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Integration of peripheral transcriptomics, genomics, and interactomics following trauma identifies causal genes for symptoms of post-traumatic stress and major depression. Mol Psychiatry 2021; 26:3077-3092. [PMID: 33963278 DOI: 10.1038/s41380-021-01084-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 02/26/2021] [Accepted: 03/26/2021] [Indexed: 02/03/2023]
Abstract
Posttraumatic stress disorder (PTSD) is a debilitating syndrome with substantial morbidity and mortality that occurs in the aftermath of trauma. Symptoms of major depressive disorder (MDD) are also a frequent consequence of trauma exposure. Identifying novel risk markers in the immediate aftermath of trauma is a critical step for the identification of novel biological targets to understand mechanisms of pathophysiology and prevention, as well as the determination of patients most at risk who may benefit from immediate intervention. Our study utilizes a novel approach to computationally integrate blood-based transcriptomics, genomics, and interactomics to understand the development of risk vs. resilience in the months following trauma exposure. In a two-site longitudinal, observational prospective study, we assessed over 10,000 individuals and enrolled >700 subjects in the immediate aftermath of trauma (average 5.3 h post-trauma (range 0.5-12 h)) in the Grady Memorial Hospital (Atlanta) and Jackson Memorial Hospital (Miami) emergency departments. RNA expression data and 6-month follow-up data were available for 366 individuals, while genotype, transcriptome, and phenotype data were available for 297 patients. To maximize our power and understanding of genes and pathways that predict risk vs. resilience, we utilized a set-cover approach to capture fluctuations of gene expression of PTSD or depression-converting patients and non-converting trauma-exposed controls to find representative sets of disease-relevant dysregulated genes. We annotated such genes with their corresponding expression quantitative trait loci and applied a variant of a current flow algorithm to identify genes that potentially were causal for the observed dysregulation of disease genes involved in the development of depression and PTSD symptoms after trauma exposure. We obtained a final list of 11 driver causal genes related to MDD symptoms, 13 genes for PTSD symptoms, and 22 genes in PTSD and/or MDD. We observed that these individual or combined disorders shared ESR1, RUNX1, PPARA, and WWOX as driver causal genes, while other genes appeared to be causal driver in the PTSD only or MDD only cases. A number of these identified causal pathways have been previously implicated in the biology or genetics of PTSD and MDD, as well as in preclinical models of amygdala function and fear regulation. Our work provides a promising set of initial pathways that may underlie causal mechanisms in the development of PTSD or MDD in the aftermath of trauma.
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Salomon T, Cohen A, Barazany D, Ben-Zvi G, Botvinik-Nezer R, Gera R, Oren S, Roll D, Rozic G, Saliy A, Tik N, Tsarfati G, Tavor I, Schonberg T, Assaf Y. Brain volumetric changes in the general population following the COVID-19 outbreak and lockdown. Neuroimage 2021; 239:118311. [PMID: 34182098 DOI: 10.1016/j.neuroimage.2021.118311] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 05/30/2021] [Accepted: 06/23/2021] [Indexed: 10/21/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) outbreak introduced unprecedented health-risks, as well as pressure on the economy, society, and psychological well-being due to the response to the outbreak. In a preregistered study, we hypothesized that the intense experience of the outbreak potentially induced stress-related brain modifications in the healthy population, not infected with the virus. We examined volumetric changes in 50 participants who underwent MRI scans before and after the COVID-19 outbreak and lockdown in Israel. Their scans were compared with those of 50 control participants who were scanned twice prior to the pandemic. Following COVID-19 outbreak and lockdown, the test group participants uniquely showed volumetric increases in bilateral amygdalae, putamen, and the anterior temporal cortices. Changes in the amygdalae diminished as time elapsed from lockdown relief, suggesting that the intense experience associated with the pandemic induced transient volumetric changes in brain regions commonly associated with stress and anxiety. The current work utilizes a rare opportunity for real-life natural experiment, showing evidence for brain plasticity following the COVID-19 global pandemic. These findings have broad implications, relevant both for the scientific community as well as the general public.
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Affiliation(s)
- Tom Salomon
- School of Neurobiology, Biochemistry and Biophysics, Faculty of Life Science, Tel Aviv University, Tel Aviv, Israel
| | - Adi Cohen
- School of Neurobiology, Biochemistry and Biophysics, Faculty of Life Science, Tel Aviv University, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Barazany
- The Strauss Center for Computational Neuroimaging, Tel Aviv University, Tel Aviv, Israel
| | - Gal Ben-Zvi
- School of Neurobiology, Biochemistry and Biophysics, Faculty of Life Science, Tel Aviv University, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Rotem Botvinik-Nezer
- School of Neurobiology, Biochemistry and Biophysics, Faculty of Life Science, Tel Aviv University, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel; Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, USA
| | - Rani Gera
- School of Neurobiology, Biochemistry and Biophysics, Faculty of Life Science, Tel Aviv University, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel; School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Shiran Oren
- School of Neurobiology, Biochemistry and Biophysics, Faculty of Life Science, Tel Aviv University, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Dana Roll
- School of Neurobiology, Biochemistry and Biophysics, Faculty of Life Science, Tel Aviv University, Tel Aviv, Israel
| | - Gal Rozic
- School of Neurobiology, Biochemistry and Biophysics, Faculty of Life Science, Tel Aviv University, Tel Aviv, Israel
| | - Anastasia Saliy
- School of Neurobiology, Biochemistry and Biophysics, Faculty of Life Science, Tel Aviv University, Tel Aviv, Israel
| | - Niv Tik
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel; Department of Anatomy and Anthropology, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Galia Tsarfati
- Division of Diagnostic Imaging, Sheba Medical Center, Tel-Hashomer, affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Tavor
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel; The Strauss Center for Computational Neuroimaging, Tel Aviv University, Tel Aviv, Israel; Department of Anatomy and Anthropology, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tom Schonberg
- School of Neurobiology, Biochemistry and Biophysics, Faculty of Life Science, Tel Aviv University, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel; The Strauss Center for Computational Neuroimaging, Tel Aviv University, Tel Aviv, Israel
| | - Yaniv Assaf
- School of Neurobiology, Biochemistry and Biophysics, Faculty of Life Science, Tel Aviv University, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel; The Strauss Center for Computational Neuroimaging, Tel Aviv University, Tel Aviv, Israel.
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van Rooij SJH, Ravi M, Ely TD, Michopoulos V, Winters SJ, Shin J, Marin MF, Milad MR, Rothbaum BO, Ressler KJ, Jovanovic T, Stevens JS. Hippocampal activation during contextual fear inhibition related to resilience in the early aftermath of trauma. Behav Brain Res 2021; 408:113282. [PMID: 33819532 PMCID: PMC8128041 DOI: 10.1016/j.bbr.2021.113282] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 03/30/2021] [Accepted: 03/30/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Impaired contextual fear inhibition is often associated with posttraumatic stress disorder (PTSD). Our previous work has demonstrated that more hippocampal activation during a response inhibition task after trauma exposure was related to greater resilience and fewer future PTSD symptoms. In the current study, we sought to extend our previous findings by employing a contextual fear conditioning and extinction paradigm to further determine the role of the hippocampus in resilience and PTSD in the early aftermath of trauma. METHODS Participants (N = 28) were recruited in the Emergency Department shortly after experiencing a traumatic event. A contextual fear inhibition task was conducted in a 3 T MRI scanner approximately two months post-trauma. Measures of resilience (CD-RISC) at time of scan and PTSD symptoms three months post-trauma were collected. The associations between hippocampal activation during fear conditioning and during the effect of context during extinction, and post-trauma resilience and PTSD symptoms at three-months were assessed. RESULTS During fear conditioning, activation of the bilateral hippocampal region of interest (ROI) correlated positively with resilience (r = 0.48, p = 0.01). During the effect of context during extinction, greater bilateral hippocampal activation correlated with lower PTSD symptoms three months post-trauma after controlling for baseline PTSD symptoms, age and gender (r=-0.59, p=0.009). CONCLUSIONS Greater hippocampal activation was related to post-trauma resilience and lower PTSD symptoms three months post-trauma. The current study supports and strengthens prior findings suggesting the importance of hippocampus-dependent context processing as a mechanism for resilience versus PTSD risk, which could be a potential mechanistic target for novel early interventions.
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Affiliation(s)
- Sanne J H van Rooij
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
| | - Meghna Ravi
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Timothy D Ely
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Vasiliki Michopoulos
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Sterling J Winters
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA
| | - Jaemin Shin
- MR Applied Science Lab, GE Healthcare, New York, NY, USA
| | - Marie-France Marin
- Department of Psychology, Université du Québec à Montréal, Quebec, Canada
| | - Mohammed R Milad
- Department of Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
| | - Barbara O Rothbaum
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Kerry J Ressler
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA; McLean Hospital, Department of Psychiatry, Harvard Medical School, Belmont, MA, USA
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA
| | - Jennifer S Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
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Ressler KJ. Translating Across Circuits and Genetics Toward Progress in Fear- and Anxiety-Related Disorders. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2021; 19:247-255. [PMID: 34690590 PMCID: PMC8475910 DOI: 10.1176/appi.focus.19205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/15/2020] [Indexed: 06/13/2023]
Abstract
(Reprinted with permission from Am J Psychiatry 2020; 177:214-222).
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Harnett NG, van Rooij SJH, Ely TD, Lebois LAM, Murty VP, Jovanovic T, Hill SB, Dumornay NM, Merker JB, Bruce SE, House SL, Beaudoin FL, An X, Zeng D, Neylan TC, Clifford GD, Linnstaedt SD, Germine LT, Bollen KA, Rauch SL, Lewandowski C, Hendry PL, Sheikh S, Storrow AB, Musey PI, Haran JP, Jones CW, Punches BE, Swor RA, McGrath ME, Pascual JL, Seamon MJ, Mohiuddin K, Chang AM, Pearson C, Peak DA, Domeier RM, Rathlev NK, Sanchez LD, Pietrzak RH, Joormann J, Barch DM, Pizzagalli DA, Sheridan JF, Harte SE, Elliott JM, Kessler RC, Koenen KC, Mclean S, Ressler KJ, Stevens JS. Prognostic neuroimaging biomarkers of trauma-related psychopathology: resting-state fMRI shortly after trauma predicts future PTSD and depression symptoms in the AURORA study. Neuropsychopharmacology 2021; 46:1263-1271. [PMID: 33479509 PMCID: PMC8134491 DOI: 10.1038/s41386-020-00946-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/12/2020] [Accepted: 12/16/2020] [Indexed: 01/30/2023]
Abstract
Neurobiological markers of future susceptibility to posttraumatic stress disorder (PTSD) may facilitate identification of vulnerable individuals in the early aftermath of trauma. Variability in resting-state networks (RSNs), patterns of intrinsic functional connectivity across the brain, has previously been linked to PTSD, and may thus be informative of PTSD susceptibility. The present data are part of an initial analysis from the AURORA study, a longitudinal, multisite study of adverse neuropsychiatric sequalae. Magnetic resonance imaging (MRI) data from 109 recently (i.e., ~2 weeks) traumatized individuals were collected and PTSD and depression symptoms were assessed at 3 months post trauma. We assessed commonly reported RSNs including the default mode network (DMN), central executive network (CEN), and salience network (SN). We also identified a proposed arousal network (AN) composed of a priori brain regions important for PTSD: the amygdala, hippocampus, mamillary bodies, midbrain, and pons. Primary analyses assessed whether variability in functional connectivity at the 2-week imaging timepoint predicted 3-month PTSD symptom severity. Left dorsolateral prefrontal cortex (DLPFC) to AN connectivity at 2 weeks post trauma was negatively related to 3-month PTSD symptoms. Further, right inferior temporal gyrus (ITG) to DMN connectivity was positively related to 3-month PTSD symptoms. Both DLPFC-AN and ITG-DMN connectivity also predicted depression symptoms at 3 months. Our results suggest that, following trauma exposure, acutely assessed variability in RSN connectivity was associated with PTSD symptom severity approximately two and a half months later. However, these patterns may reflect general susceptibility to posttraumatic dysfunction as the imaging patterns were not linked to specific disorder symptoms, at least in the subacute/early chronic phase. The present data suggest that assessment of RSNs in the early aftermath of trauma may be informative of susceptibility to posttraumatic dysfunction, with future work needed to understand neural markers of long-term (e.g., 12 months post trauma) dysfunction. Furthermore, these findings are consistent with neural models suggesting that decreased top-down cortico-limbic regulation and increased network-mediated fear generalization may contribute to ongoing dysfunction in the aftermath of trauma.
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Affiliation(s)
- Nathaniel G Harnett
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Sanne J H van Rooij
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA
| | - Timothy D Ely
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA
| | - Lauren A M Lebois
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Vishnu P Murty
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | - Sarah B Hill
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA
| | | | - Julia B Merker
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA
| | - Steve E Bruce
- Department of Psychological Sciences, University of Missouri - St. Louis, Springfield, MO, USA
| | - Stacey L House
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Francesca L Beaudoin
- Department of Emergency Medicine & Health Services, Policy, and Practice, Rhode Island Hospital and The Miriam Hospital, The Alpert Medical School of Brown University, Providence, RI, USA
| | - Xinming An
- Institute of Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Donglin Zeng
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Thomas C Neylan
- Departments of Psychiatry and Neurology, University of California at San Francisco, San Francisco, CA, USA
| | - Gari D Clifford
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, USA
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Sarah D Linnstaedt
- Institute of Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Laura T Germine
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA
| | - Kenneth A Bollen
- Department of Psychology and Neuroscience, Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Scott L Rauch
- Department of Psychiatry, McLean Hospital, Belmont, MA, USA
| | | | - Phyllis L Hendry
- Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Sophia Sheikh
- Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Alan B Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Paul I Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - John P Haran
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Christopher W Jones
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Brittany E Punches
- Department of Emergency Medicine, College of Medicine & College of Nursing, University of Cincinnati, Cincinnati, OH, USA
| | - Robert A Swor
- Department of Emergency Medicine, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Meghan E McGrath
- Department of Emergency Medicine, Boston Medical Center, Boston, MA, USA
| | - Jose L Pascual
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Mark J Seamon
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Kamran Mohiuddin
- Department of Emergency Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Anna M Chang
- Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia, PA, USA
| | - Claire Pearson
- Department of Emergency Medicine, Wayne State University, Detroit, MI, USA
| | - David A Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Massachusetts, MA, USA
| | - Robert M Domeier
- Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, MI, USA
| | - Niels K Rathlev
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, MO, USA
| | - Leon D Sanchez
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
| | - Robert H Pietrzak
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Jutta Joormann
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Deanna M Barch
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO, USA
| | - Diego A Pizzagalli
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - John F Sheridan
- Department of Biosciences and Neuroscience, OSU Wexner Medical Center, Columbus, OH, USA
- Institute for Behavioral Medicine Research, OSU Wexner Medical Center, Columbus, OH, USA
| | - Steven E Harte
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
- Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - James M Elliott
- The Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, Camperdown, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
- Physical Therapy & Human Movement Sciences, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Karestan C Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Samuel Mclean
- Institute of Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kerry J Ressler
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Jennifer S Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA.
