腰背痛患者静息态fMRI的脑功能局部一致性研究

目的 利用功能磁共振成像(fMRI)技术探讨静息状态下腰背痛患者脑局部一致性(ReHo)变化的特点. 方法 选择自2011年8月至2012年1月南方医科大学珠江医院康复医学科招募的15例年龄、性别和文化程度相近的健康者作为受试者,向其右侧腰背部肌肉注射0.3 mL30g/L的高渗盐水制造腰背痛模型,采用3.0T MR仪分别在注射前、注射后进行静息状态fMRI扫描,所得数据进行配对t检验,比较疼痛及非疼痛状态下静息态脑功能的局部一致性差异. 结果 与正常状态相比,腰背痛受试者ReHo增高的脑区有:双侧前额叶内侧、左额下回、右额中回、右小脑扁桃体、右脑桥、右岛叶、右尾状核、右楔前叶、右海马旁回、后扣带回;ReHo减低的脑区有:右颞上回、左颞中回、左中央前回、左中央后回、左海马旁回、左梭状回、左前扣带回、左顶上小叶、右顶下小叶(P＜0.005,体素值≥10). 结论 静息状态下腰背痛患者部分脑区存在脑活动区域一致性异常.     

抑郁症患者静息状态的功能磁共振成像研究

目的 了解在静息状态下抑郁症患者脑区的局部一致性特点.方法 采用功能磁共振成像(fMRI)技术,检测静息状态下27例抑郁症患者(患者组)和性别、年龄、受教育程度均与患者相匹配的27名正常人(对照组)的脑功能活动,并对两组进行比较.利用局部一致性方法 分析fMRI数据,用SPM2软件进行配对t检验(P＜0.005).结果 与对照组相比,患者组双侧额中回、右额下回、右颞上回、左前扣带回、右后扣带回、右岛叶、双侧豆状核、双侧屏状核、左尾状核局部一致性显著增高(P＜0.005,未校正,体素值＞10);未显示脑区有明显的局部一致性减低.结论 抑郁症患者神经环路脑区局部在静息状态下具有很高的一致性,其局部一致性的增高可能参与了抑郁症的代偿机制.     

抑郁症首次发病患者静息态脑功能局部一致性的研究

目的 利用功能磁共振(fMRI)和局部一致性(regional homogeneity,ReHo)探讨抑郁症首次发病(以下简称首发)患者在静息态脑功能是否存在异常及异常部位.方法 对34例符合美国精神疾病诊断与统计手册第4版诊断标准的首发抑郁症患者(抑郁症组)和34名性别、年龄、文化程度匹配的健康志愿者(对照组)进行静息态fMRI扫描.结果 抑郁症组静息态脑血氧水平依赖信号的ReHo高于对照组的脑区有左侧额叶眶回、顶下小叶、颞上回,右侧额内侧回、顶下小叶、小脑后叶;低于对照组的脑区有左颞下回、右颞上同和胼胝体、双侧后扣带回(P＜0.005,K≥10).结论首发抑郁症患者在静息态存在多个腩区功能活动的异常,并可能和抑郁症的病理机制有关.     

以妄想为主的男性精神分裂症患者脑局部一致性的功能磁共振研究

目的：探讨男性偏执型精神分裂症患者在静息状态下是否存在脑功能活动异常及其区域。方法：采用病例一对照研究方法,对20例以妄想为主的男性精神分裂症患者（患者组）和20名性别、年龄、受教育程度相匹配的正常对照者（正常对照组）进行功能磁共振成像（fMRI）扫描,分析静息状态下各脑区的局部一致性（regionalhomogeneity,ReHo）的差异。结果：设P〈0．05、体素范围（k值）≥85,与正常对照组比较,患者组双侧额上回、双侧颞中回、左额中回、左中央前回、左小脑脚和右扣带回局部一致性（ReHo值）减低,右颞上回和左颞下回ReHo值增高,而左梭状回ReHo值既有增高也有减低。结论：以妄想为主的男性精神分裂症患者在静息状态下可能存在广泛分布的脑区功能异常。     

男性偏执型精神分裂症患者静息态功能磁共振脑自发低频振幅的变化

目的:利用静息态功能性磁共振成像(fMRI)技术观察男性偏执型精神分裂症患者脑自发低频振幅(ALFF)的变化。方法:对36例男性偏执型精神分裂症患者(病例组)和19名年龄、利手、性别、受教育程度相匹配的健康者(对照组)进行静息态fMRI扫描;分析两组全脑各区域ALFF的差异。结果:与对照组比较,病例组双侧额中回、右颞中回、右顶下回、左中央前回ALFF明显减低;右颞上回、双侧颞下回、左枕下回ALFF明显增强(P均0.01)。结论:男性偏执型精神分裂症患者脑部广泛区域存在ALFF异常。     

