A focus on female vets

Minnesota Medicine - Carmen Peota - 2015-08-01James L
When Lisa M. James, PhD, arrived at the
Brain Sciences Center

Brain Sciences Center (BSC)

A research group in collaboration with the Minnesota American Legion, Minneapolis VA Medical Center, and the University of Minnesota.
at the Minneapolis Veterans Affairs Medical Center in 2010, the young scientist was very much aware that researchers there had just shown that
Magnetoencephalography

Magnetoencephalography (MEG)

A noninvasive technique that detects magnetic fields above the surface of the head produced by postsynaptic potentials in the brain.
could be used to diagnose post-traumatic stress disorder (
Posttraumatic Stress Disorder

Posttraumatic Stress Disorder (PTSD)

A complex psychiatric syndrome that develops in response to trauma exposure. Individuals with PTSD experience intrusive recollections or reexperiencing of the traumatic event, avoidance of trauma reminders, emotional numbing, and hyperarousal. In addition, PTSD is associated with high rates of concomitant physical and mental health problems, increased health care use, and impairment in social and occupational functioning. Almost 7% of the general population and up to 30% of veterans meet lifetime criteria for PTSD. Indeed, PTSD is one of the most common psychiatric disorders, representing a significant and costly public health concern.
). In a 2010 article published in the Journal of Neural Engineering, they reported being able to distinguish, with better than 90 percent accuracy, between brain scans of people who did and did not have
PTSD

Posttraumatic Stress Disorder (PTSD)

A complex psychiatric syndrome that develops in response to trauma exposure. Individuals with PTSD experience intrusive recollections or reexperiencing of the traumatic event, avoidance of trauma reminders, emotional numbing, and hyperarousal. In addition, PTSD is associated with high rates of concomitant physical and mental health problems, increased health care use, and impairment in social and occupational functioning. Almost 7% of the general population and up to 30% of veterans meet lifetime criteria for PTSD. Indeed, PTSD is one of the most common psychiatric disorders, representing a significant and costly public health concern.
.James was interested in building on that work, most of which had been done using male veterans as subjects. But she had a fresh question: What about female veterans?James knew women had higher rates of
PTSD

Posttraumatic Stress Disorder (PTSD)

A complex psychiatric syndrome that develops in response to trauma exposure. Individuals with PTSD experience intrusive recollections or reexperiencing of the traumatic event, avoidance of trauma reminders, emotional numbing, and hyperarousal. In addition, PTSD is associated with high rates of concomitant physical and mental health problems, increased health care use, and impairment in social and occupational functioning. Almost 7% of the general population and up to 30% of veterans meet lifetime criteria for PTSD. Indeed, PTSD is one of the most common psychiatric disorders, representing a significant and costly public health concern.
than men (the rate is estimated at 20 percent for women compared with 8 percent overall) and experienced different types of trauma. "Whereas combat exposure might be more common in male veterans, things like sexual trauma are more common in female veterans," she explains. And there was some evidence that women might have a different neural signature of
PTSD

Posttraumatic Stress Disorder (PTSD)

A complex psychiatric syndrome that develops in response to trauma exposure. Individuals with PTSD experience intrusive recollections or reexperiencing of the traumatic event, avoidance of trauma reminders, emotional numbing, and hyperarousal. In addition, PTSD is associated with high rates of concomitant physical and mental health problems, increased health care use, and impairment in social and occupational functioning. Almost 7% of the general population and up to 30% of veterans meet lifetime criteria for PTSD. Indeed, PTSD is one of the most common psychiatric disorders, representing a significant and costly public health concern.
than men. Most important, women were participating in the military in unprecedented numbers and hadn't been studied much. It seemed to her that an intentional focus on female veterans was warranted.James designed a research project, applied for and got a VA grant, and last August began a three-year study that will eventually include 200 female veterans in this region. She has two main goals: defining the neural signature of
PTSD

Posttraumatic Stress Disorder (PTSD)

A complex psychiatric syndrome that develops in response to trauma exposure. Individuals with PTSD experience intrusive recollections or reexperiencing of the traumatic event, avoidance of trauma reminders, emotional numbing, and hyperarousal. In addition, PTSD is associated with high rates of concomitant physical and mental health problems, increased health care use, and impairment in social and occupational functioning. Almost 7% of the general population and up to 30% of veterans meet lifetime criteria for PTSD. Indeed, PTSD is one of the most common psychiatric disorders, representing a significant and costly public health concern.
for women and finding a genetic basis for why some women might be more resilient than others. Specifically, she's looking at a gene called
Apolipoprotein E

Apolipoprotein E (ApoE)

a plasma lipoprotein discovered in 1973 (Shore and Shore 1973). It binds low-density lipoprotein receptors, thereby facilitating cellular lipoprotein exchange and metabolism. The human apoE polypeptide consists of 299 amino acids and comprises three polymorphisms resulting from single amino acid substitutions. Three isoforms (E4, E3, and E2) are the result of cysteine^aEUR"arginine interchanges at two sites, namely residues 112 and 158; however, other genetic variants have been described. These three isoforms, each differentially affecting protein function, result in six phenotypes: three homozygotes (E4/4, E3/3, E2/2) and three heterozygotes (E4/3, E4/2, E3/2). With respect to the number of cysteine residues per mole, E2/2 contains 4, E3/2 contains 3, E4/2 and E3/3 each contain 2, E4/3 contains 1, and E4/4 contains 0. The number of cysteine residues per mole (CysR/mole) provides a numerical, biochemical scale in lieu of the genotype-based categories.
, which she's found to be associated with
PTSD

Posttraumatic Stress Disorder (PTSD)

A complex psychiatric syndrome that develops in response to trauma exposure. Individuals with PTSD experience intrusive recollections or reexperiencing of the traumatic event, avoidance of trauma reminders, emotional numbing, and hyperarousal. In addition, PTSD is associated with high rates of concomitant physical and mental health problems, increased health care use, and impairment in social and occupational functioning. Almost 7% of the general population and up to 30% of veterans meet lifetime criteria for PTSD. Indeed, PTSD is one of the most common psychiatric disorders, representing a significant and costly public health concern.
symptom severity.James and her team are asking female vets about their military experience, trauma history and mental health status; drawing blood for genetic tests; and having the women spend about five minutes lying on a table while recording their brain activity using
MEG

Magnetoencephalography (MEG)

A noninvasive technique that detects magnetic fields above the surface of the head produced by postsynaptic potentials in the brain.
. She hopes the work will have clinical applications. "Our goal is that we'd have this neural signature for
PTSD

Posttraumatic Stress Disorder (PTSD)

A complex psychiatric syndrome that develops in response to trauma exposure. Individuals with PTSD experience intrusive recollections or reexperiencing of the traumatic event, avoidance of trauma reminders, emotional numbing, and hyperarousal. In addition, PTSD is associated with high rates of concomitant physical and mental health problems, increased health care use, and impairment in social and occupational functioning. Almost 7% of the general population and up to 30% of veterans meet lifetime criteria for PTSD. Indeed, PTSD is one of the most common psychiatric disorders, representing a significant and costly public health concern.
in women that we can then use to potentially diagnose women vets and track treatment outcomes," she explains.Although James says it's too early to talk about findings, this research has already attracted the attention of the American Association of Medical Colleges, which is highlighting projects aimed at rectifying a health or health care inequity related to mental health (see "Snapshot"). "We're recognizing that there are women vets," she says, "and they merit study as well as men."