A Harvard researcher credits new efforts by the Army to prevent PTSD, as well as ensuring that those who do develop the disorder receive the best treatment available.

Early estimates suggested PTSD would affect up to 30 percent of the troops, said Harvard professor of psychology Dr. Richard J. McNally in an article that appears in the May 18 issue of Science. But current surveys show the actual rates ranging from 2.1 to 13.8 percent, he noted.

The most rigorous survey of American troops found that 4.3 percent of all American military personnel deployed to Iraq and Afghanistan developed PTSD, while 7.6 percent of those who saw combat developed the disorder, he added.

“As a society we’re much more aware of these issues than ever before,” McNally said. “That is reflected by the fact that the military and the Veteran’s Administration has established programs to ensure soldiers receive the best treatment possible. The title of my article is ‘Are We Winning the War Against Post-Traumatic Stress Disorder?’ I think a provisional answer to that is, ‘Yes, we might be.’”

The suggestion that 30 percent of troops might develop PTSD was based on the findings of the National Vietnam Veterans Readjustment Study (NVVRS), completed in 1990, which found that 30.9 percent of Vietnam veterans showed symptoms of PTSD. While later analyses brought that number down, the findings served to galvanize Army efforts to address the risk of soldiers developing the disorder, McNally said.

Part of the drop may be that today’s wars are less lethal — in a decade of war in Iraq, fewer than 5,000 American troops were killed, compared to more than 55,000 killed over a similar period in Vietnam, McNally noted. He was quick to add that new efforts by the Army to tackle the disorder sooner, and ensure soldiers receive the best treatment available, may be helping as well.

“It’s important to remember that simply being deployed carries a great deal of stress,” he said. “Soldiers miss their family, and those who stay at home essentially become a one-parent family. Difficulties with children, or school, or making ends meet — there are all kinds of stressors that have to do with separating families, let along having one member in a war zone. Fortunately, the military has taken steps to help soldiers cope with these stressors in addition to the traumatic combat stressors that can produce PTSD.”

Those steps include the Comprehensive Soldier Fitness (CSF) program, created to help soldiers build the resilience necessary to reduce their risk for PTSD before being deployed, and Battlemind training, which was created to treat those at risk of developing the disorder after they return.

“It’s not therapy per se, but a preventive intervention to help people put their experiences in perspective,” McNally said. “For example, it encourages soldiers to use the sort of emotional bonding that happens within units to reconnect with their families, and to see symptoms like hypervigilance not as symptoms of a mental disorder, but as something they need to adjust when they come home. It helps people realize that those things are part of the normal readjustment process.”

Evidence suggests the training is working, McNally said, pointing to the results of random trials that show that four months after returning home, soldiers who underwent Battlemind training showed fewer symptoms of PTSD and depression than those who underwent the Army’s standard post-deployment program. No such trials have been conducted with CSF, so it remains unclear what impact, if any, it has on the incidence of PTSD, he added.

Despite such efforts, however, some soldiers will develop PTSD, McNally said. Those who do have access to what are known to be the best treatments for the disorder, including prolonged exposure and cognitive processing therapy.

“Until this initiative, less than 10 percent of the clinical specialists in PTSD used these treatments,” McNally said. “These treatments weren’t available to veterans of the Vietnam War — they were only developed in the 1990s — and the evidence shows that the longer you have PTSD, the more likely it is that other problems will accumulate. The earlier we can get people into treatment, the quicker we can help them get their lives back together.”

Source: Harvard University

According to researchers, patients who have been in an ICU often suffer post-traumatic stress, anxiety, or depression due not only to the illness or trauma that put them there, but to the very nature of the ICU and life-saving treatment.

Researchers from the Karolinska University Hospital Solna and the Karolinska Institutet in Sweden compared patients’ recovery from 2006, before a follow-up program was started, with that of patients in 2007 and 2008.

The follow-up consisted of non-compulsory meetings at three, six and 12 months after being discharged from the ICU with a nurse, physician, and a physiotherapist, as well as revisiting the ICU. In severe cases, patients were referred to a psychiatric unit for further therapy.

Before the follow-up program went into place, women had much higher scores on the Impact Event Scale (IES), which measures post-traumatic stress, than men. After the introduction of follow-up, women’s scores were significantly reduced, the researchers noted. However, the follow-up program had no effect on the IES score of men.

“In general, for the same event, women are twice as likely to suffer post-traumatic stress disorder, recover more slowly, and are more prone to suffer long-term effects,” said Dr. Peter Sackey, who led this study, which was published in BioMed Central’s open access journal Critical Care.

