User login
Gut microbiome dysregulation implicated in OCD
SAN FRANCISCO – Patients with obsessive-compulsive disorder have a gut bacterial microbiome marked by diminished species diversity and abundance, compared with that of healthy controls, according to the first study to examine the issue.
Results of this pilot study also suggest that OCD patients with tic disorder have a distinctly different gut microbiome, compared with other OCD patients, Jasmine Turna said at the annual conference of the Anxiety and Depression Association of America.
She reported on 11 OCD patients and 12 healthy controls who underwent gut microbiome analysis using DNA extracted from their morning stool samples. Results from another nine OCD patients and 10 controls remained pending at the time of the conference but will be completed shortly.
In addition to the decreased abundance and diversity of bacteria present in the microbiomes of the OCD patients, compared with controls, another key finding was that the OCD patients had increased levels of systemic inflammation. Their mean level of high-sensitivity C-reactive protein was 3.03 mg/L, compared with 1.1 mg/L in the controls. In addition, the microbiome in those OCD patients who had elevated systemic inflammation as defined by a CRP level greater than 2.0 mg/L was more restricted than was that of OCD patients with a normal-range CRP.
In an interview, Ms. Turna noted that a cross-sectional study such as this is hypothesis generating and not definitive. Even if these findings are replicated, that will not answer the key question of whether the altered microbiome present in OCD patients is a contributing cause or a consequence of the psychiatric disorder. But she and her coinvestigators already have launched a prospective randomized controlled trial that attempts to address this question by having a group of OCD patients regularly consume a probiotic in an effort to diversify their gut microbiome.
“Maybe getting more fermented foods into the diet – kimchi, miso, yogurt, kefir – could be an adjunctive therapy,” she said. “Right now, OCD research is kind of at a standstill. Our treatments work in a lot of people, but they also don’t work in a lot of people. Our research opens up a new place to explore.”
Ms. Turna reported having no financial conflicts.
SAN FRANCISCO – Patients with obsessive-compulsive disorder have a gut bacterial microbiome marked by diminished species diversity and abundance, compared with that of healthy controls, according to the first study to examine the issue.
Results of this pilot study also suggest that OCD patients with tic disorder have a distinctly different gut microbiome, compared with other OCD patients, Jasmine Turna said at the annual conference of the Anxiety and Depression Association of America.
She reported on 11 OCD patients and 12 healthy controls who underwent gut microbiome analysis using DNA extracted from their morning stool samples. Results from another nine OCD patients and 10 controls remained pending at the time of the conference but will be completed shortly.
In addition to the decreased abundance and diversity of bacteria present in the microbiomes of the OCD patients, compared with controls, another key finding was that the OCD patients had increased levels of systemic inflammation. Their mean level of high-sensitivity C-reactive protein was 3.03 mg/L, compared with 1.1 mg/L in the controls. In addition, the microbiome in those OCD patients who had elevated systemic inflammation as defined by a CRP level greater than 2.0 mg/L was more restricted than was that of OCD patients with a normal-range CRP.
In an interview, Ms. Turna noted that a cross-sectional study such as this is hypothesis generating and not definitive. Even if these findings are replicated, that will not answer the key question of whether the altered microbiome present in OCD patients is a contributing cause or a consequence of the psychiatric disorder. But she and her coinvestigators already have launched a prospective randomized controlled trial that attempts to address this question by having a group of OCD patients regularly consume a probiotic in an effort to diversify their gut microbiome.
“Maybe getting more fermented foods into the diet – kimchi, miso, yogurt, kefir – could be an adjunctive therapy,” she said. “Right now, OCD research is kind of at a standstill. Our treatments work in a lot of people, but they also don’t work in a lot of people. Our research opens up a new place to explore.”
Ms. Turna reported having no financial conflicts.
SAN FRANCISCO – Patients with obsessive-compulsive disorder have a gut bacterial microbiome marked by diminished species diversity and abundance, compared with that of healthy controls, according to the first study to examine the issue.
Results of this pilot study also suggest that OCD patients with tic disorder have a distinctly different gut microbiome, compared with other OCD patients, Jasmine Turna said at the annual conference of the Anxiety and Depression Association of America.
