**** ANXIETY DISORDERS
(PTSD, OCD, etc.)
*PTSD
Biological Psychiatry
Article in Press, Corrected Proof
Long-term treatment with paroxetine
increases verbal declarative memory and hippocampal
volume in posttraumatic stress disorder
Eric Vermetten, Meena Vythilingam, Steven M.
Southwick, Dennis S. Charney and J. Douglas Bremner
Animal
studies have shown that stress is associated with damage to the hippocampus,
inhibition of neurogenesis, and deficits in hippocampal-based memory dysfunction. Studies in patients
with posttraumatic stress disorder (PTSD) found deficits in hippocampal-based
declarative verbal memory and smaller hippocampal
volume, as measured with magnetic resonance imaging (MRI). Recent preclinical
evidence has shown that selective serotonin reuptake inhibitors promote neurogenesis and reverse the effects of stress on hippocampal atrophy. This study assessed the effects of
long-term treatment with paroxetine on hippocampal volume and declarative memory performance in
PTSD. Methods Declarative memory was assessed with the Wechsler Memory
Scale–Revised and Selective Reminding Test before and after 9–12 months of
treatment with paroxetine in PTSD. Hippocampal volume was measured with MRI. Of the 28
patients who started the protocol, 23 completed the full course of treatment
and neuropsychological testing. Twenty patients were able to complete MRI
imaging. Results Patients with PTSD showed a significant improvement in PTSD
symptoms with treatment. Treatment resulted in significant improvements in
verbal declarative memory and a 4.6% increase in mean hippocampal
volume. Conclusions These findings suggest
that long-term treatment with paroxetine is
associated with improvement of verbal declarative memory deficits and an
increase in hippocampal volume in PTSD.
Single photon emission computed tomography in
posttraumatic stress disorder before and after treatment with a selective
serotonin reuptake inhibitor, J Affective Disorders, In Press, Soraya Seedat, James Warwick, Barend van Heerden, Charmaine Hugo, Nompumelelo Zungu-Dirwayi, Jeanine Van Kradenburg,
and Dan J. Stein
Background:
Posttraumatic stress disorder (PTSD) is recognized as a disorder mediated by
specific neurobiological circuits. Functional imaging studies using
script-driven trauma imagery and pharmacological challenges have documented
altered cerebral function (activation and deactivation) in several brain
regions, including the amygdala, hippocampus,
prefrontal cortex and anterior cingulate. However,
the neural substrates of PTSD remain poorly understood and the effect of
selective serotonin reuptake inhibition on regional cerebral activity is
deserving of further investigation. Methods: Eleven adult patients (seven men,
four women) (mean age+S.D.=33.6±9.2 years) with a
DSM-IV diagnosis of PTSD, as determined by the Structured Clinical Interview
for DSM-IV (SCID-I) and the Clinician-Administered PTSD Scale (CAPS), underwent
single photon emission computed tomography (SPECT) with Tc-99m HMPAO pre- and
post-8 weeks of treatment with the selective serotonin reuptake inhibitor, citalopram. Symptoms were assessed at baseline and at
2-week intervals with the Clinician-Administered PTSD Scale (CAPS), Montgomery–Asberg Depression Rating Scale (MADRS), and the Clinical
Global Impression Scale (CGI). Image analysis of baseline and post-treatment
scans was performed using Statistical Parametric Mapping (SPM). Results:
Treatment with citalopram resulted in significant
deactivation in the left medial temporal cortex irrespective of clinical
response. On covariate analysis, a significant correlation
between CAPS score reduction and activation in the left paracingulate region (medial prefrontal cortex) was
observed post-treatment. No significant pre-treatment differences were observed
between responders and non-responders in anterior cingulate
perfusion. Conclusions: These preliminary findings are consistent with
clinical data indicating temporal and prefrontal cortical dysfunction in PTSD
and preclinical data demonstrating serotonergic innervation of these regions. However, further studies,
in particular in vivo receptor imaging studies, are needed to confirm whether
these regional abnormalities correlate with clinical features and treatment
response.
Journal of Rehabilitation
Research and Development Vol. 40, No. 5, Sept/Oct 2003 Pages 397–
An examination of the
relationship between chronic pain and post-traumatic stress disorder
John D. Otis, PhD; Terence
M. Keane, PhD; Robert D. Kerns, PhD
This review summarizes the current literature pertaining
to the prevalence and development of chronic pain and PTSD. Research describing
the comorbidity of both conditions is reviewed, and
several theoretical models are presented to explain the mechanisms by which
these two disorders may be maintained.
Future directions for research and clinical implications are discussed.
J Neuropsychiatry Clin Neurosci 15:367-370, August 2003
In Vivo Proton Magnetic Resonance Spectroscopy of the
Medial Temporal Lobes of Former Prisoners of War With
and Without Posttraumatic Stress Disorder
Shelley Brown, M.D., Thomas Freeman, M.D., Tim Kimbrell, M.D., David Cardwell, B.S. and Richard Komoroski, Ph.D.; Thomas.Freeman@med.va.gov
Proton
magnetic resonance spectroscopy was used to compare medial temporal lobe (MTL)
concentrations of N-acetylaspartate and choline between former prisoners of war (POWs) with and
without posttraumatic stress disorder (PTSD). MTL N-acetylaspartate
and reexperiencing symptoms correlated strongly in
the POW subjects with PTSD, suggesting a relationship between reexperiencing symptoms and the integrity of MTL
structures.
Neuropsychopharmacology (2003)
28, 1656-1665
Higher Cortisol Levels
Following Exposure to Traumatic Reminders in Abuse-Related PTSD
Bernet M Elzinga1, Christian G
Schmahl2, Eric Vermetten3, Richard van Dyck4 and J Douglas Bremner5,6,7
E-mail: elzinga@fsw.leidenuniv.nl
Animal
studies have found that prior stressful events can result in increased
reactivity in the HPA-axis. However, baseline function of the HPA-axis has
typically been normal or decreased in post-traumatic stress disorder (PTSD).
The first purpose of this study was to assess cortisol
responsivity to traumatic reminders in women with
PTSD related to childhood abuse. The second aim was to assess the relationship
between stress-induced cortisol levels and neutral
and emotional memory. Salivary cortisol levels were
measured before, during and after exposure to personalized trauma scripts in
abused women with (N=12) and without current PTSD (N=12). Memory for neutral
and emotional material was assessed immediately after trauma scripts exposure
and 3 days later. PTSD patients had 122% higher cortisol
levels during script exposure, 69% higher cortisol
levels during recovery, and 60% higher levels in the period leading up to the
script exposure compared to controls. PTSD symptoms were highly predictive of cortisol levels during trauma script exposure (r=0.70), but
not during periods of rest. Both in PTSD patients and controls, memory
consolidation after the trauma scripts was impaired relative to baseline
(P<0.001), with no differences between the two groups on memory performance.
There was no association between memory performance and cortisol
levels. These results are consistent with higher cortisol
levels following exposure to traumatic stressors in PTSD.
Psychoneuroendocrinology
Volume 28, Issue 6 , August 2003,
Pages 733-750
Cortisol response to a
cognitive stress challenge in posttraumatic stress disorder (PTSD) related to
childhood abuse
J. D. Bremnerb, c, , , a, M. Vythilingamd, E. Vermettenb, c,
a, J. Adilb, c, a, S. Khanb,
c, a, A. Nazeerb, c, a, N. Afzalb,
c, a, T. McGlashane, B. Elzingab,
c, a, G. M. Andersonf, G. Heningere,
S. M. Southwicke and D. S. Charneyd
Preclinical
studies show that animals with a history of chronic stress exposure have
increased hypothalamic-pituitary-adrenal (HPA) axis reactivity following reexposure to stress. Patients with posttraumatic stress
disorder (PTSD) have been found to have normal or decreased function of the HPA
axis, however no studies have looked at the HPA
response to stress in PTSD. The purpose of this study was to assess cortisol responsivity to a
stressful cognitive challenge in patients with PTSD related to childhood abuse.
Salivary cortisol levels, as well as heart rate and
blood pressure, were measured before and after a stressful cognitive challenge
in patients with abuse-related PTSD (N=23) and healthy comparison subjects
(N=18). PTSD patients had 61% higher group mean cortisol
levels in the time period leading up to the cognitive challenge, and 46% higher
cortisol levels during the time period of the
cognitive challenge, compared to controls. Both PTSD patients and controls had
a similar 66–68% increase in cortisol levels from
their own baseline with the cognitive challenge. Following the cognitive
challenge, cortisol levels fell in both groups and
were similar in PTSD and control groups. PTSD patients appeared to have an
increased cortisol response in anticipation of a
cognitive challenge relative to controls. Although cortisol
has been found to be low at baseline, there does not appear to be an impairment in cortisol response
to stressors in PTSD.
Neuropsychopharmacology advance
online publication,
Delta Sleep Response to Metyrapone
in Post-Traumatic Stress Disorder
Thomas C Neylan, Maryanne Lenoci, Melissa L Maglione,
Nicholas Z Rosenlicht, Thomas J Metzler, Christian Otte, Frank B Schoenfeld, Rachel Yehuda and Charles R Marmar;
E-mail: neylan@itsa.ucsf.edu
Metyrapone blocks cortisol synthesis, which results in the stimulation of
hypothalamic cortiocotropin-releasing factor (CRF)
and a reduction in delta sleep. We examined the effect of metyrapone administration on endocrine and sleep measures
in male subjects with and without chronic PTSD. We hypothesized that metyrapone would result in a decrease in delta sleep and
that the magnitude of this decrease would be correlated with the endocrine
response. Finally, we utilized the delta sleep response to metyrapone
as an indirect measure of hypothalamic CRF activity and hypothesized that PTSD
subjects would have decreased delta sleep at baseline and a greater decrease in
delta sleep induced by metyrapone. Three nights of polysomnography were obtained in 24 male subjects with
combat-related PTSD and 18 male combat-exposed normal controls. On day 3, metyrapone was administered during normal waking hours
until habitual sleep onset preceding night 3.
Endocrine responses to metyrapone were measured in
plasma obtained the morning following sleep recordings, the day before and
after administration. Repeated measures ANOVAs were conducted to compare the
endocrine and sleep response to metyrapone in PTSD
and controls. PTSD subjects had significantly less delta sleep as indexed by
stages 3 and 4, and total delta integrated amplitude prior to metyrapone administration. There were no differences in premetyrapone cortisol or ACTH
levels in PTSD vs controls. PTSD subjects had a
significantly decreased ACTH response to metyrapone
compared to controls. Metyrapone caused an increase
in awakenings and a marked decrease in quantitative measures of delta sleep
that was significantly greater in controls compared to PTSD. The decline in
delta sleep was significantly associated with the magnitude of increase in both
11-deoxycortisol and ACTH. The results suggest that the delta sleep response
to metyrapone is a measure of the brain response to
increases in hypothalamic CRF. These data also suggest that the ACTH and sleep
EEG response to hypothalamic CRF is decreased in PTSD.
Psychiatry Research: Neuroimaging,
Volume 123, Issue 2,
Single-voxel proton MR
spectroscopy of right versus left hippocampi in PTSD,
Pages 101-108
P. Mohanakrishnan Menon, Henry A. Nasrallah, Judith
A. Lyons, Mertis F. Scott and Vincent Liberto
Previous
magnetic resonance (MR) volume imaging and proton MR spectroscopy studies have
suggested a reduction in the hippocampal size and/or
neuronal/axonal density in posttraumatic stress disorder (PTSD). The lack of
agreement on the laterality of the hippocampal
dysfunction prompted this study. A total of 20 veterans (18 men and two women)
and one female non-veteran participated in this study conducted in accordance
with approved human study protocols. Six of the male veterans and the female
non-veteran were without PTSD.
Psychiatry Research
Volume 119, Issues 1-2 ,
Prospective evaluation of plasma cortisol
in recent trauma survivors with posttraumatic stress disorder
Omer Bonne, , a, Dalia Brandesa, Ronen Segmana, Roger K. Pitmanb, Rachel Yehudac, d and Arieh Y. Shaleva
Hypothalamic
pituitary adrenal axis abnormalities have been described in posttraumatic
stress disorder (PTSD), and among the recently traumatized. Plasma cortisol and continuous measures of PTSD symptoms were
obtained from 21 survivors, at 1 week and 6 months after traumatic events.
