Presented by:
Dr. John Williamson, Ph.D., ABPP-CN
Associate Professor of Psychiatry, Neuroscience, & Clinical and Health Psychology
Center for OCD & Anxiety-Related Disorders, UF
Center for Cognitive Aging and Memory, UF
Lead, Cognitive Function Initiative
Brain Rehabilitation Research Center, North FL/South GA VAMC
Faculty Disclosure:
Dr. Williamson has disclosed that he has no relevant financial relationships. No one else in a position to control content has any financial relationships to disclose.
Conflict of interest information for the CME Advisory Committee members can be found on the following website: https://cme.ufl.edu/disclosure/. All relevant financial relationships have been mitigated.
Release Date: November 5, 2022
Expiration Date: November 4, 2025
Target Audience: All physicians
Learning Objectives:
As a result of participation in this activity, participants should be able to:
- Identify potential sources of persistent neurobehavioral disruption resulting from traumatic brain injury.
- Determine possible role of heterogeneity of white matter injury in presentation of disorders such as PTSD.
- Describe role of chronic stress in brain aging in the context of neuropsychiatric symptoms.
Requirements for successful completion: Certificates are awarded upon successful completion (80% proficiency) of the post-test.
Accreditation: The University of Florida College of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
Credit: The University of Florida College of Medicine designates this enduring material for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Resource(s) for further study:
- Posttraumatic Stress Disorder Subsequent to Apparent Mild Traumatic Brain Injury. Rieke, et al. Cognitive and Behavioral Neurology: March 2021:34(1);26-37. Doi:10.1097/WNN.0000000000000264.
- VA/DoD Concussion-Mild Traumatic Brain Injury Clinical Practice Guideline
- Hoge CW, McGurk D, Thomas JL, Cox AL, Engel CC, Castro CA. Mild Traumatic Brain Injury in U.S. Soldiers Returning from Iraq. N Engl J Med 2008;358:453-463. Doi:10.1056/NEJMoa072972.
- Vasterling JJ, Aslan M, Lee LO, Proctor SP, Ko J, Jacob S, Concato J. Longitudinal Associations among Posttraumatic Stress Disorder Symptoms, Traumatic Brain Injury, and Neurocognitive Functioning in Army Soldiers Deployed to the Iraq War. JINS 2017. https://www.cambridge.org/core/journals/journal-of-the-international-neuropsychological-society/article/longitudinal-associations-among-posttraumatic-stress-disorder-symptoms-traumatic-brain-injury-and-neurocognitive-functioning-in-army-soldiers-deployed-to-the-iraq-war/968E79B2CA4194DBC7A95BDA00AEDD20
- Stein MB, Kessler RC, Heeringa SG, et al. Prospective Longitudinal Evaluation of the Effect of Deployment-Acquired Traumatic Brain Injury on Posttraumatic Stress and Related Disorders: Results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). American Journal of Psychiatry 2015. https://doi.org/10.1176/appi.ajp.2015.14121572
- Sorg SF, Schiehser DM, Bondi MW, et al. White Matter Microstructural Compromise is Associated with Cognition but not Posttraumatic Stress Disorder Symptoms in Military Veterans with Traumatic Brain Injury. J Head Trauma Rehabil. 2016; 31(5):297-308. PubMed ID: 26360008. https://brain.unboundmedicine.com/medline/citation/26360008/White_Matter_Microstructural_Compromise_Is_Associated_With_Cognition_But_Not_Posttraumatic_Stress_Disorder_Symptoms_in_Military_Veterans_With_Traumatic_Brain_Injury_
