非侵入性脑刺激应用于创伤后应激障碍和物质滥用障碍的记忆干预

记忆是进行思维、想象等高级心理活动的基础,是累积经验、促进个体生存的重要功能。然而,创伤后应激障碍和物质滥用障碍具有某种非适应性记忆过强的特征,不利于个体生存。因此,以病理性改变的记忆为靶点,通过削弱或更新非适应性记忆,可以达到缓解症状甚至治愈的目的。记忆并非是对经验的刻板记录,而是对经验不断更新整合的过程,因此记忆有被干预的可能。记忆的再次激活可能会诱发记忆消退和再巩固,这为记忆相关精神疾病的干预提供了思路和启发。非侵入性脑刺激（noninvasive brain stimulation,NIBS）技术作为一种时间、空间分辨率较高的无创神经调控技术,近年来开始被结合运用到记忆干预研究中。不同刺激参数的NIBS （如频率、极性,以及受刺激区域的初始神经激活状态）应用于特定大脑皮质区域,可以调节神经可塑性,增强或降低靶点脑区的兴奋性,从而削弱或增强行为表现,实现记忆消退增强或在再巩固时间窗内干预记忆。本文首先介绍了记忆相关的脑功能基础研究与局部脑区干预方案的理论联系,继而回顾了近年来NIBS与记忆干预相结合应用于创伤或物质滥用相关障碍的临床干预研究,为精神疾病临床诊疗提供理论依据和启发。     

综述: 引发“战斗?鄄逃跑”反应的神经环路机制

\"战斗-逃跑\"反应是人和动物面临生存威胁时,产生的一系列应激行为和生理反应,该反应有助于个体提高战斗或逃跑的能力,以提高生存概率.过度或反复\"战斗-逃跑\"反应能诱发一类称为创伤后压力应激障碍(post-traumatic stress disorder,PTSD)的精神疾病.频繁的自然灾害和交通事故使我国人口受到PTSD的严重危害.要揭示PTSD的发病机理,首先需要深入地了解引发\"战斗-逃跑\"反应的脑内神经环路和机制.本文综述了该研究领域的进展和亮点工作,强调了该研究在国家相关领域中的重要性.     

四逆散对PTSD及睡眠障碍大鼠海马CA1/CA3区神经元动作电位的影响

目的：研究四逆散对创伤后应激障碍（PTSD）及睡眠障碍大鼠海马CA1/CA3区神经元动作电位的影响。方法：SD雄性大鼠50只随机分为5组：空白组、生理盐水组、模型组、四逆散组和帕罗西汀组（n=10）。空白组和生理盐水组正常饲养,其他组用幽闭电击法复制PTSD模型,生理盐水组每天灌胃给予生理盐水10 ml/kg,模型组于造模前1 h灌胃生理盐水10 ml/kg,帕罗西汀组和四逆散组分别于造模前1 h灌胃盐酸帕罗西汀4.2 mg/kg和四逆散2.41 g/kg进行处理,每天1次,连续7 d,造模和干预同时进行。使用在体多通道神经信号采集系统,采集大鼠海马CA1/CA3区神经元动作电位。结果：生理盐水组与空白组大鼠海马CA1/CA3区动作电位发放均多为发散状,且脉冲较密集。与生理盐水组相比,模型组大鼠海马CA1/CA3区动作电位发放脉冲较稀少,电位发放呈簇状。与模型组相比,帕罗西汀组、四逆散组动作电位发放脉冲稍多,呈发散状。与空白组比较,生理盐水组大鼠海马CA1/CA3区平均峰电位发放速率无明显差异,提示灌胃刺激对大鼠海马CA1/CA3区平均峰电位发放速率影响不明显。模型组大鼠海马CA1/CA3区平均峰电位发放速率显著低于生理盐水组,表明幽闭电击能明显抑制海马CA1/CA3区平均峰电位发放速率。与模型组相比,四逆散组和帕罗西汀组大鼠海马CA1/CA3区平均峰电位发放速率均显著升高,提示两药物对PTSD大鼠海马CA1/CA3区单位时间峰电位发放速率有明显调节作用。结论：四逆散对大鼠海马CA1/CA3区神经元时空特性损害有明显的改善作用。     

