Major depresif bozukluğu olan hastalar ve sağlıklı bireylerde duygu yüklü ifadelerin ödülü öğrenmeye etkisinin karşılaştırılması
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Tarih
2017
Yazarlar
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Cilt Başlığı
Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
GİRİŞ: Major depresif bozukluğun (MDB) çekirdek kriterlerinden biri anhedonidir. Bu hastalığın tanı, tedavi ve prognozunda önemli olan bu bulguyu değerlendirmek için ödül işleme sistemi kullanılır. Bunun yanında bireylerin toplumdaki ilişkilerini sağlıklı bir şekilde yürütebilmesini sağlayan sosyal kognisyon becerilerinin en başında emosyonel uyaranları doğru anlamlamak gelir. Depresif bireyler çevreden gelen emosyonel uyaranları negatif yönde yorumlama eğilimindedirler. Bu durum bireylerin toplumsal ilişkilerini olumsuz etkilemekte, toplumsal ilişkilerinin olumsuz olması da depresif belirtilerinin artmasına yol açmaktadır. Emosyonel uyaranlar ile ödül işleme sürecinin birlikte değerlendirilmesi, nöral yansımasının nasıl olduğunun bilinmesi; tanı, tedavi ve prognozu ön görme başarısını arttıracaktır. AMAÇ: Bu çalışmada, günümüzdeki en önemli toplumsal sağlık sorunlarından biri olan MDB'de emosyonel uyaranın, ödül ya da ceza getirecek uyaranı öğrenmeye olan etkisi araştırılmıştır. Buna ek olarak depresif bireylerde ödül-ceza duyarlılığının değerlendirilmesi mercek altına alınmış, hem ödül-ceza hem de emosyonel sürecin nöral izdüşümün nasıl değişeceğinin belirlenmesi amaçlanmıştır. HİPOTEZ: Negatif emosyon yüklü ifadelerin sonrasında gösterilen ödül getirecek ipucunu öğrenme başarısı depresif hastalarda pozitif ve nötr yüz ifadelerine oranla daha yüksektir. Depresif bireylerin ödül duyarlılığı sağlıklı bireylere göre daha düşüktür. YÖNTEM: Çalışmamız; hasta grubunda 33 kişi, sağlıklı kontrol grubunda 32 kişi ile tamamlanmıştır. Katılımcıların psikiyatrik muayenesinde SCID-I (DSM IV için yapılandırılmış klinik görüşme), Hamilton Depresyon Değerlendirme Ölçeği (HAM-D-17), Beck Depresyon Ölçeği, Fiziksel Anhedoni Ölçeği ve Sosyal Anhedoni Ölçeği ve Davranışsal İnhibisyon-Aktivasyon Sistemi Ölçeği (DİS/DAS) uygulanmıştır. Kişilerin psikiyatrik muayenesi ve ölçek uygulamalarından en fazla 1 hafta sonrasında 3 Tesla Manyetik Rezonans Görüntüleme (MRG) cihazı ile yapısal ve fonksiyonel görüntülemeleri tamamlanmıştır. Katılımcılara fonksiyonel MRG çekiminde uygulanan görevde bireylerden kapalı bir kart arkasındaki sayısının beşten büyük ya da küçük olmasını tahmin etmeleri istenmiştir. Bu tahmini öncesinde görecekleri olasılıksal ipucuna göre yapmaları talimatı verilmiştir. Kişiler doğru tahminleri için para kazanmış, yanlış tahminleri ya da cevap vermedikleri durumlarda para kaybetmişlerdir. Bu ödevde bireyler olasılıksal ipucundan önce kısa süreli emosyon içeren (mutlu, nötr, üzgün) yüz görmüşlerdir. Ancak MR öncesi verilen eğitimde bu yüzlerin karttaki değerden tamamen bağımsız olduğu ve dikkatlerini