“We found this was also true in ICU survivors. The women with the highest IES scores were the ones who were most helped by the follow-up scheme. While it is not clear whether the scheme only helps patients at severe risk of PTSD, it does mean that these people have access to the treatment they need.”

Source: BioMed Central

Scientists at the Virginia Commonwealth University School of Medicine say this may explain the neurological symptoms experienced by those who have experienced a head injury associated with sports, accidents or combat.

Previous research has shown that even a mild case of traumatic brain injury (TBI) can result in long-lasting neurological issues, such as slowing of cognitive processes, confusion, chronic headaches, post-traumatic stress disorder, and depression.

Led by Kimberle M. Jacobs, Ph.D., associate professor in the Department of Anatomy and Neurobiology, the research team said they used sophisticated bioimaging and electrophysiological approaches to demonstrate that mild injury can cause structural disruption of axons in the brain while also changing the way the neurons fire in areas where they have not been structurally altered.

Axons are nerve fibers in the brain responsible for conducting electrical impulses. The researchers used models of mild traumatic brain injury and followed neurons in live cortical slices.

“These findings should help move the field forward by providing a unique bioimaging and electrophysiological approach to assess the evolving changes evoked by mild TBI and their potential therapeutic modulation,” said co-investigator John T. Povlishock, Ph.D., professor and chair of the VCU School of Medicine’s Department of Anatomy and Neurobiology.

The study was published in the May issue of the Journal of Neuroscience.

Source: Virginia Commonwealth University School of Medicine

In two separate studies, researchers examined the stability and satisfaction of intimate relationships among college students with a history of childhood emotional maltreatment (CEM).

The studies, published in the Journal of Social & Clinical Psychology, suggest that emotional abuse as a child impacted relationship fulfillment due to self-criticism.

Researchers discovered that participants had an extremely strong tendency to self-criticize, and this interfered with their relationship satisfaction.

The studies also revealed that some participants had symptoms of post-traumatic stress disorder (PTSD) due to the emotional abuse they endured. Researchers suggest this could be the result of internalizing behaviors caused by the maltreatment or by a child’s inability to properly comprehend their circumstances.

Childhood maltreatment includes sexual and physical abuse, emotional maltreatment and neglect. Childhood maltreatment is a significant contributor to the dramatic increase in referrals to university counseling centers, researchers believe.

Investigators believe childhood maltreatment also generates self-criticism causing a destructive effect on romantic relationships.

“Over time, this tendency might be consolidated, becoming a defining part of a person’s personality, and ultimately derailing relationships in general and romantic relationships in particular,” said Dana Lassri, whose doctoral dissertation, supervised by psychologist Dr. Golan Shahar, served as the basis for the study.

Lassri believes that even though these findings were gathered from college-age individuals, the behaviors could potentially worsen throughout adulthood.

Source: American Associates, Ben-Gurion University of the Negev

The finding that ACE (angiotensin converting enzyme) inhibitors or ARBs (angiotensin receptor blockers) could aid in the treatment or prevention of PTSD could profoundly impact treatment of the disorder.

“These results are particularly exciting because it’s the first time ACE inhibitors and ARBs have been connected to PTSD, and it gives us a new direction to build on,” said senior author Kerry Ressler, M.D., Ph.D.

However, researchers warn that the findings result from a study of a population, rather than isolated clinical trials. Nevertheless, the resutls suggest that a class of medications whose safety record is well known could be rolled into action quickly.

The results were published online in the Journal of Clinical Psychiatry.

The study, termed the Grady Trauma Project, was an observational study of more than 5,000 low-income Atlanta residents. Individuals studied live with high levels of exposure to violence and physical and sexual abuse, resulting in high rates of civilian PTSD.

All 505 participants in this study were exposed to at least one traumatic event, and around 35 percent of them (180) met the criteria for diagnosis with PTSD. Out of 98 participants taking ACE inhibitors or ARBs, generally for the primary purpose of blood pressure control, 26 had a PTSD diagnosis.

Symptoms of PTSD typically include hyperarousal, avoidance/numbing, and intrusive thoughts. All the participants in the study reported how often they experienced these symptoms and the responses were compiled into a PTSD symptom score.

Patients taking ACE inhibitors or ARBs had an approximately 30 percent decrease in PTSD symptom scores, but no significant differences were apparent for those taking other blood pressure medications, including beta-blockers, calcium channel blockers, and diuretics.

ACE inhibitors or ARBs appear to significantly lower levels of hyperarousal and intrusive thoughts.

Scientists say the results demonstrate the linkage between stress, response to PTSD, and blood pressure regulation. Both ACE inhibitors and ARBs interfere with angiotensin II, a hormone that regulates blood pressure.

