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Fronza MG, Ferreira BF, Pavan-Silva I, Guimarães FS, Lisboa SF. "NO" Time in Fear Response: Possible Implication of Nitric-Oxide-Related Mechanisms in PTSD. Molecules 2023; 29:89. [PMID: 38202672 PMCID: PMC10779493 DOI: 10.3390/molecules29010089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/05/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024] Open
Abstract
Post-traumatic stress disorder (PTSD) is a psychiatric condition characterized by persistent fear responses and altered neurotransmitter functioning due to traumatic experiences. Stress predominantly affects glutamate, a neurotransmitter crucial for synaptic plasticity and memory formation. Activation of the N-Methyl-D-Aspartate glutamate receptors (NMDAR) can trigger the formation of a complex comprising postsynaptic density protein-95 (PSD95), the neuronal nitric oxide synthase (nNOS), and its adaptor protein (NOS1AP). This complex is pivotal in activating nNOS and nitric oxide (NO) production, which, in turn, activates downstream pathways that modulate neuronal signaling, including synaptic plasticity/transmission, inflammation, and cell death. The involvement of nNOS and NOS1AP in the susceptibility of PTSD and its comorbidities has been widely shown. Therefore, understanding the interplay between stress, fear, and NO is essential for comprehending the maintenance and progression of PTSD, since NO is involved in fear acquisition and extinction processes. Moreover, NO induces post-translational modifications (PTMs), including S-nitrosylation and nitration, which alter protein function and structure for intracellular signaling. Although evidence suggests that NO influences synaptic plasticity and memory processing, the specific role of PTMs in the pathophysiology of PTSD remains unclear. This review highlights pathways modulated by NO that could be relevant to stress and PTSD.
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Affiliation(s)
- Mariana G. Fronza
- Pharmacology Departament, Ribeirão Preto Medical School, University of São Paulo, São Paulo 14049-900, Brazil; (M.G.F.); (B.F.F.); (I.P.-S.)
| | - Bruna F. Ferreira
- Pharmacology Departament, Ribeirão Preto Medical School, University of São Paulo, São Paulo 14049-900, Brazil; (M.G.F.); (B.F.F.); (I.P.-S.)
| | - Isabela Pavan-Silva
- Pharmacology Departament, Ribeirão Preto Medical School, University of São Paulo, São Paulo 14049-900, Brazil; (M.G.F.); (B.F.F.); (I.P.-S.)
| | - Francisco S. Guimarães
- Pharmacology Departament, Ribeirão Preto Medical School, University of São Paulo, São Paulo 14049-900, Brazil; (M.G.F.); (B.F.F.); (I.P.-S.)
| | - Sabrina F. Lisboa
- Pharmacology Departament, Ribeirão Preto Medical School, University of São Paulo, São Paulo 14049-900, Brazil; (M.G.F.); (B.F.F.); (I.P.-S.)
- Biomolecular Sciences Department, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, São Paulo 14040-903, Brazil
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2
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Siehl S, Zohair R, Guldner S, Nees F. Gray matter differences in adults and children with posttraumatic stress disorder: A systematic review and meta-analysis of 113 studies and 11 meta-analyses. J Affect Disord 2023; 333:489-516. [PMID: 37086802 DOI: 10.1016/j.jad.2023.04.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 03/21/2023] [Accepted: 04/14/2023] [Indexed: 04/24/2023]
Abstract
BACKGROUND In this systematic review and meta-analysis, we aimed to provide a comprehensive overview of gray matter alterations of adult- and underage patients with posttraumatic stress disorder (PTSD) in comparison to healthy trauma-exposed (TC) and non-exposed (HC) individuals. METHODS We subdivided our groups into patients with PTSD after trauma exposure in adulthood (aa) or childhood (ac) as well as children with PTSD (cc). We identified 113 studies, including 6.800 participants in our review, which we divided into studies focusing on whole-brain and region-of-interest (ROI) analysis. We performed a coordinate-based meta-analysis on 14 studies in the group of aa-PTSD. RESULTS We and found lower gray matter volume in patients with PTSD (aa) in the medial frontal gyrus (PTSD<HC/TC) and Culmen/posterior cingulate cortex (PTSD<TC). Results from ROI-based studies mainly show alterations for patients with PTSD in the prefrontal cortex, hippocampus, anterior cingulate cortex, insula, corpus callosum, and amygdala. LIMITATIONS Due to a limited number of studies reporting whole-brain results, the meta-analyses could only be performed in one subgroup and within this subgroup for a limited number of studies. CONCLUSIONS Our results are in line with psychobiological models of PTSD that associate the identified regions with brain circuits involved in context processing, threat detection and emotion regulation.
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Affiliation(s)
- Sebastian Siehl
- Institute of Medical Psychology and Medical Sociology, University Medical Center Schleswig-Holstein, Kiel University, Kiel, Germany.
| | - Rabia Zohair
- Institute of Medical Psychology and Medical Sociology, University Medical Center Schleswig-Holstein, Kiel University, Kiel, Germany
| | - Stella Guldner
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Frauke Nees
- Institute of Medical Psychology and Medical Sociology, University Medical Center Schleswig-Holstein, Kiel University, Kiel, Germany
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3
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Wang Y, Xie C, Xu Y, Zhang Y, Zhu C, Zhou K. Cerebellar irradiation does not cause hyperactivity, fear, and anxiety-related disorders in the juvenile rat brain. Eur Radiol Exp 2022; 6:57. [PMCID: PMC9663786 DOI: 10.1186/s41747-022-00307-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/28/2022] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background
The cerebellum is involved in hyperactivity, fear, and anxiety disorders that could be induced by whole-brain irradiation (WBI). However, whether cerebellar irradiation alone (CIA) could induce these disorders is unknown. We investigated the effect of CIA in an animal model.
Methods
Eleven-day-old rat pups underwent a single 3-Gy dose of either WBI (n = 28) or CIA (n = 20), while 34 rat pups were sham-irradiated (controls). Cell death was evaluated in the subgranular zone of the hippocampus by counting pyknotic cells after haematoxylin/eosin staining at 6 h after irradiation for 10, 8, and 9 pups, respectively. Behavioural changes were evaluated via open-field test at 6 weeks for 18, 12, and 25 pups, respectively. Unpaired two-tailed t-test and one-way and two-way repeated ANOVA were used.
Results
Massive cell death in cerebellar external granular layer was detected at 6 h after CIA (1,419 ± 211 mm, mean ± S.E.M. versus controls (68 ± 12 mm) (p < 0.001)), while no significant difference between CIA (1,419 ± 211 mm) versus WBI (1,433 ± 107 mm) (p = 0.955) was found. At open-field behavioural test, running distance, activity, wall distance, middle zone visit times, and duration were higher for WBI versus controls (p < 0.010), but no difference between CIA and controls was found (p > 0.05).
Conclusions
Although the cerebellum is involved in hyperactivity, fear, and anxiety disorders, CIA did not induce these disorders, indicating that WBI-induced cerebellar injury does not directly cause these behavioural abnormalities after WBI. Thus, targeting the cerebellum alone may not be enough to rescue or reduce these behavioural abnormalities after WBI.
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4
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Sarigedik E, Naldemir IF, Karaman AK, Altinsoy HB. Intergenerational transmission of psychological trauma: A structural neuroimaging study. Psychiatry Res Neuroimaging 2022; 326:111538. [PMID: 36113385 DOI: 10.1016/j.pscychresns.2022.111538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 07/29/2022] [Accepted: 08/31/2022] [Indexed: 11/26/2022]
Abstract
Traumatic events have an important effect in human life and may lead to psychopathological disturbances by affecting the personal and social lives of individuals. Recently, various studies have been reported in the literature showing that the traumatic experiences may be associated with intergenerational psychopathologies. However, there is limited data regarding the neuroimaging studies investigating changes in brain structures in children of traumatized mothers. In this study, we aimed to investigate the potential changes in the hippocampus and amygdala volumes in the children of mothers exposed to mass trauma. The traumatic event experienced by the mothers was the two devastating earthquakes they experienced when they were teenagers. Hippocampus and amygdala volumes were evaluated in magnetic resonance imaging of 40 children whose mothers were exposed to earthquakes and 27 children in control group. Bilateral amygdala volumes were significantly smaller in the children of mothers exposed to earthquake compared to the control group. In addition, right amygdala and hippocampus volumes were smaller in children of mothers exposed to earthquakes than left. This is one of the pioneering neuroimaging studies on the intergenerational transmission of trauma. Our study shows that there may be a potential relationship between intergenerational trauma and various brain structures.
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Affiliation(s)
- Enes Sarigedik
- Department of Child and Adolescent Psychiatry, Sakarya University, Sakarya, Turkey
| | | | - Ahmet Kursat Karaman
- Department of Radiology, Sureyyapasa Chest Diseases and Thoracic Surgery Training Hospital, Istanbul, Turkey
| | - Hasan Baki Altinsoy
- Department of Radiology, Duzce University, Faculty of Medicine, Duzce, Turkey
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5
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Chen HJ, Qi R, Ke J, Qiu J, Xu Q, Zhong Y, Lu GM, Chen F. Evaluation of gray matter reduction in patients with typhoon-related posttraumatic stress disorder using causal network analysis of structural MRI. Psychol Med 2022; 52:1481-1490. [PMID: 32938511 DOI: 10.1017/s0033291720003281] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The structural changes recent-onset posttraumatic stress disorder (PTSD) subjects were rarely investigated. This study was to compare temporal and causal relationships of structural changes in recent-onset PTSD with trauma-exposed control (TEC) subjects and non-TEC subjects. METHODS T1-weighted magnetic resonance images of 27 PTSD, 33 TEC and 30 age- and sex-matched healthy control (HC) subjects were studied. The causal network of structural covariance was used to evaluate the causal relationships of structural changes in PTSD patients. RESULTS Volumes of bilateral hippocampal and left lingual gyrus were significantly smaller in PTSD patients and TEC subjects than HC subjects. As symptom scores increase, reduction in gray matter volume began in the hippocampus and progressed to the frontal lobe, then to the temporal and occipital cortices (p < 0.05, false discovery rate corrected). The hippocampus might be the primary hub of the directional network and demonstrated positive causal effects on the frontal, temporal and occipital regions (p < 0.05, false discovery rate corrected). The frontal regions, which were identified to be transitional points, projected causal effects to the occipital lobe and temporal regions and received causal effects from the hippocampus (p < 0.05, false discovery rate corrected). CONCLUSIONS The results offer evidence of localized abnormalities in the bilateral hippocampus and remote abnormalities in multiple temporal and frontal regions in typhoon-exposed PTSD patients.
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Affiliation(s)
- Hui Juan Chen
- Department of Radiology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), NO. 19, XIUHUA ST, XIUYING DIC, Haikou, 570311, Hainan, P.R. China
| | - Rongfeng Qi
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China
| | - Jun Ke
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province 215006, China
| | - Jie Qiu
- Department of Ultrasound, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), NO. 19, XIUHUA ST, XIUYING DIC, Haikou, 570311, Hainan, P.R. China
| | - Qiang Xu
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China
| | - Yuan Zhong
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China
| | - Guang Ming Lu
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China
| | - Feng Chen
- Department of Radiology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), NO. 19, XIUHUA ST, XIUYING DIC, Haikou, 570311, Hainan, P.R. China
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6
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Zilcha‐Mano S, Zhu X, Lazarov A, Suarez‐Jimenez B, Helpman L, Kim Y, Maitlin C, Neria Y, Rutherford BR. Structural brain features signaling trauma, PTSD, or resilience? A systematic exploration. Depress Anxiety 2022; 39:695-705. [PMID: 35708133 PMCID: PMC9588504 DOI: 10.1002/da.23275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 04/15/2022] [Accepted: 05/30/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Studies have searched for neurobiological markers of trauma exposure, posttraumatic stress disorder (PTSD) diagnosis, and resilience to trauma to identify therapeutic targets for PTSD. Despite some promising results, findings are inconsistent. AIMS The present study adopted a data-driven approach to systematically explore whether structural brain markers of trauma, PTSD, or resilience emerge when all are explored. MATERIALS & METHODS Differences between clusters in the proportion of PTSD, healthy controls (HC), and trauma-exposed healthy controls (TEHC) served to indicate the presence of PTSD, trauma, and resilience markers, respectively. A total of 129 individuals, including 46 with PTSD, 49 TEHCs, and 34 HCs not exposed to trauma were scanned. Volumes, cortical thickness, and surface areas of interest were obtained from T1 structural MRI and used to identify data-driven clusters. RESULTS Two clusters were identified, differing in the proportion of TEHCs but not of PTSDs or HCs. The cluster with the higher proportion of TEHCs, referred to as the resilience cluster, was characterized by higher volume in brain regions implicated in trauma exposure, especially the thalamus and rostral middle frontal gyrus. Cross-validation established the robustness and consistency of the identified clusters. DISCUSSION & CONCLUSION Findings support the existence of structural brain markers of resilience.
