采用ReHo方法检测针刺重性抑郁患者百会穴激活的脑功能区

目的 采用局部一致性(ReHo)算法fMRI观察针刺首发未治疗重度抑郁(MDD)患者百会穴(GV20)后激活的脑功能区。方法 采用非重复事件相关设计范式,对16例首发未治疗MDD患者经电针刺激GV20或假穴后行静息态fMRI,采用ReHo方法分析针刺后MDD患者全脑的激活情况。结果 与假穴对比,针刺GV20后,MDD患者左腹内侧前额叶、左侧岛叶、左侧前扣带回、右侧丘脑、右侧颞上回、双侧楔前叶、双侧小脑前叶及右侧小脑后叶的ReHo值升高。结论 基于fMRI技术,采用ReHo方法可检测针刺MDD患者GV20后引发的相应脑功能区的变化,为探索针刺治疗MDD的中枢机制提供了一种新的影像学方法。     

电休克治疗抑郁症的海马功能磁共振研究进展

电休克(ECT)是治疗抑郁症的有效手段之一,但机制仍然不清楚。海马及其相关结构在抑郁症的发病及治疗机制中有重要的作用,功能磁共振成像(fMRI)目前在研究抑郁症方面得到了广泛应用和长足发展。本文将综合最新研究成果,从形态结构(基于体素的形态测量学技术)、局部脑血流(动脉自旋标记灌注成像)和局部白质纤维(弥散张量成像)3个方面阐述fMRI在ECT治疗抑郁症机制中的研究进展。     

封面文章

正抑郁症(major depression disorder,MDD)发病率逐年上升,全球平均发病率在4.4%左右。我国约有5500万MDD患者,大部分MDD患者通过药物治疗有效,但约35%的MDD患者会发展成为药物难治性抑郁症(treatment-resistant depression,TRD),成为危害大众健康的严重疾病。     

人脑对事件相关食物视觉刺激反应的功能磁共振成像的初步研究

目的通过功能磁共振成像(fMRI)初步研究人脑对事件相关食物视觉刺激反应.方法本研究利用fMRI技术具有时间分辨率高、对人体无创并且可以对单例数据处理分析的优势,采用平面回波成像(EPI)序列,检测在饥饿状态下,人脑对事件相关食物视觉刺激反应.实验中2名健康志愿受试者,选择事件相关任务模式禁食12 h后扫描.扫描的同时接受随机播放的食物图片、非食物图片和空白模糊图片的视觉刺激.用SPM 2软件处理功能成像数据,对由三类图片所引发的感兴趣区(ROI)做相关t检验统计.结果与食物渴求相关的脑区分布在杏仁核、眶额皮质以及枕叶皮质,与既往的正电子放射扫描成像(PET)实验结果相符.结论确定与食物渴求相关的奖赏通路,对于了解人类在饥饿状态下对食物渴求的复杂认知规律,为进一步寻找有效调控人类摄食行为的手段有重要意义.     

电休克治疗抑郁症的脑源性神经生长因子相关机制研究进展

电休克治疗(ECT)能有效改善抑郁症(MDD)患者症状,但作用机制目前仍然不明确。有研究表明ECT治疗后海马等脑结构出现神经增生,脑源性神经生长因子(BDNF)可能在其中发挥重要作用。较多研究表明,ECT治疗后MDD患者血清或血浆BDNF水平上升,并出现BDNF通路的相应生物学改变。但也有少部分不一致的研究结果,BDNF前体(ProBDNF)的研究将可能进一步完善该机制。     

中国人群MTHFR C677T基因多态性与重症抑郁症发病风险的meta分析

目的 探讨中国人群四氢叶酸还原酶(MTHFR)基因 C677T多态性与重症抑郁症(MDD)的关系.方法 对符合条件的研究进行 meta分析,分别以1168例MDD患者和1378例对照人群等位基因和基因型频率分布的 OR值为统计量,采用固定或随机效应模型进行合并分析,并进行偏倚评估.结果 9篇文献符合条件纳入研究,入选文献无明显发表偏倚.数据合并结果 显示:T/C等位基因、TT基因型合并的OR值(95%C1)分别为1.45(1.12--1.88)和1.37(0.98--1.92).其次发现重症抑郁症患者组中TT基因型HAMD-17评分均高于CT、CC基因型,差异有统计学意义.且血清半胱氨酸(HCY)的浓度依次从CC、CT、TT基因型之间升高,两组比较均有显著性差异.结论 MTHFR C677T基因多态性与重症抑郁症发病风险、严重程度及血清半胱氨酸浓度具有相关性.     

