151
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Selemon LD, Young KA, Cruz DA, Williamson DE. Frontal Lobe Circuitry in Posttraumatic Stress Disorder. CHRONIC STRESS (THOUSAND OAKS, CALIF.) 2019; 3:2470547019850166. [PMID: 31435577 PMCID: PMC6703563 DOI: 10.1177/2470547019850166] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 04/23/2019] [Indexed: 12/31/2022]
Abstract
Symptoms of posttraumatic stress disorder include hyperarousal, avoidance of trauma-related stimuli, re-experiencing of trauma, and mood changes. This review focuses on the frontal cortical areas that form crucial links in circuitry pertinent to posttraumatic stress disorder symptomatology: (1) the conditioned fear extinction circuit, (2) the salience circuit, and (3) the mood circuit. These frontal areas include the ventromedial prefrontal cortex (conditioned fear extinction), the dorsal anterior cingulate and insular cortices (salience), and the lateral orbitofrontal and subgenual cingulate cortices (mood). Frontal lobe structural abnormalities in posttraumatic stress disorder, including volumetric reductions in the cingulate cortices, impact all three circuits. Functional analyses of frontal cortices in posttraumatic stress disorder show abnormal activation in all three according to task demand and emotional valence. Network analyses reveal altered amygdalo-frontal connectivity and failure to suppress the default mode network during cognitive engagement. Spine shape alterations also have been detected in the medial orbito-frontal cortex in posttraumatic stress disorder postmortem brains, suggesting reduced synaptic plasticity. Importantly, frontal lobe abnormalities in posttraumatic stress disorder extend beyond emotion-related circuits to include the lateral prefrontal cortices that mediate executive functions. In conclusion, widespread frontal lobe dysfunction in posttraumatic stress disorder provides a neurobiologic basis for the core symptomatology of the disorder, as well as for executive function impairment.
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Affiliation(s)
- Lynn D. Selemon
- Department of Neuroscience, Yale School
of Medicine, Yale University, New Haven, CT, USA
| | - Keith A. Young
- Baylor Scott & White Psychiatry,
Central Texas Veterans Health Care System, Temple, TX, USA
- Department of Psychiatry, Texas A&M
College of Medicine, College Station, USA
- Department of Veterans Affairs,
VISN
17 Center of Excellence for Research on Returning War
Veterans, Waco, TX,USA
| | - Dianne A. Cruz
- Department of Psychiatry and Behavioral
Sciences,
Duke
University, Durham, NC, USA
| | - Douglas E. Williamson
- Department of Psychiatry and Behavioral
Sciences,
Duke
University, Durham, NC, USA
- Durham
VA Medical Center, Durham, NC, USA
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152
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Du X, Choa FS, Chiappelli J, Wisner KM, Wittenberg G, Adhikari B, Bruce H, Rowland LM, Kochunov P, Hong LE. Aberrant Middle Prefrontal-Motor Cortex Connectivity Mediates Motor Inhibitory Biomarker in Schizophrenia. Biol Psychiatry 2019; 85:49-59. [PMID: 30126607 PMCID: PMC6289820 DOI: 10.1016/j.biopsych.2018.06.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 05/29/2018] [Accepted: 06/09/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Inhibitory deficits in motor cortex in schizophrenia have been well demonstrated using short-interval intracortical inhibition (SICI) by transcranial magnetic stimulation. However, it remains unknown whether these deficits originate from dysfunction of motor cortex itself or reflect abnormal modulations of motor cortex by other schizophrenia-related brain areas. METHODS The study was completed by 24 patients with schizophrenia spectrum disorders and 30 healthy control subjects. SICI was obtained by delivering transcranial magnetic stimulation over the left motor cortex. Resting-state functional magnetic resonance imaging and diffusion tensor imaging fractional anisotropy were used to measure functional connectivity (FC) and white matter microstructures, respectively. Stimulation sites for SICI at motor cortex were used as the seeds to obtain whole-brain FC maps. Clinical symptoms were assessed with the Brief Psychiatric Rating Scale. RESULTS In schizophrenia, left prefrontal cortex-motor cortex FC was inversely associated with SICI but positively associated with the underlying white matter microstructure at the left corona radiata and also associated with overall symptoms (all corrected p < .05). Mediation analysis showed that the prefrontal-motor cortex FC significantly mediated the corona radiata white matter effects on SICI (p = .007). CONCLUSIONS Higher resting-state left prefrontal-motor cortex FC, accompanied by a higher fractional anisotropy of left corona radiata, predicted fewer inhibitory deficits, suggesting that the inhibitory deficits in motor cortex in schizophrenia may in part be mediated by a top-down prefrontal influence. SICI may serve as a robust biomarker indexing inhibitory dysfunction at anatomic as well as circuitry levels in schizophrenia.
