Central noradrenergic responsiveness to a clonidine challenge in Generalized Anxiety Disorder: a Single Photon Emission Computed Tomography study
Central noradrenergic responsiveness to a clonidine challenge in Generalized Anxiety Disorder: a Single Photon Emission Computed Tomography study
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DOI：
10.1177/0269881111415730
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发表时间：
2012-04-01
影响因子：
4.1
通讯作者：
Nutt, D. J.
中科院分区：
文献类型：
--
作者：
Kalk, N. J.;Melichar, J.;Nutt, D. J.
广泛性焦虑障碍（GAD）可能涉及去甲肾上腺素a2受体的低反应性。为了验证这一假设，我们使用tc -99m-hexa-甲基-丙烯-胺肟（HMPAO）单光子发射计算机断层扫描测量了未治疗的广泛性焦虑症患者、文拉法辛治疗的患者和健康对照者在可乐定前后单词生成期间的局部脑灌注。同时的心理和生理措施支持在某些情况下广泛性焦虑症的去甲肾上腺素能功能障碍。采用一日分次给药技术。使用SPM5 （Institute of Neurology）对图像进行处理。析因分析无显著结果。进行了探索性分析。语言流畅性的区域灌注在可乐定前各组之间存在差异。与健康对照相比，未经治疗的广泛性焦虑症患者显示左侧布洛卡区和左侧枕颞区灌注增加。经治疗的广泛性焦虑症患者表现为双侧小脑灌注增加。可乐定与各组脑灌注变化的相关性不同。健康受试者的右侧边缘上回、治疗过的广泛性焦虑症患者的左侧中央前回以及未治疗过的广泛性焦虑症患者的右侧小脑和额叶中回均有所增加。尽管存在这些差异，但研究结果与去甲肾上腺素能低反应假说不一致，因为治疗组表现出不同的反应模式，而不是正常的反应。
Generalized Anxiety Disorder (GAD) may involve hypo-responsiveness of noradrenaline a2 receptors. To test this hypothesis, we used Tc-99m-hexa-methyl-propylene-amine-oxime (HMPAO) Single Photon Emission Computed Tomography to measure regional cerebral perfusion in patients with untreated GAD, venlafaxine-treated patients and healthy controls during word generation before and after clonidine. Concurrent psychological and physiological measures supported noradrenergic hypofunction in GAD in some cases. A single-day split-dose technique was used. Images were processed using SPM5 (Institute of Neurology). Factorial analysis revealed no significant results. Exploratory analyses were done. Regional perfusion during verbal fluency differed by group pre-clonidine. Compared with healthy controls, patients with untreated GAD displayed increased perfusion in the left Broca's area and left occipitotemporal region. Treated GAD patients displayed increased cerebellar perfusion bilaterally. Clonidine was associated with different changes in cerebral perfusion in each group. Increases were seen in the right supra-marginal gyrus in healthy subjects, in the left pre-central gyrus in treated GAD patients and in the right cerebellum and middle frontal gyrus in untreated GAD patients. Despite these differences, the findings were not consistent with a noradrenergic hypo-responsiveness hypothesis, as the treated group showed a different pattern of response rather than a normalization of response.