A meta-analysis of structural brain abnormalities in PTSD

Karl, Anke; Schaefer, Michael; Malta, Loretta S.; Dörfel, Denise; Rohleder, Nicolas; Werner, Annett

doi:10.1016/j.neubiorev.2006.03.004

Cited by 786 publications

(684 citation statements)

References 111 publications

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“…None of our patients had experienced traumatic exposure, which is associated with amygdalar and hippocampal size reduction. 6 We excluded patients with comorbid depression because major depressive disorder was shown to be also related to small hippocampal size. 7 We found significant relations between right hippocampal volume and social phobia severity, indicating smaller volumes in GSP patients with a more generalized disorder.…”

Section: Discussionmentioning

confidence: 99%

“…Significant negative relations between hippocampal size and PTSD severity have been well established. 6 There is also evidence that the small hippocampal size of individuals with major depressive disorder is related to stronger anxiety symptoms. 25 Animal experiments have shown that lesions of the hippocampus destroy the ability to avoid stressful stimuli.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4] A recent study suggests that these changes may resolve after successful psychotherapeutic or psychopharmacologic treatment of social phobia. 5 There is now an extensive body of evidence suggesting that PTSD 6 and major depressive disorder 7,8 are related to abnormal amygdalar and hippocampal size. However, the mechanisms underlying these changes are not well understood.…”

Section: Introductionmentioning

confidence: 99%

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Reduced amygdalar and hippocampal size in adults with generalized social phobia

Irle

Ruhleder

Lange

et al. 2010

jpn

128

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Background: Structural and functional brain imaging studies suggest abnormalities of the amygdala and hippocampus in posttraumatic stress disorder and major depressive disorder. However, structural brain imaging studies in social phobia are lacking. Methods: In total, 24 patients with generalized social phobia (GSP) and 24 healthy controls underwent 3-dimensional structural magnetic resonance imaging of the amygdala and hippocampus and a clinical investigation. Results: Compared with controls, GSP patients had significantly reduced amygdalar (13%) and hippocampal (8%) size. The reduction in the size of the amygdala was statistically significant for men but not women. Smaller right-sided hippocampal volumes of GSP patients were significantly related to stronger disorder severity. Limitations: Our sample included only patients with the generalized subtype of social phobia. Because we excluded patients with comorbid depression, our sample may not be representative. Conclusion: We report for the first time volumetric results in patients with GSP. Future assessment of these patients will clarify whether these changes are reversed after successful treatment and whether they predict treatment response. Brief ReportReduced amygdalar and hippocampal size in adults with generalized social phobia IntroductionPresent evidence from functional brain imaging studies suggests that patients with social phobia, posttraumatic stress disorder (PTSD) or specific phobia share a pattern of hyperactivity of the amygdala and surrounding cortices, including the hippocampus, linked to negative emotional responses. 1 The majority of studies including patients with social phobia suggest that these changes may be most pronounced in the generalized subtype of social phobia (GSP). 2-4 A recent study suggests that these changes may resolve after successful psychotherapeutic or psychopharmacologic treatment of social phobia. 5 There is now an extensive body of evidence suggesting that PTSD 6 and major depressive disorder 7,8 are related to abnormal amygdalar and hippocampal size. However, the mechanisms underlying these changes are not well understood. Research in nonhuman primates has suggested that stress and prolonged glucocorticoid exposure may damage the hippocampus, 9 thus raising the possibility that stress may also induce hippocampal degeneration in humans with anxiety or affective disorders. Another possibility is that preexisting small hippocampal size increases the risk for developing anxiety or affective disorders. 10,11 However, structural brain imaging studies in social phobia are lacking. Given the fact that patients with traumatic and nontraumatic anxiety disorders share a pattern of medial temporal hyperactivity during functional neuroimaging, 1 investigation into structural aspects of the amygdala and hippocampus in social phobia are warranted. Furthermore, because the more severe form of social phobia (i.e., GSP) is likely associated with continuous and extreme stress, the possibility of a reduction of the size of the amygdal...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Reduced amygdalar and hippocampal size in adults with generalized social phobia

Irle

Ruhleder

Lange

et al. 2010

jpn

128

View full text Add to dashboard Cite

show abstract

“…In particular, the subgenual ACC and OFC were significantly smaller in antidepressant-free patients compared with medicated patients (Bora et al, 2012). A previous meta-analysis also found significantly smaller ACC in adults with PTSD than in trauma-exposed controls (Karl et al, 2006).…”

Section: Traumatic Experiences Induce Structural Changes In the Prefrmentioning

confidence: 75%

“…Woon and Hedges (2009) analyzed published data from nine studies comparing amygdala volumes in adult subjects with PTSD, and found no significant effect on amygdala volumes. However, another meta-analysis found significantly smaller left amygdala volumes in adults with PTSD than in either healthy or trauma-exposed controls (Karl et al, 2006). In addition, Nunes et al (2009) in a meta-analysis of six studies demonstrated significantly reduced volumes of both right and left hippocampi and amygdalae in patients with BPD.…”

Section: Traumatic Experiences Induce Changes In Amygdala Volumementioning

confidence: 97%