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Huffhines L, Parade SH, Martin SE, Gottipaty A, Kavanaugh B, Spirito A, Boekamp JR. Early childhood trauma exposure and neurocognitive and emotional processes: Associations in young children in a partial hospital program. Dev Psychopathol 2024:1-17. [PMID: 38711378 DOI: 10.1017/s0954579424000956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
Early childhood trauma has been linked to neurocognitive and emotional processing deficits in older children, yet much less is known about these associations in young children. Early childhood is an important developmental period in which to examine relations between trauma and executive functioning/emotion reactivity, given that these capacities are rapidly developing and are potential transdiagnostic factors implicated in the development of psychopathology. This cross-sectional study examined associations between cumulative trauma, interpersonal trauma, and components of executive functioning, episodic memory, and emotion reactivity, conceptualized using the RDoC framework and assessed with observational and performance-based measures, in a sample of 90 children (ages 4-7) admitted to a partial hospital program. Children who had experienced two or more categories of trauma had lower scores in episodic memory, global cognition, and inhibitory control as measured in a relational (but not computerized) task, when compared to children with less or no trauma. Interpersonal trauma was similarly associated with global cognition and relational inhibitory control. Family contextual factors did not moderate associations. Findings support examining inhibitory control in both relationally significant and decontextualized paradigms in early childhood, and underscore the importance of investigating multiple neurocognitive and emotional processes simultaneously to identify potential targets for early intervention.
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Affiliation(s)
- Lindsay Huffhines
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- Bradley/Hasbro Children's Research Center, E. P Bradley Hospital, Riverside, RI, USA
| | - Stephanie H Parade
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- Bradley/Hasbro Children's Research Center, E. P Bradley Hospital, Riverside, RI, USA
| | - Sarah E Martin
- Department of Psychology, Simmons University, Boston, MA, USA
- Emma Pendleton Bradley Hospital, Riverside, RI, USA
| | - Anjali Gottipaty
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- Emma Pendleton Bradley Hospital, Riverside, RI, USA
| | - Brian Kavanaugh
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- Emma Pendleton Bradley Hospital, Riverside, RI, USA
| | - Anthony Spirito
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - John R Boekamp
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- Emma Pendleton Bradley Hospital, Riverside, RI, USA
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Fleming LL, Harnett NG, Ressler KJ. Sensory alterations in post-traumatic stress disorder. Curr Opin Neurobiol 2024; 84:102821. [PMID: 38096758 PMCID: PMC10922208 DOI: 10.1016/j.conb.2023.102821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 11/19/2023] [Accepted: 11/20/2023] [Indexed: 01/13/2024]
Abstract
PTSD is characterized by difficulties in accurately evaluating the threat value of sensory stimuli. While the role of canonical fear and threat neural circuitry in this ability has been well studied, recent lines of evidence suggest a need to include more emphasis on sensory processing in the conceptualization of PTSD symptomology. Specifically, studies have demonstrated a strong association between variability in sensory processing regions and the severity of PTSD symptoms. In this review, we summarize recent findings that underscore the importance of sensory processing in PTSD, in addition to the structural and functional characteristics of associated sensory brain regions. First, we discuss the link between PTSD and various behavioral aspects of sensory processing. This is followed by a discussion of recent findings that link PTSD to variability in the structure of both gray and white matter in sensory brain regions. We then delve into how brain activity (measured with task-based and resting-state functional imaging) in sensory regions informs our understanding of PTSD symptomology.
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Affiliation(s)
- Leland L Fleming
- Division of Depression and Anxiety, McLean Hospital, Belmont, USA; Department of Psychiatry, Harvard Medical School, Boston, USA
| | - Nathaniel G Harnett
- Division of Depression and Anxiety, McLean Hospital, Belmont, USA; Department of Psychiatry, Harvard Medical School, Boston, USA
| | - Kerry J Ressler
- Division of Depression and Anxiety, McLean Hospital, Belmont, USA; Department of Psychiatry, Harvard Medical School, Boston, USA.
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3
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Lin ERH, Roeckner AR, Fani N, Merrill N, Gillespie CF, Ely TD, Bradley B, Michopoulos V, Powers A, Jovanovic T, Stevens JS. Association between dimensions of trauma-related psychopathology and asthma in trauma-exposed women. Front Behav Neurosci 2023; 17:1268877. [PMID: 38025383 PMCID: PMC10648896 DOI: 10.3389/fnbeh.2023.1268877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 09/22/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Exposure to traumatic events and stressful life experiences are associated with a wide range of adverse mental and physical health outcomes. Studies have found post-traumatic stress disorder (PTSD), depression, and anxiety sensitivity occurrence to be common in addition to inflammatory diseases like asthma, especially in women. Moreover, overlapping neurobiological mechanisms have been linked to both PTSD and asthma. Methods In the current study, n = 508 women reported on presence of lifetime asthma diagnosis and symptoms of trauma-related psychopathology including PTSD and depression. A separate group of female participants (n = 64) reported on asthma, PTSD, depression and anxiety sensitivity, and underwent functional MRI scans during a fearful faces task, and their anterior insula responses were analyzed. Results Overall, PTSD and depression severity were significantly higher in those with asthma versus those without asthma. There was a positive association between anterior insula response to social threat cues and depression symptoms only among individuals without a lifetime presence of asthma. Discussion These findings provide continued evidence on the interactions between stress, neural mechanisms involved in interoception and salience detection, and trauma-related psychopathology.
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Affiliation(s)
- Esther R.-H. Lin
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Alyssa R. Roeckner
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Negar Fani
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Natalie Merrill
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Charles F. Gillespie
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Timothy D. Ely
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Bekh Bradley
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
- Atlanta VA Health Care System, Atlanta, GA, United States
| | - Vasiliki Michopoulos
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Abigail Powers
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Tanja Jovanovic
- Wayne State University School of Medicine, Detroit, MI, United States
| | - Jennifer S. Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
- Atlanta VA Health Care System, Atlanta, GA, United States
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Raeder R, Clayton NS, Boeckle M. Narrative-based autobiographical memory interventions for PTSD: a meta-analysis of randomized controlled trials. Front Psychol 2023; 14:1215225. [PMID: 37829075 PMCID: PMC10565228 DOI: 10.3389/fpsyg.2023.1215225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 08/25/2023] [Indexed: 10/14/2023] Open
Abstract
Introduction The aim of this systematic review and meta-analysis is to evaluate the efficacy of narrative-based interventions (NBIs) for individuals with post-traumatic stress disorder (PTSD). Investigating the efficacy of NBIs should yield insight on autobiographical memory (AM) phenomena implicated in PTSD onset and recovery, leading to improved intervention protocols. Furthermore, by analyzing how NBIs influence maladaptive AM distortions, we hope to shed light on the theorized narrative architecture of AM more generally. Methods A systematic literature search was conducted according to PRISMA and Cochrane guidelines in MEDLINE, EMBASE, PsychINFO, and PubMed. Additional studies were then also identified from the reference lists of other relevant literature and considered for inclusion. Studies were then evaluated for adherence to the inclusion/exclusion criteria and assessed for risk of bias. Various meta-analyses were performed on included studies to understand how NBIs may or may not influence the overall effect size of treatment. Results The results of the meta-analysis of 35 studies, involving 2,596 participants, suggest that NBIs are a viable and effective treatment option for PTSD, yielding a statistically significant within-group effect size and decrease in PTSD symptomatology at both post-treatment [g = 1.73, 95% CI (1.23-2.22)] and 3-9 month follow-up assessments [g = 2.33, 95% CI (1.41-3.26)]. Furthermore, the difference in effect sizes between NBIs compared to active and waitlist controls was statistically significant, suggesting that NBIs are superior. Sub-analyses showed that NET provided a stronger effect size than FORNET, which may be due to the nature of the traumatic event itself and not the treatment protocol. While evidence of small study and publication bias was present, a weight-function model and trim-and-fill method suggested it was not influencing the overall results. Discussion This meta-analysis presents strong evidence supporting the use of NBIs in the treatment of PTSD. Clear similarities can be identified between NBIs included in this analysis that make them distinct from non-NBI interventions, which are reviewed in the discussion. Controlled comparisons between NBIs and non-NBIs would help to further understand AM mechanisms of action implicated in recovery and how various interventions facilitate them. Future research should also aim to elucidate the full range of AM impairment in individuals with PTSD to gain insight on how other memory capabilities, such as the ability to mentally simulate the future, are implicated in the pathogenesis of PTSD.
