1
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Yoo JH, Park YW, Kim D, Park H, Jeong B. Effects of Parental Verbal Abuse Experience on the Glutamate Response to Swear Words in the Ventromedial Prefrontal Cortex: A Functional 1H-magnetic Resonance Spectroscopy Study. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE : THE OFFICIAL SCIENTIFIC JOURNAL OF THE KOREAN COLLEGE OF NEUROPSYCHOPHARMACOLOGY 2023; 21:559-571. [PMID: 37424423 PMCID: PMC10335905 DOI: 10.9758/cpn.22.1019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/12/2022] [Accepted: 10/17/2022] [Indexed: 07/11/2023]
Abstract
Objective Several lines of evidence indicate verbal abuse (VA) critically impacts the developing brain; however, whether VA results in changes in brain neurochemistry has not been established. Here, we hypothesized that exposure to recurrent parental VA elicits heightened glutamate (Glu) responses during the presentation of swear words, which can be measured with functional magnetic resonance spectroscopy (fMRS). Methods During an emotional Stroop task consisting of blocks of color and swear words, metabolite concentration changes were measured in the ventromedial prefrontal cortex (vmPFC) and the left amygdalohippocampal region (AMHC) of healthy adults (14 F/27 M, 23 ± 4 years old) using fMRS. The dynamic changes in Glu and their associations with the emotional state of the participants were finally evaluated based on 36 datasets from the vmPFC and 30 from the AMHC. Results A repeated-measures analysis of covariance revealed a modest effect of parental VA severity on Glu changes in the vmPFC. The total score on the Verbal Abuse Questionnaire by parents (pVAQ) was associated with the Glu response to swear words (ΔGluSwe). The interaction term of ΔGluSwe and baseline N-acetyl aspartate (NAA) level in the vmPFC could be used to predict state-trait anxiety level and depressive mood. We could not find any significant associations between ΔGluSwe in the AMHC and either pVAQ or emotional states. Conclusion Parental VA exposure in individuals is associated with a greater Glu response towards VA-related stimuli in the vmPFC and that the accompanying low NAA level may be associated with anxiety level or depressive mood.
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Affiliation(s)
- Jae Hyun Yoo
- Department of Psychiatry, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Korea
| | - Young Woo Park
- School of Electrical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Korea
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Dohyun Kim
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Korea
- Department of Psychiatry, Dankook University College of Medicine, Cheonan, Korea
| | - HyunWook Park
- School of Electrical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Korea
| | - Bumseok Jeong
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Korea
- KAIST Institute for Health Science and Technology and KI for Artificial Intelligence, KAIST, Daejeon, Korea
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2
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Naeser MA, Martin PI, Ho MD, Krengel MH, Bogdanova Y, Knight JA, Hamblin MR, Fedoruk AE, Poole LG, Cheng C, Koo B. Transcranial Photobiomodulation Treatment: Significant Improvements in Four Ex-Football Players with Possible Chronic Traumatic Encephalopathy. J Alzheimers Dis Rep 2023; 7:77-105. [PMID: 36777329 PMCID: PMC9912826 DOI: 10.3233/adr-220022] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 11/19/2022] [Indexed: 12/28/2022] Open
Abstract
Background Chronic traumatic encephalopathy, diagnosed postmortem (hyperphosphorylated tau), is preceded by traumatic encephalopathy syndrome with worsening cognition and behavior/mood disturbances, over years. Transcranial photobiomodulation (tPBM) may promote improvements by increasing ATP in compromised/stressed cells and increasing local blood, lymphatic vessel vasodilation. Objective Aim 1: Examine cognition, behavior/mood changes Post-tPBM. Aim 2: MRI changes - resting-state functional-connectivity MRI: salience, central executive, default mode networks (SN, CEN, DMN); magnetic resonance spectroscopy, cingulate cortex. Methods Four ex-players with traumatic encephalopathy syndrome/possible chronic traumatic encephalopathy, playing 11- 16 years, received In-office, red/near-infrared tPBM to scalp, 3x/week for 6 weeks. Two had cavum septum pellucidum. Results The three younger cases (ages 55, 57, 65) improved 2 SD (p < 0.05) on three to six neuropsychological tests/subtests at 1 week or 1 month Post-tPBM, compared to Pre-Treatment, while the older case (age 74) improved by 1.5 SD on three tests. There was significant improvement at 1 month on post-traumatic stress disorder (PTSD), depression, pain, and sleep. One case discontinued narcotic pain medications and had reduced tinnitus. The possible placebo effect is unknown. At 2 months Post-tPBM, two cases regressed. Then, home tPBM was applied to only cortical nodes, DMN (12 weeks); again, significant improvements were seen. Significant correlations for increased SN functional connectivity (FC) over time, with executive function, attention, PTSD, pain, and sleep; and CEN FC, with verbal learning/memory, depression. Increased n-acetyl-aspartate (NAA) (oxygen consumption, mitochondria) was present in anterior cingulate cortex (ACC), parallel to less pain and PTSD. Conclusion After tPBM, these ex-football players improved. Significant correlations of increased SN FC and CEN FC with specific cognitive tests and behavior/mood ratings, plus increased NAA in ACC support beneficial effects from tPBM.
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Affiliation(s)
- Margaret A. Naeser
- VA Boston Healthcare System, Jamaica Plain Campus, Boston, MA, USA,Department of Neurology, Boston University School of Medicine, Boston, MA, USA,Correspondence to: Margaret A. Naeser, PhD, VA Boston Healthcare System (12A), Jamaica Plain Campus, 150 So. Huntington Ave., Boston, MA 02130 USA. E-mail:
| | - Paula I. Martin
- VA Boston Healthcare System, Jamaica Plain Campus, Boston, MA, USA,Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Michael D. Ho
- VA Boston Healthcare System, Jamaica Plain Campus, Boston, MA, USA
| | - Maxine H. Krengel
- VA Boston Healthcare System, Jamaica Plain Campus, Boston, MA, USA,Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Yelena Bogdanova
- VA Boston Healthcare System, Jamaica Plain Campus, Boston, MA, USA,Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Jeffrey A. Knight
- VA Boston Healthcare System, Jamaica Plain Campus, Boston, MA, USA,Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA,National Center for PTSD - Behavioral Sciences Division, VA Boston Healthcare System, Boston, MA, USA
| | - Michael R. Hamblin
- Laser Research Centre, Faculty of Health Science, University of Johannesburg, Doornfontein, South Africa,Radiation Biology Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Luke G. Poole
- VA Boston Healthcare System, Jamaica Plain Campus, Boston, MA, USA
| | - ChiaHsin Cheng
- Department of Anatomy & Neurobiology, Bio-imaging Informatics Lab, Boston University School of Medicine, Boston, MA, USA
| | - BangBon Koo
- Department of Anatomy & Neurobiology, Bio-imaging Informatics Lab, Boston University School of Medicine, Boston, MA, USA
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3
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Swanberg KM, Campos L, Abdallah CG, Juchem C. Proton Magnetic Resonance Spectroscopy in Post-Traumatic Stress Disorder-Updated Systematic Review and Meta-Analysis. CHRONIC STRESS (THOUSAND OAKS, CALIF.) 2022; 6:24705470221128004. [PMID: 36237981 PMCID: PMC9551353 DOI: 10.1177/24705470221128004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 09/06/2022] [Indexed: 11/06/2022]
Abstract
A stressor-related disorder wherein traumatic experience precipitates protracted
disruptions to mood and cognition, post-traumatic stress disorder (PTSD) is
associated with wide-ranging abnormalities across the body. While various
methods have investigated these deviations, only proton magnetic resonance
spectroscopy (1H MRS) enables noninvasive measurement of
small-molecule metabolites in the living human. 1H MRS has
correspondingly been employed to test hypotheses about the composition and
function of multiple brain regions putatively involved in PTSD. Here we
systematically review methodological considerations and reported findings, both
positive and negative, of the current 1H-MRS literature in PTSD
(N = 32 studies) to communicate the brain regional metabolite alterations
heretofore observed, providing random-effects model meta-analyses for those most
extensively studied. Our review suggests significant PTSD-associated decreases
in N-acetyl aspartate in bilateral hippocampus and anterior cingulate cortex
with less evident effect in other metabolites and regions. Model heterogeneities
diverged widely by analysis (I2 < 0.01% to 90.1%) and suggested
regional dependence on quantification reference (creatine or otherwise). While
observed variabilities in methods and reported findings suggest that
1H-MRS explorations of PTSD could benefit from methodological
standardization, informing this standardization by quantitative assessment of
the existing literature is currently hampered by its small size and limited
scope.
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Affiliation(s)
- Kelley M. Swanberg
- Department of Biomedical Engineering,
Columbia
University Fu Foundation School of Engineering and Applied
Science, New York, NY, USA
- Kelley M. Swanberg, Department of
Biomedical Engineering, Columbia University Fu Foundation School of Engineering
and Applied Science, 351 Engineering Terrace, 1210 Amsterdam Avenue, New York,
NY 10027, USA.
| | - Leonardo Campos
- Department of Biomedical Engineering,
Columbia
University Fu Foundation School of Engineering and Applied
Science, New York, NY, USA
| | - Chadi G. Abdallah
- Department of Psychiatry, Yale University School of
Medicine, New Haven, CT, USA
- Clinical Neuroscience Division, Department of Veterans Affairs
National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut
Healthcare System, West Haven, CT, USA
- Psychiatry and Behavioral Sciences,
Baylor College
of Medicine, Houston, TX, USA
| | - Christoph Juchem
- Department of Biomedical Engineering,
Columbia
University Fu Foundation School of Engineering and Applied
Science, New York, NY, USA
- Department of Radiology, Columbia University College of Physicians and
Surgeons, New York, NY, USA
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4
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Lange RT, Merritt VC, Brickell TA, Dalgard CL, Soltis AR, Hershaw J, Lippa SM, Gill J, French LM. Apolipoprotein E e4 is associated with worse self-reported neurobehavioral symptoms following uncomplicated mild traumatic brain injury in U.S. military service members. Behav Brain Res 2021; 415:113491. [PMID: 34333069 DOI: 10.1016/j.bbr.2021.113491] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 06/24/2021] [Accepted: 07/25/2021] [Indexed: 11/16/2022]
Abstract
Past research has found a relationship between the apolipoprotein E (APOE) e4 allele and worse neurobehavioral functioning following mild traumatic brain injury (MTBI) in civilian populations. The purpose of this study was to examine this relationship in service members and veterans (SMVs) following MTBI. Participants were 151 SMVs (103 uncomplicated MTBI; 48 Injured Controls [IC]) prospectively enrolled in the DVBIC-TBICoE 15-Year Longitudinal TBI Study. Participants completed a battery of self-reported neurobehavioral symptom measures on average 76.2 months post-injury (SD = 31.8). APOE genotyping was undertaken using non-fasting blood samples. Participants were classified into four subgroups based on injury (MTBI vs. IC) and APOE e4 allele status (e4 present/absent). In the IC group, there were no significant differences across APOE e4 status subgroups for all measures. In the MTBI group, participants with the APOE e4 allele had significantly worse scores on measures of depression, pain, anxiety, grief, positive well-being, social participation, and resilience compared to those without the e4 allele (d = .44 to d = .69). When comparing the number of 'clinically elevated' neurobehavioral measures simultaneously, the MTBI/e4 present subgroup consistently had a higher number of elevated measures compared to the MTBI/e4 absent, IC/e4 present, and IC/e4 absent subgroups. The APOE e4 allele was associated with poorer neurobehavioral outcome in SMVs in the chronic phase of recovery following MTBI. APOE e4 could be incorporated into screening tools to predict SMVs at risk for poor long-term neurobehavioral outcome in an effort to provide early intervention to improve long-term clinical outcome.
