Sosic-Vasic Zrinka, Abler Birgit, Grön Georg, Plener Paul, Straub Joana
Departments of aPsychiatry and Psychotherapy III bChild and Adolescent Psychiatry and Psychotherapy, University Clinic of Ulm, Ulm, Germany.
Neuroreport. 2017 Apr 12;28(6):348-353. doi: 10.1097/WNR.0000000000000770.
A number of neuroimaging studies have identified altered regional cerebral blood flow (rCBF) related to major depressive disorder (MDD) in adult samples, particularly in the lateral prefrontal, cingular and temporal regions. In contrast, neuroimaging investigations in adolescents with MDD are rare, although investigating young patients during a significant period of brain maturation might offer valuable insights into the neural mechanisms of MDD. We acquired perfusion images obtained with continuous arterial spin labelling in 21 medication-naive adolescents with MDD before and after a five-session cognitive behavioural group therapy (group CBT). A control group included medication-naive patients under treatment as usual while waiting for the psychotherapy. We found relatively increased rCBF in the right dorsolateral prefrontal cortex (DLPFC; BA 46), the right caudate nucleus and the left inferior parietal lobe (BA 40) after CBT compared with before CBT. Relatively increased rCBF in the right DLPFC postgroup CBT was confirmed by time (post vs. pre)×group (intervention/waiting list) interaction analyses. In the waiting group, relatively increased rCBF was found in the thalamus and the anterior cingulate cortex (BA 24). The relatively small number of patients included in this pilot study has to be considered. Our findings indicate that noninvasive resting perfusion scanning is suitable to identify CBT-related changes in adolescents with MDD. rCBF increase in the DLPFC following a significant reduction in MDD symptoms in adolescents might represent the core neural correlate of changes in 'top-down' cognitive processing, a possible correlate of improved self-regulation and cognitive control.
多项神经影像学研究已确定，在成人样本中，与重度抑郁症（MDD）相关的局部脑血流量（rCBF）发生了改变，尤其是在外侧前额叶、扣带回和颞叶区域。相比之下，对患有MDD的青少年进行的神经影像学研究很少，尽管在大脑显著成熟的时期对年轻患者进行研究可能会为MDD的神经机制提供有价值的见解。我们采集了21名未接受过药物治疗的MDD青少年在五节认知行为团体治疗（团体认知行为疗法）前后通过连续动脉自旋标记获得的灌注图像。一个对照组包括在等待心理治疗期间按常规接受治疗的未接受过药物治疗的患者。我们发现，与团体认知行为疗法前相比，治疗后右侧背外侧前额叶皮质（DLPFC；BA 46）、右侧尾状核和左侧顶下小叶（BA 40）的rCBF相对增加。通过时间（治疗后与治疗前）×组（干预/等待名单）交互分析证实了团体认知行为疗法后右侧DLPFC中rCBF的相对增加。在等待组中，丘脑和前扣带回皮质（BA 24）的rCBF相对增加。必须考虑到这项初步研究纳入的患者数量相对较少。我们的研究结果表明，无创静息灌注扫描适用于识别患有MDD的青少年中与团体认知行为疗法相关的变化。青少年MDD症状显著减轻后DLPFC中rCBF的增加可能代表了“自上而下”认知加工变化的核心神经关联，这可能是自我调节和认知控制改善的一个关联因素。
