疾病和健康中的人類行為

HumanBehaviorinHealthandIllness

健康和疾病中的人類行為

HumanBehaviorinHealthandIllness精神分析認(rèn)知行為學(xué)習(xí)神經(jīng)認(rèn)知應(yīng)激反應(yīng)神經(jīng)生物學(xué)行為目標(biāo)學(xué)習(xí)理解人的正常與異常行為有關(guān)的生物、行為、認(rèn)知、心理學(xué)的原理、過程理解行為、認(rèn)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的情緒狀態(tài)，減少心理疾病的負(fù)擔(dān)Today’sOutline今日的概要臨床相關(guān)案例的討論

Case1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(xué)檢查妻子疑其使用可卡因，但他否認(rèn)當(dāng)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(rèn)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，感到有些苦惱他承認(rèn)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Case1。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(rèn)為他可能有那種授權(quán)進(jìn)一步評價的精神障礙?Case1Accordingtocurrentpsychiatricnosology(classificationofdisease),whatsuggeststhathemayhaveapsychiatricdisorderthatwarrantsfurtherevaluation?據(jù)據(jù)當(dāng)前精神病學(xué)的疾病分類學(xué)(疾病的分類)，認(rèn)為他可能有那種授權(quán)進(jìn)一步評價的精神障礙Hiswifesuspectsthathemayhavebeenusingcocaine,buthehasdeniedittoherandfamilymemberswhohaveinquired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(rèn)了Hegetsannoyedwhenaskedabouthisdruguse.當(dāng)詢問他的吸毒時他很生氣Whenalone,Mr.Smithadmitstousingcocaine,“butnotmuchatall”.當(dāng)醫(yī)生單獨和他談話時史密斯承認(rèn)使用可卡因，“但不多”。Mr.Smithsaysheusescocaine“forescape”andto“gethigh”andendorsesanintenseeuphoriaonitandfeelsan“incrediblesenseofpower”。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”Hesayshethinksaboutcocainemuchoftheday–andhowhewillbeabletogettimeawaytouseit;hefeelsthatthiscausesquiteabitofdistress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(dāng)大的痛苦Headmitsthathisuseofcocainehasmadehimmissworkseveraldaysthispastmonth,andthathistemperhasgottenworseleadingtoverbalfightswithhiswife他承認(rèn)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(dǎo)致了打他的妻子并和妻子發(fā)生了口角。

Case1(cont’d)案件1Uponfurtherinquiry,Mr.Smithadmitstousingcocaineonaregularbasis(4-5timesperweek),and經(jīng)過進(jìn)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), -Besideseuphoria,hehasalsohadperceptualdisturbancesduringacutecocaineintoxication(除了人興奮,他曾在可卡因急性中毒時有感知失調(diào)）Whatsymptomswouldconstitutepsychosis?Why?精神病會有什么癥狀?為什么? Whatneurotransmitterislikelyresponsiblefortheseperceptualdisturbances?Inwhichtract/pathwayisthisneurotransmitterexertingitseffects?是什么神經(jīng)遞質(zhì)可能導(dǎo)致感知失調(diào)?在這神經(jīng)遞質(zhì)域/途徑發(fā)揮什么作用?Case1(cont’d)

Whatsymptomswouldconstitutepsychosis?Why?什么癥狀將構(gòu)成精神病?為什么?-Auditoryhallucinations(hearingvoicesinsidehisheadwhenalone)幻聽(當(dāng)獨自一人時在他腦子里聽到聲音） - -Impairedrealitytesting–sensoryperceptionintheParanoiddelusions(thinkingthathisco-workersarespyingonhimdespitenoevidencetosupportsuchsuspicions)absenceoftrueinput(hallucination)andfixed,inflexiblefalsebelief(delusion)現(xiàn)實感知受損測試-偏執(zhí)妄想(認(rèn)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)Whatneurotransmitterislikelyresponsiblefortheseperceptualdisturbances?Inwhichtract/pathwayisthisneurotransmitterexertingitseffects?什么神經(jīng)遞質(zhì)可能負(fù)責(zé)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 -Mesolimbicand/ormesocorticaltract(VTAtolimbic[ventralstriatum,amygdala]and/orfrontalcortex,respectively)

