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Bertolini F, Robertson L, Bisson JI, Meader N, Churchill R, Ostuzzi G, Stein DJ, Williams T, Barbui C. Early pharmacological interventions for prevention of post-traumatic stress disorder (PTSD) in individuals experiencing acute traumatic stress symptoms. Cochrane Database Syst Rev 2024; 5:CD013613. [PMID: 38767196 PMCID: PMC11103774 DOI: 10.1002/14651858.cd013613.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
BACKGROUND Acute traumatic stress symptoms may develop in people who have been exposed to a traumatic event. Although they are usually self-limiting in time, some people develop post-traumatic stress disorder (PTSD), a severe and debilitating condition. Pharmacological interventions have been proposed for acute symptoms to act as an indicated prevention measure for PTSD development. As many individuals will spontaneously remit, these interventions should balance efficacy and tolerability. OBJECTIVES To assess the efficacy and acceptability of early pharmacological interventions for prevention of PTSD in adults experiencing acute traumatic stress symptoms. SEARCH METHODS We searched the Cochrane Common Mental Disorders Controlled Trial Register (CCMDCTR), CENTRAL, MEDLINE, Embase and two other databases. We checked the reference lists of all included studies and relevant systematic reviews. The search was last updated on 23 January 2023. SELECTION CRITERIA We included randomised controlled trials on adults exposed to any kind of traumatic event and presenting acute traumatic stress symptoms, without restriction on their severity. We considered comparisons of any medication with placebo, or with another medication. We excluded trials that investigated medications as an augmentation to psychotherapy. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodological procedures. Using a random-effects model, we analysed dichotomous data as risk ratios (RR) and calculated the number needed to treat for an additional beneficial/harmful outcome (NNTB/NNTH). We analysed continuous data as mean differences (MD) or standardised mean differences (SMD). Our primary outcomes were PTSD severity and dropouts due to adverse events. Secondary outcomes included PTSD rate, functional disability and quality of life. MAIN RESULTS We included eight studies that considered four interventions (escitalopram, hydrocortisone, intranasal oxytocin, temazepam) and involved a total of 779 participants. The largest trial contributed 353 participants and the next largest, 120 and 118 participants respectively. The trials enrolled participants admitted to trauma centres or emergency departments. The risk of bias in the included studies was generally low except for attrition rate, which we rated as high-risk. We could meta-analyse data for two comparisons: escitalopram versus placebo (but limited to secondary outcomes) and hydrocortisone versus placebo. One study compared escitalopram to placebo at our primary time point of three months after the traumatic event. There was inconclusive evidence of any difference in terms of PTSD severity (mean difference (MD) on the Clinician-Administered PTSD Scale (CAPS, score range 0 to 136) -11.35, 95% confidence interval (CI) -24.56 to 1.86; 1 study, 23 participants; very low-certainty evidence), dropouts due to adverse events (no participant left the study early due to adverse events; 1 study, 31 participants; very low-certainty evidence) and PTSD rates (RR 0.59, 95% CI 0.03 to 13.08; NNTB 37, 95% CI NNTB 15 to NNTH 1; 1 study, 23 participants; very low-certainty evidence). The study did not assess functional disability or quality of life. Three studies compared hydrocortisone to placebo at our primary time point of three months after the traumatic event. We found inconclusive evidence on whether hydrocortisone was more effective in reducing the severity of PTSD symptoms compared to placebo (MD on CAPS -7.53, 95% CI -25.20 to 10.13; I2 = 85%; 3 studies, 136 participants; very low-certainty evidence) and whether it reduced the risk of developing PTSD (RR 0.47, 95% CI 0.09 to 2.38; NNTB 14, 95% CI NNTB 8 to NNTH 5; I2 = 36%; 3 studies, 136 participants; very low-certainty evidence). Evidence on the risk of dropping out due to adverse events is inconclusive (RR 3.19, 95% CI 0.13 to 75.43; 2 studies, 182 participants; low-certainty evidence) and it is unclear whether hydrocortisone might improve quality of life (MD on the SF-36 (score range 0 to 136, higher is better) 19.70, 95% CI -1.10 to 40.50; 1 study, 43 participants; very low-certainty evidence). No study assessed functional disability. AUTHORS' CONCLUSIONS This review provides uncertain evidence regarding the use of escitalopram, hydrocortisone, intranasal oxytocin and temazepam for people with acute stress symptoms. It is therefore unclear whether these pharmacological interventions exert a positive or negative effect in this population. It is important to note that acute traumatic stress symptoms are often limited in time, and that the lack of data prevents the careful assessment of expected benefits against side effects that is therefore required. To yield stronger conclusions regarding both positive and negative outcomes, larger sample sizes are required. A common operational framework of criteria for inclusion and baseline assessment might help in better understanding who, if anyone, benefits from an intervention. As symptom severity alone does not provide the full picture of the impact of exposure to trauma, assessment of quality of life and functional impairment would provide a more comprehensive picture of the effects of the interventions. The assessment and reporting of side effects may facilitate a more comprehensive understanding of tolerability.
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Affiliation(s)
- Federico Bertolini
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Lindsay Robertson
- Cochrane Common Mental Disorders, University of York, York, UK
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Jonathan I Bisson
- Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Nicholas Meader
- Cochrane Common Mental Disorders, University of York, York, UK
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Rachel Churchill
- Cochrane Common Mental Disorders, University of York, York, UK
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Giovanni Ostuzzi
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Dan J Stein
- SAMRC Unit on Risk & Resilience in Mental Disorders, Dept of Psychiatry & Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Taryn Williams
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Corrado Barbui
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
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2
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Xiao S, Ebner NC, Manzouri A, Li TQ, Cortes DS, Månsson KNT, Fischer H. Age-dependent effects of oxytocin in brain regions enriched with oxytocin receptors. Psychoneuroendocrinology 2024; 160:106666. [PMID: 37951085 PMCID: PMC10841644 DOI: 10.1016/j.psyneuen.2023.106666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 09/03/2023] [Accepted: 10/29/2023] [Indexed: 11/13/2023]
Abstract
Although intranasal oxytocin administration to tap into central functions is the most commonly used non-invasive means for exploring oxytocin's role in human cognition and behavior, the way by which intranasal oxytocin acts on the brain is not yet fully understood. Recent research suggests that brain regions densely populated with oxytocin receptors may play a central role in intranasal oxytocin's action mechanisms in the brain. In particular, intranasal oxytocin may act directly on (subcortical) regions rich in oxytocin receptors via binding to these receptors while only indirectly affecting other (cortical) regions via their neural connections to oxytocin receptor-enriched regions. Aligned with this notion, the current study adopted a novel approach to test 1) whether the connections between oxytocin receptor-enriched regions (i.e., the thalamus, pallidum, caudate nucleus, putamen, and olfactory bulbs) and other regions in the brain were responsive to intranasal oxytocin administration, and 2) whether oxytocin-induced effects varied as a function of age. Forty-six young (24.96 ± 3.06 years) and 44 older (69.89 ± 2.99 years) participants were randomized, in a double-blind procedure, to self-administer either intranasal oxytocin or placebo before resting-state fMRI. Results supported age-dependency in the effects of intranasal oxytocin administration on connectivity between oxytocin receptor-enriched regions and other regions in the brain. Specifically, compared to placebo, oxytocin decreased both connectivity density and connectivity strength of the thalamus for young participants while it increased connectivity density and connectivity strength of the caudate for older participants. These findings inform the mechanisms underlying the effects of exogenous oxytocin on brain function and highlight the importance of age in these processes.
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Affiliation(s)
- Shanshan Xiao
- Department of Psychology, Stockholm University, Campus Albano hus 4, Albanovägen, SE-114 19 Stockholm, Sweden.
| | - Natalie C Ebner
- Department of Psychology, University of Florida, P.O. Box 112250, Gainesville, FL 32611-2250, USA; Cognitive Aging and Memory Program, Clinical Translational Research Program (CAM-CTRP), University of Florida, 2004 Mowry Road, Gainesville, FL 32611, USA; McKnight Brain Institute, University of Florida, 1149 Newell Drive, Gainesville, FL 32610, USA.
| | - Amirhossein Manzouri
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Norra stationsgatan 69, SE-113 64 Stockholm, Sweden.
| | - Tie-Qiang Li
- Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Alfred Nobels Allé 8, SE-141 52 Huddinge, Sweden; Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, SE-141 86 Stockholm, Sweden.
| | - Diana S Cortes
- Department of Psychology, Stockholm University, Campus Albano hus 4, Albanovägen, SE-114 19 Stockholm, Sweden.
| | - Kristoffer N T Månsson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Norra stationsgatan 69, SE-113 64 Stockholm, Sweden.
| | - Håkan Fischer
- Department of Psychology, Stockholm University, Campus Albano hus 4, Albanovägen, SE-114 19 Stockholm, Sweden; Stockholm University Brain Imaging Center (SUBIC), SE-106 91 Stockholm, Sweden; Aging Research Center, Karolinska Institutet and Stockholm University, Tomtebodavägen 18 A, SE-171 77 Stockholm, Sweden.
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3
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Zhang H, Chen K, Bao J, Wu H. Oxytocin enhances the triangular association among behavior, resting-state, and task-state functional connectivity. Hum Brain Mapp 2023; 44:6074-6089. [PMID: 37771300 PMCID: PMC10619367 DOI: 10.1002/hbm.26498] [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: 02/15/2023] [Revised: 09/12/2023] [Accepted: 09/15/2023] [Indexed: 09/30/2023] Open
Abstract
Considerable advances in the role of oxytocin (OT) effect on behavior and the brain network have been made, but the effect of OT on the association between inter-individual differences in functional connectivity (FC) and behavior is elusive. Here, by using a face-perception task and multiple connectome-based predictive models, we aimed to (1) determine whether OT could enhance the association among behavioral performance, resting-state FC (rsFC), and task-state FC (tsFC) and (2) if so, explore the role of OT in enhancing this triangular association. We found that in the OT group, the prediction performance of using rsFC or tsFC to predict task behavior was higher than that of the PL group. Additionally, the correlation coefficient between rsFC and tsFC was substantially higher in the OT group than in the PL group. The strength of these associations could be partly explained by OT altering the brain's FCs related to social cognition and face perception in both the resting and task states, mainly in brain regions such as the limbic system, prefrontal cortex, temporal poles, and temporoparietal junction. Taken together, these results provide novel evidence and a corresponding mechanism for how neuropeptides cause increased associations among inter-individual differences across different levels (e.g., behavior and large-scale brain networks in both resting and task-state), and may inspire future research on the role of neuropeptides in the cross levels association of both clinical and nonclinical use.
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Affiliation(s)
- Haoming Zhang
- Centre for Cognitive and Brain Sciences and Department of PsychologyUniversity of MacauMacauChina
| | - Kun Chen
- Centre for Cognitive and Brain Sciences and Department of PsychologyUniversity of MacauMacauChina
| | - Jin Bao
- Shenzhen Neher Neural Plasticity Laboratory, Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced TechnologyChinese Academy of Sciences (CAS)ShenzhenChina
- Shenzhen‐Hong Kong Institute of Brain Science‐Shenzhen Fundamental Research InstitutionsShenzhenChina
| | - Haiyan Wu
- Centre for Cognitive and Brain Sciences and Department of PsychologyUniversity of MacauMacauChina
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4
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Lotfinia S, Afshar A, Yaseri A, Olff M, Quidé Y. Functional brain changes after alternative pharmacological interventions in posttraumatic stress disorder: A systematic review of clinical trials. Brain Behav 2023; 13:e3292. [PMID: 37864378 PMCID: PMC10726808 DOI: 10.1002/brb3.3292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 09/21/2023] [Accepted: 10/11/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is a complex and heterogeneous mental health condition that can develop after exposure to a traumatic event. Clinical trials have used alternative pharmacological agents to treat PTSD, but their associated neural correlates remain unclear. The present systematic review aims to summarize the changes in brain function associated with the use of these alternative pharmacological agents in PTSD. METHODS Clinical trials using functional magnetic resonance imaging, either at rest or during the performance of tasks, were included if they compared the effects of alternative pharmacological agents between PTSD patients and either trauma-exposed controls or never-exposed healthy controls. RESULTS Sixteen studies were included, of which 11 used intranasal oxytocin, 2 used hydrocortisone, and 3 used delta-9-tetrahydrocannabinol (THC). Oxytocin administration was associated with the normalization of functional connectivity between the ventromedial prefrontal cortex and amygdala as well as enhanced the function of brain regions specifically involved in emotion processing (e.g., amygdala), working memory (e.g., dorsolateral prefrontal cortex), and reward (e.g., putamen). Hydrocortisone did not influence brain function at rest or during the performance of an autobiographical memory task, whereas THC was associated with the reduction of the amygdala and increased medial prefrontal cortex activation. CONCLUSIONS This systematic review identified preliminary evidence for normalizing brain function after the use of alternative pharmacological agents. Importantly, sex-specific differences were noted, in particular when using oxytocin, that will require further investigation.