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Affiliation(s)
- Robert Raeder
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom
| | - Nicola S. Clayton
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom
| | - Markus Boeckle
- Scientific Working Group, Karl Landsteiner University of Health Sciences, Krems, Austria
- Department of Transitory Psychiatry, University Hospital Tulln, Tulln, Austria
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Al Jowf GI, Ahmed ZT, Reijnders RA, de Nijs L, Eijssen LMT. To Predict, Prevent, and Manage Post-Traumatic Stress Disorder (PTSD): A Review of Pathophysiology, Treatment, and Biomarkers. Int J Mol Sci 2023; 24:ijms24065238. [PMID: 36982313 PMCID: PMC10049301 DOI: 10.3390/ijms24065238] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/28/2023] [Accepted: 03/07/2023] [Indexed: 03/11/2023] Open
Abstract
Post-traumatic stress disorder (PTSD) can become a chronic and severely disabling condition resulting in a reduced quality of life and increased economic burden. The disorder is directly related to exposure to a traumatic event, e.g., a real or threatened injury, death, or sexual assault. Extensive research has been done on the neurobiological alterations underlying the disorder and its related phenotypes, revealing brain circuit disruption, neurotransmitter dysregulation, and hypothalamic–pituitary–adrenal (HPA) axis dysfunction. Psychotherapy remains the first-line treatment option for PTSD given its good efficacy, although pharmacotherapy can also be used as a stand-alone or in combination with psychotherapy. In order to reduce the prevalence and burden of the disorder, multilevel models of prevention have been developed to detect the disorder as early as possible and to reduce morbidity in those with established diseases. Despite the clinical grounds of diagnosis, attention is increasing to the discovery of reliable biomarkers that can predict susceptibility, aid diagnosis, or monitor treatment. Several potential biomarkers have been linked with pathophysiological changes related to PTSD, encouraging further research to identify actionable targets. This review highlights the current literature regarding the pathophysiology, disease development models, treatment modalities, and preventive models from a public health perspective, and discusses the current state of biomarker research.
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Affiliation(s)
- Ghazi I. Al Jowf
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, 6200 MD Maastricht, The Netherlands
- Department of Public Health, College of Applied Medical Sciences, King Faisal University, Al-Ahsa 31982, Saudi Arabia
- European Graduate School of Neuroscience, Maastricht University, 6200 MD Maastricht, The Netherlands
- Correspondence: (G.I.A.J.); (L.M.T.E.)
| | - Ziyad T. Ahmed
- College of Medicine, Sulaiman Al Rajhi University, Al-Bukairyah 52726, Saudi Arabia
| | - Rick A. Reijnders
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, 6200 MD Maastricht, The Netherlands
- European Graduate School of Neuroscience, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Laurence de Nijs
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, 6200 MD Maastricht, The Netherlands
- European Graduate School of Neuroscience, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Lars M. T. Eijssen
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, 6200 MD Maastricht, The Netherlands
- European Graduate School of Neuroscience, Maastricht University, 6200 MD Maastricht, The Netherlands
- Department of Bioinformatics—BiGCaT, School of Nutrition and Translational Research in Metabolism (NUTRIM), Faculty of Health, Medicine and Life Sciences, Maastricht University, 6200 MD Maastricht, The Netherlands
- Correspondence: (G.I.A.J.); (L.M.T.E.)
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Seligowski AV, Webber TK, Marvar PJ, Ressler KJ, Philip NS. Involvement of the brain-heart axis in the link between PTSD and cardiovascular disease. Depress Anxiety 2022; 39:663-674. [PMID: 35708302 PMCID: PMC9588548 DOI: 10.1002/da.23271] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 04/22/2022] [Accepted: 05/13/2022] [Indexed: 01/27/2023] Open
Abstract
Posttraumatic stress disorder (PTSD) has long been associated with a heightened risk of cardiovascular disease (CVD). A number of mechanisms have been implicated to underlie this brain-heart axis relationship, such as altered functioning of the autonomic nervous system and increased systemic inflammation. While neural alterations have repeatedly been observed in PTSD, they are rarely considered in the PTSD-CVD link. The brain-heart axis is a pathway connecting frontal and limbic brain regions to the brainstem and periphery via the autonomic nervous system and it may be a promising model for understanding CVD risk in PTSD given its overlap with PTSD neural deficits. We first provide a summary of the primary mechanisms implicated in the association between PTSD and CVD. We then review the brain-heart axis and its relevance to PTSD, as well as findings from PTSD trials demonstrating that a number of PTSD treatments have effects on areas of the brain-heart axis. Finally, we discuss sex considerations in the PTSD-CVD link. A critical next step in this study is to determine if PTSD treatments that affect the brain-heart axis (e.g., brain stimulation that improves autonomic function) also reduce the risk of CVD.