-多巴胺------Mesolimbic和/或mesocortical區(qū)域,到邊緣VTA神經(jīng)元,杏仁核][前部紋狀體和/或額葉皮質(zhì),分別)Case1(cont’d)Uponfurtherinquiryaboutjobdysfunctionatworkandinterpersonalconflictsathomeandregularuseoverthepastfewyears,Mr.Smithdoesn’tbelievethathehasaproblemwithhiscocaineuse,sayshecanquitatanytime.Hesaysthatthecocainehas“helpedmeconcentrate”andthathisperformanceisenhancedbycocaine–hehasreadthatusingcocaineislike“drinkingalotofcoffee”.Mr.Smithinformsthedoctorthathiswifehasbeencryingregularly,isdepressedanddistraughtabouthisspiralinguse,theirdeterioratingmarriage,andherfearofpotentialviolencewhenheisintoxicated.Whenhearingthis,heappearsindifferent,andemotionallynon-expressive.經(jīng)過進(jìn)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(dāng)他使用可卡因事他的妻子哭了,感到沮喪和悲痛欲絕,他們的婚姻不斷惡化,當(dāng)他陶醉使用可卡因時,她擔(dān)心潛在的暴力。當(dāng)聽到這個消息,他顯得冷漠,而且情緒沒有改變。WhatdefensemechanismsarebeingexhibitedbyMr.Smith?Aretheyconsideredmaturedefenses?史密斯先生表現(xiàn)出的什么防御機制?他們被認(rèn)為是成熟的防御嗎?Case1(cont’d)WhatdefensemechanismsarebeingexhibitedbyMr.Smith?Aretheyconsideredmaturedefenses?什么防御機制被展現(xiàn)?他們是成熟防衛(wèi)嗎?Denial–RefusaltoperceivetheharshaspectsofrealityRationalization–ConstructionofalogicalexplanationforadecisionthatwasderivedviaanothermentalprocessIntellectualization/IsolationofAffect–Distancingoneselffromthenegativeemotionsevoked對嚴(yán)酷的現(xiàn)實觀點否定——拒絕建設(shè)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(dǎo)出了智能化/隔離自己的影響-使自己遠(yuǎn)離負(fù)面情緒Alltheabovearenotconsideredasmature.所有以上不考慮是成熟的Levelsofdefenses: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,actingout未成熟的:分裂，回歸，離解，理想化，表演III.Neurotic:displacement,intellectualization/isolationofaffect, rationalization,repression,undoing,reactionformation神經(jīng)質(zhì)的:移位，理智化/隔離的影響，合理化，壓迫，復(fù)原，反向形成IV.Mature:humor,suppression,anticipation,sublimation,altruism成熟:幽默，抑制，預(yù)期，升華，利他主義Case1(cont’d)HowwouldyoudescribeaFreudianstructuralmodelofMr.Smith’sbehaviors?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:

Cocaineuseforpleasureservesastheselfish,primitive,childish,pleasure-orientedpartofthepersonalitywithnoabilitytodelaygratification

Superego:Attimesfeelsandknowsthathiscocaineuseis“bad”/”wrong”basedoninternalizedsocietalandparentalstandardsEgo:themoderatorbetweentheidandsuperegowhichseekscompromisestopacifybot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(biāo)準(zhǔn)自我:中古英語h.

Defensemechanismsservewhichoftheabove?Whichoftheabovearebelievedtobeprimarilyunconscious?防御機制,上述服務(wù)嗎?以上的被認(rèn)為是主要的無意識?

EgoIdCase1(cont’d)Uponfurtherinquiry,Mr.Smithsaysthathehadtriedtoquitcocaineuse,buthascontinuedtorelapse.Hefindshimselfcraving(intensifiedwanting)whenhedrivesintotheparkingstructureatworkbecauseheoftensnortscocainethere,orwhenhesitsdownatthisdeskbecausethereisavialofcocaineinhisdeskdrawer,orwhenherunsintohisofficemateJoe(whooftenjoinshimintheparkingstructuretousecocaine)經(jīng)過進(jìn)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(fù)發(fā)。他發(fā)現(xiàn)自己渴望(增強)：當(dāng)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(dāng)他坐在這張桌子時,因為那里有一只碗的可卡因在他的書桌的抽屜里,或者當(dāng)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)Accordingtobehavioraltheory,hiscravingassociatedwiththevisualcuesisknownaswhatprocess?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?Classicalconditioning(associativelearning): US: CS: UR:

PairingUS+CSleadstolearningSubsequentCS(eventwithUS)evokesanticipationandcraving隨后(與我們)CS事件喚起期望和渴求.cocaineparkingstructure,desk,Joeeuphoriafromcocaineintoxication古柯堿中毒興奮Case1(cont’d)Mr.Smithisconsideringenteringpsychodynamicpsychotherapytouncoverhispastexperiencesinordertogaininsightintohiscurrentbehaviors(self-destructivedruguse)anddefensemechanismsinordertoeradicatehis“falseself”andaccepthis“trueself.”史密斯先生正在考慮進(jìn)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hatarethemajorfociofthistypeoftherapy?有什么主要的局灶性這種類型的治療嗎?Case1(cont’d)

