“We found Veterans with PTSD had twice the chance for later being diagnosed with dementia than Veterans without PTSD,” said Mark Kunik, M.D., M.P.H., a psychiatrist at the Michael E. DeBakey VA Medical Center, Texas, USA, and senior author of the article. “Although we cannot at this time determine the cause for this increased risk, it is essential to determine whether the risk of dementia can be reduced by effectively treating PTSD. This could have enormous implications for Veterans now returning from Iraq and Afghanistan.”

The study included 10,481 Veterans at least 65 years of age who had been seen at the VA Medical Centre at least twice between 1997 and 1999. Outpatient data were gathered for all identified patients until 2008. Subjects who had been wounded during combat (with and without a PTSD diagnosis) were also identified to provide a group with confirmed injuries and combat experience. A group with two visits, but no PTSD or combat related injuries, was identified for purposes of comparison.

36.4% of the Veterans in this study had PTSD. 11.1% of those with PTSD but not injured, and 7.2% of those with PTSD and injured, had dementia, compared to 4.5% and 5.9% respectively in the non-PTSD groups. These results remained significant after other risk factors of dementia were taken into account like diabetes, hypertension, heart disease, stroke, etc.

“Despite the increased risk for those with PTSD, it is noteworthy that most Veterans with PTSD did not develop dementia during the period we studied,” said Salah Qureshi, M.D., a staff psychiatrist and investigator with the Houston VA Center of Excellence and first author of the article.”It will be important to determine which Veterans with PTSD are at greatest risk and to determine whether PTSD induced by situations other than war injury is also associated with greater risk.”

The authors note there could be several explanations for their findings. It could be that cognitive impairment in PTSD is an early marker of dementia, having PTSD makes one more likely to get dementia, or PTSD and dementia have some characteristics in common. They emphasize the need for further study with a broader sample in the civilian population.

In an editorial accompanying this paper, Dr. Soo Borson of the University of Washington Medical Centre, Washington, highlights the need for further research to explain the association and also the wider significance of these findings, “Confirmation of a causal link between PTSD and cognitive impairment in late life would have enormous global implications in a world facing a rising societal burden of dementia, a shrinking workforce to sustain its economies, and the difficulties of containing human violence. Soldiers and other U.S. war veterans are just one of many groups exposed to deeply traumatizing experiences with lifetime effect.”

Material adapted from Wiley-Blackwell.

“Most returning veterans don’t have PTSD or difficulty with anger or aggressiveness, but for the small subset who do, this study helps to identify related risk factors,” said Eric Elbogen, PhD, lead author of the study, an assistant professor of psychiatry in the UNC School of Medicine and a staff psychologist at the VA Medical Center in Durham, N.C.

“The data showed that PTSD symptoms such as flashbacks or avoiding reminders of a trauma were not consistently connected to aggressiveness,” said Elbogen. “Instead, we found that post-deployment anger and hostility were associated with PTSD hyperarousal symptoms: sleep problems, being ‘on guard,’ jumpiness, irritability, and difficulty concentrating.”

From interviews with 676 veterans, Elbogen and VA colleagues identified features associated with anger and hostility, which result in increased risk of post-deployment adjustment problems as veterans transition to civilian life.

Veterans who said they had difficulty controlling violent behavior were more likely to report witnessing pre-military family violence, firing a weapon during deployment, being deployed more than 1 year, and experiencing current hyperarousal symptoms. There was an association with a history of traumatic brain injury, but it was not as robust as the relationship to hyperarousal symptoms. Elbogen said, “Our data suggest the effects of traumatic brain injury on anger and hostility are not straightforward.”

Veterans with aggressive urges were more likely than others to report hyperarousal symptoms, childhood abuse, a family history of mental illness, and reexperiencing a traumatic event. Difficulty managing anger was associated with being married, having a parent with a criminal history, and avoiding reminders of the trauma, as well as hyperarousal symptoms.

“As we learn more about risk factors and how to manage them, we’ll be helping not only the veterans but their families and society at large. Veterans with these adjustment problems should seek help through the VA so we can best serve those who have served our country” Elbogen said.

Material adapted from University of North Carolina School of Medicine by CFisher.

“Identification of the biologic underpinnings of PTSD will be crucial for developing appropriate psychological and/or pharmacological interventions, particularly in the wake of an increasing number of military veterans returning home following recent wars worldwide.”

The findings are published today online in Proceedings of the National Academy of Sciences (PNAS).

Previous studies have found that lifetime experiences may alter the activity of specific genes by changing their methylation patterns. Methylated genes are generally inactive, while unmethylated genes are generally active.

The new study is the first large scale investigation to search for trauma-induced changes in the genes of people with PTSD. DNA samples were obtained from participants in the Detroit Neighborhood Health Study (DNHS), a longitudinal epidemiologic study investigating PTSD and other mental disorders in the city of Detroit. The researchers analyzed the methylation patterns of over 14,000 genes from blood samples taken from 100 Detroit residents, 23 of whom suffer from PTSD.

