The neural bases of obsessive-compulsive disorder in children and adults.
The neural bases of obsessive-compulsive disorder in children and adults.
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DOI：
10.1017/s0954579408000606
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发表时间：
2008
影响因子：
3.3
通讯作者：
Peterson, Badley S.
中科院分区：
文献类型：
--
作者：
Maia, Tiago V.;Cooney, Rebecca E.;Peterson, Badley S.
功能成像研究报告称，强迫症（OCD）患者的眶额皮层（OFC）、前扣带皮层（ACC）和尾状核均表现出显着的一致性过度活跃。这些发现通常被解释为证据，表明涉及 OFC 和 ACC 的皮质基底节丘脑皮质环路异常与强迫症有因果关系。然而，这种解释仍然存在争议，因为这种多动症可能代表症状的原因或结果。本文分析了这些循环在儿童和成人强迫症中的因果作用的证据。文章首先回顾了强迫症患者这些环的解剖异常的有力证据。然而，这些发现不足以确定因果关系，因为解剖结构的改变本身可能是症状的结果而不是原因。文章随后回顾了三类证据，尽管它们有其自身的局限性，但仍允许进行更强有力的因果推论：脑损伤后强迫症的发展、与链球菌感染相关的儿童自身免疫性神经精神疾病，以及减轻强迫症的神经外科病变。来自这些不同研究方向的综合证据支持皮质-基底节-丘脑-皮质环路的因果作用，其中涉及 OFC 和 ACC 在儿童和成人强迫症的发病机制中。
Functional imaging studies have reported with remarkable consistency hyperactivity in the orbitofrontal cortex (OFC), anterior cingulate cortex (ACC), and caudate nucleus of patients with Obsessive-Compulsive Disorder (OCD). These findings have often been interpreted as evidence that abnormalities in cortico-basal ganglia-thalamo-cortical loops involving the OFC and ACC are causally related to OCD. This interpretation remains controversial, however, because such hyperactivity may represent either a cause or a consequence of the symptoms. This article analyzes the evidence for a causal role of these loops in producing OCD in children and adults. The article first reviews the strong evidence for anatomical abnormalities in these loops in patients with OCD. These findings are not sufficient to establish causality, however, because anatomical alterations may themselves be a consequence rather than a cause of the symptoms. The article then reviews three lines of evidence that, despite their own limitations, permit stronger causal inferences: the development of OCD following brain injury, pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection, and neurosurgical lesions that attenuate OCD. Converging evidence from these various lines of research supports a causal role for the cortico-basal ganglia-thalamo-cortical loops that involve the OFC and ACC in the pathogenesis of OCD in children and adults.