Alain Brunet

Immediate treatment with propranolol decreases posttraumatic stress disorder two months after trauma

BACKGROUND This study investigated the efficacy of propranolol prescribed shortly after trauma exposure in the prevention of posttraumatic stress disorder (PTSD) symptoms and diagnosis. METHODS Eleven patients received 40 mg of propranolol 3 times daily for 7 days, followed by a taper period of 8-12 days. They were compared with eight patients who refused propranolol but agreed to participate in the study. Though nonrandomized, the two groups did not differ on demographics, exposure characteristics, physical injury severity, or peritraumatic emotional responses. RESULTS Posttraumatic stress disorder rates were higher in the group who refused propranolol (3/8) compared with those who received the medication (1/11), as were the levels of PTSD symptoms (U = 85, p =.037). CONCLUSIONS Our results are consistent with earlier findings and suggest that propranolol may be useful for mitigating PTSD symptoms or perhaps even preventing the development of PTSD.

Project Ice Storm: Prenatal Maternal Stress Affects Cognitive and Linguistic Functioning in 5½-Year-Old Children

OBJECTIVE This was a prospective study designed to determine the extent to which the degree of exposure to prenatal maternal stress due to a natural disaster explains variance in the intellectual and language performance of offspring at age 5(1/2) while controlling for several potential confounding variables. METHOD Subjects were eighty-nine 5(1/2)-year-old children whose mothers were pregnant during a natural disaster: the January 1998 ice storm crisis in the Canadian province of Québec that resulted in power losses for 3 million people for as long as 40 days. In June 1998, women completed several questionnaires including those about the extent of objective stress (Storm 32) and subjective distress (Impact of Events Scale-Revised) experienced due to the storm. Their children were assessed with the Wechsler Preschool and Primary Scale of Intelligence-Revised (IQ) and Peabody Picture Vocabulary Test-Revised (language) at 5(1/2) years of age, and mothers completed assessments of recent life events and psychological functioning. RESULTS Children exposed in utero to high levels of objective stress had lower Full Scale IQs, Verbal IQs, and language abilities compared to children exposed to low or moderate levels of objective prenatal maternal stress; there were no effects of subjective stress or objective stress on Performance IQs. Trend analyses show that for all outcome variables except Block Design, there was a significant curvilinear association between objective stress and functioning. CONCLUSIONS Prenatal exposure to a moderately severe natural disaster is associated with lower cognitive and language abilities at 5(1/2) years of age.

Validation of a French version of the impact of event scale-revised.

Objective: This report presents a French translation and validation of the Impact of Event Scale-Revised (IES-R) in a population of women exposed to a natural disaster during or preceding pregnancy. Method: A total of 223 francophone women who were either pregnant at the time of the 1998 ice storm or who became pregnant shortly thereafter completed the IES-R and other questionnaires 6 months after the disaster. Results: The French IES-R has good internal consistency, with alpha coefficients ranging from 0.81 to 0.93 for its 3 subscales and total score. The test–retest reliability of the scale, although examined with another sample, proved to be satisfactory, with correlation coefficients ranging from 0.71 to 0.76 for its 3 subscales and total score. Its convergent validity with perceived life threat and general psychiatric symptoms was judged to be marginally acceptable. Finally, a principal components analysis was conducted and a 3-factor solution, which explained 56% of the variance, was retained: a hyperarousal factor (7 items), an avoidance factor (6 items), and an intrusion factor (6 items). Conclusions: The French version of the IES-R has satisfactory internal validity and test–retest reliability. Further, the factor structure of the translation was similar to the proposed theoretical structure of the IES-R.

