Emotion Regulation Circuitries in Youth with Mild Traumatic Brain Injury.

轻度创伤性脑损伤青少年的情绪调节回路。

• 批准号: 10051423
• 负责人: Anthony P Kontos
• 金额: $ 65.58万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-12-19 至 2022-10-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10051423
• 关键词: Accounting; Acute; Adult; Age; Amygdaloid structure; Anxiety; Behavioral; Biological Markers; Brain; Brain Injuries; Childhood; Chronic; Clinical assessments; Collaborations; Data; Deltastab; Development; Diffusion; Disease; Early Diagnosis; Early Intervention; Emotional; Family; Family history of; Female; Functional Imaging; Functional Magnetic Resonance Imaging; Gender; Health; Image; Injury; International; Intervention; Knowledge; Lesion; Limbic System; Link; Literature; Measures; Mental Depression; Mental disorders; Mission; Mood Disorders; Moods; Morbidity - disease rate; Participant; Population; Post-Concussion Syndrome; Predictive Factor; Prognosis; Protocols documentation; Psychopathology; Public Health; Recording of previous events; Recurrence; Reporting; Research; Research Personnel; Resolution; Risk; Risk Factors; Scanning; Severities; Short-Term Memory; Sports; Structure; Symptoms; Techniques; Thick; Traumatic Brain Injury; United States National Institutes of Health; Visit; Youth; base; brain abnormalities; clinical risk; depressive symptoms; deviant; disability; emotion dysregulation; emotion regulation; emotional functioning; functional outcomes; gray matter; innovation; mild traumatic brain injury; multimodality; neural circuit; neurodevelopment; neuroimaging; neuromechanism; pediatric traumatic brain injury; prospective; psychiatric symptom; sex; social; white matter

ABSTRACT Psychiatric morbidity is one of the most common and socially disabling consequences in adults with mild traumatic brain injury (mTBI), yet poorly studied in youth. According to the International Collaboration in mTBI Prognosis, prediction of psychiatric morbidity in mTBI remains a challenge. Post-concussion symptoms are highly aspecific and significantly overlap with psychiatric symptoms. In fact, depression, anxiety, mood lability, and irritability are common after injury. Yet, a clear link between pathophysiologic mechanisms of mTBI and the subsequent onset of post-TBI psychiatric symptoms remains unclear. This relationship is of utmost importance in the study of developing brains, where brain lesions have the potential to mine the normative development of neural circuitries involved in emotional regulation. An imbalance in fronto-temporo-limbic systems has been proposed as a neural mechanism of emotional dysregulation in pediatric psychiatric disorders. Yet, no study has examined the relationship between fronto-temporo-limbic lesions and the onset of post-TBI psychiatric symptoms. The rational for the proposed research is that abnormalities in fronto-temporo- limbic regions in youth with mTBI might represent the structural basis for the vulnerability of emotional regulation circuitries, possibly leading to a heightened risk for post-TBI psychiatric morbidity. The objective of this application is to use multimodal neuroimaging techniques to characterize the brain structure and functioning of emotional regulation circuitries in 200 youth 1 week after injury. Five clinical assessments will define 1-year trajectories of depressive symptoms, anxiety, mood lability and irritability in each participant. Based on the extant literature and our preliminary findings, our overall hypothesis is that acute injury quantifiable with neuroimaging measures of brain structure and functioning predates the onset and course of post-TBI psychiatric symptoms in youth prospectively characterized for up to 1 year after injury. Specifically, this proposal aims to 1) examine if mTBI-related lesions in fronto-temporo-limbic regions predict the severity of post-TBI psychiatric symptoms 3 weeks after injury. This proposal also aims to 2) identify demographic and clinical risk factors predicting 1-year trajectories of post-TBI psychiatric symptoms. This approach is innovative because no study examined if mTBI- related lesions in emotional regulation circuitries relate to the acute onset of post-TBI psychiatric symptoms in youth with mTBI. The identification of 1-year trajectories of post-TBI psychiatric symptoms is also innovative and will allow to examine if the combined use of neuroimaging measures and clinical risk factors can help predict these symptoms up to 1-year after mTBI. Finally, by collecting a second scan in a subsample of youth (n=100) 6 months after mTBI, we will examine if neuroimaging measures at 6-month, more than neuroimaging measures at-injury, can help predict 1-year trajectories of post-TBI psychiatric symptoms. This contribution is anticipated to be significant because this strategy has the potential to identify a subset of youth at-risk for developing post-TBI psychiatric morbidity, who might benefit from early intervention strategies.

摘要 精神病发病率是轻度精神分裂症患者中最常见和社会致残的后果之一。 创伤性脑损伤（mTBI），但在年轻人中的研究很少。根据mTBI的国际合作， 预后，预测mTBI的精神病发病率仍然是一个挑战。脑震荡后的症状是 高度非特异性并与精神症状明显重叠实际上，抑郁，焦虑，情绪不稳定， 和易激惹是受伤后的常见现象。然而，mTBI的病理生理机制与 创伤性脑损伤后精神症状的后续发作仍不清楚。这种关系至关重要 在发育中的大脑研究的重要性，其中大脑病变有可能挖掘的规范 参与情绪调节的神经回路的发展。额颞叶边缘系统的不平衡 系统被认为是儿童精神病患者情绪失调的神经机制 紊乱然而，还没有研究探讨额颞叶边缘系统病变与脑卒中发病之间的关系。 创伤后精神症状提出这项研究的理由是，额颞叶的异常， mTBI青年的边缘区可能代表了情感脆弱性的结构基础， 调节电路，可能导致TBI后精神病发病率的风险增加。的目标 本申请是使用多模态神经成像技术来表征脑结构和功能， 200名青年伤后1周的情绪调节回路。5项临床评估将定义1年 每个参与者的抑郁症状、焦虑、情绪不稳定和易怒的轨迹。根据现存的 文献和我们的初步发现，我们的总体假设是，急性损伤可量化的神经影像学 脑结构和功能的测量早于TBI后精神症状的发作和病程， 青少年损伤后1年内的前瞻性特征。具体而言，本建议旨在：1）研究 额颞叶边缘区的mTBI相关病变可预测TBI后精神症状的严重程度3 受伤后的几周该提案还旨在2）确定预测1年死亡的人口统计学和临床风险因素 创伤后精神症状的轨迹这种方法是创新的，因为没有研究检查mTBI- 情绪调节回路中的相关病变与TBI后精神症状的急性发作有关， mTBI的年轻人TBI后精神症状的1年轨迹的识别也是创新的 并将允许检查神经影像学措施和临床风险因素的联合使用是否有帮助 预测mTBI后1年内的这些症状。最后，通过在年轻人的子样本中收集第二次扫描， （n=100）mTBI后6个月，我们将检查6个月时的神经影像学测量是否超过神经影像学测量。 损伤时的测量可以帮助预测TBI后精神症状的1年轨迹。这种贡献 预计将是重要的，因为这一战略有可能确定一个子集的青年风险， 发展后TBI精神病发病率，谁可能受益于早期干预策略。