Kennis PhD Mitzy, van Rooij PhD Sanne J H, Reijnen MSc Alieke, Geuze PhD Elbert
Research Centre Military Mental Healthcare, Dutch Ministry of Defence, Utrecht, The Netherlands.
Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands.
Depress Anxiety. 2017 May;34(5):410-418. doi: 10.1002/da.22605. Epub 2017 Mar 15.
Posttraumatic stress disorder (PTSD) can be treated with trauma-focused therapy, although only about 50% of the patients recover on the short-term. In order to improve response rates it is important to identify who will and will not recover from trauma-focused therapy. Although previous studies reported dorsal anterior cingulate cortex (ACC) activity, as well as dorsal cingulum bundle white matter microstructure integrity as markers for the persistence of PTSD symptoms on the short-term, it remains unclear whether these markers also predict long-term PTSD symptom severity.
PTSD patients (n = 57) were investigated with clinical interviews and an MRI protocol before the start of treatment. Clinical interviews were repeated after 6-8 months of treatment (short-term follow-up), and on average 4 years later (long-term follow-up). Twenty-eight PTSD patients returned for the long-term follow-up. Dorsal ACC activity in response to negative images, and fractional anisotropy (FA) of the dorsal cingulum were the neural markers investigated.
In this long-term follow-up sample (n = 28), dorsal ACC activity and dorsal cingulum FA values significantly predicted CAPS scores on short- and long-term follow-up. The results remained significant after controlling for baseline CAPS score, early trauma, and comorbidity.
This study confirms the importance of the cingulate cortex activation and white matter integrity not only for short-term treatment outcome, but also for PTSD long-term symptom severity. Future treatments should target ACC function in particular during treatment in order to improve response rates.
创伤后应激障碍（PTSD）可采用以创伤为重点的治疗方法，尽管短期内只有约50%的患者能康复。为提高缓解率，识别哪些患者能从以创伤为重点的治疗中康复、哪些不能很重要。尽管先前的研究报告称背侧前扣带回皮质（ACC）活动以及背侧扣带束白质微结构完整性可作为PTSD症状短期内持续存在的标志物，但这些标志物是否也能预测PTSD症状的长期严重程度仍不清楚。
对57例PTSD患者在治疗开始前进行临床访谈和MRI检查。治疗6 - 8个月后（短期随访）以及平均4年后（长期随访）重复进行临床访谈。28例PTSD患者返回进行长期随访。研究的神经标志物为对负面图像的背侧ACC活动以及背侧扣带束的分数各向异性（FA）。
在这个长期随访样本（n = 28）中，背侧ACC活动和背侧扣带束FA值在短期和长期随访中均能显著预测CAPS评分。在控制基线CAPS评分、早期创伤和共病因素后，结果仍然显著。
本研究证实扣带回皮质激活和白质完整性不仅对短期治疗结果很重要，而且对PTSD的长期症状严重程度也很重要。未来的治疗应特别针对治疗期间的ACC功能，以提高缓解率。
