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Dementia in military and veteran populations:a review of risk factors—traumatic brain injury,post-traumatic stress disorder,deployment,and sleep

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Military Medical Research 2022年第3期9卷 351-364页

作者： Zara Raza Syeda F.Hussain Suzanne Ftouni Gershon Spitz Nick Caplin Russell G.Foster Renata S.M.Gomes Research and Innovation Blind Veterans UK12-14 Harcourt StreetLondonW1H 4HDUK BRAVO VICTOR Research12-14 Harcourt StreetLondonW1H 4HDUK Circadian Therapeutics OxfordOX11BYUK School of Psychological Sciences Monash University18 Innovation WalkClayton CampusWellington RoadMelbourneVIC3800Australia Sleep&Circadian Neuroscience Institute(SCNi) Nuffield Department of Clinical NeurosciencesSir William Dunn School of PathologyOxford Molecular Pathology InstituteUniversity of OxfordSouth Parks RoadOxfordOX13RFUK Northern Hub for Veterans and Military Families Research Department of NursingMidwifery and HealthFaculty of Health and Life SciencesNorthumbria UniversityNewcastleNE77XAUK

The military population face a unique set of risk factors that may increase the risk of being diagnosed with dementia.traumatic brain injury(TBI)and post-traumatic stress disorder(PTSD)have a higher prevalence in this group in comparison to the civilian population.By delving into the individual relationships between TBI and dementia,and PTSD and dementia,we are able to better explore dementia in the military and veteran populations.While there are some inconsistencies in results,the TBI-dementia association has become more widely accepted.Moderate-tosevere TBI has been found to increase the risk of being diagnosed with Alzheimer’s disease.A correlation between PTSD and dementia has been established,however,whether or not it is a causal relationship remains unclear.Factors such as blast,combat and chemical exposure may occur during a deployment,along with TBI and/or PTSD diagnosis,and can impact the risk of dementia.However,there is a lack of literature exploring the direct effects of deployment on dementia risk.Sleep problems have been observed to occur in those following TBI,PTSD and deployment.Poor sleep has been associated with possible dementia risk.Although limited studies have focused on the link between sleep and dementia in military and veteran populations,sleep is a valuable factor to study due to its association and interconnection with other military/veteran factors.This review aims to inform of various risk factors to the cognitive health of military members and veterans:TBI,PTSD,deployment,and sleep.

关键词： Dementia Alzheimer’s disease traumatic brain injury post-traumatic stress disorder Military Veteran Deployment Sleep

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Phytochemical interventions for post-traumatic stress disorder:A cluster co-occurrence network analysis using CiteSpace

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Journal of Integrative Medicine 2023年第4期21卷 385-396页

作者： Biao Gao Yi-cui Qu Meng-yu Cai Yin-yin Zhang Hong-tao Lu Hong-xia Li Yu-xiao Tang Hui Shen Department of Naval Nutrition and Food Hygiene Naval Medical UniversityShanghai 200433China Teaching and Research Support Center Naval Medical UniversityShanghai 200433China

Objective:This study investigated trends in the study of phytochemical treatment of post-traumatic stress disorder(PTSD).Methods:The Web of Science database(2007-2022)was searched using the search terms“phytochemicals”and“PTSD,”and relevant literature was compiled.Network clustering co-occurrence analysis and qualitative narrative review were conducted.Results:Three hundred and one articles were included in the analysis of published research,which has surged since 2015 with nearly half of all relevant articles coming from North America.The category is dominated by neuroscience and neurology,with two journals,Addictive Behaviors and Drug and Alcohol Dependence,publishing the greatest number of papers on these topics.Most studies focused on psychedelic intervention for PTSD.Three timelines show an“ebb and flow”phenomenon between“substance use/marijuana abuse”and“psychedelic medicine/medicinal cannabis.”Other phytochemicals account for a small proportion of the research and focus on topics like neurosteroid turnover,serotonin levels,and brain-derived neurotrophic factor expression.Conclusion:Research on phytochemicals and PTSD is unevenly distributed across countries/regions,disciplines,and journals.Since 2015,the research paradigm shifted to constitute the mainstream of psychedelic research thus far,leading to the exploration of botanical active ingredients and molecular mechanisms.Other studies focus on anti-oxidative stress and anti-inflammation.