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Affiliation(s)
- Shahab Lotfinia
- Department of Clinical Psychology, School of MedicineShahid Beheshti University of Medical ScienceTehranIran
| | - Amin Afshar
- Faculty of MedicineQazvin University of Medical ScienceQazvinIran
| | - Aram Yaseri
- School of MedicineShahid Beheshti University of Medical ScienceTehranIran
| | - Miranda Olff
- Department of PsychiatryAmsterdam University Medical Centers Location AMC, Amsterdam Public HealthAmsterdamThe Netherlands
- ARQ National Psychotrauma CentreDiemenThe Netherlands
| | - Yann Quidé
- NeuroRecovery Research Hub, School of PsychologyThe University of New South Wales (UNSW) SydneySydneyNew South WalesAustralia
- Neuroscience Research AustraliaRandwickNew South WalesAustralia
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Meier IM, Montoya ER, Spencer H, Orellana SC, van Buuren M, van Honk J, Bos PA. Preliminary data on oxytocin modulation of neural reactivity in women to emotional stimuli of children depending on childhood emotional neglect. Dev Psychobiol 2023; 65:e22349. [PMID: 36567648 PMCID: PMC9828591 DOI: 10.1002/dev.22349] [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: 12/16/2021] [Revised: 09/21/2022] [Accepted: 10/30/2022] [Indexed: 11/28/2022]
Abstract
Sensitivity for rewarding cues and distress signals from children is fundamental to human caregiving and modulated by the neuropeptide oxytocin. In a functional magnetic resonance imaging study, we investigated whether oxytocin regulates neural responses to reward or distress cues form children. In a placebo-controlled, within-subject design, we measured neural responses to positive, negative, and neutral cues from children in 22 healthy female subjects who received oxytocin (24 IU) versus placebo. Further, based on current literature, we hypothesized that oxytocin effects are modulated by experiences of childhood trauma. The task elicited valence-specific effects-positive images activated the ventromedial prefrontal cortex, left anterior cingulate cortex, and right putamen, and images of children in distress activated the bilateral amygdala, hippocampus, and right medial superior frontal cortex. The effects of oxytocin depended on subjective reports of childhood emotional neglect. Self-reported neglect interacted with oxytocin administration in the amygdala, hippocampus, and prefrontal areas. In individuals with higher scores of emotional neglect, oxytocin increased neural reactivity of limbic structures to positive and neutral images. Our findings need replication in larger samples and can therefore be considered preliminary but are in line with the recent literature on the modulating effect of childhood adversity on the sensitivity to oxytocin administration.
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Affiliation(s)
- Isabell M. Meier
- Department of Experimental PsychologyUtrecht UniversityUtrechtThe Netherlands
| | - Estrella R. Montoya
- Department of Experimental PsychologyUtrecht UniversityUtrechtThe Netherlands
| | - Hannah Spencer
- Research Institute of Child Development and EducationUniversity of AmsterdamAmsterdamThe Netherlands
| | - Sofia C. Orellana
- Department of PsychiatryUniversity of Cambridge, Cambridge Biomedical CampusCambridgeUK
| | - Mariët van Buuren
- Department of Clinical, Neuro and Developmental Psychology, Institute for Brain and Behavior AmsterdamVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Jack van Honk
- Department of Experimental PsychologyUtrecht UniversityUtrechtThe Netherlands,Department of Psychiatry and Mental Health, Groote Schuur Hospital, MRC Unit on Anxiety & Stress DisordersUniversity of Cape TownCape TownSouth Africa,Institute of Infectious Diseases and Molecular MedicineUniversity of Cape TownCape TownSouth Africa
| | - Peter A. Bos
- Institute of Education and Child StudiesLeiden UniversityLeidenThe Netherlands
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6
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Bose M, Farias Quipildor G, Ehrlich ME, Salton SR. Intranasal Peptide Therapeutics: A Promising Avenue for Overcoming the Challenges of Traditional CNS Drug Development. Cells 2022; 11:cells11223629. [PMID: 36429060 PMCID: PMC9688574 DOI: 10.3390/cells11223629] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 11/10/2022] [Accepted: 11/12/2022] [Indexed: 11/18/2022] Open
Abstract
The central nervous system (CNS) has, among all organ systems in the human body, the highest failure rate of traditional small-molecule drug development, ranging from 80-100% depending on the area of disease research. This has led to widespread abandonment by the pharmaceutical industry of research and development for CNS disorders, despite increased diagnoses of neurodegenerative disorders and the continued lack of adequate treatment options for brain injuries, stroke, neurodevelopmental disorders, and neuropsychiatric illness. However, new approaches, concurrent with the development of sophisticated bioinformatic and genomic tools, are being used to explore peptide-based therapeutics to manipulate endogenous pathways and targets, including "undruggable" intracellular protein-protein interactions (PPIs). The development of peptide-based therapeutics was previously rejected due to systemic off-target effects and poor bioavailability arising from traditional oral and systemic delivery methods. However, targeted nose-to-brain, or intranasal (IN), approaches have begun to emerge that allow CNS-specific delivery of therapeutics via the trigeminal and olfactory nerve pathways, laying the foundation for improved alternatives to systemic drug delivery. Here we review a dozen promising IN peptide therapeutics in preclinical and clinical development for neurodegenerative (Alzheimer's, Parkinson's), neuropsychiatric (depression, PTSD, schizophrenia), and neurodevelopmental disorders (autism), with insulin, NAP (davunetide), IGF-1, PACAP, NPY, oxytocin, and GLP-1 agonists prominent among them.
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Affiliation(s)
- Meenakshi Bose
- Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Gabriela Farias Quipildor
- Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Michelle E. Ehrlich
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Stephen R. Salton
- Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Correspondence: ; Tel.: +1-212-824-9308
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7
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Marazziti D, Diep PT, Carter S, Carbone MG. Oxytocin: An Old Hormone, A Novel Psychotropic Drug And Possible Use In Treating Psychiatric Disorders. Curr Med Chem 2022; 29:5615-5687. [PMID: 35894453 DOI: 10.2174/0929867329666220727120646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 03/17/2022] [Accepted: 04/19/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Oxytocin is a nonapeptide synthesized in the paraventricular and supraoptic nuclei of the hypothalamus. Historically, this molecule has been involved as a key factor in the formation of infant attachment, maternal behavior and pair bonding and, more generally, in linking social signals with cognition, behaviors and reward. In the last decades, the whole oxytocin system has gained a growing interest as it was proposed to be implicated in etiopathogenesis of several neurodevelopmental and neuropsychiatric disorders. METHODS With the main goal of an in-depth understanding of the oxytocin role in the regulation of different functions and complex behaviors as well as its intriguing implications in different neuropsychiatric disorders, we performed a critical review of the current state of art. We carried out this work through PubMed database up to June 2021 with the search terms: 1) "oxytocin and neuropsychiatric disorders"; 2) "oxytocin and neurodevelopmental disorders"; 3) "oxytocin and anorexia"; 4) "oxytocin and eating disorders"; 5) "oxytocin and obsessive-compulsive disorder"; 6) "oxytocin and schizophrenia"; 7) "oxytocin and depression"; 8) "oxytocin and bipolar disorder"; 9) "oxytocin and psychosis"; 10) "oxytocin and anxiety"; 11) "oxytocin and personality disorder"; 12) "oxytocin and PTSD". RESULTS Biological, genetic, and epigenetic studies highlighted quality and quantity modifications in the expression of oxytocin peptide or in oxytocin receptor isoforms. These alterations would seem to be correlated with a higher risk of presenting several neuropsychiatric disorders belonging to different psychopathological spectra. Collaterally, the exogenous oxytocin administration has shown to ameliorate many neuropsychiatric clinical conditions. CONCLUSION Finally, we briefly analyzed the potential pharmacological use of oxytocin in patient with severe symptomatic SARS-CoV-2 infection due to its anti-inflammatory, anti-oxidative and immunoregulatory properties.
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Affiliation(s)
- Donatella Marazziti
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Italy.,Saint Camillus International University of Health and Medical Sciences, Rome, Italy
| | - Phuoc-Tan Diep
- Department of Histopathology, Royal Lancaster Infirmary, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, United Kingdom
| | - Sue Carter
- Director Kinsey Institute, Indiana University, Bloomington, IN, USA
| | - Manuel G Carbone
- Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, 21100 Varese, Italy
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8
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Procyshyn TL, Lombardo MV, Lai MC, Jassim N, Auyeung B, Crockford SK, Deakin JB, Soubramanian S, Sule A, Terburg D, Baron-Cohen S, Bethlehem RAI. Oxytocin Enhances Basolateral Amygdala Activation and Functional Connectivity While Processing Emotional Faces: Preliminary Findings in Autistic Versus Non-Autistic Women. Soc Cogn Affect Neurosci 2022; 17:929-938. [PMID: 35254443 PMCID: PMC9527468 DOI: 10.1093/scan/nsac016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 01/13/2022] [Accepted: 03/04/2022] [Indexed: 11/30/2022] Open
Abstract
Oxytocin is hypothesized to promote social interactions by enhancing the salience of social stimuli. While previous neuroimaging studies have reported that oxytocin enhances amygdala activation to face stimuli in autistic men, effects in autistic women remain unclear. In this study, the influence of intranasal oxytocin on activation and functional connectivity of the basolateral amygdala—the brain’s ‘salience detector’—while processing emotional faces vs shapes was tested in 16 autistic and 21 non-autistic women by functional magnetic resonance imaging in a placebo-controlled, within-subject, cross-over design. In the placebo condition, minimal activation differences were observed between autistic and non-autistic women. However, significant drug × group interactions were observed for both basolateral amygdala activation and functional connectivity. Oxytocin increased left basolateral amygdala activation among autistic women (35-voxel cluster, Montreal Neurological Institute (MNI) coordinates of peak voxel = −22 −10 −28; mean change = +0.079%, t = 3.159, PTukey = 0.0166) but not among non-autistic women (mean change = +0.003%, t = 0.153, PTukey = 0.999). Furthermore, oxytocin increased functional connectivity of the right basolateral amygdala with brain regions associated with socio-emotional information processing in autistic women, but not in non-autistic women, attenuating group differences in the placebo condition. Taken together, these findings extend evidence of oxytocin’s effects on the amygdala to specifically include autistic women and specify the subregion of the effect.
