创伤后应激障碍脑功能成像研究进展

精神创伤最严重的后果之一就是导致创伤后应激障碍（post-traumatic stress disorders,PTSD）。PTSD最先由美国精神病协会于1980年在DSM-Ⅲ进行首次定义。PTSD作为一种精神创伤性事件后高发的、后果严重的精神疾病,其发病率高达20%,约1/3的患者终生不愈,1/2以上的患者常伴有物质滥用和其他精神障碍,     

慢性创伤后应激障碍患者的脑功能磁共振研究

目的:探讨慢性创伤后应激障碍(post-traumatic stress disorder,PTSD)患者脑功能激活特征。方法:对17例矿难相关的慢性PTSD患者和14例经历相同矿难未患病的对照进行脑功能磁共振成像。使用Matlab6.5和SPM2软件对功能磁共振数据进行处理。结果:与对照组相比,患者组左海马旁回激活增强;右楔前叶激活降低。与中性图片相比,患者组面对负性图片时右海马旁回、右梭状回、右枕下回、双侧枕中回的激活增强;左顶下小叶、左顶上小叶、右中央后回、左楔叶、背外侧前额叶的激活降低。对照组面对负性图片时,右楔前叶激活增强;右岛叶激活降低。结论:这些脑区改变可能反映了PTSD患者症状包括对创伤情绪和记忆加工不足的复杂的生物学机制。     

创伤后应激障碍患者创伤后应激症状与自传体记忆过度概括化的相关

目的:探讨伤后应激障碍患者的创伤后应激障碍症状与过度概括化自传体记忆的相互关系。方法:选取符合入组条件的创伤后应激障碍患者30人,正常对照组30人,所有被试均接受自传体记忆(AMT)、创伤后应激障碍症状自评量表(PTSD-SS)测验。结果:1与正常对照组比较,PTSD患者PTSD症状量表各症状及过度概括化自传体记忆总分上存在显著性的统计学意义(P0.05);2相关分析表明,创伤后应激障碍患者PTSD症状的重复体验、回避功能、社会功能与过度概括化自传体记忆呈高度的正相关性,分别为(r=0.59,0.53,0.71,0.59;P0.05)。结论:创伤后应激障碍患者PTSD症状及过度概括化的自传体记忆明显,且过度概括化的自传体记忆水平越高,PTSD患者的重复体验、回避功能、社会功能问题就越明显。     

中国消防救援人员中创伤后应激障碍的症状结构

目的：分析我国消防救援人员中创伤后应激障碍的症状结构。方法：被试为685名经历过职业创伤暴露的消防救援人员,年龄27.5±6.0岁。采用创伤后应激障碍诊断量表的症状分量表进行评估。使用验证性因素分析对4个竞争性模型进行检验。结果：验证性因素分析与模型比较的结果支持七维混合模型优于其它竞争模型。结论：本研究结果支持采用闯入、回避、负性情感、快感缺失、外化行为、焦虑性唤起和痛苦性唤起等7个症状簇能更好地解释与组织创伤后应激障碍的症状结构。     

创伤后应激障碍患者海马容积与磁共振波谱的研究

目的探讨创伤后应激障碍患者海马容积与氢质子波谱(1H-MRS)的相关性。方法对50例急性型创伤后应激障碍患者和50例健康志愿者行磁共振海马容积测量和磁共振波谱检查,采用相除法标准化海马容积与N-乙酰天门冬氨酸(NAA)、胆碱(Cho)和肌酸(Cr)的比值对照分析。结果急性型创伤后应激障碍患者海马容积不同程度缩小,其中31例急性型创伤后应激障碍者海马容积明显缩小,与对照组比较差异有统计学意义(P<0.05)。创伤后应激障碍患者NAA峰高度降低、Cho峰增高,NAA/Cr比值不同程度减小、Cho/Cr值增高,31例重度患者NAA/Cr值明显减小,与对照组比较具有显著性差异(P<0.01);Cho/Cr值增高差异无统计学意义(P>0.05)。急性型创伤后应激障碍患者海马容积缩小程度与NAA/Cr降低幅度呈正相关。结论急性型创伤后应激障碍患者海马容积缩小、NAA丢失严重,提示神经递质N-乙酰天冬氨酸-谷氨酸在创伤后应激障碍发展中起重要作用。     

