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Brain imaging in posttraumatic stress disorder. 创伤后应激障碍的脑成像。
Pub Date : 2001-04-01 DOI: 10.1053/SCNP.2001.21840
G. Villarreal, C. King
This is a review article of neuroimaging studies in post-traumatic stress disorder (PTSD). Findings from structural, biochemical, and functional studies are summarized. Magnetic resonance imaging (MRI) volumetric studies have consistently reported decreased hippocampal volumes in PTSD. Proton magnetic resonance spectroscopy studies report decreased N-acetyl aspartate (NAA) ratios and absolute concentrations in the medial temporal lobe. Although still controversial, these findings from volumetric and spectroscopic studies are thought to represent decreased neuronal density of the hippocampus. Functional imaging studies document different patterns of limbic and paralimbic structure activation in PTSD compared with controls. Of theoretical importance are findings of failure to activate the anterior cingulate as well as amygdala activation during symptom provocation studies. Also, increased amygdala activation was found with a behavioral task targeted to this structure. A neurobiological model is presented that takes into account findings from neuroimaging studies in PTSD as well as animal studies of fear conditioning. This model proposes that central to symptom mediation is a dysfunction of the anterior cingulate, with a failure to inhibit amygdala activation and/or an intrinsic lower threshold of amygdala response to fearful stimuli. The model further proposes that hippocampal atrophy is a result of the chronic hyperarousal symptoms mediated by amygdala activation.
这是一篇关于创伤后应激障碍(PTSD)神经影像学研究的综述文章。综述了结构、生化和功能方面的研究结果。磁共振成像(MRI)体积研究一致报道PTSD患者海马体积减少。质子磁共振波谱研究报告了内侧颞叶n -乙酰天冬氨酸(NAA)比率和绝对浓度的下降。尽管仍有争议,但这些来自体积和光谱研究的发现被认为代表了海马神经元密度的下降。功能成像研究表明,与对照组相比,创伤后应激障碍患者的边缘和副边缘结构激活模式不同。具有理论重要性的是在症状激发研究中未能激活前扣带和杏仁核激活的发现。此外,针对杏仁核结构的行为任务也会增加杏仁核的激活。提出了一个神经生物学模型,该模型考虑了创伤后应激障碍的神经影像学研究结果以及恐惧条件反射的动物研究。该模型提出,症状调解的核心是前扣带功能障碍,无法抑制杏仁核的激活和/或杏仁核对恐惧刺激的内在低阈值反应。该模型进一步提出海马萎缩是由杏仁核激活介导的慢性高觉醒症状的结果。
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引用次数: 88
Prefrontal changes and treatment response prediction in depression. 抑郁症患者前额叶变化及治疗反应预测。
Pub Date : 2001-04-01 DOI: 10.1053/SCNP.2001.21844
Ian A. Cook, A. Leuchter
A continuing challenge in the treatment of depression is how to determine whether an effective drug has been selected for a particular patient, given that individuals will respond to some antidepressants but not others. The factors that contribute to response for each person have been examined from a variety of perspectives, both psychological and physiological. Advances in neuroimaging and in quantitative electroencephalography (QEEG) have made it possible to examine features of brain activity that are associated with response. A new QEEG measure, cordance, is correlated with regional cortical perfusion, and has been used with retrospective and prospective studies to evaluate specific findings that are predictive of clinical response in major depression. We present here a series of depressed subjects treated with antidepressants of different classes; decreases in prefrontal activity were seen as early as 48 hours into treatment in responders and were absent in nonresponders. These findings suggest a role for the prefrontal region in mediating response to medications with different mechanisms of action and raise the possibility of using new QEEG measures to identify changes in brain activity that are predictive of clinical outcome from antidepressant treatment.