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Ginty AT, Young DA, Tyra AT, Hurley PE, Brindle RC, Williams SE. Heart Rate Reactivity to Acute Psychological Stress Predicts Higher Levels of Posttraumatic Stress Disorder Symptoms During the COVID-19 Pandemic. Psychosom Med 2021; 83:351-357. [PMID: 32796336 DOI: 10.1097/psy.0000000000000848] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Increased autonomic arousal is a proposed risk factor for posttraumatic stress disorder (PTSD). Few studies have prospectively examined the association between physiological responses to acute psychological stress before a traumatic event and later PTSD symptoms. The present prospective study examined whether cardiovascular responses to an acute psychological stress task before the COVID-19 global pandemic predicted PTSD symptoms related to the ongoing pandemic. METHODS Participants (n = 120) were a subsample of an ongoing research study. Phase 1 consisted of a 10-minute baseline and 4-minute acute psychological stress task with blood pressure and heart rate recorded throughout. Phase 2 was initiated 2 weeks after the COVID-19 pandemic declaration. Participants completed the Impact of Event Scale-Revised (IES-R) with respect to the ongoing pandemic. Hierarchical linear regression analyses were used to examine whether cardiovascular stress reactivity predicted COVID-19 PTSD symptoms. RESULTS Heart rate reactivity significantly predicted IES intrusion (β = -0.208, t = -2.28, p = .025, ΔR2 = 0.041, confidence interval = -0.021 to -0.001) and IES hyperarousal (β = -0.224, t = -2.54, p = .012, ΔR2 = 0.047, confidence interval = -0.22 to - 0.003), but not IES avoidance (p = .077). These results remained statistically significant after adjustment for sex, socioeconomic status, baseline cardiovascular activity, neuroticism, race, ethnicity, body mass index, and adverse childhood experiences. There were no statistically significant associations between blood pressure and any of the Impact of Event Scale-Revised subscales (p values > .12). CONCLUSIONS Diminished heart rate responses (i.e., lower physiological arousal) to acute psychological stress before the COVID-19 pandemic significantly predicted reported PTSD symptoms during the crisis.
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Affiliation(s)
- Annie T Ginty
- From the Department of Psychology and Neuroscience (Ginty, Young, Tyra, Hurley), Baylor University, Waco, Texas; Department of Cognitive and Behavioral Science and Neuroscience Program (Brindle), Washington and Lee University, Lexington, Virginia; and School of Sport, Exercise, and Rehabilitation Sciences (Williams), University of Birmingham, Birmingham, United Kingdom
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Rajbhandari AK, Octeau CJ, Gonzalez S, Pennington ZT, Mohamed F, Trott J, Chavez J, Ngyuen E, Keces N, Hong WZ, Neve RL, Waschek J, Khakh BS, Fanselow MS. A Basomedial Amygdala to Intercalated Cells Microcircuit Expressing PACAP and Its Receptor PAC1 Regulates Contextual Fear. J Neurosci 2021; 41:3446-3461. [PMID: 33637560 PMCID: PMC8051692 DOI: 10.1523/jneurosci.2564-20.2021] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 02/12/2021] [Accepted: 02/17/2021] [Indexed: 11/21/2022] Open
Abstract
Trauma can cause dysfunctional fear regulation leading some people to develop disorders, such as post-traumatic stress disorder (PTSD). The amygdala regulates fear, whereas PACAP (pituitary adenylate activating peptide) and PAC1 receptors are linked to PTSD symptom severity at genetic/epigenetic levels, with a strong link in females with PTSD. We discovered a PACAPergic projection from the basomedial amygdala (BMA) to the medial intercalated cells (mICCs) in adult mice. In vivo optogenetic stimulation of this pathway increased CFOS expression in mICCs, decreased fear recall, and increased fear extinction. Selective deletion of PAC1 receptors from the mICCs in females reduced fear acquisition, but enhanced fear generalization and reduced fear extinction in males. Optogenetic stimulation of the BMA-mICC PACAPergic pathway produced EPSCs in mICC neurons, which were enhanced by the PAC1 receptor antagonist, PACAP 6-38. Our findings show that mICCs modulate contextual fear in a dynamic and sex-dependent manner via a microcircuit containing the BMA and mICCs, and in a manner that was dependent on behavioral state.SIGNIFICANCE STATEMENT Traumatic stress can affect different aspects of fear behaviors, including fear learning, generalization of learned fear to novel contexts, how the fear of the original context is recalled, and how fear is reduced over time. While the amygdala has been studied for its role in regulation of different aspects of fear, the molecular circuitry of this structure is quite complex. In addition, aspects of fear can be modulated differently in males and females. Our findings show that a specific circuitry containing the neuropeptide PACAP and its receptor, PAC1, regulates various aspects of fear, including acquisition, generalization, recall, and extinction in a sexually dimorphic manner, characterizing a novel pathway that modulates traumatic fear.
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Affiliation(s)
- Abha K Rajbhandari
- Department of Psychology, University of California, Los Angeles, California 90095
- Staglin Center for Brain and Behavior, University of California, Los Angeles, California 90095
| | - Christopher J Octeau
- Department of Physiology, University of California, Los Angeles, California 90095
| | - Sarah Gonzalez
- Department of Psychology, University of California, Los Angeles, California 90095
- Staglin Center for Brain and Behavior, University of California, Los Angeles, California 90095
| | - Zachary T Pennington
- Department of Psychology, University of California, Los Angeles, California 90095
| | - Farzanna Mohamed
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York 10029
| | - Jeremy Trott
- Department of Psychology, University of California, Los Angeles, California 90095
- Staglin Center for Brain and Behavior, University of California, Los Angeles, California 90095
| | - Jasmine Chavez
- Department of Psychology, University of California, Los Angeles, California 90095
| | - Erin Ngyuen
- Department of Psychology, University of California, Los Angeles, California 90095
| | - Natasha Keces
- Department of Psychology, University of California, Los Angeles, California 90095
| | - Weizhe Z Hong
- Department of Neurobiology, University of California, Los Angeles, California 90095
| | - Rachael L Neve
- Gene Delivery Technology Core, Massachusetts General Hospital, Boston, Massachusetts, California 02114
| | - James Waschek
- Department of Psychiatry, University of California, Los Angeles, California 90095
| | - Baljit S Khakh
- Department of Physiology, University of California, Los Angeles, California 90095
- Department of Neurobiology, University of California, Los Angeles, California 90095
| | - Michael S Fanselow
- Department of Psychology, University of California, Los Angeles, California 90095
- Staglin Center for Brain and Behavior, University of California, Los Angeles, California 90095
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Bryant RA. A critical review of mechanisms of adaptation to trauma: Implications for early interventions for posttraumatic stress disorder. Clin Psychol Rev 2021; 85:101981. [PMID: 33588312 DOI: 10.1016/j.cpr.2021.101981] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 11/23/2020] [Accepted: 01/19/2021] [Indexed: 10/22/2022]
Abstract
Although many attempts have been made to limit development of posttraumatic stress disorder (PTSD) by early intervention after trauma exposure, these attempts have achieved only modest success. This review critiques the biological and cognitive strategies used for early intervention and outlines the extent to which they have prevented PTSD. The major predictors of PTSD are reviewed, with an emphasis on potential mechanisms that may underpin the transition from acute stress reaction to development of PTSD. This review highlights that there is a wide range of biological and cognitive factors that have been shown to predict PTSD. Despite this, the major attempts at early intervention have focused on strategies that attempt to augment extinction processes or alter appraisals in the acute period. The documented predictors of PTSD indicate that a broader range of potential strategies could be explored to limit PTSD. The evidence that people follow different trajectories of stress response following trauma and there is a wide array of acute predictors of PTSD indicates that a flexible and tailored approach needs to be investigated to evaluate more effective early intervention strategies.
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Rubin M, Telch MJ. Pupillary Response to Affective Voices: Physiological Responsivity and Posttraumatic Stress Disorder. J Trauma Stress 2021; 34:182-189. [PMID: 32969073 DOI: 10.1002/jts.22574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 04/30/2020] [Accepted: 06/02/2020] [Indexed: 01/10/2023]
Abstract
Posttraumatic stress disorder (PTSD) is related to dysfunctional emotional processing, thus motivating the search for physiological indices that can elucidate this process. Toward this aim, we compared pupillary response patterns in response to angry and fearful auditory stimuli among 99 adults, some with PTSD (n = 14), some trauma-exposed without PTSD (TE; n = 53), and some with no history of trauma exposure (CON; n = 32). We hypothesized that individuals with PTSD would show more pupillary response to angry and fearful auditory stimuli compared to those in the TE and CON groups. Among participants who had experienced a traumatic event, we explored the association between PTSD symptoms and pupillary response; contrary to our prediction, individuals with PTSD displayed the least pupillary response to fearful auditory stimuli compared those in the TE, B = -0.022, p = .077, and CON, B = -0.042, p = .002, groups, but they did not differ on angry auditory stimuli, B = 0.019, p = .118 and B = 0.006, p = .634, respectively. It is important to note that within-group analyses revealed that participants with PTSD differed significantly in their response to angry versus fearful stimuli, B = -0.032, p = .015. We also found a positive association between PTSD symptoms and pupillary response to angry stimuli. Our findings suggest that differential pupil response to anger and fear stimuli may be a promising way to understand emotional processing in PTSD.
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Affiliation(s)
- Mikael Rubin
- Department of Psychology, University of Texas at Austin, Austin, Texas, USA
| | - Michael J Telch
- Department of Psychology, University of Texas at Austin, Austin, Texas, USA
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60
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Central Amygdala Projections to Lateral Hypothalamus Mediate Avoidance Behavior in Rats. J Neurosci 2021; 41:61-72. [PMID: 33188067 DOI: 10.1523/jneurosci.0236-20.2020] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 10/26/2020] [Accepted: 10/28/2020] [Indexed: 11/21/2022] Open
Abstract
Persistent avoidance of stress-related stimuli following acute stress exposure predicts negative outcomes such as substance abuse and traumatic stress disorders. Previous work using a rat model showed that the central amygdala (CeA) plays an important role in avoidance of a predator odor stress-paired context. Here, we show that CeA projections to the lateral hypothalamus (LH) are preferentially activated in male rats that show avoidance of a predator odor-paired context (termed Avoider rats), that chemogenetic inhibition of CeA-LH projections attenuates avoidance in male Avoider rats, that chemogenetic stimulation of the CeA-LH circuit produces conditioned place avoidance (CPA) in otherwise naive male rats, and that avoidance behavior is associated with intrinsic properties of LH-projecting CeA cells. Collectively, these data show that CeA-LH projections are important for persistent avoidance of stress-related stimuli following acute stress exposure.SIGNIFICANCE STATEMENT This study in rats shows that a specific circuit in the brain [i.e., neurons that project from the central amygdala (CeA) to the lateral hypothalamus (LH)] mediates avoidance of stress-associated stimuli. In addition, this study shows that intrinsic physiological properties of cells in this brain circuit are associated with avoidance of stress-associated stimuli. Further characterization of the CeA-LH circuit may improve our understanding of the neural mechanisms underlying specific aspects of stress-related disorders in humans.
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Gould F, Harvey PD, Hodgins G, Jones MT, Michopoulos V, Maples-Keller J, Rothbaum BO, Rothbaum AO, Ressler KJ, Nemeroff CB. Prior trauma-related experiences predict the development of posttraumatic stress disorder after a new traumatic event. Depress Anxiety 2021; 38:40-47. [PMID: 32789992 DOI: 10.1002/da.23084] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/25/2020] [Accepted: 07/12/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Many reports have documented the relationship between previous traumatic experiences, including childhood trauma, and the development of later life psychopathology, including posttraumatic stress disorder (PTSD). Identification of individuals at greatest risk for the development of PTSD could lead to preventative interventions. The present study examined the developmental course of PTSD after trauma exposure, using histories of previous traumatic experiences and the severity of the reaction to the trauma as predictors. METHODS Participants (N = 713) were recruited from Emergency Departments in Miami and Atlanta immediately following a traumatic experience. Histories of previous traumatic experiences and the immediate reaction to the new trauma were examined at baseline. Follow-up assessments of PTSD severity were conducted at 1, 3, and 6 months. RESULTS Histories of child abuse and pre-existing trauma symptoms predicted the immediate response to stress (R2 = .21, p < .001) and the initial trauma reaction (p < .005).) A mixed-model repeated-measures analysis of variance found that immediate stress response and a history of prior trauma (p < .001) significantly predicted the course of PTSD symptoms. Area under the curve (AUC) analyses suggested that the presence of PTSD at each successive assessment was predicted most substantially by the severity of PTSD at the immediately prior follow-up assessment (AUC > 0.86). CONCLUSIONS The current findings suggest that previous traumatic experiences lead to a greater immediate reaction to trauma and combine to predict the development of PTSD, the maintenance of which is not moderated by these earlier experiences. The identification of people likely to develop PTSD may be aided by the assessment of prior experiences and immediate reactions.
