Severity and Symptom Trajectory in Combat-Related PTSD: a Review of the Literature

Able, Michael L; Benedek, David M.

doi:10.1007/s11920-019-1042-z

Cited by 22 publications

(17 citation statements)

References 30 publications

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“…Exaggerated startle response is considered a hallmark symptom of PTSD [1] and is predictive of disease severity in combat-exposed veterans returning home from active duty [11]. In a sample of predominantly male (76.8%) military service members referred for psychiatric evaluation for suicide-related concerns, the hyperarousal symptom cluster was the only significant predictor of subsequent suicide attempts [12].…”

Section: Introductionmentioning

confidence: 99%

Sex differences in traumatic stress reactivity in rats with and without a history of alcohol drinking

2020

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Background: Alcohol misuse and post-traumatic stress disorder (PTSD) are highly comorbid, and treatment outcomes are worse in individuals with both conditions. Although more men report experiencing traumatic events than women, the lifetime prevalence of PTSD is twice as high in females. Despite these data trends in humans, preclinical studies of traumatic stress reactivity have been performed almost exclusively in male animals. Methods: This study was designed to examine sex differences in traumatic stress reactivity in alcohol-naive rats (experiment 1) and rats given intermittent access to 20% ethanol in a 2-bottle choice paradigm for 5 weeks (experiment 2). Animals were exposed to predator odor (bobcat urine) and tested for contextual avoidance 24 h later; unstressed controls were never exposed to predator odor. We evaluated changes in physiological arousal using the acoustic startle response (ASR) test at day 2 post-stress and anxiety-like behavior measured in the elevated plus-maze (EPM) at day 17 post-stress. In experiment 3, time course of corticosterone response was examined in male and female rats following exposure to predator odor stress. Results: Alcohol-naive males and females exposed to predator odor displayed blunted weight gain 24 h post-stress, but only a subset of stressed animals exhibited avoidance behavior. In alcohol-drinking animals, the proportion of avoiders was higher in males than females, and predator odor exposure increased ASR in males only. Stressed females exhibited blunted ASR relative to unstressed females and stressed males, regardless of alcohol drinking history. Alcohol-experienced females presented lower anxiety-like behavior and higher general activity in the EPM in comparison with alcohol-experienced males. Plasma corticosterone levels were higher in females immediately after predator odor exposure until 60 min post-stress relative to males. Conclusions: We report robust sex differences in behavioral and endocrine responses to bobcat urine exposure in adult Wistar rats. Also, males with a history of chronic moderate alcohol drinking exhibited increased traumatic stress reactivity relative to alcohol-drinking females. Our findings emphasize the importance of considering sex as a biological variable in the investigation of traumatic stress effects on physiology and behavior.

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Section: Introductionmentioning

confidence: 99%

Sex differences in traumatic stress reactivity in rats with and without a history of alcohol drinking

2020

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“…Exaggerated startle response is considered a hallmark symptom of PTSD ( American Psychiatric Association, 2013 ) and is predictive of disease severity ( Able and Benedek, 2019 ). However, investigations of startle responsivity in male and female patients with PTSD have produced mixed results ( Medina et al, 2020 ; Morgan et al, 1996 ).…”

Section: Discussionmentioning

confidence: 99%

Amygdalar endocannabinoids are affected by predator odor stress in a sex-specific manner and modulate acoustic startle reactivity in female rats

Albrechet‐Souza

Nastase

Hill

et al. 2021

Neurobiology of Stress

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Understanding sex differences in behavioral and molecular effects of stress has important implications for understanding the vulnerability to chronic psychiatric disorders associated with stress response circuitry. The amygdala is critical for emotional learning and generating behavioral responses to stressful stimuli, and preclinical studies indicate that amygdalar endocannabinoid (eCB) signaling regulates emotional states. This study measured eCB contents in the basolateral (BLA) and central (CeA) amygdala of male and female rats exposed to predator odor stress (bobcat urine) and tested for contextual avoidance 24 h later. Stressed females had lower levels of 2-arachidonoyl glycerol (2-AG) in the BLA and higher levels of anandamide (AEA) in the CeA, while exposure to bobcat urine did not affect amygdalar eCB contents in males. We previously reported that female rats exposed to bobcat urine exhibit blunted acoustic startle reactivity (ASR) 48 h after predator odor stress. Therefore, we tested the hypothesis that intra-BLA injection of a diacylglycerol lipase (DAGL) inhibitor (which would be expected to reduce 2-AG levels in BLA) and intra-CeA injection of a fatty acid amide hydrolase (FAAH) inhibitor (which would be expected to increase AEA levels in CeA) would mimic previously observed predator odor stress-induced reductions in ASR. Contrary to our hypothesis, microinjections of either the DAGL inhibitor DO34 into the BLA or the FAAH inhibitor URB597 into the CeA significantly increased ASR in females compared to vehicle-treated rats. These findings describe sex-specific effects of predator odor stress on amygdalar eCBs, and new roles for amygdalar eCBs in regulating behavior in females.

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“…Studying the links between specific stressor exposure and trauma in military populations is associated with particular challenges (Tanielian, Tanielian & Jaycox, 2008;Able & Benedek, 2019). Civilian trauma cohorts often consist of people who have been the victim of a singular horrific event, such as a manmade or natural disaster, sexual assault or an act of violence (Atwoli, Stein, Koenen & McLaughlin, 2015;Gradus, 2017).…”

Section: The Impact Of Killing On Mental Healthmentioning

confidence: 99%

Killing in Combat; the Diverging Mental Health Impact on Distinct Veteran Populations – A Two-Sample Study

Ae¹,

Gjerstad²,

Hjemdal³

et al. 2020

Preprint

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This study examined the warzone stressors: killing in combat, experiencing personal threats, or traumatic witnessing during deployment in relation to psychological distress, alcohol consumption and quality of life at long-term follow-up. The study was conducted in two samples of Norwegian veterans who had served in Afghanistan (Study 1, N = 4,053) or in Lebanon (Study 2, N = 10,605), respectively. Data were collected through two postdeployment mental health surveys conducted by the Norwegian Armed Forces Joint Medical Services. Using linear regressions, we investigated the impact of warzone stressors on posttraumatic stress symptoms, depression, anxiety, insomnia, alcohol use, and quality of life. In study 1 (Afghanistan veterans), killing was not a significant predictor of psychological distress, alcohol use, or quality of life, when controlling for Personal Threats and Witnessing exposure. In study 2 (Lebanon veterans) killing remained a significant predictor (p < .001) of symptoms of posttraumatic stress, depression, and anxiety, after controlling for other warzone stressors. However, killing was not a significant predictor of alcohol use or quality of life in Study 2. In summary, killing in combat may be associated with increased reports of psychological distress, but there were distinct results in the two studies. Differences in mission statements, rules of engagement, and mental states during combat could explain the diverging outcomes. The results indicate that it may be erroneous to ubiquitously regard killing in combat as a moral stressor, and highlight the importance of clear rules of engagements that accounts for the “on the ground” reality of soldiers.

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Severity and Symptom Trajectory in Combat-Related PTSD: a Review of the Literature

Cited by 22 publications

References 30 publications

Sex differences in traumatic stress reactivity in rats with and without a history of alcohol drinking

Sex differences in traumatic stress reactivity in rats with and without a history of alcohol drinking

Amygdalar endocannabinoids are affected by predator odor stress in a sex-specific manner and modulate acoustic startle reactivity in female rats

Killing in Combat; the Diverging Mental Health Impact on Distinct Veteran Populations – A Two-Sample Study

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