Nightmares are common but underreported in US military personnel
Nearly one in three military personnel meet criteria for nightmare disorder
March 15, 2018
Science Daily/American Academy of Sleep Medicine
A new study shows that a high percentage of military personnel with sleep disturbances met criteria for nightmare disorder, but few of them reported nightmares as a reason for sleep evaluation. Those with nightmare disorder had an increased risk of other sleep and mental health disorders.
Results show that 31 percent of military participants had clinically significant nightmares, and trauma-related nightmares occurred in 60 percent of them. Participants who met criteria for nightmare disorder were five times more likely to have post-traumatic stress disorder (PTSD), four times more likely to have depression, three times more likely to have anxiety, and two times more likely to have insomnia. Despite their common presence, nightmares were reported as a sleep-related concern by only 3.9 percent of military personnel.
"This research provides a basis for furthering the study and knowledge of nightmares in survivors of traumatic experiences," said principal investigator Dr. Jennifer Creamer, medical director of the Sleep Medicine Center at Martin Army Medical Center in Fort Benning, Georgia. "Treatment of nightmares can lead to improvement in sleep, quality of life, and other disorders such as suicidality."
The study results are published in the March 15 issue of the Journal of Clinical Sleep Medicine.
Nightmares are vivid, realistic and disturbing dreams typically involving threats to survival or security, which often evoke emotions of anxiety, fear or terror. A nightmare disorder may occur when repeated nightmares cause distress or impairment in social or occupational functioning.
According to the authors, this was the largest study to assess clinically significant nightmares in an active duty population referred for the evaluation of sleep disorders. The study involved 493 active duty U.S. military personnel. Participants had a mean age of 38 years, and 78.5 percent were men. Participants predominantly served in the Army (45.6 percent) and Air Force (45.2 percent); 9.2 percent served in the Navy/Marines. Approximately 74 percent of them had been deployed. Those with trauma-related nightmares were more likely to have traumatic brain injury, PTSD, anxiety and depression.
Nightmares beginning within three months of a trauma are present in up to 80 percent of patients with PTSD, and these post-traumatic nightmares may persist throughout life. Post-traumatic nightmares may take the form of a realistic reliving of a traumatic event or may depict only some of its elements or emotional content.
"Nightmare disorder is highly prevalent but under-recognized in military personnel with sleep disturbances," said Creamer.
A best practice guide from the American Academy of Sleep Medicine indicates that treatment options for nightmare disorder include medications, most prominently prazosin. Several behavioral therapies also can be effective, such as image rehearsal therapy and other nightmare-focused cognitive behavioral therapy variants.
"Military personnel and health care providers require education that nightmares are not normal and there are treatments available," added Creamer.
https://www.sciencedaily.com/releases/2018/03/180315091305.htm
Scientists find heightened attention to surprise in veterans with PTSD
January 9, 2018
Science Daily/Virginia Tech
Scientists have found that people with PTSD have an increased learning response to surprising events. While most everyone reacts to surprise, people with PTSD tend to pay even more attention to the unexpected.
Fireworks on nights other than the fourth of July or New Year's Eve might be nothing more than inconsiderate neighbors, but for veterans with Post Traumatic Stress Disorder (PTSD), the shock of noise and light may trigger a deeply learned expectation of danger.
Scientists at the Virginia Tech Carilion Research Institute (VTCRI) have found that people with PTSD have an increased learning response to surprising events. While most everyone reacts to surprise, people with PTSD tend to pay even more attention to the unexpected.
The study was published this week in eLife, an open-access journal published by the Howard Hughes Medical Institute, the Max Planck Society, and the Wellcome Trust.
"Disproportionate reactions to unexpected stimuli in the environment are a core symptom of PTSD," said Pearl Chiu, an associate professor at the VTCRI and the lead author on the study. "These results point to a specific disruption in learning that helps to explain why these reactions occur."
Chiu and her team used functional MRI to scan the brains of 74 veterans, all of whom had experienced trauma while serving at least one combat tour in Afghanistan or Iraq. Some of the study participants were diagnosed with PTSD, while others were not. In the functional MRI, participants played a gambling game, in which they learned to associate certain choices with monetary gains or losses.
