金钱激励延迟任务中抑郁症动机行为损害的计算建模研究

目的：本研究旨在使用金钱激励延迟任务（MID）和计算行为建模方法，探索首发未服药重性抑郁障碍患者（major depressive disorder, MDD）在奖赏和惩罚条件下动机行为的心理机制。方法：55名MDD患者和37名健康对照(healthy controls, HC)进行临床量表评估和金钱激励延迟任务，运用漂移扩散模型对两组被试不同条件下的漂移率进行分析和统计检验。结果：MDD组反应时显著长于HC组。漂移扩散模型分析显示，MDD组在奖赏条件下的加工速度显著低于健康对照组，但在惩罚和中性条件下均无显著差异。结论：本研究创新性地提供了计算建模的实证依据，支持MDD患者在奖赏条件下动机行为学习损害的存在，并提示在不同效价目标下MDD动机行为的损害可能存在分离。计算行为建模的方法探索到了普通行为学难以观察到的细微差异，对临床实践转化具有重要意义。     

经颅直流电刺激联合舍曲林对抑郁患者认知功能、神经递质水平及睡眠状况的影响

目的:探讨经颅直流电刺激(Transcranial direct current stimulation,tDCS)联合舍曲林对抑郁(Major depressive disorder,MDD)患者的治疗效果.方法:将 2020 年 1 月至 2023 年6 月收治的MDD患者 84 例纳入研究,按照随机单双号分为药物组(单号)与联合tDCS组(双号)各 42 例,药物组采用盐酸舍曲林片与伪刺激治疗,联合tDCS 组采用盐酸舍曲林片联合 tDCS 治疗.比较两组治疗效果,治疗前后抑郁程度[认知扭曲问卷(Cognition distortions questiosaire,CDQ)、汉密尔顿抑郁量表(Hamilton depression scale,HAMD-17)]、认知功能[数字划销测验(Cancellation Test,NCT)、威斯康星卡片分类测验(Wisconsin card sorting test,WCST)]、神经递质水平[γ-氨基丁酸(γ-aminobutyric acid,GABA)、去甲肾上腺素(Norepinephrine,NE)、五羟色胺(5-Hydroxytryptamine,5-HT)和多巴胺(Dopamine,DA)]和睡眠状况[阿森斯失眠量表(Athens insomnia scale,AIS)、匹兹堡睡眠质量指数(Pittsburgh Sleep Quality Index,PSQI)]变化.结果:联合tDCS组治疗有效率(88.10%)显著高于药物组(69.05%)(P＜0.05);治疗后,联合tDCS组CDQ评分、HAMD-17 评分、AIS和PSQI评分低于药物组(P＜0.05),NCT 正确个数、净分、WCST 总应答数、正确应答数和完成分类数高于药物组(P＜0.05),NCT 错误个数、漏划个数和WCST持续性错误数低于药物组(P＜0.05);联合tDCS组GABA、NE、5-HT和DA水平显著高于药物组(P＜0.05).结论:tDCS 联合舍曲林能有效缓解 MDD 患者抑郁症状,提升认知功能、神经递质水平,改善睡眠状况.     

首发重性抑郁症患者抗抑郁治疗前星形胶质源性蛋白(S100B)水平与短期疗效的关系

目的:研究重性抑郁症患者抗抑郁治疗前S100B(星形胶质源性蛋白)水平与短期疗效的关系。方法:按照入组标准和排除标准纳入首发重性抑郁症患者36例,并对抑郁症患者在入组时通过ELISA方法检测血清S100B水平。并应用汉密尔顿抑郁量表(HAMD)评估抗抑郁治疗4周的疗效(短期疗效)。结果:1短期治疗有效的患者组入组时S100B(1.64±0.77)ng/mL,与短期治疗无效的患者组(1.04±0.31)ng/mL相比有显著差异性(t=-3.276,P0.05);2重性抑郁症患者血清S100B与ΔHAMD变化值成正比(r=0.389,P0.05)。结论:首发重性抑郁症患者抗抑郁治疗前的S100B水平能够预测不同的短期疗效。     

GABA受体在儿童失神性癫痫发病机制中的作用

γ-氨基丁酸(GABA)是一种脑内含量极高的抑制性神经递质,本文主要针对GABA受体在儿童失神性癫痫(CAE)的发病机制方面进行相关论述.     

