1
|
Sartori SB, Keil TMV, Kummer KK, Murphy CP, Gunduz-Cinar O, Kress M, Ebner K, Holmes A, Singewald N. Fear extinction rescuing effects of dopamine and L-DOPA in the ventromedial prefrontal cortex. Transl Psychiatry 2024; 14:11. [PMID: 38191458 PMCID: PMC10774374 DOI: 10.1038/s41398-023-02708-8] [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: 04/12/2023] [Revised: 12/01/2023] [Accepted: 12/07/2023] [Indexed: 01/10/2024] Open
Abstract
The ventromedial prefrontal cortex (vmPFC; rodent infralimbic cortex (IL)), is posited to be an important locus of fear extinction-facilitating effects of the dopamine (DA) bio-precursor, L-DOPA, but this hypothesis remains to be formally tested. Here, in a model of impaired fear extinction (the 129S1/SvImJ inbred mouse strain; S1), we monitored extracellular DA dynamics via in vivo microdialysis in IL during fear extinction and following L-DOPA administration. Systemic L-DOPA caused sustained elevation of extracellular DA levels in IL and increased neuronal activation in a subpopulation of IL neurons. Systemic L-DOPA enabled extinction learning and promoted extinction retention at one but not ten days after training. Conversely, direct microinfusion of DA into IL produced long-term fear extinction (an effect that was insensitive to ɑ-/ß-adrenoreceptor antagonism). However, intra-IL delivery of a D1-like or D2 receptor agonist did not facilitate extinction. Using ex vivo multi-electrode array IL neuronal recordings, along with ex vivo quantification of immediate early genes and DA receptor signalling markers in mPFC, we found evidence of reduced DA-evoked mPFC network responses in S1 as compared with extinction-competent C57BL/6J mice that were partially driven by D1 receptor activation. Together, our data demonstrate that locally increasing DA in IL is sufficient to produce lasting rescue of impaired extinction. The finding that systemic L-DOPA increased IL DA levels, but had only transient effects on extinction, suggests L-DOPA failed to reach a threshold level of IL DA or produced opposing behavioural effects in other brain regions. Collectively, our findings provide further insight into the neural basis of the extinction-promoting effects of DA and L-DOPA in a clinically relevant animal model, with possible implications for therapeutically targeting the DA system in anxiety and trauma-related disorders.
Collapse
Affiliation(s)
- Simone B Sartori
- Department of Pharmacology and Toxicology, Institute of Pharmacy and Center for Molecular Biosciences Innsbruck, University of Innsbruck, Innsbruck, Austria
| | - Thomas M V Keil
- Department of Pharmacology and Toxicology, Institute of Pharmacy and Center for Molecular Biosciences Innsbruck, University of Innsbruck, Innsbruck, Austria
| | - Kai K Kummer
- Institute of Physiology, Department of Physiology and Medical Physics, Medical University of Innsbruck, Innsbruck, Austria
| | - Conor P Murphy
- Department of Pharmacology and Toxicology, Institute of Pharmacy and Center for Molecular Biosciences Innsbruck, University of Innsbruck, Innsbruck, Austria
| | - Ozge Gunduz-Cinar
- Laboratory of Behavioral and Genomic Neuroscience, NIH/NIAAA, Rockville, MD, USA
| | - Michaela Kress
- Institute of Physiology, Department of Physiology and Medical Physics, Medical University of Innsbruck, Innsbruck, Austria
| | - Karl Ebner
- Department of Pharmacology and Toxicology, Institute of Pharmacy and Center for Molecular Biosciences Innsbruck, University of Innsbruck, Innsbruck, Austria
| | - Andrew Holmes
- Laboratory of Behavioral and Genomic Neuroscience, NIH/NIAAA, Rockville, MD, USA
| | - Nicolas Singewald
- Department of Pharmacology and Toxicology, Institute of Pharmacy and Center for Molecular Biosciences Innsbruck, University of Innsbruck, Innsbruck, Austria.
| |
Collapse
|
2
|
Yao Y, Wang X. Efficacy of intensive antibiotic regimens on postcraniotomy fever and cerebrospinal fluid examination results in patients with infratentorial surgeries. Medicine (Baltimore) 2022; 101:e32214. [PMID: 36550878 PMCID: PMC9771276 DOI: 10.1097/md.0000000000032214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Postcraniotomy fever is a common complication in patients undergoing infratentorial surgeries. There are few studies about it and the efficacy of intensive antibiotic regimens, which remain to be studied. We carried out a retrospective study in patients undergoing infratentorial surgeries to analyze the factors associated with postcraniotomy fever and further investigated the efficacy of different antibiotic regimens on fever and abnormal cerebrospinal fluid (CSF) results. Among the 115 patients, 74 (64.3%) had fever after craniotomy. Univariate analysis results showed that disease type, drainage tube placement, duration of drainage tube, and intraoperative bleeding volume were associated with postcraniotomy fever in patients undergoing infratentorial surgeries (P < .05). The multivariate analysis results showed that the duration of drainage tube (odds ratio = 1.010, 95% confidence interval: 1.232-6.178, P = .014) and duration of surgery (odds ratio = 1.010, 95% confidence interval: 1.002-1.017, P = .013) were associated with postcraniotomy fever in these patients. After treatment with different antibiotic regimens, the changes of white blood cells, sugar, chlorine and protein in CSF in patients with intensive antibiotic regimens were -638.48 × 106/L, 0.25 mmol/L, -0.76 mmol/L and -0.16 g/L respectively, which did not show significant differences when compared with ordinary antibiotic regimens (P > .05). Most cases of fever at the early stage after craniotomy in patients with infratentorial surgeries were nonintracranial infectious. Intensive antibiotic regimens did not show obvious advantages in improving the body temperature and CSF examination results. It is not necessary to use intensive antibiotic regimens too early, such as carbapenems or linezolids.
