识别负性表情时抑郁症患者杏仁核的磁源性影像动态变化

目的:探讨识别负性动态表情时抑郁症患者杏仁核的动态变化及其功能偏侧化特点在抑郁症病理机制中的作用。方法:利用脑磁图检测14例抑郁症患者及14名年龄、性别、受教育年限近似匹配的健康对照者识别表情时的脑部反应。结果:与对照组相比,患者组双侧杏仁核在50～150ms、100～200ms、150～250ms、300～400ms、450～550ms以及600～700ms时间段过度激活(P<0.05);左侧杏仁在50～150ms、100～200ms、150～250ms、300～400ms以及750～850ms时间段过度激活(P<0.05);右侧杏仁核在50～150ms、100～200ms、150～250ms、250～350ms、300～400ms、450～550ms、550～650ms、600～700ms以及750～850ms时间段过度激活(P<0.05);而且右侧杏仁核功能激活水平始终高于左侧杏仁核(P<0.05)。结论:抑郁症患者情绪障碍发生可能与抑郁症患者杏仁核异常及杏仁核功能偏侧化协调异常有关。     

抑郁症患者识别喜悦面孔时边缘系统信息传递的磁源性影像研究北大核心CSCD

目的 探究抑郁症患者和健康人在识别喜悦面孔时情绪信息在全脑传递过程中的差异,以及抑郁症患者正性情绪处理加工可能的电生理机制.方法 利用脑磁图分别对34例抑郁症患者（抑郁症组）以及性别、年龄、受教育年限与之相匹配的34名健康对照者（对照组）进行扫描,选取喜悦表情刺激下的脑磁信号,采用一致性方法计算0～600 ms时间段全脑功能连接矩阵,然后计算每个节点的介数中心性值,经非参数检验2组差异有统计学意义的节点与HAMD17总分和各因子分进行Pearson相关分析.结果 在0～600 ms时间段抑郁症组右侧眶部额上回（P=0.000 38,通过FDR校正）、左侧眶内额上回（P=0.000 16,通过FDR校正）、右侧眶内额上回（P=0.000 23,通过FDR校正）、右侧杏仁核（P=0.000 43,通过FDR校正）的介数中心性值均较对照组下降.其中,抑郁症组右侧眶部额上回的介数中心性值与HAMD17总分（r=-0.481,P=0.004）和焦虑/躯体化因子分（r=-0.383,P=0.026）呈负相关,右侧眶内额上回的介数中心性值与HAMD17总分（r=-0.749,P＜0.01）和焦虑/躯体化因子分（r=-0.431,P=0.011）呈负相关.结论 抑郁症患者识别喜悦面孔时边缘系统信息传递异常,尤其是眶额回和杏仁核局部脑区存在信息传递障碍,可能是抑郁症患者正性情绪处理异常的重要病理基础.     

抑郁症患者情绪图片刺激早期低频脑磁图研究

目的：探讨抑郁症患者给予视觉情绪图片刺激早期0～100ms、100～200ms、200～300ms3个时段8～30Hz的神经磁场激活特征。方法：8例抑郁症患者及12例健康右利手对照者,在给予国际情绪图片库（IAPS）正性、中性、负性情绪图片刺激同时记录脑磁图信号,使用SPM8b软件进行数据分析：设两样本t检验P〈0.01（未校正）和K值≥10个体素范围为差异有统计学意义。结果：与对照组相比,抑郁组在正性情绪图片刺激下,100～200ms内的左侧额下回,右侧的终板旁回、额内侧回、海马回激活增强。在中性情绪图片刺激下,抑郁组在0～100ms的右侧豆状核、岛叶、额上回,左内侧额叶,100～200ms内的右侧岛叶、豆状核壳核及屏状核,左侧额下回、额上回、颞上回,200～300ms内的右侧岛叶、豆状核、尾状核体激活增强。负性情绪图片刺激下抑郁组在0～100ms内的右侧颞上回、岛叶、尾状核头部、额中下回激活增强,100～200ms内的右侧额中回、尾状核体,200～300ms内右额下回激活增强。此外还比较一致的发现抑郁组在楔前叶、后扣带回等顶叶脑区激活降低。结论：抑郁个体起注意调节功能的顶叶脑区如楔前叶功能不足,对视觉皮质向前部脑区情绪信息颞叶底部传递通路抑制不足,腹侧前额皮质、岛叶过度的激活,可能是抑郁症的一个发病基础。     

