PTSD and Suicide Ideation in Veterans

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PTSD and Suicide Ideation in Veterans

Post by trader32176 »

"Brain injury in the form of Chronic Traumatic Encephalopathy is a major scourge on the bravest elements of our society: the veterans. It is estimated that approximately 1 suicide per hour occurs because of PTSD," said Famela Ramos


Background :

Traumatic Brain Injury (TBI)


https://www.research.va.gov/topics/tbi.cfm

The Centers for Disease Control and Prevention (CDC) defines a traumatic brain injury (TBI) as "a disruption in the normal function of the brain that can be caused by a bump, blow, or jolt to the head, or penetrating head injury." Individuals can experience a TBI through everyday activities like playing contact sports, being involved in a car accident, or falling and striking their head. Military service members and Veterans are also at risk of brain injury from explosions experienced during combat or training exercises.

Depending on the severity of the brain injury, a person with TBI may experience a change in consciousness that can range from being dazed and confused to losing consciousness. They may also experience memory loss.

Due to improved diagnostics and increased vigilance, there are now more accurate statistics on military TBI rates. The Defense and Veterans Brain Injury Center (DVBIC) reported nearly 414,000 TBIs among U.S. service members worldwide between 2000 and late 2019. More than 185,000 Veterans who use VA for their health care have been diagnosed with at least one TBI. The majority of those TBIs were classified as mild. TBI and its associated co-morbidities are also a significant cause of disability outside of military settings.

Conditions stemming from TBI can range from headaches, irritability, and sleep disorders to memory problems, slower thinking, and depression. These conditions often lead to long-term mental and physical health problems that can impair Veterans' employment, family relationships, and reintegration into home communities.

The severity of a TBI can usually be assessed through computed tomography (CT) scan (evidence of brain bleeding, bruising, or swelling), the length of loss or alteration of consciousness, the length of memory loss, and how responsive the individual was after the injury. Most TBIs are considered mild, but even mild cases can involve serious long-term effects on areas such as thinking ability, memory, mood, and focus. Other symptoms may include headaches, vision, and hearing problems.

Mild traumatic brain injury (mTBI) is also referred to as a concussion. It can be more difficult to identify than more severe TBI, because there may be no observable head injuries, even on imaging tests, and some of the symptoms may be similar to other problems that stem from combat trauma, such as posttraumatic stress disorder (PTSD).

While most people with mTBI have symptoms that resolve within hours to weeks, a minority may experience persistent symptoms that last for several months or longer. Treatment can include a mix of cognitive, physical, speech, and occupational therapy, along with medication to control specific symptoms such as headaches or anxiety.

A complicating risk factor for mTBI is a person's lifetime accumulation of TBI events. Receiving multiple concussions has been associated with greater risk of developing a neurodegenerative disease like chronic traumatic encephalopathy (CTE). Scientists have found an association between CTE and repetitive mTBI in professional athletes and combat Veterans after autopsy. There is some evidence from epidemiological studies (studies that use clinical diagnostic codes in health records) that shows a link between multiple mTBIs and progressive neurodegenerative conditions, like Parkinson's disease, as well as increased association between the two with increasing severity of TBI.

Brain changes in TBI

TBI can result in brain damage that is sometimes subtle. This damage can result in changes in memory, attention, thinking, personality, and behavior that are difficult to diagnose and treat. VA researchers are refining ways to reliably diagnose TBI and to predict Veterans' outcomes and care needs.

Larger amygdalas in Veterans with mTBI and combat-related PTSD—The amygdala is the region of the brain that processes such emotions as fear, anxiety, and aggression. A 2020 study led by researchers at the VA San Diego Health Care System found that Veterans and service members with combat-related PTSD and mild TBI had larger amygdalas than those with only brain injury.

The study included 89 Veterans and active-duty military personnel, about a third of whom had both PTSD and mTBI. The rest had mTBI only and served as a control group. The research team cautioned that their findings don't prove a cause-and-effect relationship, only a correlation. Additional investigation is needed, they concluded, to determine whether amygdala size could be used to screen people at risk for PTSD or whether it could be used to monitor the effectiveness of medical solutions.

Another study published in 2020 by members of the same team found that those with a history of combat-related mTBI have much higher levels of abnormally fast brain waves in two of the four lobes of the cerebral cortex: the pre-frontal and posterior parietal lobes. Those two lobes affect functions including reasoning, organization, planning, execution, attention, and problem-solving. These abnormally fast brain waves could cause poorer cognitive functioning.

Higher psychiatric risk and symptoms—A review of 33 relevant studies, published in 2020 by researchers from the Minneapolis VA Health Care System, found that service members with TBIs have higher rates of PTSD, depressive disorder, substance use disorder, and anxiety disorder than those without TBI. A number of studies from throughout the nation linked TBI to greater severity of PTSD symptoms, and one study showed higher rates of suicide attempts. However, studies on the effect of TBI on the severity of depression and substance use disorder symptoms were mixed.

The researchers believe there needs to be an increased emphasis on the evaluation of psychiatric conditions in service members and Veterans with a history of TBI.

Cerebellum issues
—A 2016 study by researchers with the VA Puget Sound Health Care System and the University of Washington identified the cerebellum as particularly vulnerable to repeated blast exposures. The cerebellum, an area of the brain, coordinates and regulates muscle activity.

