Processing of emotional content and brain activation in adolescents treated with

接受治疗的青少年的情绪内容处理和大脑激活

• 批准号: 7942327
• 负责人: Giovanni Tirado-Santiago
• 金额: $ 42.68万
• 依托单位: UNIVERSITY OF PUERTO RICO RIO PIEDRAS
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-08-01 至 2013-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7942327
• 关键词: 17 year old; Adolescent; Adolescent Psychiatry; Adult; Affect; Aftercare; Amygdaloid structure; Anisotropy; Anterior; Area; Atrophic; Behavioral; Brain; Brain Mapping; Brain imaging; Brain region; Characteristics; Child; Childhood; Clinical; Cognitive; Cognitive Therapy; Control Groups; Coupling; Development; Diagnosis; Diffusion Magnetic Resonance Imaging; Emotional; Evaluation; Family history of; Fluoxetine; Functional Magnetic Resonance Imaging; Genetic; Goals; Health Professional; Hippocampus (Brain); Hyperactive behavior; Image; Individual; Institutes; Intake; Intervention; Interview; Knowledge; Learning; Licensing; Life; Link; Longevity; Magnetic Resonance Imaging; Major Depressive Disorder; Measures; Medical; Mental Health; Metabolic; Microscopic; Modality; Modeling; Parents; Participant; Patients; Pediatric Hospitals; Performance; Pharmaceutical Preparations; Population; Process; Puerto Rico; Qualifying; Recruitment Activity; Regulation; Relapse; Research; Resolution; Rest; Risk; Scanning; Science; Selective Serotonin Reuptake Inhibitor; Stress; Stressful Event; Structure; Symptoms; System; Therapeutic; Treatment Efficacy; United States Food and Drug Administration; Universities; base; blood oxygen level dependent; brain volume; cingulate cortex; cognitive control; coping; depressive symptoms; effective therapy; emotion regulation; emotional experience; emotional stimulus; follow-up; functional status; interest; programs; psychologic; public health relevance; relating to nervous system; response; sound; stressor; suicidal behavior; trait; treatment effect; white matter

DESCRIPTION (provided by applicant): This is an application for a R15 that seeks to examine the relationship between a) the efficacy of cognitive behavioral therapy (CBT) and fluoxetine treatment in adolescents with a positive diagnosis for major depressive disorder (MDD), and b) brain structure and metabolic activity related to the processing of emotional information. We plan to recruit 45 adolescents (13-17 years old) and their parents through referrals. All adolescents and their parents will be interviewed along the following domains: (a) depressive symptoms and diagnosis, (b) stress symptoms, (c) patient and parent functional status, (d) measures of proposed mediational process in CBT, and (e) family history of depressive symptoms. Based on these interviews, adolescents will be assigned to three equally sized groups. Baseline information will be obtained from a group of adolescents with a negative diagnosis of MDD. Two other groups of adolescents with a positive diagnosis of MDD will be treated with either 12 weekly sessions of CBT or the administration of fluoxetine. Treatment will be provided by qualified licensed mental health professionals at either the Institute for Psychological Research at the University of Puerto Rico (UPR), R¿o Piedras Campus (CBT treatment group), or the Child and Adolescent Psychiatry Program at UPR, Medical Sciences Campus (SSRI treatment group). We plan to conduct evaluations at intake (week 0), mid-treatment (week 6), post-treatment (week 12), and follow-up (at 3 and 6 months post-treatment). All participants will also undergo brain imaging sessions at the functional magnetic resonance imaging (fMRI) facility at the San Jorge Children's Hospital to assess: a) brain activity associated to the processing of emotional content as measured by Blood Oxygen Level Dependent (BOLD) contrast (fMRI), b) BOLD-based resting-state functional connectivity among pre-selected brain regions of interest (fcMRI), c) microscopic white matter integrity as measured by fractional anisotropy brain maps generated with diffusion tensor imaging (DTI), and d) anatomical volume of selected brain regions (MRI). All participants will undergo scanning at intake. Participants with a positive diagnosis of MDD will also be scanned immediately after end of treatment and 6 months after end of treatment. One of the main goals of this research is to examine whether short and long-term treatment efficacy for each therapeutic modality is related to basal levels of brain activity and to any potential changes in post-treatment emotional content processing as measured by fMRI and fcMRI. The other goal is to measure whether treatment efficacy and performance in behavioral tasks involving emotional content are related to brain structure and structural connectivity between corticolimbic regions as measured by pre-treatment MRI and DTI scans. PUBLIC HEALTH RELEVANCE: The potential contribution of this study is that obtaining knowledge of the brain metabolic and structural characteristics of adolescents diagnosed with major depression, and how it relates to clinical measures, would allow personalized and more effective treatments for this population. This study will also provide scientific evidence on the efficacy of two of the most common modalities for treating major depression in adolescents: cognitive behavioral therapy and treatment with fluoxetine.

描述（由申请人提供）：这是一项R15申请，旨在检查a）认知行为疗法（CBT）和氟西汀治疗重度抑郁症（MDD）阳性诊断青少年的疗效与B）与情绪信息处理相关的大脑结构和代谢活动之间的关系。我们计划通过推荐招募45名青少年（13-17岁）及其父母。所有青少年及其父母将接受沿着以下领域的访谈：（a）抑郁症状和诊断，（B）应激症状，（c）患者和父母的功能状态，（d）CBT中建议的调解过程的测量，以及（e）抑郁症状的家族史。根据这些访谈，青少年将被分配到三个同等大小的组。基线信息将从一组MDD诊断阴性的青少年中获得。另外两组诊断为MDD阳性的青少年将接受12次每周一次的CBT治疗或氟西汀治疗。治疗将由波多黎各大学（UPR）心理研究所（Réo Piedras校区）（CBT治疗组）或UPR医学科学校区（SSRI治疗组）儿童和青少年精神病学项目的合格持牌心理健康专业人员提供。我们计划在入组（第0周）、治疗中期（第6周）、治疗后（第12周）和随访（治疗后3个月和6个月）时进行评价。所有参与者还将在San Jorge儿童医院的功能性磁共振成像（fMRI）设施进行脑成像，以评估：a）通过血氧水平依赖（BOLD）对比度（fMRI）测量的与情绪内容的处理相关的脑活动，B）预先选择的感兴趣脑区域之间基于BOLD的静息状态功能连接（fcMRI），c）通过用扩散张量成像（DTI）生成的分数各向异性脑图测量的微观白色物质完整性，和d）所选脑区域（MRI）的解剖体积。所有参与者将在入院时接受扫描。MDD阳性诊断的受试者也将在治疗结束后立即和治疗结束后6个月进行扫描。本研究的主要目标之一是检查每种治疗方式的短期和长期治疗效果是否与大脑活动的基础水平以及通过fMRI和fcMRI测量的治疗后情感内容处理的任何潜在变化有关。另一个目标是测量治疗效果和涉及情感内容的行为任务的表现是否与大脑结构和皮质边缘区域之间的结构连接有关，如治疗前MRI和DTI扫描所测量的。 公共卫生相关性：这项研究的潜在贡献是，获得诊断为重度抑郁症的青少年的大脑代谢和结构特征的知识，以及它与临床措施的关系，将允许对这一人群进行个性化和更有效的治疗。这项研究还将为青少年抑郁症的两种最常见治疗方式的疗效提供科学证据：认知行为疗法和氟西汀治疗。