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Tan J, Zhang G, Hao J, Cai H, Wu D, Su Z, Liu B, Wu M. Progress in the application of molecular imaging in psychiatric disorders. PSYCHORADIOLOGY 2023; 3:kkad020. [PMID: 38666107 PMCID: PMC10917387 DOI: 10.1093/psyrad/kkad020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 09/20/2023] [Accepted: 10/06/2023] [Indexed: 04/28/2024]
Abstract
Psychiatric disorders have always attracted a lot of attention from researchers due to the difficulties in their diagnoses and treatments. Molecular imaging, as an emerging technology, has played an important role in the researchers of various diseases. In recent years, molecular imaging techniques including magnetic resonance spectroscopy, nuclear medicine imaging, and fluorescence imaging have been widely used in the study of psychiatric disorders. This review will briefly summarize the progression of molecular imaging in psychiatric disorders.
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Affiliation(s)
- Jia Tan
- Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu 610041, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu 610041, China
| | - Guangying Zhang
- Department of Radiology, Banan People's Hospital, Chongqing Medical University, Chongqing 400037, China
| | - Jiaqi Hao
- Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu 610041, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu 610041, China
| | - Huawei Cai
- Department of Nuclear Medicine and Laboratory of Clinical Nuclear Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Dingping Wu
- Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Zhuoxiao Su
- Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Beibei Liu
- Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Min Wu
- Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu 610041, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu 610041, China
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Siehl S, Zohair R, Guldner S, Nees F. Gray matter differences in adults and children with posttraumatic stress disorder: A systematic review and meta-analysis of 113 studies and 11 meta-analyses. J Affect Disord 2023; 333:489-516. [PMID: 37086802 DOI: 10.1016/j.jad.2023.04.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 03/21/2023] [Accepted: 04/14/2023] [Indexed: 04/24/2023]
Abstract
BACKGROUND In this systematic review and meta-analysis, we aimed to provide a comprehensive overview of gray matter alterations of adult- and underage patients with posttraumatic stress disorder (PTSD) in comparison to healthy trauma-exposed (TC) and non-exposed (HC) individuals. METHODS We subdivided our groups into patients with PTSD after trauma exposure in adulthood (aa) or childhood (ac) as well as children with PTSD (cc). We identified 113 studies, including 6.800 participants in our review, which we divided into studies focusing on whole-brain and region-of-interest (ROI) analysis. We performed a coordinate-based meta-analysis on 14 studies in the group of aa-PTSD. RESULTS We and found lower gray matter volume in patients with PTSD (aa) in the medial frontal gyrus (PTSD<HC/TC) and Culmen/posterior cingulate cortex (PTSD<TC). Results from ROI-based studies mainly show alterations for patients with PTSD in the prefrontal cortex, hippocampus, anterior cingulate cortex, insula, corpus callosum, and amygdala. LIMITATIONS Due to a limited number of studies reporting whole-brain results, the meta-analyses could only be performed in one subgroup and within this subgroup for a limited number of studies. CONCLUSIONS Our results are in line with psychobiological models of PTSD that associate the identified regions with brain circuits involved in context processing, threat detection and emotion regulation.
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Affiliation(s)
- Sebastian Siehl
- Institute of Medical Psychology and Medical Sociology, University Medical Center Schleswig-Holstein, Kiel University, Kiel, Germany.
| | - Rabia Zohair
- Institute of Medical Psychology and Medical Sociology, University Medical Center Schleswig-Holstein, Kiel University, Kiel, Germany
| | - Stella Guldner
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Frauke Nees
- Institute of Medical Psychology and Medical Sociology, University Medical Center Schleswig-Holstein, Kiel University, Kiel, Germany
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Swanberg KM, Campos L, Abdallah CG, Juchem C. Proton Magnetic Resonance Spectroscopy in Post-Traumatic Stress Disorder-Updated Systematic Review and Meta-Analysis. CHRONIC STRESS (THOUSAND OAKS, CALIF.) 2022; 6:24705470221128004. [PMID: 36237981 PMCID: PMC9551353 DOI: 10.1177/24705470221128004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 09/06/2022] [Indexed: 11/06/2022]
Abstract
A stressor-related disorder wherein traumatic experience precipitates protracted
disruptions to mood and cognition, post-traumatic stress disorder (PTSD) is
associated with wide-ranging abnormalities across the body. While various
methods have investigated these deviations, only proton magnetic resonance
spectroscopy (1H MRS) enables noninvasive measurement of
small-molecule metabolites in the living human. 1H MRS has
correspondingly been employed to test hypotheses about the composition and
function of multiple brain regions putatively involved in PTSD. Here we
systematically review methodological considerations and reported findings, both
positive and negative, of the current 1H-MRS literature in PTSD
(N = 32 studies) to communicate the brain regional metabolite alterations
heretofore observed, providing random-effects model meta-analyses for those most
extensively studied. Our review suggests significant PTSD-associated decreases
in N-acetyl aspartate in bilateral hippocampus and anterior cingulate cortex
with less evident effect in other metabolites and regions. Model heterogeneities
diverged widely by analysis (I2 < 0.01% to 90.1%) and suggested
regional dependence on quantification reference (creatine or otherwise). While
observed variabilities in methods and reported findings suggest that
1H-MRS explorations of PTSD could benefit from methodological
standardization, informing this standardization by quantitative assessment of
the existing literature is currently hampered by its small size and limited
scope.
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Affiliation(s)
- Kelley M. Swanberg
- Department of Biomedical Engineering,
Columbia
University Fu Foundation School of Engineering and Applied
Science, New York, NY, USA
- Kelley M. Swanberg, Department of
Biomedical Engineering, Columbia University Fu Foundation School of Engineering
and Applied Science, 351 Engineering Terrace, 1210 Amsterdam Avenue, New York,
NY 10027, USA.
| | - Leonardo Campos
- Department of Biomedical Engineering,
Columbia
University Fu Foundation School of Engineering and Applied
Science, New York, NY, USA
| | - Chadi G. Abdallah
- Department of Psychiatry, Yale University School of
Medicine, New Haven, CT, USA
- Clinical Neuroscience Division, Department of Veterans Affairs
National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut
Healthcare System, West Haven, CT, USA
- Psychiatry and Behavioral Sciences,
Baylor College
of Medicine, Houston, TX, USA
| | - Christoph Juchem
- Department of Biomedical Engineering,
Columbia
University Fu Foundation School of Engineering and Applied
Science, New York, NY, USA
- Department of Radiology, Columbia University College of Physicians and
Surgeons, New York, NY, USA
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Pankey BS, Riedel MC, Cowan I, Bartley JE, Pintos Lobo R, Hill-Bowen LD, Salo T, Musser ED, Sutherland MT, Laird AR. Extended functional connectivity of convergent structural alterations among individuals with PTSD: a neuroimaging meta-analysis. Behav Brain Funct 2022; 18:9. [PMID: 36100907 PMCID: PMC9472396 DOI: 10.1186/s12993-022-00196-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 08/27/2022] [Indexed: 02/04/2023] Open
Abstract
Background Post-traumatic stress disorder (PTSD) is a debilitating disorder defined by the onset of intrusive, avoidant, negative cognitive or affective, and/or hyperarousal symptoms after witnessing or experiencing a traumatic event. Previous voxel-based morphometry studies have provided insight into structural brain alterations associated with PTSD with notable heterogeneity across these studies. Furthermore, how structural alterations may be associated with brain function, as measured by task-free and task-based functional connectivity, remains to be elucidated. Methods Using emergent meta-analytic techniques, we sought to first identify a consensus of structural alterations in PTSD using the anatomical likelihood estimation (ALE) approach. Next, we generated functional profiles of identified convergent structural regions utilizing resting-state functional connectivity (rsFC) and meta-analytic co-activation modeling (MACM) methods. Finally, we performed functional decoding to examine mental functions associated with our ALE, rsFC, and MACM brain characterizations. Results We observed convergent structural alterations in a single region located in the medial prefrontal cortex. The resultant rsFC and MACM maps identified functional connectivity across a widespread, whole-brain network that included frontoparietal and limbic regions. Functional decoding revealed overlapping associations with attention, memory, and emotion processes. Conclusions Consensus-based functional connectivity was observed in regions of the default mode, salience, and central executive networks, which play a role in the tripartite model of psychopathology. Taken together, these findings have important implications for understanding the neurobiological mechanisms associated with PTSD. Supplementary Information The online version contains supplementary material available at 10.1186/s12993-022-00196-2.