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Affiliation(s)
| | - Xi Zhu
- Department of PsychiatryColumbia UniversityNew YorkNew YorkUSA,New York State Psychiatric Institute, Columbia University Medical CenterNew YorkNew YorkUSA
| | - Amit Lazarov
- School of Psychological SciencesTel‐Aviv UniversityTel‐AvivIsrael,Department of PsychiatryColumbia University Medical CenterNew YorkNew YorkUSA
| | - Benjamin Suarez‐Jimenez
- New York State Psychiatric Institute, Columbia University Medical CenterNew YorkNew YorkUSA,Department of NeuroscienceUniversity of RochesterRochesterNew YorkUSA
| | - Liat Helpman
- Department of Counseling and Human DevelopmentUniversity of HaifaMount CarmelHaifaIsrael,Tel Aviv Sourasky Medical CenterTel AvivIsrael
| | - Yoojean Kim
- Department of PsychiatryColumbia UniversityNew YorkNew YorkUSA,New York State Psychiatric Institute, Columbia University Medical CenterNew YorkNew YorkUSA
| | - Carly Maitlin
- Department of PsychiatryColumbia UniversityNew YorkNew YorkUSA,New York State Psychiatric Institute, Columbia University Medical CenterNew YorkNew YorkUSA
| | - Yuval Neria
- Department of PsychiatryColumbia UniversityNew YorkNew YorkUSA,New York State Psychiatric Institute, Columbia University Medical CenterNew YorkNew YorkUSA
| | - Bret R. Rutherford
- Columbia University College of Physicians and Surgeons, New York State Psychiatric InstituteNew York CityNew YorkUSA
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7
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Roy O, Levasseur-Moreau J, Renauld E, Hébert LJ, Leblond J, Bilodeau M, Fecteau S. Whole-brain morphometry in Canadian soldiers with posttraumatic stress disorder. Ann N Y Acad Sci 2021; 1509:37-49. [PMID: 34791677 DOI: 10.1111/nyas.14707] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 08/25/2021] [Accepted: 10/04/2021] [Indexed: 01/11/2023]
Abstract
Patients with posttraumatic stress disorder (PTSD) display several structural brain differences when compared with healthy individuals. However, findings are particularly inconsistent for soldiers with PTSD. Here, we characterized the brain morphometry of 37 soldiers from the Canadian Armed Forces with adulthood war-related PTSD using structural magnetic resonance imaging. We assessed time since trauma, as well as PTSD, depressive, and anxiety symptoms with the Modified PTSD Symptoms Scale, Beck Depression Inventory, and Beck Anxiety Inventory, respectively. Whole-brain morphometry was extracted with FreeSurfer and compared with a validated normative database of more than 2700 healthy individuals. Volume and thickness from several regions differed from the norms. Frontal regions were smaller and thinner, particularly the superior and rostral middle frontal gyri. Furthermore, smaller left rostral middle frontal gyrus, left pericalcarine cortex, and right fusiform gyrus were associated with more recent trauma. All subcortical structures were bigger, except the hippocampus. These findings suggest a particular brain morphometric signature of PTSD in soldiers. Smaller and thinner frontal and larger subcortical regions support impaired top-down and/or downregulation of emotional response in PTSD. Finally, the correlation of smaller frontal, temporal, and occipital regions with more recent trauma might inform future therapeutic approaches.
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Affiliation(s)
- Olivier Roy
- CERVO Brain Research Centre, Quebec, Canada.,Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, Canada.,Department of Psychiatry and Neurosciences, Université Laval, Quebec, Canada
| | - Jean Levasseur-Moreau
- CERVO Brain Research Centre, Quebec, Canada.,Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, Canada.,Department of Psychiatry and Neurosciences, Université Laval, Quebec, Canada
| | - Emmanuelle Renauld
- CERVO Brain Research Centre, Quebec, Canada.,Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, Canada.,Department of Psychiatry and Neurosciences, Université Laval, Quebec, Canada
| | - Luc J Hébert
- Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, Canada.,Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Quebec, Canada.,Department of Rehabilitation, Université Laval, Quebec, Canada
| | - Jean Leblond
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Quebec, Canada
| | - Mathieu Bilodeau
- Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, Canada.,Department of Psychiatry and Neurosciences, Université Laval, Quebec, Canada
| | - Shirley Fecteau
- CERVO Brain Research Centre, Quebec, Canada.,Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, Canada.,Department of Psychiatry and Neurosciences, Université Laval, Quebec, Canada
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8
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Bremner JD, Hoffman M, Afzal N, Cheema FA, Novik O, Ashraf A, Brummer M, Nazeer A, Goldberg J, Vaccarino V. The environment contributes more than genetics to smaller hippocampal volume in Posttraumatic Stress Disorder (PTSD). J Psychiatr Res 2021; 137:579-588. [PMID: 33168198 PMCID: PMC8345282 DOI: 10.1016/j.jpsychires.2020.10.042] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Studies using structural magnetic resonance imaging (MRI) volumetrics showed smaller hippocampal volume in patients with post-traumatic stress disorder (PTSD). These studies were cross-sectional and did not address whether smaller volume is secondary to stress-induced damage, or whether pre-existing factors account for the findings. The purpose of this study was to use a co-twin case control design to assess the relative contribution of genetic and environmental factors to hippocampal volume in PTSD. METHODS Monozygotic (N = 13 pairs) and dizygotic (N = 21 pairs) twins with a history of Vietnam Era military service, where one brother went to Vietnam and developed PTSD, while his brother did not go to Vietnam or develop PTSD, underwent MR imaging of the brain. Structural MRI scans were used to manually outline the left and right hippocampus on multiple coronal slices, add the areas and adjust for slice thickness to determine hippocampal volume. RESULTS Twins with Vietnam combat-related PTSD had a mean 11% smaller right hippocampal volume in comparison to their twin brothers without combat exposure or PTSD (p < .05). There was no significant interaction by zygosity, suggesting that this was not a predisposing risk factor or genetic effect. CONCLUSIONS These findings are consistent with smaller hippocampal volume in PTSD, and suggest that the effects are primarily due to environmental effects such as the stress of combat.
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Affiliation(s)
- J. Douglas Bremner
- Departments of Psychiatry and Behavioral Sciences, USA, Radiology, and Medicine (Cardiology), USA, Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA, Corresponding author. Dept of Psychiatry & Behavioral Sciences, Emory University School of Medicine, 12 Executive Park Dr NE, USA. (J.D. Bremner)
| | | | - Nadeem Afzal
- Departments of Psychiatry and Behavioral Sciences, USA
| | - Faiz A. Cheema
- Departments of Psychiatry and Behavioral Sciences, USA, The Vietnam Era Twin Registry, Seattle Veterans Administration Epidemiology Research, USA
| | - Olga Novik
- Departments of Psychiatry and Behavioral Sciences, USA, The Vietnam Era Twin Registry, Seattle Veterans Administration Epidemiology Research, USA
| | - Ali Ashraf
- Departments of Psychiatry and Behavioral Sciences, USA
| | | | - Ahsan Nazeer
- Departments of Psychiatry and Behavioral Sciences, USA
| | - Jack Goldberg
- Information Center and Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Viola Vaccarino
- Emory University School of Medicine, Atlanta GA; Atlanta VAMC, Decatur, GA, USA, The Vietnam Era Twin Registry, Seattle Veterans Administration Epidemiology Research, USA
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9
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Misaki M, Mulyana B, Zotev V, Wurfel BE, Krueger F, Feldner M, Bodurka J. Hippocampal volume recovery with real-time functional MRI amygdala neurofeedback emotional training for posttraumatic stress disorder. J Affect Disord 2021; 283:229-235. [PMID: 33561804 DOI: 10.1016/j.jad.2021.01.058] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/08/2021] [Accepted: 01/30/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Small hippocampal volume is a prevalent neurostructural abnormality in posttraumatic stress disorder (PTSD). However, whether the hippocampal atrophy is the cause of disease symptoms or a pre-existing risk factor and whether it is a reversible alteration or a permanent trait are unclear. The trait- or state-dependent alteration could also differ among the hippocampal subfields. METHODS The study examined the longitudinal hippocampal volume changes due to positive emotional training with left amygdala (LA) real-time fMRI neurofeedback (rtfMRI-nf) in combat veterans with PTSD. The participants were trained to increase the neurofeedback signal from LA (experimental group, N = 20) or brain region not involved in emotion processing (control group, N = 9) by recalling a positive autobiographical memory. The pre- and post-training structural MRI brain images were processed with FreeSurfer to evaluate the hippocampal subfield volumes. Hippocampal volumes for healthy controls (N = 43) were also examined to evaluate the baseline abnormality in PTSD. RESULTS A significant group difference in volume change was found in the left CA1 head region. This region had the most significant volume reduction at the baseline in PTSD. The experimental group showed a significant volume increase, while the control group showed a significant volume decrease in this region. The volume change in the control group negatively correlated with interval days between the scans. LIMITATIONS A cognitive improvement due to the hippocampal volume increase could not be found with symptom scales. CONCLUSIONS RtfMRI-nf positive emotional training increased the hippocampus volume among people with PTSD, suggesting that hippocampal atrophy in PTSD is modifiable.
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Affiliation(s)
- Masaya Misaki
- Laureate Institute for Brain Research, Tulsa, OK, United States.
| | - Beni Mulyana
- Laureate Institute for Brain Research, Tulsa, OK, United States; Electrical and Computer Engineering, University of Oklahoma, Tulsa, OK, United States
| | - Vadim Zotev
- Laureate Institute for Brain Research, Tulsa, OK, United States
| | - Brent E Wurfel
- Laureate Institute for Brain Research, Tulsa, OK, United States; Laureate Psychiatric Clinic and Hospital, Tulsa, OK, United States
| | - Frank Krueger
- Neuroscience Department, George Mason University, Fairfax, VA, United States
| | - Matthew Feldner
- Department of Psychological Science, University of Arkansas, Fayetteville, AR, United States
| | - Jerzy Bodurka
- Laureate Institute for Brain Research, Tulsa, OK, United States; Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK, United States.
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10
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Meeuwsen KD, Groeneveld KM, Walker LA, Mennenga AM, Tittle RK, White EK. Z-score neurofeedback, heart rate variability biofeedback, and brain coaching for older adults with memory concerns. Restor Neurol Neurosci 2021; 39:9-37. [PMID: 33386829 PMCID: PMC7990441 DOI: 10.3233/rnn-201053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND The three-month, multi-domain Memory Boot Camp program incorporates z-score neurofeedback (NFB), heart rate variability (HRV) biofeedback, and one-on-one coaching to teach memory skills and encourage behavior change in diet, sleep, physical fitness, and stress reduction. OBJECTIVE This prospective trial evaluates the Memory Boot Camp program for adults ages 55 to 85 with symptoms of Mild Cognitive Impairment (MCI) and subjective memory complaints. METHODS Participants were evaluated via the Montreal Cognitive Assessment (MoCA), NeuroTrax Global Cognitive Score, measures of anxiety, depression, sleep, quality of life, quantitative electroencephalography (QEEG), and HRV parameters at four timepoints: baseline, pre-program, post-program, and follow-up. The trial included a three-month waiting period between baseline and pre-program, such that each participant acted as their own control, and follow-up took place six months after completion of the program. RESULTS Participants' MoCA scores and self-reported measures of anxiety, depression, sleep quality, and quality of life improved after treatment, and these changes were maintained at follow-up. Physiological changes in HRV parameters after treatment were not significant, however, breathing rate and QEEG parameters were improved at post-program and maintained at follow-up. Finally, participants' improvement in MoCA score over the treatment period was correlated with their improvement in two brain oscillation parameters targeted by the z-score NFB protocol: relative power of delta and relative power of theta. CONCLUSIONS Trial results suggest that the Memory Boot Camp program is a promising treatment strategy for older adults with symptoms of MCI and subjective memory complaints.
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11
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Cwik JC, Vahle N, Woud ML, Potthoff D, Kessler H, Sartory G, Seitz RJ. Reduced gray matter volume in the left prefrontal, occipital, and temporal regions as predictors for posttraumatic stress disorder: a voxel-based morphometric study. Eur Arch Psychiatry Clin Neurosci 2020; 270:577-588. [PMID: 30937515 DOI: 10.1007/s00406-019-01011-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 03/26/2019] [Indexed: 02/07/2023]
Abstract
The concept of acute stress disorder (ASD) was introduced as a diagnostic entity to improve the identification of traumatized people who are likely to develop posttraumatic stress disorder (PTSD). Neuroanatomical models suggest that changes in the prefrontal cortex, amygdala, and hippocampus play a role in the development of PTSD. Using voxel-based morphometry, this study aimed to investigate the predictive power of gray matter volume (GMV) alterations for developing PTSD. The GMVs of ASD patients (n = 21) were compared to those of PTSD patients (n = 17) and healthy controls (n = 18) in whole-brain and region-of-interest analyses. The GMV alterations seen in ASD patients shortly after the traumatic event (T1) were also correlated with PTSD symptom severity and symptom clusters 4 weeks later (T2). Compared with healthy controls, the ASD patients had significantly reduced GMV in the left visual cortex shortly after the traumatic event (T1) and in the left occipital and prefrontal regions 4 weeks later (T2); no significant differences in GMV were seen between the ASD and PTSD patients. Furthermore, a significant negative association was found between the GMV reduction in the left lateral temporal regions seen after the traumatic event (T1) and PTSD hyperarousal symptoms 4 weeks later (T2). Neither amygdala nor hippocampus alterations were predictive for the development of PTSD. These data suggest that gray matter deficiencies in the left hemispheric occipital and temporal regions in ASD patients may predict a liability for developing PTSD.
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Affiliation(s)
- Jan Christopher Cwik
- Department of Clinical Psychology and Psychotherapy, Faculty of Human Sciences, Universität zu Köln, Pohligstr. 1, 50969, Cologne, Germany. .,Faculty of Psychology, Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany.
| | - Nils Vahle
- Department of Psychology and Psychotherapy, University Witten/Herdecke, Witten, Germany
| | - Marcella Lydia Woud
- Faculty of Psychology, Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Denise Potthoff
- Department of Neurology, Center for Neurology and Neuropsychiatry, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - Henrik Kessler
- Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr-Universität Bochum, Bochum, Germany
| | - Gudrun Sartory
- Department of Clinical Psychology and Psychotherapy, School of Human and Social Sciences, Bergische Universität Wuppertal, Wuppertal, Germany
| | - Rüdiger J Seitz
- Department of Neurology, Center for Neurology and Neuropsychiatry, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
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12
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Park YW, Jun S, Noh J, Chung SJ, Han S, Lee PH, Kim C, Lee SK. Structural and Resting-State Brain Alterations in Trauma-Exposed Firefighters: Preliminary Results. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2020; 81:676-687. [PMID: 36238613 PMCID: PMC9431906 DOI: 10.3348/jksr.2020.81.3.676] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/08/2019] [Accepted: 10/14/2019] [Indexed: 12/17/2022]
Abstract
Purpose To analyze the altered brain regions and intrinsic brain activity patterns in trauma-exposed firefighters without posttraumatic stress disorder (PTSD). Materials and Methods Resting-state functional MRI (rsfMRI) was performed for all subjects. Thirty-one firefighters over 40 years of age without PTSD (31 men; mean age, 49.8 ± 4.7 years) were included. Twenty-six non-traumatized healthy controls (HCs) (26 men; mean age, 65.3 ± 7.84 years) were also included. Voxel-based morphometry was performed to investigate focal differences in the brain anatomy. Seed-based functional connectivity analysis was performed to investigate differences in spontaneous brain characteristics. Results The mean z-scores of the Seoul Verbal Learning Test for immediate and delayed recall, Controlled Oral Word Association Test (COWAT) score for animals, and COWAT phonemic fluency were significantly lower in the firefighter group than in the HCs, indicating decreased neurocognitive function. Compared to HCs, firefighters showed reduced gray matter volume in the left superior parietal gyrus and left inferior temporal gyrus. Further, in contrast to HCs, firefighters showed alterations in rsfMRI values in multiple regions, including the fusiform gyrus and cerebellum. Conclusion Structural and resting-state functional abnormalities in the brain may be useful imaging biomarkers for identifying alterations in trauma-exposed firefighters without PTSD.