关键词： Phytochemical post-traumatic stress disorder Text analysis Clustering co-occurrence network Psychedelic

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Intranasal temperature-sensitive hydrogels of cannabidiol inclusion complex for the treatment of post-traumatic stress disorder

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Acta Pharmaceutica Sinica B 2021年第7期11卷 2031-2047页

作者： Lulu Pang Siqing Zhu Jinqiu Ma Lin Zhu Yijing Liu Ge Ou Ruiteng Li Yaxin Wang Yi Liang Xu Jin Lina Du Yiguang Jin Department of Pharmaceutical Sciences Beijing Institute of Radiation MedicineBeijing 100850China College of Pharmacy Shandong University of Traditional Chinese MedicineJinan 250355China College of Pharmacy Anhui Medical UniversityHefei 230001China Pharmacy Department Chinese PLA General HospitalBeijing 100853China Department of Anesthesiology Beijing Tiantan HospitalCapital Medical UniversityBeijing 100070China

post-traumatic stress disorder(PTSD)is a psychiatric disease that seriously affects brain function.Currently,selective serotonin reuptake inhibitors(SSRIs)are used to treat PTSD clinically but have decreased efficiency and increased side effects.In this study,nasal cannabidiol inclusion complex temperature-sensitive hydrogels(CBD TSGs)were prepared and evaluated to treat PTSD.Mice model of PTSD was established with conditional fear box.CBD TSGs could significantly improve the spontaneous behavior,exploratory spirit and alleviate tension in open field box,relieve anxiety and tension in elevated plus maze,and reduce the freezing time.Hematoxylin and eosin and c-FOS immunohistochemistry slides showed that the main injured brain areas in PTSD were the prefrontal cortex,amygdala,and hippocampus CA1.CBD TSGs could reduce the level of tumor necrosis factor-a caused by PTSD.Western blot analysis showed that CBD TSGs increased the expression of the 5-HT1 A receptor.Intranasal administration of CBD TSGs was more efficient and had more obvious brain targeting effects than oral administration,as evidenced by the pharmacokinetics and brain tissue distribution of CBD TSGs.Overall,nasal CBD TSGs are safe and effective and have controlled release.There are a novel promising option for the clinical treatment of PTSD.

关键词： post-traumatic stress disorder Cannabidiol Hydroxypropyl-β-cyclodextrin Inclusion complex Hydrogels Brain targeting Blood-brain barrier Intranasal administration

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Antidepressant-Like Effects of Hesperidin in Animal Model of post-traumatic stress disorder

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Chinese Journal of Integrative Medicine 2021年第1期27卷 39-46页

作者： Bombi Lee Gwang Muk Choi Bongjun Sur Acupuncture and Meridian Science Research Center College of Korean MedicineKyung Hee UniversitySeoul(02447)Republic of Korea Center for Converging Humanities Kyung Hee UniversitySeoul(02447)Republic of Korea The Graduate School of Basic Science of Medicine College of MedicineKyung Hee UniversitySeoul(02447)Republic of Korea Dopartmont of Molcoular Mcdicine and TIDRC School of MedicineEwha Womans UniversitySeoul(07985)Republic of Korea

Objective:post-traumatic stress disorder(PTSD)is a psychiatric disorder characterized by depression and anxiety,that arises due to an imbalance of neurotransmitters in response to excessive stress.Hesperidin(HSD)is a naturally occurring flavonoid shown to exert a variety of biological activities,including antioxidant,anti-inflammatory,and neuroprotective effects.Methods:This study was used the open field test(OFT)and forced swimming test(FST)to examine the effects of HSD on the depression-like response of rats after exposure to a single prolonged stress(SPS)leading to the dysregulation of the serotonergic activation system.Male rats were given HSD(20,50,and 100 mg/kg,intraperitoneal injection,n=6–7 per group)once daily for 14 days after exposure to SPS.The influence of administration of HSD on SPS-induced behavioral responses and concentrations of serotonin(5-HT),5-hydroxyindoleacetic acid(5-HIAA),and monoamine oxidase-A(MAO-A)in the rat brain were also investigated using enzyme-linked immunoassays(ELISAs).Results:Daily HSD administration significantly improved depression-like behaviors in the FST(P<0.05),increased the number of lines crossed in the central zone of the OFT(P<0.01),and reduced freezing behavior both in contextual and cued fear conditioning.HSD treatment also attenuated the reduction in SPS-induced 5-HT concentrations in the hippocampus and amygdala.This increase in 5-HT concentrations during HSD treatment was partially attributed to a decrease in the 5-HIAA/5-HT ratio in the hippocampus of rats with PTSD.Furthermore,HSD treatment inhibited activity of MAO-A and decreases of tryptophan hydroxylase-1 expression in the hippocampus.Conclusion:HSD was shown to exert antidepressant effects in rats exposed to SPS,suggesting that this natural flavonoid may be an effective medicine for PTSD.

