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Van der Watt ASJ, Du Plessis S, Ahmed F, Roos A, Lesch E, Seedat S. Hippocampus, amygdala, and insula activation in response to romantic relationship dissolution stimuli: A case-case-control fMRI study on emerging adult students. J Affect Disord 2024; 356:604-615. [PMID: 38631423 DOI: 10.1016/j.jad.2024.04.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 04/11/2024] [Accepted: 04/14/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Romantic relationship dissolutions (RRDs) are associated with posttraumatic stress symptoms (PTSS). Functional magnetic resonance imaging in RRD studies indicate overlapping neural activation similar to posttraumatic stress disorder. These studies combine real and hypothetical rejection, and lack contextual information and control and/or comparison groups exposed to non-RRD or DSM-5 defined traumatic events. AIM We investigated blood oxygen level dependent (BOLD) activation in the hippocampus, amygdala, and insula of participants with RRDs compared with other traumatic or non-trauma stressors. METHODS Emerging adults (mean age = 21.54 years; female = 74.7 %) who experienced an RRD (n = 36), DSM-5 defined trauma (physical and/or sexual assault: n = 15), or a non-RRD or DSM-5 stressor (n = 28) completed PTSS, depression, childhood trauma, lifetime trauma exposure, and attachment measures. We used a general and customised version of the International Affective Picture System to investigate responses to index-trauma-related stimuli. We used mixed linear models to assess between-group differences, and ANOVAs and Spearman's correlations to analyse factors associated with BOLD activation. RESULTS BOLD activity increased between index-trauma stimuli as compared to neutral stimuli in the hippocampus and amygdala, with no significant difference between the DSM-5 Trauma and RRD groups. Childhood adversity, sexual orientation, and attachment style were associated with BOLD activation changes. Breakup characteristics (e.g., initiator status) were associated with increased BOLD activation in the hippocampus and amygdala, in the RRD group. CONCLUSION RRDs should be considered as potentially traumatic events. Breakup characteristics are risk factors for experiencing RRDs as traumatic. LIMITATION Future studies should consider more diverse representation across sex, ethnicity, and sexual orientation.
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Affiliation(s)
- A S J Van der Watt
- Department of Psychiatry, Stellenbosch University, Tygerberg, South Africa.
| | - S Du Plessis
- Department of Psychiatry, Stellenbosch University, Tygerberg, South Africa; SAMRC Genomics of Brain Disorders Research Unit, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - F Ahmed
- Department of Psychiatry, Stellenbosch University, Tygerberg, South Africa
| | - A Roos
- Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - E Lesch
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - S Seedat
- Department of Psychiatry, Stellenbosch University, Tygerberg, South Africa; SAMRC Genomics of Brain Disorders Research Unit, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
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2
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Gilmore N, Tseng CEJ, Maffei C, Tromly SL, Deary KB, McKinney IR, Kelemen JN, Healy BC, Hu CG, Ramos-Llordén G, Masood M, Cali RJ, Guo J, Belanger HG, Yao EF, Baxter T, Fischl B, Foulkes AS, Polimeni JR, Rosen BR, Perl DP, Hooker JM, Zürcher NR, Huang SY, Kimberly WT, Greve DN, Mac Donald CL, Dams-O’Connor K, Bodien YG, Edlow BL. Impact of repeated blast exposure on active-duty United States Special Operations Forces. Proc Natl Acad Sci U S A 2024; 121:e2313568121. [PMID: 38648470 PMCID: PMC11087753 DOI: 10.1073/pnas.2313568121] [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: 08/22/2023] [Accepted: 03/22/2024] [Indexed: 04/25/2024] Open
Abstract
United States (US) Special Operations Forces (SOF) are frequently exposed to explosive blasts in training and combat, but the effects of repeated blast exposure (RBE) on SOF brain health are incompletely understood. Furthermore, there is no diagnostic test to detect brain injury from RBE. As a result, SOF personnel may experience cognitive, physical, and psychological symptoms for which the cause is never identified, and they may return to training or combat during a period of brain vulnerability. In 30 active-duty US SOF, we assessed the relationship between cumulative blast exposure and cognitive performance, psychological health, physical symptoms, blood proteomics, and neuroimaging measures (Connectome structural and diffusion MRI, 7 Tesla functional MRI, [11C]PBR28 translocator protein [TSPO] positron emission tomography [PET]-MRI, and [18F]MK6240 tau PET-MRI), adjusting for age, combat exposure, and blunt head trauma. Higher blast exposure was associated with increased cortical thickness in the left rostral anterior cingulate cortex (rACC), a finding that remained significant after multiple comparison correction. In uncorrected analyses, higher blast exposure was associated with worse health-related quality of life, decreased functional connectivity in the executive control network, decreased TSPO signal in the right rACC, and increased cortical thickness in the right rACC, right insula, and right medial orbitofrontal cortex-nodes of the executive control, salience, and default mode networks. These observations suggest that the rACC may be susceptible to blast overpressure and that a multimodal, network-based diagnostic approach has the potential to detect brain injury associated with RBE in active-duty SOF.
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Affiliation(s)
- Natalie Gilmore
- Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Boston, MA02114
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA02114
| | - Chieh-En J. Tseng
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA02129
| | - Chiara Maffei
- Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Boston, MA02114
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA02114
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA02129
| | - Samantha L. Tromly
- Institute of Applied Engineering, University of South Florida, Tampa, FL33612
| | | | - Isabella R. McKinney
- Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Boston, MA02114
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA02114
| | - Jessica N. Kelemen
- Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Boston, MA02114
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA02114
| | - Brian C. Healy
- Harvard T.H. Chan School of Public Health, Boston, MA02115
| | - Collin G. Hu
- United States Army Special Operations Aviation Command, Fort Liberty, NC28307
- Department of Family Medicine, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD20814
| | - Gabriel Ramos-Llordén
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA02129
| | - Maryam Masood
- Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Boston, MA02114
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA02114
| | - Ryan J. Cali
- Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Boston, MA02114
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA02114
| | - Jennifer Guo
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA02114
| | - Heather G. Belanger
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL33613
| | - Eveline F. Yao
- Office of the Air Force Surgeon General, Falls Church, VA22042
| | - Timothy Baxter
- Institute of Applied Engineering, University of South Florida, Tampa, FL33612
| | - Bruce Fischl
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA02129
| | | | - Jonathan R. Polimeni
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA02129
| | - Bruce R. Rosen
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA02129
| | - Daniel P. Perl
- Department of Pathology, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD20814
| | - Jacob M. Hooker
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA02129
| | - Nicole R. Zürcher
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA02129
| | - Susie Y. Huang
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA02129
| | - W. Taylor Kimberly
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA02114
| | - Douglas N. Greve
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA02129
| | | | - Kristen Dams-O’Connor
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY10029
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY10029
| | - Yelena G. Bodien
- Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Boston, MA02114
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA02114
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Harvard Medical School, Charlestown, MA02129
| | - Brian L. Edlow
- Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Boston, MA02114
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA02114
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA02129
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Babov KD, Zabolotna IB, Plakida AL, Volyanska VS, Babova IK, Gushcha SG, Kolker IA. The effectiveness of high-tone therapy in the complex rehabilitation of servicemen with post-traumatic stress disorder complicated by traumatic brain injury. Neurol Sci 2023; 44:1039-1048. [PMID: 36417014 DOI: 10.1007/s10072-022-06510-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 11/14/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION As a result of local military conflicts that have become more frequent over the past decades, the number of military personnel subjected to combat stress has sharply increased. More than 50% of them suffer from combat posttraumatic stress disorder. The most common comorbidity in this category of patients is a traumatic brain injury. Due to the undesirability of the long-term use of pharmacological agents, for rehabilitation, preference should be given to physiotherapeutic procedures. OBJECTS AND METHODS We examined 50 patients with post-traumatic stress disorder in combination with a closed craniocerebral injury. Group 1-25 patients received standard complex treatment at the sanatoriumresort rehabilitation stage (diet therapy, climatotherapy, balneotherapy, exercise therapy, psychotherapy). Group 2-25 patients, in addition to the standard complex treatment, received a course of high-tone therapy. RESULTS Complex rehabilitation of patients with the use of high-tone therapy contributes to a significant decrease in astheno-neurotic (p < 0.05) and asthenic depressive (p < 0.01) syndromes and has a psycho-relaxing effect on anxiety syndrome (p < 0.01). There was also a decrease in the severity of pyramidal symptoms and regression of the vestibulo-atactic syndrome (p < 0.05). The course application of hightone therapy was accompanied by a significant restoration of the elastotonic properties of the vascular wall and an improvement in cerebral perfusion (p < 0.05). Positive dynamics of electrophysiological indicators were noted: a decrease in the intensity of slow rhythms against the background of an increase in the frequency and intensity of the alpha rhythm in both hemispheres (p < 0.05), which indicates the harmonization of the bioelectrical activity of the brain.
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Affiliation(s)
- Kostyantyn D Babov
- State Institution "Ukrainian Research Institute of Medical Rehabilitation Therapy of Ministry of Health of Ukraine", Odessa, 65014, Ukraine
| | - Iryna B Zabolotna
- State Institution "Ukrainian Research Institute of Medical Rehabilitation Therapy of Ministry of Health of Ukraine", Odessa, 65014, Ukraine
| | - Alexander L Plakida
- State Institution "Ukrainian Research Institute of Medical Rehabilitation Therapy of Ministry of Health of Ukraine", Odessa, 65014, Ukraine.
| | | | - Iryna K Babova
- State Institution "South Ukrainian National Pedagogical University Named After K.D. Ushynsky", Odessa, 65020, Ukraine
| | - Sergey G Gushcha
- State Institution "Ukrainian Research Institute of Medical Rehabilitation Therapy of Ministry of Health of Ukraine", Odessa, 65014, Ukraine
| | - Iryna A Kolker
- Odessa National Medical University, Odessa, 65000, Ukraine
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4
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Rosen JB, Schulkin J. Hyperexcitability: From Normal Fear to Pathological Anxiety and Trauma. Front Syst Neurosci 2022; 16:727054. [PMID: 35993088 PMCID: PMC9387392 DOI: 10.3389/fnsys.2022.727054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 06/20/2022] [Indexed: 11/16/2022] Open
Abstract
Hyperexcitability in fear circuits is suggested to be important for development of pathological anxiety and trauma from adaptive mechanisms of fear. Hyperexcitability is proposed to be due to acquired sensitization in fear circuits that progressively becomes more severe over time causing changing symptoms in early and late pathology. We use the metaphor and mechanisms of kindling to examine gains and losses in function of one excitatory and one inhibitory neuropeptide, corticotrophin releasing factor and somatostatin, respectively, to explore this sensitization hypothesis. We suggest amygdala kindling induced hyperexcitability, hyper-inhibition and loss of inhibition provide clues to mechanisms for hyperexcitability and progressive changes in function initiated by stress and trauma.
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Affiliation(s)
- Jeffrey B. Rosen
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, United States
- *Correspondence: Jeffrey B. Rosen,
| | - Jay Schulkin
- School of Medicine, University of Washington, Seattle, WA, United States
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5
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Weis CN, Webb EK, deRoon-Cassini TA, Larson CL. Emotion Dysregulation Following Trauma: Shared Neurocircuitry of Traumatic Brain Injury and Trauma-Related Psychiatric Disorders. Biol Psychiatry 2022; 91:470-477. [PMID: 34561028 PMCID: PMC8801541 DOI: 10.1016/j.biopsych.2021.07.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 07/13/2021] [Accepted: 07/25/2021] [Indexed: 11/02/2022]
Abstract
The psychological trauma associated with events resulting in traumatic brain injury (TBI) is an important and frequently overlooked factor that may impede brain recovery and worsen mental health following TBI. Indeed, individuals with comorbid posttraumatic stress disorder (PTSD) and TBI have significantly poorer clinical outcomes than individuals with a sole diagnosis. Emotion dysregulation is a common factor leading to poor cognitive and affective outcomes following TBI. Here, we synthesize how acute postinjury molecular processes stemming from either physical or emotional trauma may adversely impact circuitry subserving emotion regulation and ultimately yield long-term system-level functional and structural changes that are common to TBI and PTSD. In the immediate aftermath of traumatic injury, glucocorticoids stimulate excess glutamatergic activity, particularly in prefrontal cortex-subcortical circuitry implicated in emotion regulation. In human neuroimaging work, assessing this same circuitry well after the acute injury, TBI and PTSD show similar impacts on prefrontal and subcortical connectivity and activation. These neural profiles indicate that emotion regulation may be a useful target for treatment and early intervention to prevent the adverse sequelae of TBI. Ultimately, the success of future TBI and PTSD early interventions depends on the fields' ability to address both the physical and emotional impact of physical injury.
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6
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Event related potentials indexing the influence of emotion on cognitive processing in veterans with comorbid post-traumatic stress disorder and traumatic brain injury. Clin Neurophysiol 2021; 132:1389-1397. [PMID: 34023623 DOI: 10.1016/j.clinph.2021.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 02/23/2021] [Accepted: 03/06/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Emotion regulation and cognitive executive control are significantly impaired in both post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI). These illnesses are increasingly common in veterans and their co-occurrence may exacerbate symptoms and recovery. The current study sought to investigate neural correlates of these impairments via event-related potentials (ERPs) and examined the association of PTSD symptom severity and impulsivity with these correlates. METHODS Electroencephalographic data from seventy-nine veterans with PTSD and TBI and 17 control participants were recorded during a visual emotional oddball task and analyzed for the N2 and P3b ERPs. RESULTS Results revealed that veterans showed a reduced P3b ERP in response to both target images and standard images. However, for standard images that followed a negative emotional distractor, the veterans showed a heightened N2 amplitude while the controls did not. In addition, impulsivity predicted modulation of the P3b across stimulus conditions, with a greater P3b amplitude associated with an increase in impulsivity. CONCLUSIONS These findings suggest that veterans showed hyper-responsivity to background information and reduced ERPs to task-relevant information. SIGNIFICANCE These findings may reflect heightened internal states that create neural noise and a reduced ability to modulate relevant responses.
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Samuelson KW, Engle K, Abadjian L, Jordan J, Bartel A, Talbot M, Powers T, Bryan L, Benight C. Cognitive Training for Mild Traumatic Brain Injury and Posttraumatic Stress Disorder. Front Neurol 2020; 11:569005. [PMID: 33324318 PMCID: PMC7726225 DOI: 10.3389/fneur.2020.569005] [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: 06/03/2020] [Accepted: 10/23/2020] [Indexed: 01/17/2023] Open
Abstract
Although there is evidence of mild cognitive impairments for many individuals with mild traumatic brain injury (mTBI) and posttraumatic stress disorder (PTSD), little research evaluating the effectiveness of cognitive training interventions has been conducted. This randomized controlled trial examined the effectiveness of a 9-h group cognitive training targeting higher-order functions, Strategic Memory Advanced Reasoning Training (SMART), compared to a 9-h psychoeducational control group in improving neurocognitive functioning in adults with mTBI and PTSD. A sample of 124 adults with histories of mild TBI (n = 117) and/or current diagnoses of PTSD (n = 84) were randomized into SMART (n = 66) or Brain Health Workshop (BHW; n = 58) and assessed at three time points: baseline, following training, and 6 months later. Participants completed a battery of neurocognitive tests, including a test of gist reasoning (a function directly targeted by SMART) as well as tests of verbal, visual, and working memory and executive functioning, functions commonly found to be mildly impaired in mTBI and PTSD. The two groups were compared on trajectories of change over time using linear mixed-effects models with restricted maximum likelihood (LMM). Contrary to our hypothesis that SMART would result in superior improvements compared to BHW, both groups displayed statistically and clinically significant improvements on measures of memory, executive functioning, and gist reasoning. Over 60% of the sample showed clinically significant improvements, indicating that gains can be found through psychoeducation alone. A longer SMART protocol may be warranted for clinical samples in order to observe gains over the comparison group.
