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淡漠与神经认知相关性:从“精准精神病学”角度的综述。

Apathy and neurocognitive correlates: review from the perspective of 'precision psychiatry'.

机构信息

Hospital Universitario Miguel Servet.

Departamento de Medicina y Psiquiatría, Universidad de Zaragoza, Zaragoza, Spain.

出版信息

Curr Opin Psychiatry. 2021 Mar 1;34(2):193-198. doi: 10.1097/YCO.0000000000000677.

Abstract

PURPOSE OF REVIEW

From the perspective of motivated behaviour and the so-called 'precision psychiatry', we try to identify recent advances in the neurocognitive and biological correlates of apathy.

RECENT FINDINGS

New evidence supports the notion that apathy is a common transdiagnostic and heterogeneous clinical syndrome, now conceptualized as a reduction in 'goal-directed' activity. Similarly, abundant evidence has been found related to neurocognitive correlates of apathy and the associations between clinical apathy and the processes primarily responsible for mediating motivational drive and effort-based decision making.Notwithstanding that the neurobiological basis is still poorly understood, there is some agreement in recent articles about a common system-level mechanism underlying apathy, pointing at specific medial frontal cortex and subcortical structures, including anterior cingulate cortex, medial orbitofrontal cortex and ventral striatum and related circuitry.

SUMMARY

Although difficulties in interpreting the results of these studies are apparent, because of different concepts of apathy used and methodological shortcomings identified, we have found consistent advances in the neurocognitive and biological correlates of apathy, relevant for the deep phenotyping proposed by the 'precision psychiatry' approach. This framework may eventually facilitate the identification of predictive-risk models and new specific therapeutic targets in psychiatry.

摘要

目的综述

从动机行为和所谓的“精准精神病学”的角度出发,我们试图确定冷漠的神经认知和生物学相关性的最新进展。

最新发现

新的证据支持了这样一种观点,即冷漠是一种常见的跨诊断和异质的临床综合征,现在被概念化为“目标导向”活动的减少。同样,也发现了大量与冷漠的神经认知相关性以及临床冷漠与主要负责调节动机驱动和基于努力的决策过程之间的关联有关的证据。尽管神经生物学基础仍知之甚少,但最近的一些文章就冷漠的共同系统水平机制达成了一些共识,指出了特定的内侧前额叶皮层和皮质下结构,包括前扣带皮层、内侧眶额皮层和腹侧纹状体以及相关的回路。

总结

尽管由于使用了不同的冷漠概念和确定了方法学上的缺陷,这些研究结果的解释存在困难,但我们已经发现冷漠的神经认知和生物学相关性方面的一致进展,这与“精准精神病学”方法提出的深度表型有关。该框架最终可能有助于确定精神疾病的预测风险模型和新的特定治疗靶点。

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