All posts by Carson Patterson

Prefrontal Norepinephrine Determines Attribution of “High” Motivational Salience

Methods and Results

This study used intracerebral microdialysis to measure the norepinephrine outflow and depletion in response to both conditioned and unconditional stimuli in order to determine whether or not there is any chemical selectivity in the attribution of motivational salience to unconditioned stimuli. With regard to conditioned stimuli, the norepinephrine output corresponded to salience but the depletion of the chemical transmission was not affected by salience. This was was different when considering unconditioned stimuli, where they found that if the new stimulus was particularly intense and induced a sustained chemical outflow then the attributed salience was selective.

Study Participants and Factors

This study was performed on mice using chocolate consumption and forced isolation as stimulus for the norepinephric gauge of stimulus. White chocolate and milk chocolate were used as positive stimulus. Isolation with varying light exposure and food restriction was the adverse stimulus.

So, What Does this Mean

Exposure to new, highly salient stimuli increased norepinephrine output regardless of whether it was good or bad stimuli. Following exposure to a highly salient negative situation, previously mild stimulus triggered a norepinephric output on par with the highly salient. The results of this study point to norepinephric output as necessary for the place-conditioning process. Or in the words of the researchers:

“Thus, these results confirm our hypothesis and demonstrate that prefrontal cortical NE transmission is necessary for the acquisition of conditioned properties to stimuli paired with highly salient natural rewarding or aversive events in a place-conditioning procedure.”

Link to the Study

 http://www.plosone.org/article/info:doi/10.1371/journal.pone.0003044

 

Psychological Distress and Burden Among Female Partners of Combat Veterans With PTSD

This article focused on the partner/spouse relationship that I am currently looking at for my proposal, if it is a bit narrow for my taste. It is specific only to women as the partners. However it did delve in to several interesting aspects such as threat appraisal and to  the partners control over the veteran’s  emotional difficulties to involvement in treatment. Additionally it informed me as to an interesting test for assessing burden an psychological state, BSI-18.

Link: http://ovidsp.tx.ovid.com/sp-3.13.1a/ovidweb.cgi?QS2=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

Military-related PTSD and intimate relationships: From description to theory-driven research and intervention development

This article truly complemented the ethnographic aspect of my proposal. The aim of the is was to look at the intimate relationships that veterans suffering from PTSD maintain and the negative effect it has on those relationships in order to provide insight for later treatment. They in effect paved the way into exploring the true outcome of PTSD, not only with regard to the individual sufferer but to their families as well.  This particular study did not touch on children but it did reference study of the interplay between PTSD sufferers and their offspring  as a future avenue for study.

Link: http://www.sciencedirect.com/science/article/pii/S0272735809001196

Different Regional Gray Matter Loss in Recent Onset PTSD and Non PTSD after a Single Prolonged Trauma Exposure

This study had quite a bit to offer when it came to understanding the implantation that PTSD has on the brain. It seem that the in people that had survived a trauma the volume of gray matter in the brain correlates negatively with the CAPS, or  Clinician-Administered PTSD Scale. This means that their score, which indicates increasing severity of symptom expression, is shown to increase as their gray matter decreases. This article provides insight into which parts of the brain are associated with PTSD  and how MRI can serve to aid in study and diagnosis.

Link: http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0048298

Efficacy of Virtual Reality Exposure Therapy in the Treatment of PTSD: A Systematic Review

This article really informed my thoughts on the different methods of therapy that can be made available to PTSD. The therapeutic aspect of PTSD plays an integral role in my proposal. Therapies like the use of personal narrative and rationalization seem affective, however these methods seek to employ a level of realism that virtual reality innately has.

Link: http://www.plosone.org/article/info:doi/10.1371/journal.pone.0048469

Anthropology and Post-Traumatic Stress Disorder among Veterans: An Interview with Erin Finley

This dialogue between Finley and Lende was high informative on the clinical characterization of  PTSD as a disorder. Additionally, Finleys insight into coping mechanisms was extremely informative for the purposed of informing my research proposal.

Link: http://blogs.plos.org/neuroanthropology/2011/07/18/anthropology-and-post-traumatic-stress-disorder-among-veterans-an-interview-with-erin-finley/

Prospective Study of Police Officer Spouse/Partners: A New Pathway to Secondary Trauma and Relationship Violence?

I found this article to be extremely informative in exploring the interpersonal relationships with PTSD sufferers. This article covered a study done on police officers and their significant others. It looked at instances of violence that occur in relationships after experience of trauma. The instances of violence were more statistically related to officers that had experienced a secondary trauma. This leads to an assumption that prolonged exposure has a profound effect. This nicely correlates to the military paradigm of my proposal.

