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A study on post traumatic stress disorder ptsd in returning gis

Other attributes of a high-performing system are fostering new research on innovative approaches for PTSD management; expediting translation of new research findings to people who have PTSD and to their health care settings; striving to anticipate future research directions to address knowledge gaps; and exploring new ways to reduce stigma and promote access to and dissemination of evidence-based treatment.

In its phase 1 report, the committee presented an overview of the current knowledge base on PTSD prevention, assessment, diagnosis, and treatment, including comorbidities and rehabilitation. The chapter ends with a discussion of the challenges to translating research into practice and a discussion of leveraging technology to improve access to and delivery of PTSD care. Some of the ways in which DoD and VA and to some extent NIH have fostered PTSD-related research are establishing clear mission statements for research, investing in the research, establishing an action plan, learning how to translate research into practice, and supporting innovation in technology.

Research in VA tends to be focused on the long-term health of veterans. Its infrastructure can support and leverage clinical trials and epidemiological studies, and it has the capability to translate research findings into clinical care.

Results of such basic and clinical research can be used to inform PTSD prevention, diagnosis, and treatment. There are also private efforts by foundations and other organizations to improve care of people who have PTSD.

  1. Translating animal models of PTSD to the clinic. Basic research on physiological and biological mechanisms potentially relevant to PTSD has used primarily animal models Almli et al.
  2. If current or recently completed studies on developing Web-based or new training curricula or tools are effective, they could be used to reach a larger audience. First, studies of drug effects on brain structure and chemistry, such as effects of escitalopram on BDNF, are valuable, and more studies of this type are needed.
  3. Intimate Partner Violence Intimate partner violence is an often overlooked research topic with regard to PTSD, but it can have substantial impact on families. Studies indicating you can get post-traumatic.
  4. Those research priorities reflect the mental health needs of the service member and veteran populations that each department serves and are reflected in the types and numbers of studies that are funded see Table 9-2. The following databases provided most of the research information.
  5. Concurrent Treatment of Comorbidities As noted in Chapter 2 , people who have PTSD are often diagnosed with one or more comorbidities, including other anxiety disorders, depression, and alcohol and substance use disorders Brown and Wolfe, 1994 ; IOM, 2012 ; Jacobsen et al.

For each component of the continuum—foundational science, epidemiology, etiology, prevention and screening, treatment, follow-up care, and services research—the interagency group was to undertake a gap analysis and identify short-term, mid-term, and long-term research needs to improve the prevention and diagnosis of and treatment for PTSD in service members and veterans Castro et al. The research plan also considers comorbid conditions as appropriate.

They also identified several cross-cutting actions to increase transparency and communication among the departments DoD et al. The committee believes that such a move will increase the transparency of mental health and other research being funded by DoD. The committee commends DoD, VA, and NIH for the thorough review they are undertaking, and it agrees with the gaps and future research goals the departments have identified. The greatest funding that year went to treatment 40.

Case studies on post traumatic stress disorder

The greatest funding went to treatment 42. Those research priorities reflect DoD and VA efforts to understand, prevent, and treat for PTSD in service members and veterans who are exposed to traumatic events.

The committee was also asked to provide recommendations for future PTSD research.

  • NIH has made an effort to streamline the translation of mental health research to the clinic;
  • Traumatic events that result in PTSD could be conceptualized as resulting in memories that are over-consolidated;
  • In healthy humans and in clinical populations, studies do not generally exclude women, even if the differences between males and females are not fully explored or characterized Lebron-Milad and Milad, 2012.

To identify PTSD research projects, the committee looked at several publicly available research databases. The committee limited its review to studies in adult populations and those on mechanisms, screening, diagnosis, treatment, or barriers related to PTSD in service members and veterans.

Studies were excluded if they were specific to traumatic brain injury TBIcaregiver support, or insomnia, chronic pain, and unexplained illnesses in veterans.

  1. Emphasis is being placed on target validation and experimental therapeutic studies instead of traditional efficacy trials in an effort to identify new targets for treatment and to improve knowledge of the disease process NIMH, 2013b.
  2. The committee found that there were as many mindfulness projects in the NIH RePORT database as there were projects for treating for PTSD with a combination of pharmacotherapy and psychotherapy approaches—an indication that research on mindfulness is growing. The databases also varied in how costs and funding information were presented, so the number of studies in each funding column in Table 9-2 may be underestimated.
  3. However, this research has limited usefulness if its applicability to and modification by the complex cognitive, social, and emotional factors typical of human experiences cannot be explored.
  4. Post traumatic stress disorder review articles, posttraumatic stress disorder ptsd may develop after a person is exposed to one or more traumatic ev. Genetic disorder research paper.

The remaining studies were categorized into broad topic areas see Table 9-2. Studies in each category were enumerated by funding agency and summarized to identify gaps and overlaps in the research. The following databases provided most of the research information: The committee recognizes that this database is not static and that new projects may have been funded since June 2012.

