Female Soldiers At Greater Risk for PTSD

US_Flag_Flying_1Results of a 3-year longitudinal study of 2665 female National Guard soldiers began in 2008 of their mental health status before and after their deployment to Iraq provides new evidence that women have more than twice the risk of developing combat-related posttraumatic stress disorder (PTSD) than their male counterparts, 18.7% vs. 8.7%. Women soldiers, with the same level of combat exposure, are also much less likely than men to feel prepared for combat (14.3% vs. 32.2%) or to take advantage of unit cohesion, which are the two most important protective factors against PTSD.

When we investigated the reasons for this we found men felt much more prepared for combat than women, and they were also much more likely to feel they had the support of their unit than women.—Anna Kline, Ph.D. Principal Investigator, Department of Veterans Affairs–New Jersey Health Care System, East Orange

The results of this study, presented May 17 at the American Psychiatric Association 2011 Annual Meeting, confirm previous studies among the general population, which have shown a higher prevalence of PTSD from all causes among women compared with men. What made this study among servicewomen possible was the higher percentage of female soldiers in combat zones, which in Operation Iraqi Freedom and Operation Enduring Freedom reached a high of 14% of total deployed forces.

According to the researchers, these findings may be more accurate because the study was conducted in anonymity. This factor alone may have improved the reliability of findings, as asking sensitive questions about mental health and substance use among identifiable servicemen and women has been shown to produce less that candid responses.

"The military now has integrated gender-based basic training so men and women do prepare together. However, it is possible that even if they get exactly the same training, their perceptions [of training] could be very different. It is also possible that training is geared more towards the strengths of men, so they feel more prepared to handle the rigors of combat. These are areas that need further investigation," said Dr. Kline.

The Bipolar Hippocampus

aavanGogh_1888_PontLAngloisA Vanderbilt University study just published in the Archives of General Psychiatry reveals that hippocampal interneurons are modified by bipolar depression. The hippocampus is an important component of the limbic system that acts as the switching center through which incoming sensory signals are retransmitted and initiate behavioral reactions for different purposes. Its importance has been demonstrated empirically: experimental artificial stimulation of the hippocampus can induce a wide variety of behavioral patterns such as pleasure, rage, passivity, or excessive sexual drive. Because of its central function in the modulation of emotions, the hippocampus is believed to have a role in mood disorders such as depression. Numerous postmortem studies conducted on the brain of individuals who were affected by bipolar disorder have shown a decreased density and decreased gene expression of hippocampal interneurons. These findings, however, had not been confirmed by neuroimaging studies of hippocampal volume and function in live subjects—until now.

hippocampal_anatomyTo assess hippocampal volume, neuron number, and interneurons the Vanderbilt study examined sample brain specimens of hippocampi from 14 individuals with bipolar disorder and compared them to those taken from 18 healthy control subjects. The specimens, provided by the Harvard Brain Tissue Resource Center at McLean Hospital, were cut at 2.5-mm intervals and sections from each tissue slice were either Nissl-stained or stained with antibodies against somatostatin or parvalbumin. Messenger RNA was extracted from fixed tissue and real-time quantitative polymerase chain reaction was performed.

The researchers analyzed each sample by measuring the volume of pyramidal and nonpyramidal cell layers, overall neuron number and size, number of somatostatin- and parvalbumin-positive interneurons, and messenger RNA levels of somatostatin, parvalbumin, and glutamic acid decarboxylase 1.

After comparing healthy and unhealthy hippocampal samples, the study showed that the 2 groups did not differ in the total number of hippocampal neurons, but the bipolar disorder group showed reduced volume of the nonpyramidal cell layers, reduced somal volume in cornu ammonis sector 2/3, reduced number of somatostatin- and parvalbumin-positive neurons, and reduced messenger RNA levels for somatostatin, parvalbumin, and glutamic acid decarboxylase 1.

According to the researchers, these results indicate a specific alteration of hippocampal interneurons in bipolar disorder, which is likely to produce a hippocampal dysfunction that can have, among other manifestations, an effect on the onset and severity of bipolar depression.

Stress in Pregnancy a Health Risk for the Child

aavanEyck_1434_ArnolfiniMarriageAn anxious expectant father can make a pregnant woman more anxious, and their combined higher level of stress can have a negative influence on the health of their newborn child. While it is a well-known fact that significant mental distress in pregnant women due to anxiety, lack of social support or low self-esteem can result in higher health risks for the infant child, the impact of fathers’ anxiety heretofore had not been examined.

A new study shows that the stress related to pregnancy uniquely affects the mental health of expectant fathers, and that this in turn also has an effect on the health of expectant mothers and their infants. A University of Missouri researcher arrived at these conclusions by examining the underlying factors of the Prenatal Psychosocial Profile as a composite measure of stress, support from partner, support from others and self-esteem; and compared factor structures between pregnant women and expectant fathers.