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Affiliation(s)
- Tanya L Procyshyn
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Michael V Lombardo
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
- Laboratory for Autism and Neurodevelopmental Disorders, Center for Neuroscience and Cognitive Systems @UniTn, Istituto Italiano di Tecnologia, Rovereto, Italy
| | - Meng-Chuan Lai
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
- Centre for Addiction and Mental Health and The Hospital for Sick Children, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Nazia Jassim
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Bonnie Auyeung
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
- Department of Psychology, School of Philosophy, Psychology and Language Sciences, University of Edinburgh, Edinburgh, UK
| | - Sarah K Crockford
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
- Department of Theoretical and Applied Linguistics, University of Cambridge, Cambridge, UK
| | - Julia B Deakin
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Sentil Soubramanian
- South West London and St. George’s Mental Health NHS Trust, London, UK
- Liaison Psychiatry Service, St Helier Hospital, Epsom and St Helier University Hospitals NHS Trust, Surrey, UK
| | - Akeem Sule
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - David Terburg
- Department of Experimental Psychology, Utrecht University, Utrecht, the Netherlands
- Department of Psychiatry and Mental Health, Groote Schuur Hospital, MRC Unit on Anxiety & Stress Disorders, University of Cape Town, Cape Town, South Africa
| | - Simon Baron-Cohen
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Richard A I Bethlehem
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
- Department of Psychiatry, University of Cambridge, Cambridge, UK
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9
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Bertolini F, Robertson L, Bisson JI, Meader N, Churchill R, Ostuzzi G, Stein DJ, Williams T, Barbui C. Early pharmacological interventions for universal prevention of post-traumatic stress disorder (PTSD). Cochrane Database Syst Rev 2022; 2:CD013443. [PMID: 35141873 PMCID: PMC8829470 DOI: 10.1002/14651858.cd013443.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) is a severe and debilitating condition. Several pharmacological interventions have been proposed with the aim to prevent or mitigate it. These interventions should balance efficacy and tolerability, given that not all individuals exposed to a traumatic event will develop PTSD. There are different possible approaches to preventing PTSD; universal prevention is aimed at individuals at risk of developing PTSD on the basis of having been exposed to a traumatic event, irrespective of whether they are showing signs of psychological difficulties. OBJECTIVES To assess the efficacy and acceptability of pharmacological interventions for universal prevention of PTSD in adults exposed to a traumatic event. SEARCH METHODS We searched the Cochrane Common Mental Disorders Controlled Trial Register (CCMDCTR), CENTRAL, MEDLINE, Embase, two other databases and two trials registers (November 2020). We checked the reference lists of all included studies and relevant systematic reviews. The search was last updated on 13 November 2020. SELECTION CRITERIA We included randomised clinical trials on adults exposed to any kind of traumatic event. We considered comparisons of any medication with placebo or with another medication. We excluded trials that investigated medications as an augmentation to psychotherapy. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodological procedures. In a random-effects model, we analysed dichotomous data as risk ratios (RR) and number needed to treat for an additional beneficial/harmful outcome (NNTB/NNTH). We analysed continuous data as mean differences (MD) or standardised mean differences (SMD). MAIN RESULTS We included 13 studies which considered eight interventions (hydrocortisone, propranolol, dexamethasone, omega-3 fatty acids, gabapentin, paroxetine, PulmoCare enteral formula, Oxepa enteral formula and 5-hydroxytryptophan) and involved 2023 participants, with a single trial contributing 1244 participants. Eight studies enrolled participants from emergency departments or trauma centres or similar settings. Participants were exposed to a range of both intentional and unintentional traumatic events. Five studies considered participants in the context of intensive care units with traumatic events consisting of severe physical illness. Our concerns about risk of bias in the included studies were mostly due to high attrition and possible selective reporting. We could meta-analyse data for two comparisons: hydrocortisone versus placebo, but limited to secondary outcomes; and propranolol versus placebo. No study compared hydrocortisone to placebo at the primary endpoint of three months after the traumatic event. The evidence on whether propranolol was more effective in reducing the severity of PTSD symptoms compared to placebo at three months after the traumatic event is inconclusive, because of serious risk of bias amongst the included studies, serious inconsistency amongst the studies' results, and very serious imprecision of the estimate of effect (SMD -0.51, 95% confidence interval (CI) -1.61 to 0.59; I2 = 83%; 3 studies, 86 participants; very low-certainty evidence). No study provided data on dropout rates due to side effects at three months post-traumatic event. The evidence on whether propranolol was more effective than placebo in reducing the probability of experiencing PTSD at three months after the traumatic event is inconclusive, because of serious risk of bias amongst the included studies, and very serious imprecision of the estimate of effect (RR 0.77, 95% CI 0.31 to 1.92; 3 studies, 88 participants; very low-certainty evidence). No study assessed functional disability or quality of life. Only one study compared gabapentin to placebo at the primary endpoint of three months after the traumatic event, with inconclusive evidence in terms of both PTSD severity and probability of experiencing PTSD, because of imprecision of the effect estimate, serious risk of bias and serious imprecision (very low-certainty evidence). We found no data on dropout rates due to side effects, functional disability or quality of life. For the remaining comparisons, the available data are inconclusive or missing in terms of PTSD severity reduction and dropout rates due to adverse events. No study assessed functional disability. AUTHORS' CONCLUSIONS This review provides uncertain evidence only regarding the use of hydrocortisone, propranolol, dexamethasone, omega-3 fatty acids, gabapentin, paroxetine, PulmoCare formula, Oxepa formula, or 5-hydroxytryptophan as universal PTSD prevention strategies. Future research might benefit from larger samples, better reporting of side effects and inclusion of quality of life and functioning measures.
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Affiliation(s)
- Federico Bertolini
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Lindsay Robertson
- Cochrane Common Mental Disorders, University of York, York, UK
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Jonathan I Bisson
- Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Nicholas Meader
- Cochrane Common Mental Disorders, University of York, York, UK
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Rachel Churchill
- Cochrane Common Mental Disorders, University of York, York, UK
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Giovanni Ostuzzi
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Dan J Stein
- Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- MRC Unit on Risk & Resilience in Mental Disorders, University of Cape Town, Cape Town, South Africa
| | - Taryn Williams
- Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Corrado Barbui
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
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Carmassi C, Marazziti D, Mucci F, Della Vecchia A, Barberi FM, Baroni S, Giannaccini G, Palego L, Massimetti G, Dell'Osso L. Decreased Plasma Oxytocin Levels in Patients With PTSD. Front Psychol 2021; 12:612338. [PMID: 34276462 PMCID: PMC8280334 DOI: 10.3389/fpsyg.2021.612338] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 03/24/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction Although the pathophysiology of post-traumatic stress disorder (PTSD) is still unclear, growing preclinical evidences suggest that oxytocin (OT), a pleiotropic hormone, is possibly involved. However, direct studies on OT levels or clinical trials with this exogenous hormone in patients with PTSD led to inconsistent findings. Therefore, the aim of the present study was at exploring and comparing the plasma OT levels in a group of patients with PTSD and matched healthy subjects as the control group. Materials and Methods Twenty-six outpatients (13 men, 13 women, mean age: 40.3 ± 11.5 years) suffering from PTSD, according to the Diagnostic and Statistical Manual for Mental Disorders, fifth edition (DSM-5), and 26 healthy subjects (13 men, 13 women, mean age: 43.8 ± 12.7 years) were included. The patients were assessed through the structured clinical interview for DSM-5 research version, patient edition (SCID-I/P), and the Impact for Event Scale revised (IES-R). All fasting subjects underwent three venous blood samples for the subsequent oxytocin radioimmunoassay. We used unpaired Student’s t-test to assess OT levels and the intergroup difference of demographic characteristics, while anxiety, avoidance, and hyperarousal scores were compared among groups adjusting for the effect of gender and age by means of analysis of covariance (ANCOVA). The correlations between different variables were investigated by Pearson’s method. Results The most common traumatic events of patients with PTSD were the following: severe car accident, physical violence, sexual violence, sudden death of a loved one, and natural disaster. The IES total score was 55 ± 15. Student’s t-test revealed that the patients showed significantly lower OT levels (mean ± SD, pg/ml) than healthy control subjects (4.37 ± 1.61 vs 5.64 ± 2.17, p < 0.001). We detected no correlation between the IES total score, subscales, or single items and OT plasma levels. Again, no difference between men and women was detected in the patients’ group, while healthy control women showed higher OT levels than men. Discussion Our study, while reporting the presence of decreased plasma OT levels in outpatients with PTSD of both sexes, as compared with healthy control subjects, would support the possible involvement of OT in the pathophysiology of PTSD. However, given the complexity of the clinical picture, future investigations are necessary to better deepen the role and level of OT in PTSD.
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Affiliation(s)
- Claudia Carmassi
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Donatella Marazziti
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy.,Unicamillus-Saint Camillus International University of Medical and Health Sciences, Rome, Italy
| | - Federico Mucci
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, Siena, Italy.,Department of Psychiatry, North-Western Tuscany Region, NHS Local Health Unit, Viareggio, Italy
| | - Alessandra Della Vecchia
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Filippo Maria Barberi
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Stefano Baroni
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | | | | | - Gabriele Massimetti
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
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Aarts I, Vriend C, Snoek A, van den End A, Blankers M, Beekman ATF, Dekker J, van den Heuvel OA, Thomaes K. Neural correlates of treatment effect and prediction of treatment outcome in patients with PTSD and comorbid personality disorder: study design. Borderline Personal Disord Emot Dysregul 2021; 8:13. [PMID: 33947471 PMCID: PMC8097786 DOI: 10.1186/s40479-021-00156-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 04/09/2021] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Neural alterations related to treatment outcome in patients with both post-traumatic stress disorder (PTSD) and comorbid personality disorder are unknown. Here we describe the protocol for a neuroimaging study of treatment of patients with PTSD and comorbid borderline (BPD) or cluster C (CPD) personality disorder traits. Our specific aims are to 1) investigate treatment-induced neural alterations, 2) predict treatment outcome using structural and functional magnetic resonance imaging (MRI) and 3) study neural alterations associated with BPD and CPD in PTSD patients. We hypothesize that 1) all treatment conditions are associated with normalization of limbic and prefrontal brain activity and hyperconnectivity in resting-state brain networks, with additional normalization of task-related activation in emotion regulation brain areas in the patients who receive trauma-focused therapy and personality disorder treatment; 2) Baseline task-related activation, together with structural brain measures and clinical variables predict treatment outcome; 3) dysfunction in task-related activation and resting-state connectivity of emotion regulation areas is comparable in PTSD patients with BPD or CPD, with a hypoconnected central executive network in patients with PTSD+BPD. METHODS We aim to include pre- and post-treatment 3 T-MRI scans in 40 patients with PTSD and (sub) clinical comorbid BPD or CPD. With an expected attrition rate of 50%, at least 80 patients will be scanned before treatment. MRI scans for 30 matched healthy controls will additionally be acquired. Patients with PTSD and BPD were randomized to either EMDR-only or EMDR combined with Dialectical Behaviour Therapy. Patients with PTSD and CPD were randomized to Imaginary Rescripting (ImRs) or to ImRs combined with Schema Focused Therapy. The scan protocol consists of a T1-weighted structural scan, resting state fMRI, task-based fMRI during an emotional face task and multi-shell diffusion weighted images. For data analysis, multivariate mixed-models, regression analyses and machine learning models will be used. DISCUSSION This study is one of the first to use neuroimaging measures to predict and better understand treatment response in patients with PTSD and comorbid personality disorders. A heterogeneous, naturalistic sample will be included, ensuring generalizability to a broad group of treatment seeking PTSD patients. TRIAL REGISTRATION Clinical Trials, NCT03833453 & NCT03833531 . Retrospectively registered, February 2019.
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Affiliation(s)
- Inga Aarts
- Sinai Centrum, Amstelveen, The Netherlands.
- Department of Anatomy and Neurosciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, 1117, Amsterdam, Netherlands.
