Dorsolateral Prefrontal Cortex Activation During Emotional Anticipation and Neuropsychological Performance in Posttraumatic Stress Disorder

Dorsolateral Prefrontal Cortex Activation During Emotional Anticipation and Neuropsychological Performance in Posttraumatic Stress Disorder

 Archives of General Psychiatry 2012 69 (4) pp, 360-371.

Robin L. Aupperle; Carolyn B. Allard; Erin M. Grimes; Alan N. Simmons; Taru Flagan; Michelle Behrooznia; Shadha H. Cissell; Elizabeth W. Twamley; Steven R. Thorp; Sonya B. Norman; Martin P. Paulus; Murray B. Stein.

Abstract 

Context Posttraumatic stress disorder (PTSD) has been associated with executive or attentional dysfunction and problems in emotion processing. However, it is unclear whether these two domains of dysfunction are related to common or distinct neurophysiological substrates.

Objective To examine the hypothesis that greater neuropsychological impairment in PTSD relates to greater disruption in prefrontal-subcortical networks during emotional anticipation.

Design Case-control, cross-sectional study.

Setting General community and hospital and community psychiatric clinics.

Participants Volunteer sample of 37 women with PTSD related to intimate partner violence and 34 age-comparable healthy control women.

Main Outcome Measures We used functional magnetic resonance imaging (fMRI) to examine neural responses during anticipation of negative and positive emotional images. The Clinician-Administered PTSD Scale was used to characterize PTSD symptom severity. The Wechsler Adult Intelligence Scale, Third Edition, Digit Symbol Test, Delis-Kaplan Executive Function System Color-Word Interference Test, and Wisconsin Card Sorting Test were used to characterize neuropsychological performance.

Results Women with PTSD performed worse on complex visuomotor processing speed (Digit Symbol Test) and executive function (Color-Word Interference Inhibition/Switching subtest) measures compared with control subjects. Posttraumatic stress disorder was associated with greater anterior insula and attenuated lateral prefrontal cortex (PFC) activation during emotional anticipation. Greater dorsolateral PFC activation (anticipation of negative images minus anticipation of positive images) was associated with lower PTSD symptom severity and better visuomotor processing speed and executive functioning. Greater medial PFC and amygdala activation related to slower visuomotor processing speed.

Conclusions During emotional anticipation, women with PTSD show exaggerated activation in the anterior insula, a region important for monitoring internal bodily state. Greater dorsolateral PFC response in PTSD patients during emotional anticipation may reflect engagement of cognitive control networks that are beneficial for emotional and cognitive functioning. Novel treatments could be aimed at strengthening the balance between cognitive control (dorsolateral PFC) and affective processing (medial PFC and amygdala) networks to improve overall functioning for PTSD patients.

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Innovations in Practice: Preliminary evidence for effective family engagement in treatment for child traumatic stress–trauma systems therapy approach to preventing dropout

Innovations in Practice: Preliminary evidence for effective family engagement in treatment for child traumatic stress–trauma systems therapy approach to preventing dropout, Child and Adolescent Mental Health, 2012, 17 (1) pp. 58–61

Saxe, G. N., Heidi Ellis, B., Fogler, J. and Navalta, C. P.

Abstract:

Background:  This study aimed to obtain preliminary evidence for the extent to which a novel intervention embedded within a systems-oriented treatment model [trauma systems therapy (TST)] engages and retains traumatized children and their families in treatment.

Method:  Twenty youth who had prominent symptoms of posttraumatic stress were randomly assigned to receive TST or care as usual (CAU).

Results:  At the 3-month assessment, 90% of TST participants were still in treatment, whereas only 10% of CAU participants remained. Within-group analyses of TST participants demonstrated significant reductions in posttraumatic stress and aggression as well as a slight improvement in home safety.

Conclusions:  These preliminary findings point to the need to utilize effective engagement approaches to retain traumatized children and their families in treatment.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Veterans – Combat stressors and post-traumatic stress in deployed military healthcare professionals: an integrative review

Combat stressors and post-traumatic stress in deployed military healthcare professionals: an integrative review , Journal of Advanced Nursing, 2012, 68(1), pp. 3–21

Susanne W. Gibbons et al.

Abstract:

 

Background.  While there has been a growing body of literature on the impact of combat stressors and post-traumatic stress on military service members involved in current conflicts, there has been little available information that directly examines the impact of these on healthcare providers.

 

Aims.  Aims for this integrative review included: (1) identifying exposures, experiences and other factors influencing stress responses in military healthcare providers previously engaged in a war effort and (2) describing the incidence of post-traumatic stress and related mental health problems in this population.

 

Review Methods.  Using Cooper’s integrative review method, relevant documents were collected and analysed using content categories and a coding scheme to assist with identifying and recording data for units of analysis.

 

Data Sources.  Literature searches (including all years to present) were conducted using keywords for stress reaction, for healthcare provider and for military war effort involvement. Literature was obtained using the Cumulative Index to Nursing and Allied Health Literature, the National Library of Medicine and the American Psychological Association databases.

