Background

The bed nucleus of the stria terminalis (BNST) plays an important role in rodent posttraumatic stress disorder (PTSD), but evidence to support its relevance to human PTSD is limited. We sought to understand the role of the BNST in human PTSD via fMRI, behavioral, and physiological measurements.

Methods

29 patients with PTSD (childhood sexual abuse) and 23 healthy controls (HC) underwent BOLD imaging with an emotional word paradigm. Symptom severity was assessed using the Clinician-Administered PTSD Scale and HPA-axis dysfunction was assessed by measuring the diurnal cortisol amplitude index (DCAI). A data-driven multivariate analysis was used to determine BNST task-based functional co-occurrence (tbFC) across individuals.

Results

In the trauma-versus-neutral word contrast, patients showed increased activation compared to HC in the BNST, medial prefrontal cortex (mPFC), posterior cingulate gyrus (PCG), caudate heads, and midbrain, and decreased activation in dorsolateral prefrontal cortex (DLPFC). Symptom severity positively correlated with activity in the BNST, caudate head, amygdala, hippocampus, dorsal anterior cingulate gyrus (dACG), and PCG, and negatively with activity in the medial orbiotofrontal cortex (mOFC) and DLPFC. Patients and HC showed marked differences in the relationship between the DCAI and BOLD activity in the BNST, septal nuclei, dACG, and PCG. Patients showed stronger tbFC between the BNST and closely linked limbic and subcortical regions, and a loss of negative tbFC between the BNST and DLPFC.

Conclusions

Based upon novel data, we present a new model of dysexecutive emotion processing and HPA-axis dysfunction in human PTSD that incorporates the role of the BNST and functionally linked neurocircuitry.

中文翻译：

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外伤性纹状体床核和功能性连接的神经回路调节创伤后应激障碍的情绪处理和HPA轴功能障碍

背景

末端纹状体床核（BNST）在啮齿动物创伤后应激障碍（PTSD）中起着重要作用，但支持其与人PTSD相关性的证据有限。我们试图通过功能磁共振成像，行为和生理测量来了解BNST在人PTSD中的作用。

方法

29例PTSD（儿童性虐待）和23例健康对照（HC）患者接受了BOLD影像学检查，并带有情感词范例。使用临床医生管理的PTSD量表评估症状严重程度，并通过测量昼夜皮质醇振幅指数（DCAI）评估HPA轴功能障碍。数据驱动的多元分析用于确定个体之间基于BNST任务的功能共现（tbFC）。

结果

在外伤-中立词对比中，与HC相比，BNST，内侧前额叶皮层（mPFC），后扣带回（PCG），尾状头和中脑患者的激活增加，而背外侧前额叶皮层（DLPFC）的激活减少）。症状严重程度与BNST，尾状头，杏仁核，海马，背侧扣带回（dACG）和PCG的活性呈正相关，与内侧或生物额叶皮质（mOFC）和DLPFC的活性呈负相关。患者和HC在BAIST，间隔核，dACG和PCG中DCAI和BOLD活性之间的关系上显示出明显差异。患者在BNST与紧密相连的边缘和皮质下区域之间显示出更强的tbFC，并且在BNST和DLPFC之间失去阴性tbFC。

结论

基于新数据，我们提出了人类PTSD中执行力情感处理和HPA轴功能障碍的新模型，该模型结合了BNST和功能性连接的神经回路的作用。