地震后不同生活改变受灾民众的创伤后应激症状和抑郁症状

在经历了汶川地震后,受灾民众不仅遭受了经济和心理上的影响,还面临着很多生活上的改变[1-4]。研究发现,经历创伤事件的个体会出现睡眠紊乱[5-6],以及对烟酒等物质使用上的变化[7-9]。本研究在震后3个月,对彭州板房区的受灾民众可能出现的睡眠、娱乐、吸烟及饮酒等生活改变进行     

癌症患者创伤后应激障碍症状特点及社会心理相关因素

目的研究癌症患者创伤后应激障碍(PTSD)症状特点及社会心理相关因素。方法采用PTSD筛查量表、社会支持评定量表、简易应对方式量表、艾森克人格量表对198例癌症患者进行问卷调查。结果①有20%的癌症患者PTSD筛查量表3个分量表均分大于3;②不同居住地被试PTSD症状有显著差异,农村显著高于城市(t=2.240,P<0.05);③不同癌症类型被试PTSD症状有显著差异,乳腺癌和子宫癌患者要显著低于其他类型的癌症(F=2.313,P<0.05);④不同患病时间被试PTSD症状有显著差异,随着时间推移有上升的趋势(F=2.389,2.626,2.418;P<0.05);⑤癌症患者PTSD症状与消极应对、精神质、神经质成正相关(P<0.05),与积极应对、社会支持成负相关(P<0.05)。结论有20%癌症患者的各类症状达到中度以上的水平,居住在农村的癌症患者PTSD症状更严重、乳腺癌和子宫癌患者的症状更少、随着时间推移癌症患者PTSD症状更严重。人格特征、应对方式、社会支持是影响癌症患者PTSD的重要因素。     

震后6个月都江堰地区青少年创伤后应激症状及相关因素

目的:了解汶川地震6个月后都江堰地区青少年创伤后应激症状(Posttramatic Stress Symptoms,PTSS)的检出率及人群特征,并分析其相关因素。方法:采用便利取样,选取都江堰市区内学校规模较大、学生生源来自城镇和农村的一所初中和一所高中,抽取学生2004人,其中初中7～9年级777人(年龄11～14岁),高中10年级1227人(年龄15～17岁),用心理创伤后应激障碍自评量表(Post-Trau-matic Stress Disorder Self-rating Scale,PTSD-SS)、青少年自评生活事件量表(Adolescent Self-rating Life E-vent Checklist,ASLEC)、儿童简易应付方式问卷(Children Simple Coping Style Questionnaire,CSCSQ)、自编一般人口学及地震暴露情况调查表评估创伤后应激症状及其相关因素。结果:(1)PTSS的检出率为15.9%,女生检出率高于男生(19.0%vs.12.2%,P0.05),15～17岁年龄组检出率高于11～14岁年龄组(19.4%vs.10.4%,P0.05);(2)使用协方差分析后,女生PTSD-SS总分仍高于男生,15～17岁组仍高于11～14岁组,农村学生仍高于城镇学生[(39.0±14.0)vs.(35.6±13.6),(39.2±15.1)vs.(34.8±11.4),(40.0±15.7)vs.(36.7±13.3),Ps0.05],但非独生子女与独生子女间PTSS-SS总分差异无统计学意义(P=0.260);(3)较多的震后负性生活事件(β=0.387)、消极应对方式(β=0.258)、有家人伤亡(β=0.184)、其他财产损失(β=0.059)和目睹经历(β=0.136)是PTSS的危险因素(Ps0.05),而积极应对对PTSS有保护作用(β=-0.178,P0.001)。结论:震后6个月都江堰地区青少年创伤后应激症状的检出率依然较高;减少灾后负性生活事件的发生并引导学生采用积极的应对方式,对促进其心理康复有重要作用。     

震后1年某极重灾区干部的创伤后应激症状及相关因素

地震灾区干部既是地震受灾群体,又是灾后重建的组织者.在震后的重点工作中,他们长期处于高强度、高负荷的工作状态,精神高度紧张,身心倍感疲惫.为了解地震后1年灾区干部的心理健康状况,对四川省某地震极重灾县灾区干部的心理状况进行了调查.     

