Dear editor, We have read with great interest the recent paper by Herrold et al. （2014） published in Neural Regeneration Research. There is evidence that approximately 20-90% of patients with mild traumatic brain in...Dear editor, We have read with great interest the recent paper by Herrold et al. （2014） published in Neural Regeneration Research. There is evidence that approximately 20-90% of patients with mild traumatic brain injury develop posttraumatic symptoms, and 40% of these patients have persistent symptoms after trauma （Bazarian et al., 1999; Koski et al., 2015）. Therefore, mild traumatic brain injury becomes an important cause of temporary disability. Indeed, posttraumatic disorders have a significant epidemiological relevance, even though it is still undervalued in most of the trauma centers （Bazarian et al., 1999） and there is no specific treatment method （Koski et al., 2015）. Recently, many neurological and posttraumatic stress disorders had been treated with noninvasive brain stimulation （Boggio et al., 2010; Fox et al., 2012）.展开更多
BACKGROUND Patients with multiple injuries endure not just physical trauma and suffering but are also at risk of psychological conditions such as posttraumatic stress disorder(PTSD),anxiety,and depression.The co-occur...BACKGROUND Patients with multiple injuries endure not just physical trauma and suffering but are also at risk of psychological conditions such as posttraumatic stress disorder(PTSD),anxiety,and depression.The co-occurrence of PTSD in these patients may cause prolonged physical and mental health complications,thereby further increasing their healthcare expenses.AIM To determine the association between the high-risk factors of PTSD and anxiety as well as depression among patients with multiple injuries.METHODS This study selected 110 patients with multiple injuries who were admitted to our hospital from November 2022 to November 2024.The number and percentage of patients developing PTSD were tallied.Univariate and multivariate analyses were conducted to investigate the high-risk factors of PTSD in these patients.Subse-quently,the associations between these factors and the anxiety and depression levels of patients were analyzed.RESULTS Of the 110 patients,33 suffered from PTSD,representing an incidence rate of 30.0%.The univariate analysis identified age,personality,Hamilton Anxiety Scale(HAMA),Hamilton Depression Scale(HAMD),economic status,negative life events,and smoking history to be significantly associated with PTSD in patients with multiple injuries.Further,the multivariate analysis revealed age,HAMA,HAMD,monthly income,and negative life events as prominent high-risk factors for PTSD in such patients.Regarding the relationships between these factors and HAMA and HAMD,age exhibited a significant positive correlation(r=0.398,P<0.001;r=0.387,P<0.001),monthly income showed a significant negative correlation(r=-0.437,P<0.001;r=-0.319,P<0.001),and negative life events demonstrated a significant positive correlation(r=0.505,P<0.001;r=0.365,P<0.001).CONCLUSION These results indicate age,HAMA,HAMD,monthly income,negative life events,etc.as high-risk factors for PTSD in patients with multiple injuries,among which age,monthly income,and negative life events are closely associated with anxiety and depression.展开更多
Objective:To elucidate the specific mechanisms by which electroacupuncture(EA)alleviates anxiety and fear behaviors associated with posttraumatic stress disorder(PTSD),focusing on the role of lipocalin-2(Lcn2).Methods...Objective:To elucidate the specific mechanisms by which electroacupuncture(EA)alleviates anxiety and fear behaviors associated with posttraumatic stress disorder(PTSD),focusing on the role of lipocalin-2(Lcn2).Methods:The PTSD mouse model was subjected to single prolonged stress and shock(SPS&S),and the animals received 15 min sessions of EA at Shenmen acupoint(HT7).Behavioral tests were used to investigate the effects of EA at HT7 on anxiety and fear.Western blotting and enzyme-linked immunosorbent assay were used to quantify Lcn2 and inflammatory cytokine levels in the prefrontal cortex(PFC).Additionally,the activity of PFC neurons was evaluated by immunofluorescence and in vivo electrophysiology.Results:Mice subjected to SPS&S presented increased anxiety-and fear-like behaviors.Lcn2 expression in the PFC was significantly upregulated following SPS&S,leading to increased expression of the proinflammatory cytokines tumor necrosis factor-a and interleukin-6 and suppression of PFC neuronal activity.However,EA at HT7 inhibited Lcn2 release,reducing neuroinflammation and hypoexcitability in the PFC.Lcn2 overexpression mitigated the effects of EA at HT7,resulting in anxiety-and fear-like behaviors.Conclusion:EA at HT7 can ameliorate PTSD-associated anxiety and fear,and its mechanism of action appears to involve the inhibition of Lcn2-mediated neural activity and inflammation in the PFC.展开更多
Alcohol use disorder （AUD）, mild traumatic brain injury （mTBI）, and posttraumatic stress disorder （PTSD） commonly co-occur （AUD ＋ mTBI ＋ PTSD）. These conditions have overlapping symptoms which are, in part, ...Alcohol use disorder （AUD）, mild traumatic brain injury （mTBI）, and posttraumatic stress disorder （PTSD） commonly co-occur （AUD ＋ mTBI ＋ PTSD）. These conditions have overlapping symptoms which are, in part, reflective of overlapping neuropathology. These conditions become problematic because their co-occurrence can exacerbate symptoms. Therefore, treatments must be developed that are inclusive to all three conditions. Repetitive transcranial magnetic stimulation （rTMS） is non-invasive and may be an ideal treatment for co-occurring AUD ＋ mTBI ＋ PTSD. There is accumulating evidence on rTMS as a treatment for people with AUD, mTBI, and PTSD each alone. However, there are no published studies to date on rTMS as a treatment for co-occurring AUD ＋ mTBI ＋ PTSD. This review article advances the knowledge base for rTMS as a treatment for AUD ＋ mTBI ＋ PTSD. This review provides background information about these co-occurring conditions as well as rTMS. The existing literature on rTMS as a treatment for people with AUD, TBI, and PTSD each alone is reviewed. Finally, neurobiological findings in support of a theoretical model are discussed to inform TMS as a treatment for co-occurring AUD ＋ mTBI ＋ PTSD. The peer-reviewed literature was identified by targeted literature searches using PubMed and supplemented by cross-referencing the bibliographies of relevant review articles. The existing evidence on rTMS as a treatment for these conditions in isolation, coupled with the overlapping neuropathology and symptomology of these conditions, suggests that rTMS may be well suited for the treatment of these conditions together.展开更多
BACKGROUND:Postpartum posttraumatic stress disorder(PTSD)can occur in women who give birth after emergency admission.The identification of risk factors for this condition is crucial for developing effective preventive...BACKGROUND:Postpartum posttraumatic stress disorder(PTSD)can occur in women who give birth after emergency admission.The identification of risk factors for this condition is crucial for developing effective preventive measures.This retrospective study aimed to explore the incidence and risk factors for postpartum PTSD in women who give birth after emergency admission.METHODS:Medical records of women who gave birth after emergency admission were collected between March 2021 and April 2023.The patients’general conditions and perinatal clinical indicators were recorded.The puerperae were divided into PTSD group and control group based on symptom occurrence at six weeks postpartum.Multivariate logistic regression analysis was performed to identify risk factors.RESULTS:A total of 276 puerperae were included,with a PTSD incidence of 20.3% at six weeks postpartum.Multivariate logistic regression analysis identified emergency cesarean section(odds ratio[OR]=2.102;95%confidence interval[CI]:1.114-3.966,P=0.022),admission to the emergency department after midnight(12:00 AM)(OR=2.245;95%CI:1.170-4.305,P<0.001),and cervical dilation(OR=3.203;95%CI:1.670–6.141,P=0.039)as independent risk factors for postpartum PTSD.Analgesia pump use(OR=0.500;95%CI:0.259–0.966,P=0.015)was found to be a protective factor against postpartum PTSD.CONCLUSION:Emergency cesarean section,admission to the emergency department after midnight,and cervical dilation were identified as independent risk factors for postpartum PTSD,while analgesic pump use was a protective factor.These findings provide insights for developing more effective preventive measures for women who give birth after emergency admission.展开更多
Complex posttraumatic stress disorder(Complex PTSD)has been recently proposed as a distinct clinical entity in the WHO International Classification of Diseases,11^(th)version,due to be published,two decades after its ...Complex posttraumatic stress disorder(Complex PTSD)has been recently proposed as a distinct clinical entity in the WHO International Classification of Diseases,11^(th)version,due to be published,two decades after its first initiation.It is described as an enhanced version of the current definition of PTSD,with clinical features of PTSD plus three additional clusters of symptoms namely emotional dysregulation,negative self-cognitions and interpersonal hardship,thus resembling the clinical features commonly encountered in borderline personality disorder(BPD).Complex PTSD is related to complex trauma which is defined by its threatening and entrapping context,generally interpersonal in nature.In this manuscript,we review the current findings related to traumatic events predisposing the above-mentioned disorders as well as the biological correlates surrounding them,along with their clinical features.Furthermore,we suggest that besides the present distinct clinical diagnoses(PTSD;Complex PTSD;BPD),there is a cluster of these comorbid disorders,that follow a continuum of trauma and biological severity on a spectrum of common or similar clinical features and should be treated as such.More studies are needed to confirm or reject this hypothesis,particularly in clinical terms and how they correlate to clinical entities'biological background,endorsing a shift from the phenomenologically only classification of psychiatric disorders towards a more biologically validated classification.展开更多
