重症抑郁MajorDepressiveDisorder是一种以显着而持久的心境.DOCVIP

抑郁症心理治疗早期大脑自发活动功能连接的改变及相应的神经调节机制 瞿航1,2，谢鹏*,2，王韬2,3，黄远君2,3 重庆医科大学神经科学研究中心，重庆 400016，中国 1重庆医科大学附属第一医院放射科 2重庆医科大学神经科学研究中心 3重庆医科大学附属第一医院神经内科 瞿航，E-mail：543035567@谢鹏（通讯作者），E-mail：xiepeng@ Functional magnetic resonance research of psychotherapy in Major Depressive Disorder：the Top-down mechanism Hang Qu, Peng Xie, Wang Tao, Huang Yuanjun Institute of neuroscience, Chongqing Medical University, Chongqing 400016, China 【Abstract】Objective To explore the underlying brain mechanism of psychotherapy in major depressive disorder (MDD) by resting-state functional magnetic resonance imaging. Methods A total of 23 MDD patients and 20 age-, sex-, and education- matched healthy controls were enrolled. Resting-state magnetic resonance date was acquired at the baseline, and after guided-imagery psychotherapy. Longitudinal changes of amplitude of low-frequency fluctuation (fALFF) and functional connectivity were assessed. Results MDD patients showed increased fALFF in bilateral orbitofrontal cortex and right paracentral lobule. After therapy we observed decreased fALFF in爉iddle cingulate and subgenual cingulate (sgACC). Functional connectivity between sgACC and爏upplementary motor area, middle cingulate and dorsolateral prefrontal cortex significantly increased. Conclusion We speculated that psychotherapy could modulate the connectivity of cingulate cortex to remodel the emotion-related functional loop. The activity alteration in sgACC would be identified as prognostic marker. Our finding demonstrated the “top-down” regulatory mechanism of psychotherapy. 【Key works】Corresponding author: Peng Xie, E-mail：xiepeng@ 重症抑郁(Major Depressive Disorder)是一种以显著而持久的心境低落，悲观消极为主要临床表现的情感障碍类疾病[1]。患者常伴有不典型躯体症状及认知功能损害，严重者甚至伴有自杀冲动并最终发展为自杀行为。随着患病率的增加以及发病年龄提早，重症抑郁已经成为致死致残的主要原因之一，带来了严重的社会及家庭负担[2]。研究认为抑郁症患者的认知损害的核心是执行功能障碍，并在注意导向，行为抑制，策略制定，工作记忆编码等多个方面的功能异常[3, 4]。对有明显社会及认知功能损害的患者，心理治疗(psychotherapy)是一种非常有效的方法[5]。 先前研究显示，抑郁症患者存在广泛的认知功能障碍，这是其社会功能丧失的重要因素。心理治疗通过倾听、解释、鼓励、安慰等方法帮助患者识别和矫正认知的曲解，改变患者人际