Dimensional structure and course of post-traumatic stress symptomatology in World Trade Center responders

Pietrzak, Robert H.; Feder, Adriana; Schechter, Clyde B.; Singh, Ritika; Cancelmo, Leo; Bromet, Evelyn J.; Katz, Craig L.; Reissman, Dori B.; Özbay, Fatih; Sharma, Vanshdeep; Crane, Michael; Harrison, Denise; Herbert, Robin; Levin, S. M.; Luft, Benjamin J.; Moline, Jacqueline; Stellman, Jeanne Mager; Udasin, Iris; El‐Gabalawy, Renée; Landrigan, Philip J.; Southwick, Steven M.

doi:10.1017/s0033291713002924

Cited by 65 publications

(52 citation statements)

References 66 publications

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“…These classes of compounds are currently being investigated for their potential efficacy in treating mood and anxiety disorders. Given that core aspects of threat symptomatology such as hyperarousal are key drivers of more disabling aspects of the trauma-related phenotype such as emotional numbing (Marshall et al, 2006;Pietrzak et al, 2013;Schell et al, 2004;Solomon et al, 2009), pharmacotherapeutic targeting of threat symptomatology in symptomatic trauma survivors may have utility in reducing the chronicity and morbidity of trauma-related psychiatric disorders such as PTSD, MDD, and GAD.…”

Section: Discussionmentioning

confidence: 99%

RETRACTED ARTICLE: Cannabinoid Type 1 Receptor Availability in the Amygdala Mediates Threat Processing in Trauma Survivors

Pietrzak

Huang

Corsi-Travali

et al. 2014

Neuropsychopharmacol

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Attentional bias to threat is a key endophenotype that contributes to the chronicity of trauma-related psychopathology. However, little is known about the neurobiology of this endophenotype and no known in vivo molecular imaging study has been conducted to evaluate candidate receptor systems that may be implicated in this endophenotype or the phenotypic expression of trauma-related psychopathology that comprises threat (ie, re-experiencing, avoidance, and hyperarousal) and loss (ie, emotional numbing, depression/ dysphoria, generalized anxiety) symptomatology. Using the radioligand [ 11 C]OMAR and positron emission tomography (PET), we evaluated the relationship between in vivo cannabinoid receptor type 1 (CB 1 ) receptor availability in the amygdala, and performance on a dot-probe measure of attentional bias to threat, and clinician interview-based measures of trauma-related psychopathology. The sample comprised adults presenting with a broad spectrum of trauma-related psychopathology, ranging from nontrauma-exposed, psychiatrically healthy adults to trauma-exposed adults with severe trauma-related psychopathology. Results revealed that increased CB 1 receptor availability in the amygdala was associated with increased attentional bias to threat, as well as increased severity of threat, but not loss, symptomatology; greater peripheral anandamide levels were associated with decreased attentional bias to threat. A mediation analysis further suggested that attentional bias to threat mediated the relationship between CB 1 receptor availability in the amygdala and severity of threat symptomatology. These data substantiate a key role for compromised endocannabinoid function in mediating both the endophenotypic and phenotypic expression of threat symptomatology in humans. They further suggest that novel pharmacotherapies that target the CB 1 system may provide a more focused, mechanism-based approach to mitigating this core aspect of trauma-related psychopathology.

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Section: Discussionmentioning

confidence: 99%

RETRACTED ARTICLE: Cannabinoid Type 1 Receptor Availability in the Amygdala Mediates Threat Processing in Trauma Survivors

Pietrzak

Huang

Corsi-Travali

et al. 2014

Neuropsychopharmacol

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“…Additional research is needed to increasingly characterize these symptom dimensions at multiple units of analysis. Furthermore, longitudinal studies are needed to delineate the course of these dimensions and to investigate how symptom dimension trajectories relate to aspects of adolescent post-disaster functioning (Pietrzak et al, 2013). As we learn more about the key dimensions underlying disaster-related PTSD in youth and their functional correlates, this knowledge has the potential to be used to tailor post-disaster intervention efforts based on PTSD symptom dimension profiles.…”

Section: Discussionmentioning

confidence: 99%

Elucidating dimensions of posttraumatic stress symptoms and their functional correlates in disaster-exposed adolescents

