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Brown JC, Kweon J, Sharma P, Siddiqi SH, Isserles M, Ressler KJ. Critically Assessing the Unanswered Questions of How, Where, and When to Induce Plasticity in the Posttraumatic Stress Disorder Network with Transcranial Magnetic Stimulation. Biol Psychiatry 2024:S0006-3223(24)01390-8. [PMID: 38909668 DOI: 10.1016/j.biopsych.2024.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 06/02/2024] [Accepted: 06/10/2024] [Indexed: 06/25/2024]
Abstract
Extinction of traumatic memory, a primary treatment approach (termed exposure therapy) in post-traumatic stress disorder (PTSD), occurs through relearning and may be subserved at the molecular level by long-term potentiation (LTP) of relevant circuits. In parallel, repetitive transcranial magnetic stimulation (rTMS) is thought to work through LTP-like mechanisms and may provide a novel, safe, and effective treatment for PTSD. Our recent failed randomized controlled trial (1) emphasizes the necessity of correctly identifying cortical targets, directionality of TMS protocol, and role of memory activation. Here we provide a systematic review of TMS for PTSD to further identify how, where, and when TMS treatment should be delivered to alleviate PTSD symptoms. We conducted a systematic review of the literature searching for rTMS clinical trials involving PTSD patients and outcomes. We searched MEDLINE through October 25th, 2023 for "TMS and PTSD" and "transcranial magnetic stimulation and posttraumatic stress disorder." Thirty-one publications met our inclusion criteria (k=17 randomized controlled trials (RCTs), k=14 open label). RCT protocols were varied in TMS protocols, cortical TMS targets, and memory activation protocols. There was no clear superiority across protocols of low-frequency (k=5) vs. high-frequency protocols (k=6), or by stimulation location. Memory provocation or exposure protocols (k=7) appear to enhance response. Overall, TMS appears to be effective in treating PTSD symptoms across a variety of TMS frequencies, hemispheric target differences, and exposure protocols. Disparate protocols may be conceptually harmonized when viewed as potentiating proposed anxiolytic networks or suppressing anxiogenic networks.
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Affiliation(s)
- Joshua C Brown
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, Massachusetts, USA; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.
| | - Jamie Kweon
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, Massachusetts, USA
| | - Prayushi Sharma
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, Massachusetts, USA
| | - Shan H Siddiqi
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA; Brigham & Women's Hospital, Boston, Massachusetts, USA
| | - Moshe Isserles
- The Jerusalem Center for Mental Health, Jerusalem, Israel
| | - Kerry J Ressler
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, Massachusetts, USA; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.
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Chang WL, Hen R. Adult Neurogenesis, Context Encoding, and Pattern Separation: A Pathway for Treating Overgeneralization. ADVANCES IN NEUROBIOLOGY 2024; 38:163-193. [PMID: 39008016 DOI: 10.1007/978-3-031-62983-9_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/16/2024]
Abstract
In mammals, the subgranular zone of the dentate gyrus is one of two brain regions (with the subventricular zone of the olfactory bulb) that continues to generate new neurons throughout adulthood, a phenomenon known as adult hippocampal neurogenesis (AHN) (Eriksson et al., Nat Med 4:1313-1317, 1998; García-Verdugo et al., J Neurobiol 36:234-248, 1998). The integration of these new neurons into the dentate gyrus (DG) has implications for memory encoding, with unique firing and wiring properties of immature neurons that affect how the hippocampal network encodes and stores attributes of memory. In this chapter, we will describe the process of AHN and properties of adult-born cells as they integrate into the hippocampal circuit and mature. Then, we will discuss some methodological considerations before we review evidence for the role of AHN in two major processes supporting memory that are performed by the DG. First, we will discuss encoding of contextual information for episodic memories and how this is facilitated by AHN. Second, will discuss pattern separation, a major role of the DG that reduces interference for the formation of new memories. Finally, we will review clinical and translational considerations, suggesting that stimulation of AHN may help decrease overgeneralization-a common endophenotype of mood, anxiety, trauma-related, and age-related disorders.
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Affiliation(s)
- Wei-Li Chang
- Departments of Psychiatry and Neuroscience, Columbia University, New York, NY, USA
- Division of Systems Neuroscience, New York State Psychiatric Institute, New York, NY, USA
| | - Rene Hen
- Departments of Psychiatry and Neuroscience, Columbia University, New York, NY, USA.
- Division of Systems Neuroscience, New York State Psychiatric Institute, New York, NY, USA.