The United States Food and Drug Administration's(FDA's)August 2024 determination that an additional phase Ⅱ study will be required to consider the approval of midomafetamine for the treatment of posttraumatic...The United States Food and Drug Administration's(FDA's)August 2024 determination that an additional phase Ⅱ study will be required to consider the approval of midomafetamine for the treatment of posttraumatic stress disorder(PTSD)could delay the potential approval of this promising treatment by several years.展开更多
Background:Disaster mental health outcomes of individuals may be affected by the families they inhabit,with effects rippling through the entire family system.Existing research on the experience of children in disaster...Background:Disaster mental health outcomes of individuals may be affected by the families they inhabit,with effects rippling through the entire family system.Existing research on the experience of children in disasters has typically been limited to examining single individuals or,at most,family dyads.Research is needed to explore interactions within families as a whole,including interactions among multiple family members,as well as with community entities in a broad systems approach with dynamic analysis of family systems over time.The purpose of this study was to combine quantitative and qualitative data using structured diagnostic interviews and accompanying open-ended narratives of family members(spouses and children)of survivors of the 9/11 attacks.Methods:This study examined 60 members in 25 families of employees affected by the 9/11 attacks on New York City’s World Trade Center,using a mixed methods approach,collecting quantitative data using full assessments of psychiatric disorders and qualitative data from detailed personal disaster narratives.The employees were a highly 9/11 trauma-exposed group,with about one-fourth developing posttraumatic stress disorder(PTSD).The employees’exposures and PTSD did not regularly appear to propagate straightforwardly to psychopathology in their spouses or children.Based on the impact of disaster experience,4 illustrative families were selected for narrative and family systems analyses.Results:Qualitative analysis of their narratives suggested distinct family system patterns or archetypes that may reflect different ways that families cope with disaster.Conclusion:Findings suggest that family systems and family dynamics may influence not only disaster trauma-exposed members but also other family members in supporting one another and coping with the disaster,with interactions with outside community influences adding further complexity.This information may help guide disaster response efforts to provide psychosocial support targeted to specific family patterns.展开更多
BACKGROUND The characteristics of cerebral hemodynamic indexes of patients with different types of auditory verbal hallucinations(AVHs)was not clear.AIM To explore the characteristics of cerebral hemodynamic indexes o...BACKGROUND The characteristics of cerebral hemodynamic indexes of patients with different types of auditory verbal hallucinations(AVHs)was not clear.AIM To explore the characteristics of cerebral hemodynamic indexes of patients with different types of AVHs and construct the risk nomogram prediction model of patients with different types of AVHs.METHODS Patients with different types of verbal hallucinations who visited Wenzhou Seventh People’s Hospital were retrospectively selected from March 2021 to March 2023,and these patients were classified into 117 cases of schizophrenia(SCZ)with AVHs,108 cases of post-traumatic stress disorder(PTSD)with AVHs,and 105 cases of recurrent depressive disorder with AVHs according to type.Transcranial doppler was performed to measure the hemodynamic parameters of the anterior cerebral artery(ACA),middle cerebral artery(MCA),posterior cerebral artery(PCA),basilar artery(BA)and vertebral artery(VA).Logistic regression modelling was used to explore the factors affecting patients with different types of AVHs and odds ratio,95%confidence interval(CI).A clinical prediction model was constructed,and the efficacy of the clinical prediction model was evaluated by using receiver operating characteristic,Hosmer-Lemeshow Goodness-of-Fit test,calibration curves and decision curve analysis.RESULTS The differences between the three groups of patients in mean velocity(Vm)-MCA,end-diastolic velocity(Vd)-MCA,Vm-ACA,pulsatility index(PI)-ACA,Vm-PCA,peak systolic velocity(Vs)-PCA,Vd-PCA,Vm-BA,Vs-BA,Vd-BA,PI-BA,resistance index(RI)-BA,Vm-VA,Vs-VA,Vd-VA,PI-VA,and RI-VA indexes were statistically significant.Rising Vm-ACA is an independent risk factor for SCZ with AVHs,and falling Vm-VA,Vd-MCA,and Vd-VA are independent risk factors for SCZ with AVHs.Rising Vm-ACA,Vm-PCA,Vs-PCA,Vd-PCA,Vm-BA,and Vs-BA are independent risk factors for PTSD with AVHs,and Vm-MCA,Vs-MCA,Vd-MCA,PI-PCA,and RIBA are independent protective factors for PTSD with AVHs.Elevated Vm-MCA,Vd-MCA,RI-BA,Vm-VA,and Vd-VA were independent risk factors,and elevated Vm-ACA,Vs-ACA,Vm-PCA,Vs-PCA,and Vd-PCA were independent protective factors.The areas under the curve of the three models were 0.82(95%CI:0.76-0.87),0.88(95%CI:0.83-0.92),and 0.81(95%CI:0.77-0.86),respectively;the Hosmer-Lemeshow Goodness-of-Fit test of the calibration curves of the three models suggests that P>0.05.CONCLUSION Monitoring the cerebral hemodynamic indexes of patients with AVHs is of practical significance in determining the type of mental disorder,which helps clinicians identify the type of AVHs and adopt more efficient treatment strategies to help patients recover.展开更多
BACKGROUND: Liver transplantation can lead to the development of posttraumatic stress disorder (PTSD), but the risk factors associated with this progression are not well understood. To study this syndrome in adult liv...BACKGROUND: Liver transplantation can lead to the development of posttraumatic stress disorder (PTSD), but the risk factors associated with this progression are not well understood. To study this syndrome in adult liver transplant recipients, a cross-sectional investigation of 296 recipients at our hospital was carried out between January and June 2010. METHODS: Study participants completed two questionnaires [a PTSD self-rating scale (PTSD-SS) and a validated Chinese version of the Medical Outcomes Study Short Form-36 (SF-36)]. Clinical and demographic data were collected from the records of the Chinese Liver Transplant Registry and via questionnaires. RESULTS: The prevalence of full PTSD and partial PTSD (that met the criteria for 2 of the 3 symptom clusters) was 3.7% and 5.4%, respectively, for all transplant recipients. Significant differences between the recipients with no PTSD, partial PTSD, and full PTSD were found in all SF-36 domains except for physical functioning (P=0.466). In general, domain scores were the highest in the recipients who did not meet the criteria for PTSD and the lowest in the recipients who met the criteria for full PTSD. Greater severity of posttraumatic stress symptoms was correlated with poorer quality of life, especially in the bodily pain (P=0.004), social functioning (P=0.001), role-emotional (P=0.048), and mental health (P<0.001) domains. The model for end-stage liver disease (MELD) scores, complications, and educational status were identified by multiple regression analysis as risk factors for developing PTSD. CONCLUSIONS: PTSD occurred after liver transplantation and was significantly associated with decreased quality of life. Higher MELD scores and complications after transplantation were risk factors that contributed to PTSD, and higher education was a protective factor.展开更多
Because posttraumatic stress disorder(PTSD) is a highly debilitating condition, prevention is an important research topic. This article reviews possible prevention approaches that involve the administration of drugs b...Because posttraumatic stress disorder(PTSD) is a highly debilitating condition, prevention is an important research topic. This article reviews possible prevention approaches that involve the administration of drugs before the traumatic event takes place. The considered approaches include drugs that address the sympathetic nervous system, drugs interfere with the hypothalamic-pituitary-adrenal(HPA) axis, narcotics and other psychoactive drugs, as well as modulators of protein synthesis. Furthermore, some thoughts on potential ethical implications of the use of drugs for the primary prevention of PTDS are presented. While there are many barriers to overcome in this field of study, this paper concludes with a call for additional research, as there are currently no approaches that are well-suited for regular daily use.展开更多
