Limbic activation associated with misidentification of fearful faces and flat affect in schizophrenia
Limbic activation associated with misidentification of fearful faces and flat affect in schizophrenia
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DOI：
10.1001/archpsyc.64.12.1356
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发表时间：
2007-12-01
影响因子：
--
通讯作者：
Gur, Ruben C.
中科院分区：
文献类型：
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作者：
Gur, Raquel E.;Loughead, James;Gur, Ruben C.
背景：情绪加工缺陷在精神分裂症中很突出，而扁平情绪对治疗有抵抗性，预示着不良的预后。研究潜在的神经回路可以阐明情感性功能障碍。目的：研究面部情绪处理的脑回路，从面部表情的影响来剖析任务要求的反应。设计：在高场（4-T）磁共振成像期间进行面部情绪识别任务。与混乱的面部基线（阻塞分析）和以下4种目标表情的出现（与事件相关）进行对比：快乐、悲伤、愤怒和恐惧。环境：来自精神分裂症研究中心的参与者在宾夕法尼亚大学医学中心接受了功能性磁共振成像研究。参与者：从社区招募dsm - iv定义的精神分裂症患者（n=16）和健康对照（n= 17）。主要结局指标：每次对比的信号改变百分比、表现和临床症状严重程度评分。结果：与对照组相比，患者在情绪识别任务中表现出较低的边缘激活。然而，事件相关分析显示，在对照组中，更大的杏仁核激活与对威胁相关（愤怒和恐惧）表情的正确识别有关，而患者表现出相反的效果，更大的边缘激活预示着错误的识别。此外，更大的杏仁核对恐惧面孔的激活程度与更严重的扁平情绪高度相关。结论：精神分裂症患者在面对恐惧面孔时异常的杏仁核激活与无法识别情绪和更严重的情绪低落相矛盾。这一发现表明，精神分裂症中的平坦情绪与边缘系统的过度刺激有关。
Context: Deficits in emotion processing are prominent in schizophrenia, and flat affect is resistant to treatment and portends poor outcome. Investigation of the underlying neural circuitry can elucidate affective dysfunction.Objective: To examine the brain circuitry for facial emotion processing, dissecting response to task demands from effects of the appearance of facial expressions.Design: A facial emotion identification task was presented during high-field (4-T) magnetic resonance imaging. Blood oxygenation level-dependent changes were contrasted for task compared with a scrambled face baseline (blocked analysis) and for the appearance of each of the following 4 target expressions compared with neutral faces (event related): happy, sad, anger, and fear.Setting: Participants from the Schizophrenia Research Center underwent a functional magnetic resonance imaging study at the University of Pennsylvania Medical Center.Participants: Patients with DSM-IV-defined schizophrenia (n=16) and healthy controls (n= 17) were recruited from the community.Main Outcome Measures: The percentage of signal change for each contrast and performance and clinical symptom severity ratings.Results: Patients showed reduced limbic activation compared with controls for the emotion identification task. However, event-related analysis revealed that whereas in controls greater amygdala activation was associated with correct identifications of threat-related (anger and fear) expressions, patients showed the opposite effect of greater limbic activation, portending misidentifications. Furthermore, greater amygdala activation to the presentation of fearful faces was highly correlated with greater severity of flat affect.Conclusions: Abnormal amygdala activation in schizophrenia in response to presentation of fearful faces is paradoxically associated with failure to recognize the emotion and with more severe flat affect. This finding suggests that flat affect in schizophrenia relates to overstimulation of the limbic system.