精神分裂症患者及高危群体的共情缺损：一项探讨社会认知过程及其神经机制的研究

Social cognition, defined as the ability to process social information, has been found to be closely related to social functioning, the deficit of which is a key symptom in patients with schizophrenia. Among the domains of social cognition, empathy, which is the ability to understand and share other’s experiences and feelings, remains the least examined construct and the few studies that examined the empathic deficits in schizophrenia patients have provided mixed findings. Likewise, the mechanisms underlying the relationship between the psychopathology of schizophrenia and empathy are not fully understood. Thus, the purpose of this study is twofold: (a) to examine the potential empathic deficits in both schizophrenia patients and high-risk participants, as well as the associations between empathic deficits, neurocognition, clinical symptoms, and social functioning, and (b) to examine the neural underpinnings of the relationship between psychopathology of schizophrenia and empathy. To examine the first goal we will recruit at-risk individuals prone for psychosis, including first-degree relatives of schizophrenia patients and psychometrically-defined schizotypy, as well as patients with schizophrenia and healthy controls, approximately 40 participants for each group. Participants will be assessed on measures of empathy, schizotypal traits, neurocognition, social functioning and clinical symptoms. The advantage of recruiting at-risk individuals is that it minimizes the potential impact of medication status and illness duration, which will help us to understand the psychopathological mechanisms underlying the development of psychosis. To examine our second goal we will recruit at least 20 participants for each group who will then attend the functional and structural MRI scans. The findings of these studies are expected to have important theoretical and practical implications. In terms of theory, we will be able to clarify the deficits of empathic ability in schizophrenia spectrum and its role in the development of psychosis. Most importantly, the findings will shed light on the early detection and intervention of individuals prone for psychosis in the near future.

社会功能受损是精神分裂症患者的关键症状之一，目前临床上还没有比较有效的治疗方法用于改善这一症状。共情（Empathy）是理解并分享他人感受的能力，对维持良好的人际交往和社会功能具有重要作用。尽管研究发现精神分裂症患者存在共情缺损，但对于共情缺损的心理和神经机制尚不明确。高危群体的研究取向使我们能够排除临床研究中病程和药物等混淆因素的影响探讨这一问题，有助于理解精神疾病的发病机制，对精神分裂症的早期识别和干预具有重要意义。本项目旨在考察精神分裂症患者以及精神分裂症高危群体（包括精神分裂症患者未患病一级家属和心理计量学定义的分裂型特质高危群体）的共情缺损及相关的神经机制。本项目将包括两个研究：研究一通过自评问卷和行为测试考察共情能力，探讨高危群体中是否存在共情缺损；共情与认知功能、临床症状以及社会功能的关系；研究二将通过脑结构像和共情任务中脑功能成像实验考察共情相关的神经机制。

社会功能受损是精神分裂症患者的关键症状之一，目前临床上还没有比较有效的治疗方法用于改善这一症状。心理理论（theory of mind）和共情（empathy）是非常重要的社会认知内容，涉及到理解他人的意图和情绪状态，分享他人感受的能力，对维持良好的人际交往和社会功能具有重要作用。尽管研究发现精神分裂症患者存在共情缺损，但对于共情缺损的心理和神经机制尚不明确。高危群体的研究取向使我们能够排除临床研究中病程和药物等混淆因素的影响探讨这一问题，有助于理解精神疾病的发病机制，对精神分裂症的早期识别和干预具有重要意义。本项目考察了精神分裂症患者以及精神分裂症高危群体的共情缺损及相关的神经机制。在行为水平上，我们修订了测量共情认知和情感成分的量表，编制了共情准确性的实验范式；通过回顾性研究，总结了精神分裂症患者和情感障碍患者的社会认知研究；采用行为任务考察认知和情感心理理论，结果发现相对于情感障碍患者，精神分裂症患者在认知共情和情感共情能力上都表现出更加严重的缺损；以分裂型特质筛选的高危群体中没有发现明显的行为异常。在神经机制方面，采用图片诱发的共情任务进行功能态磁共振成像研究发现，在健康对照组中，与观看情绪图片相比，模仿情绪时被试在双侧脑岛有更强的激活；然而这一激活增强并没有在精神分裂症患者中观察到。采用卡通故事任务进行功能磁共振研究发现，高危群体的研究发现颞顶联合区、颞中回以及楔叶等脑区的脑活动与分裂型特质阴性维度有显著相关。总之，本项目通过行为和脑成像研究探讨了精神分裂症谱系群体的社会认知缺损及其内在神经机制，进一步理解共情/心理理论相关的脑机制以及与精神疾病的症状和风险特质之间的关系，其中行为表现和特定脑区的脑活动有望成为早期识别指标，为精神疾病的早期识别提供依据。