强迫症患者脑部功能影像学的研究现状及进展

强迫症(obsessive-compulsive disorder,OCD)是以强迫行为及强迫思维为主要表现的一种神经症.该疾病以有意识的自我强迫与反强迫同时存在为特征,患者被难以控制、反复出现的想法或画面等困扰,强烈的想将其转化为现实行为或精神活动,明知是一种持续存在的不合理的行为,却无法克制重复上述过程.随着病程的发展,患者逐渐丧失工作、学习等社会功能,部分患者还可能因为某些形式的症状,造成躯体的客观伤害.随着药物的干预以及疾病自身的演进,OCD部分症状可以有所缓解,但由于疾病本身对药物治疗的不敏感性,罕有痊愈者.因此,有观点认为OCD患者脑部可能存在一些器质性病变,从而导致了其症状难以通过药物来控制,同时认为异常主要集中在眶额叶回路(orbito-frotal cortex,OFC).本文围绕相关辅助检查所得结果,针对异常部位的功能及结构改变进行如下总结及分析.     

The Ultimatum Game and the brain: A meta-analysis of neuroimaging studies

Social decision-making tasks involve psychological processes key to effective functioning in a complex, social world. The Ultimatum Game (UG) is a widely studied social decision-making task, which models responses to fairness. A number of neuroimaging studies have investigated the UG to identify neural correlates of unfairness and decisions to reject versus accept an offer. We present the first quantitative summary of neuroimaging studies in social decision-making with a meta-analysis of 11 fMRI studies of the UG, including data from 282 participants. Effect-Size Signed Differential Mapping was used to estimate effect sizes from statistical parametric maps and reported peak information before meta-analysing them. Consistent activations were seen in the anterior insula, anterior cingulate cortex (ACC), supplementary motor area (SMA) and cerebellum in response to unfair offers. Robust activations in the ACC, SMA and putamen were seen when deciding to reject rather than accept UG offers. These are consistent with models of motivational conflict during the UG decision-making process, a response to norm violations, with a possible role for the reward system.     

The "paradoxical" engagement of the primary auditory cortex in patients with auditory verbal hallucinations: a meta-analysis of functional neuroimaging studies

The existing literature on neuroimaging studies of auditory verbal hallucinations (AVHs) in patients with schizophrenia contains an apparent “paradox” in that the same areas in the auditory cortex seem to be both activated and deactivated in relation to AVHs, depending on whether an external auditory stimulus is present or not. We performed meta-analyses of neuroimaging studies examining patients with schizophrenia during the processing of auditory stimuli and in individuals experiencing hallucinations in the absence of auditory stimuli to examine whether the auditory cortex shows the paradoxical decrease/increase pattern across studies. Databases PubMed and ISI Web of Knowledge were queried with the combination of the keywords “auditory verbal hallucinations”, “auditory hallucinations”, “fMRI”, “PET”, “imaging”, yielding 11 studies involving comparison between schizophrenia and control group during external auditory stimulation, and 12 studies of hallucinating subjects experiencing AVHs and resting in the absence of auditory stimulation. The data were analyzed using Activation Likelihood Estimation method. The results showed overlapping increased activation in the absence of an external stimulus, and decreased activation in the presence of an external auditory stimulus in the left primary auditory cortex and in the right rostral prefrontal cortex, confirming the “paradoxical” brain activation in relation to AVHs. It is suggested that the “paradox” may be caused by an attentional bias towards internally generated information and failure of down- and up-regulation of the default mode and auditory processing networks, respectively, with the consequence that the spontaneous activation in the absence of an external stimulus shuts down the perceptual apparatus for further processing.     

Towards a neurocircuitry in anorexia nervosa: Evidence from functional neuroimaging studies

Functional neuroimaging is widely used to unravel changes in brain functioning in psychiatric disorders. In the current study, we review single-photon emission tomography (SPECT), positron emission tomography (PET) and functional magnetic resonance imaging (fMRI) studies in anorexia nervosa (AN), a difficult-to-treat eating disorder with the highest mortality rate among psychiatric disorders. We discuss the role of the parietal cortex, anterior and subgenual cingulate cortex, frontal cortex and temporal lobe in light of the cardinal symptoms of AN. The insights of the current review may ultimately lead to the development of new treatments.     