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Affiliation(s)
- Xiaoming Du
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, Maryland.
| | - Fow-Sen Choa
- Department of Electrical Engineering and Computer Science,
University of Maryland Baltimore County, Baltimore, MD, USA
| | - Joshua Chiappelli
- Maryland Psychiatric Research Center, Department of
Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Krista M. Wisner
- Maryland Psychiatric Research Center, Department of
Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - George Wittenberg
- Departments of Neurology, Physical Therapy and
Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD,
USA
| | - Bhim Adhikari
- Maryland Psychiatric Research Center, Department of
Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Heather Bruce
- Maryland Psychiatric Research Center, Department of
Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Laura M. Rowland
- Maryland Psychiatric Research Center, Department of
Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Peter Kochunov
- Maryland Psychiatric Research Center, Department of
Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - L. Elliot Hong
- Maryland Psychiatric Research Center, Department of
Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
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153
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Abstract
PURPOSE OF REVIEW Poor treatment response is a hallmark of major depressive disorder. To tackle this problem, recent neuroimaging studies have sought to characterize antidepressant response in terms of pretreatment differences in intrinsic functional brain networks. Our aim is to review recent studies that predict antidepressant response using intrinsic network connectivity. We discuss current methodological limitations and directions for future antidepressant biomarker studies. RECENT FINDINGS Functional connectivity stemming from the subgenual and rostral anterior cingulate has shown particular consistency in predicting antidepressant response. Differences in this connectivity may prove fruitful in differentiating treatment responders to many antidepressant interventions. Future biomarker studies should integrate biological MDD subtypes to address the disorder's inherent clinical heterogeneity. These clinical and scientific advancements have the potential to address this population marked by limited treatment response. Methodological considerations, including patient selection, response criteria, and model overfitting, will require future investigation to ensure that biomarkers generalize for prospective prediction of treatment response.
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Affiliation(s)
- Katharine Dunlop
- Brain and Mind Research Institute, Weill Cornell Medicine, 413 East 69th Street, Box 240, New York, NY, 10021, USA.
