Precision psychiatry: a neural circuit taxonomy for depression and anxiety

Abstract

Although there have been tremendous advances in the understanding of human dysfunctions in the brain circuitry for self-reflection, emotion, and cognitive control, a brain-based taxonomy for mental disease is still lacking. As a result, these advances have not been translated into actionable clinical tools, and the language of brain circuits has not been incorporated into training programmes. To address this gap, I present this synthesis of published work, with a focus on functional imaging of circuit dysfunctions across the spectrum of mood and anxiety disorders. This synthesis provides the foundation for a taxonomy of putative types of dysfunction, which cuts across traditional diagnostic boundaries for depression and anxiety and includes instead distinct types of neural circuit dysfunction that together reflect the heterogeneity of depression and anxiety. This taxonomy is suited to specifying symptoms in terms of underlying neural dysfunction at the individual level and is intended as the foundation for building mechanistic research and ultimately guiding clinical practice.

Psychiatric, Demographic, and Brain Morphological Predictors of Relapse After Treatment for an Alcohol Use Disorder

“…The rostral/perigenual division of the ACC is indicated to subserve processing of affective or emotional stimuli or contexts (Bush et al, 2000, Mohanty et al, 2007). The caudal/dorsal region of the ACC and interconnectivity with the insula and amygdala complex are proposed as critical components in the salience network, which is implicated in conflict monitoring, interoceptive-autonomic, and reward-processing (Seeley et al, 2007, Williams, 2016). Therefore, macrostructural integrity of both major divisions of the ACC may be related to the ability of the salience network to facilitate appropriate cognitive control in response to external and interoceptive stimuli that has affective and/or emotionally laden content.…”

A neurociência computacional no estudo dos processos cognitivos

“…It should be noted that the results obtained in general neuroscience and in computational neuroscience are very incipient for the ultimate goal of understanding how the brain represents and computes stimuli. However, the study of neural circuits is already proving useful for obtaining robust and detailed diagnoses of mental disorders (Williams, 2016;Williams et al, 2016), confirming its practical validity. In particular, neural computation studies are very far from a revolutionary impact given the classic problems of Psychology, which attempt to understand the complexity of the human being through several theoretical orientations.…”

“…Despite that, the number of studies that seek out a relation between cognitive processes and their neuroanatomic correlates has increased, such as those using functional magnetic resonance imaging Berman, Jonides, & Nee, 2006;Fornito, Zalesky, & Breakspear, 2015;Van Essen et al, 2013). In fact, much of the effort in the field of neuropsychology contributes to the understanding of such correlates, which have practical application in psychiatric diagnoses and psychological treatments (for a discussion, refer to Williams, 2016;Williams et al, 2016). In this type of approach, the concept of cognition is adapted to the spatial restrictions imposed by the anatomy of the nervous system.…”

“…However, the structured study of computational mechanisms of cognition, based on neurons and their circuits, helps understand how cognitive processes occur in the nervous system, albeit in an incipient way. Such knowledge has immediate practical implications, one of the most important being the consistency in diagnosing mental disorders (Williams, 2016). Also, understanding the nervous system as a complex system that quickly performs difficult tasks weakens an old research paradigm that considers the brain as a conglomerate of neurotransmitters, due to the lack of technologies to study the functioning of the brain in action (Fenno, Yizhar, & Deisseroth, 2011;Tye & Deisseroth, 2012).…”

Beyond the DSM: trends in psychiatry diagnoses

“…In fact, a recurring suggestion has been that psychiatric nosology should be based on the etiology of mental disorders, similarly to mainstream medicine 8 . However, there are several obstacles in this approach.…”