Coronavirus: Posttraumatic stress after the covid-19 pandemic | Gray matter

Coronavirus: Posttraumatic stress after the covid-19 pandemic |  Gray matter  Science



Some people who were in danger of death from coronavirus in an intensive care unit and was able to survive, she may have suffered from post-traumatic stress disorder, a disorder that causes those who have had an intense negative experience to create intrusive memories of fear that regularly evoke thoughts, nightmares, aggravated nervousness and stress in any situation they evoke or recall stimuli related to the original trauma. This is nothing new, as it is the same type of disorder suffered by some war veterans who have seen their comrades die in battle, or some of the women attacked or raped by violence, but may increase its global prevalence due to the traumatic experience of serious illness from coronavirus.

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Clinical psychology has not stopped fighting post-traumatic stress, but tried and tested treatment has not achieved effective treatment, only temporary relief, which often ends in relapses. One of the classic treatments was to expose those affected to long-term exposures, actual or suspected, to the same stimuli that cause symptoms, such as a threatening weapon or a robbery site, that have been shown to be effective in disappearing them in laboratory experiments with animals. Today, we know that this process of extinction, while not erasing traumatic memory, creates new memories of relief in the brain that are imposed on the unwanted. However, clinical experience shows that about half of those affected relapse into disorder, so the fight to erase traumatic memories from the brain continues.

Special treatment is promoted by Field Trip, a psychedelic clinic in Manhattan, New York. It was attended by Rachel Feltman, Executive Editor-in-Chief Popular science, the main journal of scientific dissemination in the United States, to undergo treatment with the drug ketamine (used as an anesthetic in surgery) to combat the post-traumatic stress that years ago caused him and still had an offensive relationship with a partner. Ketamine has previously been used to treat depression with promising results. Thus, NIMH (National Institutes of Mental Health, USA) showed an improvement in 75% of depressed patients treated with this effect, a effect that was surprisingly seen the day after a single intravenous injection and lasted for one week in at least a third of the injections, which goes beyond what sometimes requires years of traditional therapy or treatment. Ketamine has been suggested to work by reactivating receptors for glutamate, an affected brain neurotransmitter in depressed patients, but this mode of action is uncertain.

About half of those affected relapse into disorder, so the fight to erase traumatic memories from the brain does not stop

A special experience of Rachel Feltman, as she explains herself, consisted of two injections of ketamine per week for three weeks. The psychedelic journey gave her a strange sense of peace, well-being, and self-acceptance, and three months after the last injection, she felt better about her trauma, but not as good as she had a few weeks ago. So the effect was temporary, and Rachel had to return to her previous treatments, such as speech therapy and meditation. However, Ketamin says that the journalist herself helped her feel that she was not imprisoned, as she felt, in a “haunted house”, but that she herself was that house. The memories, horrors, and reflections that her PTSD caused were not her ex, but herself. In such a case, we can assume that instead of erasing his intrusive memories, ketamine acted as a cure for extinction, creating new as well as temporary ways in his brain and mind to feel the traumatic experience.

On the other hand, in experiments with rodents, it has been observed that the best time to try to clear a memory is when it is reactivated, that is, when we recall it, when we remember. A metaphor is a pot of food. If you want to add or remove something before placing it in the fire, you have to open it, remove the lid, because even if it is covered, its contents cannot be modified. Something similar happens to memories, if we do not open them by evocation, that is, by remembering, we cannot change them. Each time we recall a complex memory, its brain imprint weakens and is reworked, strengthened and even modified by its contents. This process is called memory consolidation and requires the neurons involved to synthesize new proteins so that it can be prevented by injecting chemicals into the brain that prevent such synthesis. This means that we can chemically prevent the re-creation of memory once it is reactivated and thus weakened. For example, in order for a rat to stop feeling scared when it hears the sound associated with an electric shock in its legs, we make that sound in the laboratory and immediately afterwards give it an amnestic substance that it no longer has to go through. followed by shock, because the next day, when the rat hears the same sound, it no longer shows signs of fear. The sound-reactivated memory is thus erased and the rat is directly exposed to the original situation that created it.

Chemically, we can prevent the re-creation of memory once it is reactivated and thus weakened

But in a human clinic, reactivation of memories is not achieved directly, exposing the patient to the original traumatic situation, but indirectly, forcing him to imagine the situation or related stimuli, such as healthcare workers, tubing, and tubes. Instruments used in the intensive care unit for trauma patients who have had a severe coronavirus infection. Of all the stimuli related to trauma, the place where the experience was experienced is especially important, because neurons of the hippocampus, areas of the brain, can register this place as a spatial memory of fear of what happened, which, as we can prevent, drugs that inhibit synthesis proteins.

Now try to make it easier to erase unwanted memories by strengthening their relationship to where they come from, team of neurologists from the University of Texas (USA) This reversed the traditional way of creating memories of fear in rats, because instead of making a sound first, followed immediately by an electric shock, what they do is shock first, and immediately after the sound. This investment has the advantage that the sound is primarily associated with the place where the rat hears it, but also indirectly with the shock it has received there before. The site is then registered in the hippocampus as a reminder of the fear that scientists will be able to alleviate by injecting the rat drug rapamycin, an inhibitor of protein synthesis, immediately after inducing it by resubmitting the sound.

In addition, the same researchers were able to chemically label neurons in the rat hippocampus that create a memory of fear, to the point that simply by activating drugs designed for that purpose, the rats feel fear, which is manifested by remaining motionless as if frozen. The success of modern neuroscience engineering tells us that memories of fear can be stored in precise places in the brain where they can be modified or eliminated. The work of clinical psychologists and neurologists can now also be combined with finding the best way to activate these memories in patients with post-traumatic stress and try to eliminate them with amnesic treatment given when they are evoked, ie it is uncovered. Even old and well-established memories can be sensitive to attenuation by amnesic chemicals after adequate reactivation.

Ignacio Morgado Bernal He is Professor of Psychobiology at the Institute of Neurosciences and at the Faculty of Psychology of the Autonomous University of Barcelona. Author of “Learn, Remember, and Forget: Brain Keys to Memory and Education” (Ariel, 2017).

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