Prominence of Hyperarousal Symptoms Explains Variability of Sleep Disruption in Posttraumatic Stress Disorder.

Prominence of Hyperarousal Symptoms Explains Variability of Sleep Disruption in Posttraumatic Stress Disorder.

Psychol Trauma. 2016 Apr 11;

Authors: van Wyk M, Thomas KG, Solms M, Lipinska G

Abstract

OBJECTIVE: Disrupted sleep is a central feature of posttraumatic stress disorder (PTSD). The precise nature of that disruption is not agreed upon, however, and there is no explanation for why sleep disruptions are detected in some PTSD-diagnosed individuals but not in others. We tested the novel proposition that PTSD-diagnosed individuals with prominent hyperarousal symptoms will have more disrupted sleep than those without such symptoms.

METHOD: We assigned each of 57 female volunteers to 1 of 4 groups: PTSD + Hyperarousal (PTSD + HYP; n = 14), PTSD – Hyperarousal (n = 13), depression (n = 14), or healthy control (n = 16). Each experienced 1 night of polysomnographic recording in a sleep laboratory.

RESULTS: General linear modeling confirmed that group status (i.e., being in the PTSD + HYP group rather than the other groups) predicted disrupted sleep quality most strongly. PTSD patients with prominent hyperarousal symptoms, relative to those without such symptoms, experienced reduced sleep efficiency, spent more time awake after sleep onset, and self-reported poorer sleep quality.

CONCLUSION: These preliminary findings, although requiring replication in larger samples, suggest an important association between hyperarousal symptoms and sleep quality in PTSD, and may help explain why some PTSD-diagnosed individuals experience markedly disrupted sleep whereas others do not. (PsycINFO Database Record

PMID: 27065065 [PubMed – as supplied by publisher]

Prescription opioid use: Patient characteristics and misuse in community pharmacy.

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Prescription opioid use: Patient characteristics and misuse in community pharmacy.

J Am Pharm Assoc (2003). 2016 Mar 24;

Authors: Cochran G, Bacci JL, Ylioja T, Hruschak V, Miller S, Seybert AL, Tarter R

Abstract

OBJECTIVES: Opioid pain medication misuse is a major concern for US public health. The purpose of this article is to: 1) describe the demographic and physical, behavioral, and mental health characteristics of patients who fill opioid medications in community pharmacy settings; and 2) describe the extent of opioid medication misuse behaviors among these patients.

DESIGN: We recruited and screened a convenience sample of patients with the use of a tablet computer-based assessment protocol that examined behavioral, mental, and physical health. Descriptive and inferential statistics were calculated to describe respondents and their opioid medication misuse and health characteristics.

SETTING: Patients were screened in two urban and two rural community pharmacies in southwestern Pennsylvania.

PARTICIPANTS: Survey participants were adult patients filling opioid pain medications who were not currently receiving treatment for a cancer diagnosis.

INTERVENTION: None.

MAIN OUTCOME MEASURES: Validated screening measures included the: Prescription Opioid Misuse Index, Alcohol Use Disorders Identification Test C, Short Form 12, Drug Abuse Screening Test 10, Primary Care Post-traumatic Stress Disorder (PTSD) screen, and the Patient Health Questionnaire 2.

RESULTS: A total of 333 patients were screened (71.2% response rate). Nearly the entire population reported pain above and general health below national norms. Hydrocodone (19.2%) and morphine (20.8%) were found to be the medications with the highest rates of misuse-with hydrocodone having more than four times higher odds of misuse compared with other medications (adjusted odds ratio [AOR] 4.48, 95% confidence interval [CI] 1.1-17.4). Patients with positive screens for illicit drug use (AOR 8.07, 95% CI 2.7-24.0), PTSD (AOR 5.88, 95% CI 2.3-14.7), and depression (AOR 2.44, 95% CI 1.0-5.9) also had significantly higher odds for misuse compared with those with negative screening results.

CONCLUSION: These findings provide important foundational data that suggest implementation of regular opioid misuse screening protocols within community pharmacies. Such screening activities could foster a culture of prevention and overall reduction for misuse among patients filling opioid medications in community pharmacies.

