摘要
目的:病因学研究发现遗传、体内的生化变化、人脑的某些部位、脑电生理和心理机制均可能与惊恐发作的产生有关;基于国内外迄今对于惊恐障碍的病因尚无统一、明确和公认观点的现状,就其病理心理学、病理生理学和神经解剖学机制,对其病因学研究作一综述。资料来源:应用计算机检索Medline2000-01/2004-12的与惊恐障碍病因学研究相关文献,检索词“panicdisorder,etiology”。同时计算机检索万方数据库2000-01/2004-08及中国学术期刊全文数据库2000-01/2004-08的与惊恐障碍病因学研究相关文献,检索词“惊恐障碍”,并限定文献语种为中文,从中筛选有关病因学研究的文章。资料选择:纳入标准:①随机盲法对照研究,前后对照研究,前瞻性及回顾性研究。②研究领域为惊恐障碍的病理心理学机制、病理生理学机制和神经解剖学。排除标准:文献中重复研究、综述和个案报道。资料提炼:共收集到56篇关于惊恐障碍病因学研究现状随机盲法对照研究、前后对照研究、前瞻性及回顾性研究,24篇研究符合纳入标准。排除的32篇中14篇是重复的同一研究,8篇为治疗性研究,10篇是分子遗传学研究。资料综合:①病理心理学机制:精神分析动力学理论认为即往的发育创伤经历使患者处于持续性压抑愤怒的状态,导致了后来的惊恐发作。依恋理论认为,惊恐障碍来源于病态性降低的释放烦恼情感的阈值。惊恐障碍患者的人格特征中精神质分和内外向性分较高。②病理生理学机制:临床和实验室研究都发现惊恐障碍有着呼吸生理功能的异常,提示异常的呼吸控制机制可能是该病的一个原因。焦虑障碍的生化发病机制主要包括神经递质假说和神经内分泌功能紊乱假说两方面,脑内的γ-氨基丁酸的异常有可能是焦虑反应的病理生理基础。③定性磁共振成像研究表明惊恐障碍患者有大脑功能和结构的异常,主要位于颞叶尤其是近中髓颞叶区,患者双侧颞叶体积均有缩小,海马区功能异常可能是一个病因。结论:惊恐障碍是一个多病因疾病,与心理机制、体内的生化(乳酸盐、神经递质和受体)变化、人脑的某些部位(如脑干、边缘系等)功能失调等多因素有关。可以在该病可能的病理心理机制和病理生理机制上建立有针对性的预防和治疗方法。
OBJECTIVE： Etiological researches find that genetics, intrinsic biochemical changes, some locations in the cerebrum, cerebral electrophysiology and psychological mechanism may have effects on the origin of the panic disorder, Based on the situation that no absolute and definite conclusion has been set up for the etiology of panic disorder, we summarized the researches about the pathopsychology, path physiology and neural anatomy of panic disorder. DATA SOURCES： A computer-based online search of Medline database was undertaken to identify articles about the etiology of panic disorder published in English from January 2000 to December 2004 by using the keywords of ＂panic disorder, etiology＂. Meanwhile, Chinese articles about the etiology of panic disorder published between January 2000 and August 2004 were searched in Wanfang database, the keywords were ＂panic disorder＂in Chinese. STUDY SELECTION： Inclusive criteria： ① Researches of randomized blind control design, before and after control design, perspective and retrospective studies, ②Researches of pathopsychology, pathophysiology and neural anatomy of panic disorder. Exclusive criteria： the repetitive researches, summarizations and the individual reports. DATA EXTRACTION： Totally 56 articles related to the etiological research of panic disorder of randomized blind control design, before and after control design, perspective and retrospective studies were collected, and 24 of which accorded with the inclusive criteria. Of the 32 excluded ones, 14 were repetitive researches, 8 were therapy researches and 10 were concerning with the genetics. DATA SYNTHESIS： ①Pathopsychological mechanism： Psychoanalysis theory believes that past traumatic experience in growth puts the patient in a persisting status of depression and anger, which leads to the latter panic attacks. Attachment theory believes that panic disorder originates from pathological decreasing threshold of releasing anxiety. The personality characteristics of patients with panic disorder are high scores of psychoticism and extraversion-introversion in Eysenck Personality Questionnaire. ② Pathophysiological mechanism： thE abnormalities of respiratory physiological function of panic disorder found by clinical and laboratory researches reveals that the abnormal respiratory controlling mechanism may be a reason of this disease. The biochemical mechanism of the anxiety disorder contains the hypothesis of neurotransmitter and the hypothesis of neuroendocrine dysfunction. The abnormality of the γ- propalanine in the brain may be the pathophysiological basis of anxiety reaction. ③ Quantitative magnetic resonance imaging studies reveal that there are abnormalities in the construction and function of the brain, mainly locating in the temporal lobe. Since the volume of the bilateral temporal lobes in patients with panic disorder is smaller, the dysfunction of hippocampus may be a reason. CONCLUSION： Panic disorder is a multifactor disease related to the psychological mechanism, intrinsic biochemical changes including variations of the lactic acid, neurotransmitters and receptors, dysfunction of some locations in the cerebrum such as the brain stem, marginal area, and other relevant factors. The effective prevention and treatment may base on the possible pathopsychology and pathophysiology of this disease.
出处
《中国临床康复》
CSCD
北大核心
2005年第48期111-113,共3页
Chinese Journal of Clinical Rehabilitation
