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Post-Traumatic Stress Study: UNC Has the Experience to Lead

It was January 2005 and Travis Woody was driving through the Iraqi city of Fallujah when his truck got hit with an IED. It was his fifth deployment, or maybe his sixth — well before the military’s greater understanding now of traumatic brain injuries — and his superiors said, “You good?” and sent him back out the next day.

(iStock photo)

(iStock photo)

The Marine was stationed in Iraq five times in all and in Afghanistan three, and it’s hard for him to pinpoint exactly when in all of those deployments he changed. There was the bomb, but there were other things, too. Dragging his buddies’ bodies out of the line of fire, finding out that yet another had died or lost a limb or suffered something that would be unimaginable to the people back home.

He remembers blacking out once when he was stateside himself and his sons, then 3 and 8, had left out toys, maybe some socks.

“I walked in and completely flipped out, yelling and screaming and making an ass out of myself,” he says, “and my wife was like, ‘What is wrong with you?!’ ”

The next day he sought out his medical officer, who sent him to a psychiatrist, who asked him a litany of questions and wrote out a prescription. There was another prescription after that. And another.

He showed some of the classic signs of post-traumatic stress — hypervigilance, disrupted sleep, unstable moods — and he graduated to what he calls “crazy gadgets,” like a device that sent electrical stimulation into him through little clips on his earlobes. He has blacked-out goggles and lights that flash at different speeds and intensities and headphones that broadcast a heartbeat sort of sound. Some of the treatments help, but the thing is doctors still don’t know why.

They also don’t know why some people exposed to trauma, in war or in civilian life, develop such symptoms while others in the same circumstance bounce back.

Dr. Samuel McLean (UNC photo)

Dr. Samuel McLean (UNC photo)

Now Dr. Samuel McLean, UNC’s Jeffrey Houpt Distinguished Investigator and an associate professor of anesthesiology, emergency medicine and psychiatry, is leading one of the most comprehensive studies ever designed to tease apart the symptoms loosely clustered under the diagnoses of depression and post-traumatic stress and figure out precisely which physical processes are correlated with which problems.

The National Institute of Mental Health has committed $21 million so that McLean and more than 40 scientists working at 19 institutions can study civilians in the immediate aftermath of a trauma, whether it be sexual assault or an automobile accident. They’ll take blood to study the patient’s genetic makeup, run EKGs to study the heart’s reaction, and hook up functional MRIs to see exactly what’s happening in the mysterious folds of the brain. They then will follow the patients for a year, checking the GPS on patients’ phones to see if they’ve stopped leaving the house and tracking a wrist-wearable to measure their heart rate and sleep patterns. They’ll do neurocognitive assessments over the phone, bring patients back into the lab for follow-up MRIs, and ping them by text off and on throughout the day to ask how they’re feeling.

All of this is replacing what was about a 20-question diagnostic survey administered after symptoms started to show, and the hope is that more precise knowledge of what is happening biologically right after the triggering event will result in more precise treatments and a greater willingness of people to come forward when they’re suffering.

“One of the reasons post-traumatic mental health disorders are so stigmatized is that they’re a black box, and by elucidating you do something about that stigma,” McLean said. “So we’re using a lot of fancy-pants, latest biological methods, the latest genomic and physiologic and neuroimaging methods, all on the same person, so we’ll get lots of information from their genes up through their symptoms. Of course, we could do a lot more genomics with more money.”

They’re also throwing out old diagnostic categories and starting with data, parsing it into discreet units so they can understand what is happening at the most precise level, so that they have a better chance to create effective treatments.

When the NIMH’s $21 million commitment was announced in October, McLean noted: “Twenty-one million dollars sounds like a heck of a lot of money, and it is, but given the very high costs of the latest science — comprehensive molecular, neuroimaging and bioinformatics methods — we actually need to leverage these public dollars with private support so that we can take full advantage of this once-in-a-generation opportunity 
to advance care for veterans and civilian survivors of traumas such as sexual assault.”

The NIMH invested in the topic because of the epidemic of post-traumatic stress and depression in the 2.6 million veterans who have deployed since 9/11 and the reported 22 veterans a day who die by suicide. A major supporter is Peter Chiarelli, a retired general who was the 33nd vice chief of staff of the Army and is now CEO of One Mind, a not-for-profit that works with researchers trying to understand the issues of veterans.

“I refuse to call it a disorder,” Chiarelli said. “It’s just horrible to tell someone they have a disorder, let alone a veteran who had to pick up body parts. I think it’s going to prove to be an injury.”

McLean was chosen as primary investigator in part because of the collaborative network he already has in place to study sexual assault survivors and try to find interventions that can minimize later symptoms of PTS, chronic pain and depression.

“The critical part of the biology plays out in the initial hours and weeks after a traumatic event, so we want to drill down and look carefully in that period of the time and see what’s going on in both body and brain and create risk prediction tools to use in the ER or field hospitals that will identify people who have been injured who are at risk of adverse outcomes.”

The advantage of working with trauma survivors is that there is a precipitating event, said Farris Tuma, chief of NIMH’s Traumatic Stress Research Program, so there’s a starting point to look for the earliest signs of extreme distress and dysfunction while they’re unfolding, but also of resilience, and thus come up with more strategic and scientific methods to prevent the suffering and promote the recovery.

“The more education there can be around the legitimacy of the injuries to brain and body that we’re currently diagnosing as post-traumatic stress, the more likely people are to acknowledge those problems and not think they’re something they should get over on their own, because it’s not a matter of will.”

 Janine Latus

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