Seminars in clinical neuropsychiatry最新文献

Relatively less research has been performed in the delineation of the neural system abnormalities underlying bipolar disorder (BD) than in their correlates in unipolar depression. However, neuroimaging research has recently provided in vivo evidence to support the involvement of regional brain abnormalities in BD implicated by the localization of lesions associated with secondary mood symptoms. This article reviews (1) neural systems implicated in BD by brain lesions associated with secondary mood changes and impaired neuropsychologic paradigm performance; (2) structural and functional neuroimaging evidence to support the involvement of these neural systems in BD; and (3) potential functional neuroanatomic models of BD symptoms. Because depression is covered in detail elsewhere in this issue, this article focuses primarily on abnormalities associated with the manic state, as well as ones associated with euthymia, and may thus represent trait abnormalities in BD. We suggest that ventral and medial prefrontal and amygdalar abnormalities may play important roles in a subset of BD symptoms and are potential targets for treatments.

Research in mood disorder pathophysiology has stimulated considerable interest in clinical and biologic aspects of mood disorders among children and adolescents. From the clinical perspective, developmental aspects of psychiatric disorders have crystallized in the relatively new theoretical school known as developmental psychopathology. This school attempts to understand the nature of developmental changes in behavior, with the goal of differentiating normal from abnormal stage-related behavior. This perspective has exerted major impact on conceptualizations of psychiatric disorders. From the basic science perspective, biologic findings in emotion have stimulated an integration of basic and clinical approaches to mood disorders. The term emotion is often used to refer to brain states elicited by stimuli for which an organism will extend effort to obtain (rewards) or avoid (punishments). Imaging studies suggest that brain regions engaged by rewarding and punishing stimuli in lower mammals are also implicated in mood disorders. Other studies suggest that environmental factors exert profound effects on the development of these brain regions. The impact of 4 areas of research on our understanding of depression pathophysiology is reviewed: (1) mood disorder onset, (2) structural magnetic resonance imaging (MRI), (3) behavioral or cognitive correlates of major depression, and (4) functional MRI of brain regions engaged across development. This is a US government work. There are no restrictions on its use.

Here we review human functional neuroimaging studies suggesting that the amygdala may play a key role in depression. We begin by reviewing animal and human data concerning the function of the amygdala. We then compare these results with those of neuroimaging studies of normal human amygdala function. Finally, we discuss functional neuroimaging studies of the amygdala in depression in light of the animal and human data. We conclude that the initial studies of this disorder provide evidence of amygdala involvement. Furthermore, we suggest that the scope of the amygdala's involvement may go beyond its well-known role in fear to its more subtle and generalized role in modulating moment-to-moment vigilance levels.