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Affiliation(s)
- Antonia V. Seligowski
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- McLean Hospital, Belmont, MA, USA
| | | | | | - Kerry J. Ressler
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- McLean Hospital, Belmont, MA, USA
| | - Noah S. Philip
- VA RR&D Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School, of Brown University, Providence, RI, USA
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Gupta S, Guleria RS. Involvement of Nuclear Factor-κB in Inflammation and Neuronal Plasticity Associated with Post-Traumatic Stress Disorder. Cells 2022; 11:cells11132034. [PMID: 35805118 PMCID: PMC9265339 DOI: 10.3390/cells11132034] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/17/2022] [Accepted: 06/18/2022] [Indexed: 11/29/2022] Open
Abstract
Post-traumatic stress disorder (PTSD) is a debilitating psychiatric condition which develops either due to stress or witnessing a traumatic situation. PTSD is characterized by acute and chronic stress response exhibit anxiety, fear, and an increased inflammatory etiology. Inflammation contributes a critical role in several parts of the brain that control fear and flashback cognatic function. It is known that impairment of the neurological circuit leads to the development of PTSD. Evidence has suggested that dysregulation of the sympathetic nervous system and hypothalamic-pituitary adrenal (HPA) axis and inflammatory responsiveness are pivotal and a greater risk in PTSD. NF-κB, a master regulator for inflammation, has been showed to modulate memory reconsolidation and synaptic plasticity; however, NF-κB’s association with PTSD remain elusive. In this review, we provide relevant findings regarding NF-κB activity in various components of brain and describe a potential mechanism linking PTSD using preclinical and clinical models. We envisage NF-κB signaling as a crucial mediator for inflammation, cognitive function, memory restoration and behavioral actions of stress and suggest that it could be used for therapeutic intervention in PTSD.
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Dunsmoor JE, Cisler JM, Fonzo GA, Creech SK, Nemeroff CB. Laboratory models of post-traumatic stress disorder: The elusive bridge to translation. Neuron 2022; 110:1754-1776. [PMID: 35325617 PMCID: PMC9167267 DOI: 10.1016/j.neuron.2022.03.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/18/2022] [Accepted: 02/28/2022] [Indexed: 12/14/2022]
Abstract
Post-traumatic stress disorder (PTSD) is a debilitating mental illness composed of a heterogeneous collection of symptom clusters. The unique nature of PTSD as arising from a precipitating traumatic event helps simplify cross-species translational research modeling the neurobehavioral effects of stress and fear. However, the neurobiological progress on these complex neural circuits informed by animal models has yet to produce novel, evidence-based clinical treatment for PTSD. Here, we provide a comprehensive overview of popular laboratory models of PTSD and provide concrete ideas for improving the validity and clinical translational value of basic research efforts in humans. We detail modifications to simplified animal paradigms to account for myriad cognitive factors affected in PTSD, which may contribute to abnormalities in regulating fear. We further describe new avenues for integrating different areas of psychological research underserved by animal models of PTSD. This includes incorporating emerging trends in the cognitive neuroscience of episodic memory, emotion regulation, social-emotional processes, and PTSD subtyping to provide a more comprehensive recapitulation of the human experience to trauma in laboratory research.
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Affiliation(s)
- Joseph E Dunsmoor
- Department of Psychiatry and Behavioral Sciences, University of Texas at Austin Dell Medical School, Austin, TX, USA; Center for Psychedelic Research and Therapy, University of Texas at Austin Dell Medical School, Austin, TX, USA.
| | - Josh M Cisler
- Department of Psychiatry and Behavioral Sciences, University of Texas at Austin Dell Medical School, Austin, TX, USA; Institute for Early Life Adversity Research, University of Texas at Austin, Austin, TX, USA; Center for Psychedelic Research and Therapy, University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Gregory A Fonzo
- Department of Psychiatry and Behavioral Sciences, University of Texas at Austin Dell Medical School, Austin, TX, USA; Institute for Early Life Adversity Research, University of Texas at Austin, Austin, TX, USA; Center for Psychedelic Research and Therapy, University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Suzannah K Creech
- Department of Psychiatry and Behavioral Sciences, University of Texas at Austin Dell Medical School, Austin, TX, USA; Institute for Early Life Adversity Research, University of Texas at Austin, Austin, TX, USA
| | - Charles B Nemeroff
- Department of Psychiatry and Behavioral Sciences, University of Texas at Austin Dell Medical School, Austin, TX, USA; Institute for Early Life Adversity Research, University of Texas at Austin, Austin, TX, USA; Center for Psychedelic Research and Therapy, University of Texas at Austin Dell Medical School, Austin, TX, USA.
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9
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Leroy A, Very E, Birmes P, Yger P, Szaffarczyk S, Lopes R, Outteryck O, Faure C, Duhem S, Grandgenèvre P, Warembourg F, Vaiva G, Jardri R. Intrusive experiences in posttraumatic stress disorder: Treatment response induces changes in the directed functional connectivity of the anterior insula. Neuroimage Clin 2022; 34:102964. [PMID: 35189456 PMCID: PMC8861823 DOI: 10.1016/j.nicl.2022.102964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 01/27/2022] [Accepted: 02/08/2022] [Indexed: 11/18/2022]
Abstract
Many causal paths were less influenced by the AI after effective therapy for PTSD. Insular influences over the rest of the brain were found to be positively correlated with re-experiencing. Re-experiencing was linked with changes in intrinsic networks’ spatial stability after treatment.
Background One of the core features of posttraumatic stress disorder (PTSD) is re-experiencing trauma. The anterior insula (AI) has been proposed to play a crucial role in these intrusive experiences. However, the dynamic function of the AI in re-experiencing trauma and its putative modulation by effective therapy need to be specified. Methods Thirty PTSD patients were enrolled and exposed to traumatic memory reactivation therapy. Resting-state functional magnetic resonance imaging (fMRI) scans were acquired before and after treatment. To explore AI-directed influences over the rest of the brain, we referred to a mixed model using pre-/posttreatment Granger causality analysis seeded on the AI as a within-subject factor and treatment response as a between-subject factor. To further identify correlates of re-experiencing trauma, we investigated how intrusive severity affected (i) causality maps and (ii) the spatial stability of other intrinsic brain networks. Results We observed changes in AI-directed functional connectivity patterns in PTSD patients. Many within- and between-network causal paths were found to be less influenced by the AI after effective therapy. Insular influences were found to be positively correlated with re-experiencing symptoms, while they were linked with a stronger default mode network (DMN) and more unstable central executive network (CEN) connectivity. Conclusion We showed that directed changes in AI signaling to the DMN and CEN at rest may underlie the degree of re-experiencing symptoms in PTSD. A positive response to treatment further induced changes in network-to-network anticorrelated patterns. Such findings may guide targeted neuromodulation strategies in PTSD patients not suitably improved by conventional treatment.
