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Kalisch R, Russo SJ, Müller MB. Neurobiology and systems biology of stress resilience. Physiol Rev 2024; 104:1205-1263. [PMID: 38483288 PMCID: PMC11381009 DOI: 10.1152/physrev.00042.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 03/06/2024] [Accepted: 03/12/2024] [Indexed: 05/16/2024] Open
Abstract
Stress resilience is the phenomenon that some people maintain their mental health despite exposure to adversity or show only temporary impairments followed by quick recovery. Resilience research attempts to unravel the factors and mechanisms that make resilience possible and to harness its insights for the development of preventative interventions in individuals at risk for acquiring stress-related dysfunctions. Biological resilience research has been lagging behind the psychological and social sciences but has seen a massive surge in recent years. At the same time, progress in this field has been hampered by methodological challenges related to finding suitable operationalizations and study designs, replicating findings, and modeling resilience in animals. We embed a review of behavioral, neuroimaging, neurobiological, and systems biological findings in adults in a critical methods discussion. We find preliminary evidence that hippocampus-based pattern separation and prefrontal-based cognitive control functions protect against the development of pathological fears in the aftermath of singular, event-type stressors [as found in fear-related disorders, including simpler forms of posttraumatic stress disorder (PTSD)] by facilitating the perception of safety. Reward system-based pursuit and savoring of positive reinforcers appear to protect against the development of more generalized dysfunctions of the anxious-depressive spectrum resulting from more severe or longer-lasting stressors (as in depression, generalized or comorbid anxiety, or severe PTSD). Links between preserved functioning of these neural systems under stress and neuroplasticity, immunoregulation, gut microbiome composition, and integrity of the gut barrier and the blood-brain barrier are beginning to emerge. On this basis, avenues for biological interventions are pointed out.
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Affiliation(s)
- Raffael Kalisch
- Leibniz Institute for Resilience Research (LIR), Mainz, Germany
- Neuroimaging Center (NIC), Focus Program Translational Neuroscience (FTN), Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Scott J Russo
- Nash Family Department of Neuroscience, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States
- Brain and Body Research Center, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Marianne B Müller
- Leibniz Institute for Resilience Research (LIR), Mainz, Germany
- Translational Psychiatry, Department of Psychiatry and Psychotherapy, Johannes Gutenberg University Medical Center, Mainz, Germany
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2
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Agebjörn J, Gillberg C, Eberhard J, Billstedt E, Nyrenius J. Association Between Autism and PTSD Among Adult Psychiatric Outpatients. J Autism Dev Disord 2024:10.1007/s10803-024-06439-7. [PMID: 38916696 DOI: 10.1007/s10803-024-06439-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2024] [Indexed: 06/26/2024]
Abstract
PURPOSE Autism Spectrum Disorder (ASD) occurs in 1-1.5% of the general population and possibly in up to 20% of psychiatric outpatients. Post Traumatic Stress Disorder (PTSD) occurs at some point in life in 4% of the general population and in 14-20% of psychiatric outpatients. Knowledge about how PTSD manifests in people with ASD is important in order for it to be correctly diagnosed and intervened for. METHODS This study investigated the relationship between PTSD and autism among adult psychiatric outpatients (N = 90) of whom 63 had ASD or subthreshold ASD based on DSM-5 criteria. The study group was subjected to in-depth psychiatric assessments using validated instruments. Diagnosis of PTSD was made based on the Mini International Neuropsychiatric Interview (MINI). RESULTS There was a trend towards PTSD being more common among participants with ASD compared to participants without ASD, although significant differences could not be shown in this small sample. 21% of the ASD group had current PTSD, compared to 4% of the study group without ASD. There were no differences between the groups regarding exposure to trauma. There was a trend towards a relationship between number of autism symptoms and hyperarousal symptoms in PTSD. Conversely, the PTSD symptom of irritability/outbursts of anger, was significantly associated with number of autism symptoms. CONCLUSIONS A subgroup of psychiatric outpatients with ASD also suffer from PTSD. Hyperarousal symptoms are possibly more prevalent in the presentation of PTSD in individuals/patients with ASD compared to those without ASD.
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Affiliation(s)
- Johan Agebjörn
- Adult Psychiatric Clinic Arlöv, Region Skåne, Arlöv, Sweden.
| | - Christopher Gillberg
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jonas Eberhard
- Adult Psychiatry Helsingborg, Region Skåne, Sweden; and Department of Clinical Sciences Lund/Clinical Sciences Helsingborg,, Lund University, Lund, Sweden
| | - Eva Billstedt
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Johan Nyrenius
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Adult Psychiatry Helsingborg, Region Skåne, Sweden; and Department of Clinical Sciences Lund/Clinical Sciences Helsingborg,, Lund University, Lund, Sweden
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3
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Devignes Q, Ren B, Clancy KJ, Howell K, Pollmann Y, Martinez-Sanchez L, Beard C, Kumar P, Rosso IM. Trauma-related intrusive memories and anterior hippocampus structural covariance: an ecological momentary assessment study in posttraumatic stress disorder. Transl Psychiatry 2024; 14:74. [PMID: 38307849 PMCID: PMC10837434 DOI: 10.1038/s41398-024-02795-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 01/09/2024] [Accepted: 01/17/2024] [Indexed: 02/04/2024] Open
Abstract
Trauma-related intrusive memories (TR-IMs) are hallmark symptoms of posttraumatic stress disorder (PTSD), but their neural correlates remain partly unknown. Given its role in autobiographical memory, the hippocampus may play a critical role in TR-IM neurophysiology. The anterior and posterior hippocampi are known to have partially distinct functions, including during retrieval of autobiographical memories. This study aimed to investigate the relationship between TR-IM frequency and the anterior and posterior hippocampi morphology in PTSD. Ninety-three trauma-exposed adults completed daily ecological momentary assessments for fourteen days to capture their TR-IM frequency. Participants then underwent anatomical magnetic resonance imaging to obtain measures of anterior and posterior hippocampal volumes. Partial least squares analysis was applied to identify a structural covariance network that differentiated the anterior and posterior hippocampi. Poisson regression models examined the relationship of TR-IM frequency with anterior and posterior hippocampal volumes and the resulting structural covariance network. Results revealed no significant relationship of TR-IM frequency with hippocampal volumes. However, TR-IM frequency was significantly negatively correlated with the expression of a structural covariance pattern specifically associated with the anterior hippocampus volume. This association remained significant after accounting for the severity of PTSD symptoms other than intrusion symptoms. The network included the bilateral inferior temporal gyri, superior frontal gyri, precuneus, and fusiform gyri. These novel findings indicate that higher TR-IM frequency in individuals with PTSD is associated with lower structural covariance between the anterior hippocampus and other brain regions involved in autobiographical memory, shedding light on the neural correlates underlying this core symptom of PTSD.
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Affiliation(s)
- Quentin Devignes
- Center for Depression, Anxiety and Stress Disorders, McLean Hospital, Belmont, MA, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Boyu Ren
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Psychiatric Biostatistics Laboratory, McLean Hospital, Belmont, MA, USA
| | - Kevin J Clancy
- Center for Depression, Anxiety and Stress Disorders, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Kristin Howell
- Center for Depression, Anxiety and Stress Disorders, McLean Hospital, Belmont, MA, USA
| | - Yara Pollmann
- Center for Depression, Anxiety and Stress Disorders, McLean Hospital, Belmont, MA, USA
| | | | - Courtney Beard
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
| | - Poornima Kumar
- Center for Depression, Anxiety and Stress Disorders, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Isabelle M Rosso
- Center for Depression, Anxiety and Stress Disorders, McLean Hospital, Belmont, MA, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
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Kim EJ, Kim JJ. Neurocognitive effects of stress: a metaparadigm perspective. Mol Psychiatry 2023; 28:2750-2763. [PMID: 36759545 PMCID: PMC9909677 DOI: 10.1038/s41380-023-01986-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 01/26/2023] [Accepted: 01/27/2023] [Indexed: 02/11/2023]
Abstract
Stressful experiences, both physical and psychological, that are overwhelming (i.e., inescapable and unpredictable), can measurably affect subsequent neuronal properties and cognitive functioning of the hippocampus. At the cellular level, stress has been shown to alter hippocampal synaptic plasticity, spike and local field potential activity, dendritic morphology, neurogenesis, and neurodegeneration. At the behavioral level, stress has been found to impair learning and memory for declarative (or explicit) tasks that are based on cognition, such as verbal recall memory in humans and spatial memory in rodents, while facilitating those that are based on emotion, such as differential fear conditioning in humans and contextual fear conditioning in rodents. These vertically related alterations in the hippocampus, procedurally observed after subjects have undergone stress, are generally believed to be mediated by recurrently elevated circulating hypothalamic-pituitary-adrenal (HPA) axis effector hormones, glucocorticoids, directly acting on hippocampal neurons densely populated with corticosteroid receptors. The main purposes of this review are to (i) provide a synopsis of the neurocognitive effects of stress in a historical context that led to the contemporary HPA axis dogma of basic and translational stress research, (ii) critically reappraise the necessity and sufficiency of the glucocorticoid hypothesis of stress, and (iii) suggest an alternative metaparadigm approach to monitor and manipulate the progression of stress effects at the neural coding level. Real-time analyses can reveal neural activity markers of stress in the hippocampus that can be used to extrapolate neurocognitive effects across a range of stress paradigms (i.e., resolve scaling and dichotomous memory effects issues) and understand individual differences, thereby providing a novel neurophysiological scaffold for advancing future stress research.
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Affiliation(s)
- Eun Joo Kim
- Department of Psychology, University of Washington, Seattle, WA, 98195, USA
- School of Psychology, Korea University, Seoul, 02841, Republic of Korea
| | - Jeansok J Kim
- Department of Psychology, University of Washington, Seattle, WA, 98195, USA.
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Abstract
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.
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Petzold M, Bunzeck N. Impaired episodic memory in PTSD patients - A meta-analysis of 47 studies. Front Psychiatry 2022; 13:909442. [PMID: 36245884 PMCID: PMC9553990 DOI: 10.3389/fpsyt.2022.909442] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 08/16/2022] [Indexed: 11/13/2022] Open
Abstract
Episodic memory impairments beyond the traumatic event might be a characteristic hallmark of post-traumatic stress disorder (PTSD). Although several studies support such a claim, empirical findings are inconsistent. Therefore, we performed a random-effects meta-analysis including data from a total of 47 studies and 3,062 subjects. As main finding, we can show that PTSD patients show episodic memory deficits compared to all controls. This effect was significantly stronger for PTSD vs. non-traumatized healthy controls as compared to PTSD vs. traumatized controls without PTSD. Finally, episodic memory impairments in PTSD were most pronounced in verbal memory tests as compared to non-verbal memory tests. Our results provide new evidence that PTSD is characterized by impaired episodic long-term memory beyond the traumatic event, and these deficits are particularly pronounced in verbal memory. We will discuss our findings in the context of physiological, psychological and trauma related memory models. From a broader perspective, our findings may have implications for the treatment of PTSD by suggesting that the assessment and, if necessary, training of memory deficits could be included as part of diagnostics and psychotherapeutic treatment.
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Affiliation(s)
- Maria Petzold
- Department of Psychology, University of Lübeck, Lübeck, Germany
| | - Nico Bunzeck
- Department of Psychology, University of Lübeck, Lübeck, Germany.,Center of Brain, Behavior, and Metabolism, University of Lübeck, Lübeck, Germany
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Koch SBJ, van Ast VA, Kaldewaij R, Hashemi MM, Zhang W, Klumpers F, Roelofs K. Larger dentate gyrus volume as predisposing resilience factor for the development of trauma-related symptoms. Neuropsychopharmacology 2021; 46:1283-1292. [PMID: 33479507 PMCID: PMC8134447 DOI: 10.1038/s41386-020-00947-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 12/16/2020] [Indexed: 12/17/2022]
Abstract
Early interventions to improve resilience require the identification of objective risk biomarkers for PTSD symptom development. Although altered hippocampal and amygdala volumes are consistently observed in PTSD, it remains currently unknown whether they represent a predisposing vulnerability factor for PTSD symptom development or an acquired consequence of trauma exposure and/or the disorder. We conducted a longitudinal, prospective study in 210 police recruits at high risk for trauma exposure (56 females(26.7%); mean[SD] age = 24.02[5.19]). Structural MRI scans and trauma-related symptom severity were assessed at pre-trauma baseline and at 16-month follow-up. Between assessments, police recruits were exposed to various potentially traumatic events during their police training. Police recruits reported a significant increase in police-related trauma exposure and stress-related symptoms between assessments. Smaller hippocampal left dentate gyrus (DG) volumes at baseline predicted increase in self-reported PTSD symptoms (B[SE] = -0.21[0.08], p = 0.011), stress symptoms (B[SE] = -0.16[0.07], p = 0.024) and negative affect (B[SE] = -0.21[0.07], p = 0.005) upon trauma exposure. Amount of police-related trauma exposure between assessments was positively associated with an increase in left basal amygdala nucleus volume (B[SE] = 0.11[0.05], p = 0.026). Taken together, smaller DG-volumes pre-trauma may represent a predisposing neurobiological vulnerability factor for development of trauma-related symptoms. On the other hand, amount of trauma exposure between assessments was positively associated with increased amygdala basal nucleus volume, suggesting acquired neural effects. These findings suggest that preventive interventions for PTSD aimed at improving resilience could be targeted at increasing DG-volume and potentially its functioning.
