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 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,.

BBC News released an article: “Childhood abuse ‘quickens ageing.'”

Here are some excerpts:

[begin excerpts]

Physical or emotional abuse during childhood could speed up the body’s
ageing process, US research suggests.

A team from Brown University focused on telomeres, the protective caps
on the chromosomes that keep a cell’s DNA stable but shorten with age.

They found the telomeres of 31 people who had reported abuse as children
tended to shorten more rapidly, speeding up cells’ ageing process.

Experts cautioned that the study needed to be replicated on a larger scale.

The study is featured in Biological Psychiatry.

Lead researcher Dr Audrey Tyrka said: “It gives us a hint that early
developmental experiences may have profound effects on biology that can
influence cellular mechanisms at a very basic level.” (more…)

 

The *American Journal of Preventive Medicine* issued the following news
release about a study to appear in the November issue:
Traumatic Childhood Might Take Years Off Adult Life
Many U.S. children face a terrible burden of stressors that can harm the
development of their brains and nervous systems.
These stressors can lead to health problems and diseases throughout
their lives, ultimately causing some to die prematurely, according to
the lead author of a new study.
David W. Brown., D.Sc., an epidemiologist at the Centers for Disease
Control and Prevention (CDC), and colleagues found that children who
were exposed to six or more “adverse childhood experiences” or ACEs were
at double the risk of premature death compared to children who had not
suffered these experiences.
On average, the children at highest risk eventually died at age 60,
compared to low-risk children who lived to age 79.
The study appears in the November issue of the American Journal of
Preventive Medicine.

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

The Mayo Clinic just issued the following news release:

Mayo Clinic Researchers Examine the Psychological Impact of Child Abuse

SAN FRANCISCO, May 21 — According to a new Mayo Clinic study, a history
of child abuse significantly impacts the wide range of challenges facing
depressed inpatients.

Included are an increase in suicide attempts, prevalence of substance
use disorder, and a higher incidence rate of personality disorder.

Additionally, these victims also had an earlier onset of mental illness
and an increase in psychiatric hospitalizations for psychiatric issues.

The study was presented at the American Psychiatric Association 2009
Annual Meeting in San Francisco.

The impact of child abuse already is known to increase the risk of
suicide; however, the literature about other characteristics of
depressed victims of child abuse is scarce.

Although the findings of the Mayo study do not confirm causality, the
information stresses the importance of more aggressive approaches from
the public health perspective to prevent child abuse.

“A history of child abuse makes most psychiatric illnesses worse,”
according to Magdalena Romanowicz, M.D., lead author of the study.

“We found that it significantly impacts the wide range of
characteristics of depressed inpatients, including increased risk of
suicide attempt, substance abuse, as well as earlier onset of mental
illness and more psychiatric hospitalizations.

This new information serves as a reminder of the importance of child
abuse prevention from a public health perspective.”

Dr. Romanowicz says plans are under way to further examine the
association between child abuse and metal illness in a larger study of
patients.

Other authors of this Mayo Clinic study include: Gen Shinozaki, M.D.;
Victoria Passov, M.D.; Simon Kung, M.D.; Renato Alarcon, M.D.; and David
Mrazek, M.D.

Courtesy of Ken Pope

The *Journal of Epidemiology and Community Health* issued the following
news release:

People with parents who fight are more likely to have mental health
problems in later life

Exposure to interparental violence and psychosocial maladjustment in the
adult life course: Advocacy for early prevention

People with parents who were violent to each other are more likely to
have mental health problems when they grow up, reveals research
published in the Journal of Epidemiology and Community Health.

Researchers looked at what impact interparental violence had on people
as children by observing their mental health outcomes in adulthood.

A child being exposed to interparental violence is a form of
maltreatment with consequences for a child’s development, but in some
countries it is only seen as a risk factor for later problems with no
specific outcomes.

The authors studied 3,023 adults in the Paris metropolitan area in 2005
by carrying out at-home face to face interviews.

People who agreed to take part were found from a population based cohort
study in Paris held by the National Institute of Health and Medical Research.

The researchers measured current depression and lifetime suicide
attempts, intimate partner violence, violence against children and
alcohol dependence.

They also asked people about childhood adversities such as parental
separation, divorce, parental death or imprisonment, alcoholism and
physical and/or sexual abuse, as well as asking about social level
stressors including poor parental health, housing problems, prolonged
parental unemployment, and financial troubles.

Among the group of people interviewed, 16% said they had witnessed
interparental violence before the age of 18 and this was far more common
in certain situations. For example, it was up to eight times more likely
in cases where parents had been alcoholics.

Other factors were also relevant and witnessing violence was more common
in families with financial problems, serious parental diseases, housing
problems or unemployment.

After adjusting for family and social level stressors, the researchers
found that people who were exposed to interparental violence had a 1.4
times higher risk of having depression, were more than three times more
likely to be involved in conjugal violence, were almost five times more
likely to mistreat their own child and 1.75 times more likely to have a
dependence on alcohol.

The authors concluded: “Intensification of prevention of and screening
for domestic violence including interparental violence is a public
health issue for the well-being of future generations.”

Courtesy of Ken Pope

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

“There is an idea current in the prevailing culture that writing about something that means you heal the pain.  I was not, when I began writing my life story, and I am not now, healed of my mother.  You do gain a small distance from anything by keeping it in suspension in your mind while you work at finding the words to fit it.  The process is so slow and incremental that you do not notice its effect, but the point is that it is a process.  I found out when I was a little girl that if you are crying uncontrollably and want to stop, the thing is to do something useful with your tears — water a plant, say.  They’ll dry up for themselves.  The same happens when you try to make sentences of painful material: the material lightens as it is put to work.”

Nualo O’Faolain in “Almost There”, pg. 36.