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Patients with posttraumatic stress disorder (PTSD) exhibit smaller regional brain volumes in commonly reported regions including the amygdala and hippocampus, regions associated with fear and memory processing. In the current study, we have conducted a voxel-based morphometry (VBM) meta-analysis using whole-brain statistical maps with neuroimaging data from the ENIGMA-PGC PTSD working group.
Methods
T1-weighted structural neuroimaging scans from 36 cohorts (PTSD n = 1309; controls n = 2198) were processed using a standardized VBM pipeline (ENIGMA-VBM tool). We meta-analyzed the resulting statistical maps for voxel-wise differences in gray matter (GM) and white matter (WM) volumes between PTSD patients and controls, performed subgroup analyses considering the trauma exposure of the controls, and examined associations between regional brain volumes and clinical variables including PTSD (CAPS-4/5, PCL-5) and depression severity (BDI-II, PHQ-9).
Results
PTSD patients exhibited smaller GM volumes across the frontal and temporal lobes, and cerebellum, with the most significant effect in the left cerebellum (Hedges’ g = 0.22, pcorrected = .001), and smaller cerebellar WM volume (peak Hedges’ g = 0.14, pcorrected = .008). We observed similar regional differences when comparing patients to trauma-exposed controls, suggesting these structural abnormalities may be specific to PTSD. Regression analyses revealed PTSD severity was negatively associated with GM volumes within the cerebellum (pcorrected = .003), while depression severity was negatively associated with GM volumes within the cerebellum and superior frontal gyrus in patients (pcorrected = .001).
Conclusions
PTSD patients exhibited widespread, regional differences in brain volumes where greater regional deficits appeared to reflect more severe symptoms. Our findings add to the growing literature implicating the cerebellum in PTSD psychopathology.
Recent changes to US research funding are having far-reaching consequences that imperil the integrity of science and the provision of care to vulnerable populations. Resisting these changes, the BJPsych Portfolio reaffirms its commitment to publishing mental science and advancing psychiatric knowledge that improves the mental health of one and all.
The UK has seen an outbreak of riots after the death of three children in a knife attack. Misinformation about the suspect's heritage and religion was spread by social media, which was then used to incite violence and racism resulting in damage to property, terror and injuries. We put forward arguments that this was an extremist act and draw on the literature on terrorism, extremism and identity to put forward a deeper analysis of how this happened and what can be done to prevent future riots. We bring an interdisciplinary perspective drawing on research from social, cultural, psychological and political perspectives.
As a wave of backsliding has swept across both new and established democracies, scholars have sought to identify formal and informal institutions that can act as guardrails of democracy. But while informal norms, party structures, and formal institutions such as separation of powers have all been singled out as potential bulwarks against democratic backsliding, the literature has had less to say about what role, if any, federalism might play in stopping democracies from sliding into autocracy. While some constitutional designers and scholars have argued that federalism can help to prevent the emergence of a national tyranny, most contemporary research has emphasized the damaging effects federalism can have on democracy. In this article, we assess the relationship between federalism and threats posed by national rulers, with quantitative analysis of that relationship in countries around the world and with structured, focused comparative case studies in the United States, Brazil, Venezuela, and India. Our quantitative analysis finds no systematic relationship between federalism and backsliding, while our comparative case studies support our argument that federalism is only likely to serve as a bulwark against autocratic threats posed by national rulers under a limited set of conditions.
Functional connectivity of the default mode network (DMN) during rest has been shown to be different among adults with Mild Cognitive Impairment (MCI) relative to aged-matched individuals without MCI and is predictive of transition to dementia. Post-traumatic stress disorder (PTSD) is also associated with aberrant connectivity of the DMN. Prior work from this group has demonstrated a higher rate of MCI and PTSD among World Trade Center (WTC) responders relative to the general population. The current study sought to investigate the main and interactive effects of MCI and PTSD on DMN functioning. Based on prior work, we hypothesized that MCI, but not PTSD, would predict aberrant connectivity in the DMN.
Participants and Methods:
99 WTC responders aged 44–65 stratified by MCI status (yes/no) and PTSD status (yes/no) and matched for age in years, sex (male vs. female), race (white, black, and other), and educational attainment (high school or less, some college / technical school, and university degree), and occupation on September 11, 2001 (law enforcement vs. other) underwent fMRI using a 3T Siemens Biograph MR scanner. A single 10-minute continuous functional MR sequence was acquired while participants were at rest with their eyes open. Group-level analyses were conducted using SPM-12, with correction for multiple comparisons using AFNI's 3dClustSim. Based on this threshold, the number of comparisons in our imaging volume, and the smoothness of our imaging data as measured by 3dFWHMx-acf, a minimum cluster size of 1134 voxels was required to have a corrected p . .05 with 2-sided thresholding. Spherical 3 mm seeds were placed in the dorsal (4, -50, 26) and ventral (4, -60, 46) posterior cingulate cortex (PCC).
Results:
Individuals with PTSD demonstrated significantly less connectivity of the dorsal posterior cingulate cortex (PCC) with medial insula (T = 5.21), subthalamic nucleus (T = 4.66), and postcentral gyrus (T = 3.81). There was no difference found in this study for connectivity between groups stratified by MCI status. There were no significant results for the ventral PCC seed.
