Post-Traumatic-Stress-Disorder (PTSD)

Question 1

What is the criterion A for PTSD?

Answer 1

Criterion A: Trauma
The person was exposed to (one required)…
…death
…actual or threatened serious injury
…actual or threatened sexual violence
-> direct exposure
-> witnessing in person
-> Indirectly, by learning that a close relative or close friend was exposed to trauma. If the event involved actual or threatened death, it must have been violent or accidental
-> Repeated or extreme indirect exposure to aversive details of the event(s), usually in the course of professional duties (eg.: first responders, collecting body parts, professionals repeatedly exposed to details of child abuse)

Question 2

What are examples for traumatic events?

Answer 2

• accidents
• natural disaster
• physical or sexual assault
• witnessing homocide
• sudden death
• human suffering
• exposure to war
• etc.

Question 3

What are demographic vulnerability factors to develop PTSD?

Answer 3

• females have a higher risk than males
• young people have a higher risk

Question 4

What is included in the Criterion B for PTSD according to the DSM-V?

Answer 4

Criterion B: Intrusive symptoms
The traumatic event is persistently re-experienced as (one required)…
…recurrent, involuntarily and intrusive memories
…traumatic nightmares
…dissociative reactions (flashbacks) -> can even lead to complete unconsciousness of a situation
…intense or prolonged stress when confronted with trauma reminders (eg.: sounds, smells,…)
…marked physiological reaction due to trauma-related stimuli

Question 5

What is included in Criterion C for PTSD according to the DSM-V?

Answer 5

Criterion C: Avoidance
avoiding trauma-related stimuli in daily life:
- trauma-related thoughts or feelings
- trauma-related external reminders (eg.: places, conversations, objects, crowded places)

Question 6

Criterion D for PTSD?

Answer 6

Criterion D: Negative alterations in cognitions and mood
- persistent negative trauma related emtions (eg. fear, horror)
- diminished interest in various activities
- feeling alienated from others (eg.: detachment)
- constricted affect: inability to experience positive emotions

Question 7

Criterion E for PTSD?

Answer 7

Criterion E: alterations in arousal and reactivity that began or worsened after event
- aggressive behavior
- reckless or self-destructive behavior
- hypervigilance
-exagerated in startle response
- problems in concentration
- sleep disturbances
-

Question 8

What is the time criterion for PTSD (criterion F)?

Answer 8

at least 1 month

Question 9

What is the problem about trauma-focused psychotherapy such as EMDR or CBT in veterans with PTSD?

Answer 9

40% of veterans with PTSD tried at least one of the trauma-focus treatments but are still experiencing their symptoms. Thus, they chronically affected by their symptoms.

Question 10

How do high doses of cortisol impact the brain (rat study)?

Answer 10

Exposing high doses of cortisol to pyramidal cells is leading to necrosis and shrinking of the brain.

Question 11

Why were neuro studies mostly focused on hippocampal differences?

Answer 11

Previous studies showed that glucocorticoids (eg.: cortisol) has a huge influence on the hippocampus.

Question 12

What neuroanatomic differences were found in PTSD patients?

Answer 12

• thinner pre-frontal cortex
• smaller hippocampus

Question 13

What showed the twin-study by Gilbertson et al. (2002)?

Answer 13

The twin-study showed evidence that a smaller hippocampus is a vulnerability factor to develop PTSD. (trait effect)

Question 14

Is the left or right hippocampus volume more reduced in PTSD patients?

Answer 14

The left hippocampus is often significantly more reduced than the right one.

Question 15

What was found in the PTSD group that did not recover after treatment compared to the other groups?

Answer 15

• In the PTSD patients that recovered (due to treatment) showed a very similar hippocampal volume as compared to the combat controls (without PTSD)
• BUT: The PTSD group that did not recover (these 40% mentioned before), are the ones who actually have a significantly smaller hippocampal volume

Question 16

Summarize the findings about hippocampal volume in PTSD patients.