"Computer science and mathematics have given us new tools to understand how the brain learns. We used these tools to study whether and how learning might play a role in PTSD," said Chiu, who is also an associate professor of psychology in Virginia Tech's College of Science. "These results suggest that people with PTSD don't necessarily have a disrupted response to unexpected outcomes, rather they pay more attention to these surprises," Chiu said.
The researchers found that people with PTSD had significantly more activity in the parts of their brains associated with how much attention they paid to surprising events when the learning task threw an unexpected curve ball their way.
"Fireworks unexpectedly going off after a person has exchanged fire in the field can trigger an over-estimation of danger," said Brooks King-Casas, an associate professor at the VTCRI who co-led the study. "Particularly for individuals with PTSD, unexpected surprising events -- noise or otherwise -- could be a matter of life or death. The study shows that while everyone is affected by unexpected events, in PTSD extra attention is given to these surprises."
King-Casas is also an associate professor of psychology in Virginia Tech's College of Science and an associate professor in the Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences.
Earlier studies have connected greater attention to perceived threats and unexpected events in PTSD, but the mechanistic underpinning of this hypersensitivity to unexpected outcomes have been unclear until now.
"The work by Brown and colleagues is an important step forward to be able to differentiate the brain and behavioral processes that are affected as a consequence of post-traumatic stress," said Martin Paulus, a medical doctor and the scientific director and president of the Laureate Institute for Brain Research in Tulsa, Oklahoma. He was not involved in this study. "The finding that individuals with PTSD have difficulty appropriately allocating attention to their environment when it changes has clear implications for the development of novel behavioral interventions."
Vanessa Brown, first author on the paper and a graduate student in the department of psychology in Virginia Tech's College of Science, said that both the behavioral and neural findings show that people with PTSD pay more attention to surprise while learning.
"This disrupted learning increases with more severe PTSD," said Brown, who is conducting her dissertation research in Chiu's laboratory at the VTCRI. "Now that we understand how attention to surprise plays a role in PTSD, we may be able to refine our assessment tools or develop new interventions that target specific learning disruptions in people with PTSD or other psychiatric disorders."
https://www.sciencedaily.com/releases/2018/01/180109090251.htm
Traumatic brain injury causes intestinal damage
Two-way brain-gut interactions may worsen outcome after TBI
December 6, 2017
Science Daily/University of Maryland School of Medicine
A two-way link between traumatic brain injury and intestinal changes has been uncovered by research. These interactions may contribute to increased infections in these patients, and may also worsen chronic brain damage.
This is the first study to find that TBI in mice can trigger delayed, long-term changes in the colon and that subsequent bacterial infections in the gastrointestinal system can increase posttraumatic brain inflammation and associated tissue loss. The findings were published recently in the journal Brain, Behavior, and Immunity.
"These results indicate strong two-way interactions between the brain and the gut that may help explain the increased incidence of systemic infections after brain trauma and allow new treatment approaches," said the lead researcher, Alan Faden, MD, the David S. Brown Professor in Trauma in the Departments of Anesthesiology, Anatomy & Neurobiology, Psychiatry, Neurology, and Neurosurgery at UMSOM, and director of the UMSOM Shock, Trauma and Anesthesiology Research Center.
Researchers have known for years that TBI has significant effects on the gastrointestinal tract, but until now, scientists have not recognized that brain trauma can make the colon more permeable, potentially allowing allow harmful microbes to migrate from the intestine to other areas of the body, causing infection.. People are 12 times more likely to die from blood poisoning after TBI, which is often caused by bacteria, and 2.5 times more likely to die of a digestive system problem, compared with those without such injury.
In this study, the researchers examined mice that received an experimental TBI. They found that the intestinal wall of the colon became more permeable after trauma, changes that were sustained over the following month.
It is not clear how TBI causes these gut changes. A key factor in the process may be enteric glial cells (EGCs), a class of cells that exist in the gut. These cells are similar to brain astroglial cells, and both types of glial cells are activated after TBI. After TBI, such activation is associated with brain inflammation that contributes to delayed tissue damage in the brain. Researchers don't know whether activation of ECGs after TBI contributes to intestinal injury or is instead an attempt to compensate for the injury.
