van Oort J, Kohn N, Vrijsen J N, Collard R, Duyser F A, Brolsma S C A, Fernández G, Schene A H, Tendolkar I, van Eijndhoven P F
Department of Psychiatry, Radboud University Medical Centre, Reinier Postlaan 4, 6525 EX, P.O. Box 9101, 6500 HB, Nijmegen, Netherlands; Department of Cognitive Neuroscience, Radboud University Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, Netherlands.
Donders Institute for Brain, Cognition and Behavior, Centre for Neuroscience, P.O. Box 9010, 6500 GL, Nijmegen, Netherlands.
Neuroimage Clin. 2020;25:102176. doi: 10.1016/j.nicl.2020.102176. Epub 2020 Jan 11.
Clinically, it is well-established that vulnerability to stress is a common feature across a broad spectrum of psychiatric disorders. However, this link has been mechanistically studied almost exclusively in patients with so-called stress-related disorders such as depression and anxiety. To probe transdiagnostic mechanisms, we set out to study the acute stress response across a broader range of psychiatric disorders taking a large-scale brain network perspective. We investigated the brain's response to a mild, experimentally well-controlled psychological stressor in the form of an aversive movie. We studied 168 patients with stress-related and/or neurodevelopmental disorders (including comorbidity) and 46 control subjects. We focused on three networks that have a central role in the brain's stress response and are affected in a wide range of psychiatric disorders: the salience network (SN), default mode network (DMN) and frontoparietal network (FPN). Our results support an increased vulnerability to stress across all patients, indicated by a higher subjective stress level at baseline and follow-up compared to matched controls. At the brain systems level, the stress response was characterized by a relatively decreased FPN connectivity and an absence of a decrease in the within DMN connectivity across all disorders compared to controls. At the neurocognitive level, these findings may reflect a diminished top-down control and a tendency to more pronounced (negative) self-referential processing. Besides these shared aspects of the maladaptive stress response, we also discuss indications for disorder-specific aspects. Taken together, our results emphasize the importance of investigating the mechanistic underpinnings of psychiatric disorders transdiagnostically as recently done in neurogenetics.
临床上，应激易感性是广泛的精神障碍的一个共同特征，这一点已得到充分证实。然而，几乎仅在患有所谓应激相关障碍（如抑郁症和焦虑症）的患者中对这种联系进行了机制研究。为了探究跨诊断机制，我们从大规模脑网络的角度出发，着手研究更广泛的精神障碍中的急性应激反应。我们研究了大脑对以厌恶电影形式呈现的轻度、实验控制良好的心理应激源的反应。我们研究了168例患有应激相关和/或神经发育障碍（包括共病）的患者以及46名对照受试者。我们关注在大脑应激反应中起核心作用且在多种精神障碍中受到影响的三个网络：突显网络（SN）、默认模式网络（DMN）和额顶网络（FPN）。我们的结果支持所有患者的应激易感性增加，这表现为与匹配的对照组相比，基线和随访时主观应激水平更高。在脑系统层面，与对照组相比，所有障碍的应激反应特征是FPN连接性相对降低，且DMN内连接性没有下降。在神经认知层面，这些发现可能反映了自上而下控制的减弱以及更明显的（消极）自我参照加工倾向。除了这种适应不良应激反应的这些共同方面，我们还讨论了特定障碍方面的迹象。综上所述，我们的结果强调了如最近在神经遗传学中所做的那样跨诊断地研究精神障碍的机制基础的重要性。