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Affiliation(s)
- Yae Won Park
- Department of Radiology, Ewha Womans University College of Medicine, Seoul, Korea
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Suhnyoung Jun
- Department of Psychology, Yonsei University College of Medicine, Seoul, Korea
| | - Juwhan Noh
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Seok Jong Chung
- Department of Neurology, Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sanghoon Han
- Department of Psychology, Yonsei University College of Medicine, Seoul, Korea
| | - Phil Hyu Lee
- Department of Neurology, Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Changsoo Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Seung-Koo Lee
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
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13
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Klaming R, Spadoni AD, Veltman DJ, Simmons AN. Expansion of hippocampal and amygdala shape in posttraumatic stress and early life stress. NEUROIMAGE-CLINICAL 2019; 24:101982. [PMID: 31437724 PMCID: PMC6706650 DOI: 10.1016/j.nicl.2019.101982] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/09/2019] [Accepted: 08/12/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The aim of this study was to examine the effect of Posttraumatic Stress Disorder (PTSD) and childhood adversity on brain structure. We assessed hippocampal and amygdala shape in veterans with varying levels of PTSD symptom severity and exposure to early life stressors (ELS). METHODS A total of 70 male veterans, who were deployed to a combat area during OIF/OEF/OND and who had been exposed to trauma during deployment, were included in the study. We applied a vertex-wise shape analysis of 3T MRI scans to measure indentation or expansion in hippocampal and amygdala shape. RESULTS Analyses showed a positive correlation between number of ELS and vertices in the right amygdala and the right hippocampus, as well as a positive correlation between PTSD symptom severity and right hippocampal vertices. There were no significant interactions between PTSD symptoms, ELS, and brain shape. DISCUSSION Results indicate a relationship between exposure to more childhood adversity and expansion in amygdala and hippocampal shape as well as between more severe PTSD symptoms and expansion in hippocampal shape. These findings may have important implications for the pathophysiology of trauma-related disorders.
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Affiliation(s)
- Ruth Klaming
- VA San Diego Healthcare System, University of California San Diego, San Diego, CA, USA; Department of Psychiatry, University of California San Diego, San Diego, CA, USA; Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands.
| | - Andrea D Spadoni
- VA San Diego Healthcare System, University of California San Diego, San Diego, CA, USA; Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Dick J Veltman
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
| | - Alan N Simmons
- VA San Diego Healthcare System, University of California San Diego, San Diego, CA, USA; Department of Psychiatry, University of California San Diego, San Diego, CA, USA
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14
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Henigsberg N, Kalember P, Petrović ZK, Šečić A. Neuroimaging research in posttraumatic stress disorder - Focus on amygdala, hippocampus and prefrontal cortex. Prog Neuropsychopharmacol Biol Psychiatry 2019; 90:37-42. [PMID: 30419321 DOI: 10.1016/j.pnpbp.2018.11.003] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 10/26/2018] [Accepted: 11/03/2018] [Indexed: 01/21/2023]
Abstract
Neuroimaging research reflects the complexity of post-traumatic stress disorder and shares some common difficulties of post-traumatic stress disorder research, such as the different classifications of the disorder over time, changes in diagnostic criteria, and extensive comorbidities, as well as precisely delineated and prevailing genetic and environmental determinants in the development of the disorder and its clinical manifestations. Synthesis of neuroimaging findings in an effort to clarify causes, clinical manifestations, and consequences of the disorder is complicated by a variety of applied technical approaches in different brain regions, differences in symptom dimensions in a study population, and typically small sample sizes, with the interplay of all of these consequently bringing about divergent results. Furthermore, combinations of the aforementioned issues serve to weaken any comprehensive meta-analytic approach. In this review, we focus on recent neuroimaging studies and those performed on larger samples, with particular emphasis on research concerning the amygdala, hippocampus, and prefrontal cortex, as these are the brain regions postulated by the core research to play a prominent role in the pathophysiology of post-traumatic stress disorder. Additionally, we review the guidelines for future research and list a number of new intersectional and cross-sectional approaches in the area of neuroimaging. We conclude that future neuroimaging research in post-traumatic stress disorder will certainly benefit from a higher integration with genetic research, better profiling of control groups, and a greater involvement of the neuroimaging genetics approach and from larger collaborative studies.
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Affiliation(s)
- Neven Henigsberg
- Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Croatia; University Psychiatric Hospital Vrapče, Zagreb, Croatia
| | - Petra Kalember
- Polyclinic Neuron, Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Croatia
| | - Zrnka Kovačić Petrović
- Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Croatia; University Psychiatric Hospital Vrapče, Zagreb, Croatia
| | - Ana Šečić
- Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Croatia; University Hospital Centre, 'Sestre milosrdnice', Zagreb, Croatia.
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15
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Hannoun S, Tutunji R, El Homsi M, Saaybi S, Hourani R. Automatic Thalamus Segmentation on Unenhanced 3D T1 Weighted Images: Comparison of Publicly Available Segmentation Methods in a Pediatric Population. Neuroinformatics 2018; 17:443-450. [DOI: 10.1007/s12021-018-9408-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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16
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Moreno-Rius J. The cerebellum in fear and anxiety-related disorders. Prog Neuropsychopharmacol Biol Psychiatry 2018; 85:23-32. [PMID: 29627508 DOI: 10.1016/j.pnpbp.2018.04.002] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 03/29/2018] [Accepted: 04/04/2018] [Indexed: 01/06/2023]
Abstract
Fear and anxiety-related disorders are highly prevalent psychiatric conditions characterized by avoidant and fearful reactions towards specific stimuli or situations, which are disproportionate given the real threat such stimuli entail. These conditions comprise the most common mental disorder group. There are a high proportion of patients who fail to achieve remission and the presence of high relapse rates indicate the therapeutic options available are far from being fully efficient. Despite an increased understanding the neural circuits underlying fear and anxiety-related behaviors in the last decades, a factor that could be partially contributing to the lack of adequate therapies may be an insufficient understanding of the core features of the disorders and their associated neurobiology. Interestingly, the cerebellum shows connections with fear and anxiety-related brain areas and functional involvement in such processes, but explanations for its role in anxiety disorders are lacking. Therefore, the aims of this review are to provide an overview of the neural circuitry of fear and anxiety and its connections to the cerebellum, and of the animal studies that directly assess an involvement of the cerebellum in these processes. Then, the studies performed in patients suffering from anxiety disorders that explore the cerebellum will be discussed. Finally, we'll propose a function for the cerebellum in these disorders, which could guide future experimental approaches to the topic and lead to a better understanding of the neurobiology of anxiety-related disorders, ultimately helping to develop more effective treatments for these conditions.
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Affiliation(s)
- Josep Moreno-Rius
- Department of Pharmacology and Toxicology, University of Innsbruck, Innsbruck, Austria.
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17
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Logue MW, van Rooij SJH, Dennis EL, Davis SL, Hayes JP, Stevens JS, Densmore M, Haswell CC, Ipser J, Koch SBJ, Korgaonkar M, Lebois LAM, Peverill M, Baker JT, Boedhoe PSW, Frijling JL, Gruber SA, Harpaz-Rotem I, Jahanshad N, Koopowitz S, Levy I, Nawijn L, O'Connor L, Olff M, Salat DH, Sheridan MA, Spielberg JM, van Zuiden M, Winternitz SR, Wolff JD, Wolf EJ, Wang X, Wrocklage K, Abdallah CG, Bryant RA, Geuze E, Jovanovic T, Kaufman ML, King AP, Krystal JH, Lagopoulos J, Bennett M, Lanius R, Liberzon I, McGlinchey RE, McLaughlin KA, Milberg WP, Miller MW, Ressler KJ, Veltman DJ, Stein DJ, Thomaes K, Thompson PM, Morey RA. Smaller Hippocampal Volume in Posttraumatic Stress Disorder: A Multisite ENIGMA-PGC Study: Subcortical Volumetry Results From Posttraumatic Stress Disorder Consortia. Biol Psychiatry 2018; 83:244-253. [PMID: 29217296 PMCID: PMC5951719 DOI: 10.1016/j.biopsych.2017.09.006] [Citation(s) in RCA: 284] [Impact Index Per Article: 47.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 09/01/2017] [Accepted: 09/01/2017] [Indexed: 01/30/2023]
Abstract
BACKGROUND Many studies report smaller hippocampal and amygdala volumes in posttraumatic stress disorder (PTSD), but findings have not always been consistent. Here, we present the results of a large-scale neuroimaging consortium study on PTSD conducted by the Psychiatric Genomics Consortium (PGC)-Enhancing Neuroimaging Genetics through Meta-Analysis (ENIGMA) PTSD Working Group. METHODS We analyzed neuroimaging and clinical data from 1868 subjects (794 PTSD patients) contributed by 16 cohorts, representing the largest neuroimaging study of PTSD to date. We assessed the volumes of eight subcortical structures (nucleus accumbens, amygdala, caudate, hippocampus, pallidum, putamen, thalamus, and lateral ventricle). We used a standardized image-analysis and quality-control pipeline established by the ENIGMA consortium. RESULTS In a meta-analysis of all samples, we found significantly smaller hippocampi in subjects with current PTSD compared with trauma-exposed control subjects (Cohen's d = -0.17, p = .00054), and smaller amygdalae (d = -0.11, p = .025), although the amygdala finding did not survive a significance level that was Bonferroni corrected for multiple subcortical region comparisons (p < .0063). CONCLUSIONS Our study is not subject to the biases of meta-analyses of published data, and it represents an important milestone in an ongoing collaborative effort to examine the neurobiological underpinnings of PTSD and the brain's response to trauma.
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Affiliation(s)
- Mark W Logue
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, Massachusetts; Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts; Department of Biomedical Genetics, Boston University School of Medicine, Boston, Massachusetts; Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Sanne J H van Rooij
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia
| | - Emily L Dennis
- Imaging Genetics Center, Mary and Mark Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Marina del Rey, California
| | - Sarah L Davis
- Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham VA Medical Center, Durham, North Carolina; Duke-UNC Brain Imaging and Analysis Center, Duke University, Durham, North Carolina
| | - Jasmeet P Hayes
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, Massachusetts; Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Jennifer S Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia
| | - Maria Densmore
- Department of Psychiatry, University of Western Ontario, London, Ontario, Canada
| | - Courtney C Haswell
- Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham VA Medical Center, Durham, North Carolina; Duke-UNC Brain Imaging and Analysis Center, Duke University, Durham, North Carolina
| | - Jonathan Ipser
- Department of Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Saskia B J Koch
- Brain Imaging Center, Academic Medical Center, Amsterdam, the Netherlands
| | - Mayuresh Korgaonkar
- Brain Dynamics Centre, Westmead Institute for Medical Research, Sydney, Australia
| | - Lauren A M Lebois
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts; McLean Hospital, Harvard University, Belmont, Massachusetts
| | - Matthew Peverill
- Department of Psychology, University of Washington, Seattle, Washington
| | - Justin T Baker
- McLean Hospital, Harvard University, Belmont, Massachusetts
| | - Premika S W Boedhoe
- Department of Psychiatry, VU University Medical Center, Amsterdam, the Netherlands
| | - Jessie L Frijling
- Department of Psychiatry, Academic Medical Center, Amsterdam, the Netherlands
| | - Staci A Gruber
- McLean Hospital, Harvard University, Belmont, Massachusetts
| | - Ilan Harpaz-Rotem
- Clinical Neuroscience Division, VA National Center for PTSD, VA Connecticut HealthCare System, West Haven, Connecticut; Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Neda Jahanshad
- Imaging Genetics Center, Mary and Mark Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Marina del Rey, California
| | - Sheri Koopowitz
- Department of Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Ifat Levy
- Clinical Neuroscience Division, VA National Center for PTSD, VA Connecticut HealthCare System, West Haven, Connecticut; Interdepartmental Neuroscience Program, Yale University, New Haven, Connecticut
| | - Laura Nawijn
- Department of Psychiatry, Academic Medical Center, Amsterdam, the Netherlands
| | - Lauren O'Connor
- Department of Psychology, John Jay College of Criminal Justice, City University of New York, New York, New York; Graduate Center, City University of New York, New York, New York
| | - Miranda Olff
- Department of Psychiatry, Academic Medical Center, Amsterdam, the Netherlands; Department of Psychiatry, Arq National Trauma Center, Diemen, the Netherlands
| | - David H Salat
- Neuroimaging Research for Veterans Center, VA Boston Healthcare System, Boston, Massachusetts; Department of Radiology, Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts
| | - Margaret A Sheridan
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, North Carolina
| | - Jeffrey M Spielberg
- Neuroimaging Research for Veterans Center, VA Boston Healthcare System, Boston, Massachusetts; Department of Psychological and Brain Sciences, University of Delaware, Newark, Delaware
| | - Mirjam van Zuiden
- Department of Psychiatry, Academic Medical Center, Amsterdam, the Netherlands
| | | | - Jonathan D Wolff
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts; McLean Hospital, Harvard University, Belmont, Massachusetts
| | - Erika J Wolf
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, Massachusetts; Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Xin Wang
- Department of Psychiatry, University of Toledo, Toledo, Ohio
| | - Kristen Wrocklage
- Clinical Neuroscience Division, VA National Center for PTSD, VA Connecticut HealthCare System, West Haven, Connecticut; Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Chadi G Abdallah
- Clinical Neuroscience Division, VA National Center for PTSD, VA Connecticut HealthCare System, West Haven, Connecticut; Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Richard A Bryant
- Department of Psychology, University of New South Wales, Sydney, Australia
| | - Elbert Geuze
- Brain Center Rudolf Magnus, University Medical Center, Utrecht, the Netherlands
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia
| | - Milissa L Kaufman
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts; McLean Hospital, Harvard University, Belmont, Massachusetts
| | - Anthony P King
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - John H Krystal
- Clinical Neuroscience Division, VA National Center for PTSD, VA Connecticut HealthCare System, West Haven, Connecticut; Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Jim Lagopoulos
- Neuroimaging Brain & Mind Research Institute, University of Sydney, Sydney, Australia
| | - Maxwell Bennett
- Neuroimaging Brain & Mind Research Institute, University of Sydney, Sydney, Australia
| | - Ruth Lanius
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, Massachusetts; Department of Psychiatry, University of Western Ontario, London, Ontario, Canada
| | - Israel Liberzon
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Regina E McGlinchey
- Translational Research Center for TBI and Stress Disorders, VA Boston Healthcare System, Boston, Massachusetts; Geriatric Research, Educational and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | | | - William P Milberg
- Translational Research Center for TBI and Stress Disorders, VA Boston Healthcare System, Boston, Massachusetts; Geriatric Research, Educational and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Mark W Miller
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, Massachusetts; Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Kerry J Ressler
- McLean Hospital, Harvard University, Belmont, Massachusetts; Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia
| | - Dick J Veltman
- Department of Psychiatry, VU University Medical Center, Amsterdam, the Netherlands
| | - Dan J Stein
- Department of Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Kathleen Thomaes
- Department of Psychiatry, VU University Medical Center, Amsterdam, the Netherlands
| | - Paul M Thompson
- Imaging Genetics Center, Mary and Mark Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Marina del Rey, California
| | - Rajendra A Morey
- Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham VA Medical Center, Durham, North Carolina; Duke-UNC Brain Imaging and Analysis Center, Duke University, Durham, North Carolina; Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina.
