Dose-Related Effects of Ketamine for Antidepressant-Resistant Symptoms of Posttraumatic Stress Disorder in Veterans and Active Duty Military: A Double-blind, Randomized, Placebo-Controlled Multi-Center Clinical Trial

Background: This study tested the efficacy of repeated intravenous ketamine doses to reduce antidepressant-resistant symptoms of posttraumatic stress disorder (PTSD). Methods: Veterans and service members with PTSD (n=158) who failed previous antidepressant treatment were randomized to 8 infusions administered twice weekly of intravenous placebo (n=54), low dose (0.2mg/kg; n=53) or standard dose (0.5mg/kg; n=51) ketamine. Participants were assessed at baseline, during treatment, and for 4 weeks after their last infusion. Primary analyses used mixed effects models. The primary outcome measure was the self-report PTSD Checklist for DSM-5 (PCL-5), and secondary outcome measures were the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) and the Montgomery Asberg Depression Rating Scale (MADRS). Results: There were no significant group-by-time interactions for PTSD symptoms measured by the PCL-5 or CAPS-5. The standard dose ketamine significantly reduced symptoms after the first infusion, while the low dose showed significant symptom reduction after the last infusion and at the 4-week follow-up. The standard ketamine dose also significantly ameliorated depression measured by the MADRS. Ketamine produced dose-related dissociative and psychotomimetic effects, which returned to baseline within 2 hours and were less pronounced with repeated administration. There was no evidence of differential treatment discontinuation by ketamine dose, consistent with good tolerability. Conclusions: This clinical trial failed to find a significant dose-related effect of ketamine on PTSD symptoms. Secondary analyses suggested that the low dose reduced PTSD symptoms and the standard dose exerted rapid antidepressant effects. Further studies are needed to determine the role of ketamine in PTSD treatment. ClinicalTrials.gov identifier: NCT02655692

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Posttraumatic stress disorder symptoms among trauma-exposed adolescents from low- and middle-income countries

Child and Adolescent Psychiatry and Mental Health ◽

10.1186/s13034-021-00378-2 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Dusko Stupar ◽

Dejan Stevanovic ◽

Panos Vostanis ◽

Olayinka Atilola ◽

Paulo Moreira ◽

...

Keyword(s):

Posttraumatic Stress Disorder ◽

Posttraumatic Stress ◽

Stress Disorder ◽

Traumatic Events ◽

Ptsd Symptoms ◽

Middle Income ◽

Palestinian Territories ◽

Middle Income Countries ◽

Dsm 5 ◽

Low And Middle Income

Abstract Background Exposure to traumatic events in childhood is associated with the development and maintenance of various psychiatric disorders, but most frequently with posttraumatic stress disorder (PTSD). The aim of this study was to evaluate the types of traumatic events experienced and the presence and predictors of PTSD symptoms among adolescents from the general population from ten low- and middle-income countries (LMICs). Methods Data were simultaneously collected from 3370 trauma-exposed adolescents (mean age = 15.41 [SD = 1.65] years, range 12–18; 1465 (43.5%) males and 1905 (56.5%) females) in Brazil, Bulgaria, Croatia, Indonesia, Montenegro, Nigeria, the Palestinian Territories, the Philippines, Romania, and Serbia, with Portugal, a high-income country, as a reference point. The UCLA PTSD Reaction Index for the DSM-5 (PTSD-RI-5) was used for the assessment of traumatic events and PTSD symptoms. Results The most frequently reported traumatic events were death of a close person (69.7%), witnessing violence other than domestic (40.5%), being in a natural disaster (34.4%) and witnessing violent death or serious injury of a close person (33.9%). In total, 28.5% adolescents endorsed two to three DSM-5 PTSD criteria symptoms. The rates of adolescents with symptoms from all four DSM-5 criteria for PTSD were 6.2–8.1% in Indonesia, Serbia, Bulgaria, and Montenegro, and 9.2–10.5% in Philippines, Croatia and Brazil. From Portugal, 10.7% adolescents fall into this category, while 13.2% and 15.3% for the Palestinian Territories and Nigeria, respectively. A logistic regression model showed that younger age, experiencing war, being forced to have sex, and greater severity of symptoms (persistent avoidance, negative alterations in cognitions and mood, and alterations in arousal and reactivity) were significant predictors of fulfilling full PTSD criteria. Conclusions Nearly every third adolescent living in LMICs might have some PTSD symptoms after experiencing a traumatic event, while nearly one in ten might have sufficient symptoms for full DSM-5 PTSD diagnosis. The findings can inform the generation of PTSD burden estimates, allocation of health resources, and designing and implementing psychosocial interventions for PTSD in LMICs.