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Affiliation(s)
- Rael T Lange
- Traumatic Brain Injury Center of Excellence, 1335 E W Hwy, Silver Spring, MD, 20910, United States; Walter Reed National Military Medical Center, 4494 Palmer Rd N, Bethesda, MD, 20814, United States; National Intrepid Center of Excellence, Palmer Rd S, Bethesda, MD, 20814, United States; University of British Columbia, Vancouver, BC, V6T 1Z4, Canada; Contractor, General Dynamics Information Technology, 3150 Fairview Park Dr, Falls Church, VA, 22042, United States; Centre of Excellence on Post-traumatic Stress Disorder, 1145 Carling Ave, Ottawa, ON, K1Z 7K4, Canada.
| | - Victoria C Merritt
- VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, 92161, United States; University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, United States.
| | - Tracey A Brickell
- Traumatic Brain Injury Center of Excellence, 1335 E W Hwy, Silver Spring, MD, 20910, United States; Walter Reed National Military Medical Center, 4494 Palmer Rd N, Bethesda, MD, 20814, United States; National Intrepid Center of Excellence, Palmer Rd S, Bethesda, MD, 20814, United States; Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD, 20814, United States; Contractor, General Dynamics Information Technology, 3150 Fairview Park Dr, Falls Church, VA, 22042, United States; Centre of Excellence on Post-traumatic Stress Disorder, 1145 Carling Ave, Ottawa, ON, K1Z 7K4, Canada.
| | - Clifton L Dalgard
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD, 20814, United States; The American Genome Center, 4301 Jones Bridge Rd, Bethesda, MD, 20814, United States.
| | - Anthony R Soltis
- Henry M Jackson Foundation, 6720A Rockledge Dr, Bethesda, MD, 20817, United States; PRIMER, 4301 Jones Bridge Rd, Bethesda, MD, 20814, United States.
| | - Jamie Hershaw
- Traumatic Brain Injury Center of Excellence, 1335 E W Hwy, Silver Spring, MD, 20910, United States; Walter Reed National Military Medical Center, 4494 Palmer Rd N, Bethesda, MD, 20814, United States; National Intrepid Center of Excellence, Palmer Rd S, Bethesda, MD, 20814, United States; Contractor, General Dynamics Information Technology, 3150 Fairview Park Dr, Falls Church, VA, 22042, United States.
| | - Sara M Lippa
- Walter Reed National Military Medical Center, 4494 Palmer Rd N, Bethesda, MD, 20814, United States; National Intrepid Center of Excellence, Palmer Rd S, Bethesda, MD, 20814, United States.
| | - Jessica Gill
- National Institutes of Health, National Institute of Nursing Research, 10 Center Dr, Bethesda, MD, 20814, United States.
| | - Louis M French
- Traumatic Brain Injury Center of Excellence, 1335 E W Hwy, Silver Spring, MD, 20910, United States; Walter Reed National Military Medical Center, 4494 Palmer Rd N, Bethesda, MD, 20814, United States; National Intrepid Center of Excellence, Palmer Rd S, Bethesda, MD, 20814, United States; Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD, 20814, United States.
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5
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Harnett NG, Goodman AM, Knight DC. PTSD-related neuroimaging abnormalities in brain function, structure, and biochemistry. Exp Neurol 2020; 330:113331. [PMID: 32343956 DOI: 10.1016/j.expneurol.2020.113331] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 04/06/2020] [Accepted: 04/24/2020] [Indexed: 12/20/2022]
Abstract
Although approximately 90% of the U.S. population will experience a traumatic event within their lifetime, only a fraction of those traumatized individuals will develop posttraumatic stress disorder (PTSD). In fact, approximately 7 out of 100 people in the U.S. will be afflicted by this debilitating condition, which suggests there is substantial inter-individual variability in susceptibility to PTSD. This uncertainty regarding who is susceptible to PTSD necessitates a thorough understanding of the neurobiological processes that underlie PTSD development in order to build effective predictive models for the disorder. In turn, these predictive models may lead to the development of improved diagnostic markers, early intervention techniques, and targeted treatment approaches for PTSD. Prior research has characterized a fear learning and memory network, centered on the prefrontal cortex, hippocampus, and amygdala, that plays a key role in the pathology of PTSD. Importantly, changes in the function, structure, and biochemistry of this network appear to underlie the cognitive-affective dysfunction observed in PTSD. The current review discusses prior research that has demonstrated alterations in brain function, structure, and biochemistry associated with PTSD. Further, the potential for future research to address current gaps in our understanding of the neural processes that underlie the development of PTSD is discussed. Specifically, this review emphasizes the need for multimodal neuroimaging research and investigations into the acute effects of posttraumatic stress. The present review provides a framework to move the field towards a comprehensive neurobiological model of PTSD.
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Affiliation(s)
- Nathaniel G Harnett
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Adam M Goodman
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - David C Knight
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA.
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6
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Miller JS, Rodriguez-Saona L, Hackshaw KV. Metabolomics in Central Sensitivity Syndromes. Metabolites 2020; 10:E164. [PMID: 32344505 PMCID: PMC7240948 DOI: 10.3390/metabo10040164] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/11/2020] [Accepted: 04/19/2020] [Indexed: 01/09/2023] Open
Abstract
Central sensitization syndromes are a collection of frequently painful disorders that contribute to decreased quality of life and increased risk of opiate abuse. Although these disorders cause significant morbidity, they frequently lack reliable diagnostic tests. As such, technologies that can identify key moieties in central sensitization disorders may contribute to the identification of novel therapeutic targets and more precise treatment options. The analysis of small molecules in biological samples through metabolomics has improved greatly and may be the technology needed to identify key moieties in difficult to diagnose diseases. In this review, we discuss the current state of metabolomics as it relates to central sensitization disorders. From initial literature review until Feb 2020, PubMed, Embase, and Scopus were searched for applicable studies. We included cohort studies, case series, and interventional studies of both adults and children affected by central sensitivity syndromes. The majority of metabolomic studies addressing a CSS found significantly altered metabolites that allowed for differentiation of CSS patients from healthy controls. Therefore, the published literature overwhelmingly supports the use of metabolomics in CSS. Further research into these altered metabolites and their respective metabolic pathways may provide more reliable and effective therapeutics for these syndromes.
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Affiliation(s)
- Joseph S. Miller
- Department of Medicine, Ohio University Heritage College of Osteopathic Medicine, Dublin, OH 43016, USA;
| | - Luis Rodriguez-Saona
- Department of Food Science and Technology, Ohio State University, Columbus, OH 43210, USA;
| | - Kevin V. Hackshaw
- Department of Internal Medicine, Division of Rheumatology, Dell Medical School, The University of Texas, 1701 Trinity St, Austin, TX 78712, USA
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7
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Pattinson CL, Gill JM, Lippa SM, Brickell TA, French LM, Lange RT. Concurrent Mild Traumatic Brain Injury and Posttraumatic Stress Disorder Is Associated With Elevated Tau Concentrations in Peripheral Blood Plasma. J Trauma Stress 2019; 32:546-554. [PMID: 31291489 PMCID: PMC6690750 DOI: 10.1002/jts.22418] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 01/22/2019] [Accepted: 02/03/2019] [Indexed: 12/19/2022]
Abstract
Concurrent mild traumatic brain injury (mTBI) and posttraumatic stress disorder (PTSD) are common in U.S. military service members and veterans. Tau and amyloid-beta-42 (Aβ42) are proteins that have been linked to cognitive impairment, neurological hallmarks of Alzheimer's disease, and may also relate to recovery from mTBI. However, the role of these proteins in the maintenance or resolution of chronic symptoms has not yet been determined. Participants in the current study were 102 service members and veterans who had sustained an mTBI (n = 84) or injured controls (IC) without TBI (n = 18). They were categorized into three groups based on the presence or absence of mTBI and PTSD: IC/PTSD-Absent (n = 18), mTBI/PTSD-Absent (n = 63), and mTBI/PTSD-Present (n = 21). Concentrations of tau and Aβ42 in peripheral blood plasma were measured using SimoaTM , an ultrasensitive technology, and compared across groups. Tau concentrations were highest in the mTBI/PTSD-Present group, F(2, 99) = 4.33, p = .016, compared to the other two groups. Linear multiple regression was conducted to determine the independent effects of PTSD and mTBI on tau concentrations, controlling for gender and sleep medication. PTSD was a significant and independent predictor of tau concentrations, β = .25, p = .009, ηp 2 = .26. Aβ42 concentrations did not differ between the groups. The results indicated that PTSD was associated with an elevation of tau in peripheral blood and suggest that there may be increased biological effects of PTSD in this young cohort of service members and veterans following mTBI.
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Affiliation(s)
- Cassandra L. Pattinson
- National Institutes of Health, National Institute of Nursing Research, Bethesda, Maryland, USA
| | - Jessica M. Gill
- National Institutes of Health, National Institute of Nursing Research, Bethesda, Maryland, USA
| | - Sara M. Lippa
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, Maryland, USA,National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Tracey A. Brickell
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, Maryland, USA,National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA,Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Louis M. French
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, Maryland, USA,National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA,Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Rael T. Lange
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, Maryland, USA,National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA,University of British Columbia, Vancouver, British Columbia, Canada
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8
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Wang W, Sun H, Su X, Tan Q, Zhang S, Xia C, Li L, Kemp GJ, Yue Q, Gong Q. Increased right amygdala metabolite concentrations in the absence of atrophy in children and adolescents with PTSD. Eur Child Adolesc Psychiatry 2019; 28:807-817. [PMID: 30392119 DOI: 10.1007/s00787-018-1241-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 10/20/2018] [Indexed: 02/05/2023]
Abstract
Previous studies have shown that posttraumatic stress disorder (PTSD) is associated with dysfunction of the limbic system, in which the amygdala plays an important role. The purpose of this study was to evaluate whether the neurochemical concentrations assessed by proton magnetic resonance spectroscopy (1H-MRS) in the amygdala are abnormal in children and adolescents with PTSD. Twenty-eight pediatric PTSD patients (11 boys, 17 girls) and 24 matched trauma-exposed control subjects (9 boys, 15 girls) underwent magnetic resonance brain imaging and 1H-MRS of the bilateral amygdalae. The concentrations of N-acetylaspartate (NAA), myo-inositol (mI), total creatine (tCr) and total choline (tCho) in the right amygdala were significantly increased in PTSD patients compared with trauma-exposed control subjects. There were significant group-by-age interactions in the left amygdala NAA and right amygdala mI concentrations: older pediatric patients with PTSD had higher left amygdala NAA concentration and younger patients had higher right amygdala mI concentration than trauma-exposed control subjects. There was also a significant correlation between right mI concentration and time since trauma in PTSD patients. Finally, there was significant group-by-age interaction in the left amygdala volume; intragroup analysis revealed that the right amygdala volume was significantly lower than the left in the PTSD group, but not in the control group. These neurochemical abnormalities of the amygdala may indicate that dysfunctions of both neurons and glial cells are involved in the pathology of pediatric PTSD.
