Hostname: page-component-78c5997874-8bhkd Total loading time: 0 Render date: 2024-11-19T14:49:01.980Z Has data issue: false hasContentIssue false
  • English
  • Français

Injury Increases the Risk for PTSD: An Examination of Potential Neurobiological and Psychological Mediators

Published online by Cambridge University Press:  07 November 2014

Danny Koren ,
Deborah Hemel  and
Ehud Klein
Get access Rights & Permissions [Opens in a new window]

Abstract

A growing number of common traumatic events involve both physical and emotional injuries. In contrast to previously held beliefs, the rapidly growing body of literature shows quite convincingly that physical injury, over and above exposure to the traumatic event itself, increases rather than decreases the risk for posttraumatic stress disorder (PTSD). A pertinent question becomes how bodily injury contributes to the risk of developing PTSD. In this article, we review contemporary findings regarding the neurobiological and psychological mechanisms by which bodily injury may augment or independently contribute to chronic posttraumatic stress. In addition, we propose three theoretical pathways through which physical injury can increase the risk for PTSD. These pathways are: additive, unique, and recovery impeding. Finally, we highlight unresolved issues pertaining to each one of these pathways and propose directions for future research to address them.

Type
Review Articles
Information
CNS Spectrums , Volume 11 , Issue 8 , August 2006 , pp. 616 - 624
Copyright
Copyright © Cambridge University Press 2006

