Abstract
Post Traumatic Stress Disorder (PTSD) is a complex and heterogeneous psychiatric disorder. Patients with chronic PTSD present with significant psychiatric co-morbidities. Current treatment guidelines recommend the use of selective serotonin reuptake inhibitors in PTSD patients, but only 50–60% of these patients respond favorably. To improve the response rate, understanding the underlying pathophysiology is necessary. Serotonergic transmission has been implicated in PTSD and the intensity-dependent auditory evoked potential (IDAEP) is presumed to reflect central serotonergic activity, thereby providing an opportunity to more precisely characterize PTSD patient populations and possibly predict response to treatment. We studied nineteen patients diagnosed with PTSD, matched for age and medications. Based on the stimulus intensity relationship, the patients were divided into two groups: augmenters and reducers. These groups were further evaluated using resting state quantitative EEG and HMPAO-based SPECT brain perfusion acquired simultaneously. The imaging data were correlated with behavioral measures characterizing symptoms of PTSD and measurements of mood state. The augmenters differed from the reducers in the resting state quantitative EEG and SPECT perfusion measures. The differences were primarily localized to the right hemisphere. There were significant differences in measures of PTSD symptoms, but not in overall measures of depression. Item analysis of depression measures showed a significant difference between the augmenters and the reducers in reported sleep difficulties, which correlated with the reported anxiety measures. Objective separation of patients into subgroups based on the IDAEP contributes to the understanding of PTSD biological substrate and can potentially lead to more effective treatment strategies.
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APA Practice Guidelines (2004). http://www.psychiatryonline.com
Arora, R. C., Fichtner, C. G., O’Connor, F., & Crayton, J.W. (1993). Paroxetine binding in the blood platelets of posttraumatic stress disorder patients. Life Sciences, 53, 919–928.
Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561–571.
Blake, D. D., Weathers, F. W., Nagy, L. M., Kaloupek, D. G., Klauminzer, G., Charney, D. S., et al. (1990). A clinician rating scale for assessing current and lifetime PTSD: The CA-PS-1. Behavior Therapist, 13, 187–188.
Bonne, O., Gilboa, A., Louzoun, Y., Brandes, D., Yona, I., Lester, H., et al. (2003). Resting regional cerebral perfusion in recent posttraumatic stress disorder. Biological Psychiatry, 54, 1077–1086.
Bremner, J. D. (2003). MRI and PET Study of Deficits in Hippocampal Structure and Function in Women With Childhood Sexual Abuse and Posttraumatic Stress Disorder. American Journal of Psychiatry, 160, 924–932.
Bremner, J. D., Narayan, M., Staib, L. H., Southwick, S. M., McGlashan, T., & Charney, D. S. (1999). Neural correlates of memories of childhood sexual abuse in women with and without posttraumatic stress disorder. American Journal of Psychiatry, 156, 1787–1795.
Bremner, J. D., Randall, P., Vermetten, E., Staib, L., Bronen, R. A., Mazure, C., et al. (1997). Magnetic resonance imaging-based measurement of hippocampal volume in posttraumatic stress disorder related to childhood physical and sexual abuse—a preliminary report. Biological Psychiatry, 41, 23–32.
Buchsbaum, M. S. a. S. J. (1968). Stimulus intensity control and the cortical evoked response. Psychosomatic Medicine, 30, 12–22.
Foa, E. B., Davidson, J. & Frances, A. (1999). The expert consensus guideline series: Treatment of posttraumatic stress disorder. Journal of Clinical Psychiatry, 60, 6–79.
Gallinat, J., Bottlender, R., Juckel, G., Munke-Puchner, A., Stotz, G., Kuss, H. J., et al. (2000). The loudness dependency of the auditory evoked N1/P2-component as a predictor of the acute SSRI response in depression. Psychopharmacology, 148, 404–411.
Harvey, B. H., Naciti, C., Brand, L., & Stein, D. (2004). Serotonin and Stress: Protective or Malevolent Actions in the Bio-behavioral Response to Repeated Trauma? Annals of the New York Academy of Sciences, 1032, 267.
Hegerl, U., Bottlender, R., Gallinat, J., Kuss, H. J., Ackenheil, M., & Möller, H. J. (1998). The serotonin syndrome scale: first results on validity. European Archives of Psychiatry and Clinical Neuroscience, 248, 96–103.
Hegerl, U., Gallinat, J., & Juckel, G. (2001). Event-related potentials Do they reflect central serotonergic neurotransmission and do they predict clinical response to serotonin agonists? Journal of Affective Disorders, 62, 93–100.
Juckel, G., Hegerl, U., Molnar, M., Csepe, V., & Karmos, G. (1999). Auditory evoked potentials reflect serotonergic neuronal activity—a study in behaving cats administered drugs acting on 5-HT1A autoreceptors in the dorsal raphe nucleus. Neuropsychopharmacology, 21, 710–716.
Juckel, G., Mavrogiorgou, P., Bredemeier, S., Gallinat, J., Frodl, T., Schulz, C., et al. (2004). Loudness Dependence of Primary Auditory-Cortex-Evoked Activity as Predictor of Therapeutic Outcome to Prophylactic Lithium Treatment in Affective Disorders-A Retrospective Study. Pharmacopsychiatry, 37, 46–51.