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Affiliation(s)
- Saskia B J Koch
- Donders Institute, Centre for Cognitive Neuroimaging, Radboud University, Nijmegen, The Netherlands.
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands.
| | - Vanessa A van Ast
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Reinoud Kaldewaij
- Donders Institute, Centre for Cognitive Neuroimaging, Radboud University, Nijmegen, The Netherlands
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Mahur M Hashemi
- Donders Institute, Centre for Cognitive Neuroimaging, Radboud University, Nijmegen, The Netherlands
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Wei Zhang
- Donders Institute, Centre for Cognitive Neuroimaging, Radboud University, Nijmegen, The Netherlands
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Floris Klumpers
- Donders Institute, Centre for Cognitive Neuroimaging, Radboud University, Nijmegen, The Netherlands
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Karin Roelofs
- Donders Institute, Centre for Cognitive Neuroimaging, Radboud University, Nijmegen, The Netherlands
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
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Basavaraju R, France J, Maas B, Brickman AM, Flory JD, Szeszko PR, Yehuda R, Neria Y, Rutherford BR, Provenzano FA. Right parahippocampal volume deficit in an older population with posttraumatic stress disorder. J Psychiatr Res 2021; 137:368-375. [PMID: 33761425 DOI: 10.1016/j.jpsychires.2021.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/03/2021] [Accepted: 03/05/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Posttraumatic Stress Disorder (PTSD) is an increasingly prevalent condition among older adults and may escalate further as the general population including veterans from recent conflicts grow older. Despite growing evidence of higher medical comorbidity, cognitive impairment and dementia, and disability in older individuals with PTSD, there are very few studies examining brain cortical structure in this population. Hence, we examined cortical volumes in a cross-sectional study of veterans and civilians aged ≥50 years, of both sexes and exposed to trauma (interpersonal, combat, non-interpersonal). METHODS Cortical volumes were obtained from T1-weighted structural MRI and compared between individuals with PTSD and Trauma Exposed Healthy Controls (TEHC) adjusting for age, sex, estimated intracranial volume, depression severity, and time elapsed since trauma exposure. RESULTS The PTSD group (N = 55) had smaller right parahippocampal gyrus compared to TEHC (N = 36), corrected p(pFWER) = 0.034, with an effect size of 0.75 (Cohen's d), with no significant group differences in other cortical areas. CONCLUSIONS These findings are different from the structural brain findings reported in studies in younger age groups (larger parahippocampal volume in PTSD patients), suggesting a possible significant change in brain structure as PTSD patients age. These results need replication in longitudinal studies across the age-span to test whether they are neuroanatomical markers representing disease vulnerability, trauma resilience or pathological neurodegeneration associated with cognitive impairment and dementia.
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Affiliation(s)
- Rakshathi Basavaraju
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, Columbia University Medical Center, USA.
| | - Jeanelle France
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, Columbia University Medical Center, USA.
| | - Benjamin Maas
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, Columbia University Medical Center, USA.
| | - Adam M Brickman
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, G.H. Sergievsky Center, Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, USA.
| | - Janine D Flory
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, USA.
| | - Philip R Szeszko
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, NY, USA; James J. Peters VA Medical Center, Bronx, NY, USA.
| | - Rachel Yehuda
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, USA.
| | - Yuval Neria
- Department of Psychiatry, Columbia University Medical Center & New York State Psychiatric Institute, USA.
| | - Bret R Rutherford
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons & New York State Psychiatric Institute, USA.
| | - Frank A Provenzano
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, Columbia University Medical Center, USA.
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Bremner JD, Hoffman M, Afzal N, Cheema FA, Novik O, Ashraf A, Brummer M, Nazeer A, Goldberg J, Vaccarino V. The environment contributes more than genetics to smaller hippocampal volume in Posttraumatic Stress Disorder (PTSD). J Psychiatr Res 2021; 137:579-588. [PMID: 33168198 PMCID: PMC8345282 DOI: 10.1016/j.jpsychires.2020.10.042] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Studies using structural magnetic resonance imaging (MRI) volumetrics showed smaller hippocampal volume in patients with post-traumatic stress disorder (PTSD). These studies were cross-sectional and did not address whether smaller volume is secondary to stress-induced damage, or whether pre-existing factors account for the findings. The purpose of this study was to use a co-twin case control design to assess the relative contribution of genetic and environmental factors to hippocampal volume in PTSD. METHODS Monozygotic (N = 13 pairs) and dizygotic (N = 21 pairs) twins with a history of Vietnam Era military service, where one brother went to Vietnam and developed PTSD, while his brother did not go to Vietnam or develop PTSD, underwent MR imaging of the brain. Structural MRI scans were used to manually outline the left and right hippocampus on multiple coronal slices, add the areas and adjust for slice thickness to determine hippocampal volume. RESULTS Twins with Vietnam combat-related PTSD had a mean 11% smaller right hippocampal volume in comparison to their twin brothers without combat exposure or PTSD (p < .05). There was no significant interaction by zygosity, suggesting that this was not a predisposing risk factor or genetic effect. CONCLUSIONS These findings are consistent with smaller hippocampal volume in PTSD, and suggest that the effects are primarily due to environmental effects such as the stress of combat.
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Affiliation(s)
- J. Douglas Bremner
- Departments of Psychiatry and Behavioral Sciences, USA, Radiology, and Medicine (Cardiology), USA, Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA, Corresponding author. Dept of Psychiatry & Behavioral Sciences, Emory University School of Medicine, 12 Executive Park Dr NE, USA. (J.D. Bremner)
| | | | - Nadeem Afzal
- Departments of Psychiatry and Behavioral Sciences, USA
| | - Faiz A. Cheema
- Departments of Psychiatry and Behavioral Sciences, USA, The Vietnam Era Twin Registry, Seattle Veterans Administration Epidemiology Research, USA
| | - Olga Novik
- Departments of Psychiatry and Behavioral Sciences, USA, The Vietnam Era Twin Registry, Seattle Veterans Administration Epidemiology Research, USA
| | - Ali Ashraf
- Departments of Psychiatry and Behavioral Sciences, USA
| | | | - Ahsan Nazeer
- Departments of Psychiatry and Behavioral Sciences, USA
| | - Jack Goldberg
- Information Center and Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Viola Vaccarino
- Emory University School of Medicine, Atlanta GA; Atlanta VAMC, Decatur, GA, USA, The Vietnam Era Twin Registry, Seattle Veterans Administration Epidemiology Research, USA
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Pfeiffer JR, Bustamante AC, Kim GS, Armstrong D, Knodt AR, Koenen KC, Hariri AR, Uddin M. Associations between childhood family emotional health, fronto-limbic grey matter volume, and saliva 5mC in young adulthood. Clin Epigenetics 2021; 13:68. [PMID: 33789736 PMCID: PMC8010979 DOI: 10.1186/s13148-021-01056-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 03/22/2021] [Indexed: 11/13/2022] Open
Abstract
Background Poor family emotional health (FEH) during childhood is prevalent and impactful, and likely confers similar neurodevelopmental risks as other adverse social environments. Pointed FEH study efforts are underdeveloped, and the mechanisms by which poor FEH are biologically embedded are unclear. The current exploratory study examined whether variability in 5-methyl-cytosine (5mC) and fronto-limbic grey matter volume may represent pathways through which FEH may become biologically embedded. Results In 98 university students aged 18–22 years, retrospective self-reported childhood FEH was associated with right hemisphere hippocampus (b = 10.4, p = 0.005), left hemisphere amygdala (b = 5.3, p = 0.009), and right hemisphere amygdala (b = 5.8, p = 0.016) volumes. After pre-processing and filtering to 5mC probes correlated between saliva and brain, analyses showed that childhood FEH was associated with 49 5mC principal components (module eigengenes; MEs) (prange = 3 × 10–6 to 0.047). Saliva-derived 5mC MEs partially mediated the association between FEH and right hippocampal volume (Burlywood ME indirect effect b = − 111, p = 0.014), and fully mediated the FEH and right amygdala volume relationship (Pink4 ME indirect effect b = − 48, p = 0.026). Modules were enriched with probes falling in genes with immune, central nervous system (CNS), cellular development/differentiation, and metabolic functions. Conclusions Findings extend work highlighting neurodevelopmental variability associated with adverse social environment exposure during childhood by specifically implicating poor FEH, while informing a mechanism of biological embedding. FEH-associated epigenetic signatures could function as proxies of altered fronto-limbic grey matter volume associated with poor childhood FEH and inform further investigation into primarily affected tissues such as endocrine, immune, and CNS cell types. Supplementary Information The online version contains supplementary material available at 10.1186/s13148-021-01056-y.
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Affiliation(s)
- J R Pfeiffer
- Department of Psychology, University of Illinois at Urbana-Champaign, Urbana, IL, USA.,Carl R. Woese Institute for Genomic Biology, Urbana, IL, USA
| | - Angela C Bustamante
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Grace S Kim
- Medical Scholars Program, University of Illinois College of Medicine, Urbana, IL, USA
| | - Don Armstrong
- Carl R. Woese Institute for Genomic Biology, Urbana, IL, USA
| | - Annchen R Knodt
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA.,Laboratory of NeuroGenetics, Duke University, Durham, NC, USA
| | - Karestan C Koenen
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | - Ahmad R Hariri
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA.,Laboratory of NeuroGenetics, Duke University, Durham, NC, USA
| | - Monica Uddin
- Genomics Program, College of Public Health, University of South Florida, 3720 Spectrum Blvd., Suite 304, Tampa, FL, USA.
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11
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Assari S. Race, Ethnicity, Family Socioeconomic Status, and Children's Hippocampus Volume. ACTA ACUST UNITED AC 2020; 5:25-45. [PMID: 33103023 DOI: 10.22158/rhs.v5n4p25] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Introduction The hippocampus has a significant role in memory, learning, and cognition. Although hippocampal size is highly susceptible to family socioeconomic status (SES) and associated stress, very little is known on racial and ethnic group differences in the effects of SES indicators on hippocampus volume among American children. Purpose This study explored the multiplicative effects of race, ethnicity, and family SES on hippocampus volume among American children. Methods Using data from the Adolescent Brain Cognitive Development (ABCD), we analyzed the functional Magnetic Resonance Imaging (fMRI) data of 9390 9-10 years old children. The main outcome was hippocampus volume. The predictor was parental education. Subjective family SES was the independent variable. Age, sex, and marital status were the covariates. Racial and ethnic group membership were the moderators. To analyze the data, we used regression models. Results High subjective family SES was associated with larger hippocampus volume. This effect was significantly larger for Whites than Black families. Conclusions The effect of subjective family SES on children's hippocampus volume is weaker in Black than White families.
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Affiliation(s)
- Shervin Assari
- Department of Family Medicine, College of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90059, USA.,Department of Urban Public Health, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90059, USA
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Lou T, Ma J, Wang Z, Terakoshi Y, Lee CY, Asher G, Cao L, Chen Z, Sakurai K, Liu Q. Hyper-Activation of mPFC Underlies Specific Traumatic Stress-Induced Sleep-Wake EEG Disturbances. Front Neurosci 2020; 14:883. [PMID: 32973436 PMCID: PMC7461881 DOI: 10.3389/fnins.2020.00883] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 07/28/2020] [Indexed: 11/28/2022] Open
Abstract
Sleep disturbances have been recognized as a core symptom of post-traumatic stress disorders (PTSD). However, the neural basis of PTSD-related sleep disturbances remains unclear. It has been challenging to establish the causality link between a specific brain region and traumatic stress-induced sleep abnormalities. Here, we found that single prolonged stress (SPS) could induce acute changes in sleep/wake duration as well as short- and long-term electroencephalogram (EEG) alterations in the isogenic mouse model. Moreover, the medial prefrontal cortex (mPFC) showed persistent high number of c-fos expressing neurons, of which more than 95% are excitatory neurons, during and immediately after SPS. Chemogenetic inhibition of the prelimbic region of mPFC during SPS could specifically reverse the SPS-induced acute suppression of delta power (1–4 Hz EEG) of non-rapid-eye-movement sleep (NREMS) as well as most of long-term EEG abnormalities. These findings suggest a causality link between hyper-activation of mPFC neurons and traumatic stress-induced specific sleep–wake EEG disturbances.
