PTSD rate among prison employees equals that of war veterans

July 16, 2018

Science Daily/Washington State University

Prison employees experience PTSD on par with Iraq and Afghanistan war veterans, a new study from a Washington State University College of Nursing researcher found.

Working conditions in a prison can include regular exposure to violence and trauma, and threats of harm to the workers and their families. Previous studies have shown that prison workers have some of the highest rates of mental illness, sleep disorders and physical health issues of all U.S. workers. But the rate of PTSD among prison workers isn't well understood.

The new study, "Prison employment and post-traumatic stress disorder: Risk and protective factors," was conducted by lead investigator Lois James, Ph.D., assistant professor at the WSU College of Nursing, and co-investigator Natalie Todak, assistant professor at the University of Alabama at Birmingham.

It recently was published in the American Journal of Industrial Medicine and excerpted in Force Science News.

"Prison employees can face some of the toughest working conditions of U.S. workers," said James, "yet limited evidence exists on the specific risk and protective factors to inform targeted interventions."

Among the study's findings:

·     Prison employees work under an almost constant state of threat to their personal safety, and about a quarter of them routinely experience serious threats to themselves or their families.

·     Almost half have witnessed co-workers being seriously injured by inmates.

·     More than half have seen an inmate die or have encountered an inmate who recently died.

·     The vast majority have dealt with inmates who were recently beaten and/or sexually assaulted.

PTSD rates were higher among women, black employees, and employees with more than 10 years of experience. PTSD scores, using criteria from the Diagnostic and Statistical Manual of Mental Disorders, didn't differ based on where the employee worked, such as a minimum versus maximum security facility.

James and Todak note that the research included a small sample of 355 employees of one labor union at the Washington State Department of Corrections, and recommended further study of the issue.

Still, they said their findings suggest the corrections profession could benefit from specific training to promote resilience. They also said issues common to nearly every workplace also can protect prison employees from PTSD, such as having good relationships with supervisors and coworkers, and liking their work assignments.

https://www.sciencedaily.com/releases/2018/07/180716091509.htm

Teens with concussion may benefit from earlier physical therapy

June 27, 2018

Science Daily/Wolters Kluwer Health

For adolescents with symptoms following a concussion, starting physical therapy (PT) earlier -- within less than three weeks after the injury -- provides outcomes similar to those of later PT.

"Multimodal PT interventions administered by licensed physical therapists may be feasible and safe even within the first few weeks after injury to help facilitate prompt recovery and mitigate the onset of secondary effects from delayed treatment," write Catherine Quatman-Yates, DPT, PhD, of The Ohio State University, Columbus, and colleagues. The study is part of a JNPT special issue on "Rehabilitation Management of Concussion," highlighting research-driven changes geared toward promoting return to activity in young patients with concussion.

Similar Outcomes for Teens with Concussion Undergoing Earlier or Later PT

The researchers looked how the timing of PT affected the course of concussion-related symptoms in 120 adolescents: 78 females and 42 males, median age 14 years. Physical therapy was classified as early (beginning 0 to 20 days after concussion) in 27.5 percent of patients, middle (21 to 41 days) in 32.5 percent, and late (42 days or after) in 40 percent.

The PT program consisted of progressive exercise; vestibular/oculomotor training (targeting inner ear/balance and visual symptoms); and cervical spine manual therapy, stretching, and strengthening exercises. This multimodal treatment was delivered by licensed physical therapists with special training in concussion treatment.

Whether started earlier or later, PT led to similar reductions in concussion-related symptoms. The number of sessions and duration of PT care were similar across groups. There was a low rate of adverse events, most of which were unrelated to PT.

Symptoms worsened in a few patients, more commonly in the late PT group. Some of these patients may have had concussion-related impairments not directly addressed by PT, such as anxiety, depression, or sleep problems.

Recent research has led to new insights into medical management of concussion in children and adolescents. Past guidelines recommended complete physical and cognitive (mental) rest after concussion, until symptoms resolved. But recent studies have suggested that resting for more than a day or two has limited benefits, and may even be linked to increased concussive symptoms.

Today, concussion management is shifting toward a shorter period of rest, followed by gradual return to usual activities, guided by the patient's symptoms. Physical therapy has been recommended for adolescents with persistent symptoms of concussion, generally after three weeks.

The new study provides evidence that starting PT earlier is a safe and feasible approach for adolescents after concussion, with improved symptoms regardless of the timing of the intervention. "Introducing PT earlier in the recovery process may be beneficial in minimizing the potential burden of longer recovery trajectories," Dr. Quatman-Yates and coauthors write. They emphasize the need for further research to determine PT's role in the "optimal plan of care" for young patients with concussion.

Other articles in the special issue include a neuroscience perspective on the role of rest versus physical activity in recovery for young people with concussion, along with new research on changes in vestibular/oculomotor function and the role of balance testing after concussion.

Physical therapists can play a critical role in evaluating and choosing targeted interventions most likely to result in the best outcomes for patients with concussion, according to a Guest Editorial by Karen L. McCulloch, PT, PhD, NCS, and Kathleen Gill-Body, PT, DPT, MS, NCS, FAPTA. They write, "We are in an ideal position to continue our process of returning people to activities and roles that they care about...because it is what we do."

https://www.sciencedaily.com/releases/2018/06/180627160258.htm

Certain PTSD therapies prove effective long after patients stop treatment

Reducing severity of PTSD symptoms long-term holds significant public-health and economic implications

April 19, 2018

Science Daily/Case Western Reserve University

Reducing severity of PTSD symptoms long-term holds significant public-health and economic implications.

Both civilians and military veterans with post-traumatic stress disorder (PTSD) reap long-term benefits from psychotherapies used for short-term treatment, according to a new study from Case Western Reserve University.

The findings suggest effective and lasting approaches for symptoms of PTSD-a debilitating and typically chronic disorder that rarely diminishes spontaneously and is associated with significant distress, impairment and considerable economic costs.

For U.S.-based military veterans alone, lost productivity, health-care and other costs are estimated to be in the billions of dollars, according to recent peer-reviewed research.

The paper, published in the journal Clinical Psychology Review, was based on a meta-analysis of 32 PTSD-related studies-involving 72 treatment conditions-that followed up with patients at least six months, and up to nearly two years, after treatment ended.

Patients displayed less-intense symptoms up to two years after treatment ended, compared to six months post-therapy, according to the study.

"It is possible that the longer time between post-treatment and follow-up assessments may provide a better opportunity for new skills to be practiced and reinforced, and for treatment gains to crystallize," said Alex Kline, a co-author of the study and a PhD student in adult clinical psychology in the Department of Psychological Sciences at Case Western Reserve.

