Hwang S, Nolan Z T, White S F, Williams W C, Sinclair S, Blair R J R
University of Nebraska Medical Center,Omaha,NE,USA.
Penn State College of Medicine,MD/PhD Program,Hershey,PA,USA.
Psychol Med. 2016 May;46(7):1485-96. doi: 10.1017/S0033291716000118. Epub 2016 Feb 15.
To determine the functional integrity of the neural systems involved in emotional responding/regulation and response control/inhibition in youth (age 10-18 years) with disruptive behavioral disorders (DBDs: conduct disorder and/or oppositional defiant disorder) as a function of callous-unemotional (CU) traits.
Twenty-eight healthy youths and 35 youths with DBD [high CU (HCU), n = 18; low CU (LCU), n = 17] performed the fMRI Affective Stroop task. Participants viewed positive, neutral, and negative images under varying levels of cognitive load. A 3-way ANOVA (group×emotion by task) was conducted on the BOLD response data.
Youth with DBD-HCU showed significantly less activation of ventromedial prefrontal cortex (vmPFC) and amygdala in response to negative stimuli, compared to healthy youth and youth with DBD-LCU. vmPFC responsiveness was inversely related to CU symptoms in DBD. Youth with DBD-LCU showed decreased functional connectivity between amygdala and regions including inferior frontal gyrus in response to emotional stimuli. Youth with DBD (LCU and HCU) additionally showed decreased insula responsiveness to high load (incongruent trials) compared to healthy youth. Insula responsiveness was inversely related to ADHD symptoms in DBD.
These data reveal two forms of pathophysiology in DBD. One associated with reduced amygdala and vmPFC responses to negative stimuli and related to increased CU traits. Another associated with reduced insula responses during high load task trials and related to ADHD symptoms. Appropriate treatment will need to be individualized according to the patient's specific pathophysiology.
确定患有破坏性行为障碍（DBD：品行障碍和/或对立违抗障碍）的青少年（10 - 18岁）中，与情绪反应/调节以及反应控制/抑制相关的神经系统功能完整性与冷酷无情（CU）特质之间的关系。
28名健康青少年和35名患有DBD的青少年[高CU（HCU）组，n = 18；低CU（LCU）组，n = 17]进行了功能磁共振成像情感斯特鲁普任务。参与者在不同认知负荷水平下观看正性、中性和负性图像。对血氧水平依赖（BOLD）反应数据进行三因素方差分析（组×情绪×任务）。
与健康青少年和DBD - LCU青少年相比，DBD - HCU青少年对负性刺激的腹内侧前额叶皮质（vmPFC）和杏仁核激活明显减少。在DBD中，vmPFC反应性与CU症状呈负相关。DBD - LCU青少年在对情绪刺激的反应中，杏仁核与包括额下回在内的区域之间的功能连接减少。与健康青少年相比，患有DBD（LCU和HCU）的青少年在高负荷（不一致试验）时脑岛反应性也降低。脑岛反应性与DBD中的注意力缺陷多动障碍（ADHD）症状呈负相关。
这些数据揭示了DBD的两种病理生理学形式。一种与杏仁核和vmPFC对负性刺激的反应减少有关，且与CU特质增加有关。另一种与高负荷任务试验期间脑岛反应减少有关，且与ADHD症状有关。需要根据患者的具体病理生理学进行个体化的适当治疗。
