Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Minneapolis, Minnesota.
Masonic Institute for the Developing Brain, University of Minnesota Medical School, Minneapolis, Minnesota; Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota.
Biol Psychiatry. 2023 Apr 15;93(8):704-716. doi: 10.1016/j.biopsych.2022.12.020. Epub 2022 Dec 30.
The ability of our current psychiatric nosology to accurately delineate clinical populations and inform effective treatment plans has reached a critical point with only moderately successful interventions and high relapse rates. These challenges continue to motivate the search for approaches to better stratify clinical populations into more homogeneous delineations, to better inform diagnosis and disease evaluation, and prescribe and develop more precise treatment plans. The promise of brain-based subtyping based on neuroimaging data is that finding subgroups of individuals with a common biological signature will facilitate the development of biologically grounded, targeted treatments. This review provides a snapshot of the current state of the field in empirical brain-based subtyping studies in child, adolescent, and adult psychiatric populations published between 2019 and March 2022. We found that there is vast methodological exploration and a surprising number of new methods being created for the specific purpose of brain-based subtyping. However, this methodological exploration and advancement is not being met with rigorous validation approaches that assess both reproducibility and clinical utility of the discovered brain-based subtypes. We also found evidence for a collaboration crisis, in which methodological exploration and advancements are not clearly grounded in clinical goals. We propose several steps that we believe are crucial to address these shortcomings in the field. We conclude, and agree with the authors of the reviewed studies, that the discovery of biologically grounded subtypes would be a significant advancement for treatment development in psychiatry.
当前的精神病学分类学能够准确地区分临床人群并为有效的治疗计划提供信息,但干预效果仅为中等,且复发率很高,这使得其已经达到了一个关键的临界点。这些挑战继续促使人们寻找方法,将临床人群更精确地划分为更同质的分类,以更好地为诊断和疾病评估提供信息,并制定更精确的治疗计划。基于神经影像学数据的大脑亚型分类的前景在于,找到具有共同生物学特征的个体亚组将有助于开发基于生物学的靶向治疗。本综述提供了 2019 年至 2022 年 3 月期间发表的儿童、青少年和成年精神病学人群中基于经验的大脑亚型分类研究领域的现状快照。我们发现,存在大量的方法学探索,并且为了专门进行大脑亚型分类,还创建了许多新的方法。然而,这种方法学的探索和进步并没有与严格的验证方法相结合,这些方法评估了所发现的基于大脑的亚型的可重复性和临床实用性。我们还发现了证据表明存在合作危机,即方法学的探索和进步并未明确以临床目标为基础。我们提出了几个步骤,我们认为这些步骤对于解决该领域的这些缺陷至关重要。我们得出结论,并同意所审查研究的作者的观点,即发现基于生物学的亚型将是精神病学治疗发展的重大进展。