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Anatomical MRI findings in mood and anxiety disorders

  • Paolo Brambilla (a1) (a2) (a3), Francesco Barale (a1), Edgardo Caverzasi (a1) and Jair Constante Soares (a2)
Summary

ObjectiveIn vivo structural magnetic resonance imaging (MRI) studies have evaluated the brain anatomy of various psychiatric disorders, allowing the investigation of putative abnormal brain circuits possibly involved in the patophysiology of psychiatric disorders. Here we reviewed the structural MRI literature in mood and anxiety disorders. Methods – All anatomical MRI studies evaluating mood and anxiety disorder patients were identified through a comprehensive Medline search conducted for the period from 1966 to January 2002, and a manual search of bibliographic cross-referencing complemented the Medline search. Results – Differential patterns of anatomical brain abnormalities appear to be involved in subtypes of mood disorders, with hippocampus and basal ganglia being abnormal in unipolar disorder, and amygdala and cerebellum in bipolar disorders, suggesting that these two mood disorders are biologically distinct. As for anxiety disorders, orbital frontal regions and basal ganglia have been reported to be anatomically abnormal in obsessive-compulsive disorder, temporal lobe was found to be abnormally reduced in panic disorder, and abnormal hippocampus shrinkage was shown in posttraumatic stress disorder. Conclusions – The structural MRI findings reviewed here suggest abnormalities in specific brain regions participating in proposed neuroanatomic models possibly involved in the pathophysiology of mood disorders and anxiety disorders. Nonetheless, available MRI studies have suffered from limitations related to relatively small patient samples and involvement of medicated patients, and were largely cross-sectional investigations. Therefore, longitudinal MRI studies involving more sizeable samples of drug-free patients, patients at first episode of illness or at high risk for mood or anxiety disorders, associated to genetic studies, are likely to be extremely valuable to separate state from trait brain abnormalities and to characterize further the pathophysiology of these disorders.

Scopo – Gli studi con Risonanza Magnetica Nucleare (RMN) hanno permesso la valutazione in vivo dell'anatomia cerebrale di vari disturbi psichiatrici e l'approfondimento degli ipotetici circuiti cerebrali disfunzionali coinvolti nella patofisiologia di queste malattie. In questo articolo abbiamo revisionato la letteratura comprendente gli studi con RMN condotti nei disturbi dell'umore e d'ansia. Metodi – Tutti gli studi in Inglese con RMN condotti in pazienti con disturbo dell'umore o d'ansia pubblicati tra il 1966 ed il gennaio 2002 sono stati identificati attraverso una ricerca Medline, completata dall'analisi manuale delle referenze bibliografiche. Risultati – Differenti aree anatomiche cerebrali sembrano essere coinvolte nei diversi sottotipi di disturbo dell'umore. Infatti, l'ippocampo ed i gangli della base sembrano essere anormali nei disturbo unipolare, mentre l'amigdala ed il cervelletto in quello bipolare. Questo suggerisce che le due malattie abbiano un substrata biologico distinto. Per quanto riguarda i disturbi d'ansia, le regioni orbito-frontali ed i gangli della base sembrano avere un'anatomia anormale nei disturbo ossessivo-compulsivo, i lobi temporali nei disturbo da attacchi di panico e l'ippocampo nei disturbo post-traumatico da stress. Conclusioni – I dati della letteratura riassunti in questo articolo suggeriscono che specifiche aree cerebrali siano coinvolte nella patofisiologia dei disturbi dell'umore e d'ansia. Tuttavia, gli studi a tutt'oggi a disposizione sono stati condotti su campioni relativamente piccoli di soggetti, spesso sottoposti a medicamenti psicotropi, e sono in gran parte studi trasversali. Per tale motivo gli studi con RMN in futuro dovranno avere un disegno di tipo longitudinale ed arruolare campioni più ampi di soggetti, possibilmente senza trattamento psicofarmacologico, al primo episodio di malattia o ad alto rischio di sviluppare un disturbo dell'umore o d'ansia. Inoltre, l'associazione di questo tipo di ricerche con studi di tipo genetico potranno essere estremamente utili per separare anomalie anatomiche cerebrali di stato da quelle di tratto e per ulteriormente caratterizzare la patofisiologia di questi disturbi.

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Corresponding author
Indirizzo per la corrispondenza: Dr. P. Brambilla, Dipartimento di Psichiatria, Università degli Studi di Pavia, IRCCS S. Matteo, Pavia. Fax: +39-0382-680.0936 E-mail: brambillapf@tiscalinet.it
References
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