Dataset Information

Reduction of Posttraumatic Stress Disorder (PTSD) Symptoms in PTSD and Major Depressive Disorder Comorbidity After Acute Hypoglycemia-A Case Report.

ABSTRACT: Background: Approximately half of all patients with posttraumatic stress disorder (PTSD) also suffer from major depressive disorder (MDD). This co-occurrence might lead to an impairment of cognitive functions, worse response to antidepressant medications, and an increased risk of suicide in comparison to patients with PTSD alone. Prognosis for people with PTSD and MDD co-occurrence is poorer than for either one alone; therefore, researchers look for novel, effective treatments. Case Presentation: A patient with MDD with the co-occurrence of PTSD was admitted to the Department of Endocrinology with suspicion of adrenal insufficiency. In order to assess the adrenocorticotropin/cortisol axis, a standard insulin tolerance test was performed. After inducing a hypoglycemic episode with intravenous short-acting insulin, PTSD symptoms were reduced. To the best of our knowledge, this is the first report on the reduction of PTSD symptoms after performing an insulin tolerance test. Conclusion: Reduction of PTSD symptoms in PTSD and MDD comorbidity has been noticed after a hypoglycemic episode. This demonstrates the mutual dependencies between the endocrine and nervous systems, covered extensively by psychoneuroendocrinology.

SUBMITTER: Pawlowski T

PROVIDER: S-EPMC6675865 | biostudies-other | 2019

REPOSITORIES: biostudies-other

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Reduction of Posttraumatic Stress Disorder (PTSD) Symptoms in PTSD and Major Depressive Disorder Comorbidity After Acute Hypoglycemia-A Case Report.

Pawlowski Tomasz T Daroszewski Jacek J Czerwinska Agnieszka A Rymaszewska Joanna J

Frontiers in psychiatry 20190726

<b>Background:</b> Approximately half of all patients with posttraumatic stress disorder (PTSD) also suffer from major depressive disorder (MDD). This co-occurrence might lead to an impairment of cognitive functions, worse response to antidepressant medications, and an increased risk of suicide in comparison to patients with PTSD alone. Prognosis for people with PTSD and MDD co-occurrence is poorer than for either one alone; therefore, researchers look for novel, effective treatments. <b>Case Pr ...[more]

PMID: 31404284

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Project description:IntroductionThe high smoking prevalence amongst individuals with psychiatric disorders constitutes a major public health disparity. Negative reinforcement models of addiction posit that severe tobacco withdrawal symptoms, related to the affective vulnerabilities of these smokers, may thwart their quitting smoking successfully. However, relatively few studies have prospectively examined the effects of nicotine deprivation on withdrawal symptoms in these groups.MethodsThis study compared the level of withdrawal symptoms both before and after nicotine deprivation in those diagnosed with posttraumatic stress disorder (PTSD) or major depressive disorder (MDD) and in those without psychiatric diagnoses. Participants were US veterans who smoked (≥10 cigarettes/day) and met diagnostic criteria for PTSD (n = 38), MDD (n = 43), or no psychiatric diagnosis ("controls" n = 44). Participants attended study visits before and during 48-hour nicotine deprivation to report tobacco withdrawal symptoms. Analyses evaluated withdrawal symptom levels (baseline and during nicotine deprivation) and the change in symptoms related to nicotine deprivation and compared (1) participants with a psychiatric diagnosis versus controls, and (2) participants with PTSD versus MDD.ResultsContrary to hypotheses, nicotine deprivation produced greater increases in most withdrawal symptoms amongst controls than in those with psychiatric diagnoses. Compared with controls, those with PTSD or MDD reported elevated symptom levels both before and after tobacco deprivation for most withdrawal symptoms.ConclusionsThese findings suggest that chronically high levels of distress and craving, rather than acute increases in withdrawal symptoms because of nicotine deprivation, may account for the quitting difficulties of those with comorbid conditions such as PTSD and MDD.ImplicationsSevere tobacco withdrawal may account for the higher quitting difficulties of smokers with either posttraumatic stress disorder (PTSD) or major depressive disorder (MDD). Paradoxically, this study showed that individuals with no psychiatric diagnosis had greater increases in tobacco withdrawal severity because of nicotine deprivation than did those with either PTSD or MDD. Those with either PTSD or MDD showed high stable levels of withdrawal symptom severity both before and during two days of abstinence, suggesting that their quitting difficulties may be related to their chronically high levels of distress rather than nicotine deprivation per se.