She reported on 11 OCD patients and 12 healthy controls who underwent gut microbiome analysis using DNA extracted from their morning stool samples. Results from another nine OCD patients and 10 controls remained pending at the time of the conference but will be completed shortly.
In addition to the decreased abundance and diversity of bacteria present in the microbiomes of the OCD patients, compared with controls, another key finding was that the OCD patients had increased levels of systemic inflammation. Their mean level of high-sensitivity C-reactive protein was 3.03 mg/L, compared with 1.1 mg/L in the controls. In addition, the microbiome in those OCD patients who had elevated systemic inflammation as defined by a CRP level greater than 2.0 mg/L was more restricted than was that of OCD patients with a normal-range CRP.
In an interview, Ms. Turna noted that a cross-sectional study such as this is hypothesis generating and not definitive. Even if these findings are replicated, that will not answer the key question of whether the altered microbiome present in OCD patients is a contributing cause or a consequence of the psychiatric disorder. But she and her coinvestigators already have launched a prospective randomized controlled trial that attempts to address this question by having a group of OCD patients regularly consume a probiotic in an effort to diversify their gut microbiome.
“Maybe getting more fermented foods into the diet – kimchi, miso, yogurt, kefir – could be an adjunctive therapy,” she said. “Right now, OCD research is kind of at a standstill. Our treatments work in a lot of people, but they also don’t work in a lot of people. Our research opens up a new place to explore.”
Ms. Turna reported having no financial conflicts.
AT ANXIETY AND DEPRESSION CONFERENCE 2017
Key clinical point:
Major finding: Patients with obsessive-compulsive disorder have a gut bacterial microbiome that is distinctly different from healthy controls, with less abundance and species diversity.
Data source: This study analyzed DNA extracted from morning stool samples to map the gut microbiomes of 11 patients with obsessive-compulsive disorder and 12 healthy controls.
Disclosures: The study presenter reported having no financial conflicts.
Hoarding disorder patients deem few treatments as acceptable
SAN FRANCISCO – Patients with hoarding disorder are notoriously difficult to engage in treatment. They are embarrassed by their behavior and reluctant to seek help. And Carolyn I. Rodriguez, MD, PhD, has a good idea why: Her first-of-its-kind survey of individuals with hoarding disorder showed they find the currently available array of treatments and services by and large unacceptable.
The online survey included 203 individuals with clinically significant hoarding symptoms as defined by a Saving Inventory–Revised score of at least 40. The survey contained written and audio thumbnail descriptions of 11 current treatments and services, some evidence based, others not. Participants were asked to rate the acceptability of each of the 11 interventions on a 0-10 scale, with 0 being not at all acceptable. 
The results? “Nobody wanted anything!” Dr. Rodriguez said at the annual conference of the Anxiety and Depression Association of America.
Acceptability of a given intervention was defined a priori as an average score of 6 or more on the Likert Scale. She had hoped to see some 7s and 8s, strong endorsements that might have helped guide her efforts to develop attractive and engaging new therapies for this common disorder. But in fact, only 3 of the 11 items squeaked by the acceptability threshold with tepid endorsements hovering around 6: individual cognitive-behavioral therapy (CBT), with an average rating of 6.2; use of a professional organizing service, at 6.1; and use of a self-help book, at 6.0.
The least acceptable of the 11 options, not surprisingly, was a court-appointed guardian, with an average score of less than 1. Next most unpopular was use of a cleaning and removal service, followed by pharmacotherapy with a serotonin reuptake inhibitor, drug therapy with a stimulant, and group CBT.
Rounding out the list of 11 treatments and services were an online support group, a facilitated support group based upon the model described in the book “Buried in Treasures” (Oxford University Press, 2013), by David F. Tolin, PhD; Randy O. Frost, PhD; and Gail Steketee, PhD; and involvement of a case manager.
Participants were asked to describe what they liked and disliked about the 11 options. What they liked about the three that were acceptable – albeit barely – was the prospect of personalized care, being held accountable, and their belief that those three strategies really work. What they disliked about the least acceptable interventions was the feeling that they would have no control over the process, anticipation that these treatments and services would cause them distress, and skepticism about their efficacy.
