Institute for Translational Psychiatry, University of Münster, Albert-Schweitzer-Campus 1, Building A9, 48149, Münster, Germany.
Institute for Translational Psychiatry, University of Münster, Albert-Schweitzer-Campus 1, Building A9, 48149, Münster, Germany; Department of Psychiatry, University of Halle, Emil-Abderhalden-Str. 26-27, 06108, Halle, Germany.
J Psychiatr Res. 2021 Oct;142:226-239. doi: 10.1016/j.jpsychires.2021.07.022. Epub 2021 Jul 16.
Major depressive disorder (MDD) and anxiety disorders (ANX) share core symptoms such as negative affect and often co-exist. Magnetic-resonance imaging (MRI) research suggests shared neuroanatomical/neurofunctional underpinnings. So far, studies considering transdiagnostic and disorder-specific neural alterations in MDD and ANX as well as the comorbid condition (COM) have not been reviewed systematically.
Following PRISMA guidelines, the literature was screened and N = 247 articles were checked according to the PICOS criteria: MRI studies investigating transdiagnostic (across MDD, ANX, COM compared to healthy controls) and/or disorder-specific (between MDD, ANX, COM) neural alterations. N = 35, thereof n = 13 structural MRI and diffusion-tensor imaging studies and n = 22 functional MRI studies investigating emotional, cognitive deficits and resting state were included and quality coded.
Results indicated transdiagnostic structural/functional alterations in the orbitofrontal cortex/middle frontal cortex and in limbic regions (amygdala, cingulum, hippocampus). Few and inconsistent disorder-specific alterations were reported. However, depression-specific functional alterations were reported for the inferior frontal gyrus and dorsolateral prefrontal cortex during emotional tasks, and limbic regions at rest. Preliminary results for anxiety-specific functional alterations were found in the insula and frontal regions during emotional tasks, in the inferior parietal lobule, superior frontal gyrus and superior temporal gyrus during cognitive tasks, and (para)limbic alterations at rest.
This review provides evidence to support existing transdiagnostic fronto-limbic neural models in MDD and ANX. On top, it expands existing knowledge taking into account comorbidity and comparing MDD with ANX. Heterogeneous evidence exists for disorder-specific alterations. Research focusing on ANX sub-types, and the consideration of COM would contribute to a better understanding of basic neural underpinnings.
重度抑郁症（MDD）和焦虑症（ANX）具有相似的核心症状，如负性情绪，且常共病。磁共振成像（MRI）研究表明这些疾病具有共同的神经解剖学/神经功能基础。到目前为止，还没有对 MDD 和 ANX 以及共病（COM）中的跨诊断和疾病特异性神经改变进行系统的综述。
根据 PRISMA 指南，对文献进行筛选，并根据 PICOS 标准检查了 247 篇文章：对 MDD、ANX、COM 与健康对照组进行跨诊断（跨 MDD、ANX、COM）和/或疾病特异性（MDD、ANX、COM 之间）神经改变的 MRI 研究。共纳入了 35 项研究，其中包括 13 项结构 MRI 和弥散张量成像研究，22 项功能 MRI 研究，研究内容包括情绪、认知缺陷和静息状态。这些研究的质量被编码。
结果表明，眶额皮质/额中回和边缘区域（杏仁核、扣带回、海马）存在跨诊断的结构/功能改变。仅报道了少量不一致的疾病特异性改变。然而，在情绪任务中，报告了与抑郁相关的特定功能改变，涉及额下回和背外侧前额叶，在静息状态下，涉及边缘区域。在情绪任务中，岛叶和额区，在认知任务中，下顶叶、额上回和颞上回，以及（副）边缘区域在静息状态下，也有初步的焦虑特异性功能改变的报道。
本综述提供了证据支持 MDD 和 ANX 中现有的跨诊断额-边缘神经模型。此外，它还扩展了现有的关于共病和 MDD 与 ANX 比较的知识。疾病特异性改变的证据存在异质性。对焦虑亚型的研究以及共病的考虑将有助于更好地理解基本的神经基础。
