Greater affective network maturity is associated with better clinical outcomes in women with early sexual trauma.

Early-life adversity accelerates the maturation of affect-related circuitry, which might be a short-term adaptation with long-term tradeoffs. Sexual trauma is associated with a particularly strong impact on pubertal development and mental health outcomes. Our objective was to test the relations between trauma type, affective network maturity, and mental health outcomes in young women with trauma history. Trauma-exposed women aged 18-29 completed a clinical interview (n = 35) and an fMRI scan (n = 28). We used a public data set to train a machine learning algorithm to predict age from resting-state affective network connectivity and calculated network maturity as the difference between predicted and true age. We also performed principal component analysis on mental health outcomes and retained two components: clinical and state psychological outcomes. Compared to nonsexual trauma (n = 17), sexual trauma (n = 11) was associated with greater affective network maturity. In addition, for sexual trauma only, greater affective network maturity was associated with better clinical but not state psychological outcomes. These results suggest that sexual trauma during development might uniquely alter the maturational trajectory of affect-related circuitry, with distinct mental health consequences in emerging adulthood. Whereas delayed affective network maturation is associated with adverse clinical outcomes, accelerated affective network maturation might confer resilience in survivors.

Rejection Distress Suppresses Medial Prefrontal Cortex in Borderline Personality Disorder.

BACKGROUND: Borderline personality disorder (BPD) is characterized by an elevated distress response to social exclusion (i.e., rejection distress), the neural mechanisms of which remain unclear. Functional magnetic resonance imaging studies of social exclusion have relied on the classic version of the Cyberball task, which is not optimized for functional magnetic resonance imaging. Our goal was to clarify the neural substrates of rejection distress in BPD using a modified version of Cyberball, which allowed us to dissociate the neural response to exclusion events from its modulation by exclusionary context. METHODS: Twenty-three women with BPD and 22 healthy control participants completed a novel functional magnetic resonance imaging modification of Cyberball with 5 runs of varying exclusion probability and rated their rejection distress after each run. We tested group differences in the whole-brain response to exclusion events and in the parametric modulation of that response by rejection distress using mass univariate analysis. RESULTS: Although rejection distress was higher in participants with BPD (F1,40 = 5.25, p = .027, η2 = 0.12), both groups showed similar neural responses to exclusion events. However, as rejection distress increased, the rostromedial prefrontal cortex response to exclusion events decreased in the BPD group but not in control participants. Stronger modulation of the rostromedial prefrontal cortex response by rejection distress was associated with higher trait rejection expectation, r = -0.30, p = .050. CONCLUSIONS: Heightened rejection distress in BPD might stem from a failure to maintain or upregulate the activity of the rostromedial prefrontal cortex, a key node of the mentalization network. Inverse coupling between rejection distress and mentalization-related brain activity might contribute to heightened rejection expectation in BPD.

Trauma Characteristics Moderate the Relation Between Estradiol and Trauma-Related Symptoms.

Women are more likely to develop posttraumatic stress disorder (PTSD) than men, and fluctuations in gonadal hormones might contribute to this vulnerability. Low-estradiol states are associated with aversive affective experiences, including trauma-related symptoms. However, the impact of trauma characteristics on the relation between estradiol and trauma-related symptoms is unknown. We used a clinical interview and 10-day ecological momentary assessment (EMA) that spanned low- and high-estradiol menstrual cycle phases to test trauma type, chronicity, and timing as moderators of the association between estradiol and trauma-related symptoms in 40 naturally cycling young women. We tested interactions between trauma characteristics and (a) estradiol on self-reported symptoms and (b) menstrual cycle-related change in estradiol on change in symptoms. Sexual, chronic, and earlier trauma was associated with more severe symptoms as reported during the interview, rs = .51-.33, but not mean symptoms across the EMA. Estradiol at the time of the interview was inversely associated with symptoms in women with sexual but not nonsexual trauma, interaction: B = -12.62 (SE = 5.28), p = .022. Menstrual cycle-related change in estradiol was inversely associated with change in symptoms in women with chronic trauma, B = -9.65 (SE = 3.49), p = .006, and earlier trauma, B = 0.71 (SE = 0.34), p = .036, but not discrete or later trauma. Sexual, chronic, or early trauma exposure might confer higher symptom vulnerability in low-estradiol states. Clinicians who work with women with particular trauma histories might anticipate menstrual cycle-related variation in symptoms.

Estradiol, stress reactivity, and daily affective experiences in trauma-exposed women.

OBJECTIVE: Women experience higher risk for PTSD following trauma compared with men. Fluctuations in ovarian hormones might contribute to this greater vulnerability, given that estradiol is associated with affect and stress reactivity. Our objective was to test the relations between menstrual cycle-related changes in estradiol, affect, stress reactivity, and trauma-related symptoms. METHOD: We assessed trauma-related symptoms in ethnically diverse naturally cycling women with a history of trauma during a clinical interview. Participants also completed a 10-day ecological momentary assessment (EMA) that included lower- and higher-estradiol phases. We tested associations between estradiol and PTSD symptoms and stress reactivity to a trauma reminder using Spearman correlation and Wilcoxon rank-sum tests. We tested the effect of menstrual cycle day on daily affect using multilevel modeling. RESULTS: Estradiol was negatively associated with symptom severity (rs = -.36), and participants in low- versus high-estradiol cycle phases at interview had higher sympathetic (r = .35) and lower hypothalamic-pituitary-adrenal axis (r = .41) reactivity. Across the EMA period, participants showed a decrease in daily PTSD symptoms (b = -.39), negative (b = -.11) and positive (b = -.24) affect, and variability in daily valence (b = -.07) and arousal (b = -.08), from the low- to high-estradiol phase. CONCLUSIONS: Consistent with prior evidence of more aversive affective experiences in low-estradiol states, lower estradiol was associated with higher trauma-related symptoms. In addition, trauma-exposed women showed a discordant pattern of stress reactivity to a trauma reminder, higher daily symptoms, and greater affective lability in a low-estradiol phase. Given that our sample consisted of high-functioning trauma-exposed women, these results should be replicated in women with PTSD. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Resection of a Posterior Fossa Endodermal Cyst With Exoscopic Assistance: 2-Dimensional Operative Video.