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Affiliation(s)
- Kristin W Samuelson
- Department of Psychology, National Institute for Human Resilience, University of Colorado Colorado Springs, Colorado Springs, CO, United States
| | - Krista Engle
- Department of Psychology, National Institute for Human Resilience, University of Colorado Colorado Springs, Colorado Springs, CO, United States
| | - Linda Abadjian
- Department of Psychology, National Institute for Human Resilience, University of Colorado Colorado Springs, Colorado Springs, CO, United States
| | - Joshua Jordan
- Department of Psychiatry, University of California San Francisco, San Francisco, San Francisco, CA, United States
| | - Alisa Bartel
- Department of Psychology, National Institute for Human Resilience, University of Colorado Colorado Springs, Colorado Springs, CO, United States
| | - Margaret Talbot
- Department of Psychology, National Institute for Human Resilience, University of Colorado Colorado Springs, Colorado Springs, CO, United States
| | - Tyler Powers
- Department of Psychology, National Institute for Human Resilience, University of Colorado Colorado Springs, Colorado Springs, CO, United States
| | - Lori Bryan
- Department of Psychology, National Institute for Human Resilience, University of Colorado Colorado Springs, Colorado Springs, CO, United States
| | - Charles Benight
- Department of Psychology, National Institute for Human Resilience, University of Colorado Colorado Springs, Colorado Springs, CO, United States
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Novakovic-Agopian T, Posecion L, Kornblith E, Abrams G, McQuaid JR, Neylan TC, Burciaga J, Joseph J, Carlin G, Groberio J, Maruyama B, Chen AJW. Goal-Oriented Attention Self-Regulation Training Improves Executive Functioning in Veterans with Post-Traumatic Stress Disorder and Mild Traumatic Brain Injury. J Neurotrauma 2020; 38:582-592. [PMID: 33019861 DOI: 10.1089/neu.2019.6806] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Difficulties in executive-control functions are common sequelae of both traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD). The goal of this study was to assess whether a cognitive rehabilitation training that was applied successfully in civilian and military TBI would be effective for military Veterans with comorbid PTSD and mild TBI (mTBI). In the previous study, Veterans with a history of mild to severe TBI improved significantly after goal-oriented attentional self-regulation (GOALS) training on measures of attention/executive function, functional task performance, and emotional regulation. The objective of this study was to assess effects of GOALS training in Veterans with comorbid PTSD and mTBI. Forty Veterans with a current PTSD diagnosis and history of mTBI (6+ months post) were randomized to either five weeks of GOALS or Brain-Health Education (BHE) training matched in time and intensity. Evaluator-blinded assessments at baseline and post-training included neuropsychological and complex functional task performance, and self-report measures of emotional functioning/regulation. After GOALS but not BHE training, participants significantly improved from baseline on primary outcome measures of: overall complex attention/executive function neuropsychological performance composite (F = 12.35, p = 0.001; Cohen d = 0.48), and overall mood disturbance -POMS emotional regulation self-report (F = 4.29, p = 0.05, Cohen d = 0.41). In addition, GOALS but not BHE participants indicated a significant decrease in PTSD symptoms (PCL-M Total Score) (F = 4.80, p = 0.05, Cohen d = 0.60), and demonstrated improvement on complex functional task performance-GPS Learning and Memory (F = 5.06, p = 0.05, Cohen d = 0.56]. Training in attentional self-regulation applied to participant-defined goals may improve cognitive functioning in Veterans with comorbid PTSD and mTBI. Improving cognitive control functioning may also improve functioning in other domains such as emotional regulation and functional performance, potentially making it particularly relevant for Veterans with a history of mTBI and comorbid psychiatric symptoms.
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Affiliation(s)
- Tatjana Novakovic-Agopian
- San Francisco VA Health Care System, San Francisco, California, USA.,University of California, San Francisco, San Francisco, California, USA.,VA Northern California Health Care System, Martinez, California, USA
| | - Lainie Posecion
- San Francisco VA Health Care System, San Francisco, California, USA
| | - Erica Kornblith
- San Francisco VA Health Care System, San Francisco, California, USA.,University of California, San Francisco, San Francisco, California, USA
| | - Gary Abrams
- San Francisco VA Health Care System, San Francisco, California, USA.,University of California, San Francisco, San Francisco, California, USA
| | - John R McQuaid
- San Francisco VA Health Care System, San Francisco, California, USA.,University of California, San Francisco, San Francisco, California, USA
| | - Thomas C Neylan
- San Francisco VA Health Care System, San Francisco, California, USA.,University of California, San Francisco, San Francisco, California, USA
| | - Joaquin Burciaga
- San Francisco VA Health Care System, San Francisco, California, USA
| | - Jeremy Joseph
- San Francisco VA Health Care System, San Francisco, California, USA.,University of California, San Francisco, San Francisco, California, USA
| | - Gerald Carlin
- San Francisco VA Health Care System, San Francisco, California, USA
| | - Jessica Groberio
- San Francisco VA Health Care System, San Francisco, California, USA
| | - Brian Maruyama
- San Francisco VA Health Care System, San Francisco, California, USA
| | - Anthony J W Chen
- University of California, San Francisco, San Francisco, California, USA.,VA Northern California Health Care System, Martinez, California, USA
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9
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Gilis-Januszewska A, Kluczyński Ł, Hubalewska-Dydejczyk A. Traumatic brain injuries induced pituitary dysfunction: a call for algorithms. Endocr Connect 2020; 9:R112-R123. [PMID: 32412425 PMCID: PMC7274553 DOI: 10.1530/ec-20-0117] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 04/21/2020] [Indexed: 12/13/2022]
Abstract
Traumatic brain injury affects many people each year, resulting in a serious burden of devastating health consequences. Motor-vehicle and work-related accidents, falls, assaults, as well as sport activities are the most common causes of traumatic brain injuries. Consequently, they may lead to permanent or transient pituitary insufficiency that causes adverse changes in body composition, worrisome metabolic function, reduced bone density, and a significant decrease in one's quality of life. The prevalence of post-traumatic hypopituitarism is difficult to determine, and the exact mechanisms lying behind it remain unclear. Several probable hypotheses have been suggested. The diagnosis of pituitary dysfunction is very challenging both due to the common occurrence of brain injuries, the subtle character of clinical manifestations, the variable course of the disease, as well as the lack of proper diagnostic algorithms. Insufficiency of somatotropic axis is the most common abnormality, followed by presence of hypogonadism, hypothyroidism, hypocortisolism, and diabetes insipidus. The purpose of this review is to summarize the current state of knowledge about post-traumatic hypopituitarism. Moreover, based on available data and on our own clinical experience, we suggest an algorithm for the evaluation of post-traumatic hypopituitarism. In addition, well-designed studies are needed to further investigate the pathophysiology, epidemiology, and timing of pituitary dysfunction after a traumatic brain injury with the purpose of establishing appropriate standards of care.
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Affiliation(s)
- Aleksandra Gilis-Januszewska
- Chair and Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland
- Endocrinology Department, University Hospital in Krakow, Krakow, Poland
| | - Łukasz Kluczyński
- Chair and Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland
- Endocrinology Department, University Hospital in Krakow, Krakow, Poland
- Correspondence should be addressed to Ł Kluczyński:
| | - Alicja Hubalewska-Dydejczyk
- Chair and Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland
- Endocrinology Department, University Hospital in Krakow, Krakow, Poland
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10
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Dossi G, Delvecchio G, Prunas C, Soares JC, Brambilla P. Neural Bases of Cognitive Impairments in Post-Traumatic Stress Disorders: A Mini-Review of Functional Magnetic Resonance Imaging Findings. Front Psychiatry 2020; 11:176. [PMID: 32256405 PMCID: PMC7090214 DOI: 10.3389/fpsyt.2020.00176] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 02/24/2020] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION Post-Traumatic Stress Disorder (PTSD) is often associated with impairments in emotional and cognitive domains. Contrarily to the emotional sphere, neural basis underpinnings to cognitive impairments are still not well known. METHODS We performed a bibliographic search on PUBMED of all the studies investigating the cognitive impairments in PTSD individuals. We considered only studies that applied cognitive tasks using a functional Magnetic Resonance Imaging technique. The inclusion criteria were met by nine studies. RESULTS Overall, PTSD individuals reported significant impairments in the dorsolateral prefrontal cortex, anterior cingulate cortex, inferior frontal gyrus, insula, inferior temporal cortex, supplement motor area, and Default Mode Network (DMN). Moreover, abnormal activity was reported in subcortical structures (e.g. hippocampus, amygdala, thalamus) and in the cerebellum. LIMITATIONS Cognitive functioning was assessed using different cognitive tasks. Potential confounding factors such as age, sex, symptoms intensity, and comorbidities might have influenced the results. CONCLUSION So far, the evidence reported that PTSD is characterized by cognitive impairments in several domains, such as attention, memory and autonomic arousal, which may be due to selective dysfunctions in brain regions that are part of cortical networks, the limbic system and DMN. However, further studies are needed in order to better assess the role of cognitive impairments in PTSD and to develop more targeted therapeutic approaches.
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Affiliation(s)
- Gabriele Dossi
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Giuseppe Delvecchio
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Cecilia Prunas
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Jair C Soares
- Department of Psychiatry and Behavioural Sciences, UT Houston Medical School, Houston, TX, United States
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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11
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Hampstead BM, Mascaro N, Schlaefflin S, Bhaumik A, Laing J, Peltier S, Martis B. Variable symptomatic and neurophysiologic response to HD-tDCS in a case series with posttraumatic stress disorder. Int J Psychophysiol 2019; 154:93-100. [PMID: 31783040 DOI: 10.1016/j.ijpsycho.2019.10.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 10/22/2019] [Accepted: 10/29/2019] [Indexed: 01/04/2023]
Abstract
Chronic Posttraumatic stress disorder (PTSD), characterized by symptoms of re-experiencing, hyperarousal, and avoidance, is challenging to treat as a significant proportion of patients remain symptomatic following even empirically supported interventions. The current case series investigated the effects of up to 10 sessions of high definition transcranial direct current stimulation (HD-tDCS) on symptoms of PTSD. Participants received HD-tDCS that targeted the right lateral temporal cortex (LTC; center cathode placed over T8), given this region's potential involvement in symptoms of re-experiencing and, possibly, hyperarousal. Five of the six enrolled patients completed at least 8 sessions. Of these five, four showed improvement in symptoms of re-experiencing after HD-tDCS. This improvement was accompanied by connectivity change in the right LTC as well as a larger extended fear network but not a control network that consisted of visual cortex regions; however, the nature of the change varied across participants as some showed increased connectivity whereas others showed decreased connectivity. These preliminary data suggest that HD-tDCS may be beneficial for treatment of specific PTSD symptoms, in at least some individuals, and warrants further investigation.
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Affiliation(s)
- Benjamin M Hampstead
- Mental Health Service, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; Neuropsychology Section, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
| | - Nathan Mascaro
- Trauma Recovery Program, Atlanta VAMC, Decatur, GA, USA; Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA
| | - Stephen Schlaefflin
- Neuropsychology Section, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Arijit Bhaumik
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Julia Laing
- Neuropsychology Section, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Scott Peltier
- Functional MRI Laboratory, University of Michigan, Ann Arbor, MI, USA; Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Brian Martis
- Mental Health Service, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
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12
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McCurry KL, Frueh BC, Chiu PH, King-Casas B. Opponent Effects of Hyperarousal and Re-experiencing on Affective Habituation in Posttraumatic Stress Disorder. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2019; 5:203-212. [PMID: 31759868 DOI: 10.1016/j.bpsc.2019.09.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 09/06/2019] [Accepted: 09/09/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Aberrant emotion processing is a hallmark of posttraumatic stress disorder (PTSD), with neurobiological models suggesting both heightened neural reactivity and diminished habituation to aversive stimuli. However, empirical work suggests that these response patterns may be specific to subsets of those with PTSD. This study investigates the unique contributions of PTSD symptom clusters (re-experiencing, avoidance and numbing, and hyperarousal) to neural reactivity and habituation to negative stimuli in combat-exposed veterans. METHODS Ninety-five combat-exposed veterans (46 with PTSD) and 53 community volunteers underwent functional magnetic resonance imaging while viewing emotional images. This study examined the relationship between symptom cluster severity and hemodynamic responses to negative compared with neutral images (NEG>NEU). RESULTS Veterans exhibited comparable mean and habituation-related responses for NEG>NEU, relative to civilians. However, among veterans, habituation, but not mean response, was differentially related to PTSD symptom severity. Hyperarousal symptoms were related to decreased habituation for NEG>NEU in a network of regions, including superior and inferior frontal gyri, ventromedial prefrontal cortex, superior and middle temporal gyri, and anterior insula. In contrast, re-experiencing symptoms were associated with increased habituation in a similar network. Furthermore, re-experiencing severity was positively related to amygdalar functional connectivity with the left inferior frontal gyrus and dorsal anterior cingulate cortex for NEG>NEU. CONCLUSIONS These results indicate that hyperarousal symptoms in combat-related PTSD are associated with decreased neural habituation to aversive stimuli. These impairments are partially mitigated in the presence of re-experiencing symptoms, such that during exposure to negative stimuli, re-experiencing symptoms are positively associated with amygdalar connectivity to prefrontal regions implicated in affective suppression.
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Affiliation(s)
- Katherine L McCurry
- Salem Veterans Affairs Medical Center, Salem, Virginia; Fralin Biomedical Research Institute at Virginia Tech Carilion, Virginia Tech, Roanoke, Virginia; Department of Psychology, Virginia Tech, Blacksburg, Virginia
| | - B Christopher Frueh
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Virginia Tech, Roanoke, Virginia; Department of Psychology, University of Hawaii at Hilo, Hilo, Hawaii; Trauma and Resilience Center, Department of Psychiatry, University of Texas Health Sciences Center, Houston, Texas
| | - Pearl H Chiu
- Salem Veterans Affairs Medical Center, Salem, Virginia; Fralin Biomedical Research Institute at Virginia Tech Carilion, Virginia Tech, Roanoke, Virginia; Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia; Department of Psychology, Virginia Tech, Blacksburg, Virginia.
| | - Brooks King-Casas
- Salem Veterans Affairs Medical Center, Salem, Virginia; Fralin Biomedical Research Institute at Virginia Tech Carilion, Virginia Tech, Roanoke, Virginia; Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia; Department of Psychology, Virginia Tech, Blacksburg, Virginia; School of Biomedical Engineering and Sciences, Virginia Tech-Wake Forest University, Blacksburg, Virginia.
