強迫癥學(xué)術(shù)論文(3)
強迫癥學(xué)術(shù)論文
可見，OCD的腦功能障礙明顯涉及額葉皮層-皮層下的多個神經(jīng)網(wǎng)絡(luò)的信息加工，任何一個加工階段出現(xiàn)的故障都可能導(dǎo)致OCD相關(guān)癥狀的出現(xiàn)。OFC和ACC是前額皮層的重要網(wǎng)絡(luò)作用節(jié)點，它們都參與了錯誤信號的識別加工，并通過向尾狀核的大量投射強化行為計劃。紋狀體，尤其尾狀核是皮層下的關(guān)鍵網(wǎng)絡(luò)作用節(jié)點，它在獎賞驅(qū)動行為的情緒性和動機性加工中發(fā)揮重要作用，因而可以選擇和產(chǎn)生新的活動模式，以便對環(huán)境中有意義的信息作出反應(yīng)。反復(fù)的強迫性行為也許就是來自對這些加工的過多的表達(dá)，以兌現(xiàn)獎賞來緩解內(nèi)部緊張。另外，來自腦干的多巴胺和5-羥色胺能神經(jīng)遞質(zhì)都作用于以上主要的網(wǎng)絡(luò)節(jié)點，多巴胺功能增強與5-羥色胺功能減弱，以及兩者間的相互作用也會調(diào)節(jié)OCD強迫癥狀的產(chǎn)生。
顯然，來自神經(jīng)解剖、神經(jīng)生理、神經(jīng)心理和神經(jīng)功能成像的研究資料在一定程度上支持了OCD癥狀的現(xiàn)象學(xué)解釋，但有關(guān)OCD癥狀與腦功能障礙之間的聯(lián)系仍有一定的推測性，其中有些重要問題尚未解決。首先，由神經(jīng)功能成像技術(shù)觀察到的OCD病人前額葉腦區(qū)和皮層下相關(guān)結(jié)構(gòu)的功能改變是強迫癥狀的原因還是結(jié)果，還需進(jìn)一步確認(rèn);其次，既然這些功能改變所涉及的幾個關(guān)鍵腦區(qū)，如OFC、ACC和DLPC在人類的動機、情緒、高級認(rèn)知和目的行為的調(diào)節(jié)中起著關(guān)鍵作用，那么，為什么多數(shù)OCD病人除了表現(xiàn)出特定的強迫癥狀之外，一般均有正常的自知力、智能水平?近期的一些研究資料[3,13]也提示，OCD病人在多數(shù)執(zhí)行功能相關(guān)的任務(wù)的加工中并沒有缺陷;再次，OCD是由這些神經(jīng)網(wǎng)絡(luò)回路內(nèi)特定腦區(qū)之間特殊神經(jīng)聯(lián)系的機能障礙所致，還是由多巴胺系統(tǒng)與5-羥色胺系統(tǒng)之間不平衡造成的;最后，導(dǎo)致這種腦功能障礙的原因是什么?是發(fā)生在大腦特定區(qū)域的某些結(jié)構(gòu)缺陷，還是受精神因素影響所出現(xiàn)的病理性突觸改變。這些問題的解答將有助于最終揭示OCD的發(fā)病機制，為臨床上對OCD的有效診斷與治療奠定基礎(chǔ)。
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