Castro-Vale Ivone, Carvalho Davide
Medical Psychology Unit, Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Al. Prof. Hernâni Monteiro, 4200-319 Porto, Portugal.
i3S-Institute for Research and Innovation in Health, University of Porto, Rua Alfredo Allen, 208, 4200-135 Porto, Portugal.
Healthcare (Basel). 2020 Oct 1;8(4):376. doi: 10.3390/healthcare8040376.
Post-traumatic stress disorder (PTSD) only develops after exposure to a traumatic event in some individuals. PTSD can be chronic and debilitating, and is associated with co-morbidities such as depression, substance use, and cardiometabolic disorders. One of the most important pathophysiological mechanisms underlying the development of PTSD and its subsequent maintenance is a dysfunctional hypothalamic-pituitary-adrenal (HPA) axis. The corticotrophin-releasing hormone, cortisol, glucocorticoid receptor (GR), and their respective genes are some of the mediators of PTSD's pathophysiology. Several treatments are available, including medication and psychotherapies, although their success rate is limited. Some pharmacological therapies based on the HPA axis are currently being tested in clinical trials and changes in HPA axis biomarkers have been found to occur in response not only to pharmacological treatments, but also to psychotherapy-including the epigenetic modification of the GR gene. Psychotherapies are considered to be the first line treatments for PTSD in some guidelines, even though they are effective for some, but not for all patients with PTSD. This review aims to address how knowledge of the HPA axis-related genetic makeup can inform and predict the outcomes of psychotherapeutic treatments.
创伤后应激障碍（PTSD）仅在某些个体经历创伤事件后才会出现。PTSD可能是慢性且使人衰弱的，并与诸如抑郁症、物质使用和心脏代谢紊乱等共病相关。PTSD发生及其后续维持的最重要病理生理机制之一是下丘脑-垂体-肾上腺（HPA）轴功能失调。促肾上腺皮质激素释放激素、皮质醇、糖皮质激素受体（GR）及其各自的基因是PTSD病理生理学的一些介质。虽然成功率有限，但有几种治疗方法可供选择，包括药物治疗和心理治疗。目前一些基于HPA轴的药物疗法正在临床试验中进行测试，并且已发现HPA轴生物标志物的变化不仅会对药物治疗产生反应，而且会对心理治疗产生反应——包括GR基因的表观遗传修饰。在一些指南中，心理治疗被认为是PTSD的一线治疗方法，尽管它们对一些PTSD患者有效，但并非对所有患者都有效。本综述旨在探讨与HPA轴相关的基因构成知识如何为心理治疗的结果提供信息并进行预测。