PTSD symptoms predict waking salivary cortisol levels in police officers

This study examines whether pre- or post-dexamethasone salivary cortisol is related to cumulative critical incident exposure, peritraumatic responses, or post-traumatic stress disorder (PTSD) symptom severity. Thirty active duty police officers completed the study protocol, which included measures of peritraumatic emotional distress, peritraumatic dissociation, duty-related trauma exposure, and PTSD symptoms. Salivary cortisol was consolidated into three outcome variables: (1) pre-dexamethasone free cortisol levels at 1, 30, 45, and 60 min after awakening, (2) post-dexamethasone cortisol levels at the identical wake times, and (3) percentage of cortisol suppression. Control variables included age, gender, average daily alcohol use, night shift work, routine work environment stressors, and salivary dexamethasone levels. Zero order correlations showed that greater levels of PTSD symptoms, peritraumatic distress, and peritraumatic dissociation were associated with lower levels of pre-dexamethasone cortisol levels on awakening, but were not associated with the other two cortisol variables. A trend was also noted for older subjects to have lower pre-dexamethasone cortisol on awakening. When these four predictors were entered simultaneously in a regression analysis, only age and PTSD symptom severity significantly predicted pre-dexamethasone awakening cortisol levels. These results replicate previous research indicating a relationship between greater PTSD symptoms and lower levels of basal cortisol on awakening, and extend this finding to a previously unstudied non-treatment seeking population, urban police.

Size Versus Shape Differences: Contrasting Voxel-Based and Volumetric Analyses of the Anterior Cingulate Cortex in Individuals with Acute Posttraumatic Stress Disorder

BACKGROUND Two studies found morphological differences in the anterior cingulate cortex (ACC) of individuals with chronic posttraumatic stress disorder (PTSD). We sought to replicate and extend these findings in a sample of individuals with acute PTSD. METHODS The ACCs of individuals with acute PTSD (n = 14) and matched healthy control subjects (n = 14) were compared using voxel-based morphometry (VBM), semi-automated volumetric analyses, and probabilistic maps. Posttraumatic stress disorder diagnosis was ascertained by a psychologist using a structured interview. RESULTS Voxel-based morphometry analyses revealed significantly less gray-matter density in the right pregenual ACC and in the left insula of the PTSD group. However, volumetric analyses of the ACC revealed no significant differences between groups. Probabilistic maps of the labels of the pregenual ACC indicated that the difference between groups in gray matter density was due to shape differences. CONCLUSIONS Although there are no volumetric differences in the ACC of acute PTSD individuals compared with normal control subjects, significant shape differences exist, which might indicate volumetric differences in the surrounding structures.

Critical Incident Exposure and Sleep Quality in Police Officers

Objective Police officers face many stressors that may negatively impact sleep quality. This study compares subjective sleep quality in police officers with that in control subjects not involved in police or emergency services. We examined the effects of critical incident exposure (trauma exposure) and routine (nontraumatic) work environment stressors on sleep quality after controlling for the effects of work shift schedule. Methods Subjective sleep disturbances were measured by the Pittsburgh Sleep Quality Index in police officers (variable-shift workers, N = 551; stable day-shift workers, N = 182) and peer-nominated comparison subjects (variable-shift workers, N = 98; stable day-shift workers, N = 232). The main predictor variables were 1) duty-related critical incident exposure to on-line policing and 2) work environment stress related to routine administrative and organizational aspects of police work. Results Police officers on both variable and stable day shifts reported significantly worse sleep quality and less average sleep time than the two corresponding control groups. Within police officers, cumulative critical incident exposure was associated with nightmares but only weakly associated with poor global sleep quality. In contrast, the stress from officers’ general work environment was strongly associated with poor global sleep quality. Sleep disturbances were strongly associated with posttraumatic stress symptoms and general psychopathology. Conclusions A large percentage of police officers report disturbances in subjective sleep quality. Although the life-threatening aspects of police work are related to nightmares, the routine stressors of police service seem to most affect global sleep quality in these subjects. These findings may have implications for health and occupational performance.

Childhood abuse and dissociative symptoms in adult schizophrenia

Dissociative symptoms, occurring in many psychiatric disorders including schizophrenia, are often preceded by traumatic experience. We hypothesized that various types of childhood trauma would correlate with levels of dissociative symptomatology in adult patients. Twenty-six patients completed the Dissociative Experiences Scale (DES) and the Childhood Trauma Questionnaire (CTQ). Dissociation was significantly correlated with emotional abuse (r=0.84, one-tailed p<0.001), and physical abuse (r=0.55, p<0.01). We suggest that emotional abuse may play an important role in the etiology of dissociation in schizophrenia.

