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Long Term Effects Of Ptsd On The Brain
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Ptsd And Adult Survivors Of Child Abuse
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I.M. Sechenov Ministry of Health of the Russian Federation First Moscow State Medical University (Sechenov University), 8/2 Trubetskaya Str., 119991 Moscow, Russia
Traumatic Brain Injury And Posttraumatic Stress Disorder: Conceptual, Diagnostic, And Therapeutic Considerations In The Context Of Co Occurrence
Institute of Physiologically Active Compounds, Russian Academy of Sciences, Severny pr. 1, Chernogolovka, 142432 Moscow Region, Russia
Department of Biochemistry, Center of Excellence in Regenerative Medicine and Molecular Biology (CEMR), JSS Academy of Higher Education and Research (JSS AHER), Mysore 570015, Karnataka, India
Received date: May 20, 2020/Revision date: August 10, 2020/Accepted date: September 4, 2020/Published date: September 12, 2020
(This article belongs to the Special Issue Pharmacogenomics and Mitochondrial Genomics as Strategies for the Diagnosis and Treatment of PTSD)
Harnessing Psilocybin To Treat Ptsd
Post-traumatic stress disorder (PTSD) is a well-known mental illness that affects millions of people around the world. Pharmacodynamics and cognitive behavioral therapy (CBT) have been used to treat patients with post-traumatic stress disorder (PTSD). However, it remains unclear whether psychopathological and neurophysiological factors associated with PTSD are concurrently altered. Past reports have described that PTSD patients with efficient fatty acid metabolism, neurogenesis, and mitochondrial energy homeostasis have improved abilities to cope with conditioned fear responses and traumatic memories. Additionally, cognitive, behavioral, cellular and molecular evidence can be combined to create personalized treatments for PTSD patients with or without comorbidities such as depression or memory impairment. Unfortunately, evidence is still lacking to fully understand the underlying neurophysiological and psychopathological aspects associated with PTSD. This review extensively discusses single nucleotide polymorphisms (SNPs) as genetic contributors to PTSD, the impact of inflammation, neurotransmitter genomics, metabolic alterations, and neuroendocrine disorders (hypothalamic-pituitary-adrenal (HPA) axis ), mitochondrial dynamics, neurogenesis, and premature aging have been implicated in PTSD-induced psychopathology and neurophysiology. Additionally, this review addresses the importance of CBT and several pharmacodynamic therapies in reducing PTSD symptoms.
Posttraumatic stress disorder (PTSD) encompasses a range of cognitive and emotional changes [1]. Post-traumatic stress disorder (PTSD) is associated with a range of devastating symptoms that result from sustained and long-term exposure to traumatic events that directly or indirectly induce stress [2]. PTSD was reclassified in the Diagnostic and Statistical Manual, Fifth Edition (DSM-5). It is no longer classified as an anxiety disorder, but instead as a “trauma and stress or related disorder.” This reclassification was prompted by the same adverse effects as other stress-related disorders as well as new diagnostic criteria [3, 4]. According to the DSM-5, diagnostic criteria for classifying PTSD are exposure to actual or threatened death, serious injury, or sexual assault. According to the American Psychiatric Association, exposure must be due to one or more of the following conditions in which the individual:
The above list is not exhaustive. There are other examples of traumatic events, namely violent crime, accidents, emotional social abuse, physical assault, military combat, civil unrest, natural disasters, child abuse, which can cause some people to develop PTSD. Post-traumatic stress disorder is therefore known as a psychiatric disorder that may be characterized by clinically significant social impairment, inability to work, or reduced mental ability to perform other daily functions [4]. Events that are personally traumatic are undisputed. There is no threshold or benchmark to determine whether an event is severe enough to trigger PTSD. Currently, approximately 24 million people in the United States are diagnosed with PTSD (approximately 8% of the population). Additionally, the public cost of treating PTSD increases by nearly $43 billion annually [3].
PTSD is characterized by a range of psychoemotional and neurophysiological effects, such as re-experiencing trauma in the form of vivid intrusive memories, flashbacks or nightmares [3]. These experiences are often accompanied by overwhelming fear and intense physical sensations. People with post-traumatic stress disorder (PTSD) often attempt to withdraw from society by suppressing memories or avoiding activities that are reminiscent of the traumatic event. People with post-traumatic stress disorder (PTSD) also report increased fear of current threats, such as hypervigilance and overreaction to unexpected noises. These symptoms significantly impair personal, family, social, educational, occupational and other important areas of functioning and quality of life [3, 4].
How Chronic Stress Changes The Brain
Neurophysiological abnormalities are related to hypothalamic-pituitary-adrenal (HPA) axis [5] dysfunction, changes in immune, neurotransmitter and neurotrophic functions [1], increased thyroid activity [6], high sensitivity of the nervous system, and accelerated aging of DNA. A process resulting from increased damage and shortened telomeres [1]. Additionally, PTSD is associated with osteoporosis, migraines, sleep disorders, respiratory diseases, cardiovascular diseases, autoimmune diseases, chronic inflammation, metabolic syndrome, and unexplained premature death [7, 8].
The psychopathology and pathophysiology of PTSD is related to profound feelings or memories of the traumatic event. Not only do these memories fade over time, but they may persist for years or even become stronger [3]. These effects may be related to progressive damage within the central nervous system, thereby promoting the development of chronic PTSD. The smaller hippocampus in patients with PTSD may be responsible for greater feelings of fear and acquisition of avoidance associated with auditory cues and shock [9, 10]. Furthermore, hippocampal volume correlates with fear-mediated manifestations and may predispose individuals to diminished neuroendocrine function via the HPA axis. This is evident in many people with post-traumatic stress disorder (PTSD) who suffered childhood trauma due to elevated cortisol levels [11]. Therefore, small hippocampal volume is associated with psychopathological changes and may predispose patients to sustained conditioned psychoemotional responses to hormone-induced stress cues [12, 13].
Multiple pathophysiological changes have been reported in patients with PTSD, and these changes overlap with clinical manifestations observed in patients with traumatic brain injury (TBI) [6] . In addition, pathophysiological changes in the amygdala, hippocampus, and related brain structures are associated with PTSD [14, 15, 16, 17]. It has been reported that underlying networks from these brain regions with parahippocampal gyrus and visual processing streams are involved in processing traumatic information and recalling traumatic memories [18, 19]. Involuntary memory intrusion may be mediated by the processing of traumatic visual memories [20, 21, 22].
Brain scans using single-photon emission computed tomography (SPECT) may help diagnose PTSD with a high degree of accuracy compared to other MRI and CT scans, which often yield normal results in PTSD patients. SPECT imaging has been shown to differentiate between PTSD and traumatic brain injury (TBI) of varying severity in large patient groups. SPECT scans can reveal relative increases in perfusion in limbic zones, basal ganglia, thalamus, and temporal lobes in PTSD patients compared with TBI subjects [23]. Clinicians should seek the most accurate diagnostic methods to select appropriate treatment options for PTSD [22]. Furthermore, brain tissue recovery is enhanced as PTSD patients acquire new learning skills through social interactions, exercise regularly, avoid potential threats and negative thoughts, and actively develop skills to perform challenging tasks [1, 3]. This healthy lifestyle, supplemented by nutrition and weight management, is great
