1
|
Gopaldas M, Flook EA, Blackford JU. Bridging Neuroscience and Clinical Assessment in a Patient with Alcohol Use Disorder, Anxiety, and Trauma. J Psychiatr Pract 2024; 30:62-67. [PMID: 38227730 DOI: 10.1097/pra.0000000000000763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
This article presents a unique framework that combines insights from neuroscience with clinical assessment to evaluate individuals who have co-occurring alcohol use disorder, anxiety, and trauma. Through the use of a case study, the authors demonstrate the practical application of this framework and contextualize the relevant neurocircuitry associated with alcohol withdrawal, maladaptive fear and anxiety, and chronic stress. By integrating these perspectives, they provide a comprehensive approach for assessing and treating patients with complex psychiatric histories, particularly those presenting with anxiety symptoms, offering valuable insights for practitioners.
Collapse
|
2
|
Flook EA, Feola B, Benningfield MM, Silveri MM, Winder DG, Blackford JU. Alterations in BNST Intrinsic Functional Connectivity in Early Abstinence from Alcohol Use Disorder. Alcohol Alcohol 2023; 58:298-307. [PMID: 36847484 PMCID: PMC10168710 DOI: 10.1093/alcalc/agad006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 01/03/2023] [Accepted: 01/22/2023] [Indexed: 03/01/2023] Open
Abstract
AIMS Maintaining abstinence from alcohol use disorder (AUD) is extremely challenging, partially due to increased symptoms of anxiety and stress that trigger relapse. Rodent models of AUD have identified that the bed nucleus of the stria terminalis (BNST) contributes to symptoms of anxiety-like behavior and drug-seeking during abstinence. In humans, however, the BNST's role in abstinence remains poorly understood. The aims of this study were to assess BNST network intrinsic functional connectivity in individuals during abstinence from AUD compared to healthy controls and examine associations between BNST intrinsic functional connectivity, anxiety and alcohol use severity during abstinence. METHODS The study included resting state fMRI scans from participants aged 21-40 years: 20 participants with AUD in abstinence and 20 healthy controls. Analyses were restricted to five pre-selected brain regions with known BNST structural connections. Linear mixed models were used to test for group differences, with sex as a fixed factor given previously shown sex differences. RESULTS BNST-hypothalamus intrinsic connectivity was lower in the abstinent group relative to the control group. There were also pronounced sex differences in both the group and individual analyses; many of the findings were specific to men. Within the abstinent group, anxiety was positively associated with BNST-amygdala and BNST-hypothalamus connectivity, and men, not women, showed a negative relationship between alcohol use severity and BNST-hypothalamus connectivity. CONCLUSIONS Understanding differences in connectivity during abstinence may help explain the clinically observed anxiety and depression symptoms during abstinence and may inform the development of individualized treatments.
Collapse
Affiliation(s)
- Elizabeth A Flook
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Philadelphia, PA 19104, USA
- Vanderbilt University School of Medicine, 1161 21st Ave S # D3300, Nashville, TN 37232, USA
- Vanderbilt Center for Addiction Research, Vanderbilt University, 2215 Garland Ave, Nashville, TN 37232, USA
| | - Brandee Feola
- Department of Psychiatry and Behavioral Science, Vanderbilt University Medical Center, 1601 23rd Avenue South, Nashville, TN 37212, USA
| | - Margaret M Benningfield
- Vanderbilt University School of Medicine, 1161 21st Ave S # D3300, Nashville, TN 37232, USA
- Vanderbilt Center for Addiction Research, Vanderbilt University, 2215 Garland Ave, Nashville, TN 37232, USA
- Department of Psychiatry and Behavioral Science, Vanderbilt University Medical Center, 1601 23rd Avenue South, Nashville, TN 37212, USA
| | - Marisa M Silveri
- Neurodevelopmental Laboratory on Addictions and Mental Health, Brain Imaging Center, McLean Hospital, 115 Mill St, Belmont, MA 02478, USA
- Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, MA 02215, USA
| | - Danny G Winder
- Vanderbilt Center for Addiction Research, Vanderbilt University, 2215 Garland Ave, Nashville, TN 37232, USA
- Department of Molecular Physiology and Biophysics, Vanderbilt University, 2215 Garland Avenue, Nashville, TN 37212, USA
- Department of Pharmacology, Vanderbilt University, 465 21st Avenue South, Nashville, TN 37240, USA
| | - Jennifer Urbano Blackford
- Vanderbilt Center for Addiction Research, Vanderbilt University, 2215 Garland Ave, Nashville, TN 37232, USA
- Department of Psychiatry and Behavioral Science, Vanderbilt University Medical Center, 1601 23rd Avenue South, Nashville, TN 37212, USA
- Munroe-Meyer Institute, University of Nebraska Medical Center, 6902 Pine Street, Omaha, NE 68106, USA
