Prefrontal-subcortical and limbic circuit mediation of major depressive disorder.
Prefrontal-subcortical and limbic circuit mediation of major depressive disorder.
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DOI：
10.1053/scnp.2001.21837
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发表时间：
2001-04-01
期刊：
影响因子：
--
通讯作者：
Saxena, S
中科院分区：
文献类型：
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作者：
Brody, A L;Barsom, M W;Saxena, S
利用脑功能成像和结构成像在阐明重性抑郁症（MDD）的病理生理学方面取得了实质性进展。在基线时比较MDD受试者与正常对照的功能成像研究中，发现MDD患者的背外侧前额叶皮层（DLPFC）活动减少，腹外侧前额叶皮层（VLPFC）活动增加。基线研究中发现的其他异常区域包括前扣带回（AC）、颞叶和基底神经节。检查情绪状态变化（使用睡眠剥夺、悲伤诱导和色氨酸耗竭）和治疗前后变化的研究通常显示，这些异常随着MDD症状改善而改善，这些异常随着症状恶化而恶化。在结构成像研究中，额叶、海马和基底节体积减少是最常见的结果。MDD的临床特征与脑功能之间存在几种关联：（1）积极悲伤的想法/悲伤，DLPFC和背侧AC活动减少，VLPFC和腹侧AC活动增加（2）精神发育迟滞，左前额叶活动减少（3）焦虑，左AC活动增加（4）情节记忆受损，左前额叶和内侧颞叶功能障碍，以及（5）持续注意力受损伴有右前额叶和顶叶功能障碍
Substantial progress has been made in elucidating the pathophysiology of major depressive disorder (MDD) using functional and structural brain imaging. In functional imaging studies comparing MDD subjects to normal controls at baseline, dorsolateral prefrontal cortex (DLPFC) activity has been found to be decreased and ventrolateral prefrontal cortex (VLPFC) activity has been found to be increased in MDD. Other regions found abnormal in baseline studies include the anterior cingulate gyrus (AC), temporal lobe, and basal ganglia. Studies examining mood state change (using sleep deprivation, sadness-induction, and tryptophan depletion) and changes from pre- to posttreatment have generally shown improvement of these abnormalities with improved MDD symptoms and worsening of these abnormalities with worsening symptoms. In structural imaging studies, decreased frontal lobe, hippocampal, and basal ganglia volumes are the most commonly reported findings. Several associations can be made between clinical features of MDD and brain function: (1) active sad thoughts/sadness with both decreased DLPFC and dorsal AC activity and increased VLPFC and ventral AC activity (2) psychomotor retardation with decreased left prefrontal activity (3) anxiety with increased left AC activity (4) impaired episodic memory with left prefrontal and medial temporal dysfunction and (5) impaired sustained attention with right prefrontal and parietal dysfunction.