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Hinojosa CA, George GC, Ben-Zion Z. Neuroimaging of posttraumatic stress disorder in adults and youth: progress over the last decade on three leading questions of the field. Mol Psychiatry 2024:10.1038/s41380-024-02558-w. [PMID: 38632413 DOI: 10.1038/s41380-024-02558-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 04/04/2024] [Accepted: 04/08/2024] [Indexed: 04/19/2024]
Abstract
Almost three decades have passed since the first posttraumatic stress disorder (PTSD) neuroimaging study was published. Since then, the field of clinical neuroscience has made advancements in understanding the neural correlates of PTSD to create more efficacious treatment strategies. While gold-standard psychotherapy options are available, many patients do not respond to them, prematurely drop out, or never initiate treatment. Therefore, elucidating the neurobiological mechanisms that define the disorder can help guide clinician decision-making and develop individualized mechanisms-based treatment options. To this end, this narrative review highlights progress made in the last decade in adult and youth samples on three outstanding questions in PTSD research: (1) Which neural alterations serve as predisposing (pre-exposure) risk factors for PTSD development, and which are acquired (post-exposure) alterations? (2) Which neural alterations can predict treatment outcomes and define clinical improvement? and (3) Can neuroimaging measures be used to define brain-based biotypes of PTSD? While the studies highlighted in this review have made progress in answering the three questions, the field still has much to do before implementing these findings into clinical practice. Overall, to better answer these questions, we suggest that future neuroimaging studies of PTSD should (A) utilize prospective longitudinal designs, collecting brain measures before experiencing trauma and at multiple follow-up time points post-trauma, taking advantage of multi-site collaborations/consortiums; (B) collect two scans to explore changes in brain alterations from pre-to-post treatment and compare changes in neural activation between treatment groups, including longitudinal follow up assessments; and (C) replicate brain-based biotypes of PTSD. By synthesizing recent findings, this narrative review will pave the way for personalized treatment approaches grounded in neurobiological evidence.
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Affiliation(s)
- Cecilia A Hinojosa
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
| | - Grace C George
- Department of Psychiatry, McLean Hospital, Belmont, MA, USA
| | - Ziv Ben-Zion
- Department of Comparative Medicine, Yale University School of Medicine, New Haven, CT, USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- US Department of Veterans Affairs National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA
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Sendi M, Fu Z, Harnett N, van Rooij S, Vergara V, Pizzagalli D, Daskalakis N, House S, Beaudoin F, An X, Neylan T, Clifford G, Jovanovic T, Linnstaedt S, Germine L, Bollen K, Rauch S, Haran J, Storrow A, Lewandowski C, Musey P, Hendry P, Sheikh S, Jones C, Punches B, Swor R, Gentile N, Murty V, Hudak L, Pascual J, Seamon M, Harris E, Chang A, Pearson C, Peak D, Merchant R, Domeier R, Rathlev N, O'Neil B, Sergot P, Sanchez L, Bruce S, Sheridan J, Harte S, Kessler R, Koenen K, McLean S, Stevens J, Calhoun V, Ressler K. Brain dynamics reflecting an intra-network brain state is associated with increased posttraumatic stress symptoms in the early aftermath of trauma. Res Sq 2024:rs.3.rs-4004473. [PMID: 38496567 PMCID: PMC10942549 DOI: 10.21203/rs.3.rs-4004473/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
This study examines the association between brain dynamic functional network connectivity (dFNC) and current/future posttraumatic stress (PTS) symptom severity, and the impact of sex on this relationship. By analyzing 275 participants' dFNC data obtained ~2 weeks after trauma exposure, we noted that brain dynamics of an inter-network brain state link negatively with current (r=-0.179, pcorrected= 0.021) and future (r=-0.166, pcorrected= 0.029) PTS symptom severity. Also, dynamics of an intra-network brain state correlated with future symptom intensity (r = 0.192, pcorrected = 0.021). We additionally observed that the association between the network dynamics of the inter-network brain state with symptom severity is more pronounced in females (r=-0.244, pcorrected = 0.014). Our findings highlight a potential link between brain network dynamics in the aftermath of trauma with current and future PTSD outcomes, with a stronger protective effect of inter-network brain states against symptom severity in females, underscoring the importance of sex differences.
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Affiliation(s)
| | - Zening Fu
- d Data Science (TReNDS), Georgia State University, Georgia Institute of Technology, Emory University
| | | | | | | | | | | | | | - Francesca Beaudoin
- The Alpert Medical School of Brown University, Rhode Island Hospital and The Miriam Hospital
| | - Xinming An
- University of North Carolina at Chapel Hill
| | - Thomas Neylan
- San Francisco VA Healthcare System; University of California San Francisco
| | - Gari Clifford
- Emory University School of Medicine; Georgia Institute of Technology
| | | | | | | | | | | | - John Haran
- University of Massachusetts Medical School
| | | | | | | | | | | | | | - Brittany Punches
- University of Cincinnati College of Medicine & University of Cincinnati College of Nursing
| | | | | | | | | | - Jose Pascual
- Perelman School of Medicine at the University of Pennsylvania
| | | | | | | | | | | | | | | | | | | | - Paulina Sergot
- Department of Emergency Medicine, McGovern Medical School at UTHealth
| | | | | | | | | | | | | | | | | | - Vince Calhoun
- Georgia Institute of Technology, Emory University and Georgia State University
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3
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Fleming LL, Harnett NG, Ressler KJ. Sensory alterations in post-traumatic stress disorder. Curr Opin Neurobiol 2024; 84:102821. [PMID: 38096758 PMCID: PMC10922208 DOI: 10.1016/j.conb.2023.102821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 11/19/2023] [Accepted: 11/20/2023] [Indexed: 01/13/2024]
Abstract
PTSD is characterized by difficulties in accurately evaluating the threat value of sensory stimuli. While the role of canonical fear and threat neural circuitry in this ability has been well studied, recent lines of evidence suggest a need to include more emphasis on sensory processing in the conceptualization of PTSD symptomology. Specifically, studies have demonstrated a strong association between variability in sensory processing regions and the severity of PTSD symptoms. In this review, we summarize recent findings that underscore the importance of sensory processing in PTSD, in addition to the structural and functional characteristics of associated sensory brain regions. First, we discuss the link between PTSD and various behavioral aspects of sensory processing. This is followed by a discussion of recent findings that link PTSD to variability in the structure of both gray and white matter in sensory brain regions. We then delve into how brain activity (measured with task-based and resting-state functional imaging) in sensory regions informs our understanding of PTSD symptomology.
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Affiliation(s)
- Leland L Fleming
- Division of Depression and Anxiety, McLean Hospital, Belmont, USA; Department of Psychiatry, Harvard Medical School, Boston, USA
| | - Nathaniel G Harnett
- Division of Depression and Anxiety, McLean Hospital, Belmont, USA; Department of Psychiatry, Harvard Medical School, Boston, USA
| | - Kerry J Ressler
- Division of Depression and Anxiety, McLean Hospital, Belmont, USA; Department of Psychiatry, Harvard Medical School, Boston, USA.
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Zilcha-Mano S, Duek O, Suarez-Jimenez B, Zhu X, Lazarov A, Helpman L, Korem N, Malka M, Harpaz-Rotem I, Neria Y. Underlying Hippocampal Mechanism of Posttraumatic Stress Disorder Treatment Outcome: Evidence From Two Clinical Trials. Biol Psychiatry Glob Open Sci 2023; 3:867-874. [PMID: 37881552 PMCID: PMC10593870 DOI: 10.1016/j.bpsgos.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/12/2022] [Accepted: 01/23/2023] [Indexed: 02/05/2023] Open
Abstract
Background The hippocampus plays an important role in the pathophysiology of posttraumatic stress disorder (PTSD) and its prognosis. Accumulating findings suggest that individuals with larger pretreatment hippocampal volume are more likely to benefit from PTSD treatment, but the mechanism underlying this effect is unknown. We investigated whether further increase in hippocampal volume during treatment explains the better prognosis of individuals with greater pretreatment hippocampal volume. Methods We collected structural magnetic resonance imagesfrom patients with PTSD before and after treatment. We examined whether larger hippocampal volume moderates the effect of increased hippocampal volume during treatment on symptom reduction. Given the relatively small sample sizes of treatment studies with pre- and posttreatment magnetic resonance imaging, we focused on effect sizes and sought to replicate findings in an external sample. We tested our hypothesis in study 1 (N = 38; prolonged exposure therapy) and then tested whether the results could be externally replicated in study 2 (N = 20; ketamine infusion followed by exposure therapy). Results Findings from study 1 revealed that increased right hippocampal volume during treatment was associated with greater PTSD symptom reduction only in patients with greater pretreatment right hippocampal volume (p = .03; η2 = 0.13, a large effect). Findings were partially replicated in study 2 for depressive symptoms (p = .034; η2 = 0.25, a very large effect) and for PTSD symptoms (p = .15; η2 = 0.15, a large effect). Conclusions Elucidating increased hippocampal volume as one of the neural mechanisms predictive of therapeutic outcome for individuals with larger pretreatment hippocampal volume may help identify clinical targets for this subgroup.
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Affiliation(s)
| | - Or Duek
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | | | - Xi Zhu
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, New York
| | - Amit Lazarov
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, New York
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Liat Helpman
- Department of Counseling and Human Development, University of Haifa, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Nachshon Korem
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
- National Center for PTSD, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
| | - Michal Malka
- Department of Psychology, University of Haifa, Haifa, Israel
| | - Ilan Harpaz-Rotem
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
- National Center for PTSD, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
| | - Yuval Neria
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, New York
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Marchand WR. Potential Mechanisms of Action and Outcomes of Equine-Assisted Services for Veterans with a History of Trauma: A Narrative Review of the Literature. Int J Environ Res Public Health 2023; 20:6377. [PMID: 37510609 PMCID: PMC10379349 DOI: 10.3390/ijerph20146377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/08/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023]
Abstract
Equine-assisted services (EASs) are being increasingly used as complementary interventions for military veterans who have experienced trauma. However, there is limited evidence of benefit for this population and almost no literature describing the desired potential outcomes and possible mechanisms of action. The aim of this article is to address these gaps by reviewing the extant literature of animal-assisted interventions in general, and equine-assisted services in particular, with the goal of providing guidance for future investigations in the field. Currently, the field is in the early stage of scientific development, but published results are promising. Interventions that enhance treatment compliance and/or outcomes could benefit this population. Preliminary results, reviewed herein, indicate that EAS interventions might benefit the military veteran population by enhancing treatment engagement and therapeutic alliance, as well as by contributing to symptom reduction and resulting in various transdiagnostic benefits. It is recommended that future studies include exploration of potential beneficial outcomes discussed herein, as well as investigate suggested mechanisms of action.
