The posttraumatic stress disorder project in Brazil: neuropsychological, structural and molecular neuroimaging studies in victims of urban violence.
BACKGROUND
Life trauma is highly prevalent in the general population and posttraumatic stress disorder is among the most prevalent psychiatric consequences of trauma exposure. Brazil has a unique environment to conduct translational research about psychological trauma and posttraumatic stress disorder, since urban violence became a Brazilian phenomenon, being particularly related to the rapid population growth of its cities. This research involves three case-control studies: a neuropsychological, a structural neuroimaging and a molecular neuroimaging study, each focusing on different objectives but providing complementary information. First, it aims to examine cognitive functioning of PTSD subjects and its relationships with symptomatology. The second objective is to evaluate neurostructural integrity of orbitofrontal cortex and hippocampus in PTSD subjects. The third aim is to evaluate if patients with PTSD have decreased dopamine transporter density in the basal ganglia as compared to resilient controls subjects. This paper shows the research rationale and design for these three case-control studies.


METHODS
Cases and controls will be identified through an epidemiologic survey conducted in the city of São Paulo. Subjects exposed to traumatic life experiences resulting in posttraumatic stress disorder (cases) will be compared to resilient victims of traumatic life experiences without PTSD (controls) aiming to identify biological variables that might protect or predispose to PTSD. In the neuropsychological case-control study, 100 patients with PTSD, will be compared with 100 victims of trauma without posttraumatic stress disorder, age- and sex-matched controls. Similarly, 50 cases and 50 controls will be enrolled for the structural study and 25 cases and 25 controls in the functional neuroimaging study. All individuals from the three studies will complete psychometrics and a structured clinical interview (the Structured Clinical Interview for DSM-IV and the Clinician-Administered PTSD Scale, Beck Anxiety Inventory, Beck Depression Inventory, Global Assessment of Function, The Social Adjustment Scale, Medical Outcomes Study 36-Item Short-Form Health Survey, Early Trauma Inventory, Clinical global Impressions, and Peritraumatic Dissociative Experiences Questionnaire). A broad neuropsychological battery will be administered for all participants of the neuropsychological study. Magnetic resonance scans will be performed to acquire structural neuroimaging data. Single photon emission computerized tomography with [(99m)Tc]-TRODAT-1 brain scans will be performed to evaluate dopamine transporters.


CONCLUSIONS
This study protocol will be informative for researchers and clinicians interested in considering, designing and/or conducting translational research in the field of trauma and posttraumatic stress disorder.
Bressan
Rodrigo A
RA
Laboratório Interdisciplinar de Neurosciencias Clínicas - LiNC, São Paulo, Brazil. r.bressan@iop.kcl.ac.uk
Quarantini
Lucas C
LC
Andreoli
Sérgio B
SB
Araújo
Celia
C
Breen
Gerome
G
Guindalini
Camila
C
Hoexter
Marcelo
M
Jackowski
Andrea P
AP
Jorge
Miguel R
MR
Lacerda
Acioly L T
AL
Lara
Diogo R
DR
Malta
Stella
S
Moriyama
Tais S
TS
Quintana
Maria I
MI
Ribeiro
Wagner S
WS
Ruiz
Juliana
J
Schoedl
Aline F
AF
Shih
Ming C
MC
Figueira
Ivan
I
Koenen
Karestan C
KC
Mello
Marcelo F
MF
Mari
Jair J
JJ
D000223:Adaptation, Psychological; D001938:Brazil / Q000453:epidemiology; D019548:Crime Victims; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D009483:Neuropsychological Tests; D010555:Personality Inventory; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics; D012720:Severity of Illness Index; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis* / Q000453:epidemiology; D011795:Surveys and Questionnaires; D014505:Urban Population; D014754:Violence