Lab research supports the observation that use of blood pressure medication can reduce stress and fear. In fact, lab data suggests that this class of medication may both decrease the body’s physiological response to stress in the cardiovascular system as well as decrease the brain’s response to stress.

However, the finding that beta blockers were not effective was surprising, Ressler says. Some musicians and athletes take beta blockers to relieve performance anxiety symptoms, and some early clinical studies have examined whether they can be used to treat PTSD. Beta blockers diminish the body’s response to the stress hormones norepinephrine and epinephrine.

“Beta blockers did appear to have a trend toward an effect, but the effects of the angiotensin medications were stronger, and when people in our study took both, only the angiotensin medications survived statistical analysis,” Ressler said.

“Beta blockers may be useful in the moment for decreasing social or performance anxiety, but their efficacy in PTSD treatment is still an open question.”

Source: Emory University

The event may be traumatic, such as relationship problems, abuse and sexual assault or could surface after changing school or moving.

As explained in an article found in the May issue of the Journal of Clinical Nursing, eating disorders includes conditions of anorexia and bulimia.

In the study, researchers from the University of Minnesota spoke to 26 women and one man receiving treatment from a specialist outpatient clinic. These individual who ranged in age from 17 to 64 had suffered from eating disorders for an average of 20 years.

“The aim of our study was to find out if there was any link between transitional events in family life and the onset of eating disorders,” said lead author Jerica M. Berge, Ph.D.

“Eating disorders are an important public health issue and knowing what causes them can help us to develop more effective treatment and support.”

The patients had a median age of 27 years and had been receiving treatment for between ten months and 18 years. Nine had anorexia nervosa, three had bulimia nervosa, one had both and the other 14 had eating disorders that did not meet the diagnostic criteria for any one specific condition.

Six key themes covered the significant (translational) events that preceded eating disorders:

• School transition. Some talked about the problems they had adapting to the more independent world of junior high school and others talked about leaving home to go to college and how they missed friends and family.

Starting college was very hard for one woman. “Nobody knew who I was…I was incredibly lonely with no support and I just stopped eating.” Another struggled to cope without regular support. “You don’t receive the daily love that you are used to growing up, you are left to provide that for yourself and I just wasn’t able to do it.”

• Relationship changes. Breaking up with a partner affected some participants and others talked about their parents splitting up and moving on.

When her father got a new girlfriend when she was seven, one woman lost the close relationship they had enjoyed. “Overnight she became the most important thing in his life…his girlfriend would be really mean to me and my dad wouldn’t defend me.” Another woman described how her dad left for “the perfect Barbie”, adding “I was so mad at my dad for choosing her over us…I think that is when my eating disorder really began.”

• Death of a family member. The death of a family member or close friend often proved traumatic, with people saying that they didn’t not know how to deal with their grief and that they received little support.

One woman’s sister died when she was five, but no-one talked about this “major event” in her life. “I started to eat – to compensate for feelings of anxiety.” Another lost her mother to an eating disorder when she was 11. She found herself living in a single-parent household where she was given “so much freedom with not much emotional support… I lost control.”

• Home and job transition. Some were affected by their family relocating or losing their job and described how they felt lonely, unsupported and lacked close relationships during these transitions.

A new job left one woman with little time for friends and she struggled to relate to her workmates who were all much older than her. “I felt really alone and had no-one to talk to or hang out with.” Moving house at 16 was really hard for another woman. “I just felt lost and my eating problems began.”

• Illness/hospitalization. A number had been ill and some said that their weight loss made them feel good and prompted positive comments from others.

Having viral meningitis scared one woman – she realized she had no control over her illness, but could control her eating. “I guess I was thinking that if I could be this small, people would kind of take care of things for me.” Being diagnosed with hypoglycemia aged from 17 to 64 and being told she needed to eat frequently was the start of another woman’s problems. “I started to think constantly about food…since then I’ve had a real struggle with bingeing.”

• Abuse/sexual assault/incest. Some talked about abusive events and how they felt let down or deserted by the very friends and family they needed to support them. Two said they ate more to become unattractive or bigger and intimidating.

Being sexually abused by her brother triggered one woman’s eating disorder. “I think in a way I developed the eating disorder just to get away from it…Just to kill the pain because I couldn’t tell anyone.” Another woman started eating to try and stop the abuse and violence from her partner. “I thought if I gained weight that he would leave me alone or I could fight him back.”

Berge said the study confirms that eating disorders can be triggered by a number of life changes and that lack of support was a common theme.

“We hope that our findings will be of interest to parents as well as health professionals as they underline the need for greater awareness and support at times of change and stress.”