Collapse
Affiliation(s)
- Yuan Yao
- Department of Neurosurgery, The First Affiliated Hospital of Yangtze University, Jingzhou, China
| | - Xian Wang
- Department of Pharmacy, The First Affiliated Hospital of Yangtze University, Jingzhou, China
| |
Collapse
|
3
|
FALIOVA OLENA. The Role of Defence Mechanisms in Coping with Stress in PTSD Patients. SCIENTIFIC BULLETIN OF MUKACHEVO STATE UNIVERSITY SERIES “PEDAGOGY AND PSYCHOLOGY” 2022. [DOI: 10.52534/msu-pp.8(4).2022.18-25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
In the context of the war in Ukraine, the risk of post-traumatic stress disorders increases, which in critical cases cause the development of chronic mental illnesses and a decline in physiological functions. In connection with the emergence of a feeling of helplessness due to the inability to act effectively in a dangerous situation, various psychological defence mechanisms are formed to overcome intrapsychic conflicts. The purpose of this stud was to investigate the dominant mechanisms in individuals with post-traumatic stress disorder who had been in regions with different scenarios for the development of hostilities since the beginning of the war, using the PlutchikKellerman-Conte methodology. The information was collected from people of different age categories, types of employment, educational qualification levels, and gender who were in Kyiv, Kharkiv, and Lviv during the first two months of the full-scale war and periodically moved through the territory of Central and Western Ukraine. Cases of short-term residence abroad were also considered during the study. The results of the tension of psychological defence indicate that in individuals with post-traumatic stress disorder that stayed in different regions of Central and Western Ukraine since the beginning of the war, the projection mechanism dominated (75%), and the substitution mechanisms (12.5%) and denial mechanisms (12.5%) were equally distributed. The dominance of the projection may indicate the transfer of intrapsychic conflict to the outside. In this case, the external world is perceived by the individual as the main carrier of the threat from which they need to protect themselves. Instead, denial may indicate ignoring certain aspects of reality. Respondents who are prone to substitution use the approach of transferring repressed emotions, which can be expressed in the form of anger, fear, and hostility towards more accessible objects that are no less dangerous than those that led to frustrating experiences. It was determined that the total sample tension does not exceed 50%. This may indicate the ability of patients with post-traumatic stress disorder to resolve intrapsychic conflicts that have developed at the moment. The results of the study may be of practical interest to specialists investigating the identification and generation of methods for the prevention and treatment of post-traumatic stress disorder
Collapse
|
4
|
Zhou P, Deng M, Wu J, Lan Q, Yang H, Zhang C. Ventral Tegmental Area Dysfunction and Disruption of Dopaminergic Homeostasis: Implications for Post-traumatic Stress Disorder. Mol Neurobiol 2021; 58:2423-2434. [PMID: 33428093 DOI: 10.1007/s12035-020-02278-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 12/30/2020] [Indexed: 12/27/2022]
Abstract
Post-traumatic stress disorder (PTSD) is a debilitating psychiatric condition characterized by intrusive recollections of the traumatic event, avoidance behaviors, hyper-arousal to event-related cues, cognitive disruption, and mood dysregulation. Accumulating preclinical and clinical evidence implicates dysfunction of the ventral tegmental area (VTA) dopaminergic system in PTSD pathogenesis. This article reviews recent advances in our knowledge of the relationship between dopaminergic dyshomeostasis and PTSD, including the contributions of specific dopaminergic gene variants to disease susceptibility, alterations in VTA dopamine neuron activity, dysregulation of dopaminergic transmission, and potential pharmacological and psychological interventions for PTSD targeting the dopaminergic system. An in-depth understanding of PTSD etiology is crucial for the development of innovative risk assessment, diagnostic, and treatment strategies following traumatic events.
