Identification of a common neurobiological substrate for mental illness.
Identification of a common neurobiological substrate for mental illness.
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确定精神疾病的一种常见神经生物学基础。
DOI：
10.1001/jamapsychiatry.2014.2206
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发表时间：
2015-04
期刊：
影响因子：
25.8
通讯作者：
Etkin A
中科院分区：
文献类型：
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作者：
Goodkind M;Eickhoff SB;Oathes DJ;Jiang Y;Chang A;Jones-Hagata LB;Ortega BN;Zaiko YV;Roach EL;Korgaonkar MS;Grieve SM;Galatzer-Levy I;Fox PT;Etkin A
精神病诊断目前是根据一系列特定症状来区分的。然而，遗传和临床分析发现，在各种各样的诊断中存在相似之处，这表明精神疾病可能存在共同的神经生物学底物。对多种精神病诊断的结构神经影像学研究进行荟萃分析，然后对3个大规模健康参与者数据集进行平行分析，以帮助解释荟萃分析中的结构发现。检索PubMed，以确定截至2012年7月比较精神病患者与健康对照个体的基于体素的形态测量学研究，以进行荟萃分析。3个平行的健康受试者数据集包括静息状态功能磁共振成像，数千个神经成像实验的激活灶数据库，以及结构成像和认知任务表现数据的数据集。如果研究报告了轴I诊断患者和对照个体之间在全脑立体定向坐标中基于体素的形态测量学差异，并且主要不存在于儿童期，并且至少有10项研究有助于该诊断（或在密切相关的诊断中），则将其纳入荟萃分析。使用激活似然估计方法对峰值体素坐标进行荟萃分析。我们测试了轴I诊断中常见的灰质体积增加或减少的区域，以及诊断之间的差异区域。对其他健康参与者数据集的后续分析测试了与荟萃分析产生的区域相关的连接性以及灰质体积与认知的关系。基于对193项研究的基于体素的形态测量学荟萃分析，包括6个不同诊断组（精神分裂症，双相情感障碍，抑郁症，成瘾，强迫症和焦虑症）的15892名个体，我们发现灰质损失在3个区域的诊断中收敛：背侧前扣带回，右侧扣带回和左侧扣带回。相比之下，几乎没有诊断特异性效应，仅将精神分裂症和抑郁症与其他诊断区分开来。在对3个独立的健康参与者数据集的平行随访分析中，我们发现，在任务期间和休息时，常见的灰质损失区域形成了一个紧密相连的网络，并且该网络中的较低灰质与执行功能低下有关。我们确定了一个一致的精神病诊断的完整性方面的前扣带回/背侧前扣带回为基础的网络，这可能与执行功能缺陷的诊断。这种一致性提供了一个组织模型，强调共享的神经基板在精神病理学的重要性，尽管可能的病因，这是目前还没有一个明确的组成部分精神病分类。
Psychiatric diagnoses are currently distinguished based on sets of specific symptoms. However, genetic and clinical analyses find similarities across a wide variety of diagnoses, suggesting that a common neurobiological substrate may exist across mental illness. To conduct a meta-analysis of structural neuroimaging studies across multiple psychiatric diagnoses, followed by parallel analyses of 3 large-scale healthy participant data sets to help interpret structural findings in the meta-analysis. PubMed was searched to identify voxel-based morphometry studies through July 2012 comparing psychiatric patients to healthy control individuals for the meta-analysis. The 3 parallel healthy participant data sets included resting-state functional magnetic resonance imaging, a database of activation foci across thousands of neuroimaging experiments, and a data set with structural imaging and cognitive task performance data. Studies were included in the meta-analysis if they reported voxel-based morphometry differences between patients with an Axis I diagnosis and control individuals in stereotactic coordinates across the whole brain, did not present predominantly in childhood, and had at least 10 studies contributing to that diagnosis (or across closely related diagnoses). The meta-analysis was conducted on peak voxel coordinates using an activation likelihood estimation approach. We tested for areas of common gray matter volume increase or decrease across Axis I diagnoses, as well as areas differing between diagnoses. Follow-up analyses on other healthy participant data sets tested connectivity related to regions arising from the meta-analysis and the relationship of gray matter volume to cognition. Based on the voxel-based morphometry meta-analysis of 193 studies comprising 15 892 individuals across 6 diverse diagnostic groups (schizophrenia, bipolar disorder, depression, addiction, obsessive-compulsive disorder, and anxiety), we found that gray matter loss converged across diagnoses in 3 regions: the dorsal anterior cingulate, right insula, and left insula. By contrast, there were few diagnosis-specific effects, distinguishing only schizophrenia and depression from other diagnoses. In the parallel follow-up analyses of the 3 independent healthy participant data sets, we found that the common gray matter loss regions formed a tightly interconnected network during tasks and at resting and that lower gray matter in this network was associated with poor executive functioning. We identified a concordance across psychiatric diagnoses in terms of integrity of an anterior insula/dorsal anterior cingulate-based network, which may relate to executive function deficits observed across diagnoses. This concordance provides an organizing model that emphasizes the importance of shared neural substrates across psychopathology, despite likely diverse etiologies, which is currently not an explicit component of psychiatric nosology.