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反社會人格紊亂(APD)來源于大腦

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Bully on the Brain



Feb. 14, 2000 (Boston) -- For the first time, a brain defect that could be at least partly responsible for extremely violent criminal actions and antisocial behaviors of some men has been identified, report researchers from the University of Southern California (USC).



Men with antisocial personality disorder (APD) -- a form of mental illness often seen in serial killers and other violent, aggressive, wildly impulsive, or dangerous people -- had an 11% reduction in a certain type of tissue (gray matter) in the part of the brain known as the prefrontal cortex when compared with either normal men or men with a history of drug or alcohol abuse but no APD.



Researchers have pinpointed the prefrontal cortex as the part of the brain where emotion, arousal, attention, moral conscience, and self-control primarily reside.



The link between extremely violent and antisocial behavior and damage to prefrontal cortex from disease or trauma has been long established. One of the most famous cases was that of a Vermont railroad worker named Phineas Gage, who in 1848 survived and, remarkably, recovered rapidly from a horrific accident in which a heavy iron tamping rod more than three feet in length was driven by an explosion completely through his skull. Following the accident, however, he underwent a dramatic personality change, and began to display many of the traits of APD, including antisocial behavior, use of sexually explicit language, apparent lack of moral conscience, impulsiveness, irritability, aggressiveness, and an inability to focus on work or plan for the future.



Although children are not typically diagnosed with personality disorders until they reach adulthood, according to the American Psychiatric Association, children that exhibit signs similar to APD typically violate rules and show signs of extreme aggression, such as the torture of animals or other people, frequent bullying or threatening, use of weapons that could cause serious injury, lying, sexual aggression, vandalism, and theft. Adults with APD frequently commit criminal acts, get into fights, cheat, show a general disregard for the safety of themselves or others, and show a lack of remorse for their own behavior.



But the findings from the USC study raise legal and ethical questions about whether some violent offenders are completely responsible for their actions, and whether they can or should be treated with specific interventions that could curb impulsive behaviors and dampen their aggressive tendencies so that they no longer present a threat to society at large.



"I don't think anyone would argue that you can treat extreme antisocial behavior by locking people away, but then how would we treat them, and is it possible to prevent such behaviors from occurring in the first place?" asks M. Marsel Mesulam, MD, in an interview with WebMD seeking objective analysis. Mesulam is professor of psychiatry and behavioral sciences at Northwestern University Medical School in Chicago.



"The exciting part would be if this could be a marker to identify children who are at increased risk for this troublesome adult outcome, and if it would have sufficient accuracy to pick up children who are at risk for this condition, because that's a prerequisite for any targeted intervention program," agrees David R. Offord, MD, director of the Centre for Studies of Children at Risk at McMaster University in Hamilton, Ontario.



If the causes of the underlying problem can be identified, it could allow doctors to design therapies such as drugs or surgery to treat the specific brain defect, combined with other strategies such as psychiatric treatment and behavioral therapy. Such therapies would be likely to be more effective in children, whose brains are more adaptable to change than those of adults, says researcher Adrian Raine, DPhil, professor of psychology at the USC, in an interview with WebMD.



"We have to try to discover what the causes of the prefrontal damage are, and that's what we can't answer at the moment," Raine says. "The deficit could occur from environmental factors, such as birth complications, which could traumatize the brain. We did research a few years ago showing that birth complications predispose to violent offending in adulthood. Perhaps if we gave under-served mothers better prenatal and postnatal health care, we might be in a better position to do something about reducing one of the sources of prefrontal damage."



"Another source of the damage could be very early infant abuse. If you repeatedly shake an infant, you'll lacerate the white nerve fibers connecting the frontal cortex, effectively shutting it off from the rest of the brain and perhaps leading to some neuronal [nerve cell] degeneration. So the question may be, what do we do to prevent early infant abuse?" he says.



Raine tells WebMD that although there is little hope now of curing adults with APD, "we know that in the next 10 years we'll have the first microchip implant to replace the hippocampus [the area of the brain thought to be involved in emotion and memory], and scientists are working on using microchip implants to replace other damaged brain structures. It's not inconceivable, therefore, that within the next 15 to 20 years we might be able to do something about the tissue loss that occurs in these individuals."



Vital Information:



Antisocial personality disorder (APD) is a form of mental illness often seen in serial killers and other violent, aggressive, wildly impulsive, or dangerous people.


Researchers have found that men with APD have an 11% reduction in a type of tissue in the prefrontal cortex -- the area of the brain associated with emotion, arousal, attention, moral conscience, and self-control.


Some suggestions as to what actually causes the damage to this area of the brain include environmental factors, such as complications during birth, or early infant abuse.