The role of the amygdala in emotional processing: a quantitative meta-analysis of functional neuroimaging studies

Functional neuroimaging studies have provided strong support for a critical role of the amygdala in emotional processing. However, several controversies remain in terms of whether different factors—such as sex, valence and stimulus type—have an effect on the magnitude and lateralization of amygdala responses. To address these issues, we conducted a meta-analysis of functional neuroimaging studies of visual emotional perception that reported amygdala activation. Critically, unlike previous neuroimaging meta-analyses, we took into account the magnitude (effect size) and reliability (variance) associated with each of the activations. Our results confirm that the amygdala responds to both positive and negative stimuli, with a preference for faces depicting emotional expressions. We did not find evidence for amygdala lateralization as a function of sex or valence. Instead, our findings provide strong support for a functional dissociation between left and right amygdala in terms of temporal dynamics. Taken together, results from this meta-analysis shed new light on several of the models proposed in the literature regarding the neural basis of emotional processing.     

Experimental design and interpretation of functional neuroimaging studies of cognitive processes

This article discusses how the relation between experimental and baseline conditions in functional neuroimaging studies affects the conclusions that can be drawn from a study about the neural correlates of components of the cognitive system and about the nature and organization of those components. I argue that certain designs in common use--in particular the contrast of qualitatively different representations that are processed at parallel stages of a functional architecture--can never identify the neural basis of a cognitive operation and have limited use in providing information about the nature of cognitive systems. Other types of designs-such as ones that contrast representations that are computed in immediately sequential processing steps and ones that contrast qualitatively similar representations that are parametrically related within a single processing stage-are more easily interpreted.     

Diversity of the inferior frontal gyrus--a meta-analysis of neuroimaging studies

Purpose

The inferior frontal gyrus (IFG) has attracted a lot of interest due to its involvement in motor control and language processing. More recently, it has also been implicated for the processing of empathy. The aim of this meta-analysis was to investigate if neuroimaging studies in humans reveal distinct foci related to empathy as compared to those in motor and speech control in the IFG.

Materials and methods

We reviewed MEDLINE for functional imaging studies on healthy subjects published between 1991 and 2007. With the search terms “inferior frontal gyrus”, and “statistical parametric mapping” 485 studies were identified. We performed a non-hierarchical cluster-centre analysis of the stereotactic coordinates of the reported 1042 significant activation peaks and investigated seven functional categories using a score of specificity (SCSP).

Results

We found four significant, spatially distinct clusters. Three left-hemispheric clusters included one for processing of empathy, one closely adjacent for semantic and phonological processing, and one for working memory, while one cluster for fine movement control was located in the right hemisphere.

Conclusions

This meta-analysis demonstrates a spatio-functional diversity of the left human IFG for processing of language, working memory and empathy. Notably, phonological and semantic processing collapsed into one cluster. Fine movement control located in a cluster in the right IFG occurred in a virtually mirror-like location to processing of empathy in the left hemisphere. These observations are in accordance with the notion of the mirror neuron system mediating specialized links between perception and action.     

Structural and functional neuroimaging methods in the diagnosis of dementias: A retrospective chart and brain imaging review

Objective: Assess the contribution of structural and functional neuroimaging methods to the diagnosis of dementia. Methods: This was a retrospective chart and imaging review. Participants were 24 inpatient dementia cases from a general hospital-based, university medical psychiatry unit. Data from clinical charts and imaging results were reviewed. Results: Most common initial diagnoses were dementia NOS and vascular dementia (VD); most common discharge diagnoses were VD, Alzheimer's, Dementia NOS and dementia with Lewy bodies. Most diagnostic changes occurred following family meetings or SPECT/PET, with fewer changes after CT/MRI. Conclusions: Diagnostic steps that contributed the most to the final diagnosis were the family meeting and the functional neuroimaging evaluation.     