难治性抑郁症脑局部葡萄糖代谢的初步研究

目的 探索难治性抑郁症的脑局部葡萄糖代谢模式.方法 对符合国际疾病分类标准第10版(ICD.10)抑郁症诊断标准的8例难治性抑郁症患者和8名正常对照进行静息态正电子发射计算机断层/18F-氟代脱氧葡萄糖(PET/FDG)扫描,利用参数统计图(SPM2)方法分析组间脑局部代谢差异.结果 患者组的双侧额中回、左侧眶额皮质、左顶下小叶、左腹侧前扣带回、右侧额下回、右颞是回和颞中回以及双侧背侧前扣带回FDG代谢水平明显低于对照组;而左侧中央前/后回、右侧额内侧回、右颞极、右岛叶以及双侧小脑等脑区代谢水平则明显高于对照组.上述差异均有统计学意义(P<0.005).结论 难治性抑郁症患者存在旁边缘系统代谢增高和皮质代谢降低的交互性改变的异常代谢模式.     

抑郁症患者对正性面部表情功能识别

目的：利用任务态功能核磁共振成像技术,初步探讨抗抑郁治疗对正性情绪识别脑区功能的影响。方法：检测19例抑郁症患者治疗前和治疗10周后在识别正性及中性面部表情视频时的激活脑区,并与19例匹配的健康者对照比较。结果：与正常对照组相比,治疗前抑郁症患者左右颞上回（BA39）、左后扣带回（BA23）、右后扣带回（BA30）、左丘脑、右岛叶（BA13）等脑区激活显著降低;治疗后患者左颞上回（BA39）、右颞上回（BA22）、左颞中回（BA37）、左右海马旁回（BA30）、右后扣带回（BA29）、右梭状回（BA36）、左额中回（BA8）、右额下回（BA47）、左顶下小叶（BA40）、右岛叶（BA13）等脑区激活较治疗前增强;但与正常组相比,左颞上回（BA22）、左额中回（BA10）、左梭状回（BA20）、左楔叶（BA19）、右顶上小叶（BA7）、右岛叶（BA13）等脑区激活仍存在一定程度的降低。结论：经抗抑郁治疗,抑郁症患者正性情绪识别脑区功能较治疗前有所改善,但与正常对照组相比,仍存在一定程度的功能损害。进一步证实了积极有效的抗抑郁治疗能够部分逆转正性情绪相关脑区损害。     

以妄想为主的男性精神分裂症患者内侧前额叶功能连接的静息态磁共振成像研究

目的:利用静息态功能性磁共振成像(fMRI)技术,观察以妄想为主的男性精神分裂症患者内侧前额叶(MPFC)的功能连接. 方法:对17例以妄想为主的男性精神分裂症患者(患者组)和17例年龄、利手、性别、受教育程度与患者组均匹配的健康者(对照组)进行静息态fMRI扫描.通过分析MPFC与大脑其他区域的低频fMRI信号波动的相关性,观察MPFC的功能连接.将患者组和对照组在静息状态下MPFC的脑功能连接活动进行相关分析,设P＜0.005且体素范围(K值)≥12为相关具有显著差异. 结果:与对照组相比,患者组MPFC与右颞上回、右额上回及双侧额中回、右海马、右杏仁核、眶额叶、右海马旁回的功能连接减低;与左枕叶中部、左顶下小叶及左小脑前叶的功能连接增强.结论:静息态下以妄想为主的男性精神分裂症患者MPFC与默认网络其他结构的功能连接存在异常.     

首发抑郁症患者静息态MRI脑局部一致性的改变

目的 利用静息态MRI 技术去探索首发抑郁症患者特异脑区的脑功能改变。方法 对符 合抑郁症诊断标准的20 例患者及20 名健康志愿者进行静息态MRI检查,使用静息态MRI局部一致性 （ReHo）分析方法,比较抑郁症组与对照组ReHo 值,发现特异性增高或减低的脑区。结果 抑郁症组 对比对照组,ReHo 增高的脑区有小脑后叶、颞下回、枕中回、舌回、中央后回、中央前回、额上回、顶 叶等;ReHo 降低的脑区有边缘叶、海马旁回、壳核、丘脑、豆状核、额下回、额中回、楔前叶、扣带回等。 结论 静息态MRI 的ReHo 分析方法可能发现抑郁症异常的脑区,为抑郁症发病机制的探索提供帮助。     

