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1、Chapter 2Current Paradigms in PsychopathologyThe Genetic Paradigm The genetic paradigm:Almost all behavior is heritable to some degreeGenes do not operate in isolation from the environment. 所有行為都部份受到遺傳影響而且某種程度都具有遺傳性；基因無法獨立於環境的影響而運作Psychopathology will be polygenic: several genes operating at differe
2、nt times during the course of development will be the essence of genetic vulnerability.The Genetic ParadigmHeritability: The extent to which variability in a particular behavior (or disorder) in a population can be accounted for by genetic factors.遺傳性：在一群人口中能以遺傳因子解釋特殊行為的變異性（整體性統計.00-1.0數字愈高遺傳性愈高；變異性
3、測量而不是判定一人口群中有某一行為的測量；eg：ADHD.70）Environmental factorsShared environment共有環境（家庭收入教養孩子的方式）Nonshared environment非共有環境（家庭成員間不同的環境因子，某個人和朋友關係；某個人的特殊生活事件）Behavior GeneticsBehavior genetics is the study of how individual differences in genetic makeup contribute to differences in behavior行為遺傳學行為遺傳學：主要是研究基因組
4、成不同，造成每一個人某些行為的不同主要是研究基因組成不同，造成每一個人某些行為的不同（不是研究基因如何決定行為，而是研究基因之間到底有什麼不同？）Genotype is the total genetic makeup, composed of genes 基因型基因型：一個人的所有基因組成一個人的所有基因組成，包括遺傳的基因，這包括遺傳的基因，這是無法觀察的基因組態是無法觀察的基因組態Phenotype is the observable behavioral profile 表表現型現型：一個人可以觀察得到的行為特質一個人可以觀察得到的行為特質，例如焦慮的程度例如焦慮的程度The phen
5、otype can change over time as a function of the interaction of genes and environment表現型會隨著時間改變，而且常常被當作基因型和環境互動而來的產物。Molecular Genetics分子遺傳學To find out what exactly is heritable by identifying particular genes and their functions.研究主要希望能夠找出遺傳而來遺傳而來的特定基因及其功能Animal studies依據依據動物的研究動物的研究，現欲進一步對人類進行研究現欲進
6、一步對人類進行研究（老鼠某個主要負責血清素神經傳導物質5-HT1A的接受器的基因，在出生之後就被關 閉，老鼠長大後出現焦慮型的表現型的老鼠）Human studies (Linkage analysis）連結分析連結分析是運用在人類的分是運用在人類的分 子遺傳學子遺傳學的研究方法之一的研究方法之一。主要是研究某種疾病的家庭主要是研究某種疾病的家庭，並且收集罹病者及親戚的血液樣本並且收集罹病者及親戚的血液樣本。用血液樣本研究特病的遺傳型態，而且目前已完全了解這些基因，稱為基因標記。杭丁頓症（單基因的研究）阿茲海默症(極重要的好幾個染色體上面的特定基因)Association studies相關研
7、究相關研究研究者利用電腦算出某些對偶基因和人口群當中某特質或行為的關聯。對偶基因對偶基因APOE-4，與未罹病者的人相較常在晚發型的阿茲海默症患者身上發現這種基因。Gene-Environment Interactions(基因和環境的互動基因和環境的互動合作方式）合作方式）A given persons sensitivity or reaction to an environmental event is influenced by genes. 一個人對於環境事件的敏感度及反應程度是受到基因的影響Example 1:Adoption studies for Antisocial PD 反
8、社會人格障礙父母所生小孩，如果在不健康的環境中成長更容易 發展成反社會人格障礙。比反社會人格障礙父母所生小孩反社會人格障礙父母所生小孩在健康的環境中成長 ；沒有沒有反社會人格障礙父母所生小孩反社會人格障礙父母所生小孩在不健康的環境中成長。Example 2: Depression (Figure 2.2)早期受虐跟成年憂鬱症的關聯性。基因具備多型性，因此有些人有兩個短的對偶基因；有些人有二長的基因；有些人有一長一短的對偶基因組合。需要一短的對偶基因加上出現早期的生活事件才能預測其成年時的憂鬱症）Example 3: rats good parenting behaviors (LG-ABN)
9、高度LG ABN的母鼠所帶出來的小鼠，其身上的某些基因表現增加（醣皮 質素接受器）（ LG：舔小鼠的整容的行為；ABN：躬身的哺育行為) (基因表現增加可歸因於DNA促進元區域之調節 實驗結果小鼠即使被低度LG ABN的母鼠所帶大，只要注射醣皮質素接受器基因表現之藥物可以達到高度LG ABN的母鼠所帶出來的小鼠的效果。Reciprocal Gene-Environment Interactions基因和環境之雙向互動基因和環境之雙向互動Genes may predispose us to seek out certain environments that then increase our