关键词： hesperidin post-traumatic stress disorder depression serotonin

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post-traumatic stress disorder:a psychiatric disorder requiring urgent attention

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Medical Review 2022年第3期2卷 219-243页

作者： Jun Du Huapeng Diao Xiaojuan Zhou Chunkui Zhang Yifei Chen Yan Gao Yizheng Wang Science Center Beijing Institute of Basic Medical SciencesBeijingChina

post-traumatic stress disorder(PTSD)is a severe and heterogenous psychiatric disorder that was first defined as a mental disorder in 1980.Currently,the Diagnostic and Statistical Manual of Mental disorders Fifth Edition(DSM-5)and the International Classification of Diseases 11th Edition(ICD-11)offer the most widely accepted diagnostic guidelines for PTSD.In both diagnostic categories,experiencing a traumatic event(TE)is the necessary criterion for diagnosing PTSD.The TEs described in the DSM-5 include actual or threatened death,serious injury,sexual violence,and other extreme stressors,either directly or indirectly.More than 70%of adults worldwide are exposed to a TE at least once in their lifetime,and approximately 10%of individuals develop PTSD after experiencing a TE.The important features of PTSD are intrusion or re-experiencing fear memories,pervasive sense of threat,active avoidance,hyperarousal symptoms,and negative alterations of cognition and mood.Individuals with PTSD have high comorbidities with other psychiatric diseases,including major depressive disorder,generalized anxiety disorder,and substance use disorder.Multiple lines of evidence suggest that the pathophysiology of PTSD is complex,involving abnormal neural circuits,molecular mechanisms,and genetic mechanisms.A combination of both psychotherapy and pharmacotherapy is used to treat PTSD,but has limited efficacy in patients with refractory PTSD.Because of the high prevalence,heavy burden,and limited treatments,PTSD is a psychiatric disorder that requires urgent attention.In this review,we summarize and discuss the diagnosis,prevalence,TEs,pathophysiology,and treatments of PTSD and draw attention to its prevention.

关键词： animal models comorbidity pathophysiology post-traumatic stress disorder traumatic events treatments

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Advances in Treatment of post-traumatic stress disorder with Chinese Medicine

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Chinese Journal of Integrative Medicine 2021年第11期27卷 874-880页

作者： HU Guang-tao WANG Yong Department of Psychological Medicine Army 958th HospitalChongqing400039China Department of Traditional Chinese Medicine Southwest HospitalArmy Medical UniversityChongqing400038China

“Timely,near,and expectation”is the main principle of battlefield rescue for military combat stress reaction(CSR).post-traumatic stress disorder(PTSD)is the most common form of CSR and a long-term persistent mental disorder that is caused by unusual threatening or catastrophic psychological trauma.Chinese medicine(CM)has abundant resources,is simple,easy to master,with few side effects.This article summarizes the cellular and animal experimental mechanisms of CM treatment on PTSD,suggesting that traditional Chinese herbs and acupuncture can protect brain functional areas,and adjust hypothalamus-pituitary-adrenal axis.Traditional Chinese herbs and acupuncture have shown good anti-stress efficacy and fewer side effects in clinical application,which may improve the CSR in the battlefield.