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13
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Shim M, Jin MJ, Im CH, Lee SH. Machine-learning-based classification between post-traumatic stress disorder and major depressive disorder using P300 features. NEUROIMAGE-CLINICAL 2019; 24:102001. [PMID: 31627171 PMCID: PMC6812119 DOI: 10.1016/j.nicl.2019.102001] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 08/29/2019] [Accepted: 09/02/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND The development of optimal classification criteria for specific mental disorders which share similar symptoms is an important issue for precise diagnosis. We investigated whether P300 features in both sensor-level and source-level could be effectively used to classify post-traumatic stress disorder (PTSD) and major depressive disorder (MDD). METHOD EEG signals were recorded from fifty-one PTSD patients, 67 MDD patients, and 39 healthy controls (HCs) while performing an auditory oddball task. Amplitude and latency of P300 were evaluated, and the current source analysis of P300 components was conducted using sLORETA. Finally, we classified two groups using machine-learning methods with both sensor- and source-level features. Moreover, we checked the comorbidity effects using the same approaches (PTSD-mono diagnosis (PTSDm, n = 28) and PTSD-comorbid diagnosis (PTSDc, n = 23)). RESULTS PTSD showed significantly reduced P300 amplitudes and prolonged latency compared to HCs and MDD. Moreover, PTSD showed significantly reduced source activities, and the source activities were significantly correlated with symptoms of depression and anxiety. Also, the best classification accuracy at each pair was as follows: 80.00% (PTSD-HCs), 67.92% (MDD-HCs), 70.34% (PTSD-MDD), 82.09% (PTSDm-HCs), 71.58% (PTSDm-MDD), 82.56% (PTSDc-HCs), and 76.67% (PTSDc- MDD). CONCLUSION Since abnormal P300 reflects pathophysiological characteristics of PTSD, PTSD patients were well-discriminated from MDD and HCs when using P300 features. Thus, altered P300 characteristics in both sensor- and source-level may be useful biomarkers to diagnosis PTSD.
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Affiliation(s)
- Miseon Shim
- Department of Biomedical Sciences, University of Missouri, Kansas City, USA; Clinical Emotion and Cognition Research Laboratory, Goyang, Republic of Korea
| | - Min Jin Jin
- Clinical Emotion and Cognition Research Laboratory, Goyang, Republic of Korea; Department of Psychology, Chung-Ang University, Seoul, Republic of Korea
| | - Chang-Hwan Im
- Department of Biomedical Engineering, Hanyang University, Seoul, Republic of Korea
| | - Seung-Hwan Lee
- Clinical Emotion and Cognition Research Laboratory, Goyang, Republic of Korea; Psychiatry Department, Ilsan Paik Hospital, Inje University, Goyang, Republic of Korea.
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14
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Rangaprakash D, Dretsch MN, Katz JS, Denney TS, Deshpande G. Dynamics of Segregation and Integration in Directional Brain Networks: Illustration in Soldiers With PTSD and Neurotrauma. Front Neurosci 2019; 13:803. [PMID: 31507353 PMCID: PMC6716456 DOI: 10.3389/fnins.2019.00803] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 07/17/2019] [Indexed: 01/08/2023] Open
Abstract
Brain functioning relies on various segregated/specialized neural regions functioning as an integrated-interconnected network (i.e., metastability). Various psychiatric and neurologic disorders are associated with aberrant functioning of these brain networks. In this study, we present a novel framework integrating the strength and temporal variability of metastability in brain networks. We demonstrate that this approach provides novel mechanistic insights which enables better imaging-based predictions. Using whole-brain resting-state fMRI and a graph-theoretic framework, we integrated strength and temporal-variability of complex-network properties derived from effective connectivity networks, obtained from 87 U.S. Army soldiers consisting of healthy combat controls (n = 28), posttraumatic stress disorder (PTSD; n = 17), and PTSD with comorbid mild-traumatic brain injury (mTBI; n = 42). We identified prefrontal dysregulation of key subcortical and visual regions in PTSD/mTBI, with all network properties exhibiting lower variability over time, indicative of poorer flexibility. Larger impairment in the prefrontal-subcortical pathway but not prefrontal-visual pathway differentiated comorbid PTSD/mTBI from the PTSD group. Network properties of the prefrontal-subcortical pathway also had significant association (R 2 = 0.56) with symptom severity and neurocognitive performance; and were also found to possess high predictive ability (81.4% accuracy in classifying the disorders, explaining 66-72% variance in symptoms), identified through machine learning. Our framework explained 13% more variance in behaviors compared to the conventional framework. These novel insights and better predictions were made possible by our novel framework using static and time-varying network properties in our three-group scenario, advancing the mechanistic understanding of PTSD and comorbid mTBI. Our contribution has wide-ranging applications for network-level characterization of healthy brains as well as mental disorders.
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Affiliation(s)
- D Rangaprakash
- Department of Electrical and Computer Engineering, AU MRI Research Center, Auburn University, Auburn, AL, United States.,Departments of Radiology and Biomedical Engineering, Northwestern University, Chicago, IL, United States
| | - Michael N Dretsch
- U.S. Army Aeromedical Research Laboratory, Fort Rucker, AL, United States.,U.S. Army Medical Research Directorate-West, Walter Reed Army Institute for Research, Joint Base Lewis-McChord, WA, United States.,Department of Psychology, Auburn University, Auburn, AL, United States
| | - Jeffrey S Katz
- Department of Electrical and Computer Engineering, AU MRI Research Center, Auburn University, Auburn, AL, United States.,Department of Psychology, Auburn University, Auburn, AL, United States.,Alabama Advanced Imaging Consortium, Auburn, AL, United States.,Center for Neuroscience, Auburn University, Auburn, AL, United States
| | - Thomas S Denney
- Department of Electrical and Computer Engineering, AU MRI Research Center, Auburn University, Auburn, AL, United States.,Department of Psychology, Auburn University, Auburn, AL, United States.,Alabama Advanced Imaging Consortium, Auburn, AL, United States.,Center for Neuroscience, Auburn University, Auburn, AL, United States
| | - Gopikrishna Deshpande
- Department of Electrical and Computer Engineering, AU MRI Research Center, Auburn University, Auburn, AL, United States.,Department of Psychology, Auburn University, Auburn, AL, United States.,Alabama Advanced Imaging Consortium, Auburn, AL, United States.,Center for Neuroscience, Auburn University, Auburn, AL, United States.,Center for Health Ecology and Equity Research, Auburn University, Auburn, AL, United States.,Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
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15
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Abstract
PURPOSE Traumatic brain injury most commonly affects young adults under the age of 35 and frequently results in reduced quality of life, disability, and death. In long-term survivors, hypopituitarism is a common complication. RESULTS Pituitary dysfunction occurs in approximately 20-40% of patients diagnosed with moderate and severe traumatic brain injury giving rise to growth hormone deficiency, hypogonadism, hypothyroidism, hypocortisolism, and central diabetes insipidus. Varying degrees of hypopituitarism have been identified in patients during both the acute and chronic phase. Anterior pituitary hormone deficiency has been shown to cause morbidity and increase mortality in TBI patients, already encumbered by other complications. Hypopituitarism after childhood traumatic brain injury may cause treatable morbidity in those survivors. Prospective studies indicate that the incidence rate of hypopituitarism may be ten-fold higher than assumed; factors altering reports include case definition, geographic location, variable hospital coding, and lost notes. While the precise pathophysiology of post traumatic hypopituitarism has not yet been elucidated, it has been hypothesized that, apart from the primary mechanical event, secondary insults such as hypotension, hypoxia, increased intracranial pressure, as well as changes in cerebral flow and metabolism may contribute to hypothalamic-pituitary damage. A number of mechanisms have been proposed to clarify the causes of primary mechanical events giving rise to ischemic adenohypophysial infarction and the ensuing development of hypopituitarism. CONCLUSION Future research should focus more on experimental and clinical studies to elucidate the exact mechanisms behind post-traumatic pituitary damage. The use of preventive medical measures to limit possible damage in the pituitary gland and hypothalamic pituitary axis in order to maintain or re-establish near normal physiologic functions are crucial to minimize the effects of TBI.
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Affiliation(s)
- Aydin Sav
- Department of Pathology, Yeditepe University, School of Medicine, Kosuyolu Hospital, Kosuyolu Mahallesi, Koşuyolu Cd. 168, 34718, Kadikoy, Istanbul, Turkey.
| | - Fabio Rotondo
- Department of Laboratory Medicine, Division of Pathology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Luis V Syro
- Department of Neurosurgery, Hospital Pablo Tobon Uribe and Clinica Medellin, Medellin, Colombia
| | - Carlos A Serna
- Laboratorio de Patologia y Citologia Rodrigo Restrepo, Department of Pathology, Clinica Las Américas, Universidad CES, Medellin, Colombia
| | - Kalman Kovacs
- Department of Laboratory Medicine, Division of Pathology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
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16
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Jak AJ, Crocker LD, Aupperle RL, Clausen A, Bomyea J. Neurocognition in PTSD: Treatment Insights and Implications. Curr Top Behav Neurosci 2019; 38:93-116. [PMID: 28025811 DOI: 10.1007/7854_2016_62] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Post-traumatic stress disorder (PTSD) is classified as a traumatic stress-related condition and is most often discussed in terms of emotional dysfunction. However, given that cognitive and emotional processes are intricately intertwined, implemented by overlapping brain networks, and effectively integrated in at least some of the same regions (e.g., prefrontal cortex, for a review, see Crocker et al. 2013), an abundance of literature now highlights the key role that cognitive functioning plays in both the development and maintenance (or exacerbation) of PTSD symptoms (Aupperle et al. 2012a; Verfaellie et al. 2012). Findings from this body of work detail objective impairment in neuropsychological function in those with PTSD (Brandes et al. 2002; Hayes et al. 2012a; Koenen et al. 2001). Yet despite the impact of neurocognition on PTSD treatment engagement and success (e.g., Haaland et al. 2016; Nijdam et al. 2015) and conversely, the role of PTSD treatment in normalizing cognitive dysfunction, a much smaller literature exists on neurocognitive changes following treatment for PTSD. Even aside from its role in treatment, cognitive functioning in PTSD has significant implications for daily functioning for individuals with this disorder, as cognition is predictive of school achievement, obtaining and maintaining employment, job advancement, maintaining relationships, greater wealth, and better health and quality of life (e.g., Diamond and Ling 2016).
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Affiliation(s)
- Amy J Jak
- VA San Diego Healthcare System, San Diego, CA, USA.
- University of California, San Diego, La Jolla, CA, USA.
| | | | - Robin L Aupperle
- Laureate Institute for Brain Research, Tulsa, OK, USA
- University of Tulsa, Tulsa, OK, USA
| | - Ashley Clausen
- Laureate Institute for Brain Research, Tulsa, OK, USA
- University of Tulsa, Tulsa, OK, USA
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17
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Spadoni AD, Huang M, Simmons AN. Emerging Approaches to Neurocircuits in PTSD and TBI: Imaging the Interplay of Neural and Emotional Trauma. Curr Top Behav Neurosci 2019; 38:163-192. [PMID: 29285732 PMCID: PMC8896198 DOI: 10.1007/7854_2017_35] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) commonly co-occur in general and military populations and have a number of overlapping symptoms. While research suggests that TBI is risk factor for PTSD and that PTSD may mediate TBI-related outcomes, the mechanisms of these relationships are not well understood. Neuroimaging may help elucidate patterns of neurocircuitry both specific and common to PTSD and TBI and thus help define the nature of their interaction, refine diagnostic classification, and may potentially yield opportunities for targeted treatments. In this review, we provide a summary of some of the most common and the most innovative neuroimaging approaches used to characterize the neural circuits associated with PTSD, TBI, and their comorbidity. We summarize the state of the science for each disorder and describe the few studies that have explicitly attempted to characterize the neural substrates of their shared and dissociable influence. While some promising targets in the medial frontal lobes exist, there is not currently a comprehensive understanding of the neurocircuitry mediating the interaction of PTSD and TBI. Future studies should exploit innovative neuroimaging approaches and longitudinal designs to specifically target the neural mechanisms driving PTSD-TBI-related outcomes.
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Affiliation(s)
- Andrea D Spadoni
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA.
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.
| | - Mingxiong Huang
- Radiology and Research Services, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
| | - Alan N Simmons
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
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18
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Kowalski J, Wypych M, Marchewka A, Dragan M. Neural Correlates of Cognitive-Attentional Syndrome: An fMRI Study on Repetitive Negative Thinking Induction and Resting State Functional Connectivity. Front Psychol 2019; 10:648. [PMID: 30971987 PMCID: PMC6443848 DOI: 10.3389/fpsyg.2019.00648] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 03/08/2019] [Indexed: 11/13/2022] Open
Abstract
Aim Cognitive-attentional syndrome (CAS) is the main factor underlying depressive and anxiety disorders in the metacognitive approach to psychopathology and psychotherapy. This study explore neural correlates of this syndrome during induced negative thinking, abstract thinking, and resting states. Methods n = 25 people with high levels of CAS and n = 33 people with low levels of CAS were chosen from a population-based sample (N = 1225). These groups filled-in a series of measures of CAS, negative affect, and psychopathology; they also underwent a modified rumination induction procedure and a resting state fMRI session. Resonance imaging data were analyzed using static general linear model and functional connectivity approaches. Results The two groups differed with large effect sizes on all used measures of CAS, negative affect, and psychopathology. We did not find any group differences in general linear model analyses. Functional connectivity analyses showed that high levels of CAS were related to disrupted patterns of connectivity within and between various brain networks: the default mode network, the salience network, and the central executive network. Conclusion We showed that low- and high-CAS groups differed in functional connectivity during induced negative and abstract thinking and also in resting state fMRI. Overall, our results suggest that people with high levels of CAS tend to have disrupted neural processing related to self-referential processing, task-oriented processing, and emotional processing.
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Affiliation(s)
| | - Marek Wypych
- Laboratory of Brain Imaging, Nencki Institute of Experimental Biology, Polish Academy of Sciences, Warsaw, Poland
| | - Artur Marchewka
- Laboratory of Brain Imaging, Nencki Institute of Experimental Biology, Polish Academy of Sciences, Warsaw, Poland
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19
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Ewing-Cobbs L, DeMaster D, Watson CG, Prasad MR, Cox CS, Kramer LA, Fischer JT, Duque G, Swank PR. Post-Traumatic Stress Symptoms after Pediatric Injury: Relation to Pre-Frontal Limbic Circuitry. J Neurotrauma 2019; 36:1738-1751. [PMID: 30672379 DOI: 10.1089/neu.2018.6071] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Pre-frontal limbic circuitry is vulnerable to effects of stress and injury. We examined microstructure of pre-frontal limbic circuitry after traumatic brain injury (TBI) or extracranial injury (EI) and its relation to post-traumatic stress symptoms (PTSS). Participants aged 8 to 15 years who sustained mild to severe TBI (n = 53) or EI (n = 26) in motor vehicle incidents were compared with healthy children (n = 38) in a prospective longitudinal study. At the seven-week follow-up, diffusion tensor imaging was obtained in all groups; injured children completed PTSS ratings using a validated scale. Using probabilistic diffusion tensor tractography, pathways were seeded from bilateral amygdalae and hippocampi to estimate the trajectory of white matter connecting them to each other and to targeted pre-frontal cortical (PFC) regions. Microstructure was estimated using fractional anisotropy (FA) in white matter and mean diffusivity (MD) in gray matter. Pre-frontal limbic microstructure was similar across groups, except for reduced FA in the right hippocampus to orbital PFC pathway in the injured versus healthy group. We examined microstructure of components of pre-frontal limbic circuitry with concurrently obtained PTSS cluster scores in the injured children. Neither microstructure nor PTSS scores differed significantly in the TBI and EI groups. Across PTSS factors, specific symptom clusters were related positively to higher FA and MD. Higher hyperarousal, avoidance, and re-experiencing symptoms were associated with higher FA in amygdala to pre-frontal and hippocampus to amygdala pathways. Higher hippocampal MD had a central role in hyperarousal and emotional numbing symptoms. Age moderated the relation of white and gray matter microstructure with hyperarousal scores. Our findings are consistent with models of traumatic stress that implicate disrupted top-down PFC and hippocampal moderation of overreactive subcortical threat arousal systems. Alterations in limbic pre-frontal circuitry and PTSS place children with either brain or body injuries at elevated risk for both current and future psychological health problems.