The investigators looked at brain scans from Veterans who had experienced an average of 21 mTBIs each as a result of explosions. The more blasts they were exposed to, the more likely they were to show lower levels of glucose metabolism in the cerebellum. Glucose metabolism is a marker of brain activity.

The research team also created "shock tubes" to test similar blast effects in mice—and found that repeated explosions ruptured part of the blood-brain barrier and led to the loss of neurons in the cerebellum. They also revealed the buildup of proteins associated with dementia and Alzheimer's disease.

Chronic traumatic encephalopathy and TBI—In 2012, an international team including researchers from the Boston VA Healthcare System discovered chronic traumatic encephalopathy (CTE) in the brains of four Veterans after their deaths, including three who had survived explosions from improvised explosive devices. The fourth had suffered multiple concussions in and out of service.

CTE is a degenerative disease thought to be linked to repeated head traumas such as concussions and has been identified in the brains of football players who have committed suicide. It is possible that some of the symptoms of PTSD and other mental health conditions in Veterans are caused by CTE.

Another study by the team, published in 2017, found that a protein found in the brain, CCL11, might be used as a biomarker to potentially allow CTE to be diagnosed in living people. By analyzing recently deceased athletes, the team found that those with CTE—but not those with dementia or Alzheimer's disease—had significantly elevated levels of CCL11 in their spinal fluid, which creates the possibility that CC11 can also be measured in living people, and a determination can be made whether they have CTE. Previously, CTE could only be correctly diagnosed and distinguished from Alzheimer's disease after death.

VA, along with Boston University and the Concussion Legacy Foundation, have established a Brain Bank to collect and study post-mortem human brain and spinal cord tissue to better understand the effects of trauma on the human nervous system. The Brain Bank has both Veteran and non-Veteran brain samples and has been at the forefront in research neurodegenerative disease that could be linked to lifetime TBI exposure.

Electroencephalograms and mTBI—mTBI and PTSD often cause similar symptoms such as irritability, restlessness, hypersensitivity to stimulation, memory loss, fatigue, and dizziness. In 2016, a team of researchers from the DVBIC used electroencephalograms (EEGs) to learn there were patterns of brain activities at different locations on the scalp for mTBI and PTSD in Iraq and Afghanistan Veterans.

This finding can reduce the possibility these conditions can be confused with each other, thereby improving diagnosis and treatment. It also shows that electrical activity in the brain appears to be affected long after combat-related mTBI, suggesting long term changes in the signaling between cells in the nervous system.

Another study, published in 2017, used a technique called magnetoencephalography to map activity in the brains of patients with PTSD and mTBI. Results indicated that, in PTSD but not mTBI, alpha brain waves showed reductions in network structure (the interconnected symptoms of neurons in the brain). The technique could be another way for clinicians to differentiate between the two conditions.

Tracking mTBI over decades—A federally funded study has enrolled at least 1,200 service members and Veterans who served in Iraq and Afghanistan to learn more about mTBI and how it can best be evaluated and perhaps prevented and treated. The researchers, under the auspices of CENC, hope to follow the cohort for 20 years or more to better understand the long-term neurological effects of mTBI and other deployment-related conditions. Methods and procedures for the study were described in a 2016 article.

The first findings of the study, published in 2018, found that Veterans with mTBI had greater combat exposure; less social support; and more comorbidities, including asthma, PTSD, and sleeping problems. They also had greater pain symptoms and more difficulties in processing information and executive functioning. These findings will guide further research by the study team.

Effects of TBI

TBI associated with an increased risk of dementia—A 2018 study led by researchers with CENC has found that mTBI with and without loss of consciousness is associated with a heightened risk of developing dementia. The study compared nearly 179,000 Veterans with a TBI diagnosis to a similar group without TBI over a period from 2001 to 2014. In those groups, 2.6% of Veterans without TBI developed dementia, compared with 6.1% of those with TBI.

According to the study team, moderate and severe TBIs had previously been associated with increased dementia risk, but no clear association had previously been demonstrated between dementia and mTBI, especially without loss of consciousness.

The team concluded that even mTBI without loss of consciousness was associated with more than a twofold increase in the risk of a dementia diagnosis. Accordingly, they believe studies of strategies to determine mechanisms, prevention, and treatment of TBI-related dementia in Veterans are urgently needed.

Increased tinnitus risk among service members with TBI—Tinnitus is a condition that involves hearing sound, such as ringing in the ears, when no external sound is present. In a study published in 2019, researchers from the VA San Diego Healthcare System and elsewhere assessed the hearing of 2,600 Marines before and after combat deployment and found that both PTSD and TBI, particularly TBI resulting from a blast, were linked to worsening tinnitus.

Those who already had tinnitus before being deployed found the progression of the condition also increased with hearing loss. The researchers concluded that screening service members before deployment may lead to increased hearing protection for those at risk.

TBI and suicide
—Veterans with a history of TBI are more than twice as likely to die by suicide compared to those without such a diagnosis, according to a 2019 study by a team led by researchers from the VHA Rocky Mountain Mental Illness Research Education and Clinical Center in Colorado.

The researchers reviewed electronic medical records of more than 1.4 million Veterans receiving care from VA between Oct. 1, 2005 and Sept. 30, 2015. After adjusting for psychiatric diagnoses such as depression, the team found that those with a moderate or severe TBI were 2.45 times more likely to die by suicide compared to those without a TBI diagnosis. They also found that among those who died, the odds of using firearms as a means of suicide was significantly increased for those with moderate or severe TBI as compared to those without a history of TBI.

