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Jaswetz L, de Voogd LD, Becker ES, Roelofs K. The relevance of accounting for parasympathetic as well as sympathetic arousal in threat conditioning: Methodological and clinical considerations. Int J Psychophysiol 2025; 212:112561. [PMID: 40180249 DOI: 10.1016/j.ijpsycho.2025.112561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Revised: 03/18/2025] [Accepted: 03/31/2025] [Indexed: 04/05/2025]
Abstract
Alterations in associative threat learning have been thought to underlie the aetiology and maintenance of anxiety disorders. Recent insights into the facilitatory role of parasympathetic arousal for threat coping have raised the question whether individual differences in sympathetic versus parasympathetic dominance during threat learning may shed light on the complex relationship with anxiety vulnerability versus resilience. We applied an established differential-cue delay threat conditioning paradigm in 78 neurotypical individuals and assessed parasympathetic responses (threat-induced bradycardia), as well as sympathetic responses (threat-induced tachycardia and increased skin conductance responses-SCR). We found evidence that patterns of threat-induced bradycardia as well as tachycardia are present during associative learning. Threat bradycardia was linked to weaker initial conditioned SCRs (mainly driven by responses to the CS+), a finding that may be relevant for current common practice in the field of threat learning: namely participants with weak differential skin conductance responses - who according to frequently applied 'SCR non-learner' criteria are often considered non-learners and sometimes even excluded from analyses - were in fact showing successful learning in terms of parasympathetic arousal. Additionally, the presence of threat bradycardia as well as the magnitude of overall conditioned heart rate responses were linked to relatively lower trait anxiety. These findings not only have practical research implications but also clinical implications when assessing markers for anxiety vulnerability versus resilience.
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Affiliation(s)
- Lars Jaswetz
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, the Netherlands; Behavioural Science Institute, Radboud University, the Netherlands.
| | | | - Eni S Becker
- Behavioural Science Institute, Radboud University, the Netherlands
| | - Karin Roelofs
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, the Netherlands; Behavioural Science Institute, Radboud University, the Netherlands
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2
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McGranahan MJ, O'Connor PJ. Effect of high-intensity interval training exercise on sleep quality in women with probable post-traumatic stress disorder: A pilot randomized controlled trial. Sleep Med 2025; 129:245-256. [PMID: 40056660 DOI: 10.1016/j.sleep.2025.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2024] [Revised: 12/14/2024] [Accepted: 02/19/2025] [Indexed: 03/10/2025]
Abstract
Poor sleep quality is a major problem for women with post-traumatic stress disorder (PTSD). Potential causes of poor sleep quality include elevated symptoms of anxiety, hyperarousal, and decreased high frequency-heart rate variability (HF-HRV). Exercise training both decreases anxiety symptoms and increases HF-HRV among samples without PTSD. The effect of exercise training on sleep quality, HF-HRV and PTSD-related symptoms has not been tested in a sample of women exposed to trauma. This study aimed to evaluate the impact of High-Intensity Interval Training (HIIT) on sleep quality in a sample of women with probable PTSD and test if reductions in anxiety or hyperarousal symptoms and/or increased HF-HRV mediate improved sleep quality. Thirty women with poor sleep quality and a Post-Traumatic Diagnostic Scale (PDS-5) score indicative of PTSD (≥ 28) were randomly assigned to either six-weeks of HIIT or a waitlist control (WL). Sleep quality, PTSD and anxiety symptoms were assessed at baseline (BL), weeks 2, 4, 6, and post-intervention (POST). HF-HRV was measured at BL and POST. A mixed model ANOVA 2 group × 5 time interaction for sleep quality was significant (p < 0.001; HIIT BL: 11.27 ± 2.55; POST: 5.60 ± 2.03 versus WL BL: 9.47 ± 2.83; POST: 8.23 ± 2.39; Hedges' d = -1.57). Anxiety and hyperarousal symptom reductions significantly mediated sleep quality changes. HF-HRV mediation models were non-significant. HIIT-based cycle exercise training in a sample of women with probable PTSD improves sleep quality, and reductions in trait anxiety and hyperarousal symptoms mediated these improvements. CLINICAL TRIAL REGISTRATION: (Clinical Trials. gov) Identifier: NCT05097352.
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Affiliation(s)
| | - Patrick J O'Connor
- Department of Kinesiology, University of Georgia, Athens GA, United States
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3
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Seligowski AV, Harnett NG, Ellis RA, Grasser LR, Hanif M, Wiltshire C, Ely TD, Lebois LAM, van Rooij SJH, House SL, Beaudoin FL, An X, Neylan TC, Clifford GD, Linnstaedt SD, Germine LT, Bollen KA, Rauch SL, Haran JP, Storrow AB, Lewandowski C, Musey PI, Hendry PL, Sheikh S, Jones CW, Punches BE, Swor RA, Hudak LA, Pascual JL, Seamon MJ, Harris E, Pearson C, Peak DA, Merchant RC, Domeier RM, Rathlev NK, O'Neil BJ, Sergot P, Sanchez LD, Bruce SE, Harte SE, Koenen KC, Kessler RC, McLean SA, Ressler KJ, Stevens JS, Jovanovic T. Probing the neurocardiac circuit in trauma and posttraumatic stress. J Psychiatr Res 2024; 176:173-181. [PMID: 38875773 PMCID: PMC11283955 DOI: 10.1016/j.jpsychires.2024.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 05/20/2024] [Accepted: 06/04/2024] [Indexed: 06/16/2024]
Abstract
The neurocardiac circuit is integral to physiological regulation of threat and trauma-related responses. However, few direct investigations of brain-behavior associations with replicable physiological markers of PTSD have been conducted. The current study probed the neurocardiac circuit by examining associations among its core regions in the brain (e.g., insula, hypothalamus) and the periphery (heart rate [HR], high frequency heart rate variability [HF-HRV], and blood pressure [BP]). We sought to characterize these associations and to determine whether there were differences by PTSD status. Participants were N = 315 (64.1 % female) trauma-exposed adults enrolled from emergency departments as part of the prospective AURORA study. Participants completed a deep phenotyping session (e.g., fear conditioning, magnetic resonance imaging) two weeks after emergency department admission. Voxelwise analyses revealed several significant interactions between PTSD severity 8-weeks posttrauma and psychophysiological recordings on hypothalamic connectivity to the prefrontal cortex (PFC), insula, superior temporal sulcus, and temporoparietaloccipital junction. Among those with PTSD, diastolic BP was directly correlated with right insula-hypothalamic connectivity, whereas the reverse was found for those without PTSD. PTSD status moderated the association between systolic BP, HR, and HF-HRV and hypothalamic connectivity in the same direction. While preliminary, our findings may suggest that individuals with higher PTSD severity exhibit compensatory neural mechanisms to down-regulate autonomic imbalance. Additional study is warranted to determine how underlying mechanisms (e.g., inflammation) may disrupt the neurocardiac circuit and increase cardiometabolic disease risk in PTSD.
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Affiliation(s)
- Antonia V Seligowski
- Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Nathaniel G Harnett
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA
| | - Robyn A Ellis
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA
| | - Lana R Grasser
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | - Mubeena Hanif
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | - Charis Wiltshire
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | - Timothy D Ely
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Lauren A M Lebois
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA
| | - Sanne J H van Rooij
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Stacey L House
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Francesca L Beaudoin
- Department of Epidemiology, Brown University, Providence, RI, USA; Department of Emergency Medicine, Brown University, Providence, RI, USA
| | - Xinming An
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Thomas C Neylan
- Departments of Psychiatry and Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Gari D Clifford
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, USA; Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Sarah D Linnstaedt
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Laura T Germine
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA; The Many Brains Project, Belmont, MA, USA
| | - Kenneth A Bollen
- Department of Psychology and Neuroscience & Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Scott L Rauch
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA; Department of Psychiatry, McLean Hospital, Belmont, MA, USA
| | - John P Haran
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Alan B Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Paul I Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Phyllis L Hendry
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, USA
| | - Sophia Sheikh
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, USA
| | - Christopher W Jones
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Brittany E Punches
- Department of Emergency Medicine, Ohio State University College of Medicine, Columbus, OH, USA; Ohio State University College of Nursing, Columbus, OH, USA
| | - Robert A Swor
- Department of Emergency Medicine, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Lauren A Hudak
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Jose L Pascual
- Department of Surgery, Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mark J Seamon
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Erica Harris
- Department of Emergency Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Claire Pearson
- Department of Emergency Medicine, Wayne State University, Ascension St. John Hospital, Detroit, MI, USA
| | - David A Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Roland C Merchant
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Robert M Domeier
- Department of Emergency Medicine, Trinity Health-Ann Arbor, Ypsilanti, MI, USA
| | - Niels K Rathlev
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, USA
| | - Brian J O'Neil
- Department of Emergency Medicine, Wayne State University, Detroit Receiving Hospital, Detroit, MI, USA
| | - Paulina Sergot
- Department of Emergency Medicine, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Leon D Sanchez
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA; Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
| | - Steven E Bruce
- Department of Psychological Sciences, University of Missouri - St. Louis, St. Louis, MO, USA
| | - Steven E Harte
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA; Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Karestan C Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Samuel A McLean
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Institute for Trauma Recovery, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kerry J Ressler
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA
| | - Jennifer S Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
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Gazi AH, Sanchez-Perez JA, Saks GL, Alday EAP, Haffar A, Ahmed H, Herraka D, Tarlapally N, Smith NL, Bremner JD, Shah AJ, Inan OT, Vaccarino V. Quantifying Posttraumatic Stress Disorder Symptoms During Traumatic Memories Using Interpretable Markers of Respiratory Variability. IEEE J Biomed Health Inform 2024; 28:4912-4924. [PMID: 38713564 PMCID: PMC11364449 DOI: 10.1109/jbhi.2024.3397589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2024]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) causes heightened fight-or-flight responses to traumatic memories (i.e., hyperarousal). Although hyperarousal is hypothesized to cause irregular breathing (i.e., respiratory variability), no quantitative markers of respiratory variability have been shown to correspond with PTSD symptoms in humans. OBJECTIVE In this study, we define interpretable markers of respiration pattern variability (RPV) and investigate whether these markers respond during traumatic memories, correlate with PTSD symptoms, and differ in patients with PTSD. METHODS We recruited 156 veterans from the Vietnam-Era Twin Registry to participate in a trauma recall protocol. From respiratory effort and electrocardiogram measurements, we extracted respiratory timings and rate using a robust quality assessment and fusion approach. We then quantified RPV using the interquartile range and compared RPV between baseline and trauma recall conditions, correlated PTSD symptoms to the difference between trauma recall and baseline RPV (i.e., ∆RPV), and compared ∆RPV between patients with PTSD and trauma-exposed controls. Leveraging a subset of 116 paired twins, we then uniquely controlled for factors shared by co-twins via within-pair analysis for further validation. RESULTS We found RPV was increased during traumatic memories (p .001), ∆ RPV was positively correlated with PTSD symptoms (p .05), and patients with PTSD exhibited higher ∆ RPV than trauma-exposed controls (p . 05). CONCLUSIONS This paper is the first to elucidate RPV markers that respond during traumatic memories, especially in patients with PTSD, and correlate with PTSD symptoms. SIGNIFICANCE These findings encourage future studies outside the clinic, where interpretable markers of respiratory variability are used to track hyperarousal.
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Peitzsch AG, Kong Y, Posada-Quintero HF, Chon KH. Objective Assessment of Acute Stress Disorder in Female Subjects Using Wearable Measures of Electrodermal Activity . ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2024;2024:1-4. [PMID: 40039157 DOI: 10.1109/embc53108.2024.10782849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/06/2025]
Abstract
Acute Stress Disorder (ASD) is a precursor disease to Post Traumatic Stress Disorder (PTSD), occurring within the first month after trauma and may serve as a vital timepoint for treating chronic PTSD. Current ASD diagnosis is resource intensive and may miss vulnerable patients in early prescreening steps, particularly female patients who are known to have higher rates of PTSD and a higher conversion rate from ASD to PTSD. We propose a new ASD diagnostic tool based on electrodermal activity (EDA) to measure changes in sympathetic nervous system (SNS) activity post-trauma. Using both traditional phasic decomposition and time-frequency decomposition methods, we are able to detect key differences in ASD and non-ASD groups within 72 hours of trauma. We compared several machine learning models to determine optimal diagnostic capability. Our logistic regression model was able detect ASD in female subjects with a balanced accuracy of 0.72 and an F1 score of 0.78. Our time-frequency decomposition techniques are highly sensitive to SNS changes post trauma. Future study on EDA dynamics in the early stages of trauma may help improve detection of ASD and increase PTSD treatment outcomes.
