抑郁症自杀未遂者静息态脑功能连接改变及其与心理痛苦的关系  

Resting-State Functional Connectivity of Depressed Patients with Suicide Attempts and Its Relationship with Psychological Pain

作　　者：甄子昂 李欢欢[1] 郝子雨 蒋松源 王湘[2] ZHEN Zi-ang;LI Huan-huan;HAO Zi-yu;JIANG Song-yuan;WANG Xiang(Department of Psychology,Renmin University of China,Beijing 100872,China;The Second Xiangya Hospital,Central South Univesity,Changsha 410011,China)

机构地区：[1]中国人民大学心理学系,北京100872 [2]中南大学湘雅二医院医学心理研究中心,长沙410011

出　　处：《中国临床心理学杂志》2021年第5期891-896,共6页Chinese Journal of Clinical Psychology

基　　金：中央高校中国人民大学科学研究基金重大项目(21XNL016)。

摘　　要：目的:考察抑郁症自杀未遂者静息态下痛苦加工环路的脑功能连接变化,探索三维心理痛苦模型,尤其是痛苦逃避动机预测抑郁症自杀未遂的潜在脑影像学指标。方法:对60名抑郁症患者和32名健康对照组(HC)进行临床量表评估和静息态磁共振扫描。其中,依据有无自杀未遂史,病例组分为抑郁自杀未遂组(DSA,n=23)和抑郁自杀意念组(DSI,n=37)。运用基于感兴趣区域(ROI-wise)功能连接方法计算痛苦加工环路内各节点间功能连接系数的组间差异,进一步分析脑功能连接系数与抑郁、自杀意念、自杀未遂和心理痛苦三维量表得分之间的关系。结果:①DSA组的自杀意念、痛苦逃避得分显著高于DSI组和HC组;②与DSI组和HC组相比,DSA组左内侧眶额皮层与左侧脑岛的功能连接减弱;③与HC组相比,DSA组和DSI组右外侧眶额皮层与右侧丘脑的功能连接增强,左外侧眶额皮层与左侧杏仁核的功能连接增强;④左内侧眶额皮层与左侧脑岛的功能连接系数与自杀意念、痛苦逃避得分呈显著正相关。结论:三维心理痛苦模型中的痛苦逃避维度是区分有无自杀未遂史抑郁症患者的敏感行为学指标。静息态下左内侧眶额皮层与左侧脑岛的功能连接减弱作为痛苦加工环路异常的脑区特征,可能是自杀脑的神经基础。Objective:To investigate the changes of brain functional connections in the pain processing circuit in the resting state of depressed suicidal attempters,and to explore the potential brain imaging indicators of the three-dimensional psychological pain model,especially pain avoidance,in predicting suicidal attempters in depression.Methods:60 patients with depression and 32 healthy controls(HC)were assessed with clinical scales and rs-fMRI.Then,according to the history of suicide attempt,patient group was divided into Depressed patients with Suicide Attempt(DSA,n=23)and Depressed patients with Suicide Ideation(DSI,n=37).Results:①The score of suicidal ideation and pain avoidance in DSA group were significantly higher than that in DSI group and HC group.②Compared with DSI group and HC group,the functional connection between left medial orbitofrontal cortex(OFC)and left insula was weakened in DSA group.③Compared with the HC group,the functional connection between the right lateral OFC and the right thalamus was enhanced in DSA group and DSI group,while the functional connection between the left lateral OFC and the left amygdala was also enhanced.④The functional connection coefficient of left medial OFC and left insula was significantly positively correlated with suicidal ideation and pain avoidance scores.Conclusion:Pain avoidance is a sensitive behavioral indicator to distinguish depressed patients with a history of suicide attempt from those without such histories.Altered functional connectivity between left medial OFC and left insula may characterize abnormal pain processing circuits underlined suicide.

关 键 词：三维心理痛苦 抑郁症 自杀未遂 静息态功能连接 

分 类 号：R395.1[哲学宗教—心理学]