Source: Wiley-Blackwell

Young woman weighing herself photo by shutterstock.

Concordia University’s Carsten Wrosch, Ph.D., and Catherine Sabiston, Ph.D., of McGill University discovered that when the breast cancer survivors redirected their goals, the self-imposed pressure of now unrealistic goals was lifted. As a result, individuals’ quality of life improved, as did their level of physical activity.

In the study, Wronsch and Sabiston were interested in looking at how to encourage breast cancer survivors to become more active. Some 48 per cent of breast cancer survivors are overweight or obese, and they also tend to be more sedentary than women who have not been diagnosed with breast cancer.

The researchers studied 176 breast cancer survivors between the ages of 28 and 79, who were, on average, approximately 11 months past their diagnosis and close to three months post-treatment.

Researchers assessed each individual’s capacity to adjust their goals at the start of the study. At the same time, researchers also measured self-report of physical activity, sedentary activity, emotional well-being, and daily physical symptoms such as nausea and pain.

Three months later, they took a look at another round of self-reports. The study found that goal re-engagement (being able to set new goals) was associated with more physical activity, increased emotional well-being and fewer physical symptoms.

Researchers learned that breast cancer survivors who were able to let go of old goals and to find new ones were less sedentary — a factor that contributed to an improved well-being. These findings support earlier research showing that goal adjustment can influence better well-being and health.

“By engaging in new goals a person can reduce the distress that arises from the desire to attain the unattainable, while continuing to derive a sense of purpose in life by finding other pursuits of value,” says Wrosch.

“Abandoning old goals allows someone to invest sufficient time and energy in effectively addressing their new realities.”

Activity experts say that breast cancer survivors should engage in at least 150 minutes of moderate to vigorous-intensity physical activity every week to gain health benefits. “It is safe, feasible and effective for enhancing well-being and health among breast cancer survivors,” said Sabiston. “Unfortunately, few survivors are engaging in the recommended levels of activity.”

“Our research reveals that the capacity to adjust goals plays a pivotal role in facilitating not only high physical activity but also low sedentary activity and thereby contributing to overall improved well-being,” said Wrosch.

“Given that it is possible to influence adjustment to specific goals; it may be beneficial to integrate goal adjustment processes into clinical practice.”

Source: Concordia University

The study showed that otherwise healthy women who tested high for neuroticism — a trait associated with having more negative emotions, such as anxiety — tended to return to their bad memories to think about them over and over.

This action, called rumination, is known to be associated with depression, the researchers said.

Furthermore, women who dealt with bad memories by trying to suppress them were actually more likely to remember them, and then feel bad after thinking about them, compared with women who used other coping strategies. No such link was found in men.

The findings suggest that learning to deal with emotional challenges, such as negative memories, in a healthy way may help prevent depression, said study researcher Florin Dolcos, a psychology professor at the University of Illinois at Urbana-Champaign.

For the study, Dolcos and his team surveyed about 70 men and women ages 18 to 34 with no history of depression or other psychiatric disorders. Volunteers completed a questionnaire with 115 phrases intended to awaken memories of distinct life events such as “being hospitalized,” “birth of a family member,” or “witnessing an accident.”

Participants recorded the date of the event, reported how often they thought about it, and rated the emotional intensity of the memory. Only memories with strong emotional significance were chosen for the study’s analysis. Volunteers also completed a personality test.

Men who scored high in neuroticism were able to recall more negative memories than men who were low in neuroticism. On the other hand, women high in neuroticism tended to revisit the same negative memories over and over.

The study also focused on which of two general strategies participants used to deal with bad memories: suppression, which includes trying not to think about a memory, and reappraisal, in which a person attempts to lessen the blow of a negative memory by looking at it from a new perspective.

For example, you don’t get the job you wanted, but an opportunity or new connection resulted from the interview, Dolcos said. You could reappraise your memory by focusing on the positive points in any situation.

Dolcos said that by refusing to think about negative memories, a person does not get a chance to resolve their feelings about the situation. If you relive memories to reappraise them, you can find a solution to help you feel better, he added.

Choosing to reappraise bad memories will interrupting harmful rumination, and may help prevent the development of clinical disorders, including depression, Dolcos said.

Source: University of Illinois

A team of physicians and psychologists from Johns Hopkins University determined that over 33 percent of patients admitted to The Johns Hopkins Hospital’s inpatient epilepsy monitoring unit had symptoms caused by stress, rather than a true seizure disorder.

These patients were a heterogeneous group including returning war veterans, mothers in child-custody battles and overextended professionals alike. After an evaluation, physicians determined they were demonstrating psychogenic non-epileptic seizures (PNES).

