3a post traumatic stress disorder mrs talk baker
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Marine Resiliency Study
Dewleen G. Baker M.D1. & William P. Nash M.D.2
Co-Principal Investigators
VA Center of Excellence for Stress & Mental Health &University of California San Deigo1
Headquarters Marine Corps, Quantico & University of
California San Diego2
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Why a Marine
Resiliency Study?
Improved knowledge about risk and resiliencyImproved knowledge about risk and resiliencywill help towill help to
PreventPreventIdentifyIdentify
TreatTreatOperational and Combat Stress InjuriesOperational and Combat Stress Injuries
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Why a Resiliency Study?
In theater: Daily hardships and combatIn theater: Daily hardships and combatoperations trigger acute and chronic stressoperations trigger acute and chronic stress
Physical: dehydration & wetness, dirt and mud, sleepPhysical: dehydration & wetness, dirt and mud, sleepdeprivation, noise & blasts, fumes & smells, bright light &deprivation, noise & blasts, fumes & smells, bright light &
darkness, malnutrition, illness & injurydarkness, malnutrition, illness & injuryCognitive: lack of information or too much information,Cognitive: lack of information or too much information,ambiguous or changing mission or role, ambiguous or changingambiguous or changing mission or role, ambiguous or changingrules of engagement,rules of engagement, loyalityloyalityconflicts, boredom & monotony,conflicts, boredom & monotony,
experience that dont make senseexperience that dont make sense
Emotional: losses of friends to death or injury, fear, shame &Emotional: losses of friends to death or injury, fear, shame &guilt, helplessness, horror, killingguilt, helplessness, horror, killing
Social: isolation from social supports, lack of privacy, the medSocial: isolation from social supports, lack of privacy, the mediaia& public opinion& public opinion
from Nash 2007from Nash 2007
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Why a Resiliency Study?
The adaptive responses to chronic andThe adaptive responses to chronic andintermittent stress is not fully understoodintermittent stress is not fully understood
Retrospective studies associate genotype,Retrospective studies associate genotype,physiology and personality traits with conditionsphysiology and personality traits with conditions--anxiety, depression and posttraumatic stressanxiety, depression and posttraumatic stresssymptomssymptomsthought to result from stressthought to result from stress
Age, genderAge, gender
Reactivity to stress, tendency to dissociateReactivity to stress, tendency to dissociate
Childhood stress and/or traumaChildhood stress and/or trauma
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Why a Resiliency Study?
The retrospective studies provide clues aboutThe retrospective studies provide clues aboutresilience but a better understanding of the fullresilience but a better understanding of the fullrange of adaptive responses to combatrange of adaptive responses to combat
operational stress is needed in order to designoperational stress is needed in order to designprograms that promote resiliencyprograms that promote resiliency
Prospective studies could fill in knowledge gapsProspective studies could fill in knowledge gapsabout the trajectories of adaptation to combatabout the trajectories of adaptation to combatoperational stressoperational stress
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Why a Resiliency Study?
As yet, there are no prospective studiesAs yet, there are no prospective studiesshowing the various trajectories of adaptation toshowing the various trajectories of adaptation tocombatcombatthis proposed study would be the firstthis proposed study would be the first
Components (projects) that are likely impactComponents (projects) that are likely impactadaptationadaptation
Cognitive, psychological, socialCognitive, psychological, socialBiologicalBiological
GeneticGenetic
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Trajectories of Adaptation toOperational Stress and Trauma
SYM
PTO
M
BURD E
N Hig
h
M
od
er
ate
Lo
w
Gr
ow
th PRE-DEPLOY
MENT
DEPLOYMENT
RETURN
3MOS.POST
6MOS.POST
CHRONIC COURSE
RECOVERY COURSE
INNOCULATION COURSE
RESILIENT COURSE
GROWTH COURSE
Diagram courtesy of Brett Litz, PhD, NCPTSD, Boston
DELAYED COURSE
PTSD
SYMPTOM
BURD
EN
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Study Who/when?
