Different neural modifications underpin PTSD after different traumatic events: an fMRI meta-analytic study

North Korean defectors with PTSD and complex PTSD show alterations in default mode network resting-state functional connectivity

BACKGROUND

North Korean defectors (NKDs) have often been exposed to traumatic events. However, there have been few studies of neural alterations in NKDs with post-traumatic stress disorder (PTSD) and complex PTSD (cPTSD).

AIMS

To investigate neural alterations in NKDs with PTSD and cPTSD, with a specific focus on alterations in resting-state functional connectivity networks, including the default mode network (DMN).

METHOD

Resting-state functional connectivity was assessed using brain functional magnetic resonance imaging in three groups of NKDs: without PTSD, with PTSD and with cPTSD. Statistical tests were performed, including region of interest (ROI)-to-ROI and ROI-to-voxel analysis, followed by post hoc correlation analysis.

RESULTS

In the ROI-to-ROI analysis, differences in functional connectivity were found among the components of the DMN, as well as in the thalamus and the basal ganglia. Right hippocampus-left pallidum and right amygdala-left lingual gyrus connectivity differed between groups in the ROI-to-voxel analysis, as did connectivity involving the basal ganglia. The post hoc analysis revealed negative correlations between Coping and Adaptation Processing Scale (CAPS) score and left posterior cingulate cortex-right pallidum connectivity and between CAPS score and right putamen-left angular gyrus connectivity in the control group, which were not observed in other groups.

CONCLUSIONS

The results suggest that there are alterations in the functional connectivity of the DMN and the limbic system in NKDs with PTSD and cPTSD, and that these alterations involve the basal ganglia. The lower correlations of CAPS score with right basal ganglia-DMN functional connectivity in patients compared with controls further implies that these connectivities are potential targets for treatment of PTSD and cPTSD.

Neural correlates of PTSD in women with childhood sexual abuse with and without PTSD and response to paroxetine treatment: A placebo-controlled, double-blind trial

Objective

Childhood sexual abuse is the leading cause of posttraumatic stress disorder (PTSD) in women, and is a prominent cause of morbidity and loss of function for which limited treatments are available. Understanding the neurobiology of treatment response is important for developing new treatments. The purpose of this study was to assess neural correlates of personalized traumatic memories in women with childhood sexual abuse with and without PTSD, and to assess response to treatment.

Methods

Women with childhood sexual abuse with (N = 28) and without (N = 17) PTSD underwent brain imaging with High-Resolution Positron Emission Tomography scanning with radiolabeled water for brain blood flow measurements during exposure to personalized traumatic scripts and memory encoding tasks. Women with PTSD were randomized to paroxetine or placebo followed by three months of double-blind treatment and repeat imaging with the same protocol.

Results

Women with PTSD showed decreases in areas involved in the Default Mode Network (DMN), a network of brain areas usually active when the brain is at rest, hippocampus and visual processing areas with exposure to traumatic scripts at baseline while women without PTSD showed increased activation in superior frontal gyrus and other areas (p < 0.005). Treatment of women with PTSD with paroxetine resulted in increased anterior cingulate activation and brain areas involved in the DMN and visual processing with scripts compared to placebo (p < 0.005).

Conclusion

PTSD related to childhood sexual abuse in women is associated with alterations in brain areas involved in memory and the stress response and treatment with paroxetine results in modulation of these areas.

Neural patterns differentiate traumatic from sad autobiographical memories in PTSD

For people with post-traumatic stress disorder (PTSD), recall of traumatic memories often displays as intrusions that differ profoundly from processing of 'regular' negative memories. These mnemonic features fueled theories speculating a unique cognitive state linked with traumatic memories. Yet, to date, little empirical evidence supports this view. Here we examined neural activity of patients with PTSD who were listening to narratives depicting their own memories. An intersubject representational similarity analysis of cross-subject semantic content and neural patterns revealed a differentiation in hippocampal representation by narrative type: semantically similar, sad autobiographical memories elicited similar neural representations across participants. By contrast, within the same individuals, semantically similar trauma memories were not represented similarly. Furthermore, we were able to decode memory type from hippocampal multivoxel patterns. Finally, individual symptom severity modulated semantic representation of the traumatic narratives in the posterior cingulate cortex. Taken together, these findings suggest that traumatic memories are an alternative cognitive entity that deviates from memory per se.

Childhood trauma, intraindividual reaction time variability, baseline respiratory sinus arrhythmia, and perceived relapse tendency among males with substance use disorders

Background: People with substance use disorders (SUDs) who have experienced serious childhood trauma may have executive function impairments contributing to relapse. Baseline respiratory sinus arrhythmia (RSA) reflects physiological regulation capacity, which has been found to buffer the negative effects of childhood trauma. Baseline RSA has also been found to be related to intraindividual reaction time variability (IIRTV), which is an index of executive function.Objectives: The present study examined the relationship between childhood trauma and perceived relapse tendency, the mediation role of IIRTV, and the moderation role of baseline RSA.Methods: The study is cross-sectional, a total of 110 males with SUDs participated (Mage = 46.45 years, SD = 11.24). The Childhood Trauma Questionnaire and Intention to Rehabilitate Questionnaire were used to assess childhood trauma and perceived relapse tendency, the two-choice oddball task was used to measure IIRTV, and electrocardiogram (ECG) data were collected to obtain baseline RSA.Results: IIRTV mediated the relationship between childhood trauma and perceived relapse tendency (Coeff = 0.049, Boot CI [0.004, 0.121]); interaction of childhood trauma and Baseline RSA negatively influences IIRTV (β = -0.208, t = -2.022, p = .046).Conclusion: The results suggest that males with SUDs who have experienced serious childhood trauma may have executive function impairments that contribute to relapse, and baseline RSA may buffer the negative effect of childhood trauma on IIRTV. These findings suggest that the prevention of relapse through cognitive enhancement can be complemented by the enhancement of physiological regulation.

Visuo-vestibular and cognitive connections of the vestibular neuromatrix are conserved across age and injury populations

BACKGROUND AND PURPOSE

Given the prevalence of vestibular dysfunction in pediatric concussion, there is a need to better understand pathophysiological disruptions within vestibular and associated cognitive, affective, and sensory-integrative networks. Although current research leverages established intrinsic connectivity networks, these are nonspecific for vestibular function, suggesting that a pathologically guided approach is warranted. The purpose of this study was to evaluate the generalizability of the previously identified "vestibular neuromatrix" in adults with and without postconcussive vestibular dysfunction to young athletes aged 14-17.

METHODS

This retrospective study leveraged resting-state functional MRI data from two sites. Site A included adults with diagnosed postconcussive vestibular impairment and healthy adult controls and Site B consisted of young athletes with preseason, postconcussion, and postseason time points (prospective longitudinal data). Adjacency matrices were generated from preprocessed resting-state data from each sample and assessed for overlap and network structure in MATLAB.

RESULTS

Analyses indicated the presence of a conserved "core" network of vestibular regions as well as areas subserving visual, spatial, and attentional processing. Other vestibular connections were also conserved across samples but were not linked to the "core" subnetwork by regions of interest included in this study.

CONCLUSIONS

Our results suggest that connections between central vestibular, visuospatial, and known intrinsic connectivity networks are conserved across adult and pediatric participants with and without concussion, evincing the significance of this expanded, vestibular-associated network. Our findings thus support this network as a workable model for investigation in future studies of dysfunction in young athlete populations.

Altered whole-brain resting-state functional connectivity and brain network topology in typhoon-related post-traumatic stress disorder

Background

Altered resting-state functional connectivity has been found in patients with post-traumatic stress disorder (PTSD). However, the alteration of resting-state functional connectivity at whole-brain level in typhoon-traumatized individuals with PTSD remains largely unknown.

Objectives

To investigate changes in whole-brain resting-state functional connectivity and brain network topology in typhoon-traumatized subjects with and without PTSD.

Design

Cross-sectional study.

Methods

Twenty-seven patients with typhoon-related PTSD, 33 trauma-exposed controls (TEC), and 30 healthy controls (HC) underwent resting-state functional MRI scanning. The whole brain resting-state functional connectivity network was constructed based on the automated anatomical labeling atlas. The graph theory method was used to analyze the topological properties of the large-scale resting-state functional connectivity network. Whole-brain resting-state functional connectivity and the topological network property were compared by analyzing the variance.