Hearing support—A 2015 study by VA's National Center for Rehabilitative Auditory Research (NCRAR) looked at 99 Veterans who were exposed to blasts in Iraq or Afghanistan. All 99 had clinically normal hearing, but all reported problems hearing in difficult listening situations.

The research team asked the Veterans to participate in 10 performance-based tests that have been shown to uncover problems in processing hearing signals. They found that many of the participants had difficulty in one or more of the tests, compared with non–blast-exposed Veterans, although they may have performed well in other tests.

The team concluded that auditory processing symptoms may vary among Veterans exposed to blasts, but that blast injuries can and do result in damage to the central auditory system.

TBI and epilepsy—In 2015, researchers at the VA South Texas Health Care System and the University of Texas reported that Iraq and Afghanistan Veterans with mild TBIs were about 28% more likely to have developed epilepsy than those without TBIs.

The researchers also showed that Veterans who suffered penetrating or severe TBIs had the highest risk of developing epilepsy. The study looked at 256,284 Iraq and Afghanistan Veterans who received either inpatient or outpatient care at VA in 2009 and 2010.

Previous studies of Veterans from World War II and the Korean War have shown a link between combat-related head injury and epilepsy. The research team concluded that because war-related epilepsy in Vietnam Veterans continued 35 years after the war, a detailed, prospective study is needed to understand the long-term relationship between epilepsy and TBI severity in Iraq and Afghanistan Veterans.

TBI and returning to work—Few service members and Veterans with moderate to severe TBI return to work one year after their injury, according to a 2017 VA Polytrauma Rehabilitation Centers study. Those who were older, minorities, or had a more severe TBI were more likely to be unemployed. Of the 293 Veterans and service members in the study, 85% of subjects with severe TBI were unemployed, while 63% with moderate TBI were unemployed. The results will help VA plan rehabilitation services for these patients.

Diagnosing TBI

Little research on blast versus nonblast TBI—A 2017 review of existing studies by researchers at the Minneapolis VA Health Care System found that little information is available about outcomes for TBIs caused by blasts versus those caused by other factors. The available research showed that blast and nonblast TBI groups had similar rates of depression, sleep disorders, alcohol use, vision loss, balance problems, and functional status.

Results were inconsistent about PTSD, headache, hearing loss, and neurocognitive functions. More research is needed, according to the researchers, on the differences between blast and nonblast TBI, along with consistent definitions of blast exposure.

Post-concussive symptoms after deployment—In a 2017 study by DVBIC, nearly half of soldiers who had an mTBI while serving in Afghanistan or Iraq had post-concussive symptoms such as sleep problems, forgetfulness, irritability, and headaches three months after their deployment. According to the researchers, this suggests that mTBI is associated with continuing problems for longer than has been generally recognized in the active duty population.
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Re: PTSD and Suicide Ideation in Veterans

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CTE: Are Veterans Sustaining Repeat Concussive Injury from Weapons Training?

https://www.veteranslaw.com/cte-are-vet ... -training/

CTE, or Chronic Traumatic Encephalopathy, is a progressive, neurodegenerative disease that starts with concussive injury to the head and ends in cognitive impairment, sleep and mood disorders, and in many cases, suicide. The condition is associated with professional football players and in earlier times, with boxers. It is being studied by scientists at the Uniformed Services Health University as the etiology behind the behavioral and physical symptoms exhibited by veterans who experienced blast injuries.

Current thinking in military medicine is that PTSD and TBI, with their similar symptoms, have overlapping etiology, and that etiology is related to concussive injury from blast trauma. Since CTE is a progressive, fatal condition that can only be confirmed by biopsy of the brain after death, the VA and other military medicine specialists have been hesitant to clarify the role of repeated blast injuries to CTE in veterans. Liability issues, of course, are also of a concern.

In December 2016, the Pentagon shelved a project that was using mobile sensors attached to helmets and body armor that was designed to measure blast force trauma, in an effort to quantify the amount of blast and concussive injury military members received. Part of several studies looking at blast trauma, the sensors were also used in studies by the USMC to measure signs of concussive trauma in weapons training instructors. At this time, they have no plans to begin using the blast sensors again. It is a rule of thumb in health care that if you do not intend to treat a condition, don’t test for it. You don’t want documentation of untreated symptoms in someone’s medical record. But not testing servicemembers for blast injuries from weapons training and combat is not going to prevent the resulting brain damage.
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Re: PTSD and Suicide Ideation in Veterans

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Chronic traumatic encephalopathy in an Iraqi war veteran with posttraumatic stress disorder who committed suicide

file:///C:/Users/Admin/AppData/Local/Temp/[10920684%20-%20Neurosurgical%20Focus]%20Chronic%20traumatic%20encephalopathy%20in%20an%20Iraqi%20war%20veteran%20with%20posttraumatic%20stress%20disorder%20who%20committed%20suicide.pdf

Dr. Bennet Omalu discovered and described CTE in a football player when he performed an au-topsy on Mike Webster. Since 2002, Dr. Omalu, the Brain Injury Research Institute, and other researchers have identified and described CTE in numerous football players, wrestlers, boxers, and ice hockey players, which have been reported in the literature. Following our elucidation of CTE in athletes, we hypothesized that PTSD in war veterans may belong to the CTE spectrum given that active military personnel are high-risk cohorts for repeated subconcussive and concussive traumatic brain injuries; for example, bomb blasts can cause traumatic brain injuries from primary pressure wave and acceleration-deceleration injury mechanisms. We expanded our CTE surveillance and brain tissue analyses to include deceased military veterans who were diagnosed with PTSD.In 2010 we encountered CTE changes in the brain of a 61-year-old deceased Vietnam war veteran, who died suddenly as a result of coronary atherosclerotic disease. This case was reported in the Stars and Stripes news magazine of the Department of Defense. The case was not published because we did not have comprehensive access to the medical records and family and social histories. Approximately 1 year later we have identified CTE changes in the brain of a 27-year-old Iraqi war veteran who was diagnosed with PTSD and committed suicide by hanging.

