Psychiatry

Neurobiology of PTSD: A Review of Neuroimaging Findings
falseGarfinkel, Sarah N, PhD [pic]; Liberzon, Israel [pic].
Psychiatric Annals[pic]39.6 (Jun 2009): 370-372,376-381.
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Neuroimaging serves as an effective way to investigate the neurocircuitry involved in the development of posttraumatic stress disorder (PTSD).1-3 A number of models describing functional neuroanatomy of PTSD symptom development emerged over the past decade, inspired by both basic animal research and an increasing number of human neuroimaging studies. These models have traditionallyconceptualized PTSD as a state of heightened responsivity to threatening stimuli and later as a state of insufficient inhibitory control over-exaggerated threat-sensitivity. They emphasize the centrality of threat-related processing in the pathophysiology of PTSD and therefore account for the "hypersensitivity to threat," which is highly characteristic of PTSD (such as hypervigilance and hyperarousal).Neuroimaging findings in PTSD lend credence to incorporating "hypersensitivity to threat" within the conceptualization of PTSD, and these findings will be discussed within this review.
It is becoming increasingly apparent, however, that the "hypersensitivity to threat" models do not fully capture the full complexity of PTSD, nor the complexity of changes associated with, trauma exposure and PTSDdevelopment. For instance, important phenomena associated with PTSD, such avoidance and numbing, generalization of fear, vulnerability, and resilience factors, all need to be further understood in terms of underlying psychological mechanisms and their neurobiological substrates. The dysfunction of neuronal regions in PTSD, and the implication this has for the disruption of cognitive and psychologicalprocesses, will also be discussed.
This review summarizes the neuroimaging findings pertaining to PTSD and PTSD vulnerability and will focus on a few key regions known to be particularly implicated in PTSD pathophysiology, specifically amygdala, nucleus accumbens (ACC), medical prefrontal cortex (mPFC), and hippocampus. It will first start by reviewing key structural alterations associated withPTSD, and then progress to discussing functional abnormalities, with a particular emphasis on symptom provocation studies, cognitive activation studies, and functional connectivity analyses. Finally, neurochemical differences, as revealed via receptor imaging, will be addressed followed by a discussion of potential future directions for PTSD research.
Different neuroimaging modalities, such assingle-photon emission tomography (SPECT), positron emission tomography (PET), magnetic resonance spectroscopy (MRS), magnetic resonance imaging (MRI), and functional MRI (fMRI) have all been used in conjunction with PTSD research. This article will incorporate many of these modalities, with a particular emphasis on MRI in the structural section, and fMRI when dealing with functional studies.STRUCTURAL ABNORMALITIES ASSOCIATED WITH PTSD
Structural neuroimaging studies have originally focused on hippocampal volume in PTSD patients, although emerging evidence suggests structural alterations are also present in other regions. The following section will outline key structural alterations associated with PTSD and PTSD vulnerability focusing on the hippocampus, ACC, and amygdala.
Hippocampus...