Neuroimaging in Posttraumatic Stress Disorder and Other Stress-Related Disorders

doi:10.1016/j.nic.2007.07.003

Neuroimaging Clinics of North America

Volume 17, Issue 4, November 2007, Pages 523-538

https://doi.org/10.1016/j.nic.2007.07.003 Get rights and content

Traumatic stress has a broad range of effects on the brain. Brain areas implicated in the stress response include the amygdala, the hippocampus, and the prefrontal cortex. Studies in patients who have posttraumatic stress disorder (PTSD) and other psychiatric disorders related to stress have replicated findings in animal studies by finding alterations in these brain areas. Brain regions implicated in PTSD also play an important role in memory function, highlighting the important interplay between memory and the traumatic stress response. Abnormalities in these brain areas are hypothesized to underlie symptoms of PTSD and other stress-related psychiatric disorders.

Section snippets

Effects of traumatic stress on the individual

Traumatic stressors, including childhood abuse, can lead to posttraumatic stress disorder (PTSD), depression [1], [2], substance abuse [3], [4], dissociative disorders [5], personality disorders [6], [7], and health problems [8]. For many trauma victims, PTSD, which affects about 8% of Americans at some time in their lives [3], may be a life-long problem [9]. However, the development of effective treatments is limited by gaps in knowledge about the underlying neurobiologic mechanisms that

Neural circuits of posttraumatic stress disorder

PTSD is characterized by specific symptoms, including intrusive thoughts, hyperarousal, flashbacks, nightmares and sleep disturbances, changes in memory and concentration, and startle responses. Symptoms of PTSD are hypothesized to represent the behavioral manifestation of stress-induced changes in brain structure and function. Stress results in acute and chronic changes in neurochemical systems and specific brain regions, which result in long-term changes in brain “circuits” involved in the

Changes in brain structure in posttraumatic stress disorder and stress-related disorders

Studies have demonstrated several consistent changes in cognition and brain structure associated with PTSD, including verbal declarative memory deficits [15], [41], [42], [43]. Patients who had PTSD secondary to combat [44], [45], [46], [47], [48] and childhood abuse [49], [50] have been reported to have deficits in verbal declarative memory function based on neuropsychologic testing. Using various measures, including the Wechsler Memory Scale, the visual and verbal components of the Selective

Functional neuroimaging studies in posttraumatic stress disorder

Imaging studies of brain function in PTSD implicate dysfunction of the medial prefrontal cortex, amygdala, and hippocampus [13], [104], [105], [106], [107], [108], [109], [110]. Methodologies used in imaging studies of PTSD are outlined in Table 1 and a summary of findings by investigator and brain region appears in Table 2. Studies of resting cerebral blood flow or metabolism with positron emission tomography (PET) and single photon emission tomography (SPECT) have shown alterations at rest in

Effects of pharmacotherapy on brain function and structure in posttraumatic stress disorder

The author's group has begun to assess the effects of pharmacotherapy on brain structure and function in PTSD, and recently has evaluated the effects of phenytoin on brain structure and function [155]. Studies in animals have shown that phenytoin, which is used in the treatment of epilepsy and is known to modulate glutamatergic function, blocks the effects of stress on the hippocampus [27]. The author's group studied nine patients who had PTSD in an open-label function before and after

Summary

Traumatic stress has a broad range of effects on brain function. Brain areas implicated in the stress response include the amygdala, hippocampus, and prefrontal cortex. These regions also play a critical role in memory, highlighting the important interplay between memory and the traumatic stress response. Preclinical studies show that stress affects these brain areas. Furthermore, antidepressants have effects on the hippocampus that counteract the effects of stress. In fact, promotion of nerve

