Circuit dysregulation and circuit-based treatments in posttraumatic stress disorder.
Circuit dysregulation and circuit-based treatments in posttraumatic stress disorder.
复制标题
创伤后应激障碍的回路失调和基于回路的治疗。
DOI：
10.1016/j.neulet.2016.11.014
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发表时间：
2017
影响因子：
2.5
通讯作者：
Liberzon,Israel
中科院分区：
文献类型：
--
作者：
Sheynin,Jony;Liberzon,Israel
创伤后应激障碍（PTSD）是一种精神疾病，在某些个体暴露于创伤事件后发展，例如实际或威胁死亡，严重伤害或性侵犯。据推测，在一些特定的神经回路的失调，其特征在于杏仁核，dACC和杏仁核的反应性提高，减少mPFC的反应性，受损的海马功能和皮质区的赤字，在关键的PTSD症状的发展和表达的基础。在这里，我们简要地描述了三个功能性神经回路涉及PTSD的病理生理学和简要回顾这些神经回路的背景下选择的治疗策略。我们从通常涉及的神经回路模型，即恐惧学习和威胁检测电路，然后讨论上下文处理电路，其中起着重要作用，在恐惧调节。然后，我们讨论了情绪调节电路，这可以进一步促进PTSD的病理生理学，并得出结论，讨论的治疗方法，可能是针对这些电路在PTSD患者的失调。具体来说，我们讨论了如何以恐惧为基础的治疗可能针对恐惧学习电路，以及旨在增强这些治疗的药理学和脑刺激干预。最后，我们讨论了其他药理学和认知治疗方法，可以增强或恢复上下文处理和情绪调节电路的功能。
Posttraumatic stress disorder (PTSD) is a psychiatric disorder that develops in some individuals in the aftermath of exposure to traumatic events, such as actual or threatened death, serious injury or sexual assault. It has been hypothesized that dysregulations in a number of specific neurocircuits, characterized by heightened responsivity of amygdala, dACC and insula, diminished responsivity of mPFC, impaired hippocampal function and deficits in cortical regions, underlie the development and expression of key PTSD symptoms. Here, we concisely describe three functional neural circuits implicated in PTSD pathophysiology and briefly review selected treatment strategies in the context of these neural circuits. We start with the commonly implicated neurocircuit model, namely, the fear learning and threat detection circuits, and then discuss the context processing circuitry, which plays an important role among others, in fear regulation. We then discuss the emotion regulation circuitry, which can further contribute to PTSD pathophysiology, and conclude with a discussion of the therapeutic approaches that might be targeting dysregulation in these circuits in PTSD patients. Specifically, we discuss how exposure-based treatments might be targeting fear learning circuits, and the pharmacological and brain-stimulation interventions aimed to augment these therapies. Finally, we discuss other pharmacological and cognitive therapeutic approaches that can augment or restore the function of the context processing and emotional regulation circuits.