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.”

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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;.

Almost 1 in 10 Canadians has post-traumatic stress at some point: study
Last Updated: Thursday, September 18, 2008 | 10:11 AM ET Comments16Recommend24
CBC News

Canadians are most accustomed to hearing about post-traumatic stress disorder among returning soldiers, but a newly published study suggests that almost one in 10 civilians meets the criteria for PTSD at some point in his or her lifetime.

Researchers at McMaster University in Hamilton have released the findings of a national survey that appear in the latest issue of the quarterly journal CNS Neuroscience and Therapeutics.

They conducted a telephone survey of 2,991 people, age 18 and over, from across Canada in July and August 2002, and found the prevalence rate of lifetime PTSD was estimated at 9.2 per cent.

(more…)

The American Pain Society issued the following news release:

PTSD Influences Levels Of Depression And Pain
22 Jul 2008

Patients with accident or trauma related chronic pain often have post-
traumatic stress disorder (PTSD) and depression. What isn’t clearly
known, however, is how PTSD relates to mood disorders and pain severity
in chronic pain patients.

University of Michigan researchers examined the contribution of PTSD to
the pain experience, functional disability and frequency of depressive
symptoms. They studied 241 patients referred to the university
hospital’s pain rehabilitation program who reported their pain began
after a traumatic injury. The subjects completed the McGill Pain
Questionnaire and were administered the Pain Disability Index and the
Post-traumatic Chronic Pain Test.

Results showed PTSD and depression are significantly correlated and both
disorders are associated with perceived disability attributed to chronic
pain. Therefore, in cases of disabling accident-related chronic pain
with comorbid depression, symptoms of PTSD may be critical to
understanding both disorders.

The authors concluded that increased attention to treating PTSD as a
primary focus in the rehabilitation of patients with chronic pain and
comorbid depression is important when prior treatment efforts for pain
and depression have not been successful.

13 July 2008 – *Clinical Psychology Review* (vol. 28, #5) includes an article: “The
relative efficacy of bona fide psychotherapies for treating post-
traumatic stress disorder: A meta-analysis of direct comparisons” by
Steven Benish, Zac Imel, & Bruce Wampold.

Here’s the abstract: “Psychotherapy has been found to be an effective
treatment of post-traumatic stress disorder (PTSD), but meta-analyses
have yielded inconsistent results on relative efficacy of
psychotherapies in the treatment of PTSD. The present meta-analysis
controlled for potential confounds in previous PTSD meta-analyses by
including only bona fide psychotherapies, avoiding categorization of
psychotherapy treatments, and using direct comparison studies only. The
primary analysis revealed that effect sizes were homogenously
distributed around zero for measures of PTSD symptomology, and for all
measures of psychological functioning, indicating that there were no
differences between psychotherapies. Additionally, the upper bound of
the true effect size between PTSD psychotherapies was quite small. The
results suggest that despite strong evidence of psychotherapy
efficaciousness vis-à-vis no treatment or common factor controls, bona
fide psychotherapies produce equivalent benefits for patients with PTSD.”

The Geisinger Health System has issued the following news release about
a study in the new issue of *Psychosomatic Medicine*:

Post Traumatic Stress Disorder Causes Early Heart Disease Death
07 Jul 2008

Vietnam veterans who experienced posttraumatic stress disorder (PTSD)
were twice as likely to die from heart disease as veterans without PTSD,
a new Geisinger study finds.
(more…)