From the Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences, and the Institute for Policy Research, Northwestern University, Chicago; the Department of Psychiatry, University of Pittsburgh, Pittsburgh; the Center for Neurobehavioral Research, Boys Town National Research Hospital, Boys Town, Nebr.; the Department of Psychiatry, University of Connecticut, Farmington, Conn.; and the National Institute of Mental Health, Bethesda, Md.
Am J Psychiatry. 2018 Feb 1;175(2):114-130. doi: 10.1176/appi.ajp.2017.17010045. Epub 2017 Nov 17.
The arrival of the Journal's 175th anniversary occurs at a time of recent advances in research, providing an ideal opportunity to present a neurodevelopmental roadmap for understanding, preventing, and treating psychiatric disorders. Such a roadmap is particularly relevant for early-childhood-onset neurodevelopmental conditions, which emerge when experience-dependent neuroplasticity is at its peak. Employing a novel developmental specification approach, this review places recent neurodevelopmental research on early childhood disruptive behavior within the historical context of the Journal. The authors highlight irritability and callous behavior as two core exemplars of early disruptive behavior. Both phenotypes can be reliably differentiated from normative variation as early as the first years of life. Both link to discrete pathophysiology: irritability with disruptions in prefrontal regulation of emotion, and callous behavior with abnormal fear processing. Each phenotype also possesses clinical and predictive utility. Based on a nomologic net of evidence, the authors conclude that early disruptive behavior is neurodevelopmental in nature and should be reclassified as an early-childhood-onset neurodevelopmental condition in DSM-5. Rapid translation from neurodevelopmental discovery to clinical application has transformative potential for psychiatric approaches of the millennium. [AJP at 175: Remembering Our Past As We Envision Our Future November 1938: Electroencephalographic Analyses of Behavior Problem Children Herbert Jasper and colleagues found that brain abnormalities revealed by EEG are a potential causal factor in childhood behavioral disorders. (Am J Psychiatry 1938; 95:641-658 )].
本刊迎来创刊 175 周年之际，正值研究领域取得新进展之时，此刻推出理解、预防和治疗精神疾病的神经发育路线图恰逢其时。对于儿童早期发病的神经发育障碍而言，该路线图尤为重要，因为此类障碍出现在依赖经验的神经可塑性达到顶峰之时。本综述采用一种新颖的发育特征方法，将近期有关儿童早期破坏性行为的神经发育研究置于本刊的历史背景中。作者强调易激惹和冷酷行为是两种核心的早期破坏性行为表现。这两种表型都可以在生命的头几年从正常变化中可靠地区分出来。两者都与特定的病理生理学相关联：易激惹与前额叶调节情绪的紊乱有关，冷酷行为与异常的恐惧处理有关。每种表型都具有临床和预测效用。基于一个具有充分证据的网络，作者得出结论，早期破坏性行为具有神经发育的性质，应该在 DSM-5 中重新归类为儿童早期发病的神经发育障碍。从神经发育发现到临床应用的快速转化，为精神科在本世纪的方法提供了变革性的潜力。[AJP 于 175 年：铭记过去，展望未来 1938 年 11 月：脑电图分析行为问题儿童 赫伯特·贾斯珀（Herbert Jasper）及其同事发现，脑电图显示的大脑异常是儿童行为障碍的一个潜在因果因素。（美国精神病学杂志 1938 年；95:641-658 ）]。