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18
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Mendoza C, Barreto GE, Iarkov A, Tarasov VV, Aliev G, Echeverria V. Cotinine: A Therapy for Memory Extinction in Post-traumatic Stress Disorder. Mol Neurobiol 2018; 55:6700-6711. [PMID: 29335846 DOI: 10.1007/s12035-018-0869-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 01/07/2018] [Indexed: 12/14/2022]
Abstract
Post-traumatic stress disorder (PTSD) is a mental disorder that may develop after exposure to exceptionally threatening or unescapable horrifying events. Actual therapies fail to alleviate the emotional suffering and cognitive impairment associated with this disorder, mostly because they are ineffective in treating the failure to extinguish trauma memories in a great percentage of those affected. In this review, current behavioral, cellular, and molecular evidence supporting the use of cotinine for treating PTSD are reviewed. The role of the positive modulation by cotinine of the nicotinic acetylcholine receptors (nAChRs) and their downstream effectors, the protection of astroglia, and the inhibition of microglia in the PTSD brain are also discussed.
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Affiliation(s)
- Cristhian Mendoza
- Facultad de Ciencias de la Salud, Universidad San Sebastián, Lientur 1457, 4030000, Concepción, Chile
| | - George E Barreto
- Departamento de Nutrición y Bioquímica, Facultad de Ciencias, Pontificia Universidad Javeriana, Bogotá D.C., Colombia.,Instituto de Ciencias Biomédicas, Universidad Autónoma de Chile, Santiago, Chile
| | - Alexandre Iarkov
- Facultad de Ciencias de la Salud, Universidad San Sebastián, Lientur 1457, 4030000, Concepción, Chile
| | - Vadim V Tarasov
- Institute of Pharmacy and Translational Medicine, Sechenov First Moscow State Medical University, 119991, Moscow, Russia
| | - Gjumrakch Aliev
- Institute of Physiologically Active Compounds of the Russian Academy of Sciences, Severniy Proezd, Chernogolovka, Moscow Region, 1142432, Russia. .,"GALLY" International Biomedical Research Consulting LLC, San Antonio, TX, 78229, USA. .,School of Health Sciences and Healthcare Administration, University of Atlanta, Johns Creek, GA, 30097, USA.
| | - Valentina Echeverria
- Facultad de Ciencias de la Salud, Universidad San Sebastián, Lientur 1457, 4030000, Concepción, Chile. .,Bay Pines VA Healthcare System, Research and Development, Bay Pines, FL, 33744, USA.
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19
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Averill CL, Satodiya RM, Scott JC, Wrocklage KM, Schweinsburg B, Averill LA, Akiki TJ, Amoroso T, Southwick SM, Krystal JH, Abdallah CG. Posttraumatic Stress Disorder and Depression Symptom Severities Are Differentially Associated With Hippocampal Subfield Volume Loss in Combat Veterans. ACTA ACUST UNITED AC 2017. [PMID: 29520395 PMCID: PMC5839647 DOI: 10.1177/2470547017744538] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Two decades of human neuroimaging research have associated volume reductions
in the hippocampus with posttraumatic stress disorder. However, little is
known about the distribution of volume loss across hippocampal subfields.
Recent advances in neuroimaging methods have made it possible to accurately
delineate 10 gray matter hippocampal subfields. Here, we apply a volumetric
analysis of hippocampal subfields to data from a group of combat-exposed
Veterans. Method Veterans (total, n = 68, posttraumatic stress disorder, n = 36; combat
control, n = 32) completed high-resolution structural magnetic resonance
imaging. Based on previously validated methods, hippocampal subfield volume
measurements were conducted using FreeSurfer 6.0. The Clinician-Administered
PTSD Scale assessed posttraumatic stress disorder symptom severity; Beck
Depression Inventory assessed depressive symptom severity. Controlling for
age and intracranial volume, partial correlation analysis examined the
relationship between hippocampal subfields and symptom severity. Correction
for multiple comparisons was performed using false discovery rate. Gender,
intelligence, combat severity, comorbid anxiety, alcohol/substance use
disorder, and medication status were investigated as potential
confounds. Results In the whole sample, total hippocampal volume
negatively correlated with Clinician-Administered PTSD Scale and Beck Depression Inventory scores. Of the 10
hippocampal subfields, Clinician-Administered PTSD Scale symptom severity
negatively correlated with the hippocampus–amygdala
transition area (HATA). Beck Depression Inventory scores
negatively correlated with dentate gyrus, cornu ammonis 4 (CA4), HATA,
CA2/3, molecular layer, and CA1. Follow-up analysis limited to the
posttraumatic stress disorder group showed a negative correlation between
Clinician-Administered PTSD Scale symptom severity and each of HATA, CA2/3,
molecular layer, and CA4. Conclusion This study provides the first evidence relating posttraumatic stress disorder
and depression symptoms to abnormalities in the HATA, an anterior
hippocampal region highly connected to prefrontal-amygdala circuitry.
Notably, dentate gyrus abnormalities were associated with depression
severity but not posttraumatic stress disorder symptoms. Future confirmatory
studies should determine the extent to which dentate gyrus volume can
differentiate between posttraumatic stress disorder- and depression-related
pathophysiology.
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Affiliation(s)
- Christopher L Averill
- National Center for PTSD, Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, CT, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Ritvij M Satodiya
- National Center for PTSD, Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, CT, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - J Cobb Scott
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,VISN4 Mental Illness Research, Education, and Clinical Center, Philadelphia VA Medical Center, Philadelphia, PA, USA
| | - Kristen M Wrocklage
- National Center for PTSD, Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, CT, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.,Gaylord Specialty Healthcare, Department of Psychology, Wallingford, CT, USA
| | - Brian Schweinsburg
- National Center for PTSD, Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, CT, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Lynnette A Averill
- National Center for PTSD, Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, CT, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Teddy J Akiki
- National Center for PTSD, Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, CT, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Timothy Amoroso
- National Center for PTSD, Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, CT, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Steven M Southwick
- National Center for PTSD, Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, CT, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - John H Krystal
- National Center for PTSD, Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, CT, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Chadi G Abdallah
- National Center for PTSD, Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, CT, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
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20
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O'Doherty DCM, Tickell A, Ryder W, Chan C, Hermens DF, Bennett MR, Lagopoulos J. Frontal and subcortical grey matter reductions in PTSD. Psychiatry Res Neuroimaging 2017; 266:1-9. [PMID: 28549317 DOI: 10.1016/j.pscychresns.2017.05.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 05/12/2017] [Accepted: 05/19/2017] [Indexed: 12/18/2022]
Abstract
Post-traumatic stress disorder (PTSD) is characterised by a range of debilitating psychological, physical and cognitive symptoms. PTSD has been associated with grey matter atrophy in limbic and frontal cortical brain regions. However, previous studies have reported heterogeneous findings, with grey matter changes observed beyond limbic/frontal areas. Seventy-five adults were recruited from the community, 25 diagnosed with PTSD along with 25 healthy and 25 trauma exposed age and gender matched controls. Participants underwent clinical assessment and magnetic resonance imaging. The data-analyses method Voxel Based Morphometry (VBM) was used to estimate cortical grey matter volumes. When compared to both healthy and trauma exposed controls, PTSD subjects demonstrated decreased grey matter volumes within subcortical brain regions-including the hippocampus and amygdala-along with reductions in the anterior cingulate cortex, frontal medial cortex, middle frontal gyrus, superior frontal gyrus, paracingulate gyrus, and precuneus cortex. Significant negative correlations were found between total CAPS lifetime clinical scores/sub-scores and GM volume of both the PTSD and TC groups. GM volumes of the left rACC and right amygdala showed a significant negative correlation within PTSD diagnosed subjects.
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Affiliation(s)
- Daniel C M O'Doherty
- The University of Sydney, Brain and Mind Centre, 100 Mallett Street, Camperdown, NSW 2050, Australia.
| | - Ashleigh Tickell
- The University of Sydney, Brain and Mind Centre, 100 Mallett Street, Camperdown, NSW 2050, Australia
| | - Will Ryder
- The University of Sydney, Brain and Mind Centre, 100 Mallett Street, Camperdown, NSW 2050, Australia
| | - Charles Chan
- The University of Sydney, Brain and Mind Centre, 100 Mallett Street, Camperdown, NSW 2050, Australia
| | - Daniel F Hermens
- The University of Sydney, Brain and Mind Centre, 100 Mallett Street, Camperdown, NSW 2050, Australia
| | - Maxwell R Bennett
- The University of Sydney, Brain and Mind Centre, 100 Mallett Street, Camperdown, NSW 2050, Australia
| | - Jim Lagopoulos
- University of the Sunshine Coast, Sunshine Coast Mind and Neuroscience - Thompson Institute, 12 Innovation Parkway, Birtinya, QLD 4575, Australia
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Posttraumatic stress disorder symptom severity is associated with left hippocampal volume reduction: a meta-analytic study. CNS Spectr 2017; 22:363-372. [PMID: 27989265 DOI: 10.1017/s1092852916000833] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Many studies have reported hippocampal volume reductions associated with posttraumatic stress disorder (PTSD), while others have not. Here we provide an updated meta-analysis of such reductions associated with PTSD and evaluate the association between symptom severity and hippocampal volume. METHODS A total of 37 studies met the criteria for inclusion in the meta-analysis. Mean effect sizes (Hedges' g) and 95% confidence intervals (CI 95%) were computed for each study and then averaged to obtain an overall mean effect size across studies. Meta-regression was employed to examine the relationship between PTSD symptom severity and hippocampal volume. RESULTS Results showed that PTSD is associated with significant bilateral reduction of the hippocampus (left hippocampus effect size=-0.400, p<0.001, 5.24% reduction; right hippocampus effect size=-0.462, p<0.001, 5.23% reduction). Symptom severity, as measured by the Clinician-Administered PTSD Scale (CAPS), was significantly associated with decreased left, but not right, hippocampal volume. CONCLUSIONS PTSD was associated with significant bilateral volume reduction of the hippocampus. Increased symptom severity was significantly associated with reduced left hippocampal volume. This finding is consistent with the hypothesis that PTSD is more neurotoxic to the left hippocampus than to the right. However, whether the association between PTSD and lower hippocampal volume reflects a consequence of or a predisposition to PTSD remains unclear. More prospective studies are needed in this area.
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Hayes JP, Logue MW, Reagan A, Salat D, Wolf EJ, Sadeh N, Spielberg JM, Sperbeck E, Hayes SM, McGlinchey RE, Milberg WP, Verfaellie M, Stone A, Schichman SA, Miller MW. COMT Val158Met polymorphism moderates the association between PTSD symptom severity and hippocampal volume. J Psychiatry Neurosci 2017; 42:95-102. [PMID: 28234210 PMCID: PMC5373706 DOI: 10.1503/jpn.150339] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Memory-based alterations are among the hallmark symptoms of posttraumatic stress disorder (PTSD) and may be associated with the integrity of the hippocampus. However, neuroimaging studies of hippocampal volume in individuals with PTSD have yielded inconsistent results, raising the possibility that various moderators, such as genetic factors, may influence this association. We examined whether the catechol-O-methyltransferase (COMT) Val158Met polymorphism, which has previously been shown to be associated with hippocampal volume in healthy individuals, moderates the association between PTSD and hippocampal volume. METHODS Recent war veterans underwent structural MRI on a 3 T scanner. We extracted volumes of the right and left hippocampus using FreeSurfer and adjusted them for individual differences in intracranial volume. We assessed PTSD severity using the Clinician-Administered PTSD Scale. Hierarchical linear regression was used to model the genotype (Val158Met polymorphism) × PTSD severity interaction and its association with hippocampal volume. RESULTS We included 146 white, non-Hispanic recent war veterans (90% male, 53% with diagnosed PTSD) in our analyses. A significant genotype × PTSD symptom severity interaction emerged such that individuals with greater current PTSD symptom severity who were homozygous for the Val allele showed significant reductions in left hippocampal volume. LIMITATIONS The direction of proposed effects is unknown, thus precluding definitive assessment of whether differences in hippocampal volume reflect a consequence of PTSD, a pre-existing characteristic, or both. CONCLUSION Our findings suggest that the COMT polymorphism moderates the association between PTSD and hippocampal volume. These results highlight the role that the dopaminergic system has in brain structure and suggest a possible mechanism for memory disturbance in individuals with PTSD.