Although it does not include all clinical trials conducted in the United States, it does contain the majority of federally and privately funded studies conducted under investigational new drug applications. Studies were eliminated if they were completed or expected to be completed before 2011, or were withdrawn.

Table 9-2 gives an overview of the research categories used by the committee and the number of funded studies in each category. The committee then provides a broad description of why each research category in this chapter is important for understanding and treating for PTSD in DoD and VA. Because the research is ongoing and not yet published in most casescitations could not be provided for some of the summaries below.

More detailed descriptions of the ongoing studies reviewed by the committee are given in Appendix E. The level of detail provided in each of the research categories below and in Appendix E are variable and reflect the number of studies and the level of information the committee was able to obtain about those studies.

For example, some of the research descriptions had details on the study population, methodology, and even preliminary results, whereas others had only a title and a brief description of the goals and objectives of the study.

The databases also varied in how costs and funding information were presented, so the number of studies in each funding column in Table 9-2 may be underestimated. In some cases, it was difficult to determine who was funding a particular study. The table does not reflect ongoing collaborations. Thus, the table should be considered as a general representation of currently or recently funded PTSD research.

One reason is a desire to understand the brain—behavior interactions from a basic neuroscience perspective. Another is a desire to advance knowledge of the psychopathology of anxiety and mood disorders in general and of PTSD in particular. DoD, VA, and NIMH have set priorities for funding in these topics to elucidate the mechanistic underpinnings of the pathophysiology of fear and anxiety that are commonly observed in people who have PTSD. Some of the research reviewed by the committee is summarized below with a discussion of its relevance to PTSD psychopathology and treatment.

The committee notes that other emotions, such as shame and guilt, frequently accompany a diagnosis of PTSD Lee et al. That understanding has been approached from a number of perspectives, from cellular to cognitive to cultural Feodorova and Saragian, 2012 ; Martin et al. Given that PTSD is triggered by experience and is commonly viewed a study on post traumatic stress disorder ptsd in returning gis a disorder that emerges with an inability to cope with or recover from the aftermath of the trauma Shvil et al.

Some people diagnosed with PTSD overgeneralize their fears and exhibit substantial avoidance symptoms, so animal research on passive and active avoidance is helpful. Overgeneralization is another research area that is very active Dunsmoor et al. The mechanisms of action by which some experiences can change neural networks are of the utmost importance for understanding the development and persistence of PTSD. On the cellular level, one approach to understanding mechanisms of action is to study how different types of receptors interact with their ligands to mediate memory formation under normal physiological conditions.

That knowledge can inform how malfunction or modification of cellular mechanisms could lead to changes in memory formation that may be relevant to the pathophysiology of PTSD. Over the last several decades, research has generated a wealth of knowledge about the processes by which learning and memory lead to the activation of several types of receptors; this activation triggers intracellular cascades that result in the activation of gene transcription and translation and causes synthesis of new proteins and modification of synaptic connections between neurons Andero and Ressler, a study on post traumatic stress disorder ptsd in returning gis ; Gunduz-Cinar et al.

That line of research has helped to identify some cellular targets that may play a role in the pathophysiology of PTSD, such as corticotrophin-releasing factor, brain-derived neurotrophic factor BDNFand N-methyl-D-aspartate receptors. A recent study by Pace et al. New and promising work in preclinical neuroscience reviewed by the committee includes research to understand BDNF and its receptors tyrosine receptor kinase B and some potential new targets such as neuropeptide Y and neurosteroids. Building on the foundation of the cellular and molecular mechanisms of memory requires an understanding of the diverse and interacting brain systems and psychological processes that support adaptive and maladaptive memory formation and expression.

One fundamental principle is that several kinds of memory make up distinct brain circuits, each having unique characteristics.

For instance, different memory systems support the conscious retrieval of episodes, habitual actions, and physiological defensive reactions Luethi et al. Preliminary research suggests that the impact of trauma and stress on learning and memory depends on the type of memory assessed. One important topic that has not been investigated extensively is how different types of memory systems interact.

Given that PTSD is characterized by intrusive and habitual episodic memory retrieval accompanied by heightened learned threat responses and physiological arousal, this might be an important avenue for future research. Cellular and brain systems that support learning and memory have the potential to elucidate mechanisms of memory storage consolidation and restorage reconsolidation. Traumatic events that result in PTSD could be conceptualized as resulting in memories that are over-consolidated.

Knowing how that works, whether and how memories are retained in the absence of retrieval, and how memories are reconsolidated after retrieval are critical for understanding PTSD and could lead to new interventions. Traditional research on learning and memory has focused on memory encoding and retrieval, not the storage process itself, which is a promising topic.

