scholarly journals Genes and hormones of the hypothalamic–pituitary–adrenal axis in post-traumatic stress disorder. What is their role in symptom expression and treatment response?

2021 ◽  
Author(s):  
Susanne Fischer ◽  
Tabea Schumacher ◽  
Christine Knaevelsrud ◽  
Ulrike Ehlert ◽  
Sarah Schumacher
Keyword(s):  
Hpa Axis ◽  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Stress Disorder ◽  
Ptsd Symptoms ◽  
Post Traumatic Stress ◽  
Alternative Treatments ◽  
Hypothalamic Pituitary Adrenal ◽  
Post Traumatic

Abstract Background Less than half of all individuals with post-traumatic stress disorder (PTSD) remit spontaneously and a large proportion of those seeking treatment do not respond sufficiently. This suggests that there may be subgroups of individuals who are in need of augmentative or alternative treatments. One of the most frequent pathophysiological findings in PTSD is alterations in the hypothalamic–pituitary–adrenal (HPA) axis, including enhanced negative feedback sensitivity and attenuated peripheral cortisol. Given the role of the HPA axis in cognition, this pattern may contribute to PTSD symptoms and interfere with key processes of standard first-line treatments, such as trauma-focused cognitive behavioural therapy (TF-CBT). Methods This review provides a comprehensive summary of the current state of research regarding the role of HPA axis functioning in PTSD symptoms and treatment. Results Overall, there is preliminary evidence that hypocortisolaemia contributes to symptom manifestation in PTSD; that it predicts non-responses to TF-CBT; and that it is subject to change in parallel with positive treatment trajectories. Moreover, there is evidence that genetic and epigenetic alterations within the genes NR3C1 and FKBP5 are associated with this hypocortisolaemic pattern and that some of these alterations change as symptoms improve over the course of treatment. Conclusions Future research priorities include investigations into the role of the HPA axis in day-to-day symptom variation, the time scale in which biological changes in response to treatment occur, and the effects of sex. Furthermore, before conceiving augmentative or alternative treatments that target the described mechanisms, multilevel studies are warranted.

scholarly journals Protagonist Role of Opioidergic System on Post-Traumatic Stress Disorder and Associated Pain

2020 ◽  
Vol 17 (6) ◽  
pp. 506-516
Author(s):  
Marjan Nikbakhtzadeh ◽  
Fatemeh Mohtashami Borzadaran ◽  
Elham Zamani ◽  
Mohammad Shabani
Keyword(s):  
Chronic Pain ◽  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Stress Disorder ◽  
Pain Reduction ◽  
Ptsd Symptoms ◽  
Post Traumatic Stress ◽  
Opioidergic System ◽  
Post Traumatic

Objective Post-traumatic stress disorder (PTSD) and chronic pain often co-occur. Studies have shown an interaction between pain and PTSD. In this narrative review, we aim to support conducting comprehensive studies by describing PTSD, pain and determining whether opioidergic system, its agonist and antagonist manipulation could positively or negatively affect PTSD symptoms and concurrent pain.Methods Term searches was done in Google Scholar, Scopus, ScienceDirect, Web of Science and PubMed databases as well as hand searching in key resource journals from 1979–2019.Results There are a lot of contradictions and disputes when endogenous opioidergic system and opioidergic antagonist system are studied in PTSD patients. Exogenous morphine administration in PTSD patients can decrease the symptoms of PTSD but it doesn’t have a pain reduction effect to an acceptable level. Beta-endorphin as an endogenous opioid is effective in pain reduction in the moment of events but after minutes to hours, the endorphins withdrawal syndrome leads to exaggerated intrusive thoughts and flashbacks of PTSD, which exacerbate the pain. It has also been shown that naloxone, as an opioidergic antagonist, can reduce or increase the PTSD symptoms and its associated pain.Conclusion Data suggest different roles of opioidergic system and their antagonist in pain control and mood in PTSD. However, further investigations need to be done in order to reveal the role of endogenous opioidergic system and opioidergic antagonist system as a mediator in PTSD patients suffering from acute or chronic pain.

scholarly journals Impact of Post Traumatic Stress Disorder on Employee Job Performance: Moderating Role of Spirituality

2021 ◽  
Author(s):  
Qadar Bakhsh Baloch ◽  
Verdah Qadar Baloch ◽  
Sourath Maher ◽  
Nadeem Iqbal ◽  
Syed Naseeb Shah ◽  
...  
Keyword(s):  
Job Performance ◽  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Stress Disorder ◽  
Well Being ◽  
Ptsd Symptoms ◽  
Post Traumatic Stress ◽  
Post Traumatic ◽  
Moderating Role

Abstract The aim of this paper was to determine the correlation amid post-traumatic stress disorder (PTSD) and employee job performance with moderating role of spirituality among Police officials who experienced during the war on terror. Ninety seven personnel from Pakistan Security Forces, hospitalized as result of injuries in war against terror, were selected as study respondents and personally administered with the seventeen items questionnaire to measure PTSD symptoms. All the instruments administered to measure PTSD symptoms, employees’ performance and spiritualty were adopted. Andrew F. Hayes Process model was used to test the hypotheses derived from the study’s conceptual model as it was identical with the Andrew model (Hayes 2013) in which moderation is tested with one moderator that is spirituality. Correlation and Regression analysis were carried out by using SPSS. Moderation analysis checked the moderating effect of spirituality upon the relationship between PTSD and employees performance. The research concluded that PTSD negatively affects the job performance, however, spirituality reduces the negative outcomes of PTSD. The research found that the spirituality contributes positively to the psychological well-being of a person, thereby making one’s self more robust to tremor and harrowing engagement and subsiding the negative impacts of PTSD. Managerial implications and future direction were also discussed.

