疾病和健康中的人類行為

1、Human Behavior in Health and Illness 健康和疾病中的人類行為,,,Human Behavior in Health and Illness,,精神分析認知行為學習神經(jīng)認知應激反應神經(jīng)生物學,,行為,目 標,學習理解人的正常與異常行為有關(guān)的生物、行為、認知、心理學的原理、過程理解行為、認知、思維、心境的異常如何可能源于這些過程的變異，引發(fā)精神疾病理解這些過程如何有可能被用于治療異常

2、的情緒狀態(tài)，減少心理疾病的負擔,Today’s Outline今日的概要,臨床相關(guān)案例的討論,Case 1案件1,史先生，45歲，餐廳老板，妻子懷疑其有藥物濫用問題，由妻子陪同作常規(guī)醫(yī)學檢查妻子疑其使用可卡因，但他否認當家人問其藥物使用問題時，他發(fā)怒醫(yī)生單獨和他談話，他承認使用可卡因，但不多他說用可卡因是為了逃避，獲得快感， 用藥后有強烈的愉快感，感到不可思議的力量感他說他一天里常想可卡因，想怎樣抽空出去用它，感到有些苦惱

3、他承認過去一個月由于使用可卡因，他有幾天耽誤了工作，脾氣變壞，還與妻子發(fā)生口角,Case 1,。史密斯一個45歲餐館老板，訪問他的醫(yī)生為他做了一個例行體檢，伴隨著他的妻子懷疑他有一個“毒品問題”，認為他可能有那種授權(quán)進一步評價的精神障礙?,Case 1,According to current psychiatric nosology (classification of disease), what suggests that he

4、may have a psychiatric disorder that warrants further evaluation?據(jù)據(jù)當前精神病學的疾病分類學(疾病的分類)，認為他可能有那種授權(quán)進一步評價的精神障礙His wife suspects that he may have been using cocaine, but he has denied it to her and family members who have

5、inquired他的妻子懷疑他可能已經(jīng)使用可卡因，但他在妻子和調(diào)查的家庭成員面前否認了He gets annoyed when asked about his drug use.當詢問他的吸毒時他很生氣When alone, Mr. Smith admits to using cocaine, “but not much at all”.當醫(yī)生單獨和他談話時史密斯承認使用可卡因，“但不多”。Mr. Smith says he us

6、es cocaine “for escape” and to “get high” and endorses an intense euphoria on it and feels an “incredible sense of power” 。史密斯說他用可卡因“為了逃避”，“獲得快感”，感覺它有一有激烈欣快感，感覺一個“難以置信力量感” He says he thinks about cocaine much of the day

7、 – and how he will be able to get time away to use it; he feels that this causes quite a bit of distress他說他一天中很多時候惦記著可卡因及如何能夠得到時間去使用它;他覺得這引起相當大的痛苦He admits that his use of cocaine has made him miss work several days thi

8、s past month, and that his temper has gotten worse leading to verbal fights with his wife他承認自己用過可卡因使他耽誤了幾天工作，這過去一個月,他的脾氣變得更糟,而導致了打他的妻子并和妻子發(fā)生了口角。,Case 1 (cont’d)案件1,Upon further inquiry, Mr. Smith admits to using cocaine

9、on a regular basis (4-5 times per week), and經(jīng)過進一步的調(diào)查,史密斯先生決定定期有規(guī)律使用可卡因(每周4 – 5次),- Besides euphoria, he has also had perceptual disturbances during acute cocaine intoxication(除了人興奮,他曾在可卡因急性中毒時有感知失調(diào)）What symptoms wo

10、uld constitute psychosis? Why?精神病會有什么癥狀?為什么?What neurotransmitter is likely responsible for these perceptual disturbances? In which tract / pathway is this neurotransmitter exerting its effects?是什么神經(jīng)遞質(zhì)可能導致感知失調(diào)?在這神經(jīng)遞質(zhì)域