There are various types of traumatic stimuli,such as catastrophic events like wars,natural calamities like earthquakes,and personal trauma from physical and psychological neglect or abuse and sexual abuse.Traumatic ev...There are various types of traumatic stimuli,such as catastrophic events like wars,natural calamities like earthquakes,and personal trauma from physical and psychological neglect or abuse and sexual abuse.Traumatic events can be divided into type I and type II trauma,and their impacts on individuals depend not only on the severity and duration of the traumas but also on individuals’self-evaluation of the traumatic events.Individual stress reactions to trauma include posttraumatic stress disorder(PTSD),complex PTSD and trauma-related depression.Trauma-related depression is a reactive depression with unclear pathology,and depression occurring due to trauma in the childhood has gained increasing attention,because it has persisted for a long time and does not respond to conventional antidepressants but shows good or partial response to psychotherapy,which is similar to the pattern observed for PTSD.Because trauma-related depression is associated with high risk of suicide and is chronic with a propensity to relapse,it is necessary to explore its pathogenesis and therapeutic strategy.展开更多
BACKGROUND Studies have demonstrated that patients who have experienced acute coronary syndrome(ACS)have an increased risk of developing posttraumatic stress disorder(PTSD)and experiencing worse survival outcomes than...BACKGROUND Studies have demonstrated that patients who have experienced acute coronary syndrome(ACS)have an increased risk of developing posttraumatic stress disorder(PTSD)and experiencing worse survival outcomes than those who do not develop PTSD.Nevertheless,the prevalence rates of PTSD following ACS vary widely across studies,and it is noteworthy that in most cases,the diagnosis of PTSD was based on self-report symptom questionnaires,rather than being established by psychiatrists.Additionally,the individual characteristics of patients who develop PTSD after ACS can differ widely,making it difficult to identify any consistent patterns or predictors of the disorder.AIM To investigate the prevalence of PTSD among a large sample of patients undergoing cardiac rehabilitation(CR)after ACS,as well as their characteristics in comparison to a control group.METHODS The participants of this study are patients who have experienced ACS with or without undergoing percutaneous coronary intervention and are enrolled in a 3-wk CR program at the largest CR center in Croatia,the Special Hospital for Medical Rehabilitation Krapinske Toplice.Patient recruitment for the study took place over the course of one year,from January 1,2022,to December 31,2022,with a total of 504 participants.The expected average follow-up period for patients included in the study is about 18 mo,and currently ongoing.Using self-assessment questionnaire for PTSD criteria and clinical psychiatric interview,a group of patients with a PTSD diagnosis was identified.From the participants who do not have a PTSD diagnosis,patients who would match those with a PTSD diagnosis in terms of relevant clinical and medical stratification variables and during the same rehabilitation period were selected to enable comparability of the two groups.RESULTS A total of 507 patients who were enrolled in the CR program were approached to participate in the study.Three patients declined to participate in the study.The screening PTSD Checklist-Civilian Version questionnaire was completed by 504 patients.Out of the total sample of 504 patients,74.2%were men(n=374)and 25.8%were women(n=130).The mean age of all participants was 56.7 years(55.8 for men and 59.1 for women).Among the 504 participants who completed the screening questionnaire,80 met the cutoff criteria for the PTSD and qualified for further evaluation(15.9%).All 80 patients agreed to a psychiatric interview.Among them,51 patients(10.1%)were diagnosed with clinical PTSD by a psychiatrist according to Diagnostic and Statistical Manual of Mental Disorders criteria.Among the variables analyzed,there was a noticeable difference in the percentage of theoretical maximum achieved on exercise testing between the PTSD and non-PTSD groups.Non-PTSD group achieved a significantly higher percentage of their maximum compared to the PTSD group(P=0.035).CONCLUSION The preliminary results of the study indicate that a significant proportion of patients with PTSD induced by ACS are not receiving adequate treatment.Furthermore,the data suggest that these patients may exhibit reduced physical activity levels,which could be one of the possible underlying mechanisms in observed poor cardiovascular outcomes in this population.Identifying cardiac biomarkers is crucial for identifying patients at risk of developing PTSD and may derive benefits from personalized interventions based on the principles of precision medicine in multidisciplinary CR programs.展开更多
BACKGROUND Studies have indicated that childhood exposure to domestic violence is a common factor in posttraumatic growth(PTG)and posttraumatic stress disorder(PTSD),but it is unclear whether PTG and PTSD share a comm...BACKGROUND Studies have indicated that childhood exposure to domestic violence is a common factor in posttraumatic growth(PTG)and posttraumatic stress disorder(PTSD),but it is unclear whether PTG and PTSD share a common/different underlying mechanism.AIM To explore the common/different underlying mechanism of PTG and PTSD.METHODS Between February 12 and 17,2020,a nationwide cross-sectional online survey was conducted in China among 2038 university students,and a self-administered questionnaire was used for the data collection.The data included demographic characteristics,such as age,gender,and subjective social economic status,and childhood exposure to domestic violence scale that was selected from the Chinese version of revised Adverse Childhood Experiences Question,Self-compassion Scale,Connor–Davidson Resilience Scale,Posttraumatic Growth Inventory,and the Abbreviated PTSD Checklist-Civilian version.A structural equation model was used to test the hypotheses.RESULTS Exposure to domestic violence was significantly associated with PTG and PTSD via a 1-step indirect path of self-compassion(PTG:β=-0.023,95%CI:-0.44 to-0.007;PTSD:β=0.008,95%CI:0.002,0.014)and via a 2-step indirect path from self-compassion to resilience(PTG:β=-0.008,95%CI:-0.018 to-0.002;PTSD:β=0.013,95%CI:0.004-0.024).However,resilience did not mediate the relationship between exposure to domestic violence and PTG and PTSD.CONCLUSION PTG and PTSD are common results of childhood exposure to domestic violence,which may be influenced by self-compassion and resilience.展开更多
BACKGROUND The literature suggests that there is a high degree of co-occurrence between chronic pain and posttraumatic stress disorder(PTSD). An association has been found between PTSD and substance abuse. PTSD is a s...BACKGROUND The literature suggests that there is a high degree of co-occurrence between chronic pain and posttraumatic stress disorder(PTSD). An association has been found between PTSD and substance abuse. PTSD is a severe disorder that should be taken into account when opioids are prescribed. It has been found that the prevalence of opioid use disorder(OUD) in chronic pain patients is higher among those with PTSD than those without this disorder.AIM To perform a systematic review on the association between PTSD, chronic noncancer pain(CNCP), and opioid intake(i.e., prescription, misuse, and abuse).METHODS We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The Patient, Intervention,Comparator, and Outcomes(PICOS) criteria were formulated a priori in the protocol of the systematic review. A search was conducted of the PROSPERO database. In March 2019, searches were also conducted of 5 other databases:Pub Med, MEDLINE, Psyc INFO, Web of Science, and PILOTS. The Scottish Intercollegiate Guidelines Network checklist for cohort studies was used to assess the selected studies for their methodological quality and risk of bias. Each study was evaluated according to its internal validity, participant sampling,confounding variables, and the statistical analysis.RESULTS A total of 151 potentially eligible studies were identified of which 17 were retained for analysis. Only 10 met the selection criteria. All the studies were published between 2008 and 2018 and were conducted in the United States. The eligible studies included a total of 1622785 unique participants. Of these, 196516 had comorbid CNCP and PTSD and were consuming opiates. The participants had a cross-study mean age of 35.2 years. The majority of participants were men(81.6%). The most common chronic pain condition was musculoskeletal pain:back pain(47.14% across studies;range: 16%-60.6%), arthritis and joint pain(31.1%;range: 18%-67.5%), and neck pain(28.7%;range: 3.6%-63%). In total,42.4% of the participants across studies had a diagnosis of PTSD(range: 4.7%-95%). In relation to opioid intake, we identified 2 different outcomes: opioid prescription and OUD. All the studies reported evidence of a greater prevalence of PTSD in CNCP patients who were receiving prescribed opioids and that PTSD was associated with OUD in CNCP patients.CONCLUSION Opioid analgesic prescription as the treatment of choice for CNCP patients should include screening for baseline PTSD to ensure that these drugs are safely consumed.展开更多
