双相情感障碍儿童和成人患者的额-边缘-纹状体功能障碍：面部情绪和注意力需求的影响
Fronto-limbic-striatal dysfunction in pediatric and adult patients with bipolar disorder: impact of face emotion and attentional demands.
作者信息
Brotman M A, Tseng W-L, Olsavsky A K, Fromm S J, Muhrer E J, Rutenberg J G, Deveney C M, Adleman N E, Zarate C A, Pine D S, Leibenluft E
机构信息
Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA.
Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA.
出版信息
Psychol Med. 2014 Jun;44(8):1639-51. doi: 10.1017/S003329171300202X. Epub 2013 Aug 12.
BACKGROUND
Research in bipolar disorder (BD) implicates fronto-limbic-striatal dysfunction during face emotion processing but it is unknown how such dysfunction varies by task demands, face emotion and patient age.
METHOD
During functional magnetic resonance imaging (fMRI), 181 participants, including 62 BD (36 children and 26 adults) and 119 healthy comparison (HC) subjects (57 children and 62 adults), engaged in constrained and unconstrained processing of emotional (angry, fearful, happy) and non-emotional (neutral) faces. During constrained processing, subjects answered questions focusing their attention on the face; this was processed either implicitly (nose width rating) or explicitly (hostility; subjective fear ratings). Unconstrained processing consisted of passive viewing.
RESULTS
Pediatric BD rated neutral faces as more hostile than did other groups. In BD patients, family-wise error (FWE)-corrected region of interest (ROI) analyses revealed dysfunction in the amygdala, inferior frontal gyrus (IFG), anterior cingulate cortex (ACC) and putamen. Patients with BD showed amygdala hyperactivation during explicit processing (hostility ratings) of fearful faces and passive viewing of angry and neutral faces but IFG hypoactivation during implicit processing of neutral and happy faces. In the ACC and striatum, the direction of dysfunction varied by task demand: BD demonstrated hyperactivation during unconstrained processing of angry or neutral faces but hypoactivation during constrained processing (implicit or explicit) of angry, neutral or happy faces.
CONCLUSIONS
Findings suggest amygdala hyperactivation in BD while processing negatively valenced and neutral faces, regardless of attentional condition, and BD IFG hypoactivation during implicit processing. In the cognitive control circuit involving the ACC and putamen, BD neural dysfunction was sensitive to task demands.
背景
双相情感障碍（BD）的研究表明，在面部情绪处理过程中存在前额叶-边缘叶-纹状体功能障碍，但尚不清楚这种功能障碍如何因任务需求、面部情绪和患者年龄而有所不同。
方法
在功能磁共振成像（fMRI）期间，181名参与者，包括62名双相情感障碍患者（36名儿童和26名成人）和119名健康对照（HC）受试者（57名儿童和62名成人），参与了对情绪化（愤怒、恐惧、高兴）和非情绪化（中性）面孔的受限和非受限处理。在受限处理过程中，受试者回答问题，将注意力集中在面部；这一过程通过隐式（鼻子宽度评级）或显式（敌意；主观恐惧评级）方式进行处理。非受限处理包括被动观看。
结果
儿童双相情感障碍患者将中性面孔评为比其他组更具敌意。在双相情感障碍患者中，经家族性错误率（FWE）校正的感兴趣区域（ROI）分析显示杏仁核、额下回（IFG）、前扣带回皮质（ACC）和壳核存在功能障碍。双相情感障碍患者在对恐惧面孔的显式处理（敌意评级）以及对愤怒和中性面孔的被动观看过程中表现出杏仁核过度激活，但在对中性和高兴面孔的隐式处理过程中额下回激活不足。在ACC和纹状体中，功能障碍的方向因任务需求而异：双相情感障碍患者在对愤怒或中性面孔的非受限处理过程中表现出过度激活，但在对愤怒、中性或高兴面孔的受限处理（隐式或显式）过程中表现出激活不足。
结论
研究结果表明，双相情感障碍患者在处理负性情绪和中性面孔时，无论注意力条件如何，杏仁核均会过度激活，且在隐式处理过程中额下回激活不足。在涉及ACC和壳核的认知控制回路中，双相情感障碍患者的神经功能障碍对任务需求敏感。
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