11、/途徑發(fā)揮什么作用?,Case 1 (cont’d),What symptoms would constitute psychosis? Why?什么癥狀將構(gòu)成精神病?為什么?- Auditory hallucinations (hearing voices inside his head when alone)幻聽(當獨自一人時在他腦子里聽到聲音）- - Impaired reality testing – sensory p

12、erception in the Paranoid delusions (thinking that his co-workers are spying on him despite no evidence to support such suspicions)absence of true input (hallucination) and fixed, inflexible false belief (delusion)現(xiàn)實感知受

13、損測試-偏執(zhí)妄想(認為他的同事們監(jiān)視他,盡管沒有證據(jù)能支持這種懷疑)缺乏真正的輸入(幻覺)和固定,呆板的錯誤信念(幻覺)What neurotransmitter is likely responsible for these perceptual disturbances? In which tract / pathway is this neurotransmitter exerting its effects?什么神經(jīng)遞質(zhì)可能負

14、責這些知覺的的騷亂?，什么管道/通路是這個神經(jīng)遞質(zhì)施加它的影響?- Dopamine- Mesolimbic and/or mesocortical tract (VTA to limbic [ventral striatum, amygdala] and/or frontal cortex, respectively) -多巴胺- - - - - - Mesolimbic和/或mesocortical區(qū)域,到邊緣VTA神經(jīng)元

15、,杏仁核][前部紋狀體和/或額葉皮質(zhì),分別),Case 1 (cont’d),Upon further inquiry about job dysfunction at work and interpersonal conflicts at home and regular use over the past few years, Mr. Smith doesn’t believe that he has a problem with

16、his cocaine use, says he can quit at any time. He says that the cocaine has “helped me concentrate” and that his performance is enhanced by cocaine – he has read that using cocaine is like “drinking a lot of coffee”.

17、Mr. Smith informs the doctor that his wife has been crying regularly, is depressed and distraught about his spiraling use, their deteriorating marriage, and her fear of potential violence when he is intoxicated. When he

18、aring this, he appears indifferent, and emotionally non-expressive.經(jīng)過進一步的對就業(yè)障礙和家庭人際沖突調(diào)查工作和經(jīng)常使用。過去幾年來史密斯先生不相信他有問題，問他吸上了可卡因,說他能在任何時候辭職。他表示,“可卡因幫助我集中精力”,他的表現(xiàn)就有所提高了是由于使用了可卡因——他已經(jīng)讀了使用可卡因就像“喝很多咖啡?！笔访芩瓜壬嬖V醫(yī)生當他使用可卡因事他的妻子哭了,感到沮喪和

19、悲痛欲絕,他們的婚姻不斷惡化,當他陶醉使用可卡因時,她擔心潛在的暴力。當聽到這個消息,他顯得冷漠,而且情緒沒有改變。What defense mechanisms are being exhibited by Mr. Smith? Are they considered mature defenses?史密斯先生表現(xiàn)出的什么防御機制?他們被認為是成熟的防御嗎?,Case 1 (cont’d),What defense mechani

20、sms are being exhibited by Mr. Smith? Are they considered mature defenses?什么防御機制被展現(xiàn)?他們是成熟防衛(wèi)嗎?Denial – Refusal to perceive the harsh aspects of reality Rationalization – Construction of a logical explanation for a dec

21、ision thatwas derived via another mental processIntellectualization / Isolation of Affect – Distancing oneself from the negative emotions evoked對嚴酷的現(xiàn)實觀點否定——拒絕建設的合理化-邏輯性的解釋是一個決定,通過另一個心理過程,推導出了智能化/隔離自己的影響-使自己遠離負面情緒All

22、 the above are not considered as mature.所有以上不考慮是成熟的Levels of defenses:防御的水平:I. Psychotic: denial, fantasy, hallucinations精神病的:拒絕，幻想，幻覺II. Immature: splitting, regression, dissociation, idealization, acting out未成