PTSD treatments effective in both the short- and long-term include trauma-focused cognitive behavioral therapy and exposure therapy. Both are relatively common in veterans' facilities yet are inconsistently available elsewhere-a major barrier to access and effective treatment, Kline said.

"It's important to get a better understanding of who responds to what and why," Kline said. "Showing that PTSD treatment gains are being maintained is meaningful for health-care providers choosing how to improve patient outcomes and drive down costs of ineffectual care."

Broadly, cognitive behavioral therapy reduces symptoms by changing patient behavior and addressing maladaptive thoughts. In particular, exposure therapy-considered the current standard for PTSD treatment-exposes patients to feared stimuli under deliberate, controlled, safe conditions.

While some PTSD patients do not respond to current treatments, most do-across a range of populations, settings and trauma types.

PTSD often co-occurs with depression, but the findings run counter to a recent similar study of long-term depression outcomes, where effectiveness decreased with longer follow-up periods. That was noteworthy, Kline said, given the diagnostic overlap between PTSD and depression and high rates of co-occurrence between the two disorders.

"Eventually, our findings and others could optimize treatments," he said. "The goal is to match patients with what's best for them."

https://www.sciencedaily.com/releases/2018/04/180419131133.htm

How chronic early-life stress raises PTSD vulnerability

Persistent stress in adolescence appears to increase vulnerability through elevated ghrelin levels in rat model and in humans

April 11, 2018

Science Daily/Massachusetts General Hospital

A collaboration between investigators at Massachusetts General Hospital and Khyber Medical University in Pakistan may have discovered how chronic stress experienced early in life increases vulnerability to post-traumatic stress disorder (PTSD) later in life. In their report published in Translational Psychiatry the researchers describe finding that chronic stress induces a persistent increase in the hormone ghrelin, both in a rat model and in human adolescents. Rats with stress-induced ghrelin elevations were more vulnerable to an excessive fear response long after the stressful experience, a vulnerability that was eliminated by long-term blockade of ghrelin signaling.

"Ghrelin is called the 'hunger hormone,' and while it does play an important role in appetite, it has many other effects," says Ki Goosens, PhD, of the MassGeneral Institute for Neurodegenerative Disease, who led the study. "Several teams have shown that repeated stress exposure increases circulating ghrelin levels in many organisms, but those studies examined ghrelin shortly after the stressor exposure ended. Ours is the first to show that traumatic stress increases ghrelin in humans -- specifically in adolescent humans -- and the first to look at ghrelin elevation over long time periods after the end of the stressor."

Considerable evidence supports the impact of early-life stress on brain function and on other health outcomes in human adults. Adolescents are known to have increased emotional reactions to their experiences, and stress may enhance that reactivity, increasing vulnerability to several mental health disorders. Since areas of the brain such as the prefrontal cortex that regulate fear-responsive structures including the amygdala continue to develop during adolescence, stress-induced disruption of the developmental process during adolescence could interfere with those regulatory circuits.

To investigate the potential long-term impact of chronic stress on ghrelin levels, the researchers conducted a series of experiments. Chronic stress was induced in a group of adolescent rats by immobilizing them inside their cages daily for two weeks. A control group was handled daily by research team members over the same time period. Not only were ghrelin levels in the stress-exposed rats significantly higher 24 hours after the last stress exposure, as previously reported, they also remained elevated 130 days later, roughly equivalent to 12 years in human lifespan.

To investigate whether long-term stress produced similar persistent ghrelin elevation in humans, the researcher enrolled 88 children from the Khyber Pukhtunkhwa province of Pakistan, an area affected by more than a decade of terrorist activity. The participants averaged around age 14 at the time of study, and some had either experienced a personal injury or lost a family member in a terrorist attack around four years prior to entering the study. The control group consisted of children who had not experienced those specific types of trauma.

Blood tests revealed that circulating ghrelin levels in the trauma-affected children were around twice those of the control group. Based on interviews with the children and their parents, trauma-affected children also had differences in their sleep, emotional regulation and social isolation, compared with the control group. And while all participants had a body mass index (BMI) within the normal range, the BMIs of trauma-exposed children were significantly lower than those of the control group.

To test the long-term impact of stress-induced ghrelin elevation in the rat model, the research team exposed two other groups of animals to 14 days of either chronic stress induction or daily handling. Two weeks later both groups went through a standard behavioral protocol called fear conditioning, which trained them to expect an unpleasant sensation -- a mild but not painful foot shock -- when they heard a specific sound. After they learn that association, animals will typically 'freeze' in expectation of the shock when they hear that sound. Compared to the control animals, the chronic-stress-exposed rats showed a stronger fear memory by freezing longer during the sound when it was not paired with a shock.

To test whether blocking ghrelin signaling could reduce the stress-enhanced fear response, the researchers administered a drug that blocks the ghrelin receptor to groups of rats over three different schedules -- throughout both the two-week chronic stress induction period and the two weeks prior to fear conditioning, during the stress induction period only or during only the two weeks between stress induction and fear conditioning. While blocking the ghrelin receptor for the full four weeks did eliminate the stress-induced enhanced fear response, blocking ghrelin signaling either only during or only after stress induction did not prevent the enhanced response.

"It appears that blocking the ghrelin receptor throughout the entire period of ghrelin elevation -- both during and after stress -- prevents fear enhancement when the animals subsequently encounter a traumatic event," says Goosens. "But only blocking the receptor during stress, when ghrelin is initially elevated, or after stress, when it remains elevated, does not prevent the fear-enhanced, PTSD-like response."

She adds, "Previous work from my lab shows that exposing brain cells to high levels of ghrelin reduces their sensitivity to the hormone, which we call 'ghrelin resistance.' We've also shown that ghrelin inhibits fear in unstressed individuals, and we believe that stress-induced ghrelin resistance interferes with that inhibition. Finding a way to reverse ghrelin resistance could have important therapeutic implications. The ability to identify individuals who are more vulnerable to the detrimental effects of stress, as well as the 'tipping point' when they become vulnerable, could enable early intervention with either therapy or medication."

https://www.sciencedaily.com/releases/2018/04/180411220806.htm

Severe war injuries and PTSD can impact hypertension risk

March 19, 2018

Science Daily/American Heart Association

US service members severely injured in the Iraq or Afghanistan wars or diagnosed with PTSD (posttraumatic stress disorder) face a greater risk of high blood pressure. Injury severity and PTSD were each independently associated with an increased risk of high blood pressure.

PTSD, a mental health disorder that stems from a traumatic or life-threatening event, has been previously linked to risk of high blood pressure and other issues, including substance abuse, obesity, coronary artery disease, and suicide.