青少年学生创伤后应激障碍症状与个性特征相关性分析

目的了解汶川地震后5个月都江堰青少年学生创伤后应激障碍症状发生情况及其与个性特征的关系。方法采用事件影响量表中文修订版(IES-R)及艾森克人格问卷(简称EPQ(成人版))对四川省都江堰市第一中学和都江堰中学等学校的472名青少年学生进行心理测评。结果在472名青少年学生中,出现创伤后应激障碍症状的有220人,占46.61%。女生与男生创伤后应激障碍症状发生情况的比较差异有统计学意义(高警觉因子t=-2.016,P0.05);参与震后营救和未参与营救的同学所产生的创伤后应激障碍症状有显著差异(闯入因子t=2.054,P0.05)。IES得分阳性的学生N分和P分明显高于IES得分阴性的学生,而E分明显低于IES得分阴性的学生。EPQ-N与IES的各因子之间呈显著正相关(r=0.369～0.522),EPQ-P与IES的高警觉因子呈显著正相关(r=0.057～0.153)。结论灾区青少年学生创伤后应激障碍症状的发生率较高,个性特征与创伤后应激障碍症状密切相关,具有精神质倾向、性格内向及情绪不稳定的个性特征者更容易出现创伤后应激障碍症状,应重视和关注灾区青少年学生的心理健康问题。     

A functional magnetic resonance imaging study of local/global processing with stimulus presentation in the peripheral visual hemifields

When stimuli are presented in the left or right visual fields, hemispheric specialization for global and local processing in occipital areas is attenuated. Using functional magnetic resonance imaging, we investigated how this attenuation is compensated for when information must cross the corpus callosum to reach the areas specialized for global and local processing. We presented hierarchically nested letters (e.g. a large E made of smaller E's) to the right or the left visual hemifield while subjects fixated centrally. In half the trials, subjects indicated whether the global aspect and in the other half whether the local aspect of the stimulus matched a pre-specified target letter. Visual hemifield presentations showed the expected contralateral activations of occipital cortex. The main effects of locally or globally directed attention did not show any differential occipital activations, but the right anterior cingulate cortex was activated differentially during local processing. Region-of-interest-based analyses showed increased neural activity in left posterior occipital cortex during local processing when stimuli were presented in the left hemifield. During global processing with stimulus presentation to the right hemifield, the right posterior occipital cortex was activated. Activation of right anterior cingulate cortex during local processing is likely to reflect the suppression of global processing precedence in order to select correctly the local stimulus level. The activations in left (local) and right (global) occipital areas are likely to reflect the top-down augmentation of stimulus information that has been degraded by callosal crossing in order to access the hemisphere specialized for local or global processing.     

Cross-modal integration of intranasal stimuli: A functional magnetic resonance imaging study

Most odorants, in addition to the olfactory system, also activate the intranasal trigeminal system. Recent studies have shown that pure trigeminal stimulation activates somatosensory regions as well as regions traditionally thought of as primary olfactory areas. As a main aim of this study we wished to a) ascertain which brain regions are responsive to an “artificially” bimodal odor composed of a trigeminal (CO₂) and an olfactory stimulant (phenyl ethyl alcohol, PEA) and b) determine if presenting CO₂ and PEA simultaneously activates different brain regions than when presenting them individually. Fifteen men were scanned using functional magnetic resonance imaging while smelling PEA, CO₂, and a mixture of both stimuli (CO₂PEA) presented simultaneously. Odors were presented monorhinally to the right nostril in a block design. The contrast between CO₂PEA and baseline revealed areas implicated in the processing of both olfactory and trigeminal stimuli. When the mixture was contrasted with the sum of its single components (CO₂PEA−{CO₂+PEA}), activations in integration centers (left superior temporal and right intraparietal sulcus) and in orbitofrontal areas (left medial and lateral orbitofrontal cortex) were detected. The opposite contrast ({CO₂+PEA}−CO₂PEA) did not reveal any significant activation. In contrast to studies which have used natural mixed olfactory/trigeminal stimuli, we have shown that the perception of an artificial mixed olfactory/trigeminal stimulus activates, as opposed to inhibiting the olfactory cortex. Further, we also conclude that a mixed olfactory/trigeminal stimulus appears to lead to higher cortical activations than the sum of its parts.     

