Krüger Stephanie, Seminowicz David, Goldapple Kim, Kennedy Sidney H, Mayberg Helen S
Department of Psychiatry (SK), University of Dresden, Dresden, Germany.
Biol Psychiatry. 2003 Dec 1;54(11):1274-83. doi: 10.1016/s0006-3223(03)00691-7.
Even in remission, patients with bipolar disorder (BD) remain sensitive to external stressors that can trigger new episodes. Imitating such stressors by the controlled transient exposure to an emotional stimulus may help to identify brain regions modulating this sensitivity.
Transient sadness was induced in 9 euthymic and in 11 depressed subjects with BD. Regional blood flow (rCBF) changes were measured using (15)O-water positron emission tomography.
Common changes in both groups were increased rCBF in anterior insula and cerebellum and decreased rCBF in dorsal-ventral-medial frontal cortex, posterior cingulate, inferior parietal, and temporal cortices. Decreases in dorsal ventral medial frontal cortices occurred in both groups, but subjects in remission showed a greater magnitude of change. Unique to remitted subjects with BD were rCBF increases in dorsal anterior cingulate and in premotor cortex. Lateral prefrontal rCBF decreases were unique to depressed subjects with BD. At baseline, remitted subjects showed a unique increase in dorsal anterior cingulate and orbitofrontal cortex.
Common rCBF changes in remitted and depressed subjects identifies potential sites of disease vulnerability. Unique cingulate and orbitofrontal changes both at baseline and with induced sadness seen in the absence of prefrontal rCBF decreases may identify regional interactions important to the euthymic state in this population.
即使处于缓解期，双相情感障碍（BD）患者仍对外界应激源敏感，这些应激源可引发新的发作。通过控制性短暂暴露于情感刺激来模拟此类应激源，可能有助于识别调节这种敏感性的脑区。
对9名处于心境正常期和11名处于抑郁发作期的BD患者诱发短暂悲伤情绪。使用（15）O-水正电子发射断层扫描测量局部脑血流（rCBF）变化。
两组的共同变化是，前岛叶和小脑的rCBF增加，背侧-腹侧-内侧额叶皮质、后扣带回、顶下叶和颞叶皮质的rCBF减少。两组患者背侧腹侧内侧额叶皮质均出现减少，但处于缓解期的患者变化幅度更大。BD缓解期患者独有的变化是背侧前扣带回和运动前皮质的rCBF增加。外侧前额叶rCBF减少是BD抑郁发作期患者独有的变化。在基线时，缓解期患者背侧前扣带回和眶额皮质出现独特的增加。
缓解期和抑郁发作期患者常见的rCBF变化确定了疾病易感性的潜在部位。在没有前额叶rCBF减少的情况下，基线时以及诱发悲伤时扣带回和眶额皮质出现的独特变化，可能确定了该人群中对心境正常状态重要的区域间相互作用。
