Bilder R M, Wu H, Bogerts B, Degreef G, Ashtari M, Alvir J M, Snyder P J, Lieberman J A
Department of Psychiatry, Hillside Hospital Division of Long Island Jewish Medical Center, NY 11004.
Am J Psychiatry. 1994 Oct;151(10):1437-47. doi: 10.1176/ajp.151.10.1437.
The goal of this study was to determine whether patients experiencing their first episode of schizophrenia differ from healthy subjects in regional cerebral hemispheric volumes or asymmetries.
Regional volumes corresponding to prefrontal, premotor, sensorimotor, occipitoparietal, and temporal lobes in each hemisphere were measured on contiguous coronal magnetic resonance images in 70 patients experiencing their first episode of schizophrenia and in 51 healthy comparison subjects.
Patients did not differ from the comparison subjects in regional or total hemispheric volumes, but they had abnormal hemispheric asymmetries. Subjects in the comparison group had significant lateral asymmetries in each region: their occipitoparietal and sensorimotor regions were larger on the left, and their premotor, prefrontal, and temporal regions were larger on the right. Patients lacked lateral asymmetries and showed significantly less asymmetry than healthy subjects in occipitoparietal, premotor, and prefrontal regions. Absence of the normal asymmetry was more common among patients initially diagnosed with the undifferentiated than with the paranoid subtype of schizophrenia and was associated with more severe negative symptoms among men. Asymmetries were related to sex and handedness regardless of diagnosis; specifically, dextral men showed more asymmetry than nondextral men or dextral women.
The absence of normal hemispheric asymmetries suggests an anomaly in the development of laterally specialized cerebral systems in schizophrenia, and this may be associated with an initial presentation of nonparanoid psychosis.
本研究的目的是确定首次发作精神分裂症的患者在大脑半球区域体积或不对称性方面是否与健康受试者存在差异。
在70例首次发作精神分裂症的患者和51例健康对照受试者的连续冠状磁共振图像上，测量每个半球对应于前额叶、运动前区、感觉运动区、枕顶叶和颞叶的区域体积。
患者在区域或全脑半球体积方面与对照受试者没有差异，但他们存在异常的半球不对称性。对照组受试者在每个区域都有明显的侧别不对称性：他们的枕顶叶和感觉运动区左侧较大，而运动前区、前额叶和颞叶右侧较大。患者缺乏侧别不对称性，并且在枕顶叶、运动前区和前额叶区域的不对称性明显低于健康受试者。与偏执型精神分裂症亚型相比，未分化型精神分裂症患者中正常不对称性的缺失更为常见，并且与男性更严重的阴性症状相关。无论诊断如何，不对称性都与性别和利手有关；具体而言，右利手男性比非右利手男性或右利手女性表现出更多的不对称性。
正常半球不对称性的缺失表明精神分裂症中侧化特化脑系统发育异常，这可能与非偏执型精神病的初始表现有关。
