The GAD65 knock out mouse – a model for GABAergic processes in fear‐ and stress‐induced psychopathology

The γ‐amino butyric acid (GABA) synthetic enzyme glutamic acid decarboxylase (GAD)65 is critically involved in the activity‐dependent regulation of GABAergic inhibition in the central nervous system. It is also required for the maturation of the GABAergic system during adolescence, a phase that is critical for the development of several neuropsychiatric diseases. Mice bearing a null mutation of the GAD65 gene develop hyperexcitability of the amygdala and hippocampus, and a phenotype of increased anxiety and pathological fear memory reminiscent of posttraumatic stress disorder. Although genetic association of GAD65 in human has not yet been reported, these findings are in line with observations of reduced GABAergic function in these brain regions of anxiety disorder patients. The particular value of GAD65(?/?) mice thus lies in modeling the effects of reduced GABAergic function in the mature nervous system. The expression of GAD65 and a second GAD isozyme, GAD67, are differentially regulated in response to stress in limbic brain areas suggesting that by controlling GABAergic inhibition these enzymes determine the vulnerability for the development of pathological anxiety and other stress‐induced phenotypes. In fact, we could recently show that GAD65 haplodeficiency, which results in delayed postnatal increase of GABA levels, provides resilience to juvenile‐stress‐induced anxiety to GAD65(+/?) mice thus foiling the increased fear and anxiety in homozygous GAD65(?/?) mice.     

The Treatment of Recalcitrant Post-traumatic Nightmares with Autogenic Training and Autogenic Abreaction: A Case Study

Recurrent and frightening dreams are commonly experienced by patients who suffer from post-traumatic stress disorder after a motor vehicle accident. Such nocturnal episodes, if left untreated, can result in the experience of severe distress with physical, emotional, and psychophysiological concomitant. The present single-case study investigated the effects of the standard autogenic exercises and autogenic abreaction in reducing the frequency and severity of post-traumatic nightmares in a survivor of a car crash. The patient was also instructed in two additional organ-specific formulas in order to improve her sleep. The results of the study showed that the interventions were successful in effectively treating the patient's distressing nightmares. Follow-up data suggested that the treatment effects persisted after the termination of therapy. Suggestions for future investigations are discussed.     

A comparison of lifelong and posttrauma nightmares in a civilian trauma sample: Nightmare characteristics, psychopathology, and treatment outcome.

Nightmares and sleep disturbances are thought to play a key role in the development of posttrauma problems. Research efforts have increased in an attempt to understand this association. The present study examined differences in nightmare characteristics, related psychopathology, treatment outcome, and trauma history among trauma-exposed individuals whose nightmares began before a traumatic event and those whose nightmares began after a traumatic event, while controlling for posttraumatic stress disorder status. Individuals whose nightmares began following a trauma experienced more depression and posttraumatic stress symptoms and poorer sleep quality, reported a higher number of traumatic events, and were more likely to report nightmares replicative of or similar to the trauma than those whose nightmares began before the trauma. No other between-groups differences were found for nightmare characteristics or response to treatment. This study is an important step in understanding the nature of nightmares and their relationship to traumatic events and consequences, but additional research is warranted. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Commentary: Deconstructing Critiques on the Internationalization of PTSD

When PTSD entered the DSM, advocacy for the diagnosis was a critical part of advocacy for Vietnam veterans. Over the next two decades, the range of contexts in which this clinical concept was applied increased dramatically. In a recent article in Culture, Medicine and Psychiatry, Breslau (2004) describes PTSD as a “prominent cultural model” to account for suffering as well as the synergy between human rights or political advocacy and traumatic stress advocacy. In this article I question the sequence of steps that Breslau took to critique the internationalization of the PTSD construct. I also question Breslau's critique on our work in Nepal. Finally, I will formulate some future challenges for psychiatry and anthropology to bridge their universalistic and relativistic points of view.     

Social rhythm regularity moderates the relationship between sleep disruption and depressive symptoms in veterans with post-traumatic stress disorder and major depressive disorder

ABSTRACT

Approximately 50% to 80% of individuals with posttraumatic stress disorder (PTSD) also meet criteria for major depressive disorder (MDD). Sleep disturbance is a major concern in both PTSD and MDD, and is associated with poor treatment response, poor functional outcome and increased suicide risk. Social rhythm regularity, or the consistency of daily habitual behaviors, is theoretically linked to circadian rhythms and may be disturbed in both PTSD and MDD. The present study examined the relationship between social rhythm regularity, sleep disruption and MDD and PTSD symptoms in a sample of veterans with comorbid PTSD and MDD. Baseline data were obtained from 56 male veterans who met DSM-IV criteria for PTSD and MDD. Veterans completed the Social Rhythm Metric (SRM), a self-report questionnaire that assesses the regularity of routines by determining how regularly individuals completed 17 different types of activities. In a linear regression model, increased minutes awake after sleep onset (WASO) was a significant predictor of increased depression scores on the Hamilton Rating Scale for Depression (p < .05). SRM scores did not significantly predict depressive symptoms, however the interaction of WASO and SRM significantly predicted depressive symptoms (p = <.05), with significant relationships found at SRM scores less than 3.62. Neither minutes awake after sleep onset, SRM scores, nor their interaction was associated with PTSD symptom severity. Social and possibly circadian rhythm regularity may represent a risk or resilience factor for individuals with comorbid PTSD and MDD. Findings highlight the importance of exploring the interactions of sleep and social/circadian rhythms in depression in order to inform continued treatment development.     

Characteristics of chronic nightmares in a trauma-exposed treatment-seeking sample.

Chronic nightmares pose a significant problem for many individuals affected by trauma. The present study attempts to extend current knowledge on the nature, characteristics, and associated sequelae of chronic nightmares. Data were collected from 94 trauma-exposed, treatment-seeking participants (74 women and 20 men). These data suggest that most participants reported their nightmares to be similar or dissimilar to their traumatic experience rather than exact replications (replicative). Not surprisingly, though, nightmare-related distress was positively related to the degree of similarity between their nightmare and their trauma, with replicative nightmares eliciting the greatest distress. Persons with a current diagnosis of posttraumatic stress disorder (PTSD) were more likely to report problems related to nightmares and sleep disturbance than persons without current PTSD. Nonetheless, even after controlling for PTSD-related symptomatology, frequency and severity of nightmares significantly predicted some distress outcomes (e.g., poor sleep quality), suggesting that nightmares contribute to psychological distress above and beyond PTSD symptoms. Implications for future research, and for the treatment of nightmares and PTSD, are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)