Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health (CAMH), Toronto, Canada; University of Toronto, Canada.
University of Toronto, Canada; Sunnybrook Health Sciences Centre, Toronto, Canada.
J Am Acad Child Adolesc Psychiatry. 2022 Dec;61(12):1455-1465. doi: 10.1016/j.jaac.2022.04.010. Epub 2022 Apr 26.
Building on prior findings in adults, this study investigated regional cerebral blood flow (CBF) in relation to DSM-5 criterion A symptoms of depression and mania in youth with bipolar disorder (BD).
The study recruited 81 youths with BD and 75 healthy controls 13-20 years old. CBF was ascertained using pseudocontinuous arterial spin labeling magnetic resonance imaging. Region-of-interest analyses examined the amygdala, anterior cingulate cortex (ACC), middle frontal gyrus, and global gray matter CBF. The association of criterion A depression and mania symptoms with CBF was examined dimensionally in youth with BD in regression analyses with continuous symptom severity scores. Age and sex were included as covariates. False discovery rate (FDR) was used to correct for 28 tests (4 regions by 7 symptoms; α < .0017). CBF for BD and healthy control groups was compared to give context for findings.
In youth with BD, depressed mood inversely correlated with ACC (β = -0.31, p = .004, p = .056) and global (β = -0.27, p = .013, p = .09) CBF. The same pattern was observed for anhedonia (ACC CBF: β = -0.33, p = .004, p = .056; global CBF: β = -0.29, p = .008, p = .07). There were no significant findings for manic symptoms or in BD vs healthy control contrasts.
The present findings, while not significant after correction for multiple testing, highlight the potential value of focusing on ACC in relation to depressed mood and anhedonia, and demonstrate that CBF is sensitive to depression symptom severity in youth. Lack of findings regarding manic symptoms may relate to the exclusion of fully manic participants in this outpatient sample.
基于先前在成人中的研究结果，本研究探讨了与双相障碍（BD）青少年的 DSM-5 抑郁和躁狂标准 A 症状相关的区域性脑血流（CBF）。
本研究招募了 81 名患有 BD 的青少年和 75 名 13-20 岁的健康对照者。使用伪连续动脉自旋标记磁共振成像来确定 CBF。使用感兴趣区域分析检查了杏仁核、前扣带皮层（ACC）、中额回和全脑灰质 CBF。在回归分析中，采用连续症状严重程度评分，对 BD 青少年的标准 A 抑郁和躁狂症状与 CBF 的关系进行了维度分析。年龄和性别被纳入协变量。采用假发现率（FDR）对 28 项测试（4 个区域×7 个症状；α<.0017）进行校正。比较了 BD 和健康对照组的 CBF，以提供研究结果的背景。
在患有 BD 的青少年中，抑郁情绪与 ACC（β=-0.31，p=0.004，p=0.056）和全脑（β=-0.27，p=0.013，p=0.09）CBF 呈负相关。快感缺失也呈现出同样的模式（ACC CBF：β=-0.33，p=0.004，p=0.056；全脑 CBF：β=-0.29，p=0.008，p=0.07）。在躁狂症状或 BD 与健康对照组对比中，没有发现显著的结果。
虽然在进行多次测试校正后，这些发现没有统计学意义，但它们强调了关注 ACC 与抑郁情绪和快感缺失之间关系的潜在价值，并表明 CBF 对青少年抑郁症状严重程度敏感。在这个门诊样本中，由于排除了完全躁狂的参与者，因此关于躁狂症状的发现可能与之相关。