In our 2010 CTE paper,20 we had defined CTE as a progressive neurodegenerative syndrome caused by single, episodic, or repetitive blunt force impacts to the head and transfer of acceleration-deceleration forces to the brain. Chronic traumatic encephalopathy presents clinically after a prolonged latent period as a composite syndrome of mood disorders and neuropsychiatric and cognitive impairment. Direct brain tissue analysis reveals multifocal or diffuse tauopathy, which may be accompanied by low-grade and multifocal white matter rarefac-tion, microglial activation, and parenchymal histiocytes. Amyloidopathy may be present; however, the primary proteinopathy in CTE is a tauopathy. Some patients with CTE may not exhibit the classic prolonged latency period before clinical symptoms begin.Posttraumatic stress disorder in war veterans was first designated in 1978 to describe a condition in Viet-nam war veterans, and the syndrome was first recognized by the American Psychiatric Association in the early 1980s.30 A primary neurodegenerative proteinopathy has not been defined for PTSD in war veterans. Pathognomonic tissue neuropathological features have not been specified. Clinical diagnoses are currently based on presenting clinical symptomatology, based on two diagnostic systems, which continue to evolve as our understanding of PTSD continues to grow.30,32 Table 1 shows the DSM-IV-TR clinical criteria for PTSD diagnosis,1 and Table 2 shows the ICD-10 clinical criteria for PTSD diagnosis.31We report this case as a sentinel case of CTE in an Iraqi war veteran diagnosed with PTSD to possibly stimulate new lines of thought and research in the possible pathoetiology and pathogenesis of PTSD in military veterans as it relates to PTSD being part of the CTE spectrum of diseases, and as chronic sequelae and outcomes of repetitive traumatic brain injuries.

Conclusions

In this paper we present the case of a 27-year-old USMC Iraqi war veteran who developed persistent impaired neuropsychiatric and cognitive functioning, and mood disorders, following deployments to Iraq and an honorable discharge. He was clinically diagnosed with PTSD and prescribed neurotropic drugs. He eventually committed suicide by hanging. Autopsy, as well as gross and histomorphological examination of his brain, revealed CTE changes similar to the CTE changes we have observed in American athletes. Chronic traumatic encephalopathy is the cumulative outcome of repeated subconcussive and concussive brain injuries, and in this instance, it is our opinion that the decedent sustained repeated subconcussive and concussive brain injuries primarily from exposures from blasts and secondarily from training activities and noncombat activities as a marine. Other possible tertiary nonmilitary contributory factors to his cumulative risk of developing CTE may have included a remote traumatic history of nasal bone fracture and engagement in contact sports such as football and hockey for leisure. This sentinel case highlights the need for forensic, observational, and translational research to further confirm that a proportion of PTSD cases in war veterans may be due to, or contributed to by, CTE caused by repeated subconcussive and concussive traumatic brain injuries.
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Re: PTSD and Suicide Ideation in Veterans

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VA Boston and BU researchers use machine learning to streamline the diagnostic tool for PTSD

9/30/20

https://www.news-medical.net/news/20200 ... -PTSD.aspx

Post-traumatic stress disorder (PTSD) affects eight million adults in the US, including hundreds of thousands of veterans of the conflicts in Iraq and Afghanistan. And as the COVID crisis continues to take its toll on everyone's mental health, PTSD symptoms are on the rise in the general population. But diagnosing PTSD is a time-consuming process, taking upwards of 30 minutes--too long for most clinical visits.

Now, researchers from the VA Boston Healthcare System and the Boston University School of Public Health (BUSPH) have used machine learning to explore streamlining the "gold standard" diagnostic tool for PTSD.

Published in the journal Assessment, the study finds that six of the 20 questions could be cut from the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (SCID-5), while maintaining accuracy in a veteran population. The study also finds that different questions in the SCID-5 are more or less important for male or for female veterans.

"We found that several of the PTSD items could be removed because they did not make substantial contributions to accurate prediction of PTSD relative to the other PTSD items. It's likely that some of these items are removable because they are redundant with other items. Other items may be removable because they aren't specific enough to PTSD," says study lead author Tammy Jiang, a doctoral candidate in epidemiology at BUSPH.

However, a machine learning system is still no match for a human mental health provider, who can interpret test results and evaluate the complexities and nuances of what a patient is going through.

" Our study is only a first step--but an important one, because it shows that machine learning methods can be used to help inform efforts to make care more efficient, without sacrificing or degrading the quality of care provided."

