Davranım bozukluğu komorbid dikkat eksikliği hiperaktivite bozukluğu tanılı erkek çocukların kraniyal fonksiyonel manyetik rezonans görüntüleme bulgularının sağlıklı gelişen erkek çocuklar ile karşılaştırılması
Küçük Resim Yok
Tarih
2023
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Giriş: Davranım bozukluğu (DB), sıklıkla çocukluk veya ergenlik döneminde ortaya çıkan, insanlara veya hayvanlara karşı fiziksel agresyon, hırsızlık, başkasının malına zarar verme veya kuralları ihlal etme ile karakterize, yineleyen ve süreklilik gösteren bir davranış örüntüsüdür. Sıklıkla dikkat eksikliği hiperaktivite bozukluğu (DEHB) ile komorbidite göstermektedir. DEHB, dikkatsizlik veya hiperaktivite-impulsivite veya her iki belirti kümesi ile karakterize çocukluk çağının oldukça sık rastlanan psikiyatrik bozukluklarından biridir. Amaç: Çalışmamızın ana amacı DB komorbid DEHB (DB-K DEHB) olan erkek çocuklarla sağlıklı kontroller arasında yanıt inhibisyonu görev temelli bir task olan go/no-go kullanılarak kraniyal fonksiyonel manyetik rezonans görüntüleme (MRG) bulgularının karşılaştırılmasıdır. Yöntem: Çalışmamıza 18 DB-K DEHB olgusu ve 18 sağlıklı kontrol dahil edilmiştir. DB-K DEHB grubu Ege Üniversitesi Tıp Fakültesi Çocuk ve Ergen Ruh Sağlığı ve Hastalıkları Anabilimdalı polikliniğine başvuran 7-14 yaş aralığındaki sağ elini kullanan erkek olgulardan seçilmiştir. Sağlıklı kontroller ilan verilerek alınmıştır. Tanılama ve ek psikiyatrik tanıları dışlamak amacıyla olgular Okul C?ag?ı C?ocukları ic?in Duygulanım Bozuklukları ve S?izofreni Formu-S?imdi ve Yas?am Boyu S?ekli DSM-5 Tu?rkc?e Uyarlaması (C?DS?G-S?Y-DSM-5-T) ile değerlendirilmiştir. Uygun olan olguların ailelerine Turgay DEHB Formu, öğretmenlerine Turgay DEHB ve Öğretmen Bilgi Formu verilmiştir. Olguların ve ebeveynlerin sosyodemografik özellikleri olgu rapor formuna kaydedilmiştir. Çalışmaya katılmayı kabul eden olguların 3 Tesla MRG cihazı ile fonksiyonel görüntülemeleri tamamlanmıştır. Çekim esnasında yanıt inhibisyonunu değerlendiren go/no-go görevi kullanılmıştır. Bulgular: Go>baseline kontrastında DB-K DEHB grubunda sağ supramarginal girus (t=4.13) ve sağ superior temporal girusta (t=3.81) anlamlı düzeyde aktivasyon artışı olduğu (p<0,001); sağlıklı kontrol grubunda ise sağ anterior prefrontal korteks (t=3.76 ve t=3.54) ve sağ supramarginal girusta (t=3,66) anlamlı aktivasyon olduğu görülmüştür (p<0,001). No-go>baseline kontrastında, DB-K DEHB grubunda sağ superior temporal girusta (t=3.76, p<0,001); sağlıklılarda ise sağ anterior prefrontal korteks (t=4.90 ve t=3.53), sağ dorsolateral prefrontal korteks (t=4.21 ve t=3.52), sol globus pallidus (t=3.93), sağ kaudat (t=3.92) ve sol ventral anterior singulat (t=3.51) bölgede anlamlı düzeyde aktivasyon artışı olduğu görülmüştür (p<0,001). No-go>go kontrastında sağlıklılarda sol fusiform girus (t=4.62), sol frontal göz alanı (t=3.96), posterior singulat bölgenin parçaları olan sol agranüler retrolimbik alan-BA30 (t=3.76) ve sol dorsal posterior singulat girus-BA31 (t=3.56), sağ prekuneus (t=3.74), sol sekonder visual korteksin parçaları olan orta oksipital girus-BA18 (t=3.73) ve inferior oksipital girus-BA19 (t=3.60), sağ suplementer motor alan (t=3.56) ve sağ insula (t=3.44)'da anlamlı aktivasyon artışı olduğu görülmüştür (p<0,001). No-go>go kontrastında DB-K DEHB olgularında sağlıklı kontrol grubuna göre anlamlı bir farklılık saptanmamıs?tır (p>0.001). Sonuç: Sonuç olarak sağlıklı kontrollerde DB-K DEHB grubuna göre; yanıt inhbisyonu, bilişsel kontrol ve dikkat ağları ile ilişkilendirilen prefrontal, parietal, singulat ve subkortikal bölgelerde ve dikkatle ilişkili visual alanlar olan oksipital bölgelerde aktivasyon artışı olduğu görülmüştür. Prefrontal korteks; bilişsel kontrolü destekleyen büyük bir beyin ağı olan fronto-singulo-parietal ağın parçası olup subkortikal yapılarla etkileşim halindedir. Bu bağlamda bakıldığında yürütücü işlevler, dikkat ve yanıt inhibisyonunun DB-K DEHB olan grupta sağlıklı kontrollere göre bozulmuş olduğu düşünülmektedir. DB-K DEHB grubunda ise sağlıklı kontrol grubuna göre bir assosiyasyon alanı olan ve ventral dikkat ağı ile ilişkilendirilen temporo-parietal bağlantıda aktivasyon artışı olduğu görülmüştür. Bu farklılığın nedeni gruplar arasında stimulusun işlenme sürecindeki farklılıklar ve dikkatle ilişkilendirilen fronto-singulo-parietal ağda anormallikler saptadığımız DB-K DEHB grubundaki çocukların geliştirdiği bir kompansasyon mekanizması olabilir.