Project description:Background: Major Depressive Disorder (MDD) is a moderately heritable disorder with a high lifetime prevalence. At present, laboratory blood tests to support MDD diagnosis are not available. Methods: We used a classifier approach on blood gene expression profiles of a unique set of non-medicated subjects (MDD patients and controls) to select genes of which expression is predictive for disease status. To reveal blood gene expression changes related to MDD disease, we applied a powerful ex vivo stimulus to the blood, i.e. incubation with lipopolysaccharide (LPS; 10 ng/ml blood). Results: Based on LPS-stimulated blood gene expression using whole-genome microarrays in 42 subjects (primary cohort; 21 MDD patients (mean age 42.3 years), 21 healthy controls (mean age 41.9 years)), we identified a set of genes (CAPRIN1, CLEC4A, KRT23, MLC1, PLSCR1, PROK2, ZBTB16) that serves as a molecular signature of MDD. These findings were validated for the primary cohort using an independent quantitative PCR method (P = 0.007). The difference between depressive patients and controls was confirmed (P = 0.019) in a replication cohort of 13 patients with MDD (mean age 42.8 years) and 14 controls (mean age 45.6 years). The MDD-signature score comprised of expression levels of 7 genes could discriminate depressive patients from controls with sensitivity of 76.9% and specificity of 71.8%. Conclusions: We show for the first time that molecular analysis of stimulated blood cells can be used as an endophenotype for MDD diagnosis, which is a milestone in establishing biomarkers for neuropsychiatric disorders with moderate heritability in general. Our results may provide a new entry point for following and predicting treatment outcome, as well as prediction of severity and recurrence of MDD. In total, 33 MDD patients and 34 healthy controls were analyzed using basal gene expression in whole blood, and gene expression from whole blood that was stimulated with LPS for 5-6 h, using microarrays. Patients were arbitrarily selected from all patients to serve as primary cohort (nMDD = 21 (MDD01-MDD21); nControls = 21 (Con01-Con21)), or replication cohort (nMDD = 12 (MDD22-MDD35); nControls = 13 (Con22-Con37)) using microarrays. This submission does not include Samples CON21_LPS or CON30_LPS.

Project description:BackgroundDecisions under risk and with outcomes that are delayed in time are ubiquitous in real life and can have a significant impact on the health and wealth of the decision-maker. Despite its potential relevance for real-world choices, the degree of aberrant risky and intertemporal decision-making in patients suffering from major depressive disorder (MDD) and posttraumatic stress disorder (PTSD) has received little attention to date.MethodWe used a case-control design to compare decision-making in healthy control subjects (N=16) versus untreated depressed subjects in a current major depressive episode (N=20). In order to examine how major depressive disorder (MDD) may impact decision-making, subjects made decisions over (1) risky outcomes and (2) delayed outcomes in the domain of gains and losses using choice paradigms from neuroeconomics. In a pre-planned analysis, depressed subjects were subdivided into those with primary PTSD along with comorbid MDD (MDD+PTSD) versus those with primary MDD without PTSD (MDD-only). Choice behavior was modeled via a standard econometric model of intertemporal choice, a quasi-hyperbolic temporal discounting function, which was estimated for each subject group separately.ResultsUnder conditions of potential gain, depressed subjects demonstrated greater discounting for gains across all time frames compared to controls. In the realm of losses, both subgroups of depressed subjects discounted more steeply than controls for short time frames. However, for delayed losses ranging from >1-10 years, MDD+PTSD subjects showed shallower discounting rates relative to MDD-only subjects, who continued to discount future losses steeply. Risk attitudes did not contribute to differences in intertemporal choice.ConclusionsDepressed patients make choices that minimize current pain and maximize current reward, despite severe later consequences or lost opportunities. Anxiety associated with PTSD may serve as a partially protective factor in decision-making about long-term potential losses compared to MDD patients without PTSD.

Dataset Information

Reduction of Posttraumatic Stress Disorder (PTSD) Symptoms in PTSD and Major Depressive Disorder Comorbidity After Acute Hypoglycemia-A Case Report.

Publications

Reduction of Posttraumatic Stress Disorder (PTSD) Symptoms in PTSD and Major Depressive Disorder Comorbidity After Acute Hypoglycemia-A Case Report.

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