The Clinical Neurosciences Division has made great strides in recent years in the neurobiology of PTSD, including research in genetics, brain structure and functioning, molecular imaging techniques, and pharmacology.
The Division continues to investigate novel approaches to treating Veterans with PTSD. Data collection was completed on a large multi-center VA Cooperative Study of risperidone, and analysis was completed on the first study to compare the efficacy of a selective serotonin reuptake inhibitor and a serotonin-norepinephrine reuptake inhibitor in Veterans with PTSD and comorbid alcohol dependence. The division also published the first study on the use of duloxetine for the treatment of PTSD.
Ongoing treatment trials include the use of propranolol to reduce memory reconsolidation in OEF/OIF Veterans, the use of prazosin for the treatment of PTSD and comorbid alcohol dependence, and a modified cognitive processing treatment for PTSD and comorbid alcohol dependence.
Barriers to receiving needed mental health care and treatment utilization are being examined in treatment seeking Veterans and in Soldiers returning from deployment to Ft. Drum, NY.
As part of the Women's Veterans Cohort Study, CND researchers are beginning to examine gender differences related to risk and resilience factors for the development of trauma-related psychopathology including alcohol use among male and female OEF/OIF Veterans. Recent analyses of data from the Connecticut OEF/OIF Veterans Study have included analyses and/or publications on suicidal ideation, sleep disturbances, resilience, coping strategies, social support and posttraumatic growth.
Over the past decade, the Division has conducted numerous psychobiological studies designed to identify resilience factors in soldiers who are the product of elite military selection programs (for example, the role of NPY and DHEA in the preservation of cognitive performance during exposure to operational stress and in the ability to return to pre-stress baseline states after stress exposure has ceased). The Division is actively working with the Marine Special Operations Command and with the Special Warfare Center and School, Ft. Bragg, to assess neurohormones and cognition (working memory, prefrontal functioning, eyewitness memory), as well as psychological constructs (such as burnout) that may affect performance under stress. These studies are designed to prepare for intervention studies aimed at sustaining cognitive performance during stress or to enhance recovery from stress-induced cognitive deficits.
Analyzing data from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions, Division researchers examined the comorbidity between PTSD and other mental and physical health conditions. Staff is also examining risk and protective factors associated with trauma-related psychopathology and resilience among 22,000 World Trade Center workers. Other research includes a 27-year follow-up of former Vietnam Prisoners of War, and collaboration with the Executive Division on a multi-site study of psychosocial, genetic, and endocrine factors associated with post-disaster adaptation and resilience in survivors of Hurricane Ike.
Several studies of traumatized children are also underway. These include a study of child and family resilience and adaptation to serious medical illness being conducted with Paul Newman's Hole in the Wall Gang camps, a study of child adjustment to parental combat deployment among active duty military children at Ft. Drum NY, and ongoing studies of abused children and their families through the Division's Laboratory of Neurodevelopment and The Child and Adolescent Research and Education Program.
The Division maintains an innovative research program on the role of stress-related neurotransmitter transporters and receptors. Imaging studies are examining the serotonin transporter in individuals with PTSD and comorbid depression, the norepinephrine transporter, and the Serotonin 1B receptor. The Brain Rehabilitation, Assessment, and Integrated Neuropsychology Clinic and Laboratory has formed a collaboration with Yale researchers who are examining the impact of improvised explosive devise blast exposure on brain functioning using comprehensive neuropsychology testing and multi-modal neuroimaging markers. The laboratory also continued its learning based cognitive rehabilitation treatment trial in Veterans with PTSD and will soon begin a study of neuropsychological function and re-emergence of PTSD symptoms in Veterans who are experiencing decline in cognition and memory.
The Division's Laboratory of Molecular Neuroscience and Genetics continued its whole genome array analysis of postmortem tissue in PTSD patients with the goal of identifying abnormally expressed gene products in postmortem brain tissue of PTSD patients to matched controls. The functional significance of the lab's finding of a dramatic prefrontal cortical reduction in SGK1 (serum and glucocorticoid-induced kinase which is involved in cellular stress response) is being followed up in rodent models. The laboratory also continues its investigations of stress, antidepressants and neurotrophic factors. The Division remains involved in a biological arm of the National Center for Disaster Mental Health Research, investigating genetic correlates of disaster mental health.
Studies in cognitive neuroscience include investigations of fear conditioning, electrophysiological correlates of emotional perception, emotional training in PTSD, and the ability to discriminate threatening from safe stimuli among Veterans with and without PTSD. Stress reactivity as a marker of treatment response to prazosin is also being examined in Veterans with PTSD and comorbid alcohol dependence. In addition, researchers continue to investigate whether Veterans with PTSD demonstrate increased recognition memory for unpleasant stimuli or decreased recognition for pleasant stimuli relative to combat Veterans without PTSD and non-combat controls.