Topiramate was effective in improving reexperiencing and avoidance/numbing symptom clusters in patients with PTSD. This study supports the use of anticonvulsants for the improvement of symptoms of PTSD.

The new issue of CNS Neuroscience & Therapeutics includes an article: “A Double-Blind Randomized Controlled Trial To Study the Efficacy of Topiramate in a Civilian Sample of PTSD.”

The authors are Mary S. L. Yeh, Jair Jesus Mari, Mariana Caddrobi Pupo Costa, Sergio Baxter Andreoli, Rodrigo Affonseca Bressan, & Marcelo Feijó Mello.

Method: We conducted a 12-week double-blind, randomized, placebo-controlled study comparing topiramate to placebo. Men and women aged 18 – 62 years with diagnosis of PTSD according to DSM-IV were recruited … 35 patients were randomized to either group. The primary outcome measure was the CAPS total score changes.

Results: 82.35% of patients in the topiramate group exhibited improvements in PTSD symptoms. The efficacy analysis demonstrated that patients in the topiramate group exhibited significant improvements in reexperiencing symptoms: flashbacks, intrusive memories, and nightmares of the trauma (CAPS-B; P= 0.04) and in avoidance/numbing symptoms associated with the trauma, social isolation, and emotional numbing (CAPS-C; P= 0.0001). Furthermore, the experimental group demonstrated a significant difference in decrease in CAPS total score (topiramate 57.78; placebo 32.41; P= 0.0076). Mean topiramate dose was 102.94 mg/d. Topiramate was generally well tolerated.
——————–
Comment: this is important, as psychotherapy helps many, but not all people with PTSD, and is often not available for a variety of social and economic factors.

What predicts which women will develop PTSD after a potentially traumatic event?

Number of baseline PTSD reexperiencing symptoms, rape history, and history of childhood physical assault were all found to predict PTSD chronicity 2 years later.

Chronic cases were also more likely to experience subsequent exposure to potentially traumatic stressors not involving interpersonal violence.

Contrary to our prediction, binge drinking and poorer perceived health did not predict chronicity.

An analysis of mental health treatment seeking revealed no relationship between remission status and treatment seeking at baseline or any of the follow-up assessments, even when controlling for baseline PTSD symptom severity.

The absence of a relationship between subsequent treatment seeking and remission status suggests that, for many women, symptoms subsided without professional assistance.”

[Comment: That is, I would say, 1/2 got better using their own network and resources, not those of a professional; this probably does not mean that PTSD just evaporates.]

Psychological Trauma: Theory, Research, Practice, and Policy has scheduled an article for publication in a future issue: “Factors Associated With Chronicity in Posttraumatic Stress Disorder: A Prospective Analysis of a National Sample of Women.” The authors are Jesse R. Cougle, Heidi Resnick, and Dean G. Kilpatrick.

The American Academy of Sleep Medicine issued the following news release:

Bright light therapy improves sleep disturbances in soldiers with combat PTSD

Study suggests that bright light therapy may be an effective treatment
for combat-related post-traumatic stress disorder

Bright light therapy has significant effects on sleep disturbances
associated with combat-related post-traumatic stress disorder, according
to a research abstract that will be presented Monday, June 7, 2010, in
San Antonio, Texas, at SLEEP 2010, the 24th annual meeting of the
Associated Professional Sleep Societies LLC.

Results indicate that bright light therapy produced a significantly
greater improvement than placebo in sleep disturbances specific to PTSD.

Bright light therapy also produced a moderate improvement in PTSD
symptoms and depression.

“Results of this ongoing study show significant effects of bright light
on disruptive nocturnal behaviors associated with combat PTSD, as well
as positive effects of bright light therapy on PTSD symptom severity,”
said study coordinator Shannon Cornelius, PhD, graduate research
assistant for Dr. Shawn D. Youngstedt in the department of exercise
science at the University of South Carolina in Columbia, S.C.

“Because bright light therapy is a relatively simple, self-administered,
inexpensive treatment with few side effects, these results are an
important step to further establish the efficacy of bright light therapy
as an alternative or adjunct treatment for combat-related PTSD.”

The study involved 16 soldiers who returned to the U.S. with combat-
related PTSD after serving in Operation Enduring Freedom or Operation
Iraqi Freedom. Following a one-week baseline, participants were
randomized to one of two four-week treatments.

