精神医学63巻3号

2021年03月発行

特集 サイコーシスとは何か—概念，病態生理，診断・治療における意義

サイコーシスの神経基盤とバイオロジカルマーカー—脳画像研究による知見

著者： 笹林大樹¹² 鈴木道雄¹²

所属機関： ¹富山大学学術研究部医学系神経精神医学講座 ²富山大学研究推進機構アイドリング脳科学研究センター

ページ範囲：P.371 - P.380

抄録　精神疾患のディメンジョナルなアプローチへの注目とともに，サイコーシスを対象とした脳画像研究の報告は増えている。サイコーシスを構成する主な精神症状である思考形式障害，言語性幻聴，関係妄想，および自我障害の神経基盤として，言語領野や前頭前野など多様な脳領域の関与が指摘されているが，これらは局所的な独立成分ではなく，連続体として捉え得る。またサイコーシスへの早期介入研究によって，サイコーシス発症前後の縦断的脳変化や後にサイコーシスを発症したハイリスク症例におけるベースラインでの特徴的な脳形態所見などが見出されつつあり，サイコーシスの発症機序の解明やサイコーシスの発症予測に寄与し得るバイオロジカルマーカーの発見とその臨床応用への発展が期待される。

参考文献

1)Takahashi T, Suzuki M：Brain morphologic changes in early stages of psychosis：implications for clinical application and early intervention. Psychiatry Clin Neurosci 72：556-571, 2018

2)Insel TR, Cuthbert BN：Endophenotypes：bridging genomic complexity and disorder heterogeneity. Biol Psychiatry 66：988-989, 2009

3)橋本亮太，山森英長，安田由華，他：Research Domain Criteria(RDoC)プロジェクトの概念．精神医学 60：9-19, 2018

4)Pankow A, Knobel A, Voss M, et al：Neurobiological correlates of delusion：beyond the salience attribution hypothesis. Neuropsychobiology 66：33-43, 2012

5)Backasch B, Sommer J, Klohn-Saghatolislam F, et al：Dysconnectivity of the inferior frontal gyrus：implications for an impaired self-other distinction in patients with schizophrenia. Psychiatry Res 223：202-209, 2014

6)Bohlken MM, Hugdahl K, Sommer IEC：Auditory verbal hallucinations：neuroimaging and treatment. Psychol Med 47：199-209, 2017

7)Cavelti M, Kircher T, Nagels A, et al：Is formal thought disorder in schizophrenia related to structural and functional aberrations in the language network? A systematic review of neuroimaging findings. Schizophr Res 199：2-16, 2018

8)Huang J, Zhuo C, Xu Yong, et al：Auditory verbal hallucination and the auditory network：from molecules to connectivity. Neuroscience 410：59-67, 2019

9)Price CJ：The anatomy of language：a review of 100 fMRI studies published in 2009. Ann N Y Acad Sci 1191：62-88, 2010

10)Copolov DL, Seal ML, Maruff P, et al：Cortical activation associated with the experience of auditory hallucinations and perception of human speech in schizophrenia：a PET correlation study. Psychiatry Res 122：139-152, 2003

11)Allen P, Freeman D, Johns L, et al：Misattribution of self-generated speech in relation to hallucinatory proneness and delusional ideation in healthy volunteers. Schizophr Res 84：281-288, 2006

12)Kompus K, Westerhausen R, Hugdahl K, et al：The “paradoxical” engagement of the primary auditory cortex in patients with auditory verbal hallucinations：a meta-analysis of functional neuroimaging studies. Neuropsychologia 49：3361-3369, 2011

13)Fletcher PC, Frith CD：Perceiving is believing：a Bayesian approach to explaining the positive symptoms of schizophrenia. Nat Rev Neurosci 10：48-58, 2009

14)Maruff P, Wood SJ, Velakoulis D, et al：Reduced volume of parietal and frontal association areas in patients with schizophrenia characterized by passivity delusions. Psychol Med 35：783-789, 2005

15)Bopp MHA, Zöllner R, Jansen A, et al：White matter integrity and symptom dimensions of schizophrenia：a diffusion tensor imaging study. Schizophr Res 184：59-68, 2017

16)Leube D, Whitney C, Kircher T：The neural correlates of ego-disturbances(passivity phenomena)and formal thought disorder in schizophrenia. Eur Arch Psychiatry Clin Neurosci 258：22-27, 2008

17)Lindner A, Thier P, Kircher TTJ, et al：Disorders of agency in schizophrenia correlate with an inability to compensate for the sensory consequences of actions. Curr Biol 15：1119-1124, 2005

18)Koreki A, Maeda T, Okimura T, et al：Dysconnectivity of the agency network in schizophrenia：a functional magnetic resonance imaging study. Front Psychiatry 10：171, 2019

19)Yung AR, Yuen HP, McGorry PD, et al：Mapping the onset of psychosis：the comprehensive assessment of at-risk mental states. Aust N Z J Psychiatry 39：964-971, 2005

20)Stafford MR, Jackson H, Mayo-Wilson E, et al：Early interventions to prevent psychosis：systematic review and meta-analysis. BMJ 346：f185, 2013

21)Cannon TD, Chung Y, He G, et al：Progressive reduction in cortical thickness as psychosis develops：a multisite longitudinal neuroimaging study of youth at elevated clinical risk. Biol Psychiatry 77：147-157, 2015

22)Howes OD, Bose SK, Turkheimer F, et al：Dopamine synthesis capacity before onset of psychosis：a prospective［18F］-DOPA PET imaging study. Am J Psychiatry 168：1311-1317, 2011

23)Howes OD, Bose S, Turkheimer F, et al：Progressive increase in striatal dopamine synthesis capacity as patients develop psychosis：a PET study. Mol Psychiatry 16：885-886, 2011

24)Takayanagi Y, Kulason S, Sasabayashi D, et al：Reduced thickness of the anterior cingulate cortex in individuals with an at-risk mental state who later develop psychosis. Schizophr Bull 43：907-913, 2017

25)Sasabayashi D, Takayanagi Y, Takahashi T, et al：Increased occipital gyrification and development of psychotic disorders in individuals with an at-risk mental state：a multicenter study. Biol Psychiatry 82：737-745, 2017

26)根本清貴，田村昌士，織内直毅，他：脳構造画像による統合失調症の判別．日生物精医会誌 27：197-201, 2016

27)Koutsouleris N, Meisenzahl E, Davatzikos C, et al：Use of neuroanatomical pattern classification to identify subjects in at-risk mental states of psychosis and predict disease transition. Arch Gen Psychiatry 66：700-712, 2009

28)Schmidt A, Cappucciati M, Radua J, et al：Improving prognostic accuracy in subjects at clinical high risk for psychosis：systematic review of predictive models and meta-analytical sequential testing simulation. Schizophr Bull 43：375-388, 2017

29)小池進介，森田健太郎，植松明子，他：Why are collaborative studies in Asian countries needed? The concept and framework of the Asian Consortium on MRI studies in Psychosis(ACMP)．日生物精医会誌 31：12-19, 2020