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Affiliation(s)
- William R Marchand
- VISN 19 Whole Health Flagship Site, VA Salt Lake City Health Care System, 500 Foothill, Salt Lake City, UT 84148, USA
- Department of Psychiatry, School of Medicine, University of Utah, 501 Chipeta Way, Salt Lake City, UT 84108, USA
- Animal, Dairy and Veterinary Sciences, Utah State University, 4815 Old Main Hill, Logan, UT 84322, USA
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6
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Suarez-Jimenez B, Lazarov A, Zhu X, Pine DS, Bar-Haim Y, Neria Y. Attention allocation to negatively-valenced stimuli in PTSD is associated with reward-related neural pathways. Psychol Med 2023; 53:4666-4674. [PMID: 35652602 PMCID: PMC9715854 DOI: 10.1017/s003329172200157x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 03/13/2022] [Accepted: 05/11/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND In a recent eye-tracking study we found a differential dwell time pattern for negatively-valenced and neutral faces among patients with posttraumatic stress disorder (PTSD), trauma-exposed healthy control (TEHCs), and healthy control (HC) participants. Here, we explored whether these group differences relate to resting-state functional connectivity (rsFC) patterns of brain areas previously linked to both attention processes and PTSD. These encompass the amygdala, dorsal anterior cingulate cortex (dACC), dorsolateral prefrontal cortex (dlPFC), ventrolateral prefrontal cortex (vlPFC), and nucleus accumbens (NAcc). METHODS Ten minutes magnetic resonance imaging rsFC scans were recorded in 17 PTSD patients, 21 TEHCs, and 16 HCs. Participants then completed a free-viewing eye-tracking task assessing attention allocation outside the scanner. Dwell time on negatively-valenced stimuli (DT%) were assessed relative to functional connectivity in the aforementioned seed regions of interest (amygdala, dACC, dlPFC, vlPFC, and NAcc) to whole-brain voxel-wise rsFC. RESULTS As previously reported, group differences occurred in attention allocation to negative-valence stimuli, with longer dwell time on negatively valence stimuli in the PTSD and TEHC groups than the HC group. Higher DT% correlated with weaker NAcc-orbitofrontal cortex (OFC) connectivity in patients with PTSD. Conversely, a positive association emerged in the HC group between DT% and NAcc-OFC connectivity. CONCLUSIONS While exploratory in nature, present findings may suggest that reward-related brain areas are involved in disengaging attention from negative-valenced stimuli, and possibly in regulating ensuing negative emotions.
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Affiliation(s)
- Benjamin Suarez-Jimenez
- Department of Neuroscience, The Del Monte Institute for Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Amit Lazarov
- School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Xi Zhu
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, NY, USA
| | - Daniel S. Pine
- Section on Developmental Affective Neuroscience, National Institute of Mental Health, Bethesda, MD, USA
| | - Yair Bar-Haim
- School of Psychological Sciences and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Yuval Neria
- Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, New York, NY, USA
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7
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Nestor SM, Giacobbe P, Abrahao A, Davidson B, Rabin JS, Lipsman N, Hamani C. Advances in deep brain stimulation for the treatment of post-traumatic stress disorder. Expert Rev Med Devices 2023; 20:995-998. [PMID: 37930275 DOI: 10.1080/17434440.2023.2280023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 11/02/2023] [Indexed: 11/07/2023]
Affiliation(s)
- Sean M Nestor
- Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Peter Giacobbe
- Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Agessandro Abrahao
- Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Benjamin Davidson
- Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer S Rabin
- Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Nir Lipsman
- Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Clement Hamani
- Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Abi-Dargham A, Moeller SJ, Ali F, DeLorenzo C, Domschke K, Horga G, Jutla A, Kotov R, Paulus MP, Rubio JM, Sanacora G, Veenstra-VanderWeele J, Krystal JH. Candidate biomarkers in psychiatric disorders: state of the field. World Psychiatry 2023; 22:236-262. [PMID: 37159365 PMCID: PMC10168176 DOI: 10.1002/wps.21078] [Citation(s) in RCA: 35] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/08/2023] [Indexed: 05/11/2023] Open
Abstract
The field of psychiatry is hampered by a lack of robust, reliable and valid biomarkers that can aid in objectively diagnosing patients and providing individualized treatment recommendations. Here we review and critically evaluate the evidence for the most promising biomarkers in the psychiatric neuroscience literature for autism spectrum disorder, schizophrenia, anxiety disorders and post-traumatic stress disorder, major depression and bipolar disorder, and substance use disorders. Candidate biomarkers reviewed include various neuroimaging, genetic, molecular and peripheral assays, for the purposes of determining susceptibility or presence of illness, and predicting treatment response or safety. This review highlights a critical gap in the biomarker validation process. An enormous societal investment over the past 50 years has identified numerous candidate biomarkers. However, to date, the overwhelming majority of these measures have not been proven sufficiently reliable, valid and useful to be adopted clinically. It is time to consider whether strategic investments might break this impasse, focusing on a limited number of promising candidates to advance through a process of definitive testing for a specific indication. Some promising candidates for definitive testing include the N170 signal, an event-related brain potential measured using electroencephalography, for subgroup identification within autism spectrum disorder; striatal resting-state functional magnetic resonance imaging (fMRI) measures, such as the striatal connectivity index (SCI) and the functional striatal abnormalities (FSA) index, for prediction of treatment response in schizophrenia; error-related negativity (ERN), an electrophysiological index, for prediction of first onset of generalized anxiety disorder, and resting-state and structural brain connectomic measures for prediction of treatment response in social anxiety disorder. Alternate forms of classification may be useful for conceptualizing and testing potential biomarkers. Collaborative efforts allowing the inclusion of biosystems beyond genetics and neuroimaging are needed, and online remote acquisition of selected measures in a naturalistic setting using mobile health tools may significantly advance the field. Setting specific benchmarks for well-defined target application, along with development of appropriate funding and partnership mechanisms, would also be crucial. Finally, it should never be forgotten that, for a biomarker to be actionable, it will need to be clinically predictive at the individual level and viable in clinical settings.
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Affiliation(s)
- Anissa Abi-Dargham
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Scott J Moeller
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Farzana Ali
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Christine DeLorenzo
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Katharina Domschke
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Centre for Basics in Neuromodulation, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Guillermo Horga
- Department of Psychiatry, Columbia University, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Amandeep Jutla
- Department of Psychiatry, Columbia University, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Roman Kotov
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | | | - Jose M Rubio
- Zucker School of Medicine at Hofstra-Northwell, Hempstead, NY, USA
- Feinstein Institute for Medical Research - Northwell, Manhasset, NY, USA
- Zucker Hillside Hospital - Northwell Health, Glen Oaks, NY, USA
| | - Gerard Sanacora
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Jeremy Veenstra-VanderWeele
- Department of Psychiatry, Columbia University, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - John H Krystal
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
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Scheer JR, Helminen EC, Cascalheira CJ, Jaipuriyar V, Shaw TJ, Zabelski S, Behari K, Pirog S, Batchelder AW, Possemato K, Hughes TL, Sullivan TP. Probable PTSD, PTSD symptom severity, and comorbid PTSD and hazardous drinking among sexual minority women compared to heterosexual women: A meta-analysis. Clin Psychol Rev 2023; 102:102283. [PMID: 37150043 PMCID: PMC10205673 DOI: 10.1016/j.cpr.2023.102283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 01/24/2023] [Accepted: 04/20/2023] [Indexed: 05/09/2023]
Abstract
Posttraumatic stress disorder (PTSD) is more prevalent among sexual minority women (SMW) than among heterosexual women. PTSD risk varies among SMW, but no meta-analysis has clarified sexual identity-related disparities in probable PTSD among women or SMW's heterogeneity in PTSD risk. SMW are also at pronounced risk of comorbid PTSD and hazardous drinking (HD). However, the difference in comorbid PTSD/HD between SMW and heterosexual women is understudied. This meta-analysis aimed to provide a comprehensive understanding of differences between SMW and heterosexual women and among SMW across demographic characteristics. Peer-reviewed publications that were written in English and reported quantitative data on PTSD specific to SMW were included. Eligible publications (n = 45) were identified through a systematic search of 11 electronic databases, supplemented by a search of reference lists of relevant papers. We found that probable PTSD, PTSD symptom severity, and probable comorbid PTSD/HD are highly prevalent among SMW, with SMW of color, transgender and gender diverse people, and bi+ women (e.g., bisexual, pansexual, queer) being at greatest risk. These results emphasize the need to improve accurate assessment of trauma-related sequelae among SMW and to develop, disseminate, and implement culturally sensitive treatments to reduce PTSD and comorbid PTSD/HD among at-risk SMW.