抑郁症的脑磁图研究进展

脑磁图可探测大脑神经电磁生理变化,具有高时间空间分辨率的优势,本文将国外脑磁图在抑郁症脑病理生理方面的研究现状做一综述.     

抑郁症患者恐惧与中性面孔刺激的脑磁图研究

目的:利用脑磁图探讨抑郁症患者给予重复恐惧、中性面孔刺激后早期神经磁场激活特征。方法:8例抑郁症患者及12名健康右利手对照者,在给予恐惧、中性面孔图片刺激同时记录脑磁图信号,使用SPM8b软件进行数据分析;设两样t检验P<0.005(未校正)和K值≥40个体素范围为差异有统计学意义。结果:在0～50Hz频率范围内,与对照组相比,抑郁组在恐惧面孔图片刺激下显示出左侧眶额皮质、腹外侧前额皮质激活增强;在中性面孔刺激下,抑郁组显示出左侧腹外侧前额皮质和眶额皮质、左前扣带回激活增强,双侧顶叶如楔前叶等激活减弱。结论:抑郁症患者情绪感受脑区左侧前额皮质低频脑磁图功率增强。     

脑磁图在抑郁症中的应用

脑磁图能精确检测组织电生理的功能性信息，介绍其在抑郁症诊断治疗中的应用。     

磁源性影像对颞叶癫(癎)定位的临床价值

目的探讨磁源性影像（MSI）对颞叶癫癎患者癫癎灶的定位价值。方法23例颞叶癫癎的患者进行了MSI检查,将结果与普通EEG、视频EEG和皮质EEG结果进行比较。其中8例行手术治疗,5例行伽玛刀治疗。结果23例患者中MEG显示单致癎灶15例,多致癎灶8例,MEG于V-EEG的符合率为84.6%,17例MRI检查异常,MEG与MRI结果符合率76.4%。8例术中ECoG定位检查,与MEG定侧定位均完全符合。13例患者MEG定位后行手术或伽玛刀治疗,疗效满意。结论MSI对颞叶癫癎定位准确,具有指导临床进一步治疗的价值。     

脑磁图在神经外科中的应用

目的 探讨脑磁图（MEG）在癫痫外科中的定位价值。方法 本组26例癫痫患，男18例，女8例，术前均行脑电图（EEG）检查和影像学检查，同时做了脑磁图（MEG）检查。所有患手术均在MEG指导下进行，术中加用皮层脑电图（ECoG)监测。结果 26例患均能通过MEG进行术前致痫灶与功能定位，其阳性率明显高于EEG和影像学检查。术后复查EEG，22例患较好。短期随访1－3个月，25例患癫痫发作完全消失。结论 MEG是一项术前痫灶定位和功能保护的有效检查方法。     

脑磁图功能定位在脑功能区肿瘤手术中的应用

目的 评价脑磁图(MEG)功能定位在脑功能区肿瘤手术的应用价值.方法 回顾性分析24例肿瘤位于功能区及其附近病人的临床资料.术前行MEG功能定位,术中结合神经导航系统实时定位肿瘤及功能区,指导肿瘤切除和功能保护.结果 肿瘤位于功能区6例,与功能区部分重叠6例,功能区边缘5例,功能区外1-2cm7例.肿瘤全切除20例,次全切除4例.术后出现一过性神经功能障碍加重6例,持久性功能障碍加重4例.结论 MEG功能定位是术前无创功能定位技术,能够明确肿瘤与功能区位置关系,应用于功能区及附近肿瘤手术,可减少神经功能障碍的发生,提高病人术后生活质量.     

