双相障碍患者的自杀和非自杀患者的大脑结构异常与特质冲动性。
Brain structural abnormalities and trait impulsivity in suicidal and non-suicidal patients with bipolar disorder.
机构信息
Department of Psychiatry, YuanShan and Suao Branches of Taipei Veterans General Hospital, Ilan, Taiwan; Division of Psychiatry, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Institute of Brain Science, National Yang Ming Chao Tung University, Taipei, Taiwan.
Institute of Brain Science, National Yang Ming Chao Tung University, Taipei, Taiwan.
出版信息
J Affect Disord. 2023 Jul 15;333:10-17. doi: 10.1016/j.jad.2023.04.050. Epub 2023 Apr 18.
BACKGROUND
Impulsivity is a characteristic of patients with bipolar disorder (BD) and may result in a higher risk of suicide attempt (SA). Although brain structural abnormalities have been suggested in the pathophysiology of BD, the relationship to impulsivity and suicide in BD is still not clear.
METHODS
52 euthymic patients with BD (26 of them had a history of SA) and 56 age- and sex-matched healthy controls were recruited. All participants received clinical assessment, including Barratt impulsiveness scale (BIS), and underwent structural magnetic resonance imaging examination. An automated surface-based method (FreeSurfer) was used to measure brain volume and cortical surface area. A general linear model was applied to analyze the association between brain-wise greater gray matter volume (GMV), surface area and BIS scores separately for BD patients with and without SA history.
RESULTS
BD patients with SA history scored higher in BIS total score and subscores in attention, motor, cognitive complexity and cognitive instability than those without SA history and controls (all p < 0.01). In patients with SA history, higher BIS scores were associated with greater GMV in the left pars triangularis and greater surface area in left pars opercularis (all p < 0.01). BD patients with SA history showed a greater GMV in inferior frontal gyrus than patients without SA history (p < 0.05).
LIMITATION
The cross-sectional design precluded examination of chronological relationships of SA, brain structural abnormalities, and trait impulsivity among BD.
CONCLUSIONS
The findings indicate that the prefrontal cortex, especially the left inferior frontal gyrus, plays a vital role in trait impulsivity and suicidal behavior among patients with BD.
背景
冲动是双相障碍（BD）患者的一个特征，可能导致自杀企图（SA）的风险更高。尽管大脑结构异常已被提出是 BD 的病理生理学的一部分，但 BD 中的冲动和自杀之间的关系仍不清楚。
方法
招募了 52 名心境稳定的 BD 患者（其中 26 名有 SA 病史）和 56 名年龄和性别匹配的健康对照者。所有参与者都接受了临床评估，包括巴瑞特冲动量表（BIS），并接受了结构磁共振成像检查。使用基于表面的自动方法（FreeSurfer）测量脑体积和皮质表面积。一般线性模型用于分析 BD 患者有无 SA 病史的大脑灰质体积（GMV）和皮质表面积与 BIS 评分之间的关联。
结果
有 SA 病史的 BD 患者的 BIS 总分和注意力、运动、认知复杂性和认知不稳定性的子评分均高于无 SA 病史的患者和对照组（均 p<0.01）。在有 SA 病史的患者中，较高的 BIS 评分与左侧三角部 GMV 较大和左侧脑岛盖部皮质表面积较大有关（均 p<0.01）。有 SA 病史的 BD 患者的下额叶 GMV 大于无 SA 病史的患者（p<0.05）。
局限性
横断面设计排除了 BD 中 SA、大脑结构异常和特质冲动之间的时间关系的检查。
结论
这些发现表明，前额叶皮层，特别是左侧下额叶，在 BD 患者的特质冲动和自杀行为中起着重要作用。
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