Collapse
Affiliation(s)
- Peiling Zhou
- School of Educational Sciences & Guangdong Provincial Key Laboratory of Development and Education for Special Needs Children, Lingnan Normal University, 29 Cunjing Road, Chikan District, Zhanjiang, 524048, China
| | - Meiping Deng
- School of Educational Sciences & Guangdong Provincial Key Laboratory of Development and Education for Special Needs Children, Lingnan Normal University, 29 Cunjing Road, Chikan District, Zhanjiang, 524048, China
| | - Jiashan Wu
- School of Educational Sciences & Guangdong Provincial Key Laboratory of Development and Education for Special Needs Children, Lingnan Normal University, 29 Cunjing Road, Chikan District, Zhanjiang, 524048, China
| | - Qinghui Lan
- School of Educational Sciences & Guangdong Provincial Key Laboratory of Development and Education for Special Needs Children, Lingnan Normal University, 29 Cunjing Road, Chikan District, Zhanjiang, 524048, China
| | - Huifang Yang
- School of Educational Sciences & Guangdong Provincial Key Laboratory of Development and Education for Special Needs Children, Lingnan Normal University, 29 Cunjing Road, Chikan District, Zhanjiang, 524048, China.
| | - Changzheng Zhang
- School of Educational Sciences & Guangdong Provincial Key Laboratory of Development and Education for Special Needs Children, Lingnan Normal University, 29 Cunjing Road, Chikan District, Zhanjiang, 524048, China. .,School of Psychology, Nanjing Normal University, 122 Ninghai Road, Gulou District, Nanjing, 210097, China.
| |
Collapse
|
5
|
Corrêa PS, Pagnussat AS, Cabeleira MEP, Schifino GP, Rieder CRDM, da Silva Junior N, Cechetti F. Is the dopaminergic loss associated with gait and postural impairments in subjects with Parkinson's disease at different motor stages? Eur J Neurosci 2019; 50:3889-3895. [PMID: 31386234 DOI: 10.1111/ejn.14522] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 06/05/2019] [Accepted: 07/15/2019] [Indexed: 11/28/2022]
Abstract
Gait and postural control deficiencies in Parkinson's disease (PD) involve several specific motor aspects. The aim of this study was to identify and compare the main changes in gait kinematics and postural control with dopaminergic loss in the striatum region. This is a cross-sectional study that included 42 individuals with PD at different motor stages, according to the Hoehn & Yahr scale (H&Y). Motor subsection of the Movement Disorder Society-Unified Parkinson Disease Rating Scale-part III (MDS-UPDRS III) was used to evaluate general motor aspects. Gait kinematics was assessed using a three-dimensional motion capture system. Postural control was assessed by stabilometry using force platforms. Dopamine depletion was verified through 99mTc-TRODAT-1 (SPECT-CT) examination. We included 12, 15 and 15 individuals classified as H&Y I, II and III, respectively. We identified worse values of dopamine transporter uptake, MDS-UPDRS III, gait parameters (velocity, step length and stride length) and center of pressure displacement as the disease progressed. Our results indicate that higher dopaminergic loss and gait and postural control deficits occur between the H&Y levels II and III.
Collapse
Affiliation(s)
- Philipe Souza Corrêa
- Post-Graduation Program in Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - Aline Souza Pagnussat
- Post-Graduation Program in Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil.,Post-Graduation Program in Health Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | | | - Giulia Palermo Schifino
- Post-Graduation Program in Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - Carlos Roberto de Mello Rieder
- Post-Graduation Program in Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil.,Post-Graduation Program in Health Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | | | - Fernanda Cechetti
- Post-Graduation Program in Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| |
Collapse
|
6
|
Cabeleira MEP, Pagnussat AS, Pinho AS, Asquidamini ACD, Freire AB, Pereira BT, Mello Rieder CR, Schifino GP, Fornari LHT, Junior NDS, Corrêa PS, Cechetti F. Impairments in gait kinematics and postural control may not correlate with dopamine transporter depletion in individuals with mild to moderate Parkinson's disease. Eur J Neurosci 2019; 49:1640-1648. [DOI: 10.1111/ejn.14328] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 10/29/2018] [Accepted: 12/21/2018] [Indexed: 01/08/2023]
Affiliation(s)
| | - Aline Souza Pagnussat
- Federal University of Health Sciences of Porto AlegrePost‐Graduation Program in Rehabilitation Sciences Porto Alegre Brazil
- Federal University of Health Sciences of Porto AlegrePost‐Graduation Program in Health Sciences Porto Alegre Brazil
| | - Alexandre Severo Pinho
- Federal University of Health Sciences of Porto AlegrePost‐Graduation Program in Health Sciences Porto Alegre Brazil
| | - Ane Caroline Dotta Asquidamini
- Federal University of Health Sciences of Porto AlegrePost‐Graduation Program in Rehabilitation Sciences Porto Alegre Brazil