BACKGROUND The capacity of posttraumatic stress disorder(PTSD)to occur with delayed onset has been documented in several systematic reviews and meta-analyses.Neurobiological models of PTSD may provide insight into the...BACKGROUND The capacity of posttraumatic stress disorder(PTSD)to occur with delayed onset has been documented in several systematic reviews and meta-analyses.Neurobiological models of PTSD may provide insight into the mechanisms underlying the progressive increase in PTSD symptoms over time as well as into occasional occurrences of long-delayed PTSD with few prodromal symptoms.AIM To obtain an overview of key concepts explaining and types of evidence supporting neurobiological underpinnings of delayed PTSD.METHODS A scoping review of studies reporting neurobiological findings relevant to delayed PTSD was performed,which included 38 studies in the qualitative synthesis.RESULTS Neurobiological mechanisms underlying PTSD symptoms,onset,and course involve several interconnected systems.Neural mechanisms involve the neurocircuitry of fear,comprising several structures,such as the hippocampus,amygdala,and prefrontal cortex,that are amenable to time-dependent increases in activity through sensitization and kindling.Neural network models explain generalization of the fear response.Neuroendocrine mechanisms consist of autonomic nervous system and hypothalamic-pituitary-adrenocortical axis responses,both of which may be involved in sensitization to stress.Neuroinflammatory mechanisms are characterized by immune activation,which is sometimes due to the effects of traumatic brain injury.Finally,neurobehavioral/contextual mechanisms involve the effects of intervening stressors and mental and physical disorder comorbidities,and these may be particularly relevant in cases of long-delayed PTSD.CONCLUSION Thus,delayed PTSD may result from multiple underlying neurobiological mechanisms that may influence the likelihood of developing prodromal symptoms preceding the onset of full-blown PTSD.展开更多
Mental health symptoms secondary to trauma exposure and substance use disorders(SUDs)co-occur frequently in both clinical and community samples.The possibility of a shared aetiology remains an important question in tr...Mental health symptoms secondary to trauma exposure and substance use disorders(SUDs)co-occur frequently in both clinical and community samples.The possibility of a shared aetiology remains an important question in translational neuroscience.Advancements in genetics,basic science,and neuroimaging have led to an improved understanding of the neural basis of these disorders,their frequent comorbidity and high rates of relapse remain a clinical challenge.This project aimed to conduct a review of the field’s current understanding regarding the neural circuitry underlying posttraumatic stress disorder and SUD.A comprehensive review was conducted of available published literature regarding the shared neurobiology of these disorders,and is summarized in detail,including evidence from both animal and clinical studies.Upon summarizing the relevant literature,this review puts forth a hypothesis related to their shared neurobiology within the context of fear processing and reward cues.It provides an overview of brain reward circuitry and its relation to the neurobiology,symptomology,and phenomenology of trauma and substance use.This review provides clinical insights and implications of the proposed theory,including the potential development of novel pharmacological and therapeutic treatments to address this shared neurobiology.Limitations and extensions of this theory are discussed to provide future directions and insights for this shared phenomena.展开更多
Introduction: On the 5<sup>th</sup> of June 2022, an incident of a mass attack following multiple gunshots and explosions occurred in a community in Ondo State Nigeria. This study aims to assess the mental...Introduction: On the 5<sup>th</sup> of June 2022, an incident of a mass attack following multiple gunshots and explosions occurred in a community in Ondo State Nigeria. This study aims to assess the mental health status of victims of the mass attack to guide further interventions among them. Methods: A cross-sectional study was conducted among victims of a mass attack in Owo community, Ondo State. A total of 209 affected victims were interviewed on socio-demographic characteristics, symptoms of anxiety (AD) and post-traumatic stress disorder (PTSD), threat experienced, and mental health support received. A 7-item Generalized Anxiety Disorder (GAD-7) and 9-item Post Traumatic Stress Disorder (PTSD) scale were used to assess the mental health status of the victims. A point was assigned to respondents who reported the symptoms of GAD, with a maximum score of 7 attained. For GAD, scores were categorized as follows: 1 - 2 as mild, 2 - 3 as minimal, 4 - 5 as moderate and 6 - 7 as severe. The PTSD symptoms were rated using a 5-point Likert scale response, and assigned the following points;4 = extremely, 3 = quite a bit, 2 = moderate, 1 = a little bit and 0 = not at all. From a maximum score of 36, participants with scores 18 and above were categorized as those with provisional PTSD. The independent samples t-test and correlational analysis were used to determine the association between PTSD score and other independent variables, with an alpha level of significance set at 0.05. Results: Generally, 38 (18.2%) of the respondents had severe AD. About half (89;42.6%) were categorized as those with provisional PTSD. The mean level of both AD (3.40 ± 2.26) and PTSD (16.51 ± 7.63) score is higher among those who were married compared to those not married (anxiety disorder;2.52 ± 2.20, P = 0.005 and PTSD;13.20 ± 8.86, P = 0.004). Respondents who have been counseled by a healthcare worker had a higher mean level (15.89 ± 7.58) of provisional PTSD compared to those not counseled by a healthcare worker (13.56 ± 9.22, P = 0.046). The level of PTSD score increased with a higher age group (r = 0.21, P = 0.003). Conclusions: The results show that the mass attack had psychological consequences among a high proportion of the victims, particularly, those married and in the older age groups. This suggests the need for continuous supportive counseling targeting these affected groups, and considering other factors moderating the effectiveness of counseling among them in future interventions.展开更多
Post-traumatic stress disorder(PTSD)remains a debilitating psychiatric condition with limited pharmacological treatment options.Identifying novel therapeutic targets is critical for addressing its unmet clinical needs...Post-traumatic stress disorder(PTSD)remains a debilitating psychiatric condition with limited pharmacological treatment options.Identifying novel therapeutic targets is critical for addressing its unmet clinical needs.Through our comprehensive human clinical research,including both cross-sectional and longitudinal studies,we revealed a compelling link between dysregulated prefrontal gamma-aminobutyric acid(GABA)levels and PTSD symptoms.Notably,elevated prefrontal GABA levels in PTSD patients are associated with impaired cerebral blood flow(CBF)and symptom severity,normalizing with recovery,highlighting GABA dysregulation as a key mechanism in the disorder.Postmortem and PTSD-like mouse models implicated monoamine oxidase B(MAOB)-dependent astrocytic GABA as a primary driver of this imbalance,exacerbating deficit in fear extinction retrieval.展开更多
AIM To summarize the current evidence on psychological issues in thoracic aortic disease(TAD) and infective endocarditis(IE) setting. METHODS We performed a narrative review about psychological issues in adults with I...AIM To summarize the current evidence on psychological issues in thoracic aortic disease(TAD) and infective endocarditis(IE) setting. METHODS We performed a narrative review about psychological issues in adults with IE and TAD. Through the electronic databases, Pub Med and Psyc INFO, we searched full manuscripts in English and published until September 1, 2014. RESULTS We found sixteen studies exploring psychological issues in patients with IE(six studies) and in TAD(ten papers). Psychological issues assessed were quality of life, depression, anxiety and posttraumatic stress disorder. Quality of life was explored in IE(four papers) and in TAD(eight papers). Depression and anxiety were analyzed in TAD only(five papers). Post-traumatic stress disorder was assessed in IE(one study). Quality of life was found impaired in three of four studies about IE and in three of eight studies about TAD. Posttraumatic stress disorder was present in 11% and was associated with lower levels of quality of life in IE patients. In TAD patients, anxiety and depression levels after different invasive interventions did not differ. CONCLUSION Sixteen studies report about psychological issues in IE and TAD. Most of them explore quality of life and to a less extent anxiety and depression.展开更多
文摘Dear editor, We have read with great interest the recent paper by Herrold et al. （2014） published in Neural Regeneration Research. There is evidence that approximately 20-90% of patients with mild traumatic brain injury develop posttraumatic symptoms, and 40% of these patients have persistent symptoms after trauma （Bazarian et al., 1999; Koski et al., 2015）. Therefore, mild traumatic brain injury becomes an important cause of temporary disability. Indeed, posttraumatic disorders have a significant epidemiological relevance, even though it is still undervalued in most of the trauma centers （Bazarian et al., 1999） and there is no specific treatment method （Koski et al., 2015）. Recently, many neurological and posttraumatic stress disorders had been treated with noninvasive brain stimulation （Boggio et al., 2010; Fox et al., 2012）.
