Posttraumatic Stress Disorder: A State-of-the-Science Review

Nemeroff, Charles B.; Bremner, J. Douglas; Foa, Edna B.; Mayberg, Helen S.; North, Carol S.; Stein, Murray B.

doi:10.1176/foc.7.2.foc254

Cited by 67 publications

(72 citation statements)

References 122 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…While DBT was initially designed for individuals with borderline personality disorder, it has also been effective in treating other populations (Gratz et al, 2005). Problem solving interventions have been successful in the treatment of SMB (Townsend et al, 2001) and the prescribing of selective serotonin reuptake inhibitors (SSRIs) may be a helpful adjunct intervention for the SMB, PTSD, and depression constellation (Bohne et al, 2005;Cipriani et al, 2005;Nemeroff et al, 2006).…”

Section: Discussionmentioning

confidence: 99%

Self-mutilative behaviors in male veterans with posttraumatic stress disorder

Sacks

Flood

Dennis

et al. 2008

Journal of Psychiatric Research

View full text Add to dashboard Cite

Self-mutilative behaviors (SMB) were examined in a sample of male veterans with posttraumatic stress disorder (PTSD). The primary objective was to determine the prevalence of SMB and any physical, cognitive, or affective antecedents and correlates for these behaviors. Participants included 509 male veterans with PTSD and levels of PTSD, depression, alcohol use, hostility, and impulsivity were evaluated to determine if these variables were related to SMB. Antecedents and sequelae of SMB were also examined to generate hypotheses regarding the functions of these behaviors. A second type of habit behavior, body-focused repetitive behaviors (BFRB), was also examined as part of the study. Findings indicated that veterans who engaged in either type of habit behavior were younger than those who did not engage in SMB or BFRB. Veterans reporting SMB also reported higher levels of PTSD, depression, hostility, and impulsivity compared to the BFRB and no-habit groups. Examination of habit antecedents and sequelae showed support for the automatic-positive reinforcement function of SMB. These findings are discussed in the context of research and treatment involving male veterans with PTSD who engage in SMB. Keywordsself-mutilation; self-injury; posttraumatic stress disorder; male veterans Self-mutilative behaviors (SMB) include the direct and deliberate destruction or alteration of one's own body tissue without suicidal intent (Gratz, 2001;Nock and Prinstein, 2005). SMB typically refers to cutting, burning, or otherwise marking of one's own flesh, with self-cutting being the most frequently endorsed type of SMB (Suyemoto, 1998;van der Kolk et al., 1991). Rates of SMB are approximately 4% in the general adult population (Briere, 1998), between 14% to 35% in college students (Favazza et al., 1989;Gratz, 2001), and approximately 21% in adult clinical populations (Briere, 1998;Klonsky et al., 2003). Self-mutilative behaviors have been linked to negative outcomes, including increased risk for successful suicide (Cooper

show abstract

Section: Discussionmentioning

confidence: 99%

Self-mutilative behaviors in male veterans with posttraumatic stress disorder

Sacks

Flood

Dennis

et al. 2008

Journal of Psychiatric Research

View full text Add to dashboard Cite

show abstract

“…53,54 Standard efficacious PTSD treatments are a reasonable starting point for an ICD specific treatment for a postshock stress reaction. 55,56 A promising pilot study revealed success of CBT in a group of patients with myocardial infarction and PTSD symptomatology, which signals support of its applicability with the shocked ICD patient population. 24 Additionally, relaxation techniques are often used in those with PTSD, including diaphragmatic breathing, meditation, progressive muscle relaxation, and hypnosis.…”

