Mental Health Service Line,Minneapolis Veteran Administration Medical Center,One Veterans Drive, Minneapolis Minnesota, 55147,USA.
Psychol Med. 2019 Jan;49(1):1-8. doi: 10.1017/S0033291718003252. Epub 2018 Nov 9.
Given the failure of psychiatry to develop clinically useful biomarkers for psychiatric disorders, and the concomitant failure to develop significant advances in diagnosis and treatment, the National Institute of Mental Health (NIMH) in 2010 launched the Research Domain Criteria (RDoC), a framework for research based on the assumption that mental disorders are disorders of identifiable brain neural circuits, with neural circuitry at the center of units of analysis ranging from genes, molecules, and cells to behavior, self-reports, and paradigms. These were to be integrated with five validated dimensional psychological constructs such as negative and positive valence systems. Four years later, the NIMH stated that the ultimate goal of RDoC is precision medicine for psychiatry, with the assumption that precision medications will normalize dysfunctional neural circuits. How this could be accomplished is not obvious, given that neural circuits are widely distributed, have unclear boundaries, and exhibit a significant degree of neuroplasticity, with multiple circuits present in any given disorder. Moreover, the early focus on neural circuitry has been criticized for its reductionism and neglect of the more recent RDoC emphasis on the integration and equivalence of biological and psychological phenomena. Yet this seems inconsistent with the priorities of the NIMH director, an advocate of the central role of neural circuitry and projects such as the Brain Initiative and the Human Connectome Project. Will such projects, at a cost of at least $10 billion, lead to precision medications for mental disorders, or further diminish funding for clinical care and research?
鉴于精神病学未能开发出用于精神障碍的临床有用生物标志物，并且在诊断和治疗方面也没有取得重大进展，美国国立精神卫生研究所（NIMH）于 2010 年推出了研究领域标准（RDoC），这是一个基于精神障碍是可识别的大脑神经回路障碍的假设的研究框架，神经回路是从基因、分子和细胞到行为、自我报告和范式的分析单位的核心。这些将与五个经过验证的维度心理结构（如正负效价系统）相结合。四年后，NIMH 表示，RDoC 的最终目标是精神科的精准医学，假设精准药物将使功能失调的神经回路正常化。鉴于神经回路广泛分布、边界不清且表现出高度的神经可塑性，在任何给定的疾病中都存在多个回路，因此如何实现这一目标并不明显。此外，早期对神经回路的关注因其还原论和对 RDoC 最近强调生物和心理现象的整合和等效性的忽视而受到批评。然而，这似乎与 NIMH 主任的优先事项不一致，他是神经回路核心作用的倡导者，以及诸如大脑倡议和人类连接组计划等项目。这些项目（至少耗资 100 亿美元）将导致针对精神障碍的精准药物，还是进一步减少临床护理和研究的资金？
