Elevated reward-related neural activation as a unique biological marker of bipolar disorder: assessment and treatment implications.
Elevated reward-related neural activation as a unique biological marker of bipolar disorder: assessment and treatment implications.
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DOI：
10.1016/j.brat.2014.08.011
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发表时间：
2014-11
影响因子：
4.1
通讯作者：
Damme KS
中科院分区：
文献类型：
--
作者：
Nusslock R;Young CB;Damme KS
越来越多的证据表明，双相情感障碍的风险特征是涉及腹侧纹状体和眶额皮质等区域的额纹状体奖励神经回路的激活升高。有人提出，奖励相关神经激活异常升高的个体在涉及奖励或目标奋斗和实现的生活事件中，面临着与方法相关的动机过度增加的风险。在极端情况下，这种动机的增加反映在轻躁狂/躁狂症状中。相比之下，单相抑郁症（没有轻躁狂/躁狂史）的特点是奖赏反应性降低和奖赏相关神经激活减少。总的来说，这表明双相情感障碍和单相抑郁症的风险特征是奖励处理和奖励相关神经激活的不同和相反的特征。本文的目标有三个。首先，我们回顾了双相情感障碍的奖励处理和奖励相关神经激活的文献，特别是轻躁狂/躁狂的风险。其次，我们提出，与奖励相关的神经激活反映了双相情感障碍与单相抑郁差异风险的生物标志物，这可能有助于促进精神病学评估和鉴别诊断。然而，我们还讨论了在临床环境中使用神经科学技术和生物标记物进行评估和诊断的挑战。最后，我们讨论双相情感障碍奖励相关神经激活研究的药理学和心理社会治疗意义。
Growing evidence indicates that risk for bipolar disorder is characterized by elevated activation in a fronto-striatal reward neural circuit involving the ventral striatum and orbitofrontal cortex, among other regions. It is proposed that individuals with abnormally elevated reward-related neural activation are at risk for experiencing an excessive increase in approach-related motivation during life events involving rewards or goal striving and attainment. In the extreme, this increase in motivation is reflected in hypomanic/manic symptoms. By contrast, unipolar depression (without a history of hypomania/mania) is characterized by decreased reward responsivity and decreased reward-related neural activation. Collectively, this suggests that risk for bipolar disorder and unipolar depression are characterized by distinct and opposite profiles of reward processing and reward-related neural activation. The objective of the present paper is threefold. First, we review the literature on reward processing and reward-related neural activation in bipolar disorder, and in particular risk for hypomania/mania. Second, we propose that reward-related neural activation reflects a biological marker of differential risk for bipolar disorder versus unipolar depression that may help facilitate psychiatric assessment and differential diagnosis. We also discuss, however, the challenges to using neuroscience techniques and biological markers in a clinical setting for assessment and diagnostic purposes. Lastly, we address the pharmacological and psychosocial treatment implications of research on reward-related neural activation in bipolar disorder.
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