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Affiliation(s)
- Jillian R Scheer
- Department of Psychology, Syracuse University, 414 Huntington Hall, Syracuse, NY 13244, USA.
| | - Emily C Helminen
- Department of Psychology, Syracuse University, 414 Huntington Hall, Syracuse, NY 13244, USA; College of Health Science and Technology, Rochester Institute of Technology, USA
| | - Cory J Cascalheira
- Department of Psychology, Syracuse University, 414 Huntington Hall, Syracuse, NY 13244, USA; Department of Counseling & Educational Psychology, New Mexico State University, Las Cruces, NM, USA
| | - Virinca Jaipuriyar
- Department of Psychology, Syracuse University, 414 Huntington Hall, Syracuse, NY 13244, USA
| | - Thomas J Shaw
- Department of Psychology, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | - Sasha Zabelski
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Kriti Behari
- Department of Psychology, Syracuse University, 414 Huntington Hall, Syracuse, NY 13244, USA
| | - Sophia Pirog
- Department of Psychology, Syracuse University, 414 Huntington Hall, Syracuse, NY 13244, USA
| | - Abigail W Batchelder
- Harvard Medical School, Harvard University, Boston, MA, USA; Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Kyle Possemato
- VA Center for Integrated Healthcare, Syracuse Veterans Affairs Medical Center, Syracuse, NY, USA
| | - Tonda L Hughes
- School of Nursing and Department of Psychiatry, Columbia University, New York, NY, USA; Columbia University School of Nursing Center for Sexual and Gender Minority Research, New York, NY, USA
| | - Tami P Sullivan
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
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10
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Clancy KJ, Devignes Q, Kumar P, May V, Hammack SE, Akman E, Casteen EJ, Pernia CD, Jobson SA, Lewis MW, Daskalakis NP, Carlezon WA, Ressler KJ, Rauch SL, Rosso IM. Circulating PACAP levels are associated with increased amygdala-default mode network resting-state connectivity in posttraumatic stress disorder. Neuropsychopharmacology 2023:10.1038/s41386-023-01593-5. [PMID: 37161077 PMCID: PMC10267202 DOI: 10.1038/s41386-023-01593-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/10/2023] [Accepted: 04/20/2023] [Indexed: 05/11/2023]
Abstract
The pituitary adenylate cyclase-activating polypeptide (PACAP) system is implicated in posttraumatic stress disorder (PTSD) and related amygdala-mediated arousal and threat reactivity. PTSD is characterized by increased amygdala reactivity to threat and, more recently, aberrant intrinsic connectivity of the amygdala with large-scale resting state networks, specifically the default mode network (DMN). While the influence of PACAP on amygdala reactivity has been described, its association with intrinsic amygdala connectivity remains unknown. To fill this gap, we examined functional connectivity of resting-state functional magnetic resonance imaging (fMRI) in eighty-nine trauma-exposed adults (69 female) screened for PTSD symptoms to examine the association between blood-borne (circulating) PACAP levels and amygdala-DMN connectivity. Higher circulating PACAP levels were associated with increased amygdala connectivity with posterior DMN regions, including the posterior cingulate cortex/precuneus (PCC/Precun) and left angular gyrus (lANG). Consistent with prior work, this effect was seen in female, but not male, participants and the centromedial, but not basolateral, subregions of the amygdala. Clinical association analyses linked amygdala-PCC/Precun connectivity to anxious arousal symptoms, specifically exaggerated startle response. Taken together, our findings converge with previously demonstrated effects of PACAP on amygdala activity in PTSD-related processes and offer novel evidence for an association between PACAP and intrinsic amygdala connectivity patterns in PTSD. Moreover, these data provide preliminary evidence to motivate future work ascertaining the sex- and subregion-specificity of these effects. Such findings may enable novel mechanistic insights into neural circuit dysfunction in PTSD and how the PACAP system confers risk through a disruption of intrinsic resting-state network dynamics.
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Affiliation(s)
- Kevin J Clancy
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Quentin Devignes
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Poornima Kumar
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Victor May
- Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | | | - Eylül Akman
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
| | - Emily J Casteen
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
| | - Cameron D Pernia
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Sydney A Jobson
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
| | - Michael W Lewis
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Nikolaos P Daskalakis
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - William A Carlezon
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Kerry J Ressler
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Scott L Rauch
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Isabelle M Rosso
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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11
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Wheaton MG, Choo TH, Markowitz JC. Changes in avoidance and distress related to trauma reminders in PTSD psychotherapy. J Behav Ther Exp Psychiatry 2023; 78:101805. [PMID: 36435547 PMCID: PMC10029731 DOI: 10.1016/j.jbtep.2022.101805] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 11/02/2022] [Accepted: 11/11/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Research has examined reductions in patient distress recounting trauma narratives in Prolonged Exposure (PE) for posttraumatic stress disorder (PTSD). It remains unclear whether changes in distress and avoidance related to environmental trauma reminders matter in PE and other PTSD treatments, including non-exposure Interpersonal Psychotherapy (IPT). METHODS Data came from adults with chronic PTSD (N = 92) who completed a treatment trial comparing PE, IPT, and Relaxation Therapy (RT). We employed the Self-Initiated In-Vivo Exposure Scale (SIIVES), which measures patient distress from and avoidance of situational trauma reminders, to calculate reliable change in distress and avoidance. PTSD symptoms, depression, quality of life, and functioning assessments were collected before and after 14 weeks of treatment. RESULTS Overall, 48.1% of patients experienced reliable change in avoidance, while 51.9% showed reliable change in distress. Rates of reliable change did not differ by treatment group, although PE appeared to achieve reliable change earlier. Only one baseline characteristic predicted reliable change: patients with comorbid depression were less likely to reliably change in avoidance. At post-treatment, patients achieving reliable change had lower PTSD severity and depression and increased quality of life and social functioning. Statistical modeling revealed that changes in distress and avoidance related to subsequent reduction in PTSD symptoms in all three treatment groups, though this relationship appeared strongest in PE. LIMITATIONS The sample was relatively small. CONCLUSIONS Change in avoidance and distress associated with situational trauma reminders was associated with a range of clinical outcomes and may represent important factors in multiple PTSD psychotherapies.
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Affiliation(s)
- Michael G Wheaton
- Barnard College, Department of Psychology, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA.
| | - Tse-Hwei Choo
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City, NY, USA
| | - John C Markowitz
- New York State Psychiatric Institute, New York, NY, USA; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City, NY, USA
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12
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Katsumi Y, de Voogd LD, Ventura-Bort C, Liu W, Qin S. Editorial: Interaction between affect and memory in the brain: From basic mechanisms to clinical implications. Front Behav Neurosci 2023; 17:1120282. [PMID: 36761035 PMCID: PMC9903060 DOI: 10.3389/fnbeh.2023.1120282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 01/10/2023] [Indexed: 01/26/2023] Open
Affiliation(s)
- Yuta Katsumi
- Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States,*Correspondence: Yuta Katsumi ✉
| | - Lycia D. de Voogd
- Center for Cognitive Neuroimaging, Donders Institute for Brain Cognition and Behaviour, Radboud University, Nijmegen, Netherlands,Behavioral Science Institute, Radboud University, Nijmegen, Netherlands
| | - Carlos Ventura-Bort
- Department of Biological Psychology and Affective Science, Faculty of Human Sciences, University of Potsdam, Potsdam, Germany
| | - Wei Liu
- Key Laboratory of Adolescent Cyberpsychology and Behavior (CCNU), Ministry of Education, Wuhan, China,Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, China
| | - Shaozheng Qin
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China,Chinese Institute for Brain Research, Beijing, China
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13
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Kaplan GB, Dadhi NA, Whitaker CS. Mitochondrial dysfunction in animal models of PTSD: Relationships between behavioral models, neural regions, and cellular maladaptation. Front Physiol 2023; 14:1105839. [PMID: 36923289 PMCID: PMC10009692 DOI: 10.3389/fphys.2023.1105839] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 01/31/2023] [Indexed: 02/17/2023] Open
Abstract
Post-traumatic stress disorder (PTSD) is a trauma-related condition that produces distressing fear memory intrusions, avoidance behaviors, hyperarousal, stress responses, insomnia and other symptoms. This review of rodent models of PTSD examines trauma effects on fear-related learning, cognition, and avoidance, emotional and arousal behaviors and on mitochondrial dysfunction in relevant neural pathways. The review focuses on research that includes four elements: consensus PTSD rodent models, behavioral phenotyping, mitochondrial dysfunction within key neural regions. This approach allows for the integration of behavioral, neural and cellular findings in PTSD models. The PTSD models reviewed include fear conditioning, predator/social stress, chronic restraint stress, single prolonged stress, social isolation, chronic unpredictable stress and early life stress. These models produce a variety of PTSD-related behaviors that include associative and non-associative fear- and stress-related responses, hyperarousal, avoidance behaviors, cognitive disturbances, social withdrawal, compulsive behaviors, anhedonia-, anxiety- and depression-related behaviors. Neural regions included fear- and stress-related regions of the prefrontal cortex, hippocampal, amygdala, nucleus accumbens and hypothalamus. PTSD models produced mitochondrial dysfunction that includes dysregulation of oxidative phosphorylation and other metabolic pathways including β-oxidation of fatty acids and the tricarboxylic acid pathway. These models generated neural reactive oxygen species that damage DNA, proteins, and lipids. Trauma models further altered mitochondrial structure and replication and affected neuroinflammatory responses, signal transduction and apoptosis. Antidepressant medications used for the treatment of PTSD reversed stress-induced changes in some PTSD-like behaviors and many elements of brain mitochondrial dysfunction. Future studies can develop PTSD models which are ecologically valid and result in a broader manifestation of PTSD-related behaviors as it is clinically defined. This review highlights mitochondrial mechanisms associated with PTSD-like behaviors that have been produced in an array of consensus PTSD models and identifies putative circuit-based targets for more effective treatment for this debilitating disorder.
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Affiliation(s)
- Gary B Kaplan
- Mental Health Service, VA Boston Healthcare System, West Roxbury, MA, United States.,Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States.,Graduate Program in Neuroscience, Boston University, Boston, MA, United States
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14
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Keefe JR, Suarez-Jimenez B, Zhu X, Lazarov A, Durosky A, Such S, Marohasy C, Lissek S, Neria Y. Elucidating behavioral and functional connectivity markers of aberrant threat discrimination in PTSD. Depress Anxiety 2022; 39:891-901. [PMID: 36336894 PMCID: PMC10583266 DOI: 10.1002/da.23295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 10/12/2022] [Accepted: 10/22/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Patients with posttraumatic stress disorder (PTSD) tend to overgeneralize threat to safe stimuli, potentially reflecting aberrant stimuli discrimination. Yet, it is not clear whether threat overgeneralization reflects general discrimination deficits, or rather a specific bias related to aversive stimuli. Here we tested this question and characterized the neural correlates of threat discrimination. METHODS One-hundred and eight participants (33 PTSD; 43 trauma-exposed controls; 32 healthy controls) completed an emotionally neutral complex shape discrimination task involving identifying in 42 similar pairs the previously observed shape; and an emotionally aversive discrimination task, involving providing risk ratings for an aversive conditioned stimulus (CS+), and for several stimuli gradually differing in size from the original CS+. Resting state functional connectivity (rsFC) was collected before completing the tasks. RESULTS No group differences emerged on the emotionally neutral task. Conversely, on the emotionally aversive task, individuals with PTSD had steeper linear risk rating slopes as the stimuli more resembled the conditioned stimulus. Finally, lower rsFC of amygdala-default mode network (DMN) and DMN-salience network (SN) were associated with steeper risk slopes, while for hippocampus-SN, lower rsFC was found only among participants with PTSD. CONCLUSIONS Individuals with PTSD show deficits in discrimination only when presented with aversive stimuli. Dysregulated discrimination pattern may relate to a lack of input from regulatory brain areas (e.g., DMN/hippocampus) to threat-related brain areas (e.g., SN/amygdala).
