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Researchers and clinicians: Learn about the National Center for PTSD’s research initiatives across its 7 divisions: owl.li/4n6Jjd

April 30, 2016 13:45

Researchers and clinicians: Learn about the National Center for PTSD’s research initiatives across its 7 divisions: owl.li/4n6Jjd

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Nat’l Ctr. for PTSD
@VA_PTSD_Info

Researchers and clinicians: Learn about the National Center for PTSD’s research initiatives across its 7 divisions: owl.li/4n6Jjd

Concussion in the military: an evidence-base review of mTBI in US military personnel focused on posttraumatic headache – Holtkamp MD, Grimes J, Ling G.

April 29, 2016 15:15

Concussion in the military: an evidence-base review of mTBI in US military personnel focused on posttraumatic headache – Holtkamp MD, Grimes J, Ling G. Traumatic brain injury (TBI) is defined as an alteration in brain function caused by an external force. Mild TBI or concussion is now well recognized to be a risk of military service as well as participation in athletic sports such as football. Posttraumat… (Source: SafetyLit)

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Treating posttraumatic stress disorder with MDMA-assisted psychotherapy: A preliminary meta-analysis and comparison to prolonged exposure therapy.

April 28, 2016 14:59

Treating posttraumatic stress disorder with MDMA-assisted psychotherapy: A preliminary meta-analysis and comparison to prolonged exposure therapy.

Treating posttraumatic stress disorder with MDMA-assisted psychotherapy: A preliminary meta-analysis and comparison to prolonged exposure therapy.

J Psychopharmacol. 2016 Apr 26;

Authors: Amoroso T, Workman M

Abstract

Since the wars in Iraq and Afghanistan, posttraumatic stress disorder (PTSD) has become a major area of research and development. The most widely accepted treatment for PTSD is prolonged exposure (PE) therapy, but for many patients it is intolerable or ineffective. ±3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy (MDMA-AP) has recently re-emerged as a new treatment option, with two clinical trials having been published and both producing promising results. However, these results have yet to be compared to existing treatments. The present paper seeks to bridge this gap in the literature. Often the statistical significance of clinical trials is overemphasized, while the magnitude of the treatment effects is overlooked. The current meta-analysis aims to provide a comparison of the cumulative effect size of the MDMA-AP studies with those of PE. Effect sizes were calculated for primary and secondary outcome measures in the MDMA-AP clinical trials and compared to those of a meta-analysis including several PE clinical trials. It was found that MDMA-AP had larger effect sizes in both clinician-observed outcomes than PE did (Hedges’ g=1.17 vs. g=1.08, respectively) and patient self-report outcomes (Hedges’ g=0.87 vs. g=0.77, respectively). The dropout rates of PE and MDMA-AP were also compared, revealing that MDMA-AP had a considerably lower percentage of patients dropping out than PE did. These results suggest that MDMA-AP offers a promising treatment for PTSD.

PMID: 27118529 [PubMed – as supplied by publisher]

Nerve Stimulation May Relieve Chronic PTSD Symptoms

April 28, 2016 04:50

Nerve Stimulation May Relieve Chronic PTSD Symptoms

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.

Belonging protects against postdeployment depression in military personnel.

April 27, 2016 14:14

Belonging protects against postdeployment depression in military personnel.

http:--media.wiley.com-assets-7315-19-WiRelated Articles

Belonging protects against postdeployment depression in military personnel.

Depress Anxiety. 2015 May;32(5):349-55

Authors: Bryan CJ, Heron EA

Abstract

BACKGROUND: Depression among U.S. military personnel has received relatively little empirical attention compared to posttraumatic stress disorder, despite evidence that depression is associated with poor psychosocial outcomes and increased suicide risk. Even less is known about factors that protect against depression in military populations.

METHODS: A sample of 168 active duty Air Force convoy operators completed self-report measures of depression, posttraumatic stress, and sense of “belonging” before deploying to Iraq, and again at 1, 3, 6, and 12 months following their return. Linear growth modeling was used to test the associations of the variables over time.

RESULTS: Mean depression scores remained low and stable across the deployment and 12-month follow-up period. Increased depression severity was significantly associated with low belonging (P < .001) and with posttraumatic stress symptoms (P < .001) at every time point.

LIMITATIONS: Relatively small, predominantly male sample utilizing self-report methods.

CONCLUSIONS: A sense of belongingness may protect service members from depression at all stages of the deployment cycle, from predeployment preparations through deployment and postdeployment adjustment.

PMID: 25903038 [PubMed – indexed for MEDLINE]

Ketamine for treatment-resistant depression: recent developments and clinical applications.

April 27, 2016 14:06

Ketamine for treatment-resistant depression: recent developments and clinical applications.

Related Articles

Ketamine for treatment-resistant depression: recent developments and clinical applications.