Eight soldiers received 10,000 lux of bright light therapy for 30
minutes each day. The other eight participants were assigned to the
placebo group and received sham treatment with an inactivated negative
ion generator.

The Clinician-Administered PTSD Scale (CAPS-2) was completed at
baseline and immediately following completion of the study.

At weekly intervals, depression was assessed with the Beck Depression
Inventory (BDI-II), and sleep quality was assessed with the Pittsburgh
Sleep Quality Index (PSQI) with addendum for PTSD (PSQI-PTSD).

Cornelius noted that sleep disturbance is a commonly reported problem
that can play both a precipitating and perpetuating role in PTSD, making
it an important target for therapy.

“Disturbed sleep is known to interact with depression and anxiety in a
vicious cycle,” said Cornelius.

“By reducing the severity and occurrence of sleep disturbances, it may
be possible to reduce the severity of symptoms such as anxiety and
depression in combat-related PTSD.”

The American Academy of Sleep Medicine reports that 70 to 90 percent of
people with PTSD describe subjective sleep disturbance. Recurrent
nightmares of the traumatic event represent one of the most problematic
and enduring symptoms of PTSD.

These nightmares may take the form of a realistic reliving of the
traumatic event or depict only some of its elements.

Bright light therapy exposes your eyes to intense but safe amounts of
light for a specific and regular length of time.

Typically it involves exposure to up to 10,000 lux of light for
scheduled periods of 20 minutes or more using a small light box.

In a 2007 study published in the journal BMC Psychiatry, Youngstedt
reported that bright light exposure may have an anxiolytic effect.

Three hours of exposure to 3,000 lux of bright light for three
consecutive days reduced anxiety in a group of low-anxiety adults.

The selective serotonin reuptake inhibitors (SSRIs) are considered the first-line pharmacological treatment for PTSD. However, even when treated with this class of drugs, response rates rarely exceed 60% and less than 20-30% of the patients achieve full remission. The non-antidepressant agent with the strongest scientific evidence supporting its use in PTSD is risperidone, which can be envisaged as an effective add-on therapy when patients did not fully benefit from previous treatment with SSRIs. Prazosin, an adrenergic-inhibiting agent, is a promising alternative for cases of PTSD where nightmares and insomnia are prominent symptoms. So far, there is no consistent empirical support for using benzodiazepines in the prevention or in the treatment of PTSD

From the abstract for: Progress in Neuro-Psychopharmacology and Biological Psychiatry* (Volume 33, Issue 2, Pages 169-180) includes an article: “Pharmacologic alternatives to antidepressants in posttraumatic stress disorder: A systematic review.”

By William Bergera, Mauro V. Mendlowicza, Carla Marques-Portellaa, Gustavo Kinrysc, Leonardo F. Fontenellea, Charles R. Marmard, & Ivan Figueiraa,.

Adults who suffer migraine headaches are more apt to have post-traumatic stress disorder (PTSD) than the general population, a new study suggests. And having PTSD and migraine may lead to greater headache-related disability.

Excerpts follow:

<snip>

Among a group of 593 adults with migraine, PTSD was present in roughly 30 percent of those who suffered chronic daily headaches and about 22 percent of those with “episodic” migraine headaches. By comparison, approximately 8 percent of the population is estimated to have PTSD.

<snip>

“The implications are such that abuse causes not just psychological distress from PTSD but also physical pain such as migraine,” Peterlin said, and there is an increased disability seen in those migraine sufferers with PTSD than those without PTSD.

<snip>

SOURCE: Headache April 2009.
The full article can be found at
http://www.canada.com/news/Post+traumatic+stress+common+migraine+sufferers/1461579/story.html

June’s *British Journal of Psychiatry* (vol. 194, #6) includes an
article: “Delayed-onset post-traumatic stress disorder among war
veterans in primary care clinics.”

The authors are B. Christopher Frueh, Anouk L. Grubaugh, Derik E.
Yeager, & Kathryn M. Magruder.

Here’s the abstract:

Background

Only limited empirical data support the existence of delayed-onset post-
traumatic stress disorder (PTSD).

Aims

To expand our understanding of delayed-onset PTSD prevalence and
phenomenology.

