Fournier Jay C, Chase Henry W, Greenberg Tsafrir, Etkin Amit, Almeida Jorge R, Stiffler Richelle, Deckersbach Thilo, Weyandt Sarah, Cooper Crystal, Toups Marisa, Carmody Tom, Kurian Benji, Peltier Scott, Adams Phillip, McInnis Melvin G, Oquendo Maria A, McGrath Patrick J, Fava Maurizio, Weissman Myrna, Parsey Ramin, Trivedi Madhukar H, Phillips Mary L
Department of Psychiatry, University of Pittsburgh School of Medicine.
Department of Psychiatry, Stanford University School of Medicine.
Biol Psychiatry Cogn Neurosci Neuroimaging. 2017 Mar;2(2):138-148. doi: 10.1016/j.bpsc.2016.11.008. Epub 2016 Dec 6.
Personality dysfunction represents one of the only predictors of differential response between active treatments for depression to have replicated. In this study, we examine whether depressed patients with higher neuroticism scores, a marker of personality dysfunction, show differences versus depressed patients with lower scores in the functioning of two brain regions associated with treatment response, the anterior cingulate and anterior insula cortices.
Functional magnetic resonance imaging data during an emotional Stroop task were collected from 135 adults diagnosed with major depressive disorder at four academic medical centers participating in the Establishing Moderators and Biosignatures of Antidepressant Response for Clinical Care (EMBARC) study. Secondary analyses were conducted including a sample of 28 healthy individuals.
In whole-brain analyses, higher neuroticism among depressed adults was associated with increased activity in and connectivity with the right anterior insula cortex to incongruent compared to congruent emotional stimuli (ks>281, s<0.05 FWE corrected), covarying for concurrent psychiatric distress. We also observed an unanticipated relationship between neuroticism and reduced activity in the precuneus (k=269, <0.05 FWE corrected). Exploratory analyses including healthy individuals suggested that associations between neuroticism and brain function may be nonlinear over the full range of neuroticism scores.
This study provides convergent evidence for the importance of the right anterior insula cortex as a brain-based marker of clinically meaningful individual differences in neuroticism among adults with depression. This is a critical next step in linking personality dysfunction, a replicated clinical predictor of differential antidepressant treatment response, with differences in underlying brain function.
人格功能障碍是抑郁症积极治疗之间差异反应的少数可重复预测因素之一。在本研究中，我们检验了神经质得分较高（人格功能障碍的一个标志）的抑郁症患者与得分较低的抑郁症患者相比，在与治疗反应相关的两个脑区（前扣带回和前岛叶皮质）的功能上是否存在差异。
在参与“建立抗抑郁反应的调节因素和生物标志物用于临床护理（EMBARC）”研究的四个学术医学中心，收集了135名被诊断为重度抑郁症的成年人在情绪Stroop任务期间的功能磁共振成像数据。进行了二级分析，包括28名健康个体的样本。
在全脑分析中，与情绪一致的刺激相比，抑郁症成年人中较高的神经质与右侧前岛叶皮质对不一致情绪刺激的活动增加及连接增强相关（k>281，s<0.05，经FWE校正），同时考虑了并发的精神痛苦。我们还观察到神经质与楔前叶活动减少之间存在意外关系（k=269，<0.05，经FWE校正）。包括健康个体的探索性分析表明，在整个神经质得分范围内，神经质与脑功能之间的关联可能是非线性的。
本研究为右侧前岛叶皮质作为抑郁症成年人神经质临床意义个体差异的基于脑的标志物的重要性提供了一致证据。这是将人格功能障碍（抗抑郁治疗反应差异的一个可重复临床预测因素）与潜在脑功能差异联系起来的关键下一步。
