Nusslock Robin, Alloy Lauren B
Northwestern University, United States.
Temple University, United States.
J Affect Disord. 2017 Jul;216:3-16. doi: 10.1016/j.jad.2017.02.001. Epub 2017 Feb 4.
Two objectives of the NIMH Research Domain Criteria (RDoC) initiative are to identify (a) mechanisms that are common to multiple psychiatric disorders, and (b) mechanisms that are unique to specific psychiatric symptoms, and that reflect markers of differential risk for these symptoms. With respect to these objectives, a brain-behavior dimension that has received considerable attention and that is directly relevant to the Positive Valence Systems domain of the RDoC initiative involves reward processing.
The present review paper first examines the relationship between reward processing and mood-related symptoms from an RDoC perspective. We then place this work in a larger context by examining the relationship between reward processing abnormalities and psychiatric symptoms defined broadly, including mood-related symptoms, schizophrenia, and addiction.
Our review suggests that reward hyposensitivity relates to a subtype of anhedonia characterized by motivational deficits in unipolar depression, and reward hypersensitivity relates to a cluster of hypo/manic symptoms characterized by excessive approach motivation in the context of bipolar disorder. Integrating this perspective with research on reward processing abnormalities in schizophrenia and addiction, we further argue that the principles of equifinality and multifinality may be preferable to a transdiagnostic perspective for conceptualizing the relationship between reward processing and psychiatric symptoms defined broadly.
We propose that vulnerability to either motivational anhedonia or approach-related hypo/manic symptoms involve extreme and opposite profiles of reward processing. We further propose that an equifinality and multifinality perspective may serve as a useful framework for future research on reward processing abnormalities and psychiatric symptoms.
美国国立精神卫生研究所研究领域标准（RDoC）计划的两个目标是确定：（a）多种精神疾病共有的机制；（b）特定精神症状所特有的机制，这些机制反映了这些症状的不同风险标志物。关于这些目标，一个受到相当多关注且与RDoC计划的正性效价系统领域直接相关的脑-行为维度涉及奖赏处理。
本综述文章首先从RDoC的角度研究奖赏处理与情绪相关症状之间的关系。然后，我们通过研究奖赏处理异常与广义定义的精神症状（包括情绪相关症状、精神分裂症和成瘾）之间的关系，将这项工作置于更广泛的背景中。
我们的综述表明，奖赏低敏与以单相抑郁中的动机缺陷为特征的快感缺失亚型有关，而奖赏高敏与以双相情感障碍背景下过度趋近动机为特征的一组轻躁狂症状有关。将这一观点与对精神分裂症和成瘾中奖赏处理异常的研究相结合，我们进一步认为，对于概念化奖赏处理与广义定义的精神症状之间的关系，等效性和多终性原则可能比跨诊断观点更可取。
我们提出，对动机性快感缺失或与趋近相关的轻躁狂症状的易感性涉及奖赏处理的极端且相反的特征。我们还提出，等效性和多终性观点可能为未来关于奖赏处理异常和精神症状的研究提供一个有用的框架。