Results

There was no significant difference in the area under the curve of γ, λ, σ, global efficiency, and local efficiency among the three groups. The PTSD group showed increased dorsal cingulate cortex (dACC) resting-state functional connectivity with the postcentral gyrus (PoCG) and paracentral lobe and increased nodal betweenness centrality in the precuneus relative to both control groups. Compared with the PTSD and HC groups, the TEC group showed increased resting-state functional connectivity between the hippocampus and PoCG and increased connectivity strength in the putamen. In addition, compared with the HC group, both the PTSD and TEC groups showed increased connectivity strength and nodal efficiency in the insula.

Conclusion

Aberrant resting-state functional connectivity and topology were found in all trauma-exposed individuals. These findings broaden our knowledge of the neuropathological mechanisms of PTSD.

Structural equation modeling of treatment-related changes in neural connectivity for youth with PTSD

BACKGROUND

Previous studies suggest that improvement in symptoms of posttraumatic stress disorder (PTSD) is accompanied by changes in neural connectivity, however, few studies have investigated directional (effective) connectivity. The current study assesses treatment-related changes in effective connectivity in youth with PTSD undergoing Trauma-Focused Cognitive Behavioral Therapy (TF-CBT).

METHODS

Functional MRI scans before and after 16 weeks of TF-CBT for 20 youth with PTSD, or the same time interval for 20 healthy controls (HC) were included in the analysis. Structural equation modeling was used to model group differences in directional connectivity at baseline, and changes in connectivity from pre- to post-treatment.

RESULTS

At baseline, the PTSD group, relative to the HC group, had significantly greater connectivity in the path from dorsal cingulate to anterior cingulate and from dorsal cingulate to posterior cingulate corticies. From pre- to post-treatment, connectivity in these paths decreased significantly in the PTSD group, as did connectivity from right hippocampus to left superior temporal gyrus. Connectivity from the left amygdala to the lateral orbital frontal cortex was significantly lower in PTSD vs HC at baseline, but did not change from pre- to post-treatment.

CONCLUSION

Although based on a small sample, these results converge with previous studies in suggesting a central role for the dorsal cingulate cortex in PTSD symptoms. The direction of this connectivity suggests that the dorsal cingulate is the source of modulation of anterior and posterior cingulate cortex during trauma-focused cognitive behavioral therapy.

Spontaneous brain activity, graph metrics, and head motion related to prospective post-traumatic stress disorder trauma-focused therapy response

Introduction

Trauma-focused psychotherapy for post-traumatic stress disorder (PTSD) is effective in about half of all patients. Investigating biological systems related to prospective treatment response is important to gain insight in mechanisms predisposing patients for successful intervention. We studied if spontaneous brain activity, brain network characteristics and head motion during the resting state are associated with future treatment success.

Methods

Functional magnetic resonance imaging scans were acquired from 46 veterans with PTSD around the start of treatment. Psychotherapy consisted of trauma-focused cognitive behavioral therapy (tf-CBT), eye movement desensitization and reprocessing (EMDR), or a combination thereof. After intervention, 24 patients were classified as treatment responders and 22 as treatment resistant. Differences between groups in spontaneous brain activity were evaluated using amplitude of low-frequency fluctuations (ALFF), while global and regional brain network characteristics were assessed using a minimum spanning tree (MST) approach. In addition, in-scanner head motion was assessed.

Results

No differences in spontaneous brain activity and global network characteristics were observed between the responder and non-responder group. The right inferior parietal lobule, right putamen and left superior parietal lobule had a more central position in the network in the responder group compared to the non-responder group, while the right dorsolateral prefrontal cortex (DLPFC), right inferior frontal gyrus and left inferior temporal gyrus had a less central position. In addition, responders showed less head motion.

Discussion

These results show that areas involved in executive functioning, attentional and action processes, learning, and visual-object processing, are related to prospective PTSD treatment response in veterans. In addition, these findings suggest that involuntary micromovements may be related to future treatment success.

Stress-related hippocampus activation mediates the association between polyvictimization and trait anxiety in adolescents

Early life stress exposures are associated with adverse health outcomes and heightened anxiety symptoms in adolescents. Stress-sensitive brain regions like the hippocampus and amygdala are particularly impacted by early life adversities and are also implicated in the development of anxiety disorders. However, to date, no studies have specifically examined the neural correlates of polyvictimization (exposure to multiple categories of victimization) or the contribution of stress-sensitive neural nodes to polyvictimization's impact on mental health. To elucidate these relationships, the current study analyzed associations between polyvictimization, hippocampal and amygdalar activation during an acute stress task and trait anxiety in a sample of 80 children and adolescents aged 9-16 years (33 female participants). Results showed that polyvictimization was associated with higher trait anxiety as well as greater stress-related right hippocampus activation, and this greater hippocampal activity predicted heightened trait anxiety. Robust mediation analyses revealed that stress-related right hippocampus activation partially mediated the relationship between polyvictimization and trait anxiety. Our results expand upon the existing polyvictimization literature by suggesting a possible neurobiological pathway through which polyvictimization is connected to the etiology of mental illness.

MEG neural signature of sexual trauma in women veterans with PTSD

Previous research has documented the utility of synchronous neural interactions (SNI) in classifying women veterans with and without posttraumatic stress disorder (PTSD) and other trauma-related outcomes based on functional connectivity using magnetoencephalography (MEG). Here, we extend that line of research to evaluate trauma-specific PTSD neural signatures with MEG in women veterans. Participants completed diagnostic interviews and underwent a task-free MEG scan from which SNI was computed. Thirty-five women veterans were diagnosed with PTSD due to sexual trauma and sixteen with PTSD due to non-sexual trauma. Strength of SNI was compared in women with and without sexual trauma, and linear discriminant analysis was used to classify the brain patterns of women with PTSD due to sexual trauma and non-sexual trauma. Comparison of SNI strength between the two groups revealed widespread hypercorrelation in women with sexual trauma relative to those without sexual trauma. Furthermore, using SNI, the brains of participants were classified as sexual trauma or non-sexual trauma with 100% accuracy. These findings bolster evidence supporting the utility of task-free SNI and suggest that neural signatures of PTSD are trauma-specific.

An exploratory study of resting-state functional connectivity of amygdala subregions in posttraumatic stress disorder following trauma in adulthood

We carried out an exploratory study aimed at identifying differences in resting-state functional connectivity for the amygdala and its subregions, right and left basolateral, centromedial and superficial nuclei, in patients with Posttraumatic Stress Disorder (PTSD), relative to controls. The study included 10 participants with PTSD following trauma in adulthood (9 females), and 10 controls (9 females). The results suggest PTSD was associated with a decreased (negative) functional connectivity between the superficial amygdala and posterior brain regions relative to controls. The differences were observed between right superficial amygdala and right fusiform gyrus, and between left superficial amygdala and left lingual and left middle occipital gyri. The results suggest that among PTSD patients, the worse the PTSD symptoms, the lower the connectivity. The results corroborate the fMRI literature that shows PTSD is associated with weaker amygdala functional connectivity with areas of the brain involved in sensory and perceptual processes. The results also suggest that though the patients traumatic experience occured in adulthood, the presence of early traumatic experiences were associated with negative connectivity between the centromedial amygdala and sensory and perceptual regions. We argue that the understanding of the mechanisms of PTSD symptoms, its behaviors and the effects on quality of life of patients may benefit from the investigation of brain function that underpins sensory and perceptual symptoms associated with the disorder.