首发未服药抑郁症患者的额叶α不对称性

目的：考察抑郁症（Major Depressive Disorder,MDD）患者静息态脑电（Resting-State Electroencephalogram,rsEEG）中的额叶α不对称性（Frontal Alpha Asymmetry,FAA）能否作为有效识别抑郁症的神经电生理标记。方法：42名首发未服药MDD患者和42名健康对照被试（Health Control,HC）完成了rsEEG的采集,以及流调中心用抑郁量表、状态焦虑量表、简明情感强度量表负性情感强度分量表的评估。采用重复测量方差分析比较两组在功率谱密度（Power Spectral Density,PSD）与FAA上的差异,采用机器学习算法进行特征筛选与分类验证,并计算所筛选特征与心理量表的相关程度。结果：各电极对中,MDD组右侧电极的PSD均显著小于左侧电极,HC组右侧电极的PSD值均显著大于左侧电极。MDD组的FAA值均显著低于HC组。FAAF4-F3、FAAF6-F5、FAAF8-F7可有效识别MDD,且与抑郁、焦虑、负性情感强度量表得分均呈显著负相关。结论：静息状态下,MDD患者右侧额叶的活动强度较左侧额叶更...     

静息态下低频振幅与功能连接异常可识别重性抑郁症

目的:考察静息状态下异常的低频振幅(Amplitude of Low Frequency Fluctuations, ALFF)与功能连接(Functional Connectivity, FC)能否识别出重性抑郁症(Major Depressive Disorder, MDD),并作为MDD可能的神经生物学标记。方法:35名MDD患者与33名对照组被试完成了结构磁共振与静息态功能磁共振的扫描,并完成流调中心用抑郁量表与状态-特质焦虑量表。比较ALFF与FC的组间差异,采用机器学习算法进行特征挑选、建模与分类,并计算支持向量机分类边际值与抑郁得分的相关程度。结果:与对照组相比,MDD组右侧脑岛的ALFF显著增加,额上回与左侧额下回的ALFF显著降低,右侧脑岛至同侧前扣带回的FC显著增加,额上回至双侧梭状回与右侧楔前叶的FC显著降低。脑岛、额上回与额下回的ALFF异常、额上回至左侧梭状回的FC异常可以有效识别MDD,且MDD组的SVM分类边际值与其抑郁症状严重程度呈显著正相关。结论:在静息状态下,MDD患者的ALFF与FC存在异常,且该异常模式可作为识别MDD的候选神经生物学标记。     

首发抑郁症患者海马质子磁共振波谱成像研究

目的:探讨首发抑郁症患者海马的磁共振质子波谱(1HMRS)特点.方法:应用1HMRS成像技术检测21例未用药首发抑郁症患者和14例健康志愿者海马N-乙酰天门冬氨酸(NAA)、胆碱(Cho)、肌酸(Cr)3种代谢物,计算NAA/Cr和Cho/Cr比值.结果:首发抑郁症患者组双侧海马NAA/Cr比值低于对照组,差异有统计学意义(右侧:0.88±0.29/1.37±0.51,P=0.004;左侧:0.76±0.33/1.40±0.99,P=0.034);Cho/Cr比值两组间无统计学差异(P＞0.05);双侧海马NAA/Cr和Cho/Cr与抑郁严重度无相关性(P＞0.05).结论:首发抑郁症患者可能存在双侧海马神经元活力和功能下降.     

