Why
do you think your work is highly cited?
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“The conceptualization of PTSD has become rooted in the field of neuroscience.”
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Our group was the first to apply brain imaging to the study of
posttraumatic stress disorder (PTSD). This work, published in 1995,
followed up studies in animals showing that stress is toxic to a
part of the brain involved in learning and memory called the
hippocampus. This work is relevant to PTSD because PTSD patients
have trouble with learning and memory. It is also thought that the
hippocampus is involved in turning off the fear response, or
extinction of fear, which is also relevant to PTSD. In our study we
used magnetic resonance imaging (MRI) to show smaller hippocampal
volume in PTSD related to combat. We later replicated this in adult
survivors of childhood abuse. Using neuropsychological testing as a
probe of hippocampal function, we found deficits in verbal
declarative memory function in PTSD. In the first study of
cerebrospinal fluid in PTSD, we reported elevations of the peptide
corticotropin releasing factor (CRF), which plays a critical role in
the stress response. We also showed exaggerated norepinephrine
function in PTSD. Finally, positron emission tomography (PET)
studies of brain function showed a decrease in medial prefrontal and
anterior cingulate function with a variety of methods to induce
symptoms of PTSD. Because these studies were amongst the first in
the field of the neurobiology of PTSD and generated interest and
attempts at replication, they became highly cited.
What
are the circumstances which led you to your work?
I was a psychiatry resident and research fellow at Yale when the
National Center for PTSD was established at the West Haven VA in
1988. There were good mentors and resources and a highly productive
group.
Would
you describe the significance of this work for your field?
These studies showed that brain circuits and systems known from
animal studies to play a critical role in stress show long-term
alterations in patients with PTSD, and these alterations likely
underlie the symptoms of PTSD. It has moved PTSD from being viewed
as a psychological disorder to a brain-based disorder. The
conceptualization of PTSD has become rooted in the field of
neuroscience. All this has happened in only the past 10 years.
How
much has this research advanced since you first started publishing on
it?
My first publications started coming out in 1992. At that time
there were only two or three biological studies looking at hormones
in urinary samples and one controlled treatment study. I was able to
read all studies in PTSD in a single day. Today there are literally
hundreds of papers on the topic.
Where
do you see this research going 10 years from now?
In the future we will use brain imaging to more specifically look
at brain receptors and chemicals in PTSD, examine gene-environment
interactions, and look more at the longitudinal course of the
biological response to trauma.
What
lessons would you draw from your work to share with the next
generation of researchers?
Focus on areas in science that have not been the subject of
investigation because there is an open field, even if it is not seen
as attractive to more established scientists at the time. It is
always good to be first to do something. Take risks.
n our
Special Topic on Posttraumatic Stress Disorder, Dr. J. Douglas
Bremner’s work ranks at #3, with 40 papers cited a total of
1,714 times to date. Dr. Bremner is also the author of the
papers ranked at #2 and #5 in our 10-year paper listing on
this topic. In the 
Web product, Dr. Bremner’s work can be found in the field of
Psychiatry/Psychology. Dr. Bremner is the Director of the
Emory Center for Positron Emission Tomography at Emory
University’s School of Medicine, as well as the Director of
Mental Health Research at the VA Medical Center in Atlanta,
Georgia.