有自杀意念的重性抑郁障碍患者皮质-边缘-纹状体回路的完整性异常。
Aberrant integrity of the cortico-limbic-striatal circuit in major depressive disorder with suicidal ideation.
机构信息
Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China; National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China.
Department of Psychiatry, University of Western Ontario, London, ON, Canada; Robarts Research Institute, University of Western Ontario, London, ON, Canada; Lawson Health Research Institute, London, ON, Canada.
出版信息
J Psychiatr Res. 2022 Apr;148:277-285. doi: 10.1016/j.jpsychires.2022.02.003. Epub 2022 Feb 12.
BACKGROUND
Suicidal ideation is a common symptom of major depressive disorder (MDD) that reflects a cognitive alteration in the background of intense emotional dysregulation. Amygdala is a critical emotion processing center that facilitates moving from emotional appraisal to action. However, whether MDD patients with suicidal ideation show dysconnectivity of the amygdala within a large-scale neurocognitive circuitry remains unknown.
METHODS
Participants were 22 MDD patients without suicidal ideation (MDD-NSI), 59 MDD patients with suicidal ideation (MDD-SI), and 60 healthy controls (HCs). We compared the amygdala-based resting-state functional connectivity of four amygdala subregions across the three groups. We selected brain regions with significant between-group differences in amygdalar conectivity as the regions of interest (ROI) and performed ROI-to-ROI and graph-theoretical analyses to explore dysconnectivity patterns at various granularity levels.
RESULTS
Brain regions showing omnibus differences across the three groups were distributed across a cortico-limbic-striatal circuitry. MDD-SI had unique dysconnectivity of the lateral amygdala with caudate, middle temporal gyrus, and postcentral gyrus compared with the other two groups. MDD-SI and MDD-NSI had shared dysconnectivity of the medial amygdala with medial superior frontal gyrus and middle temporal gyrus. Within the derived cortico-limbic-striatal circuitry, MDD-SI exhibited lower global connectivity, reduced sigma (small-worldness), but increased lambda (path-length) than HCs. Reduced sigma correlated with increased severity of suicidal ideation. We achieved high classification accuracy (84.09%, with AUC 0.82) in distinguishing MDD-SI from MDD-NSI.
CONCLUSIONS
Aberrant integrity of the cortico-limbic-striatal circuit centered on the amygdala provides a promising neural substrate for suicidal ideation that requires further investigation in MDD.
背景
自杀意念是重性抑郁障碍（MDD）的常见症状，反映了强烈情绪失调背景下的认知改变。杏仁核是一个关键的情绪处理中心，有助于从情绪评估转向行动。然而，是否有自杀意念的 MDD 患者在一个大规模的神经认知回路中表现出杏仁核的连通中断仍不清楚。
方法
参与者包括 22 名没有自杀意念的 MDD 患者（MDD-NSI）、59 名有自杀意念的 MDD 患者（MDD-SI）和 60 名健康对照者（HCs）。我们比较了三组之间四个杏仁核亚区的基于杏仁核的静息态功能连接。我们选择在杏仁核连接方面具有组间差异的大脑区域作为感兴趣区（ROI），并进行 ROI 到 ROI 和图论分析，以探索不同粒度水平的连通中断模式。
结果
三组之间出现总体差异的大脑区域分布在皮质-边缘-纹状体回路中。与其他两组相比，MDD-SI 的外侧杏仁核与尾状核、颞中回和中央后回之间存在独特的连通中断。MDD-SI 和 MDD-NSI 的内侧杏仁核与内侧额上回和颞中回之间存在共享的连通中断。在得出的皮质-边缘-纹状体回路中，MDD-SI 表现出较低的全局连接性、降低的 sigma（小世界）和增加的 lambda（路径长度），与 HCs 相比。降低的 sigma 与自杀意念的严重程度增加相关。我们在区分 MDD-SI 和 MDD-NSI 方面实现了较高的分类准确性（84.09%，AUC 为 0.82）。
结论
以杏仁核为中心的皮质-边缘-纹状体回路的完整性受损为自杀意念提供了一个有前途的神经基础，需要在 MDD 中进一步研究。
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