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, 1117, Amsterdam, Netherlands.
| | - Chris Vriend
- Department of Anatomy and Neurosciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, 1117, Amsterdam, Netherlands
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, 1117, Amsterdam, Netherlands
| | - Aishah Snoek
- Sinai Centrum, Amstelveen, The Netherlands
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, 1117, Amsterdam, Netherlands
| | - Arne van den End
- Sinai Centrum, Amstelveen, The Netherlands
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, 1117, Amsterdam, Netherlands
| | - Matthijs Blankers
- Arkin Research, Amsterdam, the Netherlands
- Trimbos Institute, Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | - Aartjan T F Beekman
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, 1117, Amsterdam, Netherlands
- GGZinGeest, Department of Psychiatry, Amsterdam, The Netherlands
| | - Jack Dekker
- Arkin Research, Amsterdam, the Netherlands
- VU University, Faculty of Behavioural and Movement Sciences, Amsterdam, The Netherlands
| | - Odile A van den Heuvel
- Department of Anatomy and Neurosciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, 1117, Amsterdam, Netherlands
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, 1117, Amsterdam, Netherlands
| | - Kathleen Thomaes
- Sinai Centrum, Amstelveen, The Netherlands
- Department of Anatomy and Neurosciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, 1117, Amsterdam, Netherlands
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, 1117, Amsterdam, Netherlands
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12
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Zheng S, Punia D, Wu H, Liu Q. Graph Theoretic Analysis Reveals Intranasal Oxytocin Induced Network Changes Over Frontal Regions. Neuroscience 2021; 459:153-165. [PMID: 33484821 DOI: 10.1016/j.neuroscience.2021.01.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 01/04/2021] [Accepted: 01/11/2021] [Indexed: 11/27/2022]
Abstract
In this study, we aim to elucidate how intranasal oxytocin modulates brain network characteristics, especially over the frontal network. As an essential brain hub of social cognition and emotion regulation, we also explore the association between graphic properties of the frontal network and individual personality traits under oxytocin (OT) administration. Fifty-nine male participants administered intranasal OT or placebo were followed by resting-state fMRI scanning. The correlation-based network model was applied to study OT modulation effects. We performed community detection algorithms and conducted further network analyses, including clustering coefficient, average shortest path and eigenvector centrality. In addition, we conducted a correlation analysis between clustering coefficients and the self-assessed psychological scales. Modular organizations in the OT group reveal integrations of the frontoparietal network (FPN) and the default mode network (DMN) over frontal regions. Results show that frontal nodes within the FPN are characterized by lower clustering coefficients and higher average shortest path values compared to the placebo group. Notably, these modulation effects on frontal network property are associated with Interpersonal Reactivity Index (IRI) fantasy value. Our results suggest that OT elevates integrations between FPN, DMN and limbic system as well as reduces small-worldness within the FPN. Our results support graph theoretic analysis as a potential tool to assess OT induced effects on the information integration in the frontal network.
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Affiliation(s)
- Shuhan Zheng
- Department of Biomedical Engineering, Southern University of Science and Technology, Shenzhen 518055, China; Department of Physics, Southern University of Science and Technology, Shenzhen 518055, China
| | | | - Haiyan Wu
- Centre for Cognitive and Brain Sciences and Department of Psychology, University of Macau, Taipa, Macau.
| | - Quanying Liu
- Department of Biomedical Engineering, Southern University of Science and Technology, Shenzhen 518055, China.
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13
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Quintana DS, Lischke A, Grace S, Scheele D, Ma Y, Becker B. Advances in the field of intranasal oxytocin research: lessons learned and future directions for clinical research. Mol Psychiatry 2021; 26:80-91. [PMID: 32807845 PMCID: PMC7815514 DOI: 10.1038/s41380-020-00864-7] [Citation(s) in RCA: 105] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 07/16/2020] [Accepted: 08/05/2020] [Indexed: 01/01/2023]
Abstract
Reports on the modulatory role of the neuropeptide oxytocin on social cognition and behavior have steadily increased over the last two decades, stimulating considerable interest in its psychiatric application. Basic and clinical research in humans primarily employs intranasal application protocols. This approach assumes that intranasal administration increases oxytocin levels in the central nervous system via a direct nose-to-brain route, which in turn acts upon centrally-located oxytocin receptors to exert its behavioral effects. However, debates have emerged on whether intranasally administered oxytocin enters the brain via the nose-to-brain route and whether this route leads to functionally relevant increases in central oxytocin levels. In this review we outline recent advances from human and animal research that provide converging evidence for functionally relevant effects of the intranasal oxytocin administration route, suggesting that direct nose-to-brain delivery underlies the behavioral effects of oxytocin on social cognition and behavior. Moreover, advances in previously debated methodological issues, such as pre-registration, reproducibility, statistical power, interpretation of non-significant results, dosage, and sex differences are discussed and integrated with suggestions for the next steps in translating intranasal oxytocin into psychiatric applications.
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Affiliation(s)
- Daniel S Quintana
- Norwegian Centre for Mental Disorders Research (NORMENT), University of Oslo and Oslo University Hospital, Oslo, Norway.
| | - Alexander Lischke
- Department of Psychology, University of Greifswald, Greifswald, Germany
| | - Sally Grace
- School of Psychology, Australian Catholic University, Melbourne, Australia
| | - Dirk Scheele
- Division of Medical Psychology, Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
- Department of Psychiatry, School of Medicine & Health Sciences, University of Oldenburg, Oldenburg, Germany
| | - Yina Ma
- State Key Laboratory of Cognitive Neuroscience and Learning, IDG/McGovern Institute for Brain Research, Beijing Key Laboratory of Brain Imaging and Connectomics, Beijing Normal University, Beijing, China
| | - Benjamin Becker
- The Clinical Hospital of the Chengdu Brain Science Institute, Key Laboratory for NeuroInformation, School of Life Science and Technology, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, China.
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14
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Ma Y, Ran G, Hu N, Hu Y, Long W, Chen X. Intranasal oxytocin attenuates insula activity in response to dynamic angry faces. Biol Psychol 2020; 157:107976. [PMID: 33157152 DOI: 10.1016/j.biopsycho.2020.107976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 09/25/2020] [Accepted: 10/15/2020] [Indexed: 12/12/2022]
Abstract
The effects of intranasal oxytocin on amygdala activity during emotional perception are often mixed. Given that the brain is organized into networks of interconnected areas, functional connectivity might provide an effective way to further understand the oxytocin effect. The aim of the present study was to investigate whether oxytocin administration affects amygdala activity and its functional connectivity during dynamic facial expression perception. Using a between-group, double-blind, placebo-controlled design, 55 participants were randomly assigned to groups receiving a single dose of 24 IU oxytocin or a placebo via intranasal administration. An implicit emotional task was employed to investigate the effect of oxytocin on neural responses to dynamic angry, neutral, and happy facial expressions with fMRI. Participants were instructed to respond only when the inverted dynamic faces were presented. The results indicated that oxytocin attenuated activation of insula and emotional processing-related regions (e.g., ACC, thalamus, and MFG) during the viewing of dynamic angry faces. However, functional connectivity between the regions involved in the perception of dynamic angry faces was not changed following oxytocin administration. The present findings may contribute to our understanding of the anxiolytic effects of oxytocin and eventually facilitate human clinical applications.
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Affiliation(s)
- Yuanxiao Ma
- Key Laboratory of Cognition and Personality of Ministry of Education, Faculty of Psychology, Southwest University, Chongqing, 400715, China; School of Psychology, Nanjing Normal University, Nanjing, 210024, China
| | - Guangming Ran
- Institute of Education, China West Normal University, Nanchong, 637002, China
| | - Na Hu
- School of Psychology and Cognitive Science, East China Normal University, Shanghai, 200062, China
| | - Yuting Hu
- Key Laboratory of Cognition and Personality of Ministry of Education, Faculty of Psychology, Southwest University, Chongqing, 400715, China
| | - Wenshuang Long
- Key Laboratory of Cognition and Personality of Ministry of Education, Faculty of Psychology, Southwest University, Chongqing, 400715, China
| | - Xu Chen
- Key Laboratory of Cognition and Personality of Ministry of Education, Faculty of Psychology, Southwest University, Chongqing, 400715, China.
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15
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Oxytocin treatment attenuates amygdala activity in autism: a treatment-mechanism study with long-term follow-up. Transl Psychiatry 2020; 10:383. [PMID: 33159033 PMCID: PMC7648620 DOI: 10.1038/s41398-020-01069-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 09/29/2020] [Accepted: 10/20/2020] [Indexed: 12/12/2022] Open
Abstract
Intranasal administration of the neuropeptide oxytocin (IN-OT) is increasingly considered as a potential treatment for targeting the core symptoms of autism spectrum disorder (ASD), but the effects of continual use on neural substrates are fairly unexplored and long-term effects are unknown. In this double-blind, randomized, placebo-controlled study, we investigated the effects of single-dose and multiple-dose IN-OT treatment (4 weeks of daily (24 IU) administrations) on brain activity related to processing emotional states. Thirty-eight adult men with ASD (aged between 18 and 35 years) underwent functional magnetic resonance imaging of the posterior superior temporal gyrus (pSTS) and amygdala regions while processing emotional states from point-light biological motion. In line with prior research, a single dose of IN-OT induced a reliable increase in pSTS brain activity during the processing of point-light biological motion, but no consistent long-term changes in pSTS activity were induced after the multiple-dose treatment. In terms of bilateral amygdala, the multiple-dose treatment induced a consistent attenuation in brain activity, which outlasted the period of actual administrations until four weeks and one year post-treatment. Critically, participants with stronger attenuations in amygdala-activity showed greater behavioral improvements, particularly in terms of self-reported feelings of avoidant attachment and social functioning. Together, these observations provide initial insights into the long-lasting neural consequences of chronic IN-OT use on amygdala functioning and provide first indications that the acute versus chronic effects of IN-OT administration may be qualitatively different. Larger studies are however warranted to further elucidate the long-term impact of IN-OT treatment on human neural substrates and its behavioral consequences.
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Exogenous effects of oxytocin in five psychiatric disorders: a systematic review, meta-analyses and a personalized approach through the lens of the social salience hypothesis. Neurosci Biobehav Rev 2020; 114:70-95. [DOI: 10.1016/j.neubiorev.2020.04.023] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 04/19/2020] [Accepted: 04/21/2020] [Indexed: 02/08/2023]
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Orihashi R, Mizoguchi Y, Imamura Y, Yamada S, Ueno T, Monji A. Oxytocin and elderly MRI-based hippocampus and amygdala volume: a 7-year follow-up study. Brain Commun 2020; 2:fcaa081. [PMID: 32954331 PMCID: PMC7472904 DOI: 10.1093/braincomms/fcaa081] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 05/01/2020] [Accepted: 05/15/2020] [Indexed: 12/03/2022] Open
Abstract
Oxytocin is deeply involved in human relations. In recent years, it is becoming clear that oxytocin is also involved in social cognition and social behaviour. Oxytocin receptors are also thought to be present in the hippocampus and amygdala, and the relationship between oxytocin and the structure and function of the hippocampus and amygdala has been reported. However, a few studies have investigated oxytocin and its relationship to hippocampus and amygdala volume in elderly people. The aim of this study is to investigate the association between serum oxytocin levels and hippocampus and amygdala volume in elderly people. The survey was conducted twice in Kurokawa-cho, Imari, Saga Prefecture, Japan, among people aged 65 years and older. We collected data from 596 residents. Serum oxytocin level measurements, brain MRI, Mini–Mental State Examination and Clinical Dementia Rating were performed in Time 1 (2009–11). Follow-up brain MRI, Mini–Mental State Examination and Clinical Dementia Rating were performed in Time 2 (2016–17). The interval between Time 1 and Time 2 was about 7 years. Fifty-eight participants (14 men, mean age 72.36 ± 3.41 years, oxytocin 0.042 ± 0.052 ng/ml; 44 women, mean age 73.07 ± 4.38 years, oxytocin 0.123 ± 0.130 ng/ml) completed this study. We analysed the correlation between serum oxytocin levels (Time 1) and brain volume (Time 1, Time 2 and Times 1–2 difference) using voxel-based morphometry implemented with Statistical Parametric Mapping. Analysis at the cluster level (family-wise error; P < 0.05) showed a positive correlation between serum oxytocin levels (Time 1) and brain volume of the region containing the left hippocampus and amygdala (Time 2). This result suggests that oxytocin in people aged 65 years and older may be associated with aging-related changes in hippocampus and amygdala volume.
