Active clinical trials for "Stress Disorders, Post-Traumatic"

The primary objective is to examine the percentage of patients with PTSD who were prescribed an antipsychotic over the past seven years in the VA Network 7 (AL, GA, SC) and compare the percentage on an annual basis. We will also determine the type and dose of antipsychotics received. We hypothesize that there has been a significant increase in antipsychotic use, especially atypical antipsychotics, prescribed for patients with PTSD over the last 7 years

Assessing FM and psychiatric state among PTSD, MDD and healthy participants

The primary goals for this investigation are to quantify: (1) fluctuations in PTSD symptom reports when assessed at bi-weekly intervals; (2) change in PTSD symptoms associated with stressful life events; and (3) change in PTSD symptoms associated with perceived social support.

Studies have shown that admission to hospital during a coronavirus epidemic is associated with increased levels of anxiety, depression and panic disorder. During the SARS-CoV-2 pandemic in North London the Royal Free Hospital admitted over 500 patients with Covid-19. As part of the standard of care, these patients are screened at 8 weeks post discharge for signs of anxiety and depression. The Feeling Good app is a NHS approved digital application which utilises applied relaxation, mindfulness based cognitive therapy and positive visualisation through audio tracks for the treatment of anxiety and depression. This is a naturalistic cohort study aimed to track the post illness psychological symptoms of those who have been admitted with Covid-19 to the Royal Free hospital up to 5-7 months after discharge. The study population is those who are exhibiting anxiety or depressive symptoms as measure by the PHQ-2 or TSQ questionnaires. All those with symptoms will be offered free access to a NHS approved app for anxiety and depression, and followed up for 3 months after recruitment to track changes to their symptoms.

The epidemic of coronavirus induces a major influx of patients implying a rapid modification of the organizations, a work overload and a significant stress for the care teams and supports of the hospitals of the Assistance Publique - Hôpitaux de Paris (AP-HP) . To this is added the impact on each professional of the large number of very severe patients to be treated, of death and the anxiety of contamination, reinforced by the actual cases of staff themselves sick. Emergency phone numbers for professionals in the event of psychological suffering were quickly put in place at the AP-HP and Hospitals level. The objective of this study is to assess the psychopathological and psycho-traumatic consequences of this exceptional situation on the staff, during the epidemic and at a distance from it, in order to be able to target the solutions to be implemented. Hypothesis is that some personnel may develop one or more of the following disorders: adjustment disorder or other anxiety disorder, acute stress disorder, post-traumatic stress disorder (PTSD), and depressive episodes as defined in the DSM-5. This study also aimes to assess effect of support measures put in place, by comparing the evolution of those who benefited from those who did not use them, as well as the risk factors specific. The results will make it possible to have an estimate of the percentage of people who may require specific support, and to identify the staff most at risk, and thus predict the importance of the circuits and structures for support of staff which will be necessary in the short and long term. The main anticipated risk factors are: being a nurse, having a low number of years of professional experience, and being on the front line of care for affected patients.

Traumatic events may lead to strong emotional episodic memories common in Post- Traumatic Stress Disorder(PTSD). Intense affect may inhibit efficacy of glutamatergic neurotransmission in two particular areas of the limbic system that have been implicated in the processing of emotionally charged memories: the amygdala and the hippocampus(1,2). Dysfunction of glutamatergic neurotransmission is associated with disbalance of long-term potentiation (LTP) and long-term depression (LTD)- two underlying mechanisms that cooperate to achieve synaptic plasticity and its expressations- learning and memory(3). LTP- the long lasting enhancement of synaptic function includes changes in the amount of neurotransmitter glutamate released into a synapse, changes in the levels of key proteins in synapses, protein phosphorylation and changes the density of receptors on their synaptic membranes. LTD is the inverse of LTP, a long lasting reduction in synaptic transmission (4). Interactions among the different forms of plasticity underlie different forms of memories. Normally these mechanisms are balanced. In the current literature there is data that a class I major histocompatibility complex (MHC class I) molecules, known to be important for immune responses to antigen, are expressed also by neurons that undergo activity-dependence, long-term structural and synaptic modifications (5). The brain produces its own immune molecules, the proteins MHC class I and CD3-zeta (a component of receptors for MHC class I). In the immune system, the two proteins act as part of a lock and key system to recognize and get rid of the body's foreign invaders. The CD3-zeta polypeptide is component of the T cell antigen receptor (TCR) which contribute to its efficient cell surface expression and account for part of its transducing capability (6). In the brain, they may be part of a signaling system that recognizes and eliminates inappropriate neural connections. Expression of MHC class I is regulated by the naturally occurring electrical activity, and sensitive to both natural and pathological changes in the activity. Electrical activity of neurons drives to an establishment of the final pattern of connection. Changes in the strength of individual synapses such as potention and depression leads to stabilization and withdrawal, respectively, of the affected connections. There are data, that in mice with deficiency of MHC class I and CD3-zeta the LTP in the hippocampus is enhanced significantly and LTD is absent. Thus, MHC class I is crucial for translating activity into changes in synaptic strength and neuronal connectivity in vivo. He required for normal activity dependent potentiation, depression, removal of inappropriate connection and responding to injury in the CNS (6). Glutamate receptors play critical roles in LTP/LTD mechanisms. Some researchers consider that a key role in pathogenesis of PTSD is being played by excessive excitation of NMDA-receptors in limbic system structures (1). The existing data allows to assume, that equation of plasticity mechanisms depends on mutual relations between the MHC class I and glutamate receptors. T-cells, like neurons, express high levels of glutamate receptors that are identical to the brain glutamate receptors. Presence of ionotropic and metabotropic glutamate receptors in membranes of lymphocytes makes them sensitive to the same alarm molecules which operate neuronal activity. Glutamate by itself triggers several T-cell activation which differs quantitatively or qualitatively from that ones triggered by "classical' T-cell activators like antigens(7). There are data about influence of T cell receptor-CD3 complex- on the expression of T-cells glutamate receptors (8). It is possible, that the key roles in this function play CD3-zeta.

