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Munguia A, Ostrosky F, Lozano A, Castañeda D, Lujan A, Diaz K, Perez M, Lara R, Sacristan E. The relationship between changes in functional networks and cognitive changes and PTSD symptoms in maltreated children before and after TF-CBT. Behav Brain Res 2024; 471:115091. [PMID: 38838966 DOI: 10.1016/j.bbr.2024.115091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 05/27/2024] [Accepted: 06/02/2024] [Indexed: 06/07/2024]
Abstract
Several studies have found that maltreated children show neuropsychological deficits in various cognitive domains such as memory and attention, language, visuospatial skills, emotional regulation, social cognition, and executive functioning. In terms of functional connectivity, abused children show an increased connectivity in the salience network (SN) as opposed to a decreased connectivity within the default (DMN) and executive networks (CEN). Children who suffer maltreatment may develop post-traumatic stress disorder (PTSD), which in turn, can increase psychological and cognitive sequelae. The present study examined the relation between resting state functional connectivity (RSFC), PTSD symptoms and neuropsychological profiles in abused children before and after following a psychological therapy named Trauma Focused Cognitive Behavioral therapy (TF-CBT). Resting state functional magnetic resonance imaging, neuropsychological (attention, memory and executive functions) and clinical evaluations were performed in 13 abused children with PTSD (mean age=8.77 years old, S.D.=1.83) recruited from a non-governmental shelter in Mexico and in a control group of 10 children from the general population (mean age = 9.57 years old, S.D. = 1.91). Both groups were matched according to age and gender. Changes in PTSD symptoms correlated with changes in the left insula node. Additionally, significant correlations were identified between changes in the average connectivity of the DMN, intra-nodal connectivity of lateral parietal and medial prefrontal regions, and performance in attention and memory tasks.
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Affiliation(s)
- Ana Munguia
- Facultad de Psicología, Universidad Nacional Autónoma de México, Ciudad de México 04510, Mexico
| | - Feggy Ostrosky
- Facultad de Psicología, Universidad Nacional Autónoma de México, Ciudad de México 04510, Mexico.
| | - Asucena Lozano
- Facultad de Psicología, Universidad Nacional Autónoma de México, Ciudad de México 04510, Mexico
| | - Dianela Castañeda
- Facultad de Psicología, Universidad Nacional Autónoma de México, Ciudad de México 04510, Mexico
| | - Angélica Lujan
- Facultad de Psicología, Universidad Nacional Autónoma de México, Ciudad de México 04510, Mexico
| | - Karla Diaz
- Facultad de Psicología, Universidad Nacional Autónoma de México, Ciudad de México 04510, Mexico
| | - Martha Perez
- Facultad de Psicología, Universidad Nacional Autónoma de México, Ciudad de México 04510, Mexico
| | - Rafael Lara
- Centro Nacional de Investigación en Imagenología e Instrumentación Médica, Universidad Autónoma Metropolitana, Ciudad de México 09340, Mexico
| | - Emilio Sacristan
- Centro Nacional de Investigación en Imagenología e Instrumentación Médica, Universidad Autónoma Metropolitana, Ciudad de México 09340, Mexico
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2
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Ostrosky F, Decety J, Lozano A, Lujan A, Perez M, Munguia A, Castañeda D, Diaz K, Lara R, Sacristan E, Bobes MA, Borja K, Camarena B, Hernández-Muñoz S, Álvarez A, Franco-Bourland RE. [Formula: see text] Can psychopathy be prevented? Clinical, neuroimaging, and genetic data: an exploratory study. Child Neuropsychol 2024; 30:861-881. [PMID: 37947201 DOI: 10.1080/09297049.2023.2277396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 10/25/2023] [Indexed: 11/12/2023]
Abstract
The aim of the study was to explore the relationship among brain functional activations elicited by an emotional paradigm, clinical scores (PTSD, anxiety, and depression), psychopathic traits, and genetic characteristics (5-HTTLPR) in a group of severely maltreated children compared to a healthy control group before and after the implementation of a Trauma Focused-Cognitive Behavioral Therapy. The final sample consisted of an experimental group of 14 maltreated children (mean age = 8.77 years old, S.D. = 1.83) recruited from a non-governmental shelter in Mexico City for children who had experienced child abuse and a control group of 10 children from the general population (mean age = 9.57 years old, S.D. = 1.91). Both groups were matched according to age and gender and were assessed before and after the implementation of the aforementioned therapy by means of clinical scales and an emotional paradigm that elicited brain activations which were recorded through functional magnetic resonance imaging. Genotyping of the 5-HTTLPR polymorphism was made at first assessment. A region of interest analysis showed amygdala hyperactivation during exposure to fear and anger stimuli in the maltreated children before treatment. Following therapy, a decrease in brain activity as well as a decrease in clinical symptoms were also observed. 5-HTTLPR polymorphism did not show any effect on the severity of clinical symptoms in maltreated children. Trauma-Focused Behavioral Therapy may help reorganize the brain's processing of emotional stimuli. These observations reveal the importance of an early intervention when the mechanisms of neuroplasticity may be still recruited.
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Affiliation(s)
- Feggy Ostrosky
- Facultad de Psicología, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - Jean Decety
- Department of Psychology, University of Chicago, Chicago, IL, USA
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago Medicine, Chicago, IL, USA
| | - Azucena Lozano
- Facultad de Psicología, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - Angélica Lujan
- Facultad de Psicología, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - Martha Perez
- Facultad de Psicología, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - Ana Munguia
- Facultad de Psicología, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - Dianela Castañeda
- Facultad de Psicología, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - Karla Diaz
- Facultad de Psicología, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - Rafael Lara
- Centro Nacional de Investigación en Imagenología e Instrumentación Médica, Universidad Autónoma Metropolitana, Ciudad de México, México
| | - Emilio Sacristan
- Centro Nacional de Investigación en Imagenología e Instrumentación Médica, Universidad Autónoma Metropolitana, Ciudad de México, México
| | - Maria A Bobes
- Departamento de Neurociencias Cognitivas, Centro de Neurociencias de Cuba, Cubanacan, Cuba
| | - Karina Borja
- Social Brain Lab, Netherlands Institute for Neuroscience, Amsterdam, Netherlands
| | - Beatriz Camarena
- Departamento de Farmacogenética, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, México
| | - Sandra Hernández-Muñoz
- Departamento de Farmacogenética, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, México
| | - Aurora Álvarez
- Facultad de Psicología, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - Rebecca E Franco-Bourland
- Jefa de Servicio, Laboratorio de Bioquímica, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Ciudad de México, México
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Ireton R, Hughes A, Klabunde M. A Functional Magnetic Resonance Imaging Meta-Analysis of Childhood Trauma. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2024; 9:561-570. [PMID: 38311289 DOI: 10.1016/j.bpsc.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Traumatic experiences during childhood significantly impact the developing brain and contribute to the development of numerous physical and mental health problems. To date, however, a comprehensive understanding of the functional impairments within the brain associated with childhood trauma histories does not exist. Previous functional magnetic resonance imaging (fMRI) meta-analytical tools required homogeneity of task types and the clinical populations studied, thus preventing the comprehensive pooling of brain-based deficits present in children who have trauma histories. We hypothesized that the use of the novel, data-driven Bayesian author-topic model approach to fMRI meta-analyses would reveal deficits in brain networks that span fMRI task types in children with trauma histories. METHODS To our knowledge, this is the first study to use the Bayesian author-topic model approach to fMRI meta-analyses within a clinical population. Using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we present data-driven results obtained by combining activation patterns across heterogeneous tasks from 1428 initially screened studies and combining data from 14 studies that met study criteria (285 children with trauma histories, 297 healthy control children). RESULTS Altered brain activity was revealed within 2 clusters in children with trauma histories compared to control children: the default mode/affective network/posterior insula and the central executive network. Our identified clusters were associated with tasks pertaining to cognitive processing, emotional/social stress, self-referential thought, memory, unexpected stimuli, and avoidance behaviors in youths who have experienced childhood trauma. CONCLUSIONS Our results reveal disturbances in children with trauma histories within the modulation of the default mode and central executive networks-but not the salience network-regardless of whether children also presented with posttraumatic stress symptoms.
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Affiliation(s)
- Rebecca Ireton
- Department of Psychology and Centre for Brain Sciences, University of Essex, Wivenhoe, United Kingdom
| | - Anna Hughes
- Department of Psychology and Centre for Brain Sciences, University of Essex, Wivenhoe, United Kingdom
| | - Megan Klabunde
- Department of Psychology and Centre for Brain Sciences, University of Essex, Wivenhoe, United Kingdom.
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4
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Gkintoni E, Kourkoutas E, Yotsidi V, Stavrou PD, Prinianaki D. Clinical Efficacy of Psychotherapeutic Interventions for Post-Traumatic Stress Disorder in Children and Adolescents: A Systematic Review and Analysis. CHILDREN (BASEL, SWITZERLAND) 2024; 11:579. [PMID: 38790574 PMCID: PMC11119036 DOI: 10.3390/children11050579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 04/30/2024] [Accepted: 05/09/2024] [Indexed: 05/26/2024]
Abstract
Background: This systematic review aggregates research on psychotherapeutic interventions for Post-Traumatic Stress Disorder (PTSD) in children and adolescents. PTSD in this demographic presents differently from adults, necessitating tailored therapeutic approaches. In children and adolescents, PTSD arises from exposure to severe danger, interpersonal violence, or abuse, leading to significant behavioral and emotional disturbances that jeopardize long-term development. The review focuses on describing PTSD within two age groups, children (6 to 12 years) and adolescents (12 to 18 years), while evaluating the effectiveness of various clinical interventions aimed at this condition. Methods: Utilizing the PRISMA guidelines, this review systematically examines studies that assess clinical interventions for PTSD in the younger population. Results: Key symptoms of PTSD in children and adolescents include avoidance, overstimulation, flashbacks, depression, and anxiety. The review identifies several effective treatments, including Cognitive Behavioral Therapy (CBT), Trauma-Focused CBT (TF-CBT), Eye Movement Desensitization and Reprocessing (EMDR), Systemic Therapy, Play Therapy, Exposure Therapy, Relaxation Techniques, and Psychodynamic Psychotherapy. Particularly, TF-CBT is highlighted as the most effective and commonly used method in treating childhood and adolescent PTSD, as supported by most of the studies reviewed. Conclusions: A significant outcome of this study is the short-term effectiveness of CBT in reducing PTSD symptoms in children and adolescents. The findings underline the importance of psychotherapeutic interventions and mark a substantial advancement in understanding PTSD in young populations. It is crucial for practitioners to integrate various psychotherapeutic strategies into their practice to improve patient outcomes and treatment efficacy.