精神分裂症幻听患者初级听觉皮质的脑磁图研究

目的 探讨在不同频率纯音刺激下男性精神分裂症幻听患者初级听觉皮质的脑磁图(MEG)定位.方法 对均为右利手的10例男性精神分裂症幻听患者(研究组)和11名男性健康受试者(对照组),分别给予频率为0.5,2,4,8 kHz的纯音刺激,强度90 dB,持续200ms,刺激声间隔1 s.用脑磁图设备记录刺激后产生的听觉诱发磁场,并将MEG资料叠加到核磁共振成像以获得磁源性影像.结果 (1)对照组初级听觉皮质均定位于双侧颞横回;与对照组比较,研究组右侧初级听觉皮质位置更靠近颞横回外部,左侧明显偏向颞上回后外下部(P<0.05).(2)在分别给予2 kHz和4kHz纯音刺激时,研究组大脑双侧M100潜伏期[2 kHz:左(97±16)ms,右(97±10)ms,4 kHz:左(93±13)ms,右(99±14)ms]均短于对照组[2 kHz:左(121±15)ms,右(113±6)ms,4 kHz:左(113±13)ms,右(114±6)ms](均P<0.01),而波幅[2 kHz:左(89±10)fT,右(118±37)fT,4 kHz:左(81±9)fT,右(108±14)fT]高于对照组[2 kHz:左(73±12)fT,右(79±13)fT,4 kHz:左(69±14)fT,右(81±20)fT](均P<0.05～0.01).结论 男性精神分裂症幻听患者的初级听觉皮质位置与正常人不同,其M100波幅高,潜伏期短,这些功能及解剖结构的异常可能是精神分裂症幻听产生的病理生理机制之一.     

抑郁症首次发病患者认知功能的研究

目的探讨抑郁症首次发病(以下简称首发)患者的认知功能特点及其影响因素。方法采用韦氏成人智力量表、韦氏记忆量表、威斯康星卡片分类测验(WCST)分别评定116例首发抑郁症患者(抑郁症组)和41名健康人(对照组)的认知状况,采用汉密尔顿抑郁量表(24项,HAMD)评定病情严重程度。对影响神经心理学测验成绩的临床症状进行逐步多元回归分析。结果(1)抑郁症组的长时记忆[(35.28±7.27)分]、短时记忆[(51.32±13.41)分]、记忆商数[(89.46±17.84)]、语言智商数[(110.96±13.72)]、操作智商数[101.90±15.98)]、智商数[(107.41±15.78)]均明显低于对照组[长时记忆(44.05±5.06)分,短时记忆(71.41±8.51)分,记忆商数(121.90±11.26),语言智商数(117.49±10.99),操作智商数(117.24±10.54),智商数[(118.98±10.95)],差异均有统计学意义(均P<0.01)。抑郁症组的WCST总测验数[(74.70±27.96)个]、持续错误数[(26.07±15.31)个]、随机错误数[(24.46±17.54)个]均明显高于对照组[WCST总测验数(60.15±23.05)个,持续错误数(17.56±11.44)个,随机错误数(17.73±14.27)个],差异有统计学意义(P<0.01或<0.05)。抑郁症组长时记忆成绩、短时记忆成绩和记忆商数低于对照组2个标准差。(2)逐步多元回归分析显示,抑郁症患者的长时记忆成绩及记忆商数与绝望感因子分均呈负相关(均P=0.00),短时记忆成绩和即刻记忆成绩与阻滞因子分均呈负相关(均P=0.00),语言智商与焦虑/躯体化因子分呈负相关(P=0.01),操作智商及智商与HAMD总分均呈负相关(均P=0.01),WCST总测验数和持续错误数与HAMD总分均呈正相关(P=0.01,P=0.02),随机错误数与阻滞因子分呈正相关(P=0.02)。结论首发抑郁症患者急性期的记忆、语言智商、操作智商和执行功能明显减退,临床症状严重程度影响认知功能的改变。     