Link: http://www.plosone.org/article/info:doi/10.1371/journal.pone.0100663

Neuropsychological functioning in posttraumatic stress disorder following forced displacement in older adults and their offsprings

This article looked at the memory deficits that can be caused by PTSD in a comparative study that looked at PTSD suffers, non-PTSD sufferers, and additionally their offspring in an attempt to ascertain the affect that PTSD had on cognitive abilities and depressive symptoms but also whether or not those affect translated into the lives of their offspring. What i found to be intriguing here was the methodology.  The researchers looked at two generations, the parent and the offspring, and three distinct groups, PTSD sufferers, non-PTSD sufferers, and a group which had experienced no trauma. They also administered three separate test to determine placement; Structured Clinical Interview, Beck-Depression Inventory, and the Post-traumatic Diagnostic Scale. The result of the study were found to be null, with the only significant differences between groups resulting from the PDS scores. The offspring generation also seemed to be particularly resilient, with the offspring of PTSD sufferer scoring similarly to the non in the cognitive tests as well as the depressive test. The methodology of the study was beyond reproach though the data is not what I expected the ways in which it was garnered seems highly applicable and is to be emulated.

Link to the article:

http://www.sciencedirect.com/science/article/pii/S0165178113003533

 

Trauma: The Post Trauma Enviroment

Daniel  Lende expounds on the importance of the post trauma environment on the reintegration process.  The focus is is less on the traumatic origins and more about the different  ways that the post traumatic environment can positively or negatively affect the traumatized individuals’ ability to successfully rejoin their community. He touches on a very basic example from an experiment performed by Paul Plotsky on mother rats an their pups. The experiment looked at how the trauma of separation could be mitigated by allowing the mother rat control of the environment in which the reunion with her pups took place. If the mother rat was allowed to escape the location where she and her pups were originally separated and to seek out new locations for reunion in different room of her enclosure then she was better able to care for her pups when they were returned to her. Even after repeated separations, the pups showed little to no signs of trauma. Granting the mother a new environment as well as individual control over the choice seem to be the major factor in the presentation of trauma in the pups. This is a  very simplistic example of a complex issue, but is was also attacked on the human level.  Brandon Kohrt looked at the reintegration of child soldiers in Nepal and how their reception and treatment affected their ability to thrive in the post traumatic environment. Those that were included in a positive manner tended to succeed  more so than those who returned to their pre-trauma environment or who were treated as outsiders.

War and Dislocation: A Neuroanthropological Model of Trauma among American Veterans with Combat PTSD

