easily startled) and avoid reminders of the event, for example by withdrawing from social interaction or turning to substance abuse. In addition re-experiencing the event, patients with subclinical PTSD may exhibit either hyperarousal or avoidance, but not both.
Psychologists began noticing this pattern more frequently in the nineties in veterans returning from the first Iraq War, and even more frequently in veterans returning from Iraq and Afghanistan in the last decade. As researchers have learned more about these patients over time, varying and sometimes conflicting symptoms have provided an incomplete picture of the disorder and how to treat it. Further confounding the issue is that those with subclinical PTSD are often excluded from clinical trials testing treatments for PTSD--patients with only some symptoms of PTSD commonly aren't included in the healthy control group or in the group with full PTSD. As a result, there is still no standard psychotherapy for treating subclinical PTSD as there is for full PTSD.
The researchers devised an intuitive approach -- Why not treat subclinical PTSD patients with one of the standard evidence-based psychotherapy tools already being used in PTSD patients? They enrolled 200 patients with combat-related PTSD symptoms from the Ralph H. Johnson VA Medical Center located adjacent to MUSC, identifying those with either subclinical or full PTSD. For eight weeks, patients received intensive weekly sessions of behavioral activation and therapeutic exposure therapy, designed to lessen their PTSD symptoms by helping them safely re-experience and resolve elements of the original trauma. Psychologists rated the patients' PTSD symptoms and had patients rate their own symptoms before, during, and after the eight weeks.
The results were encouraging. Those with subclinical or full PTSD each experienced a real drop in PTSD symptoms after treatment. The striking result was in how much those symptoms dropped: 29% in those with subclinical PTSD as compared to 14% with full PTSD.
It may seem obvious that patients with a less severe form of PTSD would respond better to standard psychotherapy, but the implications for treatment extend beyond that. PTSD symptoms often worsen over time; as they do, treatments become less effective at reducing symptoms. In this context, subclinical PTSD could be seen as "early-stage" PTSD, in that treatment might be more effective when the disorder is caught early.
Gros' group hopes these early studies can move beyond men in combat to civilians of both sexes.
"It is our hope that providing treatment for subclinical PTSD could have a significant impact on the cost-effectiveness of treating this common disorder," says Korte. "It could lead to the prevention of more intractable forms of PTSD that can occur when subclinical PTSD goes untreated."
https://www.sciencedaily.com/releases/2016/03/160317084553.htm
Can yoga help those experiencing depression, anxiety or PTSD?
Potential benefits of yoga for people who experience mental health problems related to trauma
March 9, 2016
Science Daily/University of North Carolina at Chapel Hill
Across the country, health and human service providers have shown a growing interest in using yoga as an option for treating people who experience mental health problems. But a recent study has found that while there are some promising benefits to using yoga, there isn't yet enough evidence to support the practice as a standalone solution for improving mental health and well-being.
"I really wanted to know if yoga is something we should be suggesting to people who have post-traumatic stress disorder, or depression, or anxiety or various traumas. What does the evidence really say?," said Rebecca Macy, a researcher who works with violence and trauma survivors who headed up the study at the UNC School of Social Work.
For their study, Macy and her colleagues analyzed 13 literature reviews to conduct a meta-review of 185 articles published between 2000 and 2013. Overall, the researchers found that yoga holds potential promise for helping improve anxiety, depression, PTSD and/or the psychological consequences of trauma at least in the short term.
The study, published recently in the journal Trauma, Violence, & Abuse, also suggested that clinicians and service providers consider recommending yoga as an intervention in addition to other "evidence-based and well-established treatments," including psychotherapy and medication.
"Even though I do think yoga is, in general, incredibly beneficial, I also think there needs to be a whole lot more education about how to use yoga specifically to treat survivors of trauma in order to be the most effective and helpful," said Leslie Roach, a certified yoga instructor and massage therapist who co-authored the study. "So as a standalone treatment right now, it's just not viable. However, I think with more education, more research, and more experienced instructors, it will be."
Macy and Roach are considering several possible future studies, including one that would examine the use of yoga within a rape crisis center or domestic violence shelter. However, because yoga is a holistic practice, researchers must be careful not to "undermine yoga's approach," Macy added.
"One of our recommendations was that researchers and yoga instructors partner together so that we use holistic methods in future research," Macy said. "We need to ask ourselves if we're taking these Western research methods and trying too hard to fit a round peg in a square hole. As a researcher, I don't want to undo the potential benefits of yoga by making the practice unnecessarily standard and systematic."
https://www.sciencedaily.com/releases/2016/03/160309140042.htm
Brain boost: Research to improve memory through electricity?
February 29, 2016
Science Daily/Office of Naval Research
In a breakthrough study that could improve how people learn and retain information, researchers significantly boosted the memory and mental performance of laboratory mice through electrical stimulation.
Dr. Claudio Grassi (right) and two members of his research team at the Catholic University Medical School in Rome, Italy. In a breakthrough study that could improve how people learn and retain information, the researchers significantly boosted the memory and mental performance of laboratory mice through electrical stimulation.
Credit: Photo provided by Dr. Claudio Grassi
The study, sponsored by the Office of Naval Research (ONR) Global, involved the use of Transcranial Direct Current Stimulation, or tDCS, on the mice. A noninvasive technique for brain stimulation, tDCS is applied using two small electrodes placed on the scalp, delivering short bursts of extremely low-intensity electrical currents.