23、熟的:分裂，回歸，離解，理想化，表演III. Neurotic: displacement, intellectualization/isolation of affect, rationalization, repression, undoing, reaction formation神經(jīng)質(zhì)的:移位，理智化/隔離的影響，合理化，壓迫，復原，反向形成IV. Mature: humor, suppression, an

24、ticipation, sublimation, altruism成熟:幽默，抑制，預期，升華，利他主義,Case 1 (cont’d),How would you describe a Freudian structural model of Mr. Smith’s behaviors?如何將你描述一個弗洛伊德先生的結(jié)構(gòu)模型。史密斯的行為?,Id: Cocaine use for pleasure serves as the self

25、ish, primitive, childish, pleasure-oriented part of the personality with no ability to delay gratification Superego: At times feels and knows that his cocaine use is “bad”/”wrong” based on internalized societal and pare

26、ntal standards Ego: the moderator between the id and superego which seeks compromises to pacify bot可卡因用為了取樂作為自私，原始，幼稚，pleasure-oriented部分個性同沒有的能力延遲滿足超我:有時感覺，知道那個他的可卡因用“壞”/”錯”以內(nèi)化為依據(jù)社會的，父母的標準自我:中古英語h.,Defense mechanisms

27、serve which of the above? Which of the above are believed to be primarily unconscious?防御機制,上述服務嗎?以上的被認為是主要的無意識?,Ego Id,Case 1 (cont’d),Upon further inquiry, Mr. Smith says that he had tried to quit cocaine use, but h

28、as continued to relapse. He finds himself craving (intensified wanting) when he drives into the parking structure at work because he often snorts cocaine there, or when he sits down at this desk because there is a vial

29、of cocaine in his desk drawer, or when he runs into his office mate Joe (who often joins him in the parking structure to use cocaine)經(jīng)過進一步的調(diào)查,史密斯先生說他曾試圖放棄古柯堿的使用,但不斷的復發(fā)。他發(fā)現(xiàn)自己渴望(增強)：當他開車到工作點的停車廠時,因為他經(jīng)常在那里吸食可卡因;當他坐在這張桌子時,因為

30、那里有一只碗的可卡因在他的書桌的抽屜里,或者當他到他的辦公室伙伴喬那時(經(jīng)常和他在停車廠使用可卡因)According to behavioral theory, his craving associated with the visual cues is known as what process?根據(jù)行為理論,他渴望與之關(guān)聯(lián)的視覺線索稱為什么過程?,Classical conditioning (associative learn

31、ing):US:CS:UR:,Pairing US + CS leads to learning Subsequent CS (event with US) evokes anticipation and craving隨后(與我們)CS事件喚起期望和渴求.,cocaineparking structure, desk, Joeeuphoria from cocaine intoxication古柯堿中毒興奮,

32、Case 1 (cont’d),Mr. Smith is considering entering psychodynamic psychotherapy to uncover his past experiences in order to gain insight into his current behaviors (self-destructive drug use) and defense mechanisms in orde

33、r to eradicate his “false self” and accept his “true self.”史密斯先生正在考慮進入精神動力療法來掀開他過去的經(jīng)歷,以洞察他目前的行為(自我毀滅的用藥)和防御機制以消除他的“假我”與接受他的“真實的自我?！盬hat are the major foci of this type of therapy?有什么主要的局灶性這種類型的治療嗎?,Case 1 (cont’d),What

34、 are the major foci of psychodynamic psychotherapy?有什么主要的局灶性精神動力療法嗎?Uncover and learn about unconscious mechanisms(free association, behavior, relationship, mistakes)揭示和了解無意識機制(自由聯(lián)想、行為、人際關(guān)系、錯誤）Work on transference

35、 and countertransference轉(zhuǎn)變和反向移情的研究Example?Work on resistance / ambivalence to change阻礙和矛盾引起改變的研究Example?,Case 1 (cont’d),Example of transference: Mr. Smith grew up in an authoritarian household with strict rul