Sumner

Pietrzak

Danielson

et al. 2014

Journal of Psychiatric Research

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The aim of this study was to elucidate the dimensional structure of posttraumatic stress disorder (PTSD) and potential moderators and functional correlates of this structure in disaster-affected adolescents. A population-based sample of 2,000 adolescents aged 12–17 years (M=14.5 years; 51% female) completed interviews on post-tornado PTSD symptoms, substance use, and parent-adolescent conflict between 4 and 13 months (M=8.8, SD=2.6) after tornado exposure. Confirmatory factor analyses revealed that all models fit well but a 5-factor dysphoric arousal model provided a statistically significantly better representation of adolescent PTSD symptoms compared to 4-factor dysphoria and emotional numbing models. There was evidence of measurement invariance of the dysphoric arousal model across gender and age, although girls and older adolescents aged 15–17 years had higher mean scores than boys and younger adolescents aged 12–14 years, respectively, on some PTSD dimensions. Differential magnitudes of association between PTSD symptom dimensions and functional correlates were observed, with emotional numbing symptoms most strongly positively associated with problematic substance use since the tornado, and dysphoric arousal symptoms most strongly positively associated with parent-adolescent conflict; both correlations were significantly larger than the corresponding correlations with anxious arousal. Taken together, these results suggest that the dimensional structure of tornado-related PTSD symptomatology in adolescents is optimally characterized by five separate clusters of re-experiencing, avoidance, numbing, dysphoric arousal, and anxious arousal symptoms, which showed unique associations with functional correlates. Findings emphasize that PTSD in disaster-exposed adolescents is not best conceptualized as a homogeneous construct and highlight potential differential targets for post-disaster assessment and intervention.

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“…Researchers have explored how factors of posttraumatic symptoms may influence each other longitudinally (Marshall, Schell, Glynn, & Shetty, 2006; Pietrzak et al, 2014; Schell, Marshall, & Jaycox, 2004; Solberg, Birkeland, Blix, Hansen, & Heir, 2016; Solomon, Horesh, & Ein-Dor, 2009). Common findings among these studies are that intrusive and hyperarousal symptoms predict further symptom development.…”

Section: Introductionmentioning

confidence: 99%

Making connections: exploring the centrality of posttraumatic stress symptoms and covariates after a terrorist attack

Birkeland

Heir

2017

European Journal of Psychotraumatology

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Background: Posttraumatic stress symptoms are interconnected. Knowledge about which symptoms of posttraumatic stress are more strongly interconnected or central than others may have implications for the targeting of clinical interventions. Exploring whether symptoms of posttraumatic stress may be differentially related to covariates can contribute to our knowledge on how posttraumatic stress symptoms arise and are maintained. Objective: This study aimed to identify the most central symptoms of posttraumatic stress and their interconnections, and to explore how covariates such as exposure, sex, neuroticism, and social support are related to the network of symptoms of posttraumatic stress. Method: This study used survey data from ministerial employees collected approximately 10 months after the 2011 Oslo bombing that targeted the governmental quarters (n = 190). We conducted network analyses using Gaussian graphical models and the lasso regularization. Results: The network analysis revealed reliably strong connections between intrusive thoughts and nightmares, feeling easily startled and overly alert, and between feeling detached and emotionally numb. The most central symptom in the symptom network was feeling emotionally numb. The covariates were generally not found to have high centrality in the symptom network. An exception was that being female was connected to a high physiological reactivity to reminders of the trauma. Conclusions: Ten months after a workplace terror attack emotional numbness appears to be of high centrality in the symptom network of posttraumatic stress. Fear circuitry and dysphoric symptoms may constitute two functional entities in chronic posttraumatic stress. Clinical interventions targeting numbness may be beneficial in the treatment of posttraumatic stress, at least after workplace terrorism.

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Dimensional structure and course of post-traumatic stress symptomatology in World Trade Center responders

Cited by 65 publications

References 66 publications

RETRACTED ARTICLE: Cannabinoid Type 1 Receptor Availability in the Amygdala Mediates Threat Processing in Trauma Survivors

RETRACTED ARTICLE: Cannabinoid Type 1 Receptor Availability in the Amygdala Mediates Threat Processing in Trauma Survivors

Elucidating dimensions of posttraumatic stress symptoms and their functional correlates in disaster-exposed adolescents

Making connections: exploring the centrality of posttraumatic stress symptoms and covariates after a terrorist attack

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