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14 - Functional imaging of post-traumatic stress disorder

from Section III - Anxiety Disorders

Published online by Cambridge University Press:  10 January 2011

Lisa M. Shin
Affiliation:
Department of Psychology Tufts University Medford, MA, USA and Department of Psychiatry Massachusetts General Hospital Harvard Medical School Boston, MA, USA
Kathryn Handwerger Brohawn
Affiliation:
Department of Psychology Tufts University Medford, MA, USA
Danielle L. Pfaff
Affiliation:
Department of Psychology Tufts University Medford, MA, USA
Roger K. Pitman
Affiliation:
Department of Psychiatry Massachusetts General Hospital Harvard Medical School Boston, MA, USA
Martha E. Shenton
Affiliation:
VA Boston Healthcare System and Brigham and Women's Hospital, Harvard Medical School
Bruce I. Turetsky
Affiliation:
University of Pennsylvania
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Summary

Introduction

Post-traumatic stress disorder (PTSD) is an anxiety disorder that can develop in individuals who (1) are exposed to an event or events that involve the threat of death or serious injury, and (2) react with intense fear, helplessness or horror (APA,2000). Individuals with PTSD re-experience the traumatic event in various ways, including nightmares, intrusive recollections, and flashbacks. In addition, patients may attempt to avoid thoughts or reminders of the trauma and may experience a restricted range of affect, especially positive affect. Finally, patients with PTSD report hyperarousal symptoms, such as hypervigilance, exaggerated startle, and difficulty concentrating (APA, 2000).

In this chapter, we will summarize a neurocircuitry model of PTSD and briefly describe the techniques that have been used to study brain function in this disorder. We will then review the findings of relevant functional neuroimaging studies. Given that current neurocircuitry models focus on the amygdala, medial prefrontal cortex, and hippocampus, this review will include studies that have reported significant findings in those brain regions. (For other recent reviews, see Francati et al., 2007; Lanius et al., 2006; Rauch et al., 2006.) Lastly, we will summarize the findings and suggest directions for future research.

Type
Chapter
Information
Understanding Neuropsychiatric Disorders
Insights from Neuroimaging
, pp. 214 - 228
Publisher: Cambridge University Press
Print publication year: 2010

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References

, APA. 2000. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text-Revision. Washington, DC: American Psychiatric Press.
Armony, J L, Corbo, V, Clement, M H and Brunet, A. 2005. Amygdala response in patients with acute PTSD to masked and unmasked emotional facial expressions. Am J Psychiatry 162, 1961–3.Google Scholar
Astur, R S, St Germain, S A, Tolin, D, Ford, J, Russell, D and Stevens, M. 2006. Hippocampus function predicts severity of post-traumatic stress disorder. Cyberpsychol Behav 9, 234–40.Google Scholar
Binder, E B, Bradley, R G, Liu, W, et al. 2008. Association of FKBP5 polymorphisms and childhood abuse with risk of posttraumatic stress disorder symptoms in adults. JAMA 299, 1291–305.Google Scholar
Bishop, S, Duncan, J, Brett, M and Lawrence, A D. 2004. Prefrontal cortical function and anxiety: Controlling attention to threat-related stimuli. Nat Neurosci 7, 184–8.Google Scholar
Bonne, O, Gilboa, A, Louzoun, Y, et al. 2003. Resting regional cerebral perfusion in recent posttraumatic stress disorder. Biol Psychiatry 54, 1077–86.Google Scholar
Breiter, H C, Etcoff, N L, Whalen, P J, et al. 1996. Response and habituation of the human amygdala during visual processing of facial expression. Neuron 17, 875–87.Google Scholar
Bremner, J D, Innis, R B, Ng, C K, et al. 1997. Positron emission tomography measurement of cerebral metabolic correlates of yohimbine administration in combat-related posttraumatic stress disorder. Arch Gen Psychiatry 54, 246–54.Google Scholar
