Attademo Luigi, Bernardini Francesco, Verdolini Norma
Department of Mental Health, Hospital Psychiatric Service for Diagnosis and Care (S.P.D.C.) of Potenza, ASP Basilicata, Italian National Health Service, Potenza, Italy.
Department of Mental Health, Hospital Psychiatric Service for Diagnosis and Care (S.P.D.C.) of Potenza, AsFO Friuli Occidentale, Italian National Health Service, Pordenone, Italy.
Curr Med Imaging. 2021;17(11):1283-1298. doi: 10.2174/1573405617666210114142206.
Schizotypal Personality Disorder (SPD) is a cluster A personality disorder affecting 1.0% of the general population, characterised by disturbances in cognition and reality testing dimensions, affected regulation, and interpersonal function. SPD shares similar but attenuated phenomenological, genetic, and neurobiological abnormalities with Schizophrenia (SCZ) and is described as part of schizophrenia spectrum disorders.
The aim of this work was to identify major neural correlates of SPD.
This is a systematic review conducted according to PRISMA statement. The protocol was prospectively registered in PROSPERO - International prospective register of systematic reviews. The review was performed to summarise the most comprehensive and updated evidence on functional neuroimaging and neurophysiology findings obtained through different techniques (DW- MRI, DTI, PET, SPECT, fMRI, MRS, EEG) in individuals with SPD.
Of the 52 studies included in this review, 9 were on DW-MRI and DTI, 11 were on PET and SPECT, 11 were on fMRI and MRS, and 21 were on EEG. It was complex to synthesise all the functional abnormalities found in a single, unified, pathogenetic pathway, but a common theme emerged: the dysfunction of brain circuits including striatal, frontal, temporal, limbic regions (and their networks) together with a dysregulation along the dopaminergic pathways.
Brain abnormalities in SPD are similar, but less marked, than those found in SCZ. Furthermore, different patterns of functional abnormalities in SPD and SCZ have been found, confirming the previous literature on the 'presence' of possible compensatory factors, protecting individuals with SPD from frank psychosis and providing diagnostic specificity.
分裂型人格障碍（SPD）是一种A类人格障碍，影响着1.0%的普通人群，其特征为认知和现实检验维度、情感调节及人际功能方面的障碍。SPD与精神分裂症（SCZ）具有相似但程度较轻的现象学、遗传学和神经生物学异常，被描述为精神分裂症谱系障碍的一部分。
本研究旨在确定SPD的主要神经关联。
这是一项根据PRISMA声明进行的系统评价。该方案已在PROSPERO（国际系统评价前瞻性注册库）中进行了前瞻性注册。本评价旨在总结通过不同技术（扩散加权磁共振成像、扩散张量成像、正电子发射断层扫描、单光子发射计算机断层扫描、功能磁共振成像、磁共振波谱、脑电图）在SPD个体中获得的功能神经影像学和神经生理学研究结果的最全面和最新证据。
本评价纳入的52项研究中，9项是关于扩散加权磁共振成像和扩散张量成像的，11项是关于正电子发射断层扫描和单光子发射计算机断层扫描的，11项是关于功能磁共振成像和磁共振波谱的，21项是关于脑电图的。将所有发现的功能异常整合到一个单一、统一的致病途径中很复杂，但一个共同的主题浮现出来：包括纹状体、额叶、颞叶、边缘区域（及其网络）在内的脑回路功能障碍，以及多巴胺能通路的调节异常。
SPD中的脑异常与SCZ中的相似，但程度较轻。此外，还发现了SPD和SCZ中不同的功能异常模式，这证实了先前关于可能存在补偿因素的文献，这些因素保护SPD个体不患明显的精神病，并提供了诊断特异性。
