A veteran commits suicide every 65 minutes in America. One of the key reasons is PTSD. What will happen to Ukrainian veterans, and whether we will face similar disappointing statistics, depends on the ability to identify PTSD and its treatment. Viktor Dosenko, professor at the Bogomolets Institute of Physiology, head of the development and innovation department at CSD LAB medical laboratory, pathophysiologist, MD, told Interfax-Ukraine about the peculiarities of diagnosis, course and prospects for treatment of PTSD.
Text: Anna Levchenko
– Currently, Ukraine is just beginning to study the issue of PTSD. How relevant is this problem for Ukraine? When will we face the manifestations of PTSD, when will its impact be visible?
– Both extremes – that everyone has PTSD, or that there is no PTSD – certainly do not correspond to the real state of affairs, do not correspond to scientific data, and have negative consequences. How should the scientific and medical community approach this issue? In a balanced, logical, scientific way: Not everyone will have PTSD, of course, and not everyone has it, not even half of the population. Many military men do not have any PTSD. But at the same time, the number of people with PTSD in Ukraine is quite large – unfortunately, we do not have a register of patients with this pathology, so there are no exact figures.
To detect PTSD in a person, there is a screening. In particular, CSD LAB has taken a serious interest in this problem and has a separate section on the medical laboratory’s website where anyone can take a screening test for PTSD. Because in order to treat, you need to identify the patients. The task of finding such people is not an easy one. No one will come to the hospital and say: “I have PTSD, treat me”. A person may not know about his or her condition.
I want to note that the world celebrates the International PTSD Screening Day every year. Currently, the problem of diagnosis is relevant all over the world, because it occurs not only in countries where there are hostilities. Many other factors can also lead to the development of this serious mental illness. The earlier we detect this disease, the better and more effective the therapy will be. Therefore, screening programs to detect PTSD are currently being practiced around the world. In particular, experts from the US National Center for PTSD Research have developed the so-called five questions of perception. If a person gives a positive answer to at least three of them, this does not mean that he or she has PTSD, but it does mean that he or she needs to see a specialist.
– Can we say that PTSD is a mental illness, or is it just a situational problem of a spoiled mood?
– It is a mental illness. In the international classification of diseases, it is classified as a mental health disorder. The diagnosis of PTSD is made by a psychiatrist.
– But in practice, as psychiatrists say, a person with mental health problems usually believes that everything is fine, it’s just that the world around them is different. How do you get a person to pay attention to their condition and start treatment?
– A person needs to take a test and answer these five questions of perception. Our task now is to bring this information to the public. This is a free, evidence-based and very accurate way of screening. Not diagnosis, but screening, which, if necessary, will refer a person to a specialist for treatment.
PTSD is a serious problem. According to statistics from the U.S. Department of Veterans Affairs, a veteran commits suicide every 65 minutes in America. Healthy men who have returned from serving in the U.S. military, with all the support programs and rehabilitation centers, face this problem. We are not saying that all veterans in the United States have PTSD and are suicidal, but if we compare veterans with other men, the presence of PTSD increases the likelihood of suicide six times. For women, this figure is even higher. This is terrible data and, unfortunately, there is no reason to think that it will be any different in Ukraine.
– When, according to your forecasts, can we expect, say, a surge in cases or symptoms of PTSD? Should we expect this now, or will it take some time after the war?
– Most likely, we should expect a surge after returning from the war. A significant number of soldiers may already have PTSD, but unfortunately, we don’t have statistics. Actually, this data is not collected, there are no statistics on mental illnesses. We do not know how many people we have with PTSD and what the dynamics are. To understand the picture, veterans must undergo diagnostics and, if necessary, rehabilitation. But most veterans do not have this opportunity. After defeating the enemy, most of them will return to normal life. And it is then that we can expect this disease to manifest itself and there will be an avalanche-like increase in the number of diagnoses of PTSD. Because now PTSD exists, but there is no screening. Or it is not effective enough.
– What is the root cause of PTSD?
– There are two factors that trigger the development of PTSD. The first is direct contact with death. Not on television, not in photos, not in telegram channels, but direct, visual contact with death. A person sees death, and it strikes at what is called the core of the personality, at their own beliefs about what is good and what is evil. The second factor that can trigger PTSD is indirect contact with death, even without contact. These are two established factors. Everything else is a risk factor that increases the probability. That is, a person with existing mental illness is more likely to have PTSD. People who have used or are using drugs have a higher probability. People who have weak social support, no family, no children, or a traumatic personal life are more likely to have PTSD. Of course, there is also a genetic predisposition. But these are not causes, they are factors that increase the probability.
