title: Neural correlates of trauma-unrelated emotional processing in war veterans with PTSD.
abstract: BACKGROUND
  Post-traumatic stress disorder (PTSD) is thought to be characterized by general heightened amygdala activation. However, this hypothesis is mainly based on specific studies presenting fear or trauma-related stimuli, hence, a thorough investigation of trauma-unrelated emotional processing in PTSD is needed.
  
  
  METHODS
  In this study, 31 male medication-naive veterans with PTSD, 28 male control veterans (combat controls; CC) and 25 non-military men (healthy controls; HC) were included. Participants underwent functional MRI while trauma-unrelated neutral, negative and positive emotional pictures were presented. In addition to the group analyses, PTSD patients with and without major depressive disorder (MDD) were compared.
  
  
  RESULTS
  All groups showed an increased amygdala response to negative and positive contrasts, but amygdala activation did not differ between groups. However, a heightened dorsal anterior cingulate cortex (dACC) response for negative contrasts was observed in PTSD patients compared to HC. The medial superior frontal gyrus was deactivated in the negative contrast in HC, but not in veterans. PTSD+MDD patients showed decreased subgenual ACC (sgACC) activation to all pictures compared to PTSD-MDD.
  
  
  CONCLUSIONS
  Our findings do not support the hypothesis that increased amygdala activation in PTSD generalizes to trauma-unrelated emotional processing. Instead, the increased dACC response found in PTSD patients implicates an attentional bias that extends to trauma-unrelated negative stimuli. Only HC showed decreased medial superior frontal gyrus activation. Finally, decreased sgACC activation was related to MDD status within the PTSD group.
authors.affiliation: Brain Center Rudolf Magnus, Department of Psychiatry,University Medical Center Utrecht,The Netherlands.
authors.forename: S J H
authors.initials: SJ
authors.lastname: van Rooij
authors.affiliation: Research Centre, Military Mental Healthcare, Ministry of Defence,The Netherlands.
authors.forename: A R
authors.initials: AR
authors.lastname: Rademaker
authors.affiliation: Brain Center Rudolf Magnus, Department of Psychiatry,University Medical Center Utrecht,The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Kennis
authors.affiliation: Brain Center Rudolf Magnus, Department of Psychiatry,University Medical Center Utrecht,The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Vink
authors.affiliation: Brain Center Rudolf Magnus, Department of Psychiatry,University Medical Center Utrecht,The Netherlands.
authors.forename: R S
authors.initials: RS
authors.lastname: Kahn
authors.affiliation: Brain Center Rudolf Magnus, Department of Psychiatry,University Medical Center Utrecht,The Netherlands.
authors.forename: E
authors.initials: E
authors.lastname: Geuze
mesh_terms: D000328:Adult; D000679:Amygdala / Q000503:physiopathology*; D016022:Case-Control Studies; D003865:Major Depressive Disorder / Q000503:physiopathology; D004644:Emotions / Q000502:physiology*; D006179:Gyrus Cinguli / Q000503:physiopathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D013313:Stress Disorders, Post-Traumatic / Q000150:complications* / Q000503:physiopathology*; D014728:Veterans / Q000523:psychology*; D000067453:War Exposure
keywords: Amygdala; anterior cingulate cortex (ACC); emotional processing; functional magnetic resonance imaging (fMRI); major depressive disorder (MDD); post-traumatic stress disorder (PTSD)