Single photon emission computed tomography (SPECT) of anxiety disorders before and after treatment with citalopram.
Single photon emission computed tomography (SPECT) of anxiety disorders before and after treatment with citalopram.
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DOI：
10.1186/1471-244x-4-30
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发表时间：
2004-10-14
期刊：
影响因子：
4.4
通讯作者：
Stein DJ
中科院分区：
文献类型：
--
作者：
Carey PD;Warwick J;Niehaus DJ;van der Linden G;van Heerden BB;Harvey BH;Seedat S;Stein DJ
几项研究现在已经检查了选择性5-羟色胺再摄取抑制剂（SSRI）治疗对各种焦虑症（包括强迫症（OCD），创伤后应激障碍（PTSD）和社交焦虑症（社交恐惧症）（SAD））脑功能的影响。SSRI治疗后脑灌注的区域变化已被证明是所有三种疾病。眶额皮质（OFC）（OCD）、尾状核（OCD）、内侧前额叶/扣带回（OCD、SAD、PTSD）、颞叶（OCD、SAD、PTSD）和丘脑区域（OCD、SAD）是其中一些涉及的区域。一些数据还表明，前扣带回（PTSD）、OFC、尾状核（OCD）和前外侧颞区（SAD）的较高灌注预处理预测随后的治疗反应。本文进一步探讨了SSRI治疗焦虑症的神经回路重叠的概念，以及SSRI治疗焦虑症的治疗反应。在用SSRI西酞普兰治疗8周（SAD）和12周（OCD和PTSD）之前和之后，对患有OCD、PTSD和SAD的受试者使用Tc-99 m HMPAO进行单光子发射计算机断层扫描（SPECT）以评估脑灌注。使用统计参数图（SPM）比较合并受试者组的扫描结果（给药前与给药后，应答者与非应答者）。西酞普兰治疗导致整个组的扣带回上级（t = 4.78）和前部（t = 4.04）、右侧丘脑（t = 4.66）和左侧海马（t = 3.96）显著失活（p = 0.001）。在治疗应答者中，左中央前叶（t = 4.26）、右额叶中部（t = 4.03）、右下额叶（t = 3.99）、左前额叶（3.81）和右楔前叶（t= 3.85）内的失活（p = 0.001）更明显。基线激活模式无法区分后续药物治疗的应答者和非应答者。虽然每种焦虑症可能由不同的神经回路介导，但它们对SSRI治疗的反应在功能神经解剖学上存在一些重叠。目前的数据与以前的工作是一致的，证明了边缘回路在这一系列疾病中的重要性。这些在认知情感处理中起着至关重要的作用，由多巴胺能神经元支配，并且在多巴胺能药物治疗期间其活性的变化似乎至关重要。
Several studies have now examined the effects of selective serotonin reuptake inhibitor (SSRI) treatment on brain function in a variety of anxiety disorders including obsessive-compulsive disorder (OCD), posttraumatic stress disorder (PTSD), and social anxiety disorder (social phobia) (SAD). Regional changes in cerebral perfusion following SSRI treatment have been shown for all three disorders. The orbitofrontal cortex (OFC) (OCD), caudate (OCD), medial pre-frontal/cingulate (OCD, SAD, PTSD), temporal (OCD, SAD, PTSD) and, thalamic regions (OCD, SAD) are some of those implicated. Some data also suggests that higher perfusion pre-treatment in the anterior cingulate (PTSD), OFC, caudate (OCD) and antero-lateral temporal region (SAD) predicts subsequent treatment response. This paper further examines the notion of overlap in the neurocircuitry of treatment and indeed treatment response across anxiety disorders with SSRI treatment. Single photon emission computed tomography (SPECT) using Tc-99 m HMPAO to assess brain perfusion was performed on subjects with OCD, PTSD, and SAD before and after 8 weeks (SAD) and 12 weeks (OCD and PTSD) treatment with the SSRI citalopram. Statistical parametric mapping (SPM) was used to compare scans (pre- vs post-medication, and responders vs non-responders) in the combined group of subjects. Citalopram treatment resulted in significant deactivation (p = 0.001) for the entire group in the superior (t = 4.78) and anterior (t = 4.04) cingulate, right thalamus (t = 4.66) and left hippocampus (t = 3.96). Deactivation (p = 0.001) within the left precentral (t = 4.26), right mid-frontal (t = 4.03), right inferior frontal (t = 3.99), left prefrontal (3.81) and right precuneus (t= 3.85) was more marked in treatment responders. No pattern of baseline activation distinguished responders from non-responders to subsequent pharmacotherapy. Although each of the anxiety disorders may be mediated by different neurocircuits, there is some overlap in the functional neuro-anatomy of their response to SSRI treatment. The current data are consistent with previous work demonstrating the importance of limbic circuits in this spectrum of disorders. These play a crucial role in cognitive-affective processing, are innervated by serotonergic neurons, and changes in their activity during serotonergic pharmacotherapy seem crucial.