Association of Prepubertal and Postpubertal Exposure to Childhood Maltreatment With Adult Amygdala Function.
Association of Prepubertal and Postpubertal Exposure to Childhood Maltreatment With Adult Amygdala Function.
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青春期前和青春期后暴露于儿童期虐待与成人杏仁核功能的关系。
DOI：
10.1001/jamapsychiatry.2019.0931
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发表时间：
2019-08
期刊：
影响因子：
25.8
通讯作者：
Jianjun Zhu;S. Lowen;C. Anderson;K. Ohashi;Alaptigin Khan;Martin H. Teicher
中科院分区：
文献类型：
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作者：
Jianjun Zhu;S. Lowen;C. Anderson;K. Ohashi;Alaptigin Khan;Martin H. Teicher
在焦虑症、自闭症、双相情感障碍、抑郁症、创伤后应激障碍和精神分裂症中，人们观察到杏仁核对威胁面孔反应的重要性异常。异常的多动和低动反应通常与焦虑和抑制、冒险和不适当的社交行为有关。虐待是大多数这些疾病的主要风险因素，并与杏仁核功能异常有关。目的探讨儿童期虐待的类型和年龄与青春期杏仁核反应过度和减退的关系。这项回溯性队列研究的设计、设置和参与者数据收集从2010年11月8日进行到2012年8月23日。数据分析从2012年9月20日至2018年6月27日进行。参与者是从波士顿市区和郊区招募的，没有基于暴露史的诊断限制。使用虐待和虐待暴露年表(MACE)来回顾评估儿童遭受虐待的类型和年龄。主要结果和指标使用激活和模式信息功能磁共振成像来评估双侧杏仁核对愤怒和恐惧面孔或中性面孔或形状的反应，并使用交叉验证的人工智能预测分析(50次平均随机迭代，63.3%的训练和36.7%的样本测试)确定敏感暴露时间。结果在202名参与者中(平均年龄23.2[1.7]岁；118名女性[58.4%])，52名(25.7%)报告没有遭受过虐待，150名(74.3%)报告遭受过一种或多种虐待。8名(15.1%)MACE评分为0的参与者(15.1%)和51名(34.2%)MACE评分为1或更高的参与者有严重抑郁史(优势比为2.40；95%可信区间为1.05-6.06；P=.03)；8名未接触过风险的参与者(15.1%)和46名MACE评分为1或更高的参与者(30.9%)有1种或更多焦虑症的病史(优势比为2.45；95%可信区间为1.03-6.50；P=.03)。3-6岁的身体虐待和13-15岁的同龄人情绪虐待的回顾性自我报告与杏仁核对情绪面孔和形状的激活有关。早期暴露与钝化反应相关(β=-0.17，P<；.001)，而较晚暴露与增强反应相关(β=0.16，P<；.001)。青春期前和青春期后虐待与体素反应模式在相同类型的聚集刺激上的相反反应(例如，4岁身体虐待的平均[SD]情绪椭圆形区域与13岁的非言语情绪虐待：1.41[1.05]vs 0.25[0.10]，P<；.001)以及区分不同类型的刺激(例如，6岁与13岁的同伴情绪虐待的[SD]情绪与中性面孔的平均距离：1.89[0.75]vs 0.80[0.39]，P<；.001)。结论和相关性研究结果表明，青春期前和青春期后，虐待与杏仁核对威胁性或显著刺激的反应之间的关系存在发育差异。了解逆境在不同敏感暴露时期的作用，以及杏仁核反应减弱和增强的潜在适应意义，可能有助于解释为什么虐待可能是许多不同疾病的风险因素，并促进创造有针对性的干预措施，以预防高危青少年出现精神病理学。
Importance Abnormalities in amygdala response to threatening faces have been observed in anxiety disorders, autism, bipolar disorder, depression, posttraumatic stress disorder, and schizophrenia. Abnormally hyperactive and hypoactive responses have typically been associated with anxiety and inhibition vs risk taking and inappropriate social behaviors. Maltreatment is a major risk factor for most of these disorders and is associated with abnormal amygdala function. Objective To identify the type and age of exposure to childhood maltreatment that are associated with hyperactive and hypoactive amygdala responses in young adulthood. Design, Setting, and Participants Data collection for this retrospective cohort study took place from November 8, 2010, to August 23, 2012. Data analyses were conducted from September 20, 2012, to June 27, 2018. Participants were recruited from the urban and suburban Boston vicinity without diagnostic restrictions based on exposure history. Exposures The Maltreatment and Abuse Chronology of Exposure (MACE) scale was used to retrospectively assess type and age of exposure to childhood maltreatment. Main Outcomes and Measures Activation and pattern information functional magnetic resonance imaging were used to assess bilateral amygdala response to angry and fearful faces vs neutral faces or shapes, and sensitive exposure periods were identified using cross-validated artificial intelligence predictive analytics (50 averaged randomized iterations with training on 63.3% and testing on 36.7% of the sample). Results Of the 202 participants (mean [SD] age, 23.2 [1.7] years; 118 [58.4%] female), 52 (25.7%) reported no exposure to maltreatment and 150 (74.3%) reported exposure to 1 or more maltreatment types. Eight participants (15.1%) with a MACE score of 0 and 51 (34.2%) with a MACE score of 1 or higher had a history of major depression (odds ratio, 2.40; 95% CI, 1.05-6.06; P = .03); 8 unexposed participants (15.1%) and 46 with MACE scores of 1 or higher (30.9%) had a history of 1 or more anxiety disorders (odds ratio, 2.45; 95% CI, 1.03-6.50; P = .03). Retrospective self-report of physical maltreatment between 3 and 6 years of age and peer emotional abuse at 13 and 15 years were associated with amygdala activation to emotional faces vs shapes. Early exposure was associated with blunted response (β = -0.17, P < .001), whereas later exposure was associated with augmented response (β = 0.16, P < .001). Prepubertal vs postpubertal maltreatment was associated with an opposite response on the voxelwise response pattern in clustering stimuli of the same type (eg, mean [SD] emotional ellipse areas for physical maltreatment at age 4 years vs nonverbal emotional abuse at 13 years: 1.41 [1.05] vs 0.25 [0.10], P < .001) and in distinguishing between stimuli of different types (eg, mean [SD] emotional vs neutral faces distance for peer emotional abuse at age 6 years vs 13 years: 1.89 [0.75] vs 0.80 [0.39], P < .001). Conclusions and Relevance The findings suggest that prepubertal vs postpubertal developmental differences in the association between maltreatment and amygdala response to threatening or salient stimuli exist. Understanding the role of adversity in different sensitive exposure periods and the potential adaptive significance of attenuated vs enhanced amygdala response may help explain why maltreatment may be a risk factor for many different disorders and foster creation of targeted interventions to preempt the emergence of psychopathology in at-risk youths.