Actually, while the evidence regarding pharmacotherapy is limited to a few open-label, uncontrolled, prospective case series involving hoarding disorder patients not concurrently in psychotherapy, the medication data look quite promising, according to Dr. Rodriguez, who is affiliated with the department of psychiatry and behavioral sciences at Stanford (Calif.) University.
Investigators at the University of California, San Diego, treated 24 patients meeting DSM-5 criteria for hoarding disorder with extended-release venlafaxine (Effexor XR) for 12 weeks. Twenty-three of the 24 completed the study, achieving a mean 32% reduction in Saving Inventory–Revised scores and a 36% reduction in UCLA Hoarding Severity Scale scores (Int Clin Psychopharmacol. 2014 Sep;29[5]:266-73).
Sixteen of the 23 completers were categorized as treatment responders. The investigators noted that this 70% efficacy rate for venlafaxine extended-release was markedly better than published CBT success rates, which hover around 28% for individual CBT and range from 10% to 30% for group CBT.
Also, Dr. Rodriguez has published her experience in prescribing extended-release methylphenidate for four patients with hoarding disorder without comorbid attention-deficit/hyperactivity disorder, all of whom previously had failed to respond to at least one serotonin reuptake inhibitor. The therapeutic rationale for stimulant therapy was that patients with hoarding disorder have problems with attention and decision making that may contribute to accumulation of clutter.
In this 4-week study, patients were started on methylphenidate extended-release at 18 mg/day, with the dosing increased by 18 mg/day each week to a maximum of 72 mg/day. Three of the four patients achieved at least a 50% reduction in measures of inattention, and two patients showed decreases in hoarding symptoms of 25% and 32% on the Saving Inventory–Revised. But at the end of 4 weeks, all four patients opted not to continue on the medication because they didn’t like the side effects, mainly insomnia and palpitations (J Clin Psychopharmacol. 2013 Jun;33[3]:444-7).
Pharmacotherapy has a couple of other potentially appealing features: It works much faster than does psychotherapy, and it also is effective therapy for some of the other psychiatric conditions commonly comorbid with hoarding disorder.
Several audience members observed that even though survey participants did not rate group CBT or facilitated support groups as acceptable treatments, in their own experience as therapists, they’ve found these interventions to be among the most successful. Dr. Rodriguez agreed. Based in part upon her survey findings, her new research initiatives emphasize offering choice, since there’s clearly no one-size-fits-all intervention. She’s also stressing accountability, incorporation of tools aimed at reducing shame and stigma, and providing more information about evidence-based therapies to strengthen patients’ beliefs that treatment actually works.
Toward that end, she recently has trained individuals from the community in how to run a 3-month, skills-based, group therapy program using the Buried in Treasures approach with group in-home visits and decluttering sessions. These group therapy modules will be evaluated formally as to acceptability and efficacy.
Hoarding disorder has a prevalence of 2%-6%. It’s a condition that poses significant public health risks, including fire hazard and pest infestation. Hoarding disorder typically starts in childhood or the teen years and follows a chronic, progressive course. Affected individuals do not initiate treatment until age 50, on average. The condition is more common in men than women. They are often single, highly educated, and live alone. Insight is often poor. A family history of hoarding is common. Psychiatric comorbidity also is common, with depression topping the list.
Dr. Rodriguez’s survey was funded by the National Institute of Mental Health and foundation grants. She reported serving as a consultant to Allergan, Rugen Therapeutics, and BlackThorn Therapeutics.
SAN FRANCISCO – Patients with hoarding disorder are notoriously difficult to engage in treatment. They are embarrassed by their behavior and reluctant to seek help. And Carolyn I. Rodriguez, MD, PhD, has a good idea why: Her first-of-its-kind survey of individuals with hoarding disorder showed they find the currently available array of treatments and services by and large unacceptable.
The online survey included 203 individuals with clinically significant hoarding symptoms as defined by a Saving Inventory–Revised score of at least 40. The survey contained written and audio thumbnail descriptions of 11 current treatments and services, some evidence based, others not. Participants were asked to rate the acceptability of each of the 11 interventions on a 0-10 scale, with 0 being not at all acceptable.
