摘要
目的:探讨认知行为治疗(CBT)对成人注意缺陷多动障碍(ADHD)患者静息态局部脑功能的影响。方法:被试包括10例18~65岁、符合精神障碍诊断与统计手册第4版(DSM-Ⅵ)ADHD诊断标准的患者及12例年龄、性别匹配的正常对照。对成人ADHD患者在CBT治疗前分别使用ADHD评定量表(ADHD-RS)及执行功能行为评定量表成人版自评问卷(BRIEF)进行症状、执行功能的评估,并进行静息态功能磁共振成像(rfMRI)扫描,此后进行12次CBT治疗,治疗完成后进行第2次症状、执行功能评估及MRI扫描,以观察ADHD症状、执行功能及静息态局部一致性(ReHo)的变化;对正常对照进行一次ADHD症状、执行功能评估及MRI扫描。结果:CBT治疗后ADHD患者的ADHD症状量表总分[(43±7)vs.(31±7),P<0.01]、注意缺陷分及多动/冲动分降低,BRIEF中的监控[(15±2)vs.(11±2),P<0.01]及组织因子[(19±5)vs.(14±4),P<0.01]的分数降低。在脑功能层面,治疗前,成人ADHD患者默认网络内脑区(左侧海马旁回)及双侧前扣带回ReHo值低于正常对照,治疗后,成人ADHD患者默认网络内脑区(右侧海马旁回)及额-顶网络内脑区(右侧中央前、后回及左侧中央后回)的ReHo值增高,但右侧额上回的ReHo值仍低于正常对照(P<0.05,团块体积>3051mm3,校正后P<0.01)。结论:CBT治疗可以改善成人ADHD患者的核心症状及认知功能,对默认网络内(海马旁回)及额-顶网络内(双侧中央前后回)脑区功能可能有影响,此脑功能的改变可能是ADHD症状和执行功能改善的神经基础。
Objective： To determine the effects of cognitive-behavioral therapy （CBT） on resting-state brain functional changes in adults with attention-deficit/hyperactivity disorder （ADHD）. Methods： Participants including 10 adults with ADHD aged 18 - 65 years, diagnosed with the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition （DSM-IV） and 12 age-and gender-matched healthy controls. The ADHD symptoms and executives functions were assessed using the ADHD Rating Scale （ADHD-RS） and Behavior Rating Inventory of Executive Function （BRIEF） respectively and resting-state functional magnetic resonance imaging were acquired before and after 12-session CBT for ADHD patients. The healthy controls were also scanned. We used the regional homogeneity （ReHo） to capture the changes of regional brain function between pre- and post-CBT in ADHD for measuring the effects of CBT. Results： After CBT, the total scores of ADHD-RS [ （43 ± 7） vs. （31 ± 7）, P 〈 0.01 ], the subscale of inattention and subseale of hyperactivity/impulsivity were decreased in ADHD adults. As for the execu- tive functions, the subscales of monitor [ （ 15 ± 2） vs. （ 11 ± 2）, P 〈 0. 01 ] and organization [ （ 19 _± 5） vs. （ 14 ± 4）, P 〈 0. 01 ] in BRIEF were reduced significantly in adults with ADHD after CBT training. The ReHo was increased in the regions involved in default mode network and fronto-parietal network, i. e., fight parahippocampa gyms, right precentral gyrus, fight postcentral gyms and left postcentral gyms （ Voxels with P 〈 0. 05 and cluster size 〉 3051mm3, which resulted in a corrected threshold of P 〈 0. 01 determined by AlphaSim）. Conelusion： These findings support that CBT could selectively modulate the regional brain function in the default mode network and fron- to-parietal network which may contribute to the improvement of ADHD symptoms and executive functions.
作者
曹庆久
王晓丽
曲姗
王鹏
吴赵敏
孙黎
王玉凤
CAO Qing-Jiu WANG Xiao-Li QU Shan WANG Peng WU Zhao-Min SUN Li WANG Yu-Feng(Peking University Sixth Hospital, Peking University Institute of Mental Health, National Clinical research Center for Mental Disorders, Key Laboratory of Mental Health, Ministry of Health （Peking University）, Beijing 100191, China Guangdong Provincial Corps Hospital of Chinese People＇s Armed Police Forces, Guangzbou 510505, China)
出处
《中国心理卫生杂志》
CSSCI
CSCD
北大核心
2017年第3期183-189,共7页
Chinese Mental Health Journal
基金
国家重点基础研究发展计划(2014CB846104)
国家自然科学基金(81471382
81371496
81000593)
认知神经科学与学习国家重点实验室开放课题基金(CNLYB1508)资助
关键词
注意缺陷多动障碍
成人
局部一致性
静息态功能磁共振成像
attention-deficit/hyperactivity disorder
adult
regional homogeneity
resting-state functional magnetic resonance imaging