The researchers also focused on the two-way nature of the process: how gut dysfunction may worsen brain inflammation and tissue loss after TBI. They infected the mice with Citrobacter rodentium, a species of bacteria that is the rodent equivalent of E. coli, which infects humans. In mice with a TBI who were infected with this the bacteria, brain inflammation worsened. Furthermore, in the hippocampus, a key region for memory, the mice who had TBI and were then infected lost more neurons than animals without infection.
This suggests that TBI may trigger a vicious cycle, in which brain injury causes gut dysfunction, which then has the potential to worsen the original brain injury. "These results really underscore the importance of bi-directional gut-brain communication on the long-term effects of TBI," said Dr. Faden.
https://www.sciencedaily.com/releases/2017/12/171206174243.htm
Patients with post-traumatic stress disorder respond differently to certain sounds
November 30, 2017
Science Daily/University of Birmingham
A new neurobiological marker have have just been found to help recognize patients with post-traumatic stress disorder (PTSD).
Using an electroencephalogram (EEG) -- a test that detects electrical activity in a person's brain via electrodes attached to their scalp -- researchers studied the brain activity of a group of thirteen patients with PTSD. The group was then compared to a group who had suffered a similar trauma but had not gone on to develop PDST.
PTSD is estimated to affect about one in every ten people who have a traumatic experience. It can develop immediately after someone experiences a disturbing event or it can occur weeks, months or even years later and can affect a person's memory.
The type of events that can cause PTSD include serious road accidents, violent personal assaults, witnessing violent deaths, military combat, being held hostage, terrorist attacks and natural disasters.
Dr Ali Mazaheri, of the University of Birmingham's School of Psychology and Centre for Human Brain Health, said of the study published in Nature Scientific Reports: "We know that a symptom of PTSD can be heightened sensory sensitivity.
"In this study, we tested the brain's response to a simple auditory sensory change by playing simple (standard 1000Hz) tones every second, and then intermittently playing a slightly altered tone (1200 Hz), known as a deviant.
"What we found was that patients who had developed PTSD showed enhanced brain responses to deviant tones, suggesting their brain over-processed any change in the environment.
"Importantly we found the more enhanced their response was, the more poorly they performed on cognitive tests looking at memory."
Katrin Bangel, of the University of Amsterdam, said: "This is the first research study of its kind. The neurobiological evidence we now have shows how altered brain activity of a patient with PTSD is closely related to the way it processes the world.
"What's more, this study is very unique in that it compared PTSD patients with a control group of those that also suffered similar trauma but didn't develop PTSD, rather than a control group who had no trauma or PTSD -- this really allows us to look at what triggers PTSD following significant trauma.
"We now potentially have a new neurobiological marker for PTSD patients that maps to their own individual symptoms.
"This marker, if validated, could be used to assess if an individual is getting better with treatment. It can also be potentially used in diagnosing patients."
Professor Dr Miranda Olff, of the University of Amsterdam and Arq Psychotrauma Expert Group, said: "This area of research is incredibly important.
"Post-traumatic stress disorder (PTSD) is a debilitating disorder caused by very stressful, frightening or distressing events.
"Someone with PTSD often relives the traumatic event through nightmares and flashbacks, and may experience feelings of isolation, irritability and guilt.
"They may also have problems sleeping, such as insomnia, and find concentrating difficult.
"These symptoms are often severe and persistent enough to have a significant impact on the person's day-to-day life.
"Therefore it is vital that we find new ways to treat the condition and also assess treatment outcomes."
The team has now begun further research validating the marker and also plans a clinical trial to test potential treatments on patients with PTSD.
https://www.sciencedaily.com/releases/2017/11/171130093952.htm
Injury from contact sport has harmful, though temporary effect on memory
November 14, 2017
Science Daily/McMaster University
Neuroscientists studying sports-related head injuries have found that it takes less than a full concussion to cause memory loss, possibly because even mild trauma can interrupt the production of new neurons in a region of the brain responsible for memory.
Though such losses are temporary, the findings raise questions about the long-term effects of repeated injuries and the academic performance of student athletes.
The researchers spent months following dozens of athletes involved in high-contact sports such as rugby and football, and believe that concussions and repetitive impact can interrupt neurogenesis -- or the creation of new neurons -- in the hippocampus, a vulnerable region of the brain critical to memory.
