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漫谈躯体形式障碍的神经影像学与神经递质关联性

Study on the Association of Neuroimaging and Neurotransmitter in Somatoform Disorders

中国心理学前沿 / 2021,3(9)：973-986 / 2021-09-23 299 415

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• 作者： 蔡政忠¹      陈玲滢²     
• 单位：

  1. 莆田学院医疗健康产业管理系，莆田；
  2. 福州超德中学，福州

• 关键词： 躯体形式障碍；身体畸形恐惧症；水仙花综合症；神经影像学；神经递质
• Somatoform Disorder; Body Dysmorphic Disorder; Narcissus Complex; Neuroimaging; Neurotransmitter
• 摘要： 摘要：躯体形式障碍（somatoform disorders, SFDs）是与精神心理密切相关的身心共病症状，是身心医学最早期的发现，该类型的疾患一般无法透过体格检查、实验室检查来发现阳性结果并由此列入SFDs的诊断依据。SFDs疾病发现历史，最早是由Briquet描述这类疾病的症状群，后来被Freud、Breuer列入癔症范围，直到1980年DSM-Ⅲ才首次将SFDs单独分门别类并与焦虑障碍并列，SFDs主导症状是对躯体症状长期保持优势观念的忧虑，病患最初就诊首发地均出现在专科门诊，因患者回诊率高，只要经专科医师一到两次诊疗并联系照会精神心理门诊之后，即可初步判定为SFDs。本文先从功能影像学视角来分析躯体化障碍、疑病症、转换障碍、慢性疲劳综合症、躯体变形障碍等五种SFDs的神经影像学成像技术侦测到病患背外侧前额叶皮层、腹外侧前额叶皮层、额极、前扣带回皮层、顶下小叶、海马回等区域出现部分各向异性数值异常与糖代谢率低于一般正常值，在使用精神障碍磁共振成像试验来对SFDs患者的工作记忆能力进行测试时发现，一旦任务增强到2-back水平时，患者血氧水平依赖开始出现减缓下降趋势。最后，本文再从神经生化学的单胺假说、多巴胺能亢进现象、P物质与阿片类神经调质的影响来论证SFDs致病的机理。
• Abstract: Somatoform disorders(SFDs) are symptoms of mind and body comorbidities closely related to mental psychology. It is the earliest discovery in psychosomatics. Generally, it is impossible to ascertain the positive result through physical examination and laboratory tests fot this type of patient and as a diagnosis basis for SDFs. Trace the origin of the bygone, somatoform disorders was first described by Briquet as the symptom group of these diseases and they were later included in the scope of hysteria by Freus and Breuer. It was not until 1980 that DSM-Ⅲ first classified SFDs as separate category and tied it with anxiety disorders. The dominant symptom of SDFs is concerned about the long-term dominance of the physical symptoms. The first place of patients’ initial visited was the specialist clinic. Due to the high rate of patients return, as long as they are treated by a specialist once or twice and contact psychiatric clinic, they will be preliminary identified as SFDs. In this paper, the neuroimaging imaging of five SFDs, including somatization disorder, hypochondria, conversion disorder, chronic fatigue syndrome and body dysmorphic disorder, was analyzed from the perspective of functional imaging. The technique detected that some anisotropy values were abnormal and the glucose metabolism rate was lower than the general normal value in the dorsolateral prefrontal cortex, ventrolateral prefrontal cortex, frontal pole, anterior cingulate cortex, inferior parietal lobule and hippocampal gyrus of patients. When testing the working memory ability of patients with SFDs using the mental disorder magnetic resonance imaging test, it was found that once the task was enhanced to the 2-back level, the declining tendency of the blood oxygen level dependence of patients began to slow down. Finally, the mechanism of SFDs pathogenesis was demonstrated from the following aspects of the monoamine hypothesis of neurobiochemistry, the phenomenon of dopaminergic hyperactivity, and the influence of substance P and opioid neuromodulators.
• DOI： https://doi.org/10.35534/pc.0309113
• 引用： 蔡政忠，陈玲滢．漫谈躯体形式障碍的神经影像学与神经递质关联性［J］。中国心理学前沿，2021，3（9）：973-986．