Chemokines in post-traumatic stress disorder: A network meta-analysis

BackgroundPrevious studies on the association between chemokines concentrations and post-traumatic stress disorder (PTSD) yielded inconsistent results. Therefore, the purpose of this network meta-analysis was to summarize these results.MethodsThe databases of PubMed, Web of Science, Psyc-ARTICLES, Embase and Cochrane Library were searched for relevant articles published not later than January 15, 2020. Then, eligible studies were selected based on predefined study selection criteria. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated as group differences in chemokines concentrations. Moreover, network meta-analysis was used to rank chemokines effect values according to their respective surface under cumulative ranking curve (SUCRA) probabilities.FindingsA total of 18 eligible studies that investigated the association between 9 different chemokines and PTSD were identified. They involved 1,510 patients and 2,012 controls. Results of the meta-analysis showed that the concentrations of CCL3, CCL4 and CCL5 in the PTSD patients were significantly higher than that in the controls (SMDs of 4.12, 6.11 and 1.53 respectively). However, although not statistically significant, concentrations of CCL2 tended to be lower in PTSD patients than in the controls (SMD = -0.76); whereas concentrations of CXCL12 tended to be higher in PTSD patients than in the controls (SMD = 0.37). SUCRA probabilities showed that, among all the chemokines studied, the effect of CCL5 was the highest in PTSD patients.InterpretationConcentrations of CCL3, CCL4 and CCL5 may be associated with a trauma and/or PTSD. Also, CXCL12 and CCL2 may be the underlying biomarkers for trauma and/or PTSD. Thus, future studies with large population based samples are needed to further assess these associations. In addition, future research should explore possible mechanisms underlying these associations, with the aim to develop new diagnostics for PTSD. PROSPERO CRD42019147703.     

颅脑损伤患者术后创伤后成长与创伤后应激障碍的相关性

目的 观察颅脑损伤患者术后创伤后成长水平及创伤后应激障碍(PTSD)情况,分析创伤后成长水平与PTSD的关系.方法 选取2017-02—2019-02郑州市第九人民医院手术治疗的63例颅脑损伤患者,所有患者术后1个月接受创伤后成长评定量表(PTGI)评估,依据评估结果分为高水平组与低水平组,调查2组一般资料并评估患者术...     

Efficacy and acceptability of atypical antipsychotics for the treatment of post-traumatic stress disorder: A meta-analysis of randomized,double-blind,placebo-controlled clinical trials

As some evidences demonstrated that atypical antipsychotics (AA) may be efficacious in treating post-traumatic stress disorder (PTSD), we preformed a meta-analysis of randomized, double-blind, placebo-controlled clinical trials (RCTs) of AAs for the treatment of PTSD. Two hundred and fifty one papers were searched and screened. Eight RCTs met the inclusion criteria. AAs may be superior to placebo in the treatment of PTSD, as indicated by the changes in Clinician Administered PTSD Scale (CAPS) total scores (weighted mean differences (WMD)=−5.89, 95% confidence interval (CI) [−9.21, −2.56], P=0.0005) and also in CAPS subscale intrusion (WMD=−2.58, 95% CI[−3.83, −1.33], P<0.0001 ) and subscale hyperarousal (WMD=−2.94, 95% CI[−5.45, −0.43], P=0.02). The acceptability measured by dropout rates between AAs and placebo showed no statistical difference (OR=1.24, 95%CI [0.78, 1.97], P=0.36). PTSD symptom cluster, especially in intrusion and hyperarousal. However, we should be careful to generalize the conclusion because of the small number of included trails. We expect more RCTs will be done in the future so as to clarify the specific value of AAs for PTSD.     

