Investigation of Limbic White Matter Microstructure and Grey Matter Volume in Patients with Post-traumatic Stress Disorder with and without Psychosis

Evdokiya Knyazhanskaya, BA
Department of Psychiatry
Poster Overview

Post-traumatic stress disorder (PTSD) is a debilitating disorder that presents with symptoms of emotional distress and is highly prevalent in veteran populations. Occasionally, PTSD patients can experience psychotic symptoms like auditory hallucinations. Imaging allows for the determination of brain regions that play a role in the development of these manifestations. Prior studies have shown that limbic regions (brain areas associated with emotional processing) might be altered in PTSD. However, results have not been consistent, and no study has included patients with PTSD and psychotic symptoms. This study aims to characterize brain volumes and tissue organization of limbic regions in patients with PTSD, patients with PTSD and psychotic symptoms, and healthy individuals using sophisticated imaging methods. Neuroimaging data were acquired from 12 healthy individuals and 28 patients with PTSD (15 with and 13 without psychotic symptoms). Lower volumes and less organized tissue in the limbic regions were found in patients with PTSD compared to healthy individuals. Patients with PTSD and psychotic symptoms did not differ from patients with just PTSD. Our results demonstrate the benefit of using neuroimaging methods to study brain areas involved in emotion regulation in PTSD. This illuminates an area of focus for future diagnostic and treatment measures.

Scientific Abstract

Post-traumatic stress disorder (PTSD) can present with an array of debilitating symptoms, including psychotic features. While many studies have implicated the limbic circuit in the pathology of PTSD, no study has investigated the association between psychotic symptoms and brain structure in PTSD. The goal of the present study is to compare the macro- and microstructure of the limbic circuit between patients with PTSD, patients with PTSD and psychotic symptoms, and healthy individuals.

MRI data were acquired from 12 healthy controls (HCs) and 28 patients with PTSD (15 with and 13 without psychotic symptoms) from the VA Medical Center and preprocessed using the HCP minimal-processing pipeline. Free-water imaging was used to extract measures of GM microstructural organization (FAT) for 8 limbic regions. FAT and macrostructural volume measurements were compared between groups using ANVOCAs (corrected for sex and age).

Patients had significantly lower volumes than HCs in the hippocampus, higher volumes in the orbitofrontal cortex, and lower FAT in the hippocampus and cingulum. No differences were found between patient groups.

Results demonstrate macro- and microstructural impairments of limbic regions in PTSD independent of psychotic symptoms. Further studies are needed to determine if other brain regions are affiliated with psychotic symptoms in PTSD.

Clinical Implications
Treatment of PTSD is challenging, but is made even more so by co-occuring conditions, like psychotic symptoms. Investigating the neuropathology of PTSD with psychotic symptoms could illuminate better diagnostic criteria and treatment options for affected individuals.
Research Areas
Evdokiya E. Knyazhanskaya, Johanna Seitz, Diane Smedberg, Aengus รณ Conghaile, Kang Ik Cho, Elisabetta C. del Re, Mike Coleman, Margaret Niznikiewicz, Martha E. Shenton, Lynn DeLisi, Marek Kubicki
Principal Investigator
Marek Kubicki

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