Clinical signs of the condition include uncontrollable movements and far-off stares or convulsions.

Johns Hopkins researchers say the signs are not the result of the abnormal electrical discharges in the brain that characterize epilepsy, but instead appear to be stress-related behaviors that mimic and are misdiagnosed as the neurological disorder.

Researchers say diagnosing the condition was aided by the fact that antiseizure medications failed to stop these patients’ symptoms. This suggested that nothing was physically wrong with subject’s brains’ electrical activity. The researchers also say the diagnoses appear to be on the rise, at least by what they have seen in recent months.

Historically, behaviors like PNES were called “hysteria.” Now they are often considered by psychiatrists as part of a “conversion” disorder, in which the patient unconsciously converts emotional dysfunction into physical symptoms.

In some cases, those afflicted have become paralyzed or blind because of emotional trauma.

People at risk for pseudo-seizures are typically highly suggestible – which is why physicians often have tried not to publicize or draw attention to the condition.

In the past few months, media reports from western New York have described a group of more than a dozen female high school students who experienced uncontrollable tics and other movements, which many experts now believe are manifestations of a “contagious” psychiatric rather than neurological disorder.

In this new study, a team of neuropsychologists and neurologists at the Johns Hopkins University School of Medicine suggest that people with PNES don’t necessarily experience more frequent or severe stressful events than people with epilepsy or neurologically healthy people. However, they seem to lack effective coping mechanisms necessary to deal with those stresses and feel more distressed by them.

“These patients behave as if they have an organic brain disease, but they don’t,” said Jason Brandt, Ph.D., the study’s senior investigator. “And it turns out that their life stresses weren’t all that high, but they’re very sensitive to stress and they don’t deal with it well.”

The Johns Hopkins researchers say they undertook the new study in an effort to learn why “psychogenic” symptoms so closely simulate a physical disorder and why some people are more susceptible to these behaviors than others. Clearly, not every overwhelmed person develops seizure symptoms, they note, nor is it known how many people experience pseudo-seizures.

In the study, researchers evaluated 40 patients with PNES, 20 people with epilepsy and 40 healthy control volunteers, all of whom were asked to report the frequency of various stressful life events (both positive and negative) over the previous five years.

The research subjects then appraised the distress these events induced. Each group reported roughly the same number of stressful events, but the PNES group reported much higher distress levels than the other two groups. The researchers found that the PNES group was less likely to plan a course of action to counter stressful life events.

Those who used denial — the failure to acknowledge stressors — experienced greater distress than those who did not, illustrating the ineffectiveness of denial as a way of warding off anxiety, Brandt said.

Along with seizure symptoms, patients with PNES often have other problematic behaviors and unstable relationships. Many remain occupationally disabled and have high health care expenditures, even years after the non-epileptic nature of their events is identified, the authors reported.

The behavior is costly in many ways. Financially, there are the costs of doctor visits, medication that doesn’t work and hospitalizations in specialty units like Hopkins’ epilepsy monitoring unit (EMU), says Brandt. In the EMU, patients are hooked up to both a video camera to capture the onset and characteristics of a seizure and an EEG (an electroencephalogram) that monitors the electrical signals of the brain. Sensors attached to the scalp check for alignment of seizure behavior and abnormal electrical discharges in the brain.

There are also psychological and social costs of having disabling seizures that can’t be controlled.

Gregory L. Krauss, M.D., a professor of neurology at Johns Hopkins and one of the study’s co-authors, said he was surprised by how many patients are being referred to his epilepsy unit without having epilepsy at all. And the numbers appear to be growing. He says that in recent months, as many as half of those referred to the unit have pseudo-seizures.

When the team discovers individuals who, using a computer analogy, don’t have a hardware problem but a software glitch, they get the good news. Often, Krauss says, symptoms go away quickly. But, Brandt said, such patients often need cognitive-behavioral therapy to help them develop more effective coping skills.

“There’s a lot of stress out there in our modern society, and this research highlights that many people don’t have the skills to cope with that,” Krauss said.

People with PNES can spend years in treatment for epilepsy, said Krauss and his colleagues, who also report that neurologists may be misdiagnosing PNES patients by misreading their EEGs. In a study of 46 patients, published in the journal Neurology in 2005, the patterns seen on 54 percent of EEG readouts were misinterpreted as epilepsy. Krauss said patients often will come to him already having been told by a neurologist that their EEG shows they have epilepsy.

Another report by Krauss in Neurology, published in 2007, looked at the use of service dogs trained to assist patients with epilepsy. The researchers determined that four of the six patients in the study actually had PNES and not epilepsy, and by alerting patients to an oncoming seizure, the dogs may instead have been perpetuating the pseudo-seizures by putting the idea of them into the minds of those with PNES.

