Identifying Electrophysiological Prodromes of Post-traumatic Stress Disorder: Results from a Pilot Study

Frontiers in Psychiatry

Christopher J. Cellucci¹  Michelle E. Costanzo²  Michael J. Roy²  Dominic E. Nathan³  Kylee Bashirelahi⁴  David Darmon⁴  Chao Wang⁴  David O. Keyser⁵  Paul E. Rapp⁵ 

[1] Aquinas LLC, Berwyn, PA, USA;Department of Medicine and Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA;Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, MD, USA;The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA;Traumatic Injury Research Program, Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA;

关键词: post-traumatic stress disorder;    prodromes;    event-related potentials;    delayed onset;    traumatic brain injury;    P300;   

DOI  :  10.3389/fpsyt.2017.00071

来源: DOAJ

【 摘 要 】

The objective of this research project is the identification of a physiological prodrome of post-traumatic stress disorder (PTSD) that has a reliability that could justify preemptive treatment in the sub-syndromal state. Because abnormalities in event-related potentials (ERPs) have been observed in fully expressed PTSD, the possible utility of abnormal ERPs in predicting delayed-onset PTSD was investigated. ERPs were recorded from military service members recently returned from Iraq or Afghanistan who did not meet PTSD diagnostic criteria at the time of ERP acquisition. Participants (n = 65) were followed for up to 1 year, and 7.7% of the cohorts (n = 5) were PTSD-positive at follow-up. The initial analysis of the receiver operating characteristic (ROC) curve constructed using ERP metrics was encouraging. The average amplitude to target stimuli gave an area under the ROC curve of greater than 0.8. Classification based on the Youden index, which is determined from the ROC, gave positive results. Using average target amplitude at electrode Cz yielded Sensitivity = 0.80 and Specificity = 0.87. A more systematic statistical analysis of the ERP data indicated that the ROC results may simply represent a fortuitous consequence of small sample size. Predicted error rates based on the distribution of target ERP amplitudes approached those of random classification. A leave-one-out cross validation using a Gaussian likelihood classifier with Bayesian priors gave lower values of sensitivity and specificity. In contrast with the ROC results, the leave-one-out classification at Cz gave Sensitivity = 0.65 and Specificity = 0.60. A bootstrap calculation, again using the Gaussian likelihood classifier at Cz, gave Sensitivity = 0.59 and Specificity = 0.68. Two provisional conclusions can be offered. First, the results can only be considered preliminary due to the small sample size, and a much larger study will be required to assess definitively the utility of ERP prodromes of PTSD. Second, it may be necessary to combine ERPs with other biomarkers in a multivariate metric to produce a prodrome that can justify preemptive treatment.

【 授权许可】

Unknown