Longitudinal MRI study of PTSD development from days to weeks after trauma

描述（由申请人提供）：创伤后应激障碍越来越被认为是一种常见的、致残的心理健康问题。神经影像学研究表明，PTSD与大脑功能和结构异常有关，但对这种异常的发展知之甚少。先进的神经可塑性研究表明，成年人的大脑能够动态地改变其功能和结构。基于这些证据，创伤后应激障碍可以被定义为一种对创伤的不适应。目前的研究将通过测试创伤性机动车碰撞（MVC）后最初几周的渐进式变化来检验这一观点。目前的假设是，在创伤后的最初几周内，患有PTSD和未患PTSD的幸存者的大脑功能和结构会发生不同的变化。在急诊科（ED）招募的MVC幸存者将进行纵向研究，从最初几天（最多2周）开始，并在MVC后约12周再次进行研究。在功能磁共振成像（fMRI）中，采用重评价情绪调节任务（Reappraisal emotion Regulation Task, ret）和转移注意情绪评价任务（shift -attention emotion evaluation Task， SEAT）研究PTSD患者负性情绪下调特征性缺陷的相关神经活动。此外，高分辨率结构MRI （sMRI）扫描将用于检查皮质厚度。在最初几天和第12周的扫描期间，与情绪任务相关的激活和皮层厚度的差异将用于定义这一时期的渐进式功能和结构变化。创伤后应激障碍和非创伤后应激障碍幸存者大脑进行性变化的组间差异将用于确定导致创伤后应激障碍的大脑功能和结构的差异。这项工作填补了当前创伤后应激障碍发展模型的重要空白，确定了区分创伤应激后自然恢复与导致创伤后应激障碍的适应不良恢复的因素。这些发现可以帮助开发早期干预措施来预防和治疗创伤后应激障碍。从MVC幸存者中收集了初步数据，这些幸存者在MVC发生后的几天（9 - 4天）和12周内进行了扫描。初步结果表明，在创伤暴露组的头几周内，额叶和颞叶皮质厚度发生了变化，而在无创伤的对照组中，在相当的时间间隔内没有变化。与情绪处理相关的大脑激活在左前额叶和视觉皮层增加，但在左边缘上回和副海马体减少。这些初步结果提供了这一时期包括FC区域在内的几个大脑区域功能和结构变化的初步迹象。提出的研究扩展了这项工作。

DESCRIPTION (provided by applicant): PTSD is increasingly recognized as a common, disabling mental health problem after trauma. Neuroimaging studies suggest that PTSD is related to abnormal brain function and structure, but the development of such abnormalities is poorly understood. Advanced neuroplasticity research demonstrates that the adult brain is capable of dynamically altering its function and structure. Based on this evidence, PTSD can be conceptualized as a form of maladaptation to trauma. The current study will examine this idea by testing for progressive changes during the initial weeks after a traumatic motor vehicle collision (MVC). The working hypothesis is that brain function and structure in survivors who do and in survivors who do not develop PTSD will change differently during the early post-trauma weeks. Survivors of MVCs recruited at the Emergency Department (ED) will be longitudinally studied, starting within the initial days (up to 2 weeks) and again at approximately 12 weeks after the MVC. Neural activity associated with characteristic deficits in down-regulation of negative emotion in PTSD patients will be studied using a Reappraisal Emotion Regulation Task (RERT) and a Shifted-attention Emotion Appraisal Task (SEAT) during functional magnetic resonance imaging (fMRI). In addition, high-resolution structural MRI (sMRI) scans will be used to examine cortical thickness. The differences in activation associated with emotional tasks and in cortical thickness between scan sessions at initial days and 12 weeks will be used to define progressive functional and structural changes over this period. Group differences in progressive brain changes in PTSD and non-PTSD survivors will be used to identify differences in brain function and structure that contribute to PTSD. The proposed work fills an important gap in current models of PTSD development by identifying factors that differentiate a natural recovery following traumatic stress from a maladaptive recovery that leads to PTSD. The findings can help develop early interventions to prevent and treat PTSD. Preliminary data have been collected from MVC survivors scanned within days (9¿4 days) and 12 weeks after an MVC. Preliminary results suggest that cortical thickness in frontal and temporal cortices changed over the initial weeks in trauma exposed groups, but not in trauma free controls over a comparable time interval. Brain activation associated with emotional processing increased in left prefrontal and visual cortices, but decreased in left supramarginal gyrus and parahippocampus. These preliminary results provide initial indications of functional and structural changes over this perid in several brain areas, including FC regions. The proposed research extends this work.