Addictions Neuroclinical Assessment: A Neuroscience-Based Framework for Addictive Disorders.
Addictions Neuroclinical Assessment: A Neuroscience-Based Framework for Addictive Disorders.
复制标题
成瘾神经临床评估：基于神经科学的成瘾性疾病框架。
DOI：
10.1016/j.biopsych.2015.10.024
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发表时间：
2016-08-01
影响因子：
10.6
通讯作者：
Goldman D
中科院分区：
文献类型：
--
作者：
Kwako LE;Momenan R;Litten RZ;Koob GF;Goldman D
本文提出了一个启发式的框架成瘾神经临床评估（ANA），包括来自成瘾的神经回路的关键功能域。我们回顾了成瘾性疾病（AD）目前的诊断，以及需要新的神经临床措施，以区分患者谁符合临床标准成瘾相同的代理，而不同的病因，预后和治疗反应。需要更好地理解的机制，挑起和维持成瘾，证明了目前的治疗和诊断内的临床异质性的局限性，阐明。此外，最近的变化，在疾病分类的AD，挑战目前的分类系统，和以前的尝试与AD亚型的个人进行了描述。补充措施，包括研究领域标准（RDoC）项目，建立了精神疾病的神经科学框架，进行了讨论。三个领域，执行功能，激励显着性和负面情绪，与成瘾循环的不同阶段联系在一起，形成了AD的核心功能元素。在流行病学、遗传学、临床和治疗研究中对这些领域的测量将为理解成瘾的跨人群和时间变化、成瘾性疾病的共同机制、变化的环境影响的影响和基因鉴定提供基础。最后，我们表明，这是实际的，以实现这样一个深刻的神经临床评估使用神经影像学和性能指标的组合。神经临床评估是在过程和病因学的基础上重新概念化AD疾病分类的关键，这一进步可以改善预防和治疗。
This paper proposes a heuristic framework for an Addictions Neuroclinical Assessment (ANA) that incorporates key functional domains derived from the neurocircuitry of addiction. We review how addictive disorders (AD) are presently diagnosed, and the need for new neuroclinical measures to differentiate patients who meet clinical criteria for addiction to the same agent while differing in etiology, prognosis and treatment response. The need for a better understanding of the mechanisms provoking and maintaining addiction, as evidenced by the limitations of current treatments and within-diagnosis clinical heterogeneity, is articulated. In addition, recent changes in the nosology of AD, challenges to current classification systems, and prior attempts to subtype individuals with AD are described. Complementary initiatives, including the Research Domain Criteria (RDoC) project, which have established frameworks for the neuroscience of psychiatric disorders, are discussed. Three domains, executive function, incentive salience, and negative emotionality, tied to different phases in the cycle of addiction, form the core functional elements of AD. Measurement of these domains in epidemiologic, genetic, clinical, and treatment studies will provide the underpinnings for an understanding of cross-population and temporal variation in addictions, shared mechanisms in addictive disorders, impact of changing environmental influences, and gene identification. Finally, we show that it is practical to implement such a deep neuroclinical assessment using a combination of neuroimaging and performance measures. Neuroclinical assessment is key to reconceptualizing the nosology of AD on the basis of process and etiology, an advance that can lead to improved prevention and treatment.