| | - Aleksandr Talishinsky
- 000000041936877Xgrid.5386.8Brain and Mind Research Institute, Weill Cornell Medicine, 413 East 69th Street, Box 240, New York, NY 10021 USA
| | - Conor Liston
- 000000041936877Xgrid.5386.8Brain and Mind Research Institute, Weill Cornell Medicine, 413 East 69th Street, Box 240, New York, NY 10021 USA ,000000041936877Xgrid.5386.8Department of Psychiatry, Weill Cornell Medicine, New York, NY USA
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154
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Namgung E, Kim M, Yoon S. Repetitive transcranial magnetic stimulation in trauma-related conditions. Neuropsychiatr Dis Treat 2019; 15:701-712. [PMID: 30936700 PMCID: PMC6430993 DOI: 10.2147/ndt.s189498] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Some of trauma-exposed individuals develop posttraumatic stress disorder (PTSD), an incapacitating psychiatric disorder that is characterized by intrusion, avoidance, negative changes in mood and cognition, and hyperarousal. A number of other trauma-related conditions are very frequently found in individuals with PTSD. Traumatic brain injury (TBI) is one of the most frequently observed trauma-related conditions that trauma-exposed individuals with PTSD may experience. TBI refers to transient or permanent brain dysfunction that results in a wide range of neurological, cognitive, and psychiatric symptoms. These trauma-related conditions significantly affect one's quality of life, leading to substantial disability and socioeconomic burden. As the prevalence of PTSD with comorbid TBI is increasing in the general population along with the rates of crimes and accidents, effective prevention and intervention strategies are necessitated. However, a definitive treatment for PTSD with comorbid TBI is still lacking, resulting in high rates of treatment resistance and chronicity. It is essential to investigate the neurobiological mechanisms and potential therapeutics of PTSD with comorbid TBI. Yet, a few repetitive transcranial magnetic stimulation (rTMS) studies have recently investigated therapeutic efficacy in treatment-resistant patients with PTSD and/or TBI. Thus, this article reviews rTMS studies in trauma-related conditions, mainly focusing on PTSD and PTSD with TBI as one of the comorbidities. The review focuses on the applications of rTMS in reducing PTSD symptoms with and without comorbidities based on differential parameters and effects of rTMS as well as concomitant clinical conditions. The section on PTSD with comorbidities focuses on TBI with neurological, cognitive, and psychiatric symptoms. Although there were some inconsistencies in the clinical outcomes and optimized parameters of rTMS applied in PTSD and TBI, low frequency stimulation over the hyperactive frontal regions and/or high frequency stimulation over the hypoactive frontal regions generally improved the clinical symptoms of PTSD and TBI. Lastly, the limitations of the rTMS studies in PTSD and TBI as well as potential directions for future research are discussed.
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Affiliation(s)
- Eun Namgung
- Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea, .,Ewha Brain Institute, Ewha Womans University, Seoul, South Korea,
| | - Myeongju Kim
- Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea, .,Ewha Brain Institute, Ewha Womans University, Seoul, South Korea,
| | - Sujung Yoon
- Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea, .,Ewha Brain Institute, Ewha Womans University, Seoul, South Korea,
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155
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Jang KI, Shim M, Lee S, Hwang HJ, Chae JH. Changes in Global and Nodal Networks in Patients With Unipolar Depression After 3-Week Repeated Transcranial Magnetic Stimulation Treatment. Front Psychiatry 2019; 10:686. [PMID: 31649561 PMCID: PMC6794380 DOI: 10.3389/fpsyt.2019.00686] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 08/23/2019] [Indexed: 12/21/2022] Open
Abstract
Objectives: Repeated transcranial magnetic stimulation (rTMS) therapy has been applied in depressive disorders, but its neurobiological effect has not been well understood. Changes in cortical source network after treatment need to be confirmed. The present study investigated the effect of 3-week rTMS therapy on the symptom severity and cortical source network in patients with unipolar depression. Methods: Thirty-five patients with unipolar major depressive disorder participated in the study. High-frequency (10 Hz) rTMS was applied at the left dorsolateral prefrontal cortex during 3 weeks (five consecutive weekdays every week). Clinical symptoms were examined using the Hamilton Rating Scale for Depression and Anxiety. The resting state electroencephalography was recorded with 62 scalp channels before and after rTMS treatment. Results: Clinical symptoms significantly improved after rTMS treatment in both the active (p = 0.001) and sham groups (p = 0.002). However, an increased cortical source network in global and nodal levels was observed only in the active group after a 3-week treatment. Conclusions: The present study indicates that rTMS treatment leads to improved symptoms in patients with unipolar depression. Furthermore, treatment outcome of real effect was assured in changes of cortical source network.
