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Zhang L, Rakesh D, Cropley V, Whittle S. Neurobiological correlates of resilience during childhood and adolescence - A systematic review. Clin Psychol Rev 2023; 105:102333. [PMID: 37690325 DOI: 10.1016/j.cpr.2023.102333] [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: 02/15/2023] [Revised: 07/09/2023] [Accepted: 09/03/2023] [Indexed: 09/12/2023]
Abstract
Research examining the neurobiological mechanisms of resilience has grown rapidly over the past decade. However, there is vast heterogeneity in research study design, methods, and in how resilience is operationalized, making it difficult to gauge what we currently know about resilience biomarkers. This preregistered systematic review aimed to review and synthesize the extant literature to identify neurobiological correlates of resilience to adversity during childhood and adolescence. Literature searches on MEDLINE and PsycINFO yielded 3834 studies and a total of 49 studies were included in the final review. Findings were synthesized based on how resilience was conceptualized (e.g., absence of psychopathology, trait resilience), and where relevant, the type of outcome examined (e.g., internalizing symptoms, post-traumatic stress disorder). Our synthesis showed that findings were generally mixed. Nevertheless, some consistent findings suggest that resilience neural mechanisms may involve prefrontal and subcortical regions structure/activity, as well as connectivity between these regions. Given substantial heterogeneity in the definition and operationalization of resilience, more methodological consistency across studies is required for advancing knowledge in this field.
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Affiliation(s)
- Lu Zhang
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, Australia.
| | - Divyangana Rakesh
- Neuroimaging Department, Institute of Psychology, Psychiatry & Neuroscience, King's College London, London, UK; Department of Psychology, Harvard University, MA, USA
| | - Vanessa Cropley
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, Australia
| | - Sarah Whittle
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, Australia
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2
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Siehl S, Zohair R, Guldner S, Nees F. Gray matter differences in adults and children with posttraumatic stress disorder: A systematic review and meta-analysis of 113 studies and 11 meta-analyses. J Affect Disord 2023; 333:489-516. [PMID: 37086802 DOI: 10.1016/j.jad.2023.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 03/21/2023] [Accepted: 04/14/2023] [Indexed: 04/24/2023]
Abstract
BACKGROUND In this systematic review and meta-analysis, we aimed to provide a comprehensive overview of gray matter alterations of adult- and underage patients with posttraumatic stress disorder (PTSD) in comparison to healthy trauma-exposed (TC) and non-exposed (HC) individuals. METHODS We subdivided our groups into patients with PTSD after trauma exposure in adulthood (aa) or childhood (ac) as well as children with PTSD (cc). We identified 113 studies, including 6.800 participants in our review, which we divided into studies focusing on whole-brain and region-of-interest (ROI) analysis. We performed a coordinate-based meta-analysis on 14 studies in the group of aa-PTSD. RESULTS We and found lower gray matter volume in patients with PTSD (aa) in the medial frontal gyrus (PTSD<HC/TC) and Culmen/posterior cingulate cortex (PTSD<TC). Results from ROI-based studies mainly show alterations for patients with PTSD in the prefrontal cortex, hippocampus, anterior cingulate cortex, insula, corpus callosum, and amygdala. LIMITATIONS Due to a limited number of studies reporting whole-brain results, the meta-analyses could only be performed in one subgroup and within this subgroup for a limited number of studies. CONCLUSIONS Our results are in line with psychobiological models of PTSD that associate the identified regions with brain circuits involved in context processing, threat detection and emotion regulation.
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Affiliation(s)
- Sebastian Siehl
- Institute of Medical Psychology and Medical Sociology, University Medical Center Schleswig-Holstein, Kiel University, Kiel, Germany.
| | - Rabia Zohair
- Institute of Medical Psychology and Medical Sociology, University Medical Center Schleswig-Holstein, Kiel University, Kiel, Germany
| | - Stella Guldner
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Frauke Nees
- Institute of Medical Psychology and Medical Sociology, University Medical Center Schleswig-Holstein, Kiel University, Kiel, Germany
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3
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Regier PS, Sinko L, Jagannathan K, Aryal S, Teitelman AM, Childress AR. In young women, a link between childhood abuse and subliminal processing of aversive cues is moderated by impulsivity. BMC Psychiatry 2022; 22:159. [PMID: 35236322 PMCID: PMC8889687 DOI: 10.1186/s12888-022-03770-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 01/31/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Childhood maltreatment is a serious public health concern. The association between child maltreatment, adverse behaviors, mental health outcomes, and alterations to brain function and structure have begun to be characterized. Less is known about the specific associations of maltreatment subtypes with cue-response to evocative cues and the moderating effects of confounding mental health/behavioral variables. METHODS Fifty-four emerging adult women (aged 18-24) completed assessments for behaviors, mental health, and childhood maltreatment. They participated in a fMRI task featuring passive viewing of evocative (33 ms) cues presented by "backward masking" to prevent conscious processing. Correlations of abuse/neglect scores, behavioral/mental health factors, and brain function were assessed. Follow-up analyses investigated the moderating effects of behavioral/mental health factors on maltreatment and brain relationships. RESULTS Greater frequency of childhood abuse and neglect were correlated with higher scores of impulsivity, depressive symptoms, and anxious attachment. Childhood abuse was positively associated with increased medial orbitofrontal cortical (mOFC) response to aversive (vs. neutral) cues. Among the behavioral/mental health variables, only impulsivity appeared to have a moderating effect on the relationship between childhood abuse and brain response to aversive cues. CONCLUSIONS The link between childhood abuse and a heightened mOFC response to "unseen" aversive stimuli, moderated by impulsivity, adds to the growing literature on the impact of prior adversity on brain function. These findings offer further understanding for the way in which childhood maltreatment affects the brain processing of negative stimuli, helping to explain the well-documented link between childhood maltreatment and a variety of adverse outcomes in adulthood.
