Brain and Mental Health RECOVERY

大脑和心理健康恢复

• 批准号: 8774109
• 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/8774109
• 关键词: Address; Affect; Afghanistan; Anger; 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; 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; cognitive reappraisal; combat; emotion regulation; frontal lobe; improved; innovation; meetings; neural correlate; neuroimaging; neuromechanism; neurophysiology; prospective; psychologic; psychosocial; public health relevance; relating to nervous system; resilience; response; social; stressor; sustained attention

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）是主要的公众和VA健康问题，对多达20％的士兵在阿富汗和伊拉克的部署中造成了重大负担。认知和情感神经科学方法的证据表明，在PTSD的病理生理学中，恐惧处理和情绪调节期间的内侧额叶皮层（MFC）功能障碍至关重要。但是，这些证据中的许多证据来自几十年前对战斗剧院的老年退伍军人的研究，以及脑成像技术的研究相对较贵，转化为临床环境，这些技术相对昂贵。关于从该疾病中恢复的神经机制知之甚少。本应用的总体目标是通过使用脑电图（EEG）的事件相关电位（ERP）的措施来推进研究大脑功能的替代方法，这是一种便携式技术，可以在“现实世界”办公室设置中部署并提供时间锁定的刺激性神经反应群集，这些刺激性神经反应是可靠的。我们最近的大部分工作都集中在MFC ERP上，反映了对社会信号的神经反应性，即在认知能力，自愿性调控通过重新评估策略对负面影响的社会信号 - 与避免威胁/危险和失调的情感紧密相关的过程，PTSD的标志性症状紧密相关。提出的前瞻性自然主义纵向研究将在两个经过验证的ERP任务中评估并遵循临床状况，轨迹和大脑功能，其中涉及与PTSD（n = 120）的退伍军人的威胁处理和情绪调节，与他们在部署期间的战斗创伤和在退伍军人（n = 60）（n = 60）相关的战斗创伤（n = 120）（n = 60）中没有相似的战斗曝光水平。此外，将在6个月后及12个月后进行研究入门时进行全面的临床评估，包括对治疗的密切跟踪，以确定PTSD的持久性或恢复性。 ERP成像也将在6个月和一年后的入口中进行4个目标：1）与研究入学时CEC相比，在威胁感知和PTSD患者的情绪调节过程中，在威胁感知和情绪调节过程中表征了神经生理功能； 2）一年后，比较了持续性PTSD患者的神经生理功能和康复和战斗暴露对照的患者（CEC）； 3）将神经生理功能的变化与PTSD症状的变化相关联； 4）检查神经生理功能与PTSD症状学之间假设关系的临床和社会心理主持人以及介体。这项研究的结果将为鉴定PTSD中威胁和情绪调节的社会信号的脑部机制以及该大脑功能障碍与PTSD的维持和恢复的临床相关性。这种知识对于确定适当的大脑目标至关重要，以指导当前的干预措施和创新新干预措施，这是针对我们返回的士兵中PTSD的主要和次要预防的新干预措施。