首发未药物治疗青少年重性抑郁障碍患者脑三维结构磁共振病例对照研究

目的:探讨首发未药物治疗青少年重性抑郁障碍患者脑灰质体积与正常对照组青少年之间的异同。方法:对18名首发未治疗青少年重性抑郁障碍患者和年龄性别匹配的18名青少年健康对照组进行脑三维结构扫描,对脑灰质体积异常变化应用基于体素的形态测量学分析方法VBM进行分析比较。结果:抑郁组相比对照组VBM灰质形态学体积增加的部位主要在右脑颞上回及双侧颞叶颞中回,尤其是BA22和BA19;抑郁组相比对照组VBM体积减少部位主要位于右脑额叶(BA11,47)、左脑顶叶(BA7,40)和右脑顶叶(BA5),左脑岛叶(BA13)及左脑颞叶(BA13)。结论:抑郁组相比对照组的灰质体积以下降为主,主要在右脑额叶及左脑顶叶、右脑顶叶、左脑岛叶和左脑颞叶。     

活体磁共振波谱定量检测前额皮层γ-氨基丁酸的方法和临床意义

正磁共振波谱(magnetic resonance spectroscopy,MRS)及相关的磁共振波谱成像(magnetic resonance spectroscopy imaging,MRSI)广泛用于非侵入性评价临床和临床前研究的脑物质代谢。氢质子磁共振波谱(1H-MRS)是一种可无创地测量脑内神经化学物质的技术。1H-MRS已被应用于精神类疾病患者的活体病理生理研究。其中前额皮层(prefrontal cortex,PFC)在精神类疾病中起到重要作用。抑制性神经递质氨基丁酸(γ-aminobutyric acid,GABA)是中枢神经系统中最重要的神经递质,对机体的功能具有重要的调节作用。定量检测精神疾病患者PFC中的GABA水平,有望阐明此类疾病的病理生理及发病机制。本文从人类PFC的解剖功能以及     

个体大脑枕叶GABA+分布差异性及原因探究

抑制性神经递质γ-氨基丁酸(GABA)是脑神经领域重点关注的代谢物,但其在大脑中含量很低,与其他代谢物在化学位移上重叠而不易检测。磁共振波谱序列(MEGA-PRESS)实现了对大脑中单体素感兴趣区域(VOI)GABA的检测,促进了对GABA的相关研究。对一组被试进行多次扫描,同一区域相同大小的VOI内(约20～30 mm³)所包含的灰质(GM)比例很难保持完全一致。而GM是皮层主要成分,有解剖、切片染色等实验发现大脑皮层中GABA含量更高,然而多数基于单体素VOI的研究并未进一步考虑VOI中GM占比对结果分析的影响。通过扫描14名健康被试(7男7女),在高分辨率T1加权结构像上重现VOI对应区域,并计算其内GM等占比。个体重复实验结果表明,枕叶VOI内GABA+均值与GM占比均值呈正相关(r=0.74, P<0.01),且二者的波动具有一致性。该结果表明,在进行GABA相关的病理或功能研究时,需要考虑单体素内GM占比的影响,以进一步提升实验结果的分析准确度。     

Elevated plasma N-terminal ProBNP levels in unmedicated patients with major depressive disorder

There is considerable evidence that cardiovascular diseases are more prevalent in patients with major depressive disorder (MDD). Secretion of N-terminal pro-B-type natriuretic peptide (NT-proBNP) increases in several cardiac illnesses, making this neurohormone a reliable diagnostic and prognostic biomarker of cardiovascular risk. We measured plasma NT-proBNP levels in the following three groups of subjects free of overt cardiovascular disease: unmedicated patients with MDD (n=40), unmedicated patients with schizophrenia (n=44), and normal control subjects (n=42). The severity of depressive symptoms was rated using the Hamilton Depression Rating Scale (HAMD). Plasma NT-proBNP levels were assayed by ELISA. Plasma NT-proBNP levels were significantly higher in the MDD group (median: 217.1 pmol/L; interquartile range: 179.4-277.1 pmol/L) than in patients with schizophrenia (175.7 pmol/L [139.0-218.9]; P<0.05) or in the control group (158.9 pmol/L [98.3-212.1]; P<0.001). Among patients with MDD, there was a significant positive correlation (Spearman's rank correlation=0.422, P=0.008) between plasma NT-proBNP and HAMD scores. Altogether, our results indicate that elevated NT-proBNP levels may play a role in linking MDD with increased cardiovascular risk.     