The results? “Nobody wanted anything!” Dr. Rodriguez said at the annual conference of the Anxiety and Depression Association of America.
Acceptability of a given intervention was defined a priori as an average score of 6 or more on the Likert Scale. She had hoped to see some 7s and 8s, strong endorsements that might have helped guide her efforts to develop attractive and engaging new therapies for this common disorder. But in fact, only 3 of the 11 items squeaked by the acceptability threshold with tepid endorsements hovering around 6: individual cognitive-behavioral therapy (CBT), with an average rating of 6.2; use of a professional organizing service, at 6.1; and use of a self-help book, at 6.0.
The least acceptable of the 11 options, not surprisingly, was a court-appointed guardian, with an average score of less than 1. Next most unpopular was use of a cleaning and removal service, followed by pharmacotherapy with a serotonin reuptake inhibitor, drug therapy with a stimulant, and group CBT.
Rounding out the list of 11 treatments and services were an online support group, a facilitated support group based upon the model described in the book “Buried in Treasures” (Oxford University Press, 2013), by David F. Tolin, PhD; Randy O. Frost, PhD; and Gail Steketee, PhD; and involvement of a case manager.
Participants were asked to describe what they liked and disliked about the 11 options. What they liked about the three that were acceptable – albeit barely – was the prospect of personalized care, being held accountable, and their belief that those three strategies really work. What they disliked about the least acceptable interventions was the feeling that they would have no control over the process, anticipation that these treatments and services would cause them distress, and skepticism about their efficacy.
Actually, while the evidence regarding pharmacotherapy is limited to a few open-label, uncontrolled, prospective case series involving hoarding disorder patients not concurrently in psychotherapy, the medication data look quite promising, according to Dr. Rodriguez, who is affiliated with the department of psychiatry and behavioral sciences at Stanford (Calif.) University.
Investigators at the University of California, San Diego, treated 24 patients meeting DSM-5 criteria for hoarding disorder with extended-release venlafaxine (Effexor XR) for 12 weeks. Twenty-three of the 24 completed the study, achieving a mean 32% reduction in Saving Inventory–Revised scores and a 36% reduction in UCLA Hoarding Severity Scale scores (Int Clin Psychopharmacol. 2014 Sep;29[5]:266-73).
Sixteen of the 23 completers were categorized as treatment responders. The investigators noted that this 70% efficacy rate for venlafaxine extended-release was markedly better than published CBT success rates, which hover around 28% for individual CBT and range from 10% to 30% for group CBT.
Also, Dr. Rodriguez has published her experience in prescribing extended-release methylphenidate for four patients with hoarding disorder without comorbid attention-deficit/hyperactivity disorder, all of whom previously had failed to respond to at least one serotonin reuptake inhibitor. The therapeutic rationale for stimulant therapy was that patients with hoarding disorder have problems with attention and decision making that may contribute to accumulation of clutter.
In this 4-week study, patients were started on methylphenidate extended-release at 18 mg/day, with the dosing increased by 18 mg/day each week to a maximum of 72 mg/day. Three of the four patients achieved at least a 50% reduction in measures of inattention, and two patients showed decreases in hoarding symptoms of 25% and 32% on the Saving Inventory–Revised. But at the end of 4 weeks, all four patients opted not to continue on the medication because they didn’t like the side effects, mainly insomnia and palpitations (J Clin Psychopharmacol. 2013 Jun;33[3]:444-7).
Pharmacotherapy has a couple of other potentially appealing features: It works much faster than does psychotherapy, and it also is effective therapy for some of the other psychiatric conditions commonly comorbid with hoarding disorder.
Several audience members observed that even though survey participants did not rate group CBT or facilitated support groups as acceptable treatments, in their own experience as therapists, they’ve found these interventions to be among the most successful. Dr. Rodriguez agreed. Based in part upon her survey findings, her new research initiatives emphasize offering choice, since there’s clearly no one-size-fits-all intervention. She’s also stressing accountability, incorporation of tools aimed at reducing shame and stigma, and providing more information about evidence-based therapies to strengthen patients’ beliefs that treatment actually works.
Toward that end, she recently has trained individuals from the community in how to run a 3-month, skills-based, group therapy program using the Buried in Treasures approach with group in-home visits and decluttering sessions. These group therapy modules will be evaluated formally as to acceptability and efficacy.