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Affiliation(s)
- Felicia Gould
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Philip D Harvey
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida.,Research Service, Bruce W. Carter Miami VA Medical Center, Miami, Florida
| | - Gabrielle Hodgins
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida.,Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - Mackenzie T Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Vasiliki Michopoulos
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Jessica Maples-Keller
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Barbara O Rothbaum
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Alex O Rothbaum
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia.,Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio
| | - Kerry J Ressler
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia.,Mclean Hospital, Harvard Medical School, Belmont, Massachusetts
| | - Charles B Nemeroff
- Department of Psychiatry, Dell Medical School, University of Texas at Austin, Austin, Texas.,Institute for Early Life Adversity Research, University of Texas at Austin, Austin, Texas
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62
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Harnett NG, Stevens JS, van Rooij SJH, Ely TD, Michopoulos V, Hudak L, Jovanovic T, Rothbaum BO, Ressler KJ, Fani N. Multimodal structural neuroimaging markers of risk and recovery from posttrauma anhedonia: A prospective investigation. Depress Anxiety 2021; 38:79-88. [PMID: 33169525 PMCID: PMC7785637 DOI: 10.1002/da.23104] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 08/24/2020] [Accepted: 09/30/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Anhedonic symptoms of posttraumatic stress disorder (PTSD) reflect deficits in reward processing that have significant functional consequences. Although recent evidence suggests that disrupted integrity of fronto-limbic circuitry is related to PTSD development, including anhedonic PTSD symptoms (posttrauma anhedonia [PTA]), little is known about potential structural biomarkers of long-term PTA as well as structural changes in fronto-limbic pathways associated with recovery from PTA over time. METHODS We investigated associations between white matter microstructure, gray matter volume, and PTA in 75 recently traumatized individuals, with a subset of participants (n = 35) completing follow-up assessment 12 months after trauma exposure. Deterministic tractography and voxel-based morphometry were used to assess changes in white and gray matter structure associated with changes in PTA. RESULTS Reduced fractional anisotropy (FA) of the uncinate fasciculus at around the time of trauma predicted greater PTA at 12-months posttrauma. Further, increased FA of the fornix over time was associated with lower PTA between 1 and 12-months posttrauma. Increased gray matter volume of the ventromedial prefrontal cortex and precuneus over time was also associated with reduced PTA. CONCLUSIONS The microstructure of the uncinate fasciculus, an amygdala-prefrontal white matter connection, may represent a biomarker of vulnerability for later PTA. Conversely, development and recovery from PTA appear to be facilitated by white and gray matter structural changes in a major hippocampal pathway, the fornix. The present findings shed new light on neuroanatomical substrates of recovery from PTA and characterize white matter biomarkers of risk for posttraumatic dysfunction.
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Affiliation(s)
- Nathaniel G. Harnett
- Division of Depression and Anxiety, McLean Hospital, Emory University,Department of Psychiatry, Harvard Medical School, Emory University
| | | | | | - Timothy D. Ely
- Department of Psychiatry and Behavioral Sciences, Emory University
| | | | - Lauren Hudak
- Department of Emergency Medicine, Emory University
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Sciences, Emory University,Department of Psychiatry and Behavioral Neuroscience, Wayne State University
| | | | - Kerry J. Ressler
- Division of Depression and Anxiety, McLean Hospital, Emory University,Department of Psychiatry, Harvard Medical School, Emory University,Department of Psychiatry and Behavioral Sciences, Emory University
| | - Negar Fani
- Department of Psychiatry and Behavioral Sciences, Emory University,Address correspondence to: Negar Fani, PhD, Assistant Professor, Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, 101 Woodruff Circle Suite 6007, Atlanta, Georgia 30322,
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63
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Longitudinal Risk for Posttraumatic Stress Disorder and Chronic Pain: Shared Circuitry in the Midbrain? BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2020; 5:844-845. [PMID: 32896298 DOI: 10.1016/j.bpsc.2020.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 11/21/2022]
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64
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Linnstaedt SD, Zannas AS, McLean SA, Koenen KC, Ressler KJ. Literature review and methodological considerations for understanding circulating risk biomarkers following trauma exposure. Mol Psychiatry 2020; 25:1986-1999. [PMID: 31863020 PMCID: PMC7305050 DOI: 10.1038/s41380-019-0636-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 11/24/2019] [Accepted: 12/11/2019] [Indexed: 12/29/2022]
Abstract
Exposure to traumatic events is common. While many individuals recover following trauma exposure, a substantial subset develop adverse posttraumatic neuropsychiatric sequelae (APNS) such as posttraumatic stress, major depression, and regional or widespread chronic musculoskeletal pain. APNS cause substantial burden to the individual and to society, causing functional impairment and physical disability, risk for suicide, lost workdays, and increased health care costs. Contemporary treatment is limited by an inability to identify individuals at high risk of APNS in the immediate aftermath of trauma, and an inability to identify optimal treatments for individual patients. Our purpose is to provide a comprehensive review describing candidate blood-based biomarkers that may help to identify those at high risk of APNS and/or guide individual intervention decision-making. Such blood-based biomarkers include circulating biological factors such as hormones, proteins, immune molecules, neuropeptides, neurotransmitters, mRNA, and noncoding RNA expression signatures, while we do not review genetic and epigenetic biomarkers due to other recent reviews of this topic. The current state of the literature on circulating risk biomarkers of APNS is summarized, and key considerations and challenges for their discovery and translation are discussed. We also describe the AURORA study, a specific example of current scientific efforts to identify such circulating risk biomarkers and the largest study to date focused on identifying risk and prognostic factors in the aftermath of trauma exposure.
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Affiliation(s)
- Sarah D Linnstaedt
- Institute for Trauma Recovery, University of North Carolina, Chapel Hill, NC, USA
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC, USA
| | - Anthony S Zannas
- Institute for Trauma Recovery, University of North Carolina, Chapel Hill, NC, USA
- Departments of Psychiatry and Genetics, University of North Carolina, Chapel Hill, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Samuel A McLean
- Institute for Trauma Recovery, University of North Carolina, Chapel Hill, NC, USA
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC, USA
- Department of Emergency Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Karestan C Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Kerry J Ressler
- Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, MA, USA.
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65
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Elorette C, Aguilar BL, Novak V, Forcelli PA, Malkova L. Dysregulation of behavioral and autonomic responses to emotional and social stimuli following bidirectional pharmacological manipulation of the basolateral amygdala in macaques. Neuropharmacology 2020; 179:108275. [PMID: 32835765 DOI: 10.1016/j.neuropharm.2020.108275] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 07/24/2020] [Accepted: 08/13/2020] [Indexed: 11/28/2022]
Abstract
The amygdala is a key component of the neural circuits mediating the processing and response to emotionally salient stimuli. Amygdala lesions dysregulate social interactions, responses to fearful stimuli, and autonomic functions. In rodents, the basolateral and central nuclei of the amygdala have divergent roles in behavioral control. However, few studies have selectively examined these nuclei in the primate brain. Moreover, the majority of non-human primate studies have employed lesions, which only allow for unidirectional manipulation of amygdala activity. Thus, the effects of amygdala disinhibition on behavior in the primate are unknown. To address this gap, we pharmacologically inhibited by muscimol or disinhibited by bicuculline methiodide the basolateral complex of the amygdala (BLA; lateral, basal, and accessory basal) in nine awake, behaving male rhesus macaques (Macaca mulatta). We examined the effects of amygdala manipulation on: (1) behavioral responses to taxidermy snakes and social stimuli, (2) food competition and social interaction in dyads, (3) autonomic arousal as measured by cardiovascular response, and (4) prepulse inhibition of the acoustic startle (PPI) response. All modalities were impacted by pharmacological inhibition and/or disinhibition. Amygdala inhibition decreased fear responses to snake stimuli, increased examination of social stimuli, reduced competitive reward-seeking in dominant animals, decreased heart rate, and increased PPI response. Amygdala disinhibition restored fearful response after habituation to snakes, reduced competitive reward-seeking behavior in dominant animals, and lowered heart rate. Thus, both hypoactivity and hyperactivity of the basolateral amygdala can lead to dysregulated behavior, suggesting that a narrow range of activity is necessary for normal functions.
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Affiliation(s)
- Catherine Elorette
- Interdisciplinary Program in Neuroscience, Georgetown University Medical Center, USA; Department of Pharmacology & Physiology, Georgetown University Medical Center, USA
| | - Brittany L Aguilar
- Interdisciplinary Program in Neuroscience, Georgetown University Medical Center, USA; Department of Pharmacology & Physiology, Georgetown University Medical Center, USA
| | - Vera Novak
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, USA
| | - Patrick A Forcelli
- Interdisciplinary Program in Neuroscience, Georgetown University Medical Center, USA; Department of Pharmacology & Physiology, Georgetown University Medical Center, USA; Department of Neuroscience, Georgetown University Medical Center, USA.
| | - Ludise Malkova
- Interdisciplinary Program in Neuroscience, Georgetown University Medical Center, USA; Department of Pharmacology & Physiology, Georgetown University Medical Center, USA.
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66
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The association of PTSD symptom severity with amygdala nuclei volumes in traumatized youths. Transl Psychiatry 2020; 10:288. [PMID: 32807799 PMCID: PMC7431855 DOI: 10.1038/s41398-020-00974-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 06/03/2020] [Accepted: 06/03/2020] [Indexed: 12/11/2022] Open
Abstract
The amygdala is a core component in neurobiological models of stress and stress-related pathologies, including post-traumatic stress disorder (PTSD). While numerous studies have reported increased amygdala activity following traumatic stress exposure and in PTSD, the findings regarding amygdala volume have been mixed. One reason for these mixed findings may be that the amygdala has been considered as a homogenous entity, while it in fact consists of several nuclei with unique cellular and connectivity profiles. Here, we investigated amygdala nuclei volumes of the basolateral and the centrocorticomedial complex in relation to PTSD symptom severity in 47 young survivors from the 2011 Norwegian terror attack 24-36 months post-trauma. PTSD symptoms were assessed 4-5, 14-15 and 24-36 months following the trauma. We found that increased PTSD symptom severity 24-36 months post-trauma was associated with volumetric reductions of all basolateral as well as the central and the medial nuclei. However, only the lateral nucleus was associated with longitudinal symptom development, and mediated the association between 4-5 months and 24-36 months post-trauma symptoms. The results suggest that the amygdala nuclei may be differentially associated with cross-sectional and longitudinal measures of PTSD symptom severity. As such, investigations of amygdala total volume may not provide an adequate index of the association between amygdala and stress-related mental illness.
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67
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Nordman JC, Ma X, Gu Q, Potegal M, Li H, Kravitz AV, Li Z. Potentiation of Divergent Medial Amygdala Pathways Drives Experience-Dependent Aggression Escalation. J Neurosci 2020; 40:4858-4880. [PMID: 32424020 PMCID: PMC7326350 DOI: 10.1523/jneurosci.0370-20.2020] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 03/25/2020] [Accepted: 04/14/2020] [Indexed: 12/20/2022] Open
Abstract
Heightened aggression can be serious concerns for the individual and society at large and are symptoms of many psychiatric illnesses, such as post-traumatic stress disorder. The circuit and synaptic mechanisms underlying experience-induced aggression increase, however, are poorly understood. Here we find that prior attack experience leading to an increase in aggressive behavior, known as aggression priming, activates neurons within the posterior ventral segment of the medial amygdala (MeApv). Optogenetic stimulation of MeApv using a synaptic depression protocol suppresses aggression priming, whereas high-frequency stimulation enhances aggression, mimicking attack experience. Interrogation of the underlying neural circuitry revealed that the MeApv mediates aggression priming via synaptic connections with the ventromedial hypothalamus (VmH) and bed nucleus of the stria terminalis (BNST). These pathways undergo NMDAR-dependent synaptic potentiation after attack. Furthermore, we find that the MeApv-VmH synapses selectively control attack duration, whereas the MeApv-BNST synapses modulate attack frequency, both with no effect on social behavior. Synaptic potentiation of the MeApv-VmH and MeApv-BNST pathways contributes to increased aggression induced by traumatic stress, and weakening synaptic transmission at these synapses blocks the effect of traumatic stress on aggression. These results reveal a circuit and synaptic basis for aggression modulation by experience that can be potentially leveraged toward clinical interventions.SIGNIFICANCE STATEMENT Heightened aggression can have devastating social consequences and may be associated with psychiatric disorders, such as post-traumatic stress disorder. The circuit and synaptic mechanisms underlying experience-induced aggression escalation, however, are poorly understood. Here we identify two aggression pathways between the posterior ventral segment of the medial amygdala and its downstream synaptic partners, the ventromedial hypothalamus and bed nucleus of the stria terminalis that undergo synaptic potentiation after attack and traumatic stress to enhance aggression. Notably, weakening synaptic transmission in these circuits blocks aggression priming, naturally occurring aggression, and traumatic stress-induced aggression increase. These results illustrate a circuit and synaptic basis of aggression modulation by experience, which can be potentially targeted for clinical interventions.
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Affiliation(s)
- Jacob C Nordman
- Section on Synapse Development and Plasticity, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland 20892
- National Institute of General Medical Sciences, National Institutes of Health, Bethesda, Maryland 20892
| | - Xiaoyu Ma
- Section on Synapse Development and Plasticity, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland 20892
| | - Qinhua Gu
- Section on Synapse Development and Plasticity, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland 20892
| | - Michael Potegal
- Program in Occupational Therapy, Center for Neurobehavioral Development, University of Minnesota, Minneapolis, Minnesota 55455
| | - He Li
- Department of Psychiatry, Uniformed Services University, Bethesda, Maryland 20892
| | - Alexxai V Kravitz
- Eating and Addiction Section, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892
| | - Zheng Li
- Section on Synapse Development and Plasticity, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland 20892
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Branco RC, Burkett JP, Black CA, Winokur E, Elsworth W, Dhamsania RK, Lohr KM, Schroeder JP, Weinshenker D, Jovanovic T, Miller GW. Vesicular monoamine transporter 2 mediates fear behavior in mice. GENES, BRAIN, AND BEHAVIOR 2020; 19:e12634. [PMID: 31898856 PMCID: PMC8170828 DOI: 10.1111/gbb.12634] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 12/27/2019] [Accepted: 12/29/2019] [Indexed: 11/26/2022]
Abstract
A subset of people exposed to a traumatic event develops post-traumatic stress disorder (PTSD), which is associated with dysregulated fear behavior. Genetic variation in SLC18A2, the gene that encodes vesicular monoamine transporter 2 (VMAT2), has been reported to affect risk for the development of PTSD in humans. Here, we use transgenic mice that express either 5% (VMAT2-LO mice) or 200% (VMAT2-HI mice) of wild-type levels of VMAT2 protein. We report that VMAT2-LO mice have reduced VMAT2 protein in the hippocampus and amygdala, impaired monoaminergic vesicular storage capacity in both the striatum and frontal cortex, decreased monoamine metabolite abundance and a greatly reduced capacity to release dopamine upon stimulation. Furthermore, VMAT2-LO mice showed exaggerated cued and contextual fear expression, altered fear habituation, inability to discriminate threat from safety cues, altered startle response compared with wild-type mice and an anxiogenic-like phenotype, but displayed no deficits in social function. By contrast, VMAT2-HI mice exhibited increased VMAT2 protein throughout the brain, higher vesicular storage capacity and greater dopamine release upon stimulation compared with wild-type controls. Behaviorally, VMAT2-HI mice were similar to wild-type mice in most assays, with some evidence of a reduced anxiety-like responses. Together, these data show that presynaptic monoamine function mediates PTSD-like outcomes in our mouse model, and suggest a causal link between reduced VMAT2 expression and fear behavior, consistent with the correlational relationship between VMAT2 genotype and PTSD risk in humans. Targeting this system is a potential strategy for the development of pharmacotherapies for disorders like PTSD.
