Experimental New Control Therapy for PTSD

"When I see a procedure like this, I almost consider it a no-brainer to make it accessible to other people."

"It doesn't involve any extra training and is already done in pain clinics."

"If we can make this accessible, it would be very beneficial."

Psychiatrist Dr. Rebecca Gomez, Royal Ottawa Hospital

There is a procedure called stellate ganglion block (SGB) which involves injecting local anesthetic into a cluster of nerve cell bodies near the base of the neck. The slender needle used to inject the anesthetic is guided by ultrasound. It is a procedure performed routinely in hospitals across Canada in the treatment of complex nerve pain. The treatment is being used in the United States as a therapeutic protocol for veterans affected by PTSD.

 

Dr. Dan James, medical director of the pain clinic at The Ottawa Hospital was persuaded by psychiatrist Dr. Gomez, to experimentally use the process on one of her patients suffering from PTSD who had himself researched the use of SGB. Dr. James had himself heard of the SGB therapy used to treat symptoms of PTSD and was interested. "The stars sort of aligned and the timing was quite perfect", he said.

The procedure took only fifteen minutes to complete, and for the patient who had suffered the symptoms of PTSD for years, its effect was close to immediate. "It was like the volume on the world had been turned down. I had been listening to white noise for years and the white noise was gone. It was this weird sense of peace."

 

The drug wears off after a few hours, but its effect on PTSD symptoms lasts for months. Local anesthesia is injected into the structures providing most of the sympathetic nerve signals to head, neck, arms and part of the upper chest. When the patient displays signs of a condition named Horner syndrome (a patient's face droops on one side) doctors realize the target has been hit.

 

Dr. Gomez speaks of the theory behind the treatment; the local anesthetic acts as a reset button through blocking nerves temporarily that travel from the stellate ganglion to parts of the brain more active in PTSD, decreasing release of stress hormones like norepinephrine or adrenalin. The stellate ganglion is part of the sympathetic nervous system affecting a person's fight or fight response.

 

There is a theory of PTSD being a syndrome where the fight or flight nervous system sticks in the ON position. SGB appears to act like an OFF switch, resetting that response. Dr. Gomez and her colleagues from the Operational Stress Injury Clinic at the University of Ottawa Institute for Mental Health Research and the Royal Hospital were recognized with an award for their case study on SGB involving 30 patients who received the procedure. Survey results received from ten of the participants indicated a significant decrease in symptoms such as sleep disturbances, intrusive thoughts and flashbacks, with patients also reporting a significant decrease in symptoms of depression.

 

About eight percent of Canadians experience symptoms of PTSD, according to a 2021 Survey on Mental Health and Stressful Events from Statistics Canada. First responders and the military are often associated with PTSD, but the syndrome affects a broad segment of society. Symptoms can include unwanted thoughts or dreams, strong physical reactions when reminded of an event, strong negative emotions, and a loss of interest in activities once enjoyed. In addition, PTSD is more common among women than men. Compared to eight percent of men, one in ten Canadian women have symptoms of PTSD.

 

The anesthetic used in the procedure -- bupivacaine -- costs roughly $18 for each injection. Not every patient experiences profound remedial results, however. Of nine patients who undergo SGB, about three will see a significant improvement; three or four will realize some benefit, but not as notable. About two will experience no noticeable benefit. However, up to 80 percent of patients report a 50 percent reduction in symptoms.

 

Possible breakthrough treatment for PTSD   CBS News

Magnifying Grief

"Grief is a normal response to the loss of someone close, but traumatic losses may severely harm survivors for years."

"Our findings suggest that when treating trauma survivors, targeting symptoms of PTSD early might help them avoid complicated grief later on. Complicated grief has been defined as a persistent, intense yearning, longing and sadness, usually accompanied by insistent thoughts or images of the deceased and a sense of disbelief or an inability to accept the painful reality of the person's death."

"The fact that we found that PTSD symptoms predicted complicated grief reactions at a subsequent time point, but complicated grief did not predict the development of PTSD, is interesting because it suggests that targeting PTSD symptoms may hinder later development of complicated grief."

"This may have important implications for clinicians working with bereaved trauma survivors."

Kristin Alve Glad, researcher, Norwegian Centre for Violence and Traumatic Stress Studies

Terrified youngsters hid in the woods, with some jumping into the water to escape the hail of bullets.  AFP

A new study placed its focus on survivors of the terrorist attack that took place in Oslo, Norway, and on the nearby island of Utaya in 2011, when 77 people lost their lives. This event -- a shooting spree combined with a bombing -- represented the deadliest attack to take place in Norway since the Second World War. Published in the journal Psychological Trauma: Theory, Research, Practice and Policy, the research found symptoms of a more complex grief can intensify over time with the potential to prevent survivors from leading normal lives.

 

In most instances when people suffer a shocking loss such as the death of a loved one, the sorrow it brings tends to recede with the passage of time. However, those people who experience PTSD resulting from a traumatic event which directed involved/impacted them personally and that also claimed the life of someone near and dear, according to the study conclusions, may end up suffering from a persistent sense of sadness which leaves them with an inability to cope, years on.

