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Dysfunctional neurocognition in individuals with clinically significant psychopathic traits
 具有临床显著精神病特征的个体的功能性神经认知障碍
IF 8.3 2区 医学 Q1 Medicine Pub Date : 2019-09-01 DOI: 10.31887/DCNS.2019.21.3/rblair
R. Blair
The main goal of this review is to consider the main forms of dysfunctional neurocognition seen in individuals with clinically significant psychopathic traits (ie, reduced guilt/empathy and increased impulsive/antisocial behavior). A secondary goal is to examine the extent to which these forms of dysfunction are seen in both adults with psychopathic traits and adolescents with clinically significant antisocial behavior that may also involve callous-unemotional traits (reduced guilt/empathy). The two main forms of neurocognition considered are emotional responding (to distress/pain cues and emotional stimuli more generally) and reward-related processing. Highly related forms of neurocognition, the response to drug cues and moral judgments, are also discussed. It is concluded that dysfunction in emotional responsiveness and moral judgments confers risk for aggression across adolescence and into adulthood. However, reduced reward-related processing, including to drug cues, is only consistently found in adolescents with clinically significant antisocial behavior, not adults with psychopathy.

本综述的主要目的是考虑在具有临床显著精神病特征(即内疚/共情减少和冲动/反社会行为增加)的个体中看到的功能障碍神经认知的主要形式。第二个目标是检查这些形式的功能障碍在具有精神病特征的成年人和具有临床显著反社会行为的青少年中所见的程度,这些反社会行为也可能涉及冷酷无情的特征(减少内疚/同理心)。神经认知的两种主要形式是情绪反应(对悲伤/疼痛线索和更普遍的情绪刺激)和奖励相关处理。高度相关的神经认知形式,对药物线索和道德判断的反应,也进行了讨论。由此得出结论,情绪反应和道德判断的功能障碍会增加青春期和成年期的攻击风险。然而,包括药物线索在内的奖励相关加工的减少,只在具有临床显著反社会行为的青少年中持续存在,而在患有精神病的成年人中则没有。
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引用次数: 8
Domains of cognition and their assessment
 认知领域及其评估
IF 8.3 2区 医学 Q1 Medicine Pub Date : 2019-09-01 DOI: 10.31887/DCNS.2019.21.3/pharvey
Philip D. Harvey
Cognitive performance is typically conceptualized in terms of domains of functioning. These domains are hierarchical in nature, with the bottom referring to more basic sensory and perceptual processes and the top referring to elements of executive functioning and cognitive control. Domains are not independent of each other and executive functioning exerts control over the utilization of more basic processes. Assessments are typically targeted at subdomains of each ability area and careful combination of tasks can reveal patterns of performance consistent with a variety of different neurological and neuropsychiatric conditions. This review covers the general structures of domains, the patterns of impairments across domains seen in common neuropsychiatric conditions, and use of assessment strategies to differentiate, to the extent possible, between different types of conditions manifesting cognitive impairment.

