neurological disorders和psychiatric disorders的区别

NeuroTimes | Nov. 7, 2015

Credits: BMJ

最近有人指出,neurological disorders(神经疾病)和psychiatric disorders(精神疾病)的说法应该统一,以强调所有大脑疾病的根源是大脑的生理。然而,BMJ上一篇文章,通过voxel-based morphometry (VBM)的meta-analysis,说明neurological disorders和neurological disorders还是存在差异的。

结果显示,neurological disorders中basal ganglia, insula, sensorimotor和temporal cortex的损伤更多,而psychiatric disorders中,cingulate, medial frontal, superior frontal和occipital cortex损伤更多。这显示了,neurological disorders更多涉及感觉和运动损伤,而psychiatric disorders更多涉及自我和社会认知的损伤。


这场争论也让我们更多去思考,psychiatric disorder到底是什么。像The Perspectives of Psychiatry里说的那样,psychiatrists的工作不仅关注身体(body),而且关注心智(mind),而且是社交环境下的心智。这比其他疾病的诊断更加复杂。

“In the everyday world of the clinic, psychiatrists are distinguished from other medical specialists not because they are concerned with “minds” rather than “bodies”, but because they focus on complaints appearing in people's thoughts, perceptions, moods, and behaviours rather than their skins, bones, muscles and viscera … The diagnostic process may be difficult, but causal explanations are always complex and depend on the physician's capacity to evaluate issues ranging from intermediary metabolism (a “body” issue) to interpersonal misunderstanding (a “mind” issue). Psychiatric concerns thus extend from the ultrastructure of the body to the relationship of groups of minds within a social context.”

neurologist或者psychiatrists与纯粹的scientists看问题视角不同,有时候更像一群更单纯更有情怀的人,Oliver Sacks写幻觉的时候就说过,在论述幻觉机制和神经间可能存在的相互关联时,他更关注的是尽心体会病人和笔友的感受,以及幻觉对他们自身的影响,因为幻觉的力量只能以第一人称加以感受。

I think of this book, then, as a sort of natural history or anthology of hallucinations, describing the experiences and impact of hallucinations on those who have them, for the power of hallucinations is only to be understood from firstperson accounts.




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