Psychiatric disorders share the same pattern of longitudinal evolution and have courses that tend to be chronic and recurrent. These aspects of chronicity and longitudinal evolution are currently studied under the deficit-oriented neuroprogression framework. Interestingly, considering the plasticity of the brain, it is also necessary to emphasize the bidirectional nature of neuroprogression. We review evidence highlighting alterations of the brain associated with the longitudinal evolution of psychiatric disorders from the framework of neuroplastic adaptation to pathology. This new framework highlights that substantial plasticity and remodeling may occur beyond the classic deficit-oriented neuroprogressive framework, which has been associated with progressive loss of gray matter thickness, decreased brain connectivity, and chronic inflammation. We also integrate the brain economy concept in the neuroplastic adaptation to pathology framework, emphasizing that to preserve its economy, i.e. function, the brain learns how to cope with the disease by adapting its architecture. Neuroplastic adaptation to pathology is a proposition for a paradigm shift to overcome the shortcomings of traditional psychiatric diagnostic boundaries; this approach can disentangle both the specific pathophysiology of psychiatric symptoms and the adaptation to pathology, thus offering a new framework for both diagnosis and treatment.

中文翻译：

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精神病学对病理学的塑性适应：精神病患者是否是病理学专家？

精神疾病具有相同的纵向演变模式，并且其病程往往是慢性和复发性的。目前，在面向缺陷的神经进步框架下研究了慢性和纵向进化的这些方面。有趣的是，考虑到大脑的可塑性，还需要强调神经进程的双向特性。我们审查了证据，突出显示了从神经塑性适应到病理学的角度，与精神疾病纵向演变相关的大脑改变。这个新的框架突显出，除了经典的以缺陷为导向的神经进行性框架外，可能还会发生大量的可塑性和重塑，这与灰质厚度的逐渐丧失，大脑连接性下降和慢性炎症有关。我们还将大脑经济概念整合到病理模型的神经塑形适应中，强调要保持其经济性（即功能），大脑将学习如何通过适应其结构来应对这种疾病。神经塑性适应病理学是为克服传统精神病学诊断方法的缺陷而进行范式转换的命题。这种方法可以使精神症状的特定病理生理学和对病理学的适应性都难以区分，从而为诊断和治疗提供了新的框架。神经塑性适应病理学是为克服传统精神病学诊断方法的缺陷而进行范式转换的命题。这种方法可以使精神症状的特定病理生理学和对病理学的适应性都难以区分，从而为诊断和治疗提供了新的框架。神经塑性适应病理学是为克服传统精神病学诊断方法的缺陷而进行范式转换的命题。这种方法可以使精神症状的特定病理生理学和对病理学的适应性都难以区分，从而为诊断和治疗提供了新的框架。