10、risk for developing a particular disorder.E.g. alcohol dependence, depression基因會促成我們尋求某種類型的特定環境基因會促成我們尋求某種類型的特定環境，我們稱之為我們稱之為基因和環境雙向互動基因和環境雙向互動，並增加罹患某些疾病的風險。，並增加罹患某些疾病的風險。例如：酒癮的基因，可使人在面對壓力環境時，讓自己處於濫用酒精的高度危險環境，例如違法例如：憂鬱症的基因脆弱性，也促成某些生活事件，例如和男友分手；和父母相處的困境，這些都會引起青少年的憂鬱症Evaluating the Genetic Paradigm評估基因
11、學派典Genes do their work via environment.基因借由環境來表現。基因沒有環境的影響無法單獨操作Challenge: to specify exactly how genes and environments reciprocally influence one another.找出特定的基因和環境互相影響的方式Animal studies v.s. human studies在實驗室用動物做是最簡單的研究；想要了解基因和複雜的人類環境互動方式及整個病程的發展則困難許多。The Neuroscience Paradigm神經科學派典Mental disorder
12、s are linked to aberrant processes in the brain.精神疾病跟大腦程序混亂有關E.g. depression neurotransmitter problems; anxiety a defect within the autonomic nervous system; dementia impairments in structures of the brain憂鬱症和大腦中的神經傳導物質有關；焦慮症可能和自律神經系統的缺陷有關導致太容易被激發；失智症跟大腦的結構缺損有關4 components of this paradigm四個重要的組成部分N
13、eurons and neurotransmitters神經元和神經傳導Structure and function of the human brain大腦的結構和功能The autonomic nervous system自律神經系統The neuroendocrine system神經內分泌系統Neurons and NeurotransmittersNeuron: the cell body; dendrites; axons; terminal buttons 神經元神經元：細胞體；樹突（較短或較粗的細胞的延伸）； 一條較長且較細的軸突從細胞延伸出相當距離；神經細胞終端Nerve i
14、mpulse神經衝動神經衝動Synapse 突觸突觸：神經細胞的終端有一小的間隙（一個神經元傳到下一個神經元，就得要通過神經突觸的間隙）Neurotransmitters: chemical substances that allow a nerve impulse to cross the synapse化學物質能夠讓神經衝動順利過關樹突樹突細胞核細胞核細胞體細胞體神經衝動神經衝動軸突神經元神經元突觸突觸(前細胞前細胞)突觸突觸The Synapse突觸間隙突觸間隙突觸小泡突觸小泡粗腺體粗腺體終端終端軸軸突突終終端端分分枝枝Neurons and NeurotransmittersNeuro
15、ns signal information by releasing packets of chemical transmitters from the axon terminalChemical molecules bind to receptors on the membrane of adjacent nerve cellsBinding in turn changes the electrical activity of the adjacent cell and can trigger an action potentialA reuptake process in the axon
16、 membrane takes up excess chemical for reuseSecond messengers (Figure 2.5)Neurons and NeurotransmittersNeurons signal information by releasing packets of chemical transmitters from the axon terminal 當神經衝動要從一神經元傳到下一個神經元，就必須通過神經突觸的間隙。神經末梢有多突出的小泡，小泡裡充滿神經傳導物質。這種化學物質能夠讓神經衝動順利通過突觸。當神經傳導物質流入突觸之後某些分子會跑到接受端，
17、也就是突觸後神經元。 突觸後神經元細胞膜含有特殊蛋白質叫做受器接受端。 這個接受端能接受特定的神經傳導物質來和他們配合。當神經傳導物質找到符合的接受端，整個訊息才能夠順利傳遞到突觸後細胞。突觸後神經元必須整合數千個類似的訊息才會發生真正的反應。 - Chemical molecules bind to receptors on the membrane of adjacent nerve cells。Binding in turn changes the electrical activity of the adjacent cell and can trigger an action pot
18、ential。A reuptake process in the axon membrane takes up excess chemical for reuse 一旦突觸前神經元釋放神經傳導物質，最後一步驟就是突觸必須恢復到常態。並不是所有釋放出來的神經傳導物質都可以找到突觸後接受器，有些留在突觸的神經傳導物質會被酵素分解，有一些則會透過再吸收再吸收的過程，重新被吸收至突觸前細胞Second messengers (Figure 2.5)如果一細胞放電的頻率太高，接受器就會釋放次級神經元。次級神經元能夠在神經細胞過度活化時，協助神經元調整接受器的敏感度。第一個神經元第一個神經元(神經傳導物質