The suicidal mind and brain: A review of neuropsychological and neuroimaging studies

Abstract

Objectives. We aimed at reviewing studies exploring dysfunctional cognitive processes, and their neuroanatomical basis, in suicidal behaviour, and to develop a neurocognitive working model. Methods. A literature search was conducted. Results. Several limitations were found. The main reported neuropsychological findings are a higher attention to specific negative emotional stimuli, impaired decision-making, lower problem-solving abilities, reduced verbal fluency, and possible reduced non-specific attention and reversal learning in suicide attempters. Neuroimaging studies mainly showed the involvement of ventrolateral orbital, dorsomedial and dorsolateral prefrontal cortices, the anterior cingulate gyrus, and, to a lesser extent, the amygdala. In addition, alterations in white matter connections are suggested. Conclusions. These studies support the concept of alterations in suicidal behaviour distinct from those of comorbid disorders. We propose that a series of neurocognitive dysfunctions, some with trait-like characteristics, may facilitate the development of a suicidal crisis during stressful circumstances: (1) an altered modulation of value attribution, (2) an inadequate regulation of emotional and cognitive responses, and (3) a facilitation of acts in an emotional context. This preliminary model may represent a framework for the design of future studies on the pathophysiology, prediction and prevention of these complex human behaviours.     

The neural correlates of retrieval and procedural strategies in mental arithmetic: A functional neuroimaging meta-analysis

Mental arithmetic is a complex skill of great importance for later academic and life success. Many neuroimaging studies and several meta-analyses have aimed to identify the neural correlates of mental arithmetic. Previous meta-analyses of arithmetic grouped all problem types into a single meta-analytic map, despite evidence suggesting that different types of arithmetic problems are solved using different strategies. We used activation likelihood estimation (ALE) to conduct quantitative meta-analyses of mental arithmetic neuroimaging (n = 31) studies, and subsequently grouped contrasts from the 31 studies into problems that are typically solved using retrieval strategies (retrieval problems) (n = 18) and problems that are typically solved using procedural strategies (procedural problems) (n = 19). Foci were compiled to generate probabilistic maps of activation for mental arithmetic (i.e., all problem types), retrieval problems, and procedural problems. Conjunction and contrast analyses were conducted to examine overlapping and distinct activation for retrieval and procedural problems. The conjunction analysis revealed overlapping activation for retrieval and procedural problems in the bilateral inferior parietal lobules, regions typically associated with magnitude processing. Contrast analyses revealed specific activation in the left angular gyrus for retrieval problems and specific activation in the inferior frontal gyrus and cingulate gyrus for procedural problems. These findings indicate that the neural bases of arithmetic systematically differs according to problem type, providing new insights into the dynamic and task-dependent neural underpinnings of the calculating brain.     

A review of functional neuroimaging studies of vagus nerve stimulation (VNS)

Vagus nerve stimulation (VNS) is a new method for preventing and treating seizures, and shows promise as a potential new antidepressant. The mechanisms of action of VNS are still unknown, although the afferent direct and secondary connections of the vagus nerve are well established and are the most likely route of VNS brain effects. Over the past several years, many groups have used functional brain imaging to better understand VNS effects on the brain. Since these studies differ somewhat in their methodologies, findings and conclusions, at first glance, this literature may appear inconsistent. Although disagreement exists regarding the specific locations and the direction of brain activation, the differences across studies are largely due to different methods, and the results are not entirely inconsistent. We provide an overview of these functional imaging studies of VNS. PET (positron emission tomography) and SPECT (single photon emission computed tomography) studies have implicated several brain areas affected by VNS, without being able to define the key structures consistently and immediately activated by VNS. BOLD (blood oxygen level dependent) fMRI (functional magnetic resonance imaging), with its relatively high spatio-temporal resolution, performed during VNS, can reveal the location and level of the brain's immediate response to VNS. As a whole, these studies demonstrate that VNS causes immediate and longer-term changes in brain regions with vagus innervations and which have been implicated in neuropsychiatric disorders. These include the thalamus, cerebellum, orbitofrontal cortex, limbic system, hypothalamus, and medulla. Functional neuroimaging studies have the potential to provide greater insight into the brain circuitry behind the activity of VNS.     

