Researchers at The University of Texas Health Science Center at Houston (UTHealth) are investigating whether post traumatic stress disorder (PTSD) is a brain disorder that can affect multiple parts of the body and cause lifelong illnesses.
"In the last few years, we've made a great deal of headway in our studies and understanding of PTSD. It has become apparent that PTSD isn't just a psychological adjustment disorder," said Paul Schulz, M.D., lead investigator and associate professor of neurology at the UTHealth Medical School. "We and others have shown more strokes, heart attacks, alcohol use, drug abuse, depression and dementia associated with PTSD patients."
Schulz, whose clinical experience includes 25 years of working with soldiers suffering from PTSD at the Michael E. DeBakey VA Medical Center, is part of the Mischer Neuroscience Institute at Memorial Hermann-Texas Medical Center.
"Memorial Hermann has the busiest trauma emergency room in the world," Schulz said. "We see people with PTSD who are victims of violence or have experienced something traumatic such as a bad car accident or their house burning down. You can heal the injury but the brain is still affected in some people."
He said that any discoveries they make from the civilian population study could be directly relevant to military personnel.
"As far as we can tell, PTSD acquired through civilian trauma is the same as military PTSD. But in the VA system, we didn't have access to military personnel at the time of the inciting event - they were overseas. Here at UTHealth and Memorial Hermann, we see people within hours of their trauma and sometimes within minutes," he said. "The problem with PTSD is that it's lifelong. We could potentially affect the quality of life for millions of people worldwide."
In the first part of the study, Schulz and his team are trying to determine risk factors for PTSD by enrolling 400 patients who have experienced trauma. "From that group, we expect to identify about 80 people with PTSD and we hope to be able to determine factors associated with their getting PTSD versus the other 320 who didn't get it," he said. In the second part of the study, researchers hope to use the risk factors to identify 80 of 400 new trauma patients and treat them in advance to see whether they can prevent PTSD.
The second phase will also include brain scans at baseline and one year after the traumatic event. "There is a suggestion that some specific parts of the brain may shrink as a person develops PTSD," he said. "If that's the case, there may be treatment approaches based on the affected areas of the brain."
According to the National Institutes of Health, PTSD is an anxiety disorder and the cause is unknown. It changes the body's response to stress, affecting hormones and chemicals that carry information between the nerves. Symptoms are in three general categories: reliving the event acutely enough to affect daily life; avoidance, emotional numbness and depression; and having an exaggerated response to things that startle the person, as well as irritability and angry outbursts. PTSD occurs in 20 to 25 percent of people who experience a trauma, but symptoms are often delayed for months, which in turn delays treatment.
The study is part of the UTHealth Trauma Research Center directed by Col. John Holcomb, M.D., professor and chief of the Division of Acute Care Surgery at UTHealth and director of the Texas Trauma Institute at Memorial Hermann-Texas Medical Center. It is funded by the National Institutes of Health.
"For a long time, we assumed that PTSD was an adjustment disorder in the psychiatric realm that required anxiety medications and antidepressants," Schulz said. "But we couldn't understand why people got PTSD and why it was so difficult to get rid of. Frankly, the medications don't work very well in people with PTSD."
The "Holy Grail," he said, is trying to find ways to prevent the conversion of acute stress disorder into chronic PTSD.
"Once we can identify a group of people who are more likely to develop it, we can offer intensive anti-anxiety treatment in a controlled study to see whether it will prevent the development of PTSD," Schulz said.