- Zhao J, Huynh J, Hylin MJ, et al. Mild Traumatic Brain Injury Reduces Spine Density of Projection Neurons in the Medial Prefrontal Cortex and Impairs Extinction of Contextual Fear Memory. Journal of Neurotrauma. 2018; 35(1):149-156. Online ahead of print August 28, 2017. https://doi.org/10.1089/neu.2016.4898
- Bottari SA, Lamb DG, Murphy AJ, et al. Hyperarousal symptoms and decreased right hemispheric frontolimbic white matter integrity predict poorer sleep quality in combat-exposed veterans. Brain Inj. 2021 Jul 3;35(8):922-933. Doi: 10.1080/02699052.2021.1927186. Epub 2021 May 29. PMID: 34053386 https://pubmed.ncbi.nlm.nih.gov/34053386/
- Schneider BL, Ghoddoussi F, Charlton JL, et al. Increased Cortical Gamma-Aminobutyric Acid Precedes Incomplete Extinction of Conditioned Fear and Increased Hippocampal Excitatory Tone in a Mouse Model of Mild Traumatic Brain Injury. Journal of Neurotrauma 2016; 33(17):1614-1624. Doi: 10.1089/neu.2015.4190
- Meyfroidt G, Baguley I, Menon DK, et al. Paroxysmal sympathetic hyperactivity: the storm after acute brain injury. The Lancet: Neurology. 2017; 16(9):721-729. https://doi.org/10.1016/S1474-4422(17)30259-4
- Thayer JF, Hansen AL, Saus-Rose E, Johnsen BH. Heart rate variability, prefrontal neural function, and cognitive performance: the neurovisceral integration perspective on self-regulation, adaptation, and health. Ann Behav Med 2009;37(2):141-53. Doi: 10.1007/s12160-009-9101-z. Epub 2009 May 8. PMID: 19424767.
- Williamson JB, Lewis G, Grippo AJ, et al. Autonomic predictors of recovery following surgery: A comparative study. Autonomic Neuroscience 2010;156(1-2):60-66. https://doi.org/10.1016/j.autneu.2010.03.009
- Griesbach GS, Hovda DA, Tio DL, et al. Heightening of the stress response during the first weeks after a milk traumatic brain injury. Neuroscience 2011;178(31):147-158. https://doi.org/10.1016/j.neuroscience.2011.01.028
- Griesbach GS, Tio DL, Nair S, et al. Temperature and Heart Rate Responses to Exercise following Mild Traumatic Brain Injury. Journal of Neurotrauma 2013;30(4):281-291. Online ahead of print February 4, 2013. https://doi.org/10.1089/neu.2012.2616
- Griesbach GS, Tio DL, Nair S, et al. Recovery of Stress Response Coincides with Responsiveness to Voluntary Exercise after Traumatic Brain Injury. Journal of Neurotrauma 2014;31(7):674-682. Online ahead of print December 19, 2013. https://doi.org/10.1089/neu.2013.3151
- Dale LP, Carroll LE, Galen G, Hayes JA, Webb KW, Porges SW. Abuse History is related to Autonomic Regulation to Mild Exercise and Psychological Wellbeing. Applied Psychophysiology and Biofeedback 2009;34(299). https://link.springer.com/article/10.1007/s10484-009-9111-4
- Minassian A, Gever MA, Baker DG, et al. Heart rate variability characteristics in a large group of active-duty Marines and relationship to posttraumatic stress. Psychosom Med 2014;76(4):292-301. PMID: 24804881. Doi: 10.1097/PSY.0000000000000056
- McTeague LM, Lang PJ, Laplante MC, et al. Aversive Imagery in Posttraumatic Stress Disorder: Trauma Recurrence, Comorbidity, and Physiological Reactivity. Biological Psychiatry 2010;67(4):346-356. https://doi.org/10.1016/j.biopsych.2009.08.023
- Busch et al. Meta-analyses of cardiovascular reactivity to rumination: A possible mechanism linking depression and hostility to cardiovascular disease. Psychological Bulletin 143(12):1378-1394. https://doi.org/10.1037/bul0000119
- Novaco RW & Chemtob CM. Anger and Combat-Related Posttraumatic Stress Disorder. Journal of Traumatic Stress 2002;15:123-132. https://link.springer.com/article/10.1023/A:1014855924072
