Generalized and Specific Neurocognitive Deficits in Psychotic Disorders: Utility for Evaluating Pharmacological Treatment Effects and as Intermediate Phenotypes for Gene Discovery
Generalized and Specific Neurocognitive Deficits in Psychotic Disorders: Utility for Evaluating Pharmacological Treatment Effects and as Intermediate Phenotypes for Gene Discovery
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DOI：
10.1093/schbul/sbu013
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发表时间：
2014-05-01
影响因子：
6.6
通讯作者：
Sweeney, John A.
中科院分区：
文献类型：
--
作者：
Reilly, James L.;Sweeney, John A.
越来越多的研究表明，精神分裂症和双相情感障碍具有重叠的临床、神经生物学和遗传特征，这提出了关于这两种主要精神障碍的界限和区别性的重要问题。一直以来，人们都认为全身性认知障碍是精神分裂症的核心特征。最近，认知障碍也出现在双相情感障碍中，特别是那些有精神病症状史的患者，这一点变得很明显。一系列精神障碍是否存在全面性缺陷还不太清楚。此外，在广泛损害的背景下，确定特定认知过程中的缺陷仍然是一个重大挑战，这些缺陷可能具有不同的神经化学或区域脑底物，并与特定的风险相关遗传因素有关。在这篇文章中，我们回顾了包括精神分裂症、分裂情感障碍和双相情感障碍在内的一系列神经心理学研究的结果，并得出结论，现有证据有力地支持了精神障碍存在普遍缺陷，这些精神障碍在严重程度上的差异大于形式上的差异。然后，我们考虑了精神病中普遍的和特定的缺陷对两个研究领域的影响--针对认知缺陷的药物治疗的评估，以及在家族遗传学研究中对认知中间表型的调查。文中提供了文献中涉及这些情况下普遍缺陷的相关性的例子，并考虑到继续需要确定可与普遍缺陷分开的具体损害，以便促进药物和基因的发现。
A growing body of research suggests that schizophrenia and bipolar disorder share overlapping clinical, neurobiological, and genetic features, raising important questions about the boundaries and distinctiveness of these 2 major psychiatric disorders. A generalized cognitive impairment has long been understood to be a core feature of schizophrenia. More recently, it has become apparent that cognitive impairment also occurs in bipolar disorder, particularly in those patients with a history of psychotic symptoms. Whether a generalized deficit exists across a spectrum of psychotic disorders is less clearly established. Additionally, in the context of a broad impairment, it remains a significant challenge to identify deficits in specific cognitive processes that may have distinct neurochemical or regional brain substrates and linkages to particular risk-associated genetic factors. In this article, we review the findings from neuropsychological studies across a spectrum that includes schizophrenia, schizoaffective and bipolar disorders, and conclude the available evidence strongly supports that a generalized deficit is present across psychotic disorders that differs in severity more so than form. We then consider the implications of generalized and specific deficits in psychosis for 2 areas of research-the evaluation of pharmacological treatments targeting cognitive deficits, and the investigation of cognitive intermediate phenotypes in family genetic studies. Examples from the literature that touch on the relevance of the generalized deficit in these contexts are provided, as well as consideration for the continued need to identify specific impairments that are separable from the generalized deficit in order to advance drug and gene discovery.