Structural alterations in lateral prefrontal, parietal and posterior midline regions of men with chronic posttraumatic stress disorder
Structural alterations in lateral prefrontal, parietal and posterior midline regions of men with chronic posttraumatic stress disorder
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DOI：
10.1503/jpn.100010
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发表时间：
2011-05-01
影响因子：
4.3
通讯作者：
Kolassa, Iris-Tatjana
中科院分区：
文献类型：
--
作者：
Eckart, Cindy;Stoppel, Christian;Kolassa, Iris-Tatjana
背景资料：迄今为止，与创伤后应激障碍（PTSD）相关的神经网络主要涉及杏仁核、海马和内侧前额叶皮层。然而，越来越多的证据表明，超出这个网络的皮层区域也可能与PTSD的病理生理学有关。我们的目的是调查PTSD相关的结构改变在这些地区。方法：我们在研究中招募了高度创伤的难民，有和没有（创伤对照）创伤后应激障碍和非创伤对照。为了增加我们的结果的有效性，我们结合了自动皮质分割技术和基于体素的形态测量。结果：总共有39名难民（20名有PTSD，19名无PTSD）和13名对照参加了这项研究。参与者是中年男性，他们不含精神活性物质，几乎不喝酒。PTSD患者（以及较小程度的创伤对照组）的右下顶叶皮质、左额中喙皮质、双侧眶额外侧皮质和双侧扣带回峡部的体积减少。累积的创伤压力对扣带回峡部和外侧眶额皮质的影响表明，至少在这些地区，结构的改变可能与反复的压力经历。基于体素的形态学分析产生了很大程度上一致的结果，但由于信噪比较差，传统的统计学没有达到显著性。局限性：尽管我们控制了几个重要的混杂变量（例如，例如，在一个实施例中，性，酗酒）与我们的特定样本，这可能会限制我们的数据的普遍性。此外，在我们的研究中，PTSD和重性抑郁症的高共病率阻碍了这些疾病的明确分离。最后，关于外侧眶额皮质的结果应谨慎解释，因为该区域的磁共振成像采集受到一般信号丢失的影响。结论：我们的研究结果表明，外侧前额叶，顶叶和后中线结构在PTSD的病理生理。由于这些区域特别涉及情景记忆，情绪处理和执行控制，这可能对理解PTSD症状具有重要意义。
Background: So far, the neural network associated with posttraumatic stress disorder (PTSD) has been suggested to mainly involve the amygdala, hippocampus and medial prefrontal cortex. However, increasing evidence indicates that cortical regions extending beyond this network might also be implicated in the pathophysiology of PTSD. We aimed to investigate PTSD-related structural alterations in some of these regions. Methods: We enrolled highly traumatized refugees with and without (traumatized controls) PTSD and non traumatized controls in the study. To increase the validity of our results, we combined an automatic cortical parcellation technique and voxel-based morphometry. Results: In all, 39 refugees (20 with and 19 without PTSD) and 13 controls participated in the study. Participants were middle-aged men who were free of psychoactive substances and consumed little to no alcohol. Patients with PTSD (and to a lesser extent traumatized controls) showed reduced volumes in the right inferior parietal cortex, the left rostral middle frontal cortex, the bilateral lateral orbitofrontal cortex and the bilateral isthmus of the cingulate. An influence of cumulative traumatic stress on the isthmus of the cingulate and the lateral orbitofrontal cortex indicated that, at least in these regions, structural alterations might be associated with repeated stress experiences. Voxel-based morphometry analyses produced largely consistent results, but because of a poorer signal-to-noise ratio, conventional statistics did not reach significance. Limitations: Although we controlled for several important confounding variables (e. g., sex, alcohol abuse) with our particular sample, this might limit the generalizibility of our data. Moreover, high comorbidity of PTSD and major depression hinders a definite separation of these conditions in our findings. Finally, the results concerning the lateral orbitofrontal cortex should be interpreted with caution, as magnetic resonance imaging acquisition in this region is affected by a general signal loss. Conclusion: Our results indicate that lateral prefrontal, parietal and posterior midline structures are implicated in the pathophysiology of PTSD. As these regions are particularly involved in episodic memory, emotional processing and executive control, this might have important implications for the understanding of PTSD symptoms.