Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Department of Child and Adolescent Psychiatry, Amsterdam Neuroscience, Amsterdam, the Netherlands.
Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Amsterdam, the Netherlands.
J Psychiatr Res. 2021 Jan;132:207-214. doi: 10.1016/j.jpsychires.2020.10.037. Epub 2020 Oct 30.
Randomized controlled trials have shown efficacy of trauma-focused psychotherapies in youth with posttraumatic stress disorder (PTSD), but little is known about the relationship between treatment response and alternations in brain structures associated with PTSD. In this study, we longitudinally examined the association between treatment response and pre-to posttreatment changes in structural magnetic resonance imaging (MRI) scans using a voxel-based morphometry approach. We analyzed MRI scans of 35 patients (ages 8-18 years, 21 female) with PTSD (80%) or partial PTSD (20%) before and after eight weekly sessions of trauma-focused psychotherapy. PTSD severity was assessed longitudinally using the Clinician-Administered PTSD scale for Children and Adolescents to divide participants into responders and non-responders. Group by time interaction analysis showed significant differences in grey-matter volume in the bilateral insula due to volume reductions over time in non-responders compared to responders. Despite the significant group by time interaction, there were no significant group differences at baseline or follow-up. As typical development is associated with insula volume increase, these longitudinal MRI findings suggest that treatment non-response is associated with atypical neurodevelopment of the insula, which may underlie persistence of PTSD in youth. The absence of structural MRI changes in treatment responders, while in need of replication, suggest that successful trauma-focused psychotherapy may not directly normalize brain abnormalities associated with PTSD.
随机对照试验已经证明了创伤焦点心理疗法在创伤后应激障碍（PTSD）青少年中的疗效，但对于治疗反应与与 PTSD 相关的大脑结构变化之间的关系知之甚少。在这项研究中，我们使用基于体素的形态测量学方法，纵向检查了治疗反应与结构磁共振成像（MRI）扫描前后的变化之间的关联。我们分析了 35 名 PTSD（80%）或部分 PTSD（20%）患者（年龄 8-18 岁，21 名女性）的 MRI 扫描，这些患者在接受八周的创伤焦点心理治疗前后进行了 MRI 扫描。使用儿童和青少年临床医生管理 PTSD 量表纵向评估 PTSD 严重程度，将参与者分为反应者和非反应者。组间时间交互分析显示，由于非反应者的灰质体积随时间减少，双侧岛叶的灰质体积存在显著差异。尽管存在显著的组间时间交互作用，但在基线或随访时均无显著的组间差异。由于典型的发育与岛叶体积的增加有关，这些纵向 MRI 发现表明，治疗无反应与岛叶的非典型神经发育有关，这可能是青少年 PTSD 持续存在的基础。治疗反应者没有结构 MRI 变化，尽管需要进一步验证，但这表明成功的创伤焦点心理治疗可能不会直接使与 PTSD 相关的大脑异常正常化。
