Post-traumatic stress disorder: A time bomb (not only) in Iraq

Even after the end of a traumatic event or time, many people will keep on battling an “inner war” that is sometimes visible to others – and sometimes not. Can biochemistry help us diagnose PTSD in time to improve the treatment of survivors?

By Daniele Suzete Persike and Suad Yousif Al-Kass

Post-Traumatic Stress Disorder (PTSD) is a severe anxiety disorder and often a disabling condition involving physical and psychological signs and symptoms in response to trauma. As mental health disorders are still widely associated with social stigma, there is little coverage and, therefore, few research articles, which systematically assess the issue.

The Iraqi population is particularly affected by this lack of information. The incidence of suicides in the Kurdistan Independent Region has increased at an alarming rate, especially among women – a situation that has been reported since 2009. The situation became particularly dramatic after the Islamic State of Iraq and Syria (ISIS) attacked the Yazidi‘s ancestral homeland in northwestern Iraq in 2014. Among various atrocities, ISIS abducted and enslaved thousands of girls and women. At this point, many of them are still missing.

Measuring the risk of developing PTSD?

PTSD has a very complex pathophysiology and shares some symptomatic and biochemical similarities with other psychiatric disorders. The identification of PTSD cases is often based on self-reported symptoms, which can lead to misdiagnoses and thus severely affect the treatment of the disease.

For this exact reason, so the authors of a brief review in Hormone Molecular Biology and Clinical Investigation claim, biochemical evaluations are now urgently needed to identify specific biomarkers for PTSD. A biomarker, or biological marker is a measurable indicator of some biological state or condition. Biomarkers are often measured and evaluated to examine normal biological processes, pathogenic processes, or pharmacologic responses to a therapeutic intervention.

According to the researchers from the University of Dohuk in Kurdistan, the knowledge of specific biomarkers will help to diagnose PTSD accurately and to improve treatment. In their article, they discuss the main biochemical mechanisms involved in PTSD as well as the main methods applied to assess the disorders.

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In addition to adjustments because of trauma, some pre-exposure factors can make persons particularly vulnerable to developing PTSD. For example, the disease has been shown to be associated with dysfunction of parts of our neuroendocrine system, more precisely the hypothalamic-pituitary-adrenal (HPA) axis and the hypothalamic-pituitary-thyroid (HPT) axis.

The sympathetic nervous system (SNS) activity, which promotes our “fight-or-flight response”, plays a role in PTSD by releasing norepinephrine and adrenaline. Cortisol release increases the response of the SNS. Cortisol levels in PTSD patients, especially women, are later reduced by a negative feedback mechanism, which contributes to neuroendocrine changes and promotes structural changes in the brain leading to PTSD.

In their article, the researchers hypothesize that gender differences in the general response to the HPA-axis may be associated with an increased likelihood of women developing PTSD. Furthermore, serotonin and dopamine levels usually fluctuate in the presence of PTSD. Mechanisms such as the induction of neuroinflammation and changes in mitochondrial energy processing have also been associated with PTSD.

To help survivors of trauma – in Iraq and worldwide – more research is now urgently needed to provide a better understanding of the disease and to find specific biomarkers, which may facilitate the diagnosis, prediction, and treatment of PTSD.

To find out more, read the original article here:

Daniele Suzete Persike and Suad Yousif Al-Kass: Challenges of post-traumatic stress disorder (PTSD) in Iraq: biochemical network and methodologies. A brief review, 06.11.2020.

The Editors

Articles signed by the editors were written in a collective effort.

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