Whatarethemajorfociofpsychodynamicpsychotherapy?有什么主要的局灶性精神動力療法嗎?Uncoverandlearnaboutunconsciousmechanisms (freeassociation,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） Workontransferenceandcountertransference轉(zhuǎn)變和反向移情的研究

Example? Workonresistance/ambivalencetochange阻礙和矛盾引起改變的研究

Example?Case1(cont’d)

Exampleoftransference:Mr.Smithgrewupinanauthoritarianhouseholdwithstrictrulesandpunishmentimposeduponhimbyhisfather.Intherapy,herelateshispastrelationshipwithhisfatherwithhiscurrentrelationshipwithhismaletherapist.Attheinitialstagesoftherapy,heaccusesthetherapist:“Youarebeingtootoughonme…whatdoyouexpectfromme?AreyougettingupsetthatIcontinuetousecocainedespiteourtreament?”

Exampleofcountertransference:Thetherapist,Dr.Jones,istheoldestof4sons,andhadbeentheprimarycaretakertakerofhisyoungerbrotherswhohavehadexhibiteddefianceandoppositionto“brotherly”guidance.Intherapy,hegetsupsetwithMr.Smithbecauseheis

notcompliantwithtreatmentrecommendations.Exampleofresistance:Mr.Smithbeginstomissorcomeslateappointmentsoncehiscocaineusebecomeslessfrequentandmoreundercontrol遷移實例：史密斯先生成長在一個嚴(yán)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(zé)治療師:“你過于嚴(yán)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(dǎo)。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(dāng)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。

Case1(cont’d)Mr.Smithisconsideringenteringcognitivebehavioralpsychotherapytouncoverhispastexperiencesinordermodifyhisrecurrentdruguse.。史密斯先生正在考慮進(jìn)入認(rèn)知行為療法來掀開他過去的經(jīng)歷以便于他反復(fù)修改用藥。

Whatarethemajorfociofthistypeoftherapy?主要焦點的這種治療的類型是什么?Mr.Smithisconsideringenteringcognitivebehavioralpsychotherapytouncoverhispastexperiencesinordermodifyhisrecurrentdruguse.Case1(cont’d)Whatarethemajorfociofcognitivebehavioraltherapyand/orsociallearningtherapy?什么是主要關(guān)鍵的認(rèn)知行為治療或社會學(xué)習(xí)療法? Identifycue-inducedcravingpatterns模式識別cue-induced渴望 Establishoperantconditioning(instrumentallearning)treatment建立操作條件反射(工具性學(xué)習(xí))治療 Modifyattributionoflocusofcontrol(fromcocainebacktoself)修改軌跡控制的歸因(從可卡因后面的對自我) Correctdistortedthinking/beliefsaboutself,others,world關(guān)于自己、他人、世界的正確或錯誤的認(rèn)識/信仰.。 Establishgrouptreatmentwithsponsors(NarcoticsAnonymous)inwhichbehaviorismodifiedbyobservationofarolemodel(e.g.,sponsor)andthroughenhancingself-efficacy對贊助者進(jìn)行團(tuán)體治療(麻醉治療匿名)在這個治療中行為被標(biāo)準(zhǔn)模式觀察監(jiān)測（贊助者)和通過強化自我效能感。Case1(cont’d)Inanoperantconditioning-basedtypetherapy,Mr.Smithengagesincontingency/tokentreatment,inwhichhereceivesatoken(tobeexchangedfortangiblegoods/rewards)foreachcleanurinesampleheprovidestothecliniconrandomchecks.在一個操作性conditioning-based類型治療中，史密斯從事應(yīng)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。

Thisisanexampleofwhattypeofreinforcement?這是一個典型的信息加強的類型? Whatwouldbetheoptimalreinforcementscheduletomaintainabstinencefromcocaineuse?什么是較佳強化程序去在可卡因利用中保持節(jié)制?

Case1(cont’d)Inanoperantconditioning-basedtypetherapy,Mr.Smithengagesincontingency/tokentreatment,在一個操作性conditioning-based類型治療，。史密斯從事應(yīng)變/象征性的的治療。 Thisisanexampleofwhattypeofreinforcement?這是一個典型的信息加強的類型? Positivereinforcement(tokens/reward)topromoteabstinence.

