认知矫正治疗对精神分裂症患者脑白质弥散张量的影响.ppt
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认知矫正治疗对精神分裂症患者脑白质弥散张量的影响.ppt
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BraineffectsofComputerizedCognitiveRemediationTherapyinschizophrenia:
aDiffusionTensorImagingstudy,Thesisdefenseformastersdegreeofclinicalpsychiatry,Contents,1、Introduction2、Methods3、Results4、Discussion5、Conclusion6、Limitations,1、Introduction,CognitiveimpairmentisoneofthecoresymptomsofSZ.1CRTwasprovedtobeaneffectivewayforcognitivedeficits.2MRIstudiesshowedthatCRTcanimprovebrainactivityandgraymattervoluminpatientswithSZ.,1.KeefeRSE,FentonWS.HowshouldDSM-Vcriteriaforschizophreniaincludecognitiveimpairment?
J.Schizophreniabulletin,2007,33(4):
912-920.2.BellM,FiszdonJ,GreigT,etal.Neurocognitiveenhancementtherapywithworktherapyinschizophrenia:
6-monthfollow-upofneuropsychologicalperformanceJ.JournalofRehabilitationResearch&Development,2007,44(5).,CRTimprovedbrainactivities3,3.BorJ,BrunelinJ,dAmatoT,etal.Howcancognitiveremediationtherapymodulatebrainactivationsinschizophrenia?
:
AnfMRIstudyJ.PsychiatryResearch:
Neuroimaging,2011,192(3):
160-166.,CRTimprovedgraymattervolum4,4.EackSM,HogartyGE,ChoRY,etal.Neuroprotectiveeffectsofcognitiveenhancementtherapyagainstgraymatterlossinearlyschizophrenia:
resultsfroma2-yearrandomizedcontrolledtrialJ.ArchivesofGeneralPsychiatry,2010,67(7):
674.,ThelimitationsofCRT.TherelationshipbetweenCRTandCCRT.BothCCRTandCRTCansignificantlyimprovecognitivefunctionsofpatientswithSZ.5,5.TANShu-ping,ZOUyi-zhuang,WANGJian,etal.Effectsofcognitiveremediationtherapyandcomputerizedcognitiveremediationtherapyoncognitivedeficitsinpatientswithschizophrenia:
arandomizedcontrolledstudyJ.ChinJpaychiatry,2010,43(3):
140-145.,So,canCCRTalsocontributestobrainchanges?
DTIistheonlynon-invasivemethodforcharacterisingthemicrostructuralorganizationofwhitematterintegrityinvivo.6FAisthemainparameterofDTIthatispositivelycorrelatedwithwhitemyelinintegrity、axonsdensityandparallelity.,6.JonesDK,LeemansA.DiffusiontensorimagingM/MagneticResonanceNeuroimaging.HumanaPress,2011:
127-144.,PreviousstudieshaveshownthatpatientswithSZexhibitareducedFAinbroadbrainregions,suchasspleniumandgenuofcorpuscallosum、anteriorcingulate、superiorandmiddlecerebellarpeduncle.7.8ThereducedFAoftheseregionswerecorrelatedwithcognitiveimparement.7.8,7、MagnottaVA,AdixML,CaprahanA,etal.Investigatingconnectivitybetweenthecerebellumandthalamusinschizophreniausingdiffusiontensortractography:
apilotstudyJ.PsychiatryResearch:
Neuroimaging,2008,163(3):
193-200.8、WANGYing,JIAYan-bing,LingXue-ying,etal.DiffusiontensorimaginginpatientswithfirstepisodicschizophreniaJ.ChinJPsychiatry,2008,41
(2):
73-76.,Sowecometothehypothesis:
WehypothesisedthatCCRTcanimprovecognitivefunctioninSZpatients,atthesametimeitwillmaketheFAofthoseregionsincreasing.,2、Methods,Procedures:
Participants:
Patientgroup:
Inclusioncriteria:
1)MetDSM-IVcriteriaforSZ;2)Long-termhospitalizationinpatients;3)Agebetween20y40y;4)Edu9y;5)MMSE27.Exclusioncriteria:
Allsubjectsincludedheadtrauma,substanceabuse,ormedicalorneurologicillnessthatmightaffectimagingmeasureswereexcluded.Healthycontrol:
1)Matchedwithpatientgroupinsex、age、Edu;2)Nomentalornervediseasesintheirrelatives;3)Exclusioncriteriawasthesame.,MRIscanning(GESigna3.0T)Psychologicaltests:
Positiveandnegativesyndromescale,PANSSMini-MentalStateExamination,MMSETrailMakingTest,TMTHopkinsVerbalLearningTest一Revised,HVLT-RWisconsinCardSortingTest,WCSTDigitSpanTest,DSContinuousPerformanceTest,CPT,CCRT:
HealthmenCCRTwasusedhere,itcontainscognitiveshifting、workingmemory、plantraining、socialcognition.Trainingperiods:
6M3/W30Min.DTIdataanalysis:
