Positron emission tomography of regional brain metabolic responses to a serotonergic challenge and lethality of suicide attempts in major depression
Positron emission tomography of regional brain metabolic responses to a serotonergic challenge and lethality of suicide attempts in major depression
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DOI：
10.1001/archpsyc.60.1.14
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发表时间：
2003-01-01
影响因子：
--
通讯作者：
Mann, JJ
中科院分区：
文献类型：
--
作者：
Oquendo, MA;Placidi, GPA;Mann, JJ
背景：较低的血清素活性与重度抑郁症的高致命性自杀企图相关。对自杀者血清素受体的尸检研究发现，腹侧前额皮质（PFC）发生了局部变化。我们研究了高致死率自杀未遂的抑郁症患者腹侧前额皮质的血清素能反应。方法：将有高致死率自杀企图史的抑郁症患者 (n = 16) 与低致死率自杀未遂患者 (n = 9) 的抑郁水平、自杀意图和意念、冲动、攻击性和神经心理学测试表现进行比较。在单盲安慰剂后和第二天给予盐酸芬氟拉明后，受试者在未服用药物的情况下进行扫描。通过氟脱氧葡萄糖 F 18 和连续催乳素水平的正电子发射断层扫描成像来测量大脑反应。通过统计参数映射来比较扫描结果。评估相对区域脑摄取 (rCMRglu) 变化与临床和神经心理学测量的相关性。结果：与低致死率自杀者相比，抑郁的高致死率自杀者腹侧、内侧和外侧 PFC 的 rCMRglu 较低。给予芬氟拉明后这种差异更加明显。较低的腹内侧 PFC 活性与较低的终生冲动、较高的自杀意图（计划）和较高的自杀企图相关。在同一区域，较高的语言流利度与 rCMRglu 呈正相关。结论：前额叶局部功能减退和血清素反应性受损与自杀企图的致死率成正比，并且可能介导自杀意图和冲动对致死率的影响。需要进行正电子发射断层扫描神经受体研究来确定死后血清素受体的发现是否也存在于体内并导致异常的 rCMRglu 反应。
Background: Lower serotonergic activity correlates with high-lethality suicide attempts in major depression. Postmortem studies of serotonin receptors in suicides localize changes to the ventral prefrontal cortex (PFC). We studied serotonergic response in ventral PFC in depressed patients surviving a high-lethality suicide attempt.Methods: Depressed patients with a history of a high-lethality suicide attempt (n = 16) were compared with those with low-lethality attempts (n = 9) for level of depression, suicidal intent and ideation, impulsivity, aggression, and neuropsychological test performance. Subjects were scanned while medication free after a single-blind placebo and after fenfluramine hydrochloride administration on a second day. Brain responses were measured by positron emission tomography imaging of fludeoxyglucose F 18 and serial prolactin levels. Scans were compared by means of statistical parametric mapping. Correlations of changes in relative regional cerebral uptake (rCMRglu) with clinical and neuropsychological measures were assessed.Results: Depressed high-lethality suicide attempters had lower rCMRglu in ventral, medial, and lateral PFC compared with low-lethality attempters. This difference was more pronounced after fenfluramine administration. Lower ventromedial PFC activity was associated with lower lifetime impulsivity, higher suicidal intent (planning), and higher-lethality suicide attempts. Higher verbal fluency was positively correlated with rCMRglu in the same regions.Conclusions: Prefrontal localized hypofunction and impaired serotonergic responsivity are proportional to the lethality of the suicide attempt and may mediate the effects of suicide intent and impulsivity on lethality. Positron emission tomographic neuroreceptor studies are needed to determine whether postmortem serotonin receptor findings are also present in vivo and contribute to the abnormal rCMRglu responses.