19、神經傳導物質)接受器接受器G蛋白蛋白第一個傳訊元第一個傳訊元會引起受體的改變會引起受體的改變G蛋白蛋白能能與接受器連結與接受器連結連結一旦發生連結一旦發生就會釋放出次級傳訊元就會釋放出次級傳訊元Neurons and NeurotransmittersKey neurotransmitters in psychopathologyDopamine(多巴胺) & serotonin(血清素) schizophrenia & depressionNorepinephrine(正腎上腺素): producing states of high arousal; anxiety disorders an
20、d other stress-related conditionsGamma-aminobutyric acid (-胺基丁酸)(GABA): inhibit nerve impulses; anxiety disordersNeurons and NeurotransmittersAbnormal behavior could result from:Too much or too little of a specific neurotransmitter owing to changes in synthesis of the transmitterToo much or too litt
21、le of a specific neurotransmitter owing to changes in reuptake of the transmitterToo many or too few receptors on the postsynaptic neuron membrane特定的神經傳導物質太多或太少，問題可能出在代謝的途徑。特定的神經傳導物質的失調，可能來自於神經傳導物質釋放之後，在活化的過程出了問題。這種沒有辦法活化的過程，也包括再吸收過程出了問題，即神經傳導物質沒辦法被回收到突觸前細胞。近期研究聚焦在神經傳導接受器出了問題導致出現某些心理病理。如果突觸後神經元接受器太多
22、或者太容易受到刺激，會造成神經傳導物質的過度分泌。突觸神經元就更容易刺激。Neurons and NeurotransmittersAgonist & Antagonist促進劑拮抗劑Agonist: a drug that stimulates a particular neurotransmitters receptors. (e.g. serotonin)血清素促進劑，就是能夠刺激血清接受器，就如同血清素在自然的情況下能刺激接受器產生效應一樣。Antagonist: a drug that works on a neurotransmitters receptors to dampen
23、the activity of that neurotransmitter. (e.g.dopamin)作用在神經傳導物質的接受器，能夠降低神經傳導物質的活性。Structure and Function of the BrainCerebrum；Corpus callosum胼胝體4 lobesFrontal lobe額葉: 推理、問題解決、工作記憶及其它執行功能、細膩的自主運動Parietal lobe頂葉:Temporal lobe顳葉:聲音辨識Occipital lobe枕葉:視覺中央溝之前：骨骼肌運動之發動中央溝之後：（觸、壓力、痛、溫度、及身體位置）感覺接收左半腦：語言與分析性思考
24、（右利者及相當多的左利者）右半腦：空間關係與型態額葉額葉中央溝中央溝頂葉頂葉枕葉枕葉側腦溝側腦溝顳葉顳葉Structure and Function of the BrainThalamus丘腦: a relay station for all sensory pathways except the olfactory.除了嗅覺外所有感覺的傳遞途徑的傳播中心Brain stem腦幹: pons(腦橋) & the medulla oblongata(延腦)；a neural relay stationCerebellum(小腦): balance & coordination of the b
25、ody小腦主要在維持平衡及協調（小腦由兩個纏繞許多小腦迴的半球組成有灰質外層皮質及內部白質通路）Structure and Function of the BrainLimbic system邊緣系統: control the visceral and physical expression of emotion, and the expression of appetitive and other primary drives.控制內臟和身體的情緒表現：增加呼吸、造成顫抖、發汗、改變臉部表情及胃口表現何其他原始驅力Anterior cingulate 前扣帶回（扣帶回的前部一直延伸到倂胝體）
26、Septal area 中隔區域（在丘腦的前方）Hippocampus 海馬回（長條型管狀）主要是從中區隔區域一直進入顳葉Thpothalamus 下視丘（可以調節代謝、體溫、流汗、血壓、睡眠和食慾）Amygdala杏仁核（專注在重要情緒之刺激，以及情緒相關的記憶是非常重要的結構）（憂鬱症患者看到情緒變化時杏仁核的反應高於一般人）The Autonomic Nervous SystemNervous systemSomatic (voluntary) nervous system體神經系統Autonomic (involuntary) nervous system(ANS) 自律神經系統Sym
27、pathetic nervous system交感神經(亢奮)Parasympathetic nervous system副交感神經(平靜)The Neuroendocrine SystemHPA axis軸: Hypothalamus丘腦下部Pituitary腦下垂體Adrenal cortex腎上腺 (分泌Cortisol及其他賀爾蒙促使血壓上升，增加代謝率遍及全身) (Figure 2.10) The bodys response to stressCortisol氫基皮脂酮: the stress hormone-血液身體器官-activities下視丘下視丘腦下垂體腦下垂體腎上腺皮質
