NEURO PTSD

What is the history of post traumatic stress disorder?

Started with people who went to war, they would get Shell shock. Was finally included as a formal diagnostic entity in 1980, is now part of trauma and related disorders, one of the only disorders where there's a biomarker associated with it

What are the essential features of PTSD?

development of characteristics syndromes following exposure to one or more traumatic events. Presentation varies can be fear and anxiety, arousal, and reactive or dissociative or combination. Has to have impacted psychological well being for at least 1 month

Diagnostic features (trauma)

confirmed experience of trauma, either by directly experiencing it or witnessing the event or hearing about the event of a close friend or family member (911)

Diagnostic features (presence of intrusion symptoms)

recurrent involuntary and intrusive distressing memories or dreams, dissociative reactions and state, and intense prolonged psychological distress, and physiological response to the cues associated with the trauma

Diagnostic features (negative alterations in cognitions and mood)

inability to remember detail details associated with the trauma, negative beliefs about self and expectations, feelings of detachment or estrangement from others

What is PTSD epidemiology for most common forms of traumatic events?

Transport accidents (35.3%), physical assault (18.5%), life-threatening, illness or injury (18.4%)

What are sex differences for PTSD epidemiology?

more prevalent among females than males across the lifespan and experience PTSD for a longer duration, most likely due to greater exposure to sexual assault.

Many students have experienced highly traumatic events

allstudents have experienced events, family member suffers mental illness, witnesses violence of a family, and divorce of parents

What is fear circuitry?

medial pre-frontal cortex appraises the nature of the threat (should I run?) if it is a threat, it will signal to the amygdala and the HPA access. Amygdala signals to hippocampus and hypothalamus and it activates brain stem response to fear.

What is fear circuitry traumatic events?

the amygdala is hyper sensitive as it is over activated, the prefrontal cortex activity is reduced, and it results in hyper vigilance, intrusion symptoms, avoidance of stimuli associated with trauma, and cognitive distortions. (need to have these if you are a child of abuse)

What is the structural anatomical findings?

significantly reduce volume of the hippocampus, ventral medial portion of the prefrontal cortex.

What what does reduced volume of the hippocampus and ventral medial portion of the prefrontal cortex mean?

hippocampus is not able to use contextual cues in the environment to signal safety. It fails to maintain extinction of conditioned emotional responses. Once traumatic learning is no longer relevant.

What is gene and environmental interactions?

shows that the people who go into combat have lower volume hippocampus, and those with normal hippocampus did not go to combat. It means that those who went into combat had a shrunken hippocampus due to stress.

What is functional anatomical differences?

there was exaggerated amygdala activation in response to trauma related stimuli as well as generic stimuli. They took PTSD and normal patients and compared combat sounds.

What are neurobiological differences?

PTSD patient showed enhanced stress activation both Sam and HPA pathways. They had altered adrenaline noradrenaline and cortisol levels. The deregulated signalling of noradrenaline is considered a biomarker of PTSD.

PTSD from pharmacological treatment

the administration of propranolol (a beta receptor antagonist it prevents binding of noradrenaline) within hours, following trauma exposure reduces likelihood of developing PTSD, seems to prevent consolidation of memories, ten-day 40 mg of this drug four times a day within 20 hours of trauma leads to reduced physiological reactivity to trauma accuses, three months post trauma. Seems to be most effective when administered upon memory reactivation.

treatment, and cannabis use for PTSD

people with PTSD or increased odds of using cannabis, they have a higher number of cannabinoid receptors and lower levels of Endocannabinoids, suggesting a dysregulated ECB system post trauma.

treatment, and PTSD in cannabis use (smoking)

smoking cannabis with higher levels of THC are associated with worsening PTSD symptoms where is cannabidiol (CBD) may decrease symptoms, seems to be effective at reducing fear, memory, and enhances fear extinction