Aetiology of Abnormal Psychology

济宁医学院精神医学系

李功迎

副教授 医学博士
Contents
 Overview
 The classification of causes in temporal
dimension
 Models in aetiology
 Methodological approaches
 Overview
 Objective
First :clinical work, try to discover the cause of the
mental disorders
Second: in seeking a wide understanding of
psychiatry, from clinical studies, community
surveys, or laboratory investigations
 The complexity of causes in psychiatry
 by two problems
The first problem is that causes are often remote in
time from the effects
The second problem is that a single cause may
lead to several effects. Conversely, a single effect
may arise from several different individuals, or by
multiple causes
 Overview
• An approach to etiology
• Biological factors, psychological
factors and social factors
• Biopsychosocial perspective
 The classification of causes in
temporal dimension
• To divide causes chronologically into
predisposing, precipitating, and perpetuating
(maintaining)
• Predisposing factors
from early life; in infancy and childhood
These are factors, many of them operating from
early life, that determine a persons vulnerability
to causes acting close to the time of the illness.
They include genetic endowment and the
environment in utero, as well as physical,
psychological, and social factors in infancy and
childhood.
 The classification of causes in temporal
dimension
Precipitating factors
Events that occur shortly before the onset of a
disorder and appear to have induced it .

They may be physical, psychological, or social. Physical

precipitating factors include, for example, cerebral
tumours or drugs. Psychological and social
precipitants include personal misfortunes such as the
loss of a job, and changes in the routine of life such as
moving home. Sometimes the same factor can act in
more than one way; for example a head injury can
induce psychological disorder either through physical
changes in the brain or through its stressful
implications to the patient.
 The classification of causes in
temporal dimension
Perpetuating factors
Prolong the course of a disorder after it
has been provoked
The interweaving of temporal and
biopsychosocial factors
 Biological Psychological Social
Predisposing Genes Upbringing Cultural
demands
Mothers Parental strife Poverty
alcoholism
Maternal health Personality Migration
in pregnancy traits

Precipitating Trauma Bereavement Retirement

Infections Exam failure Being robbed
Illicit drugs Being jilted Stock-market
loss
Perpetuating Malnutrition Bad marriage Demands at
work
Poor sanitation Conflict with Refugee status
others
 Methodological approaches
 Genetics
 Biochemical studies
 Brain-imaging methods
 Psychopharmacology
 Endocrinology
 Neuropathology
 Electrophysiology
 Psychology
 Sociology
 Genetics
• Population genetics (epidemiological
study)
• Cytogenetics and molecular genetic
• Population genetics
Family risk studies
Twin studies
Adoption studies
Mode of inheritance
 Genetics

• Family risk studies:

The results of family studies
– The risk of Schizophrenia.
Schizoaffective disorder, and
schizotypal personality is increased in
first-degree relatives of patients with
Schizophrenia.
– The risk of both Schizophrenia and
mood disorder is increased in first-
degree relatives of patients with
schizoaffective disorder.
– The risk of bipolar illness is not
 Genetics

Twin studies
The results of twin studies
– concordance rates among MZ pairs
is higher than that among
control(35-60 times)
– concordance rates are about 50%
for MZ and about 10% for DZ. It
might be expected that some
environmental factors relevant to
etiology.
 情感障碍的单卵双生与双卵双生的同病率
单卵双生 双卵双生
同病的双生子对
同病率 同病的双生子对 同病率
参考文献 数 / 总双生子对
(%) 数 / 总双生子对数 (%)
数
Luxenberger(193
3/4 75.0 0/13 0.0
0)
Rosanoff et
16/23 69.6 11/67 16.4
al(1935)
Slater(1953) 4/7 57.1 4/17 23.5
Kallman(1954) 25/27 92.6 15/55 23.6
Harvald and
10/15 66.7 2/40 5.0
Hauge(1965)
Allen et al (1974) 5/15 33.3 0/34 0.0
Bertelsen(1979) 32/55 58.3 0/52 17.3
总平均 95/146 65.0 39/278 14.0

