Zusammenfassung
Akustische Halluzinationen, meistens in der Form des Stimmenhörens, sind ein verbreitetes
Symptom der Schizophrenie. Halluzinationen können in allen Sinnesmodalitäten und bei
vielen neuropsychiatrischen Krankheitsbildern auftreten. Daneben stellen sie ein wichtiges
wahrnehmungspsychologisches Modell für die Erforschung sensorischer Erfahrung ohne
adäquaten Außenreiz dar. Die Befunde der funktionellen Bildgebung deuten auf eine
Aktivierung der Hörrinde, aber auch des limbischen Systems und von motorischen und
sensorischen Spracharealen während der akustischen Halluzinationen. Die psychologischen
und neurophysiologischen Modelle könnten dahingehend konvergieren, dass bei der Schizophrenie
intern generierte Monologe oder Dialoge externen Quellen zugeschrieben werden. Damit
wäre die beobachtete Aktivität von Spracharealen kompatibel. Die Aktivität der Hörrinde
könnte die besondere Lebhaftigkeit und Realitätsnähe der akustischen Halluzinationen
bei der Schizophrenie erklären, während das limbische System die emotionale Beteiligung
repräsentiert. Während psychologisch motivierte Therapieansätze schon seit längerem
verfolgt werden, steht eine physiologisch begründete Therapie mit der transkraniellen
Magnetstimulation noch am Anfang der Erprobung und kann noch nicht für den Routineeinsatz
empfohlen werden. Die zukünftige Forschung mit funktioneller und struktureller Bildgebung
sollte sich neben der Korrelation von Symptom und Hirnaktivität auch den Mustern der
Kommunikation zwischen Hirnarealen und der Integrität der Faserverbindungen widmen,
um den neurobiologischen Ursachen der Halluzinationen näher zu kommen.
Abstract
Auditory verbal hallucinations are a common symptom of schizophrenia. In general,
hallucinations can affect all sensory modalities and occur in many neuropsychiatric
disorders. They also serve the psychology of perception as the classic example of
sensory experience in the absence of adequate external stimuli. Functional imaging
studies showed the auditory cortex, the limbic system and language areas, both motor
and sensory, to be active during auditory hallucinations. The psychological and neurophysiological
models of hallucination can be integrated if we consider that patients with schizophrenia
might ascribe internal monologues or dialogues to external sources. The activity of
language areas during hallucinations would conform to such a model while the activity
in auditory cortex might explain why auditory hallucinations are often so vivid and
real for the patients suffering from them. Moreover, the activation of the limbic
system might correspond to the emotional aspects of the content of the voices and
the accompanying arousal. While the neurophysiological models of hallucination are
thus already rather refined, the attempt at suppressing auditory cortex activity with
repetitive transcranial magnetic stimulation in order to alleviate treatment-resistant
acoustic hallucinations, which is based on the functional imaging findings, still
needs further study. Treatment schemes that are based on the psychological theories
are more varied and have shown more consistent and long lasting effects but also suffer
from the difficulty in measuring hallucinations quantitatively. Future research with
functional and structural imaging should go beyond correlating brain activity and
symptoms and also address the functional and structural connectivity patterns in the
brain that enable hallucinations.
Schlüsselwörter
Schizophrenie - Psychopathologie - Schläfenlappen
Key words
schizophrenia - psychopathology - tempral lobe
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Prof. Dr. Dr. David E. J. Linden
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