Adams T G, Kelmendi B, Brake C A, Gruner P, Badour C L, Pittenger C
School of Medicine - Department of Psychiatry, Yale University.
Clinical Neuroscience Division of the VA National Center for PTSD.
Chronic Stress (Thousand Oaks). 2018 Jan-Dec;2. doi: 10.1177/2470547018758043. Epub 2018 Mar 4.
Individuals with OCD often identify psychosocial stress as a factor that exacerbates their symptoms, and many trace the onset of symptoms to a stressful period of life or a discrete traumatic incident. However, the pathophysiological relationship between stress and OCD remains poorly characterized: it is unclear whether trauma or stress is an independent cause of OCD symptoms, a triggering factor that interacts with a preexisting diathesis, or simply a nonspecific factor that can exacerbate OCD along with other aspects of psychiatric symptomatology. Nonetheless, preclinical research has demonstrated that stress has conspicuous effects on corticostriatal and limbic circuitry. Specifically, stress can lead to neuronal atrophy in frontal cortices (particularly the medial prefrontal cortex), the dorsomedial striatum (caudate), and the hippocampus. Stress can also result in neuronal hypertrophy in the dorsolateral striatum (putamen) and amygdala. These neurobiological effects mirror reported neural abnormalities in OCD and may contribute to an imbalance between goal-directed and habitual behavior, an imbalance that is implicated in the pathogenesis and expression of OCD symptomatology. The modulation of corticostriatal and limbic circuits by stress and the resultant imbalance between habit and goal-directed learning and behavior offers a framework for investigating how stress may exacerbate or trigger OCD symptomatology.
强迫症患者常常认为心理社会压力是加剧其症状的一个因素,许多人将症状的发作追溯到生活中的一段压力时期或一个具体的创伤事件。然而,压力与强迫症之间的病理生理关系仍未得到充分描述:尚不清楚创伤或压力是强迫症症状的独立病因、与预先存在的素质相互作用的触发因素,还是仅仅是一个能与精神症状学的其他方面一起加剧强迫症的非特异性因素。尽管如此,临床前研究表明,压力对皮质纹状体和边缘回路有显著影响。具体而言,压力可导致额叶皮质(特别是内侧前额叶皮质)、背内侧纹状体(尾状核)和海马体的神经元萎缩。压力还可导致背外侧纹状体(壳核)和杏仁核的神经元肥大。这些神经生物学效应反映了强迫症中报告的神经异常情况,并可能导致目标导向行为和习惯行为之间的失衡,这种失衡与强迫症症状学的发病机制和表现有关。压力对皮质纹状体和边缘回路的调节以及由此导致的习惯与目标导向学习和行为之间的失衡,为研究压力如何加剧或触发强迫症症状学提供了一个框架。