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Del Casale A, Ferracuti S, Barbetti AS, Bargagna P, Zega P, Iannuccelli A, Caggese F, Zoppi T, De Luca GP, Parmigiani G, Berardelli I, Pompili M. Grey Matter Volume Reductions of the Left Hippocampus and Amygdala in PTSD: A Coordinate-Based Meta-Analysis of Magnetic Resonance Imaging Studies. Neuropsychobiology 2022; 81:257-264. [PMID: 35158360 DOI: 10.1159/000522003] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 01/15/2022] [Indexed: 01/18/2023]
Abstract
INTRODUCTION In recent years, research on posttraumatic stress disorder (PTSD) focused on the description of different biological correlates of illness. Morphological changes of different brain regions were involved in PTSD neurophysiopathology, being related to trauma or considered a resilience biomarker. In this meta-analysis, we aimed to investigate the grey matter changes reported in magnetic resonance imaging (MRI) studies on patients who have developed PTSD compared to exposed subjects who did not show a clinical PTSD onset. METHODS We meta-analysed eight peer-reviewed MRI studies conducted on trauma-exposed patients and reported results corrected for false positives. We then conducted global and intergroup comparisons from neuroimaging data of two cohorts of included subjects. The included studies were conducted on 250 subjects, including 122 patients with PTSD and 128 non-PTSD subjects exposed to trauma. RESULTS Applying a family-wise error correction, PTSD subjects compared to trauma-exposed non-PTSD individuals showed a significant volume reduction of a large left-sided grey matter cluster extended from the parahippocampal gyrus to the uncus, including the amygdala. CONCLUSIONS These volumetric reductions are a major structural correlate of PTSD and can be related to the expression of symptoms. Future studies might consider these and other neural PTSD correlates, which may lead to the development of clinical applications for affected patients.
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Affiliation(s)
- Antonio Del Casale
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University, Unit of Psychiatry, "Sant'Andrea" University Hospital, Rome, Italy
| | - Stefano Ferracuti
- Department of Human Neuroscience, Faculty of Medicine and Dentistry, Sapienza University, Rome, Unit of Risk Management, "Sant'Andrea" University Hospital, Rome, Italy
| | - Andrea Steven Barbetti
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University, Unit of Psychiatry, "Sant'Andrea" University Hospital, Rome, Italy
| | - Paride Bargagna
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University, Unit of Psychiatry, "Sant'Andrea" University Hospital, Rome, Italy
| | - Paolo Zega
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University, Unit of Psychiatry, "Sant'Andrea" University Hospital, Rome, Italy
| | - Alessia Iannuccelli
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University, Unit of Psychiatry, "Sant'Andrea" University Hospital, Rome, Italy
| | - Federico Caggese
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University, Unit of Psychiatry, "Sant'Andrea" University Hospital, Rome, Italy
| | - Teodolinda Zoppi
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University, Unit of Psychiatry, "Sant'Andrea" University Hospital, Rome, Italy
| | - Gabriele Pasquale De Luca
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University, Unit of Psychiatry, "Sant'Andrea" University Hospital, Rome, Italy
| | - Giovanna Parmigiani
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Isabella Berardelli
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University, Unit of Psychiatry, "Sant'Andrea" University Hospital, Rome, Italy
| | - Maurizio Pompili
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University, Unit of Psychiatry, "Sant'Andrea" University Hospital, Rome, Italy
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Bremner JD, Hoffman M, Afzal N, Cheema FA, Novik O, Ashraf A, Brummer M, Nazeer A, Goldberg J, Vaccarino V. The environment contributes more than genetics to smaller hippocampal volume in Posttraumatic Stress Disorder (PTSD). J Psychiatr Res 2021; 137:579-588. [PMID: 33168198 PMCID: PMC8345282 DOI: 10.1016/j.jpsychires.2020.10.042] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Studies using structural magnetic resonance imaging (MRI) volumetrics showed smaller hippocampal volume in patients with post-traumatic stress disorder (PTSD). These studies were cross-sectional and did not address whether smaller volume is secondary to stress-induced damage, or whether pre-existing factors account for the findings. The purpose of this study was to use a co-twin case control design to assess the relative contribution of genetic and environmental factors to hippocampal volume in PTSD. METHODS Monozygotic (N = 13 pairs) and dizygotic (N = 21 pairs) twins with a history of Vietnam Era military service, where one brother went to Vietnam and developed PTSD, while his brother did not go to Vietnam or develop PTSD, underwent MR imaging of the brain. Structural MRI scans were used to manually outline the left and right hippocampus on multiple coronal slices, add the areas and adjust for slice thickness to determine hippocampal volume. RESULTS Twins with Vietnam combat-related PTSD had a mean 11% smaller right hippocampal volume in comparison to their twin brothers without combat exposure or PTSD (p < .05). There was no significant interaction by zygosity, suggesting that this was not a predisposing risk factor or genetic effect. CONCLUSIONS These findings are consistent with smaller hippocampal volume in PTSD, and suggest that the effects are primarily due to environmental effects such as the stress of combat.
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Affiliation(s)
- J. Douglas Bremner
- Departments of Psychiatry and Behavioral Sciences, USA, Radiology, and Medicine (Cardiology), USA, Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA, Corresponding author. Dept of Psychiatry & Behavioral Sciences, Emory University School of Medicine, 12 Executive Park Dr NE, USA. (J.D. Bremner)
| | | | - Nadeem Afzal
- Departments of Psychiatry and Behavioral Sciences, USA
| | - Faiz A. Cheema
- Departments of Psychiatry and Behavioral Sciences, USA, The Vietnam Era Twin Registry, Seattle Veterans Administration Epidemiology Research, USA
| | - Olga Novik
- Departments of Psychiatry and Behavioral Sciences, USA, The Vietnam Era Twin Registry, Seattle Veterans Administration Epidemiology Research, USA
| | - Ali Ashraf
- Departments of Psychiatry and Behavioral Sciences, USA
| | | | - Ahsan Nazeer
- Departments of Psychiatry and Behavioral Sciences, USA
| | - Jack Goldberg
- Information Center and Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Viola Vaccarino
- Emory University School of Medicine, Atlanta GA; Atlanta VAMC, Decatur, GA, USA, The Vietnam Era Twin Registry, Seattle Veterans Administration Epidemiology Research, USA
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7
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Wermuth K, Ülsmann D, Borngräber J, Gallinat J, Schulte-Herbrüggen O, Kühn S. Structural signature of trauma: white matter volume in right inferior frontal gyrus is positively associated with use of expressive suppression in recently traumatized individuals. Eur J Psychotraumatol 2021; 12:1837512. [PMID: 33505636 PMCID: PMC7817216 DOI: 10.1080/20008198.2020.1837512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Background: Differences in grey and white matter structure have been found between trauma-exposed individuals with and without PTSD. Yet, it remains unclear which functional processes are underlying these volumetric changes. Avoidance- and suppression-based emotion regulation strategies are candidates of interest since they play an important role in the development and maintenance of PTSD. Method: We used voxel-based morphometry to examine differences in brain structure in 20 recently trauma-exposed individuals and 20 healthy controls in respect of their relation to emotion regulation. Results: We found a significantly larger white matter volume close to the right inferior frontal gyrus (rIFG) in patients compared to healthy controls. White matter volume close to the rIFG was positively correlated with expressive suppression. Conclusion: The region of volumetric white matter difference in our study overlaps with brain regions previously associated with executive functioning and inhibitory control, functions that are known to be impaired in PTSD. Our findings support the idea that impaired executive functions in PTSD might be compensated by suppression-based emotion regulation strategies.