Whatwouldbetheoptimalreinforcementscheduletomaintainabstinencefromcocaineuse?什么是較佳強化程序去在可卡因利用中保持節(jié)制?Variabletokenamountandvariableintervalsofurinedrugscreens,whichwouldresultinslowerlearning,butslowerextinction尿液藥物變化的數(shù)量和變量區(qū)間變量將會引起學(xué)習(xí),但是執(zhí)行速度較慢消失。

Case2Mr.Bonineisa44-year-old,single,unemployed,manisbroughttotheemergencyroombythepoliceforstrikinganelderlywomaninhisapartmentbuilding.。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。Lastyearhesufferedatraumaticbraininjuryfollowinghead-onmotorvehiclecollisioninwhichhisheadhitthiswindshielduponcontact.去年他被迎面的的馬達(dá)車輛碰撞，他的頭擊中這個擋風(fēng)玻璃，得了創(chuàng)傷性腦損傷。

Whattypeofcognitiveandemotionalsymptomswouldyouexpect?你認(rèn)為將有什么認(rèn)知的的類型，情緒化的癥狀? Suchinjuriesaresimilartowhattypeofneuropsychiatricdisorders?這樣外傷類似于什么神經(jīng)精神系統(tǒng)的紊亂類型?Cognitive,Emotional,andBehavioralChangesfollowingFrontalLobeInjury認(rèn)知的，情緒化，行為的變動遵循額葉受傷Impulsiveness(actingbeforethinking)沖動性(做在想之前）Disinhibition(lackofself-control)去抑制(缺乏自我控制)Inappropriatesexualactivity不當(dāng)性行為Apathy/Poorinitiation(troublegettingstarted)冷漠/貧乏的動機(困難開始出現(xiàn))Frustrationandlossoftemper挫折和發(fā)脾氣Poorinsight(lackofself-awarenessofchanges)眼光差(缺乏自我意識的變化）Emotionalproblems:depression,anxiety,irritability,anger,moodswings情緒化問題:失望，焦慮，易怒，憤怒，情緒波動ChangesinFrontalLobeDisorders變動在額葉紊亂DorsolateralPrefrontalCortex–DysexecutiveSyndrome(unabletoplanorchangeplansflexibly,perseveration,unabletoshiftbehavior)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)OrbitofrontalCortex–DisinhibitedSyndrome(impulsive,labileaffect,poorjudgment)眶額皮層-disinhibited綜合癥(浮躁，不穩(wěn)定的影響，判斷力差)MedialFrontalCortex–ApatheticSyndrome(apathetic,behaviorallyinert,poorspontaneity)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)PersonalityChangesinFrontalLobeDisorders人格改變在額葉紊亂Headinjuries(TraumaticBrainInjury)頭部受傷(創(chuàng)傷性腦損傷)FrontotemporalDementia(Pick’sDisease,額顳癡呆(皮克癥）FrontotemporalLobarDegeneration)AnteriorStroke(CerebralVascularAccidentfromanteriorportionofmiddlecerebralarteries)前面的的行程(前中的一部分腦動脈腦血管意外)Case2(cont’d)44-year-oldmalewithtraumaticbraininjuryfollowinghead-onmotorvehiclecollision一個44歲男性被迎面的的馬達(dá)車輛碰撞而患創(chuàng)傷性腦損傷Whatneuropsychologicaltestscouldyouadministertoexaminehisexecutivefunction?什么神經(jīng)心理的測試可以有助于檢查他的執(zhí)行功能?Thefunctionofwhichareasofthebrainareprobedwiththesetests?哪一個腦的地區(qū)功能，被探測同這些測試有關(guān)?Case2(cont’d)44-year-oldmalewithtraumaticbraininjuryfollowinghead-onmotorvehiclecollision

Whatneuropsychologicaltestscouldyouadministertoexaminehisexecutivefunction?Thefunctionofwhichareasofthebrainareprobedwiththesetests? WisconsinCardSortTest,TrailMaking–PartB,N-Back TestsDorsolateralPrefrontalCortexintermsofcognitiveflexibility (goal-directedbehavior,planning),workingmemory StroopTask TestsAnteriorCingulateCortexintermsofselectiveattention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(rèn)知靈活性(目標(biāo)導(dǎo)向行為、規(guī)劃),工作記憶Stroop任務(wù)測試前扣帶皮質(zhì)選擇性注意力方面Go-NoGoTask TestsAnteriorCingulateandPrefrontalcortexforimpulsecontrol測試前扣帶，前額葉皮層控制脈沖 DecisionMaking(ondailytasksofjudgment;finances) TestsOrbitofrontal/VentromedialPrefrontalCortexfordecision making決策(每日的判決任務(wù)表;金融)測試orbitofrontal/腹前額葉皮層控制決策

Tounderstandthementalprocessinvolvedtrythisexperiment.Lookatthefollowinglettersonthescreen:tree.Ifyouarelikemostpeopleitisdifficultforyounottoquicklyreadtheword“tree.”