The analysis found that participants with PTSD had six to seven times more unmethylated genes than unaffected participants, and most of the unmethylated genes were involved in the immune system.

The observed methylation changes in the immune system genes were reflected in the PTSD participants’ immune systems: levels of antibodies to a herpes virus were high in PTSD patients, indicative of a compromised immune system.

While people who experience severe trauma will exhibit a normal stress response, in PTSD, the stress response system becomes deregulated and chronically overactive causing compromised immune functioning. PTSD has long been linked to increased risk of numerous physical health problems – including diabetes and cardiovascular disease. This paper suggests why PTSD is so strongly associated with physical health problems – trauma exposure causes epigenetic changes in immune system genes and thus, compromised immune functioning putting individuals at risk for a host of disorders.

“Our findings show that PTSD may be associated with epigenetic changes in immune-system genes. If this is the case, these clusters could provide clues to our understanding of how a traumatic event changes gene expression, thus altering immune function and resulting in other possible physiologic alterations,” says Dr. Galea.

Material adapted from Columbia University’s Mailman School of Public Health by CFisher.

The study found that 589 survivors, or 9 percent, reported significant functional impairment and clinical distress as well as symptoms consistent with a full diagnosis of PTSD. In comparison, eight siblings, or 2 percent, reported impairment, distress and PTSD symptoms. The study is published in the May issue of the journal Pediatrics.

“Childhood cancer survivors, like others with PTSD, have been exposed to an event that made them feel very frightened or helpless or horrified,” said Dr. Margaret Stuber, a professor of psychiatry and biobehavioral sciences, a Jonsson Cancer Center researcher and first author of the study. “This study demonstrates that some of these survivors are suffering many years after successful treatment. Development of PTSD can be quite disabling for cancer survivors. This is treatable and not something they have to just live with.”

Affected survivors reported symptoms such as increased arousal, phobias, startling easily, being hyper vigilant, avoidance of reminders of their cancer diagnosis and treatment, being on edge and suffering extreme anxiety. They also reported that the symptoms kept them from functioning normally.

Other studies have looked for PTSD in childhood cancer survivors while they’re still children or adolescents, but the percentage reporting symptoms is far less, about 3 percent, Stuber said.

There could be several reasons for the discrepancy. Today’s treatment regimens employ less toxic treatments and rely far less on whole head radiation for brain tumors, causing far less trauma to the young patients. Additionally, the improved supportive care available today may result in fewer physical and cognitive late effects from treatment.

The survivors in Stuber’s study often underwent far harsher treatment regimens commonly used in the 1970s and early 1980s, and within the group studied, those that underwent the more toxic and damaging therapies reported more cases of PTSD.

Another possible reason that more of the young adults reported PTSD symptoms is because they’re facing the stressful situations typical for people at that age – finding a job, getting married, starting a family. That stress may exacerbate the PTSD, Stuber said.

“It may be that symptoms, clinical distress and functional impairment only emerge among the more vulnerable childhood cancer survivors as they contend with the developmental tasks of young adulthood and the added challenges of the late effects of treatment,” the study states. “The relative protection of the parental home is diminished as young adult survivors face the challenges of completing their education, finding a job, getting health insurance, establishing long-lasting intimate relationships and starting a family.”

And because many of the patients in the study underwent harsh therapies, they often suffer from significant late effects – infertility, cognitive impairment, stunted growth. This add to stress levels as well. Those that suffer from cognitive impairment may find it impossible to go to college or to land a good job that earns them an adequate income.

“These survivors may find that can’t get health insurance. They may be reluctant to put themselves on the marriage market because they’re sterile. Those that can have children may be afraid of passing their ‘bad genes’ onto their children. Some treatments affect growth, so some survivors may be shorter and heavier than their peers,” Stuber said. “They may feel like they’re damaged goods.”

Treatment options such as therapy and medication are available to help the survivors manage their symptoms. But addressing the issue will not be simple, Stuber said.

“People who had more intense treatment are more likely to have these symptoms because their treatment was more traumatic,” Stuber said. “And because more damage was done to their bodies, it makes it more difficult to have a good life later. It’s all interdigitating.”

Video
A link to a video interview with the researcher is here.

Material adapted from University of California – Los Angeles by CFisher.

More than 230,000 Iraq and Afghanistan war veterans sought treatment for the first time at VA healthcare facilities nationwide between 2002 and 2008. More than 20 percent of these veterans, almost 50,000, received a new PTSD diagnosis. Treatments that have been shown to be effective for PTSD typically require 10-12 weekly sessions. VA follows these recommendations, however, fewer than ten percent of those Iraq and Afghanistan veterans with newly diagnosed PTSD complete this recommended “dose” of PTSD treatment. When the time frame was expanded to a year rather than four months, fewer than thirty percent of the veterans completed the recommended course of treatment.