The new study reviewed records of 3,846 U.S. service members in the Iraq and Afghanistan wars who received intensive care for combat injuries sustained from February 2002 until February 2011. Their average age when they were wounded was 26. More than 14 percent of combatants developed high blood pressure at least 90 days after being wounded. How severe initial injuries were, and how frequently PTSD was noted in medical records after the wounding, separately affected later risk of hypertension, the study found.

"What we found surprised us. PTSD does appear to increase the risk of hypertension," said Maj. Ian J. Stewart, M.D., the study's senior author, who works from the David Grant U.S. Air Force Medical Center at Travis Air Force Base in California. "But we thought that hypertension risk from the injury would depend on the presence of PTSD. Instead, increased hypertension risk is additive to the injury itself," said Stewart.

The study incorporated each service member's Injury Severity Score, a scale ranging from 1 to 75 that gauges the total impact of multiple injuries, based on assessment of six body regions.

For instance, a third-degree burn covering 20 percent of the skin's surface, plus a concussion and minor scalp cut, would yield a score of 11. A traumatic amputation at the hip would be scored at 16, and a 60 percent third-degree burn plus six rib fractures would be scored at 41.

The study found that for every five-point increase in Injury Severity Score, overall risk of high blood pressure rose 5 percent. Patients with an Injury Severity Score of 25 or lower and no recorded PTSD diagnosis had the lowest hypertension risk.

Compared with patients who had no record of a PTSD diagnosis, those with 1 to 15 PTSD notations in their files had an 85 percent higher risk of hypertension. Those who had PTSD noted more than 15 times -- suggesting the condition was more chronic -- had 114 percent increase in the risk of high blood pressure, the study found.

As in other studies, this research found that age, acute kidney injury and race were associated with risk of developing high blood pressure. Risk increased about 5 percent for every year older a veteran was, and was 69 percent higher for African-Americans, compared with whites. Suffering acute injury to the kidneys, which play a key role in regulating blood pressure, also was linked to a higher risk for hypertension.

It's important for policy makers to better understand Iraq and Afghanistan veterans' long-term potential health-related risks and costs, Stewart said. He cited a report from Harvard Kennedy School estimating those could total about $970 billion, including almost $288 billion in direct medical costs, over the next 40 years.

"Veterans suffer long after wars end and wounds heal," he said. "Our society will be paying the price for years to come."

The study included up to 10 years' worth of records following each wounded service member, reflecting care in both Department of Defense health facilities and medical visits through the TRICARE program, a health care program of the U.S. Department of Defense Military Health System.

Stewart and his colleagues suspect that development of high blood pressure and other chronic medical conditions after combat injury might generally be traced through three routes:

through PTSD or other mental health conditions that arise, such as depression or anxiety;

through physiological changes, including inflammatory or metabolic responses,

or due to lifestyle changes such as smoking or gaining weight. More research into these areas is needed, the authors note.

High blood pressure is defined as blood pressure readings 130/80 mm Hg and above. Untreated, it can lead to stroke, heart and kidney disease, vision loss and sexual dysfunction.

Strengths of the study include the high number of medical visits recorded for each patient, and the use of Department of Defense databases that allowed researchers to track patients over time rather than rely on individuals' own accounts. However, the study did not follow patients in real time, and couldn't control for differences in how blood pressure readings were taken. The study also lacked biological data such as measurements of inflammatory markers, and information about behaviors such as smoking that impact future health.

https://www.sciencedaily.com/releases/2018/03/180319090719.htm

Nightmares are common but underreported in US military personnel

Nearly one in three military personnel meet criteria for nightmare disorder

March 15, 2018

Science Daily/American Academy of Sleep Medicine

A new study shows that a high percentage of military personnel with sleep disturbances met criteria for nightmare disorder, but few of them reported nightmares as a reason for sleep evaluation. Those with nightmare disorder had an increased risk of other sleep and mental health disorders.

Results show that 31 percent of military participants had clinically significant nightmares, and trauma-related nightmares occurred in 60 percent of them. Participants who met criteria for nightmare disorder were five times more likely to have post-traumatic stress disorder (PTSD), four times more likely to have depression, three times more likely to have anxiety, and two times more likely to have insomnia. Despite their common presence, nightmares were reported as a sleep-related concern by only 3.9 percent of military personnel.

"This research provides a basis for furthering the study and knowledge of nightmares in survivors of traumatic experiences," said principal investigator Dr. Jennifer Creamer, medical director of the Sleep Medicine Center at Martin Army Medical Center in Fort Benning, Georgia. "Treatment of nightmares can lead to improvement in sleep, quality of life, and other disorders such as suicidality."

The study results are published in the March 15 issue of the Journal of Clinical Sleep Medicine.

Nightmares are vivid, realistic and disturbing dreams typically involving threats to survival or security, which often evoke emotions of anxiety, fear or terror. A nightmare disorder may occur when repeated nightmares cause distress or impairment in social or occupational functioning.

According to the authors, this was the largest study to assess clinically significant nightmares in an active duty population referred for the evaluation of sleep disorders. The study involved 493 active duty U.S. military personnel. Participants had a mean age of 38 years, and 78.5 percent were men. Participants predominantly served in the Army (45.6 percent) and Air Force (45.2 percent); 9.2 percent served in the Navy/Marines. Approximately 74 percent of them had been deployed. Those with trauma-related nightmares were more likely to have traumatic brain injury, PTSD, anxiety and depression.

Nightmares beginning within three months of a trauma are present in up to 80 percent of patients with PTSD, and these post-traumatic nightmares may persist throughout life. Post-traumatic nightmares may take the form of a realistic reliving of a traumatic event or may depict only some of its elements or emotional content.

"Nightmare disorder is highly prevalent but under-recognized in military personnel with sleep disturbances," said Creamer.

A best practice guide from the American Academy of Sleep Medicine indicates that treatment options for nightmare disorder include medications, most prominently prazosin. Several behavioral therapies also can be effective, such as image rehearsal therapy and other nightmare-focused cognitive behavioral therapy variants.

"Military personnel and health care providers require education that nightmares are not normal and there are treatments available," added Creamer.

https://www.sciencedaily.com/releases/2018/03/180315091305.htm

Scientists find heightened attention to surprise in veterans with PTSD

January 9, 2018

Science Daily/Virginia Tech

Scientists have found that people with PTSD have an increased learning response to surprising events. While most everyone reacts to surprise, people with PTSD tend to pay even more attention to the unexpected.

Fireworks on nights other than the fourth of July or New Year's Eve might be nothing more than inconsiderate neighbors, but for veterans with Post Traumatic Stress Disorder (PTSD), the shock of noise and light may trigger a deeply learned expectation of danger.

