PTSD game changer? Looking at brain molecules, sleep patterns for answersPosttraumatic Stress Disorder is a significant or extreme emotional or psychological response to a shocking, dangerous, or traumatic event. Researchers discussed PTSD studies on sleep patterns and biomarkers at the Military Health System Research Symposium in Kissimmee, Florida. (U.S. Air Force photo by Senior Airman Christian Clausen/Released)Whether service members experience a traumatic event in a warzone or at home, posttraumatic stress disorder can affect every aspect of their lives. Research on the disorder continues to advance as experts study its impact on behavior, psychology, and physiology.
During the Military Health System Research Symposium, researchers shared studies focusing on a specific aspect of posttraumatic stress disorder research: biomarkers. A biomarker is a molecule that can indicate unusual processes going on in a person’s body. These markers can flag a clinician’s attention for an underlying condition, including PTSD. They can objectively diagnose the disorder or show how severe the symptoms are in service members and veterans.
Using sleep as a pathway to understanding more about the disorder can open doors to innovative research, said Ashlee McKeon, a postdoctoral scholar with the military sleep tactics and resilience research team at the University of Pittsburgh. She studied the differences in self-reported symptoms, such as the amount of distress caused by memories and gaps in awareness, slow wave activity, and sleep spindle activity in service members and veterans with and without the disorder. Sleep spindles are a marker of light sleep while slow wave activity indicates deep sleep, which is restorative and helps with brain function.
“Despite being a PTSD diagnostic criterion, cognitive alterations receive less attention in the literature when compared to other symptoms,” said McKeon while speaking at the Military Health System Research Symposium in Kissimmee, Florida. The disorder can have clear physical and psychological indicators, such as problems with memory and thinking. People may suffer from nightmares, flashbacks, and sleep difficulties. “However, these symptoms can and do have a chronic negative impact on … overall functioning and quality of life.”
Previous studies on sleep show a connection between performance and sleep. These studies have also shown shortfalls in areas like working memory, attention, and function – all of which are known to be impaired in PTSD, said McKeon. Impaired cognitive performance has been linked to reduced slow wave activity and sleep spindle activity, both of which are needed for brain power.
Since the disorder can cause issues with sleep, whether it is the inability to sleep or nightmares, slow wave activity in people who experience ongoing sleep restrictions can mark just the opposite – increased pressure for sleep, said McKeon.
“It’s an intriguing finding that we’re excited to further explore in future work,” said McKeon. “I think we’re just starting to scratch the surface of how to understand slow wave activity and its influence on cognition in those with PTSD.”
Experts are also looking into the use of biomarkers as a way to tell if an individual has PTSD, mild traumatic brain injury, or both. Dr. Anne Van Cott, a neurologist with the Department of Veterans Affairs and University of Pittsburgh, said there can be a big overlap between the symptoms of PTSD and mild traumatic brain injury, which are often found together in patients. In these cases, there can be an advantage to using magnetic resonance spectroscopic imaging or MRSI, she added. In addition to the images provided through MRI testing, clinicians can use MRSI to go in closer and measure biochemical changes in the brain in a noninvasive way.
“It can identify biochemical changes that would not be detected in conventional anatomical imaging studies,” said Van Cott, adding that the advantage of this technique is that researchers can study a much smaller part of the brain tissue, and it can be done faster. Van Cott tried to find patients suffering from only PTSD, but found that many of the patients actually dealt with mild traumatic brain injury as well. During the study, she found veterans with only PTSD or with both PTSD and TBI had abnormalities to the left hippocampus, considered the center of emotion and memory, as compared to the control group.
“We believe … MRSI may serve as one reliable diagnostic biomarker for identifying military service personnel with PTSD, and military personnel with PTSD and mild traumatic brain injury,” said Van Cott. “There is some hope, based on the small sample size we have, that … MRSI may be able to distinguish between patients with PTSD alone and those with both, which is what I think we see clinically.”
The Military Health System Research Symposium brought medical providers, researchers, and senior leaders together to share research and health care advancements. The symposium highlights research for combat casualty care, operational medicine, clinical and rehabilitative medicine, and infectious diseases.
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Magnets show promise in relieving depression, post-traumatic stress symptomsA patient undergoes a procedure that stimulates the frontal part of the brain with a rapidly changing magnetic field. The treatment is seen as an alternative for techniques to treat post-traumatic stress. (Air Force photo by Staff Sgt. Chad Usher)An alternative treatment for posttraumatic stress disorder might come in the form of a magnet. Researchers are studying a technique called repetitive transcranial magnetic stimulation, which applies a rapidly changing magnetic field to the front part of the brain.
“This pulse affects the medial pre-frontal cortex (the front area of the head and brain), where you make decisions about processing personal information, such as autobiographical memories [affecting post-traumatic stress],” said Army Maj. John Coleman with the department of clinical investigation at Tripler Army Medical Center in Hawaii. Stimulating the neurons there can increase serotonin, a biochemical in the brain thought to regulate moods, he said.
Coleman studied the effects of the treatment on 77 patients who came into his clinic. Overall, the treatment significantly lowered depression and post-traumatic stress index scores, meaning patients felt less depressed and had fewer post-traumatic stress symptoms after treatment. Used since 1995, not only does the treatment help with post-traumatic stress, it also keeps warfighters off specific meds, such as those known commercially as Zoloft and Prozac, which can disqualify them from some kinds of military work.
