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NTIS 바로가기생물정신의학 = Korean journal of biological psychiatry, v.18 no.2, 2011년, pp.55 - 60
정범석 (을지대학교 의과대학 을지대학병원 정신과학교실) , 최지욱 (가톨릭대학교 의과대학 대전성모병원 정신과학교실)
Neuroimaging studies in schizophrenia have remarkably increased and provided some clues to understand its pathophysiology. Here, we reviewed the neuroimaging, studies including volume analysis, functional magnetic resonance imaging (MRI) and diffusion tensor imaging, and findings in both early stage...
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핵심어 | 질문 | 논문에서 추출한 답변 |
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정신분열병의 병태생리적 모형에 있어서 Keshavan 등의 가설은 어떤 내용인가? | 그 외에 다양한 가설에 대해서 Keshavan 등9)은 아래와 같이 소개하였다. 첫째, 신경해부학적 가설로는 뇌의 구조적, 기능적 기능 이상을 들 수 있다. 예를 들어 정신분열병은 운동영역과 같이 한 가지 감각을 처리하는 곳이 아닌 이마앞 이랑(전전두회, prefrontal gyrus), 위쪽 관자이랑(상측두회, superior temporal gyrus), 아래 마루피질(두정피질, inferior parietal cortex)과 같이 이종 연합피질(heteromodal association cortex)의 이상,10) 정상적인 좌우반구의 비대칭의 소실이나 역전이나 뇌량(corpus callosum)의 이상11) 등 좌우 반구의 비정상적 연결성,12) 피질-시상-소뇌 연결회로의 기능적 이상,13) 비정상적 기저핵-시상-피질 회로14) 등으로 이해되기도 한다. 둘째, 발병과 관련된 가설은 주로 발병 시기에 초점이 맞추어져 있다. 신경발달 모형(neurodevelopmental model)에서는 신경의 이동 혹은 증식의 초기과정 이상,15) 후기 신경발달과정인 청소년기의 신경 연접의 가지치기 이상15)16) 등에 의해 정신분열병의 발병 이유를 설명하고 있다. 신경퇴행 모형(neurodegenerative model)에서는 신경의 흥분독성(neuronal excitotoxicity) 혹은 신경화학적 민감화에 따른 발병 후 신경 황폐(deterioration)17)18) 등으로 정신분열병의 병리를 설명하고 있다. 셋째, 정신분열병의 원인적 모형에서는 유전적 요소,19) 유전자의 비정상적인 발현 혹은 후성적(epigenitic) 요인,20) 다양한 환경적 요인21) 등이 고려되고 있다. 위에 소개된 다양한 측면의 가설들은 정신분열병의 원인, 현상, 경과 등의 일부분을 설명할 수 있으며, 이 가설들은 다양한 측면에서 서로 연관이 있기도 하다. | |
영상을 이용한 연구들의 결과를 종합한 결과 정신분열병의 뇌는 어떤 소견을 보이는가? | 위에서 소개한 뇌 용적, 기능적 자기공명영상, 확산텐서영상을 이용한 연구들의 결과를 종합하면 정신분열병의 뇌는 회백질, 백질 각각뿐 아니라 이들의 구성하는 해부학적, 기능적 회로의 이상 소견을 보이며, 이러한 경향은 발병 전 고위험군의 뇌에서도 일부 관찰된다는 것이다. 따라서 회백질과 백질을 모두 고려한 통합 연구를 통해 정신분열병의 뇌 회로 이상을 좀더 잘 이해할 수 있을 것이다. | |
정신분열병의 뇌 구조 이상은 어떤 관점에서 연구가 설계되고 해석될 수 있는가? | 따라서 정신분열병의 뇌영상 연구 결과 또한 이러한 다양한 가설의 측면에서 의문과 해석이 이루어져야 한다. 예를 들어 정신분열병의 뇌 구조 이상은 유전적, 환경적, 신경발달적, 신경퇴행적 모형의 관점에서 연구가 설계되고 해석될 수 있다. 이런 관점에서 정신분열병의 뇌영상 연구에서 구조적, 기능적 이상의 의미에 대해 두 가지 중요한 질문을 해 볼 수 있다. |
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