Genome survey for susceptibility loci for recurrent,early‐onset major depression: Results at 10cM resolution

Recurrent (two or more episodes), early‐onset (first episode at ≤ 25 years) major depressive disorder (RE‐MDD) is a strongly familial condition (λ_{first‐degreerelatives} = 8) whose malignant effects have a significant negative impact on the health and longevity of patients and their family members. The goal of this study was to identify candidate susceptibility loci that influence the development of RE‐MDD. We completed a systematic survey of the human genome, conducted at an average resolution of 10 cM, for the identification of simple sequence tandem repeat polymorphisms (SSTRPs) that target susceptibility genes for RE‐MDD by virtue of linkage disequilibrium. The efficiency of our association study was enhanced by genotyping pools of DNA from 100 adults with RE‐MDD and 100 adult controls who had no personal or family history of mental disorders. Both groups included equal numbers of Caucasian men and women and were matched as closely as possible for age and ethnicity. Allelic associations with RE‐MDD were observed for 19 of the 387 SSTRPs in the CHLC Human Screening Set/Weber Version 9. Sixteen of the 19 candidate susceptibility loci revealed significant allelic associations with RE‐MDD in men (n = 7) or women (n = 9), but not in both sexes. Evidence for both risk and protective alleles was detected. Two of the candidate susceptibility loci reside within several Mb of loci previously reported‐megabases to be linked to “comorbid alcoholism and depression” in families of individuals with alcoholism and to a broadly defined affected phenotype that included recurrent major depression in the families of patients with bipolar disorder. Although it has been suggested that the genes that influence risk for MDD in the two sexes may not be entirely the same, the results of our study suggest that sex specificity of susceptibility loci for RE‐MDD may be the rule rather than the exception. The observed preponderance of sex‐specific susceptibility loci for RE‐MDD suggests that there may be important differences in the molecular pathophysiology of RE‐MDD in men and women. Alternatively, our findings may reflect the existence of sex‐specific differences in the molecular mechanisms that determine resilience to endogenous or environmental depressogenic stimuli. © 2002 Wiley‐Liss, Inc.     

The influence of adversity and perceived social support on the outcome of major depressive disorder in subjects with different levels of depressive symptoms

BACKGROUND: Adverse life events and social support may influence the outcome of major depressive disorder (MDD). We hypothesized that outcome would depend on the level of depressive symptoms present at the outset, with those in partial remission being particularly vulnerable. METHOD: In the Vantaa Depression Study (VDS), patients with DSM-IV MDD were interviewed at baseline, and at 6 and 18 months. Life events were investigated with the Interview for Recent Life Events (IRLE) and social support with the Interview Measure of Social Relationships (IMSR) and the Perceived Social Support Scale - Revised (PSSS-R). The patients were divided into three subgroups at 6 months, those in full remission (n = 68), partial remission (n = 75) or major depressive episode (MDE) (n = 50). The influence of social support and negative life events during the next 12 months on the level of depressive symptoms, measured by the Hamilton Rating Scale for Depression (HAMD), was investigated at endpoint. RESULTS: The severity of life events and perceived social support influenced the outcome of depression overall, even after adjusting for baseline level of depression and neuroticism. In the full remission subgroup, both severity of life events and subjective social support significantly predicted outcome. However, in the partial remission group, only the severity of events, and in the MDE group, the level of social support were significant predictors. CONCLUSIONS: Adverse life events and/or poor perceived social support influence the medium-term outcome of all psychiatric patients with MDD. These factors appear to have the strongest predictive value in the subgroup of patients currently in full remission.     