认知表现通常是根据功能领域来定义的。这些领域在本质上是分层的,底部指的是更基本的感觉和知觉过程,顶部指的是执行功能和认知控制的要素。领域不是相互独立的,执行功能对更基本过程的利用施加控制。评估通常针对每个能力领域的子领域,仔细组合任务可以揭示与各种不同神经和神经精神状况一致的表现模式。这篇综述涵盖了域的一般结构,在常见的神经精神疾病中看到的跨域的损伤模式,以及使用评估策略来区分,在可能的程度上,不同类型的条件表现出认知障碍。
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引用次数: 207
Cognition and addiction
 认知与成瘾
IF 8.3 2区 医学 Q1 Medicine Pub Date : 2019-09-01 DOI: 10.31887/DCNS.2019.21.3/gdom
A. Verdéjo-Garcia, G. García-Fernández, G. Dom
In this targeted review, we summarize current knowledge on substance-use disorder (SUD)-related cognitive deficits, the link between these deficits and clinical outcomes, and the cognitive training, remediation, and pharmacological approaches that have the potential to rescue cognition. We conclude that: (i) people with SUDs have moderate deficits in memory, attention, executive functions, and decision-making (including reward expectancy, valuation, and learning); (ii) deficits in higher-order executive functions and decision-making are significant predictors of relapse; (iii) cognitive training programs targeting reward-related appetitive biases, cognitive remediation strategies targeting goal-based decision-making, and pharmacotherapies targeting memory, attention, and impulsivity have potential to rescue SUD-related cognitive deficits. We suggest avenues for future research, including developing brief, clinically oriented harmonized cognitive testing suites to improve individualized prediction of treatment outcomes; computational modeling that can achieve deep phenotyping of cognitive subtypes likely to respond to different interventions; and phenotype-targeted cognitive, pharmacological, and combined interventions. We conclude with a tentative model of neuroscience-informed precision medicine.
在这篇有针对性的综述中,我们总结了目前关于物质使用障碍(SUD)相关认知缺陷的知识,这些缺陷与临床结果之间的联系,以及有可能拯救认知的认知训练、补救和药物方法。我们的结论是:(i)患有sud的人在记忆、注意力、执行功能和决策(包括奖励预期、评估和学习)方面存在中度缺陷;(ii)高阶执行功能和决策缺陷是复发的重要预测因素;(iii)针对奖励相关的食欲偏差的认知训练计划,针对基于目标的决策的认知补救策略,以及针对记忆、注意力和冲动的药物治疗都有可能挽救与sud相关的认知缺陷。我们提出了未来研究的途径,包括开发简短的、临床导向的统一认知测试套件,以提高治疗结果的个性化预测;计算模型可以实现对不同干预措施可能作出反应的认知亚型的深度表型;以及以表型为目标的认知、药理学和综合干预。我们以神经科学为基础的精准医学的初步模型作为结论。
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引用次数: 35
Cognitive impairment in psychotic illness: prevalence, profile of impairment, developmental course, and treatment considerations
. 精神疾病中的认知障碍:患病率、损害概况、发展过程和治疗考虑
IF 8.3 2区 医学 Q1 Medicine Pub Date : 2019-09-01 DOI: 10.31887/DCNS.2019.21.3/amccleery
Amanda McCleery, Keith H Nuechterlein

Despite effective pharmacological treatments for psychotic symptoms (eg, hallucinations, delusions), functional outcomes for people with psychotic disorders are often disappointing. Although it is not included in the diagnostic criteria for psychotic disorders, cognitive impairment is one of the strongest determinants of community functioning in this clinical population, and thus it is an important target for intervention. In this review, we discuss the major areas of research regarding impaired cognition in psychotic illness. The specific topics covered include: (i) the prevalence of cognitive impairment in psychotic disorders; (ii) the profile and magnitude of cognitive impairment in psychotic disorders; (iii) the developmental course of cognitive impairment; (iv) the longitudinal stability of cognitive impairment; and (v) treatment approaches to improve cognitive performance in people with psychotic disorders.
.

尽管对精神病症状(如幻觉、妄想)进行了有效的药物治疗,但精神病患者的功能结果往往令人失望。尽管认知障碍不包括在精神病性疾病的诊断标准中,但认知障碍是该临床人群中社区功能的最强决定因素之一,因此是干预的重要目标。在这篇综述中,我们讨论了关于精神病认知障碍的主要研究领域。所涵盖的具体主题包括:(i)精神病患者认知障碍的患病率;(ii)精神病性障碍的认知障碍的特征和程度;(iii)认知障碍的发展过程;(iv)认知障碍的纵向稳定性;以及(v)改善精神病患者认知能力的治疗方法。
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引用次数: 91
The synaptic pathology of cognitive life
 认知生活的突触病理学
IF 8.3 2区 医学 Q1 Medicine Pub Date : 2019-09-01 DOI: 10.31887/DCNS.2019.21.3/whoner
W. Honer, A. Ramos-Miguel, J. Alamri, K. Sawada, A. Barr, J. Schneider, D. Bennett
Prospective, community-based studies allow evaluation of associations between cognitive functioning and synaptic measures, controlled for age-related pathologies. Findings from >400 community-based participants are reviewed. Levels of two presynaptic proteins, complexin-I (inhibitory terminals), and complexin-II (excitatory terminals) contributed to cognitive variation from normal to dementia. Adding the amount of protein-protein interaction between two others, synaptosome-associated protein-25 and syntaxin, explained 6% of overall variance. The presynaptic protein Munc18-1 long variant was localized to inhibitory terminals, and like complexin-I, was positively associated with cognition. Associations depended on Braak stage, with the level of complexin-I contributing nearly 15% to cognitive variation in stages 0-II, while complexin-II contributed 7% in stages V-VI. Non-denaturing gels identified multiple soluble N-ethylmaleimide-sensitive factor attachment protein receptor protein-protein (SNARE) complexes in frontal and in temporal lobes, making specific contributions to cognitive functions. Multiple mechanisms of presynaptic plasticity contribute to cognitive function during aging.