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Affiliation(s)
- Arnaud Leroy
- Univ Lille, INSERM, CHU Lille, Lille Neuroscience & Cognition Centre (U-1172), Plasticity & SubjectivitY Team, CURE Platform, 59000 Lille, France; CHU Lille, Fontan Hospital, General Psychiatry Dpt., 59037 Lille Cedex, France; Centre National de Ressources et Résilience pour les psychotraumatismes (CN2R Lille - Paris), 59000 Lille, France.
| | - Etienne Very
- CHU Toulouse, Purpan Hospital, Psychiatry Department, 31059 Toulouse Cedex, France; ToNIC, Toulouse NeuroImaging Center, INSERM U-1214, UPS, France
| | - Philippe Birmes
- ToNIC, Toulouse NeuroImaging Center, INSERM U-1214, UPS, France
| | - Pierre Yger
- Univ Lille, INSERM, CHU Lille, Lille Neuroscience & Cognition Centre (U-1172), Plasticity & SubjectivitY Team, CURE Platform, 59000 Lille, France; Institut de la Vision, Sorbonne Université, Inserm S968, CNRS UMR7210, Paris, France
| | - Sébastien Szaffarczyk
- Univ Lille, INSERM, CHU Lille, Lille Neuroscience & Cognition Centre (U-1172), Plasticity & SubjectivitY Team, CURE Platform, 59000 Lille, France
| | - Renaud Lopes
- Univ Lille, INSERM, CHU Lille, Lille Neuroscience & Cognition Centre (U-1772), Degenerative & Vascular Cognitive Disorders Team, 59000 Lille, France; Univ Lille, CNRS, INSERM, CHU Lille, Institut Pasteur de Lille, US 41 - UMS 2014 - PLBS, 59000 Lille, France
| | - Olivier Outteryck
- Univ Lille, INSERM, CHU Lille, Lille Neuroscience & Cognition Centre (U-1772), Degenerative & Vascular Cognitive Disorders Team, 59000 Lille, France; CHU Lille, Department of Neuroradiology, Roger Salengro Hospital, 59037 Lille Cedex, France
| | - Cécile Faure
- Univ Lille, INSERM, CHU Lille, Lille Neuroscience & Cognition Centre (U-1172), Plasticity & SubjectivitY Team, CURE Platform, 59000 Lille, France
| | - Stéphane Duhem
- CHU Lille, Fontan Hospital, General Psychiatry Dpt., 59037 Lille Cedex, France; Centre National de Ressources et Résilience pour les psychotraumatismes (CN2R Lille - Paris), 59000 Lille, France; Université de Lille, Inserm, CHU Lille, CIC 1403 - Clinical Investigation Center, 59000 Lille, France
| | - Pierre Grandgenèvre
- Univ Lille, INSERM, CHU Lille, Lille Neuroscience & Cognition Centre (U-1172), Plasticity & SubjectivitY Team, CURE Platform, 59000 Lille, France; CHU Lille, Fontan Hospital, General Psychiatry Dpt., 59037 Lille Cedex, France
| | | | - Guillaume Vaiva
- Univ Lille, INSERM, CHU Lille, Lille Neuroscience & Cognition Centre (U-1172), Plasticity & SubjectivitY Team, CURE Platform, 59000 Lille, France; CHU Lille, Fontan Hospital, General Psychiatry Dpt., 59037 Lille Cedex, France; Centre National de Ressources et Résilience pour les psychotraumatismes (CN2R Lille - Paris), 59000 Lille, France
| | - Renaud Jardri
- Univ Lille, INSERM, CHU Lille, Lille Neuroscience & Cognition Centre (U-1172), Plasticity & SubjectivitY Team, CURE Platform, 59000 Lille, France; CHU Lille, Fontan Hospital, Child & Adolescent Psychiatry Dpt., 59037 Lille Cedex, France
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10
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Clinical Manifestations of Body Memories: The Impact of Past Bodily Experiences on Mental Health. Brain Sci 2022; 12:brainsci12050594. [PMID: 35624981 PMCID: PMC9138975 DOI: 10.3390/brainsci12050594] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/29/2022] [Accepted: 04/30/2022] [Indexed: 12/04/2022] Open
Abstract
Bodily experiences such as the feeling of touch, pain or inner signals of the body are deeply emotional and activate brain networks that mediate their perception and higher-order processing. While the ad hoc perception of bodily signals and their influence on behavior is empirically well studied, there is a knowledge gap on how we store and retrieve bodily experiences that we perceived in the past, and how this influences our everyday life. Here, we explore the hypothesis that negative body memories, that is, negative bodily experiences of the past that are stored in memory and influence behavior, contribute to the development of somatic manifestations of mental health problems including somatic symptoms, traumatic re-experiences or dissociative symptoms. By combining knowledge from the areas of cognitive neuroscience and clinical neuroscience with insights from psychotherapy, we identify Clinical Body Memory (CBM) mechanisms that specify how mental health problems could be driven by corporeal experiences stored in memory. The major argument is that the investigation of the neuronal mechanisms that underlie the storage and retrieval of body memories provides us with empirical access to reduce the negative impact of body memories on mental health.
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Yun JY, Jin MJ, Kim S, Lee SH. Stress-related cognitive style is related to volumetric change of the hippocampus and FK506 binding protein 5 polymorphism in post-traumatic stress disorder. Psychol Med 2022; 52:1243-1254. [PMID: 32892762 DOI: 10.1017/s0033291720002949] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Patients with post-traumatic stress disorder (PTSD) show a different stress-related cognitive style compared with healthy controls (HC). The FK506 binding protein 5 gene (FKBP5), one of the PTSD known risk factors, is involved in the stress response through the hypothalamic-pituitary-adrenal axis and brain volumetric alterations. The present study aimed to uncover the neural correlates of stress-related cognitive styles through the analysis of the regional brain volumes and FKBP5 genotype in patients with PTSD compared with HC. METHODS In this study, 51 patients with PTSD and 94 HC were assessed for stress-related cognitive styles, PTSD symptoms severity, and genotype of FKBP5 single nucleotide polymorphisms, and underwent T1-weighted structural magnetic resonance imaging. Diagnosis-by-genotype interaction for regional brain volumes was examined in 16 brain regions of interest. RESULTS Patients with PTSD showed significantly higher levels of catastrophizing, ruminative response, and repression, and reduced distress aversion and positive reappraisal compared with HC (p < 0.001). Significant diagnosis-by-genotype interactions for regional brain volumes were observed for bilateral hippocampi and left frontal operculum. A significant positive correlation between the severity of the repression and left hippocampal volume was found in a subgroup of patients with PTSD with FKBP5 rs3800373 (AA genotype) or rs1360780 (CC genotype). CONCLUSIONS The present study showed the influences of FKBP5 genotype on the distorted cognitive styles in PTSD by measuring the volumetric alteration of hippocampal regions, providing a possible role of the hippocampus and left frontal operculum as significant neurobiological correlates of PTSD.
