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  • Addiction, Drugs
  • Information from Lay-Language Summaries is Embargoed Until the Conclusion of the Scientific Presentation

    011—Brain Injury: Models and Human Studies

    Saturday, November 09, 2013, 1:00 pm - 4:30 pm

    11.09: Neural biomarkers of treatment response in combat trauma

    Location: 32B

    ">*A. D. SPADONI1,2, I. A. STRIGO1,2, S. B. NORMAN2,1, A. N. SIMMONS2,1;
    1UCSD, San Diego, CA; 2VA Ctr. of Excellence for Stress and Mental Hlth., VA San Diego Healthcare Syst., San Diego, CA

    Abstract Body: Background: Posttraumatic stress disorder (PTSD) is a debilitating neuropsychiatric disease. Neuroimaging techniques may help delineate a neural profile of treatment responsiveness to empirically supported interventions, and provide important information to help advance our ability to care for those suffering from PTSD.
    Methods: Subjects were 18 male veterans, aged 31.94(7.13), with severe PTSD (mean baseline Clinician Administered PTSD Scale (CAPS) score = 90.22(15.01)). All subjects performed a validated stop-signal task (Matthews et al., 2009) in the MRI scanner. Using a linear mixed modeling approach with difficulty (hard vs. easy), accuracy (error vs. correct) and post-treatment CAPS scores as factors, we used baseline brain response during the stop signal task to predict post-treatment CAPS scores following 8-weeks treatment with Prolonged Exposure therapy.
    Results: Subjects demonstrated a wide range of clinical outcomes following therapy (i.e., change in CAPS scores ranged from -3 to 94). Significant interactions were observed in multiple prefrontal regions whereby degree of recovery was associated with different patterns of baseline prefrontal activation, depending upon level of difficulty and/or accuracy.
    Conclusions: We found that degree of recovery in PTSD individuals following Prolonged Exposure therapy was associated with differential patterns of pre-treatment prefrontal brain response during inhibition demands. These findings may suggest that neural characteristics of inhibitory processing may predict treatment responsiveness, and that they may serve as a useful tool in aiding future treatment planning for individuals with PTSD.

    Lay Language Summary: Exposure to one or more life-threatening events can result in posttraumatic stress disorder (or PTSD) and this disorder is very difficult to treat. We found that pre-treatment patterns of prefrontal brain response during inhibition may tell us whether individuals with PTSD will or will not benefit from a type of cognitive behavioral therapy, such as Prolonged Exposure. Through brain imaging during an inhibition task that measures one’s capacity to stop an automatic hand movement (or button press) we highlight the importance of specific neural mechanisms that may be dysfunctional in individuals that have PTSD and do not respond as well to treatment. Identifying brain mechanisms that pinpoint individuals who benefit from a certain type of treatment is a step toward personalized medicine for those who suffer from posttraumatic symptoms after experiencing trauma.
    There is a dearth of studies examining factors that predict PTSD treatment outcomes, especially in regards to neural characteristics. Characterization of brain response prior to treatment and its association with treatment outcomes may advance our ability to screen individuals prior to treatment entrance and select interventions that are most likely to be effective. Our results indicate that decreased pre-treatment rostral anterior cingulate cortex activation during correct responses to a difficult inhibition task is related to increased severity of post-treatment PTSD symptoms. These findings are consistent with previous studies that observed diminished activation of this brain region in PTSD individuals. Such a pattern is thought to illustrate impaired ability to regulate the brain’s emotional centers. Therefore, the current findings may underscore the importance of those neural mechanisms supporting emotional regulation for the successful recovery from PTSD.
    To examine the neural underpinnings of inhibition demands, we recruited 18 male veterans (~32 years old) with severe PTSD to complete a brain imaging study. All subjects performed a validated inhibition task in the MRI scanner. We used baseline brain response during the inhibition task to predict post-treatment PTSD severity following 8-weeks treatment with Prolonged Exposure therapy.
    Studies like this one may help develop a neural profile associated with favorable responses to our most effective treatments for PTSD. A process that allows us to screen and appropriately triage individuals into empirically validated care would decrease the cost of clinical trials by including subjects most likely to benefit, reduce the duration of mental illness by matching individuals to appropriate treatments, and ultimately improve remission rates of PTSD. In the future, brain activation patterns may serve as a useful tool in aiding future treatment planning for individuals with PTSD.