Background: Conduct disorder is a repetitive and persistent pattern of behavior that often manifests in childhood or adolescence, characterized by physical aggression towards people or animals, theft, damage to property, or breaking rules. It often shows comorbidity with attention deficit hyperactivity disorder (ADHD). ADHD is one of the most common psychiatric disorders of childhood characterized by inattention, hyperactivity-impulsivity, or both symptom clusters. Aim: The main aim of our study was to compare cranial functional magnetic resonance imaging (MRI) findings between boys with conduct disorder comorbid attention deficit hyperactivity disorder (CD-C ADHD) and healthy controls using a go/no-go task-based response inhibition scheme. Materials and Methods: Eighteen CD-C ADHD cases and eighteen healthy controls were included in our study. The CD-C ADHD group was selected from right-handed male patients aged 7-14 years who applied to the Ege University Medical Faculty Child and Adolescent Psychiatry Department outpatient clinic. Healthy controls were included on a voluntary basis . In order to confirm diagnosis and exclude additional psychiatric diagnoses, the cases were evaluated with the DSM-5 Turkish Adaptation of the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL-DSM-5-T). The families of the eligible cases were given the Turgay ADHD Form, and their teachers were given the Turgay ADHD Form and the Teacher Information Form. Sociodemographic characteristics of the cases and their parents were recorded in the case report form. Functional imaging of the cases who accepted to participate in the study was completed with a 3 Tesla MRI device. The go/no-go task was used to assess response inhibition during MRI. Results: In the go>baseline contrast, there was a significant activation increase in the right supramarginal gyrus (t=4.13) and right superior temporal gyrus (t=3.81) in the CD-C ADHD group (p<0.001), whereas significant activation was observed in the right anterior prefrontal cortex (t=3.76 and t=3.54) and right supramarginal gyrus (t=3.66) in the healthy control group (p<0.001). In the no-go>baseline contrast, there was a significant activation increase in the right superior temporal gyrus (t=3.76, p<0.001) in the CD-C ADHD group, whereas a significant activation increase was observed in the right anterior prefrontal cortex (t=4.90 and t=3.53), right dorsolateral prefrontal cortex (t=4.21 and t=3.52), left globus pallidus (t=3.93), right caudate (t=3.92), and left ventral anterior cingulate (t=3.51) regions in the control group (p<0.001). In the no-go>go contrast, a significant increase in activation was observed in the left fusiform gyrus (t=4.62), left frontal eye area (t=3.96), left agranular retrolimbic area-BA30 (t=3.76) and left dorsal posterior cingulate gyrus-BA31 (t=3.56) that are parts of the posterior cingulate region, right precuneus (t=3.74), middle occipital gyrus-BA18 (t=3.73) and inferior occipital gyrus-BA19 (t=3.60) that are parts of the left secondary visual cortex, right supplementary motor area (t=3.56), and the right insula (t=3.44) in healthy controls (p<0.001). In the no-go>go contrast, no significant difference was found in CD-C ADHD cases compared to the healthy control group (p>0.001). Conclusion: According to the results obtained in the present study, there was an increase in activation in the prefrontal, parietal, cingulate and subcortical regions associated with response inhibition, cognitive control and attention networks, and in the occipital regions, which are visual areas associated with attention, in healthy controls compared to the CD-C ADHD group. The prefrontal cortex is part of the fronto-cingulo-parietal network, a large brain network that supports cognitive control and interacts with subcortical structures. In this context, executive functions, attention and response inhibition are thought to be impaired in the CD-C ADHD group compared to healthy controls. In the CD-C ADHD group, there was an increase in activation in the temporo-parietal connection, which is an association area and associated with the ventral attention network. This may be due to the differences in the processing of stimuli between the groups and a compensation mechanism developed by CD-C ADHD children in whom we detected abnormalities in the fronto-cingulo-parietal network associated with attention.
