PTSD Study Takes Holistic Approach
The University of South Dakota has established a Center for Genetics and Behavioral Health. The center received a $3.4 million grant from the Governor’s Research Center Program over five years to study genetic and environmental influences that interact with other biological, psychological, and behavioral factors to impact post-traumatic stress disorders (PTSD). Researchers will take a holistic approach to be able to determine if someone exposed to a traumatic event can develop severe PTSD.
"If only the brain was less complicated than it is it would be easier to figure it out."
SDPB’s host of Innovation - Cara Hetland met with the team of scientists who are studying everything from genetics to gut microbes in an attempt to identify people who may be prone to PTSD and identify screenings and earlier treatments.
For the purpose of this study, Lee Baugh (baa) needs to be clear – post-traumatic stress disorder or PTSD refers to any traumatic event. It can be witnessing violence – whether it’s criminal, domestic or an act of war. It can be sexual trauma, or an automobile accident. What it isn’t is serious heart ache after a break up – even though that is traumatic to some.
"So it’s a much broader set of conditions that can result in PTSD."
Lee Baugh is an Associate Professor of Neuro Science and Basic bio Medical Sciences at the University of South Dakota School of Medicine. He says the study is made up of a broad group of investigators working on the same problem in South Dakota.
Nationally PTSD affects about 3 and a half percent of the population. It’s double that in South Dakota and why Baugh and his team are looking for better treatment options for those suffering from PTSD. He’s clear scientists are still learning about the disorder.
"That’s what’s really stumped a lot of treatment and identification of PTSD is the fact that 50-60% of people at some point in their lifetime could be exposed to a traumatic event that could cause PTSD but a much smaller percentage go on to develop the full blown symptoms," says Baugh. "So we’re looking to identify those individuals who go on to develop PTSD and then guide treatment based on this information – the genetics, psych, neuro imaging to best tell what treatment is going to work well,"
Participants in the study will give a blood sample, a stool sample, answer a whole lot of questions and also agree brain imaging. It’s a little more complicated than that on the science side but Zach King says it’s pretty simple to get enrolled in the study. He’s a Clinical Research Coordinator for the Center for Genetics and Behavioral Health.
"As long as they meet the criterion for inclusion – won’t be any issue with the blood draw, they’re an adult between the ages of 18 and 55, and they’ve experienced a significant traumatic event, then we set up time to talk with them," says King.
King says participants need to travel to one of three locations – Vermillion, Yankton or Sioux Falls. There is a stipend for participants – about $160 if they qualify for all of the different phases. The goal is to enroll 325 participants over the next five years. So far, King says, they have five.
"People are hesitant – no one wants to tell you their dirty secrets or admit weakness. Especially because with PTSD a large proportion of them are military veterans – there’s a hesitancy if they want to open up about this. A lot question if it’ll be reported to higher ups," says King.
King assures all information is kept confidential. King has a series of questions ranging from demographics to personality characteristics to medications. These questions determine if participants are invited for the next round. That involves more psychological testing and more details about the traumatic events in their lives.
All qualifying participants will give a blood sample for genetic testing. Scientists want to know if specific markers could be used as a screening for PTSD in military recruits. Participants also give a stool sample. Learning about how the microbes in the gut interact with brain function is a new approach. Jamie Scholl – research associate and project manager for the center for genetics and behavioral health. She says nobody really knows if there are specific strains or any one particular bacterium that’s more important than the other in your gut or why.
"So you hear a lot about probiotics but what particular thing are we trying to promote – is it the same for everybody – is there something that’s more beneficial to somebody who experienced one type of trauma over another or people who have comorbid symptoms with depression and PTSD. So just trying to look to see if there are relationships between the severity of mental disease and the microorganisms and if that could be something that could be used as a target for future health care and treatment," says Scholl.
Scholl says diet does play a role. She says the higher quality of food you eat and the more variety of food you eat the better off you are. Highly processed food can dampen the diversity of your gut. There isn’t any data she says on the difference between the gut microorganisms in a vegan versus a meat eater. She doesn’t know which is better than the other – she only knows they’re different. It’s all data she looks forward to exploring in this study.
The last phase of the study requires Functional Magnetic Resonance Imaging or F-MRI this is the collection of low-resolution images of the brain very quickly that captures changes in blood oxygenation while participants complete a task. Lee Baugh says the tasks are themed around traumatic events. Participants will see a series of words and be asked to count how many words.
"What we know from previous research is when those word are related to something that have trauma centered around – so for example if this individual came from a military context the stimuli is the word mortar four times in a row – that’s going to result in an increased reaction time – so it takes them longer to respond to that task," says Baugh.
They have a harder time counting the number of words in that situation. The scan shows their brain activity and Baugh says they’ll see an elevated response in parts of the brain known to be associated with the assessment of threat.
"So by presenting stimuli that are related to these traumatic events and contrasting that to stimuli that people shouldn’t have stressful response to – words like table or drawer – dull and boring we can look at brain activity when people are exposed to traumatic event related words," says Baugh.
Baugh says every participant will see words related to different traumatic events and he predicts they react only to the event the participant experienced.
Once all the data is collected from 325 participants then the real fun begins according to Lee Baugh
"A part of this project is to come up with ways to deal with all of that data – computer may have one or two terabytes of storage on it – we’re talking about hundreds of terabytes of data we’re collecting to the point we’ve had to upgrade the storage at University to be able to hold all the data we’re getting so then we have to figure out some way to combine it," says Baugh.
Baugh says they’ll rely on the university computer science department to assist with how to use machine learning and classification algorithms to put the data together. This study is also part of the academics at the university and one of the requirements of the governor grant is work force development – giving STEM - Science, Technology, Engineering and Math graduate students training from a different perspective. That’s where this computer science analytics, or communication classes may come in order. Brian Burrell is a professor of neuro science division of basic biomedical sciences.
"The benefit is to make a more broadly educated STEM graduate student so they have access to a wider array to potential careers and it may allow some of these students to stay in the area a little bit better too. … keep best and brightest around here," says Burrell.
Burrell says the skills students learn working on research projects are skills that are transferable to other types of questions and disciplines as well. He says for the purpose of the multimodal approach – looking at genetics, gut biome, and brain imaging is to have data that compares apples to apples. He says what is learned here can help many other disorders like depression, Alzheimer’s disease. He says they’re all inter-related.
"Certain people with certain genetic predispositions may respond differently to the therapy. The same thing is probably happening with PTSD and depression. And so if we can start to – as one of the results of our multi-modal tool – start to separate out different categories of patients. Companies who are trying to develop pharmacological therapies might enjoy better success if they’re looking at a more pure patient pool, basically," says Burrell.
The ultimate goal for this project according to Lee Baugh is to develop classification routines.
"So you would be able to take someone you never interacted with and tell the system this person has a genetic profile that looks like this, their brain function looks like that, their cortisol levels look like this and then have the system say whether they are likely to develop post-traumatic stress disorder or not," says Baugh.
Baugh says calls machine learning a “black art” in computer sciences. He says he’s not sure why it always works but it does.
"By feeding a classification system enough data it can actually begin to make enough predictions as to whether someone is likely to be in category A or category B based on those data points. And that’s ultimately what we’re looking for because that’s what’s going to guide treatment, that’s what’s going to allow us to say well, this person should have this form of treatment or this person – even though they experienced a traumatic event they’re not likely to develop post-traumatic stress disorder, so we don’t have to worry about them," says Baugh.
Baugh says while the participants in this study may not benefit directly; the information from the data collected he says will lead to new therapies and treatments for years to come.