28、促素腎上腺皮質促素經過血液經過血液釋放因子釋放因子腎上腺皮質腎上腺皮質可分泌可體松和使血糖上升增加可分泌可體松和使血糖上升增加、全身新陳代謝率的賀爾蒙全身新陳代謝率的賀爾蒙The Psychoanalytic ParadigmPsychopathology resulted from unconscious conflicts in the individual. 一個人的精神病理來自於一個人的潛意識衝突The various forms of psychopathology resulted from the presence of strong drives or id instincts
29、, which set the stage for the development of unconscious conflicts linked to a particular psychosexual stage.不同的精神病理來自存在的強烈驅力或原我本能，這些力量形成潛意識衝突和特定的心性發展階段有關。The Psychoanalytic ParadigmEgo analysis (Karen Horney, Anna Freud, Erik Erikson, David Rapaport, heinz Hartmann)人具有控制環境以及選擇滿足基本需求之時間與方法的能力不只探討與問題
30、行為有關的早期經驗,也關注個人目前的生活狀況較不強調移情作用個人的社會互動可以提供某種滿足(Freud: 自我與克服社會的壓力與限制,以使本我獲得滿足)The Psychoanalytic ParadigmBrief psychodynamic therapy focuses on a few specific problems and involves few sessions(6-25 sessions)The therapist takes a more active role.治療者取更主動的角色Focused on the amelioration of the pts worst
31、symptoms, on helping the pt understand what is going on in his or her life, and on enabling the pt to cope better in the future.治療目標在於減緩惡化的症狀協助病患了解生活中究竟發生發生了哪些事情以及協助她們在未來能有更好的因應方式Interpretations are directed more toward present life circumstances and patient behavior.解析朝向於目前的生活環境及病患的行為而不是過去的重要情緒Deve
32、lopment of transference is not encouraged, but some positive transference is fostered.不鼓勵發展移情關係但鼓勵在治療時發展正向移情關係協助病患更能遵守治療師的建議和忠告Evaluating the Psychoanalytic ParadigmCriticisms: not objective and scientific; low generalizability and reliability.Freud contributions include the views that:Childhood exp
33、eriences help shape adult personality.兒童期的經驗能夠協助形成成年人的性格There are unconscious influences on behavior.潛意識對於行為造成影響The causes and purposes of human behavior are now always obvious.人類行為的原因和目的常不明顯。必須努力找出表面行為以下的隱含意義。The Cognitive Behavioral ParadigmInfluences from behavior therapyProblem behavior is likel
34、y to continue if it is reinforced4 possible consequencesGetting attentionEscaping from tasksGenerating sensory feedbackGaining access to desirable things or situationsTime-out: The person is sent for a period of time to a location where positive reinforcers are not available.The Cognitive Behavioral
35、 ParadigmPositive reinforcement: making positive reinforcers contingent on behaviorToken economy: A procedure in which tokens are given for desired behavior; the tokens can later be exchanged for desirable items and activities.Exposure: the anxiety will extinguish if the person can face the object o
36、r situation for long enough with no actual harm occurring.“in vivo”- in real-life situationImaginal exposureCriticism: minimizing the importance of thinking and feeling.The Cognitive Behavioral ParadigmCognitive scienceCognition involves the mental processes of perceiving, recognizing, judging and r