创伤性脑损伤患者创伤后成长与创伤后应激障碍的调查研究

目的分析创伤性脑损伤（TBI）患者创伤后成长（PTG）与创伤后应激障碍（PTSD）的现况及其影响因素。 方法通过便利抽样的方法,选取首都医科大学附属北京天坛医院神经外科自2019年7月至2020年1月就诊的85例TBI患者为研究对象,使用创伤后成长评定量表（PTGI）、创伤后应激障碍量表平民版（PCL-C）调查TBI患者的PTG水平、PTSD情况,并进一步分析TBI患者PTG的影响因素。 结果TBI患者PTGI总分为（58.41±23.05）分,处于低水平。PCL-C得分为（36.18±16.52）分,PCL-C阳性症状检出率为41.2%。多元线性回归分析结果显示,文化程度、性格类型、社会支持、警觉性增高、创伤再体验是TBI患者PTG的影响因素。TBI患者文化水平低、外向型性格、社会支持水平越高其PTG水平越高。TBI事件后警觉性反应低者,PTG水平较高,创伤再体验症状促进PTG的发生。 结论TBI患者创伤后早期同时出现PTG及PTSD,通过调动患者个体内部因素及外在社会联系等方面积极因素,可能提高患者PTG水平。     

军人创伤后应激障碍患者脑干听觉反应的对照研究

目的　探讨军人创伤后应激障碍 (PTSD)患者脑干听觉反应 (ABR)的特点。方法　对 36例PTSD患者和 4 0名健康军人 (对照组 )应用美国NicoletBravo脑电生理仪 ,采用Click短声刺激进行ABR测查。结果　与对照组比较 ,PTSD组的Pz脑区波V绝对潜伏期延迟 (t=4 .5 2 ,P <0 .0 1) ,OZ 脑区波V绝对潜伏期前移(t=4 .5 1,P <0 .0 1) ,OZ 脑区波Ⅱ绝对波幅与PZ 脑区波Ⅳ绝对波幅均降低 (t =5 .5 6和t =5 .5 9,均P <0 .0 1)。结论　ABR对临床辅助诊断PTSD有一定参考价值     

Sleep management in posttraumatic stress disorder: a systematic review and meta-analysis

ObjectivePost-traumatic stress disorder (PTSD) can lead to many negative secondary outcomes for patients, including sleep disturbances. The objective of this meta-analysis is (1) to evaluate the effect of interventions for adults with PTSD on sleep outcomes, PTSD outcomes, and adverse events, and (2) to evaluate the differential effectiveness of interventions aiming to improve sleep compared to those that do not.MethodsNine databases were searched for relevant randomized controlled trials (RCTs) in PTSD from January 1980 to October 2019. Two independent reviewers screened 7176 records, assessed 2139 full-text articles, and included 89 studies in 155 publications for this review. Sleep, PTSD, and adverse event outcomes were abstracted and meta-analyses were performed using the Hartung-Knapp-Sidik-Jonkman method for random effects.ResultsInterventions improved sleep outcomes (standardized mean difference [SMD] −0.56; confidence interval [CI] −0.75 to −0.37; 49 RCTs) and PTSD symptoms (SMD -0.48; CI -0.67 to −0.29; 44 RCTs) across studies. Adverse events were not related to interventions overall (RR 1.17; CI 0.91 to 1.49; 15 RCTs). Interventions targeting sleep improved sleep outcomes more than interventions that did not target sleep (p = 0.03). Improvement in PTSD symptoms did not differ between intervention types.ConclusionsInterventions for patients with PTSD significantly improve sleep outcomes, especially interventions that specifically target sleep. Treatments for adults with PTSD directed towards sleep improvement may benefit patients who suffer from both ailments.     

Reduced recognition of fear and sadness in post-traumatic stress disorder

Post-traumatic stress disorder (PTSD) is associated with impairments in emotional experience and expression. The current study examined the recognition of emotional facial expressions in PTSD patients and matched healthy controls, both in terms of accuracy and sensitivity. The task involved short video clips of a neutral face changing (morphing) into one of the six basic emotions (happiness, anger, fear, surprise, disgust and sadness). Clips differed in length, with short clips terminating at 20% of maximum emotional intensity, and the longest ones ending with a full-blown expression. We observed a specific impairment in the PTSD group for recognizing the emotions fear and sadness. This result was observed via a reduced accuracy and a decreased sensitivity for these emotions. We discuss the observed altered affective processing and its possible clinical implications.     

