Laboratory of Molecular Psychiatry, Universidade Federal do Rio Grande do Sul, Brazil.
Braz J Psychiatry. 2013 Mar;35(1):70-4. doi: 10.1016/j.rbp.2012.09.001.
The use of clinical staging models is emerging as a novel and useful paradigm for diagnosing severe mental disorders. The term "neuroprogression" has been used to define the pathological reorganization of the central nervous system along the course of severe mental disorders. In bipolar disorder (BD), neural substrate reactivity is changed by repeated mood episodes, promoting a brain rewiring that leads to an increased vulnerability to life stress.
A search in the PubMed database was performed with the following terms: "staging", "neuroprogression", "serum", "plasma", "blood", "neuroimaging", "PET scan", "fMRI", "neurotrophins", "inflammatory markers" and "oxidative stress markers", which were individually crossed with "cognition", "functionality", "response to treatments" and "bipolar disorder". The inclusion criteria comprised original papers in the English language. Abstracts from scientific meetings were not included.
We divided the results according to the available evidence of serum biomarkers as potential mediators of neuroprogression, with brain imaging, cognition, functioning and response to treatments considered as consequences.
The challenge in BD treatment is translating the knowledge of neuronal plasticity and neurobiology into clinical practice. Neuroprogression and staging can have important clinical implications, given that early and late stages of the disorder appear to present different biological features and therefore may require different treatment strategies.
临床分期模型的使用正成为诊断严重精神障碍的一种新颖且有用的范式。“神经进展”一词已被用于定义严重精神障碍过程中中枢神经系统的病理性重塑。在双相情感障碍（BD）中，反复的情绪发作改变了神经基质的反应性，促进了大脑的重新布线，从而增加了对生活压力的脆弱性。
在 PubMed 数据库中使用以下术语进行搜索：“分期”、“神经进展”、“血清”、“血浆”、“血液”、“神经影像学”、“正电子发射断层扫描”、“功能磁共振成像”、“神经生长因子”、“炎症标志物”和“氧化应激标志物”，这些术语分别与“认知”、“功能”、“治疗反应”和“双相情感障碍”交叉。纳入标准包括英语原创论文。不包括科学会议的摘要。
我们根据血清生物标志物作为神经进展潜在介质的现有证据进行了结果分类，将脑成像、认知、功能和治疗反应视为后果。
BD 治疗的挑战是将神经元可塑性和神经生物学的知识转化为临床实践。神经进展和分期具有重要的临床意义，因为该疾病的早期和晚期似乎具有不同的生物学特征，因此可能需要不同的治疗策略。