The study showed that there are groups of veterans that are less likely to receive adequate care than others, such as male veterans (compared to female veterans), veterans under twenty-five years old, veterans who received their PTSD diagnoses from primary care clinics (requiring referral to a mental health program), and veterans living in rural areas.

Dr. Karen Seal, head researcher for the study and practitioner at the San Francisco Veteran Affairs Medical Center, says that while the majority of veterans with PTSD attend at least one mental health follow-up visit, there are still substantial barriers to care that prevent the majority from completing what is considered an adequate course of PTSD treatment. Many of obstacles are system-level or are personal barriers resulting in lack of patient follow-up on appointments, etc.

The study doesn’t account for care that veterans may be receiving outside of the VA, such as care received at Vet Centers or other community-based clinics. The study concludes there is further need for the VA and other healthcare systems to develop new and innovative ways to overcome barriers to care in delivering these effective mental health treatments. The success of VA’s most recent efforts to enhance PTSD care cannot be determined from the study’s findings, which cover the period through 2008 only.

Material adapted from Wiley-Blackwell by CFisher.

The ability to objectively diagnose PTSD is the first step towards helping those afflicted with this severe anxiety disorder. PTSD often stems from war, but also can be a result of exposure to any psychologically traumatic event. The disorder can manifest itself in flashbacks, recurring nightmares, anger, or hypervigilance.

With more than 90 percent accuracy, researchers were able to differentiate PTSD patients from healthy control subjects (250 people with clean mental health) using the MEG. All behavior and cognition in the brain involves networks of nerves continuously interacting – these interactions occur on a millisecond by millisecond basis. The MEG has 248 sensors that record the interactions in the brain on a millisecond by millisecond basis, much faster than current methods of evaluation such as the functional magnetic resonance imaging (fMRI), which takes seconds to record.

The measurements recorded by the MEG represent the workings of tens of thousands of brain cells. This recording method allowed researchers to locate unique biomarkers in the brains of patients exhibiting PTSD.

The findings are published January 20 in the Journal of Neural Engineering and led by Apostolos Georgopoulos, M.D., Ph.D., and Brian Engdahl., Ph.D. – both members of the Brain Sciences Center at the Minneapolis VA Medical Center and University of Minnesota.

“These findings document robust differences in brain function between the PTSD and control groups that can be used for differential diagnosis and which possess the potential for assessing and monitoring disease progression and effects of therapy,” Georgopoulos said.

Besides diagnosing those with PTSD, the researchers also are able to judge the severity of how much they are suffering, which means the MEG may be able to be used to gauge the how badly patients are impacted by other brain disorders.

It is likely that the study will be replicated and administered to a larger group to assure the accuracy of its results.

This work, specifically on detecting post-traumatic stress disorder, follows success in detecting other brain diseases, such as Alzheimer’s and multiple sclerosis, using MEG, as reported in September 2007.

Material adapted from University of Minnesota by CFisher.

Extreme stressors such as experiencing abuse or witnessing violence can make children isolate themselves from family and friends, feel disconnected from reality, experience intrusive thoughts about the trauma and struggle in school. “Post-traumatic stress is not only about the traumatic memories; it really affects daily living,” said Carrion, who is an associate professor of child and adolescent psychiatry at the School of Medicine and director of Stanford’s early life stress research program. The research will be published online Dec. 8 in the Journal of Pediatric Psychology. (The paper’s Digital Object Identifier, or DOI, is 10.1093/jpepsy/jsp112.)

The findings could be an important step toward better monitoring of PTSD treatments, which include psychotherapy techniques such as teaching relaxation exercises, helping children to construct a cohesive story about the traumatic event and helping them learn to cope with reminders of the trauma. Right now, psychologists assess such treatments by looking for improvements in symptoms, but that’s a problem because the symptoms can fluctuate from day to day. “That method has the disadvantage that we don’t know what’s happening at the neural level,” Carrion said.

To observe how kids’ brains work after trauma, Carrion’s team used functional magnetic resonance imaging to compare 16 young people who had PTSD symptoms with a control group of 11 normal youths. The scientists scanned the brains of the 10- to 17-year-old subjects during a simple test of verbal memory. Subjects read a list of words, then saw a similar list with new words added, and were asked which terms were present on the original list.

The hippocampus worked equally well in stressed and control subjects when the word list was first introduced. However, subjects with PTSD symptoms made more errors on the recall part of the test and showed less hippocampus activity than control subjects doing the same task.

Subjects with the worst hippocampus function were also most likely to experience a specific set of PTSD symptoms: Such impairment of the hippocampus was strongly correlated with “avoidance and numbing” symptoms of PTSD, including difficulty remembering the trauma, feeling cut off from others and lack of emotion.

