疾病和健康中的人类行为.ppt

现在学习的是第1页，共46页精神分析精神分析认知行为学习认知行为学习神经认知神经认知应激反应应激反应神经生物学神经生物学行为行为现在学习的是第2页，共46页学习理解人的正常与异常行为有关的生物、行为、认知、心理学的原理、过程理解行为、认知、思维、心境的异常如何可能源于这些过程的变异，引发精神疾病理解这些过程如何有可能被用于治疗异常的情绪状态，减少心理疾病的负担现在学习的是第3页，共46页临床相关案例的讨论现在学习的是第4页，共46页史先生，45岁，餐厅老板，妻子怀疑其有药物滥用问题，由妻子陪同作常规医学检查妻子疑其使用可卡因，但他否认当家人问其药物使用问题时，他发怒医生单独和他谈话，他承认使用可卡因，但不多他说用可卡因是为了逃避，获得快感，用药后有强烈的愉快感，感到不可思议的力量感他说他一天里常想可卡因，想怎样抽空出去用它，感到有些苦恼他承认过去一个月由于使用可卡因，他有几天耽误了工作，脾气变坏，还与妻子发生口角现在学习的是第5页，共46页。史密斯一个45岁餐馆老板，访问他的医生为他做了一个例行体检，伴随着他的妻子怀疑他有一个“毒品问题”，认为他可能有那种授权进一步评价的精神障碍?现在学习的是第6页，共46页Accordingtocurrentpsychiatricnosology(classificationofdisease),whatsuggeststhathemayhaveapsychiatricdisorderthatwarrantsfurtherevaluation?据据当前精神病学的疾病分类学(疾病的分类)，认为他可能有那种授权进一步评价的精神障碍Hiswifesuspectsthathemayhavebeenusingcocaine,buthehasdeniedittoherandfamilymemberswhohaveinquired他的妻子怀疑他可能已经使用可卡因，但他在妻子和调查的家庭成员面前否认了Hegetsannoyedwhenaskedabouthisdruguse.当询问他的吸毒时他很生气Whenalone,Mr.Smithadmitstousingcocaine,“butnotmuchatall”.当医生单独和他谈话时史密斯承认使用可卡因，“但不多”。Mr.Smith says he uses cocaine“for escape”and to“get high”andendorsesanintenseeuphoriaonitandfeelsan“incrediblesenseofpower”。史密斯说他用可卡因“为了逃避”，“获得快感”，感觉它有一有激烈欣快感，感觉一个“难以置信力量感”Hesayshethinksaboutcocainemuchofthedayandhowhewillbeabletogettimeawaytouseit;hefeelsthatthiscausesquiteabitofdistress他说他一天中很多时候惦记着可卡因及如何能够得到时间去使用它;他觉得这引起相当大的痛苦Headmitsthathisuseofcocainehasmadehimmissworkseveraldaysthispastmonth,andthathistemperhasgottenworseleadingtoverbalfightswithhiswife他承认自己用过可卡因使他耽误了几天工作，这过去一个月,他的脾气变得更糟,而导致了打他的妻子并和妻子发生了口角。现在学习的是第7页，共46页Uponfurtherinquiry,Mr.Smithadmitstousingcocaineonaregularbasis(4-5timesperweek),and经过进一步的调查,史密斯先生决定定期有规律使用可卡因(每周45次),-Besides euphoria,he has also had perceptual disturbances during acute cocaineintoxication(除了人兴奋,他曾在可卡因急性中毒时有感知失调）Whatsymptomswouldconstitutepsychosis?Why?精神病会有什么症状?为什么?Whatneurotransmitterislikelyresponsiblefortheseperceptualdisturbances?Inwhichtract/pathwayisthisneurotransmitterexertingitseffects?是什么神经递质可能导致感知失调?在这神经递质域/途径发挥什么作用?现在学习的是第8页，共46页Whatsymptomswouldconstitutepsychosis?Why?什么症状将构成精神病?为什么?-Auditoryhallucinations(hearingvoicesinsidehisheadwhenalone)幻听(当独自一人时在他脑子里听到声音）-Impaired reality testing sensory perception in the Paranoid delusions(thinkingthathisco-workersarespyingonhimdespitenoevidencetosupportsuchsuspicions)absenceoftrueinput(hallucination)andfixed,inflexiblefalsebelief(delusion)现实感知受损测试-偏执妄想(认为他的同事们监视他,尽管没有证据能支持这种怀疑)缺乏真正的输入(幻觉)和固定,呆板的错误信念(幻觉)Whatneurotransmitterislikelyresponsiblefortheseperceptualdisturbances?Inwhichtract/pathwayisthisneurotransmitterexertingitseffects?