"In addition to potentially enhancing task performance for Sailors and Marines," said ONR Global Commanding Officer Capt. Clark Troyer, "understanding how this technique works biochemically may lead to advances in the treatment of conditions like post-traumatic stress disorder, depression and anxiety--which affect learning and memory in otherwise healthy individuals."
The implications of this research also have great potential to strengthen learning and memory in both healthy people and those with cognitive deficits such as Alzheimer's.
"We already have promising results in animal models of Alzheimer's disease," said Dr. Claudio Grassi, who leads the research team. "In the near future, we will continue this research and extend analyses of tDCS to other brain areas and functions."
After exposing the mice to single 20-minute tDCS sessions, the researchers saw signs of improved memory and brain plasticity (the ability to form new connections between neurons when learning new information), which lasted at least a week. This intellectual boost was demonstrated by the enhanced performance of the mice during tests requiring them to navigate a water maze and distinguish between known and unknown objects.
Using data gathered from the sessions, Grassi's team discovered increased synaptic plasticity in the hippocampus, a region of the brain critical to memory processing and storage.
Although tDCS has been used for years to treat patients suffering from conditions such as stroke, depression and bipolar disorder, there are few studies supporting a direct link between tDCS and improved plasticity--making Grassi's work unique.
More important, the researchers identified the actual molecular trigger behind the bolstered memory and plasticity--increased production of BDNF, a protein essential to brain growth. BDNF, which stands for "brain-derived neurotrophic factor," is synthesized naturally by neurons and is crucial to neuronal development and specialization.
"While the technique and behavioral effects of tDCS are not new," said ONR Global Associate Director Dr. Monique Beaudoin, "Dr. Grassi's work is the first to describe BDNF as a mechanism for the behavioral changes that occur after tDCS treatment. This is an exciting and growing research area of great interest to ONR."
Beaudoin said tDCS treatment could one day benefit Sailors and Marines, from helping them learn faster and more effectively to easing the effects of post-traumatic stress disorder.
"Our warfighters face tremendous challenges that are both physically and cognitively taxing," she said. "They perform their duties in stressful environments where there are often suddenly and randomly varying levels of environmental stimulation, disrupted sleep cycles and a constant need to stay alert and vigilant.
"We want to explore all interventions that could help them stay healthy and perform optimally in these environments--especially when treatments are potentially noninvasive, effective and lead to long-lasting changes."
https://www.sciencedaily.com/releases/2016/02/160229152918.htm
Can gaming mend damaged brains?
February 24, 2016
Science Daily/Taylor & Francis
An innovative research study carried out by Macquarie University, Australia, has found that first person shooter computer games, such as Medal of Honor, can help rehabilitate patients with Traumatic Brain Injuries.
This type of injury can leave patients with brain damage unable to carry out basic day to day tasks or return to work, because they have problems processing basic information. In, Cognitive Rehabilitation of Attention Deficits in Traumatic Brain Injury using Action Video Games: A Controlled Trial, Clinical Neuropsychologist Dr Alexandra Vakili details a pilot study on patients with this type of injury.
Participants were trained on a first person shooter game while they were taught skills and strategies based on the problems presented in the game, to see if the program would help improve their attention and ability to process information. Crucially, participants not only got better at the game, but were able to carry out some everyday tasks faster and more successfully than the control group.
'This type of injury can have lifelong implications,' said Dr Alexandra Vakili, 'rehabilitation is a long process, but without intervention the patient may never return to work. The economic benefits of retraining cognitive functioning benefits both the individual and the community at large.'
The study used an action video game and a commercially available video game console as a cognitive rehabilitation tool for Traumatic Brain Injury, building on previous research that demonstrates action video game players make faster and more accurate judgments.
Given that the typical demographic of Traumatic Brain Injury survivors is young men, a computer-assisted intervention has immediate appeal, and reduces the need for specialized equipment.
'What we need now,' said Dr Alexandra Vakili, 'are larger randomised controlled trials in this area, to build on the positive results reported by the participants. The potential that action gaming has to help this set of patients is really exciting.'
https://www.sciencedaily.com/releases/2016/02/160224133524.htm
Longer, intense rehabilitation boosts recovery after brain injury
February 22, 2016
Science Daily/University of California, San Diego Health Sciences
Cognitive and functional recovery after a stroke or traumatic injury requires intense rehabilitative therapy to help the brain repair and restructure itself. New findings report that not only is rehabilitation vital but that a longer, even more intense period of rehabilitation may produce even greater benefit.
"This has implications for medical practice and medical insurance," said senior study author Mark Tuszynski, MD, PhD, professor in the Department of Neurosciences and director of the Center for Neural Repair at UC San Diego School of Medicine, and a neurologist with the VA San Diego Healthcare System. "Typically, insurance supports brief periods of rehab to teach people to get good enough to go home. These findings suggest that if insurance would pay for longer and more intensive rehab, patients might actually recover more function."
The findings are published in the February 22 online early edition of PNAS.
In recent years, numerous studies have documented the surprising plasticity or ability of the adult central nervous system to recover from injury. The emerging question has been how to best encourage the repair and regrowth of damaged nerve cells and connections.
To better understand what happens at the molecular and cellular levels and how rehabilitation might be made more effective after brain injury, researchers studied rats relearning skills and physical abilities. They found rats that received intensive therapy for an extended period of time showed significant restructuring of the brain around the damage site: Surviving neurons sprouted greater numbers of dendritic spines, which made more connections with other neurons. The result, said Tuszynski, was a dramatic 50 percent recovery of function.