Neurenteric cysts are rare benign congenital tumors of endodermal origin that most commonly occur in the cervical and upper thoracic spine, with only about 10% to 18% of the reported cases occurring intracranially.1 A definitive preoperative diagnosis is complicated by the variable appearance of neurenteric cysts on magnetic resonance (MR) imaging.2 The recommended treatment of neurenteric cysts is complete surgical resection when possible.3,4 We present a case of a posterior fossa neurenteric cyst. A 33-yr-old man without medical history presented with left-sided headache and mild left-sided facial numbness and weakness. Admission MR imaging revealed a nonenhancing mass, which was hyperintense on T1-weighted MR images, compressing the brainstem anteriorly. The lesion was isointense on T2 FLAIR images and hypointense on diffusion-weighted imaging, initially read as possible epidermoid cyst. The patient underwent a left-sided retrosigmoid craniotomy via far lateral transcondylar approach. The tumor was adjacent to both vertebral arteries, the left PICA, and cranial nerves (CN) VII-XII with superior extension to CN V. The cyst was encased in a thin capsule, and its contents were yellowish in color and ranged from thick liquid to colloidal and caseous consistency. The cyst also contained heavily calcified portions, which were excised using sharp dissection. Images of the cyst wall show that it is focally lined with ciliated columnar epithelium with intracellular mucin confirming an endodermal or neurenteric cyst. After the operation, the patient's symptoms resolved, and he was discharged on postoperative day 4. Postoperative MR images confirmed gross total resection. The patient consented to video production.

Salivary Biomarkers of Parenting Stress in Mothers Under Community Criminal Justice Supervision.

BACKGROUND: Community criminal justice supervised mothers are an underserved population who experience high rates of psychological distress and unique parenting challenges, but little is known about physiological stress system function in this population. OBJECTIVE: We tested the salivary biomarkers of the sympathetic nervous system (SNS) and hypothalamic-pituitary-adrenal (HPA) axis function as predictors of subjective maternal stress. METHOD: We recruited 23 mothers (age: M = 35.6 years, SD = 9.3 years; 35% Hispanic, 22% Black, 22% White, 22% multiracial) who were court mandated to a residential treatment center. We measured salivary alpha-amylase (AA) and cortisol, which index SNS and HPA activity, respectively, before and after a naturalistic reminder of a stressful parenting experience. We assessed self-reported parenting stress using the Parenting Stress Index-Short Form (PSI-SF) subscales Parental Distress, Parent-Child Dysfunctional Interactions, and Difficult Child. We used regression to test AA and cortisol mean levels and reactivity as predictors of subscale scores. RESULTS: Mean, but not reactive, salivary stress biomarker levels were associated with parenting stress domains. Mean cortisol levels predicted scores on the Parent-Child Dysfunctional Interaction subscale (adj. R = .48), whereas mean AA predicted Difficult Child subscale scores (adj. R = .28). DISCUSSION: Our results demonstrate the potential predictive utility of AA and cortisol as salivary biomarkers of maternal stress in community-supervised mothers. Given that maternal stress is associated with criminal recidivism and child behavioral health in this population, these biomarkers could potentially inform interventions to improve dyadic health and social outcomes.

Resting amygdala connectivity and basal sympathetic tone as markers of chronic hypervigilance.

BACKGROUND: Chronic hypervigilance, a state of sustained alertness and hyperarousal in the absence of threat, has been shown to predict poorer clinical outcomes post-trauma. An exaggerated and persistent amygdala alerting response to affective information has been proposed as a reactivity-based, and thus indirect, marker of hypervigilance. However, because chronic hypervigilance is a persistent rather than reactive state, it should be directly observable under resting-state conditions without the need for exposure to affectively charged stimuli. OBJECTIVE: We tested resting amygdala connectivity and basal sympathetic and hypothalamic-pituitary-adrenal axis activity as direct neural and neuroendocrine markers of chronic hypervigilance. PARTICIPANTS: 24 trauma-exposed women (age M = 22.9, SD = 5.5) and 20 no-trauma controls (age M = 21.1, SD = 3.2). MEASURES: Amygdala connectivity was measured using functional magnetic resonance imaging at rest and during viewing of novel and familiar affective scenes. Elevated amygdala connectivity during the viewing of novel scenes (exaggerated alerting response) and familiar scenes (persistent alerting response) was used as a reactivity-based index of hypervigilance. Resting amygdala connectivity and basal salivary alpha-amylase (sAA) and cortisol were tested as neural and neuroendocrine markers of hypervigilance, respectively. RESULTS: Compared to no-trauma controls, trauma-exposed women showed greater connectivity between the left amygdala and the ventral anterior cingulate cortex (vACC) both during affective processing and at rest. Exaggerated neural novelty response was associated with greater resting left amygdala-vACC connectivity and higher basal sAA, but not cortisol. CONCLUSIONS: Greater synchronization of threat-detection circuitry in the absence of threat and basal sympathetic tone might serve as complementary resting-state markers of the cognitive and physiological components of chronic hypervigilance, respectively.