Low posttrauma GABA plasma levels as a predictive factor in the development of acute posttraumatic stress disorder

BACKGROUND Gamma amino-butyric acid (GABA) regulates the intensity and the duration of the central hyperadrenergic response in times of high stress and has been negatively associated with anxiety, depression, and sleep problems. We hypothesized that individuals with low plasma GABA levels may be more prone to develop posttraumatic stress disorder (PTSD) in the aftermath of trauma exposure. METHODS To test this hypothesis, we measured plasma GABA levels in a population of 108 road traffic accident victims on arrival at a traumatology department and assessed them for PTSD 6 weeks later. RESULTS The mean GABA level (nmol/mL) in the PTSD group (n = 55; M =.20; SD =.08) was significantly lower compared with members of the trauma-exposed group who did not develop PTSD [n = 17; M =.30; SD =.09), t(70) = 3.94, p =.0002]. CONCLUSIONS Provided that GABA levels in the brain are genetically predetermined, our results would suggest that individuals with low plasma GABA levels are premorbidly more vulnerable to stress-related disorders such as acute PTSD. If replicated, plasma GABA levels measured in the aftermath of trauma exposure might help to identify individuals at high risk for developing PTSD.

Propranolol’s effects on the consolidation and reconsolidation of long-term emotional memory in healthy participants: a meta-analysis

BACKGROUND Considering the pivotal role of negative emotional experiences in the development and persistence of mental disorders, interfering with the consolidation/reconsolidation of such experiences would open the door to a novel treatment approach in psychiatry. We conducted a meta-analysis on the experimental evidence regarding the capacity of the ß-blocker propranolol to block the consolidation/reconsolidation of emotional memories in healthy adults. METHODS Selected studies consisted of randomized, double-blind experiments assessing long-term memory for emotional material in healthy adults and involved at least 1 propranolol and 1 placebo condition. We searched PsycInfo, PubMed, Web of Science, Cochrane Central, PILOTS, Google Scholar and clinicaltrials.org for eligible studies from the period 1995-2012. Ten consolidation (n = 259) and 8 reconsolidation (n = 308) experiments met the inclusion criteria. We calculated effect sizes (Hedges g) using a random effects model. RESULTS Compared with placebo, propranolol given before memory consolidation reduced subsequent recall for negatively valenced stories, pictures and word lists (Hedges g = 0.44, 95% confidence interval [CI] 0.14-0.74). Propranolol before reconsolidation also reduced subsequent recall for negatively valenced emotional words and the expression of cue-elicited fear responses (Hedges g = 0.56, 95% CI 0.13-1.00). LIMITATIONS Limitations include the moderate number of studies examining the influence of propranolol on emotional memory consolidation and reconsolidation in healthy adults and the fact that most samples consisted entirely of young adults, which may limit the ecological validity of results. CONCLUSION Propranolol shows promise in reducing subsequent memory for new or recalled emotional material in healthy adults. However, future studies will need to investigate whether more powerful idiosyncratic emotional memories can also be weakened and whether this weakening can bring about long-lasting symptomatic relief in clinical populations, such as patients with posttraumatic stress or other event-related disorders.

Memory and executive dysfunctions associated with acute posttraumatic stress disorder.

Posttraumatic stress disorder (PTSD) in its chronic form has been associated with a number of neurocognitive impairments involving emotionally neutral stimuli. It remains unknown whether such impairments also characterize acute PTSD. In the present investigation, neurocognitive functions were examined in trauma exposed individuals with (n=21) and without (n=16) acute PTSD, as well as in a group of individuals never exposed to trauma (n=17) using specific and standardized tasks such as the Rey Auditory Verbal Learning Test, the Aggies Figure Learning Test, the Autobiographical Memory Interview, the D2 test, the Stroop task, the digit and visual span tasks of the Wechsler Memory Scale-III, the Trail Making Test, the Tower of London and the vocabulary subtest of the Wechsler Adult Intelligence Scale-III. A number of deficits in the cognitive domains of memory, high-level attentional resources, executive function and working memory were found in the group with a diagnosis of acute PTSD only and not among the other groups. The findings, which point to the possibility of disturbed fronto-temporal system function in trauma-exposed individuals with acute PTSD, are particularly relevant for the early clinical management of this disorder.