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Affiliation(s)
- Kuk-In Jang
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,Emotion Laboratory, Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Miseon Shim
- Department of Psychiatry, University of Missouri-Kansas City, Center for Behavioral Medicine, Kansas, MO, United States.,Department of Medical IT Convergence Engineering, Kumoh National Institute of Technology, Gumi, South Korea
| | - Sangmin Lee
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,Emotion Laboratory, Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Han-Jeong Hwang
- Department of Medical IT Convergence Engineering, Kumoh National Institute of Technology, Gumi, South Korea
| | - Jeong-Ho Chae
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,Emotion Laboratory, Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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156
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Akiki TJ, Averill LA, Abdallah CG. Neurobiological studies of trauma-related psychopathology: a public health perspective. Eur J Psychotraumatol 2018; 9:1556554. [PMID: 30637093 PMCID: PMC6319465 DOI: 10.1080/20008198.2018.1556554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 11/23/2018] [Accepted: 11/28/2018] [Indexed: 01/30/2023] Open
Abstract
The societal burden of psychiatric disorders that result after exposure to psychological trauma is enormous. The study of trauma-related disorders using neurobiological and public health approaches is often disjointed. It is critical to emphasize the translational potential of neurobiological work and its relevance to the public health burden of psychological trauma. Applying a public health model to traumatology that includes primary, secondary, and tertiary levels, we highlight ways in which advancing the field of neurobiology can pave the way for scalable interventions that can improve outcomes and help to address the public health problem.
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Affiliation(s)
- Teddy J. Akiki
- Clinical Neurosciences Division National Center for PTSD, United States Department of Veterans Affairs, West Haven, CT, USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Lynnette A. Averill
- Clinical Neurosciences Division National Center for PTSD, United States Department of Veterans Affairs, West Haven, CT, USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Chadi G. Abdallah
- Clinical Neurosciences Division National Center for PTSD, United States Department of Veterans Affairs, West Haven, CT, USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
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157
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Ford JD. Trauma Memory Processing in Posttraumatic Stress Disorder Psychotherapy: A Unifying Framework. J Trauma Stress 2018; 31:933-942. [PMID: 30444287 DOI: 10.1002/jts.22344] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 09/05/2018] [Accepted: 09/08/2018] [Indexed: 12/19/2022]
Abstract
Trauma memory processing (TMP) is an empirically supported approach to psychotherapy for posttraumatic stress disorder (PTSD). However, TMP is not a single, uniform intervention but instead a paradigm that can be operationalized through a variety of component procedures that have not been systematically elucidated and formally tested. Based on findings from phenomenological/structural and neuroimaging research, a central feature of PTSD is theorized to be the involuntary immersion in trauma memories with diminished awareness or negative appraisals of self and current context. Such intrusive reexperiencing-which is epitomized by, but not limited to, flashbacks-is postulated to underlie PTSD's avoidance, altered emotions and cognitions, dissociative, and hyperarousal/hypervigilance symptoms; it is thus a logical target for TMP. The varied approaches to TMP for PTSD are conceptualized as having the common goal of activation of the neural networks in the brain that underlie two key capacities disrupted by intrusive reexperiencing in PTSD: intentional self-referential retrieval of memories and suppression of memory retrieval. Therefore, TMP is postulated to involve two core functions (purposeful reflective remembering and memory awareness in situ) and three essential types (in vivo, imaginal, and cognitive reappraisal). Several implications of this framework for clinical practice and research on TMP for PTSD are discussed.
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Affiliation(s)
- Julian D Ford
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, Connecticut, USA
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158
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Stojek MM, McSweeney LB, Rauch SAM. Neuroscience Informed Prolonged Exposure Practice: Increasing Efficiency and Efficacy Through Mechanisms. Front Behav Neurosci 2018; 12:281. [PMID: 30515086 PMCID: PMC6255793 DOI: 10.3389/fnbeh.2018.00281] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 11/02/2018] [Indexed: 12/16/2022] Open
Abstract
Prolonged exposure (PE) is an empirically supported efficacious treatment for posttraumatic stress disorder (PTSD). In this focused review, we briefly review the neurobiological networks in PTSD relevant to PE, discuss the theoretical basis of PE, review the neurobiological mechanisms underlying the effectiveness of PE and identify the enhancements that can be applied to increase treatment response and retention. Based on the reviewed studies, it is clear that PTSD results in disrupted network of interconnected regions, and PE has been shown to increase the connectivity within and between these regions. Successful extinction recall in PE is related to increased functional coherence between the ventromedial prefrontal cortex (vmPFC), amygdala and the hippocampus. Increased connectivity within the dorsolateral PFC (dlPFC) following PE is associated with more effective downregulation of emotional responses in stressful situations. Pre-existing neural connectivity also in some cases predicts response to exposure treatment. We consider various enhancements that have been used with PE, including serotonin reuptake inhibitors (SSRIs), D-cycloserine (DCS), allopregnanolone (ALLO) and propranolol, repetitive transcranial magnetic stimulation (rTMS), oxytocin and MDMA. Given that neural connectivity appears to be crucial in mechanisms of action of PE, rTMS is a logical target for further research as an enhancement of PE. Additionally, exploring the effectiveness and mechanisms of action of oxytocin and MDMA in conjunction with PE may lead to improvement in treatment engagement and retention.