Potential Relationship between Season of Birth and Clinical Characteristics in Major Depressive Disorder in Koreans: Results from the CRESCEND Study

We aimed to examine the potential relationship between season of birth (SOB) and clinical characteristics in Korean patients with unipolar non-psychotic major depressive disorder (MDD). Using data from the Clinical Research Center for Depression (CRESCEND) study in South Korea, 891 MDD patients were divided into two groups, those born in spring/summer (n=457) and those born in autumn/winter (n=434). Measurement tools comprising the Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Brief Psychiatric Rating Scale, Scale for Suicidal Ideation, Clinical Global Impression of severity, Social and Occupation Functional Assessment Scale, WHO Quality of Life assessment instrument-abbreviated version, Alcohol Use Disorder Identification Test, and Temperament and Character Inventory were used to evaluate depression, anxiety, overall symptoms, suicidal ideation, global severity, social function, quality of life, drinking, and temperament and character, respectively. Using independent t-tests for continuous variables and χ² tests for discrete variables, the clinical characteristics of the two groups were compared. MDD patients born in spring/summer were on average younger at onset of first depressive episode (t=2.084, p=0.038), had greater loss of concentration (χ²=4.589, p=0.032), and were more self-directed (t=2.256, p=0.025) than those born in autumn/winter. Clinically, there was a trend for the MDD patients born in spring/summer to display the contradictory characteristics of more severe clinical course and less illness burden; this may have been partly due to a paradoxical effect of the 5-HT system.     

缓解期重性抑郁与心境恶劣患者人格特征及人格障碍研究

目的：研究重性抑郁症(MDD)和心境恶劣障碍(DD)患者在人格维度、人格特质水平及人格模型及人格障碍倾向性方面的特征。方法：采用NEO-PI-R个性调查表及人格诊断问卷(PDQ^ 4)对58例MDD和57例DD患者及115例正常人进行测试。结果：MDD和DD在NEO-PI-R的五因素人格模型的外向性、严谨性得分均低于正常组，DD患者的神经质分高于MDD患者，MDD患者的顺同性分高于正常组；在30个特质层面上，MDD和DD与正常组之间有显著性差异，DD患者的N1(焦虑)、N4(自我意识)分明显高于MDD患者，E4(热情性)、A1(信任感)分明显低于MDD患者；MDD和DD在PDQ^ 4的边缘型(BDL)、回避型(AVD)、抑郁型(DEP)、分裂性(SZD)、偏执型(PND)、强迫型(OBC)人格障碍得分明显高于正常组，DD患者在分裂型得分明显高于MDD患者，在表演型(HST)分明显高于正常组。结论：MDD和DD的人格特征既有共同的之处，也存在差异。两者均伴有人格障碍，但DD患者比MDD患者人格障碍更明显。     

Gene expression and association analysis of the epithelial membrane protein 1 gene in major depressive disorder in the Japanese population

The epithelial membrane protein 1 (EMP1) plays a role in neuronal differentiation and neurite outgrowth, which are involved in the pathogenesis of major depressive disorder (MDD). We sought to determine whether the EMP1 gene is implicated in MDD. We determined the mRNA expression levels of the EMP1 gene in peripheral-blood leukocytes of patients and control subjects (n=27 each). Next, we performed case-control association analyses (MDD, n=182; controls, n=350) in the Japanese population. The level of expression of the EMP1 mRNA was significantly lower in medication-free patients compared with control subjects (P<0.001). The association analysis revealed an absence of association between the polymorphisms studied and MDD, whereas a gender-specific association was observed between male controls and male patients for marker rs7315725 (permutation P=0.039). Our results suggest that the EMP1 gene may be implicated in the pathophysiology of MDD in the Japanese population.     