The findings were presented today (Tuesday, November 14th) at the Society for Neuroscience's annual conference, Neuroscience 2017, in Washington D.C.
"Not only are newborn neurons critical for memory, but they are also involved in mood and anxiety," explains Melissa McCradden, a neuroscience postdoctoral fellow at McMaster University who conducted the work. "We believe these results may help explain why so many athletes experience difficulties with mood and anxiety in addition to memory problems."
For the study, researchers administered memory tests and assessed different types of athletes in two blocks over the course of two years. In the first block, they compared athletes who had suffered a concussion, uninjured athletes who played the same sport, same-sport athletes with musculoskeletal injuries, and healthy athletes who acted as a control group.
Concussed athletes performed worse on the memory assessment called a mnemonic similarity test (MST), which evaluates a person's ability to distinguish between images that are new, previously presented, or very similar to images previously presented.
In the second study, rugby players were given the MST before the season started, halfway through the season, and one month after their last game. Scores for injured and uninjured athletes alike dropped midseason, compared to preseason scores, but recovered by the postseason assessment.
Both concussed and non-concussed players showed a significant improvement in their performance on the test after a reprieve from their sport.
For the concussed athletes, this occurred after being medically cleared to return to full practice and competition. For the rugby players, they improved after approximately a month away from the sport.
If neurogenesis is negatively affected by concussion, researchers say, exercise could be an important tool in the recovery process, since it is known to promote the production of neurons. A growing body of new research suggests that gentle exercise which is introduced before a concussed patient is fully symptom free, is beneficial.
"The important message here is that the brain does recover from injury after a period of reprieve," says McCradden. "There is a tremendous potential for the brain to heal itself."
https://www.sciencedaily.com/releases/2017/11/171114104225.htm
Role of gut microbiome in posttraumatic stress disorder: More than a gut feeling
October 25, 2017
Science Daily/Stellenbosch University
The bacteria in your gut could hold clues to whether or not you will develop posttraumatic stress disorder (PTSD) after experiencing a traumatic event.
PTSD is a serious psychiatric disorder that can develop after a person experiences a life-threatening trauma. However, not everyone exposed to a traumatic event will develop PTSD, and several factors influence an individual's susceptibility, including living conditions, childhood experiences and genetic makeup. Stellenbosch University researchers are now also adding gut bacteria to this list.
In recent years, scientists have become aware of the important role of microbes existing inside the human gastrointestinal tract, called the gut microbiome. These microbes perform important functions, such as metabolising food and medicine, and fighting infections. It is now believed that the gut microbiome also influences the brain and brain function by producing neurotransmitters/hormones, immune-regulating molecules and bacterial toxins.
In turn, stress and emotions can change the composition of the gut microbiome. Stress hormones can affect bacterial growth and compromise the integrity of the intestinal lining, which can result in bacteria and toxins entering the bloodstream. This can cause inflammation, which has been shown to play a role in several psychiatric disorders.
"Our study compared the gut microbiomes of individuals with PTSD to that of people who also experienced significant trauma, but did not develop PTSD (trauma-exposed controls). We identified a combination of three bacteria (Actinobacteria, Lentisphaerae and Verrucomicrobia) that were different in people with PTSD," explains the lead researcher, Dr Stefanie Malan-Muller. She is a postdoctoral fellow in the Department of Psychiatry at the Faculty of Medicine and Health Sciences.
Individuals with PTSD had significantly lower levels of this trio of bacteria compared to trauma-exposed control groups. Individuals who experienced trauma during their childhood also had lower levels of two of these bacteria (Actinobacteria and Verrucomicrobia). "What makes this finding interesting, is that individuals who experience childhood trauma are at higher risk of developing PTSD later in life, and these changes in the gut microbiome possibly occurred early in life in response to childhood trauma," says Malan-Muller. She collaborated with researchers from the University of Colorado Boulder on the study.
One of the known functions of these bacteria is immune system regulation, and researchers have noted increased levels of inflammation and altered immune regulation in individuals with PTSD. "Changes in immune regulation and increased inflammation also impact the brain, brain functioning and behaviour. Levels of inflammatory markers measured in individuals shortly after a traumatic event, was shown to predict later development of PTSD.
"We therefore hypothesise that the low levels of those three bacteria may have resulted in immune dysregulation and heightened levels of inflammation in individuals with PTSD, which may have contributed to their disease symptoms," explains Malan-Muller.