| |
Collapse
|
3
|
Feola B, Flook EA, Gardner H, Phan KL, Gwirtsman H, Olatunji B, Blackford JU. Altered bed nucleus of the stria terminalis and amygdala responses to threat in combat veterans with posttraumatic stress disorder. J Trauma Stress 2023; 36:359-372. [PMID: 36938747 PMCID: PMC10548436 DOI: 10.1002/jts.22918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 12/15/2022] [Accepted: 12/16/2022] [Indexed: 03/21/2023]
Abstract
Posttraumatic stress disorder (PTSD) significantly impacts many veterans. Although PTSD has been linked to alterations in the fear brain network, the disorder likely involves alterations in both the fear and anxiety networks. Fear involves responses to imminent, predictable threat and is driven by the amygdala, whereas anxiety involves responses to potential, unpredictable threat and engages the bed nucleus of the stria terminalis (BNST). The BNST has been implicated in PTSD, but the role of the BNST in combat veterans with PTSD has yet to be examined. Identifying alterations in BNST responses to unpredictable threat could provide important new targets for treatment. The current study examined whether veterans with PTSD have altered BNST or amygdala responses (function and connectivity) to unpredictable and predictable threat. The fMRI task involved viewing predictable threat cues followed by threat images, predictable neutral cues followed by neutral images, and unpredictable threat cues followed by either a threat or neutral image. Participants included 32 combat-exposed veterans with PTSD and 13 combat-exposed controls without PTSD. Across all conditions, veterans with PTSD had heightened BNST activation and displayed stronger BNST and amygdala connectivity with multiple fear and anxiety regions (hypothalamus, hippocampus, insula, ventromedial prefrontal cortex) relative to controls. In contrast, combat controls showed a pattern of stronger connectivity during neutral conditions (e.g., BNST-vmPFC), which may suggest a neural signature of resilience to developing PTSD, ηp 2 = .087-.527, ps < .001. These findings have implications for understanding fear and anxiety networks that may contribute to the development and maintenance of PTSD.
Collapse
Affiliation(s)
- Brandee Feola
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Elizabeth A Flook
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Hannah Gardner
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - K Luan Phan
- Department of Psychiatry, The Ohio State University, Columbus, Ohio, USA
| | - Harry Gwirtsman
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Tennessee Valley HealthCare System, U.S. Department of Veterans Affairs, Nashville, Tennessee, USA
| | - Bunmi Olatunji
- Department of Psychology, Vanderbilt University, Nashville, Tennessee, USA
| | - Jennifer Urbano Blackford
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Tennessee Valley HealthCare System, U.S. Department of Veterans Affairs, Nashville, Tennessee, USA
- Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, Nebraska, USA
| |
Collapse
|
4
|
Feola B, Melancon SNT, Clauss JA, Noall MP, Mgboh A, Flook EA, Benningfield MM, Blackford JU. Bed nucleus of the stria terminalis and amygdala responses to unpredictable threat in children. Dev Psychobiol 2021; 63:e22206. [PMID: 34813095 DOI: 10.1002/dev.22206] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 09/15/2021] [Accepted: 09/26/2021] [Indexed: 01/25/2023]
Abstract
Substantial evidence from studies in humans suggests the amygdala is pivotal for anxiety. Findings from animal models and translational studies suggests the bed nucleus of the stria terminalis (BNST) is also critical for anxiety and the anticipation of unpredictable threat in adults. However, it remains unknown whether the BNST is involved in unpredictable threat anticipation in children. Forty-two 8-10-year-olds completed resting-state functional magnetic resonance imaging (fMRI) scans and an unpredictable threat fMRI task in which they were trained to associate cues with images. Intrinsic connectivity analyses were performed to establish functional BNST and amygdala networks. BNST and amygdala activation to cues and images was tested. Significant findings were followed by task-based functional connectivity analyses. Children showed evidence for BNST and amygdala intrinsic connectivity that was similar to previous patterns observed in adults. In response to unpredictable cues relative to neutral face cues, children had a significant amygdala response but no response in the BNST. The amygdala, but not the BNST, also showed a significantly greater response to fear face images relative to neutral images. Thus, unpredictable threat activated the amygdala, but not BNST, in children. This finding is contrary to studies showing robust BNST activation to unpredictable threat in adults and may suggest that the BNST's role in threat processing emerges later in development.
