Archives for April 2016

Future Blood Test to Gauge Risk for PTSD?

The way your body responds to stress helps determine your overall coping skills and ability to “move on” after a stressful or traumatic event. Poor recovery after trauma can trigger post-traumatic stress disorder (PTSD), depression, pain, or fatigue in some people.

Research has shown that we have a “personal profile” of resilience to stress. Our profile is based on our brain’s ability to regulate stress combined with molecular elements.

In a new study, researchers at Tel Aviv University (TAU) closely analyzed what happens in the body after a stressful experience — from cellular changes to brain function, emotional responses, and behavior. The new findings may lead to a future blood test that would facilitate preventive or early intervention in professions prone to high stress or trauma, such as combat soldiers or police officers.

“We all need to react to stress; it’s healthy to react to something considered a challenge or a threat,” said Professor Talma Hendler of TAU’s Sagol School of Neuroscience and the Director of the Functional Brain Center at Tel Aviv Sourasky Medical Center.

“The problem is when you don’t recover in a day, or a week, or more. This indicates your brain and/or body do not regulate properly and have a hard time returning to homeostasis (i.e., a balanced baseline). We found that this recovery involves both neural and epigenetic/cellular mechanisms, together contributing to our subjective experience of the stress.”

“This is perhaps the first study to induce stress in the lab and look at resulting changes to three levels of the stress response — neural (seen in brain imaging), cellular (measured through epigenetics), and experience (assessed through behavioral report).”

The study involved 49 healthy young male adults. Researchers integrated the analysis of fMRI images of brain function during an acute social stress task and also measured levels of microRNAs — small RNAs that exert powerful regulatory effects — obtained in a blood test before and three hours after the induced stress.

“We found that vulnerability to stress is not only related to a predisposition due to a certain gene,” said Dr. Noam Shomron of TAU’s Sagol School of Neuroscience and Sackler School of Medicine. “The relevant gene can be expressed or not expressed according to a person’s experience, environment, and many other context-related factors.

“This type of interaction between the environment and our genome has been conceptualized lately as the ‘epigenetic process.’ It has become clear that these processes are of an utmost importance to our health and well being, and are probably, in some cases, above and beyond our predispositions.”

The researchers found that twenty minutes after the stress drill had ended, there were basically two groups: the recovered (those no longer stressed) and the sustainers (those still stressed) . The sustainers either didn’t go back to baseline or took much longer to do so.

“If you can identify through a simple blood test those likely to develop maladaptive responses to stress, you can offer a helpful prevention or early intervention,” said Shomron.

The findings are published in the journal PLOS ONE.

Source: American Friends of Tel Aviv University

Nerve Stimulation May Relieve Chronic PTSD Symptoms

A new University of California (UCLA) study may have found an answer for people with symptoms of PTSD that persist for years or even decades.

Researchers followed 12 individuals with persistent symptoms after an initial trauma that occurred, on average, 30 years ago. Participants reported problems with depression, anxiety, hypervigilant behavior, difficult sleeping, and a high incidence of nightmares.

The participants — survivors of rape, car accidents, domestic abuse, and other traumas — found significant relief from an unobtrusive patch on the forehead that provided mild electrical stimulation while they slept.

Electrodes are placed so as to stimulate the trigeminal nerve.

“We’re talking about patients for whom illness had almost become a way of life,” said Dr. Andrew Leuchter, the study’s senior author, a UCLA professor of psychiatry and director of the neuromodulation division at UCLA.

“Yet they were coming in and saying, ‘For the first time in years I slept through the night,’ or ‘My nightmares are gone.’ The effect was extraordinarily powerful.”

The research, which has been presented at three scholarly conferences and published in the journal Neuromodulation: Technology at the Neural Interface, revealed the first evidence that trigeminal nerve stimulation, or TNS, holds promise for treating chronic PTSD.