olasılıksal ipucu üzerinde yoğunlaştırmaları gerektiği vurgulanmıştır. Görüntü verileri olasılıksal ipucu periyodu ve geribildirim periyodu olarak ikiye ayrılmış ve analize dahil edilmiştir. BULGULAR: Hastalardaki HAM-D-17, fiziksel anhedoni, sosyal anhedoni puanları kontrol grubuna göre anlamlı oranda yüksek tespit edilmiştir ( p<0,001). DİS/DAS ölçeği alt puanlarından ödül duyarlılığının kontrol grubunda anlamlı oranda (p=0,015) fazla olduğu bulunmuştur. Davranışsal verilerde gruplar arasında; katılımcıların ellerinde kalan parayı ifade eden net skor ve doğru yanıt sayılarında istatistiksel olarak anlamlı fark bulunamamıştır. Davranışsal verilerin ana etkileri incelendiğinde emosyondan ve gruptan bağımsız olarak olasılık değerleri arasında anlamlı ana etki saptanmıştır (p<0,001). Net skor ve davranışsal inhibisyon puanı arasında istatistiksel olarak anlamlı negatif koralasyon tespit edilmiştir (p<0,05). Görüntüleme sonuçlarında ise olasılıksal ipucu periyodunda emosyon ana etkisi incelendiğinde sağ fusiform girus (FG), sağ posterior singulat girus (pSG), sağ parahippokampus bölgelerinde anlamlı aktivasyon alanı gözlenmiştir (sırasıyla F=11,66; F=11,11; F=8,60 p <0.001 uncorr). Hasta grubunda; üzgün yüz gördükten sonra gelen olasıksal ipucunda sağ kaudat nucleus ve sağ amigdalada (sırasıyla t=4,41; t=3,79 p<0,001 uncorr) aktivasyon alanı saptanmıştır. Kontrol grubunda ise aynı ipucu sırasında bilateral superior ve medial frontal girusta aktivasyon gözlenmiştir (sırasıyla t=4,31; t=3,78 p<0,001 uncorr). Geri bildirim periyodunda; geribildirim ana etkisi kaudat nükleus, putamen (sırasıyla F=59,57; F=46,73 p<0,001 FWE), aSG, pSG ve orbitofrontal kortekste (OFK) istatistiksel olarak anlamlı bulunmuştur (sırasıyla F=30,39; F=29,31; F=39,48 p=0.005 FWE, p=0.001 FEW p<0.001 FEW). Ödül ve ceza arasındaki karşılaştırmalar hasta/kontrol grubuna indirgenerek incelendiğinde kontrol grubunda ödül gördüğü zaman bu alanlardaki aktivasyonunun anlamlı olduğu görülmüştür. Bu veri hasta grubunda bu bölgelerdeki aktivasyonun azalmasından kaynaklanmaktadır. SONUÇ: Çalışmamızda depresif bireyler ile sağlıklı bireyler arasında, davranışsal verilerde emosyona göre olasılıksal ipucunu öğrenme ve net skor olarak fark bulunmamasına rağmen nöral yansımanın farklı olduğu tespit edilmiştir. Depresif bireylerde negatif emosyon sırasında bellek, dikkat ve öğrenme alanında rolü olan bölgelerde artmış bir aktivasyon gözlenmekte iken; pozitif emosyon ve ödül kazanma sırasında ise benzer bölgelerde aktivasyonun azaldığı tespit edilmiştir. Bu verilerle depresif bireylerin olumsuz emosyonları öğrenip kaydetmeleri ve bunun yanında ödüle duyarlılıklarının azalmasının nöral temelinin striatumu oluşturan kaudat nükleus ve putamen, bunun yanında amigdala, OFK, aSG ve pSG disregülasyondan kaynaklanabileceği söylenebilir. Klinik değerlendirme sırasında bu verilerin hatırlanması hem prognozu ön görmeyi sağlayacak hem de tedavi stratejilerini etkileyecektir.
