Caligiuri Michael P, Brown Gregory G, Meloy M J, Eberson Sonja C, Kindermann Sandra S, Frank Larry R, Zorrilla Lisa Eyler, Lohr James B
Movement Disorders Laboratory, Department of Psychiatry (0603), University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA.
Psychiatry Res. 2003 Jul 30;123(3):171-82. doi: 10.1016/s0925-4927(03)00075-1.
Structural neuroimaging studies have identified abnormalities in the basal ganglia in patients with bipolar disorder. Findings have been mixed with regard to affective state and have not elaborated on the role of medication on functional brain activity. The aims of the present study were to use functional magnetic resonance imaging (fMRI) to test whether depressed and manic bipolar disorder patients differ in terms of activity in cortical and subcortical brain areas and to examine the effects of psychotropic medication. Twenty-four bipolar disorder subjects and 13 healthy comparison subjects participated in an fMRI study of manual reaction time. Both manic and depressed subjects exhibited abnormally elevated blood oxygen level dependent BOLD responses in cortical and subcortical areas. Manic bipolar subjects had significantly higher BOLD responses in the left globus pallidus and significantly lower BOLD responses in the right globus pallidus compared with depressed bipolar patients. Correlational analyses revealed significant relationships between the severity of mania and activity within the globus pallidus and caudate. Patients off antipsychotic or mood-stabilizing medication exhibited significantly higher BOLD responses throughout the motor cortex, basal ganglia and thalamus compared with patients on these medications. These results suggest that affective state in bipolar disorder may be related to a disturbance of inhibitory regulation within the basal ganglia and that antipsychotics and/or mood stabilizers normalize cortical and subcortical hyperactivity.
结构神经影像学研究已确定双相情感障碍患者的基底神经节存在异常。关于情感状态的研究结果不一，且未详细阐述药物对大脑功能活动的作用。本研究的目的是使用功能磁共振成像（fMRI）来测试抑郁和躁狂双相情感障碍患者在皮质和皮质下脑区的活动是否存在差异，并研究精神药物的影响。24名双相情感障碍受试者和13名健康对照受试者参与了一项关于手动反应时间的fMRI研究。躁狂和抑郁受试者在皮质和皮质下区域均表现出血氧水平依赖（BOLD）反应异常升高。与抑郁双相情感障碍患者相比，躁狂双相情感障碍受试者左侧苍白球的BOLD反应显著更高，而右侧苍白球的BOLD反应显著更低。相关性分析显示，躁狂严重程度与苍白球和尾状核内的活动之间存在显著关系。与服用抗精神病药物或心境稳定剂的患者相比，未服用这些药物的患者在整个运动皮质、基底神经节和丘脑的BOLD反应显著更高。这些结果表明，双相情感障碍的情感状态可能与基底神经节内抑制调节紊乱有关，抗精神病药物和/或心境稳定剂可使皮质和皮质下的活动亢进恢复正常。
