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Kobelt M, Waldhauser GT, Rupietta A, Heinen R, Rau EMB, Kessler H, Axmacher N. The memory trace of an intrusive trauma-analog episode. Curr Biol 2024; 34:1657-1669.e5. [PMID: 38537637 DOI: 10.1016/j.cub.2024.03.005] [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: 08/25/2023] [Revised: 12/05/2023] [Accepted: 03/06/2024] [Indexed: 04/25/2024]
Abstract
Intrusive memories are a core symptom of posttraumatic stress disorder. Compared with memories of everyday events, they are characterized by several seemingly contradictory features: intrusive memories contain distinct sensory and emotional details of the traumatic event and can be triggered by various perceptually similar cues, but they are poorly integrated into conceptual memory. Here, we conduct exploratory whole-brain analyses to investigate the neural representations of trauma-analog experiences and how they are reactivated during memory intrusions. We show that trauma-analog movies induce excessive processing and generalized representations in sensory areas but decreased blood-oxygen-level-dependent (BOLD) responses and highly distinct representations in conceptual/semantic areas. Intrusive memories activate generalized representations in sensory areas and reactivate memory traces specific to trauma-analog events in the anterior cingulate cortex. These findings provide the first evidence of how traumatic events could distort memory representations in the human brain, which may form the basis for future confirmatory research on the neural representations of traumatic experiences.
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Affiliation(s)
- M Kobelt
- Department of Neuropsychology, Ruhr-Universität Bochum, Bochum 44801, North Rhine-Westphalia, Germany.
| | - G T Waldhauser
- Department of Neuropsychology, Ruhr-Universität Bochum, Bochum 44801, North Rhine-Westphalia, Germany.
| | - A Rupietta
- Department of Clinical Psychology and Psychotherapy, Ruhr-Universität Bochum, Bochum 44787, North Rhine-Westphalia, Germany
| | - R Heinen
- Department of Neuropsychology, Ruhr-Universität Bochum, Bochum 44801, North Rhine-Westphalia, Germany
| | - E M B Rau
- Department of Neuropsychology, Ruhr-Universität Bochum, Bochum 44801, North Rhine-Westphalia, Germany
| | - H Kessler
- Department of Psychosomatic Medicine and Psychotherapy, Campus Fulda, Universität Marburg, Marburg 35032, Hessen, Germany; Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr-Universität Bochum, Bochum 44791, North Rhine-Westphalia, Germany
| | - N Axmacher
- Department of Neuropsychology, Ruhr-Universität Bochum, Bochum 44801, North Rhine-Westphalia, Germany.
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2
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de Kloet ER, Joëls M. The cortisol switch between vulnerability and resilience. Mol Psychiatry 2024; 29:20-34. [PMID: 36599967 DOI: 10.1038/s41380-022-01934-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 12/14/2022] [Accepted: 12/16/2022] [Indexed: 01/06/2023]
Abstract
In concert with neuropeptides and transmitters, the end products of the hypothalamus-pituitary-adrenal (HPA) axis, the glucocorticoid hormones cortisol and corticosterone (CORT), promote resilience: i.e., the ability to cope with threats, adversity, and trauma. To exert this protective action, CORT activates mineralocorticoid receptors (MR) and glucocorticoid receptors (GR) that operate in a complementary manner -as an on/off switch- to coordinate circadian events, stress-coping, and adaptation. The evolutionary older limbic MR facilitates contextual memory retrieval and supports an on-switch in the selection of stress-coping styles at a low cost. The rise in circulating CORT concentration after stress subsequently activates a GR-mediated off-switch underlying recovery of homeostasis by providing the energy for restraining the primary stress reactions and promoting cognitive control over emotional reactivity. GR activation facilitates contextual memory storage of the experience to enable future stress-coping. Such complementary MR-GR-mediated actions involve rapid non-genomic and slower gene-mediated mechanisms; they are time-dependent, conditional, and sexually dimorphic, and depend on genetic background and prior experience. If coping fails, GR activation impairs cognitive control and promotes emotional arousal which eventually may compromise resilience. Such breakdown of resilience involves a transition to a chronic stress construct, where information processing is crashed; it leads to an imbalanced MR-GR switch and hence increased vulnerability. Novel MR-GR modulators are becoming available that may reset a dysregulated stress response system to reinstate the cognitive flexibility required for resilience.
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Affiliation(s)
- E Ronald de Kloet
- Division of Endocrinology, Department of Internal Medicine, Leiden University Medical Center, Leiden University, Leiden, The Netherlands.
- Leiden/Amsterdam Center of Drug Research, Leiden University, Leiden, The Netherlands.
| | - Marian Joëls
- Dept. Translational Neuroscience, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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3
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Hinchey LME, Pernice FM, Christian JN, Michon A, Rice K. A Contemporary Review of the Clubhouse Model of Psychosocial Rehabilitation: Past, Present, and Emerging Directions. Psychiatr Q 2023; 94:569-604. [PMID: 37796378 DOI: 10.1007/s11126-023-10051-w] [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] [Accepted: 08/28/2023] [Indexed: 10/06/2023]
Abstract
Since the 1940s, the Clubhouse model of psychosocial rehabilitation has evolved towards a comprehensive practice of social theory and intervention. Despite the model's cost effectiveness and observational evidence of its efficacy, empirical research remains lacking. The current narrative review examines studies from recent years (2015-2021), not to assess study rigor, but to identify trends in research aims, findings, and methodology, as well as specify future research directions. A narrative review was conducted using PRISMA guidelines. Using the search term "Clubhouse," 194 articles were identified in online databases. 38 met criteria for inclusion. Most studies were qualitative (60.5%) and few utilized experimental or quasi-experimental designs (7.9%). Narrative synthesis revealed research aims and outcome variables falling into six key areas: social integration and connectedness, quality of life (QOL), recovery outcomes, relational dynamics, policy, and virtual adaptations of the model. Findings indicate that recent Clubhouse-related research trends have primarily involved studies of social connectedness, QOL, recovery, relationships, and policy, as well as studies examining the value of the virtual Clubhouse in maintaining well-being. However, heterogeneity of methodologies and measures present a critical limitation to assessing results across studies. Options for increasing experimental methodologies in this area are reviewed. Recommended future directions involve moving towards a biopsychosocial approach to clarifying the mechanisms through which the model promotes recovery-aims that may yield implications beyond the realm of serious mental illness.
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Affiliation(s)
- Liza M E Hinchey
- Department of Theoretical and Behavioral Foundations, College of Education, Wayne State University, 5425 Gullen Mall, Education Building, Room 351, Detroit, MI, 48202, USA.
| | - Francesca M Pernice
- Department of Theoretical and Behavioral Foundations, College of Education, Wayne State University, 5425 Gullen Mall, Education Building, Room 351, Detroit, MI, 48202, USA
| | - Janay N Christian
- Department of Theoretical and Behavioral Foundations, College of Education, Wayne State University, 5425 Gullen Mall, Education Building, Room 351, Detroit, MI, 48202, USA
| | - Amber Michon
- Department of Theoretical and Behavioral Foundations, College of Education, Wayne State University, 5425 Gullen Mall, Education Building, Room 351, Detroit, MI, 48202, USA
| | - Kevin Rice
- Fountain House New York, 425 West 47Th Street, New York, NY, 10036, USA
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4
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Zhao Z, Duek O, Seidemann R, Gordon C, Walsh C, Romaker E, Koller WN, Horvath M, Awasthi J, Wang Y, O'Brien E, Fichtenholtz H, Hampson M, Harpaz-Rotem I. Amygdala downregulation training using fMRI neurofeedback in post-traumatic stress disorder: a randomized, double-blind trial. Transl Psychiatry 2023; 13:177. [PMID: 37230984 PMCID: PMC10209552 DOI: 10.1038/s41398-023-02467-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 04/19/2023] [Accepted: 05/03/2023] [Indexed: 05/27/2023] Open
Abstract
Hyperactivation of amygdala is a neural marker for post-traumatic stress disorder (PTSD) and improvement in control over amygdala activity has been associated with treatment success in PTSD. In this randomized, double-blind clinical trial we evaluated the efficacy of a real-time fMRI neurofeedback intervention designed to train control over amygdala activity following trauma recall. Twenty-five patients with PTSD completed three sessions of neurofeedback training in which they attempted to downregulate the feedback signal after exposure to personalized trauma scripts. For subjects in the active experimental group (N = 14), the feedback signal was from a functionally localized region of their amygdala associated with trauma recall. For subjects in the control group (N = 11), yoked-sham feedback was provided. Changes in control over the amygdala and PTSD symptoms served as the primary and secondary outcome measurements, respectively. We found significantly greater improvements in control over amygdala activity in the active group than in the control group 30-days following the intervention. Both groups showed improvements in symptom scores, however the symptom reduction in the active group was not significantly greater than in the control group. Our finding of greater improvement in amygdala control suggests potential clinical application of neurofeedback in PTSD treatment. Thus, further development of amygdala neurofeedback training in PTSD treatment, including evaluation in larger samples, is warranted.