数据未经年龄校正，诊断包括了双相和单相障碍
 Genetics
Adoption studies
The results of adoption studies
– The rate for Schizophrenia is greater
among the biological relatives of the
Schizophrenia Adoptees than among
the relatives of control.
– The finding supports the genetic
hypothesis.
双相障 碍生物 学亲 属中情 感障 碍患病 率为 31%
对照组 患病率 为 2%
被收养 和未被 收养 的双相 障碍 先证者 的亲 属患
 Genetics

Mode of inheritance
 The mode of inheritance is not simple :
dominant, recessive, sex-linked
 polygenic inheritance
 Genetics
• CELLULAR AND MOLECULAR GENETICS
• Cytogenetic studies
These aim to identify abnormalities in the
structure or number of chromosomes
• Linkage studies
These studies seek to identify the chromosomal
region likely to be carrying the genes
responsible for a disorder in a family or group of
families
• Association studies
polymorphism/allelic variant
 Biochemical studies
• Biochemical studies in psychiatry are difficult to
carry out for three main reasons
• 1. The living brain is inaccessible to direct study and
post-mortem tissue is not often available
• 2. Animal studies are of limited use because there
are no obvious parallels in animals to the mental
disorders found in man.
• 3. It is difficult to prove that any biochemical
abnormalities detected are causal and not secondary
either to changes in diet or in activity induced by the
mental disorder, or to the effects of drugs used in
treatment.
• In schizophrenia, the density of dopamine receptors
is increased
• In severe affective disorder, some studies have
found reduced 5-HT (serotonin) function
受体： 位于神经 元细 胞膜上 的蛋 白质复 合体 ，主要 分
布在 突触 部位－ 突触 后膜和 前膜 ，是特 定的信 息传 递识
别位 点。
 Brain-imaging methods

• More recently, brain-imaging methods

have been used to study biochemical
function in living brain tissue
• Structural imaging techniques
• Functional imaging techniques
（ PTSD=15. Victims without PTSD=12) 1. 脑结构分 析结 果

解剖位置

1= 左海马 (B),
2= 左前扣带 回 (C).
3= 双侧岛叶 (D),

患者上述 脑区灰质密 度低于对照 者

 创伤暴 露的 fMR I 结果

杏仁核
后扣带回
创伤 暴露 时， PTSD 患者杏仁 核、 后扣 带回过 度激 活
情绪词 汇识数 str oo p （与矿 难有关 的词 汇
）

受试 暴露于 与矿 难有关 的词 汇时， 相比

Non-PTSD 组， PTSD 组右侧海 马旁 回功能
减弱 。
受试暴露 于与 矿难有 关的 词汇时 ，相 比没有 应激 史的
患者，有 应激 史的 PTSD 患者 左侧颞 中回 、右侧 舌回 、右
侧颞下回 、左 侧颞上 回、 右侧额 上回 、右侧 前楔 叶、左 侧
内侧额叶 、右 侧中央 后回 和左侧 楔叶 等部位 激活 减弱。
 Psychopharmacology
• If a drug alleviates a disorder, and if the
mode of action of the drug is known,
then it might be possible to infer the
biochemical abnormality underlying the
disorder
 Endocrinology
• Tests have been used to determine
how hormonal activity changes in
psychiatric disorder. For example, it
has been shown that cortisol is
produced at an increased rate in
depressed patients.
• DST
•   精神 生化学 者和 精神病 遗传 学研究 工作 者
经过长 期对抑 郁症 患者的 研究 后发现 正常 人服
用地塞 米松后 ，通 过负反 馈机 制抑制 肾上 腺皮
质激素 的分泌 ，而 抑郁症 患者 则不同 ，血 浆皮
质醇浓 度升高 ，能 抵制地 塞米 松的抑 制作 用，
所以抑 郁症患 者服 用地塞 米松 后血浆 中皮 质醇
浓度较 正常人 和其 他精神 病患 者为高 ，这 是用
于诊断 抑郁症 的客 观依据 ，即 地塞米 松抑 制试
验（ DST ）。