什么神经递质可能负责这些知觉的的骚乱?，什么管道/通路是这个神经递质施加它的影响?-Dopamine-Mesolimbic and/or mesocortical tract(VTA to limbic ventral striatum,amygdalaand/orfrontalcortex,respectively)-多巴胺-Mesolimbic和/或mesocortical区域,到边缘VTA神经元,杏仁核前部纹状体和/或额叶皮质,分别)现在学习的是第9页，共46页Uponfurtherinquiryaboutjobdysfunctionatworkandinterpersonalconflictsathomeandregularuseoverthepastfewyears,Mr.Smithdoesntbelievethathehasaproblemwithhiscocaineuse,sayshecanquitatanytime.He says that the cocaine has“helped me concentrate”and that hisperformanceisenhancedbycocainehehasreadthatusingcocaineislike“drinkingalotofcoffee”.Mr.Smithinformsthedoctorthathiswifehasbeencryingregularly,isdepressedanddistraughtabouthisspiralinguse,theirdeterioratingmarriage,andherfearofpotentialviolencewhenheisintoxicated.When hearing this,he appears indifferent,and emotionallynon-expressive.经过进一步的对就业障碍和家庭人际冲突调查工作和经常使用。过去几年来史密斯先生不相信他有问题，问他吸上了可卡因,说他能在任何时候辞职。他表示,“可卡因帮助我集中精力”,他的表现就有所提高了是由于使用了可卡因他已经读了使用可卡因就像“喝很多咖啡。”史密斯先生告诉医生当他使用可卡因事他的妻子哭了,感到沮丧和悲痛欲绝,他们的婚姻不断恶化,当他陶醉使用可卡因时,她担心潜在的暴力。当听到这个消息,他显得冷漠,而且情绪没有改变。WhatdefensemechanismsarebeingexhibitedbyMr.Smith?Aretheyconsideredmaturedefenses?史密斯先生表现出的什么防御机制?他们被认为是成熟的防御吗?现在学习的是第10页，共46页WhatdefensemechanismsarebeingexhibitedbyMr.Smith?Aretheyconsideredmaturedefenses?什么防御机制被展现?他们是成熟防卫吗?DenialRefusaltoperceivetheharshaspectsofrealityRationalizationConstructionofalogicalexplanationforadecisionthatwasderivedviaanothermentalprocessIntellectualization/IsolationofAffectDistancingoneselffromthenegativeemotionsevoked对严酷的现实观点否定拒绝建设的合理化-逻辑性的解释是一个决定,通过另一个心理过程,推导出了智能化/隔离自己的影响-使自己远离负面情绪Alltheabovearenotconsideredasmature.所有以上不考虑是成熟的Levelsofdefenses:防御的水平:I.Psychotic:denial,fantasy,hallucinations精神病的:拒绝，幻想，幻觉II.Immature:splitting,regression,dissociation,idealization,actingout未成熟的:分裂，回归，离解，理想化，表演III.Neurotic:displacement,intellectualization/isolationofaffect,rationalization,repression,undoing,reactionformation神经质的:移位，理智化/隔离的影响，合理化，压迫，复原，反向形成IV.Mature:humor,suppression,anticipation,sublimation,altruism成熟:幽默，抑制，预期，升华，利他主义现在学习的是第11页，共46页HowwouldyoudescribeaFreudianstructuralmodelofMr.Smithsbehaviors?如何将你描述一个弗洛伊德先生的结构模型。史密斯的行为?Id:Cocaineuseforpleasureservesastheselfish,primitive,childish,pleasure-orientedpartofthepersonalitywithnoabilitytodelaygratification Superego:Attimesfeelsandknowsthathiscocaineuseis“bad”/”wrong”basedoninternalizedsocietalandparentalstandardsEgo:themoderatorbetweentheidandsuperegowhichseekscompromisestopacifybot可卡因用为了取乐作为自私，原始，幼稚，pleasure-oriented部分个性同没有的能力延迟满足超我:有时感觉，知道那个他的可卡因用“坏”/”错”以内化为依据社会的，父母的标准自我:中古英语h.Defensemechanismsservewhichoftheabove?Whichoftheabovearebelievedtobeprimarilyunconscious?