Rutherford Bret R, Taylor Warren D, Brown Patrick J, Sneed Joel R, Roose Steven P
Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute.
Vanderbilt University Medical Center, Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs, Tennessee Valley Health Care Center.
J Gerontol A Biol Sci Med Sci. 2017 Mar 1;72(3):343-352. doi: 10.1093/gerona/glw241.
Advances in understanding the biological bases of aging have intellectually revitalized the field of geriatric psychiatry and broadened its scope to include promoting successful aging and studying resilience factors in older adults. To describe the process by which this paradigm shift has occurred and illustrate its implications for treatment and research of late-life brain disorders, late-life depression is discussed as a prototype case. Prior phases of geriatric psychiatry research were focused on achieving depressive symptom relief, outlining pharmacokinetic and pharmacodynamic differences between older and younger adults, and identifying moderators of treatment response. Building on this work, current geriatric psychiatry researchers have begun to disentangle the etiologic complexity in late-life depression by focusing on the causative aging-related processes involved, identifying both neurobiological and behavioral intermediates, and finally delineating depression subtypes that are distinguishable by their underlying biology and the treatment approach required. In this review, we discuss several age-related processes that are critical to the development of late-life mood disorders, outline implications of these processes for the clinical evaluation and management of later-life psychiatric disorders, and finally put forth suggestions for better integrating aging and developmental processes into the National Institute of Mental Health's Research Domain Criteria.
在理解衰老生物学基础方面取得的进展，在学术上重振了老年精神病学领域，并拓宽了其范围，将促进成功衰老和研究老年人的复原力因素纳入其中。为了描述这一范式转变发生的过程，并说明其对晚年脑部疾病治疗和研究的影响，本文将晚年抑郁症作为一个典型案例进行讨论。老年精神病学研究的先前阶段主要集中在实现抑郁症状缓解、概述老年人与年轻人在药代动力学和药效学上的差异，以及确定治疗反应的调节因素。在这项工作的基础上，当前的老年精神病学研究人员已开始通过关注所涉及的与衰老相关的致病过程、识别神经生物学和行为中间变量，并最终界定可根据其潜在生物学特性和所需治疗方法加以区分的抑郁症亚型，来理清晚年抑郁症的病因复杂性。在本综述中，我们讨论了几个对晚年情绪障碍发展至关重要的与年龄相关的过程，概述了这些过程对晚年精神疾病临床评估和管理的影响，最后提出了关于如何更好地将衰老和发育过程纳入美国国立精神卫生研究所的研究领域标准的建议。
