Diler Rasim Somer, Segreti Anna Maria, Ladouceur Cecile D, Almeida Jorge R C, Birmaher Boris, Axelson David A, Phillips Mary L, Pan Lisa
Department of Child Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh, PA 15213, USA.
J Child Adolesc Psychopharmacol. 2013 Apr;23(3):214-21. doi: 10.1089/cap.2012.0054.
Abnormal prefrontal and subcortical activity during cognitive control tasks is identified in non-depressed adolescents with bipolar disorder (BD); however, little is known about the neural correlates of bipolar adolescents in a depressed state (BDd). We aimed to investigate baseline versus after-treatment patterns of neural activity underlying motor response and response inhibition in adolescents with BDd.
In this functional magnetic resonance imaging (fMRI) study, 10 adolescents with BDd relative to 10 age- and sex-matched healthy controls (HC) completed a well-validated go/no go block-design cognitive control task at baseline and after 6 weeks of naturalistic treatment. We used whole-brain analysis and controlled our results for multiple comparisons.
There was significant improvement in depression scores (mean change: 57%±28). There was no behavioral difference in BDd baseline versus HC and after treatment. BDd adolescents relative to HC had higher baseline cortical, but not subcortical, neural activity (e.g., bilateral ventrolateral prefrontal during both the go [motor control] and the no go [response inhibition] conditions, and left superior temporal during the no go condition). However, after-treatment activity relative to baseline neural activity during response inhibition was significantly increased in subcortical (e.g., right hippocampus and left thalamus), but not cortical, regions. In addition, at baseline, lower left thalamus activity was correlated with higher depression scores.
Adolescents with BDd had baseline prefrontal and temporal hyperactivity underlying motor control and response inhibition that did not change after treatment in contrast to relatively decreased baseline subcortical activity underlying response inhibition associated with the depressive state that was increased after the treatment.
在未患抑郁症的双相情感障碍（BD）青少年中，已发现其在认知控制任务期间前额叶和皮质下活动异常；然而，对于处于抑郁状态的双相情感障碍青少年（BDd）的神经关联知之甚少。我们旨在研究BDd青少年运动反应和反应抑制背后神经活动的基线与治疗后模式。
在这项功能磁共振成像（fMRI）研究中，10名BDd青少年与10名年龄和性别匹配的健康对照者（HC）在基线时以及进行6周自然主义治疗后，完成了一项经过充分验证的“去/不去”块设计认知控制任务。我们采用全脑分析，并对结果进行多重比较控制。
抑郁评分有显著改善（平均变化：57%±28）。BDd组在基线时与HC组以及治疗后在行为上没有差异。与HC组相比，BDd青少年在基线时具有更高的皮质神经活动，但皮质下神经活动没有差异（例如，在“去”[运动控制]和“不去”[反应抑制]条件下双侧腹外侧前额叶，以及在“不去”条件下左侧颞上回）。然而，在反应抑制期间，与基线神经活动相比，治疗后皮质下区域（例如，右侧海马体和左侧丘脑）的活动显著增加，而皮质区域没有。此外，在基线时，左侧丘脑较低的活动与较高的抑郁评分相关。
BDd青少年在运动控制和反应抑制方面存在基线前额叶和颞叶多动，治疗后没有变化，与之形成对比的是，与抑郁状态相关的反应抑制的基线皮质下活动相对降低，治疗后有所增加。