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Affiliation(s)
- Ryuzo Orihashi
- Department of Psychiatry, Faculty of Medicine, Saga University, Saga 849-8501, Japan
| | - Yoshito Mizoguchi
- Department of Psychiatry, Faculty of Medicine, Saga University, Saga 849-8501, Japan
| | - Yoshiomi Imamura
- Department of Psychiatry, Faculty of Medicine, Saga University, Saga 849-8501, Japan
| | | | - Takefumi Ueno
- Division of Clinical Research, National Hospital Organization, Hizen Psychiatric Center, Kanzaki, Saga 842-0192, Japan
| | - Akira Monji
- Department of Psychiatry, Faculty of Medicine, Saga University, Saga 849-8501, Japan
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Oxytocin induces long-lasting adaptations within amygdala circuitry in autism: a treatment-mechanism study with randomized placebo-controlled design. Neuropsychopharmacology 2020; 45:1141-1149. [PMID: 32161366 PMCID: PMC7234999 DOI: 10.1038/s41386-020-0653-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/31/2020] [Accepted: 03/02/2020] [Indexed: 12/11/2022]
Abstract
Intranasal administration of the neuropeptide oxytocin (IN-OT) is increasingly explored as a potential treatment for targeting the core symptoms of autism spectrum disorder (ASD). To date, however, the impact of multiple-dose IN-OT treatment on human neural circuitry is largely unknown, and also the possibility that long-term IN-OT use may induce long-lasting neural adaptations remains unexplored. Using a double-blind, randomized, placebo-controlled, between-subject design (including 38 adult men with ASD), this treatment-mechanism study showed that 4 weeks of daily oxytocin administration (24 IU/day) significantly altered intrinsic (resting-state fMRI) functional connectivity of the amygdala to core regions of the "social brain" (particularly orbitofrontal cortex and superior temporal sulcus) up to 4 weeks and 1 year post treatment. The neural adaptations in functional coupling of the amygdala to the orbitofrontal cortex were associated with reduced feelings of avoidance toward others and-at the trend level-reduced repetitive behaviors. These observations contribute to a deeper mechanistic understanding of the neural substrates that underlie behavioral effects of multiple-dose IN-OT treatment, and provide initial insights into the long-lasting neural consequences of chronic IN-OT use on amygdala circuitry. Future studies are however warranted to further elucidate the long-term impact of IN-OT treatment on human neural circuitry and its behavioral consequences.
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Witteveen AB, Stramrood CAI, Henrichs J, Flanagan JC, van Pampus MG, Olff M. The oxytocinergic system in PTSD following traumatic childbirth: endogenous and exogenous oxytocin in the peripartum period. Arch Womens Ment Health 2020; 23:317-329. [PMID: 31385103 PMCID: PMC7244459 DOI: 10.1007/s00737-019-00994-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 07/22/2019] [Indexed: 12/12/2022]
Abstract
Birth experiences can be traumatic and may give rise to PTSD following childbirth (PTSD-FC). Peripartum neurobiological alterations in the oxytocinergic system are highly relevant for postpartum maternal behavioral and affective adaptions like bonding and lactation but are also implicated in the response to traumatic events. Animal models demonstrated that peripartum stress impairs beneficial maternal postpartum behavior. Early postpartum activation of the oxytocinergic system may, however, reverse these effects and thereby prevent adverse long-term consequences for both mother and infant. In this narrative review, we discuss the impact of trauma and PTSD-FC on normal endogenous oxytocinergic system fluctuations in the peripartum period. We also specifically focus on the potential of exogenous oxytocin (OT) to prevent and treat PTSD-FC. No trials of exogenous OT after traumatic childbirth and PTSD-FC were available. Evidence from non-obstetric PTSD samples and from postpartum healthy or depressed samples implies restorative functional neuroanatomic and psychological effects of exogenous OT such as improved PTSD symptoms and better mother-to-infant bonding, decreased limbic activation, and restored responsiveness in dopaminergic reward regions. Adverse effects of intranasal OT on mood and the increased fear processing and reduced top-down control over amygdala activation in women with acute trauma exposure or postpartum depression, however, warrant cautionary use of intranasal OT. Observational and experimental studies into the role of the endogenous and exogenous oxytocinergic system in PTSD-FC are needed and should explore individual and situational circumstances, including level of acute distress, intrapartum exogenous OT exposure, or history of childhood trauma.
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Affiliation(s)
- A. B. Witteveen
- Department of Midwifery Science/AVAG, Amsterdam Public Health research institute, Amsterdam UMC, location VUmc, Van der Boechorststraat 7, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
| | - C. A. I. Stramrood
- Department of Obstetrics and Gynaecology, Amsterdam UMC, location AMC, Meibergdreef 9, Amsterdam, 1105 AZ The Netherlands
| | - J. Henrichs
- Department of Midwifery Science/AVAG, Amsterdam Public Health research institute, Amsterdam UMC, location VUmc, Van der Boechorststraat 7, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
| | - J. C. Flanagan
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St., Charleston, 29425 SC USA
| | - M. G. van Pampus
- Department of Obstetrics and Gynaecology, OLVG, Oosterpark 9, Amsterdam, 1091 AC The Netherlands
| | - M. Olff
- Department of Psychiatry, Amsterdam UMC, location AMC, Meibergdreef 9, Amsterdam, 1105 AZ The Netherlands
- Arq Psychotrauma Expert Group, Nienoord 5, Diemen, 1112 XE The Netherlands
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20
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Hoge E, Bui E, Rosencrans P, Orr S, Ross R, Ojserkis R, Simon N. Influence of intranasal oxytocin on fear consolidation in healthy humans. Gen Psychiatr 2019; 32:e100131. [PMID: 31922086 PMCID: PMC6936973 DOI: 10.1136/gpsych-2019-100131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 10/29/2019] [Accepted: 11/12/2019] [Indexed: 12/17/2022] Open
Abstract
Background Although recent data in healthy humans suggestthat treatment with intranasal oxytocin (OT) may facilitate extinction recall,to date, little is known about the effects of OT on memory consolidationprocesses. Aim To examine the effect of intranasal administration of OT compared with placebo on memory consolidation blockade of a de novo fear memory in a classical 2-day fear conditioning procedure. Results There were no significant differences between the OT and the placebo groups on the first two extinction trials (mean (SD)=0.01 (0.39) vs 0.15 (0.31), t=−1.092, p=0.28). Similarly, during early extinction, analysis of variance for repeated measures failed to show significant main effects of extinction trials: trials (F(4, 112)=1.58, p=0.18), drug (F(1, 112)=0.13, p=0.72) or drug × trials interaction (F(4, 112)=0.76, p=0.56). Conclusion Our results suggest that OT administered in a double-blind fashion immediately after fear conditioning does not significantly reduce consolidation of fear learning as measured by a differential skin conductance response tested at the beginning of extinction.
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Affiliation(s)
- Elizabeth Hoge
- Department of Psychiatry, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Eric Bui
- Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, United States
| | | | - Scott Orr
- Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, United States
| | - Rachel Ross
- Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, United States
| | | | - Naomi Simon
- Department of Psychiatry, New York University Medical Center, New York City, New York, USA
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21
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Effects of intraperitoneal and intracerebroventricular injections of oxytocin on social and emotional behaviors in pubertal male mice. Physiol Behav 2019; 212:112701. [DOI: 10.1016/j.physbeh.2019.112701] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 09/27/2019] [Accepted: 10/04/2019] [Indexed: 12/20/2022]
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22
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Zhu R, Liu C, Li T, Xu Z, Fung B, Feng C, Wu H, Luo Y, Wang L. Intranasal oxytocin reduces reactive aggression in men but not in women: A computational approach. Psychoneuroendocrinology 2019; 108:172-181. [PMID: 31374475 DOI: 10.1016/j.psyneuen.2019.06.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 06/07/2019] [Accepted: 06/28/2019] [Indexed: 01/06/2023]
Abstract
Aggression is an important behaviour that concerns individual survival and large-scale social stability. It comprises a variety of psychological subcomponents and is modulated by different biological factors. Two factors in particular, gender and oxytocin, appear to play a robust role in aggressive behaviour. However, whether these two factors interact to impact aggressive behaviour is not currently known. The current study investigated the modulating effect of gender on the relationship between oxytocin and aggression and characterized its underlying mechanisms by combining behavioural economic, pharmacological, and computational approaches. Specifically, we employed a double-blind, randomized, placebo-controlled, between-subjects design, in which one hundred participants (50 men and 50 women) completed a norm-training version of the multi-round one-shot ultimatum game (UG) after intranasal oxytocin or placebo administration. Rejection rates in the UG were adopted as an indicator of reactive aggression. The results indicated that oxytocin compared with placebo administration decreased aggression among men but not among women. Further analyses suggested that this decrease in aggression was a result of changes in men's sensitivity to provocation and positive affect, rather than norm adaptation rates or concerns about the cost of aggression. These findings highlight the role of gender in the relationship between oxytocin and reactive aggression and reveal its underlying psychological and computational mechanisms.
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Affiliation(s)
- Ruida Zhu
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China; Center for Collaboration and Innovation in Brain and Learning Sciences, Beijing Normal University, Beijing, China; Beijing Key Laboratory of Brain Imaging and Connectomics, Beijing Normal University, Beijing, China
| | - Chao Liu
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China; Center for Collaboration and Innovation in Brain and Learning Sciences, Beijing Normal University, Beijing, China; Beijing Key Laboratory of Brain Imaging and Connectomics, Beijing Normal University, Beijing, China
| | - Ting Li
- Institute for Brain Research and Rehabilitation (IBRR), South China Normal University, Guangzhou, China
| | - Zhenhua Xu
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China; Center for Collaboration and Innovation in Brain and Learning Sciences, Beijing Normal University, Beijing, China; Beijing Key Laboratory of Brain Imaging and Connectomics, Beijing Normal University, Beijing, China
| | - Bowen Fung
- Division of Humanities and Social Sciences and Computation and Neural Systems Program, California Institute of Technology, Pasadena, USA
| | - Chunliang Feng
- Guangdong Provincial Key Laboratory of Mental Health and Cognitive Science, Center for Studies of Psychological Application, School of Psychology, South China Normal University, Guangzhou, China.
| | - Haiyan Wu
- Division of Humanities and Social Sciences and Computation and Neural Systems Program, California Institute of Technology, Pasadena, USA; CAS Key Laboratory of Behavioral Science, Institute of Psychology, Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
| | - Yi Luo
- Fralin Biomedical Research Institute at VTC, Virginia Tech, Roanoke, USA.
| | - Li Wang
- Collaborative Innovation Center of Assessment toward Basic Education Quality, Beijing Normal University, Beijing, China.
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Matsushita H, Latt HM, Koga Y, Nishiki T, Matsui H. Oxytocin and Stress: Neural Mechanisms, Stress-Related Disorders, and Therapeutic Approaches. Neuroscience 2019; 417:1-10. [PMID: 31400490 DOI: 10.1016/j.neuroscience.2019.07.046] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 07/25/2019] [Accepted: 07/26/2019] [Indexed: 12/24/2022]
Abstract
Clinical reports show that oxytocin (OT) is related to stress-related disorders such as depression, anxiety disorder, and post-traumatic stress disorder. Two key structures in the brain should be paid special attention with regard to stress regulation, namely, the hypothalamus and the hippocampus. The former is the region for central command for most, if not all, of the major endocrine systems, and the latter takes a key position in the regulation of mood and anxiety. There are extensive neural projections between the two structures, and both are functionally intertwined. The hypothalamus projects OTergic neurons to the hippocampus, and the latter possesses high levels of OT receptors. The hippocampus also regulates the secretion of glucocorticoids, a major group of stress hormones. Excessive levels of glucocorticoids in chronic stress cause atrophy of the hippocampus, whereas OT has been shown to protect hippocampal neurons from the toxic effects of glucocorticoids. In this article, we discuss how neural and endocrine mechanisms interplay in stress regulation, with an emphasis on the role of OT, as well as its therapeutic potential in the treatment of stress-related disorders.
