The role of stress in the pathogenesis and maintenance of obsessive-compulsive disorder.
The role of stress in the pathogenesis and maintenance of obsessive-compulsive disorder.
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DOI：
10.1177/2470547018758043
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发表时间：
2018-01
期刊：
影响因子：
--
通讯作者：
Pittenger C
中科院分区：
文献类型：
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作者：
Adams TG;Kelmendi B;Brake CA;Gruner P;Badour CL;Pittenger C
患有强迫症的人通常认为心理社会压力是加剧症状的一个因素，许多人将症状的发作追溯到生活中的压力时期或离散的创伤事件。然而，压力和强迫症之间的病理生理学关系仍然很差的特点：目前还不清楚是否创伤或压力是一个独立的原因强迫症症状，触发因素，与预先存在的素质，或只是一个非特异性的因素，可以加剧强迫症沿着其他方面的精神病学。尽管如此，临床前研究已经表明，压力对皮质纹状体和边缘系统回路有显着的影响。具体来说，压力会导致额叶皮质（特别是内侧前额叶皮质）、背内侧纹状体（尾状核）和海马体的神经元萎缩。压力也可以导致背外侧纹状体（壳核）和杏仁核中的神经元肥大。这些神经生物学效应反映了强迫症中报告的神经异常，并可能导致目标导向和习惯行为之间的不平衡，这种不平衡与强迫症的发病机制和表现有关。压力对皮质纹状体和边缘系统回路的调节以及由此产生的习惯和目标导向的学习和行为之间的不平衡为研究压力如何加剧或触发强迫症提供了一个框架。
Individuals with obsessive-compulsive disorder often identify psychosocial stress as a factor that exacerbates their symptoms, and many trace the onset of symptoms to a stressful period of life or a discrete traumatic incident. However, the pathophysiological relationship between stress and obsessive-compulsive disorder remains poorly characterized: it is unclear whether trauma or stress is an independent cause of obsessive-compulsive disorder symptoms, a triggering factor that interacts with a preexisting diathesis, or simply a nonspecific factor that can exacerbate obsessive-compulsive disorder along with other aspects of psychiatric symptomatology. Nonetheless, preclinical research has demonstrated that stress has conspicuous effects on corticostriatal and limbic circuitry. Specifically, stress can lead to neuronal atrophy in frontal cortices (particularly the medial prefrontal cortex), the dorsomedial striatum (caudate), and the hippocampus. Stress can also result in neuronal hypertrophy in the dorsolateral striatum (putamen) and amygdala. These neurobiological effects mirror reported neural abnormalities in obsessive-compulsive disorder and may contribute to an imbalance between goal-directed and habitual behavior, an imbalance that is implicated in the pathogenesis and expression of obsessive-compulsive disorder symptomatology. The modulation of corticostriatal and limbic circuits by stress and the resultant imbalance between habit and goal-directed learning and behavior offers a framework for investigating how stress may exacerbate or trigger obsessive-compulsive disorder symptomatology.