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Affiliation(s)
- Evgenia Gkintoni
- Department of Psychiatry, University General Hospital of Patras, 26504 Patras, Greece
| | - Elias Kourkoutas
- Department of Primary Education, Research Center for the Humanities, Social and Education Sciences, University of Crete, 74100 Rethymno, Greece;
| | - Vasiliki Yotsidi
- Department of Psychology, Panteion University, 17671 Athens, Greece;
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Zantvoord JB, Ensink JBM, Op den Kelder R, Diehle J, Lok A, Lindauer RJL. Autonomic nervous system function before and after trauma-focused psychotherapy in youth with (partial) posttraumatic stress disorder. Psychoneuroendocrinology 2024; 162:106945. [PMID: 38244488 DOI: 10.1016/j.psyneuen.2023.106945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/17/2023] [Accepted: 12/21/2023] [Indexed: 01/22/2024]
Abstract
While trauma-focused psychotherapies have been shown effective in youth with PTSD, the relationship between treatment response and alterations in the autonomic nervous system (ANS) associated with PTSD, remains incompletely understood. During neutral and personalized trauma script imagery heart rate (HR), pre-ejection period (PEP) and respiratory sinus arrhythmia (RSA) were recorded in youth aged 8-18 with PTSD or partial PTSD (n = 76) and trauma-exposed controls (TEC) (n = 27) to determine ANS activity and stress reactivity. Within the patient group, 77.6% met the full DSM-IV diagnostic criteria for PTSD, the remaining 22.4% met the criteria for partial PTSD. Youth with (partial) PTSD were subsequently treated with eight sessions of either trauma-focused cognitive behavioral therapy or eye movement desensitization and reprocessing. PTSD severity was assessed using the Clinician-Administered PTSD scale for Children and Adolescents to divide patients into responders and non-responders. Youth with (partial) PTSD relative to TEC had higher overall HR during both neutral and trauma imagery (p = .05). Youth with (partial) PTSD showed RSA decrease during trauma imagery relative to neutral imagery, the reverse of TEC (p = .01). Relative to non-responders, responders demonstrated a significant baseline to posttreatment increase of RSA response to stress only when employing a ≥ 50% response criterion (p = .05) and not with the primary ≥ 30% criterion (p = .12). Our results suggest overall higher HR and sympathetic nervous system activity as well as vagal withdrawal in response to stress in youth with (partial) PTSD and only provide partial support for normalization of the latter with successful trauma-focused psychotherapy.
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Affiliation(s)
- Jasper B Zantvoord
- Department of Psychiatry, Amsterdam University Medical Center, Amsterdam, the Netherlands; Department of Child and Adolescent Psychiatry, Amsterdam University Medical Center, Amsterdam, the Netherlands.
| | - Judith B M Ensink
- Department of Child and Adolescent Psychiatry, Amsterdam University Medical Center, Amsterdam, the Netherlands; Levvel, Academic Centre for Child and Adolescent Psychiatry, Amsterdam, the Netherlands
| | - Rosanne Op den Kelder
- Levvel, Academic Centre for Child and Adolescent Psychiatry, Amsterdam, the Netherlands
| | - Julia Diehle
- WODC-Research and Documentation Centre, The Hague, the Netherlands
| | - Anja Lok
- Department of Psychiatry, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Ramon J L Lindauer
- Department of Child and Adolescent Psychiatry, Amsterdam University Medical Center, Amsterdam, the Netherlands; Levvel, Academic Centre for Child and Adolescent Psychiatry, Amsterdam, the Netherlands
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6
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Nicolaides NC, Kanaka-Gantenbein C, Pervanidou P. Developmental Neuroendocrinology of Early-Life Stress: Impact on Child Development and Behavior. Curr Neuropharmacol 2024; 22:461-474. [PMID: 37563814 PMCID: PMC10845081 DOI: 10.2174/1570159x21666230810162344] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 02/22/2023] [Accepted: 03/15/2023] [Indexed: 08/12/2023] Open
Abstract
Our internal balance, or homeostasis, is threatened or perceived as threatened by stressful stimuli, the stressors. The stress system is a highly conserved system that adjusts homeostasis to the resting state. Through the concurrent activation of the hypothalamic-pituitary-adrenal axis and the locus coeruleus/norepinephrine-autonomic nervous systems, the stress system provides the appropriate physical and behavioral responses, collectively termed as "stress response", to restore homeostasis. If the stress response is prolonged, excessive or even inadequate, several acute or chronic stress-related pathologic conditions may develop in childhood, adolescence and adult life. On the other hand, earlylife exposure to stressors has been recognized as a major contributing factor underlying the pathogenesis of non-communicable disorders, including neurodevelopmental disorders. Accumulating evidence suggests that early-life stress has been associated with an increased risk for attention deficit hyperactivity disorder and autism spectrum disorder in the offspring, although findings are still controversial. Nevertheless, at the molecular level, early-life stressors alter the chemical structure of cytosines located in the regulatory regions of genes, mostly through the addition of methyl groups. These epigenetic modifications result in the suppression of gene expression without changing the DNA sequence. In addition to DNA methylation, several lines of evidence support the role of non-coding RNAs in the evolving field of epigenetics. In this review article, we present the anatomical and functional components of the stress system, discuss the proper, in terms of quality and quantity, stress response, and provide an update on the impact of early-life stress on child development and behavior.
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Affiliation(s)
- Nicolas C. Nicolaides
- Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens, School of Medicine, ‘Aghia Sophia’ Children's Hospital, Athens, 11527, Greece
- Division of Endocrinology and Metabolism, Center of Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, Athens, 11527, Greece
- School of Medicine, University Research Institute of Maternal and Child Health and Precision Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Department of Molecular Genetics, Function and Therapy, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - Christina Kanaka-Gantenbein
- Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens, School of Medicine, ‘Aghia Sophia’ Children's Hospital, Athens, 11527, Greece
| | - Panagiota Pervanidou
- Unit of Developmental and Behavioral Pediatrics, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, “Aghia Sophia” Children's Hospital, Athens, Greece
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7
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Gilgoff R, Mengelkoch S, Elbers J, Kotz K, Radin A, Pasumarthi I, Murthy R, Sindher S, Harris NB, Slavich GM. The Stress Phenotyping Framework: A multidisciplinary biobehavioral approach for assessing and therapeutically targeting maladaptive stress physiology. Stress 2024; 27:2327333. [PMID: 38711299 PMCID: PMC11219250 DOI: 10.1080/10253890.2024.2327333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 03/02/2024] [Indexed: 05/08/2024] Open
Abstract
Although dysregulated stress biology is becoming increasingly recognized as a key driver of lifelong disparities in chronic disease, we presently have no validated biomarkers of toxic stress physiology; no biological, behavioral, or cognitive treatments specifically focused on normalizing toxic stress processes; and no agreed-upon guidelines for treating stress in the clinic or evaluating the efficacy of interventions that seek to reduce toxic stress and improve human functioning. We address these critical issues by (a) systematically describing key systems and mechanisms that are dysregulated by stress; (b) summarizing indicators, biomarkers, and instruments for assessing stress response systems; and (c) highlighting therapeutic approaches that can be used to normalize stress-related biopsychosocial functioning. We also present a novel multidisciplinary Stress Phenotyping Framework that can bring stress researchers and clinicians one step closer to realizing the goal of using precision medicine-based approaches to prevent and treat stress-associated health problems.
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Affiliation(s)
- Rachel Gilgoff
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Palo Alto, CA, USA
| | - Summer Mengelkoch
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Jorina Elbers
- Trauma recovery Program, HeartMath Institute, Boulder Creek, CA, USA
| | | | | | - Isha Pasumarthi
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Palo Alto, CA, USA
| | - Reanna Murthy
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Palo Alto, CA, USA
| | - Sayantani Sindher
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Palo Alto, CA, USA
| | | | - George M. Slavich
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
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8
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Russell JD, Heyn SA, Herringa RJ. Through a Developmental Lens: Emerging Insights to Understand and Treat Pediatric PTSD. Am J Psychiatry 2023; 180:636-644. [PMID: 37654114 PMCID: PMC10636806 DOI: 10.1176/appi.ajp.20230523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Affiliation(s)
- Justin D Russell
- Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison
| | - Sara A Heyn
- Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison
| | - Ryan J Herringa
- Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison
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9
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Kotzalidis GD, Ferrara OM, Margoni S, Ieritano V, Restaino A, Bernardi E, Fischetti A, Catinari A, Monti L, Chieffo DPR, Simonetti A, Sani G. Are the Post-COVID-19 Posttraumatic Stress Disorder (PTSD) Symptoms Justified by the Effects of COVID-19 on Brain Structure? A Systematic Review. J Pers Med 2023; 13:1140. [PMID: 37511753 PMCID: PMC10381510 DOI: 10.3390/jpm13071140] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/07/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
COVID-19 affects brain function, as deduced by the "brain fog" that is often encountered in COVID-19 patients and some cognitive impairment that is observed in many a patient in the post-COVID-19 period. Approximately one-third of patients, even when they have recovered from the acute somatic disease, continue to show posttraumatic stress disorder (PTSD) symptoms. We hypothesized that the persistent changes induced by COVID-19 on brain structure would overlap with those associated with PTSD. We performed a thorough PubMed search on 25 April 2023 using the following strategy: ((posttraumatic OR PTSD) AND COVID-19 AND (neuroimaging OR voxel OR VBM OR freesurfer OR structural OR ROI OR whole-brain OR hippocamp* OR amygd* OR "deep gray matter" OR "cortical thickness" OR caudate OR striatum OR accumbens OR putamen OR "regions of interest" OR subcortical)) OR (COVID-19 AND brain AND (voxel[ti] OR VBM[ti] OR magnetic[ti] OR resonance[ti] OR imaging[ti] OR neuroimaging[ti] OR neuroimage[ti] OR positron[ti] OR photon*[ti] OR PET[ti] OR SPET[ti] OR SPECT[ti] OR spectroscop*[ti] OR MRS[ti])), which produced 486 records and two additional records from other sources, of which 36 were found to be eligible. Alterations were identified and described and plotted against the ordinary PTSD imaging findings. Common elements were hypometabolism in the insula and caudate nucleus, reduced hippocampal volumes, and subarachnoid hemorrhages, while white matter hyperintensities were widespread in both PTSD and post-COVID-19 brain infection. The comparison partly supported our initial hypothesis. These data may contribute to further investigation of the effects of long COVID on brain structure and function.
