Introduction

Reduced reactivity to pleasurable stimulation is a defining symptom of post-traumatic stress disorder (PTSD), but trauma exposure also increases the severity of many anxiety and mood disorders, including depression, social anxiety, and panic disorder, suggesting that reward system dysfunction might be pervasive in the internalizing disorders. The ventromedial prefrontal cortex (vmPFC) and ventral striatum are core components of the reward circuit and the current study assesses functional activity and connectivity in this circuit during emotional picture viewing in anxiety and mood disorder patients.

Method

Functional brain activity (fMRI) and functional connectivity in the fronto-striatal circuit were measured in a large sample of patients diagnosed with anxiety and mood disorders (n=155) during affective scene viewing as it varied with trauma exposure and temperament.

Results

In women, but not men, blunted fronto-striatal connectivity was associated with increased posttraumatic anhedonic symptoms, whereas the amplitude of functional activity was not related to trauma exposure. In both men and women, reduced fronto-striatal connectivity was associated with decreases in temperamental positive affect. When predicting fronto-striatal connectivity, temperament and posttraumatic symptomology accounted for independent proportions of variance.

Limitations

In this civilian sample of anxiety disorder patients, men reported very little trauma-related symptomology.

Conclusions

Because dysfunctional reward processing due to trauma and temperament is pervasive across the internalizing disorder spectrum, assessing the integrity of the fronto-striatal reward circuit could provide important information in diagnostic and treatment protocols.

中文翻译：

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额叶纹状体奖励回路中与创伤相关的功能障碍

介绍

对愉悦刺激的反应性降低是创伤后应激障碍（PTSD）的明确症状，但是外伤暴露还会增加许多焦虑和情绪障碍的严重程度，包括抑郁症，社交焦虑症和恐慌症，表明奖惩系统功能障碍可能是普遍存在于内在性疾病中。腹侧前额叶皮层（vmPFC）和腹侧纹状体是奖励回路的核心组件，当前研究评估焦虑和情绪障碍患者在情绪图片浏览过程中该回路的功能活动和连通性。

方法

在情感场景观察期间，被诊断患有焦虑和情绪障碍（n = 155）的大量患者的样本中，测量了额叶纹状体回路中的功能性大脑活动（fMRI）和功能连通性，因为其随创伤暴露和气质的不同而不同。

结果

在女性而非男性中，额叶纹状体连接性减弱与创伤后无痛性症状增加有关，而功能活动的幅度与创伤暴露无关。在男性和女性中，额叶纹状体连通性的降低与气质积极影响的降低有关。当预测额-纹状体的连通性时，气质和创伤后症状占变异的独立比例。

局限性

在这个焦虑症患者的平民样本中，男性报告很少有与创伤有关的症状。

结论

由于创伤和气质引起的功能失常的奖励处理在内部化疾病谱中普遍存在，因此评估额纹状体奖励电路的完整性可以为诊断和治疗方案提供重要信息。