基金Supported by Nanjing Municipal Special Fund for Health Science and Technology Development Support Project,No.GBX21333.
文摘BACKGROUND Patients with multiple injuries endure not just physical trauma and suffering but are also at risk of psychological conditions such as posttraumatic stress disorder(PTSD),anxiety,and depression.The co-occurrence of PTSD in these patients may cause prolonged physical and mental health complications,thereby further increasing their healthcare expenses.AIM To determine the association between the high-risk factors of PTSD and anxiety as well as depression among patients with multiple injuries.METHODS This study selected 110 patients with multiple injuries who were admitted to our hospital from November 2022 to November 2024.The number and percentage of patients developing PTSD were tallied.Univariate and multivariate analyses were conducted to investigate the high-risk factors of PTSD in these patients.Subse-quently,the associations between these factors and the anxiety and depression levels of patients were analyzed.RESULTS Of the 110 patients,33 suffered from PTSD,representing an incidence rate of 30.0%.The univariate analysis identified age,personality,Hamilton Anxiety Scale(HAMA),Hamilton Depression Scale(HAMD),economic status,negative life events,and smoking history to be significantly associated with PTSD in patients with multiple injuries.Further,the multivariate analysis revealed age,HAMA,HAMD,monthly income,and negative life events as prominent high-risk factors for PTSD in such patients.Regarding the relationships between these factors and HAMA and HAMD,age exhibited a significant positive correlation(r=0.398,P<0.001;r=0.387,P<0.001),monthly income showed a significant negative correlation(r=-0.437,P<0.001;r=-0.319,P<0.001),and negative life events demonstrated a significant positive correlation(r=0.505,P<0.001;r=0.365,P<0.001).CONCLUSION These results indicate age,HAMA,HAMD,monthly income,negative life events,etc.as high-risk factors for PTSD in patients with multiple injuries,among which age,monthly income,and negative life events are closely associated with anxiety and depression.
基金supported by the Anhui Provincial Department of Education Outstanding Young Teachers Cultivation Key Project(No.YQZD2023046)the Anhui University of Traditional Chinese Medicine School Talent Support Program Project(Nos.DT2400000222 and DT2100000545)。
文摘Objective:To elucidate the specific mechanisms by which electroacupuncture(EA)alleviates anxiety and fear behaviors associated with posttraumatic stress disorder(PTSD),focusing on the role of lipocalin-2(Lcn2).Methods:The PTSD mouse model was subjected to single prolonged stress and shock(SPS&S),and the animals received 15 min sessions of EA at Shenmen acupoint(HT7).Behavioral tests were used to investigate the effects of EA at HT7 on anxiety and fear.Western blotting and enzyme-linked immunosorbent assay were used to quantify Lcn2 and inflammatory cytokine levels in the prefrontal cortex(PFC).Additionally,the activity of PFC neurons was evaluated by immunofluorescence and in vivo electrophysiology.Results:Mice subjected to SPS&S presented increased anxiety-and fear-like behaviors.Lcn2 expression in the PFC was significantly upregulated following SPS&S,leading to increased expression of the proinflammatory cytokines tumor necrosis factor-a and interleukin-6 and suppression of PFC neuronal activity.However,EA at HT7 inhibited Lcn2 release,reducing neuroinflammation and hypoexcitability in the PFC.Lcn2 overexpression mitigated the effects of EA at HT7,resulting in anxiety-and fear-like behaviors.Conclusion:EA at HT7 can ameliorate PTSD-associated anxiety and fear,and its mechanism of action appears to involve the inhibition of Lcn2-mediated neural activity and inflammation in the PFC.
基金supported with resources by Department of Veterans Affairs(VA),Health Services Research and Development Service and the Office of Academic Affiliations(TPP 42-013)at Edward Hines VA Hospitalsupported by the following:VA OAA Polytrauma Fellowship to AAH,NIDRR Merit Switzer Research Fellowship Award H133F130011to AAH and the VA RR&D CDA-II RX000949-01A2 to AAH
文摘Alcohol use disorder （AUD）, mild traumatic brain injury （mTBI）, and posttraumatic stress disorder （PTSD） commonly co-occur （AUD ＋ mTBI ＋ PTSD）. These conditions have overlapping symptoms which are, in part, reflective of overlapping neuropathology. These conditions become problematic because their co-occurrence can exacerbate symptoms. Therefore, treatments must be developed that are inclusive to all three conditions. Repetitive transcranial magnetic stimulation （rTMS） is non-invasive and may be an ideal treatment for co-occurring AUD ＋ mTBI ＋ PTSD. There is accumulating evidence on rTMS as a treatment for people with AUD, mTBI, and PTSD each alone. However, there are no published studies to date on rTMS as a treatment for co-occurring AUD ＋ mTBI ＋ PTSD. This review article advances the knowledge base for rTMS as a treatment for AUD ＋ mTBI ＋ PTSD. This review provides background information about these co-occurring conditions as well as rTMS. The existing literature on rTMS as a treatment for people with AUD, TBI, and PTSD each alone is reviewed. Finally, neurobiological findings in support of a theoretical model are discussed to inform TMS as a treatment for co-occurring AUD ＋ mTBI ＋ PTSD. The peer-reviewed literature was identified by targeted literature searches using PubMed and supplemented by cross-referencing the bibliographies of relevant review articles. The existing evidence on rTMS as a treatment for these conditions in isolation, coupled with the overlapping neuropathology and symptomology of these conditions, suggests that rTMS may be well suited for the treatment of these conditions together.
基金Science and Technology Development Plan Project of Suzhou(SKJYD2021035)Science and Technology Development Plan Project of Suzhou(SKJYD2022078)The Key Project Research Fund of the Second Affiliated Hospital of Wannan Medical College(YK2023Z04)。
文摘BACKGROUND:Postpartum posttraumatic stress disorder(PTSD)can occur in women who give birth after emergency admission.The identification of risk factors for this condition is crucial for developing effective preventive measures.This retrospective study aimed to explore the incidence and risk factors for postpartum PTSD in women who give birth after emergency admission.METHODS:Medical records of women who gave birth after emergency admission were collected between March 2021 and April 2023.The patients’general conditions and perinatal clinical indicators were recorded.The puerperae were divided into PTSD group and control group based on symptom occurrence at six weeks postpartum.Multivariate logistic regression analysis was performed to identify risk factors.RESULTS:A total of 276 puerperae were included,with a PTSD incidence of 20.3% at six weeks postpartum.Multivariate logistic regression analysis identified emergency cesarean section(odds ratio[OR]=2.102;95%confidence interval[CI]:1.114-3.966,P=0.022),admission to the emergency department after midnight(12:00 AM)(OR=2.245;95%CI:1.170-4.305,P<0.001),and cervical dilation(OR=3.203;95%CI:1.670–6.141,P=0.039)as independent risk factors for postpartum PTSD.Analgesia pump use(OR=0.500;95%CI:0.259–0.966,P=0.015)was found to be a protective factor against postpartum PTSD.CONCLUSION:Emergency cesarean section,admission to the emergency department after midnight,and cervical dilation were identified as independent risk factors for postpartum PTSD,while analgesic pump use was a protective factor.These findings provide insights for developing more effective preventive measures for women who give birth after emergency admission.