     这一试验 方法 可以作 为内 源性抑 郁症 的

诊断、 分型、 评定 严重程 度的 辅助指 标
 Neuropathology
• Post-mortem brain studies have been
carried out for over a century, yielding
useful information about dementias
and other organic disorders
• “organic disorders” Vs “ functional
psychoses”
 Electrophysiology
• Electrophysiological recordings made
with electrodes on the skull surface (as
in electroencephalography) do not give
precise information about the nature and
site of abnormal brain activity and have
contributed little to the understanding of
psychiatric disorders, except for those
related to epilepsy
 Psychology
• Learning theory
• Classic conditioning :Learning through
association explains, for example, the
development of situational anxiety in phobic
patients following an initial attack of anxiety
in the situation. Swallow; saliva

Operant conditioning: The reinforcement of

behaviour by its consequences explains, for
example, the maintenance of disruptive
behaviour in some patients by the extra
attention that is provided by staff or
relatives when this behaviour occurs.
 Psychology
• Cognitive processes are concerned with aspects
of the ways in which patients select, interpret,
and act on the information from the sense organs
and memory stores. Some disorders are
maintained, in part, by the ways that patients
think about the physical symptoms associated
with emotional arousal. For example, patients
with panic disorder think that palpitations are a
precursor of a heart attack and so become more
anxious. Knowledge of these psychological
mechanisms led to the development of the
cognitive behaviour therapies.
 Psychology
• Coping mechanisms
• Personality factors
 Bleuler(1911) commented on the
frequency of abnormalities of
personality preceding the onset of
schizophrenia.
 Kretschmer(1936) suggested a
continuous variation between normal
personality ,schizoid personality, and
schizophrenia.
 Current finding suggest that the
schizophrenia illness may share a
common diathesis with schizotypal
personality and some related
personality disorder.
 精神障碍的病因学

• 心理因素
人格特征：癔症，分裂症等
人格指先天素质和后天习得性综合形成的
个体精神活动模式（情绪和行为特征）
。

人格特征与某些精神障碍有比较密切的联
系：
• 分裂样人格特征——孤僻、内向、敏
感不合群、多疑――易患精神分裂症
• 拘谨、胆小、抑郁、犹豫不决、追求
完美过分的性格特征――易患抑郁症
、强迫症
• 过分外向和活跃、易激动、行为冲动
、情绪波动大――双相情感障碍
• 固执、偏激、敏感、多疑、自我中心
、拒绝批评――偏执性精神障碍的人
格特征
• 自我中心、好表演、暗示性强、情绪
波动――癔症的性格特征
• 自幼形重形成的明显反常的个性特征
与人格格不入，社会适应不良――人
格障碍
 Psycho-social factors
• Stress-diathesis mode
• Stress
• Life events
精神障碍的病因学

精神

性格特
征

癔症
Peaceful
time
 What’s stress:
Hostage event of Moscow
more than 200 hostages
 What’s stress:
Airplane accident
 Earthquake of
Tangshan
160,000 death 240,000
invalid
 9
.11
War
SARS
 Sociology
• Sick role
• Social class
• Life events
• Culture
• Migration
 Sociology
• Social class :Status within society, determined
usually on the basis of job or income. There is an
association between schizophrenia and low social
class . Life event A stressful aspect of living that may
be associated with changes in health status.
• Life events :have been shown to contribute to the
onset and maintenance of schizophrenia, affective
disorder, and some other psychiatric disorders.
• Migration :Movement between societies. Migration
can be a stressful experience and it has been
suggested as a cause of mental disorder.
 精神障碍的病因学

• 社会因素
环境因素：大气污染、噪音、交通混乱、居住拥
挤、
人际关系紧张、社会变动巨大等。
文化因素：民族文化、社会风俗、宗教信仰、
生活
习惯等如马来西亚、印尼等东南亚国
家
或地区有恐缩症 (Koro) 。
移民因素：移居国外与移居本国的人群相比，前
者
 精神障碍的病因学

• 小结
生 物 学 因 素 和 心 理 社 会 因 素 ， 即内 在 因 素 和
外在因素在精神疾病的 发 病当中共同起着决定性
的作用。但 应 注意到二者的作用并非平分秋色。
在某 些精神 疾病 中某种因素 起着主 导作 用，而 另
一些疾病中则另一些因素起决定性的影响。
大量的临床实践证明，许多精神疾病的起
因，不是单一的因素，而是多种因素共同作用的
结果。