Associations of neural processing of reward with posttraumatic stress disorder and secondary psychotic symptoms in trauma-affected refugees

Abstract

Background: Psychological traumatic experiences can lead to posttraumatic stress disorder (PTSD). Secondary psychotic symptoms are not common but may occur. Objectives: Since psychotic symptoms of schizophrenia have been related to aberrant reward processing in the striatum, using the same paradigm we investigate whether the same finding extends to psychotic and anhedonic symptoms in PTSD. Methods: A total of 70 male refugees: 18 PTSD patients with no secondary psychotic symptoms (PTSD-NSP), 21 PTSD patients with secondary psychotic symptoms (PTSD-SP), and 31 healthy controls (RHC) were interviewed and scanned with functional magnetic resonance imaging (fMRI) during a monetary incentive delay task. Using region of interest analysis of the prefrontal cortex and ventral striatum, we investigated reward-related activity.Results: Compared to RHC, participants with PTSD had decreased neural activity during monetary reward. Also, participants with PTSD-SP exhibited decreased activity in the associative striatum relative to participants with PTSD-NSP during processing of motivational reward anticipation which correlated with severity of psychotic symptoms. However, the difference between the two PTSD groups disappeared when PTSD severity and trauma exposure were accounted for. Conclusions: Anhedonia and secondary psychotic symptoms in PTSD are characterized by dysfunctional reward consumption and anticipation processing, respectively. The latter may reflect a mechanism by which abnormal reward signals in the basal ganglia facilitates psychotic symptoms across psychiatric conditions. ARTICLE HISTORY

White matter diffusivity and its correlations to state measures of psychopathology in male refugees with posttraumatic stress disorder

“…Although the fibre bundles between OF and striatum have not specifically been investigated in PTSD, a decreased integrity of OF-ST fibre tracts may contribute to anhedonia, as anhedonia in PTSD has been linked to reduced task-related functional recruitment of orbitofrontal regions and ventral striatum ( Felmingham et al, 2014 , Frewen et al, 20112011 , Frewen et al, 2010 , Olson et al, 2018 , Sailer et al, 2008 ). Of note, we found reduced orbitofrontal ventral striatal activation, when measuring brain activity during a monetary reward paradigm in the same sample population that was investigated in the present study ( Uldall et al, 2020b ).…”

“…The sample size was initially determined to answer a research question related to an fMRI component of the study testing a salience contrast in a reward paradigm. Here, the sample provided a statistical power of 80% at an alpha level of 0.05 for observing a standardized difference of 1.23 ( Uldall et al, 2020b ). Although the sample size in the present paper was not determined by a power calculation related to DTI analyses, previous DTI studies comparing PTSD and healthy controls on FA have been able to show a statistically significant effect with considerable smaller samples (see Siehl et al, 2018 for a review).…”

“…All participants gave written informed consent after written and oral explanation of study aims and procedures and were compensated with a small fee in addition to reimbursements of public transportation. All participants were part of two other studies investigating the reward circuitry ( Uldall et al, 2020b ) and the relationship between symptom provocation and emotional processing ( Uldall et al, 2020a ) with functional MRI.…”

A Meta-Analysis of Neural Correlates of Reward Anticipation in Individuals at Clinical Risk for Schizophrenia

“…Fourteen datasets from 13 whole-brain fMRI studies with 318 CHR individuals (mean age = 23.30 years; percentage of males = 55.00%) and 426 HC (mean age = 23.24 years; percentage of males = 59.00%) were included during the reward anticipation phase ( Juckel et al, 2012 ; Roiser et al, 2013 ; Wotruba et al, 2014 ; Smieskova et al, 2015 ; Li et al, 2016b ; Yan et al, 2016 ; Bourque et al, 2017 ; Schmidt et al, 2017 ; Winton-Brown et al, 2017 ; Michielse et al, 2019 ; Wilson et al, 2019 ; Millman et al, 2020 ; Uldall et al, 2020 ). No significant difference was found for age ( t = 0.025, P = .659) or sex (χ 2 = 1.626, P = .202) between the CHR and HC groups.…”

Reward disturbances in antipsychotic-naïve patients with first-episode psychosis and their association to glutamate levels

“…Brain reward activity was examined with fMRI while participants played a variant of the MID task (Knutson, Westdorp, Kaiser, & Hommer, 2000; Uldall et al, 2020), a task widely used to probe the neural activity of anticipation and outcome. The paradigm used in the present study included trials with the possibility of winning or losing money and neutral stimuli only (Fig.…”