Background: Conduct disorder is a repetitive and persistent pattern of behavior that often manifests in childhood or adolescence, characterized by physical aggression towards people or animals, theft, damage to property, or breaking rules. It often shows comorbidity with attention deficit hyperactivity disorder (ADHD). ADHD is one of the most common psychiatric disorders of childhood characterized by inattention, hyperactivity-impulsivity, or both symptom clusters. Aim: The main aim of our study was to compare cranial functional magnetic resonance imaging (MRI) findings between boys with conduct disorder comorbid attention deficit hyperactivity disorder (CD-C ADHD) and healthy controls using a go/no-go task-based response inhibition scheme. Materials and Methods: Eighteen CD-C ADHD cases and eighteen healthy controls were included in our study. The CD-C ADHD group was selected from right-handed male patients aged 7-14 years who applied to the Ege University Medical Faculty Child and Adolescent Psychiatry Department outpatient clinic. Healthy controls were included on a voluntary basis . In order to confirm diagnosis and exclude additional psychiatric diagnoses, the cases were evaluated with the DSM-5 Turkish Adaptation of the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL-DSM-5-T). The families of the eligible cases were given the Turgay ADHD Form, and their teachers were given the Turgay ADHD Form and the Teacher Information Form. Sociodemographic characteristics of the cases and their parents were recorded in the case report form. Functional imaging of the cases who accepted to participate in the study was completed with a 3 Tesla MRI device. The go/no-go task was used to assess response inhibition during MRI. Results: In the go>baseline contrast, there was a significant activation increase in the right supramarginal gyrus (t=4.13) and right superior temporal gyrus (t=3.81) in the CD-C ADHD group (p<0.001), whereas significant activation was observed in the right anterior prefrontal cortex (t=3.76 and t=3.54) and right supramarginal gyrus (t=3.66) in the healthy control group (p<0.001). In the no-go>baseline contrast, there was a significant activation increase in the right superior temporal gyrus (t=3.76, p<0.001) in the CD-C ADHD group, whereas a significant activation increase was observed in the right anterior prefrontal cortex (t=4.90 and t=3.53), right dorsolateral prefrontal cortex (t=4.21 and t=3.52), left globus pallidus (t=3.93), right caudate (t=3.92), and left ventral anterior cingulate (t=3.51) regions in the control group (p<0.001). In the no-go>go contrast, a significant increase in activation was observed in the left fusiform gyrus (t=4.62), left frontal eye area (t=3.96), left agranular retrolimbic area-BA30 (t=3.76) and left dorsal posterior cingulate gyrus-BA31 (t=3.56) that are parts of the posterior cingulate region, right precuneus (t=3.74), middle occipital gyrus-BA18 (t=3.73) and inferior occipital gyrus-BA19 (t=3.60) that are parts of the left secondary visual cortex, right supplementary motor area (t=3.56), and the right insula (t=3.44) in healthy controls (p<0.001). In the no-go>go contrast, no significant difference was found in CD-C ADHD cases compared to the healthy control group (p>0.001). Conclusion: According to the results obtained in the present study, there was an increase in activation in the prefrontal, parietal, cingulate and subcortical regions associated with response inhibition, cognitive control and attention networks, and in the occipital regions, which are visual areas associated with attention, in healthy controls compared to the CD-C ADHD group. The prefrontal cortex is part of the fronto-cingulo-parietal network, a large brain network that supports cognitive control and interacts with subcortical structures. In this context, executive functions, attention and response inhibition are thought to be impaired in the CD-C ADHD group compared to healthy controls. In the CD-C ADHD group, there was an increase in activation in the temporo-parietal connection, which is an association area and associated with the ventral attention network. This may be due to the differences in the processing of stimuli between the groups and a compensation mechanism developed by CD-C ADHD children in whom we detected abnormalities in the fronto-cingulo-parietal network associated with attention.
Açıklama
Anahtar Kelimeler
Psikiyatri, Psychiatry, davranım bozukluğu, dikkat eksikliği hiperaktivite bozukluğu, yanıt inhibisyonu, fMRG, conduct disorder, attention deficit hyperactivity disorder, response inhibition, fMRI