Brain injury from explosive blast is a prominent feature of contemporary combat. Although protective armor and effective acute medical intervention allows soldiers to survive blast events, a growing number of veterans will have disability stemming from blast-related neural damage. Soldiers also return from combat with psychological disabilities caused by traumatic war events. The clinical presentation of individuals with blast-related neural damage and post-traumatic psychopathology are markedly similar and thus a clear description of the direct consequences of explosive blast is complicated by the emotional and cognitive sequelae of psychological trauma. We will use sophisticated measures of neural function and structure to characterize brain injury from explosive blasts in a sample of Operation Iraqi Freedom (OIF) National Guard soldiers who returned from deployment in the fall of 2007. Survey data gathered near the end of deployment indicated that over 50% of the brigade had been exposed to direct physical effects of explosive blasts. To fully characterize the effects of blast on the brain and differentiate them from post-traumatic stress disorder, we will contrast groups of soldiers exposed to blast and with groups experiencing post-traumatic stress disorder. This investigation will improve the characterization of blast-related traumatic brain injury, describe the essential features of the condition in terms of neural function and structure to inform diagnosis, and characterize mechanisms of recovery after blast-related neural injury to allow the creation of interventions that return soldiers to maximum levels of functioning.

'Post perfusion syndrome' was a term historically associated to cardiac surgery in view of the transient neuro-cognitive deficits attributed to cardio pulmonary bypass pump. During their recovery period, a significant number of patients experience delirium, a clinical syndrome of acute onset and fluctuant course.Though these deficits are often known to be transient without any permanent physical or neurological impairment, the experience can still psycho-socially affect these patients for a longer length of time even after discharge. The presence of delirium puts excessive, undesired strain on the patient, their families, health care providers and hospital resources. PTSS is an anxiety disorder caused by very stressful, frightening or distressing events. It is known to either develop immediately after the disturbing event or weeks and months later. The actual symptoms can be varied but are categorized in three sections: i.e.: re-experiencing, avoidance and emotional numbing and hyperarousal (feeling 'on edge'). A problem that has such an impact on any patient is worth investigating and understood better. Being in such a unique professional position, as a Clinical nurse practitioner, the investigator is ideally placed to conduct this study. In this study, the researcher will be focusing on the pre-operative risk factors in developing delirium, actual incidence of delirium and follow the patients post operatively to evaluate the after effects of delirium in the form of PTSS.

More than 70% of ambulatory patients with IDD have attempted suicide (APA, 2015). This disorder, as well as all the disorders on the dissociation spectrum, must therefore be clarified and better diagnosed. The goal of this research is : to assess the prevalence of dissociative disorders using specific tools in patients suffering from PTSD. to validate the French version of the DDIS interview (Ross, 1997) that the investigators have translated.

A psychiatric diagnosis of post-traumatic stress disorder (PTSD) is currently based mainly on non-quantitative elements, such as interviews and subjective impressions. PTSD has physiological manifestations, some of which are likely reflected in the levels and ratios of certain stress-related proteins in the interstitial fluid and plasma. Discernable patterns of such stress-related proteins may constitute a biochemical phenotype characteristic of PTSD, which may serve as a biomarker and support diagnostic decisions, as well as personalized treatment plans. The current study is a non-interventional observational study aimed at examining the possibility of basing a psychiatric diagnosis by measuring changes in the biochemical phenotype of participants with PTSD.