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Affiliation(s)
- P. S. Regier
- grid.25879.310000 0004 1936 8972Perelman School of Medicine, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA USA
| | - L. Sinko
- grid.25879.310000 0004 1936 8972School of Nursing, University of Pennsylvania, Philadelphia, PA USA ,grid.264727.20000 0001 2248 3398College of Public Health, Temple University, Philadelphia, USA
| | - K. Jagannathan
- grid.25879.310000 0004 1936 8972Perelman School of Medicine, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA USA
| | - S. Aryal
- grid.25879.310000 0004 1936 8972School of Nursing, University of Pennsylvania, Philadelphia, PA USA
| | - A. M. Teitelman
- grid.25879.310000 0004 1936 8972School of Nursing, University of Pennsylvania, Philadelphia, PA USA
| | - A. R. Childress
- grid.25879.310000 0004 1936 8972Perelman School of Medicine, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA USA
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4
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Sussman TJ, Posner J, Jackowski AP, Correa A, Hoffmann EV, Porto de Oliveira Peruzzi F, Grecco FR, Nitzsche SH, Mesquita ME, Foester BU, Benatti di Cillo F, Mello MF, Coelho Milani AC. The relationship between recent PTSD secondary to sexual assault, hippocampal volume and resting state functional connectivity in adolescent girls. Neurobiol Stress 2022; 17:100441. [PMID: 35257017 PMCID: PMC8897602 DOI: 10.1016/j.ynstr.2022.100441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/09/2022] [Accepted: 02/22/2022] [Indexed: 11/19/2022] Open
Abstract
Objective Improved understanding of the time course of neural changes associated with adolescent PTSD would elucidate the development of the disorder and could inform approaches to treatment. We compared hippocampal volumes and resting state functional connectivity (RSFC) in adolescent girls with post-traumatic stress disorder (PTSD) secondary to sexual assault, within six months of onset and age- and gender-matched, non-trauma exposed healthy controls (HCs) in São Paulo, Brazil. We also examined the relationship between pre- and post-treatment PTSD symptoms and RSFC. Method We collected brain structure, RSFC, and PTSD symptoms in 30 adolescents with PTSD (mean age: 15.7 ± 1.04 years) and 21 HCs (mean age: 16.2 ± 1.21 years) at baseline. We collected repeated measures in 21 participants with PTSD following treatment; 9 participants dropped out. Hippocampal volume and RSFC from hippocampal and default mode network (DMN) seeds were compared between participants with PTSD and HCs. We examined associations between within-subject changes in RSFC and PTSD symptoms following treatment. Results No hippocampal volumetric differences between groups were found. Compared to HCs, adolescents with recent PTSD had reduced RSFC between hippocampus and the lateral parietal node of the DMN, encompassing the angular gyrus, peak coordinates: −38, −54, 16; 116 voxels; peak F1,47 = 31.76; FDR corrected p = 0.038. Improvements in PTSD symptoms were associated with increased RSFC between hippocampus and part of the lateral parietal node of the DMN, peak coordinates: −38, −84, 38; 316 voxels; peak F1,47 = 40.28; FDR corrected p < 0.001. Conclusion Adolescents with recent PTSD had reduced hippocampal-DMN RSFC, while no group differences in hippocampal volume were found, suggesting that hippocampal function, but not structure, is altered early in the course of PSTD. Following treatment, hippocampal-DMN RSFC increased with symptom improvement and may indicate an important neural mechanism related to successful PTSD treatment.
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Affiliation(s)
- Tamara J. Sussman
- Department of Psychiatry, Columbia University and New York State Psychiatric Institute, 1051 Riverside Dr., New York, NY, 10032, USA
- Corresponding author. 1051 Riverside Drive, New York, NY, 10032, USA.
| | - Jonathan Posner
- Department of Psychiatry, Columbia University and New York State Psychiatric Institute, 1051 Riverside Dr., New York, NY, 10032, USA
| | - Andrea Parolin Jackowski
- Departamento de Psiquiatria, Universidade Federal de São Paulo, R Rua Major Maragliano, 241, Vila Clementino, São Paulo, SP, 04017030, Brazil
| | - Adriana Correa
- Departamento de Psiquiatria, Universidade Federal de São Paulo, R Rua Major Maragliano, 241, Vila Clementino, São Paulo, SP, 04017030, Brazil
| | - Elis Viviane Hoffmann
- Departamento de Psiquiatria, Universidade Federal de São Paulo, R Rua Major Maragliano, 241, Vila Clementino, São Paulo, SP, 04017030, Brazil
| | - Fernanda Porto de Oliveira Peruzzi
- Departamento de Psiquiatria, Universidade Federal de São Paulo, R Rua Major Maragliano, 241, Vila Clementino, São Paulo, SP, 04017030, Brazil
| | - Fernando Rodrigues Grecco
- Departamento de Psiquiatria, Universidade Federal de São Paulo, R Rua Major Maragliano, 241, Vila Clementino, São Paulo, SP, 04017030, Brazil
| | - Samara Hipolito Nitzsche
- Departamento de Psiquiatria, Universidade Federal de São Paulo, R Rua Major Maragliano, 241, Vila Clementino, São Paulo, SP, 04017030, Brazil
| | - Maria Eugenia Mesquita
- Departamento de Psiquiatria, Universidade Federal de São Paulo, R Rua Major Maragliano, 241, Vila Clementino, São Paulo, SP, 04017030, Brazil
| | - Bernd Uwe Foester
- Departamento de Psiquiatria, Universidade Federal de São Paulo, R Rua Major Maragliano, 241, Vila Clementino, São Paulo, SP, 04017030, Brazil
| | - Felipe Benatti di Cillo
- Departamento de Psiquiatria, Universidade Federal de São Paulo, R Rua Major Maragliano, 241, Vila Clementino, São Paulo, SP, 04017030, Brazil
| | - Marcelo Feijo Mello
- Departamento de Psiquiatria, Universidade Federal de São Paulo, R Rua Major Maragliano, 241, Vila Clementino, São Paulo, SP, 04017030, Brazil
| | - Ana Carolina Coelho Milani
- Departamento de Psiquiatria, Universidade Federal de São Paulo, R Rua Major Maragliano, 241, Vila Clementino, São Paulo, SP, 04017030, Brazil
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Mo X, He M, Zhou L, Liu Y, Zhu H, Huang X, Zeng G, Zhang J, Li L. Mapping structural covariance networks in children and adolescents with post-traumatic stress disorder after earthquake. Front Psychiatry 2022; 13:923572. [PMID: 36186852 PMCID: PMC9520616 DOI: 10.3389/fpsyt.2022.923572] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
For children and adolescents, there is a high risk of developing post-traumatic stress disorder (PTSD) after suffering from catastrophic events. Previous studies have identified brain functionally and subcortical brain volumes structurally abnormalities in this population. However, up till now, researches exploring alterations of regional cortical thickness (CTh) and brain interregional structural covariance networks (SCNs) are scarce. In this cross-sectional study, CTh measures are derived from 3-Tesla Tl-weighted MRI imaging data in a well-characterized combined group of children and adolescents with PTSD after an earthquake (N = 35) and a traumatized healthy control group (N = 24). By using surface-based morphometry (SBM) techniques, the regional CTh analysis was conducted. To map interregional SCNs derived from CTh, twenty-five altered brain regions reported in the PTSD population were selected as seeds. Whole-brain SBM analysis discovered a significant thickness reduction in the left medial orbitofrontal cortex for the subjects with PTSD. Similarly, analysis of SCNs associated with "seed" regions primarily located in default mode network (DMN), midline cortex structures, motor cortex, auditory association cortex, limbic system, and visual cortex demonstrated that children and adolescents with PTSD are associated with altered structural covariance with six key regions. This study provides evidence for distinct CTh correlates of PTSD that are present across children and adolescents, suggesting that brain cortical abnormalities related to trauma exposure are present in this population, probably by driving specific symptom clusters associated with disrupted extinction recall mechanisms for fear, episodic memory network and visuospatial attention.
