Auditory/verbal hallucinations, speech perception neurocircuitry, and the social deafferentation hypothesis
Auditory/verbal hallucinations, speech perception neurocircuitry, and the social deafferentation hypothesis
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DOI：
10.1177/155005940803900213
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发表时间：
2008-04-01
影响因子：
2
通讯作者：
Hoffman, Ralph E.
中科院分区：
文献类型：
--
作者：
Hoffman, Ralph E.
幻听/言语幻觉（AVH）由似乎来自特定的非自我说话者的口语对话组成。一赫兹重复经颅磁刺激 (rTMS) 会降低受刺激大脑区域的兴奋性。利用 1 Hz rTMS 传递到左颞顶叶皮层（对言语感知至关重要的大脑区域）的研究表明，相对于假模拟，AVH 具有统计学上的显着改善。提出了 AVH 的一种新机制，即戏剧性的精神病前社交退缩促使“社交大脑”进行神经塑性重组，通过会话言语的幻觉产生虚假的社交意义。支持这一假设的初步证据包括，在患有精神分裂症和 AVH 的患者中，在明显的精神病发作之前，社交退缩的发生率非常高。此外，颞顶 1-Hz rTMS 引起的 AVH 减少可能反映了长期抑郁的增强。一些证据表明，实验诱导的传入神经阻滞后，长期抑郁症状会消失。最后，异常的皮质-皮质耦合与 AVH 相关，也是传入神经阻滞的常见结果。60-80% 的精神分裂症患者在病程中的不同时间报告有口语或“声音”的听觉/言语幻觉 (AVH)。(1-2) AVH 与高度痛苦相关，(3-5) 功能障碍，(6) 并可能导致暴力(7,8) 在 AVH 患者中，大约 25% 的病例中这些症状对目前可用的治疗反应仍然很差或不完全。对于对抗精神病药物确实有反应的 AVH 患者来说，这些经历很有可能在随后的发作中再次出现。(10) 对潜在病理生理学的更精确表征可能会导致更有效的治疗。
Auditory/verbal hallucinations (AVHs) are comprised of spoken conversational speech seeming to arise from specific, nonself speakers. One hertz repetitive transcranial magnetic stimulation (rTMS) reduces excitability in the brain region stimulated. Studies utilizing 1-Hz rTMS delivered to the left temporoparietal cortex, a brain area critical to speech perception, have demonstrated statistically significant improvements in AVHs relative to sham simulation. A novel mechanism of AVHs is proposed whereby dramatic pre-psychotic social withdrawal prompts neuroplastic reorganization by the "social brain" to produce spurious social meaning via hallucinations of conversational speech. Preliminary evidence supporting this hypothesis includes a very high rate of social withdrawal emerging prior to the onset of frank psychosis in patients who develop schizophrenia and AVHs. Moreover, reduced AVHs elicited by temporoparietal 1-Hz rTMS are likely to reflect enhanced long-term depression. Some evidence suggests a loss of long-term depression following experimentally-induced deafferentation. Finally, abnormal cortico-cortical coupling is associated with AVHs and also is a common outcome of deafferentation.Auditory/verbal hallucinations (AVHs) of spoken speech or "voices" are reported by 60-80% of persons with schizophrenia at various times during the course of illness.(1-2) AVHs are associated with high levels of distress,(3-5) functional disability,(6) and can lead to violent acts.(7,8) Among patients with AVHs, these symptoms remain poorly or incompletely responsive to currently available treatments in approximately 25% of cases.' For patients with AVHs who do respond to antipsychotic drugs, there is a very high likelihood that these experiences will recur in subsequent episodes.(10) A more precise characterization of underlying pathophysiology may lead to more efficacious treatments.