Discrete and recurrent traumatization in PTSD: fear vs. anxious misery.
Discrete and recurrent traumatization in PTSD: fear vs. anxious misery.
复制标题
DOI：
10.1007/s10880-011-9252-5
复制
发表时间：
2011-06
影响因子：
2.2
通讯作者：
McTeague, Lisa M.
中科院分区：
文献类型：
--
作者：
Lang, Peter J.;McTeague, Lisa M.
As noted in a report from the VA National Center for PTSD (Consensus Conference Recommendations for Veteran Treatment of PTSD and Comorbid TBI: updated 2010):‘‘No screening instruments available can reliably make the diagnosis [of PTSD]; the gold standard remains an interview by a skilled clinician.’’That is, unlike for most medical disease entities, we currently do not have good quantitative, biological symptom measures that can help the clinician define the pathology of PTSD and assure reliable diagnosis, serve as efficient prognostic tools, and provide better targets for treatment. This circumstance is also true for the other anxiety and mood disorder diagnoses, many of which are frequently comorbid with PTSD. The above consideration has recently prompted a National Institute of Mental Health (NIMH) initiative—Research Domain Criteria (RDoC)(eg, Insel & Cuthbert, 2009; Sanislow et al., 2010)—to define for research purposes promising domains of study that are not constrained by traditional diagnostic categories. The aim is to develop measures that might serve as endophenotypes to better relate to emerging data in genetics and clinical neuroscience. Consistent with this program, we have undertaken psychophysiological study of the full range of anxiety spectrum disorders, evaluating reflex outputs from the brain’s fear/defense circuitry, and assessing a current sample of over 500 treatment-seeking anxiety patients and community controls (Lang & McTeague, 2009). These participants complete a structured clinical interview establishing DSM-IV diagnoses along with a battery of questionnaire measures. In a subsequent session emotional imagery of both standard arousing events and personally relevant fear memories are evoked and autonomic and somatic measures are recorded.Of particular interest in this assessment is the potentiated probe startle reflex evoked during imagery, a response readily measured by the magnitude of its first component—the eyeblink. Startle potentiation is mediated by the brain’s fear/defense circuit—as defined over several decades of infrahuman neuroscience research (eg, Kapp & Pascoe, 1986; Kapp, Pascoe, & Bixler, 1984; LeDoux, 1987; Sarter & Markowitsch, 1985). Circuit activation begins when the lateral and basolateral nuclei of the amygdala receive threat-relevant information from sensory/memory systems. These nuclei project to the amygdala’s central nucleus and the bed nucleus of the stria terminalis (a subregion of the extended amygdala), which in turn project to a variety of hypothalamic sites, the central gray, facial motor nucleus, and brainstem target areas, initiating a range of defensive reflexes that evolved to counter imminent threats to survival (cf. Lang & Davis, 2006). Importantly, the amygdala and bed nucleus of the stria terminals also project to the central pontine site of the startle circuit, increasing the magnitude of the startle reaction during threat/fear states (Davis, Walker, Miles, & Grillon, 2010). Startle reactions are elicited by any abrupt sensory stimulus, and serve as a primitive escape response in many species. In the case of human fear, recording the startle response to a brief acoustic probe (eg, 95 dB white noise) has provided a productive, cost-effective, and non-invasive measure of defensive neural activation.
登录
查看更多内容
在大鼠和人类中持续的恐惧：恐惧与焦虑中的杏仁核的作用。
DOI：
10.1038/npp.2009.109
发表时间：
2010-01
期刊：
Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology
影响因子：
--
作者：
通讯作者：
--
影响因子：
4.3
作者：
Hughes KC;Shin LM
通讯作者：
Shin LM
影响因子：
10.6
作者：
Norrholm, Seth D.;Jovanovic, Tanja;Olin, Ilana W.;Sands, Lauren A.;Karapanou, India;Bradley, Bekh;Ressler, Kerry J.
通讯作者：
Ressler, Kerry J.
影响因子：
4.6
作者：
Sanislow, Charles A.;Pine, Daniel S.;Cuthbert, Bruce N.
通讯作者：
Cuthbert, Bruce N.
影响因子：
10.6
作者：
McTeague, Lisa M.;Lang, Peter J.;Bradley, Margaret M.
通讯作者：
Bradley, Margaret M.