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Affiliation(s)
- John R. Keefe
- Psychiatry Research Institute at Montefiore Einstein, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Xi Zhu
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- New York State Psychiatric Institute, New York, New York, USA
| | - Amit Lazarov
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Ariel Durosky
- Department of Psychology, The University of Tulsa, Oklahoma, Tulsa, USA
| | - Sara Such
- Department of Psychology, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Caroline Marohasy
- Department of Psychology, University of Washington, Seattle, Washington, USA
| | - Shmuel Lissek
- Department of Psychology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Yuval Neria
- Neuroscience Department, University of Rochester, Rochester, New York, USA
- New York State Psychiatric Institute, New York, New York, USA
- Department of Epidemiology, Columbia University Irving Medical Center, New York, New York, USA
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15
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Kulbe JR, Jain S, Nelson LD, Korley FK, Mukherjee P, Sun X, Okonkwo DO, Giacino JT, Vassar MJ, Robertson CS, McCrea MA, Wang KKW, Temkin N, Mac Donald CL, Taylor SR, Ferguson AR, Markowitz AJ, Diaz-Arrastia R, Manley GT, Stein MB. Association of day-of-injury plasma glial fibrillary acidic protein concentration and six-month posttraumatic stress disorder in patients with mild traumatic brain injury. Neuropsychopharmacology 2022; 47:2300-2308. [PMID: 35717463 PMCID: PMC9630517 DOI: 10.1038/s41386-022-01359-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/16/2022] [Accepted: 05/31/2022] [Indexed: 11/10/2022]
Abstract
Several proteins have proven useful as blood-based biomarkers to assist in evaluation and management of traumatic brain injury (TBI). The objective of this study was to determine whether two day-of-injury blood-based biomarkers are predictive of posttraumatic stress disorder (PTSD). We used data from 1143 individuals with mild TBI (mTBI; defined as admission Glasgow Coma Scale [GCS] score 13-15) enrolled in TRACK-TBI, a prospective longitudinal study of level 1 trauma center patients. Plasma glial fibrillary acidic protein (GFAP) and serum high sensitivity C-reactive protein (hsCRP) were measured from blood collected within 24 h of injury. Two hundred and twenty-seven (19.9% of) patients had probable PTSD (PCL-5 score ≥ 33) at 6 months post-injury. GFAP levels were positively associated (Spearman's rho = 0.35, p < 0.001) with duration of posttraumatic amnesia (PTA). There was an inverse association between PTSD and (log)GFAP (adjusted OR = 0.85, 95% CI 0.77-0.95 per log unit increase) levels, but no significant association with (log)hsCRP (adjusted OR = 1.11, 95% CI 0.98-1.25 per log unit increase) levels. Elevated day-of-injury plasma GFAP, a biomarker of glial reactivity, is associated with reduced risk of PTSD after mTBI. This finding merits replication and additional studies to determine a possible neurocognitive basis for this relationship.
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Affiliation(s)
- Jacqueline R. Kulbe
- grid.266100.30000 0001 2107 4242Department of Psychiatry, University of California, San Diego, La Jolla, CA USA
| | - Sonia Jain
- grid.266100.30000 0001 2107 4242Biostatistics Research Center, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA USA
| | - Lindsay D. Nelson
- grid.30760.320000 0001 2111 8460Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, WI USA
| | - Frederick K. Korley
- grid.214458.e0000000086837370Department of Emergency Medicine, University of Michigan, Ann Arbor, MI USA
| | - Pratik Mukherjee
- grid.266102.10000 0001 2297 6811Department of Radiology & Biomedical Imaging, UCSF, San Francisco, CA USA ,grid.266102.10000 0001 2297 6811Department of Bioengineering & Therapeutic Sciences, UCSF, San Francisco, CA USA
| | - Xiaoying Sun
- grid.266100.30000 0001 2107 4242Biostatistics Research Center, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA USA
| | - David O. Okonkwo
- grid.412689.00000 0001 0650 7433Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA USA
| | - Joseph T. Giacino
- grid.38142.3c000000041936754XDepartment of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA USA ,grid.416228.b0000 0004 0451 8771Spaulding Rehabilitation Hospital, Charlestown, MA USA
| | - Mary J. Vassar
- grid.416732.50000 0001 2348 2960Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA USA ,grid.266102.10000 0001 2297 6811Department of Neurological Surgery, UCSF, San Francisco, CA USA
| | - Claudia S. Robertson
- grid.39382.330000 0001 2160 926XDepartment of Neurosurgery, Baylor College of Medicine, Houston, TX USA
| | - Michael A. McCrea
- grid.30760.320000 0001 2111 8460Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, WI USA
| | - Kevin K. W. Wang
- grid.15276.370000 0004 1936 8091Department of Emergency Medicine, University of Florida, Gainesville, FL USA
| | - Nancy Temkin
- grid.34477.330000000122986657Department of Neurological Surgery, University of Washington, Seattle, WA USA
| | - Christine L. Mac Donald
- grid.34477.330000000122986657Department of Neurological Surgery, University of Washington, Seattle, WA USA
| | - Sabrina R. Taylor
- grid.416732.50000 0001 2348 2960Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA USA ,grid.266102.10000 0001 2297 6811Department of Neurological Surgery, UCSF, San Francisco, CA USA
| | - Adam R. Ferguson
- grid.416732.50000 0001 2348 2960Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA USA
| | - Amy J. Markowitz
- grid.416732.50000 0001 2348 2960Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA USA
| | - Ramon Diaz-Arrastia
- grid.25879.310000 0004 1936 8972Department of Neurology, University of Pennsylvania, Philadelphia, PA USA
| | - Geoffrey T. Manley
- grid.416732.50000 0001 2348 2960Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA USA ,grid.266102.10000 0001 2297 6811Department of Neurological Surgery, UCSF, San Francisco, CA USA
| | - Murray B. Stein
- grid.266100.30000 0001 2107 4242Department of Psychiatry, University of California, San Diego, La Jolla, CA USA ,grid.266100.30000 0001 2107 4242School of Public Health, University of California, San Diego, La Jolla, CA USA ,grid.410371.00000 0004 0419 2708VA San Diego Healthcare System, San Diego, CA USA
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16
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Zhu X, Suarez-Jimenez B, Lazarov A, Such S, Marohasy C, Small SS, Wager TD, Lindquist MA, Lissek S, Neria Y. Sequential fear generalization and network connectivity in trauma exposed humans with and without psychopathology. Commun Biol 2022; 5:1275. [PMID: 36414703 PMCID: PMC9681725 DOI: 10.1038/s42003-022-04228-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 11/04/2022] [Indexed: 11/23/2022] Open
Abstract
While impaired fear generalization is known to underlie a wide range of psychopathology, the extent to which exposure to trauma by itself results in deficient fear generalization and its neural abnormalities is yet to be studied. Similarly, the neural function of intact fear generalization in people who endured trauma and did not develop significant psychopathology is yet to be characterized. Here, we utilize a generalization fMRI task, and a network connectivity approach to clarify putative behavioral and neural markers of trauma and resilience. The generalization task enables longitudinal assessments of threat discrimination learning. Trauma-exposed participants (TE; N = 62), compared to healthy controls (HC; N = 26), show lower activity reduction in salience network (SN) and right executive control network (RECN) across the two sequential generalization stages, and worse discrimination learning in SN measured by linear deviation scores (LDS). Comparison of resilient, trauma-exposed healthy control participants (TEHC; N = 31), trauma exposed individuals presenting with psychopathology (TEPG; N = 31), and HC, reveals a resilience signature of network connectivity differences in the RECN during generalization learning measured by LDS. These findings may indicate a trauma exposure phenotype that has the potential to advance the development of innovative treatments by targeting and engaging specific neural dysfunction among trauma-exposed individuals, across different psychopathologies.
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Affiliation(s)
- Xi Zhu
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA.,New York State Psychiatric Institute, New York, NY, USA
| | | | - Amit Lazarov
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA.,School School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Sara Such
- Department of Psychology, Pennsylvania State University, State College, PA, USA
| | - Caroline Marohasy
- Department of Neuroscience, University of Rochester, Rochester, NY, USA
| | - Scott S Small
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA.,New York State Psychiatric Institute, New York, NY, USA.,Department of Neurology, Columbia University Irving Medical Center, New York, USA
| | - Tor D Wager
- Neuroscience Department, Dartmouth College, Hanover, NH, USA
| | - Martin A Lindquist
- Department of Biostatistics, Johns Hopkins University, Baltimore, MD, USA
| | - Shmuel Lissek
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Yuval Neria
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA. .,New York State Psychiatric Institute, New York, NY, USA. .,Department of Epidemiology, Columbia University Irving Medical Center, New York, NY, USA.
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17
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Li Q, Coulson Theodorsen M, Konvalinka I, Eskelund K, Karstoft KI, Bo Andersen S, Andersen TS. Resting-state EEG functional connectivity predicts post-traumatic stress disorder subtypes in veterans. J Neural Eng 2022; 19. [PMID: 36250685 DOI: 10.1088/1741-2552/ac9aaf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 10/13/2022] [Indexed: 01/11/2023]
Abstract
Objective. Post-traumatic stress disorder (PTSD) is highly heterogeneous, and identification of quantifiable biomarkers that could pave the way for targeted treatment remains a challenge. Most previous electroencephalography (EEG) studies on PTSD have been limited to specific handpicked features, and their findings have been highly variable and inconsistent. Therefore, to disentangle the role of promising EEG biomarkers, we developed a machine learning framework to investigate a wide range of commonly used EEG biomarkers in order to identify which features or combinations of features are capable of characterizing PTSD and potential subtypes.Approach. We recorded 5 min of eyes-closed and 5 min of eyes-open resting-state EEG from 202 combat-exposed veterans (53% with probable PTSD and 47% combat-exposed controls). Multiple spectral, temporal, and connectivity features were computed and logistic regression, random forest, and support vector machines with feature selection methods were employed to classify PTSD. To obtain robust results, we performed repeated two-layer cross-validation to test on an entirely unseen test set.Main results. Our classifiers obtained a balanced test accuracy of up to 62.9% for predicting PTSD patients. In addition, we identified two subtypes within PTSD: one where EEG patterns were similar to those of the combat-exposed controls, and another that were characterized by increased global functional connectivity. Our classifier obtained a balanced test accuracy of 79.4% when classifying this PTSD subtype from controls, a clear improvement compared to predicting the whole PTSD group. Interestingly, alpha connectivity in the dorsal and ventral attention network was particularly important for the prediction, and these connections were positively correlated with arousal symptom scores, a central symptom cluster of PTSD.Significance. Taken together, the novel framework presented here demonstrates how unsupervised subtyping can delineate heterogeneity and improve machine learning prediction of PTSD, and may pave the way for better identification of quantifiable biomarkers.