Hoarding disorder has a prevalence of 2%-6%. It’s a condition that poses significant public health risks, including fire hazard and pest infestation. Hoarding disorder typically starts in childhood or the teen years and follows a chronic, progressive course. Affected individuals do not initiate treatment until age 50, on average. The condition is more common in men than women. They are often single, highly educated, and live alone. Insight is often poor. A family history of hoarding is common. Psychiatric comorbidity also is common, with depression topping the list.
Dr. Rodriguez’s survey was funded by the National Institute of Mental Health and foundation grants. She reported serving as a consultant to Allergan, Rugen Therapeutics, and BlackThorn Therapeutics.
SAN FRANCISCO – Patients with hoarding disorder are notoriously difficult to engage in treatment. They are embarrassed by their behavior and reluctant to seek help. And Carolyn I. Rodriguez, MD, PhD, has a good idea why: Her first-of-its-kind survey of individuals with hoarding disorder showed they find the currently available array of treatments and services by and large unacceptable.
The online survey included 203 individuals with clinically significant hoarding symptoms as defined by a Saving Inventory–Revised score of at least 40. The survey contained written and audio thumbnail descriptions of 11 current treatments and services, some evidence based, others not. Participants were asked to rate the acceptability of each of the 11 interventions on a 0-10 scale, with 0 being not at all acceptable.
The results? “Nobody wanted anything!” Dr. Rodriguez said at the annual conference of the Anxiety and Depression Association of America.
Acceptability of a given intervention was defined a priori as an average score of 6 or more on the Likert Scale. She had hoped to see some 7s and 8s, strong endorsements that might have helped guide her efforts to develop attractive and engaging new therapies for this common disorder. But in fact, only 3 of the 11 items squeaked by the acceptability threshold with tepid endorsements hovering around 6: individual cognitive-behavioral therapy (CBT), with an average rating of 6.2; use of a professional organizing service, at 6.1; and use of a self-help book, at 6.0.
The least acceptable of the 11 options, not surprisingly, was a court-appointed guardian, with an average score of less than 1. Next most unpopular was use of a cleaning and removal service, followed by pharmacotherapy with a serotonin reuptake inhibitor, drug therapy with a stimulant, and group CBT.
Rounding out the list of 11 treatments and services were an online support group, a facilitated support group based upon the model described in the book “Buried in Treasures” (Oxford University Press, 2013), by David F. Tolin, PhD; Randy O. Frost, PhD; and Gail Steketee, PhD; and involvement of a case manager.
Participants were asked to describe what they liked and disliked about the 11 options. What they liked about the three that were acceptable – albeit barely – was the prospect of personalized care, being held accountable, and their belief that those three strategies really work. What they disliked about the least acceptable interventions was the feeling that they would have no control over the process, anticipation that these treatments and services would cause them distress, and skepticism about their efficacy.
Actually, while the evidence regarding pharmacotherapy is limited to a few open-label, uncontrolled, prospective case series involving hoarding disorder patients not concurrently in psychotherapy, the medication data look quite promising, according to Dr. Rodriguez, who is affiliated with the department of psychiatry and behavioral sciences at Stanford (Calif.) University.
Investigators at the University of California, San Diego, treated 24 patients meeting DSM-5 criteria for hoarding disorder with extended-release venlafaxine (Effexor XR) for 12 weeks. Twenty-three of the 24 completed the study, achieving a mean 32% reduction in Saving Inventory–Revised scores and a 36% reduction in UCLA Hoarding Severity Scale scores (Int Clin Psychopharmacol. 2014 Sep;29[5]:266-73).
Sixteen of the 23 completers were categorized as treatment responders. The investigators noted that this 70% efficacy rate for venlafaxine extended-release was markedly better than published CBT success rates, which hover around 28% for individual CBT and range from 10% to 30% for group CBT.
Also, Dr. Rodriguez has published her experience in prescribing extended-release methylphenidate for four patients with hoarding disorder without comorbid attention-deficit/hyperactivity disorder, all of whom previously had failed to respond to at least one serotonin reuptake inhibitor. The therapeutic rationale for stimulant therapy was that patients with hoarding disorder have problems with attention and decision making that may contribute to accumulation of clutter.
