Early treatment for post-traumatic stress disorder accelerates recovery, but does not sustain it
April 12, 2016
Science Daily/NYU Langone Medical Center
The majority of people with post-traumatic stress disorder (PTSD) recover after early treatment -- but a substantial number still suffer for years after a traumatic event even with early clinical interventions, according to a study.
Over a 12-week period, researchers looked at several groups of non-military individuals suffering from PTSD (a total study cohort of 232 individuals) after a single traumatic event. All participants received either prolonged exposure therapy; cognitive therapy; treatment with selective serotonin reuptake inhibitors (SSRIs); or a placebo pill one month after the traumatic event. They also followed individuals who declined treatment. All were reassessed at five months and at 36 months.
While the groups receiving prolonged exposure and cognitive therapy showed a significant reduction of symptoms by five months (61% better than the other groups), and their symptoms remained low for three years, the other groups, including those who declined treatment, reached the same level of low symptoms by three years. In that sense, early-prolonged exposure and cognitive therapy significantly shortened the time to recovery, but did not reduce a three-year prevalence of PTSD.
"We assume that people living in an otherwise stable environment would have better conditions for long-term recovery than individuals who experience lengthy wars or live in a constant state of violence," says Arieh Y. Shalev, MD, the Barbara Wilson Professor in the Department of Psychiatry at NYU Langone Medical Center, and a co-director of NYU Langone's Steven and Alexandra Cohen Veterans Center. "This might explain part of their spontaneous recovery without initial treatment. However, what this study tells us at its core is that there is a significant public health challenge ahead. Individuals continually expressing initial PTSD symptoms, and who are resistant to early treatment, should be the focus of future research," Dr. Shalev adds. "They are the ones who remain chronically distressed and disabled, and require care long after their traumatic incident. We need to find ways to identify these subjects, increase the early favorable responses to existing treatment, and find new ways to reduce the long-term burden of PTSD."
This study continues the work of Dr. Shalev and colleagues who developed a computational tool that can identify individuals at high-risk for PTSD. In a study published last year in BMC Psychiatry, those at high-risk for PTSD could be identified in less than two weeks after they are first seen in an emergency room following a traumatic event.
Approximately eight million Americans (civilian and military populations) will experience PTSD in a given year, according to the U.S. Department of Veterans Affairs' National Center for PTSD. Trauma is also very common in women; five out of ten women will experience a traumatic event at some point during their lifetime.
https://www.sciencedaily.com/releases/2016/04/160412135326.htm
Posttraumatic stress disorder reveals an imbalance between signalling systems in the brain
December 1, 2015
Science Daily/Uppsala University
Experiencing a traumatic event can cause life-long anxiety problems, called posttraumatic stress disorder. Researchers now show that people with posttraumatic stress disorder have an imbalance between two neurochemical systems in the brain, serotonin and substance P. The greater the imbalance, the more serious the symptoms patients have.
Many people experience traumatic events in life, e.g. robbery, warfare, a serious accident or sexual assault. Approximately 10 percent of people subjected to trauma suffer long-lasting symptoms in the form of disturbing flashbacks, insomnia, hyperarousal and anxiety. If these problems lead to impairment, the person is said to suffer from posttraumatic stress disorder, PTSD.
It has previously been shown that people with PTSD have altered brain anatomy and function. A new study by researchers from the Department of Psychology at Uppsala University and Clinical Neuroscience at Karolinska Institutet shows that people with PTSD have an imbalance between two neurochemical signalling systems of the brain, serotonin and substance P. Professors Mats Fredrikson and Tomas Furmark led the study using a so-called PET scanner to measure the relationship between these systems.
The study, which has been published in the scientific journal Molecular Psychiatry, shows that it is the imbalance between the two signalling systems which determines the severity of the symptoms suffered by the individual rather than the degree of change in a single system. Others have previously speculated that the biological basis of psychiatric disorders such as PTSD includes a shift in the balance between different signalling systems in the brain but none has yet proved it. The results of the study are a great leap forward in our understanding of PTSD. It will contribute new knowledge which can be used to design improved treatments for traumatised individuals.
"At present, PTSD is often treated with selective serotonin re-uptake inhibitors (SSRIs) which have a direct effect on the serotonin system. SSRI drugs provide relief for many but do not help everybody. Restoring the balance between the serotonin and substance P systems could become a new treatment strategy for individuals suffering from traumatic incidents," says lead author Andreas Frick, researcher at the Department of Psychology, Uppsala University.
http://www.sciencedaily.com/releases/2015/12/151201093515.htm