Martino Matteo, Magioncalda Paola
Graduate Institute of Mind Brain and Consciousness, Taipei Medical University, Taipei, Taiwan.
Brain and Consciousness Research Center, Taipei Medical University - Shuang Ho Hospital, New Taipei City, Taiwan.
Mol Psychiatry. 2022 Feb;27(2):793-802. doi: 10.1038/s41380-020-00982-2. Epub 2021 Jan 7.
Bipolar disorder (BD) shows complex alterations in psychomotor, affective, and thought dimensions, as described by Kraepelin in his fundamental model of manic-depressive illness. In turn, the expression of behavioral/phenomenological dimensions is traceable to intrinsic brain activity. We reported a data overview on intrinsic brain functioning and its changes in BD. Accordingly, we proposed a three-dimensional model of the relationship between brain functioning and behavioral/phenomenological patterns, along with its application to BD. In this model, intrinsic brain activity is organized in distinct units in accordance to connectivity patterns and related setting of input/output processing, underlying the different behavioral/phenomenological dimensions. An external unit (mainly involving the sensorimotor network) is connected with the external environment and sets the exteroceptive input/somatomotor output processing, underlying the psychomotor dimension. An internal unit (mainly involving the salience network) is connected to the internal/body environment and sets the interoceptive input/visceromotor output processing, underlying the affective dimension. Finally, an associative unit (mainly involving the default-mode network) is not connected with the environment and sets the processing of associative inputs/outputs, underlying the thought dimension. In each unit, neurotransmitter signaling couples the subcortical-cortical loop, which modulates the network activity levels, in turn setting input/output processing and related expression levels of the behavioral/phenomenological dimension. Different combinations in neurotransmitter signaling favor network balancing into distinct functional brain states, which manifest in different combinations of excitation or inhibition in psychomotricity, affectivity, and thought, resulting in the manic, depressive, and mixed states of BD. Our working model might provide a coherent framework for tracing the complex BD psychopathology to core functional brain alterations.
双相情感障碍（BD）在精神运动、情感和思维维度上表现出复杂的变化，正如克雷佩林在其躁狂抑郁症基本模型中所描述的那样。反过来，行为/现象学维度的表达可追溯到大脑的内在活动。我们报告了关于BD患者大脑内在功能及其变化的数据概述。因此，我们提出了一个大脑功能与行为/现象学模式之间关系的三维模型，以及其在BD中的应用。在这个模型中，大脑内在活动根据连接模式和输入/输出处理的相关设置被组织成不同的单元，这些单元构成了不同的行为/现象学维度的基础。一个外部单元（主要涉及感觉运动网络）与外部环境相连，并设置外部感受性输入/躯体运动输出处理，这构成了精神运动维度的基础。一个内部单元（主要涉及突显网络）与内部/身体环境相连，并设置内部感受性输入/内脏运动输出处理，这构成了情感维度的基础。最后，一个联想单元（主要涉及默认模式网络）不与环境相连，并设置联想输入/输出的处理，这构成了思维维度的基础。在每个单元中，神经递质信号传导耦合了皮质下-皮质环路，该环路调节网络活动水平，进而设置输入/输出处理以及行为/现象学维度的相关表达水平。神经递质信号传导的不同组合有利于网络平衡到不同的功能性脑状态，这些状态表现为精神运动性、情感性和思维方面兴奋或抑制的不同组合，从而导致BD的躁狂、抑郁和混合状态。我们的工作模型可能为将复杂的BD精神病理学追溯到核心功能性脑改变提供一个连贯的框架。