Bremner, J D, Narayan, M, Staib, L H, Southwick, S M, McGlashan, T and Charney, D S. 1999a. Neural correlates of memories of childhood sexual abuse in women with and without posttraumatic stress disorder. Am J Psychiatry 156, 1787–95.Google Scholar
Bremner, J D, Randall, P, Scott, T M, et al. 1995. MRI-based measurement of hippocampal volume in patients with combat-related posttraumatic stress disorder. Am J Psychiatry 152, 973–81.Google Scholar
Bremner, J D, Staib, L H, Kaloupek, D, Southwick, S M, Soufer, R and Charney, D S. 1999b. Neural correlates of exposure to traumatic pictures and sound in Vietnam combat veterans with and without posttraumatic stress disorder: A positron emission tomography study. Biol Psychiatry 45, 806–16.Google Scholar
Bremner, J D, Vermetten, E, Schmahl, C, et al. 2005. Positron emission tomographic imaging of neural correlates of a fear acquisition and extinction paradigm in women with childhood sexual-abuse-related post-traumatic stress disorder. Psychol Med 35, 791–806.Google Scholar
Bremner, J D, Vermetten, E, Vythilingam, M, et al. 2004 Neural correlates of the classic color and emotional stroop in women with abuse-related posttraumatic stress disorder. Biol Psychiatry 55, 612–20.Google Scholar
Bremner, J D, Vythilingam, M, Vermetten, E, et al. 2003a. MRI and PET study of deficits in hippocampal structure and function in women with childhood sexual abuse and posttraumatic stress disorder. Am J Psychiatry 160, 924–32.Google Scholar
Bremner, J D, Vythilingam, M, Vermetten, E, et al. 2003b. Neural correlates of declarative memory for emotionally valenced words in women with posttraumatic stress disorder related to early childhood sexual abuse. Biol Psychiatry 53, 879–89.Google Scholar
Britton, J C, Phan, K L, Taylor, S F, Fig, L M and Liberzon, I. 2005. Corticolimbic blood flow in posttraumatic stress disorder during script-driven imagery. Biol Psychiatry 57, 832–40.Google Scholar
Bryant, R A, Felmingham, K L, Kemp, A H, et al. 2005. Neural networks of information processing in posttraumatic stress disorder: A functional magnetic resonance imaging study. Biol Psychiatry 58, 111–8.Google Scholar
Bryant, R A, Felmingham, K, Kemp, A, Das, P, Hughes, G, Peduto, A and Williams, L. 2008a. Amygdala and ventral anterior cingulate activation predicts treatment response to cognitive behaviour therapy for post-traumatic stress disorder. Psychol Med 38, 555–61.Google Scholar
Bryant, R A, Kemp, A H, Felmingham, K L, et al. 2008b. Enhanced amygdala and medial prefrontal activation during nonconscious processing of fear in posttraumatic stress disorder: An fMRI study. Hum Brain Mapp 29, 517–23.Google Scholar
Carrion, V G, Garrett, A, Menon, V, Weems, C F and Reiss, A L. 2008. Posttraumatic stress symptoms and brain function during a response-inhibition task: An fMRI study in youth. Depress Anxiety 25, 514–26.Google Scholar
Chung, Y A, Kim, S H, Chung, S K, et al. 2006. Alterations in cerebral perfusion in posttraumatic stress disorder patients without re-exposure to accident-related stimuli. Clin Neurophysiol 117, 637–42.Google Scholar
Corcoran, K A and Maren, S. 2001. Hippocampal inactivation disrupts contextual retrieval of fear memory after extinction. J Neurosci 21, 1720–6.Google Scholar
Davis, M and Whalen, P J. 2001. The amygdala: Vigilance and emotion. Mol Psychiatry 6, 13–34.Google Scholar
Dickie, E W, Brunet, A, Akerib, V and Armony, J L. 2008. An fMRI investigation of memory encoding in PTSD: Influence of symptom severity. Neuropsychologia 46, 1522–31.Google Scholar
Dolcos, F, LaBar, K S and Cabeza, R. 2004. Interaction between the amygdala and the medial temporal lobe memory system predicts better memory for emotional events. Neuron 42, 855–63.Google Scholar
Driessen, M, Beblo, T, Mertens, M, et al. 2004. Posttraumatic stress disorder and fMRI activation patterns of traumatic memory in patients with borderline personality disorder. Biol Psychiatry 55, 603–11.Google Scholar
