強(qiáng)迫癥學(xué)術(shù)論文(3)
強(qiáng)迫癥學(xué)術(shù)論文
可見(jiàn)，OCD的腦功能障礙明顯涉及額葉皮層-皮層下的多個(gè)神經(jīng)網(wǎng)絡(luò)的信息加工，任何一個(gè)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(diǎn)，它們都參與了錯(cuò)誤信號(hào)的識(shí)別加工，并通過(guò)向尾狀核的大量投射強(qiáng)化行為計(jì)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(diǎn)，它在獎(jiǎng)賞驅(qū)動(dòng)行為的情緒性和動(dòng)機(jī)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(dòng)模式，以便對(duì)環(huán)境中有意義的信息作出反應(yīng)。反復(fù)的強(qiáng)迫性行為也許就是來(lái)自對(duì)這些加工的過(guò)多的表達(dá)，以兌現(xiàn)獎(jiǎng)賞來(lái)緩解內(nèi)部緊張。另外，來(lái)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(diǎn)，多巴胺功能增強(qiáng)與5-羥色胺功能減弱，以及兩者間的相互作用也會(huì)調(diào)節(jié)OCD強(qiáng)迫癥狀的產(chǎn)生。
顯然，來(lái)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(cè)性，其中有些重要問(wèn)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(qiáng)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(gè)關(guān)鍵腦區(qū)，如OFC、ACC和DLPC在人類的動(dòng)機(jī)、情緒、高級(jí)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(qiáng)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(méi)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(jī)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(wèn)題的解答將有助于最終揭示OCD的發(fā)病機(jī)制，為臨床上對(duì)OCD的有效診斷與治療奠定基礎(chǔ)。
參考文獻(xiàn)
[1] Schwartz J M. Neuroanatomical aspects of cognitive behavioural therapy response in obsessive compulsive disorder. An evolving perspective on brain and behaviour. British Journal of Psychiatry, 1998, (Suppl.):38~44
[2] Schwartz J M. A role of volition and attention in the generation of new brain circuitry: Toward a neurobiology of mental force. Journal of Consciousness Study, 1999, 6: 115~142
[3] Aouizerate B, Guehl D, Cuny E, et al. Pathophysiology of obsessivecompulsive disorder: A necessary link between phenomenology, neuropsychology, imagery and physiology. Progress in Neurobiology, 2004 , 72: 195~221
[4] Krawczyk D C. Contributions of the prefrontal cortex to the neural basis of human decision making. Neuroscience of Biobehavioral Review, 2002, 26: 631~664
[5] Passingham R E. The frontal lobes and voluntary action. Oxford: Oxford University Press, 1993
[6] Tremblay L, Schultz W. Modifications of reward expectation-related neuronal activity during learning in primate orbitofrontal cortex. Journal of Neurophysiology, 2000, 83: 1877~1885
[7] Alptekin K, Degirmenci B, Kivircik B, et al. Tc-99m HMPAO brain perfusion SPECT in drug-free obsessive compulsive patients without depression. Psychiatry Research, 2001, 107: 51~56
[8] Swedo S E, Schapiro M B, Grady C L, et al. Cerebral glucose metabolism in childhood-onset obsessivecompulsive disorder. Archives of General Psychiatry, 1989, 46: 518~523
[9] Lacerda A L, Dalgalarrondo P, Caetano D, et al. Elevated thalamic and prefrontal regional cerebral blood flow in obsessivecompulsive disorder: A SPECT study. Psychiatry Research, 2003, 123: 125~134
[10] Bannon S, Gonsalves C J, Croft R J. Response inhibition deficits in obsessive compulsive disorders. Psychiatry Research, 2002, 110: 165~174
[11] Bokura H, Yamaguchi S, Kobayashi S. Electrophysiological correlates for response inhibition in a Go/No-Go task. Clinical Neurophysiology, 2001,112: 2224~2232
[12] Casey B J, Trainor R J, Orendi J L, et al. A developmental functional MRI study of prefrontal activation during performance of a Go-No-Go task. Journal of Cognitive Neuroscience, 1997, 9: 835~847
[13] Evans DW, Lewis M D, Iobst E. The role of the orbitofrontal cortex in normally developing compulsive-like behaviors and obsessive-compulsive disorder. Brain and Cognition, 2004, 55: 220~234
[14] Ochsner K N, Bunge S A, Gross J J, et al. Rethinking feelings: An fMRI study of the cognitive regulation of emotion. Journal of Cognitive Neuroscience, 2002, 14: 1215~1229
[15] Depue R A, Collins P F. Neurobiology of the structure of personality: dopamine, facilitation of incentive motivation, and extraversion. Behavioral and Brain Science, 1999, 22: 491~569
[16] Molina V, Montz R, Martin-Loeches M, et al. Drug therapy and cerebral perfusion in obsessivecompulsive disorder. Journal of Nuclear Medicine, 1995, 36: 2234~2238
[17] Perani D, Colombo C, Bressi S, et al. [18F]FDG PET study in obsessivecompulsive disorder: A clinical/metabolic correlation study after treatment. British Journal of Psychiatry, 1995, 166: 244 ~ 250
[18] 蔡厚德, 劉昌. 大腦前扣帶回皮層與執(zhí)行功能. 心理科學(xué)進(jìn)展, 2004, 12(5): 643~650
[19] Bush G, Luu P, Posner M I. Cognitive and emotional influences in anterior cingulate cortex. Trends in Cognitive Science, 2000,4: 215~222
強(qiáng)迫癥學(xué)術(shù)論文相關(guān)文章：
1.關(guān)于心理學(xué)學(xué)術(shù)論文結(jié)構(gòu)