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Affiliation(s)
- Zhiying Zhao
- Centre for Cognitive and Brain Sciences, University of Macau, Macau SAR, China
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Or Duek
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- National Center for PTSD, West Haven, CT, USA
| | - Rebecca Seidemann
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- National Center for PTSD, West Haven, CT, USA
| | - Charles Gordon
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- National Center for PTSD, West Haven, CT, USA
| | - Christopher Walsh
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Emma Romaker
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - William N Koller
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Mark Horvath
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- National Center for PTSD, West Haven, CT, USA
| | - Jitendra Awasthi
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Yao Wang
- Centre for Cognitive and Brain Sciences, University of Macau, Macau SAR, China
| | - Erin O'Brien
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- National Center for PTSD, West Haven, CT, USA
| | - Harlan Fichtenholtz
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Psychology, Keene State College, Keene, NH, USA
| | - Michelle Hampson
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA.
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA.
- Department of Biomedical Engineering, Yale University School of Medicine, New Haven, CT, USA.
| | - Ilan Harpaz-Rotem
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
- National Center for PTSD, West Haven, CT, USA.
- Department of Psychology and Wu Tsai Institute, Yale University, New Haven, CT, USA.
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5
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Gill JL, Schneiders JA, Stangl M, Aghajan ZM, Vallejo M, Hiller S, Topalovic U, Inman CS, Villaroman D, Bari A, Adhikari A, Rao VR, Fanselow MS, Craske MG, Krahl SE, Chen JWY, Vick M, Hasulak NR, Kao JC, Koek RJ, Suthana N, Langevin JP. A pilot study of closed-loop neuromodulation for treatment-resistant post-traumatic stress disorder. Nat Commun 2023; 14:2997. [PMID: 37225710 PMCID: PMC10209131 DOI: 10.1038/s41467-023-38712-1] [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: 01/03/2023] [Accepted: 05/12/2023] [Indexed: 05/26/2023] Open
Abstract
The neurophysiological mechanisms in the human amygdala that underlie post-traumatic stress disorder (PTSD) remain poorly understood. In a first-of-its-kind pilot study, we recorded intracranial electroencephalographic data longitudinally (over one year) in two male individuals with amygdala electrodes implanted for the management of treatment-resistant PTSD (TR-PTSD) under clinical trial NCT04152993. To determine electrophysiological signatures related to emotionally aversive and clinically relevant states (trial primary endpoint), we characterized neural activity during unpleasant portions of three separate paradigms (negative emotional image viewing, listening to recordings of participant-specific trauma-related memories, and at-home-periods of symptom exacerbation). We found selective increases in amygdala theta (5-9 Hz) bandpower across all three negative experiences. Subsequent use of elevations in low-frequency amygdala bandpower as a trigger for closed-loop neuromodulation led to significant reductions in TR-PTSD symptoms (trial secondary endpoint) following one year of treatment as well as reductions in aversive-related amygdala theta activity. Altogether, our findings provide early evidence that elevated amygdala theta activity across a range of negative-related behavioral states may be a promising target for future closed-loop neuromodulation therapies in PTSD.
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Affiliation(s)
- Jay L Gill
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
- Medical Scientist Training Program, University of California, Los Angeles, CA, USA
| | - Julia A Schneiders
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
- Research and Development Service; Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Matthias Stangl
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Zahra M Aghajan
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
- Department of Neurosurgery, University of California, Los Angeles, CA, USA
| | - Mauricio Vallejo
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Sonja Hiller
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Uros Topalovic
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
- Department of Electrical and Computer Engineering, University of California, Los Angeles, CA, USA
| | - Cory S Inman
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Diane Villaroman
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Ausaf Bari
- Department of Neurosurgery, University of California, Los Angeles, CA, USA
| | - Avishek Adhikari
- Department of Psychology, University of California, Los Angeles, CA, USA
| | - Vikram R Rao
- Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Michael S Fanselow
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
- Department of Psychology, University of California, Los Angeles, CA, USA
| | - Michelle G Craske
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
- Department of Psychology, University of California, Los Angeles, CA, USA
| | - Scott E Krahl
- Research and Development Service; Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Department of Neurosurgery, University of California, Los Angeles, CA, USA
| | - James W Y Chen
- Neurology Service; Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Department of Neurology, University of California, Los Angeles, CA, USA
| | | | - Nicholas R Hasulak
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
- Phoenix Research Consulting LLC, Gilbert, AZ, USA
| | - Jonathan C Kao
- Department of Electrical and Computer Engineering, University of California, Los Angeles, CA, USA
| | - Ralph J Koek
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
- Psychiatry and Mental Health Service; Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Nanthia Suthana
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA.
- Department of Neurosurgery, University of California, Los Angeles, CA, USA.
- Department of Psychology, University of California, Los Angeles, CA, USA.
- Department of Bioengineering, University of California, Los Angeles, CA, USA.
| | - Jean-Philippe Langevin
- Department of Neurosurgery, University of California, Los Angeles, CA, USA.
- Neurosurgery Service; Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
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6
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Lieberman JM, Rabellino D, Densmore M, Frewen PA, Steyrl D, Scharnowski F, Théberge J, Neufeld RWJ, Schmahl C, Jetly R, Narikuzhy S, Lanius RA, Nicholson AA. Posterior cingulate cortex targeted real-time fMRI neurofeedback recalibrates functional connectivity with the amygdala, posterior insula, and default-mode network in PTSD. Brain Behav 2023; 13:e2883. [PMID: 36791212 PMCID: PMC10013955 DOI: 10.1002/brb3.2883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 12/07/2022] [Accepted: 12/12/2022] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Alterations within large-scale brain networks-namely, the default mode (DMN) and salience networks (SN)-are present among individuals with posttraumatic stress disorder (PTSD). Previous real-time functional magnetic resonance imaging (fMRI) and electroencephalography neurofeedback studies suggest that regulating posterior cingulate cortex (PCC; the primary hub of the posterior DMN) activity may reduce PTSD symptoms and recalibrate altered network dynamics. However, PCC connectivity to the DMN and SN during PCC-targeted fMRI neurofeedback remains unexamined and may help to elucidate neurophysiological mechanisms through which these symptom improvements may occur. METHODS Using a trauma/emotion provocation paradigm, we investigated psychophysiological interactions over a single session of neurofeedback among PTSD (n = 14) and healthy control (n = 15) participants. We compared PCC functional connectivity between regulate (in which participants downregulated PCC activity) and view (in which participants did not exert regulatory control) conditions across the whole-brain as well as in a priori specified regions-of-interest. RESULTS During regulate as compared to view conditions, only the PTSD group showed significant PCC connectivity with anterior DMN (dmPFC, vmPFC) and SN (posterior insula) regions, whereas both groups displayed PCC connectivity with other posterior DMN areas (precuneus/cuneus). Additionally, as compared with controls, the PTSD group showed significantly greater PCC connectivity with the SN (amygdala) during regulate as compared to view conditions. Moreover, linear regression analyses revealed that during regulate as compared to view conditions, PCC connectivity to DMN and SN regions was positively correlated to psychiatric symptoms across all participants. CONCLUSION In summary, observations of PCC connectivity to the DMN and SN provide emerging evidence of neural mechanisms underlying PCC-targeted fMRI neurofeedback among individuals with PTSD. This supports the use of PCC-targeted neurofeedback as a means by which to recalibrate PTSD-associated alterations in neural connectivity within the DMN and SN, which together, may help to facilitate improved emotion regulation abilities in PTSD.
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Affiliation(s)
- Jonathan M Lieberman
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Imaging, Lawson Health Research Institute, London, Ontario, Canada
| | - Daniela Rabellino
- Imaging, Lawson Health Research Institute, London, Ontario, Canada.,Department of Neuroscience, Western University, London, Ontario, Canada
| | - Maria Densmore
- Imaging, Lawson Health Research Institute, London, Ontario, Canada.,Department of Psychiatry, Western University, London, Ontario, Canada
| | - Paul A Frewen
- Department of Neuroscience, Western University, London, Ontario, Canada.,Department of Psychology, Western University, London, Ontario, Canada
| | - David Steyrl
- Department of Cognition, Emotion, and Methods in Psychology, University of Vienna, Vienna, Austria
| | - Frank Scharnowski
- Department of Cognition, Emotion, and Methods in Psychology, University of Vienna, Vienna, Austria
| | - Jean Théberge
- Imaging, Lawson Health Research Institute, London, Ontario, Canada.,Department of Psychiatry, Western University, London, Ontario, Canada.,Department of Medical Biophysics, Western University, London, Ontario, Canada.,Department of Diagnostic Imaging, St. Joseph's Healthcare, London, Ontario, Canada
| | - Richard W J Neufeld
- Department of Neuroscience, Western University, London, Ontario, Canada.,Department of Psychiatry, Western University, London, Ontario, Canada.,Department of Psychology, Western University, London, Ontario, Canada.,Department of Psychology, University of British Columbia, Okanagan, Kelowna, British Columbia, Canada
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Heidelberg University, Heidelberg, Germany
| | - Rakesh Jetly
- The Institute of Mental Health Research, University of Ottawa, Royal Ottawa Hospital, Ontario, Canada
| | - Sandhya Narikuzhy
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Ruth A Lanius
- Imaging, Lawson Health Research Institute, London, Ontario, Canada.,Department of Neuroscience, Western University, London, Ontario, Canada.,Department of Psychiatry, Western University, London, Ontario, Canada.,Homewood Research Institute, Guelph, Ontario, Canada
| | - Andrew A Nicholson
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Department of Cognition, Emotion, and Methods in Psychology, University of Vienna, Vienna, Austria.,Department of Medical Biophysics, Western University, London, Ontario, Canada.,The Institute of Mental Health Research, University of Ottawa, Royal Ottawa Hospital, Ontario, Canada.,Homewood Research Institute, Guelph, Ontario, Canada.,Atlas Institute for Veterans and Families, Ottawa, Ontario, Canada.,School of Psychology, University of Ottawa, Ottawa, Canada
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7
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Bocharov AV, Savostyanov AN, Tamozhnikov SS, Karpova AG, Milakhina NS, Zavarzin EA, Saprigyn AE, Knyazev GG. Electrophysiological signatures of resting state networks under new environmental conditions. Neurosci Lett 2023; 794:137012. [PMID: 36521645 DOI: 10.1016/j.neulet.2022.137012] [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: 08/19/2022] [Revised: 11/29/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022]
Abstract
It is assumed that cognitive processes are provided by the regulatory interactions of different brain networks. The three most stable resting state networks, among which the default mode network (DMN), the central executive network (CEN) and the salience network (SN) are considered to be the key neurocognitive networks for understanding higher cognitive functions. Peculiarities of changes in the connectivity of resting state networks of an individual entering a new environment and after a year of adaptation in this environment remain poorly studied. The aim of this study was to investigate the peculiarities of the connectivity of resting state networks calculated in EEG data in students right after moving to an unfamiliar environment and one year after moving. 128-channel EEGs were recorded in the resting state in 45 students (all men) aged from 18 to 29 years, who moved to the North region of Russia (Yakutsk, Republic of Sakha (Yakutia)). Resting state networks were calculated by the seed-based method. The subjects had increased SN connectivity with the sensorimotor cortex and the posterior node of DMN (posterior cingulate cortex and precuneus) in the condition when they were exposed to a new unfamiliar environment, compared to the condition after a year in the same environment. In general, the obtained data are consistent with the notion of increased SN functioning when encountering new significant stimuli and tasks, i.e. new environmental conditions, and the representation of SN as closely related to the function of homeostasis regulation according to organism's internal goals and environmental requirements.