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Affiliation(s)
- Jasmeet P. Hayes
- Correspondence to: J.P. Hayes, National Center for PTSD (116B-2), VA Boston Healthcare System, 150 S. Huntington Ave., Boston MA 02130;
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Ahmed-Leitao F, Spies G, van den Heuvel L, Seedat S. Hippocampal and amygdala volumes in adults with posttraumatic stress disorder secondary to childhood abuse or maltreatment: A systematic review. Psychiatry Res Neuroimaging 2016; 256:33-43. [PMID: 27669407 DOI: 10.1016/j.pscychresns.2016.09.008] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 09/16/2016] [Accepted: 09/16/2016] [Indexed: 01/15/2023]
Abstract
We systematically reviewed differences in hippocampal and amygdala volumes between adults with childhood maltreatment-related posttraumatic stress disorder (PTSD) and healthy controls. Using the terms "adults", "MRI", "magnetic resonance imaging", with "posttraumatic stress disorder" "PTSD", "child abuse", and "child maltreatment", we conducted searches on several electronic databases. We identified 10 studies that met our inclusion criteria; 7 of which were included in a meta-analysis of hippocampal volume and 4 that were included in a meta-analysis of amygdala volume. Mean hippocampal and amygdala volumes were used to determine effect sizes. We found bilateral reduction of both the hippocampus and amygdala in the PTSD group compared to healthy controls, with effect sizes of -0.66 and -0.67 for the left and right hippocampus (p<0.00001 and p=0.002) and -1.08 and -1.15 for the left and right amygdala, (p=0.013 and p=0.003), respectively. Confidence intervals were -0.93,-0.39 and -1.26,-0.29 for the left and right hippocampus, respectively. For the amygdala, confidence intervals were -1.92,-0.23 and -1.19, -0.39 for the left and right amygdala. The relatively few studies available for analysis is a limitation. Additionally, sex diverse MRI studies in PTSD are needed to determine whether sex plays a significant role in the hippocampal effects associated with childhood-onset trauma.
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Affiliation(s)
- Fatima Ahmed-Leitao
- South African Research Chairs Initiative (SARChI) in Posttraumatic Stress Disorder, Department of Psychiatry, Stellenbosch University, South Africa.
| | - Georgina Spies
- South African Research Chairs Initiative (SARChI) in Posttraumatic Stress Disorder, Department of Psychiatry, Stellenbosch University, South Africa.
| | | | - Soraya Seedat
- MRC Unit on Anxiety and Stress Disorders, Department of Psychiatry, Stellenbosch University, South Africa.
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Lyden H, Gimbel SI, Del Piero L, Tsai AB, Sachs ME, Kaplan JT, Margolin G, Saxbe D. Associations between Family Adversity and Brain Volume in Adolescence: Manual vs. Automated Brain Segmentation Yields Different Results. Front Neurosci 2016; 10:398. [PMID: 27656121 PMCID: PMC5011142 DOI: 10.3389/fnins.2016.00398] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 08/12/2016] [Indexed: 12/03/2022] Open
Abstract
Associations between brain structure and early adversity have been inconsistent in the literature. These inconsistencies may be partially due to methodological differences. Different methods of brain segmentation may produce different results, obscuring the relationship between early adversity and brain volume. Moreover, adolescence is a time of significant brain growth and certain brain areas have distinct rates of development, which may compromise the accuracy of automated segmentation approaches. In the current study, 23 adolescents participated in two waves of a longitudinal study. Family aggression was measured when the youths were 12 years old, and structural scans were acquired an average of 4 years later. Bilateral amygdalae and hippocampi were segmented using three different methods (manual tracing, FSL, and NeuroQuant). The segmentation estimates were compared, and linear regressions were run to assess the relationship between early family aggression exposure and all three volume segmentation estimates. Manual tracing results showed a positive relationship between family aggression and right amygdala volume, whereas FSL segmentation showed negative relationships between family aggression and both the left and right hippocampi. However, results indicate poor overlap between methods, and different associations were found between early family aggression exposure and brain volume depending on the segmentation method used.
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Affiliation(s)
- Hannah Lyden
- Department of Psychology, University of Southern California Los Angeles, CA, USA
| | - Sarah I Gimbel
- Department of Psychology, Brain and Creativity Institute, University of Southern California Los Angeles, CA, USA
| | - Larissa Del Piero
- Department of Psychology, University of Southern California Los Angeles, CA, USA
| | - A Bryna Tsai
- Department of Psychology, University of Southern California Los Angeles, CA, USA
| | - Matthew E Sachs
- Department of Psychology, Brain and Creativity Institute, University of Southern California Los Angeles, CA, USA
| | - Jonas T Kaplan
- Department of Psychology, University of Southern CaliforniaLos Angeles, CA, USA; Department of Psychology, Brain and Creativity Institute, University of Southern CaliforniaLos Angeles, CA, USA
| | - Gayla Margolin
- Department of Psychology, University of Southern California Los Angeles, CA, USA
| | - Darby Saxbe
- Department of Psychology, University of Southern California Los Angeles, CA, USA
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Sussman D, Pang EW, Jetly R, Dunkley BT, Taylor MJ. Neuroanatomical features in soldiers with post-traumatic stress disorder. BMC Neurosci 2016; 17:13. [PMID: 27029195 PMCID: PMC4815085 DOI: 10.1186/s12868-016-0247-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 03/21/2016] [Indexed: 11/25/2022] Open
Abstract
Background Posttraumatic stress disorder (PTSD), an anxiety disorder that can develop after exposure to psychological trauma, impacts up to 20 % of soldiers returning from combat-related deployment. Advanced neuroimaging holds diagnostic and prognostic potential for furthering our understanding of its etiology. Previous imaging studies on combat-related PTSD have focused on selected structures, such as the hippocampi and cortex, but none conducted a comprehensive examination of both the cerebrum and cerebellum. The present study provides a complete analysis of cortical, subcortical, and cerebellar anatomy in a single cohort. Forty-seven magnetic resonance images (MRIs) were collected from 24 soldiers with PTSD and 23 Control soldiers. Each image was segmented into 78 cortical brain regions and 81,924 vertices using the corticometric iterative vertex based estimation of thickness algorithm, allowing for both a region-based and a vertex-based cortical analysis, respectively. Subcortical volumetric analyses of the hippocampi, cerebellum, thalamus, globus pallidus, caudate, putamen, and many sub-regions were conducted following their segmentation using Multiple Automatically Generated Templates Brain algorithm. Results Participants with PTSD were found to have reduced cortical thickness, primarily in the frontal and temporal lobes, with no preference for laterality. The region-based analyses further revealed localized thinning as well as thickening in several sub-regions. These results were accompanied by decreased volumes of the caudate and right hippocampus, as computed relative to total cerebral volume. Enlargement in several cerebellar lobules (relative to total cerebellar volume) was also observed in the PTSD group. Conclusions These data highlight the distributed structural differences between soldiers with and without PTSD, and emphasize the diagnostic potential of high-resolution MRI.
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Affiliation(s)
- D Sussman
- Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - E W Pang
- Division of Neurology, Neuroscience and Mental Health Program, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - R Jetly
- Directorate of Mental Health, Canadian Forces Health Services, Ottawa, ON, Canada
| | - B T Dunkley
- Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
| | - M J Taylor
- Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
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26
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Abstract
A distinctive characteristic of psychiatry is that it is a discipline that deals with both the physical and the mental lives of individuals. Largely because of this characteristic, different models are used for different disorders, however, there is still a remnant tendency towards reductionist views in the field. In this paper I argue that the available empirical evidence from psychiatry gives us reasons to question biological reductionism and that, in its place, we should adopt a pluralistic explanatory model that is more suited to the needs of the discipline and to the needs of the patients it is meant to help. This will allow us to retain psychiatry as an autonomous science that can productively co-exist with neuroscience while also giving patients the kind of attention they need. I further argue that this same evidence supports a view of the mind that is anti-reductive and that allows that causation can be both bottom-up and top-down and that such a view is available in emergentism coupled with an interventionist model of causation.
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27
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O'Doherty DCM, Chitty KM, Saddiqui S, Bennett MR, Lagopoulos J. A systematic review and meta-analysis of magnetic resonance imaging measurement of structural volumes in posttraumatic stress disorder. Psychiatry Res 2015; 232:1-33. [PMID: 25735885 DOI: 10.1016/j.pscychresns.2015.01.002] [Citation(s) in RCA: 232] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 11/15/2014] [Accepted: 01/08/2015] [Indexed: 12/15/2022]
Abstract
Posttraumatic stress disorder (PTSD) is a debilitating condition associated with mild to moderate cognitive impairment and with a prevalence rate of up to 22% in veterans. This systematic review and quantitative meta-analysis explore volumetric differences of three key structural brain regions (hippocampus, amygdala and anterior cingulate cortex (ACC)), all of which have been implicated in dysfunction of both salience network (SN) and default mode network (DMN) in PTSD sufferers. A literature search was conducted in Embase, Medline, PubMed and PsycINFO in May 2013. Fifty-nine volumetric analyses from 44 articles were examined and included (36 hippocampus, 14 amygdala and nine ACC) with n=846 PTSD participants, n=520 healthy controls (HCs) and n=624 traumatised controls (TCs). Nine statistical tests were performed for each of the three regions of interest (ROIs), measuring volume differences in PTSD subjects, healthy and traumatised controls. Hippocampal volume was reduced in subjects with PTSD, with a greater reduction in the left hippocampus. A medium effect size reduction was found in bilateral amygdala volume when compared with findings in healthy controls; however, no significant differences in amygdala volume between PTSD subjects and trauma-exposed controls were found. Significant volume reductions were found bilaterally in the ACC. While often well matched with their respective control groups, the samples of PTSD subjects composed from the source studies used in the meta-analyses are limited in their homogeneity. The current findings of reduced hippocampal volume in subjects with PTSD are consistent with the existing literature. Amygdala volumes did not show significant reductions in PTSD subjects when compared with volumes in trauma-exposed controls-congruous with reported symptoms of hypervigilance and increased propensity in acquisition of conditioned fear memories-but a significant reduction was found in the combined left and right hemisphere volume analysis when compared with healthy controls. Bilateral volume reductions in the ACC may underpin the attentional deficits and inabilities to modulate emotions that are characteristically associated with PTSD patients.
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Affiliation(s)
- Daniel C M O'Doherty
- Brain and Mind Research Institute, University of Sydney, 100 Mallett Street, Camperdown, NSW 2050, Australia.
| | - Kate M Chitty
- Brain and Mind Research Institute, University of Sydney, 100 Mallett Street, Camperdown, NSW 2050, Australia.
| | - Sonia Saddiqui
- Faculty of Human Sciences, Macquarie University, Sydney, Australia.
| | - Maxwell R Bennett
- Brain and Mind Research Institute, University of Sydney, 100 Mallett Street, Camperdown, NSW 2050, Australia.
| | - Jim Lagopoulos
- Brain and Mind Research Institute, University of Sydney, 100 Mallett Street, Camperdown, NSW 2050, Australia.
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28
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Ochs AL, Ross DE, Zannoni MD, Abildskov TJ, Bigler ED. Comparison of Automated Brain Volume Measures obtained with NeuroQuant and FreeSurfer. J Neuroimaging 2015; 25:721-7. [PMID: 25727700 DOI: 10.1111/jon.12229] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 01/04/2015] [Accepted: 01/16/2015] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To examine intermethod reliabilities and differences between FreeSurfer and the FDA-cleared congener, NeuroQuant, both fully automated methods for structural brain MRI measurements. MATERIALS AND METHODS MRI scans from 20 normal control subjects, 20 Alzheimer's disease patients, and 20 mild traumatically brain-injured patients were analyzed with NeuroQuant and with FreeSurfer. Intermethod reliability was evaluated. RESULTS Pairwise correlation coefficients, intraclass correlation coefficients, and effect size differences were computed. NeuroQuant versus FreeSurfer measures showed excellent to good intermethod reliability for the 21 regions evaluated (r: .63 to .99/ICC: .62 to .99/ES: -.33 to 2.08) except for the pallidum (r/ICC/ES = .31/.29/-2.2) and cerebellar white matter (r/ICC/ES = .31/.31/.08). Volumes reported by NeuroQuant were generally larger than those reported by FreeSurfer with the whole brain parenchyma volume reported by NeuroQuant 6.50% larger than the volume reported by FreeSurfer. There was no systematic difference in results between the 3 subgroups. CONCLUSION NeuroQuant and FreeSurfer showed good to excellent intermethod reliability in volumetric measurements for all brain regions examined with the only exceptions being the pallidum and cerebellar white matter. This finding was robust for normal individuals, patients with Alzheimer's disease, and patients with mild traumatic brain injury.