– How does PTSD differ from other reactions to a stressful situation?
– The fact that this horror of contact with death stays in the brain, in the psyche. It does not leave a person, and they keep returning to the traumatic situation. This event already exists exclusively in memories, it is detached from life, it has nothing to do with the current situation, but it is imprinted in the psyche and begins to dominate consciousness. The situation that caused PTSD has already happened, it does not repeat itself, and the person is still in it. This makes PTSD very different from other diseases, including chronic stress.
PTSD leads to hormonal disruptions. To a certain extent, PTSD is a neurohumoral disease. When the hormonal background changes, when stress is “lame” by one hormone. What this means is that under stress, the level of both adrenaline and cortisol in the blood should increase. But in PTSD, only the level of adrenaline rises, and cortisol is even lower than in healthy people. It’s like stress, but inferior – adrenaline dominates, and there is no cortisol, which should provide negative feedback and stop the stress response.
– And how does this threaten the human body?
– This is fraught with the fact that the body does not receive communication. Cortisol is supposed to come to the brain after stress and trigger recovery mechanisms. But there is no cortisol, the brain believes that the order to mobilize has not been fulfilled, so it gives commands to produce adrenaline and a stress response again and again. This exhausts the body. In medicine, this is called a “vicious circle,” from which the psyche cannot break free on its own.
– If we’re talking about hormones, hormonal levels, are there any tests, such as blood tests, that would allow us to detect the presence of PTSD as a chemical reaction of the body?
– We are on the way to this. We are currently working on this task together with the specialists of the Lisova Halyana psycho-rehabilitation center. We are trying to find the best solution, because the existing solutions are very expensive, and screening should be cheap.
– What does “expensive solution” mean?
– It takes a lot of money to identify people with PTSD. And this is a problem. Because screening means a cheap test that can be done to millions of people: all military personnel, all military families. But when the cost of the test is significant, it significantly complicates the ability to fight PTSD.
– How much is significant?
– According to our calculations, it was about 5 thousand UAH for one test. Therefore, if we talk about determining PTSD “by a drop of blood,” the methodological basis already exists, but there is a nuance – screening should be affordable. The whole world is looking for opportunities to conduct such screenings, but nowhere in the world have PTSD biomarkers been introduced. CSD LAB has developed them, but we hope to find a solution to reduce their cost. On the way to this solution, we have already introduced a test for biomarkers of chronic stress. This is no less dangerous pathology, which is certainly related to the war. Not everyone has contact with death, but the war introduces a state of uncertainty. This is what is happening now: news, traumatic information and sympathy trigger the so-called chronic stress. This is very well known in medicine. And all a person needs to do is take a test and see a psychotherapist, who will prescribe medication if necessary.
But I emphasize that chronic stress and PTSD are different things.
– Are there any medications being developed for PTSD?
– Currently, there are only two antidepressants that have been proven to work and improve the condition. Other drugs are being studied. There are quite a few of them, so we expect that new drugs will appear and be researched. In particular, medicines based on medical cannabis and psychotropic drugs. But, unfortunately, Ukraine is currently outside of these studies not only because of the war, but also because it is forbidden to study these drugs in Ukraine.
However, there is currently a demand for such research in Ukraine and around the world. There are international organizations that are ready to collaborate with Ukrainian experts and institutions to study these issues. For example, we are preparing a number of applications for participation in international research and hope that these studies will eventually begin. This, in my opinion, is a very good solution, because instead of standing with our hand out and asking for money, we will be able to develop it ourselves.
– Once upon a time, young Ukrainians were forced to take part in wars waged by the former Soviet Union, particularly in Afghanistan. Now these people are about 50-55 years old, they are a fairly active category of citizens, but they have a complicated history. We’ve seen many stories of guys returning from Afghanistan with crippled lives, crippled psyches, and not all of them were able to adapt to peaceful life. Are there any studies conducted among Afghanistan veterans?
– In the USSR and in all post-Soviet countries, unfortunately, this diagnosis was ignored. In Ukraine, there used to be no legal definition of PTSD. In this aspect, the question was not raised at all. That is, if a person had the consequences of a military injury or contusion, they could be offered treatment and rehabilitation in a sanatorium, and restored in neurological terms. Psychiatry and psychological assistance were out of the question. Currently, we also do not see work with those who may have suffered from PTSD 30 years ago. Only now have we begun to pay attention to these people. The first diagnoses of PTSD appeared in America in the 80s of the last century, and for quite a long time in other countries, even in Europe, it was believed that it was not a disease. That is, it took decades for PTSD to be accepted. Now it is necessary to develop diagnostic criteria and to communicate these criteria to doctors.
