The Epidemiology and Neuroimaging Research in Coal Mining Accident Survivors with Posttraumatic Stress Disorder
|School||Central South University|
|Course||Psychiatry and Mental Health|
|Keywords||Post-traumatic stress disorder Mine Survivor Incidence Influencing factors PTSD fMRI 3D DTI|
PartⅠPrevalence and risk factors for posttraumatic stressdisorder among survivors from a Hunan coal miningaccident after two and ten monthsObjective The study ascertained the prevalence of posttraumaticstress disorder (PTSD) among survivors from a Hunan coal miningaccident after two and ten months. Factors related to PTSD were alsoconsidered.Methods To estimate the prevalence of PTSD, the miners weresurveyed through use of the PTSD Checklist-Civilian Version (PCL-C)after two months of the coal mining accident. According the rating ofPCL-C, 24 acute severe PTSD patients and 24 Non-PTSD subjects wereevaluated through the use of Clinician Associated PTSD scale (CAPS),Impact of Event Scale-Revised (IES-R), State-Trait Anxiety Inventory(STAI), Beck Depression Inventory(BDI), Eysenck PersonalityQuestionnaire (EPQ), Wechsler memory Scale -Revised (WMS-R) anddetailed instances before and after the accident. After ten months of theaccident, the surviors were surveyed again.Results one hundred and four (92.9%) of the 112 survivors weresurveyed. The current prevalence rate among survivors from the coalmining accident was 50%. There were significant difference of PTSD symptoms, anxiety and depression, personality, and memory performancebetween the chosen 24 severe PTSD patients and 24 Non-PTSD controls.State anxiety, when to renew the work, BDI, EPQ-Neurorticism, wherewere they when accident happening, and length services are predictors ofPTSD. After ten months of the accident, 85 survivors were evaluated, inwhich 30.6 percent surviors still met the criterion of PTSD. In theabove-mentioned 48 miners, 18 PTSD patients and 23 Non-PTSDcontrols received the second evaluation. Compared with 2 months afterthe accident, PTSD symptoms, anxiety, as well as memory performanceimproved clearly, while the depressive symptoms had no significantdifference. We found that state anxiety, when to renew the work, positivecoping, emotional balance and length services were the factors of PTSDsymptoms healing.Conclusion The current prevalence rate of PTSD among survivorsfrom coal mining accident is high. The mining accident had made greatinfluence on victims, and psychological or medication interventions werenecessary. There were lots of risk factors of the prevalence of PTSD, andpositive coping may be a benefit factor of PTSD recovery.PartⅡThe brain functional and structural mechanism incoal mining survivors with PTSD after two and ten monthsObjective Functional and structural neuroimaging studies havelargely been performed in patients with longstanding chronicposttraumatic stress disorder (PTSD). We sought to characterize the brain responses and structure of patients with acute severe PTSD, andinvestigate the neurocircuit of PTSD. All subjects would be reevaluatedat ten months after the coal mining accident for the longitudinalobservations.Methods 24 individuals with acute severe PTSD resulting from themining accident and 24 subjects exposed to the mining accident withoutPTSD underwent functional magnetic resonance imaging (fMRI) whileperforming the emotional counting stroop, the symptom provocation andtrauma related short-term memory recall paradigms. All three functionaltasks were block designs. The duration of every series was 5 minutes and12 seconds. 3 dimension imaging (3D) and diffusion tensor magneticresonance imaging (DTI) examinations were followed. After fMRI andMRI tests were finished, we offered to them free psychological andmedication therapy. All the subjects were reassessed and diagnosed forPTSD symptoms at the ten months from the mining accident, and thePTSD patients who were diagnosed for the first time received fMRI andMRI tests for the second time. The data of structural and functional MRIwere dealt with statistical parametric mapping (SPM2) software.Results (1) During the emotional counting stroop, PTSD subjectsshowed diminished responses in bilateral anterior cingulate gyrus, rightinferior frontal gyrus, left superior temporal gyrus and etc, compared withNon-PTSD controls at the two months after the accident. PTSD subjectsshowed enhanced responses in left medial frontal gyrus, right middlefrontal gyrus, right cingulate gyrus, left parahippocampal gyrus comparedwith Non-PTSD controls at ten months after the accident. When PTSDsubjects at ten months were compared with at two months by paired t-test,bilateral superior frontal gyrus, bilateral middle frontal gyrus, rightcingulate gyrus, left parahippocampal gyrus had enhanced responses. (2) During symptom provocation paradigm, PTSD subjects showeddiminished responses in right anterior cingulate gyrus, left inferior frontalgyrus and bilateral middle frontal gyrus, and enhanced leftparahippocampal gyrus response compared with Non-PTSD controls attwo months after the accident. PTSD subjects showed enhanced rightsuperior temporal (BA 38) response and diminished responses in rightsuperior temporal gyrus (BA 22), right insula compared with Non-PTSDsubjects at ten months after the accident. By paried t-test, PTSD patientsat ten months showed diminished right cingulate gyrus responsecompared with PTSD patients at two months. (3) During the short-termmemory recall paradigm, PTSD group showed diminished responses inright inferior frontal gyrus, right middle frontal and left middle occipitalgyrus in comparison with controls at two months. PTSD group showeddiminished responses in right inferior frontal gyrus and right middlefrontal gyrus compared with Non-PTSD subjects at ten months. By pariedt-test, PTSD subjects at ten months showed diminished rightparahippocampus gyrus and bilateral superior temporal gyrus comparedwith PTSD patients at two months. (4) PTSD group exhibited diminishedright parahippocampal gyrus response during the memory recall task ascompared to the symptom provocation task at two months. PTSD groupexhibited diminished left parahippocampal gyrus response during thememory recall task as compared to the symptom provocation task at tenmonths. (5) The brain morphologic showed that the Gray Matter Density(GMD) of left middle frontal gyrus was significantly lower than thecontrols at two months. The brain morphologic showed that the GrayMatter Density (GMD) of bilateral parahippocampal and right middlefrontal gyrus were significantly lower than the controls at ten months.The brain morphologic showed that the Gray Matter Density (GMD) ofright parahippocampal, left cingulate gyrus, left inferior frontal gyrus, left medial frontal gyrus, left middle temporal gyrus, left inferior temporal,left insula and left inferior parietal lobule were significantly higher than attwo months. (6) The DTI results showed PTSD patients at two monthshad significantly higher fractional anisotropy values in the left anteriorcingulate gyrus, right posterior cingulate gyrus, left subcorpus callosum,right middle frontal gyrus, and left parahippocampal gyrus.Conclusions Our findings suggest that neurophysiologicalalterations, memory performance deficit have developed in acute severePTSD. By longitudinal research, we found the brain function andstructure made changes. Some brain regions recovered, but some didn’t.In all, the brain areas such as frontal lobe and hippocampus mayimportantly contribute to the PTSD neurocircurity. Additionally, therewere some ambivalent results in the present study and need futureresearch and interpretation. Tranma influenced PTSD patientschronically.