Prasad Konasale M R, Patel Anita R, Muddasani Srirangam, Sweeney John, Keshavan Matcheri S
University of Pittsburgh Medical Center, Western Psychiatric Institute and Clinic, 3811 O'Hara St., Pittsburgh, PA 15213, USA.
Am J Psychiatry. 2004 Sep;161(9):1612-9. doi: 10.1176/appi.ajp.161.9.1612.
Neuropathological findings regarding the entorhinal cortex in schizophrenia are conflicting. The authors used structural magnetic resonance imaging to examine the entorhinal cortex volumes of healthy subjects and medication-naive patients experiencing their first episode of psychotic illness.
The study included 33 patients with schizophrenia and related disorders, 11 patients with nonschizophrenic disorders, and 43 matched healthy subjects. All subjects were rated on the Scale for the Assessment of Positive Symptoms and the Scale for the Assessment of Negative Symptoms, and volumetric measurements of the entorhinal cortex were obtained for all subjects. The authors examined differences across the groups as well as clinical correlations of entorhinal cortex volumes adjusted for intracranial volume.
A significant diagnosis effect was seen in the left entorhinal cortex: patients with schizophrenia and related disorders and patients with nonschizophrenic psychotic disorders had smaller left entorhinal cortex volumes than healthy subjects. The mean entorhinal cortex volume of patients with schizophrenic disorders did not differ from that of patients with nonschizophrenic psychotic disorders. In patients with schizophrenic disorders, the entorhinal cortex volume positively correlated with severity of delusions. The mean entorhinal cortex volume of patients with nondelusional psychotic disorders was significantly smaller than that of patients with delusional psychotic disorders and healthy subjects.
Smaller entorhinal cortex volume in first-episode, neuroleptic-naive psychotic disorders may not be a confound of the effects of illness chronicity or antipsychotic treatment. Entorhinal cortex pathology appears to have a significant association with positive symptoms, specifically delusions. The impairment of functions in which the entorhinal cortex participates-such as novelty detection, associative learning, and processing episodic, recognition, and autobiographical memory-could be responsible for its association with psychotic disorders and delusions.
关于精神分裂症内嗅皮质的神经病理学研究结果相互矛盾。作者使用结构磁共振成像来检查健康受试者以及首次发作精神病性疾病且未服用药物的患者的内嗅皮质体积。
该研究纳入了33例精神分裂症及相关障碍患者、11例非精神分裂症障碍患者和43例匹配的健康受试者。所有受试者均接受阳性症状评定量表和阴性症状评定量表评估，并对所有受试者进行内嗅皮质体积测量。作者检查了各组之间的差异以及经颅内体积校正后的内嗅皮质体积与临床的相关性。
在左侧内嗅皮质观察到显著的诊断效应：精神分裂症及相关障碍患者和非精神分裂症性精神病性障碍患者的左侧内嗅皮质体积小于健康受试者。精神分裂症性障碍患者的平均内嗅皮质体积与非精神分裂症性精神病性障碍患者的平均内嗅皮质体积无差异。在精神分裂症性障碍患者中，内嗅皮质体积与妄想严重程度呈正相关。无妄想性精神病性障碍患者的平均内嗅皮质体积显著小于有妄想性精神病性障碍患者和健康受试者的平均内嗅皮质体积。
首次发作、未使用抗精神病药物的精神病性障碍患者内嗅皮质体积较小，可能不是疾病慢性化或抗精神病药物治疗影响的混杂因素。内嗅皮质病理似乎与阳性症状，特别是妄想有显著关联。内嗅皮质参与的功能损害，如新奇性检测、联想学习以及情景记忆、识别记忆和自传体记忆的处理，可能是其与精神障碍和妄想相关的原因。
