The Neural Crossroads of Psychiatric Illness: An Emerging Target for Brain Stimulation

Abstract

Recent meta-analyses of structural and functional neuroimaging studies are converging on a collective core of brain regions affected across most psychiatric disorders, centered on the dorsal anterior cingulate cortex (dACC) and anterior insula. These nodes correspond well to an anterior cingulo-insular (aCIN) or 'salience' network, and stand at a crossroads within the functional architecture of the brain, acting as a switch to deploy other major functional networks according to motivational demands and environmental constraints. Therefore, disruption of these 'linchpin' areas may be disproportionately disabling, even when other networks remain intact. These regions may represent promising targets for a new generation of anatomically directed brain stimulation treatments. Here, we review the potential of the psychiatric core areas as targets for therapeutic brain stimulation in psychiatric disease.

Keywords: DBS; VBM; cingulate; insula; neuroimaging; psychiatry; rTMS; resting-state; salience; tDCS.