-Dr. Jaimie Gradus, study co-author, associate professor of epidemiology at BUSPH

The researchers used data from the SCID-5 assessments of 1,265 veterans of the Afghanistan and Iraq conflicts, and a kind of machine learning system called "random forests" (made up of "forests" of decision trees). The random forests system learned how strongly different items in the diagnostic predicted a PTSD diagnosis. This allowed the researchers to identify which items had weak enough associations that they could be cut while still maintaining at least 90% accuracy.

For the 1,265 veterans in the sample--half of them male and half female--the researchers identified six items that could be cut: dissociative reactions; reckless or self-destructive behavior; irritable behavior and anger; hypervigilance; persistent inability to experience positive emotions; and exaggerated startle response.

The most important item for a diagnosis was detachment or estrangement from others. This was true both for the whole sample and for male and female veterans separately. However, the researchers found that different items could be cut for male and for female veterans:

For the male veterans, they identified four items that could be cut: inability to recall important aspects of a traumatic event; dissociative reactions; reckless or self-destructive behavior; and hypervigilance.

For the female veterans, they identified six: reckless or self-destructive behavior; dissociative reactions; persistent inability to experience positive emotions; irritable behavior and angry outbursts; exaggerated startle response; and hypervigilance.

"This study demonstrates very clearly that the most efficient manner of diagnosing PTSD may differ for men and women.
This finding is especially critical in a setting like VA, which serves a small but growing number of women veterans," says study senior author Dr. Brian Marx, staff psychologist at the National Center for PTSD at the VA Boston Healthcare System and a professor of psychiatry at the BU School of Medicine.

Marx says the study has exciting implications for the future, at the VA and beyond. "Although we already have reliable and valid screening measures for PTSD that are used in VA healthcare and other settings, they are only capable of providing provisional diagnostic determinations, which require verification using gold standard clinical diagnostic interviews," he says. "Our findings potentially pave a path from which we could eventually skip right to an abbreviated--but still gold standard--diagnostic interview that would accurately identify those with PTSD and get them into treatment as soon as possible."

And with the COVID-19 pandemic leading to more PTSD, depression, anxiety, substance use, and other disorders in the general population, "the application of machine learning methods to streamline mental health assessments may help reduce the burden," Jiang says, "and help people receive care more efficiently."
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Re: PTSD and Suicide Ideation in Veterans

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Nurture trumps nature in determining severity of PTSD symptoms

October 1, 2020

https://www.sciencedaily.com/releases/2 ... 113705.htm

Researchers at Yale and elsewhere previously identified a host of genetic risk factors that help explain why some veterans are especially susceptible to the debilitating symptoms of post-traumatic stress disorder (PTSD).


A new Yale-led study published Oct. 1 in the journal Biological Psychiatry has now identified a social factor that can mitigate these genetic risks: the ability to form loving and trusting relationships with others.

The study is one of the first to explore the role of nurture as well as nature in its investigation of the biological basis of PTSD.

"We exist in a context. We are more than our genes," said Yale's Robert H. Pietrzak, associate professor of psychiatry and public health, and senior author of the study.

Pietrzak is also director of the Translational Psychiatric Epidemiology Laboratory of the Clinical Neurosciences Division of the U.S. Department of Veterans Affairs National Center for PTSD.

Like many genetic studies on mental disorders such as depression, anxiety, and schizophrenia, PTSD studies have revealed numerous genetic risk factors that contribute to the severity of the disorder
. For instance, a previous study of more than 165,000 U.S. military veterans led by Yale's Joel Gelernter, the Foundations Fund Professor of Psychiatry and professor of genetics and of neuroscience, found variants in eight separate regions of the genome that help predict who is most likely to experience the repeated disturbing memories and flashbacks that are hallmark symptoms of PTSD.

In the new study, Pietrzak, Gelernter, and colleagues looked at psychological as well as genetic data collected from the National Health and Resilience in Veterans Study, which surveyed a national sample of U.S. military veterans, and is supported by the National Center for PTSD. The researchers specifically focused on a measure of attachment style -- the ability or inability to form meaningful relations with others -- as a potential moderator of genetic risk for PTSD symptoms.

Individuals with a secure attachment style perceive relationships as stable, feel that they are worthy of love and trust, and are able to solicit help from others. Those with an insecure attachment style report an aversion to or anxiety about intimacy with others, and have difficulty asking for help from others.

They found that the ability to form secure attachments essentially neutralized the collective effects of genetic risk for PTSD symptoms. The impact was particularly pronounced in a variant of the IGSF11 gene, which has been linked to synaptic plasticity or the ability of the brain to form new connections between brain cells.

Pietrzak noted that deficits in synaptic plasticity have also been linked to PTSD, depression, and anxiety, among other mental disorders. The findings illustrate the importance of integrating environmental and social as well as genetic factors in the study of PTSD and related disorders, the authors said.

"Social environmental factors are critical to informing risk for PTSD and should be considered as potential moderators of genetic effects," he said. "The ability to form secure attachments is one of the strongest protective factors for PTSD."

The findings, which will help predict who is at greater risk of experiencing severe symptoms of PTSD, also suggest that psychological treatments targeting interpersonal relationships may help mitigate PTSD symptoms in veterans with elevated genetic risk for this disorder, he said.
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Re: PTSD and Suicide Ideation in Veterans

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Veterans with PTSD at a Higher Risk of Suicide

September 29, 2020


https://www.psychiatryadvisor.com/home/ ... f-suicide/

Veterans who tested positive for posttraumatic stress disorder (PTSD) were associated with a 58% higher risk of suicide right after screening compared to vets without PTSD. One year later, vets with PTSD had a 26% higher risk. The strongest indicator was a “yes” answer to feeling “numb or detached from others, activities, or your surroundings.”

