Zusammenfassung
Neben der charakteristischen psychopathologischen Symptomatik stellen kognitive Defizite ein zentrales Merkmal der Schizophrenie dar. Diese Defizite können nur im Kontext miteinander interagierender Hirnareale verstanden werden. Zur Untersuchung dieser funktionellen Wechselbeziehungen wurden Strukturgleichungsmodelle („structural equation modeling“, SEM) zur Auswertung von fMRT-Datensätzen verwendet. In einer Untersuchungsreihe bei schizophrenen Patienten ergab sich sowohl bei antipsychotisch behandelten als auch bei unbehandelten Patienten ein Muster gesteigerter thalamokortikaler funktioneller Konnektivität als Hinweis auf eine mögliche Störung fronto-striato-thalamo-kortikaler Regelkreise. Unbehandelte Patienten und Patienten unter typischen Antipsychotika zeichneten sich zudem durch eine reduzierte interhemisphärische kortikokortikale Konnektivität aus. Dieser Unterschied zu den Gesunden war bei den Patienten unter atypischen Antipsychotika nicht mehr in dieser Ausprägung zu beobachten, was als Ausdruck einer möglichen positiven Beeinflussung der Informationsverarbeitung bei Patienten unter Atypika interpretiert werden könnte. Die erhaltenen Ergebnisse sind konsistent mit dem Modell der Schizophrenie als einem Diskonnektionssyndrom und früheren Konzeptionen einer „kognitiven Dysmetrie“ als Grundlage kognitiver Defizite bei dieser Erkrankung.
Abstract
Aside from characteristic psychopathological symptoms, cognitive deficits are a core feature of schizophrenia. These deficits can only be addressed within the context of widespread functional interactions among different brain areas. To examine these interactions, structural equation modeling (SEM) was used for the analysis of fMRI datasets. In a series of studies, both in antipsychotic-treated and drug-free schizophrenic patients, a pattern of enhanced thalamocortical functional connectivity could be observed as an indicator for possible disruptions of frontostriatal thalamocortical circuitry. Moreover, drug-free patients and those receiving typical antipsychotic drugs were characterized by reduced interhemispheric corticocortical connectivity. This difference relative to normal controls was less in patients under atypical antipsychotic drugs. The results could be interpreted as a beneficial effect of atypical antipsychotic drugs on information processing in schizophrenic patients. The present findings are consistent with the model of schizophrenia as a disconnection syndrome and earlier concepts of “cognitive dysmetria” in schizophrenia.
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Schlösser, R., Wagner, G., Köhler, S. et al. Schizophrenie als Diskonnektionssyndrom . Radiologe 45, 137–143 (2005). https://doi.org/10.1007/s00117-004-1160-3
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DOI: https://doi.org/10.1007/s00117-004-1160-3