Pediatric maltreatment-related PTSD: Psychobiology

描述（由申请人提供）：这个职业中期研究者奖在以病人为导向的研究（K24）应用程序是在响应程序公告（PA-99-133）“职业发展奖：虐待儿童和虐待儿童的研究。“儿童虐待相关的PTSD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。在发展创伤学以前的工作的基础上，这个K24的目的是调查有效的创伤后应激障碍治疗性虐待儿童的心理生物学。职业发展计划的目标是：1）发展循证心理治疗方面的专业知识，即，认知行为疗法（CBT）和联合心理药理学干预虐待儿童创伤后应激障碍，2）进一步发展和认知神经科学的候选人的知识，强调整合和翻译的脑成像测量，因为它涉及到神经诊断评估和治疗，第三章增加候选人在治疗开发（包括高级研究）的相关临床试验的实施和设计方面的实践和经验知识进行纵向研究和临床试验的设计、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，强调本研究翻译部分的知识传播。该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记。该研究计划的目的是一项CBT治疗研究，使用非侵入性生物标志物（24小时尿皮质醇和儿茶酚胺浓度，内侧前额叶皮质基于MRS的大脑NAA浓度，以及神经心理功能的测量），在前后设计中调查30名6至12岁的性虐待儿童的PTSD发病机制。还提出了在创伤集中的CBT +舍曲林和CBT +安慰剂中探索这些生物标志物。

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.