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过度觉醒、解离、情绪失调和再体验——迈向理解创伤后应激障碍症状的分子层面

Hyperarousal, Dissociation, Emotion Dysregulation and Re-Experiencing-Towards Understanding Molecular Aspects of PTSD Symptoms.

作者信息

Brzozowska Aleksandra, Grabowski Jakub

机构信息

Adult Psychiatry Scientific Circle, Division of Developmental Psychiatry, Psychotic and Geriatric Disorders, Department of Psychiatry, Faculty of Medicine, Medical University of Gdansk, 80-282 Gdansk, Poland.

Division of Developmental Psychiatry, Psychotic and Geriatric Disorders, Department of Psychiatry, Faculty of Medicine, Medical University of Gdansk, 80-282 Gdansk, Poland.

出版信息

Int J Mol Sci. 2025 May 29;26(11):5216. doi: 10.3390/ijms26115216.

Abstract

Approximately 70% of people will experience a traumatic event in their lifetime, but post-traumatic stress disorder (PTSD) will only develop in 3.9% and complex post-traumatic stress disorder (CPTSD) in 1-8% of the population worldwide, although in some countries (e.g., Poland and Northern Ireland) it will develop in a much higher percentage. Stress-related disorders have a complex pathogenesis involving neurophysiological, genetic, epigenetic, neuroendocrine and environmental factors. This article reviews the current state of knowledge on the molecular aspects of selected PTSD symptoms: hypervigilance, re-experiencing, emotion dysregulation and dissociation, i.e., the symptoms with strong neurobiological components. Among analysed susceptibility factors are specific gene polymorphisms (e.g., , , , , , and ) and their interactions with the environment, changes in the HPA axis, adrenergic hyperactivity and disturbances in the activity of selected anatomical structures (including the amygdala, prefrontal cortex, corpus callosum, anterior cingulate gyrus and hippocampus). It is worth noting that therapeutic methods with proven effectiveness in PTSD (TF-CBT and EMDR) have a substantial neurobiological rationale. Molecular aspects seem crucial when searching for effective screening/diagnostic methods and new potential therapeutic options.

摘要

约70%的人在一生中会经历创伤性事件,但创伤后应激障碍(PTSD)仅在3.9%的人群中发生,复杂性创伤后应激障碍(CPTSD)在全球1%-8%的人群中发生,不过在一些国家(如波兰和北爱尔兰),其发病率要高得多。与应激相关的障碍具有复杂的发病机制,涉及神经生理学、遗传学、表观遗传学、神经内分泌和环境因素。本文综述了关于PTSD特定症状(过度警觉、反复体验、情绪调节障碍和解离,即具有强烈神经生物学成分的症状)分子方面的现有知识。在分析的易感性因素中,有特定的基因多态性(如 、 、 、 、 、 和 )及其与环境的相互作用、下丘脑-垂体-肾上腺(HPA)轴的变化、肾上腺素能亢进以及选定解剖结构(包括杏仁核、前额叶皮质、胼胝体、前扣带回和海马体)活动的紊乱。值得注意的是,在PTSD中已证实有效的治疗方法(创伤焦点认知行为疗法和眼动脱敏再处理疗法)具有重要的神经生物学理论依据。在寻找有效的筛查/诊断方法和新的潜在治疗选择时,分子方面似乎至关重要。

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