Eight survivors met Clinician Administered PTSD Scale criteria for PTSD at 6
months. Cortisol levels at 1 week did not predict
subsequent PTSD. Survivors with and without PTSD had similar mean levels of cortisol at both time points. Cortisol
levels at 6 months negatively correlated with self-reported PTSD symptoms
within PTSD subjects.
NeuroImage
Volume 19, Issue 3 , July 2003,
Pages 587-600
Sensing the invisible: differential sensitivity of
visual cortex and amygdala to traumatic context
Talma Hendler,
, a, Pia Rotshteina, Yaara Yeshuruna, Tal Weizmannb, c, Itamar Kahna, Dafna
Ben-Bashata, Rafael Malachd
and Avi Bleichb, c
To what
extent does emotional traumatic context affect sensory processing in the brain?
A striking example of emotional impact on sensation is manifested in
posttraumatic stress disorder (PTSD), in which a severe emotional trauma
produces recurrent and vivid unpleasant sensory recollections. Here we report
on an fMRI study exploring the sensory processing of
trauma-related pictures in the visual cortex and amygdala
in respect to PTSD. The impact of traumatic experience on brain responses was
tested in relation to stimuli content and its level of recognition in a
parametric factorial design. Twenty combat veterans, 10 with and 10 without
PTSD, viewed backward-masked images of combat and noncombat
content, presented at below, near, and above recognition thresholds. The
response to combat content evoked more activation in the visual cortex in PTSD
subjects than in non-PTSD subjects, only when images were presented at below
recognition threshold. By contrast, the amygdala
demonstrated increased activation in PTSD subjects irrespective of content and
recognition threshold of the images. These intriguing findings are compatible
with the notion that in PTSD, emotional traumatic experience could modify
visual processing already at the preattentive level.
On the other hand, lack of content specificity in the amygdala
point to a possible predisposed mechanism for pathological processing of
traumatic experience. The differential sensitivity of the amygdala and visual cortex to traumatic context implies
distinct roles of limbic and sensory regions in the registration and
recollection of emotional experience in the brain.
Psychoneuroendocrinology
Article in Press, Corrected Proof - Note to users
Effects of trauma exposure on the cortisol
response to dexamethasone administration in PTSD and
major depressive disorder
Rachel Yehuda,
, Sarah L. Halligan, Julia A. Golier, Robert Grossman and Linda M. Bierer
Objective:
To evaluate cortisol suppression following 0.5 mg of dexamethasone (DEX) in trauma survivors (N=52) with
posttraumatic stress disorder (PTSD), major depressive disorder (MDD), both, or
neither disorder, and in subjects never exposed to trauma (N=10), in order to
examine interactions between diagnosis and trauma history on cortisol negative feedback inhibition. Method: Lifetime
trauma exposure and psychiatric diagnoses were assessed and blood samples were
obtained at
Psychoneuroendocrinology
Article in Press, Corrected Proof - Note to users
Blunted growth hormone response to clonidine
in post-traumatic stress disorder
Philip Morris, , a, Malcolm Hopwoodb, Kay Maguirec, Trevor Normanb and Isaac Schweitzerc
Hyperactivity
of the sympathetic and noradrenergic systems is thought to be a feature of
post-traumatic stress disorder (PTSD). Assessment of noradrenergic receptor
function can be undertaken by measuring the growth hormone (GH) response to the
2-agonist clonidine. The aim of this study was to
examine whether subjects with combat-related PTSD (with or without co-morbid
depression) have a blunted growth hormone response to clonidine,
compared to a combat-exposed control group. Twenty-three
Clinical Psychology Review
Volume 23, Issue 4 , July 2003,
Pages 587-603
Posttraumatic disorders following injury: an empirical
and methodological review
Meaghan L. O'Donnella,
b, , , Mark Creamerb, c,
Richard A. Bryantd, Ulrich Schnydere
and Arik Shalevf
Although
there has been a marked increase in research on psychological disorders
following physical injury in recent years, there are many discrepancies between
the reported findings. This paper reviews the prevalence outcomes of recent
studies of the mental health sequelae of physical
injury with a focus on posttraumatic stress disorder (PTSD), acute stress
disorder (ASD), and depression. The review critically outlines some of the
methodological factors that may have contributed to these discrepancies. The
phenomenological overlap between organic and psychogenic symptoms, the use of
narcotic analgesia, the role of brain injury, the timing and content of
assessments, and litigation are discussed in terms of their potential to
confound findings with this population. Recommendations are proposed to clarify
methodological approaches in this area. It is suggested that a clearer
understanding of the psychological effects of physical injury will require the
widespread adoption of more rigorous, standardized and transparent
methodological procedures.
Journal of Anxiety Disorders
Volume 17, Issue 5 , 2003, Pages
479-499
Prolonged exposure counterconditioning
as a treatment for chronic posttraumatic stress disorder
Nenad Paunovi,
Department of Psychology,
A counterconditioning model is presented from which the
behavioral treatment prolonged exposure counterconditioning
(PEC) was developed. The first part of a PEC session is intended to increase
trauma exposure tolerance and counter numbing symptoms, the second to elicit
trauma responses fully, and the third to weaken trauma responses. The first
client with chronic posttraumatic stress disorder (PTSD) who was treated with
PEC is presented. A statistical technique for analyzing single-case subject
designs was used to evaluate the treatment. PEC effectively decreased the
client's PTSD and associated psychopathology. Crucial differences between PEC
and other behavioral treatments are discussed. An associative functional model
is presented as a potentially useful conceptualization of PTSD, depression, and
other anxiety disorders.
Behaviour Research and Therapy
Volume 41, Issue 9 , September
2003, Pages 1105-1112
Posttraumatic stress disorder and psychosocial
functioning within two samples of MVA survivors
Eric Kuhn, , a, Edward B. Blancharda and Edward J. Hicklingb,
a
To
examine criterion F variables of PTSD, the psychosocial functioning of two
samples of motor vehicle accident (MVA) survivors was investigated. Within each
sample, comparisons between MVA survivors with and without PTSD were conducted
on four psychosocial functioning indices at three time points. In addition, the
relationships between specific PTSD symptom clusters and psychosocial
functioning indices were examined. The study revealed that, in general, MVA
survivors with PTSD evidenced poorer psychosocial functioning than did
survivors without PTSD. The emotional numbing symptoms of PTSD emerged as the
most consistent predictors of the psychosocial functioning indices. The
implications of these findings to the comprehensive treatment of PTSD are
discussed.
Clin Psychol
Rev. 2003 May;23(3):339-376
Psychological theories of posttraumatic stress disorder,
Chris R. Brewin and Emily A.
Holmes
We
summarize recent research on the psychological processes implicated in
posttraumatic stress disorder (PTSD) as an aid to evaluating theoretical models
of the disorder. After describing a number of early approaches, including
social-cognitive, conditioning, information-processing, and anxious
apprehension models of PTSD, the article provides a comparative analysis and
evaluation of three recent theories: Foa and Rothbaum's [Foa, E. B. & Rothbaum, B. O. (1998). Treating the
trauma of rape: cognitive behavioral therapy for PTSD.
Clin Psychol
Rev. 2003 May;23(3):377-407.
Sleep and posttraumatic stress disorder: a review,
Pages 377-407
Allison G. Harvey, Charlie Jones and D. Anne Schmidt
Research
seeking to establish the relationship between sleep and posttraumatic stress
disorder (PTSD) is in its infancy. An empirically supported theory of the
relationship is yet to emerge. The aims of the present paper are threefold: to summarise the literature on the prevalence and treatment of
sleep disturbance characteristic of acute stress disorder (ASD) and PTSD, to
critically review this literature, and to draw together the disparate
theoretical perspectives that have been proposed to account for the empirical
findings. After a brief overview of normal human sleep, the literature
specifying the relation between sleep disturbance and PTSD is summarized. This
includes studies of the prevalence of sleep disturbance and nightmares, content
of nightmares, abnormalities in rapid eye movement (REM) sleep, arousal
threshold during sleep, body movement during sleep, and breathing-related sleep
disorders. In addition, studies of the treatment of sleep disturbance in
individuals with PTSD are reviewed. We conclude that the role of sleep in
PTSD is complex, but that it is an important area for further elucidating the
nature and treatment of PTSD. Areas for future research are specified. In particular,
a priority is to improve the methodology of the research conducted.
Clin Psychol
Rev. 2003 May;23(3):409-448
Posttraumatic stress disorder following medical illness
and treatment,
Josephine E. Tedstone and
Nicholas Tarrier
Studies
describing posttraumatic stress disorder (PTSD) as a result of physical illness
and its treatment were reviewed. PTSD was described in studies investigating
myocardial infarction (MI), cardiac surgery, haemorrhage
and stroke, childbirth, miscarriage, abortion and gynaecological
procedures, intensive care treatment, human immunodeficiency virus (HIV)
infection, awareness under anaesthesia, and in a
group of miscellaneous conditions. Cancer medicine was not included as it had
been the subject of a recent review in this journal. Studies were reviewed in
terms of the prevalence rates for PTSD, intrusive and avoidance symptoms,
predictive and associated factors and the consequences of PTSD on healthcare
utilization and outcome. There was considerable variability both in the study
methodology and design and in the results. The highest prevalence rates were
identified in patients treated in intensive care units (ICUs) and those with
HIV infection. Irrespective of the physical illness, posttraumatic symptomatology is more common than PTSD caseness.
Existing characteristics of the patient may well predispose individuals to the
development of PTSD as do other factors such as poor social support and
negative interactions with healthcare staff. Generally, the severity of the
illness itself is not predictive of PTSD. Issues relating to sampling,
attrition, diagnosis, the course of symptoms, aetiological
pathways, and the consequences of the disorder are discussed. The presence of
PTSD most probably influences the patient's use of healthcare resources and may
affect their clinical outcome.
Clin Psychol
Rev. 2003 May;23(3): 449-480
Vicarious traumatization:
implications for the mental health of health workers?, 449-480
Rachel Sabin-Farrell and Graham
Turpin
It has
been suggested that a unique feature of some mental heath practitioners' work
is exposure through their role as therapists to clients' descriptions of and
reactions to trauma, and that these experiences may actually indirectly cause
distress and traumatization to the therapist. This
proposed phenomenon has been termed "vicarious traumatization"
(VT) and is the focus of the current review. The concept of VT, together with
other related concepts such as "burnout," "compassion
fatigue," "secondary traumatic stress" (STS), and "work
stress" are appraised. Psychological mechanisms that might be
theoretically involved in VT are considered. The measurement of VT is reviewed
alongside the limited research evidence supporting its existence. Factors such
as direct trauma exposure and the personal attributes of mental health workers,
which have been suggested to be associated with VT, are also assessed. It is
concluded that the evidence to support the existence of VT is meager and
inconsistent. Future research needs to be directed at distinguishing VT
from other sources of distress arising within the workplace. Finally, the
organizational relevance of VT and its possible implications for the management
of mental health workers are critically appraised.
Clin Psychol
Rev. 2003 May;23(3): 481-499
Single-session early psychological interventions
following traumatic events 481-499
Jonathan I. Bisson
Single-session
early psychological interventions became widely advocated during the 1980s and
1990s as a way to prevent the development of psychological sequalae
following traumatic events. There have now been 13 randomised
controlled trials of single-session interventions within 1 month of a traumatic
event. Notwithstanding their methodological shortcomings and clinical
heterogeneity, the results are neutral overall in terms of clinical
effectiveness. Possible explanations include a failure to encourage
individuals' personal coping mechanisms and defence
mechanisms and that insufficient time was allowed for habituation to intense
exposure to occur. With the present evidence, the routine use of single-session
interventions following traumatic events cannot be justified. This does not
mean that there should be nothing offered, as many individuals involved in
traumatic events clearly have emotional needs. Hopefully, future research will
identify alternative forms of early intervention that prove useful to those
individuals who would otherwise develop more significant psychological
difficulties.
Clin Psychol
Rev. 2003 May;23(3): 501-522
Cognitive behaviour therapy
for posttraumatic stress disorder
Allison G. Harvey, Richard A. Bryant and Nicholas Tarrier
Following
considerable empirical scrutiny, cognitive behaviour
therapy (CBT) has proven to be a safe and effective treatment for posttraumatic
stress disorder (PTSD). This article overviews the general principles of
treatment and describes the components that comprise CBT for PTSD. We then move
on to review the efficacy of CBT for the treatment of PTSD caused by various
traumas, including assault, road traffic accident (RTA), combat, and terrorism.