Method

A cross-sectional, epidemiological design (n = 747) incorporating
structured interviews to obtain relevant information for analyses in a
multisite study of military veterans.

Results

A small percentage of veterans with identified current PTSD (8.3%,
7/84), current subthreshold PTSD (6.9%, 2/29), and lifetime PTSD only
(5.4%, 2/37) met criteria for delayed onset with PTSD symptoms
initiating more than 6 months after the index trauma. Altogether only
0.4% (3/747) of the entire sample had current PTSD with delayed-onset
symptoms developing more than 1 year after trauma exposure, and no PTSD
symptom onset was reported more than 6 years post-trauma.

Conclusions

Retrospective reports of veterans reveal that delayed-onset PTSD
(current, subthreshold or lifetime) is extremely rare 1 year post-
trauma, and there was no evidence of PTSD symptom onset 6 or more years
after trauma exposure.

Courtesy of Ken Pope

Today’s new issue of *Journal of the American Medical Association* (Vol.
301 No. 13, April 1, 2009) includes an article: “Abuse and the Brain” by
Joan Stephenson, PhD.

Here’s how the article begins:

[begin excerpt]

Early childhood abuse might exert lifelong effects by altering a
person’s DNA and reducing levels of glucocorticoid receptors in the
brain, which are important for responding to stress, Canadian scientists
have found (McGowan PO et al. Nat Neurosci. 2009;12[3]:342-348).

The investigators examined brain tissue from 24 men who had committed
suicide, half of whom had a history of childhood abuse, and from 12 men
who had not been abused and died suddenly from other causes.

Men with a history of abuse had lower levels of glucocorticoid receptors
than did men who had not been abused or had not committed suicide.

In addition, in those who had been abused, a snippet of “promoter” DNA
that normally facilitates the production of glucocorticoid receptors had
been silenced by the attachment of a methyl group.

The researchers noted the work confirms their previous findings…

[end excerpt]

The article is online — but requires a subscription — at:
<http://tinyurl.com/comoql&gt;.

Courtesy of Ken Pope

Stroke post-traumatic stress risk

Many stroke sufferers are left with post-traumatic stress disorder (PTSD), a British study suggests.

More than a third of 105 brain haemorrhage survivors tested positive for the disorder, with flashbacks and painful memories of their bleed.

This is a similar level to that found in soldiers returning from war zones and amongst victims of sexual assault, Neurosurgery journal reports.

The authors of the study say diagnosing and treating PTSD will aid recovery.

Subarachnoid haemorrhage affects about 8,000 people in the UK each year and is a sudden leak of blood over the surface of the brain.

Doctors do realise this type of stroke is stressful for the patient, but they do not always ask the patient about anxiety and depression. Someone needs to

Professor Allan House of the Stroke Association

Although emotional distress following this type of stroke is common, it is under-recognised, they say, partly because clinicians tend to focus on physical recovery.

The team from Durham University, the James Cook University Hospital in Middlesbrough and the Newcastle General Hospital assessed the patients at three months and again at 13 months after their subarachnoid haemorrhage using a simple questionnaire.

At both stages, the answers given suggested 37% of the patients had PTSD.

The authors say their findings are not surprising, given the nature of this type of stroke – its sudden, often unexpected and painful onset in relatively young people, requiring emergency invasive investigations and surgery.

Add to this having to deal with the fact that they have had a life-threatening illness, it is understandable why many patients experience emotional reactions, they say.

Adam Noble and his team say it is relatively easy to spot which stroke patients are at greatest risk of PTSD by looking for signs of “poor” coping, such as denial and self-blame.

These patients could be offered pre-emptive treatment, they say.

Mr Noble suggested tailored treatment such as group therapy “and, where possible, prevention through teaching patients more appropriate stress-coping strategies after they suffer a stroke”.

Professor Allan House of the Stroke Association said: “Doctors do realise this type of stroke is stressful for the patient, but they do not always ask the patient about anxiety and depression. Someone needs to.

“Some patients undoubtedly have PTSD, while others might have depression or anxiety after a subarachnoid haemorrhage and it is understandable why.”

Peter Chapman, from Hartlepool, suffered a subarachnoid brain haemorrhage at the age of 45 in 2001.

His PTSD was not picked up until two years after his stroke.