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Affiliation(s)
- Georgios D Kotzalidis
- NESMOS (Neurosciences, Mental Health, and Sensory Organs) Department, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Sapienza-Università di Roma, 00189 Rome, Italy
- Department of Neuroscience, Section of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, 00168 Rome, Italy
- Centro Lucio Bini, 00193 Rome, Italy
| | - Ottavia Marianna Ferrara
- Department of Neuroscience, Section of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, 00168 Rome, Italy
| | - Stella Margoni
- Department of Neuroscience, Section of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, 00168 Rome, Italy
| | - Valentina Ieritano
- Department of Neuroscience, Section of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, 00168 Rome, Italy
| | - Antonio Restaino
- Department of Neuroscience, Section of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, 00168 Rome, Italy
| | - Evelina Bernardi
- Department of Neuroscience, Section of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, 00168 Rome, Italy
| | - Alessia Fischetti
- Department of Neuroscience, Section of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, 00168 Rome, Italy
| | - Antonello Catinari
- Department of Neuroscience, Section of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, 00168 Rome, Italy
| | - Laura Monti
- UOS Clinical Psychology, Clinical Government, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Daniela Pia Rosaria Chieffo
- UOS Clinical Psychology, Clinical Government, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Women, Children and Public Health Department, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Alessio Simonetti
- Department of Neuroscience, Section of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, 00168 Rome, Italy
- Centro Lucio Bini, 00193 Rome, Italy
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, USA
- Institute of Psychiatry, Department of Neuroscience, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Gabriele Sani
- Department of Neuroscience, Section of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, 00168 Rome, Italy
- Institute of Psychiatry, Department of Neuroscience, Catholic University of the Sacred Heart, 00168 Rome, Italy
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10
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Scharpf F, Saupe L, Crombach A, Haer R, Ibrahim H, Neuner F, Peltonen K, Qouta S, Saile R, Hecker T. The network structure of posttraumatic stress symptoms in war-affected children and adolescents. JCPP ADVANCES 2023; 3:e12124. [PMID: 37431314 PMCID: PMC10241473 DOI: 10.1002/jcv2.12124] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 10/07/2022] [Indexed: 09/20/2024] Open
Abstract
Background It is unclear whether findings from previous network analyses of posttraumatic stress disorder (PTSD) symptoms among children and adolescents are generalizable to youth living in war-torn settings and whether there are differences in the structure and connectivity of symptoms between children and adolescents. This study examined the network structure of PTSD symptoms in a sample of war-affected youth and compared the symptom networks of children and adolescents. Methods The overall sample comprised 2007 youth (6-18 years old) living in Burundi, Democratic Republic of Congo, Iraq, Palestine, Tanzania, and Uganda amid or close to war and armed conflict. Youth reported their PTSD symptoms using a self-report questionnaire in Palestine and structured clinical interviews in all other countries. We computed the networks of the overall sample and of two sub-samples of 412 children (6-12 years) and 473 adolescents (13-18 years) and compared the structure and global connectivity of symptoms among children and adolescents. Results In both the overall sample and the sub-samples, re-experiencing and avoidance symptoms were most strongly connected. The adolescents' network had a higher global connectivity of symptoms than the children's network. Hyperarousal symptoms and intrusions were more strongly connected among adolescents compared to children. Conclusion The findings lend support to a universal concept of PTSD among youth characterized by core deficits in fear processing and emotion regulation. However, different symptoms may be particularly important in different developmental stages, with avoidance and dissociative symptoms dominating in childhood and intrusions and hypervigilance gaining importance in adolescence. Stronger symptom connections may render adolescents more vulnerable to the persistence of symptoms.
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Affiliation(s)
- Florian Scharpf
- Department of PsychologyBielefeld UniversityBielefeldGermany
- Institute for Interdisciplinary Research on Conflict and ViolenceBielefeld UniversityBielefeldGermany
| | - Laura Saupe
- Department of PsychologyUniversity Eichstätt‐IngolstadtEichstättGermany
| | - Anselm Crombach
- Department of PsychologyKonstanz UniversityKonstanzGermany
- Department of PsychologySaarland UniversitySaarbrückenGermany
| | - Roos Haer
- Institute of Political ScienceLeiden UniversityLeidenNetherlands
| | - Hawkar Ibrahim
- Department of PsychologyBielefeld UniversityBielefeldGermany
| | - Frank Neuner
- Department of PsychologyBielefeld UniversityBielefeldGermany
| | - Kirsi Peltonen
- Research Center for Child PsychiatryUniversity of TurkuTurkuFinland
| | - Samir Qouta
- School of Social Sciences and HumanitiesDoha Instiute for Graduate StudiesAl DaayenQatar
| | - Regina Saile
- Treatment Center for Victims of TortureUlmGermany
| | - Tobias Hecker
- Department of PsychologyBielefeld UniversityBielefeldGermany
- Institute for Interdisciplinary Research on Conflict and ViolenceBielefeld UniversityBielefeldGermany
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11
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Guidetti C, Brogna P, Chieffo DPR, Turrini I, Arcangeli V, Rausa A, Bianchetti M, Rolleri E, Santomassimo C, Di Cesare G, Ducci G, Romeo DM, Brogna C. Eye Movement Desensitization and Reprocessing (EMDR) as a Possible Evidence-Based Rehabilitation Treatment Option for a Patient with ADHD and History of Adverse Childhood Experiences: A Case Report Study. J Pers Med 2023; 13:jpm13020200. [PMID: 36836434 PMCID: PMC9961224 DOI: 10.3390/jpm13020200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 01/19/2023] [Accepted: 01/19/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Children with Attention Deficit Hyperactivity Disorder (ADHD) having a history of adverse childhood experiences (ACEs) could be very difficult to treat with standard psychotherapeutic approaches. Some children diagnosed with ADHD may have Post-Traumatic Stress Disorder (PTSD) or have had experienced a significant traumatic event. Trauma and PTSD could exacerbate ADHD core symptoms and be a risk factor of poor outcome response. OBJECTIVE to report for the first time the history of a patient with ADHD and ACE successfully treated with an EMDR approach. CONCLUSION EMDR could be a promising treatment for ADHD children with a history of traumatic experiences in addition to pharmacological treatments.
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Affiliation(s)
- Clotilde Guidetti
- Pediatric Neurology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Patrizia Brogna
- Complex Operative Unit Prevention and Early Interventions (PIPSM), Department of Mental Health ASL ROMA 1, 00193 Rome, Italy
| | - Daniela Pia Rosaria Chieffo
- Clinical Psychology Unit, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, 00168 Rome, Italy
- Department Women Children and Public Health, Catholic University of Sacred Heart, 00168 Rome, Italy
| | - Ida Turrini
- Pediatric Neurology Unit, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, 00168 Rome, Italy
| | - Valentina Arcangeli
- Clinical Psychology Unit, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, 00168 Rome, Italy
| | - Azzurra Rausa
- Pediatric Neurology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | | | - Elisa Rolleri
- Pediatric Neurology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Chiara Santomassimo
- Complex Operative Unit Prevention and Early Interventions (PIPSM), Department of Mental Health ASL ROMA 1, 00193 Rome, Italy
| | - Gianluigi Di Cesare
- Complex Operative Unit Prevention and Early Interventions (PIPSM), Department of Mental Health ASL ROMA 1, 00193 Rome, Italy
| | - Giuseppe Ducci
- Complex Operative Unit Prevention and Early Interventions (PIPSM), Department of Mental Health ASL ROMA 1, 00193 Rome, Italy
| | - Domenico M. Romeo
- Pediatric Neurology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Pediatric Neurology Unit, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, 00168 Rome, Italy
| | - Claudia Brogna
- Pediatric Neurology Unit, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, 00168 Rome, Italy
- Correspondence: or ; Tel.: +39-06-30155340; Fax: +39-06-30154363
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12
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Zaverdinou E, Katimertzi M, Chrousos GP, Darviri C, Vlachakis D, Kanaka-Gantenbein C, Bacopoulou F. Post-traumatic Stress Disorder as a Risk Factor for the Development of Risky Behavior Among Adolescent Offenders: A Systematic Review. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1425:119-129. [PMID: 37581786 DOI: 10.1007/978-3-031-31986-0_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
The purpose of this research study was to obtain greater insight into the associations of post-traumatic stress disorder (PTSD) and trauma-exposed experiences with the development of offending behavior in adolescents. Using the PubMed and Scopus databases, we performed a systematic review of recent cross-sectional studies between 2016 and 2022, investigating the associations of PTSD and trauma with the social and mental behavior of adolescents. Fifty-three articles were initially identified. Due to duplication, eight articles were excluded, leaving 45 remaining articles. In addition, 34 articles were excluded due to year of publication, review, abstract, or irrelevant title. Seven articles were included in this systematic review after excluding the remaining due to different study types or samples. Included studies primarily examined the associations of PTSD symptomatology and expression of externalizing symptoms with risky behavior and the commission of a crime. The strongest outcomes were increased levels of violent behavior, violent delinquency, and total risk in correlation with PTSD symptoms, emotional numbing, use of drugs, and in some cases maltreatment. The results of the systematic review suggest that PTSD symptoms and risky behavior, which can be also fueled by maltreatment activities in the family circle, are associated with criminal behavior. Future research is needed to confirm these findings.
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Affiliation(s)
- Eleni Zaverdinou
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Katimertzi
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - George P Chrousos
- University Research Institute of Maternal and Child Health & Precision Medicine, and UNESCO Chair in Adolescent Health Care, Aghia Sophia Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Christina Darviri
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Vlachakis
- Laboratory of Genetics, Department of Biotechnology, School of Applied Biology and Biotechnology, Agricultural University of Athens, Athens, Greece
| | - Christina Kanaka-Gantenbein
- First Department of Pediatrics, School of Medicine, Aghia Sophia Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Flora Bacopoulou
- Center for Adolescent Medicine and UNESCO Chair in Adolescent Health Care, First Department of Pediatrics, School of Medicine, Aghia Sophia Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece.
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13
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Walker BH, Brown DC, Walker CS, Stubbs-Richardson M, Oliveros AD, Buttross S. Childhood adversity associated with poorer health: Evidence from the U.S. National Survey of Children's Health. CHILD ABUSE & NEGLECT 2022; 134:105871. [PMID: 36095924 DOI: 10.1016/j.chiabu.2022.105871] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 07/22/2022] [Accepted: 08/31/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The association between adverse childhood experiences (ACEs) and increased risk of health problems is well established. However, many studies have relied on unrepresentative or high-risk samples and have focused on a narrow range of health problems. Prior research assessing potential age differences in the ACE-health connection is also sparse. OBJECTIVE To comprehensively examine the extent to which ACEs are associated with physical, mental, and neurodevelopmental health outcomes in childhood and assess whether these associations differ between age groups. PARTICIPANTS & SETTING Pooled cross-sectional data from the 2016-2019 National Survey of Children's Health (N = 98,732). METHODS We estimated age-stratified binary logistic regression models examining associations between the number of ACEs and physical, mental, and neurodevelopmental health problems net of sociodemographic and socioeconomic controls. Separate models were estimated for the total population (ages 3-17), early childhood (ages 3-5), middle childhood (ages 6-11), and adolescence (ages 12-17). RESULTS We observed a dose-response relationship between ACE exposure and childhood physical, mental, and neurodevelopmental health problems in all age groups. The largest disparities exist between children with no ACEs and three or more ACEs. Compared to children without ACEs, children with three or more ACEs had significantly higher adjusted odds of externalizing disorders (OR = 4.40), internalizing disorders (OR = 5.13), neurodevelopmental disorders (OR = 2.40), and physical health problems (OR = 2.08). CONCLUSIONS Our results add to evidence linking ACEs to childhood health disparities. Further, findings indicate that ACEs have persistent negative effects across age groups and that clinicians should monitor ACEs when assessing children's physical, mental, and neurodevelopmental health at any age.