关键词： combat stress reaction post-traumatic stress disorder Chinese medicine acupuncture treatment

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Prevalence of post-traumatic stress disorder after earthquakes among the elderly in China: A meta-analysis

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World Journal of Emergency Medicine 2021年第2期12卷 137-142页

作者： Yong Liang Hong Zeng Yu-geng Liu Ai-min Xu Wen-hong Liu Emergency Medicine Clinical Research Center Beijing Chao-Yang HospitalCapital Medical UniversityBeijing 100043China

BACKGROUND: The study aims to investigate the occurrence of post-traumatic stress disorder(PTSD) after earthquakes among the elderly. METHODS: Data from cross-sectional studies focusing on the prevalence of PTSD after earthquakes among the elderly were collected from Pub Med, EMBASE, Cochrane Library, and China National Knowledge Infrastructure in December 2019. The search terms included post-traumatic stress disorder, earthquake, and elderly. This study used Review Manager 5.0 to evaluate the impact of the results. In addition, forest plots, sensitivity analysis, and bias analysis were carried out on the included articles. The combined estimate of the risk ratio and the standard deviation of the 95% confidence interval(95% CI) were measurements of the size of the effect.RESULTS: There were 4,834 patients included from 10 eligible studies. The sample sizes of PTSD group and non-PTSD group were 1,277 and 3,557, respectively. The meta-analysis showed that the overall occurrence of PTSD after earthquakes among the elderly was 0.25;the occurrence in females was higher than that in males, and the occurrence in the same province indicated little difference(Wenchuan city 0.25 and Ya'an city 0.24).CONCLUSIONS: After earthquakes, the occurrence of PTSD is higher among the elderly than among other age groups, and higher among the females than among the males, while there is little difference among different areas within the same province. This indicated that prioritized specific psychological interventions should be provided to the aged and the females.

关键词： post-traumatic stress disorder The elderly Earthquake

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Double-blind randomized controlled study of the efficacy, safety and tolerability of eszopiclone vs placebo for the treatment of patients with post-traumatic stress disorder and insomnia

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World Journal of Psychiatry 2020年第3期10卷 21-28页

作者： Sheila M Dowd Alyson K Zalta Helen J Burgess Elizabeth C Adkins Zerbrina Valdespino-Hayden Mark H Pollack Department of Psychiatry and Behavioral Sciences Rush University Medical CenterChicagoIL 60601United States Department of Psychological Science University of California IrvineIrvineCA 92697United States Sleep and Circadian Research Laboratory Department of PsychiatryUniversity of MichiganAnn ArborMI 48109United States Center for Behavioral Intervention Technologies|Department of Preventive Medicine Northwestern University Feinberg School of MedicineChicagoIL 60611United States Department of Psychology Montclair State UniversityMontclairNJ 07043United States

BACKGROUND Sleep disturbance is a core feature of post-traumatic stress disorder(PTSD).Given the relationship between sleep disturbance and PTSD,there has been a relative paucity of studies examining the potential therapeutic impact of using pharmacotherapy to target sleep disturbance in patients with PTSD.Eszopiclone(ESZ)is a non-benzodiazepine y-aminobutyric acid-A receptor agonist indicated for the treatment of sleep and may affect sleep in patients with PTSD.AIM To evaluate the efficacy of ESZ vs placebo(PBO)for patients with PTSD and insomnia.METHODS The study was a 12-wk,double blind,randomized controlled trial with 3 mg of ESZ(n=13)or PBO(n=12).RESULTS Patients in both arms experienced significant improvement in PTSD symptoms as assessed by the Clinician-Administered PTSD Scale for DSM-IV(CAPS):ESZ(t11=-3.12,P=0.005)and PBO(t11=-3.5,P=0.002)and by self-report with the Short PTSD Rating Interview(ESZ t11=-3.38,P=0.003 and PBO t11=-4.48,P=0.0005).There were no significant differences between treatments on the CAPS(t22=-0.13,P=0.70)or the Short PTSD Rating Interview(t22=-0.58,P=0.56).Similarly,both treated groups improved on sleep measures as assessed by the Pittsburgh Sleep Quality Index with PTSD Addendum(PSQI)and on total sleep time(TST)and sleep latency assessed by actigraphy with no significant differences between groups(PSQI t22=-0.24,P=0.81;total sleep time t10=0.13,P=0.90 and sleep latency t10=0.68,P=0.50).There was a significant correlation between improvement in sleep and overall improvement in PTSD as measured by change scores on the PSQI and CAPS,r(8)=0.79,P=0.01 for ESZ treated subjects,but not for those treated with PBO r(9)=0.16,P=0.69.Adverse events of ESZ were consistent with the known profile of the medication including dysgeusia(30%,mild),sedation(20%,mild)and headache(20%,moderate to severe).CONCLUSION Results do not support the hypothesis of a specific positive effect of ESZ compared to PBO for measures of PTSD and associated sleep disturbance.

