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Brain Advance Access originally published online on March 2, 2005
Brain 2005 128(5):963-978; doi:10.1093/brain/awh466
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© The Author (2005). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oupjournals.org

Review Article

Right hemisphere language functions and schizophrenia: the forgotten hemisphere?

Rachel L. C. Mitchell1,2,3 and Tim J. Crow4

1 School of Psychology, University of Reading, Reading, 2 Neuroscience and Emotion Section, Institute of Psychiatry, London, 3 Berkshire Healthcare NHS Trust and 4 SANE POWIC Centre, Department of Psychiatry, University of Oxford, Oxford, UK

Correspondence to: Rachel L. C. Mitchell, School of Psychology, University of Reading, Whiteknights Road, Reading, Berkshire RG31 4RA, UK E-mail: r.l.c.mitchell{at}rdg.ac.uk

This review highlights the importance of right hemisphere language functions for successful social communication and advances the hypothesis that the core deficit in psychosis is a failure of segregation of right from left hemisphere functions. Lesion studies of stroke patients and dichotic listening and functional imaging studies of healthy people have shown that some language functions are mediated by the right hemisphere rather than the left. These functions include discourse planning/comprehension, understanding humour, sarcasm, metaphors and indirect requests, and the generation/comprehension of emotional prosody. Behavioural evidence indicates that patients with typical schizophrenic illnesses perform poorly on tests of these functions, and aspects of these functions are disturbed in schizo-affective and affective psychoses. The higher order language functions mediated by the right hemisphere are essential to an accurate understanding of someone's communicative intent, and the deficits displayed by patients with schizophrenia may make a significant contribution to their social interaction deficits. We outline a bi-hemispheric theory of the neural basis of language that emphasizes the role of the sapiens-specific cerebral torque in determining the four-chambered nature of the human brain in relation to the origins of language and the symptoms of schizophrenia. Future studies of abnormal lateralization of left hemisphere language functions need to take account of the consequences of a failure of lateralization of language functions to the right as well as the left hemisphere.


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