重度抑郁症患者免疫细胞组成及特征分析

目的：研究重度抑郁症（MDD）患者体内免疫细胞的变化,以及炎症和吸烟对MDD患者免疫细胞占比的 影响。方法：选择 GEO 数据库（GSE19738）中 33 例 MDD 患者和 34 例健康对照的数据为研究对象,利用 CIBERSORT计算并比较MDD患者和健康对照的免疫细胞成分;并分析炎症和吸烟对MDD患者免疫细胞占 比的影响。结果：通过CIBERSORT法分析得到免疫细胞共包括22种免疫亚型,MDD患者体内单核细胞的含 量相比健康对照人群出现显著下降（P＜0.05）。脂多糖（LPS）刺激后MDD患者的CD8+T细胞占比明显高于健 康对照人群（P＜0.05）,浆细胞占比明显低于健康对照人群（P＜0.05）。吸烟MDD患者的CD8+T细胞占比明 显高于戒烟患者的CD8+T细胞占比（P＜0.05）,吸烟患者与戒烟患者相比,CCL5、ORM1、GPR84、GDNF基因 的表达明显升高。结论：CD8+T细胞可能在MDD的发病中起到重要作用。     

电针刺激头皮感觉区联合感觉再训练治疗脑卒中感觉障碍的fMRI分析

目的 采用功能性磁共振成像(fMRI)观察电针刺激头皮感觉区联合感觉再训练对脑卒中患者感觉障碍的影响.方法 采用随机数字表法将40例脑卒中患者分为治疗组和对照组.2组患者均给予感觉再训练治疗,治疗组在此基础上辅以电针刺激头皮感觉区.于治疗前、治疗6周后采用Fugl-Meyer量表四肢感觉功能部分对2组患者偏瘫侧感觉功能进行评定;并于上述时间点对2组患者进行fMRI全脑扫描,在fMRI扫描期间2组患者均针刺患侧踝部(非穴位处)以获取针刺刺激时的脑功能激活图.结果 2组患者分别经6周治疗后,发现其感觉功能均较治疗前明显改善(P＜0.05),其中治疗组感觉功能评分[(16.52±2.31)分]明显优于对照组水平[(12.21±2.42)分](P＜0.05);通过fMRI扫描发现,治疗组患者治疗后其患侧感觉运动皮质区(SMG)激活出现率(80.0％)明显高于对照组(50.0％),组间差异具有统计学意义(P＜0.05).结论 电针刺激头皮感觉区联合感觉再训练能促进脑卒中患者躯干感觉皮质及大脑感觉皮质兴奋性改变,提示fMRI对研究电针刺激头皮感觉区的作用机制具有重要价值.     

首发重性抑郁障碍患者治疗前后面部表情认知的脑功能磁共振研究

目的用功能磁共振手段对首发未用药的重性抑郁障碍(MDD)患者治疗前后面部表情认知时脑功能活动的变化进行研究。方法对21例MDD患者分别在治疗前后进行脑功能磁共振扫描,比较MDD患者治疗前后进行面部表情认知时的脑激活区域差异。结果与治疗前相比,治疗后MDD患者在进行悲伤表情认知时激活显著减弱的脑区有:两侧额叶中央前回、两侧额中回、左侧顶叶中央后回和左侧扣带回;激活显著增强的脑区有:两侧顶上小叶和左侧枕中回。与治疗前相比,治疗后MDD患者在进行愉快表情认知时激活显著减弱的脑区有:左侧额中回、右侧扣带回和右侧海马旁回;激活显著增强的脑区有:右侧额下回和左侧枕叶梭状回。结论治疗前后MDD患者在进行悲伤或愉快表情认知时存在脑区激活的动态变化,说明MDD患者存在多个脑区的脑功能异常,并且这种异常能在有效的抗抑郁治疗后随着症状缓解而改善,抑郁症患者的脑功能异常可能在抑郁症的发病机制中发挥重要作用。     

