抑郁症自杀相关的神经影像学研究

Progress in neuroimaging related to suicide in depression

抑郁症是以显著而持久的心境低落为主要临床特征的情感障碍,是一种严重的精神障碍,具有高发病率、高致残率、高自杀率的特点。自杀是抑郁症最危险的临床症状,对个人、家庭和社会都造成巨大危害。目前临床上对抑郁症患者自杀行为的预防主要依赖于临床医师的经验,而缺乏准确的预知模型,了解抑郁症自杀行为的神经生物学基础,有助于对抑郁症患者自杀行为的有效预防,减轻社会负担。近年来,利用结构磁共振和功能磁共振技术发现抑郁症有自杀意念或自杀行为的患者存在明显的脑结构或功能的改变,主要涉及眶额叶、颞顶叶、扣带回、海马、纹状体等脑区以及脑核心认知网络,尤其是前额叶-边缘系统的异常变化。未来需要更多的研究探索伴自杀意念或自杀行为的抑郁症患者的脑结构和功能改变,以期发现可以用于临床早期识别抑郁症是否伴发自杀意念/行为的神经影像学标志物。

Depression is an emotional disorder characterized by significant and persistent depression,and it is a serious mental disorder with high incidence rate,high disability rate and high suicide rate.Suicide is the most dangerous clinical symptom of depression,causing great harm to individuals,families and society.At present,the prevention of suicidal behavior in patients with depression mainly depends on the experience of clinicians,but there is a lack of an accurate predictive model.Understanding the neurobiological basis of suicidal behavior in patients with depression will help to effectively prevent suicidal behavior in patients with depression and reduce the social burden.In recent years,structural and functional magnetic resonance imaging(fMRI)technology has been used to explore the neuroimaging charictristics for the depression patient with or without suicidal ideation or suicidal behavior.It mainly involves the abnormal changes of orbitofrontal lobe,temporal parietal lobe,cingulate gyrus,hippocampus,striatum and other brain regions,and brain core cognitive network,especially prefrontal limbic system.It is clear that abnormal changes of brain structure or function were significantly associated with suicidal severity in depression patients.More studies are needed to explore the changes of brain structure and function in depression patients with suicidal ideation or suicidal behavior,and look for thepotentially neuroimaging markers that can be used to identify whether depression is accompanied by suicidal ideation/behavior in the early clinical stage.