Institute for Juvenile Research, Center for Cognitive Medicine, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL 60608, USA.
Psychiatry Res. 2011 Jul 30;193(1):28-37. doi: 10.1016/j.pscychresns.2011.01.005. Epub 2011 May 17.
The aim of this research was to determine the relative effects of risperidone and divalproex on brain function in pediatric mania. This is a double-blind 6-week functional magnetic resonance imaging trial with 24 unmedicated manic patients randomized to risperidone or divalproex, and 14 healthy controls (HCs) matched for IQ and demographic factors (mean age: 13.1±3.3years). A pediatric affective color matching task, in which subjects matched the color of a positive, negative or neutral word with one of two colored circles, was administered. The primary clinical measure was the Young Mania Rating Scale (YMRS). The risperidone group, relative to HC, showed an increase in activation from pre- to post-treatment in right pregenual and subgenual anterior cingulate cortex and decreased activation in bilateral middle frontal gyrus during the negative condition; and decreased activation in left inferior and medial, and right middle frontal gyri, left inferior parietal lobe, and right striatum with positive condition. In the divalproex group, relative to HC, there was an increased activation in right superior temporal gyrus in the negative condition; and in left medial frontal gyrus and right precuneus with the positive condition. Greater pre-treatment right amygdala activity with negative and positive condition in the risperidone group, and left amygdala activity with positive condition in divalproex group, predicted poor response on YMRS. Risperidone and divalproex yield differential patterns of prefrontal activity during an emotion processing task in pediatric mania. Increased amygdala activity at baseline is a potential biomarker predicting poor treatment response to both the risperidone and divalproex.
这项研究的目的是确定利培酮和丙戊酸钠对儿科躁狂症患者大脑功能的相对影响。这是一项为期 6 周的双盲功能磁共振成像试验，共有 24 名未经药物治疗的躁狂症患者随机分为利培酮组或丙戊酸钠组，以及 14 名匹配 IQ 和人口统计学因素的健康对照组（平均年龄：13.1±3.3 岁）。患者需要完成一个儿童情感色彩匹配任务，在这个任务中，他们需要将一个积极、消极或中性词的颜色与两个彩色圆圈中的一个相匹配。主要的临床测量指标是 Young Mania Rating Scale (YMRS)。与健康对照组相比，利培酮组在治疗前后右前扣带回的前、后皮质以及双侧额中回的活动增加，在负性条件下的活动减少；在正性条件下，左侧额下回和内侧、右侧额中回、左侧顶下小叶和右侧纹状体的活动减少。与健康对照组相比，丙戊酸钠组在负性条件下右侧颞上回的活动增加；在正性条件下左侧额内侧回和右侧楔前叶的活动增加。在利培酮组中，治疗前右侧杏仁核在负性和正性条件下的活动越强，以及在丙戊酸钠组中，治疗前左侧杏仁核在正性条件下的活动越强，与 YMRS 评分较差的反应相关。利培酮和丙戊酸钠在儿科躁狂症患者进行情绪处理任务时，会产生不同的前额叶活动模式。基线时杏仁核活动增加可能是利培酮和丙戊酸钠治疗反应不良的潜在生物标志物。