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Affiliation(s)
- Hiroaki Matsushita
- Department of Physiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan.
| | - Hein Min Latt
- Department of Physiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan.
| | - Yuuri Koga
- Department of Physiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Teiichi Nishiki
- Department of Physiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Hideki Matsui
- Department of Physiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
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24
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Alaerts K, Bernaerts S, Vanaudenaerde B, Daniels N, Wenderoth N. Amygdala-Hippocampal Connectivity Is Associated With Endogenous Levels of Oxytocin and Can Be Altered by Exogenously Administered Oxytocin in Adults With Autism. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2019; 4:655-663. [PMID: 30846366 DOI: 10.1016/j.bpsc.2019.01.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 01/22/2019] [Accepted: 01/22/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Oxytocin (OT) plays a pivotal role in interpersonal bonding, affiliation, and trust, and its intranasal administration is increasingly considered as a potential treatment for autism spectrum disorder. METHODS We explored whether variations in endogenous salivary OT concentration are related to interindividual differences in core autism symptoms and expressions of attachment in 38 male adults with autism spectrum disorder. Further, resting-state functional magnetic resonance imaging was adopted to specifically explore whether interindividual differences are reflected in the intrinsic network organization of key regions of the central oxytocinergic system. RESULTS Positive correlations were identified between peripheral OT and expressions of secure attachment (the State Adult Attachment Measure and the Inventory of Peer Attachment), but no significant relationships were identified with scales assessing core autism symptom domains (the Social Responsiveness Scale and the Repetitive Behavior Scale). At the neural level, higher levels of endogenous OT were associated with lower degrees of interregional functional coupling between the amygdala and hippocampal regions. Interestingly, a single dose of exogenously administered OT induced a further reduction in amygdala-hippocampal connectivity, indicating that a higher availability of OT can alter the degree of amygdala-hippocampal connectivity. CONCLUSIONS The identified associations between the oxytocinergic system, expressions of secure attachment, and amygdala-hippocampal pathways are anticipated to be of relevance for understanding the role of OT in modulating appropriate neural and physiological responses to stress and restoring homeostasis.
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Affiliation(s)
- Kaat Alaerts
- Department of Rehabilitation Sciences, Group Biomedical Sciences, Neuromotor Rehabilitation Research Group, University of Leuven, Katholieke Universiteit Leuven, Belgium.
| | - Sylvie Bernaerts
- Department of Rehabilitation Sciences, Group Biomedical Sciences, Neuromotor Rehabilitation Research Group, University of Leuven, Katholieke Universiteit Leuven, Belgium
| | - Bart Vanaudenaerde
- Department of Chronic Diseases, Metabolism and Ageing, Group Biomedical Sciences, Pneumology Research Group, University of Leuven, Katholieke Universiteit Leuven, Belgium
| | - Nicky Daniels
- Department of Rehabilitation Sciences, Group Biomedical Sciences, Neuromotor Rehabilitation Research Group, University of Leuven, Katholieke Universiteit Leuven, Belgium
| | - Nicole Wenderoth
- Department of Health Sciences and Technology, Neural Control of Movement Lab, Eidgenössische Technische Hochschule, Zurich, Switzerland
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25
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Akiki TJ, Averill LA, Abdallah CG. Neurobiological studies of trauma-related psychopathology: a public health perspective. Eur J Psychotraumatol 2018; 9:1556554. [PMID: 30637093 PMCID: PMC6319465 DOI: 10.1080/20008198.2018.1556554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 11/23/2018] [Accepted: 11/28/2018] [Indexed: 01/30/2023] Open
Abstract
The societal burden of psychiatric disorders that result after exposure to psychological trauma is enormous. The study of trauma-related disorders using neurobiological and public health approaches is often disjointed. It is critical to emphasize the translational potential of neurobiological work and its relevance to the public health burden of psychological trauma. Applying a public health model to traumatology that includes primary, secondary, and tertiary levels, we highlight ways in which advancing the field of neurobiology can pave the way for scalable interventions that can improve outcomes and help to address the public health problem.
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Affiliation(s)
- Teddy J. Akiki
- Clinical Neurosciences Division National Center for PTSD, United States Department of Veterans Affairs, West Haven, CT, USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Lynnette A. Averill
- Clinical Neurosciences Division National Center for PTSD, United States Department of Veterans Affairs, West Haven, CT, USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Chadi G. Abdallah
- Clinical Neurosciences Division National Center for PTSD, United States Department of Veterans Affairs, West Haven, CT, USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
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26
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Intranasal oxytocin and OXTR genotype effects on resting state functional connectivity: A systematic review. Neurosci Biobehav Rev 2018; 95:17-32. [DOI: 10.1016/j.neubiorev.2018.09.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 08/08/2018] [Accepted: 09/15/2018] [Indexed: 01/09/2023]
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27
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Grace SA, Rossell SL, Heinrichs M, Kordsachia C, Labuschagne I. Oxytocin and brain activity in humans: A systematic review and coordinate-based meta-analysis of functional MRI studies. Psychoneuroendocrinology 2018; 96:6-24. [PMID: 29879563 DOI: 10.1016/j.psyneuen.2018.05.031] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 04/20/2018] [Accepted: 05/23/2018] [Indexed: 02/02/2023]
Abstract
Oxytocin (OXT) is a neuropeptide which has a critical role in human social behaviour and cognition. Research investigating the role of OXT on functional brain changes in humans has often used task paradigms that probe socioemotional processes. Preliminary evidence suggests a central role of the amygdala in the social cognitive effects of intranasal OXT (IN-OXT), however, inconsistencies in task-design and analysis methods have led to inconclusive findings regarding a cohesive model of the neural mechanisms underlying OXT's actions. The aim of this meta-analysis was to systematically investigate these findings. A systematic search of PubMed, PsycINFO, and Scopus databases was conducted for fMRI studies which compared IN-OXT to placebo in humans. First, we systematically reviewed functional magnetic resonance imaging (fMRI) studies of IN-OXT, including studies of healthy humans, those with clinical disorders, and studies examining resting-state fMRI (rsfMRI). Second, we employed a coordinate-based meta-analysis for task-based neuroimaging literature using activation likelihood estimation (ALE), whereby, coordinates were extracted from clusters with significant differences in IN-OXT versus placebo in healthy adults. Data were included for 39 fMRI studies that reported a total of 374 distinct foci. The meta-analysis identified task-related IN-OXT increases in activity within a cluster of the left superior temporal gyrus during tasks of emotion processing. These findings are important as they implicate regions beyond the amygdala in the neural effects of IN-OXT. The outcomes from this meta-analysis can guide a priori predictions for future OXT research, and provide an avenue for targeted treatment interventions.
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Affiliation(s)
- Sally A Grace
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia.
| | - Susan L Rossell
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia; Monash Alfred Psychiatry Research Centre, Monash University, Melbourne, Australia; Psychiatry, St Vincent's Hospital, Melbourne, Australia
| | - Markus Heinrichs
- School of Psychology, Australian Catholic University, Melbourne, Australia; Department of Psychology, Albert-Ludwigs-University of Freiburg, Freiburg, Germany; Freiburg Brain Imaging Center, University Medical Center, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | | | - Izelle Labuschagne
- School of Psychology, Australian Catholic University, Melbourne, Australia
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28
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Janeček M, Dabrowska J. Oxytocin facilitates adaptive fear and attenuates anxiety responses in animal models and human studies-potential interaction with the corticotropin-releasing factor (CRF) system in the bed nucleus of the stria terminalis (BNST). Cell Tissue Res 2018; 375:143-172. [PMID: 30054732 DOI: 10.1007/s00441-018-2889-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 07/04/2018] [Indexed: 01/28/2023]
Abstract
Despite its relatively well-understood role as a reproductive and pro-social peptide, oxytocin (OT) tells a more convoluted story in terms of its modulation of fear and anxiety. This nuanced story has been obscured by a great deal of research into the therapeutic applications of exogenous OT, driving more than 400 ongoing clinical trials. Drawing from animal models and human studies, we review the complex evidence concerning OT's role in fear learning and anxiety, clarifying the existing confusion about modulation of fear versus anxiety. We discuss animal models and human studies demonstrating the prevailing role of OT in strengthening fear memory to a discrete signal or cue, which allows accurate and rapid threat detection that facilitates survival. We also review ostensibly contrasting behavioral studies that nonetheless provide compelling evidence of OT attenuating sustained contextual fear and anxiety-like behavior, arguing that these OT effects on the modulation of fear vs. anxiety are not mutually exclusive. To disambiguate how endogenous OT modulates fear and anxiety, an understudied area compared to exogenous OT, we survey behavioral studies utilizing OT receptor (OTR) antagonists. Based on emerging evidence about the role of OTR in rat dorsolateral bed nucleus of stria terminalis (BNST) and elsewhere, we postulate that OT plays a critical role in facilitating accurate discrimination between stimuli representing threat and safety. Supported by human studies, we demonstrate that OT uniquely facilitates adaptive fear but reduces maladaptive anxiety. Last, we explore the limited literature on endogenous OT and its interaction with corticotropin-releasing factor (CRF) with a special emphasis on the dorsolateral BNST, which may hold the key to the neurobiology of phasic fear and sustained anxiety.
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Affiliation(s)
- Michael Janeček
- Department of Cellular and Molecular Pharmacology, Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, 60064, USA
| | - Joanna Dabrowska
- Department of Cellular and Molecular Pharmacology, Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, 60064, USA. .,Department of Neuroscience, Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, 60064, USA.
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29
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Wang D, Yan X, Li M, Ma Y. Neural substrates underlying the effects of oxytocin: a quantitative meta-analysis of pharmaco-imaging studies. Soc Cogn Affect Neurosci 2018; 12:1565-1573. [PMID: 29048602 PMCID: PMC5647800 DOI: 10.1093/scan/nsx085] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 06/22/2017] [Indexed: 01/08/2023] Open
Abstract
The hypothalamic peptide oxytocin (OT) is crucial in social adaptation and used to treat emotional and social deficits. Here, we conducted a systematic, quantitative meta-analysis of functional-MRI studies intranasally administering OT (IN-OT) to uncover neural substrates underlying the IN-OT effects and to elucidate differential IN-OT effects between healthy and clinical populations. Meta-analyses were conducted on 66 IN-OT fMRI studies, stratified by psychopathology, valence and sex. IN-OT increased bilateral amygdala, caudate head, and superior temporal activity in healthy individuals and increased dorsal anterior cingulate activity in patients. Moreover, IN-OT decreased amygdala activity in both patients and healthy individuals but did so to a greater degree in patients than healthy individuals. The OT-increased amygdala activity was only found on the negative social and affective processes, whereas the OT-decreased amygdala activity was mainly contributed by contrasts on negative-valenced processes. IN-OT increased parahippocampal activity and decreased amygdala activity during negative socio-affective processing. During positive socio-affective processes, IN-OT increased caudate head activity. This study indicates convergent neural substrates and the underlying neuropsychological mechanisms for IN-OT effects on social and affective processes. The common and different effects of IN-OT on patients and healthy individuals and the modulation of OT effects by valence have critical implications.