– Can PTSD be cured, or is it a chronic disease that stays with a person for life?
– PTSD is treatable, of course! In half of the cases, it will go away on its own. But this information is dangerous, because people will think that they don’t need to see a doctor, they say, PTSD will go away on its own. This is a mistake! You need to see a doctor to treat PTSD. In half of the people, PTSD can go away on its own, and in half of them it will not. And no one knows which half a person belongs to. PTSD is perfectly treated with psychotherapy, of course, if you start in time and if there are qualified specialists. In some cases, pharmacotherapy is required. Experts around the world are looking for new techniques, new drugs, new approaches to the treatment of this complex, dangerous disease. I hope that Ukrainian scientists will successfully join this research and together we will find effective methods of screening, diagnosing and treating PTSD.
CSD LAB Medical Laboratory (Kyiv) has doubled the number of laboratory offices in nine months of 2023.
“At the beginning of this year, the CSD LAB network included 40 laboratory offices, and as of October 1, their number has already reached 83,” the laboratory said in a press release.
In addition, by the end of 2023, it is planned to increase this figure to 100.
“This will allow the company to be present in all regions of the country where it is possible. In particular, covering the frontline regions – in the summer, partner offices were opened in Kramatorsk and Sloviansk,” the company reports.
CSD LAB specifies that in 2023, laboratory offices were opened in Zhytomyr, Cherkasy, Khmelnytskyi, Uzhhorod, Rivne, Kremenchuk, Kharkiv, Mykolaiv, Mukachevo, Irpin, Vasylkiv, and Vyshhorod.
It is specified that since the beginning of the year, the network of CSD LAB’s own laboratory offices has grown fivefold to 45, and the number of partner offices has increased from 11 to 22.
The laboratory also reminds about the strategy of expanding its work in the franchise format.
CSD LAB is one of the leading laboratories in Ukraine that provides more than 1500 tests: from a general blood test to the determination of genetic disorders in a tumor using the NGS method. It has been one of the largest pathology laboratories in Eastern Europe for 13 years.
What a question – of course, because there are characteristic “aggravating” summer factors, when the heat is replaced by a cool breeze or air conditioning, when you want water from the refrigerator (or not water, but ice cream :)), and no one has canceled the classic pathogens of SARS.
But there is something else that mimics the common cold.
It looks like a stuffy nose and rhinitis that occur in late summer. There may be itchy eyes or watery eyes, a sore throat, subfebrile fever, loss of concentration, and sometimes a dry, hacking cough. It sounds like a cold, doesn’t it?
But the symptoms last for several weeks or more. A person goes to the doctor and may hear that they need to be tested for… allergies.
August and September are characterized by pollinating weeds. There are many of them, but we usually hear about ragweed and wormwood most often (and for good reason, because they are classic representatives of the class).
You can see these representatives not only in the countryside, but also on city roadsides. Sensitized people experience allergy symptoms during their pollination, and sometimes cross-reactivity symptoms in the form of allergic reactions to certain foods (for example, sunflower seeds, watermelon, melon, and grapes, which are also in season now).
What should I do if I experience the above symptoms?
Of course, consult a doctor who will conduct an examination and prescribe additional tests to confirm the diagnosis.
If you notice the same symptoms for several years in a row and/or suspect a pollen allergy, ask your doctor what tests you should take.
In CSD LAB you can find the following tests:
Determination of Ig E antibodies to wormwood pollen extract (by ELISA and ImmunoCAP);
Determination of Ig E antibodies to ragweed pollen extract (ELISA and ImmunoCAP);
“Seasonal rhinitis” package (contains the determination of Ig E antibodies to wormwood, ragweed and other plant pollen);
Determination of Ig E antibodies to the main molecules of ragweed pollen (n Amb a 1), wormwood (n Art v 1, n Art v 3) and minor grass allergens (r Phl p 7 r Phl p 12 complex);
Also, the determination of Ig E antibodies to ragweed and wormwood pollen allergen components is included in multiplex allergy panels.
In addition, for a comprehensive health check, CSD LAB reduces prices for the most popular allergy tests until the end of summer:
– ALEX2 – allergy test (Total IgE + specific IgE to 295 allergens).
