Brain and Mental Health RECOVERY

大脑和心理健康恢复

• 批准号: 8630625
• 负责人: K. Luan Phan
• 金额: --
• 依托单位: JESSE BROWN VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-10-01 至 2017-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8630625
• 关键词: Address; Affect; Afghanistan; Anger; Attention; Attenuated; Base of the Brain; Brain; Brain imaging; Clinical; Clinical assessments; Cognitive; Data; Disease; Disease remission; Electroencephalography; Emotions; Etiology; Event-Related Potentials; Exhibits; Face; Failure; Fright; Functional Magnetic Resonance Imaging; Functional disorder; Goals; Health; Image; Imaging Techniques; Intervention; Iraq; Knowledge; Life; Light; Longitudinal Studies; Maintenance; Measures; Medial; Mediating; Mediator of activation protein; Mental Health; Metric; Neuropsychological Tests; Outcome; Outpatients; Pathologic Processes; Patients; Pattern; Perception; Performance; Pharmacological Treatment; Positron-Emission Tomography; Post-Traumatic Stress Disorders; Primary Prevention; Process; Proxy; Publishing; Recovery; Regulation; Research; Sampling; Scanning; Secondary Prevention; Signal Transduction; Social support; Soldier; Stimulus; Stress; Symptoms; Techniques; Therapeutic Intervention; Time; Translations; Trauma; Veterans; Vietnam; War; Work; affective neuroscience; base; clinically relevant; cognitive neuroscience; combat; emotion regulation; frontal lobe; improved; innovation; meetings; neuroimaging; neuromechanism; neurophysiology; prospective; psychologic; psychosocial; public health relevance; relating to nervous system; resilience; response; social; stressor

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.

描述（由申请人提供）： 创伤后应激障碍 (PTSD) 是一个主要的公众和退伍军人事务部健康问题，给从阿富汗和伊拉克部署返回的多达 20% 的士兵带来沉重负担。认知和情感神经科学方法的证据表明，恐惧处理和情绪调节过程中的内侧额叶皮层（MFC）功能障碍是 PTSD 病理生理学的核心。然而，这些证据大部分来自对几十年前战场上的老年退伍军人的研究，以及相对昂贵且临床环境转化有限的脑成像技术。对于从该疾病中恢复所涉及的神经机制知之甚少。本申请的总体目标是通过使用事件相关电位（ERP）的脑电图（EEG）测量来推进大脑功能研究的替代方法，这是一种可以在“现实世界”中部署的便携式技术办公室环境，并提供可靠的时间锁定刺激神经反应指标。我们最近的大部分工作都集中在MFC ERP上，它反映了神经对威胁/危险的社会信号的反应，以及在认知过程中的神经参与，通过重新评估策略对负面情绪进行意志调节——与避免威胁/危险和失调的情绪密切相关的过程，这是创伤后应激障碍。拟议的前瞻性、自然纵向研究将评估和跟踪两项经过验证的 ERP 任务期间的临床状态、轨迹和大脑功能，涉及患有 PTSD 的退伍军人 (n=120) 的威胁处理和情绪调节，这些 PTSD 与他们在部署期间的战斗创伤和退伍军人有关。 n = 60）具有相似的战斗暴露水平，但没有发展为创伤后应激障碍（CEC）。此外，将在研究开始时、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 的持续或恢复。 ERP 成像也将在研究开始时、6 个月和一年后进行，以实现 4 个目标：1）与研究开始时的 CEC 相比，表征 PTSD 患者在威胁感知和情绪调节过程中的神经生理功能； 2) 比较一年后持续性 PTSD 患者与康复患者和暴露于战斗中的对照组 (CEC) 的神经生理功能； 3) 将神经生理功能的变化与 PTSD 症状的变化联系起来； 4) 检查神经生理功能与 PTSD 症状之间假设关系的临床和心理社会调节因素和中介因素。这项研究的结果将为评估 PTSD 中威胁和情绪调节的社会信号的大脑机制提供新的线索，以及这种脑功能障碍与 PTSD 的维持和恢复的临床相关性。这些知识对于确定适当的大脑目标来指导当前的干预措施和创新新的干预措施至关重要，旨在对我们返回的士兵进行创伤后应激障碍的一级和二级预防。