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Affiliation(s)
- Rachel C. Branco
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - James P. Burkett
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Carlie A. Black
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Emily Winokur
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - William Elsworth
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Rohan K. Dhamsania
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Kelly M. Lohr
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Jason P. Schroeder
- Department of Human Genetics, Emory University School of Medicine, Atlanta, Georgia
| | - David Weinshenker
- Department of Human Genetics, Emory University School of Medicine, Atlanta, Georgia
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Gary W. Miller
- Department of Environmental Health, Rollins School of Public Health, Department of Pharmacology, Department of Neurology, Center for Neurodegenerative Diseases, Emory University, Atlanta, Georgia
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69
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Pöhlchen D, Leuchs L, Binder FP, Blaskovich B, Nantawisarakul T, Topalidis P, Brückl TM, Norrholm SD, Jovanovic T, Spoormaker VI, Binder EB, Czisch M, Erhardt A, Grandi NC, Ilic-Cocic S, Lucae S, Sämann P, Tontsch A. No robust differences in fear conditioning between patients with fear-related disorders and healthy controls. Behav Res Ther 2020; 129:103610. [DOI: 10.1016/j.brat.2020.103610] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 03/09/2020] [Accepted: 03/23/2020] [Indexed: 11/29/2022]
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Brown LC, Murphy AR, Lalonde CS, Subhedar PD, Miller AH, Stevens JS. Posttraumatic stress disorder and breast cancer: Risk factors and the role of inflammation and endocrine function. Cancer 2020; 126:3181-3191. [PMID: 32374431 DOI: 10.1002/cncr.32934] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 03/10/2020] [Accepted: 03/23/2020] [Indexed: 12/20/2022]
Abstract
A breast cancer diagnosis can be a life-changing and stressful experience that can lead to chronic mental health conditions such as posttraumatic stress disorder (PTSD). Greater than one-third of patients initially diagnosed with PTSD after a diagnosis of breast cancer continue to have persistent or worsening PTSD symptoms after 4 years. An emerging body of literature has indicated several key environmental and biological risk factors for PTSD among survivors of breast cancer. Well-recognized risk factors include having a history of childhood trauma, being nonwhite, obesity, younger age at the time of diagnosis, diagnosis with a higher stage of breast cancer, and short time since treatment. Of the emerging risk factors related to fear circuitry in the brain, 2 pathways of particular importance are the stress-driven activation of inflammatory pathways and the long-term effect of antiendocrine therapies. These central and peripheral responses during and after stress exposure are important because increased fear and anxiety can lead to the maintenance of PTSD and worse patient outcomes. Given the poor outcomes associated with PTSD and the high prevalence of breast cancer in women, more research to identify those women at heightened risk of PTSD after breast cancer is warranted to reduce the number of diagnoses and lessen the negative impact of this chronic mental health condition.
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Affiliation(s)
- Lauren C Brown
- Emory University College of Arts and Sciences, Atlanta, Georgia, USA
| | - Amy R Murphy
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Chloe S Lalonde
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Preeti D Subhedar
- Glenn Family Breast Center, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA.,Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Andrew H Miller
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, USA.,Glenn Family Breast Center, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Jennifer S Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, USA.,Glenn Family Breast Center, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
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71
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Sillivan SE, Jamieson S, de Nijs L, Jones M, Snijders C, Klengel T, Joseph NF, Krauskopf J, Kleinjans J, Vinkers CH, Boks MP, Geuze E, Vermetten E, Berretta S, Ressler KJ, Rutten BP, Rumbaugh G, Miller CA. MicroRNA regulation of persistent stress-enhanced memory. Mol Psychiatry 2020; 25:965-976. [PMID: 31142820 PMCID: PMC6883139 DOI: 10.1038/s41380-019-0432-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 03/04/2019] [Accepted: 04/11/2019] [Indexed: 12/28/2022]
Abstract
Disruption of persistent, stress-associated memories is relevant for treating posttraumatic stress disorder (PTSD) and related syndromes, which develop in a subset of individuals following a traumatic event. We previously developed a stress-enhanced fear learning (SEFL) paradigm in inbred mice that produces PTSD-like characteristics in a subset of mice, including persistently enhanced memory and heightened cFos in the basolateral amygdala complex (BLC) with retrieval of the remote (30-day-old) stress memory. Here, the contribution of BLC microRNAs (miRNAs) to stress-enhanced memory was investigated because of the molecular complexity they achieve through their ability to regulate multiple targets simultaneously. We performed small-RNA sequencing (smRNA-Seq) and quantitative proteomics on BLC tissue collected from mice 1 month after SEFL and identified persistently changed microRNAs, including mir-135b-5p, and proteins associated with PTSD-like heightened fear expression. Viral-mediated overexpression of mir-135b-5p in the BLC of stress-resilient animals enhanced remote fear memory expression and promoted spontaneous renewal 14 days after extinction. Conversely, inhibition of BLC mir-135b-5p in stress-susceptible animals had the opposite effect, promoting a resilient-like phenotype. mir-135b-5p is highly conserved across mammals and was detected in post mortem human amygdala, as well as human serum samples. The mir-135b passenger strand, mir-135b-3p, was significantly elevated in serum from PTSD military veterans, relative to combat-exposed control subjects. Thus, miR-135b-5p may be an important therapeutic target for dampening persistent, stress-enhanced memory and its passenger strand a potential biomarker for responsivity to a mir-135-based therapeutic.
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Affiliation(s)
- Stephanie E. Sillivan
- Department of Molecular Medicine, The Scripps Research Institute, Jupiter, FL USA,Department of Neuroscience, The Scripps Research Institute, Jupiter, FL USA
| | - Sarah Jamieson
- Department of Molecular Medicine, The Scripps Research Institute, Jupiter, FL USA,Department of Neuroscience, The Scripps Research Institute, Jupiter, FL USA
| | - Laurence de Nijs
- School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Meghan Jones
- Department of Molecular Medicine, The Scripps Research Institute, Jupiter, FL USA,Department of Neuroscience, The Scripps Research Institute, Jupiter, FL USA
| | - Clara Snijders
- School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Torsten Klengel
- Department of Psychiatry, Harvard Medical School, McLean Hospital, Belmont, MA, USA
| | - Nadine F. Joseph
- Department of Molecular Medicine, The Scripps Research Institute, Jupiter, FL USA,Department of Neuroscience, The Scripps Research Institute, Jupiter, FL USA
| | - Julian Krauskopf
- Department of Toxicogenomics, Maastricht University, Maastricht, The Netherlands
| | - Jos Kleinjans
- Department of Toxicogenomics, Maastricht University, Maastricht, The Netherlands
| | - Christiaan H. Vinkers
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, The Netherlands
| | - Marco P.M. Boks
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, The Netherlands
| | - Elbert Geuze
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, The Netherlands.,Research Centre for Military Mental Healthcare, Ministry of Defence, Utrecht, The Netherlands
| | - Eric Vermetten
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, The Netherlands.,Research Centre for Military Mental Healthcare, Ministry of Defence, Utrecht, The Netherlands.,Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - Sabina Berretta
- Department of Psychiatry, Harvard Medical School, McLean Hospital, Belmont, MA, USA
| | - Kerry J. Ressler
- Department of Psychiatry, Harvard Medical School, McLean Hospital, Belmont, MA, USA
| | - Bart P.F. Rutten
- School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Gavin Rumbaugh
- Department of Neuroscience, The Scripps Research Institute, Jupiter, FL USA
| | - Courtney A. Miller
- Department of Molecular Medicine, The Scripps Research Institute, Jupiter, FL USA,Department of Neuroscience, The Scripps Research Institute, Jupiter, FL USA.,Correspondence to: Courtney Miller , 130 Scripps Way, Jupiter, FL 33458, Phone 561-228-2958
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72
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Harnett NG, Goodman AM, Knight DC. PTSD-related neuroimaging abnormalities in brain function, structure, and biochemistry. Exp Neurol 2020; 330:113331. [PMID: 32343956 DOI: 10.1016/j.expneurol.2020.113331] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 04/06/2020] [Accepted: 04/24/2020] [Indexed: 12/20/2022]
Abstract
Although approximately 90% of the U.S. population will experience a traumatic event within their lifetime, only a fraction of those traumatized individuals will develop posttraumatic stress disorder (PTSD). In fact, approximately 7 out of 100 people in the U.S. will be afflicted by this debilitating condition, which suggests there is substantial inter-individual variability in susceptibility to PTSD. This uncertainty regarding who is susceptible to PTSD necessitates a thorough understanding of the neurobiological processes that underlie PTSD development in order to build effective predictive models for the disorder. In turn, these predictive models may lead to the development of improved diagnostic markers, early intervention techniques, and targeted treatment approaches for PTSD. Prior research has characterized a fear learning and memory network, centered on the prefrontal cortex, hippocampus, and amygdala, that plays a key role in the pathology of PTSD. Importantly, changes in the function, structure, and biochemistry of this network appear to underlie the cognitive-affective dysfunction observed in PTSD. The current review discusses prior research that has demonstrated alterations in brain function, structure, and biochemistry associated with PTSD. Further, the potential for future research to address current gaps in our understanding of the neural processes that underlie the development of PTSD is discussed. Specifically, this review emphasizes the need for multimodal neuroimaging research and investigations into the acute effects of posttraumatic stress. The present review provides a framework to move the field towards a comprehensive neurobiological model of PTSD.
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Affiliation(s)
- Nathaniel G Harnett
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Adam M Goodman
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - David C Knight
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA.
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73
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Amygdala functional connectivity in the acute aftermath of trauma prospectively predicts severity of posttraumatic stress symptoms. Neurobiol Stress 2020; 12:100217. [PMID: 32435666 PMCID: PMC7231977 DOI: 10.1016/j.ynstr.2020.100217] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 02/20/2020] [Accepted: 03/27/2020] [Indexed: 12/20/2022] Open
Abstract
Understanding neural mechanisms that confer risk for posttraumatic stress disorder (PTSD) is critical for earlier intervention, yet longitudinal work has been sparse. The amygdala is part of a core network consistently implicated in PTSD symptomology. Most neural models of PTSD have focused on the amygdala's interactions with the dorsal anterior cingulate cortex, ventromedial prefrontal cortex, and hippocampus. However, an increasing number of studies have linked PTSD symptoms to aberrations in amygdala functional connections with other brain regions involved in emotional information processing, self-referential processing, somatosensory processing, visual processing, and motor control. In the current study, trauma-exposed individuals (N = 54) recruited from the emergency department completed a resting state fMRI scan as well as a script-driven trauma recall fMRI task scan two-weeks post-trauma along with demographic, PTSD, and other clinical symptom questionnaires two-weeks and six-months post-trauma. We examined whether amygdala-whole brain functional connectivity (FC) during rest and task could predict six-month post-trauma PTSD symptoms. More negative amygdala-cerebellum and amygdala-postcentral gyrus FC during rest as well as more negative amygdala-postcentral gyrus and amygdala-midcingulate cortex during recall of the trauma memory predicted six-month post-trauma PTSD after controlling for scanner type. Follow-up multiple regression sensitivity analyses controlling for several other relevant predictors of PTSD symptoms, revealed that amygdala-cerebellum FC during rest and amygdala-postcentral gyrus FC during trauma recall were particularly robust predictors of six-month PTSD symptoms. The results extend cross-sectional studies implicating abnormal FC of the amygdala with other brain regions involved in somatosensory processing, motor control, and emotional information processing in PTSD, to the prospective prediction of risk for chronic PTSD. This work may contribute to earlier identification of at-risk individuals and elucidate potential intervention targets.
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74
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Acute Posttrauma Resting-State Functional Connectivity of Periaqueductal Gray Prospectively Predicts Posttraumatic Stress Disorder Symptoms. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2020; 5:891-900. [PMID: 32389746 DOI: 10.1016/j.bpsc.2020.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/04/2020] [Accepted: 03/08/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is characterized by hyperarousal, avoidance, and intrusive/re-experiencing symptoms. The periaqueductal gray (PAG), which generates behavioral responses to physical and psychological stressors, is also implicated in threat processing. Distinct regions of the PAG elicit opposing responses to threatening or stressful stimuli; the ventrolateral PAG evokes passive coping strategies (e.g., analgesia), whereas the dorsolateral PAG (dlPAG) promotes active responses (e.g., fight or flight). We investigated whether altered PAG resting-state functional connectivity (RSFC) prospectively predicted PTSD symptoms. METHODS A total of 48 trauma-exposed individuals underwent an RSFC scan 2 weeks posttraumatic injury. Self-report measures, including the visual analog scale for pain and the Impact of Event Scale, were collected at 2 weeks and 6 months posttrauma. We analyzed whether acute bilateral PAG RSFC was a marker of risk for total 6-month symptom severity and specific symptom clusters. In an exploratory analysis, we investigated whether dlPAG RSFC predicted PTSD symptoms. RESULTS After adjusting for physical pain ratings, greater acute posttrauma PAG-frontal pole and PAG-posterior cingulate cortex connectivity was positively associated with 6-month total PTSD symptoms. Weaker dlPAG-superior/inferior parietal lobule connectivity predicted both higher hyperarousal and higher intrusive symptoms, while weaker dlPAG-supramarginal gyrus RSFC was associated with only hyperarousal symptoms. CONCLUSIONS Altered connectivity of the PAG 2 weeks posttrauma prospectively predicted PTSD symptoms. These findings suggest that aberrant PAG function may serve as a marker of risk for chronic PTSD symptoms, possibly by driving specific symptom clusters, and more broadly that connectivity of specific brain regions may underlie specific symptom profiles.