考虑到个体对某些抗抑郁药有反应,而对其他抗抑郁药没有反应,如何确定是否为特定患者选择了有效的药物,这是抑郁症治疗中一个持续存在的挑战。影响每个人反应的因素已经从心理和生理的不同角度进行了研究。神经成像和定量脑电图(QEEG)技术的进步,使研究与反应相关的脑活动特征成为可能。一种新的QEEG测量,cordance,与区域皮质灌注相关,并已用于回顾性和前瞻性研究,以评估预测重度抑郁症临床反应的具体结果。我们在这里介绍了一系列用不同种类的抗抑郁药治疗的抑郁受试者;早在治疗后48小时,反应者的前额叶活动就出现了下降,而无反应者则没有。这些发现表明,前额叶区域在介导不同作用机制的药物反应中发挥了作用,并提高了使用新的QEEG测量方法来识别大脑活动变化的可能性,这些变化可以预测抗抑郁药物治疗的临床结果。
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引用次数: 63
Images of the mind. 心灵的意象。
Pub Date : 2001-04-01 DOI: 10.1053/SCNP.2001.21829
Joel Yager, John Lauriello
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引用次数: 3
Starving the brain: structural abnormalities and cognitive impairment in adolescents with anorexia nervosa. 饥饿的大脑:青少年神经性厌食症的结构异常和认知障碍。
Pub Date : 2001-04-01 DOI: 10.1053/SCNP.2001.22263
D. Katzman, B. Christensen, A. Young, R. Zipursky
Anorexia nervosa (AN) is one of the most common chronic illnesses afflicting adolescent girls and is associated severe medical complications. The structural abnormalities found in the brain of adolescents with AN are among the earliest and most striking physical consequences. In the past, it had been assumed that the brain abnormalities found in patients with AN reverse with weight-recovery. Recent evidence has shown that not all of these changes are completely reversible with weight recovery. To date, very little is known about the functional significance of these brain abnormalities. Several studies have shown that cognitive dysfunction is also a common feature of AN. Although current evidence suggests that there may be some degree of improvement in cognition with weight-recovery, it is unclear whether cognition recovers fully or equally across all neuropsychological domains. Furthermore, it remains unknown whether the reported functional consequences are associated with these structural brain changes. This article will review the current literature on structural brain abnormalities and cognitive dysfunction in adolescents with AN.
神经性厌食症(AN)是困扰青春期女孩最常见的慢性疾病之一,并伴有严重的医学并发症。在患有AN的青少年大脑中发现的结构异常是最早和最显著的身体后果之一。过去,人们认为AN患者的大脑异常会随着体重恢复而逆转。最近的证据表明,并非所有这些变化都能随着体重的恢复而完全逆转。迄今为止,对这些大脑异常的功能意义所知甚少。多项研究表明,认知功能障碍也是AN的共同特征。尽管目前的证据表明,体重恢复可能会在一定程度上改善认知,但尚不清楚认知是否在所有神经心理学领域完全或平等地恢复。此外,目前尚不清楚所报道的功能后果是否与这些大脑结构变化有关。本文将回顾目前关于青少年AN的结构性脑异常和认知功能障碍的文献。
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引用次数: 94
Proton magnetic resonance spectroscopy (H-MRS) studies of schizophrenia. 质子磁共振波谱(H-MRS)研究精神分裂症。
Pub Date : 2001-04-01 DOI: 10.1053/SCNP.2001.21838
L. Rowland, J. Bustillo, J. Lauriello
Proton magnetic resonance spectroscopy ((1)H-MRS) is a noninvasive technique that can quantify biochemical compounds in the brain. (1)H-MRS has been used to investigate neural structures implicated in the pathology of schizophrenia. The majority of research has revealed reduced N-acetylaspartate (NAA), an index of neuronal integrity, in frontal and temporal regions of medicated and chronically ill patients with schizophrenia. This review summarizes basic principles of (1)H-MRS, studies of frontal, temporal, subcortical, and cerebellar regions in schizophrenia. Technical and study design limitations are also discussed.
质子磁共振波谱(H-MRS)是一种非侵入性技术,可以量化大脑中的生化化合物。(1)H-MRS已被用于研究与精神分裂症病理有关的神经结构。大多数研究表明,在服用药物和慢性精神分裂症患者的额叶和颞叶区域,神经完整性指标n -乙酰天冬氨酸(NAA)减少。本文综述了H-MRS的基本原理,以及对精神分裂症患者额叶、颞叶、皮质下和小脑区域的研究。还讨论了技术和研究设计的局限性。
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引用次数: 27
Prefrontal-subcortical and limbic circuit mediation of major depressive disorder. 前额叶-皮层下和边缘回路对重度抑郁症的调节作用。
Pub Date : 2001-04-01 DOI: 10.1053/SCNP.2001.21837
A. Brody, M. Barsom, Robert G. Bota, S. Saxena
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.
