Department of Psychiatry, National OCDs Specialist Centre, Hertfordshire Partnership NHS Foundation Trust, Queen Elizabeth II Hospital, Welwyn Garden City, Hertfordshire, UK.
Neuropsychopharmacology. 2010 Feb;35(3):591-604. doi: 10.1038/npp.2009.185. Epub 2009 Nov 25.
Failures in cortical control of fronto-striatal neural circuits may underpin impulsive and compulsive acts. In this narrative review, we explore these behaviors from the perspective of neural processes and consider how these behaviors and neural processes contribute to mental disorders such as obsessive-compulsive disorder (OCD), obsessive-compulsive personality disorder, and impulse-control disorders such as trichotillomania and pathological gambling. We present findings from a broad range of data, comprising translational and human endophenotypes research and clinical treatment trials, focussing on the parallel, functionally segregated, cortico-striatal neural projections, from orbitofrontal cortex (OFC) to medial striatum (caudate nucleus), proposed to drive compulsive activity, and from the anterior cingulate/ventromedial prefrontal cortex to the ventral striatum (nucleus accumbens shell), proposed to drive impulsive activity, and the interaction between them. We suggest that impulsivity and compulsivity each seem to be multidimensional. Impulsive or compulsive behaviors are mediated by overlapping as well as distinct neural substrates. Trichotillomania may stand apart as a disorder of motor-impulse control, whereas pathological gambling involves abnormal ventral reward circuitry that identifies it more closely with substance addiction. OCD shows motor impulsivity and compulsivity, probably mediated through disruption of OFC-caudate circuitry, as well as other frontal, cingulate, and parietal connections. Serotonin and dopamine interact across these circuits to modulate aspects of both impulsive and compulsive responding and as yet unidentified brain-based systems may also have important functions. Targeted application of neurocognitive tasks, receptor-specific neurochemical probes, and brain systems neuroimaging techniques have potential for future research in this field.
皮质控制额纹状体神经回路的失败可能是冲动和强迫行为的基础。在这篇叙述性综述中，我们从神经过程的角度探讨这些行为，并考虑这些行为和神经过程如何导致强迫症（OCD）、强迫型人格障碍和冲动控制障碍等精神障碍，如拔毛癖和病理性赌博。我们介绍了广泛数据的发现，包括转化和人类内表型研究和临床治疗试验，重点关注平行的、功能分离的皮质纹状体神经投射，从眶额皮质（OFC）到内侧纹状体（尾状核），被认为驱动强迫活动，以及从前扣带/腹内侧前额叶皮层到腹侧纹状体（伏隔核壳），被认为驱动冲动活动，以及它们之间的相互作用。我们认为，冲动和强迫性似乎都是多维的。冲动或强迫行为由重叠和不同的神经基质介导。拔毛癖可能是一种运动冲动控制障碍，而病理性赌博则涉及异常的腹侧奖励回路，使其更接近物质成瘾。强迫症表现出运动冲动和强迫性，可能是通过破坏 OFC-尾状核回路介导的，以及其他额叶、扣带和顶叶连接。血清素和多巴胺在这些回路中相互作用，调节冲动和强迫反应的各个方面，而尚未确定的大脑为基础的系统也可能具有重要的功能。神经认知任务、受体特异性神经化学探针和大脑系统神经影像学技术的靶向应用有可能为该领域的未来研究提供潜力。