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The association between post-traumatic stress disorder (PTSD) and cognitive impairment: A systematic review of neuroimaging findings
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Accumulating evidence suggests that post-traumatic stress disorder (PTSD) may increase the risk of various types of dementia. Despite the large number of studies linking these critical conditions, the underlying mechanisms remain unclear. The past decade has witnessed an exponential increase in interest on brain imaging research to assess the neuroanatomical underpinnings of PTSD. This systematic review provides a critical assessment of available evidence of neuroimaging correlates linking PTSD to a higher risk of dementia.
The EMBASE, PubMed/MEDLINE, and SCOPUS electronic databases were systematically searched from 1980 to May 22, 2021 for original references on neuroimaging correlates of PTSD and risk of dementia. Literature search, screening of references, methodological quality appraisal of included articles as well as data extractions were independently conducted by at least two investigators. Eligibility criteria included: 1) a clear PTSD definition; 2) a subset of included participants must have developed dementia or cognitive impairment at any time point after the diagnosis of PTSD through any diagnostic criteria; and 3) brain imaging protocols [structural, molecular or functional], including whole-brain morphologic and functional MRI, and PET imaging studies linking PTSD to a higher risk of cognitive impairment/dementia.
Overall, seven articles met eligibility criteria, comprising findings from 366 participants with PTSD. Spatially convergent structural abnormalities in individuals with PTSD and co-occurring cognitive dysfunction involved primarily the bilateral frontal (e.g., prefrontal, orbitofrontal, cingulate cortices), temporal (particularly in those with damage to the hippocampi), and parietal (e.g., superior and precuneus) regions.
A meta-analysis could not be performed due to heterogeneity and paucity of measurable data in the eligible studies.
Our systematic review provides putative neuroimaging correlates associated with PTSD and co-occurring dementia/cognitive impairment particularly involving the hippocampi. Further research examining neuroimaging features linking PTSD to dementia are clearly an unmet need of the field. Future imaging studies should provide a better control for relevant confounders, such as the selection of more homogeneous samples (e.g., age, race, education), a proper control for co-occurring disorders (e.g., co-occurring major depressive and anxiety disorders) as well as the putative effects of psychotropic medication use. Furthermore, prospective studies examining imaging biomarkers associated with a higher rate of conversion from PTSD to dementia could aid in the stratification of people with PTSD at higher risk for developing dementia for whom putative preventative interventions could be especially beneficial.
Phytochemical interventions for post-traumatic stress disorder: A cluster co-occurrence network analysis using CiteSpace
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This study investigated trends in the study of phytochemical treatment of post-traumatic stress disorder (PTSD).
The Web of Science database (2007–2022) was searched using the search terms “phytochemicals” and “PTSD,” and relevant literature was compiled. Network clustering co-occurrence analysis and qualitative narrative review were conducted.
Three hundred and one articles were included in the analysis of published research, which has surged since 2015 with nearly half of all relevant articles coming from North America. The category is dominated by neuroscience and neurology, with two journals, Addictive Behaviors and Drug and Alcohol Dependence, publishing the greatest number of papers on these topics. Most studies focused on psychedelic intervention for PTSD. Three timelines show an “ebb and flow” phenomenon between “substance use/marijuana abuse” and “psychedelic medicine/medicinal cannabis.” Other phytochemicals account for a small proportion of the research and focus on topics like neurosteroid turnover, serotonin levels, and brain-derived neurotrophic factor expression.
Research on phytochemicals and PTSD is unevenly distributed across countries/regions, disciplines, and journals. Since 2015, the research paradigm shifted to constitute the mainstream of psychedelic research thus far, leading to the exploration of botanical active ingredients and molecular mechanisms. Other studies focus on anti-oxidative stress and anti-inflammation.
Please cite this article as: Gao B, Qu YC, Cai MY, Zhang YY, Lu HT, Li HX, Tang YX, Shen H. Phytochemical interventions for post-traumatic stress disorder: A cluster co-occurrence network analysis using CiteSpace. J Integr Med. 2023; 21(4):385–396.
Biomarkers of post-traumatic stress disorder from emotional trauma: A systematic review
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Post-Traumatic Stress Disorder (PTSD) is a debilitating condition that can develop after traumatic events or stressors. These extreme threats or horrific stressors can be short- or long-lasting, and can be physical (e.g., injury) or emotional (e.g., witnessing a catastrophic event). Identifying reliable PTSD biomarkers could facilitate more accurate diagnosis of the disorder, and distinguish those at increased risk for PTSD from those who are resilient. Identifying biomarkers has been challenging because PTSD is a heterogeneous diagnosis with multifactorial etiology and variable, combined symptoms. Another difficulty is determining whether a marker is PTSD-specific or related to its common psychiatric comorbidities.
The aim of this systematic review was to provide an overview of PTSD-associated biomarkers in the adult civilian population, with an emphasis on those who have experienced emotional trauma, rather than physical or war-specific trauma.
A total of six papers was identified as publications of interest. The research reviewed herein suggests that among those who have experienced emotional trauma, PTSD or PTSD symptoms may be triggered through the same neurobiological pathways activated by physical trauma, including functional or structural alterations of the hippocampus and prefrontal cortex, epigenetic modifications, and HPA axis dysfunction. Thus, physical and emotional trauma may share potential biomarkers for diagnosing PTSD and predicting risk or resilience.
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Cognitive dysfunction and posttraumatic stress disorder (PTSD) are common in methamphetamine patients. However, few studies have investigated the cognitive performance of methamphetamine patients with PTSD. The purpose of this study was to investigate the impact of comorbid PTSD on cognitive function in Chinese male methamphetamine patients.
We analyzed 464 methamphetamine patients and 156 healthy volunteers. The PTSD Screening Scale (PCL-5) was used to assess PTSD and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was used to assess cognitive function.
Compared with healthy controls, methamphetamine patients had more cognitive dysfunction in immediate memory, visuospatial/constructional, language, attention and delayed memory. Moreover, methamphetamine patients with PTSD had less cognitive dysfunction in immediate memory, attention, and delayed memory than methamphetamine patients without PTSD. Further stepwise regression analysis showed that PTSD alterations in arousal and reactivity cluster were risk predictors for language, and PTSD negative alteration in cognition and mood cluster were risk predictors for delayed memory.
Our results indicate that methamphetamine patients without PTSD have poorer cognitive dysfunction than those with PTSD. Some demographic and PTSD symptom clusters are protective or risk factors for cognitive dysfunction in methamphetamine patients.
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Posttraumatic stress disorder (PTSD) is an acquired, debilitating, psychiatric disorder characterized by functionally deficient physiological and psychological symptoms in the aftermath of a traumatic event. This chapter emphasizes the critical role of pharmacoepigenetics in addressing the interindividual variability seen in patients treated with current medications for trauma- and stress-related neuropsychiatric disorders such as PTSD, and highlights the scarcity of effective drugs for treating the symptoms of patients with these disorders. Chronic PTSD treatment is complicated by comorbid symptomatology, and attempts to suppress traumatic memories, for example, remain difficult. As the epigenome can either modulate drug response or be pharmacologically regulated, we underline the importance of epigenetic-based interventions for alleviating PTSD pathogenesis. We hypothesize that selective epigenetic machinery targeting with epidrugs and/or epinutraceuticals could be a viable strategy to mitigate trauma- and stress-related neuropsychiatric disorders. Furthermore, compelling evidence has linked immune system dysregulation to abnormal neuronal signaling and psychiatric disorders. However, much effort is required to transform and advance our understanding of PTSD and comorbid disorders so that new and innovative interventions for those suffering from this critical neuropsychiatric illness can be developed.
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Neuroimaging in Posttraumatic Stress Disorder and Other Stress-Related Disorders

