焦虑障碍精神病理内表型特征及其早期识别和优化治疗研究进展

Research progress on endophenotype characteristics of psychopathology,early recognition and optimized treatment on anxiety disorder

近年来,随着中国社会的发展和转型,焦虑障碍的发病率明显上升,2009年我国焦虑障碍在普通人群中的患病率已高达5.6%。此病病因复杂,治疗缓解率低而复发率高,其中强迫症更是世界十大致残性疾病之一。鉴于此,以探索生物学发病机制为基础,以早期识别和优化治疗为导向的焦虑障碍循证研究已成为精神卫生发展的当务之急。本课题组对焦虑障碍的生物学病因和临床特征进行了研究,提炼出了早期筛查的指标,并形成一套切实有效的早期识别工具包,在综合性医院内推广和应用,帮助非精神心理专科医师早期识别焦虑障碍。我们从遗传学、脑电影像和神经生化等多个角度探索焦虑障碍生物学发病机制,发现了常染色体1p1.1和20p13区域的拷贝数扩增和缺失、脑内眶额回灰质部位N-乙酰天冬氨酸水平、岛叶和右侧背外侧前额叶皮质-BOLD信号强度、扣带回事件相关电位错误相关负电位信号强度、头皮事件相关电位N400和P50抑制比和血浆脑源性神经营养因子等生物学指标,有助于焦虑障碍的早期生物学识别,为建立焦虑症的预测和干预模型提供了生物学依据。同时在多年临床积累和科研实践的基础上,形成了一套多维度评估体系和优化治疗方案,经验证其在心理治疗中具有较好的实践及科学价值,为临床医师和患者提供有效合理的治疗方案。

Along with China＇s economic and social development, the incidence of anxiety disorder has been increasing. According to the reports in 2009, the prevalence of anxiety disorder reached 5.6% in general population. The etiology of anxiety disorder is very complicated, and the overall remission rate is quite low, but apt to relapse, especially for the obsessive compulsive disorder which is one of the most severe and disabling type of diseases. Therefore, it is time for us to conduct an evidence based study to explore the endophenotype characteristics of psychopathology, early recognition and optimized treatment of anxiety disorder. Our studies focused on the biological pathogenesis and clinical features of anxiety disorder, picked the most essential elements and simplified as a toolkit for the early recognition, and applied to a successful promotion of general hospital to help the general practitioners identify anxiety disorder. The genetics, EEG, MRI and biochemistry research methods were used to explore the etiology of anxiety disorder. Our results show that a number of factors contribute to the risk of anxiety disorder： amplification or lack of copy number of lpl. 1 and 20p13 area of euchromosome, the increased N-acetylaspartate level relative to creatine in the medial prefrontal cortex, error-related negativity abnormalities, level of brain-derived neurotrophic factor （BDNF）, et al. Those abnormal tests may help to early identify anxiety disorder through biological way. What＇s more, we formulated the muhi-dimension evaluation system and optimized treatment for anxiety disorder based on years of clinical experiences and research practice, which were proved as accurate and efficient methods for clinical practice.