van Honk Jack, Schutter Dennis J L G
Utrecht University, The Netherlands.
Cogn Neuropsychiatry. 2006 May;11(3):285-306. doi: 10.1080/13546800500233728.
The neurobiological basis of primary psychopathy, an emotional disorder characterised by a lack of fear and empathy, on the one hand, and extremely violent, antisocial tendencies, on the other, is relatively unknown. Nevertheless, theoretical models that emphasise the role of fearlessness, imbalanced motivation, defective somatic markers, and dysfunctional violence inhibition mechanisms have complementary proposals regarding motivations and brain mechanisms involved.
Presently, incorporating the heuristic value of these models and further theorising on the basis of recent data from neuropsychology, neuroendocrinology, neuroimaging, and repetitive transcranial magnetic stimulation (rTMS), an attempt is made to construct a neurobiological framework of emotion processing in primary psychopathy with clinical applicability.
According to this framework, defective emotional processing in primary psychopathy results from bottom-up hormone-mediated imbalances at: (1) the subcortical level; (2) in subcortico-cortical "cross-talk"; that end up in an instrumental stance at the cortical level (3). An endocrine dual-system approach for the fine-tuned restoration of these hormone-mediated imbalances is proposed as a possible clinical application.
This application may be capable of laying a neurobiological foundation for more successful sociotherapeutic interventions in primary psychopathy.
原发性精神病是一种情绪障碍，一方面表现为缺乏恐惧和同理心，另一方面表现为极其暴力的反社会倾向，其神经生物学基础相对未知。然而，强调无畏、动机失衡、躯体标记缺陷和暴力抑制机制功能失调作用的理论模型，对所涉及的动机和脑机制有互补性的提议。
目前，结合这些模型的启发价值，并基于神经心理学、神经内分泌学、神经影像学和重复经颅磁刺激（rTMS）的最新数据进行进一步理论化，试图构建一个具有临床适用性的原发性精神病情绪加工神经生物学框架。
根据这个框架，原发性精神病中情绪加工缺陷源于以下方面由激素介导的自下而上的失衡：（1）皮层下水平；（2）皮层下 - 皮层的“相互作用”；最终在皮层水平形成一种工具性姿态（3）。提出一种内分泌双系统方法来微调这些激素介导的失衡，作为一种可能的临床应用。
这种应用可能能够为原发性精神病更成功的社会治疗干预奠定神经生物学基础。