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Affiliation(s)
- Alfred L Ochs
- Virginia Institute of Neuropsychiatry, Midlothian, VA.,Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA
| | - David E Ross
- Virginia Institute of Neuropsychiatry, Midlothian, VA.,Department of Psychiatry, Virginia Commonwealth University, Richmond, VA
| | | | - Tracy J Abildskov
- Department of Psychology and Neuroscience Center, Brigham Young University, Provo, UT
| | - Erin D Bigler
- Department of Psychology and Neuroscience Center, Brigham Young University, Provo, UT.,Department of Psychiatry and The Brain Institute of Utah, University of Utah, Salt Lake City, UT
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29
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Anatomical deficits in adult posttraumatic stress disorder: a meta-analysis of voxel-based morphometry studies. Behav Brain Res 2014; 270:307-15. [PMID: 24859173 DOI: 10.1016/j.bbr.2014.05.021] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 05/12/2014] [Accepted: 05/15/2014] [Indexed: 02/05/2023]
Abstract
Evidence from previous anatomical studies indicate that widespread brain regions are involved in the pathogenesis of posttraumatic stress disorder (PTSD). The aim of the present study was to quantitatively integrate the literature on structural abnormalities seen on individuals with PTSD. Twenty voxel-based analysis studies were analysed through a comprehensive series of meta-analyses. Compared with healthy controls, PTSD patients showed a significant reduction in grey matter (GM) in the left anterior cingulate gyrus (ACC) at the whole-brain level. Several brain regions, including the left ACC, the left insula and the right parahippocampal gyrus were significantly smaller in individuals with PTSD than in trauma-exposed healthy subjects. Furthermore, the clinician-administered PTSD scale scores were negatively correlated with GM in the left ACC and positively correlated with GM in the left insula. In addition, PTSD patients who experienced accidental or non-accidental trauma had anatomical changes in different brain regions. These results suggest that the smaller ACC and insular cortex within the limbic-prefrontal circuit contribute to the pathogenesis of PTSD. Moreover, the PTSD patients with different types of trauma may have different cerebral deficits.
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30
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Qi S, Mu Y, Liu K, Zhang J, Huan Y, Tan Q, Shi M, Wang Q, Chen Y, Wang H, Wang H, Zhang N, Zhang X, Xiong L, Yin H. Cortical inhibition deficits in recent onset PTSD after a single prolonged trauma exposure. NEUROIMAGE-CLINICAL 2013; 3:226-33. [PMID: 24273707 PMCID: PMC3815016 DOI: 10.1016/j.nicl.2013.08.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 08/19/2013] [Accepted: 08/27/2013] [Indexed: 11/17/2022]
Abstract
A variety of structural abnormalities have been described in post traumatic stress disorder (PTSD), but only a few studies have focused on cortical thickness alterations in recent onset PTSD. In this study, we adopted surface-based morphometry (SBM), which enables an exploration of global structural changes throughout the brain, in order to compare cortical thickness alterations in recent onset PTSD patients, trauma-exposed subjects but without PTSD, and normal controls. Moreover, we used region of interest (ROI) partial correlation analysis to evaluate the correlation among PTSD symptom severity and significant changes of cortical thickness. The widespread cortical thickness reduction relative to the normal controls were found in bilateral inferior and superior parietal lobes, frontal lobes, hippocampus, cingulate cortex, and right lateral occipital lobes in trauma survivors, whereas cortical thickness was only increased in left calcarine cortex in PTSD group. The average cortical thickness of hippocampus and cingulate cortex decreased by 10.75% and 9.09% in PTSD, 3.48% and 2.86% in non PTSD. We further demonstrated that the cortical thicknesses of bilateral ACC and PCC, superior frontal lobes, and hippocampus are negatively correlated with CAPS scores in all trauma survivors. Our study results suggest that stress widens cortical thinning regions and causes more serious effect in recent onset PTSD than non PTSD. It also shows that the cortical thinning in recent onset PTSD predicts the symptom severity.
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Affiliation(s)
- Shun Qi
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, China
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31
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Ranta ME, Chen M, Crocetti D, Prince JL, Subramaniam K, Fischl B, Kaufmann WE, Mostofsky SH. Automated MRI parcellation of the frontal lobe. Hum Brain Mapp 2013; 35:2009-26. [PMID: 23897577 DOI: 10.1002/hbm.22309] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Revised: 03/12/2013] [Accepted: 04/02/2013] [Indexed: 01/26/2023] Open
Abstract
Examination of associations between specific disorders and physical properties of functionally relevant frontal lobe sub-regions is a fundamental goal in neuropsychiatry. Here, we present and evaluate automated methods of frontal lobe parcellation with the programs FreeSurfer(FS) and TOADS-CRUISE(T-C), based on the manual method described in Ranta et al. [2009]: Psychiatry Res 172:147-154 in which sulcal-gyral landmarks were used to manually delimit functionally relevant regions within the frontal lobe: i.e., primary motor cortex, anterior cingulate, deep white matter, premotor cortex regions (supplementary motor complex, frontal eye field, and lateral premotor cortex) and prefrontal cortex (PFC) regions (medial PFC, dorsolateral PFC, inferior PFC, lateral orbitofrontal cortex [OFC] and medial OFC). Dice's coefficient, a measure of overlap, and percent volume difference were used to measure the reliability between manual and automated delineations for each frontal lobe region. For FS, mean Dice's coefficient for all regions was 0.75 and percent volume difference was 21.2%. For T-C the mean Dice's coefficient was 0.77 and the mean percent volume difference for all regions was 20.2%. These results, along with a high degree of agreement between the two automated methods (mean Dice's coefficient = 0.81, percent volume difference = 12.4%) and a proof-of-principle group difference analysis that highlights the consistency and sensitivity of the automated methods, indicate that the automated methods are valid techniques for parcellation of the frontal lobe into functionally relevant sub-regions. Thus, the methodology has the potential to increase efficiency, statistical power and reproducibility for population analyses of neuropsychiatric disorders with hypothesized frontal lobe contributions.
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Affiliation(s)
- Marin E Ranta
- Kennedy Krieger Institute, Laboratory for Neurocognitive Imaging and Research, Baltimore, Maryland
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32
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Zoladz PR, Diamond DM. Current status on behavioral and biological markers of PTSD: a search for clarity in a conflicting literature. Neurosci Biobehav Rev 2013; 37:860-95. [PMID: 23567521 DOI: 10.1016/j.neubiorev.2013.03.024] [Citation(s) in RCA: 188] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 03/23/2013] [Accepted: 03/27/2013] [Indexed: 12/24/2022]
Abstract
Extensive research has identified stereotypic behavioral and biological abnormalities in post-traumatic stress disorder (PTSD), such as heightened autonomic activity, an exaggerated startle response, reduced basal cortisol levels and cognitive impairments. We have reviewed primary research in this area, noting that factors involved in the susceptibility and expression of PTSD symptoms are more complex and heterogeneous than is commonly stated, with extensive findings which are inconsistent with the stereotypic behavioral and biological profile of the PTSD patient. A thorough assessment of the literature indicates that interactions among myriad susceptibility factors, including social support, early life stress, sex, age, peri- and post-traumatic dissociation, cognitive appraisal of trauma, neuroendocrine abnormalities and gene polymorphisms, in conjunction with the inconsistent expression of the disorder across studies, confounds attempts to characterize PTSD as a monolithic disorder. Overall, our assessment of the literature addresses the great challenge in developing a behavioral and biomarker-based diagnosis of PTSD.
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Affiliation(s)
- Phillip R Zoladz
- Department of Psychology, Sociology, & Criminal Justice, Ohio Northern University, 525 S. Main St., Ada, OH, 45810, USA
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33
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Grodin EN, Lin H, Durkee CA, Hommer DW, Momenan R. Deficits in cortical, diencephalic and midbrain gray matter in alcoholism measured by VBM: Effects of co-morbid substance abuse. NEUROIMAGE-CLINICAL 2013; 2:469-76. [PMID: 24179800 PMCID: PMC3777684 DOI: 10.1016/j.nicl.2013.03.013] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Revised: 03/15/2013] [Accepted: 03/21/2013] [Indexed: 12/13/2022]
Abstract
Objective Alcoholism has been associated with a widespread pattern of gray matter atrophy. This study sought to investigate the spectrum of volume alterations in a population of alcoholics with only alcohol dependence, polysubstance abusing alcoholics, and a comparison population of healthy controls. Method Thirty-seven ‘pure’ alcoholics, 93 polysubstance abusing alcoholics, and 69 healthy controls underwent structural T1 MRI scans. Voxel-based morphometry was performed to investigate gray matter alterations. Results Alcoholic dependent inpatients (both with and without a history of DSM-IV substance abuse/dependence diagnosis) displayed significant gray matter differences in the mesial region of the frontal lobe and right temporal lobe. ‘Pure’ alcoholics exhibited a pattern of subcortical changes similar to that seen in Wernicke–Korsakoff Syndrome when compared to polysubstance abusing alcoholics. ‘Pure’ alcoholics and polysubstance abusing alcoholics did not differ significantly in measures of cortical gray matter, liver function, or nutrition. Conclusions These findings reinforce the accepted literature in regards to frontal lobe gray matter atrophy in alcohol dependence. This study calls for additional research in order to investigate the spectrum from uncomplicated alcoholism to Wernicke–Korsakoff Syndrome. Further research is needed to elucidate the exact cause of this pattern of differences and to determine what factors are responsible for the patterns of gray matter reduction or difference in ‘pure’ and polysubstance abusing alcoholics. Large scale voxel-based morphometry study on alcoholics and healthy controls. Alcoholics display less gray matter in the mesial frontal lobe and the temporal lobe. “Pure” alcoholics show a pattern of deficit similar to that of Wernicke's Encephalopathy.
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Affiliation(s)
- Erica N Grodin
- Laboratory of Clinical Studies, National Institute on Alcohol Abuse Alcoholism, National Institutes of Health, Bethesda, MD 20892-7003, USA
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Abstract
PURPOSE Although most neuroscientists and physicians would argue against Cartesian dualism, Descartes's version of the psyche/soma divide, which has been controversial since he proposed it in the seventeenth century, continues to haunt contemporary neurological diagnoses through terms such as functional, organic, and psychogenic. Drawing on my own experiences as a person with medically unexplained seizures, I ask what this language actually means if all human experience has an organic basis. METHODS Close reading of a textbook chapter on psychogenic seizures. RESULTS I expose the author's unreflective embrace of psyche and soma as distinct entities, his inherent bias against illnesses labeled psychogenic, and the implicit sexism of his position. I further argue that even when a patient's symptoms are not alleviated, heightened self-consciousness and narrative framing can strengthen his or her sense of agency and have therapeutic benefits. CONCLUSION The ethical treatment of patients requires a respect for their stories.
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Decreased premotor cortex volume in victims of urban violence with posttraumatic stress disorder. PLoS One 2012; 7:e42560. [PMID: 22952599 PMCID: PMC3432060 DOI: 10.1371/journal.pone.0042560] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Accepted: 07/10/2012] [Indexed: 12/05/2022] Open
Abstract
Background Studies addressing posttraumatic stress disorder (PTSD) have demonstrated that PTSD patients exhibit structural abnormalities in brain regions that relate to stress regulation and fear responses, such as the hippocampus, amygdala, anterior cingulate cortex, and ventromedial prefrontal cortex. Premotor cortical areas are involved in preparing to respond to a threatening situation and in representing the peripersonal space. Urban violence is an important and pervasive cause of human suffering, especially in large urban centers in the developing world. Violent events, such as armed robbery, are very frequent in certain cities, and these episodes increase the risk of PTSD. Assaultive trauma is characterized by forceful invasion of the peripersonal space; therefore, could this traumatic event be associated with structural alteration of premotor areas in PTSD? Methodology/Principal Findings Structural magnetic resonance imaging scans were acquired from a sample of individuals that had been exposed to urban violence. This sample consisted of 16 PTSD patients and 16 age- and gender-matched controls. Psychometric questionnaires differentiated PTSD patients from trauma-exposed controls with regard to PTSD symptoms, affective, and resilience predispositions. Voxel-based morphometric analysis revealed that, compared with controls, the PTSD patients presented significant reductions in gray matter volume in the ventral premotor cortex and in the pregenual anterior cingulate cortex. Conclusions Volume reduction in the premotor cortex that is observed in victims of urban violence with PTSD may be associated with a disruption in the dynamical modulation of the safe space around the body. The finding that PTSD patients presented a smaller volume of pregenual anterior cingulate cortex is consistent with the results of other PTSD neuroimaging studies that investigated different types of traumatic events.
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Fotuhi M, Do D, Jack C. Modifiable factors that alter the size of the hippocampus with ageing. Nat Rev Neurol 2012; 8:189-202. [PMID: 22410582 DOI: 10.1038/nrneurol.2012.27] [Citation(s) in RCA: 214] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The hippocampus is particularly vulnerable to the neurotoxic effects of obesity, diabetes mellitus, hypertension, hypoxic brain injury, obstructive sleep apnoea, bipolar disorder, clinical depression and head trauma. Patients with these conditions often have smaller hippocampi and experience a greater degree of cognitive decline than individuals without these comorbidities. Moreover, hippocampal atrophy is an established indicator for conversion from the normal ageing process to developing mild cognitive impairment and dementia. As such, an important aim is to ascertain which modifiable factors can have a positive effect on the size of the hippocampus throughout life. Observational studies and preliminary clinical trials have raised the possibility that physical exercise, cognitive stimulation and treatment of general medical conditions can reverse age-related atrophy in the hippocampus, or even expand its size. An emerging concept--the dynamic polygon hypothesis--suggests that treatment of modifiable risk factors can increase the volume or prevent atrophy of the hippocampus. According to this hypothesis, a multidisciplinary approach, which involves strategies to both reduce neurotoxicity and increase neurogenesis, is likely to be successful in delaying the onset of cognitive impairment with ageing. Further research on the constellation of interventions that could be most effective is needed before recommendations can be made for implementing preventive and therapeutic strategies.
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Affiliation(s)
- Majid Fotuhi
- Neurology Institute for Brain Health and Fitness, 1205 York Road, Suite 18, Lutherville, MD 21093, USA.