Veterans experience higher rates of both PTSD and suicide compared to the general population. This study links the two.

Researchers used the VHA Corporate Data Warehouse to identify more than 1.5 million people who completed Primary Care–Posttraumatic Stress Disorder (PC-PTSD) screens in 2014 who fit the criteria. Suicide mortality was measured one day after PTSD screen administration. The researchers also categorized the type of care patients received on the PTSD screen date: primary care, specialty mental health care, and inpatient mental health stay, among others.

Without adjusting for covariates, a positive PTSD screen was associated with a 90% increase in the risk of suicide mortality at 1 day after screening (hazard ratio [HR], 1.90; 95% CI, 1.44-2.52) compared with a negative result. The risk decreased throughout the 3-year follow up period. With adjusting for covariates, a positive PTSD screen was associated with a 58% increase in the risk of suicide mortality at 1 day after screening. Risk also decreased over time.

“In lieu of waiting for a formal diagnosis, it may be important to consider initiating suicide risk assessment strategies for patients with positive responses on the PC-PTSD,” the researchers said. “Another reason to use and incorporate the PC-PTSD into suicide risk assessment strategies is that, unlike a medical records diagnosis, the PC-PTSD asks a patient about PTSD symptoms experienced within the past month. The symptom severity of PTSD may fluctuate daily.”
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Re: PTSD and Suicide Ideation in Veterans

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‘Not all wounds are visible’: Dog helps veteran cope with PTSD

Posted: Oct 2, 2020


https://www.wate.com/news/not-all-wound ... with-ptsd/

Charlottesville, Va. (WRIC) — After seven years in the Army, one Virginia veteran says adjusting back to civilian life has not been easy.

“For me, it’s like climbing Mount Everest every time I leave my house,” said Michelle, who was diagnosed with post-traumatic stress disorder. She did not want her last name used.

But a group in Charlottesville is helping to change lives one canine at a time.

Service Dogs of Virginia (SDV) trains puppies and then places them with those in need when the dogs are about 2 years old.

Service members who have survived combat and war zones often face challenges as they return to everyday life. Many military veterans suffer from the paralyzing effects of PTSD.

Michelle was having trouble going out in public.

“For example, going to the grocery store is a task that I am not able to do. I am not able to go to Target. Wal-Mart, forget about it,” she explained.


From rescue to rescuer: Abandoned dog being trained by first responders

Michelle, like many veterans, has gone through a list of treatments and therapies to no avail. But then she learned about SDV. After about a year-long wait, she was paired with Dottie, a black Labrador retriever.

“My hope for having Dottie is that I am finally able to return to a normal life again,” she said. “That I am able to have a sense of normalcy back in my life.”

To get a service dog like Dottie, it costs approximately $40,000 over a two-year period to raise, train and place the dog with a person in need. That cost is never passed on to the new owner. Rather, money is raised to cover the expenses.

“I do everything I can to raise funds. I do not pass on that cost to our clients. I write grants. We have individual donors. I get corporate sponsorships,” said Sally Day, SDV director of development.


Rescue group says it won’t turn over 15 bulldogs found at O’Hare

Fundraising has been difficult, due to the coronavirus pandemic, Day said, but the organization is determined to continue the work they’ve been doing for over 10 years.

“When the organizations began, they started with a waiting list because there was so much need,” she said.

Michelle says she hopes her story inspires other veterans to ask for help.

“Not all wounds are visible,” she said.
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Re: PTSD and Suicide Ideation in Veterans

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The Biology of Suicidal Thoughts in PTSD Patients

Researchers link levels of a receptor in the brain to suicidal ideation in people with post-traumatic stress disorder.


https://www.the-scientist.com/the-liter ... ents-66335

People with major depressive disorder often have other mental health problems, such as post-traumatic stress disorder. But while studying depression a few years ago, Yale University psychiatrist Irina Esterlis noticed that the brains of people with PTSD looked different from those in people with depression alone. In particular, people with PTSD had higher levels of a protein called metabotropic glutamate receptor 5 (mGluR5) on the surface of their brain cells, she says. “That was really odd to us.”

Esterlis and her colleagues wondered whether the receptor, which had recently been linked to suicidal behavior, might tell them something about suicidal thinking, or ideation, in PTSD patients. Using brain scans, the team found that in 29 people with PTSD (some of whom also had depression), “the upregulation of mGluR5 availability was specific to people who were thinking suicidal thoughts,” as measured by questionnaires on the day of the scan, Esterlis says. No such relationship was found in people with depression alone, or in healthy controls.

That mGluR5 levels only predicted suicidal ideation in people with PTSD is remarkable says Greg Ordway, a neurobiologist at East Tennessee State University who studies suicide but was not involved in this work. “That would imply that there’s a different biology to suicidal ideation in some disorders than others.” However, he cautions that the data show substantial overlap in mGluR5 levels between PTSD patients who were having suicidal thoughts and those who weren’t, limiting the receptor’s usefulness as a biomarker of suicidal ideation on its own.