Eichenbaum, H. 2000. A cortical–hippocampal system for declarative memory. Nat Rev Neurosci 1, 41–50.Google Scholar
Elzinga, B M and Bremner, J D. 2002. Are the neural substrates of memory the final common pathway in posttraumatic stress disorder (PTSD)? J Affect Disord 70, 1–17.Google Scholar
Felmingham, K, Kemp, A, Williams, L, et al. 2007. Changes in anterior cingulate and amygdala after cognitive behavior therapy of posttraumatic stress disorder. Psychol Sci 18, 127–9.Google Scholar
Fernandez, M, Pissiota, A, Frans, O, Knorring, L, Fischer, H and Fredrikson, M. 2001. Brain function in a patient with torture related post-traumatic stress disorder before and after fluoxetine treatment: A positron emission tomography provocation study. Neurosci Lett 297, 101–04.Google Scholar
Francati, V, Vermetten, E and Bremner, J D. 2007. Functional neuroimaging studies in posttraumatic stress disorder: Review of current methods and findings. Depress Anxiety 24, 202–18.Google Scholar
Frewen, P, Lane, R D, Neufeld, R W, Densmore, M, Stevens, T and Lanius, R. 2008. Neural correlates of levels of emotional awareness during trauma script-imagery in posttraumatic stress disorder. Psychosom Med 70, 27–31.Google Scholar
Geuze, E, Vermetten, E, Ruf, M, Kloet, C S and Westenberg, H G. 2008. Neural correlates of associative learning and memory in veterans with posttraumatic stress disorder. J Psychiatr Res 42, 659–69.Google Scholar
Gilboa, A, Shalev, A Y, Laor, L, et al. 2004. Functional connectivity of the prefrontal cortex and the amygdala in posttraumatic stress disorder. Biol Psychiatry 55, 263–72.Google Scholar
Gurvits, T V, Shenton, M E, Hokama, H, et al. 1996. Magnetic resonance imaging study of hippocampal volume in chronic, combat-related posttraumatic stress disorder. Biol Psychiatry 40, 1091–9.Google Scholar
Hamner, M B, Lorberbaum, J P and George, M S. 1999. Potential role of the anterior cingulate cortex in PTSD: Review and hypothesis. Depress Anxiety 9, 1–14.Google Scholar
Hendler, T, Rotshtein, P, Yeshurun, Y, et al. 2003. Sensing the invisible: Differential sensitivity of visual cortex and amygdala to traumatic context. Neuroimage 19, 587–600.Google Scholar
Hopper, J W, Frewen, P A, Kolk, B A and Lanius, R A. 2007. Neural correlates of reexperiencing, avoidance, and dissociation in PTSD: Symptom dimensions and emotion dysregulation in responses to script-driven trauma imagery. J Trauma Stress 20, 713–25.Google Scholar
Hou, C, Liu, J, Wang, K, et al. 2007. Brain responses to symptom provocation and trauma-related short-term memory recall in coal mining accident survivors with acute severe PTSD. Brain Res 1144, 165–74.Google Scholar
Karl, A, Schaefer, M, Malta, L S, Dorfel, D, Rohleder, N and Werner, A. 2006. A meta-analysis of structural brain abnormalities in PTSD. Neurosci Biobehav Rev 30, 1004–31.Google Scholar
Kim, M J, Chey, J, Chung, A, et al. 2008. Diminished rostral anterior cingulate activity in response to threat-related events in posttraumatic stress disorder. J Psychiatr Res 42, 268–77.Google Scholar
Koenen, K C, Saxe, G, Purcell, S, et al. 2005. Polymorphisms in FKBP5 are associated with peritraumatic dissociation in medically injured children. Mol Psychiatry 10, 1058–9.Google Scholar
Lang, P J, Levin, D N, Miller, G A and Kozak, M J. 1983. Fear behavior, fear imagery, and the psychophysiology of emotion: The problem of affective response integration. J Abnorm Psychol 92, 276–306.Google Scholar
Lanius, R, Williamson, P, Boksman, K, et al. 2002. Brain activation during script-driven imagery induced dissociative responses in PTSD: A functional magnetic resonance imaging investigation. Biol Psychiatry 52, 305.Google Scholar
Lanius, R A, Bluhm, R, Lanius, U and Pain, C. 2006. A review of neuroimaging studies in PTSD: Heterogeneity of response to symptom provocation. J Psychiatr Res 40, 709–29.Google Scholar