INTRODUCTION: One of the core criteria of major depressive disorder (MDD) is anhedonia. The reward processing system should be examined to assess this finding, which is important in the diagnosis, treatment and prognosis of this disease. Besides, understanding the emotional stimuli correctly is at the top of the social cognitive skills which ensures the individuals to maintain their social relations in a healthy way. Depressed individuals tend to interpret emotional stimuli negatively. This situation negatively affects the social relations of the individuals and this negativity of the social relations lead to the increase of the depressive symptoms. The evaluation of emotional stimuli and reward processing together, knowing how neural reflections are; would increase the success on diagnosis, treatment and the prediction of prognosis. AIM: In this study it is aimed to assess the effect of emotional stimuli on learning the signal which leads to reward or punishment in major depressive disorder, which is one of the most important heatlh problems of society nowadays. It is also aimed to evaluate the assessment of reward- punishment sensitivity, to determine the change of the neural reflections of both reward-punishment process and emotional process in depressed individuals. HYPOTHESIS: The success on learning the cue that will bring the reward which is shown after face expressions with negative emotions is higher in depressed patients compared to the face expressions with positive emotions or neutral face expressions. Depressed individuals have lower reward awareness than healthy individuals. METHOD: Our study was completed with 33 people in the patient group and 32 people in the healthy control group. During the psychiatric examinations of the participants SCID-I (Structured Clinical Interview for DSM IV), Hamilton Depression Rating Scale (HAM-D 17), Beck Depression Inventory, Physical Anhedonia Scale, Social Anhedonia Scale, Behavioural Inhibition Scale/ Behavioural Activation Scale (BIS/BAS) were applied. Within a maximum of 1 week duration after the psychiatric examinations and scale applications of participants, their structural and functional imaging by 3-Tesla Magnetic Resonance Device was completed. It was required from individuals in the task which is applied to the participants during MRI screening to predict the number which is written behind a closed card to be higher or lower than five. They were ordered to make this prediction due to the probabilistic cue they would see before. Individuals gained money for their correct predictions, lost money for their wrong predictions or for no responded situations. In this task, individuals had seen facial expressions with emotions (happy, neutral, sad) for a short duration before the probabilistic cue. However during the education before the application of MRI it was emphasized that those faces were completely independent from the value of the card and that they need to focus their attention on the probabilistic cue. The data of the imaging were seperated into two parts as the period of probablistic cue and the period of feedback and they were included in the analysis. RESULTS: The scores of HAM-D-17, physical anhedonia and social anhedonia in the patients were significantly higher than the control group (p <0,001). When the subscales of behavioral inhibition-activation scale were controlled, the reward sensitivity was found to be significantly higher in the control group (p = 0.015). In the behavioral data, there was no statistically significant difference between groups in net score, which means the total amount of money rest, and number of correct answers. When the main effects of behavioral data were examined, significant main effect was determined between the values of the probabilities independent of the emotion and the group (p<0,001). In addition, statistically significant negative correlation was found between the net score and the behavioral inhibition score in the subscale of BIS/BAS scale (p<0,05). In the imaging results, when the main effect of emotion is examined in the probabilistic cue period significant activation regions were observed in the right FG, right pCC and right parahippocampus (F=11,66; F=11,11; F=8,60 p <0.001 uncorr respectively). In the probabilistic cue period after experiencing sad face, region of activation in the right caudate nucleus and right amygdala were detected in the patients group (t=4,41; t=3,79 p<0,001 uncorr respectively). In the control group, during the same cue regions of activation in bilateral superior and medial frontal gyrus (t=4,31; t=3,78 p<0,001 uncorr, respectively) were observed. During the feedback period, main effect of feedback is found significant in the caudate nucleus, putamen (F=59,57; F=46,73 p<0,001 FEW respectively), aCC, pCC and orbitofrontal corteks (OFC) (F=30,39; F=29,31; F=39,48 p=0.005 FWE, p=0.001 FEW p<0.001 FWE, respectively). In the control group the activation in these regions was meaningful when they received a reward. This data is due to the decrease of activation in these regions in the patient group. CONCLUSION: In our study, neural reflections between depressed individuals and healthy individuals were found to be different, although there is no difference in learning the probabilistic cue according to the emotion in behavioral data. In depressed individuals, during negative emotions, increased activation is observed in regions of memory, attention, and learning roles. In similar regions activation was found decreased during the reward and positive emotions. This data suggests that, depressive individuals learn and record negative emotions. In addition to this, their sensitivity to reward has decreased. It can be said that the neural basis of these symptoms may be due to dysregulation of the striatum and putamen, amygdala, OFC, aCC and pCC. Remembering these data will help to predict prognosis and affect treatment strategies during clinical evaluation.
