Oyebode Femi
Department of Psychiatry, University of Birmingham, Queen Elizabeth Psychiatric Hospital, Birmingham, UK.
Med Princ Pract. 2008;17(4):263-9. doi: 10.1159/000129603. Epub 2008 Jun 3.
The neural basis of psychosis is yet to be fully elucidated. In this review the contribution of schizophrenia-like psychosis of epilepsy, delusional misidentification syndromes and psychotic phenomena, such as auditory and visual hallucinations, to our understanding of the neural basis of psychosis is examined. Schizophrenia-like psychosis of epilepsy is associated with seizures originating from the limbic structures. Reduced seizure frequency, left-sided electrical foci, and neurodevelopmental lesions manifesting as cortical dysgenesis are known to influence the likelihood of developing schizophrenia-like psychosis of epilepsy. The delusional misidentification syndromes are a group of rare psychiatric symptoms in which impairments of face recognition memory are present. These conditions appear also to be associated with organic lesions affecting limbic structures and also involving both the frontal and parietal lobes. There is evidence that right-sided lesions predominate in the aetiology of delusional misidentification syndromes. Thus, the common link between schizophrenia, schizophrenia-like psychosis of epilepsy and delusional misidentification syndromes appears to be involvement of limbic structures in their pathophysiology. Discrete psychotic phenomena such as visual and auditory hallucinations appear to arise from functional changes in the same cortical areas subserving the normal physiological functions of vision and audition but also involving limbic structures. In conclusion, the limbic structures appear to be central to the psychopathology of psychosis but with involvement of frontal and parietal structures. These inquiries are revealing as much about psychosis as they are about the nature of normal brain function.
精神病的神经基础尚未完全阐明。在本综述中，将探讨癫痫所致精神分裂症样精神病、妄想性错认综合征以及诸如幻听和幻视等精神病性现象，对我们理解精神病神经基础的作用。癫痫所致精神分裂症样精神病与起源于边缘结构的癫痫发作有关。已知癫痫发作频率降低、左侧电灶以及表现为皮质发育异常的神经发育性病变会影响患癫痫所致精神分裂症样精神病的可能性。妄想性错认综合征是一组罕见的精神症状，存在面部识别记忆障碍。这些病症似乎也与影响边缘结构且累及额叶和顶叶的器质性病变有关。有证据表明，右侧病变在妄想性错认综合征的病因中占主导地位。因此，精神分裂症、癫痫所致精神分裂症样精神病和妄想性错认综合征之间的共同联系似乎是边缘结构参与了它们的病理生理过程。诸如幻视和幻听等离散的精神病性现象似乎源于那些既服务于视觉和听觉正常生理功能又涉及边缘结构的相同皮质区域的功能变化。总之，边缘结构似乎是精神病心理病理学的核心，但额叶和顶叶结构也参与其中。这些研究揭示的关于精神病的内容与它们揭示的关于正常脑功能本质的内容一样多。