37、easoningThe cognitive paradigm focuses on how people structure and understand their experiences and how these experiences are related to past experiences stored in memoryThe Cognitive Behavioral ParadigmThe learner as an active interpreter of a situation, with the learners past knowledge imposing a
38、perceptual funnel on the experience.Schema: an organized network of already accumulated knowledge; cognitive setThe Cognitive Behavioral ParadigmAttention studiesAnxiety disorder: attention to threatening or anxiety-producing events or situationsSchizophrenia: hard to concentrate attention for a per
39、iod of timeStroop task: To name the ink color as fast as possible without making mistakes (Figure 2.11)Cognitive explanationsDepression: negative cognitive set; hopelessnessCognitive Behavior Therapy(CBT)Cognitive therapy assumes that thought patterns can cause a disturbance of emotion or behavior C
40、ognitive restructuring involves changing thought patterns that lead to abnormalityBecks Cognitive Therapy : depression represents a distorted pattern of thought in which a person misperceives their life experience;the attention, interpretation, and recall of negative and positive information were bi
41、ased in depression. changing these maladaptive thought patterns changing the depressive emotionCognitive Behavior Therapy(CBT)Elliss Rational-Emotive Behavior Therapy (REBT)Irrational beliefsinternal sentences that people repeat to themselvesemotional reactionsTo eliminate self-defeating beliefs cha
42、nging the emotionFactors that cut across the paradigmsEmotion and psychopathology85% of psychological disorders include disturbances in emotional processing of some kindEmotion: short-lived states, lasting for a few seconds, minutes, or at most hoursExpressive componentExperiential (subjective feeli
43、ng) componentPhysiological componentAffect: short-lasting emotional feelingsMood: emotional experiences that endure for a longer period of timeFactors that cut across the paradigmsSociocultural factors and psychopathologyEnvironment factors can trigger, exacerbate, or maintain the symptoms that make
44、 up the different disorders.Epidemiological studies流行病學研究Depression: male: female=1:2Antisocial PD & alcohol dependence: malefemaleADHD: boysgirlsThe quality of relationship: family and marital relationships, social supportDiathesis-stress: An integrative paradigmFocus on the interaction between a p
45、redisposition toward disease (the diathesis) and environmental, or life, disturbances (the stress).Diathesis: a constitutional predisposition toward illness any characteristic or set of characteristics of a person that increases his or her chance of developing a disorder.Both diathesis and stress ar
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