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Affiliation(s)
- Monika M. Stojek
- Department of Psychiatry, Emory University School of Medicine, Atlanta, GA, United States
- Emory Healthcare Veterans Program, Atlanta, GA, United States
| | - Lauren B. McSweeney
- Department of Psychiatry, Emory University School of Medicine, Atlanta, GA, United States
- Emory Healthcare Veterans Program, Atlanta, GA, United States
| | - Sheila A. M. Rauch
- Department of Psychiatry, Emory University School of Medicine, Atlanta, GA, United States
- Emory Healthcare Veterans Program, Atlanta, GA, United States
- Atlanta VA Medical Center, Atlanta, GA, United States
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159
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Singh MK, Leslie SM, Packer MM, Weisman EF, Gotlib IH. Limbic Intrinsic Connectivity in Depressed and High-Risk Youth. J Am Acad Child Adolesc Psychiatry 2018; 57:775-785.e3. [PMID: 30274652 DOI: 10.1016/j.jaac.2018.06.017] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 05/31/2018] [Accepted: 06/21/2018] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Depression runs in families and has been associated with dysfunctional limbic connectivity. Whether aberrant limbic connectivity is a risk factor for or a consequence of depression is unclear. To examine this question, we compared resting state functional connectivity (RSFC) in youth with depressive disorders (DEP), healthy offspring of parents with depression (DEP-risk), and healthy comparison (HC) youth. METHOD Magnetic resonance imaging at rest was acquired from 119 youth, aged 8 to 17 years (DEP, n = 41, DEP-risk, n = 39, and HC, n = 39) and analyzed using seed-based RSFC in bilateral amygdala and nucleus accumbens (NAcc), covarying for age, IQ, and sex. RESULTS We found distinct risk- and disorder-specific patterns of RSFC across groups. DEP-risk and DEP youth shared reduced negative amygdala-right frontal cortex RSFC and reduced positive amygdala-lingual gyrus RSFC compared to HC youth (p < .001). DEP-risk youth had weaker negative amygdala-precuneus RSFC compared to DEP and HC youth (p < .001), suggesting a resilience marker for depression. In contrast, DEP youth had increased positive NAcc-left frontal cortex RSFC and reduced positive NAcc-insula RSFC compared to DEP-risk and HC youth (p < .001), suggestive of disorder-specific features of depression. Greater depression severity was correlated with disorder-specific amygdala and NAcc RSFC (p < .05). CONCLUSION RSFC in the amygdala and NAcc may represent selective disorder- and risk-specific markers in youth with, and at familial risk for, depression. Longitudinal studies are needed to determine whether these patterns predict long-term clinical outcomes.
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160
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Kozel FA. Clinical Repetitive Transcranial Magnetic Stimulation for Posttraumatic Stress Disorder, Generalized Anxiety Disorder, and Bipolar Disorder. Psychiatr Clin North Am 2018; 41:433-446. [PMID: 30098656 DOI: 10.1016/j.psc.2018.04.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is being investigated for psychiatric disorders such as posttraumatic stress disorder (PTSD), generalized anxiety disorder (GAD), and both phases of bipolar disorder. Case series, open trials, and randomized controlled studies have demonstrated preliminary support for treating PTSD with rTMS alone as well as with rTMS combined with psychotherapy. Similarly, there is some evidence that GAD can be treated with rTMS. The results for treating either phase of bipolar disorder are mixed with most of the current studies showing lack of benefit over sham. Further study is required before rTMS can be recommended for these disorders.
