Am J Psychiatry 161:1724, September 2004
© 2004 American Psychiatric Association
Drs. Buchanan and Pearlson Reply
ROBERT W. BUCHANAN, M.D., and
GODFREY PEARLSON, M.D.
Baltimore, Md.
To the Editor: Dr. Green correctly notes that there are a number of differences between our definition of the heteromodal cortex and the one provided by Mesulam in his textbook (his reference 2). We asserted that our definition was primarily based on the definition provided by Mesulam, but we agree that the use of the word "primarily" does not provide an accurate accounting of the noted differences between the two definitions, nor does it reflect accurately how we modified the Mesulam definition in our other written descriptions of the heteromodal association cortex (1). In particular, we attempted to refine the concept based on the work of Goldman-Rakic and colleagues, who conducted a series of studies demonstrating the intimate, reciprocal structural connections between the prefrontal cortex, the inferior parietal cortex, and the superior temporal gyrus (reviewed in reference 1). These considerations have led us and other researchers to adopt a more conservative definition of the heteromodal cortex (2, 3). In addition, we would argue that the faceplate (Dr. Green’s reference 2) underestimates the extent of the involvement of the superior temporal gyrus in the heteromodal cortex, as reviewed by one of us (4).
Dr. Green also observes that our definition of the prefrontal cortex includes the premotor cortex. In a previous article (5), we acknowledged the point that there is no reliable sulcal boundary between the premotor cortex and the prefrontal cortex and that our definition of the superior and middle prefrontal regions includes the supplementary motor area and the premotor cortex, respectively. We did not reiterate this point in the current article. We thank Dr. Green for giving us an opportunity to clarify these issues.
References
- Pearlson GD, Petty RG, Ross CA, Tien AY: Schizophrenia: a disease of heteromodal association cortex? Neuropsychopharmacology 1996; 14:1–7
- Keshavan MS, Sanders RD, Sweeney JA, Diwadkar VA, Goldstein G, Pettegrew JW, Schooler NR: Diagnostic specificity and neuroanatomical validity of neurological abnormalities in first-episode psychoses. Am J Psychiatry 2003; 160:1298–1304[Abstract/Free Full Text]
- Cannon TD, Thompson PM, van Erp TG, Toga AW, Poutanen VP, Huttunen M, Lonnqvist J, Standerskjold-Nordenstam CG, Narr KL, Khaledy M, Zoumalan CI, Dail R, Kaprio J: Cortex mapping reveals regionally specific patterns of genetic and disease-specific gray-matter deficits in twins discordant for schizophrenia. Proc Natl Acad Sci USA 2002; 99:3228–3233[Abstract/Free Full Text]
- Pearlson GD: Superior temporal gyrus and planum temporale in schizophrenia: a selective review. Prog Neuropsychopharmacol Biol Psychiatry 1997; 21:1203–1229
- Buchanan RW, Vladar K, Barta PE, Pearlson GD: Structural evaluation of the prefrontal cortex in schizophrenia. Am J Psychiatry 1998; 155:1049–1055[Abstract/Free Full Text]
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