36、es and punishment imposed upon him by his father. In therapy, he relates his past relationship with his father with his current relationship with his male therapist. At the initial stages of therapy, he accuses the ther

37、apist: “You are being too tough on me…what do you expect from me? Are you getting upset that I continue to use cocaine despite our treament?” Example of countertransference: The therapist, Dr. Jones, is the oldest

38、of 4 sons, and had been the primary caretaker taker of his younger brothers who have had exhibited defiance and opposition to “brotherly” guidance. In therapy, he gets upset with Mr. Smith because he is not compliant wit

39、h treatment recommendations. Example of resistance: Mr. Smith begins to miss or comes late appointments once his cocaine use becomes less frequent and more under control遷移實例：史密斯先生成長在一個嚴格的規(guī)章制度和父親獨裁的家庭中。在治療中,他把過去與他的父親

40、的關(guān)系轉(zhuǎn)移到他與治療師的關(guān)系。在初始階段的治療,他指責治療師:“你過于嚴厲了…你期望從我這里得到什么?盡管我們在治療中我將繼續(xù)使用可卡因，這樣你會很心煩嗎?” 反向移情實例：治療師,瓊斯博士是4個兒子中最大的,已經(jīng)主要看守他的弟弟調(diào)查員有展出,反對“兄弟蔑視”指導。在治療中,他就會心煩意亂,因為他不贊成史密斯先生治療建議。 抵抗實例:當他吸可卡因變得更少更規(guī)律且更在控制之下時，史密斯先生開始想念、抵制、遲來。,Cas

41、e 1 (cont’d),Mr. Smith is considering entering cognitive behavioral psychotherapy to uncover his past experiences in order modify his recurrent drug use. 。史密斯先生正在考慮進入認知行為療法來掀開他過去的經(jīng)歷以便于他反復修改用藥。What are the major foci

42、of this type of therapy?主要焦點的這種治療的類型是什么?,Mr. Smith is considering entering cognitive behavioral psychotherapy to uncover his past experiences in order modify his recurrent drug use.,Case 1 (cont’d),What are the major foc

43、i of cognitive behavioral therapy and/or social learning therapy?什么是主要關(guān)鍵的認知行為治療或社會學習療法?Identify cue-induced craving patterns模式識別cue-induced渴望Establish operant conditioning (instrumental learning) treatment建立操作條件反射

44、(工具性學習)治療Modify attribution of locus of control (from cocaine back to self)修改軌跡控制的歸因(從可卡因后面的對自我)Correct distorted thinking / beliefs about self, others, world關(guān)于自己、他人、世界的正確或錯誤的認識/信仰.。Establish group treatment wit

45、h sponsors (Narcotics Anonymous) in which behavior is modified by observation of a role model (e.g., sponsor) and through enhancing self-efficacy對贊助者進行團體治療(麻醉治療匿名)在這個治療中行為被標準模式觀察監(jiān)測（贊助者)和通過強化自我效能感。,Case 1 (cont’d),In an o

46、perant conditioning-based type therapy, Mr. Smith engages in contingency / token treatment, in which he receives a token (to be exchanged for tangible goods/rewards) for each clean urine sample he provides to the clinic

47、on random checks.在一個操作性conditioning-based類型治療中，史密斯從事應變/象征性的的治療，他收到一個象征暗示(被交換有形貨物/報酬)為每個清潔尿樣他提供隨機的診所支票。This is an example of what type of reinforcement? 這是一個典型的信息加強的類型?What would be the optimal reinforcement s

48、chedule to maintain abstinence from cocaine use?什么是較佳強化程序去在可卡因利用中保持節(jié)制?,Case 1 (cont’d),In an operant conditioning-based type therapy, Mr. Smith engages in contingency / token treatment,在一個操作性conditioning-based類型治療，。史密斯從事