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Affiliation(s)
- Andrey V Bocharov
- Laboratory of Differential Psychophysiology, Scientific Research Institute of Neurosciences and Medicine, Novosibirsk 630117, Russia; Institute for the Humanities, Novosibirsk State University, Novosibirsk 630090, Russia.
| | - Alexander N Savostyanov
- Laboratory of Differential Psychophysiology, Scientific Research Institute of Neurosciences and Medicine, Novosibirsk 630117, Russia; Institute for the Humanities, Novosibirsk State University, Novosibirsk 630090, Russia; Laboratory of Psychological Genetics, Institute of Cytology and Genetics SB RAS, Novosibirsk 630090, Russia
| | - Sergey S Tamozhnikov
- Laboratory of Differential Psychophysiology, Scientific Research Institute of Neurosciences and Medicine, Novosibirsk 630117, Russia
| | | | - Natalya S Milakhina
- Laboratory of Psychological Genetics, Institute of Cytology and Genetics SB RAS, Novosibirsk 630090, Russia
| | - Evgeny A Zavarzin
- Laboratory of Differential Psychophysiology, Scientific Research Institute of Neurosciences and Medicine, Novosibirsk 630117, Russia
| | - Alexander E Saprigyn
- Laboratory of Differential Psychophysiology, Scientific Research Institute of Neurosciences and Medicine, Novosibirsk 630117, Russia; Laboratory of Psychological Genetics, Institute of Cytology and Genetics SB RAS, Novosibirsk 630090, Russia
| | - Gennady G Knyazev
- Laboratory of Differential Psychophysiology, Scientific Research Institute of Neurosciences and Medicine, Novosibirsk 630117, Russia
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8
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Kotler S, Mannino M, Kelso S, Huskey R. First few seconds for flow: A comprehensive proposal of the neurobiology and neurodynamics of state onset. Neurosci Biobehav Rev 2022; 143:104956. [PMID: 36368525 DOI: 10.1016/j.neubiorev.2022.104956] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 10/22/2022] [Accepted: 11/06/2022] [Indexed: 11/09/2022]
Abstract
Flow is a cognitive state that manifests when there is complete attentional absorption while performing a task. Flow occurs when certain internal as well as external conditions are present, including intense concentration, a sense of control, feedback, and a balance between the challenge of the task and the relevant skillset. Phenomenologically, flow is accompanied by a loss of self-consciousness, seamless integration of action and awareness, and acute changes in time perception. Research has begun to uncover some of the neurophysiological correlates of flow, as well as some of the state's neuromodulatory processes. We comprehensively review this work and consider the neurodynamics of the onset of the state, considering large-scale brain networks, as well as dopaminergic, noradrenergic, and endocannabinoid systems. To accomplish this, we outline an evidence-based hypothetical situation, and consider the flow state in a broader context including other profound alterations in consciousness, such as the psychedelic state and the state of traumatic stress that can induce PTSD. We present a broad theoretical framework which may motivate future testable hypotheses.
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Affiliation(s)
| | | | - Scott Kelso
- Human Brain & Behavior Laboratory, Center for Complex Systems and Brain Sciences, Florida Atlantic University, United States; Intelligent Systems Research Centre, Ulster University, Derry∼Londonderry, North Ireland
| | - Richard Huskey
- Cognitive Communication Science Lab, Department of Communication, University of California Davis, United States; Cognitive Science Program, University of California Davis, United States; Center for Mind and Brain, University of California Davis, United States.
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9
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Rosenfield PJ, Jiang D, Pauselli L. Childhood adversity and psychotic disorders: Epidemiological evidence, theoretical models and clinical considerations. Schizophr Res 2022; 247:55-66. [PMID: 34210561 DOI: 10.1016/j.schres.2021.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/31/2021] [Accepted: 06/04/2021] [Indexed: 02/08/2023]
Abstract
While genetic factors play a critical role in the risk for schizophrenia and other psychotic disorders, increasing evidence points to the role of childhood adversity as one of several environmental factors that can significantly impact the development, manifestations and outcome of these disorders. This paper reviews the epidemiological evidence linking childhood adversity and psychotic disorders and explores various theoretical models that seek to explain the connection. We discuss neurobiological parallels between the impact of childhood trauma and psychosis on the brain and then explore the impact of childhood adversity on different domains of clinical presentation. Finally, implications for prevention and treatment are considered, both on individual and structural levels.
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Affiliation(s)
- Paul J Rosenfield
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, United States of America.
| | - David Jiang
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, United States of America.
| | - Luca Pauselli
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, United States of America.
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10
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Szeszko PR, Bierer LM, Bader HN, Chu KW, Tang CY, Murphy KM, Hazlett EA, Flory JD, Yehuda R. Cingulate and hippocampal subregion abnormalities in combat-exposed veterans with PTSD. J Affect Disord 2022; 311:432-439. [PMID: 35598747 DOI: 10.1016/j.jad.2022.05.081] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 05/02/2022] [Accepted: 05/15/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND The hippocampus and cingulate gyrus are strongly interconnected brain regions that have been implicated in the neurobiology of post-traumatic stress disorder (PTSD). These brain structures are comprised of functionally distinct subregions that may contribute to the expression of PTSD symptoms or associated cardio-metabolic markers, but have not been well investigated in prior studies. METHODS Two divisions of the cingulate cortex (i.e., rostral and caudal) and 11 hippocampal subregions were investigated in 22 male combat-exposed veterans with PTSD and 22 male trauma-exposed veteran controls (TC). Cardio-metabolic measures included cholesterol, body mass index, and mean arterial pressure. RESULTS Individuals with PTSD had less caudal cingulate area compared to TC even after controlling for caudal cingulate thickness. Total hippocampus volume was lower in PTSD compared to TC, accounted for by differences in CA1-CA4, granule cell layer of the dentate gyrus, molecular layer, and subiculum. Individuals with PTSD had higher mean arterial pressure compared to TC, which correlated with hippocampus volume only in the PTSD group. LIMITATIONS Sample size, cross-sectional analysis, no control for medications and findings limited to males. CONCLUSIONS These data demonstrate preferential involvement of caudal cingulate area (vs. thickness) and hippocampus subregions in PTSD. The inverse association between hippocampus volume and mean arterial pressure may contribute to accelerated aging known to be associated with PTSD.
