Intrinsic functional neurocircuitry associated with treatment response to transdiagnostic CBT in bipolar disorder with anxiety.
Intrinsic functional neurocircuitry associated with treatment response to transdiagnostic CBT in bipolar disorder with anxiety.
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DOI：
10.1016/j.jad.2018.06.002
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发表时间：
2018-10-01
影响因子：
6.6
通讯作者：
Deckersbach T
中科院分区：
文献类型：
--
作者：
Ellard KK;Gosai AG;Bernstein EE;Kaur N;Sylvia LG;Camprodon JA;Dougherty DD;Nierenberg AA;Deckersbach T
双相情感障碍（BD）的焦虑加剧了情绪失调，降低了治疗反应。我们最近进行了一项针对双相障碍患者辅助药物治疗的焦虑和情绪失调的跨诊断CBT的试点试验。抑郁和焦虑症状的减少可以通过神经质和感知情感控制的基线水平，以及情绪调节技能随时间的变化来显著预测。本研究通过检查基线情绪调节相关神经回路与试验结果之间的关系来探讨治疗反应的机制。19名患者在随机化治疗前完成了基线静息状态fMRI扫描。研究人员检测了前叶岛（AI）与突出网络（SN）、默认模式网络（DMN）和执行控制网络（ECN）区域之间的功能连通性，作为情绪调节基线和治疗相关变化的预测因子。较弱的右侧AI背侧-右侧腹外侧前额叶皮层（VLPFC； SN）和较强的双侧AI背侧-双侧杏仁核功能连通性预示着更大的情绪调节改善。基线神经质与右侧背侧AI-下顶叶（ECN）功能连通性呈负相关，而感知情感控制的基线缺陷与腹侧AI-双侧dACC （SN）连通性呈正相关。小样本限制了治疗特异性效果的可解释性。情绪调节相关神经回路的基线功能连通性显著预测焦虑和抑郁症状减轻相关情绪调节相关维度的变化。未来的研究需要确定采用神经调节等方法来修复相关的神经回路是否可以改善CBT对双相障碍和焦虑的最终治疗效果。
Anxiety in bipolar disorder (BD) exacerbates emotion dysregulation and reduces treatment response. We recently conducted a pilot trial of transdiagnostic CBT to target anxiety and emotion dysregulation in BD adjunctive to pharmacotherapy. Reductions in depression and anxiety symptoms were significantly predicted by baseline levels of neuroticism and perceived affective control, as well as changes over time in emotion regulation skills. The present study investigates mechanism of treatment response by examining the relationship between baseline emotion regulation-related neural circuitry and trial outcomes. Nineteen patients completed baseline resting state fMRI scans prior to treatment randomization. Functional connectivity between the anterior insula (AI) and regions in the salience network (SN), default mode network (DMN), and executive control network (ECN) were examined as predictors of baseline and treatment-related changes in emotion regulation. Greater improvements in emotion regulation were predicted by weaker right dorsal AI – right ventrolateral prefrontal cortex (VLPFC; SN) and stronger bilateral dorsal AI – bilateral amygdala functional connectivity. Baseline neuroticism was negatively correlated with right dorsal AI- inferior parietal lobule (ECN) functional connectivity, and baseline deficits in perceived affective control were positively associated with ventral AI – bilateral dACC (SN) connectivity. Small sample limits interpretability of treatment-specific effects. Baseline functional connectivity of emotion-regulation related neural circuitry significantly predicted change in emotion regulation-related dimensions associated with anxiety and depression symptom reduction. Future studies are needed to determine if employing methods such as neuromodulation to rehabilitate relevant neural circuitry may improve ultimate treatment outcomes of transdiagnostic CBT for BD and anxiety.
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影响因子：
5.7
作者：
Foland-Ross LC;Bookheimer SY;Lieberman MD;Sugar CA;Townsend JD;Fischer J;Torrisi S;Penfold C;Madsen SK;Thompson PM;Altshuler LL
通讯作者：
Altshuler LL
影响因子：
19.9
作者：
Etkin, Amit;Egner, Tobias;Kalisch, Raffael
通讯作者：
Kalisch, Raffael
DOI：
10.1098/rstb.2016.0011
发表时间：
2016-11-19
影响因子：
6.3
作者：
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通讯作者：
Hamilton, Paul
影响因子：
6.6
作者：
Ellard, Kristen K.;Bernstein, Emily E.;Deckersbach, Thilo
通讯作者：
Deckersbach, Thilo
影响因子：
4.8
作者：
Fowler, J. Christopher;Charak, Ruby;Oldham, John M.
通讯作者：
Oldham, John M.