Family functioning and mood disorders: a comparison between patients with major depressive disorder and bipolar I disorder

Within a sample of patients with major depressive disorder (MDD; n = 121) and bipolar affective disorder (BPAD; n = 69), the authors examined (a) diagnostic differences in family functioning at acute episode, (b) diagnostic differences in family functioning at episode recovery, (c) within-group changes in family functioning from acute episode to recovery, and (d) whether within-group changes from acute episode to recovery varied by diagnosis. Using a multidimensional model, the authors evaluated interviewer, patient, and family ratings. Overall, patients with MDD and BPAD evidenced similar levels of family impairment at acute episode and recovery. Generally, patients in both groups experienced improvement in family functioning over time, yet mean scores at recovery continued to range from fair to poor. Although certain specific differences emerged, diagnostic groups appeared to be more similar than different in level and pattern of family functioning.     

The difference in patterns of motor and cognitive function in chronic fatigue syndrome and severe depressive illness

BACKGROUND: Chronic fatigue syndrome (CFS) and major depressive disorder (MDD) share many symptoms and aetiological factors but may have different neurobiological underpinnings. We wished to determine the profile of the biological variables disturbed in CFS and MDD, and identify any critical factors that differentiate the disorders. METHODS: Thirty patients with CFS, 20 with MDD and 15 healthy controls matched group-wise for age and sex were recruited. Subjects were given a detailed battery of motor and cognitive tests, including measures of psychomotor speed, memory and maximal voluntary muscle contraction in both the morning and evening that were balanced to avoid order effects. RESULTS: CFS patients generally performed worse on cognitive tests than healthy controls, but better than patients with MDD. Both patient groups had markedly impaired motor function compared with healthy controls. MDD subjects showed a significantly greater diurnal improvement in maximal voluntary contraction than healthy controls. CONCLUSIONS: Patients with CFS and MDD show similarly substantial motor impairment, but cognitive deficits are generally more marked in MDD. Diurnal changes in some functions in MDD may differentiate the disorder from CFS.     

抑郁症患者无抽搐电休克治疗的疗效与脑源性神经营养因子基因多态性

目的:探讨抑郁症患者脑源性神经营养因子(brain-derived neurotrophic factor,BDNF)基因两个单核苷酸多态性位点的多态性与无抽搐电休克治疗(modified electroconvulsive therapy,MECT)疗效的关系。方法:采用病例对照研究,研究组为110例符合美国精神障碍诊断统计手册第4版(Diagnostic and Statistical Manual of Mental Disorders,Fourth Edition,DSM-IV)抑郁症诊断标准的门诊及住院患者,对照组为100名正常人。患者入组后连续接受MECT8次,使用汉密顿抑郁量表(Hamilton Depression Rating Scale for Depression,HRSD)进行抑郁严重程度及疗效评估。运用PCR扩增及测序的方法,分析BD-NF基因rs6265、rs7103411单核苷酸多态性的分布,分析rs6265、rs7103411基因型及等位基因频率分布与MECT疗效的关系。结果:BDNF基因rs6265、rs7103411位点基因型及等位基因频率在对照组与患者组间的差异无统计学意义,MECT后2个位点基因型及rs7103411等位基因频率在不同疗效组间的差异无统计学意义。rs6265位点A等位基因频率和G等位基因频率在减分率≥50%组分别为47.9%、52.1%;在减分率<25%组分别为27.5%、72.5%,两组比较差异有统计学意义(P<0.05),且A等位基因对MECT反应好于G等位基因(OR=1.740,95%CI:1.022~2.963)。结论:病情严重的抑郁症患者BDNF基因rs6265位点A等位基因可能与无抽搐电休克治疗效果有关,A等位基因携带者接受MECT的疗效较G等位基因携带者好。