Conclusions:
Contrary to hypotheses that were driven by a study of cortical thickness in WTC responders, the impact of PTSD appears to outweigh the impact of MCI on dorsal DMN connectivity among WTC responders stratified by PTSD and MCI status. This study is limited by several issues, including low number of female and minority participants, relatively small group cell sizes (n = 23–27 per cell), a brief resting state sequence (10 minutes), and lack of a non-WTC control group. Importantly, responders are a unique population so generalizability to other populations may be limited. Individuals in the current study are now being followed longitudinally to relate baseline resting state functional connectivity with cognitive changes and changes in connectivity over a four-year period.
We measured sex differences in emotion regulation (ER) abilities – relying on exercise of cognitive reappraisal – during an image rating task in adults over 55 years of age with varying degrees of depression symptom severity. We also collected a self-report measure on participants' views of their own ER capacities. Previous research by this group has demonstrated the importance of emotion processing in the context of sex and aging in depression. We hypothesized that females would (1) score higher on the Cognitive Reappraisal Facet of the ERQ, (2) be more successful in utilizing cognitive reappraisal skills in response to negative stimuli; and (3) have self-report scores on the ERQ that more closely match their success at cognitive reappraisal than would males.
Participants and Methods:
capacities. Previous research by this group has demonstrated the importance of emotion processing in the context of sex and aging in depression. We hypothesized that females would (1) score higher on the Cognitive Reappraisal Facet of the ERQ, (2) be more successful in utilizing cognitive reappraisal skills in response to negative stimuli; and (3) have self-report scores on the ERQ that more closely match their success at cognitive reappraisal than would males.
Results:
Only the first of our three outcome measures was successfully predicted by the model including age, MADRS scores, and sex as predictors. Scores on the ERQ cognitive reappraisal facet with sex accounted for 11.3% of the variance (F=7.344, p=.009). Age and depression symptom severity did not reach significance. Performance on the ERT itself and the correlation between the two were not meaningfully modeled.
Conclusions:
Women showed both better cognitive reappraisal abilities overall and more insight into the level of those abilities, findings that fall in line with most ER literature. However, we found that females were also more likely than males to be skewed in the positive or “overconfident” direction; to overestimate those same abilities. This information is useful for clinicians interpreting self-report information in the emotion regulation domain. These findings may not generalize to a more diverse (racially and socioeconomically) population and given the cognitive nature of the reappraisal strategy; these results may not extend to a less educated population. These data will be useful to inform the interpretation of fMRI images from this same experiment.
We explore what can be learned from authoritarian backsliding in middle income countries about the threats to American democracy posed by the election of Donald Trump. We develop some causal hunches and an empirical baseline by considering the rise of elected autocrats in Venezuela, Turkey, and Hungary. Although American political institutions may forestall a reversion to electoral autocracy, we see some striking parallels in terms of democratic dysfunction, polarization, the nature of autocratic appeals, and the processes through which autocratic incumbents sought to exploit elected office. These processes could generate a diminished democratic system in which electoral competition survives, but within a political space that is narrowed by weakened horizontal checks on executive power and rule of law.
This article extends Lau and Redlawsk's notion of correct voting – whether voters, under conditions of uncertainty, choose the alternative they would have chosen had they been fully informed about the issues and candidates in that election – to sixty-nine elections in thirty-three established and emerging democracies around the world. At the individual level, political sophistication, political experience and motivation all significantly predict the probability of casting a correct vote. However several institutional factors proved to be even more important. In particular, elections with more parties running – and settings that encourage candidate-centred voting – decrease the probability of correct voting, while more ideologically distinctive alternatives, clearer lines of responsibility and greater media access to information are associated with higher rates of correct voting.
Recent work by Carles Boix and Daron Acemoglu and James Robinson has focused on the role of inequality and distributive conflict in transitions to and from democratic rule. We assess these claims through causal process observation, using an original qualitative dataset on democratic transitions and reversions during the “third wave” from 1980 to 2000. We show that distributive conflict, a key causal mechanism in these theories, is present in just over half of all transition cases. Against theoretical expectations, a substantial number of these transitions occur in countries with high levels of inequality. Less than a third of all reversions are driven by distributive conflicts between elites and masses. We suggest a variety of alternative causal pathways to both transitions and reversions.
Countries of the former Soviet Union and Eastern Europe are entering the second decade of political transformation and economic reform. The first decade involved macroeconomic stabilization, privatization, and development of the basic institutional infrastructure of a market economy. The new policy challenges center on the nature of the social contract between citizens and their governments. These challenges include identifying the appropriate boundaries between the obligations of the public sector and the responsibilities of individual citizens, the range of public goods the government should supply, and who should pay for and benefit from their provision. The essays in this volume, first published in 2001, focus on two interrelated issues: the making of fiscal policy and the provision of citizens' welfare, particularly regarding pensions and health care. The essays emphasize that there is no single model of a market economy; rather, governments and publics face a range of options for restructuring the socialist welfare state.
The draft paper sets out the authors' views of what good practice for the actuarial aspects of internal models will look like in 2012, the year Solvency II is expected to be implemented. Actuaries working on internal models can expect to have to follow such practices if their internal models are to be approved for use in calculating regulatory capital. The paper is therefore relevant for actuaries who plan to work on internal model implementation for Solvency II.
Moreover, the risk quantification techniques discussed in the paper can also be used in the Own Risk Solvency Assessment (ORSA) process also required by Solvency II. The paper is therefore relevant to actuaries working in companies that are not planning to apply to use an internal model.
The paper covers both life and non-life insurance and reinsurance, and reviews current practice as well as setting out possible future practice. This leads to identification of areas for research by the Profession to prepare for 2012 and an indication of the directions this work might take.
The paper is effectively a work in progress, and readers should ask themselves what they should do in response to the ideas discussed.