| 【Objective】1. By investigating the changes of bilateral amygdala functional connectivity andneurons spontaneous activity in adolescents with first-episode generalized anxietydisorder compared with health controls so as to explore the pathophysiologicalmechanism of adolescent generalized anxiety disorder. Besides, we exploreassociation between abnormal functional connectivity as well as neurons spontaneousactivity and the severity of anxiety symptom, as well as cognitive emotion regulationfeatures.2. To investigate the changes of bilateral amygdala functional connectivity andneurons spontaneous activity in adolescents with first-episode generalized anxietydisorder following12-week cognitive behavior therapy so as to explore thepathophysiological mechanism of CBT effects in adolescents with generalized anxietydisorder. To explore how abnormal functional connectivity and neurons spontaneousactivity predict the efficacy of CBT.【Methods】1. By using convenient sampling method,31adolescents aged13to18withgeneralized anxiety disorder were recruited in Children andAdolescent ClinicalDepartment, Shanghai Mental Health Center.20health control adolescents matched ingender, age as well as education years were recruited in School. All subjects werechosen to fill the Screen for child anxiety related emotional disorders (SCARED), theDepression Self-Rating Scale for Children (DSRSC), the Cognitive EmotionRegulation Questionnaire (CERQ), Coping Style Questionnaire, Chinese version ofClinical Global Impression(CGI), MINI International Neuropsychiatric Interview forchildren and adolescents(MINI-kid) clinical interviewing.All subjects were scannedusing3T functional magnetic resonance imaging during resting-state functionalmagnetic resonance. GAD patients who participated in cognitive behavioral therapyaccepted both all the questionnaire and resting state functional magnetic resonancescan as the first time once they finished12weeks CBT interventions.2. Resting state functional connectivity analysis, amplitude of low-frequencyfluctuation and regional homogeneity method were adopted to calculate resting state data both in GAD patients and health controls. Two sample t test, paired t test andSpearman correlation were used for Statistical analysis.【Results】1. Patients with GAD showed decreased amplitude of low-frequency fluctuationin right fusiform gyrus, ventrolateral prefrontal gyrus and superior occipital gyrus(P<0.01, clusters≥18, corrected byAlphasim). Patients with GAD showed reducedReHo in occipital lobe, middle temporal gyrus, posterior cingulate gyrus and medialprefrontal gyrus, increased ReHo in dorsolateral prefrontal gyrus, precuneus andpostcentral gyrus (P<0.01, clusters≥18, corrected byAlphasim). Adolescents withGAD exhibited disruptions in amygdala-based functional connectivity networks, wefound increased functional connectivity between left amygdala with right anteriorcerebellum lobe, and right inferior temporal gyrus extending to fusiform gyrus;decreased left amygdala with left dorsalateral prefrontal cortex (DLPFC) and thatincreased functional connectivity between right amygdala with right posteriorcerebellum lobe, anterior cerebellum lobe, insula, superior temporal gyrus andputamen extenting to caudate as well as parahippocampus; decreased functionalconnectivity between right amygdala and left temporal pole, and left amygdalaextending to parahippocampus (P<0.01, clusters≥18, corrected byAlphasim).2. Negative correlations between superior occipital gyrus values of ALFF andsocial anxiety factor score were observed within GAD (r=-0.34, P<0.05). Postiveassociation between ventrolateral prefrontal gyrus values of ALFF and score ofpositive reappraisal were observed (r=0.45, P<0.05). Negative correlations betweenfusiform gyrus values of ReHo and total SCARED scores were observed (r=-0.55,P<0.05). Positive correlations between medial prefrontal cortex values of ReHo andpositive reappraisal factor scores were observed(r=0.49, P<0.05). Negativecorrelations between GAD factor scores (r=-0.46, P<0.05) and amygdala functionalconnectivity with cerebellum were also observed within GAD group.3.Although without significant difference, patients with GAD showed values ofALFF with increasing trend compared with pretreatment in fusiform gyrus,ventrolateral prefrontal gyrus as well as superior occipital gyrus (P>0.01, clusters≥18,corrected byAlphasim). Adolescents with GAD showed increased ReHo in middletemporal gyrus and anterior cingulate gyrus after12weeks CBT (P<0.01, clusters≥18,corrected byAlphasim). After12weeks intervention with CBT, adolescents withGAD showed increased functional connectivity between left amygdala with rightpostcentral gyrus, increased right amygdala functional connectivity with left lingualgyrus and parahippocampal gyrus, as well as right postcentral gyrus; decreasedfunctional connectivity between right amygdala and right putanmen extending toparahippocampal gyrus (P<0.01, clusters≥18, corrected byAlphasim). 4. Positive correlations between Clinical Global Impression-Global Improvement(CGI-GI) scores and right amygdala functional connectivity with right putamanextending to parahippocampal gyrus were observed within GAD group (r=0.57, P<0.05).【Conclusion】The research showed that both spontaneous activities among emotional relatedbrain regions and functional connectivity between amygdala and emotional relatedbrain regions existed abnormal, which may be pathological mechanism of GAD.AfterCBT, with reduced anxiety symptoms as well as improved cognitive emotionregulation strategies,patients with GAD showed improved abnormal spontanous brainactivity as well as improved amygdala based functional connectivity. Functionalconnectivity between amygdala and putamen may be severed as a biomarker indicatorof the efficacy of CBT. |
PDF Full Text Request