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Affiliation(s)
- Philip R Szeszko
- Mental Health Patient Care Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Linda M Bierer
- Mental Health Patient Care Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Heather N Bader
- Mental Health Patient Care Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - King-Wai Chu
- Mental Illness Research, Education, and Clinical Center (MIRECC), James J. Peters VA Medical Center, Bronx, NY, USA
| | - Cheuk Y Tang
- Mental Illness Research, Education, and Clinical Center (MIRECC), James J. Peters VA Medical Center, Bronx, NY, USA; Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Katharine M Murphy
- Mental Health Patient Care Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Erin A Hazlett
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Mental Illness Research, Education, and Clinical Center (MIRECC), James J. Peters VA Medical Center, Bronx, NY, USA
| | - Janine D Flory
- Mental Health Patient Care Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rachel Yehuda
- Mental Health Patient Care Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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11
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Sydnor VJ, Cieslak M, Duprat R, Deluisi J, Flounders MW, Long H, Scully M, Balderston NL, Sheline YI, Bassett DS, Satterthwaite TD, Oathes DJ. Cortical-subcortical structural connections support transcranial magnetic stimulation engagement of the amygdala. SCIENCE ADVANCES 2022; 8:eabn5803. [PMID: 35731882 PMCID: PMC9217085 DOI: 10.1126/sciadv.abn5803] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 05/04/2022] [Indexed: 05/31/2023]
Abstract
The amygdala processes valenced stimuli, influences emotion, and exhibits aberrant activity across anxiety disorders, depression, and PTSD. Interventions modulating amygdala activity hold promise as transdiagnostic psychiatric treatments. In 45 healthy participants, we investigated whether transcranial magnetic stimulation (TMS) elicits indirect changes in amygdala activity when applied to ventrolateral prefrontal cortex (vlPFC), a region important for emotion regulation. Harnessing in-scanner interleaved TMS/functional MRI (fMRI), we reveal that vlPFC neurostimulation evoked acute and focal modulations of amygdala fMRI BOLD signal. Larger TMS-evoked changes in the amygdala were associated with higher fiber density in a vlPFC-amygdala white matter pathway when stimulating vlPFC but not an anatomical control, suggesting this pathway facilitated stimulation-induced communication between cortex and subcortex. This work provides evidence of amygdala engagement by TMS, highlighting stimulation of vlPFC-amygdala circuits as a candidate treatment for transdiagnostic psychopathology. More broadly, it indicates that targeting cortical-subcortical structural connections may enhance the impact of TMS on subcortical neural activity and, by extension, subcortex-subserved behaviors.
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Affiliation(s)
- Valerie J. Sydnor
- Penn Lifespan Informatics and Neuroimaging Center (PennLINC), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Matthew Cieslak
- Penn Lifespan Informatics and Neuroimaging Center (PennLINC), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Romain Duprat
- Center for Neuromodulation in Depression and Stress (CNDS), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Joseph Deluisi
- Center for Neuromodulation in Depression and Stress (CNDS), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Matthew W. Flounders
- Center for Neuromodulation in Depression and Stress (CNDS), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Hannah Long
- Center for Neuromodulation in Depression and Stress (CNDS), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Morgan Scully
- Center for Neuromodulation in Depression and Stress (CNDS), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Nicholas L. Balderston
- Center for Neuromodulation in Depression and Stress (CNDS), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Yvette I. Sheline
- Center for Neuromodulation in Depression and Stress (CNDS), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Dani S. Bassett
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Electrical and Systems Engineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Physics and Astronomy, College of Arts and Sciences, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Santa Fe Institute, Santa Fe, NM 87501, USA
| | - Theodore D. Satterthwaite
- Penn Lifespan Informatics and Neuroimaging Center (PennLINC), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Desmond J. Oathes
- Center for Neuromodulation in Depression and Stress (CNDS), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Penn Brain Science, Translation, Innovation, and Modulation Center (brainSTIM), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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Leroy A, Very E, Birmes P, Yger P, Szaffarczyk S, Lopes R, Outteryck O, Faure C, Duhem S, Grandgenèvre P, Warembourg F, Vaiva G, Jardri R. Intrusive experiences in posttraumatic stress disorder: Treatment response induces changes in the directed functional connectivity of the anterior insula. Neuroimage Clin 2022; 34:102964. [PMID: 35189456 PMCID: PMC8861823 DOI: 10.1016/j.nicl.2022.102964] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 01/27/2022] [Accepted: 02/08/2022] [Indexed: 11/18/2022]
Abstract
Many causal paths were less influenced by the AI after effective therapy for PTSD. Insular influences over the rest of the brain were found to be positively correlated with re-experiencing. Re-experiencing was linked with changes in intrinsic networks’ spatial stability after treatment.
Background One of the core features of posttraumatic stress disorder (PTSD) is re-experiencing trauma. The anterior insula (AI) has been proposed to play a crucial role in these intrusive experiences. However, the dynamic function of the AI in re-experiencing trauma and its putative modulation by effective therapy need to be specified. Methods Thirty PTSD patients were enrolled and exposed to traumatic memory reactivation therapy. Resting-state functional magnetic resonance imaging (fMRI) scans were acquired before and after treatment. To explore AI-directed influences over the rest of the brain, we referred to a mixed model using pre-/posttreatment Granger causality analysis seeded on the AI as a within-subject factor and treatment response as a between-subject factor. To further identify correlates of re-experiencing trauma, we investigated how intrusive severity affected (i) causality maps and (ii) the spatial stability of other intrinsic brain networks. Results We observed changes in AI-directed functional connectivity patterns in PTSD patients. Many within- and between-network causal paths were found to be less influenced by the AI after effective therapy. Insular influences were found to be positively correlated with re-experiencing symptoms, while they were linked with a stronger default mode network (DMN) and more unstable central executive network (CEN) connectivity. Conclusion We showed that directed changes in AI signaling to the DMN and CEN at rest may underlie the degree of re-experiencing symptoms in PTSD. A positive response to treatment further induced changes in network-to-network anticorrelated patterns. Such findings may guide targeted neuromodulation strategies in PTSD patients not suitably improved by conventional treatment.
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Affiliation(s)
- Arnaud Leroy
- Univ Lille, INSERM, CHU Lille, Lille Neuroscience & Cognition Centre (U-1172), Plasticity & SubjectivitY Team, CURE Platform, 59000 Lille, France; CHU Lille, Fontan Hospital, General Psychiatry Dpt., 59037 Lille Cedex, France; Centre National de Ressources et Résilience pour les psychotraumatismes (CN2R Lille - Paris), 59000 Lille, France.
| | - Etienne Very
- CHU Toulouse, Purpan Hospital, Psychiatry Department, 31059 Toulouse Cedex, France; ToNIC, Toulouse NeuroImaging Center, INSERM U-1214, UPS, France
| | - Philippe Birmes
- ToNIC, Toulouse NeuroImaging Center, INSERM U-1214, UPS, France
| | - Pierre Yger
- Univ Lille, INSERM, CHU Lille, Lille Neuroscience & Cognition Centre (U-1172), Plasticity & SubjectivitY Team, CURE Platform, 59000 Lille, France; Institut de la Vision, Sorbonne Université, Inserm S968, CNRS UMR7210, Paris, France
| | - Sébastien Szaffarczyk
- Univ Lille, INSERM, CHU Lille, Lille Neuroscience & Cognition Centre (U-1172), Plasticity & SubjectivitY Team, CURE Platform, 59000 Lille, France
| | - Renaud Lopes
- Univ Lille, INSERM, CHU Lille, Lille Neuroscience & Cognition Centre (U-1772), Degenerative & Vascular Cognitive Disorders Team, 59000 Lille, France; Univ Lille, CNRS, INSERM, CHU Lille, Institut Pasteur de Lille, US 41 - UMS 2014 - PLBS, 59000 Lille, France
| | - Olivier Outteryck
- Univ Lille, INSERM, CHU Lille, Lille Neuroscience & Cognition Centre (U-1772), Degenerative & Vascular Cognitive Disorders Team, 59000 Lille, France; CHU Lille, Department of Neuroradiology, Roger Salengro Hospital, 59037 Lille Cedex, France
| | - Cécile Faure
- Univ Lille, INSERM, CHU Lille, Lille Neuroscience & Cognition Centre (U-1172), Plasticity & SubjectivitY Team, CURE Platform, 59000 Lille, France
| | - Stéphane Duhem
- CHU Lille, Fontan Hospital, General Psychiatry Dpt., 59037 Lille Cedex, France; Centre National de Ressources et Résilience pour les psychotraumatismes (CN2R Lille - Paris), 59000 Lille, France; Université de Lille, Inserm, CHU Lille, CIC 1403 - Clinical Investigation Center, 59000 Lille, France
| | - Pierre Grandgenèvre
- Univ Lille, INSERM, CHU Lille, Lille Neuroscience & Cognition Centre (U-1172), Plasticity & SubjectivitY Team, CURE Platform, 59000 Lille, France; CHU Lille, Fontan Hospital, General Psychiatry Dpt., 59037 Lille Cedex, France
| | | | - Guillaume Vaiva
- Univ Lille, INSERM, CHU Lille, Lille Neuroscience & Cognition Centre (U-1172), Plasticity & SubjectivitY Team, CURE Platform, 59000 Lille, France; CHU Lille, Fontan Hospital, General Psychiatry Dpt., 59037 Lille Cedex, France; Centre National de Ressources et Résilience pour les psychotraumatismes (CN2R Lille - Paris), 59000 Lille, France
| | - Renaud Jardri
- Univ Lille, INSERM, CHU Lille, Lille Neuroscience & Cognition Centre (U-1172), Plasticity & SubjectivitY Team, CURE Platform, 59000 Lille, France; CHU Lille, Fontan Hospital, Child & Adolescent Psychiatry Dpt., 59037 Lille Cedex, France
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Eising CM, Maercker A, Malagurski B, Jäncke L, Mérillat S. A longitudinal resting-state functional connectivity analysis on trauma exposure and post-traumatic stress symptoms in older individuals. Neuroimage Clin 2022; 35:103052. [PMID: 35644110 PMCID: PMC9144015 DOI: 10.1016/j.nicl.2022.103052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 05/09/2022] [Accepted: 05/15/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Given the present demographic shift towards an aging society, there is an increased need to investigate the brain's functional connectivity in the context of aging. Trauma exposure and post-traumatic stress disorder (PTSD) symptoms are factors known to impact healthy aging and have been reported to be associated with functional connectivity differences. In the present study, we examined and compared differences in within-default mode network (DMN), within-salience network (SN) and between-DMN-SN functional connectivity, between trauma-exposed individuals with and without PTSD symptoms as well as non-traumatized individuals in a non-clininical older adult sample. METHODS Resting state functional MRI and behavioral data is taken from the Longitudinal Healthy Aging Brain Database Project (LHAB). For the present analysis, participants who completed the questionnaires on trauma exposure and PTSD symptoms (N = 110 individuals of which n = 50 individuals reported previous trauma exposure and n = 25 individuals reported PTSD symptoms; mean age = 70.55 years, SD = 4.82) were included. RESULTS The reporting of PTSD symptoms relative to no symptoms was associated with lower within-DMN connectivity, while on a trend level trauma-exposed individuals showed higher within-SN connectivity compared to non-trauma exposed individuals. Consistent with existing models of healthy aging, between-DMN-SN functional connectivity showed an increase across time in older age. CONCLUSION Present results suggest that alterations in within-DMN and within-SN functional connectivity also occur in non-treatment seeking older adult populations with trauma exposure and in association with PTSD symptoms. These changes manifest, alongside altered between-DMN-SN functional connectivity, in older age supposedly independent of aging-related functional desegregation.