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Bazanova OM, Balioz NV, Ermolaeva SA, Zakharov AV, Zonov AA, Larkova IV, Mariyanovska TA, Melnikov AA, Nikolenko ED, Plotnikova EP, Rudych PD, Shirolapov IV. Study of Psychophysiological Indicators of Sensorimotor Integration in PTSD. Justification of the Choice of Targets for Biofeedback. HUMAN PHYSIOLOGY 2024; 50:249-259. [DOI: 10.1134/s036211972360056x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 11/11/2023] [Accepted: 11/24/2023] [Indexed: 01/04/2025]
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7
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Hsu TW, Bai YM, Tsai SJ, Chen TJ, Chen MH, Liang CS. Risk of autoimmune diseases after post-traumatic stress disorder: a nationwide cohort study. Eur Arch Psychiatry Clin Neurosci 2024; 274:487-495. [PMID: 37322294 DOI: 10.1007/s00406-023-01639-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 06/03/2023] [Indexed: 06/17/2023]
Abstract
This longitudinal study aimed to investigate the risk of subsequent autoimmune disease in patients with post-traumatic stress disorder (PTSD) in Asian population. Between 2002 and 2009, we enrolled 5273 patients with PTSD and 1:4 matched controls from the National Health Insurance Database of Taiwan, and followed up the patients until December 31, 2011, or death. The investigated autoimmune diseases included thyroiditis, lupus, rheumatic arthritis, inflammatory bowel disease, Sjogren's syndrome, dermatomyositis, and polymyositis. The Cox regression model was used to estimate the risk of developing autoimmune diseases, with adjustment for demographics and psychiatric and medical comorbidities. Furthermore, we examined the psychiatric clinics utility of patients with PTSD indicating the severity of PTSD in association with autoimmune diseases. After adjusting for confounders, patients with PTSD had a 2.26-fold higher risk of developing any autoimmune diseases (reported as hazard ratios with 95% confidence intervals: 1.82-2.80) than the controls. For specific autoimmune diseases, patients with PTSD had a 2.70-fold higher risk (1.98-3.68) of thyroiditis, a 2.95-fold higher risk (1.20-7.30) of lupus, and a 6.32-fold higher risk (3.44-11.60) of Sjogren's syndrome. Moreover, the PTSD severity was associated with the risk of autoimmune diseases in a dose-dependent manner. The patient with the highest psychiatric clinics utility was associated with an 8.23-fold higher risk (6.21-10.90) of any autoimmune diseases than the controls. Patients with PTSD had an increased risk of autoimmune diseases, and such risk was associated with the severity of PTSD in a dose-dependent manner. However, the present study did not provide a direct effect between PTSD and autoimmune diseases, but rather an association. Further studies are warranted to examine the underlying pathophysiological mechanisms.
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Affiliation(s)
- Tien-Wei Hsu
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Ya-Mei Bai
- Department of Psychiatry, Taipei Veterans General Hospital, No. 201, Sec. 2, Shihpai Road, Beitou District, Taipei, 11217, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Jen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, No. 201, Sec. 2, Shihpai Road, Beitou District, Taipei, 11217, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan
| | - Mu-Hong Chen
- Department of Psychiatry, Taipei Veterans General Hospital, No. 201, Sec. 2, Shihpai Road, Beitou District, Taipei, 11217, Taiwan.
- Department of Psychiatry, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan.
| | - Chih-Sung Liang
- Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, National Defense Medical Center, No. 60, Xinmin Road, Beitou District, Taipei, 11243, Taiwan.
- Department of Psychiatry, National Defense Medical Center, Taipei, Taiwan.
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8
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Rountree-Harrison D, Berkovsky S, Kangas M. Heart and brain traumatic stress biomarker analysis with and without machine learning: A scoping review. Int J Psychophysiol 2023; 185:27-49. [PMID: 36720392 DOI: 10.1016/j.ijpsycho.2023.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 01/22/2023] [Accepted: 01/25/2023] [Indexed: 01/31/2023]
Abstract
The enigma of post-traumatic stress disorder (PTSD) is embedded in a complex array of physiological responses to stressful situations that result in disruptions in arousal and cognitions that characterise the psychological disorder. Deciphering these physiological patterns is complex, which has seen the use of machine learning (ML) grow in popularity. However, it is unclear to what extent ML has been used with physiological data, specifically, the electroencephalogram (EEG) and electrocardiogram (ECG) to further understand the physiological responses associated with PTSD. To better understand the use of EEG and ECG biomarkers, with and without ML, a scoping review was undertaken. A total of 124 papers based on adult samples were identified comprising 19 ML studies involving EEG and ECG. A further 21 studies using EEG data, and 84 studies employing ECG meeting all other criteria but not employing ML were included for comparison. Identified studies indicate classical ML methodologies currently dominate EEG and ECG biomarkers research, with derived biomarkers holding clinically relevant diagnostic implications for PTSD. Discussion of the emerging trends, algorithms used and their success is provided, along with areas for future research.
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Affiliation(s)
- Darius Rountree-Harrison
- Macquarie University, Balaclava Road, Macquarie Park, New South Wales 2109, Australia; New South Wales Service for the Rehabilitation and Treatment of Torture and Trauma Survivors (STARTTS), 152-168 The Horsley Drive Carramar, New South Wales 2163, Australia.
| | - Shlomo Berkovsky
- Macquarie University, Balaclava Road, Macquarie Park, New South Wales 2109, Australia
| | - Maria Kangas
- Macquarie University, Balaclava Road, Macquarie Park, New South Wales 2109, Australia
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9
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Lagatta DC, Fassini A, Terzian AL, Corrêa FMA, Resstel LBM. The medial prefrontal cortex and the cardiac baroreflex activity: physiological and pathological implications. Pflugers Arch 2023; 475:291-307. [PMID: 36695881 DOI: 10.1007/s00424-022-02786-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 12/16/2022] [Accepted: 12/25/2022] [Indexed: 01/26/2023]
Abstract
The cardiac baroreflex is an autonomic neural mechanism involved in the modulation of the cardiovascular system. It influences the heart rate and peripheral vascular resistance to preserve arterial blood pressure within a narrow variation range. This mechanism is mainly controlled by medullary nuclei located in the brain stem. However, supramedullary areas, such as the ventral portion of medial prefrontal cortex (vMPFC), are also involved. Particularly, the glutamatergic NMDA/NO pathway in the vMPFC can facilitate baroreflex bradycardic and tachycardic responses. In addition, cannabinoid receptors in this same area can reduce or increase those cardiac responses, possibly through alteration in glutamate release. This vMPFC network has been associated to cardiovascular responses during stressful situations. Recent results showed an involvement of glutamatergic, nitrergic, and endocannabinoid systems in the blood pressure and heart rate increases in animals after aversive conditioning. Consequently, baroreflex could be modified by the vMPFC neurotransmission during stressful situations, allowing necessary cardiovascular adjustments. Remarkably, some mental, neurological and neurodegenerative disorders can involve damage in the vMPFC, such as posttraumatic stress disorder, major depressive disorder, Alzheimer's disease, and neuropathic pain. These pathologies are also associated with alterations in glutamate/NO release and endocannabinoid functions along with baroreflex impairment. Thus, the vMPFC seems to play a crucial role on the baroreflex control, either during pathological or physiological stress-related responses. The study of baroreflex mechanism under such pathological view may be helpful to establish causality mechanisms for the autonomic and cardiovascular imbalance found in those conditions. It can explain in the future the reasons of the high cardiovascular risk some neurological and neurodegenerative disease patients undergo. Additionally, the present work offers insights on the possible contributions of vMPFC dysfunction on baroreflex alterations, which, in turn, may raise questions in what extent other brain areas may play a role in autonomic deregulation under such pathological situations.
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Affiliation(s)
- Davi C Lagatta
- Faculty of Pharmaceutical Sciences, Food and Nutrition, Federal University of Mato Grosso do Sul, MS, 79070-900, Campo Grande, Brazil
| | - Aline Fassini
- Department of Pharmacology, Medical School of Ribeirão Preto, University of São Paulo, Avenida Bandeirantes 3900, Ribeirão Preto, SP, 14090-900, Brazil
| | - Ana L Terzian
- Department of Pharmacology, Medical School of Ribeirão Preto, University of São Paulo, Avenida Bandeirantes 3900, Ribeirão Preto, SP, 14090-900, Brazil
| | - Fernando M A Corrêa
- Department of Pharmacology, Medical School of Ribeirão Preto, University of São Paulo, Avenida Bandeirantes 3900, Ribeirão Preto, SP, 14090-900, Brazil
| | - Leonardo B M Resstel
- Department of Pharmacology, Medical School of Ribeirão Preto, University of São Paulo, Avenida Bandeirantes 3900, Ribeirão Preto, SP, 14090-900, Brazil.
- Center for Interdisciplinary Research On Applied Neurosciences (NAPNA), Medical School of Ribeirão Preto, University of São Paulo (USP), Ribeirão Preto, Brazil.
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10
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Fernandes O, Marra da Silva R, Rego Ramos L, Gama TM, Lobo I, Guerra Leal Souza G, Arruda Sanchez T. The impact of a violent community on mental health and the benefits of a sport program for social development. JOURNAL OF COMMUNITY PSYCHOLOGY 2023; 51:51-66. [PMID: 35583853 DOI: 10.1002/jcop.22877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 03/28/2022] [Accepted: 04/25/2022] [Indexed: 06/15/2023]
Abstract
The aim of the present study was to evaluate the impact of a violent environment on mental health and the impact of a sport for social development (SSD) program on quality of life, mental distress symptoms, and heart rate variability (HRV). HRV and psychometric data were measured from 20 men professional athletes assisted by the SSD and 20 men living in the same violent community. The comparison of groups revealed greater sympathetic parameters of HRV, positive affect, and quality of life in the SSD group. Multiple regression analysis showed that the quality of life in the SSD group was positively predicted by positive affect, while in the control group the quality of life was negatively predicted by their history of traumatic events. Both groups reported high levels of exposure to traumatic events and posttraumatic stress symptoms. However, this study demonstrates the benefits of SSD programs in mental health.
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Affiliation(s)
- Orlando Fernandes
- Laboratório de Neuroimagem e Psicofisiologia, Departamento de Radiologia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ruy Marra da Silva
- Laboratório de Neuroimagem e Psicofisiologia, Departamento de Radiologia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
- Programa de Pós-graduação em Cardiologia, Instituto do Coração Edson Saad, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Lucas Rego Ramos
- Laboratório de Neuroimagem e Psicofisiologia, Departamento de Radiologia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Tamires M Gama
- Laboratório de Neuroimagem e Psicofisiologia, Departamento de Radiologia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Isabela Lobo
- Grupo de Psicobiologia/Laboratório Integrado de Morfologia, Instituto de Biodiversidade e Sustentabilidade/NUPEM, Universidade Federal do Rio de Janeiro, Macaé, Rio de Janeiro, Brazil
| | - Gabriela Guerra Leal Souza
- Laboratório de Psicofisiologia, Departamento de Ciências Biológicas, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais, Brazil
| | - Tiago Arruda Sanchez
- Laboratório de Neuroimagem e Psicofisiologia, Departamento de Radiologia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
- Programa de Pós-graduação em Cardiologia, Instituto do Coração Edson Saad, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
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11
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Carleton RN, McCarron M, Krätzig GP, Sauer-Zavala S, Neary JP, Lix LM, Fletcher AJ, Camp RD, Shields RE, Jamshidi L, Nisbet J, Maguire KQ, MacPhee RS, Afifi TO, Jones NA, Martin RR, Sareen J, Brunet A, Beshai S, Anderson GS, Cramm H, MacDermid JC, Ricciardelli R, Rabbani R, Teckchandani TA, Asmundson GJG. Assessing the impact of the Royal Canadian Mounted Police (RCMP) protocol and Emotional Resilience Skills Training (ERST) among diverse public safety personnel. BMC Psychol 2022; 10:295. [PMID: 36494748 PMCID: PMC9733219 DOI: 10.1186/s40359-022-00989-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/13/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Public safety personnel (PSP; e.g., border services personnel, correctional workers, firefighters, paramedics, police, public safety communicators) are frequently exposed to potentially psychologically traumatic events. Such events contribute to substantial and growing challenges from posttraumatic stress injuries (PTSIs), including but not limited to posttraumatic stress disorder. METHODS The current protocol paper describes the PSP PTSI Study (i.e., design, measures, materials, hypotheses, planned analyses, expected implications, and limitations), which was originally designed to evaluate an evidence-informed, proactive system of mental health assessment and training among Royal Canadian Mounted Police for delivery among diverse PSP (i.e., firefighters, municipal police, paramedics, public safety communicators). Specifically, the PSP PTSI Study will: (1) adapt, implement, and assess the impact of a system for ongoing (i.e., annual, monthly, daily) evidence-based assessments; (2) evaluate associations between demographic variables and PTSI; (3) longitudinally assess individual differences associated with PTSI; and, (4) assess the impact of providing diverse PSP with a tailored version of the Emotional Resilience Skills Training originally developed for the Royal Canadian Mounted Police in mitigating PTSIs based on the Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders. Participants are assessed pre- and post-training, and then at a follow-up 1-year after training. The assessments include clinical interviews, self-report surveys including brief daily and monthly assessments, and daily biometric data. The current protocol paper also describes participant recruitment and developments to date. DISCUSSION The PSP PTSI Study is an opportunity to implement, test, and improve a set of evidence-based tools and training as part of an evidence-informed solution to protect PSP mental health. The current protocol paper provides details to inform and support translation of the PSP PTSI Study results as well as informing and supporting replication efforts by other researchers. TRIAL REGISTRATION Hypotheses Registration: aspredicted.org, #90136. Registered 7 March 2022-Prospectively registered. TRIAL REGISTRATION ClinicalTrials.gov, NCT05530642. Registered 1 September 2022-Retrospectively registered. The subsequent PSP PTSI Study results are expected to benefit the mental health of all participants and, ultimately, all PSP.
