Category: PTSD

The diagnosis and treatment of cancer does not only trigger posttraumatic stress disorder in adults and older children; infants and toddlers with cancer also suffer from trauma disorders, as researchers from the University of Zurich and the University Children's Hospital Zurich show for the first time. This discovery should be taken into account while treating children to prevent them from developing long-term psychological disorders.

People who suffer from posttraumatic stress disorder relive their traumatic experiences in the form of flashbacks and nightmares — and in childhood, also in traumatic plays during which they re-enact the experience over and over again. They avoid stimuli that remind them of the trauma or suffer from vegetative hyperarousal such as insomnia, hypervigilance or concentration problems. For the first time, researchers from the University of Zurich and the University Children's Hospital Zurich now show that infants and toddlers can also develop posttraumatic stress disorder in the wake of a cancer diagnosis and the subsequent, often very stressful treatment with chemotherapy, radiotherapy or surgery.

Toddlers more at risk than babies

Within the scope of the study, under the supervision of Professor Markus Landolt and with the support of pediatric oncologist Eva Bergsträsser, doctoral student Anna Graf interviewed a total of 48 mothers whose children had been diagnosed with cancer. Nine (18.8 percent) of the babies and young children examined exhibited the complete clinical picture of preschool posttraumatic stress disorder. In another 20 children (41.7 percent), they detected at least some symptoms of a stress disorder, the most common being flashbacks and anxiety. Children over 18 months were considerably more at risk of developing a disorder than younger children. Likewise, posttraumatic stress disorder in the mother increased the probability of a disorder in the child. Interestingly, there was no correlation between the development of posttraumatic stress disorder and the disease characteristics studied.

Child-friendly treatment

"The results of our study show that cancer and its treatment can also have a traumatic impact in babyhood and infancy," explains Professor Landolt. The children affected can develop more prolonged disorders that impair their development. In order to avoid this, various implications for treating young children with cancer emerge: "More care should be taken to ensure that potentially stressful procedures, such as bone marrow aspiration, are carried out as child-friendly and painlessly as possible," recommends Professor Landolt. Moreover, any measures that improve the child's sense of security in hospital and during the medical treatment and thus reduce their anxiety should be encouraged. There is therefore an urgent need for personnel that have been trained specifically for childhood ages and an infrastructure that is suitable for children. Last but not least, the parents should also be given as much psychological support as possible since they are the child's most important reference people and resources during illness.

48 children aged between eight and 48 months

Studying posttraumatic stress disorder in very young children poses a major challenge as the symptoms manifest themselves differently at this age compared to adults or older children. Under the supervision of Professor Markus Landolt and with the support of pediatric oncologist Eva Bergsträsser, doctoral student Anna Graf interviewed a total of 48 mothers whose children had been diagnosed with cancer. At the time of the study, the children were between eight and 48 months old. On average, 15 months had elapsed since the diagnosis.

The most common medical diagnoses were solid tumors, leukemia, lymphomas and brain tumors. 85 percent of the children had received chemotherapy, 56 percent had been operated on, just under 17 percent had been treated with radiotherapy and 12.5 percent had received a bone marrow transplantation. 21 children (about 44 percent) were still undergoing medical treatment at the time of the study.

Oncosuisse and the Claus Cramer Stiftung supported the study financially.

— Results of a study led by researchers at Boston University School of Medicine (BUSM) and the Veterans Affairs (VA) Boston Healthcare System indicate that the proposed changes to the diagnosis of post-traumatic stress disorder (PTSD) will not substantially affect the number of people who meet criteria for the disorder.

Mark W. Miller, PhD, associate professor at BUSM and a clinical research psychologist at the National Center for PTSD at VA Boston Healthcare System served as lead author of the study, which is published online in Psychological Trauma: Theory, Research, Practice and Policy.

The Diagnostic and Statistical Manual of Mental Disorders (DSM), the handbook that defines psychiatric disorders, has been undergoing revisions for the past decade in advance of the publication of its fifth edition (DSM-5). Included in the proposed revisions are the first major changes to the PTSD diagnosis since its initial appearance in DSM-III back in 1980. These include the addition of new symptoms, revision of existing ones and a new set of diagnostic criteria.

