Reward Processing and Circuit Dysregulation in Posttraumatic Stress Disorder

Posttraumatic stress, anxiety, and depression in mothers after preterm delivery and the associated psychological processes

BACKGROUND

Mothers of preterm infants report traumatic, anxious and depressive symptoms in the postpartum period. Many studies have focused on biological, social, and life circumstance factors to explain the emergence of these symptoms. The process model proposes to focus on psychological processes, which are mechanisms underlying mental disorders. However, the psychological processes underlying the onset of traumatic, anxious, and depressive symptoms in postpartum mothers of preterm infants had not yet been investigated. The aim of this study was to identify the most common symptoms experienced in the first few days after delivery and determine whether processes of anhedonia, brooding rumination, and worry are related to posttraumatic stress (PTS), anxiety, and depression symptoms.

METHODS

A sample of 106 mothers was screened for PTS, anxiety, and depression symptoms within the first 10 days after their preterm delivery. Anhedonia, brooding rumination, and worry were also assessed as psychological processes. Student's t-tests were performed to identify the most severe manifestation reported. To explore the relationship between psychological processes and symptoms, multiple linear regressions were performed on each symptom.

RESULTS

Descriptive analysis shows that 75.5% of mothers reported a pathological symptom level for at least one of PTS, anxiety, or depression. Being alert and worrying are the predominant manifestations experienced in the first few days after preterm birth. Multiple linear regression showed that PTS symptoms were associated with worry and brooding rumination; anxiety symptoms were associated with worry, reminiscence pleasure and a deficit in consummatory pleasure; and depressive symptoms were associated with worry and a deficit in consummatory pleasure.

CONCLUSIONS

Our findings support the transdiagnostic nature of psychological processes and suggest that anhedonia, brooding rumination, and worry may be relevant targets for psychological interventions to concurrently treat PTS, anxiety, and depression symptoms. Behavioral activation could be an effective intervention to target these dysfunctional processes and thus improve maternal symptoms.

DeepFocus: a transnasal approach for optimized deep brain stimulation of reward circuit nodes

Objective.Transcranial electrical stimulation (TES) is an effective technique to modulate brain activity and treat diseases. However, TES is primarily used to stimulate superficial brain regions and is unable to reach deeper targets. The spread of injected currents in the head is affected by volume conduction and the additional spreading of currents as they move through head layers with different conductivities, as is discussed in Forssellet al(2021J. Neural Eng.18046042). In this paper, we introduce DeepFocus, a technique aimed at stimulating deep brain structures in the brain's 'reward circuit' (e.g. the orbitofrontal cortex, Brodmann area 25, amygdala, etc).Approach.To accomplish this, DeepFocus utilizes transnasal electrode placement (under the cribriform plate and within the sphenoid sinus) in addition to electrodes placed on the scalp, and optimizes current injection patterns across these electrodes. To quantify the benefit of DeepFocus, we develop the DeepROAST simulation and optimization platform. DeepROAST simulates the effect of complex skull-base bones' geometries on the electric fields generated by DeepFocus configurations using realistic head models. It also uses optimization methods to search for focal and efficient current injection patterns, which we use in our simulation and cadaver studies.Main results.In simulations, optimized DeepFocus patterns created larger and more focal fields in several regions of interest than scalp-only electrodes. In cadaver studies, DeepFocus patterns created large fields at the medial orbitofrontal cortex (OFC) with magnitudes comparable to stimulation studies, and, in conjunction with established cortical stimulation thresholds, suggest that the field intensity is sufficient to create neural response, e.g. at the OFC.Significance.This minimally invasive stimulation technique can enable more efficient and less risky targeting of deep brain structures to treat multiple neural conditions.

Reward functioning in posttraumatic stress disorder, metabolic syndrome, and psychological resilience

BACKGROUND

Reward system dysfunction may play a role in the comorbidity of metabolic syndrome (MetS) in posttraumatic stress disorder (PTSD). Psychological resilience, through its effects on the reward system, may modulate outcomes in PTSD. Utilising a monetary incentive delay task during functional magnetic resonance imaging in a case-control study (PTSD, n = 88, trauma-exposed controls [TEC], n = 85), we aimed to investigate reward system function in relation to PTSD, MetS, and psychological resilience.

METHODS

Using repeated measures analysis of variance, we assessed change in activation in the ventral striatum (VS) during reward anticipation and in the orbitofrontal cortex (OFC) during reward outcome, in relation to PTSD, MetS, and psychological resilience, controlling for possible confounders including depression severity, childhood trauma and trauma load.