Negative BOLD during tongue movement: A functional magnetic resonance imaging study

The aim of this functional magnetic resonance imaging (fMRI) study was to evaluate negative blood oxygen level-dependent (BOLD) signals during voluntary tongue movement. Deactivated (Negative BOLD) regions included the posterior parietal cortex (PPC), precuneus, and middle temporal gyrus. Activated (Positive BOLD) regions included the primary somatosensory-motor area (SMI), inferior parietal lobule, medial frontal gyrus, superior temporal gyrus, insula, lentiform nucleus, and thalamus. The results were not consistent with previous studies involving unilateral hand and finger movements showing the deactivation of motor-related cortical areas including the ipsilateral MI. The areas of Negative BOLD in the PPC and precuneus might reflect specific neural networks relating to voluntary tongue movement.     

Saccular stimulation of the human cortex: A functional magnetic resonance imaging study

Recent imaging studies have reported the projection of semicircular canal signals onto wide regions of the cerebral cortex but little is known about otolith projections onto the cerebral cortex. We used functional magnetic resonance imaging (fMRI) to investigate the activation of the cortex by loud clicks that selectively stimulate the sacculus. Twelve normal volunteers were presented with auditory stimuli via an earphone containing a piezo electric element. High-intensity [maximum volume of 120 dB (SPL)] or low-intensity [maximum volume of 110 dB (SPL)] clicks were delivered at a frequency of 1 Hz and lasted 1 ms. We first checked that the high-intensity, but not low-intensity, clicks stimulated the sacculus by determining the vestibular evoked myogenic potentials. We then analyzed two task conditions (high- and low-intensity clicks) in a boxcar paradigm. We obtained gradient echo echo-planar images by using a 1.5 T MRI system. We analyzed the fMRI time series data with SPM2. High-intensity clicks activated wide areas of the cortex, namely, the frontal lobe (prefrontal cortex, premotor cortex, and frontal eye fields), parietal lobe (the region around the intraparietal sulcus, temporo-parietal junction, and paracentral lobule), and cingulate cortex. These areas are similar to those reported in previous imaging studies that analyzed the cortical responses to the activation of the semicircular canals. Thus, semicircular canal and otolith/saccular signals may be processed in similar regions of the human cortex.     

Cross-modal integration during vowel identification in audiovisual speech: A functional magnetic resonance imaging study

To investigate the neural substrates of the perception of audiovisual speech, we conducted a functional magnetic resonance imaging study with 28 normal volunteers. We hypothesized that the constraint provided by visually-presented articulatory speech (mouth movements) would lessen the workload for speech identification if the two were concordant, but would increase the workload if the two were discordant. In auditory attention sessions, subjects were required to identify vowels based on auditory speech. Auditory vowel stimuli were presented with concordant or discordant visible articulation movements, unrelated lip movements, and without visual input. In visual attention sessions, subjects were required to identify vowels based on the visually-presented vowel articulation movements. The movements were presented with concordant or discordant uttered vowels and noise, and without sound. Irrespective of the attended modality, concordant conditions significantly shortened the reaction time, whereas discordant conditions lengthened the reaction time. Within the neural substrates that were commonly activated by auditory and visual tasks, the mid superior temporal sulcus showed greater activity for discordant stimuli than concordant stimuli. These findings suggest that the mid superior temporal sulcus plays an important role in the auditory–visual integration process underlying vowel identification.     

Neural correlates of the judgment of lying: A functional magnetic resonance imaging study

Lie judgment is an estimation of the speaker's intention to deceive inevitably accompanied by moral judgment. To depict their neural substrates, we conducted a functional magnetic resonance imaging study. Eighteen subjects read short stories and made judgments in three different tasks: a control gender judgment task, a moral judgment task, and a lie judgment task. Compared with the control task, both the moral and lie judgment tasks activated the left temporal lobe, the medial prefrontal cortex, the lateral orbitofrontal cortex extending to the dorsolateral prefrontal cortex, the caudate nucleus, the left temporo-parietal junction (TPJ), and the right cerebellum. Neural activations were greater in the left middle frontal gyrus, the bilateral TPJ, and the right superior temporal sulcus in the lie judgment condition than in the moral judgment condition. In addition, the left TPJ showed greater activation when a protagonist told lies for anti-social rather than pro-social purposes. These data suggest that the judgment of lies is mediated by the neural substrates of moral judgment (conventionality) and those involved in detecting the intent to deceive (intentionality), and that the left TPJ might play a key role in processing both the conventional and the intentional information involved in the judgment of lying.     

A functional magnetic resonance imaging study of mental subtraction in human subjects.

