未服药的强迫症患者认知行为治疗前后杏仁核亚区的静息态功能连接。
Resting-state functional connectivity of the amygdala subregions in unmedicated patients with obsessive-compulsive disorder before and after cognitive behavioural therapy.
机构信息
From the National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China (Gao, Yang, Chen, Liu, Wang, Meng, Li, Zhou); the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China (Gao, Yang, Chen, Liu, Wang, Meng, Li); the CAS Key Laboratory of Behavioral Science, Institute of Psychology, Beijing, China (Zhou); the Department of Psychology, University of Chinese Academy of Sciences, Beijing, China (Zhou); and the Magnetic Resonance Imaging Research Center, Institute of Psychology, Chinese Academy of Sciences, Beijing, China (Zhou).
出版信息
J Psychiatry Neurosci. 2021 Nov 16;46(6):E628-E638. doi: 10.1503/jpn.210084. Print 2021 Nov-Dec.
BACKGROUND
Cognitive behavioural therapy (CBT) is considered an effective first-line treatment for obsessive-compulsive disorder (OCD). However, the neural basis of CBT for OCD has not yet been elucidated. The role of the amygdala in OCD and its functional coupling with the cerebral cortex have received increasing attention, and may provide new understanding of the neural basis of CBT for OCD.
METHODS
We acquired baseline resting-state functional MRI (fMRI) scans from 45 unmedicated patients with OCD and 40 healthy controls; we then acquired another wave of resting-state fMRI scans from the patients with OCD after 12 weeks of CBT. We performed seed-based resting-state functional connectivity analyses of the amygdala subregions to examine changes in patients with OCD as a result of CBT.
RESULTS
Compared to healthy controls, patients with OCD showed significantly increased resting-state functional connectivity at baseline between the left basolateral amygdala and the right middle frontal gyrus, and between the superficial amygdala and the right cuneus. In patients with OCD who responded to CBT, we found decreased resting-state functional connectivity after CBT between the amygdala subregions and the visual association cortices and increased resting-state functional connectivity between the amygdala subregions and the right inferior parietal lobe. Furthermore, these changes in resting-state functional connectivity were positively associated with changes in scores on the compulsion or obsession subscales of the Yale-Brown Obsessive-Compulsive Scale.
LIMITATIONS
Because of the lack of a second scan for healthy controls after 12 weeks, our results may have been confounded by other variables.
CONCLUSION
Our findings yield insights into the pathophysiology of OCD; they also reveal the potential neural changes elicited by CBT, and thus have implications for guiding effective treatment strategies with CBT for OCD.
背景
认知行为疗法（CBT）被认为是治疗强迫症（OCD）的一线有效方法。然而，CBT 治疗 OCD 的神经基础尚未阐明。杏仁核在 OCD 中的作用及其与大脑皮层的功能耦合受到越来越多的关注，这可能为 OCD 的 CBT 神经基础提供新的认识。
方法
我们从 45 名未经药物治疗的 OCD 患者和 40 名健康对照者中获得了基线静息状态功能磁共振成像（fMRI）扫描；然后，我们在 12 周的 CBT 后从 OCD 患者中获得了另一波静息状态 fMRI 扫描。我们对杏仁核亚区进行基于种子的静息状态功能连接分析，以检查 CBT 对 OCD 患者的影响。
结果
与健康对照组相比，OCD 患者在基线时左基底外侧杏仁核与右侧额中回之间以及浅层杏仁核与右侧楔前叶之间的静息状态功能连接明显增加。在对 CBT 有反应的 OCD 患者中，我们发现 CBT 后杏仁核亚区与视觉联合皮质之间的静息状态功能连接减少，而杏仁核亚区与右侧下顶叶之间的静息状态功能连接增加。此外，静息状态功能连接的这些变化与耶鲁-布朗强迫症量表中的强迫或痴迷子量表评分的变化呈正相关。
局限性
由于缺乏健康对照组在 12 周后的第二次扫描，我们的结果可能受到其他变量的干扰。
结论
我们的研究结果深入了解了 OCD 的病理生理学；它们还揭示了 CBT 引起的潜在神经变化，从而为 OCD 的 CBT 指导有效治疗策略提供了依据。
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