Carolyn Fort

Association between trait emotional awareness and dorsal anterior cingulate activity during emotion is arousal-dependent

The dorsal anterior cingulate cortex (dACC) is commonly thought to subserve primarily cognitive functions, but has been strongly implicated in the allocation of attention to emotional information. In a previous positron emission tomography (PET) study, we observed that women with higher emotional awareness as measured by the Levels of Emotional Awareness Scale (LEAS) showed greater changes in regional cerebral blood flow (rCBF) in dACC induced by emotional films and recall. In the current study, we tested whether these effects were due to the processing of any non-neutral stimulus, or were specific to conditions of high emotional arousal. Our results extend the previous finding by demonstrating a positive correlation between emotional awareness and dACC activity only in the context of viewing highly arousing pictures. No such relationship was observed when comparing pleasant or unpleasant pictures to neutral or to each other. We also observed that the relationship between LEAS and dACC activity was present in both sexes but stronger in women than men. These results reinforce the concept that greater trait awareness of ones own emotional experiences is associated with greater engagement of the dACC during emotional arousal, which we suggest may reflect greater attentional processing of emotional information.

Antidepressant effects of sertraline associated with volume increases in dorsolateral prefrontal cortex

BACKGROUND Structural brain imaging has revealed differences in gray matter volume between depressed individuals and control subjects in key structures related to emotion. The aim of the present study was to assess within subjects whether regional changes in gray matter volume were observed over time in depressed patients treated with sertraline. METHODS Thirteen depressed patients were assigned to selective serotonin reuptake inhibitor (SSRI) treatment with sertraline. Structural magnetic resonance imaging (MRI) was performed at four time points over 12 weeks of treatment. Depressed individuals were compared to a control group of 10 subjects scanned at the same time points using voxel based morphometry and a statistical growth modeling technique. RESULTS SSRI-treated patients showed a region of significantly increasing gray matter volume over time within the left dorsolateral prefrontal cortex (DLPFC) that specifically correlated with decreases in self-reported depression levels. No statistically significant changes were observed related to time in controls. LIMITATIONS This study included a small sample size and the method of analysis was capable of detecting only linear changes in volume. CONCLUSIONS Effective antidepressant treatment with sertraline is associated with left DLPFC volume increases. These volume increases may reflect cortical architectural changes associated with top-down neuronal modulation of emotion.

Psychological Stress Preceding Idiopathic Ventricular Fibrillation

Objective: Emotional stress is well established as a trigger of sudden death in the context of coronary heart disease (CHD), but its role in patients experiencing cardiac arrest with apparently normal hearts is unknown. This study sought to determine the role of psychosocial stress as a precipitant of cardiac arrest in patients with apparently normal hearts, so-called idiopathic ventricular fibrillation (IVF). Methods: We interviewed 25 IVF survivors (12 men, 13 women) and 25 matched comparison patients regarding life events during the 6 months and 24 hours preceding the cardiac event. The comparison group consisted of patients with an acute myocardial infarction or angina pectoris requiring angioplasty but without cardiac arrest. Judges independently rated written summaries of these interviews for psychosocial stress at each time point on a three-point scale (low, moderate, severe). Results: During the 6 months before the cardiac event, 20 patients sustaining IVF had severe/moderate stress and five had low stress, whereas 10 comparison patients had severe/moderate stress and 15 had low stress (Fisher exact p = .008). During the preceding 24 hours, nine patients with IVF had severe/moderate stress and 16 had low stress, whereas two comparison patients had severe/moderate stress and 22 had low stress (Fisher exact p = .04) (one silent myocardial infarction could not be precisely dated). Conclusion: These data suggest that psychosocial stress is playing a role in otherwise unexplained cardiac arrest. CHD = coronary heart disease; DSM-IV = Diagnostic and Statistical Manual, Fourth Edition; ICD = implantable cardioverter defibrillator; IVF = idiopathic ventricular fibrillation; IVF-US = Idiopathic Ventricular Fibrillation Registry of the United States; UCARE = Unexplained Cardiac Arrest Registry of Europe.