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Affiliation(s)
- Je-Yeon Yun
- Seoul National University Hospital, Seoul, Republic of Korea
- Yeongeon Student Support Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Min Jin Jin
- Department of Psychiatry, Wonkwang University Hospital, Iksan, Republic of Korea
- Institute of General Education, Kongju National University, Gongju, Republic of Korea
| | - Sungkean Kim
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
| | - Seung-Hwan Lee
- Clinical Emotion and Cognition Research Clinical Emotion and Cognition Research Laboratory, Inje University, Goyang, Republic of Korea
- Department of Psychiatry, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
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12
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von Känel R, Meister-Langraf RE, Zuccarella-Hackl C, Znoj H, Pazhenkottil AP, Schmid JP, Barth J, Schnyder U, Princip M. Association Between Changes in Post-hospital Cardiac Symptoms and Changes in Acute Coronary Syndrome-Induced Symptoms of Post-traumatic Stress. Front Cardiovasc Med 2022; 9:852710. [PMID: 35498017 PMCID: PMC9046908 DOI: 10.3389/fcvm.2022.852710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/24/2022] [Indexed: 12/15/2022] Open
Abstract
BackgroundAfter acute coronary syndrome (ACS), one in eight patients develops clinically significant symptoms of Post-traumatic stress disorder (PTSD). We hypothesized that changes in cardiac symptoms from 3 to 12 months after ACS are associated with changes in ACS-induced PTSD symptoms.MethodsAt 3 (n = 154) and/or 12 months (n = 106) post-ACS, patients (n = 156, mean age 59 years, 85% men) completed a clinical interview assessing chest tightness/pain (at rest and/or during exertion), heartbeat symptoms (heart palpitations, racing of heart, heart stumbling or skipping a beat) and PTSD symptoms during the prior 4 weeks. Random mixed regression models examined the association between the onset (or remission) from 3 to 12 months in cardiac symptoms with changes in PTSD symptoms, adjusting for a range of potential predictors of ACS-induced PTSD symptoms.ResultsThe onset of chest tightness/pain [estimate = 0.588, 95% confidence interval: 0.275, 0.090; p < 0.001] and of heartbeat symptoms [0.548 (0.165, 0.931); p = 0.005] from 3 to 12 months was independently associated with an increase in total PTSD symptoms. There were also independent associations between the onset of chest tightness/pain and heartbeat symptoms with an increase in PTSD symptom clusters. Specifically, the onset of chest tightness/pain showed associations with an increase in re-experiencing [0.450 (0.167, 0.733); p = 0.027] and avoidance/numbing [0.287 (0.001, 0.574); p = 0.049]. The onset of heartbeat symptoms showed associations with an increase in re-experiencing [0.392 (0.045, 0.739); p = 0.002], avoidance/numbing [0.513 (0.161, 0.864); p = 0.004] and hyperarousal [0.355 (0.051, 0.659); p = 0.022]. An increase in the total number of cardiac symptoms (score range 0–6) was also associated with an increase in total PTSD symptoms [0.343 (0.202, 0.484); p < 0.001]. Psychotherapy in the post-hospital period moderated the association between the change in heartbeat symptoms and the change in total PTSD symptoms [−0.813 (−1.553, −0.074); p = 0.031 for interaction]; the association between the onset of heart beat symptoms and an increase in total PTSD symptoms was weaker in patients who attended psychotherapy [0.437 (−0.178, 1.052); p = 0.16] than in those who did not [0.825 (0.341, 1.309); p < 0.001].ConclusionChanges in cardiac symptoms between 3 and 12 months after hospitalization are associated with changes in ACS-induced PTSD symptoms. ClinicalTrials.gov #NCT01781247.
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Affiliation(s)
- Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- *Correspondence: Roland von Känel
| | - Rebecca E. Meister-Langraf
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Clienia Schlössli AG, Zurich, Switzerland
| | - Claudia Zuccarella-Hackl
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Hansjörg Znoj
- Department of Health Psychology and Behavioral Medicine, University of Bern, Bern, Switzerland
| | - Aju P. Pazhenkottil
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Cardiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jean-Paul Schmid
- Department of Internal Medicine and Cardiology, Clinic Gais AG, Gais, Switzerland
| | - Jürgen Barth
- Institute for Complementary and Integrative Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Mary Princip
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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13
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Sussman TJ, Posner J, Jackowski AP, Correa A, Hoffmann EV, Porto de Oliveira Peruzzi F, Grecco FR, Nitzsche SH, Mesquita ME, Foester BU, Benatti di Cillo F, Mello MF, Coelho Milani AC. The relationship between recent PTSD secondary to sexual assault, hippocampal volume and resting state functional connectivity in adolescent girls. Neurobiol Stress 2022; 17:100441. [PMID: 35257017 PMCID: PMC8897602 DOI: 10.1016/j.ynstr.2022.100441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/09/2022] [Accepted: 02/22/2022] [Indexed: 11/19/2022] Open
Abstract
Objective Improved understanding of the time course of neural changes associated with adolescent PTSD would elucidate the development of the disorder and could inform approaches to treatment. We compared hippocampal volumes and resting state functional connectivity (RSFC) in adolescent girls with post-traumatic stress disorder (PTSD) secondary to sexual assault, within six months of onset and age- and gender-matched, non-trauma exposed healthy controls (HCs) in São Paulo, Brazil. We also examined the relationship between pre- and post-treatment PTSD symptoms and RSFC. Method We collected brain structure, RSFC, and PTSD symptoms in 30 adolescents with PTSD (mean age: 15.7 ± 1.04 years) and 21 HCs (mean age: 16.2 ± 1.21 years) at baseline. We collected repeated measures in 21 participants with PTSD following treatment; 9 participants dropped out. Hippocampal volume and RSFC from hippocampal and default mode network (DMN) seeds were compared between participants with PTSD and HCs. We examined associations between within-subject changes in RSFC and PTSD symptoms following treatment. Results No hippocampal volumetric differences between groups were found. Compared to HCs, adolescents with recent PTSD had reduced RSFC between hippocampus and the lateral parietal node of the DMN, encompassing the angular gyrus, peak coordinates: −38, −54, 16; 116 voxels; peak F1,47 = 31.76; FDR corrected p = 0.038. Improvements in PTSD symptoms were associated with increased RSFC between hippocampus and part of the lateral parietal node of the DMN, peak coordinates: −38, −84, 38; 316 voxels; peak F1,47 = 40.28; FDR corrected p < 0.001. Conclusion Adolescents with recent PTSD had reduced hippocampal-DMN RSFC, while no group differences in hippocampal volume were found, suggesting that hippocampal function, but not structure, is altered early in the course of PSTD. Following treatment, hippocampal-DMN RSFC increased with symptom improvement and may indicate an important neural mechanism related to successful PTSD treatment.
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Affiliation(s)
- Tamara J. Sussman
- Department of Psychiatry, Columbia University and New York State Psychiatric Institute, 1051 Riverside Dr., New York, NY, 10032, USA
- Corresponding author. 1051 Riverside Drive, New York, NY, 10032, USA.