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Affiliation(s)
- Katharina Wermuth
- Max Planck Institute for Human Development, Center for Lifespan Psychology, Berlin, Germany.,St. Hedwig-Krankenhaus, Clinic for Psychiatry and Psychotherapy, Charité University Medicine, Berlin, Germany
| | - Dominik Ülsmann
- Friedrich Von Bodelschwingh-Klinik Clinic for Psychiatry, Psychotherapy and Psychosomatic Medicine, Berlin, Germany
| | - Janine Borngräber
- St. Hedwig-Krankenhaus, Clinic for Psychiatry and Psychotherapy, Charité University Medicine, Berlin, Germany
| | - Jürgen Gallinat
- St. Hedwig-Krankenhaus, Clinic for Psychiatry and Psychotherapy, Charité University Medicine, Berlin, Germany.,University Clinic Hamburg-Eppendorf, Clinic and Policlinic for Psychiatry and Psychotherapy, Hamburg, Germany
| | - Olaf Schulte-Herbrüggen
- St. Hedwig-Krankenhaus, Clinic for Psychiatry and Psychotherapy, Charité University Medicine, Berlin, Germany.,Friedrich Von Bodelschwingh-Klinik Clinic for Psychiatry, Psychotherapy and Psychosomatic Medicine, Berlin, Germany
| | - Simone Kühn
- Max Planck Institute for Human Development, Center for Lifespan Psychology, Berlin, Germany.,University Clinic Hamburg-Eppendorf, Clinic and Policlinic for Psychiatry and Psychotherapy, Hamburg, Germany
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Gosnell SN, Meyer MJ, Jennings C, Ramirez D, Schmidt J, Oldham J, Salas R. Hippocampal Volume in Psychiatric Diagnoses: Should Psychiatry Biomarker Research Account for Comorbidities? CHRONIC STRESS 2020; 4:2470547020906799. [PMID: 32440605 PMCID: PMC7219869 DOI: 10.1177/2470547020906799] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 01/24/2020] [Indexed: 12/26/2022]
Abstract
Background Many research papers claim that patients with specific psychiatric disorders
(major depressive disorder, posttraumatic stress disorder, borderline
personality disorder, alcohol use disorder, and others) have smaller
hippocampi, but most of those reports compared patients to healthy controls.
We hypothesized that if psychiatrically matched controls (psychiatric
control, matched for demographics and psychiatric comorbidities) were used,
much of the biomarker literature in psychiatric research would not
replicate. We used hippocampus and amygdala volume only as examples, as
these are very commonly replicated results in psychiatry biomarker research.
We propose that psychiatry biomarker research could benefit from using
psychiatric controls, as the use of healthy controls results in data that
are not disorder-specific. Method Hippocampus/amygdala volumes were compared between major depressive disorder,
sex-/age-/race-matched healthy control, and psychiatric control
(N = 126/group). Similar comparisons were performed for posttraumatic stress
disorder (N = 67), borderline personality disorder (N = 111), and alcohol
use disorder (N = 136). Results Major depressive disorder patients had smaller left
(p = 8.79 × 10−3) and right (p = 3.13 × 10−3)
hippocampal volumes than healthy control. Posttraumatic stress disorder had
smaller left (p = 0.018) and right (p = 8.64 × 10−4) hippocampi
than healthy control. Borderline personality disorder had smaller right
hippocampus (p = 7.90 × 10−3) and amygdala
(p = 1.49 × 10−3) than healthy control. Alcohol use disorder
had smaller right hippocampus (p = 0.034) and amygdala (p = .024) than
healthy control. No differences were found between any of the four
diagnostic groups and psychiatric control. Conclusion When psychiatric controls were used, there was no difference in hippocampal
or amygdalar volume between any of the diagnoses studied and controls. This
strategy (keeping all possible relevant variables matched between
experimental groups) has been used to advance science for hundreds of years,
and we propose should also be used in biomarker psychiatry research.
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Affiliation(s)
- Savannah N Gosnell
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.,Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA
| | - Matthew J Meyer
- School of Medicine, Baylor College of Medicine, Houston, TX, USA
| | | | - Danna Ramirez
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA
| | | | - John Oldham
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.,The Menninger Clinic, Houston, TX, USA
| | - Ramiro Salas
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.,Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA.,The Menninger Clinic, Houston, TX, USA.,Center for Translational Research on Inflammatory Diseases, Michael E DeBakey VA Medical Center, Houston, TX, USA
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Abstract
Posttraumatic stress disorder is a serious and often disabling syndrome that develops in response to a traumatic event. Many individuals who initially develop the disorder go on to experience a chronic form of the condition that in some cases can last for many years. Among these patients, psychiatric and medical comorbidities are common, including early onset of age-related conditions such as chronic pain, cardiometabolic disease, neurocognitive disorders, and dementia. The hallmark symptoms of posttraumatic stress-recurrent sensory-memory reexperiencing of the trauma(s)-are associated with concomitant activations of threat- and stress-related neurobiological pathways that occur against a tonic backdrop of sleep disturbance and heightened physiological arousal. Emerging evidence suggests that the molecular consequences of this stress-perpetuating syndrome include elevated systemic levels of oxidative stress and inflammation. In this article we review evidence for the involvement of oxidative stress and inflammation in chronic PTSD and the neurobiological consequences of these processes, including accelerated cellular aging and neuroprogression. Our aim is to update and expand upon previous reviews of this rapidly developing literature and to discuss magnetic resonance spectroscopy as an imaging technology uniquely suited to measuring oxidative stress and inflammatory markers in vivo. Finally, we highlight future directions for research and avenues for the development of novel therapeutics targeting oxidative stress and inflammation in patients with PTSD.
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Affiliation(s)
- Mark W Miller
- From the Department of Psychiatry, Boston University School of Medicine (Drs. M. W. Miller, Wolf, and D. R. Miller); National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, MA (Drs. M. W. Miller, Wolf, and D. R. Miller); Harvard Medical School and Department of Radiology, Brigham & Women's Hospital, Boston, MA (Dr. Lin)
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10
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Quadrelli S, Mountford C, Ramadan S. Systematic review of in-vivo neuro magnetic resonance spectroscopy for the assessment of posttraumatic stress disorder. Psychiatry Res Neuroimaging 2018; 282:110-125. [PMID: 30097168 DOI: 10.1016/j.pscychresns.2018.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 07/18/2018] [Accepted: 07/19/2018] [Indexed: 10/28/2022]
Abstract
Posttraumatic stress disorder (PTSD) is a trauma and stressor-related disorder that results in complex somatic, cognitive, affective and behavioural effects, after exposure to traumatic event(s). Conventional imaging (T1 and T2 weighted magnetic resonance imaging) has little to offer in the way of diagnosis of mental health conditions such as PTSD and there is currently no objective diagnostic test available. Magnetic resonance spectroscopy (MRS) allows for non-invasive measurement of metabolites and neurochemicals in the brain using a conventional MRI scanner and offers the potential to predict, diagnose and monitor PTSD. This systematic review summarises the results of 24 MRS studies, performed between 1998 and 2017, to measure neurochemical differences, occurring as a consequence of PTSD. The most consistent finding in subjects with PTSD is lower N-acetylaspartate levels in the hippocampus and anterior cingulate cortex, with and without atrophic change. More recent studies, using more advanced techniques and modern hardware, have shown evidence of glutamatergic dysfunction and differences in gamma-aminobutyric acid levels in the brain of patients with PTSD. Conflicting results have been reported in choline-containing metabolites and there is emerging evidence of glutathione being affected. Myo-inositol and creatine are unchanged in the majority of studies.
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Affiliation(s)
- Scott Quadrelli
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW 2308, Australia; Department of Radiology, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD 4024, Australia; The Translational Research Institute, Woolloongabba, QLD 4024, Australia; The University of Queensland, St Lucia, QLD 4072, Australia.
| | - Carolyn Mountford
- The Translational Research Institute, Woolloongabba, QLD 4024, Australia
| | - Saadallah Ramadan
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW 2308, Australia
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11
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Posttraumatic stress disorder symptom severity is associated with left hippocampal volume reduction: a meta-analytic study. CNS Spectr 2017; 22:363-372. [PMID: 27989265 DOI: 10.1017/s1092852916000833] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Many studies have reported hippocampal volume reductions associated with posttraumatic stress disorder (PTSD), while others have not. Here we provide an updated meta-analysis of such reductions associated with PTSD and evaluate the association between symptom severity and hippocampal volume. METHODS A total of 37 studies met the criteria for inclusion in the meta-analysis. Mean effect sizes (Hedges' g) and 95% confidence intervals (CI 95%) were computed for each study and then averaged to obtain an overall mean effect size across studies. Meta-regression was employed to examine the relationship between PTSD symptom severity and hippocampal volume. RESULTS Results showed that PTSD is associated with significant bilateral reduction of the hippocampus (left hippocampus effect size=-0.400, p<0.001, 5.24% reduction; right hippocampus effect size=-0.462, p<0.001, 5.23% reduction). Symptom severity, as measured by the Clinician-Administered PTSD Scale (CAPS), was significantly associated with decreased left, but not right, hippocampal volume. CONCLUSIONS PTSD was associated with significant bilateral volume reduction of the hippocampus. Increased symptom severity was significantly associated with reduced left hippocampal volume. This finding is consistent with the hypothesis that PTSD is more neurotoxic to the left hippocampus than to the right. However, whether the association between PTSD and lower hippocampal volume reflects a consequence of or a predisposition to PTSD remains unclear. More prospective studies are needed in this area.
