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伴有精神运动迟缓的重度抑郁症中的动作监测

Action monitoring in major depressive disorder with psychomotor retardation.

作者信息

Schrijvers Didier, de Bruijn Ellen R A, Maas Yvonne, De Grave Carmen, Sabbe Bernard G C, Hulstijn Wouter

机构信息

Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium.

出版信息

Cortex. 2008 May;44(5):569-79. doi: 10.1016/j.cortex.2007.08.014. Epub 2007 Dec 23.

Abstract

Major depressive disorder (MDD) is characterized by disturbances of mood and affect, but also by a distinct pattern of psychomotor and cognitive deficits such as motor retardation and impaired executive functioning. An important aspect of executive functioning is performance monitoring, i.e., a continuous checking whether intended action goals have been reached and whether correction of the applied strategy is necessary. A well-known marker for action monitoring is the error negativity (Ne) or error-related negativity (ERN), an event-related potential (ERP) component generated in the anterior cingulate cortex (ACC) following erroneous responses. To date, Ne/ERN amplitudes have been investigated in moderately depressed patients only. The present study is the first to investigate action monitoring in severely depressed patients (mean Hamilton score=28.4). In addition, the patients' psychomotor performance was assessed to see whether there is a relationship between action monitoring and psychomotor retardation. Behavioural and ERP measurements were obtained during performance on a speeded two-choice reaction task in 26 patients with MDD and 25 healthy, matched controls. Psychomotor performance measures were speed of simple movements in various psychomotor tasks and the score on the Salpêtrière retardation rating scale (SRRS). Relative to the controls, the patients' behavioural results revealed a similar, but slower performance pattern. Overall between-group differences were demonstrated for the error positivity (Pe) amplitudes, but not for the Ne/ERN amplitudes. However, correlations of the Ne/ERN amplitude with several psychomotor variables were strong. In the depressed patients taking benzodiazepines an additional attenuation of Ne/ERN amplitudes was observed. Only severely depressed patients manifesting retardation showed impeded action monitoring. The correlations between action monitoring and psychomotor performance indicate that in MDD these two processes are highly interdependent, both being deregulated. Moreover, the same network of brain regions is likely to be implicated in both processes.

摘要

重度抑郁症(MDD)的特征不仅在于情绪和情感障碍,还在于一种独特的精神运动和认知缺陷模式,如运动迟缓及执行功能受损。执行功能的一个重要方面是绩效监测,即持续检查预期的行动目标是否已达成以及是否需要纠正所应用的策略。一个广为人知的行动监测指标是错误负波(Ne)或错误相关负波(ERN),它是一种在错误反应后在前扣带回皮质(ACC)产生的事件相关电位(ERP)成分。迄今为止,仅对中度抑郁症患者的Ne/ERN波幅进行了研究。本研究首次对重度抑郁症患者(汉密尔顿平均评分=28.4)的行动监测进行了调查。此外,还评估了患者的精神运动表现,以观察行动监测与精神运动迟缓之间是否存在关联。在26例MDD患者和25例健康匹配对照者执行快速二选一反应任务期间,获取了行为和ERP测量数据。精神运动表现指标包括各种精神运动任务中简单动作的速度以及萨尔佩特里埃迟缓评定量表(SRRS)的得分。相对于对照组,患者的行为结果显示出相似但较慢的表现模式。总体而言,组间在错误正波(Pe)波幅上存在差异,但在Ne/ERN波幅上没有差异。然而,Ne/ERN波幅与几个精神运动变量之间的相关性很强。在服用苯二氮䓬类药物的抑郁症患者中,观察到Ne/ERN波幅有额外降低。只有表现出迟缓的重度抑郁症患者存在行动监测障碍。行动监测与精神运动表现之间的相关性表明,在MDD中这两个过程高度相互依赖,且均失调。此外,这两个过程可能涉及相同的脑区网络。

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