前瞻性的、基于社区的研究允许评估认知功能和突触测量之间的关联,并对年龄相关的病理进行控制。对400多名社区参与者的调查结果进行了审查。两种突触前蛋白,络合剂I(抑制性末端)和络合剂II(兴奋性末端)的水平有助于从正常到痴呆的认知变化。加上另外两种蛋白质-蛋白质相互作用的量,突触小体相关蛋白-25和突触结合蛋白,解释了6%的总体方差。突触前蛋白Munc18-1长变体定位于抑制性终末,与复合物I一样,与认知呈正相关。关联取决于Braak阶段,在0-II阶段,络合剂I的水平对认知变化的贡献率接近15%,而在V-VI阶段,络素II的贡献率为7%。非变性凝胶在额叶和颞叶中鉴定出多种可溶性N-乙基马来酰亚胺敏感因子附着蛋白-受体蛋白-蛋白(SNARE)复合物,对认知功能有特定贡献。突触前可塑性的多种机制有助于衰老过程中的认知功能。
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引用次数: 14
Metacognitive and cognitive-behavioral interventions for psychosis: new developments
 精神病的元认知和认知行为干预:新进展
IF 8.3 2区 医学 Q1 Medicine Pub Date : 2019-09-01 DOI: 10.31887/DCNS.2019.21.3/smoritz
S. Moritz, J. Klein, P. Lysaker, Stephanie Mehl
This review describes four cognitive approaches for the treatment of schizophrenia: cognitive-behavioral therapy for psychosis (CBTp), metacognitive therapy, metacognitive training, and metacognitive reflection insight therapy (MERIT). A central reference point of our review is a seminal paper by James Flavell, who introduced the term metacognition (“cognition about cognition”). In a way, every psychotherapeutic approach adopts a metacognitive perspective when therapists reflect with clients about their thoughts. Yet, the four approaches map onto different components of metacognition. CBTp conveys some “metacognitive knowledge” (eg, thoughts are not facts) but is mainly concerned with individual beliefs. Metacognitive therapy focuses on unhelpful metacognitive beliefs about thinking styles (eg, thought suppression). Metacognitive training brings distorted cognitive biases to the awareness of patients; a central goal is the reduction of overconfidence. MERIT focuses on larger senses of identity and highlights metacognitive knowledge about oneself and other persons. For CBTp and metacognitive training, meta-analytic evidence supports their efficacy; single studies speak for the effectiveness of MERIT and metacognitive therapy.