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Im JJ, Namgung E, Choi Y, Kim JY, Rhie SJ, Yoon S. Molecular Neuroimaging in Posttraumatic Stress Disorder. Exp Neurobiol 2016; 25:277-295. [PMID: 28035179 PMCID: PMC5195814 DOI: 10.5607/en.2016.25.6.277] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 11/11/2016] [Accepted: 11/14/2016] [Indexed: 01/10/2023] Open
Abstract
Over the past decade, an increasing number of neuroimaging studies have provided insight into the neurobiological mechanisms of posttraumatic stress disorder (PSTD). In particular, molecular neuroimaging techniques have been employed in examining metabolic and neurochemical processes in PTSD. This article reviews molecular neuroimaging studies in PTSD and focuses on findings using three imaging modalities including positron emission tomography (PET), single photon emission computed tomography (SPECT), and magnetic resonance spectroscopy (MRS). Although there were some inconsistences in the findings, patients with PTSD showed altered cerebral metabolism and perfusion, receptor bindings, and metabolite profiles in the limbic regions, medial prefrontal cortex, and temporal cortex. Studies that have investigated brain correlates of treatment response are also reviewed. Lastly, the limitations of the molecular neuroimaging studies and potential future research directions are discussed.
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Affiliation(s)
- Jooyeon Jamie Im
- Ewha Brain Institute, Ewha Womans University, Seoul 03760, Korea.; Interdisciplinary Program in Neuroscience, College of Natural Sciences, Seoul National University, Seoul 08826, Korea
| | - Eun Namgung
- Ewha Brain Institute, Ewha Womans University, Seoul 03760, Korea.; Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul 03760, Korea
| | - Yejee Choi
- Ewha Brain Institute, Ewha Womans University, Seoul 03760, Korea.; Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul 03760, Korea
| | - Jung Yoon Kim
- Ewha Brain Institute, Ewha Womans University, Seoul 03760, Korea.; Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul 03760, Korea
| | - Sandy Jeong Rhie
- Ewha Brain Institute, Ewha Womans University, Seoul 03760, Korea.; College of Pharmacy and Division of Life and Pharmaceutical Sciences, Ewha Womans University, Seoul 03760, Korea
| | - Sujung Yoon
- Ewha Brain Institute, Ewha Womans University, Seoul 03760, Korea.; Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul 03760, Korea
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13
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Abstract
Previous studies have demonstrated that patients with posttraumatic stress disorder (PTSD) caused by different types of trauma may show divergence in epidemiology, clinical manifestation and treatment outcome. However, it is still unclear whether this divergence has neuroanatomic correlates in PTSD brains. To elucidate the general and trauma-specific cortical morphometric alterations, we performed a meta-analysis of grey matter (GM) changes in PTSD (N = 246) with different traumas and trauma-exposed controls (TECs, N = 347) using anisotropic effect-size signed differential mapping and its subgroup analysis. Our results revealed general GM reduction (GMR) foci in the prefrontal-limbic-striatal system of PTSD brains when compared with those of TECs. Notably, the GMR patterns were trauma-specific. For PTSD by single-incident traumas, GMR foci were found in bilateral medial prefrontal cortex (mPFC), anterior cingulate cortex (ACC), insula, striatum, left hippocampus and amygdala; and for PTSD by prolonged traumas in the left insula, striatum, amygdala and middle temporal gyrus. Moreover, Clinician-Administered PTSD Scale scores were found to be negatively associated with the GM changes in bilateral ACC and mPFC. Our study indicates that the GMR patterns of PTSD are associated with specific traumas, suggesting a stratified diagnosis and treatment for PTSD patients.
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Yang ZY, Quan H, Peng ZL, Zhong Y, Tan ZJ, Gong QY. Proton magnetic resonance spectroscopy revealed differences in the glutamate + glutamine/creatine ratio of the anterior cingulate cortex between healthy and pediatric post-traumatic stress disorder patients diagnosed after 2008 Wenchuan earthquake. Psychiatry Clin Neurosci 2015; 69:782-90. [PMID: 26171979 DOI: 10.1111/pcn.12332] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 06/09/2015] [Accepted: 07/03/2015] [Indexed: 02/05/2023]
Abstract
AIMS Earthquakes always leave many surviving teenagers suffering from various mental problems, such as post-traumatic stress disorder (PTSD). We studied the metabolites in current and remitted pediatric PTSD patients and healthy controls after an earthquake, aiming to find the neurochemistry differences in these teenagers. METHODS Proton magnetic resonance spectroscopy ((1) H-MRS) was performed in the anterior cingulate cortex (ACC) of 21 healthy, 10 PTSD and 23 remitted subjects. RESULTS Significantly lower glutamate + glutamine/creatine (Glx/Cr) levels in the ACC (1.15 ± 0.14 vs 1.37 ± 0.08, P = 0.047) were found in PTSD subjects relative to remitted subjects; and significantly lower Glx/Cr levels in the ACC (1.37 ± 0.08 vs 1.59 ± 0.10, P = 0.045) were found in remitted subjects relative to healthy controls. CONCLUSIONS Our findings imply that the Glx/Cr ratio in the ACC can be used to differentiate not only between healthy and pediatric PTSD patients, but also between the current and remitted phases of pediatric PTSD. The changes in the Glx/Cr ratio may be caused by brain dysfunction in the current phase and recovery in the remitted phase.
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Affiliation(s)
- Zhi-Yong Yang
- Laboratory of Biological & Medical Physics and Key Laboratory of Artificial Micro- & Nano-structures of Ministry of Education, School of Physics and Technology, Wuhan University, Wuhan, China.,Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hong Quan
- Laboratory of Biological & Medical Physics and Key Laboratory of Artificial Micro- & Nano-structures of Ministry of Education, School of Physics and Technology, Wuhan University, Wuhan, China
| | - Zu-Lai Peng
- Institute of Mental Health, Peking University, Beijing, China
| | - Yang Zhong
- Laboratory of Biological & Medical Physics and Key Laboratory of Artificial Micro- & Nano-structures of Ministry of Education, School of Physics and Technology, Wuhan University, Wuhan, China
| | - Zhi-Jie Tan
- Laboratory of Biological & Medical Physics and Key Laboratory of Artificial Micro- & Nano-structures of Ministry of Education, School of Physics and Technology, Wuhan University, Wuhan, China
| | - Qi-Yong Gong
- Huaxi MR Research Center, Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
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15
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O'Doherty DCM, Chitty KM, Saddiqui S, Bennett MR, Lagopoulos J. A systematic review and meta-analysis of magnetic resonance imaging measurement of structural volumes in posttraumatic stress disorder. Psychiatry Res 2015; 232:1-33. [PMID: 25735885 DOI: 10.1016/j.pscychresns.2015.01.002] [Citation(s) in RCA: 232] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 11/15/2014] [Accepted: 01/08/2015] [Indexed: 12/15/2022]
Abstract
Posttraumatic stress disorder (PTSD) is a debilitating condition associated with mild to moderate cognitive impairment and with a prevalence rate of up to 22% in veterans. This systematic review and quantitative meta-analysis explore volumetric differences of three key structural brain regions (hippocampus, amygdala and anterior cingulate cortex (ACC)), all of which have been implicated in dysfunction of both salience network (SN) and default mode network (DMN) in PTSD sufferers. A literature search was conducted in Embase, Medline, PubMed and PsycINFO in May 2013. Fifty-nine volumetric analyses from 44 articles were examined and included (36 hippocampus, 14 amygdala and nine ACC) with n=846 PTSD participants, n=520 healthy controls (HCs) and n=624 traumatised controls (TCs). Nine statistical tests were performed for each of the three regions of interest (ROIs), measuring volume differences in PTSD subjects, healthy and traumatised controls. Hippocampal volume was reduced in subjects with PTSD, with a greater reduction in the left hippocampus. A medium effect size reduction was found in bilateral amygdala volume when compared with findings in healthy controls; however, no significant differences in amygdala volume between PTSD subjects and trauma-exposed controls were found. Significant volume reductions were found bilaterally in the ACC. While often well matched with their respective control groups, the samples of PTSD subjects composed from the source studies used in the meta-analyses are limited in their homogeneity. The current findings of reduced hippocampal volume in subjects with PTSD are consistent with the existing literature. Amygdala volumes did not show significant reductions in PTSD subjects when compared with volumes in trauma-exposed controls-congruous with reported symptoms of hypervigilance and increased propensity in acquisition of conditioned fear memories-but a significant reduction was found in the combined left and right hemisphere volume analysis when compared with healthy controls. Bilateral volume reductions in the ACC may underpin the attentional deficits and inabilities to modulate emotions that are characteristically associated with PTSD patients.