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Affiliation(s)
- Carla M Eising
- University of Zürich, Psychopathology and Clinical Intervention, Institute of Psychology, Binzmuehlestrasse 14 / 17, 8050 Zürich, Switzerland; University Research Priority Program "Dynamics of Healthy Aging", University of Zürich, Switzerland.
| | - Andreas Maercker
- University of Zürich, Psychopathology and Clinical Intervention, Institute of Psychology, Binzmuehlestrasse 14 / 17, 8050 Zürich, Switzerland; University Research Priority Program "Dynamics of Healthy Aging", University of Zürich, Switzerland
| | - Brigitta Malagurski
- University Research Priority Program "Dynamics of Healthy Aging", University of Zürich, Switzerland
| | - Lutz Jäncke
- University Research Priority Program "Dynamics of Healthy Aging", University of Zürich, Switzerland; Division Neuropsychology, Department of Psychology, University of Zurich, Binzmuehlestrasse 14, 8050 Zurich, Switzerland
| | - Susan Mérillat
- University Research Priority Program "Dynamics of Healthy Aging", University of Zürich, Switzerland
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14
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Rieger NS, Varela JA, Ng AJ, Granata L, Djerdjaj A, Brenhouse HC, Christianson JP. Insular cortex corticotropin-releasing factor integrates stress signaling with social affective behavior. Neuropsychopharmacology 2022; 47:1156-1168. [PMID: 35220413 PMCID: PMC9018766 DOI: 10.1038/s41386-022-01292-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/10/2022] [Accepted: 02/02/2022] [Indexed: 02/02/2023]
Abstract
Impairments in identifying and responding to the emotions of others manifest in a variety of psychopathologies. Therefore, elaborating the neurobiological mechanisms that underpin social responses to social emotions, or social affective behavior, is a translationally important goal. The insular cortex is consistently implicated in stress-related social and anxiety disorders, which are associated with diminished ability to make and use inferences about the emotions of others to guide behavior. We investigated how corticotropin-releasing factor (CRF), a neuromodulator evoked upon exposure to stressed conspecifics, influenced the insula. We hypothesized that social affective behavior requires CRF signaling in the insular cortex in order to detect stress in social interactions. In acute slices from male and female rats, CRF depolarized insular pyramidal neurons. In males, but not females, CRF suppressed presynaptic GABAergic inhibition leading to greater excitatory synaptic efficacy in a CRF receptor 1 (CRF1)- and cannabinoid receptor 1 (CB1)-dependent fashion. In males only, insular CRF increased social investigation, and CRF1 and CB1 antagonists interfered with social interactions with stressed conspecifics. To investigate the molecular and cellular basis for the effect of CRF we examined insular CRF1 and CB1 mRNAs and found greater total insula CRF1 mRNA in females but greater CRF1 and CB1 mRNA colocalization in male insular cortex glutamatergic neurons that suggest complex, sex-specific organization of CRF and endocannabinoid systems. Together these results reveal a new mechanism by which stress and affect contribute to social affective behavior.
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Affiliation(s)
- Nathaniel S Rieger
- Department of Psychology & Neuroscience, Boston College, 140 Commonwealth Ave, Chestnut Hill, MA, 02467, USA
| | - Juan A Varela
- Department of Psychology & Neuroscience, Boston College, 140 Commonwealth Ave, Chestnut Hill, MA, 02467, USA
| | - Alexandra J Ng
- Department of Psychology & Neuroscience, Boston College, 140 Commonwealth Ave, Chestnut Hill, MA, 02467, USA
| | - Lauren Granata
- Psychology Department, Northeastern University, 360 Huntington Avenue, 115 Richards Hall, Boston, MA, 02115, USA
| | - Anthony Djerdjaj
- Department of Psychology & Neuroscience, Boston College, 140 Commonwealth Ave, Chestnut Hill, MA, 02467, USA
| | - Heather C Brenhouse
- Psychology Department, Northeastern University, 360 Huntington Avenue, 115 Richards Hall, Boston, MA, 02115, USA
| | - John P Christianson
- Department of Psychology & Neuroscience, Boston College, 140 Commonwealth Ave, Chestnut Hill, MA, 02467, USA.
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15
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Nicholson AA, Rabellino D, Densmore M, Frewen PA, Steryl D, Scharnowski F, Théberge J, Neufeld RWJ, Schmahl C, Jetly R, Lanius RA. Differential mechanisms of posterior cingulate cortex downregulation and symptom decreases in posttraumatic stress disorder and healthy individuals using real-time fMRI neurofeedback. Brain Behav 2022; 12:e2441. [PMID: 34921746 PMCID: PMC8785646 DOI: 10.1002/brb3.2441] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 10/25/2021] [Accepted: 11/09/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Intrinsic connectivity networks, including the default mode network (DMN), are frequently disrupted in individuals with posttraumatic stress disorder (PTSD). The posterior cingulate cortex (PCC) is the main hub of the posterior DMN, where the therapeutic regulation of this region with real-time fMRI neurofeedback (NFB) has yet to be explored. METHODS We investigated PCC downregulation while processing trauma/stressful words over 3 NFB training runs and a transfer run without NFB (total n = 29, PTSD n = 14, healthy controls n = 15). We also examined the predictive accuracy of machine learning models in classifying PTSD versus healthy controls during NFB training. RESULTS Both the PTSD and healthy control groups demonstrated reduced reliving symptoms in response to trauma/stressful stimuli, where the PTSD group additionally showed reduced symptoms of distress. We found that both groups were able to downregulate the PCC with similar success over NFB training and in the transfer run, although downregulation was associated with unique within-group decreases in activation within the bilateral dmPFC, bilateral postcentral gyrus, right amygdala/hippocampus, cingulate cortex, and bilateral temporal pole/gyri. By contrast, downregulation was associated with increased activation in the right dlPFC among healthy controls as compared to PTSD. During PCC downregulation, right dlPFC activation was negatively correlated to PTSD symptom severity scores and difficulties in emotion regulation. Finally, machine learning algorithms were able to classify PTSD versus healthy participants based on brain activation during NFB training with 80% accuracy. CONCLUSIONS This is the first study to investigate PCC downregulation with real-time fMRI NFB in both PTSD and healthy controls. Our results reveal acute decreases in symptoms over training and provide converging evidence for EEG-NFB targeting brain networks linked to the PCC.