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A perspective on the contribution of animal models to the pharmacological treatment of posttraumatic stress disorder

Australasian Psychiatry ◽

10.1177/1039856217716288 ◽

2017 ◽

Vol 25 (4) ◽

pp. 342-347 ◽

Cited By ~ 3

Author(s):

Valerie Bertaina-Anglade ◽

Susan M O’Connor ◽

Emile Andriambeloson

Keyword(s):

Posttraumatic Stress Disorder ◽

Clinical Practice ◽

Animal Models ◽

Posttraumatic Stress ◽

Potential Role ◽

Stress Disorder ◽

Traumatic Event ◽

Ptsd Symptoms ◽

Off Label ◽

Dsm 5

Objectives: Posttraumatic stress disorder (PTSD) is a prevalent, chronic, disabling disorder that may develop following exposure to a traumatic event. This review summarizes currently used animal models of PTSD and their potential role in the development of better therapeutics. Heterogeneity is one of the main characteristics of PTSD with the consequence that many pharmacological approaches are used to relieve symptoms of PTSD. To address the translational properties of the animal models, we discuss the types of stressors used, the rodent correlates of human PTSD (DSM-5) symptoms, and the efficacy of approved, recommended and off-label drugs used to treat PTSD in ‘PTSD-animals’. Conclusions: Currently available animal models reproduce most PTSD symptoms and are validated by existing therapeutics. However, novel therapeutics are needed for this disorder as not one drug alleviates all symptoms and many have side effects that lead to non-compliance among PTSD patients. The true translational power of animal models of PTSD will only be demonstrated when new therapeutics acting through novel mechanisms become available for clinical practice.

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Differential Effects of Comorbid Psychiatric Disorders on Treatment Outcome in Posttraumatic Stress Disorder from Childhood Trauma

Journal of Clinical Medicine ◽

10.3390/jcm10163708 ◽

2021 ◽

Vol 10 (16) ◽

pp. 3708

Author(s):

Nele Assmann ◽

Eva Fassbinder ◽

Anja Schaich ◽

Christopher W. Lee ◽

Katrina Boterhoven de Haan ◽

...

Keyword(s):

Posttraumatic Stress Disorder ◽

Treatment Outcome ◽

Posttraumatic Stress ◽

Childhood Trauma ◽

Stress Disorder ◽

Secondary Outcome ◽

Ptsd Symptoms ◽

Moderator Effect ◽

Ptsd Treatment ◽

The Impact

Patients with posttraumatic stress disorder (PTSD) frequently have comorbid diagnoses such as major depressive disorder (MDD) and anxiety disorders (AD). Studies into the impact of these comorbidities on the outcome of PTSD treatment have yielded mixed results. The different treatments investigated in these studies might explain the varied outcome. The purpose of this study was to examine the impact of these comorbidities on the outcome of two specific PTSD treatments. MDD and AD were analyzed as predictors and moderators in a trial comparing 12 sessions of either eye movement desensitization and reprocessing (EMDR) or imagery rescripting (IR) in 155 adult patients with PTSD from childhood trauma. The primary outcome was reduction of PTSD symptoms (clinician-administered PTSD Scale for DSM-5, CAPS-5) assessed at eight-week follow-up and a secondary outcome was self-report PTSD symptoms (Impact of Event Scale, IES-R). MDD was not a predictor of treatment outcome but did have a significant moderator effect. Patients with MDD showed a better outcome if they were treated with IR, whereas patients without MDD improved more in the EMDR condition. No impact of AD emerged. It seems essential to consider comorbid MDD when planning PTSD treatment to improve treatment outcomes. More research is needed to replicate our findings and focus on different kinds of PTSD treatments and other comorbidities.

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Dimensions of DSM-5 Posttraumatic Stress Disorder (PTSD) Symptoms

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1901 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S514-S514 ◽

Cited By ~ 1

Author(s):

C. Soberón ◽

M. Crespo ◽

M. Gómez-Gutiérrez ◽

V. Fernández-Lansac

Keyword(s):