49、應變/象征性的的治療。This is an example of what type of reinforcement? 這是一個典型的信息加強的類型?Positive reinforcement (tokens/reward) to promote abstinence.What would be the optimal reinforcement schedule to maintain abstinence f

50、rom cocaine use?什么是較佳強化程序去在可卡因利用中保持節(jié)制?Variable token amount and variable intervals of urine drug screens,which would result in slower learning, but slower extinction尿液藥物變化的數(shù)量和變量區(qū)間變量將會引起學習,但是執(zhí)行速度較慢消失。,Case 2,Mr. Bonine

51、is a 44-year-old, single, unemployed, man is brought to the emergency room by the police for striking an elderly woman in his apartment building. 。博尼恩一個44歲，單身，失業(yè)的男性，因為在他的公寓大樓打一個老年女子被警察送到蘇醒急診室。Last year he suffered a tr

52、aumatic brain injury following head-on motor vehicle collision in which his head hit this windshield upon contact.去年他被迎面的的馬達車輛碰撞，他的頭擊中這個擋風玻璃，得了創(chuàng)傷性腦損傷。What type of cognitive and emotional symptoms would you expect?你認為將有

53、什么認知的的類型，情緒化的癥狀?Such injuries are similar to what type of neuropsychiatric disorders?這樣外傷類似于什么神經(jīng)精神系統(tǒng)的紊亂類型?,Cognitive, Emotional, and Behavioral Changes following Frontal Lobe Injury認知的，情緒化，行為的變動遵循額葉受傷,Impulsiveness (

54、acting before thinking)沖動性(做在想之前）Disinhibition (lack of self-control)去抑制(缺乏自我控制)Inappropriate sexual activity不當性行為Apathy/Poor initiation (trouble getting started)冷漠/貧乏的動機(困難開始出現(xiàn))Frustration and loss of temper挫折和發(fā)脾氣P

55、oor insight (lack of self-awareness of changes)眼光差(缺乏自我意識的變化）Emotional problems: depression, anxiety, irritability, anger, mood swings情緒化問題:失望，焦慮，易怒，憤怒，情緒波動,Changes in Frontal Lobe Disorders變動在額葉紊亂,Dorsolateral Prefront

56、al Cortex – Dysexecutive Syndrome (unable to plan or change plans flexibly, perseveration, unable to shift behavior)背側(cè)前額葉皮層-dysexecutive綜合癥(無法對計劃或靈活變動計劃，持續(xù)言語，無法對轉(zhuǎn)換行為)Orbitofrontal Cortex – Disinhibited Syndrome (impuls

57、ive, labile affect, poor judgment)眶額皮層-disinhibited綜合癥(浮躁，不穩(wěn)定的影響，判斷力差)Medial Frontal Cortex – Apathetic Syndrome (apathetic, behaviorally inert, poor spontaneity)中間的額葉皮質(zhì)-麻木不仁綜合癥(麻木不仁，惰性的行為活動，自發(fā)性差),Personality Changes i

58、n Frontal Lobe Disorders人格改變在額葉紊亂,Head injuries (Traumatic Brain Injury)頭部受傷(創(chuàng)傷性腦損傷)Frontotemporal Dementia (Pick’s Disease,額顳癡呆(皮克癥）Frontotemporal Lobar Degeneration)Anterior Stroke (Cerebral Vascular Accident from a

59、nterior portion of middle cerebral arteries)前面的的行程(前中的一部分腦動脈腦血管意外),Case 2 (cont’d),44-year-old male with traumatic brain injury following head-on motor vehicle collision 一個44歲男性被迎面的的馬達車輛碰撞而患創(chuàng)傷性腦損傷What neuropsychologica

60、l tests could you administer to examine his executive function?什么神經(jīng)心理的測試可以有助于檢查他的執(zhí)行功能?The function of which areas of the brain are probed with these tests ?哪一個腦的地區(qū)功能，被探測同這些測試有關(guān)?,Case 2 (cont’d),44-year-old male with tra