Animals that did not undergo intensive rehabilitation did not rebuild brain structure or recover function.
Additionally, the researchers found that a key system in the brain -- the basal forebrain cholinergic system -- is critical to rehabilitation. Structures in this part of the brain, such as the nucleus basalis, produce acetylcholine, a chemical released by nerve cells to send signals to other cells. Specifically, motor neurons release acetylcholine to activate muscles.
Damage to the cholinergic system, which can occur naturally during aging, completely blocks brain plasticity mediated by rehabilitation and significantly reduces functional recovery. Tuszynski said the finding suggests that a class of drugs called cholinesterase inhibitors, which boost the levels and persistence of acetylcholine and are used in some treatments for Alzheimer's disease, might further improve functional outcomes after brain injury.
"We did not try to do this in our study," said Tuszynski, "but we did suggest future studies could be done to look at this possibility."
https://www.sciencedaily.com/releases/2016/02/160222155824.htm
Targeting the mind/body connection in stress
Researchers combine genetic testing and brain imaging to determine vulnerability to PTSD
February 4, 2016
Science Daily/American Friends of Tel Aviv University
New research used cutting-edge brain imaging technologies to determine that the brain function responsible for regulating our stress response can also produce a personal profile of resilience to stress. These findings may lead to a future blood test that would facilitate early intervention in professions prone to high stress or trauma such as combat soldiers and policemen.
Our ability to cope with stress depends on how efficiently our body and mind regulate their response to it. Poor recovery from extremely stressful encounters can trigger post-traumatic stress disorder (PTSD), depression, or even chronic somatic dysfunction (such as pain and fatigue) in some people. Insight into the multi-level sequence of events -- from cellular changes to brain function, emotional responses, and observed behavior -- will help medical professionals make more informed decisions concerning interventions.
A new Tel Aviv University study published in PLOS ONE provides it. Researchers have used cutting-edge genetic research and brain imaging technologies to determine that the brain function responsible for regulating our stress response intertwines with molecular regulatory elements to produce a personal profile of resilience to stress. Their findings may lead to a future blood test that would facilitate preventive or early intervention in professions prone to high stress or trauma (combat soldiers and policemen, for example).
The research was led jointly by Prof. Talma Hendler of TAU's Sagol School of Neuroscience and the Director of the Functional Brain Center at Tel Aviv Sourasky Medical Center and Dr. Noam Shomron of TAU's Sagol School of Neuroscience and Sackler School of Medicine. Research for the study was conducted by TAU doctoral students Dr. Sharon Vaisvaser and Dr. Shira Modai.
The biological complexity of stress
"We can't look at one measurement at one point in time and think we have the whole picture of the stress response," Prof. Hendler explained. "This is perhaps the first study to induce stress in the lab and look at resulting changes to three levels of the stress response -- neural (seen in brain imaging), cellular (measured through epigenetics), and experience (assessed through behavioral report)."
"We found that vulnerability to stress is not only related to a predisposition due to a certain gene," said Dr. Shomron. "The relevant gene can be expressed or not expressed according to a person's experience, environment, and many other context-related factors.
"This type of interaction between the environment and our genome has been conceptualized lately as the 'epigenetic process.' It has become clear that these processes are of an utmost importance to our health and well being, and are probably, in some cases, above and beyond our predispositions."
The research for this study was conducted on 49 healthy young male adults. Researchers integrated the analysis of fMRI images of brain function during an acute social stress task and also measured levels of microRNAs -- small RNAs that exert potent regulatory effects -- obtained in a blood test before and three hours after the induced stress. Dr. Vaisvaser explains, "Twenty minutes after the stress drill ended, we had two groups: the sustainers, those still stressed, and the recovered, those no longer stressed. The sustainers either didn't go back to baseline or took much longer to do so."
The researchers found that a specific alteration in the expression of the microRNA miR-29c was greater among the stress sustainers, implying a marker of slow recovery. Intriguingly, this change corresponded with modified connectivity of a major stress regulation node in the brain, the vento-medial prefrontal cortex (vmPFC).
The researchers were able to interpret functions in the brain through RNA molecules tested in the blood. They found that miR-29c played a mediating role, linking the enhancement of vmPFC connectivity with the anterior insula, a core node in the saliency network, sustaining the feeling of stress.
From basic research to practical treatment
"We all need to react to stress; it's healthy to react to something considered a challenge or a threat," said Prof. Hendler. "The problem is when you don't recover in a day, or a week, or more. This indicates your brain and'or body do not regulate properly and have a hard time returning to homeostasis (i.e., a balanced baseline). We found that this recovery involves both neural and epigenetic/cellular mechanisms, together contributing to our subjective experience of the stress.
"Knowing the brain metric that corresponds to such genetic vulnerability will make it possible to develop a personalized plan for brain-guided treatment based on a blood test."
"If you can identify through a simple blood test those likely to develop maladaptive responses to stress, you can offer a helpful prevention or early intervention," Dr. Shomron added.
"Conducting a collaborative interdisciplinary study is a great challenge," said Dr. Vaisvaser. "But the challenge is worth it, opening up new ways of looking at dynamics between concurrent factors contributing to the overall experience of stress."
