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Barcia JA, Avecillas-Chasín JM, Nombela C, Arza R, García-Albea J, Pineda-Pardo JA, Reneses B, Strange BA. Personalized striatal targets for deep brain stimulation in obsessive-compulsive disorder. Brain Stimul 2018; 12:724-734. [PMID: 30670359 DOI: 10.1016/j.brs.2018.12.226] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 12/05/2018] [Accepted: 12/15/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Psychiatric conditions currently treated with deep brain stimulation (DBS), such as obsessive-compulsive disorder (OCD), are heterogeneous diseases with different symptomatic dimensions, indicating that fixed neuroanatomical DBS targets for all OCD cases may not be efficacious. OBJECTIVE/HYPOTHESIS We tested whether the optimal DBS target for OCD is fixed for all patients or whether it is individualized and related to each patient's symptomatic content. Further, we explored if the optimal target can be predicted by combining functional neuroimaging and structural connectivity. METHODS In a prospective, randomized, double-blinded study in 7 OCD patients, symptomatic content was characterized pre-operatively by clinical interview and OCD symptom-provocation during functional MRI. DBS electrode implantation followed a trajectory placing 4 contacts along a striatal axis (nucleus accumbens to caudate). Patients underwent three-month stimulation periods for each contact (and sham), followed by clinical evaluation. Probabilistic tractography, applied to diffusion-weighted images acquired pre-operatively, was used to study the overlap between projections from the prefrontal areas activated during symptom provocation and the volume of activated tissue of each electrode contact. RESULTS Six patients were classified responders, with median symptomatic reduction of 50% achieved from each patient's best contact. This was located at the caudate in 4 cases and at the accumbens in 2. Critically, the anatomical locus of the best contact (accumbens or caudate) was related to an index derived by combining functional MRI responses to prevailing symptom provocation and prefronto-cortico-striatal projections defined by probabilistic tractography. CONCLUSION Our results therefore represent a step towards personalized, content-specific DBS targets for OCD.
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Affiliation(s)
- Juan A Barcia
- Service of Neurosurgery, Hospital Clinico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Department of Surgery, Universidad Complutense de Madrid, Madrid, Spain.
| | - Josué M Avecillas-Chasín
- Service of Neurosurgery, Hospital Clinico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - Cristina Nombela
- Service of Neurosurgery, Hospital Clinico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - Rocío Arza
- Service of Neurosurgery, Hospital Clinico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - Julia García-Albea
- Service of Psychiatry, Hospital Clinico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - José A Pineda-Pardo
- CINAC, HM Puerta del Sur, Hospitales de Madrid, Mostoles, and CEU-San Pablo University, Madrid, Spain
| | - Blanca Reneses
- Service of Psychiatry, Hospital Clinico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - Bryan A Strange
- Laboratory for Clinical Neuroscience, Centre for Biomedical Technology, Universidad Politecnica de Madrid, Spain; Department of Neuroimaging, Reina Sofia Centre for Alzheimer's Disease, Madrid, Spain
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Hirjak D, Meyer-Lindenberg A, Fritze S, Sambataro F, Kubera KM, Wolf RC. Motor dysfunction as research domain across bipolar, obsessive-compulsive and neurodevelopmental disorders. Neurosci Biobehav Rev 2018; 95:315-335. [PMID: 30236781 DOI: 10.1016/j.neubiorev.2018.09.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 08/08/2018] [Accepted: 09/12/2018] [Indexed: 02/07/2023]
Abstract
Although genuine motor abnormalities (GMA) are frequently found in schizophrenia, they are also considered as an intrinsic feature of bipolar, obsessive-compulsive, and neurodevelopmental disorders with early onset such as autism, ADHD, and Tourette syndrome. Such transnosological observations strongly suggest a common neural pathophysiology. This systematic review highlights the evidence on GMA and their neuroanatomical substrates in bipolar, obsessive-compulsive, and neurodevelopmental disorders. The data lends support for a common pattern contributing to GMA expression in these diseases that seems to be related to cerebello-thalamo-cortical, fronto-parietal, and cortico-subcortical motor circuit dysfunction. The identified studies provide first evidence for a motor network dysfunction as a correlate of early neurodevelopmental deviance prior to clinical symptom expression. There are also first hints for a developmental risk factor model of these mental disorders. An in-depth analysis of motor networks and related patho-(physiological) mechanisms will not only help promoting Research Domain Criteria (RDoC) Motor System construct, but also facilitate the development of novel psychopharmacological models, as well as the identification of neurobiologically plausible target sites for non-invasive brain stimulation.
