Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Mass., USA.
Psychother Psychosom. 2014;83(6):364-70. doi: 10.1159/000364906. Epub 2014 Oct 16.
Psychodynamic psychotherapy has been used to treat depression for more than a century. However, not all patients respond equally well, and there are few reliable predictors of treatment outcome.
We used resting (18)F-fluorodeoxyglucose positron emission tomography ((18)FDG-PET) scans immediately before and after a structured, open trial of brief psychodynamic psychotherapy (n = 16) in conjunction with therapy process ratings and clinical outcome measures to identify neural correlates of treatment response.
Pretreatment glucose metabolism within the right posterior insula correlated with depression severity. Reductions in depression scores correlated with a pre- to posttreatment reduction in right insular metabolism, which in turn correlated with higher objective measures of patient insight obtained from videotaped therapy sessions. Pretreatment metabolism in the right precuneus was significantly higher in patients who completed treatment and correlated with psychological mindedness.
Resting brain metabolism predicted both clinical course and relevant psychotherapeutic process during short-term psychodynamic psychotherapy for depression.
动力性心理治疗用于治疗抑郁症已有一个多世纪。然而，并非所有患者的反应都一样好，并且很少有可靠的治疗结果预测指标。
我们在一项简短的动力性心理治疗（n = 16）的结构化开放性试验之前和之后立即使用静息（18）F-氟脱氧葡萄糖正电子发射断层扫描（（18）FDG-PET）扫描，同时结合治疗过程评估和临床结果测量，以确定治疗反应的神经相关性。
右后岛叶的治疗前葡萄糖代谢与抑郁严重程度相关。抑郁评分的降低与治疗前至治疗后右岛叶代谢的降低相关，而右岛叶代谢的降低与从录像治疗会话中获得的更高的患者洞察力的客观测量相关。完成治疗的患者右楔前叶的治疗前代谢明显更高，与心理意识相关。
在抑郁症的短期动力性心理治疗期间，静息大脑代谢预测了临床过程和相关的心理治疗过程。