这篇综述描述了四种治疗精神分裂症的认知方法:精神病认知行为疗法(CBTp)、元认知疗法、元认知训练和元认知反思-洞察力疗法(MERIT)。我们综述的一个中心参考点是James Flavell的一篇开创性论文,他引入了元认知(“关于认知的认知”)一词。在某种程度上,当治疗师与客户反思他们的想法时,每一种心理治疗方法都采用元认知视角。然而,这四种方法映射到元认知的不同组成部分。CBTp传达了一些“元认知知识”(例如,思想不是事实),但主要与个人信仰有关。元认知疗法侧重于对思维方式的无益元认知信念(如思维抑制)。元认知训练给患者的认知带来扭曲的认知偏差;一个中心目标是减少过度自信。MERIT关注更大的身份感,并强调关于自己和他人的元认知知识。对于CBTp和元认知训练,元分析证据支持其功效;单项研究证明了MERIT和元认知疗法的有效性。
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引用次数: 44
Nonpharmacological treatment of dyscognition in schizophrenia: effects 
of aerobic exercise
 精神分裂症认知障碍的非药物治疗:有氧运动的影响
IF 8.3 2区 医学 Q1 Medicine Pub Date : 2019-09-01 DOI: 10.31887/DCNS.2019.21.3/aschmitt
I. Maurus, A. Röh, P. Falkai, B. Malchow, A. Schmitt, A. Hasan
Cognitive symptoms are a core feature of schizophrenia and are related to an unfavorable disease outcome. So far, there are no satisfactory pharmacological approaches to address cognitive symptoms. For some time now, aerobic exercise has been demonstrated in various trials to be a promising candidate for this indication. The aim of this brief qualitative review was to present the most recent meta-analyses regarding the capacity of exercise to improve cognition in schizophrenia patients. Additionally, we give a short overview of the effects in other conditions, like healthy subjects and patients with major depression. We conducted a focused literature search using the PubMed database, concentrating on meta-analyses which are based on a systematic search. The most recent meta-analysis investigating the efficacy of aerobic exercise on cognitive impairments in schizophrenia patients provides evidence that exercise has positive effects on cognitive functioning in this population. However, the effect seems not to be specific; there were positive findings regarding healthy subjects and patients with depressive disorders as well, even if they were less consistent. As most available trials have a small to modest sample size and have no consensus with regard to the intervention regime, nor to the assessment of cognition, the findings are difficult to generalize. In the future, standardized clinical trials focusing on the long-term effects of exercise are needed to evaluate whether the improvements in cognition are sustainable.

认知症状是精神分裂症的核心特征,并与不利的疾病结局有关。到目前为止,还没有令人满意的药理学方法来解决认知症状。一段时间以来,有氧运动已经在各种试验中被证明是治疗这种适应症的有希望的候选者。这篇简短的定性综述的目的是介绍关于运动改善精神分裂症患者认知能力的最新荟萃分析。此外,我们还简要概述了在其他情况下的影响,如健康受试者和重度抑郁症患者。我们使用PubMed数据库进行了重点文献检索,集中于基于系统检索的元分析。最近的荟萃分析调查了有氧运动对精神分裂症患者认知功能障碍的影响,提供了证据表明运动对这一人群的认知功能有积极影响。然而,这种影响似乎并不具体;对健康受试者和抑郁症患者也有积极的发现,即使他们不那么一致。由于大多数可用的试验样本量小到中等,并且在干预方案和认知评估方面没有达成共识,因此研究结果很难推广。在未来,需要标准化的临床试验来关注运动的长期影响,以评估认知方面的改善是否可持续。
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引用次数: 6
Pharmacological treatment of cognitive deficits in nondementing mental health disorders
 非痴呆性精神健康障碍中认知缺陷的药物治疗
IF 8.3 2区 医学 Q1 Medicine Pub Date : 2019-09-01 DOI: 10.31887/DCNS.2019.21.3/trobbins
T. Robbins
Evidence for pharmacological remediation of cognitive deficits in three major psychiatric disorders—attention deficit- hyperactivity disorder (ADHD), schizophrenia, and depression—is reviewed. ADHD is effectively treated with the stimulant medications methylphenidate and d-amphetamine, as well as nonstimulants such as atomoxetine, implicating cognitive enhancing effects mediated by noradrenaline and dopamine. However, the precise mechanisms underlying these effects remains unclear. Cognitive deficits in schizophrenia are less effectively treated, but attempts via a variety of neurotransmitter strategies are surveyed. The possibility of treating cognitive deficits in depression via antidepressant medication (eg, selective serotonin reuptake inhibitors) and by adjunctive drug treatment has only recently received attention because of confounding, or possibly interactive, effects on mood. Prospects for future advances in this important area may need to take into account transdiagnostic perspectives on cognition (including neurodegenerative diseases) as well as improvements in neuropsychological, neurobiological, and clinical trial design approaches to cognitive enhancement.

