Am J Psychiatry：月经前焦虑障碍与女性背外侧前额叶功能异常

　　日前，一项发表于《美国精神病学杂志》（Am J Psychiatry）的神经影像学研究提示，月经前焦虑障碍（PMDD）患者异常工作记忆激活，特别是在背外侧前额叶皮层的激活，与PMDD的严重程度、症状、发病年龄和疾病负担相关，这些结果支持了这些发现的临床相关性并提出背外侧前额叶皮质功能障碍表示有PMDD风险基础。正电子发射断层扫描（PET）和功能性磁共振成像（fMRI）数据的一致性证明了这些结果的神经生物学有效性。

　　为了研究PMDD的神经机制，研究人员测量了6个月激素处理方案作用下的工作记忆期间，[15O] H2O PET、局部脑血流量（rCBF）和血氧水平依赖（BOLD）的fMRI信号。

　　PET和fMRI扫描资料来自于经前瞻性（研究）证实为PMDD的女性和无症状对照者，他们在三种激素条件下完成了n-back任务：促性腺素释放激素激动剂醋酸亮丙瑞林，醋酸亮丙瑞林加雌二醇，亮丙瑞林加孕激素引起卵巢抑制。15例患者以及15例匹配的对照者接受了PET成像检查; 14例患者和14名对照者进行了功能磁共振成像。在每一种激素条件下，在n-back工作记忆范例期间，应用[15O]H2O PET检测rCBF，应用fMRI检测BOLD信号。研究人员记录了使用激素处理前每一个病人的功能大体评定量表 (GAF）评分和临床特点，以及处理前后的症状特征。

　　在PET和fMRI研究中，研究人员观察了诊断的主要影响，即PMDD患者比对照受试者表现出更明显的前额叶激活。在患者组，背外侧前额叶皮层激活异常增加的程度与疾病的几个维度相关：GAF评分所指示的残疾，症状发作的年龄，PMDD持续的时间，和月经前后PMDD症状的差异。

与焦虑相关的拓展阅读：

• Depress Anxiety：预防抑郁症和自杀应处理焦虑症状
• Depress Anxiety：焦虑障碍患者或应筛查复杂性悲伤
• Br J Psychiatry：戒烟可减少焦虑
• 医学证实生气焦虑会升高血糖
• AHA2012：ICD电击会增加患者焦虑程度和死亡率
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Perinatal Choline Effects on Neonatal Pathophysiology Related to Later Schizophrenia Risk

Objective  

Deficient cerebral inhibition is a pathophysiological brain deficit related to poor sensory gating and attention in schizophrenia and other disorders. Cerebral inhibition develops perinatally, influenced by genetic and in utero factors. Amniotic choline activates fetal α7-nicotinic acetylcholine receptors and facilitates development of cerebral inhibition. Increasing this activation may protect infants from future illness by promoting normal brain development. The authors investigated the effects of perinatal choline supplementation on the development of cerebral inhibition in human infants.

Method  

A randomized placebo-controlled clinical trial of dietary phosphatidylcholine supplementation was conducted with 100 healthy pregnant women, starting in the second trimester. Supplementation to twice normal dietary levels for mother or newborn continued through the third postnatal month. All women received dietary advice regardless of treatment. Infants’ electrophysiological recordings of inhibition of the P50 component of the cerebral evoked response to paired sounds were analyzed. The criterion for inhibition was suppression of the amplitude of the second P50 response by at least half, compared with the first response.

Results 

No adverse effects of choline were observed in maternal health and delivery, birth, or infant development. At the fifth postnatal week, the P50 response was suppressed in more choline-treated infants (76%) compared with placebo-treated infants (43%) (effect size=0.7). There was no difference at the 13th week. A CHRNA7 genotype associated with schizophrenia was correlated with diminished P50 inhibition in the placebo-treated infants, but not in the choline-treated infants.

Conclusions  

Neonatal developmental delay in inhibition is associated with attentional problems as the child matures. Perinatal choline activates timely development of cerebral inhibition, even in the presence of gene mutations that otherwise delay it.