Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Department of Comparative Medicine, Yale University School of Medicine, New Haven, CT, USA; U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA.
Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Department of Epidemiology, Biostatistics and Community Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Psychiatry Res Neuroimaging. 2024 Sep;343:111864. doi: 10.1016/j.pscychresns.2024.111864. Epub 2024 Aug 2.
Post-traumatic stress disorder (PTSD) has been linked to altered communication within the limbic system, including reduced structural connectivity in the uncinate fasciculus (UNC; i.e., decreased fractional anisotropy; FA) and reduced resting-state functional connectivity (RSFC) between the hippocampus and ventromedial prefrontal cortex (vmPFC). Previous research has demonstrated attenuation of PTSD symptoms and alterations in RSFC following exposure-based psychotherapy. However, the relationship between changes in structural and functional connectivity patterns and PTSD symptoms following treatment remains unclear. To investigate this, we conducted a secondary analysis of data from a randomized clinical trial of intensive exposure therapy, evaluating alterations in UNC FA, hippocampus-vmPFC RSFC, and PTSD symptoms before (pre-treatment), 7 days after (post-treatment), and 30 days after (follow-up) the completion of therapy. Our results showed that post-treatment changes in RSFC were positively correlated with post-treatment and follow-up changes in UNC FA and that post-treatment changes in UNC FA were positively correlated with post-treatment and follow-up changes in PTSD symptoms. These findings suggest that early changes in functional connectivity are associated with sustained changes in anatomical connectivity, which in turn are linked to reduced PTSD symptom severity.
创伤后应激障碍（PTSD）与边缘系统内的通讯改变有关，包括钩束（UNC）的结构连接减少（即各向异性分数降低；FA）和海马体与腹内侧前额叶皮质（vmPFC）之间的静息状态功能连接（RSFC）减少。先前的研究表明，暴露疗法后 PTSD 症状减轻和 RSFC 改变。然而，治疗后结构和功能连接模式的变化与 PTSD 症状之间的关系尚不清楚。为了研究这一点，我们对密集暴露疗法的随机临床试验数据进行了二次分析，评估了治疗前（治疗前）、治疗后 7 天（治疗后）和治疗结束后 30 天（随访）UNC FA、海马体-vmPFC RSFC 和 PTSD 症状的变化。我们的结果表明，治疗后 RSFC 的变化与 UNC FA 的治疗后和随访后变化呈正相关，而 UNC FA 的治疗后变化与 PTSD 症状的治疗后和随访后变化呈正相关。这些发现表明，功能连接的早期变化与解剖连接的持续变化相关，而解剖连接的持续变化又与 PTSD 症状严重程度的降低有关。