防御机制,上述服务吗?以上的被认为是主要的无意识?EgoId现在学习的是第12页，共46页Uponfurtherinquiry,Mr.Smithsaysthathehadtriedtoquitcocaineuse,buthascontinuedtorelapse.Hefindshimselfcraving(intensifiedwanting)whenhedrivesintotheparkingstructureatworkbecauseheoftensnortscocainethere,orwhenhesitsdownatthisdeskbecausethereisavialofcocaineinhisdeskdrawer,orwhenherunsintohisofficemateJoe(whooftenjoinshimintheparkingstructuretousecocaine)经过进一步的调查,史密斯先生说他曾试图放弃古柯碱的使用,但不断的复发。他发现自己渴望(增强)：当他开车到工作点的停车厂时,因为他经常在那里吸食可卡因;当他坐在这张桌子时,因为那里有一只碗的可卡因在他的书桌的抽屉里,或者当他到他的办公室伙伴乔那时(经常和他在停车厂使用可卡因)Accordingtobehavioraltheory,hiscravingassociatedwiththevisualcuesisknownaswhatprocess?根据行为理论,他渴望与之关联的视觉线索称为什么过程?Classicalconditioning(associativelearning):US:CS:UR:PairingUS+CSleadstolearningSubsequentCS(eventwithUS)evokesanticipationandcraving随后(与我们)CS事件唤起期望和渴求.cocaineparkingstructure,desk,Joeeuphoriafromcocaineintoxication古柯碱中毒兴奋现在学习的是第13页，共46页Mr.Smith is considering entering psychodynamic psychotherapy to uncover his pastexperiencesinordertogaininsightintohiscurrentbehaviors(self-destructivedruguse)anddefensemechanismsinordertoeradicatehis“falseself”andaccepthis“trueself.”史密斯先生正在考虑进入精神动力疗法来掀开他过去的经历,以洞察他目前的行为(自我毁灭的用药)和防御机制以消除他的“假我”与接受他的“真实的自我。”Whatarethemajorfociofthistypeoftherapy?有什么主要的局灶性这种类型的治疗吗?现在学习的是第14页，共46页Whatarethemajorfociofpsychodynamicpsychotherapy?有什么主要的局灶性精神动力疗法吗?Uncoverandlearnaboutunconsciousmechanisms(freeassociation,behavior,relationship,mistakes)揭示和了解无意识机制(自由联想、行为、人际关系、错误）Workontransferenceandcountertransference转变和反向移情的研究Example?Workonresistance/ambivalencetochange阻碍和矛盾引起改变的研究Example?现在学习的是第15页，共46页Exampleoftransference:Mr.Smithgrewupinanauthoritarianhouseholdwithstrictrulesandpunishmentimposeduponhimbyhisfather.Intherapy,herelateshispastrelationshipwithhisfatherwithhiscurrentrelationshipwithhismaletherapist.Attheinitialstagesoftherapy,heaccusesthetherapist:“Youarebeingtootoughonmewhatdoyouexpectfromme?AreyougettingupsetthatIcontinuetousecocainedespiteourtreament?”Exampleofcountertransference:Thetherapist,Dr.Jones,istheoldestof4sons,andhadbeentheprimarycaretakertakerofhisyoungerbrotherswhohavehadexhibiteddefianceandoppositionto“brotherly”guidance.Intherapy,hegetsupsetwithMr.Smithbecauseheisnotcompliantwithtreatmentrecommendations.Exampleofresistance:Mr.Smithbeginstomissorcomeslateappointmentsoncehiscocaineusebecomeslessfrequentandmoreundercontrol迁移实例：史密斯先生成长在一个严格的规章制度和父亲独裁的家庭中。在治疗中,他把过去与他的父亲的关系转移到他与治疗师的关系。