The anatomy of fear learning in the cerebellum: A systematic meta-analysis

Recent neuro-imaging studies have implicated the cerebellum in several higher-order functions. Its role in human fear conditioning has, however, received limited attention. The current meta-analysis examines the loci of cerebellar contributions to fear conditioning in healthy subjects, thus mapping, for the first time, the neural response to conditioned aversive stimuli onto the cerebellum. By using the activation likelihood estimation (ALE) technique for analyses, we identified several distinct regions in the cerebellum that activate in response to the presentation of the conditioned stimulus: the cerebellar tonsils, lobules HIV–VI, and the culmen. These regions have separately been implicated in fear acquisition, consolidation of fear memories and expression of conditioned fear responses. Their specific role in these processes may be attributed to the general contribution of cerebellar cortical networks to timing and prediction. Our meta-analysis highlights the potential role of the cerebellum in human cognition and emotion in general, and addresses the possibility how deficits in associative cerebellar learning may play a role in the pathogenesis of anxiety disorders. Future studies are needed to further clarify the mechanistic role of the cerebellum in higher order functions and neuropsychiatric disorders.     

默认网络的功能影像学研究在精神神经疾病中的研究进展

默认网络(Default Mode Network,DMN)是指功能影像学研究中,人脑在靜息状态下,某些功能脑区的激活比较活跃,将这些静息状态下比较活跃的脑区构成的网络定义为“默认网络”.     

The neural mechanisms of hallucinations: A quantitative meta-analysis of neuroimaging studies

Activation likelihood estimation meta-analysis of functional neuroimaging data was used to investigate the neural mechanisms underlying auditory-verbal and visual hallucinations (AVHs and VHs). Consistent activation across studies during AVHs, but not VHs, in Wernicke’s and Broca’s areas is consistent with involvement of speech and language processes in the experience of hearing voices when none are present. Similarly, greater activity in auditory cortex during AVHs and in visual cortex during VHs supports models proposing over-stimulation of sensory cortices in the generation of these perceptual anomalies. Activation across studies in the medial temporal lobe highlights a role for memory intrusions in the provision of content for AVHs, whereas insula activation may relate to the involvement of awareness and self-representation. Finally, activation in the paracingulate region of medial prefrontal cortex during AVHs is consistent with models implicating reality monitoring impairment in the misattribution of self-generated information as externally perceived. In the light of the results, the need for unified theoretical frameworks that account for the full range of hallucinatory experiences is discussed.     

The search for the number form area: A functional neuroimaging meta-analysis

Recent studies report a putative “number form area” (NFA) in the inferior temporal gyrus (ITG) suggested to be specialized for Arabic numeral processing. However, a number of earlier studies report no such NFA. The reasons for such discrepancies across studies are unclear. To examine evidence for a convergent NFA across studies, we conducted two activation likelihood estimation meta-analyses on 31 and a subset of 20 neuroimaging studies that have contrasted digits with other meaningful symbols. Results suggest the potential existence of an NFA in the right ITG, in addition to a ‘symbolic number processing network’ comprising bilateral parietal regions, and right-lateralized superior and inferior frontal regions. Critically, convergent localization for the NFA was only evident when contrasts were appropriately controlled for task demands, and does not appear to depend on employing methods designed to overcome fMRI signal dropout in the ITG. Importantly, only five studies had foci within the identified ITG NFA cluster boundary, indicating that more empirical evidence is necessary to determine the true functional specialization and regional specificity of the putative NFA.     

Neuroticism and the brain: A quantitative meta-analysis of neuroimaging studies investigating emotion processing

Neuroticism is a robust personality trait that constitutes a risk factor for mood disorders. Neuroimaging findings related to neuroticism have been inconsistent across studies and hardly integrated in order to construct a model of the underlying neural correlates of neuroticism. The aim of the current meta-analysis was to provide a quantitative summary of the literature, using a parametric coordinate-based meta-analysis (PCM) approach. Data were pooled for emotion processing tasks investigating the contrasts (negative > neutral) and (positive > neutral) to identify brain regions that are consistently associated with neuroticism across studies. Significant negative and positive correlations with neuroticism were found only for the contrast (negative > neutral) after multiple comparisons correction. Differences in brain activation were found to be associated with neuroticism during fear learning, anticipation of aversive stimuli and the processing and regulation of emotion. The relationship between neuroticism and these three psychological processes and their corresponding neural correlates is discussed. Furthermore, the meta-analytic findings are incorporated into a general model of emotion processing in neuroticism.     