The researchers are currently taking the study forward to look for the dynamic oscillations in the epigenetic markers of people suffering from stress disorders to confirm whether they can be modified via brain-targeted treatments.
http://www.sciencedaily.com/releases/2016/02/160204111636.htm
Soldiers with PTSD more 'tuned' to angry faces because of over-connected brain circuits
Understanding the brain's responses to angry faces could help diagnosis
January 20, 2016
Science Daily/Elsevier
Soldiers with post-traumatic stress disorder (PTSD) are more 'tuned' to perceive threatening facial expressions than people without PTSD because of more over-connected brain circuits, according to a new study. The researchers say understanding how this works could help researchers develop better ways to assess when soldiers are ready to be redeployed.
A study of the Canadian Armed Forces estimates that 86% of those serving in the armed forces will experience some kind of trauma, such as physical or sexual assault, combat or disaster. This leads to around 7% of those in the Canadian Military developing PTSD at some point in their lives, the risk being higher in soldiers compared to civilians.
PTSD is diagnosed by a physician or psychologist, and can be treated with psychotherapy and medication. However, it is difficult to assess as the symptoms can vary considerably; many are similar to those of concussion -- such as memory loss and attention deficit -- so the two conditions can be confused. Understanding the brain circuitry that makes PTSD patients more sensitive to threatening facial expressions could help identify ways to scan the brain and diagnose the condition.
"The heightened perception of anger in PTSD is driven by complicated brain circuitry where the mechanism of communication among a number of key regions that control fear and emotion is over-connected," explained Dr. Benjamin Dunkley, lead author of the study from SickKids.
"Potentially, our new findings can tell us about the heightened threat perception people with PTSD experience -- known as hyperarousal -- and allow us to develop novel ways of assessing treatment and determining when a soldier is ready to return to deployment."
Individuals with PTSD have a heightened perception of threat, caused by changes in brain activity. Parts of the brain crucial for emotional reactions, called the amygdalae, are overactive and trigger the "fight or flight" response more readily. The part of the brain that is important for inhibiting fear, called the ventral medial prefrontal cortex, is underactive. However, we do not yet understand how these two regions communicate.
In the new study, Dr. Dunkley and the team showed Canadian Armed Forces soldiers with and without PTSD pictures of angry and happy faces and monitored their brain activity. They carried out the study with 20 soldiers with PTSD and 25 without, and compared the brain activity in the amygdalae and ventral medial prefrontal cortex between the two groups.
The results showed that the soldiers' behavioural reactions to the faces were similar, but their brain responses were very different. The researchers found that a high number of brain regions were over-connected in soldiers with PTSD when they were shown photos of angry faces, but not when they looked at happy faces.
Furthermore, they found that both the amygdala and the ventral medial prefrontal cortex were highly connected to other brain regions in soldiers with PTSD when looking at angry faces. This suggests that the heightened perception of threat experienced by those with PTSD is caused by a set of brain regions and circuits becoming over-connected.
"We were surprised to find that all key brain circuits were over-connected in PTSD," said Dr. Dunkley. "This may be why emotional responses are so immediate and automatic, and why threatening faces are such a trigger. These findings emphasize the challenges of living with this PTSD and treating PTSD."
Similar studies had been done previously using MRI, but this method involves a time lag between the response and the measurement, which affects the results. For the new study, the researchers used a technique called magnetoencephalography (MEG) that can directly measure brain activity in real-time.
"The latest advances in imaging techniques are pushing forward the boundaries of what we know about the human central nervous system, and are increasingly being used to study psychiatric and neurological conditions, providing valuable information about the neurobiological basis of such disorders," said Dr. Dunkley. "PTSD is a complicated, multifaceted disorder that can be now be studied using these advanced techniques."
http://www.sciencedaily.com/releases/2016/01/160120091706.htm
Transcendental Meditation may reduce PTSD symptoms, medication use in active-duty personnel
January 11, 2016
Science Daily/Medical College of Georgia at Georgia Regents University
Regular practice of Transcendental Meditation enables some active duty service members battling post-traumatic stress disorder to reduce or even eliminate their psychotropic medication and get better control of their often-debilitating symptoms, researchers report.
The study looked at 74 active-duty service members with PTSD or anxiety disorder, often resulting from multiple deployments over multiple years, who were seeking treatment at Dwight David Eisenhower Army Medical Center's Traumatic Brain Injury Clinic at Fort Gordon, Georgia.
Half the service members voluntarily practiced Transcendental Meditation regularly in addition to their other therapy; half did not. At one month, 83.7 percent of the meditators had stabilized, reduced or stopped their use of psychotropic drugs to treat their conditions while 10.9 percent had increased their medication dosage.
Of those who did not meditate, 59.4 percent had stabilized, reduced or stopped taking psychotropic drugs while 40.5 percent were taking more medication. Similar percentages held up in the following months and by six months, non-meditators had experienced about a 20 percent increase in their symptoms compared with those using the meditation practice.
Headaches, memory, sleep and mood issues are the big four symptoms following a concussion, and these patients had multiple concussions that occurred in the heat of war, said Dr. John L. Rigg, physiatrist at Eisenhower and the study's senior author. Rigg is program director of the military hospital's TBI Clinic, one of the largest of its kind in the nation, which offers an intensive outpatient approach where service members with mild brain injuries learn skills to help with their PTSD.
