Neural correlates of clinical improvement in response to N-acetylcysteine in adolescents with non-suicidal self-injury
Neural correlates of clinical improvement in response to N-acetylcysteine in adolescents with non-suicidal self-injury
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DOI：
10.1016/j.pnpbp.2019.109778
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发表时间：
2020-04-20
影响因子：
5.6
通讯作者：
Mueller, Bryon A.
中科院分区：
文献类型：
--
作者：
Cullen, Kathryn R.;Schreiner, Melinda Westlund;Mueller, Bryon A.
非自杀性自伤（NSSI）是青少年中常见的严重临床问题。需要新的，生物学上知情的方法来治疗青少年的NSSI，以防止慢性NSSI和未来自杀企图等负面后果。N-乙酰半胱氨酸（NAC）已成功地用于解决涉及重复性适应不良行为的其他条件，并可能在解决NSSI中具有实用性。本研究探讨了在患有NSSI的女性青少年中进行NAC的开放标签、8周试验后的神经回路变化。我们使用静息态功能性神经成像技术测量了治疗前后杏仁核和延髓核的全脑静息态功能连接（RSFC）。治疗前和治疗后的可用神经影像学数据可用于18名参与者。NSSI频率的减少与左杏仁核RSFC和右辅助运动区（SMA）的减少相关，但与右杏仁核RSFC和右下额叶皮质的增加相关。对于延髓核，NSSI频率的降低与右侧延髓核和左侧上级内侧额叶皮质之间的连接减少有关。我们还报告了伴随抑郁症和全球精神病理学指标临床改善的类似回路的变化。这些初步研究结果表明，杏仁核和杏仁核为基础的电路作为潜在的治疗目标，并为未来的研究奠定了基础，旨在确认这些神经靶点，使用随机，安慰剂对照设计，以确认临床疗效和作用机制。
Non-suicidal self-injury (NSSI) is a serious clinical problem that is common in adolescents. Novel, biologically-informed approaches for treating NSSI in adolescents are needed to prevent negative outcomes such as chronic NSSI and future suicide attempts. N-acetylcysteine (NAC) has been used successfully to address other conditions that involve repetitive maladaptive behaviors and may have utility in addressing NSSI. This study explored neural circuit changes following an open-label, 8-week trial of NAC in female adolescents with NSSI. We measured whole-brain resting-state functional connectivity (RSFC) of the amygdala and the nucleus accumbens before and after treatment using resting-state functional neuroimaging. Usable neuroimaging data from both pre- and post-treatment were available for 18 participants. Reduction in NSSI frequency was associated with a decrease in left amygdala RSFC with right supplementary motor area (SMA), but with an increase in right amygdala RSFC with right inferior frontal cortex. For nucleus accumbens, a reduction in NSSI frequency was associated with a decrease in connectivity between right nucleus accumbens and left superior medial frontal cortex. We also report change in similar circuits accompanying clinical improvement in depression and global psychopathology measures. These preliminary findings suggest amygdala and nucleus accumbens-based circuits as potential treatment targets, and set the stage for future research designed to confirm these neural targets using randomized, placebo-controlled designs to confirm clinical efficacy and mechanisms of effect.