Gonul Ali Saffet, Kula Mustafa, Bilgin Arzu Guler, Tutus Ahmet, Oguz Aslan
Department of Psychiatry, Ege University, School of Medicine, 35100-Izmir, Turkey.
Prog Neuropsychopharmacol Biol Psychiatry. 2004 Sep;28(6):1015-21. doi: 10.1016/j.pnpbp.2004.05.036.
Depressive patients with psychotic features demonstrate distinct biological abnormalities in the hypothalamic-pituitary-adrenal axis (HPA), dopaminergic activity, electroencephalogram sleep profiles and measures of serotonergic function when compared to nonpsychotic depressive patients. However, very few functional neuroimaging studies were specifically designed for studying the effects of psychotic features on neuroimaging findings in depressed patients. The objective of the present study was to compare brain Single Photon Emission Tomography (SPECT) images in a group of unmedicated depressive patients with and without psychotic features. Twenty-eight patients who fully met DSM-IV criteria for major depressive disorder (MDD, 12 had psychotic features) were included in the study. They were compared with 16 control subjects matched for age, gender and education. Both psychotic and nonpsychotic depressed patients showed significantly lower regional cerebral blood flow (rCBF) values in the left and right superior frontal cortex, and left anterior cingulate cortex compared to those of controls. In comparison with depressive patients without psychotic features (DwoPF), depressive patients with psychotic features (DwPF) showed significantly lower rCBF perfusion ratios in left parietal cortex, left cerebellum but had higher rCBF perfusion ratio in the left inferior frontal cortex and caudate nucleus. The present study showed that DwPF have a different rCBF pattern compared to patients without psychotic features. Abnormalities involving inferior frontal cortex, striatum and cerebellum may play an important role in the generation of psychotic symptoms in depression.
与非精神病性抑郁患者相比，伴有精神病性特征的抑郁患者在下丘脑 - 垂体 - 肾上腺轴（HPA）、多巴胺能活性、脑电图睡眠特征以及血清素能功能指标方面表现出明显的生物学异常。然而，专门针对研究精神病性特征对抑郁患者神经影像学结果影响的功能性神经影像学研究非常少。本研究的目的是比较一组未服药的伴有和不伴有精神病性特征的抑郁患者的脑单光子发射断层扫描（SPECT）图像。28名完全符合DSM - IV重度抑郁症（MDD）标准的患者（其中12名有精神病性特征）被纳入研究。将他们与16名在年龄、性别和教育程度上匹配的对照受试者进行比较。与对照组相比，精神病性和非精神病性抑郁患者在左右额上叶皮质以及左前扣带回皮质的局部脑血流量（rCBF）值均显著降低。与无精神病性特征的抑郁患者（DwoPF）相比，有精神病性特征的抑郁患者（DwPF）在左顶叶皮质、左小脑的rCBF灌注率显著降低，但在左下额叶皮质和尾状核的rCBF灌注率较高。本研究表明，与无精神病性特征的患者相比，DwPF具有不同的rCBF模式。涉及下额叶皮质、纹状体和小脑的异常可能在抑郁症精神病性症状的产生中起重要作用。