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On making (and turning adaptive to) maladaptive aversive memories in laboratory rodents. Neurosci Biobehav Rev 2023; 147:105101. [PMID: 36804263 DOI: 10.1016/j.neubiorev.2023.105101] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 02/03/2023] [Accepted: 02/14/2023] [Indexed: 02/18/2023]
Abstract
Fear conditioning and avoidance tasks usually elicit adaptive aversive memories. Traumatic memories are more intense, generalized, inflexible, and resistant to attenuation via extinction- and reconsolidation-based strategies. Inducing and assessing these dysfunctional, maladaptive features in the laboratory are crucial to interrogating posttraumatic stress disorder's neurobiology and exploring innovative treatments. Here we analyze over 350 studies addressing this question in adult rats and mice. There is a growing interest in modeling several qualitative and quantitative memory changes by exposing already stressed animals to freezing- and avoidance-related tests or using a relatively high aversive training magnitude. Other options combine aversive/fearful tasks with post-acquisition or post-retrieval administration of one or more drugs provoking neurochemical or epigenetic alterations reported in the trauma aftermath. It is potentially instructive to integrate these procedures and incorporate the measurement of autonomic and endocrine parameters. Factors to consider when defining the organismic and procedural variables, partially neglected aspects (sex-dependent differences and recent vs. remote data comparison) and suggestions for future research (identifying reliable individual risk and treatment-response predictors) are discussed.
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Vizeli P, Straumann I, Duthaler U, Varghese N, Eckert A, Paulus MP, Risbrough V, Liechti ME. Effects of 3,4-Methylenedioxymethamphetamine on Conditioned Fear Extinction and Retention in a Crossover Study in Healthy Subjects. Front Pharmacol 2022; 13:906639. [PMID: 35910354 PMCID: PMC9326355 DOI: 10.3389/fphar.2022.906639] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/02/2022] [Indexed: 11/13/2022] Open
Abstract
Background: 3,4-Methylenedioxymethamphetamine (MDMA) has shown initial promise as an adjunct in psychotherapy to treat posttraumatic stress disorder (PTSD). Its efficacy and safety have been demonstrated across phase I-III studies. However, the mechanism underlying the potential utility of MDMA to treat PTSD in humans has not yet been thoroughly investigated. Preliminary evidence suggests that MDMA may facilitate fear extinction recall, which may be through the release of oxytocin. To test this hypothesis, we examined the efficacy of acute MDMA treatment to enhance fear extinction learning and recall. Methods: We used a two-period, double-blind, randomized, placebo-controlled crossover design in 30 healthy male subjects who received a placebo and a single dose of MDMA (125 mg). Fear extinction was tested using two separate Pavlovian fear conditioning paradigms, one using skin conductance response (SCR), and the other fear-potentiated startle (FPS) to conditioned cues. MDMA treatment occurred after fear conditioning and 2 h before extinction learning. Extinction recall was tested 23 h after MDMA intake. Additional outcome measures included subjective effects, emotion recognition tasks, plasma levels of oxytocin, and pharmacokinetics. Results: Fear conditioning and extinction learning were successful in both fear extinction paradigms (generalized eta-squared [ges] for SCR: 0.08; FPS: 0.07). Compared to placebo treatment, MDMA treatment significantly reduced SCRs to the reinforced conditioned stimulus (CS+) during extinction learning (ges = 0.03) and recall (ges = 0.06). Intensity of the subjective effects of MDMA (good effect, trust, and openness) during extinction learning negatively correlated with the discrimination between CS+ and the safety stimulus (CS-) during recall. MDMA did not influence FPS to conditioned cues. Oxytocin concentration was increased fourfold on average by MDMA during acute effects but was not associated with fear extinction outcomes. Conclusions: MDMA treatment facilitated rapid fear extinction and retention of extinction as measured by SCR to fear cues, in line with animal studies of MDMA facilitation of extinction. However, this effect may be limited to certain forms of learned fear responses, as it was not observed in the extinction model using startle reactivity as the outcome. This study provides further evidence for the facilitation of extinction with MDMA treatment and suggests this may be a component of its efficacy when paired with psychotherapy. Clinical Trial registration: clinicaltrials.gov identifier: NCT03527316.
