Impaired Mind-Body Connections in Psychosomatic Patients: A Contemporary Neuropsychodynamic Model

In alexithymia-type psychosomatic patients who do not have the capacity to mentalize, arousal is experienced non-symbolically within the body. These people also often have significant histories of attachment trauma and other adverse childhood experiences. This article extends a previous neuropsychodynamic formulation that takes into account recent work on how attachment trauma is internalized in developing brain circuits. Specifically, it considers the possibility that early attachment trauma impairs thalamo-amygdala-striatal-thalamic circuits, resulting in disconnect of subcortical arousal to the prefrontal cortex where the arousal can be mentalized. These impaired subcortical circuits perpetuate stress deep within these patients' implicit procedural circuitry, making them very resistant to psychotherapy. Knowledge of this interaction deepens our understanding of these patients, who suffer greatly, and suggests guidelines for treatment approaches with which they are more likely to engage.

Neurocircuitry models of posttraumatic stress disorder and beyond: a meta-analysis of functional neuroimaging studies

Over the past two decades a relatively large number of studies have investigated the functional neuroanatomy of posttraumatic stress disorder (PTSD). However, findings are often inconsistent, thus challenging traditional neurocircuitry models of PTSD. As evidence mounts that cognition and behavior is an emergent property of interacting brain networks, the question arises whether PTSD can be understood by examining dysfunction in large-scale, spatially distributed neural networks. We used the activation likelihood estimation quantitative meta-analytic technique to synthesize findings across functional neuroimaging studies of PTSD that either used a non-trauma (N=20) or trauma-exposed (N=19) comparison control group. In line with neurocircuitry models, our findings support hyperactive amygdala and hypoactive medial prefrontal regions, but suggest hyperactive hippocampi. Characterization of additional regions under a triple network model showed functional alterations that largely overlapped with the salience network, central executive network, and default network. However, heterogeneity was observed within and across the neurocircuitry and triple network models, and between results based on comparisons to non-trauma and trauma-exposed control groups. Nonetheless, these results warrant further exploration of the neurocircuitry and large-scale network models in PTSD using connectivity analyses.

Abnormal grey matter in victims of rape with PTSD in Mainland China: a voxel-based morphometry study

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.

Hippocampus function predicts severity of post-traumatic stress disorder

Post-traumatic stress disorder (PTSD) is often accompanied by memory problems and abnormal brain structure, particularly within the hippocampus. We implemented a cross-species, hippocampal-dependent task--the virtual Morris Water task--to assess hippocampal function in people with PTSD and age-matched controls during functional magnetic resonance imaging (fMRI). Performance on the task was equivalent between the groups. However, when correlating fMRI-derived hippocampal activity during this task with PTSD severity, we observe a -0.84 correlation, indicating that those with reduced hippocampal activity show more severe PTSD symptoms. This correlation is not explained by differences in task performance, IQ, duration since trauma, nor time with PTSD. Hence, PTSD severity is predicted by functionally assessing the hippocampus using the virtual Morris water task, suggesting that this task may be used to identify those at risk for developing PTSD following a trauma.

The Mind-Brain Relation and Neuroscientific Foundations: III. Brain and Psychopathology, the Split Brain, and Dreaming

In addition to the findings of neuroscientific research on brain function, reviewed in the previous articles (Meissner, 2006a, 2006b), contemporary findings relevant to the mind-brain relation derive also from the study of the underlying patterns of brain dysfunction related to various forms of psychopathology. Other information derives from study of split-brain conditions and from research on dream processes and their relation to brain mechanisms. Review of these research findings casts further light on aspects of the mind-brain relation and further substantiates a unified theory of mind-brain integration.