文摘Complex posttraumatic stress disorder(Complex PTSD)has been recently proposed as a distinct clinical entity in the WHO International Classification of Diseases,11^(th)version,due to be published,two decades after its first initiation.It is described as an enhanced version of the current definition of PTSD,with clinical features of PTSD plus three additional clusters of symptoms namely emotional dysregulation,negative self-cognitions and interpersonal hardship,thus resembling the clinical features commonly encountered in borderline personality disorder(BPD).Complex PTSD is related to complex trauma which is defined by its threatening and entrapping context,generally interpersonal in nature.In this manuscript,we review the current findings related to traumatic events predisposing the above-mentioned disorders as well as the biological correlates surrounding them,along with their clinical features.Furthermore,we suggest that besides the present distinct clinical diagnoses(PTSD;Complex PTSD;BPD),there is a cluster of these comorbid disorders,that follow a continuum of trauma and biological severity on a spectrum of common or similar clinical features and should be treated as such.More studies are needed to confirm or reject this hypothesis,particularly in clinical terms and how they correlate to clinical entities'biological background,endorsing a shift from the phenomenologically only classification of psychiatric disorders towards a more biologically validated classification.
文摘The United States Food and Drug Administration's(FDA's)August 2024 determination that an additional phase Ⅱ study will be required to consider the approval of midomafetamine for the treatment of posttraumatic stress disorder(PTSD)could delay the potential approval of this promising treatment by several years.
基金supported by National Institute of Mental Health(NIMH)Grant MH68853the National Memorial Institute for the Prevention of Terrorism(MIPT)and Office of State and Local Government Coordination and Preparedness,US Department of Homeland Security MIPT106-113-2000-020.
文摘Background:Disaster mental health outcomes of individuals may be affected by the families they inhabit,with effects rippling through the entire family system.Existing research on the experience of children in disasters has typically been limited to examining single individuals or,at most,family dyads.Research is needed to explore interactions within families as a whole,including interactions among multiple family members,as well as with community entities in a broad systems approach with dynamic analysis of family systems over time.The purpose of this study was to combine quantitative and qualitative data using structured diagnostic interviews and accompanying open-ended narratives of family members(spouses and children)of survivors of the 9/11 attacks.Methods:This study examined 60 members in 25 families of employees affected by the 9/11 attacks on New York City’s World Trade Center,using a mixed methods approach,collecting quantitative data using full assessments of psychiatric disorders and qualitative data from detailed personal disaster narratives.The employees were a highly 9/11 trauma-exposed group,with about one-fourth developing posttraumatic stress disorder(PTSD).The employees’exposures and PTSD did not regularly appear to propagate straightforwardly to psychopathology in their spouses or children.Based on the impact of disaster experience,4 illustrative families were selected for narrative and family systems analyses.Results:Qualitative analysis of their narratives suggested distinct family system patterns or archetypes that may reflect different ways that families cope with disaster.Conclusion:Findings suggest that family systems and family dynamics may influence not only disaster trauma-exposed members but also other family members in supporting one another and coping with the disaster,with interactions with outside community influences adding further complexity.This information may help guide disaster response efforts to provide psychosocial support targeted to specific family patterns.
文摘BACKGROUND The characteristics of cerebral hemodynamic indexes of patients with different types of auditory verbal hallucinations(AVHs)was not clear.AIM To explore the characteristics of cerebral hemodynamic indexes of patients with different types of AVHs and construct the risk nomogram prediction model of patients with different types of AVHs.METHODS Patients with different types of verbal hallucinations who visited Wenzhou Seventh People’s Hospital were retrospectively selected from March 2021 to March 2023,and these patients were classified into 117 cases of schizophrenia(SCZ)with AVHs,108 cases of post-traumatic stress disorder(PTSD)with AVHs,and 105 cases of recurrent depressive disorder with AVHs according to type.Transcranial doppler was performed to measure the hemodynamic parameters of the anterior cerebral artery(ACA),middle cerebral artery(MCA),posterior cerebral artery(PCA),basilar artery(BA)and vertebral artery(VA).Logistic regression modelling was used to explore the factors affecting patients with different types of AVHs and odds ratio,95%confidence interval(CI).A clinical prediction model was constructed,and the efficacy of the clinical prediction model was evaluated by using receiver operating characteristic,Hosmer-Lemeshow Goodness-of-Fit test,calibration curves and decision curve analysis.RESULTS The differences between the three groups of patients in mean velocity(Vm)-MCA,end-diastolic velocity(Vd)-MCA,Vm-ACA,pulsatility index(PI)-ACA,Vm-PCA,peak systolic velocity(Vs)-PCA,Vd-PCA,Vm-BA,Vs-BA,Vd-BA,PI-BA,resistance index(RI)-BA,Vm-VA,Vs-VA,Vd-VA,PI-VA,and RI-VA indexes were statistically significant.Rising Vm-ACA is an independent risk factor for SCZ with AVHs,and falling Vm-VA,Vd-MCA,and Vd-VA are independent risk factors for SCZ with AVHs.Rising Vm-ACA,Vm-PCA,Vs-PCA,Vd-PCA,Vm-BA,and Vs-BA are independent risk factors for PTSD with AVHs,and Vm-MCA,Vs-MCA,Vd-MCA,PI-PCA,and RIBA are independent protective factors for PTSD with AVHs.Elevated Vm-MCA,Vd-MCA,RI-BA,Vm-VA,and Vd-VA were independent risk factors,and elevated Vm-ACA,Vs-ACA,Vm-PCA,Vs-PCA,and Vd-PCA were independent protective factors.The areas under the curve of the three models were 0.82(95%CI:0.76-0.87),0.88(95%CI:0.83-0.92),and 0.81(95%CI:0.77-0.86),respectively;the Hosmer-Lemeshow Goodness-of-Fit test of the calibration curves of the three models suggests that P>0.05.CONCLUSION Monitoring the cerebral hemodynamic indexes of patients with AVHs is of practical significance in determining the type of mental disorder,which helps clinicians identify the type of AVHs and adopt more efficient treatment strategies to help patients recover.
基金supported by a grant from the National Science and Technology Key Projects of China (2008ZX10002-026)
文摘BACKGROUND: Liver transplantation can lead to the development of posttraumatic stress disorder (PTSD), but the risk factors associated with this progression are not well understood. To study this syndrome in adult liver transplant recipients, a cross-sectional investigation of 296 recipients at our hospital was carried out between January and June 2010. METHODS: Study participants completed two questionnaires [a PTSD self-rating scale (PTSD-SS) and a validated Chinese version of the Medical Outcomes Study Short Form-36 (SF-36)]. Clinical and demographic data were collected from the records of the Chinese Liver Transplant Registry and via questionnaires. RESULTS: The prevalence of full PTSD and partial PTSD (that met the criteria for 2 of the 3 symptom clusters) was 3.7% and 5.4%, respectively, for all transplant recipients. Significant differences between the recipients with no PTSD, partial PTSD, and full PTSD were found in all SF-36 domains except for physical functioning (P=0.466). In general, domain scores were the highest in the recipients who did not meet the criteria for PTSD and the lowest in the recipients who met the criteria for full PTSD. Greater severity of posttraumatic stress symptoms was correlated with poorer quality of life, especially in the bodily pain (P=0.004), social functioning (P=0.001), role-emotional (P=0.048), and mental health (P<0.001) domains. The model for end-stage liver disease (MELD) scores, complications, and educational status were identified by multiple regression analysis as risk factors for developing PTSD. CONCLUSIONS: PTSD occurred after liver transplantation and was significantly associated with decreased quality of life. Higher MELD scores and complications after transplantation were risk factors that contributed to PTSD, and higher education was a protective factor.
