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The present study consists of two parts: The first part is made up of questions concerning the cognitive underpinnings of auditory verbal hallucinations in schizophrenia. As this thesis framed schizophrenia as a multivariate problem, neural correlates to auditory verbal and visual hallucinations were investigated in the second part. The main finding is that vividness of mental imagery was increased in all putative high-risk groups as well as the patients themselves, compared with low-schizotypy controls. Therefore, it seems that vivid imagery is a trait rather than a state marker, and may be related to the genetic liability to develop schizophrenia. However, no evidence was found for a linear relationship between vividness of mental imagery and predisposition to hallucinate. Self-reported imagery vividness and predisposition to hallucinate did not depend on psychomotor speed or intelligence. In addition, individual psychopathology ratings did not correlate significantly with the mental imagery scores. Furthermore, the analysis of the control orientation and the degree of dysfunctional psychopathological status across the schizophrenia spectrum, showed an independence of control orientation and dysfunctional status from each other, as well as from other markers of schizophrenia or schizophrenic-like individuals. As a conclusion, external control orientation seems to be a symptom or a trait marker of schizophrenia. The results lead to the assumption that, beside schizophrenic individuals, first-degree relatives and schizotypy controls have some impairments and visible signs without suffering from the illness directly. This would lead to the further assumption that the illness schizophrenia is not only genetic but also dependent on environmental factors. In the second part of the study, we investigated anatomical and functional brain abnormalities in the schizophrenia patients compared with first-degree relatives and healthy controls. Here, the results followed the continuum of healthy controls, first-degree relatives and schizophrenic patients in the functional and anatomical data sets, and in the language lateralization. The decrease of lateralisation correlated with the severity of symptoms in the patient group. The investigation of visual hallucinations showed activity in higher visual areas during the experience of visual hallucinations in a schizophrenia patient and in a blindfolded subject. The activity in higher visual areas followed the boundaries of category-selective areas in both subjects. In contrast to the memory-related areas found in the schizophrenic patient experiencing visual hallucinations, we did not observe memory-related areas during visual hallucinations induced by blindfolding. This suggests that the neural mechanisms underlying hallucinations in schizophrenia are at least partly distinct from those operational in cortical deafferentation. It is proposed that individual differences in psychopathology, as well as neuropsychological and psychosocial functioning may provide further means to understand the complex and highly dynamic aspects of hallucinations specifically and schizophrenia in general. The enlargement of the subject sample to high-schizotypy controls and first-degree relatives of patients allowed new insights into the mental imagery debate and the dysfunctional connectivity pattern known to be responsible for psychotic symptoms. Further topics of research are discussed.
Martin Heidegger
(2001)
Wenn wir im folgenden die problematische Persönlichkeitsstruktur Heideggers und deren Äußerung im Werk psychographisch untersuchen, so soll genauso wenig wie bei C. G. Jung und im späteren Beitrag über Axel Springer das Werk pathologisiert werden. Wohl aber soll, wie schon bei Jung, gefragt werden, welche Anteile die Persönlichkeitsstruktur am Werk hat. Das Geniale der Schöpfungen beider ist nicht ohne Hinzuziehung biographischer Faktoren zu erklären.
Current theories of schizophrenia suggest that the pathophysiology of the disorder may be the result of a deficit in the coordination of neural activity within and between areas of the brain, which may lead to impairments in basic cognitive functions such as contextual disambiguation and dynamic grouping (Phillips and Silverstein, 2003). This notion has been supported by recent studies showing that patients with schizophrenia are characterized by reduced synchronous, oscillatory activity in the gamma-frequency band during sensory processing (Spencer et al. 2003, Green et al. 2003, Wynn et al. 2005). However, it is currently unclear to what extent high-frequency gamma-band oscillations (> 60 Hz) contribute to impaired neural synchronization as research has so far focussed on gamma-band oscillations between 30 and 60 Hz. In addition, it is not known whether deficits in high-frequency oscillations are already present at the onset of the disorder and to what extent reductions may be related to the confounding influence of antipsychotic medication. Finally, the neural generators underlying impairments in synchronous oscillatory activity in schizophrenia have not been investigated yet. To address these questions, we recorded MEG activity during a visual closure task (Mooney faces task) in medicated chronic schizophrenia patients, drug-naive first-episode schizophrenia patients and healthy controls. MEG data were analysed for spectral power between 25 and 150 Hz, and beamforming techniques were used to localize the sources of oscillatory gamma-band activity. In healthy controls, we observed that the processing of Mooney faces was associated with sustained high-frequency gamma-band activity (> 60 Hz). A time-resolved analysis of the neural generators underlying perceptual closure revealed a network of distributed sources in occipito-temporal, parietal and frontal regions, which were differentially activated during specific time intervals. In chronic schizophrenia patients, we found a pronounced reduction of high-frequency gamma-band oscillatory activity that was accompanied by an impairment in perceptual organization and involved reduced source power in various brain regions associated with perceptual closure. First-episode patients were also characterized by a deficit in high-frequency gamma-band activity and reductions of source power in multiple areas; these impairments, however, were less pronounced than in chronic patients. Regarding behavioral performance, first-episode patients were not impaired in their ability to detect Mooney faces, but exhibited a loss in specificity of face detection. In conclusion, our results suggest that schizophrenia is associated with a widespread reduction in high-frequency oscillations that indicate local network abnormalities. These dysfunctions are independent of medication status and already present at illness onset, suggesting a possible progressive deficit during the course of the disorder.