对三种主要精神疾病——注意力缺陷多动障碍(ADHD)、精神分裂症和抑郁症——的认知缺陷的药物补救证据进行了综述。多动症可以用兴奋剂药物哌甲酯和d-安非他明以及非兴奋剂如阿托西汀有效治疗,这暗示了去甲肾上腺素和多巴胺介导的认知增强作用。然而,这些影响背后的确切机制尚不清楚。精神分裂症的认知缺陷治疗效果较差,但尝试通过各种神经递质策略进行了调查。通过抗抑郁药物(例如,选择性血清素再摄取抑制剂)和辅助药物治疗抑郁症认知缺陷的可能性直到最近才受到关注,因为它们对情绪的影响是混杂的,或者可能是相互作用的。展望这一重要领域的未来进展,可能需要考虑认知(包括神经退行性疾病)的跨诊断观点,以及神经心理学、神经生物学和临床试验设计方法的改进,以增强认知。
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引用次数: 16
Cognition in psychiatry
 精神病学认知
IF 8.3 2区 医学 Q1 Medicine Pub Date : 2019-09-01 DOI: 10.31887/DCNS.2019.21.3/fthibaut
Sonia Acuna-Vargas, F. Thibaut
Cognition has attracted a growing interest in psychiatry. Since the 1990s, cognition as a whole has become an important determinant in the outcome of psychosis. Despite recent progress in the genetics of cognition, the development of new pharmacological compounds in order to improve cognition has not progressed as quickly. This issue will review and discuss the main areas of clinical and basic research in this domain.

认知在精神病学中引起了越来越多的兴趣。自20世纪90年代以来,认知作为一个整体已成为精神病预后的重要决定因素。尽管认知遗传学最近取得了进展,但为了改善认知而开发新的药理化合物的进展并没有那么快。本期将回顾和讨论该领域临床和基础研究的主要领域。
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引用次数: 0
Assessing behavior and cognition in rodents, nonhuman primates, and humans: where are the limits of translation?
 评估啮齿类动物、非人类灵长类动物和人类的行为和认知:翻译的极限在哪里?
IF 8.3 2区 医学 Q1 Medicine Pub Date : 2019-09-01 DOI: 10.31887/DCNS.2019.21.3/mrossner
M. Stephan, Paul Volkmann, M. Rossner
New psychopharmacological treatments are needed for affective and nonaffective psychoses, especially for the associated negative and cognitive symptoms. Earlier developments mostly failed, probably partly because of limitations in behavioral models used for validation. Now, deeper understanding of the genetics underlying disease pathogenesis and progress in genetic engineering will generate many rodent models with increased construct validity. To improve these models’ translational value, we need complementary data from nonhuman primates. We also have to improve and streamline behavioral test systems to cope with increased demand. Here, we propose a comprehensive neurocognitive test battery that should overcome the disadvantages of single tests and yield cognitive/behavioral profiles for modeling subsets of patient symptoms. Further, we delineate a concept for classifying disease-relevant cognitive endophenotypes to balance between face and construct validity and clinical diagnostics. In summary, this review discusses new concepts and the limitations and future potential of translational research on cognition in psychiatry.

情感性和非情感性精神病需要新的精神药理学治疗,特别是相关的阴性和认知症状。早期的开发大多失败了,部分原因可能是用于验证的行为模型的局限性。现在,随着对疾病发病机制的遗传学的深入了解和基因工程的进展,将产生许多结构效度更高的啮齿动物模型。为了提高这些模型的翻译价值,我们需要来自非人类灵长类动物的补充数据。我们还必须改进和简化行为测试系统,以应对日益增长的需求。在这里,我们提出了一个全面的神经认知测试电池,它应该克服单一测试的缺点,并产生用于建模患者症状子集的认知/行为概况。此外,我们描述了一种分类疾病相关认知内表型的概念,以平衡面部和结构有效性和临床诊断。综上所述,本文讨论了精神病学认知转化研究的新概念、局限性和未来潜力。
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引用次数: 18
期刊
Dialogues in Clinical Neuroscience
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