Acute Neurocognitive-affective Predictors of Chronic Post-trauma Outcomes

慢性创伤后结果的急性神经认知情感预测因子

• 批准号: 9118338
• 负责人: Christine L Larson
• 金额: $ 65.92万
• 依托单位: UNIVERSITY OF WISCONSIN MILWAUKEE
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-08-01 至 2020-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9118338
• 关键词: Acute; Address; Affective; Alcohol or Other Drugs use; Attention; Basic Science; Chronic; Clinical; Cognitive; Data; Distress; Early Intervention; Early identification; Emotions; Event; Exhibits; Exposure to; Extinction (Psychology); Fright; Functional disorder; Goals; Health; Impairment; Individual; Intervention; Knowledge; Light; Link; Maps; Measures; Mental Depression; Mission; Modeling; National Institute of Mental Health; Nature; Neurobiology; Neurocognitive; Outcome; Outcomes Research; Pathology; Patients; Physiology; Plant Roots; Population; Post-Traumatic Stress Disorders; Process; Process Measure; Public Health; Quality of life; Recruitment Activity; Research; Research Domain Criteria; Rest; Risk; Risk Factors; Sampling; Scanning; Sensitivity and Specificity; Services; Severities; Symptoms; Syndrome; Thinking; Translating; Trauma; United States; Veins; Wisconsin; Work; affective neuroscience; anxiety symptoms; attentional bias; attentional control; base; cognitive neuroscience; conditioned fear; emotion regulation; indexing; innovation; medical schools; neural circuit; neuroimaging; neuromechanism; novel; outcome forecast; patient population; post-traumatic stress; relating to nervous system; self reported behavior; stress symptom; suicidal risk; trauma centers; trauma symptom; traumatic event

 DESCRIPTION (provided by applicant): Trauma exposure is extremely common and increases risk for a host of negative health outcomes, most notably posttraumatic stress disorder (PTSD). Given the potential harmful sequelae of trauma exposure, it is crucial to identify acute post-trauma risk factors that predict chronic PTSD and other poor post-trauma outcomes. While some progress has been made in this effort, attempts to identify recently traumatized individuals at risk for poor long-term post-trauma adjustment have proven difficult. In this project we aim to identify predictors of both acute and chronic posttrauma symptoms, and more importantly, identify acute post-trauma measures that predict chronic PTSD, as well as other syndromes including depression and substance use problems. We will assess the predictive utility of three processes that are 1) rooted in basic cognitive and affective neuroscience, 2) articulated in the RDoC matrix, 3) map directly onto established interventions, and 4) show promise in our preliminary data. Leveraging our unique access to the large patient population in the Level 1 trauma service at the Medical College of Wisconsin, we will conduct multi-level (neural circuits, physiology, behavior, self-report) longitudinal assessments of posttrauma and other symptoms, and RDoC-based predictors of these symptoms. Within two weeks of trauma exposure we will assess RDoC-based indices of processes hypothesized to in- crease posttraumatic stress symptoms, including extinction and retention of extinction of conditioned fear (Acute Threat/Fear, Sustained Threat), impaired filtering of threat (Attentional Control), and attentional bias to threat (Sustained Threat). At six months post-exposure we will again conduct multilevel assessments of these processes and measure symptoms of PTSD and other relevant syndromes. In addition to these two primary assessment points (both involving neuroimaging), we will also collect a battery indexing cognitive and affective functioning and symptom severity at multiple points up to 24 months post-exposure. We will scan 220 individuals, oversampled for acute posttrauma symptoms, at 2 weeks with the goal of a final six-month sample of 200, and a final 24-month sample of 150. We hypothesize that acute impairments in fear extinction, extinction- related plasticity (changes in resting state functional connectivity from before to after extinction), attentional filtering, and attentional bias will preict elevated PTSD symptoms six to twenty-four months post-exposure. This work offers several key innovations: 1) longitudinal multi-level assessment of acutely traumatized patients, 2) the use of neural measures to predict long-term outcomes, 3) the use of a novel paradigm to assess extinction-induced plasticity, and 4) the combination of extinction and attention, two core mechanisms hypothesized to increase risk for PTSD, in the same sample. We expect this project to further the NIMH mission through the use of RDoC indices grounded in basic science, translated to clinical indicators, and directly linked to empirically-determined interventions. Findings from this work will provide new knowledge aiding early identification of trauma-exposed individuals most-at risk for chronic PTSD, and potentially targets for early intervention.

 描述（由适用提供）：创伤暴露非常普遍，并增加了许多负面健康结果的风险，最著名的是创伤后应激障碍（PTSD）。鉴于创伤暴露的潜在有害后遗症，至关重要的是要鉴定出预测慢性PTSD和其他不良事后结果的急性创伤后风险因素。尽管在这项工作中取得了一些进展，但事实证明，试图确定近期创伤的人有差的长期创伤后调整风险的人很困难。在该项目中，我们旨在确定急性和慢性创伤后症状的预测因子，更重要的是，确定急性的创伤后测量值，这些测量值可以预测慢性PTSD，以及其他综合症，包括抑郁症和药物使用问题。我们将评估三个过程的预测效用1）植根于基本的认知和情感神经科学，2）在RDOC矩阵中阐明，3）直接映射到已建立的干预措施中，4）在我们的初步数据中表现出希望。利用我们在威斯康星州医学院1级创伤服务中与大型患者人群的独特接触，我们将对创伤后和其他症状的多层次（神经回路，生理学，行为，自我报告）纵向评估，以及这些症状的基于RDOC的预测指标。在暴露创伤的两周内，我们将评估基于RDOC的索引的折磨后压力症状的过程，包括扩展和保留条件恐惧的扩展（急性威胁/恐惧，持续威胁，持续威胁），威胁的过滤受损（注意力控制）（注意控制）和注意力偏见（持续威胁）（持续威胁）。暴露后六个月，我们将再次对PTSD和其他相关综合症的这些过程和测量症状进行多级评估。除了这两个主要的评估点（均涉及神经影像学）外，我们还将收集电池索引，以在暴露后24个月内多个点，在多个点下的认知和情感功能和症状严重程度。我们将在2周时扫描220个人，对急性创伤后症状进行了超采样，目的是进行最终的六个月样本，最终的24个月样本150个样本。我们假设我们假设恐惧延伸，延伸相关的可变性（静止状态功能的变化） 从前到延伸后的连通性），注意力偏置和注意力偏置将预测暴露后六至二十四个月的PTSD症状升高。这项工作提供了几项关键创新：1）对急性创伤患者的纵向多层次评估，2）使用神经元措施预测长期结局，3）使用新型范式来评估扩展诱导的可塑性，以及4）扩展和注意力的组合，两种核心机制可以增加对PTS的风险，以增加风险。我们希望该项目通过使用基础科学以基础科学为基础，转化为临床指标的RDOC指数来进一步实现NIMH任务，并与经验确定的干预措施直接相关。这项工作的发现将提供新的知识，以帮助早期识别出慢性PTSD风险的受创伤暴露的个体，并有可能实现早期干预的目标。