This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (137)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Stress  • Alert me on articles by topic  Social Bookmarking   What's this?

Lisa M. Shin, PhD; Scott P. Orr, PhD; Margaret A. Carson, PhD, RN; Scott L. Rauch, MD; Michael L. Macklin, BA; Natasha B. Lasko, PhD; Patricia Marzol Peters, BA; Linda J. Metzger, PhD; Darin D. Dougherty, MD; Paul A. Cannistraro, MD; Nathaniel M. Alpert, PhD; Alan J. Fischman, MD, PhD; Roger K. Pitman, MD

Arch Gen Psychiatry. 2004;61:168-176.

Context  Theoretical neuroanatomic models of posttraumatic stress disorder (PTSD) and the results of previous neuroimaging studies of PTSD highlight the potential importance of the amygdala and medial prefrontal regions in this disorder. However, the functional relationship between these brain regions in PTSD has not been directly examined.

Objective  To examine the relationship between the amygdala and medial prefrontal regions during symptom provocation in male combat veterans (MCVs) and female nurse veterans (FNVs) with PTSD.

Design  Case-control study.

Setting  Academic medical center.

Participants  Volunteer sample of 17 (7 men and 10 women) Vietnam veterans with PTSD (PTSD group) and 19 (9 men and 10 women) Vietnam veterans without PTSD (control group).

Main Outcome Measures  We used positron emission tomography and the script-driven imagery paradigm to study regional cerebral blood flow (rCBF) during the recollection of personal traumatic and neutral events. Psychophysiologic and emotional self-report data also were obtained to confirm the intended effects of script-driven imagery.

Results  The PTSD group exhibited rCBF decreases in medial frontal gyrus in the traumatic vs neutral comparison. When this comparison was conducted separately by subgroup, MCVs and FNVs with PTSD exhibited these medial frontal gyrus decreases. Only MCVs exhibited rCBF increases in the left amygdala. However, for both subgroups with PTSD, rCBF changes in medial frontal gyrus were inversely correlated with rCBF changes in the left amygdala and the right amygdala/periamygdaloid cortex. Furthermore, in the traumatic condition, for both subgroups with PTSD, symptom severity was positively related to rCBF in the right amygdala and negatively related to rCBF in medial frontal gyrus.

Conclusions  These results suggest a reciprocal relationship between medial prefrontal cortex and amygdala function in PTSD and opposing associations between activity in these regions and symptom severity consistent with current functional neuroanatomic models of this disorder.

From the Department of Psychology, Tufts University, Medford, Mass (Dr Shin); the Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston (Drs Shin, Orr, Rauch, Lasko, Metzger, Dougherty, Cannistraro, and Pitman and Ms Peters); VA Research Service, Manchester, NH(Drs Orr, Carson, Lasko, and Metzger and Mr Macklin); Continuing Nursing Education, St Anselm College, Manchester (Dr Carson); the Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston (Drs Rauch, Dougherty, Alpert, and Fischman); and Adult Oncology, Dana Farber Cancer Center, Boston (Ms Peters).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Posttraumatic Stress Disorder: The Role of Medial Prefrontal Cortex and Amygdala
Koenigs and Grafman
Neuroscientist 2009;15:540-548.
ABSTRACT  

Resting Metabolic Activity in the Cingulate Cortex and Vulnerability to Posttraumatic Stress Disorder
Shin et al.
Arch Gen Psychiatry 2009;66:1099-1107.
ABSTRACT | FULL TEXT  

Stress reduction correlates with structural changes in the amygdala
Holzel et al.
Soc Cogn Affect Neurosci 2009;0:nsp034v1-nsp034.
ABSTRACT | FULL TEXT  

Human vulnerability to stress depends on amygdala's predisposition and hippocampal plasticity
Admon et al.
Proc. Natl. Acad. Sci. USA 2009;106:14120-14125.
ABSTRACT | FULL TEXT  

Threat to Life and Risk-Taking Behaviors: A Review of Empirical Findings and Explanatory Models
Ben-Zur and Zeidner
Pers Soc Psychol Rev 2009;13:109-128.
ABSTRACT  

Changes in Relative Glucose Metabolic Rate Following Cortisol Administration in Aging Veterans with Posttraumatic Stress Disorder: An FDG-PET Neuroimaging Study
Yehuda et al.
J. Neuropsychiatry Clin. Neurosi. 2009;21:132-143.
ABSTRACT | FULL TEXT  

Neural Correlates of Anxiety in Healthy Volunteers: A Voxel-Based Morphometry Study
Spampinato et al.
J. Neuropsychiatry Clin. Neurosi. 2009;21:199-205.
ABSTRACT | FULL TEXT  

Extinction circuits for fear and addiction overlap in prefrontal cortex
Peters et al.
Learn. Mem. 2009;16:279-288.
ABSTRACT | FULL TEXT  

