难治性病例中常规脑电图的证据意义:精神病学范式的转变。

Ronald J Swatzyna, Lorrianne M Morrow, Diana M Collins, Emma A Barr, Alexandra J Roark, Robert P Turner
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摘要

在过去十年中,《诊断与统计手册》中根据症状开药的方法受到了挑战。美国国家精神卫生研究所开始向精准医学转变,而世界精神病学协会则认为需要进行范式转变。本研究为这一转变提供了支持,提供了解释精神科用药失败率高的证据,并提出了迈向精准医疗的第一步。一家大型精神科诊所从 2012 年开始为这项研究收集脑电图(EEG)。同一神经生理学家(获得脑电图认证)对 1233 名患者的脑电图进行了分析。这项研究确定了导致难治性患者药物治疗失败的 4 个脑电图生物标志物:局灶性放缓、棘波β过多、脑病和孤立的癫痫样放电。每种脑电图生物标志物都提示潜在的大脑调节失调,这可能解释了之前的药物治疗为何会失败。根据目前的精神评估方法,无法识别脑电图生物标志物,而且根据定位、强度和持续时间的不同,这些生物标志物都可能表现为复杂的行为或精神问题。该研究强调,脑电图生物标志物识别方法是精神病学向个性化医疗迈出的积极一步,进一步推进了 "检测我们试图治疗的器官 "的临床思维。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Evidentiary Significance of Routine EEG in Refractory Cases: A Paradigm Shift in Psychiatry.

Over the past decade, the Diagnostic and Statistical Manual's method of prescribing medications based on presenting symptoms has been challenged. The shift toward precision medicine began with the National Institute of Mental Health and culminated with the World Psychiatric Association's posit that a paradigm shift is needed. This study supports that shift by providing evidence explaining the high rate of psychiatric medication failure and suggests a possible first step toward precision medicine. A large psychiatric practice began collecting electroencephalograms (EEGs) for this study in 2012. The EEGs were analyzed by the same neurophysiologist (board certified in electroencephalography) on 1,233 patients. This study identified 4 EEG biomarkers accounting for medication failure in refractory patients: focal slowing, spindling excessive beta, encephalopathy, and isolated epileptiform discharges. Each EEG biomarker suggests underlying brain dysregulation, which may explain why prior medication attempts have failed. The EEG biomarkers cannot be identified based on current psychiatric assessment methods, and depending upon the localization, intensity, and duration, can all present as complex behavioral or psychiatric issues. The study highlights that the EEG biomarker identification approach can be a positive step toward personalized medicine in psychiatry, furthering the clinical thinking of "testing the organ we are trying to treat."

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