Cassiers Laura L M, Sabbe Bernard G C, Schmaal Lianne, Veltman Dick J, Penninx Brenda W J H, Van Den Eede Filip
Collaborative Antwerp Psychiatric Research Institute, University of Antwerp, Antwerp, Belgium.
University Department of Psychiatry, Campus Antwerp University Hospital, Antwerp, Belgium.
Front Psychiatry. 2018 Aug 3;9:329. doi: 10.3389/fpsyt.2018.00329. eCollection 2018.
Childhood trauma subtypes sexual abuse, physical abuse, emotional maltreatment, and neglect may have differential effects on the brain that persist into adulthood. A systematic review of neuroimaging findings supporting these differential effects is as yet lacking. The present systematic review aims to summarize the findings of controlled neuroimaging trials regarding long-term differential effects of trauma subtypes on the human brain. A systematic literature search was performed using the PubMed and PsycINFO databases from January 2017 up to and including January 2018. Additional papers were identified by a manual search in the reference lists of selected papers and of relevant review articles retrieved by the initial database search. Studies were then assessed for eligibility by the first author. Only original human studies directly comparing neuroimaging findings of exposed and unexposed individuals to well-defined emotional, physical or sexual childhood maltreatment while controlling for the effects of other subtypes were included. A visual summary of extracted data was made for neuroimaging modalities for which comparison between trauma subtypes was feasible, taking the studies' numbers and sample sizes into account. The systematic literature search yielded 25 publications. Sexual abuse was associated with structural deficits in the reward circuit and genitosensory cortex and amygdalar hyperreactivity during sad autobiographic memory recall. Emotional maltreatment correlated with abnormalities in fronto-limbic socioemotional networks. In neglected individuals, white matter integrity and connectivity were disturbed in several brain networks involved in a variety of functions. Other abnormalities, such as reduced frontal cortical volume, were common to all maltreatment types. There is some evidence for long-term differential effects of trauma subtypes on the human brain. The observed alterations may result from both protective adaptation of and damage to the brain following exposure to threatening life events. Though promising, the current evidence is incomplete, with few brain regions and neuroimaging modalities having been investigated in all subtypes. The comparability of the available evidence is further limited by the heterogeneity of study populations regarding gender, age and comorbid psychopathology. Future neuroimaging studies should take this potentially differential role of childhood trauma subtypes into account.
童年创伤的亚型，如性虐待、身体虐待、情感虐待和忽视，可能对大脑产生不同的影响，并持续至成年期。目前尚缺乏支持这些不同影响的神经影像学研究结果的系统综述。本系统综述旨在总结对照神经影像学试验的结果，这些试验涉及创伤亚型对人脑的长期不同影响。我们使用PubMed和PsycINFO数据库，对2017年1月至2018年1月（含）期间的文献进行了系统检索。通过手动检索选定论文及初始数据库检索得到的相关综述文章的参考文献列表，确定了其他论文。然后由第一作者评估研究的 eligibility。仅纳入直接比较暴露于明确的情感、身体或性童年虐待的个体与未暴露个体的神经影像学结果，同时控制其他亚型影响的原始人体研究。对于可行创伤亚型比较的神经影像学模式，考虑研究数量和样本量，对提取的数据进行了可视化总结。系统文献检索共得到25篇出版物。性虐待与奖励回路、生殖感觉皮层的结构缺陷以及悲伤自传体记忆回忆期间杏仁核的过度反应有关。情感虐待与额边缘社会情感网络的异常有关。在被忽视的个体中，涉及多种功能的几个脑网络中的白质完整性和连通性受到干扰。其他异常，如额叶皮质体积减小，在所有虐待类型中都很常见。有证据表明创伤亚型对人脑有长期不同影响。观察到的改变可能是由于接触威胁生命事件后大脑的保护性适应和损伤所致。尽管前景乐观，但目前的证据并不完整，所有亚型中研究的脑区和神经影像学模式较少。现有证据的可比性还受到研究人群在性别年龄和共病精神病理学方面的异质性的进一步限制。未来的神经影像学研究应考虑童年创伤亚型的这种潜在差异作用。
