Anesthesia and the neurobiology of fear and posttraumatic stress disorder.
Anesthesia and the neurobiology of fear and posttraumatic stress disorder.
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DOI：
10.1097/aco.0000000000001176
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发表时间：
2022-10-01
期刊：
影响因子：
--
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中科院分区：
文献类型：
--
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恐惧记忆系统功能障碍是围手术期和重症监护患者中出现的一系列临床重要且高度流行的心理疾病的基础，其中最典型的是创伤后应激障碍（PTSD）。已知几种镇静催眠药和镇痛药可以调节恐惧系统，从理论上讲，麻醉师的临床决策可能会影响心理结果。这篇综述的目的是提供一个集中的综合相关文献从多个研究领域。有证据表明，在某些情况下，无意识的恐惧记忆系统对麻醉剂的敏感性低于有意识的记忆系统。阿片类药物可以抑制恐惧系统的激活，并有利于预防创伤后应激障碍。有不一致的证据表明，使用异丙酚和苯二氮卓类镇静创伤后可能会加强创伤后应激障碍的发展相对于其他药物。氯胺酮在治疗重度抑郁症中的益处在PTSD集群精神病理学中并没有明显的复制，它对恐惧过程的影响是复杂的。有多种理论机制，麻醉药物可以调节恐惧系统和临床上重要的基于恐惧的精神病理学。目前的研究状况提供了一些证据，以支持进一步的假设调查。然而，缺乏有效性研究和来自较小研究的不一致信号提供的证据不足以提供目前的临床指导。
Dysfunction of fear memory systems underlie a cluster of clinically important and highly prevalent psychological morbidities seen in perioperative and critical care patients, most archetypally post-traumatic stress disorder (PTSD). Several sedative-hypnotics and analgesics are known to modulate fear systems, and it is theoretically plausible that clinical decisions of the anesthesiologist could impact psychological outcomes. This review aims to provide a focused synthesis of relevant literature from multiple fields of research. There is evidence in some contexts that unconscious fear memory systems are less sensitive to anesthetics than are conscious memory systems. Opiates may suppress the activation of fear systems and have benefit in the prevention of PTSD following trauma. There is inconsistent evidence that the use of propofol and benzodiazepines for sedation following trauma may potentiate the development of PTSD relative to other drugs. The benefits of ketamine seen in the treatment of major depression are not clearly replicated in PTSD-cluster psychopathologies, and its effects on fear processes are complex. There are multiple theoretical mechanisms by which anesthetic drugs can modulate fear systems and clinically important fear-based psychopathologies. The current state of research provides some evidence to support further hypothesis investigation. However, the absence of effectiveness studies and the inconsistent signals from smaller studies provide insufficient evidence to currently offer firm clinical guidance.
重症监护病房治疗一年后的心理发病率。
影响因子：
2
作者：
Zisopoulos G;Roussi P;Mouloudi E
通讯作者：
Mouloudi E