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Affiliation(s)
- Andrew A Nicholson
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Department of Cognition, Emotion, and Methods in Psychology, University of Vienna, Vienna, Austria
| | - Daniela Rabellino
- Department of Neuroscience, Western University, London, Ontario, Canada.,Imaging, Lawson Health Research Institute, London, Ontario, Canada
| | - Maria Densmore
- Imaging, Lawson Health Research Institute, London, Ontario, Canada.,Department of Psychiatry, Western University, London, Ontario, Canada
| | - Paul A Frewen
- Department of Neuroscience, Western University, London, Ontario, Canada.,Department of Psychology, Western University, London, Ontario, Canada
| | - David Steryl
- Department of Cognition, Emotion, and Methods in Psychology, University of Vienna, Vienna, Austria
| | - Frank Scharnowski
- Department of Cognition, Emotion, and Methods in Psychology, University of Vienna, Vienna, Austria
| | - Jean Théberge
- Imaging, Lawson Health Research Institute, London, Ontario, Canada.,Department of Medical Biophysics, Western University, London, Ontario, Canada.,Department of Psychiatry, Western University, London, Ontario, Canada.,Department of Diagnostic Imaging, St. Joseph's Healthcare, London, Ontario, Canada
| | - Richard W J Neufeld
- Department of Neuroscience, Western University, London, Ontario, Canada.,Department of Psychology, Western University, London, Ontario, Canada.,Department of Psychiatry, Western University, London, Ontario, Canada.,Department of Psychology, University of British Columbia, Okanagan, Kelowna, British Columbia, Canada
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Heidelberg University, Heidelberg, Germany
| | - Rakesh Jetly
- Canadian Forces, Health Services, Ottawa, Ontario, Canada
| | - Ruth A Lanius
- Department of Neuroscience, Western University, London, Ontario, Canada.,Imaging, Lawson Health Research Institute, London, Ontario, Canada.,Department of Psychiatry, Western University, London, Ontario, Canada
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Lloyd CS, Nicholson AA, Densmore M, Théberge J, Neufeld RWJ, Jetly R, McKinnon MC, Lanius RA. Shame on the brain: Neural correlates of moral injury event recall in posttraumatic stress disorder. Depress Anxiety 2021; 38:596-605. [PMID: 33369799 DOI: 10.1002/da.23128] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 11/21/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Moral injury (MI) is consistently associated with adverse mental health outcomes, including the development of posttraumatic stress disorder (PTSD) and suicidality. METHODS We investigated neural activation patterns associated with MI event recall using functional magnetic resonance imaging in participants with military and public safety-related PTSD, relative to civilian MI-exposed controls. RESULTS MI recall in the PTSD as compared to control group was associated with increased neural activation among salience network nodes involved in viscerosensory processing and hyperarousal (right posterior insula, dorsal anterior cingulate cortex; dACC), regions involved in defensive responding (left postcentral gyrus), and areas responsible for top-down cognitive control of emotions (left dorsolateral prefrontal cortex; dlPFC). Within the PTSD group, measures of state and trait shame correlated negatively with activity among default mode network regions associated with self-related processing and moral cognition (dorsomedial prefrontal cortex; dmPFC) and salience network regions associated with viscerosensory processing (left posterior insula), respectively. CONCLUSIONS These findings suggest that MI event processing is altered in military and public safety-related PTSD, relative to MI-exposed controls. Here, it appears probable that as individuals with PTSD recall their MI event, they experience a surge of blame-related processing of bodily sensations within salience network regions, including the right posterior insula and the dACC, which in turn, prompt regulatory strategies at the level of the left dlPFC aimed at increasing cognitive control and inhibiting emotional affect. These results are consistent with previous findings showing enhanced sensory processing and altered top-down control in PTSD samples during autobiographical memory recall.
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Affiliation(s)
- Chantelle S Lloyd
- Department of Psychology, Neuroscience, and Behaviour, McMaster University, Hamilton, Ontario, Canada.,Department of Psychiatry, Western University, London, Ontario, Canada.,Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.,Homewood Research Institute, Homewood Health, Guelph, Ontario, Canada
| | - Andrew A Nicholson
- Homewood Research Institute, Homewood Health, Guelph, Ontario, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Maria Densmore
- Department of Psychiatry, Western University, London, Ontario, Canada.,Imaging Division, Lawson Health Research Institute, London, Ontario, Canada
| | - Jean Théberge
- Department of Psychiatry, Western University, London, Ontario, Canada.,Imaging Division, Lawson Health Research Institute, London, Ontario, Canada.,Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - Richard W J Neufeld
- Department of Psychiatry, Western University, London, Ontario, Canada.,Department of Psychology, Western University, London, Ontario, Canada.,Department of Neuroscience, Western University, London, Ontario, Canada
| | - Rakesh Jetly
- Canadian Forces, Health Services, Ottawa, Ontario, Canada
| | - Margaret C McKinnon
- Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.,Homewood Research Institute, Homewood Health, Guelph, Ontario, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Ruth A Lanius
- Department of Psychiatry, Western University, London, Ontario, Canada.,Homewood Research Institute, Homewood Health, Guelph, Ontario, Canada.,Imaging Division, Lawson Health Research Institute, London, Ontario, Canada.,Department of Neuroscience, Western University, London, Ontario, Canada
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van den End A, Dekker J, Beekman ATF, Aarts I, Snoek A, Blankers M, Vriend C, van den Heuvel OA, Thomaes K. Clinical Efficacy and Cost-Effectiveness of Imagery Rescripting Only Compared to Imagery Rescripting and Schema Therapy in Adult Patients With PTSD and Comorbid Cluster C Personality Disorder: Study Design of a Randomized Controlled Trial. Front Psychiatry 2021; 12:633614. [PMID: 33868050 PMCID: PMC8044980 DOI: 10.3389/fpsyt.2021.633614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 02/23/2021] [Indexed: 12/29/2022] Open
Abstract
Background: Posttraumatic stress disorder (PTSD) is a serious and relatively common mental disorder causing a high burden of suffering. Whereas evidence-based treatments are available, dropout and non-response rates remain high. PTSD and Cluster C personality disorders (avoidant, dependent or obsessive-compulsive personality disorder; CPD) are highly comorbid and there is evidence for suboptimal treatment effects in this subgroup of patients. An integrated PTSD and CPD treatment may be needed to increase treatment efficacy. However, no studies directly comparing the efficacy of regular PTSD treatment and treatment tailored to PTSD and comorbid CPD are available. Whether integrated treatment is more effective than treatment focused on PTSD alone is important, since (1) no evidence-based guideline for PTSD and comorbid CPD treatment exists, and (2) treatment approaches to CPD are costly and time consuming. Present study design describes a randomized controlled trial (RCT) directly comparing trauma focused treatment with integrated trauma focused and personality focused treatment. Methods: An RCT with two parallel groups design will be used to compare the clinical efficacy and cost-effectiveness of "standalone" imagery rescripting (n = 63) with integrated imagery rescripting and schema therapy (n = 63). This trial is part of a larger research project on PTSD and personality disorders. Predictors, mediators and outcome variables are measured at regular intervals over the course of 18 months. The main outcome is PTSD severity at 12 months. Additionally, machine-learning techniques will be used to predict treatment outcome using biopsychosocial variables. Discussion: This study protocol outlines the first RCT aimed at directly comparing the clinical efficacy and cost-effectiveness of imagery rescripting and integrated imagery rescripting and schema therapy for treatment seeking adult patients with PTSD and comorbid cluster C personality pathology. Additionally, biopsychosocial variables will be used to predict treatment outcome. As such, the trial adds to the development of an empirically informed and individualized treatment indication process. Clinical Trial registration: ClinicalTrials.gov, NCT03833531.
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Affiliation(s)
- Arne van den End
- Sinai Centrum, Amstelveen, Netherlands.,Department of Psychiatry, Academic Medical Center, Location Vrije Universiteit Medical Center, Amsterdam, Netherlands
| | - Jack Dekker
- Arkin Mental Health Care, Amsterdam, Netherlands.,Faculty of Behavioural and Movement Sciences, VU University, Amsterdam, Netherlands
| | - Aartjan T F Beekman
- Department of Psychiatry, Academic Medical Center, Location Vrije Universiteit Medical Center, Amsterdam, Netherlands.,GGZ inGeest, Amsterdam, Netherlands
| | - Inga Aarts
- Sinai Centrum, Amstelveen, Netherlands.,Department of Psychiatry, Academic Medical Center, Location Vrije Universiteit Medical Center, Amsterdam, Netherlands
| | - Aishah Snoek
- Sinai Centrum, Amstelveen, Netherlands.,Department of Psychiatry, Academic Medical Center, Location Vrije Universiteit Medical Center, Amsterdam, Netherlands
| | - Matthijs Blankers
- Arkin Mental Health Care, Amsterdam, Netherlands.,Netherlands Institute of Mental Health and Addiction (Trimbos Institute), Utrecht, Netherlands
| | - Chris Vriend
- Amsterdam Neuroscience, Amsterdam University Medical Center, Location Vrije Universiteit Medical Center, Amsterdam, Netherlands.,Department of Anatomy and Neurosciences, Amsterdam University Medical Center, Location Vrije Universiteit Medical Center, Amsterdam, Netherlands
| | - Odile A van den Heuvel
- Amsterdam Neuroscience, Amsterdam University Medical Center, Location Vrije Universiteit Medical Center, Amsterdam, Netherlands.,Department of Anatomy and Neurosciences, Amsterdam University Medical Center, Location Vrije Universiteit Medical Center, Amsterdam, Netherlands
| | - Kathleen Thomaes
- Sinai Centrum, Amstelveen, Netherlands.,Department of Psychiatry, Academic Medical Center, Location Vrije Universiteit Medical Center, Amsterdam, Netherlands.,Arkin Mental Health Care, Amsterdam, Netherlands
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18
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Nicholson AA, Ros T, Densmore M, Frewen PA, Neufeld RWJ, Théberge J, Jetly R, Lanius RA. A randomized, controlled trial of alpha-rhythm EEG neurofeedback in posttraumatic stress disorder: A preliminary investigation showing evidence of decreased PTSD symptoms and restored default mode and salience network connectivity using fMRI. Neuroimage Clin 2020; 28:102490. [PMID: 33395981 PMCID: PMC7708928 DOI: 10.1016/j.nicl.2020.102490] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/20/2020] [Accepted: 10/27/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The default-mode network (DMN) and salience network (SN) have been shown to display altered connectivity in posttraumatic stress disorder (PTSD). Restoring aberrant connectivity within these networks with electroencephalogram neurofeedback (EEG-NFB) has been shown previously to be associated with acute decreases in symptoms. Here, we conducted a double-blind, sham-controlled randomized trial of alpha-rhythm EEG-NFB in participants with PTSD (n = 36) over 20-weeks. Our aim was to provide mechanistic evidence underlying clinical improvements by examining changes in network connectivity via fMRI. METHODS We randomly assigned participants with a primary diagnosis of PTSD to either the experimental group (n = 18) or sham-control group (n = 18). We collected resting-state fMRI scans pre- and post-NFB intervention, for both the experimental and sham-control PTSD groups. We further compared baseline brain connectivity measures pre-NFB to age-matched healthy controls (n = 36). RESULTS With regard to the primary outcome measure of PTSD severity, we found a significant main effect of time in the absence of a group × time interaction. Nevertheless, we found significantly decreased PTSD severity scores in the experimental NFB group only, when comparing post-NFB (dz = 0.71) and 3-month follow-up scores (dz = 0.77) to baseline measures. Interestingly, we found evidence to suggest a shift towards normalization of DMN and SN connectivity post-NFB in the experimental group only. Both decreases in PTSD severity and NFB performance were correlated to DMN and SN connectivity post-NFB in the experimental group. Critically, remission rates of PTSD were significant higher in the experimental group (61.1%) as compared to the sham-control group (33.3%). CONCLUSION The current study shows mechanistic evidence for therapeutic changes in DMN and SN connectivity that are known to be associated with PTSD psychopathology with no patient dropouts. This preliminary investigation merits further research to demonstrate fully the clinical efficacy of EEG-NFB as an adjunctive therapy for PTSD.