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Affiliation(s)
- Daniel C M O'Doherty
- Brain and Mind Research Institute, University of Sydney, 100 Mallett Street, Camperdown, NSW 2050, Australia.
| | - Kate M Chitty
- Brain and Mind Research Institute, University of Sydney, 100 Mallett Street, Camperdown, NSW 2050, Australia.
| | - Sonia Saddiqui
- Faculty of Human Sciences, Macquarie University, Sydney, Australia.
| | - Maxwell R Bennett
- Brain and Mind Research Institute, University of Sydney, 100 Mallett Street, Camperdown, NSW 2050, Australia.
| | - Jim Lagopoulos
- Brain and Mind Research Institute, University of Sydney, 100 Mallett Street, Camperdown, NSW 2050, Australia.
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Li L, Wu M, Liao Y, Ouyang L, Du M, Lei D, Chen L, Yao L, Huang X, Gong Q. Grey matter reduction associated with posttraumatic stress disorder and traumatic stress. Neurosci Biobehav Rev 2014; 43:163-72. [DOI: 10.1016/j.neubiorev.2014.04.003] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 04/05/2014] [Accepted: 04/10/2014] [Indexed: 10/25/2022]
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17
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Anatomical deficits in adult posttraumatic stress disorder: a meta-analysis of voxel-based morphometry studies. Behav Brain Res 2014; 270:307-15. [PMID: 24859173 DOI: 10.1016/j.bbr.2014.05.021] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 05/12/2014] [Accepted: 05/15/2014] [Indexed: 02/05/2023]
Abstract
Evidence from previous anatomical studies indicate that widespread brain regions are involved in the pathogenesis of posttraumatic stress disorder (PTSD). The aim of the present study was to quantitatively integrate the literature on structural abnormalities seen on individuals with PTSD. Twenty voxel-based analysis studies were analysed through a comprehensive series of meta-analyses. Compared with healthy controls, PTSD patients showed a significant reduction in grey matter (GM) in the left anterior cingulate gyrus (ACC) at the whole-brain level. Several brain regions, including the left ACC, the left insula and the right parahippocampal gyrus were significantly smaller in individuals with PTSD than in trauma-exposed healthy subjects. Furthermore, the clinician-administered PTSD scale scores were negatively correlated with GM in the left ACC and positively correlated with GM in the left insula. In addition, PTSD patients who experienced accidental or non-accidental trauma had anatomical changes in different brain regions. These results suggest that the smaller ACC and insular cortex within the limbic-prefrontal circuit contribute to the pathogenesis of PTSD. Moreover, the PTSD patients with different types of trauma may have different cerebral deficits.
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18
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Shu XJ, Xue L, Liu W, Chen FY, Zhu C, Sun XH, Wang XP, Liu ZC, Zhao H. More vulnerability of left than right hippocampal damage in right-handed patients with post-traumatic stress disorder. Psychiatry Res 2013; 212:237-44. [PMID: 23149034 DOI: 10.1016/j.pscychresns.2012.04.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Revised: 04/09/2012] [Accepted: 04/12/2012] [Indexed: 01/14/2023]
Abstract
Previous studies have shown hippocampal abnormalities in people with post-traumatic stress disorder (PTSD), but findings of diminished volume in shortages in the hippocampus have been inconsistent. In this study, we investigated changes in hippocampal volume and neuronal metabolites in right-handed PTSD patients to determine their possible relationship(s) with PTSD severity. We performed a case-control study of 11 right-handed PTSD patients and 11 healthy controls using magnetic resonance imaging (MRI) and proton magnetic resonance spectroscopy ((1)H MRS). Hippocampal volume and metabolite ratios of N-acetylaspartate (NAA) to creatine (Cr) (NAA/Cr) and choline compounds (Cho) to Cr (Cho/Cr) were calculated. The severity of PTSD was evaluated by the Clinician-Administered PTSD Scale (CAPS). Significantly decreased left and total normalized hippocampal volumes were found in PTSD patients compared with controls (6.6% for the left hippocampus, 5.5% for total hippocampus). Also, the bilateral hippocampal NAA/Cr ratio of PTSD patients was significantly reduced compared with controls. The volume of the left hippocampus was negatively correlated to the CAPS total and CPAS-C scores. The left hippocampal NAA/Cr ratio was negatively correlated to the CAPS-total, CAPS-B, CAPS-C, and CAPS-D scores. The CAPS total and the CAPS-B scores were positively correlated to the Cho/Cr ratio of the right hippocampus. Our results indicate that hippocampal dysfunction is asymmetric in right-handed PTSD patients, with the left side affected more than the right.
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Affiliation(s)
- Xi-Ji Shu
- Department of Pathology and Pathophysiology, Medical School, Jianghan University, Wuhan 430056, Hubei, China
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Gray matter correlates of posttraumatic stress disorder: a quantitative meta-analysis. Biol Psychiatry 2013; 73:70-4. [PMID: 22840760 DOI: 10.1016/j.biopsych.2012.06.029] [Citation(s) in RCA: 183] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Revised: 06/01/2012] [Accepted: 06/25/2012] [Indexed: 11/21/2022]
Abstract
BACKGROUND Since the inception of the diagnosis posttraumatic stress disorder (PTSD), attempts have been undertaken to understand why only a subpopulation of individuals exposed to trauma develops PTSD. Cerebral gray matter reductions have been suggested to be a crucial pathobiological marker of PTSD. However, a quantitative meta-analysis of whole-brain voxel-based morphometry studies is lacking. METHODS Here, we investigated concurrence across voxel-based morphometry studies in PTSD compared with trauma-exposed individuals without PTSD (all together nine studies with 319 subjects) by means of activation likelihood estimation. RESULTS We identified brain regions of consistent gray matter reduction in anterior cingulate cortex, ventromedial prefrontal cortex, left temporal pole/middle temporal gyrus, and left hippocampus in PTSD patients compared with individuals exposed to trauma without PTSD. CONCLUSIONS This is the first quantitative whole-brain meta-analysis showing brain structure deficits in traumatized subjects with PTSD compared with trauma-exposed healthy control subjects. The gray matter deficit profile overlaps with brain networks of emotion processing, fear extinction, and emotion regulation known to be affected in PTSD. Although the data cannot clarify if this is a predisposition or a consequence of the disease, the results may facilitate the need to control for structural characteristics in future functional brain studies.
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20
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Guo M, Chen F, Guo JC, Lu CZ, Jiang XL, Liu T, Li M, Song W. Study of the hippocampus and the anterior cingulate gyrus by proton MR spectroscopy in patients with post-traumatic stress disorder. ASIAN PAC J TROP MED 2012; 5:162-4. [PMID: 22221763 DOI: 10.1016/s1995-7645(12)60017-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Revised: 12/15/2011] [Accepted: 01/15/2012] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To explore the characteristics of metabolic changes in patients with post-traumatic stress disorder through 1H-MRS in neuroanatomical circuit comparing with age-matches controls. METHODS Fifty patients with post-traumatic stress disorder and 50 gender-and age-matched normal controls were involved. The neurochemical abnormalities including the levels of choline (Cho)/creatine(Cr) and N-acetylaspartate (NAA)/Cr were measured respectively in hippocampus and the anterior cingulate gyrus with three-dimension 1H-proton spectroscopy(3D 1H-MRS). RESULTS The values of NAA/Cr ratios in hippocampus and the anterior cingulate gyrus were significant lower in patients with post-traumatic stress disorder(1.71±0.32, left 1.58±0.29, right 1.55±0.31) than that in controls(2.24±0.41, left 1.98±0.27, right 2.02±0.36)(P<0.05), but the values of Cho/Cr in hippocampus(left 1.64±0.23, right 1.66±0.34) were no significant with that of controls (left 1.48±0.29, right 1.54±0.38). Values of Cho/Cr in cingulate gyrus were significant higher in post-traumatic stress disorder patients (1.88±0.44) than that in controls (1.37.±0.32) (P<0.05). CONCLUSIONS The results indicate some special neurochemical and histological structure changes in post-traumatic stress disorder patients, which might occurre earlier in anterior cingulate gyrusthe than in hippocampus.