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Affiliation(s)
- Patrick Vizeli
- Clinical Pharmacology and Toxicology, Department of Biomedicine and Department of Clinical Research, University Hospital Basel, Basel, Switzerland,Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland,Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States,*Correspondence: Patrick Vizeli, ; Matthias E. Liechti,
| | - Isabelle Straumann
- Clinical Pharmacology and Toxicology, Department of Biomedicine and Department of Clinical Research, University Hospital Basel, Basel, Switzerland,Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Urs Duthaler
- Clinical Pharmacology and Toxicology, Department of Biomedicine and Department of Clinical Research, University Hospital Basel, Basel, Switzerland,Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Nimmy Varghese
- Psychiatric University Hospital, University of Basel, Basel, Switzerland,Transfaculty Research Platform Molecular and Cognitive Neuroscience, University of Basel, Basel, Switzerland
| | - Anne Eckert
- Psychiatric University Hospital, University of Basel, Basel, Switzerland,Transfaculty Research Platform Molecular and Cognitive Neuroscience, University of Basel, Basel, Switzerland
| | | | - Victoria Risbrough
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States,Center of Excellence for Stress and Mental Health, San Diego, CA, United States
| | - Matthias E. Liechti
- Clinical Pharmacology and Toxicology, Department of Biomedicine and Department of Clinical Research, University Hospital Basel, Basel, Switzerland,Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland,*Correspondence: Patrick Vizeli, ; Matthias E. Liechti,
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Friend SF, Nachnani R, Powell SB, Risbrough VB. C-Reactive Protein: Marker of risk for post-traumatic stress disorder and its potential for a mechanistic role in trauma response and recovery. Eur J Neurosci 2022; 55:2297-2310. [PMID: 33131159 PMCID: PMC8087722 DOI: 10.1111/ejn.15031] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/17/2020] [Accepted: 10/06/2020] [Indexed: 01/08/2023]
Abstract
Increasing evidence indicates that inflammation plays a role in PTSD and stress disorder pathophysiology. PTSD is consistently associated with higher circulating inflammatory protein levels. Rodent models demonstrate that inflammation promotes enduring avoidance and arousal behaviors after severe stressors (e.g., predator exposure and social defeat), suggesting that inflammation may play a mechanistic role in trauma disorders. C-reactive protein (CRP) is an innate acute phase reactant produced by the liver after acute infection and chronic disease. A growing number of investigations report associations with PTSD diagnosis and elevated peripheral CRP, CRP gene mutations, and CRP gene expression changes in immune signaling pathways. CRP is reasonably established as a potential marker of PTSD and trauma exposure, but if and how it may play a mechanistic role is unclear. In this review, we discuss the current understanding of immune mechanisms in PTSD with a particular focus on the innate immune signaling factor, CRP. We found that although there is consistent evidence of an association of CRP with PTSD symptoms and risk, there is a paucity of data on how CRP might contribute to CNS inflammation in PTSD, and consequently, PTSD symptoms. We discuss potential mechanisms through which CRP could modulate enduring peripheral and CNS stress responses, along with future areas of investigation probing the role of CRP and other innate immune signaling factors in modulating trauma responses. Overall, we found that CRP likely contributes to central inflammation, but how it does so is an area for further study.
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Affiliation(s)
- Samantha F. Friend
- Veterans Affairs Center of Excellence for Stress and Mental HealthSan DiegoCAUSA,Department of PsychiatryUniversity of California San DiegoSan DiegoCAUSA
| | - Rahul Nachnani
- Department of PharmacologyPenn State College of MedicineHersheyPAUSA
| | - Susan B. Powell
- Department of PsychiatryUniversity of California San DiegoSan DiegoCAUSA,Research ServiceVA San Diego Healthcare SystemSan DiegoCAUSA
| | - Victoria B. Risbrough
- Veterans Affairs Center of Excellence for Stress and Mental HealthSan DiegoCAUSA,Department of PsychiatryUniversity of California San DiegoSan DiegoCAUSA
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Ferland-Beckham C, Chaby LE, Daskalakis NP, Knox D, Liberzon I, Lim MM, McIntyre C, Perrine SA, Risbrough VB, Sabban EL, Jeromin A, Haas M. Systematic Review and Methodological Considerations for the Use of Single Prolonged Stress and Fear Extinction Retention in Rodents. Front Behav Neurosci 2021; 15:652636. [PMID: 34054443 PMCID: PMC8162789 DOI: 10.3389/fnbeh.2021.652636] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/22/2021] [Indexed: 12/14/2022] Open
Abstract
Posttraumatic stress disorder (PTSD) is a mental health condition triggered by experiencing or witnessing a terrifying event that can lead to lifelong burden that increases mortality and adverse health outcomes. Yet, no new treatments have reached the market in two decades. Thus, screening potential interventions for PTSD is of high priority. Animal models often serve as a critical translational tool to bring new therapeutics from bench to bedside. However, the lack of concordance of some human clinical trial outcomes with preclinical animal efficacy findings has led to a questioning of the methods of how animal studies are conducted and translational validity established. Thus, we conducted a systematic review to determine methodological variability in studies that applied a prominent animal model of trauma-like stress, single prolonged stress (SPS). The SPS model has been utilized to evaluate a myriad of PTSD-relevant outcomes including extinction retention. Rodents exposed to SPS express an extinction retention deficit, a phenotype identified in humans with PTSD, in which fear memory is aberrantly retained after fear memory extinction. The current systematic review examines methodological variation across all phases of the SPS paradigm, as well as strategies for behavioral coding, data processing, statistical approach, and the depiction of data. Solutions for key challenges and sources of variation within these domains are discussed. In response to methodological variation in SPS studies, an expert panel was convened to generate methodological considerations to guide researchers in the application of SPS and the evaluation of extinction retention as a test for a PTSD-like phenotype. Many of these guidelines are applicable to all rodent paradigms developed to model trauma effects or learned fear processes relevant to PTSD, and not limited to SPS. Efforts toward optimizing preclinical model application are essential for enhancing the reproducibility and translational validity of preclinical findings, and should be conducted for all preclinical psychiatric research models.
