1、Human Behavior in Health and Illness 健康和疾病中的人类行为,Human Behavior in Health and Illness,精神分析认知行为学习神经认知应激反应神经生物学,行为,目 标,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,Todays Outline今日的概要,临床相关案例的讨论,Case 1案件1,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
2、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,Case 1,。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?,Case 1,According to current psychiatric nosology (classificatio
3、n of disease), what suggests that he may have a psychiatric disorder that warrants further evaluation?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His wife suspects that he may have been using cocaine, but he has denied it to her and family members who have inquired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He
4、 gets annoyed when asked about his drug use.当询问他的吸毒时他很生气When alone, Mr. Smith admits to using cocaine, “but not much at all”.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” and endorses an intense euphoria on it and feels an “incredible sense of power” 。史密斯说他
5、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” He says he thinks about cocaine much of the day and how he will be able to get time away to use it; he feels that this causes quite a bit of distress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He admits that his use of cocaine has made him miss work several
6、days this past month, and that his temper has gotten worse leading to verbal fights with his wife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。,Case 1 (contd)案件1,Upon further inquiry, Mr. Smith admits to using cocaine on a regular basis (4-5 times per week), 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
7、4 5次),- Besides euphoria, he has also had perceptual disturbances during acute cocaine intoxication(除了人兴奋,他曾在可卡因急性中毒时有感知失调）What symptoms would constitute psychosis? Why?精神病会有什么症状?为什么?What neurotransmitter is likely responsible for these perceptual disturbances? In which tract / pathway is this neuro
8、transmitter exerting its effects?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?,Case 1 (contd),What symptoms would constitute psychosis? Why?什么症状将构成精神病?为什么?- Auditory hallucinations (hearing voices inside his head when alone)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 delus
9、ions (thinking that his co-workers are spying on him despite no evidence to support such suspicions)absence of true input (hallucination) and fixed, inflexible false belief (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)What neurotransmitter is likely responsible for thes
10、e perceptual disturbances? In which tract / pathway is this neurotransmitter exerting its effects?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, amygdala and/or frontal cortex, respectively) -多巴胺- - - - - - Mesolimbic和/或meso
11、cortical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),Case 1 (contd),Upon further inquiry about job dysfunction at work and interpersonal conflicts at home and regular use over the past few years, Mr. Smith doesnt believe that he has a problem with his cocaine use, says he can quit at any time. He says that the
12、cocaine has “helped me concentrate” and that his performance is enhanced by cocaine he has read that using cocaine is like “drinking a lot of coffee”. Mr. Smith informs the doctor that his wife has been crying regularly, is depressed and distraught about his spiraling use, their deteriorating marria
13、ge, and her fear of potential violence when he is intoxicated. When hearing this, he appears indifferent, and emotionally non-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
14、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。What defense mechanisms are being exhibited by Mr. Smith? Are they considered mature defenses?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?,Case 1 (contd),What defense mechanisms are being exhibited by Mr. Smith? Are they considered mature defenses?什么防御机制被展现?他们是成熟防卫吗?De
15、nial Refusal to perceive the harsh aspects of reality Rationalization Construction of a logical explanation for a decision thatwas derived via another mental processIntellectualization / Isolation of Affect Distancing oneself from the negative emotions evoked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,
16、推导出了智能化/隔离自己的影响-使自己远离负面情绪All the above are not considered as mature.所有以上不考虑是成熟的Levels of defenses: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, acting out未成熟的:分裂，回归，离解，理想化，表演III. Neurotic: displacement, intellectualiz
17、ation/isolation of affect, rationalization, repression, undoing, reaction formation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,Case 1 (contd),How would you describe a Freudian structural model of Mr. Smiths behaviors?如何将你描述一个
