Regional cerebral blood flow in the amygdala and medial prefrontal cortex during traumatic imagery in male and female Vietnam veterans with PTSD.
BACKGROUND
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.


METHODS
Case-control study.


METHODS
Academic medical center.


METHODS
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).


METHODS
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.
Shin
Lisa M
LM
Department of Psychology, Tufts University, Medford, MA 02155, USA. lisa.shin@tufts.edu
Orr
Scott P
SP
Carson
Margaret A
MA
Rauch
Scott L
SL
Macklin
Michael L
ML
Lasko
Natasha B
NB
Peters
Patricia Marzol
PM
Metzger
Linda J
LJ
Dougherty
Darin D
DD
Cannistraro
Paul A
PA
Alpert
Nathaniel M
NM
Fischman
Alan J
AJ
Pitman
Roger K
RK
D000679:Amygdala / Q000098:blood supply* / Q000473:pathology; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D019018:Imagery, Psychotherapy; D008297:Male; D008875:Middle Aged; D017397:Prefrontal Cortex / Q000098:blood supply* / Q000473:pathology; D012039:Regional Blood Flow; D013313:Stress Disorders, Post-Traumatic / Q000503:physiopathology*; D014055:Tomography, Emission-Computed; D014728:Veterans / Q000523:psychology*; D014744:Vietnam; D014857:Warfare; D014947:Wounds and Injuries / Q000523:psychology