文摘Because posttraumatic stress disorder(PTSD) is a highly debilitating condition, prevention is an important research topic. This article reviews possible prevention approaches that involve the administration of drugs before the traumatic event takes place. The considered approaches include drugs that address the sympathetic nervous system, drugs interfere with the hypothalamic-pituitary-adrenal(HPA) axis, narcotics and other psychoactive drugs, as well as modulators of protein synthesis. Furthermore, some thoughts on potential ethical implications of the use of drugs for the primary prevention of PTDS are presented. While there are many barriers to overcome in this field of study, this paper concludes with a call for additional research, as there are currently no approaches that are well-suited for regular daily use.
基金Supported by the Science and Technology Project of Zhejiang Provincial,No.GF22H093655Nonprofit Applied Research Project of Huzhou Science and Technology Bureau,2021GYB16.
文摘There are various types of traumatic stimuli,such as catastrophic events like wars,natural calamities like earthquakes,and personal trauma from physical and psychological neglect or abuse and sexual abuse.Traumatic events can be divided into type I and type II trauma,and their impacts on individuals depend not only on the severity and duration of the traumas but also on individuals’self-evaluation of the traumatic events.Individual stress reactions to trauma include posttraumatic stress disorder(PTSD),complex PTSD and trauma-related depression.Trauma-related depression is a reactive depression with unclear pathology,and depression occurring due to trauma in the childhood has gained increasing attention,because it has persisted for a long time and does not respond to conventional antidepressants but shows good or partial response to psychotherapy,which is similar to the pattern observed for PTSD.Because trauma-related depression is associated with high risk of suicide and is chronic with a propensity to relapse,it is necessary to explore its pathogenesis and therapeutic strategy.
文摘BACKGROUND Studies have demonstrated that patients who have experienced acute coronary syndrome(ACS)have an increased risk of developing posttraumatic stress disorder(PTSD)and experiencing worse survival outcomes than those who do not develop PTSD.Nevertheless,the prevalence rates of PTSD following ACS vary widely across studies,and it is noteworthy that in most cases,the diagnosis of PTSD was based on self-report symptom questionnaires,rather than being established by psychiatrists.Additionally,the individual characteristics of patients who develop PTSD after ACS can differ widely,making it difficult to identify any consistent patterns or predictors of the disorder.AIM To investigate the prevalence of PTSD among a large sample of patients undergoing cardiac rehabilitation(CR)after ACS,as well as their characteristics in comparison to a control group.METHODS The participants of this study are patients who have experienced ACS with or without undergoing percutaneous coronary intervention and are enrolled in a 3-wk CR program at the largest CR center in Croatia,the Special Hospital for Medical Rehabilitation Krapinske Toplice.Patient recruitment for the study took place over the course of one year,from January 1,2022,to December 31,2022,with a total of 504 participants.The expected average follow-up period for patients included in the study is about 18 mo,and currently ongoing.Using self-assessment questionnaire for PTSD criteria and clinical psychiatric interview,a group of patients with a PTSD diagnosis was identified.From the participants who do not have a PTSD diagnosis,patients who would match those with a PTSD diagnosis in terms of relevant clinical and medical stratification variables and during the same rehabilitation period were selected to enable comparability of the two groups.RESULTS A total of 507 patients who were enrolled in the CR program were approached to participate in the study.Three patients declined to participate in the study.The screening PTSD Checklist-Civilian Version questionnaire was completed by 504 patients.Out of the total sample of 504 patients,74.2%were men(n=374)and 25.8%were women(n=130).The mean age of all participants was 56.7 years(55.8 for men and 59.1 for women).Among the 504 participants who completed the screening questionnaire,80 met the cutoff criteria for the PTSD and qualified for further evaluation(15.9%).All 80 patients agreed to a psychiatric interview.Among them,51 patients(10.1%)were diagnosed with clinical PTSD by a psychiatrist according to Diagnostic and Statistical Manual of Mental Disorders criteria.Among the variables analyzed,there was a noticeable difference in the percentage of theoretical maximum achieved on exercise testing between the PTSD and non-PTSD groups.Non-PTSD group achieved a significantly higher percentage of their maximum compared to the PTSD group(P=0.035).CONCLUSION The preliminary results of the study indicate that a significant proportion of patients with PTSD induced by ACS are not receiving adequate treatment.Furthermore,the data suggest that these patients may exhibit reduced physical activity levels,which could be one of the possible underlying mechanisms in observed poor cardiovascular outcomes in this population.Identifying cardiac biomarkers is crucial for identifying patients at risk of developing PTSD and may derive benefits from personalized interventions based on the principles of precision medicine in multidisciplinary CR programs.
文摘BACKGROUND Studies have indicated that childhood exposure to domestic violence is a common factor in posttraumatic growth(PTG)and posttraumatic stress disorder(PTSD),but it is unclear whether PTG and PTSD share a common/different underlying mechanism.AIM To explore the common/different underlying mechanism of PTG and PTSD.METHODS Between February 12 and 17,2020,a nationwide cross-sectional online survey was conducted in China among 2038 university students,and a self-administered questionnaire was used for the data collection.The data included demographic characteristics,such as age,gender,and subjective social economic status,and childhood exposure to domestic violence scale that was selected from the Chinese version of revised Adverse Childhood Experiences Question,Self-compassion Scale,Connor–Davidson Resilience Scale,Posttraumatic Growth Inventory,and the Abbreviated PTSD Checklist-Civilian version.A structural equation model was used to test the hypotheses.RESULTS Exposure to domestic violence was significantly associated with PTG and PTSD via a 1-step indirect path of self-compassion(PTG:β=-0.023,95%CI:-0.44 to-0.007;PTSD:β=0.008,95%CI:0.002,0.014)and via a 2-step indirect path from self-compassion to resilience(PTG:β=-0.008,95%CI:-0.018 to-0.002;PTSD:β=0.013,95%CI:0.004-0.024).However,resilience did not mediate the relationship between exposure to domestic violence and PTG and PTSD.CONCLUSION PTG and PTSD are common results of childhood exposure to domestic violence,which may be influenced by self-compassion and resilience.
文摘BACKGROUND The literature suggests that there is a high degree of co-occurrence between chronic pain and posttraumatic stress disorder(PTSD). An association has been found between PTSD and substance abuse. PTSD is a severe disorder that should be taken into account when opioids are prescribed. It has been found that the prevalence of opioid use disorder(OUD) in chronic pain patients is higher among those with PTSD than those without this disorder.AIM To perform a systematic review on the association between PTSD, chronic noncancer pain(CNCP), and opioid intake(i.e., prescription, misuse, and abuse).METHODS We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The Patient, Intervention,Comparator, and Outcomes(PICOS) criteria were formulated a priori in the protocol of the systematic review. A search was conducted of the PROSPERO database. In March 2019, searches were also conducted of 5 other databases:Pub Med, MEDLINE, Psyc INFO, Web of Science, and PILOTS. The Scottish Intercollegiate Guidelines Network checklist for cohort studies was used to assess the selected studies for their methodological quality and risk of bias. Each study was evaluated according to its internal validity, participant sampling,confounding variables, and the statistical analysis.RESULTS A total of 151 potentially eligible studies were identified of which 17 were retained for analysis. Only 10 met the selection criteria. All the studies were published between 2008 and 2018 and were conducted in the United States. The eligible studies included a total of 1622785 unique participants. Of these, 196516 had comorbid CNCP and PTSD and were consuming opiates. The participants had a cross-study mean age of 35.2 years. The majority of participants were men(81.6%). The most common chronic pain condition was musculoskeletal pain:back pain(47.14% across studies;range: 16%-60.6%), arthritis and joint pain(31.1%;range: 18%-67.5%), and neck pain(28.7%;range: 3.6%-63%). In total,42.4% of the participants across studies had a diagnosis of PTSD(range: 4.7%-95%). In relation to opioid intake, we identified 2 different outcomes: opioid prescription and OUD. All the studies reported evidence of a greater prevalence of PTSD in CNCP patients who were receiving prescribed opioids and that PTSD was associated with OUD in CNCP patients.CONCLUSION Opioid analgesic prescription as the treatment of choice for CNCP patients should include screening for baseline PTSD to ensure that these drugs are safely consumed.
