Towards objective definition of psychopathology in post-traumatic stress disorder.
Towards objective definition of psychopathology in post-traumatic stress disorder.
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走向创伤后应激障碍精神病理学的客观定义。
DOI：
10.1038/s41386-019-0504-7
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发表时间：
2020
期刊：
影响因子：
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通讯作者：
Etkin,Amit
中科院分区：
文献类型：
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作者：
Etkin,Amit
人类和啮齿动物可以将行动与结果联系起来，并在联系发生变化时修改预期。这些认知适应变化，并可能优化决策。例如，当建筑物挡住我们的道路时，我们可能会修改我们的驾驶路线，或者当我们需要开车时戒酒，并期望这两个行动都能让我们安全回家。跨物种，内侧前额叶皮层区域参与连接行动与有价值的结果，但眶额皮层的贡献仍然存在争议。一个问题是眶额皮质占据了很大的区域，但有时被视为同源结构。一个相关的问题是假设腹内侧亚区，像外侧区一样，专门从事刺激-结果关联（将线索而不是行动与可能的结果联系起来），而不知道行动-结果关联。然而，在神经精神疾病中，决策能力差或异常是很常见的，因此有必要对行动-结果关联如何形成、更新和巩固进行全面剖析。[1]在解决争议方面取得了重要进展。老鼠被训练将两个动作与一个食物奖励联系起来;然后在贬值测试前的几天里，这些动作与不同的独特奖励配对。失活的腹外侧眶额皮质（VLO），无论是在最后的训练日或在随后的探针测试阻止了大鼠的能力，选择行动的基础上的价值，各自的奖励。与此同时，当训练过程中行动-结果偶然事件没有改变时，VLO失活没有影响。在另一项研究中，在小鼠中违反熟悉的行为-结果关联后立即灭活VLO，即使VLO恢复“在线”，也会在随后的测试中阻断最佳反应[2]。因此，VLO似乎是稳定新形成或更新的行动-结果关联所必需的，然后指导未来的行为。
Humans and rodents can associate actions with their outcomes and modify expectations when associations change. These cognitive adaptions accommodate change and presumably optimize decision-making. For example, we might modify our driving route when construction blocks our path or abstain from alcohol when we need to drive, expecting that both actions will deliver us safely home. Across species, medial prefrontal cortical regions are involved in linking actions with valued outcomes, but contributions of the orbitofrontal cortex remain contentious. One issue is that the orbitofrontal cortex occupies a large territory, yet is sometimes treated as a homologous structure. A related concern is the assumption that ventromedial subregions, like lateral regions, specialize in stimulus− outcome associations (linking cues, rather than actions, with likely outcomes) agnostic to action− outcome associations. Nevertheless, poor or aberrant decision-making is commonplace in neuropsychiatric illnesses, necessitating a full dissection of how action-outcome associations form, update, and solidify.Parkes et al.[1] made important in-roads in resolving controversies. Rats were trained to associate two actions with a single food reward; then the actions were paired with different, unique rewards in the days preceding a devaluation test. Inactivation of the ventrolateral orbitofrontal cortex (VLO) either during the final training days or during the subsequent probe test blocked the ability of rats to choose actions based on the value of respective rewards. Meanwhile, VLO inactivation had no effect when action− outcome contingencies had not changed during training. In another investigation, inactivation of the VLO immediately following the violation of a familiar action− outcome association in mice occluded optimal responding in a later test, even when the VLO was back “on-line”[2]. Thus, the VLO appears necessary for stabilizing newly formed or updated action− outcome associations, which then guide future behavior.