Nagamitsu Shinichiro, Sakurai Rieko, Matsuoka Michiko, Chiba Hiromi, Ozono Shuichi, Tanigawa Hitoshi, Yamashita Yushiro, Kaida Hayato, Ishibashi Masatoshi, Kakuma Tatsuki, Croarkin Paul E, Matsuishi Toyojiro
Department of Pediatrics and Child Health, Kurume University School of Medicine , Fukuoka , Japan.
Graduate School of Medicine, Kurume University , Fukuoka , Japan.
Front Psychiatry. 2016 Feb 16;7:16. doi: 10.3389/fpsyt.2016.00016. eCollection 2016.
Several lines of evidence suggest that anxiety plays a key role in the development and maintenance of anorexia nervosa (AN) in children. The purpose of this study was to examine cortical GABA(A)-benzodiazepine receptor binding before and after treatment in children beginning intensive AN treatment. Brain single-photon emission computed tomography (SPECT) measurements using (123)I-iomazenil, which binds to GABA(A)-benzodiazepine receptors, was performed in 26 participants with AN who were enrolled in a multimodal treatment program. Sixteen of the 26 participants underwent a repeat SPECT scan immediately before discharge at conclusion of the intensive treatment program. Eating behavior and mood disturbances were assessed using Eating Attitudes Test with 26 items (EAT-26) and the short form of the Profile of Mood States (POMS). Clinical outcome scores were evaluated after a 1-year period. We examined association between relative iomazenil-binding activity in cortical regions of interest and psychometric profiles and determined which psychometric profiles show interaction effects with brain regions. Further, we determined if binding activity could predict clinical outcome and treatment changes. Higher EAT-26 scores were significantly associated with lower iomazenil-binding activity in the anterior and posterior cingulate cortex. Higher POMS subscale scores were significantly associated with lower iomazenil-binding activity in the left frontal, parietal cortex, and posterior cingulate cortex (PCC). "Depression-Dejection" and "Confusion" POMS subscale scores, and total POMS score showed interaction effects with brain regions in iomazenil-binding activity. Decreased binding in the anterior cingulate cortex and left parietal cortex was associated with poor clinical outcomes. Relative binding increases throughout the PCC and occipital gyrus were observed after weight gain in children with AN. These findings suggest that cortical GABAergic receptor binding is altered in children with AN. This may be a state-related change, which could be used to monitor and guide the treatment of eating disorders.
多项证据表明，焦虑在儿童神经性厌食症（AN）的发展和维持中起着关键作用。本研究的目的是在开始强化AN治疗的儿童中，检查治疗前后皮质GABA(A)-苯二氮䓬受体结合情况。对26名参加多模式治疗项目的AN患者进行了脑单光子发射计算机断层扫描（SPECT）测量，使用与GABA(A)-苯二氮䓬受体结合的(123)I-碘西泮。26名参与者中有16名在强化治疗项目结束即将出院前立即接受了重复SPECT扫描。使用26项饮食态度测试（EAT-26）和情绪状态剖面图简表（POMS）评估饮食行为和情绪障碍。1年后评估临床结局评分。我们检查了感兴趣的皮质区域中相对碘西泮结合活性与心理测量概况之间的关联，并确定哪些心理测量概况显示与脑区有交互作用。此外，我们确定结合活性是否可以预测临床结局和治疗变化。较高的EAT-26评分与前扣带回和后扣带回皮质中较低的碘西泮结合活性显著相关。较高的POMS子量表评分与左额叶、顶叶皮质和后扣带回皮质（PCC）中较低的碘西泮结合活性显著相关（PCC）。“抑郁-沮丧”和“困惑”POMS子量表评分以及总POMS评分在碘西泮结合活性方面显示与脑区有交互作用。前扣带回皮质和左顶叶皮质中结合减少与不良临床结局相关。在AN患儿体重增加后，观察到整个PCC和枕叶回的相对结合增加。这些发现表明，AN患儿的皮质GABA能受体结合发生了改变。这可能是一种与状态相关的变化，可用于监测和指导饮食失调的治疗。
