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儿童创伤后应激障碍中前额叶-杏仁核反常地参与对愤怒和快乐表情的反应

Paradoxical Prefrontal-Amygdala Recruitment to Angry and Happy Expressions in Pediatric Posttraumatic Stress Disorder.

作者信息

Keding Taylor J, Herringa Ryan J

机构信息

Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.

出版信息

Neuropsychopharmacology. 2016 Nov;41(12):2903-2912. doi: 10.1038/npp.2016.104. Epub 2016 Jun 22.

Abstract

The neural substrates of pediatric posttraumatic stress disorder (PTSD) remain incompletely understood, but likely involve abnormal function and development of emotion processing circuitry. Valence-specific and age-related abnormalities during emotion processing have not been elucidated. We examined implicit emotional face processing in pediatric PTSD, predicting abnormalities specific to threat-related emotion. Youth (ages 8-18 years) with PTSD (n=25) and healthy youth (n=28) completed a dynamic emotional face task during fMRI, viewing faces changing from neutral to angry or happy, or changing shape control. Group and cross-sectional age-related differences in activation and functional connectivity were examined in amygdala/hippocampus, medial prefrontal cortex (mPFC), and whole-brain analyses. The post hoc analyses examined the relationship of neural abnormalities with symptom measures of PTSD, anxiety, and depression. Compared with decreased activation with age in healthy youth, PTSD youth showed increased amygdala activation to emotional faces with age. In a group by emotion interaction, PTSD youth showed dorsal (d)ACC hyperactivation to happy faces relative to healthy youth, with no difference for angry faces. Connectivity analyses revealed paradoxical coupling in prefrontal-amygdala circuits, including dACC-dorsomedial (dm)PFC, amygdala-dmPFC, and amygdala-ventrolateral (vl)PFC. In each case, PTSD youth showed reduced connectivity to angry faces, but increased connectivity to happy faces, the reverse of healthy youth. Valence-abnormal recruitment was associated with greater symptom severity, implicating a role in trauma-related psychopathology in youth. Notably, impaired recruitment during angry faces and heightened recruitment to happy faces may reflect increased salience and ambiguity of positive emotional expressions in pediatric PTSD. Finally, age-related findings suggest a developmental sensitization of the amygdala across emotional expressions in youth with PTSD. These findings provide novel insights into the underlying pathophysiology of pediatric PTSD, extending beyond abnormal neural responses to canonical threat.

摘要

儿童创伤后应激障碍(PTSD)的神经基础尚未完全明确,但可能涉及情绪处理回路的功能异常和发育异常。情绪处理过程中特定效价和年龄相关的异常情况尚未阐明。我们研究了儿童PTSD患者的内隐情绪面孔加工,预测与威胁相关情绪特有的异常情况。患有PTSD的青少年(8至18岁,n = 25)和健康青少年(n = 28)在功能磁共振成像(fMRI)期间完成了一项动态情绪面孔任务,观看从中性变为愤怒或高兴的面孔,或形状变化的对照面孔。在杏仁核/海马体、内侧前额叶皮质(mPFC)以及全脑分析中,研究了激活和功能连接方面的组间差异以及与年龄相关的横断面差异。事后分析研究了神经异常与PTSD、焦虑和抑郁症状指标之间的关系。与健康青少年随着年龄增长激活减少不同,患有PTSD的青少年随着年龄增长对情绪面孔的杏仁核激活增加。在组间与情绪的交互作用中,与健康青少年相比,患有PTSD的青少年对高兴面孔表现出背侧前扣带回(dACC)过度激活,对愤怒面孔则无差异。连接性分析揭示了前额叶 - 杏仁核回路中的矛盾耦合,包括dACC - 背内侧(dm)PFC、杏仁核 - dmPFC和杏仁核 - 腹外侧(vl)PFC。在每种情况下,患有PTSD的青少年与愤怒面孔的连接性降低,但与高兴面孔的连接性增加,与健康青少年相反。效价异常的募集与更高的症状严重程度相关,这表明其在青少年创伤相关精神病理学中起作用。值得注意的是,对愤怒面孔的募集受损以及对高兴面孔的募集增强可能反映了儿童PTSD中积极情绪表达的显著性增加和模糊性增加。最后,与年龄相关的研究结果表明,患有PTSD的青少年杏仁核对各种情绪表达的发育敏感性增加。这些发现为儿童PTSD的潜在病理生理学提供了新的见解,超越了对典型威胁的异常神经反应。

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