– FOX – allergy test (Food Xplorer, specific IgG to 286 food allergens).
Important! It is worth remembering that even when choosing tests on your own, you should always seek a doctor’s examination to confirm the diagnosis, possibly a more detailed examination and determine further treatment tactics.
CSD LAB Medical Laboratory has introduced pharmacogenetic laboratory diagnostics services.
As the laboratory told Interfax-Ukraine, CSD LAB offers two tests that will allow individualizing the treatment of many diseases. In particular, the laboratory conducts a PCR test that determines sensitivity to warfarin. The test helps to prevent and reduce the risk of bleeding as a result of warfarin therapy by up to 50%.
Warfarin therapy is used for the treatment and prevention of deep vein thrombosis and pulmonary embolism, for the secondary prevention of myocardial infarction and prevention of thromboembolic complications (stroke or systemic embolism) after myocardial infarction in patients with heart failure or prosthetic heart valves, prevention of dynamic cerebrovascular disease and stroke, and prevention of postoperative thrombosis.
In addition, CSD Lab has implemented a pharmacogenetic test that allows to determine variations in the CYP2C19 gene. This gene is a clinically important enzyme involved in the biotransformation of a number of antidepressants, anticoagulants, and antimycotic drugs. The test helps to identify and adjust antiplatelet therapy for a number of diseases.
“The main goal of pharmacogenetics is to use the patient’s individual genetic information to inform and prescribe the most effective type and dose of drugs. Targeted diagnostics and treatment of a patient can be determined according to the results of the study of his or her genetic profile, which makes pharmacotherapy for patients as effective, safe and affordable as possible,” CSD LAB emphasized.
At the same time, the laboratory emphasizes that pharmacotherapy based on the principles of personalized medicine is a relatively new area in medicine in general. The essence of personalized medicine is the individualization of drug therapy. Pharmacogenetics seeks to identify genes and their variants that determine the adequacy of pharmacotherapy and reduce the risk of side effects.
“The new approach is to test patients for possible reactions to the use of new drugs and to formulate a treatment based on the test results,” the laboratory emphasized.
CSD LAB plans to hold a course of lectures on pharmacogenetics for doctors in the fall.
CSD LAB is one of the leading laboratories in Ukraine that provides more than 1500 tests: from a complete blood count to the determination of genetic disorders in a tumor using NGS. It has been one of the largest pathology laboratories in Eastern Europe for 13 years.
It has long been known that the body’s response to various drugs, and thus the effectiveness of treatment, depends on the metabolic characteristics of each individual. But the study of genetic factors that affect chemical transformations in the body began only in the 20th century.
The paradigm of “treating the patient, not the disease” resulted in the concept of “personalized medicine”. The essence of personalized medicine is the individualization of drug therapy. The response to a drug, the optimal class of drug, its dose and mode of administration are determined, at least in part, by genetic determinants. Pharmacogenetics seeks to identify genes and their variants that determine the adequacy of pharmacotherapy and reduce the risk of side effects.
For a modern doctor, pharmacogenetics is a convenient and affordable tool to increase the effectiveness of evidence-based therapy for many diseases and, at the same time, reduce the likelihood of side effects. For a patient, pharmacogenetics means confidence that the drug prescribed by a doctor will act reliably and predictably, and will show maximum therapeutic effectiveness.
What needs to be done for this? Investigate the genetic information of a particular person regarding the genes that affect drug transport.
CSD LAB has long established itself as a progressive and innovative laboratory that implements modern diagnostic methods that should be useful to doctors for prescribing effective therapy. This spring, we created the Development and Innovation Department, which aims to develop diagnostic capabilities and medical science for their further implementation in the everyday life of the Ukrainian medical community.
From now on, the first pharmacogenetics services have been introduced in the list of CSD LAB laboratory diagnostics.
What pharmacogenetics tools are available in Ukraine today?
Currently, CSD LAB offers two tests that will allow individualizing the treatment of many diseases.
1. CYP2C9 (analysis of polymorphism of alleles *2, *3) and VKORC1 (analysis of G1639A polymorphism), determination of warfarin sensitivity, PCR, blood \ N
https://www.csdlab.ua/analyzes/farmakohenetka/cyp2c19-analiz-polimorfizmu-aleley-2-3-ta-vkorc1-analiz-polimorfizmu-g1639a
The test determines sensitivity to warfarin by detecting CYP2C9*2, CYP2C9*3 and VKORC1 G1639A mutations in human genomic DNA by real-time PCR.
