创伤暴露后持续性分离及其神经相关性预测结果。

Persistent Dissociation and Its Neural Correlates in Predicting Outcomes After Trauma Exposure.

机构信息

Division of Depression and Anxiety Disorders (Lebois, Harnett, Ravichandran, Dumornay, Finegold, Merker, Pizzagalli, Ressler), Institute for Technology in Psychiatry (Germine, Rauch), and Department of Psychiatry (Rauch), McLean Hospital, Belmont, Mass.; Department of Psychiatry (Lebois, Harnett, Ravichandran, Germine, Rauch, Pizzagalli, Ressler), Department of Emergency Medicine (Sanchez), and Department of Health Care Policy (Kessler), Harvard Medical School, Boston; Department of Psychiatry and Behavioral Sciences (van Rooij, Ely, Stevens), Department of Biomedical Informatics (Clifford), and Department of Emergency Medicine (Hudak), Emory University School of Medicine, Atlanta; Department of Psychiatry and Behavioral Neurosciences (Jovanovic) and Department of Emergency Medicine (Pearson, O'Neil), Wayne State University, Detroit; Department of Psychological Sciences, University of Missouri-St. Louis, St. Louis (Bruce); Department of Emergency Medicine, Washington University School of Medicine, St. Louis (House); Department of Psychology, Northern Illinois University, DeKalb (Hill); McLean Hospital, Belmont, Mass. (Phillips); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Phillips); Department of Emergency Medicine and Department of Health Services, Policy, and Practice, Alpert Medical School of Brown University, Rhode Island Hospital, and Miriam Hospital, Providence, R.I. (Beaudoin); Institute for Trauma Recovery (An, Linnstaedt, McLean), Department of Anesthesiology (An, Linnstaedt), Department of Psychiatry (McLean), and Department of Emergency Medicine (McLean), University of North Carolina at Chapel Hill; Departments of Psychiatry and Neurology, University of California San Francisco, San Francisco (Neylan); Department of Biomedical Engineering, Georgia Institute of Technology, and Emory University, Atlanta (Clifford); Many Brains Project, Belmont, Mass. (Germine); Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester (Haran); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tenn. (Storrow); Department of Emergency Medicine, Henry Ford Health System, Detroit (Lewandowski); Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (Musey); Department of Emergency Medicine, University of Florida College of Medicine-Jacksonville (Hendry, Sheikh); Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, N.J. (Jones); Department of Emergency Medicine, University of Cincinnati College of Medicine, and College of Nursing, University of Cincinnati, Cincinnati (Punches); Department of Emergency Medicine, Oakland University William Beaumont School of Medicine, Rochester, Mich. (Swor); Department of Emergency Medicine, Boston Medical Center, Boston (McGrath); Department of Surgery and Department of Neurosurgery (Pascual), Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery (Seamon), and Perelman School of Medicine (Pascual, Seamon), University of Pennsylvania, Philadelphia; Department of Emergency Medicine, Einstein Healthcare Network, Philadelphia (Datner); Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia (Datner); Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia (Chang); Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ypsilanti, Mich. (Domeier); Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield (Rathlev); Department of Emergency Medicine, McGovern Medical School, University of Texas Health, Houston (Sergot); Department of Emergency Medicine, Brigham and Women's Hospital, Boston (Sanchez); National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston (Miller); Department of Psychiatry, Boston University School of Medicine, Boston (Miller); National Center for PTSD, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven (Pietrzak); Department of Psychiatry, Yale School of Medicine, New Haven, Conn. (Pietrzak); Department of Psychology, Yale University, New Haven, Conn. (Joormann); Department of Psychological and Brain Sciences, Washington University in St. Louis (Barch); Department of Biosciences and Institute for Behavioral Medicine Research, OSU Wexner Medical Center, Columbus, Ohio (Sheridan); Department of Psychiatry, Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston (Smoller); Stanley Center for Psychiatric Research, Broad Institute, Cambridge, Mass. (Smoller); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Luna); Department of Anesthesiology and Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor (Harte); Kolling Institute of Medical Research, University of Sydney, St Leonards, New South Wales, Australia (Elliott); Faculty of Medicine and Health, University of Sydney, Northern Sydney Local Health District, New South Wales, Australia (Elliott); Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Elliott); Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston (Koenen); Lurie Center for Autism, Lexington, Mass. (Ravichandran).

出版信息

Am J Psychiatry. 2022 Sep;179(9):661-672. doi: 10.1176/appi.ajp.21090911. Epub 2022 Jun 22.

DOI:10.1176/appi.ajp.21090911

PMID:35730162

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9444876/

Abstract

OBJECTIVE

Dissociation, a disruption or discontinuity in psychological functioning, is often linked with worse psychiatric symptoms; however, the prognostic value of dissociation after trauma is inconsistent. Determining whether trauma-related dissociation is uniquely predictive of later outcomes would enable early identification of at-risk trauma populations. The authors conducted the largest prospective longitudinal biomarker study of persistent dissociation to date to determine its predictive capacity for adverse psychiatric outcomes following acute trauma.

METHODS

All data were part of the Freeze 2 data release from the Advancing Understanding of Recovery After Trauma (AURORA) study. Study participants provided self-report data about persistent derealization (N=1,464), a severe type of dissociation, and completed a functional MRI emotion reactivity task and resting-state scan 2 weeks posttrauma (N=145). Three-month follow-up reports were collected of posttraumatic stress, depression, pain, anxiety symptoms, and functional impairment.

RESULTS

Derealization was associated with increased ventromedial prefrontal cortex (vmPFC) activation in the emotion reactivity task and decreased resting-state vmPFC connectivity with the cerebellum and orbitofrontal cortex. In separate analyses, brain-based and self-report measures of persistent derealization at 2 weeks predicted worse 3-month posttraumatic stress symptoms, distinct from the effects of childhood maltreatment history and current posttraumatic stress symptoms.

CONCLUSIONS

The findings suggest that persistent derealization is both an early psychological and biological marker of worse later psychiatric outcomes. The neural correlates of trauma-related dissociation may serve as potential targets for treatment engagement to prevent posttraumatic stress disorder. These results underscore dissociation assessment as crucial following trauma exposure to identify at-risk individuals, and they highlight an unmet clinical need for tailored early interventions.

摘要

目的

心理功能的分离或中断，即解离，常与更严重的精神症状相关；然而，创伤后解离的预后价值并不一致。确定创伤相关的解离是否能独特地预测后期结果，将使我们能够早期识别高危创伤人群。作者进行了迄今为止规模最大的关于持续性解离的前瞻性纵向生物标志物研究，以确定其对急性创伤后不良精神结果的预测能力。

方法

所有数据均来自 Advancing Understanding of Recovery After Trauma (AURORA) 研究的 Freeze 2 数据发布。研究参与者提供了关于持续性现实解体（N=1,464）的自我报告数据，现实解体是一种严重的解离类型，并在创伤后 2 周完成了功能磁共振情绪反应任务和静息态扫描（N=145）。在创伤后 3 个月收集了创伤后应激、抑郁、疼痛、焦虑症状和功能障碍的随访报告。