Collapse
Affiliation(s)
- Brandee Feola
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee, USA
| | - Sir Norman T Melancon
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, California, USA
| | | | - Madison P Noall
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Adaora Mgboh
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Elizabeth A Flook
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Margaret M Benningfield
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jennifer Urbano Blackford
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, Nebraska, USA
| |
Collapse
|
5
|
Feola B, McHugo M, Armstrong K, Noall MP, Flook EA, Woodward ND, Heckers S, Blackford JU. BNST and amygdala connectivity are altered during threat anticipation in schizophrenia. Behav Brain Res 2021; 412:113428. [PMID: 34182009 DOI: 10.1016/j.bbr.2021.113428] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 05/25/2021] [Accepted: 06/21/2021] [Indexed: 12/20/2022]
Abstract
In schizophrenia, impairments in affect are prominent and anxiety disorders are prevalent. Neuroimaging studies of fear and anxiety in schizophrenia have focused on the amygdala and show alterations in connectivity. Emerging evidence suggests that the bed nucleus of the stria terminalis (BNST) also plays a critical role in anxiety, especially during anticipation of an unpredictable threat; however, previous studies have not examined the BNST in schizophrenia. In the present study, we examined BNST function and connectivity in people with schizophrenia (n = 31; n = 15 with comorbid anxiety) and controls (n = 15) during anticipation of unpredictable and predictable threat. A secondary analysis tested for differences in activation and connectivity of the central nucleus of the amygdala (CeA), which has also been implicated in threat anticipation. Analyses tested for group differences in both activation and connectivity during anticipation of unpredictable threat and predictable threat (p < .05). Relative to controls, individuals with schizophrenia showed stronger BNST-middle temporal gyrus (MTG) connectivity during unpredictable threat anticipation and stronger BNST-MTG and BNST-dorsolateral prefrontal connectivity during predictable threat anticipation. Comparing subgroups of individuals with schizophrenia and a comorbid anxiety disorder (SZ+ANX) to those without an anxiety disorder (SZ-ANX) revealed broader patterns of altered connectivity. During unpredictable threat anticipation, the SZ+ANX group had stronger BNST connectivity with regions of the salience network (insula, dorsal anterior cingulate cortex). During predictable threat anticipation, the SZ+ANX group had stronger BNST connectivity with regions associated with fear processing (insula, extended amygdala, prefrontal cortex). A secondary CeA analysis revealed a different pattern; the SZ+ANX group had weaker CeA connectivity across multiple brain regions during threat anticipation compared to the SZ-ANX group. These findings provide novel evidence for altered functional connectivity during threat anticipation in schizophrenia, especially in individuals with comorbid anxiety.
Collapse
Affiliation(s)
- Brandee Feola
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, United States; Department of Psychology and Human Development, Vanderbilt University, Nashville, TN, United States
| | - Maureen McHugo
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Kristan Armstrong
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Madison P Noall
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Elizabeth A Flook
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Neil D Woodward
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Stephan Heckers
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Jennifer Urbano Blackford
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, United States; Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, NE, United States.