"Concussions heal, but this is a unique concussion because it happened when somebody was trying to kill them," Rigg said. "It's not like you or I were riding bikes on the weekend and fell down and hit our head. There is significant emotional trauma, hyperarousal of basic instincts of survival. They are having a normal reaction to an abnormal situation, which is being in an environment where somebody is trying to kill them on a daily basis."
"Regular practice of Transcendental Meditation provides a habit of calming down and healing the brain," said Dr. Vernon A. Barnes, physiologist at the Georgia Prevention Institute at the Medical College of Georgia at Augusta University. Barnes, the study's lead author, teaches Eisenhower's TBI Clinic patients the practice, which he recommends be done twice daily for 20 minutes.
Transcendental Meditation takes users from a level of active thinking to a state of inner quietness that reduces levels of stress hormones and activation of the sympathetic nervous system, which drives the so-called fight-or-flight response by increasing heart rate and blood pressure, Barnes said.
When soldiers come home, that hyperactive state can come with them, leaving them on edge, irritable, anxious, prone to overreacting, and more. Memory problems can continue because they have trouble concentrating on anything beyond potential dangers.
"Even going to a crowded restaurant for dinner can be problematic," said Rigg with the echo of the 24-hour warzone mantra "strangers are dangers" replaying in their head. In this hypervigilant state of mind, a soldier might be inclined to get a table where he can sit with his back to the wall and monitor other patrons' comings and goings rather than the conversation his partner is trying to have with him.
Eisenhower Army Medical Center is among the first to use Transcendental Meditation in active duty personnel, although the practice has been more widely used with veterans. Rigg, who has worked at Eisenhower since 2008, quickly realized that medication, such as antidepressants and anti-anxiety drugs, often are not sufficient to help active duty personnel struggling with PTSD. In the pursuit of non-pharmacologic options, his friend, former Kansas City Royals shortstop Buddy Biancalana, told him about the work of the David Lynch Foundation's Operation Warrior Wellness, which teaches Transcendental Meditation to veterans. David Lynch Foundation Director of Research Dr. Sarina Grosswald put Rigg in touch with Barnes, whose years of work with Transcendental Meditation includes demonstrating its ability to lower blood pressure in black adolescents with above-normal blood pressures.
In addition to using evidence-based therapies, such as cognitive processing therapy, where service members learn ways to better handle their distressing thoughts, the Eisenhower clinic staff wanted better ways to help restore a more regular state of awareness in these hyperaroused individuals, said Jennifer J. Williams, social worker and primary behavioral health therapist at the TBI Clinic. After regularly practicing Transcendental Meditation, soldiers began to report that they felt less irritable, slept better, and their relationships were improving, said Williams, a study co-author.
While there was some skepticism among service members when they added Transcendental Meditation to the skill list in early 2012, the clinic now has a waiting list for the course where Barnes first introduces the technique's origin and benefits before teaching the technique. Other mind-body techniques used in the clinic, such as yoga, helped pave the way for Transcendental Meditation, which is still not considered a frontline treatment, Rigg said.
The researchers note that health care providers may be hesitant to reduce medication dosage in these patients because they are not certain whether the stabilization is due to meditation or medication. Previous studies, including a 1985 study in Vietnam Veterans, showed that soldiers who practiced Transcendental Meditation instead of taking medication experienced significantly reduced PTSD symptoms.
Response rates to psychotropic medication -- such as the selective serotonin reuptake inhibitors also used for depression -- for PTSD and anxiety disorders is only about 30 percent, the researchers report. Treatment success can be further complicated by brain injury, drug abuse, and sleep and mood disorders. PTSD medications have a host of potential side effects including exacerbating memory loss and depression. Transcendental Meditation has no known adverse side effects.
PTSD affects about 13 percent of service members deployed to Operations Enduring and Iraqi Freedom. Finding the optimal therapy remains in debate as these prolonged wars have large numbers of active duty and veteran personnel struggling with the emotional aftershock, the researchers write.
http://www.sciencedaily.com/releases/2016/01/160111121344.htm
Veterans, civilian patients at risk of ICU-related PTSD up to a year post discharge
January 7, 2016
Science Daily/American Thoracic Society
One in ten patients is at risk of having new post-traumatic stress disorder (PTSD) related to their ICU experience up to a year post-discharge. This was the finding from a multicenter, prospective cohort research study of veterans and civilians.
In the study "Incidence and Risk Factors for ICU-related Posttraumatic Stress Disorder in Veterans and Civilians," researchers led by Mayur Patel, MD, MPH, FACS, Assistant Professor of Surgery & Neurosurgery at Vanderbilt University Medical Center and Staff Surgeon and Surgical Intensivist at the Nashville VA Medical Center, analyze data from a cohort of medical and surgical ICU survivors enrolled in studies from three Veterans Affairs hospitals (MIND-ICU Study, NCT00400062) and one civilian hospital (BRAIN-ICU Study, NCT00392795). Using the PTSD Checklist for the DSM-IV to determine PTSD for this study, among PTSD measurements listed by the U.S. Department of Veteran Affairs' National Center for PTSD, a total of 181 patients were assessed at three months and 160 were further assessed at 12 months.
The cumulative incidence of PTSD was 6 percent to 12 percent within one year following hospitalization. "Although lower than prior research and public perception suggests, the rate of ICU-related PTSD is very comparable to the 8 percent PTSD rates seen in current and former service members deployed to the recent Iraq and Afghanistan conflicts," Patel said. "It is important to understand more about PTSD following the traumatizing events of a critical illness so we can better support the growing number of ICU survivors."
