McTeague Lisa M, Huemer Julia, Carreon David M, Jiang Ying, Eickhoff Simon B, Etkin Amit
From the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston; the Department of Psychiatry and Behavioral Sciences and Stanford Neurosciences Institute, Stanford University, Stanford, Calif.; VA Palo Alto Healthcare System and the Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Palo Alto, Calif.; the Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna; the Institute for Neuroscience and Medicine, Research Center Jülich, Jülich, Germany; the Institute for Clinical Neuroscience and Medical Psychology, Heinrich-Heine University Düsseldorf, and the Institute for Systems Neuroscience, School of Medicine, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.
Am J Psychiatry. 2017 Jul 1;174(7):676-685. doi: 10.1176/appi.ajp.2017.16040400. Epub 2017 Mar 21.
Cognitive deficits are a common feature of psychiatric disorders. The authors investigated the nature of disruptions in neural circuitry underlying cognitive control capacities across psychiatric disorders through a transdiagnostic neuroimaging meta-analysis.
A PubMed search was conducted for whole-brain functional neuroimaging articles published through June 2015 that compared activation in patients with axis I disorders and matched healthy control participants during cognitive control tasks. Tasks that probed performance or conflict monitoring, response inhibition or selection, set shifting, verbal fluency, and recognition or working memory were included. Activation likelihood estimation meta-analyses were conducted on peak voxel coordinates.
The 283 experiments submitted to meta-analysis included 5,728 control participants and 5,493 patients with various disorders (schizophrenia, bipolar or unipolar depression, anxiety disorders, and substance use disorders). Transdiagnostically abnormal activation was evident in the left prefrontal cortex as well as the anterior insula, the right ventrolateral prefrontal cortex, the right intraparietal sulcus, and the midcingulate/presupplementary motor area. Disruption was also observed in a more anterior cluster in the dorsal cingulate cortex, which overlapped with a network of structural perturbation that the authors previously reported in a transdiagnostic meta-analysis of gray matter volume.
These findings demonstrate a common pattern of disruption across major psychiatric disorders that parallels the "multiple-demand network" observed in intact cognition. This network interfaces with the anterior-cingulo-insular or "salience network" demonstrated to be transdiagnostically vulnerable to gray matter reduction. Thus, networks intrinsic to adaptive, flexible cognition are vulnerable to broad-spectrum psychopathology. Dysfunction in these networks may reflect an intermediate transdiagnostic phenotype, which could be leveraged to advance therapeutics.
认知缺陷是精神疾病的常见特征。作者通过一项跨诊断神经影像学荟萃分析，研究了精神疾病中认知控制能力背后神经回路中断的性质。
在PubMed上搜索截至2015年6月发表的全脑功能神经影像学文章，这些文章比较了患有轴I障碍的患者与匹配的健康对照参与者在认知控制任务中的激活情况。纳入了探究表现或冲突监测、反应抑制或选择、任务转换、语言流畅性以及识别或工作记忆的任务。对峰值体素坐标进行激活似然估计荟萃分析。
纳入荟萃分析的283项实验包括5728名对照参与者和5493名患有各种障碍（精神分裂症、双相或单相抑郁症、焦虑症和物质使用障碍）的患者。跨诊断异常激活在左前额叶皮层以及前岛叶、右腹外侧前额叶皮层、右顶内沟和中央扣带/辅助运动前区明显可见。在背侧扣带皮层更靠前的一个簇中也观察到了中断，该簇与作者先前在灰质体积的跨诊断荟萃分析中报告的结构扰动网络重叠。
这些发现表明，主要精神疾病中存在一种共同的中断模式，与完整认知中观察到的“多需求网络”相似。该网络与前扣带回-岛叶或“突显网络”相互作用，后者已被证明在跨诊断中容易出现灰质减少。因此，适应性、灵活性认知所固有的网络容易受到广谱精神病理学的影响。这些网络的功能障碍可能反映了一种中间的跨诊断表型，可利用该表型推进治疗。
