Cognitive Impairment And Neuroimaging In Child Abuse-related PTSD

Objective:Posttraumatic Stress Disorder Classic posttraumatic (PTSD) is the delay and (or) lasting reaction to unusual threatening, catastrophic events. Traumatic event is the necessary condition for the diagnosis of PTSD, including natural disasters or man-made disasters, such as war, serious accidents, and seeing others dies tragically, under torture, etc. We investigated whether child abuse-related PTSD effect the clinical symptom, cognitive function, brain structural magnetic resonance imaging.Methods:We randomly selected27female PTSD patients consistent with DSM-IV Axis diagnosis from Hebei Medical University-Institute of Mental Health, according to the childhood trauma questionnaire score which divided into PTSD children trauma high group and PTSD children trauma low group, with an additional choice to match with the study group of20healthy volunteers. The people in each group should be given clinical assessment, including PTSD17item screening questionnaire (PCL-C), the clinical diagnosis using DSM-Ⅳ PTSD Scale (CAPS), Childhood Trauma Questionnaire-28Short Form (CTQ-SF), State-Trait Anxiety Inventory (STAI), Minnesota Multiphasic Personality Inventory (MMPI); memory-related indicators for assessment, including the Wechsler Adult Intelligence Scale (WAIS-R) Short Form (similarities and block design assessment of verbal and performance IQ), Merriam-Webster Memory Scale measurement of learning and memory function test (WPS-R) including an understanding of memory (understanding of memory), delayed memory test (half-hour later, repeat contents of understanding memory and immediate visual regeneration test (the image of memory), and delayed visual regeneration); Wisconsin Card Sorting Test (WCST) measured executive function;functional static3D structures such as nuclear magnetic resonance examination.The results of all scales using SPSS13.0software analyze, F test used by completely random design measurement data which meeting normality and homogeneity of variance, LSD of the analysis of variance used in Three measurement data groups, according to the data not conform to the normal distribution,we used Spearson related for the relationship between CTQ and CAPS scores, using voxel-based morphological (VBM) analysis method, set P<0.001, difference in area size>30pixels, with SPM5package, analyze the differences of cerebral gray matter volume among the three groups.Results:1No significant differences were found in age and average education level among PTSD child trauma high score group, PTSD child trauma low score group and normal control group (P>0.05)2Significant differences among three groups on STAI (P<0.01). The scores of S-AI and T-AI were higher on PTSD child trauma high score group than other groups (P<0.01)3Comparison of MMPI scores in three group, there were no significant differences on L, F, K, Mf, Ma scores (P>0.05). Comparison between any two groups D, Pt scores had significant differences. Comparing PTSD child trauma low score group with high score group, there were no significant differences on Hs, Hy, Pd, Pa scores (P>0.05), but PTSD child trauma low score group vs normal control group and PTSD child trauma high score group vs normal control group had significant differences (P<0.05). PTSD child trauma high score group vs normal control group had significant differences on Sc factor score (P<0.05), others had no statistical significant. Contrast to Si scores, PTSD child trauma low score group vs PTSD child trauma low score group and PTSD child trauma high score group vs normal control group had significant differences (P<0.05), no significant differences between PTSD child trauma low score group vs normal control group (P>0.05)4Among three groups there were significant differences on WAIS-RC (P<0.05), PTSD child trauma high score group scores were lower than normal control group (P<0.05). Four kinds of memory function including understanding memory(C), delayed understanding memory(DC), visual regeneration(R), and delayed visual regeneration(DR), there were significant differences in four kinds of memory function among the three groups (P<0.01). Comparison between any two groups, PTSD child trauma low score group vs normal control group and PTSD child trauma high score group vs normal control group had significant differences on C, DC, R, DR (P<0.05).5There was significant differences on WCST by using analysis of variance method among the three groups in the executive function (P<0.05), PTSD child trauma low score group vs normal control group and PTSD child trauma high score group vs normal control group had significant differences on the total number of responses (Ra), the completion of classification number (Cc), the number of correct response (Rc), the error response number (Re), continuous errors (Rpe)(P<0.05). Comparing between any two groups, the completion of the first one required to answer a few categories (Rf), non-persistent errors (nRpe) had statistically significant difference (P<0.05).6Analysis of correlation between CTQ scores and CAPS scores in three groups, B factor were positively correlate with physical abuse, sexual abuse (r=0.477, r=0.412, P<0.05). C factor were positively correlate with physical abuse, physical neglect (r=0.412, r=0.416, P<0.05). D factor were positively correlate with physical abuse, physical neglect (r=0.480、r=0.408, P<0.05).CAPS total scores were positively correlate with physical abuse (r=0.504, P<0.01).7VBM analysis revealed that there were no significant differences between PTSD child trauma high score group and low score group[P<0.001(FDR)]. PTSD child trauma low score group had smaller gray matter volume of part of frontal lobe, temporal lobe than normal control group [P<0.001(FDR)]. Comparison to normal control group, PTSD child trauma high score group had less gray matter volume in widely of frontal lobe, temporal lobe, cerebellum [P<0.001(FDR)] Conclusion:1The higher Childhood Trauma Questionnaire scores on PTSD patient who experienced children traumatic event, the more serious trait and state anxiety they felt.2There was some personality changed on PTSD patient who had high scores on child trauma questionnaire.3There were obviously declined on intelligence, memory, executive function on PTSD patient who had high scores on child trauma questionnaire.4Certain correlation between the type of Child trauma and typical clinical symptoms with PTSD.5The negative life events might affect brain development. comparing to normal control group, PTSD children trauma high group had less gray matter volume in extensive prefrontal lobe, temporal lobe and cerebellar.