Recent advances in early intervention and in the treatment of disorders that
are comorbid with PTSD are reviewed. Finally, future
directions are discussed. In particular, it is proposed that randomised controlled trials (RCT) of CBT for PTSD must be
conducted with enhanced methodological rigour and
public health relevance.
Prospective evaluation of plasma cortisol
in recent trauma survivors with posttraumatic stress disorder, Psychiatry Research,
Volume 119, Issues 1-2,
Omer Bonne, Dalia Brandes, Ronen Segman, Roger K. Pitman, Rachel Yehuda
and Arieh Y. Shalev
Hypothalamic
pituitary adrenal axis abnormalities have been described in posttraumatic
stress disorder (PTSD), and among the recently traumatized. Plasma cortisol and continuous measures of PTSD symptoms were
obtained from 21 survivors, at 1 week and 6 months after traumatic events.
Eight survivors met Clinician Administered PTSD Scale criteria for PTSD at 6
months. Cortisol levels at 1 week did not predict
subsequent PTSD. Survivors with and without PTSD had similar mean levels of cortisol at both time points. Cortisol
levels at 6 months negatively correlated with self-reported PTSD symptoms
within PTSD subjects.
Performance on visuospatial
copying tasks in individuals with chronic posttraumatic stress disorder,
Psychiatry Research, Volume 112, Issue 3,
Tamara V. Gurvits, Natasha B. Lasko, Ann L. Repak, Linda J.
Metzger, Scott P. Orr and Roger K. Pitman
The
ability to copy figures was evaluated in 41 subjects with chronic posttraumatic
stress disorder (PTSD) and 27 trauma-exposed, non-PTSD comparison subjects.
Individuals with PTSD demonstrated significantly impaired performance. However,
after adjusting for pre-trauma variables, there was only a marginally
significant association between figure-copying performance and PTSD. These
findings are consistent with pre-trauma visual-spatial impairment as being
among the risk factors for chronic PTSD.
A pilot study of noradrenergic and HPA axis functioning
in PTSD vs. panic disorder, Psychiatry Research, Volume 110, Issue 3,
Randall D. Marshall, Carlos Blanco, David Printz, Michael R. Liebowitz,
Donald F. Klein and Jeremy Coplan
The
biological literature in the anxiety disorders has focused on comparisons
between patient groups and normal volunteers, with relatively little
comparative study of the anxiety disorders. We therefore conducted this pilot
study to compare a group of patients with post-traumatic stress disorder (PTSD)
(n=7) to a contiguously studied panic disorder group (n=17) and healthy control
subjects (n=16) on baseline levels of cortisol and
3-methoxy-4-hydroxyphenylglycol (MHPG), and response to clonidine
challenge. Despite the small sample size, highly significant differences were
found on the following measures: PTSD patients had lower cortisol,
lower MHPG, reduced MHPG volatility to clonidine
challenge, and marginally reduced cortisol volatility
compared to patients with panic disorder. These biological findings support
existing clinical, epidemiologic, family study, and clinical trial findings
that distinguish these two disorders as distinct syndromes.
PTSD symptoms and cognitive performance in recent
trauma survivors, Psychiatry Research, Volume 110, Issue 3,
Dalia Brandes,
Gershon Ben-Schachar, Assaf Gilboa, Omer Bonne, Sara
Freedman and Arieh Y. Shalev
Chronic
post-traumatic stress disorder (PTSD) has been associated with cognitive
impairments involving memory and attention. The association between cognitive
impairment and early PTSD symptoms is unknown, yet such association may lead to
poorer processing of traumatic memories and thereby contribute to subsequent
PTSD. This study evaluated the relationship between PTSD symptoms and cognitive
functioning within 10 days of traumatic events. Forty-eight survivors were
assessed for symptoms of PTSD, anxiety, depression and dissociation and for immediate
and delayed verbal and figural memory, attention, learning and IQ. Survivors
with high levels of PTSD symptoms showed impaired attention and immediate
recall for figural information and lower IQ. They did not show, however, an
impairment of verbal recall and learning. The observed difference was not
explained by anxiety or dissociation. It disappeared, however, when the effect
of depressive symptoms was controlled for. Lower IQ and impaired attention
are associated with early PTSD and depressive symptoms. Poorer attention may
have a role in shaping traumatic memories.
Journal of Traumatic Stress
16 (4): 319-323, August 2003
Hypothalamic–Pituitary–Adrenal Activity Among Armenian Adolescents with PTSD Symptoms
Armen K. Goenjian:
agoenjia@aol.com
Robert S. Pynoos, Alan M.
Steinberg, David Endres , Khachik
Abraham , Mitchell E. Geffner, Lynn A. Fairbanks
This
study evaluated basal levels and responsiveness to exercise of plasma adrenocorticotropic hormone (ACTH), and serum thyroid
stimulating hormone (TSH), growth hormone (GH) and cortisol
among adolescents from two differentially exposed groups 6[half] years after
the 1988 earthquake in Armenia. Severity of total PTSD and Category C and D
symptoms were negatively correlated with baseline cortisol.
Preexercise ACTH was significantly lower,
and preexercise TSH higher, among adolescents with
more exposure. Depressive symptoms were negatively correlated with baseline cortisol and positively with TSH. Mean GH, TSH, and cortisol levels in both groups fell within normal limits. The
pre- to postexercise increase in GH, TSH, and cortisol suggests that exercise challenge may be useful in
the field investigation of neurohormonal activity
among traumatized individuals
Curr Psychiatry Rep. 2003 Oct;5(5):369-83.
Neuroimaging and Neurocircuitry in Post-traumatic Stress Disorder: What Is
Currently Known?
Tanev K.
Department of Psychiatry, University of
Neurobiologic, psychologic, and
social factors interact jointly to create and perpetuate the symptoms of
post-traumatic stress disorder (PTSD). The fear conditioning paradigm in animal
research helped researchers gather preclinical evidence for the possible contribution
of several brain areas to PTSD symptoms. In the past 10 years, highly
sophisticated neuroimaging techniques made it
possible for researchers to look at the brain of patients with PTSD and draw
conclusions about the neurocircuitry underlying PTSD
symptoms. In this article, the author will review the evidence from neuroimaging studies for the involvement of the following
brain areas in PTSD neurocircuitry: the amygdala, the anterior cingulate
cortex and subcallosal gyrus,
the inferior frontal gyrus, the posterior cingulate cortex, and the hippocampus. Neuroimaging studies have shown these areas as
altered in structure or function in patients with PTSD. The author also
presents the normal functions that these areas subserve
and, whenever possible based on the evidence, infer how their dysfunction
may contribute importantly to the symptomatology of
PTSD.
Hypoactivation of the
prefrontal cortex during verbal fluency test in PTSD: a near-infrared
spectroscopy study.
Matsuo K, Taneichi K, Matsumoto
A, Ohtani T, Yamasue H, Sakano Y, Sasaki T, Sadamatsu M,
Kasai K, Iwanami A, Asukai N, Kato N, Kato T.
Several studies have suggested that there is frontal
dysfunction in subjects with posttraumatic stress disorder (PTSD). We
investigated the relationship between alterations of the hemodynamic
response of the prefrontal cortex during a cognitive task (verbal fluency task;
VFT) and memory function measured using the Wechsler Memory Scale-Revised
(WMS-R). The subjects were victims of the Tokyo Subway Sarin
attack with (n=8) or without (n=26) PTSD. Hemodynamic
response in the prefrontal cortex was measured using a 24-channel near-infrared
spectroscopy (NIRS) system. Subjects with PTSD had a significantly smaller
response of oxygenated hemoglobin and total hemoglobin during the VFT compared
with those without PTSD, although there was no significant difference in
performance on the VFT. Subjects with PTSD had significantly lower scores on
attention and concentration in the WMS-R, which was positively correlated with
the increase of total hemoglobin during the VFT. The 'frontal
dysfunction' observed in subjects with PTSD may be a secondary phenomenon to
reduced attentional capacity.
Event-related potential dysfunction in posttraumatic
stress disorder: the role of numbing, Psychiatry Research, Volume 109,
Issue 2,
Kim L. Felmingham, Richard A.
Bryant, Carmen Kendall and Evian Gordon
The
purpose of this study was to examine the relationship between disturbance in
event-related potentials (ERPs) and symptom clusters
in posttraumatic stress disorder (PTSD). ERPs were
recorded in 17 unmedicated civilian PTSD patients and
17 age- and sex-matched controls during a conventional auditory oddball task.
PTSD symptom clusters (re-experiencing, active avoidance, numbing, hyperarousal) were correlated with
ERP measures. The PTSD group showed ERP disturbances to target stimuli (reduced
P200 and P300 and increased N200 amplitude, increased N200 and P300 latency)
and reduced P200 amplitude to common stimuli compared to the control group. A
significant negative correlation was found between the intensity of numbing
symptoms and parietal P300 amplitude. This study replicates findings of
disturbed N200 and P300 components in PTSD, reflecting impairments in stimulus
discrimination and attention. The finding that numbing was associated with
reduced attention processing (P300) is consistent with models positing a
relationship between disordered arousal and attention in PTSD.
European Psychiatry
Volume 18, Issue 4 , June 2003,
Pages 172-176
Prediction of the occurrence and intensity of
post-traumatic stress disorder in victims 32 months after bomb attack
Louis Jehel, ,
a, Sabrina Paternitib, Alain Brunetc,
Clara Ducheta and Julien
Daniel Guelfid
Introduction. – Our objective was to identify factors that
predict occurrence and severity of post-traumatic stress disorder (PTSD) after a terrorism attack. Population. –
We evaluated 32 victims of a bomb attack in a
Annals of General Hospital Psychiatry
Risk and resiliency factors in posttraumatic stress
disorder
Marcia A Voges1 and David M Romney
Email: Marcia A Voges -
mavoges@ucalgary.ca; David M Romney* - romney@ucalgary.ca
Background:
Not everyone who experiences a trauma develops posttraumatic stress
disorder (PTSD). The aim of this study was to determine the risk and resiliency
factors for this disorder in a sample of people exposed to trauma. Method: Twenty-five
people who had developed PTSD following a trauma and 27 people who had not were
asked to complete the Posttraumatic Stress Diagnostic Scale, the Coping
Inventory for Stressful Situations, and the State-Trait Anxiety Inventory. In
addition, they completed a questionnaire to provide information autobiographic
and other information. Analysis: Five variables that discriminated
significantly between the two groups using chi-square analysis or t-tests were
entered into a logistic regression equation as predictors, namely, being
female, perceiving a threat to one's life, having a history of sexual abuse,
talking to someone about the event, and the "intentionality" of the
trauma.
Results: Only being female and perceiving a threat to
one's life were significant predictors of PTSD. Taking base rates into
account, 96.0% of participants with PTSD were correctly classified as
having the disorder and 37.0% of participants without PTSD were correctly
classified as not having the disorder, for an overall success rate of 65.4% Conclusions:
Because women are more likely than men to develop PTSD, more preventive
measures should be directed towards them. The same is true for trauma victims
(of both sexes) who feel that their life was in danger
Comorbidity of PTSD
and depression: associations with trauma exposure, symptom severity and functional
impairment in Bosnian refugees resettled in Australia, J Affective
Disorders, In Press, Corrected Proof, Available online
Shakeh Momartin,
Derrick Silove, Vijaya Manicavasagar and Zachary Steel
Background:
Posttraumatic stress disorder (PTSD) is common in refugees but its association
with longer-term psychosocial dysfunction remains unclear. We examined whether
a subgroup of refugees with comorbid PTSD and
depression were at particularly high risk of disability. We also investigated whether
specific trauma experiences were linked to this comorbid
pattern. Methods: Consecutive Bosnians (and one or two compatriots nominated by
them) were recruited from a community centre, yielding a total sample of 126
participants (response rate 86%). Measures included a trauma inventory, the
Clinician Administered PTSD Scale (CAPS) ([Blake et al]) and the depression
module of the Structured Clinical Interview (SCID) ( [First
et al]). Results: Three diagnostic groupings emerged: normals
(n=39), pure PTSD (n=29), and comorbid PTSD and
depression (n=58). Of four trauma dimensions derived from principle components
analysis (human rights violations, dispossession and eviction, life threat and
traumatic loss), life threat alone was associated with pure PTSD, with life
threat and traumatic loss both being associated with comorbidity.
Compared to normals and those with pure PTSD, the comorbid group manifested more severe PTSD symptoms as well
as higher levels of disability on all indices (global dysfunction: odds
RATIO=5.0, P<0.001, distress: odds RATIO=6.0, P<0.001, social impairment:
odds ratio 5.9, P<0.001, and occupational disability: odds ratio 5.0,
P<0.001). Limitations: Recruitment was not random, the sample size was
modest, and trauma event endorsement was based on retrospective accounts.
