Original articleNeuroimaging correlates of anxiety after pediatric traumatic brain injury
Section snippets
Design overview
The methods, sample characteristics, and data on prevalence and clinical risk factors of anxiety and PTSD outcomes have been described elsewhere Gerring et al., 2000, Gerring et al., 2002, Vasa et al., 2002. This was a 1-year prospective cohort study that used a parent report to rate the child's behavior at two times: 1) immediately after enrollment to retrospectively assess premorbid anxiety, and 2) 1 year postinjury to obtain current anxiety status. Only parent reports of child anxiety were
Brain lesion characteristics
Table 1 shows the brain lesion characteristics of the sample. Two children descriptors of brain damage, the volume and number of lesions, are presented for five areas.
Anxiety disorders
Nine subjects had a preinjury disorder; seven children had one disorder, and two had 2 disorders. Specific disorders included 5 SP, 3 OCD, 2OAD, and 1 SAD. Twelve subjects had one postinjury disorder; one subject had two disorders. Specific disorders included 6 SP, 5 OAD, 1 SAD, and 1 OCD. Seven children had postinjury PTSD. One
Discussion
This is the first lesion-based study to examine the neural correlates of anxiety after pediatric TBI. The main finding shows that children with more damage to the OFC are less likely to develop anxiety. This finding was significant in the univariate and multivariate regressions when using multiple descriptors of brain damage (i.e., the volume and presence or absence of lesions) and when controlling for preinjury anxiety and damage to other brain regions. These results show that, similar to
Acknowledgements
This research was funded by National Institute of Mental Health Grant No. K20 MH-00997 and National Institutes of Health Grant No. MO-RR00052, which was awarded to the senior author. We thank Laurie Tochterman for her assistance in preparing this manuscript.
References (67)
- et al.
Recognition of facial emotion in nine individuals with bilateral amygdala damage
Neuropsychologia
(1999) - et al.
Functional magnetic resonance imaging of facial affect recognition in children and adolescents
J Am Acad Child Adolesc Psychiatry
(1999) - et al.
Response and habituation of the human amygdala during visual processing of facial expression
Neuron
(1996) - et al.
A functional anatomy of anticipatory anxiety
Neuroimage
(1999) - et al.
A pilot study of amygdala volumes in pediatric generalized anxiety disorder
Biol Psychiatry
(2000) - et al.
A pilot longitudinal study of hippocampal volumes in pediatric maltreatment-related posttraumatic stress disorder
Biol Psychiatry
(2001) - et al.
Clinical predictors of posttraumatic stress disorder after closed head injury in children
J Am Acad Child Adolesc Psychiatry
(2002) - et al.
Human amygdala activation during conditioned fear acquisition and extinctionA mixed-trial fMRI study
Neuron
(1998) - et al.
Differential limbic-cortical correlates of sadness and anxiety in healthy subjectsImplications for affective disorders
Soc Biol Psychiatry
(2000) - et al.
Traumatic brain injury in children and adolescentsPsychiatric disorders at two years
J Am Acad Child Adolesc Psychiatry
(1997)
The functional neuroanatomy of anxietyA study of three disorders using positron emission tomography and symptom provocation
Biol Psychiatry
Diagnostic interview for children and adolescents (DICA)
J Am Acad Child Adolesc Psychiatry
Assessment of coma and impaired consciousnessA practical scale
Lancet
Anxiety following severe pediatric closed head injury
J Am Acad Child Adolesc Psychiatry
Lesions of the human amygdala impair enhanced perception of emotionally salient events
Nature
How the brain processes information
Ann N Y Acad Sci
Generalized anxiety disorder in stroke patients
Stroke
Emotion, decision making and the orbitofrontal cortex
Cereb Cortex
Personality changes with frontal and temporal lobe lesions
Neuroimaging studies in post-traumatic stress disorder
Curr Psychiatry Rep
Reduced volume of orbitofrontal cortex in major depression
Biol Psychiatry
A prospective study of children with head injuriesIII. Psychiatric sequelae
Psychol Med
Effects of orbital frontal lesions on aversive and aggressive behaviors in rhesus monkeys
J Comp Physiol Psychol
Generalized anxiety disorder after stroke
J Nerv Ment Dis
The somatic marker hypothesis and the possible function of the prefrontal cortex
Phil Trans R Soc Lond B
Lesion Analysis in Neuropsychology
The return of Phineas GageClues about the brain from the skull of a famous patient
Science
Mapping image data to stereotactic spacesApplications to brain mapping
Hum Brain Mapp
Frontal brain asymmetry predicts infants' response to maternal separation
J Abnorm Psychol
A double dissociation in the affective modulation of startle in humansEffects of unilateral temporal lobectomy
J Cogn Neurosci
Orbitofrontal cortex and representation of incentive value in associative learning
J Neurosci
Neuroimaging variables related to development of Secondary Attention Deficit Hyperactivity Disorder after closed head injury in children and adolescents
Brain Injury
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