He said: “The first six months were the worst. I was so worried that it might happen again and I have never shed so many tears in my life.

“If I had been tested and treated for PTSD right from the beginning, my life would have been 500% better than what it has been, and would have made the world of difference to my recovery.”

The new issue of *Archives of General Psychiatry* (Vol. 66 No. 3, March)
includes an article: “Posttraumatic Stress Disorder and Suicide Attempts
in a Community Sample of Urban American Young Adults.”

The authors are Holly C. Wilcox, PhD; Carla L. Storr, ScD; & Naomi
Breslau, PhD.

Here’s the abstract:

Context

Previous research has shown that exposure to traumatic events,
especially sexual trauma during childhood, is associated with an
increased risk of attempted suicide. However, no information is
available as to whether the increased risk of attempted suicide is
related primarily to posttraumatic stress disorder (PTSD) following
traumatic experiences or applies also to persons who experienced trauma
but did not develop PTSD.

Objective

We examine the association between exposure to traumatic events with and
without resulting PTSD and the risk of a subsequent suicide attempt in a
community sample of urban young adults.

Design

A cohort study followed young adults who had participated in a
randomized trial of all first-grade students entering 19 public schools.

Setting

Baltimore, Maryland, an urban setting.

Participants

A total of 1698 young adults (mean age, 21; 47% male; 71% African
American) who represented 75% of the original cohort of 2311 persons.

Main Outcome Measure

Relative risk of a subsequent suicide attempt associated with PTSD and
with exposure to assaultive and nonassaultive traumas (no PTSD), as
estimated using discrete time survival analysis.

Results

Posttraumatic stress disorder was associated with increased risk of a
subsequent suicide attempt
. The PTSD-suicide attempt association was
robust, even after adjustment for a prior major depressive episode,
alcohol abuse or dependence, and drug abuse or dependence (adjusted
relative risk, 2.7; 95% confidence interval, 1.3-5.5; P < .01). In
contrast, exposure to traumatic events without PTSD was not associated
with an increased risk of attempted suicide.

Conclusions

Posttraumatic stress disorder is an independent predictor of attempted
suicide. Exposure to traumatic events without PTSD is not associated
with a later suicide attempt.

Child abuse ‘impacts stress gene’ and has long-lasting effects

Abuse in early childhood permanently alters how the brain reacts to stress, a Canadian study suggests.

Analysis of brain tissue from adults who had committed suicide found key genetic changes in those who had suffered abuse as a child.

It affects the production of a receptor known to be involved in stress responses, the researchers said.

The Nature Neuroscience study underpins the impact of stress on early brain development, experts said.

Previous research has shown that abuse in childhood is associated with an increased reaction to stressful circumstances.
Whilst these results obviously need to be replicated, they provide a mechanism by which experiences early in life can have an effect on behaviour later in adulthood

But exactly how environmental factors interact with genes and contribute to depression or other mental disorders in adulthood is not well understood.

A research team led by McGill University, in Montreal, examined the gene for the glucocorticoid receptor – which helps control the response to stress – in a specific brain region of 12 suicide victims with a history of child abuse and 12 suicide victims who did not suffer abuse when younger.

They found chemical changes which reduced the activity of the gene in those who suffered child abuse.

And they showed this reduced activity leads to fewer glucocorticoid receptors.

Those affected would have had an abnormally heightened response to stress, the researchers said.

It suggests that experience in childhood when the brain is developing, can have a long-term impact on how someone responds to stressful situations.

But study leader Professor Michael Meaney said they believe these biochemical effects could also occur later in life.

“If you’re a public health individual or a child psychologist you could say this shows you nothing you didn’t already know.

“But until you show the biological process, many people in government and policy-makers are reluctant to believe it’s real.

“Beyond that, you could ask whether a drug could reverse these effects and that’s a possibility.”

Dr Jonathan Mill, from the Institute of Psychiatry at Kings College London said the research added to growing evidence that environmental factors can alter the expression of genes – a process known as epigenetics.

“Whilst these results obviously need to be replicated, they provide a mechanism by which experiences early in life can have an effect on behaviour later in adulthood.

“The exciting thing about epigenetic alterations is that they are potentially reversible, and thus perhaps a future target for therapeutic intervention.”

from <http://news.bbc.co.uk/2/hi/health/7901337.stm&gt;.