成人抑郁症心理治疗早期大脑白质纤维完整性研究

发布时间：2018-08-09 07:22

【摘要】：背景:大量研究证据表明，在重型抑郁症的治疗中，抗抑郁药物与心理治疗有着近乎相当的疗效。先前研究已用功能磁共振研究过抑郁状态及治疗产生的脑局部血流变化，但依然没有证据表明治疗可引起相关白质纤维微结构改变。目的:利用弥散张量成像技术，探索成年重型抑郁症患者接受引导想象心理治疗后的特异性白质改变。方法:本研究招募了重型抑郁症患者21名（16女，5男，平均年龄29.6岁），，于4周心理治疗前后各进行一次弥散张量成像；与22名健康被试（14女,8男,平均年龄30.2岁）进行各向异性分数的比较。结果:与健康对照相比，抑郁症病人的右侧丘脑、小脑蚓部、右侧中央后回及表现出显著的各向异性分数增高，右侧楔叶降低；四周疗程后，左侧额叶白质内出现了一个各向异性分数增加的区域。结论:接受心理治疗的早期阶段，在与额叶情绪调节相关的区域产生了各向异性分数增加，这表明心理治疗可以引起额叶的白质改变。这可能是通过重塑大脑情绪调节网络中结点的联接起效的，本研究结果支持了心理治疗起效的『自上而下』机制。
[Abstract]:Background: there is considerable evidence that antidepressants are almost as effective as psychotherapy in the treatment of severe depression. Previous studies have used functional magnetic resonance to study depression and changes in regional cerebral blood flow resulting from treatment, but there is still no evidence that treatment can lead to changes in the microstructures of white matter fibers. Objective: to explore the specific changes of white matter in adult patients with severe depression after guided psychotherapy with diffuse Zhang Liang imaging. Methods: a total of 21 patients with severe depression (16 females, 5 males, mean age 29.6 years) were enrolled in this study. They were examined by diffusive Zhang Liang imaging before and after 4 weeks of psychotherapy, and 22 healthy subjects (14 females and 8 males) were enrolled in the study. The average age was 30.2 years. Results: compared with healthy controls, the right thalamus, cerebellar vermis, right posterior central gyrus and right posterior gyrus showed a significant increase in anisotropic fraction, and the right cuneate lobe decreased after four weeks of treatment. An area of increased anisotropy appeared in the white matter of the left frontal lobe. Conclusion: in the early stage of psychotherapy, anisotropy scores were increased in the regions associated with emotional regulation in the frontal lobe, indicating that psychotherapy could cause changes in the white matter of the frontal lobe. This may be done by reinventing the connections of nodes in the brain's emotional regulatory network, and the results support the "top-down" mechanism of psychotherapy.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R749.4

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