- Reardon et al. An analysis of post-traumatic stress symptoms in United States Air Force drone operators. Journal of Anxiety Disorders 2014;28(5):480-487. https://doi.org/10.1016/j.janxdis.2014.05.003
- McMillan KA, Asmundson G, et al. Comorbid PTSD and Social Anxiety Disorder: Associations with Quality of Life and Suicide Attempts. Journal of Nervous and Mental Disease 2017;205(9):732-737. doi: 10.1097/NMD.0000000000000704
- Ahmadian A, et al. Differences in maladaptive schemas between patients suffering from chronic and acute posttraumatic stress disorder and healthy controls. Neuropsychiatr Dis Treat 2015;11:1677-1684. Doi: 10.2147/NDT.S85959
- Williamson JB & Harrison DW. Functional cerebral asymmetry in hostility: A dual task approach with fluency and cardiovascular regulation. Brain and Cognition 2003;52(2):167-174. https://doi.org/10.1016/S0278-2626(03)00038-1
- Wormald D, et al. Reduced heart rate variability in pet dogs affected by anxiety-related behavior problems. Physiology & Behavior 2017;168(1):122-127. https://doi.org/10.1016/j.physbeh.2016.11.003
- Bartoli F, et al. Posttraumatic Stress Disorder and Risk of Obesity: Systematic Review and Meta-Analysis. Journal of Clinical Psychiatry 2015;76(10):e1253-e1261. doi: 10.4088/JCP.14r09199
- Wolf EJ, et al. Longitudinal associations between post-traumatic stress disorder and metabolic syndrome severity. Psychological Medicine 2016;46(10):2215-2226. https://doi.org/10.1017/S0033291716000817
- Mathias JL, Alvaro PK, et al. Prevalence of sleep disturbances, disorders, and problems following traumatic brain injury: A meta-analysis. Sleep Medicine 2012;13(7):898-905. https://doi.org/10.1016/j.sleep.2012.04.006
- Rezaeitalab F, et al. Response to a letter to the editor by Mohammad Rasoul Ghadami et al.: “Obstructive sleep apnea in veterans with post-traumatic stress disorder: looking beyond their complaint.” Sleep and Breathing 2018, 23, 295-296. https://link.springer.com/article/10.1007/s11325-018-1707-6
- Sprecher KE, et al. Poor sleep is associated with CSF biomarkers of amyloid pathology in cognitively normal adults. Neurology 2017;89(5). DOI: https://doi.org/10.1212/WNL.0000000000004171
- Van Liempt S, et al. Sympathetic activity and hypothalamo-pituitary-adrenal axis activity during sleep in post-traumatic stress disorder: A study assessing polysomnography with simultaneous blood sampling. Psychoneuroendocrinology 2013;38(1):155-165. https://doi.org/10.1016/j.psyneuen.2012.05.015
- Deng W, et al. Adult-Born Hippocampal Dentate Granule Cells Undergoing Maturation Modulate Learning and Memory in the Brain. Journal of Neuroscience 2009;29(43):13532-13542. DOI: https://doi.org/10.1523/JNEUROSCI.3362-09.2009
- Egeland M, et al. Molecular mechanisms in the regulation of adult neurogenesis during stress. Nature Reviews Neuroscience 2015;16:189-200. https://www.nature.com/articles/nrn3855
- Schoenfeld TJ, Gould E. Stress, stress hormones, and adult neurogenesis. Experimental Neurology 2012;233(1):12-21. https://doi.org/10.1016/j.expneurol.2011.01.008
- Hannum G, et al. Genome-wide Methylation Profiles Reveal Quantitative Views of Human Aging Rates. Molecular Cell 2013;49(2):359-367. https://doi.org/10.1016/j.molcel.2012.10.016
- Shah AJ, et al. Posttraumatic Stress Disorder and Impaired Autonomic Modulation in Male Twins. Biological Psychiatry 2013;73(11):1103-1110. https://doi.org/10.1016/j.biopsych.2013.01.019
If you have any questions please feel free to contact Nancy Boyd at (352) 594-4298 or at nancy.boyd@ufl.edu