Deficient Activity in the Neural Systems That Mediate Self-regulatory Control in Bulimia Nervosa
Deficient Activity in the Neural Systems That Mediate Self-regulatory Control in Bulimia Nervosa
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DOI：
10.1001/archgenpsychiatry.2008.504
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发表时间：
2009-01-01
影响因子：
--
通讯作者：
Peterson, Bradley S.
中科院分区：
文献类型：
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作者：
Marsh, Rachel;Steinglass, Joanna E.;Peterson, Bradley S.
内容：介导自主性自我调节过程的神经系统的紊乱可能通过将进食行为从调节控制中释放出来而导致神经性贪食症（BN）。目的：研究BN女性患者中有助于自我调节控制的神经回路的功能活动。我们比较了功能磁共振成像血氧水平-在执行Simon空间不相容任务期间BN患者与健康对照的依赖性反应。设置：大学研究所。参与者：40名女性：20名BN患者和20名健康对照参与者。主要结果测量：我们使用Simon空间不相容任务相关激活的一般线性模型来比较各组与成功或不成功的自我调节控制相关的大脑激活模式。与健康对照组相比，BN患者的反应更冲动，在任务中犯的错误更多;症状最严重的患者犯的错误最多。在对不一致试验做出正确反应期间，患者未能在左侧下外侧前额叶皮质（布罗德曼区[BA] 45）、双侧额下回（BA 44）、豆状核和尾状核以及前扣带皮质（BA 24/32）中以与健康对照相同的程度激活额纹回路。患者激活背侧前扣带皮层（BA 32）时，犯错误时比正确的反应。相比之下，健康受试者在正确反应时比不正确反应时更多地激活前扣带皮层，而在不正确反应时更多地激活纹状体，这可能反映了一种自动反应倾向，即在没有伴随的前扣带皮层活动的情况下，产生不正确的反应。BN女性的自我调节过程受损，可能是因为她们未能适当地参与额纹状体回路。这些发现通过指出有助于自我调节控制的神经系统内的功能异常增强了我们对BN发病机制的理解，这可能有助于BN女性的暴饮暴食和其他冲动行为。
Context: Disturbances in neural systems that mediate voluntary self-regulatory processes may contribute to bulimia nervosa (BN) by releasing feeding behaviors from regulatory control.Objective: To study the functional activity in neural circuits that subserve self-regulatory control in women with BN.Design: We compared functional magnetic resonance imaging blood oxygenation level-dependent responses in patients with BN with healthy controls during performance of the Simon Spatial Incompatibility task.Setting: University research institute.Participants: Forty women: 20 patients with BN and 20 healthy control participants.Main Outcome Measure: We used general linear modeling of Simon Spatial Incompatibility task-related activations to compare groups on their patterns of brain activation associated with the successful or unsuccessful engagement of self-regulatory control.Results: Patients with BN responded more impulsively and made more errors on the task than did healthy controls; patients with the most severe symptoms made the most errors. During correct responding on incongruent trials, patients failed to activate frontostriatal circuits to the same degree as healthy controls in the left inferolateral prefrontal cortex (Brodmann area [BA] 45), bilateral inferior frontal gyrus (BA 44), lenticular and caudate nuclei, and anterior cingulate cortex (BA 24/32). Patients activated the dorsal anterior cingulate cortex (BA 32) more when making errors than when responding correctly. In contrast, healthy participants activated the anterior cingulate cortex more during correct than incorrect responses, and they activated the striatum more when responding incorrectly, likely reflecting an automatic response tendency that, in the absence of concomitant anterior cingulate cortex activity, produced incorrect responses.Conclusions: Self-regulatory processes are impaired in women with BN, likely because of their failure to engage frontostriatal circuits appropriately. These findings enhance our understanding of the pathogenesis of BN by pointing to functional abnormalities within a neural system that subserves self-regulatory control, which may contribute to binge eating and other impulsive behaviors in women with BN.