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Affiliation(s)
- Linda Ewing-Cobbs
- 1 Children's Learning Institute and Department of Pediatrics, University of Texas Health Science Center at Houston, Houston, Texas
| | - Dana DeMaster
- 1 Children's Learning Institute and Department of Pediatrics, University of Texas Health Science Center at Houston, Houston, Texas
| | - Christopher G Watson
- 1 Children's Learning Institute and Department of Pediatrics, University of Texas Health Science Center at Houston, Houston, Texas
| | - Mary R Prasad
- 1 Children's Learning Institute and Department of Pediatrics, University of Texas Health Science Center at Houston, Houston, Texas
| | - Charles S Cox
- 2 Department of Pediatric Surgery, University of Texas Health Science Center at Houston, Houston, Texas
| | - Larry A Kramer
- 4 Department of Interventional Radiology, University of Texas Health Science Center at Houston, Houston, Texas
| | - Jesse T Fischer
- 5 Department of Psychology, University of Houston, Houston, Texas
| | - Gerardo Duque
- 1 Children's Learning Institute and Department of Pediatrics, University of Texas Health Science Center at Houston, Houston, Texas
| | - Paul R Swank
- 3 School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas
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20
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Henigsberg N, Kalember P, Petrović ZK, Šečić A. Neuroimaging research in posttraumatic stress disorder - Focus on amygdala, hippocampus and prefrontal cortex. Prog Neuropsychopharmacol Biol Psychiatry 2019; 90:37-42. [PMID: 30419321 DOI: 10.1016/j.pnpbp.2018.11.003] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 10/26/2018] [Accepted: 11/03/2018] [Indexed: 01/21/2023]
Abstract
Neuroimaging research reflects the complexity of post-traumatic stress disorder and shares some common difficulties of post-traumatic stress disorder research, such as the different classifications of the disorder over time, changes in diagnostic criteria, and extensive comorbidities, as well as precisely delineated and prevailing genetic and environmental determinants in the development of the disorder and its clinical manifestations. Synthesis of neuroimaging findings in an effort to clarify causes, clinical manifestations, and consequences of the disorder is complicated by a variety of applied technical approaches in different brain regions, differences in symptom dimensions in a study population, and typically small sample sizes, with the interplay of all of these consequently bringing about divergent results. Furthermore, combinations of the aforementioned issues serve to weaken any comprehensive meta-analytic approach. In this review, we focus on recent neuroimaging studies and those performed on larger samples, with particular emphasis on research concerning the amygdala, hippocampus, and prefrontal cortex, as these are the brain regions postulated by the core research to play a prominent role in the pathophysiology of post-traumatic stress disorder. Additionally, we review the guidelines for future research and list a number of new intersectional and cross-sectional approaches in the area of neuroimaging. We conclude that future neuroimaging research in post-traumatic stress disorder will certainly benefit from a higher integration with genetic research, better profiling of control groups, and a greater involvement of the neuroimaging genetics approach and from larger collaborative studies.
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Affiliation(s)
- Neven Henigsberg
- Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Croatia; University Psychiatric Hospital Vrapče, Zagreb, Croatia
| | - Petra Kalember
- Polyclinic Neuron, Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Croatia
| | - Zrnka Kovačić Petrović
- Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Croatia; University Psychiatric Hospital Vrapče, Zagreb, Croatia
| | - Ana Šečić
- Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Croatia; University Hospital Centre, 'Sestre milosrdnice', Zagreb, Croatia.
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21
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Negreira AM, Abdallah CG. A Review of fMRI Affective Processing Paradigms Used in the Neurobiological Study of Posttraumatic Stress Disorder. CHRONIC STRESS 2019; 3. [PMID: 30828684 PMCID: PMC6391723 DOI: 10.1177/2470547019829035] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Posttraumatic stress disorder (PTSD) is a chronic and debilitating psychiatric disorder with a complex clinical presentation. The last two decades have seen a proliferation of literature on the neurobiological mechanisms subserving affective processing in PTSD. The current review will summarize the neuroimaging results of the most common experimental designs used to elucidate the affective signature of PTSD. From this summary, we will provide a heuristic to organize the various paradigms discussed and report neural patterns of activations using this heuristic as a framework. Next, we will compare these results to the traditional functional neurocircuitry model of PTSD and discuss biological and analytic variables which may account for the heterogeneity within this literature. We hope that this approach may elucidate the role of experimental parameters in influencing neuroimaging findings.
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Affiliation(s)
- Alyson M Negreira
- Clinical Neurosciences Division, United States Department of Veterans Affairs, National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Chadi G Abdallah
- Clinical Neurosciences Division, United States Department of Veterans Affairs, National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
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22
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Butt M, Espinal E, Aupperle RL, Nikulina V, Stewart JL. The Electrical Aftermath: Brain Signals of Posttraumatic Stress Disorder Filtered Through a Clinical Lens. Front Psychiatry 2019; 10:368. [PMID: 31214058 PMCID: PMC6555259 DOI: 10.3389/fpsyt.2019.00368] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 05/13/2019] [Indexed: 12/14/2022] Open
Abstract
This review aims to identify patterns of electrical signals identified using electroencephalography (EEG) linked to posttraumatic stress disorder (PTSD) diagnosis and symptom dimensions. We filter EEG findings through a clinical lens, evaluating nuances in findings according to study criteria and participant characteristics. Within the EEG frequency domain, greater right than left parietal asymmetry in alpha band power is the most promising marker of PTSD symptoms and is linked to exaggerated physiological arousal that may impair filtering of environmental distractors. The most consistent findings within the EEG time domain focused on event related potentials (ERPs) include: 1) exaggerated frontocentral responses (contingent negative variation, mismatch negativity, and P3a amplitudes) to task-irrelevant distractors, and 2) attenuated parietal responses (P3b amplitudes) to task-relevant target stimuli. These findings suggest that some individuals with PTSD suffer from attention dysregulation, which could contribute to problems concentrating on daily tasks and goals in lieu of threatening distractors. Future research investigating the utility of alpha asymmetry and frontoparietal ERPs as diagnostic and predictive biomarkers or intervention targets are recommended.
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Affiliation(s)
- Mamona Butt
- Department of Psychology, Queens College, City University of New York, Flushing, NY, United States
| | - Elizabeth Espinal
- Department of Psychology, Queens College, City University of New York, Flushing, NY, United States
| | - Robin L Aupperle
- Laureate Institute for Brain Research, Tulsa, OK, United States.,Department of Community Medicine, Oxley College of Health Sciences, University of Tulsa, Tulsa, OK, United States
| | - Valentina Nikulina
- Department of Psychology, Queens College, City University of New York, Flushing, NY, United States.,Department of Psychology, The Graduate Center, City University of New York, New York, NY, United States
| | - Jennifer L Stewart
- Laureate Institute for Brain Research, Tulsa, OK, United States.,Department of Community Medicine, Oxley College of Health Sciences, University of Tulsa, Tulsa, OK, United States
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23
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Kornblith E, Abrams G, Chen AJW, Burciaga J, D’Esposito M, Novakovic-Agopian T. Impact of baseline neurocognitive functioning on outcomes following rehabilitation of executive function training for veterans with history of traumatic brain injury. APPLIED NEUROPSYCHOLOGY-ADULT 2018; 27:108-120. [DOI: 10.1080/23279095.2018.1490738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | - Gary Abrams
- Neurology Service, SFVA Medical Center, University of California, San Francisco, California, USA
| | - Anthony J.-W. Chen
- VA Northern California Health Care System, University of California, San Francisco, CA, USA
| | | | - Mark D’Esposito
- University of California Berkeley, Helen Wills Neuroscience Institute, Berkeley CA, USA
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24
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Stout DM, Buchsbaum MS, Spadoni AD, Risbrough VB, Strigo IA, Matthews SC, Simmons AN. Multimodal canonical correlation reveals converging neural circuitry across trauma-related disorders of affect and cognition. Neurobiol Stress 2018; 9:241-250. [PMID: 30450388 PMCID: PMC6234282 DOI: 10.1016/j.ynstr.2018.09.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 07/02/2018] [Accepted: 09/14/2018] [Indexed: 11/30/2022] Open
Abstract
Trauma-related disorders of affect and cognition (TRACs) are associated with a high degree of diagnostic comorbidity, which may suggest that these disorders share a set of underlying neural mechanisms. TRACs are characterized by aberrations in functional and structural circuits subserving verbal memory and affective anticipation. Yet, it remains unknown how the neural circuitry underlying these multiple mechanisms contribute to TRACs. Here, in a sample of 47 combat Veterans, we measured affective anticipation using functional magnetic resonance imaging (fMRI), verbal memory with fluorodeoxyglucose positron emission tomography (FDG-PET), and grey matter volume with structural magnetic resonance imaging (sMRI). Using a voxel-based multimodal canonical correlation analysis (mCCA), the set of neural measures were statistically integrated, or fused, with a set of TRAC symptom measures including mild traumatic brain injury (mTBI), posttraumatic stress, and depression severity. The first canonical correlation pair revealed neural convergence in clusters encompassing the middle frontal gyrus and supplemental motor area, regions implicated in top-down cognitive control and affect regulation. These results highlight the potential of leveraging multivariate neuroimaging analysis for linking neurobiological mechanisms associated with TRACs, paving the way for transdiagnostic biomarkers and targets for treatment.
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Affiliation(s)
- Daniel M Stout
- Center of Excellence in Stress and Mental Health, San Diego VA Health Care System, USA.,Department of Psychiatry, University of California, San Diego, USA
| | - Monte S Buchsbaum
- Department of Psychiatry, University of California, San Diego, USA.,Department of Radiology, University of California, San Diego, USA
| | - Andrea D Spadoni
- Center of Excellence in Stress and Mental Health, San Diego VA Health Care System, USA.,Department of Psychiatry, University of California, San Diego, USA
| | - Victoria B Risbrough
- Center of Excellence in Stress and Mental Health, San Diego VA Health Care System, USA.,Department of Psychiatry, University of California, San Diego, USA
| | - Irina A Strigo
- Department of Psychiatry, University of California, San Francisco, & San Francisco VA Health Care System, USA
| | - Scott C Matthews
- Center of Excellence in Stress and Mental Health, San Diego VA Health Care System, USA.,Department of Psychiatry, University of California, San Diego, USA
| | - Alan N Simmons
- Center of Excellence in Stress and Mental Health, San Diego VA Health Care System, USA.,Department of Psychiatry, University of California, San Diego, USA
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25
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Novakovic-Agopian T, Kornblith E, Abrams G, Burciaga-Rosales J, Loya F, D'Esposito M, Chen AJW. Training in Goal-Oriented Attention Self-Regulation Improves Executive Functioning in Veterans with Chronic Traumatic Brain Injury. J Neurotrauma 2018; 35:2784-2795. [PMID: 29717652 DOI: 10.1089/neu.2017.5529] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Deficits in executive control functions are some of the most common and disabling consequences of both military and civilian brain injury. However, effective interventions are scant. The goal of this study was to assess whether cognitive rehabilitation training that was successfully applied in chronic civilian brain injury would be effective for military veterans with traumatic brain injury (TBI). In a prior study, participants with chronic acquired brain injury significantly improved after training in Goal-Oriented Attentional Self-Regulation (GOALS) on measures of attention/executive function, functional task performance, and goal-directed control over neural processing on functional magnetic resonance imaging. The objective of this study was to assess effects of GOALS training in veterans with chronic TBI. A total of 33 veterans with chronic TBI and executive difficulties in their daily life completed either 5 weeks of manualized GOALS training or Brain-Health Education (BHE) matched by time and intensity. Evaluator-blinded assessments at baseline and post-training included neuropsychological and complex functional task performance and self-report measures of emotional regulation. After GOALS, but not BHE training, participants significantly improved from baseline on primary outcome measures of Overall Complex Attention/Executive Function composite neuropsychological performance score (F = 7.10, p = 0.01; partial η2 = 0.19), and on overall complex functional task performance (Goal Processing Scale Overall Performance; F = 6.92, p = 0.01, partial η2 = 0.20). Additionally, post-GOALS participants indicated significant improvement on emotional regulation self-report measures (Profile of Mood States Confusion Score; F = 6.05, p = 0.02, partialη2 = 0.20). Training in attentional self-regulation applied to participant-defined goals may improve cognitive functioning in veterans with chronic TBI. Attention regulation training may not only impact executive control functioning in real-world complex tasks, but also may improve emotional regulation and functioning. Implications for treatment of veterans with TBI are discussed.
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Affiliation(s)
- Tatjana Novakovic-Agopian
- 1 Veterans Administration Medical Center , San Francisco, California.,2 University of California , San Francisco, California.,3 Veterans Administration Northern California Health Care System , Martinez, California
| | - Erica Kornblith
- 1 Veterans Administration Medical Center , San Francisco, California
| | - Gary Abrams
- 1 Veterans Administration Medical Center , San Francisco, California.,2 University of California , San Francisco, California
| | | | - Fred Loya
- 3 Veterans Administration Northern California Health Care System , Martinez, California
| | - Mark D'Esposito
- 3 Veterans Administration Northern California Health Care System , Martinez, California.,4 University of California , Berkeley, California
| | - Anthony J W Chen
- 2 University of California , San Francisco, California.,3 Veterans Administration Northern California Health Care System , Martinez, California.,4 University of California , Berkeley, California
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26
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Molaie AM, Maguire J. Neuroendocrine Abnormalities Following Traumatic Brain Injury: An Important Contributor to Neuropsychiatric Sequelae. Front Endocrinol (Lausanne) 2018; 9:176. [PMID: 29922224 PMCID: PMC5996920 DOI: 10.3389/fendo.2018.00176] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 04/03/2018] [Indexed: 12/19/2022] Open
Abstract
Neuropsychiatric symptoms following traumatic brain injury (TBI) are common and contribute negatively to TBI outcomes by reducing overall quality of life. The development of neurobehavioral sequelae, such as concentration deficits, depression, anxiety, fatigue, and loss of emotional well-being has historically been attributed to an ambiguous "post-concussive syndrome," considered secondary to frank structural injury and axonal damage. However, recent research suggests that neuroendocrine dysfunction, specifically hypopituitarism, plays an important role in the etiology of these symptoms. This post-head trauma hypopituitarism (PHTH) has been shown in the past two decades to be a clinically prevalent phenomenon, and given the parallels between neuropsychiatric symptoms associated with non-TBI-induced hypopituitarism and those following TBI, it is now acknowledged that PHTH is likely a substantial contributor to these impairments. The current paper seeks to provide an overview of hypothesized pathophysiological mechanisms underlying neuroendocrine abnormalities after TBI, and to emphasize the significance of this phenomenon in the development of the neurobehavioral problems frequently seen after head trauma.
