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作者信息

Sorella Sara, Lapomarda Gaia, Messina Irene, Frederickson Jon Julius, Siugzdaite Roma, Job Remo, Grecucci Alessandro

机构信息

Department of Psychology and Cognitive Science (DiPSCo), University of Trento, Rovereto, Italy.

Universitas Mercatorum, Roma, Italy.

出版信息

Neuroimage Clin. 2019;23:101854. doi: 10.1016/j.nicl.2019.101854. Epub 2019 May 4.

Abstract

Despite the traditional view of Schizophrenia (SZ) and Bipolar disorder (BD) as separate diagnostic categories, the validity of such a categorical approach is challenging. In recent years, the hypothesis of a continuum between Schizophrenia (SZ) and Bipolar disorder (BD), postulating a common pathophysiologic mechanism, has been proposed. Although appealing, this unifying hypothesis may be too simplistic when looking at cognitive and affective differences these patients display. In this paper, we aim to test an expanded version of the continuum hypothesis according to which the continuum extends over three clusters: the psychotic, the cognitive, and the affective. We applied an innovative approach known as Source-based Morphometry (SBM) to the structural images of 46 individuals diagnosed with SZ, 46 with BD and 66 healthy controls (HC). We also analyzed the psychological profiles of the three groups using cognitive, affective, and clinical tests. At a neural level, we found evidence for a shared psychotic core in a distributed network involving portions of the medial parietal and temporo-occipital areas, as well as parts of the cerebellum and the middle frontal gyrus. We also found evidence of a cognitive core more compromised in SZ, including alterations in a fronto-parietal circuit, and mild evidence of an affective core more compromised in BD, including portions of the temporal and occipital lobes, cerebellum, and frontal gyrus. Such differences were confirmed by the psychological profiles, with SZ patients more impaired in cognitive tests, while BD in affective ones. On the bases of these results we put forward an expanded view of the continuum hypothesis, according to which a common psychotic core exists between SZ and BD patients complemented by two separate cognitive and affective cores that are both impaired in the two patients' groups, although to different degrees.

摘要

尽管传统观点将精神分裂症(SZ)和双相情感障碍(BD)视为不同的诊断类别,但这种分类方法的有效性正面临挑战。近年来,有人提出精神分裂症(SZ)和双相情感障碍(BD)之间存在连续体的假说,假定存在共同的病理生理机制。尽管这一假说颇具吸引力,但从这些患者表现出的认知和情感差异来看,这个统一假说可能过于简单。在本文中,我们旨在检验连续体假说的一个扩展版本,即连续体涵盖三个集群:精神病性、认知和情感。我们将一种称为基于源的形态测量法(SBM)的创新方法应用于46名被诊断为SZ的个体、46名BD患者和66名健康对照(HC)的结构图像。我们还使用认知、情感和临床测试分析了这三组的心理特征。在神经层面,我们发现证据表明在一个分布式网络中存在共同的精神病性核心,该网络涉及内侧顶叶和颞枕叶区域的部分,以及小脑和额中回的部分。我们还发现证据表明SZ患者的认知核心受损更严重,包括额顶叶回路的改变,以及轻度证据表明BD患者的情感核心受损更严重,包括颞叶和枕叶的部分、小脑和额回。这些差异在心理特征中得到了证实,SZ患者在认知测试中受损更严重,而BD患者在情感测试中受损更严重。基于这些结果,我们提出了连续体假说的扩展观点,即SZ和BD患者之间存在共同的精神病性核心,辅之以两个独立的认知和情感核心,这两个核心在两组患者中均受损,尽管程度不同。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ffec/6529770/f6fffc42ff06/gr1.jpg

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