scholarly journals Medication-enhanced psychotherapy for posttraumatic stress disorder: Recent findings on oxytocin’s involvement in the neurobiology and treatment of posttraumatic stress disorder

2021 ◽  
Vol 3 (4) ◽  
Author(s):  
Katrin Preckel ◽  
Sebastian Trautmann ◽  
Philipp Kanske
Keyword(s):  
Posttraumatic Stress Disorder ◽  
Posttraumatic Stress ◽  
Stress Disorder ◽  
Treatment Options ◽  
Stressful Events ◽  
Traumatic Experiences ◽  
Future Research ◽  
Neural Basis ◽  
Psychotherapeutic Treatment ◽  
Social Support Seeking

Background Traumatic experiences may result in Posttraumatic Stress Disorder (PTSD), which is characterized as an exaggerated fear response that cannot be extinguished over time or in safe environments. What are beneficial psychotherapeutic treatment options for PTSD patients? Can oxytocin (OXT), which is involved in the stress response, and safety learning, ameliorate PTSD symptomatology and enhance psychotherapeutic effects? Here, we will review recent studies regarding OXT’s potential to enhance psychotherapeutic therapies for PTSD treatment. Method We conducted a literature review on the neurobiological underpinnings of PTSD especially focusing on OXT’s involvement in the biology and memory formation of PTSD. Furthermore, we researched successful psychotherapeutic treatments for PTSD patients and discuss how OXT may facilitate observed psychotherapeutic effects. Results For a relevant proportion of PTSD patients, existing psychotherapies are not beneficial. OXT may be a promising candidate to enhance psychotherapeutic effects, because it dampens responses to stressful events and allows for a faster recovery after stress. On a neural basis, OXT modulates processes that are involved in stress, arousal and memory. OXT effectively counteracts memory impairments caused by stress and facilitates social support seeking which is a key resilience factor for PTSD and which is beneficial in psychotherapeutic settings. Conclusion OXT has many characteristics that are promising to positively influence psychotherapy for PTSD patients. It potentially reduces intrusions, but preserves memory of the event itself. Introducing OXT into psychotherapeutic settings may result in better treatment outcomes for PTSD patients. Future research should directly investigate OXT’s effects on PTSD, especially in psychotherapeutic settings.

scholarly journals Pharmacotherapy of 1,044 inpatients with posttraumatic stress disorder: current status and trends in German-speaking countries

2020 ◽  
Author(s):  
Matthias A. Reinhard ◽  
Johanna Seifert ◽  
Timo Greiner ◽  
Sermin Toto ◽  
Stefan Bleich ◽  
...  
Keyword(s):  
Posttraumatic Stress Disorder ◽  
Posttraumatic Stress ◽  
Stress Disorder ◽  
Treatment Options ◽  
Psychiatric Inpatient ◽  
Primary Diagnosis ◽  
Current Status ◽  
German Speaking ◽  
Inpatient Settings ◽  
Prescription Rates

AbstractPosttraumatic stress disorder (PTSD) is a debilitating psychiatric disorder with limited approved pharmacological treatment options and high symptom burden. Therefore, real-life prescription patterns may differ from guideline recommendations, especially in psychiatric inpatient settings. The European Drug Safety Program in Psychiatry (“Arzneimittelsicherheit in der Psychiatrie”, AMSP) collects inpatients’ prescription rates cross-sectionally twice a year in German-speaking psychiatric hospitals. For this study, the AMSP database was screened for psychiatric inpatients with a primary diagnosis of PTSD between 2001 and 2017. N = 1,044 patients with a primary diagnosis of PTSD were identified with 89.9% taking psychotropics. The average prescription rate was 2.4 (standard deviation: 1.5) psychotropics per patient with high rates of antidepressant drugs (72.0%), antipsychotics drugs (58.4%) and tranquilizing drugs (29.3%). The presence of psychiatric comorbidities was associated with higher rates of psychotropic drug use. The most often prescribed substances were quetiapine (24.1% of all patients), lorazepam (18.1%) and mirtazapine (15.0%). The use of drugs approved for PTSD was low (sertraline 11.1%; paroxetine 3.7%). Prescription rates of second-generation antipsychotic drugs increased, while the use of tranquilizing drugs declined over the years. High prescription rates and extensive use of sedative medication suggest a symptom-driven prescription (e.g., hyperarousal, insomnia) that can only be explained to a minor extent by existing comorbidities. The observed discrepancy with existing guidelines underlines the need for effective pharmacological and psychological treatment options in psychiatric inpatient settings.