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Affiliation(s)
- Dusan Hirjak
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
| | - Andreas Meyer-Lindenberg
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Stefan Fritze
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | | | - Katharina M Kubera
- Center for Psychosocial Medicine, Department of General Psychiatry, Heidelberg University, Heidelberg, Germany
| | - Robert C Wolf
- Center for Psychosocial Medicine, Department of General Psychiatry, Heidelberg University, Heidelberg, Germany
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Hong JS, Kim SM, Aboujaoude E, Han DH. Investigation of a Mobile "Serious Game" in the Treatment of Obsessive-Compulsive Disorder: A Pilot Study. Games Health J 2018; 7:317-326. [PMID: 30129775 DOI: 10.1089/g4h.2017.0158] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Exposure and response prevention (ERP) therapy is considered a first-line treatment for obsessive-compulsive disorder (OCD). Dysregulation in the cortico-striato-thalamo-cortical (CSTC) circuit has been implicated in the pathophysiology of OCD, as have decreased functional connectivity (FC) between the dorsal anterior cingulate cortex (dACC) and the prefrontal cortex and increased FC between the dACC and the basal ganglia. We hypothesized that a new ERP-inspired mobile "serious game" would improve clinical symptoms in OCD and that symptom improvement would be associated with altered FC within CSTC. MATERIALS AND METHODS Fifteen OCD subjects and 15 healthy controls were recruited. All subjects completed questionnaires covering demographic data, the Yale-Brown Obsessive-Compulsive Scale, the Beck Depressive Inventory, and the Beck Anxiety Inventory. In addition, all subjects were scanned at baseline to assess brain FC using resting-state functional magnetic resonance imaging. RESULTS After 3 weeks of gameplay, FC from the left dACC seed to the right frontal precentral gyrus and from the right dACC seed to the left inferior frontal gyrus and the right middle frontal gyrus, increased in the OCD group. Responders showed increased brain connectivity from the left dACC seed to the right superior frontal gyrus compared with nonresponders. CONCLUSION Our results suggest that serious games may improve symptoms in OCD and that this improvement may be related to increased brain connectivity between the dACC and the prefrontal cortex. Further exploration is needed to assess the potential role of serious games in OCD treatment.
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Affiliation(s)
- Ji Sun Hong
- 1 Department of Psychiatry, Chung Ang University Hospital , Seoul, South Korea
| | - Sun Mi Kim
- 1 Department of Psychiatry, Chung Ang University Hospital , Seoul, South Korea
| | - Elias Aboujaoude
- 2 Department of Psychiatry, Stanford University School of Medicine , Stanford, California
| | - Doug Hyun Han
- 1 Department of Psychiatry, Chung Ang University Hospital , Seoul, South Korea
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Zhou C, Xu J, Ping L, Zhang F, Chen W, Shen Z, Jiang L, Xu X, Cheng Y. Cortical thickness and white matter integrity abnormalities in obsessive-compulsive disorder: A combined multimodal surface-based morphometry and tract-based spatial statistics study. Depress Anxiety 2018; 35:742-751. [PMID: 29734487 DOI: 10.1002/da.22758] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 03/05/2018] [Accepted: 03/12/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Cerebral morphological abnormalities may play a key role in pathogenesis of obsessive-compulsive disorder (OCD). However, few studies have used multimodal imaging strategies to investigate alterations of cortical morphometry and white matter (WM) integrity. This study aimed to evaluate cortical thickness, cortical and subcortical volume, and WM integrity characteristics in OCD patients comprehensively. METHODS We acquired magnetic resonance imaging (MRI) scans from 52 OCD patients and 46 well-matched healthy controls (HCs). Cortical thickness and cortical and subcortical volume were measured using the surface-based morphometry (SBM) approach. We also evaluated fractional anisotropy (FA) and mean diffusivity (MD) derived from diffusion tensor imaging (DTI) using tract-based spatial statistics (TBSS). The disease severity