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Affiliation(s)
- R. Nicholas Carleton
- Anxiety and Illness Behaviours Laboratory, Department of Psychology, University of Regina, Regina, SK S4S 0A2 Canada
| | - Michelle McCarron
- Research Department, Saskatchewan Health Authority, Regina, SK S4S 0A5 Canada
| | - Gregory P. Krätzig
- Department of Psychology, University of Regina, Regina, SK S4S 0A2 Canada
| | - Shannon Sauer-Zavala
- Treatment Innovation for Psychological Services Research Program, Department of Psychology, University of Kentucky, Lexington, KY 40506 USA
| | - J. Patrick Neary
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, SK S4S 0A2 Canada
| | - Lisa M. Lix
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB R3E 0W3 Canada
| | - Amber J. Fletcher
- Department of Sociology and Social Studies, University of Regina, Regina, SK S4S 0A2 Canada
| | - Ronald D. Camp
- Faculty of Business and Economics, University of Northern British Columbia, Prince George, BC V2N 4Z9 Canada
| | | | - Laleh Jamshidi
- Canadian Institute for Public Safety Research and Treatment, University of Regina, Regina, SK S4S 0A2 Canada
| | - Jolan Nisbet
- Canadian Institute for Public Safety Research and Treatment, University of Regina, Regina, SK S4S 0A2 Canada
| | - Kirby Q. Maguire
- Canadian Institute for Public Safety Research and Treatment, University of Regina, Regina, SK S4S 0A2 Canada
| | - Renée S. MacPhee
- Department of Kinesiology and Physical Education, Wilfrid Laurier University, Waterloo, ON N2L 3C5 Canada
| | - Tracie O. Afifi
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB R3E 0W5 Canada
| | - Nicholas A. Jones
- Department of Justice Studies, University of Regina, Regina, SK S4S 0A2 Canada
| | - Ronald R. Martin
- Faculty of Education, University of Regina, Regina, SK S4S 0A2 Canada
| | - Jitender Sareen
- Department of Psychiatry, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB R3E 0W5 Canada
| | - Alain Brunet
- McGill’s Psychiatry Department and Douglas Institute Research Center, 6875 Lasalle Boulevard, Verdun, QC H4H 1R3 Canada
| | - Shadi Beshai
- Department of Psychology, University of Regina, Regina, SK S4S 0A2 Canada
| | | | - Heidi Cramm
- School of Rehabilitation Therapy, Faculty of Health Sciences, Queen’s University, Kingston, ON K7L 3N6 Canada
| | - Joy C. MacDermid
- School of Physiotherapy, Western University, London, ON N6A 3K7 Canada
| | - Rosemary Ricciardelli
- School of Maritime Studies, Fisheries and Marine Institute, Memorial University of Newfoundland, St. John’s, NL A1C 5R3 Canada
| | - Rasheda Rabbani
- George & Fay Yee Centre for Healthcare Innovation, Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Taylor A. Teckchandani
- Canadian Institute for Public Safety Research and Treatment, University of Regina, Regina, SK S4S 0A2 Canada
| | - Gordon J. G. Asmundson
- Anxiety and Illness Behaviours Laboratory, Department of Psychology, University of Regina, Regina, SK S4S 0A2 Canada
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Cesari V, Vallefuoco A, Agrimi J, Gemignani A, Paolocci N, Menicucci D. Intimate partner violence: psycho-physio-pathological sequelae for defining a holistic enriched treatment. Front Behav Neurosci 2022; 16:943081. [PMID: 36248029 PMCID: PMC9561850 DOI: 10.3389/fnbeh.2022.943081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 09/13/2022] [Indexed: 11/13/2022] Open
Abstract
Intimate partner violence (IPV) is a health priority, which worldwide, mainly affects women. The consequences of IPV include several psychophysiological effects. These range from altered levels of hormones and neurotrophins to difficulties in emotion regulation and cognitive impairment. Mounting evidence from preclinical studies has shown that environmental enrichment, a form of sensory-motor, cognitive, and social stimulation, can induce a wide range of neuroplastic processes in the brain which consistently improve recovery from a wide variety of somatic and psychiatric diseases. To support IPV survivors, it is essential to ensure a safe housing environment, which can serve as a foundation for environmental enrichment-based interventions. However, some concerns have been raised when supportive housing interventions focus on the economic aspects of survivors’ lives instead of the emotional ones. We thus propose a holistic intervention in which supportive housing is integrated with evidenced-based psychotherapies which could constitute an enriched therapeutic approach for IPV survivors.
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Affiliation(s)
- Valentina Cesari
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Alessandra Vallefuoco
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Jacopo Agrimi
- Department of Biomedical Sciences, University of Padua, Padua, Italy
| | - Angelo Gemignani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
- Clinical Psychology branch, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Nazareno Paolocci
- Department of Biomedical Sciences, University of Padua, Padua, Italy
- Division of Cardiology, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, MD, United States
| | - Danilo Menicucci
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
- Comitato Unico di Garanzia, University of Pisa, Pisa, Italy
- *Correspondence: Danilo Menicucci
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13
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Vlemincx E, Severs L, Ramirez JM. The psychophysiology of the sigh: II: The sigh from the psychological perspective. Biol Psychol 2022; 173:108386. [PMID: 35803439 DOI: 10.1016/j.biopsycho.2022.108386] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 06/21/2022] [Accepted: 07/03/2022] [Indexed: 02/02/2023]
Abstract
A sigh is a distinct respiratory behavior with specific psychophysiological roles. In two accompanying reviews we will discuss the physiological and psychological functions of the sigh. The present review will focus on the psychological functions of the sigh. We discuss the regulatory effects of a sigh, and argue how these effects may become maladaptive when sighs occur excessively. The adaptive role of a sigh is discussed in the context of regulation of psychophysiological states. We propose that sighs facilitate transitions from one psychophysiological state to the next, and this way contribute to psychophysiological flexibility, via a hypothesized resetting mechanism. We discuss how a sigh resets respiration, by controlling mechanical and metabolic properties of respiration associated with respiratory symptoms. Next, we elaborate on a sigh resetting emotional states by facilitating emotional transitions. We attempt to explain the adaptive and maladaptive functions of a sigh in the framework of stochastic resonance, in which we propose occasional, spontaneous sighs to be noise contributing to psychophysiological regulation, while excessive sighs result in psychophysiological dysregulation. In this context, we discuss how sighs can contribute to therapeutic interventions, either by increasing sighs to improve regulation in case of a lack of sighing, or by decreasing sighs to restore regulation in case of excessive sighing. Finally, a research agenda on the psychology of sighs is presented.
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Affiliation(s)
- Elke Vlemincx
- Department of Health Sciences, Vrije Universiteit Amsterdam, The Netherlands; Health Psychology, KU Leuven, Belgium.
| | - Liza Severs
- Center for Integrative Brain Research, Seattle Children's Research Institute, USA; Department of Neurological Surgery, Department of Physiology and Biophysics, School of Medicine, University of Washington, USA
| | - Jan-Marino Ramirez
- Center for Integrative Brain Research, Seattle Children's Research Institute, USA; Department of Neurological Surgery, Department of Physiology and Biophysics, School of Medicine, University of Washington, USA
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14
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Kang SS, Sponheim SR, Lim KO. Interoception Underlies Therapeutic Effects of Mindfulness Meditation for Posttraumatic Stress Disorder: A Randomized Clinical Trial. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2022; 7:793-804. [PMID: 34688923 DOI: 10.1016/j.bpsc.2021.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 10/04/2021] [Accepted: 10/04/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Mindfulness-based interventions have proven efficacy in treating posttraumatic stress disorder (PTSD), but the neurobiological mechanism underlying the therapeutic effects is unknown. As mindfulness meditation cultivates attention to the present moment and bodily sensations, neural functions related to interoception (i.e., central processes of bodily signals) might be such a mechanism. METHODS We conducted a clinical trial in which veterans with PTSD were randomly assigned to receive an 8-week mindfulness-based stress reduction (MBSR) intervention (n = 47) or an active control intervention (present-centered group therapy; n = 51). We assessed pre- and postintervention PTSD symptoms and electroencephalography measures of neural outcomes, including spontaneous brain activity, cognitive task-related brain responses, and interoceptive brain responses (heartbeat-evoked brain responses). We conducted statistical causal mediation analyses using treatment type as a predictor, pre- and postintervention measures of symptom severity as treatment response, and the neural outcomes as mediators. RESULTS Compared with the control group, the MBSR group had greater improvements in PTSD symptoms and increases in spontaneous alpha power (8-13 Hz), task-related frontal theta power (4-7 Hz in 140-220 ms after stimulus), and frontal theta heartbeat-evoked brain responses (3-5 Hz and 265-336 ms after R peak). The mediation analysis using latent difference score modeling revealed that only changes in frontal theta heartbeat-evoked brain responses mediated the MBSR treatment effect. CONCLUSIONS Mindfulness meditation improves brain functions of attentional control and resting brain states reflective of internally oriented relaxation. However, interoceptive neural functions enhanced by MBSR seem to be a primary cerebral mechanism that improves symptoms of PTSD.
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Affiliation(s)
- Seung Suk Kang
- Department of Biomedical Sciences, University of Missouri-Kansas City, Kansas City, Missouri.
| | - Scott R Sponheim
- Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota; Veterans Affairs Health Care System, Minneapolis, Minnesota
| | - Kelvin O Lim
- Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota; Veterans Affairs Health Care System, Minneapolis, Minnesota
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15
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Respiratory Sinus Arrhythmia Change during Trauma-Focused Cognitive-Behavioral Therapy: Results from a Randomized Controlled Feasibility Trial. Res Child Adolesc Psychopathol 2022; 50:1487-1499. [PMID: 35689729 PMCID: PMC9187846 DOI: 10.1007/s10802-022-00946-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2022] [Indexed: 11/22/2022]
Abstract
Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) is a well-established treatment for pediatric posttraumatic stress disorder (PTSD). Animal-assisted therapy (AAT) has been proposed as an adjunct to TF-CBT that may improve treatment effects through enhanced targeting of affect regulation, as indexed by specific changes in the respiratory sinus arrhythmia (RSA). The current study reports results from a randomized controlled feasibility trial (N = 33; Mage = 11.79 [SD = 3.08]; 64% White; 67% female) that measured RSA during Sessions 1, 4, 8, and 12 of a twelve-session TF-CBT protocol and tested whether: 1) TF-CBT + AAT achieved higher average RSA amplitudes relative to TF-CBT alone, and 2) RSA regulation, defined as less variability around person-specific RSA slopes during treatment, explained variation in post-treatment PTSD symptoms. Multilevel modeling failed to support an effect for TF-CBT + AAT on RSA amplitudes (δ001 = 0.08, p = 0.844). However, regardless of treatment condition, greater RSA withdrawal was observed within Sessions 4 (γ11 = -.01, p < .001) and 12 (γ13 = -.01, p = .015) relative to the Session 1 baseline. The average level of RSA amplitude in Session 8 was also significantly lower compared to Session 1 (γ02 = -0.70, p = .046). Intraindividual regression models demonstrated that greater RSA regulation predicted improved PTSD symptoms at post-treatment after adjusting for pre-treatment levels (b3 = 20.00, p = .012). These preliminary results offer support for future confirmatory trials testing whether affect regulation, as indexed by changes in RSA, is a mechanism of action for TF-CBT in the treatment of pediatric PTSD.
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16
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Kava J, Dunlap E, Tanaka H. Water immersion skin wrinkling: modulation by common participant characteristics. Int J Dermatol 2022; 61:1481-1486. [DOI: 10.1111/ijd.16171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 01/26/2022] [Accepted: 03/08/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Jonathon Kava
- Department of Kinesiology and Health Education The University of Austin at Texas Austin TX USA
| | - Emily Dunlap
- Department of Kinesiology and Health Education The University of Austin at Texas Austin TX USA
| | - Hirofumi Tanaka
- Department of Kinesiology and Health Education The University of Austin at Texas Austin TX USA
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17
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Horesh D, Milstein N, Tomashin A, Mayo O, Gordon I. Pre-pandemic electrodermal activity predicts current COVID-related fears: household size during lockdown as a moderating factor. Stress 2022; 25:22-29. [PMID: 34812098 DOI: 10.1080/10253890.2021.2006179] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Background: Despite the immense impact of COVID-19 on mental health, there is a lack of prospective studies examining physiological predictors of current risk factors. Moreover, although physiological processes evidently interact with socio-demographic factors to modulate individuals' response to a crisis, it remains largely unknown how these complex interactions shape people's mental responses to COVID-19. To fill these gaps of knowledge, we chose a potent physiological marker of distress - heightened baseline electrodermal activity (EDA) measured before the pandemic began - and hypothesized it would be related to greater COVID-related fears and worries as a function of individuals' household size.Method: 185 individuals (71% women), who had participated in our lab studies 2-3 years ago, in which we assessed their baseline EDA, completed several questionnaires online, including assessments of their current fears regarding COVID. Participants also reported the number of people in their household, with whom they had been together during a lockdown which was taking place at the time. We used pre-pandemic EDA measures in combination with their household size to predict participants' current fears.Results: Pre-pandemic EDA measures predicted current COVID-related fears and worries. Specifically for the EDA measure "number of skin conductance responses", we further found that the number of people in the household during the lockdown, moderated the abovementioned relationship, such that it occurred in individuals with average and larger households and not in those with small households.Conclusions: We provide a highly relevant and unique combination of physiological, socio-demographic, and psychological measures, which augments the potential to optimally target populations vulnerable to COVID-related distress, and subsequently offer them early mental health interventions.
