NeuRA Magazine #20

CHILDHOOD TRAUMA AND PSYCHOSIS

Understanding the various causes of psychosis is a key way to improve treatments. Dr Yann Quidé is using fMRI to understand how childhood trauma may change the brain of a person who has experienced psychosis.

Dr Yann Quidé

There is increasing evidence that exposure to childhood trauma is a risk factor for some psychiatric conditions, including post-traumatic stress disorder, depression, anxiety and psychotic disorders. Trauma may present a different pathway to illness compared to those who have a psychiatric condition but who did not experience childhood trauma, and so may require a different treatment approach.

Within the Imaging Genetics in Psychosis project, lead by Assoc Prof Melissa Green, around 60 percent of psychosis patients and around 40 percent of healthy participants were exposed to significant levels of childhood trauma. This includes emotional and physical abuse, neglect and sexual abuse. Interestingly, there is a significant overlap between the cognitive domains that are usually affected in psychotic disorders, and those reported in (non-psychotic) psychiatric and non-psychiatric populations exposed to childhood trauma. The overlap appears to include executive functions, working memory and social cognition.

To identify these trauma-related brain abnormalities in psychosis, participants underwent functional magnetic resonance imaging (fMRI) while performing tasks that use the previously mentioned overlapping cognitive domains. Results indicated that being exposed to trauma was associated with inefficient activation of key brain regions for working memory in psychosis patients.

The study, led by Dr Yann Quidé, also found that some people with schizophrenia or schizoaffective disorder who experienced childhood trauma present abnormal patterns of brain function in regions important to understanding another person’s mental state, also called theory-of-mind. These findings confirm that trauma-exposure leads to distinct brain abnormalities in psychosis, and may help to improve personalised approaches to treatment of psychosis.

However, childhood trauma exposure also sets off a cascade of other biological processes that influence the pathway to illness. These include the stress system, otherwise known as the HPA (hypothalamic pituitary adrenal) axis; pro-inflammatory immune responses; or neuronal growth and differentiation. Modifications of these biological markers can lead to the physiological changes in brain structure or function, as we observed.

Dr Yann Quidé recently received an 2016 Early-Career Project Grant award from the Society for Mental Health Research (SMHR) in order to further investigate the associations between these biological dysfunctions, trauma-exposure and psychosis.

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Brain and Knee Muscle Weakness Study

Why Does Quadriceps Weakness Persist after Total Knee Replacement? An Exploration of Neurophysiological Mechanisms Total knee replacement is a commonly performed surgery for treating end-staged knee osteoarthritis. Although most people recover well after surgery, weakness of the quadriceps muscles (the front thigh muscles) persists long after the surgery (at least for 12 months), despite intensive physiotherapy and exercise. Quadriceps muscle weakness is known to be associated with more severe pain and greatly affect daily activities. This study aims to investigate the mechanisms underlying weakness of the quadriceps muscles in people with knee osteoarthritis and total knee replacement. We hope to better understand the relationship between the changes of the brain and a loss of quadriceps muscle strength after total knee replacement. The study might be a good fit for you if you: Scheduled to undergo a total knee replacement; The surgery is scheduled within the next 4 weeks; Do not have a previous knee joint replacement in the same knee; Do not have high tibial osteotomy; Do not have neurological disorders, epilepsy, psychiatric conditions, other chronic pain conditions; Do not have metal implants in the skull; Do not have a loss of sensation in the limbs. If you decide to take part you would: Be contacted by the researcher to determine your eligibility for the study Be scheduled for testing if you are eligible and willing to take part in the study Sign the Consent Form when you attend the first testing session Attend 3 testing sessions (approximately 2 hours per session): 1) before total knee replacement, 2) 3 months and 3) 6 months after total knee replacement. The testing will include several non-invasive measures of brain representations of the quadriceps muscles, central pain mechanisms, and motor function and questionnaires. Will I be paid to take part in the research study? You will be reimbursed ($50.00 per session) for travel and parking expenses associated with the research study visits. If you would like more information or are interested in being part of the study, please contact: Name: Dr Wei-Ju Chang Email: w.chang@neura.edu.au Phone: 02 9399 1260 This research is being funded by the Physiotherapy Research Foundation.  
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