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Affiliation(s)
| | - Lauren E Chaby
- Cohen Veterans Bioscience, New York City, NY, United States
| | - Nikolaos P Daskalakis
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States.,McLean Hospital, Belmont, MA, United States
| | - Dayan Knox
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, United States
| | - Israel Liberzon
- Department of Psychiatry, Texas A&M University, Bryan, TX, United States
| | - Miranda M Lim
- Departments of Neurology, Behavioral Neuroscience, Medicine, Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR, United States.,Sleep Disorders Clinic, VA Portland Health Care System, Portland, OR, United States
| | - Christa McIntyre
- Department of Neuroscience, The University of Texas at Dallas, Richardson, TX, United States
| | - Shane A Perrine
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, United States.,Research Service, John. D. Dingell VA Medical Center, Detroit, MI, United States
| | - Victoria B Risbrough
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States.,Center for Excellence in Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, United States
| | - Esther L Sabban
- Department of Biochemistry and Molecular Biology, New York Medical College, Valhalla, NY, United States
| | | | - Magali Haas
- Cohen Veterans Bioscience, New York City, NY, United States
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7
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Deng J, Fang W, Gong Y, Bao Y, Li H, Su S, Sun J, Shi J, Lu L, Shi L, Sun H. Augmentation of fear extinction by theta-burst transcranial magnetic stimulation of the prefrontal cortex in humans. J Psychiatry Neurosci 2021; 46:E292-E302. [PMID: 33844484 PMCID: PMC8061738 DOI: 10.1503/jpn.200053] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Fear extinction alone does not erase the original fear memory. Interventions that enhance extinction can be beneficial for the treatment of fear-related disorders. Repetitive transcranial magnetic stimulation has been shown to improve memory performance. The present study examined the effects of intermittent theta-burst stimulation (iTBS) on fear extinction and the return of fear memory in humans. METHODS Ninety-one young healthy volunteers underwent 3 experiments using a randomized controlled experimental design. Participants first acquired fear conditioning, after which they received 30 Hz iTBS before and after extinction training. The iTBS was applied to 1 of 2 targets: the left dorsolateral prefrontal cortex (dlPFC) and the vertex (control). Fear responses were measured 24 hours later and 1 month later. RESULTS During the spontaneous recovery and reinstatement tests, iTBS of the left dlPFC before and after extinction significantly reduced fear response, whereas iTBS of the vertex had no effect on fear memory performance. This combined approach had a relatively long-lasting effect (i.e., at least 1 month). LIMITATIONS We did not explore the effect of iTBS of the dlPFC on the expression of fear without extinction training. The neural mechanisms of iTBS with fear extinction to inhibit the fear response are unclear. Our results are preliminary and should be interpreted with caution. CONCLUSION `The present results showed that 30 Hz iTBS of the left dlPFC enhanced retention of fear extinction. Our study introduces a new intervention for fear memory and suggests that the left dlPFC may be a treatment target for fear-related disorders.
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Affiliation(s)
- Jiahui Deng
- From the Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), Peking University, Beijing 100191, China (Deng, Gong, Li, Su, Sun, Lu, Shi, Sun); the Psychological Hospital Affiliated with Anhui Medical University, Anhui Mental Health Center, Hefei Fourth People's Hospital, Hefei 230022, China (Feng); the National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing 100191, China (Bao); and the Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing 100191, China (Lu)
| | - Wenmei Fang
- From the Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), Peking University, Beijing 100191, China (Deng, Gong, Li, Su, Sun, Lu, Shi, Sun); the Psychological Hospital Affiliated with Anhui Medical University, Anhui Mental Health Center, Hefei Fourth People's Hospital, Hefei 230022, China (Feng); the National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing 100191, China (Bao); and the Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing 100191, China (Lu)
| | - Yimiao Gong
- From the Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), Peking University, Beijing 100191, China (Deng, Gong, Li, Su, Sun, Lu, Shi, Sun); the Psychological Hospital Affiliated with Anhui Medical University, Anhui Mental Health Center, Hefei Fourth People's Hospital, Hefei 230022, China (Feng); the National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing 100191, China (Bao); and the Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing 100191, China (Lu)
| | - Yanping Bao
- From the Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), Peking University, Beijing 100191, China (Deng, Gong, Li, Su, Sun, Lu, Shi, Sun); the Psychological Hospital Affiliated with Anhui Medical University, Anhui Mental Health Center, Hefei Fourth People's Hospital, Hefei 230022, China (Feng); the National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing 100191, China (Bao); and the Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing 100191, China (Lu)
| | - Hui Li
