Lateral and medial hypofrontality in first-episode schizophrenia: Functional activity in a medication-naive state and effects of short-term atypical antipsychotic treatment
Lateral and medial hypofrontality in first-episode schizophrenia: Functional activity in a medication-naive state and effects of short-term atypical antipsychotic treatment
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DOI：
10.1176/appi.ajp.162.12.2322
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发表时间：
2005-12-01
影响因子：
17.7
通讯作者：
Carter, CS
中科院分区：
文献类型：
--
作者：
Snitz, BE;MacDonald, A;Carter, CS
目的：背外侧前额叶皮质和前扣带回皮质是执行控制相关脑回路的关键组成部分。本研究的目的是在一组从未服用过药物的首发精神分裂症患者中研究与控制相关的背外侧前额叶皮质功能以及与冲突相关的前扣带回皮质功能，以确定在疾病发作时这两个区域是否都显示功能障碍。第二个目的是评估非典型抗精神病药物对背外侧前额叶皮质和前扣带回皮质功能的短期影响。
方法：23名首发精神分裂症患者和24名健康对照受试者接受了事件相关的功能性磁共振成像（fMRI），并执行一项旨在从功能上区分这两个区域的认知任务。在患者开始药物治疗4周后，11名患者和16名对照受试者的一个子集接受了重复评估。
结果：在基线水平，患者在背外侧前额叶皮质和前扣带回皮质表现出低激活。经过4周的抗精神病治疗后，患者在前扣带回皮质的功能有所改善，但在背外侧前额叶皮质没有改善。
结论：这些发现证实了在精神分裂症病程早期存在背外侧前额叶皮质功能障碍，并表明前扣带回皮质功能在疾病发作时也可能发生改变。结果还表明前扣带回皮质功能可能对补救性抗精神病治疗效果特别敏感。这些发现与不断涌现的文献一致，这些文献记录了非典型抗精神病药物对精神分裂症认知缺陷相关神经回路的短期益处。
Objective: The dorsolateral prefrontal cortex and the anterior cingulate cortex are critical components of the brain circuitry underlying executive control. The objective of this study was to investigate control-related dorsolateral prefrontal cortex functioning and conflict-related anterior cingulate cortex functioning in a group of never medicated first-episode schizophrenia patients to determine whether both regions show dysfunction at illness onset. A second objective was to assess short-term effects of atypical antipsychotic medication on dorsolateral prefrontal cortex and anterior cingulate cortex functioning.Method: First-episode schizophrenia patients (N = 23) and healthy comparison subjects (N = 24) underwent event-related fMRI and performed a cognitive task designed to functionally dissociate the two regions. Four weeks after initiation of pharmacotherapy for patients, a subset of 11 patients and 16 comparison subjects underwent a repeat assessment.Results: At baseline, patients exhibited hypoactivation in the dorsolateral prefrontal cortex and anterior cingulate cortex. After 4 weeks of antipsychotic treatment, the patients demonstrated improved functioning in the anterior cingulate cortex but not in the dorsolateral prefrontal cortex.Conclusions: These findings confirm the presence of dorsolateral prefrontal cortex dysfunction early in the course of schizophrenia and suggest that anterior cingulate cortex functioning may be altered at illness onset as well. Results also suggest that anterior cingulate cortex functioning may be especially sensitive to remedial antipsychotic treatment effects. These findings are consistent with an emerging literature documenting short-term benefits of atypical antipsychotic medication for the neural circuitry underlying cognitive deficits in schizophrenia.