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Can a New Blood Test Help Identify Troops & Veterans with PTSD?

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Medical professionals could potentially one day identify veterans with post-traumatic stress disorder (PTSD) through a quick blood test instead of complex psychological tests, thanks to new research from the
US Army and outside biometrics experts.

The study, which appeared in the journal Molecular Psychiatry, found a set of 27 blood markers which helped identify patients suffering from PTSD.

Researchers said the findings support past hypotheses that the disorder “affects not just the brain, but the entire body.”

In a statement, US Army Medical Research Systems Biology Chief Scientist Marti Jett said those markers “will continue to be refined and adapted for commercialisation” in coming years.

Researchers are hopeful blood tests can lead not only to more accurate diagnoses but also earlier ones, perhaps indicating signs of problems even before PTSD has fully manifested.

Senior study author Dr. Charles Marmar, chair of the Department of Psychiatry at the New York University School of Medicine, said a blood test could indicate signs of PTSD that veterans are unaware of or deliberately hiding out of fear surrounding the stigma of the diagnosis. It could also more quickly eliminate PTSD as a potential problem for patients with unclear medical issues.

“This is an attempt to take the field of psychiatry from the subjective to the objective,” he said. “It’s a way to start a new conversation about how to find the invisible wounds of war.”

But the study has limits. No women were among the veterans tracked for the research, and no civilians were included. Marmar said creating a simple, inexpensive blood test for widespread use to help diagnose PTSD is likely still years away. But he still lauded the findings as an important medical breakthrough for health experts looking for ways to more accurately track troops’ health.

Defence Department and Veterans Affairs researchers have estimated that as many as 25% of individuals who served in combat zones in Iraq or Afghanistan may suffer from PTSD, marked by uncontrolled anxiety, confusion or anger.

Officials have spent years trying to break down the stigma surrounding the diagnosis, which many service members fear could render them undeployable or otherwise unfit for duty because of the non-physical nature of the symptoms.

The study, the culmination of six years of work, tracked blood samples from 165 veterans, half of whom suffer from PTSD following deployments into war zones.

Scientists studied their medical histories and biochemistry, trimming down the list of potential identifying characteristics in their blood from more
than 1 million to less than 30.

In subsequent tests with other patients, the final set of blood markers showed a 77% accuracy rate in helping identify PTSD. Marmar said that is more than enough for a potential screening test, where medical professionals can follow up with more in-depth
examinations to diagnose the illness.

Past studies have hinted at blood markers as a potential indicator of PTSD, but researchers in the new study which included the Harvard John A. Paulson School of Engineering and Applied Sciences and the US Army Medical Research and Development Command said this is the first time a coherent set of measures has been developed.

Jett said that any screening tool that comes from the research would be used before and after deployments, and treatment for those issues would be provided based on military medical standards.

The full study is available on the journal’s website @ https://www.nature.com/articles/s41380-019-0496-z.

Psychotraumatology: What Have We Learned?

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Research Paper Title

A decennial review of psychotraumatology: what did we learn and where are we going?

Background

On 06 December 2019 the reviewers started the 10th year of the European Journal of Psychotraumatogy (EJPT), a full Open Access journal on psychotrauma.

This editorial is part of a special issue/collection celebrating the 10 years anniversary of the journal where the reviewers will acknowledge some of their most impactful articles of the past decade.

In this editorial the editors present a decennial review of the field addressing a range of topics that are core to both the journal and to psychotraumatology as a discipline.

These include neurobiological developments (genomics, neuroimaging and neuroendocrine research), forms of trauma exposure and impact across the lifespan, mass trauma and early interventions, work-related trauma, trauma in refugee populations, and the potential consequences of trauma such as PTSD or Complex PTSD, but also resilience.

The reviewers address innovations in psychological, medication (enhanced) and technology-assisted treatments, mediators and moderators like social support and finally how new research methods help them to gain insights in symptom structures or to better predict symptom development or treatment success. We aimed to answer three questions

  1. Where did we stand in 2010?
  2. What did we learn in the past 10 years?
  3. What are our knowledge gaps?

The reviewers conclude with a number of recommendations concerning top priorities for the future direction of the field of psychotraumatology and correspondingly the journal.

Reference

Olff, M., Amstadter, A., Armour, C., Birkeland, M.S., Bui, E., Cloitre, M., Ehlers, A., Ford, J.D., Greene, T., Hansen, M., Lanius, R., Roberts, N., Rosner, R. & Thoresen, S. (2019) A decennial review of psychotraumatology: what did we learn and where are we going? European Journal of Psychotraumatology. 10(1):1672948. doi: 10.1080/20008198.2019.1672948. eCollection 2019.

