Neurophysiology Markers of PTSD's Presence, Severity, and Therapy Outcome

创伤后应激障碍(PTSD)，一种慢性致残性焦虑症，由暴露于 创伤性事件与行为以及社会和职业功能的显著缺陷有关。 美国(美国)退伍军人患创伤后应激障碍的风险很高，终生患病率 越南退伍军人估计占19%，而在OEF/OIF士兵和退伍军人中，约17% 伊拉克战争中的现役士兵和25%的预备役士兵符合创伤后应激障碍的标准。 目前诊断和管理创伤后应激障碍的做法主要依赖于 临床医生以及患者自我报告。一种独立的、客观的、基于神经生理学的方法 直接评估大脑功能是不可用的，但对于改善脑部疾病的诊断和治疗是非常必要的 创伤后应激障碍。美国国家科学院医学研究所的建议强调了这一需求 (IOM-NAS)，对目前的创伤后应激障碍的诊断和治疗进行了全面评估 方法，并找出当前诊断和治疗技术的潜在缺陷。一位少校 国际移民组织-国家行动组的建议是，迫切需要开发更精确和 客观诊断创伤后应激障碍及其严重程度，客观、快速地评估治疗效果，以及 能够预测谁可能有复发的风险。 解决开发诊断创伤后应激障碍的客观方法、确定其严重程度的迫切需要 水平，并潜在地预测治疗反应，我们建议测试新的生物标记物，这些标记物基于 睡眠期间大脑皮层各区域之间连贯活动的测量。这项测试的选择 睡眠状况(睡眠)是由患有睡眠障碍的人中异常普遍的睡眠障碍引起的 创伤后应激障碍，以至于一些人假设睡眠障碍是这种疾病的一个显著特征。在……里面 退伍军人单纯创伤后应激障碍(n=38)、单纯脑外伤(n=30)睡眠脑电的初步研究 创伤后应激障碍合并脑外伤组(n=25)，无创伤后应激障碍或脑外伤对照组(n=38)，我们发现一组神经标记物 对创伤后应激障碍的存在高度敏感/特异，并对症状的严重性高度敏感 创伤后应激障碍组。该项目的总体目标是在以下方面验证这一新的神经生理学标记：(1) 回溯性研究，分析将应用于现有的健康相关大型数据库(n=656 患有创伤后应激障碍的退伍军人的生活质量和功能结果测量，以及睡眠脑电记录 仅限于，仅有创伤后应激障碍，既有创伤后应激障碍，又有创伤后应激障碍，仅有抑郁(没有创伤后应激障碍或脑外伤)，对照组(没有创伤后应激障碍， 脑损伤、抑郁、睡眠呼吸暂停)，(2)有创伤后应激障碍的前瞻性研究1(n=10)和对照(n=10) 使用密集阵列评估神经标记物性能的潜在改进(通道) 脑电蒙太奇，和(3)接受心理治疗的退伍军人队列(n=50)的前瞻性研究2，其中 我们将评估神经标记物对创伤后应激障碍症状和其他功能改善的敏感性。 和健康相关的生活质量测量，以回应心理治疗。

Post-traumatic stress disorder (PTSD), a chronic and disabling anxiety disorder that results from exposure to a traumatic event, is associated with marked deficits in behavioral as well as social and occupational functioning. United States (U.S.) military Veterans’ risk of developing PTSD is high, lifetime prevalence of PTSD among Vietnam Veterans is estimated at 19%, while among OEF/OIF soldiers and Veterans, approximately 17% of active duty soldiers and 25% of reserve soldiers from the Iraq war met criteria for PTSD. Current practice for diagnosing and managing PTSD relies primarily on subjective clinical assessments by clinicians as well as patient self-report. An independent, objective and neuro-physiology based method for directly assessing brain function is not available, but is much needed to improve diagnosis and management of PTSD. This need is highlighted by recommendations from the Institute of Medicine, National Academy of Science (IOM-NAS), which conducted a comprehensive assessment of the current PTSD diagnosis and treatment methods and identified potential shortcomings of current diagnostic and treatment techniques. A major recommendation by the IOM-NAS was the urgent need for development of methods for more precise and objective diagnosis of PTSD and its severity level, objective and faster evaluation of treatment efficacy, and ability to predict who might be at risk of relapse. To address the critical need for developing objective methods for diagnosis of PTSD, determining its severity level, and potentially predicting treatment response, we propose to test novel biomarkers which are based on measures of coherent activity among the regions of cerebral cortex during sleep. The selection of this test condition (sleep) was motivated by the extraordinarily high prevalence of sleep disturbances in individuals with PTSD, so much so that some have postulated that sleep disturbances are a hallmark feature of the disorder. In preliminary studies on EEG acquired during sleep from Veterans with PTSD alone (n=38), TBI alone (n=30), PTSD and TBI (n=25), and no PTSD or TBI control group (n=38), we have shown that a set of neuromarkers were highly sensitive/specific to the presence of PTSD, and highly sensitive to the severity of symptoms in PTSD group. The overall goal of this Merit project is to validate this novel neurophysiology marker in: (1) retrospective study, where the analyses will be applied to a large existing database (n=656) of health-related quality of life and functional outcome measures, as well as sleep EEG recordings, from Veterans with PTSD only, with TBI only, with both PTSD and TBI, with depression only ( no PTSD or TBI), and controls (no PTSD, TBI, Depression, Sleep Apnea), (2) prospective study 1 with PTSD (n=10) and control (n=10) where we will evaluate potential improvement on the performance of the neuromarkers using a dense array (64 channel) EEG montage , and (3) prospective study 2 in a cohort (n=50) of Veterans undergoing psychotherapy, where we will evaluate the sensitivity of neuromarkers to the improvements in PTSD symptoms, and other functional and health related quality of life measures, in response to psychotherapy.