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首页> 外文期刊>The journal of clinical psychiatry >Enhanced prefrontal function with pharmacotherapy on a response inhibition task in adolescent bipolar disorder.
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Enhanced prefrontal function with pharmacotherapy on a response inhibition task in adolescent bipolar disorder.

机译：在青少年双相情感障碍的反应抑制任务中，用药物治疗增强前额叶功能。

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OBJECTIVE: The aim of the current study is to determine whether pharmacotherapy normalizes cognitive circuitry function supporting voluntary behavioral inhibition in adolescent bipolar disorder. METHOD: Healthy controls and unmedicated patients with DSM-IV adolescent bipolar disorder in manic, mixed, or hypomanic episodes were matched on demographics and IQ (n = 13 per group; mean age = 14.4 +/- 2.4 years). Functional magnetic resonance imaging studies were performed at baseline and after 14 weeks, during which time patients with adolescent bipolar disorder were treated initially with second-generation antipsychotics (SGAs) followed by lamotrigine monotherapy. The primary outcome measure was a Response Inhibition Task, which involved a planned motor response, already "on the way" to execution, that had to be voluntarily inhibited by the subjects in the trials in which a stop signal was presented. There were 6 blocks, each with a predominant rate of either "go" or "stop" trials. The study was conducted from June 2006 through July 2009. RESULTS: All patients showed significant improvement (P < .001) in both the manic and depressive symptoms from baseline. Behavioral data showed that accuracy improved over 14 weeks in patients and healthy controls. Significant time by group interaction effects for the difference between stop versus go blocks showed greater increases of activation in prefrontal (left inferior and middle frontal gyri and medial frontal gyrus bilaterally) and temporal (left superior temporal gyrus and right middle temporal gyrus) regions and greater decreases in activation in right putamen and bilateral thalamus at follow-up in the adolescent bipolar disorder group than in healthy controls. Increased ventrolateral prefrontal cortex function was related to clinical treatment response. CONCLUSIONS: Treatment with SGAs followed by lamotrigine monotherapy enhanced prefrontal and temporal lobe activity during a Response Inhibition Task demonstrating the reversal of disorder-relevant neural circuitry dysfunction in patients with adolescent bipolar disorder. Patient performance was not slowed down with this treatment regimen. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00176228.
机译：目的：本研究的目的是确定药物治疗是否能使支持青少年自愿性行为抑制的认知回路功能正常化。方法：对健康对照者和未接受药物治疗的躁狂，混合性或躁狂发作的DSM-IV青少年双相情感障碍患者进行人口统计学和智商匹配（每组n = 13;平均年龄= 14.4 +/- 2.4岁）。功能性磁共振成像研究在基线和14周后进行，在此期间，青少年双相情感障碍患者首先接受第二代抗精神病药（SGA）治疗，然后接受拉莫三嗪单药治疗。主要的结局指标是“抑制反应任务”，该反应涉及计划的运动反应，该反应已经“在执行中”，在试验中必须由受试者自愿抑制，并提出停止信号。有6个区块，每个区块的“通过”或“停止”试用率最高。该研究于2006年6月至2009年7月进行。结果：所有患者的躁狂和抑郁症状均较基线水平显着改善（P <.001）。行为数据显示，患者和健康对照者在14周内准确性有所提高。停止与行走障碍之间差异的显着时间分组影响显示，额叶前额区（左下额中回和中间额中回和双侧额额中回）和颞（左颞上回和右颞中回）区域的激活增加更大，并且更大与健康对照组相比，青少年双相情感障碍组随访时右壳壳和双侧丘脑的激活降低。腹外侧前额叶皮层功能增加与临床治疗反应有关。结论：SGAs联合拉莫三嗪单药治疗可增强反应抑制任务期间的额叶和颞叶活动，这表明青春期双相情感障碍患者与疾病相关的神经回路功能障碍可以逆转。该治疗方案并未降低患者的表现。试验注册：clinicaltrials.gov标识符：NCT00176228。

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