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Affiliation(s)
- Andrew A Nicholson
- Department of Cognition, Emotion, and Methods in Psychology, University of Vienna, Austria
| | - Tomas Ros
- Departments of Neuroscience and Psychiatry, University of Geneva, Campus Biotech, Geneva, Switzerland
| | - Maria Densmore
- Departments of Neuroscience, Western University, London, ON, Canada; Imaging, Lawson Health Research Institute, London, ON, Canada
| | - Paul A Frewen
- Departments of Neuroscience, Western University, London, ON, Canada; Departments of Psychology, Western University, London, ON, Canada
| | - Richard W J Neufeld
- Departments of Neuroscience, Western University, London, ON, Canada; Departments of Psychiatry, Western University, London, ON, Canada; Departments of Psychology, Western University, London, ON, Canada
| | - Jean Théberge
- Departments of Psychiatry, Western University, London, ON, Canada; Departments of Psychology, Western University, London, ON, Canada; Departments of Medical Imaging, Western University, London, ON, Canada; Imaging, Lawson Health Research Institute, London, ON, Canada; Department of Diagnostic Imaging, St. Joseph's Healthcare, London, ON, Canada
| | - Rakesh Jetly
- Canadian Forces, Health Services, Ottawa, Ontario, Canada
| | - Ruth A Lanius
- Departments of Neuroscience, Western University, London, ON, Canada; Departments of Psychiatry, Western University, London, ON, Canada; Imaging, Lawson Health Research Institute, London, ON, Canada.
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19
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Carlson HN, Weiner JL. The neural, behavioral, and epidemiological underpinnings of comorbid alcohol use disorder and post-traumatic stress disorder. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2020; 157:69-142. [PMID: 33648676 DOI: 10.1016/bs.irn.2020.09.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Alcohol use disorder (AUD) and (PTSD) frequently co-occur and individuals suffering from this dual diagnosis often exhibit increased symptom severity and poorer treatment outcomes than those with only one of these diseases. Although there have been significant advances in our understanding of the neurobiological mechanisms underlying each of these disorders, the neural underpinnings of the comorbid condition remain poorly understood. This chapter summarizes recent epidemiological findings on comorbid AUD and PTSD, with a focus on vulnerable populations, the temporal relationship between these disorders, and the clinical consequences associated with the dual diagnosis. We then review animal models of the comorbid condition and emerging human and non-human animal research that is beginning to identify maladaptive neural changes common to both disorders, primarily involving functional changes in brain reward and stress networks. We end by proposing a neural framework, based on the emerging field of affective valence encoding, that may better explain the epidemiological and neural findings on AUD and PTSD.
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Affiliation(s)
- Hannah N Carlson
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Jeff L Weiner
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC, United States.
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20
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Davidson B, Suresh H, Goubran M, Rabin JS, Meng Y, Mithani K, Pople CB, Giacobbe P, Hamani C, Lipsman N. Predicting response to psychiatric surgery: a systematic review of neuroimaging findings. J Psychiatry Neurosci 2020; 45:387-394. [PMID: 32293838 PMCID: PMC7595737 DOI: 10.1503/jpn.190208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Psychiatric surgery, including deep brain stimulation and stereotactic ablation, is an important treatment option in severe refractory psychiatric illness. Several large trials have demonstrated response rates of approximately 50%, underscoring the need to identify and select responders preoperatively. Recent advances in neuroimaging have brought this possibility into focus. We systematically reviewed the psychiatric surgery neuroimaging literature to assess the current state of evidence for preoperative imaging predictors of response. METHODS We performed this study in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-analysis of Observational Studies in Epidemiology (MOOSE) frameworks, and preregistered it using PROSPERO. We systematically searched the Medline, Embase and Cochrane databases for studies reporting preoperative neuroimaging analyses correlated with clinical outcomes in patients who underwent psychiatric surgery. We recorded and synthesized the methodological details, imaging results and clinical correlations from these studies. RESULTS After removing duplicates, the search yielded 8388 unique articles, of which 7 met the inclusion criteria. The included articles were published between 2001 and 2018 and reported on the outcomes of 101 unique patients. Of the 6 studies that reported significant findings, all identified clusters of hypermetabolism, hyperconnectivity or increased size in the frontostriatal limbic circuitry. LIMITATIONS The included studies were few and highly varied, spanning 2 decades. CONCLUSION Although few studies have analyzed preoperative imaging for predictors of response to psychiatric surgery, we found consistency among the reported results: most studies implicated overactivity in the frontostriatal limbic network as being correlated with clinical response. Larger prospective studies are needed. REGISTRATION www.crd.york.ac.uk/prospero/display_record.php?RecordID=131151.
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Affiliation(s)
- Benjamin Davidson
- From the Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada (Davidson, Suresh, Hamani, Lipsman); and the Harquail Centre for Neuromodulation, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada (Davidson, Goubran, Rabin, Meng, Mithani, Pople, Giacobbe, Hamani, Lipsman)
| | - Hrishikesh Suresh
- From the Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada (Davidson, Suresh, Hamani, Lipsman); and the Harquail Centre for Neuromodulation, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada (Davidson, Goubran, Rabin, Meng, Mithani, Pople, Giacobbe, Hamani, Lipsman)
| | - Maged Goubran
- From the Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada (Davidson, Suresh, Hamani, Lipsman); and the Harquail Centre for Neuromodulation, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada (Davidson, Goubran, Rabin, Meng, Mithani, Pople, Giacobbe, Hamani, Lipsman)
| | - Jennifer S Rabin
- From the Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada (Davidson, Suresh, Hamani, Lipsman); and the Harquail Centre for Neuromodulation, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada (Davidson, Goubran, Rabin, Meng, Mithani, Pople, Giacobbe, Hamani, Lipsman)
| | - Ying Meng
- From the Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada (Davidson, Suresh, Hamani, Lipsman); and the Harquail Centre for Neuromodulation, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada (Davidson, Goubran, Rabin, Meng, Mithani, Pople, Giacobbe, Hamani, Lipsman)
| | - Karim Mithani
- From the Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada (Davidson, Suresh, Hamani, Lipsman); and the Harquail Centre for Neuromodulation, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada (Davidson, Goubran, Rabin, Meng, Mithani, Pople, Giacobbe, Hamani, Lipsman)
| | - Christopher B Pople
- From the Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada (Davidson, Suresh, Hamani, Lipsman); and the Harquail Centre for Neuromodulation, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada (Davidson, Goubran, Rabin, Meng, Mithani, Pople, Giacobbe, Hamani, Lipsman)
| | - Peter Giacobbe
- From the Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada (Davidson, Suresh, Hamani, Lipsman); and the Harquail Centre for Neuromodulation, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada (Davidson, Goubran, Rabin, Meng, Mithani, Pople, Giacobbe, Hamani, Lipsman)
| | - Clement Hamani
- From the Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada (Davidson, Suresh, Hamani, Lipsman); and the Harquail Centre for Neuromodulation, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada (Davidson, Goubran, Rabin, Meng, Mithani, Pople, Giacobbe, Hamani, Lipsman)
| | - Nir Lipsman
- From the Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada (Davidson, Suresh, Hamani, Lipsman); and the Harquail Centre for Neuromodulation, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada (Davidson, Goubran, Rabin, Meng, Mithani, Pople, Giacobbe, Hamani, Lipsman)
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21
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Månsson KNT, Lueken U, Frick A. Enriching CBT by Neuroscience: Novel Avenues to Achieve Personalized Treatments. Int J Cogn Ther 2020. [DOI: 10.1007/s41811-020-00089-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
AbstractAlthough cognitive behavioral therapy (CBT) is an established and efficient treatment for a variety of common mental disorders, a considerable number of patients do not respond to treatment or relapse after successful CBT. Recent findings and approaches from neuroscience could pave the way for clinical developments to enhance the outcome of CBT. Herein, we will present how neuroscience can offer novel perspectives to better understand (a) the biological underpinnings of CBT, (b) how we can enrich CBT with neuroscience-informed techniques (augmentation of CBT), and (c) why some patients may respond better to CBT than others (predictors of therapy outcomes), thus paving the way for more personalized and effective treatments. We will introduce some key topics and describe a selection of findings from CBT-related research using tools from neuroscience, with the hope that this will provide clinicians and clinical researchers with a brief and comprehensible overview of the field.
