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Understanding the Scientific Basis of Post-traumatic Stress Disorder (PTSD): Precision Behavioral Management Overrides Stigmatization

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Abstract

Post-traumatic stress disorder (PTSD) is a severe polygenic disorder triggered by environmental factors. Many polymorphic genes, particularly the genetic determinants of hypodopaminergia (low dopamine function), associate with a predisposition to PTSD as well as substance use disorder. Support from the National Institutes of Health for neuroimaging research and molecular, genetic applied technologies has improved understanding of brain reward circuitry functions that have inspired the development of new innovative approaches to their early diagnosis and treatment of some PTSD symptomatology and addiction. This review presents psychosocial and genetic evidence that vulnerability or resilience to PTSD can theoretically be impacted by dopamine regulation. From a neuroscience perspective, dopamine is widely accepted as a major neurotransmitter. Questions about how to modulate dopamine clinically in order to treat and prevent PTSD and other types of reward deficiency disorders remain. Identification of genetic variations associated with the relevant genotype–phenotype relationships can be characterized using the Genetic Addiction Risk Score (GARS®) and psychosocial tools. Development of an advanced genetic panel is under study and will be based on a new array of genes linked to PTSD. However, for now, the recommendation is that enlistees for military duty be given the opportunity to voluntarily pre-test for risk of PTSD with GARS, before exposure to environmental triggers or upon return from deployment as part of PTSD management. Dopamine homeostasis may be achieved via customization of neuronutrient supplementation “Precision Behavioral Management” (PBM™) based on GARS test values and other pro-dopamine regulation interventions like exercise, mindfulness, biosensor tracking, and meditation.

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Acknowledgments

We acknowledge editorial assistance from Margaret Madigan.

Funding

Research directed toward improving substance use disorders, especially in under-served populations, is the basis of an NIH grant awarded to Dr. Kenneth Blum and Marjorie Gondré-Lewis (Drs. Blum and Gondré-Lewis are the recipients of 1R41MD012318-01/MD/NIMHD NIH HHS/USA). Dr. R.D. Badgaiyan is partially supported by the National Institutes of Health grants 1R01NS073884 and 1R21MH073624; and VA Merit Review Awards CX000479 and CX000780. Dr. P. K. Thanos is the recipient of R01HD70888-01A1.

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Authors and Affiliations

  1. Graduate School of Biomedical Sciences, Western University Health Sciences, Pomona, CA, USA

    Kenneth Blum & D. Baron

  2. Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary

    Kenneth Blum

  3. Department of Psychiatry, Boonshoft School of Medicine, Wright University, Dayton, OH, USA

    Kenneth Blum

  4. Department of Precision Behavioral Management, Geneus Health, San Antonio, TX, USA

    Kenneth Blum, L. Lott, D. Siwicki & L. Fried

  5. Division of Neurogenetic Research & Addiction Therapy, The Florida House Experience, Deerfield Beach, FL, USA

    Kenneth Blum & A. Howeedy

  6. Division of Addiction Services, Dominion Diagnostics, North Kingston, RI, USA

    Kenneth Blum, D. Siwicki & M. Hauser

  7. Division of Neuroscience & Addiction Research, Pathway Healthcare, LLC., Burmingham, AL, USA

    Kenneth Blum

  8. Department of Anatomy, Developmental Neuropsychopharmacology Laboratory, Howard University College of Medicine, Washington, DC, USA

    M. C. Gondré-Lewis

  9. Department of Psychology, Curry College, Milton, MA, USA

    E. J. Modestino

  10. Center for Psychiatric Medicine, Lawrence, MA, USA

    T. McLaughlin

  11. Department of Neurology, Boston University School of Medicine and VA Boston Healthcare System, Boston, MA, USA

    M. H. Krengel & M. Oscar-Berman

  12. Behavioral Neuropharmacology & Neuroimaging Laboratory on Addiction, Research Institute on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, Buffalo, NY, USA

    P. K. Thanos

  13. Department of Psychiatry, Cooper University School of Medicine, Camden, NJ, USA

    I. Elman

  14. Transformations Treatment Center, Delray Beach, FL, USA

    L. Fried

  15. Division of Anatomy, Biochemistry and Genetics Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine

    A. Bowirrat

  16. Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    R. D. Badgaiyan

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  1. Kenneth Blum
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Correspondence to Kenneth Blum.

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Blum, K., Gondré-Lewis, M.C., Modestino, E.J. et al. Understanding the Scientific Basis of Post-traumatic Stress Disorder (PTSD): Precision Behavioral Management Overrides Stigmatization. Mol Neurobiol 56, 7836–7850 (2019). https://doi.org/10.1007/s12035-019-1600-8

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