基金Supported by the Danish Working Environment Research Fund from Arbejdsmilj?forskningsfonden(to Bonde JP)。
文摘BACKGROUND The capacity of posttraumatic stress disorder(PTSD)to occur with delayed onset has been documented in several systematic reviews and meta-analyses.Neurobiological models of PTSD may provide insight into the mechanisms underlying the progressive increase in PTSD symptoms over time as well as into occasional occurrences of long-delayed PTSD with few prodromal symptoms.AIM To obtain an overview of key concepts explaining and types of evidence supporting neurobiological underpinnings of delayed PTSD.METHODS A scoping review of studies reporting neurobiological findings relevant to delayed PTSD was performed,which included 38 studies in the qualitative synthesis.RESULTS Neurobiological mechanisms underlying PTSD symptoms,onset,and course involve several interconnected systems.Neural mechanisms involve the neurocircuitry of fear,comprising several structures,such as the hippocampus,amygdala,and prefrontal cortex,that are amenable to time-dependent increases in activity through sensitization and kindling.Neural network models explain generalization of the fear response.Neuroendocrine mechanisms consist of autonomic nervous system and hypothalamic-pituitary-adrenocortical axis responses,both of which may be involved in sensitization to stress.Neuroinflammatory mechanisms are characterized by immune activation,which is sometimes due to the effects of traumatic brain injury.Finally,neurobehavioral/contextual mechanisms involve the effects of intervening stressors and mental and physical disorder comorbidities,and these may be particularly relevant in cases of long-delayed PTSD.CONCLUSION Thus,delayed PTSD may result from multiple underlying neurobiological mechanisms that may influence the likelihood of developing prodromal symptoms preceding the onset of full-blown PTSD.
文摘Mental health symptoms secondary to trauma exposure and substance use disorders(SUDs)co-occur frequently in both clinical and community samples.The possibility of a shared aetiology remains an important question in translational neuroscience.Advancements in genetics,basic science,and neuroimaging have led to an improved understanding of the neural basis of these disorders,their frequent comorbidity and high rates of relapse remain a clinical challenge.This project aimed to conduct a review of the field’s current understanding regarding the neural circuitry underlying posttraumatic stress disorder and SUD.A comprehensive review was conducted of available published literature regarding the shared neurobiology of these disorders,and is summarized in detail,including evidence from both animal and clinical studies.Upon summarizing the relevant literature,this review puts forth a hypothesis related to their shared neurobiology within the context of fear processing and reward cues.It provides an overview of brain reward circuitry and its relation to the neurobiology,symptomology,and phenomenology of trauma and substance use.This review provides clinical insights and implications of the proposed theory,including the potential development of novel pharmacological and therapeutic treatments to address this shared neurobiology.Limitations and extensions of this theory are discussed to provide future directions and insights for this shared phenomena.
文摘Introduction: On the 5<sup>th</sup> of June 2022, an incident of a mass attack following multiple gunshots and explosions occurred in a community in Ondo State Nigeria. This study aims to assess the mental health status of victims of the mass attack to guide further interventions among them. Methods: A cross-sectional study was conducted among victims of a mass attack in Owo community, Ondo State. A total of 209 affected victims were interviewed on socio-demographic characteristics, symptoms of anxiety (AD) and post-traumatic stress disorder (PTSD), threat experienced, and mental health support received. A 7-item Generalized Anxiety Disorder (GAD-7) and 9-item Post Traumatic Stress Disorder (PTSD) scale were used to assess the mental health status of the victims. A point was assigned to respondents who reported the symptoms of GAD, with a maximum score of 7 attained. For GAD, scores were categorized as follows: 1 - 2 as mild, 2 - 3 as minimal, 4 - 5 as moderate and 6 - 7 as severe. The PTSD symptoms were rated using a 5-point Likert scale response, and assigned the following points;4 = extremely, 3 = quite a bit, 2 = moderate, 1 = a little bit and 0 = not at all. From a maximum score of 36, participants with scores 18 and above were categorized as those with provisional PTSD. The independent samples t-test and correlational analysis were used to determine the association between PTSD score and other independent variables, with an alpha level of significance set at 0.05. Results: Generally, 38 (18.2%) of the respondents had severe AD. About half (89;42.6%) were categorized as those with provisional PTSD. The mean level of both AD (3.40 ± 2.26) and PTSD (16.51 ± 7.63) score is higher among those who were married compared to those not married (anxiety disorder;2.52 ± 2.20, P = 0.005 and PTSD;13.20 ± 8.86, P = 0.004). Respondents who have been counseled by a healthcare worker had a higher mean level (15.89 ± 7.58) of provisional PTSD compared to those not counseled by a healthcare worker (13.56 ± 9.22, P = 0.046). The level of PTSD score increased with a higher age group (r = 0.21, P = 0.003). Conclusions: The results show that the mass attack had psychological consequences among a high proportion of the victims, particularly, those married and in the older age groups. This suggests the need for continuous supportive counseling targeting these affected groups, and considering other factors moderating the effectiveness of counseling among them in future interventions.
基金supported by National Research Foundation of Korea grants funded by the Ministry of Science and ICT(RS-2024-00457381 to I.K.L.2020M3E5D9079742 to H.R.)+2 种基金by the Ministry of Education(2020R1A6A1A03043528 to I.K.L.)This work was also in part supported by the Institute for Basic Science(IBS),Center for Cognition and Sociality(IBS-R001-D2 to C.J.L)This project applied tools developed under NIH grants R01 EB016089,R01 EB023963 and P41 EB031771.
文摘Post-traumatic stress disorder(PTSD)remains a debilitating psychiatric condition with limited pharmacological treatment options.Identifying novel therapeutic targets is critical for addressing its unmet clinical needs.Through our comprehensive human clinical research,including both cross-sectional and longitudinal studies,we revealed a compelling link between dysregulated prefrontal gamma-aminobutyric acid(GABA)levels and PTSD symptoms.Notably,elevated prefrontal GABA levels in PTSD patients are associated with impaired cerebral blood flow(CBF)and symptom severity,normalizing with recovery,highlighting GABA dysregulation as a key mechanism in the disorder.Postmortem and PTSD-like mouse models implicated monoamine oxidase B(MAOB)-dependent astrocytic GABA as a primary driver of this imbalance,exacerbating deficit in fear extinction retrieval.
文摘AIM To summarize the current evidence on psychological issues in thoracic aortic disease(TAD) and infective endocarditis(IE) setting. METHODS We performed a narrative review about psychological issues in adults with IE and TAD. Through the electronic databases, Pub Med and Psyc INFO, we searched full manuscripts in English and published until September 1, 2014. RESULTS We found sixteen studies exploring psychological issues in patients with IE(six studies) and in TAD(ten papers). Psychological issues assessed were quality of life, depression, anxiety and posttraumatic stress disorder. Quality of life was explored in IE(four papers) and in TAD(eight papers). Depression and anxiety were analyzed in TAD only(five papers). Post-traumatic stress disorder was assessed in IE(one study). Quality of life was found impaired in three of four studies about IE and in three of eight studies about TAD. Posttraumatic stress disorder was present in 11% and was associated with lower levels of quality of life in IE patients. In TAD patients, anxiety and depression levels after different invasive interventions did not differ. CONCLUSION Sixteen studies report about psychological issues in IE and TAD. Most of them explore quality of life and to a less extent anxiety and depression.