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Affiliation(s)
- F Andrew Kozel
- Mental Health and Behavioral Sciences & HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans' Administration Hospital and Clinics, 116A, 13000 Bruce B. Downs Boulevard, Tampa, FL 33612, USA; Department of Psychiatry and Behavioral Neurosciences, University of South Florida, 3515 E Fletcher Avenue, Tampa, FL 33613, USA.
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161
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Assaf M, Rabany L, Zertuche L, Bragdon L, Tolin D, Goethe J, Diefenbach G. Neural functional architecture and modulation during decision making under uncertainty in individuals with generalized anxiety disorder. Brain Behav 2018; 8:e01015. [PMID: 29931835 PMCID: PMC6085921 DOI: 10.1002/brb3.1015] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 04/30/2018] [Accepted: 05/07/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Recent evidence suggests that repetitive transcranial magnetic stimulation (rTMS) might be effective in treating generalized anxiety disorder (GAD). Cognitive models of GAD highlight the role of intolerance of uncertainty (IU) in precipitating and maintaining worry, and it has been hypothesized that patients with GAD exhibit decision-making deficits under uncertain conditions. Improving understanding of the neural mechanisms underlying cognitive deficits associated with IU may lead to the identification of novel rTMS treatment targets and optimization of treatment parameters. The current report describes two interrelated studies designed to identify and verify a potential neural target for rTMS treatment of GAD. METHODS Study I explored the integrity of prefrontal cortex (PFC) and amygdala neural networks, which underlie decision making under conditions of uncertainty, in GAD. Individuals diagnosed with GAD (n = 31) and healthy controls (n = 20) completed a functional magnetic resonance imaging (fMRI) gambling task that manipulated uncertainty using high versus low error rates. In a subsequent randomized-controlled trial (Study II), a subset of the GAD sample (n = 16) completed the fMRI gambling task again after 30 sessions of active versus sham rTMS (1 Hz, right dorsolateral prefrontal cortex) to investigate the modulation of functional networks and symptoms. RESULTS In Study I, participants with GAD demonstrated impairments in PFC-PFC and PFC-amygdala functional connectivity (FC) mostly during the high uncertainty condition. In Study II, one region of interest pair, dorsal anterior cingulate (ACC) - subgenual ACC, showed "normalization" of FC following active, but not sham, rTMS, and neural changes were associated with improvement in worry symptoms. CONCLUSIONS These results outline a possible treatment mechanism of rTMS in GAD, and pave the way for future studies of treatment optimization.