The pathophysiology of schizophrenia is still poorly understood. Investigating the neurophysiological correlates of cognitive dysfunction with functional neuroimaging techniques such as electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) is widely considered to be a possible solution for this problem. Working memory impairment is one of the most prominent cognitive impairments found in schizophrenia. Working memory can be divided into a number of component processes, encoding, maintenance and retrieval. They appear to be differentially affected in schizophrenia, but little is known about the neurophysiological disturbances which contribute to deficits in these component processes. The aim of this dissertation was to elucidate the neurophysiological underpinnings of the component processes of working memory and their disturbance in schizophrenia. In the first study the the neurophysiological substrates of visual working memory capacity limitations were investigated during encoding, maintenance and retrieval in 12 healthy subjects using event-related fMRI. Subjects had to encode up to four abstract visual shapes and maintain them in working memory for 12 seconds. Afterwards a test stimulus was presented, which matched one of the previously shown shapes in fifty percent of the trials. A bilateral inverted U-shape pattern of BOLD activity with increasing memory load in areas closely linked with selective attention, i.e. the frontal eye fields and areas around the intraparietal sulcus, was observed already during encoding. The increase of the number of stored items from memory load three to memory load four in these regions was negatively correlated with the increase of BOLD activity from memory load three to memory load four. These results point to a crucial role of attentional processes for the limited capacity of working memory. In the second study, the contribution of early perceptual processing deficits during encoding and retrieval to working memory dysfunction was investigated in 17 patients with schizophrenia and 17 healthy control subjects using EEG and event-related fMRI. A slightly modified version of the working memory task used in the fist study was employed. Participants only had to encode and maintain up to three items. In patients the amplitude of the P1 event-related potential was significantly reduced already during encoding in all memory load conditions. Similarly, BOLD activity in early visual areas known to generate the P1 was significantly reduced in patients. In controls, a stronger P1 amplitude increase with increasing memory load predicted better performance. These findings indicate that in addition to later memory related processing stages early visual processing is disturbed in schizophrenia and contributes to working memory dysfunction by impairing the encoding of information. In the third study, which was based on the same data set as the second study, cortical activity and functional connectivity in 17 patients with schizophrenia and 17 to healthy control subjects during the working memory encoding, maintenance and retrieval was investigated using event-related fMRI. Patients had reduced working memory capacity. During encoding activation in the left ventrolateral prefrontal cortex and extrastriate visual cortex was reduced in patients but positively correlated with working memory capacity in controls. During early maintenance patients switched from hyper- to hypoactivation with increasing memory load in a fronto-parietal network which included left dorsolateral prefrontal cortex. During retrieval right ventrolateral prefrontal hyperactivation was correlated with encoding-related hypoactivation of left ventrolateral prefrontal cortex in patients. Cortical dysfunction in patients during encoding and retrieval was accompanied by abnormal functional connectivity between fronto-parietal and visual areas. These findings indicate a primary encoding deficit in patients caused by a dysfunction of prefrontal and visual areas. The findings of these studies suggest that isolating the component processes of working memory leads to more specific markers of cortical dysfunction in schizophrenia, which had been obscured in previous studies. This approach may help to identify more reliable biomarkers and endophenotypes of schizophrenia.