INTRODUCTION: One of the core criteria of major depressive disorder (MDD) is anhedonia. The reward processing system should be examined to assess this finding, which is important in the diagnosis, treatment and prognosis of this disease. Besides, understanding the emotional stimuli correctly is at the top of the social cognitive skills which ensures the individuals to maintain their social relations in a healthy way. Depressed individuals tend to interpret emotional stimuli negatively. This situation negatively affects the social relations of the individuals and this negativity of the social relations lead to the increase of the depressive symptoms. The evaluation of emotional stimuli and reward processing together, knowing how neural reflections are; would increase the success on diagnosis, treatment and the prediction of prognosis. AIM: In this study it is aimed to assess the effect of emotional stimuli on learning the signal which leads to reward or punishment in major depressive disorder, which is one of the most important heatlh problems of society nowadays. It is also aimed to evaluate the assessment of reward- punishment sensitivity, to determine the change of the neural reflections of both reward-punishment process and emotional process in depressed individuals. HYPOTHESIS: The success on learning the cue that will bring the reward which is shown after face expressions with negative emotions is higher in depressed patients compared to the face expressions with positive emotions or neutral face expressions. Depressed individuals have lower reward awareness than healthy individuals. METHOD: Our study was completed with 33 people in the patient group and 32 people in the healthy control group. During the psychiatric examinations of the participants SCID-I (Structured Clinical Interview for DSM IV), Hamilton Depression Rating Scale (HAM-D 17), Beck Depression Inventory, Physical Anhedonia Scale, Social Anhedonia Scale, Behavioural Inhibition Scale/ Behavioural Activation Scale (BIS/BAS) were applied. Within a maximum of 1 week duration after the psychiatric examinations and scale applications of participants, their structural and functional imaging by 3-Tesla Magnetic Resonance Device was completed. It was required from individuals in the task which is applied to the participants during MRI screening to predict the number which is written behind a closed card to be higher or lower than five. They were ordered to make this prediction due to the probabilistic cue they would see before. Individuals gained money for their correct predictions, lost money for their wrong predictions or for no responded situations. In this task, individuals had seen facial expressions with emotions (happy, neutral, sad) for a short duration before the probabilistic cue. However during the education before the application of MRI it was emphasized that those faces were completely independent from the value of the card and that they need to focus their attention on the probabilistic cue. The data of the imaging were seperated into two parts as the period of probablistic cue and the period of feedback and they were included in the analysis. RESULTS: The scores of HAM-D-17, physical anhedonia and social anhedonia in the patients were significantly higher than the control group (p <0,001). When the subscales of behavioral inhibition-activation scale were controlled, the reward sensitivity was found to be significantly higher in the control group (p = 0.015). In the behavioral data, there was no statistically significant difference between groups in net score, which means the total amount of money rest, and number of correct answers. When the main effects of behavioral data were examined, significant main effect was determined between the values of the probabilities independent of the emotion and the group (p<0,001). In addition, statistically significant negative correlation was found between the net score and the behavioral inhibition score in the subscale of BIS/BAS scale (p<0,05). In the imaging results, when the main effect of emotion is examined in the probabilistic cue period significant activation regions were observed in the right FG, right pCC and right parahippocampus (F=11,66; F=11,11; F=8,60 p <0.001 uncorr respectively). In the probabilistic cue period after experiencing sad face, region of activation in the right caudate nucleus and right amygdala were detected in the patients group (t=4,41; t=3,79 p<0,001 uncorr respectively). In the control group, during the same cue regions of activation in bilateral superior and medial frontal gyrus (t=4,31; t=3,78 p<0,001 uncorr, respectively) were observed. During the feedback period, main effect of feedback is found significant in the caudate nucleus, putamen (F=59,57; F=46,73 p<0,001 FEW respectively), aCC, pCC and orbitofrontal corteks (OFC) (F=30,39; F=29,31; F=39,48 p=0.005 FWE, p=0.001 FEW p<0.001 FWE, respectively). In the control group the activation in these regions was meaningful when they received a reward. This data is due to the decrease of activation in these regions in the patient group. CONCLUSION: In our study, neural reflections between depressed individuals and healthy individuals were found to be different, although there is no difference in learning the probabilistic cue according to the emotion in behavioral data. In depressed individuals, during negative emotions, increased activation is observed in regions of memory, attention, and learning roles. In similar regions activation was found decreased during the reward and positive emotions. This data suggests that, depressive individuals learn and record negative emotions. In addition to this, their sensitivity to reward has decreased. It can be said that the neural basis of these symptoms may be due to dysregulation of the striatum and putamen, amygdala, OFC, aCC and pCC. Remembering these data will help to predict prognosis and affect treatment strategies during clinical evaluation.
Açıklama
Anahtar Kelimeler
Major Depresif Bozukluğun (MDB), Emosyon, Ödül Ceza Sistemi, Fonksiyonel Manyetik Rezonans Görüntüleme (Fmrg), Major Depressive Disorder (MDD), Emotion, Reward-Punishment System, Functional Magnetic Resonance İmaging (Fmrı)