1600 Members (2 Infantry Battalions) of the 11600 Members (2 Infantry Battalions) of the 1ststMarine Division will be offered invitations toMarine Division will be offered invitations toparticipate in the prospective studyparticipate in the prospective study
Information (data) will be gathered at four timeInformation (data) will be gathered at four timepointspoints
Time 1: Within the month prior to deploymentTime 1: Within the month prior to deploymentTime 2: One weekTime 2: One weekpostdeploymentpostdeployment(questionnaires only)(questionnaires only)
Time 3: Three monthsTime 3: Three monthspostdeploymentpostdeployment
Time 4: Six monthsTime 4: Six monthspostdeploymentpostdeployment
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The projects?Project 1Psychiatric, psychosocial and cognitivePsychiatric, psychosocial and cognitive
predictors of adaptation trajectoriespredictors of adaptation trajectories
Brett Litz Ph.D.; Boston University andBrett Litz Ph.D.; Boston University and
National Center for PTSD; William P. NashNational Center for PTSD; William P. NashM.D., Headquarters Marine Corps, Quantico &M.D., Headquarters Marine Corps, Quantico &
University of California San Diego; JenniferUniversity of California San Diego; Jennifer
Vasterling; Boston University & NationalVasterling; Boston University & National
Center for PTSD); Paul Hammer M.D.,Center for PTSD); Paul Hammer M.D.,
Division Psychiatrist, 1Division Psychiatrist, 1stst Marine Corps, CampMarine Corps, Camp
PendletonPendleton
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The projects?Project 2Startle thresholds,Startle thresholds, sensorimotorsensorimotor gating, heartgating, heart
rate (HR) reactivity, baseline as predictorsrate (HR) reactivity, baseline as predictors
of adaptation trajectoryof adaptation trajectory
Victoria Risbrough Ph.D., San Diego VAVictoria Risbrough Ph.D., San Diego VACESAMH & University of California San DiegoCESAMH & University of California San Diego
(UCSD); Mark Geyer Ph.D, San Diego VA(UCSD); Mark Geyer Ph.D, San Diego VA
CESAMH & UCSD; Dewleen Baker M.D., SanCESAMH & UCSD; Dewleen Baker M.D., San
Diego VA CESAMH & UCSDDiego VA CESAMH & UCSD
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The projects?Project 3Characterization of catecholamineCharacterization of catecholamine
((norepinephrinenorepinephrine) genotype, stress) genotype, stress--relatedrelated
proteins and blood pressure (BP) asproteins and blood pressure (BP) as
predictors of intermediate biological traitspredictors of intermediate biological traits
(phenotype) and adaptation trajectory(phenotype) and adaptation trajectory
Daniel OConnor M.D.,SanDaniel OConnor M.D.,SanDeigoDeigoVA &VA &
Department of Medicine, UCSD; NicholasDepartment of Medicine, UCSD; Nicholas
Schork M.D.,San Diego VA CESAMH, ScrippsSchork M.D.,San Diego VA CESAMH, Scripps
Institute & UCSD; Dewleen Baker M.D.,SanInstitute & UCSD; Dewleen Baker M.D.,San
Diego VA CESAMH & UCSDDiego VA CESAMH & UCSD
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Rationale?Project 3There is considerable evidence for theThere is considerable evidence for the
involvement ofinvolvement of catecholaminescatecholamines
((norepinephrinenorepinephrine) in arousal, memory) in arousal, memory
formation, startle, blood pressure andformation, startle, blood pressure and
pulse, and in PTSDpulse, and in PTSD
Daniel OConnor M.D.,SanDaniel OConnor M.D.,SanDeigoDeigoVA &VA &
Department of Medicine, UCSD; NicholasDepartment of Medicine, UCSD; Nicholas
Schork M.D.,San Diego VA CESAMH, ScrippsSchork M.D.,San Diego VA CESAMH, Scripps
Institute & UCSD; Dewleen Baker M.D.,SanInstitute & UCSD; Dewleen Baker M.D.,San
Diego VA CESAMH & UCSDDiego VA CESAMH & UCSD
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CSF Norepinephrine in PTSD and Control Subjects
0.250
0.300
0.350
0.400
0.450
0.500
0.550
0.600
0.650
0.700
CSFNorepineph
rine(pmol/ml)
TIME
11:40 12:40 13:40 14:40 15:40 16:40
PTSD
CONTROL
GeraciotiGeracioti, Baker et al, Baker et al20012001
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Total Score on Clinician-Administered PTSD Scale
20 40 60 80 100 120
MeanC
oncentrationof
CSFNorep
inephrine(pmol/ml
)
0.2
0.4
0.6
0.8
1.0
Relationship Between Mean CSF NorepinephrineConcentration and PTSD Symptoms in 11 Patients with PTSD
GeraciotiGeracioti, Baker et al 2001, Baker et al 2001
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Special aspectsof this study
ProspectiveProspective
MultisystemMultisystem
Integrated (examination of data acrossIntegrated (examination of data across
projects)projects)
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Pia SantiagoPia Santiago
FengwenFengwenRaoRao
Caroline NievergeltCaroline Nievergelt
Michele FrybargerMichele Frybarger
Todd MayTodd May
Patricia GormanPatricia Gorman
Juan MontgomeryJuan Montgomery
MichaelangeloMichaelangeloMaamoMaamo
William NashWilliam Nash
Gerald LarsonGerald Larson
Brett LitzBrett Litz
Mark GeyerMark GeyerJennifer VasterlingJennifer Vasterling
Victoria RisbroughVictoria Risbrough
Daniel OConnorDaniel OConnor
Nicholas SchorkNicholas Schork
Paul HammerPaul Hammer
EdwardEdwardHesselHessel
Thomas GaskinThomas Gaskin