Lanius, R A, Williamson, P C, Bluhm, R L, et al. 2005. Functional connectivity of dissociative responses in posttraumatic stress disorder: A functional magnetic resonance imaging investigation. Biol Psychiatry 57, 873–84.Google Scholar
Lanius, R A, Williamson, P C, Densmore, M, et al. 2001. Neural correlates of traumatic memories in posttraumatic stress disorder: A functional MRI investigation. Am J Psychiatry 158, 1920–2.Google Scholar
Lanius, R A, Williamson, P C, Hopper, J, et al. 2003. Recall of emotional states in posttraumatic stress disorder: An fMRI investigation. Biol Psychiatry 53, 204–10.Google Scholar
Lansing, K, Amen, D G, Hanks, C and Rudy, L. 2005. High-resolution brain SPECT imaging and eye movement desensitization and reprocessing in police officers with PTSD. J Neuropsychiatry Clin Neurosci 17, 526–32.Google Scholar
Layton, B and Krikorian, R. 2002. Memory mechanisms in posttraumatic stress disorder. J Neuropsychiatry Clin Neurosci 14, 254–61.Google Scholar
LeDoux, J E. 2000. Emotion circuits in the brain. Annu Rev Neurosci 23, 155–84.Google Scholar
Lee, H J, Lee, M S, Kang, R H, et al. 2005. Influence of the serotonin transporter promoter gene polymorphism on susceptibility to posttraumatic stress disorder. Depress Anxiety 21, 135–9.Google Scholar
Levin, P, Lazrove, S. and Kolk, B. 1999. What psychological testing and neuroimaging tell us about the treatment of Posttraumatic Stress Disorder by Eye Movement Desensitization and Reprocessing. J Anxiety Disord 13, 159–72.Google Scholar
Liberzon, I, Taylor, S F, Amdur, R, et al. 1999. Brain activation in PTSD in response to trauma-related stimuli. Biol Psychiatry 45, 817–26.Google Scholar
Lindauer, R J, Booij, J, Habraken, J B, et al. 2004. Cerebral blood flow changes during script-driven imagery in police officers with posttraumatic stress disorder. Biol Psychiatry 56, 853–61.Google Scholar
Maren, S and Holt, W. 2000. The hippocampus and contextual memory retrieval in Pavlovian conditioning. Behav Brain Res 110, 97–108.Google Scholar
McGaugh, J L. 2004. The amygdala modulates the consolidation of memories of emotionally arousing experiences. Annu Rev Neurosci 27, 1–28.Google Scholar
Milad, M R and Quirk, G J. 2002. Neurons in medial prefrontal cortex signal memory for fear extinction. Nature 420, 70–4.Google Scholar
Mirzaei, S, Knoll, P, Keck, A, et al. 2001. Regional cerebral blood flow in patients suffering from post-traumatic stress disorder. Neuropsychobiology 43, 260–4.Google Scholar
Molina, M E, Isoardi, R, Prado, M N and Bentolila, S. 2010. Basal cerebral glucose distribution in long-term post-traumatic stress disorder. World J Biol Psychiatry 11 , 493–501.Google Scholar
Moores, K A, Clark, C R, McFarlane, A C, Brown, G C, Puce, A and Taylor, D J. 2008. Abnormal recruitment of working memory updating networks during maintenance of trauma-neutral information in post-traumatic stress disorder. Psychiatry Res 163, 156–70.Google Scholar
Morey, R A, Dolcos, F, Petty, C M, et al. 2008. The role of trauma-related distractors on neural systems for working memory and emotion processing in posttraumatic stress disorder. J Psychiatr Res 43, 809–17.Google Scholar
Morgan, M A, Romanski, L M and LeDoux, J E. 1993. Extinction of emotional learning: Contribution of medial prefrontal cortex. Neurosci Lett 163, 109–13.Google Scholar
Orr, S P, Metzger, L J, Lasko, N B, et al. 2000. De novo conditioning in trauma-exposed individuals with and without posttraumatic stress disorder. J Abnorm Psychol 109, 290–8.Google Scholar
Osuch, E A, Benson, B, Geraci, M, et al. 2001. Regional cerebral blood flow correlated with flashback intensity in patients with posttraumatic stress disorder. Biol Psychiatry 50, 246–53.Google Scholar
Osuch, E A, Willis, M W, Bluhm, R, Ursano, R J and Drevets, W C. 2008. Neurophysiological responses to traumatic reminders in the acute aftermath of serious motor vehicle collisions using [15O]-H2O positron emission tomography. Biol Psychiatry 64, 327–35.Google Scholar