Factors Associated With Posttraumatic Stress Disorder Symptomology Among Women Who Have Experienced Sexual Assault in Canada

2019 ◽  
pp. 088626051986008
Author(s):  
Janice Du Mont ◽  
Holly Johnson ◽  
Cassandra Hill
Keyword(s):  
Posttraumatic Stress Disorder ◽  
Sexual Assault ◽  
Posttraumatic Stress ◽  
Dating Violence ◽  
Sexual Victimization ◽  
Stress Disorder ◽  
General Social Survey ◽  
Future Research ◽  
Ptsd Symptoms ◽  
Sexually Assaulted

There is a dearth of information about the association of victim-related and assailant-related characteristics and posttraumatic stress disorder (PTSD) among sexually assaulted women. Recently, Statistics Canada included items measuring the possible presence of PTSD symptoms in their 2014 nationally representative General Social Survey on Victimization (GSS-V), for the purpose of improving the understanding of mental health impacts associated with sexual victimization. The present study used the GSS-V to examine the association of sociodemographic, health, and assailant characteristics and prior traumatic experiences in the form of physical or sexual dating violence, physical assault, stalking, childhood abuse, and witnessing of violence between parents with PTSD symptomology among sexually assaulted women. Among 319 women who reported experiencing at least one incident of sexual assault in the 12 months prior to the survey, 68.6% had experienced at least one negative emotional impact as a result, among whom, 43.6% reported past-month PTSD symptoms. Logistic regression modeling revealed that prior traumatic events in the form of physical or sexual dating violence, stalking, and having witnessed violence between parents were associated with higher odds of experiencing PTSD symptoms, as was having been sexually assaulted by a known assailant. In contrast, the odds of experiencing PTSD symptoms was lower for Aboriginal or visible minority women. The results suggest that PTSD symptoms in the near aftermath of sexual victimization are common, and there are a range of factors that contribute to the likelihood of developing these symptoms. Implications for future research are discussed.

scholarly journals Adjunct pharmacotherapy for psychotherapy

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S166-S167
Author(s):  
Jessica Lochtenberg ◽  
Ari Kirshenbaum ◽  
Matthew Johnson
Keyword(s):  
Posttraumatic Stress Disorder ◽  
Therapeutic Alliance ◽  
Posttraumatic Stress ◽  
Substance Dependence ◽  
Stress Disorder ◽  
Psychiatric Symptoms ◽  
Treatment Options ◽  
Term Treatment ◽  
Compulsive Disorder ◽  
Long Term Treatment

AimsA variety of pharmacotherapies have been used to assist the psychotherapy process as “adjunctive therapies.” These drugs are used in an acute, targeted fashion, such that they are explicitly delivered in the context of psychotherapy for anxiety, mood and substance-dependence disorders (SUDs). Our narrative review highlights the potential of medically-assisted psychotherapy by outlining the current state of research on few of these medications and describing the basic science that supports their use.MethodFirstly, we researched an assortment of medications that have been used off-label to enhance psychotherapy, and selected a few that have received the most empirical attention in preclinical and clinical-trial settings. Our review of clinical trials focused on three of the most common psychiatric ailments. For all studies reviewed, we identify the strengths and weaknesses of the data supporting the use of the medications for the three aforementioned disorders.ResultD-cycloserine: accelerates the process of associative emotional learning, enhancing exposure therapy in the treatment of various anxiety disorders, including obsessive-compulsive disorder and posttraumatic stress disorder. Limited studies are available on efficacy in treating SUDs.Intranasal oxytocin: accelerates memory retrieval-extinction procedures used in posttraumatic stress disorder, and promotes prosocial cognition and behaviour, facilitating a therapeutic alliance. Sufficiently powered studies and safety studies are required before strong conclusions can be made.Propranolol: interrupts the reconsolidation of memories (leading to maladaptive learned responses) involved in posttraumatic stress disorder during memory-reactivation therapy sessions, but there is little evidence that this drug can be used for depression or SUDs.Psychedelics: may effect the brain's default mode network, engendering a transformative experience that is often followed by a reduction in psychiatric symptoms. 3,4-methylenedioxymethamphetamine may additionally modulate the amygdala response in a way that allows for reprocessing of traumatic memories, and improves the therapeutic alliance. Anxiety, mood, and SUDs appear to be positively influence by traditional and non-traditional (ketamine) psychedelics.ConclusionAlthough the efficacy of the medically-assisted psychotherapies reviewed is still under investigation, we propose that these novel treatment approaches may be preferred over traditional psychopharmacological treatments due to the presence of fewer chronic side effects, as well less toxicity and abuse potential. Furthermore, these adjunctive pharmacotherapies may help to reinforce the psychotherapeutic alliance and may ultimately yield better long-term treatment outcomes. If at least some of the adjunctive pharmacotherapies outlined in this review are found to be clinically efficacious and safe, patients will benefit from having more treatment options available to them in the future.