在初始阶段的治疗,他指责治疗师:“你过于严厉了你期望从我这里得到什么?尽管我们在治疗中我将继续使用可卡因，这样你会很心烦吗?”反向移情实例：治疗师,琼斯博士是4个儿子中最大的,已经主要看守他的弟弟调查员有展出,反对“兄弟蔑视”指导。在治疗中,他就会心烦意乱,因为他不赞成史密斯先生治疗建议。抵抗实例:当他吸可卡因变得更少更规律且更在控制之下时，史密斯先生开始想念、抵制、迟来。现在学习的是第16页，共46页Mr.Smithisconsideringenteringcognitivebehavioralpsychotherapytouncoverhispastexperiencesinordermodifyhisrecurrentdruguse.。史密斯先生正在考虑进入认知行为疗法来掀开他过去的经历以便于他反复修改用药。Whatarethemajorfociofthistypeoftherapy?主要焦点的这种治疗的类型是什么?Mr.Smithisconsideringenteringcognitivebehavioralpsychotherapytouncoverhispastexperiencesinordermodifyhisrecurrentdruguse.现在学习的是第17页，共46页Whatarethemajorfociofcognitivebehavioraltherapyand/orsociallearningtherapy?什么是主要关键的认知行为治疗或社会学习疗法?Identifycue-inducedcravingpatterns模式识别cue-induced渴望Establishoperantconditioning(instrumentallearning)treatment建立操作条件反射(工具性学习)治疗Modifyattributionoflocusofcontrol(fromcocainebacktoself)修改轨迹控制的归因(从可卡因后面的对自我)Correctdistortedthinking/beliefsaboutself,others,world关于自己、他人、世界的正确或错误的认识/信仰.。Establish group treatment with sponsors(Narcotics Anonymous)in which behavior ismodified by observation of a role model(e.g.,sponsor)and through enhancing self-efficacy对赞助者进行团体治疗(麻醉治疗匿名)在这个治疗中行为被标准模式观察监测（赞助者)和通过强化自我效能感。现在学习的是第18页，共46页Inanoperantconditioning-basedtypetherapy,Mr.Smithengagesincontingency/tokentreatment,in which he receives a token(to be exchanged for tangiblegoods/rewards)foreachcleanurinesampleheprovidestothecliniconrandomchecks.在一个操作性conditioning-based类型治疗中，史密斯从事应变/象征性的的治疗，他收到一个象征暗示(被交换有形货物/报酬)为每个清洁尿样他提供随机的诊所支票。Thisisanexampleofwhattypeofreinforcement?这是一个典型的信息加强的类型?Whatwouldbetheoptimalreinforcementscheduletomaintainabstinencefromcocaineuse?什么是较佳强化程序去在可卡因利用中保持节制?现在学习的是第19页，共46页In an operant conditioning-based type therapy,Mr.Smith engages in contingency/tokentreatment,在一个操作性conditioning-based类型治疗，。史密斯从事应变/象征性的的治疗。Thisisanexampleofwhattypeofreinforcement?这是一个典型的信息加强的类型?Positivereinforcement(tokens/reward)topromoteabstinence.Whatwouldbetheoptimalreinforcementscheduletomaintainabstinencefromcocaineuse?什么是较佳强化程序去在可卡因利用中保持节制?Variabletokenamountandvariableintervalsofurinedrugscreens,whichwouldresultinslowerlearning,butslowerextinction尿液药物变化的数量和变量区间变量将会引起学习,但是执行速度较慢消失。现在学习的是第20页，共46页Mr.Bonineisa44-year-old,single,unemployed,manisbroughttotheemergencyroombythepoliceforstrikinganelderlywomaninhisapartmentbuilding.。博尼恩一个44岁，单身，失业的男性，因为在他的公寓大楼打一个老年女子被警察送到苏醒急诊室。Lastyearhesufferedatraumaticbraininjuryfollowinghead-onmotorvehiclecollisioninwhichhisheadhitthiswindshielduponcontact.去年他被迎面的的马达车辆碰撞，他的头击中这个挡风玻璃，得了创伤性脑损伤。