Answer 16

• smaller hippocampal volume is not a result of stress exposure
• a smaller hippocampal volume is not compulsory to develop PTSD
• hippocampal volume does not increase after treatment
  => BUT: patients with a taller hippocampal volume have a better prognosis and (early) recovery from PTSD

Question 17

What happens in the amygdala when a PTSD patient is exposed to emotional faces, trauma-related smells and sounds, or traumatic words?

Answer 17

The amygdala becomes hyperactive.

Question 18

Explain and describe the study conducted by van Roij et al. (2014) and its findings.

Answer 18

Participants (HC, PTSD, combat controls) were exposed to emotional processing task with neutral stimuli and trauma-unrelated negative pictures (not war).
-> no difference in amygdala activation was found, thus, it implies that the amygdala becomes only hyperactive in PTSD patients when exposed to trauma-related stimuli
-> BUT: PTSD patients and the combat controls showed increase in the medial superior frontal gyrus (highly relevant for cognitive controls)
-> increased activity in dACC in PTSD participants (this are is important for emotional and cognitive processing) => increased activity in dACC very specific for PTSD compared to other anxiety disorders
After treatment:
- the non-recovered PTSD patients showed pre-and post treatment increased activity in the insula and the dACC (compared to recovered PTSD and HC) -> at least amygdala does decrease (probably also due to habituation to the stimuli)

Question 19

Summarize the findings of the emotional processing task (Roij et al., 2014).

Answer 19

• Increased amygdala activity occurs only when exposed to trauma-related stimuli
• Dorsal ACC activity may indicate increased attention (bias) for negative stimuli in PTSD compared to other anxiety disorders
• Patients who do not recover after treatment show increased activity in salience network (dACC, insula, amygdala) prior to treatment
• Increased amygdala, dACC and insula activity is predictive of treatment persistence
  -> even when controlling for education and PTSD severity

Question 20

What was found in the PRISMO scan study?

Question 20

What was found in the PRISMO scan study?

Answer 20

This study assessed soldiers before deployment, 1 month after coming back and 1,5 years later, compared to soldiers who were never deployed.
Results:
- deployed soldiers showed increased amygdala activation at the 1 month follow up -> Amygdala was much more sensitive to negative stimuli compared to HC
- BUT: 1,5 years later normalized the amygdala activity if the soldier that home (in The Netherlands)

Question 21

What did the longitudinal study (Eckhout et al., 2016) on biomarkers for PTSD find?

Answer 21

Results:
- huge group does not develop PTSD -> resilient (85%)
- some develop quite late symptoms of PTSD (ca. 2years) -> 9%)
- some develop immediately after coming back PTSD and recover (mostly due to treatment) -> 5%

Question 22

What was found to be predictors for PTSD (Eckhout et al., 2015)

Answer 22

• young age (<21) increased risk for PTSD symptoms 5 years after deployment
• lower ranks increased risk for PTSD symptoms 5 years after deployment
• early life trauma does increase the risk for PTSD at baseline but not at later time points
• Veterans with a more active role during deployment showed a greater increase in PTSD symptoms

Question 23

What were found to be biomarkers for PTSD?

Answer 23

Individuals with a Higher number of GR prior to deployment are the ones who develop PTSD
-> GR (Glucocorticoid receptors) are receptors that are on the white blood cells

Question 24

What personality traits are leading to a higher risk of developing PTSD?

Answer 24

Individuals who are…
… more hostile, harm avoiding
… scoring lower on self-directedness
show a higher chance to develop PTSD

Question 25

How are GR (glucocorticoid receptors associated with the amygdala in individuals?

Answer 25

Individuals with high amount of glucocorticoid receptors showed also an increase in amygdala activity after deployment

Question 26

What was investigated by ALTO neuroscience (Amit Etkin) regarding EG measures?

Answer 26

He has shown that a small EG measurement (approx. 5-6 min) prior to treatment is sufficient to predict who will benefit from SSRIs, Psychotherapy, or tDCS