Esterlis’s team is conducting further research on mGluR5’s biological role in PTSD, and whether the findings could help identify people who might be prone to developing the condition. Additionally, she says, “we are trying to evaluate whether we can modulate mGluR5 . . . so that we can potentially treat PTSD.”
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Re: PTSD and Suicide Ideation in Veterans

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PTSD Symptoms in Women: Unnoticed and Undiagnosed

What causes PTSD in women and do the symptoms differ from PTSD in men?


https://www.psycom.net/PTSD-symptoms-women

When you mention Post Traumatic Stress Disorder (PTSD), most people think about a male combat veteran who has experienced horrific events during war. They envision a veteran with flashbacks, having nightmares and memories they cannot control. Many movies and television shows have been guilty of showing only men as victims of this disorder. And while there is some truth to that image, PTSD is not limited to people who have served in the military.

What Causes PTSD?


“PTSD comes from some type of traumatic event
,” said Colleen Cira, PsyD., a psychologist who specializes in women and trauma. “It can include things like war, car accidents, rape, physical assault, or even verbal and emotional abuse. Basically, any kind of scary or disturbing event that overwhelms our ability to cope falls into the PTSD category.”

According to the American Psychological Association, “women are twice as likely to develop PTSD, experience a longer duration of posttraumatic symptoms and display more sensitivity to stimuli that remind them of the trauma.” When PTSD symptoms are left untreated it can have drastic mental health implications which can lead to physical health issues as well, including headaches, stomach problems and sexual dysfunction.

“With PTSD, it’s not only that the person is remembering that painful event, the body responds as if it’s happening again,” says Debi Silber, a transformational psychologist and author of the book: The Unshakable Woman: 4 Steps to Rebuilding Your Body, Mind, and Life after a Life Crisis. “So while cognitively they know it’s not, at a subconscious level, they’re re-experiencing it, and as the stress response is ignited, stress hormones are released and the cascade of physical, mental and emotional symptoms emerge.”

PTSD Symptoms in Women


Women who are victims of a trauma that leads to PTSD often hesitate to seek help from a mental health professional, and it is not uncommon for them to wait years to receive treatment. Sadly, PTSD in women is often undiagnosed or misdiagnosed by health professionals because of a lack of training or time spent treating PTSD.

To make matters even worse, many women who are victims of PTSD do not realize they have the disorder. According to Dr. Cira, a lot of women simply don’t know they are experiencing the effects of PTSD. “Women often internalize, meaning that instead of searching for answers in their world or circumstances, they assume something is wrong with them,” Dr. Cira explains. “So they might not attribute their own thoughts, feelings, emotions or behaviors to something that happened to them because they just figure this is who they are.”

Simon Rego, PsyD, chief psychologist at Montefiore Medical Center in New York believes that society has an obligation to recognize that women do suffer from PTSD. “We need to do a better job educating people about the causes, symptoms, and treatments for PTSD,” he said. “Unfortunately, there is still a stigma against mental health disorders in general, and worse, for women reporting PTSD symptoms after an assault. They are often further traumatized by being questioned or challenged about the veracity of the event and their reaction to it.”

The Differences Between PTSD in Men vs. Women


Mental health experts agree that women can sometimes experience PTSD in different ways than men. For example, women with PTSD are more likely to feel depressed and anxious, as well as have trouble feeling or dealing with their emotions. They also tend to avoid activities and things that remind them of whatever traumatic event they suffered through. And while men with PTSD have a higher probability of turning to alcohol or drugs to mask their trauma, women are less likely to do so.

According to the nonprofit organization Solace for Mothers, some women who have a difficult time in the delivery room also suffer from a type of PTSD, and if left untreated, it can stay with them through their journey as a parent. It may also explain why some women do not want to go through childbirth again and may decide to stop having more children. This is very different from postpartum depression. Solace for Mothers seeks to support women who have been traumatized and prevent birth trauma.

When people are educated about how PTSD can affect women they have a better understanding of the fact that the disorder is not only a real medical problem, it is also highly treatable.

“Sometimes women will feel the need to be perfect, and admitting to something they perceive as a weakness may feel like the last thing on earth they want to do,” says Dr. Cira. “Women are constantly sent the message that they need to do it all, and do it all very well, which, of course, isn’t possible. But it does not change the fact that they still feel that way and live with that kind of pressure.”

Some of the psychological treatments that have proved to be effective in helping women cope with the symptoms of PTSD include Cognitive-Behavioral therapy (CBT), which helps someone put the emphasis on how they evaluate and respond to certain feelings, thoughts, and memories. Another type of treatment is Exposure Therapy, which is more of a behavioral treatment for PTSD. It can help someone reduce their fear and anxiety by having them confront the problems that caused them to be traumatized.

The first part of any true trauma treatment is normalizing the symptoms and experiences of someone who is struggling with PTSD. What does “normalizing” look like?

Recognize that physical pain may be part of the process. For some people who struggle with PTSD they can have severe migraines, pain in the backs or even stomach and digestive issues.
Be aware that “flashbacks and/or nightmares” can occur in anyone who has experienced a traumatic event. Often times they can be triggered by sounds, smells or a phrase that someone says.

