以功能性磁振造影探討首次發作之精神分裂症患者，「語言側化」在治療前、後的差別

Abstract

目的：語言缺損是精神分裂症的核心症狀之一。前人研究發現精神分裂症病人腦部的語言側化有減少的現象，然而，在首次發作且未曾治療的精神分裂症病人，這樣的側化異常是否能經由抗精神病劑的治療而矯正，目前不得而知。本研究的目的，即是觀察在這個族群的病人身上，語言側化、臨床症狀、和語言相關能力，經過抗精神病劑治療後的改變情形。方法：本實驗收集了十一位首次發作且未曾治療的精神分裂症病人，以及十一位逐一配對的對照組健康成人。兩組一開始均接受了神經心理學測驗，病人的症狀則是使用「正性及負性症狀評量表」加以評估，接著，兩組人員在進行語意判斷測驗的同時，接受了功能性磁振造影。而後，病人組開始接受抗精神病劑aripiprazole的治療(平均日劑量為6.5mg)。在第四週時，病人組再度接受神經心理學測驗、和「正性及負性症狀評量表」的評估，第六週時，則接受第二次的語意判斷測驗、及同時進行的功能性磁振造影。由功能性磁振造影的資料，計算出病人在治療前、治療後的語言側化指數，此外，並用側化指數、腦部在語意判斷測驗的活化程度、語意判斷測驗的表現、「正性及負性症狀評量表」的指數、和神經心理學測驗中和語言有關的評量項目，進行相關分析。結果：在病人組，治療前相較於治療後，右腦半球額下迴與顳中迴/顳下迴有較多的活化，而經aripiprazole的治療，額下迴與顳下迴的側化指數有所反轉，導因於右腦半球額下迴與顳下迴的活化減少。此外，顳下迴經治療後的側化指數，與治療前的語文智商項目的分數、以及治療前後的工作記憶呈現正相關。治療前的語文智商項目的分數、及類別性語言流暢分數，則與治療後的負性症狀分數呈現負相關。結論：經aripiprazole的治療，確實觀察到了語言側化指數的反轉，而治療前較佳的語文智商分數，正相關於治療後顳下迴的側化指數、而負相關於負性症狀分數。研究結果顯示語言側化的異常、可經由抗精神病劑的治療而反轉，而這個轉變與臨床症狀的進步有所關聯。

Purpose: Language disorder is one of the core symptoms of schizophrenia. Previous studies have found the decrease of language-related lateralization in patients with schizophrenia. However, little is known whether the aberrant language-related lateralization could be reversed after treatment with antipsychotics for drug-naive first-episode patients. This study was aimed to observe changes of language-related lateralization, clinical symptoms, and language-related functions after antipsychotics treatment. Methods: Eleven drug-naive first-episode patients and eleven matched healthy controls were recruited. Before treatment, both groups received neuropsychological testing (NPT), and the patient group received additional clinical rating with the Positive and Negative Syndrome Scale (PANSS). Both groups also underwent the semantic judgment task within a magnetic resonance imaging (MRI) scanner. The patient group then received treatment with aripiprazole (averaged dose of 6.5 mg/day). At week 4, the patient group received NPT and PANSS again, and at week 6 the second semantic judgment task within MRI scanner. Brain images were collected and lateralization index in patients was calculated before/after treatment. Additionally, the magnitudes of brain activations were correlated with the behavioral performance, PANSS rating scores, and language-related NPT measures. Results: The direct comparison of before-treatment versus after-treatment produced significant activation in right inferior frontal gyrus (IFG) and right middle/inferior temporal gyrus (MTG/ITG) for the patient group. The lateralization index of the IFG and ITG was reversed after aripiprazole treatment due to less activation of right IFG and ITG. Moreover, the lateralization index of the ITG after treatment was positively correlated with before-treatment verbal-IQ items, and before-treatment/ after-treatment working memory. Two before-treatment measures (categorical verbal fluency and verbal-IQ items) were correlated with lower PANSS negative subscale scores after-treatment. Conclusion: Reversed language-related lateralization index could be observed in patients after treatment with aripiprazole. Better pre-treatment verbal-IQ scores were related to greater lateralization of ITG and lower negative subscale scores of the PANSS after-treatment. The findings suggest that the aberrant language-related lateralization could be reversed after treatment with antipsychotics, and that the change of lateralization was related to improved clinical symptoms.