The dogs are trained to anticipate overt behavior and presumably cannot distinguish between PNES and true seizure disorders.

“We’re just seeing a large number of these patients, and we’ll probably see more of them,” Krauss said.

The current study is published online in the journal Seizure.

Source: Johns Hopkins Medicine

UCLA scientists believe genetics explain why some persons succumb to post-traumatic stress disorder (PTSD) while others who suffered the same ordeal, do not.

Researchers have linked two serotonin producing genes to a higher risk of developing PTSD.

In the study, published in the online edition in the Journal of Affective Disorders, authors believe the role of heredity is so strong that future exploration of the genetic link may result in new ways of screening for and treating the disorder.

“People can develop post-traumatic stress disorder after surviving a life-threatening ordeal like war, rape or a natural disaster,” said lead author Dr. Armen Goenjian. “If confirmed, our findings could eventually lead to new ways to screen people at risk for PTSD and target specific medicines for preventing and treating the disorder.”

PTSD can arise following child abuse, terrorist attacks, sexual or physical assault, major accidents, natural disasters or exposure to war or combat. Symptoms include flashbacks, feeling emotionally numb or hyper-alert to danger, and avoiding situations that remind one of the original trauma.

Goenjian and his colleagues extracted the DNA of 200 adults from several generations of 12 extended families who suffered PTSD symptoms after surviving the devastating 1988 earthquake in Armenia.

In studying the families’ genes, the researchers found that persons who possessed specific variants of two genes were more likely to develop PTSD symptoms. Called TPH1 and TPH2, these genes control the production of serotonin, which helps to regulate mood, sleep and alertness — all of which are disrupted in PTSD.

“We suspect that the gene variants produce less serotonin, predisposing these family members to PTSD after exposure to violence or disaster,” said Goenjian. “Our next step will be to try and replicate the findings in a larger, more heterogeneous population.”

PTSD affects about 7 percent of Americans, with the disorder becoming a pressing health issue for a large percentage of war veterans returning from Iraq and Afghanistan. The UCLA team’s discovery could be used to help screen persons who may be at risk for developing PTSD.

“A diagnostic tool based upon TPH1 and TPH2 could enable military leaders to identify soldiers who are at higher risk of developing PTSD, and reassign their combat duties accordingly,” observed Goenjian.

“Our findings may also help scientists uncover alternative treatments for the disorder, such as gene therapy or new drugs that regulate the chemicals responsible for PTSD symptoms.”

According to Goenjian, the advantages of pinpointing genes connected with PTSD symptoms are far-reaching.

Researchers believe the findings will help neuroscientists classify the disorder based on brain biology instead of clinical observation. Psychiatrists currently rely on a trial and error approach to identify the best medication for controlling an individual patient’s symptoms.

Serotonin is a common target of mental health pharmaceuticals. Popular antidepressants known as SSRIs, or selective serotonin reuptake inhibitors, prolong the effect of serotonin in the brain by slowing its absorption by brain cells.

Recently, physicians are expanding prescription of SSRIs to treat psychiatric disease beyond depression, including PTSD and obsessive compulsive disorder.

Source: UCLA

Researchers from Massachusetts General Hospital (MHG) believe the use of a virtual environment to teach mind/body relaxation techniques can improve access for a variety of individuals including those in rural communities and among people with physical mobility problems.

“Our finding that a medical intervention – in this case teaching a mind/body approach that includes the relaxation response – can be delivered via a virtual environment is important because these environments are richer and more rewarding than simply using interactive web sites,” said Daniel Hoch, M.D., Ph.D., corresponding author of the report in the open-access journal PLoS One.

Hoch explains that, while practices that elicit the relaxation response have been shown to benefit individuals with a wide variety of health problems, the traditional way of teaching these practices – face-to-face meetings over several weeks – can present significant difficulties for patients, particularly those with limited mobility.

Furthermore, individuals who are uncomfortable with group programs may prefer the anonymity of a virtual educational setting.

While Internet-based programs have been used for mental health screening and support programs, Hoch and his colleagues were not aware of any prior efforts to systematically study a virtual mind-body intervention.

Investigators used Second Life, a three-dimensional “virtual world” in which users interact by means of online avatars that can communicate basic body language and emotional states.

Second Life is being used by many patient support groups for individuals with neurologic disorders. The virtual community is being used to share information and experiences.

Because learning to use Second Life can be challenging, the study only enrolled healthy individuals who had experience in the virtual environment.

Participants enrolled in groups of up to 10 individuals and participated in twice-weekly virtual meetings led by an experienced clinician. The clinician taught different methods of eliciting the relaxation response, guided participants through their practice, answered questions and discussed the participants’ experiences.