PTSD can occur in patients after the traumatizing events of critical illness, and this 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 this study 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 study is the first to also include the expanding and aging Veteran population.
Assessing risk factors for ICU-related PTSD, the researchers found that pre-existing PTSD as well as prior depression were strong risk factors associated with ICU-related PTSD at three and 12 months post-discharge. Being a veteran did not increase risk of ICU-related PTSD, nor did duration of delirium, amount of pain medication, or amount of sedative.
"Currently, the international psychological aftercare for ICU survivors is not organized proactively; rather, it is largely reactive in response to disabling reports from survivors, caregivers, and primary care providers. The Institute of Medicine in the United States has recommended a systematic collection, analysis, and dissemination of data assessing the quality of post-conflict PTSD care in the military and veteran populations. We suggest that the same should apply to the large civilian and veteran populations of critically ill survivors," the authors advised.
http://www.sciencedaily.com/releases/2016/01/160107094420.htm
Posttraumatic stress disorder reveals an imbalance between signalling systems in the brain
December 1, 2015
Science Daily/Uppsala University
Experiencing a traumatic event can cause life-long anxiety problems, called posttraumatic stress disorder. Researchers now show that people with posttraumatic stress disorder have an imbalance between two neurochemical systems in the brain, serotonin and substance P. The greater the imbalance, the more serious the symptoms patients have.
Many people experience traumatic events in life, e.g. robbery, warfare, a serious accident or sexual assault. Approximately 10 percent of people subjected to trauma suffer long-lasting symptoms in the form of disturbing flashbacks, insomnia, hyperarousal and anxiety. If these problems lead to impairment, the person is said to suffer from posttraumatic stress disorder, PTSD.
It has previously been shown that people with PTSD have altered brain anatomy and function. A new study by researchers from the Department of Psychology at Uppsala University and Clinical Neuroscience at Karolinska Institutet shows that people with PTSD have an imbalance between two neurochemical signalling systems of the brain, serotonin and substance P. Professors Mats Fredrikson and Tomas Furmark led the study using a so-called PET scanner to measure the relationship between these systems.
The study, which has been published in the scientific journal Molecular Psychiatry, shows that it is the imbalance between the two signalling systems which determines the severity of the symptoms suffered by the individual rather than the degree of change in a single system. Others have previously speculated that the biological basis of psychiatric disorders such as PTSD includes a shift in the balance between different signalling systems in the brain but none has yet proved it. The results of the study are a great leap forward in our understanding of PTSD. It will contribute new knowledge which can be used to design improved treatments for traumatised individuals.
"At present, PTSD is often treated with selective serotonin re-uptake inhibitors (SSRIs) which have a direct effect on the serotonin system. SSRI drugs provide relief for many but do not help everybody. Restoring the balance between the serotonin and substance P systems could become a new treatment strategy for individuals suffering from traumatic incidents," says lead author Andreas Frick, researcher at the Department of Psychology, Uppsala University.
http://www.sciencedaily.com/releases/2015/12/151201093515.htm
Younger generations of those in the military more vulnerable to suicide
November 18, 2015
Science Daily/SAGE
While many researchers have largely focused on risk factors among individual soldiers, in a new study, researchers contend that the increase in suicide may also indicate increased vulnerability among more recent generations of young adults.
In the last 10 years, the U.S. military has experienced an unprecedented increase in suicides among personnel. While many researchers have largely focused on risk factors among individual soldiers, in a new study, researchers contend that the increase in suicide may also indicate increased vulnerability among more recent generations of young adults. Evidence supporting this perspective is out today in Armed Services and Society (a SAGE journal).
James Griffith and Craig Bryan from the National Center for Veterans Studies at The University of Utah build on research suggesting that increased young adult suicide rates reflect generational declines in social integration (such as access to predictable, stable, and enduring relationships for support and relief) and behavioral regulation (norms that determine the acceptability of certain behaviors).
Griffith and Bryan noted scientific evidence reflecting increased emotional and behavioral problems among younger generations of high school and college students, as well as generational shifts in their values. Of note, more recent generations of high school and college students report that they value fame and wealth more but value community relations, interest in social problems, and civic engagement less than earlier generations. These changes have been especially pronounced during the transition from Generation Xers to the Millennials.
"The fact that a comparable rise in suicides has not been seen among adolescents and young adults more broadly across the U.S. suggests the possibility that the Army is recruiting individuals with more risk factors," the researchers noted.
Recruitment trends since the elimination of the draft and the inception of the All-Volunteer Force support this possibility. Since the elimination of the military draft, the number of volunteers for military service has diminished. Of this pool of volunteers, nearly half are accepted into military service; a much larger proportion of the full volunteer pool than the 7% acceptance rate that existed during the time of the military draft. Of those recruits accepted into military service, larger proportions have waivers for health conditions or behavior problems, and a larger proportion come from nontraditional family structures.
http://www.sciencedaily.com/releases/2015/11/151118070812.htm
Child abuse rises in connection with soldiers' deployments
Large study explores child maltreatment patterns in families of US Army soldier-parents
November 13, 2015
Science Daily/Children's Hospital of Philadelphia
Children under age two may be at heightened risk for abuse and neglect during the six months immediately following a parent's return from deployment in the US Army, and the risk may rise among Army families with soldiers who are deployed more than once, suggests new research.
