Functional Neuroanatomy of Emotion and Its Regulation in PTSD.
Functional Neuroanatomy of Emotion and Its Regulation in PTSD.
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DOI：
10.1097/hrp.0000000000000185
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发表时间：
2018
影响因子：
3.8
通讯作者：
Phan KL
中科院分区：
文献类型：
--
作者：
Fitzgerald JM;DiGangi JA;Phan KL
创伤后应激障碍是一种毁灭性的疾病，与严重的精神、身体、职业和功能障碍有关。此外，它是一种高度复杂的疾病，其特征是症状跨多个领域的异质性。然而，由对威胁的夸大反应和/或无法调节负面情绪状态引起的情绪失调在创伤后应激障碍的病理生理学中起着决定性的作用。为了更好地了解情绪失调在这种疾病中的表现，过去20年的功能神经成像研究为创伤后应激障碍背景下情绪失调的每个组成部分提供了巨大的神经解剖学基础。虽然先前的综述是关于创伤后应激障碍文献中神经影像发现的主题，但本综述通过情绪及其调节的镜头来综合这项工作。对采用情绪反应和症状激发任务、内隐调节(如情绪失控和干扰)、外显调节(如认知再评价)和恐惧条件作用/消退研究的研究进行了综述。研究结果表明，创伤后应激障碍患者的情绪失调是由涉及杏仁核、脑岛、海马体、前扣带回皮质和前额叶皮质的大型神经回路中的并发症引起的。尽管杏仁核和脑岛对负面情绪触发的夸大反应普遍存在，但创伤后应激障碍的特点也是缺乏对负面情绪状态的评估、解决和管理，而ACC和PFC在调节过程中辅佐着这些状态。综上所述，这进一步支持了将情绪调节缺陷与夸张的症状挑衅结合起来研究的重要性，以便更好地理解PTSD患者存在的一系列症状。
PTSD is a devastating disorder, linked to profound mental, physical, occupational, and functional impairment. In addition, it is a highly complex disorder, characterized by symptom heterogeneity across multiple domains. Nevertheless, emotion dysregulation arising from exaggerated response to threat and/or inability to regulate negative emotional states plays a defining role in the pathophysiology of PTSD. In order to improve our understanding of how emotion dysregulation manifests in this illness, functional neuroimaging research over the past 20 years provides great insight into underlying neuroanatomy of each component of emotion dysregulation in the context of PTSD. While prior reviews exist on the topic of neuroimaging findings in PTSD literature, the present review synthesizes this work through the lens of emotion and its regulation. Studies that employed tasks of emotional responding and symptom provocation, implicit regulation (e.g., emotional stroop and interference), explicit regulation (e.g., cognitive reappraisal), and fear conditioning/extinction studies were reviewed. Findings demonstrate that emotion dysregulation in PTSD arises from complications within a large neurocircuitry involving the amygdala, insula, hippocampus, anterior cingulate cortex, and prefrontal cortex. Although exaggerated response in the amygdala and insula to negative emotional triggers is pervasive, PTSD is also marked by deficient appraisal, resolution, and management of negative emotional states sub-served by the ACC and PFC during regulation. Together, this further supports the importance of studying emotion regulation deficits in tandem to exaggerated symptom provocation in order to better understand the constellation of symptoms present in those with PTSD.