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Affiliation(s)
- Min Guo
- Psychological Research Center, Hainan Provincial People's Hospital, China
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21
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Zhang J, Tan Q, Yin H, Zhang X, Huan Y, Tang L, Wang H, Xu J, Li L. Decreased gray matter volume in the left hippocampus and bilateral calcarine cortex in coal mine flood disaster survivors with recent onset PTSD. Psychiatry Res 2011; 192:84-90. [PMID: 21498053 DOI: 10.1016/j.pscychresns.2010.09.001] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2010] [Revised: 09/03/2010] [Accepted: 09/04/2010] [Indexed: 10/18/2022]
Abstract
Although limbic structure changes have been found in chronic and recent onset post-traumatic stress disorder (PTSD) patients, there are few studies about brain structure changes in recent onset PTSD patients after a single extreme and prolonged trauma. In the current study, 20 coal mine flood disaster survivors underwent magnetic resonance imaging (MRI). Voxel-based morphometry (VBM) and region of interest (ROI) techniques were used to detect the gray matter and white matter volume changes in 10 survivors with recent onset PTSD and 10 survivors without PTSD. The correlation between the Clinician-Administered PTSD Scale (CAPS) and gray matter density in the ROI was also studied. Compared with survivors without PTSD, survivors with PTSD had significantly decreased gray matter volume and density in left anterior hippocampus, left parahippocampal gyrus, and bilateral calcarine cortex. The CAPS score correlated negatively with the gray matter density in bilateral calcarine cortex and left hippocampus in coal mine disaster survivors. Our study suggests that the gray matter volume and density of limbic structure decreased in recent onset PTSD patients who were exposed to extreme trauma. PTSD symptom severity was associated with gray matter density in calcarine cortex and hippocampus.
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Affiliation(s)
- Jian Zhang
- Department of Respiratory Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, 710032, China
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22
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Jackowski A, Perera TD, Abdallah CG, Garrido G, Tang CY, Martinez J, Mathew SJ, Gorman JM, Rosenblum LA, Smith EL, Dwork AJ, Shungu DC, Kaffman A, Gelernter J, Coplan JD, Kaufman J. Early-life stress, corpus callosum development, hippocampal volumetrics, and anxious behavior in male nonhuman primates. Psychiatry Res 2011; 192:37-44. [PMID: 21377844 PMCID: PMC4090111 DOI: 10.1016/j.pscychresns.2010.11.006] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2009] [Revised: 11/10/2010] [Accepted: 11/12/2010] [Indexed: 12/01/2022]
Abstract
Male bonnet monkeys (Macaca radiata) were subjected to the variable foraging demand (VFD) early stress paradigm as infants, MRI scans were completed an average of 4 years later, and behavioral assessments of anxiety and ex-vivo corpus callosum (CC) measurements were made when animals were fully matured. VFD rearing was associated with smaller CC size, CC measurements were found to correlate with fearful behavior in adulthood, and ex-vivo CC assessments showed high consistency with earlier MRI measures. Region of interest (ROI) hippocampus and whole brain voxel-based morphometry assessments were also completed and VFD rearing was associated with reduced hippocampus and inferior and middle temporal gyri volumes. The animals were also characterized according to serotonin transporter genotype (5-HTTLPR), and the effect of genotype on imaging parameters was explored. The current findings highlight the importance of future research to better understand the effects of stress on brain development in multiple regions, including the corpus callosum, hippocampus, and other regions involved in emotion processing. Nonhuman primates provide a powerful model to unravel the mechanisms by which early stress and genetic makeup interact to produce long-term changes in brain development, stress reactivity, and risk for psychiatric disorders.
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Affiliation(s)
- Andrea Jackowski
- LiNC, Departamento de Psiquiatria, Universidade Federal de São Paulo, SP, Brazil
| | - Tarique D. Perera
- Department of Biological Psychiatry, New York State Psychiatric Institute, College of Physicians and Surgeons of Columbia University, New York, NY, USA
| | - Chadi G. Abdallah
- Nonhuman Primate Facility, Department of Psychiatry, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Griselda Garrido
- Serviço de Informática Médica, Instituto do Coração, Universidade de São Paulo, SP, Brazil
| | - Cheuk Y. Tang
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA
| | - Jose Martinez
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA
| | - Sanjay J. Mathew
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA
| | - Jack M. Gorman
- Comprehensive NeuroScience Inc. (JMG), White Plains, NY, USA
| | - Leonard A. Rosenblum
- Nonhuman Primate Facility, Department of Psychiatry, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Eric L.P. Smith
- Nonhuman Primate Facility, Department of Psychiatry, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Andrew J. Dwork
- Department of Biological Psychiatry, New York State Psychiatric Institute, College of Physicians and Surgeons of Columbia University, New York, NY, USA
- Department of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, and Department of Pathology and Cell Biology, College of Physicians and Surgeons of Columbia University, New York, NY, USA
| | - Dikoma C. Shungu
- Departments of Radiology, Psychiatry and Biophysics, Weill Medical College of Cornell University, New York, NY, USA
| | - Arie Kaffman
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Joel Gelernter
- Division of Human Genetics (Psychiatry), Yale University School of Medicine, New Haven, CT
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Jeremy D. Coplan
- Department of Biological Psychiatry, New York State Psychiatric Institute, College of Physicians and Surgeons of Columbia University, New York, NY, USA
- Nonhuman Primate Facility, Department of Psychiatry, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Joan Kaufman
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
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Woon FL, Sood S, Hedges DW. Hippocampal volume deficits associated with exposure to psychological trauma and posttraumatic stress disorder in adults: a meta-analysis. Prog Neuropsychopharmacol Biol Psychiatry 2010; 34:1181-8. [PMID: 20600466 DOI: 10.1016/j.pnpbp.2010.06.016] [Citation(s) in RCA: 243] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2010] [Revised: 05/30/2010] [Accepted: 06/16/2010] [Indexed: 01/14/2023]
Abstract
Trauma exposure itself in the absence of posttraumatic stress disorder (PTSD) may be associated with hippocampal volume deficits. We meta-analytically compared hippocampal volumes in PTSD subjects, in trauma-exposed subjects without PTSD, and in trauma-unexposed subjects. Using the words and phrases PTSD, neuroimaging, hippocampus, brain, violence, trauma, abuse, rape, war, combat, accident, and disaster, we searched major computerized databases to obtain candidate studies through 2008 for inclusion. We identified 39 hippocampal volumetric studies in adults with PTSD compared to control groups consisting of either trauma-exposed controls without PTSD or trauma-unexposed controls, or both. We meta-analytically compared left, right, and total hippocampal volumes between 1) PTSD subjects and a trauma-unexposed group, 2) PTSD subjects and a trauma-exposed group without PTSD, and 3) a trauma-unexposed group and a trauma-exposed group without PTSD. Hippocampal volumes were smaller in the PTSD group and trauma-exposed group without PTSD compared to the trauma-unexposed group. Further, the right hippocampus was smaller in the PTSD group compared to the trauma-exposed group without PTSD. Additionally, the right hippocampus was larger than the left in the PTSD and trauma-unexposed groups but not in the trauma-exposed group without PTSD. Hippocampal volume reduction is associated with trauma exposure independent of PTSD diagnosis, albeit additional hippocampal reduction was found in PTSD compared to the trauma-exposed group without PTSD.
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Affiliation(s)
- Fu Lye Woon
- Psychology Department, 1001 SWKT, Brigham Young University, Provo, UT 84602, USA
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24
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Premorbid brain volume estimates and reduced total brain volume in adults exposed to trauma with or without posttraumatic stress disorder: a meta-analysis. Cogn Behav Neurol 2010; 23:124-9. [PMID: 20535062 DOI: 10.1097/wnn.0b013e3181e1cbe1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The primary objective of this study was to meta-analytically investigate whether total brain volume (TBV) and total intracranial volume (TICV) differ between adult participants with posttraumatic stress disorder (PTSD) and controls. BACKGROUND TICV reaches maximum growth by early adolescence and provides an estimate of premorbid brain size. Little work has directly examined TBV in PTSD participants, although limited evidence suggests that deficits in brain volume may occur. METHODS Using electronic databases, we identified articles containing TBV and TICV data for adult PTSD participants. Data were extracted and effect sizes were calculated. RESULTS We identified 8 studies with TBV data (105 PTSD participants and 122 trauma-unexposed controls) and 2 studies with TICV data (18 PTSD participants and 25 trauma-unexposed controls). TBV was significantly smaller in PTSD participants compared with trauma-unexposed controls. In contrast, TICV did not differ between these groups. There were no significant differences in TBV and TICV between PTSD and trauma-exposed controls. CONCLUSIONS TBV is significantly smaller in adult PTSD participants compared with trauma-unexposed controls. TICV did not differ significantly between these groups, suggesting that a deficit in TBV occurred at some point after the attainment of maximum brain volume in the PTSD group.