RESULTS

Activation in the VS and OFC didn't differ in relation to PTSD and MetS. When we controlled for depression severity, PTSD cases had significantly lower activation in the VS and a greater increase in activation in the OFC compared to TEC. Psychological resilience was significantly associated with decreased change in activation in the VS and increased change in activation in the OFC. We also observed a greater increase in activation during reward outcome in the OFC in those with greater childhood trauma exposure and those with exposure to fewer lifetime traumatic events.

CONCLUSIONS

The effects of depression and psychological resilience on reward system function in PTSD can be utilised towards developing interventions targeted at altering positive valence systems in PTSD.

Maternal History of Childhood Maltreatment and Pregnancy Weight Outcomes

BACKGROUND

Childhood maltreatment is associated with elevated adult weight. It is unclear whether this association extends to pregnancy, a critical window for the development of obesity.

METHODS

We examined associations of childhood maltreatment histories with prepregnancy body mass index (BMI) and gestational weight gain among women who had participated for >20 years in a longitudinal cohort. At age 26-35 years, participants reported childhood maltreatment (physical, sexual, and emotional abuse; emotional neglect) and, 5 years later, about prepregnancy weight and gestational weight gain for previous pregnancies (n = 656). Modified Poisson regression models were used to estimate associations of maltreatment history with prepregnancy BMI and gestational weight gain z -scores, adjusting for sociodemographics. We used multivariate imputation by chained equations to adjust outcome measures for misclassification using data from an internal validation study.

RESULTS

Before misclassification adjustment, results indicated a higher risk of prepregnancy BMI ≥30 kg/m 2 in women with certain types of maltreatment (e.g., emotional abuse risk ratio = 2.4; 95% confidence interval: 1.5, 3.7) compared with women without that maltreatment type. After misclassification adjustment, estimates were attenuated but still modestly elevated (e.g., emotional abuse risk ratio = 1.7; 95% confidence interval: 1.1, 2.7). Misclassification-adjusted estimates for maltreatment associations with gestational weight gain z -scores were close to the null and imprecise.

CONCLUSIONS

Findings suggest an association of maltreatment with prepregnancy BMI ≥30 kg/m 2 but not with high gestational weight gain. Results suggest a potential need for equitable interventions that can support all women, including those with maltreatment histories, as they enter pregnancy.

Neuronal Mechanisms of Reading Informational Texts in People with Different Levels of Mental Resilience

The aim of this study was to verify whether the level of mental resilience would differentiate reading comprehension performance when using different information carriers. More than 150 people filled out a test regarding the level of resilience. They then participated in a survey using fNIRS. Their task was to read a one-page informational text and answer several questions. The results showed no differences in correct answers between groups of people with different levels of resilience. In the groups of people with high and low levels of resilience, the number of correct answers was not differentiated by the type of carrier. Among those with moderate levels of resilience, better results were obtained by those who read text printed on paper. Analyses of neuronal mechanisms showed that the type of carrier differentiated brain activity in each group. Obtaining the same number of correct answers in the test was the result of different neuronal mechanisms activated in those who used a computer and those who read a printed text.

A translational neuroscience perspective on loneliness: Narrative review focusing on social interaction, illness and oxytocin

This review addresses key findings on loneliness from the social, neurobiological and clinical fields. From a translational perspective, results from studies in humans and animals are included, with a focus on social interaction, mental and physical illness and the role of oxytocin in loneliness. In terms of social interactions, lonely individuals tend to exhibit a range of abnormal behaviors based on dysfunctional social cognitions that make it difficult for them to form meaningful relationships. Neurobiologically, a link has been established between loneliness and the hypothalamic peptide hormone oxytocin. Since social interactions and especially social touch regulate oxytocin signaling, lonely individuals may have an oxytocin imbalance, which in turn affects their health and well-being. Clinically, loneliness is a predictor of physical and mental illness and leads to increased morbidity and mortality. There is evidence that psychopathology is both a cause and a consequence of loneliness. The final section of this review summarizes the findings from social, neurobiological and clinical perspectives to present a new model of the complex construct of loneliness.