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Affiliation(s)
- Weina Wang
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Huaiqiang Sun
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Xiaorui Su
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Qiaoyue Tan
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Simin Zhang
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Chunchao Xia
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Lingjiang Li
- Mental Health Institute, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Graham J Kemp
- Liverpool Magnetic Resonance Imaging Centre (LiMRIC) and Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Qiang Yue
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, China.
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China.
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9
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Piggott VM, Bosse KE, Lisieski MJ, Strader JA, Stanley JA, Conti AC, Ghoddoussi F, Perrine SA. Single-Prolonged Stress Impairs Prefrontal Cortex Control of Amygdala and Striatum in Rats. Front Behav Neurosci 2019; 13:18. [PMID: 31114487 PMCID: PMC6502983 DOI: 10.3389/fnbeh.2019.00018] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 01/21/2019] [Indexed: 12/17/2022] Open
Abstract
Medial prefrontal cortex (mPFC), amygdala, and striatum neurocircuitry has been shown to play an important role in post-traumatic stress disorder (PTSD) pathology in humans. Clinical studies show hypoactivity in the mPFC and hyperactivity in the amygdala and striatum of PTSD patients, which has been associated with decreased mPFC glutamate levels. The ability to refine neurobiological characteristics of PTSD in an animal model is critical in furthering our mechanistic understanding of the disease. To this end, we exposed male rats to single-prolonged stress (SPS), a validated model of PTSD, and hypothesized that traumatic stress would differentially activate mPFC subregions [prelimbic (PL) and infralimbic (IL) cortices] and increase striatal and amygdalar activity, which would be associated with decreased mPFC glutamate levels. in vivo, neural activity in the subregions of the mPFC, amygdala, and striatum was measured using manganese-enhanced magnetic resonance imaging (MEMRI), and glutamate and N-acetylaspartate (NAA) levels in the mPFC and the dorsal striatum (dSTR) were measured using proton magnetic resonance spectroscopy (1H-MRS) longitudinally, in rats exposed to SPS or control conditions. As hypothesized, SPS decreased MEMRI-based neural activity in the IL, but not PL, cortex concomitantly increasing activity within the basolateral amygdala (BLA) and dorsomedial striatum (dmSTR). 1H-MRS studies in a separate cohort revealed SPS decreased glutamate levels in the mPFC and increased NAA levels in the dSTR. These results confirm previous findings that suggest SPS causes mPFC hypoactivation as well as identifies concurrent hyperactivation in dmSTR and BLA, effects which parallel the clinical neuropathology of PTSD.
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Affiliation(s)
- Veronica M Piggott
- Research & Development Service, John D. Dingell VA Medical Center, Detroit, MI, United States.,Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, United States
| | - Kelly E Bosse
- Research & Development Service, John D. Dingell VA Medical Center, Detroit, MI, United States.,Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, United States
| | - Michael J Lisieski
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, United States
| | - John A Strader
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, United States
| | - Jeffrey A Stanley
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, United States
| | - Alana C Conti
- Research & Development Service, John D. Dingell VA Medical Center, Detroit, MI, United States.,Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, United States
| | - Farhad Ghoddoussi
- Department of Anesthesiology, Wayne State University School of Medicine, Detroit, MI, United States
| | - Shane A Perrine
- Research & Development Service, John D. Dingell VA Medical Center, Detroit, MI, United States.,Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, United States
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10
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Abstract
Posttraumatic stress disorder is a serious and often disabling syndrome that develops in response to a traumatic event. Many individuals who initially develop the disorder go on to experience a chronic form of the condition that in some cases can last for many years. Among these patients, psychiatric and medical comorbidities are common, including early onset of age-related conditions such as chronic pain, cardiometabolic disease, neurocognitive disorders, and dementia. The hallmark symptoms of posttraumatic stress-recurrent sensory-memory reexperiencing of the trauma(s)-are associated with concomitant activations of threat- and stress-related neurobiological pathways that occur against a tonic backdrop of sleep disturbance and heightened physiological arousal. Emerging evidence suggests that the molecular consequences of this stress-perpetuating syndrome include elevated systemic levels of oxidative stress and inflammation. In this article we review evidence for the involvement of oxidative stress and inflammation in chronic PTSD and the neurobiological consequences of these processes, including accelerated cellular aging and neuroprogression. Our aim is to update and expand upon previous reviews of this rapidly developing literature and to discuss magnetic resonance spectroscopy as an imaging technology uniquely suited to measuring oxidative stress and inflammatory markers in vivo. Finally, we highlight future directions for research and avenues for the development of novel therapeutics targeting oxidative stress and inflammation in patients with PTSD.
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Affiliation(s)
- Mark W Miller
- From the Department of Psychiatry, Boston University School of Medicine (Drs. M. W. Miller, Wolf, and D. R. Miller); National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, MA (Drs. M. W. Miller, Wolf, and D. R. Miller); Harvard Medical School and Department of Radiology, Brigham & Women's Hospital, Boston, MA (Dr. Lin)
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11
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Hinojosa CA, Kaur N, VanElzakker MB, Shin LM. Cingulate subregions in posttraumatic stress disorder, chronic stress, and treatment. HANDBOOK OF CLINICAL NEUROLOGY 2019; 166:355-370. [DOI: 10.1016/b978-0-444-64196-0.00020-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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12
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Quadrelli S, Mountford C, Ramadan S. Systematic review of in-vivo neuro magnetic resonance spectroscopy for the assessment of posttraumatic stress disorder. Psychiatry Res Neuroimaging 2018; 282:110-125. [PMID: 30097168 DOI: 10.1016/j.pscychresns.2018.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 07/18/2018] [Accepted: 07/19/2018] [Indexed: 10/28/2022]
Abstract
Posttraumatic stress disorder (PTSD) is a trauma and stressor-related disorder that results in complex somatic, cognitive, affective and behavioural effects, after exposure to traumatic event(s). Conventional imaging (T1 and T2 weighted magnetic resonance imaging) has little to offer in the way of diagnosis of mental health conditions such as PTSD and there is currently no objective diagnostic test available. Magnetic resonance spectroscopy (MRS) allows for non-invasive measurement of metabolites and neurochemicals in the brain using a conventional MRI scanner and offers the potential to predict, diagnose and monitor PTSD. This systematic review summarises the results of 24 MRS studies, performed between 1998 and 2017, to measure neurochemical differences, occurring as a consequence of PTSD. The most consistent finding in subjects with PTSD is lower N-acetylaspartate levels in the hippocampus and anterior cingulate cortex, with and without atrophic change. More recent studies, using more advanced techniques and modern hardware, have shown evidence of glutamatergic dysfunction and differences in gamma-aminobutyric acid levels in the brain of patients with PTSD. Conflicting results have been reported in choline-containing metabolites and there is emerging evidence of glutathione being affected. Myo-inositol and creatine are unchanged in the majority of studies.
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Affiliation(s)
- Scott Quadrelli
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW 2308, Australia; Department of Radiology, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD 4024, Australia; The Translational Research Institute, Woolloongabba, QLD 4024, Australia; The University of Queensland, St Lucia, QLD 4072, Australia.
| | - Carolyn Mountford
- The Translational Research Institute, Woolloongabba, QLD 4024, Australia
| | - Saadallah Ramadan
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW 2308, Australia
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13
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Abnormal metabolite concentrations and amygdala volume in patients with recent-onset posttraumatic stress disorder. J Affect Disord 2018; 241:539-545. [PMID: 30153637 DOI: 10.1016/j.jad.2018.08.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 07/08/2018] [Accepted: 08/07/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Previous psychoradiological studies of posttraumatic stress disorder (PTSD) were mainly of patients at a chronic stage, focusing on brain regions outside the amygdala. The goals of this study were to investigate the early biochemical and structural changes of anterior cingulate cortex (ACC) and amygdala in patients with PTSD and to explore their relationships. METHODS Seventy-eight drug-naïve PTSD subjects and 71 non-PTSD age- and sex-matched control subjects were enrolled, all of whom had suffered the same earthquake about one year before. Single-voxel proton magnetic resonance spectroscopy (1H-MRS) was performed and absolute metabolite concentrations in ACC and bilateral amygdalae were estimated with LCModel. Bilateral amygdalae were manually outlined and their volumes were calculated and corrected for the total intracranial volume. RESULTS The PTSD group showed significantly increased N-acetylaspartate (NAA) concentration in the ACC, increased creatine (Cr) concentration in the left amygdala, and increased myo-inositol (mI) concentration in the right amygdala, compared to non-PTSD controls. The NAA concentration in ACC was negatively correlated with the time since trauma. The PTSD group showed significantly decreased volumes of bilateral amygdalae compared to non-PTSD controls, but amygdala volumes were not correlated with metabolite concentrations. LIMITATIONS Longitudinal studies are needed to explore the metabolic and structural changes of PTSD at different stages. The volume of ACC was not measured. CONCLUSIONS This concurrent increase in some metabolite concentrations and decrease of amygdala volumes may represent a pattern of biochemical and morphological changes in recent-onset PTSD which is different from that reported in chronic PTSD.
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14
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Ogoh S, Yoo JK, Badrov MB, Parker RS, Anderson EH, Wiblin JL, North CS, Suris A, Fu Q. Cerebral blood flow regulation and cognitive function in women with posttraumatic stress disorder. J Appl Physiol (1985) 2018; 125:1627-1635. [DOI: 10.1152/japplphysiol.00502.2018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Posttraumatic stress disorder (PTSD) is associated with structural and functional alterations in a number of interacting brain regions, but the physiological mechanism for the high risk of cerebrovascular disease or impairment in brain function remains unknown. Women are more likely to develop PTSD after a trauma than men. We hypothesized that cerebral blood flow (CBF) regulation is impaired in women with PTSD, and it is associated with impairment in cognitive function. To test our hypothesis, we examined dynamic cerebral autoregulation (CA) and cognitive function by using a transfer function analysis between arterial pressure and middle cerebral artery blood velocity and the Stroop Color and Word test (SCWT), respectively. We did not observe any different responses in these hemodynamic variables between women with PTSD ( n = 15) and healthy counterparts (all women; n = 8). Cognitive function was impaired in women with PTSD; specifically, reaction time for the neutral task of SCWT was longer in women with PTSD compared with healthy counterparts ( P = 0.011), but this cognitive dysfunction was not affected by orthostatic stress. On the other hand, transfer function phase, gain, and coherence were not different between groups in either the supine or head-up tilt (60°) position, or even during the cognitive challenge, indicating that dynamic CA was well maintained in women with PTSD. In addition, there was no relationship between cognitive function and dynamic CA. These findings suggest that PTSD-related cognitive dysfunction may not be due to compromised CBF regulation. NEW & NOTEWORTHY Cognitive function was impaired; however, dynamic cerebral autoregulation (CA) as an index of cerebral blood flow regulation was not impaired during supine and 60° head-up tilt in women with PTSD compared with healthy females. In addition, there was no relationship between cognitive function and dynamic CA. These findings suggest that the mechanism of PTSD-related cognitive dysfunction may not be due to CBF regulation.