脑功能和脑结构成像技术在阐明重度抑郁症(MDD)的病理生理学方面取得了实质性进展。在功能成像研究中,将MDD受试者与基线正常对照进行比较,发现MDD患者的背外侧前额叶皮层(DLPFC)活性降低,而腹外侧前额叶皮层(VLPFC)活性升高。其他在基线研究中发现异常的区域包括前扣带回(AC)、颞叶和基底神经节。检查情绪状态变化(使用睡眠剥夺、悲伤诱导和色氨酸消耗)和治疗前后变化的研究普遍显示,这些异常随着重度抑郁症症状的改善而改善,这些异常随着症状的恶化而恶化。在结构成像研究中,额叶、海马和基底节区体积减少是最常见的发现。MDD的临床特征与脑功能之间存在以下几种联系:(1)活跃的悲伤思想/悲伤伴DLPFC和背侧AC活动减少,VLPFC和腹侧AC活动增加;(2)精神运动迟缓伴左前额叶活动减少;(3)焦虑伴左前额叶活动增加;(4)情景记忆受损伴左前额叶和内侧颞叶功能障碍;(5)持续注意力受损伴右前额叶和顶叶功能障碍。
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引用次数: 184
Brain-behavior relationships in obsessive-compulsive disorder. 强迫症的脑-行为关系。
Pub Date : 2001-04-01 DOI: 10.1053/SCNP.2001.21833
S. Saxena, R. Bota, A. Brody
Advances in neuroimaging have led to a greater understanding of brain-behavior relationships in obsessive-compulsive disorder (OCD). This article provides an updated review and analysis of the structural and functional neuroimaging studies in OCD published to date and discusses how evidence from various types of neuroimaging studies has been synthesized to generate and test hypotheses regarding these relationships. We also review the basic science literature on the functional neuroanatomy of cortico-basal ganglia-thalamo-cortical circuits and integrate this information with neuroimaging data in OCD, to present a theoretical model of brain mediation of OCD symptoms and response to treatment. Taken together, neuroimaging studies indicate that OCD symptoms are mediated by hyperactivity in orbitofrontal-subcortical circuits, which may be attributable to an imbalance of tone between direct and indirect striato-pallidal pathways. Serotonergic drugs may ameliorate OCD symptoms by changing the relative balance of tone through the indirect versus direct orbitofrontal-subcortical pathways, thereby decreasing activity in the overall circuit that exists in the symptomatic state.
神经影像学的进步使我们对强迫症(OCD)的脑-行为关系有了更深入的了解。本文对迄今为止发表的强迫症的结构和功能神经影像学研究进行了最新的回顾和分析,并讨论了如何综合各种类型的神经影像学研究的证据来产生和检验关于这些关系的假设。我们还回顾了关于皮质-基底神经节-丘脑-皮质回路的功能神经解剖学的基础科学文献,并将这些信息与强迫症的神经影像学数据相结合,提出了大脑介导强迫症症状和治疗反应的理论模型。综上所述,神经影像学研究表明强迫症症状是由眶额-皮层下回路的过度活跃介导的,这可能是由于直接和间接纹状体-苍白质通路之间的张力不平衡。5 -羟色胺类药物可能通过改变间接与直接眶额-皮质下通路的张力相对平衡来改善强迫症症状,从而降低症状状态下存在的整个回路的活性。
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引用次数: 220
Stress, medical illness, and depression. 压力、疾病和抑郁。
Pub Date : 2001-01-01 DOI: 10.1053/SCNP.2001.9554
L. Slimmer, J. Lyness, E. Caine
In this review, we present potential pathways through which medical illness may act as a stress-related catalyst of major depression. We will consider available evidence and discuss biological, psychological, and psychosocial theories, individually and in their interplay, in an attempt to better understand the potential roles of stress in mediating the relationships between medical illness and mood disorder. We will use the specific example of major depression occurring after acute myocardial infarction to illustrate the application of our theoretical framework.
在这篇综述中,我们提出了医学疾病可能作为应激相关的重性抑郁症催化剂的潜在途径。我们将考虑现有的证据,并讨论生物学、心理学和社会心理理论,分别以及它们之间的相互作用,试图更好地理解压力在调解医学疾病和情绪障碍之间的关系中的潜在作用。我们将使用急性心肌梗死后发生重度抑郁症的具体例子来说明我们的理论框架的应用。
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引用次数: 11
Aging, stress, and affective disorders. 衰老、压力和情感障碍。
Pub Date : 2001-01-01 DOI: 10.1053/SCNP.2001.20881
L. Blake
The interaction between aging, stress, and affective disorders has interested researchers for many years. Many stressful events occur as a part of aging. The majority of elderly people seem to tolerate this fairly well, but constant uncontrollable stress can lead to changes in the functioning of the hypothalamic-pituitary-adrenal axis. There are also age-related changes in the sensitivity of the hypothalamic-pituitary-adrenal axis, which have little clinical effect on healthy subjects, but may be more significant in the presence of an affective disorder. Stress is a more important predictor of depression in the elderly than are genetic factors. Attempts to minimize stress and the stress response in the elderly may improve treatments of affective disorders in this population.