- From the Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), Peking University, Beijing 100191, China (Deng, Gong, Li, Su, Sun, Lu, Shi, Sun); the Psychological Hospital Affiliated with Anhui Medical University, Anhui Mental Health Center, Hefei Fourth People's Hospital, Hefei 230022, China (Feng); the National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing 100191, China (Bao); and the Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing 100191, China (Lu)
| | - Sizhen Su
- From the Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), Peking University, Beijing 100191, China (Deng, Gong, Li, Su, Sun, Lu, Shi, Sun); the Psychological Hospital Affiliated with Anhui Medical University, Anhui Mental Health Center, Hefei Fourth People's Hospital, Hefei 230022, China (Feng); the National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing 100191, China (Bao); and the Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing 100191, China (Lu)
| | - Jie Sun
- From the Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), Peking University, Beijing 100191, China (Deng, Gong, Li, Su, Sun, Lu, Shi, Sun); the Psychological Hospital Affiliated with Anhui Medical University, Anhui Mental Health Center, Hefei Fourth People's Hospital, Hefei 230022, China (Feng); the National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing 100191, China (Bao); and the Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing 100191, China (Lu)
| | - Jie Shi
- From the Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), Peking University, Beijing 100191, China (Deng, Gong, Li, Su, Sun, Lu, Shi, Sun); the Psychological Hospital Affiliated with Anhui Medical University, Anhui Mental Health Center, Hefei Fourth People's Hospital, Hefei 230022, China (Feng); the National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing 100191, China (Bao); and the Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing 100191, China (Lu)
| | - Lin Lu
- From the Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), Peking University, Beijing 100191, China (Deng, Gong, Li, Su, Sun, Lu, Shi, Sun); the Psychological Hospital Affiliated with Anhui Medical University, Anhui Mental Health Center, Hefei Fourth People's Hospital, Hefei 230022, China (Feng); the National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing 100191, China (Bao); and the Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing 100191, China (Lu)
| | - Le Shi
- From the Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), Peking University, Beijing 100191, China (Deng, Gong, Li, Su, Sun, Lu, Shi, Sun); the Psychological Hospital Affiliated with Anhui Medical University, Anhui Mental Health Center, Hefei Fourth People's Hospital, Hefei 230022, China (Feng); the National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing 100191, China (Bao); and the Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing 100191, China (Lu)
| | - Hongqiang Sun
- From the Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Chinese Academy of Medical Sciences Research Unit (No. 2018RU006), Peking University, Beijing 100191, China (Deng, Gong, Li, Su, Sun, Lu, Shi, Sun); the Psychological Hospital Affiliated with Anhui Medical University, Anhui Mental Health Center, Hefei Fourth People's Hospital, Hefei 230022, China (Feng); the National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing 100191, China (Bao); and the Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing 100191, China (Lu)
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Lycopene ameliorates PTSD-like behaviors in mice and rebalances the neuroinflammatory response and oxidative stress in the brain. Physiol Behav 2020; 224:113026. [DOI: 10.1016/j.physbeh.2020.113026] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/19/2020] [Accepted: 06/22/2020] [Indexed: 12/14/2022]
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Abstract
Understanding the neurobiological basis of post-traumatic stress disorder (PTSD) is fundamental to accurately diagnose this neuropathology and offer appropriate treatment options to patients. The lack of pharmacological effects, too often observed with the most currently used drugs, the selective serotonin reuptake inhibitors (SSRIs), makes even more urgent the discovery of new pharmacological approaches. Reliable animal models of PTSD are difficult to establish because of the present limited understanding of the PTSD heterogeneity and of the influence of various environmental factors that trigger the disorder in humans. We summarize knowledge on the most frequently investigated animal models of PTSD, focusing on both their behavioral and neurobiological features. Most of them can reproduce not only behavioral endophenotypes, including anxiety-like behaviors or fear-related avoidance, but also neurobiological alterations, such as glucocorticoid receptor hypersensitivity or amygdala hyperactivity. Among the various models analyzed, we focus on the social isolation mouse model, which reproduces some deficits observed in humans with PTSD, such as abnormal neurosteroid biosynthesis, changes in GABAA receptor subunit expression and lack of pharmacological response to benzodiazepines. Neurosteroid biosynthesis and its interaction with the endocannabinoid system are altered in PTSD and are promising neuronal targets to discover novel PTSD agents. In this regard, we discuss pharmacological interventions and we highlight exciting new developments in the fields of research for novel reliable PTSD biomarkers that may enable precise diagnosis of the disorder and more successful pharmacological treatments for PTSD patients.