Scientists at the Virginia Tech Carilion Research Institute (VTCRI) have found that people with PTSD have an increased learning response to surprising events. While most everyone reacts to surprise, people with PTSD tend to pay even more attention to the unexpected.

The study was published this week in eLife, an open-access journal published by the Howard Hughes Medical Institute, the Max Planck Society, and the Wellcome Trust.

"Disproportionate reactions to unexpected stimuli in the environment are a core symptom of PTSD," said Pearl Chiu, an associate professor at the VTCRI and the lead author on the study. "These results point to a specific disruption in learning that helps to explain why these reactions occur."

Chiu and her team used functional MRI to scan the brains of 74 veterans, all of whom had experienced trauma while serving at least one combat tour in Afghanistan or Iraq. Some of the study participants were diagnosed with PTSD, while others were not. In the functional MRI, participants played a gambling game, in which they learned to associate certain choices with monetary gains or losses.

"Computer science and mathematics have given us new tools to understand how the brain learns. We used these tools to study whether and how learning might play a role in PTSD," said Chiu, who is also an associate professor of psychology in Virginia Tech's College of Science. "These results suggest that people with PTSD don't necessarily have a disrupted response to unexpected outcomes, rather they pay more attention to these surprises," Chiu said.

The researchers found that people with PTSD had significantly more activity in the parts of their brains associated with how much attention they paid to surprising events when the learning task threw an unexpected curve ball their way.

"Fireworks unexpectedly going off after a person has exchanged fire in the field can trigger an over-estimation of danger," said Brooks King-Casas, an associate professor at the VTCRI who co-led the study. "Particularly for individuals with PTSD, unexpected surprising events -- noise or otherwise -- could be a matter of life or death. The study shows that while everyone is affected by unexpected events, in PTSD extra attention is given to these surprises."

King-Casas is also an associate professor of psychology in Virginia Tech's College of Science and an associate professor in the Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences.

Earlier studies have connected greater attention to perceived threats and unexpected events in PTSD, but the mechanistic underpinning of this hypersensitivity to unexpected outcomes have been unclear until now.

"The work by Brown and colleagues is an important step forward to be able to differentiate the brain and behavioral processes that are affected as a consequence of post-traumatic stress," said Martin Paulus, a medical doctor and the scientific director and president of the Laureate Institute for Brain Research in Tulsa, Oklahoma. He was not involved in this study. "The finding that individuals with PTSD have difficulty appropriately allocating attention to their environment when it changes has clear implications for the development of novel behavioral interventions."

Vanessa Brown, first author on the paper and a graduate student in the department of psychology in Virginia Tech's College of Science, said that both the behavioral and neural findings show that people with PTSD pay more attention to surprise while learning.

"This disrupted learning increases with more severe PTSD," said Brown, who is conducting her dissertation research in Chiu's laboratory at the VTCRI. "Now that we understand how attention to surprise plays a role in PTSD, we may be able to refine our assessment tools or develop new interventions that target specific learning disruptions in people with PTSD or other psychiatric disorders."

https://www.sciencedaily.com/releases/2018/01/180109090251.htm

Traumatic brain injury causes intestinal damage

Two-way brain-gut interactions may worsen outcome after TBI

December 6, 2017

Science Daily/University of Maryland School of Medicine

A two-way link between traumatic brain injury and intestinal changes has been uncovered by research. These interactions may contribute to increased infections in these patients, and may also worsen chronic brain damage.

This is the first study to find that TBI in mice can trigger delayed, long-term changes in the colon and that subsequent bacterial infections in the gastrointestinal system can increase posttraumatic brain inflammation and associated tissue loss. The findings were published recently in the journal Brain, Behavior, and Immunity.

"These results indicate strong two-way interactions between the brain and the gut that may help explain the increased incidence of systemic infections after brain trauma and allow new treatment approaches," said the lead researcher, Alan Faden, MD, the David S. Brown Professor in Trauma in the Departments of Anesthesiology, Anatomy & Neurobiology, Psychiatry, Neurology, and Neurosurgery at UMSOM, and director of the UMSOM Shock, Trauma and Anesthesiology Research Center.

Researchers have known for years that TBI has significant effects on the gastrointestinal tract, but until now, scientists have not recognized that brain trauma can make the colon more permeable, potentially allowing allow harmful microbes to migrate from the intestine to other areas of the body, causing infection.. People are 12 times more likely to die from blood poisoning after TBI, which is often caused by bacteria, and 2.5 times more likely to die of a digestive system problem, compared with those without such injury.

In this study, the researchers examined mice that received an experimental TBI. They found that the intestinal wall of the colon became more permeable after trauma, changes that were sustained over the following month.

It is not clear how TBI causes these gut changes. A key factor in the process may be enteric glial cells (EGCs), a class of cells that exist in the gut. These cells are similar to brain astroglial cells, and both types of glial cells are activated after TBI. After TBI, such activation is associated with brain inflammation that contributes to delayed tissue damage in the brain. Researchers don't know whether activation of ECGs after TBI contributes to intestinal injury or is instead an attempt to compensate for the injury.

The researchers also focused on the two-way nature of the process: how gut dysfunction may worsen brain inflammation and tissue loss after TBI. They infected the mice with Citrobacter rodentium, a species of bacteria that is the rodent equivalent of E. coli, which infects humans. In mice with a TBI who were infected with this the bacteria, brain inflammation worsened. Furthermore, in the hippocampus, a key region for memory, the mice who had TBI and were then infected lost more neurons than animals without infection.

This suggests that TBI may trigger a vicious cycle, in which brain injury causes gut dysfunction, which then has the potential to worsen the original brain injury. "These results really underscore the importance of bi-directional gut-brain communication on the long-term effects of TBI," said Dr. Faden.

https://www.sciencedaily.com/releases/2017/12/171206174243.htm

Patients with post-traumatic stress disorder respond differently to certain sounds

November 30, 2017

Science Daily/University of Birmingham

A new neurobiological marker have have just been found to help recognize patients with post-traumatic stress disorder (PTSD).

Using an electroencephalogram (EEG) -- a test that detects electrical activity in a person's brain via electrodes attached to their scalp -- researchers studied the brain activity of a group of thirteen patients with PTSD. The group was then compared to a group who had suffered a similar trauma but had not gone on to develop PDST.

PTSD is estimated to affect about one in every ten people who have a traumatic experience. It can develop immediately after someone experiences a disturbing event or it can occur weeks, months or even years later and can affect a person's memory.

The type of events that can cause PTSD include serious road accidents, violent personal assaults, witnessing violent deaths, military combat, being held hostage, terrorist attacks and natural disasters.

Dr Ali Mazaheri, of the University of Birmingham's School of Psychology and Centre for Human Brain Health, said of the study published in Nature Scientific Reports: "We know that a symptom of PTSD can be heightened sensory sensitivity.

