Nicholson Andrew A, Densmore Maria, Frewen Paul A, Théberge Jean, Neufeld Richard Wj, McKinnon Margaret C, Lanius Ruth A
Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
Lawson Health Research Institute, London, Ontario, Canada.
Neuropsychopharmacology. 2015 Sep;40(10):2317-26. doi: 10.1038/npp.2015.79. Epub 2015 Mar 19.
Previous studies point towards differential connectivity patterns among basolateral (BLA) and centromedial (CMA) amygdala regions in patients with posttraumatic stress disorder (PTSD) as compared with controls. Here we describe the first study to compare directly connectivity patterns of the BLA and CMA complexes between PTSD patients with and without the dissociative subtype (PTSD+DS and PTSD-DS, respectively). Amygdala connectivity to regulatory prefrontal regions and parietal regions involved in consciousness and proprioception were expected to differ between these two groups based on differential limbic regulation and behavioral symptoms. PTSD patients (n=49) with (n=13) and without (n=36) the dissociative subtype and age-matched healthy controls (n=40) underwent resting-state fMRI. Bilateral BLA and CMA connectivity patterns were compared using a seed-based approach via SPM Anatomy Toolbox. Among patients with PTSD, the PTSD+DS group exhibited greater amygdala functional connectivity to prefrontal regions involved in emotion regulation (bilateral BLA and left CMA to the middle frontal gyrus and bilateral CMA to the medial frontal gyrus) as compared with the PTSD-DS group. In addition, the PTSD+DS group showed greater amygdala connectivity to regions involved in consciousness, awareness, and proprioception-implicated in depersonalization and derealization (left BLA to superior parietal lobe and cerebellar culmen; left CMA to dorsal posterior cingulate and precuneus). Differences in amygdala complex connectivity to specific brain regions parallel the unique symptom profiles of the PTSD subgroups and point towards unique biological markers of the dissociative subtype of PTSD.
先前的研究表明，与对照组相比，创伤后应激障碍（PTSD）患者的基底外侧（BLA）和中央内侧（CMA）杏仁核区域之间存在不同的连接模式。在此，我们描述了第一项直接比较有解离亚型（分别为PTSD+DS和PTSD-DS）和无解离亚型的PTSD患者之间BLA和CMA复合体连接模式的研究。基于不同的边缘系统调节和行为症状，预计这两组患者杏仁核与参与意识和本体感觉的调节性前额叶区域及顶叶区域之间的连接会有所不同。49例PTSD患者（其中13例有解离亚型，36例无解离亚型）以及年龄匹配的40名健康对照者接受了静息态功能磁共振成像（fMRI）检查。通过基于种子点的方法，使用SPM解剖工具箱比较双侧BLA和CMA的连接模式。在PTSD患者中，与PTSD-DS组相比，PTSD+DS组杏仁核与参与情绪调节的前额叶区域（双侧BLA和左侧CMA与额中回，双侧CMA与额内侧回）的功能连接更强。此外，PTSD+DS组杏仁核与参与意识、觉知及本体感觉的区域（与人格解体和现实解体有关）的连接更强（左侧BLA与顶上叶和小脑山顶；左侧CMA与背侧后扣带回和楔前叶）。杏仁核复合体与特定脑区连接的差异与PTSD亚组独特的症状特征平行，指向PTSD解离亚型独特的生物学标志物。