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Affiliation(s)
- Shigehiko Ogoh
- Department of Biomedical Engineering, Toyo University, Kawagoe-Shi, Saitama, Japan
| | - Jeung-Ki Yoo
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Texas
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Mark B. Badrov
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Texas
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Rosemary S. Parker
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Texas
| | - Elizabeth H. Anderson
- University of Texas Southwestern Medical Center, Dallas, Texas
- Veterans Affairs North Texas Health Care System, Dallas, Texas
| | - Jessica L. Wiblin
- University of Texas Southwestern Medical Center, Dallas, Texas
- Veterans Affairs North Texas Health Care System, Dallas, Texas
| | - Carol S. North
- Metrocare Services and the University of Texas Southwestern Medical Center, Dallas, Texas
| | - Alina Suris
- University of Texas Southwestern Medical Center, Dallas, Texas
- Veterans Affairs North Texas Health Care System, Dallas, Texas
| | - Qi Fu
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Texas
- University of Texas Southwestern Medical Center, Dallas, Texas
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15
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Hippocampus Glutamate and N-Acetyl Aspartate Markers of Excitotoxic Neuronal Compromise in Posttraumatic Stress Disorder. Neuropsychopharmacology 2017; 42:1698-1705. [PMID: 28195577 PMCID: PMC5518902 DOI: 10.1038/npp.2017.32] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 12/23/2016] [Accepted: 02/03/2017] [Indexed: 01/01/2023]
Abstract
Hippocampus atrophy is implicated in posttraumatic stress disorder (PTSD), and may partly reflect stress-induced glutamate excitotoxicity that culminates in neuron injury and manifests as re-experiencing symptoms and other memory abnormalities. This study used high-field proton magnetic resonance spectroscopy (MRS) to determine whether PTSD is associated with lower hippocampus levels of the neuron marker N-acetyl aspartate (NAA), along with higher levels of glutamate (Glu) and Glu/NAA. We also predicted that metabolite levels would correlate with re-experiencing symptoms and lifetime trauma load. Twenty-four adult PTSD patients and 23 trauma-exposed normal controls (TENC) underwent 4T MRS of the left and right hippocampus. Participants received psychiatric interviews, and completed the Traumatic Life Events Questionnaire to define lifetime trauma load. Relative to TENC participants, PTSD patients exhibited significantly lower NAA in right and left hippocampi, and significantly higher Glu and Glu/NAA in the right hippocampus. Re-experiencing symptoms were negatively correlated with left and right NAA, and positively correlated with right Glu and right Glu/NAA. Trauma load was positively correlated with right Glu/NAA in PTSD patients. When re-experiencing symptoms and trauma load were examined together in relation to right Glu/NAA, only re-experiencing symptoms remained a significant correlate. This represents the first report that PTSD is associated with MRS markers of hippocampus Glu excess, together with indices of compromised neuron integrity. Their robust associations with re-experiencing symptoms affirm that MRS indices of hippocampus neuron integrity and glutamate metabolism may reflect biomarkers of clinically significant disease variation in PTSD.
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16
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Im JJ, Namgung E, Choi Y, Kim JY, Rhie SJ, Yoon S. Molecular Neuroimaging in Posttraumatic Stress Disorder. Exp Neurobiol 2016; 25:277-295. [PMID: 28035179 PMCID: PMC5195814 DOI: 10.5607/en.2016.25.6.277] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 11/11/2016] [Accepted: 11/14/2016] [Indexed: 01/10/2023] Open
Abstract
Over the past decade, an increasing number of neuroimaging studies have provided insight into the neurobiological mechanisms of posttraumatic stress disorder (PSTD). In particular, molecular neuroimaging techniques have been employed in examining metabolic and neurochemical processes in PTSD. This article reviews molecular neuroimaging studies in PTSD and focuses on findings using three imaging modalities including positron emission tomography (PET), single photon emission computed tomography (SPECT), and magnetic resonance spectroscopy (MRS). Although there were some inconsistences in the findings, patients with PTSD showed altered cerebral metabolism and perfusion, receptor bindings, and metabolite profiles in the limbic regions, medial prefrontal cortex, and temporal cortex. Studies that have investigated brain correlates of treatment response are also reviewed. Lastly, the limitations of the molecular neuroimaging studies and potential future research directions are discussed.
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Affiliation(s)
- Jooyeon Jamie Im
- Ewha Brain Institute, Ewha Womans University, Seoul 03760, Korea.; Interdisciplinary Program in Neuroscience, College of Natural Sciences, Seoul National University, Seoul 08826, Korea
| | - Eun Namgung
- Ewha Brain Institute, Ewha Womans University, Seoul 03760, Korea.; Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul 03760, Korea
| | - Yejee Choi
- Ewha Brain Institute, Ewha Womans University, Seoul 03760, Korea.; Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul 03760, Korea
| | - Jung Yoon Kim
- Ewha Brain Institute, Ewha Womans University, Seoul 03760, Korea.; Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul 03760, Korea
| | - Sandy Jeong Rhie
- Ewha Brain Institute, Ewha Womans University, Seoul 03760, Korea.; College of Pharmacy and Division of Life and Pharmaceutical Sciences, Ewha Womans University, Seoul 03760, Korea
| | - Sujung Yoon
- Ewha Brain Institute, Ewha Womans University, Seoul 03760, Korea.; Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul 03760, Korea
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17
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Yang ZY, Quan H, Peng ZL, Zhong Y, Tan ZJ, Gong QY. Proton magnetic resonance spectroscopy revealed differences in the glutamate + glutamine/creatine ratio of the anterior cingulate cortex between healthy and pediatric post-traumatic stress disorder patients diagnosed after 2008 Wenchuan earthquake. Psychiatry Clin Neurosci 2015; 69:782-90. [PMID: 26171979 DOI: 10.1111/pcn.12332] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 06/09/2015] [Accepted: 07/03/2015] [Indexed: 02/05/2023]
Abstract
AIMS Earthquakes always leave many surviving teenagers suffering from various mental problems, such as post-traumatic stress disorder (PTSD). We studied the metabolites in current and remitted pediatric PTSD patients and healthy controls after an earthquake, aiming to find the neurochemistry differences in these teenagers. METHODS Proton magnetic resonance spectroscopy ((1) H-MRS) was performed in the anterior cingulate cortex (ACC) of 21 healthy, 10 PTSD and 23 remitted subjects. RESULTS Significantly lower glutamate + glutamine/creatine (Glx/Cr) levels in the ACC (1.15 ± 0.14 vs 1.37 ± 0.08, P = 0.047) were found in PTSD subjects relative to remitted subjects; and significantly lower Glx/Cr levels in the ACC (1.37 ± 0.08 vs 1.59 ± 0.10, P = 0.045) were found in remitted subjects relative to healthy controls. CONCLUSIONS Our findings imply that the Glx/Cr ratio in the ACC can be used to differentiate not only between healthy and pediatric PTSD patients, but also between the current and remitted phases of pediatric PTSD. The changes in the Glx/Cr ratio may be caused by brain dysfunction in the current phase and recovery in the remitted phase.
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Affiliation(s)
- Zhi-Yong Yang
- Laboratory of Biological & Medical Physics and Key Laboratory of Artificial Micro- & Nano-structures of Ministry of Education, School of Physics and Technology, Wuhan University, Wuhan, China.,Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hong Quan
- Laboratory of Biological & Medical Physics and Key Laboratory of Artificial Micro- & Nano-structures of Ministry of Education, School of Physics and Technology, Wuhan University, Wuhan, China
| | - Zu-Lai Peng
- Institute of Mental Health, Peking University, Beijing, China
| | - Yang Zhong
- Laboratory of Biological & Medical Physics and Key Laboratory of Artificial Micro- & Nano-structures of Ministry of Education, School of Physics and Technology, Wuhan University, Wuhan, China
| | - Zhi-Jie Tan
- Laboratory of Biological & Medical Physics and Key Laboratory of Artificial Micro- & Nano-structures of Ministry of Education, School of Physics and Technology, Wuhan University, Wuhan, China
| | - Qi-Yong Gong
- Huaxi MR Research Center, Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
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18
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Scott JC, Matt GE, Wrocklage KM, Crnich C, Jordan J, Southwick SM, Krystal JH, Schweinsburg BC. A quantitative meta-analysis of neurocognitive functioning in posttraumatic stress disorder. Psychol Bull 2015. [PMID: 25365762 DOI: 10.1037/a00389039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Posttraumatic stress disorder (PTSD) is associated with regional alterations in brain structure and function that are hypothesized to contribute to symptoms and cognitive deficits associated with the disorder. We present here the first systematic meta-analysis of neurocognitive outcomes associated with PTSD to examine a broad range of cognitive domains and describe the profile of cognitive deficits, as well as modifying clinical factors and study characteristics. This report is based on data from 60 studies totaling 4,108 participants, including 1,779 with PTSD, 1,446 trauma-exposed comparison participants, and 895 healthy comparison participants without trauma exposure. Effect-size estimates were calculated using a mixed-effects meta-analysis for 9 cognitive domains: attention/working memory, executive functions, verbal learning, verbal memory, visual learning, visual memory, language, speed of information processing, and visuospatial abilities. Analyses revealed significant neurocognitive effects associated with PTSD, although these ranged widely in magnitude, with the largest effect sizes in verbal learning (d = -.62), speed of information processing (d = -.59), attention/working memory (d = -.50), and verbal memory (d =-.46). Effect-size estimates were significantly larger in treatment-seeking than community samples and in studies that did not exclude participants with attention-deficit/hyperactivity disorder, and effect sizes were affected by between-group IQ discrepancies and the gender composition of the PTSD groups. Our findings indicate that consideration of neuropsychological functioning in attention, verbal memory, and speed of information processing may have important implications for the effective clinical management of persons with PTSD. Results are further discussed in the context of cognitive models of PTSD and the limitations of this literature.