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Affiliation(s)
- Danyang Wang
- State Key Laboratory of Cognitive Neuroscience and Learning, IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing 100875, China
| | - Xinyuan Yan
- State Key Laboratory of Cognitive Neuroscience and Learning, IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing 100875, China
| | - Ming Li
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences and Yunnan Province, Kunming Institute of Zoology, Kunming, Yunnan 650223, China
| | - Yina Ma
- State Key Laboratory of Cognitive Neuroscience and Learning, IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing 100875, China
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30
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Donadon MF, Martin-Santos R, Osório FDL. The Associations Between Oxytocin and Trauma in Humans: A Systematic Review. Front Pharmacol 2018; 9:154. [PMID: 29545749 PMCID: PMC5838009 DOI: 10.3389/fphar.2018.00154] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 02/13/2018] [Indexed: 01/01/2023] Open
Abstract
Studies have shown that traumatic experiences may affect hormonal systems mediated by the hypothalamic-pituitary-adrenal (HPA) axis and the oxytocinergic system. This effect is the result of long-term impairments in hypothalamic structures and negative feedback mechanisms within the HPA axis, structures that mediate the response to stress. This deregulation reduces the production and release of cortisol and oxytocin (OXT), which may alter stress responses and lead to increased vulnerability to impairments from stressful experiences. The presence of gene polymorphisms might also have an impact on the vulnerability to psychopathology. We made a systematic review of articles dealing with the relationship between OXT and traumatic emotional experiences in humans. Thirty-five studies were reviewed and significant associations between experiences of emotional trauma (ET) and OXT were found. The main results showed that the presence of ET and post-traumatic stress disorder (PTSD) is strongly associated with reductions in endogenous OXT, and also that the acute effects of OXT administrations in individuals with ET tend to be anxiolytic only in less severe forms. In victims of recent traumatic experiences (RTE), OXT increased the re-experience of traumas and restored the function of different neural networks associated with fear control/extinction in PTSD patients. The results available also suggest that gene receptor polymorphisms may have a protective function in different outcomes after the experience of traumatic events. We conclude that the relationship between ET and OXT is multifaceted, complex, and mediated by contextual and individual factors. Directions for future studies are suggested considering the gaps in the available literature.
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Affiliation(s)
- Mariana Fortunata Donadon
- Department of Neuroscience and Behavior, Medical School of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Rocio Martin-Santos
- Department of Psychiatry and Psychology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación en Red de Salud Mental (CIBERSAM), Barcelona, Spain.,Department of Medicine, University of Barcelona, Barcelona, Spain.,Technology Institute for Translational Medicine (INCT), National Council for Scientific and Technological Development (CNPq), Brasília, Brazil
| | - Flávia de Lima Osório
- Department of Neuroscience and Behavior, Medical School of Ribeirão Preto, University of São Paulo, São Paulo, Brazil.,Technology Institute for Translational Medicine (INCT), National Council for Scientific and Technological Development (CNPq), Brasília, Brazil
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31
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Leppanen J, Ng KW, Kim YR, Tchanturia K, Treasure J. Meta-analytic review of the effects of a single dose of intranasal oxytocin on threat processing in humans. J Affect Disord 2018; 225:167-179. [PMID: 28837950 DOI: 10.1016/j.jad.2017.08.041] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 06/23/2017] [Accepted: 08/14/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Heightened threat sensitivity is a transdiagnostic feature in several psychiatric disorders. The neuropeptide oxytocin has been shown to reduce fear related behaviours and facilitated fear extinction in animals. These findings have led to increasing interest to explore the effects of intranasal oxytocin on threat processing in humans. METHODS The review included 26 studies (N = 1173), nine of which included clinical populations (N = 234). The clinical groups included were people with borderline personality disorder (BPD), anorexia nervosa, bulimia nervosa, depression, anxiety, and alcohol dependence disorder. We examined the effects of a single dose of intranasal oxytocin on startle response, attentional responses, and behavioural responses to threat. RESULTS A single dose of intranasal oxytocin significantly increased the physiological startle response to threat in healthy people with a small effect size. However, oxytocin did not have significant effects on attentional bias towards social or disorder-specific threat, fixation towards threatening stimuli among healthy or clinical populations, or on threat related behavioural approach or avoidance responses. LIMITATIONS No studies investigated the effects of oxytocin on the startle response to threat among clinical populations. Additionally, only one of the reviewed studies had sufficient power to detect at least a moderate effect of oxytocin according to our criterion. DISCUSSION The synthesis of literature suggest that oxytocin may influence the salience of threatening stimuli among healthy individuals, increasing the startle response to threat. It would be of interest to investigate the effects of oxytocin on the startle response to threat among clinical populations.
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Affiliation(s)
- Jenni Leppanen
- King's College London, Institute of Psychiatry, Psychology, and Neuroscience, Department of Psychological Medicine, London, United Kingdom.
| | - Kah Wee Ng
- Singapore General Hospital, 20 College Road, Academia, 169865 Singapore, Singapore
| | - Youl-Ri Kim
- Department of Psychiatry, Seoul Paik Hospital, Inje University, Seoul, South Korea
| | - Kate Tchanturia
- King's College London, Institute of Psychiatry, Psychology, and Neuroscience, Department of Psychological Medicine, London, United Kingdom; Department of Psychology, Illia State University, Tbilisi, Georgia
| | - Janet Treasure
- King's College London, Institute of Psychiatry, Psychology, and Neuroscience, Department of Psychological Medicine, London, United Kingdom
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Helpman L, Zhu X, Suarez-Jimenez B, Lazarov A, Monk C, Neria Y. Sex Differences in Trauma-Related Psychopathology: a Critical Review of Neuroimaging Literature (2014-2017). Curr Psychiatry Rep 2017; 19:104. [PMID: 29116470 PMCID: PMC5737777 DOI: 10.1007/s11920-017-0854-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE OF REVIEW Sex differences in the epidemiology and clinical presentation of trauma-related psychopathology have long been documented. Multiple underlying mechanisms have been examined, both psychosocial and biological. Among the most promising biological mechanisms are neural substrates of trauma-related psychopathology that have been uncovered in recent years. RECENT FINDINGS Neuroimaging studies of sex-related heterogeneity published over the past 3 years (2014-2017) demonstrate an interaction between sex and type, timing, and load of trauma exposure. These studies suggest that, for males, early trauma exposure may involve a loss of gray matter in the limbic system, including the prefrontal cortex (PFC), amygdala, and hippocampus, and an over-activity and increased connectivity of salience hubs, and particularly dorsal anterior cingulate cortex (dACC). For females, however, early trauma exposure may involve overactive and possibly an enlarged amygdala, as well as decreased connectivity of salience hubs such as the dACC. Underlying mechanisms may include interaction with several endocrine systems and result in differential neural response to naturally occurring and added endocrine ligands, as well as sex-specific genetic and epigenetic risk and resilience factors. This complex interaction between multiple biological systems may be associated with sex-specific behavioral patterns, in turn associated with trauma-related psychopathology. While substantial number of published studies present preliminary evidence for neural mechanisms of sex-specific posttraumatic responses, there is a paucity of research directly designed to examine sex as a biological factor in trauma-related psychopathology. Specific foci for future studies aiming to bridge current gaps in the literature are discussed.
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Affiliation(s)
- Liat Helpman
- Department of Psychiatry and the New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Dr. Unit no. 69, New York, NY, 10025, USA.
| | - Xi Zhu
- Department of Psychiatry and the New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Dr. Unit no. 69, New York, NY 10025, USA
| | - Benjamin Suarez-Jimenez
- Department of Psychiatry and the New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Dr. Unit no. 69, New York, NY 10025, USA
| | - Amit Lazarov
- Department of Psychiatry and the New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Dr. Unit no. 69, New York, NY 10025, USA
| | - Catherine Monk
- Department of Psychiatry and the New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Dr. Unit no. 69, New York, NY 10025, USA
| | - Yuval Neria
- Department of Psychiatry and the New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Dr. Unit no. 69, New York, NY 10025, USA
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Woodward SH, Jamison AL, Gala S, Holmes TH. Canine companionship is associated with modification of attentional bias in posttraumatic stress disorder. PLoS One 2017; 12:e0179912. [PMID: 29020064 PMCID: PMC5636264 DOI: 10.1371/journal.pone.0179912] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 06/06/2017] [Indexed: 12/01/2022] Open
Abstract
Attentional bias towards aversive stimuli has been demonstrated in the anxiety disorders and in posttraumatic stress disorder, and attentional bias modification has been proposed as a candidate treatment. This study rigorously assessed attentional bias towards aversive and pleasant visual imagery associated with the presence or absence of a familiar service canine in 23 veterans with chronic military-related posttraumatic stress disorder. Participants were repeatedly tested with and without their service canines present on two tasks designed to elicit spontaneous visual attention to facial and scenic image pairs, respectively. Each stimulus contrasted an emotive image with a neutral image. Via eye-tracking, the difference in visual attention directed to each image was analyzed as a function of the valence contrast and presence/absence of the canine. Across both tasks, the presence of a familiar service canine attenuated the normative attentional bias towards aversive image content. In the facial task, presence of the service canine specifically reduced attention toward angry faces. In that task, as well, accumulated days with the service canine similarly modulated attention toward facial emotion. The results suggest that the presence of a familiar service canine is associated with attenuation of attentional bias to aversive stimuli in chronic military-service-related posttraumatic stress disorder. Questions remain regarding the generalization of such effects to other populations, their dependence on the familiarity, breed, and training of the canine, and on social context.
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Affiliation(s)
- Steven H. Woodward
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System, Palo Alto, CA, United States of America
- * E-mail:
| | - Andrea L. Jamison
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System, Palo Alto, CA, United States of America
| | - Sasha Gala
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System, Palo Alto, CA, United States of America
| | - Tyson H. Holmes
- Human Immune Monitoring Center (HIMC), Institute for Immunity, Transplantation and Infection, Stanford University School of Medicine, Stanford, CA, United States of America
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Debiec J, Sullivan RM. The neurobiology of safety and threat learning in infancy. Neurobiol Learn Mem 2017; 143:49-58. [PMID: 27826033 PMCID: PMC5418109 DOI: 10.1016/j.nlm.2016.10.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 10/25/2016] [Accepted: 10/27/2016] [Indexed: 12/20/2022]
Abstract
What an animal needs to learn to survive is altered dramatically as they change from dependence on the parent for protection to independence and reliance on self-defense. This transition occurs in most altricial animals, but our understanding of the behavioral neurobiology has mostly relied on the infant rat. The transformation from dependence to independence occurs over three weeks in pups and is accompanied by complex changes in responses to both natural and learned threats and the supporting neural circuitry. Overall, in early life, the threat system is quiescent and learning is biased towards acquiring attachment related behaviors to support attachment to the caregiver and proximity seeking. Caregiver-associated cues learned in infancy have the ability to provide a sense of safety throughout lifetime. This attachment/safety system is activated by learning involving presumably pleasurable stimuli (food, warmth) but also painful stimuli (tailpinch, moderate shock). At about the midway point to independence, pups begin to have access to the adult-like amygdala-dependent threat system and amygdala-dependent responses to natural dangers such as predator odors. However, pups have the ability to switch between the infant and adult-like system, which is controlled by maternal presence and modification of stress hormones. Specifically, if the pup is alone, it will learn fear but if with the mother it will learn attachment (10-15days of age). As pups begin to approach weaning, pups lose access to the attachment system and rely only on the amygdala-dependent threat system. However, pups learning system is complex and exhibits flexibility that enables the mother to override the control of the attachment circuit, since newborn pups may acquire threat responses from the mother expressing fear in their presence. Together, these data suggest that the development of pups' threat learning system is not only dependent upon maturation of the amygdala, but it is also exquisitely controlled by the environment. Most notably the mother can switch pup learning between attachment to threat learning in a moment's notice. This enables the mother to navigate pup's learning about the world and what is threatening and what is safe.
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Affiliation(s)
- Jacek Debiec
- Molecular & Behavioral Neuroscience Institute and Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States.
| | - Regina M Sullivan
- Emotional Brain Institute, Nathan Kline Institute for Psychiatric Research, Child and Adolescent Psychiatry, New York University Langone Medical Center, United States.
