Szeszko Philip R, MacMillan Shauna, McMeniman Marjorie, Lorch Elisa, Madden Rachel, Ivey Jennifer, Banerjee S Preeya, Moore Gregory J, Rosenberg David R
Department of Psychiatry Research, Zucker Hillside Hospital, North Shore - Long Island Jewish Health System, Glen Oaks, NY 11004, USA.
Neuropsychopharmacology. 2004 Apr;29(4):826-32. doi: 10.1038/sj.npp.1300399.
The amygdala is believed to be highly relevant to the pathophysiology of obsessive-compulsive disorder (OCD) given its prominent role in fear conditioning and because it is an important target of the serotonin reuptake inhibitors (SRIs), the pharmacotherapy of choice for OCD. In the present study, we measured in vivo volumetric changes in the amygdala in pediatric patients with OCD following 16 weeks of monotherapy with the selective SRI, paroxetine hydrochloride. Amygdala volumes were computed from contiguous 1.5 mm magnetic resonance (MR) images in 11 psychotropic drug-naive patients with OCD prior to and then following treatment. Eleven healthy pediatric comparison subjects also had baseline and follow-up scans, but none of these subjects received medication. Patients demonstrated significant asymmetry of the amygdala (L>R) prior to pharmacologic intervention in contrast to healthy comparison subjects who showed no asymmetry at the time of their baseline scan. Mixed model analyses using age and total brain volume as time varying covariates indicated that left amygdala volume decreased significantly in patients following treatment. The reduction in left amygdala volume in patients correlated significantly with higher paroxetine dosage at the time of the follow-up scan and total cumulative paroxetine exposure between the scans. No significant changes in either right or left amygdala volume were evident among healthy comparison subjects from the baseline to the follow-up scan. These preliminary findings suggest that abnormal asymmetry of the amygdala may play a role in the pathogenesis of OCD and that paroxetine treatment may be associated with a reduction in amygdala volume.
杏仁核被认为与强迫症（OCD）的病理生理高度相关，这是因为它在恐惧条件反射中起重要作用，且它是5-羟色胺再摄取抑制剂（SRIs）的重要靶点，而SRIs是强迫症的首选药物治疗方法。在本研究中，我们测量了16周选择性SRI盐酸帕罗西汀单一疗法治疗后，小儿强迫症患者杏仁核的活体体积变化。在11名未服用过精神药物的强迫症患者治疗前及治疗后，根据连续的1.5毫米磁共振（MR）图像计算杏仁核体积。11名健康小儿对照受试者也进行了基线和随访扫描，但这些受试者均未接受药物治疗。与健康对照受试者在基线扫描时无不对称性不同，患者在药物干预前杏仁核存在显著不对称（左>右）。使用年龄和全脑体积作为随时间变化的协变量进行混合模型分析表明，治疗后患者左侧杏仁核体积显著减小。患者左侧杏仁核体积的减小与随访扫描时较高的帕罗西汀剂量以及两次扫描之间帕罗西汀的总累积暴露量显著相关。从基线扫描到随访扫描，健康对照受试者的右侧或左侧杏仁核体积均无明显变化。这些初步研究结果表明，杏仁核的异常不对称可能在强迫症的发病机制中起作用，且帕罗西汀治疗可能与杏仁核体积减小有关。