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Allen, JG. Coping with Trauma: A Guide to Self-Understanding. Washington, DC: American Psychiatric Press; 1995.Google Scholar
2.Ulman, RB, Brothers, D. A self-psychological reevaluation of posttraumatic stress disorder (PTSD) and its treatment: shattered fantasies. J Am Acad Psychoanal. 1987;15:175–203.Google Scholar
3.Koren, D, Norman, D, Cohen, A, Berrman, J, Klein, EM. Increased PTSD risk with combat-related injury: a matched comparison study of injured and uninjured soldiers experiencing the same combat events. Am J Psychiatry. 2005;162:276–282.CrossRefGoogle ScholarPubMed
4.de Kloet, CS, Vermetten, E, Geuze, E, Kavelaars, A, Heijnen, CJ, Westenberg, HG. Assessment of HPA-axis function in posttraumatic stress disorder: pharmacological and non-pharmacological challenge tests, a review. J Psychiatr Res. 2005 Oct 6; [Epub ahead of print].Google Scholar
5.Yehuda, R, Giller, EL, Southwick, SM, Lowy, MT, Mason, JW. Hypothalamic-pituitary-adrenal dysfunction in posttraumatic stress disorder. Biol Psychiatry. 1991;30:1031–1048.CrossRefGoogle ScholarPubMed
6.Olff, M, Langeland, W, Gersons, BP. The psychobiology of PTSD: coping with trauma. Psychoneuroendocrinology. 2005;30:974–982.Google Scholar
7.Davidson, JR, Stein, DJ, Shalev, AY, Yehuda, R. Posttraumatic stress disorder: acquisition, recognition, course, and treatment. J Neuropsychiatry Clin Neurosci. 2004;16:135–147.Google Scholar
8.Shavit, Y, Weidenfeld, J, DeKeyser, FG, et al.Effects of surgical stress on brain prostaglandin E2 production and on the pituitary-adrenal axis: attenuation by pre-emptive analgesia and by central amygdala lesion. Brain Res. 2005;1047:10–17.Google Scholar
9.Desborough, JP. The stress response to trauma and surgery. Br J Anaesth. 2000;85:109–117.CrossRefGoogle ScholarPubMed
10.Shalev, AY, Sahar, T, Freedman, S, et al.A prospective study of heart rate response following trauma and the subsequent development of posttraumatic stress disorder. Arch Gen Psychiatry. 1998;55:553–559.Google Scholar
11.Buckley, TC, Kaloupek, DG. A meta-analytic examination of basal cardiovascular activity in posttraumatic stress disorder. Psychosom Med. 2001;63:585–594.Google Scholar
12.Schoenfeld, FB, Marmar, CR, Neylan, TC. Current concepts in pharmacotherapy for posttraumatic stress disorder. Psychiatr Serv. 2004;55:519–531.Google Scholar
13.Yehuda, R, Bryant, R, Marmar, C, Zohar, J. Pathological responses to terrorism. Neuropsychopharmacology. 2005;30:1793–1805.CrossRefGoogle ScholarPubMed
14.Nguyen, NT, Goldman, CD, Ho, HS, Gosselin, RC, Singh, A, Wolfe, BM. Systemic stress response after laparoscopic and open gastric bypass. J Am Coll Surg. 2002;194:557–566.Google Scholar
15.Kitayama, N, Vaccarino, V, Kutner, M, Weiss, P, Bremner, JD. Magnetic resonance imaging (MRI) measurement of hippocampal volume in posttraumatic stress disorder: a meta-analysis. J Affect Disord. 2005;88:79–86.Google Scholar
16.Smith, ME. Bilateral hippocampal volume reduction in adults with post-traumatic stress disorder: a meta-analysis of structural MRI studies. Hippocampus. 2005;15:798–807.Google Scholar
17.Gilbertson, MW, Shenton, ME, Ciszewski, A, et al.Smaller hippocampal volume predicts pathologic vulnerability to psychological trauma. Nat Neurosci. 2002;5:1242–1247.Google Scholar
18.Protopopescu, X, Pan, H, Tuescher, O, et al.Differential time courses and specificity of amygdala activity in posttraumatic stress disorder subjects and normal control subjects. Biol Psychiatry. 2005;57:464–473.Google Scholar
19.Shin, LM, Wright, CI, Cannistraro, PA, et al.A functional magnetic resonance imaging study of amygdala and medial prefrontal cortex responses to overtly presented fearful faces in posttraumatic stress disorder. Arch Gen Psychiatry. 2005;62:273–281.Google Scholar
20.Matsuoka, Y, Yamawaki, S, Inagaki, M, Akechi, T, Uchitomi, Y. A volumetric study of amygdala in cancer survivors with intrusive recollections. Biol Psychiatry. 2003;54:736–743.CrossRefGoogle ScholarPubMed
21.Narita, M, Kishimoto, Y, Ise, Y, Yajima, Y, Misawa, K, Suzuki, T. Direct evidence for the involvement of the mesolimbic kappa-opioid system in the morphine-induced rewarding effect under an inflammatory pain-like state. Neuropsychopharmacology. 2005;30:111–118.Google Scholar
22.Schinkel, C, Gaertner, A, Zaspel, J, Zedler, S, Faist, E, Schuermann, M. Inflammatory mediators are altered in the acute phase of posttraumatic complex regional pain syndrome. Clin J Pain. 2006;22:235–239.Google Scholar
23.Schreiber, S, Galai-Gat, T. Uncontrolled pain following physical injury as the coretrauma in post-traumatic stress disorder. Pain. 1993;54:107–110.CrossRefGoogle ScholarPubMed
24.Akil, H, Watson, SJ, Young, E. Endogenous opioids: biology and function. Annu Rev Neurosci. 1983;7:223–255.CrossRefGoogle Scholar
25.Siegfried, B, Frischknecht, HR, Nunes de Souza, RL. An ethological model for the study of activation and interaction of pain, memory and defensive systems in the attacked mouse. Role of endogenous opioids. Neurosci Biobehav Rev. 1990;14:481–490.Google Scholar
26.Beecher, H. Pain in men wounded in battle. Ann Surg. 1946;123:96–105.Google Scholar
27.van der Kolk, B, Greenberg, M, Boyd, H, Krystal, J. Inescapable shock, neurotransmitters, and addiction to trauma: toward a psychobiology of post traumatic stress. Biol Psychiatry. 1985;20:314–325.Google Scholar
