fMRI functional connectivity of the periaqueductal gray in PTSD and its dissociative subtype.
fMRI functional connectivity of the periaqueductal gray in PTSD and its dissociative subtype.
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DOI：
10.1002/brb3.579
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发表时间：
2016-12
影响因子：
3.1
通讯作者：
Lanius, Ruth A.
中科院分区：
文献类型：
--
作者：
Harricharan, Sherain;Rabellino, Daniela;Frewen, Paul A.;Densmore, Maria;Theberge, Jean;McKinnon, Margaret C.;Schore, Allan N.;Lanius, Ruth A.
关键词：
创伤后应激障碍（PTSD）与过度觉醒和积极的战斗或逃跑防御反应有关。与此相反，PTSD的分离亚型，以人格解体和现实丧失症状为特征，经常伴随着与自主神经钝化相关的额外的被动或顺从防御反应。在这里，中脑导水管周围灰质（PAG）在防御反应中起着中心作用，背外侧（DL-PAG）和腹外侧PAG（VL-PAG）被认为分别介导主动和被动防御反应。我们通过PickAtlas和SPM 12使用基于种子的方法检查了三组PAG亚区（背外侧和腹外侧）静息状态功能连接：无分离亚型的PTSD患者（n = 60）;分离亚型的PTSD患者（n = 37）;和健康对照组（n = 40）。与对照组（n = 40）相比，所有PTSD患者在休息时均表现出广泛的DL-和VL-PAG功能连接，与情绪反应和防御行动相关的区域。尽管所有的PTSD患者都表现出与主动应对策略和过度觉醒相关的区域的DL-PAG功能连接（例如，背侧前扣带;前额叶），只有分离性PTSD患者表现出与被动应对策略相关的大脑区域的更大的VL-PAG功能连接和增加的人格解体水平（例如，颞顶交界处;罗兰岛盖）。这些研究结果表明，即使在休息时，PTSD患者也会表现出更强的防御姿态，并表明与没有这种亚型的患者相比，分离亚型的患者显示出独特的PAG功能连接模式。总的来说，这些发现代表了确定治疗干预的神经和行为目标的重要第一步，这些干预措施解决了创伤相关疾病的防御策略。
Posttraumatic stress disorder (PTSD) is associated with hyperarousal and active fight or flight defensive responses. By contrast, the dissociative subtype of PTSD, characterized by depersonalization and derealization symptoms, is frequently accompanied by additional passive or submissive defensive responses associated with autonomic blunting. Here, the periaqueductal gray (PAG) plays a central role in defensive responses, where the dorsolateral (DL‐PAG) and ventrolateral PAG (VL‐PAG) are thought to mediate active and passive defensive responses, respectively. We examined PAG subregion (dorsolateral and ventrolateral) resting‐state functional connectivity in three groups: PTSD patients without the dissociative subtype (n = 60); PTSD patients with the dissociative subtype (n = 37); and healthy controls (n = 40) using a seed‐based approach via PickAtlas and SPM12. All PTSD patients showed extensive DL‐ and VL‐PAG functional connectivity at rest with areas associated with emotional reactivity and defensive action as compared to controls (n = 40). Although all PTSD patients demonstrated DL‐PAG functional connectivity with areas associated with initiation of active coping strategies and hyperarousal (e.g., dorsal anterior cingulate; anterior insula), only dissociative PTSD patients exhibited greater VL‐PAG functional connectivity with brain regions linked to passive coping strategies and increased levels of depersonalization (e.g., temporoparietal junction; rolandic operculum). These findings suggest greater defensive posturing in PTSD patients even at rest and demonstrate that those with the dissociative subtype show unique patterns of PAG functional connectivity when compared to those without the subtype. Taken together, these findings represent an important first step toward identifying neural and behavioral targets for therapeutic interventions that address defensive strategies in trauma‐related disorders.
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