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反社会人格紊乱(APD)来源于大脑

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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.



反社会人格紊乱(APD)来源于大脑



2000年2月14日(波士顿)-南加州大学(USC)的研究人员说他们已经首次辨认出一个至少部分与某些人的极度暴力犯罪行为和反社会行为有关的大脑缺陷。



反社会人格紊乱(APD)是一种经常发生在连环杀手和有暴力和侵略性倾向,冲动危险人物身上的一种心理疾病?;加蠥PD的人大脑前额皮层的某个组织(灰质)的体积与正常人或者有吸毒酗酒史但没有APD 的人比起来减少了11%。



研究人员已经确认前额皮层是与情感,激发,注意力,良知道德和自制有关的脑区。



极度暴力倾向和反社会行为和由于疾病或外伤造成的大脑前额皮层损害之间的关系很早以前就已经为人们所认识。最著名的病例是美国佛蒙特州一个名叫Phineas Gage的铁路工人。1848年他从一次可怕的事故中幸免遇难并且很快地康复了。在这次事故中,一根三英尺多长的沉重的小铁棒被爆炸气流炸飞起来穿透了他的头骨。事故过后,他的人格发生了明显的变化,表现出很多APD的特征,包括反社会行为,使用下流的语言,明显缺乏道德感,冲动,易怒,有侵略倾向,工作不能集中注意力以及对未来缺乏计划等。



据美国精神病协会报道,虽然儿童要等到成年才能表现出典型的人格紊乱症状,一些表现出与APD相似的特征的儿童与其他儿童比起来尤其可能违反纪律和具有侵略倾向,比如折磨小动物或周围的人,经常威胁恐吓别人,使用会引起严重伤害的武器,撒谎,损坏公物,偷窃等?;加蠥PD的成年人经常做出触犯法律的举动,斗殴,欺骗,漠视本人和他人的安全,对自己的行为不悔改等。



但是USC的研究结果也从法律和道德角度对这一现象提出了疑问,一些暴力倾向者是否可以对自己的行为负完全责任,人们是否应该采用特殊方式对待他们,阻止他们的冲动行为,减轻他们的侵略性倾向,使他们即使在无人监护时也不会对社会构成威胁。



芝加哥西北大学精神病学和行为科学教授M. Marsel Mesulam在接受WebMD网采访时就这一问题寻求客观分析的时候说,“我想任何人都不会把将这些人锁起来作为阻止极度反社会行为的方法,那该怎么对待这些人呢,有没有可能把这些行为控制在刚出现的时候呢”?



汉密尔顿McMaster 大学特殊儿童研究中心主任David R. Offord对这一看法表示同意,“这一发现令人激动的地方在于它是一个参量,这个参量可以帮助我们辨认出那些正逐步走向危险,在成人后会产生这一令人棘手地结果的儿童,可以帮助我们准确地发现处于潜伏期儿童”。



如果发现了产生这一问题的原因,医生就可以找到治疗方法来医治这种大脑损伤,比如药物或手术治疗,或结合其他的方法如精神治疗和行为疗法。



Raine说,“我们试图发现前额额叶损伤的原因所在,但目前我们还找不到答案。损伤可以由环境因素引发,如出生时的并发症会损伤大脑。几年前我们进行的相关研究显示出生时的并发症会导致成年后的暴力倾向。如果我们给妇女更好的产前和产后照顾,我们就有可能减少造成对额叶造成损伤的原因之一”。



他还说,“另外一个原因可能是婴儿早期受到虐待。如果婴儿被反复摇晃,连接前额皮层的白神经纤维就会断裂,从而前额皮层与大脑其余部分的联系也断开,导致一些神经细胞的衰退。所以问题就是我们应该怎样防止婴儿在早期受到虐待”。



Raine告诉WebMD网说,虽然现在医治患有APD的成年人几乎没有什么希望,但“我们已经知道十年内我们会把第一块微芯片植入人脑代替大脑中与情感和记忆有关的海马区,并且科学家正在试验植入微芯片代替其他受损害的大脑组织。所以在十五到二十年之内我们应该可以为这些大脑组织受到损伤的人做些事情”。



重要信息:



*反社会人格紊乱(APD)是一种经常发生在连环杀手和有暴力侵略性倾向和冲动危险的人物身上的一种心理疾病。



*研究人员发现患有APD的人大脑前额皮层的某种组织减少了11%-这一脑区与情感,激发,注意力,良知道德和自制有关。



*这一脑区受到损伤的原因究竟是什么,答案包括环境因素如出生时的并发症,和婴儿在早期受到虐待。

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