Neurobiology and systems biology of stress resilience

Stress resilience is the phenomenon that some people maintain their mental health despite exposure to adversity or show only temporary impairments followed by quick recovery. Resilience research attempts to unravel the factors and mechanisms that make resilience possible and to harness its insights for the development of preventative interventions in individuals at risk for acquiring stress-related dysfunctions. Biological resilience research has been lagging behind the psychological and social sciences but has seen a massive surge in recent years. At the same time, progress in this field has been hampered by methodological challenges related to finding suitable operationalizations and study designs, replicating findings, and modeling resilience in animals. We embed a review of behavioral, neuroimaging, neurobiological, and systems biological findings in adults in a critical methods discussion. We find preliminary evidence that hippocampus-based pattern separation and prefrontal-based cognitive control functions protect against the development of pathological fears in the aftermath of singular, event-type stressors [as found in fear-related disorders, including simpler forms of posttraumatic stress disorder (PTSD)] by facilitating the perception of safety. Reward system-based pursuit and savoring of positive reinforcers appear to protect against the development of more generalized dysfunctions of the anxious-depressive spectrum resulting from more severe or longer-lasting stressors (as in depression, generalized or comorbid anxiety, or severe PTSD). Links between preserved functioning of these neural systems under stress and neuroplasticity, immunoregulation, gut microbiome composition, and integrity of the gut barrier and the blood-brain barrier are beginning to emerge. On this basis, avenues for biological interventions are pointed out.

Out of touch? How trauma shapes the experience of social touch - Neural and endocrine pathways

Trauma can shape the way an individual experiences the world and interacts with other people. Touch is a key component of social interactions, but surprisingly little is known about how trauma exposure influences the processing of social touch. In this review, we examine possible neurobiological pathways through which trauma can influence touch processing and lead to touch aversion and avoidance in trauma-exposed individuals. Emerging evidence indicates that trauma may affect sensory touch thresholds by modulating activity in the primary sensory cortex and posterior insula. Disturbances in multisensory integration and oxytocin reactivity combined with diminished reward-related and anxiolytic responses may induce a bias towards negative appraisal of touch contexts. Furthermore, hippocampus deactivation during social touch may reflect a dissociative state. These changes depend not only on the type and severity of the trauma but also on the features of the touch. We hypothesise that disrupted touch processing may impair social interactions and confer elevated risk for future stress-related disorders.

Prefrontal control of superior colliculus modulates innate escape behavior following adversity

Innate defensive responses, though primarily instinctive, must also be highly adaptive to changes in risk assessment. However, adaptive changes can become maladaptive, following severe stress, as seen in posttraumatic stress disorder (PTSD). In a series of experiments, we observed long-term changes in innate escape behavior of male mice towards a previously non-threatening stimulus following an adverse shock experience manifested as a shift in the threshold of threat response. By recording neural activity in the superior colliculus (SC) while phototagging specific responses to afferents, we established the crucial influence of input arriving at the SC from the medial prefrontal cortex (mPFC), both directly and indirectly, on escape-related activity after adverse shock experience. Inactivating these specific projections during the shock effectively abolished the observed changes. Conversely, optogenetically activating them during encounters controlled escape responses. This establishes the necessity and sufficiency of those specific mPFC inputs into the SC for adverse experience related changes in innate escape behavior.

The Stress Phenotyping Framework: A multidisciplinary biobehavioral approach for assessing and therapeutically targeting maladaptive stress physiology

Although dysregulated stress biology is becoming increasingly recognized as a key driver of lifelong disparities in chronic disease, we presently have no validated biomarkers of toxic stress physiology; no biological, behavioral, or cognitive treatments specifically focused on normalizing toxic stress processes; and no agreed-upon guidelines for treating stress in the clinic or evaluating the efficacy of interventions that seek to reduce toxic stress and improve human functioning. We address these critical issues by (a) systematically describing key systems and mechanisms that are dysregulated by stress; (b) summarizing indicators, biomarkers, and instruments for assessing stress response systems; and (c) highlighting therapeutic approaches that can be used to normalize stress-related biopsychosocial functioning. We also present a novel multidisciplinary Stress Phenotyping Framework that can bring stress researchers and clinicians one step closer to realizing the goal of using precision medicine-based approaches to prevent and treat stress-associated health problems.

