Preventing PTSD with oxytocin: effects of oxytocin administration on fear neurocircuitry and PTSD symptom development in recently trauma-exposed individuals.
Preventing PTSD with oxytocin: effects of oxytocin administration on fear neurocircuitry and PTSD symptom development in recently trauma-exposed individuals.
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DOI：
10.1080/20008198.2017.1302652
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发表时间：
2017
影响因子：
5
通讯作者：
Frijling JL
中科院分区：
文献类型：
--
作者：
Frijling JL
背景资料：创伤后应激障碍（PTSD）是一种使人衰弱的精神障碍，在大约10%的创伤暴露个体中发展。目前，PTSD的早期预防干预措施很少。创伤后早期鼻内催产素给药可以预防PTSD症状的发展，因为以前发现催产素给药有益地影响神经生物学（例如杏仁核反应性）和社会情感PTSD脆弱性因素。 目的：本论文的总体目标是研究鼻内催产素给药作为PTSD早期预防干预的潜力。 研究方法：我们进行了一项功能性磁共振成像（fMRI）研究，以评估近期创伤暴露的急诊科患者（范围n = 37-41）单次给予催产素对功能性恐惧神经回路（包括杏仁核和（前）额叶脑区）的急性影响。此外，我们进行了一项多中心随机双盲安慰剂对照临床试验（RCT），以评估创伤后早期重复鼻内催产素给药预防创伤后应激障碍症状发展至创伤后6个月的疗效（n = 107）。 结果如下：在我们的功能磁共振成像实验中，我们观察到在最近遭受创伤的个体中，在单次催产素给药后，杏仁核对恐惧面孔的反应急剧增加，杏仁核-腹内侧和腹外侧前额叶皮层功能连接减弱。然而，在我们的随机对照试验中，我们发现创伤后早期反复鼻内催产素给药减少了近期创伤暴露的急诊科高急性PTSD症状患者随后的PTSD症状发展。 结论：这些研究结果表明，反复鼻内催产素是一个有前途的早期预防干预PTSD的个人在PTSD的风险增加，由于高急性症状的严重程度。催产素的管理频率依赖性影响或催产素管理的显着性处理的影响，可以作为对比催产素对焦虑相关的措施在我们的临床和神经影像学研究的解释框架。
Background: Posttraumatic stress disorder (PTSD) is a debilitating psychiatric disorder which develops in approximately 10% of trauma-exposed individuals. Currently, there are few early preventive interventions available for PTSD. Intranasal oxytocin administration early posttrauma may prevent PTSD symptom development, as oxytocin administration was previously found to beneficially impact neurobiological (e.g. amygdala reactivity) and socio-emotional PTSD vulnerability factors. Objective: The overall aim of this dissertation was to investigate the potential of intranasal oxytocin administration as early preventive intervention for PTSD. Methods: We performed a functional magnetic resonance imaging (fMRI) study to assess the acute effects of a single administration of oxytocin on the functional fear neurocircuitry – consisting of the amygdala and (pre)frontal brain regions – in recently trauma-exposed emergency department patients (range n = 37–41). In addition, we performed a multicentre randomized double-blind placebo-controlled clinical trial (RCT) to assess the efficacy of repeated intranasal oxytocin administration early after trauma for preventing PTSD symptom development up to six months posttrauma (n = 107). Results: In our fMRI experiments we observed acutely increased amygdala reactivity to fearful faces and attenuated amygdala-ventromedial and ventrolateral prefrontal cortex functional connectivity after a single oxytocin administration in recently trauma-exposed individuals. However, in our RCT we found that repeated intranasal oxytocin administration early posttrauma reduced subsequent PTSD symptom development in recently trauma-exposed emergency department patients with high acute PTSD symptoms. Conclusions: These findings indicate that repeated intranasal oxytocin is a promising early preventive intervention for PTSD for individuals at increased risk for PTSD due to high acute symptom severity. Administration frequency dependent effects of oxytocin or the effects of oxytocin administration on salience processing may serve as explanatory frameworks for the contrasting oxytocin effects on anxiety-related measures in our clinical and neuroimaging studies.