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Schmidt U, Vermetten E. Integrating NIMH Research Domain Criteria (RDoC) into PTSD Research. Curr Top Behav Neurosci 2019; 38:69-91. [PMID: 28341942 DOI: 10.1007/7854_2017_1] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Three and a half decades of research on posttraumatic stress disorder (PTSD) has produced substantial knowledge on the pathobiology of this frequent and debilitating disease. However, despite all research efforts, so far no drug that has specifically targeted PTSD core symptoms progressed to clinical use. Instead, although not overly efficient, serotonin re-uptake inhibitors continue to be considered the gold standard of PTSD pharmacotherapy. The psychotherapeutic treatment and symptom-oriented drug therapy options available for PTSD treatment today show some efficacy, although not in all PTSD patients, in particular not in a substantial percent of those suffering from the detrimental sequelae of repeated childhood trauma or in veterans with combat related PTSD. PTSD has this in common with other psychiatric disorders - in particular effective treatment for incapacitating conditions such as resistant major depression, chronic schizophrenia, and frequently relapsing obsessive-compulsive disorder as well as dementia has not yet been developed through modern neuropsychiatric research.In response to this conundrum, the National Institute of Mental Health launched the Research Domain Criteria (RDoC) framework which aims to leave diagnosis-oriented psychiatric research behind and to move on to the use of research domains overarching the traditional diagnosis systems. To the best of our knowledge, the paper at hand is the first that has systematically assessed the utility of the RDoC system for PTSD research. Here, we review core findings in neurobiological PTSD research and match them to the RDoC research domains and units of analysis. Our synthesis reveals that several core findings in PTSD such as amygdala overactivity have been linked to all RDoC domains without further specification of their distinct role in the pathophysiological pathways associated with these domains. This circumstance indicates that the elucidation of the cellular and molecular processes ultimately decisive for regulation of psychic processes and for the expression of psychopathological symptoms is still grossly incomplete. All in all, we find the RDoC research domains to be useful but not sufficient for PTSD research. Hence, we suggest adding two novel domains, namely stress and emotional regulation and maintenance of consciousness. As both of these domains play a role in various if not in all psychiatric diseases, we judge them to be useful not only for PTSD research but also for psychiatric research in general.
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Affiliation(s)
- Ulrike Schmidt
- Trauma Outpatient Unit and RG Molecular Psychotraumatology, Clinical Department, Max Planck Institute of Psychiatry, Kraepelinstrasse 10, Munich, 80804, Germany
| | - Eric Vermetten
- Department Psychiatry, Leiden University Medical Center Utrecht, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands.
- Arq Psychotruama Research Group, Diemen, The Netherlands.
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Abstract
The goals of animal research in post-traumatic stress disorder (PTSD) include better understanding the neurophysiological etiology of PTSD, identifying potential targets for novel pharmacotherapies, and screening drugs for their potential use as PTSD treatment in humans. Diagnosis of PTSD relies on a patient interview and, as evidenced by changes to the diagnostic criteria in the DSM-5, an adequate description of this disorder in humans is a moving target. Therefore, it may seem insurmountable to model the construct of PTSD in animals such as rodents. Fortunately, the neural circuitry involved in fear and anxiety, thought to be essential to the etiology of PTSD in humans, is highly conserved throughout evolution. Furthermore, many symptoms can be modeled using behavioral tests that have face, construct, and predictive validity. Because PTSD is precipitated by a definite traumatic experience, animal models can simulate the induction of PTSD, and test causal factors with longitudinal designs. Accordingly, several animal models of physical and psychological trauma have been established. This review discusses the widely used animal models of PTSD in rodents, and overviews their strengths and weaknesses in terms of face, construct, and predictive validity.
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Affiliation(s)
- Elizabeth I Flandreau
- Grand Valley State University, 1 Campus Drive, Allendale, MI, 49401, USA.
- Department of Behavioral Neurobiology, Hungarian Academy of Sciences, Institute of Experimental Medicine, 43 Szigony Street, Budapest, 1083, Hungary.
| | - Mate Toth
- Grand Valley State University, 1 Campus Drive, Allendale, MI, 49401, USA
- Department of Behavioral Neurobiology, Hungarian Academy of Sciences, Institute of Experimental Medicine, 43 Szigony Street, Budapest, 1083, Hungary
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Glenn DE, Risbrough VB, Simmons AN, Acheson DT, Stout DM. The Future of Contextual Fear Learning for PTSD Research: A Methodological Review of Neuroimaging Studies. Curr Top Behav Neurosci 2019; 38:207-228. [PMID: 29063483 DOI: 10.1007/7854_2017_30] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
There has been a great deal of recent interest in human models of contextual fear learning, particularly due to the use of such paradigms for investigating neural mechanisms related to the etiology of posttraumatic stress disorder. However, the construct of "context" in fear conditioning research is broad, and the operational definitions and methods used to investigate contextual fear learning in humans are wide ranging and lack specificity, making it difficult to interpret findings about neural activity. Here we will review neuroimaging studies of contextual fear acquisition in humans. We will discuss the methodology associated with four broad categories of how contextual fear learning is manipulated in imaging studies (colored backgrounds, static picture backgrounds, virtual reality, and configural stimuli) and highlight findings for the primary neural circuitry involved in each paradigm. Additionally, we will offer methodological recommendations for human studies of contextual fear acquisition, including using stimuli that distinguish configural learning from discrete cue associations and clarifying how context is experimentally operationalized.