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Affiliation(s)
- Qianliang Li
- Section for Cognitive Systems, DTU Compute, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Maya Coulson Theodorsen
- Section for Cognitive Systems, DTU Compute, Technical University of Denmark, Kongens Lyngby, Denmark.,Department of Military Psychology, Danish Veteran Centre, Danish Defence, Copenhagen, Denmark.,Research and Knowledge Centre, Danish Veteran Centre, Danish Defence, Ringsted, Denmark
| | - Ivana Konvalinka
- Section for Cognitive Systems, DTU Compute, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Kasper Eskelund
- Department of Military Psychology, Danish Veteran Centre, Danish Defence, Copenhagen, Denmark.,Research and Knowledge Centre, Danish Veteran Centre, Danish Defence, Ringsted, Denmark
| | - Karen-Inge Karstoft
- Research and Knowledge Centre, Danish Veteran Centre, Danish Defence, Ringsted, Denmark.,Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Søren Bo Andersen
- Research and Knowledge Centre, Danish Veteran Centre, Danish Defence, Ringsted, Denmark
| | - Tobias S Andersen
- Section for Cognitive Systems, DTU Compute, Technical University of Denmark, Kongens Lyngby, Denmark
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18
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Evans TC, Alonso MR, Jagger-Rickels A, Rothlein D, Zuberer A, Bernstein J, Fortier CB, Fonda JR, Villalon A, Jorge R, Milberg W, McGlinchey R, DeGutis J, Esterman M. PTSD symptomatology is selectively associated with impaired sustained attention ability and dorsal attention network synchronization. Neuroimage Clin 2022; 36:103146. [PMID: 36055063 PMCID: PMC9437905 DOI: 10.1016/j.nicl.2022.103146] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/03/2022] [Accepted: 08/03/2022] [Indexed: 12/14/2022]
Abstract
Posttraumatic Stress Disorder (PTSD) symptomatology is associated with dysregulated sustained attention, which produces functional impairments. Performance on sustained attention paradigms such as continuous performance tasks are influenced by both the ability to sustain attention and response strategy. However, previous studies have not dissociated PTSD-related associations with sustained attention ability and strategy, which limits characterization of neural circuitry underlying PTSD-related attentional impairments. Therefore, we characterized and replicated PTSD-related associations with sustained attention ability and response strategy in trauma-exposed Veterans, which guided characterization of PTSD-related differences in neural circuit function. In Study 1, PTSD symptoms were selectively associated with reduced sustained attention ability, but not more impulsive response strategies. In Study 2, we utilized task and resting-state fMRI to characterize neural circuitry underlying PTSD-related differences in sustained attention ability. Both PTSD symptomatology and sustained attention ability exhibited converging associations with reduced dorsal attention network (DAN) synchronization to endogeneous attentional fluctuations. Post-hoc time course analyses demonstrated that PTSD symptoms were most accurately characterized by delayed, rather than globally reduced, DAN synchronization to endogenous attentional fluctuations. Together, these findings suggest that PTSD symptomatology may selectively impair sustained attention ability by disrupting proactive engagement of attentional control circuitry.
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Affiliation(s)
- Travis C. Evans
- Boston Attention and Learning Lab (BALLAB), VA Boston Healthcare System, USA,Department of Psychiatry, Boston University School of Medicine, USA,Corresponding author at: VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA 02130, USA.
| | | | - Audreyana Jagger-Rickels
- Boston Attention and Learning Lab (BALLAB), VA Boston Healthcare System, USA,National Center for PTSD, VA Boston Healthcare System, USA
| | - David Rothlein
- Boston Attention and Learning Lab (BALLAB), VA Boston Healthcare System, USA,National Center for PTSD, VA Boston Healthcare System, USA
| | - Agnieszka Zuberer
- Boston Attention and Learning Lab (BALLAB), VA Boston Healthcare System, USA,Department of Psychiatry and Psychotherapy, University Hospital Jena, Germany,Department of Psychiatry and Psychotherapy, University of Tübingen, Germany
| | - John Bernstein
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, USA
| | - Catherine B. Fortier
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, USA,Department of Psychiatry, Harvard Medical School, USA,Geriatric Research, Education, and Clinical Center (GRECC), VA Boston Healthcare System, USA
| | - Jennifer R. Fonda
- Department of Psychiatry, Boston University School of Medicine, USA,Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, USA,Department of Psychiatry, Harvard Medical School, USA,Geriatric Research, Education, and Clinical Center (GRECC), VA Boston Healthcare System, USA
| | - Audri Villalon
- Translational Research Center for TBI and Stress Disorders (TRACTS), Michael E. DeBakey VA Medical Center, Houston, TX, USA,Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry, Baylor College of Medicine, USA
| | - Ricardo Jorge
- Translational Research Center for TBI and Stress Disorders (TRACTS), Michael E. DeBakey VA Medical Center, Houston, TX, USA,Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry, Baylor College of Medicine, USA
| | - William Milberg
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, USA,Department of Psychiatry, Harvard Medical School, USA,Geriatric Research, Education, and Clinical Center (GRECC), VA Boston Healthcare System, USA
| | - Regina McGlinchey
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, USA,Department of Psychiatry, Harvard Medical School, USA,Geriatric Research, Education, and Clinical Center (GRECC), VA Boston Healthcare System, USA
| | - Joseph DeGutis
- Boston Attention and Learning Lab (BALLAB), VA Boston Healthcare System, USA,Department of Psychiatry, Harvard Medical School, USA,Geriatric Research, Education, and Clinical Center (GRECC), VA Boston Healthcare System, USA
| | - Michael Esterman
- Boston Attention and Learning Lab (BALLAB), VA Boston Healthcare System, USA,Department of Psychiatry, Boston University School of Medicine, USA,National Center for PTSD, VA Boston Healthcare System, USA,Neuroimaging Research for Veterans (NeRVe) Center, VA Boston Healthcare System, USA
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19
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James LM, Leuthold AF, Georgopoulos AP. MEG neural signature of sexual trauma in women veterans with PTSD. Exp Brain Res 2022; 240:2135-2142. [PMID: 35786746 DOI: 10.1007/s00221-022-06405-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 06/18/2022] [Indexed: 11/28/2022]
Abstract
Previous research has documented the utility of synchronous neural interactions (SNI) in classifying women veterans with and without posttraumatic stress disorder (PTSD) and other trauma-related outcomes based on functional connectivity using magnetoencephalography (MEG). Here, we extend that line of research to evaluate trauma-specific PTSD neural signatures with MEG in women veterans. Participants completed diagnostic interviews and underwent a task-free MEG scan from which SNI was computed. Thirty-five women veterans were diagnosed with PTSD due to sexual trauma and sixteen with PTSD due to non-sexual trauma. Strength of SNI was compared in women with and without sexual trauma, and linear discriminant analysis was used to classify the brain patterns of women with PTSD due to sexual trauma and non-sexual trauma. Comparison of SNI strength between the two groups revealed widespread hypercorrelation in women with sexual trauma relative to those without sexual trauma. Furthermore, using SNI, the brains of participants were classified as sexual trauma or non-sexual trauma with 100% accuracy. These findings bolster evidence supporting the utility of task-free SNI and suggest that neural signatures of PTSD are trauma-specific.
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Affiliation(s)
- Lisa M James
- The PTSD Research Group, Brain Sciences Center (11B), Department of Veterans Affairs Health Care System, One Veterans Drive, Minneapolis, MN, USA. .,Department of Neuroscience, University of Minnesota Medical School, Minneapolis, MN, USA. .,Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA. .,Center for Cognitive Sciences, University of Minnesota, Minneapolis, MN, USA.
| | - Arthur F Leuthold
- The PTSD Research Group, Brain Sciences Center (11B), Department of Veterans Affairs Health Care System, One Veterans Drive, Minneapolis, MN, USA.,Department of Neuroscience, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Apostolos P Georgopoulos
- The PTSD Research Group, Brain Sciences Center (11B), Department of Veterans Affairs Health Care System, One Veterans Drive, Minneapolis, MN, USA.,Department of Neuroscience, University of Minnesota Medical School, Minneapolis, MN, USA.,Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA.,Center for Cognitive Sciences, University of Minnesota, Minneapolis, MN, USA.,Department of Neurology, University of Minnesota, Minneapolis, MN, USA
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20
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Dunsmoor JE, Cisler JM, Fonzo GA, Creech SK, Nemeroff CB. Laboratory models of post-traumatic stress disorder: The elusive bridge to translation. Neuron 2022; 110:1754-1776. [PMID: 35325617 PMCID: PMC9167267 DOI: 10.1016/j.neuron.2022.03.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/18/2022] [Accepted: 02/28/2022] [Indexed: 12/14/2022]
Abstract
Post-traumatic stress disorder (PTSD) is a debilitating mental illness composed of a heterogeneous collection of symptom clusters. The unique nature of PTSD as arising from a precipitating traumatic event helps simplify cross-species translational research modeling the neurobehavioral effects of stress and fear. However, the neurobiological progress on these complex neural circuits informed by animal models has yet to produce novel, evidence-based clinical treatment for PTSD. Here, we provide a comprehensive overview of popular laboratory models of PTSD and provide concrete ideas for improving the validity and clinical translational value of basic research efforts in humans. We detail modifications to simplified animal paradigms to account for myriad cognitive factors affected in PTSD, which may contribute to abnormalities in regulating fear. We further describe new avenues for integrating different areas of psychological research underserved by animal models of PTSD. This includes incorporating emerging trends in the cognitive neuroscience of episodic memory, emotion regulation, social-emotional processes, and PTSD subtyping to provide a more comprehensive recapitulation of the human experience to trauma in laboratory research.