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Affiliation(s)
- J Cobb Scott
- VISN4 Mental Illness Research, Education, and Clinical Center, Philadelphia VA Medical Center
| | - Georg E Matt
- Department of Psychology, San Diego State University
| | | | | | - Jessica Jordan
- National Center for PTSD, VA Connecticut Healthcare System
| | | | - John H Krystal
- National Center for PTSD, VA Connecticut Healthcare System
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19
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Scott JC, Matt GE, Wrocklage KM, Crnich C, Jordan J, Southwick SM, Krystal JH, Schweinsburg BC. A quantitative meta-analysis of neurocognitive functioning in posttraumatic stress disorder. Psychol Bull 2015; 141:105-140. [PMID: 25365762 PMCID: PMC4293317 DOI: 10.1037/a0038039] [Citation(s) in RCA: 313] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Posttraumatic stress disorder (PTSD) is associated with regional alterations in brain structure and function that are hypothesized to contribute to symptoms and cognitive deficits associated with the disorder. We present here the first systematic meta-analysis of neurocognitive outcomes associated with PTSD to examine a broad range of cognitive domains and describe the profile of cognitive deficits, as well as modifying clinical factors and study characteristics. This report is based on data from 60 studies totaling 4,108 participants, including 1,779 with PTSD, 1,446 trauma-exposed comparison participants, and 895 healthy comparison participants without trauma exposure. Effect-size estimates were calculated using a mixed-effects meta-analysis for 9 cognitive domains: attention/working memory, executive functions, verbal learning, verbal memory, visual learning, visual memory, language, speed of information processing, and visuospatial abilities. Analyses revealed significant neurocognitive effects associated with PTSD, although these ranged widely in magnitude, with the largest effect sizes in verbal learning (d = -.62), speed of information processing (d = -.59), attention/working memory (d = -.50), and verbal memory (d =-.46). Effect-size estimates were significantly larger in treatment-seeking than community samples and in studies that did not exclude participants with attention-deficit/hyperactivity disorder, and effect sizes were affected by between-group IQ discrepancies and the gender composition of the PTSD groups. Our findings indicate that consideration of neuropsychological functioning in attention, verbal memory, and speed of information processing may have important implications for the effective clinical management of persons with PTSD. Results are further discussed in the context of cognitive models of PTSD and the limitations of this literature.
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Affiliation(s)
- J. Cobb Scott
- VISN4 Mental Illness Research, Education, and Clinical Center at the Philadelphia VA Medical Center, Philadelphia, PA, 19104, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Georg E. Matt
- Department of Psychology, San Diego State University, San Diego, CA, 92182, USA
| | | | | | - Jessica Jordan
- VA Connecticut Healthcare System, West Haven, CT, 06516, USA
| | - Steven M. Southwick
- VA Connecticut Healthcare System, West Haven, CT, 06516, USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, 06511, USA
| | - John H. Krystal
- VA Connecticut Healthcare System, West Haven, CT, 06516, USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, 06511, USA
- Department of Neurobiology, Yale University School of Medicine, New Haven, CT 06510 USA
- Psychiatry Services, Yale-New Haven Hospital, New Haven, CT 06510
| | - Brian C. Schweinsburg
- VA Connecticut Healthcare System, West Haven, CT, 06516, USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, 06511, USA
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20
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Koch SBJ, van Zuiden M, Nawijn L, Frijling JL, Veltman DJ, Olff M. Intranasal oxytocin as strategy for medication-enhanced psychotherapy of PTSD: salience processing and fear inhibition processes. Psychoneuroendocrinology 2014; 40:242-56. [PMID: 24485496 DOI: 10.1016/j.psyneuen.2013.11.018] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 11/21/2013] [Accepted: 11/22/2013] [Indexed: 12/13/2022]
Abstract
About ten percent of people experiencing a traumatic event will subsequently develop post-traumatic stress disorder (PTSD). PTSD is characterized by an exaggerated fear response which fails to extinguish over time and cannot be inhibited in safe contexts. The neurobiological correlates of PTSD involve enhanced salience processing (i.e. amygdala, dorsal anterior cingulate cortex (dACC) and anterior insula (AI) hyperactivity), and reduced top-down inhibitory control over this fear response (i.e. dorsal and ventromedial prefrontal cortex (vmPFC) hypoactivity and diminished structural and functional connectivity between the vmPFC, hippocampus and amygdala). Therefore, dampening the exaggerated fear response (i.e. by reducing amygdala hyperactivity) and enhancing top-down inhibitory control (i.e. by promoting prefrontal control over the amygdala) during psychotherapy is an important target for medication-enhanced psychotherapy (MEP) in PTSD patients. Since the neuropeptide oxytocin (OT) has been found to act on these two processes, we propose that OT is a promising pharmacological agent to boost treatment response in PTSD. Human fMRI studies indicate that intranasal OT attenuates amygdala (hyper)activity and enhances connectivity of the amygdala with the vmPFC and hippocampus, resulting in increased top-down control over the fear response. In addition, intranasal OT was found to attenuate amygdala-brainstem connectivity and to change activity and connectivity in nodes of the salience network (i.e. AI and dACC). Furthermore, OT administration may modulate hypothalamus-pituitary-adrenal (HPA) axis and autonomic nervous system (ANS) function and may enhance social behaviour, which could be beneficial in the therapeutic alliance. We also discuss contextual and interindividual factors (e.g. gender and social context) which may influence the effectiveness of OT in MEP. In all, we propose that intranasal OT given prior to each psychotherapy session may be an effective additive treatment to boost treatment response in PTSD.
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Affiliation(s)
- Saskia B J Koch
- Center for Psychotrauma, Department of Psychiatry, Academic Medical Center, University of Amsterdam, The Netherlands.
| | - Mirjam van Zuiden
- Center for Psychotrauma, Department of Psychiatry, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Laura Nawijn
- Center for Psychotrauma, Department of Psychiatry, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Jessie L Frijling
- Center for Psychotrauma, Department of Psychiatry, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Dick J Veltman
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
| | - Miranda Olff
- Center for Psychotrauma, Department of Psychiatry, Academic Medical Center, University of Amsterdam, The Netherlands; Arq Psychotrauma Expert Center, Diemen, The Netherlands
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21
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Shu XJ, Xue L, Liu W, Chen FY, Zhu C, Sun XH, Wang XP, Liu ZC, Zhao H. More vulnerability of left than right hippocampal damage in right-handed patients with post-traumatic stress disorder. Psychiatry Res 2013; 212:237-44. [PMID: 23149034 DOI: 10.1016/j.pscychresns.2012.04.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Revised: 04/09/2012] [Accepted: 04/12/2012] [Indexed: 01/14/2023]
Abstract
Previous studies have shown hippocampal abnormalities in people with post-traumatic stress disorder (PTSD), but findings of diminished volume in shortages in the hippocampus have been inconsistent. In this study, we investigated changes in hippocampal volume and neuronal metabolites in right-handed PTSD patients to determine their possible relationship(s) with PTSD severity. We performed a case-control study of 11 right-handed PTSD patients and 11 healthy controls using magnetic resonance imaging (MRI) and proton magnetic resonance spectroscopy ((1)H MRS). Hippocampal volume and metabolite ratios of N-acetylaspartate (NAA) to creatine (Cr) (NAA/Cr) and choline compounds (Cho) to Cr (Cho/Cr) were calculated. The severity of PTSD was evaluated by the Clinician-Administered PTSD Scale (CAPS). Significantly decreased left and total normalized hippocampal volumes were found in PTSD patients compared with controls (6.6% for the left hippocampus, 5.5% for total hippocampus). Also, the bilateral hippocampal NAA/Cr ratio of PTSD patients was significantly reduced compared with controls. The volume of the left hippocampus was negatively correlated to the CAPS total and CPAS-C scores. The left hippocampal NAA/Cr ratio was negatively correlated to the CAPS-total, CAPS-B, CAPS-C, and CAPS-D scores. The CAPS total and the CAPS-B scores were positively correlated to the Cho/Cr ratio of the right hippocampus. Our results indicate that hippocampal dysfunction is asymmetric in right-handed PTSD patients, with the left side affected more than the right.
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Affiliation(s)
- Xi-Ji Shu
- Department of Pathology and Pathophysiology, Medical School, Jianghan University, Wuhan 430056, Hubei, China
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The impact of the Great East Japan earthquake on mandatory psychiatric emergency hospitalizations in Tokyo: a retrospective observational study. Transl Psychiatry 2012; 2:e168. [PMID: 23032944 PMCID: PMC3565828 DOI: 10.1038/tp.2012.98] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
On 11 March 2011, the eastern part of Japan was struck by a magnitude 9.0 quake. About 20 000 people were killed or were missing, and a nuclear crisis followed. In Tokyo, people were indirectly exposed to the earthquake and nuclear crisis by TV broadcast. The aim of our study was to evaluate the potential effect of the series of catastrophes on psychiatric emergency hospitalizations in Tokyo. Clinical records of patients who were mandatorily admitted to Tokyo Metropolitan Matsuzawa Hospital by law because of urgent risk to self or others were reviewed. Records regarding the 2 years of investigation, which include the 6 months after the earthquake, were reviewed. The six months after the earthquake were compared with the eighteen months before the earthquake in clinical and demographic data using independent t-tests or χ(2) tests. During the 6 months before and after the earthquake, 97 and 127 people were mandatorily admitted. χ(2) Tests demonstrated a significant increase in the number of patients after the earthquake (P = 0.045), attributable to the significant increase in the number of patients with schizophrenia after the earthquake (P = 0.011, 32 vs 56), whereas there were no significant differences in the number of patients with other diagnoses between those two periods. Independent t-tests revealed that patients admitted after the earthquake had marginally significantly shorter periods of education compared with those admitted before the earthquake (13.78 vs 12.82 years, P = 0.084). This work suggests that patients with schizophrenia were more sensitive to indirect exposure to the earthquake and that a shorter period of education was a potential risk factor.
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Guo M, Chen F, Guo JC, Lu CZ, Jiang XL, Liu T, Li M, Song W. Study of the hippocampus and the anterior cingulate gyrus by proton MR spectroscopy in patients with post-traumatic stress disorder. ASIAN PAC J TROP MED 2012; 5:162-4. [PMID: 22221763 DOI: 10.1016/s1995-7645(12)60017-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Revised: 12/15/2011] [Accepted: 01/15/2012] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To explore the characteristics of metabolic changes in patients with post-traumatic stress disorder through 1H-MRS in neuroanatomical circuit comparing with age-matches controls. METHODS Fifty patients with post-traumatic stress disorder and 50 gender-and age-matched normal controls were involved. The neurochemical abnormalities including the levels of choline (Cho)/creatine(Cr) and N-acetylaspartate (NAA)/Cr were measured respectively in hippocampus and the anterior cingulate gyrus with three-dimension 1H-proton spectroscopy(3D 1H-MRS). RESULTS The values of NAA/Cr ratios in hippocampus and the anterior cingulate gyrus were significant lower in patients with post-traumatic stress disorder(1.71±0.32, left 1.58±0.29, right 1.55±0.31) than that in controls(2.24±0.41, left 1.98±0.27, right 2.02±0.36)(P<0.05), but the values of Cho/Cr in hippocampus(left 1.64±0.23, right 1.66±0.34) were no significant with that of controls (left 1.48±0.29, right 1.54±0.38). Values of Cho/Cr in cingulate gyrus were significant higher in post-traumatic stress disorder patients (1.88±0.44) than that in controls (1.37.±0.32) (P<0.05). CONCLUSIONS The results indicate some special neurochemical and histological structure changes in post-traumatic stress disorder patients, which might occurre earlier in anterior cingulate gyrusthe than in hippocampus.