Mosthumansaresoproficientatreadingprintedwordsthattheycannoteasilyignorethem.Infactittakesconsiderableattentionalefforttoignorethem.ThistendencytoquicklyreadawordisusedintheStroopTask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，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(dāng)?shù)木θズ雎运鼈?。在Stroop任務(wù)中這種很快讀出單詞的趨勢被運用。TheStroopTaskisapsychologicaltestofourmental(attentional)vitalityandflexibility.Thetasktakesadvantageofourabilitytoreadwordsmorequicklyandautomaticallythanwecannamecolors.Ifawordisprintedordisplayedinacolordifferentfromthecoloritactuallynames;forexample,iftheword“green”iswritteninblueink(asshowninthefiguretotheleft)wewillsaytheword“green”morereadilythanwecannamethecolorinwhichitisdisplayed,whichinthiscaseis“blue.”

stroop任務(wù)一個我們的精神活力和靈活性的心理測試(attentional)。任務(wù)利用我們的能力去比在我們能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(lán)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(lán)色”。Thecognitivemechanisminvolvedinthistaskiscalleddirectedattention,youhavetomanageyourattention,inhibitorstoponeresponseinordertosayordosomethingelse.

Althoughthefunctionsoftheanteriorcingulateareverycomplex,broadlyspeakingitactsasaconduitbetweenlower,somewhatmoreimpulse-drivenbrainregionsandhigher,somewhatmorethought-drivenbehaviors.TheStroopeffect‘ssensitivitytochangesinbrainfunctionmayberelatedtoitsassociationwiththeanteriorcingulate參與這任務(wù)的認(rèn)知機制被叫做直接關(guān)注，你必須掌控你的注意力，為了了說或做其他事情而抑制或停止一種反應(yīng)。盡管功能的前扣帶高度的復(fù)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(dāng)一個通道，有些更多思想驅(qū)動行為。stroop效應(yīng)的敏感性在大腦功能變動可能同前扣帶協(xié)同有關(guān)。TheStroopTestprovidesinsightintocognitiveeffectsthatareexperiencedasaresultofattentionalfatigue.stroop測驗提供認(rèn)知的洞察影響，那個被認(rèn)為是attentional疲勞的結(jié)果。ForadiscussionofthecapacitytodirectattentionanditsfatigueseeKaplan,S.(1995).Therestorativebenefitsofnature:Towardanintegrativeframework.JournalofEnvironmentalPsychology,15,169-182

and

Kaplan,S.(2001).Meditation,restorationandthemanagementofmentalfatigue.EnvironmentandBehavior,33,Case2(cont’d)44-year-oldmalewithtraumaticbraininjuryfollowinghead-onmotorvehiclecollision.Theaccidentalsocauseashearinginjurytotheleftinferiorfrontalgyrusofthefrontallobe(BrodmannArea44,45).44歲男性被迎面的的馬達(dá)車輛碰撞至創(chuàng)傷性腦損傷。意外也導(dǎo)致左邊的額下回額葉剪力性損傷(布羅德曼區(qū)44，45)。

Howwouldhislanguagebedisturbed?如何干擾他的語言功能?

Case2(cont’d)44-year-oldmalewithtraumaticbraininjuryfollowinghead-onmotorvehiclecollision.Theaccidentalsocauseashearinginjurytotheleftinferiorfrontalgyrusofthefrontallobe(BrodmannArea44,45).

Howwouldhislanguagebedisturbed?

