双相障碍不同阶段的大脑功能变化。
Brain functional changes across the different phases of bipolar disorder.
机构信息
Edith Pomarol-Clotet, MD, PhD, Silvia Alonso-Lana, BSc, FIDMAG, Germanes Hospitalàries, Barcelona and Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain; Noemi Moro, MD, FIDMAG, Germanes Hospitalàries and Benito Menni Complex Assistencial en Salut Mental, Barcelona, Spain; Salvador Sarró, MD, FIDMAG, Germanes Hospitalàries, Barcelona and Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain; Mar C. Bonnin, BSc, José M. Goikolea, MD, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM) and Bipolar Disorder Program, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, Barcelona, Spain; Paloma Fernandez-Corcuera, MD, Germanes Hospitalàries and Benito Menni Complex Assistencial en Salut Mental, Barcelona, Spain; Benedikt L. Amann, MD, PhD, Anna Romaguera, MD, FIDMAG, Germanes Hospitalàries, Barcelona, Spain and Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain; Eduard Vieta, MD, PhD, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM) and Bipolar Disorder Program, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, Barcelona, Spain; Josep Blanch, MD, Hospital Sant Joan de Déu Infantil, Barcelona, Spain; Peter J. McKenna, MRCPsych, Raymond Salvador, PhD, FIDMAG, Germanes Hospitalàries, Barcelona, Spain and Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain.
出版信息
Br J Psychiatry. 2015 Feb;206(2):136-44. doi: 10.1192/bjp.bp.114.152033. Epub 2014 Dec 11.
BACKGROUND
Little is known about how functional imaging changes in bipolar disorder relate to different phases of the illness.
AIMS
To compare cognitive task activation in participants with bipolar disorder examined in different phases of illness.
METHOD
Participants with bipolar disorder in mania (n = 38), depression (n = 38) and euthymia (n = 38), as well as healthy controls (n = 38), underwent functional magnetic resonance imaging during performance of the n-back working memory task. Activations and de-activations were compared between the bipolar subgroups and the controls, and among the bipolar subgroups. All participants were also entered into a linear mixed-effects model.
RESULTS
Compared with the controls, the mania and depression subgroups, but not the euthymia subgroup, showed reduced activation in the dorsolateral prefrontal cortex, the parietal cortex and other areas. Compared with the euthymia subgroup, the mania and depression subgroups showed hypoactivation in the parietal cortex. All three bipolar subgroups showed failure of de-activation in the ventromedial frontal cortex. Linear mixed-effects modelling revealed a further cluster of reduced activation in the left dorsolateral prefrontal cortex in the patients; this was significantly more marked in the mania than in the euthymia subgroup.
CONCLUSIONS
Bipolar disorder is characterised by mood state-dependent hypoactivation in the parietal cortex. Reduced dorsolateral prefrontal activation is a further feature of mania and depression, which may improve partially in euthymia. Failure of de-activation in the medial frontal cortex shows trait-like characteristics.
背景
关于双相情感障碍的功能影像学变化与疾病不同阶段的关系，我们知之甚少。
目的
比较处于不同疾病阶段的双相情感障碍患者的认知任务激活情况。
方法
对 38 例躁狂期、38 例抑郁期和 38 例缓解期的双相情感障碍患者以及 38 例健康对照者进行功能磁共振成像，让他们在执行 n-back 工作记忆任务时进行检测。比较双相情感障碍亚组与对照组以及双相情感障碍亚组之间的激活和失活情况。所有参与者还被纳入线性混合效应模型。
结果
与对照组相比，躁狂期和抑郁期亚组，但不是缓解期亚组，表现出背外侧前额叶皮层、顶叶皮层和其他区域的激活减少。与缓解期亚组相比，躁狂期和抑郁期亚组表现出顶叶皮层的低激活。所有三个双相情感障碍亚组在前额叶内侧皮质的失活失败。线性混合效应模型显示，患者的左侧背外侧前额叶皮层进一步显示出激活减少；与缓解期亚组相比，躁狂期亚组更为明显。
结论
双相情感障碍的特征是与情绪状态相关的顶叶皮层的低激活。背外侧前额叶皮层的激活减少是躁狂和抑郁的另一个特征，在缓解期可能会部分改善。内侧额叶皮质的失活失败表现出特质性特征。
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