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Affiliation(s)
- Min Guo
- Psychological Research Center, Hainan Provincial People's Hospital, China
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Liu W, Shu XJ, Chen FY, Zhu C, Sun XH, Liu LJ, Ai YX, Li YG, Zhao H. Tianeptine reverses stress-induced asymmetrical hippocampal volume and N-acetylaspartate loss in rats: an in vivo study. Psychiatry Res 2011; 194:385-392. [PMID: 22047727 DOI: 10.1016/j.pscychresns.2011.02.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Revised: 01/30/2011] [Accepted: 02/10/2011] [Indexed: 02/05/2023]
Abstract
Stress-induced hippocampal volume loss and decrease in N-acetylaspartate (NAA) level have been reported to be associated with impaired neural plasticity and neuronal damage in adults. Accordingly, reversing structural and metabolite damage in the hippocampus may be a desirable goal for antidepressant therapy. The present study investigated the effects of tianeptine on chronic stress-induced hippocampal volume loss and metabolite alterations in vivo in 24 Sprague-Dawley rats. Rats were subjected to a consecutive 28-day forced swimming test stress. Tianeptine (50mg/kg) or saline was administered intragastrically 4h after swimming each day. Spontaneous behaviors, serum corticosterone concentration, hippocampal volume and NAA level were evaluated after stress. Chronic tianeptine treatment counteracted the chronic stress-induced suppression of spontaneous behaviors, elevated serum corticosterone concentration, reduced hippocampal volume and decreased NAA level. Moreover, we found asymmetrical right-left hippocampal volume loss in stressed rats, with the left hippocampus more sensitive to chronic stress than the right hippocampus. In addition, stressed rats showed a decreased level of hippocampal metabolites, without significant loss of hippocampal volume. These findings provide experimental evidence for impaired structural plasticity of the brain being an important feature of depressive illness and suggest that prophylactic tianeptine treatments could reverse structural changes in brain. The structural and neurochemical alterations in the hippocampus may be valuable indexes for evaluating the prophylactic and curative effect of antidepressant treatments in depressive and stress-related disorders.
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Affiliation(s)
- Wei Liu
- Department of Pathology and Pathophysiology, Shantou University Medical College, Shantou, 515041, Guangdong, China; Department of Pathology and Pathophysiology, Medical School, Jianghan University, Wuhan, 430056, Hubei, China
| | - Xi-Ji Shu
- Department of Pathology and Pathophysiology, Medical School, Jianghan University, Wuhan, 430056, Hubei, China
| | - Fu-Yin Chen
- Department of Forensic Medicine, Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Cheng Zhu
- Department of Forensic Medicine, Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Xiao-Hai Sun
- Department of Forensic Medicine, Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Li-Jiang Liu
- Department of Pathology and Pathophysiology, Medical School, Jianghan University, Wuhan, 430056, Hubei, China
| | - Yong-Xun Ai
- Department of Pathology and Pathophysiology, Medical School, Jianghan University, Wuhan, 430056, Hubei, China
| | - Yu-Guang Li
- Department of Pathology and Pathophysiology, Shantou University Medical College, Shantou, 515041, Guangdong, China; Department of Cardiology, the First Affiliated Hospital of Shantou University Medical College, Shantou 515041, Guangdong, China.
| | - Hu Zhao
- Faculty of Forensic Medicine, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, 510080, Guangdong, China.
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Kowalczyk I, Duggal N, Bartha R. Proton magnetic resonance spectroscopy of the motor cortex in cervical myelopathy. Brain 2011; 135:461-8. [DOI: 10.1093/brain/awr328] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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26
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Eckart C, Kaufmann J, Kanowski M, Tempelmann C, Hinrichs H, Elbert T, Heinze HJ, Kolassa IT. Magnetic resonance volumetry and spectroscopy of hippocampus and insula in relation to severe exposure of traumatic stress. Psychophysiology 2011; 49:261-70. [PMID: 22092224 DOI: 10.1111/j.1469-8986.2011.01303.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Accepted: 08/08/2011] [Indexed: 11/28/2022]
Abstract
Severe and chronic stress affects the hippocampus, especially during development. However, studies concerning structural alterations of the hippocampus yielded a rather inconsistent picture. Moreover, further anxiety-relevant brain regions, such as the insula, might be implicated in the pathophysiology of posttraumatic stress disorder (PTSD). We combined magnetic resonance (MR) volumetric and spectroscopic analyses of hippocampus and insula in highly traumatized refugees without a history of alcohol/substance abuse or other comorbid diseases. No PTSD-related difference was apparent in the volumes or neurometabolite levels of bilateral hippocampus or insula. However, an association between left hippocampal N-acetyl-aspartate (NAA) and adverse childhood experiences indicated a potential detrimental effect of the early environment on hippocampal integrity. Our results add to increasing evidence that PTSD-related, morphological alterations in the hippocampus are a consequence of early adversity or may result from other factors, such as extensive use of alcohol.
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Affiliation(s)
- Cindy Eckart
- Clinical Psychology & Neuropsychology, Department of Psychology, University of Konstanz, Konstanz, Germany.
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27
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Adamec R, Toth M, Haller J, Halasz J, Blundell J. A comparison of activation patterns of cells in selected prefrontal cortical and amygdala areas of rats which are more or less anxious in response to predator exposure or submersion stress. Physiol Behav 2011; 105:628-38. [PMID: 21971366 DOI: 10.1016/j.physbeh.2011.09.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Revised: 09/09/2011] [Accepted: 09/13/2011] [Indexed: 12/12/2022]
Abstract
This study had two purposes. First: to compare predator and water submersion stress cFos activation in medial prefrontal cortices (mPFC) and the medial amygdala (MeA). Second: to identify markers of vulnerability to stressors within these areas. Rats were either predator or submersion stressed and tested 1.75 h later for anxiety. Immediately thereafter, rats were sacrificed and cFos expression was examined. Predator and submersion stress equally increased anxiety-like behavior in the elevated plus maze (EPM) and hole board. To examine vulnerability, rats which were less anxious (LA) and more (highly) anxious (MA) in the EPM were selected from among handled control and stressed animals. LA stressed rats were considered stress non-responsive while MA stressed rats were considered stress responsive. Predator stress, but not submersion stress, activated MeA cFos. CFos expression of mPFC cells was elevated in LA rats and reduced in MA rats in predator stressed animals only, correlating negatively with anxiety. These findings are consistent with data implicating greater mPFC excitability in protection against the effects on affect of traumatic stress. The findings also suggest that this conclusion is stressor specific, applying to predator stress but not submersion stress. Both stressors have been suggested to model hyperarousal and comorbid anxiety aspects of PTSD in humans. Hence the use of these paradigms to identify brain bases of vulnerability and resilience to traumatic stress in PTSD has translation potential. On the other hand, our evidence of stressor specificity of vulnerability/resilience markers raises a caution. The data suggest that preclinical markers of vulnerability/resilience in a given stress paradigm are at best suggestive, and translational value must ultimately be confirmed in humans.
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Affiliation(s)
- Robert Adamec
- Memorial University, St. John's, Newfoundland, Canada.
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28
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Bédard MJ, Chantal S. Brain magnetic resonance spectroscopy in obsessive-compulsive disorder: the importance of considering subclinical symptoms of anxiety and depression. Psychiatry Res 2011; 192:45-54. [PMID: 21377338 DOI: 10.1016/j.pscychresns.2010.10.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2009] [Revised: 10/21/2010] [Accepted: 10/22/2010] [Indexed: 10/18/2022]
Abstract
Brain metabolite concentrations have recently been assessed in different cerebral regions presumably targeted in patients with obsessive-compulsive disorder (OCD) using magnetic resonance spectroscopy (MRS). However, results have been divergent. Possible confounding variables, such as the cerebral localisation of investigated regions and metabolites considered, as well as subclinical symptoms of anxiety and depression, could have affected these MRS profiles. The main goal of this study was to assess MRS metabolite differences between 13 individuals with OCD and 12 matched healthy controls in seven brain regions potentially involved in OCD. The secondary objective was to assess the relationships between levels of anxiety and depression and brain metabolite concentrations. No difference was found for N-acetylaspartate, glutamate-glutamine, myo-inositol (mI) and choline relative to creatine (Cr) concentration in either the left or right orbitofrontal area, left or right median temporal lobe, left or right thalamus or the anterior cingulate cortex. A significant negative correlation between the mI/Cr in the left orbitofrontal area and the severity of OCD symptomatology was observed while subclinical anxiety and depression were closely related to brain metabolite ratios. Thus, these subclinical symptoms, commonly associated with OCD, should be considered in assessing brain metabolite concentrations and may be central to the comprehension of this disorder.
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Affiliation(s)
- Marie-Josée Bédard
- Département de Psychologie, Université du Québec à Trois-Rivières, Trois-Rivieres, Quebec, Canada
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29
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Mathew SJ, Price RB, Shungu DC, Mao X, Smith ELP, Amiel JM, Coplan JD. A pilot study of the effects of chronic paroxetine administration on hippocampal N-acetylaspartate in generalized anxiety disorder. J Psychopharmacol 2010; 24:1175-81. [PMID: 19204062 DOI: 10.1177/0269881108101796] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The neural basis of generalized anxiety disorder (GAD) is poorly characterized. The effect of chronic administration (12 weeks) of paroxetine, a selective serotonin reuptake inhibitor, on N-acetylaspartate (NAA), a marker of neuronal viability, was evaluated in adults with GAD using proton magnetic resonance spectroscopic imaging ((1)H MRSI) at 1.5 T. We hypothesized that, pretreatment abnormalities in hippocampal NAA/creatine (NAA/Cr) would normalize with symptomatic improvement. Nine GAD patients (mean age = 41.7 year; 4 females) received 12 weeks of open-label paroxetine treatment, flexibly dosed up to 60 mg/day. Clinical outcome was assessed with the Hamilton Anxiety Rating Scale (HAM-A). Multislice ( 1)H MRSI scans were performed at unmedicated baseline and following 6 and 12 weeks of treatment. Ten untreated healthy volunteers (HVs) (mean age = 37.1 year; 4 females) received scans at the same intervals. All patients achieved remission (HAM-A <or= 7) by week 12. Compared to HVs, GAD patients showed persistently lower levels of bilateral hippocampal NAA/Cr (17.7% mean decrease; Cohen's d = 1.29) that were maintained across all three time points, despite marked symptom improvement. This pilot study failed to support an association between a hippocampal neuronal marker and anxiolytic response to paroxetine, and suggests further investigation of potential trait-like hippocampal abnormalities in GAD.
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Affiliation(s)
- S J Mathew
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY 10029, USA.
