Astrocytes in Post-traumatic Stress Disorder

Although posttraumatic stress disorder (PTSD) is on the rise, traumatic events and their consequences are often hidden or minimized by patients for reasons linked to PTSD itself. Traumatic experiences can be broadly classified into mental stress (MS) and traumatic brain injury (TBI), but the cellular mechanisms of MS- or TBI-induced PTSD remain unknown. Recent evidence has shown that the morphological remodeling of astrocytes accompanies and arguably contributes to fearful memories and stress-related disorders. In this review, we summarize the roles of astrocytes in the pathogenesis of MS-PTSD and TBI-PTSD. Astrocytes synthesize and secrete neurotrophic, pro- and anti-inflammatory factors and regulate the microenvironment of the nervous tissue through metabolic pathways, ionostatic control, and homeostatic clearance of neurotransmitters. Stress or trauma-associated impairment of these vital astrocytic functions contribute to the pathophysiological evolution of PTSD and may present therapeutic targets.     

Prevalence and Comorbidity of Prolonged Grief Disorder in a Sample of Caregivers of Patients in a Vegetative State

Previous studies have shown that Prolonged Grief Disorder (PGD), Post-traumatic Stress Disorder (PTSD) and major depression are autonomous nosological entities. The present study aims at further analyzing the relationship among them in a sample of caregivers of patients in Vegetative State (VS) or Minimally Conscious State (MCS). We also investigated factors predicting the development of PGD. We sampled 40 Caregivers of patients in VS or MCS consecutively admitted to long-term care units. Caregivers were administered the PG-12, the Depression Questionnaire, the SCID I and the Davidson Trauma Scale. Six participants (15%) fulfilled the criteria for PGD, 25% (N = 10) for depression and 25% (N = 10) for PTSD. Although significant correlations emerged among symptom domains of the three disorders, no relevant association was found between a diagnosis of PGD, depression and PTSD. The severity of PTSD symptoms was found to be predictive of PGD. Clinical implications are discussed.     

A Study on the Factors Affecting Anger in Patients With Post-traumatic Stress Disorder

Objective To identify the factors affecting anger in post-traumatic stress disorder (PTSD) patients who underwent Clinician-Administered PTSD Scale (CAPS) and Minnesota Multiphasic Personality Inventory-2 (MMPI-2). Methods We retrospectively reviewed patients who underwent CAPS and MMPI-2 at Veteran Health Service Medical Center, Seoul, Korea. Based on the CAPS score, the patients were divided into the PTSD group (n=46) and the trauma exposed without PTSD group (n=29). After checking the correlation between anger, CAPS, and MMPI-2 scales, logistic regression analysis was performed to identify the risk factors for clinically relevant symptoms. Results The PTSD group showed significant differences in schizophrenia-related symptoms, ideas of persecution, aggressiveness, psychoticism, and anger scales compared to the trauma-exposed without PTSD group. There was a significant correlation between anger, CAPS, and MMPI-2 except masculinity/femininity, disconstraint, and MacAndrew Alcoholism-Revised. In particular, anger has been shown to have a substantial connection with paranoia, schizophrenia-related symptoms, ideas of persecution, aberrant experiences, and psychoticism. Multiple regression analysis identified that the only significant risk factor for anger was the negative emotionality/neuroticism scale (odds ratio=1.152, p<0.001). Conclusion The PTSD group had increased anger compared to the trauma-exposed without PTSD group, and that negative emotions may be a risk factor for PTSD.     

创伤后应激障碍对儿童大脑发育的影响

儿童由于其特殊的生长与发育特点,在经历创伤后应激障碍(PTSD)时对其身心的影响更加严重,但有关儿童(PTSD)的发生、发展机制尚不完全清楚。因此,文中就儿童PTSD发病特点及其对脑发育的影响进行综述。     

Group Therapy for Partners of Combat Veterans With Post-traumatic Stress Disorder

topic . An 18-month group-therapy experience with women partners of combat veterans with post-traumatic stress disorder (PTSD).
purpose . To describe the application of group process and feminist theory to the planning and development of a group of women partners of veterans with PTSD.
source . The authors'clinical work.
conclusions . Using group psychotherapy theory and feminist theory, the group content and process involved the themes of rescuing, dissociation, and individuation. The exploration of transference and countertransference were useful in facilitating individual as well as process.     