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Affiliation(s)
- Tingting Lou
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Japan
| | - Jing Ma
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Japan.,HIT Center for Life Sciences (HCLS), School of Life Sciences and Technology, Harbin Institute of Technology, Harbin, China
| | - Zhiqiang Wang
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Japan.,HIT Center for Life Sciences (HCLS), School of Life Sciences and Technology, Harbin Institute of Technology, Harbin, China
| | - Yuka Terakoshi
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Japan
| | - Chia-Ying Lee
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Japan
| | - Greg Asher
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Japan
| | - Liqin Cao
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Japan
| | - Zhiyu Chen
- National Institute of Biological Sciences (NIBS), Beijing, China.,Tsinghua Institute of Multidisciplinary Biomedical Research (TIMBR), Tsinghua University, Beijing, China
| | - Katsuyasu Sakurai
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Japan
| | - Qinghua Liu
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Japan.,National Institute of Biological Sciences (NIBS), Beijing, China.,Tsinghua Institute of Multidisciplinary Biomedical Research (TIMBR), Tsinghua University, Beijing, China
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13
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Family Income Mediates the Effect of Parental Education on Adolescents' Hippocampus Activation During an N-Back Memory Task. Brain Sci 2020; 10:brainsci10080520. [PMID: 32764344 PMCID: PMC7464386 DOI: 10.3390/brainsci10080520] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/23/2020] [Accepted: 08/03/2020] [Indexed: 12/11/2022] Open
Abstract
Introduction: Hippocampus, a medial temporal lobe structure, has significant implications in memory formation and learning. Although hippocampus activity is believed to be affected by socioeconomic status (SES), limited knowledge exists on which SES indicators influence hippocampus function. Purpose: This study explored the separate and combined effects of three SES indicators, namely parental education, family income, and neighborhood income, on adolescents’ hippocampus activation during an N-Back memory task. As some of the effects of parental education may be through income, we also tested if the effect of parental education on hippocampus activation during our N-Back memory task is mediated by family or neighborhood income. Methods: The Adolescent Brain Cognitive Development (ABCD) study is a national multi-center investigation of American adolescents’ brain development. Functional magnetic resonance imaging (fMRI) data of a total sample of 3067 9–10-year-old adolescents were used. The primary outcome was left- hippocampus activation during the N-Back memory task (mean beta weight for N-Back run 1 2 back versus 0 back contrast in left hippocampus). The independent variable was parental education. Family income and neighborhood income were two possible mediators. Age, sex, and marital status were the covariates. To test mediation, we used hierarchical linear regression models first without and then with our mediators. Full mediation was defined according to Kenny. The Sobel test was used to confirm statistical mediation. Results: In the absence of family and neighborhood income in the model, higher parental educational attainment was associated with lower level of left hippocampus activation during the N-Back memory task. This effect was significant while age, sex, and marital status were controlled. The association between parental educational attainment and hippocampus activation during the N-Back memory task was no more significant when we controlled for family and neighborhood income. Instead, family income was associated with hippocampus activation during the N-Back memory task. These findings suggested that family income fully mediates the effect of parental educational attainment on left hippocampus activation during the N-Back memory task. Conclusions: The effect of parental educational attainment on adolescents’ hippocampus activation during an N-Back memory task is fully explained by family income. That means low family income is why adolescents with low-educated parents show highlighted hippocampus activation during an N-Back memory task. Given the central role of the hippocampus in learning and memory and as income is a modifiable factor by tax and economic policies, income-redistribution policies, fair taxation, and higher minimum wage may have implications for promotion of adolescent equality and social justice. There is a need to focus on family-level economic needs across all levels of neighborhood income.
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14
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Gosnell SN, Oh H, Schmidt J, Oldham J, Fowler JC, Patriquin M, Ress D, Salas R. Right temporal pole volume reduction in PTSD. Prog Neuropsychopharmacol Biol Psychiatry 2020; 100:109890. [PMID: 32084508 DOI: 10.1016/j.pnpbp.2020.109890] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 01/24/2020] [Accepted: 02/16/2020] [Indexed: 12/12/2022]
Abstract
Previous magnetic resonance imaging studies of post-traumatic stress disorder (PTSD) have reported cortical volume alterations in the parahippocampal, anterior cingulate cortex, and temporal pole. It is unclear, however, if these cortical regions are specifically associated with PTSD or associated with common comorbidities. Here, we present the result of cortical volume differences between PTSD and healthy and psychiatric controls. In this study, healthy controls (n = 67) were matched for demographic characteristics (age, sex, race) and psychiatric controls (n = 67) were matched for demographic characteristics plus all other psychiatric diagnoses (past and current) to a group of PTSD patients (N = 67). We assessed group differences of 34 bilateral cortical structure volumes using statistically defined brain regions-of-interest from FreeSurfer between PTSD patients and healthy controls. We found 10 regions to be significantly different between PTSD and healthy controls and analyzed the group differences between PTSD and psychiatric controls within these regions. The right temporal pole volume in PTSD was found to be significantly smaller than both healthy and psychiatry controls. Our finding suggests only right temporal pole volume reduction is specifically associated with PTSD, and also highlights the need for using appropriate controls in psychiatry research.
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Affiliation(s)
- Savannah N Gosnell
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA; Michael E DeBakey VA Medical Center, Houston, TX, USA; Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA
| | - Hyuntaek Oh
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA; The Menninger Clinic, Houston, TX, USA
| | - Jake Schmidt
- EOG Resources INC - Data Science, Houston, TX, USA
| | - John Oldham
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA; The Menninger Clinic, Houston, TX, USA
| | - J Christopher Fowler
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Michelle Patriquin
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA; The Menninger Clinic, Houston, TX, USA
| | - David Ress
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA
| | - Ramiro Salas
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA; Michael E DeBakey VA Medical Center, Houston, TX, USA; Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA; The Menninger Clinic, Houston, TX, USA.
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15
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Gosnell SN, Meyer MJ, Jennings C, Ramirez D, Schmidt J, Oldham J, Salas R. Hippocampal Volume in Psychiatric Diagnoses: Should Psychiatry Biomarker Research Account for Comorbidities? CHRONIC STRESS 2020; 4:2470547020906799. [PMID: 32440605 PMCID: PMC7219869 DOI: 10.1177/2470547020906799] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 01/24/2020] [Indexed: 12/26/2022]
Abstract
Background Many research papers claim that patients with specific psychiatric disorders
(major depressive disorder, posttraumatic stress disorder, borderline
personality disorder, alcohol use disorder, and others) have smaller
hippocampi, but most of those reports compared patients to healthy controls.
We hypothesized that if psychiatrically matched controls (psychiatric
control, matched for demographics and psychiatric comorbidities) were used,
much of the biomarker literature in psychiatric research would not
replicate. We used hippocampus and amygdala volume only as examples, as
these are very commonly replicated results in psychiatry biomarker research.
We propose that psychiatry biomarker research could benefit from using
psychiatric controls, as the use of healthy controls results in data that
are not disorder-specific. Method Hippocampus/amygdala volumes were compared between major depressive disorder,
sex-/age-/race-matched healthy control, and psychiatric control
(N = 126/group). Similar comparisons were performed for posttraumatic stress
disorder (N = 67), borderline personality disorder (N = 111), and alcohol
use disorder (N = 136). Results Major depressive disorder patients had smaller left
(p = 8.79 × 10−3) and right (p = 3.13 × 10−3)
hippocampal volumes than healthy control. Posttraumatic stress disorder had
smaller left (p = 0.018) and right (p = 8.64 × 10−4) hippocampi
than healthy control. Borderline personality disorder had smaller right
hippocampus (p = 7.90 × 10−3) and amygdala
(p = 1.49 × 10−3) than healthy control. Alcohol use disorder
had smaller right hippocampus (p = 0.034) and amygdala (p = .024) than
healthy control. No differences were found between any of the four
diagnostic groups and psychiatric control. Conclusion When psychiatric controls were used, there was no difference in hippocampal
or amygdalar volume between any of the diagnoses studied and controls. This
strategy (keeping all possible relevant variables matched between
experimental groups) has been used to advance science for hundreds of years,
and we propose should also be used in biomarker psychiatry research.
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Affiliation(s)
- Savannah N Gosnell
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.,Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA
| | - Matthew J Meyer
- School of Medicine, Baylor College of Medicine, Houston, TX, USA
| | | | - Danna Ramirez
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA
| | | | - John Oldham
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.,The Menninger Clinic, Houston, TX, USA
| | - Ramiro Salas
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.,Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA.,The Menninger Clinic, Houston, TX, USA.,Center for Translational Research on Inflammatory Diseases, Michael E DeBakey VA Medical Center, Houston, TX, USA
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16
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Berman Z, Assaf Y, Tarrasch R, Joel D. Macro- and microstructural gray matter alterations in sexually assaulted women. J Affect Disord 2020; 262:196-204. [PMID: 31662209 DOI: 10.1016/j.jad.2019.10.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 06/13/2019] [Accepted: 10/14/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Studies with trauma survivors documented structural alterations in brain regions involved in posttraumatic stress disorder (PTSD) neurocircuitry. Nonetheless, whether such alterations exist in women who were sexually assaulted in adulthood is not clear. We investigated the macro- and microstructure of key regions implicated in PTSD pathophysiology, namely the amygdala, hippocampus, anterior cingulate cortex (ACC), and insula, in this population. METHODS Thirty-eight sexually assaulted women (PTSD, n = 25; non-PTSD, n = 13) and 24 non-exposed controls (NEC) were studied with T1- and diffusion-weighted MRI. Gray matter volume, mean diffusivity (MD), and fractional anisotropy (FA) were calculated for each region. Between-group comparisons and correlations with PTSD symptom severity were performed. RESULTS Volumetric analyses revealed lower amygdala and insula volumes in the PTSD compared with the non-PTSD group. In contrast, altered microstructure was observed in both traumatized groups compared with NEC, including higher MD and lower FA in the right amygdala, and higher FA in the ACC bilaterally. Finally, the non-PTSD group had higher FA in the right insula compared with the PTSD group. PTSD symptom severity was correlated with amygdala and insula volumes, as well as with hippocampal FA and MD. LIMITATIONS Sample size may have led to reduced statistical power. CONCLUSIONS Sexual assault and the development of PTSD in women are linked with structural alterations in key regions implicated in PTSD following other trauma types (e.g., combat), though hippocampal and ACC volumes were preserved. Further studies are needed to disentangle the unique contribution of trauma type and of sex/gender to these observations.
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Affiliation(s)
- Zohar Berman
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel; Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Yaniv Assaf
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel; Department of Neurobiology, Faculty of Life Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Ricardo Tarrasch
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel; Jaime and Joan Constantiner School of Education, Tel Aviv University, Tel Aviv, Israel
| | - Daphna Joel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel; School of Psychological Sciences, Faculty of Social Sciences, Tel Aviv University, Tel Aviv, Israel.
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17
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Wang W, Sun H, Su X, Tan Q, Zhang S, Xia C, Li L, Kemp GJ, Yue Q, Gong Q. Increased right amygdala metabolite concentrations in the absence of atrophy in children and adolescents with PTSD. Eur Child Adolesc Psychiatry 2019; 28:807-817. [PMID: 30392119 DOI: 10.1007/s00787-018-1241-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 10/20/2018] [Indexed: 02/05/2023]
Abstract
Previous studies have shown that posttraumatic stress disorder (PTSD) is associated with dysfunction of the limbic system, in which the amygdala plays an important role. The purpose of this study was to evaluate whether the neurochemical concentrations assessed by proton magnetic resonance spectroscopy (1H-MRS) in the amygdala are abnormal in children and adolescents with PTSD. Twenty-eight pediatric PTSD patients (11 boys, 17 girls) and 24 matched trauma-exposed control subjects (9 boys, 15 girls) underwent magnetic resonance brain imaging and 1H-MRS of the bilateral amygdalae. The concentrations of N-acetylaspartate (NAA), myo-inositol (mI), total creatine (tCr) and total choline (tCho) in the right amygdala were significantly increased in PTSD patients compared with trauma-exposed control subjects. There were significant group-by-age interactions in the left amygdala NAA and right amygdala mI concentrations: older pediatric patients with PTSD had higher left amygdala NAA concentration and younger patients had higher right amygdala mI concentration than trauma-exposed control subjects. There was also a significant correlation between right mI concentration and time since trauma in PTSD patients. Finally, there was significant group-by-age interaction in the left amygdala volume; intragroup analysis revealed that the right amygdala volume was significantly lower than the left in the PTSD group, but not in the control group. These neurochemical abnormalities of the amygdala may indicate that dysfunctions of both neurons and glial cells are involved in the pathology of pediatric PTSD.
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Affiliation(s)
- Weina Wang
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Huaiqiang Sun
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Xiaorui Su
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Qiaoyue Tan
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Simin Zhang
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Chunchao Xia
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Lingjiang Li
- Mental Health Institute, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Graham J Kemp
- Liverpool Magnetic Resonance Imaging Centre (LiMRIC) and Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Qiang Yue
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, China.
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China.
