Silbersweig D, Stern E
Department of Psychiatry, New York Hospital-Cornell Medical Center, NY 10021, USA.
Mol Psychiatry. 1996 Nov;1(5):367-75.
Hallucinations in schizophrenia represent an important clinical problem, an interesting neuropsychological enigma, and a significant challenge for neuroscientific research. Functional neuroimaging techniques allow the in vivo, systems-level study of brain dysfunction underlying this debilitating symptom. Clinical and scientific vantage points that can inform the design and interpretation of functional neuroimaging studies of schizophrenic hallucinations are outlined. These include considerations of the phenomenology of hallucinations, the relationship of hallucinations to other symptoms of schizophrenia, and the neuropsychological functions that are thought to be disrupted in hallucinations. They also include the anatomical and chemical brain systems in which abnormalities are implicated in schizophrenia, the neurologic conditions in which hallucinations may occur, the neurochemical contexts that are associated with hallucinations, and the methodologic details of the functional neuroimaging techniques employed. Bottom-up and top-down functional neuroimaging strategies for the investigation of schizophrenic hallucinations with positron emission tomography (PET), single photon emission computed tomography (SPECT) and functional magnetic resonance imaging (fMRI) are reviewed. Bottom-up approaches start with or measure the biology associated with hallucinations. Top-down approaches start from the specific neuropsychological dysfunctions thought to be associated with hallucinations. The distributed brain regions, systems and functions implicated in schizophrenic hallucination formation are then discussed in the context of an integration of bottom-up and top-down approaches. Focus is placed upon abnormalities in the functions of, and interactions among, auditory-linguistic association cortices, caudal and rostral limbic/paralimbic systems, prefrontal cortices, ventral striatum and (non-specific projection and associative) thalamic nuclei, as well as upon the glutamatergic, GABAergic and ventral tegmental dopaminergic modulation of these systems.
精神分裂症中的幻觉是一个重要的临床问题、一个有趣的神经心理学谜题，也是神经科学研究的一项重大挑战。功能神经成像技术能够对这种使人衰弱的症状背后的脑功能障碍进行体内系统层面的研究。本文概述了可为精神分裂症幻觉的功能神经成像研究的设计与解释提供信息的临床和科学观点。这些观点包括对幻觉现象学的考量、幻觉与精神分裂症其他症状的关系，以及被认为在幻觉中受到干扰的神经心理学功能。还包括与精神分裂症相关的解剖学和化学脑系统、可能出现幻觉的神经疾病、与幻觉相关的神经化学背景，以及所采用的功能神经成像技术的方法学细节。本文回顾了使用正电子发射断层扫描（PET）、单光子发射计算机断层扫描（SPECT）和功能磁共振成像（fMRI）研究精神分裂症幻觉的自下而上和自上而下的功能神经成像策略。自下而上的方法从与幻觉相关的生物学入手或对其进行测量。自上而下的方法则从被认为与幻觉相关的特定神经心理学功能障碍出发。然后在整合自下而上和自上而下方法的背景下，讨论精神分裂症幻觉形成中涉及的分布式脑区、系统和功能。重点关注听觉 - 语言联合皮层、尾侧和嘴侧边缘/边缘旁系统、前额叶皮层、腹侧纹状体以及（非特异性投射和联合）丘脑核团的功能异常及其相互作用，以及这些系统的谷氨酸能、GABA能和腹侧被盖区多巴胺能调节。