| | - Jonathan Posner
- Department of Psychiatry, Columbia University and New York State Psychiatric Institute, 1051 Riverside Dr., New York, NY, 10032, USA
| | - Andrea Parolin Jackowski
- Departamento de Psiquiatria, Universidade Federal de São Paulo, R Rua Major Maragliano, 241, Vila Clementino, São Paulo, SP, 04017030, Brazil
| | - Adriana Correa
- Departamento de Psiquiatria, Universidade Federal de São Paulo, R Rua Major Maragliano, 241, Vila Clementino, São Paulo, SP, 04017030, Brazil
| | - Elis Viviane Hoffmann
- Departamento de Psiquiatria, Universidade Federal de São Paulo, R Rua Major Maragliano, 241, Vila Clementino, São Paulo, SP, 04017030, Brazil
| | - Fernanda Porto de Oliveira Peruzzi
- Departamento de Psiquiatria, Universidade Federal de São Paulo, R Rua Major Maragliano, 241, Vila Clementino, São Paulo, SP, 04017030, Brazil
| | - Fernando Rodrigues Grecco
- Departamento de Psiquiatria, Universidade Federal de São Paulo, R Rua Major Maragliano, 241, Vila Clementino, São Paulo, SP, 04017030, Brazil
| | - Samara Hipolito Nitzsche
- Departamento de Psiquiatria, Universidade Federal de São Paulo, R Rua Major Maragliano, 241, Vila Clementino, São Paulo, SP, 04017030, Brazil
| | - Maria Eugenia Mesquita
- Departamento de Psiquiatria, Universidade Federal de São Paulo, R Rua Major Maragliano, 241, Vila Clementino, São Paulo, SP, 04017030, Brazil
| | - Bernd Uwe Foester
- Departamento de Psiquiatria, Universidade Federal de São Paulo, R Rua Major Maragliano, 241, Vila Clementino, São Paulo, SP, 04017030, Brazil
| | - Felipe Benatti di Cillo
- Departamento de Psiquiatria, Universidade Federal de São Paulo, R Rua Major Maragliano, 241, Vila Clementino, São Paulo, SP, 04017030, Brazil
| | - Marcelo Feijo Mello
- Departamento de Psiquiatria, Universidade Federal de São Paulo, R Rua Major Maragliano, 241, Vila Clementino, São Paulo, SP, 04017030, Brazil
| | - Ana Carolina Coelho Milani
- Departamento de Psiquiatria, Universidade Federal de São Paulo, R Rua Major Maragliano, 241, Vila Clementino, São Paulo, SP, 04017030, Brazil
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14
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Pfeiffer JR, van Rooij SJH, Mekawi Y, Fani N, Jovanovic T, Michopoulos V, Smith AK, Stevens JS, Uddin M. Blood-derived deoxyribonucleic acid methylation clusters associate with adverse social exposures and endophenotypes of stress-related psychiatric illness in a trauma-exposed cohort of women. Front Psychiatry 2022; 13:892302. [PMID: 36405926 PMCID: PMC9668877 DOI: 10.3389/fpsyt.2022.892302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 09/21/2022] [Indexed: 11/06/2022] Open
Abstract
Adverse social exposures (ASEs) such as low income, low educational attainment, and childhood/adult trauma exposure are associated with variability in brain region measurements of gray matter volume (GMV), surface area (SA), and cortical thickness (CT). These CNS morphometries are associated with stress-related psychiatric illnesses and represent endophenotypes of stress-related psychiatric illness development. Epigenetic mechanisms, such as 5-methyl-cytosine (5mC), may contribute to the biological embedding of the environment but are understudied and not well understood. How 5mC relates to CNS endophenotypes of psychiatric illness is also unclear. In 97 female, African American, trauma-exposed participants from the Grady Trauma Project, we examined the associations of childhood trauma burden (CTQ), adult trauma burden, low income, and low education with blood-derived 5mC clusters and variability in brain region measurements in the amygdala, hippocampus, and frontal cortex subregions. To elucidate whether peripheral 5mC indexes central nervous system (CNS) endophenotypes of psychiatric illness, we tested whether 73 brain/blood correlated 5mC clusters, defined by networks of correlated 5mC probes measured on Illumina's HumanMethylation Epic Beadchip, mediated the relationship between ASEs and brain measurements. CTQ was negatively associated with rostral middle frontal gyrus (RMFG) SA (β =-0.231, p = 0.041). Low income and low education were also associated with SA or CT in a number of brain regions. Seven 5mC clusters were associated with CTQ (pmin = 0.002), two with low education (pmin = 0.010), and three with low income (pmin = 0.007). Two clusters fully mediated the relation between CTQ and RMFG SA, accounting for 47 and 35% of variability, respectively. These clusters were enriched for probes falling in DNA regulatory regions, as well as signal transduction and immune signaling gene ontology functions. Methylome-network analyses showed enrichment of macrophage migration (p = 9 × 10-8), T cell receptor complex (p = 6 × 10-6), and chemokine-mediated signaling (p = 7 × 10-4) pathway enrichment in association with CTQ. Our results support prior work highlighting brain region variability associated with ASEs, while informing a peripheral inflammation-based epigenetic mechanism of biological embedding of such exposures. These findings could also serve to potentiate increased investigation of understudied populations at elevated risk for stress-related psychiatric illness development.
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Affiliation(s)
- John R Pfeiffer
- Department of Psychology, University of Illinois at Urbana-Champaign, Urbana, IL, United States.,Carl R. Woese Institute for Genomic Biology, Urbana, IL, United States
| | - Sanne J H van Rooij
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Yara Mekawi
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY, United States
| | - Negar Fani
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, United States
| | - Vasiliki Michopoulos
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Alicia K Smith
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States.,Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Jennifer S Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Monica Uddin
- Genomics Program, College of Public Health, University of South Florida, Tampa, FL, United States
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15
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An Y, Shi J, Chuan-Peng H, Wu X. The symptom structure of posttraumatic stress disorder and co-morbid depression among college students with childhood abuse experience: A network analysis. J Affect Disord 2021; 293:466-475. [PMID: 34256208 DOI: 10.1016/j.jad.2021.06.065] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 06/24/2021] [Accepted: 06/27/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) and depression are highly co-morbid among individuals with childhood abuse history, while the mechanism of the co-morbidity is highly debated. This study sought to extent the work among college students with network analysis, which is a novel method that sees the co-morbidity from a symptom interacting perspective. METHODS Data was collected from 476 college students who were assessed to have childhood abuse history, PTSD and depression at the same time, using Childhood Trauma Questionnaire- Short Form, PTSD Checklist for DSM-5 and The Center for Epidemiological Studies Depression. We created a Graphical Gaussian Model (GGM) network to show associations between symptom pairs and a Directed Acyclic Graph (DAG) to estimate potential casual relationships among symptoms. RESULTS The GGM network was reliably stable, feeling sad (Depression) and trouble experiencing positive feelings (PTSD) were the most central nodes. Trouble experiencing positive feelings and several negative affect symptoms, sleep problems and difficulty in concentrating were acting as important bridging nodes. The DAG network suggested the key triggering roles of exaggerated startle (PTSD) and several re-experiencing symptoms. LIMITATIONS The study used cross-sectional data and self-reported measures. Results from network analysis could be affected by scale factors and contain spurious correlations. CONCLUSIONS In the childhood-abuse-related co-morbid structure, several negative affect symptoms both in PTSD and depression have pivotal roles, hyper-arousal symptoms and re-experiencing symptoms could trigger the co-morbid structure. Illustrating the strength and limitations of network analysis, this study help target the potentially influential symptoms for better clinical intervention.