18、弗洛伊德先生的结构模型。史密斯的行为?,Id: Cocaine use for pleasure serves as the selfish, primitive, childish, pleasure-oriented part of the personality with no ability to delay gratification Superego: At times feels and knows that his cocaine use is “bad”/”wrong” based on internalized societal and parental standards
19、 Ego: the moderator between the id and superego which seeks compromises to pacify bot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.,Defense mechanisms serve which of the above? Which of the above are believed to be primarily unconscious?防御机制,上述服务吗
20、?以上的被认为是主要的无意识?,Ego Id,Case 1 (contd),Upon further inquiry, Mr. Smith says that he had tried to quit cocaine use, but has continued to relapse. He finds himself craving (intensified wanting) when he drives into the parking structure at work because he often snorts cocaine there, or when he sits down
21、 at this desk because there is a vial of cocaine in his desk drawer, or when he runs into his office mate Joe (who often joins him in the parking structure to use cocaine)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
22、车厂使用可卡因)According to behavioral theory, his craving associated with the visual cues is known as what process?根据行为理论,他渴望与之关联的视觉线索称为什么过程?,Classical conditioning (associative learning):US:CS:UR:,Pairing US + CS leads to learning Subsequent CS (event with US) evokes anticipation and craving随后(与我们)CS事件唤起
23、期望和渴求.,cocaineparking structure, desk, Joeeuphoria from cocaine intoxication古柯碱中毒兴奋,Case 1 (contd),Mr. Smith is considering entering psychodynamic psychotherapy to uncover his past experiences in order to gain insight into his current behaviors (self-destructive drug use) and defense mechanisms in o
24、rder to eradicate his “false self” and accept his “true self.”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。”What are the major foci of this type of therapy?有什么主要的局灶性这种类型的治疗吗?,Case 1 (contd),What are the major foci of psychodynamic psychotherapy?有什么主要的局灶性精神动力疗法吗?Uncover and
25、learn about unconscious mechanisms(free association, 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）Work on transference and countertransference转变和反向移情的研究Example?Work on resistance / ambivalence to change阻碍和矛盾引起改变的研究Example?,Case 1 (contd),Example of transference: Mr. Smith grew up in a
26、n authoritarian household with strict rules and punishment imposed upon him by his father. In therapy, he relates his past relationship with his father with his current relationship with his male therapist. At the initial stages of therapy, he accuses the therapist: “You are being too tough on mewha
27、t do you expect from me? Are you getting upset that I continue to use cocaine despite our treament?” Example of countertransference: The therapist, Dr. Jones, is the oldest of 4 sons, and had been the primary caretaker taker of his younger brothers who have had exhibited defiance and opposition to “
28、brotherly” guidance. In therapy, he gets upset with Mr. Smith because he is not compliant with treatment recommendations. Example of resistance: Mr. Smith begins to miss or comes late appointments once his cocaine use becomes less frequent and more under control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
29、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。,Case 1 (contd),Mr. Smith is considering entering cognitive behavioral psychotherapy to
30、 uncover his past experiences in order modify his recurrent drug use. 。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。What are the major foci of this type of therapy?主要焦点的这种治疗的类型是什么?,Mr. Smith is considering entering cognitive behavioral psychotherapy to uncover his past experiences in order modify his recurr
31、ent drug use.,Case 1 (contd),What are the major foci of cognitive behavioral therapy and/or social learning therapy?什么是主要关键的认知行为治疗或社会学习疗法?Identify cue-induced craving patterns模式识别cue-induced渴望Establish operant conditioning (instrumental learning) treatment建立操作条件反射(工具性学习)治疗Modify attribution of locus
32、 of control (from cocaine back to self)修改轨迹控制的归因(从可卡因后面的对自我)Correct distorted thinking / beliefs about self, 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 is modified by observation of a role model (e.g., sponsor) and through enh
33、ancing 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。,Case 1 (contd),In an operant conditioning-based type therapy, Mr. Smith engages in contingency / token treatment, in which he receives a token (to be exchanged for tangible goods/rewards) for each clean urine sample he provides
34、to the clinic on random checks.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。This is an example of what type of reinforcement? 这是一个典型的信息加强的类型?What would be the optimal reinforcement schedule to maintain abstinence from cocaine use?什么是较佳强化程序去在可卡因利用中保持节制?,Case 1