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Affiliation(s)
- Benjamin H Walker
- Department of Population Health Science, John D. Bower School of Population Health, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39212, United States of America.
| | - Dustin C Brown
- Department of Sociology, Mississippi State University, Bowen Hall, 456 Hardy Road, Mississippi State, MS 39762, United States of America; Social Science Research Center, Mississippi State University, 1 Research Blvd, Suite 103, Starkville, MS 39759, United States of America
| | - Courtney S Walker
- Department of Psychiatry, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39212, United States of America
| | - Megan Stubbs-Richardson
- Social Science Research Center, Mississippi State University, 1 Research Blvd, Suite 103, Starkville, MS 39759, United States of America
| | - Arazais D Oliveros
- Department of Psychology, Mississippi State University, PO Box 6161, 202 Magruder Hall, Mississippi State, MS 39762, United States of America
| | - Susan Buttross
- Department of Pediatrics, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39212, United States of America
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14
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Espil FM, Balters S, Li R, McCurdy BH, Kletter H, Piccirilli A, Cohen JA, Weems CF, Reiss AL, Carrion VG. Cortical activation predicts posttraumatic improvement in youth treated with TF-CBT or CCT. J Psychiatr Res 2022; 156:25-35. [PMID: 36228389 DOI: 10.1016/j.jpsychires.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/13/2022] [Accepted: 10/03/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Identifying neural activation patterns that predict youths' treatment response may aid in the development of imaging-based assessment of emotion dysregulation following trauma and foster tailored intervention. Changes in cortical hemodynamic activity measured with functional near-infrared spectroscopy (fNIRS) may provide a time and cost-effective option for such work. We examined youths' PTSD symptom change following treatment and tested if previously identified activation patterns would predict treatment response. METHODS Youth (N = 73, mean age = 12.97, SD = 3.09 years) were randomly assigned to trauma-focused cognitive behavioral therapy (TF-CBT), cue-centered therapy (CCT), or treatment as usual (TAU). Parents and youth reported on youth's PTSD symptoms at pre-intervention, post-intervention, and follow-up. Neuroimaging data (N = 31) assessed at pre-intervention were obtained while youth engaged in an emotion expression task. Treatment response slopes were calculated for youth's PTSD symptoms. RESULTS Overall, PTSD symptoms decreased from pre-intervention through follow-up across conditions, with some evidence of relative benefit of TF-CBT and CCT over TAU but significant individual variation in treatment response. Cortical activation patterns were correlated with PTSD symptom improvement slopes (r = 0.53). In particular, cortical responses to fearful and neutral facial stimuli in six fNIRS channels in the bilateral dlPFC were important predictors of PTSD symptom improvement. CONCLUSIONS The use of fNIRS provides a method of monitoring and assessing cortical activation patterns in a relatively inexpensive and portable manner. Associations between functional activation and youths' PTSD symptoms improvement may be a promising avenue for understanding emotion dysregulation in clinical populations.
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Affiliation(s)
- Flint M Espil
- Department of Psychiatry and Behavioral Sciences, Stanford University, USA.
| | - Stephanie Balters
- Department of Psychiatry and Behavioral Sciences, Stanford University, USA
| | - Rihui Li
- Department of Psychiatry and Behavioral Sciences, Stanford University, USA
| | - Bethany H McCurdy
- Department of Human Development and Family Studies, Iowa State University, USA
| | - Hilit Kletter
- Department of Psychiatry and Behavioral Sciences, Stanford University, USA
| | - Aaron Piccirilli
- Department of Psychiatry and Behavioral Sciences, Stanford University, USA
| | - Judith A Cohen
- Allegheny Health Network, Drexel University College of Medicine, USA
| | - Carl F Weems
- Department of Human Development and Family Studies, Iowa State University, USA
| | - Allan L Reiss
- Department of Psychiatry and Behavioral Sciences, Stanford University, USA; Department of Radiology, Stanford University, USA; Department of Pediatrics, Stanford University, USA
| | - Victor G Carrion
- Department of Psychiatry and Behavioral Sciences, Stanford University, USA
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15
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Zhang J, Sami S, Meiser-Stedman R. Acute stress and PTSD among trauma-exposed children and adolescents: Computational prediction and interpretation. J Anxiety Disord 2022; 92:102642. [PMID: 36356479 DOI: 10.1016/j.janxdis.2022.102642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 07/02/2022] [Accepted: 10/14/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Youth receiving medical care for injury are at risk of PTSD. Therefore, accurate prediction of chronic PTSD at an early stage is needed. Machine learning (ML) offers a promising approach to precise prediction and interpretation. AIMS The study proposes a clinically useful predictive model for PTSD 6-12 months after injury, analyzing the relationship among predictors, and between predictors and outcomes. METHODS A ML approach was utilized to train models based on 1167 children and adolescents of nine perspective studies. Demographics, trauma characteristics and acute traumatic stress (ASD) symptoms were used as initial predictors. PTSD diagnosis at six months was derived using DSM-IV PTSD diagnostic criteria. Models were validated on external datasets. Shapley value and partial dependency plot (PDP) were applied to interpret the final model. RESULTS A random forest model with 13 predictors (age, ethnicity, trauma type, intrusive memories, nightmares, reliving, distress, dissociation, cognitive avoidance, sleep, irritability, hypervigilance and startle) yielded F-scores of.973,0.902 and.961 with training and two external datasets. Shapley values were calculated for individual and grouped predictors. A cumulative effect for intrusion symptoms was observed. PDP showed a non-linear relationship between age and PTSD, and between ASD symptom severity and PTSD. A 43 % difference in the risk between non-minority and minority ethnic groups was detected. CONCLUSIONS A ML model demonstrated excellent classification performance and good potential for clinical utility, using a few easily obtainable variables. Model interpretation gave a comprehensive quantitative analysis on the operations among predictors, in particular ASD symptoms.
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Affiliation(s)
- Joyce Zhang
- Department of Clinical Psychology, Norwich Medical School, University of East Anglia, UK.
| | - Saber Sami
- Dementia Research, Norwich Medical School, University of East Anglia, UK
| | - Richard Meiser-Stedman
- Department of Clinical Psychology, Norwich Medical School, University of East Anglia, UK
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16
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Potharst ES, Truijens D, Seegers ICM, Spaargaren JF, van Steensel FJA, Bögels SM. BOAM: A Visual, Explanatory Diagnostic and Psychoeducation System Used in Collaboration with Families-Feasibility and Acceptability for Children Who Are Non-Responsive to Treatment as Usual. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14693. [PMID: 36429410 PMCID: PMC9691191 DOI: 10.3390/ijerph192214693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/04/2022] [Accepted: 11/06/2022] [Indexed: 06/16/2023]
Abstract
Many children referred to mental health services have neurodevelopmental problems, which are not always recognized because the resulting emotional and behavioral problems dominate diagnosis and treatment. BOAM (Basic needs, Order, Autonomy and Meaning) is a new diagnostic system consisting of imaginative models that explain the complexity of symptoms and underlying neuropsychological problems in a simple way. It is designed to be used in a transparent, collaborative process with families, so that family members can better understand the nature of mental health problems, thus increasing self-knowledge and mutual understanding. In this study, the feasibility of the BOAM diagnostic trajectory and subsequent treatment informed by this trajectory are evaluated clinically in 34 children who have not responded to or relapsed after treatment as usual (TAU). Parents completed questionnaires pre-test, post-test and at a 3-month follow-up. The treatment drop-out rate was 2.9%. Post-test, parents rated the BOAM trajectory positively. The questionnaires (measuring child psychopathology, attention, executive functioning, family functioning, partner relationships and parenting stress) demonstrated sensitivity to change, and therefore, seems appropriate for a future effectiveness study. A limitation was the high percentage of missing measurements both post-test (41%) and at the follow-up (41%). The BOAM diagnostic trajectory and subsequent treatment may be a feasible alternative for children who do not respond to or relapse after TAU.
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Affiliation(s)
- Eva S. Potharst
- UvA Minds, Academic Outpatient (Child and Adolescent) Treatment Centre of the University of Amsterdam, Banstraat 29, 1071 JW Amsterdam, The Netherlands
- Research Institute of Child Development and Education, University of Amsterdam, Nieuwe Achtergracht 127, 1018 WS Amsterdam, The Netherlands
| | - Damiët Truijens
- UvA Minds, Academic Outpatient (Child and Adolescent) Treatment Centre of the University of Amsterdam, Banstraat 29, 1071 JW Amsterdam, The Netherlands
| | - Isabelle C. M. Seegers
- UvA Minds, Academic Outpatient (Child and Adolescent) Treatment Centre of the University of Amsterdam, Banstraat 29, 1071 JW Amsterdam, The Netherlands
| | - Julia F. Spaargaren
- UvA Minds, Academic Outpatient (Child and Adolescent) Treatment Centre of the University of Amsterdam, Banstraat 29, 1071 JW Amsterdam, The Netherlands
| | - Francisca J. A. van Steensel
- Research Institute of Child Development and Education, University of Amsterdam, Nieuwe Achtergracht 127, 1018 WS Amsterdam, The Netherlands
| | - Susan M. Bögels
- Developmental Psychology, University of Amsterdam, Nieuwe Achtergracht 129-B, 1018 WS Amsterdam, The Netherlands
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17
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Szeszko PR, Bierer LM, Bader HN, Chu KW, Tang CY, Murphy KM, Hazlett EA, Flory JD, Yehuda R. Cingulate and hippocampal subregion abnormalities in combat-exposed veterans with PTSD. J Affect Disord 2022; 311:432-439. [PMID: 35598747 DOI: 10.1016/j.jad.2022.05.081] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 05/02/2022] [Accepted: 05/15/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND The hippocampus and cingulate gyrus are strongly interconnected brain regions that have been implicated in the neurobiology of post-traumatic stress disorder (PTSD). These brain structures are comprised of functionally distinct subregions that may contribute to the expression of PTSD symptoms or associated cardio-metabolic markers, but have not been well investigated in prior studies. METHODS Two divisions of the cingulate cortex (i.e., rostral and caudal) and 11 hippocampal subregions were investigated in 22 male combat-exposed veterans with PTSD and 22 male trauma-exposed veteran controls (TC). Cardio-metabolic measures included cholesterol, body mass index, and mean arterial pressure. RESULTS Individuals with PTSD had less caudal cingulate area compared to TC even after controlling for caudal cingulate thickness. Total hippocampus volume was lower in PTSD compared to TC, accounted for by differences in CA1-CA4, granule cell layer of the dentate gyrus, molecular layer, and subiculum. Individuals with PTSD had higher mean arterial pressure compared to TC, which correlated with hippocampus volume only in the PTSD group. LIMITATIONS Sample size, cross-sectional analysis, no control for medications and findings limited to males. CONCLUSIONS These data demonstrate preferential involvement of caudal cingulate area (vs. thickness) and hippocampus subregions in PTSD. The inverse association between hippocampus volume and mean arterial pressure may contribute to accelerated aging known to be associated with PTSD.