Conclusions: The combination of life threat and traumatic loss may be
particularly undermining to the psychological well-being of refugees and
consequent comorbidity of PTSD and depression may be
associated with longer-term psychosocial dysfunction. The findings raise the
question whether the comorbid pattern identified
should be given more recognition as a core posttraumatic affective disorder.
Partial posttraumatic stress disorder revisited, J
Affective Disorders, In Press, Corrected Proof, Available online
Jacques Mylle and Michael Maes
Background:
It is thought that the decision rule for a positive diagnosis of Posttraumatic
Stress Disorder (PTSD) may be too restrictive, leaving too many victims of a
trauma out in the cold for care, compensation, etc. Several authors have
proposed the concept of Subthreshold or Partial PTSD
(PPTSD). This concept considers that a subject may present a number of symptoms
below threshold for criteria C or D (subthreshold
syndromes) and may even present without any symptom for one or more of the
criteria B, C and D (partial syndromes). Method: Data have been collected by
means of the Composite International Diagnostic Interview (CIDI) PTSD-module,
in a group exposed to two different traumatic events (130 fire victims and 55
car accident victims). The syndrome patterns has been
assessed by means of hierarchical class analyses. Each of the criteria B, C and
D has been analyzed separately, showing the symptom patterns as hierarchically
order clusters. Results: Depending on the threshold used for criterion C (i.e.
3 or 2 symptoms), 18.4 and 22.7% of the subjects respectively satisfy the
criteria for PTSD. 8.7% of the subjects show subthreshold
syndromes. 60.7% of the subjects show partial syndromes and 16.7% of the
subjects have partial syndromes while fulfilling criterion F, i.e. a clinically
significant impairment in functioning. Conclusions: The results show a
considerable number of partial and subthreshold
syndromes. It is argued that subthreshold syndromes
and partial syndromes, which fulfill criterion F, should be regarded as
specific nosological categories or as specified PTSD
subcategories, i.e. subsyndromal or partial PTSD.
The mediating effects of sleep in the
relationship between traumatic stress and health symptom in urban police
officers.
Psychosom Med 2003;65:485–489.
2.
Objectives To explore the degree to which sleep
disturbance mediate the relationship between post-traumatic stress disorder
(PTSD) symptoms and health in a sample of police officers. 3. Study design A cross-sectional convenience sampling from three urban
police departments, with greater recruitment of minority and female officers.
4. Study population A total of 1200 officers were mailed questionnaires, 790
(66%) returned materials, 741 (62%) packages were usable, and 713 (59%)
contained complete data sets. 5. Methods Two sets of
independent variables (PTSD and sleep quality) were used in a series of stepped
logistic regression analyses to examine the strength of their relative effects
on self-reported health status. PTSD was assessed using the Mississippi
Scale–Civilian Version (MS-CV), sleep- and
health-related items were excluded. Sleep quality was assessed using the
Pittsburgh Sleep Quality Index (PSQI), excluding items assessing absolute sleep
latency and duration of sleep. Two dependent measures of health status were
physical functioning, assessed using the Physical Composite Score (PCS) of the
SF-12, and somatic symptoms, assessed using the Somatization subscale of the Symptom Checklist-90-R
(SCL-90). Three sets of potential confounding variables (demographics
––specifically age and Hispanic ethnicity; alcohol abuse, and duty-related
trauma history) were entered in the first step of each hierarchical logistic
regression analysis. The relative changes in the proportion of variance
explained by PTSD or sleep quality were explored. 6. Results Controlling
for potential confounders, 18% of the variance in somatic symptoms was
predicted by PTSD symptoms directly, this was significantly reduced to 8% when
the sleep quality was entered as a primary factor. Conversely, the association
between sleep quality and somatization was
considerably strengthened from 15 to 25% when sleep quality was entered before
the PTSD. Although the strengths of the observed relationships are relatively
weak, this finding suggests that sleep disturbance may mediate somatic symptoms
in this population. In a second set of analyses predicting residual physical
health status, 2% of the variance was (very weakly) predicted by PTSD symptoms,
dropping essentially to zero (0.3%) when the sleep quality was entered in the
prior step. 7. Conclusions The authors argue that, in general, the results
support the hypothesis that relationship between PTSD and health is mediated by
sleep quality; more specifically, that sleep quality acts as a partial mediator
of the effects of PTSD on somatic symptoms and a full mediator of health
function.
The Forensic Examiner, Sept-Oct 2003 v12 i9-10 p27(7)
Childhood trauma: its relationship to behavioral and
psychiatric disorders.
Kathryn Seifert.
It is
important to understand the relation ships among family violence, child
maltreatment, and psychiatric and behavioral disorders in order to prevent,
assess, and treat these very serious social problems. This study demonstrates a
strong level of comorbidity among these problems. All
subgroups (Psychiatric, Violent, Sexual Offending, Delinquent, Attachment
Disordered, and Substance Abusers) had a high percentage of childhood trauma,
family violence, and psychiatric problems. The psychiatric population had substantial aggression, but were less
aggressive (57%) than other groups. Seventy-three to 92% of all groups had
psychiatric disorders. Over 75% of all groups had histories of childhood trauma
with the Attachment Disordered group having the highest percentage (98%). The
study points to the need for professionals to assess a broad range of
individual and family problems when persons are referred for services, regardless
of the presenting problem. However, more study is needed.
J Trauma Stress. 2003 Oct;16(5):451-7.
A preliminary examination of treatment for
posttraumatic stress disorder in chronic pain patients: a case study.
Shipherd JC, Beck JG, Hamblen
JL, Lackner JM, Freeman JB.
Manualized treatments have become popular, despite concern
about their use when comorbid diagnoses are present.
In this report, the efficacy of manualized
posttraumatic stress disorder (PTSD) treatment was examined in the presence of
chronic pain. Additionally, the effect of PTSD treatment on chronic pain and
additional psychiatric diagnoses was explored. Six female patients with both
PTSD and chronic pain following motor vehicle accidents were treated for PTSD
using a multiple baseline design. The results indicate that manualized treatment for PTSD was effective in reducing
PTSD symptoms in these patients. Although there were no changes in
subjective pain, there were pain-related functional improvements and reductions
in other psychiatric diagnoses for the majority of patients.
Scandinavian Journal of Psychology
Volume 44 Issue 5 Page 415 - December 2003
Social network as a moderator in the relation between
trauma exposure and trauma reaction: A survey among UN soldiers and relief
workers
Marianne Kaspersen1, Stig Berge
Matthiesen2 and K. Gunnar Götestam1
Social
network as a moderator between trauma exposure and post-trauma symptomatology was studied. Two samples - relief workers
and UN soldiers - were assessed on trauma exposure, social network and three
dependent measures related to post-trauma reactions. Regression analysis and
interaction plots were used to determine the presence of interaction effects
between trauma exposure and social network. All four network variables moderated
the relationship between trauma exposure and post-trauma reactions among relief
workers, while among UN soldiers only two such buffer effects were found.
Furthermore, among UN soldiers one of these interaction effects was reversed,
indicating social support to be important for those low on trauma exposure,
while among relief workers support was important in the high-exposure
condition. The results indicate a difference with respect to the importance of
social network as a moderator between groups exposed to different kinds of war
trauma. Differences in motivational systems may also exist. However, further
research will have to establish this.
Journal of Traumatic Stress
16 (6): 555-562, December 2003
Do Patients Drop Out Prematurely from Exposure Therapy
for PTSD?
Elizabeth A. Hembree; Edna B. Foa; Nicole M. Dorfan;
Many studies have demonstrated the efficacy of exposure
therapy in the treatment of chronic posttraumatic stress disorder (PTSD).
Despite the convincing outcome literature, a concern that this treatment may
exacerbate symptoms and lead to premature dropout has been voiced on the basis
of a few reports. In this paper, we examined the hypothesis that treatments that
include exposure will be associated with a higher dropout rate than treatments
that do not include exposure. A literature search identified 25 controlled
studies of cognitive–behavioral treatment for PTSD that included data on
dropout. The results indicated no difference in dropout rates among exposure
therapy, cognitive therapy, stress inoculation training, and EMDR. These
findings are consistent with previous research about the tolerability of
exposure therapy.
Bisson, J.I., Shepherd, J.P., Joy,
D., Probert, R., Newcombe,
R.G. (2004).
Early cognitivebehavioural therapy for post-traumatic stress
symptoms after physical injury: Randomised controlled
trial.
The British Journal
of Psychiatry (2004) 184: 63-69:BissonJI@Cardiff.ac.uk
Background Early
single-session psychological interventions, including psychological debriefing
following trauma, have not been shown to reduce psychological distress. Longer
early psychological interventions have shown some promise. Aims To examine the
efficacy of a four-session cognitivebehavioural
intervention following physical injury. Method A total of 152 patients
attending an accident and emergency department displaying psychological
distress following physical injury were randomised
13 weeks post-injury to a four-session cognitivebehavioural
intervention that started 510 weeks after the injury or to no intervention and
then followed up for 13 months. Results At 13 months, the total Impact of Event
Scale score was significantly more reduced in the intervention group (adjusted
mean difference=8.4,95% CI 2.414.36). Other differences were not statistically
significant. Conclusions A brief cognitivebehavioural
intervention reduces symptoms of post-traumatic stress disorder in individuals
with physical injury who display initial distress.
The British Journal of Psychiatry (2004) 184: 63-69
Early cognitive–behavioural
therapy for post-traumatic stress symptoms after physical injury: a randomised controlled trial
JONATHAN I. BISSON, JONATHAN P. SHEPHERD, DEBORAH JOY,
RACHEL PROBERT, ROBERT G. NEWCOMBE; e-mail: BissonJI@Cardiff.ac.uk
Background Early single-session psychological
interventions, including psychological debriefing following trauma, have not
been shown to reduce psychological distress. Longer early psychological
interventions have shown some promise. Aims To examine the efficacy of a four-session cognitive–behavioural intervention following physical injury. Method A total of 152 patients attending an
accident and emergency department displaying psychological distress following
physical injury were randomised 1–3 weeks post-injury
to a four-session cognitive–behavioural intervention
that started 5–10 weeks after the injury or to no intervention and then followed
up for 13 months. Results At 13 months,
the total Impact of Event Scale score was significantly more reduced in the
intervention group (adjusted mean difference=8.4,95% CI 2.4–14.36). Other
differences were not statistically significant.
Conclusions A brief cognitive–behavioural intervention reduces symptoms of post-traumatic
stress disorder in individuals with physical injury who display initial
distress.
J Neuropsychiatry Clin Neurosci 16:102-108, February 2004
A CNV-Distraction Paradigm in Combat Veterans With Posttraumatic Stress Disorder
Matthew Kimble, Ph.D., Kathryn Ruddy, B.A., Patricia Deldin, Ph.D. and Milissa
Kaufman, B.A.; M.Kimble@bangor.ac.uk (E-mail).
Fourteen
veterans with posttraumatic stress disorder (PTSD) and 14 without PTSD participated
in a contingent negative variation (CNV)-distraction paradigm. Subjects were
instructed to press a button after hearing a high-pitched tone (S2) preceded by
a low-pitched tone (S1). One-half of the trials included a white-noise
distracter placed in the S1–S2 interval. Posttraumatic stress disorder subjects
had larger frontal, but smaller central and parietal CNVs,
regardless of condition (distracter, no distracter) or epoch (early CNV, late
CNV). In PTSD subjects, the N1/P2 complex was smaller to warning (S1) and
distracter stimuli and did not show the extent of facilitation present in
non-PTSD subjects. Findings highlight PTSD-related differences in phasic cortical excitability and attention.
*STRESS MODELS
Neuroscience & Biobehavioral
Reviews
Article in Press, Corrected Proof
Adaptations or pathologies?