“Yes...ah...Monday...er...Meandhim...(hisownname),anddoctor....er...hospital...andah...Wednesday...Wednesday,nineo‘clock...andoh...Thursday...teno’clock,ahdoctors...two...an‘doctors...ander...talk...Yah”“是的。。。啊。。。星期一。。。鉺。。。我，他。。。(他的自己的名稱)，醫(yī)生。。。。鉺。。。醫(yī)院。。。啊。。。星期三。。。星期三，九點。。。哦。。。星期四。。。十點，啊醫(yī)生。。。二。。。一個'醫(yī)生。。。鉺。。。談話。。。嚴(yán)” Non-fluentlanguageproduction(inarticulation,poorsyntax)

語言不流利的生產(chǎn)(inarticulation，貧乏的句法)

AphasiaBroca’sAphasia:“halting,agrammaticspeech”布羅卡失語癥:“停止，agrammatic發(fā)言” -Typicalcasesinvolveleftfrontallobe–inferiorfrontalgyrus典型案例涉及左側(cè)額葉-額下回 -Patientscannotfluentlyexpresslanguage;Speechimpairmentranges

fromimpoverished/mutetostereotypicnonsensicalphrases-病人不能流利地表達(dá)語言;言語障礙范圍從破產(chǎn)/啞刻板行為到糊涂的短語 -BUTpatientshaveintactlanguagecomprehension-但是病人有完整的語言理解力 Nonfluentspeech:“Son…university…smart…boy…good…good.” Repetition:Sayno,ifs,andsorbuts…”no…no...but…but”不流利發(fā)言:“兒子…大學(xué)…聰明…男孩…好…好?！敝貜?fù):說沒有，如果，和或但…”沒有…沒有。。。但是…然而”Aphasia失語癥Wernicke’sAphasia:speechwithoutanyinformationalvalue,Wernicke1874 -Typicalcasesinvolveauditoryassociationareainthesuperiortemporallobeatthetempor-parietaljunctionontheleft-side韋尼克失語癥:發(fā)言無任何信息性，韋尼克1874-典型案例涉及在tempor-parietal交界左側(cè)上司顳葉的聽覺聯(lián)合區(qū) -Patientshavefluentlanguageoutputthatisseverelydisorganized,andattimes,incomprehensiblegarble病人有流利的語言產(chǎn)生，那嚴(yán)重破壞組織，有時出現(xiàn)費解的的混淆 -Patientscannotunderstandspokenorwrittenlanguage-病人不能明白發(fā)言或書面語言 -Unawareofimpairment,patientshavedifficultyrepeatingphrases-不明的損傷，病人重復(fù)短語有困難-Fluentnonsense:“Icalledmymotheronthetelevisionanddidnotunderstandthedoor.Itwastoobreakfast,buttheycamefromfartonear.Mymotherisnottoooldformetobeyoung.” -Repetition:Saychrysanthemum…”chrysa..mum…mum”流利的廢話:“我在電視上叫我的母親，不知道門。它太早，但他們來自遠(yuǎn)近。我的母親不是太老，我年輕。”

ConductionAphasia(tractA)傳導(dǎo)性失語(一種通路） -DisconnectionbetweenBrocaandWernickeareasthatleadstofluentparaphrasicexpressionwithphoneticsubstitutions(“fetter”for“better”);comprehensionisintactwhilerepetitionisimpaired.errors-在勃龍以及最近布羅卡之間斷開，那導(dǎo)致流利paraphrasic表達(dá)同表示語音的的障礙(“腳鐐”而“更好”);理解完整的時間重復(fù)被削弱。 -Problemswithproducingfluentspeech-生產(chǎn)流利發(fā)言的問題 -Canhearownspeech-能聽自己的的發(fā)言

MajorAphasiaSyndromes主要的失語癥綜合征Type Production Comp. Repetition NamingGlobal impaired impaired impaired impaired全球削弱削弱削弱削弱Broca’s

notfluent intact limited limited

不流利完整限制限制Wernicke’s fluent/ impaired impaired impairedimpairedAnomic fluent/ intact intact impaired circumlocutory