正常成人与抑郁症患者之伴随负变化对照研究

本文使用ＮＩＣＯＬＥＴＣＡ－１０００叠加仪检测２８例符合中国精神疾病分类和诊断标准（ＣＣＭＤ－Ｉ）的抑郁症患者，并与正常成人进行了比较。结果表明抑郁症患者ＣＮＶ波型变异大，平均波幅较对照组降低２９％，最高峰电位降低２０％。且发现抑郁程度愈严重患者的ＣＮＶ波幅愈低，而ＰＩＮＶ时程与对照组之间无显著差异。     

Brain functional changes in facial expression recognition in patients with major depressive disorder before and after antidepressant treatment A functional magnetic resonance imaging study

Functional magnetic resonance imaging was used during emotion recognition to identify changes in functional brain activation in 21 first-episode, treatment-naive major depressive disorder patients before and after antidepressant treatment. Following escitalopram oxalate treatment, patients exhibited decreased activation in bilateral precentral gyrus, bilateral middle frontal gyrus, left middle temporal gyrus, bilateral postcentral gyrus, left cingulate and right parahippocampal gyrus, and increased activation in right superior frontal gyrus, bilateral superior parietal lobule and left occipital gyrus during sad facial expression recognition. After antidepressant treatment, patients also exhibited decreased activation in the bilateral middle frontal gyrus, bilateral cingulate and right parahippocampal gyrus, and increased activation in the right inferior frontal gyrus, left fusiform gyrus and right precuneus during happy facial expression recognition. Our experimental findings indicate that the limbic-cortical network might be a key target region for antidepressant treatment in major depressive disorder.     

Chronic pain and major depressive disorder in the general population

This study aims (1) to assess the prevalence of Chronic Painful Physical Condition (CPPC) and major depressive disorder (MDD) in the general population; (2) to evaluate their interaction and co-morbidity with sleep and organic disorders; and (3) to investigate their daily functioning and socio-professional consequences. A random sample of 3243 subjects (?18 years), representative of California inhabitants, was interviewed by telephone. CPPC duration was at least 6 months. Frequency, severity, duration and consequences on daily functioning, consultations, sick leave and treatment were investigated. MDD were assessed using DSM-IV criteria. The point prevalence of CPPC was 49% (95% confidence interval: 47.0-51.0%). Back area pain was the most frequent; 1-month prevalence of MDD was at 6.3% (95% CI: 5.5-7.2%); 66.3% of MDD subjects reported at least one CPPC. In 57.1% of cases, pain appeared before MDD. Pain severity was increased by poor sleep, stress and tiredness in MDD subjects. Being confined to bed, taking sick leave and interference of pain with daily functioning were twice as frequent among MDD subjects with CPPC than in non-MDD subjects with CPPC; obese individuals with CP were 2.6 times as likely to have MDD. Pain is highly linked with depressive disorder. It deteriorates physical, occupational and socio-professional activities. Pain and sleep disturbances are a prime motive of consultation rather than depressed mood, underlining the risk of missing a depression diagnosis.     

