Nutt David J, Malizia Andrea L
Psychopharmacology Unit, University of Bristol,Bristol, United Kingdom.
J Clin Psychiatry. 2004;65 Suppl 1:11-7.
Posttraumatic stress disorder (PTSD) is a highly disabling condition that is associated with intrusive recollections of a traumatic event, hyperarousal, avoidance of clues associated with the trauma, and psychological numbing. The field of neuroimaging has made tremendous advances in the past decade and has contributed greatly to our understanding of the physiology of fear and the pathophysiology of PTSD. Neuroimaging studies have demonstrated significant neurobiologic changes in PTSD. There appear to be 3 areas of the brain that are different in patients with PTSD compared with those in control subjects: the hippocampus, the amygdala, and the medial frontal cortex. The amygdala appears to be hyperreactive to trauma-related stimuli. The hallmark symptoms of PTSD, including exaggerated startle response and flashbacks, may be related to a failure of higher brain regions (i.e., the hippocampus and the medial frontal cortex) to dampen the exaggerated symptoms of arousal and distress that are mediated through the amygdala in response to reminders of the traumatic event. The findings of structural and functional neuroimaging studies of PTSD are reviewed as they relate to our current understanding of the pathophysiology of this disorder.
创伤后应激障碍（PTSD）是一种严重致残的疾病，与创伤事件的侵入性回忆、过度觉醒、回避与创伤相关的线索以及心理麻木有关。在过去十年中，神经影像学领域取得了巨大进展，极大地促进了我们对恐惧生理学和PTSD病理生理学的理解。神经影像学研究已证实PTSD存在显著的神经生物学变化。与对照受试者相比，PTSD患者的大脑似乎有3个区域存在差异：海马体、杏仁核和内侧前额叶皮质。杏仁核对与创伤相关的刺激似乎反应过度。PTSD的标志性症状，包括夸张的惊吓反应和闪回，可能与大脑高级区域（即海马体和内侧前额叶皮质）无法抑制由杏仁核介导的、因创伤事件提示而产生的过度觉醒和痛苦症状有关。本文综述了PTSD的结构和功能神经影像学研究结果，以及它们与我们目前对该疾病病理生理学的理解之间的关系。