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Abstract
Posttraumatic stress disorder (PTSD) differs from other anxiety disorders in that experience of a traumatic event is necessary for the onset of the disorder. The condition runs a longitudinal course, involving a series of transitional states, with progressive modification occurring with time. Notably, only a small percentage of people that experience trauma will develop PTSD. Risk factors, such as prior trauma, prior psychiatric history, family psychiatric history, peritraumatic dissociation, acute stress symptoms, the nature of the biological response, and autonomic hyperarousal, need to be considered when setting up models to predict the course of the condition. These risk factors influence vulnerability to the onset of PTSD and its spontaneous remission. In the majority of cases, PTSD is accompanied by another condition, such as major depression, an anxiety disorder, or substance abuse. This comorbidity can also complicate the course of the disorder and raises questions about the role of PTSD in other psychiatric conditions. This article reviews what is known about the emergence of PTSD following exposure to a traumatic event using data from clinical studies.
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Affiliation(s)
- A C McFarlane
- Department of Psychiatry, University of Adelaide, Queen Elizabeth Hospital, Woodville, South Australia, Australia.
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19
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Abnormal metabolite concentrations and amygdala volume in patients with recent-onset posttraumatic stress disorder. J Affect Disord 2018; 241:539-545. [PMID: 30153637 DOI: 10.1016/j.jad.2018.08.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 07/08/2018] [Accepted: 08/07/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Previous psychoradiological studies of posttraumatic stress disorder (PTSD) were mainly of patients at a chronic stage, focusing on brain regions outside the amygdala. The goals of this study were to investigate the early biochemical and structural changes of anterior cingulate cortex (ACC) and amygdala in patients with PTSD and to explore their relationships. METHODS Seventy-eight drug-naïve PTSD subjects and 71 non-PTSD age- and sex-matched control subjects were enrolled, all of whom had suffered the same earthquake about one year before. Single-voxel proton magnetic resonance spectroscopy (1H-MRS) was performed and absolute metabolite concentrations in ACC and bilateral amygdalae were estimated with LCModel. Bilateral amygdalae were manually outlined and their volumes were calculated and corrected for the total intracranial volume. RESULTS The PTSD group showed significantly increased N-acetylaspartate (NAA) concentration in the ACC, increased creatine (Cr) concentration in the left amygdala, and increased myo-inositol (mI) concentration in the right amygdala, compared to non-PTSD controls. The NAA concentration in ACC was negatively correlated with the time since trauma. The PTSD group showed significantly decreased volumes of bilateral amygdalae compared to non-PTSD controls, but amygdala volumes were not correlated with metabolite concentrations. LIMITATIONS Longitudinal studies are needed to explore the metabolic and structural changes of PTSD at different stages. The volume of ACC was not measured. CONCLUSIONS This concurrent increase in some metabolite concentrations and decrease of amygdala volumes may represent a pattern of biochemical and morphological changes in recent-onset PTSD which is different from that reported in chronic PTSD.
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20
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Pagani M, Castelnuovo G, Daverio A, La Porta P, Monaco L, Ferrentino F, Chiaravalloti A, Fernandez I, Di Lorenzo G. Metabolic and Electrophysiological Changes Associated to Clinical Improvement in Two Severely Traumatized Subjects Treated With EMDR-A Pilot Study. Front Psychol 2018; 9:475. [PMID: 29713297 PMCID: PMC5911467 DOI: 10.3389/fpsyg.2018.00475] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 03/21/2018] [Indexed: 01/23/2023] Open
Abstract
Neuroimaging represents a powerful tool to investigate the neurobiological correlates of Eye Movements Desensitization and Reprocessing (EMDR). The impact of EMDR on cortical and sub-cortical brain regions has been proven by several investigations demonstrating a clear association between symptoms disappearance and changes in cortical structure and functionality. The aim of this study was to assess by electroencephalography (EEG) and for the first time by positron emission tomography (PET) the changes occurring after EMDR therapy in two cases of psychological trauma following brain concussion and comatose state due to traffic accident. A 28 and a 29 years old men underwent extensive neuropsychological examination, which investigated: (i) categorical and phonological verbal fluency; (ii) episodic verbal memory; (iii) executive functions; (iv) visuospatial abilities; (v) attention and working memory as well as clinical assessment by means of psychopathological tests (CAPS, IES, BDI, SCL90R, and DES). They were then treated by eight sessions of EMDR. During the first session EEG monitoring was continuously performed and 18F-FDG PET scans, depicting brain metabolism, were acquired at rest within a week (T0). After the last session, in which the two clients were considered to be symptoms-free, neuropsychological, clinical, and PET assessment were repeated (T1). PET data were semi-quantitatively compared to a group of 18 normal controls, as for EEG the preferential cortical activations were disclosed by thresholding the individual z-score to a p < 0.05. There was a significant improvement in clinical condition for both clients associated with a significant decrease in CAPS scores. IES and BDI were found to be pathological at T0 and improved at T1 in only one subject. Visuo-constructive abilities and abstract reasoning improved after EMDR in both subjects. As for EEG, the most striking changes occurred in fronto-temporal-parietal cortex in subject 1 while subject 2 showed only minor changes. PET showed more pronounced metabolism in orbito-frontal and prefrontal cortex at T1 as compared to T0 in both subjects. In conclusion both clients had a clear clinical improvement in PTSD symptoms associated with metabolic and electrophysiological changes in limbic and associative cortex, respectively, highlighting the value of EMDR also in such extreme pathological conditions.
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Affiliation(s)
- Marco Pagani
- Institute of Cognitive Sciences and Technologies, Consiglio Nazionale delle Ricerche, Rome, Italy
| | - Gianluca Castelnuovo
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Ospedale San Giuseppe, Verbania, Italy.,Department of Psychology, Universitá Cattolica del Sacro Cuore, Milan, Italy
| | - Andrea Daverio
- Laboratory of Psychophysiology, Chair of Psychiatry, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.,Chair of Psychiatry, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.,Psychiatry and Clinical Psychology Unit, Department of Neurosciences, Fondazione Policlinico "Tor Vergata", Rome, Italy
| | | | - Leonardo Monaco
- Laboratory of Psychophysiology, Chair of Psychiatry, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.,Chair of Psychiatry, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Fabiola Ferrentino
- Laboratory of Psychophysiology, Chair of Psychiatry, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.,Chair of Psychiatry, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Agostino Chiaravalloti
- Department of Nuclear Medicine, University of Rome "Tor Vergata", Rome, Italy.,IRCCS Neuromed, Pozzilli, Italy
| | | | - Giorgio Di Lorenzo
- Laboratory of Psychophysiology, Chair of Psychiatry, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.,Chair of Psychiatry, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.,Psychiatry and Clinical Psychology Unit, Department of Neurosciences, Fondazione Policlinico "Tor Vergata", Rome, Italy
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21
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Milani ACC, Foerster B, Cogo-Moreira H, Farias TMDB, Salido F, Carrete H, Mello MF, Jackowski AP. A Longitudinal 1H-MRS Study of the Anterior Cingulate Gyrus in Child and Adolescent Victims of Multiple Forms of Violence. CHRONIC STRESS 2018; 2:2470547018763359. [PMID: 32440581 PMCID: PMC7219876 DOI: 10.1177/2470547018763359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 02/13/2018] [Indexed: 11/16/2022]
Abstract
Background The anterior cingulate gyrus is involved in the extinction of conditioned fear responses and is implicated in the pathophysiology of posttraumatic stress disorder. The expression of N-acetylaspartate and choline may be altered in the anterior cingulate gyri of children and adolescents with posttraumatic stress disorder. Methods We conducted a proton magnetic resonance spectroscopy study, longitudinally investigating N-acetylaspartate/creatine and choline/creatine ratios in the anterior cingulate gyri of children and adolescents, aged from 8 to 12 years, who had been exposed to various forms of violence or were non-trauma control. Based on baseline posttraumatic stress symptoms ("sub-clinical"), participants were divided into two groups: posttraumatic stress (n = 19) and control (n = 19). Proton magnetic resonance spectroscopy scans were repeated a year later in trauma exposed participants. Trauma assessments included the Childhood Trauma Questionnaire. Results Exploratory analyses revealed a significant negative correlation between follow-up anterior cingulate gyrus N-acetylaspartate/creatine and Childhood Trauma Questionnaire scores in posttraumatic stress (r = -0.62, p = 0.01) but not control group (r = 0.16, p = 0.66). However, we found no significant differences in anterior cingulate gyrus N-acetylaspartate/creatine or choline/creatine between posttraumatic stress and control. In addition, there were no significant effects of time, group, or time-by-group interactions. Conclusions In this pediatric population, anterior cingulate gyrus N-acetylaspartate/creatine and choline/creatine were not affected by posttraumatic stress and on average these metabolites remained stable over time. However, the study provided intriguing preliminary evidence revealing that participants suffering from posttraumatic stress at baseline have shown, a year later, reduced anterior cingulate gyrus N-acetylaspartate/creatine among those with high trauma severity. This pilot evidence warrants replication in future studies to confirm these findings and to determine the longitudinal effects and interactions between childhood posttraumatic stress and trauma.
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Affiliation(s)
| | - Bernd Foerster
- 1Department of Psychiatry, Federal University of São Paulo, Sao Paulo, Brazil
| | - Hugo Cogo-Moreira
- 1Department of Psychiatry, Federal University of São Paulo, Sao Paulo, Brazil
| | | | - Francisco Salido
- 2Department of Radiology, Federal University of São Paulo, Sao Paulo, Brazil
| | - Henrique Carrete
- 2Department of Radiology, Federal University of São Paulo, Sao Paulo, Brazil
| | - Marcelo Feijo Mello
- 1Department of Psychiatry, Federal University of São Paulo, Sao Paulo, Brazil
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22
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Bolsinger J, Seifritz E, Kleim B, Manoliu A. Neuroimaging Correlates of Resilience to Traumatic Events-A Comprehensive Review. Front Psychiatry 2018; 9:693. [PMID: 30631288 PMCID: PMC6315158 DOI: 10.3389/fpsyt.2018.00693] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 11/28/2018] [Indexed: 12/13/2022] Open
Abstract
Improved understanding of the neurobiological correlates of resilience would be an important step toward recognizing individuals at risk of developing post-traumatic stress disorder (PTSD) or other trauma-related diseases, enabling both preventative measures and individually tailored therapeutic approaches. Studies on vulnerability factors allow drawing conclusions on resilience. Structural changes of cortical and subcortical structures, as well as alterations in functional connectivity and functional activity, have been demonstrated to occur in individuals with PTSD symptoms. Relevant areas of interest are hippocampus, amygdala, insula, anterior cingulate cortex, and prefrontal cortex, as well as related brain networks, such as the default-mode, salience, and central executive network. This review summarizes the existing literature and integrates findings from cross-sectional study designs with two-group designs (trauma exposed individuals with and without PTSD), three-group designs (with an additional group of unexposed, healthy controls), twin-studies and longitudinal studies. In terms of structural findings, decreased hippocampal volume in PTSD individuals might be either a vulnerability factor or a result of trauma exposure, or both. Reduced anterior cingulate cortex and prefrontal cortex volumes seem to be predisposing factors for increased vulnerability. Regarding functional connectivity, increased amygdala connectivity has been demonstrated selectively in PTSD individuals, as well as increased default-mode-network and salience network connectivity. In terms of functional activity, increased amygdala and anterior cingulate cortex activities, and decreased prefrontal cortex activity as a response to external stimuli have been associated with higher vulnerability. Increased prefrontal cortex activity seemed to be a protective factor. Selecting adequate study designs, optimizing the diagnostic criteria, as well as differentiating between types of trauma and accounting for other factors, such as gender-specific differences, would be well-served in future research. Conclusions on potential preventative measures, as well as clinical applications, can be drawn from the present literature, but more studies are needed.
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Affiliation(s)
- Julia Bolsinger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital, University of Zurich, Zurich, Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital, University of Zurich, Zurich, Switzerland
| | - Birgit Kleim
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital, University of Zurich, Zurich, Switzerland.,Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Andrei Manoliu
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital, University of Zurich, Zurich, Switzerland
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Stevens JS, Reddy R, Kim YJ, van Rooij SJH, Ely TD, Hamann S, Ressler KJ, Jovanovic T. Episodic memory after trauma exposure: Medial temporal lobe function is positively related to re-experiencing and inversely related to negative affect symptoms. Neuroimage Clin 2017; 17:650-658. [PMID: 29204343 PMCID: PMC5709292 DOI: 10.1016/j.nicl.2017.11.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 10/31/2017] [Accepted: 11/18/2017] [Indexed: 12/18/2022]
Abstract
Hippocampal structure is particularly sensitive to trauma and other stressors. However, previous findings linking hippocampal function with trauma-related psychopathology have been mixed. Heterogeneity in psychological responses to trauma has not been considered with respect to hippocampal function and may contribute to mixed findings. To address these issues, we examined associations between data-driven symptom dimensions and episodic memory formation, a key function of the hippocampus, in a trauma-exposed sample. Symptom dimensions were defined using principal components analysis (PCA) in 3881 trauma-exposed African-American women recruited from primary care waiting rooms of a large urban hospital. Hippocampal and amygdala function were subsequently investigated in an fMRI study of episodic memory formation in a subset of 54 women. Participants viewed scenes with neutral, negative, and positive content during fMRI, and completed a delayed cued recall task. PCA analysis produced five symptom dimensions interpreted as reflecting negative affect, somatic symptoms, re-experiencing, hyper-arousal, and numbing. Re-experiencing was the only symptom type associated with hippocampal function, predicting increased memory encoding-related activation in the hippocampus as well as the amygdala. In contrast, the negative affect component predicted lower amygdala activation for subsequently recalled scenes, and lower functional coupling with other important memory-related regions including the precuneus, inferior frontal gyrus, and occipital cortex. Symptom dimensions were not related to hippocampal volume. The fMRI findings for re-experiencing versus negative affect parallel differences in behavioral memory phenomena in PTSD versus MDD, and highlight a need for more complex models of trauma-related pathology.