Impaired learning, memory, and extinction in posttraumatic stress disorder: translational meta-analysis of clinical and preclinical studies

Current evidence-based treatments for post-traumatic stress disorder (PTSD) are efficacious in only part of PTSD patients. Therefore, novel neurobiologically informed approaches are urgently needed. Clinical and translational neuroscience point to altered learning and memory processes as key in (models of) PTSD psychopathology. We extended this notion by clarifying at a meta-level (i) the role of information valence, i.e. neutral versus emotional/fearful, and (ii) comparability, as far as applicable, between clinical and preclinical phenotypes. We hypothesized that cross-species, neutral versus emotional/fearful information processing is, respectively, impaired and enhanced in PTSD. This preregistered meta-analysis involved a literature search on PTSD+Learning/Memory+Behavior, performed in PubMed. First, the effect of information valence was estimated with a random-effects meta-regression. The sources of variation were explored with a random forest-based analysis. The analyses included 92 clinical (N = 6732 humans) and 182 preclinical (N = 6834 animals) studies. A general impairment of learning, memory and extinction processes was observed in PTSD patients, regardless of information valence. Impaired neutral learning/memory and fear extinction were also present in animal models of PTSD. Yet, PTSD models enhanced fear/trauma memory in preclinical studies and PTSD impaired emotional memory in patients. Clinical data on fear/trauma memory was limited. Mnemonic phase and valence explained most variation in rodents but not humans. Impaired neutral learning/memory and fear extinction show stable cross-species PTSD phenotypes. These could be targeted for novel PTSD treatments, using information gained from neurobiological animal studies. We argue that apparent cross-species discrepancies in emotional/fearful memory deserve further in-depth study; until then, animal models targeting this phenotype should be applied with utmost care.

Neural Correlates of Reward Processing in the Onset, Maintenance, and Treatment of Posttraumatic Stress Disorder

Posttraumatic stress disorder (PTSD) is a prevalent, debilitating, and heterogeneous psychiatric condition marked by both exaggerated threat responding and diminished positive affect. While symptom profiles of PTSD differ across individuals, symptoms also vary within individuals over the course of illness. Functional magnetic resonance imaging studies have provided crucial insights into the neurobiology of heightened threat responsivity in PTSD, which has aided in identifying neurobiological risk factors and treatment targets for this disorder. Despite this demonstrated utility, the application of functional magnetic resonance imaging to understanding deficits in reward responsivity in PTSD remains underexplored. Significantly, over 60% of individuals with PTSD experience anhedonia, or an inability to feel pleasure, which may reflect reward processing deficits. To better understand the neural underpinnings of reward deficits and their relevance to the onset, maintenance, and treatment of PTSD, we reviewed the functional magnetic resonance imaging literature through the framework of disease prognosis. Here, we provide insights on whether reward deficits are central to PTSD or are better explained by comorbid major depressive disorder, and we clarify how reward-related deficiencies in PTSD fit into the context of more intensely studied threat-related deficits.

Ketamine for Treatment of Posttraumatic Stress Disorder: State of the Field

Posttraumatic stress disorder (PTSD) is a chronic and debilitating condition. Although several psychotherapeutic and pharmacological treatments are recommended for PTSD, many individuals do not respond to treatment or respond only partially, highlighting a critical need for additional treatments. Ketamine has the potential to address this therapeutic need. This review discusses how ketamine emerged as a rapid-acting antidepressant and has become a potential treatment for PTSD. A single dose of intravenous (IV) ketamine has been shown to facilitate rapid reduction of PTSD symptoms. Repeated IV ketamine administration significantly improved PTSD symptoms, compared with midazolam, in a predominantly civilian sample of individuals with PTSD. However, in a veteran and military population, repeated IV ketamine did not significantly reduce PTSD symptoms. Further study of ketamine as a treatment for PTSD is necessary, including which populations benefit most from this therapy and the potential benefits of combining psychotherapy and ketamine.

Biological Psychiatry in Displaced Populations: What We Know, and What We Need to Begin to Learn

Conflict and climate change continue to displace millions of people, who experience unique trauma and stressors as they resettle in host countries. Both children and adults who are forcibly displaced, or choose to migrate, experience posttraumatic stress disorder, anxiety, depression, and other mental health conditions at higher rates than the general population. This may be attributed to severe, cumulative stress and trauma (largely interpersonal traumas); discrimination and harassment in host countries; and structural barriers to accessing and addressing mental health concerns, including clinician availability, language barriers, cultural differences, geographic accessibility, health care access, and stigma. Despite high exposure to and clinical impact of such experiences, and despite representing 1% of the world population, forcibly displaced people are underrepresented in neuroscientific research. The availability of such literature and research findings is significant in understanding the unique genetic and cultural aspects of trauma- and stress-related mental health, advocacy, reducing stigma, informing prevention, and treatment. The present work aimed to explore how the field of neuroscience can address mental health equity for individuals who have been uprooted in relation to land, with a focus on refugee populations. We offer practical suggestions on how to improve research in this area and narrow the gap in knowledge.

