Posttraumatic stress disorder as a diagnostic entity – clinical perspectives

Carvajal, C

doi:10.31887/dcns.2018.20.3/ccarvajal

Cited by 12 publications

(12 citation statements)

References 53 publications

(44 reference statements)

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“…In contrast, anxiety is a response to potential threats and is operationally defined as avoidance of potential risks involving open spaces, bright lights, and novel conspecifics ( Steimer, 2002 ; LeDoux, 2015 ). An association between stress and anxiety is well-established ( Shin and Liberzon, 2010 ; Bystritsky and Kronemyer, 2014 ; Daviu et al, 2019 ) with stress being a contributing factor for most anxiety disorders including social anxiety disorder and posttraumatic stress disorder (PTSD) ( Bystritsky and Kronemyer, 2014 ; Carvajal, 2018 ). The causal relationship between stress and anxiety is most dramatically exemplified by PTSD where a single but intensely stressful experience can lead to a long-lasting anxiety state in susceptible individuals ( Nemeroff et al, 2006 ; Craske and Stein, 2016 ).…”

Section: Stress and Anxietymentioning

confidence: 99%

The Paraventricular Nucleus of the Thalamus as an Integrating and Relay Node in the Brain Anxiety Network

Kirouac

2021

Front. Behav. Neurosci.

104

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The brain anxiety network is composed of a number of interconnected cortical regions that detect threats and execute appropriate defensive responses via projections to the shell of the nucleus accumbens (NAcSh), dorsolateral region of the bed nucleus of the stria terminalis (BSTDL) and lateral region of the central nucleus of the amygdala (CeL). The paraventricular nucleus of the thalamus (PVT) is anatomically positioned to integrate threat- and arousal-related signals from cortex and hypothalamus and then relay these signals to neural circuits in the NAcSh, BSTDL, and CeL that mediate defensive responses. This review describes the anatomical connections of the PVT that support the view that the PVT may be a critical node in the brain anxiety network. Experimental findings are reviewed showing that the arousal peptides orexins (hypocretins) act at the PVT to promote avoidance of potential threats especially following exposure of rats to a single episode of footshocks. Recent anatomical and experimental findings are discussed which show that neurons in the PVT provide divergent projections to subcortical regions that mediate defensive behaviors and that the projection to the NAcSh is critical for the enhanced social avoidance displayed in rats exposed to footshocks. A theoretical model is proposed for how the PVT integrates cortical and hypothalamic signals to modulate the behavioral responses associated with anxiety and other challenging situations.

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Section: Stress and Anxietymentioning

confidence: 99%

The Paraventricular Nucleus of the Thalamus as an Integrating and Relay Node in the Brain Anxiety Network

Kirouac

2021

Front. Behav. Neurosci.

104

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“…However, an emerging and broader view suggests that PTSD is a systemic metabolic disorder “in disguise” (Bukhbinder & Schulz, 2016; Michopoulos et al, 2016), involving CNS, neuroendocrine, metabolic, and inflammatory elements (Carvajal, 2018; Flory & Yehuda, 2018; McFarlane, 2017; Mellon et al, 2018; Michopoulos et al, 2016). This alternate perspective suggests that PTSD be reconceptualized as broader than a psychological disorder (McFarlane, 2017; Michopoulos et al, 2016).…”

mentioning

confidence: 99%

Post-traumatic stress disorder (PTSD) as a systemic disorder: Pathways to cardiovascular disease.

Krantz¹,

Shank²,

Goodie³

2022

Health Psychology

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Evidence indicates that post-traumatic stress disorder (PTSD) is a significant risk factor for the development and progression of cardiovascular disease (CVD). Most explanations for PTSD-CVD associations conceptualize PTSD as a stress-related mental health disorder that elicits physiological, behavioral, and psychological responses that are causal factors in the development of cardiovascular disorders. This article reviews evidence for the broader physical health consequences of PTSD, and presents a conceptual model based on research suggesting that PTSD is a systemic disorder. Specifically, research findings indicate that diagnostic criteria are just the "tip of the iceberg" of a broader systemic disorder with elements that are cardiovascular risk factors. These systemic physiological and behavioral elements therefore should not be regarded as accompanying but unrelated diseases or comorbidities, but as inherent components of PTSD that directly impact the development of CVD. The systemic disorder approach has implications for the conceptualization of PTSD as a cardiovascular risk factor, for needed research on PTSD and CVD, and for clinical efforts to reduce PTSD-associated cardiovascular risk. It is suggested that treatments that aim to reduce cardiovascular disease risk need to address both the PTSD diagnostic components and its associated cardiovascular risk factors. Further research is needed to test the applicability and implications of the systemic disorder perspective.

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“…A systematic review conducted by Jellestad et al ( 23 ) found PTSD has been associated with impairment in the ICF domains of “General Tasks and Demands, Mobility, Self-Care, Domestic Life, Interpersonal Interactions and Relationships, Major Life Areas and Community, Social and Civic Life” (p. 14). The DSM III criteria for PTSD was based on dysfunctions in three domains: hypervigilance, the re-experiencing of the original trauma, and avoidant behavior of stimuli associated with the original trauma ( 24 ). In 1994, the DSM IV revised and expanded the diagnostic criteria for PTSD, which were subsequently widely criticized for reasons as disparate and contradictory as being too narrow in defining trauma to being over-diagnosed and thus too sensitive in populations recently exposed to traumatic events ( 25 , 26 ).…”

Section: Ptsdmentioning

confidence: 99%

A proposed mechanism for the MDMA-mediated extinction of traumatic memories in PTSD patients treated with MDMA-assisted therapy

Sottile

Vida

2022

Front. Psychiatry

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Post-traumatic stress disorder (PTSD) is a devastating psychiatric disorder afflicting millions of people around the world. Characterized by severe anxiety, intrusive thoughts, pervasive nightmares, an assortment of somatic symptoms, associations with severe long-term health problems, and an elevated risk of suicide, as much as 40–70% of patients suffer from refractory disease. 3,4-Methylenedioxy-methamphetamine (MDMA), like classic psychedelics such as psilocybin, have been used to enhance the efficacy of psychotherapy almost since their discovery, but due to their perceived potential for abuse and inclusion on USFDA (United States Food and Drug Administration) schedule 1, research into the mechanism by which they produce improvements in PTSD symptomology has been limited. Nevertheless, several compelling rationales have been explored, with the pro-social effects of MDMA thought to enhance therapeutic alliance and thus facilitate therapist-assisted trauma processing. This may be insufficient to fully explain the efficacy of MDMA in the treatment of psychiatric illness. Molecular mechanisms such as the MDMA mediated increase of brain-derived neurotrophic factor (BDNF) availability in the fear memory learning pathways combined with MDMA's pro-social effects may provide a more nuanced explanation for the therapeutic actions of MDMA.

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Posttraumatic stress disorder as a diagnostic entity – clinical perspectives

Cited by 12 publications

References 53 publications

The Paraventricular Nucleus of the Thalamus as an Integrating and Relay Node in the Brain Anxiety Network

The Paraventricular Nucleus of the Thalamus as an Integrating and Relay Node in the Brain Anxiety Network

Post-traumatic stress disorder (PTSD) as a systemic disorder: Pathways to cardiovascular disease.

A proposed mechanism for the MDMA-mediated extinction of traumatic memories in PTSD patients treated with MDMA-assisted therapy

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