Pavic, L, Gregurek, R, Petrovic, R, et al. 2003. Alterations in brain activation in posttraumatic stress disorder patients with severe hyperarousal symptoms and impulsive aggressiveness. Eur Arch Psychiatry Clin Neurosci 253, 80–3.Google Scholar
Peres, J F, Newberg, A B, Mercante, J P, et al. 2007. Cerebral blood flow changes during retrieval of traumatic memories before and after psychotherapy: A SPECT study. Psychol Med 37, 1481–91.Google Scholar
Phan, K L, Britton, J C, Taylor, S F, Fig, L M and Liberzon, I. 2006. Corticolimbic blood flow during nontraumatic emotional processing in posttraumatic stress disorder. Arch Gen Psychiatry 63, 184–92.Google Scholar
Piefke, M, Pestinger, M, Arin, T, et al. 2007. The neurofunctional mechanisms of traumatic and non-traumatic memory in patients with acute PTSD following accident trauma. Neurocase 13, 342–57.Google Scholar
Pissiota, A, Frans, O, Fernandez, M, Knorring, L, Fischer, H and Fredrikson, M. 2002. Neurofunctional correlates of posttraumatic stress disorder: A PET symptom provocation study. Eur Arch Psychiatry Clin Neurosci 252, 68–75.Google Scholar
Pitman, R K, Orr, S P, Forgue, D F, Jong, J B and Claiborn, J M. 1987. Psychophysiologic assessment of posttraumatic stress disorder imagery in Vietnam combat veterans. Arch Gen Psychiatry 44, 970–5.Google Scholar
Protopopescu, X, Pan, H, Tuescher, O, et al. 2005. Differential time courses and specificity of amygdala activity in posttraumatic stress disorder subjects and normal control subjects. Biol Psychiatry 57, 464–73.Google Scholar
Quirk, G J, Russo, G K, Barron, J L and Lebron, K. 2000. The role of ventromedial prefrontal cortex in the recovery of extinguished fear. J Neurosci 20, 6225–31.Google Scholar
Rauch, S L, Shin, L M and Phelps, E A. 2006. Neurocircuitry models of posttraumatic stress disorder and extinction: Human neuroimaging research – Past, present, and future. Biol Psychiatry 60, 376–82.Google Scholar
Rauch, S L, Shin, L M, Segal, E, et al. 2003. Selectively reduced regional cortical volumes in post-traumatic stress disorder. Neuroreport 14, 913–6.Google Scholar
Rauch, S L, Shin, L M, Whalen, P J and Pitman, R K. 1998. Neuroimaging and the neuroanatomy of PTSD. CNS Spectrums 3 (Suppl 2), 30–41.Google Scholar
Rauch, S L, Kolk, B A, Fisler, R E, et al. 1996. A symptom provocation study of posttraumatic stress disorder using positron emission tomography and script-driven imagery. Arch Gen Psychiatry 53, 380–7.Google Scholar
Rauch, S L, Whalen, P J, Shin, L M, et al. 2000. Exaggerated amygdala response to masked facial stimuli in posttraumatic stress disorder: A functional MRI study. Biol Psychiatry 47, 769–76.Google Scholar
Reiman, E M, Lane, R D, Ahern, G L, et al. 1997. Neuroanatomical correlates of externally and internally generated human emotion. Am J Psychiatry 154, 918–25.Google Scholar
Sachinvala, N, Kling, A, Suffin, S, Lake, R and Cohen, M. 2000. Increased regional cerebral perfusion by 99mTc hexamethyl propylene amine oxime single photon emission computed tomography in post-traumatic stress disorder. Mil Med 165, 473–9.Google Scholar
Sailer, U, Robinson, S, Fischmeister, F P, et al. 2008. Altered reward processing in the nucleus accumbens and mesial prefrontal cortex of patients with posttraumatic stress disorder. Neuropsychologia 46, 2836–44.Google Scholar
Sanders, M, Wiltgen, B and Fanselow, M. 2003. The place of the hippocampus in fear conditioing. Eur J Pharmacol 463, 217–23.Google Scholar
Seedat, S, Warwick, J, Heerden, B, et al. 2004. Single photon emission computed tomography in posttraumatic stress disorder before and after treatment with a selective serotonin reuptake inhibitor. J Affect Disord 80, 45–53.Google Scholar
Semple, W E, Goyer, P F, McCormick, R, et al. 2000. Higher brain blood flow at amygdala and lower frontal cortex blood flow in PTSD patients with comorbid cocaine and alcohol abuse compared with normals. Psychiatry 63, 65–74.Google Scholar