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Affiliation(s)
- Jennifer S Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
| | - Renuka Reddy
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Ye Ji Kim
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Sanne J H van Rooij
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Timothy D Ely
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Stephan Hamann
- Department of Psychology, Emory University, Atlanta, GA, USA
| | - Kerry J Ressler
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA; Harvard Medical School, Boston, MA, USA; McLean Hospital, Belmont, MA, USA
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
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24
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Pagani M, Amann BL, Landin-Romero R, Carletto S. Eye Movement Desensitization and Reprocessing and Slow Wave Sleep: A Putative Mechanism of Action. Front Psychol 2017; 8:1935. [PMID: 29163309 PMCID: PMC5681964 DOI: 10.3389/fpsyg.2017.01935] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 10/19/2017] [Indexed: 12/22/2022] Open
Abstract
Eye Movement Desensitization and Reprocessing (EMDR) is considered highly efficacious for the treatment of Post-traumatic Stress Disorder and has proved to be a valid treatment approach with a wide range of applications. However, EMDR’s mechanisms of action is not yet fully understood. This is an active area of clinical and neurophysiological research, and several different hypotheses have been proposed. This paper discusses a conjecture which focuses on the similarity between the delta waves recorded by electroencephalography during Slow Wave Sleep (SWS) and those registered upon typical EMDR bilateral stimulation (eye movements or alternate tapping) during recurrent distressing memories of an emotionally traumatic event. SWS appears to have a key role in memory consolidation and in the reorganization of distant functional networks, as well as Eye Movements seem to reduce traumatic episodic memory and favor the reconsolidation of new associated information. The SWS hypothesis may put forward an explanation of how EMDR works, and is discussed also in light of other theories and neurobiological findings.
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Affiliation(s)
- Marco Pagani
- Institute of Cognitive Sciences and Technologies (CNR), Rome, Italy
| | - Benedikt L Amann
- Institut de Neuropsiquiatria i Addiccions, Centre Fòrum Research Unit, Parc de Salut Mar, Barcelona, Spain.,Department of Psychiatry, Hospital del Mar Medical Research Institute, Autonomous University of Barcelona, Barcelona, Spain.,Centro de Investigación Biomedica en Red de Salud Mental, Barcelona, Spain
| | - Ramon Landin-Romero
- Brain and Mind Centre and School of Psychology, The University of Sydney, Sydney, NSW, Australia.,ARC Centre of Excellence in Cognition and its Disorders, Sydney, NSW, Australia
| | - Sara Carletto
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
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25
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O'Doherty DCM, Tickell A, Ryder W, Chan C, Hermens DF, Bennett MR, Lagopoulos J. Frontal and subcortical grey matter reductions in PTSD. Psychiatry Res Neuroimaging 2017; 266:1-9. [PMID: 28549317 DOI: 10.1016/j.pscychresns.2017.05.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 05/12/2017] [Accepted: 05/19/2017] [Indexed: 12/18/2022]
Abstract
Post-traumatic stress disorder (PTSD) is characterised by a range of debilitating psychological, physical and cognitive symptoms. PTSD has been associated with grey matter atrophy in limbic and frontal cortical brain regions. However, previous studies have reported heterogeneous findings, with grey matter changes observed beyond limbic/frontal areas. Seventy-five adults were recruited from the community, 25 diagnosed with PTSD along with 25 healthy and 25 trauma exposed age and gender matched controls. Participants underwent clinical assessment and magnetic resonance imaging. The data-analyses method Voxel Based Morphometry (VBM) was used to estimate cortical grey matter volumes. When compared to both healthy and trauma exposed controls, PTSD subjects demonstrated decreased grey matter volumes within subcortical brain regions-including the hippocampus and amygdala-along with reductions in the anterior cingulate cortex, frontal medial cortex, middle frontal gyrus, superior frontal gyrus, paracingulate gyrus, and precuneus cortex. Significant negative correlations were found between total CAPS lifetime clinical scores/sub-scores and GM volume of both the PTSD and TC groups. GM volumes of the left rACC and right amygdala showed a significant negative correlation within PTSD diagnosed subjects.
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Affiliation(s)
- Daniel C M O'Doherty
- The University of Sydney, Brain and Mind Centre, 100 Mallett Street, Camperdown, NSW 2050, Australia.
| | - Ashleigh Tickell
- The University of Sydney, Brain and Mind Centre, 100 Mallett Street, Camperdown, NSW 2050, Australia
| | - Will Ryder
- The University of Sydney, Brain and Mind Centre, 100 Mallett Street, Camperdown, NSW 2050, Australia
| | - Charles Chan
- The University of Sydney, Brain and Mind Centre, 100 Mallett Street, Camperdown, NSW 2050, Australia
| | - Daniel F Hermens
- The University of Sydney, Brain and Mind Centre, 100 Mallett Street, Camperdown, NSW 2050, Australia
| | - Maxwell R Bennett
- The University of Sydney, Brain and Mind Centre, 100 Mallett Street, Camperdown, NSW 2050, Australia
| | - Jim Lagopoulos
- University of the Sunshine Coast, Sunshine Coast Mind and Neuroscience - Thompson Institute, 12 Innovation Parkway, Birtinya, QLD 4575, Australia
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26
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Posttraumatic stress disorder symptom severity is associated with left hippocampal volume reduction: a meta-analytic study. CNS Spectr 2017; 22:363-372. [PMID: 27989265 DOI: 10.1017/s1092852916000833] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Many studies have reported hippocampal volume reductions associated with posttraumatic stress disorder (PTSD), while others have not. Here we provide an updated meta-analysis of such reductions associated with PTSD and evaluate the association between symptom severity and hippocampal volume. METHODS A total of 37 studies met the criteria for inclusion in the meta-analysis. Mean effect sizes (Hedges' g) and 95% confidence intervals (CI 95%) were computed for each study and then averaged to obtain an overall mean effect size across studies. Meta-regression was employed to examine the relationship between PTSD symptom severity and hippocampal volume. RESULTS Results showed that PTSD is associated with significant bilateral reduction of the hippocampus (left hippocampus effect size=-0.400, p<0.001, 5.24% reduction; right hippocampus effect size=-0.462, p<0.001, 5.23% reduction). Symptom severity, as measured by the Clinician-Administered PTSD Scale (CAPS), was significantly associated with decreased left, but not right, hippocampal volume. CONCLUSIONS PTSD was associated with significant bilateral volume reduction of the hippocampus. Increased symptom severity was significantly associated with reduced left hippocampal volume. This finding is consistent with the hypothesis that PTSD is more neurotoxic to the left hippocampus than to the right. However, whether the association between PTSD and lower hippocampal volume reflects a consequence of or a predisposition to PTSD remains unclear. More prospective studies are needed in this area.
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27
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Milani ACC, Hoffmann EV, Fossaluza V, Jackowski AP, Mello MF. Does pediatric post-traumatic stress disorder alter the brain? Systematic review and meta-analysis of structural and functional magnetic resonance imaging studies. Psychiatry Clin Neurosci 2017; 71:154-169. [PMID: 27778421 DOI: 10.1111/pcn.12473] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Revised: 09/01/2016] [Accepted: 10/20/2016] [Indexed: 12/20/2022]
Abstract
Several studies have recently demonstrated that the volumes of specific brain regions are reduced in children and adolescents with post-traumatic stress disorder (PTSD) compared with those of healthy controls. Our study investigated the potential association between early traumatic experiences and altered brain regions and functions. We conducted a systematic review of the scientific literature regarding functional magnetic resonance imaging and a meta-analysis of structural magnetic resonance imaging studies that investigated cerebral region volumes in pediatric patients with PTSD. We searched for articles from 2000 to 2014 in the PsycINFO, PubMed, Medline, Lilacs, and ISI (Web of Knowledge) databases. All data regarding the amygdala, hippocampus, corpus callosum, brain, and intracranial volumes that fit the inclusion criteria were extracted and combined in a meta-analysis that assessed differences between groups. The meta-analysis found reduced total corpus callosum areas and reduced total cerebral and intracranial volumes in the patients with PTSD. The total hippocampus (left and right hippocampus) and gray matter volumes of the amygdala and frontal lobe were also reduced, but these differences were not significant. The functional studies revealed differences in brain region activation in response to stimuli in the post-traumatic stress symptoms/PTSD group. Our results confirmed that the pediatric patients with PTSD exhibited structural and functional brain abnormalities and that some of the abnormalities occurred in different brain regions than those observed in adults.
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Affiliation(s)
| | - Elis V Hoffmann
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Victor Fossaluza
- Institute of Mathematics and Statistics, University of São Paulo, São Paulo, Brazil
| | - Andrea P Jackowski
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Marcelo F Mello
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
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28
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Atmaca M, Ozer O, Korkmaz S, Taskent I, Yildirim H. Evidence for the changes of pituitary volumes in patients with post-traumatic stress disorder. Psychiatry Res Neuroimaging 2017; 260:49-52. [PMID: 28013068 DOI: 10.1016/j.pscychresns.2016.12.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 12/03/2016] [Indexed: 11/19/2022]
Abstract
In pubertal and postpubertal patients with post-traumatic stress disorder (PTSD), significantly greater pituitary gland volumes have been reported. Moving from this point, in the present study, we aimed to investigate pituitary gland volumes in patients with PTSD and hypothesized that volumes of the gland would be structurally changed. Volumetric magnetic resonance imaging of the pituitary gland was performed among sixteen patients with PTSD and fifteen healthy control subjects. We found that the mean volume of the pituitary gland was statistically significant and smaller than that of healthy subjects (0.69±0.08cm3 for patient group and 0.83±0.21 for control subjects). Consequently, in the present study, we found that patients with PTSD had smaller pituitary gland volumes than those of healthy controls like other anxiety disorders. It is important to provide support for this finding in future longitudinal investigations.
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Affiliation(s)
- Murad Atmaca
- Firat University School of Medicine Department of Psychiatry, Elazig, Turkey.
| | - Omer Ozer
- Firat University School of Medicine Department of Psychiatry, Elazig, Turkey
| | - Sevda Korkmaz
- Firat University School of Medicine Department of Psychiatry, Elazig, Turkey
| | - Ismail Taskent
- Firat University School of Medicine Department of Radiology, Elazig, Turkey
| | - Hanefi Yildirim
- Firat University School of Medicine Department of Radiology, Elazig, Turkey
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29
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Gilpin NW, Weiner JL. Neurobiology of comorbid post-traumatic stress disorder and alcohol-use disorder. GENES BRAIN AND BEHAVIOR 2016; 16:15-43. [PMID: 27749004 DOI: 10.1111/gbb.12349] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 10/03/2016] [Accepted: 10/07/2016] [Indexed: 12/12/2022]
Abstract
Post-traumatic stress disorder (PTSD) and alcohol-use disorder (AUD) are highly comorbid in humans. Although we have some understanding of the structural and functional brain changes that define each of these disorders, and how those changes contribute to the behavioral symptoms that define them, little is known about the neurobiology of comorbid PTSD and AUD, which may be due in part to a scarcity of adequate animal models for examining this research question. The goal of this review is to summarize the current state-of-the-science on comorbid PTSD and AUD. We summarize epidemiological data documenting the prevalence of this comorbidity, review what is known about the potential neurobiological basis for the frequent co-occurrence of PTSD and AUD and discuss successes and failures of past and current treatment strategies. We also review animal models that aim to examine comorbid PTSD and AUD, highlighting where the models parallel the human condition, and we discuss the strengths and weaknesses of each model. We conclude by discussing key gaps in our knowledge and strategies for addressing them: in particular, we (1) highlight the need for better animal models of the comorbid condition and better clinical trial design, (2) emphasize the need for examination of subpopulation effects and individual differences and (3) urge cross-talk between basic and clinical researchers that is reflected in collaborative work with forward and reverse translational impact.