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Affiliation(s)
- Danny Horesh
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
| | - Nir Milstein
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
| | - Alon Tomashin
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
- The Gonda Multidisciplinary Brain Research Center, Bar Ilan University, Ramat-Gan, Israel
| | - Oded Mayo
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
| | - Ilanit Gordon
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
- The Gonda Multidisciplinary Brain Research Center, Bar Ilan University, Ramat-Gan, Israel
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18
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Abstract
Breathing is a critical, complex, and highly integrated behavior. Normal rhythmic breathing, also referred to as eupnea, is interspersed with different breathing related behaviors. Sighing is one of such behaviors, essential for maintaining effective gas exchange by preventing the gradual collapse of alveoli in the lungs, known as atelectasis. Critical for the generation of both sighing and eupneic breathing is a region of the medulla known as the preBötzinger Complex (preBötC). Efforts are underway to identify the cellular pathways that link sighing as well as sneezing, yawning, and hiccupping with other brain regions to better understand how they are integrated and regulated in the context of other behaviors including chemosensation, olfaction, and cognition. Unraveling these interactions may provide important insights into the diverse roles of these behaviors in the initiation of arousal, stimulation of vigilance, and the relay of certain behavioral states. This chapter focuses primarily on the function of the sigh, how it is locally generated within the preBötC, and what the functional implications are for a potential link between sighing and cognitive regulation. Furthermore, we discuss recent insights gained into the pathways and mechanisms that control yawning, sneezing, and hiccupping.
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19
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Wisnivesky JP, Becker JH, Ankam J, Markowitz SB, Doernberg M, Dickens B, Busse P, Crowley L, Federman A, Katz C, Weiss JJ, Gonzalez A, New York, Queens, and Stony Brook, NY. The Relationship Between Post-Traumatic Stress Disorder and Self-Management Behaviors in World Trade Center Workers with Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:242-249. [PMID: 34534721 PMCID: PMC8973280 DOI: 10.1016/j.jaip.2021.08.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Comorbid posttraumatic stress disorder (PTSD) is highly prevalent and associated with increased morbidity among World Trade Center (WTC) rescue and recovery workers with asthma. However, the potential behavioral pathways underlying this relationship remain unclear. OBJECTIVE To evaluate whether PTSD is associated with lower adherence to asthma self-management behaviors among WTC workers with asthma. METHODS We used data from a prospective cohort of WTC workers with a physician diagnosis of asthma who were prescribed controller medications. Presence of comorbid PTSD was determined based on structured clinical interviews. Asthma self-management behaviors included medication adherence, inhaler technique, use of action plans, and trigger avoidance. We conducted unadjusted and multiple regression analyses to evaluate the association of PTSD with asthma self-management. RESULTS Overall, 30% of 276 WTC workers with asthma had comorbid PTSD. Posttraumatic stress disorder was associated with worse asthma control and poorer quality of life. However, PTSD was not significantly associated with medication adherence (odds ratio [OR] -0.15; 95% confidence interval [CI] -0.5 to 0.2), inhaler technique (OR -0.12; 95% CI -0.7 to 0.5), use of action plans (OR 0.8; 95% CI 0.4 to 1.8), or trigger avoidance (OR 0.9; 95% CI 0.4 to 1.8). CONCLUSIONS We did not find significant differences in key asthma self-management behaviors between WTC workers with and without PTSD. These results suggest that other mechanisms, such as differences in symptom perception or inflammatory pathways, may explain the association between PTSD and increased asthma morbidity.
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Affiliation(s)
- Juan P. Wisnivesky
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY,Division of Pulmonary and Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jacqueline H. Becker
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jyoti Ankam
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Steven B. Markowitz
- Barry Commoner Center for Health and the Environment, Queens College, City University of New York, Queens, NY
| | - Molly Doernberg
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Brittany Dickens
- Barry Commoner Center for Health and the Environment, Queens College, City University of New York, Queens, NY
| | - Paula Busse
- Division of Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Laura Crowley
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alex Federman
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Craig Katz
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jeffrey J. Weiss
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Adam Gonzalez
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
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Thurner C, Horing B, Zipfel S, Stengel A, Mazurak N. Autonomic changes as reaction to experimental social stress in an inpatient psychosomatic cohort. Front Psychiatry 2022; 13:817778. [PMID: 35990055 PMCID: PMC9385984 DOI: 10.3389/fpsyt.2022.817778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Patients with psychosomatic disorders suffer from social isolation that might further lead to destabilization and exacerbation of bodily symptoms via autonomic pathways. We aimed to investigate the influence of controlled social stress (model of social ostracism) on the autonomic nerve system (ANS) in an inpatient cohort with psychosomatic disorders. METHODS We examined heart rate variability (HRV), skin conductance (SC) and skin temperature (ST) as well as ECG-derived respiration rate (EDR) and subjective reports on stress during exposure to experimental social stress (cyberball game). Data were collected from 123 participants (f:m = 88:35, 42.01 ± 13.54 years) on admission and upon discharge from the university psychosomatic clinic. All data were recorded during baseline, inclusion and exclusion phases of the cyberball game as well as during the recovery phase. RESULTS We found significant changes between admission and discharge with a decline in parasympathetic-related HRV parameters (SDRR -3.20 ± 1.30 ms, p = 0.026; RMSSD: -3.77 ± 1.28 ms, p = 0.007) as well as a decrease in SC (-0.04 ± 0.17 μS, p = 0.019) and EDR (-0.01 ± 0.01 Hz, p = 0.007), suggesting a drop in sympathetic tonus, with no changes in ST (p = 0.089) and subjective stress levels (p = 0.322). HRV parameters decreased during the cyberball game (SDRR p = 0.026; RMSSD p = 0.002; lnHF p < 0.001). In contrast, both SC (p < 0.001) and EDR (p < 0.001) increased during the game with SC being slightly lower during the exclusion phase. This can point toward a stimulation of sympathetic nervous system during game participation, which was concordant with the rise in subjective stress values (p < 0.001). ST showed a continuous, unspecific rise over time (p < 0.001). CONCLUSION Our data demonstrate the decrease of ANS parameters during experimental social stress when data upon discharge were compared to those upon admission. These results are partially contradictory to previous studies that showed a rise in HRV in a psychiatric cohort over the course of (outpatient) treatment. Further research is required to help attributing these differences to effects of treatment or acute states relating to admission to or discharge from a psychosomatic department.
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Affiliation(s)
- Carolin Thurner
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital, Tübingen, Germany
| | - Bjoern Horing
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital, Tübingen, Germany
| | - Andreas Stengel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital, Tübingen, Germany.,Clinic for Psychosomatic Medicine, Charité Center for Internal Medicine and Dermatology, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charite - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin, Germany
| | - Nazar Mazurak
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital, Tübingen, Germany
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Roche L, McLay L, Sigafoos J, Whitcombe‐Dobbs S. A review of behavioral treatments for sleep disturbances in civilians who have experienced trauma. BEHAVIORAL INTERVENTIONS 2021. [DOI: 10.1002/bin.1853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Laura Roche
- School of Education University of Newcastle Newcastle New South Wales Australia
| | - Laurie McLay
- School of Health Sciences University of Canterbury Christchurch New Zealand
| | - Jeff Sigafoos
- School of Education Victoria University of Wellington Wellington New Zealand
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22
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Fu Q. Autonomic dysfunction and cardiovascular risk in post-traumatic stress disorder. Auton Neurosci 2021; 237:102923. [PMID: 34844132 DOI: 10.1016/j.autneu.2021.102923] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 09/28/2021] [Accepted: 11/13/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND Patients with post-traumatic stress disorder (PTSD) have an increased risk for cardiovascular disease. The underlying mechanisms are unclear but impaired autonomic function may contribute. However, research in this field has shown contradictory results and the causal links between PTSD, autonomic dysfunction, and cardiovascular risk remain unknown. This brief review summarizes the current knowledge on alterations in autonomic function and cardiovascular risk in patients with PTSD. LITERATURE SEARCH STRATEGY A PubMed search of the literature was performed using the following keywords: autonomic function, heart rate variability, blood pressure variability, sympathetic activity, baroreflex function, and cardiovascular risk in combination with PTSD. Evidence-based studies conducted between 2000 and 2021 were selected. RESULTS In total 1221 articles were identified and of these, 61 (48 original research papers, 13 review articles) were included in this review. Many, though not all, studies have reported increased activity of the sympathetic nervous system and decreased activity of the parasympathetic nervous system (namely, autonomic imbalance) in PTSD patients. There seems to be enough evidence to suggest impairments in baroreflex function in PTSD, leading to blood pressure dysregulation. It appears that the chronicity of PTSD diagnosis and symptom severity are independent risk factors for cardiovascular disease, which may be linked with impaired autonomic function. CONCLUSIONS Increased cardiovascular risk may be associated with autonomic dysfunction in PTSD. Whether autonomic dysfunction can serve as a biomarker for the onset and progression of PTSD remains to be determined. It also needs to determine if autonomic imbalance increases the risk of developing PTSD.
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Affiliation(s)
- Qi Fu
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States of America.
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23
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Gazi AH, Sundararaj S, Harrison AB, Gurel NZ, Wittbrodt MT, Alkhalaf M, Soudan M, Levantsevych O, Haffar A, Shah AJ, Vaccarino V, Bremner JD, Inan OT. Transcutaneous Cervical Vagus Nerve Stimulation Inhibits the Reciprocal of the Pulse Transit Time's Responses to Traumatic Stress in Posttraumatic Stress Disorder . ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021;2021:1444-1447. [PMID: 34891557 PMCID: PMC10114282 DOI: 10.1109/embc46164.2021.9630415] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Research has shown that transcutaneous cervical vagus nerve stimulation (tcVNS) yields downstream changes in peripheral physiology in individuals afflicted with posttraumatic stress disorder (PTSD). While the cardiovascular effects of tcVNS have been studied broadly in prior work, the specific effects of tcVNS on the reciprocal of the pulse transit time (1/PTT) remain unknown. By quantifying detectable effects, tcVNS can be further evaluated as a counterbalance to sympathetic hyperactivity during distress - specifically, we hypothesized that tcVNS would inhibit 1/PTT responses to traumatic stress. To investigate this, the electrocardiogram (ECG), photoplethysmogram (PPG), and seismocardiogram (SCG), were simultaneously measured from 24 human subjects suffering from PTSD. Implementing state-of-the-art signal quality assessment algorithms, relative changes in the pulse arrival time (PAT) and the pre-ejection period (PEP) were estimated solely from signal segments of sufficient quality. Thereby computing relative changes in 1/PTT, we find that tcVNS results in reduced 1/PTT responses to traumatic stress and the first minute of stimulation, compared to a sham control (corrected p < 0.05). This suggests that tcVNS induces inhibitory effects on blood pressure (BP) and/or vasoconstriction, given the established relationship between 1/PTT and these parameters.Clinical Relevance- Relative changes in 1/PTT are induced by varying vasomotor tone and/or BP - it has therefore piqued considerable interest as a potential surrogate of continuous BP. Studying its responses to tcVNS thus furthers understanding of tcVNS-induced cardiovascular modulation. The positive effects detailed herein suggest a potential role for tcVNS in the long-term management of PTSD.
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24
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Wardenaar KJ, Riese H, Giltay EJ, Eikelenboom M, van Hemert AJ, Beekman AF, Penninx BWJH, Schoevers RA. Common and specific determinants of 9-year depression and anxiety course-trajectories: A machine-learning investigation in the Netherlands Study of Depression and Anxiety (NESDA). J Affect Disord 2021; 293:295-304. [PMID: 34225209 DOI: 10.1016/j.jad.2021.06.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/15/2021] [Accepted: 06/17/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Given the strong relationship between depression and anxiety, there is an urge to investigate their shared and specific long-term course determinants. The current study aimed to identify and compare the main determinants of the 9-year trajectories of combined and pure depression and anxiety symptom severity. METHODS Respondents with a 6-month depression and/or anxiety diagnosis (n=1,701) provided baseline data on 152 sociodemographic, clinical and biological variables. Depression and anxiety symptom severity assessed at baseline, 2-, 4-, 6- and 9-year follow-up, were used to identify data-driven course-trajectory subgroups for general psychological distress, pure depression, and pure anxiety severity scores. For each outcome (class-probability), a Superlearner (SL) algorithm identified an optimally weighted (minimum mean squared error) combination of machine-learning prediction algorithms. For each outcome, the top determinants in the SL were identified by determining variable-importance and correlations between each SL-predicted and observed outcome (ρpred) were calculated. RESULTS Low to high prediction correlations (ρpred: 0.41-0.91, median=0.73) were found. In the SL, important determinants of psychological distress were age, young age of onset, respiratory rate, participation disability, somatic disease, low income, minor depressive disorder and mastery score. For course of pure depression and anxiety symptom severity, similar determinants were found. Specific determinants of pure depression included several types of healthcare-use, and of pure-anxiety course included somatic arousal and psychological distress. LIMITATIONS Limited sample size for machine learning. CONCLUSIONS The determinants of depression- and anxiety-severity course are mostly shared. Domain-specific exceptions are healthcare use for depression and somatic arousal and distress for anxiety-severity course.