According to DSM-IV, the criteria for a diagnosis of PTSD include exposure to a traumatic event, persistent re-experiencing of the traumatic event, avoidance and emotional numbing, and persistent hyperarousal and hypervigilance. The proposed revisions for DSM-5 involve clarification regarding what constitutes a traumatic event, the addition symptoms such as self-destructive behavior and distorted blaming of oneself or others for the traumatic event and a reorganization of the diagnostic decision rules for establishing a diagnosis of PTSD.

Critics have raised concerns about the revision process, noting that some of the new symptoms are not unique to PTSD. They believe that the proposed changes could lead to a number of misdiagnoses, which could artificially increase the number of patients with the disorder.

To address this and to collect data to inform final decisions about the PTSD revision, research was initiated by the DSM-5 PTSD workgroup to see if these changes would affect the number of people diagnosed with PTSD. The researchers surveyed a nationally representative sample of 2,953 American adults and a second sample of 345 U.S. military veterans. They found that most of the proposed symptom changes were supported by statistical analysis and did not substantially affect the number of people who would meet criteria for the disorder. Based in part on these findings, the workgroup responsible for the PTSD revisions are now moving forward with the proposed revisions for DSM-5.

Post-Traumatic Stress Disorder (PTSD) develops in individuals who experience highly traumatizing situations such as terrorist attacks and car accidents, but symptoms can also come about after normal life events — including childbirth.

There was a time when a belief was widely held that premature neonates did not perceive pain. That, of course, has been refuted but measurements of neonate pain tend to rely on inexact measures, such as alertness and ability to react expressively to pain sensations. Researchers at Loma Linda University reported in The Journal of Pain that there is a significant relationship between procedural pain and detectable oxidative stress in neonates.

Previous studies have shown an approach involving measurement of systemic biochemical reactions to pain offers the benefit of providing an objective method for measuring pain in premature neonates. Exposure to painful procedures often results in reductions in oxygen saturations and tachycardia, but few studies have quantified the effects of increased pain oxygen consumption. No studies have examined the relationship between pain scores that reflect behavioral and physiological markers of pain and plasma markers of ATP utilization and oxidative stress.

In this study, 80 preterm neonates were evaluated. In about half, tape was taken off the skin following removal of catheters, and they were evaluated for oxidative stress by measuring uric acid and malondialdehyde (MDA) concentration in plasma before and after the procedure. These subjects were compared with a control group not experiencing tape removal. Pain scores were assessed using the Premature Infant Pain Profile. The data showed there was a significant relationship between procedural pain and MDA, which is a well accepted marker of oxidative stress.

There were increases in MDA in preterm neonates exposed to the single painful procedure and not in the control group. Since premature neonates undergo several painful procedures a day, the researchers concluded that if exposure to multiple painful procedures is shown to contribute to oxidative stress, biochemical markers might be useful in evaluating mechanism-based interventions that could decrease adverse effects of painful procedures.

Children who have experienced violence might really be older than their years. The DNA of 10-year-olds who experienced violence in their young lives has been found to show wear and tear normally associated with aging, a Duke University study has found.

"This is the first time it has been shown that our telomeres can shorten at a faster rate even at a really young age, while kids are still experiencing stress," said Idan Shalev, a post-doctoral researcher in psychology and neuroscience at the Duke Institute for Genome Sciences & Policy.

Telomeres are special DNA sequences found at the tips of chromosomes; much like the plastic tips of shoelaces, they prevent DNA from unraveling. Emerging evidence suggests that telomeres are "master integrators," connecting stress to biological age and associated diseases.

Telomeres are known to get shorter each time cells divide, putting a limit on the number of times a given cell can go on dividing. Smoking, obesity, psychological disorders and stress have been found to possibly accelerate that process of telomere loss. In that sense, our telomeres may reflect biological age, not just chronological age.

Previous studies of telomeres and stress had primarily looked at telomeres in adults as they recalled experiences much earlier in their lives.

In the new study, Shalev took advantage of the Environmental-Risk Longitudinal Twin Study led by Duke's Avshalom Caspi and Terrie Moffitt that has followed 1,100 British families with twins since the time those twins were born in the 1990s. The twins are now 18-year-old adults, but the researchers performed the analysis on DNA samples collected when they were just five and 10 years old. The researchers also know, based on extensive interviews held with the twins' mothers, which of them experienced some form of violence in their younger years, including domestic violence, frequent bullying or physical maltreatment by an adult.

