Ambrosi E, Arciniegas D B, Madan A, Curtis K N, Patriquin M A, Jorge R E, Spalletta G, Fowler J C, Frueh B C, Salas R
Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry, Baylor College of Medicine, Houston, TX, USA.
Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.
Acta Psychiatr Scand. 2017 Jul;136(1):129-139. doi: 10.1111/acps.12724. Epub 2017 Mar 28.
Distinguishing depressive episodes due to bipolar disorder (BD) or major depressive disorder (MDD) solely on clinical grounds is challenging. We aimed at comparing resting-state functional connectivity (rsFC) of regions subserving emotional regulation in similarly depressed BD and MDD.
We enrolled 76 in-patients (BD, n = 36; MDD, n = 40) and 40 healthy controls (HC). A seed-based approach was used to identify regions showing different rsFC with the insula and the amygdala. Insular and amygdalar parcellations were then performed along with diagnostic accuracy of the main findings.
Lower rsFC between the left insula and the left mid-dorsolateral prefrontal cortex and between bilateral insula and right frontopolar prefrontal cortex (FPPFC) was observed in BD compared to MDD and HC. These results were driven by the dorsal anterior and posterior insula (PI). Lower rsFC between the right amygdala and the left anterior hippocampus was observed in MDD compared to BD and HC. These results were driven by the centromedial and laterobasal amygdala. Left PI/right FPPC rsFC showed 78% accuracy differentiating BD and MDD.
rsFC of amygdala and insula distinguished between depressed BD and MDD. The observed differences suggest the possibility of differential pathophysiological mechanisms of emotional dysfunction in bipolar and unipolar depression.
仅基于临床依据区分双相情感障碍（BD）或重度抑郁症（MDD）所致的抑郁发作具有挑战性。我们旨在比较BD和MDD患者中同样处于抑郁状态下的情绪调节相关脑区的静息态功能连接（rsFC）。
我们招募了76名住院患者（BD患者36例，MDD患者40例）和40名健康对照者（HC）。采用基于种子点的方法来识别与脑岛和杏仁核显示出不同rsFC的脑区。然后进行脑岛和杏仁核的脑区划分以及主要研究结果的诊断准确性分析。
与MDD患者和HC相比，BD患者左侧脑岛与左侧背外侧前额叶中部皮层之间以及双侧脑岛与右侧额极前额叶皮层（FPPFC）之间的rsFC较低。这些结果是由背侧前脑岛和后脑岛（PI）驱动的。与BD患者和HC相比，MDD患者右侧杏仁核与左侧前海马体之间的rsFC较低。这些结果是由中央内侧和外侧基底杏仁核驱动的。左侧PI/右侧FPPC的rsFC在区分BD和MDD时准确率为78%。
杏仁核和脑岛的rsFC能够区分BD和MDD患者的抑郁状态。观察到的差异提示双相抑郁和单相抑郁中情绪功能障碍的病理生理机制可能不同。
