Dorsolateral Prefrontal Cortex Activation During Emotional Anticipation and Neuropsychological Performance in Posttraumatic Stress Disorder
Dorsolateral Prefrontal Cortex Activation During Emotional Anticipation and Neuropsychological Performance in Posttraumatic Stress Disorder
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DOI：
10.1001/archgenpsychiatry.2011.1539
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发表时间：
2012-04-01
影响因子：
--
通讯作者：
Stein, Murray B.
中科院分区：
文献类型：
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作者：
Aupperle, Robin L.;Allard, Carolyn B.;Stein, Murray B.
背景：创伤后应激障碍(PTSD)与执行或注意力障碍以及情绪处理问题有关。然而，目前尚不清楚这两个功能障碍领域是否与共同或不同的神经生理基础有关。目的：检验以下假设：PTSD患者更严重的神经心理损害与情绪预期过程中前额叶-皮质下网络更严重的破坏有关。设计：病例对照、横断面研究。地点：普通社区、医院和社区精神科诊所。参与者：37名与亲密伴侣暴力有关的PTSD女性志愿者样本和34名年龄相当的健康对照组女性。主要观察指标：我们使用功能磁共振成像(FMRI)来检查在预期负面和积极情绪图像时的神经反应。临床医生使用的创伤后应激障碍量表用来描述创伤后应激障碍症状的严重程度。采用韦氏成人智力量表第三版、数字符号测验、Delis-Kaplan执行功能系统颜色-文字干扰测验和威斯康星卡片分类测验进行神经心理测试。结果：创伤后应激障碍患者在复杂视觉运动加工速度(数字符号测验)和执行功能(颜色-文字干扰抑制/转换分测验)方面的成绩均低于对照组。创伤后应激障碍与更大的前脑岛和在情绪预期中减弱的外侧前额叶皮质(PFC)的激活有关。较大的背外侧PFC激活(对负面图像的预期减去对正面图像的预期)与较低的创伤后应激障碍症状严重程度以及较好的视觉运动处理速度和执行功能相关。内侧PFC和杏仁核的激活与视觉运动加工速度较慢有关。结论：在情绪预期中，创伤后应激障碍女性在前岛表现出夸大的激活，该区域是监测身体内部状态的重要区域。PTSD患者在情绪预期期间较大的背外侧PFC反应可能反映了认知控制网络的参与，这有利于情绪和认知功能。新的治疗方法可能旨在加强认知控制(背外侧PFC)和情感处理(内侧PFC和杏仁核)网络之间的平衡，以改善PTSD患者的整体功能。
Context: Posttraumatic stress disorder (PTSD) has been associated with executive or attentional dysfunction and problems in emotion processing. However, it is unclear whether these two domains of dysfunction are related to common or distinct neurophysiological substrates.Objective: To examine the hypothesis that greater neuropsychological impairment in PTSD relates to greater disruption in prefrontal-subcortical networks during emotional anticipation.Design: Case-control, cross-sectional study.Setting: General community and hospital and community psychiatric clinics.Participants: Volunteer sample of 37 women with PTSD related to intimate partner violence and 34 age-comparable healthy control women.Main Outcome Measures: We used functional magnetic resonance imaging (fMRI) to examine neural responses during anticipation of negative and positive emotional images. The Clinician-Administered PTSD Scale was used to characterize PTSD symptom severity. The Wechsler Adult Intelligence Scale, Third Edition, Digit Symbol Test, Delis-Kaplan Executive Function System Color-Word Interference Test, and Wisconsin Card Sorting Test were used to characterize neuropsychological performance.Results: Women with PTSD performed worse on complex visuomotor processing speed (Digit Symbol Test) and executive function (Color-Word Interference Inhibition/Switching subtest) measures compared with control subjects. Posttraumatic stress disorder was associated with greater anterior insula and attenuated lateral prefrontal cortex (PFC) activation during emotional anticipation. Greater dorsolateral PFC activation (anticipation of negative images minus anticipation of positive images) was associated with lower PTSD symptom severity and better visuomotor processing speed and executive functioning. Greater medial PFC and amygdala activation related to slower visuomotor processing speed.Conclusions: During emotional anticipation, women with PTSD show exaggerated activation in the anterior insula, a region important for monitoring internal bodily state. Greater dorsolateral PFC response in PTSD patients during emotional anticipation may reflect engagement of cognitive control networks that are beneficial for emotional and cognitive functioning. Novel treatments could be aimed at strengthening the balance between cognitive control (dorsolateral PFC) and affective processing (medial PFC and amygdala) networks to improve overall functioning for PTSD patients.