Irritability Trajectories, Cortical Thickness, and Clinical Outcomes in a Sample Enriched for Preschool Depression
Irritability Trajectories, Cortical Thickness, and Clinical Outcomes in a Sample Enriched for Preschool Depression
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DOI：
10.1016/j.jaac.2018.02.010
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发表时间：
2018-05-01
影响因子：
13.3
通讯作者：
Leibenluft, Ellen
中科院分区：
文献类型：
--
作者：
Pagliaccio, David;Pine, Daniel S.;Leibenluft, Ellen
目的：易怒和抑郁之间存在横断面、纵向和遗传关联。先前的研究已经检查了易怒的发展轨迹、临床结果以及与儿童和家族抑郁症的关系。然而，这些研究并没有整合神经生物学测量。本研究调查了学龄前儿童抑郁症状的易怒、临床结果和皮质结构的发展轨迹。方法：从3 ~ 5岁开始，通过临床访谈对271例早期抑郁症状丰富的儿童进行纵向评估。潜在类别混合模型确定了易怒严重程度的轨迹。危险因素、临床结果和皮质厚度在不同的轨迹分类中进行比较。从7 ~ 12岁的3波磁共振成像中提取皮质厚度测量值。结果：在这些青少年中发现了三个轨迹类别：53.50%的儿童在学龄前表现出高易怒性并纵向下降，30.26%的儿童表现出持续低易怒性，16:24%的儿童表现出持续高易怒性。与其他类别相比，高易怒类别表现出更高的母亲抑郁症，早期生活逆境，后来的精神诊断和功能障碍的发生率。此外，升高的易怒基线预测了后来的抑郁，超出了逆境和个人和母亲的抑郁史。高激惹性组表现出左侧额上回和颞上回以及右侧顶叶下小叶皮层变厚。结论：易怒表现出特定的发展轨迹，在早期抑郁症中富集。持续升高的易怒预示着较差的精神预后，较高的后期抑郁风险，以及发育后期整体功能下降。额叶、颞叶和顶叶皮质厚度也较大，提供了这种风险轨迹的神经相关性。
Objective: Cross-sectional, longitudinal, and genetic associations exist between irritability and depression. Prior studies have examined developmental trajectories of irritability, clinical outcomes, and associations with child and familial depression. However, studies have not integrated neurobiological measures. The present study examined developmental trajectories of irritability, clinical outcomes, and cortical structure among preschoolers over sampled for depressive symptoms.Method: Beginning at 3 to 5 years old, a sample of 271 children enriched for early depressive symptoms were assessed longitudinally by clinical interview. Latent class mixture models identified trajectories of irritability severity. Risk factors, clinical outcomes, and cortical thickness were compared across trajectory classes. Cortical thickness measures were extracted from 3 waves of magnetic resonance imaging at 7 to 12 years of age.Results: Three trajectory classes were identified among these youth: 53.50% of children exhibited elevated irritability during preschool that decreased longitudinally, 30.26% exhibited consistently low irritability, and 16:24% exhibited consistently elevated irritability. Compared with other classes, the elevated irritability class exhibited higher rates of maternal depression, early life adversity, later psychiatric diagnoses, and functional impairment. Further, elevated baseline irritability predicted later depression beyond adversity and personal and maternal depression history. The elevated irritability class exhibited a thicker cortex in the left superior frontal and temporal gyri and the right inferior parietal lobule.Conclusion: Irritability manifested with specific developmental trajectories in this sample enriched for early depression. Persistently elevated irritability predicted poor psychiatric outcomes, higher risk for later depression, and decreased overall function later in development. Greater frontal, temporal, and parietal cortical thickness also was found, providing neural correlates of this risk trajectory.