Am J Psychiatry. 2013 Oct;170(10):1186-94. doi: 10.1176/appi.ajp.2013.12070917.
Irritability is common in children and adolescents and is the cardinal symptom of disruptive mood dysregulation disorder, a new DSM-5 disorder, yet its neural correlates remain largely unexplored. The authors conducted a functional MRI study to examine neural responses to frustration in children with severe mood dysregulation.
The authors compared emotional responses, behavior, and neural activity between 19 severely irritable children (operationalized using criteria for severe mood dysregulation) and 23 healthy comparison children during a cued-attention task completed under nonfrustrating and frustrating conditions.
Children in both the severe mood dysregulation and the healthy comparison groups reported increased frustration and exhibited decreased ability to shift spatial attention during the frustration condition relative to the nonfrustration condition. However, these effects of frustration were more marked in the severe mood dysregulation group than in the comparison group. During the frustration condition, participants in the severe mood dysregulation group exhibited deactivation of the left amygdala, the left and right striatum, the parietal cortex, and the posterior cingulate on negative feedback trials, relative to the comparison group (i.e., between-group effect) and to the severe mood dysregulation group's responses on positive feedback trials (i.e., within-group effect). In contrast, neural response to positive feedback during the frustration condition did not differ between groups.
In response to negative feedback received in the context of frustration, children with severe, chronic irritability showed abnormally reduced activation in regions implicated in emotion, attention, and reward processing. Frustration appears to reduce attention flexibility, particularly in severely irritable children, which may contribute to emotion regulation deficits in this population. Further research is needed to relate these findings to irritability specifically, rather than to other clinical features of severe mood dysregulation.
易激惹在儿童和青少年中很常见，是 DSM-5 中新出现的心境恶劣障碍的主要症状，但心境恶劣障碍的神经相关性在很大程度上仍未得到探索。作者进行了一项功能磁共振成像研究，以检查严重情绪失调儿童对挫折的神经反应。
作者比较了 19 名严重易激惹儿童（根据严重情绪失调的标准进行操作化）和 23 名健康对照组儿童在非挫折和挫折条件下完成线索注意任务时的情绪反应、行为和神经活动。
严重情绪失调组和健康对照组的儿童在挫折条件下都报告了更高的挫折感，并且在挫折条件下表现出比非挫折条件下更差的空间注意力转移能力。然而，这些挫折的影响在严重情绪失调组比对照组更为明显。在挫折条件下，与对照组（即组间效应）和严重情绪失调组在正反馈试验中的反应（即组内效应）相比，严重情绪失调组的参与者在负反馈试验中表现出左杏仁核、左右纹状体、顶叶皮层和后扣带回的去激活。相比之下，在挫折条件下，对正反馈的神经反应在两组之间没有差异。
在挫折情境下接收到负反馈时，严重、慢性易激惹的儿童表现出与情绪、注意力和奖励处理相关的区域异常减少的激活。挫折似乎会降低注意力的灵活性，特别是在严重易激惹的儿童中，这可能导致该人群的情绪调节缺陷。需要进一步的研究将这些发现与易激惹联系起来，而不是与严重情绪失调的其他临床特征联系起来。