PMID: 27053277 [PubMed – as supplied by publisher]

Comparison of Blast-Exposed OEF/OIF Veterans with and without a History of TBI Symptoms on a Brief Computerized Neuropsychological Battery.

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Comparison of Blast-Exposed OEF/OIF Veterans with and without a History of TBI Symptoms on a Brief Computerized Neuropsychological Battery.

Appl Neuropsychol Adult. 2016 Apr 4;:1-6

Authors: Kalkstein S, Scott JC, Biester R, Brownlow JA, Harpaz-Rotem I, Gur RC

Abstract

Mild traumatic brain injuries (mild TBIs) resulting from exposure to Improvised Explosive Devices (IEDs) are highly prevalent among veterans of the wars in Iraq and Afghanistan. This exploratory study compared the neurocognitive performance of blast-exposed veterans with (n = 19) and without (n = 15) reported symptoms of mild TBI. All subjects had diagnoses of posttraumatic stress disorder (PTSD). Neurocognitive testing was administered using a well-established computerized battery, the Penn Computerized Neuropsychological Battery (CNB), and groups were well matched on age, race, education, and time since most recent blast exposure. Although differences were not observed on CNB accuracy scores, MANOVAs revealed slower processing speed in the mTBI group when answering correctly on tests of simple and sustained attention, with large effect sizes. Results suggest a potential speed-accuracy tradeoff in blast-related mild TBI, which should be further examined in larger samples.

PMID: 27045712 [PubMed – as supplied by publisher]

Influence of Mild Traumatic Brain Injury (TBI) and Posttraumatic Stress Disorder (PTSD) on Pain Intensity Levels in OEF/OIF/OND Veterans.

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Influence of Mild Traumatic Brain Injury (TBI) and Posttraumatic Stress Disorder (PTSD) on Pain Intensity Levels in OEF/OIF/OND Veterans.

Pain Med. 2016 Apr 3;

Authors: Stojanovic MP, Fonda J, Fortier CB, Higgins DM, Rudolph JL, Milberg WP, McGlinchey RE

Abstract

OBJECTIVE: Mild traumatic brain injury (mTBI) and posttraumatic stress disorder (PTSD) are common among US veterans of Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND). We postulated that these injuries may modulate pain processing in these individuals and affect their subjective pain levels.

DESIGN: Cross-sectional.

SUBJECTS: 310 deployed service members of OEF/OIF/OND without a lifetime history of moderate or severe TBI were included in this study.

METHODS: All participants completed a comprehensive evaluation for Blast Exposure, mTBI, PTSD, and Pain Levels. The Boston Assessment of TBI-Lifetime Version (BAT-L) was used to assess blast exposure and potential brain injury during military service. The Clinician-Administered PTSD Scale (CAPS) characterized presence and severity of PTSD. The Visual Analog Scale (VAS) was used to assess pain intensity over the previous month before the interview, with higher scores indicative of worse pain. Statistical analysis was performed by ANOVA and results were adjusted for co-morbidities, clinical characteristics and demographic data.

RESULTS: In comparison to control participants (veterans without mTBI or current PTSD), veterans with both current PTSD and mTBI reported the highest pain intensity levels, followed by veterans with PTSD only (P < 0.0001 andP = 0.0005, respectively). Pain levels in veterans with mTBI only were comparable to control participants.

CONCLUSIONS: Comorbid PTSD and mTBI is associated with increased self-reported pain intensity. mTBI alone was not associated with increased pain.

PMID: 27040665 [PubMed – as supplied by publisher]

EPIGENETIC VARIATION AT SKA2 PREDICTS SUICIDE PHENOTYPES AND INTERNALIZING PSYCHOPATHOLOGY.

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EPIGENETIC VARIATION AT SKA2 PREDICTS SUICIDE PHENOTYPES AND INTERNALIZING PSYCHOPATHOLOGY.

