Dolan Mairead C, Fullam Rachael S
Centre for Forensic Behavioural Science, Monash University and the Victorian Institute for Forensic Mental Health, Victoria, Australia.
Biol Psychiatry. 2009 Sep 15;66(6):570-7. doi: 10.1016/j.biopsych.2009.03.019. Epub 2009 May 15.
Comorbidity between schizophrenia and psychopathy has been noted in violent patients in forensic settings. Both disorders are characterized by deficits in processing sad and fearful emotions, but there have been no imaging studies examining the impact of comorbid psychopathic traits on emotional information processing in violent patients with schizophrenia. We tested the hypothesis that violent patients with schizophrenia who had high psychopathy scores would show attenuated amygdala responses to emotional (particularly fearful) faces compared with those with low psychopathy scores.
Twenty-four violent male patients with schizophrenia were categorized as high/low scorers based on the Psychopathy Checklist: Screening Version. Participants underwent functional magnetic resonance imaging during a block-designed implicit face affect processing task. In a region of interest approach, responses in the amygdala and prefrontal cortex were examined with contrasts between sad/fearful/angry/disgusted faces and neutral faces.
High psychopathy scorers exhibited reduced blood oxygenation level-dependent (BOLD) responses in the amygdala during exposure to fearful faces. Psychopathy scores, particularly the affective facets, correlated negatively with amygdala responses. The BOLD responses in the orbitofrontal cortex were negatively correlated with the lifestyle and antisocial facets of psychopathy during exposure to sad faces. Psychopathy scores were positively correlated with neural activation in amygdala and inferior prefrontal regions for disgust but negatively correlated for anger.
Patients with schizophrenia and high levels of psychopathic traits appear to have blunted amygdala responses to fearful faces. At a dimensional level, psychopathy subfacets show a differential relationship to functioning in amygdala-prefrontal circuitry.
在法医环境中的暴力患者中，已注意到精神分裂症与精神病态之间存在共病现象。这两种疾病的特征均为处理悲伤和恐惧情绪存在缺陷，但尚无影像学研究考察共病的精神病态特质对暴力型精神分裂症患者情绪信息处理的影响。我们检验了这样一个假设，即与低精神病态得分的暴力型精神分裂症患者相比，高精神病态得分的患者对情绪（尤其是恐惧）面孔的杏仁核反应会减弱。
根据《精神病态量表：筛查版》，将24名暴力型男性精神分裂症患者分为高得分者/低得分者。在一个组块设计的内隐面孔情感处理任务中，参与者接受功能磁共振成像检查。采用感兴趣区方法，通过悲伤/恐惧/愤怒/厌恶面孔与中性面孔之间的对比，考察杏仁核和前额叶皮质的反应。
高精神病态得分者在暴露于恐惧面孔时，杏仁核中血氧水平依赖（BOLD）反应降低。精神病态得分，尤其是情感方面的得分，与杏仁核反应呈负相关。在暴露于悲伤面孔时，眶额皮质的BOLD反应与精神病态的生活方式和反社会方面呈负相关。精神病态得分与杏仁核和前额叶下部区域对厌恶的神经激活呈正相关，但与对愤怒的神经激活呈负相关。
患有精神分裂症且具有高水平精神病态特质的患者，其杏仁核对恐惧面孔的反应似乎减弱。在维度层面，精神病态子方面与杏仁核 - 前额叶回路功能存在不同的关系。