| |
Collapse
|
6
|
Flook EA, Feola B, Benningfield MM, Silveri MM, Winder DG, Blackford JU. Alterations in connectivity of the bed nucleus of the stria terminalis during early abstinence in individuals with alcohol use disorder. Alcohol Clin Exp Res 2021; 45:1028-1038. [PMID: 33830508 DOI: 10.1111/acer.14596] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 02/24/2021] [Accepted: 03/02/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND For individuals with Alcohol Use Disorder (AUD), long-term recovery is difficult in part due to symptoms of anxiety that occur during early abstinence and can trigger relapse. Research in rodent models of AUD has identified the bed nucleus of the stria terminalis (BNST), a small, sexually dimorphic, subcortical region, as critical for regulating anxiety-like behaviors during abstinence, particularly in female mice. Furthermore, prolonged alcohol use and subsequent abstinence alter BNST afferent and efferent connections to other brain regions. To our knowledge, however, no studies of early abstinence have investigated BNST structural connectivity in humans during abstinence; this study addresses that gap. METHODS Nineteen participants with AUD currently in early abstinence and 20 healthy controls completed a diffusion tensor imaging (DTI) scan. BNST structural connectivity was evaluated using probabilistic tractography. A linear mixed model was used to test between-groups differences in BNST network connectivity. Exploratory analyses were conducted to test for correlations between BNST connectivity and alcohol use severity and anxiety within the abstinence group. Sex was included as a factor for all analyses. RESULTS The BNST showed stronger structural connectivity with the BNST network in early abstinence women than in control women, which was not seen in men. Women also showed region-specific differences, with stronger BNST-hypothalamus structural connectivity but weaker vmPFC-BNST structural connectivity than men. Exploratory analyses also demonstrated a relationship between alcohol use severity and vmPFC-BNST structural connectivity that was moderated by sex. CONCLUSIONS This study is the first to demonstrate BNST structural connectivity differences in early abstinence and revealed key sex differences. The sex-specific differences in BNST structural connectivity during early abstinence could underlie known sex differences in abstinence symptoms and relapse risk and help to inform potential sex-specific treatments.
Collapse
Affiliation(s)
- Elizabeth A Flook
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt University School of Medicine, Nashville, TN, USA.,Vanderbilt Center for Addiction Research, Nashville, TN, USA
| | - Brandee Feola
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Margaret M Benningfield
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt University School of Medicine, Nashville, TN, USA.,Vanderbilt Center for Addiction Research, Nashville, TN, USA
| | - Marisa M Silveri
- Neurodevelopmental Laboratory on Addictions and Mental Health, Brain Imaging Center, McLean Hospital, Belmont, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Danny G Winder
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt University School of Medicine, Nashville, TN, USA.,Vanderbilt Center for Addiction Research, Nashville, TN, USA.,Department of Molecular Physiology and Biophysics, Vanderbilt University, Nashville, TN, USA.,Department of Pharmacology, Vanderbilt University, Nashville, TN, USA
| | - Jennifer Urbano Blackford
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt University School of Medicine, Nashville, TN, USA.,Vanderbilt Center for Addiction Research, Nashville, TN, USA.,Department of Psychology, Vanderbilt University School of Medicine, Nashville, TN, USA
| |
Collapse
|
7
|
Flook EA, Luchsinger JR, Silveri MM, Winder DG, Benningfield MM, Blackford JU. Anxiety during abstinence from alcohol: A systematic review of rodent and human evidence for the anterior insula's role in the abstinence network. Addict Biol 2021; 26:e12861. [PMID: 31991531 DOI: 10.1111/adb.12861] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 11/13/2019] [Accepted: 11/23/2019] [Indexed: 12/30/2022]
Abstract
Alcohol Use Disorder (AUD) is a chronic, relapsing disease that impacts almost a third of Americans. Despite effective treatments for attaining sobriety, the majority of patients relapse within a year, making relapse a substantial barrier to long-term treatment success. A major factor contributing to relapse is heightened negative affect that results from the combination of abstinence-related increases in stress-reactivity and decreases in reward sensitivity. Substantial research has contributed to the understanding of reward-related changes in AUD. However, less is known about anxiety during abstinence, a critical component of understanding addiction as anxiety during abstinence can trigger relapse. Most of what we know about abstinence-related negative affect comes from rodent studies which have identified key brain regions responsible for abstinence-related behaviors. This abstinence network is composed of brain regions that make up the extended amygdala: the nucleus accumbens (NAcc), the central nucleus of the amygdala (CeA), and the bed nucleus of the stria terminalis (BNST). More recently, emerging evidence from rodent and human studies suggests a fourth brain region, the anterior insula, might be part of the abstinence network. Here, we review current rodent and human literature on the extended amygdala's role in alcohol abstinence and anxiety, present evidence for the anterior insula's role in the abstinence network, and provide future directions for research to further elucidate the neural underpinnings of abstinence in humans. A better understanding of the abstinence network is critical toward understanding and possibly preventing relapse in AUD.