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Affiliation(s)
- Daniel E Glenn
- Center of Excellence for Stress and Mental Health, Veterans Affairs San Diego Healthcare System, La Jolla, CA, 92093, USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr. MC0804, La Jolla, San Diego, CA, 92093, USA
| | - Victoria B Risbrough
- Center of Excellence for Stress and Mental Health, Veterans Affairs San Diego Healthcare System, La Jolla, CA, 92093, USA.
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr. MC0804, La Jolla, San Diego, CA, 92093, USA.
| | - Alan N Simmons
- Center of Excellence for Stress and Mental Health, Veterans Affairs San Diego Healthcare System, La Jolla, CA, 92093, USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr. MC0804, La Jolla, San Diego, CA, 92093, USA
| | - Dean T Acheson
- Center of Excellence for Stress and Mental Health, Veterans Affairs San Diego Healthcare System, La Jolla, CA, 92093, USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr. MC0804, La Jolla, San Diego, CA, 92093, USA
| | - Daniel M Stout
- Center of Excellence for Stress and Mental Health, Veterans Affairs San Diego Healthcare System, La Jolla, CA, 92093, USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr. MC0804, La Jolla, San Diego, CA, 92093, USA
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14
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Deslauriers J, Toth M, Der-Avakian A, Risbrough VB. Current Status of Animal Models of Posttraumatic Stress Disorder: Behavioral and Biological Phenotypes, and Future Challenges in Improving Translation. Biol Psychiatry 2018; 83:895-907. [PMID: 29338843 PMCID: PMC6085893 DOI: 10.1016/j.biopsych.2017.11.019] [Citation(s) in RCA: 162] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 10/05/2017] [Accepted: 11/03/2017] [Indexed: 12/23/2022]
Abstract
Increasing predictability of animal models of posttraumatic stress disorder (PTSD) has required active collaboration between clinical and preclinical scientists. Modeling PTSD is challenging, as it is a heterogeneous disorder with ≥20 symptoms. Clinical research increasingly utilizes objective biological measures (e.g., imaging, peripheral biomarkers) or nonverbal behaviors and/or physiological responses to complement verbally reported symptoms. This shift toward more-objectively measurable phenotypes enables refinement of current animal models of PTSD, and it supports the incorporation of homologous measures across species. We reviewed >600 articles to examine the ability of current rodent models to probe biological phenotypes of PTSD (e.g., sleep disturbances, hippocampal and fear-circuit dysfunction, inflammation, glucocorticoid receptor hypersensitivity) in addition to behavioral phenotypes. Most models reliably produced enduring generalized anxiety-like or depression-like behaviors, as well as hyperactive fear circuits, glucocorticoid receptor hypersensitivity, and response to long-term selective serotonin reuptake inhibitors. Although a few paradigms probed fear conditioning/extinction or utilized peripheral immune, sleep, and noninvasive imaging measures, we argue that these should be incorporated more to enhance translation. Data on female subjects, on subjects at different ages across the life span, or on temporal trajectories of phenotypes after stress that can inform model validity and treatment study design are needed. Overall, preclinical (and clinical) PTSD researchers are increasingly incorporating homologous biological measures to assess markers of risk, response, and treatment outcome. This shift is exciting, as we and many others hope it not only will support translation of drug efficacy from animal models to clinical trials but also will potentially improve predictability of stage II for stage III clinical trials.
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Affiliation(s)
- Jessica Deslauriers
- Department of Psychiatry, University of California San Diego, La Jolla, California; Center of Excellence for Stress and Mental Health, Veterans Affairs Hospital, La Jolla, California
| | - Mate Toth
- Department of Behavioural Neurobiology, Institute of Experimental Medicine, Hungarian Academy of Sciences, Budapest, Hungary
| | - Andre Der-Avakian
- Department of Psychiatry, University of California San Diego, La Jolla, California
| | - Victoria B Risbrough
- Department of Psychiatry, University of California San Diego, La Jolla, California; Center of Excellence for Stress and Mental Health, Veterans Affairs Hospital, La Jolla, California.