Depress Anxiety. 2016 Apr;33(4):308-15

Authors: Sadeh N, Wolf EJ, Logue MW, Hayes JP, Stone A, Griffin LM, Schichman SA, Miller MW

Abstract

BACKGROUND: DNA methylation of the SKA2 gene has recently been implicated as a biomarker of suicide risk and posttraumatic stress disorder (PTSD). To examine the specificity and reliability of these findings, we examined associations between SKA2 DNA methylation, broad dimensions of psychiatric symptoms, and suicide phenotypes in adults with high levels of trauma exposure.

METHODS: A total of 466 White, non-Hispanic veterans and their intimate partners (65% male) underwent clinical assessment and had blood drawn for genotyping and methylation analysis. DNA methylation of the CpG locus cg13989295 and genotype at the methylation-associated single-nucleotide polymorphism (SNP) rs7208505 were examined in relation to current and lifetime PTSD, internalizing and externalizing psychopathology, and suicide phenotypes (ideation, plans, and attempts).

RESULTS: DNA methylation at the previously implicated SKA2 CpG locus (cg13989295) was associated with current and lifetime symptoms of internalizing (but not externalizing) disorders. SKA2 methylation levels also predicted higher rates of current suicidal thoughts and behaviors, even after including well-established psychiatric risk factors for suicide in the model. Associations between PTSD and SKA2 were not significant, and genetic variation at the methylation-associated SNP (rs7208505) was not related to any of the phenotypes examined.

CONCLUSIONS: SKA2 methylation may index a general propensity to experience stress-related psychopathology, including internalizing disorders and suicidal thoughts and behaviors. This study demonstrates that SKA2 methylation levels explain unique variance in suicide risk not captured by clinical symptom interviews, providing further evidence of its potential utility as a biomarker of suicide risk and stress-related psychopathology.

PMID: 27038412 [PubMed – in process]

STRUCTURAL AND FUNCTIONAL CONNECTIVITY IN POSTTRAUMATIC STRESS DISORDER: ASSOCIATIONS WITH FKBP5.

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STRUCTURAL AND FUNCTIONAL CONNECTIVITY IN POSTTRAUMATIC STRESS DISORDER: ASSOCIATIONS WITH FKBP5.

Depress Anxiety. 2016 Apr;33(4):300-7

Authors: Fani N, King TZ, Shin J, Srivastava A, Brewster RC, Jovanovic T, Bradley B, Ressler KJ

Abstract

BACKGROUND: The integrity of connections between the hippocampus and the anterior cingulate cortex (ACC) is critical for adaptive cognitive and emotional processing; these connections may be compromised in posttraumatic stress disorder (PTSD). However, there is a lack of PTSD research that combines structural and functional connectivity data, and no studies have examined whether abnormal ACC-hippocampal connectivity is associated with genetic variability, particularly for polymorphisms of a gene that has been previously associated with PTSD, FKBP5. This was the goal of the present study.

METHODS: Fifty-four women with and without PTSD underwent diffusion tensor imaging and resting-state MRI. Probabilistic tractography was used to examine ACC-hippocampal structural connectivity; mean fractional anisotropy (FA) values were extracted from connectivity streamlines, which represent the cingulum bundle. Genotype data were collected for a single nucleotide polymorphism (SNP) of FKBP5, rs1360780.

RESULTS: Participants with PTSD demonstrated poorer structural connectivity (lower cingulum FA) compared to traumatized controls (F1, 50 = 6.77, P < .05). An interaction of FKBP5 genotype and diagnostic group was also observed (F1, 37 = 4.52, P = .04), indicating lower cingulum FA in carriers of two risk alleles for this SNP, compared to other diagnostic and genotype groups. Carriers of two FKBP5 risk alleles also demonstrated poorer hippocampus-ACC connectivity at rest (P < .05). When cingulum FA was used a regressor in a brain-wide, seed-based regression analysis, significant associations were found between the hippocampus and dorsal regions of the ACC (P < .05).

CONCLUSIONS: Individuals with PTSD demonstrated compromised structural connectivity of the hippocampus-ACC pathway. Altered hippocampus-ACC connectivity may represent a highly salient intermediate neural phenotype for PTSD.

PMID: 27038411 [PubMed – in process]