was evaluated by score of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). For those brain regions exhibiting altered structure, correlations between alterations and clinical symptoms severity were analyzed in all patients and medication-naïve patients, respectively. RESULTS Compared with controls, OCD patients exhibited cortical thinning in right posterior cingulate cortex (PCC), as well as significantly decreased FA values in the genu and body of corpus callosum (CC). In medication-naïve patients group, the total Y-BOCS score and obsession score were significantly negative correlated with right PCC cortical thickness. CONCLUSIONS OCD patients demonstrated symptom-related reduced cortical thickness structural alteration of the right PCC, and altered WM integrity in the genu and body of CC. Medication seems could alleviate the alteration of cortical thickness but not WM integrity. Combined multimodal neuroimaging methods may provide a more comprehensive perspective to clarify the pathological mechanism of OCD.
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Affiliation(s)
- Cong Zhou
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jian Xu
- Department of Internal Medicine, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Liangliang Ping
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Fengrui Zhang
- Department of Medical Imaging, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Wei Chen
- Department of Medical Imaging, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zonglin Shen
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Linling Jiang
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xiufeng Xu
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yuqi Cheng
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical University, Kunming, China
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Oñate-Cadena N, Cisneros-Otero M, Ruiz-Chow ÁA, Arellano-Reynoso A, Kobayashi-Romero LF, Pérez-Esparza R. Deep-brain stimulation in treatment-resistant obsessive-compulsive disorder: Clinical and molecular neuroimaging correlation. ACTA ACUST UNITED AC 2018; 49:62-65. [PMID: 32081211 DOI: 10.1016/j.rcp.2018.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 05/28/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Obsessive-compulsive disorder is defined by the presence of obsessions and compulsions that cause marked anxiety or distress and has been associated with a disruption in cortico-striato-thalamo-cortical circuitry. After treatment, around 50% of patients continue to experience incapacitating symptoms. Deep-brain stimulation has been shown to be an effective therapeutic alternative to regular treatment. METHODS Case report. CASE PRESENTATION A 54-year-old woman with a diagnosis of treatment-resistant obsessive-compulsive disorder was treated with deep-brain stimulation of the anterior limb of the internal capsule. Molecular imaging before and after the procedure was obtained and correlated with clinical features. CONCLUSIONS Deep-brain stimulation may be a therapeutic alternative to regular care in treatment-resistant obsessive-compulsive disorder and can be correlated to functional changes in suspected anatomical structures.
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Affiliation(s)
- Nelcy Oñate-Cadena
- Departamento de Neuropsiquiatría, Instituto Nacional de Neurología y Neurocirugía, Tlalpan, Ciudad de México, México
| | - Marcela Cisneros-Otero
- Departamento de Neuropsiquiatría, Instituto Nacional de Neurología y Neurocirugía, Tlalpan, Ciudad de México, México
| | - Ángel Alberto Ruiz-Chow
- Departamento de Neuropsiquiatría, Instituto Nacional de Neurología y Neurocirugía, Tlalpan, Ciudad de México, México
| | - Alfonso Arellano-Reynoso
- Departamento de Neurocirugía, Programa de Neurocirugía Funcional, Instituto Nacional de Neurología y Neurocirugía, Tlalpan, Ciudad de México, México
| | - Luis Fabian Kobayashi-Romero
- Laboratorio de Investigación en Adicciones, Instituto Nacional de Neurología y Neurocirugía, Tlalpan, Ciudad de México, México
| | - Rodrigo Pérez-Esparza
- Departamento de Neuropsiquiatría, Instituto Nacional de Neurología y Neurocirugía, Tlalpan, Ciudad de México, México; Laboratorio de Investigación en Adicciones, Instituto Nacional de Neurología y Neurocirugía, Tlalpan, Ciudad de México, México.