A Neurobiological Framework for the Therapeutic Potential of Music and Sound Interventions for Post-Traumatic Stress Symptoms in Critical Illness Survivors

Overview: Post traumatic stress disorder (PTSD) has emerged as a severely debilitating psychiatric disorder associated with critical illness. Little progress has been made in the treatment of post-intensive care unit (ICU) PTSD. Aim: To synthesize neurobiological evidence on the pathophysiology of PTSD and the brain areas involved, and to highlight the potential of music to treat post-ICU PTSD. Methods: Critical narrative review to elucidate an evidence-based neurobiological framework to inform the study of music interventions for PTSD post-ICU. Literature searches were performed in PubMed and CINAHL. The Scale for the Assessment of Narrative Review Articles (SANRA) guided reporting. Results: A dysfunctional HPA axis feedback loop, an increased amygdalic response, hippocampal atrophy, and a hypoactive prefrontal cortex contribute to PTSD symptoms. Playing or listening to music can stimulate neurogenesis and neuroplasticity, enhance brain recovery, and normalize stress response. Additionally, evidence supports effectiveness of music to improve coping and emotional regulation, decrease dissociation symptoms, reduce depression and anxiety levels, and overall reduce severity of PTSD symptoms. Conclusions: Despite the lack of music interventions for ICU survivors, music has the potential to help people suffering from PTSD by decreasing amygdala activity, improving hippocampal and prefrontal brain function, and balancing the HPA-axis.

Does Hippocampal Volume in Patients with Posttraumatic Stress Disorder Vary by Trauma Type?

Posttraumatic stress disorder (PTSD) is a debilitating disorder that can develop after experiencing a traumatic event and is, in part, characterized by memory disturbances. Given its important role in learning and memory, the hippocampus has been studied extensively in PTSD using volumetric neuroimaging techniques. However, the results of these studies are mixed. The variability in findings across studies could arise from differences in samples with regard to trauma type, but this connection has not yet been formally assessed. To assess this question, we conducted (1) mixed-effects meta-analyses to replicate previous meta-analytic findings of significant differences in hippocampal volumes in PTSD groups versus two different types of control groups (trauma-exposed and -unexposed groups), and (2) mixed-effects subgroup and meta-regression analyses to determine whether trauma type moderated these hippocampal volume differences. Overall, the PTSD groups showed significantly smaller right hippocampal volumes than both control groups and significantly smaller left hippocampal volumes than trauma-unexposed control groups. Subgroup and meta-regression analyses revealed that trauma type did not moderate the effect seen between PTSD and trauma-exposed non-PTSD groups but did moderate the effect between the PTSD and trauma-unexposed control groups: studies that contained participants with PTSD related to combat trauma exhibited significantly smaller effect sizes for right hippocampal volumes compared to the interpersonal violence and "other" trauma-type groups with PTSD. These findings suggest that trauma type may moderate hippocampal volume in trauma-exposed individuals but not in those with PTSD.

Neuroimaging Biomarkers of New-Onset Psychiatric Disorders Following Traumatic Brain Injury

Traumatic brain injury (TBI) has traditionally been associated with cognitive and behavioral changes during both the acute and chronic phases of injury. Because of its noninvasive nature, neuroimaging has the potential to provide unique information on underlying macroscopic and microscopic biological mechanisms that may serve as causative agents for these neuropsychiatric sequelae. This broad scoping review identifies at least 4 common macroscopic pathways that exist between TBI and new-onset psychiatric disorders, as well as several examples of how neuroimaging is currently being utilized in clinical research. The review then critically examines the strengths and limitations of neuroimaging for elucidating TBI-related microscopic pathology, such as microstructural changes, neuroinflammation, proteinopathies, blood-brain barrier damage, and disruptions in cellular signaling. A summary is then provided for how neuroimaging is currently being used to investigate TBI-related pathology in new-onset neurocognitive disorders, depression, and posttraumatic stress disorder. Identified gaps in the literature include a lack of prospective studies to definitively associate imaging findings with the development of new-onset psychiatric disorders, as well as antemortem imaging studies subsequently confirmed with postmortem correlates in the same study cohort. Although the spatial resolution and specificity of imaging biomarkers has greatly improved over the last 2 decades, we conclude that neuroimaging biomarkers do not yet exist for the definitive in vivo diagnosis of cellular pathology. This represents a necessary next step for further elucidating causal relationships between TBI and new-onset psychiatric disorders.

The "vestibular neuromatrix": A proposed, expanded vestibular network from graph theory in post-concussive vestibular dysfunction

Convergent clinical and neuroimaging evidence suggests that higher vestibular function is subserved by a distributed network including visuospatial, cognitive-affective, proprioceptive, and integrative brain regions. Clinical vestibular syndromes may perturb this network, resulting in deficits across a variety of functional domains. Here, we leverage structural and functional neuroimaging to characterize this extended network in healthy control participants and patients with post-concussive vestibular dysfunction (PCVD). Then, 27 healthy control subjects (15 females) and 18 patients with subacute PCVD (12 female) were selected for participation. Eighty-two regions of interest (network nodes) were identified based on previous publications, group-wise differences in BOLD signal amplitude and connectivity, and multivariate pattern analysis on affective tests. Group-specific "core" networks, as well as a "consensus" network comprised of connections common to all participants, were then generated based on probabilistic tractography and functional connectivity between the 82 nodes and subjected to analyses of node centrality and community structure. Whereas the consensus network was comprised of affective, integrative, and vestibular nodes, PCVD participants exhibited diminished integration and centrality among vestibular and affective nodes and increased centrality of visual, supplementary motor, and frontal and cingulate eye field nodes. Clinical outcomes, derived from dynamic posturography, were associated with approximately 62% of all connections but best predicted by amygdalar, prefrontal, and cingulate connectivity. No group-wise differences in diffusion metrics or tractography were noted. These findings indicate that cognitive, affective, and proprioceptive substrates contribute to vestibular processing and performance and highlight the need to consider these domains during clinical diagnosis and treatment planning.

An Exploratory Study on Resting-State Functional Connectivity in Individuals with Disorganized Attachment: Evidence for Key Regions in Amygdala and Hippocampus

Studies comparing organized (O) and unresolved/disorganized (UD) attachment have consistently shown structural and functional brain abnormalities, although whether and how attachment patterns may affect resting state functional connectivity (RSFC) is still little characterized. Here, we investigated RSFC of temporal and limbic regions of interest for UD attachment. Participants’ attachment was classified via the Adult Attachment Interview, and all participants underwent clinical assessment. Functional magnetic resonance imaging data were collected from 11 UD individuals and seven matched O participants during rest. A seed-to-voxel analysis was performed, including the anterior and the posterior cingulate cortex, the bilateral insula, amygdala and hippocampus as seed regions. No group differences in the clinical scales emerged. Compared to O, the UD group showed lower RSFC between the left amygdala and the left cerebellum (lobules VIII), and lower functional coupling between the right hippocampus and the posterior portion of the right middle temporal gyrus. Moreover, UD participants showed higher RSFC between the right amygdala and the anterior cingulate cortex. Our findings suggest RSFC alterations in regions associated with encoding of salient events, emotion processing, memories retrieval and self-referential processing in UD participants, highlighting the potential role of attachment experiences in shaping brain abnormalities also in non-clinical UD individuals.

Stem Cell Therapy for Post-Traumatic Stress Disorder: A Novel Therapeutic Approach

Stem cell therapy is a rapidly evolving field of regenerative medicine being employed for the management of various central nervous system disorders. The ability to self-renew, differentiate into specialized cells, and integrate into neuronal networks has positioned stem cells as an ideal mechanism for the treatment of epilepsy. Epilepsy is characterized by repetitive seizures caused by imbalance in the GABA and glutamate neurotransmission following neuronal damage. Stem cells provide benefit by reducing the glutamate excitotoxicity and strengthening the GABAergic inter-neuron connections. Similar to the abnormal neuroanatomic location in epilepsy, post-traumatic stress disorder (PTSD) is caused by hyperarousal in the amygdala and decreased activity of the hippocampus and medial prefrontal cortex. Thus, stem cells could be used to modulate neuronal interconnectivity. In this review, we provide a rationale for the use of stem cell therapy in the treatment of PTSD.

