Brüne Martin, Lissek Silke, Fuchs Nina, Witthaus Henning, Peters Sören, Nicolas Volkmar, Juckel Georg, Tegenthoff Martin
Department of Psychiatry, Ruhr-University Bochum, LWL Hospital, Alexandrinenstr 1, 44791 Bochum, Germany.
Neuropsychologia. 2008;46(7):1992-2001. doi: 10.1016/j.neuropsychologia.2008.01.023. Epub 2008 Feb 7.
Several studies have shown that patients with schizophrenia underactivate brain regions involved in theory of mind relative to controls during functional brain imaging. However, in most studies the samples were fairly heterogeneous in terms of clinical symptomatology. We examined a group of nine patients with first episode or recurrent episodes, who clinically presented with predominant "passivity" symptoms such as third-person auditory hallucinations or delusion of control, using a cartoon-based theory of mind task and compared activation patterns with a group of 13 healthy controls. All patients responded well to antipsychotic treatment and were only mildly symptomatic at the time of testing. The patient group showed significantly less activation of the right anterior cingulate cortex (ACC) and right insula compared with controls, but greater activation in dorsal areas of the medial prefrontal cortex, right temporal areas and left temporo-parietal junction. Patients with schizophrenia with predominant "passivity" symptoms and good response to antipsychotic treatment show a markedly diverging pattern of brain activation during theory of mind task performance compared with healthy controls. These findings suggest abnormal activation of those brain areas involved in the evaluation of self-reference during mental state attribution.
多项研究表明，在功能性脑成像过程中，与对照组相比，精神分裂症患者在涉及心理理论的脑区存在激活不足的情况。然而，在大多数研究中，样本在临床症状学方面相当异质。我们使用基于卡通的心理理论任务，对一组9名首次发作或复发的患者进行了检查，这些患者临床上主要表现为“被动性”症状，如第三人称幻听或被控制妄想，并将其激活模式与一组13名健康对照者进行了比较。所有患者对抗精神病药物治疗反应良好，在测试时仅有轻微症状。与对照组相比，患者组右侧前扣带回皮质（ACC）和右侧脑岛的激活明显较少，但在内侧前额叶皮质的背侧区域、右侧颞叶区域和左侧颞顶交界区的激活较多。具有主要“被动性”症状且对抗精神病药物治疗反应良好的精神分裂症患者，在心理理论任务表现期间，与健康对照者相比，脑激活模式明显不同。这些发现表明，在心理状态归因过程中，参与自我参照评估的那些脑区存在异常激活。
