Schwartz Paul J
Cincinnati Psychoanalytic Institute, Cincinnati, OH, USA.
Med Hypotheses. 2014 Dec;83(6):809-15. doi: 10.1016/j.mehy.2014.10.014. Epub 2014 Oct 23.
The season of birth risk factor for schizophrenia exerts a pervasive effect on the global population, particularly at northerly latitudes. The winter infection hypothesis and the low vitamin D hypothesis are both compelling but lack conclusive clinical data. The present work develops a maternal-fetal chronobiological hypothesis for this season of birth risk factor and its prevention by maternal bright light treatment. Around the winter solstice, due to decreased sunlight, the chronobiological apparatus of the at-risk second trimester mother is characterized by a reduced amplitude circadian pacemaker, and a reduced maximum of her nocturnal plasma melatonin concentrations (MTmax) and an increased minimum of her nocturnal core body temperatures (Tmin)--both of which exert adverse effects on the fetal hippocampus and dorsal striatum. The consequences for the fetus include reduced volume and increased excitability of the hippocampus, ventral striatal dysfunction, increased presynaptic nigrostriatal dopamine transmission, and increased propensity for pathological nigrostriatal neuronal phasic firing. Thus, the maternal-fetal chronobiological hypothesis fully accounts for the fetal precursors of the major pathognomonic abnormalities in adults with schizophrenia. Bright light treatment for the second trimester mother around the winter solstice, by increasing maternal circadian amplitude, could possibly prevent the fetal hippocampal and striatal abnormalities and eliminate the season of birth risk factor for schizophrenia.
精神分裂症的出生季节风险因素对全球人口都有普遍影响,在北纬地区尤为明显。冬季感染假说和低维生素D假说都很有说服力,但缺乏确凿的临床数据。本研究针对这一出生季节风险因素及其通过孕妇强光治疗进行预防提出了一种母婴生物钟生物学假说。在冬至前后,由于日照减少,处于风险中的孕中期母亲的生物钟系统表现为昼夜节律起搏器的振幅减小、夜间血浆褪黑素浓度最大值(MTmax)降低以及夜间核心体温最小值(Tmin)升高,这两者都会对胎儿海马体和背侧纹状体产生不利影响。对胎儿的影响包括海马体体积减小、兴奋性增加、腹侧纹状体功能障碍、突触前黑质纹状体多巴胺传递增加以及黑质纹状体神经元病理性相位性放电倾向增加。因此,母婴生物钟生物学假说充分解释了精神分裂症成年患者主要特征性异常的胎儿先兆。在冬至前后对孕中期母亲进行强光治疗,通过增加母亲的昼夜节律振幅,可能预防胎儿海马体和纹状体异常,并消除精神分裂症的出生季节风险因素。