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Affiliation(s)
- Joseph E Dunsmoor
- Department of Psychiatry and Behavioral Sciences, University of Texas at Austin Dell Medical School, Austin, TX, USA; Center for Psychedelic Research and Therapy, University of Texas at Austin Dell Medical School, Austin, TX, USA.
| | - Josh M Cisler
- Department of Psychiatry and Behavioral Sciences, University of Texas at Austin Dell Medical School, Austin, TX, USA; Institute for Early Life Adversity Research, University of Texas at Austin, Austin, TX, USA; Center for Psychedelic Research and Therapy, University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Gregory A Fonzo
- Department of Psychiatry and Behavioral Sciences, University of Texas at Austin Dell Medical School, Austin, TX, USA; Institute for Early Life Adversity Research, University of Texas at Austin, Austin, TX, USA; Center for Psychedelic Research and Therapy, University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Suzannah K Creech
- Department of Psychiatry and Behavioral Sciences, University of Texas at Austin Dell Medical School, Austin, TX, USA; Institute for Early Life Adversity Research, University of Texas at Austin, Austin, TX, USA
| | - Charles B Nemeroff
- Department of Psychiatry and Behavioral Sciences, University of Texas at Austin Dell Medical School, Austin, TX, USA; Institute for Early Life Adversity Research, University of Texas at Austin, Austin, TX, USA; Center for Psychedelic Research and Therapy, University of Texas at Austin Dell Medical School, Austin, TX, USA.
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21
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Leroy A, Very E, Birmes P, Yger P, Szaffarczyk S, Lopes R, Outteryck O, Faure C, Duhem S, Grandgenèvre P, Warembourg F, Vaiva G, Jardri R. Intrusive experiences in posttraumatic stress disorder: Treatment response induces changes in the directed functional connectivity of the anterior insula. Neuroimage Clin 2022; 34:102964. [PMID: 35189456 PMCID: PMC8861823 DOI: 10.1016/j.nicl.2022.102964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 01/27/2022] [Accepted: 02/08/2022] [Indexed: 11/18/2022]
Abstract
Many causal paths were less influenced by the AI after effective therapy for PTSD. Insular influences over the rest of the brain were found to be positively correlated with re-experiencing. Re-experiencing was linked with changes in intrinsic networks’ spatial stability after treatment.
Background One of the core features of posttraumatic stress disorder (PTSD) is re-experiencing trauma. The anterior insula (AI) has been proposed to play a crucial role in these intrusive experiences. However, the dynamic function of the AI in re-experiencing trauma and its putative modulation by effective therapy need to be specified. Methods Thirty PTSD patients were enrolled and exposed to traumatic memory reactivation therapy. Resting-state functional magnetic resonance imaging (fMRI) scans were acquired before and after treatment. To explore AI-directed influences over the rest of the brain, we referred to a mixed model using pre-/posttreatment Granger causality analysis seeded on the AI as a within-subject factor and treatment response as a between-subject factor. To further identify correlates of re-experiencing trauma, we investigated how intrusive severity affected (i) causality maps and (ii) the spatial stability of other intrinsic brain networks. Results We observed changes in AI-directed functional connectivity patterns in PTSD patients. Many within- and between-network causal paths were found to be less influenced by the AI after effective therapy. Insular influences were found to be positively correlated with re-experiencing symptoms, while they were linked with a stronger default mode network (DMN) and more unstable central executive network (CEN) connectivity. Conclusion We showed that directed changes in AI signaling to the DMN and CEN at rest may underlie the degree of re-experiencing symptoms in PTSD. A positive response to treatment further induced changes in network-to-network anticorrelated patterns. Such findings may guide targeted neuromodulation strategies in PTSD patients not suitably improved by conventional treatment.
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Affiliation(s)
- Arnaud Leroy
- Univ Lille, INSERM, CHU Lille, Lille Neuroscience & Cognition Centre (U-1172), Plasticity & SubjectivitY Team, CURE Platform, 59000 Lille, France; CHU Lille, Fontan Hospital, General Psychiatry Dpt., 59037 Lille Cedex, France; Centre National de Ressources et Résilience pour les psychotraumatismes (CN2R Lille - Paris), 59000 Lille, France.
| | - Etienne Very
- CHU Toulouse, Purpan Hospital, Psychiatry Department, 31059 Toulouse Cedex, France; ToNIC, Toulouse NeuroImaging Center, INSERM U-1214, UPS, France
| | - Philippe Birmes
- ToNIC, Toulouse NeuroImaging Center, INSERM U-1214, UPS, France
| | - Pierre Yger
- Univ Lille, INSERM, CHU Lille, Lille Neuroscience & Cognition Centre (U-1172), Plasticity & SubjectivitY Team, CURE Platform, 59000 Lille, France; Institut de la Vision, Sorbonne Université, Inserm S968, CNRS UMR7210, Paris, France
| | - Sébastien Szaffarczyk
- Univ Lille, INSERM, CHU Lille, Lille Neuroscience & Cognition Centre (U-1172), Plasticity & SubjectivitY Team, CURE Platform, 59000 Lille, France
| | - Renaud Lopes
- Univ Lille, INSERM, CHU Lille, Lille Neuroscience & Cognition Centre (U-1772), Degenerative & Vascular Cognitive Disorders Team, 59000 Lille, France; Univ Lille, CNRS, INSERM, CHU Lille, Institut Pasteur de Lille, US 41 - UMS 2014 - PLBS, 59000 Lille, France
| | - Olivier Outteryck
- Univ Lille, INSERM, CHU Lille, Lille Neuroscience & Cognition Centre (U-1772), Degenerative & Vascular Cognitive Disorders Team, 59000 Lille, France; CHU Lille, Department of Neuroradiology, Roger Salengro Hospital, 59037 Lille Cedex, France
| | - Cécile Faure
- Univ Lille, INSERM, CHU Lille, Lille Neuroscience & Cognition Centre (U-1172), Plasticity & SubjectivitY Team, CURE Platform, 59000 Lille, France
| | - Stéphane Duhem
- CHU Lille, Fontan Hospital, General Psychiatry Dpt., 59037 Lille Cedex, France; Centre National de Ressources et Résilience pour les psychotraumatismes (CN2R Lille - Paris), 59000 Lille, France; Université de Lille, Inserm, CHU Lille, CIC 1403 - Clinical Investigation Center, 59000 Lille, France
| | - Pierre Grandgenèvre
- Univ Lille, INSERM, CHU Lille, Lille Neuroscience & Cognition Centre (U-1172), Plasticity & SubjectivitY Team, CURE Platform, 59000 Lille, France; CHU Lille, Fontan Hospital, General Psychiatry Dpt., 59037 Lille Cedex, France
| | | | - Guillaume Vaiva
- Univ Lille, INSERM, CHU Lille, Lille Neuroscience & Cognition Centre (U-1172), Plasticity & SubjectivitY Team, CURE Platform, 59000 Lille, France; CHU Lille, Fontan Hospital, General Psychiatry Dpt., 59037 Lille Cedex, France; Centre National de Ressources et Résilience pour les psychotraumatismes (CN2R Lille - Paris), 59000 Lille, France
| | - Renaud Jardri
- Univ Lille, INSERM, CHU Lille, Lille Neuroscience & Cognition Centre (U-1172), Plasticity & SubjectivitY Team, CURE Platform, 59000 Lille, France; CHU Lille, Fontan Hospital, Child & Adolescent Psychiatry Dpt., 59037 Lille Cedex, France
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22
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Namkung H, Thomas KL, Hall J, Sawa A. Parsing neural circuits of fear learning and extinction across basic and clinical neuroscience: Towards better translation. Neurosci Biobehav Rev 2022; 134:104502. [PMID: 34921863 DOI: 10.1016/j.neubiorev.2021.12.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 12/22/2022]
Abstract
Over the past decades, studies of fear learning and extinction have advanced our understanding of the neurobiology of threat and safety learning. Animal studies can provide mechanistic/causal insights into human brain regions and their functional connectivity involved in fear learning and extinction. Findings in humans, conversely, may further enrich our understanding of neural circuits in animals by providing macroscopic insights at the level of brain-wide networks. Nevertheless, there is still much room for improvement in translation between basic and clinical research on fear learning and extinction. Through the lens of neural circuits, in this article, we aim to review the current knowledge of fear learning and extinction in both animals and humans, and to propose strategies to fill in the current knowledge gap for the purpose of enhancing clinical benefits.
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Affiliation(s)
- Ho Namkung
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA; Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Kerrie L Thomas
- Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, UK; School of Biosciences, Cardiff University, Cardiff, UK
| | - Jeremy Hall
- Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, UK; School of Medicine, Cardiff University, Cardiff, UK
| | - Akira Sawa
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA; Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA; Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA; Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA; Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, 21287, USA.
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23
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Blithikioti C, Nuño L, Guell X, Pascual-Diaz S, Gual A, Balcells-Olivero Μ, Miquel L. The cerebellum and psychological trauma: A systematic review of neuroimaging studies. Neurobiol Stress 2022; 17:100429. [PMID: 35146077 PMCID: PMC8801754 DOI: 10.1016/j.ynstr.2022.100429] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 12/10/2021] [Accepted: 01/10/2022] [Indexed: 12/17/2022] Open
Abstract
Psychological trauma is highly prevalent among psychiatric disorders, however, the relationship between trauma, neurobiology and psychopathology is not yet fully understood. The cerebellum has been recognized as a crucial structure for cognition and emotion, however, it has been relatively ignored in the literature of psychological trauma, as it is not considered as part of the traditional fear neuro-circuitry. The aim of this review is to investigate how psychological trauma affects the cerebellum and to make conclusive remarks on whether the cerebellum forms part of the trauma-affected brain circuitry. A total of 267 unique records were screened and 39 studies were included in the review. Structural cerebellar alterations and aberrant cerebellar activity and connectivity in trauma-exposed individuals were consistently reported across studies. Early-onset of adverse experiences was associated with cerebellar alterations in trauma-exposed individuals. Several studies reported alterations in connectivity between the cerebellum and nodes of large-brain networks, which are implicated in several psychiatric disorders, including the default mode network, the salience network and the central executive network. Also, trauma-exposed individuals showed altered resting state and task based cerebellar connectivity with cortical and subcortical structures that are involved in emotion and fear regulation. Our preferred interpretation of the results is through the lens of the Universal Cerebellar Transform, the hypothesis that the cerebellum, given its homogeneous cytoarchitecture, performs a common computation for motor, cognitive and emotional functions. Therefore, trauma-induced alterations in this computation might set the ground for a variety of psychiatric symptoms.
