The subgenual anterior cingulate cortex in mood disorders.
The subgenual anterior cingulate cortex in mood disorders.
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DOI：
10.1017/s1092852900013754
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发表时间：
2008-08
期刊：
影响因子：
3.3
通讯作者：
Savitz, Jonathan
中科院分区：
文献类型：
--
作者：
Drevets, Wayne C.;Savitz, Jonathan
在我们的神经精神病学重要神经解剖学领域系列的最新版本中，医学博士韦恩·德瑞茨和博士乔纳森·萨维茨概述了腹侧前扣带结构对情绪调节的临床重要性。大约半个世纪前，该区域是抑郁症介入神经外科手术的早期目标，今天已成为情感障碍脑深部电刺激的关键部位之一。前扣带皮层是帕佩兹最初回路的一部分，被认为与情绪调节有关。然而，从那时起，许多实验工作已经概述了不同的扣带区域具有不同的解剖连接和功能。Drevets和Savitz提请注意膝下区，并描述了局部和远端的解剖连接，强调其与几种神经精神疾病的相关性。根据人类的神经影像学研究和实验动物的损伤分析，胼胝体腹侧的前扣带皮层（ACC）与情绪行为的调节有关。在一项结合正电子发射断层扫描/磁共振成像研究的情绪障碍，我们表明，平均灰质体积的“subgenual”ACC（sgACC）皮质异常减少的主题与重度抑郁症（MDD）和双相情感障碍，无论情绪状态。从MDD或双相情感障碍受试者尸检获得的sgACC组织的神经病理学评估证实了灰质体积的减少，并显示这种异常与神经胶质的减少有关，没有等效的神经元损失。在正电子发射断层扫描研究中，相对于相同MDD受试者的缓解期，抑郁症患者该区域的代谢活性升高，有效的抗抑郁治疗与sgACC活性降低相关。其他实验室复制并扩展了这些发现，一项研究强调了这种治疗效果的临床重要性，该研究表明，sgACC的脑深部刺激可改善治疗抵抗性MDD的抑郁症状。本文在临床前文献的背景下讨论了这些发现的功能意义，这些文献暗示了该区域的推定同源物在情绪行为和压力反应的调节中。在实验动物中，这个区域参与了一个扩展的“内脏网络”结构，在奖励，恐惧和压力的神经处理过程中调节自主/神经内分泌反应和神经递质传递。因此，这些数据具有重要的意义，抑郁症的神经模型的发展，可以解释异常的动机，神经内分泌，自主神经和情绪表现明显的人类情绪障碍。
In the latest edition of our series of neuroanatomical areas of importance for neuropsychiatry, Wayne Drevets, MD, and Jonathan Savitz, PhD, have outlined the clinical importance of the ventral anterior cingulate structures for the regulation of mood. This area was an early target for interventional neurosurgery for depression some half a century ago, and today has become one of the key sites of deep brain stimulation for affective disorders. The anterior cingulate cortex was a part of the initial circuit of Papez thought to be related to the regulation of emotion. However, since then, much experimental work has outlined different cingulate regions with differing anatomical connectivity and functions. Drevets and Savitz draw attention to the subgenual area and describe the local and distant anatomical connectivities that emphasize its relevance for several neuropsychiatric disorders. The anterior cingulate cortex (ACC) ventral to the genu of the corpus callosum has been implicated in the modulation of emotional behavior on the basis of neuroimaging studies in humans and lesion analyses in experimental animals. In a combined positron emission tomography/magnetic resonance imaging study of mood disorders, we demonstrated that the mean gray matter volume of this “subgenual” ACC (sgACC) cortex is abnormally reduced in subjects with major depressive disorder (MDD) and bipolar disorder, irrespective of mood state. Neuropathological assessments of sgACC tissue acquired postmortem from subjects with MDD or bipolar disorder confirmed the decrement in gray matter volume, and revealed that this abnormality was associated with a reduction in glia, with no equivalent loss of neurons. In positron emission tomography studies, the metabolic activity was elevated in this region in the depressed relative to the remitted phases of the same MDD subjects, and effective antidepressant treatment was associated with a reduction in sgACC activity. Other laboratories replicated and extended these findings, and the clinical importance of this treatment effect was underscored by a study showing that deep brain stimulation of the sgACC ameliorates depressive symptoms in treatment-resistant MDD. This article discusses the functional significance of these findings within the context of the preclinical literature that implicates the putative homologue of this region in the regulation of emotional behavior and stress response. In experimental animals, this region participates in an extended “visceromotor network” of structures that modulates autonomic/neuroendocrine responses and neurotransmitter transmission during the neural processing of reward, fear, and stress. These data thus hold important implications for the development of neural models of depression that can account for the abnormal motivational, neuroendocrine, autonomic, and emotional manifestations evident in human mood disorders.
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