Changes in brain anatomy during the course of posttraumatic stress disorder

San Francisco Veterans Affairs Medical Center, San Francisco, CA ,CA 94121 United States.
Psychiatry Research (Impact Factor: 2.68). 06/2011; 193(2):93-100. DOI: 10.1016/j.pscychresns.2011.01.013
Source: PubMed

ABSTRACT The goal of this study was to determine whether posttraumatic stress disorder (PTSD) was associated with an increase in time-related decline in macrostructural brain volume and whether these changes were associated with accelerated cognitive decline. To quantify brain structure, three-dimensional T1-weighted MRI scans were performed at baseline and again after a minimum of 24months in 25 patients with PTSD (PTSD+) and 22 controls (PTSD-). Longitudinal changes in brain volume were measured using deformation morphometry. For the group as a whole, PTSD+ patients did not show significant ongoing brain atrophy compared to PTSD-. PTSD+ patients were then subgrouped into those with decreasing or increasing symptoms. We found little evidence for brain markers of accelerated atrophy in PTSD+ veterans whose symptoms improved over time, with only a small left parietal region showing greater ongoing tissue loss than PTSD-. PTSD patients whose symptoms increased over time showed accelerated atrophy throughout the brain, particularly brainstem and frontal and temporal lobes. Lastly, for the sample as a whole, greater rates of brain atrophy were associated with greater rates of decline in verbal memory and delayed facial recognition.

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Available from: Valerie A Cardenas, Apr 28, 2014
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    • "Multiple studies have identified smaller hippocampal volumes in subjects with posttraumatic stress disorder (PTSD) [2] [3] [4] [5] [6] [7]. Not all studies have found smaller hippocampal volumes [8] [9] [10] [11], and various groups have suggested that hippocampal volume differences in PTSD are attributable to comorbid conditions such as alcoholism [12] or depression [13]. Still, in most studies of hippocampal volume in PTSD investigators have controlled for major psychiatric comorbidities , including substance abuse, and meta-analyses reveal that the correlation between PTSD and smaller hippocampal volume is widely replicated [6,14–16]. "
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    • "Veterans with PTSD have been shown to have reduced hippocampal volume that correlates with impaired memory, and functional imaging studies indicate that patients with PTSD have impaired brain function in the medial prefrontal cortex, amygdala, and hippocampus [19]. Brain atrophy in PTSD is also affected by PTSD severity [20] [21]. However, chronic stress due to PTSD has also been shown to cause hypertrophy of the amygdala, an area of the brain that has evolved to deal with stressful, dangerous, and threatening situations. "
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    ABSTRACT: Decreased hippocampal volume is described in posttraumatic stress disorder (PTSD) and depression. However, it is not known whether it is a risk factor for the development of PTSD or a consequence of PTSD. We sought to determine the effects of PTSD and depressive symptoms on hippocampal volume. Clinical and magnetic resonance imaging data were collected in a cross sectional study of 244 Gulf War veterans. Measures included lifetime and current Clinician Administered PTSD Scale, Hamilton Depression Scale, Life Stressor Checklist, and Lifetime Drinking History. Magnetic resonance imaging data were acquired with a 1.5-T scanner and analyzed with automated and semiautomated image processing techniques. Eighty-two veterans had lifetime PTSD, 44 had current PTSD, and 38 had current depression. In the linear regression analysis, current PTSD symptoms (standardized coefficient β = -.25, p = .03) but neither lifetime PTSD symptoms nor current depression were associated with smaller hippocampal volume. Gender, age, history of early life trauma, education, lifetime and current alcohol use, current marijuana use, and treatment with antidepressants did not have independent effects. Participants with chronic PTSD had, on average, a smaller hippocampus compared with those with remitted PTSD. The finding that current but not lifetime PTSD symptom severity explains hippocampal size raises two possibilities: either a small hippocampus is a risk factor for lack of recovery from PTSD (trait) or PTSD effects on hippocampal volume are reversible once PTSD symptoms remit and the patient recovers (state).
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