| | - Ariane Bolla Freire
- Federal University of Health Sciences of Porto AlegrePost‐Graduation Program in Rehabilitation Sciences Porto Alegre Brazil
| | - Brenda Tubelo Pereira
- Federal University of Health Sciences of Porto AlegrePost‐Graduation Program in Rehabilitation Sciences Porto Alegre Brazil
| | - Carlos Roberto Mello Rieder
- Federal University of Health Sciences of Porto AlegrePost‐Graduation Program in Rehabilitation Sciences Porto Alegre Brazil
- Federal University of Health Sciences of Porto AlegrePost‐Graduation Program in Health Sciences Porto Alegre Brazil
| | - Giulia Palermo Schifino
- Federal University of Health Sciences of Porto AlegrePost‐Graduation Program in Rehabilitation Sciences Porto Alegre Brazil
| | - Luis Henrique Tieppo Fornari
- Federal University of Health Sciences of Porto AlegrePost‐Graduation Program in Rehabilitation Sciences Porto Alegre Brazil
| | | | - Philipe Souza Corrêa
- Federal University of Health Sciences of Porto AlegrePost‐Graduation Program in Rehabilitation Sciences Porto Alegre Brazil
| | - Fernanda Cechetti
- Federal University of Health Sciences of Porto AlegrePost‐Graduation Program in Rehabilitation Sciences Porto Alegre Brazil
| |
Collapse
|
7
|
Baldaçara L, Araújo C, Assunção I, Silva ID, Jackowski AP. Reduction of prefrontal thickness in military police officers with post-traumatic stress disorder. ARCH CLIN PSYCHIAT 2017. [DOI: 10.1590/0101-60830000000128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Leonardo Baldaçara
- Federal University of São Paulo, Brazil; Federal University of Tocantins, Brazil
| | | | | | | | | |
Collapse
|
8
|
Abstract
Background Cancer patients with posttraumatic stress disorder can lead to their noncompliant behaviors. However, less is known about the neurocognitive functioning of posttraumatic stress disorder in general cancer types or patient populations. The current study attempted to examine the prevalence of posttraumatic stress disorder and their relationships with executive function in individuals with cancer. Methods A total of 285 cancer patients with posttraumatic stress disorder and 150 healthy individuals were recruited for the present study. The Clinician Administered PTSD Scale, Tower of Hanoi, Wisconsin Card Sorting Test, and Wechsler Adult Intelligence Scale-Revised Chinese revision were administered to all participants. Results Significant differences in the score of Tower of Hanoi, Wisconsin Card Sorting Test, and Wechsler Adult Intelligence Scale-Revised Chinese revision were observed between the posttraumatic stress disorder group and the healthy control group ( p < 0.001). Significant correlations were found between all posttraumatic stress disorder symptoms and executive function. Conclusions These findings suggest that individuals with cancer-related posttraumatic stress disorder exhibit more severe impairment in executive function than healthy controls do.
Collapse
Affiliation(s)
- Juan Yang
- 1 Department of Psychology, Hainan Medical University, Haikou, P. R. China
| | | | | |
Collapse
|
9
|
Aupperle RL, Stillman AN, Simmons AN, Flagan T, Allard CB, Thorp SR, Norman SB, Paulus MP, Stein MB. Intimate Partner Violence PTSD and Neural Correlates of Inhibition. J Trauma Stress 2016; 29:33-40. [PMID: 26748991 DOI: 10.1002/jts.22068] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 10/08/2015] [Accepted: 10/10/2015] [Indexed: 01/22/2023]
Abstract
Posttraumatic stress disorder (PTSD) has been linked to deficits in response inhibition, and neuroimaging research suggests this may be due to differences in prefrontal cortex recruitment. The current study examined relationships between PTSD from intimate partner violence (IPV) and neural responses during inhibition. There were 10 women with PTSD from IPV and 12 female control subjects without trauma history who completed the stop signal task during functional magnetic resonance imaging. Linear mixed models were used to investigate group differences in activation (stop-nonstop and hard-easy trials). Those with PTSD exhibited greater differential activation to stop-nonstop trials in the right dorsolateral prefrontal cortex and the anterior insula and less differential activation in several default mode regions (d = 1.12-1.22). Subjects with PTSD exhibited less differential activation to hard-easy trials in the lateral frontal and the anterior insula regions (driven by less activation to hard trials) and several default mode regions (i.e., medial prefrontal cortex, posterior cingulate; driven by greater activation to easy trials; d = 1.23-1.76). PTSD was associated with difficulties disengaging default mode regions during cognitive tasks with relatively low cognitive demand, as well as difficulties modulating executive control and salience processing regions with increasing cognitive demand. Together, these results suggest that PTSD may relate to decreased neural flexibility during inhibition.
