Harmonizing the Neurobiology and Treatment of Obsessive-Compulsive Disorder.
Harmonizing the Neurobiology and Treatment of Obsessive-Compulsive Disorder.
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DOI：
10.1176/appi.ajp.2020.20111601
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发表时间：
2021-01-01
期刊：
影响因子：
--
通讯作者：
Sheth SA
中科院分区：
文献类型：
--
作者：
Goodman WK;Storch EA;Sheth SA
强迫症 (OCD) 是一种常见、慢性且常常致残的疾病。唯一确定的强迫症一线治疗方法是暴露和反应预防以及血清素再摄取抑制剂药物 (SRI)。然而，一部分患者对任何一种治疗方式都没有反应，并且很少有患者获得完全缓解。除了 SRI 单一疗法之外，抗精神病药物强化疗法是唯一具有大量经验支持的强迫症治疗方法。我们对强迫症的神经生物学的不完全了解阻碍了开发新疗法或加强现有干预措施的努力。本综述重点关注几个有前景的研究领域，这些领域可能有助于阐明强迫症的病理生理学和推进治疗。多项研究支持强迫症的显着遗传因素，但查明具体的遗传决定因素需要进一步的研究。 SRIs 在 OCD 中的优先功效既没有导致 OCD 中血清素能异常的发现，也没有导致新的 OCD 血清素能药物的开发。一些临床前和临床证据表明强迫症患者的谷氨酸能系统功能障碍，促使人们对几种有前途的谷氨酸调节剂进行测试。强迫症的功能成像研究显示，形成皮质-纹状体-丘脑-皮质（CSTC）环路的大脑区域活动增加的一致证据。使用非侵入性设备（例如经颅磁刺激）或侵入性手术（例如深部脑刺激）进行的神经调节治疗为 OCD 的 CSTC 模型提供了进一步的支持。各种干预措施（无论是药物、行为还是设备）的共同基础可能是调节（在不同节点或连接处）介导 OCD 症状的 CSTC 回路。
Obsessive-compulsive disorder (OCD) is a common, chronic, and oftentimes disabling disorder. The only established first-line treatments for OCD are exposure and response prevention, and serotonin reuptake inhibitor medications (SRIs). However, a subset of patients fails to respond to either modality, and few experience complete remission. Beyond SRI monotherapy, antipsychotic augmentation is the only medication approach for OCD with substantial empirical support. Our incomplete understanding of the neurobiology of OCD has hampered efforts to develop new treatments or enhance extant interventions. This review focuses on several promising areas of research that may help elucidate the pathophysiology of OCD and advance treatment. Multiple studies support a significant genetic contribution to OCD, but pinpointing the specific genetic determinants requires additional investigation. The preferential efficacy of SRIs in OCD has neither led to discovery of serotonergic abnormalities in OCD nor to development of new serotonergic medications for OCD. Several lines of preclinical and clinical evidence suggest dysfunction of the glutamatergic system in OCD, prompting testing of several promising glutamate modulating agents. Functional imaging studies in OCD show consistent evidence for increased activity in brain regions that form a cortico-striato-thalamo-cortical (CSTC) loop. Neuromodulation treatments with either noninvasive devices (e.g., transcranial magnetic stimulation) or invasive procedures (e.g., deep brain stimulation) provide further support for the CSTC model of OCD. A common substrate for various interventions (whether drug, behavioral, or device) may be modulation (at different nodes or connections) of the CSTC circuit that mediates the symptoms of OCD.
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影响因子：
11
作者：
International Obsessive Compulsive Disorder Foundation Genetics Collaborative (IOCDF-GC) and OCD Collaborative Genetics Association Studies (OCGAS)
通讯作者：
International Obsessive Compulsive Disorder Foundation Genetics Collaborative (IOCDF-GC) and OCD Collaborative Genetics Association Studies (OCGAS)
影响因子：
10.6
作者：
Bergqvist, PBF;Bouchard, C;Blier, P
通讯作者：
Blier, P
影响因子：
4.4
作者：
Adam, Yuki;Meinlschmidt, Gunther;Lieb, Roselind
通讯作者：
Lieb, Roselind
影响因子：
25.8
作者：
Beucke, Jan C.;Sepulcre, Jorge;Kathmann, Norbert
通讯作者：
Kathmann, Norbert
影响因子：
3.5
作者：
Bourne SK;Eckhardt CA;Sheth SA;Eskandar EN
通讯作者：
Eskandar EN