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Etkin A, Maron-Katz A, Wu W, Fonzo GA, Huemer J, Vértes PE, Patenaude B, Richiardi J, Goodkind MS, Keller CJ, Ramos-Cejudo J, Zaiko YV, Peng KK, Shpigel E, Longwell P, Toll RT, Thompson A, Zack S, Gonzalez B, Edelstein R, Chen J, Akingbade I, Weiss E, Hart R, Mann S, Durkin K, Baete SH, Boada FE, Genfi A, Autea J, Newman J, Oathes DJ, Lindley SE, Abu-Amara D, Arnow BA, Crossley N, Hallmayer J, Fossati S, Rothbaum BO, Marmar CR, Bullmore ET, O'Hara R. Using fMRI connectivity to define a treatment-resistant form of post-traumatic stress disorder. Sci Transl Med 2020; 11:11/486/eaal3236. [PMID: 30944165 DOI: 10.1126/scitranslmed.aal3236] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 02/01/2018] [Accepted: 11/07/2018] [Indexed: 12/14/2022]
Abstract
A mechanistic understanding of the pathology of psychiatric disorders has been hampered by extensive heterogeneity in biology, symptoms, and behavior within diagnostic categories that are defined subjectively. We investigated whether leveraging individual differences in information-processing impairments in patients with post-traumatic stress disorder (PTSD) could reveal phenotypes within the disorder. We found that a subgroup of patients with PTSD from two independent cohorts displayed both aberrant functional connectivity within the ventral attention network (VAN) as revealed by functional magnetic resonance imaging (fMRI) neuroimaging and impaired verbal memory on a word list learning task. This combined phenotype was not associated with differences in symptoms or comorbidities, but nonetheless could be used to predict a poor response to psychotherapy, the best-validated treatment for PTSD. Using concurrent focal noninvasive transcranial magnetic stimulation and electroencephalography, we then identified alterations in neural signal flow in the VAN that were evoked by direct stimulation of that network. These alterations were associated with individual differences in functional fMRI connectivity within the VAN. Our findings define specific neurobiological mechanisms in a subgroup of patients with PTSD that could contribute to the poor response to psychotherapy.
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Affiliation(s)
- Amit Etkin
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA. .,Wu Tsai Neurosciences Institute at Stanford, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA.,Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Adi Maron-Katz
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Wu Tsai Neurosciences Institute at Stanford, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA.,Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Wei Wu
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Wu Tsai Neurosciences Institute at Stanford, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA.,Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA.,School of Automation Science and Engineering, South China University of Technology, Guangzhou, Guangdong 510640, China
| | - Gregory A Fonzo
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Wu Tsai Neurosciences Institute at Stanford, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA.,Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Julia Huemer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Wu Tsai Neurosciences Institute at Stanford, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA
| | - Petra E Vértes
- Department of Psychiatry, Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge CB2 0SZ, UK.,School of Mathematical Sciences, Queen Mary University of London, London E1 4NS, UK.,The Alan Turing Institute, London NW1 2DB, UK
| | - Brian Patenaude
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Wu Tsai Neurosciences Institute at Stanford, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA.,Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Jonas Richiardi
- Department of Medical Radiology, Lausanne University Hospital, Lausanne, Switzerland.,Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland
| | - Madeleine S Goodkind
- New Mexico Veterans Affairs Healthcare System, Albuquerque, NM 87108, USA.,Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM 87131, USA
| | - Corey J Keller
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Wu Tsai Neurosciences Institute at Stanford, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA.,Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Jaime Ramos-Cejudo
- Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA.,Department of Psychiatry, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Yevgeniya V Zaiko
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Wu Tsai Neurosciences Institute at Stanford, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA
| | - Kathy K Peng
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA
| | - Emmanuel Shpigel
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Wu Tsai Neurosciences Institute at Stanford, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA.,Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Parker Longwell
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Wu Tsai Neurosciences Institute at Stanford, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA.,Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Russ T Toll
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Wu Tsai Neurosciences Institute at Stanford, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA.,Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Allison Thompson
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA
| | - Sanno Zack
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA
| | - Bryan Gonzalez
- Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA.,Department of Psychiatry, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Raleigh Edelstein
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Wu Tsai Neurosciences Institute at Stanford, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA.,Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Jingyun Chen
- Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA.,Department of Psychiatry, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Irene Akingbade
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA.,Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Elizabeth Weiss
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA
| | - Roland Hart
- Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA.,Department of Psychiatry, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Silas Mann
- Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA.,Department of Psychiatry, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Kathleen Durkin
- Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA.,Department of Psychiatry, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Steven H Baete
- Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA.,New Mexico Veterans Affairs Healthcare System, Albuquerque, NM 87108, USA.,Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM 87131, USA
| | - Fernando E Boada
- Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA.,Center for Advanced Imaging Innovation and Research (CAI2R), NYU School of Medicine, New York, NY 10016, USA.,Center for Biomedical Imaging, Department of Radiology, NYU School of Medicine, New York, NY 10016, USA
| | - Afia Genfi
- Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA.,Department of Psychiatry, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Jillian Autea
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Wu Tsai Neurosciences Institute at Stanford, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA.,Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Jennifer Newman
- Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA.,Department of Psychiatry, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Desmond J Oathes
- Center for Neuromodulation in Depression and Stress, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - Steven E Lindley
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA
| | - Duna Abu-Amara
- Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA.,Department of Psychiatry, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Bruce A Arnow
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA
| | - Nicolas Crossley
- Department of Psychiatry, School of Medicine, Pontificia Universidad Católica de Chile, 6513677 Santiago, Chile.,Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
| | - Joachim Hallmayer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Wu Tsai Neurosciences Institute at Stanford, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA
| | - Silvia Fossati
- Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA.,Department of Psychiatry, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Barbara O Rothbaum
- Trauma and Anxiety Recovery Program, Department of Psychiatry, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Charles R Marmar
- Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA.,Department of Psychiatry, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Edward T Bullmore
- Department of Psychiatry, Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge CB2 0SZ, UK.,Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge CB21 5EF, UK.,ImmunoPsychiatry, Alternative Discovery and Development, GlaxoSmithKline, Stevenage SG1 2NY, UK
| | - Ruth O'Hara
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA
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