RT Journal Article
SR Electronic
T1 Using fMRI connectivity to define a treatment-resistant form of post-traumatic stress disorder
JF Science Translational Medicine
FD American Association for the Advancement of Science
SP eaal3236
DO 10.1126/scitranslmed.aal3236
VO 11
IS 486
A1 Etkin, Amit
A1 Maron-Katz, Adi
A1 Wu, Wei
A1 Fonzo, Gregory A.
A1 Huemer, Julia
A1 Vértes, Petra E.
A1 Patenaude, Brian
A1 Richiardi, Jonas
A1 Goodkind, Madeleine S.
A1 Keller, Corey J.
A1 Ramos-Cejudo, Jaime
A1 Zaiko, Yevgeniya V.
A1 Peng, Kathy K.
A1 Shpigel, Emmanuel
A1 Longwell, Parker
A1 Toll, Russ T.
A1 Thompson, Allison
A1 Zack, Sanno
A1 Gonzalez, Bryan
A1 Edelstein, Raleigh
A1 Chen, Jingyun
A1 Akingbade, Irene
A1 Weiss, Elizabeth
A1 Hart, Roland
A1 Mann, Silas
A1 Durkin, Kathleen
A1 Baete, Steven H.
A1 Boada, Fernando E.
A1 Genfi, Afia
A1 Autea, Jillian
A1 Newman, Jennifer
A1 Oathes, Desmond J.
A1 Lindley, Steven E.
A1 Abu-Amara, Duna
A1 Arnow, Bruce A.
A1 Crossley, Nicolas
A1 Hallmayer, Joachim
A1 Fossati, Silvia
A1 Rothbaum, Barbara O.
A1 Marmar, Charles R.
A1 Bullmore, Edward T.
A1 O’Hara, Ruth
YR 2019
UL http://stm.sciencemag.org/content/11/486/eaal3236.abstract
AB Post-traumatic stress disorder (PTSD) is a severe psychiatric illness. Psychotherapy is the only effective treatment for PTSD but only works in a portion of patients. Etkin and colleagues now report a neuroimaging and behavioral signature in a subgroup of PTSD patients who failed to respond to psychotherapy. This signature was associated with impairments in fMRI connectivity in the brain’s ventral attention network and a deficit on a word list learning task. Use of noninvasive brain stimulation in combination with neuroimaging identified a brain location in which network connectivity correlated with the effects of stimulation. This work may help to define a target for future noninvasive brain stimulation approaches for treating patients with PTSD who are refractory to psychotherapy.A mechanistic understanding of the pathology of psychiatric disorders has been hampered by extensive heterogeneity in biology, symptoms, and behavior within diagnostic categories that are defined subjectively. We investigated whether leveraging individual differences in information-processing impairments in patients with post-traumatic stress disorder (PTSD) could reveal phenotypes within the disorder. We found that a subgroup of patients with PTSD from two independent cohorts displayed both aberrant functional connectivity within the ventral attention network (VAN) as revealed by functional magnetic resonance imaging (fMRI) neuroimaging and impaired verbal memory on a word list learning task. This combined phenotype was not associated with differences in symptoms or comorbidities, but nonetheless could be used to predict a poor response to psychotherapy, the best-validated treatment for PTSD. Using concurrent focal noninvasive transcranial magnetic stimulation and electroencephalography, we then identified alterations in neural signal flow in the VAN that were evoked by direct stimulation of that network. These alterations were associated with individual differences in functional fMRI connectivity within the VAN. Our findings define specific neurobiological mechanisms in a subgroup of patients with PTSD that could contribute to the poor response to psychotherapy.