The most common complication of warfarin therapy is bleeding, the risk of which can be reduced by 35%, and taking into account other factors (patient weight, prescription of other medications, etc.) – by 50%.
Warfarin is used for the treatment and prevention of deep vein thrombosis and pulmonary embolism, for the secondary prevention of myocardial infarction and prevention of thromboembolic complications (stroke or systemic embolism) after myocardial infarction, for the prevention of thromboembolic complications in patients with atrial fibrillation, heart disease or prosthetic heart valves, prevention of dynamic cerebrovascular disorders and stroke, and prevention of postoperative thrombosis.
2. CYP2C19 (analysis of allele polymorphism *2, *3, *17) PCR, blood \ N
https://www.csdlab.ua/analyzes/farmakohenetka/cyp2c19-analiz-polimorfizmu-aleley-2-3-17-plr-krov-n
This genetic test will allow you to determine the variations of the CYP2C19 gene (CYP2C19*2, CYP2C19*3 CYP2C19*17).
CYP2C19 is a clinically important enzyme involved in the biotransformation of a number of antidepressants, anticoagulants, and antimycotic drugs. For example, clopidogrel is a very effective antiplatelet drug whose action is based on irreversible inhibition of the platelet receptor P2RY12. However, in some patients, the therapeutic effect of the drug does not manifest itself, which is why it is necessary to change the drug, losing time in the patient’s treatment.
Why does this happen? The answer is simple: clopidogrel is a prodrug, which is activated by the cytochrome P450 complex, mainly CYP2C19. With a certain gene variant, this does not happen and the effectiveness of the drug is significantly reduced. In this case, you should choose another antiplatelet drug.
How to work with this?
The main goal of pharmacogenetics is to use the patient’s individual genetic information to inform and prescribe the most effective type and dose of drugs. Currently, targeted diagnostics and treatment of a patient can be determined according to the results of a study of his or her genetic profile, which makes pharmacotherapy for patients as effective, safe and affordable as possible.
However, personalized medicine is a relatively new area of medicine in general, and the new approach is to test patients for possible reactions to new drugs and to develop a treatment based on the test results.
In order to help Ukrainian doctors better understand pharmacogenetics, CSD LAB plans to hold a course of lectures on pharmacogenetics this fall.
Yadro Systems was established in Ukraine in 2021 and united specialists in IT industry, artificial intelligence, laboratory management and pathomorphologists to create unique software – medical information system for pathomorphological and molecular genetic laboratories.
Yaroslav Nedashkovsky, one of the creators of the system, notes that the SlidePath program is unparalleled and was developed taking into account all the peculiarities of the pathomorphological laboratory:
“The synergy of our team’s knowledge and experience helped create a really cool product. In close collaboration with the largest Ukrainian pathomorphological laboratory – CSD LAB, we developed SlidePath software that covers all the needs of small, medium and even large pathomorphological laboratories.
Quality control is an extremely important process in every laboratory, and thanks to our program, we are able to track each specimen at different stages of examination and ensure clear compliance with the technological process. Barcoding, synchronization with the laboratory equipment, protocols of conclusions – all this allows the laboratory to significantly improve not only the quality of its work, but also the speed of research.
We saw quite a great perspective in the creation of this program, because not only in Ukraine, but in the world in general, there is a need for significant automation of pathomorphological laboratories. And since our colleagues from CSD LAB have a great competence in this area, from the very beginning we tried to make software that would be suitable for different types of laboratories of different scale and scope of work”.
The IT assistant for pathomorphology laboratories created by Yadro Systems specialists has several modules that can be customized to meet the specific needs of the laboratory. The key functions of the software include: creation of an electronic database of results, the ability to print test result forms, notification of patients about the readiness of results, and quality control of studies, starting from the stage of labeling biomaterials samples to delivery of results.
Among the main advantages of SlidePath connection, Yaroslav Nedashkovsky singles out a user-friendly interface, which allows for easy mastering and quick implementation of the laboratory information system.
“This year we are launching this product in Ukraine and worldwide,” adds Yadro Systems director, “So if you are a pathomorphologist, or a small or medium-sized laboratory, you can contact us today and we will provide digilization of your workflow, because SlidePath is software developed together with pathomorphologists and a clear understanding of their needs to improve their work convenience.
CSD LAB, DIGITALIZATION, LABORATORY DIAGNOSTICS, SLIDEPATH, YADRO SYSTEMS, YAROSLAV NEDASHKOVSKY