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Affiliation(s)
- C. Blithikioti
- Psychiatry Department, Faculty of Medicine, University of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - L. Nuño
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Grup de Recerca en Addiccions Clinic. GRAC, Institut Clinic de Neurosciències, Barcelona, Spain
| | - X. Guell
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - S. Pascual-Diaz
- Magnetic Resonance Imaging Core Facility, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - A. Gual
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Μ. Balcells-Olivero
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Grup de Recerca en Addiccions Clinic. GRAC, Institut Clinic de Neurosciències, Barcelona, Spain
| | - L. Miquel
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Grup de Recerca en Addiccions Clinic. GRAC, Institut Clinic de Neurosciències, Barcelona, Spain
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24
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Neria Y, Lazarov A, Zhu X. Identifying Neurobiological Markers of Posttraumatic Stress Disorder Using Resting-State Functional Magnetic Resonance Imaging Data: The Promise of Data-Driven Computational Approaches. Biol Psychiatry Cogn Neurosci Neuroimaging 2022; 7:121-123. [PMID: 35131047 PMCID: PMC9603346 DOI: 10.1016/j.bpsc.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 06/14/2023]
Affiliation(s)
- Yuval Neria
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York; The New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, New York.
| | - Amit Lazarov
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Xi Zhu
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York; The New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, New York
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25
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Liddell BJ, Das P, Malhi GS, Felmingham KL, Outhred T, Cheung J, Den M, Nickerson A, Askovic M, Aroche J, Coello M, Bryant RA. Torture exposure and the functional brain: investigating disruptions to intrinsic network connectivity using resting state fMRI. Transl Psychiatry 2022; 12:37. [PMID: 35082270 DOI: 10.1038/s41398-022-01795-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 12/13/2021] [Accepted: 01/11/2022] [Indexed: 11/24/2022] Open
Abstract
Torture has profound psychological and physiological consequences for survivors. While some brain structures and functions appear altered in torture survivors, it is unclear how torture exposure influences functional connectivity within and between core intrinsic brain networks. In this study, 37 torture survivors (TS) and 62 non-torture survivors (NTS) participated in a resting-state fMRI scan. Data-driven independent components analysis identified active intrinsic networks. Group differences in functional connectivity in the default mode network (DMN), salience network (SN) and central executive network (CEN) of the triple network model, as well any prefrontal network, were examined while controlling for PTSD symptoms and exposure to other potentially traumatic events. The analysis identified 25 networks; eight comprised our networks of interest. Within-network group differences were observed in the left CEN (lCEN), where the TS group showed less spectral power in the low-frequency band. Differential internetwork dynamic connectivity patterns were observed, where the TS group showed stronger positive coupling between the lCEN and anterior dorsomedial and ventromedial DMN, and stronger negative coupling between a lateral frontal network and the lCEN and anterior dorsomedial DMN (when contrasted with the NTS group). Group differences were not attributed to torture severity or dissociative symptoms. Torture survivors showed disrupted dynamic functional connectivity between a laterally-aligned lCEN that serves top-down control functions over external processes and the midline DMN that underpins internal self-referential processes, which may be an adaptive response to mitigate the worst effects of the torture experience. This study provides a critical step in mapping the neural signature of torture exposure to guide treatment development and selection.
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26
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Sloan DM, Marx BP, Resick PA, Young-McCaughan S, Dondanville KA, Straud CL, Mintz J, Litz BT, Peterson AL. Effect of Written Exposure Therapy vs Cognitive Processing Therapy on Increasing Treatment Efficiency Among Military Service Members With Posttraumatic Stress Disorder: A Randomized Noninferiority Trial. JAMA Netw Open 2022; 5:e2140911. [PMID: 35015065 PMCID: PMC8753496 DOI: 10.1001/jamanetworkopen.2021.40911] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
IMPORTANCE Posttraumatic stress disorder (PTSD) occurs more commonly among military service members than among civilians; however, despite the availability of several evidence-based treatments, there is a need for more efficient evidence-based PTSD treatments to better address the needs of service members. Written exposure therapy is a brief PTSD intervention that consists of 5 sessions with no between-session assignments, has demonstrated efficacy, and is associated with low treatment dropout rates, but prior randomized clinical trials of this intervention have focused on civilian populations. OBJECTIVE To investigate whether the brief intervention, written exposure therapy, is noninferior in the treatment of PTSD vs the more time-intensive cognitive processing therapy among service members diagnosed with PTSD. DESIGN, SETTING, AND PARTICIPANTS The study used a randomized, noninferiority design with a 1:1 randomization allocation. Recruitment for the study took place from August 2016 through October 2020. Participants were active-duty military service members diagnosed with posttraumatic stress disorder. The study was conducted in an outpatient setting for service members seeking PTSD treatment at military bases in San Antonio or Killeen, Texas. INTERVENTIONS Participants received either written exposure therapy, which consisted of 5 weekly sessions, or cognitive processing therapy, which consisted of 12 twice-weekly sessions. MAIN OUTCOMES AND MEASURES Participants were assessed at baseline and at 10, 20, and 30 weeks after the first treatment session. The primary outcome measure was PTSD symptom severity assessed with the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5). Noninferiority was defined as the difference between the 2 groups being less than the upper bound of the 1-sided 95% CI-specified margin of 10 points on the CAPS-5. RESULTS Overall, 169 participants were included in the study. Participants were predominantly male (136 [80.5%]), serving in the Army (167 [98.8%]), with a mean (SD) age of 34 (8) years. Eighty-five participants were randomly assigned to written exposure therapy, with 65 (76.5%) completing all treatment sessions, and 84 to cognitive processing therapy, with 47 (54.8%) completing all treatment sessions. Findings indicated that written exposure therapy was noninferior to cognitive processing therapy, with the largest difference in change in outcome between the treatment conditions of 3.96 points on the outcome measure. The 1-sided 95% CI upper limit was less than 10 points across time points in both groups and ranged from 4.59 at week 30 to 6.81 at week 10. Within-condition effect sizes ranged from a Cohen d of 0.48 for the written exposure therapy group in the intention-to-treat analysis at week 10 to 0.95 for the cognitive processing therapy group in the per-protocol analysis at week 10, and between-condition effect size ranged from 0.06 in the intention-to-treat analysis at week 30 to 0.22 in the per-protocol analysis at week 10. CONCLUSIONS AND RELEVANCE In this randomized clinical trial, support was found for an effective and more efficient PTSD treatment approach for service members. Future research should determine who does and does not benefit from PTSD treatment to best maximize treatment outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03033602.
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Affiliation(s)
- Denise M. Sloan
- Behavioral Science Division, National Center for PTSD at VA Boston Healthcare System, Boston, Massachusetts
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Brian P. Marx
- Behavioral Science Division, National Center for PTSD at VA Boston Healthcare System, Boston, Massachusetts
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Patricia A. Resick
- Department of Psychiatry and Behavioral Sciences, Duke Health, Durham, North Carolina
| | - Stacey Young-McCaughan
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio
- Research and Development Service, South Texas Veterans Health Care System, San Antonio
| | - Katherine A. Dondanville
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio
| | - Casey L. Straud
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio
- Research and Development Service, South Texas Veterans Health Care System, San Antonio
- Department of Psychology, The University of Texas at San Antonio
| | - Jim Mintz
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio
- Research and Development Service, South Texas Veterans Health Care System, San Antonio
| | - Brett T. Litz
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
- Massachusetts Veterans Epidemiological Research and Information Center, VA Boston Healthcare System, Boston
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts
| | - Alan L. Peterson
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio
- Research and Development Service, South Texas Veterans Health Care System, San Antonio
- Department of Psychology, The University of Texas at San Antonio
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27
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Schnurr PP, Chard KM, Ruzek JI, Chow BK, Resick PA, Foa EB, Marx BP, Friedman MJ, Bovin MJ, Caudle KL, Castillo D, Curry KT, Hollifield M, Huang GD, Chee CL, Astin MC, Dickstein B, Renner K, Clancy CP, Collie C, Maieritsch K, Bailey S, Thompson K, Messina M, Franklin L, Lindley S, Kattar K, Luedtke B, Romesser J, McQuaid J, Sylvers P, Varkovitzky R, Davis L, MacVicar D, Shih MC. Comparison of Prolonged Exposure vs Cognitive Processing Therapy for Treatment of Posttraumatic Stress Disorder Among US Veterans: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2136921. [PMID: 35044471 PMCID: PMC8771295 DOI: 10.1001/jamanetworkopen.2021.36921] [Citation(s) in RCA: 48] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
IMPORTANCE Posttraumatic stress disorder (PTSD) is a prevalent and serious mental health problem. Although there are effective psychotherapies for PTSD, there is little information about their comparative effectiveness. OBJECTIVE To compare the effectiveness of prolonged exposure (PE) vs cognitive processing therapy (CPT) for treating PTSD in veterans. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial assessed the comparative effectiveness of PE vs CPT among veterans with military-related PTSD recruited from outpatient mental health clinics at 17 Department of Veterans Affairs medical centers across the US from October 31, 2014, to February 1, 2018, with follow-up through February 1, 2019. The primary outcome was assessed using centralized masking. Tested hypotheses were prespecified before trial initiation. Data were analyzed from October 5, 2020, to May 5, 2021. INTERVENTIONS Participants were randomized to 1 of 2 individual cognitive-behavioral therapies, PE or CPT, delivered according to a flexible protocol of 10 to 14 sessions. MAIN OUTCOMES AND MEASURES The primary outcome was change in PTSD symptom severity on the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) from before treatment to the mean after treatment across posttreatment and 3- and 6-month follow-ups. Secondary outcomes included other symptoms, functioning, and quality of life. RESULTS Analyses were based on all 916 randomized participants (730 [79.7%] men and 186 [20.3%] women; mean [range] age 45.2 [21-80] years), with 455 participants randomized to PE (mean CAPS-5 score at baseline, 39.9 [95% CI, 39.1-40.7] points) and 461 participants randomized to CPT (mean CAPS-5 score at baseline, 40.3 [95% CI, 39.5-41.1] points). PTSD severity on the CAPS-5 improved substantially in both PE (standardized mean difference [SMD], 0.99 [95% CI, 0.89-1.08]) and CPT (SMD, 0.71 [95% CI, 0.61-0.80]) groups from before to after treatment. Mean improvement was greater in PE than CPT (least square mean, 2.42 [95% CI, 0.53-4.31]; P = .01), but the difference was not clinically significant (SMD, 0.17). Results for self-reported PTSD symptoms were comparable with CAPS-5 findings. The PE group had higher odds of response (odds ratio [OR], 1.32 [95% CI, 1.00-1.65]; P < .001), loss of diagnosis (OR, 1.43 [95% CI, 1.12-1.74]; P < .001), and remission (OR, 1.62 [95% CI, 1.24-2.00]; P < .001) compared with the CPT group. Groups did not differ on other outcomes. Treatment dropout was higher in PE (254 participants [55.8%]) than in CPT (215 participants [46.6%]; P < .01). Three participants in the PE group and 1 participant in the CPT group were withdrawn from treatment, and 3 participants in each treatment dropped out owing to serious adverse events. CONCLUSIONS AND RELEVANCE This randomized clinical trial found that although PE was statistically more effective than CPT, the difference was not clinically significant, and improvements in PTSD were meaningful in both treatment groups. These findings highlight the importance of shared decision-making to help patients understand the evidence and select their preferred treatment. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01928732.
