Research, Observation, Service, Education (ROSE) Program, University of Cincinnati College of Medicine, Cincinnati, OH 45219, USA.
J Am Acad Child Adolesc Psychiatry. 2011 Oct;50(10):1017-26. doi: 10.1016/j.jaac.2011.07.001. Epub 2011 Aug 10.
Although previous neuroimaging studies suggest that adolescents with bipolar disorder exhibit smaller amygdala volumes compared with healthy adolescents, whether these abnormalities are present at illness onset or instead develop over time remains unclear. The aim of this study was to conduct a prospective longitudinal investigation comparing amygdala neurodevelopment among adolescents after their first manic episode, adolescents with attention-deficit/hyperactivity disorder (ADHD), and healthy adolescents.
A total of 30 adolescents hospitalized for their first manic/mixed episode associated with bipolar disorder, 29 adolescents with ADHD, and 24 demographically matched healthy teens underwent magnetic resonance imaging scanning at index assessment and approximately 12 months later. Adolescents with bipolar disorder were prospectively evaluated using diagnostic interviews and with symptom rating scales.
Mixed models examining the group × time effect for both left (p = .005) and right (p = .002) amygdala volumes were statistically significant. Change in left (p = .01) and right (p = .0008) amygdala volumes from baseline to 12 months were significantly different among groups. Specifically, left amygdala volumes increased over time in healthy adolescents (p = .008) and adolescents with ADHD (p = .0009), but not in adolescents with bipolar disorder (p = .3). Right amygdala volume increased over time in adolescents with ADHD (p < .001), but not in healthy adolescents nor in adolescents with bipolar disorder (p = .1 and p = .3, respectively). In adolescents with bipolar disorder, baseline total amygdala volume was significantly greater in those who subsequently achieved symptomatic recovery as compared with those who did not achieve recovery (p = .02).
Adolescents with mania do not exhibit normal increases in amygdala volume that occur during healthy adolescent neurodevelopment.
尽管先前的神经影像学研究表明，与健康青少年相比，双相情感障碍青少年的杏仁核体积较小，但这些异常是在疾病发病时存在还是随着时间的推移而发展尚不清楚。本研究旨在进行一项前瞻性纵向研究，比较首次躁狂发作后的青少年、注意力缺陷多动障碍（ADHD）青少年和健康青少年的杏仁核神经发育情况。
共有 30 名因双相情感障碍相关的首次躁狂/混合发作而住院的青少年、29 名 ADHD 青少年和 24 名在人口统计学上匹配的健康青少年在基线评估时和大约 12 个月后接受磁共振成像扫描。双相情感障碍青少年通过诊断访谈和症状评定量表进行前瞻性评估。
混合模型检验组×时间对左（p=.005）和右（p=.002）杏仁核体积的影响具有统计学意义。从基线到 12 个月时，左（p=.01）和右（p=.0008）杏仁核体积的组间变化差异具有统计学意义。具体而言，健康青少年（p=.008）和 ADHD 青少年（p=.0009）的左杏仁核体积随时间增加，但双相情感障碍青少年（p=.3）则不然。ADHD 青少年的右杏仁核体积随时间增加（p<.001），但健康青少年和双相情感障碍青少年则不然（p=.1 和 p=.3）。在双相情感障碍青少年中，与未达到症状缓解的患者相比，随后达到症状缓解的患者的基线总杏仁核体积显著更大（p=.02）。
患有躁狂症的青少年的杏仁核体积没有像健康青少年的神经发育那样正常增加。