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Affiliation(s)
- Klaas J Wardenaar
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), Groningen, The Netherlands.
| | - Harriëtte Riese
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), Groningen, The Netherlands
| | - Erik J Giltay
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - Merijn Eikelenboom
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Albert J van Hemert
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - Aartjan F Beekman
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Brenda W J H Penninx
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Robert A Schoevers
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), Groningen, The Netherlands
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25
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Shanker RM, Rezaii EG, Kim M, Anderson DE. Letter: Case Series: Unilateral Amygdala Ablation Ameliorates Post-Traumatic Stress Disorder Symptoms and Biomarkers. Neurosurgery 2021; 88:E478-E479. [PMID: 33582763 DOI: 10.1093/neuros/nyab025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Rachyl M Shanker
- Department of Neurological Surgery Loyola University Medical Center Maywood, Illinois, USA
| | - Elhaum G Rezaii
- Department of Neurological Surgery Loyola University Medical Center Maywood, Illinois, USA
| | - Miri Kim
- Department of Neurological Surgery Loyola University Medical Center Maywood, Illinois, USA
| | - Douglas E Anderson
- Department of Neurological Surgery Loyola University Medical Center Maywood, Illinois, USA
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26
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Li P, Li SB, Wang X, Phillips CD, Schwarz LA, Luo L, de Lecea L, Krasnow MA. Brain Circuit of Claustrophobia-like Behavior in Mice Identified by Upstream Tracing of Sighing. Cell Rep 2021; 31:107779. [PMID: 32553161 PMCID: PMC8576489 DOI: 10.1016/j.celrep.2020.107779] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 04/04/2020] [Accepted: 05/27/2020] [Indexed: 01/09/2023] Open
Abstract
Emotions are distinct patterns of behavioral and physiological responses triggered by stimuli that induce different brain states. Elucidating the circuits is difficult because of challenges in interrogating emotional brain states and their complex outputs. Here, we leverage the recent discovery in mice of a neural circuit for sighing, a simple, quantifiable output of various emotions. We show that mouse confinement triggers sighing, and this "claustrophobic" sighing, but not accompanying tachypnea, requires the same medullary neuromedin B (Nmb)-expressing neurons as physiological sighing. Retrograde tracing from the Nmb neurons identified 12 forebrain centers providing presynaptic input, including hypocretin (Hcrt)-expressing lateral hypothalamic neurons. Confinement activates Hcrt neurons, and optogenetic activation induces sighing and tachypnea whereas pharmacologic inhibition suppresses both responses. The effect on sighing is mediated by HCRT directly on Nmbneurons. We propose that this HCRT-NMB neuropeptide relay circuit mediates claustrophobic sighing and that activated Hcrt neurons are a claustrophobia brain state that directly controls claustrophobic outputs.
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Affiliation(s)
- Peng Li
- Department of Biochemistry, Howard Hughes Medical Institute, Stanford University, Stanford, CA 94305, USA; Life Sciences Institute, Departments of Biologic and Materials Sciences and of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI 48109, USA.
| | - Shi-Bin Li
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305, USA
| | - Xuenan Wang
- Life Sciences Institute, Departments of Biologic and Materials Sciences and of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Chrystian D Phillips
- Life Sciences Institute, Departments of Biologic and Materials Sciences and of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Lindsay A Schwarz
- Department of Biology, Howard Hughes Medical Institute, Stanford University, Stanford, CA 94305, USA
| | - Liqun Luo
- Department of Biology, Howard Hughes Medical Institute, Stanford University, Stanford, CA 94305, USA
| | - Luis de Lecea
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305, USA
| | - Mark A Krasnow
- Department of Biochemistry, Howard Hughes Medical Institute, Stanford University, Stanford, CA 94305, USA.
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27
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Ventromedial prefrontal cortex CRF1 receptors modulate the tachycardic activity of baroreflex. Pflugers Arch 2021; 473:697-709. [PMID: 33839941 DOI: 10.1007/s00424-020-02512-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 12/09/2020] [Accepted: 12/26/2020] [Indexed: 10/21/2022]
Abstract
Ventral medial prefrontal cortex (vMPFC) glutamatergic neurotransmission has a facilitatory role on cardiac baroreflex activity which is mediated by NMDA receptors activation. Corticotrophin releasing factor receptors type1 and 2 (CRF1 and CRF2), present in the vMPFC, are colocalized in neurons containing glutamate vesicles, suggesting that such receptors may be involved in glutamate release in this cortical area. Therefore, our hypothesis is that the CRF1 and CRF2 receptors can modulate the baroreflex bradycardic and tachycardic responses. In order to prove this assumption, male Wistar rats had bilateral stainless steel guide cannula implanted into the vMPFC, and baroreflex was activated by intravenous infusion of phenylephrine or sodium nitroprusside through a vein catheter. A second catheter was implanted into the femoral artery for cardiovascular measurements. The CRF1 receptor antagonist administration in either infralimbic cortex (IL) or prelimbic cortex (PL), vMPFC regions, was unable to change the bradycardic responses but increased the slope of the baroreflex tachycardic activity. Microinjection of the CRF2 receptor antagonist into the IL and PL did not alter ether bradycardic nor tachycardic baroreflex responses. The administration of the non-selective CRF receptors agonist, urocortin in these areas, did not modify bradycardic responses but decreased tachycardia slope of the baroreflex. CRF1 receptor antagonist administration prior to non-selective CRF agonist in vMPFC prevented the tachycardic responses reduction. However, CRF2 receptor antagonism could not prevent the effect of CRF receptors agonist. These results suggest that IL and PL CRF1 but not CRF2 receptors have an inhibitory role on the baroreflex tachycardic activity. Furthermore, they have no influence on baroreflex bradycardic activity.
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28
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Pongratz G. Das gestresste Immunsystem und Autoimmunität. AKTUEL RHEUMATOL 2021. [DOI: 10.1055/a-1389-7949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
ZusammenfassungÜber einen möglichen Zusammenhang zwischen psychologischem
Stress, Immunsystem und Autoimmunität wird schon lange debattiert.
Erkenntnisse aus der Grundlagen- und epidemiologischen Forschung, die das
Verständnis für diesen komplexen Zusammenhang
erhöhen werden in dieser kurzen Übersicht zusammengestellt.
Zunächst werden bekannte anatomisch-physiologische Grundlagen
für einen Zusammenhang zwischen psychologischem Stress und
Immunsystem dargestellt. Es wird beschrieben, dass die Interaktion zwischen
Gehirn über autonomes Nervensystem und Hormonsystem bis zur
Immunzelle mit entsprechenden Rezeptoren für Neurotransmitter und
Hormone mittlerweile bis auf die molekulare Ebene gut beschrieben ist. Im
Rahmen der akuten Stressreaktion treten charakteristische
Veränderungen im Immunsystem auf, die ebenfalls gut dokumentiert
sind. In einem zweiten Teil wird dann beschrieben welche
Veränderungen im Rahmen einer chronischen Stressbelastung am
Immunsystem auftreten können und zuletzt wird diskutiert inwiefern
diese Veränderungen auch für pathophysiologische
Zustände des Immunsystems, z. B. im Rahmen von
Autoimmunerkrankungen, relevant sein könnten. Zusammenfassend
führt akuter Stress, im Sinne der optimalen Vorbereitung einer
fight&flight Situation, zu einer Steigerung der Immunfunktion
v. a. der humoralen Immunität, wohingegen die Auswirkungen
von chronischem Stress weniger klar definiert sind und es eher zu einer
Immundysregulation mit verminderter basaler Immunfunktion, v. a. der
zytotoxischen Funktion aber einer gesteigerten Reaktion nach Aktivierung,
v. a. im angeborenen Immunschenkel kommt. Epidemiologische Daten
belegen gut, dass chronischer Stress zu einer erhöhten
Suzeptibilität für Autoimmunerkrankungen führt.
Erste klinische Anwendungen, wie beispielsweise die gezielte neuronale
Stimulation des N. vagus sind in Erprobung, für einen breiteren
klinischen Einsatz sollten aber die biologischen Netzwerkstrukturen noch
besser verstanden werden, um die besten Angriffspunkte zu finden.
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Affiliation(s)
- Georg Pongratz
- Poliklinik, Funktionsbereich und Hiller Forschungszentrum für Rheumatologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
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Levine GN, Cohen BE, Commodore-Mensah Y, Fleury J, Huffman JC, Khalid U, Labarthe DR, Lavretsky H, Michos ED, Spatz ES, Kubzansky LD. Psychological Health, Well-Being, and the Mind-Heart-Body Connection: A Scientific Statement From the American Heart Association. Circulation 2021; 143:e763-e783. [PMID: 33486973 DOI: 10.1161/cir.0000000000000947] [Citation(s) in RCA: 342] [Impact Index Per Article: 85.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
As clinicians delivering health care, we are very good at treating disease but often not as good at treating the person. The focus of our attention has been on the specific physical condition rather than the patient as a whole. Less attention has been given to psychological health and how that can contribute to physical health and disease. However, there is now an increasing appreciation of how psychological health can contribute not only in a negative way to cardiovascular disease (CVD) but also in a positive way to better cardiovascular health and reduced cardiovascular risk. This American Heart Association scientific statement was commissioned to evaluate, synthesize, and summarize for the health care community knowledge to date on the relationship between psychological health and cardiovascular health and disease and to suggest simple steps to screen for, and ultimately improve, the psychological health of patients with and at risk for CVD. Based on current study data, the following statements can be made: There are good data showing clear associations between psychological health and CVD and risk; there is increasing evidence that psychological health may be causally linked to biological processes and behaviors that contribute to and cause CVD; the preponderance of data suggest that interventions to improve psychological health can have a beneficial impact on cardiovascular health; simple screening measures can be used by health care providers for patients with or at risk for CVD to assess psychological health status; and consideration of psychological health is advisable in the evaluation and management of patients with or at risk for CVD.
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Blood endocannabinoid levels in patients with panic disorder. Psychoneuroendocrinology 2020; 122:104905. [PMID: 33091759 DOI: 10.1016/j.psyneuen.2020.104905] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 09/29/2020] [Accepted: 10/02/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND The development and maintenance of anxiety disorders is not fully understood. There is consensus in the literature that in addition to genetic factors, social, psychological and neurobiological factors are of crucial importance. The present exploratory study investigates the influence of the endocannabinoids (EC) and related N-acylethanolamines (NA) on the maintenance of panic disorder (PD). METHODS A total of n = 36 PD and n = 26 healthy controls (HC) were included in the study. Baseline characteristics showed no differences between the two groups. The participants were exposed to the Trier Social Stress Test (TSST) for reliable laboratory stress induction. Blood samples were taken during the TSST by an intravenous catheter to examine the endocannabinoid (EC) stress response. Repeated measures ANOVA was conducted to test for main effects of time and group as well as the respective interaction. RESULTS Participants with PD consistently had significantly higher EC and NA blood levels than HC. The consistently high EC and NA levels barely showed any reactivity as indicated by a lack of statistical variance. In line with these findings no reaction to the psychosocial stressor TSST could be detected. CONCLUSION Our main results show significant differences in EC concentrations between participants with PD and HC. These findings suggest that an imbalance in the ECS contributes to the maintenance of PD. Increased endocannabinoid levels may have important implications for organic diseases such as cardiovascular disorders. The limitations of the study as well as implications for further investigations are discussed.
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Kokkosis AG, Tsirka SE. Neuroimmune Mechanisms and Sex/Gender-Dependent Effects in the Pathophysiology of Mental Disorders. J Pharmacol Exp Ther 2020; 375:175-192. [PMID: 32661057 PMCID: PMC7569311 DOI: 10.1124/jpet.120.266163] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 07/09/2020] [Indexed: 12/12/2022] Open
Abstract
Innate and adaptive immune mechanisms have emerged as critical regulators of CNS homeostasis and mental health. A plethora of immunologic factors have been reported to interact with emotion- and behavior-related neuronal circuits, modulating susceptibility and resilience to mental disorders. However, it remains unclear whether immune dysregulation is a cardinal causal factor or an outcome of the pathologies associated with mental disorders. Emerging variations in immune regulatory pathways based on sex differences provide an additional framework for discussion in these psychiatric disorders. In this review, we present the current literature pertaining to the effects that disrupted immune pathways have in mental disorder pathophysiology, including immune dysregulation in CNS and periphery, microglial activation, and disturbances of the blood-brain barrier. In addition, we present the suggested origins of such immune dysregulation and discuss the gender and sex influence of the neuroimmune substrates that contribute to mental disorders. The findings challenge the conventional view of these disorders and open the window to a diverse spectrum of innovative therapeutic targets that focus on the immune-specific pathophenotypes in neuronal circuits and behavior. SIGNIFICANCE STATEMENT: The involvement of gender-dependent inflammatory mechanisms on the development of mental pathologies is gaining momentum. This review addresses these novel factors and presents the accumulating evidence introducing microglia and proinflammatory elements as critical components and potential targets for the treatment of mental disorders.
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Affiliation(s)
- Alexandros G Kokkosis
- Department of Pharmacological Sciences, Stony Brook University, Stony Brook, New York
| | - Stella E Tsirka
- Department of Pharmacological Sciences, Stony Brook University, Stony Brook, New York
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Won E, Kim YK. Neuroinflammation-Associated Alterations of the Brain as Potential Neural Biomarkers in Anxiety Disorders. Int J Mol Sci 2020; 21:ijms21186546. [PMID: 32906843 PMCID: PMC7555994 DOI: 10.3390/ijms21186546] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/30/2020] [Accepted: 09/02/2020] [Indexed: 02/06/2023] Open
Abstract
Stress-induced changes in the immune system, which lead to neuroinflammation and consequent brain alterations, have been suggested as possible neurobiological substrates of anxiety disorders, with previous literature predominantly focusing on panic disorder, agoraphobia, and generalized anxiety disorder, among the anxiety disorders. Anxiety disorders have frequently been associated with chronic stress, with chronically stressful situations being reported to precipitate the onset of anxiety disorders. Also, chronic stress has been reported to lead to hypothalamic–pituitary–adrenal axis and autonomic nervous system disruption, which may in turn induce systemic proinflammatory conditions. Preliminary evidence suggests anxiety disorders are also associated with increased inflammation. Systemic inflammation can access the brain, and enhance pro-inflammatory cytokine levels that have been shown to precipitate direct and indirect neurotoxic effects. Prefrontal and limbic structures are widely reported to be influenced by neuroinflammatory conditions. In concordance with these findings, various imaging studies on panic disorder, agoraphobia, and generalized anxiety disorder have reported alterations in structure, function, and connectivity of prefrontal and limbic structures. Further research is needed on the use of inflammatory markers and brain imaging in the early diagnosis of anxiety disorders, along with the possible efficacy of anti-inflammatory interventions on the prevention and treatment of anxiety disorders.