Evidence for the role of corticotropin-releasing factor in major depressive disorder

Major depressive disorder (MDD) is a devastating disease affecting over 300 million people worldwide, and costing an estimated 380 billion Euros in lost productivity and health care in the European Union alone. Although a wealth of research has been directed toward understanding and treating MDD, still no therapy has proved to be consistently and reliably effective in interrupting the symptoms of this disease. Recent clinical and preclinical studies, using genetic screening and transgenic rodents, respectively, suggest a major role of the CRF₁ gene, and the central expression of CRF₁ receptor protein in determining an individual's risk of developing MDD. This gene is widely expressed in brain tissue, and regulates an organism's immediate and long-term responses to social and environmental stressors, which are primary contributors to MDD. This review presents the current state of knowledge on CRF physiology, and how it may influence the occurrence of symptoms associated with MDD. Additionally, this review presents findings from multiple laboratories that were presented as part of a symposium on this topic at the annual 2014 meeting of the International Behavioral Neuroscience Society (IBNS). The ideas and data presented in this review demonstrate the great progress that has been made over the past few decades in our understanding of MDD, and provide a pathway forward toward developing novel treatments and detection methods for this disorder.     

Randomized controlled trial of transcranial magnetic stimulation in pregnant women with major depressive disorder

Background

Major depressive disorder (MDD) affects 10% of pregnancies. Because transcranial magnetic stimulation (TMS) is a nonmedication option, psychiatric patients who do not tolerate or prefer to avoid antidepressants are good candidates for TMS.

抑郁症患者外显性与内隐性情绪处理的脑功能磁共振研究

目的以健康者为对照,利用脑功能磁共振研究抑郁症患者的外显性和内隐性情绪处理过程。方法2006年12月-2007年12月,收集临床诊断抑郁症患者14例（DSM-Ⅳ标准）。14例健康志愿者作为对照。采用传统的组块设计,采集患者在高兴与悲伤2组脸像刺激下,判断表情的外显性情绪处理和判断性别的内隐性情绪处理过程的脑功能磁共振图像,利用SPM2统计软件计算出个体及组内在不同表情刺激和不同任务操作下激活的脑功能区。结果①抑郁症患者判断表情时,悲伤脸像的主要激活区位于顶叶、海马旁回、基底节、梭状回、丘脑、岛叶、前扣带回及胼胝体下回;高兴脸像激活区仅有前扣带回;②抑郁症患者判断性别任务时,悲伤脸像激活区分布在额中回、顶下小叶、前扣带回、颞中回;高兴脸像未见明显脑功能激活区。结论①抑郁症患者外显性与内隐性情绪刺激的脑内加工过程不同,悲伤脸像脑功能区激活均强于高兴脸像;②与健康人群相比,不同情绪处理过程中,抑郁症患者的高兴脸像激活区较弱,而悲伤脸像的激活明显增强。提示抑郁症患者情绪处理的神经系统存在异常,对正性情绪的神经反应减弱,而对负性情绪的神经反应增强。     

Amygdala volume in major depressive disorder: a meta-analysis of magnetic resonance imaging studies

Major depressive disorder has been associated with volumetric abnormality in the amygdala. In this meta-analysis we examine results from magnetic resonance imaging volumetry studies of the amygdala in depression in order to assess both the nature of the relationship between depression and amygdala volume as well as the influence of extraexperimental factors that may account for significant variability in reported findings. We searched PubMed and ISI Web of Knowledge databases for articles published from 1985 to 2008 that used the wildcard terms 'Depress*' and 'Amygdal*' in the title, keywords or abstract. From the 13 studies that met inclusion criteria for our meta-analysis, we calculated aggregate effect size and heterogeneity estimates from amygdala volumetric data; we then used meta-regression to determine whether variability in specific extraexperimental factors accounted for variability in findings. The lack of a reliable difference in amygdala volume between depressed and never-depressed individuals was accounted for by a positive correlation between amygdala volume differences and the proportion of medicated depressed persons in study samples: whereas the aggregate effect size calculated from studies that included only medicated individuals indicated that amygdala volume was significantly increased in depressed relative to healthy persons, studies with only unmedicated depressed individuals showed a reliable decrease in amygdala volume in depression. These findings are consistent with a formulation in which an antidepressant-mediated increase in levels of brain-derived neurotrophic factor promotes neurogenesis and protects against glucocorticoid toxicity in the amygdala in medicated but not in unmedicated depression.