In this 4-week study, patients were started on methylphenidate extended-release at 18 mg/day, with the dosing increased by 18 mg/day each week to a maximum of 72 mg/day. Three of the four patients achieved at least a 50% reduction in measures of inattention, and two patients showed decreases in hoarding symptoms of 25% and 32% on the Saving Inventory–Revised. But at the end of 4 weeks, all four patients opted not to continue on the medication because they didn’t like the side effects, mainly insomnia and palpitations (J Clin Psychopharmacol. 2013 Jun;33[3]:444-7).
Pharmacotherapy has a couple of other potentially appealing features: It works much faster than does psychotherapy, and it also is effective therapy for some of the other psychiatric conditions commonly comorbid with hoarding disorder.
Several audience members observed that even though survey participants did not rate group CBT or facilitated support groups as acceptable treatments, in their own experience as therapists, they’ve found these interventions to be among the most successful. Dr. Rodriguez agreed. Based in part upon her survey findings, her new research initiatives emphasize offering choice, since there’s clearly no one-size-fits-all intervention. She’s also stressing accountability, incorporation of tools aimed at reducing shame and stigma, and providing more information about evidence-based therapies to strengthen patients’ beliefs that treatment actually works.
Toward that end, she recently has trained individuals from the community in how to run a 3-month, skills-based, group therapy program using the Buried in Treasures approach with group in-home visits and decluttering sessions. These group therapy modules will be evaluated formally as to acceptability and efficacy.
Hoarding disorder has a prevalence of 2%-6%. It’s a condition that poses significant public health risks, including fire hazard and pest infestation. Hoarding disorder typically starts in childhood or the teen years and follows a chronic, progressive course. Affected individuals do not initiate treatment until age 50, on average. The condition is more common in men than women. They are often single, highly educated, and live alone. Insight is often poor. A family history of hoarding is common. Psychiatric comorbidity also is common, with depression topping the list.
Dr. Rodriguez’s survey was funded by the National Institute of Mental Health and foundation grants. She reported serving as a consultant to Allergan, Rugen Therapeutics, and BlackThorn Therapeutics.
AT ANXIETY AND DEPRESSION CONFERENCE 2017
Key clinical point:
Major finding: Only three interventions received even lukewarm endorsement: individual cognitive-behavioral therapy, a professional organizing service, and self-help books.
Data source: In an online survey, 203 individuals with clinically significant hoarding disorder symptoms rated the acceptability of 11 different therapies and services.
Disclosures: This work was funded by the National Institute of Mental Health and foundation grants. The study presenter reported serving as a consultant to Allergan, Rugen Therapeutics, and BlackThorn Therapeutics.
PTSD linked to cognitive decline in middle-aged women
SAN FRANCISCO – Posttraumatic stress disorder is associated with worse cognitive function in middle-aged women, Jennifer A. Sumner, PhD, reported at the annual conference of the Anxiety and Depression Association of America.
The strongest link between PTSD and impaired cognitive function found in this new analysis from the Nurses’ Health Study 2 was observed among those women with elevated PTSD symptoms indicative of probable PTSD and comorbid depression, added Dr. Sumner, a clinical psychologist affiliated with Columbia University in New York.
The findings are important, in part because they help fill a gender gap in PTSD research. The great majority of studies of PTSD and its long-term consequences for physical and mental health have focused on male military veterans. Yet PTSD is twice as common in women as in men and is on average more severe and causes more impairment in women as well.
Growing evidence suggests that brain aging and cognitive decline begin in midlife, long before the dysfunction becomes manifest as dementia. The Nurses’ Health Study 2 findings raise the testable hypothesis that PTSD might be a modifiable risk factor for early cognitive decline, Dr. Sumner observed.
The Nurses’ Health Study 2 is one of the largest ongoing longitudinal studies of women’s health in the world. Dr. Sumner’s analysis focused on 14,029 participants who in 2008 underwent assessment of lifetime exposure to 16 types of trauma included in the Brief Trauma Questionnaire, lifetime PTSD symptoms using the Short Screening Scale for PTSD, and current depressive symptoms via the Center for Epidemiologic Studies Depression Scale. The women then completed the Cogstate Brief Battery in 2014-2016. The Cogstate is a validated, sensitive, self-administered online cognitive battery that measures psychomotor speed, attention, working memory, and learning. It takes 10-15 minutes to complete.