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15
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Krystal JH, Davis LL, Neylan TC, A Raskind M, Schnurr PP, Stein MB, Vessicchio J, Shiner B, Gleason TC, Huang GD. It Is Time to Address the Crisis in the Pharmacotherapy of Posttraumatic Stress Disorder: A Consensus Statement of the PTSD Psychopharmacology Working Group. Biol Psychiatry 2017; 82:e51-e59. [PMID: 28454621 DOI: 10.1016/j.biopsych.2017.03.007] [Citation(s) in RCA: 155] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 03/02/2017] [Accepted: 03/03/2017] [Indexed: 11/19/2022]
Affiliation(s)
- John H Krystal
- Departments of Psychiatry and Neuroscience, Yale University School of Medicine, New Haven; Clinical Neuroscience Division, National Center for PTSD, West Haven, Connecticut; Psychiatry Services, VA Connecticut Healthcare System, West Haven, Connecticut.
| | - Lori L Davis
- Development Service, Tuscaloosa VA Medical Center, Tuscaloosa; Department of Psychiatry, University of Alabama School of Medicine, Birmingham, Alabama
| | - Thomas C Neylan
- Department of Psychiatry, University of California, San Francisco; San Francisco VA Medical Center, San Francisco
| | - Murray A Raskind
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington; VA Puget Sound Health Care System, Seattle, Washington
| | - Paula P Schnurr
- Executive Division, National Center for PTSD, White River Junction, Vermont; Department of Psychiatry, Geisel School of Medicine at Dartmouth, White River Junction, Vermont
| | - Murray B Stein
- Departments of Psychiatry and Family Medicine & Public Health, University of California, San Diego, La Jolla; VA San Diego Healthcare System, San Diego, California
| | - Jennifer Vessicchio
- Clinical Neuroscience Division, National Center for PTSD, West Haven, Connecticut; Psychiatry Services, VA Connecticut Healthcare System, West Haven, Connecticut
| | - Brian Shiner
- Executive Division, National Center for PTSD, White River Junction, Vermont; Department of Psychiatry, Geisel School of Medicine at Dartmouth, White River Junction, Vermont
| | - Theresa C Gleason
- Departments of Psychiatry and Neuroscience, Yale University School of Medicine, New Haven
| | - Grant D Huang
- Department of Veterans Affairs, Office of Research & Development, Washington, DC; Cooperative Studies Program Central Office, VA Office of Research and Development, Washington, DC
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Goode TD, Holloway-Erickson CM, Maren S. Extinction after fear memory reactivation fails to eliminate renewal in rats. Neurobiol Learn Mem 2017; 142:41-47. [PMID: 28274824 PMCID: PMC5457330 DOI: 10.1016/j.nlm.2017.03.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 03/01/2017] [Accepted: 03/02/2017] [Indexed: 11/20/2022]
Abstract
Retrieving fear memories just prior to extinction has been reported to effectively erase fear memories and prevent fear relapse. The current study examined whether the type of retrieval procedure influences the ability of extinction to impair fear renewal, a form of relapse in which responding to a conditional stimulus (CS) returns outside of the extinction context. Rats first underwent Pavlovian fear conditioning with an auditory CS and footshock unconditional stimulus (US); freezing behavior served as the index of conditioned fear. Twenty-four hours later, the rats underwent a retrieval-extinction procedure. Specifically, 1h prior to extinction (45 CS-alone trials; 44 for rats receiving a CS reminder), fear memory was retrieved by either a single exposure to the CS alone, the US alone, a CS paired with the US, or exposure to the conditioning context itself. Over the next few days, conditional freezing to the extinguished CS was tested in the extinction and conditioning context in that order (i.e., an ABBA design). In the extinction context, rats that received a CS+US trial before extinction exhibited higher levels of conditional freezing than animals in all other groups, which did not differ from one another. In the renewal context, all groups showed renewal, and none of the reactivation procedures reduced renewal relative to a control group that did not receive a reactivation procedure prior to extinction. These data suggest retrieval-extinction procedures may have limited efficacy in preventing fear renewal.
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Affiliation(s)
- Travis D Goode
- Institute for Neuroscience, Texas A&M University, College Station, TX 77843-3474, United States
| | | | - Stephen Maren
- Institute for Neuroscience, Texas A&M University, College Station, TX 77843-3474, United States; Department of Psychology, Texas A&M University, College Station, TX 77843-3474, United States.
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17
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Toward Micro-Switching Exposure Therapy: Potential Relevance for Posttraumatic Stress Disorder. Biol Psychiatry 2017; 81:e87-e89. [PMID: 28554392 DOI: 10.1016/j.biopsych.2017.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 03/27/2017] [Indexed: 11/21/2022]
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18
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Garcia MA, Delahanty DL. Oxytocin and Other Pharmacologic Preventive Interventions for Posttraumatic Stress Disorder: Not a One-Size-Fits-All Approach. Biol Psychiatry 2017; 81:977-978. [PMID: 28554390 DOI: 10.1016/j.biopsych.2017.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 04/04/2017] [Accepted: 04/04/2017] [Indexed: 02/01/2023]
Affiliation(s)
- Monica A Garcia
- Department of Psychological Sciences, Kent State University, Kent
| | - Douglas L Delahanty
- Department of Psychological Sciences, Kent State University, Kent; Department of Psychiatry, Northeastern Ohio Medical University, Rootstown, Ohio.
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