精神病学基础教学大纲

1、精神病学基础教学大纲（供 精神卫生 专业本科使用）济宁医学院精神卫生学院（系、部）二 00 六 年 六 月精神病学基础课程教学大纲课程主任：王克勤开课单位：精神病学基础教研室课程编码：0310014课程中文名称： 精神病学基础课程英文名称：The Foundation for Psychiatry精神病学基础课程是精神卫生专业本科高等教育的专业基础课程。其基本任务是为更好的预防和治疗精神疾病提供有效的理论基础。精神疾病是特殊复杂的，这主要在于人的精神活动既受生物、心理、社会和自然环境的多种影响， 又反过来能影响到这其中的诸多因素。 但人的精神活动的物质基础是大脑，不管是什么样的原因，通过什么样

2、的途径，最终都要作用于大脑，才能导致精神活动 异常。精神病学基础以脑科学为基础，以与精神病学密切有关的功能神经解 剖、神经生化、认知神经科学、神经心理学等领域的相关知识为主要讲授内容， 是集理论性与应用性为一体的学科。设置本课程的目的是：使学习者全面了解与精神病学密切有关的神经生物学 和心理社会科学内容，系统掌握有关的功能神经解剖、神经生化、神经发育、神 经可塑性、认知神经科学、病因学、心理社会科学等方面的基础知识，具备在临 床工作中全面、客观的认识、分析、判断精神疾病的实际技能，从而胜任精神科 临床医疗和教学工作。学习本课程的要求是：学习者应认识到、生物 -心理-社会这种医学模式在精 神科尤

3、为重要。在学习中，要系统掌握：1、精神活动和行为的神经生物学基础， 2、社会因素和心理活动及行为与大脑的相互作用、相互影响，3、人格和行为模式的形成和可变性。学会在临床工作中自觉地从生物、心理、社会三个方面全面、 深刻地认识、分析、判断具体的疾病。提高诊断、治疗、预防精神疾病的水平， 为成为一名高水平的精神科医生打下良好的基础。先修课程要求：神经解剖学、神经生化学、神经病理学、病理生理学、内分 泌学和遗传学本课程计划42学时，3.5学分选用教材：自编英文版精神病学基础教学手段：课堂讲授考核方法：闭卷考试教学进程安排表:早节教学内容学时理论实践合计1Introduction of Brain a

4、nd Behavior22Neural Sig nali ng23Intraneuronal sig nali ng pathways24Neurotra nsmitter45Limbic Structure and Basal Gan glia26Cerebral Cortex47Neuropsychological Developme nt28Neural Plasticity29Memory210Emoti on and Social Cogn itive211Aetiology of psychiatry412Con tributi ons of the Psychosocial Sc

5、ie nces to Huma n Behavior613Theories of Pers on ality and Psychopathology414Psychology and Psychiatry:Psychometric andNeuropsychological Test ing4合计42第一章 脑与行为概述一、学习目的通过本章的学习， 明确为什么研究脑和行为， 理解脑和正常及异常精神活动的关系， 掌握神经系统功能原则。本章计划 2 学时。二、课程内容1. Why Study Brain and Behavior?The human brain is the biological

6、substrate for all of our emotions, cognitive abilities, and behaviors that is, everything we feel, think, and do. The accumulated research suggests three reasons for linking the study of brain and behavior: A growing list of behavioral disorders can be explained and possibly cured by understanding t

7、he brain. Indeed, more than 2000 disorders may in some way be related to brain abnormalities. The brain is the most complex living organ on Earth and is found in many different groups of animals. How the brain produces both behavior and human consciousnessis a major unanswered scientific question.2.