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Affiliation(s)
- Michal Assaf
- Olin Neuropsychiatry Research Center, Institute of Living, Hartford Hospital, Hartford, Connecticut.,Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Liron Rabany
- Olin Neuropsychiatry Research Center, Institute of Living, Hartford Hospital, Hartford, Connecticut
| | - Luis Zertuche
- Olin Neuropsychiatry Research Center, Institute of Living, Hartford Hospital, Hartford, Connecticut
| | - Laura Bragdon
- Psychology Department, Binghamton University, Binghamton, New York.,Anxiety Disorders Center, Institute of Living, Hartford Hospital, Hartford, Connecticut
| | - David Tolin
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut.,Anxiety Disorders Center, Institute of Living, Hartford Hospital, Hartford, Connecticut
| | - John Goethe
- Burlingame Center, Institute of Living, Hartford Hospital, Hartford, Connecticut
| | - Gretchen Diefenbach
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut.,Anxiety Disorders Center, Institute of Living, Hartford Hospital, Hartford, Connecticut
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162
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Goal Directed and Self-Control Systems in Bulimia Nervosa: An fMRI Study. EBioMedicine 2018; 34:214-222. [PMID: 30045816 PMCID: PMC6116351 DOI: 10.1016/j.ebiom.2018.07.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 06/28/2018] [Accepted: 07/11/2018] [Indexed: 12/24/2022] Open
Abstract
Background Binge eating is apparently the opposite of the strict control over food intake typically set by “maladaptive dieters”. Using functional magnetic resonance imaging (fMRI), we investigated the role of goal-directed behaviors, and the related use of self-control, in binge-related food choices in patients with Bulimia Nervosa (BN). Method While undergoing fMRI, women aged 18–35 with BN (N = 35) and healthy control women (N = 26) rated foods for healthiness and tastiness and then made food choices on a 5 points Likert scale between two conflicting options: one food with lower healthiness and higher tastiness (defined as uncontrolled choice) than the other food (defined as controlled choice). Results BN and healthy participants made more uncontrolled than controlled choices (63% vs 24% and 65% vs 18% respectively). While healthy participants used only food tastiness (chose tastier foods more often) to make food choices (p < .001), BN patients used both food healthiness (chose unhealthy food more often, p < .001) and food tastiness (p < .001) to make binge-related food choices. Activity in the ventromedial prefrontal cortex (vmPFC), which correlated with food choices (pFWE = 0.02), reflected this difference in the integration of food healthiness and food tastiness into a decision value. Functional connectivity analysis showed that the activity in the dorsolateral prefrontal cortex was coupled with vmPFC activity in uncontrolled food choices (pFWE = 0.03). Interpretation Contrary to what might be expected, not only food tastiness but also unhealthiness (a more abstract cognitive-based attribute than food tastiness) plays a role in uncontrolled choices in BN. These choices are likely goal-directed behaviors and recruit self-control.
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163
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Ahmadizadeh MJ, Rezaei M. Unilateral right and bilateral dorsolateral prefrontal cortex transcranial magnetic stimulation in treatment post-traumatic stress disorder: A randomized controlled study. Brain Res Bull 2018; 140:334-340. [DOI: 10.1016/j.brainresbull.2018.06.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 05/30/2018] [Accepted: 06/01/2018] [Indexed: 01/07/2023]
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164
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Abend R, Sar-El R, Gonen T, Jalon I, Vaisvaser S, Bar-Haim Y, Hendler T. Modulating Emotional Experience Using Electrical Stimulation of the Medial-Prefrontal Cortex: A Preliminary tDCS-fMRI Study. Neuromodulation 2018; 22:884-893. [PMID: 29741803 DOI: 10.1111/ner.12787] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 03/23/2018] [Accepted: 03/26/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Implicit regulation of emotions involves medial-prefrontal cortex (mPFC) regions exerting regulatory control over limbic structures. Diminished regulation relates to aberrant mPFC functionality and psychopathology. Establishing means of modulating mPFC functionality could benefit research on emotion and its dysregulation. Here, we tested the capacity of transcranial direct current stimulation (tDCS) targeting mPFC to modulate subjective emotional states by facilitating implicit emotion regulation. MATERIALS AND METHODS Stimulation was applied concurrently with functional magnetic resonance imaging to validate its neurobehavioral effect. Sixteen participants were each scanned twice, counterbalancing active and sham tDCS application, while undergoing negative mood induction (clips featuring negative vs. neutral contents). Effects of stimulation on emotional experience were assessed using subjective and neural measures. RESULTS Subjectively, active stimulation led to significant reduction in reported intensity of experienced emotions to negatively valenced (p = 0.005) clips but not to neutral clips (p > 0.99). Active stimulation further mitigated a rise in stress levels from pre- to post-induction (sham: p = 0.004; active: p = 0.15). Neurally, stimulation increased activation in mPFC regions associated with implicit emotion regulation (ventromedial-prefrontal cortex; subgenual anterior-cingulate cortex, sgACC), and in ventral striatum, a core limbic structure (all ps < 0.05). Stimulation also altered functional connectivity (assessed using whole-brain psycho-physiological interaction) between these regions, and with additional limbic regions. Stimulation-induced sgACC activation correlated with reported emotion intensity and depressive symptoms (rs > 0.64, ps < 0.018), suggesting individual differences in stimulation responsivity. CONCLUSIONS Results of this study indicate the potential capacity of tDCS to facilitate brain activation in mPFC regions underlying implicit regulation of emotion and accordingly modulate subjective emotional experiences.
