Unmasking disease-specific cerebral blood flow abnormalities: Mood challenge in patients with remitted unipolar depression
Unmasking disease-specific cerebral blood flow abnormalities: Mood challenge in patients with remitted unipolar depression
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DOI：
10.1176/appi.ajp.159.11.1830
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发表时间：
2002-11-01
影响因子：
17.7
通讯作者：
Jerabek, P
中科院分区：
文献类型：
--
作者：
Liotti, M;Mayberg, HS;Jerabek, P
目的：缓解的重度抑郁障碍是一种脆弱的临床状态，提示在发作之间存在潜在的疾病素质。为了研究这种风险的神经相关性，并确定潜在的抑郁特征标记，研究了缓解期的欣快型单相患者、急性抑郁症患者和从未抑郁的志愿者在短暂性悲伤情绪挑战前后的情况。方法：采用[O-15]H2O正电子发射断层扫描，观察自传体记忆脚本激发悲伤后，不同组间局部血流变化的共性和差异性。结果：两组抑郁患者的情绪刺激均导致内侧眶前叶Brodmann‘s区10/11区局部脑血流量(RCBF)下降，而正常组无此现象。在缓解组，情绪刺激导致前扣带回24a出现独特的rCBF下降。健康受试者的主要效应，扣带回Brodmann‘s区25区rCBF增加和右侧前额皮质Brodmann’s区9区rCBF降低在抑郁症组中不存在。结论：完全缓解的单相抑郁患者的情绪挑战揭示了一个明显的抑郁特征标记物。急性CBF变化的模式与乐观的健康志愿者不同，反映了在严重抑郁发作期间看到的未经治疗的抑郁状态，以及在抑郁患者中看到的变化模式。这些发现表明，介导短暂情绪变化的通路的疾病特异性修饰在单相抑郁中存在，与临床疾病状态无关。这些发现对了解缓解患者复发的脆弱性有一定的意义。
Objective: Remitted major depressive disorder is a vulnerable clinical state, suggesting persistence of an underlying disease diathesis between episodes. To investigate neural correlates of such risk and to identify potential depression trait markers, euthymic unipolar patients in remission, acutely depressed patients, and never-depressed volunteers were studied before and after transient sad mood challenge. Method: Common and differential changes in regional blood flow among the groups relative to the baseline state were examined with [O-15]H2O positron emission tomography after provocation of sadness with autobiographical memory scripts. Results: Mood provocation in both depressed groups resulted in regional cerebral blood flow (rCBF) decreases in medial orbitofrontal cortex Brodmann's area 10/11, which were absent in the healthy group. In the remitted group, mood provocation produced a unique rCBF decrease in pregenual anterior cingulate 24a. The main effects in healthy subjects, an rCBF increase in subgenual cingulate Brodmann's area 25 and a decrease in right prefrontal cortex Brodmann's area 9, were not present in the depressed groups. Conclusions: Mood challenge in unipolar euthymic patients in full remission unmasks an apparent depression trait marker. The pattern of acute CBF changes is distinct from that seen in euthymic healthy volunteers and mirrors the untreated depressed state seen during a major depressive episode and the pattern of change seen in depressed patients. These findings suggest that disease-specific modifications of pathways mediating transient mood changes are present in unipolar depression independent of clinical illness status. These findings have implications for understanding the vulnerability of remitted patients for illness relapse.