Ehrlich Tobin J, Bhat Jyoti, Horwege Andrea M, Mathalon Daniel H, Glover Gary H, Roach Brian J, Badran Bashar W, Forman Steven D, George Mark S, Scott J Cobb, Thase Michael E, Yesavage Jerome A, Yurgelun-Todd Deborah A, Rosen Allyson C
Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave (151Y), Palo Alto, CA, 94304, USA.
University of Michigan, Ann Arbor, MI, USA.
Brain Imaging Behav. 2022 Jun;16(3):1186-1195. doi: 10.1007/s11682-021-00596-4. Epub 2021 Dec 3.
Patients with depression who ruminate repeatedly focus on depressive thoughts; however, there are two cognitive subtypes of rumination, reflection and brooding, each associated with different prognoses. Reflection involves problem-solving and is associated with positive outcomes, whereas brooding involves passive, negative, comparison with other people and is associated with poor outcomes. Rumination has also been related to atypical functional hyperconnectivity between the default mode network and subgenual prefrontal cortex. Repetitive pulse transcranial magnetic stimulation of the prefrontal cortex has been shown to alter functional connectivity, suggesting that the abnormal connectivity associated with rumination could potentially be altered. This study examined potential repetitive pulse transcranial magnetic stimulation prefrontal cortical targets that could modulate one or both of these rumination subtypes. Forty-three patients who took part in a trial of repetitive pulse transcranial magnetic stimulation completed the Rumination Response Scale questionnaire and resting-state functional magnetic resonance imaging. Seed to voxel functional connectivity analyses identified an anticorrelation between the left lateral orbitofrontal cortex (-44, 26, -8; k = 172) with the default mode network-subgenual region in relation to higher levels of reflection. Parallel analyses were not significant for brooding or the RRS total score. These findings extend previous studies of rumination and identify a potential mechanistic model for symptom-based neuromodulation of rumination.
反复沉思的抑郁症患者会不断专注于抑郁想法；然而，沉思有两种认知亚型，即反思和沉思，每种亚型都与不同的预后相关。反思涉及解决问题，与积极结果相关，而沉思则涉及消极、被动地与他人比较，与不良结果相关。沉思还与默认模式网络和膝下前额叶皮质之间的非典型功能超连接有关。前额叶皮质的重复脉冲经颅磁刺激已被证明可改变功能连接，这表明与沉思相关的异常连接可能会被改变。本研究考察了可能调节这两种沉思亚型之一或两者的潜在重复脉冲经颅磁刺激前额叶皮质靶点。43名参与重复脉冲经颅磁刺激试验的患者完成了沉思反应量表问卷和静息态功能磁共振成像。种子点到体素的功能连接分析确定，左侧眶额皮质（-44, 26, -8；k = 172）与默认模式网络-膝下区域之间存在反相关，与更高水平的反思有关。对沉思或沉思反应量表总分的平行分析无显著意义。这些发现扩展了先前对沉思的研究，并确定了基于症状的沉思神经调节的潜在机制模型。