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Affiliation(s)
- Xian Mo
- College of Electrical Engineering, Sichuan University, Chengdu, Sichuan, China.,Med-X Center for Informatics, Sichuan University, Chengdu, Sichuan, China
| | - Meirong He
- College of Electrical Engineering, Sichuan University, Chengdu, Sichuan, China
| | - Lijun Zhou
- College of Electrical Engineering, Sichuan University, Chengdu, Sichuan, China
| | - Yunfei Liu
- College of Electrical Engineering, Sichuan University, Chengdu, Sichuan, China
| | - Hongru Zhu
- Med-X Center for Informatics, Sichuan University, Chengdu, Sichuan, China.,Mental Health Center and Psychiatric Laboratory, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiaoqi Huang
- West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Guojun Zeng
- West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Junran Zhang
- College of Electrical Engineering, Sichuan University, Chengdu, Sichuan, China.,Med-X Center for Informatics, Sichuan University, Chengdu, Sichuan, China
| | - Lingjiang Li
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
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6
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Zilcha‐Mano S, Zhu X, Lazarov A, Suarez‐Jimenez B, Helpman L, Kim Y, Maitlin C, Neria Y, Rutherford BR. Structural brain features signaling trauma, PTSD, or resilience? A systematic exploration. Depress Anxiety 2022; 39:695-705. [PMID: 35708133 PMCID: PMC9588504 DOI: 10.1002/da.23275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 04/15/2022] [Accepted: 05/30/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Studies have searched for neurobiological markers of trauma exposure, posttraumatic stress disorder (PTSD) diagnosis, and resilience to trauma to identify therapeutic targets for PTSD. Despite some promising results, findings are inconsistent. AIMS The present study adopted a data-driven approach to systematically explore whether structural brain markers of trauma, PTSD, or resilience emerge when all are explored. MATERIALS & METHODS Differences between clusters in the proportion of PTSD, healthy controls (HC), and trauma-exposed healthy controls (TEHC) served to indicate the presence of PTSD, trauma, and resilience markers, respectively. A total of 129 individuals, including 46 with PTSD, 49 TEHCs, and 34 HCs not exposed to trauma were scanned. Volumes, cortical thickness, and surface areas of interest were obtained from T1 structural MRI and used to identify data-driven clusters. RESULTS Two clusters were identified, differing in the proportion of TEHCs but not of PTSDs or HCs. The cluster with the higher proportion of TEHCs, referred to as the resilience cluster, was characterized by higher volume in brain regions implicated in trauma exposure, especially the thalamus and rostral middle frontal gyrus. Cross-validation established the robustness and consistency of the identified clusters. DISCUSSION & CONCLUSION Findings support the existence of structural brain markers of resilience.
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Affiliation(s)
| | - Xi Zhu
- Department of PsychiatryColumbia UniversityNew YorkNew YorkUSA,New York State Psychiatric Institute, Columbia University Medical CenterNew YorkNew YorkUSA
| | - Amit Lazarov
- School of Psychological SciencesTel‐Aviv UniversityTel‐AvivIsrael,Department of PsychiatryColumbia University Medical CenterNew YorkNew YorkUSA
| | - Benjamin Suarez‐Jimenez
- New York State Psychiatric Institute, Columbia University Medical CenterNew YorkNew YorkUSA,Department of NeuroscienceUniversity of RochesterRochesterNew YorkUSA
| | - Liat Helpman
- Department of Counseling and Human DevelopmentUniversity of HaifaMount CarmelHaifaIsrael,Tel Aviv Sourasky Medical CenterTel AvivIsrael
| | - Yoojean Kim
- Department of PsychiatryColumbia UniversityNew YorkNew YorkUSA,New York State Psychiatric Institute, Columbia University Medical CenterNew YorkNew YorkUSA
| | - Carly Maitlin
- Department of PsychiatryColumbia UniversityNew YorkNew YorkUSA,New York State Psychiatric Institute, Columbia University Medical CenterNew YorkNew YorkUSA
| | - Yuval Neria
- Department of PsychiatryColumbia UniversityNew YorkNew YorkUSA,New York State Psychiatric Institute, Columbia University Medical CenterNew YorkNew YorkUSA
| | - Bret R. Rutherford
- Columbia University College of Physicians and Surgeons, New York State Psychiatric InstituteNew York CityNew YorkUSA
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7
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Li L, Zhang Y, Zhao Y, Li Z, Kemp GJ, Wu M, Gong Q. Cortical thickness abnormalities in patients with post-traumatic stress disorder: A vertex-based meta-analysis. Neurosci Biobehav Rev 2022; 134:104519. [PMID: 34979190 DOI: 10.1016/j.neubiorev.2021.104519] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/21/2021] [Accepted: 12/30/2021] [Indexed: 02/05/2023]
Abstract
Neuroimaging studies report altered cortical thickness in patients with post-traumatic stress disorder (PTSD), but the results are inconsistent. Using anisotropic effect-size seed-based d mapping (AES-SDM) software with its recently-developed meta-analytic thickness mask, we conducted a meta-analysis of published studies which used whole-brain surface-based morphometry, in order to define consistent cortical thickness alterations in PTSD patients. Eleven studies with 438 patients and 396 controls were included. Compared with all controls, patients with PTSD showed increased cortical thickness in right superior temporal gyrus, and in left and right superior frontal gyrus; the former survived in subgroup analysis of adult patients, and in subgroup comparison with only non-PTSD trauma-exposed controls, the latter in subgroup comparison with only non-trauma-exposed healthy controls. Cortical thickness in right superior frontal gyrus was positively associated with percentage of female patients, and cortical thickness in left superior frontal gyrus was positively associated with symptom severity measured by the clinician-administered PTSD scale. These robust results may help to elucidate the pathophysiology of PTSD.
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Affiliation(s)
- Lei Li
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, PR China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, Sichuan, China; Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Yu Zhang
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, PR China
| | - Youjin Zhao
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, PR China
| | - Zhenlin Li
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, PR China
| | - Graham J Kemp
- Liverpool Magnetic Resonance Imaging Centre and Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Min Wu
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, PR China.
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, PR China; Department of Radiology, West China Xiamen Hospital of Sichuan University, Xiamen, Fujian, China.
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8
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Graziano R, Bruce S, Paul R. The Corpus Callosum and PTSD Severity. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:7480-7494. [PMID: 30866699 DOI: 10.1177/0886260519835007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Posttraumatic stress disorder (PTSD) is a chronic, debilitating disorder that is associated with neural alterations in multiple brain regions. Neuroimaging studies have largely focused on gray matter abnormalities in PTSD, with less information known about the integrity of white matter tracts. Prior studies of brain white matter in PTSD have produced mixed results, likely due to differences in neuroimaging sequences and clinical variables. This study addressed this gap by examining the microstructural integrity of the corpus callosum, the largest white matter fiber bundle in the brain, using diffusion tensor imaging (DTI). Sixty adult females diagnosed with PTSD with a history of interpersonal violence were compared with 18 trauma-exposed controls. All participants underwent DTI using 1.5 T. MANOVA revealed significantly higher fractional anisotropy (FA; p = .012) in the genu of the corpus callosum (GCC) compared with the trauma-exposed controls. These results suggest the GCC to relate to PTSD symptomatology. Further studies of this mechanism may provide insight into improving treatment and prevention efforts.