Treating Schizophrenic with Comorbid Alopecia Universalis (AU) with add-on High Definition Transcranial Direct Current Stimulation (HD-tDCS

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Research Paper Title

Successful application of add-on high-definition transcranial direct current stimulation in a schizophrenic patient with comorbid alopecia universalis.

Background

High-definition transcranial direct current stimulation (HD-tDCS), an advanced version of tDCS, is found to show alleviation of auditory verbal hallucinations (AVHs) as an add-on treatment modality in schizophrenia.

There is a scarcity of data evaluating the utility and tolerability of the same.

Local skin-related side effects are the most common adversities reported with HD-tDCS.

Density of hair follicles is hypothesised to be influencing the sensory adversities related to electrical stimulation and insulation, and loss of hair as seen with alopecia might pose a technical challenge.

In this case report, the researchers describe the utility and tolerability of HD-tDCS in a patient diagnosed with schizophrenia with persistent AVH with comorbid alopecia universalis (AU).

Reference

Parlikar, R., Selvaraj, S., Shiva, L., Sreeraj, V.S., Venkatasubramanian, G. & Chandra, P.S. (2019) Successful application of add-on high-definition transcranial direct current stimulation in a schizophrenic patient with comorbid alopecia universalis.

The Taluk Mental Health Programme Initiative

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Research Paper Title

Taluk Mental Health Program: The new kid on the block?

Background

This article highlights the platform and framework for the new public mental health initiative, the Taluk Mental Health Programme (TMHP), rolled out by the Government of India, as part of the expansion of the District Mental Health Programme.

In this initial phase, TMHP has been approved for ten taluks of Karnataka state.

In the authors’ collective opinion, few of the initiatives in the country could be considered as foundations for conceptualising the TMHP:

  • Research programmes and projects in the community;
  • Community intervention programmes running in two taluks of Karnataka since the past one and a half decade (Thirthahalli and Turuvekere taluks of Karnataka); and
  • The Primary Care Psychiatry Programme of National Institute of Mental Health and Neurosciences.

The article briefly describes the above initiatives and ends with further suggestions to scale up TMHP.

Reference

Manjunatha, N., Kumar, C.N., Chander, K.R., Sadh, K., Gowda, G.S., Vinay, B., Shashidhara, H.N., Parthasarathy, R., Rao, G.N., Math, S.B. & Thirthalli, J. (2019) Taluk Mental Health Program: The new kid on the block? Indian Journal of Psychiatry. 61(6), pp.635-639. doi: 10.4103/psychiatry.IndianJPsychiatry_343_19.

Electroconvulsive Therapy (ECT) in Treatment-Resistant Schizophrenia & Coexisting Myasthenia Gravis (MG)

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Research Paper Title

Successful administration of electroconvulsive therapy in a patient with treatment-resistant schizophrenia and coexisting myasthenia gravis.

Background

Electroconvulsive therapy (ECT) is an efficacious treatment for resistant schizophrenia.

However, the presence of comorbid myasthenia gravis (MG) poses considerable challenge and concerns for administering anesthesia during ECT.

To the best of the researchers knowledge, till this date, there is only a solitary case reporting the use of ECT in schizophrenia with coexisting MG.

Hence, in this case report, they describe successful administration of modified ECT under anaesthesia in a patient with treatment-resistant schizophrenia with MG.

Reference

Sreeraj, V.S., Venkataramaiah, S., Sunka, A., Kamath, S. & Rao, N.P. (2019) Successful administration of electroconvulsive therapy in a patient with treatment-resistant schizophrenia and coexisting myasthenia gravis. Indian Journal of Psychiatry. 61(6), pp.653-654. Available from World Wide Web: http://www.indianjpsychiatry.org/text.asp?2019/61/6/653/270349. [Accessed: 16 February, 2020].

Investigating Spontaneous Brain Activity in Bipolar Disorder

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Research Paper Title

Investigating spontaneous brain activity in bipolar disorder: A resting-state functional magnetic resonance imaging study.

Background

Despite several neuroimaging studies in the past few years, the exact pathophysiology responsible for the development of bipolar disorder (BD) is still not completely known.

Importantly, to the best of our knowledge, no study from India has examined resting state (RS) connectivity abnormalities in BD using regional homogeneity (ReHo).

Hence, the researchers examined spontaneous brain activity in patients with BD using RS functional magnetic resonance imaging (RS-fMRI).

Therefore, the aim of the study was to examine the spontaneous brain activity in patients with BD-I using ReHo approach and RS-fMRI compared to age- and gender-matched healthy control (HC).

Methods

A total of 20 patients with BD and 20 age-, gender-, and education-matched HCs participated in the study. The fMRI data were obtained using 1.5T scanner. RS-fMRI abnormalities were analysed using ReHo method.

