Self-rating scales assessing subjective well-being and distress correlate with rCBF in PTSD-sensitive regions

Background: The aim of this study was to investigate the distribution of the regional cerebral blood flow (rCBF) in occupational-related PTSD subjects and to seek for possible correlations between brain perfusion and self-rating scales (SRSs) in order to cross-check their diagnostic value and to look for their neural correlates. Method: Thirteen traumatized underground and long-distance train drivers developing (S) and 17 not developing (NS) PTSD having experienced a “person under train” accident or having been assaulted at work underwent clinical assessment and 99mTc-HMPAO SPECT imaging during autobiographical trauma scripts. Statistical parametric mapping (SPM2) was applied to analyze rCBF changes in S as compared to NS, and to search for correlations between rCBF and the administered SRSs scores, modeling age, months to SPECT, and the ratio ‘gray matter/intra-cranial volume’ as nuisance variables. Results: Significantly higher activity was observed during trauma script in left posterior and anterior insula, posterior cingulate, inferior parietal lobule, precuneus, caudate and putamen in PTSD subjects as compared to trauma-exposed control group. Impact of Event Scale (IES) and World Health Organisation (ten) Well-Being Index (WHO-10) scores highly correlated with tracer uptake to a great extent in the same regions in which rCBF differences between S and NS were found. Conclusions: These findings support the involvement of insular, cingulate, and parietal cortices (as well as the basal ganglia) in the pathogenesis of PTSD and in the processing of related subjective well-being and distress.