Brain and Mental Health RECOVERY

描述（由申请人提供）： 创伤后应激障碍（PTSD）是一个主要的公共和退伍军人健康问题，并施加了巨大的负担多达20%的士兵从部署在阿富汗和伊拉克返回。认知和情感神经科学方法的证据表明，内侧额叶皮层（MFC）功能障碍的恐惧处理和情绪调节是中央的PTSD的病理生理。然而，这些证据大部分来自几十年前对战斗剧院的老年退伍军人的研究，以及相对昂贵的大脑成像技术，这些技术在临床环境中的应用有限。人们对从这种疾病中恢复所涉及的神经机制知之甚少。本申请的首要目标是通过使用事件相关电位（ERP）的脑电图（EEG）测量来推进脑功能研究的替代方法，这是一种便携式技术，可以在“真实的世界”办公室环境中部署，并提供可靠的时间锁定刺激神经响应度量。我们最近的大部分工作都集中在MFC ERP上，反映了在认知过程中对威胁/危险的社会信号的神经反应以及通过重新评估策略对负面影响的意志调节过程中的神经参与-这些过程与避免威胁/危险和失调的影响密切相关，这是PTSD的标志性症状。拟议的前瞻性，自然主义纵向研究将评估和遵循的临床状态，轨迹和脑功能在两个验证ERP任务，涉及威胁处理和情绪调节的退伍军人与创伤后应激障碍（n=120）与他们的战斗创伤在部署期间和退伍军人（n=60）具有类似的战斗暴露水平谁没有发展创伤后应激障碍（CEC）。此外，将在研究入组时、6个月后和12个月后进行全面的临床评估，包括密切跟踪治疗，以确定PTSD的持续性或恢复情况。还将在入组时、6个月和1年后进行ERP成像，以解决4个目的：1）与研究入组时的CEC相比，表征PTSD患者在威胁感知和情绪调节期间的神经生理功能; 2）比较持续性PTSD患者和康复患者以及战斗暴露对照（CEC）的神经生理功能; 3）将神经生理功能的变化与PTSD病理学的变化联系起来; 4）检查神经生理功能和PTSD病理学之间假设关系的临床和心理社会调节剂和介导剂。这项研究的结果将揭示新的障碍，在评估社会信号的威胁和情绪调节PTSD和这种脑功能障碍的临床相关性PTSD的维护和恢复的大脑机制。这些知识对于确定适当的大脑目标以指导当前的干预措施和创新新的干预措施至关重要，旨在对我们归国士兵的PTSD进行初级和二级预防。

DESCRIPTION (provided by applicant): Posttraumatic stress disorder (PTSD) is a major public and VA health concern and exerts substantial burden on as many as 20% of soldiers returning from deployment in Afghanistan and Iraq. Evidence of cognitive and affective neuroscience approaches suggest that the medial frontal cortex (MFC) dysfunction during fear processing and emotion regulation is central in the pathophysiology of PTSD. However, much of this evidence comes from studies of older veterans from combat theaters from decades ago, and from brain imaging techniques that are relatively expensive with limited translation to clinical settings. Little is known about the neura mechanism involved in recovery from the disorder. The overarching goal of the present application is to advance an alternative approach to the study of brain function through the use of electroencephalography (EEG) measures of event-related potentials (ERP), a portable technique that can be deployed in the 'real world' office setting and provides time-locked stimulus neural response metrics that are reliable. Much of our recent work focuses on MFC ERPs reflecting neural reactivity to social signals of threat/danger and neural engagement during cognitive, volitional regulation of negative affect through reappraisal strategies - processes tightly related to avoidance of threat/danger and dysregulated affect, hallmark symptoms of PTSD. The proposed prospective, naturalistic longitudinal study will assess and follow the clinical status, trajectory and brain function during two validated ERP tasks involving threat processing and emotion regulation in veterans with PTSD (n=120) related to their combat trauma during deployment and in veterans (n=60) with similar levels of combat exposure who did not develop PTSD (CEC). Moreover, comprehensive clinical assessments, including close tracking of treatment, will be conducted at study entry, 6 months later and 12 months later to ascertain persistence of or recovery from PTSD. ERP imaging will also occur at entry, 6 months and one year later in order to address 4 Aims: 1) Characterize neurophysiological function during threat perception and emotion regulation in PTSD patients compared to CECs at study entry; 2) Compare neurophysiological function of patients with persistent PTSD and patients who recover and combat-exposed controls (CEC), one year later; 3) Relate change in neurophysiological function to change in PTSD symptomatology; and 4) Examine clinical and psychosocial moderators and mediators of the hypothesized relationship between neurophysiological function and PTSD symptomatology. The findings of this study will shed new light on the brain mechanisms underlying disturbances in appraising social signals of threat and emotion regulation in PTSD and the clinical relevance of this brain dysfunction to the maintenance of and recovery from PTSD. Such knowledge is critically important to identifying the appropriate brain targets to guide current interventions and innovating new interventions, aimed at primary and secondary prevention of PTSD in our returning soldiers.