Longitudinal changes in brain function associated with symptom improvement in youth with PTSD
Longitudinal changes in brain function associated with symptom improvement in youth with PTSD
复制标题
DOI：
10.1016/j.jpsychires.2019.04.021
复制
发表时间：
2019-07-01
影响因子：
4.8
通讯作者：
Agras, W. Stewart
中科院分区：
文献类型：
--
作者：
Garrett, Amy;Cohen, Judith A.;Agras, W. Stewart
背景：以往的研究表明，青少年创伤后应激障碍(PTSD)患者大脑中情绪处理的重要区域存在异常激活。目前尚不清楚这些地区的症状改善是否伴随着规范性变化。这项研究确定了与症状改善相关的神经变化，长期目标是确定干预的可塑性靶点。方法：总共收集了80例功能性磁共振成像(FMRI)扫描，包括20名9-17岁的青少年创伤后应激障碍(PTSD)患者和20名年龄和性别匹配的健康对照组，每次扫描都是在5个月之前和之后进行的。创伤后应激障碍组接受创伤认知行为治疗，以确保症状的改善。对面部表情任务数据进行全脑体素激活和兴趣区分析，以识别基线时PTSD组相对于HC的异常，以及从BL到EOS症状改善的神经变化。结果：在基线时，PTSD组在扣带皮质、海马体、杏仁核和额叶内侧皮质的激活异常高于HC。从BL到EOS，创伤后应激障碍症状平均改善39%。PTSD症状的纵向改善与后扣带回、扣带中和海马区的激活减少有关，而分离性症状的改善与杏仁核的激活减少相关。结论：青年PTSD患者情绪加工脑网络的异常随着症状的改善而正常化，表明青年PTSD患者这些区域的神经可塑性以及早期干预的重要性。
Background: Previous studies indicate that youth with posttraumatic stress disorder (PTSD) have abnormal activation in brain regions important for emotion processing. It is unknown whether symptom improvement is accompanied by normative changes in these regions. This study identified neural changes associated with symptom improvement with the long-term goal of identifying malleable targets for interventions.Methods: A total of 80 functional magnetic resonance imaging (fMRI) scans were collected, including 20 adolescents with PTSD (ages 9-17) and 20 age- and sex-matched healthy control subjects, each scanned before and after a 5-month period. Trauma-focused cognitive behavioral therapy was provided to the PTSD group to ensure improvement in symptoms. Whole brain voxel-wise activation and region of interest analyses of facial expression task data were conducted to identify abnormalities in the PTSD group versus HC at baseline (BL), and neural changes correlated with symptom improvement from BL to EOS of study (EOS).Results: At BL, the PTSD group had abnormally elevated activation in the cingulate cortex, hippocampus, amygdala, and medial frontal cortex compared to HC. From BL to EOS, PTSD symptoms improved an average of 39%. Longitudinal improvement in symptoms of PTSD was associated with decreasing activation in posterior cingulate, mid-cingulate, and hippocampus, while improvement in dissociative symptoms was correlated with decreasing activation in the amygdala.Conclusions: Abnormalities in emotion-processing brain networks in youth with PTSD normalize when symptoms improve, demonstrating neural plasticity of these regions in young patients and the importance of early intervention.