Early Intervention Following Trauma May Mitigate Genetic Risk for PTSD in Civilians

Abstract

Background Civilian posttraumatic stress disorder (PTSD) and combat PTSD are major public health concerns. Although a number of psychosocial risk factors have been identified related to PTSD risk, there are no accepted, robust biological predictors that identify who will develop PTSD or who will respond to early intervention following trauma. We wished to examine whether genetic risk for PTSD can be mitigated with an early intervention. Method 65 emergency department patients recruited in 2009–2010 at Grady Memorial Hospital in Atlanta, Georgia, who met criterion A of DSM-IV PTSD received either 3 sessions of an exposure intervention, beginning in the emergency department shortly after trauma exposure or assessment only. PTSD symptoms were assessed 4 and 12 weeks after trauma exposure. A composite additive risk score was derived from polymorphisms in 10 previously identified genes associated with stress-response (ADCYAP1R1, COMT, CRHR1, DBH, DRD2, FAAH, FKBP5, NPY, NTRK2, and PCLO), and gene x treatment effects were examined. The intervention included 3 sessions of imaginal exposure to the trauma memory and additional exposure homework. The primary outcome measure was the PTSD Symptom Scale-Interview Version or DSM-IV–based PTSD diagnosis in patients related to genotype and treatment group. Results A gene x intervention x time effect was detected for individual polymorphisms, in particular the PACAP receptor, ADCYAP1R1, as well as with a combined genotype risk score created from independent SNP markers. Subjects who did not receive treatment had higher symptoms than those who received intervention. Furthermore, subjects with the “risk” genotypes who did not receive intervention had higher PTSD symptoms compared to those with the “low-risk” or “resilience” genotypes or those who received intervention. Additionally, PTSD symptoms correlated with level of genetic risk at week 12 (P < .005) in the assessment-only group, but with no relationship in the intervention group, even after controlling for age, sex, race, education, income, and childhood trauma. Using logistic regression, the number of risk alleles was significantly associated with likelihood of PTSD diagnosis at week 12 (P < .05). Conclusions This pilot prospective study suggests that combined genetic variants may serve to predict those most at risk for developing PTSD following trauma. A psychotherapeutic intervention initiated in the emergency department within hours of the trauma may mitigate this risk. The role of genetic predictors of risk and resilience should be further evaluated in larger, prospective intervention and prevention trials. Trial Registration ClinicalTrials.gov identifier: NCT00895518

Post-traumatic Stress Disorder and Social Isolation among North Korean Refugee Women in South Korea: The Moderating Role of Formal and Informal Support

“…Most North Korean refugees stay in embassies of third countries for a short duration before entering South Korea [39] (p. 2). As numerous studies suggest the importance of early intensive interventions in PTSD [90,91], it is necessary to amend policies in which the Korean Embassy in the third countries would not only protect the refugees but would also offer expert crisis interventions to refugees exposed to traumatic events. In addition, there is a need to strengthen the quantitative and qualitative formal support systems provided after resettlement.…”

Early interventions for the prevention of PTSD in adults: a systematic literature review

“…Results were divided according to the type of intervention (pharmacological or psychological). From the 29 articles reviewed, 16 reported significant effects of interventions for the prevention of PTSD or symptoms related to the disorder [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] . Of these, 22 studies used psychological interventions and 7 used pharmacological interventions (Table 2).…”

“…Four of the six studies that used CBT or related techniques reported results compatible with reduced occurrence of PTSD or PTSDrelated symptoms in groups who underwent interventions in relation to control groups 9,[17][18][19] . In the study by Mouthaan et al 24 , which did not report reductions in the occurrence of PTSD, the authors discuss the fact that one-fifth of the volunteers failed to adhere to the intervention program.…”

Pszichológiai intervenciók traumatikus események után a poszttraumás stressz zavar megelőzésére. Szisztematikus irodalmi áttekintés

“…A fokozatos expozíciós terá-pia hatása a nemi erőszakot elszenvedett személyek esetében volt a legmarkánsabb. A szerzők a minta egy részén genetikai tesztelést is végeztek és azt találták, hogy a terápiás segítséget nem kapó kontrollcsoportban a magas genetikai rizikóval rendelkező személyek PTSD-szintje magasabb volt, mint az alacsony kockázatúaké, valamint, hogy a genetikai rizikó magasan korrelált a PTSD-tüne-tekkel a kontrollcsoportban, de nem a terápiás csoportban [57].…”