精神医学65巻8号

2023年08月発行

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特集 複雑性PTSDの臨床

複雑性PTSDの神経生物学—逆境的小児期体験（ACEs）と心的外傷後ストレス症（PTSD）の研究からの考察

著者： 堀弘明¹

所属機関： ¹国立精神・神経医療研究センター精神保健研究所行動医学研究部

ページ範囲：P.1172 - P.1182

抄録
　複雑性心的外傷後ストレス症（PTSD）は，幼少期の虐待などの長期にわたり持続・反復するトラウマとの関連が強い精神疾患である。ICD-11において初めて公式診断に採用されたという経緯もあり，公式診断基準での複雑性PTSDを対象とした神経生物学的研究の報告は現在のところほとんど存在しない。一方，逆境的小児期体験（ACEs）による神経生物学的変化についての知見や，PTSD患者における神経生物学的異常についての知見が蓄積されてきている。そのうちACEsを有する者とPTSD患者に共通に認められる重要な所見として，視床下部-下垂体-副腎系の機能異常，炎症の亢進，扁桃体の過活動，海馬の体積減少が挙げられる。これらの知見はACEsからPTSDへと至る生物学的経路を示唆していると考えられ，複雑性PTSDの病因・病態を理解する上でも手がかりになる可能性がある。今後，複雑性PTSDを対象とした神経生物学的研究が進展することにより，病態に基づいたよりよい治療法の開発へとつながっていくことが期待される。

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