The Interplay Between Post-traumatic Stress Disorder and Dementia: A Systematic Review

BackgroundPost-traumatic stress disorder (PTSD) has been reported to increase the risk for dementia in veterans and civilians. Conversely, case reports have described the delayed onset of PTSD in individuals developing dementia, suggesting a complex relationship between these two conditions.ObjectivesTo critically review studies investigating the association between PTSD and dementia and to assess the evidence for a bidirectional relationship between the two conditions.MethodsA systematic review of Web of Science Core databases was carried out from inception of databases up to November 2018 to identify observational studies pertaining to both PTSD and dementia. Populations enrolled, stressors and neuropathologies, and main outcomes of studies were extracted, in addition to age at trauma and at onset of PTSD and dementia. The different temporal relationships between trauma and onset of the conditions were characterized.ResultsTwenty-five articles were included in the review; 14 articles assessed the association of PTSD with subsequent dementia and 11 articles reported the delayed onset of PTSD with the onset of dementia. Most reported traumas occurred in early-life (<40 years) and were related to war combat experiences. PTSD in mid-life (between 40 and 60 years of age) was associated with an increased risk of late-onset dementia. Numerous case series reported the delayed onset of PTSD in Alzheimer's disease and vascular dementia.ConclusionCurrent evidence suggests that PTSD and dementia have a bidirectional relationship: PTSD increases the risk for late-onset dementia and dementia increases the risk for delayed-onset PTSD in those who experienced a significant trauma earlier in life.     

The Quality of Life of Family Caregivers of Eating Disorder Patients

Having a relative with an eating disorder (ED) affects the life of family caregivers and may thus affect their quality of life. To study this aspect, 40 caregivers of ED patients filled out a health-related quality of life questionnaire (Short Form-36) and a questionnaire on the impact of the ED on various areas of life domains, and on the relationship with the ED patient and the need for professional support. Quality of life of caregivers was worse than in a normal reference group. Specifically, mental health, vitality and emotional role functioning were reported to be most impaired. ED appeared to affect families’ lives substantially. In response to the ED, caregivers felt anxious, powerless, sad, or desperate. The relationship of the caregiver with the ED patient had also changed. Caregivers were more worried, lost their trust, and reported more conflicts. Seventy five percent welcomed professional support. Caregivers need practical advice, information on ED, and emotional support. Quality of life of caregivers should be addressed in the treatment of ED.     

Post-traumatic Stress Disorder Symptoms in Children After the 1999 Marmara Earthquake in Turkey

<P> Objective: The aim of this study is to evaluate the symptoms of post-traumatic stress disorder in different age groups of children after the 1999 Marmara earthquake in Turkey. </P><P>Method: The study included thirty-five patients, two to sixteen years old, who presented to the child and adolescent psychiatry department with symptoms of PTSD after the earthquake. An Earthquake Information Form and a Post-traumatic Stress Disorder Symptoms Checklist were filled out with clinical interviews of cases</P>     

The Link Between Post-traumatic Stress Disorder and Physical Comorbidities: A Systematic Review

Context Returning veterans from Afghanistan and Iraq will increase frequency of post-traumatic stress disorder (PTSD). Little is known about its impact on physical health. Objective Systematic literature review focusing on the association between PTSD and specific physical disorders. Data Sources An electronic search using PUBMED and hand search of four journals with an anxiety focus for studies published between January 1981 and July 2008, plus a manual search of article bibliographies. Study Selection Original research reports focusing on PTSD and its association with physical health. Studies investigating only PTSD symptoms, trauma and physical disorders classified at the organ-system level were excluded. Eighty studies were reviewed and seven selected for final analysis. Data Extraction Specific physical-health diagnoses were organized by system and tabulated. They were considered positive only if results were statistically significant. Total number of positive and negative studies for each diagnosis was then calculated for review. Results Seven studies examined the relationship between PTSD and specific physical disorders. Arthritis was associated with PTSD in most studies. Data conflicted regarding diabetes, coronary heart disease, and stroke. Conclusions Few studies have examined the relationship between PTSD and physical health. Large, prospective epidemiological trials are needed.