Shin, L M, Bush, G, Whalen, P J, et al. 2007. Dorsal anterior cingulate function in posttraumatic stress disorder. J Trauma Stress 20, 701–12.Google Scholar
Shin, L M, Kosslyn, S M, McNally, R J, et al. 1997. Visual imagery and perception in posttraumatic stress disorder. A positron emission tomographic investigation. Arch Gen Psychiatry 54, 233–41.Google Scholar
Shin, L M, Lasko, N B, Macklin, M L, et al. 2009. Resting metabolic activity in the cingulate cortex and vulnerability to posttraumatic stress disorder. Arch Gen Psychiatry 66, 1099–107.Google Scholar
Shin, L M, McNally, R J, Kosslyn, S M, et al. 1999. Regional cerebral blood flow during script-driven imagery in childhood sexual abuse-related PTSD: A PET investigation. Am J Psychiatry 156, 575–84.Google Scholar
Shin, L M, Orr, S P, Carson, M A, et al. 2004a. Regional cerebral blood flow in amygdala and medial prefrontal cortex during traumatic imagery in male and female Vietnam veterans with PTSD. Arch Gen Psychiatry 61, 168–76.Google Scholar
Shin, L M, Shin, P S, Heckers, S, et al. 2004b. Hippocampal function in posttraumatic stress disorder. Hippocampus 14, 292–300.Google Scholar
Shin, L M, Whalen, P J, Pitman, R K, et al. 2001. An fMRI study of anterior cingulate function in posttraumatic stress disorder. Biol Psychiatry 50, 932–42.Google Scholar
Shin, L M, Wright, C I, Cannistraro, P A, et al. 2005. A functional magnetic resonance imaging study of amygdala and medial prefrontal cortex responses to overtly presented fearful faces in posttraumatic stress disorder. Arch Gen Psychiatry 62, 273–81.Google Scholar
Thomaes, K, Dorrepaal, E, Draijer, N P, et al. 2009. Increased activation of the left hippocampus region in Complex PTSD during encoding and recognition of emotional words: A pilot study. Psychiatry Res 171, 44–53.Google Scholar
Vermetten, E, Schmahl, C, Southwick, S M and Bremner, J D. 2007. Positron tomographic emission study of olfactory induced emotional recall in veterans with and without combat-related posttraumatic stress disorder. Psychopharmacol Bull 40, 8–30.Google Scholar
Werner, N S, Meindl, T, Engel, R R, et al. 2009. Hippocampal function during associative learning in patients with posttraumatic stress disorder. J Psychiatr Res 43, 309–18.Google Scholar
Whalen, P J. 1998. Fear, vigilance, and ambiguity: Initial neuroimaging studies of the human amygdala. Curr Dir Psychol Sci 6, 178–88.Google Scholar
Whalen, P J, Bush, G, McNally, R J, et al. 1998. The emotional counting Stroop paradigm: A functional magnetic resonance imaging probe of the anterior cingulate affective division. Biol Psychiatry 44, 1219–28.Google Scholar
Whalley, M G, Rugg, M D, Smith, A P, Dolan, R J and Brewin, C R. 2009. Incidental retrieval of emotional contexts in post-traumatic stress disorder and depression: An fMRI study. Brain Cogn 69, 98–107.Google Scholar
Williams, L M, Kemp, A H, Felmingham, K, et al. 2006. Trauma modulates amygdala and medial prefrontal responses to consciously attended fear. Neuroimage 29, 347–57.Google Scholar
Woodward, S H, Kaloupek, D G, Streeter, C C, Martinez, C, Schaer, M and Eliez, S. 2006. Decreased anterior cingulate volume in combat-related PTSD. Biol Psychiatry 59, 582–7.Google Scholar
Yamasue, H, Kasai, K, Iwanami, A, et al. 2003. Voxel-based analysis of MRI reveals anterior cingulate gray-matter volume reduction in posttraumatic stress disorder due to terrorism. Proc Natl Acad Sci U S A 100, 9039–43.Google Scholar
Yang, P, Wu, M T, Hsu, C C and Ker, J H. 2004. Evidence of early neurobiological alternations in adolescents with posttraumatic stress disorder: A functional MRI study. Neurosci Lett 370, 13–8.Google Scholar
Zubieta, J K, Chinitz, J A, Lombardi, U, Fig, L M, Cameron, O G and Liberzon, I. 1999. Medial frontal cortex involvement in PTSD symptoms: A SPECT study. J Psychiatr Res 33, 259–64.Google Scholar

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