DICOM2NiiandDTI-Studio,statisticalandanalysis(SPSS12.0):
Firstly,homogeneitytestofvarianceandnormalitytestwereperformed.Thanttestwasperformedtocomparedthedifferencesbetweenandwithingroup.(P0.05),3、Results,Note:
Redstandsforright-left,greenstandsforforward-backward,bluestandsforup-down.,4.Discussion,CCRTandcognitivefunctionCCRTisaneffectivewayforcognitivedeficits.CRTcanprotectthefunctionthathaventbeendestroyed.9SowebelieveCCRTcanbeapreventivemeasureforcognitiveimpairmentinSZ.,9、EackS,GreenwaldD,HogartyS,etal.Cognitiveenhancementtherapyforearly-courseschizophrenia:
effectsofatwo-yearrandomizedcontrolledtrialJ.PsychiatricServices,2009,60(11):
1468-1476.,CCRTandPANSSCCRTrarelyeffectspsychiatrysymptoms.10Ifthecourseoftreatmentlastslongenough,theeffectswillappear.11,10、DickinsonD,TenhulaW,MorrisS,etal.ARandomizedControlledTrialofComputer-AssistedCognitiveRemediationforSchizophrenia.AmJPaychiatry,2009,167
(2):
170-180.11、EackSM,RaquelleI.Mesholam-gately,DeborahP.Greenwald,etal.Negativesymptomimprovementduringcognitiverehabilitation:
Resultsfromatwo-yeartrialofCognitiveEnhancementTherapy.PsychiatryResearch,2013,209
(1):
21-26.,SZandDTI“Disconnection”maybetheneuropathologyunderSZ.12anteriorcingulatecorpuscallosumFAsuperiorcerebellarpeduncle,12、Pettersson-yeoW,AllenP,BenttiS,etal.Dysconnectivityinschizophrenia:
Wherearewenow?
NeurosciBiobehavRev,2011,35:
1110-1124.,Anteriorcingulatelinkswithorbitofrontalcortex、parahippocampal、corpusstriatum,iftheintegritywasdamaged,itwillaffectattention、workingmemoryandmoodregulationfunction.13、14,13、TaylorKS,SeminowiczDA,DavisKD.Towsystemsofrestingstateconnectivitybetweentheinsulaandcingulatecortex.HumanBrainMapp,2009,30:
2731-2745.14、KubickiM,WestinCF,NestorPG,etal.Cingulatefasciculusintegritydisruptioninschizophrenia:
amagneticresonancediffusiontensorimagingstudyJ.Biologicalpsychiatry,2003,54(11):
1171-1180.,Corpuscallosumdisorderwillinduceabnormalthought.15EarlycourseSZhaventfoundcorpuscallosumFAdecrease16,butinourchronicSZthechangesisobviously.,15、WhitfordTJ,KubickiM,SchneidermanJS,etal.CorpuscallosumabnormalitiesandtheirassociationwithpsychoticsymptomsinpatientswithschizophreniaJ.Biologicalpsychiatry,2010,68
(1):
70-77.16、TangJ,LiaoY,ZhouB,eta1.Abnormalanteriorcingulumintegrityinfirstepisode,early-onsetschizophrenia:
adiffusiontensorimagingstudy.BrainRes,2010,1343:
199-205.,Superiorcerebellarpeduncleisthemainaccessbetweencerebralcortexandthalamus,thedecreasedFAwasrelatedtocognitivefunction.17SuperiorcerebellarpeduncleFAiscorrelatedwithMovementSequencing.18,17、OkugawaG,NobuharaK,MinamiT,etal.Neuraldisorganizationinthesuperiorcerebellarpeduncleandcognitiveabnormalityinpatientswithschizophrenia:
AdiffusiontensorimagingstudyJ.ProgNeuropsychopharmacolBiolPsychiatry,2006,30(8):
1408-1412.18、HttlovaJ,KikinisZ,KerkovskyM,etal.AbnormalitiesinMyelinationoftheSuperiorCerebellarPeduncleinPatientswithSchizophreniaandDeficitsinMovementSequencingJ.TheCerebellum,2014:
1-10.,CCRTandDTIWehaventfoundanyincreaseofFAinSZ.OnerecentstudyrevealedthatgenuandbodyofcorpuscallosumFAgotaobviouslyimprovement.13,13、PenadesR,PujolN,CatalanR,etal.BrainEffectsofCognitiveRemediationTherapyinSchizophrenia:
AStructuralandFunctionalNeuroimagingStudy.BIOLPSYCHIATRY2013,73:
10151023.,5.Conclusion,CCRTcanimprovecognitivefunctioninSZ.SZhadareductionofFAatbilateralspleniumofcorpuscallosum、bilateralanteriorcingulate、leftsuperiorcerebellarpeduncle.CCRTcanhardlyimprovetheintegrityofwhitematterinchronicSZ.,6.Limitations,ChroniccourseAnti-psychoticsImagingprocessing,Thankyouverymuch!
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- 认知 矫正 治疗 精神分裂症 患者 白质 弥散 张量 影响