急性创伤后应激障碍患者脑结构的磁共振研究

目的探讨单一、高强度持续刺激所致急性创伤后应激障碍(PTSD)患者早期脑部结构的变化。方法采用基于像素的形态学方法(VBM)研究受试者脑部结构变化。研究对象包括10名急性PTSD患者,10名未患PTSD的矿难幸存者,并对其PTSD症状积分(CAPS)与感兴趣区灰质密度进行相关性分析。结果与对照组相比,急性PTSD患者左侧海马前部、海马旁回和双侧距状裂皮质纹状区的灰质体积明显下降;而其白质体积未见明显变化。双侧距状裂及左侧海马灰质密度与CAPS积分存在显著负相关。结论本研究结果显示早期急性PTSD患者边缘系统的灰质体积明显减小,PTSD患者症状的严重程度与距状裂皮质纹状区和海马区的灰质密度相关。     

Early fear as a predictor of avoidance in a rat model of post-traumatic stress disorder

Exposure of humans and animals to an intensely fearful experience can lead to an enduring behavioral profile involving fear and avoidance. The present study examined if rats that show more fear to a novel tone one day after exposure to footshocks exhibit more avoidance-like responses over a 4-week period. Rats were exposed to an episode of moderately intense footshock (5 × 2 s episodes of 1.5 mA presented randomly over 3 min). Shock rats that exhibited a high level of fear (HR) to a novel tone one day after the shock exposure showed more avoidance of open spaces and novel rats when compared to shock rats that exhibited a lower level of fear to the novel tone (LR). Similarly, HR emitted more ultrasonic vocalization in the dysphoric range (20-30 kHz) when placed in a novel chamber or the chamber in which shock was given. This study highlights the importance of early fear as a contributing factor for the development of lasting changes in avoidance. These results also support the view that the presence of an intense peritraumatic stress response may be a predictor of the subsequent development of a lasting negative emotional state in humans exposed to trauma.     

基于CiteSpace的近五年国内外创伤后应激障碍研究可视化分析

目的 了解近五年国内外创伤后应激障碍（PTSD）的研究现状,了解该领域研究的前沿和热点。方法 检索Web of Science和中国知网（CNKI）数据库,检索时限为2017年1月1日-2021年12月31日。运用Excel和CiteSpace对纳入的8 505篇文献的数量、作者、国家、机构和关键词等进行可视化分析。结果 (1)近五年,国内外PTSD相关文献发文量均呈增长趋势;(2)国外文献中,发文数量排名前5位的国家分别为美国、英国、中国、澳大利亚和加拿大,其中加拿大中心性最高（0.18）;(3)国内外研究机构均以高校为主;(4)国外文献发文量前三位的学者是Bryant RA、Ressler KJ、Greenberg N,国内前三位分别为伍新春、李越峰、严兴科和张桂青（二者并列）,与国外作者相比,我国学者发文量总体较少;(5)研究关键词方面,国内外关注均较多的是PTSD和抑郁。结论 近五年,PTSD一直是国内外研究的热点,国内外研究均关注PTSD与抑郁症。加强国际交流,有助于推动PTSD相关研究的进步。     

The role of sleep disturbance in the relationship between post-traumatic stress disorder and suicidal ideation

We tested if the risk of suicidal ideation in individuals with PTSD symptoms was dependent on comorbid sleep disturbance. Our cross-sectional sample included 2465 participants with complete data from the 21 year follow-up of the Mater University Study of Pregnancy (MUSP), a birth cohort study of young Australians. Using structural equation modelling with indirect pathways we found that 12 month PTSD symptoms did not directly predict suicidal ideation at 21 when adjusting for major depression symptoms, polyvictimization and gender. However, PTSD symptoms had an indirect effect on suicidal ideation via past-month sleep disturbance. Our results suggest that increased suicidal ideation in those with PTSD may result from the fact that PTSD sufferers often exhibit other comorbid psychiatric conditions which are themselves known to predict suicidal behaviours. Sleep disturbance may be targeted in those who experience PTSD to help prevent suicidal ideation.     