Researchers from the PolicyLab at The Children's Hospital of Philadelphia (CHOP) performed one of the largest longitudinal retrospective studies analyzing child abuse and neglect among Army families. Supported by the Defense Health Program, the study appeared in the American Journal of Public Health.
"Prior research had revealed an increased risk to children while parents were deployed, mostly due to supervisory neglect while parents were overseas," said the study's senior author, David M. Rubin, M.D., MSCE, the co-director of PolicyLab. "This study is the first to reveal an increased risk when soldiers with young children return home from deployment. This demonstrates that elevated stress when a soldier returns home can have real and potentially devastating consequences for some military families."
"While incidents of child abuse and neglect among military families are well below that of the general population, this study is another indicator of the stress deployments place on soldiers, family members and caregivers," said Karl F. Schneider, Principal Deputy Assistant Secretary of the Army for Manpower and Reserve Affairs. "Since the end of the data collection period in 2007, the Army has enacted myriad programs to meet these kinds of challenges head on, and we will continue working to ensure services and support are available to soldiers, families, and their children."
The study drew on two different measures of child abuse from Army databases: substantiated child maltreatment reports and medical diagnoses of child maltreatment. The substantiated reports, collected by the Family Advocacy Program (FAP) of the Department of Defense, captured four types of child maltreatment: physical, sexual, and emotional, and neglect. The medical diagnoses were identified from TRICARE, the healthcare program for U.S. service members and their families.
The study included children under age two in Army families of over 112,000 soldiers deployed once or twice during the years 2001 to 2007. The first two years of a child's life are known to be a period of high stress for families.
The researchers compared patterns of abuse and neglect in Army families of soldiers deployed only once versus those deployed twice. The study focused on the first two years of a child's life because of the elevated risk for life-threatening child abuse among infants that exceeds risk in all other age groups.
Although the proportion of families whose children were identified with abuse or neglect was low, the researchers found there was an elevated risk of abuse and neglect specifically during the six months immediately following a soldier's one-time deployment. When soldiers were deployed twice, the highest rate of abuse and neglect occurred during the second deployment, and was usually perpetrated by a non-soldier caregiver. The rate of substantiated child abuse and neglect doubled during the second deployment compared to the first deployment period.
"The finding that in most cases the perpetrators were not the soldiers themselves reveals to us that the stress that plays out in Army families during or after deployment impacts the entire family, and is not simply a consequence of the soldier's experience and stress following deployment," said Christine Taylor, the study's lead author, a project manager at CHOP's PolicyLab.
The Family Advocacy Program offers a breadth of valuable services to families, such as parenting classes, child care services, and classes focused on a soldier's reintegration into home life. Ultimately, these findings may inform efforts by the military and civilian systems to standardize care and support military families during all periods of elevated risk.
http://www.sciencedaily.com/releases/2015/11/151113105622.htm
Study details prevalence of PTSD in Vietnam War women vets
October 7, 2015
Science Daily/The JAMA Network Journals
Women who served in Vietnam have higher odds of posttraumatic stress disorder (PTSD) than women stationed during that era in the United States, and this effect appears to be associated with wartime exposures including sexual discrimination or harassment and job performance pressures, according to a new article.
During the Vietnam era, approximately 5,000 to 7,500 American women served in the U.S. military in Vietnam, at least 2,000 were stationed at nearby bases in Japan, the Philippines, Guam, Korea and Thailand, and 250,000 were in the United States. Most of the deployed women were nurses, although others filled clerical, medical and personnel positions. Although women were excluded from combat, women in Vietnam were still in a war theater and many of those stationed near Vietnam were exposed to casualties and other stressors.
Kathryn Magruder, Ph.D., M.P.H., of the Johnson Veterans Affairs Medical Center, Charleston, S.C., and coauthors report the main findings from the Department of Veterans Affairs (VA) Cooperative Study 579, the Health of Vietnam-Era Women's Study (HealthVIEWS).
Among the 4,219 women (48.3 percent) who completed a survey and telephone interview, 1,956 served in Vietnam, 657 were near Vietnam and 1,606 served in the United States. Most of the women who served in Vietnam and in the United States were in the Army, while most of the women who served near Vietnam were in the Air Force. Women in Vietnam were more likely to be nurses.
The lifetime prevalence of PTSD was 20.1 percent for women in Vietnam, 11.5 percent for women near Vietnam and 14.1 percent for women in the United States. The prevalence for current PTSD active within the past year was 15.9 percent for women in Vietnam, 8.1 percent for women near Vietnam and 9.1 percent for women stationed in the U.S., the study reports.
Wartime exposure increased the odds of PTSD, especially exposure to sexual harassment and job performance pressure, according to the results. Sexual discrimination or harassment, which is not thought of as a unique war zone exposure, was higher among deployed women and related to PTSD in every model of analysis.
The authors acknowledge their findings differ from another national study of PTSD among Vietnam-era women veterans. They also note nonrespondents to the study, including those who have died, may have had a different PTSD prevalence. "Because current PTSD is still present in many of these women decades after their military service, clinicians who treat them should continue to screen for PTSD symptoms and be sensitive to their noncombat wartime experiences," the study concludes.
http://www.sciencedaily.com/releases/2015/10/151007124802.htm
High-fructose diet slows recovery from brain injury
October 2, 2015
Science Daily/University of California, Los Angeles (UCLA), Health Sciences
A diet high in processed fructose sabotages rat brains’ ability to heal after head trauma, neuroscientists report. Revealing a link between nutrition and brain health, the finding offers implications for the 5.3 million Americans living with a traumatic brain injury, or TBI.