“Most patients with PTSD do get some benefit from existing treatments, but the great majority still have symptoms and suffer for years from those symptoms,” said Leuchter, who is also a staff psychiatrist at the VA Greater Los Angeles Healthcare System.

“This could be a breakthrough for patients who have not been helped adequately by existing treatments.”

Based on the study, which was conducted primarily with civilian volunteers, the scientists are recruiting military veterans, who are at an even greater risk for PTSD, for the next phase of their research.

TNS is a new form of neuromodulation, a class of treatment in which external energy sources are used to make subtle adjustments to the brain’s electrical wiring — sometimes with devices that are implanted in the body, but increasingly with external devices.

The approach is gaining popularity for treating drug-resistant neurological and psychiatric disorders. TNS harnesses current from a 9-volt battery to power a patch that is placed on the user’s forehead.

While the person sleeps, the patch sends a low-level current to cranial nerves that run through the forehead, sending signals to parts of the brain that help regulate mood, behavior, and cognition, including the amygdala and media prefrontal cortex, as well as the autonomic nervous system.

Prior research has shown abnormal activity in those areas of the brains of PTSD sufferers.

“The chance to have an impact on debilitating diseases with this elegant and simple technology is very satisfying,” said Dr. Ian Cook, the study’s lead author.

PTSD affects approximately 3.5 percent of the U.S. population but a much higher proportion of military veterans. An estimated 17 percent of active military personnel experience symptoms, and some 30 percent of veterans returning from service in Iraq and Afghanistan have had symptoms.

Sufferers often have difficulty working with others, raising children, and maintaining healthy relationships. Many try to avoid situations that could trigger flashbacks, which makes them reluctant to socialize or venture from their homes, leaving them isolated.

People with the disorder are six times more likely than their healthy counterparts to commit suicide, and they have an increased risk for marital difficulties and dropping out of school.

For the recently completed study, the researchers recruited people with chronic PTSD and severe depression who were already being treated with psychotherapy, medication, or both. While continuing their conventional treatment, the volunteers wore the patch while they slept, for eight hours a night.

Before and after the eight-week study, the study subjects completed questionnaires about the severity of their symptoms and the extent to which the disorders affected their work, parenting and socializing.

The severity of participants’ PTSD symptoms dropped by an average of more than 30 percent, and the severity of their depression dropped by an average of more than 50 percent, the study reports.

Researchers discovered that for 25 percent of the participants, their PTSD symptoms went into remission. In addition, study subjects generally said they felt more able to participate in their daily activities.

Future research will focus on a larger population of veterans who have served in the military since 9/11. For this study, half will receive real treatment and half will be given a fake TNS patch, in the way a placebo pill would be used in a drug trial. At the end of the study, subjects who were using the fake patch will have the option of undergoing treatment with an actual TNS system.

TNS treatment has been shown to be effective in treating drug-resistant epilepsy and treatment-resistant depression.

“PTSD is one of the invisible wounds of war,” Cook said. “The scars are inside but they can be just as debilitating as visible scars. So it’s tremendous to be working on a contribution that could improve the lives of so many brave and courageous people who have made sacrifices for the good of our country.”

Source: UCLA

 
Abstract of the brain photo by shutterstock.

PTSD Advice?

I’ve been diagnosed with PTSD. Supposedly this is from the severe bullying I went through for almost 10 years. I’ve only recently gotten help on this two months ago. While going to therapy stopped the crying and anger that I had I feel increasingly tired, I’m frustrated and downright miserable and I feel like I’m failing in life and in school. I don’t have friends. The ones I do have are from High School. I’m terrified talking to people, but yet I can do a public speech perfectly. I don’t think therapy is helping me and going from what my psychology teacher is rambling about he makes me feel like this problem is simple and I shouldn’t even be so upset.

I’m tired of being like this and I’m wondering if I should see someone different to help me. Going out is a problem, dating is a problem just living is an issue I’m even ready to drop out. I was dying to go to school now that I’m in I’m so unhappy.

