A Different opinion regarding the use of opiate antagonists in PTSD: Comments on “an unusual reaction to opioid blockade with naltrexone in a case of post‐traumatic stress disorder”

Glover, Hillel

doi:10.1002/jts.2490080310

Cited by 4 publications

(4 citation statements)

References 12 publications

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“…The association of PTSD and pain processing has been established in previous studies. PTSD patients have an overactivated endogenous opioid system and demonstrate stress-induced increase in production of endogenous opioid-mediated analgesia (Glover, 1995;Pitman et al, 1990). The ACC region identified in the present CBM has been associated with decreased l-opioid receptor density in PTSD patients (Liberzon et al, 2007) and negatively correlated with affective pain ratings (Zubieta et al, 2001).…”

Section: Implications For the Neuroscience Of Ptsdmentioning

confidence: 66%

A coordinate‐based meta‐analytic model of trauma processing in posttraumatic stress disorder

Ramage

Laird

Eickhoff

et al. 2012

Human Brain Mapping

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Posttraumatic stress disorder (PTSD) has a well-defined set of symptoms that can be elicited during traumatic imagery tasks. For this reason, trauma imagery tasks are often employed in functional neuroimaging studies. Here, coordinate-based meta-analysis (CBM) was used to pool eight studies applying traumatic imagery tasks to identify sites of task-induced activation in 170 PTSD patients and 104 healthy controls. In this way, right anterior cingulate (ACC), right posterior cingulate (PCC) and left precuneus (Pcun) were identified as regions uniquely active in PTSD patients relative to healthy controls. To further characterize these regions, their normal interactions, and their typical functional roles, meta-analytic connectivity modeling (MACM) with behavioral filtering was applied. MACM indicated that the PCC and Pcun regions were frequently co-active and associated with processing of cognitive information, particularly in explicit memory tasks. Emotional processing was particularly associated with co-activity of the ACC and PCC, as mediated by the thalamus. By narrowing the regions of interest to those commonly active across multiple studies (using CBM), and developing a priori hypotheses about directed probabilistic dependencies amongst these regions, this proposed model – when applied in the context of graphical and causal modeling – should improve model fit and thereby increase statistical power for detecting differences between subject groups and between treatments in neuroimaging studies of PTSD.

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Section: Implications For the Neuroscience Of Ptsdmentioning

confidence: 66%

A coordinate‐based meta‐analytic model of trauma processing in posttraumatic stress disorder

Ramage

Laird

Eickhoff

et al. 2012

Human Brain Mapping

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mentioning

confidence: 64%

“…This apparently was the case as highlighted in Glover's comment (Glover, 1995) on our case report "An unusual reaction to opioid blockade with naltrexone in a case of posttraumatic stress disorder" (Ibarra, et al, 1994). However, several points made by Glover require clarification and/or correction.…”

mentioning

confidence: 72%

“…Even Glover does not suggest that the behavioral response is expected in the general population. The expectation by Glover of this reaction is apparently only "when an opiate antagonist is initially administered to traumatized individuals diagnosed with PTSD" (Glover, 1995). Our point was that the subject in question, Mr. B, responded to opioid blockade in a manner very atypical for the general population.…”

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confidence: 97%

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Opioid blockade in PTSD: A reply

McCubbin¹,

Ibarra²

1995

Journal of Traumatic Stress

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It is exciting when two laboratories independently verify each other's findings as a result of parallel research efforts. This apparently was the case as highlighted in Glover's comment (Glover, 1995) on our case report "An unusual reaction to opioid blockade with naltrexone in a case of posttraumatic stress disorder" (Ibarra, et al., 1994). However, several points made by Glover require clarification and/or correction.Glover seeks to make a point that the reactions reported in Ibarra et al. (1994) are not unusual. The Physician's Desk Reference (1995) indicates that some components of the reaction to naltrexone experienced by our subject have an expected incidence of less than 1%, e.g., increased blood pressure, visual disturbance. Other components of the reaction to naltrexone are not expected at all, e.g., rage, explosive behavior. By statistical criteria, cardiovascular reactions observed in response to naltrexone in our case study were beyond two and, in some cases, three standard deviations from the rest of our study subjects. Our cardiovascular results are ignored by Glover. In our opinion these results denote an unusual response. In fact, our cardiovascular results suggest that opioid-mediated phenomena in PTSD involve not only behavioral responses, but also may include the autonomic nervous system and, hence, a wide range of visceral and bodily reactions. Even Glover does not suggest that the behavioral response is expected in the general population. The expectation by Glover of this reaction is apparently only "when an opiate antagonist is initially administered to traumatized individuals diagnosed with PTSD" (Glover, 1995). Our point was that the subject in question, Mr. B, responded to opioid blockade in a manner very atypical for the general population. His history of trauma and diagnosis had been previously denied and was only discovered sub-

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Opioid blockade in PTSD: A reply

McCubbin

Ibarra

1995

J Trauma Stress

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A Different opinion regarding the use of opiate antagonists in PTSD: Comments on “an unusual reaction to opioid blockade with naltrexone in a case of post‐traumatic stress disorder”

Cited by 4 publications

References 12 publications

A coordinate‐based meta‐analytic model of trauma processing in posttraumatic stress disorder

A coordinate‐based meta‐analytic model of trauma processing in posttraumatic stress disorder

Opioid blockade in PTSD: A reply

Opioid blockade in PTSD: A reply

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