Section snippets

Effects of traumatic stress on the individual

Neural circuits of posttraumatic stress disorder

Changes in brain structure in posttraumatic stress disorder and stress-related disorders

Functional neuroimaging studies in posttraumatic stress disorder

Effects of pharmacotherapy on brain function and structure in posttraumatic stress disorder

Summary

Prev Med

J Affect Disord

Biol Psychiatry

Biol Psychiatry

Eur Neuropsychopharmacol

Eur J Pharmacol

Biol Psychiatry

Biol Psychol

Neuroscience

Clin Psychol Rev

Behav Res Ther

Psychoneuroendocrinology

Biol Psychiatry

Biol Psychiatry

Biol Psychiatry

Biol Psychiatry

Biol Psychiatry

Biol Psychiatry

Biol Psychiatry

Biol Psychiatry

Biol Psychiatry

Biol Psychiatry

J Affect Disord

Psychiatry Res

Biol Psychiatry

Biol Psychiatry

Biol Psychiatry

Biol Psychiatry

Posttraumatic stress disorder and major depressive disorder: investigating the role of overlapping symptoms in diagnostic comorbidity

J Nerv Ment Dis

Combat trauma: trauma with highest risk of delayed onset and unresolved posttraumatic stress disorder symptoms, unemployment, and abuse among men

J Nerv Ment Dis

Posttraumatic stress disorder in the national comorbidity survey

Arch Gen Psychiatry

Chronic PTSD in Vietnam combat veterans: course of illness and substance abuse

Am J Psychiatry

The clinical phenomenology of multiple personality disorder: a review of 100 recent cases

J Clin Psychiatry

Childhood maltreatment associated with adult personality disorders: findings from the Collaborative Longitudinal Personality Disorders Study

J Personal Disord

Traumatic exposure and posttraumatic stress disorder in borderline, schizotypal, avoidant, and obsessive-compulsive personality disorders: findings from the collaborative longitudinal personality disorders study

J Nerv Ment Dis

Posttraumatic stress disorder: a comprehensive text

Brain imaging handbook

Circuits and systems in stress. II. Applications to neurobiology and treatment of PTSD

Depress Anxiety

Does stress damage the brain? Understanding trauma-related disorders from a mind-body perspective

Investigating the pathogenesis of posttraumatic stress disorder with neuroimaging

J Clin Psychiatry

Circuits and systems in stress. I. Preclinical studies

Depress Anxiety

Functional neuroanatomical correlates of traumatic stress revisited 7 years later, this time with data

Psychopharmacol Bull

Proliferation of granule cell precursors in the dentate gyrus of adult monkeys is diminished by stress

Proc Natl Acad Sci U S A

Chronic psychosocial stress causes apical dendritic atrophy of hippocampal CA3 pyramidal neurons in subordinate tree shrews

J Neurosci

Regulation of BDNF and trkB mRNA in rat brain by chronic electroconvulsive seizure and antidepressant drug treatments

J Neurosci

Hippocampal damage associated with prolonged glucocorticoid exposure in primates

J Neurosci

Why stress is bad for your brain

Science

Chronic antidepressant treatment increases neurogenesis in adult rat hippocampus

J Neurosci

Stress-induced changes in cerebral metabolites, hippocampal volume, and cell proliferation are prevented by antidepressant treatment with tianeptine

Proc Natl Acad Sci U S A

Requirement of hippocampal neurogenesis for the behavioral effects of antidepressants

Science