title: Dorsolateral prefrontal cortex activation during emotional anticipation and neuropsychological performance in posttraumatic stress disorder.
abstract: BACKGROUND
  Posttraumatic stress disorder (PTSD) has been associated with executive or attentional dysfunction and problems in emotion processing. However, it is unclear whether these two domains of dysfunction are related to common or distinct neurophysiological substrates.
  
  
  OBJECTIVE
  To examine the hypothesis that greater neuropsychological impairment in PTSD relates to greater disruption in prefrontal-subcortical networks during emotional anticipation.
  
  
  METHODS
  Case-control, cross-sectional study.
  
  
  METHODS
  General community and hospital and community psychiatric clinics.
  
  
  METHODS
  Volunteer sample of 37 women with PTSD related to intimate partner violence and 34 age-comparable healthy control women.
  
  
  METHODS
  We used functional magnetic resonance imaging (fMRI) to examine neural responses during anticipation of negative and positive emotional images. The Clinician-Administered PTSD Scale was used to characterize PTSD symptom severity. The Wechsler Adult Intelligence Scale, Third Edition, Digit Symbol Test, Delis-Kaplan Executive Function System Color-Word Interference Test, and Wisconsin Card Sorting Test were used to characterize neuropsychological performance.
  
  
  RESULTS
  Women with PTSD performed worse on complex visuomotor processing speed (Digit Symbol Test) and executive function (Color-Word Interference Inhibition/Switching subtest) measures compared with control subjects. Posttraumatic stress disorder was associated with greater anterior insula and attenuated lateral prefrontal cortex (PFC) activation during emotional anticipation. Greater dorsolateral PFC activation (anticipation of negative images minus anticipation of positive images) was associated with lower PTSD symptom severity and better visuomotor processing speed and executive functioning. Greater medial PFC and amygdala activation related to slower visuomotor processing speed.
  
  
  CONCLUSIONS
  During emotional anticipation, women with PTSD show exaggerated activation in the anterior insula, a region important for monitoring internal bodily state. Greater dorsolateral PFC response in PTSD patients during emotional anticipation may reflect engagement of cognitive control networks that are beneficial for emotional and cognitive functioning. Novel treatments could be aimed at strengthening the balance between cognitive control (dorsolateral PFC) and affective processing (medial PFC and amygdala) networks to improve overall functioning for PTSD patients.
authors.affiliation: Department of Psychiatry, University of California, San Diego, USA. aupperler@umkc.edu
authors.forename: Robin L
authors.initials: RL
authors.lastname: Aupperle
authors.forename: Carolyn B
authors.initials: CB
authors.lastname: Allard
authors.forename: Erin M
authors.initials: EM
authors.lastname: Grimes
authors.forename: Alan N
authors.initials: AN
authors.lastname: Simmons
authors.forename: Taru
authors.initials: T
authors.lastname: Flagan
authors.forename: Michelle
authors.initials: M
authors.lastname: Behrooznia
authors.forename: Shadha H
authors.initials: SH
authors.lastname: Cissell
authors.forename: Elizabeth W
authors.initials: EW
authors.lastname: Twamley
authors.forename: Steven R
authors.initials: SR
authors.lastname: Thorp
authors.forename: Sonya B
authors.initials: SB
authors.lastname: Norman
authors.forename: Martin P
authors.initials: MP
authors.lastname: Paulus
authors.forename: Murray B
authors.initials: MB
authors.lastname: Stein
mesh_terms: D000328:Adult; D059031:Anticipation, Psychological / Q000502:physiology*; D004644:Emotions / Q000502:physiology*; D005260:Female; D059907:Functional Neuroimaging / Q000379:methods / Q000523:psychology / Q000706:statistics & numerical data; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods / Q000523:psychology / Q000706:statistics & numerical data; D009483:Neuropsychological Tests / Q000706:statistics & numerical data; D017397:Prefrontal Cortex / Q000503:physiopathology*; D011597:Psychomotor Performance / Q000502:physiology*; D057566:Self Report; D013313:Stress Disorders, Post-Traumatic / Q000503:physiopathology* / Q000523:psychology*