8、 Mental health and BrainWe are defined by our brains more than any other organ in our body. The brain offers endless possibilities; when the brain malfunctions, however, an individual may face an unwelcome disorder, in many cases, a live-in guest for life.The number of people suffering from mental i

9、llnesses varies; whereas schizophrenia affects about 1% of the population, depression affects about 15%, as does Alzheimer ' s disease in people ove6r5. Although exciting research is currently being conducted in neuroscience laboratories all over the world, a cure for mental illness is still elu

10、sive.3. Neuroscience in an Evolutionary ContextEvolution results from the complex interplay of biology and environment, of genes and experience. This ongoing interplay influences how humans and other animals behave and learn from earliest infancy through old age. Experience can influence the message

11、sthat genes produce, and genes, in turn, can influence an organism ' s environment anedxperience.Predictable developmental stages are initiated by the genetic code, but the details of development can be influenced by chance, by experience, and by the environment.The dance of genetic and experien

12、tial influences continues throughout our lives just as it does in the continuing evolution of our species.Experiences can turn the genes in neurons on, and the way in which genes are turned on influences experience. The influence of genes and experience is not simply to form neurons and place them i

13、n appropriate relations with one another but also to eliminate excess or faulty neurons and connections, analogously to the sculpting of a statue from an unshaped block of marble.4. The Principles of Nervous System FunctionPrinciple 1: Information-Processing Sequenee in the Brain Is“In f Integratef

14、OutPrinciple 2: Sensory and Motor Functions throughout the Nervous System Are Separated Principle 3: Inputs and Outputs to the Brain Are Crossed Principle 4: Brain Anatomy and Function Display Both Symmetry and Asymmetry Principle 5: The Nervous System Works through Excitation and Inhibition Princip

15、le 6: The Nervous System Functions on Multiple Levels Principle 7: Brain Components Operate Both Parallelly and HierarchicallyPrinciple 8: Functions in the Brain Are Both Localized in Specific Regions and DistributedPrinciple 9: Patterns of Neural Organization Are Plastic三、重点、难点提示和教学手段（一）重点：神经系统的功能原

16、则及行为意义；精神卫生和脑的关系。（二）难点：神经系统的功能原则。（三）教学手段：多媒体教学，尽量运用图片和录像增加学生的感性认识。双语教 学，讲授法（结合提问、临床病例等进行启发式教学等）。（四）教具：多媒体电脑、多媒体投影仪、投影屏幕、多媒体课件、激光笔等四、思考与练习1精神卫生专业的工作者为什么要研究大脑 2脑的功能原则的行为意义第二章 神经信号传递一、学习目的通过本章的学习，理解神经细胞信息传递的电 -化学转变过程，掌握神经细胞之间 信息传递的步骤和涉及的结构，了解不同类型的神经细胞膜电位。本章计划 2 学时。二、课程内容1. Nerve CellsIn general, neuron

17、s are composed of four morphologically identified regions: (1) the cell body or soma, which contains the nucleus and can be considered the metabolic center of the neuron. (2) The dendrites, processes that arise from the cell body, branch extensively, and serve as the major recipient zones of input f

18、rom other neurons. On some neurons, the shafts of the dendrites are smooth. On others, the shafts show numerous short spines. (3) the axon, a single process that arises from a specialized portion of the cell body (the axon hillock) and conveys information to other neurons; and (4) the axon terminals

19、, fine branches near the end of the axon that form contacts (synapses) generally with the dendrites or the cell bodies of other neurons, release neurotransmitters, and thereby provide a mechanism for interneuronal communication.2. Electrical Potentials across Nerve Cell MembranesReceptor potentials

20、are due to the activation of sensory neurons by external stimuli, such as light, sound, or heat. Neurons have a means of generating a constant voltage across their membranes when at rest. This voltage, called the resting membrane potential. Activation of the synapses generates synaptic potentials, w

21、hich allow transmission of information from one neuron to another. The electrical signals conducted along axons (or muscle fibers) by which information is conveyed from one place to another in the nervous system are calleadction potentials.3. Channels and Transporters3.1. Ion ChannelsSeveral channel

