Negative Symptoms in Schizophrenia: Neurobiological Bases
摘要
Negative symptoms of schizophrenia, including reductions in the Experiential dimension (including anhedonia, asociality, and avolition) and in the Expressive dimension (including alogia and blunted affect), represent a significant burden and a challenge in psychiatric treatment and research. Evidence stemming from behavioral research and studies using structural and functional neuroimaging points to distinct mechanisms underlying negative symptom dimensions. The neurobiology of avolition points to anomalies in reward processing, in particular reward anticipation, neurocognitive and social cognition abilities, and to dysfunctional beliefs about oneself and expectations from interactions with others. Regions such as the ventral striatum, orbitofrontal, and lateral prefrontal cortex have been identified as possible neuro-anatomical components for avolition. The neurobiology of the Expressive dimension points to anomalies in emotion expression/perception, impairments in speech fluency, and cognitive functioning. Neuro-anatomical components in the Expressive dimension consist of alterations in the regions underlying these processes, including motor cortex, superior temporal sulcus, and basal ganglia. Recent findings also suggest a contributory role for the cerebellum in the pathophysiology of negative symptoms (in particular for avolition/experiential dimension) with potential for targeted treatments. However, despite progress, the findings on the pathophysiology of negative symptoms remain heterogeneous. Future research should focus on longitudinal studies and multimodal data integration to better understand the evolution and inter-individual variability of negative symptoms. Integrating more targeted and individualized neurostimulation techniques could enhance treatment efficacy and provide causal insights.