Chamberlain Samuel R, Sahakian Barbara J
aDepartment of Psychiatry, University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital, Cambridge, UK.
Curr Opin Psychiatry. 2007 May;20(3):255-61. doi: 10.1097/YCO.0b013e3280ba4989.
Impulsive symptoms occur across neuropsychiatric disorders, with important ramifications for everyday functioning and quality of life. This article considers recent developments in the neuropsychological assessment of impulsivity with a focus on the ability to suppress motor responses (response inhibition).
Using objective tests, response inhibition deficits were identified in several neuropsychiatric conditions associated with impulsivity, namely attention deficit hyperactivity disorder, trichotillomania, obsessive-compulsive disorder, and chronic substance abuse. Deficits were also found in unaffected first-degree relatives of attention deficit hyperactivity disorder and obsessive-compulsive disorder patients. Evidence from patients with focal brain lesions and from healthy volunteers using functional MRI and transcranial stimulation implicated the right inferior frontal gyrus in response inhibition. Pharmacological manipulations of the serotonin system had no detectable behavioural effects on response inhibition, whereas manipulations of the noradrenaline system did.
Neuropsychological assessment shows great promise in the investigation of impulsivity and its brain substrates. These results support a key role for response inhibition, a function linked to the right inferior frontal gyrus, in the manifestation of impulsivity. Measures of response inhibition will contribute to the search for psychiatric endophenotypes, novel treatments, and more optimal diagnostic classification systems for neuropsychiatric disorders.
冲动症状在多种神经精神疾病中均有出现，对日常功能和生活质量有重要影响。本文探讨了冲动性神经心理学评估的最新进展，重点关注抑制运动反应的能力（反应抑制）。
通过客观测试，在与冲动性相关的几种神经精神疾病中发现了反应抑制缺陷，即注意力缺陷多动障碍、拔毛癖、强迫症和慢性药物滥用。在注意力缺陷多动障碍和强迫症患者未受影响的一级亲属中也发现了缺陷。来自局灶性脑损伤患者和使用功能磁共振成像及经颅刺激的健康志愿者的证据表明，右侧额下回与反应抑制有关。血清素系统的药物操作对反应抑制没有可检测到的行为影响，而去甲肾上腺素系统的操作则有影响。
神经心理学评估在冲动性及其脑基质的研究中显示出巨大潜力。这些结果支持反应抑制在冲动性表现中的关键作用，反应抑制这一功能与右侧额下回相关。反应抑制测量将有助于寻找精神疾病的内表型、新治疗方法以及更优化的神经精神疾病诊断分类系统。
