title: Neural correlates of inhibition and contextual cue processing related to treatment response in PTSD.
abstract: Thirty to fifty percent of posttraumatic stress disorder (PTSD) patients do not respond to treatment. Understanding the neural mechanisms underlying treatment response could contribute to improve response rates. PTSD is often associated with decreased inhibition of fear responses in a safe environment. Importantly, the mechanism of effective treatment (psychotherapy) relies on inhibition and so-called contextual cue processing. Therefore, we investigate inhibition and contextual cue processing in the context of treatment. Forty-one male war veterans with PTSD and 22 healthy male war veterans (combat controls) were scanned twice with a 6- to 8-month interval, in which PTSD patients received treatment (psychotherapy). We distinguished treatment responders from nonresponders on the base of percentage symptom decrease. Inhibition and contextual cue processing were assessed with the stop-signal anticipation task. Behavioral and functional MRI measures were compared between PTSD patients and combat controls, and between responders and nonresponders using repeated measures analyses. PTSD patients showed behavioral and neural deficits in inhibition and contextual cue processing at both time points compared with combat controls. These deficits were unaffected by treatment; therefore, they likely represent vulnerability factors or scar aspects of PTSD. Second, responders showed increased pretreatment activation of the left inferior parietal lobe (IPL) during contextual cue processing compared with nonresponders. Moreover, left IPL activation predicted percentage symptom improvement. The IPL has an important role in contextual cue processing, and may therefore facilitate the effect of psychotherapy. Hence, increased left IPL activation may represent a potential predictive biomarker for PTSD treatment response.
authors.affiliation: 1] Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands [2] Research Centre Military Mental Healthcare, Ministry of Defence, Utrecht, The Netherlands.
authors.forename: Sanne J H
authors.initials: SJ
authors.lastname: van Rooij
authors.affiliation: 1] Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands [2] Research Centre Military Mental Healthcare, Ministry of Defence, Utrecht, The Netherlands.
authors.forename: Elbert
authors.initials: E
authors.lastname: Geuze
authors.affiliation: 1] Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands [2] Research Centre Military Mental Healthcare, Ministry of Defence, Utrecht, The Netherlands.
authors.forename: Mitzy
authors.initials: M
authors.lastname: Kennis
authors.affiliation: Research Centre Military Mental Healthcare, Ministry of Defence, Utrecht, The Netherlands.
authors.forename: Arthur R
authors.initials: AR
authors.lastname: Rademaker
authors.affiliation: Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Matthijs
authors.identifier: 0000000212358347
authors.initials: M
authors.lastname: Vink
mesh_terms: D000328:Adult; D059031:Anticipation, Psychological / Q000502:physiology*; D016022:Case-Control Studies; D003463:Cues; D059907:Functional Neuroimaging; D006801:Humans; D007266:Inhibition, Psychological; D008279:Magnetic Resonance Imaging; D008297:Male; D010296:Parietal Lobe / Q000503:physiopathology; D011613:Psychotherapy; D013313:Stress Disorders, Post-Traumatic / Q000503:physiopathology* / Q000628:therapy*; D016896:Treatment Outcome; D014728:Veterans / Q000523:psychology; D055815:Young Adult