Altered reward processing in the nucleus accumbens and mesial prefrontal cortex of patients with posttraumatic stress disorder

Uta Sailer, Simon Robinson, Florian Ph S Fischmeister, Dorothea König, Claudia Oppenauer, Brigitte Lueger-Schuster, Ewald Moser, Ilse Kryspin-Exner, Herbert Bauer

Research output: Journal article (peer-reviewed)Journal article

156 Citations (Scopus)


Posttraumatic stress disorder (PTSD) is known to be associated with altered medial prefrontal activation in response to threatening stimuli and with behavioural deficits in prefrontal functions such as working memory and attention. Given the importance of these areas and processes for decision-making, this functional magnetic resonance imaging study investigated whether decision-making is altered in patients with PTSD. In particular, the neural response to gain and loss feedback was evaluated in a decision-making task in which subjects could maximise their number of points total by learning a particular response pattern. Behaviourally, controls learned the correct response pattern faster than patients. Functionally, patients and controls differed in their neural response to gains, but not in their response to losses. During the processing of gains in the late phase of learning, PTSD patients as compared to controls showed lower activation in the nucleus accumbens and the mesial PFC, critical structures in the reward pathway. This reduced activation was not due to different rates of learning, since it was similarly present in patients with unimpaired learning performance. These findings suggest that positive outcome information lost its salience for patients with PTSD. This may reflect decreasing motivation as the task progressed.

Original languageEnglish
Pages (from-to)2836-2844
Number of pages9
Issue number11
Publication statusPublished - Sept 2008
Externally publishedYes


  • Adult
  • Case-Control Studies
  • Decision Making/physiology
  • Feedback
  • Female
  • Humans
  • Image Processing, Computer-Assisted/methods
  • Magnetic Resonance Imaging/methods
  • Male
  • Mental Processes/physiology
  • Neuropsychological Tests
  • Nucleus Accumbens/blood supply
  • Oxygen/blood
  • Prefrontal Cortex/blood supply
  • Psychomotor Performance/physiology
  • Reward
  • Statistics, Nonparametric
  • Stress Disorders, Post-Traumatic/pathology


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