Collapse
Affiliation(s)
- Robin L Aupperle
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA.,Department of Community Medicine, University of Tulsa, Tulsa, Oklahoma, USA
| | - Ashley N Stillman
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA.,Department of Psychology, University of Tulsa, Tulsa, Oklahoma, USA
| | - Alan N Simmons
- Research Service, VA San Diego Healthcare System, San Diego, California, USA.,Psychiatry Service, VA San Diego Healthcare System, San Diego, California, USA.,Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California-San Diego, San Diego, California, USA
| | - Taru Flagan
- Department of Psychiatry, University of California-San Diego, San Diego, California, USA
| | - Carolyn B Allard
- Research Service, VA San Diego Healthcare System, San Diego, California, USA.,Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California-San Diego, San Diego, California, USA.,Psychology Service, VA San Diego Healthcare System, San Diego, California, USA
| | - Steven R Thorp
- Research Service, VA San Diego Healthcare System, San Diego, California, USA.,Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California-San Diego, San Diego, California, USA.,Psychology Service, VA San Diego Healthcare System, San Diego, California, USA
| | - Sonya B Norman
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California-San Diego, San Diego, California, USA.,Psychology Service, VA San Diego Healthcare System, San Diego, California, USA
| | - Martin P Paulus
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA.,Psychiatry Service, VA San Diego Healthcare System, San Diego, California, USA.,Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California-San Diego, San Diego, California, USA
| | - Murray B Stein
- Psychiatry Service, VA San Diego Healthcare System, San Diego, California, USA.,Family Medicine and Public Health, University of California-San Diego, San Diego, California, USA
| |
Collapse
|
10
|
Suliman S, Stein DJ, Seedat S. Clinical and neuropsychological predictors of posttraumatic stress disorder. Medicine (Baltimore) 2014; 93:e113. [PMID: 25396328 PMCID: PMC4616314 DOI: 10.1097/md.0000000000000113] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 08/14/2014] [Accepted: 08/14/2014] [Indexed: 11/30/2022] Open
Abstract
Although acute responses to traumatic stress generally resolve within a few weeks, some individuals experience severe and persistent problems, such as posttraumatic stress disorder (PTSD). While studies have identified a variety of predictors of PTSD, not all data are consistent. This longitudinal study examined the predictive power of neurocognitive deficits with regard to PTSD severity.One hundred thirty one road traffic collision (RTC) survivors were included within 2 weeks of the RTC and followed up 3 and 6 months later to determine severity of PTSD.Impairment on tests of information processing, executive functioning, verbal learning, and motor speed predicted PTSD severity when neuropsychological, clinical, and sociodemographic factors were all taken into account. Clinical variables (initial symptoms, psychiatric diagnoses, disability, trait anxiety, perceived stress, negative cognitions, and sleep) were associated with 3 and 6-month PTSD severity, but only trait anxiety was predictive of PTSD severity. Ethnicity and education were also found to be predictive.These findings suggest implementation of a holistic approach to screening for PTSD and support a need for interventions that target neurocognitive, clinical, and social variables. Early targeted profiling of this group of trauma survivors can inform early clinical interventions and policy.
Collapse
Affiliation(s)
- Sharain Suliman
- MRC Anxiety Disorders Unit (S Suliman, DJS, S Seedat), Department of Psychiatry, Stellenbosch University; Department of Psychiatry and Mental Health (DJS), University of Cape Town; and Department of Psychiatry (S Seedat), Stellenbosch University, Cape Town, South Africa
| | | | | |
Collapse
|
11
|
Reduction of anterior cingulate in adults with urban violence-related PTSD. J Affect Disord 2014; 168:13-20. [PMID: 25033473 DOI: 10.1016/j.jad.2014.06.036] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Accepted: 06/24/2014] [Indexed: 01/02/2023]
Abstract
BACKGROUND To evaluate differences in limbic structure volume of subjects exposed to urban violence during adulthood, between those who developed posttraumatic stress disorder (with PTSD) and resilient matched controls (without PTSD). METHODS Limbic volumetric measures of 32 subjects with PTSD and 32 subjects without PTSD who underwent brain MRI were analyzed in an epidemiological study in the city of Sao Paulo. The hippocampus, amygdala, cingulate, and parahipocampal gyri volumes were estimated using FreeSurfer software. We also investigated the association between limbic volumetric measurements, symptom´s severity, and early life stress history (measure by Early Trauma Inventory - ETI). RESULTS Subjects with PTSD presented reduced volume of the right rostral part of the anterior cingulate, compared to subjects without PTSD, after controlling for intracranial volume, ETI, and depressive symptoms. Subjects with PTSD presented larger bilateral hippocampus and right amygdala, but secondary to the higher ETI. In PTSD group there was a positive correlation between ETI with bilateral hippocampus, bilateral amygdala, and left parahippocampus. LIMITATIONS First, the cross-sectional study design precludes causal interpretation of limbic structure reduction in PTSD, consequence of PTSD, or other life events. Finally, since the sample size was not sufficiently large, we could not observe whether or not limbic structure volume could be related to the type of trauma. CONCLUSIONS The present study provides evidence of a reduced anterior cingulate volume in subjects with PTSD than in resilient subjects exposed to urban violence. Enlargement of hippocampus and amygdala volume was observed in subjects with PTSD, however secondary to early trauma experience.
Collapse
|
12
|
Methylphenidate and desipramine combined treatment improves PTSD symptomatology in a rat model. Transl Psychiatry 2014; 4:e447. [PMID: 25247592 PMCID: PMC4203011 DOI: 10.1038/tp.2014.82] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 07/23/2014] [Accepted: 07/26/2014] [Indexed: 01/10/2023] Open
Abstract
Antidepressant medication constitutes the first line pharmacological treatment for posttraumatic stress disorder (PTSD), however, because many patients display no beneficial drug effects it has been suggested that combinations of antidepressants with additional drugs may be necessary. The defining symptoms of PTSD include re-experiencing, avoidance and hyperarousal. In addition, PTSD patients were shown to become easily distracted and often suffer from poor concentration together with indications of comorbidity with attention-deficit hyperactivity disorder (ADHD). Methylphenidate (MPH) is the most common and effective drug treatment for ADHD, thus we aimed to investigate the effects of MPH treatment, by itself or in combination with the antidepressants fluoxetine (FLU) or desipramine (DES). We modified an animal model of PTSD by exposing rats to chronic stress and evaluating the subsequent development of behavioral PTSD-like symptoms, as well as the effects on proinflammatory cytokines, which were implicated in PTSD. We report that while FLU or DES had a beneficial effect on avoidance and hyperarousal symptoms, MPH improved all three symptoms. Moreover, the combination of MPH with DES produced the most dramatic beneficial effects. Serum levels of interleukin-1β (IL-1β) and IL-6 were elevated in the PTSD-like group compared with the control group, and were decreased by MPH, FLU, DES or the combination drug treatments, with the combination of DES+MPH producing the most complete rescue of the inflammatory response. Considering the versatile symptoms of PTSD, our results suggest a new combined treatment for PTSD comprising the antidepressant DES and the psychostimulant MPH.
