Treatment of Posttraumatic Stress Disorder: A State-of-the-art Review

Current Neuropharmacology, Journal Year: 2023, Volume and Issue: 22(4), P. 557 - 635

Published: May 3, 2023

Abstract: This narrative state-of-the-art review paper describes the progress in understanding and treatment of Posttraumatic Stress Disorder (PTSD). Over last four decades, scientific landscape has matured, with many interdisciplinary contributions to its diagnosis, etiology, epidemiology. Advances genetics, neurobiology, stress pathophysiology, brain imaging have made it apparent that chronic PTSD is a systemic disorder high allostatic load. The current state includes wide variety pharmacological psychotherapeutic approaches, which are evidence-based. However, myriad challenges inherent disorder, such as individual barriers good outcome, comorbidity, emotional dysregulation, suicidality, dissociation, substance use, trauma-related guilt shame, often render response suboptimal. These discussed drivers for emerging novel including early interventions Golden Hours, interventions, medication augmentation use psychedelics, well targeting nervous system. All this aims improve symptom relief clinical outcomes. Finally, phase orientation recognized tool strategize position step progression pathophysiology. Revisions guidelines systems care will be needed incorporate innovative treatments evidence emerges they become mainstream. generation well-positioned address devastating disabling impact traumatic events through holistic, cutting-edge efforts research.

Language: Английский

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The brain-body disconnect: A somatic sensory basis for trauma-related disorders

Frontiers in Neuroscience, Journal Year: 2022, Volume and Issue: 16

Published: Nov. 21, 2022

Although the manifestation of trauma in body is a phenomenon well-endorsed by clinicians and traumatized individuals, neurobiological underpinnings this remain unclear. The notion somatic sensory processing, which encompasses vestibular somatosensory processing relates to systems concerned with how physical exists space, introduced as major contributor overall regulatory, social-emotional, self-referential functioning. From phylogenetically ontogenetically informed perspective, trauma-related symptomology conceptualized be grounded brainstem-level dysfunction its cascading influences on physiological arousal modulation, affect regulation, higher-order capacities. Lastly, we introduce novel hierarchical model bridging processes limbic neocortical mechanisms regulating an individual’s emotional experience sense relational, agentive self. This provides working framework for neurobiologically assessment treatment conditions from perspective.

Language: Английский

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Potential Circumstances Associated With Moral Injury and Moral Distress in Healthcare Workers and Public Safety Personnel Across the Globe During COVID-19: A Scoping Review

Frontiers in Psychiatry, Journal Year: 2022, Volume and Issue: 13

Published: June 13, 2022

Healthcare workers (HCWs) and public safety personnel (PSP) across the globe have continued to face ethically morally challenging situations during COVID-19 pandemic that increase their risk for development of moral distress (MD) injury (MI). To date, however, global circumstances confer MD MI in these cohorts not been systematically explored, nor unique may exist countries explored. Here, we sought identify compare, globe, potentially injurious or distressful events (PMIDEs) HCWs PSP pandemic. A scoping review was conducted synthesize knowledge on PMIDEs select PSP. Six databases were searched, including MEDLINE, EMBASE, Web Science, PsychInfo, CINAHL, Global Health. total 1,412 articles retrieved, which 57 included this review. These collectively described experiences samples from 19 different countries, comprised almost exclusively HCWs. Given lack data, following results should be generalized populations without further research. Using qualitative content analysis, six themes describing associated with identified: (1) Risk contracting transmitting COVID-19; (2) Inability work frontlines; (3) Provision suboptimal care; (4) Care prioritization resource allocation; (5) Perceived support unfair treatment by organization; (6) Stigma, discrimination, abuse. a range emotions related PMIDEs, anxiety, fear, guilt, shame, burnout, anger, helplessness. Most PMIDE appeared shared globally, particularly ‘Risk COVID-19’ ‘Perceived organization.’ Articles within theme ‘Stigma, abuse’ represented smallest distribution all themes. Overall, present provides insight into encountered COVID-19. Further research is required differentiate experience HCWs, explore impact social cultural factors MI.