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Affiliation(s)
- Philip R Szeszko
- Mental Health Patient Care Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Linda M Bierer
- Mental Health Patient Care Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Heather N Bader
- Mental Health Patient Care Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - King-Wai Chu
- Mental Illness Research, Education, and Clinical Center (MIRECC), James J. Peters VA Medical Center, Bronx, NY, USA
| | - Cheuk Y Tang
- Mental Illness Research, Education, and Clinical Center (MIRECC), James J. Peters VA Medical Center, Bronx, NY, USA; Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Katharine M Murphy
- Mental Health Patient Care Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Erin A Hazlett
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Mental Illness Research, Education, and Clinical Center (MIRECC), James J. Peters VA Medical Center, Bronx, NY, USA
| | - Janine D Flory
- Mental Health Patient Care Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rachel Yehuda
- Mental Health Patient Care Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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18
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Huskey A, Taylor DJ, Friedman BH. “Generalized unsafety” as fear inhibition to safety signals in adults with and without childhood trauma. Dev Psychobiol 2022; 64:e22242. [DOI: 10.1002/dev.22242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 11/16/2021] [Accepted: 12/09/2021] [Indexed: 11/12/2022]
Affiliation(s)
- Alisa Huskey
- Department of Psychology Virginia Tech Blacksburg Virginia USA
- Department of Psychology University of Arizona Tucson Arizona USA
| | - Daniel J. Taylor
- Department of Psychology University of Arizona Tucson Arizona USA
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19
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Zhutovsky P, Zantvoord JB, Ensink JBM, Op den Kelder R, Lindauer RJL, van Wingen GA. Individual prediction of trauma-focused psychotherapy response in youth with posttraumatic stress disorder using resting-state functional connectivity. Neuroimage Clin 2022; 32:102898. [PMID: 34911201 PMCID: PMC8645516 DOI: 10.1016/j.nicl.2021.102898] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/15/2021] [Accepted: 11/23/2021] [Indexed: 01/23/2023]
Abstract
ML and rs-fMRI have shown promise in predicting treatment-response in adults with PTSD. Currently, no biomarkers for treatment-response are available in youth with PTSD. FC between the FPN and SMN was stronger in treatment non-responders on the group-level. A network within the bilateral STG predicted response for individual youth with 76% accuracy. Future studies should test generalizability of these findings and test if larger cohorts increase accuracy.
Randomized controlled trials have shown efficacy of trauma-focused psychotherapies in youth with posttraumatic stress disorder (PTSD). However, response varies considerably among individuals. Currently, no biomarkers are available to assist clinicians in identifying youth who are most likely to benefit from treatment. In this study, we investigated whether resting-state functional magnetic resonance imaging (rs-fMRI) could distinguish between responders and non-responders on the group- and individual patient level. Pre-treatment rs-fMRI was recorded in 40 youth (ages 8–17 years) with (partial) PTSD before trauma-focused psychotherapy. Change in symptom severity from pre- to post-treatment was assessed using the Clinician-Administered PTSD scale for Children and Adolescents to divide participants into responders (≥30% symptom reduction) and non-responders. Functional networks were identified using meta-independent component analysis. Group-differences within- and between-network connectivity between responders and non-responders were tested using permutation testing. Individual predictions were made using multivariate, cross-validated support vector machine classification. A network centered on the bilateral superior temporal gyrus predicted treatment response for individual patients with 76% accuracy (pFWE = 0.02, 87% sensitivity, 65% specificity, area-under-receiver-operator-curve of 0.82). Functional connectivity between the frontoparietal and sensorimotor network was significantly stronger in non-responders (t = 5.35, pFWE = 0.01) on the group-level. Within-network connectivity was not significantly different between groups. This study provides proof-of-concept evidence for the feasibility to predict trauma-focused psychotherapy response in youth with PTSD at an individual-level. Future studies are required to test if larger cohorts could increase accuracy and to test further generalizability of the prediction models.
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Affiliation(s)
- Paul Zhutovsky
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands.
| | - Jasper B Zantvoord
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands; Amsterdam UMC, University of Amsterdam, Department of Child and Adolescent Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands.
| | - Judith B M Ensink
- Amsterdam UMC, University of Amsterdam, Department of Child and Adolescent Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands; Levvel, Academic Centre for Child and Adolescent Psychiatry, Amsterdam, The Netherlands.
| | - Rosanne Op den Kelder
- Levvel, Academic Centre for Child and Adolescent Psychiatry, Amsterdam, The Netherlands; Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands.
| | - Ramon J L Lindauer
- Amsterdam UMC, University of Amsterdam, Department of Child and Adolescent Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands; Levvel, Academic Centre for Child and Adolescent Psychiatry, Amsterdam, The Netherlands.
| | - Guido A van Wingen
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands.
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20
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Balters S, Li R, Espil FM, Piccirilli A, Liu N, Gundran A, Carrion VG, Weems CF, Cohen JA, Reiss AL. Functional near-infrared spectroscopy brain imaging predicts symptom severity in youth exposed to traumatic stress. J Psychiatr Res 2021; 144:494-502. [PMID: 34768071 DOI: 10.1016/j.jpsychires.2021.10.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 09/11/2021] [Accepted: 10/18/2021] [Indexed: 10/19/2022]
Abstract
Functional near-infrared spectroscopy (fNIRS) is a non-invasive neuroimaging technique with the potential to enable the assessment of posttraumatic stress disorder (PTSD) brain biomarkers in an affordable and portable manner. Consistent with biological models of PTSD, functional magnetic resonance imaging (fMRI) and fNIRS studies of adults with trauma exposure and PTSD symptoms suggest increased activation in the dorsolateral prefrontal cortex (dlPFC) and ventrolateral PFC (vlPFC) in response to negative emotion stimuli. We tested this theory with fNIRS assessment among youth exposed to traumatic stress and experiencing PTSD symptoms (PTSS). A portable fNIRS system collected hemodynamic responses from (N = 57) youth with PTSS when engaging in a classic emotion expression task that included fearful and neutral faces stimuli. The General Linear Model was applied to identify cortical activations associated with the facial stimuli. Subsequently, a prediction model was established via a Support Vector Regression to determine whether PTSS severity could be predicted based on fNIRS-derived cortical response measures and individual demographic information. Results were consistent with findings from adult fMRI and fNIRS studies of PTSS showing increased activation in the dlPFC and vlPFC in response to negative emotion stimuli. Subsequent prediction analysis revealed ten features (i.e., cortical responses from eight frontocortical fNIRS channels, age and sex) strongly correlated with PTSS severity (r = 0.65, p < .001). Our findings suggest the potential utility of fNIRS as a portable tool for the detection of putative PTSS brain biomarkers.
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Affiliation(s)
- Stephanie Balters
- Department of Psychiatry and Behavioral Sciences, Stanford University, United States.
| | - Rihui Li
- Department of Psychiatry and Behavioral Sciences, Stanford University, United States.
| | - Flint M Espil
- Department of Psychiatry and Behavioral Sciences, Stanford University, United States
| | - Aaron Piccirilli
- Department of Psychiatry and Behavioral Sciences, Stanford University, United States
| | - Ning Liu
- Department of Psychiatry and Behavioral Sciences, Stanford University, United States
| | - Andrew Gundran
- Department of Psychiatry and Behavioral Sciences, Stanford University, United States
| | - Victor G Carrion
- Department of Psychiatry and Behavioral Sciences, Stanford University, United States
| | - Carl F Weems
- Department of Human Development and Family Studies, Iowa State University, United States
| | - Judith A Cohen
- Allegheny Health Network, Drexel University College of Medicine, United States
| | - Allan L Reiss
- Department of Psychiatry and Behavioral Sciences, Stanford University, United States; Department of Radiology, Stanford University, United States; Department of Pediatrics, Stanford University, United States
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21
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Bozinovic K, McLamb F, O'Connell K, Olander N, Feng Z, Haagensen S, Bozinovic G. U.S. national, regional, and state-specific socioeconomic factors correlate with child and adolescent ADHD diagnoses pre-COVID-19 pandemic. Sci Rep 2021; 11:22008. [PMID: 34759326 PMCID: PMC8580963 DOI: 10.1038/s41598-021-01233-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 10/25/2021] [Indexed: 11/09/2022] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD), the most diagnosed emerging neurodevelopmental disorder in children, is a growing health crisis in the United States. Due to the potential increase in ADHD severity during and post the COVID-19 pandemic, we analyzed recent national and two state-specific ADHD data distribution among U.S. children and adolescents by investigating a broad range of socioeconomic status (SES) factors. Child and adolescent ADHD diagnosis and treatment data were parent-reported via National Survey of Children's Health (NSCH). The nationwide childhood prevalence of ADHD is 8.7%, and 62.1% of diagnosed children are taking medication. Louisiana (15.7%) has the highest percentage of children diagnosed with ADHD and California (5.6%) has the lowest, followed by Nevada (5.9%). Multiple correspondence analysis (MCA, n = 51,939) examining 30 factors highlights four areas of interest at the national and state level: race/ethnicity, financial status, family structure, and neighborhood characteristics. Positive correlations between ADHD diagnosis and unsafe school, unsafe neighborhood, and economic hardship are evident nationally and statewide, while the association between a lack of ADHD diagnosis and higher urban neighborhood amenities are evident nationally, but not in two opposing outlier states-Louisiana or Nevada. National and state-specific hierarchical analyses demonstrate significant correlations between the various SES factors and ADHD outcomes. Since the national analysis does not account for the demographic heterogeneity within regions or individual states, the U.S. should rely on comprehensive, county-specific, near real-time data reporting to effectively model and mitigate the ADHD epidemic and similar national health crises.
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Affiliation(s)
- Kesten Bozinovic
- Boz Life Science Research and Teaching Institute, San Diego Science Center, 3030 Bunker Hill Street, Suite 102, San Diego, CA, 92109, USA
- University of California San Diego, Extended Studies, 9600 N Torrey Pines Rd, La Jolla, CA, 92037, USA
| | - Flannery McLamb
- Boz Life Science Research and Teaching Institute, San Diego Science Center, 3030 Bunker Hill Street, Suite 102, San Diego, CA, 92109, USA
- University of California San Diego, Extended Studies, 9600 N Torrey Pines Rd, La Jolla, CA, 92037, USA
| | - Katherine O'Connell
- Boz Life Science Research and Teaching Institute, San Diego Science Center, 3030 Bunker Hill Street, Suite 102, San Diego, CA, 92109, USA
- University of California San Diego, Extended Studies, 9600 N Torrey Pines Rd, La Jolla, CA, 92037, USA
| | - Natalie Olander
- Boz Life Science Research and Teaching Institute, San Diego Science Center, 3030 Bunker Hill Street, Suite 102, San Diego, CA, 92109, USA
- University of California San Diego, Extended Studies, 9600 N Torrey Pines Rd, La Jolla, CA, 92037, USA
| | - Zuying Feng
- Boz Life Science Research and Teaching Institute, San Diego Science Center, 3030 Bunker Hill Street, Suite 102, San Diego, CA, 92109, USA
| | - Sora Haagensen
- Boz Life Science Research and Teaching Institute, San Diego Science Center, 3030 Bunker Hill Street, Suite 102, San Diego, CA, 92109, USA
- University of California San Diego, Extended Studies, 9600 N Torrey Pines Rd, La Jolla, CA, 92037, USA
| | - Goran Bozinovic
- Boz Life Science Research and Teaching Institute, San Diego Science Center, 3030 Bunker Hill Street, Suite 102, San Diego, CA, 92109, USA.
