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Smaller hippocampal volume as a vulnerability factor for the persistence of post-traumatic stress disorder

Published online by Cambridge University Press:  04 May 2015

S. J. H. van Rooij ,
M. Kennis ,
R. Sjouwerman ,
M. P. van den Heuvel ,
R. S. Kahn  and
E. Geuze
S. J. H. van Rooij*
Affiliation:
Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands Research Centre, Military Mental Healthcare, Ministry of Defence, The Netherlands
M. Kennis
Affiliation:
Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands Research Centre, Military Mental Healthcare, Ministry of Defence, The Netherlands
R. Sjouwerman
Affiliation:
Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands Research Centre, Military Mental Healthcare, Ministry of Defence, The Netherlands
M. P. van den Heuvel
Affiliation:
Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
R. S. Kahn
Affiliation:
Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
E. Geuze
Affiliation:
Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands Research Centre, Military Mental Healthcare, Ministry of Defence, The Netherlands
*
* Address for correspondence: S. J. H. van Rooij, Ph.D., Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Heidelberglaan 100 (HPN A01.1.46), 3584 CX Utrecht, The Netherlands. (Email: [email protected])
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Abstract

Background

Smaller hippocampal volume has often been observed in patients with post-traumatic stress disorder (PTSD). However, there is no consensus whether this is a result of stress/trauma exposure, or constitutes a vulnerability factor for the development of PTSD. Second, it is unclear whether hippocampal volume normalizes with successful treatment of PTSD, or whether a smaller hippocampus is a risk factor for the persistence of PTSD.

Method

Magnetic resonance imaging (MRI) scans and clinical interviews were collected from 47 war veterans with PTSD, 25 healthy war veterans (combat controls) and 25 healthy non-military controls. All veterans were scanned a second time with a 6- to 8-month interval, during which PTSD patients received trauma-focused therapy. Based on post-treatment PTSD symptoms, patients were divided into a PTSD group who was in remission (n = 22) and a group in whom PTSD symptoms persisted (n = 22). MRI data were analysed with Freesurfer.

Results

Smaller left hippocampal volume was observed in PTSD patients compared with both control groups. Hippocampal volume of the combat controls did not differ from healthy controls. Second, pre- and post-treatment analyses of the PTSD patients and combat controls revealed reduced (left) hippocampal volume only in the persistent patients at both time points. Importantly, hippocampal volume did not change with treatment.

Conclusions

Our findings suggest that a smaller (left) hippocampus is not the result of stress/trauma exposure. Furthermore, hippocampal volume does not increase with successful treatment. Instead, we demonstrate for the first time that a smaller (left) hippocampus constitutes a risk factor for the persistence of PTSD.

Keywords

Hippocampal volumemagnetic resonance imagingpost-traumatic stress disordertrauma-focused therapywar veterans
Type
Original Articles
Information
Psychological Medicine , Volume 45 , Issue 13 , October 2015 , pp. 2737 - 2746
Copyright
Copyright © Cambridge University Press 2015 

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