Psychotrauma

Introduction

Our research focus is on trauma and trauma related disorders, in particular post traumatic stress disorder (PTSD).

Psychobiological research includes neuroimaging studies (MRI, SPECT, MEG), neuroendocrine research, and psychophysiological aspects of stress related disorders. In epidemiological studies we have examined the prevalence of stress, trauma and PTSD and other disorders in the Netherlands, but also in Afghanistan. Two large EU funded projects on psychosocial care after trauma are ongoing. We have performed randomized controlled trials on the effects of debriefing, early interventions, brief eclectic psychotherapy and Eye Movement Desensitization and Reprocessing therapy (EMDR) and are currently performing RCTs on the effects of administration of cortisol, on the effects of Cognitive Behavioural Therapy (CBT) versus medication and on the addition of biofeedback to exposure as well as on the effects of an internet intervention. We are currently also studying the role of oxytocin in trauma and PTSD.

The BONDS study: Boosting Oxytocin after trauma: Neurobiology and the Development of Stress-related psychopathology

Currently there are few evidence-based interventions to be administered shortly after trauma exposure that prevent the development of post-traumatic stress disorder in traumatized individuals.

Dysregulated stress and fear responses early post-trauma and a lack of social support early after trauma are risk factors for the development of PTSD. The neuropeptide oxytocin is a potent regulator of these processes associated with PTSD development. Therefore, early oxytocin administration appears to be a promising strategy for the prevention of PTSD, by hypothetically ameliorating dysregulated stress and fear responses as well as facilitating adaptive social functioning.

Objective:
Our research aims to study the effects of intranasal oxytocin administration early after trauma on the development of PTSD symptoms and on fear-related brain activity in recently traumatized individuals at increased risk of PTSD development. 

To this end, we are conducting two studies: a randomized controlled trial (BONDS long term study) and a neuroimaging study (BONDS brain study).

Study design:
BONDS long term study
In a prospective double-blind randomized placebo-controlled trial a comparison is made between recently traumatized individuals at increased risk of PTSD development who will receive either intranasal oxytocin or placebo administrations for one week. The effect of the intranasal oxytocin treatment on PTSD symptom severity is assessed at follow-up assessments.

BONDS brain study
In the same population as the BONDS long term study, in a cross-sectional double-blind randomized placebo-controlled study the acute effects of a single intranasal oxytocin administration (versus placebo administration) on fear-related brain activation and connectivity patterns are assessed.

Participants
Adults (18-65 years) who were recently exposed to a traumatic event and who report a high level of initial distress symptoms on screening instruments known to be predictive of PTSD are recruited. Participants are recruited from 3 participating Emergency Departments in Amsterdam.

Start date:  
May 2012

Expected end date:
BONDS brain study: March 2014
BONDS long term study: July 2015

Researchers AMC Psychiatry
Drs. J.L. Frijling
Drs. S.B.J. Koch
Drs. L. Nawijn
Dr. M. van Zuiden
Prof. dr. D.J. Veltman
Prof. dr. M. Olff

Partners
Emergency Department AMC
Trauma Unit AMC
Emergency Department VUmc
Traumatology Department VUmc
Emergency Department SLAZ
Department of Clinical Genetics AMC

Contact 
Ms. Drs. J.L. Frijling

Academic Medical Center
Department of Psychiatry
Meibergdreef 5 1105 AZ Amsterdam 
e-mail: bonds@amc.nl
Ph: 020-8913667 or  06-10153668

BOOSTER study - Boosting the oxytocin system after trauma: neurobiological effects on emotion and reward-processing in PTSD

Since a substantial part of posttraumatic stress disorder (PTSD) patients drop out of treatment, remain symptomatic, or relapse after initial response to treatment, novel strategies to boost treatment response are necessary. A promising candidate to improve treatment response in PTSD is the neuropeptide oxytocin (OT), which is involved in several processes disrupted in PTSD, including the fear response, and reward functioning. Therefore, investigating the role of OT administration on emotional and reward-related processes in the brain may lead to novel strategies to improve treatment for PTSD.


Objective:
In this functional Magnetic Resonance Imaging (fMRI) study, the primary objective is to examine the acute effects of intranasal OT administration on emotional- and reward-related brain processes in police personnel with and without PTSD.

Study design:

This is a double-blind randomized controlled within-subjects study, in which a comparison is made between PTSD patients and traumatized healthy controls, each receiving one dose of intranasal OT (40 IU) and placebo (saline)during two separate fMRI sessions.

Participants
We will recruit 40 police officers with PTSD (20 males and 20 females) and 40 traumatized healthy police controls (20 males and 20 females). Control participants are matched to PTSD patients for age, level of education and number of years in service.

