The role of the prefrontal cortex in self-consciousness: The case of auditory hallucinations
The role of the prefrontal cortex in self-consciousness: The case of auditory hallucinations
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DOI：
10.1098/rstb.1996.0136
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发表时间：
1996-10-29
影响因子：
6.3
通讯作者：
Frith, C
中科院分区：
文献类型：
--
作者：
Frith, C
许多精神分裂症患者报告出现幻觉，他们听到有人在与他们交谈或谈论他们。行为和生理研究表明，这种体验与听觉语言系统中发生的过程有关，这些过程与言语的产生和接收有关。我认为出现幻觉是因为患者很难区分自己的行为引起的感觉和外部影响引起的感觉。这种区别可以通过预测执行命令（正向建模）产生的感觉来实现。如果预测的感觉与实际的感觉相匹配，则没有外部影响发生，并且可以“取消”对变化的感知。在生理层面上，这种机制取决于执行命令起源的前额叶区域和与由此产生的感觉有关的后脑区域之间的相互作用。来自功能性脑成像的证据证实，精神分裂症患者的前额叶（执行）区域和听觉关联区域之间的相互作用是异常的。然而，在我们能够理解为什么患者感受到这些声音不仅来自外部来源，而且来自试图影响他们行为的代理人之前，这个解释还需要扩展。最近的影像学研究表明，当我们思考其他人时，内侧前额叶皮层会参与活动，但该大脑区域与其他区域相互作用的确切性质仍有待确定。
Many patients with schizophrenia report hallucinations in which they hear voices talking to them or about them. Behavioural and physiological studies show that this experience is associated with processes occurring in auditory language systems associated with both the production and the reception of speech. I propose that hallucinations are experienced because patients have difficulty in distinguishing sensations caused by their own actions from those that arise from external influences. This distinction can be made by predicting the sensations that will result from executive commands (forward modelling). If the predicted sensation matches the actual sensation then no outside influences have occurred and perception of change can be 'cancelled'. At the physiological level this mechanism depends upon interactions between the prefrontal areas where the executive commands originate and posterior brain regions concerned with the resultant sensations. Evidence from functional brain imaging confirms that interactions between prefrontal (executive) areas and auditory association areas are abnormal in schizophrenia. However, this account needs to be extended before we can understand why patients experience the voices as emanating, not just from an external source, but from agents who are trying to influence their behaviour. Recent imaging studies suggest that medial prefrontal cortex is engaged when we think about other people, but the precise nature of the interaction of this brain area with other regions remains to be established.