Juckel, G., Molnár, M., Hegerl, U., Csépe, V., & Karmos, G. (1997). Auditory-evoked potentials as indicator of brain serotonergic activity first evidence in behaving cats. Biological Psychiatry, 41, 1181–1195.
Keane, T. M. (1988). Mississippi Scale for Combat-Related Posttraumatic Stress Disorder: Three Studies in Reliabilty and Validity. Journal of Consulting and Clinical Psychology, 56, 85–90.
Lewine, J. D. (2002). Abnormal Stimulus-Response Intensity Functions in Posttraumatic Stress Disorder: An Electrophysiological Investigation. American Journal of Psychiatry, 159, 1689–1695.
Lucey, J. V., Costa, D. C., Adshead, G., Deahl, M., Busatto, G., Gacinovic, S., et al. (1997). Brain blood flow in anxiety disorders. OCD, panic disorder with agoraphobia, and post-traumatic stress disorder on 99mTcHMPAO single photon emission tomography (SPET). The British Journal of Psychiatry, 171, 346.
McPherson, W. B., Newton, J. E. O., Ackerman, P., Oglesby, D. M., & Dykman, R. A. (1997). An event-related brain potential investigation of PTSD and PTSD symptoms in abused children. Integrative Psychological and Behavioral Science, 32, 31–42.
MEDx 3.4.3 (1999). http://www.medx.sensor.com/
Metzger, L. J., Carson, M. A., Paulus, L. A., Lasko, N. B., Paige, S. R., Pitman, R. K., et al. (2002). Event-related potentials to auditory stimuli in female Vietnam nurse veterans with posttraumatic stress disorder. Psychophysiology, 39, 49–63.
Metzger, L.J., Paige, S.R., Carson, M.A., Lasko, N.B., Paulus, L.A., Pitman, R.K, & Orr, S.P. (2004). PTSD arousal and depression symptoms associated with increased right-sided parietal EEG asymmetry. Jounal of Abnormal Psychology, 113, 324–9.
Mirzaei, S., Knoll, P., Keck, A., Preitler, B., Gutierrez, E., Umek, H., et al. (2001). Regional Cerebral Blood Flow in Patients Suffering from Post-Traumatic Stress Disorder. Neu-ropsychobiology, 43, 260–264.
Paige, S. R., Reid, G. M., Allen, M. G., & Newton, J. E. (1990). Psychophysiological correlates of posttraumatic stress disorder in Vietnam veterans. Biol Psychiatry, 27(4), 419–430.
Pascual-Marqui, R. D. (1994). Low resolution electromagnetic tomography. Brain Topography, 7, 180.
Pizzagalli, D. (2001). Anterior Cingulate Activity as a Predictor of Degree of Treatment Response in Major Depression: Evidence From Brain Electrical Tomography Analysis. American Journal of Psychiatry, 158, 405–415.
Pizzagalli, D. A., Oakes, T. R., & Davidson, R. J. (2003). Coupling of theta activity and glucose metabolism in the human rostral anterior cingulate cortex: An EEG/PET study of normal and depressed subjects. Psychophysiology, 40, 939–949.
Pritchard, W. S. (1986). Cognitive event-related potential correlates of schizophrenia. Psychological bulletin., 100, 43–66.
Sachinvala, N., Kling, A., Suffin, S., Lake, R., & Cohen, M. (2000). Increased regional cerebral perfusion by 99mTc he-xamethyl propylene amine oxime single photon emission computed tomography in post-traumatic stress disorder. Military Medicine, 165, 473–9.
Schooler, C., Buchsbaum, M. S., & Carpenter Jr, W. T. (1976). Evoked response and kinesthetic measures of augmenting/reducing in schizophrenics: replications and extensions. Journal of Nervous and Mental Disease, 163, 221–232.
Southwick, S. M., Paige, S., Morgan 3rd, C. A., Bremner, J. D., Krystal, J. H., & Charney, D. S. (1999). Neurotransmitter alterations in PTSD: catecholamines and serotonin. Seminars in Clinical Neuropsychiatry, 4, 242–248.
Spielberger, C. D., Gorsuch, R. L., & Lushene, R. E. (1970). Manual for the State-Trait Anxiety Inventory. Palo Alto. Cal: Consulting Psychologists Press.
Talaraich, J., & Tournoux, P. (1988). Co-Planar Stereotaxic Atlas of the Human Brain: New York: Thieme.
Tuchtenhagen, F. (2000). High Intensity Dependence of Auditory Evoked Dipole Source Activity Indicates Decreased Se-rotonergic Activity in Abstinent Ecstasy(MDMA) Users. Neu-ropsychopharmacology, 22, 608–617.
Vertes, R. P., & Kocsis, B. (1997). Brainstem-diencephalo-septohippocampal systems controlling the theta rhythm of the hippocampus. Neuroscience, 81, 893–926.
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Poprawski, T.J., Lonser, K.A., Korpics, J. et al. Intensity-Dependent Auditory Evoked Potential Defines Subgroups of Patients with PTSD: A Multimodality Imaging Study. Act Nerv Super 51, 109–119 (2009). https://doi.org/10.1007/BF03379927
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DOI: https://doi.org/10.1007/BF03379927