The study, recently published in the Journal of Advanced Nursing was conducted on 132 expectant mothers and fathers in a sample of 66 low-income couples living in rural Missouri between 2006 and 2008.

Similarities and unique differences between expectant fathers and mothers were found. Among the stress factors, ‘problems related to family’, ‘the current pregnancy’ and ‘feeling generally overloaded’ were perceived as financial stressors by men but as emotional stressors by women. In terms of perceived partner support, women believed they were receiving more tangible support from their partners through actions such as help with tasks or care, while men felt that they were receiving more emotional support.

Among study participants, women had higher self-esteem than men during pregnancy. The assessment of psychosocial well-being in both women and men during pregnancy, especially careful assessment of stressors of pregnancy is deemed useful not only in establishing stress levels and providing adequate stress management tools to both men and women, but most especially in ensuring that reduced levels of stress and anxiety are less likely to impact the health of their infant child.

The Stress of… Stress

ClareIsland_EN-US2748591595There are times in which the stress reaction and the level of anxiety caused by a stressor are so high that the body’s reactions become extreme and add to the burden. Stress becomes stressful in itself and a problem of its own. Although the stress reaction itself is normal and necessary for survival, learning and for personal growth, the body’s reaction to the increased alert level causes a predictable and rather universal set of physical changes. These include:

  • Increased central nervous system activity—a state of full awareness
  • Increased mental activity and brainwave activity—full mental alert
  • Increased secretion of adrenaline (epinephrine), noradrenaline (norepinephrine), and cortisol into the bloodstream—a state of endocrine mobilization
  • Increased heart rate, cardiac output, and blood pressure—the way in which the body prepares to meet the physical demands of the stressor
  • Increased breathing rate, breathing airways dilation—brings more oxygen into the lungs
  • Increased metabolism, oxygen consumption, oxygen to the brain—oxygen is the principal sustainer of life for brain cells and for the whole body
  • Blood is diverted away from the digestive tract and directed into the muscles and limbs—the processing of food become secondary to averting or confronting the danger
  • Increased muscle contraction, which leads to increased strength—for either fight or flight, muscle readiness is automatically brought to the highest levels
  • Increased blood coagulation (blood clotting ability)—helps the body minimize the impact of possible injuries
  • Increased circulation of free fatty acids, a source of cellular energy—contributes to the readiness of the body to greater energy expenditure
  • Increased output of blood cholesterol—makes the blood richer in nutrients to be carried to muscles and other organs
  • Increased blood sugar released by the liver, to nourish the muscles—another important source of energy for best performance and strength
  • Release of endorphins from the pituitary gland—an activating hormone that boosts alertness throughout the body
  • Pupils of the eyes dilate—increases field and acuity of vision
  • Hair stands on its end—a remnant from the time when hair covered the most vulnerable body parts
  • Blood thins—this speeds up blood circulation for faster travel from center to periphery and back
  • Sweat glands increase secretion—a well lubricated body presents a slippery surface in a fight and cools it down below dangerous heat levels
  • Increased secretion from apocrine glands resulting in foul body odor—designed to repulse enemies
  • Capillaries under the surface of the skin constrict with a consequent increases in blood pressure—blood pumping to all parts of the body is enhanced
  • Immune system is suppressed–the immune system may have energy made available for it via reduction of other activities, may change in energetically conservative ways when the protection it confers needs to be balanced with the energetic demands of other activities such as fight or flight, or may be suppressed when other activities are more important than immunity for total well-being
  • Reproductive and sexual systems stop working normally—in times of high stress, sex and reproduction take a back seat to survival and protection
  • Decreased perception of painthe analgesia system, a pain suppressing mechanism that effectively shuts off sensory transmission to the brain, so that we are permitted to go about the business of getting out of the gravest danger without the crippling sensations of pain.

Stressed_WomanNo command is needed to activate these reactions that are programmed in the genetic code. Moreover, they cannot be prevented from occurring, except to a limited extent. At best, one can learn to control what is visible to others and, in some individuals, the heart rate can be somewhat controlled.

This cascade of physical reactions is good in two ways. First, when there is a danger or threat of some sort (e.g., a bus coming straight at us) we are instantaneously aroused into action: we step out of the bus’s path without really planning to do so, automatically. In this way, we have a chance to avoid and/or survive many physical threats to our well being. This ability enabled a  physically weak human race to survive and thrive among larger and stronger animals, earthquakes, fires, and interpersonal conflict during our long history on this planet. Can we imagine surviving very long without the mobilization caused by the stress reaction alarm system?