The new report in the journal Molecular Psychiatry shows that a subset of those children with a history of two or more kinds of violent exposures have significantly more telomere loss than other children. Since shorter telomeres have been linked to poorer survival and chronic disease, this may not bode well for those kids.

"Research on human stress genomics keeps throwing up amazing new facts about how stress can influence the human genome and shape our lives," said Caspi, the Edward M. Arnett Professor of Psychology and Neuroscience.

The findings suggest a mechanism linking cumulative childhood stress to telomere maintenance and accelerated aging, even at a young age. It appears to be an important way that childhood stress may get "under the skin" at the fundamental level of our cells.

"An ounce of prevention is worth a pound of cure," said Moffitt, who is the Knut Schmidt Nielsen Professor of Psychology and Neuroscience. "Some of the billions of dollars spent on diseases of aging such as diabetes, heart disease and dementia might be better invested in protecting children from harm."

The Duke team plans to further explore the new findings by measuring the average length of telomeres in the twins now that they are adults. They'll also repeat the study in a second, older group of 1,000 individuals in the Dunedin Study, who have been under observation since their birth in the 1970s in New Zealand.

Veterans who have faced combat are more risk-averse when it comes to investing than noncombatants, according to a new Cornell study. As a result, they may struggle to build wealth through long-term investments, the authors say.

Veterans with combat experience were 14 percent to 18 percent less likely than other veterans to invest in such risky assets as mutual funds and stocks, according to the research. There were no differences between the groups, however, in holding safe assets, such as Treasury bonds, certificates of deposit or checking accounts.

The work suggests that traumatic experiences unrelated to the financial sector affect one's investment behavior. Combat veterans appear to be overly cautious and all the worse for it financially, since portfolio choices of stock historically have been critical to economic advancement and building wealth.

"A person's investment decisions often are influenced by many factors that have nothing at all to do with income, wealth, education or the economy. We found that experiencing a trauma or psychological shock can affect your investment behavior — even when the trauma is not finance or health related," said lead author Vicki L. Bogan, assistant professor of applied economics and management at Cornell's Dyson School of Applied Economics and Management. She added that the results suggest "that veterans' combat experiences are important to consider with regard to determining and managing veterans benefits."

The paper, co-authored with Dyson School colleagues David R. Just, associate professor, and Brian Wansink, professor, will appear in a forthcoming issue of Contemporary Economic Policy.

In comparing the investing habits of veterans who said they had faced combat experience with those of veterans who didn't, the researchers controlled for physical health issues and other individual characteristics that have previously been shown to influence investment behavior. The researchers used a 2000 University of Illinois survey that was conducted for a different purpose. Most of the veterans in the sample served in World War II or the Korean or Vietnam wars.

Once veterans come home, education becomes key, Just added. "With education, the effects of trauma go away — they will put their money in reasonable risks and obtain normal returns. Without that education they will be at a financial disadvantage the rest of their lives. Strong educational support is one key to recovering from combat."

As the last U.S. troops return home from Iraq, new research lends timely insights into the rates and impact of mild traumatic brain injury (mTBI) among military personnel serving in Iraq/Afghanistan, according to a topical issue of The Journal of Head Trauma Rehabilitation (JHTR), the official journal of the Brain Injury Association of America. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

The January topical issue of JHTR includes a study suggesting that British troops deployed to Iraq or Afghanistan have lower rates of mTBI than their American counterparts, and that psychological factors present before deployment to combat are a major contributor to lasting symptoms in military personnel with mTBI. Other studies report on the surprising relationship between mTBI and other traumatic injuries, the high burden of mTBI on family caregivers, and a promising approach to treatment.

Lower Rates of mTBI in British than American Troops

Roberto J. Rona, FFPH, and colleagues of King's College London analyzed rates of mTBI and in a large sample (over 4,600) of U.K. troops deployed to Iraq or Afghanistan. mTBI — injuries with short-term loss of consciousness or changes in mental status, sometimes followed by lasting physical, cognitive, and behavioral symptoms — has emerged as an important concern in the U.S. and U.K. military. It has been described as the "signature injury" of the wars in Iraq and Afghanistan.

The study showed a 4.4 percent rate of mTBI among U.K. troops overall, increasing to 9.5 percent among those with a combat role. Blast injuries and falls were the most common causes of mTBI, followed by vehicle crashes.