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Affiliation(s)
- Amir M. Molaie
- Tufts University School of Medicine, Boston, MA, United States
| | - Jamie Maguire
- Department of Neuroscience, Sackler School of Graduate Biomedical Sciences, Boston, MA, United States
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27
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Mendoza C, Barreto GE, Iarkov A, Tarasov VV, Aliev G, Echeverria V. Cotinine: A Therapy for Memory Extinction in Post-traumatic Stress Disorder. Mol Neurobiol 2018; 55:6700-6711. [PMID: 29335846 DOI: 10.1007/s12035-018-0869-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 01/07/2018] [Indexed: 12/14/2022]
Abstract
Post-traumatic stress disorder (PTSD) is a mental disorder that may develop after exposure to exceptionally threatening or unescapable horrifying events. Actual therapies fail to alleviate the emotional suffering and cognitive impairment associated with this disorder, mostly because they are ineffective in treating the failure to extinguish trauma memories in a great percentage of those affected. In this review, current behavioral, cellular, and molecular evidence supporting the use of cotinine for treating PTSD are reviewed. The role of the positive modulation by cotinine of the nicotinic acetylcholine receptors (nAChRs) and their downstream effectors, the protection of astroglia, and the inhibition of microglia in the PTSD brain are also discussed.
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Affiliation(s)
- Cristhian Mendoza
- Facultad de Ciencias de la Salud, Universidad San Sebastián, Lientur 1457, 4030000, Concepción, Chile
| | - George E Barreto
- Departamento de Nutrición y Bioquímica, Facultad de Ciencias, Pontificia Universidad Javeriana, Bogotá D.C., Colombia.,Instituto de Ciencias Biomédicas, Universidad Autónoma de Chile, Santiago, Chile
| | - Alexandre Iarkov
- Facultad de Ciencias de la Salud, Universidad San Sebastián, Lientur 1457, 4030000, Concepción, Chile
| | - Vadim V Tarasov
- Institute of Pharmacy and Translational Medicine, Sechenov First Moscow State Medical University, 119991, Moscow, Russia
| | - Gjumrakch Aliev
- Institute of Physiologically Active Compounds of the Russian Academy of Sciences, Severniy Proezd, Chernogolovka, Moscow Region, 1142432, Russia. .,"GALLY" International Biomedical Research Consulting LLC, San Antonio, TX, 78229, USA. .,School of Health Sciences and Healthcare Administration, University of Atlanta, Johns Creek, GA, 30097, USA.
| | - Valentina Echeverria
- Facultad de Ciencias de la Salud, Universidad San Sebastián, Lientur 1457, 4030000, Concepción, Chile. .,Bay Pines VA Healthcare System, Research and Development, Bay Pines, FL, 33744, USA.
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28
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Neural differences underlying face processing in veterans with TBI and co-occurring TBI and PTSD. J Affect Disord 2017; 223:130-138. [PMID: 28753471 DOI: 10.1016/j.jad.2017.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 06/19/2017] [Accepted: 07/05/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) is common in military personnel and associated with high rates of posttraumatic stress disorder (PTSD). TBI impacts widely-distributed neural patterns, some of which influence affective processing. Better understanding how TBI and PTSD/TBI alters affective neural activity may improve our understanding of comorbidity mechanisms, but to date the neural correlates of emotional processing in these groups has been relatively understudied. METHODS Military controls, military personnel with a history of TBI, and military personnel with both TBI and PTSD (N = 53) completed an emotional face processing task during fMRI. Whole-brain activation and functional connectivity during task conditions were compared between groups. RESULTS Few whole-brain group differences emerged in planned pairwise contrasts, though the TBI group showed some areas of hypoactivation relative to other groups during processing of faces versus shapes. The PTSD/TBI group compared to the control and TBI groups demonstrated greater connectivity between the amygdala and insula seed regions and a number of prefrontal and posterior cingulate regions. LIMITATIONS Generalizability to other patient groups, including those with only PTSD, has not yet been established. CONCLUSION TBI alone was associated with hypoactivation during a condition processing faces versus shapes, but PTSD with TBI was associated altered functional connectivity between amygdala and insula regions and cingulate and prefrontal areas. Altered connectivity patterns across groups suggests that individuals with PTSD/TBI may need to increase frontal connectivity with the insulae in order to achieve similar task-based activity.
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29
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Zuj DV, Felmingham KL, Palmer MA, Lawrence-Wood E, Van Hooff M, Lawrence AJ, Bryant RA, McFarlane AC. Neural activity and emotional processing following military deployment: Effects of mild traumatic brain injury and posttraumatic stress disorder. Brain Cogn 2017; 118:19-26. [DOI: 10.1016/j.bandc.2017.07.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 06/27/2017] [Accepted: 07/04/2017] [Indexed: 11/25/2022]
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30
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Rangaprakash D, Dretsch MN, Venkataraman A, Katz JS, Denney TS, Deshpande G. Identifying disease foci from static and dynamic effective connectivity networks: Illustration in soldiers with trauma. Hum Brain Mapp 2017; 39:264-287. [PMID: 29058357 DOI: 10.1002/hbm.23841] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 08/29/2017] [Accepted: 10/01/2017] [Indexed: 12/15/2022] Open
Abstract
Brain connectivity studies report group differences in pairwise connection strengths. While informative, such results are difficult to interpret since our understanding of the brain relies on region-based properties, rather than on connection information. Given that large disruptions in the brain are often caused by a few pivotal sources, we propose a novel framework to identify the sources of functional disruption from effective connectivity networks. Our approach integrates static and time-varying effective connectivity modeling in a probabilistic framework, to identify aberrant foci and the corresponding aberrant connectomics network. Using resting-state fMRI, we illustrate the utility of this novel approach in U.S. Army soldiers (N = 87) with posttraumatic stress disorder (PTSD), mild traumatic brain injury (mTBI) and combat controls. Additionally, we employed machine-learning classification to identify those significant connectivity features that possessed high predictive ability. We identified three disrupted foci (middle frontal gyrus [MFG], insula, hippocampus), and an aberrant prefrontal-subcortical-parietal network of information flow. We found the MFG to be the pivotal focus of network disruption, with aberrant strength and temporal-variability of effective connectivity to the insula, amygdala and hippocampus. These connectivities also possessed high predictive ability (giving a classification accuracy of 81%); and they exhibited significant associations with symptom severity and neurocognitive functioning. In summary, dysregulation originating in the MFG caused elevated and temporally less-variable connectivity in subcortical regions, followed by a similar effect on parietal memory-related regions. This mechanism likely contributes to the reduced control over traumatic memories leading to re-experiencing, hyperarousal and flashbacks observed in soldiers with PTSD and mTBI. Hum Brain Mapp 39:264-287, 2018. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- D Rangaprakash
- AU MRI Research Center, Department of Electrical and Computer Engineering, Auburn University, Auburn, AL, USA.,Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Michael N Dretsch
- U.S. Army Aeromedical Research Laboratory, Fort Rucker, Alabama.,Human Dimension Division, HQ TRADOC, Fort Eustis, Virgina
| | - Archana Venkataraman
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, Maryland
| | - Jeffrey S Katz
- AU MRI Research Center, Department of Electrical and Computer Engineering, Auburn University, Auburn, AL, USA.,Department of Psychology, Auburn University, Auburn, Alabama.,Alabama Advanced Imaging Consortium, USA
| | - Thomas S Denney
- AU MRI Research Center, Department of Electrical and Computer Engineering, Auburn University, Auburn, AL, USA.,Department of Psychology, Auburn University, Auburn, Alabama.,Alabama Advanced Imaging Consortium, USA
| | - Gopikrishna Deshpande
- AU MRI Research Center, Department of Electrical and Computer Engineering, Auburn University, Auburn, AL, USA.,Department of Psychology, Auburn University, Auburn, Alabama.,Alabama Advanced Imaging Consortium, USA
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31
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Jin C, Jia H, Lanka P, Rangaprakash D, Li L, Liu T, Hu X, Deshpande G. Dynamic brain connectivity is a better predictor of PTSD than static connectivity. Hum Brain Mapp 2017; 38:4479-4496. [PMID: 28603919 PMCID: PMC6866943 DOI: 10.1002/hbm.23676] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 05/23/2017] [Indexed: 12/24/2022] Open
Abstract
Using resting-state functional magnetic resonance imaging, we test the hypothesis that subjects with post-traumatic stress disorder (PTSD) are characterized by reduced temporal variability of brain connectivity compared to matched healthy controls. Specifically, we test whether PTSD is characterized by elevated static connectivity, coupled with decreased temporal variability of those connections, with the latter providing greater sensitivity toward the pathology than the former. Static functional connectivity (FC; nondirectional zero-lag correlation) and static effective connectivity (EC; directional time-lagged relationships) were obtained over the entire brain using conventional models. Dynamic FC and dynamic EC were estimated by letting the conventional models to vary as a function of time. Statistical separation and discriminability of these metrics between the groups and their ability to accurately predict the diagnostic label of a novel subject were ascertained using separate support vector machine classifiers. Our findings support our hypothesis that PTSD subjects have stronger static connectivity, but reduced temporal variability of connectivity. Further, machine learning classification accuracy obtained with dynamic FC and dynamic EC was significantly higher than that obtained with static FC and static EC, respectively. Furthermore, results also indicate that the ease with which brain regions engage or disengage with other regions may be more sensitive to underlying pathology than the strength with which they are engaged. Future studies must examine whether this is true only in the case of PTSD or is a general organizing principle in the human brain. Hum Brain Mapp 38:4479-4496, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Changfeng Jin
- The Mental Health Institute, The Second Xiangya Hospital, Central South UniversityChangshaChina
| | - Hao Jia
- AU MRI Research Center, Department of Electrical and Computer EngineeringAuburn UniversityAuburnAlabama
- Department of Automation, College of Information EngineeringTaiyuan University of TechnologyTaiyuanShanxiChina
| | - Pradyumna Lanka
- AU MRI Research Center, Department of Electrical and Computer EngineeringAuburn UniversityAuburnAlabama
| | - D Rangaprakash
- AU MRI Research Center, Department of Electrical and Computer EngineeringAuburn UniversityAuburnAlabama
- Department of Psychiatry and Biobehavioral SciencesUniversity of California Los AngelesLos AngelesCalifornia
| | - Lingjiang Li
- The Mental Health Institute, The Second Xiangya Hospital, Central South UniversityChangshaChina
| | - Tianming Liu
- Cortical Architecture Imaging and Discovery Lab, Department of Computer Science and Bioimaging Research CenterUniversity of GeorgiaAthensGeorgia
| | - Xiaoping Hu
- Center for Advanced Neuroimaging, Department of BioengineeringUniversity of CaliforniaRiversideCalifornia
| | - Gopikrishna Deshpande
- AU MRI Research Center, Department of Electrical and Computer EngineeringAuburn UniversityAuburnAlabama
- Department of PsychologyAuburn UniversityAuburnAlabama
- Alabama Advanced Imaging Consortium, Auburn University and University of Alabama BirminghamAlabama
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32
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Rangaprakash D, Dretsch MN, Yan W, Katz JS, Denney TS, Deshpande G. Hemodynamic variability in soldiers with trauma: Implications for functional MRI connectivity studies. NEUROIMAGE-CLINICAL 2017; 16:409-417. [PMID: 28879082 PMCID: PMC5574840 DOI: 10.1016/j.nicl.2017.07.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 06/29/2017] [Accepted: 07/22/2017] [Indexed: 01/01/2023]
Abstract
Functional MRI (fMRI) is an indirect measure of neural activity as a result of the convolution of the hemodynamic response function (HRF) and latent (unmeasured) neural activity. Recent studies have shown variability of HRF across brain regions (intra-subject spatial variability) and between subjects (inter-subject variability). Ignoring this HRF variability during data analysis could impair the reliability of such fMRI results. Using whole-brain resting-state fMRI (rs-fMRI), we employed hemodynamic deconvolution to estimate voxel-wise HRF. Studying the impact of mental disorders on HRF variability, we identified HRF aberrations in soldiers (N = 87) with posttraumatic stress disorder (PTSD) and mild-traumatic brain injury (mTBI) compared to combat controls. Certain subcortical and default-mode regions were found to have significant HRF aberrations in the clinical groups. These brain regions have been previously associated with neurochemical alterations in PTSD, which are known to impact the shape of the HRF. We followed-up these findings with seed-based functional connectivity (FC) analysis using regions-of-interest (ROIs) whose HRFs differed between the groups. We found that part of the connectivity group differences reported from traditional FC analysis (no deconvolution) were attributable to HRF variability. These findings raise the question of the degree of reliability of findings from conventional rs-fMRI studies (especially in psychiatric populations like PTSD and mTBI), which are corrupted by HRF variability. We also report and discus, for the first time, voxel-level HRF alterations in PTSD and mTBI. To the best of our knowledge, this is the first study to report evidence for the impact of HRF variability on connectivity group differences. Our work has implications for rs-fMRI connectivity studies. We encourage researchers to incorporate hemodynamic deconvolution during pre-processing to minimize the impact of HRF variability.
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Affiliation(s)
- D Rangaprakash
- AU MRI Research Center, Department of Electrical and Computer Engineering, Auburn University, Auburn, AL, USA.,Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Michael N Dretsch
- Human Dimension Division, HQ TRADOC, Fort Eustis, VA, USA.,U.S. Army Aeromedical Research Laboratory, Fort Rucker, AL, USA
| | - Wenjing Yan
- AU MRI Research Center, Department of Electrical and Computer Engineering, Auburn University, Auburn, AL, USA
| | - Jeffrey S Katz
- AU MRI Research Center, Department of Electrical and Computer Engineering, Auburn University, Auburn, AL, USA.,Department of Psychology, Auburn University, Auburn, AL, USA.,Alabama Advanced Imaging Consortium, Auburn University and University of Alabama Birmingham, AL, USA
| | - Thomas S Denney
- AU MRI Research Center, Department of Electrical and Computer Engineering, Auburn University, Auburn, AL, USA.,Department of Psychology, Auburn University, Auburn, AL, USA.,Alabama Advanced Imaging Consortium, Auburn University and University of Alabama Birmingham, AL, USA
| | - Gopikrishna Deshpande
- AU MRI Research Center, Department of Electrical and Computer Engineering, Auburn University, Auburn, AL, USA.,Department of Psychology, Auburn University, Auburn, AL, USA.,Alabama Advanced Imaging Consortium, Auburn University and University of Alabama Birmingham, AL, USA
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33
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34
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DiGangi JA, Kujawa A, Aase DM, Babione JM, Schroth C, Levy DM, Kennedy AE, Greenstein JE, Proescher E, Walters R, Passi H, Langenecker SA, Phan KL. Affective and cognitive correlates of PTSD: Electrocortical processing of threat and perseverative errors on the WCST in combat-related PTSD. Prog Neuropsychopharmacol Biol Psychiatry 2017; 75:63-69. [PMID: 28089694 DOI: 10.1016/j.pnpbp.2017.01.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 12/21/2016] [Accepted: 01/09/2017] [Indexed: 01/23/2023]
Abstract
PTSD is characterized by both affective and cognitive dysfunction. Affectively, PTSD is associated with both heightened emotional reactivity and disengagement. Cognitively, perseverative thinking is a core feature of the disorder. In order to assess the interactive effects of affective and cognitive correlates of PTSD symptoms, 47 OEF/OIF/OND veterans completed an emotional faces matching task while EEG (i.e., late positive potential; LPP) was recorded, and separately completed the Wisconsin Card Sorting Test (WCST) to assess perseverative errors. There was no relationship between PTSD symptoms and either perseverative errors or EEG reactivity to faces. However, an interaction was found such that high perseverative errors on the WCST and a relatively enhanced LPP to angry faces was associated with greater PTSD symptoms, while low errors on the WCST and a relatively blunted LPP to angry faces also related to greater PTSD symptoms. These findings suggest that emotion-cognition interactions are important for understanding PTSD, and that distinct emotion-cognition constellations interact with symptoms.
