Circuits and systems in stress. II. Applications to neurobiology and treatment in posttraumatic stress disorder.
This paper follows the preclinical work on the effects of stress on neurobiological and neuroendocrine systems and provides a comprehensive working model for understanding the pathophysiology of posttraumatic stress disorder (PTSD). Studies of the neurobiology of PTSD in clinical populations are reviewed. Specific brain areas that play an important role in a variety of types of memory are also preferentially affected by stress, including hippocampus, amygdala, medial prefrontal cortex, and cingulate. This review indicates the involvement of these brain systems in the stress response, and in learning and memory. Affected systems in the neural circuitry of PTSD are reviewed (hypothalamic-pituitary-adrenal axis (HPA-axis), catecholaminergic and serotonergic systems, endogenous benzodiazepines, neuropeptides, hypothalamic-pituitary-thyroid axis (HPT-axis), and neuro-immunological alterations) as well as changes found with structural and functional neuroimaging methods. Converging evidence has emphasized the role of early-life trauma in the development of PTSD and other trauma-related disorders. Current and new targets for systems that play a role in the neural circuitry of PTSD are discussed. This material provides a basis for understanding the psychopathology of stress-related disorders, in particular PTSD.
Department of Psychiatry, Emory University School of Medicine, Atlanta, Georgia 30306, USA. evermet@emory.edu
Eric
E
Vermetten
J Douglas
JD
Bremner
D000818:Animals; D001143:Arousal / Q000502:physiology*; D001921:Brain / Q000503:physiopathology*; D001931:Brain Mapping; D006801:Humans; D009415:Nerve Net / Q000503:physiopathology*; D018377:Neurotransmitter Agents / Q000502:physiology; D017981:Receptors, Neurotransmitter / Q000502:physiology; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy
D018377:Neurotransmitter Agents; D017981:Receptors, Neurotransmitter