However, researchers are unable to determine whether this bacterial deficit contributed to PTSD susceptibility, or whether it occurred as a consequence of PTSD.
"It does, however, bring us one step closer to understanding the factors that might play a role in PTSD. Factors influencing susceptibility and resilience to developing PTSD are not yet fully understood, and identifying and understanding all these contributing factors could in future contribute to better treatments, especially since the microbiome can easily be altered with the use of prebiotics (non-digestible food substances), probiotics (live, beneficial microorganisms), and synbiotics (a combination of probiotics and prebiotics), or dietary interventions."
https://www.sciencedaily.com/releases/2017/10/171025103140.htm
Psychological toll of shame in military personnel
October 25, 2017
Science Daily/British Psychological Society (BPS)
Feelings of shame may make the symptoms of post-traumatic stress disorder (PTSD) more severe in current and former members of the Armed Services, suggests new research.
That is the conclusion of research published in the British Journal of Clinical Psychology by a team led by Dr Katherine C. Cunningham from the Department of Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, North Carolina.
In the forthcoming article, Dr Cunningham and colleagues say, "The military conflicts in Iraq and Afghanistan have resulted in increased awareness of the impact of war on military service members. Many returning service members and veterans have been diagnosed with PTSD, which is associated with poorer physical health, unemployment, legal problems, relationship conflict and reduced quality of life."
The research study, conducted at The University of Tulsa in Oklahoma, surveyed 61 American service personnel and veterans who completed an online psychological survey covering PTSD symptom severity as well as trauma-related guilt and trauma-related shame.
When the results were analysed, the researchers found that both shame and guilt predicted the presence of PTSD, jointly accounting for 46 per cent of the variance in its severity. However, they also found that trauma-related shame accounted for significantly more of that variance than trauma-related guilt.
In this study, the feeling of guilt was defined as being associated with having done something wrong, for instance "I didn't keep my friend safe in combat" or "I killed civilians during the war." Shame was defined as a belief that one is intrinsically and irrevocably flawed, for example "I'm a failure" or "I'm a monster."
In other words, guilt arises from the belief that you have done a bad thing and shame from the belief that you are a bad person.
Dr Cunningham said, "Guilt may result in more prosocial behaviour, because the underlying attributions are tied to a specific harmful action and not to one's identity. Feeling guilty can motivate an attempt to repair and strengthen social relationships by making amends, while feeling shame can lead people to withdraw from society.
"The findings of our study provide additional evidence that we should see shame and guilt as distinct emotions with unique roles in PTSD. Given shame's greater importance in explaining PTSD symptom severity, we should pay more attention to understanding and ameliorating it."
https://www.sciencedaily.com/releases/2017/10/171025122609.htm
Better sleep, less fear
Rapid eye movement sleep may dampen sensitivity to fearful stimuli
October 23, 2017
Science Daily/Society for Neuroscience
Higher quality sleep patterns are associated with reduced activity in brain regions involved in fear learning, according to a study of young adults. The results suggest that baseline sleep quality may be a useful predictor of susceptibility to post-traumatic stress disorder (PTSD).
Sleep disturbances are a common feature of PTSD. While previous research has focused on understanding how single nights of sleep influence the maintenance of already-established fear memories, few studies have investigated whether an individual's regular sleeping habits prior to trauma contributes to the acquisition of these fear memories.
Itamar Lerner, Shira Lupkin and their colleagues at Rutgers University had students monitor their sleep at home for one week using unobtrusive sleep monitoring tools, including a headband that measures brain waves, a bracelet that measures arm movements, and a sleep log. The students then participated in a neuroimaging experiment during which they learned to associate a neutral image with a mild electric shock. Students who spent more time in rapid eye movement (REM) sleep -- the phase when dreaming occurs -- exhibited weaker modulation of activity in, and connectivity between, their amygdala, hippocampus and ventromedial prefrontal cortex during fear learning.