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Affiliation(s)
- Julia A DiGangi
- Mental Health Service Line, Jesse Brown VA Medical Center, 820 S. Damen Ave., Chicago, IL 60612, USA; Department of Psychiatry, University of Illinois at Chicago, 1747 Roosevelt Road, Chicago, IL 60608, USA.
| | - Autumn Kujawa
- Department of Psychiatry, Pennsylvania State University, College of Medicine, 500 University Dr, Hershey, PA 17033, USA
| | - Darrin M Aase
- Mental Health Service Line, Jesse Brown VA Medical Center, 820 S. Damen Ave., Chicago, IL 60612, USA; Department of Psychiatry, University of Illinois at Chicago, 1747 Roosevelt Road, Chicago, IL 60608, USA; College of Health & Human Services, Governors State University, 1 University Parkway, University Park, IL 60484, USA
| | - Joseph M Babione
- Mental Health Service Line, Jesse Brown VA Medical Center, 820 S. Damen Ave., Chicago, IL 60612, USA
| | - Christopher Schroth
- Mental Health Service Line, Jesse Brown VA Medical Center, 820 S. Damen Ave., Chicago, IL 60612, USA; Department of Psychiatry, University of Illinois at Chicago, 1747 Roosevelt Road, Chicago, IL 60608, USA
| | - David M Levy
- Mental Health Service Line, Jesse Brown VA Medical Center, 820 S. Damen Ave., Chicago, IL 60612, USA
| | - Amy E Kennedy
- Mental Health Service Line, Jesse Brown VA Medical Center, 820 S. Damen Ave., Chicago, IL 60612, USA; Department of Psychiatry, University of Illinois at Chicago, 1747 Roosevelt Road, Chicago, IL 60608, USA
| | - Justin E Greenstein
- Mental Health Service Line, Jesse Brown VA Medical Center, 820 S. Damen Ave., Chicago, IL 60612, USA; Department of Psychiatry, University of Illinois at Chicago, 1747 Roosevelt Road, Chicago, IL 60608, USA
| | - Eric Proescher
- Mental Health Service Line, Jesse Brown VA Medical Center, 820 S. Damen Ave., Chicago, IL 60612, USA; Department of Psychiatry, University of Illinois at Chicago, 1747 Roosevelt Road, Chicago, IL 60608, USA
| | - Robert Walters
- Mental Health Service Line, Jesse Brown VA Medical Center, 820 S. Damen Ave., Chicago, IL 60612, USA
| | - Holly Passi
- Mental Health Service Line, Jesse Brown VA Medical Center, 820 S. Damen Ave., Chicago, IL 60612, USA
| | - Scott A Langenecker
- Department of Psychiatry, University of Illinois at Chicago, 1747 Roosevelt Road, Chicago, IL 60608, USA
| | - K Luan Phan
- Mental Health Service Line, Jesse Brown VA Medical Center, 820 S. Damen Ave., Chicago, IL 60612, USA; Department of Psychiatry, University of Illinois at Chicago, 1747 Roosevelt Road, Chicago, IL 60608, USA; Departments of Psychology, Anatomy and Cell Biology, University of Illinois at Chicago, 808 S. Wood St., Chicago, IL 60612, USA
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Rangaprakash D, Deshpande G, Daniel TA, Goodman AM, Robinson JL, Salibi N, Katz JS, Denney TS, Dretsch MN. Compromised hippocampus-striatum pathway as a potential imaging biomarker of mild-traumatic brain injury and posttraumatic stress disorder. Hum Brain Mapp 2017; 38:2843-2864. [PMID: 28295837 DOI: 10.1002/hbm.23551] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Revised: 12/24/2016] [Accepted: 02/16/2017] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES Military service members risk acquiring posttraumatic stress disorder (PTSD) and mild-traumatic brain injury (mTBI), with high comorbidity. Owing to overlapping symptomatology in chronic mTBI or postconcussion syndrome (PCS) and PTSD, it is difficult to assess the etiology of a patient's condition without objective measures. Using resting-state functional MRI in a novel framework, we tested the hypothesis that their neural signatures are characterized by functionally hyperconnected brain regions which are less variable over time. Additionally, we predicted that such connectivities possessed the highest ability in predicting the diagnostic membership of a novel subject (top-predictors) in addition to being statistically significant. METHODS U.S. Army Soldiers (N = 87) with PTSD and comorbid PCS + PTSD were recruited along with combat controls. Static and dynamic functional connectivities were evaluated. Group differences were obtained in accordance with our hypothesis. Machine learning classification (MLC) was employed to determine top predictors. RESULTS From whole-brain connectivity, we identified the hippocampus-striatum connectivity to be significantly altered in accordance with our hypothesis. Diffusion tractography revealed compromised white-matter integrity between aforementioned regions only in the PCS + PTSD group, suggesting a structural etiology for the PCS + PTSD group rather than being an extreme subset of PTSD. Employing MLC, connectivities provided worst-case accuracy of 84% (9% more than psychological measures). Additionally, the hippocampus-striatum connectivities were found to be top predictors and thus a potential biomarker of PTSD/mTBI. CONCLUSIONS PTSD/mTBI are associated with hippocampal-striatal hyperconnectivity from which it is difficult to disengage, leading to a habit-like response toward episodic traumatic memories, which fits well with behavioral manifestations of combat-related PTSD/mTBI. Hum Brain Mapp 38:2843-2864, 2017. © 2017 The Authors Human Brain Mapping Published by Wiley Periodicals, Inc.
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Affiliation(s)
- D Rangaprakash
- AU MRI Research Center, Department of Electrical and Computer Engineering, Auburn University, Auburn, Alabama.,Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, California
| | - Gopikrishna Deshpande
- AU MRI Research Center, Department of Electrical and Computer Engineering, Auburn University, Auburn, Alabama.,Department of Psychology, Auburn University, Auburn, Alabama.,Alabama Advanced Imaging Consortium, Auburn University and University of Alabama at Birmingham, Birmingham, Alabama
| | - Thomas A Daniel
- Department of Psychology, Auburn University, Auburn, Alabama.,Department of Psychology, Westfield State University, Westfield, Massachusetts
| | - Adam M Goodman
- Department of Psychology, Auburn University, Auburn, Alabama.,Department of Psychology, University of Alabama Birmingham, Birmingham, Alabama
| | - Jennifer L Robinson
- AU MRI Research Center, Department of Electrical and Computer Engineering, Auburn University, Auburn, Alabama.,Department of Psychology, Auburn University, Auburn, Alabama.,Alabama Advanced Imaging Consortium, Auburn University and University of Alabama at Birmingham, Birmingham, Alabama
| | - Nouha Salibi
- AU MRI Research Center, Department of Electrical and Computer Engineering, Auburn University, Auburn, Alabama.,MR R&D, Siemens Healthcare, Malvern, Pennsylvania
| | - Jeffrey S Katz
- AU MRI Research Center, Department of Electrical and Computer Engineering, Auburn University, Auburn, Alabama.,Department of Psychology, Auburn University, Auburn, Alabama.,Alabama Advanced Imaging Consortium, Auburn University and University of Alabama at Birmingham, Birmingham, Alabama
| | - Thomas S Denney
- AU MRI Research Center, Department of Electrical and Computer Engineering, Auburn University, Auburn, Alabama.,Department of Psychology, Auburn University, Auburn, Alabama.,Alabama Advanced Imaging Consortium, Auburn University and University of Alabama at Birmingham, Birmingham, Alabama
| | - Michael N Dretsch
- U.S. Army Aeromedical Research Laboratory, Fort Rucker, Alabama.,Human Dimension Division, HQ TRADOC, Fort Eustis, Virginia
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Schneider BL, Ghoddoussi F, Charlton JL, Kohler RJ, Galloway MP, Perrine SA, Conti AC. Increased Cortical Gamma-Aminobutyric Acid Precedes Incomplete Extinction of Conditioned Fear and Increased Hippocampal Excitatory Tone in a Mouse Model of Mild Traumatic Brain Injury. J Neurotrauma 2016; 33:1614-24. [DOI: 10.1089/neu.2015.4190] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Brandy L. Schneider
- Research and Development Service, John D. Dingell Veterans Affairs Medical Center, Detroit, Michigan
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan
| | - Farhad Ghoddoussi
- Department of Anesthesiology, Wayne State University School of Medicine, Detroit, Michigan
- Magnetic Resonance Core (MRC), Wayne State University School of Medicine, Detroit, Michigan
| | - Jennifer L. Charlton
- Research and Development Service, John D. Dingell Veterans Affairs Medical Center, Detroit, Michigan
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan
| | - Robert J. Kohler
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, Michigan
| | - Matthew P. Galloway
- Department of Anesthesiology, Wayne State University School of Medicine, Detroit, Michigan
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, Michigan
| | - Shane A. Perrine
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, Michigan
| | - Alana C. Conti
- Research and Development Service, John D. Dingell Veterans Affairs Medical Center, Detroit, Michigan
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan
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Lopez KC, Leary JB, Pham DL, Chou YY, Dsurney J, Chan L. Brain Volume, Connectivity, and Neuropsychological Performance in Mild Traumatic Brain Injury: The Impact of Post-Traumatic Stress Disorder Symptoms. J Neurotrauma 2016; 34:16-22. [PMID: 26942337 DOI: 10.1089/neu.2015.4323] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Post-traumatic stress disorder (PTSD) is commonly associated with mild traumatic brain injury (mTBI). To better understand their relationship, we examined neuroanatomical structures and neuropsychological performance in a sample of individuals with mTBI, with and without PTSD symptoms. Thirty-nine subjects with mTBI were dichotomized into those with (n = 12) and without (n = 27) significant PTSD symptoms based on scores on the PTSD Checklist. Using a region-of-interest approach, fronto-temporal volumes, fiber bundles obtained by diffusion tensor imaging, and neuropsychological scores were compared between the two groups. After controlling for total intracranial volume and age, subjects with mTBI and PTSD symptoms exhibited volumetric differences in the entorhinal cortex, an area associated with memory networks, relative to mTBI-only patients (F = 4.28; p = 0.046). Additionally, subjects with PTSD symptoms showed reduced white matter integrity in the right cingulum bundle (axial diffusivity, F = 6.04; p = 0.020). Accompanying these structural alterations, mTBI and PTSD subjects also showed impaired performance in encoding (F = 5.98; p = 0.019) and retrieval (F = 7.32; p = 0.010) phases of list learning and in tests of processing speed (Wechsler Adult Intelligence Scale Processing Speed Index, F = 12.23; p = 0.001; Trail Making Test A, F = 5.56; p = 0.024). Increased volume and white matter disruptions in these areas, commonly associated with memory functions, may be related to functional disturbances during cognitively demanding tasks. Differences in brain volume and white matter integrity between mTBI subjects and those with mTBI and co-morbid PTSD symptoms point to neuroanatomical differences that may underlie poorer recovery of mTBI subjects who experience PTSD symptoms. These findings support theoretical models of PTSD and its relationship to learning deficits.
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Affiliation(s)
- Katherine C Lopez
- 1 Center for Neuroscience and Regenerative Medicine, National Institutes of Health , Bethesda, Maryland
| | - Jacob B Leary
- 2 Rehabilitation Medicine Department, Clinical Center, National Institutes of Health , Bethesda, Maryland
| | - Dzung L Pham
- 1 Center for Neuroscience and Regenerative Medicine, National Institutes of Health , Bethesda, Maryland
| | - Yi-Yu Chou
- 1 Center for Neuroscience and Regenerative Medicine, National Institutes of Health , Bethesda, Maryland
| | - John Dsurney
- 1 Center for Neuroscience and Regenerative Medicine, National Institutes of Health , Bethesda, Maryland
| | - Leighton Chan
- 1 Center for Neuroscience and Regenerative Medicine, National Institutes of Health , Bethesda, Maryland.,2 Rehabilitation Medicine Department, Clinical Center, National Institutes of Health , Bethesda, Maryland
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38
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Fitzgerald JM, MacNamara A, DiGangi JA, Kennedy AE, Rabinak CA, Patwell R, Greenstein JE, Proescher E, Rauch SAM, Hajcak G, Phan KL. An electrocortical investigation of voluntary emotion regulation in combat-related posttraumatic stress disorder. Psychiatry Res 2016; 249:113-121. [PMID: 26922156 PMCID: PMC4890599 DOI: 10.1016/j.pscychresns.2015.12.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 10/26/2015] [Accepted: 12/05/2015] [Indexed: 12/31/2022]
Abstract
Posttraumatic stress disorder (PTSD) - a debilitating disorder characterized by severe deficits in emotion regulation - is prevalent among U.S. military veterans. Research into the pathophysiology of PTSD has focused primarily on emotional reactivity, showing evidence of heightened neural response during negative affect provocation. By comparison, studies of brain functioning during the voluntary regulation of negative affect are limited. In the current study, combat-exposed U.S. military veterans with (n=25) and without (n=25) PTSD performed an emotion regulation task during electroencephalographic (EEG) recording. The late positive potential (LPP) was used as a measure of sustained attention toward, and processing of, negative and neutral pictures, and was scored prior to and after instructions to either maintain or down-regulate emotional response using the strategy of cognitive reappraisal. Results showed that groups did not differ in picture-elicited LPP amplitude either prior to or during cognitive reappraisal; reappraisal reduced the LPP in both groups over time. Time-dependent increases in LPP amplitude as a function of emotional reactivity maintenance were evident in the non-PTSD group only. This latter finding may signal PTSD-related deficits in sustained engagement with emotion-processing over the course of several seconds.
