The Study Of Curative Effect Evaluation And Neurological Mechanism Of Mentalization-Based Family Therapy In Adolescents With Depressive Disorder

Objectives The purpose of this study was to explore the effect of mentalization-based family therapy on clinical efficacy,parent-child relationship and mentalization ability of adolescents with depressive disorder,as well as related brain regions.Methods 32 adolescent patients with depressive disorder were selected from Beijing Huilongguan Hospital in 2018.And they were divided into control group（n=15）and intervention group（n=17）.The control group was treated with conventional medicine,while in the intervention group,on the basis of routine drug treatment received mentalization-based family therapy.All the patients were tested before and after 3 months with the Self-rating and Self-Rating Anxiety and Depression Scale,Reflection functioning questionnaire for youth,Parent-child relationship Test.Their mothers were tested before and after 3 months with Reflective Function-54.10 patients（4 in the control group and 6 in the intervention group）were scanned by magnetic resonance imaging before and after three months.Results 1 There was no significant difference in the mental level,parent-child relationship,depression and anxiety of the patients（P>0.05）;and there was no significant difference in the mental level of their mothers（P>0.05）.2 Compared with the post-test of the control group,the mental level score of the intervention group was higher than that of the control group,but there was no significant difference（P>0.05）;the over-mentalization level of the mothers in the control group was significantly lower than that in the intervention group（P<0.01）,and the mental deficiency in the control group was significantly higher than that in the intervention group（P<0.001）;in parent-child relationship,the positive rejection,stringency,expectation,intervention,restlessness,blind obedience,contradiction,inconsistency,SDS and SAS of the patients in the intervention group were significantly lower than those in the control group（P<0.01）.3 Comparing before and after the control group,there was no significant difference in mental level of the patients（P>0.05）;the post-test of mother’s mental deficiency was significantly higher than that of the pre-test（P<0.05）,and there was no significant difference in mother’s over-mentalization level（P>0.05）;in parent-child relationship,the pre-test of negative rejection,positive rejection,interference,anxiety,spoiling,blind obedience,contradiction and inconsistency was significantly lower than that of the post-test（P<0.05）.And there was no significant difference in strictness and expectation（P>0.05）,nor was anxiety（P>0.05）.Pre-test of depression was significantly higher than post-test（P<0.001）.4 Comparing before and after the intervention group,the mental level of the patients increased significantly after intervention（P<0.01）;the mothers’over-mentalization level of post-test was significantly higher than that of the pre-test（P<0.01）,and the mental deficiency of post-test was significantly lower than that of the pre-test（P<0.01）;in parent-child relationship,negative rejection,positive rejection,strictness,expectation,interference,anxiety,contradiction and inconsistency were significantly reduced after the intervention（P<0.01）.There was no significant difference between spoiling and blindness（P>0.05）;anxiety and depression decreased significantly after intervention（P<0.001）.5 In the aspect of nuclear magnetic resonance scanning,using bilateral amygdala as seed point,there were stronger functional connections between the amygdala and temporal lobe and posterior parietal lobe in the intervention group of post-test,including parietal lobule,anterior cuneiform lobe and superior temporal gyrus.Statistical analysis of further value increase in the above areas showed that the functional connectivity between the amygdala and the right superior temporal gyrus in the post-test intervention group was significantly greater than that in the control group（t=4.80,P=0.007）;there was no significant difference between the control group and the intervention group in pre-test（P>0.05）;the post-test in the intervention group was significantly larger than that in the pre-test group（t=4.59,P=0.010）,while the pre-test and post-test in the control group were not significant（P>0.05）;the posterior parietal lobe was used as seed point,and there were stronger functional connections between the posterior parietal lobe area and the whole brain in the intervention group,including hippocampus,accessory motor area,superior temporal gyrus,temporoparietal junction,superior frontal gyrus and orbitofrontal cortex.The right inferior frontal gyrus had significant interaction（F=29.56,P=0.003）.The functional connections in the post-test intervention group were significantly greater than the control group（t=6.99,P=0.001）;there was no significant difference between the two groups in pre-test（P>0.05）;the post-test of the intervention group was significantly greater than the pre-test（t=9.14,P=0.001）,while the pre-test and post-test of the control group was not significant（P>0.05）.The interaction of the right fusiform gyrus was significant（F=20.63,P=0.006）.The functional connectivity of the post-test intervention group was significantly greater than that of the control group（t=7.31,P=0.001）;there was no significant difference between the pre-test group and the post-test group in the control group（P>0.05）;the post-test of the intervention group was significantly greater than that of the pre-test（t=9.76,P=0.001）,while the pre-test and post-test of the control group was not significant（P>0.05）.The interaction of right superior temporal gyrus was significant（F=8.69,P=0.032）.The functional connectivity of the post-test intervention group was significantly greater than that of the control group（t=3.01,P=0.03）;there was no significant difference between the two groups of the pre-test group（P>0.05）;the post-test of the intervention group was significantly greater than that of the pre-test（t=4.61,P=0.01）,while the pre-and post-test of the control group was not significant（P>0.05）.With medial prefrontal lobe as seed point,the intensity of functional connection between medial temporal lobe and mental system,including temporoparietal junction and anterior cervical lobe,in the intervention group was higher than that in the control group.Further analysis showed that the left middle temporal gyrus interaction was significant（F=9.49,P=0.027）.The functional connectivity of the post-test intervention group was significantly greater than that of the control group（t=3.91,P=0.011）;there was no significant difference between the pre-test group and the post-test group（P>0.05）;the post-test of the intervention group was significantly greater than that of the pre-test（t=5.15,P=0.007）,while the pre-test and post-test of the control group was not significant（P>0.05）.The interaction of right superior frontal gyrus was significant（F=8.62,P=0.032）:the functional connectivity of the intervention group was significantly greater than that of the control group（t=4.65,P=0.006）;there was no significant difference between the two groups of pre-test（P>0.05）;the post-test of the intervention group was significantly greater than that of the pre-test（t=7.60,P=0.002）,while the pre-test and post-test of the control group were not significant（P>0.05）;brain network analysis was performed with 264 ROIs in the whole brain showed that the intensity of functional connectivity in intervention group was higher than that in control group,while the average functional connectivity of intervention group was higher than that of control group.The number of modules in intervention group was significantly less than that in control group(t_（8）=-2.64,P=0.046),and the coefficient of local consistency was also lower than that in control group.Conclusions 1 Mentalization-based family therapy（MBFT）can ameliorate the anxiety and depression of adolescent depression patients and improve the mental ability of adolescent depression patients and their mothers;2 MBFT can improve the parent-child relationship of adolescent depression patients.3 MBFT can improve the functional links between amygdala and right superior temporal gyrus,right inferior frontal gyrus,right spindle gyrus,right superior temporal gyrus,left middle temporal gyrus,right superior frontal gyrus and the whole brain,and make the connections between the brain regions of patients more closely and more integrated.Figure 5;Table 14;Reference 133.