The prevalence of mTBI in British military personnel appears lower than in previous studies of U.S. troops, which reported rates ranging from 12 percent to over 22 percent. In a second paper, Rona and colleagues report that the difference in mTBI rates is partly related to differences in length of deployment — which is longer for U.S. troops. However, deployment times could not completely account for the difference in mTBI rates.

The study also found that psychological factors — especially previous mental health symptoms and alcohol misuse — were important risk factors for continued symptoms of mTBI. Posttraumatic stress disorder (PTSD) was another possible risk factor. Rona and colleagues findings partly conflict with a controversial 2008 study in The New England Journal of Medicine, which reported that mTBI was unrelated to most physical health outcomes or symptoms, after accounting for PTSD and depression.

Symptoms of More Severe TBI; High Impact on Caregivers; a Promising Treatment Approach Another study, led by Louis M. French, PsyD, of Walter Reed Army Medical Center, looked at the relationship between mTBI and other physical injuries. Surprisingly, the researchers found that symptoms related to mTBI were actually lower in veterans with more severe bodily injuries. It may be that mTBI symptoms go unnoticed, or develop later, in military personnel with other types of severe injuries.

Joan M. Griffin, PhD, of the Minneapolis VA Medical Center and colleagues looked at the experiences of family caregivers of U.S. veterans with mTBI and other injuries. They found that, for veterans who need help with basic daily functions, a tremendous amount of responsibility falls to the spouse or parents. These caregivers "may need additional resources to meet the long-term needs of their injured family member," the researchers write.

Gregory K. Wolf, PsyD, of the James A. Haley VA Medical Center, Tampa, Fla., report encouraging results with a treatment approach called prolonged exposure therapy for veterans affected by mTBI and PTSD. Including education, breathing exercise, and real-world practice, prolonged exposure therapy is one of the primary proven treatment approaches for PTSD.

"Though the sample was small, this is one of the first studies indicating that prolonged exposure therapy can be safely and effectively implemented with veterans who had had a mild or moderate TBI and consequent cognitive impairment," comments John D. Corrigan, PhD, ABPP, Professor of Physical Medicine and Rehabilitation at The Ohio State University and Editor-in-Chief of JHTR.

Dr Corrigan adds, "We hope the papers included in this topical issue will serve to stimulate awareness and appropriate clinical management of returning service members who may be living with the aftereffects of traumatic brain injury."

Survivors of Hurricane Katrina have struggled with poor mental health for years after the storm, according to a new study of low-income mothers in the New Orleans area.

The study's lead author, Christina Paxson of Princeton University, said that the results were a departure from other surveys both in the design and the results. The researchers were able to collect data on the participants before Katrina and nearly five years after the August 2005 storm, finding a persistence of poor mental health and gaining insights into how different types of hurricane-related stressors affect mental health.

"On average, people were not back to baseline mental health and they were showing pretty high levels of post-traumatic stress symptoms. There aren't many studies that trace people for this long, but the very few that there are suggest faster recovery than what we're finding here," said Paxson, who is Princeton's Hughes-Rogers Professor of Economics and Public Affairs and dean of the Woodrow Wilson School of Public and International Affairs. "I think the lesson for treatment of mental health conditions is don't think it's over after a year. It isn't."

In addition to helping mental health professionals aid survivors of Hurricane Katrina and other disasters, the research may guide policymakers in addressing areas that had a significant impact on the women in the study, such as home damage and rebuilding.

The paper appears in the January issue of the journal Social Science and Medicine. Paxson's co-authors were Elizabeth Fussell, an associate professor of sociology at Washington State University; Jean Rhodes, a professor of psychology at the University of Massachusetts Boston; and Mary Waters, the M.E. Zukerman Professor of Sociology at Harvard University.

The project began in 2003 as a study of low-income adults enrolled in community college around the country, including three sites in New Orleans. The initial questionnaire contained questions about education, income, families and health. After Hurricane Katrina, some of the researchers decided to try to continue to track the New Orleans-based participants.

"I realized right away that the kinds of information we had on mental and physical health were very rare in disaster studies," Waters said. "Researchers never know if people are suffering because of the disaster or if they had underlying conditions that would have led to depression or poor health even before the disaster hit."