A network pharmacology study with molecular docking to investigate the possibility of licorice against posttraumatic stress disorder

Post traumatic stress disorder (PTSD) is a mental health condition that has a debilitating effect on a person's quality of life and leads to a high socioeconomic burden. Licorice has been demonstrated to have neuroprotective and antidepressant-like effects, but little is known about its effects for the treatment of PTSD. The present study aimed to explore the potential of licorice for PTSD therapy using a network pharmacology approach with molecular docking studies. The compounds of licorice were obtained from databases with screening by absorption, distribution, metabolism and excretion (ADME) evaluation. Genes associated with compounds or PTSD were obtained from public databases, and the genes overlapping between licorice compounds and PTSD were compared by Venn diagram. A network of medicine-ingredients-targets-disease was constructed, visualized, and analyzed using cytoscape software. Protein-protein interactions, gene ontology, pathway enrichment and molecular docking were performed to evaluate the effect of licorice for the treatment of PTSD. 69 potential compounds were screened after ADME evaluation. A total of 81 compound-related genes and 566 PTSD-related genes were identified in the databases with 27 overlapping genes. Licorice compounds (e.g., medicarpin, 7-methoxy-2-methyl isoflavone, shinpterocarpin, formononetin, licochalcone a) and target proteins (e.g., ESR1, PTGS2, NOS2, and ADRB2) with high degree in the network were involved in G protein-coupled receptor signaling pathways at the postsynaptic/synaptic membrane. Moreover, neuroactive ligand-receptor interactions, calcium signaling, cholinergic synapse, serotonergic synapse and adrenergic signaling in cardiomyocytes may play important roles in the treatment of PTSD by licorice. This study provides molecular evidence of the beneficial effects of licorice for the treatment of PTSD.

Data-Driven Approach to the Analysis of Real-Time FMRI Neurofeedback Data: Disorder-Specific Brain Synchrony in PTSD

Brain-computer interfaces (BCIs) can be used in real-time fMRI neurofeedback (rtfMRI NF) investigations to provide feedback on brain activity to enable voluntary regulation of the blood-oxygen-level dependent (BOLD) signal from localized brain regions. However, the temporal pattern of successful self-regulation is dynamic and complex. In particular, the general linear model (GLM) assumes fixed temporal model functions and misses other dynamics. We propose a novel data-driven analyses approach for rtfMRI NF using intersubject covariance (ISC) analysis. The potential of ISC was examined in a reanalysis of data from 21 healthy individuals and nine patients with post-traumatic stress-disorder (PTSD) performing up-regulation of the anterior cingulate cortex (ACC). ISC in the PTSD group differed from healthy controls in a network including the right inferior frontal gyrus (IFG). In both cohorts, ISC decreased throughout the experiment indicating the development of individual regulation strategies. ISC analyses are a promising approach to reveal novel information on the mechanisms involved in voluntary self-regulation of brain signals and thus extend the results from GLM-based methods. ISC enables a novel set of research questions that can guide future neurofeedback and neuroimaging investigations.

Neural response to trauma-related and trauma-unrelated negative stimuli in remitted and persistent pediatric post-traumatic stress disorder

INTRODUCTION

Most youths who suffer from post-traumatic stress disorder (PTSD) lose their diagnosis in the first 1-2 years. However, there are few studies on this brain mechanism, and the heterogeneity of the findings is partially due to the different stimuli applied and the mixed trauma history. Therefore, the use of trauma-related/unrelated stimuli to study the remittance mechanism of earthquake-induced PTSD could advance our knowledge of PTSD and inspire future treatment.

METHODS

Thirteen youths with PTSD, 18 remitted participants, and 18 control participants underwent functional magnetic resonance imaging (fMRI), while viewing trauma-related pictures, trauma-unrelated negative pictures, and scrambled pictures.

RESULTS

Under trauma-unrelated condition, the neural activity of the left hippocampus in the remitted group was between the two other groups. Under trauma-related condition, the PTSD and the remitted group exhibited higher neural activity in the right middle occipital gyrus than controls. The remitted group showed higher neural activity in the right parahippocampal gyrus and right lingual gyrus under trauma-related condition than trauma-unrelated condition, while no significant difference was found in PTSD group.

CONCLUSION

PTSD status-related group differences are mainly reflected in the left hippocampus under the trauma-unrelated condition, while the hyperactivity in the right middle occipital gyrus under trauma-related condition could be an endophenotype for PTSD.

Impaired executive function exacerbates neural markers of posttraumatic stress disorder

BACKGROUND

A major obstacle in understanding and treating posttraumatic stress disorder (PTSD) is its clinical and neurobiological heterogeneity. To address this barrier, the field has become increasingly interested in identifying subtypes of PTSD based on dysfunction in neural networks alongside cognitive impairments that may underlie the development and maintenance of symptoms. The current study aimed to determine if subtypes of PTSD, based on normative-based cognitive dysfunction across multiple domains, have unique neural network signatures.

METHODS

In a sample of 271 veterans (90% male) that completed both neuropsychological testing and resting-state fMRI, two complementary, whole-brain functional connectivity analyses explored the link between brain functioning, PTSD symptoms, and cognition.

RESULTS

At the network level, PTSD symptom severity was associated with reduced negative coupling between the limbic network (LN) and frontal-parietal control network (FPCN), driven specifically by the dorsolateral prefrontal cortex and amygdala Hubs of Dysfunction. Further, this relationship was uniquely moderated by executive function (EF). Specifically, those with PTSD and impaired EF had the strongest marker of LN-FPCN dysregulation, while those with above-average EF did not exhibit PTSD-related dysregulation of these networks.

CONCLUSION

These results suggest that poor executive functioning, alongside LN-FPCN dysregulation, may represent a neurocognitive subtype of PTSD.

Stress-elicited neural activity in young adults varies with childhood sexual abuse

OBJECTIVE

Childhood physical and sexual abuse are stressful experiences that may alter the emotional response to future stressors. Stress-related emotional function is supported by brain regions that include the prefrontal cortex (PFC), hippocampus, and amygdala. The present study investigated whether childhood physical and sexual abuse are associated with stress-elicited brain activity in young adulthood.

METHODS

Participants (N = 300; Mage = 20.0; 151 female) completed a psychosocial stress task during functional magnetic resonance imaging (fMRI). Measures of physical and sexual abuse were included in a linear mixed effects model to estimate the unique relationship each type of childhood abuse had with stress-elicited brain activity.

RESULTS

Stress-elicited dorsolateral PFC, ventromedial PFC, and hippocampal activity decreased as the frequency of childhood sexual abuse increased. There were no regions in which stress-elicited activation varied with physical abuse.

CONCLUSIONS

The present findings suggest there is a unique relationship between childhood sexual abuse and the stress-elicited PFC and hippocampal activity of young adults that is not observed following childhood physical abuse.

SIGNIFICANCE

These findings may have important implications for understanding the mechanisms by which childhood sexual abuse impacts the development of future psychopathology.

Distinct cortical thickness correlates of early life trauma exposure and posttraumatic stress disorder are shared among adolescent and adult females with interpersonal violence exposure

Early life trauma (ELT) exposure and posttraumatic stress disorder (PTSD) both affect neural structure, which predicts a variety of mental health concerns throughout the lifespan and may present differently between adolescents and adults. However, few studies have identified the relationship between ELT, PTSD, development, and brain structure using cortical thickness (CT). CT may reveal previously obscured alterations that are potentially clinically relevant and, furthermore, could identify specific structural correlates distinct to ELT from PTSD. Two hundred and fifty-three female adolescent and adult survivors of interpersonal violence and non-trauma-exposed demographically matched controls underwent structural MRI at two different sites. Images were processed and CT was estimated using FreeSurfer. Vertex-wise linear model tests were conducted across the cortical surface to investigate whether PTSD and ELT exposure uniquely affect CT, controlling for scanner site. Planned follow-up tests included second-level analyses of clinical symptoms for CT clusters that were significantly related to PTSD or ELT. CT in the middle cingulate cortex was inversely related to ELT in both age groups, such that individuals with more ELT demonstrated less CT in this region. Additionally, CT was significantly greater in the bilateral intraparietal sulcus and left angular gyrus in both adolescents and adults with PTSD. Furthermore, CT in these clusters was also significantly related to clinical symptom severity in the adult PTSD group. This study provides evidence for distinct CT correlates of ELT and PTSD that are present across adolescents and adults, suggesting consistent markers related to ELT and PTSD on gray matter structure in trauma-exposed individuals.