完整Mixed/ impaired limited limited limitedNonfluentConduction fluent/ intact impaired limited circumlocutory____________TaskAffectedBroca’s,Wernicke’sArea,andConnections勃龍以及最近布羅卡的，韋尼克氏區(qū)，連接AuditoryinputmediatedbyWernicke’sarea聽覺輸入調(diào)解由韋尼克氏區(qū)驅(qū)動MotoroutputmediatedbyBroca’sarea產(chǎn)出調(diào)解由布羅卡區(qū)驅(qū)動Regionsconnectedbyarcuatefasciculus區(qū)域聯(lián)系由弓狀束驅(qū)動LanguageTasksPetersonetal.,1988Dementias癡呆Memoryimpairmentplusoneormoreothercognitivedisturbance(s):記憶障礙加上一個或更多其他認(rèn)知的騷亂Aphasia(languagedisturbance)失語癥(語騷亂)Apraxia(impairedabilitytocarryoutmotoractivitiesdespiteintactmotorfunction失用癥(削弱執(zhí)行驅(qū)動的活動的能力盡管有完整運動功能）Agnosia(failuretorecognizeoridentifyobjectsdespiteintactsensoryfunction失認(rèn)癥(沒有做或鑒定物體的能力盡管有完整感覺功能）Disturbanceinexecutivefunctioning(i.e.planning,organizing,sequencing,abstracting)在執(zhí)行功能的干擾(i。e。準(zhǔn)備，組織，排列，提取)Case3Ms.Mitsudaisa52yowomanwhoworksatalocalrestaurantreportsepisodesofbehavioralchanges. -Typicallywell-manneredandeven-tempered,whosuddenlydevelopedfearsthatthefoodwaspoisoned;shewouldbecomeacutelyanxiouswouldthereforetrytoescapefromtherestaurantoftenscreamingthatshewasafraidofthecustomersandrestaurantstaff. -Shehadexplosivelaughterorfitsofcrying.Theseemotionswerealwaysoutofcontextandofteninappropriatetothepatient’sactivities.These“episodes”wouldlastfor30minutestohours,andbeaccompaniedbyconfusionanddisorientation.Followingtheepisodes,shereturnedtonormal.Hisbehaviorandpersonalityappearedtochangewithoutreasonorwarning.Eventually,shewasdiagnosedwithrecurrentepilepticseizures

Mitsuda是一個52歲工作的女性在當(dāng)?shù)氐牟宛^報告有發(fā)作性行為變化。-她是彬彬有禮,隨和的,他突然擔(dān)心食物是否被投了毒,她會十分焦慮會因此試圖逃離這個餐館，她害怕客戶與餐廳員工而通常尖叫。她會突然歡笑和苦悶的哭泣。這些情緒總是莫明奇妙的、不符合病人的活動。這些“集”將會持續(xù)30分鐘到數(shù)小時,并伴隨著混亂和不知所措。接著,她恢復(fù)了正常。他的行為與人格出現(xiàn)改變沒有原因和預(yù)告。最終,她被診斷患有復(fù)發(fā)性癲癇。

Whereinthebrainwouldyouexpectherepilepticfoci?你認(rèn)為在她的大腦哪兒是癲癇灶？ Whatpharmacologicapproachwouldtreatbothacuteseizuresandheightenedanxiety?什么方法可以治療急性發(fā)作和高度焦慮情緒?Case3Ms.Mitsudaisa52yowomanwhoworksatalocalrestaurantreportsepisodesofafraid.Mitsuda是一個52歲工作的女性在一個地方餐館工作,調(diào)查報告示她行為的插曲變動涉及急性的恐懼。

Whereinthebrainwouldyouexpectherepilepticfoci?你認(rèn)為在她的大腦哪兒是癲癇灶？ Medialtemporallobe(amygdalalikely) Whatpharmacologicapproachwouldtreatbothacuteseizures andheightenedanxiety?什么藥理將治療急性的發(fā)作和高度焦慮情緒？ BenzodiazepinetoenhanceGABAfunction-neuroinhibition苯二氮卓提高加巴功能-neuroinhibition

Case3Ms.Mitsuda’scoursewascomplicatedbyrefractoryseizureswhichwerenotrelievedbyconventionalanti-convulsants.Therefore,sheunderwentcompletebilateraltemporalloberesection,ofboththehippocampusandamygdala.Ms.Mitsuda’s的病情被耐火的發(fā)作——不是由常規(guī)anti-convulsants緩解。因此，她經(jīng)歷完成雙邊顳葉切除包括海馬和杏仁核。

Whatwouldbethecognitiveandemotionalchangesexpectedfromsuchasurgery？由那個手術(shù)將被期待有什么認(rèn)知的，情緒變化呢?

Ms.Mitsuda’sMRIPRE-OPPOST-OPCase3(cont’d)Ms.Mitsuda’scoursewascomplicatedbyrefractoryseizureswhichwerenotrelievedbyconventionalanti-convulsants.Therefore,sheunderwentcompletebilateraltemporalloberesection,ofboththehippocampusandamygdala.

