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听觉/言语幻觉、言语感知神经回路与社会去传入假说

Auditory/Verbal hallucinations, speech perception neurocircuitry, and the social deafferentation hypothesis.

作者信息

Hoffman Ralph E

机构信息

Yale University School of Medicine, New Haven, Connecticut, USA.

出版信息

Clin EEG Neurosci. 2008 Apr;39(2):87-90. doi: 10.1177/155005940803900213.

Abstract

Auditory/verbal hallucinations (AVHs) are comprised of spoken conversational speech seeming to arise from specific, nonself speakers. One hertz repetitive transcranial magnetic stimulation (rTMS) reduces excitability in the brain region stimulated. Studies utilizing 1-Hz rTMS delivered to the left temporoparietal cortex, a brain area critical to speech perception, have demonstrated statistically significant improvements in AVHs relative to sham simulation. A novel mechanism of AVHs is proposed whereby dramatic pre-psychotic social withdrawal prompts neuroplastic reorganization by the "social brain" to produce spurious social meaning via hallucinations of conversational speech. Preliminary evidence supporting this hypothesis includes a very high rate of social withdrawal emerging prior to the onset of frank psychosis in patients who develop schizophrenia and AVHs. Moreover, reduced AVHs elicited by temporoparietal 1-Hz rTMS are likely to reflect enhanced long-term depression. Some evidence suggests a loss of long-term depression following experimentally-induced deafferentation. Finally, abnormal cortico-cortical coupling is associated with AVHs and also is a common outcome of deafferentation. Auditory/verbal hallucinations (AVHs) of spoken speech or "voices" are reported by 60-80% of persons with schizophrenia at various times during the course of illness. AVHs are associated with high levels of distress, functional disability, and can lead to violent acts. Among patients with AVHs, these symptoms remain poorly or incompletely responsive to currently available treatments in approximately 25% of cases. For patients with AVHs who do respond to antipsychotic drugs, there is a very high likelihood that these experiences will recur in subsequent episodes. A more precise characterization of underlying pathophysiology may lead to more efficacious treatments.

摘要

听觉/言语幻觉(AVH)由似乎来自特定非自身说话者的口头对话语音组成。1赫兹重复经颅磁刺激(rTMS)可降低受刺激脑区的兴奋性。利用1赫兹rTMS作用于左颞顶叶皮层(对语音感知至关重要的脑区)的研究表明,与假刺激相比,AVH有统计学上的显著改善。提出了一种AVH的新机制,即精神病前期严重的社交退缩促使“社交脑”进行神经可塑性重组,通过对话语音幻觉产生虚假的社交意义。支持这一假设的初步证据包括,在发展为精神分裂症和AVH的患者中,在明显精神病发作之前出现社交退缩的比例非常高。此外,颞顶叶1赫兹rTMS引起的AVH减少可能反映了长期抑郁的增强。一些证据表明,实验性去传入神经后会出现长期抑郁的丧失。最后,异常的皮质-皮质耦合与AVH有关,也是去传入神经的常见结果。60%-80%的精神分裂症患者在病程中的不同时间报告有言语或“声音”的听觉/言语幻觉(AVH)。AVH与高度痛苦、功能残疾相关,并可能导致暴力行为。在有AVH的患者中,这些症状在大约25%的病例中对目前可用的治疗反应不佳或不完全反应。对于对抗精神病药物有反应的AVH患者,这些经历在随后的发作中很有可能复发。对潜在病理生理学进行更精确的表征可能会带来更有效的治疗方法。

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