Neurobehavioral mechanisms of social isolation and loneliness in serious mental illness

摘要 严重精神疾病(SMI)最令人衰弱和有害的一些方面是社交孤立 (社交次数少)和2)社交脱节的主观体验(孤独感) 经常伴随这些情况。社会孤立和孤独对日常生活产生了巨大的影响 在SMI中发挥作用，并与总体较差的生活质量和早期死亡率有关。目前有 没有可用的干预措施可以防止或扭转SMI的这些破坏性后果。这可能是在 部分原因是SMI中社交孤立和孤独的潜在神经和心理机制 人们对此知之甚少。然而，最近使用先进的神经成像和数字技术的研究提供的线索 评估方法可以为研究这类机制的新方法提供基础。前期工作 表明客观孤立和孤独是相关的，但也有一定的独立性。近期 神经成像的发现支持这一模型，揭示了社交孤立和孤独都分享和 截然不同的神经关联。然而，也很明显，这些不是静态现象；基于智能手机的 评估显示，社交孤立和孤独的变化是短暂的、动态的。个体差异 在对拒绝的预期中，与短暂的孤独经历有关，更多的回避和 随之而来的是社会孤立的增加。因此，在目前的提案中，我们计划全面衡量 社交孤立和孤独的相对稳定的神经和行为预测指标，以及 在60名患有SMI的个体和60名没有SMI的个体中，这些体验的时刻变化。在目标1中 建议的项目中，我们将展示SMI中较高水平的社交隔离和孤独与 对社会刺激的共享和独特的神经反应，与社会知觉相关的回路反应较低 (内侧颞叶区域)与社会隔离有关，以及奖赏相关回路的较低反应(基础 神经节区域)与孤独有关。在目标2中，我们将测量社会孤立和 采用纵向“爆裂”设计的智能手机评估孤独感。最后，在目标3中，我们将确定 目标1和目标2中确定的社会孤立和孤独的相互关系是如何相互联系的，以及如何与 功能水平，并衡量这些联系随时间的稳定性。因此，在这个项目中，我们计划 为了证明基本的神经和行为过程驱动体验中的瞬间变化 社会孤立和孤独感，并直接影响SMI的功能和生活质量。在后续工作中， 这些发现可以作为研究旨在解决这些问题的新干预措施的量化指标 残疾和早期死亡的主要原因。

Summary Some of the most debilitating and detrimental aspects of serious mental illnesses (SMI) are the 1) social isolation (low numbers of social contacts) and 2) the subjective experiences of social disconnection (loneliness) that frequently accompany these conditions. Social isolation and loneliness have an immense impact on day-to-day functioning in SMI and are associated with an overall poor quality of life and early mortality. Currently there are no available interventions that can prevent or reverse these devastating consequences of SMI. This may be in part because the underlying neural and psychological mechanisms of social isolation and loneliness in SMI are poorly understood. However, recent clues from studies employing advanced neuroimaging and digital assessment approaches can provide the basis for a new approach to investigating such mechanisms. Prior work has indicated that objective isolation and loneliness are correlated but also somewhat independent. Recent neuroimaging findings support this model, revealing that social isolation and loneliness have both shared and distinct neural correlates. However, it is also clear that these are not static phenomena; smartphone-based assessments have revealed transient, dynamic changes in social isolation and loneliness. Individual differences in the anticipation of rejection are associated with momentary experiences of loneliness, greater avoidance and subsequent increases in social isolation. Thus, in the current proposal, we plan to comprehensively measure both the relatively stable neural and behavioral predictors of social isolation and loneliness, as well as the moment-to-moment changes in these experiences, in 60 individuals with SMI and 60 without SMI. In Aim 1 of the proposed project, we will show that the higher levels of social isolation and loneliness in SMI are linked to shared and distinct neural responses to social stimuli, with lower responses of social perception-related circuitry (medial temporal lobe regions) linked to social isolation, and lower responses of reward-related circuitry (basal ganglia regions) linked to loneliness. In Aim 2, we will measure transient changes in social isolation and loneliness with smartphone assessments using a longitudinal “burst” design. Lastly, in Aim 3, we will determine how the correlates of social isolation and loneliness identified in Aims 1 and 2 are linked to each other and to levels of functioning, and measure the stability of these associations over time. Therefore, in this project, we plan to demonstrate that fundamental neural and behavioral processes drive momentary variation in the experience of social isolation and loneliness, and directly impact functioning and quality of life in SMI. In follow-up work, these findings can be used as quantitative targets in studies of novel interventions which aim to address these major causes of disability and early mortality.