post-traumatic stress disorder (PTSD)

#PTSD linked with increased #lupus risk

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Experts say future studies are needed to determine if lifestyle interventions can reduce the risk of autoimmune disease subsequent to trauma or PTSD.
Trauma exposure and post-traumatic stress disorder (PTSD) in women have been linked with a significantly higher risk of developing lupus in a new study.
In the study of 54,763 women, investigators found a nearly three-fold elevated risk of systemic lupus erythematosus (SLE) 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. Writing in Arthritis & Rheumatology the authors said the findings contribute to growing evidence that psychosocial trauma and associated stress responses lead to autoimmune disease. “Identification of the biological pathways by which psychosocial trauma may increase the risk for autoimmune disease is crucial and may provide greater insight into disease aetiology, as well as strategies for prevention,” they said.
In addition, the authors said, identification of mechanisms by which trauma and PTSD are associated with increased risk of SLE may indicate mechanisms for the association of PTSD and trauma exposure with other chronic diseases.
The authors added that future studies are needed to determine whether treatment for PTSD affects these pathways, and whether lifestyle interventions can reduce the risk of autoimmune disease subsequent to trauma or PTSD.

#Poor evidence for efficacy of #cannabis in #chronic pain and #PTSD

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More research needed on benefits and harms of cannabis and plant-based cannabis products

Two new systematic evidence reviews have found limited evidence for the efficacy of cannabis and plant-based cannabis products in chronic pain and post traumatic stress disorder (PTSD).
The first review looked at 27 chronic pain trials, finding low-strength evidence for the benefits of cannabis in neuropathic pain, but insufficient evidence in other pain populations. Evidence is also limited on its association with an increased risk for nonserious short-term adverse effects and potentially serious mental health adverse effects, such as psychosis, the authors said.

A second review also found insufficient evidence regarding the benefits and harms of plant-based cannabis preparations in patients with PTSD. Observational studies had shown that compared with nonuse, cannabis did not reduce PTSD symptoms, the authors said. In addition, the studies had medium and high risk of bias. The authors noted, however, that several ongoing studies may soon provide important results.

In an accompanying editorial , Dr Sachin Patel from Vanderbilt Psychiatric Hospital in the US said the reviews “highlight an alarming lack of high-quality data from which to draw firm conclusions about the efficacy of cannabis for these conditions, for which cannabis is both sanctioned and commonly used.”
The reviews and editorial are published in the Annals of Internal Medicine. 

PTSD May Be Physical, Not Just Psychological

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Megan Brooks

The brain’s emotional control center is larger in individuals who develop post-traumatic stress disorder (PTSD) after mild traumatic brain injury (mTBI) than in those with mTBI who don’t develop PTSD, researchers have observed.

“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,” Joel Pieper, MD, from University of California, San Diego, said in a news release.

The study was presented July 15 at the American Academy of Neurology (AAN) 2017 Sports Concussion Conference in Jacksonville, Florida.

The study included 89 current or former members of the military with mTBI. According to standard symptom scale ratings, 29 had significant PTSD in addition to mTBI, while the remaining 60 had mTBI without PTSD.  Age, education, and sex did not significantly differ between the two groups.

Individuals with mTBI and PTSD had 6% overall larger amygdala volumes when normalized to intracranial volume, particularly on the right side, compared with those with mTBI only. Non-normalized amygdala volumes showed no significant between-group difference.

Screening Tool?

“This study shows a structural change in the brain associated with PTSD in head injury subjects,” coauthor Douglas Chang, MD, PhD, professor and chief of Physical Medicine and Rehabilitation Service at UC San Diego Health in California, told Medscape Medical News.

“It’s really interesting why we might see these results,” he added. “Are there susceptible individuals prone to PTSD symptoms after a head injury, with a larger amygdala to begin with, so that they have a brain primed to respond to fear and startle reflexes in an exaggerated fashion? Or are these physical changes a result of neuroplasticity, of a brain reaction to fear conditions resulting in growth of the neural networks of the amygdala fear processing organ?”

“We wonder,” said Dr Chang, “if amygdala size could be used to screen who is most at risk to develop PTSD symptoms after a head injury. On the other hand, if there are environmental or psychological cues that lead to neuroplasticity and enlargement of the amygdala, then maybe such influences can be followed with MRI scans and used to develop treatment interventions.”

The researchers say further studies are needed to better define the relationship between amygdala size and PTSD in mTBI. It also remains to be seen whether similar results may be found in those with sports-related concussions, as opposed to blast injuries.

A Neuropsychiatric Condition

“This is an interesting study that combines PTSD research with mild TBI research. It is increasingly known that mild TBI is a risk factor for the development of PTSD. What is notable here is the finding of increased amygdala volume in patients with PTSD and mild TBI in comparison to people with mild TBI and without PTSD symptoms,” David L. Perez, MD, MMSc, Massachusetts General Hospital in Boston, told Medscape Medical News.

“This finding builds upon the literature in PTSD showing both structural and functional changes in the amygdala, including commonly described increased amygdalar activation. The results on the volumetric side have been mixed in the literature, although there have been some studies showing increased amygdala volume in patients with PTSD,” said Dr Perez.

“As a dual-trained neurologist and psychiatrist, I think about PTSD as a neuropsychiatric condition. This is clearly a brain-based condition, and I think the field is moving in that direction both to understand the biology of PTSD itself and to understand the interplay of disorders that may increase disease risk or somehow change the trajectory of patients who go on to develop PTSD. One of those interesting intersections is the intersection of mild TBI and PTSD,” he added.