Ms.Mitsuda’s的病情被耐火的發(fā)作——不是由常規(guī)anti-convulsants緩解。因此，她經(jīng)歷完成雙邊顳葉切除包括海馬和杏仁核。Whatwouldbethecognitiveandemotionalchangesexpectedfromsuchasurgery?那個手術(shù)將被期待有什么認(rèn)知的，情緒變化呢?ImpairedDeclarative(episodic)memory:anterogradeandsomeretrogradeamnesiafromtimeofsurgeryonwards(hippocampus)陳述(幕)記憶削弱:順行，從手術(shù)的時間起有一些逆行性遺忘(海馬) Intactproceduralmemory(striatum,prefrontalcortex)完整程序性記憶(紋狀體，前額葉皮層) Impairedemotionalmemory(amygdala)情緒記憶削弱(杏仁核) Impairedfearresponsesandfearperception(amygdala)削弱恐懼反應(yīng)和害怕的知覺(杏仁核)

Case4Ms.Johnsonisa21year-oldcollegestudentwhopresentstotheEmergencyDepartmentfollowingaseveredogbitesfromapitbullattack.Shewaswalkingtoclasswhensuddenlyapitbullchasedherdown,threwherontheground,andbegantobitehereverywhere.約翰遜女士是一個21歲大學(xué)生被一個比特犬攻擊有嚴(yán)重咬傷出現(xiàn)在急診科。她在步行時突然一個比特犬追逐她，把她按在地面上，開始到處咬她。

Whataretheexpectedphysiologicresponsestothisacutestress?在這急性的應(yīng)力下期待有什么生理響應(yīng)呢?Case4(cont’d)21year-oldcollegestudentwithseveredogbitesfromapitbullattack.

21歲大學(xué)生被一個比特犬攻擊Whataretheexpectedphysiologicresponsestothisacutestress?

在這急性的應(yīng)力下期待有什么生理響應(yīng)呢?Mobilizationofenergy能源的動員Focusedattentionandmemory集中注意力和記憶Enhancedcardiovascularoutputandrespiration提高心血管的產(chǎn)出和呼吸Antidiuresis抗利尿激素分泌Suppressionofirrelevantprocesses:immunefunction,reproduction,feedingIncreasedreleaseofstresshormones(norepinephrine,cortisol)Increasedamygdalaactivity不相關(guān)的抑制過程:免疫功能，復(fù)制，提高壓力，荷爾蒙的釋放(去甲腎上腺素，皮質(zhì)醇)提高杏仁核活動AcutecortisolreleaseinadrenalsfeedbacktoinhibitpituitaryreleaseofACTHandinhibithypothalamicreleaseofCRH.Cortisolalsobindstoglucocorticoidreceptorsinthehippocampus,theprimarysiteofHPAaxiscontrol(LHPAAxis).在腎上腺反饋中急性皮質(zhì)醇釋放抑制垂體促腎上腺皮質(zhì)激素的釋放，抑制下丘腦的華潤集團(tuán)的釋放。皮質(zhì)醇也約束在海馬處的糖皮質(zhì)激素受體，百帕的主站點軸控制(LHPA軸)。Case4(cont’d)21year-oldcollegestudentwithseveredogbitesfromapitbullattack.一個21歲大學(xué)生被一個比特犬攻擊有嚴(yán)重咬傷

Intheory,whatpharmacologicapproachmaybeusefulinpreventingaversiveconditioning/fearlearningfromthistraumaticevent?在理論上，從這個創(chuàng)傷的事件中可學(xué)到藥理治療在防止厭惡條件作用/恐懼方面有效?Beta-adrenergicblockadebeta-adrenergic封鎖Inordertointerferewithamygdalarstorageofemotionalmemories.為了干擾amygdalar情緒化的記憶存儲Case4(cont’d)21year-oldcollegestudentwithseveredogbitesfromapitbullattack.Weekslater,shecontinuestohaveanxiety,hyperarousal,nightmares,andavoidswalkingdownthestreetonwhichshesufferedthetrauma.Thesesymptomslastforseveralmonthsandimpairedherschoolworkbecausesheoftenwasafraidtoleaveherhouse.Becauseofthischange,shedevelopsdepressedmoodandanhedonia.21歲大學(xué)生被一個比特犬攻擊有嚴(yán)重的狗咬傷。幾周后，因創(chuàng)傷她仍然焦慮，反應(yīng)過激，惡夢，避免順街而行。這些癥狀持續(xù)幾個月，削弱她在校學(xué)習(xí)能力，因為她常常害怕離開她的房子。因為這種變動，她開始情緒低落，缺乏快感。Doesthisconstituteanclinicaldisorder?Whichones?這將構(gòu)成一個臨床紊亂嗎?哪一種?Whatwouldbeexpectedofherrestingcortisollevelsforthesedisorders?這些疾病中什么皮質(zhì)醇水平被期望?Ifshebeginstobefearfulofalldogsandsmallanimals,andstartlesatthesiteofthem,whatwouldthisprocessbebestcalled?如果她開始害怕狗和小動物,并在現(xiàn)場驚散,那么這個過程最好稱為什么?Whatbehavioraltherapyapproach