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Affiliation(s)
- Yuanyuan An
- School of Psychology, Nanjing Normal University, 122 Ninghai Road, Gulou Distinct, Nanjing, PR China
| | - Junyi Shi
- School of Psychology, Nanjing Normal University, 122 Ninghai Road, Gulou Distinct, Nanjing, PR China
| | - Hu Chuan-Peng
- Leibniz Institute for Resilience Research, 55131 Mainz, Germany
| | - Xinchun Wu
- Faculty of Psychology, Beijing Normal University, No.19 Xinjiekou Wai Street, Beijing, PR China; Beijing Key Laboratory of Applied Experimental Psychology, Beijing Normal University, No.19 Xinjiekou Wai Street, Beijing, PR China.
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16
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Bijanki KR, van Rooij SJH, Ely TD, Stevens JS, Inman CS, Fasano RE, Carter SE, Winters SJ, Baman JR, Drane DL, Jovanovic T, Willie JT. Case Series: Unilateral Amygdala Ablation Ameliorates Post-Traumatic Stress Disorder Symptoms and Biomarkers. Neurosurgery 2021; 87:796-802. [PMID: 32259241 DOI: 10.1093/neuros/nyaa051] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 01/12/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Post-traumatic stress disorder is a severe psychobiological disorder associated with hyperactivity of the amygdala, particularly on the right side. Highly selective laser ablation of the amygdalohippocampal complex is an effective neurosurgical treatment for medically refractory medial temporal lobe epilepsy that minimizes neurocognitive deficits relative to traditional open surgery. OBJECTIVE To examine the impact of amygdalohippocampotomy upon symptoms and biomarkers of post-traumatic stress disorder. METHODS Two patients with well-documented chronic post-traumatic stress disorder who subsequently developed late-onset epilepsy underwent unilateral laser amygdalohippocampotomy. Prospective clinical and neuropsychological measurements were collected in patient 1. Additional prospective measurements of symptoms and biomarkers were collected pre- and post-surgery in patient 2. RESULTS After laser ablation targeting the nondominant (right) amygdala, both patients experienced not only reduced seizures, but also profoundly abated post-traumatic stress symptoms. Prospective evaluation of biomarkers in patient 2 showed robust improvements in hyperarousal symptoms, fear potentiation of the startle reflex, brain functional magnetic resonance imaging responses to fear-inducing stimuli, and emotional declarative memory. CONCLUSION These observations support the emerging hypothesis that the right amygdala particularly perpetuates the signs and symptoms of post-traumatic stress disorder and suggests that focal unilateral amydalohippocampotomy can provide therapeutic benefit.
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Affiliation(s)
- Kelly R Bijanki
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas.,Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia.,Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Sanne J H van Rooij
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Timothy D Ely
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Jennifer S Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Cory S Inman
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia
| | - Rebecca E Fasano
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia
| | - Sierra E Carter
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Sterling J Winters
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Justin R Baman
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Daniel L Drane
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia.,Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia.,Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, Michigan
| | - Jon T Willie
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia.,Department of Neurology, Emory University School of Medicine, Atlanta, Georgia
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17
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Stenson AF, van Rooij SJH, Carter SE, Powers A, Jovanovic T. A legacy of fear: Physiological evidence for intergenerational effects of trauma exposure on fear and safety signal learning among African Americans. Behav Brain Res 2020; 402:113017. [PMID: 33197457 DOI: 10.1016/j.bbr.2020.113017] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 10/18/2020] [Accepted: 11/10/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To determine the influence of maternal trauma and posttraumatic stress disorder (PTSD) symptoms on children's physiological response to threat and safety signals during a fear conditioning task in trauma-exposed mothers and children. METHOD Participants were African American mother-child dyads (N = 137; children aged 8-13 years). Mothers' trauma history and PTSD symptoms were assessed; Latent Class Analysis (LCA) was conducted from these measures to identify distinct classes. Children reported violence exposure and completed a differential fear conditioning task using fear-potentiated startle (FPS) responses to conditioned danger (CS+) and safety (CS-) signals. RESULTS Four classes of maternal trauma history and PTSD symptoms emerged: 1) Lower Trauma, 2) Moderate Trauma, 3) High Sexual Abuse, and 4) High Trauma and PTSD Symptoms. Children's FPS to CS + and CS- were tested with maternal class as the between-subjects factor. FPS to the danger signal was not significantly different across maternal classes, but FPS to safety (CS-) was significantly higher for the Lower Trauma and High Trauma and PTSD Symptoms classes than either the Moderate Trauma or the High Sexual Abuse classes. CONCLUSIONS Results indicate that maternal trauma impacts children's ability to modulate fear responses in the presence of a safety signal, independent of the children's own trauma exposure. To our knowledge, this is the first study to demonstrate that children's fear inhibition is impacted by maternal trauma exposure. Prior studies have linked fear inhibition to mental health outcomes, highlighting the need to understand intergenerational modulation of fear learning and physiology.
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Affiliation(s)
- Anaïs F Stenson
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, United States.
| | - Sanne J H van Rooij
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, United States
| | - Sierra E Carter
- Department of Psychology, Georgia State University, Atlanta, GA, United States
| | - Abigail Powers
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, United States
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, United States
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18
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Lambert HK, McLaughlin KA. Impaired hippocampus-dependent associative learning as a mechanism underlying PTSD: A meta-analysis. Neurosci Biobehav Rev 2019; 107:729-749. [PMID: 31545990 DOI: 10.1016/j.neubiorev.2019.09.024] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 08/10/2019] [Accepted: 09/13/2019] [Indexed: 12/19/2022]
Abstract
Smaller hippocampal volume is associated with increased risk for PTSD following trauma, but the hippocampal functions involved remain unknown. We propose a conceptual model that identifies broad impairment in hippocampus-dependent associative learning as a vulnerability factor for PTSD. Associative learning of foreground cues and background context is required to form an integrated representation of an event. People with poor associative learning may have difficulty remembering who or what was present during a trauma, where the trauma occurred, or the sequence of events, which may contribute to PTSD symptoms. We argue that associative learning difficulties in PTSD exist for cues and context, regardless of the emotional nature of the information. This contrasts with PTSD models that focus exclusively on threat-processing or contextual-processing. In a meta-analysis, people with PTSD exhibited poor associative learning of multiple information types compared to those without PTSD. Differences were of medium effect size and similar magnitude for neutral and negative/trauma-related stimuli. We provide evidence for associative learning difficulties as a neurocognitive pathway that may contribute to PTSD.
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Affiliation(s)
- Hilary K Lambert
- Department of Psychology, University of Washington, 119A Guthrie Hall, Box 351525, Seattle, WA, 98195-1525, USA.
| | - Katie A McLaughlin
- Department of Psychology, Harvard University, William James Hall, 33 Kirkland Street, Cambridge, MA 02138, USA.