About the Author
 Erin P. Finley
•      Ph.D. from Emory in medical anthropology
•      Masters in public health, also from emory
•      Investigator with VERDICT, or the Veterans Evidence-based Research Dissemination and Implementation Center at the South Texas Health care system
•      Adjunct Assistant Professor at the University of Texas in the Department of Medicine, Division of Clinical Epidemiology
•      Her research focuses on PTSD among veterans and their families. Her work has recently branched out to include the affect of relationship within the military and the American public on PTSD suffers.
FinleyEsmall
Trauma 
All trauma starts of as “the sensory and perceptual experience of danger.” That danger can come in any form, from some thing sudden and jarring to something constant and repetitive that requires the person experiencing it to always be on high alert. Regardless of the form that it comes in, trauma comes down to two elements: sensation and perception. It is only after the experience that the effects of the trauma begin to emerge. With PTSD both cognitive and neurophysiological changes result from trauma sustain in combat, in the case of this chapter the wars in both Iraq and Afghanistan. These changes can be seen through the lens of the individuals interactions with their cultural environment.
Trauma is frighteningly common with 60% of men and 51% of women experiencing it, according to the National Comorbidity Study (NCS). That same study put the prevalence of PTSD at 7.8%, not a particularly scary number. However, the more traumas an individual experiences the more likely they are to develop PTSD. Therefore groups like soldiers and refugees are seen to display higher rates of the disorder.
PTSD presents a problem when it comes to research and study. The disorder knows no disciplinary bounds and there are aspects of it that touch anthropology, neuroscience, psychology, epidemiology, psychiatry, social theory, and the humanities. Differing approaches with little to no integration of other disciplines and varying definitions of terms common to the discussion of PTSD, such as trauma and stress, has stunted the study of PTSD. In an effort to assuage the buckshot approach to the study of trauma and the disorder, Finley boiled it down to a six part framework:
1. Cultural enviroment
2. Stress
3. Horror
4. Dislocation
5. Grief
6. Cultural mediators
It is this framework that allows the neuroanthropological model of PTSD to take shape in an attempt to allow the study of trauma PTSD to move forward in a more focused and holistic way
Cultural Environment 
The cultural environment, meaning everything from the historical and political economic to social norms and gender, shapes the experience of the sufferer. Anywhere from 11% to 19% of veterans from Iraq and Afghanistan have been diagnosed with a disorder that has only been a formal diagnosis since 1980. PTSD is clinically significant impairment characterized by three symptoms: hyperarousal, reexperiencing, and numbing or avoidance. It also culturally salient I that is evoke a connection to mental health stigma, the human aspect of war, and veterans loss and benefits.
Stress
A combat zone can require an adaptive change in the sensory perception of one’s surrounding, a neurobiological reshuffling of cognitive tasks if you will. This can be extremely benificial in life-threatening scenarios.  Reaction times have been seen to improve signifigantly in such situations and those abilities have been known to remain with soldier even after returning home. However, it is when this behavior begins to interfere with a veteran’s daily life that problems can arise. That hypervigilance in wartime can cause a fundamental change in sensory perception to the point where an innocuous stimulus can trigger a violent or debilitating response. They become unable to distinguish the relevant information from the irrelevant. For example, grocery stores can become a stressful place because all that some one with PTSD can see is bright lights and large, unruly crowds. They are unable to process the fact that they are safe among the shoppers because they are processing it through the wrong lens. What is harmless in this scenario would mean danger in the one they are still living in.
Here we meet Chris, veteran who was caught in a firefight that he had not been train to deal with. He froze, unknowingly urinated on himself, and proceeded to fire wildly at nothing. He remembers the experience by comparing himself to the unrealistic ideal warrior and that moment is a key component of his battle with PTSD. The immediate, knee-jerk reaction one has to stress and its interplay with the what we are culturally primed believe about ourselves and our reactions is important if one hopes to grasp the full effect PTSD can can.
Horror
The two main components of trauma are actually or threatened death or injury and horror, an emotion so powerful it overwhelms the individual’s cognitive ability. Horror is often characterized by nightmares or intrusive thoughts forcing an individual to reexperience the trauma.
One veteran, Carlos, experienced horrific flashbacks of an instance where a little Iraqi girl was mistaken for a terrorist and was hit with a grenade launcher. She survived, but that is not how he saw her in his memories. It was the disconnect between moral combat and the senselessness of her shooting that caused the persistence of the unrealistic memories.
Dislocation
Veterans can experience dislocation in many forms,  an internal distance from self, from family and friends, or even the world in general. They tend to feel nothing or extremely heightened feelings of anger or anxiety. One theory as to why this is posits that the brain is restructured to the point that when processing information it bypasses the prefrontal cortex, that would allow for higher thinking and consideration, and instead reacts to a perceived threat immediate. In this case the threat would be some thing like a simple disagreement that would normally be quietly resolved. This neuroplasticity can drastically change a person causing a crisis of identity or forming fissure between family and friends if an understanding of PTSD is not had.
Grief
Soldiers rarely get the chance to process their grief in combat, it is their job to go back out as long as they are deployed, regardless of the fact that their friends and coworkers may die around them. There is also a sense of responsibility between these soldiers that could and often does lead to feeling of guilt. Some soldiers are overcome in the field and some make it home before the tears fall. Grief can also be felt from simply coming home, in the difference between life as a civilian and life in a combat zone. Some veterans feel that this creates a barrier of understanding between themselves and the civilians in their lives. That perceived disconnect can lead to an inability of a veteran to talk about their experience, which is a key component of rebuilding relationships post-combat.
Grief is not typically thought of as being part of the PTSD paradigm, as anger is more often the associated emotion and due to the fact grief is an experience in its own right. However the dislocations created, be they internal or external, are a major contributor and require consideration.
Cultural mediators
Cultural mediators are the tools or processes by which the trauma variables can be reconciled  and felt with. They are effective therapies that mainly consist of things like reexposure and reassessment. They allow veterans to grow accustom to there own memories that would once terrify them. They also go back an rationalize what happened. Remember Chris? He now realizes that when he froze, it wasn’t for an any length of time, likely no longer than five seconds and that relieving himself unconsciously was his sympathetic nervous system’s way of attempting to lighten him and give him more speed. He is using these cultural mediators to work through what he previously perceived to be a shameful event.
Mediators may not always present as treatment but more as an acceptable way of expressing emotion. Social support, though it can present in different forms, plays a critical role in lessening the impact of these traumas. The presence of cultural mediators speaks not only to the interconnection of the different variable but also to the fact that they can be changed and that people’s lives can improve.
Neuroanthropological  Model of Post Traumatic Stress Response
This model serves a method of trauma comparison and of the differing approaches to the study of trauma. It also aims to grow a better understanding of the interplay between the different contributing factors as well as the contributing disciplines. It is not enough to simply understand what is happening physiologically or neurologically, there must be an understanding of why.