抑郁症和双相障碍认知损害比较和治疗策略

认知损害是心境障碍的典型特点。心境障碍包括抑郁症(MDD)和双相障碍(BD)。认知损害影响患者的日常生活和社会能力,因此,为了提高生活质量,患者需要优化认知功能。而一般人群随着双相障碍进程,认知损害会逐渐进展,相比抑郁症来说认知损害更加严重。本文对抑郁症和双相障碍患者认知功能是否存在差异进行综述。从4方面进行阐述:(1)MDD和BD患者认知功能的比较;(2)认知障碍影像学鉴别;(3)认知障碍的影响因素;(4)改善认知功能的治疗策略。     

Unsupervised cross-domain functional MRI adaptation for automated major depressive disorder identification

Resting-state functional magnetic resonance imaging (rs-fMRI) data have been widely used for automated diagnosis of brain disorders such as major depressive disorder (MDD) to assist in timely intervention. Multi-site fMRI data have been increasingly employed to augment sample size and improve statistical power for investigating MDD. However, previous studies usually suffer from significant inter-site heterogeneity caused for instance by differences in scanners and/or scanning protocols. To address this issue, we develop a novel discrepancy-based unsupervised cross-domain fMRI adaptation framework (called UFA-Net) for automated MDD identification. The proposed UFA-Net is designed to model spatio-temporal fMRI patterns of labeled source and unlabeled target samples via an attention-guided graph convolution module, and also leverage a maximum mean discrepancy constrained module for unsupervised cross-site feature alignment between two domains. To the best of our knowledge, this is one of the first attempts to explore unsupervised rs-fMRI adaptation for cross-site MDD identification. Extensive evaluation on 681 subjects from two imaging sites shows that the proposed method outperforms several state-of-the-art methods. Our method helps localize disease-associated functional connectivity abnormalities and is therefore well interpretable and can facilitate fMRI-based analysis of MDD in clinical practice.     

首发未服药重性抑郁症患者静息态脑镜像同伦功能连接的差异

目的 探讨首发未服药重性抑郁症(MDD)患者大脑镜像脑区的功能连接的差异性。方法 对27例临床诊断为MDD且为首发未用药的患者(MDD组)和21名健康志愿者(对照组)行常规MRI及静息态功能成像(rs-fMRI),对rs-fMRI数据采用镜像同伦连接(VMHC)分析方法,并对两组被试差异脑区的VMHC值与汉密尔顿抑郁量表(HAMD)评分进行相关分析。结果 与对照组比较,MDD组患者的双侧额上回、后扣带回、舌回的VMHC值增加,上述差异脑区VMHC值与HAMD评分无显著相关性。结论 首发未服药MDD患者静息状态下多个大脑半球镜像脑区之间功能连接增加,可能为理解MDD的病理生理机制提供一个新的视角。     

Increased risk for major depressive disorder in severely obese patients after bariatric surgery — a 12-year nationwide cohort study

Abstract

Background: Bariatric surgery is associated with a significant improvement in depressive mood in the initial postoperative years, but the maintenance of the improvement is under debate.

Aim: To explore the association between bariatric surgery and major depressive disorder (MDD) in a 12-year nationwide cohort study.

Method: Using the National Health Insurance Research Database of Taiwan, we identified 2302 patients who underwent bariatric surgery in 2001–2009. These patients were matched by propensity score to 6493 obese patients who did not receive bariatric surgery. We followed the surgical and control cohorts until death, any diagnosis of MDD or 31 December 2012. We used Cox proportional hazard regression models to calculate the relative risk of MDD in those who received bariatric surgery.

Results: Overall, there was a 1.70-fold (95% CI: 1.27–2.27) higher risk of MDD in the surgical group. Subjects receiving malabsorptive procedures showed a higher risk of MDD (3.01, 95% CI: 1.78–5.09) than those receiving restrictive procedures (1.51, 95% CI: 1.10–2.07). Stratified by follow-up period, there was a higher risk of MDD in the surgical group (2.92, 95% CI: 1.75–4.88) than in the restrictive group four years after bariatric surgery.