Any suggestions that I can take? I’ve tried self-therapy and seeing a therapist doesn’t seem to be working.

A. Quitting therapy would be a mistake. You are already seeing results. Your expectations are unrealistic if you think that you should be “cured” by now. You can’t expect two months of counseling to correct 10 years of severe bullying. It takes time to recover from abuse.

Perhaps you misunderstood your psychology professor or maybe he or she doesn’t fully understand the therapeutic process. For most mental health problems, two months in therapy is not enough.

Therapy can sometimes be difficult. Experiencing difficult and unpleasant feelings is part of the process. Pain and suffering are part of life. No one can completely avoid it but we can learn to make better choices to minimize it. Learning those skills, in part, is the purpose of therapy.

Stopping now would be a mistake. As long as you are making progress, week after week, then you are on the right track. It’s important to be patient, adjust your expectations and to participate in therapy for however long it takes to heal. Please take care.

Dr. Kristina Randle

PTSD: Can’t Stop Purposely Triggering Myself

I was raped when I was nine years old. The abuse I suffered lasted for several months, but I have only a handful of memories, like brief flashes, and some of them are not even visual. I am so mad at myself for not being able to remember more, it makes me feel like maybe I’m making the whole thing up. I also hate that when I think of my abuse directly, I mostly feel numb. Replaying the memories in my head doesn’t upset me, I feel nothing at all. My problem is that I am obsessed with rape. I can’t stop compulsively seeking out movies and tv shows with rape in them. I don’t get pleasure from this, instead it’s like a form of self-harm. I get so hysterically upset from watching rape scenes, they give me what I call “emotional flashbacks” where I feel like it’s happening to me now, and I can feel all of the emotions that I felt during my own rape. I don’t know why I do this because it hurts me so much, and it takes hours to recover from. It’s like I need to trigger myself with these scenes and feel these things in order to prove to myself that my experiences were real, since my memories are so pathetic and easy to doubt. I usually feel so numb about my abuse, triggering myself like this is the only way I can make myself feel. I can’t stop, I think about rape all the time, it’s always in the back of my mind, and whenever I hear about a rape scene in a movie, I look it up right away, even though I know that doing so will hurt me. Why do I do this? What’s wrong with me? (age 24, from UK)

A:  I’m so sorry that you were sexually abused as a young child. As you know all too well, it can have devastating (and confusing) effects. I think that you are correct in thinking that you have Posttraumatic Stress Disorder (PTSD) and I hope that you have sought professional counseling to help you deal with the effects of the abuse. I would suggest that you seek a therapist who specializes in treating trauma and who has training in EMDR, a technique that has been proven to be very effective in treating PTSD.

Your excessive focus on watching rape scenes is most likely a form of self-harm, like you suspect, but also just a self-created coping skill to help you feel. If you feel numb most of the time, it can sometimes take extreme measures to break through that protective shield. And the fact that you have some missing or vague memories of your trauma is quite normal, don’t force yourself to dwell on these missing pieces, but put your energy into healing and getting your life back. I have worked with many sexual abuse survivors and I can promise you that if you do the work, with the help of a trained therapist, it does get better.

All the best,

Dr. Holly Counts

What happened to harmonization of the PTSD diagnosis? The divergence of ICD11 and DSM5.

What happened to harmonization of the PTSD diagnosis? The divergence of ICD11 and DSM5.

Epidemiol Psychiatr Sci. 2013 Sep;22(3):205-7

Authors: Bisson JI

Abstract

The development of ICD11 and DSM5 was seen as an opportunity to harmonize the two major classification systems for mental disorders. The proposed ICD11 and DSM5 diagnostic criteria for PTSD are markedly different. The implications of this remain to be seen, but have the potential to cause confusion to PTSD sufferers, clinicians, researchers and others impacted on by the condition.

PMID: 23601348 [PubMed – indexed for MEDLINE]