Second, we are programmed to respond not only to physical threats but also, and more importantly in our society, to non-physical threats that are emotional, social or psychological in nature. This is of great value because most threats nowadays come from circumstances of social living, such as relationships, jobs, economics, politics, environment, and technology.

Unfortunately, the stress reaction can be so overwhelmingly strong that we become stressed by stress itself, incapable of moving beyond its mesmerizing message of danger. Changing back the focus from the stress reaction to the stressor is the key to making an appropriate use of this vitally important warning system. It is also the key to responding vs. simply reacting. Learn this, and stress becomes the alert system most useful in navigating the treacherous straits of modern life.

Worst Stress Relievers: Prescription Drugs

SvetiJovan_EN-US1096946935More and more people in America seek relief from stressors by using artificial means, rather than developing the skills needed to cope with them naturally. Overdose mortality has now become a pressing public health problem. According to statistics released by the Centers for Disease Control, between 1999 and 2007 the rate of unintentional overdose in the United States has increased by 124%. Experts attribute this phenomenon to the exponential increase in prescription opioid overdoses. Some evidence suggests that the risk for drug-related adverse events is higher among individuals who are prescribed opioids at doses equal to 50 mg or more per day of pure morphine.

The abuse of opioid pharmaceuticals has been growing steadily for 10 years and has gotten to a point where it now overshadows all the other drug problems in the United States, certainly more so than heroin and cocaine. —Dr. John A. Renner, Associate Professor of Psychiatry at Boston School of Medicine in Massachusetts, Director of the Addiction Psychiatry Residency at the Boston VA.

According to a report by the IMS Institute for Healthcare Informatics, The Use of Medicines in the United States: Review of 2010, published April 2011, a prescription pain killer tops the list of the 10 most prescribed drugs in the U.S.  In order of number of prescriptions written in 2010, the 10 most-prescribed drugs in the U.S. are:

  1. Hydrocodone (combined with acetaminophen) — 131.2 million prescriptions
  2. Generic Zocor (simvastatin), a cholesterol-lowering statin drug — 94.1 million prescriptions. It is a known fact that an increased ability to cope with stress positively correlates with “good” cholesterol levels.
  3. Lisinopril (brand names include Prinivil and Zestril), a blood pressure drug — 87.4 million prescriptions. While there is no direct proof that stress by itself causes long-term high blood pressure, other behaviors linked to stress — e.g., overeating, drinking alcohol and poor sleeping habits — do cause high blood pressure. The short-term stress-related spikes in blood pressure caused by chronic stress may put individuals at risk of developing long-term high blood pressure.
  4. Generic Synthroid (levothyroxine sodium), synthetic thyroid hormone — 70.5 million prescriptions
  5. Generic Norvasc (amlodipine besylate), an angina/blood pressure drug — 57.2 million prescriptions
  6. Generic Prilosec (omeprazole), an antacid drug — 53.4 million prescriptions (does not include over-the-counter sales). The relationship among stress, psychological traits associated with chronic anxiety, acid reflux parameters, and perceptions of reflux symptoms has been established in numerous studies published in the last ten years.
  7. Azithromycin (brand names include Z-Pak and Zithromax), an antibiotic — 52.6 million prescriptions
  8. Amoxicillin (various brand names), an antibiotic — 52.3 million prescriptions
  9. Generic Glucophage (metformin), a diabetes drug — 48.3 million prescriptions
  10. Hydrochlorothiazide (various brand names), a water pill used to lower blood pressure — 47.8 million prescriptions.

The most prescribed drugs, however, are not the ones generating the highest income for pharmaceutical companies. According to the IMS report, Americans spent a staggering $307 billion on prescription drugs in 2010. The 10 best selling drugs are:

  1. Lipitor, a cholesterol-lowering statin drug — $7.2 billion
  2. Nexium, an antacid drug — $6.3 billion
  3. Plavix, a blood thinner — $6.1 billion
  4. Advair Diskus, an asthma inhaler — $4.7 billion. A connection between the development of infantile asthma and environmental stress, and adult stress and anxiety has been long established. That psychogenic factors can contribute to the onset and severity of asthma has been known for decades.
  5. Abilify, an antipsychotic drug — $4.6 billion. Usage of this drug developed to treat serious mental illness such as schizophrenia has grown significantly, primarily for stress and anxiety reduction, uses which the FDA has not approved.
  6. Seroquel, an antipsychotic drug — $4.4 billion. This drug, also developed to treat serious mental illness, is increasingly popular since it has been “discovered” to be an effective sleeping aid, a use which the FDA has not approved.
  7. Singulair, an oral asthma drug — $4.1 billion
  8. Crestor, a cholesterol-lowering statin drug — $3.8 billion
  9. Actos, a diabetes drug — $3.5 billion
  10. Epogen, an injectable anemia drug — $3.3 billion