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75
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Scult MA, Knodt AR, Radtke SR, Brigidi BD, Hariri AR. Prefrontal Executive Control Rescues Risk for Anxiety Associated with High Threat and Low Reward Brain Function. Cereb Cortex 2020; 29:70-76. [PMID: 29161340 DOI: 10.1093/cercor/bhx304] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 10/19/2017] [Indexed: 01/06/2023] Open
Abstract
Compared with neural biomarkers of risk for mental illness, little is known about biomarkers of resilience. We explore if greater executive control-related prefrontal activity may function as a resilience biomarker by "rescuing" risk associated with higher threat-related amygdala and lower reward-related ventral striatum activity. Functional MRI was used to assay baseline threat-related amygdala, reward-related ventral striatum, and executive control-related prefrontal activity in 120 young adult volunteers. Participants provided self-reported mood and anxiety ratings at baseline and follow-up. A moderation model revealed a significant three-way interaction wherein higher amygdala and lower ventral striatum activity predicted increases in anxiety in those with average or low but not high prefrontal activity. This effect was specific to anxiety, with the neural biomarkers explaining ~10% of the variance in change over time, above and beyond baseline symptoms, sex, age, IQ, presence or absence of DMS-IV diagnosis, and both early and recent stress. Our findings are consistent with the importance of top-down executive control in adaptive regulation of negative emotions, and highlight a unique combination of neural biomarkers that may identify at-risk individuals for whom the adoption of strategies to improve executive control of negative emotions may prove particularly beneficial.
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Affiliation(s)
- Matthew A Scult
- Laboratory of NeuroGenetics, Department of Psychology & Neuroscience, Duke University, Durham, NC, USA
| | - Annchen R Knodt
- Laboratory of NeuroGenetics, Department of Psychology & Neuroscience, Duke University, Durham, NC, USA
| | - Spenser R Radtke
- Laboratory of NeuroGenetics, Department of Psychology & Neuroscience, Duke University, Durham, NC, USA
| | - Bartholomew D Brigidi
- Laboratory of NeuroGenetics, Department of Psychology & Neuroscience, Duke University, Durham, NC, USA
| | - Ahmad R Hariri
- Laboratory of NeuroGenetics, Department of Psychology & Neuroscience, Duke University, Durham, NC, USA
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76
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Abstract
Anxiety and fear-related disorders are common and disabling, and they significantly increase risk for suicide and other causes of morbidity and mortality. However, there is tremendous potential for translational neuroscience to advance our understanding of these disorders, leading to novel and powerful interventions and even to preventing their initial development. This overview examines the general circuits and processes thought to underlie fear and anxiety, along with the promise of translational research. It then examines some of the data-driven "next-generation" approaches that are needed for discovery and understanding but that do not always fit neatly into established models. From one perspective, these disorders offer among the most tractable problems in psychiatry, with a great deal of accumulated understanding, across species, of neurocircuit, behavioral, and, increasingly, genetic mechanisms, of how dysregulation of fear and threat processes contributes to anxiety-related disorders. One example is the progressively sophisticated understanding of how extinction underlies the exposure therapy component of cognitive-behavioral therapy approaches, which are ubiquitously used across anxiety and fear-related disorders. However, it is also critical to examine gaps in our understanding between reasonably well-replicated examples of successful translation, areas of significant deficits in knowledge, and the role of large-scale data-driven approaches in future progress and discovery. Although a tremendous amount of progress is still needed, translational approaches to understanding, treating, and even preventing anxiety and fear-related disorders offer great opportunities for successfully bridging neuroscience discovery to clinical practice.
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77
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Beitchman JA, Griffiths DR, Hur Y, Ogle SB, Bromberg CE, Morrison HW, Lifshitz J, Adelson PD, Thomas TC. Experimental Traumatic Brain Injury Induces Chronic Glutamatergic Dysfunction in Amygdala Circuitry Known to Regulate Anxiety-Like Behavior. Front Neurosci 2020; 13:1434. [PMID: 32038140 PMCID: PMC6985437 DOI: 10.3389/fnins.2019.01434] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 12/18/2019] [Indexed: 01/01/2023] Open
Abstract
Up to 50% of traumatic brain injury (TBI) survivors demonstrate persisting and late-onset anxiety disorders indicative of limbic system dysregulation, yet the pathophysiology underlying the symptoms is unclear. We hypothesize that the development of TBI-induced anxiety-like behavior in an experimental model of TBI is mediated by changes in glutamate neurotransmission within the amygdala. Adult, male Sprague-Dawley rats underwent midline fluid percussion injury or sham surgery. Anxiety-like behavior was assessed at 7 and 28 days post-injury (DPI) followed by assessment of real-time glutamate neurotransmission in the basolateral amygdala (BLA) and central nucleus of the amygdala (CeA) using glutamate-selective microelectrode arrays. The expression of anxiety-like behavior at 28 DPI coincided with decreased evoked glutamate release and slower glutamate clearance in the CeA, not BLA. Numerous factors contribute to the changes in glutamate neurotransmission over time. In two additional animal cohorts, protein levels of glutamatergic transporters (Glt-1 and GLAST) and presynaptic modulators of glutamate release (mGluR2, TrkB, BDNF, and glucocorticoid receptors) were quantified using automated capillary western techniques at 28 DPI. Astrocytosis and microglial activation have been shown to drive maladaptive glutamate signaling and were histologically assessed over 28 DPI. Alterations in glutamate neurotransmission could not be explained by changes in protein levels for glutamate transporters, mGluR2 receptors, astrocytosis, and microglial activation. Presynaptic modulators, BDNF and TrkB, were significantly decreased at 28 DPI in the amygdala. Dysfunction in presynaptic regulation of glutamate neurotransmission may contribute to anxiety-related behavior and serve as a therapeutic target to improve circuit function.
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Affiliation(s)
- Joshua A Beitchman
- Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, United States.,Department of Child Health, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, United States.,College of Graduate Studies, Midwestern University, Glendale, AZ, United States
| | - Daniel R Griffiths
- Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, United States.,Department of Child Health, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, United States
| | - Yerin Hur
- Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, United States.,Department of Child Health, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, United States
| | - Sarah B Ogle
- Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, United States.,Department of Child Health, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, United States.,Banner University Medical Center, Phoenix, AZ, United States
| | - Caitlin E Bromberg
- Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, United States.,Department of Child Health, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, United States
| | - Helena W Morrison
- College of Nursing, University of Arizona, Tucson, AZ, United States
| | - Jonathan Lifshitz
- Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, United States.,Department of Child Health, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, United States.,Phoenix VA Health Care System, Phoenix, AZ, United States
| | - P David Adelson
- Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, United States.,Department of Child Health, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, United States
| | - Theresa Currier Thomas
- Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, United States.,Department of Child Health, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, United States.,Phoenix VA Health Care System, Phoenix, AZ, United States
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78
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Amygdala Nuclei Volume and Shape in Military Veterans With Posttraumatic Stress Disorder. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2019; 5:281-290. [PMID: 32029420 DOI: 10.1016/j.bpsc.2019.11.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 11/22/2019] [Accepted: 11/22/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND The amygdala is a subcortical structure involved in socioemotional and associative fear learning processes relevant for understanding the mechanisms of posttraumatic stress disorder (PTSD). Research in animals indicates that the amygdala is a heterogeneous structure in which the basolateral and centromedial divisions are susceptible to stress. While the amygdala complex is implicated in the pathophysiology of PTSD, little is known about the specific contributions of the individual nuclei that constitute the amygdala complex. METHODS Military veterans (n = 355), including military veterans with PTSD (n = 149) and trauma-exposed control subjects without PTSD (n = 206), underwent high-resolution T1-weighted anatomical scans. Automated FreeSurfer segmentation of the amygdala yielded 9 structures: basal, lateral, accessory basal, anterior amygdaloid, and central, medial, cortical, and paralaminar nuclei, along with the corticoamygdaloid transition zone. Subregional volumes were compared between groups using ordinary-least-squares regression with relevant demographic and clinical regressors followed by 3-dimensional shape analysis of whole amygdala. RESULTS PTSD was associated with smaller left and right lateral and paralaminar nuclei, but with larger left and right central, medial, and cortical nuclei (p < .05, false discovery rate corrected). Shape analyses revealed lower radial distance in anterior bilateral amygdala and lower Jacobian determinant in posterior bilateral amygdala in PTSD compared with control subjects. CONCLUSIONS Alterations in select amygdala subnuclear volumes and regional shape distortions are associated with PTSD in military veterans. Volume differences of the lateral nucleus and the centromedial complex associated with PTSD demonstrate a subregion-specific pattern that is consistent with their functional roles in fear learning and fear expression behaviors.
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79
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McCurry KL, Frueh BC, Chiu PH, King-Casas B. Opponent Effects of Hyperarousal and Re-experiencing on Affective Habituation in Posttraumatic Stress Disorder. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2019; 5:203-212. [PMID: 31759868 DOI: 10.1016/j.bpsc.2019.09.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 09/06/2019] [Accepted: 09/09/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Aberrant emotion processing is a hallmark of posttraumatic stress disorder (PTSD), with neurobiological models suggesting both heightened neural reactivity and diminished habituation to aversive stimuli. However, empirical work suggests that these response patterns may be specific to subsets of those with PTSD. This study investigates the unique contributions of PTSD symptom clusters (re-experiencing, avoidance and numbing, and hyperarousal) to neural reactivity and habituation to negative stimuli in combat-exposed veterans. METHODS Ninety-five combat-exposed veterans (46 with PTSD) and 53 community volunteers underwent functional magnetic resonance imaging while viewing emotional images. This study examined the relationship between symptom cluster severity and hemodynamic responses to negative compared with neutral images (NEG>NEU). RESULTS Veterans exhibited comparable mean and habituation-related responses for NEG>NEU, relative to civilians. However, among veterans, habituation, but not mean response, was differentially related to PTSD symptom severity. Hyperarousal symptoms were related to decreased habituation for NEG>NEU in a network of regions, including superior and inferior frontal gyri, ventromedial prefrontal cortex, superior and middle temporal gyri, and anterior insula. In contrast, re-experiencing symptoms were associated with increased habituation in a similar network. Furthermore, re-experiencing severity was positively related to amygdalar functional connectivity with the left inferior frontal gyrus and dorsal anterior cingulate cortex for NEG>NEU. CONCLUSIONS These results indicate that hyperarousal symptoms in combat-related PTSD are associated with decreased neural habituation to aversive stimuli. These impairments are partially mitigated in the presence of re-experiencing symptoms, such that during exposure to negative stimuli, re-experiencing symptoms are positively associated with amygdalar connectivity to prefrontal regions implicated in affective suppression.
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Affiliation(s)
- Katherine L McCurry
- Salem Veterans Affairs Medical Center, Salem, Virginia; Fralin Biomedical Research Institute at Virginia Tech Carilion, Virginia Tech, Roanoke, Virginia; Department of Psychology, Virginia Tech, Blacksburg, Virginia
| | - B Christopher Frueh
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Virginia Tech, Roanoke, Virginia; Department of Psychology, University of Hawaii at Hilo, Hilo, Hawaii; Trauma and Resilience Center, Department of Psychiatry, University of Texas Health Sciences Center, Houston, Texas
| | - Pearl H Chiu
- Salem Veterans Affairs Medical Center, Salem, Virginia; Fralin Biomedical Research Institute at Virginia Tech Carilion, Virginia Tech, Roanoke, Virginia; Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia; Department of Psychology, Virginia Tech, Blacksburg, Virginia.
| | - Brooks King-Casas
- Salem Veterans Affairs Medical Center, Salem, Virginia; Fralin Biomedical Research Institute at Virginia Tech Carilion, Virginia Tech, Roanoke, Virginia; Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia; Department of Psychology, Virginia Tech, Blacksburg, Virginia; School of Biomedical Engineering and Sciences, Virginia Tech-Wake Forest University, Blacksburg, Virginia.
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80
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Fourie MM, Stein DJ, Solms M, Gobodo-Madikizela P, Decety J. Effects of early adversity and social discrimination on empathy for complex mental states: An fMRI investigation. Sci Rep 2019; 9:12959. [PMID: 31506497 PMCID: PMC6737126 DOI: 10.1038/s41598-019-49298-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 08/22/2019] [Indexed: 01/10/2023] Open
Abstract
There is extensive evidence of an association between early adversity and enduring neural changes that impact socioemotional processing throughout life. Yet little is known about the effects of on-going social discrimination on socioemotional functioning. Here we examined how cumulative experiences of social discrimination impact brain response during empathic responding—a crucial issue in South Africa, given its historical apartheid context and continuing legacies. White and Black South Africans completed measures of social adversity (early adversity and social discrimination), and underwent fMRI while viewing video clips depicting victims and perpetrators of apartheid crimes. Increased neural response was detected in brain regions associated with cognitive rather than affective empathy, and greater social adversity was associated with reduced reported compassion across participants. Notably, social discrimination (due to income level, weight, gender) in White participants was associated with increased amygdala reactivity, whereas social discrimination (due to race) in Black participants mediated the negative associations of temporoparietal junction and inferior frontal gyrus activation with compassion during emotionally provocative conditions. These findings suggest that (i) social discrimination has comparable associations at the neural level as other psychosocial stressors, and that (ii) the mechanisms underlying empathic responding vary as a function of the type of social discrimination experienced.