创伤后应激障碍患者的焦虑抑郁与血浆皮质醇水平观察

目的观察创伤后应激障碍（PTSD）患者的焦虑抑郁症状与血浆皮质醇水平的变化。方法以PTSD患者31例为研究组,应用抑郁自评量表（SDS）和焦虑自评量表（SAS）为工具,于入院后0周、1周末和4周末分别评定患者的抑郁焦虑症状,并同步测定血浆皮质醇水平,观察其抑郁焦虑程度及血浆皮质醇水平的变化,并与30名健康者作对照。结果研究组的SDS、SAS总分在发病期（0周和1周末）均显著升高（P〈0.01）,好转后恢复至正常水平。与对照组比较,研究组的血浆皮质醇水平在发病期显著升高（P〈0.01）,随着创伤程度的减轻而恢复正常。研究组血浆皮质醇水平的变化（0周与1周末,1周末与4周末）与SDS、SAS总分的变化无相关性（P〉0.05）。结论PTSD患者在发病期存在不同程度的焦虑抑郁情绪,伴血浆皮质醇水平升高,此期需给予相应的药物治疗和心理干预。     

Single-prolonged stress induces apoptosis in the amygdala in a rat model of post-traumatic stress disorder

Objective

To detect the apoptosis-related Bax and Bcl-2 gene expression and apoptotic cell death in the amygdala region in the single-prolonged stress (SPS) rats.

Methods

A total of 100 male Wistar rats were randomly divided into a normal control group and SPS groups of 1d, 4d, 7d, and 14d. The expression of Bax and Bcl-2 was detected using immunohistochemistry and Western Blotting; TUNEL-staining and double-labeled flow cytometry (FCM) were employed for the detection and quantification of the apoptotic cells in the amygdala; morphological change of the subcellular structure in amygdala was observed by using the transmission electron microscopy (TEM).

Results

The ratio of Bax/Bcl-2 peaked at SPS 4d and then gradually decreased. The apoptosis peaked at SPS 4d. The TUNEL-positive cells were found in each SPS group and the TUNEL-positive cells rate peaked at SPS 4d. The morphological change of amygdala cells in each SPS group bears typical apoptotic characteristics.

Conclusions

In the SPS rat brain, we found apoptotic process in the amygdala region which may relate to the pathogenesis of amygdala abnormal function in PTSD.     

新冠肺炎疫情期间的心理评估和创伤后应激障碍的预防

本文目的是为广大心理援助者介绍新冠肺炎疫情期间对大众进行心理评估的方法。目前心理援助者急需掌握对精神障碍诊断和风险评估的方法,故本文对心理评估中的关键点和侧重点进行了介绍。从评估情绪和行为的基本状态、是否患有某种精神障碍、是否有自杀风险、是否已发展为创伤后应激障碍(PTSD)以及如何预防发展为PTSD的具体方法进行了探讨。     

Visual false memories in post-traumatic stress disorder (PTSD)

There is an ongoing debate whether or not patients with post-traumatic stress disorder (PTSD) are more prone to produce false memories. The present study investigated this question using a visual variant of the Deese-Roediger-McDermott (DRM) paradigm, additionally addressing underlying mechanisms of false memory production (e.g., depression, dissociation, emotional valence, arousal). The visual paradigm was administered to 48 traumatized individuals with (n = 20) and without PTSD (n = 28) and 28 non-traumatized controls. Groups did not differ with regard to memory performance and memory confidence. False memories were correlated with depression. We recommend that future studies employ trauma-related material to further explore memory aberrations in PTSD.     