Long-term changes in brain and behavior after a single exposure to severe
threat
Christoph P. Wiedenmayer, , a, b
a Department of Psychiatry, Columbia University College of
Physicians and Surgeons, 1051 Riverside Drive, Unit 40, New York, NY 10032, USA
b Division of Developmental
Psychobiology, NY State Psychiatric Institute,
The
experience of a single threatening situation may alter the behavior of an
animal in a long-lasting way. Long-lasting changes in behavior have been
induced in laboratory animals to model and investigate the development and
neural substrate of human psychopathologies. Under natural conditions, however,
changes in behavior after an aversive experience may be adaptive because
behavioral modifications allow animals to adjust to a threat for extended
periods of time. In the laboratory setting, properties of the aversive
situation and the potential of the animal to respond to the threat may be altered
and lead to extensive, prolonged changes, indicating a failure in behavioral
regulation. Such long-term changes seem to be mediated by neuronal
alterations in components of the fear pathway. To understand
psychopathologies, determinants of exaggerated responsivity
and the underlying molecular and neural processes have to be analyzed in a
comparative way under conditions that produce normal and abnormal fear and
anxiety.
Clinical Neuroscience Research
Volume 3, Issues 4-5 , December
2003, Pages 245-251
Stress models of depression
Barbara Vollmayr, and Fritz A. Henn
In order
to understand the molecular changes underlying major depression animal models
are needed. The best animal model of depression simulates the etiology and
replicates symptoms, course and treatment of human depression. This article
reviews the two most valid and best established animal models of depression,
learned helplessness and chronic mild stress. Both models use uncontrollable
stress to induce depressive like behavior, both have excellent face validity
and replicate anhedonia and anergia
in analogy to loss of interest and pleasure, one of two essential features of
depression. In addition, both models demonstrate a variety of less
specific symptoms like changes in locomotion, impaired learning ability, sleep alterations, loss of weight and decrease of sexual
behavior. Endocrine disturbances of major depression as hypercortisolemia
and dexamethasone non-suppression are also simulated
in the two animal models. Neurobiological changes accompanying the
depressive like behavior include dynamic changes of the monoamine systems and
several peptide systems including the opioid system.
Behavioral and neurobiological changes can be renormalized in both models by
antidepressant treatment, which adds predictive validity to these models.
Am J Psychiatry 161:36-44,
January 2004
The Nature of Traumatic Memories: A 4-T fMRI Functional Connectivity Analysis
Ruth A. Lanius, M.D., Ph.D.,
Peter C. Williamson, M.D., Maria Densmore, B.Sc.,
Kristine Boksman, M.A., R. W. Neufeld, Ph.D., Joseph
S. Gati, M.Sc., and Ravi S. Menon, Ph.D.
OBJECTIVE:
This study used functional connectivity analyses to assess interregional brain
activity correlations during the recall of traumatic memories in traumatized
subjects with and without posttraumatic stress disorder (PTSD). METHOD: Both
4-T functional magnetic resonance imaging (fMRI) and
functional connectivity analyses were used to assess interregional brain activity
correlations during script-driven symptom provocation in traumatized subjects
with (N=11) and without (N=13) PTSD. Functional connectivity analyses were
carried out by using data for brain regions activated in both the PTSD group
and the comparison group. The use of functional connectivity analyses in
addition to subtraction analyses allowed assessment of specific brain regions
involved in the recall of traumatic events and of the neuronal networks
underlying the recall of such events. RESULTS: Significant between-group
differences in functional connectivity were found. Comparison of connectivity
maps at coordinates x=2, y=20, z=36 (right anterior cingulate
gyrus) for the two groups showed that the subjects
without PTSD had greater correlation than the PTSD subjects in the left
superior frontal gyrus (Brodmann’s
area 9), left anterior cingulate gyrus
(Brodmann’s area 32), left striatum (caudate), left
parietal lobe (Brodmann’s areas 40 and 43), and left insula (Brodmann’s area 13). In
contrast, the PTSD subjects showed greater correlation than the subjects
without PTSD in the right posterior cingulate gyrus (Brodmann’s area 29), right
caudate, right parietal lobe (Brodmann’s areas 7
and 40), and right occipital lobe (Brodmann’s
area 19). CONCLUSIONS: The differences in brain connectivity between PTSD
and comparison subjects may account for the nonverbal nature of traumatic
memory recall in PTSD subjects, compared to a more verbal pattern of traumatic
memory recall in comparison subjects.
Am J Psychiatry 161:45-52,
January 2004
Posttraumatic Stress Disorder and Health-Related
Quality of Life in Long-Term Survivors of Acute Respiratory Distress Syndrome
Hans P. Kapfhammer, M.D., Ph.D.,
Hans B. Rothenhäusler, M.D., Till Krauseneck,
M.D., Christian Stoll, M.D., and Gustav Schelling,
M.D.
OBJECTIVE:
Intensive care often means exposure to physical and psychological stress, with
long-lasting emotional sequelae for most patients.
Psychiatric morbidity and negative effects on health-related quality of life
were assessed in long-term survivors of acute respiratory distress syndrome.
METHOD: Forty-six long-term survivors were enrolled in a psychiatric follow-up
study. All patients had received standard, protocol-driven treatment during
intensive care. The median follow-up time was 8 years after treatment. DSM-IV
was used for psychiatric diagnosis. Psychological tests were performed to
measure posttraumatic stress symptoms; depression; state anxiety; somatization; symptoms regarding concentration, attention,
and short-term memory; social support; and health-related quality of life.
RESULTS: At time of discharge, 20 of the patients suffered from posttraumaatic stress disorder (PTSD) and four from
sub-PTSD. At follow-up, 11 patients continued to suffer from PTSD and eight
from sub-PTSD. The patients with PTSD demonstrated a pronounced tendency for somatization and state anxiety. Among the groups with PTSD,
sub-PTSD, and no PTSD, there were no statistically significant differences
regarding social support and symptoms of cognitive dysfunction. Those with PTSD
showed major impairments in some dimensions of health-related quality of life,
whereas those without PTSD had scores that were in the range of the general
population. Except for duration of stay on the intensive care unit, neither age, gender, sociodemographic
variables, premorbid psychopathology, nor initial
severity of illness discriminated between the groups. CONCLUSIONS: Long-term
survivors of acute respiratory distress syndrome seem to face a major risk of
PTSD and major impairments in health-related quality of life in the long term.
*OCD
Psychiatry Research
Volume 119, Issues 1-2 ,
Abnormal P600 in obsessive–compulsive
disorder. A comparison with healthy controls
Charalabos C. Papageorgiou, , a and Andreas D. Rabavilasa, b
Recently, the P600 component of the event-related
potential (ERP), a waveform that is thought to be generated and/or modulated by
the anterior cingulate gyrus
and basal ganglia has been considered as an index of second pass-parsing
processes of information processing, having much in common with working memory
(WM) operation. Moreover, dysfunction of these brain structures as well as WM
deficits have been implicated in the pathophysiology
of obsessive–compulsive disorder (OCD). The present study is focused on P600
elicited during a WM test in OCD patients compared with healthy controls.
Twenty drug-free OCD patients and an equal number of normal subjects matched
for age, sex and educational level were studied via a computerized version of
the Wechsler digit span test. Auditory P600 was measured during the
anticipatory period of this test. The patient group, as compared with
healthy controls, showed significantly enhanced amplitudes of P600 at the right
temporoparietal area and prolonged latencies at the
right parietal region. Moreover, the memory performance of patients was
significantly impaired. These findings may indicate that OCD patients manifest
abnormal aspects of second pass-parsing processes of information processing as
they are reflected by P600 amplitudes and latencies.
Psychological Medicine (2003), 33:917-925
Neuropsychological performance of OCD patients before
and after treatment with fluoxetine: evidence for
persistent cognitive deficits
M. M. A. NIELEN a1c1 and J. A. DEN BOER a1
Background. There is an ongoing debate about the nature of
executive dysfunction that accompanies obsessive–compulsive disorder (OCD). One
reason for this may be that state-related factors, such as use of medication or
co-morbid symptoms, confound with task performance. This study tried to isolate
trait- from state-dependent cognitive impairments by examining variability of
cognition following treatment.
Method. Nineteen OCD patients
were tested on the Cambridge Neuropsychological Test Automated Battery (CANTAB)
before and after treatment with fluoxetine. Their
pattern of performance was compared to the one observed in healthy volunteers
(N=24).
Results. OCD patients displayed
impairments in planning ability, spatial memory and motor speed that persisted
after clinical improvement. With treatment, OCD performance diverged from that
of controls on measures of focused attention and strategic ability. However,
these effects were rather mild as they did not entail a significant
deterioration of performance within the OCD sample. Conclusions.
Our data suggest that cognitive impairments in OCD are not secondary to
symptoms and therefore form a trait feature of the disorder. The nature of the
deficits refers to a chronic dysfunction of the dorsolateral–striatal circuit. The minor effects of treatment on task
performance is in line with recent evidence that serotonin mediates cognitive
functions of orbitofrontal cortex to a greater extent
than those associated with dorsolateral prefrontal
regions.
Progress in Neuro-Psychopharmacology
and Biological Psychiatry
Volume 27, Issue 4 , June 2003,
Pages 601-606
Event-related potentials and neuropsychological tests
in obsessive–compulsive disorder
Berna Binnur
Kvrcka, , , Görsev G. Yenerb, Köksal Alptekina and Huriye Aydnb
Objective:
Previous studies have provided evidence from event-related potentials (ERPs) and neuropsychological testing of abnormal cognitive
processing in obsessive–compulsive disorder (OCD). The aim of this study was to
further characterize the cognitive functions of the patients with OCD by
utilizing ERPs and neuropsychological tests. Methods:
ERPs were recorded in a group of 31 drug-free OCD
patients without depression and 30 normal controls following verbal auditory
stimuli using an oddball paradigm. The specific neuropsychological tests
administered to assess cognitive functions in all participants were the Stroop Test, Trail Making Test, Design Fluency Test,
Controlled Word Association Test (Verbal Fluency test). Results: The patient
group showed shorter P300 duration compared to normal controls. In
neuropsychological tests, no significant differences were found between the two
groups. Negative correlations between Stroop duration
and P300 amplitudes in occipital, parietal, and temporal anterior regions were
observed. Conclusion: Shorter P300 duration may indicate an
acceleration in the P300 process, and speeding of cognitive processing,
dysfunction of cortico-subcortical circuits, or some
combination of all of the above.
Psychiatry Res. 2003 Jun 30;123(2):109-23
Neuropsychological correlates of P300 abnormalities in
patients with schizophrenia and obsessive–compulsive disorder
Myung-Sun Kim, Seung-Suk Kang, Tak Youn, Do-Hyung Kang, Jae-Jin Kim and Jun Soo Kwon
The
cognitive significance of P300 abnormalities in schizophrenia and
obsessive–compulsive disorder (OCD) was investigated. P300 was measured by an
auditory oddball paradigm, in which a series of standard tones (1000 Hz) and
target tones (1500 Hz) were presented. The subject's task was to count the
number of the presented target tones. Cognitive unctions
were evaluated by neuropsychological tests, which were chosen to be sensitive
to frontal and temporal dysfunction. Twenty-two schizophrenic patients, 19 OCD
patients and 21 healthy controls participated. Event-related potentials
measured at 15 electrode sites, which consisted of five levels on the
left–right dimension and three levels on the anterior–posterior dimension, were
included in the statistical analysis. P300 amplitudes on all 15 electrode sites
were significantly smaller in schizophrenic and OCD patients than in the
controls. Schizophrenic patients performed poorly on almost all
neuropsychological tests, while OCD patients showed impaired performance on the
Rey–Osterrieth Complex
Figure Test and on a controlled oral word association test. In schizophrenic
patients, P300 amplitude was associated with performance on verbal memory and
learning by the Luria–Nebraska Neuropsychological
Battery, while for OCD patients, P300 amplitude was related to the Trail Making
Test, Part B response time. These results indicate that schizophrenic patients
have generalized cognitive impairments, which are substrated
by a wide range of cortical dysfunctions. The major cognitive deficits
observed in OCD patients were impairments of controlled attention and
self-guided, flexible behavior, which are mediated by the fronto-striatal
system. The neurophysiological mechanisms underlying
P300 abnormalities observed in schizophrenic and OCD patients are discussed.
