六、创伤后应激障碍课件.ppt

*DatafromPosttraumaticStressDisorderinaCommunitySample...,BrianEngdahletal(seeBibliography)*Figure1demonstratesthat,comparedwithcontrolsubjects,patientswhohadahyperarousalresponseandrelivedtheirtraumaticexperienceafterbeingexposedtothetraumaticscriptshowedsignificantlylessactivationofthethalamus,theanteriorcingulategyrus(BA32)andthemedialfrontalgyrus(BA10,11),theoccipitallobe(BA19),andtheinferiorfrontalgyrus(BA47)(7).LowerlevelsofanteriorcingulateactivationandmedialprefrontalactivationwereconsistentwithpreviousPETstudiesofsexualabuse-relatedandcombat-relatedPTSD(5,1,2).Thesepatternsofbrainactivationarestrikinglydifferentfromthoseobservedinpatientswhodissociatedinresponsetothetraumaticscript(8).Figure2(following)showsthatthesepatientsexhibitedhigherlevelsofbrainactivationinthesuperiorandmiddletemporalgyri(BA38),theinferiorfrontalgyrus(BA47),theoccipitallobe(BA19),theparietallobe(BA7),themedialfrontalgyrus(BA10),themedialprefrontalcortex(BA9),andtheanteriorcingulategyrus(BA24andBA32).*Figure2RegionsofactivationduringtraumaticmemoryrecallversusimplicitbaselinewherethedissociatedPTSDgroup(n=7)showsgreateractivationthanthecomparisongroup(n=10),k10.

*ThereisconsistentevidencefromMRIvolumetricstudiesthathippocampalvolumeisreducedinposttraumaticstressdisorder(PTSD).Thisatrophyofthehippocampusisthoughttorepresentdecreasedneuronaldensity.However,otherstudiessuggestthathippocampalchangesareexplainedbywholebrainatophyandgeneralisedwhitematteratrophyisexhibitedbypeoplewithPTSD.*Sensoryinput,memoryformationandstressresponsemechanismsareaffectedinpatientswithpost-traumaticstressdisorder(PTSD).TheregionsofthebraininvolvedinmemoryprocessingthatareimplicatedinPTSDincludethehippocamp