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Affiliation(s)
- Jacklynn M Fitzgerald
- University of Illinois at Chicago, Department of Psychology, Chicago, IL, USA; University of Illinois at Chicago, Department of Psychiatry, Chicago, IL, USA
| | - Annmarie MacNamara
- University of Illinois at Chicago, Department of Psychiatry, Chicago, IL, USA
| | - Julia A DiGangi
- University of Illinois at Chicago, Department of Psychiatry, Chicago, IL, USA; Jesse Brown VA Medical Center, Chicago, IL, USA
| | - Amy E Kennedy
- University of Illinois at Chicago, Department of Psychiatry, Chicago, IL, USA; Jesse Brown VA Medical Center, Chicago, IL, USA
| | - Christine A Rabinak
- Wayne State University, Eugene Applebaum College of Pharmacy & Health Sciences Pharmacy Practice, Detroit, MI, USA
| | - Ryan Patwell
- University of Illinois at Chicago, Department of Psychiatry, Chicago, IL, USA
| | | | - Eric Proescher
- University of Illinois at Chicago, Department of Psychiatry, Chicago, IL, USA; Jesse Brown VA Medical Center, Chicago, IL, USA
| | - Sheila A M Rauch
- Emory University, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, USA; Atlanta VA Medical Center, Atlanta, GA, USA
| | - Greg Hajcak
- Stony Brook University, Department of Psychology, Stony Brook, NY, USA
| | - K Luan Phan
- University of Illinois at Chicago, Department of Psychology, Chicago, IL, USA; University of Illinois at Chicago, Department of Psychiatry, Chicago, IL, USA; Jesse Brown VA Medical Center, Chicago, IL, USA; University of Illinois at Chicago, Department of Anatomy and Cell Biology, Chicago, IL, USA.
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Hampstead BM, Briceño EM, Mascaro N, Mourdoukoutas A, Bikson M. Current Status of Transcranial Direct Current Stimulation in Posttraumatic Stress and Other Anxiety Disorders. Curr Behav Neurosci Rep 2016; 3:95-101. [PMID: 29479515 DOI: 10.1007/s40473-016-0070-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Several empirically supported treatments have been identified for post-traumatic stress disorder (PTSD), yet a sizable number of patients are either unable to tolerate these approaches or remain symptomatic following treatment. Transcranial direct current stimulation (tDCS) is a well-tolerated method of modulating neuronal excitability that may hold promise as a novel intervention in PTSD and related disorders. The current review summarizes literature on the disrupted neural circuitry in PTSD and discusses the rationale for the commonly targeted prefrontal cortex (PFC) as it relates to PTSD. We then review the few prior (case) studies that have evaluated tDCS in patients with PTSD (1 study) and other anxiety disorders (4 studies). There was considerable variability in both the methods/justification for selecting the targeted brain region(s) and the tDCS montage used, which obscured any clear trends in the data. Finally, we describe the rationale for our ongoing study that specifically targets the lateral temporal cortex as a method of treating the symptoms of hyperarousal and re-experiencing in PTSD. Overall, it is clear that additional work is needed to establish dosing (e.g., intensity and duration of sessions, number of sessions) and optimal treatment targets as well as to identify synergistic effects with existing treatments.
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Affiliation(s)
- Benjamin M Hampstead
- Mental Health Service, VA Ann Arbor Healthcare System, Ann Arbor, MI 48105, USA
- Neuropsychology Section, Department of Psychiatry, University of Michigan, Ann Arbor, MI 48105, USA
| | - Emily M Briceño
- Neuropsychology Section, Department of Psychiatry, University of Michigan, Ann Arbor, MI 48105, USA
| | - Nathan Mascaro
- Trauma Recovery Program, Atlanta VAMC, Decatur, GA 30033, USA
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA 30322, USA
| | - Andoni Mourdoukoutas
- Department of Biomedical Engineering, The City College of New York of CUNY, New York, NY 10031, USA
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of New York of CUNY, New York, NY 10031, USA
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40
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Kawa L, Barde S, Arborelius UP, Theodorsson E, Agoston D, Risling M, Hökfelt T. Expression of galanin and its receptors are perturbed in a rodent model of mild, blast-induced traumatic brain injury. Exp Neurol 2016; 279:159-167. [PMID: 26928087 DOI: 10.1016/j.expneurol.2016.02.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 02/22/2016] [Accepted: 02/24/2016] [Indexed: 01/05/2023]
Abstract
The symptomatology, mood and cognitive disturbances seen in post-traumatic stress disorder (PTSD) and mild blast-induced traumatic brain injury (mbTBI) overlap considerably. However the pathological mechanisms underlying the two conditions are currently unknown. The neuropeptide galanin has been suggested to play a role in the development of stress and mood disorders. Here we applied bio- and histochemical methods with the aim to elucidate the nature of any changes in the expression of galanin and its receptors in a rodent model of mbTBI. In situ hybridization and quantitative polymerase chain reaction studies revealed significant, injury-induced changes, in some cases lasting at least for one week, in the mRNA levels of galanin and/or its three receptors, galanin receptor 1-3 (GalR1-3). Such changes were seen in several forebrain regions, and the locus coeruleus. In the ventral periaqueductal gray GalR1 mRNA levels were increased, while GalR2 were decreased. Analysis of galanin peptide levels using radioimmunoassay demonstrated an increase in several brain regions including the locus coeruleus, dorsal hippocampal formation and amygdala. These findings suggest a role for the galanin system in the endogenous response to mbTBI, and that pharmacological studies of the effects of activation or inhibition of different galanin receptors in combination with functional assays of behavioral recovery may reveal promising targets for new therapeutic strategies in mbTBI.
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Affiliation(s)
- Lizan Kawa
- Department of Neuroscience, Karolinska Institutet, Retzius väg 8, SE 171 77 Stockholm, Sweden.
| | - Swapnali Barde
- Department of Neuroscience, Karolinska Institutet, Retzius väg 8, SE 171 77 Stockholm, Sweden
| | - Ulf P Arborelius
- Department of Neuroscience, Karolinska Institutet, Retzius väg 8, SE 171 77 Stockholm, Sweden
| | - Elvar Theodorsson
- Department of Clinical Chemistry, Linköping University, Linköping, Sweden
| | - Denes Agoston
- Department of Neuroscience, Karolinska Institutet, Retzius väg 8, SE 171 77 Stockholm, Sweden; Department of Anatomy, Physiology and Genetics, The Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814, United States
| | - Mårten Risling
- Department of Neuroscience, Karolinska Institutet, Retzius väg 8, SE 171 77 Stockholm, Sweden.
| | - Tomas Hökfelt
- Department of Neuroscience, Karolinska Institutet, Retzius väg 8, SE 171 77 Stockholm, Sweden
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41
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Zhang X, Zhang J, Wang L, Li R, Zhang W. Altered resting-state functional connectivity of the amygdala in Chinese earthquake survivors. Prog Neuropsychopharmacol Biol Psychiatry 2016; 65:208-14. [PMID: 26476339 DOI: 10.1016/j.pnpbp.2015.10.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 10/04/2015] [Accepted: 10/11/2015] [Indexed: 01/26/2023]
Abstract
Posttraumatic stress disorder (PTSD) is linked to abnormal amygdala activities. This study measured amygdala functional connectivity using DSM-5 criteria. There were 33 participants in the PTSD group and 33 participants in a trauma-exposed control (TEC) group, who did not have PTSD according to the PTSD checklist of the DSM-5 (PCL-5). Our findings are as follows: (1) In the PTSD group, the amygdala had increased positive connectivity with the medial prefrontal cortex (mPFC) and hippocampus, and decreased positive connectivity with the inferior mPFC and insula. The amygdala had increased negative connectivity with the orbital prefrontal cortex and decreased negative connectivity with the insula in comparison with TEC group. (2) PCL of all participants was correlated with the connectivity between the amygdala and the mPFC, hippocampus, and insula. These regions overlapped with those identified in the between-group comparisons. However, there was no association between PCL of the PTSD group and connectivity in these regions. Abnormal functional connectivity between the amygdala and mPFC subdivisions, hippocampus, and insula reveals their importance in PTSD pathogenesis.
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Affiliation(s)
- Xiaoyu Zhang
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences (CAS), No 16 LinCui Road, Chaoyang District, Beijing 100101, China; University of Chinese Academy of Sciences (UCAS), No 380 Huaibei Town, Huairou District, Beijing 101408, China
| | - Jianxin Zhang
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences (CAS), No 16 LinCui Road, Chaoyang District, Beijing 100101, China
| | - Li Wang
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences (CAS), No 16 LinCui Road, Chaoyang District, Beijing 100101, China
| | - Rui Li
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences (CAS), No 16 LinCui Road, Chaoyang District, Beijing 100101, China
| | - Wencai Zhang
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences (CAS), No 16 LinCui Road, Chaoyang District, Beijing 100101, China.
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42
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Aupperle RL, Stillman AN, Simmons AN, Flagan T, Allard CB, Thorp SR, Norman SB, Paulus MP, Stein MB. Intimate Partner Violence PTSD and Neural Correlates of Inhibition. J Trauma Stress 2016; 29:33-40. [PMID: 26748991 DOI: 10.1002/jts.22068] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 10/08/2015] [Accepted: 10/10/2015] [Indexed: 01/22/2023]
Abstract
Posttraumatic stress disorder (PTSD) has been linked to deficits in response inhibition, and neuroimaging research suggests this may be due to differences in prefrontal cortex recruitment. The current study examined relationships between PTSD from intimate partner violence (IPV) and neural responses during inhibition. There were 10 women with PTSD from IPV and 12 female control subjects without trauma history who completed the stop signal task during functional magnetic resonance imaging. Linear mixed models were used to investigate group differences in activation (stop-nonstop and hard-easy trials). Those with PTSD exhibited greater differential activation to stop-nonstop trials in the right dorsolateral prefrontal cortex and the anterior insula and less differential activation in several default mode regions (d = 1.12-1.22). Subjects with PTSD exhibited less differential activation to hard-easy trials in the lateral frontal and the anterior insula regions (driven by less activation to hard trials) and several default mode regions (i.e., medial prefrontal cortex, posterior cingulate; driven by greater activation to easy trials; d = 1.23-1.76). PTSD was associated with difficulties disengaging default mode regions during cognitive tasks with relatively low cognitive demand, as well as difficulties modulating executive control and salience processing regions with increasing cognitive demand. Together, these results suggest that PTSD may relate to decreased neural flexibility during inhibition.
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Affiliation(s)
- Robin L Aupperle
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA.,Department of Community Medicine, University of Tulsa, Tulsa, Oklahoma, USA
| | - Ashley N Stillman
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA.,Department of Psychology, University of Tulsa, Tulsa, Oklahoma, USA
| | - Alan N Simmons
- Research Service, VA San Diego Healthcare System, San Diego, California, USA.,Psychiatry Service, VA San Diego Healthcare System, San Diego, California, USA.,Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California-San Diego, San Diego, California, USA
| | - Taru Flagan
- Department of Psychiatry, University of California-San Diego, San Diego, California, USA
| | - Carolyn B Allard
- Research Service, VA San Diego Healthcare System, San Diego, California, USA.,Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California-San Diego, San Diego, California, USA.,Psychology Service, VA San Diego Healthcare System, San Diego, California, USA
| | - Steven R Thorp
- Research Service, VA San Diego Healthcare System, San Diego, California, USA.,Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California-San Diego, San Diego, California, USA.,Psychology Service, VA San Diego Healthcare System, San Diego, California, USA
| | - Sonya B Norman
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California-San Diego, San Diego, California, USA.,Psychology Service, VA San Diego Healthcare System, San Diego, California, USA
| | - Martin P Paulus
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA.,Psychiatry Service, VA San Diego Healthcare System, San Diego, California, USA.,Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California-San Diego, San Diego, California, USA
| | - Murray B Stein
- Psychiatry Service, VA San Diego Healthcare System, San Diego, California, USA.,Family Medicine and Public Health, University of California-San Diego, San Diego, California, USA
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43
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Guedes VA, Song S, Provenzano M, Borlongan CV. Understanding the pathology and treatment of traumatic brain injury and posttraumatic stress disorder: a therapeutic role for hyperbaric oxygen therapy. Expert Rev Neurother 2016; 16:61-70. [PMID: 26613116 DOI: 10.1586/14737175.2016.1126180] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Traumatic brain injury (TBI) is an intracranial injury caused by external trauma leading to different degrees of brain damage. TBI can cause a wide array of symptoms and range in severity from concussion to coma and death. The link between TBI and posttraumatic stress disorder (PTSD) has received increasing attention due to the high incidence of these conditions in soldiers returning from recent conflicts. TBI has been associated with an increased risk of PTSD. Additionally, TBI and PTSD often demonstrate overlapping symptoms. In this article, we discuss the different forms of TBI and their links to PTSD. We also discuss current therapies for TBI and PTSD, in particular detailing the therapeutic potential of hyperbaric oxygen therapy in the management of these conditions.
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Affiliation(s)
- Vivian A Guedes
- a Department of Neurosurgery and Brain Repair, Center of Excellence for Aging and Brain Repair , University of South Florida College of Medicine , Tampa , FL , USA
| | - Shuojing Song
- a Department of Neurosurgery and Brain Repair, Center of Excellence for Aging and Brain Repair , University of South Florida College of Medicine , Tampa , FL , USA
| | - Martina Provenzano
- b Laboratory of Molecular Genetics, DISPUTer, School of Medicine and Health Sciences , "G. d'Annunzio" University, Chieti-Pescara , Chieti , Italy
| | - Cesario V Borlongan
- a Department of Neurosurgery and Brain Repair, Center of Excellence for Aging and Brain Repair , University of South Florida College of Medicine , Tampa , FL , USA
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King AP, Block SR, Sripada RK, Rauch SAM, Porter KE, Favorite TK, Giardino N, Liberzon I. A Pilot Study of Mindfulness-Based Exposure Therapy in OEF/OIF Combat Veterans with PTSD: Altered Medial Frontal Cortex and Amygdala Responses in Social-Emotional Processing. Front Psychiatry 2016; 7:154. [PMID: 27703434 PMCID: PMC5028840 DOI: 10.3389/fpsyt.2016.00154] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 08/25/2016] [Indexed: 01/04/2023] Open
Abstract
Combat-related posttraumatic stress disorder (PTSD) is common among returning veterans, and is a serious and debilitating disorder. While highly effective treatments involving trauma exposure exist, difficulties with engagement and early drop may lead to sub-optimal outcomes. Mindfulness training may provide a method for increasing emotional regulation skills that may improve engagement in trauma-focused therapy. Here, we examine potential neural correlates of mindfulness training and in vivo exposure (non-trauma focused) using a novel group therapy [mindfulness-based exposure therapy (MBET)] in Afghanistan (OEF) or Iraq (OIF) combat veterans with PTSD. OEF/OIF combat veterans with PTSD (N = 23) were treated with MBET (N = 14) or a comparison group therapy [Present-centered group therapy (PCGT), N = 9]. PTSD symptoms were assessed at pre- and post-therapy with Clinician Administered PTSD scale. Functional neuroimaging (3-T fMRI) before and after therapy examined responses to emotional faces (angry, fearful, and neutral faces). Patients treated with MBET had reduced PTSD symptoms (effect size d = 0.92) but effect was not significantly different from PCGT (d = 0.43). Improvement in PTSD symptoms from pre- to post-treatment in both treatment groups was correlated with increased activity in rostral anterior cingulate cortex, dorsal medial prefrontal cortex (mPFC), and left amygdala. The MBET group showed greater increases in amygdala and fusiform gyrus responses to Angry faces, as well as increased response in left mPFC to Fearful faces. These preliminary findings provide intriguing evidence that MBET group therapy for PTSD may lead to changes in neural processing of social-emotional threat related to symptom reduction.
