Vaessen Thomas, Reininghaus Ulrich, van Aubel Evelyne, Beijer-Klippel Annelie, Steinhart Henrietta, Myin-Germeys Inez, Waltz James
Center for Contextual Psychiatry, KU Leuven, Kapucijnenvoer 33, P.O. Box 7001, 3000 Leuven, Belgium; Department of Psychology, Health, & Technology, University of Twente, P.O. Box 217, 7500AE Enschede, the Netherlands.
Department Public Mental Health, Central Institute of Mental Health, J 5, 68159 Mannheim, Germany.
Schizophr Res. 2023 May;255:93-101. doi: 10.1016/j.schres.2023.03.038. Epub 2023 Mar 27.
Affective reactivity to daily stressors are increased in individuals in the early stages of psychosis. Studies in psychosis patients and healthy individuals at increased psychosis risk show altered neural reactivity to stress in limbic (i.e., hippocampus [HC] and amygdala), prelimbic (i.e., ventromedial prefrontal cortex [vmPFC] and ventral anterior cingulate cortex [vACC]), and salience areas (i.e., Anterior Insula [AI]). We investigated whether a similar pattern of neural reactivity is present in early psychosis individuals and if brain activity in these regions is associated with daily-life stress reactivity. Twenty-nine early psychosis individuals (11 at-risk mental state and 18 first-episode psychosis) completed the Montreal Imaging Stress Task in conjunction with functional MRI. The study was part of a large-scale randomized controlled trial on the efficacy of an acceptance and commitment therapy-based ecological momentary intervention for early psychosis. All participants also provided experience sampling methodology (ESM) data on momentary affect and stressful activities in their everyday environment. Multilevel regression models were used to estimate if daily-life stress reactivity was moderated by activity in (pre)limbic and salience areas. Task-induced stress was associated with increased activation of the right AI and decreased activation in the vmPFC, vACC, and HC. Task-induced changes in vmPFC and vACC activity were associated with affective stress reactivity, whereas changes in HC and amygdala activity were associated with higher overall stress ratings. These preliminary results suggest region-specific roles in affective and psychotic daily-life stress reactivity in early psychosis. The observed pattern suggests that chronic stress plays a role in neural stress reactivity.
在精神病早期阶段，个体对日常应激源的情感反应性会增强。对精神病患者以及精神病风险增加的健康个体的研究表明，边缘系统（即海马体[HC]和杏仁核）、前额叶前部（即腹内侧前额叶皮层[vmPFC]和腹侧前扣带回皮层[vACC]）以及突显区域（即前岛叶[AI]）对压力的神经反应性发生了改变。我们调查了早期精神病个体是否存在类似的神经反应模式，以及这些区域的大脑活动是否与日常生活应激反应相关。29名早期精神病个体（11名处于风险精神状态，18名首次发作精神病患者）在进行功能磁共振成像（fMRI）的同时完成了蒙特利尔成像应激任务。该研究是一项大规模随机对照试验的一部分，该试验旨在探究基于接受与承诺疗法的生态瞬时干预对早期精神病的疗效。所有参与者还提供了关于他们日常环境中瞬时情感和应激活动的经验取样法（ESM）数据。使用多层回归模型来估计（前）边缘系统和突显区域的活动是否调节了日常生活应激反应。任务诱发的压力与右侧AI激活增加以及vmPFC、vACC和HC激活减少相关。vmPFC和vACC活动的任务诱发变化与情感应激反应相关，而HC和杏仁核活动的变化与更高的总体应激评分相关。这些初步结果表明，在早期精神病的情感和精神病性日常生活应激反应中存在区域特异性作用。观察到的模式表明慢性压力在神经应激反应中起作用。