Resting-state functional network models for posttraumatic stress disorder

Four recent articles were examined for their use of resting-state functional magnetic resonance imaging on participants with posttraumatic symptoms. Theory-driven computations were complemented by the novel use of network metrics, which revealed reduced global centrality and higher efficiency within the default mode network for participants with posttraumatic symptoms. Data-driven methods from other studies revealed associations between functional networks and posttraumatic stress disorder (PTSD) symptoms and clusters of functional activation corresponding to different PTSD presentations.

Maladaptive Alterations of Defensive Response Following Developmental Complex Stress in Rats

Objective

Despite the etiological significance of complex developmental trauma in adult personality disorders and treatment-resistant depression, neurobiological studies have been rare due to the lack of useful animal models. As a first step, we devised an animal model to investigate the effects of multiple trauma-like stress during different developmental periods.

Methods

Twenty-one male Sprague-Dawley rats were classified into 3 groups based on the stress protocol: fear conditioning control (FCC, n = 6), complex stress (ComS, n = 9), and control (n = 6). While the ComS experienced three types of stress (maternal separation, juvenile isolation, electric foot shock), the FCC only experienced an electric foot shock stress and the control never experienced any. We compared fear responses at postnatal day (PND) 29 and PND 56 through freezing time per episode (FTpE), total freezing time (TFT), total freezing episodes (TFE), and ultrasonic vocalization (USV).

Results

ComS showed the longest FTpE in the conditioned fear response test. ComS and FCC exhibited the longer TFT and these two groups only displayed USV. ComS show difference TFE between PND 29 and PND 56.

Conclusion

The results of this investigation show that complex stress may affect not quantity of fear response but characteristics of fear response. Longer FTpE may be associated with tonic immobility which could be considered as a failed self-protective reaction and might be analogous to a sign of inappropriate coping strategy and self-dysregulation in complex trauma patients.

Interaction of Temporal Lobe Epilepsy and Posttraumatic Stress Disorder: Network Analysis of a Single Case

In this case study, we present a 21 years old female with long-standing Temporal Lobe Epilepsy (TLE) who, following a sexual assault, also developed Posttraumatic Stress Disorder (PTSD), leading to a change in her seizure semiology. The new seizures seemed to be a re-enactment of the sexual assault and accordingly were at first thought to be Psychogenic Non-Epileptic Seizures (PNES). Nevertheless, electroencephalography (EEG) recording at the Epilepsy Monitoring Unit (EMU) revealed ictal epileptic brain activity during these new attacks. In order to further explore the nature of the relation between epileptic seizures and PTSD symptomatology, a functional MRI (fMRI) scan was conducted focusing on neural response to threat (fearful faces). The results indicated that the response to threat elicited bilateral amygdala activation, as well as enhanced amygdala connectivity with the insula and anterior cingulate cortex (ACC), all central nodes of the fear circuitry. Accordingly, we suggest that this unique presentation of "pseudo" PNES might stem from the anatomical proximity of the epileptic network in this patient (temporal-insular-frontal) to the fear circuitry, allowing abnormal epileptic activity to "exploit" or activate the fear circuit or vice versa. We further propose that the traumatic experience may have changed the patient's ictal semiology by modifying the course of the spread of the ictal activity toward the PTSD network.

Social supports moderate the effects of child adversity on neural correlates of threat processing

BACKGROUND

Child abuse and other forms of adversity are associated with alterations in threat processing and emotion regulation brain circuits.

OBJECTIVE

The goal of the current investigation is to determine if the availability of positive social support can ameliorate the negative impact of adversity on these brain systems.

PARTICIPANTS AND SETTING

Subjects included 55 children ages 7-16 (X = 11.8, SD = 2.0). Approximately one-third of the cohort had no significant history of adversity, one-third had a history of moderate adversity, and one-third had a history of severe adversity. Brain imaging was conducted at the University of Vermont using a 3.0 T Philips scanner.

METHODS

The Emotional Go-NoGo task with fearful and calm facial stimuli was used to assess the neural correlates of threat processing and emotion regulation in children during functional magnetic resonance imaging (fMRI). Dimensional measures of anxiety, social supports, and children's adverse experiences were also obtained.

RESULTS

A conjunction analysis was used to test if trauma-related brain activation in responding to fearful vs. calm targets was impacted by social support. This approach identified multiple activation foci, including a cluster extending from the left amygdala to several other key brain regions involved in emotion regulation, including the orbitofrontal cortex, anterior cingulate cortex (ACC), anterior insula, nucleus accumbens, and frontal pole (Family Wise Error (FWE) correction, p < 0.05).

CONCLUSIONS

Greater social support may reduce the effect that adversity has on neural processing of threat stimuli, consistent with the protective role of positive supports in promoting resilience and recovery demonstrated in the literature.

Nervous and Endocrine System Dysfunction in Posttraumatic Stress Disorder: An Overview and Consideration of Sex as a Biological Variable

Decades of research into the biological mechanisms of posttraumatic stress disorder (PTSD) suggests that chronic activation of the stress response leads to long-lasting changes in the structure and function of the nervous and endocrine systems. While the prevalence of PTSD is twice as high in females as males, little is known about how sex differences in neuroendocrine systems may contribute to PTSD. In response to the paucity of research on sex-related mechanisms, the National Institutes of Health created a policy that asks researchers to consider sex as a biological variable. This review provides an overview of the current understanding of nervous and endocrine dysfunction in PTSD (e.g., neural circuitry, autonomic arousal, hormonal response), highlighting areas where the influence of sex has been characterized and where further research is needed. We also provide recommendations for using the sex-as-a-biological-variable policy to address specific gaps in PTSD neuroscience research.

Amygdala functional connectivity in the acute aftermath of trauma prospectively predicts severity of posttraumatic stress symptoms

Understanding neural mechanisms that confer risk for posttraumatic stress disorder (PTSD) is critical for earlier intervention, yet longitudinal work has been sparse. The amygdala is part of a core network consistently implicated in PTSD symptomology. Most neural models of PTSD have focused on the amygdala's interactions with the dorsal anterior cingulate cortex, ventromedial prefrontal cortex, and hippocampus. However, an increasing number of studies have linked PTSD symptoms to aberrations in amygdala functional connections with other brain regions involved in emotional information processing, self-referential processing, somatosensory processing, visual processing, and motor control. In the current study, trauma-exposed individuals (N = 54) recruited from the emergency department completed a resting state fMRI scan as well as a script-driven trauma recall fMRI task scan two-weeks post-trauma along with demographic, PTSD, and other clinical symptom questionnaires two-weeks and six-months post-trauma. We examined whether amygdala-whole brain functional connectivity (FC) during rest and task could predict six-month post-trauma PTSD symptoms. More negative amygdala-cerebellum and amygdala-postcentral gyrus FC during rest as well as more negative amygdala-postcentral gyrus and amygdala-midcingulate cortex during recall of the trauma memory predicted six-month post-trauma PTSD after controlling for scanner type. Follow-up multiple regression sensitivity analyses controlling for several other relevant predictors of PTSD symptoms, revealed that amygdala-cerebellum FC during rest and amygdala-postcentral gyrus FC during trauma recall were particularly robust predictors of six-month PTSD symptoms. The results extend cross-sectional studies implicating abnormal FC of the amygdala with other brain regions involved in somatosensory processing, motor control, and emotional information processing in PTSD, to the prospective prediction of risk for chronic PTSD. This work may contribute to earlier identification of at-risk individuals and elucidate potential intervention targets.