"In this study, we tested the brain's response to a simple auditory sensory change by playing simple (standard 1000Hz) tones every second, and then intermittently playing a slightly altered tone (1200 Hz), known as a deviant.

"What we found was that patients who had developed PTSD showed enhanced brain responses to deviant tones, suggesting their brain over-processed any change in the environment.

"Importantly we found the more enhanced their response was, the more poorly they performed on cognitive tests looking at memory."

Katrin Bangel, of the University of Amsterdam, said: "This is the first research study of its kind. The neurobiological evidence we now have shows how altered brain activity of a patient with PTSD is closely related to the way it processes the world.

"What's more, this study is very unique in that it compared PTSD patients with a control group of those that also suffered similar trauma but didn't develop PTSD, rather than a control group who had no trauma or PTSD -- this really allows us to look at what triggers PTSD following significant trauma.

"We now potentially have a new neurobiological marker for PTSD patients that maps to their own individual symptoms.

"This marker, if validated, could be used to assess if an individual is getting better with treatment. It can also be potentially used in diagnosing patients."

Professor Dr Miranda Olff, of the University of Amsterdam and Arq Psychotrauma Expert Group, said: "This area of research is incredibly important.

"Post-traumatic stress disorder (PTSD) is a debilitating disorder caused by very stressful, frightening or distressing events.

"Someone with PTSD often relives the traumatic event through nightmares and flashbacks, and may experience feelings of isolation, irritability and guilt.

"They may also have problems sleeping, such as insomnia, and find concentrating difficult.

"These symptoms are often severe and persistent enough to have a significant impact on the person's day-to-day life.

"Therefore it is vital that we find new ways to treat the condition and also assess treatment outcomes."

The team has now begun further research validating the marker and also plans a clinical trial to test potential treatments on patients with PTSD.

https://www.sciencedaily.com/releases/2017/11/171130093952.htm

Injury from contact sport has harmful, though temporary effect on memory

November 14, 2017

Science Daily/McMaster University

Neuroscientists studying sports-related head injuries have found that it takes less than a full concussion to cause memory loss, possibly because even mild trauma can interrupt the production of new neurons in a region of the brain responsible for memory.

Though such losses are temporary, the findings raise questions about the long-term effects of repeated injuries and the academic performance of student athletes.

The researchers spent months following dozens of athletes involved in high-contact sports such as rugby and football, and believe that concussions and repetitive impact can interrupt neurogenesis -- or the creation of new neurons -- in the hippocampus, a vulnerable region of the brain critical to memory.

The findings were presented today (Tuesday, November 14th) at the Society for Neuroscience's annual conference, Neuroscience 2017, in Washington D.C.

"Not only are newborn neurons critical for memory, but they are also involved in mood and anxiety," explains Melissa McCradden, a neuroscience postdoctoral fellow at McMaster University who conducted the work. "We believe these results may help explain why so many athletes experience difficulties with mood and anxiety in addition to memory problems."

For the study, researchers administered memory tests and assessed different types of athletes in two blocks over the course of two years. In the first block, they compared athletes who had suffered a concussion, uninjured athletes who played the same sport, same-sport athletes with musculoskeletal injuries, and healthy athletes who acted as a control group.

Concussed athletes performed worse on the memory assessment called a mnemonic similarity test (MST), which evaluates a person's ability to distinguish between images that are new, previously presented, or very similar to images previously presented.

In the second study, rugby players were given the MST before the season started, halfway through the season, and one month after their last game. Scores for injured and uninjured athletes alike dropped midseason, compared to preseason scores, but recovered by the postseason assessment.

Both concussed and non-concussed players showed a significant improvement in their performance on the test after a reprieve from their sport.

For the concussed athletes, this occurred after being medically cleared to return to full practice and competition. For the rugby players, they improved after approximately a month away from the sport.

If neurogenesis is negatively affected by concussion, researchers say, exercise could be an important tool in the recovery process, since it is known to promote the production of neurons. A growing body of new research suggests that gentle exercise which is introduced before a concussed patient is fully symptom free, is beneficial.

"The important message here is that the brain does recover from injury after a period of reprieve," says McCradden. "There is a tremendous potential for the brain to heal itself."

https://www.sciencedaily.com/releases/2017/11/171114104225.htm

Role of gut microbiome in posttraumatic stress disorder: More than a gut feeling

October 25, 2017

Science Daily/Stellenbosch University

The bacteria in your gut could hold clues to whether or not you will develop posttraumatic stress disorder (PTSD) after experiencing a traumatic event.

PTSD is a serious psychiatric disorder that can develop after a person experiences a life-threatening trauma. However, not everyone exposed to a traumatic event will develop PTSD, and several factors influence an individual's susceptibility, including living conditions, childhood experiences and genetic makeup. Stellenbosch University researchers are now also adding gut bacteria to this list.

In recent years, scientists have become aware of the important role of microbes existing inside the human gastrointestinal tract, called the gut microbiome. These microbes perform important functions, such as metabolising food and medicine, and fighting infections. It is now believed that the gut microbiome also influences the brain and brain function by producing neurotransmitters/hormones, immune-regulating molecules and bacterial toxins.

In turn, stress and emotions can change the composition of the gut microbiome. Stress hormones can affect bacterial growth and compromise the integrity of the intestinal lining, which can result in bacteria and toxins entering the bloodstream. This can cause inflammation, which has been shown to play a role in several psychiatric disorders.

"Our study compared the gut microbiomes of individuals with PTSD to that of people who also experienced significant trauma, but did not develop PTSD (trauma-exposed controls). We identified a combination of three bacteria (Actinobacteria, Lentisphaerae and Verrucomicrobia) that were different in people with PTSD," explains the lead researcher, Dr Stefanie Malan-Muller. She is a postdoctoral fellow in the Department of Psychiatry at the Faculty of Medicine and Health Sciences.

Individuals with PTSD had significantly lower levels of this trio of bacteria compared to trauma-exposed control groups. Individuals who experienced trauma during their childhood also had lower levels of two of these bacteria (Actinobacteria and Verrucomicrobia). "What makes this finding interesting, is that individuals who experience childhood trauma are at higher risk of developing PTSD later in life, and these changes in the gut microbiome possibly occurred early in life in response to childhood trauma," says Malan-Muller. She collaborated with researchers from the University of Colorado Boulder on the study.

One of the known functions of these bacteria is immune system regulation, and researchers have noted increased levels of inflammation and altered immune regulation in individuals with PTSD. "Changes in immune regulation and increased inflammation also impact the brain, brain functioning and behaviour. Levels of inflammatory markers measured in individuals shortly after a traumatic event, was shown to predict later development of PTSD.