A randomized controlled effectiveness trial of cognitive behavior therapy for post-traumatic stress disorder in terrorist-affected people in Thailand

Although cognitive behaviour therapy (CBT) is the treatment of choice for post-traumatic stress disorder (PTSD), there is no evidence of its success with PTSD patients still under direct threat of terrorist attacks. This study reports the first randomized controlled trial of CBT for PTSD terrorist-affected people. Twenty-eight survivors of terrorist attacks in southern Thailand were randomized to 8 sessions of either CBT or treatment as usual (TAU). CBT was modified to accommodate the realistic threats facing patients. There were independent assessments conducted before, immediately after, and 3 months following treatment. Main outcome measures included symptoms of PTSD (PTSD Symptom Scale Interview), depression (Beck Depression Inventory) and complicated grief (Inventory of Complicated Grief). CBT resulted in significantly greater reduction in symptoms, including PTSD, depression, and complicated grief, at follow-up than TAU. Relative to TAU, CBT had stronger effect sizes at follow-up for PTSD, depression, and complicated grief. More patients in the CBT condition (75%) achieved high end-state functioning than participants in the TAU (33%). This preliminary evidence suggests that PTSD, depression, and complicated grief can be effectively treated despite ongoing threats of terrorism. Further, it demonstrates that non-specialist mental health workers in a non-western setting can be efficiently trained in using CBT, and this training can translate into successful treatment gains in trauma-affected individuals.     

Focus: The Science of Stress: Potential Societal and Cultural Implications of Transgenerational Epigenetic Methylation of Trauma and PTSD: Pathology or Resilience?

Psychological trauma is unique in that it is an environmental event that could induce biological changes and post-traumatic stress disorder (PTSD), depression, or other mood disorders in some patients. On the other hand, there may be no psychopathology (in most cases), or even sometimes post-traumatic growth and resilience. According to the DSM-5, trauma is a prerequisite for PTSD and traumatic stress disorder, but not for depressive episodes or mood disorders, or other psychiatric conditions. This paper brings attention to the preliminary literature on transgenerational inheritance due to trauma exposure and its societal and cultural implications. There is accumulating evidence that exposure to trauma can be passed transgenerationally through epigenetic inheritance leading to changes in gene expression and possible disorders or resilience. The effects of resilience from transgenerational inheritance have not been studied, but should be, for a full understanding not only of the disease risk across generations, but also of its social and cultural implications. The epigenetic pathologic effects across generations also need further studies, as the current research is preliminary; larger replications are needed for definitive and more complete understanding. I present here a glimpse of where we are, a vision of where we should go in terms of future research direction for disease risk transmission, and recommend studies of resilience and post-traumatic growth across generations, as well as other studies related to the societal implications at the population level.     

Effectiveness and specificity of a classroom-based group intervention in children and adolescents exposed to war in Lebanon

The purpose of this study was to examine the effectiveness and specificity of a classroom-based psychosocial intervention after war. All students (n=2500) of six villages in Southern Lebanon designated as most heavily exposed to war received a classroom-based intervention delivered by teachers, consisting of cognitive-behavioural and stress inoculation training strategies. A random sample of treated students (n=101) and a matched control group (n=93) were assessed one month post-war and one year later. Mental disorders and psychosocial stressors were assessed using the Diagnostic Interview for Children and Adolescents - Revised with children and parents. War exposure was measured using the War Events Questionnaire. The prevalence of major depressive disorder (MDD), separation anxiety disorder (SAD) and post-traumatic stress disorder (PTSD) was examined pre-war, one month post-war (pre-intervention), and one year post-war. Specificity of treatment was determined by rating teachers’ therapy diaries. The rates of disorders peaked one month post-war and decreased over one year. There was no significant effect of the intervention on the rates of MDD, SAD or PTSD. Post-war MDD, SAD and PTSD were associated with pre-war SAD and PTSD, family violence parameters, financial problems and witnessing war events. These findings have significant policy and public health implications, given current practices of delivering universal interventions immediately post-war.     

