对青少年抑郁障碍家庭动力与家庭治疗疗效的功能影像及生理心理机制研究

Depression is a common mental disorder in adolescents, often resulting in serious consequences. Previous studies have found that dysfunctional family dynamic contributed etiologically to depression in adolescents, and dysfunctions in the emotion-related brain regions were also linked with the development of adolescent’s depressive symptoms. However, the biological mechanism through which family circumstance leads to depression, and the mechanisms and models that family dynamic and biological dysfunctions interacted with each other when contributing to depression still remain unclear. In current study, adolescents diagnosed as Major depressive disorder will be recruited. McMaster family function assessment will be conducted to assess the family dynamic of the subjects. Adolescents’ physiological and psychological responses triggered by domestic stress would be detected and recorded using the physiological response recorder. Moreover, functional magnetic resonance imaging (fMRI) would be used to measure the functions of the brain emotion loops which are associated with domestic interpersonal conflicts, in the resting and emotional picture stimuli state, respectively. Functional network analysis will be conducted to explore the brain functional connectivity between emotion-related brain regions in adolescents with depression. Consequently, this study will explore the potential mediation and moderation mechanisms that brain dysfunctions and physiological and psychological reaction would play in the link between family dynamic and adolescent’s depression. The mechanism these three factors interact with each other when contributing to the adolescents’ depression will also be explored. Additionally, by exploring the changes in family dynamic, physiological and psychological reactions and the functions of brain emotion loops before and after family therapy, we would observe the neurobiological mechanism of family therapy in the treatment of adolescent’s depression. This study can contribute to the understanding of the complex psychological and biological pathogenesis of adolescents’ depression, and provide objective medical index for the early screening and designing of effective interventions of adolescents’ depression.

抑郁障碍是青少年常见的精神障碍，常致严重后果。前期研究发现不良家庭动力可引发青少年抑郁，患者情绪相关脑区功能存在异常，但家庭动力引发抑郁的神经生物学机制，及两者在引发抑郁中的交互作用机制不明。本研究以青少年抑郁障碍患者为对象，采用McMaster模型测量患者的家庭动力特征，利用生理反应记录仪测量家庭人际冲突引发的患者生理心理反应，并采用功能核磁共振测量患者情绪环路中与家庭冲突相关的静息态和情绪刺激任务态功能异常。应用脑功能网络分析探讨患者情绪环路功能网络连接特征，探索生理心理反应改变和情绪环路功能异常在不良家庭动力引发青少年抑郁障碍中的作用机制，及三者影响抑郁的交互作用机制。并通过比较家庭治疗前后患者家庭动力、生理心理反应及情绪环路功能变化，探讨家庭治疗起效的神经生物学机制。本研究可为阐明青少年抑郁障碍的复杂心理及生物学交互发病机制做出贡献，为其早期筛查和治疗方法制定提供客观医学参考指标。

抑郁障碍是青少年常见的精神障碍，常致严重后果。前期研究发现不良家庭动力可引发青少年抑郁，患者情绪相关脑区功能存在异常，但家庭动力引发抑郁的神经生物学机制，及两者在引发抑郁中的交互作用机制不明。本研究以青少年抑郁障碍患者为对象，采用McMaster模型测量患者的家庭动力特征，利用生理反应记录仪测量家庭人际冲突引发的患者生理心理反应，并采用功能核磁共振测量患者情绪环路中与家庭冲突相关的静息态和情绪刺激任务态功能异常。应用脑功能网络分析探讨患者情绪环路功能网络连接特征，探索生理心理反应改变和情绪环路功能异常在不良家庭动力引发青少年抑郁障碍中的作用机制，及三者影响抑郁的交互作用机制。并通过比较家庭治疗前后患者家庭动力、生理心理反应及情绪环路功能变化，探讨家庭治疗起效的神经生物学机制。研究发现抑郁障碍青少年在面对父母婚姻冲突和亲子冲突时生理反应与正常对照组存在显著差异。抑郁青少年静息态脑功能异常分布于左楔前叶、左后扣带回、右尾状核、右内侧和旁扣带脑回、左顶下缘角回等部位。抑郁青少年面对来自父亲和母亲的负面评价时期关键脑区功能变化，与接受来自父母的正面、负面评价时的脑功能存在明显差异。本研究结果可为阐明青少年抑郁障碍的复杂心理及生物学交互发病机制做出贡献，为其早期筛查和治疗方法制定提供客观医学参考指标。