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Affiliation(s)
- Eunsoo Won
- Department of Psychiatry, CHA Bundang Medical Center, CHA University, Seongnam 13496, Korea;
| | - Yong-Ku Kim
- Department of Psychiatry, Korea University Ansan Hospital, Korea University College of Medicine, Ansan 15355, Korea
- Correspondence: ; Tel.: +82-31-412-5140; Fax: +82-31-412-5144
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Schneider M, Schwerdtfeger A. Autonomic dysfunction in posttraumatic stress disorder indexed by heart rate variability: a meta-analysis. Psychol Med 2020; 50:1937-1948. [PMID: 32854795 PMCID: PMC7525781 DOI: 10.1017/s003329172000207x] [Citation(s) in RCA: 128] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 05/20/2020] [Accepted: 05/27/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Changes in autonomic nervous system (ANS) function have been observed in a variety of psychological disorders, including posttraumatic stress disorder (PTSD). Analysis of heart rate variability (HRV) provides insight into the functioning of the ANS. Previous research on PTSD found lower HRV in PTSD patients compared to controls, indicating altered sympathetic and parasympathetic activity, but findings are inconsistent. The purpose of this meta-analysis was to examine differences in HRV indices between individuals with PTSD and healthy controls at baseline and during stress. METHODS The included primary studies present an aggregate of studies analyzing different HRV indices. Examined HRV indices were standard deviation of the normalized NN-intervals (SDNN), root mean square of successive differences (RMSSD), low-frequency (LF) and high-frequency (HF) spectral components, LF/HF ratio, and heart rate (HR). Moderating effects of study design, HRV and PTSD assessment, and sample characteristics were examined via subgroup-analyses and meta-regressions. RESULTS Random-effects meta-analyses for HRV parameters at rest revealed significant group differences for RMSSD and HF-HRV, suggesting lower parasympathetic activity in PTSD. The aggregated effect size for SDNN was medium, suggesting diminished total variability in PTSD. A small effect was found for LF-HRV. A higher LF/HF ratio was found in the PTSD sample as compared to controls. Individuals with PTSD showed significantly higher HR. During stress, individuals with PTSD showed higher HR and lower HF-HRV, both indicated by small effect sizes. CONCLUSIONS Findings suggest that PTSD is associated with ANS dysfunction.
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Qiu ZK, Liu X, Chen Y, Wu RJ, Guan SF, Pan YY, Wang QB, Tang D, Zhu T, Chen JS. Translocator protein 18 kDa: a potential therapeutic biomarker for post traumatic stress disorder. Metab Brain Dis 2020; 35:695-707. [PMID: 32172519 DOI: 10.1007/s11011-020-00548-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 02/10/2020] [Indexed: 11/11/2022]
Abstract
Post traumatic stress disorder (PTSD) is widely regarded as a stress-related and trauma disorder. The symptoms of PTSD are characterized as a spectrum of vulnerabilities after the exposure to an extremely traumatic stressor. Considering as one of complex mental disorders, little progress has been made toward its diagnostic biomarkers, despite the involvement of PTSD has been studied. Many studies into the underlying neurobiology of PTSD implicated the dysfunction of neurosteroids biosynthesis and neuorinflammatory processes. Translocator protein 18 kDa (TSPO) has been considered as one of the promising therapeutic biomarkers for neurological stress disorders (like PTSD, depression, anxiety, et al) without the benzodiazepine-like side effects. This protein participates in the formation of neurosteroids and modulation of neuroinflammation. The review outlines current knowledge involving the role of TSPO in the neuropathology of PTSD and the anti-PTSD-like effects of TSPO ligands.
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Affiliation(s)
- Zhi-Kun Qiu
- Pharmaceutical Department of The First Affiliated Hospital of Guangdong Pharmaceutical University, Clinical Pharmacy Department of Guangdong Pharmaceutical University, Guangzhou, 510080, People's Republic of China
| | - Xu Liu
- Pharmacy Department of Medical Supplies Center of General Hospital of Chinese People's Armed Police Forces, Beijing, 100039, People's Republic of China
| | - Yong Chen
- Pharmaceutical Department of The First Affiliated Hospital of Guangdong Pharmaceutical University, Clinical Pharmacy Department of Guangdong Pharmaceutical University, Guangzhou, 510080, People's Republic of China
| | - Rong-Jia Wu
- Pharmaceutical Department of The First Affiliated Hospital of Guangdong Pharmaceutical University, Clinical Pharmacy Department of Guangdong Pharmaceutical University, Guangzhou, 510080, People's Republic of China
| | - Shi-Feng Guan
- Pharmaceutical Department of The First Affiliated Hospital of Guangdong Pharmaceutical University, Clinical Pharmacy Department of Guangdong Pharmaceutical University, Guangzhou, 510080, People's Republic of China
| | - Yun-Yun Pan
- Pharmaceutical Department of The First Affiliated Hospital of Guangdong Pharmaceutical University, Clinical Pharmacy Department of Guangdong Pharmaceutical University, Guangzhou, 510080, People's Republic of China
| | - Qian-Bo Wang
- Pharmaceutical Department of The First Affiliated Hospital of Guangdong Pharmaceutical University, Clinical Pharmacy Department of Guangdong Pharmaceutical University, Guangzhou, 510080, People's Republic of China
| | - Dan Tang
- Guangdong Provincial Key Laboratory of Pharmacodynamic Constituents of TCM and New Drugs Research, College of Pharmacy, Jinan University, Guangzhou, 510632, People's Republic of China
| | - Tao Zhu
- Guangdong Provincial Key Laboratory of Pharmacodynamic Constituents of TCM and New Drugs Research, College of Pharmacy, Jinan University, Guangzhou, 510632, People's Republic of China
| | - Ji-Sheng Chen
- Pharmaceutical Department of The First Affiliated Hospital of Guangdong Pharmaceutical University, Clinical Pharmacy Department of Guangdong Pharmaceutical University, Guangzhou, 510080, People's Republic of China.
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35
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Lieberman L, Funkhouser CJ, Gorka SM, Liu H, Correa KA, Berenz EC, Phan KL, Shankman SA. The Relation Between Posttraumatic Stress Symptom Severity and Startle Potentiation to Predictable and Unpredictable Threat. J Nerv Ment Dis 2020; 208:397-402. [PMID: 32053566 PMCID: PMC10627509 DOI: 10.1097/nmd.0000000000001138] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Aberrant threat reactivity has been implicated in the pathophysiology of posttraumatic stress disorder (PTSD); however, the literature on this association is mixed. One factor that may contribute to this inconsistent association is differences in severity of posttraumatic stress symptoms (PTSSs) across studies, but no studies have tested this hypothesis. The relation between PTSD and threat reactivity may also differ between unpredictable threats (U-threats) and predictable threats (P-threats), given burgeoning evidence to support a particular role for aberrant responding to U-threat in PTSD. The present study examined how PTSS severity relates to startle potentiation to U-threat and P-threat in a trauma-exposed community sample (N = 258). There was a negative linear, but not quadratic, relation between PTSS severity and startle potentiation to U-threat, but not P-threat. Blunted defensive responding to U-threat may therefore contribute to higher levels of PTSSs and may represent a novel treatment target for higher levels of PTSSs.
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Affiliation(s)
- Lynne Lieberman
- Department of Psychology, University of Illinois-Chicago
- Department of Psychiatry, University of Illinois-Chicago
| | | | - Stephanie M. Gorka
- Department of Psychology, University of Illinois-Chicago
- Department of Psychiatry, University of Illinois-Chicago
| | - Huiting Liu
- Department of Psychology, University of Illinois-Chicago
| | | | - Erin C. Berenz
- Department of Psychology, University of Illinois-Chicago
| | - K. Luan Phan
- Department of Psychology, University of Illinois-Chicago
- Department of Psychiatry, University of Illinois-Chicago
- Anatomy and Cell Biology and the Graduate Program in Neuroscience, University of Illinois-Chicago
- Jesse Brown VA Medical Center, Mental Health Service Line
| | - Stewart A. Shankman
- Department of Psychology, University of Illinois-Chicago
- Department of Psychiatry, University of Illinois-Chicago
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, Illinois
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36
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Ferreira de Sá DS, Römer S, Brückner AH, Issler T, Hauck A, Michael T. Effects of intranasal insulin as an enhancer of fear extinction: a randomized, double-blind, placebo-controlled experimental study. Neuropsychopharmacology 2020; 45:753-760. [PMID: 31896118 PMCID: PMC7076012 DOI: 10.1038/s41386-019-0593-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 11/26/2019] [Accepted: 12/16/2019] [Indexed: 01/27/2023]
Abstract
Fear-extinction based psychotherapy (exposure) is the most effective method for treating anxiety disorders. Notwithstanding, since some patients show impairments in the unlearning of fear and insufficient fear remission, there is a growing interest in using cognitive enhancers as adjuvants to exposure. As insulin plays a critical role in stress processes and acts as a memory enhancer, this study aimed to assess the capacity of intranasal insulin to augment fear extinction. A double-blind, placebo-controlled differential fear-conditioning paradigm was conducted in 123 healthy participants (63 females). Pictures of faces with neutral expressions were used as conditioned stimuli and electric shocks as unconditioned stimuli. The paradigm consisted of four phases presented on three consecutive days: acquisition (day 1), extinction (day 2), reinstatement and re-extinction (day 3). A single intranasal dose of insulin (160 IU) or placebo was applied on day 2, 45 min before fear extinction. Skin conductance response (SCR), fear-potentiated startle (FPS) and expectancy ratings were assessed. During extinction, the insulin group (independent of sex) showed a significantly stronger decrease in differential FPS in comparison with the placebo group. Furthermore, a sex-specific effect was found for SCR, with women in the insulin group showing a greater decrease of differential SCR both at early extinction and at late re-extinction. Our results provide first evidence that intranasal insulin facilitates fear extinction processes and is therefore a promising adjuvant for extinction-based therapies in anxiety and related disorders. Sex-specific effects should be taken into consideration in future studies.
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Affiliation(s)
- Diana S. Ferreira de Sá
- 0000 0001 2167 7588grid.11749.3aDivision of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Saarbrücken, Germany
| | - Sonja Römer
- 0000 0001 2167 7588grid.11749.3aDivision of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Saarbrücken, Germany
| | - Alexandra H. Brückner
- 0000 0001 2167 7588grid.11749.3aDivision of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Saarbrücken, Germany
| | - Tobias Issler
- 0000 0001 2167 7588grid.11749.3aDivision of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Saarbrücken, Germany
| | - Alexander Hauck
- 0000 0001 2167 7588grid.11749.3aDivision of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Saarbrücken, Germany
| | - Tanja Michael
- 0000 0001 2167 7588grid.11749.3aDivision of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Saarbrücken, Germany
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Guyon AJAA, Cannavò R, Studer RK, Hildebrandt H, Danuser B, Vlemincx E, Gomez P. Respiratory Variability, Sighing, Anxiety, and Breathing Symptoms in Low- and High-Anxious Music Students Before and After Performing. Front Psychol 2020; 11:303. [PMID: 32174869 PMCID: PMC7054282 DOI: 10.3389/fpsyg.2020.00303] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 02/07/2020] [Indexed: 12/21/2022] Open
Abstract
Music performance anxiety (MPA) is a major problem for music students. It is largely unknown whether music students who experience high or low anxiety differ in their respiratory responses to performance situations and whether these co-vary with self-reported anxiety, tension, and breathing symptoms. Affective processes influence dynamic respiratory regulation in ways that are reflected in measures of respiratory variability and sighing. This study had two goals. First, we determined how measures of respiratory variability, sighing, self-reported anxiety, tension, and breathing symptoms vary as a function of the performance situation (practice vs. public performance), performance phase (pre-performance vs. post-performance), and the general MPA level of music students. Second, we analyzed to what extent self-reported anxiety, tension, and breathing symptoms co-vary with the respiratory responses. The participants were 65 university music students. We assessed their anxiety, tension, and breathing symptoms with Likert scales and recorded their respiration with the LifeShirt system during a practice performance and a public performance. For the 10-min periods before and after each performance, we computed number of sighs, coefficients of variation (CVs, a measure of total variability), autocorrelations at one breath lag (ARs(1), a measure of non-random variability) and means of minute ventilation (V’E), tidal volume (VT), inspiration time (TI), and expiration time (TE). CVs and sighing were greater whereas AR(1) of V’E was lower in the public session than in the practice session. The effect of the performance situation on CVs and sighing was larger for high-MPA than for low-MPA participants. Higher MPA levels were associated with lower CVs. At the within-individual level, anxiety, tension, and breathing symptoms were associated with deeper and slower breathing, greater CVs, lower AR(1) of V’E, and more sighing. We conclude that respiratory variability and sighing are sensitive to the performance situation and to musicians’ general MPA level. Moreover, anxiety, tension, breathing symptoms, and respiratory responses co-vary significantly in the context of music performance situations. Respiratory monitoring can add an important dimension to the understanding of music performance situations and MPA and to the diagnostic and intervention outcome assessments of MPA.