Collapse
Affiliation(s)
- Elizabeth A. Flook
- Vanderbilt Center for Addiction Research Vanderbilt University School of Medicine Nashville TN USA
- Vanderbilt Brain Institute Vanderbilt University School of Medicine Nashville TN USA
- Department of Psychiatry and Behavioral Sciences Vanderbilt University Medical Center Nashville TN USA
| | - Joseph R. Luchsinger
- Vanderbilt Center for Addiction Research Vanderbilt University School of Medicine Nashville TN USA
- Vanderbilt Brain Institute Vanderbilt University School of Medicine Nashville TN USA
- Vanderbilt J.F. Kennedy Center for Research on Human Development Vanderbilt University School of Medicine Nashville TN USA
| | - Marisa M. Silveri
- Neurodevelopmental Laboratory on Addictions and Mental Health, Brain Imaging Center, McLean Hospital Belmont MA USA
- Department of Psychiatry Harvard Medical School Boston MA USA
| | - Danny G. Winder
- Vanderbilt Center for Addiction Research Vanderbilt University School of Medicine Nashville TN USA
- Vanderbilt Brain Institute Vanderbilt University School of Medicine Nashville TN USA
- Department of Psychiatry and Behavioral Sciences Vanderbilt University Medical Center Nashville TN USA
- Vanderbilt J.F. Kennedy Center for Research on Human Development Vanderbilt University School of Medicine Nashville TN USA
- Department of Molecular Physiology and Biophysics Vanderbilt University School of Medicine Nashville TN USA
| | - Margaret M. Benningfield
- Vanderbilt Center for Addiction Research Vanderbilt University School of Medicine Nashville TN USA
- Vanderbilt Brain Institute Vanderbilt University School of Medicine Nashville TN USA
- Department of Psychiatry and Behavioral Sciences Vanderbilt University Medical Center Nashville TN USA
| | - Jennifer Urbano Blackford
- Vanderbilt Center for Addiction Research Vanderbilt University School of Medicine Nashville TN USA
- Vanderbilt Brain Institute Vanderbilt University School of Medicine Nashville TN USA
- Department of Psychiatry and Behavioral Sciences Vanderbilt University Medical Center Nashville TN USA
- Vanderbilt J.F. Kennedy Center for Research on Human Development Vanderbilt University School of Medicine Nashville TN USA
- Research Health Scientist, Research and Development, Department of Veterans Affairs Medical Center Nashville TN USA
| |
Collapse
|
8
|
Flook EA, Feola B, Avery SN, Winder DG, Woodward ND, Heckers S, Blackford JU. BNST-insula structural connectivity in humans. Neuroimage 2020; 210:116555. [PMID: 31954845 DOI: 10.1016/j.neuroimage.2020.116555] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 12/10/2019] [Accepted: 01/14/2020] [Indexed: 12/20/2022] Open
Abstract
The bed nucleus of the stria terminalis (BNST) is emerging as a critical region in multiple psychiatric disorders including anxiety, PTSD, and alcohol and substance use disorders. In conjunction with growing knowledge of the BNST, an increasing number of studies examine connections of the BNST and how those connections impact BNST function. The importance of this BNST network is highlighted by rodent studies demonstrating that projections from other brain regions regulate BNST activity and influence BNST-related behavior. While many animal and human studies replicate the components of the BNST network, to date, structural connections between the BNST and insula have only been described in rodents and have yet to be shown in humans. In this study, we used probabilistic tractography to examine BNST-insula structural connectivity in humans. We used two methods of dividing the insula: 1) anterior and posterior insula, to be consistent with much of the existing insula literature; and 2) eight subregions that represent informative cytoarchitectural divisions. We found evidence of a BNST-insula structural connection in humans, with the strongest BNST connectivity localized to the anteroventral insula, a region of agranular cortex. BNST-insula connectivity differed by hemisphere and was moderated by sex. These results translate rodent findings to humans and lay an important foundation for future studies examining the role of BNST-insula pathways in psychiatric disorders.
Collapse
Affiliation(s)
- Elizabeth A Flook
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA; Vanderbilt Center for Addiction Research, Vanderbilt University, Nashville, TN, USA
| | - Brandee Feola
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Suzanne N Avery
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Danny G Winder
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA; Vanderbilt Center for Addiction Research, Vanderbilt University, Nashville, TN, USA; Department of Molecular Physiology & Biophysics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Neil D Woodward
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Stephan Heckers
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jennifer Urbano Blackford
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA; Vanderbilt Center for Addiction Research, Vanderbilt University, Nashville, TN, USA; Research and Development, Department of Veterans Affairs Medical Center, Nashville, TN, USA.
| |
Collapse
|