 

A total of 275 people were interviewed for the study; of that number 256 had lost a close friend, six lost a family member, and thirteen lost a close friend and family member/partner. In face-to-face interviews conducted by health-care professionals on three separate occasions -- five months after the attack, 15 months later, and finally 30 months later -- participants were asked questions relating to symptoms of post-traumatic stress syndrome.

 

Other questions were asked with a view to revealing feelings of complicated grief; as example, those related to difficulty in accepting the loss, managing intense grief and coping with thoughts focusing on death. The researchers found that those who reported symptoms of PTSD to be significantly likelier to relay feelings of complicated grief; those who still felt the effects of PTSD a year following the event were seen to struggle with the most intense symptoms of this severe form of grief.

 

Survivors were seen to have taken on a particularly heavy toll of grief from the terrorist attack since while they lost loved ones, they were also participants in the traumatic event, the researchers found. Leading to the conclusion that the "dual burden" of unexpected loss in combination with high exposure to the event steered PTSD symptoms in the direction of complicated grief, not identified in those who were removed from the violence.

 

The hope is that this refined understanding of the relationship between PTSD and complicated grief may lead to assisting in the development of targeted therapies to be used in giving aid to survivors who have lost loved ones to unexpected trauma. 

Locals gathered boats near the island to try and help those jumping into the water to escape   AFP

Health Diagnostic Technology

"Dopamine is an important marker for a lot of psychiatric conditions, but it’s been difficult in the past to measure it without PET imaging."
"With NM-MRI, we can understand some of the same things that PET tells us, but in a much more practical and accessible way."
"A clinical biomarker for schizophrenia would help people to get the treatment they need faster, and hopefully lead to an improved quality of life."
"In mental health care, we still don’t have widely available diagnostic tests for mental disorders. This means that psychiatrists still have to rely on a patient’s description of symptoms, and clinical behavioural observations in order to make an accurate diagnosis, which can sometimes mean significant trial and error."
Dr. Clifford Cassidy, scientist, The Royal’s Institute of Mental Health Research, Ottawa

Dr. Clifford Cassidy, a scientist at The Royal’s Institute of Mental Health Research is part of a research team that has discovered a potentially ground-breaking new way to diagnose and treat schizophrenia

 New research from The Royal's Institute of Mental Health Research at the Royal Ottawa Mental Health Centre has produced a study revealing a biomarker based in the brain, for schizophrenia identifiable with the use of specially configured MRI machines. The study, co-authored by Clifford Cassidy, offers a look at an accurate, quick diagnostic tool to diagnose whether people have schizophrenia, a diagnosis that has always been reliant on assessment by psychiatrists of an individual's behaviour and symptom descriptions. Such a readily available diagnostic test as described by the new study could result in a reliable diagnostic tool used is an improved strategy for early intervention and prevention.

Approximately one percent of any given population can be diagnosed with schizophrenia. The sooner the diagnosis is made and remedial intervention taken, the better the afflicted individual will be able to adjust to a protocol strategy that will enable him/her to successfully cope and to lead a fairly normal life. The new diagnosis technique with the use of specialty MRIs will extend beyond schizophrenia to encompass other mental health problems, such as PTSD. The very same technique outlined in the research has proven effective in detecting neurodegeneration in patients with Parkinson's disease; using it for patients with schizophrenia is a first.

The study was conducted to widen the scope of usefulness in diagnosis of a type of MRI (magnetic resonance imaging machine) called neuromelanin-sensitive, which has the capacity to indirectly measure dopamine function in patients. The brain chemical dopamine aids in regulating movement, learning, emotional response and attention. In the brains of people at risk of developing schizophrenia, or those experiencing some type of psychosis, excess dopamine is released. These specialty MRIs are able to indirectly measure that excess dopamine is being produced by targeting neuromelanin, a pigment created when dopamine breaks down. MRI scans detect the presence of the dark pigment.

The study identifies the MRI and its process as a reliable method to measure dopamine; a psychosis biomarker, in other words. Dr. Cassidy spoke of the satisfaction felt by researchers in achieving this breakthrough and the potential for it to lead to additional applications in the future, paving the way to diagnose psychosis and schizophrenia in a more 'accessible' manner in the sense that PET-CT scans also can measure the presence of excess dopamine, but PET-CT scans are expensive, not readily accessed and can often become an invasive technique.

The tool, stated Dr. Cassidy, could be useful for additional applications as for example diagnosing PTSD for which a different brain chemical -- noradrenaline -- has been associated with post-traumatic stress disorder. This chemical as well is pigmented and can be 'seen', to be measured through the use of specialized MRIs. There is an existing gap between individuals with mental illness and the problems they face versus the technological challenges of understanding brain function. And the hope is that the work undertaken in this study could lead to improved strategies for intervention and prevention of mental health diseases.

Head and neck MRI scan Kondor83 / Getty Images/iStockphoto