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[焦虑、攻击性、激动和抑郁:精神病理学方面]

[Anxiety, aggression, agitation and depression: psychopathologic aspects].

作者信息

Braconnier A, Jeanneau A

机构信息

Association de Santé mentale du XIIIe, arrondissement, Paris.

出版信息

Encephale. 1997 Jun;23 Spec No 3:43-7.

PMID:9333560
Abstract

While clinical experience has long since shown that there are different types of depression, in particular anxious and hostile depressions, the psychopathological analysis of the various forms remains of current interest. At least four psychopathological models are currently available. The first raises the question of the continuity between reactions to separation, particularly studied in children, and the clinical expression of certain forms of depression in adults. In many aspects, the latter suggest the sequence: protest-despair-detachment. The second model raises the question of the relationship between the depressive disorder and the organization of certain personalities. The considerable comorbidity between the borderline personality and affective disorders suggest that these two different disorders share a common dimension. The third-cultural-model hypothesizes a relationship between the sociocultural prohibition of aggressive responses and the incidence of depression. The fourth model is based on the existence of a specific biological constraint related to abnormalities of serotonin metabolism, to which dysregulation of anxious and aggressive-impulsive behavior patterns during depression are considered related. In conclusion, it may be considered that several models, in particular that of reaction to separation, may, at least in part, account for "positive-expression" depression, but that at least two questions have still to be answered: that regarding the relationships between depression and personality, and that concerning the relationships between the psychopathological constraints related to serotonin metabolism dysfunction and the "positive" expressions.

摘要

长期以来,临床经验表明存在不同类型的抑郁症,尤其是焦虑型和敌对型抑郁症,对各种形式的精神病理学分析目前仍备受关注。目前至少有四种精神病理学模型。第一种模型提出了对分离反应(特别是在儿童中研究的)与成人某些形式抑郁症的临床表达之间连续性的问题。在许多方面,后者显示出这样的顺序:抗议 - 绝望 - 超脱。第二种模型提出了抑郁症与某些人格结构之间关系的问题。边缘型人格障碍与情感障碍之间的显著共病现象表明,这两种不同的障碍具有共同的维度。第三种文化模型假设社会文化对攻击反应的禁止与抑郁症发病率之间存在关系。第四种模型基于与血清素代谢异常相关的特定生物学限制的存在,抑郁症期间焦虑和攻击冲动行为模式的失调被认为与之相关。总之,可以认为几种模型,特别是分离反应模型,可能至少部分地解释了“阳性表达”抑郁症,但至少仍有两个问题有待回答:一个是关于抑郁症与人格之间的关系,另一个是关于与血清素代谢功能障碍相关的精神病理学限制与“阳性”表达之间的关系。

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