Whattypeofcognitiveandemotionalsymptomswouldyouexpect?你认为将有什么认知的的类型，情绪化的症状?Suchinjuriesaresimilartowhattypeofneuropsychiatricdisorders?这样外伤类似于什么神经精神系统的紊乱类型?现在学习的是第21页，共46页Impulsiveness(acting before thinking)冲动性(做在想之前）Disinhibition(lack of self-control)去抑制(缺乏自我控制)Inappropriate sexual activity不当性行为Apathy/Poor initiation(trouble getting started)冷漠/贫乏的动机(困难开始出现)Frustration and loss of temper挫折和发脾气Poor insight(lack of self-awareness of changes)眼光差(缺乏自我意识的变化）Emotional problems:depression,anxiety,irritability,anger,mood swings情绪化问题:失望，焦虑，易怒，愤怒，情绪波动现在学习的是第22页，共46页Dorsolateral Prefrontal Cortex Dysexecutive Syndrome(unable to plan or change plans flexibly,perseveration,unable to shift behavior)背侧前额叶皮层-dysexecutive综合症(无法对计划或灵活变动计划，持续言语，无法对转换行为)Orbitofrontal Cortex Disinhibited Syndrome(impulsive,labile affect,poor judgment)眶额皮层-disinhibited综合症(浮躁，不稳定的影响，判断力差)Medial Frontal Cortex Apathetic Syndrome(apathetic,behaviorally inert,poor spontaneity)中间的额叶皮质-麻木不仁综合症(麻木不仁，惰性的行为活动，自发性差)现在学习的是第23页，共46页Head injuries(Traumatic Brain Injury)头部受伤(创伤性脑损伤)Frontotemporal Dementia(Picks Disease,额颞痴呆(皮克症）Frontotemporal Lobar Degeneration)Anterior Stroke(Cerebral Vascular Accident from anterior portion of middle cerebral arteries)前面的的行程(前中的一部分脑动脉脑血管意外)现在学习的是第24页，共46页44-year-oldmalewithtraumaticbraininjuryfollowinghead-onmotorvehiclecollision一个44岁男性被迎面的的马达车辆碰撞而患创伤性脑损伤What neuropsychological tests could you administer to examine his executivefunction?什么神经心理的测试可以有助于检查他的执行功能?Thefunctionofwhichareasofthebrainareprobedwiththesetests?哪一个脑的地区功能，被探测同这些测试有关?现在学习的是第25页，共46页44-year-old male with traumatic brain injury following head-on motor vehiclecollisionWhatneuropsychologicaltestscouldyouadministertoexaminehisexecutivefunction?Thefunctionofwhichareasofthebrainareprobedwiththesetests?WisconsinCardSortTest,TrailMakingPartB,N-BackTestsDorsolateralPrefrontalCortexintermsofcognitiveflexibility(goal-directedbehavior,planning),workingmemoryStroopTaskTestsAnteriorCingulateCortexintermsofselectiveattention威斯康辛卡片分类测试,连线N-Back-B部分背外侧前额叶皮层测试方面的认知灵活性(目标导向行为、规划),工作记忆Stroop任务测试前扣带皮质选择性注意力方面Go-NoGoTaskTestsAnteriorCingulateandPrefrontalcortexforimpulsecontrol测试前扣带，前额叶皮层控制脉冲DecisionMaking(ondailytasksofjudgment;finances)Tests Orbitofrontal/Ventromedial Prefrontal Cortex for decisionmaking决策(每日的判决任务表;金融)测试orbitofrontal/腹前额叶皮层控制决策现在学习的是第26页，共46页Tounderstandthementalprocessinvolvedtrythisexperiment.Lookatthefollowinglettersonthescreen:tree.Ifyouarelikemostpeopleitisdifficultforyounottoquicklyreadtheword“tree.”Mosthumansaresoproficientatreadingprintedwordsthattheycannoteasilyignorethem.Infactittakesconsiderableattentionalefforttoignorethem.ThistendencytoquicklyreadawordisusedintheStroopTask理解心理过程涉及尝试这个试验。