de Oliveira-Souza Ricardo, Moll Jorge
The D'Or Institute for Research & Education, Rio de Janeiro, Brazil; The Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil.
The D'Or Institute for Research & Education, Rio de Janeiro, Brazil.
Handb Clin Neurol. 2019;163:295-315. doi: 10.1016/B978-0-12-804281-6.00016-1.
Over the past 150 years, the frontal lobes (FLs) have been implicated in the neural mediation of both normal and abnormal moral conduct and social behavior (MCSB). Despite the remarkable advances that have permeated this period up to the present, a comprehensive account of the neural underpinnings of MCSB has stubbornly defied the best minds of psychology, psychiatry, and neurology. The goal of this chapter is to review a few practical and conceptual achievements that have proved heuristically valuable as an impetus for further advance of knowledge. In virtually all cases in which MCSB was compromised by brain damage, the injuries were located (i) in the prefrontal cortices, (ii) in their connections with the temporal poles and anterior insula, or (iii) in related subcortical structures and pathways, such as the thalamic dorsomedial nucleus or the anterior thalamic radiation. The clinicoanatomic associations among these structures originated the "frontal network systems" concept, which satisfactorily explains the occurrence of classical FL syndromes in patients with lesions outside the prefrontal cortices. Overall, clinicoanatomic observational studies and experimental evidence from patients with acquired sociopathy/psychopathy indicate that abnormalities of MCSB are the final common pathway of single or mixed impairments of subordinate psychologic and neural domains that support MCSB. Independent studies on normal volunteers concur with this view, indicating that MCSB is shaped by the dynamic interplay of subordinate psychologic domains, such as moral sensitivity and judgment, and their neural correlates.
在过去的150年里,额叶一直被认为与正常和异常的道德行为及社会行为(MCSB)的神经调节有关。尽管在这一时期直至现在已经取得了显著进展,但对MCSB神经基础的全面解释一直令心理学、精神病学和神经病学领域的顶尖人才难以捉摸。本章的目标是回顾一些实践和概念上的成就,这些成就已被证明具有启发价值,可作为推动知识进一步发展的动力。在几乎所有MCSB因脑损伤而受损的病例中,损伤部位位于:(i)前额叶皮质;(ii)它们与颞极和前岛叶的连接部位;或(iii)相关的皮质下结构和通路,如丘脑背内侧核或丘脑前辐射。这些结构之间的临床解剖学关联产生了“额叶网络系统”的概念,这一概念令人满意地解释了前额叶皮质以外部位病变患者中经典额叶综合征的发生。总体而言,临床解剖学观察研究以及来自后天性反社会人格障碍/精神病患者的实验证据表明,MCSB异常是支持MCSB的下属心理和神经领域单一或混合损伤的最终共同途径。对正常志愿者的独立研究也认同这一观点,表明MCSB是由下属心理领域(如道德敏感性和判断力)及其神经关联的动态相互作用所塑造的。