Group members were asked to elicit the relaxation response for at least 20 minutes each day – either in front of the computer with their avatar in the Second Life virtual teaching area or in another quiet setting – and received audio and video files and other supporting information.

Before and after the eight weeks of online sessions, participants completed standard questionnaires assessing stress and other psychological symptoms.

The full study was completed by 24 individuals in three groups, all receiving the same training program. Although the small size of the study made it difficult to arrive at statistically significant results, overall participants showed reductions in depression- and anxiety-related symptoms.

They also reported being very satisfied with the virtual environment, and several commented that they could not have taken part without the online option. Although most admitted that a face-to-face teaching environment would be even better, they also noted that the time required to travel to in-person meetings would have presented difficulties.

“Several participants have let us know, several months later, that they continue to use techniques they learned in these sessions to reduce stress in their everyday lives,” Hoch said.

“The Second Life technology is changing rapidly and its creators have scaled back their interest in educational and clinical activities, so we’re now hoping to explore the ability to have secure patient interactions in web-browser-based environments. One of the applications that I feel holds a great deal of promise is using this approach to help patients with post-traumatic stress, so I’m hopeful we’ll have the opportunity to try that in the near future.”

“Social networks and online communities represent an important element of support, information and motivation for many patients,” said Joseph Kvedar, M.D., a co-author of the PLoS One report.

“Connected health strategies are creating new opportunities to deliver quality care, for patients and providers to communicate effectively and help motivate and educate patients to stay on track with their treatment plan.”

Source: Massachusetts General Hospital

The study is the first to examine the association between cumulative traumatic stress and inflammation.

For the study, researchers looked at 979 patients (ages 45 to 90) with stable heart disease and analyzed their exposures to 18 different types of traumatic events, all of which involved either experiencing or watching a direct threat to life or physical integrity.

Next, researchers measured several clinical markers of inflammation that circulate in the bloodstream, and found a direct correlation between lifetime stress exposure and inflammation levels.

“This may be significant for people with cardiovascular disease, because we know that heart disease patients with higher levels of inflammation tend to have worse outcomes,” said lead author Aoife O’Donovan, a fellow in psychiatry at UCSF.

Five years later, researchers measured the surviving patients’ inflammation markers again, and discovered that the participants who had originally reported the highest levels of trauma still had the highest levels of inflammation.

“Even though we lost some study participants because they died, we still observed the same relationship in those who remained,” O’Donovan said. “This suggests that it wasn’t just the people who were the most sick at the outset who were driving this effect.”

Senior researcher Dr. Beth Cohen, a physician at SFVAMC, noted that the effect was consistent even after the researchers adjusted for psychiatric diagnoses including post-traumatic stress disorder (PTSD), anxiety and depression.

“Not everyone who is exposed to trauma develops PTSD,” said Cohen, who also is an assistant professor of medicine at UCSF. “This study emphasizes that traumatic stress can have a long-term negative impact on your health even if you don’t go on to develop PTSD. It also tells us that, as clinicians, we need to think about not just which diagnostic box someone might fit into, but what their lifetime trauma exposure has been.”

“We know that in the aftermath of traumatic stress, people become more sensitive to threats,” she continued. “This is actually pro-survival, because if you’re in a dangerous environment, that alertness can help you avoid future harm.”

However, she explained, people with heightened threat sensitivity may also have stronger inflammatory responses. “What we think is happening is that people with a history of multiple traumatic stress exposures have increased inflammatory response more often and for longer periods, and so inflammation becomes chronically high,” she said.

Cohen added that “this is a study of older people, and the cumulative effects that decades of traumatic experiences have on their bodies. If we could intervene with young people…using techniques that we know help fight stress, such as exercise, yoga and other integrative health techniques, it would be interesting to know if we might be able to prevent some of this.”

The study was published in Brain, Behavior and Immunity.

Source:  University of California

New research, published in the Journal of Traumatic Stress, found that dispatchers who answer 911 and 999 emergency calls suffer emotional distress which can lead to PTSD symptoms.

“Post-traumatic psychological disorders are usually associated with front line emergency workers, such as police officers, fire fighters or combat veterans,” said research leader Dr. Michelle Lilly, a psychologist at Northern Illinois University. “Usually research considers links between disorders and how much emotional distress is experienced on the scene of a traumatic event. However, this is the first study on emergency dispatchers, who experience the trauma indirectly.”

Investigators analyzed the responses of 171 currently serving emergency dispatchers from 24 U.S. states. The majority of the sample was female and Caucasian, with an average age of 38 and over 11 years of service.