FKBP5 haplotypes and PTSD modulate the resting-state brain activity in Han Chinese adults who lost their only child

The stress-related gene FKBP5 has been related to dysregulated glucocorticoid receptor (GR) signaling, showing increased GR sensitivity in trauma-exposed subjects with post-traumatic stress disorder (PTSD) but not in those without PTSD. However, the neural mechanism underlying the effects of FKBP5 remains poorly understood. Two hundred and thirty-seven Han Chinese adults who had lost their only child were included. Four FKBP5 single nucleotide polymorphisms (rs3800373, rs9296158, rs1360780, and rs9470080) were genotyped. All 179 participants were successfully divided into three FKBP5 diplotype subgroups according to two major FKBP5 H1 and H2 yin yang haplotypes. Brain average spectral power was compared using a two-way (PTSD diagnosis and FKBP5 diplotypes) analysis of covariance within four separate frequency bands (slow-5, slow-4, slow-3, and slow-2). Adults with PTSD showed lower spectral power in bilateral parietal lobules in slow-4 and in left inferior frontal gyrus (IFG) in slow-5. There was significant FKBP5 diplotype main effect in anterior cingulate cortex (ACC) in slow-4 (H1/H1 higher than other two subgroups), and in precentral/postcentral gyri and middle cingulate cortex (MCC) in slow-3 (H2/H2 higher than other two subgroups). Also, there was a significant diagnosis × FKBP5 diplotype interaction effect in right parietal lobule in slow-3. These findings suggest that adults with PTSD have lower low-frequency power in executive control network regions. Lower power in ACC and greater power in the motor/sensory areas in FKBP5 high-risk diplotype group suggest a disturbance of emotional processing and hypervigilance/sensitization to threatening stimuli. The interaction effect of diagnosis × FKBP5 in parietal lobule may contribute to PTSD development.

Effects of COMT rs4680 and BDNF rs6265 polymorphisms on brain degree centrality in Han Chinese adults who lost their only child

Losing one's only child is a major traumatic life event that may lead to posttraumatic stress disorder (PTSD); however, not all parents who experience this trauma develop PTSD. Genetic variants are associated with the risk of developing PTSD. Catechol-O-methyltransferase (COMT) rs4680 and brain-derived neurotrophic factor (BDNF) rs6265 are two most well-described single-nucleotide polymorphisms that relate to stress response; however, the neural mechanism underlying their effects on adults who lost an only child remains poorly understood. Two hundred and ten Han Chinese adults who had lost their only child (55 with PTSD and 155 without PTSD) were included in this imaging genetics study. Participants were divided into subgroups according to their COMT rs4680 and BDNF rs6265 genotypes. Degree Centrality (DC)-a resting-state fMRI index reflecting the brain network communication-was compared with a three-way (PTSD diagnosis, COMT, and BDNF polymorphisms) analysis of covariance. Diagnosis state had a significant effect on DC in bilateral inferior parietal lobules and right middle frontal gyrus (MFG), where PTSD adults showed weaker DC. BDNF × diagnosis interaction effect was found in the right MFG and hippocampus, and these two regions were reversely modulated. Also, there was a significant COMT × BDNF interaction effect in left cuneus, middle temporal gyrus, right inferior occipital gyrus, and bilateral putamen, independent of PTSD diagnosis. These findings suggest that the modulatory effect of BDNF polymorphism on the MFG and hippocampus may contribute to PTSD development in bereaved adults. Interactions of COMT × BDNF polymorphisms modulate some cortices and basal ganglia, irrespective of PTSD development.

Alexithymia and frontal-amygdala functional connectivity in North Korean refugees

BACKGROUND

Refugees commonly experience difficulties with emotional processing, such as alexithymia, due to stressful or traumatic experiences. However, the functional connectivity of the amygdala, which is central to emotional processing, has yet to be assessed in refugees. Thus, the present study investigated the resting-state functional connectivity of the amygdala and its association with emotional processing in North Korean (NK) refugees.

METHODS

This study included 45 NK refugees and 40 native South Koreans (SK). All participants were administered the Toronto Alexithymia Scale (TAS), Beck Depression Inventory (BDI), and Clinician-administered PTSD Scale (CAPS), and differences between NK refugees and native SK in terms of resting-state functional connectivity of the amygdala were assessed. Additionally, the association between the strength of amygdala connectivity and the TAS score was examined.

RESULTS

Resting-state connectivity values from the left amygdala to the bilateral dorsolateral prefrontal cortex (dlPFC) and dorsal anterior cingulate cortex (dACC) were higher in NK refugees than in native SK. Additionally, the strength of connectivity between the left amygdala and right dlPFC was positively associated with TAS score after controlling for the number of traumatic experiences and BDI and CAPS scores.

CONCLUSIONS

The present study found that NK refugees exhibited heightened frontal-amygdala connectivity, and that this connectivity was correlated with alexithymia. The present results suggest that increased frontal-amygdala connectivity in refugees may represent frontal down-regulation of the amygdala, which in turn may produce alexithymia.

Functional brain network topology in parents who lost their only child in China: Post-traumatic stress disorder and sex effects

BACKGROUND

Post-traumatic stress disorder (PTSD) is associated with disruption of the brain network topology; however, little is known about the topological changes and sex effects in PTSD patients following a unique trauma, the loss of an only child, in China.

METHODS

Fifty-one lost-only-child parents with PTSD, 93 lost-only-child non-PTSD parents (NPTSD), and 50 healthy subjects underwent resting-state functional MRI. The whole-brain functional network was constructed by thresholding partial correlation matrices of 90 brain regions. Group differences in the topological properties, the diagnosis-by-sex interaction, and the relationships between topological metrics and clinical variables were investigated.

RESULTS

Compared with healthy subjects, PTSD and NPTSD groups exhibited significantly shorter path lengths and higher nodal centralities in many brain regions across sexes; however, no significant difference was found between the PTSD and NPTSD groups. Additionally, the global topological metrics did not show any sex difference, whereas the nodal centralities in the left insula, right inferior frontal gyrus, and right posterior cingulate cortex differed significantly only in women, and the nodal centralities in the bilateral anterior cingulate cortices and left hippocampus were significantly different only in men. Furthermore, the nodal centralities of the right parahippocampus demonstrated significant diagnosis-by-sex interaction.

LIMITATION

Cross-sectional design of this study could not demonstrate the causality.

CONCLUSIONS

The parents who lost their only child exhibited a shift toward randomization and significant nodal topological alterations independent of PTSD effects. Additionally, sex differences were observed primarily in the topological properties at the nodal level, which may indicate a neurobiological contribution to the greater incidence of PTSD in females.

Large-scale white matter network reorganization in posttraumatic stress disorder

Recently, graph theoretical approaches applied to neuroimaging data have advanced understanding of the human brain connectome and its abnormalities in psychiatric disorders. However, little is known about the topological organization of brain white matter networks in posttraumatic stress disorder (PTSD). Seventy-six patients with PTSD and 76 age, gender, and years of education-matched trauma-exposed controls were studied after the 2008 Sichuan earthquake using diffusion tensor imaging and graph theoretical approaches. Topological properties of brain networks including global and nodal measurements and modularity were analyzed. At the global level, patients showed lower clustering coefficient (p = .016) and normalized characteristic path length (p = .035) compared with controls. At the nodal level, increased nodal centralities in left middle frontal gyrus, superior and inferior temporal gyrus and right inferior occipital gyrus were observed (p < .05, corrected for false-discovery rate). Modularity analysis revealed that PTSD patients had significantly increased inter-modular connections in the fronto-parietal module, fronto-striato-temporal module, and visual and default mode modules. These findings indicate a PTSD-related shift of white matter network topology toward randomization. This pattern was characterized by an increased global network integration, reflected by increased inter-modular connections with increased nodal centralities involving fronto-temporo-occipital regions. This study suggests that extremely stressful life experiences, when they lead to PTSD, are associated with large-scale brain white matter network topological reconfiguration at global, nodal, and modular levels.

Functional reorganization of neural networks involved in emotion regulation following trauma therapy for complex trauma disorders

OBJECTIVES

We investigated whether patients with complex interpersonal trauma engage neural networks that are commonly activated during cognitive reappraisal and responding naturally to affect-laden images. In this naturalistic study, we examined whether trauma treatment not only reduces symptoms but also changes neural networks involved in emotional control.

METHODS

Before and after eight weeks of phase-oriented inpatient trauma treatment, patients (n = 28) with complex posttraumatic stress disorder (cPTSD) and complex dissociative disorders (CDD) performed a cognitive reappraisal task while electroencephalography (EEG) was registered. Patients were measured as a prototypical dissociative part that aims to fulfill daily life goals while avoiding traumatic memories and associated dissociative parts. Matched healthy controls (n = 38) were measured twice as well. We examined task-related functional connectivity and assessed self-reports of clinical symptoms and emotion regulation skills.