Evid Based Ment Health. 2016 Apr 6;

Authors: Schwartz J, Murrough JW, Iosifescu DV

Abstract

Approximately one-third of patients with major depressive disorder (MDD) do not respond to existing antidepressants, and those who do generally take weeks to months to achieve a significant effect. There is a clear unmet need for rapidly acting and more efficacious treatments. We will review recent developments in the study of ketamine, an old anaesthetic agent which has shown significant promise as a rapidly acting antidepressant in treatment-resistant patients with unipolar MDD, focusing on clinically important aspects such as dose, route of administration and duration of effect. Additional evidence suggests ketamine may be efficacious in patients with bipolar depression, post-traumatic stress disorder and acute suicidal ideation. We then discuss the safety of ketamine, in which most neuropsychiatric, neurocognitive and cardiovascular disturbances are short lasting; however, the long-term effects of ketamine are still unclear. We finally conclude with important information about ketamine for primary and secondary physicians as evidence continues to emerge for its potential use in clinical settings, underscoring the need for further investigation of its effects.

PMID: 27053196 [PubMed – as supplied by publisher]

Neuroanatomical features in soldiers with post-traumatic stress disorder.

April 27, 2016 14:06

Neuroanatomical features in soldiers with post-traumatic stress disorder.

http:--http://bit.ly/26u0QXT http:--http://bit.ly/1rgTF5iRelated Articles

Neuroanatomical features in soldiers with post-traumatic stress disorder.

BMC Neurosci. 2016;17(1):13

Authors: Sussman D, Pang EW, Jetly R, Dunkley BT, Taylor MJ

Abstract

BACKGROUND: Posttraumatic stress disorder (PTSD), an anxiety disorder that can develop after exposure to psychological trauma, impacts up to 20 % of soldiers returning from combat-related deployment. Advanced neuroimaging holds diagnostic and prognostic potential for furthering our understanding of its etiology. Previous imaging studies on combat-related PTSD have focused on selected structures, such as the hippocampi and cortex, but none conducted a comprehensive examination of both the cerebrum and cerebellum. The present study provides a complete analysis of cortical, subcortical, and cerebellar anatomy in a single cohort. Forty-seven magnetic resonance images (MRIs) were collected from 24 soldiers with PTSD and 23 Control soldiers. Each image was segmented into 78 cortical brain regions and 81,924 vertices using the corticometric iterative vertex based estimation of thickness algorithm, allowing for both a region-based and a vertex-based cortical analysis, respectively. Subcortical volumetric analyses of the hippocampi, cerebellum, thalamus, globus pallidus, caudate, putamen, and many sub-regions were conducted following their segmentation using Multiple Automatically Generated Templates Brain algorithm.

RESULTS: Participants with PTSD were found to have reduced cortical thickness, primarily in the frontal and temporal lobes, with no preference for laterality. The region-based analyses further revealed localized thinning as well as thickening in several sub-regions. These results were accompanied by decreased volumes of the caudate and right hippocampus, as computed relative to total cerebral volume. Enlargement in several cerebellar lobules (relative to total cerebellar volume) was also observed in the PTSD group.

CONCLUSIONS: These data highlight the distributed structural differences between soldiers with and without PTSD, and emphasize the diagnostic potential of high-resolution MRI.

PMID: 27029195 [PubMed – in process]

Neuropsychiatric Predictors of Post-Injury Headache After Mild-Moderate Traumatic Brain Injury in Veterans.

April 27, 2016 14:06

Neuropsychiatric Predictors of Post-Injury Headache After Mild-Moderate Traumatic Brain Injury in Veterans.

http:--media.wiley.com-assets-7315-19-WiRelated Articles

Neuropsychiatric Predictors of Post-Injury Headache After Mild-Moderate Traumatic Brain Injury in Veterans.

Headache. 2016 Apr;56(4):699-710

Authors: Bomyea J, Lang AJ, Delano-Wood L, Jak A, Hanson KL, Sorg S, Clark AL, Schiehser DM

Abstract

OBJECTIVES: To determine differences in neuropsychiatric complaints between Veterans with mild to moderate traumatic brain injury (TBI), with and without headache, compared with Veteran controls, and to identify neuropsychiatric predictors of headache severity.

BACKGROUND: Mild to moderate TBI is a common occurrence in Veterans, and is frequently associated with complaints of headache. Neuropsychiatric complaints are also common among individuals who have sustained head injury, although the relationship between these factors and headache after injury is unclear. Research is needed to comprehensively determine differences between individuals with mild to moderate traumatic brain injury who differ with respect to headache, and which injury, psychological, or sleep and fatigue factors predict headache severity.

METHODS: A cross-sectional study compared 85 Veterans in three groups (positive for TBI and headache, positive for TBI without significant headache, and a control group) on a set of injury characteristics and neuropsychiatric variables. Correlates of headache severity were examined, and a regression model was used to identify significant independent predictors of headache severity.

RESULTS: Individuals with mild to moderate TBI and headache endorsed significantly greater neuropsychiatric symptoms than participants in the other groups (ηp (2)  = .23-.36) Neuropsychiatric complaints, as well as presence of posttraumatic amnesia, were correlated with headache in the subsample with TBI (rs = .44-.57). When entering all predictors into a regression model, only fatigue represented a significant independent predictor of headache severity (β = .59, R(2) = .35).

CONCLUSIONS: Rather than being a global risk factor, mild to moderate TBI was associated with poorer mental health outcomes, particularly for those who endorse headache. Findings underscore the possibility that Veterans with history of TBI who present with complaints of headache may represent a particularly vulnerable subgroup. Additionally, our findings suggest that clinical outcomes may be improved in those with neurotrauma by incorporating a focus on fatigue in treatment.

PMID: 27028095 [PubMed – in process]

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