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Affiliation(s)
- Melike M Fourie
- Studies in Historical Trauma and Transformation, Stellenbosch University, Stellenbosch, South Africa.
| | - Dan J Stein
- Department of Psychiatry and MRC Unit on Risk & Resilience in Mental Disorders, University of Cape Town, Cape Town, South Africa
| | - Mark Solms
- Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - Pumla Gobodo-Madikizela
- Studies in Historical Trauma and Transformation, Stellenbosch University, Stellenbosch, South Africa
| | - Jean Decety
- Department of Psychology and Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, United States
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81
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Fani N, Michopoulos V, van Rooij SJ, Clendinen C, Hardy RA, Jovanovic T, Rothbaum BO, Ressler KJ, Stevens JS. Structural connectivity and risk for anhedonia after trauma: A prospective study and replication. J Psychiatr Res 2019; 116:34-41. [PMID: 31181391 PMCID: PMC7039326 DOI: 10.1016/j.jpsychires.2019.05.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 03/22/2019] [Accepted: 05/09/2019] [Indexed: 01/22/2023]
Abstract
Anhedonia emerges in some people after psychological trauma, reflected by a loss of interest, diminished affect, and detachment. Structural abnormalities in specific neural pathways at the time of trauma may influence the development of these posttraumatic anhedonia (PTA) symptoms. In this prospective study, we determined whether white matter connectivity at around one month post-trauma predicts PTA and other PTSD symptoms at six months post-trauma. Thirty men and women aged 19-62 were recruited from the emergency department of a Level I trauma center. Participants received diffusion tensor imaging at approximately one month post-trauma and clinical assessments at one and six months post-trauma. Probabilistic tractography was used to examine connectivity of select pathways. A replication sample (N = 57) in an independent, cross-sectional dataset of traumatized women was similarly analyzed. Logistic regression results indicated that, after accounting for early PTSD symptoms (at one month) and other clinical risk factors, the integrity of the uncinate fasciculus (UF) uniquely predicted the presence of PTA at six months post-trauma (Beta = -225.6, p < .05). Together, these factors contributed to 76% of the variance in PTA. Integrity of the UF also predicted re-experiencing PTSD symptoms at six months post-trauma. These results were supported in our replication analyses. Our findings indicate that the integrity of the UF around 1 month post-trauma affects vulnerability for the development of anhedonic PTSD symptoms as well as re-experiencing symptoms. Connectivity of this amygdala-ventromedial prefrontal pathway appears to be a salient predictor of anhedonia, above and beyond clinical risk factors.
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Affiliation(s)
- Negar Fani
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, USA.
| | - Vasiliki Michopoulos
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, USA,Yerkes National Primate Research Center, Atlanta, GA, USA
| | - Sanne J.H. van Rooij
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, USA
| | - Cherita Clendinen
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, USA
| | - Raven A. Hardy
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, USA
| | - Tanja Jovanovic
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, USA
| | - Barbara O. Rothbaum
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, USA
| | - Kerry J. Ressler
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, USA,McLean Hospital, Harvard Medical School, USA
| | - Jennifer S. Stevens
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, USA
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Sleep in posttraumatic stress disorder: A systematic review and meta-analysis of polysomnographic findings. Sleep Med Rev 2019; 48:101210. [PMID: 31518950 DOI: 10.1016/j.smrv.2019.08.004] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 07/22/2019] [Accepted: 08/16/2019] [Indexed: 02/05/2023]
Abstract
Polysomnographic studies have been performed to examine sleep abnormalities in posttraumatic stress disorder (PTSD), but clear associations between PTSD and sleep disturbances have not been established. A systematic review of the evidence examining the polysomnographic changes in PTSD patients compared with controls was conducted using MEDLINE, EMBASE, All EBM databases, PsycINFO, and CINAHL databases. Meta-analysis was undertaken where possible. The searches identified 34 studies, 31 of which were appropriate for meta-analysis. Pooled results indicated decreased total sleep time, slow wave sleep and sleep efficiency, and increased wake time after sleep onset in PTSD patients compared with healthy controls. PTSD severity was associated with decreased sleep efficiency and slow wave sleep percentage. Rapid eye movement (REM) sleep percentage was significantly decreased in PTSD patients compared with controls in studies including participants with mean age below 30 y, but not in studies with other mean age groups (30-40 y and >40 y). Our study shows that polysomnographic abnormalities are present in PTSD. Sex, age, PTSD severity, type of controls, medication status, adaptation night, polysomnographic scoring rules and study location are several of the demographic, clinical and methodological factors that contribute to heterogeneity between studies.
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83
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Ross CA, Margolis RL. Research Domain Criteria: Strengths, Weaknesses, and Potential Alternatives for Future Psychiatric Research. MOLECULAR NEUROPSYCHIATRY 2019; 5:218-236. [PMID: 31768375 DOI: 10.1159/000501797] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 06/27/2019] [Indexed: 01/07/2023]
Abstract
The Research Domain Criteria (RDoC) paradigm was launched 10 years ago as a superior approach for investigation of mental illness. RDoC conceptualizes normal human behavior, emotion, and cognition as dimensional, with mental illnesses as dimensional extremes. We suggest that RDoC may have value for understanding normal human psychology and some conditions plausibly construed as extremes of normal variation. By contrast, for the most serious of mental illnesses, including dementia, autism, schizophrenia, and bipolar disorder, we argue that RDoC is conceptually flawed. RDoC conflates variation along dimensional axes of normal function with quantitative measurements of disease phenotypes and with the occurrence of diseases in overlapping clusters or spectra. This moves away from the disease model of major mental illness. Further, RDoC imposes a top-down approach to research. We argue that progress in major mental illness research will be more rapid with a bottom-up approach, starting with the discovery of etiological factors, proceeding to investigation of pathogenic pathways, including use of cell and animal models, and leading to a refined nosology and novel, targeted treatments.
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Affiliation(s)
- Christopher A Ross
- Division of Neurobiology, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Pharmacology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Russell L Margolis
- Division of Neurobiology, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Program in Cellular and Molecular Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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84
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Klaming R, Spadoni AD, Veltman DJ, Simmons AN. Expansion of hippocampal and amygdala shape in posttraumatic stress and early life stress. NEUROIMAGE-CLINICAL 2019; 24:101982. [PMID: 31437724 PMCID: PMC6706650 DOI: 10.1016/j.nicl.2019.101982] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/09/2019] [Accepted: 08/12/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The aim of this study was to examine the effect of Posttraumatic Stress Disorder (PTSD) and childhood adversity on brain structure. We assessed hippocampal and amygdala shape in veterans with varying levels of PTSD symptom severity and exposure to early life stressors (ELS). METHODS A total of 70 male veterans, who were deployed to a combat area during OIF/OEF/OND and who had been exposed to trauma during deployment, were included in the study. We applied a vertex-wise shape analysis of 3T MRI scans to measure indentation or expansion in hippocampal and amygdala shape. RESULTS Analyses showed a positive correlation between number of ELS and vertices in the right amygdala and the right hippocampus, as well as a positive correlation between PTSD symptom severity and right hippocampal vertices. There were no significant interactions between PTSD symptoms, ELS, and brain shape. DISCUSSION Results indicate a relationship between exposure to more childhood adversity and expansion in amygdala and hippocampal shape as well as between more severe PTSD symptoms and expansion in hippocampal shape. These findings may have important implications for the pathophysiology of trauma-related disorders.
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Affiliation(s)
- Ruth Klaming
- VA San Diego Healthcare System, University of California San Diego, San Diego, CA, USA; Department of Psychiatry, University of California San Diego, San Diego, CA, USA; Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands.
| | - Andrea D Spadoni
- VA San Diego Healthcare System, University of California San Diego, San Diego, CA, USA; Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Dick J Veltman
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
| | - Alan N Simmons
- VA San Diego Healthcare System, University of California San Diego, San Diego, CA, USA; Department of Psychiatry, University of California San Diego, San Diego, CA, USA
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85
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Zhu J, Lowen SB, Anderson CM, Ohashi K, Khan A, Teicher MH. Association of Prepubertal and Postpubertal Exposure to Childhood Maltreatment With Adult Amygdala Function. JAMA Psychiatry 2019; 76:843-853. [PMID: 31241756 PMCID: PMC6596335 DOI: 10.1001/jamapsychiatry.2019.0931] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
IMPORTANCE Abnormalities in amygdala response to threatening faces have been observed in anxiety disorders, autism, bipolar disorder, depression, posttraumatic stress disorder, and schizophrenia. Abnormally hyperactive and hypoactive responses have typically been associated with anxiety and inhibition vs risk taking and inappropriate social behaviors. Maltreatment is a major risk factor for most of these disorders and is associated with abnormal amygdala function. OBJECTIVE To identify the type and age of exposure to childhood maltreatment that are associated with hyperactive and hypoactive amygdala responses in young adulthood. DESIGN, SETTING, AND PARTICIPANTS Data collection for this retrospective cohort study took place from November 8, 2010, to August 23, 2012. Data analyses were conducted from September 20, 2012, to June 27, 2018. Participants were recruited from the urban and suburban Boston vicinity without diagnostic restrictions based on exposure history. EXPOSURES The Maltreatment and Abuse Chronology of Exposure (MACE) scale was used to retrospectively assess type and age of exposure to childhood maltreatment. MAIN OUTCOMES AND MEASURES Activation and pattern information functional magnetic resonance imaging were used to assess bilateral amygdala response to angry and fearful faces vs neutral faces or shapes, and sensitive exposure periods were identified using cross-validated artificial intelligence predictive analytics (50 averaged randomized iterations with training on 63.3% and testing on 36.7% of the sample). RESULTS Of the 202 participants (mean [SD] age, 23.2 [1.7] years; 118 [58.4%] female), 52 (25.7%) reported no exposure to maltreatment and 150 (74.3%) reported exposure to 1 or more maltreatment types. Eight participants (15.1%) with a MACE score of 0 and 51 (34.2%) with a MACE score of 1 or higher had a history of major depression (odds ratio, 2.40; 95% CI, 1.05-6.06; P = .03); 8 unexposed participants (15.1%) and 46 with MACE scores of 1 or higher (30.9%) had a history of 1 or more anxiety disorders (odds ratio, 2.45; 95% CI, 1.03-6.50; P = .03). Retrospective self-report of physical maltreatment between 3 and 6 years of age and peer emotional abuse at 13 and 15 years were associated with amygdala activation to emotional faces vs shapes. Early exposure was associated with blunted response (β = -0.17, P < .001), whereas later exposure was associated with augmented response (β = 0.16, P < .001). Prepubertal vs postpubertal maltreatment was associated with an opposite response on the voxelwise response pattern in clustering stimuli of the same type (eg, mean [SD] emotional ellipse areas for physical maltreatment at age 4 years vs nonverbal emotional abuse at 13 years: 1.41 [1.05] vs 0.25 [0.10], P < .001) and in distinguishing between stimuli of different types (eg, mean [SD] emotional vs neutral faces distance for peer emotional abuse at age 6 years vs 13 years: 1.89 [0.75] vs 0.80 [0.39], P < .001). CONCLUSIONS AND RELEVANCE The findings suggest that prepubertal vs postpubertal developmental differences in the association between maltreatment and amygdala response to threatening or salient stimuli exist. Understanding the role of adversity in different sensitive exposure periods and the potential adaptive significance of attenuated vs enhanced amygdala response may help explain why maltreatment may be a risk factor for many different disorders and foster creation of targeted interventions to preempt the emergence of psychopathology in at-risk youths.
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Affiliation(s)
- Jianjun Zhu
- School of Psychology, South China Normal University, Guangzhou, China,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts,Developmental Biopsychiatry Research Program, McLean Hospital, Belmont, Massachusetts
| | - Steven B. Lowen
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts,Brain Imaging Center, McLean Hospital, Belmont, Massachusetts,Equian, Woburn, Massachusetts
| | - Carl M. Anderson
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts,Developmental Biopsychiatry Research Program, McLean Hospital, Belmont, Massachusetts,Brain Imaging Center, McLean Hospital, Belmont, Massachusetts
| | - Kyoko Ohashi
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts,Developmental Biopsychiatry Research Program, McLean Hospital, Belmont, Massachusetts
| | - Alaptigin Khan
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts,Developmental Biopsychiatry Research Program, McLean Hospital, Belmont, Massachusetts
| | - Martin H. Teicher
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts,Developmental Biopsychiatry Research Program, McLean Hospital, Belmont, Massachusetts
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86
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Kim YJ, van Rooij SJ, Ely TD, Fani N, Ressler KJ, Jovanovic T, Stevens JS. Association between posttraumatic stress disorder severity and amygdala habituation to fearful stimuli. Depress Anxiety 2019; 36:647-658. [PMID: 31260599 PMCID: PMC6943827 DOI: 10.1002/da.22928] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 05/01/2019] [Accepted: 05/11/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Amygdala hyperreactivity to threat has been proposed to be a causal contributor to posttraumatic stress disorder (PTSD). However, emerging literature in healthy samples shows higher test-retest reliability for amygdala habituation (the change over time in response to repeated stimuli) than for its reactivity to threat. Amygdala habituation has received relatively little attention in relationship to PTSD, despite the key role of this region in the etiology of the disorder. Thus, we investigated habituation to repeated fearful face stimuli and PTSD, in a large sample of trauma exposed African American women. METHODS African American women (N = 100) were recruited from a nonprofit hospital serving a largely low-income population with a high risk of trauma exposure. Participants underwent functional magnetic resonance imaging, passively viewing fearful and neutral face stimuli, and reported their history of trauma exposure and current PTSD symptoms. We examined associations between PTSD symptom severity and amygdala reactivity (fearful > neutral) and habituation (early > late) to fearful faces. Secondary analyses tested whether amygdala habituation to fearful faces mediated the association between childhood trauma and PTSD. RESULTS PTSD symptom severity and PTSD status (based on self-report measure) were both positively associated with amygdala habituation to repeated fearful face stimuli. Whole-brain analysis showed that this association extended to the bilateral hippocampus and left fusiform gyrus. The association held when controlling for trauma history and depressive symptoms. Amygdala habituation to fearful faces partially mediated the association between childhood trauma severity and PTSD symptom severity. CONCLUSION Individuals with greater PTSD symptom severity showed greater amygdala habituation to social threat cues (fearful faces), and greater habituation may partly explain the association between childhood trauma exposure and current PTSD symptoms. Further examination of the dynamics of the amygdala response to threat cues may lead to new insights in the understanding and treatment of stress-related disorders.
