Neural Responses to Fluoxetine in Youths with Disruptive Behavior and Trauma Exposure: A Pilot Study.
Neural Responses to Fluoxetine in Youths with Disruptive Behavior and Trauma Exposure: A Pilot Study.
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DOI：
10.1089/cap.2020.0174
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发表时间：
2021-10
影响因子：
1.9
通讯作者：
Blair J
中科院分区：
文献类型：
--
作者：
Hwang S;Chung U;Chang Y;Kim E;Suk JW;Meffert H;Kratochvil C;Leibenluft E;Blair J
目的：初步调查血清素能药物（氟西汀）对患有破坏性行为障碍（DBD）和有创伤暴露史的青少年的症状特征和神经反应的影响。方法：共有三个参与者组：（i）患有 DBD 和创伤暴露的青少年，接受氟西汀治疗 8 周（n = 11）； (ii) 一组患有 DBD 和创伤暴露的青少年，他们在门诊接受常规定期随访（n = 10）； (iii) 典型发育青少年 (n = 18)。所有参与者都进行了两次表达处理功能磁共振成像任务，间隔 8 周：（DBD 青少年的治疗前和治疗后）。结果：与其他两组相比，患有 DBD 和创伤暴露的青少年接受氟西汀治疗后表现出：（i）外化、对立违抗性障碍、易怒、焦虑抑郁和创伤相关症状显着改善； (ii) 作为恐惧表达强度的函数，杏仁核反应显着降低，与自上而下的注意力控制（岛叶皮质、顶下小叶和中央后回）和情绪调节（腹内侧前额叶皮质[vmPFC]）相关区域的募集增加； (iii) DBD/烦躁症状的改善与自上而下的注意力控制区域（顶下小叶、岛叶皮质和中央后回）和情绪调节区域（vmPFC）的激活增加之间的相关性。结论：这项研究提供了初步证据，证明血清素能药物（氟西汀）可以减少患有 DBD 和创伤暴露的青少年的破坏性行为和情绪症状，这可能是通过增强自上而下的注意力控制和情绪调节区域（顶下小叶、岛叶皮质和 vmPFC）的激活来介导的。
Objective: A preliminary investigation of the impact of a serotonergic agent (fluoxetine) on symptom profile and neural response in youths with disruptive behavior disorders (DBDs) and a history of trauma exposure. Methods: There were three participant groups: (i) Youths with DBDs and trauma exposure who received fluoxetine treatment for 8 weeks (n = 11); (ii) A matched group of youths with DBDs and trauma exposure who received routine regular follow-up in an outpatient clinic (n = 10); and (iii) Typically developing youths (n = 18). All participants conducted an expression processing functional magnetic resonance imaging task twice, 8 weeks apart: (pretreatment and post-treatment for youths with DBDs). Results: Youths with DBDs and trauma exposure who received fluoxetine treatment compared to the other two groups showed: (i) significant improvement in externalizing, oppositional defiant disorder, irritability, anxiety-depression, and trauma-related symptoms; (ii) as a function of fearful expression intensity, significantly decreased amygdala response and increased recruitment of regions implicated in top-down attention control (insula cortex, inferior parietal lobule, and postcentral gyrus) and emotional regulation (ventromedial prefrontal cortex [vmPFC]); and (iii) correlation between DBD/irritability symptom improvement and increased activation of top-down attention control areas (inferior parietal lobule, insula cortex, and postcentral gyrus) and an emotion regulation area (vmPFC). Conclusions: This study provides preliminary evidence that a serotonergic agent (fluoxetine) can reduce disruptive behavior and mood symptoms in youths with DBDs and trauma exposure and that this may be mediated by enhanced activation of top-down attention control and emotion regulation areas (inferior parietal lobule, insula cortex, and vmPFC).
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