A combined neuropsychological and neuroimaging study of topographical and non-verbal memory in semantic dementia

A combined neuropsychological and neuroimaging investigation was carried out on a patient (O.I.) with semantic dementia who had asymmetrical temporal lobe atrophy, greater on the left. His performance on tests of verbal memory was gravely impaired. Similarly, his visual memory as indexed by recognition of unfamiliar faces was impaired. By contrast, his recognition memory for topographical memoranda (e.g. buildings, landscapes) and ability to find his way around was preserved. In order to identify the neural substrates supporting the preserved recognition of static topographical memoranda, O.I. was scanned using positron emission tomography (PET) during the encoding and recognition of building and landscape stimuli. In common with control subjects, during encoding O.I. activated parahippocampal cortex bilaterally, along with bilateral temporo-parietal, retrosplenial and left frontal cortices. During recognition, both patient and controls activated right parahippocampal, right superior parietal and right frontal cortices. Notably, control subjects, but not O.I., also activated at encoding the precuneus and at recognition the retrosplenial cortex. This allows the conclusion that these two areas while involved may not be necessary for topographical memory. Interestingly, the patient also activated regions that were not evident in control subjects both during encoding and recognition. These additional areas of activation may be necessary in a compensatory role. Overall, these data represent the first reported assessment of the functional integrity of degenerating brain tissue and its contribution to preserved topographical memory. The combination of the neuropsychological and neuroimaging approaches may provide insights into the functional-anatomy of memory while having clinical utility for the assessment of residual brain tissue.     

The use of neuroimaging to study behavior in patients with epilepsy

Structural and functional neuroimaging continues to play an increasing role in the presurgical evaluation of patients with epilepsy. In addition to its value in localizing the epileptogenic zone and eloquent cortex, neuroimaging is contributing to our understanding of mood comorbidity in epilepsy. Although the vast majority of research has focused on patients with temporal lobe epilepsy (TLE), neuroimaging studies of patients with extratemporal epilepsy and primary generalized epilepsy are increasing in number. In this review, structural and functional imaging modalities that have received considerable research attention in recent years are reviewed, and their strengths and limitations for understanding behavior in epilepsy are assessed. In addition, advances in multimodal imaging are discussed along with their potential application to the presurgical evaluation of patients with seizure disorders.     

Effects of handwriting exercise on functional outcome in Parkinson disease: A randomized controlled trial

Parkinson disease (PD) patients frequently experience micrographia and difficulty writing, which could potentially impact their quality of life. This study aimed to determine whether handwriting exercise could improve fine manual motor function in PD. The study was a randomized controlled trial assessing the efficacy of a 4-week handwriting exercise using a newly developed handwriting practice book. The primary endpoint was an improvement in the time used to complete the handwriting test. Secondary endpoints were accuracy of the writing performance, patient’s subjective rating scale of their handwriting and a UPDRS part III motor examination. Of a total of 46 subjects, 23 were randomly assigned to the handwriting exercise group. After 4 weeks, the mean time used to complete the test was significantly lower in the exercise group, compared to the control group (143.43 ± 34.02 vs. 175 ± 48.88 s, p = 0.015). Mean time used to complete the handwriting test decreased from the baseline by 16.16% in the exercise group, but increased by 3.63% in the control group (p < 0.001). Significant improvements were also observed by assessing the subjective rating scale and the UPDRS part III scores. The 4-week handwriting exercise using the studied handwriting practice book appears to promote an improvement in writing speed and motor function of hands. The optimal duration and frequency of the exercise, the quantity and characteristic of the letters in the handwriting practice book, and the benefits of the exercise in other languages merit further studies.