Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan.
Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan; Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan.
Biol Psychiatry. 2021 Apr 1;89(7):697-706. doi: 10.1016/j.biopsych.2020.11.012. Epub 2020 Nov 20.
The DSM provides distinct criteria for obsessive-compulsive disorder (OCD) and various types of anxiety disorders, but phenomenological overlap, high rates of comorbidity, and early onset suggest common underlying mechanisms. This notion is further supported by use of the same treatments-cognitive behavioral therapy and serotonin reuptake inhibitor medication-for managing both OCD and non-OCD anxiety disorders in clinical settings. While early intervention with these gold standard treatments is recommended for pediatric OCD and anxiety disorders, young patients often remain symptomatic even after treatment. To guide the development of novel, mechanistically targeted treatments to better resolve OCD and anxiety symptoms, the identification of neural circuits underlying psychological constructs with relevance across disorders has been recommended. One construct that may be relevant for understanding pediatric OCD and anxiety disorders is cognitive control, given the difficulty that young patients experience in dismissing obsessions, compulsions, and worry despite recognition that these symptoms are excessive and unreasonable. In this review, we examine findings from a growing body of literature implicating brain-behavioral markers of cognitive control in pediatric OCD and anxiety disorders, including before and after treatment. We conclude by suggesting that interventions designed to enhance the functioning of the task control circuits underlying cognitive control may facilitate brain maturation to help affected youth overcome symptoms.
《精神疾病诊断与统计手册》(DSM)为强迫症(OCD)和各种类型的焦虑症提供了明确的标准，但现象学上的重叠、高共病率和发病早表明存在共同的潜在机制。这一概念也得到了临床应用的支持，即使用相同的治疗方法——认知行为疗法和选择性 5-羟色胺再摄取抑制剂药物——来治疗 OCD 和非 OCD 焦虑症。虽然建议对儿科 OCD 和焦虑症进行这些黄金标准治疗的早期干预，但即使在治疗后，年轻患者的症状仍常常持续存在。为了指导开发针对特定机制的新型治疗方法，以更好地解决 OCD 和焦虑症状，人们建议确定与跨疾病相关的心理结构相关的神经回路。认知控制是一个可能与理解儿科 OCD 和焦虑症相关的结构，因为尽管年轻患者认识到这些症状是过度和不合理的，但他们在排除强迫观念、强迫行为和担忧方面存在困难。在这篇综述中，我们检查了越来越多的文献中关于认知控制的大脑-行为标志物在儿科 OCD 和焦虑症中的作用，包括治疗前后。最后我们建议，旨在增强认知控制基础上的任务控制回路功能的干预措施可能有助于大脑成熟，帮助受影响的年轻人克服症状。