35、(contd),In an operant conditioning-based type therapy, Mr. Smith engages in contingency / token treatment,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。This is an example of what type of reinforcement? 这是一个典型的信息加强的类型?Positive reinforcement (tokens/reward) to promote abstinence.What would be the opti
36、mal reinforcement schedule to maintain abstinence from cocaine use?什么是较佳强化程序去在可卡因利用中保持节制?Variable token amount and variable intervals of urine drug screens,which would result in slower learning, but slower extinction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。,Case 2,Mr. Bonine is a 44-year-old, single, unemp
37、loyed, man is brought to the emergency room by the police for striking an elderly woman in his apartment building. 。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。Last year he suffered a traumatic brain injury following head-on motor vehicle collision in which his head hit this windshield upon contact
38、.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。What type of cognitive and emotional symptoms would you expect?你认为将有什么认知的的类型，情绪化的症状?Such injuries are similar to what type of neuropsychiatric disorders?这样外伤类似于什么神经精神系统的紊乱类型?,Cognitive, Emotional, and Behavioral Changes following Frontal Lobe Injury认知的，情绪化，行为的变动遵
39、循额叶受伤,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）Emo
40、tional problems: depression, anxiety, irritability, anger, mood swings情绪化问题:失望，焦虑，易怒，愤怒，情绪波动,Changes in Frontal Lobe Disorders变动在额叶紊乱,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
41、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),Personality Changes in Frontal Lobe
42、Disorders人格改变在额叶紊乱,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),Case 2 (contd),44-year-old male
43、with traumatic brain injury following head-on motor vehicle collision 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 executive function?什么神经心理的测试可以有助于检查他的执行功能?The function of which areas of the brain are probed with these tests ?哪一个脑的地区功能，被探测同这些测试有关?,Case
44、 2 (contd),44-year-old male with traumatic brain injury following head-on motor vehicle collision What neuropsychological tests could you administer to examine his executive function? The function of which areas of the brain are probed with these tests ?Wisconsin Card Sort Test, Trail Making Part B,
45、 N-BackTests Dorsolateral Prefrontal Cortex in terms of cognitive flexibility (goal-directed behavior, planning), working memoryStroop TaskTests Anterior Cingulate Cortex in terms of selective attention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-No Go TaskTes
46、ts Anterior Cingulate and Prefrontal cortex for impulse control测试前扣带，前额叶皮层控制脉冲Decision Making (on daily tasks of judgment; finances)Tests Orbitofrontal / Ventromedial Prefrontal Cortex for decision making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,To understand the mental process involved try this ex
47、periment. Look at the following letters on the screen: tree. If you are like most people it is difficult for you not to quickly read the word “tree.” Most humans are so proficient at reading printed words that they cannot easily ignore them. In fact it takes considerable attentional effort to ignore
48、 them. This tendency to quickly read a word is used in the Stroop Task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。The Stroop Task is a psychological test of our mental (attentional) vitality and flexibility. The ta
49、sk takes advantage of our ability to read words more quickly and automatically than we can name colors. If a word is printed or displayed in a color different from the color it actually names; for example, if the word “green” is written in blue ink (as shown in the figure to the left) we will say th
50、e word “green” more readily than we can name the color in which it is displayed, which in this case is “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”。The cognitive mechanism inv
51、olved in this task is called directed attention, you have to manage your attention, inhibit or stop one response in order to say or do something else. Although the functions of the anterior cingulate are very complex, broadly speaking it acts as a conduit between lower, somewhat more impulse-driven
52、brain regions and higher, somewhat more thought-driven behaviors. The Stroop effects sensitivity to changes in brain function may be related to its association with the anterior 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
53、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。The Stroop Test provides insight into cognitive effects that are experienced as a result of attentional fatigue. stroop测验提供认知的洞察影响，那个被认为是attentional疲劳的结果。For a discussion of the capacity to direct attention and its fatigue see Kaplan, S. (1995). The restorative benefits of nature: Toward an integrative framework. Journal of Environmental Psychology, 15, 169-182 and Kaplan, S. (2001). Meditation, restoration and the management of mental fatigue. Environment and Behavior, 33,