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30
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Knox D, Perrine SA, George SA, Galloway MP, Liberzon I. Single prolonged stress decreases glutamate, glutamine, and creatine concentrations in the rat medial prefrontal cortex. Neurosci Lett 2010; 480:16-20. [PMID: 20546834 DOI: 10.1016/j.neulet.2010.05.052] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Revised: 05/13/2010] [Accepted: 05/17/2010] [Indexed: 11/26/2022]
Abstract
Application of single prolonged stress (SPS) in rats induces changes in neuroendocrine function and arousal that are characteristic of post traumatic stress disorder (PTSD). PTSD, in humans, is associated with decreased neural activity in the prefrontal cortex, increased neural activity in the amygdala complex, and reduced neuronal integrity in the hippocampus. However, the extent to which SPS models these aspects of PTSD has not been established. In order to address this, we used high-resolution magic angle spinning proton magnetic resonance spectroscopy (HR-MAS (1)H MRS) ex vivo to assay levels of neurochemicals critical for energy metabolism (creatine and lactate), excitatory (glutamate and glutamine) and inhibitory (gamma amino butyric acid (GABA)) neurotransmission, and neuronal integrity (N-acetylaspartate (NAA)) in the medial prefrontal cortex (mPFC), amygdala complex, and hippocampus of SPS and control rats. Glutamate, glutamine, and creatine levels were decreased in the mPFC of SPS rats when compared to controls, which suggests decreased excitatory tone in this region. SPS did not alter the neurochemical profiles of either the hippocampus or amygdala. These data suggest that SPS selectively attenuates excitatory tone, without a disruption of neuronal integrity, in the mPFC.
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Affiliation(s)
- Dayan Knox
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States.
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31
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Ostojic J, Kozic D, Konstantinovic J, Covickovic-Sternic N, Mijajlovic M, Koprivsek K, Semnic R. Three-dimensional multivoxel spectroscopy of the healthy hippocampus—are the metabolic differences related to the location? Clin Radiol 2010; 65:302-7. [DOI: 10.1016/j.crad.2009.11.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2009] [Revised: 10/31/2009] [Accepted: 11/08/2009] [Indexed: 11/28/2022]
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32
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Yoon SJ, Lyoo IK, Kim HJ, Kim TS, Sung YH, Kim N, Lukas SE, Renshaw PF. Neurochemical alterations in methamphetamine-dependent patients treated with cytidine-5'-diphosphate choline: a longitudinal proton magnetic resonance spectroscopy study. Neuropsychopharmacology 2010; 35:1165-73. [PMID: 20043005 PMCID: PMC2900914 DOI: 10.1038/npp.2009.221] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Cytidine-5'-diphosphate choline (CDP-choline), as an important intermediate for major membrane phospholipids, may exert neuroprotective effects in various neurodegenerative disorders. This longitudinal proton magnetic resonance spectroscopy ((1)H-MRS) study aimed to examine whether a 4-week CDP-choline treatment could alter neurometabolite levels in patients with methamphetamine (MA) dependence and to investigate whether changes in neurometabolite levels would be associated with MA use. We hypothesized that the prefrontal levels of N-acetyl-aspartate (NAA), a neuronal marker, and choline-containing compound (Cho), which are related to membrane turnover, would increase with CDP-choline treatment in MA-dependent patients. We further hypothesized that this increase would correlate with the total number of negative urine results. Thirty-one treatment seekers with MA dependence were randomly assigned to receive CDP-choline (n=16) or placebo (n=15) for 4 weeks. Prefrontal NAA and Cho levels were examined using (1)H-MRS before medication, and at 2 and 4 weeks after treatment. Generalized estimating equation regression analyses showed that the rate of change in prefrontal NAA (p=0.005) and Cho (p=0.03) levels were greater with CDP-choline treatment than with placebo. In the CDP-choline-treated patients, changes in prefrontal NAA levels were positively associated with the total number of negative urine results (p=0.03). Changes in the prefrontal Cho levels, however, were not associated with the total number of negative urine results. These preliminary findings suggest that CDP-choline treatment may exert potential neuroprotective effects directly or indirectly because of reductions in drug use by the MA-dependent patients. Further studies with a larger sample size of MA-dependent patients are warranted to confirm a long-term efficacy of CDP-choline in neuroprotection and abstinence.
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Affiliation(s)
- Sujung J Yoon
- Department of Psychiatry, Catholic University of Korea School of Medicine, Seoul, South Korea
| | - In Kyoon Lyoo
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA,Brain Imaging Center and Clinical Research Center, Seoul National University Hospital, Seoul, South Korea,Departments of Psychiatry and Neuroscience, Seoul National University College of Medicine, 28 Yongon-dong, Chongro-gu, Seoul 110-744, South Korea. Tel: +822 2072 2302; Fax: +822 3672 0677; E-mail:
| | - Hengjun J Kim
- Brain Imaging Center and Clinical Research Center, Seoul National University Hospital, Seoul, South Korea
| | - Tae-Suk Kim
- Department of Psychiatry, Catholic University of Korea School of Medicine, Seoul, South Korea
| | - Young Hoon Sung
- Department of Psychiatry and The Brain Institute, University of Utah, SLC, UT, USA,Department of Veterans Affairs VISN 19 MIRECC, SLC, UT, USA
| | - Namkug Kim
- Department of Psychiatry and The Brain Institute, University of Utah, SLC, UT, USA,Department of Veterans Affairs VISN 19 MIRECC, SLC, UT, USA
| | - Scott E Lukas
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA,McLean Hospital Brain Imaging Center, Belmont, MA, USA
| | - Perry F Renshaw
- Department of Psychiatry and The Brain Institute, University of Utah, SLC, UT, USA,Department of Veterans Affairs VISN 19 MIRECC, SLC, UT, USA
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Abstract
Anxiety disorders are a significant problem in the community, and recent neuroimaging research has focused on determining the brain circuits that underlie them. Research on the neurocircuitry of anxiety disorders has its roots in the study of fear circuits in animal models and the study of brain responses to emotional stimuli in healthy humans. We review this research, as well as neuroimaging studies of anxiety disorders. In general, these studies have reported relatively heightened amygdala activation in response to disorder-relevant stimuli in post-traumatic stress disorder, social phobia, and specific phobia. Activation in the insular cortex appears to be heightened in many of the anxiety disorders. Unlike other anxiety disorders, post-traumatic stress disorder is associated with diminished responsivity in the rostral anterior cingulate cortex and adjacent ventral medial prefrontal cortex. Additional research will be needed to (1) clarify the exact role of each component of the fear circuitry in the anxiety disorders, (2) determine whether functional abnormalities identified in the anxiety disorders represent acquired signs of the disorders or vulnerability factors that increase the risk of developing them, (3) link the findings of functional neuroimaging studies with those of neurochemistry studies, and (4) use functional neuroimaging to predict treatment response and assess treatment-related changes in brain function.
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Karl A, Werner A. The use of proton magnetic resonance spectroscopy in PTSD research--meta-analyses of findings and methodological review. Neurosci Biobehav Rev 2009; 34:7-22. [PMID: 19559046 DOI: 10.1016/j.neubiorev.2009.06.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2009] [Revised: 06/11/2009] [Accepted: 06/16/2009] [Indexed: 10/20/2022]
Abstract
Different neuroimaging techniques provided evidence for structural and functional brain alterations in posttraumatic stress disorder (PTSD). Due to technical improvements, especially concerning localization techniques and more reliable analysis methods, one technique, proton magnetic resonance spectroscopy ((1)H-MRS), has increasingly become of interest because it allows further insight into metabolic mechanisms that may contribute to these alterations. The aim of this article is, therefore, to review recent studies utilizing (1)H-MRS of the hippocampus and other brain structures in PTSD. Using meta-analytic methods, we attempted to answer the question if PTSD, as compared to different types of control samples, is accompanied by altered neurometabolite ratios and concentrations in the tissue of different brain regions. A second intent was to review methodological aspects to advise on a minimal standard for reliable results with respect to the application of (1)H-MRS in PTSD. Finally, we discussed the implications of the findings with respect to current PTSD models and future research.
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Affiliation(s)
- Anke Karl
- School of Psychology, University of Southampton, Building 44, Southampton, UK.
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Decreased glutamate/glutamine levels may mediate cytidine's efficacy in treating bipolar depression: a longitudinal proton magnetic resonance spectroscopy study. Neuropsychopharmacology 2009; 34:1810-8. [PMID: 19194376 DOI: 10.1038/npp.2009.2] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Targeting the glutamatergic system has been suggested as a promising new option for developing treatment strategies for bipolar depression. Cytidine, a pyrimidine, may exert therapeutic effects through a pathway that leads to altered neuronal-glial glutamate cycling. Pyrimidines are also known to exert beneficial effects on cerebral phospholipid metabolism, catecholamine synthesis, and mitochondrial function, which have each been linked to the pathophysiology of bipolar depression. This study was aimed at determining cytidine's efficacy in bipolar depression and at assessing the longitudinal effects of cytidine on cerebral glutamate/glutamine levels. Thirty-five patients with bipolar depression were randomly assigned to receive the mood-stabilizing drug valproate plus either cytidine or placebo for 12 weeks. Midfrontal cerebral glutamate/glutamine levels were measured using proton magnetic resonance spectroscopy before and after 2, 4, and 12 weeks of oral cytidine administration. Cytidine supplementation was associated with an earlier improvement in depressive symptoms (weeks 1-4; p=0.02, 0.001, 0.002, and 0.004, respectively) and also produced a greater reduction in cerebral glutamate/glutamine levels in patients with bipolar depression (weeks 2, 4, and 12; p=0.004, 0.004, and 0.02, respectively). Cytidine-related glutamate/glutamine decrements correlated with a reduction in depressive symptoms (p=0.001). In contrast, these relationships were not observed in the placebo add-on group. The study results suggest that cytidine supplementation of valproate is associated with an earlier treatment response in bipolar depression. Furthermore, cytidine's efficacy in bipolar depression may be mediated by decreased levels of cerebral glutamate and/or glutamine, consistent with alterations in excitatory neurotransmission.
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Impact of the brain-derived neurotrophic factor Val66Met polymorphism on levels of hippocampal N-acetyl-aspartate assessed by magnetic resonance spectroscopic imaging at 3 Tesla. Biol Psychiatry 2008; 64:856-62. [PMID: 18707679 PMCID: PMC2586327 DOI: 10.1016/j.biopsych.2008.07.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2008] [Revised: 06/19/2008] [Accepted: 07/07/2008] [Indexed: 02/08/2023]
Abstract
BACKGROUND This study was conducted to corroborate prior evidence of an effect of the brain-derived neurotrophic factor (BDNF) valine (val) to methionine (met) amino acid substitution at codon 66 (val66met) polymorphism on measures of N-acetyl-aspartate (NAA) containing compounds in healthy subjects. METHODS The NAA to creatine (Cre) ratio (NAA/Cre), NAA to choline (Cho) ratio (NAA/Cho), and Cho to Cre ratio (Cho/Cre) were measured in the left and right hippocampi, left and right dorsolateral prefrontal cortices, occipital lobe, anterior cingulate, and white matter of the centrum semiovale of 69 carefully screened healthy volunteers utilizing proton magnetic resonance spectroscopic imaging (MRSI) at 3 Tesla (T). RESULTS Val/met subjects exhibited significantly reduced levels of left hippocampal NAA/Cre and NAA/Cho compared with val/val subjects. This effect was independent of age, IQ, number of voxels, hippocampal volume, or gray matter content in the voxels of interest. Analysis of other brain regions showed no effect of BDNF genotype on NAA measures. CONCLUSIONS We confirmed the association between the met-BDNF variant and reduced levels of hippocampal NAA found with a similar technique at 1.5T. The consonance of our results with prior findings adds to the evidence that the BDNF val/met genotype affects hippocampal biology with implications for a variety of neuropsychiatric disorders.