Seventeen percent of women had both a lifetime history of exposure to trauma and probable PTSD based upon having four or more of the seven symptoms listed on the Short Screening Scale for PTSD. These women had, on average, a lower educational level, income, and self-assessed social standing, more medical comorbidities, and more depressive symptoms than the other subjects. However, in a multivariate analysis controlling for these potential confounders, the group with both trauma and PTSD performed significantly worse on the Cogstate measures of psychomotor speed/attention and learning/working memory than women with no trauma and no PTSD symptoms.
Similarly, the 17% of women with both probable PTSD and probable depression as defined by a score of 10 or more on the Center for Epidemiologic Studies Depression Scale demonstrated significantly worse cognitive function on the Cogstate, compared with women with neither condition.
In regard to potential mechanisms that might explain the observed association between PTSD and worse cognitive function, Dr. Sumner noted that other investigators have reported that PTSD is characterized by oxidative stress, systemic inflammation, and hypothalamic-pituitary-adrenal axis and neuroendocrine dysfunction. This could promote neuronal death. Moreover, PTSD also is associated with increased risk of poor health behaviors, including sleep disturbances, physical inactivity, obesity, and smoking, which also could contribute to cognitive decline down the line.
Dr. Sumner’s study, which was supported by the National Institutes of Health, recently has been published (Depress Anxiety. 2017 Apr;34[4]:356-66). She reported having no financial conflicts.
SAN FRANCISCO – Posttraumatic stress disorder is associated with worse cognitive function in middle-aged women, Jennifer A. Sumner, PhD, reported at the annual conference of the Anxiety and Depression Association of America.
The strongest link between PTSD and impaired cognitive function found in this new analysis from the Nurses’ Health Study 2 was observed among those women with elevated PTSD symptoms indicative of probable PTSD and comorbid depression, added Dr. Sumner, a clinical psychologist affiliated with Columbia University in New York.
The findings are important, in part because they help fill a gender gap in PTSD research. The great majority of studies of PTSD and its long-term consequences for physical and mental health have focused on male military veterans. Yet PTSD is twice as common in women as in men and is on average more severe and causes more impairment in women as well.
Growing evidence suggests that brain aging and cognitive decline begin in midlife, long before the dysfunction becomes manifest as dementia. The Nurses’ Health Study 2 findings raise the testable hypothesis that PTSD might be a modifiable risk factor for early cognitive decline, Dr. Sumner observed.
The Nurses’ Health Study 2 is one of the largest ongoing longitudinal studies of women’s health in the world. Dr. Sumner’s analysis focused on 14,029 participants who in 2008 underwent assessment of lifetime exposure to 16 types of trauma included in the Brief Trauma Questionnaire, lifetime PTSD symptoms using the Short Screening Scale for PTSD, and current depressive symptoms via the Center for Epidemiologic Studies Depression Scale. The women then completed the Cogstate Brief Battery in 2014-2016. The Cogstate is a validated, sensitive, self-administered online cognitive battery that measures psychomotor speed, attention, working memory, and learning. It takes 10-15 minutes to complete.
Seventeen percent of women had both a lifetime history of exposure to trauma and probable PTSD based upon having four or more of the seven symptoms listed on the Short Screening Scale for PTSD. These women had, on average, a lower educational level, income, and self-assessed social standing, more medical comorbidities, and more depressive symptoms than the other subjects. However, in a multivariate analysis controlling for these potential confounders, the group with both trauma and PTSD performed significantly worse on the Cogstate measures of psychomotor speed/attention and learning/working memory than women with no trauma and no PTSD symptoms.
Similarly, the 17% of women with both probable PTSD and probable depression as defined by a score of 10 or more on the Center for Epidemiologic Studies Depression Scale demonstrated significantly worse cognitive function on the Cogstate, compared with women with neither condition.