It is interesting, and quite frankly worrisome, to note that so many of the drugs on the most prescribed and the best-selling lists target symptoms such as hypertension, hypercholesterolemia, gastric acidity, asthma, sleeplessness, and psychogenic pain that are directly associated with psychological disorders. These include unipolar and bipolar depression, anxiety, and primary insomnia. The inability to cope with stressors that, in our modern society, are primarily psychological in nature is paving the way for an overmedicated nation where stress signals that should mobilize individuals to take effective action are simply shut off, smothered by mass-produced chemical compounds. There are much better stress relieving approaches that do not include medication and that can enable us to face our challenges with a clearer mind, no side effects and a fatter pocketbook.

Stress Hardware Review: The HPA

ScenicSkyway_EN-US2786891862In addition to genetic factors, there are many external factors that influence our individual vulnerability to stress, including childhood trauma, early environmental factors, major life events or physical illness. These factors can influence the intensity and duration of our stress reaction, in many cases producing long-lasting effects. The stress caused by traumatic events may cause chronic stress syndromes such as PTSD, promote the onset of physical disease or worsen existing conditions, including rheumatoid arthritis, chronic pain, fibromyalgia, and multiple sclerosis, among others.

However, while individuals vary greatly in their ability to respond adequately to stressful situations, every human body is programmed and equipped to respond to the initial stressor in the same biochemical way. Among the principal structures that are immediately mobilized in the event of a physical or psychological threat is the hypothalamic-pituitary-adrenal axis (HPA). The HPA consists of three elements connected by blood vessels: the hypothalamus, the pituitary gland, and the adrenal glands. Their functioning depends almost entirely on a sequence of cascading chemical signals.

The HPA Structures and Their Chemical Output

The paraventricular nucleus (PVN) of the hypothalamus is a heterogeneous collection of specialized neurons that, when activated by stress, release corticotrophin releasing hormone(CRH) in the bloodstream. The hippocampus is an important component of the negative-feedback regulation of the neuroendocrine stress response.

PituitaryGlandThe pituitary gland or hypophysis is a very small gland (one-third of an inch in diameter and one twentieth of an ounce in weight) located in a bony cavity at the base of the brain, and connected to the hypothalamus by the pituitary stalk. The pituitary two main components are the neurohypophysis that grows from the floor of the hypothalamus, and the adenohypophysis which releases adrenocorticotropic hormone (ACTH). The hormones released by the pituitary exert strong regulatory control over a wide range of bodily functions, including behavior, growth and development, metabolism, salt and water balance, reproduction and immunity. Stress influences the neuroendocrine regulation of a number of pituitary hormones including ACTH, prolactin, growth hormone, luteinizing hormone, thyrotrophin, vasopressin and oxytocin.

The adrenal glands are located in an area that lies dorsal to the kidney and release the glucocorticoid cortisol or corticosterone.

The HPA’s Starring Role in Stress Regulation

The appropriate functioning of the HPA axis is absolutely vital for species survival in humans and in all vertebrates. The HPA axis functions as a closed-loop system involving tight negative-feedback control regulated by the glucocorticoids. Automatic regulation of the HPA axis is essential for ensuring that the stress reaction is terminated after the stressor subsides, thus preventing continuous excessive activation and a healthy return to internal homeostasis.

How the HPA Responds to Acute and Chronic Stress

Most stressors affecting human life can be classified as either systemic or neurogenic stressors. Systemic stressors include all physical stressors that are a challenge to physical well-being and integrity of the body. Neurogenic stressors include those stressful stimuli that have a predominantly emotional or psychological component, such as fear or anxiety.

Exposure to acute stressors produces an immediate and intense activation of the HPA axis which results in enhanced secretion of ACTH and glucocorticoids. The HPA axis responds to the intensity of each individual stressor, in such a way that repeated or intensified stress results in increased secretion of the stress hormones. Regardless of the type of stimuli that cause an acute stress reaction, the removal of the stressor produces the return of HPA-axis activity to baseline or homeostasis.

In chronic or long-lasting stress, the exact mechanisms that produce long-term activity of the HPA axis and the near-continuous secretion of stress hormones remain largely unknown. However, numerous studies have revealed that the de-activating sequences essential to the maintenance of HPA axis integrity, including negative-feedback control, become dysregulated by prolonged stress stimulation.

Most researchers agree on the hypothesis that a defective over-activation of the HPA axis and the associated excessive secretion of powerful glucocorticoids can cause prolonged suppression of the immune system and dysregulation of immune cells, ultimately predisposing the chronically stressed individual to autoimmune disease. On the other side of the equation, the under-activation of the HPA axis has significant implications for our ability to recognize threats and be able to react to them accordingly.