"We therefore hypothesise that the low levels of those three bacteria may have resulted in immune dysregulation and heightened levels of inflammation in individuals with PTSD, which may have contributed to their disease symptoms," explains Malan-Muller.

However, researchers are unable to determine whether this bacterial deficit contributed to PTSD susceptibility, or whether it occurred as a consequence of PTSD.

"It does, however, bring us one step closer to understanding the factors that might play a role in PTSD. Factors influencing susceptibility and resilience to developing PTSD are not yet fully understood, and identifying and understanding all these contributing factors could in future contribute to better treatments, especially since the microbiome can easily be altered with the use of prebiotics (non-digestible food substances), probiotics (live, beneficial microorganisms), and synbiotics (a combination of probiotics and prebiotics), or dietary interventions."

https://www.sciencedaily.com/releases/2017/10/171025103140.htm

Psychological toll of shame in military personnel

October 25, 2017

Science Daily/British Psychological Society (BPS)

Feelings of shame may make the symptoms of post-traumatic stress disorder (PTSD) more severe in current and former members of the Armed Services, suggests new research.

That is the conclusion of research published in the British Journal of Clinical Psychology by a team led by Dr Katherine C. Cunningham from the Department of Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, North Carolina.

In the forthcoming article, Dr Cunningham and colleagues say, "The military conflicts in Iraq and Afghanistan have resulted in increased awareness of the impact of war on military service members. Many returning service members and veterans have been diagnosed with PTSD, which is associated with poorer physical health, unemployment, legal problems, relationship conflict and reduced quality of life."

The research study, conducted at The University of Tulsa in Oklahoma, surveyed 61 American service personnel and veterans who completed an online psychological survey covering PTSD symptom severity as well as trauma-related guilt and trauma-related shame.

When the results were analysed, the researchers found that both shame and guilt predicted the presence of PTSD, jointly accounting for 46 per cent of the variance in its severity. However, they also found that trauma-related shame accounted for significantly more of that variance than trauma-related guilt.

In this study, the feeling of guilt was defined as being associated with having done something wrong, for instance "I didn't keep my friend safe in combat" or "I killed civilians during the war." Shame was defined as a belief that one is intrinsically and irrevocably flawed, for example "I'm a failure" or "I'm a monster."

In other words, guilt arises from the belief that you have done a bad thing and shame from the belief that you are a bad person.

Dr Cunningham said, "Guilt may result in more prosocial behaviour, because the underlying attributions are tied to a specific harmful action and not to one's identity. Feeling guilty can motivate an attempt to repair and strengthen social relationships by making amends, while feeling shame can lead people to withdraw from society.

"The findings of our study provide additional evidence that we should see shame and guilt as distinct emotions with unique roles in PTSD. Given shame's greater importance in explaining PTSD symptom severity, we should pay more attention to understanding and ameliorating it."

https://www.sciencedaily.com/releases/2017/10/171025122609.htm

Better sleep, less fear

Rapid eye movement sleep may dampen sensitivity to fearful stimuli

October 23, 2017

Science Daily/Society for Neuroscience

Higher quality sleep patterns are associated with reduced activity in brain regions involved in fear learning, according to a study of young adults. The results suggest that baseline sleep quality may be a useful predictor of susceptibility to post-traumatic stress disorder (PTSD).

Sleep disturbances are a common feature of PTSD. While previous research has focused on understanding how single nights of sleep influence the maintenance of already-established fear memories, few studies have investigated whether an individual's regular sleeping habits prior to trauma contributes to the acquisition of these fear memories.

Itamar Lerner, Shira Lupkin and their colleagues at Rutgers University had students monitor their sleep at home for one week using unobtrusive sleep monitoring tools, including a headband that measures brain waves, a bracelet that measures arm movements, and a sleep log. The students then participated in a neuroimaging experiment during which they learned to associate a neutral image with a mild electric shock. Students who spent more time in rapid eye movement (REM) sleep -- the phase when dreaming occurs -- exhibited weaker modulation of activity in, and connectivity between, their amygdala, hippocampus and ventromedial prefrontal cortex during fear learning.

The authors replicated these results in a second study using traditional polysomnographic monitoring of sleep during the night just prior to fear learning. Taken together, the findings are consistent with the idea that REM sleep reduces levels of norepinephrine in the brain, which may dampen an individual's sensitivity to fearful stimuli. 

https://www.sciencedaily.com/releases/2017/10/171023140920.htm

Sports-related concussion symptoms linger twice as long for adolescent girls

Recovery may be complicated by pre-existing conditions more prevalent in females

October 2, 2017

Science Daily/American Osteopathic Association

Adolescent female athletes suffer concussion symptoms twice as long as their male counterparts, according to a new study. Researchers found the extended recovery period may be due to underlying conditions including migraines, depression, anxiety and stress.

The research analyzed the medical records of 110 male and 102 female athletes, ages 11 to 18, with first-time concussion diagnoses. The median duration of symptoms was 11 days for boys and 28 days for girls. The data also showed that symptoms resolved within three weeks for 75 percent of boys, compared to 42 percent of girls.

"These findings confirm what many in sports medicine have believed for some time," said lead researcher John Neidecker, DO, a sports concussion specialist in Raleigh, North Carolina. "It highlights the need to take a whole person approach to managing concussions, looking beyond the injury to understand the mental and emotional impacts on recovery when symptoms persist."

Prior research has shown that concussions exacerbate some pre-existing conditions, including headaches, depression, anxiety and stress, all of which are more prevalent in girls and mirror hallmark concussion symptoms, according to a consensus statement from the 5th International Conference on Concussion.

Treating the right condition

Understanding the overlap of symptoms means physicians must be skilled at eliciting patient history to get a full understanding of factors that might complicate recovery.

"Often in this age range, issues like migraines, depression and anxiety have not yet been diagnosed," said Dr. Neidecker. "So, if I ask a patient whether they have one of these conditions, they're likely to say 'No'. But when I ask about their experiences, I get a much clearer picture."

Dr. Neidecker gives an example of a patient with no history of migraines who admitted experiencing weekly headaches prior to the head injury. She thought the headaches were normal, but in fact the patient was suffering from migraines.

He uses a similar approach to uncovering anxiety, mental stress and depression, and says diagnosis is tricky because adolescence is inherently emotional and stressful. To better understand the patient, he recommends asking young athletes whether they are hard on themselves or feel bad about not performing their best.

Patients with Type A personality traits typically have a baseline level of stress about the need to perform and become more stressed when they cannot, Dr. Neidecker explained. Losing the physical outlet of sport for managing their stress compounds the issue during the recovery period.

