Defining biotypes for depression and anxiety based on large-scale circuit dysfunction: a theoretical review of the evidence and future directions for clinical translation.
Defining biotypes for depression and anxiety based on large-scale circuit dysfunction: a theoretical review of the evidence and future directions for clinical translation.
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DOI：
10.1002/da.22556
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发表时间：
2017-01
影响因子：
7.4
通讯作者：
Williams LM
中科院分区：
文献类型：
--
作者：
Williams LM
复杂的情感、认知和自我反思功能依赖于大规模神经回路的激活和连接。这些电路提供了一个相关的规模的重点概念化的分类抑郁症和焦虑症的基础上特定的配置文件（或生物型）的神经回路功能障碍。在这里，理论综述首先概述了目前的共识，即使用分组和荟萃分析确定的人类大脑中大规模电路的组织构成。重点是涉及休息反射（“默认模式”），检测“显着性”，情感处理（“威胁”和“奖励”），“注意力”和“认知控制”的神经回路。接下来，对目前关于这些回路中哪种功能障碍表征抑郁症和焦虑症的证据进行了综述，重点是已发表的荟萃分析和至少在两项把握度良好的病例对照研究中确定的回路功能障碍综述。接地在这些主题的审查，提出了一个概念框架，考虑神经回路定义的“生物型”。在这个框架中，生物型是由每个大规模电路的功能障碍程度的配置文件定义的。被认为是指导分类和治疗抑郁症和焦虑症的生物型方法的临床意义。未来的研究方向将开发神经回路生物型模型的有效性和临床实用性，该模型跨越诊断类别，并有助于将神经科学转化为真实的世界中的临床实践。
Complex emotional, cognitive and self-reflective functions rely on the activation and connectivity of large-scale neural circuits. These circuits offer a relevant scale of focus for conceptualizing a taxonomy for depression and anxiety based on specific profiles (or biotypes) of neural circuit dysfunction. Here, the theoretical review first outlined the current consensus as to what constitutes the organization of large-scale circuits in the human brain identified using parcellation and meta-analysis. The focus is on neural circuits implicated in resting reflection (“default mode”), detection of “salience”, affective processing (“threat” and “reward”), “attention” and “cognitive control”. Next, the current evidence regarding which type of dysfunctions in these circuits characterize depression and anxiety disorders was reviewed, with an emphasis on published meta-analyses and reviews of circuit dysfunctions that have been identified in at least two well-powered case:control studies. Grounded in the review of these topics, a conceptual framework is proposed for considering neural circuit-defined “biotypes”. In this framework, biotypes are defined by profiles of extent of dysfunction on each large-scale circuit. The clinical implications of a biotype approach for guiding classification and treatment of depression and anxiety is considered. Future research directions will develop the validity and clinical utility of a neural circuit biotype model that spans diagnostic categories and helps to translate neuroscience into clinical practice in the real world.
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