Acute Neurocognitive-affective Predictors of Chronic Post-trauma Outcomes

慢性创伤后结果的急性神经认知情感预测因子

• 批准号: 9279251
• 负责人: Christine L Larson
• 金额: $ 68.49万
• 依托单位: UNIVERSITY OF WISCONSIN MILWAUKEE
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-08-01 至 2020-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9279251
• 关键词: Acute; Address; Affective; Alcohol or Other Drugs use; Attention; Basic Science; Behavior; Chronic; Clinical; Cognitive; Data; Dimensions; Distress; Early Intervention; Early identification; Emotions; Event; Exhibits; Exposure to; Extinction (Psychology); Fright; Functional disorder; Goals; Health; Impairment; Individual; Intervention; Knowledge; Light; Link; Maps; Measures; Mental Depression; Mental disorders; Mission; Modeling; National Institute of Mental Health; Nature; Neurobiology; Neurocognitive; Outcome; Outcomes Research; Pathology; Patient Self-Report; Patients; Physiology; Plant Roots; Population; Post-Traumatic Stress Disorders; Predictive Factor; Process; Process Assessment; Process Measure; Public Health; Quality of life; Recruitment Activity; Research; Research Domain Criteria; Rest; Risk; Risk Factors; Sampling; Scanning; Sensitivity and Specificity; Services; Severities; Symptoms; Syndrome; Thinking; Translating; Trauma; United States; Veins; Wisconsin; Work; affective neuroscience; anxiety symptoms; attentional bias; attentional control; base; cognitive neuroscience; conditioned fear; emotion regulation; indexing; innovation; medical schools; neural circuit; neural recruitment; neuroimaging; neuromechanism; novel; outcome forecast; patient population; post-traumatic stress; public health relevance; relating to nervous system; stress symptom; suicidal risk; trauma centers; trauma symptom; traumatic event

 DESCRIPTION (provided by applicant): Trauma exposure is extremely common and increases risk for a host of negative health outcomes, most notably posttraumatic stress disorder (PTSD). Given the potential harmful sequelae of trauma exposure, it is crucial to identify acute post-trauma risk factors that predict chronic PTSD and other poor post-trauma outcomes. While some progress has been made in this effort, attempts to identify recently traumatized individuals at risk for poor long-term post-trauma adjustment have proven difficult. In this project we aim to identify predictors of both acute and chronic posttrauma symptoms, and more importantly, identify acute post-trauma measures that predict chronic PTSD, as well as other syndromes including depression and substance use problems. We will assess the predictive utility of three processes that are 1) rooted in basic cognitive and affective neuroscience, 2) articulated in the RDoC matrix, 3) map directly onto established interventions, and 4) show promise in our preliminary data. Leveraging our unique access to the large patient population in the Level 1 trauma service at the Medical College of Wisconsin, we will conduct multi-level (neural circuits, physiology, behavior, self-report) longitudinal assessments of posttrauma and other symptoms, and RDoC-based predictors of these symptoms. Within two weeks of trauma exposure we will assess RDoC-based indices of processes hypothesized to in- crease posttraumatic stress symptoms, including extinction and retention of extinction of conditioned fear (Acute Threat/Fear, Sustained Threat), impaired filtering of threat (Attentional Control), and attentional bias to threat (Sustained Threat). At six months post-exposure we will again conduct multilevel assessments of these processes and measure symptoms of PTSD and other relevant syndromes. In addition to these two primary assessment points (both involving neuroimaging), we will also collect a battery indexing cognitive and affective functioning and symptom severity at multiple points up to 24 months post-exposure. We will scan 220 individuals, oversampled for acute posttrauma symptoms, at 2 weeks with the goal of a final six-month sample of 200, and a final 24-month sample of 150. We hypothesize that acute impairments in fear extinction, extinction- related plasticity (changes in resting state functional connectivity from before to after extinction), attentional filtering, and attentional bias will preict elevated PTSD symptoms six to twenty-four months post-exposure. This work offers several key innovations: 1) longitudinal multi-level assessment of acutely traumatized patients, 2) the use of neural measures to predict long-term outcomes, 3) the use of a novel paradigm to assess extinction-induced plasticity, and 4) the combination of extinction and attention, two core mechanisms hypothesized to increase risk for PTSD, in the same sample. We expect this project to further the NIMH mission through the use of RDoC indices grounded in basic science, translated to clinical indicators, and directly linked to empirically-determined interventions. Findings from this work will provide new knowledge aiding early identification of trauma-exposed individuals most-at risk for chronic PTSD, and potentially targets for early intervention.

 描述（由申请人提供）：创伤暴露极为常见，会增加一系列负面健康结果的风险，尤其是创伤后应激障碍（PTSD）。鉴于创伤暴露可能产生有害后遗症，识别急性创伤后至关重要。预测慢性创伤后应激障碍（PTSD）和其他不良创伤后结果的风险因素虽然在这项工作中取得了一些进展，但事实证明，在这个项目中，我们的目标是确定近期遭受创伤的个体面临长期创伤后调整不良的风险。识别急性和慢性创伤后症状的预测因素，更重要的是，确定预测慢性创伤后应激障碍以及其他综合症（包括抑郁症和药物使用问题）的急性创伤后措施，我们将评估以下三个过程的预测效用：1）根源。在基础认知和情感神经科学中，2）在 RDoC 矩阵中阐明，3）直接映射到既定的干预措施，4）利用我们在 1 级创伤服务中接触大量患者群体的独特途径，显示出希望。威斯康星医学院，我们将对创伤后和其他症状进行多层次（神经回路、生理学、行为、自我报告）纵向评估，并在创伤暴露后两周内对这些症状进行基于 RDoC 的预测。为增加创伤后应激症状而开发的基于过程的指数，包括条件性恐惧的消退和消退保留（急性威胁/恐惧、持续威胁）、威胁过滤受损（注意控制）和注意偏差暴露后六个月，我们将再次对这些过程进行多层次评估，并测量 PTSD 和其他相关综合症的症状。除了这两个主要评估点（均涉及神经影像学）外，我们还将收集这些信息。在暴露后长达 24 个月的多个时间点对认知和情感功能以及症状严重程度进行索引的电池我们将在 2 周内对 220 人进行扫描，对急性创伤后症状进行过采样，以得出最终结果。六个月的样本为 200 个，最终的 24 个月样本为 150 个。我们捕捉到了恐惧消退、消退相关可塑性（静息状态功能的变化）的严重损伤。 这项工作提供了几项关键创新：1）对严重创伤患者进行纵向多层次评估，2）。使用神经测量来预测长期结果，3）使用一种新的范式来评估消退引起的可塑性，4）消退和注意力的结合，这是探索增加 PTSD 风险的两个核心机制。我们期望该项目通过使用基于基础科学的 RDoC 指数、转化为临床指标并与经验确定的干预措施直接联系来进一步推进 NIMH 的使命。这项工作的结果将提供有助于早期识别的新知识。遭受创伤的个体最容易患慢性创伤后应激障碍，也是早期干预的潜在目标。