scholarly journals Biomarkers in Posttraumatic Stress Disorder: Overview and Implications for Future Research

2013 ◽  
Vol 35 ◽  
pp. 43-54 ◽  
Author(s):  
Ulrike Schmidt ◽  
Sebastian F. Kaltwasser ◽  
Carsten T. Wotjak
Keyword(s):  
Posttraumatic Stress Disorder ◽  
Sexual Abuse ◽  
Anxiety Disorder ◽  
Posttraumatic Stress ◽  
Stress Disorder ◽  
Future Research ◽  
Clinical Use ◽  
Current State ◽  
Life Threatening ◽  
State Of Research

PTSD can develop in the aftermath of traumatic incidents like combat, sexual abuse, or life threatening accidents. Unfortunately, there are still no biomarkers for this debilitating anxiety disorder in clinical use. Anyhow, there are numerous studies describing potential PTSD biomarkers, some of which might progress to the point of practical use in the future. Here, we outline and comment on some of the most prominent findings on potential imaging, psychological, endocrine, and molecular PTSD biomarkers and classify them into risk, disease, and therapy markers. Since for most of these potential PTSD markers a causal role in PTSD has been demonstrated or at least postulated, this review also gives an overview on the current state of research on PTSD pathobiology.

scholarly journals Epigenetic Aspects of Posttraumatic Stress Disorder

2011 ◽  
Vol 30 (2-3) ◽  
pp. 77-87 ◽  
Author(s):  
Ulrike Schmidt ◽  
Florian Holsboer ◽  
Theo Rein
Keyword(s):  
Posttraumatic Stress Disorder ◽  
Posttraumatic Stress ◽  
Stress Disorder ◽  
Treatment Options ◽  
Adverse Life Events ◽  
Genome Wide ◽  
Recent Developments ◽  
Covalent Modifications ◽  
Genetic And Environmental Factors ◽  
And Control

Development of psychiatric diseases such as posttraumatic stress disorder (PTSD) invokes, as with most complex diseases, both genetic and environmental factors. The era of genome-wide high throughput technologies has sparked the initiation of genotype screenings in large cohorts of diseased and control individuals, but had limited success in identification of disease causing genetic variants. It has become evident that these efforts at the genomic level need to be complemented with endeavours in elucidating the proteome, transcriptome and epigenetic profiles. Epigenetics is attractive in particular because there is accumulating evidence that the lasting impact of adverse life events is reflected in certain covalent modifications of the chromatin.In this review, we outline the characteristics of PTSD as a stress-related disease and survey recent developments revealing epigenetic aspects of stress-related disorders in general. There is also increasing direct evidence for gene programming and epigenetic components in PTSD. Finally, we discuss treatment options in the light of recent discoveries of epigenetic mechanisms of psychotropic drugs.

PTSD in Children 6 Years and Younger

2018 ◽  
Author(s):  
Alexandra C. De Young ◽  
Michael S. Scheeringa
Keyword(s):  
At Risk ◽  
Posttraumatic Stress Disorder ◽  
Early Childhood ◽  
Young Children ◽  
Posttraumatic Stress ◽  
Stress Disorder ◽  
Treatment Options ◽  
High Risk Population ◽  
Accurate Assessment ◽  
Dsm 5

This chapter is an overview of the new Diagnostic and Statistical Manual of Mental Disorders (fifth edition; DSM-5) subtype “posttraumatic stress disorder for children 6 years and younger” and what is known about posttraumatic stress disorder during early childhood. It outlines issues that complicate the accurate assessment of trauma-related problems in young children and reviews the new DSM-5 category, instruments currently available, and evidence for different treatment options. Young children are a high-risk population for exposure to traumatic events and are likewise at risk of developing trauma- and stressor-related disorders following trauma exposure. Early childhood is associated with unique vulnerabilities that may put young children at risk of poor outcomes and rapid maturational growth that may enhance resilience. Early and accurate assessment and treatment of posttrauma reactions in very young children can be challenging, but, because of these factors, it is critical.

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