強迫癥學術論文(3)
強迫癥學術論文
可見，OCD的腦功能障礙明顯涉及額葉皮層-皮層下的多個神經網絡的信息加工，任何一個加工階段出現的故障都可能導致OCD相關癥狀的出現。OFC和ACC是前額皮層的重要網絡作用節(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鍵網絡作用節(jié)點，它在獎賞驅動行為的情緒性和動機性加工中發(fā)揮重要作用，因而可以選擇和產生新的活動模式，以便對環(huán)境中有意義的信息作出反應。反復的強迫性行為也許就是來自對這些加工的過多的表達，以兌現獎賞來緩解內部緊張。另外，來自腦干的多巴胺和5-羥色胺能神經遞質都作用于以上主要的網絡節(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節(jié)OCD強迫癥狀的產生。
顯然，來自神經解剖、神經生理、神經心理和神經功能成像的研究資料在一定程度上支持了OCD癥狀的現象學解釋，但有關OCD癥狀與腦功能障礙之間的聯系仍有一定的推測性，其中有些重要問題尚未解決。首先，由神經功能成像技術觀察到的OCD病人前額葉腦區(qū)和皮層下相關結構的功能改變是強迫癥狀的原因還是結果，還需進一步確認;其次，既然這些功能改變所涉及的幾個關鍵腦區(qū)，如OFC、ACC和DLPC在人類的動機、情緒、高級認知和目的行為的調節(jié)中起著關鍵作用，那么，為什么多數OCD病人除了表現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病人在多數執(zhí)行功能相關的任務的加工中并沒有缺陷;再次，OCD是由這些神經網絡回路內特定腦區(qū)之間特殊神經聯系的機能障礙所致，還是由多巴胺系統與5-羥色胺系統之間不平衡造成的;最后，導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)域的某些結構缺陷，還是受精神因素影響所出現的病理性突觸改變。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。
參考文獻
[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. 心理科學進展, 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
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