多年来,研究人员一直对衰老、压力和情感障碍之间的相互作用感兴趣。许多压力事件都是衰老的一部分。大多数老年人似乎都能很好地忍受这种压力,但持续的无法控制的压力会导致下丘脑-垂体-肾上腺轴功能的变化。下丘脑-垂体-肾上腺轴的敏感性也存在与年龄相关的变化,这对健康受试者的临床影响不大,但在情感性障碍患者中可能更为显著。压力是比遗传因素更重要的老年人抑郁预测因素。试图减少老年人的压力和压力反应可能会改善这一人群的情感性障碍的治疗。
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引用次数: 3
Novel animal models of affective disorders. 情感性障碍的新型动物模型。
Pub Date : 2001-01-01 DOI: 10.1053/SCNP.2001.20882
Eva E. Redei, N. Ahmadiyeh, A. Baum, David A. Sasso, Jennifer L. Slone, L. C. Solberg, Claire C. Will, Andreja Volenec
Is there an appropriate animal model for human affective disorders? The traditional difficulties in accepting animal models for psychopathology stem from the argument that there is no evidence for concluding that what occurs in the brain of the animal is equivalent to what occurs in the brain of a human. However, if one models any or some core aspects of affective disorder, this model can become an invaluable tool in the analysis of the multitude of causes, genetic, environmental, or pharmacological, that can bring about symptoms homologous to those of patients with affective disorders. Animal models can also allow the study of the mechanisms of specific behaviors, their pathophysiology, and can aid in developing and predicting therapeutic responses to pharmacologic agents. Although animals exhibit complex and varied social and emotional behaviors for which well-validated and standardized measures exist, an understanding that a precise replica of human affective disorders cannot be expected in a single animal model is crucial. Instead, a good animal model of a human disorder should fulfill as many of the four main criteria as possible: (1) strong behavioral similarities, (2) common cause, (3) similar pathophysiology, and (4) common treatment. An animal model fulfilling any or most of these criteria can be used to elucidate the mechanisms of the specific aspect of the model that is homologous to the human disorder. A wide range of animal models of affective disorders, primarily depression, has been developed to date. They include models in which "depressive behavior" is the result of genetic selection or manipulation, environmental stressors during development or in adulthood, or pharmacologic treatments. The assessment of these animal models is based either on behavioral tests measuring traits that are homologous to symptoms of the human disorder they model, or behavioral tests responsive to appropriate pharmacologic treatments. The goal of this review is to focus on relatively recent developments of selected models, to aid in understanding their strengths and weaknesses, and to help those choosing the difficult task of developing novel animal models of affective disorders. The ideal animal model of affective disorders of the future would be an endogenous, genetic model that reiterates the essential, core aspects of the human disease and responds to the standard regimens of therapy. Because complex diseases have been approached from the genetic startpoint by using rodent models, a genetic model of affective disorder would open up possibilities for genetic analysis of polygenic traits that seem to underlie these disorders.
人类情感障碍有合适的动物模型吗?接受精神病理学动物模型的传统困难源于这样一种观点,即没有证据表明动物大脑中发生的事情与人类大脑中发生的事情是等同的。然而,如果一个人对情感障碍的任何或某些核心方面进行建模,这个模型就可以成为分析多种原因的宝贵工具,包括遗传的、环境的或药理学的,这些原因可能带来与情感障碍患者相似的症状。动物模型还可以研究特定行为的机制及其病理生理学,并有助于开发和预测对药物的治疗反应。尽管动物表现出复杂多样的社会和情感行为,并存在经过充分验证和标准化的测量方法,但认识到不能期望在单一动物模型中精确复制人类情感障碍是至关重要的。相反,一个好的人类疾病的动物模型应该尽可能多地满足四个主要标准:(1)强烈的行为相似性,(2)共同的原因,(3)相似的病理生理学,(4)共同的治疗方法。满足任何或大多数这些标准的动物模型可以用来阐明与人类疾病相对应的模型的特定方面的机制。迄今为止,已经开发了广泛的情感障碍动物模型,主要是抑郁症。其中包括“抑郁行为”是基因选择或操纵、发育或成年期间的环境压力因素或药物治疗的结果的模型。对这些动物模型的评估要么基于行为测试,测量与它们所模拟的人类疾病症状相似的特征,要么基于对适当药物治疗有反应的行为测试。本综述的目的是集中在选定的模型的相对最新的发展,以帮助了解他们的优势和劣势,并帮助那些选择开发新的情感障碍动物模型的困难任务。未来情感障碍的理想动物模型将是一种内源性的遗传模型,重申人类疾病的基本核心方面,并对标准治疗方案作出反应。由于复杂的疾病已经通过啮齿类动物模型从遗传的角度进行了研究,情感障碍的遗传模型将为对这些疾病背后的多基因特征进行遗传分析开辟可能性。
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引用次数: 47
期刊
Seminars in clinical neuropsychiatry
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