The sample size in the study was made up of 532 low-income mothers, most of whom were African American and whose average age was 26. They were interviewed in two follow-up surveys — tracked down largely through their unchanged cellphone numbers, though they were spread across 23 states — about 11 months and nearly five years after the storm.

Due to the makeup of the sample, Paxson cautioned that the study's results cannot be assumed to apply to the population as a whole, but they shed light on natural disasters' effects on a particularly vulnerable group.

The surveys helped rate the women on two signs of poor mental health: psychological distress and post-traumatic stress symptoms (PTSS). Researchers measured psychological distress using a series of questions (also in the initial questionnaire) typically used to screen for anxiety and mood disorders, asking about feelings such as sadness, hopelessness and nervousness experienced over the last 30 days. They measured PTSS using a test used to identify individuals at a high risk of meeting the criteria for post-traumatic stress disorder; for example, the women in the study were asked how often they thought about the hurricane in the last seven days and whether they had thoughts about the storm that they could not suppress.

The researchers found that even after four years, about 33 percent of the participants still had PTSS, and 30 percent had psychological distress. Though levels for both conditions had declined from the first follow-up 11 months after the hurricane, they were not back to pre-hurricane levels.

The researchers had also interviewed the study participants about the types of stressors they had experienced during the storm: home damage, traumatic experiences the week of the hurricane (such as being in danger or lacking food, water or necessary medical care), or death of a friend or relative.

Paxson and her collaborators found that these stressors played a role in whether the participants suffered from psychological distress or PTSS, or both. For the most part, the hurricane stressors, especially home damage, were associated with the risk of chronic, long-term PTSS alone or in combination with psychological distress.

"I think Katrina might be different from a lot of natural disasters in the sense that it completely upended most people's lives," Paxson said. "About two-thirds of the sample is back in the New Orleans area, but almost nobody lives in their old home. So they're living in new communities. They've been disrupted from their friends and their families. The whole fabric of their lives has really been changed."

Demographer Narayan Sastry, a research professor in the Population Studies Center and Survey Research Center at the University of Michigan, said that the study makes an important contribution toward understanding the medium- to long-term effects of Katrina on mental health.

"The most significant aspect was its study of long-term outcomes that were assessed at multiple points in time, including prior to the hurricane — a unique feature of this study," said Sastry, who is familiar with the study but was not involved in it. "The results are important not just for designing policies and programs to help address any ongoing mental health problems being experienced by survivors of Hurricane Katrina, but also in devising the best response to help people who are affected by natural disasters in the future."

Sastry added that the study found very similar levels of psychological distress as his work on a broader, representative sample of the pre-hurricane population of New Orleans.

Paxson and her collaborators plan to further examine the data from their surveys, and to continue tracking the women in the sample. Some avenues for further study include looking at how genetics may have a played a role in the mental health responses, examining the hurricane's effects on physical health, and tracking the educational and mental health outcomes of the children of the women in the sample. They also plan to publish a book that combines the survey results with in-depth interviews with some of the women.

This research was supported by the National Institutes of Health, the National Science Foundation, the MacArthur Foundation and Princeton's Griswold Center for Economic Policy Studies.

NewsPsychology (Feb. 23, 2012) — A new study on the prevalence of Post Traumatic Stress Disorder (PTSD) among firefighters in Israel indicates that approximately 90 percent show some form of full or partial symptoms.

According to the study by Ben-Gurion University of the Negev’s Dr. Marc Lougassi, a firefighter himself, 24 percent of active firefighters in Israel suffer from full PTSD, 67 percent display partial PTSD while only nine percent showed no symptoms.

PTSD can occur after exposure to serious injury to oneself or another, or another’s death and then result in recurring stress symptoms such as nightmares, trouble sleeping and other difficulties for over a month.

According to Dr. Lougassi, “Professional firefighters are frequently exposed to extreme stress during their work in emergency situations. In addition to the physical challenges of firefighting, they must evacuate burned and injured victims or bodies. Their involvement in traumatic events exposes them not only to the pressures stemming from the traumatic event itself, but also to post-traumatic emotional expressions that result in secondary traumatization.”

“As far as Israeli firefighters are concerned, there has been no documented evidence of PTSD prevalence, despite the fact that they are exposed to additional traumas such as war and terror strikes,” says Lougassi about the first of its kind study.