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Intranasal Oxytocin to Prevent Posttraumatic Stress Disorder Symptoms: A Randomized Controlled Trial in Emergency Department Patients. Biol Psychiatry 2017; 81:1030-1040. [PMID: 28087128 DOI: 10.1016/j.biopsych.2016.11.012] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 11/23/2016] [Accepted: 11/23/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND There are currently few preventive interventions available for posttraumatic stress disorder (PTSD). Intranasal oxytocin administration early after trauma may prevent PTSD, because oxytocin administration was previously found to beneficially impact PTSD vulnerability factors, including neural fear responsiveness, peripheral stress reactivity, and socioemotional functioning. Therefore, we investigated the effects of intranasal oxytocin administration early after trauma on subsequent clinician-rated PTSD symptoms. We then assessed whether baseline characteristics moderated the intervention's effects. METHODS We performed a multicenter, randomized, double-blind, placebo-controlled clinical trial. Adult emergency department patients with moderate to severe acute distress (n = 120; 85% accident victims) were randomized to intranasal oxytocin (8 days/40 IU twice daily) or placebo (8 days/10 puffs twice daily), initiated within 12 days posttrauma. The Clinician-Administered PTSD Scale (CAPS) was administered at baseline (within 10 days posttrauma) and at 1.5, 3, and 6 months posttrauma. The intention-to-treat sample included 107 participants (oxytocin: n = 53; placebo: n = 54). RESULTS We did not observe a significant group difference in CAPS total score at 1.5 months posttrauma (primary outcome) or across follow-up (secondary outcome). Secondary analyses showed that participants with high baseline CAPS scores receiving oxytocin had significantly lower CAPS scores across follow-up than participants with high baseline CAPS scores receiving placebo. CONCLUSIONS Oxytocin administration early after trauma did not attenuate clinician-rated PTSD symptoms in all trauma-exposed participants with acute distress. However, participants with high acute clinician-rated PTSD symptom severity did show beneficial effects of oxytocin. Although replication is warranted, these findings suggest that oxytocin administration is a promising preventive intervention for PTSD for individuals with high acute PTSD symptoms.
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Opendak M, Gould E, Sullivan R. Early life adversity during the infant sensitive period for attachment: Programming of behavioral neurobiology of threat processing and social behavior. Dev Cogn Neurosci 2017; 25:145-159. [PMID: 28254197 PMCID: PMC5478471 DOI: 10.1016/j.dcn.2017.02.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 01/03/2017] [Accepted: 02/04/2017] [Indexed: 02/06/2023] Open
Abstract
Animals, including humans, require a highly coordinated and flexible system of social behavior and threat evaluation. However, trauma can disrupt this system, with the amygdala implicated as a mediator of these impairments in behavior. Recent evidence has further highlighted the context of infant trauma as a critical variable in determining its immediate and enduring consequences, with trauma experienced from an attachment figure, such as occurs in cases of caregiver-child maltreatment, as particularly detrimental. This review focuses on the unique role of caregiver presence during early-life trauma in programming deficits in social behavior and threat processing. Using data primarily from rodent models, we describe the interaction between trauma and attachment during a sensitive period in early life, which highlights the role of the caregiver's presence in engagement of attachment brain circuitry and suppressing threat processing by the amygdala. These data suggest that trauma experienced directly from an abusive caregiver and trauma experienced in the presence of caregiver cues produce similar neurobehavioral deficits, which are unique from those resulting from trauma alone. We go on to integrate this information into social experience throughout the lifespan, including consequences for complex scenarios, such as dominance hierarchy formation and maintenance.
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Affiliation(s)
- Maya Opendak
- Emotional Brain Institute, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA; Child Study Center, Child & Adolescent Psychiatry, New York University School of Medicine, New York, USA.
| | - Elizabeth Gould
- Department of Psychology, Princeton University, Princeton, NJ, USA
| | - Regina Sullivan
- Emotional Brain Institute, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA; Child Study Center, Child & Adolescent Psychiatry, New York University School of Medicine, New York, USA
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Hecht EE, Robins DL, Gautam P, King TZ. Intranasal oxytocin reduces social perception in women: Neural activation and individual variation. Neuroimage 2017; 147:314-329. [DOI: 10.1016/j.neuroimage.2016.12.046] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 09/26/2016] [Accepted: 12/15/2016] [Indexed: 10/20/2022] Open
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Sippel LM, Allington CE, Pietrzak RH, Harpaz-Rotem I, Mayes LC, Olff M. Oxytocin and Stress-related Disorders: Neurobiological Mechanisms and Treatment Opportunities. CHRONIC STRESS (THOUSAND OAKS, CALIF.) 2017; 1:2470547016687996. [PMID: 28649672 PMCID: PMC5482285 DOI: 10.1177/2470547016687996] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Revised: 12/14/2016] [Accepted: 12/15/2016] [Indexed: 11/16/2022]
Abstract
Novel pharmacotherapies that improve outcomes for individuals with stress-related psychiatric disorders are needed. The neurohormone oxytocin (OT) is a promising candidate given its influence on the social-emotional brain. In this review, we present an overview of evidence supporting OT's utility for treating major depressive disorder and posttraumatic stress disorder. We first discuss endogenous OT, which research suggests is not yet a reliable biomarker of stress-related disorders. Second, we review effects of intranasal (IN) OT on processes relevant to stress-related disorders in healthy populations (anhedonia, reward processing, psychosocial stress reactivity, fear/anxiety, and social behavior) and their neurobiological mechanisms (e.g., the salience network and hypothalamic-pituitary-adrenal axis). Third, we present the sparse but promising findings from clinical populations, followed by discussion of critical moderating variables to consider in the service of maximizing the therapeutic potential of OT (e.g., patient sex and child maltreatment). We also identify heterogeneous findings and limitations of existing research, including reliance on single-dose studies in psychiatrically healthy samples and unanswered questions regarding the effectiveness of IN drug delivery and dosing schedules. Well-controlled multidose studies including women and measures of potentially moderating variables are sorely needed and would inform our understanding of the utility of OT for preventing and treating stress-related psychiatric disorders.
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Affiliation(s)
- Lauren M. Sippel
- U.S. Department of Veterans Affairs
National Center for Posttraumatic Stress Disorder, Clinical Neurosciences Division,
VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Psychiatry, Yale
University School of Medicine, New Haven, CT, USA
| | | | - Robert H. Pietrzak
- U.S. Department of Veterans Affairs
National Center for Posttraumatic Stress Disorder, Clinical Neurosciences Division,
VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Psychiatry, Yale
University School of Medicine, New Haven, CT, USA
| | - Ilan Harpaz-Rotem
- U.S. Department of Veterans Affairs
National Center for Posttraumatic Stress Disorder, Clinical Neurosciences Division,
VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Psychiatry, Yale
University School of Medicine, New Haven, CT, USA
| | | | - Miranda Olff
- Department of Psychiatry, Academic
Medical Center, University of Amsterdam, The Netherlands
- Arq Psychotrauma Expert Group, Diemen,
The Netherlands
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Frijling JL. Preventing PTSD with oxytocin: effects of oxytocin administration on fear neurocircuitry and PTSD symptom development in recently trauma-exposed individuals. Eur J Psychotraumatol 2017; 8:1302652. [PMID: 28451068 PMCID: PMC5400019 DOI: 10.1080/20008198.2017.1302652] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 03/01/2017] [Accepted: 02/15/2017] [Indexed: 12/18/2022] Open
Abstract
Background: Posttraumatic stress disorder (PTSD) is a debilitating psychiatric disorder which develops in approximately 10% of trauma-exposed individuals. Currently, there are few early preventive interventions available for PTSD. Intranasal oxytocin administration early posttrauma may prevent PTSD symptom development, as oxytocin administration was previously found to beneficially impact neurobiological (e.g. amygdala reactivity) and socio-emotional PTSD vulnerability factors. Objective: The overall aim of this dissertation was to investigate the potential of intranasal oxytocin administration as early preventive intervention for PTSD. Methods: We performed a functional magnetic resonance imaging (fMRI) study to assess the acute effects of a single administration of oxytocin on the functional fear neurocircuitry - consisting of the amygdala and (pre)frontal brain regions - in recently trauma-exposed emergency department patients (range n = 37-41). In addition, we performed a multicentre randomized double-blind placebo-controlled clinical trial (RCT) to assess the efficacy of repeated intranasal oxytocin administration early after trauma for preventing PTSD symptom development up to six months posttrauma (n = 107). Results: In our fMRI experiments we observed acutely increased amygdala reactivity to fearful faces and attenuated amygdala-ventromedial and ventrolateral prefrontal cortex functional connectivity after a single oxytocin administration in recently trauma-exposed individuals. However, in our RCT we found that repeated intranasal oxytocin administration early posttrauma reduced subsequent PTSD symptom development in recently trauma-exposed emergency department patients with high acute PTSD symptoms. Conclusions: These findings indicate that repeated intranasal oxytocin is a promising early preventive intervention for PTSD for individuals at increased risk for PTSD due to high acute symptom severity. Administration frequency dependent effects of oxytocin or the effects of oxytocin administration on salience processing may serve as explanatory frameworks for the contrasting oxytocin effects on anxiety-related measures in our clinical and neuroimaging studies.
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Affiliation(s)
- Jessie L Frijling
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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40
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Abstract
Facilitation of social attraction and bonding by the evolutionarily conserved neuropeptide oxytocin is well-established in female mammals. However, accumulating behavioral evidence suggests that oxytocin may have evolved sex-specific functional roles in the domain of human social cognition. A critical question is how oxytocin differentially modulates neural processing of social information in men and women, leading to divergent behavioral responses. Here we show that intranasal oxytocin treatment produces sex- and valence-dependent increases in amygdala activation when women view individuals identified as praising others but in men those who criticize them. Women subsequently show increased liking for the faces of these individuals, whereas in men it is reduced. Thus, oxytocin may act differentially via the amygdala to enhance the salience of positive social attributes in women but negative ones in men. We hypothesize that oxytocin may have evolved different but complementary roles to help ensure successful reproduction by encouraging mothers to promote a prosocial rearing environment for offspring and fathers to protect against antisocial influences.
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Frijling JL, van Zuiden M, Koch SBJ, Nawijn L, Veltman DJ, Olff M. Intranasal Oxytocin Affects Amygdala Functional Connectivity after Trauma Script-Driven Imagery in Distressed Recently Trauma-Exposed Individuals. Neuropsychopharmacology 2016; 41:1286-96. [PMID: 26346640 PMCID: PMC4793112 DOI: 10.1038/npp.2015.278] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 08/13/2015] [Accepted: 08/31/2015] [Indexed: 01/14/2023]
Abstract
Approximately 10% of trauma-exposed individuals go on to develop post-traumatic stress disorder (PTSD). Neural emotion regulation may be etiologically involved in PTSD development. Oxytocin administration early post-trauma may be a promising avenue for PTSD prevention, as intranasal oxytocin has previously been found to affect emotion regulation networks in healthy individuals and psychiatric patients. In a randomized double-blind placebo-controlled between-subjects functional magnetic resonance (fMRI) study, we assessed the effects of a single intranasal oxytocin administration (40 IU) on seed-based amygdala resting-state FC with emotion regulation areas (ventromedial prefrontal cortex (vmPFC), ventrolateral prefrontal cortex (vlPFC)), and salience processing areas (insula, dorsal anterior cingulate cortex (dACC)) in 37 individuals within 11 days post trauma. Two resting-state scans were acquired; one after neutral- and one after trauma-script-driven imagery. We found that oxytocin administration reduced amygdala-left vlPFC FC after trauma script-driven imagery, compared with neutral script-driven imagery, whereas in PL-treated participants enhanced amygdala-left vlPFC FC was observed following trauma script-driven imagery. Irrespective of script condition, oxytocin increased amygdala-insula FC and decreased amygdala-vmPFC FC. These neural effects were accompanied by lower levels of sleepiness and higher flashback intensity in the oxytocin group after the trauma script. Together, our findings show that oxytocin administration may impede emotion regulation network functioning in response to trauma reminders in recently trauma-exposed individuals. Therefore, caution may be warranted in administering oxytocin to prevent PTSD in distressed, recently trauma-exposed individuals.
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Affiliation(s)
- Jessie L Frijling
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands,Brain Imaging Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands,Department of Psychiatry, Academic Medical Center, University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam, Noord-Holland, The Netherlands, Tel: +31 20 8913667, E-mail:
| | - Mirjam van Zuiden
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Saskia B J Koch
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands,Brain Imaging Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Laura Nawijn
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands,Brain Imaging Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Dick J Veltman
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
| | - Miranda Olff
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands,Arq Psychotrauma Expert Group, Diemen, The Netherlands
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