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Affiliation(s)
- Amélie J A A Guyon
- Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
| | - Rosamaria Cannavò
- Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
| | - Regina K Studer
- School of Applied Psychology, University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland
| | - Horst Hildebrandt
- Swiss University Centre for Music Physiology, Basel and Zurich Universities of the Arts, Zurich, Switzerland
| | - Brigitta Danuser
- Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
| | - Elke Vlemincx
- School of Biological and Chemical Sciences, Queen Mary University of London, London, United Kingdom
| | - Patrick Gomez
- Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
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Vlemincx E, Luminet O. Sighs can become learned behaviors via operant learning. Biol Psychol 2020; 151:107850. [DOI: 10.1016/j.biopsycho.2020.107850] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 01/20/2020] [Accepted: 01/20/2020] [Indexed: 10/25/2022]
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Gurtovenko K, Katz LF. Post-Traumatic Stress, Mother's Emotion Regulation, and Parenting in Survivors of Intimate Partner Violence. JOURNAL OF INTERPERSONAL VIOLENCE 2020; 35:876-898. [PMID: 29294652 DOI: 10.1177/0886260517690874] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Post-traumatic stress symptoms (PTSS) are high among female survivors of intimate partner violence (IPV), and children of parents experiencing PTSS are at heightened risk for a wide range of emotional and behavioral problems. Parenting has significant influence on child adjustment, and although links have been found between parental psychopathology and maladaptive parenting, little is known about the factors that may explain this relation. The current study examines mother's emotion regulation (ER) as a factor influencing the relation between mother PTSS and parenting around children's emotions in a study sample of sixty-four female survivors of IPV and their 6- to 12-year-old children. Mothers reported on their own PTSS and their parenting. Respiratory sinus arrhythmia (RSA) was used as a psychophysiological index of mother's ER. Experiential components of mother's ER was also measured by observer coding of the Meta-Emotion Interview, a structured assessment that asks parents about their attitudes toward and experiences with emotions, including their regulation of emotions. Mother's RSA reactivity moderated the relation between PTSS and negative parenting. There was also a significant indirect relation between mothers' PTSS symptom severity and supportive parenting reactions through mothers' self-report of ER. Results suggest that mother's ER abilities represent factors that significantly affect associations between maternal PTSS and parent's emotion socialization practices. Implications for assessment and intervention with families exposed to the stress of IPV are discussed.
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40
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Ge F, Yuan M, Li Y, Zhang W. Posttraumatic Stress Disorder and Alterations in Resting Heart Rate Variability: A Systematic Review and Meta-Analysis. Psychiatry Investig 2020; 17:9-20. [PMID: 31995968 PMCID: PMC6992856 DOI: 10.30773/pi.2019.0112] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 10/14/2019] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE The functions of both the central and peripheral autonomic nervous system, indexed by heart rate variability (HRV), are affected by psychology and physiology. This review summarizes the results of studies comparing the evaluation of HRV parameters between individuals with posttraumatic stress disorder (PTSD) and healthy controls. METHODS Eligible studies (n=499) were identified through literature searches of the EMBASE, Medline, PubMed and Web of Science databases. Nineteen studies met our inclusion criteria. A random effects model was used, and standardized mean differences for highfrequency HRV(HF-HRV), low-frequency HRV(LF-HRV) and the root mean square of successive R-R interval differences (RMSSD) were calculated. RESULTS Significant effects were found for HF-HRV [p<0.0001, Z=4.18; Hedges'g=-1.58, 95% confidence interval (CI) (-2.32, -0.84); k=14] and RMSSD [p<0.00001, Z=4.80; Hedges'g=-1.96, 95% CI (-2.76, -1.16); k=9] relative to healthy controls. Considerable heterogeneity was revealed, but the main effects for HF-HRV and RMSSD were robust in subsequent meta-regression and subgroup analyses. CONCLUSION Given the relationships among low vagal state, inflammation, and alterations in brain structure and function, including executive function and emotion regulation, reduced HRV may be regarded as an endophenotype in PTSD research.
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Affiliation(s)
- Fenfen Ge
- Mental Health Center of West China Hospital, Sichuan University, Chengdu, China
| | - Minlan Yuan
- Mental Health Center of West China Hospital, Sichuan University, Chengdu, China
| | - Ying Li
- Embedded System and Intelligent Computing Laboratory, University of Electronic Science and Technology of China, Chengdu, China
| | - Wei Zhang
- Mental Health Center of West China Hospital, Sichuan University, Chengdu, China
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41
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Thurston RC, Carson MY, Koenen KC, Chang Y, Matthews KA, von Känel R, Jennings JR. The relationship of trauma exposure to heart rate variability during wake and sleep in midlife women. Psychophysiology 2019; 57:e13514. [PMID: 31850525 DOI: 10.1111/psyp.13514] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 11/19/2019] [Accepted: 11/24/2019] [Indexed: 11/28/2022]
Abstract
Traumatic experiences are common and linked to cardiovascular disease (CVD) risk, yet the mechanisms underlying these relationships is less well understood. Few studies have examined trauma exposure and its relation to autonomic influence over cardiac function, a potential pathway linking trauma exposure to CVD risk. Investigating autonomic influence over cardiac function during both wake and sleep is critical, given particular links of sleep autonomic function to cardiovascular health. Among midlife women, we tested whether trauma exposure would be related to lower high frequency heart rate variability (HF-HRV), an index of vagal influence over cardiac function, during wake and sleep. Three hundred and one nonsmoking midlife women completed physical measures, a 24-hr electrocardiogram, actigraphy sleep measurement, and questionnaires about trauma (Brief Trauma Questionnaire), childhood abuse (Child Trauma Questionnaire [CTQ]), mood, demographics, and medical/psychiatric history. Relations between trauma and HF-HRV were assessed in linear mixed effects models adjusting for covariates (age, race, education, body mass index, blood pressure, psychiatric history, medication use, sleep, mood, childhood abuse history). Results indicated that most women had experienced trauma. Any trauma exposure as well as a greater number of traumatic experiences were associated with lower HF-HRV during wake and particularly during sleep. Relations were not accounted for by covariates. Among midlife women, trauma exposure was related to lower HF-HRV during wake and sleep. Trauma may have an important impact on vagal influence over the heart, particularly during sleep. Decreased vagal influence over cardiac function may be a key mechanism by which trauma is associated with CVD risk.
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Affiliation(s)
- Rebecca C Thurston
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania.,Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Mary Y Carson
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Karestan C Koenen
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Yuefang Chang
- Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Karen A Matthews
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania.,Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - J Richard Jennings
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania
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Increased epoch-to-epoch parasympathetic cardiac regulation in participants with posttraumatic stress disorder compared to those with panic disorder and control participants. J Anxiety Disord 2019; 68:102144. [PMID: 31593854 DOI: 10.1016/j.janxdis.2019.102144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 08/19/2019] [Accepted: 09/13/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Research on the link between respiratory sinus arrhythmia (RSA) and posttraumatic stress disorder (PTSD) has largely focused on average levels of RSA. However, given that rapid shifts in parasympathetic tone are necessary to maintain adaptive cardiac variability, the exclusive focus on these tonic estimates provides an incomplete quantification of parasympathetic cardiac regulation. METHOD The present study is a secondary analysis of previously published data. This analysis aimed to address this limitation by examining the dynamic regulatory effect of the parasympathetic nervous system on heart rate. As such, we examined epoch-to-epoch parasympathetic cardiac regulation - operationalized as the lagged relationship between RSA and heart rate (HR) across consecutive 30-s epochs - across a single night in participants with PTSD, panic disorder (PD), comorbid PTSD and PD (PTSD + PD), and healthy controls. Electrocardiogram and respiratory signals were continuously recorded from 23 participants with PTSD, 14 with PD, 16 with PTSD + PD, and 16 control participants over a single night of sleep in a laboratory setting. RESULTS No group differences in tonic RSA were observed; however, participants with PTSD only and PTSD + PD exhibited significantly greater epoch-to-epoch parasympathetic cardiac regulation over the night than those with PD only and control participants. Moreover, greater severity of hyperarousal symptoms was significantly associated with increased epoch-to-epoch parasympathetic cardiac regulation among participants with PTSD only and PTSD + PD. DISCUSSION These data provide preliminary evidence for an upregulatory parasympathetic response to self-reported hyperarousal in participants with PTSD only and PTSD + PD reflected by increased epoch-to-epoch parasympathetic cardiac regulation.
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43
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Jung W, Jang KI, Lee SH. Heart and Brain Interaction of Psychiatric Illness: A Review Focused on Heart Rate Variability, Cognitive Function, and Quantitative Electroencephalography. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2019; 17:459-474. [PMID: 31671483 PMCID: PMC6852682 DOI: 10.9758/cpn.2019.17.4.459] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 11/30/2018] [Accepted: 12/19/2018] [Indexed: 12/26/2022]
Abstract
Heart rate variability (HRV) reflects beat-to-beat variability in the heart rate due to the dynamic interplay of the sympathetic and parasympathetic nervous systems. HRV is considered an index of the functional status of the autonomic nervous system. A decrease in HRV is thus observed in individuals with autonomic dysfunction. Abnormal HRV has been reported in a range of mental disorders. In this review, we give an overview of HRV in patients with major depressive disorder (MDD), schizophrenia, and posttraumatic stress disorder (PTSD), one of whose core symptoms is cognitive dysfunction. The association between HRV and cognitive function is highlighted in this review. This review consists of three main sections. In the first section, we examine how HRV in patients with MDD, schizophrenia, and PTSD is characterized, and how it is different when compared to that in healthy controls. In the second section, beyond the heart itself, we discuss the intimate connection between the heart and the brain, focusing on how HRV interacts with quantitative electroencephalography (qEEG) in the context of physiological changes in the sleep cycle. Lastly, we finish the review with the examination of the association between HRV and cognitive function. The overall findings indicate that the reduction in HRV is one of main manifestations in MDD, schizophrenia, and PTSD, and also more generally HRV is closely linked to the change in qEEG and also to individual differences in cognitive performance.
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Affiliation(s)
- Wookyoung Jung
- Department of Psychology, Keimyung University, Daegu, Korea
| | - Kuk-In Jang
- 2Department of Biomedicine and Health Sciences, College of Medicine, The Catholic University of Korea, Korea.,Institute of Biomedical Industry, The Catholic University of Korea, Seoul, Korea
| | - Seung-Hwan Lee
- Department of Psychiatry,Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea.,Clinical Emotion and Cognition Research Laboratory, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
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An E, Nolty AAT, Amano SS, Rizzo AA, Buckwalter JG, Rensberger J. Heart Rate Variability as an Index of Resilience. Mil Med 2019; 185:363-369. [DOI: 10.1093/milmed/usz325] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Abstract
Introduction
Resilience is the ability to maintain or quickly return to a stable physical and psychological equilibrium despite experiencing stressful events. Flexibility of the autonomic nervous system is particularly important for adaptive stress responses and may contribute to individual differences in resilience. Power spectrum analysis of heart rate variability (HRV) allows measurement of sympathovagal balance, which helps to evaluate autonomic flexibility. The present study investigated HRV as a broad index of resilience.
Materials and Methods
Twenty-four male participants from the Army National Guard Special Forces completed psychological measures known to relate to resilience and had HRV measured while undergoing stressful virtual environment scenarios. Pearson product-moment correlations were used to explore the relationships between HRV and resilience factors. All research was conducted with the oversight of the Human Subjects Review Committee of Fuller Theological Seminary.
Results
Trends toward significance were reported in order to provide results that would reasonably be expected in a study of higher power. Trends between resilience factors and HRV were found only during specific stress-inducing simulations (see Tables III).
Conclusion
Greater resilience to stress was associated with HRV during nonstress periods. Higher levels of resilience to traumatic events were associated with HRV during circumstances that were more stressful and emotionally distressing. Post hoc analysis revealed that specific factors including flexibility, emotional control, and spirituality were driving the relationship between general resilience and HRV following emotionally laden stressors. Less stress vulnerability was associated with HRV following intermittent brief stressors. In sum, HRV appears to represent some aspects of an individual’s overall resilience profile. Although resilience remains a complex, multidimensional construct, HRV shows promise as a global psychophysiological index of resilience. This study also offers important perspectives concerning ways to optimize both physical and psychological health.