不同症状为主的精神分裂症患者静息态功能磁共振成像研究

目的:探讨不同症状为主的精神分裂症患者在静息状态下功能磁共振成像(f MRI)是否存在脑功能异常及异常其区域。方法:采用病例-对照研究方法,将病例组分为妄想组(20例)和幻觉组(20例),分别对妄想组、幻觉组和20名正常对照进行f MRI扫描,利用局部一致性(Re Ho)方法处理每个被试的f MRI数据。结果:与正常对照组比较,病例组Re Ho值普遍降低,妄想组在右颞上回和左颞下回Re Ho值增高;幻觉组在左额下回、左梭状回、右颞上回和右尾状核Re Ho值增高。结论:以妄想症状为主的患者和以幻觉症状为主的患者在静息状态下可能存在广泛分布的脑区功能异常,二者异常有共同点,也有各自的特征。     

重度抑郁症症状缓解前后海马局部一致性研究

目的观察静息态下发作期重度抑郁症患者的海马功能,以及其在抗抑郁药物治疗达临床痊愈后的变化。方法对20例24项汉密尔顿抑郁量表(HAMD24)总分35分的重度抑郁症患者在治疗前、治疗8周达临床痊愈(HAMD24减分率≥75%)后进行静息态fMRI扫描,以性别、年龄、受教育程度匹配的20名正常人做对照组。采用局部一致性(regional homogeneity,ReHo)作为海马功能的测量指标。结果治疗前患者组较正常对照组左海马ReHo值增高,差异具有统计学意义(P0.05);但患者组治疗前与治疗后、治疗后与正常对照组的左海马ReHo值的差异均无统计学意义(P0.05)。患者组治疗前、治疗后、正常对照组中每两组间右海马ReHo值的差异均无统计学意义(P0.05)。结论重度抑郁症患者海马功能受损,存在侧化现象,经短期系统的抗抑郁药物治疗达临床痊愈后,这种损伤未见有效逆转。     

Attenuation of the neural response to sad faces in major depression by antidepressant treatment: a prospective, event-related functional magnetic resonance imaging study

BACKGROUND: Depression is associated with interpersonal difficulties related to abnormalities in affective facial processing. OBJECTIVES: To map brain systems activated by sad facial affect processing in patients with depression and to identify brain functional correlates of antidepressant treatment and symptomatic response. DESIGN: Two groups underwent scanning twice using functional magnetic resonance imaging (fMRI) during an 8-week period. The event-related fMRI paradigm entailed incidental affect recognition of facial stimuli morphed to express discriminable intensities of sadness. SETTING: Participants were recruited by advertisement from the local population; depressed subjects were treated as outpatients. PATIENTS AND OTHER PARTICIPANTS: We matched 19 medication-free, acutely symptomatic patients satisfying DSM-IV criteria for unipolar major depressive disorder by age, sex, and IQ with 19 healthy volunteers.Intervention After the baseline assessment, patients received fluoxetine hydrochloride, 20 mg/d, for 8 weeks. MAIN OUTCOME MEASURES: Average activation (capacity) and differential response to variable affective intensity (dynamic range) were estimated in each fMRI time series. We used analysis of variance to identify brain regions that demonstrated a main effect of group (depressed vs healthy subjects) and a group x time interaction (attributable to antidepressant treatment). Change in brain activation associated with reduction of depressive symptoms in the patient group was identified by means of regression analysis. Permutation tests were used for inference. RESULTS: Over time, depressed subjects showed reduced capacity for activation in the left amygdala, ventral striatum, and frontoparietal cortex and a negatively correlated increase of dynamic range in the prefrontal cortex. Symptomatic improvement was associated with reduction of dynamic range in the pregenual cingulate cortex, ventral striatum, and cerebellum. CONCLUSIONS: Antidepressant treatment reduces left limbic, subcortical, and neocortical capacity for activation in depressed subjects and increases the dynamic range of the left prefrontal cortex. Changes in anterior cingulate function associated with symptomatic improvement indicate that fMRI may be a useful surrogate marker of antidepressant treatment response.     