Progress in Neuro-Psychopharmacology
and Biological Psychiatry
Volume 27, Issue 4 , June 2003,
Pages 657-665
Neuropsychological performance and regional cerebral
blood flow in obsessive–compulsive disorder
Acioly L. T. Lacerdaa,
b, , , Paulo Dalgalarrondob,
Dorgival Caetanob, Gretchen
L. Haasa, c, Edwaldo E. Camargod and Matcheri S. Keshavana
a Department of Psychiatry,
Western Psychiatric Institute and Clinic,
Convergent
findings from neuropsychological and neuroimaging
studies have suggested that neural dysfunction in frontal–subcortical
circuits may play a central role in the pathophysiology
of obsessive–compulsive disorder (OCD). To further examine the relationship
between these two sets of findings we investigated both neuropsychological
functions and regional cerebral blood flow (rCBF) in
a combined study. Fourteen unmedicated patients
fulfilling DSM-IV criteria for OCD and 14 healthy controls matched for age,
gender, handedness, and education were assessed on neuropsychological tests
that included Trail Making Test (TMT), Rey Complex
Figure Test (RCF) (copy and 5-min recall), Verbal Fluency Test (VFT), and Wisconsin
Card Sorting Test (WCST). rCBF
was studied with 99 mTc-hexamethyl-propyleneamine-oxime
(HMPAO) single photon emission computed tomography (SPECT). Patients performed
more poorly than controls (P<.05) on RCF (copy), VFT, and WCST (perseverative errors). Spearman's correlations indicated
that severity of OCD correlated inversely with performance on the RCF (copy and
recall scores) and positively with rCBF in the right
thalamus. Positive correlations were observed between nonperseverative
errors (WCST) and rCBF in frontal areas and anterior cingulate. Perseverative errors
(WCST) correlated negatively with rCBF in the right
thalamus. These findings are consistent with most previously published studies
and suggest neural dysfunctions in the frontal–subcortical
circuits probably more pronounced in the right hemisphere. They also extend
the existing research, showing associations between deficits in cortical–subcortical circuitry and performance on neuropsychological
tests of controlled attention and visuospatial
functions.
Psychiatry Res. 2003 Jun 30;123(2):125-134
Elevated thalamic and prefrontal regional cerebral
blood flow in obsessive–compulsive disorder: a SPECT study,
Acioly L. T. Lacerda,
Paulo Dalgalarrondo, Dorgival
Caetano, Edwaldo E. Camargo, Elba C. S. C. Etchebehere
and Jair C. Soares
Functional
neuroimaging studies have pointed to a possible role
of cerebral circuits involving the prefrontal and anterior cingulate
cortices, the striatum, and thalamus in the pathophysiology
of obsessive–compulsive disorder (OCD). Regional cerebral blood flow (rCBF) of 16 drug-free Brazilian patients with OCD and 17
healthy subjects matched for age, gender, handedness and level of education was
measured with [99m-Tc] HMPAO single photon emission computed tomography.
Analysis of covariance identified four regions of interest with significantly
higher rCBF: the right superior and inferior frontal
cortex and the right and left thalamus. Positive correlations between symptom
severity measured by Clinical Global Impression scores and rCBF
were found in the right and left inferior frontal lobes and in the right basal
ganglia. Compulsive behavior was inversely correlated with rCBF
in the right thalamus, and duration of illness correlated positively with rCBF in the right and left superior frontal lobes and with
the right thalamus. The findings of this SPECT study conducted in
Clinical Psychology Review
Volume 23, Issue 1 , February
2003, Pages 95-117
Neuropsychology of obsessive-compulsive disorder: a
review and treatment implications
Scott Greisberg and Dean
McKay,
Department of Psychology,
The
existing literature examining neuropsychological features of
obsessive-compulsive disorder (OCD) is reviewed. The accumulated research
points to a deficit in organizational strategies in general, suggesting
problems in executive functioning. The available research is inconsistent in
identifying memory deficits in OCD. However, memory problems are most evident
when tests are used that require an implicit organizational strategy. While
the majority of the research reviewed involves adult samples, there is emerging
evidence that these deficits are present in children as well. It is
suggested here that the interaction between organizational strategy deficits
and the effort to recall unstructured information contributes to doubting, an
important feature of OCD. Implications of this body of research for behavior
therapy are considered.
Psychiatry Res. 2003 Jun 30;123(2):135-143
Evaluation of regional cerebral blood flow changes in
panic disorder with Tc99m-HMPAO SPECT, Pages 135-143
brahim Eren, Rait Tükel,
Aslhan Polat, Remzi Karaman and Seher Ünal
The
objective of this study is to investigate differences in regional cerebral
blood flow (rCBF) and rCBF
asymmetry index values between panic disorder patients (n=22) and normal
comparison subjects (n=19) using Tc99m-hexamethylpropyleneamine oxime single photon emission tomography imaging. A decrease
in perfusion in the bilateral frontal regions and a relative increase in
perfusion in the right medial and superior frontal regions were found. There
were significant positive correlations between scores on the Panic and
Agoraphobia Scale and rCBF asymmetry index values of
the parietal, superior temporal and lateral temporal regions in the panic
disorder patients. These correlations point to a relationship between the
severity of panic disorder and relative right brain activation. Activation
of the amygdala, increased CBF in the frontal region,
or hyperactivation of the locus ceruleus
seen in panic disorder may explain the decrease in the rCBF
in the inferior frontal region.
*** a rational study that integrates vs reduces information, and employs a biopsychosocial
model...)***
European Psychiatry
Volume 18, Issue 5 , August 2003,
Pages 241-248
Neuropsychological function in obsessive-compulsive
disorder: effects of comorbid conditions on task
performance
Ayse Aycicegia,
Wayne M. Dinn, , b, Catherine
L. Harrisb and Husnu Erkmenc
Background. – Neuropsychological testing reveals a pattern
of impairment among patients with obsessive-compulsive disorder (OCD) which
implicates the orbitofrontal region. Studies of
neuropsychological function in OCD differ regarding performance deficits on
classical tests of frontal executive function. In some studies, OCD patients
did not demonstrate impaired performance on tests of executive function.
However, other researchers have documented performance deficits among OCD
patients on measures of executive function. Patients with OCD also exhibit
performance deficits on tests of visual/spatial memory and verbal memory.
Again, in some studies, OCD patients did not demonstrate impaired
performance on tests of memory function. How can we account for the
conflicting findings? One possibility is that performance deficits on tests of
cognitive function are associated with comorbid
conditions. In prior work, we observed that OCD patients who did poorly on
executive function tasks obtained high scores on a measure of schizotypal personality. A second possibility is that
executive function deficits among patients with OCD are associated with comorbid depressive symptoms. Method.
– In the present study, a comprehensive neuropsychological test battery was
administered to patients with OCD and matched healthy control subjects. We also
administered dimensional measures of schizotypal
personality and depression to patients with OCD and controls. We conducted
analyses of covariance (ANCOVA), with scores on measures of schizotypal
personality and depression used as covariates. Results.
– OCD patients demonstrated performance deficits on measures of delayed
memory, response inhibition, alternation learning, and obtained significantly
higher scores on measures of disinhibition,
impulsivity, and temporolimbic symptoms; however, OCD
patients did not exhibit impaired performance on tests of executive function
and verbal fluency, and did not report a significantly greater number of dysexecutive symptoms, when coexistent depressive and schizotypal symptoms were taken into account. Conclusion. – Findings
are consistent with the contention that dysfunction of an orbitofrontal-limbic
network underlies OCD.
Psychiatry Research: Neuroimaging,
Volume 122, Issue 1, Pages 37-47 January 2003 Neural correlates of
clinical symptoms and cognitive dysfunctions in obsessive–compulsive disorder
Jun Soo Kwon, Jae-Jin Kim, Dong Woo Lee, Jae
Sung Lee, Dong Soo Lee, Myung-Sun
Kim, In Kyoon Lyoo, Maeng Je Cho
and Myung Chul Lee
Although
results from neuropsychological and neuroimaging
studies have postulated the involvement of the frontal lobe and the subcortical brain regions in the pathophysiology
of obsessive–compulsive disorder (OCD), neuroimaging
studies have provided little evidence that cognitive abnormalities in patients
with OCD are related to dysfunctions in these areas. This study was designed to
determine whether the clinical features and cognitive deficits of OCD might be
taken to reflect frontal-subcortical dysfunction.
Fourteen patients with OCD and 14 case-matched normal subjects completed
clinical and cognitive evaluation, including four sets of neuropsychological
tests that assessed the executive functions and visual memory. Cerebral glucose
metabolic rates were measured by using positron emission tomography (PET) with
18F-fluorodeoxyglucose. Behavioral and PET data were analyzed using statistical
parametric mapping for group differences and behavioral–metabolic correlates.
The right orbitofrontal cortex showed increased
metabolic activity and the left parieto-occipital
junction showed decreased metabolic activity in patients. Metabolism in the
right hippocampus, the left putamen and the right
parietal region was associated with the severity of obsessive–compulsive
symptoms. Correlations between metabolic rates and neuropsychological test
scores in the prefrontal cortex and the putamen
occurred only in the patient group. These results suggest that patients with
OCD have distinct features of brain metabolic activities for performing
cognitive tasks as well as presenting obsessive–compulsive symptoms. In
particular, the frontal–subcortical circuits might
mediate not only symptomatic expression but also cognitive expression in
patients with OCD.
J Neuropsychiatry Clin Neurosci 15:359-362, August 2003
The Frontal Lobe Neuropsychological Tests in Patients With Schizophrenia and/or Obsessive-Compulsive Disorder
Alina Borkowska, Ph.D., Ewa
Pilaczyñska, M.D. and Janusz
K. Rybakowski, M.D.
Address correspondence to Dr. Alina
Borkowska, Clinical Neuropsychology Unit, University
School of Medicine, Bydgoszicz, Poland;
alab@amb.bydgoszcz.pl (E-mail).
This
study compared the performances of matched schizophrenia patients with or
without obsessive-compulsive (OC) symptoms, patients with obsessive-compulsive
disorder (OCD), and control subjects on selected frontal lobe tests. Schizophrenic
patients without OC were the most impaired; and OCD patients were the least,
while schizophrenic patients with OC scored between these two groups.
Clinical EEG
Volume 34, 2003, 70-74
Quantitative Electroencephalography in OCD Patients
Treated with Paroxetine
Elsebet S. Hansen, Leslie S. Prichep, Tom G. Bolwig and E. Roy
John
The
effectiveness of drugs that have a specific effect on the activity of the serotonergic neurotransmitter system has changed the
outlook for patients suffering from obsessive-compulsive disorder (OCD). With a
response rate of about 70% to such compounds and the great amount of brain
imaging studies conducted over the past decades, an understanding of the
biochemical nature and origins of OCD is beginning to unfold. Convergent data
including ethological and experimental observations, clinico-pathological
findings and different imaging methods have implicated the basal ganglia along
with the cortical and related thalamic structures to be involved in the pathophysiology of OCD.
In a
previous study using the quantitative electroencephalographic (QEEG) method known
as neurometrics, in which QEEG data from OCD patients
were compared statistically with those from an age-appropriate normative
population, two subtypes within a clinically homogeneous patient group were
classified. Patients with relative excess theta activity, especially in the
frontal regions, were nonresponders to treatment with
serotonin reuptake inhibitors (SSRI), while those with increased relative power
in alpha activity were responders to pharmacological treatment. These findings
suggested at least two subgroups in a patient population with similar symptoms
but differential responses to treatment.
In the
present study we used neurometric QEEG to subtype a
group of 20 non-depressed OCD patients, fulfilling DSM-R-III criteria, treated
with paroxetine, of whom 18 were responders to
treatment. Of the treatment responders, 94.4% were predicted by subtype
membership to be SSRI responsers. In these subjects
there was a strong relative alpha baseline activity; after successful treatment
through at least 3 months this activity decreased, looking more normal. The
group average topographic maps showed none of the characteristics seen in the nonresponder cluster (no excess relative power in theta). As
in the previous investigation, baseline QEEG profile membership points to a
predictive value with regard to therapeutic response.
Psychiatry Research
Volume 118, Issue 2 ,
Neurosteroid secretion
in panic disorder
Francesca Brambilla, , a,
Giovanni Biggiob, Maria Giuseppina
Pisub, Laura Bellodia, Giampaolo Pernaa, Vesna Bogdanovich-Djukica, Robert
H. Purdyc and Mariangela Serrab
Evidence
that neurosteroids have anxiolytic
effects in animal models of anxiety has suggested that alterations of neurosteroid secretion might be implicated in the pathogenetic mechanisms of anxiety disorders in humans. In
25 female patients with panic disorder (PD) and 11 healthy female controls, we
measured plasma concentrations of progesterone (PROG), pregnenolone
(PREG), allopregnanolone (3,5-tetrahydroprogesterone=3,5-THPROG),
dehydroepiandrosterone (DHEA) and tetrahydrodeoxycorticosterone
(3,5-THDOC) during a drug-free month and during the following month of paroxetine therapy. The neurosteroids
were measured during the early follicular phase, the mid-luteal
phase and the premenstrual phase of both months (days 7, 22 and 27 from the
beginning of the cycle). Significantly higher levels in patients than controls
were found in PROG during the mid-luteal phase of
both months, PREG in the premenstrual phase in the drug-free month, 3,5-THPROG during the follicular phase of the drug-free month
and during the premenstrual phase of the therapy month, and 3,5-THDOC during
the premenstrual phases of both months. DHEA levels did not differ in patients
and controls. These results suggest that neurosteroids
in PD are hypersecreted, possibly as an attempt to
counteract the anxiogenic underlying hyperactivity of
the hypothalamo-pituitary-adrenal axis and to improve
a reduced GABAA receptor sensitivity.