Results

Compared to healthy adults, significantly increased ReHo in the BD group was found in the right precuneus, right insula, right supramarginal gyrus, left superior frontal gyrus, right inferior frontal gyrus, right precentral gyrus, and right paracentral lobule.

No region had significantly lower ReHo values in BD patients compared to controls.

Conclusions

These results suggested that abnormal local synchronisation of spontaneous brain activity is present in the frontoparietoinsular region which may be related to the pathophysiology of BD.

Reference

Achalia, R.M., Jacob, A., Achalia, G., Sable, A., Venkatasubramanian, G. & Rao, N.P. (2019) Investigating spontaneous brain activity in bipolar disorder: A resting-state functional magnetic resonance imaging study. Indian Journal of Psychiatry. 61(6):630-634. doi: 10.4103/psychiatry.IndianJPsychiatry_391_19.

Clinical Characteristics of OCD in Children & Adolescents: Developing vs Developed Countries

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Research Paper Title

Clinical profile of obsessive-compulsive disorder in children and adolescents: A multicentric study from India.

Background

Data from the Western countries suggest that obsessive-compulsive disorder (OCD) in children and adolescents is associated with male preponderance, comorbid neurodevelopmental disorders, and high family loading.

However, data are limited from the developing countries with respect to the demographic and clinical characteristics of OCD in children and adolescents.

To study the demographic and clinical characteristics of children and adolescents (age ≤18 years) with OCD.

Methods

This was a cross-sectional study, conducted in outpatient treatment setting, across six centres in India.

Methods

Participants were assessed using a semi-structured pro forma for sociodemographic information, clinical characteristics, the Children’s Yale Brown Obsessive Compulsive Scale (CYBOCS), Structured Clinical Interview for Diagnostic and Statistical Manual, 5th Edition Research Version, Children’s Depression Rating Scale, and Family Interview for Genetic Studies.

Results

The sample was largely male with a moderate illness severity. Nearly 75% of the sample had illness onset before the age of 14 years.

Aggressive, contamination-related obsessions and washing, checking, and repeating compulsions were the most common symptoms.

CYBOCS assessment revealed that >2/3rd of children and adolescents endorsed avoidance, pathological doubting, overvalued sense of responsibility, pervasive slowness, and indecisiveness.

Family history and comorbidity rates were low. OC-related disorders were present in about 10% of the sample.

Conclusions

This study suggests that the clinical characteristics of OCD in children and adolescents in developing countries differ on certain aspects as reported from developed countries.

Reference

Sharma, E., Tripathi, A., Grover, S., Avasthi, A., Dan, A., Srivastava, C., Goyal, N., Manohari, S.M. & Reddy, J. (2019) Clinical profile of obsessive-compulsive disorder in children and adolescents: A multicentric study from India. Indian Journal of Psychiatry. 61(6), pp.564-571. doi: 10.4103/psychiatry.IndianJPsychiatry_128_19.

What is the Prevalence of Attention-Deficit/Hyperactivity Disorder (ADHD) with Atopic Dermatitis (AD)

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Research Paper Title

The Association between Attention-Deficit/Hyperactivity Disorder and Atopic Dermatitis: A Study among Iranian Children.

Background

The co-occurrence of attention-deficit/hyperactivity disorder (ADHD) with atopic dermatitis (AD) has been well described in some recent association studies; however, the researchers did not have any perspective on this relationship in their country.

Hence, the present study aimed to assess the prevalence of ADHD in children with AD.

Methods

This cross-sectional study was performed on 95 consecutive children and adolescents (aged 4-18 years) who were referred to dermatology clinics at the two hospitals in Tehran during 2017 with atopic dermatitis.

The evidence of atopy was assessed using the 2003 National Survey of Children’s Health. The diagnosis of ADHD was based on the Conner Rating Scale.

The sleep disorder was also assessed by the Pittsburg sleep quality questionnaire.

Results

The prevalence of hyperactivity and attention deficit in their AD patients was 20.0% and 29.47%, respectively.

Furthermore, patients with sleep problem were significantly more likely to have hyperactivity disorder (odds ratio [OR]: 2.91, 95% confidence interval [CI]: 1.04-8.16, P = 0.04).

According to the results of multiple logistic regression analyses, flexor involvement was the only predictor of hyperactivity disorder in the final model.

The univariate and multivariate analyses showed that having attention deficit was associated with having cheek involvement (OR = 3.63, 95% CI: 1.44-9.14, P = 0.01) and sleep problem (OR = 3.68, 95% CI: 1.45-9.33, P = 0.01).

Conclusions

It seems that neurocognitive disturbances due to sleep restriction in AD children may be one of the main triggers, especially for attention deficit.

