认知行为治疗对首发未服药轻中度抑郁症患者脑网络功能连接研究

发布时间：2018-01-07 04:09

本文关键词：认知行为治疗对首发未服药轻中度抑郁症患者脑网络功能连接研究　出处：《南京医科大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的：抑郁症(major depressive disorder, MDD)一种临床最常见的精神疾病,迄今为止MDD的发病机制不明。认知行为治疗(cognitive behavior therapy, CBT)可用作轻中度MDD的治疗,其潜在的神经作用机制亦不明。所以,本研究以首发未服药轻中度MDD患者为对象,探索6周CBT治疗前后MDD患者脑网络功能连接的改变,进一步探索MDD潜在的神经基础及早期CBT治疗对MDD的神经作用机制。方法：18名首次发作、未接受任何治疗的轻中度MDD患者及20名年龄、性别、教育水平上相匹配的健康对照组被试入组后,首先接受第一次静息态功能磁共振成像(resting state function magnetic resonance imaging, rs-fMRI)扫描。由经验丰富的专业CBT心理治疗师对MDD患者进行每周1次,共6周的CBT治疗,每次治疗均按照制定的治疗手册进行。6周CBT治疗后,MDD患者接受第二次完全相同rs-fMRI扫描。采用DPARSF、REST、BrainNet专业数据分析程序软件进行数据分析及结果显示。以文献研究结果为基础,选择背外侧前额叶(dorsalateral prefrontal cortex, DLPFC)、膝下前扣带回(subgenual anterior cingulate cortex, sgACC)为感兴趣区进行种子点功能连接分析,并比较差异。结果：认知控制网络(cognitive control network, CCN)主要包括双侧额中回、双侧额下回、背侧前扣带回、左侧中扣带回、双侧顶下小叶。治疗前,与健康对照组相比,MDD患者CCN内右侧额中回与右侧额下回功能连接降低。sgACC与左侧额上回、左侧额中回和左侧角回功能连接低。治疗后,与健康对照组相比,MDD患者CCN内右侧额中回与右侧额下回功能连接降低。sgACC与右侧额下回、右侧小脑功能连接增高,与右侧额上回、左侧额上回、左侧内侧额上回、右侧楔前叶、左侧角回功能连接降低。与治疗前相比,治疗后CCN内背侧前扣带回与左侧中扣带回功能连接降低；sgACC与左额下回、右额下回、左颞中回、右颞中回、左颞下回、右缘上回、左中央前回和右小脑功能连接增高。结论：MDD患者CCN内功能连接降低并持续到治疗后,表现认知调控能力下降,可能是MDD患者偏向性注意的神经基础。早期CBT不能直接改善MDD患者CCN功能,但可降低MDD患者认知及情绪之间的联系,可能提示为认知调整提供便利。sgACC与CCN与默认网络(default mode network, DMN)的多个脑区功能连接降低,6周CBT治疗可改善MDD患者sgACC与CCN内额下回及DMN内多个节点的功能连接。可能提示CBT治疗可一方面增强反应抑制能力,另一方面降低自我参照性加工和反刍思维,两者共同作用,促进负性情绪及负性思维的识别与处理。sgACC作为连接节点,参与CBT治疗反应。
[Abstract]:Objective: major depressive disorder (MDD) is one of the most common clinical mental disorders. Up to now, the pathogenesis of MDD is not clear. Cognitive behavior therapy can be used to treat mild to moderate MDD. The underlying neuroprotective mechanism is also unknown. Therefore, this study focused on the patients with mild to moderate MDD who did not take the first drug, to explore the changes of brain network functional connections in patients with MDD before and after 6 weeks of CBT treatment. To further explore the potential neural basis of MDD and the neuromechanism of early CBT therapy on MDD. Methods: 18 patients with mild and moderate MDD who had first attack and 20 patients with mild to moderate MDD who had not received any treatment and 20 patients of age were enrolled in this study. The gender and education level of the matched healthy control group were enrolled in the group. The first resting state function magnetic resonance imaging was accepted. Rs-fMRI scan. The patients with MDD were treated with CBT once a week for 6 weeks by experienced CBT psychotherapists. Patients with CBT received the same second rs-fMRI scan after 6 weeks of CBT treatment according to the prescribed treatment manual. BrainNet professional data analysis program software for data analysis and results display. Based on the results of literature research. Dorsalis dorsalis prefrontal cortexes (DLPFCs) were selected. The subgenual anterior cingulate cortexes (sgACCs) of the anterior cingulate gyrus of the knee were used to analyze the functional connections of seed points in the region of interest. Results: cognitive control network included bilateral middle frontal gyrus, bilateral inferior frontal gyrus and dorsal anterior cingulate gyrus. Left cingulate gyrus, bilateral inferior parietal lobule. Before treatment, the functional junctions of right middle frontal gyrus and right inferior frontal gyrus in CCN patients with MDD decreased .sgACC and left superior frontal gyrus. The functional junctions of the left middle frontal gyrus and the left corner gyrus were low. After treatment, the functional connections between the right middle frontal gyrus and the right inferior frontal gyrus in CCN patients were lower than those in the healthy control group. SgACC and right inferior frontal gyrus were lower than those in the control group. The functional connections of the right cerebellum were increased and decreased compared with the right superior frontal gyrus, left superior frontal gyrus, left medial superior frontal gyrus, right prewedge lobe and left angular gyrus. After treatment, the functional connections between the anterior cingulate gyrus and the left middle cingulate gyrus in CCN were decreased. SgACC and left inferior frontal gyrus, right inferior frontal gyrus, left middle temporal gyrus, right middle temporal gyrus, left inferior temporal gyrus, right superior temporal gyrus. Conclusion the functional junctions in CCN decreased and continued until after treatment, the cognitive regulation ability decreased in the patients with left precentral gyrus and right cerebellum. Early CBT can not directly improve the CCN function of MDD patients, but it can reduce the relationship between cognition and emotion in MDD patients. It may be suggested that the functional connections between .sgACC and CCN and the default mode network (DMNs) for cognitive adjustment are reduced. 6 weeks CBT treatment can improve the functional connection between sgACC and the inferior frontal gyrus of CCN and multiple nodes in DMN in MDD patients. It may suggest that CBT treatment can enhance the ability of inhibition of reaction on the one hand. On the other hand, reducing self-referential processing and ruminant thinking, both of them act together to promote the recognition and processing of negative emotions and negative thinking. SgACC acts as a connecting node to participate in the treatment of CBT.
【学位授予单位】：南京医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R749.4

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