PTSD and Depression in Parents of Children with Cancer

描述（由申请人提供）：此修订后的指导职业发展 申请概述了职业发展和研究计划，以研究 下丘脑-垂体-肾上腺（HPA）轴活性与 急性和慢性应激中海马的状态。研究对象将包括 最近被诊断出患有癌症的孩子的父母。该人群 独特的，因为有些人会发展创伤后应激障碍（PTSD），有些人会 不会，但所有人都会在他们出生的那一年里经历慢性压力。 随着他们的孩子接受积极的癌症治疗， 可能研究HPA轴的活动和海马的大小和形态， 与创伤后应激障碍状态和长期压力的关系。我已经有 学习、行为和焦虑的理论和应用背景。的 职业发展和研究计划旨在使我能够发展 在使用、分析和应用方面的熟练程度和专门知识 神经内分泌学测量人类的压力反应和神经成像， 解决这些反应的机制。我将开发并测试一个理论上的 一种研究早期结构和神经内分泌之间相互作用的模型 异常和随后的创伤经历的纵向设计。 导师包括：1）一位神经病学教授和一位神经成像主任 中心; 2）一个心理神经内分泌学家与特殊专业知识， 压力的心理生物学和3）医疗创伤专家的精神病学家 焦虑从课程的相关课程和实验室轮换 神经科学博士计划将完成，导师将指导体内 训练关于人类HPA轴失调的时间过程知之甚少 与极端压力有关虽然以前的研究 显示出较低的皮质醇和海马体积减少的个体， 慢性PTSD，没有人同时评估HPA状态和脑形态。 此外，研究受到经常进行的单一评估的限制， 几年后的突发创伤事件。这项建议旨在 研究即刻和长期HPA轴活动及其与 海马大小和形态在近期发生的创伤。巨蟹座父母（双方） 患有和不患有PTSD的患者将在癌症发生后1个月内进行评估 诊断，然后诊断后12个月a）PTSD，抑郁症和其他 B）异常神经内分泌活动（24小时尿皮质醇）和 c）海马大小和形态异常（通过磁共振成像）。 该研究将提供急需的HPA轴纵向数据， 海马异常的急性和慢性应激。

DESCRIPTION (provided by applicant): This revised Mentored Career Development application outlines a program of career development and research to study the relationship between hypothalamic-pituitary-adrenal (HPA) axis activity and hippocampal status in acute and chronic stress. Research subjects will consist of parents of children recently diagnosed with cancer. This population is unique because some will develop posttraumatic stress disorder (PTSD) and some will not, but all will undergo chronic stress during the year that they are followed as their child undergoes active cancer treatment Thus, it will be possible to study HPA-axis activity and hippocampal size and morphology in relation to PTSD status and chronic stress over time. I already have a theoretical and applied background in learning, behavior and anxiety. The career development and research plans are designed to enable me to develop proficiency and expertise in the use, analysis and application of neuroendocrinology to measure human stress responses and neuroimaging to address mechanisms of these responses. I will develop and test a theoretical model that examines the interaction between early structural and neuroendocrme abnormalities and subsequent traumatic experiences in a longitudinal design. Mentors include 1) a professor of neurology and director of a neuroimaging center; 2) a psychoneuroendocrinologist with special expertise in the psychobiology of stress and 3) a psychiatrist who is expert in medical trauma anxiety Relevant coursework and laboratory rotations from the curriculum of the Neuroscience Ph.D. program will be completed and mentors will direct in vivo training. Little is known about the time course of human HPA-axis dysregulation associated with exposure to extreme stress. Although previous studies have shown lower cortisol and hippocampal volume reductions in individuals with chronic PTSD, none have assessed HPA status and brain morphology concurrently. In addition, studies have been limited by single assessments often conducted years after the precipitating traumatic event. This proposal aims to investigate immediate and long-term HPA-axis activity and its relation to hippocampal size and morphology in recent-onset trauma. Cancer parents (both genders) with and without PTSD will be assessed within 1 month of the cancer diagnosis, then 12 months post-diagnosis for a) PTSD, depression, and other disorders); b) abnormal neuroendocrine activity (24-hour urinary cortisol) and c) abnormal hippocampal size and morphology (via Magnetic Resonance Imaging). The study will provide much-needed longitudinal data on HPA-axis and hippocampal abnormalities in acute and chronic stress.