A half-century of neurotransmitter research: impact on neurology and psychiatry. Nobel lecture

The effect that research on dopamine and other neutro trasmitters has on disciplines like neurology and psychiatry is described.     

The injured mind in the UK Armed Forces

The mental health of the UK Armed Forces is a topic much debated by healthcare professionals, politicians and the media. While the current operations in Afghanistan, and the recent conflict in Iraq, are relevant to this debate, much of what is known about the effects of war upon the psyche still derives from the two World Wars. This paper will examine the historical and contemporary evidence about why it is that some Service personnel suffer psychological injuries during their military service and others do not. The paper will also consider some of the strategies that today's Armed Forces have put in place to mitigate the effects of sending military personnel into danger.     

甲基苯丙胺的急性和慢性作用机理的研究进展

甲基苯丙胺是一种被广泛使用的神经兴奋剂,它可以使人兴奋,产生欣快感并引起幻觉。这主要是因为脑内的多巴胺和5-羟色胺急剧大量增加所致。长期使用甲基苯丙胺,会对多巴胺和5-羟色胺神经末梢产生持续性的损伤。甲基苯丙胺毒性机理包括兴奋性毒性、线粒体损伤、氧化应激、代谢改变以及炎症反应等,这些均会造成神经末梢损伤。综述了甲基苯丙胺造成神经末梢急性和慢性损伤的机制。     

The Treatment of Recalcitrant Post-traumatic Nightmares with Autogenic Training and Autogenic Abreaction: A Case Study

Recurrent and frightening dreams are commonly experienced by patients who suffer from post-traumatic stress disorder after a motor vehicle accident. Such nocturnal episodes, if left untreated, can result in the experience of severe distress with physical, emotional, and psychophysiological concomitant. The present single-case study investigated the effects of the standard autogenic exercises and autogenic abreaction in reducing the frequency and severity of post-traumatic nightmares in a survivor of a car crash. The patient was also instructed in two additional organ-specific formulas in order to improve her sleep. The results of the study showed that the interventions were successful in effectively treating the patient's distressing nightmares. Follow-up data suggested that the treatment effects persisted after the termination of therapy. Suggestions for future investigations are discussed.     

Previous stress increases in vivo biogenic amine response to swim stress

In vivo microdialysis was used to determine biogenic amines in medial prefrontal cortex of rats exposed to eight minutes of swim stress on two consecutive days. On the first day of stress, norepinephrine (NE) efflux increased by 183% over baseline after stress, while dopamine (DA) and serotonin (5-HT) remained stable throughout. On the second day of stress, a robust increase was observed in all 3 neurotransmitters measured, with (NE), (DA), and (5-HT) increasing by 310%, 441% and 496% respectively, and remaining elevated for an hour or more after stress. This suggests that the first exposure to swim stress, while not causing dramatic changes in biogenic amine release, may sensitize biogenic amines in medial prefrontal cortex to subsequent swim stress. Our results also serve as preliminary data concerning the neurochemical changes which might underlie the forced swimming model of behavioral despair.     