The neuronal network involved in a precise type of calculation procedure, mental subtraction, was investigated by means of functional magnetic resonance imaging. Two tasks were used requiring covert production of numbers: (1) with calculation; (2) without calculation. During the first task, activation was observed in the left dorsolateral prefrontal and premotor cortices, in Broca's area and bilaterally in the inferior parietal cortex. During the second task, activation was mainly observed in Broca's area and to a less extent in the left prefrontal and premotor cortices. Statistical comparison of data in the two situations revealed that the procedure of mental subtraction is mediated by a distributed system which includes predominantly the left dorsolateral prefrontal cortex and the inferior parietal cortex bilaterally.     

Cerebral areas processing swallowing and tongue movement are overlapping but distinct: a functional magnetic resonance imaging study

Although multiple regions of the cerebral cortex have been implicated in swallowing, the functional contributions of each brain area remain unclear. The present study sought to clarify the roles of these cortical foci in swallowing by comparing brain activation associated with voluntary saliva swallowing and voluntary tongue elevation. Fourteen healthy right-handed subjects were examined with single-event-related functional magnetic resonance imaging (fMRI) while laryngeal movements associated with swallowing and tongue movement were simultaneously recorded. Both swallowing and tongue elevation activated 1) the left lateral pericentral and anterior parietal cortex, and 2) the anterior cingulate cortex (ACC) and adjacent supplementary motor area (SMA), suggesting that these brain regions mediate processes shared by swallowing and tongue movement. Tongue elevation activated a larger total volume of cortex than swallowing, with significantly greater activation within the ACC, SMA, right precentral and postcentral gyri, premotor cortex, right putamen, and thalamus. Although a contrast analysis failed to identify activation foci specific to swallowing, superimposed activation maps suggested that the most lateral extent of the left pericentral and anterior parietal cortex, rostral ACC, precuneus, and right parietal operculum/insula were preferentially activated by swallowing. This finding suggests that these brain areas may mediate processes specific to swallowing. Approximately 60% of the subjects showed a strong functional lateralization of the postcentral gyrus toward the left hemisphere for swallowing, whereas 40% showed a similar activation bias for the tongue elevation task. This finding supports the view that the oral sensorimotor cortices within the left and right hemispheres are functionally nonequivalent.     

Error-related processing following severe traumatic brain injury: An event-related functional magnetic resonance imaging (fMRI) study

Continuous monitoring of one's performance is invaluable for guiding behavior towards successful goal attainment by identifying deficits and strategically adjusting responses when performance is inadequate. In the present study, we exploited the advantages of event-related functional magnetic resonance imaging (fMRI) to examine brain activity associated with error-related processing after severe traumatic brain injury (sTBI). fMRI and behavioral data were acquired while 10 sTBI participants and 12 neurologically-healthy controls performed a task-switching cued-Stroop task. fMRI data were analyzed using a random-effects whole-brain voxel-wise general linear model and planned linear contrasts. Behaviorally, sTBI patients showed greater error-rate interference than neurologically-normal controls. fMRI data revealed that, compared to controls, sTBI patients showed greater magnitude error-related activation in the anterior cingulate cortex (ACC) and an increase in the overall spatial extent of error-related activation across cortical and subcortical regions. Implications for future research and potential limitations in conducting fMRI research in neurologically-impaired populations are discussed, as well as some potential benefits of employing multimodal imaging (e.g., fMRI and event-related potentials) of cognitive control processes in TBI.     

Sleep stabilizes visuomotor adaptation memory: a functional magnetic resonance imaging study

The beneficial effect of sleep on motor memory consolidation is well known for motor sequence memory, but remains unsettled for visuomotor adaptation in humans. The aim of this study was to characterize more clearly the influence of sleep on consolidation of visuomotor adaptation using a between‐subjects functional magnetic resonance imaging (fMRI) design contrasting sleep to total sleep deprivation. Our behavioural results, based on seven different parameters, show that sleep stabilizes performance whereas sleep deprivation deteriorates it. During training, while a set of cerebellar, striatal and cortical areas is activated in proportion to performance improvement, the recruitment of the hippocampus and frontal cortex protects motor memory against the detrimental effects of sleep deprivation. During retest after sleep loss a cerebello–cortical network, usually involved in the earliest stage of learning, was recruited to perform the task. In contrast, no changes in cerebral activity were observed after sleep, suggesting that it may only support the stabilization of the visuomotor adaptation memory trace.