28.Pitman, RK, van der Kolk, BA, Orr, SP, Greenberg, MS. Naloxone-reversible analgesic response to combat-related stimuli in posttraumatic stress disorder. A pilot study. Arch Gen Psychiatry. 1990;47:541–544.Google Scholar
29.van der Kolk, BA, Greenberg, MS, Orr, SP, Pitman, RK. Endogenous opioids, stress induced analgesia, and posttraumatic stress disorder. Psychopharmacol Bull. 1989;25:417–421.Google Scholar
30.Nishith, P, Griffin, MG, Poth, T. Stress-induced analgesia: prediction of posttraumatic stress symptoms in battered versus nonbattered women. Biol Psychiatry. 2002;51:867–874.CrossRefGoogle ScholarPubMed
31.Schonenberg, M, Reichwald, U, Domes, G, Badke, A, Hautzinger, M. Effects of peritraumatic ketamine medication on early and sustained posttraumatic stress symptoms in moderately injured accident victims. Psychopharmacology (Berl). 2005;182:420–425.CrossRefGoogle ScholarPubMed
32.Winter, H, Irle, E. Hippocampal volume in adult burn patients with and without posttraumatic stress disorder. Am J Psychiatry. 2004;161:2194–2200.Google Scholar
33.Raison, CL, Miller, AH. When not enough is too much: the role of insufficient glucocorticoid signaling in the pathophysiology of stress-related disorders. Am J Psychiatry. 2003;160:1554–1565.Google Scholar
34.Maier, SF, Nguyen, KT, Deak, T, Milligan, ED, Watkins, LR. Stress, learned helplessness, and brain interleukin-1 beta. Adv Exp Med Biol. 1999;461:235–249.CrossRefGoogle ScholarPubMed
35.Reichenberg, A, Yirmiya, R, Schuld, A, et al.Cytokine-associated emotional and cognitive disturbances in humans. Arch Gen Psychiatry. 2001;58:445–452.Google Scholar
36.Krueger, JM, Obal, F Jr, Fang, J. Humoral regulation of physiological sleep: cytokines and GHRH. J Sleep Res. 1999;(8 suppl 1):53–59.Google Scholar
37.Anisman, H, Ravindran, AV, Griffiths, J, Merali, Z. Endocrine and cytokine correlates of major depression and dysthymia with typical or atypical features. Mol Psychiatry. 1999;4:182–188.Google Scholar
38.Larson, SJ, Dunn, AJ. Behavioral effects of cytokines. Brain Behav Immun. 2001;15:371–387.CrossRefGoogle ScholarPubMed
39.Baker, DG, Ekhator, NN, Kasckow, JW, et al.Plasma and cerebrospinal fluid interleukin-6 concentrations in posttraumatic stress disorder. Neuroimmunomodulation. 2001;9:209–217.CrossRefGoogle ScholarPubMed
40.Baker, DG, Mendenhall, CL, Simbartl, LA, Magan, LK, Steinberg, JL. Relationship between posttraumatic stress disorder and self-reported physical symptoms in Persian Gulf War veterans. Arch Intern Med. 1997;157:2076–2078.CrossRefGoogle ScholarPubMed
41.Thombs, BDFJ, McCann, UD. Stress disorders following traumatic injury: assessment and treatment considerations. Primary Psychiatry. 2005;12:51–55.Google Scholar
42.Mellman, TA, Bustamante, V, Fins, AI, Pigeon, WR, Nolan, B. REM sleep and the early development of posttraumatic stress disorder. Am J Psychiatry. 2002;169:1696–1701.Google Scholar
43.Shalev, AY. Posttraumatic stress disorder among injured survivors of a terrorist attack. Predictive value of early intrusion and avoidance symptoms. J Nerv Ment Dis. 1992;180:505–509.CrossRefGoogle ScholarPubMed
44.Michaels, AJ, Michaels, CE, Moon, CH, et al.Posttraumatic stress disorder after injury: impact on general health outcome and early risk assessment. J Trauma. 1999;47:460–466.Google Scholar
45.Pitman, RK, Altman, B, Macklin, ML. Prevalence of posttraumatic stress disorder in wounded Vietnam veterans. Am J Psychiatry. 1389;146:667–663.Google Scholar
46.Gayle Beck, J, Gudmundsdottir, B, Shipherd, JC. PTSD and emotional distress symptoms measured after a motor vehicle accident: relationships with pain coping profiles. J Psychopathol Behav Assess. 2003;25:219–227.Google Scholar
47.Buchwald, D, Goldberg, J, Noonan, C, Beals, J, Manson, S. Relationship between post-traumatic stress disorder and pain in two American Indian tribes. Pain Med. 2005;6:72–79.CrossRefGoogle ScholarPubMed
48.Asmundson, GJ, Coons, MJ, Taylor, S, Katz, J. PTSD and the experience of pain: research and clinical implications of shared vulnerability and mutual maintenance models. Can J Psychiatry. 2002;47:930–937.CrossRefGoogle ScholarPubMed
49.Fukunishi, I. Relationship of cosmetic disfigurement to the severity of posttraumatic stress disorder in burn injury or digital amputation. Psychother Psychosom. 1999;68:82–86.Google Scholar
50.Nemeroff, CB, Bremner, JD, Foa, EB, Mayberg, HS, North, CS, Stein, MB. Posttraumatic stress disorder: a state-of-the-science review. J Psychiatr Res. 2006;40:1–21.Google Scholar
51.Schelling, G, Roozendaal, B, De Quervain, DJ. Can posttraumatic stress disorder be prevented with glucocorticoids? Ann N Y Acad Sci. 2004;1032:158–166.Google Scholar
52.Gil, S, Caspi, Y, Ben-Ari, IZ, Koren, D, Klein, E. Does memory of a traumatic event increase the risk for posttraumatic stress disorder in patients with traumatic brain injury? A prospective study. Am J Psychiatry. 2005;162:963–969.Google Scholar
53.Arnon, I. Development and prevalence of post traumatic stress disorder among vehicle accidents victims [dissertation]. Haifa, Israel: Technion - Israel Institute of Technology; 1997.Google Scholar
54.Schnyder, U, Moergeli, H, Klaghofer, R, Sensky, T, Buchi, S. Does patient cognition predict time off from work after life-threatening accidents? Am J Psychiatry. 2003;160:2025–2031.Google Scholar