Steardo Luca, D'Angelo Martina, Monaco Francesco, Di Stefano Valeria, Steardo Luca
Psychiatry Unit, Department of Health Sciences, University of Catanzaro Magna Graecia, Catanzaro 88100, Italy.
Psychiatry Unit, Department of Health Sciences, University of Catanzaro Magna Graecia, Catanzaro 88100, Italy.
Neurosci Biobehav Rev. 2025 Feb;169:106030. doi: 10.1016/j.neubiorev.2025.106030. Epub 2025 Feb 1.
Bipolar disorder (BD) is characterized by a complex constellation of emotional, cognitive, and psychomotor disturbances, each deeply intertwined with underlying dysfunctions in large-scale brain networks and neurotransmitter systems. This manuscript integrates recent advances in neuroimaging, neuromodulation, and pharmacological research to provide a comprehensive view of BD's pathophysiology, emphasizing the role of network-specific dysfunctions and their clinical manifestations. We explore how dysregulation within the fronto-limbic network, particularly involving the prefrontal cortex (PFC) and amygdala, underpins the emotional instability that defines both manic and depressive episodes. Additionally, impairments in the central executive network (CEN) and default mode network (DMN) are linked to cognitive deficits, with hyperactivity in the DMN driving rumination and cognitive inflexibility, while CEN underactivity contributes to attentional lapses and impaired executive function. Psychomotor symptoms, which oscillate between hyperactivity in mania and retardation in depression, are closely associated with imbalances in neurotransmitter systems, particularly dopamine and serotonin, within the basal ganglia-thalamo-cortical motor pathway. Recent studies indicate that these psychomotor disturbances are further exacerbated by disruptions in network connectivity, leading to impairments in both motor control and emotional regulation. Emerging therapeutic strategies are discussed, with a focus on neuromodulation techniques such as transcranial magnetic stimulation (TMS) and deep brain stimulation (DBS), which show promise in restoring balance within these critical networks. Furthermore, pharmacological interventions that modulate synaptic functioning and neuronal plasticity offer potential for addressing both the emotional and motor symptoms of BD. This manuscript underscores the need for an integrative treatment approach that simultaneously targets neural circuits and neurotransmitter systems to address the full spectrum of symptoms in BD. Drawing on recent advancements in neurobiological models and therapeutic frameworks, this proposal outlines a pathway for the development of precision-tailored interventions. These approaches are designed to optimize cognitive, emotional, and psychomotor outcomes, ultimately striving to elevate the quality of life for individuals living with bipolar disorder (BD), while remaining firmly grounded in the latest empirical evidence and theoretical insights.
双相情感障碍（BD）的特征是一系列复杂的情绪、认知和精神运动障碍，每一种障碍都与大规模脑网络和神经递质系统的潜在功能障碍紧密相连。本文整合了神经影像学、神经调节和药理学研究的最新进展，以全面阐述双相情感障碍的病理生理学，强调特定网络功能障碍及其临床表现的作用。我们探讨了前额叶-边缘网络内的功能失调，特别是涉及前额叶皮质（PFC）和杏仁核的功能失调，如何构成了定义躁狂和抑郁发作的情绪不稳定的基础。此外，中央执行网络（CEN）和默认模式网络（DMN）的损伤与认知缺陷有关，DMN的过度活跃导致沉思和认知灵活性受损，而CEN的活动不足则导致注意力不集中和执行功能受损。精神运动症状在躁狂时的多动和抑郁时的迟缓之间波动，与基底神经节-丘脑-皮质运动通路内神经递质系统，特别是多巴胺和5-羟色胺的失衡密切相关。最近的研究表明，这些精神运动障碍会因网络连接中断而进一步加剧，导致运动控制和情绪调节受损。文中讨论了新兴的治疗策略，重点是经颅磁刺激（TMS）和深部脑刺激（DBS）等神经调节技术，这些技术有望恢复这些关键网络内的平衡。此外，调节突触功能和神经元可塑性的药物干预为解决双相情感障碍的情绪和运动症状提供了潜力。本文强调需要一种综合治疗方法，同时针对神经回路和神经递质系统，以解决双相情感障碍的所有症状。借鉴神经生物学模型和治疗框架的最新进展，本提议概述了精准定制干预措施的发展途径。这些方法旨在优化认知、情绪和精神运动结果，最终努力提高双相情感障碍患者的生活质量，同时始终以最新的实证证据和理论见解为坚实基础。
