VA San Diego Healthcare System, San Diego, California, and the University of California San Diego, La Jolla, California.
Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California.
J Am Acad Child Adolesc Psychiatry. 2023 Aug;62(8):874-884. doi: 10.1016/j.jaac.2023.01.024. Epub 2023 Mar 20.
Disruption of reward seeking behavior by unforeseen obstacles can promote negative affect, including frustration and irritability, in adolescents. Repeated experiences of obstructed reward may in fact contribute to the development of depression in adolescents. However, the neurocognitive mechanisms whereby goal disruption impacts reward processing in adolescent depression have not yet been characterized. The present study addresses this gap by using neuroimaging and a novel paradigm to assess how incidental action obstruction impacts reward-based decision making.
We assessed 62 unmedicated adolescents with major depressive disorder (MDD; mean age = 15.6 years, SD = 1.4 years, 67% female participants) and 68 matched healthy control participants (mean age = 15.3 years, SD = 1.4 years, 50% female participants) using functional magnetic resonance imaging (fMRI) while they played a card game in which they had to guess between 2 options to earn points, in low- and high-stake conditions. Functioning of button presses through which they made decisions was intermittently blocked, thereby blocking action efficacy.
Participants with MDD made fewer button press repetitions in response to action efficacy obstruction, which was more apparent in the low-stake condition (rate ratio =0.85, p = .034). During response repetition across stake conditions, MDDs exhibited higher activation in regions in the ventromedial prefrontal cortex, caudate, and putamen (F = 16.4-25.6, df=1,125; p values <.001; Hedges g = 0.85-0.98).
Adolescents with depression tend to exhibit less flexible behavioral orientation in the face of blocked action efficacy, and abnormalities in neural systems critical to regulating negative affect during reward-based decision making. This research highlights possible mechanisms relevant to understanding and treating affective dysregulation in adolescent depression.
意外障碍对寻求奖励行为的破坏会导致青少年产生负面情绪，包括挫折感和易怒。反复经历受阻的奖励可能实际上导致青少年抑郁的发展。然而，目标破坏如何影响青少年抑郁的奖励处理的神经认知机制尚未得到描述。本研究通过使用神经影像学和一种新的范式来评估偶然的行动障碍如何影响基于奖励的决策，从而解决了这一差距。
我们使用功能磁共振成像 (fMRI) 评估了 62 名未接受药物治疗的患有重度抑郁症 (MDD；平均年龄 15.6 岁，标准差 1.4 岁，67%为女性参与者）和 68 名匹配的健康对照组参与者（平均年龄 15.3 岁，标准差 1.4 岁，50%为女性参与者），他们在玩纸牌游戏时必须在两个选项之间猜测以赚取积分，分为低风险和高风险条件。他们做出决策的按钮按功能间歇性受阻，从而阻止了行动的效果。
MDD 参与者在面对行动效果受阻时，按钮重复次数减少，在低风险条件下更为明显（比率比 0.85，p =.034）。在跨越风险条件的反应重复过程中，MDD 患者在腹内侧前额叶皮层、尾状核和壳核中表现出更高的激活（F=16.4-25.6，df=1,125；p 值<.001；Hedges g=0.85-0.98）。
患有抑郁症的青少年在面对行动效果受阻时往往表现出较少的行为灵活性倾向，以及在基于奖励的决策中调节负面情绪的神经系统异常。这项研究强调了可能与理解和治疗青少年抑郁的情绪失调相关的机制。