RESULTS

Prior to treatment and compared to controls, patients showed hypoconnectivity within neural networks involved in emotional downregulation while reappraising affect-eliciting pictures as well as viewing neutral and affect-eliciting pictures. Following treatment, connectivity became normalized in these networks comprising regions associated with cognitive control and memory. Additionally, patients showed a treatment-related reduction of negative but not of positive dissociative symptoms.

CONCLUSIONS

This is the first study demonstrating that trauma-focused treatment was associated with favorable changes in neural networks involved in emotional control. Emotional overregulation manifesting as negative dissociative symptoms was reduced but not emotional underregulation, manifesting as positive dissociative symptoms.

A Review of fMRI Affective Processing Paradigms Used in the Neurobiological Study of Posttraumatic Stress Disorder

Posttraumatic stress disorder (PTSD) is a chronic and debilitating psychiatric disorder with a complex clinical presentation. The last two decades have seen a proliferation of literature on the neurobiological mechanisms subserving affective processing in PTSD. The current review will summarize the neuroimaging results of the most common experimental designs used to elucidate the affective signature of PTSD. From this summary, we will provide a heuristic to organize the various paradigms discussed and report neural patterns of activations using this heuristic as a framework. Next, we will compare these results to the traditional functional neurocircuitry model of PTSD and discuss biological and analytic variables which may account for the heterogeneity within this literature. We hope that this approach may elucidate the role of experimental parameters in influencing neuroimaging findings.

Psychological and Brain Connectivity Changes Following Trauma-Focused CBT and EMDR Treatment in Single-Episode PTSD Patients

Among the different therapeutic alternatives for post-traumatic stress disorder (PTSD), Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) and Eye Movement Desensitization and Reprocessing (EMDR) Therapy have shown promising results in helping patients cope with PTSD symptoms. However, given the different theoretical and methodological substrate of TF-CBT and EMDR, a potentially different impact on the brain for the two interventions could be hypothesized, as well as an interaction between trauma-specific PTSD symptomatology and response to a given psychotherapy. In this study, we monitored psychological and spontaneous functional connectivity fMRI patterns in two groups of PTSD patients who suffered by the same traumatic event (i.e., natural disaster), before and after a cycle of psychotherapy sessions based on TF-CBT and EMDR. Thirty-seven (37) PTSD patients were enrolled from a larger sample of people exposed to a single, acute psychological stress (i.e., 2002 earthquake in San Giuliano di Puglia, Italy). Patients were randomly assigned to TF-CBT (n = 14) or EMDR (n = 17) psychotherapy. Clinical assessment was performed using the Clinician-Administered PTSD Scale (CAPS), the Davidson Trauma Scale (DTS) and the Work and Social Adjustment Scale (WSAS), both at baseline and after treatment. All patients underwent a fMRI data acquisition session before and after treatment, aimed at characterizing their functional connectivity (FC) profile at rest, as well as potential connectivity changes associated with the clinical impact of psychotherapy. Both EMDR and TF-CBT induced statistically significant changes in clinical scores, with no difference in the clinical impact of the two treatments. Specific changes in FC correlated with the improvement at the different clinical scores, and differently for EMDR and TF-CBT. However, a similarity in the connectivity changes associated with changes in CAPS in both groups was also observed. Specifically, changes at CAPS in the entire sample correlated with an (i) increase in connectivity between the bilateral superior medial frontal gyrus and right temporal pole, and a (ii) decrease in connectivity between left cuneus and left temporal pole. Results point to a similar, beneficial psychological impact of EMDR and TF-CBT for treatment of natural-disaster PTSD patients. Neuroimaging data suggest a similar neurophysiological substrate for clinical improvement following EMDR and TF-CBT, involving changes affecting bilateral temporal pole connectivity.

PTSD and Physical Health

PURPOSE OF REVIEW

We review evidence linking PTSD to physical health symptoms and specific disorders, highlighting areas with multiple studies and objective measures of disease states when available. We also examine evidence for biological, behavioral, and psychosocial mechanisms underlying these associations and discuss the clinical implications of recent research.

RECENT FINDINGS

Recent meta-analyses have found that evidence is particularly strong for increased risk of cardiovascular, metabolic, and musculoskeletal disorders among patients with PTSD. Numerous studies have found alterations in the hypothalamic-pituitary-adrenal axis, sympathetic nervous system, inflammation, and health behaviors that could increase risk of illness, but few studies have simultaneously incorporated measures of mechanisms and disease outcomes. Future research should focus on expanding the diversity of populations studied, particularly with respect to underrepresented racial and ethnic groups. Longitudinal studies that incorporate repeated measures of PTSD, pathogenic mechanisms of disease, and physical health outcomes and the addition of physical health outcomes to PTSD treatment trials will be most informative for the field.

Continuous Environmental Changes May Enhance Topographic Memory Skills. Evidence From L'Aquila Earthquake-Exposed Survivors

Exposure to environmental contextual changes, such as those occurring after an earthquake, requires individuals to learn novel routes around their environment, landmarks and spatial layout. In this study, we aimed to uncover whether contextual changes that occurred after the 2009 L'Aquila earthquake affected topographic memory in exposed survivors. We hypothesized that individuals exposed to environmental changes-individuals living in L'Aquila before, during and after the earthquake (hereafter called exposed participants, EPs)-improved their topographic memory skills compared with non-exposed participants (NEPs) who moved to L'Aquila after the earthquake, as only EPs had to modify their previous cognitive map of L'Aquila. We also hypothesized that memory improvement was selective for the navigational space and did not generalize across other spatial and verbal domains. To test these hypotheses, we compared the topographic and spatial memory skills of 56 EPs without post-traumatic stress disorder (PTSD) symptoms to the skills of 47 NEPs using the Walking Corsi Test (WalCT; memory test in the navigational space) and the Corsi Block-Tapping Test (CBT; visuospatial memory test in the reaching space); EPs and NEPs were matched for gender, education and general navigational skills. A sub-group of participants also underwent the Rey-Auditory Verbal Learning Test (RAVLT; verbal memory test). The results showed that only EPs had better performances on topographic learning (TL) assessed using the WalCT rather than spatial learning assessed by the CBT. This outcome suggests the possibility that EPs specifically improved topographic memory. This effect may be due to continuous exposure to environmental changes that have required individuals to learn novel paths within the city and integrate novel information, such as "new towns," into their pre-existing mental representation of the city. Implications and limitations of the study are discussed.

Increased Inhibition of the Amygdala by the mPFC may Reflect a Resilience Factor in Post-traumatic Stress Disorder: A Resting-State fMRI Granger Causality Analysis

Purpose: To determine whether effective connectivity of the amygdala is altered in traumatized subjects with and without post-traumatic stress disorder (PTSD). Materials and Methods: Resting-state functional MRI data were obtained for 27 patients with typhoon-related PTSD, 33 trauma-exposed controls (TEC), and 30 healthy controls (HC). Effective connectivity of the bilateral amygdala was examined with Granger causality analysis and then compared between groups by conducting an analysis of variance. Results: Compared to the HC group, both the PTSD group and the TEC group showed increased effective connectivity from the amygdala to the medial prefrontal cortex (mPFC). The TEC group showed increased effective connectivity from the mPFC to the amygdala relative to the HC group. Compared to the TEC group, the PTSD group showed increased effective connectivity from the amygdala to the supplementary motor area (SMA), whereas decreased effective connectivity was detected from the SMA to the amygdala. Both the PTSD group and the TEC group showed decreased effective connectivity from the superior temporal gyrus (STG) to the amygdala relative to the HC group. Compared to the HC group, the TEC group showed increased effective connectivity from the amygdala to the dorsolateral prefrontal cortex (dlPFC), while both the PTSD group and the TEC group showed decreased effective connectivity from the dlPFC to the amygdala. The PTSD group showed decreased effective connectivity from the precuneus to the amygdala relative to both control groups, but increased effective connectivity from the amygdala to the precuneus relative to the HC group. Conclusion: Trauma leads to an increased down-top excitation from the amygdala to the mPFC and less regulation of the amygdala by the dlPFC. The results suggest that increased inhibition of the amygdala by the mPFC may reflect a resilience factor, and altered amygdala-SMA and amygdala-STG effective connectivity may reflect compensatory mechanisms of brain function. These data raise the possibility that insufficient inhibition of the amygdala by the mPFC might lead to PTSD in those who have been exposed to traumatic incidents, and may inform future therapeutic interventions.