抑郁症静息态大脑双侧杏仁核的功能连接

目的：探讨静息态下抑郁症患者大脑半球双侧杏仁核的功能连接特点，了解杏仁核及其功能相关脑区在抑郁症病理机制中的作用。方法：11例首次发作的重性抑郁症患者与11例性别、年龄、受教育程度均与患者相匹配的正常人完成静息态功能性磁共振成像（fMRI）扫描。利用Pearson相关分析方法分析受试者大脑双侧的杏仁核功能连接强度，并利用双样本t检验做组间对比，设P〈0．05为差异具有显著性。结果：静息态下，两组双侧杏仁核均具有明显的功能连接（P〈0．05），而抑郁症组较对照组的功能连接明显减低（P=0．025）。结论：静息态下抑郁症组双侧杏仁核功能连接存在异常，这可能与抑郁症患者杏仁核异常及杏仁核与其他情感调节相关脑区的协调异常有关。     

Neural responses to happy facial expressions in major depression following antidepressant treatment

OBJECTIVE: Processing affective facial expressions is an important component of interpersonal relationships. However, depressed patients show impairments in this system. The present study investigated the neural correlates of implicit processing of happy facial expressions in depression and identified regions affected by antidepressant therapy. METHOD: Two groups of subjects participated in a prospective study with functional magnetic resonance imaging (fMRI). The patients were 19 medication-free subjects (mean age, 43.2 years) with major depression, acute depressive episode, unipolar subtype. The comparison group contained 19 matched healthy volunteers (mean age, 42.8 years). Both groups underwent fMRI scans at baseline (week 0) and at 8 weeks. Following the baseline scan, the patients received treatment with fluoxetine, 20 mg daily. The fMRI task was implicit affect recognition with standard facial stimuli morphed to display varying intensities of happiness. The fMRI data were analyzed to estimate the average activation (overall capacity) and differential response to variable intensity (dynamic range) in brain systems involved in processing facial affect. RESULTS: An attenuated dynamic range of response in limbic-subcortical and extrastriate visual regions was evident in the depressed patients, relative to the comparison subjects. The attenuated extrastriate cortical activation at baseline was increased following antidepressant treatment, and symptomatic improvement was associated with greater overall capacity in the hippocampal and extrastriate regions. CONCLUSIONS: Impairments in the neural processing of happy facial expressions in depression were evident in the core regions of affective facial processing, which were reversed following treatment. These data complement the neural effects observed with negative affective stimuli.     

Changes in cognitive functioning following treatment of late-life depression

OBJECTIVE: Knowledge of the relationship between various clinical characteristics and cognitive functioning is advancing, but little is known about the cognitive response to treatment for geriatric depression. The purpose of this study was to examine the cognitive response to treatment for patients with late-life depression. METHOD: Subjects included 45 nondemented, elderly depressed patients who achieved remission after 12 weeks of antidepressant treatment and 20 elderly comparison subjects. All subjects were administered a battery of clinical measures, including cognitive screening instruments, before and after treatment. RESULTS: As a group, the elderly depressed patients showed a small improvement in overall cognitive functioning after treatment. Among depressed patients with concomitant cognitive impairment at baseline, performance on the Mattis Dementia Rating Scale domains of conceptualization and initiation/perseveration improved significantly relative to those of depressed patients with normal cognition. Despite the improvement following treatment, the overall level of cognitive functioning in the elderly depressed patients with cognitive impairment at baseline remained mildly impaired, especially in the memory and initiation/perseveration domains. CONCLUSIONS: Elderly depressed patients with cognitive impairment may experience improvement in specific domains following antidepressant treatment but may not necessarily reach normal levels of performance, particularly in memory and executive functions. This subgroup of late-life depression patients is likely at high risk of developing progressive dementia.     

Major depressive disorders in the general hospital: how to implement guidelines

OBJECTIVE: An implementation study that evaluated the impact of previously adopted guidelines on the clinical practice of medical residents was conducted to improve the recognition and treatment of major depressive disorders (MDDs) in hospitalized patients with somatic diseases. METHODS: Guidelines were implemented in two wards (ENT and oncology) using intranet diffusion, interactive sessions with medical residents, and support material. Discharge letters of 337 and 325 patients, before and after the intervention, respectively, were checked for statement of diagnosis or treatment of MDDs and, in a post hoc analysis, for any mention about psychiatric management. RESULTS: No difference was found in the number of diagnosed or treated MDDs before and after the intervention. However, significantly more statements about psychological status (29/309 vs. 13/327) and its management (36/309 vs. 19/327) were observed after the intervention (P<.01). CONCLUSION: The intervention was not successful in improving the management of MDDs. However, a possible effect on general psychological aspects of medical diseases was observed.     

Effects of Antidepressant Treatment on Sexual Arousal in Depressed Women: A Preliminary fMRI Study

Objective

There was a recent study to explore the cerebral regions associated with sexual arousal in depressed women using functional magnetic resonance imaging (fMRI). The purpose of this neuroimaging study was to investigate the effects of antidepressant treatment on sexual arousal in depressed women.

