New research: What happens in soldiers brains with PTSD in the absence of external triggers.

May 18, 2013 — Chronic trauma can inflict lasting damage to brain regions associated with fear and anxiety. Previous imaging studies of people with post-traumatic stress disorder, or PTSD, have shown that these brain regions can over-or under-react in response to stressful tasks, such as recalling a traumatic event or reacting to a photo of a threatening face. Now, researchers at NYU School of Medicine have explored for the first time what happens in the brains of combat veterans with PTSD in the absence of external triggers.

Their results, published in Neuroscience Letters, and presented today at the annual meeting of the American Psychiatry Association in San Francisco, show that the effects of trauma persist in certain brain regions even when combat veterans are not engaged in cognitive or emotional tasks, and face no immediate external threats. The findings shed light on which areas of the brain provoke traumatic symptoms and represent a critical step toward better diagnostics and treatments for PTSD.

A chronic condition that develops after trauma, PTSD can plague victims with disturbing memories, flashbacks, nightmares and emotional instability. Among the 1.7 million men and women who have served in the wars in Iraq and Afghanistan, an estimated 20% have PTSD. Research shows that suicide risk is higher in veterans with PTSD. Tragically, more soldiers committed suicide in 2012 than the number of soldiers who were killed in combat in Afghanistan that year.

“It is critical to have an objective test to confirm PTSD diagnosis as self reports can be unreliable,” says co-author Charles Marmar, MD, the Lucius N. Littauer Professor of Psychiatry and chair of NYU Langone’s Department of Psychiatry. Dr. Marmar, a nationally recognized expert on trauma and stress among veterans, heads The Steven and Alexandra Cohen Veterans Center for the Study of Post-Traumatic Stress and Traumatic Brain Injury at NYU Langone Medical Center.

The study, led by Xiaodan Yan, a research fellow at NYU School of Medicine, examined “spontaneous” or “resting” brain activity in 104 veterans of combat from the Iraq and Afghanistan wars using functional MRI, which measures blood-oxygen levels in the brain. The researchers found that spontaneous brain activity in the amygdala, a key structure in the brain’s “fear circuitry” that processes fearful and anxious emotions, was significantly higher in the 52 combat veterans with PTSD than in the 52 combat veterans without PTSD. The PTSD group also showed elevated brain activity in the anterior insula, a brain region that regulates sensitivity to pain and negative emotions.

Moreover, the PTSD group had lower activity in the precuneus, a structure tucked between the brain’s two hemispheres that helps integrate information from the past and future, especially when the mind is wandering or disengaged from active thought. Decreased activity in the precuneus correlates with more severe “re-experiencing” symptoms — that is, when victims re-experience trauma over and over again through flashbacks, nightmares and frightening thoughts.

Key scientific contributors include researchers at NYU School of Medicine, the University of California at San Francisco, Mt. Sinai School of Medicine, and the Center for Imaging of Neurodegenerative Diseases at the VA Medical Center in San Francisco.

Links Between Unemployment and Poor Emotional Health

Unemployment and living in situations of social adversity are among the main mental disorder contributory factors. This is according to new research led by Jorge Cervilla of the University of Granada Department of Psychiatry, which found being a woman is the other strongest trigger influence on subjects with a genetic predisposition to mental disorder.

A pilot study has been completed by the researchers – which include representatives of the University Hospital, the Andalusian School of Public Health and the Mental Health Program of the Andalusian Health Service – with the full study to look at 4,500 households in Andalusia.

It was found that 20 per cent of the population present a mental disorder at one time or another in their lives, with the most common of these including depression and anxiety disorders.

What do these findings mean for mental health?

Mr Cervilla said the findings “will be of great use in helping identify people at greater risk of suffering the onset of a mental disorder or of having a relapse”.

Chartered Psychologist Micheal Gallagher adds:

“This research takes place in the context of an official unemployment rate of 27 per ent in Spain, compared to just under 8 per cent for the UK. The nature and direction of the relationships between unemployment, social adversity and mental health have been matters of intense debate whenever unemployment increases substantially.

“Two studies by Butterworth and colleagues have helped to clarify such relationships. Analysis of two waves of data from a large community survey (in Australia) showed that current financial hardship was strongly and independently associated with depression, above the effects of other measures of socio-economic position and demographic characteristics. In contrast, the effect of prior financial difficulty was explained by baseline depression symptoms. There was some evidence that current hardship was more strongly associated with depression for those who were not classified as depressed at baseline than for those identified with depression at baseline. The contemporaneous association between hardship and depression suggests that addressing deprivation could moderate socio-economic inequalities in mental health.

“More recently, Butterworth et al. found that baseline mental health status was a significant predictor of overall time spent unemployed for both men and women. However, this overall effect masked gender differences. For women, but not men, baseline mental health was associated with risk of experiencing any subsequent unemployment, whereas for men – but not women – who experienced unemployment, mental health was associated with the duration of unemployment.

“The Spanish finding that being a woman increases the risk of mental health problems (in those with a genetic predisposition) may need to be analysed carefully: in my experience of various community mental services in Ireland and the North of England, women make up 60 per cent or more of referrals, but the Mental Health Foundation website provides an excellent summary of the factors – positive and negative – influencing women’s mental health. Because they are more likely to be carers, to deal with the family budget on a daily basis, and more likely to work in part-time and/or low paid jobs, economic recession may have a greater psychological impact on some women.

“The findings of the main study in Andalusia will be awaited with great interest by social psychologists, sociologists and mental health professionals who subscribe to a biopsychosocial model, but I hope that clinical psychologists will also consider the relevance of the findings for greater understanding of the experiences of many of their clients.”

Courtesy of the British Psychological Society.