Reference

Atefi, N., Rohaninasab, M., Shooshtari, M., Behrangi, E., Mehran, G., Goodarzi, A., Moghadam, S.S. & Shakoei, S. (2019) The Association between Attention-Deficit/Hyperactivity Disorder and Atopic Dermatitis: A Study among Iranian Children. Indian Journal of Dermatology. 64(6), pp.451-455. doi: 10.4103/ijd.IJD_458_18.

Are Anti-neuronal Antibodies of Clinical Significance in Psychiatric Patients?

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Research Paper Title

A prospective three-year follow-up study on the clinical significance of anti-neuronal antibodies in acute psychiatric disorders.

Background

The clinical significance of anti-neuronal antibodies for psychiatric disorders is controversial.

The researchers investigated if a positive anti-neuronal antibody status at admission to acute psychiatric inpatient care was associated with a more severe neuropsychiatric phenotype and more frequent abnormalities during clinical work-up three years later.

Methods

Patients admitted to acute psychiatric inpatient care who tested positive for N-methyl-D-aspartate receptor (NMDAR), contactin-associated protein 2 (CASPR2) and/or glutamic acid decarboxylase 65 (GAD65) antibodies (n = 24) were age – and sex matched with antibody-negative patients (1:2) from the same cohort (n = 48).

All patients were invited to follow-up including psychometric testing (e.g. Symptom Checklist-90-Revised), serum and cerebrospinal fluid (CSF) sampling, EEG and 3 T brain MRI.

Twelve antibody-positive (ab+) and 26 antibody-negative (ab-) patients consented to follow-up.

Results

Ab+ patients had more severe symptoms of depression (p = 0.03), psychoticism (p = 0.04) and agitation (p = 0.001) compared to ab- patients.

There were no differences in CSF analysis (n = 6 ab+/12 ab-), EEG (n = 7 ab+/19 ab-) or brain MRI (n = 7 ab+/17 ab-) between the groups.

Conclusions

In conclusion, anti-neuronal ab+ status during index admission was associated with more severe symptoms of depression, psychoticism and agitation at three-year follow-up.

This supports the hypothesis that anti-neuronal antibodies may be of clinical significance in a subgroup of psychiatric patients.

Reference

Schou, M.B., Sæther, S.G., Drange, O.K., Brenner, E., Crespi, J., Eikenes, L., Mykland, M.S., Pintzka, C., Håberg, A.K., Sand, T., Vaaler, A. & Kondziella, D. (2019) A prospective three-year follow-up study on the clinical significance of anti-neuronal antibodies in acute psychiatric disorders. Scientific Reports. 10(1):35. doi: 10.1038/s41598-019-56934-6.

Documentary: No Body’s Perfect (2016)

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Introduction

International fashion photographer Rankin and artist Alison Lapper explore how the explosion of digital photography, social media and selfie culture has affected people’s sense of identity.

Rankin and Alison challenge four individuals who all hate the camera for a variety of reasons to be photographed up-close to investigate different perceptions of self-worth, image and beauty.

Outline

In this documentary for BBC Four, disabled artist Alison Lapper and internationally renowned photographer Rankin tackle contemporary attitudes to beauty and identity through the medium of photography.

Alison and Rankin will meet four fascinating people who do not conform to traditional notions of beauty, or who hate being photographed, and invite them to step in front of Rankin’s camera. Each person will reveal their incredible life story and their own personal struggle with their sense of identity. Through hearing these stories and capturing them in Rankin’s studio, Alison and Rankin will explore how the explosion of digital media over the past decade, from social media to selfies, has presented new challenges to our self-image.

Each contributor has a different challenge to tackle: from an amputee who for 30 years has never come to terms with his body image, to a woman with alopecia who struggles to leave the house without full make up and a wig on, to the person whose Body Dysmorphic Disorder means they will never allow their photo to be taken.

Alison Lapper, who was born with no arms and shortened legs, knew from a young age that she was happiest without prosthetics. Partly as a result of her work through photographic media she grew to accept her body as it was born, and to feel proud and confident with her own image. Alison’s image is now well-known as a subject of sculpture, painting and photography.

By inviting these four contributors to Rankin’s studio to confront their own image in front of the camera, Alison and Rankin hope that each person will discover a new sense of self. Rankin’s intimate, beautiful and striking portraits have the potential to give each person a sense of pride and self-worth, demonstrating photography’s unique power to positively affect how we feel about ourselves in the digital world.

Production & Filming Details

  • Presenter(s): Rankin and Alison Lapper.
  • Director(s): Ian Denyer.
  • Producer(s): Ben Weston and Shola Sittabey.
  • Production: BBC.
  • Distributor(s): BBC.
  • Original Network: BBC Four.
  • Release Date: 10 November 2016.
  • Running Time: 60 minutes.
  • Country: UK.
  • Language: English.

YouTube Link