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Affiliation(s)
- Ye Ji Kim
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Sanne J.H. van Rooij
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Timothy D. Ely
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Negar Fani
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Kerry J. Ressler
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts,Division of Depression & Anxiety Disorders, McLean Hospital, Belmont, Massachusetts
| | - Tanja Jovanovic
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Jennifer S. Stevens
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
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87
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Jabbi M, Nemeroff CB. Convergent neurobiological predictors of mood and anxiety symptoms and treatment response. Expert Rev Neurother 2019; 19:587-597. [PMID: 31096806 DOI: 10.1080/14737175.2019.1620604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Introduction: Mood and anxiety disorders are leading contributors to the global burden of diseases. Comorbid mood and anxiety disorders have a lifetime prevalence of ~20% globally and increases the risk for suicide, a leading cause of death. Areas covered: In this review, authors highlight recent advances in the understanding of multilevel-neurobiological mechanisms for normal/pathological human affective-functioning. The authors then address the complex interplay between environmental-adversity and molecular-genetic mediators of brain correlates of affective-symptoms. The molecular focus is strategically limited to GTF2i, BDNF, and FKBP5 genes that are, respectively, involved in transcriptional-, neurodevelopmental- and neuroendocrine-pathway mediation of affective-functions. The importance of these genes is illustrated with studies of copy-number-variants, genome-wide association (GWAS), and candidate gene-sequence variant associations with disease etiology. Authors concluded by highlighting the predictive values of integrative neurobiological processing of gene-environment interactions for affective disorder symptom management. Expert opinion: Given the transcriptional, neurodevelopmental and neuroimmune relevance of GTF2i, BDNF, and FKBP5 genes, respectively, authors reviewed the putative roles of these genes in neurobiological mediation of adaptive affective-responses. Authors discussed the importance of studying gene-dosage effects in understanding affective disorder risk biology, and how such targeted neurogenetic studies could guide precision identification of novel pharmacotherapeutic targets and aid in prediction of treatment response.
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Affiliation(s)
- Mbemba Jabbi
- a Department of Psychiatry , Dell Medical School, University of Texas at Austin , Austin , TX , USA.,b Mulva Neuroscience Institute, Dell Medical School , University of Texas at Austin , Austin , TX , USA.,c Institute of Neuroscience , University of Texas at Austin , Austin , TX , USA.,d Department of Psychology , University of Texas at Austin , Austin , TX , USA
| | - Charles B Nemeroff
- a Department of Psychiatry , Dell Medical School, University of Texas at Austin , Austin , TX , USA.,b Mulva Neuroscience Institute, Dell Medical School , University of Texas at Austin , Austin , TX , USA.,e Institute for Early Life Adversity , Dell Medical School, University of Texas at Austin , Austin , TX , USA
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88
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Kryza-Lacombe M, Brotman MA, Reynolds RC, Towbin K, Pine DS, Leibenluft E, Wiggins JL. Neural mechanisms of face emotion processing in youths and adults with bipolar disorder. Bipolar Disord 2019; 21:309-320. [PMID: 30851221 PMCID: PMC6597279 DOI: 10.1111/bdi.12768] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Little is known about potential differences in the pathophysiology of bipolar disorder (BD) across development. The present study aimed to characterize age-related neural mechanisms of BD. METHODS Youths and adults with and without BD (N = 108, age range = 9.8-55.9 years) completed an emotional face labeling task during fMRI acquisition. We leveraged three different fMRI analytic tools to identify age-related neural mechanisms of BD, investigating (a) change in neural responses over the course of the task, (b) neural activation averaged across the entire task, and (c) amygdala functional connectivity. RESULTS We found converging Age Group × Diagnosis patterns across all three analytic methods. Compared to healthy youths vs adults, youths vs adults with BD show an altered pattern in response to repeated presentation of emotional faces in medial prefrontal, amygdala, and temporoparietal regions, as well as amygdala-temporoparietal connectivity. Specifically, medial prefrontal and lingual activation decreases over the course of repeated emotional face presentations in healthy youths vs adults but increases in youths with BD compared to adults with BD. Moreover, youths vs adults with BD show less medial prefrontal activation and amygdala-temporoparietal junction connectivity averaged over the task, but this difference is not found for healthy youths vs adults. CONCLUSION Although longitudinal confirmation and replication will be necessary, these findings suggest that neural development may be aberrant in BD and that some neural mechanisms mediating BD may differ in adults vs children with the illness.
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Affiliation(s)
- Maria Kryza-Lacombe
- San Diego State University/University of California, San
Diego Joint Doctoral Program in Clinical Psychology
| | - Melissa A. Brotman
- Emotion Development Branch, National Institute of Mental
Health, National Institutes of Health
| | - Richard C. Reynolds
- Scientific and Statistical Computing Core, National
Institute of Mental Health, National Institutes of Health
| | - Kenneth Towbin
- Emotion Development Branch, National Institute of Mental
Health, National Institutes of Health
| | - Daniel S. Pine
- Emotion Development Branch, National Institute of Mental
Health, National Institutes of Health
| | - Ellen Leibenluft
- Emotion Development Branch, National Institute of Mental
Health, National Institutes of Health
| | - Jillian Lee Wiggins
- San Diego State University/University of California, San
Diego Joint Doctoral Program in Clinical Psychology,Department of Psychology, San Diego State University
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89
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Risbrough VB, Glynn LM, Davis EP, Sandman CA, Obenaus A, Stern HS, Keator DB, Yassa MA, Baram TZ, Baker DG. Does Anhedonia Presage Increased Risk of Posttraumatic Stress Disorder? : Adolescent Anhedonia and Posttraumatic Disorders. Curr Top Behav Neurosci 2019; 38:249-265. [PMID: 29796839 PMCID: PMC9167566 DOI: 10.1007/7854_2018_51] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Anhedonia, the reduced ability to experience pleasure, is a dimensional entity linked to multiple neuropsychiatric disorders, where it is associated with diminished treatment response, reduced global function, and increased suicidality. It has been suggested that anhedonia and the related disruption in reward processing may be critical precursors to development of psychiatric symptoms later in life. Here, we examine cross-species evidence supporting the hypothesis that early life experiences modulate development of reward processing, which if disrupted, result in anhedonia. Importantly, we find that anhedonia may confer risk for later neuropsychiatric disorders, especially posttraumatic stress disorder (PTSD). Whereas childhood trauma has long been associated with increased anhedonia and increased subsequent risk for trauma-related disorders in adulthood, here we focus on an additional novel, emerging direct contributor to anhedonia in rodents and humans: fragmented, chaotic environmental signals ("FRAG") during critical periods of development. In rodents, recent data suggest that adolescent anhedonia may derive from aberrant pleasure/reward circuit maturation. In humans, recent longitudinal studies support that FRAG is associated with increased anhedonia in adolescence. Both human and rodent FRAG exposure also leads to aberrant hippocampal function. Prospective studies are underway to examine if anhedonia is also a marker of PTSD risk. These preliminary cross-species studies provide a critical construct for future examination of the etiology of trauma-related symptoms in adults and for and development of prophylactic and therapeutic interventions. In addition, longitudinal studies of reward circuit development with and without FRAG will be critical to test the mechanistic hypothesis that early life FRAG modifies reward circuitry with subsequent consequences for adolescent-emergent anhedonia and contributes to risk and resilience to trauma and stress in adulthood.
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Affiliation(s)
- Victoria B Risbrough
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.
- Center of Excellence for Stress and Mental Health, San Diego Veterans Administration, La Jolla, CA, USA.
| | - Laura M Glynn
- Department of Psychology, Chapman University, Orange, CA, USA
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA, USA
| | - Elysia P Davis
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA, USA
- Department of Psychology, University of Denver, Denver, CO, USA
| | - Curt A Sandman
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA, USA
| | - Andre Obenaus
- Department of Pediatrics, University of California, Irvine, CA, USA
| | - Hal S Stern
- Department of Statistics, University of California, Irvine, CA, USA
| | - David B Keator
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA, USA
- Department of Computer Science, University of California, Irvine, CA, USA
- Department of Neurology, University of California, Irvine, CA, USA
| | - Michael A Yassa
- Department of Neurobiology and Behavior, University of California, Irvine, CA, USA
- Center for the Neurobiology of Learning and Memory, University of California, Irvine, CA, USA
| | - Tallie Z Baram
- Department of Pediatrics, University of California, Irvine, CA, USA
- Department of Neurology, University of California, Irvine, CA, USA
- Department of Anatomy/Neurobiology, University of California, Irvine, CA, USA
| | - Dewleen G Baker
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Center of Excellence for Stress and Mental Health, San Diego Veterans Administration, La Jolla, CA, USA
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90
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Hur J, Stockbridge MD, Fox AS, Shackman AJ. Dispositional negativity, cognition, and anxiety disorders: An integrative translational neuroscience framework. PROGRESS IN BRAIN RESEARCH 2019; 247:375-436. [PMID: 31196442 PMCID: PMC6578598 DOI: 10.1016/bs.pbr.2019.03.012] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
When extreme, anxiety can become debilitating. Anxiety disorders, which often first emerge early in development, are common and challenging to treat, yet the underlying mechanisms have only recently begun to come into focus. Here, we review new insights into the nature and biological bases of dispositional negativity, a fundamental dimension of childhood temperament and adult personality and a prominent risk factor for the development of pediatric and adult anxiety disorders. Converging lines of epidemiological, neurobiological, and mechanistic evidence suggest that dispositional negativity increases the likelihood of psychopathology via specific neurocognitive mechanisms, including attentional biases to threat and deficits in executive control. Collectively, these observations provide an integrative translational framework for understanding the development and maintenance of anxiety disorders in adults and youth and set the stage for developing improved intervention strategies.
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Affiliation(s)
- Juyoen Hur
- Department of Psychology, University of Maryland, College Park, MD, United States.
| | | | - Andrew S Fox
- Department of Psychology, University of California, Davis, CA, United States; California National Primate Research Center, University of California, Davis, CA, United States
| | - Alexander J Shackman
- Department of Psychology, University of Maryland, College Park, MD, United States; Neuroscience and Cognitive Science Program, University of Maryland, College Park, MD, United States; Maryland Neuroimaging Center, University of Maryland, College Park, MD, United States.
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91
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Abstract
The processing and regulation of fear is one of the key components of posttraumatic stress disorder (PTSD). Fear can involve both acute and potential threats that can manifest in different behaviors and result from activity within different neural nodes and networks. Fear circuits have been studied extensively in animal models for several decades and in human neuroimaging research for almost 20 years. Therefore, the centrality of fear processing to PTSD lends the disorder to be more tractable to investigation at the level of brain and behavior, and provides several observable phenotypes that can be linked to PTSD symptoms. Moreover, psychophysiological metrics of fear conditioning offer tools that can be used to shift diagnostic paradigms in psychiatry toward neurobiology-consistent with a Research Domain Criteria approach to PTSD. In general, mammalian fear processing can be divided into fear learning (or acquisition), during which an association develops between previously neutral stimuli and aversive outcomes, and fear extinction, in which the latter associations are suppressed by a new form of learning. This review describes translational research in both fear acquisition and extinction, along with their relevance to PTSD and PTSD treatment, focusing specifically on the empirical value and potential clinical utility of psychophysiological methods.
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92
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van Rooij SJH, Jovanovic T. Impaired inhibition as an intermediate phenotype for PTSD risk and treatment response. Prog Neuropsychopharmacol Biol Psychiatry 2019; 89:435-445. [PMID: 30381236 PMCID: PMC6349256 DOI: 10.1016/j.pnpbp.2018.10.014] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 10/24/2018] [Accepted: 10/24/2018] [Indexed: 12/31/2022]
Abstract
Inhibition of fear involves learning and then appropriately responding to safety signals, and has been shown to be impaired in PTSD patients. Response inhibition refers to cognitive control and likely uses the same prefrontal cortex circuits as fear inhibition, and has also been implicated in PTSD. Impaired inhibition can serve as an intermediate phenotype for PTSD and can be measured with neuroimaging and psychophysiological tools. We first review the neurobiological mechanisms of fear and response inhibition. Next, we summarize the functional magnetic resonance imaging (fMRI) and psychophysiological studies using fear and response inhibition paradigms in PTSD patients. Finally, we evaluate the theranostic role of impaired inhibition in PTSD risk and treatment response.
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Affiliation(s)
- Sanne J H van Rooij
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 49 Jesse Hill Jr Dr, Atlanta, GA, USA
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 49 Jesse Hill Jr Dr, Atlanta, GA, USA; Department of Psychiatry and Behavioral Neuroscience, Wayne State University, USA.
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93
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Fox AS, Shackman AJ. The central extended amygdala in fear and anxiety: Closing the gap between mechanistic and neuroimaging research. Neurosci Lett 2019; 693:58-67. [PMID: 29195911 PMCID: PMC5976525 DOI: 10.1016/j.neulet.2017.11.056] [Citation(s) in RCA: 120] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 09/30/2017] [Accepted: 11/26/2017] [Indexed: 12/19/2022]
Abstract
Anxiety disorders impose a staggering burden on public health, underscoring the need to develop a deeper understanding of the distributed neural circuits underlying extreme fear and anxiety. Recent work highlights the importance of the central extended amygdala, including the central nucleus of the amygdala (Ce) and neighboring bed nucleus of the stria terminalis (BST). Anatomical data indicate that the Ce and BST form a tightly interconnected unit, where different kinds of threat-relevant information can be integrated to assemble states of fear and anxiety. Neuroimaging studies show that the Ce and BST are engaged by a broad spectrum of potentially threat-relevant cues. Mechanistic work demonstrates that the Ce and BST are critically involved in organizing defensive responses to a wide range of threats. Studies in rodents have begun to reveal the specific molecules, cells, and microcircuits within the central extended amygdala that underlie signs of fear and anxiety, but the relevance of these tantalizing discoveries to human experience and disease remains unclear. Using a combination of focal perturbations and whole-brain imaging, a new generation of nonhuman primate studies is beginning to close this gap. This work opens the door to discovering the mechanisms underlying neuroimaging measures linked to pathological fear and anxiety, to understanding how the Ce and BST interact with one another and with distal brain regions to govern defensive responses to threat, and to developing improved intervention strategies.
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Affiliation(s)
- Andrew S Fox
- Department of Psychology and University of California, Davis, CA 95616, United States; California National Primate Research Center, University of California, Davis, CA 95616, United States.
| | - Alexander J Shackman
- Department of Psychology, University of Maryland, College Park, MD 20742, United States; Neuroscience and Cognitive Science Program, University of Maryland, College Park, MD 20742, United States; Maryland Neuroimaging Center, University of Maryland,College Park, MD 20742, United States.