Language: Английский

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Adverse Life Experiences and Brain Function

JAMA Network Open, Journal Year: 2023, Volume and Issue: 6(11), P. e2340018 - e2340018

Published: Nov. 1, 2023

Importance Adverse life experiences have been proposed to contribute diverse mental health problems through an association with corticolimbic functioning. Despite compelling evidence from animal models, findings studies in humans mixed; activation likelihood estimation (ALE) meta-analyses failed identify a consistent of adverse events brain function. Objective To investigate the adversity exposure altered reactivity using multilevel kernel density analyses (MKDA), meta-analytic approach considered more robust than ALE small sample sizes and methodological differences between studies. Data Sources Searches were conducted PsycInfo, Medline, EMBASE, Web Science inception May 4, 2022. The following search term combinations used for each database: trauma , posttraumatic stress disorder ( PTSD ), abuse maltreatment poverty or ; functional magnetic resonance imaging fMRI ) neuroimaging; emotion regulation memory processing inhibitory control executive functioning reward . Study Selection Task-based within 4 domains (emotion processing, control, processing) that included measure whole-brain coordinate results reported Talairach Montreal Neurological Institute space included. Conference abstracts, books, reviews, meta-analyses, opinions, studies, articles not English, fewer 5 participants excluded. Extraction Synthesis Using Preferred Reporting Items Systematic Reviews Meta-Analyses reporting guideline, 2 independent reviewers assessed abstracts full-text entry criteria. A third reviewer resolved conflicts errors data extraction. pooled random-effects model analysis occurred August November Main Outcomes Measures Peak x-axis (left-right), y-axis (posterior-anterior), z-axis (inferior-superior) coordinates extracted all submitted MKDA meta-analyses. Results total 83 meta-analysis, yielding combined 5242 801 coordinates. Adversity was associated higher amygdala (familywise error rate corrected at P < .001; = 22; −4; −17) lower prefrontal cortical 10; 60; 10) across range task domains. These responses only observed adult clearest among those who had exposed severe threat trauma. Conclusions Relevance In this meta-analysis function, prior challenges. might better how diminishes ability cope later stressors produces enduring susceptibility problems.

Language: Английский

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Homeostatic normalization of alpha brain rhythms within the default-mode network and reduced symptoms in PTSD following a randomized controlled trial of EEG neurofeedback

Brain Communications, Journal Year: 2023, Volume and Issue: 5(2)

Published: March 2, 2023

Collective research has identified a key electroencephalogram signature in patients with post-traumatic stress disorder, consisting of abnormally reduced alpha (8-12 Hz) rhythms. We conducted 20-session, double-blind, randomized controlled trial desynchronizing neurofeedback disorder over 20 weeks. Our objective was to provide mechanistic evidence underlying potential clinical improvements by examining changes aberrant brain rhythms (namely, oscillations) as function treatment. randomly assigned participants primary diagnosis (n = 38) either an experimental group 20) or sham-control 18). A multichannel cap used record whole-scalp resting-state activity pre- and post-neurofeedback treatment, for both the groups. first observed significantly relative source power at baseline compared age/sex-matched neurotypical healthy controls 32), primarily within regions anterior default mode network. Post-treatment, we found that only demonstrated significant resynchronization areas displayed low baseline. In parallel, decreased severity scores only, when comparing post-treatment (Cohen's d 0.77) three-month follow-up 0.75), remission rate 60.0% follow-up. Overall, our results indicate training can rescue pathologically rhythmicity, functional biomarker repeatedly been linked symptoms hyperarousal cortical disinhibition disorder. This provides long-term suggesting 'alpha rebound effect' (i.e. homeostatic resynchronization) occurs network previously implicated

Language: Английский

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Amygdala-derived-EEG-fMRI-pattern neurofeedback for the treatment of chronic post-traumatic stress disorder. A prospective, multicenter, multinational study evaluating clinical efficacy

Psychiatry Research, Journal Year: 2024, Volume and Issue: 333, P. 115711 - 115711

Published: Jan. 8, 2024

We conducted a prospective, single arm, multisite, multinational, open label trial assessing the safety and efficacy of novel amygdala derived neurofeedback treatment, designated Amygdala-Derived-EFP, for chronic PTSD. Participants, including veterans civilians, underwent screening, training, 15 sessions over 8 weeks and; baseline, termination (8 weeks) 3 month post treatment assessments with validated measures. The primary endpoint was more than 50% participants demonstrating Minimally Clinically Important Difference (MCID) defined as 6-point reduction, on Clinician Administered PTSD Scale (CAPS-5) total score at months. Secondary measures included PCL-5, ERQ, PHQ-9, CGI. Statistical analyses were performed using SAS®V9.4. met, CAPS-5 MCID response rate 66.7%. average reduction in scores follow up 13.5 points, twice MCID. Changes from baseline CAPS-5, PHQ-9 follow-up demonstrated statistically significant improvements effect sizes ranging 0.46 to 1.07. Adverse events mild resolved after treatment. This study builds prior research similar outcomes amygdala-derived neurofeedback. Positive attributes this therapy include monitoring by non-physician personnel, affordability, accessibility, tolerability.