Revealing a link between nutrition and brain health, the finding offers implications for the 5.3 million Americans living with a traumatic brain injury, or TBI. According to the Centers for Disease Control and Prevention, an estimated 1.7 million people suffer a TBI each year, resulting in 52,000 annual deaths
"Americans consume most of their fructose from processed foods sweetened with high-fructose corn syrup," said Fernando Gomez-Pinilla, a professor of neurosurgery and integrative biology and physiology at UCLA's David Geffen School of Medicine. "We found that processed fructose inflicts surprisingly harmful effects on the brain's ability to repair itself after a head trauma."
Fructose also occurs naturally in fruit, which contains antioxidants, fiber and other nutrients that prevent the same damage.
In the UCLA study, published in the Journal of Cerebral Blood Flow and Metabolism, laboratory rats were fed standard rat chow and trained for five days to escape a maze. Then they were randomly assigned to a group that was fed plain water or a group that was fed fructose-infused water for six weeks. The fructose was crystallized from corn in a dose simulating a human diet high in foods and drinks sweetened with high-fructose corn syrup.
A week later, the rats were anesthetized and underwent a brief pulse of fluid to the head to reproduce aspects of human traumatic brain injury. After an additional six weeks, the researchers retested all the rats' ability to recall the route and escape the maze.
The scientists discovered that the animals on the fructose diet took 30 percent longer to find the exit compared to those who drank plain water.
The UCLA team also found that fructose altered a wealth of biological processes in the animals' brains after trauma. The sweetener interfered with the ability of neurons to communicate with each other, rewire connections after injury, record memories and produce enough energy to fuel basic functions.
"Our findings suggest that fructose disrupts plasticity -- the creation of fresh pathways between brain cells that occurs when we learn or experience something new," said Gomez-Pinilla, a member of the UCLA Brain Injury Research Center. "That's a huge obstacle for anyone to overcome -- but especially for a TBI patient, who is often struggling to relearn daily routines and how to care for himself or herself."
Earlier research has revealed how fructose harms the body through its role in contributing to cancer, diabetes, obesity and fatty liver. Gomez-Pinilla's study is the latest in a UCLA body of work uncovering the effects of fructose on brain function. His team previously was the first to identify the negative impact fructose has on learning and memory.
"Our take-home message can be boiled down to this: reduce fructose in your diet if you want to protect your brain," Gomez-Pinilla stressed.
Sources of fructose in the western diet include honey, cane sugar (sucrose) and high-fructose corn syrup, an inexpensive liquid sweetener. Made from cornstarch, the liquid syrup is widely added as a sweetener and preservative to processed foods, including soft drinks, condiments, applesauce and baby food.
The average American consumed roughly 27 pounds of high-fructose corn syrup in 2014 -- or just shy of eight teaspoons per day, according to the U.S. Department of Agriculture. That's a drop from a decade ago, when Americans consumed more than 36 pounds of the syrup per year.
http://www.sciencedaily.com/releases/2015/10/151002103503.htm
Reduced heart rate variability may indicate greater vulnerability to PTSD
September 10, 2015
Science Daily/University of California - San Diego
A prospective longitudinal study of US Marines suggests that reduced heart rate variability -- the changing time interval between heartbeats -- may be a contributing risk factor for post-traumatic stress disorder.
Even at rest, the normal rhythm of the heart fluctuates, reflecting influences and changes in other parts of the body. Generally speaking, the greater the heart rate variability or HRV, the better. Conversely, reduced HRV suggests poorer functioning of regulatory systems in the body and has been cited as an indicator or predictor for a number of conditions, such as fetal distress, heart disease, depression, asthma, diabetic neuropathy and disorders of the autonomic nervous system, which controls bodily functions not consciously directed, such as heartbeat, breathing and digestion.
HRV has been associated with PTSD, a mental health condition linked to a number of maladies, including anger, insomnia, substance abuse and chronic depression. PTSD is particularly associated with persons deployed to war. For example, the lifetime prevalence in Vietnam-era combat veterans is 19 percent. For veterans of Iraq and Afghanistan, it is 13 to 15 percent. In the general U.S. population, the PTSD prevalence rate is 8 percent.
Researchers investigated whether reduced HRV before combat deployment conferred increased risk of a PTSD diagnosis after deployment. From July 2008 to October 2013, they assessed two large cohorts of active-duty Marines one to two months before combat deployment and again four to six months after their return. After accounting for deployment-related combat exposure, the researchers found that U.S. Marines with reduced HRV prior to deployment displayed increased vulnerability to PTSD upon return.
"The evidence is initial and modest," said Arpi Minassian, PhD, clinical professor of psychiatry at UC San Diego School of Medicine and first author of the study. "It suggests that an altered state of the autonomic nervous system may contribute to vulnerability and resilience to PTSD, along with known risk factors, such as combat exposure and preexisting stress and trauma symptoms."
The researchers said that if the findings are buttressed by future studies, it may suggest new opportunities for preventing PTSD by addressing the biology of the autonomic nervous system.
http://www.sciencedaily.com/releases/2015/09/150910164223.htm