背景:边缘性人格障碍(BPD)是一种严重的精神疾病,并发抑郁症和自杀率很高。尽管优化BPD治疗的重要性,关于神经过程与个体治疗反应的关系知之甚少。这项研究研究了在进行为期六个月的辩证行为疗法(DBT)或选择性5-羟色胺再摄取抑制剂(SSRI)治疗的随机临床试验后,情绪调节的功能磁共振成像(fMRI)任务期间基线区域脑血氧水平依赖性(BOLD)激活与治疗反应的关系。
方法:未用药的BPD女性(N=37),最近的自杀行为或自我伤害,接受了功能磁共振成像任务,其中呈现了负面的个人记忆,并要求他们保持距离(即,下调他们的情绪反应)或沉浸(即自由体验情感)。然后患者随机接受DBT(N=16)或SSRI(N=21)治疗,评估基线和治疗后抑郁和BPD严重程度。
结果:前额叶皮层的BOLD活动,前扣带,岛与距离有关。背外侧距离时的基线BOLD,腹外侧,和眶前额叶皮质(dlPFC,vlPFC,OFC)差异预测各治疗组的抑郁反应,在SSRI组中,活性越高,反应越好,较低的活性预测DBT组的反应更好。
结论:所有女性样本。
结论:研究结果表明,情绪调节期间更多的前额叶参与可能会预测SSRIs带来更多的抗抑郁益处,而较低的参与度可能预测对DBT的反应更好。这些结果表明SSRI和DBT治疗的不同作用机制,这可能允许fMRI指导个体化治疗选择。
BACKGROUND: Borderline personality disorder (BPD) is a severe mental illness, with high rates of co-morbid depression and suicidality. Despite the importance of optimizing treatment in BPD, little is known about how neural processes relate to individual treatment response. This study examines how baseline regional brain blood oxygen level dependent (BOLD) activation during a functional magnetic resonance imaging (
fMRI) task of emotion regulation is related to treatment response following a six-month randomized clinical trial of Dialectical Behavior Therapy (DBT) or Selective Serotonin Reuptake Inhibitor (SSRI) treatment.
METHODS: Unmedicated females with BPD (N = 37), with recent suicidal behavior or self-injury, underwent an
fMRI task in which negative personal memories were presented and they were asked to distance (i.e., downregulate their emotional response) or immerse (i.e., experience emotions freely). Patients were then randomized to DBT (N = 16) or SSRI (N = 21) treatment, with baseline and post-treatment depression and BPD severity assessed.
RESULTS: BOLD activity in prefrontal cortex, anterior cingulate, and insula was associated with distancing. Baseline BOLD during distancing in dorsolateral, ventrolateral, and orbital prefrontal cortex (dlPFC, vlPFC, OFC) differentially predicted depression response across treatment groups, with higher activity predicting better response in the SSRI group, and lower activity predicting better response in the DBT group.
CONCLUSIONS: All female samples.
CONCLUSIONS: Findings indicate that greater prefrontal engagement during emotion regulation may predict more antidepressant benefit from SSRIs, whereas lower engagement may predict better response to DBT. These results suggest different mechanisms of action for SSRI and DBT treatment, and this may allow
fMRI to guide individualized treatment selection.