Altered default mode network configuration in posttraumatic stress disorder after earthquake: A resting-stage functional magnetic resonance imaging study

The neural substrates of posttraumatic stress disorder (PTSD) are still not fully elucidated. Hence, this study is to explore topological alterations of the default mode network (DMN) in victims with PTSD after a magnitude of 8.0 earthquake using resting-state functional magnetic resonance imaging (rs-fMRI).This study was approved by the local ethical review board, and all participants signed written informed consent. Sixty-two PTSD victims from the 2008 Sichuan earthquake and 62 matched exposed controls underwent rs-fMRI. PTSD was diagnosed by Clinician-Administered PTSD Scale, and underwent PTSD Checklist-Civilian Version for symptom scoring. The DMN was analyzed by using graph theoretical approaches. Further, Pearson correlation analysis was performed to correlate neuroimaging metrics to neuropsychological scores in victims with PTSD.Victims with PTSD showed decreased DMN functional connectivity strength between the right superior frontal gyrus and left inferior parietal lobule (IPL), and showed increased functional connectivity between the right IPL and precuneus or left posterior cingulate cortex. It was also found that victims with PTSD exhibited decreased nodal efficiency in right superior frontal gyrus and precuneus, and increased nodal efficiency in right hippocampus/parahippocampus. Apart from that, PTSD showed higher nodal degree in bilateral hippocampus/parahippocampus. In addition, the functional connectivity strength between the right IPL and precuneus correlated negatively to the avoid scores (r = -0.26, P = .04).This study implicates alteration of topological features on the DMN in PTSD victims after major earthquake, and provides new insights into DMN malfunction in PTSD based on graph theory.

Resting-State Neurophysiological Abnormalities in Posttraumatic Stress Disorder: A Magnetoencephalography Study

Posttraumatic stress disorder (PTSD) is a debilitating psychiatric condition that is common in veterans returning from combat operations. While the symptoms of PTSD have been extensively characterized, the neural mechanisms that underlie PTSD are only vaguely understood. In this study, we examined the neurophysiology of PTSD using magnetoencephalography (MEG) in a sample of veterans with and without PTSD. Our primary hypothesis was that veterans with PTSD would exhibit aberrant activity across multiple brain networks, especially those involving medial temporal and frontal regions. To this end, we examined a total of 51 USA combat veterans with a battery of clinical interviews and tests. Thirty-one of the combat veterans met diagnostic criteria for PTSD and the remaining 20 did not have PTSD. All participants then underwent high-density MEG during an eyes-closed resting-state task, and the resulting data were analyzed using a Bayesian image reconstruction method. Our results indicated that veterans with PTSD had significantly stronger neural activity in prefrontal, sensorimotor and temporal areas compared to those without PTSD. Veterans with PTSD also exhibited significantly stronger activity in the bilateral amygdalae, parahippocampal and hippocampal regions. Conversely, healthy veterans had stronger neural activity in the bilateral occipital cortices relative to veterans with PTSD. In conclusion, these data suggest that veterans with PTSD exhibit aberrant neural activation in multiple cortical areas, as well as medial temporal structures implicated in affective processing.

Single-Prolonged-Stress-Induced Changes in Autophagy-Related Proteins Beclin-1, LC3, and p62 in the Medial Prefrontal Cortex of Rats with Post-traumatic Stress Disorder

Autophagy, or type II programmed cell death, plays a crucial role in many nervous system diseases. However, few studies have examined the role of autophagy in post-traumatic stress disorder (PTSD), and the mechanisms underlying PTSD are poorly understood. The objective of this research was to explore the expression of three important autophagy-related proteins, Beclin-1, microtubule-associated protein 1 light chain 3 (LC3), and p62/SQSTM1 (p62), in the medial prefrontal cortex (mPFC) of an animal model of PTSD to identify changes in autophagic activity during PTSD pathogenesis. PTSD was induced in rats by exposure to a single-prolonged stress (SPS). The Morris water maze was used to assess cognitive changes in rats from the SPS and control groups. Transmission electron microscopy (TEM) was employed to observe mPFC morphological changes. Immunohistochemistry, immunofluorescence, and Western blotting techniques were used to detect expression of Beclin-1, LC3, and p62 in the mPFC. The Morris water maze test results showed that the escape latency time was increased and that the percent time in the target quadrant was decreased in the SPS group compared with that in the control group. Numerous visible autolysosomes in mPFC neurons were observed using TEM after SPS stimulation. Compared with that in the control group, the expression of Beclin-1 and the LC3-II/I ratio significantly decreased at 1 day, then increased and peaked at 7 days, and slightly decreased at 14 days after SPS stimulation, whereas the converse was found for p62 expression. In conclusion, dysregulation of autophagic activity in the mPFC may play a crucial role in PTSD pathogenesis.

Compromised hippocampus-striatum pathway as a potential imaging biomarker of mild-traumatic brain injury and posttraumatic stress disorder

OBJECTIVES

Military service members risk acquiring posttraumatic stress disorder (PTSD) and mild-traumatic brain injury (mTBI), with high comorbidity. Owing to overlapping symptomatology in chronic mTBI or postconcussion syndrome (PCS) and PTSD, it is difficult to assess the etiology of a patient's condition without objective measures. Using resting-state functional MRI in a novel framework, we tested the hypothesis that their neural signatures are characterized by functionally hyperconnected brain regions which are less variable over time. Additionally, we predicted that such connectivities possessed the highest ability in predicting the diagnostic membership of a novel subject (top-predictors) in addition to being statistically significant.

METHODS

U.S. Army Soldiers (N = 87) with PTSD and comorbid PCS + PTSD were recruited along with combat controls. Static and dynamic functional connectivities were evaluated. Group differences were obtained in accordance with our hypothesis. Machine learning classification (MLC) was employed to determine top predictors.

RESULTS

From whole-brain connectivity, we identified the hippocampus-striatum connectivity to be significantly altered in accordance with our hypothesis. Diffusion tractography revealed compromised white-matter integrity between aforementioned regions only in the PCS + PTSD group, suggesting a structural etiology for the PCS + PTSD group rather than being an extreme subset of PTSD. Employing MLC, connectivities provided worst-case accuracy of 84% (9% more than psychological measures). Additionally, the hippocampus-striatum connectivities were found to be top predictors and thus a potential biomarker of PTSD/mTBI.

CONCLUSIONS

PTSD/mTBI are associated with hippocampal-striatal hyperconnectivity from which it is difficult to disengage, leading to a habit-like response toward episodic traumatic memories, which fits well with behavioral manifestations of combat-related PTSD/mTBI. Hum Brain Mapp 38:2843-2864, 2017. © 2017 The Authors Human Brain Mapping Published by Wiley Periodicals, Inc.

Executive function in cancer patients with posttraumatic stress disorder

Background Cancer patients with posttraumatic stress disorder can lead to their noncompliant behaviors. However, less is known about the neurocognitive functioning of posttraumatic stress disorder in general cancer types or patient populations. The current study attempted to examine the prevalence of posttraumatic stress disorder and their relationships with executive function in individuals with cancer. Methods A total of 285 cancer patients with posttraumatic stress disorder and 150 healthy individuals were recruited for the present study. The Clinician Administered PTSD Scale, Tower of Hanoi, Wisconsin Card Sorting Test, and Wechsler Adult Intelligence Scale-Revised Chinese revision were administered to all participants. Results Significant differences in the score of Tower of Hanoi, Wisconsin Card Sorting Test, and Wechsler Adult Intelligence Scale-Revised Chinese revision were observed between the posttraumatic stress disorder group and the healthy control group ( p < 0.001). Significant correlations were found between all posttraumatic stress disorder symptoms and executive function. Conclusions These findings suggest that individuals with cancer-related posttraumatic stress disorder exhibit more severe impairment in executive function than healthy controls do.