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Affiliation(s)
- N W Gilpin
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, LA.,Neuroscience Center of Excellence, Louisiana State University Health Sciences Center, New Orleans, LA
| | - J L Weiner
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC, USA
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30
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Sublette ME, Galfalvy HC, Oquendo MA, Bart CP, Schneck N, Arango V, Mann JJ. Relationship of recent stress to amygdala volume in depressed and healthy adults. J Affect Disord 2016; 203:136-142. [PMID: 27288958 PMCID: PMC8903078 DOI: 10.1016/j.jad.2016.05.036] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 04/21/2016] [Accepted: 05/21/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND The amygdala is an integral part of the extrahypothalamic stress-response system, and its volume related to childhood trauma has been studied, but less is known of associations with recent stressful life events. Amygdala volume differences also have been studied in depression, with conflicting results. We hypothesized that effects of stress may be a confound for amygdala volumetric differences in the context of depression. METHODS Right-handed participants (n=61) experiencing a major depressive episode during major depressive disorder (n=40) or bipolar depression (n=21) and healthy volunteers (n=60) underwent 1.5T magnetic resonance imaging (MRI). The amygdala perimeter was manually traced with an electronic mouse, based on anatomical landmarks on consecutive coronal slices, by raters blind to diagnosis. The effects of stress on amygdala volume were examined in linear regression models with self-reported physical/sexual abuse or highest category score on the St. Paul-Ramsey scale of stressful life events within the past 6 months as predictors, testing separately for age, sex, race, and depression status as covariates. RESULTS Diagnostic groups did not differ significantly with respect to mean age (depressed, 37.8±11.8yrs; healthy, 34.9±13.8yrs) or proportion of males (depressed, 39%, healthy, 50%). We found no association between physical and/or sexual abuse history and amygdala volume. Life stress within the last six months, however, was associated with smaller left amygdala volume. The association between stress and amygdala volume did not differ by diagnostic group. LIMITATIONS Most depressed patients were off medications for at least 2 weeks; however, this may not have been long enough to reverse effects of medications on amygdala structure. CONCLUSIONS That life stress of relatively short duration was associated with amygdala size in the entire sample, while temporally distant life stress was not, suggests that amygdala volume changes may occur rapidly and reversibly, and independent of depression status.
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Affiliation(s)
- M. Elizabeth Sublette
- Department of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, Columbia University.,Department of Psychiatry, Columbia University.,Corresponding author: Dr. M. E. Sublette, Department of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, Columbia University, Unit 42, 1051 Riverside Drive, NY, NY 10032, Tel 646-774-7514, FAX 646-774-7589,
| | - Hanga C. Galfalvy
- Department of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, Columbia University.,Department of Psychiatry, Columbia University
| | - Maria A. Oquendo
- Department of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, Columbia University.,Department of Psychiatry, Columbia University
| | - Corinne P. Bart
- Department of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, Columbia University
| | - Noam Schneck
- Department of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, Columbia University.,Department of Psychiatry, Columbia University
| | - Victoria Arango
- Department of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, Columbia University.,Department of Psychiatry, Columbia University
| | - J. John Mann
- Department of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, Columbia University.,Department of Psychiatry, Columbia University.,Department of Radiology, Columbia University
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31
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Fragkaki I, Thomaes K, Sijbrandij M. Posttraumatic stress disorder under ongoing threat: a review of neurobiological and neuroendocrine findings. Eur J Psychotraumatol 2016; 7:30915. [PMID: 27511448 PMCID: PMC4980518 DOI: 10.3402/ejpt.v7.30915] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 07/07/2016] [Accepted: 07/08/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Although numerous studies have investigated the neurobiology and neuroendocrinology of posttraumatic stress disorder (PTSD) after single finished trauma, studies on PTSD under ongoing threat are scarce and it is still unclear whether these individuals present similar abnormalities. OBJECTIVE The purpose of this review is to present the neurobiological and neuroendocrine findings on PTSD under ongoing threat. Ongoing threat considerably affects PTSD severity and treatment response and thus disentangling its neurobiological and neuroendocrine differences from PTSD after finished trauma could provide useful information for treatment. METHOD Eighteen studies that examined brain functioning and cortisol levels in relation to PTSD in individuals exposed to intimate partner violence, police officers, and fire fighters were included. RESULTS Hippocampal volume was decreased in PTSD under ongoing threat, although not consistently associated with symptom severity. The neuroimaging studies revealed that PTSD under ongoing threat was not characterized by reduced volume of amygdala or parahippocampal gyrus. The neurocircuitry model of PTSD after finished trauma with hyperactivation of amygdala and hypoactivation of prefrontal cortex and hippocampus was also confirmed in PTSD under ongoing threat. The neuroendocrine findings were inconsistent, revealing increased, decreased, or no association between cortisol levels and PTSD under ongoing threat. CONCLUSIONS Although PTSD under ongoing threat is characterized by abnormal neurocircuitry patterns similar to those previously found in PTSD after finished trauma, this is less so for other neurobiological and in particular neuroendocrine findings. Direct comparisons between samples with ongoing versus finished trauma are needed in future research to draw more solid conclusions before administering cortisol to patients with PTSD under ongoing threat who may already exhibit increased endogenous cortisol levels.
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Affiliation(s)
- Iro Fragkaki
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands; ,
| | - Kathleen Thomaes
- VU University Medical Center, VU University Amsterdam, Amsterdam, The Netherlands
| | - Marit Sijbrandij
- Department of Clinical Psychology, EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, The Netherlands
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32
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Behavioral and central correlates of contextual fear learning and contextual modulation of cued fear in posttraumatic stress disorder. Int J Psychophysiol 2015; 98:584-93. [DOI: 10.1016/j.ijpsycho.2015.06.009] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 05/29/2015] [Accepted: 06/26/2015] [Indexed: 01/04/2023]
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33
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Saur L, Baptista PPA, Bagatini PB, Neves LT, de Oliveira RM, Vaz SP, Ferreira K, Machado SA, Mestriner RG, Xavier LL. Experimental Post-traumatic Stress Disorder Decreases Astrocyte Density and Changes Astrocytic Polarity in the CA1 Hippocampus of Male Rats. Neurochem Res 2015; 41:892-904. [DOI: 10.1007/s11064-015-1770-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 10/20/2015] [Accepted: 11/11/2015] [Indexed: 12/16/2022]
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34
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Burning odor-elicited anxiety in OEF/OIF combat veterans: Inverse relationship to gray matter volume in olfactory cortex. J Psychiatr Res 2015; 70:58-66. [PMID: 26424424 PMCID: PMC4605869 DOI: 10.1016/j.jpsychires.2015.08.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 07/21/2015] [Accepted: 08/27/2015] [Indexed: 12/11/2022]
Abstract
Despite the anatomical overlap between the brain's fear/threat and olfactory systems, a very limited number of investigations have considered the role of odors and the central olfactory system in the pathophysiology of PTSD. The goal of the present study was to assess structural differences in primary and secondary olfactory cortex between combat veterans with and without PTSD (CV + PTSD, CV-PTSD, respectively). An additional goal was to determine the relationship between gray matter volume (GMV) in olfactory cortex and the distressing properties of burning-related odors. A region of interest voxel-based morphometric (VBM) approach was used to measure GMV in olfactory cortex in a well-characterized group of CV + PTSD (n = 20) and CV-PTSD (n = 25). Prior to the MRI exam, combat-related (i.e., burning rubber) and control odors were systematically sampled and rated according to their potential for eliciting PTSD symptoms. Results showed that CV + PTSD exhibited significantly reduced GMV in anterior piriform (primary olfactory) and orbitofrontal (secondary olfactory) cortices compared to CV-PTSD (both p < .01). For the entire group, GMV in bilateral anterior piriform cortex was inversely related to burning rubber odor-elicited memories of trauma (p < .05). GMV in orbitofrontal cortex was inversely related to both clinical and laboratory measures of PTSD symptoms (all p < .05). In addition to replicating an established inverse relationship between GMV in anxiety-associated brain structures and PTSD symptomatology, the present study extends those findings by being the first report of volumetric decreases in olfactory cortex that are inversely related to odor-elicited PTSD symptoms. Potential mechanisms underlying these findings are discussed.
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35
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Veer IM, Oei NYL, van Buchem MA, Spinhoven P, Elzinga BM, Rombouts SARB. Evidence for smaller right amygdala volumes in posttraumatic stress disorder following childhood trauma. Psychiatry Res 2015. [PMID: 26211620 DOI: 10.1016/j.pscychresns.2015.07.016] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Hippocampus and amygdala volumes in posttraumatic stress disorder (PTSD) related to childhood trauma are relatively understudied, albeit the potential importance to the disorder. Whereas some studies reported smaller hippocampal volumes, little evidence was found for abnormal amygdala volumes. Here we investigated hippocampus and amygdala volumes and shapes in an adult sample of PTSD patients related to childhood trauma. T1-weighted MR images were acquired from 12 female PTSD patients with trauma related to physical, sexual, and/or emotional abuse before age 18, and from 12 matched controls. Hippocampus and amygdala were segmented, and volumes were calculated and corrected for the total intracranial volume. Additionally, a shape analysis was done on the surface of the structures to explore abnormalities in specific subnuclei. Smaller right amygdala volumes were found in PTSD patients as compared with the controls. This difference appeared to be located specifically in the basolateral and superficial nuclei groups. Severity of sexual abuse during childhood was negatively correlated with the size of the amygdala. No difference in hippocampal volumes was found. Although our results are not conclusive, traumatic events in childhood might impede normal development of the amygdala, which could render a person more vulnerable to develop PTSD later in life.
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Affiliation(s)
- Ilya M Veer
- Leiden Institute for Brain and Cognition (LIBC), Leiden, The Netherlands; Charité Universitätsmedizin Berlin, Division of Mind and Brain Research, Department of Psychiatry and Psychotherapy, Berlin, Germany.
| | - Nicole Y L Oei
- Leiden Institute for Brain and Cognition (LIBC), Leiden, The Netherlands; University of Amsterdam, Addiction, Development, and Psychopathology (ADAPT) Lab, Amsterdam, The Netherlands; University of Amsterdam, Amsterdam Brain and Cognition, Amsterdam, The Netherlands
| | - Mark A van Buchem
- Leiden Institute for Brain and Cognition (LIBC), Leiden, The Netherlands; Leiden University Medical Center, Department of Radiology, Leiden, The Netherlands
| | - Philip Spinhoven
- Leiden Institute for Brain and Cognition (LIBC), Leiden, The Netherlands; Leiden University - Institute of Psychology, Leiden, The Netherlands; Leiden University Medical Center, Department of Psychiatry, Leiden, The Netherlands
| | - Bernet M Elzinga
- Leiden Institute for Brain and Cognition (LIBC), Leiden, The Netherlands; Leiden University - Institute of Psychology, Leiden, The Netherlands
| | - Serge A R B Rombouts
- Leiden Institute for Brain and Cognition (LIBC), Leiden, The Netherlands; Leiden University Medical Center, Department of Radiology, Leiden, The Netherlands; Leiden University - Institute of Psychology, Leiden, The Netherlands
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Amen DG, Raji CA, Willeumier K, Taylor D, Tarzwell R, Newberg A, Henderson TA. Functional Neuroimaging Distinguishes Posttraumatic Stress Disorder from Traumatic Brain Injury in Focused and Large Community Datasets. PLoS One 2015; 10:e0129659. [PMID: 26132293 PMCID: PMC4488529 DOI: 10.1371/journal.pone.0129659] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 05/12/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD) are highly heterogeneous and often present with overlapping symptomology, providing challenges in reliable classification and treatment. Single photon emission computed tomography (SPECT) may be advantageous in the diagnostic separation of these disorders when comorbid or clinically indistinct. METHODS Subjects were selected from a multisite database, where rest and on-task SPECT scans were obtained on a large group of neuropsychiatric patients. Two groups were analyzed: Group 1 with TBI (n=104), PTSD (n=104) or both (n=73) closely matched for demographics and comorbidity, compared to each other and healthy controls (N=116); Group 2 with TBI (n=7,505), PTSD (n=1,077) or both (n=1,017) compared to n=11,147 without either. ROIs and visual readings (VRs) were analyzed using a binary logistic regression model with predicted probabilities inputted into a Receiver Operating Characteristic analysis to identify sensitivity, specificity, and accuracy. One-way ANOVA identified the most diagnostically significant regions of increased perfusion in PTSD compared to TBI. Analysis included a 10-fold cross validation of the protocol in the larger community sample (Group 2). RESULTS For Group 1, baseline and on-task ROIs and VRs showed a high level of accuracy in differentiating PTSD, TBI and PTSD+TBI conditions. This carefully matched group separated with 100% sensitivity, specificity and accuracy for the ROI analysis and at 89% or above for VRs. Group 2 had lower sensitivity, specificity and accuracy, but still in a clinically relevant range. Compared to subjects with TBI, PTSD showed increases in the limbic regions, cingulum, basal ganglia, insula, thalamus, prefrontal cortex and temporal lobes. CONCLUSIONS This study demonstrates the ability to separate PTSD and TBI from healthy controls, from each other, and detect their co-occurrence, even in highly comorbid samples, using SPECT. This modality may offer a clinical option for aiding diagnosis and treatment of these conditions.
