精神分裂症谱系障碍的认知控制缺陷的功能机制不同。
Differing functional mechanisms underlie cognitive control deficits in psychotic spectrum disorders.
机构信息
From the The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM (Stephenson, Shaikh, Shaff, Dodd, Wertz, Ryman, Hanlon, Ling, Mayer); the Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM (Bustillo, Stromberg, Lin, Abrams, Mayer); the Department of Psychology, University of New Mexico, Albuquerque, NM (Hogeveen, Yeo, Mayer); and the Department of Neurology, University of New Mexico School of Medicine, Albuquerque, NM (Mayer).
出版信息
J Psychiatry Neurosci. 2020 Nov 1;45(6):430-440. doi: 10.1503/jpn.190212.
BACKGROUND
Functional underpinnings of cognitive control deficits in unbiased samples (i.e., all comers) of patients with psychotic spectrum disorders (PSD) remain actively debated. While many studies suggest hypofrontality in the lateral prefrontal cortex (PFC) and greater deficits during proactive relative to reactive control, few have examined the full hemodynamic response.
METHODS
Patients with PSD (n = 154) and healthy controls (n = 65) performed the AX continuous performance task (AX-CPT) during rapid (460 ms) functional neuroimaging and underwent full clinical characterization.
RESULTS
Behavioural results indicated generalized cognitive deficits (slower and less accurate) across proactive and reactive control conditions in patients with PSD relative to healthy controls. We observed a delayed/prolonged neural response in the left dorsolateral PFC, the sensorimotor cortex and the superior parietal lobe during proactive control for patients with PSD. These proactive hemodynamic abnormalities were better explained by negative rather than by positive symptoms or by traditional diagnoses according to the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition, Text Revision (DSM-IV-TR), with subsequent simulations unequivocally demonstrating how these abnormalities could be erroneously interpreted as hypoactivation. Conversely, true hypoactivity, unassociated with clinical symptoms or DSM-IV-TR diagnoses, was observed within the ventrolateral PFC during reactive control.
LIMITATIONS
In spite of guidance for AX-CPT use in neuroimaging studies, one-third of patients with PSD could not perform the task above chance and were more clinically impaired.
CONCLUSION
Current findings question the utility of the AX-CPT for neuroimaging-based appraisal of cognitive control across the full spectrum of patients with PSD. Previously reported lateral PFC "hypoactivity" during proactive control may be more indicative of a delayed/prolonged neural response, important for rehabilitative purposes. Negative symptoms may better explain certain behavioural and hemodynamic abnormalities in patients with PSD relative to DSM-IV-TR diagnoses.
背景
在精神分裂症谱系障碍（PSD）的无偏样本（即所有患者）中，认知控制缺陷的功能基础仍在激烈争论中。虽然许多研究表明外侧前额叶皮层（PFC）的低功能和在主动控制相对于反应控制期间更大的缺陷，但很少有研究检查完整的血液动力学反应。
方法
PSD 患者（n=154）和健康对照者（n=65）在快速（460ms）功能神经影像学期间执行 AX 连续性能任务（AX-CPT），并进行了全面的临床特征描述。
结果
行为学结果表明 PSD 患者在主动和反应控制条件下表现出普遍的认知缺陷（较慢且准确性较低），与健康对照组相比。我们观察到 PSD 患者在主动控制期间左背外侧 PFC、感觉运动皮层和上顶叶的神经反应延迟/延长。这些主动血液动力学异常可以更好地用阴性而不是阳性症状或根据《精神障碍诊断与统计手册第四版修订版》（DSM-IV-TR）的传统诊断来解释，随后的模拟明确表明这些异常如何可能被错误地解释为低激活。相反，在反应控制期间，腹外侧 PFC 中观察到与临床症状或 DSM-IV-TR 诊断无关的真正低活动。
局限性
尽管在神经影像学研究中对 AX-CPT 的使用有指导，但三分之一的 PSD 患者无法完成任务，且临床受损更严重。
结论
目前的研究结果对 AX-CPT 在全谱 PSD 患者的神经影像学认知控制评估中的实用性提出了质疑。以前报道的主动控制期间外侧 PFC 的“低活性”可能更能说明神经反应的延迟/延长，这对于康复目的很重要。与 DSM-IV-TR 诊断相比，阴性症状可能更好地解释 PSD 患者的某些行为和血液动力学异常。
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