Section: Sears Et Al Posttraumatic Stress In Icd Patients 247mentioning

confidence: 95%

Posttraumatic Stress and the Implantable Cardioverter-Defibrillator Patient

Sears

Hauf

Kirian

et al. 2011

Circ: Arrhythmia and Electrophysiology

112

View full text Add to dashboard Cite

he implantable cardioverter-defibrillator (ICD) has revolutionized the care of patients at risk for life-threatening arrhythmias. Large-scale clinical trials established mortality benefits for the ICD over usual care or medications 1,2 and led to wider use for both primary and secondary prevention indications. More recent research confirms that the mortality benefits of the ICD extend over 8-year follow-up when compared with usual care. 3 These clinical trial successes, in terms of mortality, have allowed for greater focus on patientcentered outcomes, such as quality of life, device acceptance, psychological well-being, and trauma reactions in research and clinical care. 4 Shock has been a primary focus in this work because of its potentially traumatic impact on the patient experience. Although there is mixed evidence on the effect of single ICD shocks, 5,6 the literature consistently supports the negative impact of Ͼ5 shocks on quality of life and emotional distress. 7,8 ICD shock has been a focus of research interest because it is a unique experience for the ICD patient and can be perceived as a traumatic event. In addition, the existence of concomitant heart disease, angina, congestive heart failure, or previous sudden death may create sensitivity to traumatic stress that warrants improved understanding by attending electrophysiologists. Although psychological distress in ICD patients has been explored, the possibility that some ICD patients have trauma reactions, up to and including posttraumatic stress disorder (PTSD), has garnered increased attention recently. Therefore, the purposes of this report are to highlight the theory and research addressing psychological distress including PTSD in electrophysiology clinics, to discuss clinical management of these sequelae, and to suggest areas of future research and development. Psychosocial Distress of ICD Patients in Electrophysiology ClinicsPrevention and identification of distress in ICD patients represents comprehensive, high-quality care, regardless of the cause (eg, depression, anxiety, trauma), consistent with the biopsychosocial model of care. 9 This model of care entails the conceptualization and treatment of health problems as an interplay between biological factors, psychological factors, and social factors culminating in the manifestation of symptoms. For an electrophysiologist, these ambitious goals can include prevention of distress through cardiac care and education, recognition of distress warranting referral, optimizing quality-of-life (QoL) outcomes, and promoting patient acceptance of the ICD. Clearly, these are not easily accomplished without sufficient awareness, clinical support, and interdisciplinary expertise. Below are some key considerations for daily clinical practice. Prevalence and Impact of Psychosocial DistressGeneral or ICD-specific anxiety as a psychological morbidity has a point prevalence of 13% to 38% of ICD recipients in cross-sectional research. 4 Longitudinal assessment of anxiety has indicated that approximately 35% of pati...

show abstract

“…PTSD patients are commonly plagued by recurrent frightening thoughts and memories of the aversive experience and suffer from a host of persistent physiological and behavioral sequelae that include altered sympathetic and hypothalamic-pituitary-adrenal (HPA) axis responsivity, chronic anxiety, exaggerated startle response, and cognitive dysfunction (Johnsen and Asbjornsen, 2008;Mittal et al, 2001;Moore, 2009;Nemeroff et al, 2006;Yehuda and LeDoux, 2007). Recent studies have implicated epigenetic mechanisms in the psychopathology of PTSD.…”

Section: Epigenetic Mechanisms In Ptsdmentioning

confidence: 99%

Epigenetic Mechanisms in Learned Fear: Implications for PTSD

Zovkic

Sweatt

2012

Neuropsychopharmacol

168

106

View full text Add to dashboard Cite

One of the most exciting discoveries in the learning and memory field in the past two decades is the observation that active regulation of gene expression is necessary for experience to trigger lasting functional and behavioral change, in a wide variety of species, including humans. Thus, as opposed to the traditional view of 'nature' (genes) being separate from 'nurture' (environment and experience), it is now clear that experience actively drives alterations in central nervous system (CNS) gene expression in an ongoing fashion, and that the resulting transcriptional changes are necessary for experience to trigger altered long-term behavior. In parallel over the past decade, epigenetic mechanisms, including regulation of chromatin structure and DNA methylation, have been shown to be potent regulators of gene transcription in the CNS. In this review, we describe data supporting the hypothesis that epigenetic molecular mechanisms, especially DNA methylation and demethylation, drive long-term behavioral change through active regulation of gene transcription in the CNS. Specifically, we propose that epigenetic molecular mechanisms underlie the formation and stabilization of context-and cue-triggered fear conditioning based in the hippocampus and amygdala, a conclusion reached in a wide variety of studies using laboratory animals. Given the relevance of cued and contextual fear conditioning to post-traumatic stress, by extension we propose that these mechanisms may contribute to post-traumatic stress disorder (PTSD) in humans. Moreover, we speculate that epigenetically based pharmacotherapy may provide a new avenue of drug treatment for PTSD-related cognitive and behavioral function.

show abstract

Posttraumatic Stress Disorder: A State-of-the-Science Review

Cited by 67 publications

References 122 publications

Self-mutilative behaviors in male veterans with posttraumatic stress disorder

Self-mutilative behaviors in male veterans with posttraumatic stress disorder

Posttraumatic Stress and the Implantable Cardioverter-Defibrillator Patient

Epigenetic Mechanisms in Learned Fear: Implications for PTSD

Contact Info

Product

Resources

About