Department of Anesthesiology, Institute of Trauma Recovery, UNC School of Medicine, Chapel Hill, NC, USA.
Department of Psychiatry, McLean Hospital, Boston, MA, USA.
Mol Psychiatry. 2020 Feb;25(2):283-296. doi: 10.1038/s41380-019-0581-3. Epub 2019 Nov 19.
Adverse posttraumatic neuropsychiatric sequelae (APNS) are common among civilian trauma survivors and military veterans. These APNS, as traditionally classified, include posttraumatic stress, postconcussion syndrome, depression, and regional or widespread pain. Traditional classifications have come to hamper scientific progress because they artificially fragment APNS into siloed, syndromic diagnoses unmoored to discrete components of brain functioning and studied in isolation. These limitations in classification and ontology slow the discovery of pathophysiologic mechanisms, biobehavioral markers, risk prediction tools, and preventive/treatment interventions. Progress in overcoming these limitations has been challenging because such progress would require studies that both evaluate a broad spectrum of posttraumatic sequelae (to overcome fragmentation) and also perform in-depth biobehavioral evaluation (to index sequelae to domains of brain function). This article summarizes the methods of the Advancing Understanding of RecOvery afteR traumA (AURORA) Study. AURORA conducts a large-scale (n = 5000 target sample) in-depth assessment of APNS development using a state-of-the-art battery of self-report, neurocognitive, physiologic, digital phenotyping, psychophysical, neuroimaging, and genomic assessments, beginning in the early aftermath of trauma and continuing for 1 year. The goals of AURORA are to achieve improved phenotypes, prediction tools, and understanding of molecular mechanisms to inform the future development and testing of preventive and treatment interventions.
创伤后神经精神后遗症 (APNS) 在平民创伤幸存者和退伍军人中很常见。这些 APNS,如传统分类所示,包括创伤后应激、脑震荡后综合征、抑郁和区域性或广泛性疼痛。传统分类法已经阻碍了科学的进步,因为它们将 APNS 人为地分割成孤立的、综合征性的诊断,与大脑功能的离散成分脱钩,并进行单独研究。这种分类和本体论的局限性减缓了病理生理机制、生物行为标志物、风险预测工具以及预防/治疗干预措施的发现。克服这些局限性的进展一直具有挑战性,因为这种进展需要进行既评估广泛的创伤后后遗症(克服碎片化),又进行深入的生物行为评估(将后遗症与大脑功能域相关联)的研究。本文总结了 Advancing Understanding of RecOvery afteR traumA(AURORA)研究的方法。AURORA 使用最先进的自我报告、神经认知、生理、数字表型、心理物理、神经影像学和基因组评估工具,对创伤后早期开始并持续 1 年的 APNS 发展进行大规模(目标样本为 5000 名)深入评估。AURORA 的目标是改善表型、预测工具和分子机制的理解,为预防和治疗干预措施的未来发展和测试提供信息。