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Affiliation(s)
| | | | - Robert Paul
- Missouri Institute of Mental Health, St. Louis, USA
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9
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Ross MC, Dvorak D, Sartin-Tarm A, Botsford C, Cogswell I, Hoffstetter A, Putnam O, Schomaker C, Smith P, Stalsberg A, Wang Y, Xiong M, Cisler JM. Gray matter volume correlates of adolescent posttraumatic stress disorder: A comparison of manual intervention and automated segmentation in FreeSurfer. Psychiatry Res Neuroimaging 2021; 313:111297. [PMID: 33962164 PMCID: PMC8205994 DOI: 10.1016/j.pscychresns.2021.111297] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 03/24/2021] [Accepted: 04/22/2021] [Indexed: 01/08/2023]
Abstract
Exposure to early life trauma is common and confers risk for psychological disorders in adolescence, including posttraumatic stress disorder (PTSD). Trauma exposure and PTSD are also consistently linked to alterations in gray matter volume (GMV). Despite the quantity of structural neuroimaging research in trauma-exposed populations, little consensus exists amongst research groups on best practices for image processing method and manual editing procedures. The purpose of this report is to evaluate the utility of manual editing of magnetic resonance (MR) images for detecting PTSD-related group differences in GMV. Here, T1-weighted MR images from adolescent girls aged 11-17 were obtained and analyzed. Two datasets were created from the FreeSurfer reconall pipeline, one of which was manually edited by trained research assistants. Gray matter regions of interest were selected and total volume estimates were entered into linear mixed effects models with method (manual edits or automated) as a within-subjects factor and group dummy-coded with PTSD as the reference group. Consistent with prior literature, individuals with PTSD demonstrated reduced GMV of the amygdala compared to trauma-exposed and non-trauma exposed controls, independent of editing method. Our results demonstrate that amygdala GMV reductions in PTSD are robust to certain methodological choices and do not suggest a benefit to the time-intensive manual editing pipeline in FreeSurfer for quantifying PTSD-related GMV.
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Affiliation(s)
- Marisa C Ross
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI United States; Neuroscience and Public Policy Program, University of Wisconsin-Madison, Madison, WI United States.
| | - Delaney Dvorak
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI United States
| | - Anneliis Sartin-Tarm
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE United States
| | - Chloe Botsford
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI United States
| | - Ian Cogswell
- Institute for Health Metrics and Evaluation, Seattle, WA United States
| | - Ashley Hoffstetter
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI United States
| | - Olivia Putnam
- Department of Psychology, Northwestern University, Evanston, IL United States
| | - Chloe Schomaker
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI United States
| | - Penda Smith
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI United States
| | - Anna Stalsberg
- Department of Sociology, University of Minnesota- Twin Cities, Minneapolis, MN United States
| | - Yunling Wang
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI United States
| | - Megan Xiong
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI United States
| | - Josh M Cisler
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI United States
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10
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Dagenbach DE, Tegeler CH, Morgan AR, Laurienti PJ, Tegeler CL, Lee SW, Gerdes L, Simpson SL. Effects of an Allostatic Closed-Loop Neurotechnology (HIRREM) on Brain Functional Connectivity Laterality in Military-Related Traumatic Stress. J Neuroimaging 2021; 31:287-296. [PMID: 33406294 PMCID: PMC8005452 DOI: 10.1111/jon.12825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 11/30/2020] [Accepted: 12/01/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND PURPOSE Brain asymmetries are reported in posttraumatic stress disorder, but many aspects of laterality and traumatic stress remain underexplored. This study explores lateralization changes in resting state brain network functional connectivity in a cohort with symptoms of military‐related traumatic stress, associated with use of a closed‐loop neurotechnology, HIRREM. METHODS Eighteen participants (17 males, mean age 41 years [SD = 7]) received 19.5 (1.1) HIRREM sessions over 12 days. Whole brain resting magnetic resonance imaging was done pre‐ and post‐HIRREM. Laterality of functional connectivity was assessed on a whole brain basis, and in six predefined networks or regions. Laterality of connectivity within networks or regions was assessed separately from laterality of connections between networks or regions. RESULTS Before HIRREM, significant laterality effects of connection type (ipsilateral for either side, or contralateral in either direction) were observed for the whole brain, within networks or regions, and between networks or regions. Post‐HIRREM, there were significant changes for within‐network or within‐region analysis in the motor network, and changes for between‐network or between‐region analyses for the salience network and the motor cortex. CONCLUSIONS Among military service members and Veterans with symptoms of traumatic stress, asymmetries of network and brain region connectivity patterns were identified prior to usage of HIRREM. A variety of changes in lateralized patterns of brain connectivity were identified postintervention. These laterality findings may inform future studies of brain connectivity in traumatic stress disorders, with potential to point to mechanisms of action for successful intervention.
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Affiliation(s)
- Dale E Dagenbach
- Department of Psychology, Wake Forest University, Winston-Salem, NC.,Laboratory for Complex Brain Networks, Wake Forest School of Medicine, Winston-Salem, NC
| | - Charles H Tegeler
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Ashley R Morgan
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Paul J Laurienti
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC.,Laboratory for Complex Brain Networks, Wake Forest School of Medicine, Winston-Salem, NC
| | | | - Sung W Lee
- College of Medicine, University of Arizona, Phoenix, AZ
| | - Lee Gerdes
- Brain State Technologies, Scottsdale, AZ
| | - Sean L Simpson
- Laboratory for Complex Brain Networks, Wake Forest School of Medicine, Winston-Salem, NC.,Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
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11
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Rinne-Albers MA, Boateng CP, van der Werff SJ, Lamers-Winkelman F, Rombouts SA, Vermeiren RR, van der Wee NJ. Preserved cortical thickness, surface area and volume in adolescents with PTSD after childhood sexual abuse. Sci Rep 2020; 10:3266. [PMID: 32094427 PMCID: PMC7039962 DOI: 10.1038/s41598-020-60256-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 02/03/2020] [Indexed: 12/21/2022] Open
Abstract
Exposure to childhood adverse events is associated with severe consequences for general health and structural and functional changes in the brain of its survivors. In order to unravel and in the end influence the pathway linking adversity and pathology, neuroimaging research is crucial. Up till now studies in minors are scarce and differ in type of adversity or methodology. Almost all studies report lower cortical thickness, but in a broad variety of regions. In this study we investigated cortical thickness measures and clinical data in a well circumscribed group of adolescents with PTSD related to childhood sexual abuse (CSA) (N = 21) and a healthy non-traumatised control group (N = 21). The ventromedial PFC (vmPFC), ACC, insula, and middle/superior temporal gyrus were chosen as ROI’s due to their respective roles in emotion and information processing. No significant effect of group was found for cortical thickness, surface area or volume in any of the ROIs. This is in line with the results of research in adult women with sexual abuse related PTSD, suggesting that this may be specific to this group, independent of age. Recent research points to differential biological and pathological consequences of different types of childhood adversity.
