Non-Invasive Brain Stimulation for Post-Traumatic Stress Disorder

描述（由申请人提供）：参与战斗是一种可怕的经历，大大增加了患创伤后应激障碍（PTSD）的风险。虽然已经确定了几种有效的治疗PTSD的患者（高达50%）继续经历症状。事实上，与其他创伤经历引起的PTSD相比，与战斗有关的PTSD对现有治疗的反应更小。简而言之，慢性PTSD的治疗是不够的。 神经科学领域已经揭示，PTSD患者表现出几个大脑区域内的功能改变以及它们之间的相互作用;这些发现与慢性应激的动物模型一致。尽管有这些证据，现有的治疗方法通常不是使用这种神经解剖学知识设计的。这项研究的核心前提是，基于神经科学的信息可以用于开发更精确和有效的治疗方法。高清晰度经颅直流电刺激（HD-tDCS）将用于“纠正”功能失调的大脑区域（以及这些区域之间的通信），预计这种调制将导致症状改善。 提出的R21/R33的主要目标是验证适应不良的大脑网络，然后建立HD-tDCS调节这些网络（R21阶段）的证据。后期研究（R33期）将检查HD-tDCS和现有治疗的剂量-反应关系和协同效应。在这两个阶段，将使用多方法方法评估结果，包括使用静息状态功能磁共振成像数据的功能连接，神经心理学测试和情绪功能的自我报告测量。综合结果将为tDCS在PTSD中的正式临床试验提供重要的方法学、机制和实用信息。 最终，所提出的方法可以加强精神疾病治疗的开发和实施的根本转变，这些治疗具有共同的核心特征，这与NIMH的战略计划相一致，即使用行为维度和神经生物学措施对精神障碍进行分类和治疗。

DESCRIPTION (provided by applicant): Being involved in combat is a horrific experience that substantially increases the risk of developing posttraumatic stress disorder (PTSD). Although several effective treatments have been identified for PTSD a substantial number of patients (up to 50%) continue to experience symptoms. In fact, combat related PTSD is even less responsive to existing treatments than PTSD caused by other traumatic experiences. In short, the treatment for chronic PTSD is inadequate. The field of neuroscience has revealed that patients with PTSD demonstrate altered functioning within, and interactions between, several brain regions; findings that are consistent with animal models of chronic stress. Despite this evidence, existing treatments are generally not designed using this neuroanatomical knowledge. The central premise of the proposed study is that neuroscientifically-based information can be used to develop more precise and effective treatments. High definition transcranial direct current stimulation (HD-tDCS) will be used to "correct" the dysfunctional brain regions (and communication between these regions), with the expectation that this modulation will result in symptom improvement. The primary goals of the proposed R21/R33 are to verify the maladaptive brain networks and then establish evidence that HD-tDCS modulates these networks (R21 phase). Latter studies (R33 phase) will examine dose-response relationships and synergistic effects of HD-tDCS and existing treatments. In both phases, outcome will be assessed using a multi-method approach that includes functional connectivity using resting-state functional magnetic resonance imaging data, neuropsychological tests, and self-report measures of emotional functioning. The combined results will provide vital methodological, mechanistic, and practical information necessary for a formal clinical trial of tDCS in PTSD. Ultimately, the proposed approach could reinforce a fundamental shift in the development and implementation of treatments for mental illnesses that share common core features, which is consistent with the NIMH's Strategic Plans to classify and treat mental disorders using behavioral dimensions and neurobiological measures.