Conclusions: Bariatric surgery was significantly associated with an elevated risk of MDD.

• KEY MESSAGES

• Bariatric surgery is associated with a significant improvement in depressive mood in the initial postoperative years, but the improvement is not maintained. Less is known about the relationship between bariatric surgery and risk of major depressive disorder.

• This was the first nationwide cohort study which found that bariatric surgery was significantly associated with an elevated risk of MDD (aHR: 1.70; CI: 1.27–2.27), mainly with malabsorptive procedures (aHR: 3.01; CI: 1.78–5.09) and at time points more than four years after surgery (aHR: 2.92; CI: 1.75–4.88) compared with the risk in matched controls. These findings imply an association between long-term malabsorption and the postoperative incidence of MDD.

• Long-term malabsorption might be related to the incidence of major depressive disorder after bariatric surgery. The possible causal relationship between nutritional deficiency after bariatric surgery and major depressive disorder warrants further investigation.

     

Reward and Punishment Sensitivity and Emotion Regulation Processes Differentiate Bipolar and Unipolar Depression

Bipolar disorder (BD) and major depressive disorder (MDD) cannot be reliably differentiated by depression symptom expression alone, suggesting a need to identify processes that may more effectively differentiate the two disorders. To explore this question, currently depressed adults with BD (n?=?30) and MDD (n?=?30), and healthy control participants with no history of psychiatric illness (CTL; n?=?30), completed self-report measures of reward and punishment sensitivity (i.e., behavioral activation and inhibition) and emotion regulation processes (i.e., rumination and avoidance). Results revealed that constructs putatively linked to depression across the mood disorders (i.e., behavioral inhibition, negative rumination, dampening of positive affect, behavioral and experiential avoidance) were significantly higher in both mood disorder groups compared to CTLs. Yet there was also some specificity between mood disorder groups, such that the BD group reported significantly greater reward responsiveness and positive rumination, in addition to greater behavioral inhibition and avoidance, compared to the MDD group. These data suggest that patterns of affective responding previously linked to underlying risk for mania in BD may remain evident during a major depressive episode. Further, current models of reward sensitivity in BD may benefit from the inclusion of punishment sensitivity and behavioral avoidance, particularly with respect to bipolar depression.     

Increased Cold-Pain Thresholds in Major Depression

Most previous studies indicated that patients suffering from major depressive disorder (MDD) showed a decreased sensitivity for external or skin surface pain, eg, for heat or electrical stimuli, as compared to healthy controls. Here, we investigated cold-pain thresholds in 20 unmedicated patients suffering from MDD and 20 matched controls. We applied the ascending method of limits which has previously been used for heat-pain assessment in patients with depression. Similar to previous results for heat-pain thresholds we found a decreased sensitivity for cold pain in patients with MDD as indicated by increased cold-pain thresholds. This difference was significant on the right arm, whereas only a trend was obtained on the left arm, thus suggesting a certain degree of lateralization, similar to that seen in heat-pain perception in patients suffering from MDD or adjustment disorder. The study confirms our previous results of a lower sensitivity for externally induced pain in patients with MDD. Moreover, it adds weight to the assumption of a lateralized perception of thermal pain in depression.PerspectiveThis investigation provides further evidence for reduced pain perception of externally applied stimuli in major depression. Thus, central-nervous correlates for this altered pain perception in major depression are worth examining in future studies in order to gain more insight into mechanisms of pain perception on the one hand, and pathology of depression on the other.     

Symptoms of PTSD and Major Depression in Latinas Who Have Experienced Intimate Partner Violence

The purpose of this study was to describe symptoms of PTSD and major depression in abused Latinas and to explore the relationships among intimate partner violence (IPV) experiences, these symptoms, and health related quality of life (HRQOL). The rate of PTSD was 69.7%% and of major depressive disorder (MDD) was 57.6%%. The comorbidity of PTSD and MDD was 54.5%%. PTSD and MDD were not consistently correlated with IPV, although some significant relationships were found. PTSD and MDD symptoms were highly correlated with HRQOL. The impact of PTSD and MDD on psychological well-being and functioning in Latinas needs further investigation.     