- Division of Biology, University of California San Diego, 9500 Gillman Dr., La Jolla, CA, 92037, USA.
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22
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Brieant AE, Sisk LM, Gee DG. Associations among negative life events, changes in cortico-limbic connectivity, and psychopathology in the ABCD Study. Dev Cogn Neurosci 2021; 52:101022. [PMID: 34710799 PMCID: PMC8556598 DOI: 10.1016/j.dcn.2021.101022] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 09/28/2021] [Accepted: 10/14/2021] [Indexed: 12/25/2022] Open
Abstract
Adversity exposure is a risk factor for psychopathology, which most frequently onsets during adolescence, and prior research has demonstrated that alterations in cortico-limbic connectivity may account in part for this association. In a sample of youth from the Adolescent Brain Cognitive Development (ABCD) Study (N = 4006), we tested a longitudinal structural equation model to examine the indirect effect of adversity exposure (negative life events) on later psychopathology via changes in cortico-limbic resting-state functional connectivity (rsFC). We also examined the potential protective effects of parental acceptance. Generally, cortico-limbic connectivity became more strongly negative between baseline and year 2 follow-up, suggesting that stronger negative correlations within these cortico-limbic networks may reflect a more mature phenotype. Exposure to a greater number of negative life events was associated with stronger negative cortico-limbic rsFC which, in turn, was associated with lower internalizing (but not externalizing) symptoms. The indirect effect of negative life events on internalizing symptoms via cortico-limbic rsFC was significant. Parental acceptance did not moderate the association between negative life events and rsFC. Our findings highlight how stressful childhood experiences may accelerate neurobiological maturation in specific cortico-limbic connections, potentially reflecting an adaptive process that protects against internalizing problems in the context of adversity. Childhood adversity shapes cortico-limbic connectivity and mental health. In the ABCD Study, cortico-limbic functional connectivity changed over time. These changes explain the association between adversity and internalizing symptoms. Adversity exposure may accelerate corticolimbic development.
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Affiliation(s)
- Alexis E Brieant
- Department of Psychology, Yale University, 2 Hillhouse Ave, New Haven, CT 06520, United States.
| | - Lucinda M Sisk
- Department of Psychology, Yale University, 2 Hillhouse Ave, New Haven, CT 06520, United States
| | - Dylan G Gee
- Department of Psychology, Yale University, 2 Hillhouse Ave, New Haven, CT 06520, United States
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23
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Garrett AS, Abazid L, Cohen JA, van der Kooij A, Carrion V, Zhang W, Jo B, Franklin C, Blader J, Zack S, Reiss AL, Agras WS. Changes in Brain Volume Associated with Trauma-Focused Cognitive Behavioral Therapy Among Youth with Posttraumatic Stress Disorder. J Trauma Stress 2021; 34:744-756. [PMID: 33881197 PMCID: PMC9676083 DOI: 10.1002/jts.22678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 01/29/2021] [Accepted: 03/05/2021] [Indexed: 11/08/2022]
Abstract
This study investigated group differences and longitudinal changes in brain volume before and after trauma-focused cognitive behavioral therapy (TF-CBT) in 20 unmedicated youth with maltreatment-related posttraumatic stress disorder (PTSD) and 20 non-trauma-exposed healthy control (HC) participants. We collected MRI scans of brain anatomy before and after 5 months of TF-CBT or the same time interval for the HC group. FreeSurfer software was used to segment brain images into 95 cortical and subcortical volumes, which were submitted to optimal scaling regression with lasso variable selection. The resulting model of group differences at baseline included larger right medial orbital frontal and left posterior cingulate corticies and smaller right midcingulate and right precuneus corticies in the PTSD relative to the HC group, R2 = .67. The model of group differences in pre- to posttreatment change included greater longitudinal changes in right rostral middle frontal, left pars triangularis, right entorhinal, and left cuneus corticies in the PTSD relative to the HC group, R2 = .69. Within the PTSD group, pre- to posttreatment symptom improvement was modeled by longitudinal decreases in the left posterior cingulate cortex, R2 = .45, and predicted by baseline measures of a smaller right isthmus (retrosplenial) cingulate and larger left caudate, R2 = .77. In sum, treatment was associated with longitudinal changes in brain regions that support executive functioning but not those that discriminated PTSD from HC participants at baseline. Additionally, results confirm a role for the posterior/retrosplenial cingulate as a correlate of PTSD symptom improvement and predictor of treatment outcome.
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Affiliation(s)
- Amy S. Garrett
- Department of Psychiatry & Behavioral Sciences, University of Texas Health Science Center, San Antonio, Texas, USA,Research Imaging Institute, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Leen Abazid
- Research Imaging Institute, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Judith A. Cohen
- Department of Psychiatry, Drexel University College of Medicine, Allegheny Health Network, Pittsburg, Pennsylvania, USA
| | - Anita van der Kooij
- Institute of Psychology, Division of Methodology and Statistics, University of Leiden, Leiden, the Netherlands
| | - Victor Carrion
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Wei Zhang
- Research Imaging Institute, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Booil Jo
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Crystal Franklin
- Research Imaging Institute, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Joseph Blader
- Department of Psychiatry & Behavioral Sciences, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Sanno Zack
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Allan L. Reiss
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - W. Stewart Agras
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
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24
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Hilberdink CE, van Zuiden M, Schrantee A, Korosi A, Kaiser A, Zhutovsky P, Ginty AT, Ensink JBM, Lindauer RJL, Vrijkotte TGM, de Rooij SR. Dysregulated functional brain connectivity in response to acute social-evaluative stress in adolescents with PTSD symptoms. Eur J Psychotraumatol 2021; 12:1880727. [PMID: 33968316 PMCID: PMC8075091 DOI: 10.1080/20008198.2021.1880727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Posttraumatic stress disorder (PTSD) is associated with dysregulated neural, cortisol, and cardiac stress reactivity and recovery. This understanding is predominantly based on studies in adults applying emotional-cognitive and trauma-related stimuli inducing negative emotions or perceived threat. Despite large numbers of adolescents with PTSD, few studies are available on neurobiological stress reactivity in this population. Moreover, no previous studies investigated neural reactivity to social-evaluative stress. Objective: To investigate functional brain connectivity, cortisol and cardiac reactivity to acute social-evaluative stress, and additional cortisol measures in trauma-exposed adolescents with and without high PTSD symptoms. Method: A speech preparation task to induce acute social-evaluative stress elicited by anticipatory threat, was used in a subsample of the Amsterdam Born Child and their Development (ABCD) birth cohort, consisting of trauma-exposed adolescents with (n = 20) and without (n = 29) high PTSD symptoms. Psychophysiological interaction analyses were performed to assess group differences in functional connectivity of the hippocampus, mPFC and amygdala during social-evaluative stress and recovery, measured by fMRI. Additionally, perceived stress, heart rate and cortisol stress reactivity and recovery, cortisol awakening response and day curve were compared. Results: The stressor evoked significant changes in heart rate and perceived stress, but not cortisol. The PTSD symptom and control groups differed in functional connectivity between the hippocampus and cerebellum, middle and inferior frontal gyrus, and the mPFC and inferior frontal gyrus during social-evaluative stress versus baseline. Mostly, the same patterns were found during recovery versus baseline. We observed no significant group differences in amygdala connectivity, and cortisol and cardiac measures. Conclusions: Our findings suggest threat processing in response to social-evaluative stress is disrupted in adolescents with PTSD symptoms. Our findings are mainly but not entirely in line with findings in adults with PTSD, which denotes the importance to investigate adolescents with PTSD as a separate population.
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Affiliation(s)
- Charlotte E Hilberdink
- Department of Psychiatry, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Mirjam van Zuiden
- Department of Psychiatry, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Anouk Schrantee
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Aniko Korosi
- Swammerdam Institute for Life Sciences, Centre for Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
| | - Antonia Kaiser
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Paul Zhutovsky
- Department of Psychiatry, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Annie T Ginty
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA
| | - Judith B M Ensink
- Levvel, Academic Center for Child and Adolescent Psychiatry, Amsterdam, The Netherlands.,Department of Child and Adolescent Psychiatry (JBME, RJLL), Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Ramon J L Lindauer
- Levvel, Academic Center for Child and Adolescent Psychiatry, Amsterdam, The Netherlands.,Department of Child and Adolescent Psychiatry (JBME, RJLL), Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Tanja G M Vrijkotte
- Department of Epidemiology and Data Science, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Susanne R de Rooij
- Department of Epidemiology and Data Science, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Department of Public Health and Occupational Health, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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25
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Weems CF, Russell JD, Herringa RJ, Carrion VG. Translating the neuroscience of adverse childhood experiences to inform policy and foster population-level resilience. ACTA ACUST UNITED AC 2021; 76:188-202. [PMID: 33734788 DOI: 10.1037/amp0000780] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Imaging methods have elucidated several neurobiological correlates of traumatic and adverse experiences in childhood. This knowledge base may foster the development of programs and policies that aim to build resilience and adaptation in children and youth facing adversity. Translation of this research requires both effective and accurate communication of the science. This review begins with a discussion of integrating the language used to describe and identify childhood adversity and their outcomes to clarify the translation of neurodevelopmental findings. An integrative term, Traumatic and Adverse Childhood Experiences (TRACEs+) is proposed, alongside a revised adverse childhood experiences (ACEs) pyramid that emphasizes that a diversity of adverse experiences may lead to a common outcome and that a diversity of outcomes may result from a common adverse experience. This term facilitates linkages between the ACEs literature and the emerging neurodevelopmental knowledge surrounding the effect of traumatic adverse childhood experiences on youth in terms of the knowns and unknowns about neural connectivity in youth samples. How neuroscience findings may lead directly or indirectly to specific techniques or targets for intervention and the reciprocal nature of these relationships is addressed. Potential implications of the neuroscience for policy and intervention at multiple levels are illustrated using existing policy programs that may be informed by (and inform) neuroscience. The need for transdisciplinary models to continue to move the science to action closes the article. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Carl F Weems
- Department of Human Development and Family Studies, Iowa State University
| | - Justin D Russell
- Department of Psychiatry, School of Medicine and Public Health, University of Wisconsin-Madison
| | - Ryan J Herringa
- Department of Psychiatry, School of Medicine and Public Health, University of Wisconsin-Madison
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26
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Walker CS, Walker BH, Brown DC, Buttross S, Sarver DE. Defining the role of exposure to ACEs in ADHD: Examination in a national sample of US children. CHILD ABUSE & NEGLECT 2021; 112:104884. [PMID: 33360863 DOI: 10.1016/j.chiabu.2020.104884] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/21/2020] [Accepted: 12/04/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Clinical presentations of ADHD vary according to biological and environmental developmental influences. An emerging field of research has demonstrated relationships between exposure to adverse childhood experiences (ACEs) and ADHD prevalence, particularly in high-risk samples. However, research examining the combined role of traditional risk factors of ADHD and ACEs is limited, and reliance on high-risk samples introduces sampling bias. OBJECTIVE To examine the influence of ACEs on ADHD diagnosis using a large, nationally representative sample of US children. PARTICIPANTS AND SETTING Nationally representative samples (2017 and 2018) of 40,075 parents from the National Survey of Children's Health (NSCH). METHODS We conducted logistic regression models to examine the association of ACEs and ADHD diagnosis, controlling for child and parent demographic variables and other risk factors. RESULTS Exposure to ACEs was significantly associated with parent-reported ADHD diagnosis, controlling for known parental and child-risk factors of ADHD. The association followed a gradient pattern of increased ADHD prevalence with additional exposures. Compared to children with no ACEs, the odds of an ADHD diagnosis were 1.39, 1.92, and 2.72 times higher among children with one, two and three or more ACEs. The ACE most strongly associated with the odds of ADHD was having lived with someone with mental illness closely followed by parent/guardian incarceration. CONCLUSIONS Results further strengthen the evidence that ACEs exposure is associated with increased ADHD prevalence. Clinicians should assess ACEs in the diagnosis of ADHD. Furthermore, results of the study lend support to the efforts of agencies (both institutional and state-level) promoting routine screening of ACEs in children.