Collapse
|
13
|
Searching for a Neurobiological Basis for Self-Medication Theory in ADHD Comorbid With Substance Use Disorders. Clin Nucl Med 2014; 39:e129-34. [DOI: 10.1097/rlu.0b013e31829f9119] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
14
|
Flaks MK, Malta SM, Almeida PP, Bueno OFA, Pupo MC, Andreoli SB, Mello MF, Lacerda ALT, Mari JJ, Bressan RA. Attentional and executive functions are differentially affected by post-traumatic stress disorder and trauma. J Psychiatr Res 2014; 48:32-9. [PMID: 24199652 DOI: 10.1016/j.jpsychires.2013.10.009] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 10/07/2013] [Accepted: 10/10/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Among the neurocognitive impairments observed in patients with Post-traumatic Stress Disorder (PTSD), attentional and executive dysfunctions appear to correlate with negative effects on education, work, daily life activities, and social relations, as well as the re-experiencing, avoidance, and hyperarousal symptoms of PTSD. However, there is no consensus regarding which aspects of attentional and executive functions are impaired in PTSD patients. METHODS Attentional and executive functions were assessed using the digit span (WAIS-III) and spatial span (WMS-III) tests under forward and backward recall conditions, the Stroop Test, and the Wisconsin Card Sorting Test (WCST). Our sample was composed of victims of urban violence who developed PTSD (PTSD+) (n = 81), victims of urban violence who did not develop PTSD (PTSD-) (n = 70), and healthy controls not exposed to trauma (HC) (n = 50). RESULTS The PTSD+ group had poorer performance on the spatial span forward subtest (p = 0.023; eta(2) = 0.038) and poorer execution time (p = 0.023; eta(2) = 0.042) and accuracy (p = 0.019; eta(2) = 0.044) on the Stroop Test compared to HC. CONCLUSIONS These data suggest that there are few differences between the PTSD+ and HC groups, which are restricted to less complex measures of attentional and executive functional processes (short term capacity, selective attention, processing speed, and inhibitory control) and are related to visual stimuli. Therefore, cognitive impairments directly correlated with the manifestation of PTSD.
Collapse
Affiliation(s)
- Mariana K Flaks
- LiNC - Laboratório Interdisciplinar de Neurociências Clínicas, Universidade Federal de São Paulo (UNIFESP), Brazil; PROVE - Programa de Atendimento e Pesquisa em Violência, Universidade Federal de São Paulo (UNIFESP), Brazil.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Ribeiro WS, Mari JDJ, Quintana MI, Dewey ME, Evans-Lacko S, Vilete LMP, Figueira I, Bressan RA, de Mello MF, Prince M, Ferri CP, Coutinho ESF, Andreoli SB. The impact of epidemic violence on the prevalence of psychiatric disorders in Sao Paulo and Rio de Janeiro, Brazil. PLoS One 2013; 8:e63545. [PMID: 23667636 PMCID: PMC3648507 DOI: 10.1371/journal.pone.0063545] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Accepted: 04/09/2013] [Indexed: 11/19/2022] Open
Abstract
Background Violence and other traumatic events, as well as psychiatric disorders are frequent in developing countries, but there are few population studies to show the actual impact of traumatic events in the psychiatric morbidity in low and middle-income countries (LMIC). Aims To study the relationship between traumatic events and prevalence of mental disorders in São Paulo and Rio de Janeiro, Brazil. Methods Cross-sectional survey carried out in 2007–2008 with a probabilistic representative sample of 15- to 75-year-old residents in Sao Paulo and Rio de Janeiro, Brazil, using the Composite International Diagnostic Interview. Results The sample comprised 3744 interviews. Nearly 90% of participants faced lifetime traumatic events. Lifetime prevalence of any disorders was 44% in Sao Paulo and 42.1% in Rio de Janeiro. One-year estimates were 32.5% and 31.2%. One-year prevalence of traumatic events was higher in Rio de Janeiro than Sao Paulo (35.1 vs. 21.7; p<0.001). Participants from Rio de Janeiro were less likely to have alcohol dependence (OR = 0.55; p = 0.027), depression (OR = 0.6; p = 0.006) generalized anxiety (OR = 0.59; p = 0.021) and post-traumatic stress disorder (OR = 0.62; p = 0.027). Traumatic events correlated with all diagnoses – e.g. assaultive violence with alcohol dependence (OR = 5.7; p<0.001) and with depression (OR = 1.7; p = 0.001). Conclusion Our findings show that psychiatric disorders and traumatic events, especially violence, are extremely common in Sao Paulo and Rio de Janeiro, supporting the idea that neuropsychiatric disorders and external causes have become a major public health priority, as they are amongst the leading causes of burden of disease in low and middle-income countries. The comparison between the two cities regarding patterns of violence and psychiatric morbidity suggests that environmental factors may buffer the negative impacts of traumatic events. Identifying such factors might guide the implementation of interventions to improve mental health and quality of life in LMIC urban centers.