Journal of Behavior Therapy and Experimental Psychiatry
Volume 34, Issue 2 , June 2003,
Pages 129-140
Copyright © 2003 Elsevier Science Ltd. All rights
reserved.
Treatment of panic disorder via the Internet: a
randomized trial of CBT vs. applied relaxation
Per Carlbring, Lisa Ekselius and Gerhard Andersson,
A
randomized trial was conducted of two different self-help programs for panic
disorder (PD) on the Internet. After confirming the PD-diagnosis with an
in-person structured clinical interview for DSM-IV (SCID) interview 22
participants were randomized to either applied relaxation (AR) or a multimodal
treatment package based on cognitive behavioral therapy (CBT). Overall, the
results suggest that Internet-administered self-help plus minimal therapist
contact via e-mail has a significant medium to large effect (Cohen's d=0.71 for
AR and d=0.42 for CBT). The results from this study generally provide
evidence to support the continued use and development of Internet-distributed
self-help programs.
Biol Psychiatry. 2003 Oct 1;54(7):751-6.
Brain activation by disgust-inducing
pictures in obsessive-compulsive disorder.
Shapira NA, Liu Y, He AG,
Bradley MM, Lessig MC, James GA, Stein DJ, Lang PJ,
Goodman WK.
Department of Psychiatry,
BACKGROUND:
There is growing interest in the role of disgust in the pathogenesis of
obsessive-compulsive disorder (OCD). METHODS: Eight OCD subjects with
contamination preoccupations and eight gender- and age-matched healthy
volunteers viewed pictures from the International Affective Picture System
during functional magnetic resonance imaging scans. RESULTS: A different
distribution of brain activations was found during disgust-inducing visual
stimulation in several areas, most notably the insula,
compared with neutral stimulation in both OCD subjects and healthy volunteers.
Furthermore, whereas activation during the threat-inducing task in OCD subjects
showed a pattern similar to that in healthy volunteers, the pattern of
activation during the disgust-inducing task was significantly different,
including greater increases in the right insula, parahippocampal region, and inferior frontal sites.
CONCLUSIONS: This pilot study supports the relevance of disgust in the neurocircuitry of OCD with contamination-preoccupation
symptoms; future studies looking at non-OCD individuals with high disgust
ratings, non-contamination-preoccupied OCD individuals, and individuals with
other anxiety disorders are needed.
Psychiatry Res. 2003 Oct 15;120(3):265-71.
Reduced response-inhibition in obsessive-compulsive
disorder measured with topographic evoked potential mapping.
Herrmann MJ, Jacob C, Unterecker
S, Fallgatter AJ.
Recent neuroimaging studies have suggested that a hyperactivity of
the frontal-striate neuronal circuits, including the orbitofrontal
cortex and the basal ganglia, mediates the symptomatology
of obsessive-compulsive disorder (OCD). However, there is also some evidence
that the superior frontal cortex is less activated in OCD, and this local hypoactivity has been shown to be negatively associated
with the symptomatology. As the superior frontal
cortex is believed to be involved in inhibitory control, this study
investigated the brain electrical activity during response inhibition in OCD.
Twelve patients with OCD and 12 healthy controls performed a cued Go-NoGo task (continuous performance test), while
event-related potentials were registered with 21 electrodes. Patients reacted
significantly faster than controls, but did not differ from controls regarding
the error rate. As a main result, we found a reduced frontal activity during
the NoGo condition in OCD, which was condensed in a
reduced anteriorisation of the brain electrical
field. We suggest that this inhibitory deficit in OCD has a major contribution
to the pathophysiology of OCD, which is underscored
by the fact that the anteriorisation during the NoGo condition (NGA) was negatively correlated with the symptomatology as measured by the Yale-Brown Obsessive-Compulsive
Scale.
Journal of Anxiety Disorders
Article in Press, Corrected Proof - Note to users
Symptom subtypes of obsessive-compulsive disorder and
their relation to dissociation
David Watson, , Kevin D. Wu and
Cynthia Cutshall
Department of Psychology,
We
examined relations between obsessive-compulsive disorder (OCD) symptoms and
dissociation in three studies. Studies 1 and 2 established a strong level of
convergence between our two OCD symptom measures. Specific types of symptoms
showed a clear convergent/discriminant pattern,
indicating that they can be meaningfully distinguished from one another. In
both studies, dissociation correlated more strongly with checking and obsessive
intrusions than with cleaning, ordering, and hoarding. Moreover, these
associations remained substantial even after controlling for neuroticism (Study
1) and other types of anxiety (Study 2). In Study 3, we replicated our key
findings in a psychiatric outpatient sample, indicating that they are generalizable to clinical participants. Taken together,
our results (a) establish a strong link between dissociation and OCD, and (b)
illustrate the importance of analyzing different types of OCD symptoms separately.
J Neuropsychiatry Clin Neurosci 15:371-374, August 2003
Obsessive-Compulsive Symptoms, Obsessive-Compulsive
Disorder, and Related Disorders in Parkinson's Disease
Alex F. Maia, M.D., Adriana S.
Pinto, M.D., Egberto R. Barbosa,
M.D., Ph.D., Paulo R. Menezes, M.D., Ph.D. and Euripedes C. Miguel, M.D., Ph.D.
Ecmiguel@usp.br
This
study evaluated the frequency of obsessive-compulsive disorder (OCD),
obsessive-compulsive symptoms (OCS), and related disorders (e.g., tic
disorders, trichotillomania, and body dysmorphic disorder) in 100 patients with Parkinson's
disease (PD) and 100 individually matched controls. When compared with
controls, OCD, OCS, and related disorders were not higher in PD. Findings
revealed an association of some OCS with left side motor symptom predominance
in PD patients, particularly for symmetry and ordering/arranging. These
findings suggest that the right hemisphere likely functions in the expression
of OCS.
NeuroImage
In Press, Corrected Proof ,
Available online
Spatial working memory deficits in obsessive compulsive
disorder are associated with excessive engagement of the medial frontal cortex
Nic J. A. van der Weea, 1, Nick F. Ramsey, , a, Johan M. Jansmaa, Damiaan A. Denysa, Harold J. G.
M. van Megena, Herman M. G. Westenberga
and René S. Kahna
Recent
studies have shown that obsessive compulsive disorder (OCD) is associated with
a specific deficit in spatial working memory, especially when task difficulty
(i.e., working memory load) is high. It is not clear whether this deficit is
associated with dysfunction of the brain system that subserves
spatial working memory, or whether it is associated with a more generalized
effect on executive functions. In contrast to studies in healthy volunteers and
schizophrenia, spatial working memory in OCD has not been investigated before
using functional neuroimaging techniques. We
conducted a functional MRI study in 11 treatment-free female patients with OCD
and 11 for sex-, age-, education-, and handedness pairwise-matched
healthy controls in order to assess performance on a parametric spatial n-back
task as well as the underlying neuronal substrate and its dynamics. Patients
with OCD performed poorly at the highest level of task difficulty and engaged
the same set of brain regions as the matched healthy controls. In this set,
the effect of difficulty on magnitude of brain activity was the same in
patients and in controls except for a region covering the anterior cingulate cortex. In this region activity was significantly
elevated in patients with OCD at all levels of the parametric task. These
findings do not provide evidence for a deficit of the spatial working memory
system proper, but suggest that the abnormal performance pattern may be
secondary to another aspect of executive dysfunctioning
in OCD.
GENERAL ANXIETY
Journal of Anxiety Disorders
Volume 17, Issue 6 , 2003, Pages
627-646
Structural differentiation of self-reported depression
and anxiety in late life
Suzanne Meeks, , Janet
Woodruff-Borden and Colin A. Depp
Research
has shown impressive support for tripartite models of anxiety and depression
that include a common factor of negative affect, and the unique factors
positive affect and arousal. It is not clear whether this structure extends
into later life. The current study used confirmatory factor analysis to model
the structural relationship of anxiety and depression in two samples of older
adults: a large probability sample (N=1429) and a smaller convenience sample
(N=210). Across all analyses, a correlated, two-factor,
psychometric model was most parsimonious. The tripartite model could be fit to
the data, but added no explanatory power; in some cases a one-factor model also
fit. The results suggest that there is a unitary factor of
"distress" that incorporates anxiety and depression, but that the
structure is not consistent with factor structures found in younger samples.
Instead, the broad constructs may be represented in a more complex manner among
older adults, and are less easily differentiated.
Am J Psychiatry 161:72-78,
January 2004
Left Hemisphere Dysfunction During
Verbal Dichotic Listening Tests in Patients Who Have Social Phobia With or
Without Comorbid Depressive Disorder
Gerard E. Bruder, Ph.D.,
Franklin R. Schneier, M.D., Jonathan W. Stewart,
M.D., Patrick J. McGrath, M.D., and Frederic Quitkin,
M.D.
OBJECTIVE:
Behavioral, electrophysiological, and imaging studies have found evidence that
anxiety disorders are associated with left hemisphere dysfunction or higher
than normal activation of right hemisphere regions. Few studies, however, have
examined hemispheric asymmetries of function in social phobia, and the
influence of comorbidity with depressive disorders is
unknown. The present study used dichotic listening tests to assess lateralized
cognitive processing in patients with social phobia, depression, or comorbid social phobia and depression. METHOD: The study
used a two-by-two factorial design in which one factor was social phobia
(present versus absent) and the second factor was depressive disorder (present
versus absent). A total of 125 unmedicated patients
with social phobia, depressive disorder, or comorbid
social phobia and depressive disorder and 44 healthy comparison subjects were
tested on dichotic fused-words, consonant-vowel syllable, and complex tone
tests. RESULTS: Patients with social phobia with or without a comorbid depressive disorder had a smaller left hemisphere
advantage for processing words and syllables, compared with subjects without
social phobia, whereas no difference between groups was found in the right
hemisphere advantage for processing complex tones. Depressed women had a
larger left hemisphere advantage for processing words, compared with nondepressed women, but this difference was not seen among
men. CONCLUSIONS: The results support the hypothesis that social phobia is
associated with dysfunction of left hemisphere regions mediating verbal
processing. Given the importance of verbal processes in social interactions,
this dysfunction may contribute to the stress and difficulty experienced by
patients with social phobia in social situations.
Scandinavian Journal of Psychology
Volume 45 Issue 2 Page 123 - April 2004
Effects of age and anxiety on episodic memory:
Selectivity and variability
Juan Li1,2, Lars-Göran Nilsson2 and Zhenyun Wu3
Li, J., Nilsson, L.-G. & Wu, Z. (2004). Effects of age and anxiety on episodic
memory: Selectivity and variability.
Scandinavian Journal of Psychology, 45, 123-129.
Selective
age-related differences in source memory relative to item memory, and
individual differences in memory performance in relation to anxiety were
explored with high- and low-anxious subjects screened from normal young and
elderly adults. They were read false facts about the locations of well-known
and unknown sights in a male or female voice. Intentional and incidental
learning instructions were administered for source memory. Selective
age-related deficits in source memory were observed under both encoding
conditions. Higher level of anxiety was related to lower memory performance
only in the old group; this relation was stronger in source recall. The
findings suggest that the presence of such selectivity is unrelated to the
tradeoff between item encoding and source encoding. Anxiety affects the
variability, and mediates the selectivity of age effects on episodic memory.