Functional, Structural, and Emotional Correlates of Impaired Insight in Cocaine Addiction

IMPORTANCE Individuals with cocaine use disorder (CUD) have difficulty monitoring ongoing behavior, possibly stemming from dysfunction of brain regions mediating insight and self-awareness. OBJECTIVE To investigate the neural correlates of impaired insight in addiction using a combined functional magnetic resonance imaging and voxel-based morphometry approach. DESIGN, SETTING, AND PARTICIPANTS This multimodal imaging study was performed at the Clinical Research Center at Brookhaven National Laboratory. The study included 33 CUD cases and 20 healthy controls. MAIN OUTCOMES AND MEASURES Functional magnetic resonance imaging, voxel-based morphometry, Levels of Emotional Awareness Scale, and drug use variables. RESULTS Compared with the other 2 study groups, the impaired insight CUD group had lower error-induced rostral anterior cingulate cortex (rACC) activity as associated with more frequent cocaine use, less gray matter within the rACC, and lower Levels of Emotional Awareness Scale scores. CONCLUSIONS AND RELEVANCE These results point to rACC functional and structural abnormalities and diminished emotional awareness in a subpopulation of CUD cases characterized by impaired insight. Because the rACC has been implicated in appraising the affective and motivational significance of errors and other types of self-referential processing, functional and structural abnormalities in this region could result in lessened concern (frequently ascribed to minimization and denial) about behavioral outcomes that could potentially culminate in increased drug use. Treatments that target this CUD subgroup could focus on enhancing the salience of errors (eg, lapses).

Subgenual anterior cingulate cortex activity covariation with cardiac vagal control is altered in depression

BACKGROUND We tested the hypothesis that subgenual anterior cingulate cortex (sgACC) participates in concurrently regulating shifts in both affective state and cardiac vagal control. METHODS Eleven healthy adults and 8 depressed subjects performed the Emotional Counting Stroop task in alternating 15-second blocks of emotion words and neutral words while undergoing functional magnetic resonance imaging (fMRI) and electrocardiography (ECG). We measured the absolute value of change between adjacent 15-second blocks in both cardiac vagal control and the BOLD signal in specific regions of interest. RESULTS Strong positive correlations were observed in healthy control participants between changes in cardiac vagal control and changes in BOLD signal intensity in sgACC (BA25) (right: r=.67, p<.02; left r=.69, p<.02), as well as other key structures in the medial visceromotor network. Depressed subjects showed no significant correlations between cardiac vagal control and BOLD signal intensity within BA25 or any other brain region examined. During the transition from depression-specific emotion blocks to neutral blocks, the correlation between BOLD signal change in BA25 and cardiac vagal control change was significantly greater in controls than in depressed subjects (p<.04). CONCLUSIONS Findings in healthy volunteers suggest that sgACC participates in affective state shifting. The latter function appears to be altered in depressed individuals, and may have implications for the unvarying mood and vagal dysfunction associated with depression. LIMITATIONS Limitations include a small sample size, an inability to disentangle afferent versus efferent contributions to the results, and the lack of a whole-brain analysis.

Increased association over time between regional frontal lobe BOLD change magnitude and cardiac vagal control with sertraline treatment for major depression.

Regions of the medial visceromotor network (MVN) participate in concurrently regulating shifts in both affective state and cardiac vagal control in the attentional background, and this regulatory ability may be impaired in depression. We examined whether the relationship between changes in BOLD within MVN regions and changes in cardiac vagal control (VC) during affective state shifting changed with depression treatment. Ten depressed and ten control subjects performed an emotional counting Stroop task designed to trigger affective change in the attentional background while undergoing functional magnetic resonance imaging and concurrent electrocardiography (ECG) on four occasions: week 0 (pre-treatment) and weeks 2, 6 and 12 of treatment on sertraline. We measured the absolute value of change between adjacent emotional and neutral conditions in both VC and the BOLD signal in specific regions of the MVN. Over time consistent increases were observed in BOLD-VC magnitude correlations in depressed subjects in subgenual ACC and left DLPFC, which strongly correlated with depressive symptom improvement. Symptom improvement over time was also associated with decreases in the magnitude of both BOLD shifts and VC shifts within-subjects. This suggests that as depressive symptoms improve on sertraline, subgenual ACC and DLPFC may more efficiently regulate visceral states during affective state shifting.