Methods

Seven depressed women with sexual arousal dysfunction (mean age: 41.7±13.8, mean scores of the Beck Depression Inventory (BDI) and the 17-item Hamilton Rating Scale for Depression (HAMD-17): 35.6±7.1 and 34.9±3.1, respectively) and nine healthy women (mean age: 40.3±11.6) underwent fMRI before and after antidepressant treatment. The fMRI paradigm contrasted a 1 minute rest period viewing non-erotic film with 4 minutes of sexual stimulation viewing an erotic video film. Data were analyzed by SPM 2. The relative number of pixels activated in each period was used as an index of activation. All depressed women were treated with mirtazapine (mean dosage: 37.5 mg/day) for 8 to 10 weeks.

Results

Levels of brain activity during sexual arousal in depressed women significantly increased with antidepressant treatment (p<0.05) in the regions of the hypothalamus (3.0% to 11.2%), septal area (8.6% to 27.8%) and parahippocampal gyrus (5.8% to 14.6%). Self-reported sexual arousal during visual sexual stimulation also significantly increased post-treatment, and severity of depressive symptoms improved, as measured by the BDI and HAMD-17 (p<0.05).

Conclusion

These results show that sexual arousal dysfunction of depressed women may improve after treatment of depression, and that this improvement is associated with increased activation of the hypothalamus, septal area, and parahippocampal gyrus during sexual arousal.     

Somatic symptoms in depression and antidepressants

Somatic side effects of antidepressant medications and of depression and anxiety were quantified in depressed patients before and after 4 weeks of treatment with amitriptyline (N = 11), or desipramine (N = 12). The entire group showed significant posttreatment decreases in depression. Side-effect symptoms were significantly reduced after treatment in the amitriptyline group; less reduction was seen in the desipramine group. Significant correlations were demonstrated between levels of anxiety and side effect symptoms both before and after treatment. The reduction in side effect symptoms in the amitriptyline group can be explained by the drug's anxiolytic property. Our findings suggest that symptoms resembling antidepressant side effects seen in medicated depressed patients are influenced by the patient's clinical condition more than by the anticholinergic activity of moderate dosages of the antidepressant.     

Efficacy of continuation ECT and antidepressant drugs compared to long-term antidepressants alone in depressed patients

OBJECTIVE: The purpose of this study was to evaluate the efficacy of continuation ECT in depression. METHOD: The authors used retrospective chart review to identify 29 patients who received continuation ECT plus long-term antidepressant treatment after a positive response to acute treatment with ECT for a depressive episode (continuation ECT group). A retrospective case-controlled approach was used to ascertain a matching group of 29 patients who received long-term antidepressant treatment alone after responding positively to acute ECT (antidepressant-alone group). All 58 patients (46 with unipolar depression, 12 with bipolar disorder) had been chronically depressed before receiving acute ECT. Data from medical records were analyzed by using survival analysis and proportional hazards regression to determine outcome and risk factors. RESULTS: The mean duration of the follow-up period for all patients was 3.9 years (5.4 years for the continuation ECT patients and 2.4 years for the antidepressant-alone patients). Outcome was significantly better in the continuation ECT group. The cumulative probability of surviving without relapse or recurrence at 2 years was 93% for continuation ECT patients and 52% for antidepressant-alone patients. At 5 years, survival declined to 73% for continuation ECT patients, but fell to 18% for antidepressant-alone patients. Mean survival times were 6.9 years for the continuation ECT patients and 2.7 years for the antidepressant-alone patients. CONCLUSIONS: The findings provide strong support for the efficacy of continuation ECT plus long-term antidepressant treatment in preventing relapse and recurrence in chronically depressed patients who have responded to acute treatment with ECT.     

Exposure to antidepressant medications and suicide attempts in adult depressed inpatients

The effects of antidepressant medication on suicide risk remain unclear. This study explores any association between antidepressant medication and suicide attempts leading to hospitalization in adult depressed patients.The medical records of 103 patients admitted after a suicide attempt were examined and compared with those of a matched control group of depressed patients (n = 103) admitted without suicide attempts as well as a patient group with and without suicide attempts on separate hospitalizations (n = 25). No significant difference in antidepressant medication exposure before hospitalization was found between groups. Selective serotonin reuptake inhibitor exposure was higher in patients with suicide attempts, albeit nonsignificant, but was identical in patients admitted on two occasions with and without suicide attempts. The most common method for suicide attempt was drug overdose (52.4%). Patients in the group with suicide attempts had significantly more past suicide attempts. Study results do not confirm any relationship between antidepressants and suicide attempts. Close monitoring of depressed patients is advised especially in early treatment.