Posttraumatic Stress Disorder Shifting Toward a Developmental Framework

Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Stanford School of Medicine, Stanford University, 401 Quarry Road, Stanford, CA 94305, USA.
Child and adolescent psychiatric clinics of North America (Impact Factor: 2.88). 07/2012; 21(3):573-91. DOI: 10.1016/j.chc.2012.05.004
Source: PubMed


This article reviews the current classification of posttraumatic stress disorder and its limitations when applied to youth. Distinctions are made between single-event and multiple-event traumas. Diagnosis, neurobiology, treatment development, and treatment outcomes are presented. A summary of current empirical interventions is provided. The authors present implications for future research and for clinical practice.

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    • "Current evidence also suggests that erasure is specific to early temporal windows following a traumatic event (1–3 days later), as rodents undergoing later extinction training exhibit long-term hyper-vigilance rather than complete erasure (17). Understanding the mechanisms underlying these age-related changes in fear system plasticity may contribute to the better understanding of fear disorders, such as post traumatic stress disorder (PTSD), that are characterized by the re-experiencing of the traumatic events, hyper-vigilance, and persistent dysfunctional wiring of fear circuitry (18, 19). "
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    ABSTRACT: Early temporary windows of heightened brain plasticity called critical periods developmentally sculpt neural circuits and contribute to adult behavior. Regulatory mechanisms of visual cortex development - the preeminent model of experience-dependent critical period plasticity-actively limit adult plasticity and have proved fruitful therapeutic targets to reopen plasticity and rewire faulty visual system connections later in life. Interestingly, these molecular mechanisms have been implicated in the regulation of plasticity in other functions beyond vision. Applying mechanistic understandings of critical period plasticity in the visual cortex to fear circuitry may provide a conceptual framework for developing novel therapeutic tools to mitigate aberrant fear responses in post traumatic stress disorder. In this review, we turn to the model of experience-dependent visual plasticity to provide novel insights for the mechanisms regulating plasticity in the fear system. Fear circuitry, particularly fear memory erasure, also undergoes age-related changes in experience-dependent plasticity. We consider the contributions of molecular brakes that halt visual critical period plasticity to circuitry underlying fear memory erasure. A major molecular brake in the visual cortex, perineuronal net formation, recently has been identified in the development of fear systems that are resilient to fear memory erasure. The roles of other molecular brakes, myelin-related Nogo receptor signaling and Lynx family proteins - endogenous inhibitors for nicotinic acetylcholine receptor, are explored in the context of fear memory plasticity. Such fear plasticity regulators, including epigenetic effects, provide promising targets for therapeutic interventions.
    Full-text · Article · Nov 2013 · Frontiers in Psychiatry
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    • "For example, amygdala dysfunction has been identified in many neuropsychiatric disorders including classic developmental disorders such as Autism [4], William’s Syndrome [5], and Schizophrenia [6,7], Post-Traumatic Stress Disorder (PTSD) [8], and other anxiety disorders [9]. Interestingly, these syndromes are now thought to have a strong developmental component [10]. Thus, understanding not only the basic functions of the amygdala, but also how its early perturbation may lead to specific behavioral deficits, which may or may not differ depending on the type of pathologic insult and/or the age at which the insult occurs, is hugely relevant for providing clinically relevant biomarkers and determining optimal treatment options. "
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    ABSTRACT: The amygdala is known to be a key neural structure in many neuropsychiatric disorders. Primarily known for its involvement in fear regulation, the amygdala also plays a critical role in appetitive flexible decision-making. Yet, its contribution to the development of flexible goal-directed behavior has not been thoroughly examined. The current study examined flexible decision-making abilities after neonatal amygdala lesions in nonhuman primates using a behavioral paradigm known to measure the flexible monitoring of goal-directed choices in rodents, monkeys, and humans. Rhesus monkeys of both sexes were divided into two groups, a sham-operated control group (N=4) and a group with neonatal neurotoxic amygdala lesions (N=5). Animals received the lesions at 1-2 weeks and were tested at both four and six years of age on a concurrent discrimination reinforcer devaluation task. Although neonatal amygdala damage spared learning stimulus-reward associations, it severely impaired the ability to flexibly shift object choices away from those items associated with devalued food rewards. The results were similar to those obtained in monkeys that had acquired the same lesions in adulthood. Thus, the amygdala is critical for appetitive decision-making, and provide further evidence of little functional sparing after early amygdala insult. The findings are discussed in relation to other behavioral measures on the same animals and to clinical neuropsychiatric disorders.
    Full-text · Article · Aug 2013
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    ABSTRACT: Background: About 7000 Swedish citizens were on Christmas holiday in the disaster area at the time of the South-east Asian tsunami in 2004, in many cases with children and adolescents in their families. Aims: To investigate how adolescents experience a traumatic exposure to a natural disaster. Method: Twenty adolescents aged 16-19 years, who had experienced the 2004 tsunami and participated in a follow-up study 19 months post-disaster, were randomly selected and interviewed about their reactions, their life afterwards and their families. The study combines the face-to-face, semi-structured interviews with questionnaire data on mental health for 4910 Swedish adolescents and adults. Results: The themes that emerged inductively during the analysis of the interviews were psychological reactions during the catastrophe, the coping after, changes in self-image, worldview, role in the family, risk interpretation and altruism. The disaster had profound impact on family relations, social networks and plans for the future. Many felt strengthened by the experience and by their ability to cope in comparison with other family members, but also perceived isolation and lack of understanding. The general mental health status among the adolescents did not differ significantly from those of older age at the 19-month follow-up. Conclusions: According to the adolescents', they experienced the tsunami-disaster differently than others around them. Their subjective interpretation of the event and its aftermath indicates resilience, especially among the young men. Future follow-up studies in larger samples of both symptoms and psychological functioning are warranted.
    No preview · Article · Feb 2013 · Nordic journal of psychiatry
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