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22
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Neural correlates of safety learning. Behav Brain Res 2020; 396:112884. [PMID: 32871228 DOI: 10.1016/j.bbr.2020.112884] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/24/2020] [Accepted: 08/21/2020] [Indexed: 02/01/2023]
Abstract
Accurate discrimination between safe and dangerous stimuli is essential for survival. Prior research has begun to uncover the neural structures that are necessary for learning this discrimination, but exploration of brain regions involved in this learning process has been mostly limited to males. Recent findings show sex differences in discrimination learning, with reduced fear expression to safe cues in females compared to males. Here, we used male and female Sprague Dawley rats to explore neural activation, as measured by Fos expression, in fear and safety learning related brain regions. Neural activation after fear discrimination (Discrimination) was compared between males and females, as well as with fear conditioned (Fear Only) and stimulus presented (Control) conditions. Correlations of discrimination ability and neural activation were also calculated. We uncovered a correlation between central amygdala (CeA) activation and discrimination abilities in males and females. Anterior medial bed nucleus of the stria terminalis (BNST) was the only region where sex differences in Fos counts were observed in the Discrimination condition, and the only region where neural activation significantly differed between Fear Only and Discrimination conditions. Together, these findings indicate the importance of fear expression circuitry in mediating discrimination responses and generate important questions for future investigation.
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23
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Ivleva EI, Turkozer HB, Sweeney JA. Imaging-Based Subtyping for Psychiatric Syndromes. Neuroimaging Clin N Am 2019; 30:35-44. [PMID: 31759570 DOI: 10.1016/j.nic.2019.09.005] [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: 01/08/2023]
Abstract
Despite considerable research evidence demonstrating significant neurobiological alterations in psychiatric disorders, incorporating neuroimaging approaches into clinical practice remains challenging. There is an urgent need for biologically validated psychiatric disease constructs that can inform diagnostic algorithms and targeted treatment development. In this article, we present a conceptual review of the most robust and impactful findings from studies that use neuroimaging methods in efforts to define distinct disease subtypes, while emphasizing cross-diagnostic and dimensional approaches. In addition, we discuss current challenges in psychoradiology and outline potential future strategies for clinically applicable translation.
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Affiliation(s)
- Elena I Ivleva
- Department of Psychiatry, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, NC5, Dallas, TX 75390, USA.
| | - Halide B Turkozer
- Department of Psychiatry, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, NC5, Dallas, TX 75390, USA
| | - John A Sweeney
- Department of Psychiatry, University of Cincinnati, 2600 Clifton Avenue, Cincinnati, OH 45221, USA
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24
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Alcantara A, Berenji GR, Scherling CS, Durcanova B, Diaz-Aguilar D, Silverman DHS. Long-Term Clinical and Neuronuclear Imaging Sequelae of Cancer Therapy, Trauma, and Brain Injury. J Nucl Med 2019; 60:1682-1690. [PMID: 31601702 DOI: 10.2967/jnumed.119.237578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 10/04/2019] [Indexed: 11/16/2022] Open
Abstract
Neuronuclear imaging has been used for several decades in the study of primary neurodegenerative conditions, such as dementia and parkinsonian syndromes, both for research and for clinical purposes. There has been a relative paucity of applications of neuronuclear imaging to evaluate nonneurodegenerative conditions that can also have long-term effects on cognition and function. This article summarizes clinical and imaging aspects of 3 such conditions that have garnered considerable attention in recent years: cancer- and chemotherapy-related cognitive impairment, posttraumatic stress disorder, and traumatic brain injury. Further, we describe current research using neuroimaging tools aimed to better understand the relationships between the clinical presentations and brain structure and function in these conditions.
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Affiliation(s)
- April Alcantara
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Gholam R Berenji
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California.,Department of Radiology, VA Greater Los Angeles Healthcare System, Los Angeles, California; and
| | - Carole S Scherling
- Department of Psychological Science, Belmont University, Nashville, Tennessee
| | - Beata Durcanova
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Daniel Diaz-Aguilar
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Daniel H S Silverman
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California
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25
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Yabuki Y, Fukunaga K. Clinical Therapeutic Strategy and Neuronal Mechanism Underlying Post-Traumatic Stress Disorder (PTSD). Int J Mol Sci 2019; 20:ijms20153614. [PMID: 31344835 PMCID: PMC6695947 DOI: 10.3390/ijms20153614] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 07/19/2019] [Accepted: 07/19/2019] [Indexed: 12/15/2022] Open
Abstract
Post-traumatic stress disorder (PTSD) is characterized by an exaggerated response to contextual memory and impaired fear extinction, with or without mild cognitive impairment, learning deficits, and nightmares. PTSD is often developed by traumatic events, such as war, terrorist attack, natural calamities, etc. Clinical and animal studies suggest that aberrant susceptibility of emotion- and fear-related neurocircuits, including the amygdala, prefrontal cortex (PFC), and hippocampus may contribute to the development and retention of PTSD symptoms. Psychological and pharmacological therapy, such as cognitive behavioral therapy (CBT), and treatment with anti-depressive agents and/or antipsychotics significantly attenuate PTSD symptoms. However, more effective therapeutics are required for improvement of quality of life in PTSD patients. Previous studies have reported that ω3 long-chain polyunsaturated fatty acid (LCPUFA) supplements can suppress the development of PTSD symptoms. Fatty acid binding proteins (FABPs) are essential for LCPUFA intracellular trafficking. In this review, we have introduced Fabp3 null mice as an animal model of PTSD with impaired fear extinction. Moreover, we have addressed the neuronal circuits and novel therapeutic strategies for PTSD symptoms.
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Affiliation(s)
- Yasushi Yabuki
- Department of Pharmacology, Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai 980-8578, Japan
| | - Kohji Fukunaga
- Department of Pharmacology, Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai 980-8578, Japan.
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26
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Prasad A, Chaichi A, Kelley DP, Francis J, Gartia MR. Current and future functional imaging techniques for post-traumatic stress disorder. RSC Adv 2019; 9:24568-24594. [PMID: 35527877 PMCID: PMC9069787 DOI: 10.1039/c9ra03562a] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 08/02/2019] [Indexed: 11/21/2022] Open
Abstract
Posttraumatic stress disorder (PTSD) is a trauma and stressor related psychiatric disorder associated with structural, metabolic, and molecular alternations in several brain regions including diverse cortical areas, neuroendocrine regions, the striatum, dopaminergic, adrenergic and serotonergic pathways, and the limbic system. We are in critical need of novel therapeutics and biomarkers for PTSD and a deep understanding of cutting edge imaging and spectroscopy methods is necessary for the development of promising new approaches to better diagnose and treat the disorder. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) criterion, all forms of traumatic stress-induced disorder are considered acute stress disorder for the first month following the stressor. Only after symptoms do not remit for one month can the disorder be deemed PTSD. It would be particularly useful to differentiate between acute stress disorder and PTSD during the one month waiting period so that more intensive treatments can be applied early on to patients with a high likelihood of developing PTSD. This would potentially enhance treatment outcomes and/or prevent the development of PTSD. Comprehension of the qualities and limitations of currently applied methods as well as the novel emerging techniques provide invaluable knowledge for fast paced development. Conventional methods of studying PTSD have proven to be insufficient for diagnosis, measurement of treatment efficacy, and monitoring disease progression. As the field currently stands, there is no diagnostic biomarker available for any psychiatric disease, PTSD included. Currently, emerging and available technologies are not utilized to their full capacity and in appropriate experimental designs for the most fruitful possible studies in this area. Therefore, there is an apparent need for improved methods in PTSD research. This review demonstrates the current state of the literature in PTSD, including molecular, cellular, and behavioral indicators, possible biomarkers and clinical and pre-clinical imaging techniques relevant to PTSD, and through this, elucidate the void of current practical imaging and spectroscopy methods that provide true biomarkers for the disorder and the significance of devising new techniques for future investigations. We are unlikely to develop a single biomarker for any psychiatric disorder however. As psychiatric disorders are incomparably complex compared to other medical diagnoses, its most likely that transcriptomic, metabolomic and structural and connectomic imaging data will have to be analyzed in concert in order to produce a dependable non-behavioral marker of PTSD. This can explain the necessity of bridging conventional approaches to novel technologies in order to create a framework for further discoveries in the treatment of PTSD. Conventional methods of studying posttraumatic stress disorder (PTSD) have proven to be insufficient for diagnosis. We have reviewed clinical and preclinical imaging techniques as well as molecular, cellular, and behavioral indicators for PTSD.![]()
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Affiliation(s)
- Alisha Prasad
- Department of Mechanical and Industrial Engineering
- Louisiana State University
- Baton Rouge
- USA
| | - Ardalan Chaichi
- Department of Mechanical and Industrial Engineering
- Louisiana State University
- Baton Rouge
- USA
| | - D. Parker Kelley
- Comparative Biomedical Sciences
- School of Veterinary Medicine
- Louisiana State University
- Baton Rouge
- USA
| | - Joseph Francis
- Comparative Biomedical Sciences
- School of Veterinary Medicine
- Louisiana State University
- Baton Rouge
- USA
| | - Manas Ranjan Gartia
- Department of Mechanical and Industrial Engineering
- Louisiana State University
- Baton Rouge
- USA
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