Perseveration of traumatic re-experiencing in PTSD; a cautionary note regarding exposure based psychological treatments for PTSD when head injury and dysexecutive impairment are also present

King, Nigel

doi:10.1080/02699050110088263

Cited by 20 publications

(17 citation statements)

References 31 publications

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“…Interestingly, many stress-related mental diseases, such as posttraumatic stress disorder and depression, are characterized by problems with forgetting and behavioral flexibility that are manifested as pathological tendencies to ruminate or perseverate on negative information (Bagby et al, 1999;Gold and Chrousos, 2002;Heresco-Levy et al, 2002;King, 2002). Considering the present evidence and previous evidence from other laboratories, one may postulate that stress-induced deficits in cognitive flexibility are mediated in part by stress-induced reductions in hippocampal eCB signaling.…”

Section: Discussionsupporting

confidence: 60%

Downregulation of Endocannabinoid Signaling in the Hippocampus Following Chronic Unpredictable Stress

Hill

Patel

Carrier

et al. 2004

Neuropsychopharmacol

316

219

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Deficits in cognitive functioning and flexibility are seen following both chronic stress and modulation of endogenous cannabinoid (eCB) signaling. Here, we investigated whether alterations in eCB signaling might contribute to the cognitive impairments induced by chronic stress. Chronic stress impaired reversal learning and induced perseveratory behavior in the Morris water maze without significant effect on task acquisition. These cognitive impairments were reversed by exogenous cannabinoid administration, suggesting deficient eCB signaling underlies these phenomena. In line with this hypothesis, chronic stress downregulated CB 1 receptor expression and significantly reduced the content of the endocannabinoid 2-arachidonylglycerol within the hippocampus. CB 1 receptor density and 2-arachidonylglycerol content were unaffected in the limbic forebrain. These data suggest that stress-induced downregulation of hippocampal eCB signaling contributes to problems in behavioral flexibility and could play a role in the development of perseveratory and ruminatory behaviors in stress-related neuropsychiatric disorders.

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Section: Discussionsupporting

confidence: 60%

Downregulation of Endocannabinoid Signaling in the Hippocampus Following Chronic Unpredictable Stress

Hill

Patel

Carrier

et al. 2004

Neuropsychopharmacol

316

219

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“…Fifth, the authors rightly question whether a PTSD diagnosis in Judith's case was appropriate, and they correctly, in my opinion, suggest that it was not. In the absence of such a diagnosis, I think the likelihood of any traumatic preservation occurring, as was described in my case of FS (King, 2002), is substantially reduced (King, 2002). By drawing attention to the case of FS, however, Ward and Hogan helpfully remind the reader that psychotherapeutic encounters are not necessarily without significant risks of harm in some circumstances.…”

Section: Psychotherapy With Individuals With Severe Neurological Impamentioning

confidence: 99%

Providing Psychotherapy to People with Neuropsychological Impairment: Complexities and Issues Raised by the Case of "Judith"

King¹

2015

PCSP

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Ward and Hogan (2015) present a case study of ''Judith'' where a combination of client-centered psychotherapy, cognitive rehabilitation and social support result in very positive outcomes despite neuropsychological impairments being present and these posing challenges to the intervention. The case study highlights a number of very important issues when providing psychotherapy to clients with cognitive impairments. These include: 1) the common requirement that issues of self identity are explored; 2) the common need for adaptations to be made to the delivery of psychotherapy to mitigate against the effects of cognitive impairments on psychological interventions; 3) the need for specialist neuropsychological rehabilitation services to be available to such clients in the long-term and for specialist neuropsychological supervision to be available to clinicians working psychotherapeutically in this area; and 4) the demonstration that emotional growth and positive psychotherapeutic results are possible even when neuropsychological challenges are present. The extent to which these important issues are fully demonstrated by the case of Judith is limited in three main ways: a) there being some lack of clarity regarding the severity of the head injury sustained; b) there being a lack of psychometric data to confirm the type and severity of the cognitive impairments present; and c) there being some ambiguity regarding the relative contribution of organic and psychological factors to Judith's neuropsychological problems.

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“…The presence of PTSD appears to hinder recovery from TBI [111]. One unusual interaction between PTSD reexperiencing symptoms and status post-TBI is a case in which the reexperienced traumatic event apparently became a perseverated response [112]. During exposure treatment, a continuous and perseverative reexperiencing of the most distressing part of the traumatic event occurred, which lasted over 7 to 10 days.…”

Section: Longitudinal Coursementioning

confidence: 99%

Posttraumatic stress disorder and posttraumatic stress disorder-like symptoms and mild traumatic brain injury

Kennedy

Jaffee

Leskin³

et al. 2007

JRRD

239

157

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Abstract-In this article, we review the literature on posttraumatic stress disorder (PTSD) and PTSD-like symptoms that can occur along with mild traumatic brain injury (TBI) and concussion, with specific reference to concussive injuries in the military. We address four major areas: (1) clinical aspects of TBI and PTSD, including diagnostic criteria, incidence, predictive factors, and course; (2) biological interface between PTSD and TBI; (3) comorbidity between PTSD and other mental disorders that can occur after mild TBI; and (4) current treatments for PTSD, with specific considerations related to treatment for patients with mild TBI or concussive injuries.

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Perseveration of traumatic re-experiencing in PTSD; a cautionary note regarding exposure based psychological treatments for PTSD when head injury and dysexecutive impairment are also present

Cited by 20 publications

References 31 publications

Downregulation of Endocannabinoid Signaling in the Hippocampus Following Chronic Unpredictable Stress

Downregulation of Endocannabinoid Signaling in the Hippocampus Following Chronic Unpredictable Stress

Providing Psychotherapy to People with Neuropsychological Impairment: Complexities and Issues Raised by the Case of "Judith"

Posttraumatic stress disorder and posttraumatic stress disorder-like symptoms and mild traumatic brain injury

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