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19
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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: 51] [Impact Index Per Article: 10.2] [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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Maples-Keller JL, Jovanovic T, Dunlop BW, Rauch S, Yasinski C, Michopoulos V, Coghlan C, Norrholm S, Rizzo AS, Ressler K, Rothbaum BO. When translational neuroscience fails in the clinic: Dexamethasone prior to virtual reality exposure therapy increases drop-out rates. J Anxiety Disord 2019; 61:89-97. [PMID: 30502903 DOI: 10.1016/j.janxdis.2018.10.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 10/11/2018] [Accepted: 10/24/2018] [Indexed: 10/28/2022]
Abstract
Posttraumatic stress disorder (PTSD) is characterized by exaggerated expression of fear responses to danger and safety cues. Translational research suggests that dexamethasone facilitates fear extinction in animal and human fear conditioning models. For this randomized, placebo-controlled trial (N = 27), we aimed to translate these findings to the clinic by using virtual reality exposure (VRE) therapy for OEF/OIF/OND veterans with PTSD to determine whether dexamethasone will increase the efficacy of exposure therapy for VRE relative to placebo. VRE sessions involved imaginal exposure to the most traumatic war memories while viewing a computer-generated view of virtual Iraq or Afghanistan with multisensory stimulus options used to match patient's description of the trauma. VRE was effective in reducing PTSD symptoms but there was no interaction with dexamethasone. Drop-out rate was significantly higher in the dexamethasone group, with 10 of 13 (76.9%) participants in this group discontinuing, compared to only 4 of 14 (28.5%) in the placebo group, χ2 = 6.31, p = 0.02. Results indicate that the dexamethasone group may have experienced an increase in PTSD symptoms, particularly re-experiencing, at session 2 following first drug administration. Contrary to study hypotheses, dexamethasone did not enhance exposure therapy outcomes and was associated with increased drop-out. This demonstrates potential pitfalls in translating neuroscience models to the clinic; future research carefully examining glucocorticoid mechanisms involved in therapy augmentation is warranted.
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Affiliation(s)
- Jessica L Maples-Keller
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, United States.
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, United States
| | - Boadie W Dunlop
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, United States
| | - Sheila Rauch
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, United States
| | - Carly Yasinski
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, United States
| | - Vasiliki Michopoulos
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, United States
| | - Callan Coghlan
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, United States
| | - Seth Norrholm
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, United States
| | - Albert Skip Rizzo
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, United States; Department of Psychiatry and Behavioral Sciences, University of Southern California, United States; Department of Psychiatry, McLean Hospital/Harvard Medical School, United States
| | - Kerry Ressler
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, United States; Department of Psychiatry and Behavioral Sciences, University of Southern California, United States; Department of Psychiatry, McLean Hospital/Harvard Medical School, United States
| | - Barbara O Rothbaum
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, United States
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Powers A, Fani N, Murphy L, Briscione M, Bradley B, Tone EB, Norrholm SD, Jovanovic T. Attention bias toward threatening faces in women with PTSD: eye tracking correlates by symptom cluster. Eur J Psychotraumatol 2019; 10:1568133. [PMID: 30788062 PMCID: PMC6374933 DOI: 10.1080/20008198.2019.1568133] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 11/10/2018] [Accepted: 12/29/2018] [Indexed: 12/20/2022] Open
Abstract
Maladaptive patterns of attention to emotional stimuli are a common feature of posttraumatic stress disorder (PTSD), with growing evidence supporting sustained attention to threatening stimuli across trauma samples. However, it remains unclear how different PTSD symptom clusters are associated with attentional bias patterns, particularly in urban civilian settings with high rates of trauma exposure and PTSD. The present study examined associations among these variables in 70 traumatized primarily African American women. PTSD was measured using the Clinician Administered PTSD Scale, and eye tracking was used to measure patterns of attention as participants engaged in an attention bias (dot probe) task to emotional faces; average initial fixation (1 s) and dwell duration (overall time spent looking at emotional face versus neutral face across the 5 s task) were used to assess attention bias patterns toward emotional faces. Women with PTSD showed significantly longer dwell duration toward angry faces than women without PTSD (F = 5.16, p < .05). Bivariate correlation analyses with the PTSD symptom clusters showed a significant association between average initial fixation toward angry faces and higher levels of avoidance symptoms (r = 0.29, p < .05) as well as sustained attention to angry faces and higher levels of re-experiencing symptoms (r = 0.24, p < .05). Using separate linear regression models based on initial significant correlations, we found that PTSD avoidance symptoms were significantly related to average initial fixation toward angry faces (R 2 ∆ = 0.09, p < .05) and PTSD re-experiencing symptoms were significantly related to dwell duration toward angry faces (R 2 ∆ = 0.06, p < .05). These findings contribute to evidence that PTSD is related to both initial vigilance and sustained attention to threat and that certain symptom clusters may either drive or be more impacted by attentional biases, highlighting the benefits of addressing attentional biases within treatment.
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Affiliation(s)
- Abigail Powers
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Negar Fani
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Lauren Murphy
- Department of Psychology, Emory University, Atlanta, GA, USA
| | - Maria Briscione
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Bekh Bradley
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.,Atlanta VA Medical Center, Atlanta, GA, USA
| | - Erin B Tone
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| | - Seth D Norrholm
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.,Atlanta VA Medical Center, Atlanta, GA, USA
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
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Gagne C, Dayan P, Bishop SJ. When planning to survive goes wrong: predicting the future and replaying the past in anxiety and PTSD. Curr Opin Behav Sci 2018. [DOI: 10.1016/j.cobeha.2018.03.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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23
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Women with high estradiol status are protected against declarative memory impairment by pre-learning stress. Neurobiol Learn Mem 2018; 155:403-411. [PMID: 30172954 DOI: 10.1016/j.nlm.2018.08.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 07/26/2018] [Accepted: 08/29/2018] [Indexed: 11/21/2022]
Abstract
Stress is a potent modulator of learning and memory. Factors contributing to whether stress aids or impairs memory are timing of the stressor, memory stage, form of memory studied, and sex of the subjects. The female sex hormone 17-beta-estradiol (E2) has widespread effects in the brain and affects hippocampus-dependent memory in animals. In humans, the interaction between stress effects and E2 has not been widely studied. We report data from a healthy sample divided into 3 hormone-status groups: free-cycling women in the early follicular phase (EF: low E2, low progesterone [P4]), or during midcycle (MC: high E2, low P4), and men. Participants within each hormone-status group were randomly assigned to a psychosocial stressor or a control treatment 37 min before encoding a short story of neutral content. We found a Hormone status × Stress × Time (immediate, 35-min, 24-h delayed recall) interaction. Irrespective of time, hormone status mattered only after stress treatment: stressed early follicular women had poorer recall compared to stressed men and midcycle women. Only in the early follicular group, recall was negatively correlated with increases in salivary cortisol, but not with blood levels of E2 and P4. To uncover changes beyond immediate recall, we computed the individual percent change relative to immediate recall and repeated the analysis for these adjusted 35-min and 24-h data. Despite the lack of a stress effect in raw data, memory in stressed men was more stable over time (35-min and 24-h delay) than in unstressed men. In contrast, stressed EF-women (vs. control) recalled less at the 35-min and (as a trend) at the 24-h delay. Stressed MC-women (vs. control) showed less recall only at the 35-min delay while compensating this stress effect after a 24-h consolidation interval. Overall, results suggest that women in high-E2 midcycle phase could be less vulnerable to effects of pre-learning stress on declarative memory encoding and consolidation.
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