Approximately 342 active firefighters were recruited for this study, from all age groups, marital statuses (single, married, divorced), educational backgrounds, seniority levels (over two years), roles (firefighter, crew leader, officer, service commander, etc.). Firefighters with a psychiatric background, head injuries (loss of consciousness and neurological disturbances), in psychiatric and/or psychological treatment, with chronic diseases and those taking medications on a regular basis were excluded from the sample.

An additional 42 firefighters from flight firefighting services at Ben-Gurion Airport constituted the control group, since firefighters are not exposed to similar events. Only five percent of the control group showed signs of PTSD.

“These results support the hypothesis that increased exposure to recurring traumatizing events is a significant factor contributing to PTSD development,” according to Lougassi.

“The findings of this study can help researchers and the Israeli Firefighting Service improve the firefighters’ abilities to cope with extended exposure to traumatizing events through professional intervention programs,” he suggests.

“Moreover, these results can help the Israeli Firefighting Services develop appropriate screening tools to be used during the recruiting process of new firefighters, in order to assure their future psychological safety.”

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Story Source:

The above story is reprinted from materials provided by American Associates, Ben-Gurion University of the Negev.

Note: Materials may be edited for content and length. For further information, please contact the source cited above.

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NewsPsychology (Mar. 5, 2012) — If stress is giving you high blood pressure, blame the immune system. T cells, helpful for fighting infections, are also necessary for mice to show an increase in blood pressure after a period of psychological stress, scientists have found.

The findings suggest that the effects of chronic stress on cardiovascular health may be a side effect of having an immune system that can defend us from infection. The results also have potential implications for treating both high blood pressure and anxiety disorders.

The results are published in the journal Biological Psychiatry.

“Chronic stress has long been known to have harmful effects on the immune system as well as being a risk factor for hypertension,” says lead author Paul Marvar, a postdoctoral fellow at Emory University School of Medicine. “Our goal was to examine the role of T cells in stress-dependent hypertension.”

Marvar began his research under the guidance of David Harrison, MD, who moved from Emory to Vanderbilt University in 2011. He completed his work in the laboratory of Kerry Ressler, MD, PhD. Ressler is a Howard Hughes Medical Institute investigator and professor of psychiatry and behavioral sciences at Emory, and maintains a laboratory at Yerkes National Primate Research Center.

In the current study, researchers subjected mice to psychological stress by confining them in a small space for one hour and then putting them in cages where other mice had already left their scents. Two hours of stress per day, for a week, results in a short term rise in systolic blood pressure in normal mice.

However, mice that were genetically engineered to lack T cells did not display an increase in blood pressure under the same regimen. Introducing T cells into mice that lacked them made their blood pressure sensitive to stress again.

Harrison and his colleagues had previously shown that T cells are needed for the increase in blood pressure coming from high dietary salt or the hormone angiotensin, which regulates blood pressure, and continue to investigate the role of T cells in high blood pressure.

Several studies in animals have suggested that medications now used to control blood pressure, such as angiotensin receptor blockers or ACE (angiotensin converting enzyme) inhibitors, may also be helpful in the reduction of stress and anxiety, Marvar says.

“Further understanding the mechanisms underlying these observations and determining whether they may benefit people with anxiety disorders, for example post-traumatic stress disorder (PTSD), is a current goal of my research,” he says.

High blood pressure is a risk factor for heart attack and stroke, and many people take medications to reduce their blood pressure. Yet some find that medications are not effective in controlling their blood pressure, and researchers are investigating various alternative approaches.

“There are still many unanswered questions about clinical relevance and safety in treating hypertensive patients by targeting the immune system,” Marvar says. “Understanding what triggers the immune response in hypertension will ultimately guide the feasibility of future clinical applications.”

The research was supported by the National Heart, Lung and Blood Institute and by the Emory University Scholars Program in Interdisciplinary Neuroscience Research.

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Story Source:

The above story is reprinted from materials provided by Emory University. The original article was written by Quinn Eastman.

Note: Materials may be edited for content and length. For further information, please contact the source cited above.

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Journal Reference:

1. Paul J. Marvar, Antony Vinh, Salim Thabet, Heinrich E. Lob, Duke Geem, Kerry J. Ressler, David G. Harrison. T Lymphocytes and Vascular Inflammation Contribute to Stress-Dependent Hypertension. Biological Psychiatry, 2012; DOI: 10.1016/j.biopsych.2012.01.017