Post-traumatic stress disorder: clinical and translational neuroscience from cells to circuits

Post-traumatic stress disorder (PTSD) is a maladaptive and debilitating psychiatric disorder, characterized by re-experiencing, avoidance, negative emotions and thoughts, and hyperarousal in the months and years following exposure to severe trauma. PTSD has a prevalence of approximately 6-8% in the general population, although this can increase to 25% among groups who have experienced severe psychological trauma, such as combat veterans, refugees and victims of assault. The risk of developing PTSD in the aftermath of severe trauma is determined by multiple factors, including genetics - at least 30-40% of the risk of PTSD is heritable - and past history, for example, prior adult and childhood trauma. Many of the primary symptoms of PTSD, including hyperarousal and sleep dysregulation, are increasingly understood through translational neuroscience. In addition, a large amount of evidence suggests that PTSD can be viewed, at least in part, as a disorder that involves dysregulation of normal fear processes. The neural circuitry underlying fear and threat-related behaviour and learning in mammals, including the amygdala-hippocampus-medial prefrontal cortex circuit, is among the most well-understood in behavioural neuroscience. Furthermore, the study of threat-responding and its underlying circuitry has led to rapid progress in understanding learning and memory processes. By combining molecular-genetic approaches with a translational, mechanistic knowledge of fear circuitry, transformational advances in the conceptual framework, diagnosis and treatment of PTSD are possible. In this Review, we describe the clinical features and current treatments for PTSD, examine the neurobiology of symptom domains, highlight genomic advances and discuss translational approaches to understanding mechanisms and identifying new treatments and interventions for this devastating syndrome.

Brick by Brick: Building a Transdiagnostic Understanding of Inflammation in Psychiatry

ABSTRACT

Inflammatory phenomena are found in many psychiatric disorders-notably, depression, schizophrenia, and posttraumatic stress disorder. Inflammation has been linked to severity and treatment resistance, and may both contribute to, and result from, the pathophysiology of some psychiatric illnesses. Emerging research suggests that inflammation may contribute to symptom domains of reward, motor processing, and threat reactivity across different psychiatric diagnoses. Reward-processing deficits contribute to motivational impairments in depression and schizophrenia, and motor-processing deficits contribute to psychomotor slowing in both depression and schizophrenia. A number of experimental models and clinical trials suggest that inflammation produces deficits in reward and motor processing through common pathways connecting the cortex and the striatum, which includes the nucleus accumbens, caudate nucleus, and putamen.The observed effects of inflammation on psychiatric disorders may cut across traditional conceptualizations of psychiatric diagnoses. Further study may lead to targeted immunomodulating treatments that address difficult-to-treat symptoms in a number of psychiatric disorders. In this review, we use a Research Domain Criteria framework to discuss proposed mechanisms for inflammation and its effects on the domains of reward processing, psychomotor slowing, and threat reactivity. We also discuss data that support contributing roles of metabolic dysregulation and sex differences on the behavioral outcomes of inflammation. Finally, we discuss ways that future studies can help disentangle this complex topic to yield fruitful results that will help advance the field of psychoneuroimmunology.

Anhedonia in Posttraumatic Stress Disorder: Prevalence, Phenotypes, and Neural Circuitry

Anhedonia, the reduction of pleasure and reward-seeking behavior, is a transdiagnostic construct associated with a range of important health outcomes. As with other psychiatric disorders, anhedonia is a relatively common, though understudied, feature of posttraumatic stress disorder (PTSD) that is not adequately targeted by existing treatments. The purpose of this review is to describe the current state of the literature on anhedonia in PTSD and highlight areas for future research based on gaps in the existing evidence base. First, we review evidence for anhedonia symptoms as a distinct PTSD symptom factor and its associations with psychiatric comorbidity, disease trajectory, and quality of life outcomes, as well as describe theories that seek to explain the occurrence of anhedonia among individuals with PTSD. Second, we review evidence for behavioral and neural alterations in reward processing and circuitry, a marker of anhedonia, among individuals with PTSD and in animal models relevant to this disorder. Finally, we discuss key gaps in our understanding of anhedonia in PTSD and suggest areas for future research. Specifically, the timing of anhedonia symptom development and underlying circuit dysfunction in the trauma response trajectory, as well as potential differential associations of facets of anhedonia on clinical outcomes, remain unclear. Additionally, further research is needed to determine potential moderators of anhedonia, as well as the efficacy and effectiveness of psychotherapeutic, psychopharmacological, and device-based interventions targeting anhedonia among individuals with PTSD. A more thorough understanding of these topics will ultimately improve prevention and intervention efforts for PTSD.