Researchers asked the dispatchers about the types of potentially traumatic calls they handle and the amount of emotional distress they experienced. They were also asked to rank the types of calls which caused the most distress and to remember the worst call they had dealt with during their career.

Participants reported experiencing fear, helplessness or horror in reaction to nearly one-third of the different types of potentially traumatic calls.

Over 16 percent of the dispatchers said the worst calls were associated with the unexpected injury or death of a child; nearly 13 percent of study participants said suicidal callers were next on the list of causing emotional distress; followed by shootings involving officers, and calls involving the unexpected death of an adult — with both of these scenarios reported by nearly 10 percent of the dispatchers.

A further 3.5 percent of the sample reported symptoms severe enough to qualify for a diagnosis of PTSD.

Investigators say these results are a valuable contribution to the ongoing debate on defining a traumatic event. Currently, the definition of a traumatic event is under review with official guidelines on the designation set to be published in 2013.

Researchers believe these findings support a broad definition as it shows dispatchers experience significant levels of emotional distress at work even though they are not physically present during a traumatic event, or even know the victim of a trauma. High levels of responsibility and little ability to actually influence the outcome can add up to extremely high stress.

“Our research is the first to reveal the extent of emotional distress experienced by emergency dispatchers while on duty,” concluded researcher Heather Pierce, herself a former 911 dispatcher.

“The results show the need to provide these workers with prevention and intervention support as is currently provided for their front-line colleagues. This includes briefings and training in ways to handle emotional distress.”

Source: Wiley-Blackwell

The theory, by researchers from Boston University School of Medicine (BUSM), New York Medical College (NYMC), and the Columbia College of Physicians and Surgeons (CCPS) appears online in the journal Medical Hypothesis.

The investigators believe yoga can aid in the treatment of conditions including anxiety, high blood pressure and cardiac disease. They suggest that specific mind-body practices should be developed for the prevention and treatment of these conditions in conjunction with standard treatments.

Investigators believe yoga helps to restore stress-related nervous system imbalances. It is hypothesized that stress causes an imbalance in the autonomic nervous system (parasympathetic under-activity and sympathetic over-activity) as well as under-activity of the inhibitory neurotransmitter, gamma amino-butyric acid (GABA).

Low GABA activity occurs in anxiety disorders, post-traumatic stress disorder, depression, epilepsy, and chronic pain. According to the researchers, the hypothesis advanced in this paper could explain why vagal verve stimulation (VNS) works to decrease both seizure frequency and the symptoms of depression.

“Western and Eastern medicine complement one another. Yoga is known to improve stress-related nervous system imbalances,” said Chris Streeter, M.D., the study’s lead author.

Streeter says the paper provides a theory on the efficacy of yoga that is based on neurophysiology and neuroanatomy.

An earlier study by BUSM researchers comparing a walking group and a yoga group over a 12-week period found no increase in GABA levels in the walking group, whereas the yoga group showed increased GABA levels and decreased anxiety.

In another BUSM 12-week study, patients with chronic low back pain responded to a yoga intervention with increased GABA levels and significant reduction in pain compared to a group receiving standard care alone.

Researchers are beginning to test these theories by incorporating mind-body therapies such as yoga in their clinical studies of a wide range of stress-related medical and psychological conditions.

Source: Boston University Medical Center

Mayo Clinic investigators have completed a systematic literature review of prazosin in the treatment of nightmares. Researchers investigated 12 prazosin studies, four of which were randomized controlled trials.

“The studies showed the drug was well-tolerated and can take effect rapidly, within days to weeks, and some patients reported a return of nightmares when the course of prazosin was stopped,” said Simon Kung, M.D., principal investigator of the study.

“There’s not much available for treating nightmares in terms of medications, so prazosin is a promising option,” Kung says.

He added that the literature review opens the possibility of widening the use of prazosin.

“Because of the low side effects of prazosin as reported in these studies, it seems logical to extend the use of prazosin to non-PTSD nightmares.”

Nightmares often accompany PTSD with the dreams causing sleep loss and stress. Frequently, dreams are vivid presenting extremely frightening images of physical or emotional threats. Nightmares can be so severe that they can contribute to alcoholism, substance abuse and suicidal thinking.

Researchers believe overstimulated chemical messenger receptors in the central nervous system, in particular, norepinephrine, may cause the nightmares.

“The thinking is that pharmacologic agents, like prazosin, that block these receptors may be ideal in treating nightmares,” Kung said.

Prazosin is a hypertension medication that’s been used, following research that began a decade ago, by some Veterans Administration hospitals to treat PTSD-related nightmares.

Source: Mayo Clinic