Psychological Medicine



Original Article

Effects of psychotherapy on hippocampal volume in out-patients with post-traumatic stress disorder: a MRI investigation 1


RAMÓN J. L. LINDAUER a1a2a3c1, ERIK-JAN VLIEGER a4, MARGJE JALINK a1, MIRANDA OLFF a1, INGRID V. E. CARLIER a5, CHARLES B. L. M. MAJOIE a4, GERARD J. DEN HEETEN a4 and BERTHOLD P. R. GERSONS a1
a1 Centre for Psychological Trauma, Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
a2 De Bascule and Department of Child and Adolescent Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
a3 Graduate School Neurosciences Amsterdam, Amsterdam, The Netherlands
a4 Department of Radiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
a5 Centre for Work-Related Mental Disorders, Altrecht Institute for Mental Health Care, Utrecht, The Netherlands

Article author query
lindauer rj   [PubMed][Google Scholar] 
vlieger ej   [PubMed][Google Scholar] 
jalink m   [PubMed][Google Scholar] 
olff m   [PubMed][Google Scholar] 
carlier iv   [PubMed][Google Scholar] 
majoie cb   [PubMed][Google Scholar] 
den heeten gj   [PubMed][Google Scholar] 
gersons bp   [PubMed][Google Scholar] 

Abstract

Background. Magnetic resonance imaging (MRI) studies have especially reported smaller hippocampal volume in patients with post-traumatic stress disorder (PTSD), most of them war or sexual abuse victims. The present study compares the hippocampal volumes of out-patients with PTSD who had low co-morbidity rates to those of trauma-exposed control subjects without PTSD, and measures hippocampal volume changes in these patients after brief eclectic psychotherapy. We hypothesized that smaller hippocampal volumes are specific to PTSD and that hippocampal volume changes after effective psychotherapy would be measurable.

Method. Eighteen patients with PTSD and 14 traumatized control subjects were examined with MRI. In a randomized clinical trial, the PTSD patients were assigned to treatment (n=9) or waiting-list group (n=9). After the former received psychotherapy for 4 months, the MRI was repeated on both PTSD groups. Three temporal lobe structures were manually segmented: hippocampus, amygdala, and parahippocampal gyrus. Volumetric analysis was used to measure grey matter, white matter, and cerebrospinal fluid.

Results. PTSD patients had significantly smaller hippocampal volumes at baseline (total 13·8%, right 13·5%, left 14·1%) compared to the control subjects. After effective psychotherapy, however, no volume changes were found in the smaller hippocampi.

Conclusions. We confirmed previous findings of smaller hippocampal volume in PTSD in a new population made up of out-patients who experienced different types of traumas, reducing co-morbidity to a minimum. Smaller hippocampal volumes did not change after effective psychotherapy, even while symptoms resolved.


Correspondence:
c1 Academic Medical Centre, Department of Child and Adolescent Psychiatry, Tafelbergweg 25, 1105 BC Amsterdam, The Netherlands. [Email: R.J.Lindauer@amc.uva.nl (office) or RJL.Lindauer@12move.nl (home)]


Footnotes

1 Presented at the Annual Meeting of the International Society for Traumatic Stress Studies, New Orleans, 16 November 2004, and at the European Congress for Psychotherapy, Amsterdam, 27 November 2004.



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