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氯胺酮阻断 NMDA 受体对人类心理化能力及其神经相关性的影响:一项随机对照试验。

Effects of NMDA-receptor blockade by ketamine on mentalizing and its neural correlates in humans: a randomized control trial.

机构信息

Division of Medical Psychology, Department of Psychiatry and Psychotherapy, University Hospital of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.

Department of Psychology, University of Bonn, Bonn, Germany.

出版信息

Sci Rep. 2023 Oct 11;13(1):17184. doi: 10.1038/s41598-023-44443-6.

Abstract

Schizophrenia is associated with various deficits in social cognition that remain relatively unaltered by antipsychotic treatment. While faulty glutamate signaling has been associated with general cognitive deficits as well as negative symptoms of schizophrenia, no direct link between manipulation of glutamate signaling and deficits in mentalizing has been demonstrated thus far. Here, we experimentally investigated whether ketamine, an uncompetitive N-methyl-D-aspartate receptor antagonist known to induce psychotomimetic effects, influences mentalizing and its neural correlates. In a randomized, placebo-controlled between-subjects experiment, we intravenously administered ketamine or placebo to healthy participants performing a video-based social cognition task during functional magnetic resonance imaging. Psychotomimetic effects of ketamine were assessed using the Positive and Negative Syndrome Scale. Compared to placebo, ketamine led to significantly more psychotic symptoms and reduced mentalizing performance (more "no mentalizing" errors). Ketamine also influenced blood oxygen level dependent (BOLD) response during mentalizing compared to placebo. Specifically, ketamine increased BOLD in right posterior superior temporal sulcus (pSTS) and increased connectivity between pSTS and anterior precuneus. These increases may reflect a dysfunctional shift of attention induced by ketamine that leads to mentalizing deficits. Our findings show that a psychotomimetic dose of ketamine impairs mentalizing and influences its neural correlates, a result compatible with the notion that deficient glutamate signaling may contribute to deficits in mentalizing in schizophrenia. The results also support efforts to seek novel psychopharmacological treatments for psychosis and schizophrenia targeting glutamatergic transmission.

摘要

精神分裂症与各种社会认知缺陷有关,这些缺陷在抗精神病药物治疗中相对不变。虽然谷氨酸信号传递异常与一般认知缺陷以及精神分裂症的阴性症状有关,但迄今为止,还没有直接证明谷氨酸信号传递的操纵与心理化缺陷之间存在联系。在这里,我们通过实验研究了氯胺酮(一种非竞争性 N-甲基-D-天冬氨酸受体拮抗剂,已知会引起精神病样效应)是否会影响心理化及其神经相关性。在一项随机、安慰剂对照的受试者间实验中,我们通过静脉注射氯胺酮或安慰剂,让健康参与者在功能磁共振成像期间执行基于视频的社会认知任务。使用阳性和阴性综合征量表评估氯胺酮的精神病样效应。与安慰剂相比,氯胺酮导致明显更多的精神病症状和心理化表现下降(更多的“不心理化”错误)。与安慰剂相比,氯胺酮还影响心理化期间的血氧水平依赖(BOLD)反应。具体来说,氯胺酮增加了右侧后颞上沟(pSTS)的 BOLD,并增加了 pSTS 和前楔前叶之间的连接。这些增加可能反映了氯胺酮引起的注意力功能障碍转移,导致心理化缺陷。我们的研究结果表明,氯胺酮的精神病样剂量会损害心理化并影响其神经相关性,这一结果与谷氨酸信号传递异常可能导致精神分裂症心理化缺陷的观点一致。这些结果还支持寻求针对谷氨酸能传递的新型精神药理学治疗精神分裂症和精神病的努力。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a220/10567921/58c847a3684b/41598_2023_44443_Fig1_HTML.jpg

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