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Eckart C, Kaufmann J, Kanowski M, Tempelmann C, Hinrichs H, Elbert T, Heinze HJ, Kolassa IT. Magnetic resonance volumetry and spectroscopy of hippocampus and insula in relation to severe exposure of traumatic stress. Psychophysiology 2011; 49:261-70. [PMID: 22092224 DOI: 10.1111/j.1469-8986.2011.01303.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Accepted: 08/08/2011] [Indexed: 11/28/2022]
Abstract
Severe and chronic stress affects the hippocampus, especially during development. However, studies concerning structural alterations of the hippocampus yielded a rather inconsistent picture. Moreover, further anxiety-relevant brain regions, such as the insula, might be implicated in the pathophysiology of posttraumatic stress disorder (PTSD). We combined magnetic resonance (MR) volumetric and spectroscopic analyses of hippocampus and insula in highly traumatized refugees without a history of alcohol/substance abuse or other comorbid diseases. No PTSD-related difference was apparent in the volumes or neurometabolite levels of bilateral hippocampus or insula. However, an association between left hippocampal N-acetyl-aspartate (NAA) and adverse childhood experiences indicated a potential detrimental effect of the early environment on hippocampal integrity. Our results add to increasing evidence that PTSD-related, morphological alterations in the hippocampus are a consequence of early adversity or may result from other factors, such as extensive use of alcohol.
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Affiliation(s)
- Cindy Eckart
- Clinical Psychology & Neuropsychology, Department of Psychology, University of Konstanz, Konstanz, Germany.
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Kroes MCW, Rugg MD, Whalley MG, Brewin CR. Structural brain abnormalities common to posttraumatic stress disorder and depression. J Psychiatry Neurosci 2011; 36:256-65. [PMID: 21418787 PMCID: PMC3120894 DOI: 10.1503/jpn.100077] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) and major depression are reliably associated with reductions in brain volume in markedly similar areas. To our knowledge, no volumetric studies have directly contrasted these conditions. We investigated which, if any, grey matter reductions would be uniquely associated with each disorder. We also investigated more subtle independent effects: specifically, correlations between brain volume and self-report measures of psychopathology. METHODS We obtained structural magnetic resonance imaging scans from participants with PTSD, major depression and healthy controls exposed to trauma. Participants completed standardized self-report measures of anxiety and depression. We used voxel-based morphometry, applying the DARTEL algorithm within SPM5 to identify associated volumetric changes. RESULTS We enrolled 24 patients with PTSD, 29 with major depression and 29 controls in our study. The clinical groups had regions of markedly smaller volume compared with the control group, particularly in prefrontal areas, but did not differ from each other. Greater self-reported anxiety was inversely related to volume in several areas, particularly the inferior temporal cortex, among patients with PTSD, but was associated with some volume increases in patients with major depression. Greater self-reported depression showed similar but weaker effects, being inversely related to brain volume in patients with PTSD but positively related to volume in the cuneus and precuneus of those with major depression. LIMITATIONS To maintain the representativeness of the sample, patients with PTSD were not excluded if they had typical comorbid conditions, such as depression. Patients were not all medication-free, but we controlled for group differences in antidepressant use in the analyses. CONCLUSION We identified commonalities in areas of brain volume in patients with PTSD and those with major depression, suggesting that existing findings concerning reductions in prefrontal areas in particular may not be specific to PTSD but rather related to features of the disorder that are shared with other conditions, such as depression. More subtle differences between patients with PTSD and those with major depression were represented by distinct structural correlates of self-reported anxiety and depression.
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Affiliation(s)
| | | | | | - Chris R. Brewin
- Correspondence to: Dr. C.R. Brewin, Clinical, Educational and Health Psychology, University College London, Gower St,. London WC1E 6BT UK;
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Jackowski A, Perera TD, Abdallah CG, Garrido G, Tang CY, Martinez J, Mathew SJ, Gorman JM, Rosenblum LA, Smith EL, Dwork AJ, Shungu DC, Kaffman A, Gelernter J, Coplan JD, Kaufman J. Early-life stress, corpus callosum development, hippocampal volumetrics, and anxious behavior in male nonhuman primates. Psychiatry Res 2011; 192:37-44. [PMID: 21377844 PMCID: PMC4090111 DOI: 10.1016/j.pscychresns.2010.11.006] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2009] [Revised: 11/10/2010] [Accepted: 11/12/2010] [Indexed: 12/01/2022]
Abstract
Male bonnet monkeys (Macaca radiata) were subjected to the variable foraging demand (VFD) early stress paradigm as infants, MRI scans were completed an average of 4 years later, and behavioral assessments of anxiety and ex-vivo corpus callosum (CC) measurements were made when animals were fully matured. VFD rearing was associated with smaller CC size, CC measurements were found to correlate with fearful behavior in adulthood, and ex-vivo CC assessments showed high consistency with earlier MRI measures. Region of interest (ROI) hippocampus and whole brain voxel-based morphometry assessments were also completed and VFD rearing was associated with reduced hippocampus and inferior and middle temporal gyri volumes. The animals were also characterized according to serotonin transporter genotype (5-HTTLPR), and the effect of genotype on imaging parameters was explored. The current findings highlight the importance of future research to better understand the effects of stress on brain development in multiple regions, including the corpus callosum, hippocampus, and other regions involved in emotion processing. Nonhuman primates provide a powerful model to unravel the mechanisms by which early stress and genetic makeup interact to produce long-term changes in brain development, stress reactivity, and risk for psychiatric disorders.
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Affiliation(s)
- Andrea Jackowski
- LiNC, Departamento de Psiquiatria, Universidade Federal de São Paulo, SP, Brazil
| | - Tarique D. Perera
- Department of Biological Psychiatry, New York State Psychiatric Institute, College of Physicians and Surgeons of Columbia University, New York, NY, USA
| | - Chadi G. Abdallah
- Nonhuman Primate Facility, Department of Psychiatry, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Griselda Garrido
- Serviço de Informática Médica, Instituto do Coração, Universidade de São Paulo, SP, Brazil
| | - Cheuk Y. Tang
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA
| | - Jose Martinez
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA
| | - Sanjay J. Mathew
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA
| | - Jack M. Gorman
- Comprehensive NeuroScience Inc. (JMG), White Plains, NY, USA
| | - Leonard A. Rosenblum
- Nonhuman Primate Facility, Department of Psychiatry, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Eric L.P. Smith
- Nonhuman Primate Facility, Department of Psychiatry, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Andrew J. Dwork
- Department of Biological Psychiatry, New York State Psychiatric Institute, College of Physicians and Surgeons of Columbia University, New York, NY, USA
- Department of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, and Department of Pathology and Cell Biology, College of Physicians and Surgeons of Columbia University, New York, NY, USA
| | - Dikoma C. Shungu
- Departments of Radiology, Psychiatry and Biophysics, Weill Medical College of Cornell University, New York, NY, USA
| | - Arie Kaffman
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Joel Gelernter
- Division of Human Genetics (Psychiatry), Yale University School of Medicine, New Haven, CT
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Jeremy D. Coplan
- Department of Biological Psychiatry, New York State Psychiatric Institute, College of Physicians and Surgeons of Columbia University, New York, NY, USA
- Nonhuman Primate Facility, Department of Psychiatry, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Joan Kaufman
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
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Morey RA, Selgrade ES, Wagner HR, Huettel SA, Wang L, McCarthy G. Scan-rescan reliability of subcortical brain volumes derived from automated segmentation. Hum Brain Mapp 2011; 31:1751-62. [PMID: 20162602 DOI: 10.1002/hbm.20973] [Citation(s) in RCA: 120] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Large-scale longitudinal studies of regional brain volume require reliable quantification using automated segmentation and labeling. However, repeated MR scanning of the same subject, even if using the same scanner and acquisition parameters, does not result in identical images due to small changes in image orientation, changes in prescan parameters, and magnetic field instability. These differences may lead to appreciable changes in estimates of volume for different structures. This study examined scan-rescan reliability of automated segmentation algorithms for measuring several subcortical regions, using both within-day and across-day comparison sessions in a group of 23 normal participants. We found that the reliability of volume measures including percent volume difference, percent volume overlap (Dice's coefficient), and intraclass correlation coefficient (ICC), varied substantially across brain regions. Low reliability was observed in some structures such as the amygdala (ICC = 0.6), with higher reliability (ICC = 0.9) for other structures such as the thalamus and caudate. Patterns of reliability across regions were similar for automated segmentation with FSL/FIRST and FreeSurfer (longitudinal stream). Reliability was associated with the volume of the structure, the ratio of volume to surface area for the structure, the magnitude of the interscan interval, and the method of segmentation. Sample size estimates for detecting changes in brain volume for a range of likely effect sizes also differed by region. Thus, longitudinal research requires a careful analysis of sample size and choice of segmentation method combined with a consideration of the brain structure(s) of interest and the magnitude of the anticipated effects.
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Affiliation(s)
- Rajendra A Morey
- Duke-UNC Brain Imaging and Analysis Center, Duke University, Durham, North Carolina 27705, USA.
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Woon FL, Sood S, Hedges DW. Hippocampal volume deficits associated with exposure to psychological trauma and posttraumatic stress disorder in adults: a meta-analysis. Prog Neuropsychopharmacol Biol Psychiatry 2010; 34:1181-8. [PMID: 20600466 DOI: 10.1016/j.pnpbp.2010.06.016] [Citation(s) in RCA: 243] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2010] [Revised: 05/30/2010] [Accepted: 06/16/2010] [Indexed: 01/14/2023]
Abstract
Trauma exposure itself in the absence of posttraumatic stress disorder (PTSD) may be associated with hippocampal volume deficits. We meta-analytically compared hippocampal volumes in PTSD subjects, in trauma-exposed subjects without PTSD, and in trauma-unexposed subjects. Using the words and phrases PTSD, neuroimaging, hippocampus, brain, violence, trauma, abuse, rape, war, combat, accident, and disaster, we searched major computerized databases to obtain candidate studies through 2008 for inclusion. We identified 39 hippocampal volumetric studies in adults with PTSD compared to control groups consisting of either trauma-exposed controls without PTSD or trauma-unexposed controls, or both. We meta-analytically compared left, right, and total hippocampal volumes between 1) PTSD subjects and a trauma-unexposed group, 2) PTSD subjects and a trauma-exposed group without PTSD, and 3) a trauma-unexposed group and a trauma-exposed group without PTSD. Hippocampal volumes were smaller in the PTSD group and trauma-exposed group without PTSD compared to the trauma-unexposed group. Further, the right hippocampus was smaller in the PTSD group compared to the trauma-exposed group without PTSD. Additionally, the right hippocampus was larger than the left in the PTSD and trauma-unexposed groups but not in the trauma-exposed group without PTSD. Hippocampal volume reduction is associated with trauma exposure independent of PTSD diagnosis, albeit additional hippocampal reduction was found in PTSD compared to the trauma-exposed group without PTSD.
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Affiliation(s)
- Fu Lye Woon
- Psychology Department, 1001 SWKT, Brigham Young University, Provo, UT 84602, USA
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Woon F, Hedges DW. Gender does not moderate hippocampal volume deficits in adults with posttraumatic stress disorder: a meta-analysis. Hippocampus 2010; 21:243-52. [PMID: 20882539 DOI: 10.1002/hipo.20746] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2009] [Indexed: 11/10/2022]
Abstract
Epidemiological studies show a higher point prevalence of posttraumatic stress disorder (PTSD) in women than in men, and early evidence has suggested that gender may moderate hippocampal volume deficits in PTSD. Our objective was to use random-effects meta-regression to assess gender effects on hippocampal volume deficits in PTSD. Using the terms posttraumatic stress disorder, gender, MRI, hippocampus, trauma, and abuse, we searched electronic databases for peer-reviewed articles up to April 2009 containing data for hippocampal volume and gender composition in PTSD adults compared with controls. We identified 23 studies that met inclusion criteria and calculated effect sizes for differences in hippocampal mean volumes for each study and used the percentage of men with PTSD as a continuous moderating variable in meta-regression. Additionally, we did a subgroup analysis of hippocampal volume deficits between women and men with gender as a categorical moderating variable. Hippocampal volumes were significantly smaller in the PTSD group compared to the control group, but gender did not significantly moderate any effect sizes in the meta-regression or subgroup analyses. The lack of gender moderation on hippocampal volume deficits suggests that hippocampal volume deficits in PTSD are independent of gender. The higher prevalence of PTSD in females than in males does not correspond to increased hippocampal volume deficits in women with PTSD compared to men with PTSD, and neither gender appears protective against hippocampal volume deficits in adults with PTSD.
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Affiliation(s)
- Fu Woon
- Department of Psychology, Brigham Young University, Provo, Utah, USA
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Premorbid brain volume estimates and reduced total brain volume in adults exposed to trauma with or without posttraumatic stress disorder: a meta-analysis. Cogn Behav Neurol 2010; 23:124-9. [PMID: 20535062 DOI: 10.1097/wnn.0b013e3181e1cbe1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The primary objective of this study was to meta-analytically investigate whether total brain volume (TBV) and total intracranial volume (TICV) differ between adult participants with posttraumatic stress disorder (PTSD) and controls. BACKGROUND TICV reaches maximum growth by early adolescence and provides an estimate of premorbid brain size. Little work has directly examined TBV in PTSD participants, although limited evidence suggests that deficits in brain volume may occur. METHODS Using electronic databases, we identified articles containing TBV and TICV data for adult PTSD participants. Data were extracted and effect sizes were calculated. RESULTS We identified 8 studies with TBV data (105 PTSD participants and 122 trauma-unexposed controls) and 2 studies with TICV data (18 PTSD participants and 25 trauma-unexposed controls). TBV was significantly smaller in PTSD participants compared with trauma-unexposed controls. In contrast, TICV did not differ between these groups. There were no significant differences in TBV and TICV between PTSD and trauma-exposed controls. CONCLUSIONS TBV is significantly smaller in adult PTSD participants compared with trauma-unexposed controls. TICV did not differ significantly between these groups, suggesting that a deficit in TBV occurred at some point after the attainment of maximum brain volume in the PTSD group.