 

Results.  Evidence suggests that similar to military combatants, military healthcare provider exposure to life-threatening situations will increase the probability of adverse psychological disorders following these traumatic experiences. The presence of a strong sense of meaning and purpose, within a supportive environment appear to help mediate the impact of these dangerous and stressful events.

 

Conclusion.  Results of this review and other supporting literature indicate the need for a systematic approach to studying combat stress and post-traumatic stress in deployed healthcare providers.

 

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Veterans – The stigma of mental health problems and other barriers to care in the UK Armed Forces

The stigma of mental health problems and other barriers to care in the UK Armed Forces, BMC Health Services Research, 2011, 11:31, pp. 1-10

Iversen AC, van Staden L, Hughes JH, Greenberg N, Hotopf M, Rona RJ, Thornicroft G, Wessely S, Fear

King’s Centre for Military Health Research, King’s College London, Weston Education Centre, Cutcombe Road, London SE5 9RJ, UK

Abstract:

BACKGROUND:

As with the general population, a proportion of military personnel with mental health problems do not seek help. As the military is a profession at high risk of occupational psychiatric injury, understanding barriers to help-seeking is a priority.

METHOD:

Participants were drawn from a large UK military health study. Participants undertook a telephone interview including the Patient Health Questionnaire (PHQ); a short measure of PTSD (Primary Care PTSD, PC-PTSD); a series of questions about service utilisation; and barriers to care. The response rate was 76% (821 participants).

RESULTS:

The most common barriers to care reported are those relating to the anticipated public stigma associated with consulting for a mental health problem. In addition, participants reported barriers in the practicalities of consulting such as scheduling an appointment and having time off for treatment. Barriers to care did not appear to be diminished after people leave the Armed Forces. Veterans report additional barriers to care of not knowing where to find help and a concern that their employer would blame them for their problems. Those with mental health problems, such as PTSD, report significantly more barriers to care than those who do not have a diagnosis of a mental disorder.

CONCLUSIONS:

Despite recent efforts to de-stigmatise mental disorders in the military, anticipated stigma and practical barriers to consulting stand in the way of access to care for some Service personnel. Further interventions to reduce stigma and ensuring that Service personnel have access to high quality confidential assessment and treatment remain priorities for the UK Armed Forces.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Veterans – Stigma, help-seeking attitudes, and use of psychotherapy in veterans with diagnoses of posttraumatic stress disorder

Stigma, help-seeking attitudes, and use of psychotherapy in veterans with diagnoses of posttraumatic stress disorder, Journal of Nervous and Mental Disorder, 2011, 199(11)pp. 879-85

Rosen CS, Greenbaum MA, Fitt JE, Laffaye C, Norris VA, Kimerling R

National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, CA 94025, USA

Abstract:

 

Survey and medical record data from 482 Veterans Affairs (VA) patients who recently received diagnoses of posttraumatic stress disorder (PTSD) were examined to determine need and predisposing factors associated with utilization of psychotherapy and counseling. More than half (58%) of participants initiated VA psychotherapy for PTSD within a year of diagnosis. Of those, one third completed eight or more sessions. Roughly two thirds of participants initiated counseling at a Vet Center. Initiating PTSD psychotherapy was associated with greater impairment but not with stigma, concerns about fitting in, or satisfaction with care. The use of Vet Center counseling was associated with desire for help, concerns about fitting in, and satisfaction with care. Unexpectedly, veterans with greater stigma concerns completed more psychotherapy visits and Vet Center counseling. Negative attitudes about mental health treatment did not seem to be substantial barriers to engaging in psychotherapy among these VA patients. Future research should consider enabling treatment system factors in addition to predisposing patient characteristics.

 

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

 

Unique Patterns of Substance Misuse Associated With PTSD, Depression, and Social Phobia

Unique Patterns of Substance Misuse Associated With PTSD, Depression, and Social Phobia,  Journal of Dual Diagnosis, Volume 6, Issue 2, 2010, pgs 94-110

Meghan E. McDevitt-Murphy

Most Read Article

Abstract:

 

This study investigated the relations between post-trauma psychopathology and substance abuse in a sample of trauma-exposed college students (N = 136) assigned to four groups based on primary diagnosis: post-traumatic stress disorder (PTSD), depression, social phobia, or well-adjusted (participants who had low levels of distress). Groups were compared on a series of dimensions of substance use/abuse. Participants in the PTSD group evidenced greater substance use and abuse than those in the social phobia and well-adjusted groups on several dimensions and greater alcohol consumption than the depressed group. Correlation analyses suggested that most dimensions of substance abuse were related more strongly to avoidance and numbing (cluster C) symptoms than to re-experiencing and hyperarousal. The present findings suggest that trauma-related psychopathology may be associated with a more hazardous pattern of substance use than depression and social phobia.

 

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk