Hugdahl Kenneth, Aleman André
Department of Biological and Medical Psychology, University of Bergen, Norway; Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; Department of Radiology, Haukeland University Hospital, Bergen, Norway.
Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands.
Neurosci Biobehav Rev. 2025 Jul 29;176:106306. doi: 10.1016/j.neubiorev.2025.106306.
In this paper we discuss the role of the prefrontal cortex (PFC) in schizophrenia and particularly in auditory verbal hallucinations (AVH). The paper starts with a review of the concept of hypofrontality in the 1970s and a view of PFC as a passive bystander unable to regulate or control internally generated sensory impulses. We further discuss the relationship between PFC and memory processes and the hypothesis that AVH experiences occur because of intrusions of negative emotional memories, and regulation of the emotional content of the voices. Similarly, AVH experiences can be the result of failure of reality monitoring, due to aberrant discrimination between internally generated thoughts and external influences, also dependent on PFC functioning. We subsequently introduce a new view of the role of the PFC as an actor, or active agent, a kind of hyperfrontality seen in network connectivity studies. We suggest that both hypo- and hyperfrontality models may be an oversimplification of the complex relationship between brain and behavior in the generation of AVH-experiences. Rather, the impaired ability to regulate inter-network dynamics when environmental conditions change may play a central role. We therefore discuss how task-positive and task-negative cortical networks are dynamically up- and down-regulated across time at the diagnostic level, and how this affects the presence or absence of an AVH experience at the symptom level. We conclude by suggesting that it is this failure of dynamic interplay between large-scale networks that is critical for an understanding of schizophrenia in general and auditory verbal hallucinations in particular.
在本文中，我们探讨前额叶皮质（PFC）在精神分裂症中，尤其是在幻听（AVH）中的作用。本文开篇回顾了20世纪70年代的前额叶功能低下概念，以及将PFC视为无法调节或控制内部产生的感觉冲动的被动旁观者的观点。我们进一步讨论了PFC与记忆过程之间的关系，以及幻听体验是由于负面情绪记忆的侵入以及对声音情绪内容的调节而发生的假设。同样，幻听体验可能是现实监测失败的结果，这是由于内部产生的思想与外部影响之间的异常区分，这也依赖于PFC的功能。随后，我们引入了一种关于PFC作为参与者或主动主体的新观点，这是在网络连接性研究中看到的一种前额叶功能亢进。我们认为，前额叶功能低下和亢进模型可能都过于简化了大脑与行为在幻听体验产生中的复杂关系。相反，当环境条件变化时调节网络间动态的能力受损可能起着核心作用。因此，我们讨论了在诊断层面任务阳性和任务阴性皮质网络如何随时间动态上调和下调，以及这如何在症状层面影响幻听体验的出现与否。我们最后指出，正是大规模网络之间这种动态相互作用的失败对于理解精神分裂症总体情况，尤其是幻听至关重要。