"It can really become a vicious cycle for some of these kids," said Dr. Neidecker. "Uncovering and addressing any underlying conditions gets them back on the field faster and ultimately helps them be healthier and happier in the future."

https://www.sciencedaily.com/releases/2017/10/171002090506.htm

One in 5 teens report having had a concussion in their lifetime

September 26, 2017

Science Daily/University of Michigan

A new study confirms what many hospital emergency rooms nationwide are seeing: teens playing contact sports suffer from concussions.

In fact, one out of five teens reported at least one concussion diagnosis during their lifetime, and 5.5 percent have had more than one concussion, the study indicated.

The study, published in the Journal of the American Medical Association (JAMA), comes at a time as interest in concussions among pro athletes -- especially those in the National Football League -- has increased in the last decade. Little, however, is known about the prevalence of concussions among teens in the United States, said Phil Veliz, a researcher at the Institute for Research on Women and Gender.

Veliz and colleagues analyzed data from more than 13,088 adolescents in the 2016 Monitoring the Future survey, a national study by U-M funded by the National Institute on Drug Abuse that tracks U.S. students in grades 8, 10 and 12. Students were asked: "Have you ever had a head injury that was diagnosed as a concussion?"

Sociodemographic variables included sex, race/ethnicity, grade level, and participation in competitive sport within the past 12 months. The group, which included 50.2 percent female, indicated if they played at least one of 21 different sports. The findings showed that 19.5 percent reported at least one diagnosed concussion in their lifetime, which was consistent with regional studies and with emergency department reports stating contact sports are a leading cause of concussion among teens.

"Greater effort to track concussions using large-scale epidemiological data are needed to identify high-risk subpopulations and monitor prevention efforts," the researchers wrote.

Several factors, the study noted, were associated with higher lifetime prevalence of reporting a diagnosed concussion: Being male, white, in a higher grade, and participating in competitive sports.

https://www.sciencedaily.com/releases/2017/09/170926112019.htm

PTSD linked with increased Lupus risk

September 20, 2017

Science Daily/Wiley

Trauma exposure and posttraumatic stress disorder (PTSD) in civilian women were strongly associated with increased risk of developing lupus, an autoimmune disease.

In the study of 54,763 women, investigators found a nearly three-fold elevated risk of lupus among women with probable PTSD and more than two-fold higher risk of lupus among women who had experienced any traumatic event compared with women not exposed to trauma.

The findings contribute to growing evidence that psychosocial trauma and associated stress responses may lead to autoimmune disease.

"We were surprised that exposure to trauma was so strongly associated with risk of lupus -- trauma was a stronger predictor of developing lupus than smoking," said Dr. Andrea Roberts, lead author of the study. Our results add to considerable scientific evidence that our mental health substantially affects our physical health, making access to mental health care even more urgent."

https://www.sciencedaily.com/releases/2017/09/170920095951.htm

Concussions in women: Rates, symptoms and recovery are different than men

September 6, 2017

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

Females tend to report more symptoms -- and more severe ones -- and may also take longer to recover from brain injuries than their male counterparts.

Scientists have known for more than a decade that female athletes sustain concussions at a higher rate than males when playing sports with similar rules, such as soccer, basketball and baseball/softball. Females also tend to report more symptoms -- and more severe ones -- and may also take longer to recover from brain injuries than their male counterparts.

Despite that information, relatively little is known about how females experience concussions differently because there has been scant research on the topic. But scientists are trying to hoping to change that, says Dr. Mayumi Prins, a professor of neurosurgery at the David Geffen School of Medicine at UCLA and director of the UCLA Brain Injury Research Center education program.

"Most of the research in the past has focused on males, and there's been little basic science research done on adolescents, females and concussions," Prins says, which means that the science on why girls may suffer more concussions and more prolonged symptoms is still uncertain.

But scientific research has shown that female and male brains differ in dozens of ways in activity patterns, anatomy, chemistry and physiology.

There are some reasons why concussions might affect female athletes and non-athletes differently than males. Those include hormonal issues, differences in how their upper bodies, particularly the muscles in the neck, react after collisions, and that females may be more likely than males to disclose concussion-related symptoms such as headaches, diminished social interaction or depression, Prins says.

For parents of children who participate in sports, Prins offers the following advice:

·     While concussions in females are a serious concern, it's important to bear in mind that the relative risk of concussion is quite low compared to other activities of adolescents and young adults, such as driving, drugs, sexually transmitted diseases and obesity. "There are other things besides concussion that children and young adults are at greater risk for," Prins says.

·     Involvement in sports and athletic activities have been shown to benefit females in a variety of positive ways, such as development of positive body image, increasing bone density, psychological benefits.

·     While the majority of females (and males) will recover from concussions in a week or two, some will have prolonged symptoms, a condition known as post-concussive syndrome and should seek medical assistance from a neurologist.

·     Among adolescent women concussions can particularly affect feelings of social isolation and stress during a critical time of social development. "If you break a foot and are in a cast, everyone sees that and understands," Prins says. "But if you have a head injury, people may just look at you and pick up on some different behaviors and say 'What's wrong with you?' That can produce some social alienation, particularly in female athletes."

More information about the UCLA Steve Tisch BrainSPORT Program is available here: https://www.uclahealth.org/brainsport/about-brainsport

https://www.sciencedaily.com/releases/2017/09/170906143233.htm

Yoga helps back pain among veterans

Trial among first to show effectiveness of yoga specifically in military veterans

July 25, 2017

Science Daily/Veterans Affairs Research Communications

Those who completed a 12-week yoga program had better scores on a disability questionnaire, improved pain intensity scores, and a decline in opioid use, a study that included 150 veterans with chronic low back pain found. The findings jibe with those from two past clinical trials involving non-veterans.

In a study including 150 military veterans with chronic low back pain, researcher Dr. Erik J. Groessl and his team from the VA San Diego Healthcare System found that veterans who completed a 12-week yoga program had better scores on a disability questionnaire, improved pain intensity scores, and a decline in opioid use.

Groessl is a researcher with the VA San Diego Healthcare System and the University of California, San Diego School of Medicine. The study was published in the American Journal of Preventive Medicine on July 20, 2017.

The study shows promise for non-drug treatment of chronic low back pain, said Groessl.

"To be able to reduce the reliance upon opioids and other medications with side effects, it is crucial to establish evidence showing mind-body practices like yoga provide benefit in both veterans and non-veterans with chronic pain," he said.

Veterans in the study who were randomized to the yoga group attended a 12-week yoga program immediately after randomization. Comparison participants were invited to attend the yoga intervention only after six months.

The 12-week yoga intervention consisted of two 60-minute instructor-led yoga sessions per week, with home practice sessions encouraged. The intervention was based on hatha yoga, which involves yoga postures and movement sequences, along with regulated breathing and mindfulness meditation.

