Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.
Brain Imaging Behav. 2013 Jun;7(2):227-35. doi: 10.1007/s11682-012-9219-7.
Depressive mood in adolescents with bipolar disorder (BDd) is associated with significant morbidity and mortality, but we have limited information about neural correlates of depression and treatment response in BDd. Ten adolescents with BDd (8 females, mean age = 15.6 ± 0.9) completed two (fearful and happy) face gender labeling fMRI experiments at baseline and after 6-weeks of open treatment. Whole-brain analysis was used at baseline to compare their neural activity with those of 10 age and sex-matched healthy controls (HC). For comparisons of the neural activity at baseline and after treatment of youth with BDd, region of interest analysis for dorsal/ventral prefrontal, anterior cingulate, and amygdala activity, and significant regions identified by wholebrain analysis between BDd and HC were analyzed. There was significant improvement in depression scores (mean percentage change on the Child Depression Rating Scale-Revised 57 % ± 28). Neural activity after treatment was decreased in left occipital cortex in the intense fearful experiment, but increased in left insula, left cerebellum, and right ventrolateral prefrontal cortex in the intense happy experiment. Greater improvement in depression was associated with baseline higher activity in ventral ACC to mild happy faces. Study sample size was relatively small for subgroup analysis and consisted of mainly female adolescents that were predominantly on psychotropic medications during scanning. Our results of reduced negative emotion processing versus increased positive emotion processing after treatment of depression (improvement of cognitive bias to negative and away from positive) are consistent with the improvement of depression according to Beck's cognitive theory.
双相障碍（BDd）青少年的抑郁情绪与较高的发病率和死亡率相关，但我们对 BDd 患者抑郁的神经相关性及其治疗反应知之甚少。10 名 BDd 青少年（8 名女性，平均年龄=15.6±0.9 岁）在基线时和 6 周开放治疗后完成了两次（恐惧和快乐）面孔性别标签 fMRI 实验。在基线时使用全脑分析，将他们的神经活动与 10 名年龄和性别匹配的健康对照者（HC）进行比较。为了比较 BDd 青少年在基线和治疗后的神经活动，对背侧/腹侧前额叶、前扣带回和杏仁核的活性进行了感兴趣区分析，并对 BDd 和 HC 之间通过全脑分析确定的显著区域进行了分析。抑郁评分有显著改善（儿童抑郁评定量表修订版的平均百分比变化为 57%±28%）。在强烈恐惧实验中，治疗后左枕叶皮层的神经活动降低，但在强烈快乐实验中，左岛叶、左小脑和右腹外侧前额叶皮层的神经活动增加。抑郁改善与基线时腹侧 ACC 对轻度快乐面孔的活性较高有关。亚组分析的样本量相对较小，且主要由女性青少年组成，在扫描期间主要使用精神药物。我们的研究结果表明，治疗后负性情绪处理减少，正性情绪处理增加（对负性认知偏差的改善以及远离正性认知偏差），这与贝克认知理论中抑郁改善的观点一致。