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Affiliation(s)
- Eric An
- Graduate School of Psychology, Fuller Theological Seminary, 135 N Oakland Ave, Pasadena, CA 91101
| | - Anne A T Nolty
- Graduate School of Psychology, Fuller Theological Seminary, 135 N Oakland Ave, Pasadena, CA 91101
- Headington Institute, 402 S Marengo Ave, Pasadena, CA 91101
| | - Stacy S Amano
- Graduate School of Psychology, Fuller Theological Seminary, 135 N Oakland Ave, Pasadena, CA 91101
| | - Albert A Rizzo
- Institute for Creative Technologies, University of Southern California, 12015 E Waterfront Dr, Los Angeles, CA 90094
| | - J Galen Buckwalter
- Headington Institute, 402 S Marengo Ave, Pasadena, CA 91101
- Institute for Creative Technologies, University of Southern California, 12015 E Waterfront Dr, Los Angeles, CA 90094
| | - Jared Rensberger
- Graduate School of Psychology, Fuller Theological Seminary, 135 N Oakland Ave, Pasadena, CA 91101
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Mikolajewski AJ, Scheeringa MS. Examining the Prospective Relationship between Pre-Disaster Respiratory Sinus Arrhythmia and Post-Disaster Posttraumatic Stress Disorder Symptoms in Children. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2019; 46:1535-1545. [PMID: 29327312 DOI: 10.1007/s10802-017-0396-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Previous studies have examined the concurrent relationship between posttraumatic stress disorder (PTSD) and a range of psychophysiological variables, including respiratory sinus arrhythmia (RSA). However, there is a lack of research examining the prospective development of trauma symptomatology, and the directionality of the association between RSA level and PTSD has yet to be determined. The current study is the first prospective study to examine whether RSA level and RSA reactivity are risk factors for PTSD symptoms in children. Assessments were conducted both prior to (Time 1) and following (Time 2) a natural disaster (i.e., Hurricane Katrina). Participants were 36 children who were 3-6 years-old during the Time 1 assessment. Structured diagnostic interviews were used to assess PTSD symptoms at both Time 1 and Time 2. RSA level during a neutral stimulus, RSA reactivity to emotional video stimuli (distress, joy, and trauma videos) and RSA reactivity to memory stimuli (remote happy memory, trauma memory, mother's recall of the trauma memory) were also collected at both time points. Time 1 RSA level during a neutral stimulus was a significant predictor of Time 2 PTSD symptoms (controlling for age, Time 1 PTSD symptoms, Time 2 neutral RSA level), such that lower RSA during a neutral condition was related to higher PTSD symptoms. Also, Time 1 RSA reactivity in response to memory (but not video) stimuli, in the form of relatively less vagal withdrawal, was a significant predictor of more Time 2 PTSD symptoms (controlling for age, Time 1 PTSD symptoms, Time 2 RSA reactivity). This unique prospective study provides evidence for level of RSA and RSA reactivity as pre-existing clinical markers of stress sensitivity that predict psychopathology following a trauma.
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Affiliation(s)
- Amy J Mikolajewski
- Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, 1430 Tulane Ave. #8448, New Orleans, LA, 70112, USA.
| | - Michael S Scheeringa
- Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, 1430 Tulane Ave. #8448, New Orleans, LA, 70112, USA
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46
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Rosman L, Lampert R, Ramsey CM, Dziura J, Chui PW, Brandt C, Haskell S, Burg MM. Posttraumatic Stress Disorder and Risk for Early Incident Atrial Fibrillation: A Prospective Cohort Study of 1.1 Million Young Adults. J Am Heart Assoc 2019; 8:e013741. [PMID: 31564191 PMCID: PMC6806049 DOI: 10.1161/jaha.119.013741] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background Acute psychological stress and negative emotions are known risk factors for atrial fibrillation (AF). Whether exposure to chronic stress syndromes, such as posttraumatic stress disorder (PTSD), also increases susceptibility to AF is unknown. Methods and Results We prospectively assessed the incidence of AF over a 13-year period among 988 090 young and middle-aged veterans (mean age, 30.29±9.19 years; 87.8% men, 64.5% white) who first accessed care through the Veterans Health Administration from October 2001 to November 2014 and were free of AF, atrial flutter, or atrial tachycardia at baseline. Time-varying, multivariate Cox proportional hazard models were used to examine the independent contribution of PTSD to new AF. We also tested for effect modification by sex and controlled for healthcare use. During a mean follow-up of 4.8 years, 2491 patients were diagnosed with AF. Patients with PTSD had a higher overall incidence of AF (P<0.0001) and were more likely to develop AF at a younger age than those without PTSD (P=0.004). PTSD was significantly associated with incident AF in unadjusted models (hazard ratio, 1.31; 95% CI, 1.19-1.43) and models that adjusted for demographics, lifestyle factors, cardiovascular risk factors, and depression (hazard ratio, 1.13; 95% CI, 1.02-1.24). The interaction with sex was nonsignificant (P=0.93). Conclusions PTSD was associated increased risk for early incident AF after adjustment for established AF risk factors and depression in this cohort of young and middle-aged veterans. Findings from this study require validation in more diverse populations to determine their generalizability.
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Affiliation(s)
- Lindsey Rosman
- Department of Medicine-Cardiology University of North Carolina School of Medicine Chapel Hill NC.,Department of Internal Medicine (Cardiovascular Medicine) Yale School of Medicine New Haven CT.,VA Connecticut Healthcare System West Haven CT
| | - Rachel Lampert
- Department of Internal Medicine (Cardiovascular Medicine) Yale School of Medicine New Haven CT
| | - Christine M Ramsey
- Yale Center for Medical Informatics Yale School of Medicine New Haven CT
| | - James Dziura
- Yale Center for Medical Informatics Yale School of Medicine New Haven CT
| | - Phillip W Chui
- Department of Internal Medicine (Cardiovascular Medicine) Yale School of Medicine New Haven CT.,VA Connecticut Healthcare System West Haven CT
| | - Cynthia Brandt
- Department of Emergency Medicine Yale School of Medicine New Haven CT.,Yale Center for Medical Informatics Yale School of Medicine New Haven CT.,VA Connecticut Healthcare System West Haven CT
| | - Sally Haskell
- Department of Internal Medicine Yale School of Medicine New Haven CT.,VA Connecticut Healthcare System West Haven CT
| | - Matthew M Burg
- Department of Internal Medicine (Cardiovascular Medicine) Yale School of Medicine New Haven CT.,Department of Anesthesiology Yale School of Medicine New Haven CT.,VA Connecticut Healthcare System West Haven CT
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Wilson MA, Liberzon I, Lindsey ML, Lokshina Y, Risbrough VB, Sah R, Wood SK, Williamson JB, Spinale FG. Common pathways and communication between the brain and heart: connecting post-traumatic stress disorder and heart failure. Stress 2019; 22:530-547. [PMID: 31161843 PMCID: PMC6690762 DOI: 10.1080/10253890.2019.1621283] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Psychiatric illnesses and cardiovascular disease (CVD) contribute to significant overall morbidity, mortality, and health care costs, and are predicted to reach epidemic proportions with the aging population. Within the Veterans Administration (VA) health care system, psychiatric illnesses such as post-traumatic stress disorder (PTSD) and CVD such as heart failure (HF), are leading causes of hospital admissions, prolonged hospital stays, and resource utilization. Numerous studies have demonstrated associations between PTSD symptoms and CVD endpoints, particularly in the Veteran population. Not only does PTSD increase the risk of HF, but this relationship is bi-directional. Accordingly, a VA-sponsored conference entitled "Cardiovascular Comorbidities in PTSD: The Brain-Heart Consortium" was convened to explore potential relationships and common biological pathways between PTSD and HF. The conference was framed around the hypothesis that specific common systems are dysregulated in both PTSD and HF, resulting in a synergistic acceleration and amplification of both disease processes. The conference was not intended to identify all independent pathways that give rise to PTSD and HF, but rather identify shared systems, pathways, and biological mediators that would be modifiable in both disease processes. The results from this conference identified specific endocrine, autonomic, immune, structural, genetic, and physiological changes that may contribute to shared PTSD-CVD pathophysiology and could represent unique opportunities to develop therapies for both PTSD and HF. Some recommendations from the group for future research opportunities are provided.
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Affiliation(s)
- Marlene A. Wilson
- Department of Pharmacology, Physiology and Neuroscience, University of South Carolina School of Medicine and Research Service, Columbia VA Health Care System, Columbia SC
- Corresponding author information: Marlene A. Wilson, Department of Pharmacology, Physiology and Neuroscience, University of South Carolina School of Medicine, Columbia SC 29208, Research Service, Columbia VA Health Care System, Columbia SC 29209, ; 803-216-3507
| | - Israel Liberzon
- Department of Psychiatry, Texas A&M College of Medicine, Bryan, TX
| | - Merry L. Lindsey
- Department of Cellular and Integrative Physiology, University of Nebraska Medical Center, and Research Service, Omaha VA Medical Center, Omaha NE
| | - Yana Lokshina
- Department of Psychiatry, Texas A&M College of Medicine, Bryan, TX
| | - Victoria B. Risbrough
- VA Center of Excellence for Stress and Mental Health, La Jolla CA, Dept. of Psychiatry, University of California San Diego
| | - Renu Sah
- Department of Pharmacology and Systems Physiology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Susan K. Wood
- Department of Pharmacology, Physiology and Neuroscience, University of South Carolina School of Medicine and Research Service, Columbia VA Health Care System, Columbia SC
| | - John B. Williamson
- Department of Neurology, University of Florida College of Medicine, Gainesville FL
| | - Francis G. Spinale
- Department of Cell Biology and Anatomy, University of South Carolina School of Medicine and Research Service, Columbia VA Health Care System., Columbia SC
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48
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Insensitivity of auditory mismatch negativity to classical fear conditioning and extinction in healthy humans. Neuroreport 2019; 30:468-472. [PMID: 30817683 DOI: 10.1097/wnr.0000000000001221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The relationship between auditory mismatch negativity (MMN) and the neural cognitive processes of fear has been suggested in both healthy participants and patients with fear-related mental disorders such as post-traumatic stress disorder and panic disorder. The present study sought to confirm whether the MMN is affected by classical fear conditioning in healthy participants. MMN amplitude, N1 amplitude, and skin conductance level (SCL) in 20 healthy volunteers during a fear-conditioning paradigm consisting of three phases (habituation, fear acquisition, and fear extinction) were recorded. Red and blue light signals were presented as the conditioned stimuli CS+ (threat cue) and CS- (safety cue), respectively. In addition, an aversive electrical stimulus was delivered as the unconditioned stimulus with CS+ in the fear-acquisition phase. No MMN amplitude changes were observed between the CS types during the three phases. In the acquisition phase, the mean SCL during CS+ was significantly higher than that during CS-. The MMN amplitude and deviant N1 amplitude in the extinction phase were significantly lower than those in the other phases regardless of the CS type. Despite the clear alteration of SCL between CS types in the acquisition phase, no significant differences in MMN were observed. Decreased MMN and deviant N1 in the fear-extinction phase were considered to be mainly due to decreased arousal or attention level. Results indicate that the auditory MMN amplitude was not affected by the cognitive process of fear recognized by other sense modalities.
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Underner M, Goutaudier N, Peiffer G, Perriot J, Harika-Germaneau G, Jaafari N. [Influence of post-traumatic stress disorder on asthma]. Presse Med 2019; 48:488-502. [PMID: 31005500 DOI: 10.1016/j.lpm.2019.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 02/04/2019] [Accepted: 03/05/2019] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Exposure to a traumatic event may not only lead to a large variety of mental disorders, such as post-traumatic stress disorder (PTSD) but also respiratory symptoms and/or respiratory diseases, as asthma. OBJECTIVES Systematic literature review of data on the impact of post-traumatic stress disorder on asthma. DOCUMENTARY SOURCES Medline, on the period 1980-2018 with the following keywords: "PTSD" or "post-traumatic stress disorder" or "post-traumatic stress disorder" and "asthma", limits "title/abstract"; the selected languages were English or French. Among 141 articles, 23 abstracts have given use to a dual reading to select 14 studies. RESULTS While PTSD may develop 4 weeks after being exposed to a traumatic event during which the physical integrity of the person has been threatened, it might also develop several months or years later. PTSD has been reported to be a risk factor for asthma and also a factor that might enhance a preexisting asthma. It is also important to note that this relation has been highlighted among several populations, traumatic events and regardless the gender and/or cultural factors. Despite its impact on the development of asthma, in asthmatic patients, PTSD may be responsible for poor asthma control, increased rates of healthcare use (visit in the emergency department and/or hospitalization for asthma) and poor asthma-related quality of life. The study of the association between PTSD and asthma have to take into account some potentially confounding factors, such as smoking status and dust exposure (e.g.: asthma following the terrorist attacks of the World Trade Center). Less is known regarding the potential mechanisms involved in the association between PTSD and asthma. Several factors including the nervous system, the hypothalamo-pituitary-adrenal axis, the inflammatory response and the immune system may explain the association. CONCLUSION PTSD is a risk factor for the development of asthma and for the worsening of preexisting asthma. In asthmatic patients, it is of primary importance to systematically screen potential PTSD that might be developed after a traumatic event or a preexisting traumatic condition. Moreover, after exposure to a traumatic event, a special attention needs to be paid to somatic reactions such as asthma. The majority of studies having been conducted on American samples, replicating studies among European samples appears of prime importance in order to add a body of knowledge on the association between somatic and psychiatric conditions.
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Affiliation(s)
- Michel Underner
- Université de Poitiers, centre hospitalier Henri-Laborit, unité de recherche clinique, 86021 Poitiers, France.
| | - Nelly Goutaudier
- Université de Poitiers, centre de recherches sur la cognition et l'apprentissage, UMR CNRS 7295 MSHS, 86073 Poitiers cedex 9, France
| | - Gérard Peiffer
- CHR Metz-Thionville, service de pneumologie, 57038 Metz, France
| | - Jean Perriot
- Centre de tabacologie, dispensaire Émile-Roux, 63100 Clermont-Ferrand, France
| | - Ghina Harika-Germaneau
- Université de Poitiers, centre hospitalier Henri-Laborit, unité de recherche clinique, 86021 Poitiers, France
| | - Nematollah Jaafari
- Université de Poitiers, centre hospitalier Henri-Laborit, unité de recherche clinique, 86021 Poitiers, France
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Campbell AA, Wisco BE, Silvia PJ, Gay NG. Resting respiratory sinus arrhythmia and posttraumatic stress disorder: A meta-analysis. Biol Psychol 2019; 144:125-135. [DOI: 10.1016/j.biopsycho.2019.02.005] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 02/10/2019] [Accepted: 02/10/2019] [Indexed: 12/31/2022]
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