Margaret Legarreta

A Preliminary Study of DSM-5 PTSD Symptom Patterns in Veterans by Trauma Type

Posttraumatic stress disorder (PTSD) has a primary etiology in experiencing psychological trauma and the subsequent psychological sequelae ( American Psychiatric Association, 2013). There are multiple trauma types that may serve as the index trauma in PTSD. This exploratory study compared DSM–5 PTSD symptoms for 3 types of trauma in veterans: combat trauma (n = 36), sexual trauma (n = 21), and civilian trauma (n = 21). Results indicated that veterans with combat trauma were likely to experience diminished interest and detachment and estrangement from others. Veterans with sexual trauma were likely to experience detachment and estrangement from others, sleep disturbances, and problems with concentration. Veterans with civilian traumas were less likely to meet criteria for PTSD and were less likely to experience a number of PTSD symptoms. Results of this preliminary study suggest that PTSD is not a unitary disorder, but a disorder characterized by different subtypes based on the precipitating trauma.

DSM-5 posttraumatic stress disorder symptoms associated with suicide behaviors in veterans.

A connection between suicidality and posttraumatic stress disorder (PTSD) has been consistently demonstrated; however, the underlying relationship between suicidality and PTSD remains unclear. The aim of this study was to examine patterns of DSM-5 PTSD symptom endorsement that differentiated veteran participants with and without a history of suicide behaviors. We enrolled 95 veterans, 32 of whom reported no suicide ideation (SI) or suicide attempts (SA). The 63 remaining participants reported a history of SI, with 28 of the 63 also reporting a historical SA. Participants completed a standardized diagnostic interview (Structured Clinical Interview for DSM-IV-TR; First, Spitzer, Gibbon, & Williams, 2002), structured interview of suicidal behaviors (Columbia-Suicide Severity Rating Scale; Posner et al., 2011), and selected clinical measures. Veterans who reported SI and/or SA were more likely to meet criteria for PTSD on DSM-5 than were veterans who reported neither SI nor SA. Participants who reported SA were more likely to meet criteria for clusters C and D. Finally, at the symptom level, those who reported SI were more likely to report experiencing feelings of alienation. Those who reported a SA were more likely to report avoidance of thoughts and feelings, inability to recall an important aspect of their trauma, persistent negative beliefs, diminished interest, and feelings of alienation. These findings suggest that targeting specific symptoms of PTSD may aid in treatment of suicidal thoughts and behaviors associated with PTSD.

Orbitofrontal cortical thinning and aggression in mild traumatic brain injury patients

Although mild traumatic brain injury (mTBI) comprises 80% of all TBI, the morphological examination of the orbitofrontal cortex (OFC) in relation to clinical symptoms such as aggression, anxiety and depression in a strictly mTBI sample has never before been performed.

Altered Cortical Gamma-Amino Butyric Acid in Female Veterans With Suicidal Behavior: Sex Differences and Clinical Correlates:

Background Suicide is a public health concern in the civilian and veteran populations. Stressful life events are precipitating factors for suicide. The neurochemical underpinnings of the association between stress/trauma and suicide risk are unclear, especially with regard to sex differences. We hypothesized that gamma-amino butyric acid (GABA), the major inhibitory neurotransmitter, may be a neurochemical candidate that is critical in the association between stress and suicide risk in veterans. Methods Proton magnetic resonance spectroscopy at 3.0 Tesla was used to measure in vivo neurochemistry in the anterior cingulate cortex (predominantly the dorsal anterior cingulate cortex) of 81 veterans (16 females), including 57 (11 females) who endorsed past suicidal ideation and/or suicide attempt and 24 (5 females) with no history of suicidal ideation and/or suicide attempt. Suicidal behavior (SB) was defined as the presence of suicidal ideation and/or suicide attempt. Results We observed no significant differences in GABA/creatine + phosphocreatine (Cr + PCr) between veterans with SB (SB+) and without SB (SB−). However, the female SB+ group showed significantly reduced GABA/Cr + PCr versus the female SB− group. We observed a trend-level significant negative correlation between GABA/Cr + PCr and the Defensive Avoidance subscale on the Trauma Symptom Inventory in the SB+ group. In contrast, the SB− group exhibited a positive relationship between the two variables. Furthermore, we found significant negative correlations between GABA/Cr + PCr and Hamilton Rating Scale for Depression scores as well as between GABA/Cr + PCr and several subscales of the Trauma Symptom Inventory in female veterans. Conclusions This study suggests that reduced GABA/Cr + PCr ratio in the anterior cingulate cortex, which may be related to altered inhibitory capacity, may underlie suicide risk in female veterans. Further, the negative association between GABA/Cr + PCr and stress symptomatology and depression scores suggests that magnetic resonance spectroscopy studies may shed light on intermediate phenotypes of SB.

Increased efficiency of brain connectivity networks in veterans with suicide attempts

Background Suicide is a public health concern for United States veterans and civilians. Prior research has shown neurobiological factors in suicide. However, studies of neuroimaging correlates of suicide risk have been limited. This study applied complex weighted network analyses to characterize the neural connectivity in white matter in veterans with suicide behavior. Methods Twenty-eight veterans without suicide behavior (NS), 29 with a history of suicidal ideation only (SI), and 23 with prior suicide attempt (SA) completed diffusion tensor brain imaging, the Columbia Suicide Severity Rating Scale and Barratt Impulsiveness Scale (BIS). Structural connectivity networks among 82 parcellated brain regions were produced using whole-brain tractography. Global and nodal metrics of network topology have been calculated. Results SA had shorter characteristic path length and greater global efficiency and mean weighted degree of global network metrics (p < 0.024). SA had more hub nodes than NS and SI. The left posterior cingulate cortex (PCC) showed significantly greater weighted degree in SA relative to others (p < 0.0003). Nonplanning subscale of BIS correlated with the weighted degrees of the left PCC within SA. In rich club connectivity, SA had higher local connections than others (p = 0.001). Conclusion Veterans with prior suicide attempt had altered connectivity networks characteristics in the white matter. These findings may be distinctive neurobiological markers for individuals with suicide attempt. Strong connectivity in the left PCC may be implicated in impulsivity in veterans with suicide attempt.