The neuropsychiatry of impulsivity
The neuropsychiatry of impulsivity
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DOI：
10.1097/yco.0b013e3280ba4989
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发表时间：
2007-05-01
影响因子：
6.9
通讯作者：
Sahakian, Barbara J.
中科院分区：
文献类型：
--
作者：
Chamberlain, Samuel R.;Sahakian, Barbara J.
冲动症状发生在神经精神疾病中，对日常功能和生活质量有重要影响。本文考虑了冲动的神经心理学评估的最新进展，重点是抑制运动反应的能力（反应抑制）。通过客观测试，反应抑制缺陷在几种与冲动相关的神经精神疾病中被确定，即注意缺陷多动障碍、拔毛癖、强迫症和慢性药物滥用。在注意缺陷多动障碍和强迫症患者未受影响的一级亲属中也发现了缺陷。来自局灶性脑病变患者和健康志愿者的证据，使用功能性MRI和经颅刺激表明，右侧额下回参与反应抑制。5 -羟色胺系统的药理学操作对反应抑制没有可检测的行为影响，而去甲肾上腺素系统的操作有。神经心理学评估在冲动及其脑底物的研究中显示出巨大的前景。这些结果支持了反应抑制在冲动表现中的关键作用，这是一种与右侧额下回有关的功能。反应抑制的措施将有助于寻找精神疾病的内表型、新的治疗方法和更优的神经精神疾病诊断分类系统。
Purpose of review Impulsive symptoms occur across neuropsychiatric disorders, with important ramifications for everyday functioning and quality of life. This article considers recent developments in the neuropsychological assessment of impulsivity with a focus on the ability to suppress motor responses (response inhibition).Recent findings Using objective tests, response inhibition deficits were identified in several neuropsychiatric conditions associated with impulsivity, namely attention deficit hyperactivity disorder, trichotillomania, obsessive-compulsive disorder, and chronic substance abuse. Deficits were also found in unaffected first-degree relatives of attention deficit hyperactivity disorder and obsessive-compulsive disorder patients. Evidence from patients with focal brain lesions and from healthy volunteers using functional MRI and transcranial stimulation implicated the right inferior frontal gyrus in response inhibition. Pharmacological manipulations of the serotonin system had no detectable behavioural effects on response inhibition, whereas manipulations of the noradrenaline system did.Summary Neuropsychological assessment shows great promise in the investigation of impulsivity and its brain substrates. These results support a key role for response inhibition, a function linked to the right inferior frontal gyrus, in the manifestation of impulsivity. Measures of response inhibition will contribute to the search for psychiatric endophenotypes, novel treatments, and more optimal diagnostic classification systems for neuropsychiatric disorders.