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Affiliation(s)
- Mirjam A Rinne-Albers
- Curium-LUMC, Academic Center for Child and Adolescent Psychiatry, Oegstgeest, the Netherlands.
| | - Charlotte P Boateng
- Department of Psychiatry, Leiden University Medical Center (LUMC), Leiden, the Netherlands
| | - Steven J van der Werff
- Department of Psychiatry, Leiden University Medical Center (LUMC), Leiden, the Netherlands.,Leiden Institute for Brain and Cognition (LIBC), Leiden, the Netherlands
| | | | - Serge A Rombouts
- Leiden Institute for Brain and Cognition (LIBC), Leiden, the Netherlands.,Department of Radiology, Leiden University Medical Center (LUMC), Leiden, the Netherlands.,Institute of Psychology, Leiden University, Leiden, the Netherlands
| | - Robert R Vermeiren
- Curium-LUMC, Academic Center for Child and Adolescent Psychiatry, Oegstgeest, the Netherlands.,Leiden Institute for Brain and Cognition (LIBC), Leiden, the Netherlands
| | - Nic J van der Wee
- Department of Psychiatry, Leiden University Medical Center (LUMC), Leiden, the Netherlands.,Leiden Institute for Brain and Cognition (LIBC), Leiden, the Netherlands
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12
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Li Y, Zhu H, Ren Z, Lui S, Yuan M, Gong Q, Yuan C, Gao M, Qiu C, Zhang W. Exploring memory function in earthquake trauma survivors with resting-state fMRI and machine learning. BMC Psychiatry 2020; 20:43. [PMID: 32013935 PMCID: PMC6998246 DOI: 10.1186/s12888-020-2452-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 01/21/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Traumatized earthquake survivors may develop poor memory function. Resting-state functional magnetic resonance imaging (rs-fMRI) and machine learning techniques may one day aid the clinical assessment of individual psychiatric patients. This study aims to use machine learning with Rs-fMRI from the perspectives of neurophysiology and neuroimaging to explore the association between it and the individual memory function of trauma survivors. METHODS Rs-fMRI data was acquired for eighty-nine survivors (male (33%), average age (SD):45.18(6.31) years) of Wenchuan earthquakes in 2008 each of whom was screened by experienced psychiatrists based on the clinician-administered post-traumatic stress disorder (PTSD) scale (CAPS), and their memory function scores were determined by the Wechsler Memory Scale-IV (WMS-IV). We explored which memory function scores were significantly associated with CAPS scores. Using simple multiple kernel learning (MKL), Rs-fMRI was used to predict the memory function scores that were associated with CAPS scores. A support vector machine (SVM) was also used to make classifications in trauma survivors with or without PTSD. RESULTS Spatial addition (SA), which is defined by spatial working memory function, was negatively correlated with the total CAPS score (r = - 0.22, P = 0.04). The use of simple MKL allowed quantitative association of SA scores with statistically significant accuracy (correlation = 0.28, P = 0.03; mean squared error = 8.36; P = 0.04). The left middle frontal gyrus and the left precuneus contributed the largest proportion to the simple MKL association frame. The SVM could not make a quantitative classification of diagnosis with statistically significant accuracy. LIMITATIONS The use of the cross-sectional study design after exposure to an earthquake and the leave-one-out cross-validation (LOOCV) increases the risk of overfitting. CONCLUSION Spontaneous brain activity of the left middle frontal gyrus and the left precuneus acquired by rs-fMRI may be a brain mechanism of visual working memory that is related to PTSD symptoms. Machine learning may be a useful tool in the identification of brain mechanisms of memory impairment in trauma survivors.
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Affiliation(s)
- Yuchen Li
- 0000 0004 1770 1022grid.412901.fMental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Hongru Zhu
- 0000 0004 1770 1022grid.412901.fMental Health Center, West China Hospital of Sichuan University, Chengdu, China ,0000 0004 1770 1022grid.412901.fMental Health Center and Psychiatric Laboratory, the State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, China ,0000 0004 1770 1022grid.412901.fHuaxi Brain Research Center, West China Hospital of Sichuan University, Chengdu, China
| | - Zhengjia Ren
- 0000 0004 1770 1022grid.412901.fMental Health Center, West China Hospital of Sichuan University, Chengdu, China ,0000 0004 1760 6682grid.410570.7Department of Clinical Psychology, Southwest Hospital, Army Medical University (The Third Military Medical University), Chongqing, China
| | - Su Lui
- 0000 0004 1770 1022grid.412901.fHuaxi MR Research Center (HMRRC), Department of Radiology, State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan People’s Republic of China
| | - Minlan Yuan
- 0000 0004 1770 1022grid.412901.fMental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Qiyong Gong
- 0000 0004 1770 1022grid.412901.fHuaxi MR Research Center (HMRRC), Department of Radiology, State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan People’s Republic of China
| | - Cui Yuan
- 0000 0004 1770 1022grid.412901.fMental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Meng Gao
- 0000 0004 1770 1022grid.412901.fMental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Changjian Qiu
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China.
| | - Wei Zhang
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China.
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13
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Kribakaran S, Danese A, Bromis K, Kempton MJ, Gee DG. Meta-analysis of Structural Magnetic Resonance Imaging Studies in Pediatric Posttraumatic Stress Disorder and Comparison With Related Conditions. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2020; 5:23-34. [PMID: 31690501 PMCID: PMC6954289 DOI: 10.1016/j.bpsc.2019.08.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/22/2019] [Accepted: 08/19/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Findings on structural brain volume associated with pediatric posttraumatic stress disorder (PTSD) have been variable, and it is unclear whether any structural differences are specific to pediatric PTSD in comparison with adult PTSD or other co-occurring pediatric psychiatric conditions. METHODS We tested volumetric brain differences between pediatric groups with and without PTSD in a region-of-interest meta-analysis. We conducted meta-regressions to test the effects of age and sex on heterogeneous study findings. To assess specificity, we compared pediatric PTSD with the following: adult PTSD, pediatric trauma exposure without PTSD, pediatric depression, and pediatric anxiety. RESULTS In 15 studies examined, pediatric PTSD was associated with smaller total gray matter and cerebral, temporal lobe (total, right, and left), total cerebellar vermis, and hippocampal (total, right, and left) volumes, compared to peers without PTSD. In the pediatric PTSD group, but not the comparison group, we found a trend toward smaller total, right, and left amygdalar volumes. In an external comparison, smaller hippocampal volume was not significantly different between adult and pediatric PTSD groups. Qualitative comparisons with a pediatric trauma exposure without PTSD group, a pediatric depression group, and a pediatric anxiety group revealed differences that may be unique to pediatric PTSD, and others that may be convergent with these related clinical conditions in youth. CONCLUSIONS Pediatric PTSD is associated with structural differences that parallel those associated with adult PTSD. Furthermore, pediatric PTSD appears to be distinct from other related pediatric conditions at the structural level. Future studies employing longitudinal, dimensional, and multimodal neuroimaging approaches will further elucidate the nature of neurobiological differences in pediatric PTSD.
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Affiliation(s)
- Sahana Kribakaran
- Department of Psychology, Yale University, New Haven, Connecticut; Interdepartmental Neuroscience Program, Yale School of Medicine, New Haven, Connecticut
| | - Andrea Danese
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom; Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom; National and Specialist Child and Adolescent Mental Health Services Clinic for Trauma, Anxiety, and Depression, South London and Maudsley National Health Services Foundation Trust, London, United Kingdom
| | - Konstantinos Bromis
- School of Psychology, University of Sussex, Brighton, United Kingdom; School of Electrical and Computer Engineering, National Technical University of Athens, Greece
| | - Matthew J Kempton
- Department of Neuroimaging, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom; Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
| | - Dylan G Gee
- Department of Psychology, Yale University, New Haven, Connecticut.