In regard to potential mechanisms that might explain the observed association between PTSD and worse cognitive function, Dr. Sumner noted that other investigators have reported that PTSD is characterized by oxidative stress, systemic inflammation, and hypothalamic-pituitary-adrenal axis and neuroendocrine dysfunction. This could promote neuronal death. Moreover, PTSD also is associated with increased risk of poor health behaviors, including sleep disturbances, physical inactivity, obesity, and smoking, which also could contribute to cognitive decline down the line.
Dr. Sumner’s study, which was supported by the National Institutes of Health, recently has been published (Depress Anxiety. 2017 Apr;34[4]:356-66). She reported having no financial conflicts.
SAN FRANCISCO – Posttraumatic stress disorder is associated with worse cognitive function in middle-aged women, Jennifer A. Sumner, PhD, reported at the annual conference of the Anxiety and Depression Association of America.
The strongest link between PTSD and impaired cognitive function found in this new analysis from the Nurses’ Health Study 2 was observed among those women with elevated PTSD symptoms indicative of probable PTSD and comorbid depression, added Dr. Sumner, a clinical psychologist affiliated with Columbia University in New York.
The findings are important, in part because they help fill a gender gap in PTSD research. The great majority of studies of PTSD and its long-term consequences for physical and mental health have focused on male military veterans. Yet PTSD is twice as common in women as in men and is on average more severe and causes more impairment in women as well.
Growing evidence suggests that brain aging and cognitive decline begin in midlife, long before the dysfunction becomes manifest as dementia. The Nurses’ Health Study 2 findings raise the testable hypothesis that PTSD might be a modifiable risk factor for early cognitive decline, Dr. Sumner observed.
The Nurses’ Health Study 2 is one of the largest ongoing longitudinal studies of women’s health in the world. Dr. Sumner’s analysis focused on 14,029 participants who in 2008 underwent assessment of lifetime exposure to 16 types of trauma included in the Brief Trauma Questionnaire, lifetime PTSD symptoms using the Short Screening Scale for PTSD, and current depressive symptoms via the Center for Epidemiologic Studies Depression Scale. The women then completed the Cogstate Brief Battery in 2014-2016. The Cogstate is a validated, sensitive, self-administered online cognitive battery that measures psychomotor speed, attention, working memory, and learning. It takes 10-15 minutes to complete.
Seventeen percent of women had both a lifetime history of exposure to trauma and probable PTSD based upon having four or more of the seven symptoms listed on the Short Screening Scale for PTSD. These women had, on average, a lower educational level, income, and self-assessed social standing, more medical comorbidities, and more depressive symptoms than the other subjects. However, in a multivariate analysis controlling for these potential confounders, the group with both trauma and PTSD performed significantly worse on the Cogstate measures of psychomotor speed/attention and learning/working memory than women with no trauma and no PTSD symptoms.
Similarly, the 17% of women with both probable PTSD and probable depression as defined by a score of 10 or more on the Center for Epidemiologic Studies Depression Scale demonstrated significantly worse cognitive function on the Cogstate, compared with women with neither condition.
In regard to potential mechanisms that might explain the observed association between PTSD and worse cognitive function, Dr. Sumner noted that other investigators have reported that PTSD is characterized by oxidative stress, systemic inflammation, and hypothalamic-pituitary-adrenal axis and neuroendocrine dysfunction. This could promote neuronal death. Moreover, PTSD also is associated with increased risk of poor health behaviors, including sleep disturbances, physical inactivity, obesity, and smoking, which also could contribute to cognitive decline down the line.
Dr. Sumner’s study, which was supported by the National Institutes of Health, recently has been published (Depress Anxiety. 2017 Apr;34[4]:356-66). She reported having no financial conflicts.
AT ANXIETY AND DEPRESSION CONFERENCE 2017
Key clinical point:
Major finding: A large group of middle-aged civilian women with a history of exposure to trauma at any point in their lives along with elevated PTSD symptoms scored significantly worse on a cognitive function battery than women with no history of trauma or PTSD symptoms.
Data source: This was an analysis of more than 14,000 middle-aged women participating in the ongoing longitudinal Nurses’ Health Study 2.
Disclosures: The study was supported by the National Institutes of Health. Dr. Sumner reported having no financial conflicts.