Start date
July 2012

End date inclusion
May 2014


Researchers AMC Psychiatry
Drs. L. Nawijn
Drs. S.B.J. Koch

Drs. J.L. Frijling

Dr. M. van Zuiden
Prof. dr. D.J. Veltman
Prof. dr. M. Olff

Partners

PDC politiepoli


Contact
Ms. Drs. L. Nawijn and Ms. Drs. S. Koch

Academic Medical Center

Department of Psychiatry
Meibergdreef 5 1105 AZ Amsterdam
e-mail: booster@amc.nl

Ph: 020-8913667


Acute effects of low-dose cortisol in chronic posttraumatic stress disorder

Background:

PTSD is characterized by traumatic memories which can manifest as daytime recollections, traumatic nightmares or flashbacks in which components of the event are relived. These symptoms reflect excessive retrieval of the traumatic memory which often retains its vividness and power to evoke distress for decades or even a lifetime. Moreover, persistent retrieval and reconsolidation of traumatic memories keep these memories vivid and thereby the disorder alive. Accumulating evidence on the interplay between memory and emotion has shown differential effects of glucocorticoids on memory. An acute elevation of glucocorticoid levels seems to temporarily inhibit spatial memory in rats and retrieval of episodic memory in healthy human subjects. Furthermore, there is evidence that emotional memory is especially sensitive for the inhibiting effects of glucocorticoids. The administration of cortisol might therefore also inhibit the retrieval of traumatic memories in patients with PTSD. A pilot study of Aerni and colleagues (2004) showed that cortisol administration indeed reduced re-experiencing symptoms in the patients studied.


Objective:

To test if cortisol administration affects PTSD symptoms.


Study design:

In a placebo controlled cross-over design PTSD patients will be randomly assigned to a low dose cortisol (hydrocortisone, 20mg/day) or to placebo. Hydrocortisone/Placebo tablets will be taken twice daily (10 mg in the morning, 10 mg in the evening) for four consecutive days. After a wash out period of 3 days in between, patients will be assigned to the other arm (placebo or hydrocortisone).


Participants:

20


Start date:

November 2012


Researchers AMC Psychiatry:

Drs. A.R. Polak

Dr. A.B. Witteveen

Dr. J. Assies

Prof. dr. D. Denys

Prof. dr. M. Olff


Partners:

Arq Psychotrauma Expert GroupPDC Politiepolie, Diemen, The Netherlands

Dominique de Quervain, MD

Ulrich Schnyder, MD

University Hospital Zürich, Department of Psychiatry, Switzerland

Contact:

A.R. Polak (MSc)

Academic Medical Center

Department of Psychiatry

Meibergdreef 5 1105 AZ Amsterdam, The Netherlands

email: a.r.polak@amc.nl

Individualized EEG marker for predicting treatment outcome in PTSD

Background:

The mismatch negativity (MMN) is observed following rare or unique sensory events, and reflects pre-attentional sensory processing of unexpected stimuli. The MMN is altered in several mental illnesses, including post-traumatic stress disorder (PTSD), but did not yield consistent result yet. The Achilles-heal of the MMN which limits its clinical viability, is that it cannot be reliably identified within all individuals. We, therefore, propose to test an alternative EEG measure to the MMN, oscillatory alpha suppression, in patients with PTSD.

0ur previous work in the typical populations has shown alpha suppression to be reliably indentified within individuals, and correlate with variability in attentional performance.

 

Objective:

The objective for this study is to examine alpha suppression in PTSD andevaluate it as a predictor of treatment outcome. We will first examine if there are differencesin alpha suppression in PTSD patients (prior to treatment) and the typical population. We willthen see if these differences can be used as individualized predictors of treatment outcome.

 

Study design:

A case controlled study, with comparison within PTSD patients and versus control-subjects. An EEG will be conducted in all participants on two different measurements before treatment and following treatment (patients) or within the time span of treatment (controls). During the measurements, questionnaires and memory tests will also be performed.

 

Participants:

14 PTSD patients and 14 trauma-exposed controls without PTSD

 

Start date: 

November 2012

 

Researchers AMC Psychiatry:

Drs. A.R. Polak

Dr. A. Mazaheri

Dr. A.B. Witteveen

Prof. dr. D. Denys

Prof. dr. M. Olff

 

Partners:

PDC Politiepolie, Diemen, The Netherlands

 

Contact:

A.R. Polak (MSc)

Academic Medical Center

Department of Psychiatry

Meibergdreef 5 1105 AZ Amsterdam, The Netherlands

email: a.r.polak@amc.nl

NBB-Psy; the Netherlands Brain Bank for Psychiatry

Background:

As the personal, social, and economic burden of psychiatric disorders is high,there is an urgent need for better treatment strategies, which requires the understanding of underlying etiology and pathophysiology of psychiatric disorders. The use of human brain tissue provides the most direct strategy to develop and test hypotheses about the molecular and cellular basis of psychiatric disorders. However, the current availability of human brain tissue from patients with psychiatric disorders is by far not sufficient.