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25
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Sui SG, Wu MX, King ME, Zhang Y, Ling L, Xu JM, Weng XC, Duan L, Shan BC, Li LJ. Abnormal grey matter in victims of rape with PTSD in Mainland China: a voxel-based morphometry study. Acta Neuropsychiatr 2010; 22:118-26. [PMID: 26952803 DOI: 10.1111/j.1601-5215.2010.00459.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
UNLABELLED Sui SG, Wu MX, King ME, Zhang Y, Ling L, Xu JM, Weng XC, Duan L, Shan BC, Li LJ. Abnormal grey matter in victims of rape with PTSD in Mainland China: a voxel-based morphometry study. OBJECTIVE This study examined changes in brain grey matter in victims of rape (VoR) with and without post-traumatic stress disorder (PTSD). Previous research has focused on PTSD caused by various traumatic events, such as war and disaster, among others. Although considerable research has focused on rape-related PTSD, limited studies have been carried out in the context of Mainland China. METHODS The study included 11 VoR with PTSD, 8 VoR without PTSD and 12 healthy comparison (HC) subjects. We used voxel-based morphometry to explore changes in brain grey-matter density (GMD) by applying statistical parametric mapping to high-resolution magnetic resonance images. RESULTS Compared with HC, VoR with PTSD showed significant GMD reductions in the bilateral medial frontal cortex, left middle frontal cortex, middle temporal gyrus and fusiform cortex and significant GMD increases in the right posterior cingulate cortex, postcentral cortex, bilateral precentral cortex and inferior parietal lobule. Compared to VoR without PTSD, VoR with PTSD showed significant GMD reductions in the right uncus, left middle temporal gyrus, and the fusiform cortex, and increases in the left precentral cortex, inferior parietal lobule and right post-central cortex. CONCLUSION The findings of abnormal GMD in VoR with PTSD support the hypothesis that PTSD is associated with widespread anatomical changes in the brain. The medial frontal cortex, precentral cortex, posterior cingulate cortex, post-central cortex and inferior parietal lobule may play important roles in the neuropathology of PTSD.
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Affiliation(s)
- Shuang Ge Sui
- 1Mental Health Institute, Second Xiangya Hospital, Central-South University, Changsha, Hunan 410011, P. R. China
| | - Ming Xiang Wu
- 2ShenZhen People's Hospital, Guangdong 518020, P. R. China
| | - Mark E King
- 3Faculty of Education, The University of Hong Kong, HHSAR, P. R. China
| | - Yan Zhang
- 1Mental Health Institute, Second Xiangya Hospital, Central-South University, Changsha, Hunan 410011, P. R. China
| | - Li Ling
- 3Faculty of Education, The University of Hong Kong, HHSAR, P. R. China
| | - Jian Min Xu
- 2ShenZhen People's Hospital, Guangdong 518020, P. R. China
| | - Xu Chu Weng
- 4Laboratory for Higher Brain Function, Institute of Psychology, Chinese Academy of Sciences, Beijing100012, P. R. China
| | - Lian Duan
- 1Mental Health Institute, Second Xiangya Hospital, Central-South University, Changsha, Hunan 410011, P. R. China
| | - Bao Ci Shan
- 5Institute of High Energy Physics, Chinese Academy of Sciences, Beijing 100049, P. R. China
| | - Ling Jiang Li
- 1Mental Health Institute, Second Xiangya Hospital, Central-South University, Changsha, Hunan 410011, P. R. China
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Nardo D, Högberg G, Looi JCL, Larsson S, Hällström T, Pagani M. Gray matter density in limbic and paralimbic cortices is associated with trauma load and EMDR outcome in PTSD patients. J Psychiatr Res 2010; 44:477-85. [PMID: 19942229 DOI: 10.1016/j.jpsychires.2009.10.014] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2009] [Revised: 10/28/2009] [Accepted: 10/29/2009] [Indexed: 11/16/2022]
Abstract
There is converging evidence of gray matter (GM) structural alterations in different limbic structures in Post-Traumatic Stress Disorder (PTSD) patients. The aim of this study was to evaluate GM density in PTSD in relation to trauma load, and to assess the GM differences between responders (R) and non-responders (NR) to EMDR therapy. Magnetic Resonance Imaging (MRI) scans of 21 subjects exposed to occupational trauma, who developed PTSD (S), and of 22 who did not (NS), were compared by means of an optimized Voxel-Based Morphometry (VBM) analysis as implemented in SPM. Within S, further comparisons were made between 10 R and 5 NR. A regression analysis between GM density and the Traumatic Antecedents Questionnaire (TAQ) was also performed on all 43 subjects. Results showed a significantly lower GM density in S as compared to NS in the left posterior cingulate and the left posterior parahippocampal gyrus. Moreover, NR showed a significantly lower GM density as compared to R in bilateral posterior cingulate, as well as anterior insula, anterior parahippocampal gyrus and amygdala in the right hemisphere. Regression analysis showed that GM density negatively correlated with trauma load in bilateral posterior cingulate, left anterior insula, and right anterior parahippocampal gyrus. In conclusion, a GM lower density in limbic and paralimbic cortices were found to be associated with PTSD diagnosis, trauma load, and EMDR treatment outcome, suggesting a view of PTSD characterized by memory and dissociative disturbances.
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Affiliation(s)
- Davide Nardo
- Neuroimaging Laboratory, Santa Lucia Foundation, Rome, Italy.
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Effects of antidepressant treatment on N-acetyl aspartate and choline levels in the hippocampus and thalami of post-stroke depression patients: a study using (1)H magnetic resonance spectroscopy. Psychiatry Res 2010; 182:48-52. [PMID: 20227856 DOI: 10.1016/j.pscychresns.2009.11.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2008] [Revised: 11/14/2009] [Accepted: 11/22/2009] [Indexed: 11/23/2022]
Abstract
Previous studies in patients with a major depressive disorder show functional abnormalities in the medial frontal cortex. Functional and structural abnormalities in patients with post-stroke depression (PSD) are not well studied. The major goals of this study were to determine the biochemical abnormalities that occur in PSD and to assess the effect of antidepressants in patients with PSD at the biochemical level. We used magnetic resonance imaging to detect structural or functional abnormalities in PSD patients. In a prospective study, we included 30 patients with PSD and 20 age-matched subjects as controls. Magnetic resonance spectroscopy (MRS) of the brain was conducted in all subjects at the beginning of the study. Patients with PSD were treated with the antidepressant paroxetine (20-40mg/days) for 6 months. After the 6-month period, all PSD subjects underwent MRS again. PSD patients were evaluated with the Hamilton Depression Scale (HAMD) both before and after treatment with the antidepressant. The mean age of the PSD patients was 70.0+/-4.2 years and that of the controls was 67.2+/-5.4 years. Before treatment, N-acetyl aspartate/creatine (NAA/Cr) ratios in the bilateral hippocampus and thalami were significantly lower in PSD patients than in controls. Choline/creatine (Cho/Cr) ratios were significantly higher in the bilateral hippocampus and left thalamus in PSD patients than in controls. The Cho/Cr ratios were significantly higher in the left thalamus than in the right in PSD patients. The HAMD scores were significantly correlated with the Cho/Cr ratios in the left and right hippocampus. Compared with PSD patients before antidepressant treatment, the PSD subjects after treatment had significantly higher NAA/Cr ratios in the left hippocampus and bilateral thalami. They had significantly lower Cho/Cr ratios in bilateral hippocampus and left thalamus. Our study suggests that metabolic abnormalities in the hippocampus and thalamus are implicated in PSD. Antidepressants may alter the local metabolic abnormalities in these areas.