Outcomes were assessed at the baseline, six weeks, 12 weeks and six months.

Both study groups had reductions in disability scores after 12 weeks. However, notable differences emerged at the six-month assessment, with scores continuing to drop in the yoga group but increasing in the delayed-treatment group.

Along with those improvements, pain intensity decreased in the yoga group at all three time periods, while the delayed-treatment group had negligible changes.

There was also a 20 percent drop in opioid pain medication use at 12 weeks in both groups as determined through self-report questionnaires and a review of medical records.

Notably, reductions in disability and pain intensity were found despite the reductions in opioid use and other medical and self-help pain treatments at six months.

The trial confirms the findings of two prior randomized controlled trials with non-veterans showing that yoga is safe and can reduce pain and disability among adults with chronic low back pain.

The study is one of the first to demonstrate the effectiveness of yoga specifically in military veterans, a population that faces more health challenges and may be harder to treat than non-VA populations, say the researchers. They point out that as with other non-drug treatments for chronic low back pain, yoga may not help everyone or may not completely eliminate chronic low back pain, but reduced pain and disability can often maintained long-term with ongoing yoga home practice.

Military veterans and active duty military personnel have higher rates of chronic pain than the general U.S. population, and the back is the area of the body that is most commonly affected. In addition to pain, those with the condition also report increased disability, psychological symptoms, and reduced quality of life. In the U.S., chronic low back pain is the leading cause of lost productivity and the second most common cause for physician visits. Billions of dollars are spent each year in the U.S. on health care related to back pain.

The team says that given the results of their study, VA facilities nationwide may want to consider developing and expanding formal yoga programs to help veterans with back pain. Many VA facilities already do offer yoga classes, along with other complementary and integrative health programs.

https://www.sciencedaily.com/releases/2017/07/170725154211.htm

Many parents in the dark about concussions

Concussion affects children in numerous sports

July 13, 2017

Science Daily/University of Texas at Arlington

Despite the large volume of information about sports related concussions on the Internet, many parents and guardians of young athletes have a limited understanding of concussions, according to a study.

In the study, which was published in May in the Journal of Applied Behavioral Research, Cynthia Trowbridge, an associate professor of kinesiology and athletic trainer, and co-author Sheetal J. Patel of Stanford University, found that a significant number of caregivers have a limited understanding of concussions and their impact on a child's future.

"They did understand that it's a severe injury but they didn't understand how susceptible patients are," said Trowbridge, a noted expert on concussions in middle and high school athletes. "We found out that despite the fact that all parents had read some brochure or seen some TV show about concussions they had a low self efficacy about awareness. They tended not to know that concussions are associated with all sports, including track and field, volleyball and swimming."

Sports related concussions account for 53 percent of all head injuries in young people under the age of 19, according to the U.S. Centers for Disease Control. The CDC estimates that there are between 1.6 and 3.8 million sports related injuries among young people each year.

Concussions have received heightened attention in recent years because of the large number of retired professional football players who have sued the National Football League. These retired players claim that in some instances they were sent back into games despite the fact that their coaches knew there was a reasonable chance they may have suffered concussions on the gridiron.

In each of the 50 states there are laws requiring teams to take out athletes who may have suffered concussions. The decision is often made by members of the concussion care team, a group of objective health care professionals that includes a physician, an advanced practice nurse and an athletic trainer.

"We live in an age in which parents recognize more than ever the importance of athletics in instilling skills like discipline, concentration, team work and leadership in young people," said Anne Bavier, dean of the College of Nursing and Health Innovation. "But we need to be just as mindful about the kinds of dangerous, unseen injuries that come from playing sports. This study is a useful tool for building awareness and arming parents with some really good information."

Trowbridge said they were motivated to do the study to find out what caregivers understand about concussions and how to better educate them so they can be more effective in looking for symptoms or other possible signs of trouble.

"It's important to involve not only the athletes but the caregivers," said Trowbridge. "It is the caregiver that knows the child the best and can often recognize the signs and symptoms."

She added that studies show many young athletes do not always tell the truth about their symptoms because they want to continue playing.

"We are still learning how concussion symptoms resolve but we know that they don't get better by sending someone right back in with symptoms," Trowbridge said. "Sports is so magical and so many things can be learned from sports, but we have to give the caregivers the tools to be able to protect the youth athlete when they can't protect themselves."

Trowbridge said caregivers should be discriminating when picking physicians to examine their children for possible concussions, adding that not all physicians understand concussions. She encourages them to consult with neurologists, primary care physicians who specialize in sports medicine and concussion specialists when seeking medical advice.

https://www.sciencedaily.com/releases/2017/07/170713154828.htm

PTSD may be physical and not only psychological

Brain's emotional control center shown to be physically larger

July 11, 2017

Science Daily/American Academy of Neurology

The part of the brain that helps control emotion may be larger in people who develop post-traumatic stress disorder (PTSD) after brain injury compared to those with a brain injury without PTSD, according to a new study.

"Many consider PTSD to be a psychological disorder, but our study found a key physical difference in the brains of military-trained individuals with brain injury and PTSD, specifically the size of the right amygdala," said Joel Pieper, MD, MS, of University of California, San Diego. "These findings have the potential to change the way we approach PTSD diagnosis and treatment."

In the brain there is a right and left amygdala. Together, they help control emotion, memories, and behavior. Research suggests the right amygdala controls fear and aversion to unpleasant stimuli.

For this study, researchers studied 89 current or former members of the military with mild traumatic brain injury. Using standard symptom scale ratings, 29 people were identified with significant PTSD. The rest had mild traumatic brain injury without PTSD.

The researchers used brain scans to measure the volume of various brain regions. The subjects with mild traumatic brain injury and PTSD had 6 percent overall larger amygdala volumes, particularly on the right side, compared to those with mild traumatic brain injury only.

No significant differences in age, education or gender between the PTSD and control groups were found.

"People who suffered a concussion and had PTSD demonstrated a larger amygdala size, so we wonder if amygdala size could be used to screen who is most at risk to develop PTSD symptoms after a mild traumatic brain injury," said Pieper. "On the other hand, if there are environmental or psychological cues that lead to brain changes and enlargement of the amygdala, then maybe such influences can be monitored and treated."

"Further studies are needed to better define the relationship between amygdala size and PTSD in mild traumatic brain injury," said Pieper. "Also, while these findings are significant, it remains to be seen whether similar results may be found in those with sports-related concussions."

He pointed out that these participants' brain injuries were caused mostly by blast injuries as opposed to sports-related concussions. The study also shows only an association and does not prove PTSD causes structural changes in the amygdala.

https://www.sciencedaily.com/releases/2017/07/170711171704.htm