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Affiliation(s)
- Rany Abend
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel.,Functional Brain Center, Wohl Institute for Advanced Imaging, Sourasky Medical Center, Tel Aviv, Israel.,Section on Development and Affective Neuroscience, National Institute of Mental Health, Bethesda, MD, USA
| | - Roy Sar-El
- Functional Brain Center, Wohl Institute for Advanced Imaging, Sourasky Medical Center, Tel Aviv, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Gonen
- Functional Brain Center, Wohl Institute for Advanced Imaging, Sourasky Medical Center, Tel Aviv, Israel
| | - Itamar Jalon
- Functional Brain Center, Wohl Institute for Advanced Imaging, Sourasky Medical Center, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Sharon Vaisvaser
- Functional Brain Center, Wohl Institute for Advanced Imaging, Sourasky Medical Center, Tel Aviv, Israel
| | - Yair Bar-Haim
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Talma Hendler
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel.,Functional Brain Center, Wohl Institute for Advanced Imaging, Sourasky Medical Center, Tel Aviv, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
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165
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Philip NS, Barredo J, Aiken E, Carpenter LL. Neuroimaging Mechanisms of Therapeutic Transcranial Magnetic Stimulation for Major Depressive Disorder. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2018; 3:211-222. [PMID: 29486862 PMCID: PMC5856477 DOI: 10.1016/j.bpsc.2017.10.007] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 10/06/2017] [Accepted: 10/29/2017] [Indexed: 01/11/2023]
Abstract
Research into therapeutic transcranial magnetic stimulation (TMS) for major depression has dramatically increased in the last decade. Understanding the mechanism of action of TMS is crucial to improve efficacy and develop the next generation of therapeutic stimulation. Early imaging research provided initial data supportive of widely held assumptions about hypothesized inhibitory or excitatory consequences of stimulation. Early work also indicated that while TMS modulated brain activity under the stimulation site, effects at deeper regions, in particular, the subgenual anterior cingulate cortex, were associated with clinical improvement. Concordant with earlier findings, functional connectivity studies also demonstrated that clinical improvements were related to changes distal, rather than proximal, to the site of stimulation. Moreover, recent work suggests that TMS modulates and potentially normalizes functional relationships between neural networks. An important observation that emerged from this review is that similar patterns of connectivity changes are observed across studies regardless of TMS parameters. Though promising, we stress that these imaging findings must be evaluated cautiously given the widespread reliance on modest sample sizes and little implementation of statistical validation. Additional limitations included use of imaging before and after a course of TMS, which provided little insight into changes that might occur during the weeks of stimulation. Furthermore, as studies to date have focused on depression, it is unclear whether our observations were related to mechanisms of action of TMS for depression or represented broader patterns of functional brain changes associated with clinical improvement.
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Affiliation(s)
- Noah S Philip
- Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence, Rhode Island; Mood Disorders Research Program and Neuromodulation Research Facility, Butler Hospital, Providence, Rhode Island; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island.
| | - Jennifer Barredo
- Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence, Rhode Island; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Emily Aiken
- Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence, Rhode Island
| | - Linda L Carpenter
- Mood Disorders Research Program and Neuromodulation Research Facility, Butler Hospital, Providence, Rhode Island; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
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166
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Symptom Changes in Posttraumatic Stress Disorder and Major Depressive Disorder After Transcranial Magnetic Stimulation: Mechanisms of Where and How in the Brain. Biol Psychiatry 2018; 83:200-202. [PMID: 29277191 DOI: 10.1016/j.biopsych.2017.11.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 11/30/2017] [Indexed: 11/23/2022]
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