Department of Child and Adolescent Psychiatry and Psychology, 2017SGR881, Institute of Neurosciences, Hospital Clinic de Barcelona, Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Department of Medicine, Universitat de Barcelona, Barcelona, Spain.
Department of Child and Adolescent Psychiatry and Psychology, 2017SGR881, Institute of Neurosciences, Hospital Clinic de Barcelona, Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Department of Medicine, Universitat de Barcelona, Barcelona, Spain; Centro Investigación Biomédica en Red Salud Mental (CIBERSAM), Madrid, Spain.
Dev Cogn Neurosci. 2021 Apr;48:100940. doi: 10.1016/j.dcn.2021.100940. Epub 2021 Mar 5.
Theory of mind(ToM) impairment is a key feature of psychotic disorders and has been documented in individuals at clinical high-risk for psychosis (CHR), suggesting that it may predate illness onset. However, no study to date has examined brain functional correlates of ToM in individuals at CHR during adolescence. The "Reading-the-Mind-in-the-Eyes" test was used to measure ToM performance in 50 CHR youth, 15 of whom transitioned to psychosis (CHR-t) at follow-up (12 ± 6 months) and 36 healthy volunteers. Resting-state functional MRI was acquired to evaluate functional connectivity within the default mode network. Group by age interaction revealed an age-positive association in ToM performance in healthy volunteers, which was not present in adolescents at CHR-t. Intrinsic functional connectivity in the medial prefrontal cortex was reduced in adolescents at CHR-t relative to those who did not transition and to healthy volunteers. Survival analyses revealed that participants at CHR with lower medial prefrontal cortex connectivity were at greatest risk of developing psychosis at follow-up. We demonstrate that lack of age-related maturation of ToM and reduced medial prefrontal cortex connectivity both precede the onset of psychosis during adolescence. Medial prefrontal cortex connectivity holds potential as a brain-based marker for the early identification of transition to psychosis.
心理理论（Theory of mind，ToM）障碍是精神障碍的一个关键特征，在精神病高危个体（clinical high-risk for psychosis，CHR）中已有记录，表明其可能在发病前出现。然而，迄今为止，尚无研究在青少年 CHR 个体中检查心理理论的大脑功能相关性。本研究使用“Reading-the-Mind-in-the-Eyes”测试来衡量 50 名 CHR 青少年的心理理论表现，其中 15 名在随访（12±6 个月）时转为精神病（CHR-t），36 名健康志愿者作为对照组。采集静息态功能磁共振成像（resting-state functional MRI）来评估默认模式网络内的功能连接。组间年龄交互作用显示，对照组健康志愿者的心理理论表现与年龄呈正相关，而 CHR-t 青少年则不存在这种相关性。与未转化的个体和健康志愿者相比，CHR-t 青少年的内侧前额叶皮质的内在功能连接减少。生存分析表明，内侧前额叶皮质连接较低的 CHR 个体在随访时发生精神病的风险最高。本研究表明，心理理论的与年龄相关的成熟缺乏和内侧前额叶皮质连接减少都先于青少年精神病的发作。内侧前额叶皮质连接有可能成为精神病早期识别的基于大脑的标志物。
