Neuroanatomic differences among cognitive and symptom subtypes of schizophrenia
Neuroanatomic differences among cognitive and symptom subtypes of schizophrenia
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DOI：
10.1097/00005053-200006000-00010
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发表时间：
2000-06-01
影响因子：
1.9
通讯作者：
van Kammen, DP
中科院分区：
文献类型：
--
作者：
Allen, DN;Seaton, BE;van Kammen, DP
精神分裂症的精神症状、认知功能和大脑结构异常的异质性已被广泛报道。虽然一些精神分裂症患者主要表现出阳性症状，例如思维障碍或混乱，但其他患者可能主要表现出阴性症状（Andreasen 和 Olson，1982）。同样，一些患者的特征是严重的整体认知障碍，而其他患者则表现出平均至高于平均水平的认知能力（Goldstein 1990；Goldstein 等人，1998；Palmer 等人，1997）。精神分裂症的大脑结构异常在病变的广泛性和位置方面也可能因患者而异（Chua 和 McKenna，1995；Delisi，1994；Falkai 和 Bogerts，1995）。这种显着的异质性鼓励人们努力开发精神分裂症的亚型，其中基于精神症状的亚型得到了最广泛的研究。神经影像技术（Green，1998；Keshavan 和 Murray，1997）已被用于尝试建立特定症状亚型和综合征的病理生理学。 Liddle (1996)报道，精神分裂症的精神运动贫困综合征与左额叶脑血流活动减退有关，紊乱综合征与右腹前额叶活动不足和右前扣带回活动增加有关，现实扭曲综合征与内侧颞叶过度活跃有关。 Schroder等人（1992，1995）开发了一个基于因素分析的亚型系统，包括慢性妄想型、慢性消极型、慢性紊乱型和缓解型亚型。在CT扫描中，妄想型和阴性亚型显示出较大的额叶半球间宽度，而紊乱型亚型则显示出较大的侧脑室和第三脑室比率。正电子发射断层扫描（PET）显示，妄想组的平均海马活动最高。此外，相对于混乱亚组和正常对照，阴性亚组和妄想亚组的前扣带回和额叶活动减少。这些研究表明，特定神经系统的功能障碍与特定的症状组（综合征）或基于症状的亚型有关。
Heterogeneity of psychiatric symptoms, cognitive function, and structural brain abnormalities have been widely reported in schizophrenia. While some patients with schizophrenia exhibit primarily positive symptoms such as thought disorder or disorganization, others may exhibit primarily negative symptoms (Andreasen and Olson, 1982). Similarly, some patients are characterized by profound global cognitive impairment, whereas others exhibit average to above average cognitive abilities (Goldstein 1990; Goldstein et al., 1998; Palmer et al., 1997). Structural brain abnormalities in schizophrenia may also vary from patient to patient with regard to extensiveness and location of lesion (Chua and McKenna, 1995; Delisi, 1994; Falkai and Bogerts, 1995).This marked heterogeneity has encouraged efforts to develop subtypes of schizophrenia, with subtypes based on psychiatric symptoms being the most extensively investigated. Neuroimaging techniques (Green, 1998; Keshavan and Murray, 1997) have been used in attempts to establish the pathophysiology of specific symptom subtypes and syndromes. Liddle (1996) reported that the psychomotor poverty syndrome in schizophrenia was associated with left frontal hypoactivity of cerebral blood flow, the disorganization syndrome was associated with right ventral prefrontal underactivity and right anterior cingulate increased activity, and the reality distortion syndrome was associated with hyperactivity in the medial temporal lobe. Schroder et al.(1992, 1995) developed a factor analytically based subtyping system including chronic delusional, chronic negative, chronic disorganized, and remitted subtypes. On CT scan, the delusional and negative subtypes showed greater frontal interhemi-spheric width, whereas the disorganized subtype showed greater lateral and third ventricle ratios. Positron emission tomography (PET) revealed that mean hippocampal activity was highest in the delusional group. Also, anterior cingulum and frontal activity were reduced in the negative and delusional subgroups relative to the disorganized subgroup and normal controls. These investigations suggest that dysfunction of specific neural systems is associated with specific groups of symptoms (syndromes) or symptom-based subtypes.