Pediatric maltreatment-related PTSD: Psychobiology

描述(由申请者提供)：这项以患者为中心的研究(K24)职业中期研究人员奖的申请是对计划宣布(PA-99-133)的回应：职业发展奖：儿童虐待和忽视研究。儿童虐待相关的创伤后应激障碍与生物应激系统失调、大脑发育不良和内侧前额叶皮质功能障碍有关。在发展创伤学以前工作的基础上，这本K24的目的是调查受性虐待儿童有效的创伤后应激障碍治疗的心理生物学。职业发展计划的目标是：1)培养循证心理社会治疗方面的专门知识，即认知行为疗法(CBT)和综合精神药理学干预措施，以治疗患有创伤后应激障碍的虐待儿童；2)加深候选人对发展和认知神经科学的知识，强调与神经诊断评估和治疗有关的脑成像测量的整合和转换；3)增加候选人在进行和设计治疗发展的相关临床试验方面的实践和经验知识，包括进行纵向研究和临床试验的高级研究设计、方法和统计方面，以及4)通过指导儿童虐待和忽视研究中的初级同事，强调这项研究的翻译部分的知识传播。这项研究计划与一项正在进行的研究有关，该研究使用脑成像来帮助阐明患有创伤后应激障碍的性虐待儿童的神经生物学标志。研究计划的目标是一项CBT治疗研究，使用非侵入性生物标记物(24小时尿皮质醇和儿茶酚胺浓度，基于MRS的大脑内侧前额叶皮质NAA浓度，以及神经心理功能指标)，在事前和后设计中调查30名6至12岁的性虐待儿童PTSD的发病机制。在创伤CBT+舍曲林和CBT+安慰剂中探索这些生物标志物也被提出。

DESCRIPTION (provided by applicant): This Midcareer Investigator Award in Patient-Oriented Research (K24) application is in response to program announcement (PA-99-133) "Career Development Awards: Child Abuse and Neglect Research." Pediatric maltreatment-related PTSD is associated with dysregulation of biological stress systems, adverse brain maturation, and medial prefrontal cortical dysfunction. Building on previous work in developmental traumatology, the aim of this K24 is to investigate the psychobiology of effective PTSD treatment for sexually-abused children. The objectives of the career development plan are to: 1) develop expertise in evidence-based psychosocial treatments i.e., cognitive behavioral therapy (CBT) and combined psychopharmacologic interventions for maltreated children with PTSD, 2) further the candidate's knowledge of developmental and cognitive neuroscience emphasizing the integration and translation of brain imaging measurement as it relates to neurodiagnostic assessment and treatment, 3) increase the candidate's practical and empirical knowledge in the conduct and design of relevant clinical trials for treatment development including advanced research design, methodology and statistical aspects of conducting longitudinal studies and clinical trials, and 4) emphasize knowledge dissemination of the translational components of this research by mentoring junior colleagues in child abuse and neglect research. The research plan is linked to an ongoing study using brain imaging to help elucidate neurobiological markers in sexually abused children with PTSD. The objective of the research plan is a CBT treatment study using non-invasive biological markers (24 hour urinary concentrations of cortisol and catecholamines, MRS-based brain NAA concentrations of medial prefrontal cortex, and measures of neuropsychological functioning), in a pre-post design to investigate the pathogenesis of PTSD in 30 sexually abused children, ages 6 to 12 years. Exploring these biological markers in trauma-focused CBT + Sertraline and CBT + placebo is also proposed.