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Affiliation(s)
- Paula P. Schnurr
- Executive Division, National Center for PTSD, White River Junction, Vermont
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Kathleen M. Chard
- Cincinnati VA Medical Center, Cincinnati, Ohio
- University of Cincinnati, Cincinnati, Ohio
| | - Josef I. Ruzek
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
- Palo Alto University, Palo Alto, California
- Department of Psychology, University of Colorado, Colorado Springs
| | - Bruce K. Chow
- VA Cooperative Studies Program Coordinating Center, Palo Alto, California
| | | | - Edna B. Foa
- University of Pennsylvania Perelman School of Medicine, Department of Psychiatry, Philadelphia
| | - Brian P. Marx
- Behavioral Science Division, National Center for PTSD, Boston, Massachusetts
- VA Boston Healthcare System, Boston, Massachusetts
- Boston University School of Medicine, Boston, Massachusetts
| | - Matthew J. Friedman
- Executive Division, National Center for PTSD, White River Junction, Vermont
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Michelle J. Bovin
- Behavioral Science Division, National Center for PTSD, Boston, Massachusetts
- VA Boston Healthcare System, Boston, Massachusetts
- Boston University School of Medicine, Boston, Massachusetts
| | - Kristina L. Caudle
- Executive Division, National Center for PTSD, White River Junction, Vermont
| | - Diane Castillo
- Center of Excellence, Central Texas VA Health Care System, Waco
| | - Kyle T. Curry
- Minneapolis VA Medical Center, Minneapolis, Minnesota
| | - Michael Hollifield
- Tibor Rubin VA Medical Center, Long Beach, California
- The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
- Department of Psychiatry and Human Behavior, University of California, Riverside
| | - Grant D. Huang
- Cooperative Studies Program Central Office, Department of Veterans Affairs Office of Research & Development, Washington, District of Columbia
| | | | | | | | | | | | | | | | - Su Bailey
- Michael E. DeBakey VA Medical Center, Houston, Texas
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Karin Thompson
- Michael E. DeBakey VA Medical Center, Houston, Texas
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Michael Messina
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
- Department of Psychiatry, University of Wisconsin–Madison School of Medicine and Public Health, Madison
| | - Laurel Franklin
- New Orleans VA Medical Center, New Orleans, Louisiana
- South Central VA Mental Illness Research, Education and Clinical Center, New Orleans, Louisiana
| | - Steve Lindley
- Palo Alto VA Medical Center, Palo Alto, California
- Department of Psychiatry and Behavioral Sciences, Stanford School of Medicine, Stanford University
| | | | | | | | - John McQuaid
- San Francisco VA Medical Center, San Francisco, California
- Department of Psychiatry and Behavioral Sciences, Weill Institute of Neuroscience, University of California, San Francisco
| | - Patrick Sylvers
- VA Puget Sound Health Care System, American Lake Division, Tacoma, Washington
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle
| | - Ruth Varkovitzky
- VA Puget Sound Health Care System, American Lake Division, Tacoma, Washington
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle
| | - Lori Davis
- Tuscaloosa VA Medical Center, Tuscaloosa, Alabama
- Department of Psychiatry, University of Alabama Heersink School of Medicine, Birmingham
| | - David MacVicar
- Tuscaloosa VA Medical Center, Tuscaloosa, Alabama
- Department of Psychiatry, University of Alabama Heersink School of Medicine, Birmingham
| | - Mei-Chiung Shih
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
- VA Cooperative Studies Program Coordinating Center, Palo Alto, California
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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29
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Eder-Moreau E, Zhu X, Fisch CT, Bergman M, Neria Y, Helpman L. Neurobiological Alterations in Females With PTSD: A Systematic Review. Front Psychiatry 2022; 13:862476. [PMID: 35770056 PMCID: PMC9234306 DOI: 10.3389/fpsyt.2022.862476] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 04/20/2022] [Indexed: 11/13/2022] Open
Abstract
Most females experience at least one traumatic event in their lives, but not all develop PTSD. Despite considerable research, our understanding of the key factors that constitute risk for PTSD among females is limited. Previous research has largely focused on sex differences, neglecting within group comparisons, thereby obviating differences between females who do and do not develop PTSD following exposure to trauma. In this systematic review, we conducted a search for the extent of existing research utilizing magnetic resonance imaging (MRI) to examine neurobiological differences among females of all ages, with and without PTSD. Only studies of females who met full diagnostic criteria for PTSD were included. Fifty-six studies were selected and reviewed. We synthesized here findings from structural MRI (sMRI), functional MRI (fMRI), diffusion tensor imaging (DTI), and resting state functional connectivity (rs-FC MRI) studies, comparing females with and without PTSD. A range of biopsychosocial constructs that may leave females vulnerable to PTSD were discussed. First, the ways timing and type of exposure to trauma may impact PTSD risk were discussed. Second, the key role that cognitive and behavioral mechanisms may play in PTSD was described, including rumination, and deficient fear extinction. Third, the role of specific symptom patterns and common comorbidities in female-specific PTSD was described, as well as sex-specific implications on treatment and parenting outcomes. We concluded by identifying areas for future research, to address the need to better understand developmental aspects of brain alterations, the differential impact of trauma types and timing, the putative role of neuroendocrine system in neurobiology of PTSD among females, and the impact of social and cultural factors on neurobiology in females with PTSD.
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Affiliation(s)
- Elizabeth Eder-Moreau
- New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, NY, United States
| | - Xi Zhu
- New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, NY, United States.,Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States
| | - Chana T Fisch
- New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, NY, United States
| | - Maja Bergman
- New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, NY, United States
| | - Yuval Neria
- New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, NY, United States.,Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States
| | - Liat Helpman
- Department of Counseling and Human Development, Faculty of Education, University of Haifa, Haifa, Israel.,Psychiatric Research Unit, Tel Aviv Medical Center, Tel Aviv, Israel
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30
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Campbell-Sills L, Sun X, Choi KW, He F, Ursano RJ, Kessler RC, Levey DF, Smoller JW, Gelernter J, Jain S, Stein MB. Dissecting the heterogeneity of posttraumatic stress disorder: differences in polygenic risk, stress exposures, and course of PTSD subtypes. Psychol Med 2021; 52:1-9. [PMID: 33947479 PMCID: PMC9772910 DOI: 10.1017/s0033291721000428] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 01/27/2021] [Accepted: 02/04/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Definition of disorder subtypes may facilitate precision treatment for posttraumatic stress disorder (PTSD). We aimed to identify PTSD subtypes and evaluate their associations with genetic risk factors, types of stress exposures, comorbidity, and course of PTSD. METHODS Data came from a prospective study of three U.S. Army Brigade Combat Teams that deployed to Afghanistan in 2012. Soldiers with probable PTSD (PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition ≥31) at three months postdeployment comprised the sample (N = 423) for latent profile analysis using Gaussian mixture modeling and PTSD symptom ratings as indicators. PTSD profiles were compared on polygenic risk scores (derived from external genomewide association study summary statistics), experiences during deployment, comorbidity at three months postdeployment, and persistence of PTSD at nine months postdeployment. RESULTS Latent profile analysis revealed profiles characterized by prominent intrusions, avoidance, and hyperarousal (threat-reactivity profile; n = 129), anhedonia and negative affect (dysphoric profile; n = 195), and high levels of all PTSD symptoms (high-symptom profile; n = 99). The threat-reactivity profile had the most combat exposure and the least comorbidity. The dysphoric profile had the highest polygenic risk for major depression, and more personal life stress and co-occurring major depression than the threat-reactivity profile. The high-symptom profile had the highest rates of concurrent mental disorders and persistence of PTSD. CONCLUSIONS Genetic and trauma-related factors likely contribute to PTSD heterogeneity, which can be parsed into subtypes that differ in symptom expression, comorbidity, and course. Future studies should evaluate whether PTSD typology modifies treatment response and should clarify distinctions between the dysphoric profile and depressive disorders.
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Affiliation(s)
| | - Xiaoying Sun
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Karmel W. Choi
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute, Boston, MA, USA
| | - Feng He
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Robert J. Ursano
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Daniel F. Levey
- Department of Psychiatry, Genetics, and Neuroscience, Yale University School of Medicine, New Haven, CT, USA
- Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
| | - Jordan W. Smoller
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute, Boston, MA, USA
| | - Joel Gelernter
- Department of Psychiatry, Genetics, and Neuroscience, Yale University School of Medicine, New Haven, CT, USA
- Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
| | - Sonia Jain
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Murray B. Stein
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
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31
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Affiliation(s)
- Ned H Kalin
- Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison
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