Dysfunction of ventral striatal reward prediction in schizophrenic patients treated with typical, not atypical, neuroleptics
Dysfunction of ventral striatal reward prediction in schizophrenic patients treated with typical, not atypical, neuroleptics
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DOI：
10.1007/s00213-006-0405-4
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发表时间：
2006-08-01
影响因子：
3.4
通讯作者：
Heinz, Andreas
中科院分区：
文献类型：
--
作者：
Juckel, Georg;Schlagenhauf, Florian;Heinz, Andreas
基本原理：对精神分裂症患者的临床研究表明，非典型精神抑制剂比典型精神抑制剂更有效地减少阴性症状，包括冷漠和快感缺乏。多巴胺能奖励系统功能障碍可能导致精神分裂症的阴性症状。目的：我们使用功能磁共振成像技术评估药物治疗的精神分裂症患者和健康对照者在奖励预期期间腹侧纹状体的血氧水平依赖性反应。方法：20例精神分裂症患者[10例用典型的（例如，氟哌啶醇）和10例非典型（例如，奥氮平和利培酮）抗精神病药]和10名年龄匹配的健康志愿者参与了一项激励性金钱延迟任务，在该任务中，视觉线索预测对随后的目标刺激的快速反应将导致金钱收益或无后果。健康志愿者和接受非典型抗精神病药物治疗的精神分裂症患者在对奖励提示做出反应时，但是用典型的精神抑制剂治疗的精神分裂症患者却没有。在典型的抗精神病药物治疗的患者中，左腹侧纹状体的激活减少与阴性symptoms.Conclusions的严重程度相关：未能激活腹侧纹状体在奖励预期与精神分裂症的阴性症状的严重程度，也被发现在本研究中精神分裂症与典型的抗精神病药物治疗。在接受非典型抗精神病药物治疗的患者中未观察到腹侧纹状体激活的显著钝化，这可能反映了这些药物治疗阴性症状的疗效改善。
Rationale: Clinical studies in patients with schizophrenia suggest that atypical neuroleptics are more effective than typical neuroleptics in reducing negative symptoms including apathy and anhedonia. Dysfunction of the dopaminergic reward system may contribute to negative symptoms in schizophrenia.Objective: We used functional magnetic resonance imaging to assess the blood oxygen level dependency response in the ventral striatum of medicated schizophrenics and healthy control subjects during reward anticipation.Methods: Twenty schizophrenics [ten medicated with typical (e.g., haloperidol) and ten with atypical (e.g., olanzapine and risperidone) neuroleptics] and ten age-matched healthy volunteers participated in an incentive monetary delay task in which visual cues predicted that a rapid response to a subsequent target stimulus would result either in monetary gain or no consequence.Results: Healthy volunteers and schizophrenics treated with atypical neuroleptics showed ventral striatal activation in response to reward-indicating cues, but schizophrenics treated with typical neuroleptics did not. In patients treated with typical neuroleptics, decrease in activation of the left ventral striatum was correlated with the severity of negative symptoms.Conclusions: Failure to activate the ventral striatum during reward anticipation was previously associated with the severity of negative symptoms in schizophrenia and was also found in schizophrenics treated with typical neuroleptics in this study. Significant blunting of ventral striatal activation was not observed in patients treated with atypical neuroleptics, which may reflect the improved efficacy of these drugs in treating negative symptoms.