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14
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Elbers J, Jaradeh S, Yeh AM, Golianu B. Wired for Threat: Clinical Features of Nervous System Dysregulation in 80 Children. Pediatr Neurol 2018; 89:39-48. [PMID: 30343833 DOI: 10.1016/j.pediatrneurol.2018.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 07/22/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND The negative effect of perceived stress on health has become a cultural epidemic. Despite many health implications, the clinical impact of stress on the nervous system is not well understood. This case series describes the symptom profiles of 80 children with nervous system dysregulation attributed to maladaptive neuroendocrine responses to stress. METHODS We reviewed of 80 children with nervous system dysregulation identified from a single, tertiary care pediatric neurology clinic. Included patients were between five and 17 years of age, with unexplained medical symptoms lasting three months or longer affecting at least four of six neurological domains: (1) somatization, (2) executive function, (3) autonomic function, (4) digestion, (5) sleep, and (6) emotional regulation. Medical symptoms, diagnoses, and detailed social histories were collected. RESULTS Of 80 children, 57 were female (71%), 57 were Caucasian (71%), with median age of 14 years. Symptoms had a mean duration of 32 months, and included: 100% somatic symptoms, 100% emotional dysregulation, 92.5% disrupted sleep, 82.5% autonomic dysregulation, 75% executive dysfunction, and 66% digestive problems. Overall, 94% reported chronic or traumatic stressors; adverse childhood experiences were present in 65%. CONCLUSIONS Perceived stress impacts many functions of the neuroendocrine system through experience-dependent plasticity, resulting in a constellation of symptoms and functional impairments we describe as nervous system dysregulation. The pathophysiology of these symptoms involves dysregulation of subcortical, hormonal, and autonomic circuits, which remain largely untested. Recognition and understanding of maladaptive neurophysiology in stress-related symptoms has important implications for diagnosis, treatment, and advances in health research.
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Affiliation(s)
- Jorina Elbers
- Division of Child Neurology, Department of Neurology and Neurological Sciences, Stanford University, Stanford, California.
| | - Safwan Jaradeh
- Division of Autonomic Disorders, Department of Neurology and Neurological Sciences, Stanford University, Stanford, California
| | - Ann Ming Yeh
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Stanford University, Stanford, California
| | - Brenda Golianu
- Division of Pediatric Anesthesia and Pain Management, Department of Anesthesiology and Pain Medicine, Stanford University, Stanford, California
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15
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Psychophysiological correlates between emotional response inhibition and posttraumatic stress symptom clusters. Sci Rep 2018; 8:16876. [PMID: 30443036 PMCID: PMC6237905 DOI: 10.1038/s41598-018-35123-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 10/30/2018] [Indexed: 11/25/2022] Open
Abstract
Post-traumatic Stress Disorder (PTSD) is characterized by diverse executive function impairments as well as abnormal emotion processing. The goal of the present study was to examine the relationships between emotional response inhibition and distinct PTSD symptom clusters from a six-factor DSM-5 model. Event-related potentials (ERPs) were measured in an emotional Go/NoGo task among 58 adult survivors from a deadly earthquake. Overall, the commission errors were lower and reaction time was faster for negative pictures compared to neutral pictures. The negative pictures elicited a smaller N2 but larger P3 amplitude compared to neutral and positive pictures, and larger P3 amplitude was further associated with a faster response. Multivariate regression models showed that the PCL score was related to smaller NoGo-N2 amplitude in the negative context, suggesting that the severity of posttraumatic stress symptoms is associated with worse conflict detection. Furthermore, the severity of anhedonia symptom cluster rather than negative affect symptom cluster was associated with fewer commission errors in the positive context, and this result provided electrophysiological evidence for the six-factor model, i.e., a distinction should be made between negative affect symptom cluster and anhedonia symptom cluster.
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16
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Biedermann SV, Meliss S, Simmons C, Nöthling J, Suliman S, Seedat S. Sexual abuse but not posttraumatic stress disorder is associated with neurocognitive deficits in South African traumatized adolescents. CHILD ABUSE & NEGLECT 2018; 80:257-267. [PMID: 29649712 DOI: 10.1016/j.chiabu.2018.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 03/23/2018] [Accepted: 04/03/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Neurocognitive impairments are commonly observed in adults suffering from posttraumatic stress disorder (PTSD). The picture is less clear in adolescents. Childhood sexual abuse (CSA) may have an independent influence on neuropsychological test performance and provide partial explanatory power of the inconsistent findings. We hypothesized that adolescents with PTSD who have also suffered sexual abuse would have most pronounced deficits on neurocognitive testing. METHODS In a cross-sectional design, 105 traumatized South African adolescents, of whom 52 fulfilled criteria of PTSD and 34 reported CSA, were studied. A comprehensive neurocognitive battery including tests of memory, executive functioning, and language was used to analyze the associations of neurocognitive impairments with PTSD and CSA. RESULTS Adolescents reporting CSA manifested impairments in proactive and retroactive interference tasks on the Rey Auditory Verbal Learning test and in the copy condition of the Rey Osterrieth figure test, indicating deficits in attention and working memory. Against our hypothesis, no independent effects of PTSD were found on neurocognitive performance. Results were independent of comorbid psychiatric diagnoses. CONCLUSIONS Sexual abuse seems to have an independent influence on attention and working memory. This could be an early sign of hippocampal impairment.
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Affiliation(s)
- Sarah V Biedermann
- Clinic of Psychiatry and Psychotherapy, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Institute of Systems Neuroscience, Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Stefanie Meliss
- Clinic of Psychiatry and Psychotherapy, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Candice Simmons
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Jani Nöthling
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Sharain Suliman
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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17
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Elbers J, Rovnaghi CR, Golianu B, Anand KJS. Clinical Profile Associated with Adverse Childhood Experiences: The Advent of Nervous System Dysregulation. CHILDREN-BASEL 2017; 4:children4110098. [PMID: 29140276 PMCID: PMC5704132 DOI: 10.3390/children4110098] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 11/03/2017] [Accepted: 11/08/2017] [Indexed: 12/19/2022]
Abstract
Background: We report the prevalence of children with multiple medical symptoms in a pediatric neurology clinic, describe their symptom profiles, and explore their association with adverse childhood experiences (ACEs). Methods: We retrospectively reviewed 100 consecutive patients from an outpatient pediatric neurology clinic. Patients were included if they were ≥5 years old and reported ≥4 symptoms that were unexplained for ≥3-months. Symptom profiles across six functional domains were recorded: (1) executive dysfunction, (2) sleep disturbances, (3) autonomic dysregulation, (4) somatization, (5) digestive symptoms, and (6) emotional dysregulation. ACEs were scored for all patients. Results: Seventeen patients reported ≥4 medical symptoms. Somatization, sleep disturbances, and emotional dysregulation occurred in 100% patients, with executive dysfunction (94%), autonomic dysregulation (76%), and digestive problems (71%) in the majority. Forty-two children reported ≥1 ACE, but children with ≥4 symptoms were more likely to report ACEs compared to other children (88% vs. 33%; p < 0.0001) and had a higher median total ACE score (3 vs. 1; p < 0.001). Conclusions: Children with multiple medical symptoms should be screened for potential exposure to ACEs. A clinical profile of symptoms across multiple functional domains suggests putative neurobiological mechanisms involving stress and nervous system dysregulation that require further study.