scholarly journals Pharmacotherapy for post-traumatic stress disorder: Systematic review and meta-analysis

2015 ◽  
Vol 206 (2) ◽  
pp. 93-100 ◽  
Author(s):  
Mathew Hoskins ◽  
Jennifer Pearce ◽  
Andrew Bethell ◽  
Liliya Dankova ◽  
Corrado Barbui ◽  
...  
Keyword(s):  
Systematic Review ◽  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Stress Disorder ◽  
Positive Impact ◽  
Meta Analysis ◽  
Ptsd Symptoms ◽  
Post Traumatic Stress ◽  
Post Traumatic

BackgroundPharmacological treatment is widely used for post-traumatic stress disorder (PTSD) despite questions over its efficacy.AimsTo determine the efficacy of all types of pharmacotherapy, as monotherapy, in reducing symptoms of PTSD, and to assess acceptability.MethodA systematic review and meta-analysis of randomised controlled trials was undertaken; 51 studies were included.ResultsSelective serotonin reuptake inhibitors were found to be statistically superior to placebo in reduction of PTSD symptoms but the effect size was small (standardised mean difference −0.23, 95% CI −0.33 to −0.12). For individual pharmacological agents compared with placebo in two or more trials, we found small statistically significant evidence of efficacy for fluoxetine, paroxetine and venlafaxine.ConclusionsSome drugs have a small positive impact on PTSD symptoms and are acceptable. Fluoxetine, paroxetine and venlafaxine may be considered as potential treatments for the disorder. For most drugs there is inadequate evidence regarding efficacy for PTSD, pointing to the need for more research in this area.

"Efficacy of Cognitive Behavioral Therapy in Post-traumatic Stress Disorder Among Spinal Cord Injury Patients: A Randomized Controlled Pilot Study"

2021 ◽  
Vol 21 (2) ◽  
pp. 143-162
Author(s):  
Anwar Khan ◽  
Faseeh Ullah ◽  
Omer Abid ◽  
Khizra Hafeez Awan
Keyword(s):  
Spinal Cord ◽  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Stress Disorder ◽  
Behavioral Therapy ◽  
Ptsd Symptoms ◽  
Post Traumatic Stress ◽  
Randomized Controlled ◽  
Cord Injury ◽  
Post Traumatic

"Post-Traumatic Stress Disorder (PTSD) develops after exposure to or witnessing traumatic events. PTSD is very common among the Spinal Cord Injury (SCI) patients. PTSD can be successfully treated with the Cognitive Behavioral Therapy (CBT). However, CBT is mostly used in the western countries, so its efficacy in the eastern culture is still not fully known. Keeping this in view, the current study has determined the efficacy of CBT in the treatment of PTSD among the SCI patients in Pakistan. Using a Randomized Controlled Pilot Study design, data were collected through the Clinician-Administered PTSD Scale for DSM-5 from thirty patients admitted to the Paraplegic Center. Trauma-focused CBT(TF-CBT) protocol was applied through fourteen sessions. Data were analyzed by descriptive and multivariate statistics. Findings show that the level of PTSD symptoms gradually decreased from high at baseline (CAPS-5 Mean Scores μ= 3.6) to low during follow-up stage (CAPS-5 Mean Scores μ= 0.89). Results obtained from the present study on the efficacy of CBT are in concurrence with the research findings in other countries. This study supports the efficiency CBT intervention among Pakistani patients who had developed PTSD symptoms after suffering from SCI. Therefore, CBT can be widely used in the management of PTSD in Pakistan."

scholarly journals Perceived stress and post-traumatic stress disorder symptoms among intensive care unit staff caring for severely ill coronavirus disease 2019 patients during the pandemic: a national study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Nisha Kader ◽  
Bushra Elhusein ◽  
Nirvana Swamy Kudlur Chandrappa ◽  
Abdulqadir J. Nashwan ◽  
Prem Chandra ◽  
...  
Keyword(s):  
Mental Health ◽  
Intensive Care Unit ◽  
Perceived Stress ◽  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Stress Disorder ◽  
Well Being ◽  
Ptsd Symptoms ◽  
Post Traumatic Stress ◽  
Post Traumatic

Abstract Background Intensive care unit (ICU) staff have faced unprecedented challenges during the coronavirus disease 2019 (COVID-19) pandemic, which could significantly affect their mental health and well-being. The present study aimed to investigate perceived stress and post-traumatic stress disorder (PTSD) symptoms reported by ICU staff working directly with COVID-19 patients. Methods The Perceived Stress Scale was used to assess perceived stress, the PTSD Diagnostic Scale for the Diagnostic and Statistical Manual of Mental Disorders (5th edition) was used to determine PTSD symptoms, and a sociodemographic questionnaire was used to record different sociodemographic variables. Results Altogether, 124 participants (57.2% of whom were men) were included in the analysis. The majority of participants perceived working in the ICU with COVID-19 patients as moderately to severely stressful. Moreover, 71.4% of doctors and 74.4% of nurses experienced moderate-to-severe perceived stress. The staff with previous ICU experience were less likely to have a probable diagnosis of PTSD than those without previous ICU experience. Conclusions Assessing perceived stress levels and PTSD among ICU staff may enhance our understanding of COVID-19-induced mental health challenges. Specific strategies to enhance ICU staff’s mental well-being during the COVID-19 pandemic should be employed and monitored regularly. Interventions aimed at alleviating sources of anxiety in a high-stress environment may reduce the likelihood of developing PTSD.

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