关键词： Trauma Sleep disturbance Hypnotic post-traumatic stress disorder

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Association of post-traumatic stress disorder and work performance: A survey from an emergency medical service, Karachi, Pakistan

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World Journal of Emergency Medicine 2017年第3期8卷 214-222页

作者： Salima Kerai Omrana Pasha Uzma Khan Muhammad Islam Nargis Asad Junaid Razzak Epidemiology and Biostatistics Community Health Sciences Department Aga Khan University Community Health Sciences Department Aga Khan University Psychiatry Department Aga Khan University Emergency Medicine Department Johns Hopkins University School of Medicine

BACKGROUND: The purpose of the study was to explore the association between posttraumatic stress disorder(PTSD) and work performance of emergency medical services personnel in Karachi, Pakistan.METHODS: Emergency medical service personnel were screened for potential PTSD using Impact of Event Scale-Revised(IES-R). Work performance was assessed on the basis of fi ve variables: number of late arrivals to work, number of days absent, number of days sick, adherence to protocol, and patient satisfaction over a period of 3 months. In order to model outcomes like the number of late arrivals to work, days absent and days late, negative binomial regression was applied, whereas logistic regression was applied for adherence to protocol and linear for patient satisfaction scores.RESULTS: Mean scores of PTSD were 24.0±12.2. No association was found between PTSD and work performance measures: number of late arrivals to work(RRadj 0.99; 0.98–1.00), days absent(RRadj 0.98; 0.96–0.99), days sick(RRadj 0.99; 0.98–1.00), adherence to protocol(ORadj 1.01; 0.99–1.04) and patient satisfaction(β 0.001%–0.03%) after adjusting for years of formal schooling, living status, coping mechanism, social support, working hours, years of experience and anxiety or depression.CONCLUSION: No statistically significant association was found between PTSD and work performance amongst EMS personnel in Karachi, Pakistan.

关键词： Emergency medical service Karachi Pakistan post-traumatic stress disorder stress Work performance

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post-traumatic stress disorder status in a rescue group after the Wenchuan earthquake relief

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Neural Regeneration Research 2013年第20期8卷 1898-1906页

作者： Junhua Huang Qunying Liu Jinliang Li Xuejiang Li Jin You Liang Zhang Changfu Tian Rongsheng Luan Department of Epidemiology Huaxi Public Health School of Sichuan University Yunnan General Hospital of the Chinese People's Armed Police Forces Department of Psychological Counseling Yunnan General Hospital of the Chinese People's Armed Police Forces Department of Psychological Counseling Sichuan General Hospital of the Chinese People's Armed Police Forces Department of Infectious Diseases First Affiliated Hospital of Kunming Medical College Kunming Center for Disease Control Scientific Research and Experimental Center Kunming Medical College

Previous studies have suggested that the incidence of post-traumatic stress disorder in earthquake rescue workers is relatively high. Risk factors for this disorder include demographic characteristics, earthquake-related high-risk factors, risk factors in the rescue process, personality, social support and coping style. This study examined the current status of a unit of 1 040 rescue workers who participated in earthquake relief for the Wenchuan earthquake that occurred on May 12th, 2008. post-traumatic stress disorder was diagnosed primarily using the Clinician-Administered post-traumatic stress disorder Scale during structured interviews. Univariate and multivariate sta-tistical analyses were used to examine major risk factors that contributed to the incidence of post-traumatic stress disorder. Results revealed that the incidence of this disorder in the rescue group was 5.96%. The impact factors in univariate analysis included death of family members, contact with corpses or witnessing of the deceased or seriously injured, near-death experience, severe injury or mental trauma in the rescue process and working at the epicenter of the earthquake. Correlation analysis suggested that post-traumatic stress disorder was positively correlated with psychotic and neurotic personalities, negative coping and low social support. Impact factors in mul-tivariate logistic regression analysis included near-death experience, severe injury or mental trauma, working in the epicenter of the rescue, neurotic personality, negative coping and low social support, among which low social support had the largest odds ratio of 20.42. Findings showed that the oc-currence of post-traumatic stress disorder was the result of the interaction of multiple factors.

关键词： neural regeneration post-traumatic stress disorder incidence Wenchuan earthquake rescue groups influencing factor coping style personality social support cross-sectional investigation risk factors neuroregeneration

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