Reward processing dysfunction in major depression, bipolar disorder and schizophrenia.
Reward processing dysfunction in major depression, bipolar disorder and schizophrenia.
复制标题
DOI：
10.1097/yco.0000000000000122
复制
发表时间：
2015-01
影响因子：
6.9
通讯作者：
Pizzagalli DA
中科院分区：
文献类型：
--
作者：
Whitton AE;Treadway MT;Pizzagalli DA
本文回顾了有关重度抑郁症、躁郁症和精神分裂症奖励处理功能障碍的最新文献，重点关注方法动机、奖励学习和基于奖励的决策。新的证据表明所有三种疾病都存在奖励处理异常，支持跨诊断方法。特别是，研究结果与异常阶段性纹状体多巴胺信号传导的作用一致，这对于强化学习、有效动员努力以获得奖励以及将注意力分配到奖励预测线索至关重要。具体来说，与奖励相关的纹状体信号在重度抑郁症和精神分裂症的阴性症状中显得迟钝，在双相（低）躁狂症中升高，并且在精神病的阳性症状中错配。然而，这三种疾病是否共有或不同的病理生理机制导致纹状体信号传导异常仍不清楚。重度抑郁症、双相情感障碍和精神分裂症中奖赏处理异常的新证据使人们更好地了解与这些疾病中常见症状（例如快感缺乏）相关的神经过程。剖析奖励处理的各个子组成部分，这些子组成部分映射到部分不同的神经生物学途径，并研究它们在不同精神疾病中的失调，有望开发出更有针对性、更有效的治疗和干预策略。
This article reviews the recent literature on reward processing dysfunction in major depression, bipolar disorder and schizophrenia, with a focus on approach motivation, reward learning, and reward-based decision-making. Emerging evidence indicates the presence of reward processing abnormalities across all three disorders, supporting a transdiagnostic approach. In particular, findings are consistent with a role of abnormal phasic striatal dopamine signaling, which is critical for reinforcement learning, efficient mobilization of effort to obtain reward, and allocation of attention to reward-predictive cues. Specifically, reward-related striatal signaling appears blunted in major depression and the negative symptoms of schizophrenia, elevated in bipolar (hypo)mania, and contextually misallocated in the positive symptoms of psychosis. However, whether shared or distinct pathophysiological mechanisms contribute to abnormal striatal signaling across the three disorders remains unknown. New evidence of reward processing abnormalities in major depression, bipolar disorder and schizophrenia has led to a greater understanding of the neural processes associated with symptomatology common across these conditions (e.g., anhedonia). Dissecting various subcomponents of reward processing that map onto partially different neurobiological pathways and investigating their dysregulation in different psychiatric disorders holds promise for developing more targeted, and hopefully efficacious treatment and intervention strategies.