The structure of post-traumatic stress disorder symptoms in three female trauma samples: a comparison of interview and self-report measures

Empirical research increasingly suggests that post-traumatic stress disorder (PTSD) is comprised of four factors: re-experiencing, avoidance, numbing, and hyperarousal. Nonetheless, there remains some inconsistency in the findings of factor analyses that form the bulk of this empirical literature. One source of such inconsistency may be assessment measure idiosyncrasies. To examine this issue, we conducted confirmatory factor analyses of interview and self-report data across three trauma samples. Analyses of the interview data indicated a good fit for a four-factor model across all samples; analyses of the self-report data indicated an adequate fit in two of three samples. Overall, findings suggest that measure idiosyncrasies may account for some of the inconsistency in previous factor analyses of PTSD symptoms.     

Heart rate variability in bipolar disorder: A systematic review and meta-analysis

BackgroundHeart rate variability (HRV) has been suggested reduced in bipolar disorder (BD) compared with healthy individuals (HC). This meta-analysis investigated: HRV differences in BD compared with HC, major depressive disorder or schizophrenia; HRV differences between affective states; HRV changes from mania/depression to euthymia; and HRV changes following interventions.MethodsA systematic review and meta-analysis reported according to the PRISMA guidelines was conducted. MEDLINE, Embase, PsycINFO, The Cochrane Library and Scopus were searched. A total of 15 articles comprising 2534 individuals were included.ResultsHRV was reduced in BD compared to HC (g = -1.77, 95% CI: −2.46; −1.09, P < 0.001, 10 comparisons, n = 1581). More recent publication year, larger study and higher study quality were associated with a smaller difference in HRV. Large between-study heterogeneity, low study quality, and lack of consideration of confounding factors in individual studies were observed.ConclusionsThis first meta-analysis of HRV in BD suggests that HRV is reduced in BD compared to HC. Heterogeneity and methodological issues limit the evidence. Future studies employing strict methodology are warranted.     

The effects of bright light therapy on depression and sleep disturbances in patients with Parkinson's disease: a systematic review and meta-analysis of randomized controlled trials

BackgroundDepression and sleep disturbance are well-recognized non-motor features in patients with Parkinson's disease (PD). This meta-analysis aimed to explore the potential role of bright light therapy (BLT) in depression and sleep disturbances in Parkinson's Disease (PD).MethodsFour databases were independently searched by two reviewers: PubMed, Cochrane, Web of Science and Embase until February 2021. We evaluated the following depression related scales: Beck's Depression Inventory (BDI); the Geriatric Depression Rating Scale, 30-item (GDS-30); the Hamilton Depression Rating Scale (HDRS); the Hospital Anxiety and Depression Scale (HADS); the Epworth sleepiness scale (ESS); the Fatigue Severity Scale (FSS); the Pittsburgh sleep quality index (PSQI); the Parkinson's disease sleep scale (PDSS); Scales for Outcomes in Parkinson's disease Sleep Scale (SCOPA) and the Insomnia severity index (ISI) to access the effects of bright light therapy on depression and sleep disturbances in patients with PD. Effect size (standardized mean deviation [SMD] and 95% confidence interval [CI]) were used to analyze the continuous results data of intervention group and control light group. Data from five randomized, controlled trials totaling 173 patients with PD was included.ResultsBLT significantly improved depression symptoms (BDI, GDS-30, HDRS and HADS) of PD patients (0.34, 95% CI = 0.06–0.61). Insomnia symptoms (SCOPA and ISI) for patients with PD were significantly improved by BLT as well (1.15, 95% CI = 0.71–1.60). Whereas, no difference was observed in the control light group in improving the depression or insomnia symptoms of PD patients.ConclusionBLT is an effective intervention for improving depressive symptoms and sleep disturbances in patients with PD.