The authors replicated these results in a second study using traditional polysomnographic monitoring of sleep during the night just prior to fear learning. Taken together, the findings are consistent with the idea that REM sleep reduces levels of norepinephrine in the brain, which may dampen an individual's sensitivity to fearful stimuli.
https://www.sciencedaily.com/releases/2017/10/171023140920.htm
Sports-related concussion symptoms linger twice as long for adolescent girls
Recovery may be complicated by pre-existing conditions more prevalent in females
October 2, 2017
Science Daily/American Osteopathic Association
Adolescent female athletes suffer concussion symptoms twice as long as their male counterparts, according to a new study. Researchers found the extended recovery period may be due to underlying conditions including migraines, depression, anxiety and stress.
The research analyzed the medical records of 110 male and 102 female athletes, ages 11 to 18, with first-time concussion diagnoses. The median duration of symptoms was 11 days for boys and 28 days for girls. The data also showed that symptoms resolved within three weeks for 75 percent of boys, compared to 42 percent of girls.
"These findings confirm what many in sports medicine have believed for some time," said lead researcher John Neidecker, DO, a sports concussion specialist in Raleigh, North Carolina. "It highlights the need to take a whole person approach to managing concussions, looking beyond the injury to understand the mental and emotional impacts on recovery when symptoms persist."
Prior research has shown that concussions exacerbate some pre-existing conditions, including headaches, depression, anxiety and stress, all of which are more prevalent in girls and mirror hallmark concussion symptoms, according to a consensus statement from the 5th International Conference on Concussion.
Treating the right condition
Understanding the overlap of symptoms means physicians must be skilled at eliciting patient history to get a full understanding of factors that might complicate recovery.
"Often in this age range, issues like migraines, depression and anxiety have not yet been diagnosed," said Dr. Neidecker. "So, if I ask a patient whether they have one of these conditions, they're likely to say 'No'. But when I ask about their experiences, I get a much clearer picture."
Dr. Neidecker gives an example of a patient with no history of migraines who admitted experiencing weekly headaches prior to the head injury. She thought the headaches were normal, but in fact the patient was suffering from migraines.
He uses a similar approach to uncovering anxiety, mental stress and depression, and says diagnosis is tricky because adolescence is inherently emotional and stressful. To better understand the patient, he recommends asking young athletes whether they are hard on themselves or feel bad about not performing their best.
Patients with Type A personality traits typically have a baseline level of stress about the need to perform and become more stressed when they cannot, Dr. Neidecker explained. Losing the physical outlet of sport for managing their stress compounds the issue during the recovery period.
"It can really become a vicious cycle for some of these kids," said Dr. Neidecker. "Uncovering and addressing any underlying conditions gets them back on the field faster and ultimately helps them be healthier and happier in the future."
https://www.sciencedaily.com/releases/2017/10/171002090506.htm
One in 5 teens report having had a concussion in their lifetime
September 26, 2017
Science Daily/University of Michigan
A new study confirms what many hospital emergency rooms nationwide are seeing: teens playing contact sports suffer from concussions.
In fact, one out of five teens reported at least one concussion diagnosis during their lifetime, and 5.5 percent have had more than one concussion, the study indicated.
The study, published in the Journal of the American Medical Association (JAMA), comes at a time as interest in concussions among pro athletes -- especially those in the National Football League -- has increased in the last decade. Little, however, is known about the prevalence of concussions among teens in the United States, said Phil Veliz, a researcher at the Institute for Research on Women and Gender.
Veliz and colleagues analyzed data from more than 13,088 adolescents in the 2016 Monitoring the Future survey, a national study by U-M funded by the National Institute on Drug Abuse that tracks U.S. students in grades 8, 10 and 12. Students were asked: "Have you ever had a head injury that was diagnosed as a concussion?"
Sociodemographic variables included sex, race/ethnicity, grade level, and participation in competitive sport within the past 12 months. The group, which included 50.2 percent female, indicated if they played at least one of 21 different sports. The findings showed that 19.5 percent reported at least one diagnosed concussion in their lifetime, which was consistent with regional studies and with emergency department reports stating contact sports are a leading cause of concussion among teens.
"Greater effort to track concussions using large-scale epidemiological data are needed to identify high-risk subpopulations and monitor prevention efforts," the researchers wrote.
Several factors, the study noted, were associated with higher lifetime prevalence of reporting a diagnosed concussion: Being male, white, in a higher grade, and participating in competitive sports.
https://www.sciencedaily.com/releases/2017/09/170926112019.htm