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Affiliation(s)
- Anthony P King
- Mental Health Service, VA Ann Arbor Health System, Ann Arbor, MI, USA; Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Stefanie R Block
- Department of Psychology, University of Michigan , Ann Arbor, MI , USA
| | - Rebecca K Sripada
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; VA Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Sheila A M Rauch
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA; Mental Health Service, Atlanta VA Medical Center, Atlanta, GA, USA
| | | | - Todd K Favorite
- Mental Health Service, VA Ann Arbor Health System, Ann Arbor, MI, USA; Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; Mary A. Rackham Institute (MARI), University of Michigan, Ann Arbor, MI, USA
| | - Nicholas Giardino
- Department of Psychiatry, University of Michigan , Ann Arbor, MI , USA
| | - Israel Liberzon
- Mental Health Service, VA Ann Arbor Health System, Ann Arbor, MI, USA; Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
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MacNamara A, Rabinak CA, Kennedy AE, Fitzgerald DA, Liberzon I, Stein MB, Phan KL. Emotion Regulatory Brain Function and SSRI Treatment in PTSD: Neural Correlates and Predictors of Change. Neuropsychopharmacology 2016; 41:611-8. [PMID: 26111649 PMCID: PMC5130136 DOI: 10.1038/npp.2015.190] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 06/17/2015] [Accepted: 06/19/2015] [Indexed: 11/09/2022]
Abstract
Posttraumatic stress disorder (PTSD)-a chronic, debilitating condition, broadly characterized by emotion dysregulation-is prevalent among US military personnel who have returned from Operations Enduring Freedom (OEF) and Iraqi Freedom (OIF). Selective serotonin reuptake inhibitors (SSRIs) are a first-line treatment for PTSD, but treatment mechanisms are unknown and patient response varies. SSRIs may exert their effects by remediating emotion regulatory brain activity and individual differences in patient response might be explained, in part, by pre-treatment differences in neural systems supporting the downregulation of negative affect. Thirty-four OEF/OIF veterans, 17 with PTSD and 17 without PTSD underwent 2 functional magnetic resonance imaging scans 12 weeks apart. At each scan, they performed an emotion regulation task; in the interim, veterans with PTSD were treated with the SSRI, paroxetine. SSRI treatment increased activation in both the left dorsolateral prefrontal cortex (PFC) and supplementary motor area (SMA) during emotion regulation, although only change in the SMA over time occurred in veterans with PTSD and not those without PTSD. Less activation of the right ventrolateral PFC/inferior frontal gyrus during pre-treatment emotion regulation was associated with greater reduction in PTSD symptoms with SSRI treatment, irrespective of pre-treatment severity. Patients with the least recruitment of prefrontal emotion regulatory brain regions may benefit most from treatment with SSRIs, which appear to augment activity in these regions.
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Affiliation(s)
- Annmarie MacNamara
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Christine A Rabinak
- Department of Pharmacy Practice, Wayne State University, Detroit, MI, USA
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | - Amy E Kennedy
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
- Mental Health Service Line, Jesse Brown VA Medical Center, Chicago, IL, USA
| | - Daniel A Fitzgerald
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
- Mental Health Service Line, Jesse Brown VA Medical Center, Chicago, IL, USA
| | - Israel Liberzon
- Department of Psychiatry, University of Michigan and Mental Health Service, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Murray B Stein
- Department of Psychiatry, University of California at San Diego, San Diego, CA, USA
- Department of Family Medicine and Public Health, University of California at San Diego, San Diego, CA, USA
- VA San Diego Healthcare System, San Diego, CA, USA
| | - K Luan Phan
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
- Mental Health Service Line, Jesse Brown VA Medical Center, Chicago, IL, USA
- Department of Psychology and the Graduate Program in Neuroscience, University of Illinois at Chicago, Chicago, IL, USA
- Department of Anatomy and Cell Biology, University of Illinois at Chicago, Chicago, IL, USA
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Spadoni AD, Kosheleva E, Buchsbaum MS, Simmons AN. Neural correlates of malingering in mild traumatic brain injury: A positron emission tomography study. Psychiatry Res 2015; 233:367-72. [PMID: 26184458 DOI: 10.1016/j.pscychresns.2015.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 05/05/2015] [Accepted: 06/24/2015] [Indexed: 11/18/2022]
Abstract
The detection of malingering in cognitive performance is a challenge in clinical and legal environments. Neuroimaging may provide an objective method to determine the source of failure on tests of symptom validity. Participants comprised 45 combat veterans, 31 with mild traumatic brain injury (mTBI), not seeking medical or legal compensation, who completed the Tombaugh Test of Memory Malingering (TOMM) and a positron emission tomography (PET) scan. Based on TOMM performance (i.e., less than 45 of 50 total correct, suggesting suboptimal effort or malingering), subjects were separated into poor TOMM score (PT; n=10) and good TOMM score (GT; n=35) groups. Voxel-based multiple regression analysis with Group (GT/PT) predicting uptake of fluorodeoxyglucose revealed decreased brain metabolism in the ventromedial prefrontal cortex of poor performers. The current findings may suggest that poor TOMM performance in those with combat trauma and mTBI may be related to ventromedial prefrontal cortical dysfunction. These findings have important implications for the disentanglement of feigned versus actual memory impairment, where the latter may be secondary to neural mechanisms not consistent with forgetting or deception.
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Affiliation(s)
- Andrea D Spadoni
- Center of Excellence in Stress and Mental Health, San Diego VA Health Care System, La Jolla, CA, USA; Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Elena Kosheleva
- Center of Excellence in Stress and Mental Health, San Diego VA Health Care System, La Jolla, CA, USA; Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Monte S Buchsbaum
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Alan N Simmons
- Center of Excellence in Stress and Mental Health, San Diego VA Health Care System, La Jolla, CA, USA; Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.
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Rubin LH, Pyra M, Cook JA, Weber KM, Cohen MH, Martin E, Valcour V, Milam J, Anastos K, Young MA, Alden C, Gustafson DR, Maki PM. Post-traumatic stress is associated with verbal learning, memory, and psychomotor speed in HIV-infected and HIV-uninfected women. J Neurovirol 2015; 22:159-69. [PMID: 26404435 DOI: 10.1007/s13365-015-0380-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 08/21/2015] [Accepted: 09/02/2015] [Indexed: 01/04/2023]
Abstract
The prevalence of post-traumatic stress disorder (PTSD) is higher among HIV-infected (HIV+) women compared with HIV-uninfected (HIV-) women, and deficits in episodic memory are a common feature of both PTSD and HIV infection. We investigated the association between a probable PTSD diagnosis using the PTSD Checklist-Civilian (PCL-C) version and verbal learning and memory using the Hopkins Verbal Learning Test in 1004 HIV+ and 496 at-risk HIV- women. HIV infection was not associated with a probable PTSD diagnosis (17% HIV+, 16% HIV-; p = 0.49) but was associated with lower verbal learning (p < 0.01) and memory scores (p < 0.01). Irrespective of HIV status, a probable PTSD diagnosis was associated with poorer performance in verbal learning (p < 0.01) and memory (p < 0.01) and psychomotor speed (p < 0.001). The particular pattern of cognitive correlates of probable PTSD varied depending on exposure to sexual abuse and/or violence, with exposure to either being associated with a greater number of cognitive domains and a worse cognitive profile. A statistical interaction between HIV serostatus and PTSD was observed on the fine motor skills domain (p = 0.03). Among women with probable PTSD, HIV- women performed worse than HIV+ women on fine motor skills (p = 0.01), but among women without probable PTSD, there was no significant difference in performance between the groups (p = 0.59). These findings underscore the importance of considering mental health factors as correlates to cognitive deficits in women with HIV.
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Affiliation(s)
- Leah H Rubin
- Department of Psychiatry (MC 913), University of Illinois at Chicago, 912 S Wood St, Chicago, IL, 60612, USA.
| | - Maria Pyra
- Hektoen Institute of Medicine, Chicago, IL, USA
| | - Judith A Cook
- Department of Psychiatry (MC 913), University of Illinois at Chicago, 912 S Wood St, Chicago, IL, 60612, USA
| | - Kathleen M Weber
- Hektoen Institute of Medicine, Chicago, IL, USA.,The Core Center, Bureau of Health Services of Cook County, Chicago, IL, USA
| | - Mardge H Cohen
- Hektoen Institute of Medicine, Chicago, IL, USA.,The Core Center, Bureau of Health Services of Cook County, Chicago, IL, USA.,Department of Medicine, Stroger Hospital and Rush University, Chicago, IL, USA
| | - Eileen Martin
- Department of Psychiatry, Rush University Medical Center, Chicago, IL, USA
| | - Victor Valcour
- Department of Neurology, University of California, San Francisco, CA, USA
| | - Joel Milam
- Institute for Health Promotion and Disease Prevention Research, University of Southern California, Los Angeles, CA, USA
| | - Kathryn Anastos
- Department of Medicine and Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mary A Young
- Department of Medicine, Georgetown University, Washington, DC, USA
| | - Christine Alden
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Pauline M Maki
- Department of Psychiatry (MC 913), University of Illinois at Chicago, 912 S Wood St, Chicago, IL, 60612, USA.,Department of Psychology, University of Illinois at Chicago, Chicago, IL, USA
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Deep brain stimulation of the prelimbic medial prefrontal cortex: quantification of the effect on glucose metabolism in the rat brain using [(18) F]FDG microPET. Mol Imaging Biol 2015; 16:838-45. [PMID: 24943500 DOI: 10.1007/s11307-014-0757-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
PURPOSE Prefrontal cortex (PFC) deep brain stimulation (DBS) has been proposed as a therapy for addiction and depression. This study investigates changes in rat cerebral glucose metabolism induced by different DBS frequencies using μPET. PROCEDURES One hour DBS of the prelimbic area (PL) of the medial PFC (mPFC) (60 Hz, 130 Hz or sham) in rats (n = 9) was followed by 2-deoxy-2-[(18) F] fluoro-D-glucose ([(18) F]FDG) μPET. RESULTS Sixty Hz DBS elicited significant hypermetabolism in the ipsilateral PL ([(18) F]FDG uptake +5.2 ± 2.3 %, p < 0.05). At 130 Hz, hypometabolism was induced in the ipsilateral PL (-2.5 ± 2.6 %, non-significant). Statistical parametric mapping revealed hypo and hypermetabolism clusters for both 60 and 130 Hz versus sham and show a certain state of alertness (increased activity in sensory and motor-related regions) mainly for 60 Hz. CONCLUSIONS This study suggests the potential of 60 Hz PL mPFC DBS for the treatment of disorders associated with prefrontal hypofunction.
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Stark EA, Parsons CE, Van Hartevelt TJ, Charquero-Ballester M, McManners H, Ehlers A, Stein A, Kringelbach ML. Post-traumatic stress influences the brain even in the absence of symptoms: A systematic, quantitative meta-analysis of neuroimaging studies. Neurosci Biobehav Rev 2015; 56:207-21. [PMID: 26192104 DOI: 10.1016/j.neubiorev.2015.07.007] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 07/02/2015] [Accepted: 07/09/2015] [Indexed: 10/23/2022]
Abstract
Stress affects brain function, and may lead to post-traumatic stress disorder (PTSD). Considerable empirical data for the neurobiology of PTSD has been derived from neuroimaging studies, although findings have proven inconsistent. We used an activation likelihood estimation analysis to explore differences in brain activity between adults with and without PTSD in response to affective stimuli. We separated studies by type of control group: trauma-exposed and trauma-naïve. This revealed distinct patterns of differences in functional activity. Compared to trauma-exposed controls, regions of the basal ganglia were differentially active in PTSD; whereas the comparison with trauma-naïve controls revealed differential involvement in the right anterior insula, precuneus, cingulate and orbitofrontal cortices known to be involved in emotional regulation. Changes in activity in the amygdala and parahippocampal cortex distinguished PTSD from both control groups. Results suggest that trauma has a measurable, enduring effect upon the functional dynamics of the brain, even in individuals who experience trauma but do not develop PTSD. These findings contribute to the understanding of whole-brain network activity following trauma, and its transition to clinical PTSD.
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Affiliation(s)
- E A Stark
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom; The Scars of War Foundation, The Queen's College, Oxford, United Kingdom; Center of Functionally Integrative Neuroscience (CFIN), Aarhus University, Aarhus, Denmark
| | - C E Parsons
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom; The Scars of War Foundation, The Queen's College, Oxford, United Kingdom; Center of Functionally Integrative Neuroscience (CFIN), Aarhus University, Aarhus, Denmark; Center for Music in the Brain, Department of Clinical Medicine, Aarhus University & The Royal Academy of Music Aarhus/Aalborg, Denmark
| | - T J Van Hartevelt
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom; The Scars of War Foundation, The Queen's College, Oxford, United Kingdom; Center of Functionally Integrative Neuroscience (CFIN), Aarhus University, Aarhus, Denmark
| | - M Charquero-Ballester
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom; The Scars of War Foundation, The Queen's College, Oxford, United Kingdom; Center of Functionally Integrative Neuroscience (CFIN), Aarhus University, Aarhus, Denmark
| | - H McManners
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom; The Scars of War Foundation, The Queen's College, Oxford, United Kingdom
| | - A Ehlers
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | - A Stein
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - M L Kringelbach
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom; The Scars of War Foundation, The Queen's College, Oxford, United Kingdom; Center of Functionally Integrative Neuroscience (CFIN), Aarhus University, Aarhus, Denmark; Center for Music in the Brain, Department of Clinical Medicine, Aarhus University & The Royal Academy of Music Aarhus/Aalborg, Denmark.
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Pace-Schott EF, Germain A, Milad MR. Sleep and REM sleep disturbance in the pathophysiology of PTSD: the role of extinction memory. BIOLOGY OF MOOD & ANXIETY DISORDERS 2015; 5:3. [PMID: 26034578 PMCID: PMC4450835 DOI: 10.1186/s13587-015-0018-9] [Citation(s) in RCA: 137] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 05/12/2015] [Indexed: 01/04/2023]
Abstract
Post-traumatic stress disorder (PTSD) is accompanied by disturbed sleep and an impaired ability to learn and remember extinction of conditioned fear. Following a traumatic event, the full spectrum of PTSD symptoms typically requires several months to develop. During this time, sleep disturbances such as insomnia, nightmares, and fragmented rapid eye movement sleep predict later development of PTSD symptoms. Only a minority of individuals exposed to trauma go on to develop PTSD. We hypothesize that sleep disturbance resulting from an acute trauma, or predating the traumatic experience, may contribute to the etiology of PTSD. Because symptoms can worsen over time, we suggest that continued sleep disturbances can also maintain and exacerbate PTSD. Sleep disturbance may result in failure of extinction memory to persist and generalize, and we suggest that this constitutes one, non-exclusive mechanism by which poor sleep contributes to the development and perpetuation of PTSD. Also reviewed are neuroendocrine systems that show abnormalities in PTSD, and in which stress responses and sleep disturbance potentially produce synergistic effects that interfere with extinction learning and memory. Preliminary evidence that insomnia alone can disrupt sleep-dependent emotional processes including consolidation of extinction memory is also discussed. We suggest that optimizing sleep quality following trauma, and even strategically timing sleep to strengthen extinction memories therapeutically instantiated during exposure therapy, may allow sleep itself to be recruited in the treatment of PTSD and other trauma and stress-related disorders.
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Affiliation(s)
- Edward F. Pace-Schott
- />Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital—East, CNY 149 13th Street Room 2624, Charlestown, MA 02129 USA
| | - Anne Germain
- />Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA USA
| | - Mohammed R. Milad
- />Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital—East, CNY 149 13th Street Room 2624, Charlestown, MA 02129 USA
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