 

Objective:

It is our mission to develop a qualitatively unique tissue program to extend the number of post-mortem brains of extensively phenotyped patients: NBB-Psy (NHB-Psy in Dutch). This resource will be made available to the national and international research community via de application procedures of the NBB.

 

Study design:

The NBB and research groups of 5 different universities (Utrecht, Nijmegen, University of Amsterdam, Vrije Universiteit Amsterdam, Rotterdam) developed a strategy based on two strong assets in the Netherlands:

1.   The NBB is one of the world’s leading brain banks and is well known for its rapid fresh dissection protocols (4-10h after death);

2.   The availability of several large and extensively phenotyped cohorts of psychiatric patients.

 

Patients and family members of these cohorts will be asked prospectively to register as brain donors at the NBB. Additionally, members from patient organizations will be approached. Controls will be obtained from the cohorts, patient organizations, and the regular NBB donor program. Patients and controls who gave consent to register as donors, will undergo standardized and detailed phenotyping. cDNA banks of brains from subjects with psychiatric disorders and generation of primary and stable (stem)cell lines from fibroblasts and glia cells with further enrich this resource and provide the research community with powerful methods to study associated neuronal abnormalities. We anticipate collection of at least 230-300 psychiatric and 125-200 control brains in the first 5 years and at least 450-600 psychiatric and 250-500 control brains in the coming 10 years.

 

Partners:

Partner for post-traumatic stress disorder;

Academic Medical Centre Amsterdam, Department of PsychiatryArq Psychotrauma Expert Group

 

Start date:  
End of 2012

 

Contact: 
http://www.nbb-psy.nl/

INPREZE

INPREZE is the Dutch acronym for Internet Prevention and Self-help. In this project, we focus on the development and investigation of online applications to facilitate assessment and (early) interventions after trauma. Our research focuses 1) on the validity of a mobile application to systematically assess peri- and post trauma reactions in individuals that have been exposed to a traumatic event (the app is called SAM) and 2) on the effectiveness of a mobile application to reduce symptoms of posttraumatic stress (the app is called SUPPORT Coach).


SAM (Smart Assessment on your Mobile)


Objective:

To develop and validate a mobile app that systematically assesses resilience and psychological symptoms in the aftermath of trauma.


Study design:

Participants will complete the app on their mobile phone and will subsequently participate in a clinical diagnostic interview.


Participants:

The target population involves police officers that have experienced a traumatic event and have been referred to a psychotrauma diagnostic centre.


Period:

2014-2015


SUPPORT Coach

Objective:

To develop and study the effectiveness of the SUPPORT Coach app in reducing symptoms of posttraumatic stress.


Study design:

This is a randomized controlled trial. Participants in the intervention group receive access to the SUPPORT Coach, participants in the control group receive no acces to the app. Only participants with at least a mild level of posttraumatic stress symptoms (assessed with a short online screening) will be randomized into one of these groups.



Participants:

Health care professionals (18 years and older) that are regularly exposed to adverse events (e.g. ambulance and ED personnel) are invited to participate in the screening. Participants with at least a mild level of posttraumatic stress symptoms are eligible to participate in the randomised part of the study.


Period:

2015

Researchers AMC Psychiatry:

C.A.I. van der Meer, MSc

S. van Buschbach, MSc

S. Tariq, MSc

Dr. A. Bakker

Prof. Dr. M. Olff


Partners:

INPREZE (www.inpreze.nl)

Interapy

ARQ, psychotrauma expert groep

Dr. Leo Kannerhuis


Contact:
C.A.I. van der Meer, MSc

Zorglijn Angststoornissen
Academisch Medisch Centrum
Divisie Psychiatrie
Universiteit van Amsterdam
Meibergdreef 5 1105 AZ Amsterdam

c.a.meervander@amc.uva.nl

OPSIC: Operationalising Psychosocial Support in Crisis

Background:

Emergencies brought about by natural or man-made disasters can seriously affect entire populations with long-term psychosocial consequences impacting the survivors as well as the helpers for years to come. Providing psychosocial support to the affected population can alleviate suffering and help the process of healing and recovery.

Over the last 20 years, psychosocial support has played an increasing role in emergency response and a number of high-quality guidelines and best-practice studies have been made. However, these have never been brought together in an easy to use comprehensive guideline, which covers all target groups, all phases of disaster and all different types of disasters.

