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Brain-Based Biotypes of Psychiatric Vulnerability in the Acute Aftermath of Trauma
Jennifer S Stevens1, Nathaniel G Harnett1, Lauren A M Lebois1
1Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta (Stevens, van Rooij, Ely, Roeckner, Vincent); Division of Depression and Anxiety, McLean Hospital, Belmont, Mass. (Harnett, Lebois, Ressler); Department of Psychiatry, Harvard Medical School, Boston (Harnett, Lebois, Pizzagalli, Ressler); Departments of Emergency Medicine and Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and the Miriam Hospital, Providence, R.I. (Beaudoin); Department of Anesthesiology, Institute of Trauma Recovery, University of North Carolina, Chapel Hill (An, Linnstaedt, McLean); Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Zeng); Departments of Psychiatry and Neurology, University of California, San Francisco (Neylan); Department of Biomedical Informatics, Emory University School of Medicine, Atlanta (Clifford); Institute for Technology in Psychiatry (Germine) and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Massachusetts Medical School, Worcester (Haran); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, College of Medicine and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine and Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati (Lyons); Departments of Emergency Medicine and Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham (Kurz); Center for Injury Science, University of Alabama, Birmingham (Kurz); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Departments of Surgery (Pascual) and Neurosurgery (Pascual), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Health Care Network, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Wayne State University, Detroit (Pearson); Department of Emergency Medicine, Massachusetts General Hospital, Boston (Peak); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Mich. (Domeier); Department of Emergency Medicine, Wayne State University School of Medicine, Detroit (O'Neil); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathley); Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (Sanchez); Department of Emergency Medicine, Harvard Medical School, Boston (Sanchez); Department of Psychiatry, Yale School of Medicine, and U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, Veterans Affairs Connecticut Healthcare System, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joorman); Department of Psychological and Brain Sciences, Washington University, St. Louis (Barch); Department of Biosciences and Neuroscience and Institute for Behavioral Medicine Research, Ohio State University Wexner Medical Center, Columbus (Sheridan); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); the Kolling Institute of Medical Research, Northern Clinical School, University of Sydney, and Faculty of Medicine and Health, University of Sydney, Sydney, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Psychology, Temple University, Philadelphia (Murty); Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit (Jovanovich); Department of Psychological Sciences, University of Missouri, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Health Care Policy, Harvard Medical School, Boston (Kessler); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Koenen); Department of Emergency Medicine, University of North Carolina, Chapel Hill (McLean).
Objective:
Major negative life events, such as trauma exposure, can play a key role in igniting or exacerbating psychopathology. However, few disorders are diagnosed with respect to precipitating events, and the role of these events in the unfolding of new psychopathology is not well understood. The authors conducted a multisite transdiagnostic longitudinal study of trauma exposure and related mental health outcomes to identify neurobiological predictors of risk, resilience, and different symptom presentations.
Methods:
A total of 146 participants (discovery cohort: N=69; internal replication cohort: N=77) were recruited from emergency departments within 72 hours of a trauma and followed for the next 6 months with a survey, MRI, and physiological assessments.
Results:
Task-based functional MRI 2 weeks after a motor vehicle collision identified four clusters of individuals based on profiles of neural activity reflecting threat reactivity, reward reactivity, and inhibitory engagement. Three clusters were replicated in an independent sample with a variety of trauma types. The clusters showed different longitudinal patterns of posttrauma symptoms.
Conclusions:
These findings provide a novel characterization of heterogeneous stress responses shortly after trauma exposure, identifying potential neuroimaging-based biotypes of trauma resilience and psychopathology.
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