61、umatic brain injury following head-on motor vehicle collision What neuropsychological tests could you administer to examine his executive function? The function of which areas of the brain are probed with these tests

62、?Wisconsin Card Sort Test, Trail Making – Part B, N-BackTests Dorsolateral Prefrontal Cortex in terms of cognitive flexibility (goal-directed behavior, planning), working memoryStroop TaskTests Anterior Cin

63、gulate Cortex in terms of selective attention威斯康辛卡片分類測試,連線N-Back - B部分背外側(cè)前額葉皮層測試方面的認知靈活性(目標導向行為、規(guī)劃),工作記憶Stroop任務測試前扣帶皮質(zhì)選擇性注意力方面Go-No Go TaskTests Anterior Cingulate and Prefrontal cortex for impulse control測試

64、前扣帶，前額葉皮層控制脈沖Decision Making (on daily tasks of judgment; finances)Tests Orbitofrontal / Ventromedial Prefrontal Cortex for decision making決策(每日的判決任務表;金融)測試 orbitofrontal/腹前額葉皮層控制決策,To understand the mental process

65、 involved try this experiment. Look at the following letters on the screen: tree. If you are like most people it is difficult for you not to quickly read the word “tree.”  Most humans are so proficient at reading pr

66、inted words that they cannot easily ignore them. In fact it takes considerable attentional effort to ignore them. This tendency to quickly read a word is used in the Stroop Task理解心理過程涉及嘗試這個試驗。觀看下面屏幕上的詞:樹。如果你像大多數(shù)人一樣那對于你來說

67、，很快讀出“樹”不是很困難的?！按蠖鄶?shù)人在閱讀打印方面如此熟練，所以他們不易忽視他們。實際上，要花費相當?shù)木θズ雎运鼈?。在Stroop 任務中這種很快讀出單詞的趨勢被運用。The Stroop Task is a psychological test of our mental (attentional) vitality and flexibility. The task takes advantage of our abilit

68、y to read words more quickly and automatically than we can name colors. If a word is printed or displayed in a color different from the color it actually names; for example, if the word “green” is written in blue ink (as

69、 shown in the figure to the left) we will say the word “green” more readily than we can name the color in which it is displayed, which in this case is “blue.” stroop任務一個我們的精神活力和靈活性的心理測試(attentional) 。任務利用我們的能力去比在我們能

70、命名的顏色下更快自動讀出單詞活力和靈活性。如果一個字在一個顏色異于它其實名稱的顏色下被打印或顯示;如果字“綠色”被寫在藍墨水(如左邊圖所示)我們會讀出“綠色”比在我們更容易能命名的填色顯示下——在這種情況下是“藍色”。The cognitive mechanism involved in this task is called directed attention, you have to manage your attention,

71、 inhibit or stop one response in order to say or do something else.  Although the functions of the anterior cingulate are very complex, broadly speaking it acts as a conduit between lower, somewhat more impulse-driv

72、en brain regions and higher, somewhat more thought-driven behaviors. The Stroop effect‘s sensitivity to changes in brain function may be related to its association with the anterior cingulate參與這任務的認知機制被叫做直接關(guān)注，你必須掌控你的注意力，

73、為了了說或做其他事情而抑制或停止一種反應。盡管功能的前扣帶高度的復雜，廣義地說它在降低之間，或更多impulse-driven腦地區(qū)，或更高部位充當一個通道，有些更多思想驅(qū)動行為。stroop效應的敏感性在大腦功能變動可能同前扣帶協(xié)同有關(guān)。The Stroop Test provides insight into cognitive effects that are experienced as a result of attent

74、ional fatigue. stroop測驗提供認知的洞察影響，那個被認為是attentional疲勞的結(jié)果。For a discussion of the capacity to direct attention and its fatigue see Kaplan, S. (1995). The restorative benefits of nature: Toward an integrative framework. J