Division of Neurotherapeutics, Massachusetts General Hospital, Boston.
Obsessive-Compulsive Disorder Institute, McLean Hospital, Belmont, Massachusetts.
JAMA Psychiatry. 2018 Oct 1;75(10):1081-1087. doi: 10.1001/jamapsychiatry.2018.0930.
Obsessive-compulsive disorder (OCD) is a common and often debilitating psychiatric illness. Recent advances in the understanding of the neuroscience of OCD have provided valuable insights that have begun to transform the way we think about the management of this disorder. This educational review provides an integrated neuroscience perspective on formulation and treatment planning for patients with OCD. The article is organized around key neuroscience themes most relevant for OCD.
An integrated neuroscience formulation of OCD is predicated on a fundamental understanding of phenomenology and symptom dimensions, fear conditioning and extinction, neurochemistry, genetics and animal models, as well as neurocircuitry and neurotherapeutics. Symptom dimensions provide a means to better understand the phenotypic heterogeneity within OCD with an eye toward more personalized treatments. The concept of abnormal fear extinction is central to OCD and to the underlying therapeutic mechanism of exposure and response prevention. A framework for understanding the neurochemistry of OCD focuses on both traditional monoaminergic systems and more recent evidence of glutamatergic and γ-aminobutyric acid-ergic dysfunction. Obsessive-compulsive disorder is highly heritable, and future work is needed to understand the contribution of genes to underlying pathophysiology. A circuit dysregulation framework focuses on cortico-striato-thalamo-cortical circuit dysfunction and the development of neurotherapeutic approaches targeting this circuit. The impact of these concepts on how we think about OCD diagnosis and treatment is discussed. Suggestions for future investigations that have the potential to further enhance the clinical management of OCD are presented.
These key neuroscience themes collectively inform formulation and treatment planning for patients with OCD. The ultimate goal is to increase crosstalk between clinicians and researchers in an effort to facilitate translation of advances in neuroscience research to improved care for patients with OCD.
强迫症（OCD）是一种常见且常常使人衰弱的精神疾病。对 OCD 神经科学的理解的最新进展提供了有价值的见解，这些见解开始改变我们对这种疾病管理的思维方式。这篇教育性评论提供了 OCD 的综合神经科学观点，用于制定和治疗计划。文章围绕与 OCD 最相关的关键神经科学主题进行组织。
强迫症的综合神经科学制定是基于对现象学和症状维度、恐惧条件反射和消退、神经化学、遗传学和动物模型以及神经回路和神经治疗的基本理解。症状维度为更好地理解 OCD 内的表型异质性提供了一种手段，以期实现更个性化的治疗。异常恐惧消退的概念是 OCD 的核心，也是暴露和反应预防的潜在治疗机制的基础。理解 OCD 神经化学的框架侧重于传统的单胺能系统以及最近关于谷氨酸能和γ-氨基丁酸能功能障碍的证据。强迫症具有高度遗传性，需要进一步研究来了解基因对潜在病理生理学的贡献。一个回路失调框架侧重于皮质-纹状体-丘脑-皮质回路功能障碍以及针对该回路的神经治疗方法的发展。讨论了这些概念对我们如何思考 OCD 诊断和治疗的影响。提出了对未来研究的建议，这些研究有可能进一步增强 OCD 的临床管理。
这些关键神经科学主题共同为 OCD 患者的制定和治疗计划提供信息。最终目标是增加临床医生和研究人员之间的交流，努力将神经科学研究的进展转化为改善 OCD 患者的护理。