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Karl A, Werner A. The use of proton magnetic resonance spectroscopy in PTSD research--meta-analyses of findings and methodological review. Neurosci Biobehav Rev 2009; 34:7-22. [PMID: 19559046 DOI: 10.1016/j.neubiorev.2009.06.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2009] [Revised: 06/11/2009] [Accepted: 06/16/2009] [Indexed: 10/20/2022]
Abstract
Different neuroimaging techniques provided evidence for structural and functional brain alterations in posttraumatic stress disorder (PTSD). Due to technical improvements, especially concerning localization techniques and more reliable analysis methods, one technique, proton magnetic resonance spectroscopy ((1)H-MRS), has increasingly become of interest because it allows further insight into metabolic mechanisms that may contribute to these alterations. The aim of this article is, therefore, to review recent studies utilizing (1)H-MRS of the hippocampus and other brain structures in PTSD. Using meta-analytic methods, we attempted to answer the question if PTSD, as compared to different types of control samples, is accompanied by altered neurometabolite ratios and concentrations in the tissue of different brain regions. A second intent was to review methodological aspects to advise on a minimal standard for reliable results with respect to the application of (1)H-MRS in PTSD. Finally, we discussed the implications of the findings with respect to current PTSD models and future research.
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Affiliation(s)
- Anke Karl
- School of Psychology, University of Southampton, Building 44, Southampton, UK.
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29
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Venkatraman TN, Krishnan KRR, Steffens DC, Song AW, Taylor WD. Biochemical abnormalities of the medial temporal lobe and medial prefrontal cortex in late-life depression. Psychiatry Res 2009; 172:49-54. [PMID: 19179054 PMCID: PMC2659332 DOI: 10.1016/j.pscychresns.2008.07.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2007] [Revised: 05/01/2008] [Accepted: 07/04/2008] [Indexed: 11/24/2022]
Abstract
We utilized single-voxel (1)H magnetic resonance spectroscopy (MRS) to investigate biochemical abnormalities related to late-life depression in the medial prefrontal cortex and medial temporal lobe. Fourteen elderly subjects whose depression responded to treatment and 12 nondepressed subjects were enrolled. Subjects were scanned using a GE 3.0 Tesla whole body MR scanner. Metabolite concentrations were quantified using the LC Model software and adjusted for CSF and ratio of gray to white matter. ANCOVA models tested for group differences while controlling for age and sex. Older previously depressed individuals showed significantly reduced concentrations of total N-acetyl aspartate (NAA), choline, and creatine in the prefrontal cortex and significantly elevated left medial temporal lobe concentrations of NAA and myo-inositol. There were no significant group differences in right temporal metabolite concentrations. The prefrontal cortex observations suggest that reduced neuronal, phospolipid, and energy metabolism is present even in clinically improved depression. In contrast, elevated NAA and myo-inositol concentrations in the left medial temporal lobe could be associated with neuronal and glial cell changes in the amygdala.
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Affiliation(s)
- T. N. Venkatraman
- Department of Radiology, Duke University Medical Center, Durham, NC, The Brain Imaging and Analysis Center, Duke University Medical Center, Durham, NC
| | - K. Ranga R. Krishnan
- Department of Psychiatry, Duke University Medical Center, Durham, NC, The Duke-NUS Graduate Medical School Singapore
| | - David C. Steffens
- Department of Psychiatry, Duke University Medical Center, Durham, NC
| | - Allen W. Song
- Department of Psychiatry, Duke University Medical Center, Durham, NC, Department of Radiology, Duke University Medical Center, Durham, NC, The Brain Imaging and Analysis Center, Duke University Medical Center, Durham, NC
| | - Warren D. Taylor
- Department of Psychiatry, Duke University Medical Center, Durham, NC,Corresponding author: Warren D. Taylor, MD, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, DUMC Box 3903, Durham, NC 27710, P: (919) 668-7887, F: (919) 681-7668,
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Ferrari MCF, Busatto GF, McGuire PK, Crippa JAS. Structural magnetic ressonance imaging in anxiety disorders: an update of research findings. BRAZILIAN JOURNAL OF PSYCHIATRY 2008; 30:251-64. [DOI: 10.1590/s1516-44462008000300013] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2008] [Accepted: 05/27/2008] [Indexed: 11/22/2022]
Abstract
OBJECTIVE: The aim of the present report is to present a systematic and critical review of the more recent literature data about structural abnormalities detected by magnetic ressonance in anxiety disorders. METHOD: A review of the literature in the last five years was conducted by a search of the Medline, Lilacs and SciELO indexing services using the following key words: "anxiety", "panic", "agoraphobia", "social anxiety", "posttraumatic" and "obsessive-compulsive", crossed one by one with "magnetic resonance", "voxel-based", "ROI" and "morphometry". RESULTS: We selected 134 articles and 41 of them were included in our review. Recent studies have shown significant morphological abnormalities in various brain regions of patients with anxiety disorders and healthy controls. Despite some apparently contradictory findings, perhaps reflecting the variability and limitations of the methodologies used, certain brain regions appear to be altered in a consistent and relatively specific manner in some anxiety disorders. These include the hippocampus and the anterior cingulate cortex in posttraumatic stress disorder and the orbitofrontal cortex in obsessive-compulsive disorder. CONCLUSIONS: The present review indicates that structural neuroimaging has contributed to a better understanding of the neurobiology of anxiety disorders. Further development of neuroimaging techniques, better sample standardization and the integration of data across neuroimaging modalities may extend progress in this area.
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Abstract
OBJECTIVE Magnetic resonance spectroscopy (MRS) is a non-invasive in vivo method used to quantify metabolites that are relevant to a wide range of brain processes. This paper briefly describes neuroimaging using MRS and provides a systematic review of its application to anxiety disorders. METHOD A literature review was performed in the PubMed, Lilacs and Scielo databases using the keywords spectroscopy and anxiety disorder. References of selected articles were also hand-searched for additional citations. RESULTS Recent studies have shown that there are significant metabolic differences between patients with anxiety disorders and healthy controls in various regions of the brain. Changes were mainly found in N-acetylaspartate, which is associated with neuronal viability, but some of them were also seen in creatine, a substance that is thought to be relatively constant among individuals with different pathological conditions. CONCLUSIONS MRS is a sophisticated neuroimaging technique that has provided useful insights into the biochemical and neurobiological basis of many anxiety disorders. Nevertheless, its utilization in some anxiety disorders is still modest, particularly social phobia and generalised anxiety. Although it is an extremely useful advance in neuroimaging, further research in other brain areas and patient populations is highly advisable.
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Affiliation(s)
- Clarissa Trzesniak
- 1Department of Neuropsychiatry and Medical Psychology, Ribeirão Preto Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - David Araújo
- 1Department of Neuropsychiatry and Medical Psychology, Ribeirão Preto Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - José Alexandre S Crippa
- 1Department of Neuropsychiatry and Medical Psychology, Ribeirão Preto Faculty of Medicine, University of São Paulo, São Paulo, Brazil
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32
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Bremner JD. Neuroimaging in posttraumatic stress disorder and other stress-related disorders. Neuroimaging Clin N Am 2008; 17:523-38, ix. [PMID: 17983968 DOI: 10.1016/j.nic.2007.07.003] [Citation(s) in RCA: 118] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Traumatic stress has a broad range of effects on the brain. Brain areas implicated in the stress response include the amygdala, the hippocampus, and the prefrontal cortex. Studies in patients who have posttraumatic stress disorder (PTSD) and other psychiatric disorders related to stress have replicated findings in animal studies by finding alterations in these brain areas. Brain regions implicated in PTSD also play an important role in memory function, highlighting the important interplay between memory and the traumatic stress response. Abnormalities in these brain areas are hypothesized to underlie symptoms of PTSD and other stress-related psychiatric disorders.
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Affiliation(s)
- J Douglas Bremner
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 1256 Briarcliff Road, Room 308e, Mailstop 1256/001/AT, Atlanta GA 30306, USA.
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Abstract
Confounding is a central problem in nonexperimental trauma research. In this article, the authors review recent advances in the theoretical conception of confounding, with an emphasis on the counterfactual definition of confounding. The strengths and limitations of different techniques for controlling confounding are discussed. Special attention is given to propensity scores, a method that has been used widely in the health sciences, but only rarely in trauma research, in the last several years. The article is written for researchers who use data analytic methods to control confounding and for clinicians who read original research articles to inform their clinical practice. Guidelines to assess the appropriate use of multiple regression models and propensity scores are offered.
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Affiliation(s)
- Tobias Kurth
- Divisions of Aging and Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02120-1613, USA.
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