Understanding the Scientific Basis of Post-traumatic Stress Disorder (PTSD): Precision Behavioral Management Overrides Stigmatization
Authors: D Siwicki
A Bowirrat
E J Modestino
R D Badgaiyan
T McLaughlin
M C Gondré-Lewis
M Oscar-Berman
D Baron
P K Thanos
L Fried
Kenneth Blum
I Elman
A Howeedy
M Hauser
L Lott
M H Krengel
Journal: Molecular Neurobiology (2019)
Discipline: NEUROSCIENCE & BEHAVIOR
Keywords: Genetic addiction risk score (GARS™); Hypodopaminergia; Neuronutrient; Post-traumatic stress disorder (PTSD); Pro-dopamine regulation (KB220PAM).
Affiliations: Graduate School of Biomedical Sciences, Western University Health Sciences, Pomona, CA, USA. ., Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary. ., Department of Psychiatry, Boonshoft School of Medicine, Wright University, Dayton, OH, USA. ., Department of Precision Behavioral Management, Geneus Health, San Antonio, TX, USA. ., Division of Neurogenetic Research & Addiction Therapy, The Florida House Experience, Deerfield Beach, FL, USA. ., Division of Addiction Services, Dominion Diagnostics, North Kingston, RI, USA. ., Division of Neuroscience & Addiction Research, Pathway Healthcare, LLC., Burmingham, AL, USA. ., Department of Anatomy, Developmental Neuropsychopharmacology Laboratory, Howard University College of Medicine, Washington, DC, USA., Department of Psychology, Curry College, Milton, MA, USA., Department of Precision Behavioral Management, Geneus Health, San Antonio, TX, USA., Graduate School of Biomedical Sciences, Western University Health Sciences, Pomona, CA, USA., Division of Addiction Services, Dominion Diagnostics, North Kingston, RI, USA., Center for Psychiatric Medicine, Lawrence, MA, USA., Division of Neurogenetic Research & Addiction Therapy, The Florida House Experience, Deerfield Beach, FL, USA., Department of Neurology, Boston University School of Medicine and VA Boston Healthcare System, Boston, MA, USA., 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., Department of Psychiatry, Cooper University School of Medicine, Camden, NJ, USA., Transformations Treatment Center, Delray Beach, FL, USA., Division of Anatomy, Biochemistry and Genetics Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine., Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

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. 

Retracted: No

PubPeer comments:
  It is noteworthy that during combat stress, dopamine is released from neurons at 100 times above the resting state. Much of the paper s argument rests on this single claim, so a citation is required. I am amusing myself trying to imagine how one would study dopanergic activity in the brain during combat situations. It would be an interesting Ethics Review. , 
 Many of the self-citations are to items published through predatory journals (often ones enhanced by the presence of the authors on the Editorial Boards). [28], for instance, is to an  OMICS on-line journal. [31] is to  Austin addiction sciences 1 (2) . ![file] [38] points to an Longdom journal, which is to say a rebranded OMICS funnel. https: www.longdom.org open-access diagnosis-healing-in-veterans-suspected-suffering-post-traumatic-stress-disorder-ptsd-using-reward-gene-testing-circuitry-natural-dopaminergic-activation-2157-7412.1000116.pdf When authors choose to advertise in fraudulent OMICS journals, and then cite those advertisements, they must expect to be judged accordingly. , 
 I was startled by the large number of assertions and hypothesis that were not supported by citations, data, or (in some cases) even logical arguments. One example: There is an obvious need to classify patients at genetic risk for alcohol and drug-seeking behavior before entry to residential and or non-residential chemical dependency and pain programs, as well as before entry into the military. This u201cobvious needu201d is apparently *so* obvious to readers that it needed no citation or explanation. As documented in this paper, the assertion that genetic information on an individual would be currently useful in treating PTSD or chemical dependency has some scientific support (evidence of statistical association, but not causation), but this paper also notes that any genetic flags are substantially confounded by environmental and physiological factors, some of which are described by the authors *in the previous section*: Genetic antecedents may not tell the whole story since environmental insults or abuse (sexual and verbal) during childhood induce epigenetic changes that impact brain chemistry. Specifically, instead of being caused by differences in the DNA sequence, epigenetic changes are cellular, physiological, and behavioral characteristics (phenotypic trait) changes that are caused by external or environmental factors that switch genes on and off. Further, addressing this u201cobvious needu201d has substantial ethical and public policy implications which are not discussed or acknowledged. It is unclear to me how this paper would pass peer review. , 
 #3 I hadnu2019t seen this Neuroskeptic post before writing my comments about. This does a much better job of pointing out the numerous flaws in this paper: http: blogs.discovermagazine.com neuroskeptic 2019 05 31 a-ptsdodgy-genetic-test , 
 I sent a message to the journal editors informing them of this thread. ,