Neural Correlates of Speeded as Compared with Delayed Responses in a Stop Signal Task: An Indirect Analog of Risk Taking and Association with an Anxiety Trait
Li et al.
Cereb Cortex 2009;19:839-848.
ABSTRACT | FULL TEXT  

The Rebirth of Neuroscience in Psychosomatic Medicine, Part I: Historical Context, Methods, and Relevant Basic Science
Lane et al.
Psychosom. Med. 2009;71:117-134.
ABSTRACT | FULL TEXT  

Fear Conditioning and Extinction Differentially Modify the Intrinsic Excitability of Infralimbic Neurons
Santini et al.
J. Neurosci. 2008;28:4028-4036.
ABSTRACT | FULL TEXT  

Failure of Extinction of Fear Responses in Posttraumatic Stress Disorder: Evidence From Second-Order Conditioning
Wessa and Flor
Am. J. Psychiatry 2007;164:1684-1692.
ABSTRACT | FULL TEXT  

Functional Neuroimaging of Anxiety: A Meta-Analysis of Emotional Processing in PTSD, Social Anxiety Disorder, and Specific Phobia
Etkin and Wager
Am. J. Psychiatry 2007;164:1476-1488.
ABSTRACT | FULL TEXT  

Paralimbic and Medial Prefrontal Cortical Involvement in Neuroendocrine Responses to Traumatic Stimuli
Liberzon et al.
Am. J. Psychiatry 2007;164:1250-1258.
ABSTRACT | FULL TEXT  

The Effects of Guided Written Disclosure on Psychological Symptoms Among Parents of Children With Cancer
Duncan et al.
Journal of Family Nursing 2007;13:370-384.
ABSTRACT  

Post-traumatic stress disorder
Bisson
BMJ 2007;334:789-793.
FULL TEXT  

Pharmacological treatment of post-traumatic stress disorder
Bisson
Adv. Psychiatr. Treat. 2007;13:119-126.
ABSTRACT | FULL TEXT  

Activity in Prelimbic Cortex Is Necessary for the Expression of Learned, But Not Innate, Fears
Corcoran and Quirk
J. Neurosci. 2007;27:840-844.
ABSTRACT | FULL TEXT  

Extinction learning before trauma and subsequent posttraumatic stress.
Guthrie and Bryant
Psychosom. Med. 2006;68:307-311.
ABSTRACT | FULL TEXT  

Repeated Stress Induces Dendritic Spine Loss in the Rat Medial Prefrontal Cortex
Radley et al.
Cereb Cortex 2006;16:313-320.
ABSTRACT | FULL TEXT  

Combat Effects on Mental Health: The More Things Change, the More They Remain the Same
Pitman
Arch Gen Psychiatry 2006;63:127-128.
FULL TEXT  

Corticolimbic Blood Flow During Nontraumatic Emotional Processing in Posttraumatic Stress Disorder
Phan et al.
Arch Gen Psychiatry 2006;63:184-192.
ABSTRACT | FULL TEXT  

Brain Activity Associated with Expectancy-Enhanced Placebo Analgesia as Measured by Functional Magnetic Resonance Imaging
Kong et al.
J. Neurosci. 2006;26:381-388.
ABSTRACT | FULL TEXT  

High-Resolution Brain SPECT Imaging and Eye Movement Desensitization and Reprocessing in Police Officers With PTSD
Lansing et al.
J. Neuropsychiatry Clin. Neurosi. 2005;17:526-532.
ABSTRACT | FULL TEXT  

Amygdala Response in Patients With Acute PTSD to Masked and Unmasked Emotional Facial Expressions
Armony et al.
Am. J. Psychiatry 2005;162:1961-1963.
ABSTRACT | FULL TEXT  

Prefrontal Control of the Amygdala
Likhtik et al.
J. Neurosci. 2005;25:7429-7437.
ABSTRACT | FULL TEXT  

Thickness of ventromedial prefrontal cortex in humans is correlated with extinction memory
Milad et al.
Proc. Natl. Acad. Sci. USA 2005;102:10706-10711.
ABSTRACT | FULL TEXT  

A Functional Magnetic Resonance Imaging Study of Amygdala and Medial Prefrontal Cortex Responses to Overtly Presented Fearful Faces in Posttraumatic Stress Disorder
Shin et al.
Arch Gen Psychiatry 2005;62:273-281.
ABSTRACT | FULL TEXT  

Neural Underpinnings of Fear and Its Modulation: Implications for Anxiety Disorders
Miller et al.
J. Neuropsychiatry Clin. Neurosi. 2005;17:1-6.
FULL TEXT  

New Vistas on Amygdala Networks in Conditioned Fear
Pare et al.
J. Neurophysiol. 2004;92:1-9.
ABSTRACT | FULL TEXT  

Consolidation of Fear Extinction Requires Protein Synthesis in the Medial Prefrontal Cortex
Santini et al.
J. Neurosci. 2004;24:5704-5710.
ABSTRACT | FULL TEXT