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Affiliation(s)
- Jorina Elbers
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305, USA.
| | - Cynthia R Rovnaghi
- Pain/Stress Neurobiology Laboratory, Department of Pediatrics, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305, USA.
| | - Brenda Golianu
- Department of Anesthesiology, Perioperative & Pain Medicine, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305, USA.
| | - Kanwaljeet J S Anand
- Pain/Stress Neurobiology Laboratory, Department of Pediatrics, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305, USA.
- Departments of Pediatrics, Anesthesiology, Perioperative & Pain Medicine, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305, USA.
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18
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Milani ACC, Hoffmann EV, Fossaluza V, Jackowski AP, Mello MF. Does pediatric post-traumatic stress disorder alter the brain? Systematic review and meta-analysis of structural and functional magnetic resonance imaging studies. Psychiatry Clin Neurosci 2017; 71:154-169. [PMID: 27778421 DOI: 10.1111/pcn.12473] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Revised: 09/01/2016] [Accepted: 10/20/2016] [Indexed: 12/20/2022]
Abstract
Several studies have recently demonstrated that the volumes of specific brain regions are reduced in children and adolescents with post-traumatic stress disorder (PTSD) compared with those of healthy controls. Our study investigated the potential association between early traumatic experiences and altered brain regions and functions. We conducted a systematic review of the scientific literature regarding functional magnetic resonance imaging and a meta-analysis of structural magnetic resonance imaging studies that investigated cerebral region volumes in pediatric patients with PTSD. We searched for articles from 2000 to 2014 in the PsycINFO, PubMed, Medline, Lilacs, and ISI (Web of Knowledge) databases. All data regarding the amygdala, hippocampus, corpus callosum, brain, and intracranial volumes that fit the inclusion criteria were extracted and combined in a meta-analysis that assessed differences between groups. The meta-analysis found reduced total corpus callosum areas and reduced total cerebral and intracranial volumes in the patients with PTSD. The total hippocampus (left and right hippocampus) and gray matter volumes of the amygdala and frontal lobe were also reduced, but these differences were not significant. The functional studies revealed differences in brain region activation in response to stimuli in the post-traumatic stress symptoms/PTSD group. Our results confirmed that the pediatric patients with PTSD exhibited structural and functional brain abnormalities and that some of the abnormalities occurred in different brain regions than those observed in adults.
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Affiliation(s)
| | - Elis V Hoffmann
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Victor Fossaluza
- Institute of Mathematics and Statistics, University of São Paulo, São Paulo, Brazil
| | - Andrea P Jackowski
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Marcelo F Mello
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
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19
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Klabunde M, Weems CF, Raman M, Carrion VG. The moderating effects of sex on insula subdivision structure in youth with posttraumatic stress symptoms. Depress Anxiety 2017; 34:51-58. [PMID: 27862643 DOI: 10.1002/da.22577] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 08/09/2016] [Accepted: 09/28/2016] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The insula is involved in interoceptive processing, emotion awareness, and attention to salient stimuli. Research suggests that these functions are specific-albeit overlapping-within insula subdivisions. Additional studies also imply that sexual dimorphism and different rates of development occur within these subdivisions in youth. The purpose of this study was to examine potential insula subdivision structure differences in youth with PTSD symptoms as compared to controls and test sex as a moderator of these differences. METHODS Insula structure (volume, surface area, and thickness) was measured with structural magnetic resonance imaging (sMRI) and calculated using Freesurfer software. We compared insula structure across age- and sex-matched boys and girls with (30 with and 29 without) PTSD symptoms while also controlling for age and whole brain measurements. RESULTS Differences were specific to the insula's anterior circular sulcus. Within this subregion, boys with PTSD symptoms demonstrated larger volume and surface area than control boys, while girls with PTSD symptoms demonstrated smaller volume and surface area than control girls. DISCUSSION Findings indicate a potential neurobiological explanation for sex differences in youth with PTSD symptoms.
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Affiliation(s)
- Megan Klabunde
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Carl F Weems
- Department of Human Development and Family Studies, Iowa State University, Ames, IA, USA
| | - Mira Raman
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Victor G Carrion
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
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20
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The relationship between response inhibition and posttraumatic stress symptom clusters in adolescent earthquake survivors: an event-related potential study. Sci Rep 2015; 5:8844. [PMID: 25740732 PMCID: PMC4350076 DOI: 10.1038/srep08844] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 02/05/2015] [Indexed: 11/18/2022] Open
Abstract
Posttraumatic stress disorder (PTSD) patients experience impaired response inhibition. Little is known about the relationship between response inhibition abnormalities and distinct PTSD symptom clusters. This study investigated the relationship between response inhibition processing and a five-factor model of posttraumatic stress symptomatology in adolescents. The event-related potentials of 54 unmedicated adolescent earthquake survivors (age 15–18 years) were recorded as they completed a Go/NoGo task. The PTSD Checklist-Specific Stressor Version (PCL-S) was used to assess PTSD symptoms. Regression analyses were conducted to examine the associations between the five symptom-cluster model and response inhibition processing. The results revealed that the avoidance symptom cluster score, but not the numbing or other clusters' scores, was positively associated with NoGo-P3 latency. These results suggest that a specific PTSD symptom cluster—avoidance—has a distinct association with the slowed speed of the late step of response inhibition processing, i.e., decision or success of response inhibition in adolescent earthquake survivors.
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21
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Duval ER, Javanbakht A, Liberzon I. Neural circuits in anxiety and stress disorders: a focused review. Ther Clin Risk Manag 2015; 11:115-26. [PMID: 25670901 PMCID: PMC4315464 DOI: 10.2147/tcrm.s48528] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Anxiety and stress disorders are among the most prevalent neuropsychiatric disorders. In recent years, multiple studies have examined brain regions and networks involved in anxiety symptomatology in an effort to better understand the mechanisms involved and to develop more effective treatments. However, much remains unknown regarding the specific abnormalities and interactions between networks of regions underlying anxiety disorder presentations. We examined recent neuroimaging literature that aims to identify neural mechanisms underlying anxiety, searching for patterns of neural dysfunction that might be specific to different anxiety disorder categories. Across different anxiety and stress disorders, patterns of hyperactivation in emotion-generating regions and hypoactivation in prefrontal/regulatory regions are common in the literature. Interestingly, evidence of differential patterns is also emerging, such that within a spectrum of disorders ranging from more fear-based to more anxiety-based, greater involvement of emotion-generating regions is reported in panic disorder and specific phobia, and greater involvement of prefrontal regions is reported in generalized anxiety disorder and posttraumatic stress disorder. We summarize the pertinent literature and suggest areas for continued investigation.