This will help somewhat with the guilt, but making peace with a difficult past is a long process and dealing with the guilt is no exception. But with the right therapist, there is absolutely hope, especially when you find a therapist who understands how PTSD impacts a person’s thoughts, feelings, behaviors, relationships, and self-image.
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Re: PTSD and Suicide Ideation in Veterans

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EMDR Therapy for Anxiety, Panic, PTSD and Trauma

Eye Movement Desensitization and Reprocessing is a psychotherapy technique used to treat anxiety, PTSD, and more



https://www.psycom.net/emdr-therapy-anx ... sd-trauma/


In 1987 psychologist Francine Shapiro developed a new type of psychotherapy known as EMDR, which stands for Eye Movement Desensitization and Reprocessing. EMDR therapy has become a more common treatment in recent years as a treatment option for people suffering from anxiety, panic, PTSD, or trauma.

According to the EMDR Research Foundation, “EMDR is an integrative psychotherapy approach that has been extensively researched and proven effective for the treatment of trauma. EMDR therapy includes a set of standardized protocols that incorporate elements from many different treatment approaches. To date, EMDR has helped millions of people of all ages relieve many types of psychological stress.”

What is EMDR?


EMDR therapy is a phased, focused approach to treating traumatic and other symptoms by reconnecting the client in a safe and measured way to the images, self-thoughts, emotions, and body sensations associated with the trauma, and allowing the natural healing powers of the brain to move toward adaptive resolution. It is based on the idea that symptoms occur when trauma and other negative or challenging experiences overwhelm the brain’s natural ability to heal, and that the healing process can be facilitated and completed through bilateral stimulation while the client is re-experiencing the trauma in the context of the safe environment of the therapist’s office (dual awareness).

Dr. Romas Buivydas, PhD, LMHC, Vice President of Clinical Development for Spectrum Health Systems, says EMDR therapy is an eight-phase treatment. “It identifies and addresses traumatic experiences that have overwhelmed the brain’s natural coping capacity, and, as a result, have created traumatic symptoms, such as flashbacks or anxiety, or harmful coping strategies, such as isolating behavior and self-medication with alcohol or drugs,” he said.

How Does EMDR Work?


Through EMDR, individuals safely reprocess traumatic information until it is no longer psychologically disruptive to their lives. There are 8 phases of treatment and in the Rapid Eye Movement phase, the individual focuses on a disruptive memory and identifies the belief they hold about themselves. If it is connected to this negative memory (for example, in dealing with abuse, the person may believe, “I deserved it”) the individual then formulates a positive belief that they would like to have (“I am a worthwhile and good person in control of my life.”). All the sensations and emotions that go along the memory are identified. The individual then reviews the memory while focusing on an external stimulus that creates bilateral eye movement. Typically this is done by watching the therapist move two fingers. After each set of bilateral movements, the individual is asked how they feel. This process continues until the memory is no longer disturbing to the individual. The individual is processing the trauma. The selected positive belief is then installed, via bilateral movement, to replace the negative belief.

Sessions typically last for an hour. It is theorized that EMDR works because the “bilateral stimulation” by-passes the area of the brain that processes memories has become stuck due to the trauma and is preventing the brain from proper processing and storage of the memory. During EMDR, individuals process the memory safely and that leads to a peaceful resolution resulting in increased insight regarding both previously disturbing event and the negative thoughts about themselves that have grown out of the original traumatic event.

Who Uses EMDR Therapy?

EMDR therapy has been endorsed by the American Psychiatric Association and the International Society for Traumatic Stress Studies. In addition, it is used by the United States Department of Veterans Affairs, the Department of Defense and overseas organizations, including the United Kingdom Department of Health and the Israeli National Council for Mental Health.

According to the EMDR Research Foundation there are now over 30 gold standard studies documenting the effectiveness of EMDR therapy over the past 30 years with problems such as rape and sexual abuse, combat trauma, childhood trauma and neglect, life threatening accidents, and symptoms such as anxiety, depression, and substance abuse.

Edy Nathan, MA, LCSW, is a licensed psychotherapist with over 20 years experience and has been certified as an EMDR practitioner, believes that this type of therapy has the ability to heal people who are suffering from all types of trauma. “What the technique does is shift the way we process the presence of the physical, emotional and psychological effects related specifically to a traumatic event,” she said. “The pain and sense of danger carried within the self after a traumatic event grips the soul with such purchase that it leads into a sense of being in emotional quicksand. EMDR works to disarm belief systems, also known as cognitions, and changes the negative cognition through a series of lateral eye movements, tapping or sound, while the client is asked to create the picture of pain and danger (trauma) that most disturbs them.”

Does EMDR Therapy Actually Work?


According to the EMDR Institute, Inc., some of the studies on this type of therapy show that 84%-90% of single-trauma victims no longer have post-traumatic stress disorder after only three 90-minute sessions. Another study, funded by the HMO Kaiser Permanente, found that 100% of the single-trauma victims and 77% of multiple trauma victims no longer were diagnosed with PTSD after only six 50-minute sessions. In another study, 77% of combat veterans were free of PTSD in 12 sessions.

What is also different about this type of therapeutic intervention is that the therapist does not conversationally converse with the client while going through the process. After an EMDR session, clients can experience more vivid dreams, may sleep differently, might feel more sensitive to interactions with others or to external stimuli. This is all shared with the client at the end of each EMDR session.

Pairing EMDR Therapy with Other Therapeutic Techniques

EMDR Therapy is not the only form of therapy appropriate for people dealing with anxiety, PTSD, panic, and/or trauma, and just because someone is undergoing EMDR therapy does not mean that that person cannot undergo another form of therapy at the same time. Speak with your therapist about combinations of therapy or therapeutic techniques that might prove most effective.
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