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Affiliation(s)
| | - Benjamin H Walker
- Social Science Research Center, Mississippi State University, United States
| | - Dustin C Brown
- Social Science Research Center, Mississippi State University, United States; Department of Sociology, Mississippi State University, United States
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27
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Trauma-focused psychotherapy response in youth with posttraumatic stress disorder is associated with changes in insula volume. J Psychiatr Res 2021; 132:207-214. [PMID: 33189355 DOI: 10.1016/j.jpsychires.2020.10.037] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 10/04/2020] [Accepted: 10/26/2020] [Indexed: 02/04/2023]
Abstract
Randomized controlled trials have shown efficacy of trauma-focused psychotherapies in youth with posttraumatic stress disorder (PTSD), but little is known about the relationship between treatment response and alternations in brain structures associated with PTSD. In this study, we longitudinally examined the association between treatment response and pre-to posttreatment changes in structural magnetic resonance imaging (MRI) scans using a voxel-based morphometry approach. We analyzed MRI scans of 35 patients (ages 8-18 years, 21 female) with PTSD (80%) or partial PTSD (20%) before and after eight weekly sessions of trauma-focused psychotherapy. PTSD severity was assessed longitudinally using the Clinician-Administered PTSD scale for Children and Adolescents to divide participants into responders and non-responders. Group by time interaction analysis showed significant differences in grey-matter volume in the bilateral insula due to volume reductions over time in non-responders compared to responders. Despite the significant group by time interaction, there were no significant group differences at baseline or follow-up. As typical development is associated with insula volume increase, these longitudinal MRI findings suggest that treatment non-response is associated with atypical neurodevelopment of the insula, which may underlie persistence of PTSD in youth. The absence of structural MRI changes in treatment responders, while in need of replication, suggest that successful trauma-focused psychotherapy may not directly normalize brain abnormalities associated with PTSD.
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28
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Kerig PK, Mozley MM, Mendez L. Forensic Assessment of PTSD Via DSM-5 Versus ICD-11 Criteria: Implications for Current Practice and Future Research. PSYCHOLOGICAL INJURY & LAW 2020. [DOI: 10.1007/s12207-020-09397-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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29
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Amin R, Nadeem E, Iqbal K, Asadullah MA, Hussain B. Support for Students Exposed to Trauma (SSET) Program: An Approach for Building Resilience and Social Support Among Flood-Impacted Children. SCHOOL MENTAL HEALTH 2020. [DOI: 10.1007/s12310-020-09373-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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30
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Weems CF, Russell JD. Variation in the Developing Brain and the Role of Pediatric Posttraumatic Stress on Structural and Functional Networks. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2020; 5:7-9. [PMID: 31918892 DOI: 10.1016/j.bpsc.2019.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 10/11/2019] [Indexed: 01/16/2023]
Affiliation(s)
- Carl F Weems
- Department of Human Development and Family Studies, Iowa State University, Ames, Iowa.
| | - Justin D Russell
- Department of Psychiatry, University of Wisconsin-Madison, Madison, Wisconsin
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31
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Cohodes EM, Kitt ER, Baskin-Sommers A, Gee DG. Influences of early-life stress on frontolimbic circuitry: Harnessing a dimensional approach to elucidate the effects of heterogeneity in stress exposure. Dev Psychobiol 2020; 63:153-172. [PMID: 32227350 DOI: 10.1002/dev.21969] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 01/17/2020] [Accepted: 02/26/2020] [Indexed: 12/24/2022]
Abstract
Early-life stress confers profound and lasting risk for developing cognitive, social, emotional, and physical health problems. The effects of stress on the developing brain contribute to this risk, with frontolimbic circuitry particularly susceptible to early experiences, possibly due to its innervation with glucocorticoid receptors and the timing of frontolimbic circuit maturation. To date, the majority of studies on stress and frontolimbic circuitry have employed a categorical approach, comparing stress-exposed versus non-stress-exposed youth. However, there is vast heterogeneity in the nature of stress exposure and in outcomes. Recent forays into understanding the psychobiological effects of stress have employed a dimensional approach focused on experiential, environmental, and temporal factors that influence the association between stress and subsequent vulnerability. This review highlights empirical findings that inform a dimensional approach to understanding the effects of stress on frontolimbic circuitry. We identify the timing, type, severity, controllability, and predictability of stress, and the degree to which a caregiver is involved, as specific features of stress that may play a substantial role in differential outcomes. We propose a framework for the effects of these features of stress on frontolimbic development that may partially determine how heterogeneity in stress exposure influences this circuitry and, ultimately, mental health.
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Affiliation(s)
- Emily M Cohodes
- Department of Psychology, Yale University, New Haven, CT, USA
| | | | | | - Dylan G Gee
- Department of Psychology, Yale University, New Haven, CT, USA
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32
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Early Life Stress and Pediatric Posttraumatic Stress Disorder. Brain Sci 2020; 10:brainsci10030169. [PMID: 32183256 PMCID: PMC7139542 DOI: 10.3390/brainsci10030169] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 03/07/2020] [Accepted: 03/12/2020] [Indexed: 11/16/2022] Open
Abstract
Traumatic stress exposure during critical periods of development may have essential and long-lasting effects on the physical and mental health of individuals. Two thirds of youth are exposed to potentially traumatic experiences by the age of 17, and approximately 5% of adolescents meet lifetime criteria for posttraumatic stress disorder (PTSD). The role of the stress system is the maintenance of homeostasis in the presence of real/perceived and acute/chronic stressors. Early-life stress (ELS) has an impact on neuronal brain networks involved in stress reactions, and could exert a programming effect on glucocorticoid signaling. Studies on pediatric PTSD reveal diverse neuroendocrine responses to adverse events and related long-term neuroendocrine and epigenetic alterations. Neuroendocrine, neuroimaging, and genetic studies in children with PTSD and ELS experiences are crucial in understanding risk and resilience factors, and also the natural history of PTSD.
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33
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Weems CF. Commentary on the Special Issue on Network Analysis: Assessment, Intervention, Theory, and the Nature of Reality: Actualizing the Potential of Network Perspectives on Posttraumatic Stress Disorder. J Trauma Stress 2020; 33:116-125. [PMID: 32061111 DOI: 10.1002/jts.22482] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 12/03/2019] [Indexed: 12/12/2022]
Abstract
This commentary on the Journal of Traumatic Stress special issue on network analysis explores the network perspective on posttraumatic stress disorder (PTSD), emphasizing the advances in research made in this collection of articles. The commentary is organized around the following themes related to actualizing the perspective's methodological, assessment, and intervention potential and the potential shift in the theoretical underpinnings of mental disorders that networks models imply. First, extant data using network analysis suggest that reactions to traumatic stress are more complicated than once thought but that this complexity does not mean efficient, relatively simple heuristics to aid assessment and intervention do not exist. Attention to methodological issues in symptom assessment may help move this aspect of the research forward. Second, the extant research is largely correlational and has not yet established causal linkages, although temporal associations underlying network models are being identified. Prospective and intervention studies employing network analysis are critical. Third, the network perspective of PTSD symptoms may advance research on the mechanisms of risk and resilience (e.g., neurodevelopmental, cognitive behavioral, emotional, and social models) by helping link symptoms to theoretical causal processes. A developmental framework that views the effect of traumatic stress in terms of temporal cascades of reactions with both negative and potentially positive cognitive, behavioral, social, and emotional outcomes fits the network analysis model. Fourth, network models call into question some of the fundamental assumptions underlying the conceptualization of mental disorders, leaving several ontological questions and implications currently unanswered; research examining the implications of the new assumptions is needed.
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Affiliation(s)
- Carl F Weems
- Department of Human Development and Family Studies, Iowa State University, Ames, Iowa, USA
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34
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Idsoe T, Vaillancourt T, Dyregrov A, Hagen KA, Ogden T, Nærde A. Bullying Victimization and Trauma. Front Psychiatry 2020; 11:480353. [PMID: 33519533 PMCID: PMC7841334 DOI: 10.3389/fpsyt.2020.480353] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 12/16/2020] [Indexed: 12/24/2022] Open
Abstract
Bullying victimization and trauma research traditions operate quite separately. Hence, it is unclear from the literature whether bullying victimization should be considered as a form of interpersonal trauma. We review studies that connect bullying victimization with symptoms of PTSD, and in doing so, demonstrate that a conceptual understanding of the consequences of childhood bullying needs to be framed within a developmental perspective. We discuss two potential diagnoses that ought to be considered in the context of bullying victimization: (1) developmental trauma disorder, which was suggested but not accepted as a new diagnosis in the DSM-5 and (2) complex post-traumatic stress disorder, which has been included in the ICD-11. Our conclusion is that these frameworks capture the complexity of the symptoms associated with bullying victimization better than PTSD. We encourage practitioners to understand how exposure to bullying interacts with development at different ages when addressing the consequences for targets and when designing interventions that account for the duration, intensity, and sequelae of this type of interpersonal trauma.