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Affiliation(s)
- Daniel G. Amen
- Department of Research, Amen Clinics, Inc., Costa Mesa, California, United States of America
| | - Cyrus A. Raji
- Department of Radiology, University of California Los Angeles Medical Center, Los Angeles, California, United States of America
| | - Kristen Willeumier
- Department of Research, Amen Clinics, Inc., Costa Mesa, California, United States of America
| | - Derek Taylor
- Department of Research, Amen Clinics, Inc., Costa Mesa, California, United States of America
| | - Robert Tarzwell
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Lions Gate Hospital, North Vancouver, British Columbia, Canada
| | - Andrew Newberg
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
| | - Theodore A. Henderson
- The Synaptic Space, Denver, Colorado, United States of America
- The International Society of Applied Neuroimaging, Denver, Colorado, United States of America
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Stress, trauma and PTSD: translational insights into the core synaptic circuitry and its modulation. Brain Struct Funct 2015; 221:2401-26. [PMID: 25985955 DOI: 10.1007/s00429-015-1056-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 04/30/2015] [Indexed: 12/19/2022]
Abstract
Evidence is considered as to whether behavioral criteria for diagnosis of post-traumatic stress disorder (PTSD) are applicable to that of traumatized animals and whether the phenomena of acquisition, extinction and reactivation of fear behavior in animals are also successfully applicable to humans. This evidence suggests an affirmative answer in both cases. Furthermore, the deficits in gray matter found in PTSD, determined with magnetic resonance imaging, are also observed in traumatized animals, lending neuropsychological support to the use of animals to probe what has gone awry in PTSD. Such animal experiments indicate that the core synaptic circuitry mediating behavior following trauma consists of the amygdala, ventral-medial prefrontal cortex and hippocampus, all of which are modulated by the basal ganglia. It is not clear if this is the case in PTSD as the observations using fMRI are equivocal and open to technical objections. Nevertheless, the effects of the basal ganglia in controlling glutamatergic synaptic transmission through dopaminergic and serotonergic synaptic mechanisms in the core synaptic circuitry provides a ready explanation for why modifying these mechanisms delays extinction in animal models and predisposes towards PTSD. In addition, changes of brain-derived neurotrophic factor (BDNF) in the core synaptic circuitry have significant effects on acquisition and extinction in animal experiments with single nucleotide polymorphisms in the BDNF gene predisposing to PTSD.
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O'Doherty DCM, Chitty KM, Saddiqui S, Bennett MR, Lagopoulos J. A systematic review and meta-analysis of magnetic resonance imaging measurement of structural volumes in posttraumatic stress disorder. Psychiatry Res 2015; 232:1-33. [PMID: 25735885 DOI: 10.1016/j.pscychresns.2015.01.002] [Citation(s) in RCA: 232] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 11/15/2014] [Accepted: 01/08/2015] [Indexed: 12/15/2022]
Abstract
Posttraumatic stress disorder (PTSD) is a debilitating condition associated with mild to moderate cognitive impairment and with a prevalence rate of up to 22% in veterans. This systematic review and quantitative meta-analysis explore volumetric differences of three key structural brain regions (hippocampus, amygdala and anterior cingulate cortex (ACC)), all of which have been implicated in dysfunction of both salience network (SN) and default mode network (DMN) in PTSD sufferers. A literature search was conducted in Embase, Medline, PubMed and PsycINFO in May 2013. Fifty-nine volumetric analyses from 44 articles were examined and included (36 hippocampus, 14 amygdala and nine ACC) with n=846 PTSD participants, n=520 healthy controls (HCs) and n=624 traumatised controls (TCs). Nine statistical tests were performed for each of the three regions of interest (ROIs), measuring volume differences in PTSD subjects, healthy and traumatised controls. Hippocampal volume was reduced in subjects with PTSD, with a greater reduction in the left hippocampus. A medium effect size reduction was found in bilateral amygdala volume when compared with findings in healthy controls; however, no significant differences in amygdala volume between PTSD subjects and trauma-exposed controls were found. Significant volume reductions were found bilaterally in the ACC. While often well matched with their respective control groups, the samples of PTSD subjects composed from the source studies used in the meta-analyses are limited in their homogeneity. The current findings of reduced hippocampal volume in subjects with PTSD are consistent with the existing literature. Amygdala volumes did not show significant reductions in PTSD subjects when compared with volumes in trauma-exposed controls-congruous with reported symptoms of hypervigilance and increased propensity in acquisition of conditioned fear memories-but a significant reduction was found in the combined left and right hemisphere volume analysis when compared with healthy controls. Bilateral volume reductions in the ACC may underpin the attentional deficits and inabilities to modulate emotions that are characteristically associated with PTSD patients.
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Affiliation(s)
- Daniel C M O'Doherty
- Brain and Mind Research Institute, University of Sydney, 100 Mallett Street, Camperdown, NSW 2050, Australia.
| | - Kate M Chitty
- Brain and Mind Research Institute, University of Sydney, 100 Mallett Street, Camperdown, NSW 2050, Australia.
| | - Sonia Saddiqui
- Faculty of Human Sciences, Macquarie University, Sydney, Australia.
| | - Maxwell R Bennett
- Brain and Mind Research Institute, University of Sydney, 100 Mallett Street, Camperdown, NSW 2050, Australia.
| | - Jim Lagopoulos
- Brain and Mind Research Institute, University of Sydney, 100 Mallett Street, Camperdown, NSW 2050, Australia.
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Mercadillo RE, Alcauter S, Fernández-Ruiz J, Barrios FA. Police culture influences the brain function underlying compassion: a gender study. Soc Neurosci 2014; 10:135-52. [PMID: 25372925 DOI: 10.1080/17470919.2014.977402] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Compassion is a prototypical moral emotion supporting cooperation and involves empathic decision-making and motor processes representing the interplay of biologically evolved and cultural mechanisms. We propose a social neuroscience approach to identify gender differences and to assess biological and cultural factors shaping compassion. We consider the police force as a cultural model to study this emotion, because it comprises a mixed-gender group using specific codes for collective safety that influence empathy and cooperativeness. From a sample of Mexican police officers working in a violent environment we integrated ethnographic data categorizing compassionate elements in the officers' activities, psychometric measures evaluating empathic attitudes, and fMRI scans identifying the brain activity related to compassionate experiences and decisions. The results suggest that the police culture influences genders equally with respect to empathic behavioral expressions. Nevertheless, women showed insular and prefrontal cortical activation, suggesting a more empathic experience of compassion. Officers manifested activity in the caudate nucleus, amygdala, and cerebellum, suggesting a more a highly accurate process to infer another's suffering and a reward system motivated by the notion of service and cooperation, both of which are cultural traits represented in the police force.
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Affiliation(s)
- Roberto E Mercadillo
- a Laboratorio de Neuropsicología, Departamento de Fisiología, Facultad de Medicina and Instituto de Neurobiología , Universidad Nacional Autónoma de México , Distrito Federal , México
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Chao LL, Kriger S, Buckley S, Ng P, Mueller SG. Effects of low-level sarin and cyclosarin exposure on hippocampal subfields in Gulf War Veterans. Neurotoxicology 2014; 44:263-9. [PMID: 25058901 PMCID: PMC5464327 DOI: 10.1016/j.neuro.2014.07.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 07/10/2014] [Accepted: 07/11/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND More than 100,000 US troops were potentially exposed to chemical warfare agents sarin (GB) and cyclosarin (GF) when an ammunition dump at Khamisiyah, Iraq was destroyed during the 1991 Gulf War (GW). We previously reported reduced hippocampal volume in GW veterans with suspected GB/GF exposure relative to matched, unexposed GW veterans estimated from 1.5T magnetic resonance images (MRI). Here we investigate, in a different cohort of GW veterans, whether low-level GB/GF exposure is associated with structural alterations in specific hippocampal subfields, estimated from 4T MRI. METHODS The Automatic Segmentation of Hippocampal Subfields (ASHS) technique was used to quantify CA1, CA2, CA3 and dentate gyrus (DG), and subiculum (SUB) subfields volumes from high-resolution T2-weighted images acquired on a 4T MR scanner in 56 GW veterans with suspected GB/GF exposure and 56 "matched" unexposed GW veterans (mean age 49±7 years). RESULTS GB/GF exposed veterans had smaller CA2 (p=0.003) and CA3/DG (p=0.01) subfield volumes compared to matched, unexposed GW veterans. There were no group difference in total hippocampal volume, quantified with FreeSurfer, and no dose-response relationship between estimated levels of GB/GF exposure and total hippocampal or subfield volume. CONCLUSIONS These findings extend our previous report of structural alterations in the hippocampi of GW veterans with suspected GB/GF exposure to volume changes in the CA2, CA3, and DG hippocampal subfields in a different cohort of GW veterans with suspected GB/GF exposure.
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Affiliation(s)
- Linda L Chao
- Center for Imaging of Neurodegenerative Diseases, San Francisco Veterans Affairs Medical Center, 4150 Clement Street, 114M, San Francisco, CA 94121, United States; Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, United States; Department of Psychiatry, University of California San Francisco, San Francisco, CA, United States.
| | - Stephen Kriger
- Center for Imaging of Neurodegenerative Diseases, San Francisco Veterans Affairs Medical Center, 4150 Clement Street, 114M, San Francisco, CA 94121, United States
| | - Shannon Buckley
- Center for Imaging of Neurodegenerative Diseases, San Francisco Veterans Affairs Medical Center, 4150 Clement Street, 114M, San Francisco, CA 94121, United States
| | - Peter Ng
- Center for Imaging of Neurodegenerative Diseases, San Francisco Veterans Affairs Medical Center, 4150 Clement Street, 114M, San Francisco, CA 94121, United States
| | - Susanne G Mueller
- Center for Imaging of Neurodegenerative Diseases, San Francisco Veterans Affairs Medical Center, 4150 Clement Street, 114M, San Francisco, CA 94121, United States; Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, United States
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Zhang Q, Zhuo C, Lang X, Li H, Qin W, Yu C. Structural impairments of hippocampus in coal mine gas explosion-related posttraumatic stress disorder. PLoS One 2014; 9:e102042. [PMID: 25000505 PMCID: PMC4085015 DOI: 10.1371/journal.pone.0102042] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 06/15/2014] [Indexed: 11/18/2022] Open
Abstract
Investigations on hippocampal and amygdalar volume have revealed inconsistent results in patients with posttraumatic stress disorder (PTSD). Little is known about the structural covariance alterations between the hippocampus and amygdala in PTSD. In this study, we evaluated the alteration in the hippocampal and amygdalar volume and their structural covariance in the coal mine gas explosion related PTSD. High resolution T1-weighted magnetic resonance imaging (MRI) was performed on coal mine gas explosion related PTSD male patients (n = 14) and non-traumatized coalminers without PTSD (n = 25). The voxel-based morphometry (VBM) method was used to test the inter-group differences in hippocampal and amygdalar volume as well as the inter-group differences in structural covariance between the ipsilateral hippocampus and amygdala. PTSD patients exhibited decreased gray matter volume (GMV) in the bilateral hippocampi compared to controls (p<0.05, FDR corrected). GMV covariances between the ipsilateral hippocampus and amygdala were significantly reduced in PTSD patients compared with controls (p<0.05, FDR corrected). The coalminers with gas explosion related PTSD had decreased hippocampal volume and structural covariance with the ipsilateral amygdala, suggesting that the structural impairment of the hippocampus may implicate in the pathophysiology of PTSD.
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Affiliation(s)
- Quan Zhang
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - Chuanjun Zhuo
- Department of Psychiatry, Anning Hospital of Tianjin City, Tianjin, China
| | - Xu Lang
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - Huabing Li
- Department of Radiology, Jinmei Group General Hospital, Jincheng, Shanxi, China
| | - Wen Qin
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - Chunshui Yu
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
- * E-mail:
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Chao LL, Yaffe K, Samuelson K, Neylan TC. Hippocampal volume is inversely related to PTSD duration. Psychiatry Res 2014; 222:119-23. [PMID: 24742925 DOI: 10.1016/j.pscychresns.2014.03.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 03/07/2014] [Accepted: 03/11/2014] [Indexed: 10/25/2022]
Abstract
Numerous imaging studies have reported smaller hippocampal volumes in patients with PTSD. To investigate whether decreased hippocampal volume is associated with PTSD chronicity, independent of age, we used hierarchical linear regression to examine the relationship between PTSD duration (estimated from the amount of time that had elapsed since the traumatic event; mean=17 years; range=6-36 years) and hippocampal volume, adjusting for age and other factors. Freesurfer version 4.5 was used to quantify the volumes of the hippocampus and the caudate nucleus, which served as a "control" region, from the 1.5T Magnetic Resonance Images (MRI) of 55 combat veterans (mean age 45±9 years) with chronic and current PTSD. PTSD duration was significantly associated with right hippocampal volume (β=-0.34, t=-2.40, P=0.02) after accounting for intracranial volume, age, gender (entered in the first step) and comorbidities (e.g., early life trauma, current major depression, history of substance abuse/dependence, psychotropic medication use, entered in the second step). This finding provides support for the potential neurotoxic effects of PTSD on hippocampal volume.