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Affiliation(s)
- Elizabeth R Duval
- Department of Psychiatry, University of Michigan Health System, Ann Arbor, MI, USA
| | - Arash Javanbakht
- Department of Psychiatry, University of Michigan Health System, Ann Arbor, MI, USA
| | - Israel Liberzon
- Department of Psychiatry, University of Michigan Health System, Ann Arbor, MI, USA
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22
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Koganemaru S, Sawamoto N, Aso T, Sagara A, Ikkaku T, Shimada K, Kanematsu M, Takahashi R, Domen K, Fukuyama H, Mima T. Task-specific brain reorganization in motor recovery induced by a hybrid-rehabilitation combining training with brain stimulation after stroke. Neurosci Res 2014; 92:29-38. [PMID: 25450315 DOI: 10.1016/j.neures.2014.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 10/03/2014] [Accepted: 10/06/2014] [Indexed: 10/24/2022]
Abstract
Recently, we have developed a new hybrid-rehabilitation combining 5Hz repetitive transcranial magnetic stimulation and extensor motor training of the paretic upper-limb for stroke patients with flexor hypertonia. We previously showed that the extensor-specific plastic change in M1 was associated with beneficial effects of our protocol (Koganemaru et al., 2010). Here, we investigated whether extensor-specific multiregional brain reorganization occurred after the hybrid-rehabilitation using functional magnetic resonance imaging. Eleven chronic stroke patients were scanned while performing upper-limb extensor movements. Untrained flexor movements were used as a control condition. The scanning and clinical assessments were done before, immediately and 2 weeks after the hybrid-rehabilitation. As a result, during the trained extensor movements, the imaging analysis showed a significant reduction of brain activity in the ipsilesional sensorimotor cortex, the contralesional cingulate motor cortex and the contralesional premotor cortex in association with functional improvements of the paretic hands. The activation change was not found for the control condition. Our results suggested that use-dependent plasticity induced by repetitive motor training with brain stimulation might be related to task-specific multi-regional brain reorganization. It provides a key to understand why repetitive training of the target action is one of the most powerful rehabilitation strategies to help patients.
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Affiliation(s)
- Satoko Koganemaru
- Brain Integrative Science, Kyoto University School of Medicine, Sakyo-ku, Kyoto 606-8507, Japan; Human Brain Research Center, Kyoto University School of Medicine, Sakyo-ku, Kyoto 606-8507, Japan.
| | - Nobukatsu Sawamoto
- Department of Neurology, Kyoto University School of Medicine, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Toshihiko Aso
- Human Brain Research Center, Kyoto University School of Medicine, Sakyo-ku, Kyoto 606-8507, Japan
| | - Akiko Sagara
- Department of Physical and Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan
| | - Tomoko Ikkaku
- Department of Physical and Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan
| | - Kenji Shimada
- Department of Physical and Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan
| | - Madoka Kanematsu
- Department of Physical and Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan
| | - Ryosuke Takahashi
- Department of Neurology, Kyoto University School of Medicine, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Kazuhisa Domen
- Department of Physical and Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan
| | - Hidenao Fukuyama
- Human Brain Research Center, Kyoto University School of Medicine, Sakyo-ku, Kyoto 606-8507, Japan
| | - Tatsuya Mima
- Human Brain Research Center, Kyoto University School of Medicine, Sakyo-ku, Kyoto 606-8507, Japan
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Li L, Wu M, Liao Y, Ouyang L, Du M, Lei D, Chen L, Yao L, Huang X, Gong Q. Grey matter reduction associated with posttraumatic stress disorder and traumatic stress. Neurosci Biobehav Rev 2014; 43:163-72. [DOI: 10.1016/j.neubiorev.2014.04.003] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 04/05/2014] [Accepted: 04/10/2014] [Indexed: 10/25/2022]
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24
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Nooner KB, Mennes M, Brown S, Castellanos FX, Leventhal B, Milham MP, Colcombe SJ. Relationship of trauma symptoms to amygdala-based functional brain changes in adolescents. J Trauma Stress 2013; 26:784-7. [PMID: 24343754 PMCID: PMC4073800 DOI: 10.1002/jts.21873] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
In this pilot study, amygdala connectivity related to trauma symptoms was explored using resting-state functional magnetic resonance imaging (R-fMRI) in 23 healthy adolescents ages 13-17 years with no psychiatric diagnoses. Adolescents completed a self-report trauma symptom checklist and a R-fMRI scan. We examined the relationship of trauma symptoms to resting-state functional connectivity of the amygdala. Increasing self-report of trauma symptoms by adolescents was associated with increasing functional connectivity with the right amygdala and a local limbic cluster and decreasing functional connectivity with the amygdala and a long-range frontoparietal cluster to the left amygdala, which can be a hallmark of immaturity. These pilot findings in adolescents provide preliminary evidence that even mild trauma symptoms can be linked to the configuration of brain networks associated with the amygdala.
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Affiliation(s)
- Kate B. Nooner
- Department of Psychology, University of North Carolina Wilmington, Wilmington, North Carolina, USA
| | - Maarten Mennes
- Donders Institute for Brain, Cognition and Behaviour, Department of Cognitive Neuroscience, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands,Phyllis Green and Randolph Cōwen Institute for Pediatric Neuroscience, New York University Child Study Center, Langone Medical Center, New York, New York, USA
| | - Shaquanna Brown
- Department of Medical Physics, Nathan Kline Institute for Psychiatric Research, Orangeburg, New York, USA
| | - F. Xavier Castellanos
- Phyllis Green and Randolph Cōwen Institute for Pediatric Neuroscience, New York University Child Study Center, Langone Medical Center, New York, New York, USA,Department of Medical Physics, Nathan Kline Institute for Psychiatric Research, Orangeburg, New York, USA
| | - Bennett Leventhal
- Department of Medical Physics, Nathan Kline Institute for Psychiatric Research, Orangeburg, New York, USA
| | - Michael P. Milham
- Department of Medical Physics, Nathan Kline Institute for Psychiatric Research, Orangeburg, New York, USA,Center for the Developing Brain, Child Mind Institute, New York, New York, USA
| | - Stanley J. Colcombe
- Department of Medical Physics, Nathan Kline Institute for Psychiatric Research, Orangeburg, New York, USA
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25
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Lindemer ER, Salat DH, Leritz EC, McGlinchey RE, Milberg WP. Reduced cortical thickness with increased lifetime burden of PTSD in OEF/OIF Veterans and the impact of comorbid TBI. NEUROIMAGE-CLINICAL 2013; 2:601-11. [PMID: 24179811 PMCID: PMC3777819 DOI: 10.1016/j.nicl.2013.04.009] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 04/07/2013] [Accepted: 04/08/2013] [Indexed: 01/17/2023]
Abstract
Posttraumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI) in military personnel is increasing dramatically following the OEF/OIF conflicts and is associated with alterations to brain structure. The present study examined the relationship between PTSD and cortical thickness, and its possible modification by mTBI, in a 104-subject OEF/OIF veteran cohort ranging in age from 20 to 62 years. For each participant, two T1-weighted scans were averaged to create high-resolution images for calculation of regional cortical thickness. PTSD symptoms were assessed using the Clinician Administered PTSD Scale (CAPS) and scores were derived based on the previous month's symptoms (“current”) and a Cumulative Lifetime Burden of PTSD (CLB-P) reflecting the integral of CAPS scores across the lifetime. Mild TBI was diagnosed using the Boston Assessment of TBI-Lifetime (BAT-L). Results demonstrated a clear negative relationship between current PTSD severity and thickness in both postcentral gyri and middle temporal gyri. This relationship was stronger and more extensive when considering lifetime burden (CLB-P), demonstrating the importance of looking at trauma in the context of an individual's lifetime, rather than only at their current symptoms. Finally, interactions with current PTSD only and comorbid current PTSD and mTBI were found in several regions, implying an additive effect of lifetime PTSD and mTBI on cortical thickness.
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Affiliation(s)
- Emily R Lindemer
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, USA
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