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Jung HH, Chang WS, Kim SJ, Kim CH, Chang JW. The Potential Usefulness of Magnetic Resonance Guided Focused Ultrasound for Obsessive Compulsive Disorders. J Korean Neurosurg Soc 2018; 61:427-433. [PMID: 29631388 PMCID: PMC6046565 DOI: 10.3340/jkns.2017.0505.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 07/19/2017] [Indexed: 11/27/2022] Open
Abstract
Obsessive compulsive disorder is a debilitating condition characterized by recurrent obsessive thoughts and compulsive reactions. A great portion of the obsessive compulsive disorder (OCD) patients are managed successfully with psychiatric treatment such as selective serotonin-reuptake inhibitor and cognitive behavioral psychotherapy, but more than 10% of patients are remained as non-responder who needs neurosurgical treatments. These patients are potential candidates for the neurosurgical management. There had been various kind of operation, lesioning such as leucotomy or cingulotomy or capsulotomy or limbic leucotomy, and with advent of stereotaxic approach and technical advances, deep brain stimulation was more chosen by neurosurgeon due to its characteristic of reversibility and adjustability. Gamma knife radiosurgery are also applied to make lesion targeting based on magnetic resonance (MR) imaging, but the complication of adverse radiation effect is not predictable. In the neurosurgical field, MR guided focused ultrasound has advantage of less invasiveness, real-time monitored procedure which is now growing to attempt to apply for various brain disorder. In this review, the neurosurgical treatment modalities for the treatment of OCD will be briefly reviewed and the current state of MR guided focused ultrasound for OCD will be suggested.
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Affiliation(s)
- Hyun Ho Jung
- Department of Neurosurgery and Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Won Seok Chang
- Department of Neurosurgery and Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Se Joo Kim
- Department of Psychiatry and Institute of Behavioral Science, Yonsei University College of Medicine, Seoul, Korea
| | - Chan-Hyung Kim
- Department of Psychiatry and Institute of Behavioral Science, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Woo Chang
- Department of Neurosurgery and Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea
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57
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Acute Effects of Electrical Stimulation of the Bed Nucleus of the Stria Terminalis/Internal Capsule in Obsessive-Compulsive Disorder. World Neurosurg 2018; 111:e471-e477. [DOI: 10.1016/j.wneu.2017.12.084] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 12/13/2017] [Accepted: 12/14/2017] [Indexed: 01/16/2023]
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Distinct Neurobehavioral Mechanisms for Expectancy Violation and Value Updating. J Neurosci 2018; 38:26-28. [PMID: 29298906 DOI: 10.1523/jneurosci.2708-17.2017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 11/07/2017] [Accepted: 11/09/2017] [Indexed: 11/21/2022] Open
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Sharma M, Reeves K, Deogaonkar M, Rezai AR. Deep Brain Stimulation for Obsessive–Compulsive Disorder. Neuromodulation 2018. [DOI: 10.1016/b978-0-12-805353-9.00085-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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60
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He X, Steinberg E, Stefan M, Fontaine M, Simpson HB, Marsh R. Altered frontal interhemispheric and fronto-limbic structural connectivity in unmedicated adults with obsessive-compulsive disorder. Hum Brain Mapp 2017; 39:803-810. [PMID: 29148122 DOI: 10.1002/hbm.23883] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 10/22/2017] [Accepted: 11/02/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Previous diffusion tensor imaging (DTI) studies of obsessive-compulsive disorder (OCD) have primarily used voxel- or tract-based methods to assess white matter microstructure in medicated patients. This is the first probabilistic tractography study to assess the structural connectivity of all major white matter tracts in unmedicated adults with OCD without comorbid psychopathology. We hypothesized that OCD compared to healthy participants would show reduced integrity in frontal interhemispheric and fronto-limbic tracts. METHODS DTI data from 29 unmedicated adults with OCD were compared to that of 27 matched healthy control (HC) participants. TRACULA was used to assess probabilistic tractography and compare groups in the average fractional anisotropy (FA) of 8 bilateral tracts plus forceps minor and major, and explore group differences in axial (AD), radial (RD), and mean (MD) diffusivities in tracts where FA differed across groups. RESULTS Significantly less FA was detected in OCD compared to HC participants in forceps minor, interhemispheric fibers of the frontal cortex, and right uncinate fasciculus (UNC), association fibers connecting frontal and limbic regions (p's < .05). FA in forceps minor was inversely associated with symptom severity in the OCD participants. Exploratory analyses revealed less AD in right UNC was inversely associated with OCD symptoms. CONCLUSIONS Structural connectivity of frontal interhemispheric and fronto-limbic circuits may be altered in unmedicated adults with OCD, especially those with the most severe symptoms. These findings suggest a microstructural basis for the abnormal function and reduced resting-state connectivity of frontal regions and fronto-limbic circuits in OCD.
