Hirao Kazuyuki, Miyata Jun, Fujiwara Hironobu, Yamada Makiko, Namiki Chihiro, Shimizu Mitsuaki, Sawamoto Nobukatsu, Fukuyama Hidenao, Hayashi Takuji, Murai Toshiya
Department of Neuropsychiatry, Graduate School of Medicine, Kyoto University, Shogoin-Kawaharacho 54, Kyoto 606-8507, Japan.
Schizophr Res. 2008 Oct;105(1-3):165-74. doi: 10.1016/j.schres.2008.07.021. Epub 2008 Sep 5.
Impaired ability to infer the mental states of others (theory of mind; ToM) is considered to be a key contributor to the poor social functioning of patients with schizophrenia. Although neuroimaging and lesion studies have provided empirical evidence for the neural basis of ToM ability, including the involvement of several prefrontal and temporal structures, the association between pathology of these structures and ToM impairment in schizophrenia patients is less well understood. To address this issue, we investigated structural brain abnormalities and ToM impairment in patients with schizophrenia, and examined the relationship between them. Twenty schizophrenia patients and 20 age-, sex- and education-matched healthy participants underwent magnetic resonance imaging (MRI) and were examined for ToM ability based on the revised version of the "Reading the Mind in the Eyes" (or Eyes) test [Baron-Cohen, S., Wheelwright, S., Hill, J., Raste, Y., Plumb, I., 2001. The 'Reading the Mind in the Eyes' test revised version: A study with normal adults, and adults with Asperger syndrome or high-functioning autism. J. Child Psychol. Psychiatry 42, 241-251]. Voxel-based morphometry (VBM) was performed to investigate regional brain alterations. Relative to normal controls, schizophrenia patients exhibited gray matter reductions in the dorsomedial prefrontal cortex (DMPFC), left ventrolateral prefrontal cortex (VLPFC), ventromedial prefrontal cortex (VMPFC), anterior cingulate cortex (ACC), right superior temporal gyrus (STG) and right insula. The patients performed poorly on the Eyes test. Importantly, poor performance on the Eyes test was found to be associated with gray matter reduction in the left VLPFC in the patient group. These results suggest that prefrontal cortical reduction, especially in the left VLPFC, is a key pathology underlying the difficulties faced by schizophrenia patients in inferring the mental states of others.
推断他人心理状态的能力受损（心理理论；ToM）被认为是精神分裂症患者社交功能差的关键因素。尽管神经影像学和病变研究已经为ToM能力的神经基础提供了实证证据，包括多个前额叶和颞叶结构的参与，但这些结构的病理学与精神分裂症患者ToM损害之间的关联仍不太清楚。为了解决这个问题，我们调查了精神分裂症患者的脑结构异常和ToM损害，并研究了它们之间的关系。20名精神分裂症患者和20名年龄、性别和教育程度相匹配的健康参与者接受了磁共振成像（MRI）检查，并根据修订版的“从眼睛中读懂心思”（或眼睛）测试[Baron-Cohen, S., Wheelwright, S., Hill, J., Raste, Y., Plumb, I., 2001.《从眼睛中读懂心思》测试修订版：对正常成年人、阿斯伯格综合征或高功能自闭症成年人的研究。《儿童心理学与精神病学杂志》42, 241 - 251]对ToM能力进行了检查。采用基于体素的形态计量学（VBM）来研究脑区的改变。与正常对照组相比，精神分裂症患者在背内侧前额叶皮质（DMPFC）、左侧腹外侧前额叶皮质（VLPFC）、腹内侧前额叶皮质（VMPFC）、前扣带回皮质（ACC）、右侧颞上回（STG）和右侧岛叶出现灰质减少。患者在眼睛测试中的表现较差。重要的是，在患者组中发现眼睛测试表现不佳与左侧VLPFC的灰质减少有关。这些结果表明，前额叶皮质减少，尤其是左侧VLPFC，是精神分裂症患者在推断他人心理状态时面临困难的关键病理学基础。