A multimodal imaging study in U.S. veterans of Operations Iraqi and Enduring Freedom with and without major depression after blast-related concussion

Although the exact number of affected individuals is unknown, it has been estimated that approximately 20% of U.S. veterans of Operations Enduring Freedom (OEF) and Iraqi Freedom (OIF) have experienced mild traumatic brain injury (mTBI) (i.e., concussion), which is defined as a brief loss or alteration of consciousness from a blow or jolt to the head. Blast exposure is among the most common causes of concussion in OEF–OIF warriors. Although the mechanism is unknown, major depressive disorder (MDD) after head injury is common. The purpose of this study was to use diffusion tensor imaging (DTI) and functional magnetic resonance imaging (fMRI) to examine the structural and functional neural correlates of MDD in OEF–OIF combat veterans with a self-reported history of blast-related concussion. We hypothesized that subjects in the MDD group (i.e., individuals with a history of blast-related concussion who were experiencing current MDD) relative to individuals in the non-MDD group (i.e., individuals with a history of blast-related concussion but no current or lifetime history of MDD) would show amygdala hyperactivity and disruption of white matter tracts connecting prefrontal and limbic brain regions. To test these hypotheses, 11 MDD and 11 non-MDD individuals underwent DTI and performed a validated emotional face matching task during fMRI. MDD relative to non-MDD individuals showed greater activity during fear matching trials in the amygdala and other emotion processing structures, lower activity during fear matching trials in emotional control structures such as the dorsolateral prefrontal cortex and lower fractional anisotropy (FA) in several white matter tracts including the superior longitudinal fasciculus (SLF). Greater depressive symptom severity correlated negatively with FA in the SLF. These results suggest a biological basis of MDD in OEF–OIF veterans who have experienced blast-related concussion, and may contribute to the development of treatments aimed at improving the clinical care of this unique population of wounded warriors.     

Genetics of Depression: An Overview of the Current Science

Most psychiatric disorders, including major depressive disorder (MDD), are known to involve complex interactions between genetic and environmental influences that impact the development and severity of symptomatology. Health care practitioner competencies have been expanded to include application of genetic knowledge in mental health. Yet this information is difficult to decipher and apply. To assist with these challenges, this article synthesizes recent literature related to the genetics of MDD and illustrates the genetic pathways for major depression.     

基于静息态MRI观察比率低频振幅下产后抑郁症患者脑自发神经活动

目的 采用静息态功能MRI（fMRI）观察产后抑郁症（PPD）患者在比率低频振幅（fALFF）下大脑自发神经活动。方法 对23例产后抑郁症患者（PPD组）、28名健康产妇（HPW组）及20例女性重性抑郁障碍患者（MDD组）采集静息态fMRI数据，以fALFF技术观察各组脑自发神经活动，提取PPD组与HPW组差异脑区的fALFF值，与爱丁堡产后抑郁量表（EPDS）评分进行相关性分析。结果 相比HPW组，PPD组左侧后扣带回、左侧楔前叶、左侧枕中回、左侧枕下回及右侧距状裂周围皮质fALFF值增高（AlphaSim校正，P均<0.05），右侧眶部额下回、右侧脑岛、右侧嗅皮质、右侧海马fALFF值减低（AlphaSim校正，P均<0.05）。相比MDD组，PPD组右侧舌回、右侧小脑fALFF值增高（AlphaSim校正，P均<0.05），右侧背外侧前额叶、右侧楔前叶、左侧顶上回、左侧角回、右侧内侧旁扣带回、右侧颞下回fALFF值减低（AlphaSim校正，P均<0.05）。PPD组右侧眶部额下回fALFF值与EPDS评分呈负相关（r=-0.53，P=0.01）。结论 静息态下PPD患者与情绪、认知相关脑区存在自发神经活动异常，其右侧眶部额下回fALFF值与抑郁严重程度密切相关；PPD与MDD患者脑fALFF表现并不完全一致，PPD可能存在特征性神经功能改变。