Collapse
Affiliation(s)
- Wagner Silva Ribeiro
- Departmento de Psiquiatria, Universidade Federal de São Paulo, Sao Paulo, Brazil.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Baldaçara L, Borgio JGF, Araújo C, Nery-Fernandes F, Lacerda ALT, Moraes WADS, Montaño MBMM, Rocha M, Quarantini LC, Schoedl A, Pupo M, Mello MF, Andreoli SB, Miranda-Scippa A, Ramos LR, Mari JJ, Bressan RA, Jackowski AP. Relationship between structural abnormalities in the cerebellum and dementia, posttraumatic stress disorder and bipolar disorder. Dement Neuropsychol 2012; 6:203-211. [PMID: 29213799 PMCID: PMC5619331 DOI: 10.1590/s1980-57642012dn06040003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
New evidence suggests that the cerebellum has structural and functional abnormalities in psychiatric disorders. Objective In this research, the goal was to measure the volume of the cerebellum and its subregions in individuals with psychiatric disorders and to relate these findings to their symptoms. Methods Patients with different degrees of cognitive impairment (Epidemiology of the Elderly - UNIFESP) and patients with post-traumatic stress disorder (PTSD) from population studies were analyzed. Also, patients with bipolar disorder from an outpatient clinic (Center for the Study of Mood and Anxiety Disorders, Universidade Federal da Bahia) were recruited for this study. All subjects underwent a 1.5T structural magnetic resonance scan. Volumetric measures and symptom measurements, by psychometric scales, were performed and compared between patients and controls. Results The cerebellum volume was reduced in patients with cognitive impairment without dementia and with dementia, in patients with PTSD, and in patients with bipolar disorder compared to controls. In dementia and PTSD, the left cerebellar hemisphere and vermis volume were reduced. In bipolar disorder, volumes of both hemispheres and the vermis were reduced. In the first two studies, these cerebellar volumetric reductions correlated with symptoms of the disease. Conclusion The exact nature of cerebellar involvement in mental processes is still not fully understood. However, abnormalities in cerebellar structure and its functions have been reported in some of these diseases. Future studies with larger samples are needed to clarify these findings and investigate whether they are important for treatment and prognosis.
Collapse
Affiliation(s)
- Leonardo Baldaçara
- Federal University of São Paulo, SP, Brazil.,Federal University of Tocantins, TO, Brazil
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Hoexter MQ, Fadel G, Felício AC, Calzavara MB, Batista IR, Reis MA, Shih MC, Pitman RK, Andreoli SB, Mello MF, Mari JJ, Bressan RA. Higher striatal dopamine transporter density in PTSD: an in vivo SPECT study with [(99m)Tc]TRODAT-1. Psychopharmacology (Berl) 2012; 224:337-45. [PMID: 22700036 DOI: 10.1007/s00213-012-2755-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Accepted: 05/24/2012] [Indexed: 12/23/2022]
Abstract
RATIONALE Some evidence suggests a hyperdopaminergic state in posttraumatic stress disorder (PTSD). The 9-repetition allele (9R) located in the 3' untranslated region of the dopamine transporter (DAT) gene (SLC6A3) is more frequent among PTSD patients. In vivo molecular imaging studies have shown that healthy 9R carriers have increased striatal DAT binding. However, no prior study evaluated in vivo striatal DAT density in PTSD. OBJECTIVES The objective of this study was to evaluate in vivo striatal DAT density in PTSD. METHODS Twenty-one PTSD subjects and 21 control subjects, who were traumatized but asymptomatic, closely matched comparison subjects evaluated with the Clinician-Administered PTSD Scale underwent a single-photon emission computed tomography scan with [(99m)TC]-TRODAT-1. DAT binding potential (DAT-BP) was calculated using the striatum as the region of the interest and the occipital cortex as a reference region. RESULTS PTSD patients had greater bilateral striatal DAT-BP (mean ± SD; left, 1.80 ± 0.42; right, 1.78 ± 0.40) than traumatized control subjects (left, 1.62 ± 0.32; right, 1.61 ± 0.31; p = 0.039 for the left striatum and p = 0.032 for the right striatum). CONCLUSIONS These results provide the first in vivo evidence for increased DAT density in PTSD. Increases in DAT density may reflect higher dopamine turnover in PTSD, which could contribute to the perpetuation and potentiation of exaggerated fear responses to a given event associated with the traumatic experience. Situations that resemble the traumatic event turn to be interpreted as highly salient (driving attention, arousal, and motivation) in detriment of other daily situations.
