New insights into the circuitry of PTSD, mild traumatic brain injury

July 23, 2015

Science Daily/Elsevier

Posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) can have devastating consequences. Both are associated with high rates of disability and suicide, and although they are separate conditions, they commonly co-occur. For example, a soldier who has developed PTSD as a result of a traumatic experience may have also sustained a brain injury during that experience.

Significant research has been conducted to understand the brain mechanisms underlying PTSD and TBI, but there has still been a lack of knowledge regarding exactly which brain networks are disturbed in these disorders.

To fill this gap, Dr. Jeffrey Spielberg and his colleagues at the VA Boston Healthcare System examined brain networks in veterans with trauma exposure using functional magnetic resonance imaging and graph theory tools. As the authors explain, graph theory is a sophisticated analysis that allows us to understand brain networks at a level of complexity that was previously impossible. It permits examination of the patterns of brain connections, as opposed to examining individual connections.

The researchers recruited 208 veterans of Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn, all of whom had experienced a traumatic event. They found that veterans who had more severe PTSD re-experiencing symptoms (e.g., flashbacks or reliving the event) showed weaker connectivity in two networks.

The first altered network includes the hippocampus and prefrontal cortex, and is involved in providing contextual information. This suggests that perhaps the hippocampus may be overgeneralizing trauma-related memories, and therefore, fails to correctly classify non-threatening cues as "safe."

The second network, which was identified only in veterans with comorbid mild TBI, includes the basal ganglia and prefrontal cortex, and plays a role in working memory.

Because the veterans studied here had already experienced a traumatic event, this research cannot identify with certainty whether the observed brain network disturbances were present in these individuals before the trauma occurred, or whether they occurred as a result of the trauma exposure. Future research of at-risk individuals, perhaps examining soldiers before and after military deployment, will be necessary to clarify this point.

"It may never be possible to fully distinguish the role of the severity of stress, the capacity for resilience to stress effects, and the presence of mild TBI in PTSD-related distress and disability because these factors are so complex and intimately entwined," said Dr. John Krystal, Editor of Biological Psychiatry.

"However, this study suggests that there are subtle but important differences in brain circuit functional connectivity related to the impact of traumatic stress among individuals with and without TBI. These data provide additional evidence that TBI may complicate the capacity for recovery from traumatic stress-related symptoms."

http://www.sciencedaily.com/releases/2015/07/150723101002.htm

Pregnancy and PTSD: Surprising findings could help moms-to-be at risk

Symptoms ease during pregnancy for many -- but some face high risk of issues that can affect them and their baby

February 10, 2016

Science Daily/University of Michigan Health System

For most women, expecting a baby brings intense joy -- and a fair amount of worry. But what about women who have lived through something awful enough to cause post-traumatic stress disorder? Contrary to what researchers expected, a new study shows that pregnancy may actually reduce their PTSD symptoms. Or at the least, it won't cause a flare-up.

But what about women who have lived through something awful enough to cause post-traumatic stress disorder?

Contrary to what researchers expected, a new study shows that pregnancy may actually reduce their PTSD symptoms. Or at the least, it won't cause a flare-up.

The news isn't all good, though.

For about one in four women with PTSD, the opposite is true, the researchers find. Not only do their symptoms get worse as their pregnancy goes on, but their ability to bond with their newborn suffers, and they face a high risk of post-partum depression.

The findings, made by a University of Michigan Medical School and School of Nursing team, highlight the need to screen pregnant women for possible undiagnosed PTSD.

The study, published in the journal Depression and Anxiety, is the first to track symptoms in women with PTSD through pregnancy and after giving birth.

Past PTSD doesn't mean problems in pregnancy

More than half of the 319 women in the study had high PTSD symptoms in the first part of pregnancy -- and all members of this group experienced a decrease as they got closer to giving birth. Women who had low levels of symptoms early on stayed about the same.

But for some, PTSD got worse as pregnancy went on. Those who suffered a new stress or trauma during pregnancy, or who had the most anxiety about giving birth, had the worst experience with PTSD symptoms during pregnancy, and post-birth problems.

"We hope our results give a message of hope that women who have a past diagnosis of PTSD aren't all headed for a worsening while they're pregnant," says Maria Muzik, M.D., M.S., the U-M psychiatrist who led the study. "But we also have highlighted a vulnerable group that has a heightened risk of worsening symptom and postnatal issues that could have lasting effects for both mother and child."

Many women at risk of undiagnosed PTSD

Muzik notes that PTSD can be caused by many things -- such as combat, car crashes, being robbed or raped, living through a natural disaster or house fire, or being the victim of abuse in childhood or adulthood. With so many possible causes, many women may not have had a formal diagnosis of PTSD before their pregnancy, but may be suffering lasting effects from their trauma.

So, the researchers cast a wide net to find the women for their study. Funded by the National Institutes of Health, the original study was called the STACY Project for Stress, Trauma, Anxiety, and the Childbearing Year, and headed up by Julia Seng, PHD, CNM, FAAN, a professor in the U-M School of Nursing.

Nurses at prenatal clinics run by three academic health centers, including ones that served mostly women who rely on public insurance, invited thousands of women to participate in the larger STACY study. The new data come from the subset of women who met the formal diagnostic criteria for PTSD either at the time of their pregnancy or in their past, based on detailed interviews using standard measures.

The team interviewed the women at two points during their pregnancy, and were able to interview about half the women again in the first six weeks of motherhood.

The researchers saw four groups emerge when they looked at the results of the surveys done during pregnancy: those who started high and got either moderately or substantially better, those who started low and stayed the same, and those who started relatively low but got worse.

Women with the strongest social support networks during pregnancy appeared to be protected from the risk of worsening PTSD. That means that partners, relatives and friends can make a real difference for a pregnant woman.

Muzik heads the Women and Infants Mental Health Program in the U-M Department of Psychiatry, which serves women experiencing mood and trauma-related issues during and after pregnancy.

She hopes that the new results will encourage providers who care for pregnant women to make PTSD screening part of their regular prenatal care. "With a few questions and screening measures, they can identify women who are experiencing risk factors, and heighten their awareness for support and treatment," she says. "Preventing the worsening of symptoms could reduce their chance of post-birth illness, and protect their future child from the lasting ill effects that a mother's mental illness can have."

http://www.sciencedaily.com/releases/2016/02/160210110754.htm

Sleep Deprivation May Reduce Risk of PTSD

July 18, 2012 —

Science Daily/American Associates, Ben-Gurion University of the Negev

Sleep deprivation in the first few hours after exposure to a significantly stressful threat actually reduces the risk of Post-Traumatic Stress Disorder (PTSD), according to a study by researchers from Ben-Gurion University of the Negev (BGU) and Tel Aviv University.

The new study was published in the international scientific journal, Neuropsychopharmacology. It revealed in a series of experiments that sleep deprivation of approximately six hours immediately after exposure to a traumatic event reduces the development of post trauma-like behavioral responses. As a result, sleep deprivation the first hours after stress exposure might represent a simple, yet effective, intervention for PTSD.

"Often those close to someone exposed to a traumatic event, including medical teams, seek to relieve the distress and assume that it would be best if they could rest and "sleep on it," says Prof. Cohen. "Since memory is a significant component in the development of post-traumatic symptoms, we decided to examine the various effects of sleep deprivation immediately after exposure to trauma."

http://www.sciencedaily.com/releases/2012/07/120718131750.htm