1. Functional Neuroanatomy Of Trauma Spectrum Disorders Sensory inputs memory Anterior Cingulate, orbitofrontal, subcallosal gyrus; Planning, execution, inhibition of responses, extinction of fear response Emotional valence Sensory gateway Motor responses, peripheral sympathetic & cortisol response Posterior Cingulate, Parietal & Motor Cortex Cerebellum Visuospatial processing & assessment of threat Bremner

2. Spaced exposure causes incubation acutely Sequential Day 2 Cue Exposures Mark Barad, et al. (2000).

3. Biological Studies of Child and Adolescent Traumatic Stress Structural brain development Neurophysiology Neurohormones

4. CRH – peptide corticotropin hormone Mediates autonomic, immune, behavioral components of stress responses Important role in anxiety and fear Intraventricular administration of CRH – behavioral changes * Suppression of exploratory behavior * Potentiation of the acoustic startle reflex * Facilitation of fear conditioning ( Meaney, et al.)

5. PUTNAM’S PROSPECTIVE STUDY PUTNAM’S PROSPECTIVE STUDY CORTISOL RESPONSE CORTISOL RESPONSE Abused girls have higher a.m. cortisol, lower in p.m., more overall cortisol secretion

6. Hippocampal Volume Reduction In PTSD MRI scan of the hippocampus in a normal control & patient with PTSD secondary to childhood abuse. The hippocampus, outlined in red, is visibly smaller in PTSD. Overall 12% reduction in volume in PTSD. Bremner et al. Am J Psychiatry. 1995; 152:973-981. Bremner et al. Biol Psychiatry. 1997; 41:23-32. PTSDNORMAL

9. Normal Developmental Course of Startle Inhibition 1.Prior to about 4 years of age, inhibitory startle modulation is weak or absent, whereas facilitatory startle modulation to sustained prestimulation is strong in early infancy. 2.Both inhibitory and facilitatory startle modulation show, respectively, peak losses in startle inhibition and peak gains in startle facilitation at about 4.5 years of age. 3.Progressive increase in inhibition and decrease in facilitation follow until, by 8 years of age, mature values are obtained.

10. Modulation of Startle Amplitude by Prestimulation in Six Children with PTSD and in Six Control Children Sustained Tones 25 – msec Tones WARNING INTERVAL (msec) Difference in EMG Amplitudes BetweenWarned and Unwarned Conditions inhibtion facilitation Pynoos, et al., 1997