Magnetic Resonance Imaging Studies Of The Regional Cerebral Blood Flow In Depressive Disorder And Acute Posttraumatic Stress Disorder And In First-onset Depressive Disorder Before And After The Treatment Of Repetitive Transcranial Magnetic Stimulation

ObjectiveAccording to previous studies found that, PTSD belongs to anxious mental disorder,depressive disorder belongs to mood disorders, but their symptoms often overlap, both ofthem tend to have a certain correlation. At present, the comparative study of the PTSD anddepressive disorder is less, some study about them is confined to chronic PTSD. Butbecause the chronic PTSD patients often accompanied by alcohol and drug dependenceand comorbidity rate is higher, so which cause certain interference to the result of thestudy. The objects of our study are mainly the acute PTSD patients, compensating for theabove deficiencies. Repetitive transcranial magnetic stimulation (rTMS) technology as anew non-invasive magnetic stimulation technology is applied to the study and treatment ofmental illness, which has a good curative effect for treatment depression, but the change ofthe cerebral blood flow after rTMS treatment is no consistent conclusion. The objectivesof study are:1To detect the similar and different changes of rCBF between depressivedisorder and acute PTSD.2To detect the changes of rCBF first-onset depressive disorderbefore and after the treatment of rTMS.MethodUse a technique of pulsed arterial spin-labelling (PASL) and SPM5software，PVE-labsoftware to measure regional cerebral blood flow (rCBF) changes of each group patients. We selected the patients with depressive disorder diagnosed in the department ofPsychiatry in XiJing Hospital of Fourth Military Medical University, from March2012toOctober2012, and the people who experienced Shanxi wangjialing mine disaster on“3.28” in2010. The patients are all consistent with the diagnostic criteria of diagnostic andstatistical manual fourth edition (DSM-IV). The objects of study are divided into the fourgroups:(1) acute PTSD group:30people, including17males and13females;(2)depressive disorder group:30people, including17males and13females;(3) first-onsetdepressive disorder group: the16first-onset depressive disorder patients, including12males and4females. The group received rTMS treatment, the stimulation site of rTMS isthe left dorsolateral prefrontal lobe (DLPFC). Before and after4weeks rTMS treatment,patients were respectively assessed with Hamilton rating scale for depression17(HAMD17) quantifing the degree of depression;(4)control: we recruited healthyvolunteers participate in the scan of MRI data, who matching with the study groups.Result1Compared with the healthy controls, the rCBF of both depressive disorder patientsand acute PTSD patients decreased. Compared with the acute PTSD patients, the rCBF ofdepressive disorder patients decreased obviously in the right orbital of superior frontalgyrus, orbital of medial frontal gyrus, cuneus, calcarine gyrus, precuneus, supplementarymotor area, middle of cingulum and the left orbital of middle frontal gyrus, orbital ofinferior frontal gyrus, angular gyrus, and precentral gyrus.2Before the treatment, compared with the healthy controls, the rCBF of first-onsetdepressive disorder patients increased obviously in the right middle occipital gyrus,inferior occipital gyrus and the caudate nucleus; the rCBF of patients decreased obviouslyin the left superior-middle frontal gyrus, orbital of middle frontal gyrus, left cerebellum,left insula and right pars opercularis. After four-week effective treatment, the rCBF ofpatients increased obviously in the left middle and inferior frontal gyrus, insula, middleand inferior temporal gyrus, anterior cingulate, and the right supplementary motor area,inferior occipital gyrus, Calcarine, cerebellum; the rCBF of patients decreased obviouslyin the left thalamus, caudate nucleus and shell; and the rCBF of patients recovered significantly in the left frontal lobe and left insula.Conclusion1The study indicated that the changes of rCBF in depressive disorder patients and acutePTSD patients were all decreased, but the rCBF of depressive disorder patients decreasedmore obviously than acute PTSD patients.2The study indicated that the changes of the rCBF could be reversible in the patientsreceive effective rTMS treatment. The study also demonstrated that the change of rCBFcan be used to evaluate the efficacy of rTMS.