Neuronale Korrelate psychotherapeutischer Behandlung bei Patienten mit posttraumatischer Belastungsstörung^[*]

Zusammenfassung

Posttraumatische Belastungsstörungen (PTBS) gehen mit Veränderungen der Reagibilität auf neuronaler Ebene einher. Dabei weisen Bildgebungsstudien auf eine erhöhte Aktivität in der Amygdala und eine verminderte Aktivität im präfrontalen Kortex hin. Psychotherapeutische Interventionen gelten als Goldstandard der PTBS-Behandlung. Es wurde eine systematische Literaturrecherche anhand der Datenbanken: PubMed, PsychInfo und dem zentralen Register der kontrollierten Studien der Cochrane Library mit den Suchbegriffen „neural correlates” ODER “fMRI” ODER “SPECT” UND “therapy” UND “PTSD” durchgeführt. 20 Artikel wurden eingeschlossen: 15 verglichen Signalveränderungen von vor zu nach Psychotherapie, sieben verglichen die neuronale Aktivität vor Therapie mit der Symptomreduktion von vor zu nach Therapie und vier Studien verglichen neuronale Korrelate von Therapieansprechen. Erfolgreiche PTBS-Psychotherapie führte über mehrere Studien hinweg zu einer verminderten neuronalen Aktivität in der Amygdala und Insula und zu einer erhöhten Aktivität im dorsalen anterioren zingulären Kortex sowie dem Hippocampus, was im Sinne einer wiedergewonnenen Top-down-Kontrolle interpretiert werden kann.

Summary

Patients with posttraumatic stress disorder (PTSD) show changes in neural circuitries. Particularly, functional imaging studies found an increased amygdala and a decreased prefrontal cortex response in PTSD patients. Psychotherapy represents the gold standard for PTSD treatment. Studies were selected through systematic literature research in the databases PubMed, PsychInfo and Cochrane Library’s Central Register of Controlled Trials or were identified manually by searching reference lists of selected articles. Search terms were “neural correlates” OR “fMRI” OR “SPECT”, AND “therapy” AND “PTSD”. 20 articles were included, 15 of them compared pre-to-post therapy signal changes, seven related pre-treatment activity to pre-to-post symptom improvement and four compared neural correlates of responders versus nonresponders. After psychotherapy, several neuroimaging studies consistently found decreased activity in the amygdala and the insula as well as increased activity in the dorsal anterior cingulate cortex and hippocampus, which might reflect a regained top-downcontrol.

Schlüsselwörter

fMRT - PTBS - Psychotherapie

Keywords

fMRI - PTSD - psychotherapy

^* Die vorliegende Studie ist eine für Nervenheilkunde überarbeitete, gekürzte Fassung der englischen Originalpublikation der Evaluationsergebnisse: Malejko K, Abler B, Plener PL, Straub J. Neural correlates of psychotherapeutic treatment of post-traumatic stress disorder: A systematic literature review. Frontiers in Psychiatry 2017; 8(85).

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