TREATMENT
Clinical Applications of Breathing Regulation: Beyond
Anxiety Management
Christopher Gilbert
Behavior Modification
Volume: 27 Number: 5 Page: 692 -- 709
Abstract:
Breathing training is widely used as an aid in reducing anxiety states, but several
other applications also show promise. This article reviews evidence that normalizing
breathing patterns may offer help in some cases of essential hypertension,
angina, functional chest disorder, chronic obstructive pulmonary disease
(COPD), and cardiac rehabilitation. Hyperventilation and hypo-ventilation,
inhibited breathing, and breath suspension are all deviations from an optimal
breathing pattern in which breathing volume is closely matched to metabolic
needs. Such disordered breathing has varying effects on acid/base balance,
arterial diameter, and sodium retention by the kidneys. Therefore, a chronic
breathing imbalance can contribute to pathophysiology,
which may be remediable to an extent by altering habitual breathing pattern
*******************2001**********************************************
Journal of Anxiety Disorders
Volume 15, Issues 1-2 ,
January-April 2001, Pages 1-7
Special issue on the interface of balance disorders and
anxiety: an introduction and overview
Daniel A. Sklare, Horst R. Konrad, Jack D. Maser and Rolf G. Jacob
Clinical
accounts suggesting a potential link between dizziness/vertigo, imbalance, and
anxiety have been in the medical literature from antiquity to more recent
times, yet the causal linkage for this correlative observation has not been
investigated experimentally until recently. The presence of these and related
somatic symptoms, as well as abnormal findings on tests of vestibular function
in patients with panic disorder (PD), particularly in association with
agoraphobia, has been underscored by several recent reports, (Hoffman; Jacob; Sklare and Yardley). Neuroanatomic
studies showing direct connections between the vestibular nuclei, the locus coeruleus, and brainstem pathways that process visceral
sensory information provide a potential neural substrate for the autonomic and
affective signs and symptoms often associated with both vestibular dysfunction
and anxiety disorders (see Balaban; Gorman; Gorman
and Maser). There is also a potential neurochemical/neuropharmacological
linkage between vestibular dysfunction and anxiety disorders/PD/psychiatric
illness in the domain of monoaminergic
neurotransmission (Balaban & Thayer, this issue).
The co-occurrence of spatial disorientation, impaired balance, and anxiety can
result in a distressing and disabling syndrome in the affected individual.
At the present time the Diagnostic and Statistical Manual,
4th Revision (American Psychiatric Association, 1994) recognizes this
combination by including "feeling dizzy, unsteady, lightheaded, or
faint" as one among 13 diagnostic criteria for PD. Dimensional systems of
classification, for example, Cassano's panic spectrum
diagnostic system, also recognize the clinical overlap of balance symptoms and
anxiety (Cassano, Michelini,
et al., 1997). In Cassano's panic spectrum diagnostic
instrument there are questions related to balance and panic that tap into this
somatic/phenomenological symptom. The standardized clinical interview for panic
agoraphobia asks: "Does it sometimes feel as if your legs are made of
rubber?," "Does it sometimes feel as if you
were walking on velvet?," and "Are you fearful that you will suddenly
lose your balance?" (Cassano
and Cassano). Not all PD patients answer these
questions affirmatively and not all panic patients experience dizziness,
spatial disorientation, and/or imbalance. However, a subgroup of PD patients do
answer affirmatively and are very likely to have vestibular dysfunction
(Yardley and Yardley), particularly if these symptoms
occur between, rather than during, panic attacks (Jacob, Furman, Durrant, & Turner, 1996).
What remains to be discovered is whether or not some
balance disorders and some anxiety disorders have a common pathophysiology
in the central nervous system or is the observed comorbidity merely the chance co-occurence
of two quite separate disorders? Approaches to answering this question are
varied, but they can certainly begin with epidemiology.
In a large survey of working-age adults in the
The experience of space and motion discomfort followed by
phobic avoidance has been suggested as the thematic link between these
conditions (Jacob; Jacob and Jacob). Patients who become anxious about the
possibility of increases in dizziness or attacks of panic will tend to avoid
relevant physical activities and situations in which such consequences may be
embarrassing or dangerous. In the case of patients with balance disorders, this
avoidance response is a protective behavioral strategy that prevents exposure
to environmental stimuli (e.g., a flowing river, fog, escalators, or parapets)
that present a danger of falling or spatial disorientation. Indeed, such
avoidance behaviors were recommended to vertiginous patients by a 16th century
practitioner: "suche men havynge
this passion let them beware of clymnge or goynge up upon highe hylles or round stayres" (Borde, 1971). However, the avoidance of such movements and
environments deprive the balance system of the sensory and motor experiences
necessary for recovery following a vestibular disorder. Avoidance also deprives
the anxious individual of extinction situations and of the opportunity to
desensitize to provocative conditions.
During the last two decades, physical rehabilitation has
been shown to be effective in reducing the symptoms and improving the function
of patients with balance disorders. Rehabilitation works by utilizing normal
behavioral mechanisms such as adaptation, substitution, and relearning. In
order to accomplish these goals, exercises are aimed at the specific injuries
or deficits. These exercises require movements of the head, body, and the eyes
eliciting symptoms similar to those associated with the patient's disorder.
These symptoms are unpleasant and may produce anxiety and phobic reactions that
are observed in many of these patients. It is not surprising that these
patients are reluctant to do their exercises and that the level of anxiety in
patients with balance disorders is the highest negatively correlated finding
for predicting success from therapy (Yardley, 1994). On the other hand, anxiety
symptoms associated with dizziness and vertigo respond
to vestibular rehabilitation (Yardley, Beech, Zander,
Evans, & Weinman, 1998). Furthermore, some
patients with anxiety disorders develop symptoms of imbalance/disequilibrium
and disorientation as part of their anxiety reaction. We suspect that neither
of these patient groups respond well to treating one
component of their disorder complex/syndrome (balance or anxiety) without also
treating the other.
This special issue, comprising eight papers, will
highlight findings and ideas emerging from the first dedicated forum we are
aware of for discussion of the interface of balance disorders and anxiety. The
Workshop on the Interface of Balance Disorders and Anxiety: An Integrated View,
jointly sponsored by the National Institute on Deafness and Other Communication
Disorders, the National Institute of Mental Health, and the Office of Rare
Diseases of the National Institutes of Health, was held in the
The workshop participants determined that several areas
were ripe for further investigation. A discussion of some of these areas
follows:
1. It emerged from discussions at the workshop that there
are different levels of interaction between balance/vestibular disorders and
anxiety disorders across clinical patients An accurate and meaningful
classification system for disorders of balance and spatial orientation and
their associated psychiatric symptoms is necessary for the timely, accurate
diagnosis, and efficacious treatment of patients with dizziness and anxiety.
2. Research is needed to develop and validate treatment
plans incorporating the physical positioning maneuvers and sensory retraining
components of balance/vestibular rehabilitation with behavioral and
behavioral–cognitive therapy approaches employed in the treatment of PD and
other anxiety disorders.
3. The pathogenesis and pathophysiology
of anxiety/balance disorders may reflect linkages at different levels of the neuraxis. Each of these potential linkages needs to be
investigated.
The eight papers in this special issue of the Journal of
Anxiety Disorders are organized thematically according to the following plan:
Drs. Furman and Jacob present a clinical taxonomy for the
interface of dizziness and anxiety based on a model of the levels of linkage of
these domains. To the degree that anxiety disorder patients share symptomatology with balance disorder patients, clinicians
treating either set of disorders need to be aware of the taxonomy developed by
both disciplines. With this knowledge too, a taxonomy common to and acceptable
by both disciplines can emerge, as might be the case with "psychiatric
dizziness" that can be observed clinically in abasia
during somatoform disorders (in which the vestibular system is not
dysfunctional), depression, and panic attacks.
Balaban and Jacob provide a
scholarly review of historical background for the interface of balance
disorders and anxiety, which, some may be surprised to learn, began in
antiquity. In the middle to late 19th century, agoraphobia was seen by some
authorities as one aspect of a vertiginous state, while modern views of
abnormal behavior see vertigo as one aspect (symptom) of panic agoraphobia.
Students of anxiety disorders should find the historical review of balance
disorders as an outstanding scholarly contribution to the balance–anxiety
disorder linkage. The discussion of the relationship between the vestibular and
visual systems and fear brings to mind eye movement desensitization and reprocessing
as a controversial, but possible, treatment for posttraumatic stress disorder,
another anxiety disorder (Levin, Lazrove, & van der Kolk, 1999).
Balaban and Thayer then review
neurological linkage models for (1) fear and anxiety, (2) emotion, (3) autonomic
control, and (4) vestibular information processing. These models share common
pathways in the brain and could be a reasonable neurological underpinning for
those anxiety disorder patients who have balance problems as a prominent
symptom. Conversely, the intimate linkage between these pathways may provide a
neurological basis for balance disorder patients who report an anxiety disorder
as a prominent symptom. Critical areas of overlap include: the parabrachial nucleus, locus coeruleus,
and serotonergic pathways. It is proposed that
information processing in these structures may mediate the comorbidity
of balance disorders and anxiety.
Redfern et al. discuss the
visual influences on the balance and orientation in patients with vestibular
disorders and in patients with anxiety disorders who
also suffer from space and motion discomfort. Both patient groups show
increased reliance on vision for balance and increased postural sway when
confronted with conflicting perceptions of their visual environments. This
visual dependence of balance control is a primary feature of space and motion
discomfort (Furman & Jacob, 2001). In fact, the phenomena of visual
dependence and visual provocation of space and motion discomfort are a
recurrent theme in the history of the balance–anxiety interface (Balaban & Jacob, 2001).
Clark and Swartz's paper provides a
taxonomy of these disorders from a phenomenological, clinical
perspective. Patients with balance disorders face psychiatric problems similar
to individuals with pain and other disabilities (i.e., stress, anxiety
depression). Issues that are more prominent with this group are social anxiety
and depression related to the loss of life goals.
There are three papers that are focused on treatment.
Yardley and Redfern review the psychosomatic factors,
including habituation, arousal level, and attention, that might affect recovery
from balance disorders. When the vestibular system is damaged, the individual
must, consciously or unconsciously, change his or her perceptual–motor strategy
and compensate for the dysfunctional organ. How this multifaceted compensation
is accomplished is the subject of Yardley and Redfern's
paper. The focus is on rehabilitating the balance system, but the processes
that are manipulated are clearly psychological. Even standard physical therapy
regimens, whose goals are balance retraining, include teaching the patient that
s/he can cope behaviorally. Attention, anxiety, motor control, and motor
activity are all involved. Beidel and Horak compare behavioral treatment for patients with
anxiety disorders and vestibular rehabilitation for balance-disordered
patients. They underscore the remarkable similarities between vestibular
rehabilitation and behavior therapy for PD. Finally, Jacob et al. report
preliminary results on the effects of providing both behavioral therapy and
vestibular rehabilitation to vestibular-impaired PD/agoraphobic patients. As
the patients switched back and forth from behavior therapy to vestibular
rehabilitation, there was progressive improvement. The data are also
informative concerning the concepts of agoraphobic etiology,
since the results support the notion that vestibular dysfunction can maintain
agoraphobic symptoms.
It is the hope of the organizers of the workshop that this
special issue, highlighting the areas of overlap of balance disorders and
anxiety disorders, will provide the impetus for systematic and collaborative
investigations of the relationships between these two clinical domains that
translate into improved interventions for affected patients.
SOMATIZATION AND STRESS
Stress and Health
Volume 19, Issue 4 , Pages 195 -
204
Job stress, personality, and psychological distress as
determinants of somatization and functional somatic
syndromes in a population of nurses
Véronique De Gucht,
Benjamin Fischler, Willem Heiser
(degucht@fsw.leidenuniv.nl)
The
objective of the present study was to examine the respective contribution of
job stress dimensions (work demands, job control, and social support at work),
personality traits (neuroticism and alexithymia), and
psychological distress (anxiety and depression) to somatization
in a population of nurses. Therefore, a number of logistic regression analyses
were conducted, with the presence versus absence of three functional somatic
syndromes (functional dyspepsia (FD), irritable bowel syndrome (IBS), and
idiopathic chronic fatigue (CF) and current somatization,
defined as the presence of at least two medically unexplained symptoms (median
number of symptoms for the sample) and four medically unexplained symptoms
(highest quartile for the sample) during the past month, as the outcome
variables. The results pointed out that job stress dimensions significantly
and independently contributed to IBS (job control) and CF (work demands). The
personality trait neuroticism was a significant predictor of both current somatization and functional somatic syndromes, whereas alexithymia primarily predicted the presence of more severe
and/or more enduring forms of somatization. Finally,
three out of five outcome variables were predicted by psychological distress.
Future studies should examine (a) to what extent distinct patterns of
associations can be found between specific job stress dimensions on the one
hand, and specific functional somatic syndromes on the other and (b) the
potential interaction between job stress and personality dimensions in
determining somatization