The study was supported by the Department of Veterans Affairs and Naval Medical Research Center’s Advanced Medical Development program.  The authors have disclosed no relevant financial relationships.

American Academy of Neurology (AAN) 2017 Sports Concussion Conference. Presented July 15, 2017.

Can a voice patterns distinguish between PTSD and traumatic brain injury?

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Researchers are working on a project to determine if voice analysis could be used to diagnose "invisible injuries".

Scientists say they are close to identifying speech patterns to differentiate between post-traumatic stress disorder (PTSD) and traumatic brain injury.

MIT Technology Review reports how Charles Marmar, chairman of the department of psychiatry at New York University’s Langone Medical Center, together with researchers at Stanford University’s non-profit R&D development organisation, SRI International, are collecting voice samples to analyse vocal cues such as tone, pitch, rhythm, rate and volume.

Marmar has worked in psychiatry for 40 years and told the publication that when a combat veteran steps into his office for an evaluation, “he still can’t diagnose post-traumatic stress disorder with 100 per cent accuracy,” based on patient responses to questions as some patients may be too ashamed to answer honestly.

Over the past five years, Marmar has identified a set of 30 vocal characteristics that he believes to be associated with PTSD and traumatic brain injury, from 40,000 features extracted from the voices of war veterans and control subjects.

Early results presented back in 2015 showed that a voice test developed by Marmar and his team was 77 per cent accurate at distinguishing between PTSD patients and healthy volunteers in a study of 39 men.

Miscarriage and ectopic pregnancy may trigger PTSD

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Four in 10 women reported symptoms of PTSD three months after pregnancy loss.

Women should be routinely screened for post-traumatic stress disorder (PTSD) following a miscarriage or ectopic pregnancy and should receive specific psychological support following pregnancy loss.

The recommendation follows the publication of a new study, which found four in 10 women reported symptoms of PTSD three months after the pregnancy loss.

As part of the study, 113 women who had recently experienced a miscarriage or ectopic pregnancy were surveyed. Among the women who suffered a miscarriage, 45 per cent reported PTSD symptoms at this time, compared to 18 per cent of the women who suffered an ectopic pregnancy. Nearly a third said their symptoms had impacted on their work life, and around 40 per cent reported their relationships with friends and family had been affected.

Commenting on the findings, Dr Jessica Farren, lead author of the research said; “There is an assumption in our society that you don’t tell anyone you are pregnant until after 12 weeks. But this also means that if couples experience a miscarriage in this time, they don’t tell people. This may result in the profound psychological effects of early pregnancy loss being brushed under the carpet, and not openly discussed.”

Psychological trauma may impair blood vessels

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US study shows that blood vessels of veterans with PTSD are less reactive, thereby increasing the risk of heart attack and stroke.

Post-traumatic stress disorder (PTSD) may have a negative effect on blood vessels, a US study in veterans has indicated. The results were presented in the “Journal of the American Heart Association”.

The study, carried out by the University of California, San Francisco, included 67 veterans with PTSD and 147 without PTSD. The average age was 68 or 69 years, respectively, and the majority of the participants were male. All participants were measured using flow-mediated dilation.

Findings revealed that participants with PTSD had significantly lower flow-mediated dilation, meaning their blood vessels expanded less in response to a stimulus. Blood vessels of study subjects with PTSD expanded 5.8 per cent compared to 7.5 per cent among those without PTSD. Moreover, low levels of flow-mediated dilation were associated with advanced age, poorer kidney function and higher blood pressure; those affected were also more likely to experience depression, but were less likely to take beta-blockers or ace-inhibitors.

“Traditional risk factors such as high blood pressure, diabetes, high cholesterol and smoking, have not fully explained why people with PTSD seem to be at higher heart disease risk. Our study suggests that chronic stress may directly impact on the health of blood vessels,” said study author Marlene Grenon.

Study finds nightmares are linked to thoughts of suicide

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Bad dreams may act as a stressor in people with PTSD.

Nightmares and suicidal thoughts, plans or attempts are connected, according to a British study published in the “Journal of Clinical Sleep Medicine”. The reason, the authors suggest, lies in certain negative cognitive thoughts triggered by the dreams.

For the study, the researchers at the University of Manchester collected data from 91 participants who had experienced traumatic events. 51 of the subjects met criteria for post-traumatic stress disorder (PTSD) currently, and an additional 24 reported a prior diagnosis of PTSD. Frequency and intensity ratings of the nightmares were measured using a PTSD scale. Participants also completed questionnaire measures of suicidal behaviour, hopelessness, defeat, and entrapment.

The results show that suicidal thoughts, plans or attempts were present in 62 per cent of participants who experienced nightmares, but only in 20 per cent of those without nightmares.

Further analyses suggest that nightmares may act as a stressor in people with PTSD, triggering specific types of negative cognitive thoughts which reinforce suicidal thoughts and behaviours. The pathways between nightmares and suicidal behaviours appear to operate independent of comorbid insomnia and depression.

“PTSD increases the risk of suicidal thoughts and behaviour, and our study shows that nightmares, a hallmark symptom of PTSD, may be an important treatment target to reduce suicide risk,” said principal investigator Donna L. Littlewood. “This study emphasises the importance of specifically assessing and targeting nightmares within those individuals experiencing PTSD.”