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首页> 外文期刊>The journal of clinical psychiatry >Exposure therapy, D-cycloserine, and functional magnetic resonance imaging in patients with snake phobia: A randomized pilot study
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Exposure therapy, D-cycloserine, and functional magnetic resonance imaging in patients with snake phobia: A randomized pilot study

机译：蛇恐惧症患者的暴露疗法，D-环丝氨酸和功能磁共振成像：一项随机先导研究

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Objective: D-Cycloserine may enhance fear extinction. The effects of D-cycloserine on human brain function are not well understood, with findings suggesting that D-cycloserine could augment exposure therapy via its effects on the neural substrates of emotional learning and extinction or by acting upon different neural pathways. The aim of this exploratory study was to investigate differences in neural response in patients receiving D-cycloserine or placebo in addition to exposure therapy. Method: Twenty adults with snake phobia (DSM-IV specific phobia) received 50 mg of d-cycloserine or placebo (double-blind, randomized) 1 hour prior to a single session of graded exposure therapy in an outpatient specialty clinic. One week before and after treatment, patients completed a clinical examination and snake-stimuli symptom provocation functional magnetic resonance imaging (fMRI) task (primary outcome measure). Results: The D-cycloserine and placebo groups responded equally well to treatment, although the D-cycloserine patients reached the top of the exposure hierarchy more quickly (t = 2.61, P < .05). Only right dorsolateral prefrontal cortex showed an equivalent decrease in hyperactivation to snake stimuli in both groups. Compared to placebo, D-cycloserine augmentation resulted in different ventromedial prefrontal brain activation during processing of phobic stimuli, including enhanced medial orbitofrontal (F = 11.52, P = .001) and subgenual anterior cingulate activation (F = 7.41, P = .008) and normalized perigenual cingulate "deactivation" (F = 3.85, P = .05) to snakes. Conclusions: A single administration of D-cycloserine combined with exposure therapy can lead to lasting changes in ventromedial and other prefrontal cortex response to phobic stimuli. These changes are qualitatively different from those seen in patients receiving exposure therapy without D-cycloserine. Trial Registration: ClinicalTrials.gov identifier: NCT01450306
机译：目的：D-环丝氨酸碱可能增强恐惧的消除。 D-环丝氨酸对人脑功能的影响尚未得到很好的了解，研究结果表明，D-环丝氨酸可通过其对情绪学习和消退的神经基质的作用或通过作用于不同的神经途径来增强暴露疗法。这项探索性研究的目的是研究除暴露疗法外，接受D-环丝氨酸或安慰剂的患者在神经反应方面的差异。方法：在门诊专科门诊进行一次分级暴露疗法前一小时，二十名患有蛇型恐惧症（DSM-IV特异性恐惧症）的成年人接受了50毫克的d-环丝氨酸或安慰剂（双盲，随机分组）。在治疗前后一周，患者完成了临床检查和蛇刺激症状诱发功能性磁共振成像（fMRI）任务（主要结果测量）。结果：D-环丝氨酸和安慰剂组对治疗的反应同样好，尽管D-环丝氨酸患者更快地达到了暴露等级的最高水平（t = 2.61，P <.05）。在两组中，仅右背外侧前额叶皮层显示出与蛇刺激相同程度的过度激活。与安慰剂相比，D-环丝氨酸增强导致恐惧刺激过程中不同的腹侧前额叶大脑激活，包括眶内侧额叶增强（F = 11.52，P = .001）和膝下扣带激活（F = 7.41，P = .008）并规范化蛇腹周围带状扣带的“失活”（F = 3.85，P = .05）。结论：D-环丝氨酸与暴露疗法的单次给药可以导致腹侧和其他前额叶皮层对恐惧刺激的持久变化。这些变化与接受未经D-环丝氨酸的暴露治疗的患者在质量上有差异。试验注册：ClinicalTrials.gov标识符：NCT01450306

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