Trauma and Posttraumatic Stress Disorder in Primary Care Patients

BACKGROUND: This article examines the nature of psychological trauma and posttraumatic stress disorder (PTSD) in 504 patients recruited from primary care settings. METHOD: Patients were screened for anxiety in waiting rooms at 14 general medical settings, and those with a sufficient number and severity of anxiety symptoms were administered a standardized diagnostic clinical interview. Those who met DSM-IV criteria for an anxiety disorder and who were willing to participate were included in this study. Of the 504 patients, 185 met DSM-IV criteria for PTSD. RESULTS: Results indicated that 418 (83%) of primary care patients in our sample reported at least 1 traumatic event in their lifetime. The most prevalent traumas experienced by the entire sample of participants were witnessing others being seriously injured or killed, serious accidents, and rape. Of those participants with PTSD, rape was the strongest predictor of a PTSD diagnosis. Analyses examining gender differences indicated that, for women, a history of other unwanted sexual contact or witnessing a sexual assault, being attacked with a weapon or with intent to kill, or witnessing someone being injured were found to be risk factors for a PTSD diagnosis. Examination of clinical characteristics indicated a high rate of comorbidity of psychiatric disorders among patients with PTSD, including high rates of alcohol/substance abuse, depression, and suicide attempts. CONCLUSION: These findings emphasize the continued need to assess patients presenting at general medical facilities about trauma history.     

Increased Suicidal Ideation in Patients with Co-Occurring Bipolar Disorder and Post-Traumatic Stress Disorder

Suicide risk increases for those with Bipolar Disorder or PTSD, however little research has focused on risk for co-occurring Bipolar Disorder and PTSD. The aim of this article was to evaluate increased suicide risk in co-occurring disorders, and differences in suicide risk for patients with Bipolar I versus Bipolar II. This study evaluated suicide risk in patients with co-occurring PTSD and Bipolar Disorder (n = 3,158), using the MADRS and Suicide Questionnaire. Those with history of PTSD had significantly higher suicidal ideation than those without (U = 1063375.00, p < .0001). Those with Bipolar I had higher risk than those with Bipolar II. Patients with Bipolar I and PTSD were at higher risk for suicidal ideation, implying the importance of diagnosis and risk assessment.     

Psychiatric Comorbidity in Post-traumatic Stress Disorder Among People Seeking Treatment After the Marmara Earthquake

<P> Objective: The purpose of this study was to determine the current comorbidity of post-traumatic stress disorder among treatment-seeking people one year after the 1999 Marmara earthquake. </P><P>Method: Subjects included in the study were between eighteen and sixty-five years of age, were seeking psychiatric treatment, were living in a prefabricated housing site. A face-to-face psychiatric interview lasting thirty to forty-five minutes was conducted with persons willing to participate in the study. The Turkish version of the Structured Clinical Interview for DSM-IV, Clinical Version</P>     

Post-traumatic Stress Disorder in the Context of Terrorism: Key Highlights from the Recent Literature

The nature of life-threatening trauma has changed considerably in the last several years, as the September 11, 2001 terrorist attack and the war in Iraq exemplify. Abundant research suggests that exposure to severe psychological trauma can precipitate psychological and physical distress. The recent events in the media involving terrorism on an international scale suggest an opportunity for research to determine the psychosocial consequences of these particular events.     

Use of Conivaptan (Vaprisol) for Hyponatremic Neuro-ICU Patients

Background  

Hyponatremia is common in neurocritical care and is associated with poor outcome, but the optimal treatment is not known. We wished to test the hypothesis that for neurocritical care patients with severe hyponatremia (Na < 130 mmol/l) or hyponatremia (Na < 135 mmol/l) with depressed Glasgow Coma Scale (GCS) that conivaptan use would lead to increased serum sodium compared to usual care.     

Trauma and Posttraumatic Stress Disorder (PTSD) in Patients with Schizophrenia or Schizoaffective Disorder

Trauma and posttraumatic stress disorder (PTSD) have high prevalence among individuals with severe mental illness, such as schizophrenia or schizoaffective disorder. This study examined whether trauma and PTSD are under-detected in this population, and whether the cognitive theory of PTSD is applicable to these individuals. Traumatic experiences, PTSD symptoms and negative posttraumatic cognitions were directly measured with questionnaires, and compared to information obtained via chart-review. Results showed clear evidence of under-report of trauma and under-diagnosis of PTSD in patients’ charts. Furthermore, negative posttraumatic cognitions were positively related to PTSD symptom severity, supporting the cognitive model of PTSD. These findings underscore the importance of assessing trauma history as well as PTSD in the routine evaluation of patients with schizophrenia or schizoaffective disorder in outpatient clinical settings. Furthermore, the finding of negative posttraumatic cognitions suggests that the cognitive model of PTSD may be applicable to patients with schizophrenia or schizoaffective disorder.