Transient suppression of progenitor cell proliferation through NMDA receptors in hippocampal dentate gyrus of mice with traumatic stress experience

Post-traumatic stress disorder is a long-lasting psychiatric disease after the traumatic experience of severe fatal stress with the consequence of hippocampal atrophy. Freezing behaviors were more than quintupled on the fear-conditioning test in mice previously subjected to water immersion restrain stress (WIRS) with metronome tones when determined 1–28 days after WIRS, while these mice exhibited the increased immobility time on the forced swimming test with the increased spontaneous locomotion. Prior experience of WIRS led to a transient decrease in subsequent 5-bromo-2'-deoxyuridine (BrdU) incorporation into proliferating cells in the hippocampal dentate gyrus. These behavioral and neurochemical alterations were significantly prevented by the daily injection of the tricyclic antidepressant imipramine and the selective serotonin reuptake inhibitor fluvoxamine, respectively. Moreover, WIRS significantly decreased the number of cells holding BrdU without affecting the differentiation ratio to astroglial and neuronal lineages 28 days later. Prior administration of an NMDA receptor antagonist significantly prevented the aforementioned changes by WIRS. These results suggest that NMDA receptors may play a role in mechanisms underlying the crisis of a variety of psychiatric symptoms relevant to post-traumatic stress disorder through transient suppression of neural progenitor cell proliferation in the murine hippocampal dentate gyrus.     

Effect of Moxibustion on Dopaminergic and Serotonergic Systems of Rat Nucleus Accumbens

Acupuncture and moxibustion are traditional medical treatments that have come to play important roles in complementary and alternative medicines. Moxibustion also has a long history as a folk remedy in Japan, particularly due to the technical simplicity and selective efficacy on certain types of disease and distress. This study examined the effects of moxibustion focusing on the brain reward system, particularly in the nucleus accumbens. The effects of moxibustion stimulation at various sites and frequencies on monoamine levels of adult male Sprague-Dawley rats were examined using high-preformance liquid chromatography of dissected nucleus accumbens tissues. The rats weighing 290–310 g were divided into 3 groups according to the moxibustion point used: hindlimb, lumbar or parietal points. Each group was further divided into 3 subgroups, with stimulation for 10 consecutive days, for 1 day, or sham treatment (control). On each day of stimulation, 5 moxibustion cones with a peak temperature of 200°C were applied consecutively. Stimulation of any point on 1 day only did not change dopamine or serotonin levels, but lumbar stimulation significantly increased the metabolic turnover of dopamine. Conversely, stimulation for 10 consecutive days resulted in significantly decreased serotonin levels for hindlimb and parietal stimulations, and significantly increased 5-hydroxyindolacetic acid/serotonin ratio for hindlimb stimulation. These results suggest that the metabolic turnover of serotonin release may be accentuated by moxibustion in a reward-related brain area. Moxibustion over consecutive days, especially that to peripheral regions, appears most efficient to influence on monoamine levels in the nucleus accumbens. Special issue dedicated to Dr. Simo S. Oja     

Effect of ibogaine on serotonergic and dopaminergic interactions in striatum from mice and rats

The effect of ibogaine (Endabuse, NIH 10567) on serotonin uptake and release, and on serotonergic modulation of dopamine release, was measured in striatal tissue from rats and mice. Two hours after treatment in vivo with ibogaine (40 mg/kg i.p.), the uptake of labeled [³H]serotonin and [³H]dopamine uptake in striatal tissue was similar in the ibogaine-treated animal to that in the control. The 5HT_1B agonist CGS-12066A (10^–5 M) had no effect on stimulation-evoked tritium release from mouse or rat striatal tissue preloaded with [³H]serotonin; however, it elevated tritium efflux from striatal tissue preloaded with [³H]dopamine. This increase was not seen in mice treated with ibogaine 2 or 18 hours previously, or in rats treated 2 hours before. Dopamine autoreceptor responses were not affected by ibogaine pretreatment in either mouse or rat striatal tissue; sulpiride increased stimulation-evoked release of tritium from tissue preloaded with [³H]dopamine. The long-lasting effect of ibogaine on serotonergic functioning, in particular, its blocking of the 5HT_1B agonist-mediated increase in dopamine efflux, may have significance in the mediation of its anti-addictive properties.Special issue dedicated to Dr. Sidney Ochs.