A Sankar1, J Scott2, A Paszkiewicz3, V P Giampietro4, H Steiner5, C H Y Fu1. 1. Centre for Affective Disorders, Department of Psychological Medicine,Institute of Psychiatry, Psychology & Neuroscience, King's College London,London,UK. 2. Academic Psychiatry,Institute of Neuroscience, University of Newcastle,Newcastle upon Tyne,UK. 3. Faculty of Medicine and Health Sciences,University of Nottingham,Nottingham,UK. 4. Department of Neuroimaging, Division of Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King's College London,London,UK. 5. East London NHS Foundation Trust,London,UK.
Abstract
BACKGROUND: Dysfunctional attitudes are a feature of depression that has been correlated with receptor binding abnormalities in limbic and cortical regions. We sought to investigate the functional neuroanatomy of dysfunctional attitudes in major depressive disorder (MDD) and the effects of treatment with cognitive-behavioural therapy (CBT). METHOD: Participants were 16 patients with unipolar depression in an acute depressive episode (mean age 40.0 years) and 16 matched healthy controls (mean age 39.9 years). Patients were medication free and received a course of treatment with CBT. All participants underwent functional magnetic resonance imaging (fMRI) scans at baseline and at week 16, prior to the initiation of therapy and following the course of CBT for patients. During each fMRI scan, participants indicated their attributions to statements from a modified Dysfunctional Attitudes Scale (mDAS-48). RESULTS: MDD patients in an acute depressive episode endorsed a greater number of extreme responses to DAS statements, which normalized following CBT treatment. Extreme attributions were associated with greater activation in the left hippocampal region, inferior parietal lobe and precuneus in MDD patients as compared with healthy controls as a main effect of group. An interaction effect was found in the left parahippocampal region, which showed less attenuation in MDD patients at the follow-up scan relative to healthy controls. CONCLUSIONS: Attenuation of activity in the parahippocampal region may be indicative of an improvement in dysfunctional thinking following CBT treatment in depression, while persistent engagement of regions involved in attentional processing and memory retrieval with extreme attributions reflects a trait feature of depression.
BACKGROUND: Dysfunctional attitudes are a feature of depression that has been correlated with receptor binding abnormalities in limbic and cortical regions. We sought to investigate the functional neuroanatomy of dysfunctional attitudes in major depressive disorder (MDD) and the effects of treatment with cognitive-behavioural therapy (CBT). METHOD:Participants were 16 patients with unipolar depression in an acute depressive episode (mean age 40.0 years) and 16 matched healthy controls (mean age 39.9 years). Patients were medication free and received a course of treatment with CBT. All participants underwent functional magnetic resonance imaging (fMRI) scans at baseline and at week 16, prior to the initiation of therapy and following the course of CBT for patients. During each fMRI scan, participants indicated their attributions to statements from a modified Dysfunctional Attitudes Scale (mDAS-48). RESULTS:MDDpatients in an acute depressive episode endorsed a greater number of extreme responses to DAS statements, which normalized following CBT treatment. Extreme attributions were associated with greater activation in the left hippocampal region, inferior parietal lobe and precuneus in MDDpatients as compared with healthy controls as a main effect of group. An interaction effect was found in the left parahippocampal region, which showed less attenuation in MDDpatients at the follow-up scan relative to healthy controls. CONCLUSIONS: Attenuation of activity in the parahippocampal region may be indicative of an improvement in dysfunctional thinking following CBT treatment in depression, while persistent engagement of regions involved in attentional processing and memory retrieval with extreme attributions reflects a trait feature of depression.
Authors: Jie-Yu Chuang; Cindy C Hagan; Graham K Murray; Julia M E Graham; Cinly Ooi; Roger Tait; Rosemary J Holt; Rebecca Elliott; Adrienne O van Nieuwenhuizen; Edward T Bullmore; Belinda R Lennox; Barbara J Sahakian; Ian M Goodyer; John Suckling Journal: Front Psychiatry Date: 2017-07-11 Impact factor: 4.157