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Affiliation(s)
- Xiaofu He
- The Division of Child and Adolescent Psychiatry in the Department of Psychiatry, The New York State Psychiatric Institute and the College of Physicians & Surgeons, Columbia University, New York, New York
| | - Emily Steinberg
- The Division of Child and Adolescent Psychiatry in the Department of Psychiatry, The New York State Psychiatric Institute and the College of Physicians & Surgeons, Columbia University, New York, New York
| | - Mihaela Stefan
- The Division of Child and Adolescent Psychiatry in the Department of Psychiatry, The New York State Psychiatric Institute and the College of Physicians & Surgeons, Columbia University, New York, New York
| | - Martine Fontaine
- The Division of Child and Adolescent Psychiatry in the Department of Psychiatry, The New York State Psychiatric Institute and the College of Physicians & Surgeons, Columbia University, New York, New York
| | - H Blair Simpson
- The Division of Clinical Therapeutics in the Department of Psychiatry, The New York State Psychiatric Institute and The Department of Psychiatry, College of Physicians & Surgeons, Columbia University, New York, New York
| | - Rachel Marsh
- The Division of Child and Adolescent Psychiatry in the Department of Psychiatry, The New York State Psychiatric Institute and the College of Physicians & Surgeons, Columbia University, New York, New York
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Williams LM. Defining biotypes for depression and anxiety based on large-scale circuit dysfunction: a theoretical review of the evidence and future directions for clinical translation. Depress Anxiety 2017; 34:9-24. [PMID: 27653321 PMCID: PMC5702265 DOI: 10.1002/da.22556] [Citation(s) in RCA: 155] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 07/28/2016] [Accepted: 08/15/2016] [Indexed: 01/23/2023] Open
Abstract
Complex emotional, cognitive and self-reflective functions rely on the activation and connectivity of large-scale neural circuits. These circuits offer a relevant scale of focus for conceptualizing a taxonomy for depression and anxiety based on specific profiles (or biotypes) of neural circuit dysfunction. Here, the theoretical review first outlines the current consensus as to what constitutes the organization of large-scale circuits in the human brain identified using parcellation and meta-analysis. The focus is on neural circuits implicated in resting reflection (default mode), detection of "salience," affective processing ("threat" and "reward"), "attention," and "cognitive control." Next, the current evidence regarding which type of dysfunctions in these circuits characterize depression and anxiety disorders is reviewed, with an emphasis on published meta-analyses and reviews of circuit dysfunctions that have been identified in at least two well-powered case:control studies. Grounded in the review of these topics, a conceptual framework is proposed for considering neural circuit-defined "biotypes." In this framework, biotypes are defined by profiles of extent of dysfunction on each large-scale circuit. The clinical implications of a biotype approach for guiding classification and treatment of depression and anxiety is considered. Future research directions will develop the validity and clinical utility of a neural circuit biotype model that spans diagnostic categories and helps to translate neuroscience into clinical practice in the real world.
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Affiliation(s)
- Leanne M Williams
- Corresponding author: Leanne M Williams, PhD, Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, California, 94134-5717, , Phone: 650 723 3579
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