观看下面屏幕上的词:树。如果你像大多数人一样那对于你来说，很快读出“树”不是很困难的。“大多数人在阅读打印方面如此熟练，所以他们不易忽视他们。实际上，要花费相当的精力去忽略它们。在Stroop任务中这种很快读出单词的趋势被运用。TheStroopTaskisapsychologicaltestofourmental(attentional)vitalityandflexibility.Thetasktakesadvantageofourabilitytoreadwordsmorequicklyandautomaticallythanwecannamecolors.Ifawordisprintedordisplayedinacolordifferentfromthecoloritactuallynames;forexample,iftheword“green”iswritteninblueink(asshowninthefiguretotheleft)wewillsaytheword“green”morereadilythanwecannamethecolorinwhichitisdisplayed,whichinthiscaseis“blue.”stroop任务一个我们的精神活力和灵活性的心理测试(attentional)。任务利用我们的能力去比在我们能命名的颜色下更快自动读出单词活力和灵活性。如果一个字在一个颜色异于它其实名称的颜色下被打印或显示;如果字“绿色”被写在蓝墨水(如左边图所示)我们会读出“绿色”比在我们更容易能命名的填色显示下在这种情况下是“蓝色”。Thecognitivemechanisminvolvedinthistaskiscalleddirectedattention,youhavetomanageyourattention,inhibitorstoponeresponseinordertosayordosomethingelse.Althoughthefunctionsoftheanterior cingulateareverycomplex,broadlyspeakingitactsasaconduitbetweenlower,somewhatmoreimpulse-drivenbrainregionsandhigher,somewhatmorethought-drivenbehaviors.TheStroopeffectssensitivitytochangesinbrainfunctionmayberelatedtoitsassociationwiththeanterior cingulate参与这任务的认知机制被叫做直接关注，你必须掌控你的注意力，为了了说或做其他事情而抑制或停止一种反应。尽管功能的前扣带高度的复杂，广义地说它在降低之间，或更多impulse-driven脑地区，或更高部位充当一个通道，有些更多思想驱动行为。stroop效应的敏感性在大脑功能变动可能同前扣带协同有关。TheStroopTestprovidesinsightintocognitiveeffectsthatareexperiencedasaresultofattentionalfatigue.stroop测验提供认知的洞察影响，那个被认为是attentional疲劳的结果。ForadiscussionofthecapacitytodirectattentionanditsfatigueseeKaplan,S.(1995).Therestorativebenefitsofnature:Towardanintegrativeframework.Journal of Environmental Psychology,15,169-182andKaplan,S.(2001).Meditation,restorationandthemanagementofmentalfatigue.Environment and Behavior,33,现在学习的是第27页，共46页44-year-old male withtraumaticbrain injury following head-on motorvehicle collision.Theaccidentalsocauseashearinginjurytotheleftinferiorfrontalgyrusofthefrontallobe(BrodmannArea44,45).44岁男性被迎面的的马达车辆碰撞至创伤性脑损伤。意外也导致左边的额下回额叶剪力性损伤(布罗德曼区44，45)。Howwouldhislanguagebedisturbed?如何干扰他的语言功能?现在学习的是第28页，共46页44-year-old male with traumatic brain injury following head-on motor vehicle collision.Theaccidentalsocauseashearinginjurytotheleftinferiorfrontalgyrusofthefrontallobe(BrodmannArea44,45).Howwouldhislanguagebedisturbed?“Yes.ah.Monday.er.Meandhim.(hisownname),anddoctor.er.hospital.andah.Wednesday.Wednesday,nineoclock.an