Language: Английский

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Posterior cingulate cortex targeted real‐time fMRI neurofeedback recalibrates functional connectivity with the amygdala, posterior insula, and default‐mode network in PTSD

Brain and Behavior, Journal Year: 2023, Volume and Issue: 13(3)

Published: Feb. 15, 2023

Abstract Background Alterations within large‐scale brain networks—namely, the default mode (DMN) and salience networks (SN)—are present among individuals with posttraumatic stress disorder (PTSD). Previous real‐time functional magnetic resonance imaging (fMRI) electroencephalography neurofeedback studies suggest that regulating posterior cingulate cortex (PCC; primary hub of DMN) activity may reduce PTSD symptoms recalibrate altered network dynamics. However, PCC connectivity to DMN SN during PCC‐targeted fMRI remains unexamined help elucidate neurophysiological mechanisms through which these symptom improvements occur. Methods Using a trauma/emotion provocation paradigm, we investigated psychophysiological interactions over single session ( n = 14) healthy control 15) participants. We compared between regulate (in participants downregulated activity) view did not exert regulatory control) conditions across whole‐brain as well in priori specified regions‐of‐interest. Results During conditions, only group showed significant anterior (dmPFC, vmPFC) (posterior insula) regions, whereas both groups displayed other areas (precuneus/cuneus). Additionally, controls, significantly greater (amygdala) conditions. Moreover, linear regression analyses revealed regions was positively correlated psychiatric all Conclusion In summary, observations provide emerging evidence neural underlying PTSD. This supports use means by PTSD‐associated alterations SN, together, facilitate improved emotion regulation abilities

Language: Английский

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Increased top-down control of emotions during symptom provocation working memory tasks following a RCT of alpha-down neurofeedback in PTSD

NeuroImage Clinical, Journal Year: 2023, Volume and Issue: 37, P. 103313 - 103313

Published: Jan. 1, 2023

Posttraumatic stress disorder (PTSD) has been found to be associated with emotion under-modulation from the prefrontal cortex and a breakdown of top-down control cognition emotion. Novel adjunct therapies such as neurofeedback (NFB) have shown normalize aberrant neural circuits that underlie PTSD psychopathology at rest. However, little evidence exists for NFB-linked improvements under emotionally relevant cognitive load. The current study sought address this gap by examining effects alpha-down NFB in context an emotional n-back task. We conducted 20-week double-blind randomized, sham-controlled trial collected neuroimaging data before after protocol. Participants performed 1-back 2-back working memory task, interleaved trauma-neutral trauma-relevant cues fMRI scanner. Data 35 participants primary diagnosis were analyzed (n = 18 experimental group undergoing NFB, n 17 sham-control group). Firstly, within-group analyses showed clinically significant reductions symptom severity scores post-intervention timepoint 3-month follow-up group, not group. revealed enhanced engagement centers, dorsolateral (dlPFC), improved integration anterior posterior parts default mode network (DMN). Finally, our results also indicate increased performance correlated activity brain regions involved bodily consciousness/embodied processing self (TPJ insula). This is first provide mechanistic insights into how may dysfunctional connectivity load simultaneous provocation, adding growing body supporting therapeutic neuromodulatory NFB. preliminary highlights benefits training adjunctive therapy warrants further investigation its on those PTSD.

Language: Английский

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EEG Neurofeedback for Anxiety Disorders and Post-Traumatic Stress Disorders: A Blueprint for a Promising Brain-Based Therapy

Current Psychiatry Reports, Journal Year: 2021, Volume and Issue: 23(12)

Published: Oct. 29, 2021

Language: Английский

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Spectral decomposition of EEG microstates in post-traumatic stress disorder

NeuroImage Clinical, Journal Year: 2022, Volume and Issue: 35, P. 103135 - 103135

Published: Jan. 1, 2022

Microstates offer a promising framework to study fast-scale brain dynamics in the resting-state electroencephalogram (EEG). However, microstate have yet be investigated post-traumatic stress disorder (PTSD), despite research demonstrating alterations PTSD. We performed microstate-based segmentation of EEG clinical population participants with PTSD (N = 61) and non-traumatized, healthy control group 61). Microstate-based measures (i.e., occurrence, mean duration, time coverage) were compared group-wise using broadband (1-30 Hz) frequency-specific delta, theta, alpha, beta bands) decompositions. In comparisons, centro-posterior maximum (map E) occurred significantly less frequently (d -0.64, pFWE 0.03) had shorter duration as controls -0.71, < 0.01). These differences reflected narrow frequency bands well, lower like delta -0.78, 0.01), theta -0.74, alpha -0.65, 0.02) repeating these group-level trends, only larger effect sizes. Interestingly, support vector machine classification analysis comparing revealed that models containing band features out-perform models. When classifying PTSD, accuracy was 76% 65% for model, respectively (p 0.03). Taken together, we provide original evidence supporting utility microstates diagnostic markers demonstrate filtering into distinct improves psychiatric disorder.

Language: Английский

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