It is the aim of the OPSIC project to review existing guidelines and best practice-studies in order to match methods and tools to all relevant target groups, types and phases of emergencies, and to develop an IT based system – an Operational Guidance System (OGS) – which will function as a go-to-point for all tools needed to plan, conduct and evaluate a psychosocial support intervention.


Objective:

1. To establish criteria/indicators for best practices in psychosocial support within assessment, intervention tools and methods in disaster management.

2. To provide a clear overview of best practices in psychosocial support in emergencies focused on incidents which took place in Europe during the past ten years while using the established criteria.

3. To match best practice analysis results and assessment and intervention methods and tools to the guidelines and to the different phases of emergency, target groups and types of emergencies as well as pin point gaps and needs from the viewpoint of field experiences.


In order to achieve these objectives, a table of criteria to be used as a tool for identification of best practices will be developed.

Start date:
2013


Expected end date:

2015


Researchers AMC Psychiatry:
S.B. Thormar, MSc

S. Buschbach, MSc

M. van Gelderen, MSc

M. Olff, PhD


Partners:

Danish Red Cross

University of Austria, Innsbruck

TNO, the Netherlands

IMPACT, The Netherlands

University of Zagreb, Croatia

Magen David Adom, Israel

Tripitch Mediacreatives

Samur, Spain

Centre for Science, Society and Citizenship (CSSC), Italy

Crismart, Sweden


Contact:

Prof. dr. M. Olff

Academic Medical Center

Department of Psychiatry
Meibergdreef 5 1105 AZ Amsterdam
e-mail: m.olff@amc.uva.nl

http://opsic.eu/

Sleep and Memory in Posttraumatic Stress Disorder

Background:

Posttraumatic stress disorder (PTSD) is a mental health problem with a high prevalence in the general population; 8% of the population is diagnosed with this disorder during their lives. Previous sleep studies in healthy subjects suggest the occurrence of adaptive changes in sleep architecture after emotional experiences, which likely play a role in emotional housekeeping and attenuation of the emotional responses towards negative emotional experiences. Sleep thus seems important for emotional recovery from traumatic experiences and PTSD.

 

Objective:

This project aims to investigate the role of sleep on memory processing in PTSD. The primary aim of the study is to assess the effects of sleep architecture on emotional memory processing and neurocognitive functioning in subjects with and without PTSD. A secondary objective of the study is to assess the relationship between sleep architecture and efficacy of PTSD treatment for the patient group.

 

Study design:

Controlled patient study. Effects of sleep architecture will be assessed in emotional and neutral memory tasks, performed before and after sleep. Sleep architecture will be assessed by performing nightly polysomnography (PSG). Further main study parameters are neurocognitive functions (attention, planning, declarative memory). Correlates of sleep architecture will also be investigated in stress hormones. For the patient group, predictive effects of sleep architecture and memory processes on response to treatment will be studied.

 

Participants:

Traumatized police officers and veterans with and without PTSD.

 

Start date:  
July 2012

 

Researchers AMC Psychiatry:
Dr. M.J. Mink-Nijdam

Drs. M.J. van Gelderen

Prof. Dr. M. Olff

 

Partners:

Brain and Cognition Group, University of Amsterdam

Arq Psychotrauma Expert Group, centers in Oegstgeest and Diemen

 

Contact: 
Dr. M.J. Mink-Nijdam
Academic Medical Center
Department of Psychiatry
Meibergdreef 5 1105 AZ Amsterdam
Email m.j.nijdam@amc.uva.nl

Tel +31-20-8913672

 



Past Projects
  • The Effectiveness of CBT vs Paroxetine in the Treatment of PTSD
  • Prevalence of PTSD symptoms and Efficacy of an Online Early Intervention in an Acute Trauma Population (TraumaTIPS)
  • Efficacy of Biofeedback during Exposure Sessions in Trauma Focused CBT
  • Efficacy of Brief Eclectic Psychotherapy vs. EMDR
  • Mental Health in Humanitarian Aid Workers
  • The European Network for Traumatic Stress (TENTS)
  • Mental Health in Indonesian Red Cross Volunteers
  • Dutch Politicians' Coping with Terrorist Threat
  • The Prevalence of Trauma and PTSD in the Netherlands
  • Mental health problems after the Enschede firework disaster
  • Efficacy of Early Cognitive Behavioural Therapy for acute PTSD
  • Biological markers for PTSD
  • Efficacy of Early Psychological Debriefing
  • Brain imaging and Neurophysiological Correlates of PTSD
  • Doctoral theses