反社會人格紊亂(APD)來源于大腦



2000年2月14日(波士頓)-南加州大學(USC)的研究人員說他們已經首次辨認出一個至少部分與某些人的極度暴力犯罪行為和反社會行為有關的大腦缺陷。



反社會人格紊亂(APD)是一種經常發生在連環殺手和有暴力和侵略性傾向,沖動危險人物身上的一種心理疾病。患有APD的人大腦前額皮層的某個組織(灰質)的體積與正常人或者有吸毒酗酒史但沒有APD 的人比起來減少了11%。



研究人員已經確認前額皮層是與情感,激發,注意力,良知道德和自制有關的腦區。



極度暴力傾向和反社會行為和由于疾病或外傷造成的大腦前額皮層損害之間的關系很早以前就已經為人們所認識。最著名的病例是美國佛蒙特州一個名叫Phineas Gage的鐵路工人。1848年他從一次可怕的事故中幸免遇難并且很快地康復了。在這次事故中,一根三英尺多長的沉重的小鐵棒被爆炸氣流炸飛起來穿透了他的頭骨。事故過后,他的人格發生了明顯的變化,表現出很多APD的特征,包括反社會行為,使用下流的語言,明顯缺乏道德感,沖動,易怒,有侵略傾向,工作不能集中注意力以及對未來缺乏計劃等。



據美國精神病協會報道,雖然兒童要等到成年才能表現出典型的人格紊亂癥狀,一些表現出與APD相似的特征的兒童與其他兒童比起來尤其可能違反紀律和具有侵略傾向,比如折磨小動物或周圍的人,經常威脅恐嚇別人,使用會引起嚴重傷害的武器,撒謊,損壞公物,偷竊等。患有APD的成年人經常做出觸犯法律的舉動,斗毆,欺騙,漠視本人和他人的安全,對自己的行為不悔改等。



但是USC的研究結果也從法律和道德角度對這一現象提出了疑問,一些暴力傾向者是否可以對自己的行為負完全責任,人們是否應該采用特殊方式對待他們,阻止他們的沖動行為,減輕他們的侵略性傾向,使他們即使在無人監護時也不會對社會構成威脅。



芝加哥西北大學精神病學和行為科學教授M. Marsel Mesulam在接受WebMD網采訪時就這一問題尋求客觀分析的時候說,“我想任何人都不會把將這些人鎖起來作為阻止極度反社會行為的方法,那該怎么對待這些人呢,有沒有可能把這些行為控制在剛出現的時候呢”?



漢密爾頓McMaster 大學特殊兒童研究中心主任David R. Offord對這一看法表示同意,“這一發現令人激動的地方在于它是一個參量,這個參量可以幫助我們辨認出那些正逐步走向危險,在成人后會產生這一令人棘手地結果的兒童,可以幫助我們準確地發現處于潛伏期兒童”。



如果發現了產生這一問題的原因,醫生就可以找到治療方法來醫治這種大腦損傷,比如藥物或手術治療,或結合其他的方法如精神治療和行為療法。



Raine說,“我們試圖發現前額額葉損傷的原因所在,但目前我們還找不到答案。損傷可以由環境因素引發,如出生時的并發癥會損傷大腦。幾年前我們進行的相關研究顯示出生時的并發癥會導致成年后的暴力傾向。如果我們給婦女更好的產前和產后照顧,我們就有可能減少造成對額葉造成損傷的原因之一”。



他還說,“另外一個原因可能是嬰兒早期受到虐待。如果嬰兒被反復搖晃,連接前額皮層的白神經纖維就會斷裂,從而前額皮層與大腦其余部分的聯系也斷開,導致一些神經細胞的衰退。所以問題就是我們應該怎樣防止嬰兒在早期受到虐待”。



Raine告訴WebMD網說,雖然現在醫治患有APD的成年人幾乎沒有什么希望,但“我們已經知道十年內我們會把第一塊微芯片植入人腦代替大腦中與情感和記憶有關的海馬區,并且科學家正在試驗植入微芯片代替其他受損害的大腦組織。所以在十五到二十年之內我們應該可以為這些大腦組織受到損傷的人做些事情”。



重要信息:



*反社會人格紊亂(APD)是一種經常發生在連環殺手和有暴力侵略性傾向和沖動危險的人物身上的一種心理疾病。



*研究人員發現患有APD的人大腦前額皮層的某種組織減少了11%-這一腦區與情感,激發,注意力,良知道德和自制有關。



*這一腦區受到損傷的原因究竟是什么,答案包括環境因素如出生時的并發癥,和嬰兒在早期受到虐待。

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