Collapse
Affiliation(s)
- Marcelo Q Hoexter
- Instituto do Cérebro, Instituto de Ensino e Pesquisa do Hospital Israelita Albert Einstein, São Paulo, Brazil.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Aupperle RL, Melrose AJ, Stein MB, Paulus MP. Executive function and PTSD: disengaging from trauma. Neuropharmacology 2012; 62:686-94. [PMID: 21349277 PMCID: PMC4719148 DOI: 10.1016/j.neuropharm.2011.02.008] [Citation(s) in RCA: 408] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Accepted: 02/07/2011] [Indexed: 11/16/2022]
Abstract
Neuropsychological approaches represent an important avenue for identifying susceptibility and resiliency factors relating to the development and maintenance of posttraumatic stress disorder (PTSD) symptoms post-trauma. This review will summarize results from prospective longitudinal and retrospective cross-sectional studies investigating executive function associated with PTSD. This research points specifically towards subtle impairments in response inhibition and attention regulation that may predate trauma exposure, serve as risk factors for the development of PTSD, and relate to the severity of symptoms. These impairments may be exacerbated within emotional or trauma-related contexts, and may relate to dysfunction within dorsal prefrontal networks. A model is presented concerning how such impairments may contribute to the clinical profile of PTSD and lead to the use of alternative coping styles such as avoidance. Further neuropsychological research is needed to identify the effects of treatment on cognitive function and to potentially characterize mechanisms of current PTSD treatments. Knowledge gained from cognitive and neuroscientific research may prove valuable for informing the future development of novel, more effective, treatments for PTSD. This article is part of a Special Issue entitled 'Post-Traumatic Stress Disorder'.
Collapse
Affiliation(s)
- Robin L Aupperle
- Department of Psychiatry, University of California, San Diego (UCSD), 8939 Villa La Jolla Dr., Suite 200, La Jolla, CA 92037, USA.
| | | | | | | |
Collapse
|
19
|
Baldaçara L, Jackowski AP, Schoedl A, Pupo M, Andreoli SB, Mello MF, Lacerda ALT, Mari JJ, Bressan RA. Reduced cerebellar left hemisphere and vermal volume in adults with PTSD from a community sample. J Psychiatr Res 2011; 45:1627-33. [PMID: 21824628 DOI: 10.1016/j.jpsychires.2011.07.013] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Revised: 07/14/2011] [Accepted: 07/14/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Traumatic events exposure is a necessary condition for developing posttraumatic stress disorder (PTSD), but not all individuals exposed to the same trauma will develop PTSD. Human studies have suggested that the cerebellum is involved in human fear perception, anticipation, and recollection. In this context, the current study evaluated whether cerebellar volume is associated with PTSD. METHODS Eighty-four victims of violence, 42 who fulfilled the DSM-IV-TR criteria for PTSD and 42 resilient controls, were identified through an epidemiologic survey conducted in the city of São Paulo. Subjects were evaluated using the Clinician-Administered PTSD Scale (CAPS), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and Early Trauma Inventory (ETI). All subjects underwent a magnetic resonance imaging (MRI) scan to evaluate their cerebellar hemispheres and vermis. RESULTS PTSD subjects had relative smaller left hemisphere (p = 0.04) and vermis (p < 0.01) volumes persisted after controlling for gender, age, and brain volume. In PTSD group, left cerebellar hemisphere volume correlated negatively with PTSD (p = 0.01) and depressive symptoms (p = 0.04). Vermal volume correlated negatively with PTSD symptoms (p < 0.01), early traumatic life events (p < 0.01), depressive symptoms (p = 0.04) and anxiety (p = 0.01). CONCLUSION The cerebellum is involved in emotion modulation, and our results suggest that cerebellar volumetric reduction is associated with mood, anxiety and PTSD symptoms. Early traumatic life experiences are related to vermal volume reduction and may be a risk factor for future PTSD development.
Collapse
Affiliation(s)
- Leonardo Baldaçara
- Psychiatry, Laboratório Interdisciplinar de Neurociências Clínicas (LiNC), Universidade Federal de São Paulo (UNIFESP), Brazil.
| | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Abstract
The objective of this paper is to describe three cases of combat-related posttraumatic stress disorder (PTSD), largely refractory to standard medication treatment who responded well to psychostimulant treatment. Symptoms of PTSD potentially result from chronic, stress-induced dopaminergic dysfunction in the prefrontal cortex/basal ganglia system. Psychostimulants, by their relative propensity to enhance dopamine (DA) activity within these brain regions, may have particular value in targeting this dysfunction. Evidence of dopaminergic dysfunction following chronic stress is reviewed and possible mechanism of action of psychostimulants is explored. Psychostimulants appeared to be well tolerated and beneficial in the treatment of the cases of combat-related PTSD reported. General applicability of the use of psychostimulants in combat- and non-combat-related PTSD awaits further study. The potential implications of these findings in further delineating pathophysiology and treatment in PTSD deserve further exploration.
Collapse
|
21
|
Valente NLM, Vallada H, Cordeiro Q, Miguita K, Bressan RA, Andreoli SB, Mari JJ, Mello MF. Candidate-Gene Approach in Posttraumatic Stress Disorder After Urban Violence: Association Analysis of the Genes Encoding Serotonin Transporter, Dopamine Transporter, and BDNF. J Mol Neurosci 2011; 44:59-67. [DOI: 10.1007/s12031-011-9513-7] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Accepted: 03/07/2011] [Indexed: 12/28/2022]
|
22
|
Current Awareness in Contrast Media and Molecular Imaging. CONTRAST MEDIA & MOLECULAR IMAGING 2010. [DOI: 10.1002/cmmi.283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|