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Current nonpharmacological approaches to treating PTSD are based largely on controlling fear through either cognitive regulation or through exposure and extinction Bisson et al. Initial studies of fear conditioning and extinction focused on fear learning because patients who have PTSD may overconsolidate traumatic memories Pitman et al.

However, recent studies suggest that over consolidation of fear memories may not be evident in PTSD—at least using de novo fear conditioning and extinction paradigms—and the extinction of conditioned fear memories may be deficient in PTSD patients Milad et al. Although exploring means to enhance those techniques is useful, the committee identified relatively few ongoing studies of the mechanisms of fear resilience or fear-control techniques beyond extinction or cognitive regulation.

In addition, the committee found little research on the relationship between the stress—hypothalamic pituitary axis response and the mechanisms of emotion and fear control. Those mechanisms are inherently intertwined in PTSD, so understanding their interactions is important and research on this topic should be expanded.

Although an understanding of basic general psychological and neurobiological principles underlying the development and persistence of PTSD is clinically important, this research cannot be adequately translated into treatment and prevention unless it is known how the mechanisms interact with individual characteristics.

Post-traumatic stress disorder hitting World War II vets

For example, an important variability factor for PTSD is sex differences. The incidence of a study on post traumatic stress disorder ptsd in returning gis anxiety and mood disorders is twice as high in women Kinrys and Wygant, 2005who seem to have symptoms for longer periods and poorer prognoses compared with men Breslau et al.

Despite these epidemiological data, relatively little is known about how sex differences may impact the underlying neurobiology and psychology of PTSD. In healthy humans and in clinical populations, studies do not generally exclude women, even if the differences between males and females are not fully explored or characterized Lebron-Milad and Milad, 2012. However, the vast majority of PTSD-related research is conducted only in male animals, which may potentially limit its relevance to half the human population.

Basic research for such physical conditions as heart disease must include an appreciation of sex differences, and this same standard should be extended to basic and translational research for PTSD.

Genomics The factors that lead to individual differences in the development of PTSD are both experiential and genetic Admon et al. The genomic basis of PTSD is critically important for determining who might be at risk. That includes identifying genotypes implicated in vulnerability or resilience to PTSD, gene pathways that undergo epigenetic modification after trauma exposure, and differential expression of genes in people who have and do not have PTSD Almli et al.

Because PTSD is fundamentally a brain disorder, identifying epigenetic modifications that result in differential gene expression in brain regions known to be dysfunctional in PTSD patients has a high priority.

However, because brain tissue from living people cannot be assayed, brain-focused studies to identify differentially expressed genes are generally conducted in animal models. The committee identified human studies that are investigating whether epigenetic and expression differences observed in peripheral tissues are associated with PTSD. The genomics of PTSD is in its infancy compared with the genomics of other common psychiatric disorders such as schizophrenia Koenen et al.

There is a great deal of knowledge to be gained in this field, but whether it will translate into innovative interventions to prevent or ameliorate PTSD is unknown. The most promising research for translation appears to be prospective human studies that integrate multiple levels of biological data.

The best method for such studies begins with identifying people before exposure, but studies of people in the acute aftermath of a traumatic event are also likely to produce important translational results. The translational impact of PTSD genomics could be improved by integrating genome-wide data for example, genotype, epigenetic, and gene expression into treatment studies of PTSD, as has been done with functional magnetic resonance imaging research. Such studies may provide information on genomic profiles of people who do and do not respond to treatment and information on genomic correlates for example, gene expression changes of symptom remission.

A major concern about genomic research on PTSD is the narrow focus on candidate genes—whether for genotype, epigenetic, or gene expression studies—in light of the discrediting of this approach for other psychiatric disorders, such as schizophrenia and bipolar disorder Pitman et al. A further concern is the relatively small number of human studies due to current funding constraints. PTSD genomics would benefit from the formation of a PTSD working group in the Psychiatric Genomics Consortium aimed at sharing genotype, epigenetic, and gene expression data among human studies Koenen et al.

Large consortia have produced robust genomic discoveries related to other psychiatric disorders, such as schizophrenia Sullivan et al. The major barriers to such a consortium are VA and DoD restrictions on the sharing of genomic data.

For example, unlike NIH, which effectively requires data sharing, VA does not allow sharing of individual-level genotype data from genome-wide association studies. Such barriers to data sharing have in effect excluded VA investigators from the large consortia that are necessary for genomic research.

Addressing such barriers would help ensure progress in PTSD genomics research. Unlike other psychiatric disorders, PTSD results from a known event, and this allows for immediate intervention and possibly even the prevention of pathological symptoms.

It remains unclear why some people are resilient to trauma whereas others develop PTSD. Clarifying the reasons for this difference might improve strategies for enhancing resilience and preventing the development of PTSD.

Logistically, this research is challenging to conduct in humans, as it requires recruiting people into studies immediately after a traumatic event and following them longitudinally.