Posttraumatic Stress Disorder ◽

Posttraumatic Stress ◽

Hybrid Model ◽

Stress Disorder ◽

Externalizing Behaviors ◽

Factor Model ◽

Ptsd Symptoms ◽

Dsm 5 ◽

Dsm Iv ◽

Iv Model

IntroductionDespite the four factor model of PTSD proposed in the DSM-5 (APA, 2013) has received a better empirical support than three factor model of DSM-IV (APA, 1994), some alternative models proposed can provide a better representation of PTSD's latent structure.ObjectiveThe current study tested the fit of seven models, including the 3-factor DSM-IV model (APA, 1994), the 4-factor DSM-5 model (APA, 2000), the 4-factor dysphoria model (Simms, Watson & Doebbeling, 2002), the 5-factor dysphoric arousal model (Elhai et al., 2012), the 6-factor anhedonia model (Liu et al., 2014), the 6-factor externalizing behaviors model (Tsai et al., 2014) and the 7-factor hybrid model (Armour et al., 2015) that combines key features of the anhedonia and externalizing behaviors models.AimIt expected that the 7-factor hybrid model (Armour et al., 2015) would be the best fitting model.MethodsPTSD symptoms were assessed using the Global Assessment of Posttraumatic Stress Disorder (EGEP-5; Crespo, Gómez & Soberón, 2016) in a sample of 165 victims of different traumatic events. Confirmatory Factor Analysis (CFAs) were conducted on each of the seven models using Maximum Likelihood (ML) estimation method.ResultsAll the models tested (except for DSM-IV model) yielded an adequate fit to the data. However, 7-factor hybrid model (Armour et al., 2015) provided a better fit than other competing models.ConclusionsThe current findings suggest that the dimensional structure of DSM-5 PTSD symptoms may be best represented by the 7 factors proposed in the hybrid model instead of 4 factors of DSM-5.References not available.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Learning and Consolidation of Verbal Declarative Memory in Patients with Posttraumatic Stress Disorder

Zeitschrift für Psychologie / Journal of Psychology ◽

10.1027/0044-3409/a000020 ◽

2010 ◽

Vol 218 (2) ◽

pp. 135-140 ◽

Cited By ~ 1

Author(s):

Slawomira J. Diener ◽

Herta Flor ◽

Michèle Wessa

Keyword(s):

Posttraumatic Stress Disorder ◽

Posttraumatic Stress ◽

Verbal Memory ◽

Stress Disorder ◽

Declarative Memory ◽

Memory Performance ◽

Verbal Learning ◽

Depression Scale ◽

Learning Performance ◽

Ptsd Symptoms

Impairments in declarative memory have been reported in posttraumatic stress disorder (PTSD). Fragmentation of explicit trauma-related memory has been assumed to impede the formation of a coherent memorization of the traumatic event and the integration into autobiographic memory. Together with a strong non-declarative memory that connects trauma reminders with a fear response the impairment in declarative memory is thought to be involved in the maintenance of PTSD symptoms. Fourteen PTSD patients, 14 traumatized subjects without PTSD, and 13 non-traumatized healthy controls (HC) were tested with the California Verbal Learning Test (CVLT) to assess verbal declarative memory. PTSD symptoms were assessed with the Clinician Administered PTSD Scale and depression with the Center of Epidemiological Studies Depression Scale. Several indices of the CVLT pointed to an impairment in declarative memory performance in PTSD, but not in traumatized persons without PTSD or HC. No group differences were observed if recall of memory after a time delay was set in relation to initial learning performance. In the PTSD group verbal memory performance correlated significantly with hyperarousal symptoms, after concentration difficulties were accounted for. The present study confirmed previous reports of declarative verbal memory deficits in PTSD. Extending previous results, we propose that learning rather than memory consolidation is impaired in PTSD patients. Furthermore, arousal symptoms may interfere with successful memory formation in PTSD.

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Social Support, Emotional Intelligence, and Posttraumatic Stress Disorder Symptoms

Journal of Individual Differences ◽

10.1027/1614-0001/a000185 ◽

2016 ◽

Vol 37 (1) ◽

pp. 31-39 ◽

Cited By ~ 8

Author(s):

Nicole L. Hofman ◽

Austin M. Hahn ◽

Christine K. Tirabassi ◽

Raluca M. Gaher

Keyword(s):

Social Support ◽

Posttraumatic Stress Disorder ◽

Emotional Intelligence ◽

Protective Factors ◽

Posttraumatic Stress ◽

Stress Disorder ◽

Traumatic Events ◽

Ptsd Symptoms ◽

The Relationship

Abstract. Exposure to traumatic events and the associated risk of developing Posttraumatic stress disorder (PTSD) symptoms is a significant and overlooked concern in the college population. It is important for current research to identify potential protective factors associated with the development and maintenance of PTSD symptoms unique to this population. Emotional intelligence and perceived social support are two identified protective factors that influence the association between exposure to traumatic events and PTSD symptomology. The current study examined the mediating role of social support in the relationship between emotional intelligence and PTSD symptoms. Participants included 443 trauma-exposed university students who completed online questionnaires. The results of this study indicated that social support mediates the relationship between emotional intelligence and reported PTSD symptoms. Thus, emotional intelligence is significantly associated with PTSD symptoms and social support may play an integral role in the relationship between emotional intelligence and PTSD. The current study is the first to investigate the role of social support in the relationship between emotional intelligence and PTSD symptoms. These findings have important treatment and prevention implications with regard to PTSD.

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