Parents and other caregivers may find the new discoveries useful as they tend to traumatized children, Carrion said, particularly when children respond to trauma by withdrawing from people who are trying to help. Parents may sometimes misinterpret this behavior as a child’s attempt to retaliate, when it actually represents an overload of the brain’s normal mechanism for handling fear. “When parents understand that PTSD is real, they don’t take it as personally,” he said. “They become more available to their kids. That’s good because the kids need them.”

In the future, physicians and scientists may be able to use fMRI scans of the hippocampus to identify children who are at high risk of PTSD after mass catastrophes, added Carrion, who has consulted on response teams for natural disasters such as Hurricane Katrina and the February 2009 wildfires in southeastern Australia. However, larger studies of brain activity in pediatric PTSD are still needed to give a more detailed understanding of the disorder.

It’s already clear that untreated PTSD can interfere with a child’s normal brain development and increase the risk of other psychiatric conditions such as depression and substance abuse, Carrion concluded. “Early intervention is critical for children with post-traumatic stress,” he said.

Material adapted from Stanford University Medical Center by CFisher.

In March 2008, I along with other talk show hosts, was invited by Christian Solidarity International to visit Sudan on a humanitarian mission. Being very impressed with their work and continued dedication to freeing people in slavery after a catastrophic 22 year civil war, I was glad to have the opportunity to participate.

Ellen With Village

Given the state of this war ravaged region, there is a tremendous lack of professional assistance to the people who are very poor and without life’s basics that we tend to take for granted.

Having some training and experience with trauma, I thought teaching Coherent Breathing would make a huge difference in the incredibly difficult lives of these women and men.

Due to the lack of practitioners, Coherent Breathing is probably the only PTSD intervention that these war survivors will have access to in the foreseeable future.

The formal program began in late October 2009. All participants are requested to take a PTSD symptom evaluation every six weeks. While initial survey results are not all in yet, it is clear that everyone has suffered major effects of this decades long conflict.

We began the program in Southern Sudan in Mobil-Aweil, East County. Currently, participants come five days a week to receive instruction and breathe while listening to the RESPIRE-1 CD. We explained how the sound on the CD (2 Bells) was made by bringing a Tibetan bowl to demonstrate. Many of the participants travel long distances to participate and are paid ten dollars a week, this small stipend helping to pay for food and other expenses.

Within a couple of days participants were finding that the practice of Coherent Breathing was helping them manage their thoughts more effectively and achieve a new degree of calm. On November 17th, I received this email update:

Women Breathing

“Hi Ellen,

John talked to Dr. Luka just today and checked in on the breathing program.  Dr. Luka said the breathing program on his side of town is going well.  He said the clients are taking it seriously and it seems to benefit them.  Dr. Luka said he wasn’t sure if it was medical or psychological, but the women seem to benefit from the community and support of the breathing sessions.  He said he has not heard of any issues at Pastor Matthew’s end of the program and, to the best of his knowledge, it is going well there too.  It seems like it is off to a good start and at least some of the clients are taking it seriously and benefiting from it.  I’m pleased to hear this!

Yours,
Elliott Daniels
Washington Representative
Christian Solidarity International”

We will continue to update you as to the progress and impact of this important initiative!

Like many of us, I tend to have the most personal growth during and after a personal crisis. Twenty years ago I was experiencing a very difficult time in my own life. During this time, I met Anne Gehman, a Spiritualist minister. She introduced me to the mental healing movement of the late 1800’s. I spent many years of “off” time combing The Library Of Congress and Harvard University’s Widener Library.

During the long hours of the Monica Lewinsky scandal I would go there  for a bit of sanity and it was there that I found the work of Yogi Ramacharaka (William Walker Atkinson). By then I had moved from working in the mental health field to working as a reporter and talk media personality covering the White House.

That’s when Anne Gehman and I decided to work on a book of self help techniques. The book was almost finished but sat on the self for almost ten years until I hit another personal crisis and through Dr. Lauri Liskin became familiar with the work of Dr’s. Richard Brown, Patricia Gerbarg, and the practice of Coherent Breathing.

Ellen Breathing With Group

Coherent Breathing worked immediately and I became a “born again breather.” While showing my reporting staff the Coherent Breathing web site (www.coherence.com) I noticed that Stephen Elliott, author of The New Science of Breath had dedicated his work to the man whom I’d written so much about ten years before, Yogi Ramacharaka. Like so many things in life, the answer to my anxiety and depression had been right under my nose. It gave me the final impetus to finish the book which is now in the final editing stage.

My first book, The Other Side Of The Family- A Book For Recovery From Incest, Abuse, and Neglect, is about recovering from trauma inflicted within the family.

Thank you for your attention and thank you Christian Solidarity International,

Ellen Ratner