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94
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Harnett NG, Ference EW, Wood KH, Wheelock MD, Knight AJ, Knight DC. Trauma exposure acutely alters neural function during Pavlovian fear conditioning. Cortex 2018; 109:1-13. [PMID: 30265859 PMCID: PMC6261786 DOI: 10.1016/j.cortex.2018.08.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 06/29/2018] [Accepted: 08/22/2018] [Indexed: 12/30/2022]
Abstract
Posttraumatic stress disorder (PTSD) is associated with dysfunction of the neural circuitry that supports fear learning and memory processes. However, much of what is known about neural dysfunction in PTSD is based on research in chronic PTSD populations. Less is known about neural function that supports fear learning acutely following trauma exposure. Determining the acute effects of trauma exposure on brain function would provide new insight into the neural processes that mediate the cognitive-affective dysfunction associated with PTSD. Therefore, the present study investigated neural activity that supports fear learning and memory processes in recently Trauma-Exposed (TE) and Non-Trauma-Exposed (NTE) participants. Participants completed a Pavlovian fear conditioning procedure during functional magnetic resonance imaging (fMRI). During fMRI, participants' threat expectancy was continuously monitored. NTE participants showed greater threat expectancy during warning than safety cues, while no difference was observed in the TE group. This finding suggests TE participants overgeneralized the fear association to the safety cue. Further, only the TE group showed a negative relationship between fMRI signal responses within dorsomedial prefrontal cortex (PFC) and threat expectancy during safety cues. These results suggest the dorsomedial PFC mediates overgeneralization of learned fear as an acute result of trauma exposure. Finally, neural activity within the PFC and inferior parietal lobule showed a negative relationship with PTSD symptom severity assessed three months posttrauma. Thus, neural activity measured acutely following trauma exposure predicted future PTSD symptom severity. The present findings elucidate the acute effects of trauma exposure on cognitive-affective function and provide new insight into the neural mechanisms of PTSD.
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Affiliation(s)
- Nathaniel G Harnett
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Edward W Ference
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kimberly H Wood
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Muriah D Wheelock
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Amy J Knight
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, USA
| | - David C Knight
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA.
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95
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Abstract
PURPOSE OF REVIEW The aim of this review is to provide a summary of the current evidence pertaining to the course of acute and chronic posttraumatic stress, the diagnosis of acute stress disorder (ASD), and treatment of acute stress disorder and prevention of posttraumatic stress disorder (PTSD). RECENT FINDINGS Although acute stress disorder was introduced partly to predict subsequent PTSD, longitudinal studies indicate that ASD is not an accurate predictor of PTSD. Recent analytic approaches adopting latent growth mixture modeling have shown that trauma-exposed people tend to follow one of four trajectories: (a) resilient, (b) worsening, (c) recovery, and (d) chronically distressed. The complexity of the course of posttraumatic stress limits the capacity of the ASD diagnosis to predict subsequent PTSD. Current evidence indicates that the treatment of choice for ASD is trauma-focused cognitive behavior therapy, and this intervention results in reduced chronic PTSD severity. Recent attempts to limit subsequent PTSD by early provision of pharmacological interventions have been promising, especially administration of corticosterone to modulate glucocorticoid levels. Although the ASD diagnosis does not accurately predict chronic PTSD, it describes recently trauma-exposed people with severe distress. Provision of CBT in the acute phase is the best available strategy to limit subsequent PTSD.
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Affiliation(s)
- Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, 2052, Australia.
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96
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Stevens JS, Jovanovic T. Role of social cognition in post-traumatic stress disorder: A review and meta-analysis. GENES BRAIN AND BEHAVIOR 2018; 18:e12518. [PMID: 30221467 DOI: 10.1111/gbb.12518] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 09/11/2018] [Indexed: 12/31/2022]
Abstract
Social functioning is a key component of recovery after a potentially traumatic experience, and the buffering role of the social support in trauma resilience and recovery has been very well documented. Factors contributing to resilience and recovery are notable because although most people will experience a traumatic event during their lifetimes, only 6% to 10% are diagnosed with post-traumatic stress disorder (PTSD). The relationship between an individual and their social environment is determined both by the quality of the social environment itself, and by the individual's perception and understanding of information conveyed by the other people around them. However, little research has considered the contribution of these internal social cognitive processes to PTSD risk or resilience. The current review draws on the existing literature on social cognitive functioning in trauma exposure and PTSD, identifying key questions and themes for future research. We utilized a meta-analytic approach to assess the evidence for alterations in social cognition in PTSD, finding a consistent large deficit in social cognitive performance in PTSD groups relative to trauma-exposed and healthy controls. We then reviewed the literature on the interaction of genes and the social environment, supporting the hypothesis that social cognitive deficits are a preexisting risk factor for PTSD. Finally, we reviewed relevant neuroimaging findings, which suggest that alterations in social cognition affect the perception of threat cues in PTSD. Overall, research on social cognition and PTSD is still emerging, but existing findings suggest this is an important and understudied area for the understanding of PTSD.
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Affiliation(s)
- Jennifer S Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
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97
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Stout DM, Buchsbaum MS, Spadoni AD, Risbrough VB, Strigo IA, Matthews SC, Simmons AN. Multimodal canonical correlation reveals converging neural circuitry across trauma-related disorders of affect and cognition. Neurobiol Stress 2018; 9:241-250. [PMID: 30450388 PMCID: PMC6234282 DOI: 10.1016/j.ynstr.2018.09.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 07/02/2018] [Accepted: 09/14/2018] [Indexed: 11/30/2022] Open
Abstract
Trauma-related disorders of affect and cognition (TRACs) are associated with a high degree of diagnostic comorbidity, which may suggest that these disorders share a set of underlying neural mechanisms. TRACs are characterized by aberrations in functional and structural circuits subserving verbal memory and affective anticipation. Yet, it remains unknown how the neural circuitry underlying these multiple mechanisms contribute to TRACs. Here, in a sample of 47 combat Veterans, we measured affective anticipation using functional magnetic resonance imaging (fMRI), verbal memory with fluorodeoxyglucose positron emission tomography (FDG-PET), and grey matter volume with structural magnetic resonance imaging (sMRI). Using a voxel-based multimodal canonical correlation analysis (mCCA), the set of neural measures were statistically integrated, or fused, with a set of TRAC symptom measures including mild traumatic brain injury (mTBI), posttraumatic stress, and depression severity. The first canonical correlation pair revealed neural convergence in clusters encompassing the middle frontal gyrus and supplemental motor area, regions implicated in top-down cognitive control and affect regulation. These results highlight the potential of leveraging multivariate neuroimaging analysis for linking neurobiological mechanisms associated with TRACs, paving the way for transdiagnostic biomarkers and targets for treatment.
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Affiliation(s)
- Daniel M Stout
- Center of Excellence in Stress and Mental Health, San Diego VA Health Care System, USA.,Department of Psychiatry, University of California, San Diego, USA
| | - Monte S Buchsbaum
- Department of Psychiatry, University of California, San Diego, USA.,Department of Radiology, University of California, San Diego, USA
| | - Andrea D Spadoni
- Center of Excellence in Stress and Mental Health, San Diego VA Health Care System, USA.,Department of Psychiatry, University of California, San Diego, USA
| | - Victoria B Risbrough
- Center of Excellence in Stress and Mental Health, San Diego VA Health Care System, USA.,Department of Psychiatry, University of California, San Diego, USA
| | - Irina A Strigo
- Department of Psychiatry, University of California, San Francisco, & San Francisco VA Health Care System, USA
| | - Scott C Matthews
- Center of Excellence in Stress and Mental Health, San Diego VA Health Care System, USA.,Department of Psychiatry, University of California, San Diego, USA
| | - Alan N Simmons
- Center of Excellence in Stress and Mental Health, San Diego VA Health Care System, USA.,Department of Psychiatry, University of California, San Diego, USA
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98
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Young DA, Chao L, Neylan TC, O'Donovan A, Metzler TJ, Inslicht SS. Association among anterior cingulate cortex volume, psychophysiological response, and PTSD diagnosis in a Veteran sample. Neurobiol Learn Mem 2018; 155:189-196. [PMID: 30086395 DOI: 10.1016/j.nlm.2018.08.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 07/11/2018] [Accepted: 08/03/2018] [Indexed: 11/30/2022]
Abstract
Posttraumatic stress disorder (PTSD) is associated with fear response system dysregulation. Research has shown that the anterior cingulate cortex (ACC) may modulate the fear response and that individuals with PTSD have abnormalities in ACC structure and functioning. Our objective was to assess whether ACC volume moderates the relationship between PTSD and fear-potentiated psychophysiological response in a sample of Gulf War Veterans. 142 Veteran participants who were associated with a larger study associated with Gulf War Illness were exposed to no threat, ambiguous threat, and high threat conditions in a fear conditioned startle response paradigm and also provided MRI imaging data. PTSD was assessed using the Clinician Administered PTSD Scale (CAPS). Decreased caudal ACC volume predicted greater psychophysiological responses with a slower habituation of psychophysiological magnitudes across trials (p < 0.001). PTSD diagnosis interacted significantly with both caudal and rostral ACC volumes on psychophysiological response magnitudes, where participants with PTSD and smaller rostral and caudal ACC volumes had greater psychophysiological magnitudes across trials (p < 0.05 and p < 0.001, respectively) and threat conditions (p < 0.05 and p < 0.005). Our results suggest that ACC volume may moderate both threat sensitivity and threat response via impaired habituation in individuals who have been exposed to traumatic events. More research is needed to assess whether ACC size and these associated response patterns are due to neurological processes resulting from trauma exposure or if they are indicative of a premorbid risk for PTSD subsequent to trauma exposure.
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Affiliation(s)
- Dmitri A Young
- San Francisco VA Health Care System, 4150 Clement St. (116P), San Francisco, CA 94121, United States; Northern California Institute for Research and Education (NCIRE), The Veterans Health Research Institute, San Francisco, CA 94121, United States; Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA 94143, United States.
| | - Linda Chao
- San Francisco VA Health Care System, 4150 Clement St. (116P), San Francisco, CA 94121, United States; Northern California Institute for Research and Education (NCIRE), The Veterans Health Research Institute, San Francisco, CA 94121, United States; Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA 94143, United States; Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA 94143, United States
| | - Thomas C Neylan
- San Francisco VA Health Care System, 4150 Clement St. (116P), San Francisco, CA 94121, United States; Northern California Institute for Research and Education (NCIRE), The Veterans Health Research Institute, San Francisco, CA 94121, United States; Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA 94143, United States
| | - Aoife O'Donovan
- San Francisco VA Health Care System, 4150 Clement St. (116P), San Francisco, CA 94121, United States; Northern California Institute for Research and Education (NCIRE), The Veterans Health Research Institute, San Francisco, CA 94121, United States; Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA 94143, United States
| | - Thomas J Metzler
- San Francisco VA Health Care System, 4150 Clement St. (116P), San Francisco, CA 94121, United States; Northern California Institute for Research and Education (NCIRE), The Veterans Health Research Institute, San Francisco, CA 94121, United States; Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA 94143, United States
| | - Sabra S Inslicht
- San Francisco VA Health Care System, 4150 Clement St. (116P), San Francisco, CA 94121, United States; Northern California Institute for Research and Education (NCIRE), The Veterans Health Research Institute, San Francisco, CA 94121, United States; Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA 94143, United States
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99
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van Rooij SJH, Stevens JS, Ely TD, Hinrichs R, Michopoulos V, Winters SJ, Ogbonmwan YE, Shin J, Nugent NR, Hudak LA, Rothbaum BO, Ressler KJ, Jovanovic T. The Role of the Hippocampus in Predicting Future Posttraumatic Stress Disorder Symptoms in Recently Traumatized Civilians. Biol Psychiatry 2018; 84:106-115. [PMID: 29110899 PMCID: PMC5860925 DOI: 10.1016/j.biopsych.2017.09.005] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 09/01/2017] [Accepted: 09/05/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Understanding the neurobiological mechanisms that predict posttraumatic stress disorder (PTSD) in recent trauma survivors is important for early interventions. Impaired inhibition of fear or behavioral responses is thought to be central to PTSD symptomatology, but its role in predicting PTSD is unknown. Here we examine whether brain function during response inhibition early after a civilian trauma can predict future PTSD symptoms. METHODS Participants (original sample, n = 27; replication sample, n = 31) were recruited in the emergency department within 24 hours of trauma exposure. PTSD symptoms were assessed in the emergency department and 1, 3, and 6 months posttrauma. A Go/NoGo procedure in a 3T magnetic resonance imaging scanner was used to measure neural correlates of response inhibition 1 to 2 months posttrauma. Elastic net regression was used to define the most optimal model to predict PTSD symptoms at 3 and 6 months among demographic, clinical, and imaging measures. RESULTS Less hippocampal activation was a significant predictor in the model predicting PTSD symptoms at 3 months (F11,22 = 4.33, p = .01) and 6 months (F9,19 = 4.96, p = .01). Other significant predictors in the model were race and pain level in the emergency department (3 months), and race and baseline depression symptoms (6 months). Using these predictors in a linear regression in the replication sample again resulted in significant models (3 months [F3,23 = 3.03, p = .05], 6 months [F3,20 = 5.74, p = .007]) with hippocampal activation predicting PTSD symptoms at 3 and 6 months. CONCLUSIONS Decreased inhibition-related hippocampal activation soon after trauma predicted future PTSD symptom severity. This finding may contribute to early identification of at-risk individuals and reveals potential targets for intervention or symptom prevention in the aftermath of trauma.
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Affiliation(s)
- Sanne J H van Rooij
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia.
| | - Jennifer S Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Timothy D Ely
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Rebecca Hinrichs
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Vasiliki Michopoulos
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Sterling J Winters
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Yvonne E Ogbonmwan
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Jaemin Shin
- Center for Advanced Brain Imaging, Georgia Institute of Technology, Atlanta, Georgia
| | - Nicole R Nugent
- Division of Behavioral Genetics, Department of Psychiatry, Rhode Island Hospital, Providence, Rhode Island; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Lauren A Hudak
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Barbara O Rothbaum
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Kerry J Ressler
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia; McLean Hospital, Department of Psychiatry, Harvard Medical School, Belmont, Massachusetts
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
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100
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King AP. Identification of Human Hippocampal Circuitry Involved in Risk and Resilience to Posttraumatic Stress Disorder Following Trauma Exposure. Biol Psychiatry 2018; 84:e13-e15. [PMID: 31178064 DOI: 10.1016/j.biopsych.2018.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 05/17/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Anthony P King
- Department of Psychiatry, Trauma, Stress, and Anxiety Research Program, University of Michigan Medical School, Ann Arbor, Michigan.
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