Neuroscientific Investigation of the Pathophysiology of Mood Disorder and Suicide Behavior

我们使用正电子发射断层扫描(PET)和地塞米松(DEX)和促肾上腺皮质激素释放激素(CRH)的联合内分泌学检查，研究了包括自杀行为在内的情绪障碍的疾病特异性病理生理学。本研究包括24例未服药的重度抑郁症患者和10例抗抑郁药物治疗有效的患者在治疗前和治疗后进行脑影像分析和神经内分泌学检查。在24例心境障碍患者中，75%的患者在DEX/CRH检查中为非抑制者，他们过去有自杀未遂史的频率高于抑制者。在抑郁恢复后，大多数非抑制者转变为抑制者，但20%的情绪障碍仍然是非抑制者，这表明非抑制者的某些部分是情绪障碍的特征标记或情绪障碍的易感因素。另一方面，F-FDG-PET研究发现，情绪障碍患者的左前额叶皮质和右侧颞上回摄取的F-FDG显著减少，占比健康对照组明显减少，而海马区旁回摄入量增加。除右侧颞上回外，抑郁期的上述病理改变在抑郁恢复后均恢复正常。此外，SPM分析清楚地表明，非抑制者右侧海马旁回的18F-FDG摄入量低于抑制者。心境障碍死后脑内左侧前额叶皮质、右侧颞叶上回和右侧海马旁回的组织学改变尚需进一步研究。

We have investigated disorder-specific pathophysiology of mood disorder, including suicide behavior, by using ^<18>F-FDG-Positron Emission Tomography (PET) and combined endocrinological examination of dexamethasone (DEX) and corticotropin-releasing hormone (CRH). Drug-naive 24 patients with major depression and 10 patients who were investigated by brain imaging analysis and neuroendocrinological examination at pre-treatment and at post-treatment when they were well responded to antidepressant treatment, are included in this study. 75 % of 24 mood disorder patients were non-suppressor in DEX/CRH examination, who have had more frequently the past history of suicide attempt than suppressor. After recovery from depression, most of non-suppressors were changed to suppressors, but 20 % of mood disorders were still non-suppressor, suggesting that some parts of non-suppressor are trait marker of mood disorder or susceptive factor of mood disorder.On the other hand, ^<18>F-FDG-PET study has reveal that left pre-frontal cortex and right superior temporal gyrus of mood disorder patients are significantly decreased to take up ^<18>F-FDG than healthy controls, whereas para-hippocampal gyrus is increased in ^<18>F-FDG intake. These pathological alterations during depressive phase were normalized after recovery from depression, except right superior temporal gyrus. In addition, SPM analysis has clearly demonstrated that ^<18>F-FDG intake into right para-hippocampal gyrus was smaller in non-suppressor than in suppressor. Further studies are needed to clarify the histological alterations in left pre-frontal cortex, right superior temporal gyrus, and right para-hippocampal gyrus from postmortem brain of mood disorder.