Functional Magnetic Resonance Imaging During Planning Before and After Cognitive-Behavioral Therapy in Pediatric Obsessive-Compulsive Disorder
Functional Magnetic Resonance Imaging During Planning Before and After Cognitive-Behavioral Therapy in Pediatric Obsessive-Compulsive Disorder
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DOI：
10.1016/j.jaac.2010.08.007
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发表时间：
2010-12-01
影响因子：
13.3
通讯作者：
Boer, Frits
中科院分区：
文献类型：
--
作者：
Huyser, Chaim;Veltman, Dick J.;Boer, Frits
目的：小儿强迫症（OCD）与认知异常，特别是执行障碍和额叶-纹状体-丘脑回路功能障碍有关。本研究的目的是调查儿童强迫症中计划作为执行功能是否受到损害，并与额叶-纹状体-丘脑功能障碍相关，以及这种功能障碍在成功治疗后是否会正常化。方法：25 名未接受药物治疗的强迫症儿科患者（平均+/- SD 13.95 +/- 2.52 岁，范围 9 至 19 岁）和 25 名健康对照者，按年龄和性别匹配，使用伦敦塔的自定进度伪随机事件相关功能磁共振成像版本进行两次扫描。在接受 16 次基于方案的认知行为治疗后，患者接受了重新扫描；在类似的时间间隔后重新扫描健康对照。结果：与对照组相比，患者执行任务的速度明显较慢，但准确性相似。神经影像学结果显示，在计划任务与控制任务期间，与对照组相比，强迫症患者的额叶和顶叶区域的募集较少。随着任务负荷的增加，与对照组相比，患者表现出更多的腹外侧和内侧前额叶皮层以及岛叶和前扣带皮层的募集。治疗后，这些差异不再显着，按时间按组按任务负荷交互分析显示，与健康对照组相比，强迫症患者的右后前额叶活动显着减少。结论：强迫症儿童患者表现出轻微的计划障碍，背外侧前额叶和顶叶募集减少，但在认知行为治疗后恢复正常。计划功能障碍可能是儿童强迫症的一种状态而不是特征。 J. Am.阿卡德。儿童青少年。精神病学，2010；49(12)：1238-1248。
Objective: Pediatric obsessive compulsive disorder (OCD) has been associated with cognitive abnormalities, in particular executive impairments, and dysfunction of frontal-striatal-thalamic circuitry. The aim of this study was to investigate if planning as an executive function is compromised in pediatric OCD and is associated with frontal-striatal-thalamic dysfunction, and if this dysfunction would normalize after successful treatment. Method: Twenty-five medication-free pediatric patients (mean +/- SD 13.95 +/- 2.52 years old, range 9 to 19 years) with OCD and 25 healthy controls, matched by age and gender, were scanned twice using a self-paced pseudo-randomized event-related functional magnetic resonance imaging version of the Tower of London. Patients were rescanned after 16 sessions of protocol-based cognitive behavioral therapy; healthy controls were rescanned after a similar interval. Results: Patients performed the task significantly slower but with similar accuracy compared with controls. Neuroimaging results showed less recruitment of frontal and parietal regions in patients with OCD compared with controls during the planning versus control task. With increasing task load patients compared with controls showed more recruitment of ventrolateral and medial prefrontal cortex and insula and anterior cingulate cortex. After treatment, these differences ceased to be significant, with time by group by task load interaction analyses showing a significant decrease in right posterior prefrontal activity in patients with OCD compared with healthy controls. Conclusion: Pediatric patients with OCD showed subtle planning impairments and decreased dorsolateral prefrontal and parietal recruitment that normalized after cognitive behavioral treatment. Planning dysfunction is likely to be a state rather than a trait feature of pediatric OCD. J. Am. Acad. Child Adolesc. Psychiatry, 2010;49(12): 1238-1248.