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Affiliation(s)
- Linda L Chao
- Department of Radiology and Biomedical Imaging, University of California at San Francisco, San Francisco, CA, USA; Department of Psychiatry, University of California at San Francisco, San Francisco, CA, USA; Center for Imaging of Neurodegenerative Diseases, Department of Veterans Affairs Medical Center, 4150 Clement Street, 114M, San Francisco, CA 94121, USA.
| | - Kristine Yaffe
- Department of Psychiatry, University of California at San Francisco, San Francisco, CA, USA; Department of Neurology, University of California at San Francisco, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA, USA; Mental Health Service, Department of Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Kristin Samuelson
- Mental Health Service, Department of Veterans Affairs Medical Center, San Francisco, CA, USA; California School of Professional Psychology, Alliant International University, San Francisco, CA, USA
| | - Thomas C Neylan
- Department of Psychiatry, University of California at San Francisco, San Francisco, CA, USA; Mental Health Service, Department of Veterans Affairs Medical Center, San Francisco, CA, USA
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Sotgiu I, Rusconi ML. Why Autobiographical Memories for Traumatic and Emotional Events Might Differ: Theoretical Arguments and Empirical Evidence. THE JOURNAL OF PSYCHOLOGY 2014; 148:523-47. [DOI: 10.1080/00223980.2013.814619] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Gersons BPR, Schnyder U. Learning from traumatic experiences with brief eclectic psychotherapy for PTSD. Eur J Psychotraumatol 2013; 4:21369. [PMID: 24371510 PMCID: PMC3871836 DOI: 10.3402/ejpt.v4i0.21369] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 07/17/2013] [Accepted: 07/17/2013] [Indexed: 11/24/2022] Open
Abstract
Brief eclectic psychotherapy for PTSD (BEPP) is an evidence-based therapeutic approach that combines and integrates elements from psychodynamic, cognitive-behavioral, and directive psychotherapy. Psychoeducation is done jointly with the patient and his or her partner. Exposure, a structured writing task, and memorabilia are used to help patients accessing, feeling and expressing their suppressed emotions related to the traumatic experience. In the domain of meaning stage, patients will learn how they and their view of the world have changed, and that they have become "sadder but wiser". Much emphasis is put on the vulnerability of human beings. Finally, an individually tailored farewell ritual is done to end treatment, to reunite with loved ones, and to go on with life.
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Affiliation(s)
- Berthold P. R. Gersons
- Department of Psychiatry, University of Amsterdam and Arq Psychotrauma Expert Group, Amsterdam, The Netherlands
| | - Ulrich Schnyder
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, Zurich, Switzerland
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Abstract
Despite mounting reports about the negative effects of chronic occupational stress on cognitive functions, it is still uncertain whether and how this type of stress is associated with cerebral changes. This issue was addressed in the present MRI study, in which cortical thickness (Cth) and subcortical volumes were compared between 40 subjects reporting symptoms of chronic occupational stress (38 ± 6 years) and 40 matched controls (36 ± 6 years). The degree of perceived stress was measured with Maslach Burnout Inventory. In stressed subjects, there was a significant thinning of the mesial frontal cortex. When investigating the correlation between age and Cth, the thinning effect of age was more pronounced in the stressed group in the frontal cortex. Furthermore, their amygdala volumes were bilaterally increased (P = 0.020 and P = 0.003), whereas their caudate volumes were reduced (P = 0.040), and accompanied by impaired fine motor function. The perceived stress correlated positively with the amygdala volumes (r = 0.44, P = 0.04; r = 0.43, P = 04). Occupational stress was found to be associated with cortical thinning as well as with selective changes of subcortical volumes, with behavioral correlates. The findings support the hypothesis that stress-related excitotoxicity might be an underlying mechanism, and that the described condition is a stress related illness.
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Affiliation(s)
- Ivanka Savic
- Neurology Clinic, Karolinska University Hospital Department of Women's and Children's Health, Division of Pediatric Neurology, Karolinska Institutet, Stockholm, Sweden
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White matter microstructure alterations: a study of alcoholics with and without post-traumatic stress disorder. PLoS One 2013; 8:e80952. [PMID: 24260518 PMCID: PMC3832443 DOI: 10.1371/journal.pone.0080952] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 10/13/2013] [Indexed: 02/07/2023] Open
Abstract
Many brain imaging studies have demonstrated reductions in gray and white matter volumes in alcoholism, with fewer investigators using diffusion tensor imaging (DTI) to examine the integrity of white matter pathways. Among various medical conditions, alcoholism and post-traumatic stress disorder (PTSD) are two comorbid diseases that have similar degenerative effects on the white matter integrity. Therefore, understanding and differentiating these effects would be very important in characterizing alcoholism and PTSD. Alcoholics are known to have neurocognitive deficits in decision-making, particularly in decisions related to emotionally-motivated behavior, while individuals with PTSD have deficits in emotional regulation and enhanced fear response. It is widely believed that these types of abnormalities in both alcoholism and PTSD are related to fronto-limbic dysfunction. In addition, previous studies have shown cortico-limbic fiber degradation through fiber tracking in alcoholism. DTI was used to measure white matter fractional anisotropy (FA), which provides information about tissue microstructure, possibly indicating white matter integrity. We quantitatively investigated the microstructure of white matter through whole brain DTI analysis in healthy volunteers (HV) and alcohol dependent subjects without PTSD (ALC) and with PTSD (ALC+PTSD). These data show significant differences in FA between alcoholics and non-alcoholic HVs, with no significant differences in FA between ALC and ALC+PTSD in any white matter structure. We performed a post-hoc region of interest analysis that allowed us to incorporate multiple covariates into the analysis and found similar results. HV had higher FA in several areas implicated in the reward circuit, emotion, and executive functioning, suggesting that there may be microstructural abnormalities in white matter pathways that contribute to neurocognitive and executive functioning deficits observed in alcoholics. Furthermore, our data do not reveal any differences between ALC and ALC+PTSD, suggesting that the effect of alcohol on white matter microstructure may be more significant than any effect caused by PTSD.
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Zantvoord JB, Diehle J, Lindauer RJL. Using neurobiological measures to predict and assess treatment outcome of psychotherapy in posttraumatic stress disorder: systematic review. PSYCHOTHERAPY AND PSYCHOSOMATICS 2013; 82:142-51. [PMID: 23548778 DOI: 10.1159/000343258] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Accepted: 09/08/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Trauma-focused cognitive-behavioral therapy (TF-CBT) and eye movement desensitization and reprocessing (EMDR) are effective treatments for posttraumatic stress disorder. However, little is known about their neurobiological effects. The usefulness of neurobiological measures to predict the treatment outcome of psychotherapy also has yet to be determined. METHODS Systematic review of randomized controlled trials (RCTs) focused on neurobiological treatment effects of TF-CBT or EMDR and trials with neurobiological measures as predictors of treatment response. RESULTS We included 23 publications reporting on 16 separate trials. TF-CBT was compared with a waitlist in most trials. TF-CBT was associated with a decrease in heart rate and blood pressure and changes in activity but not in volume of frontal brain structures and the amygdala. Neurobiological changes correlated with changes in symptom severity. EMDR was only tested against other active treatments in included trials. We did not find a difference in neurobiological treatment effects between EMDR and other treatments. Publications on neurobiological predictors of treatment response showed ambiguous results. CONCLUSION TF-CBT was associated with a reduction of physiological reactivity. There is some preliminary evidence that TF-CBT influences brain regions involved in fear conditioning, extinction learning and possibly working memory and attention regulation; however, these effects could be nonspecific psychotherapeutic effects. Future trials should use paradigms aimed specifically at these brain regions and physiological reactivity. There are concerns regarding the risk of bias in some of the RCTs, indicating that methodologically more rigorous trials are required. Trials with neurobiological measures as predictors of treatment outcome render insufficient results to be useful in clinical practice.
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Affiliation(s)
- Jasper B Zantvoord
- Department of Child and Adolescent Psychiatry, Academic Medical Centre, University of Amsterdam and the Bascule Academic Centre for Child and Adolescent Psychiatry, Amsterdam, The Netherlands. J.B.Zantvoord @ amc.uva.nl
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Shu XJ, Xue L, Liu W, Chen FY, Zhu C, Sun XH, Wang XP, Liu ZC, Zhao H. More vulnerability of left than right hippocampal damage in right-handed patients with post-traumatic stress disorder. Psychiatry Res 2013; 212:237-44. [PMID: 23149034 DOI: 10.1016/j.pscychresns.2012.04.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Revised: 04/09/2012] [Accepted: 04/12/2012] [Indexed: 01/14/2023]
Abstract
Previous studies have shown hippocampal abnormalities in people with post-traumatic stress disorder (PTSD), but findings of diminished volume in shortages in the hippocampus have been inconsistent. In this study, we investigated changes in hippocampal volume and neuronal metabolites in right-handed PTSD patients to determine their possible relationship(s) with PTSD severity. We performed a case-control study of 11 right-handed PTSD patients and 11 healthy controls using magnetic resonance imaging (MRI) and proton magnetic resonance spectroscopy ((1)H MRS). Hippocampal volume and metabolite ratios of N-acetylaspartate (NAA) to creatine (Cr) (NAA/Cr) and choline compounds (Cho) to Cr (Cho/Cr) were calculated. The severity of PTSD was evaluated by the Clinician-Administered PTSD Scale (CAPS). Significantly decreased left and total normalized hippocampal volumes were found in PTSD patients compared with controls (6.6% for the left hippocampus, 5.5% for total hippocampus). Also, the bilateral hippocampal NAA/Cr ratio of PTSD patients was significantly reduced compared with controls. The volume of the left hippocampus was negatively correlated to the CAPS total and CPAS-C scores. The left hippocampal NAA/Cr ratio was negatively correlated to the CAPS-total, CAPS-B, CAPS-C, and CAPS-D scores. The CAPS total and the CAPS-B scores were positively correlated to the Cho/Cr ratio of the right hippocampus. Our results indicate that hippocampal dysfunction is asymmetric in right-handed PTSD patients, with the left side affected more than the right.
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Affiliation(s)
- Xi-Ji Shu
- Department of Pathology and Pathophysiology, Medical School, Jianghan University, Wuhan 430056, Hubei, China
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van der Werff SJA, van den Berg SM, Pannekoek JN, Elzinga BM, van der Wee NJA. Neuroimaging resilience to stress: a review. Front Behav Neurosci 2013; 7:39. [PMID: 23675330 PMCID: PMC3646289 DOI: 10.3389/fnbeh.2013.00039] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 04/18/2013] [Indexed: 12/28/2022] Open
Abstract
There is a high degree of intra-individual variation in how individuals respond to stress. This becomes evident when exploring the development of posttraumatic symptoms or stress-related disorders after exposure to trauma. Whether or not an individual develops posttraumatic symptoms after experiencing a traumatic event is partly dependent on a person's resilience. Resilience can be broadly defined as the dynamic process encompassing positive adaptation within the context of significant adversity. Even though research into the neurobiological basis of resilience is still in its early stages, these insights can have important implications for the prevention and treatment of stress-related disorders. Neuroimaging studies contribute to our knowledge of intra-individual variability in resilience and the development of posttraumatic symptoms or other stress-related disorders. This review provides an overview of neuroimaging findings related to resilience. Structural, resting-state, and task-related neuroimaging results associated with resilience are discussed. There are a limited number of studies available and neuroimaging research of resilience is still in its infancy. The available studies point at brain circuitries involved in stress and emotion regulation, with more efficient processing and regulation associated with resilience.
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Affiliation(s)
- S J A van der Werff
- Department of Psychiatry, Leiden University Medical Center Leiden, Netherlands ; Leiden Institute for Brain and Cognition Leiden, Netherlands
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Weber M, Killgore WD, Rosso IM, Britton JC, Schwab ZJ, Weiner MR, Naomi MS, Pollack MH, Rauch SL. Voxel-based morphometric gray matter correlates of posttraumatic stress disorder. J Anxiety Disord 2013; 27:413-9. [PMID: 23746489 PMCID: PMC3782384 DOI: 10.1016/j.janxdis.2013.04.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 02/01/2013] [Accepted: 04/08/2013] [Indexed: 11/18/2022]
Abstract
Posttraumatic stress disorder (PTSD) is associated with functional abnormalities within a neurocircuitry that includes the hippocampus, amygdala, and medial prefrontal cortex. Evidence of structural abnormalities within these regions, and their association with PTSD severity and symptom burden is, however, sparse. The present study evaluated the relation between indices of gray matter volume and PTSD symptom severity using voxel-based morphometry. Fifteen individuals meeting DSM-IV criteria for PTSD completed the Clinician Administered PTSD Scale and underwent structural magnetic resonance imaging. Greater PTSD severity and avoidance/numbing were correlated with increased gray matter volume of the right amygdala-hippocampal complex. Greater hyper-arousal was associated with reduced gray matter volume in the left superior medial frontal gyrus. Findings are consistent with current neurocircuitry models of PTSD, which posit that the disorder is associated with structural and functional variance within this distributed network.
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Affiliation(s)
- Mareen Weber
- McLean Hospital, Harvard Medical School, Belmont, MA
| | | | | | | | | | | | - M. Simon Naomi
- Massachusetts General Hospital, Harvard Medical School, Boston MA
| | - Mark H. Pollack
- Massachusetts General Hospital, Harvard Medical School, Boston MA
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