BRAIN and NERVE－神経研究の進歩64巻7号

2012年07月発行

増大特集 顔認知の脳内機構

統合失調症の顔認知

著者： 土居裕和¹ 篠原一之¹

所属機関： ¹長崎大学大学院医歯薬学総合研究科・神経機能学分野

ページ範囲：P.815 - P.820

文献概要

はじめに

　1．統合失調症

　統合失調症は，思考，感情，知覚，意欲，自我意識など，広範な認知機能に異常が現れる機能性精神疾患である。生涯発病率は約1％とされており¹⁾，好発年齢は男女とも15～30歳といわれているが，特に女性の場合には，それ以降に発症する例も多い²⁾。多変量解析手法を用いた下位分類研究の結果，統合失調症の症状は陽性症状と陰性症状の2つに大別されるとの説が広く受け入れられるに至っている。陽性症状（positive symptoms）は急性期にみられ，幻覚，妄想，自我意識障害，独語などの症状を指す。これに対し，陰性症状（negative symptoms）は慢性期にみられ，感覚鈍麻，感情の平板化，自閉（社会的引きこもり），無為（意欲低下），容姿への無関心などの症状を指す。

　統合失調症の発病機序に関しては，神経伝達物質の異常が有力視されている。ドパミン遮断薬により症状をコントロールすることが可能なことから³⁾，ドパミン神経系の異常が，統合失調症における症状の発現に関与しているとの「ドパミン仮説」が有力視されている。一方で，発達段階での脳構造形成異常⁴⁾や，遺伝的素因の関与⁵⁾が指摘されるなど，統合失調症の原因は，未だ明らかになっていないのが現状である。

　2．統合失調症患者における顔認知

　統合失調症患者が，顕著なコミュニケーション能力の障害を示すことは広く認められている。また，これら患者が呈する「社会性の問題」の少なくとも一部は，顔認知能力障害に起因すると考えられている。しかし，その一方で，統合失調症における顔認知障害をもたらす神経機能異常の詳細に関しては，未解明の点が多い。そこで，本稿では，社会的コミュニケーションにおいて特に重要な役割を果たす，表情認識・視線方向認知を中心として，統合失調症患者の顔認知に関する行動学的・神経科学的知見を概説する。

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