“In certain duties, such as submarine duties, people aren’t allowed to take some medications. They’re instantly unfit for duties,” said Coleman, pointing out this magnetic treatment carries no such disqualifiers. “It’s a nonmedication treatment, still doing what we want.”
Coleman’s research was part of a larger discussion on complementary and alternative techniques to treat post-traumatic stress held during the Military Health System Research Symposium in Kissimmee, Florida. Topics ranged from more conventional means, such as using a 100-year-old technique to block a certain nerve ganglion in the neck, to other methods, such as yoga and transcendental meditation.
Ronald Hoover, the clinical and psychological health research portfolio manager with the Army’s Medical Research and Materiel Command, moderated the discussion and said it’s important to look at different ways to treat ailments.
“There are alternatives to treating [post-traumatic stress] that go beyond either a medication or psychotherapy approach,” said Hoover. “Some people don’t want to take medications because of the impact on their career. Similarly, some patients find psychotherapies to be very intrusive and time consuming. They’d rather handle the problem themselves, because as part of their basic training, they’re taught to be self-sufficient, and they want to carry that into their health care.”
Using alternative therapies isn’t a new concept, as art and music therapies have been used for a while in main military clinics. “The whole idea behind complementary and alternative medical interventions is to offer a large variety of alternatives to the conventional treatments or augment those conventional treatments and allow the individual some choices in his or her care,” said Hoover.
Hoover said the symposium not only provides updates on the state of the science, it also stimulates even more research.
“It should give a great menu of choices for clinicians and patients,” said Hoover, adding people are particularly interested in meeting the challenges of post-traumatic stress without some of the stigmas some people might have with seeking this kind of help. “We’re looking for alternatives that are more palatable for service members and empower them to make a choice.”
The Military Health System Research Symposium is the only large, broad-based research conference focusing on the unique medical needs of the military.
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Research Symposium provided forum for collaborationDr. Terry Rauch (center), acting deputy assistant secretary of Defense for Health Readiness Policy and Oversight, chats with fellow attendees of the Military Health System Research Symposium, just completed in Kissimmee, Florida. (Photo: Greg Pugh, U.S. Army Medical Materiel Agency)At a table just outside a conference room sits a trauma doctor. Across the table is a psychologist. Meanwhile, a neuroscientist joins the conversation and talks about recent research done in his specialty. Their common ground: patients in the Military Health System who present with diverse symptoms, including brain injuries. As they talk, notes are scribbled on napkins and passed back and forth as they share information about patients who have gone through similar traumas and now face different issues. The recently completed Military Health System Research Symposium gave providers such as these the forum to find common areas in treatment of warfighters, retirees, and their families.
“It’s about building new scientific relationships, building interdisciplinary relationships,” said Dr. Terry Rauch, acting deputy assistant secretary of Defense for Health Readiness Policy and Oversight. “If you get various disciplines all around the table at the same time, focused on a common problem but looking at it in different ways, it produces remarkable opportunities.”
While some areas can be handled through virtual conference means, what’s learned at this meeting is incredibly valuable, said Rauch. “I really think to get the full benefit of a scientific conference, you got to have people go eyeball to eyeball and exchange information. It’s more personal than email.”
Dr. Kelley Brix, a physician and division chief with the Defense Health Agency’s Research and Development directorate, thrived on the interactions. “People can meet each other who are doing parallel and related work, sit down and say, ‘I’m grappling with a similar problem. What do you think about this?’” said Brix. “New, long-lasting collaborations come out of these conferences.”
Brix pointed to how injuries often need to be looked at in a whole-person way. This conference facilitates those conversations between the varied providers.
“The issue is providing the right care, for example, for someone who has a severe traumatic brain injury who, at the same time, has other multiple injuries and is hemorrhaging,” said Brix. “To treat the hemorrhage, there is a set of guidelines which can be contradictory to treating someone with a brain injury. This is the kind of multi-disciplinary conference where you can get people together from different medical disciplines and balance the needs of the patient.”
Rauch said in the future, he’d like to see even more presentations and conversations on what has been moved from the lab to the field for actual use.
“Those are the most challenging because, as scientists, sometimes we are challenged in taking our research effort and transitioning it with a commercial partner, which will do the manufacturing or prototyping or engineering of that device or drug or molecule, and then bring it back to us to put in our kits for service members to carry and use,” said Rauch. “One of the ultimate measures of how well we do is how well we translate findings into use.”
This year’s research symposium in Kissimmee, Florida, was the biggest so far, attracting attendees from military medicine, academia, and civilian health care practice from around the world. Rauch said he’s not surprised at how much it has grown.
“I see the momentum and enthusiasm that has been built into this conference,” said Rauch. “But I’m a scientist. I try to facilitate conversations. I run around the conference, grab people, and get on my cell phone and call somebody else and tell them, ‘Get down here now. I want you to talk to this person about the work you’re doing because they’re doing similar work, but approaching it differently.’ This is my element.”
And apparently for the thousands who attended, it was their element as well.
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