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Kim SJ, Lyoo IK, Lee YS, Sung YH, Kim HJ, Kim JH, Kim KH, Jeong DU. Increased GABA levels in medial prefrontal cortex of young adults with narcolepsy. Sleep 2008; 31:342-7. [PMID: 18363310 DOI: 10.1093/sleep/31.3.342] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES To explore absolute concentrations of brain metabolites including gamma amino-butyric acid (GABA) in the medial prefrontal cortex and basal ganglia of young adults with narcolepsy. DESIGN Proton magnetic resonance (MR) spectroscopy centered on the medial prefrontal cortex and the basal ganglia was acquired. The absolute concentrations of brain metabolites including GABA and glutamate were assessed and compared between narcoleptic patients and healthy comparison subjects. SETTING Sleep and Chronobiology Center at Seoul National University Hospital; A high strength 3.0 Tesla MR scanner in the Department of Radiology at Seoul National University Hospital. PATIENTS OR PARTICIPANTS Seventeen young adults with a sole diagnosis of HLA DQB1 0602 positive narcolepsy with cataplexy (25.1 +/- 4.6 years old) and 17 healthy comparison subjects (26.8 +/- 4.8 years old). INTERVENTIONS N/A. MEASUREMENTS AND RESULTS Relative to comparison subjects, narcoleptic patients had higher GABA concentration in the medial prefrontal cortex (t = 4.10, P <0.001). Narcoleptic patients with nocturnal sleep disturbance had higher GABA concentration in the medial prefrontal cortex than those without nocturnal sleep disturbance (t = 2.45, P = 0.03), but had lower GABA concentration than comparison subjects (t = 2.30, P = 0.03). CONCLUSIONS The current study reports that young adults with narcolepsy had a higher GABA concentration in the medial prefrontal cortex, which was more prominent in patients without nocturnal sleep disturbance. Our findings suggest that the medial prefrontal GABA level may be increased in narcolepsy, and the increased medial prefrontal GABA might be a compensatory mechanism to reduce nocturnal sleep disturbances in narcolepsy.
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Affiliation(s)
- Seog Ju Kim
- Department of Psychiatry, Gachon University of Medicine and Science, Incheon, South Korea
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Mathew SJ, Price RB, Mao X, Smith ELP, Coplan JD, Charney DS, Shungu DC. Hippocampal N-acetylaspartate concentration and response to riluzole in generalized anxiety disorder. Biol Psychiatry 2008; 63:891-8. [PMID: 18028881 PMCID: PMC2385784 DOI: 10.1016/j.biopsych.2007.09.012] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2007] [Revised: 07/31/2007] [Accepted: 09/18/2007] [Indexed: 11/16/2022]
Abstract
BACKGROUND Previous research has suggested the therapeutic potential of glutamate-modulating agents for severe mood and anxiety disorders, potentially resulting from enhancement of neuroplasticity. We used proton magnetic resonance spectroscopic imaging ((1)H MRSI) to examine the acute and chronic effects of the glutamate-release inhibitor riluzole on hippocampal N-acetylaspartate (NAA), a neuronal marker, in patients with generalized anxiety disorder (GAD) and examined the relationship between changes in NAA and clinical outcome. METHODS Fourteen medication-free GAD patients were administered open-label riluzole and then evaluated by (1)H MRSI before drug administration, and 24 hours and 8 weeks following treatment. Patients were identified as responders (n = 9) or nonresponders (n = 5). Seven untreated, medically healthy volunteers, comparable in age, sex, IQ, and body mass index to the patients, received scans at the same time intervals. Molar NAA concentrations in bilateral hippocampus, and change in anxiety ratings were the primary outcome measures. RESULTS A group-by-time interaction was found, with riluzole responders showing mean increases in hippocampal NAA across the three time points, whereas nonresponders had decreases over time. In GAD patients at Week 8, hippocampal NAA concentration and proportional increase in NAA from baseline both were positively associated with improvements in worry and clinician-rated anxiety. CONCLUSIONS These preliminary data support a specific association between hippocampal NAA and symptom alleviation following riluzole treatment in GAD. Placebo-controlled investigations that examine hippocampal NAA as a viable surrogate endpoint for clinical trials of neuroprotective and plasticity-enhancing agents are warranted.
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Affiliation(s)
- Sanjay J. Mathew
- From the Department of Psychiatry (SJM, RBP, DSC), Mount Sinai School of Medicine, New York, NY; Department of Radiology, Weill Medical College of Cornell University, New York, NY (DCS, XM); Department of Psychiatry, Downstate Medical Center, Brooklyn, NY (ELPS, JDC)
| | - Rebecca B. Price
- From the Department of Psychiatry (SJM, RBP, DSC), Mount Sinai School of Medicine, New York, NY; Department of Radiology, Weill Medical College of Cornell University, New York, NY (DCS, XM); Department of Psychiatry, Downstate Medical Center, Brooklyn, NY (ELPS, JDC)
| | - Xiangling Mao
- From the Department of Psychiatry (SJM, RBP, DSC), Mount Sinai School of Medicine, New York, NY; Department of Radiology, Weill Medical College of Cornell University, New York, NY (DCS, XM); Department of Psychiatry, Downstate Medical Center, Brooklyn, NY (ELPS, JDC)
| | - Eric L. P. Smith
- From the Department of Psychiatry (SJM, RBP, DSC), Mount Sinai School of Medicine, New York, NY; Department of Radiology, Weill Medical College of Cornell University, New York, NY (DCS, XM); Department of Psychiatry, Downstate Medical Center, Brooklyn, NY (ELPS, JDC)
| | - Jeremy D. Coplan
- From the Department of Psychiatry (SJM, RBP, DSC), Mount Sinai School of Medicine, New York, NY; Department of Radiology, Weill Medical College of Cornell University, New York, NY (DCS, XM); Department of Psychiatry, Downstate Medical Center, Brooklyn, NY (ELPS, JDC)
| | - Dennis S. Charney
- From the Department of Psychiatry (SJM, RBP, DSC), Mount Sinai School of Medicine, New York, NY; Department of Radiology, Weill Medical College of Cornell University, New York, NY (DCS, XM); Department of Psychiatry, Downstate Medical Center, Brooklyn, NY (ELPS, JDC)
| | - Dikoma C. Shungu
- From the Department of Psychiatry (SJM, RBP, DSC), Mount Sinai School of Medicine, New York, NY; Department of Radiology, Weill Medical College of Cornell University, New York, NY (DCS, XM); Department of Psychiatry, Downstate Medical Center, Brooklyn, NY (ELPS, JDC)
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Abstract
OBJECTIVE Magnetic resonance spectroscopy (MRS) is a non-invasive in vivo method used to quantify metabolites that are relevant to a wide range of brain processes. This paper briefly describes neuroimaging using MRS and provides a systematic review of its application to anxiety disorders. METHOD A literature review was performed in the PubMed, Lilacs and Scielo databases using the keywords spectroscopy and anxiety disorder. References of selected articles were also hand-searched for additional citations. RESULTS Recent studies have shown that there are significant metabolic differences between patients with anxiety disorders and healthy controls in various regions of the brain. Changes were mainly found in N-acetylaspartate, which is associated with neuronal viability, but some of them were also seen in creatine, a substance that is thought to be relatively constant among individuals with different pathological conditions. CONCLUSIONS MRS is a sophisticated neuroimaging technique that has provided useful insights into the biochemical and neurobiological basis of many anxiety disorders. Nevertheless, its utilization in some anxiety disorders is still modest, particularly social phobia and generalised anxiety. Although it is an extremely useful advance in neuroimaging, further research in other brain areas and patient populations is highly advisable.
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Affiliation(s)
- Clarissa Trzesniak
- 1Department of Neuropsychiatry and Medical Psychology, Ribeirão Preto Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - David Araújo
- 1Department of Neuropsychiatry and Medical Psychology, Ribeirão Preto Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - José Alexandre S Crippa
- 1Department of Neuropsychiatry and Medical Psychology, Ribeirão Preto Faculty of Medicine, University of São Paulo, São Paulo, Brazil
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Kolassa IT, Wienbruch C, Neuner F, Schauer M, Ruf M, Odenwald M, Elbert T. Altered oscillatory brain dynamics after repeated traumatic stress. BMC Psychiatry 2007; 7:56. [PMID: 17941996 PMCID: PMC2176059 DOI: 10.1186/1471-244x-7-56] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2007] [Accepted: 10/17/2007] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Repeated traumatic experiences, e.g. torture and war, lead to functional and structural cerebral changes, which should be detectable in cortical dynamics. Abnormal slow waves produced within circumscribed brain regions during a resting state have been associated with lesioned neural circuitry in neurological disorders and more recently also in mental illness. METHODS Using magnetoencephalographic (MEG-based) source imaging, we mapped abnormal distributions of generators of slow waves in 97 survivors of torture and war with posttraumatic stress disorder (PTSD) in comparison to 97 controls. RESULTS PTSD patients showed elevated production of focally generated slow waves (1-4 Hz), particularly in left temporal brain regions, with peak activities in the region of the insula. Furthermore, differential slow wave activity in right frontal areas was found in PTSD patients compared to controls. CONCLUSION The insula, as a site of multimodal convergence, could play a key role in understanding the pathophysiology of PTSD, possibly accounting for what has been called posttraumatic alexithymia, i.e., reduced ability to identify, express and regulate emotional responses to reminders of traumatic events. Differences in activity in right frontal areas may indicate a dysfunctional PFC, which may lead to diminished extinction of conditioned fear and reduced inhibition of the amygdala.
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Affiliation(s)
- Iris-Tatjana Kolassa
- Department of Psychology, Clinical & Neuropsychology, University of Konstanz, 78457 Konstanz, Germany.
| | - Christian Wienbruch
- Department of Psychology, Clinical & Neuropsychology, University of Konstanz, 78457 Konstanz, Germany
| | - Frank Neuner
- Department of Psychology, Clinical & Neuropsychology, University of Konstanz, 78457 Konstanz, Germany
| | - Maggie Schauer
- Department of Psychology, Clinical & Neuropsychology, University of Konstanz, 78457 Konstanz, Germany
| | - Martina Ruf
- Department of Psychology, Clinical & Neuropsychology, University of Konstanz, 78457 Konstanz, Germany
| | - Michael Odenwald
- Department of Psychology, Clinical & Neuropsychology, University of Konstanz, 78457 Konstanz, Germany
| | - Thomas Elbert
- Department of Psychology, Clinical & Neuropsychology, University of Konstanz, 78457 Konstanz, Germany
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