Chuang Jie-Yu
Department of Psychiatry, Cardinal Tien Hospital, New Taipei City, Taiwan.
School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.
Front Nutr. 2022 Apr 18;9:870665. doi: 10.3389/fnut.2022.870665. eCollection 2022.
To date, mental disorders are diagnosed and treated by the subjective judgment of psychiatrists based on diagnostic criteria and treatment guidelines, respectively. Mental disorders are heterogeneous illnesses with a substantial treatment-refractory rate. Thus, there is a great need for novel treatment approaches. This article proposes a treatment approach centered on the concept of the gut-brain axis. There is mounting evidence indicating an association between stressors, microbiota, microglia, and mental disorders. Stressors might facilitate dysbiosis, inflammation, and the occurrence of mental disorders. This novel treatment approach is based on the idea that stressor types instead of the heterogeneous psychiatric diagnosis might be closer to the neurobiological underpinnings of mental disorders. First of all, patients with treatment-resistant mental disorders will be asked to describe their major stressors. Then, clinicians will calculate the total threat score and the total deprivation score. Subsequently, treatment tailored to the major stressor type will be administered to restore a healthy gut microbiome. Presumably, treatment will be aimed at increasing microbiota diversity in those who mainly have deprivation stressors and boosting in those who have mainly threat stressors. Large-scale clinical trials are warranted to test this hypothetical approach.
迄今为止，精神障碍分别由精神科医生根据诊断标准和治疗指南进行主观判断来诊断和治疗。精神障碍是异质性疾病，治疗难治率很高。因此，非常需要新的治疗方法。本文提出了一种以肠脑轴概念为核心的治疗方法。越来越多的证据表明应激源、微生物群、小胶质细胞与精神障碍之间存在关联。应激源可能会促进微生物群失调、炎症以及精神障碍的发生。这种新的治疗方法基于这样一种观点，即应激源类型而非异质性的精神科诊断可能更接近精神障碍的神经生物学基础。首先，将要求患有难治性精神障碍的患者描述他们的主要应激源。然后，临床医生将计算总威胁分数和总剥夺分数。随后，将针对主要应激源类型进行治疗，以恢复健康的肠道微生物群。据推测，治疗将旨在增加主要有剥夺应激源患者的微生物群多样性，并增强主要有威胁应激源患者的微生物群多样性。有必要进行大规模临床试验来检验这种假设方法。