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Affiliation(s)
- Thormod Idsoe
- Norwegian Center for Child Behavioral Development, Oslo, Norway
| | | | - Atle Dyregrov
- Center for Crisis Psychology, University of Bergen, Bergen, Norway
| | | | - Terje Ogden
- Norwegian Center for Child Behavioral Development, Oslo, Norway
| | - Ane Nærde
- Norwegian Center for Child Behavioral Development, Oslo, Norway
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Kribakaran S, Danese A, Bromis K, Kempton MJ, Gee DG. Meta-analysis of Structural Magnetic Resonance Imaging Studies in Pediatric Posttraumatic Stress Disorder and Comparison With Related Conditions. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2020; 5:23-34. [PMID: 31690501 PMCID: PMC6954289 DOI: 10.1016/j.bpsc.2019.08.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/22/2019] [Accepted: 08/19/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Findings on structural brain volume associated with pediatric posttraumatic stress disorder (PTSD) have been variable, and it is unclear whether any structural differences are specific to pediatric PTSD in comparison with adult PTSD or other co-occurring pediatric psychiatric conditions. METHODS We tested volumetric brain differences between pediatric groups with and without PTSD in a region-of-interest meta-analysis. We conducted meta-regressions to test the effects of age and sex on heterogeneous study findings. To assess specificity, we compared pediatric PTSD with the following: adult PTSD, pediatric trauma exposure without PTSD, pediatric depression, and pediatric anxiety. RESULTS In 15 studies examined, pediatric PTSD was associated with smaller total gray matter and cerebral, temporal lobe (total, right, and left), total cerebellar vermis, and hippocampal (total, right, and left) volumes, compared to peers without PTSD. In the pediatric PTSD group, but not the comparison group, we found a trend toward smaller total, right, and left amygdalar volumes. In an external comparison, smaller hippocampal volume was not significantly different between adult and pediatric PTSD groups. Qualitative comparisons with a pediatric trauma exposure without PTSD group, a pediatric depression group, and a pediatric anxiety group revealed differences that may be unique to pediatric PTSD, and others that may be convergent with these related clinical conditions in youth. CONCLUSIONS Pediatric PTSD is associated with structural differences that parallel those associated with adult PTSD. Furthermore, pediatric PTSD appears to be distinct from other related pediatric conditions at the structural level. Future studies employing longitudinal, dimensional, and multimodal neuroimaging approaches will further elucidate the nature of neurobiological differences in pediatric PTSD.
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Affiliation(s)
- Sahana Kribakaran
- Department of Psychology, Yale University, New Haven, Connecticut; Interdepartmental Neuroscience Program, Yale School of Medicine, New Haven, Connecticut
| | - Andrea Danese
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom; Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom; National and Specialist Child and Adolescent Mental Health Services Clinic for Trauma, Anxiety, and Depression, South London and Maudsley National Health Services Foundation Trust, London, United Kingdom
| | - Konstantinos Bromis
- School of Psychology, University of Sussex, Brighton, United Kingdom; School of Electrical and Computer Engineering, National Technical University of Athens, Greece
| | - Matthew J Kempton
- Department of Neuroimaging, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom; Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
| | - Dylan G Gee
- Department of Psychology, Yale University, New Haven, Connecticut.
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Getting effective intervention to individuals exposed to traumatic stress: Dosage, delivery, packaging, and profiles. J Anxiety Disord 2019; 68:102154. [PMID: 31733566 DOI: 10.1016/j.janxdis.2019.102154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
There is strong evidence for the efficacy of empirically supported treatments (ESTs) for posttraumatic stress disorder (PTSD). However, treatment non-completion remains a considerable problem. Of concern with a high dropout rate is that Holmes et al. (2019) found that clients who attended more sessions improved at a greater rate and clients who completed all 12 sessions had the best outcomes. In addition to dropping out of treatment, there are a number of issues related to getting effective intervention to those exposed to traumatic stress. This commentary will discuss dosage and early treatment responders, delivery and packaging, and the need to go beyond diagnosis to build from the findings of Holmes et al. to foster the delivery of effective treatment.
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Weems CF. Posttraumatic risk‐seeking from a neurodevelopmental network perspective. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2019. [DOI: 10.1111/cpsp.12295] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bondar NP, Reshetnikov VV, Burdeeva KV, Merkulova TI. Effect of neonatal dexamethasone treatment on cognitive abilities of adult male mice and gene expression in the hypothalamus. Vavilovskii Zhurnal Genet Selektsii 2019. [DOI: 10.18699/vj19.514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The early postnatal period is critical for the development of the nervous system. Stress during this period causes negative long-term effects, which are manifested at both behavioral and molecular levels. To simulate the elevated glucocorticoid levels characteristic of early-life stress, in our study we used the administration of dexamethasone, an agonist of glucocorticoid receptors, at decreasing doses at the first three days of life (0.5, 0.3, 0.1 mg/kg, s.c.). In adult male mice with neonatal dexamethasone treatment, an increase in the relative weight of the adrenal glands and a decrease in body weight were observed, while the basal level of corticosterone remained unchanged. Dexamethasone treatment in early life had a negative impact on the learning and spatial memory of adult mice in the Morris water maze. We analyzed the effect of elevated glucocorticoid levels in early life on the expression of the Crh, Avp, Gr, and Mr genes involved in the regulation of the HPA axis in the hypothalami of adult mice. The expression level of the mineralocorticoid receptor gene (Mr) was significantly downregulated, and the glucocorticoid receptor gene (Gr) showed a tendency towards decreased expression (p = 0.058) in male mice neonatally treated with dexamethasone, as compared with saline administration. The expression level of the Crh gene encoding corticotropin-releasing hormone was unchanged, while the expression of the vasopressin gene (Avp) was increased in response to neonatal administration of dexamethasone. The obtained results demonstrate a disruption of negative feedback regulation of the HPA axis, which involves glucocorticoid and mineralocorticoid receptors, at the level of the hypothalamus. Malfunction of the HPA axis as a result of activation of the glucocorticoid system in early life may cause the development of cognitive impairment in the adult mice.
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Affiliation(s)
- N. P. Bondar
- Institute of Cytology and Genetics, SB RAS;
Novosibirsk State University
| | | | | | - T. I. Merkulova
- Institute of Cytology and Genetics, SB RAS;
Novosibirsk State University
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Herringa R. Commentary: Paediatric post-traumatic stress disorder from a neurodevelopmental network perspective: reflections on Weems et al. (2019). J Child Psychol Psychiatry 2019; 60:409-411. [PMID: 30919480 DOI: 10.1111/jcpp.13049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Paediatric post-traumatic stress disorder (PTSD) is an incredibly heterogeneous and syndromic disorder that likely has a myriad of underlying neurobiological mechanisms at play. The disorder is even more complicated in youth, given that the expression of illness interacts with ongoing developmental processes. In their review in this issue, Weems and colleagues call for broader network-based approaches for studying the development and expression of PTSD in youth. In this commentary, I highlight some of the important knowledge gaps raised by Weems et al. and propose ways in which future studies may leverage network-based approaches for eventual translation into clinical care. Key concepts include the use of network-based approaches for understanding the emergence and maintenance of PTSD symptom architecture over development, identification of resilient and vulnerable patterns of symptom and brain network architecture following trauma, and consideration of how divergence between biological (e.g. brain) and chronological may inform our understanding of resilient and vulnerable patterns over development. Importantly, advancing and translating this work to clinical care will require larger, prospective studies assessing youth as early in development as possible, and integrating information across multiple research groups and sites.
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Affiliation(s)
- Ryan Herringa
- Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Ewing-Cobbs L, DeMaster D, Watson CG, Prasad MR, Cox CS, Kramer LA, Fischer JT, Duque G, Swank PR. Post-Traumatic Stress Symptoms after Pediatric Injury: Relation to Pre-Frontal Limbic Circuitry. J Neurotrauma 2019; 36:1738-1751. [PMID: 30672379 DOI: 10.1089/neu.2018.6071] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Pre-frontal limbic circuitry is vulnerable to effects of stress and injury. We examined microstructure of pre-frontal limbic circuitry after traumatic brain injury (TBI) or extracranial injury (EI) and its relation to post-traumatic stress symptoms (PTSS). Participants aged 8 to 15 years who sustained mild to severe TBI (n = 53) or EI (n = 26) in motor vehicle incidents were compared with healthy children (n = 38) in a prospective longitudinal study. At the seven-week follow-up, diffusion tensor imaging was obtained in all groups; injured children completed PTSS ratings using a validated scale. Using probabilistic diffusion tensor tractography, pathways were seeded from bilateral amygdalae and hippocampi to estimate the trajectory of white matter connecting them to each other and to targeted pre-frontal cortical (PFC) regions. Microstructure was estimated using fractional anisotropy (FA) in white matter and mean diffusivity (MD) in gray matter. Pre-frontal limbic microstructure was similar across groups, except for reduced FA in the right hippocampus to orbital PFC pathway in the injured versus healthy group. We examined microstructure of components of pre-frontal limbic circuitry with concurrently obtained PTSS cluster scores in the injured children. Neither microstructure nor PTSS scores differed significantly in the TBI and EI groups. Across PTSS factors, specific symptom clusters were related positively to higher FA and MD. Higher hyperarousal, avoidance, and re-experiencing symptoms were associated with higher FA in amygdala to pre-frontal and hippocampus to amygdala pathways. Higher hippocampal MD had a central role in hyperarousal and emotional numbing symptoms. Age moderated the relation of white and gray matter microstructure with hyperarousal scores. Our findings are consistent with models of traumatic stress that implicate disrupted top-down PFC and hippocampal moderation of overreactive subcortical threat arousal systems. Alterations in limbic pre-frontal circuitry and PTSS place children with either brain or body injuries at elevated risk for both current and future psychological health problems.
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Affiliation(s)
- Linda Ewing-Cobbs
- 1 Children's Learning Institute and Department of Pediatrics, University of Texas Health Science Center at Houston, Houston, Texas
| | - Dana DeMaster
- 1 Children's Learning Institute and Department of Pediatrics, University of Texas Health Science Center at Houston, Houston, Texas
| | - Christopher G Watson
- 1 Children's Learning Institute and Department of Pediatrics, University of Texas Health Science Center at Houston, Houston, Texas
| | - Mary R Prasad
- 1 Children's Learning Institute and Department of Pediatrics, University of Texas Health Science Center at Houston, Houston, Texas
| | - Charles S Cox
- 2 Department of Pediatric Surgery, University of Texas Health Science Center at Houston, Houston, Texas
| | - Larry A Kramer
- 4 Department of Interventional Radiology, University of Texas Health Science Center at Houston, Houston, Texas
| | - Jesse T Fischer
- 5 Department of Psychology, University of Houston, Houston, Texas
| | - Gerardo Duque
- 1 Children's Learning Institute and Department of Pediatrics, University of Texas Health Science Center at Houston, Houston, Texas
| | - Paul R Swank
- 3 School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas
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