Trasntorno de estresse pós-traumático : investigação da conectividade cerebral e avaliação do efeito de técnicas autoaplicáveis em pacientes adultos

Abstract

Posttraumatic Stress Disorder (PTSD) is a serious world public health problem. Resting state functional magnetic resonance imaging (rs-fMRI) studies provide information about aberrant neurofunctional changes in this disorder. It is important to consider the analysis of the amygdala subdivisions (centromedial, CMA; basolateral, BLA; superficial, SFA) in this disorder to identify reliable biomarkers and therapeutic targets. This thesis is divided into two sections. SECTION I: We explored the connectivity patterns of the amygdala subregions in patients with PTSD developed by trauma in adulthood versus healthy controls. We also investigated associations of these patterns with scores of Childhood Trauma Questionnaire (CTQ), Posttraumatic Stress Disorder Checklist 5 (PCL-5), Beck Anxiety Inventory (BAI) and Patient Health Questionnaire-9 (PHQ-9). Twenty individuals participated in the study: 10 patients with PTSD and 10 healthy controls (18 women; mean age = 35.10 SD = 11.32). PTSD group showed lower connectivity among SFA and fusiform gyrus, lingual gyrus and medial occipital gyrus in compeer to control group. The PTSD group also showed negative associations among (I) CTQ scores and CMA connectivity with the anterior cingulate cortex, medial frontal gyrus and angular gyrus; (II) PCL-5 scores and CMA connectivity to supplementary motor area. It is necessary to expand investigations about connectivity dysfunctions of the amygdala subregions in PTSD to understand this relationship and the possible effects in sensoperceptive regions. SECTION II: We evaluated the effect of the joint use of two self-applicable audios on clinical outcomes (PCL-5, PHQ-9 and BAI) and brain connectivity in patients with PTSD. Eleven patients with PTSD participated in the study (10 women; mean age = 37.73 SD = 11.76). After eight weeks of intervention, the BAI, PHQ-9 and PCL-5 scores showed a significant reduction; there was a change in the connectivity scores between the left CMA and the upper right frontal gyrus. Having a technique that (I) gathers resources used in therapies already consolidated, (II) self-applicable and (III) accessible by Internet can increase access to the well-being of people who suffer the consequences of traumatic events experience. This is a pilot study with important limitations and its monitoring is essential to reduce speculation and expand the evidence.