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Nausea in the peri-traumatic period is associated with prospective risk for PTSD symptom development

Neuropsychopharmacologyvolume 44pages668673 (2019) | Download Citation

Abstract

While nausea often develops following exposure to trauma, little is known regarding the relationship between peri-traumatic nausea and prospective risk for developing posttraumatic stress disorder (PTSD). We examined the association between peri-traumatic nausea and PTSD symptom development in three independent cohorts. Participants were recruited from (1) the Emergency Departments (ED) at Grady Memorial Hospital (GMH) in Atlanta, GA, (2) from multiple other ED sites in the TRYUMPH Research Network, and (3) from the ED during evaluation for suspected acute coronary syndrome in the REACH cohort. Administration of IV ondansetron, the most predominant antiemetic used at GMH, was used as a surrogate marker for nausea in the initial GMH cohort; nausea was then directly assessed in the internal validation at GMH, and within the replication TRYUMPH Research Network and REACH cohorts. In the GMH cohort (N = 363), ondansetron administration was associated with increased 1- and 3-month posttrauma PTSD symptoms in adjusted models (all p’s < 0.05). In the GMH internal validation, nausea significantly predicted 1 month (p = 0.009; n = 68) and 3 month (p = 0.029; n = 54) PTSD symptoms. In the TRYUMPH cohort (N = 1846), patient reported nausea in the ED was significantly associated with increased PTSD symptoms (p = 0.009) in adjusted models. In the REACH cohort (N = 758), peri-traumatic nausea was associated with PTSD symptom severity at the 1-month follow-up in adjusted models (p’s ≤ 0.008). The current prospective data from three independent cohorts suggest that peri-traumatic nausea is a prospective predictor of PTSD symptom development. Further studies are needed to determine the mechanistic role of nausea as an intermediate phenotype of PTSD risk.

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Acknowledgments

We would like to particularly thank Alex Rothbaum, Thomas Crow, and Becky Hinrichs for their support and assistance. All of this work would not have been possible without the support of all the nurses, physicians, associate providers, and staff of the Emergency Care Center at Grady Memorial Hospital, the TRYUMPH Research Network sites, and Columbia University Medical Center. Additionally, we would like to acknowledge the patients and families that agreed to participate in these studies.

Funding

This work was supported by the National Institute for Health (R01 MH094757, K.J.R.), the National Institute of Arthritis and Musculoskeletal and Skin Diseases (R01 AR060852 and R01 AR056328, S.A.M.), the National Institute of Child Health and Human Development (K12 HD085850, V.M.), the National Heart, Lung, and Blood Institute (R01 HL123368, I.M.K.; R01 HL117832; K01 HL130650, J.A.S.) and the Brain and Behavior Research Foundation.

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Affiliations

  1. Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA

    • Vasiliki Michopoulos
    • , Jessica Maples-Keller
    • , Elizabeth I. Roger
    • , Barbara O. Rothbaum
    • , Charles F. Gillespie
    •  & Kerry J. Ressler
  2. Yerkes National Primate Research Center, Atlanta, GA, USA

    • Vasiliki Michopoulos
  3. Naval Medical Center San Diego, San Diego, CA, USA

    • Elizabeth I. Roger
  4. Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, USA

    • Francesca L. Beaudoin
  5. Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA

    • Jennifer A. Sumner
    •  & Ian M. Kronish
  6. Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA

    • Lauren Hudak
  7. Departments of Anesthesiology and Emergency Medicine, University of North Carolina, Chapel Hill, NC, USA

    • Samuel A. McLean
  8. Mclean Hospital, Harvard Medical School, Belmont, MA, USA

    • Kerry J. Ressler

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The authors declare no competing interests.

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Correspondence to Vasiliki Michopoulos.

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DOI

https://doi.org/10.1038/s41386-018-0276-5