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Pierson R, Johnson H, Harris G, Keefe H, Paulsen JS, Andreasen NC, Magnotta VA. Fully automated analysis using BRAINS: AutoWorkup. Neuroimage 2010; 54:328-36. [PMID: 20600977 DOI: 10.1016/j.neuroimage.2010.06.047] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2009] [Revised: 06/04/2010] [Accepted: 06/18/2010] [Indexed: 01/12/2023] Open
Abstract
The BRAINS (Brain Research: Analysis of Images, Networks, and Systems) image analysis software has been in use, and in constant development, for over 20 years. The original neuroimage analysis pipeline using BRAINS was designed as a semiautomated procedure to measure volumes of the cerebral lobes and subcortical structures, requiring manual intervention at several stages in the process. Through use of advanced image processing algorithms the need for manual intervention at stages of image realignment, tissue sampling, and mask editing have been eliminated. In addition, inhomogeneity correction, intensity normalization, and mask cleaning routines have been added to improve the accuracy and consistency of the results. The fully automated method, AutoWorkup, is shown in this study to be more reliable (ICC ≥ 0.96, Jaccard index ≥ 0.80, and Dice index ≥ 0.89 for all tissues in all regions) than the average of 18 manual raters. On a set of 1130 good quality scans, the failure rate for correct realignment was 1.1%, and manual editing of the brain mask was required on 4% of the scans. In other tests, AutoWorkup is shown to produce measures that are reliable for data acquired across scanners, scanner vendors, and across sequences. Application of AutoWorkup for the analysis of data from the 32-site, multivendor PREDICT-HD study yield estimates of reliability to be greater than or equal to 0.90 for all tissues and regions.
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Affiliation(s)
- Ronald Pierson
- The University of Iowa Roy and Lucille Carver College of Medicine, Department of Psychiatry, Iowa City, IA 52242, USA.
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Longitudinal rates of lobar atrophy in frontotemporal dementia, semantic dementia, and Alzheimer's disease. Alzheimer Dis Assoc Disord 2010; 24:43-8. [PMID: 19571735 DOI: 10.1097/wad.0b013e3181a6f101] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study compared rates of regional atrophy in Alzheimer disease (AD), frontotemporal dementia (FTD), and semantic dementia (SD). Cross-sectional studies have shown that different dementia syndromes are associated with different patterns of regional brain tissue loss. Rates of atrophy over time may be useful for differential diagnosis, and could be used to monitor disease progression, serving as an outcome measure for clinical trials. We studied patients with AD (n=12), FTD (n=13), SD (n=20), and normal controls (n=23) longitudinally with structural magnetic resonance imaging, using BRAINS2 software to measure frontal, temporal, and parietal lobe volumes. In FTD the rate of frontal lobe atrophy over 1 year was greater than in any other group, whereas SD showed the highest rate in the temporal lobes. Atrophy in these regions progressed twice as quickly in FTD and SD compared with AD. Atrophy was not significantly faster for AD in any brain region compared with the other groups. Regional atrophy over time was significantly faster in FTD and SD compared with AD, and the regions of greatest atrophy were specific for each syndrome. Measuring specific regions of cerebral volume changes by serial neuroimaging may serve as a useful biomarker outcome measure for clinical trials in neurodegenerative diseases.
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Sui SG, Wu MX, King ME, Zhang Y, Ling L, Xu JM, Weng XC, Duan L, Shan BC, Li LJ. Abnormal grey matter in victims of rape with PTSD in Mainland China: a voxel-based morphometry study. Acta Neuropsychiatr 2010; 22:118-26. [PMID: 26952803 DOI: 10.1111/j.1601-5215.2010.00459.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
UNLABELLED Sui SG, Wu MX, King ME, Zhang Y, Ling L, Xu JM, Weng XC, Duan L, Shan BC, Li LJ. Abnormal grey matter in victims of rape with PTSD in Mainland China: a voxel-based morphometry study. OBJECTIVE This study examined changes in brain grey matter in victims of rape (VoR) with and without post-traumatic stress disorder (PTSD). Previous research has focused on PTSD caused by various traumatic events, such as war and disaster, among others. Although considerable research has focused on rape-related PTSD, limited studies have been carried out in the context of Mainland China. METHODS The study included 11 VoR with PTSD, 8 VoR without PTSD and 12 healthy comparison (HC) subjects. We used voxel-based morphometry to explore changes in brain grey-matter density (GMD) by applying statistical parametric mapping to high-resolution magnetic resonance images. RESULTS Compared with HC, VoR with PTSD showed significant GMD reductions in the bilateral medial frontal cortex, left middle frontal cortex, middle temporal gyrus and fusiform cortex and significant GMD increases in the right posterior cingulate cortex, postcentral cortex, bilateral precentral cortex and inferior parietal lobule. Compared to VoR without PTSD, VoR with PTSD showed significant GMD reductions in the right uncus, left middle temporal gyrus, and the fusiform cortex, and increases in the left precentral cortex, inferior parietal lobule and right post-central cortex. CONCLUSION The findings of abnormal GMD in VoR with PTSD support the hypothesis that PTSD is associated with widespread anatomical changes in the brain. The medial frontal cortex, precentral cortex, posterior cingulate cortex, post-central cortex and inferior parietal lobule may play important roles in the neuropathology of PTSD.
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Affiliation(s)
- Shuang Ge Sui
- 1Mental Health Institute, Second Xiangya Hospital, Central-South University, Changsha, Hunan 410011, P. R. China
| | - Ming Xiang Wu
- 2ShenZhen People's Hospital, Guangdong 518020, P. R. China
| | - Mark E King
- 3Faculty of Education, The University of Hong Kong, HHSAR, P. R. China
| | - Yan Zhang
- 1Mental Health Institute, Second Xiangya Hospital, Central-South University, Changsha, Hunan 410011, P. R. China
| | - Li Ling
- 3Faculty of Education, The University of Hong Kong, HHSAR, P. R. China
| | - Jian Min Xu
- 2ShenZhen People's Hospital, Guangdong 518020, P. R. China
| | - Xu Chu Weng
- 4Laboratory for Higher Brain Function, Institute of Psychology, Chinese Academy of Sciences, Beijing100012, P. R. China
| | - Lian Duan
- 1Mental Health Institute, Second Xiangya Hospital, Central-South University, Changsha, Hunan 410011, P. R. China
| | - Bao Ci Shan
- 5Institute of High Energy Physics, Chinese Academy of Sciences, Beijing 100049, P. R. China
| | - Ling Jiang Li
- 1Mental Health Institute, Second Xiangya Hospital, Central-South University, Changsha, Hunan 410011, P. R. China
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Nardo D, Högberg G, Looi JCL, Larsson S, Hällström T, Pagani M. Gray matter density in limbic and paralimbic cortices is associated with trauma load and EMDR outcome in PTSD patients. J Psychiatr Res 2010; 44:477-85. [PMID: 19942229 DOI: 10.1016/j.jpsychires.2009.10.014] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2009] [Revised: 10/28/2009] [Accepted: 10/29/2009] [Indexed: 11/16/2022]
Abstract
There is converging evidence of gray matter (GM) structural alterations in different limbic structures in Post-Traumatic Stress Disorder (PTSD) patients. The aim of this study was to evaluate GM density in PTSD in relation to trauma load, and to assess the GM differences between responders (R) and non-responders (NR) to EMDR therapy. Magnetic Resonance Imaging (MRI) scans of 21 subjects exposed to occupational trauma, who developed PTSD (S), and of 22 who did not (NS), were compared by means of an optimized Voxel-Based Morphometry (VBM) analysis as implemented in SPM. Within S, further comparisons were made between 10 R and 5 NR. A regression analysis between GM density and the Traumatic Antecedents Questionnaire (TAQ) was also performed on all 43 subjects. Results showed a significantly lower GM density in S as compared to NS in the left posterior cingulate and the left posterior parahippocampal gyrus. Moreover, NR showed a significantly lower GM density as compared to R in bilateral posterior cingulate, as well as anterior insula, anterior parahippocampal gyrus and amygdala in the right hemisphere. Regression analysis showed that GM density negatively correlated with trauma load in bilateral posterior cingulate, left anterior insula, and right anterior parahippocampal gyrus. In conclusion, a GM lower density in limbic and paralimbic cortices were found to be associated with PTSD diagnosis, trauma load, and EMDR treatment outcome, suggesting a view of PTSD characterized by memory and dissociative disturbances.
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Affiliation(s)
- Davide Nardo
- Neuroimaging Laboratory, Santa Lucia Foundation, Rome, Italy.
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Sbordone RJ, Ruff RM. Re-examination of the Controversial Coexistence of Traumatic Brain Injury and Posttraumatic Stress Disorder: Misdiagnosis and Self-Report Measures. PSYCHOLOGICAL INJURY & LAW 2010; 3:63-76. [PMID: 20927197 PMCID: PMC2948674 DOI: 10.1007/s12207-010-9066-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2009] [Accepted: 01/10/2010] [Indexed: 11/04/2022]
Abstract
The coexistence of traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD) remains a controversial issue in the literature. To address this controversy, we focused primarily on the civilian-related literature of TBI and PTSD. Some investigators have argued that individuals who had been rendered unconscious or suffered amnesia due to a TBI are unable to develop PTSD because they would be unable to consciously experience the symptoms of fear, helplessness, and horror associated with the development of PTSD. Other investigators have reported that individuals who sustain TBI, regardless of its severity, can develop PTSD even in the context of prolonged unconsciousness. A careful review of the methodologies employed in these studies reveals that investigators who relied on clinical interviews of TBI patients to diagnose PTSD found little or no evidence of PTSD. In contrast, investigators who relied on PTSD questionnaires to diagnose PTSD found considerable evidence of PTSD. Further analysis revealed that many of the TBI patients who were initially diagnosed with PTSD according to self-report questionnaires did not meet the diagnostic criteria for PTSD upon completion of a clinical interview. In particular, patients with severe TBI were often misdiagnosed with PTSD. A number of investigators found that many of the severe TBI patients failed to follow the questionnaire instructions and erroneously endorsed PTSD symptoms because of their cognitive difficulties. Because PTSD questionnaires are not designed to discriminate between PTSD and TBI symptoms or determine whether a patient's responses are accurate or exaggerated, studies that rely on self-report questionnaires to evaluate PTSD in TBI patients are at risk of misdiagnosing PTSD. Further research should evaluate the degree to which misdiagnosis of PTSD occurs in individuals who have sustained mild TBI.
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Affiliation(s)
| | - Ronald M. Ruff
- San Francisco Clinical Neurosciences, 909 Hyde Street, San Francisco, CA 94109 USA
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Thomaes K, Dorrepaal E, Draijer NPJ, de Ruiter MB, Elzinga BM, van Balkom AJ, Smoor PLM, Smit J, Veltman DJ. Increased activation of the left hippocampus region in Complex PTSD during encoding and recognition of emotional words: a pilot study. Psychiatry Res 2009; 171:44-53. [PMID: 19081708 DOI: 10.1016/j.pscychresns.2008.03.003] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2007] [Revised: 12/20/2007] [Accepted: 03/04/2008] [Indexed: 12/20/2022]
Abstract
To gain insight into memory disturbances in Complex Posttraumatic Stress Disorder (Complex PTSD), we investigated declarative memory function and medial temporal lobe activity in patients and healthy non-traumatized controls. A case-control study was performed in nine patients with Complex PTSD and nine controls. All respondents performed a declarative memory task with neutral and emotional, negative words during functional magnetic resonance imaging. Memory performance of neutral words was impaired in Complex PTSD with a relative conservation of recall of negative words. Deep encoding of later remembered negative words, as well as correct recognition of negative words and false alarms, was associated with an enhanced Blood Oxygenation Level Dependent (BOLD) response in the left hippocampus extending into the parahippocampal gyrus of Complex PTSD patients compared with controls. Post-hoc volumetric comparisons did not reveal significant anatomical differences in the medial temporal lobe between Complex PTSD patients and controls. We conclude that in Complex PTSD preferential recall of negative words is associated with increased activation in the left hippocampus and parahippocampal gyrus during both successful and false recall. These findings support a model of an abnormally functioning hippocampus in Complex PTSD.
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50
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van Stegeren AH. Imaging stress effects on memory: a review of neuroimaging studies. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2009; 54:16-27. [PMID: 19175976 DOI: 10.1177/070674370905400105] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To review and give an overview of neuroimaging studies that look at the role of stress (hormones) on memory. METHOD An overview will be given of imaging studies that looked at the role of stress (hormones) on memory. Stress is here defined as the acute provocation of the sympathetic adrenal medullar system and the hypothalamic-pituitary-adrenal axis in experimental designs. Stress hormone levels can be raised endogenously in response to stimulus material (for example, pictures and films) or social evaluative threat situations (stress tasks). Other studies use the exogenous application of drugs to enhance or decrease stress hormone levels. Finally, we review studies on chronic stress and memory. RESULTS Stress or emotional arousal, leading to increased noradrenaline or cortisol levels, led to better memory performance when it is applied during perception or encoding. Brain regions involved in this process were medial temporal lobe regions such as amygdala and hippocampus, and several parts of the prefrontal cortex (PFC). High stress levels accompanied by high cortisol levels during retrieval led to impaired memory performance. Sex effects on memory as well as lateralization effects on brain activation were found. CONCLUSION High stress levels during encoding and consolidation of emotional material involve increased amygdala and hippocampus activation. The role of the anterior cingulate cortex and other parts of the PFC during perception and encoding of arousing material appears to be a modulating one. However, additional research is needed to shed more light on the nature of the brain changes during stress, especially during retrieval.
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Affiliation(s)
- Anda H van Stegeren
- Researcher and Assistant Professor, University of Amsterdam, Department of Clinical Psychology and Cognitive Science Centre, Amsterdam, the Netherlands
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