22、 categories are recognized. Passive (non-gated) channels are open at all times, permitting ions to move across the membrane. Voltage-gated channels contain a voltage-sensitive string of amino acids that cause the channel pore to open or close in response to changes in membrane voltage. Transmitter-g

23、ated channels abound in postsynaptic membranes. Some are activated directly by transmitter molecules, others indirectly. Transduction channels are activated by peripheral sensory stimulation.3.2. Active TransportersSeveral types of active transporter have now been identified. Although the specific j

24、obs of these transporters differ, all must translocate ions against their electrochemical gradients. Moving ions uphill requires the consumption of energy, and neuronal transporters fall into two classes based on their energy sources. Some transporters acquire energy directly from the hydrolysis of

25、ATP and are called ATPase pumps. The second class of active transporter does not use ATP directly, but depends instead on the electrochemical gradients of other ions as an energy source.3.3. Functional Properties of the Na+/K+ PumpThis channel is capable of simultaneously extruding Na+ and importing

26、 K+. Three sodium ions are exported for every two potassium ions imported. In both cases, the movement is against the existing concentration gradient. The required energy for this activity is provided by the ATPase enzyme that converts ATP to ADP. The greater the amount of Na+ in the cytosol, the gr

27、eater is the activity of the enzyme. The activity of the Na+-K+ pump is estimated to account for 20 40%of the brain '巳nergy consumption, indicating its importance for brain function.4. Synaptic TransmissionThe human brain contains at least 100 billion neurons, each with the ability to influence

28、many other cells. Clearly, sophisticated and highly efficient mechanisms are needed to enable communication among this astronomical number of elements. Such communication is made possible by synapse,s the functional contacts between neurons. Two different types of synapse electrical and chemicalcan

29、be distinguished on the basis of their mechanism of transmission.4.1. Electrical SynapsesElectrical synapses are scarce in the mammalian nervous system. The structure of an electrical synapse consists of the presynaptic and the postsynaptic element. The membranes of the two communicating neurons com

30、e extremely close at the synapse and are actually linked together by an intercellular specialization called a gap junction. Gap junctions contain precisely aligned, paired channels in the membrane of the pre- and postsynaptic neurons, such that each channel pair forms a pore.4.2. Chemical SynapsesTh

31、e typical chemical synapse comprises a presynaptic membrane, a synaptic cleft, and a postsynaptic membrane. The presynaptic membrane belongs to the terminal bouton, the postsynaptic membrane to the target neuron. The bouton contains synaptic vesicles loaded with one or more neurotransmitters, togeth

32、er with numerous mitochondria. Neurotransmitter is released from the bouton by exocytosis, traverses the narrow synaptic cleft, and activates receptors in the postsynaptic membrane. Underlying the postsynaptic membrane is a subsynaptic web, in which numerous biochemical changes are initiated by rece

33、ptor activation.4.3. Signal Transmission at Chemical SynapsesTransmission at chemical synapses is based on the elaborate sequence of events. The process is initiated when an action potential invades the terminal of the presynaptic neuron. The change in membrane potential caused by the arrival of the

34、 action potential leads to the opening of voltage-gated calcium channels in the presynaptic membrane. Because of the steep concentration gradient of Ca2+ across the presynaptic membrane (the external Ca2+ concentration is approximately 10-3 M, -7 whereas the internal Ca2+ concentration is approximat

35、ely 10 M), the opening of these channels causes a rapid influx of Ca2+ into the presynaptic terminal, with the result that the Ca2+ concentration of the cytoplasm in the terminal transiently rises to a much higher value. Elevation of the presynaptic Ca2+ concentration, in turn, allows synaptic vesic

36、les to fuse with the plasma membrane of the presynaptic neuron. The Ca2+ -dependent fusion of synaptic vesicles with the terminal membrane causes their contents to be released into the synaptic cleft.5. Neurotransmitters5.1. Criteria That Define a NeurotransmitterThe neurotransmitter is the substanc

37、e that is released by synaptic terminal for the purpose of transmitting information from one nerve cell to another. Several criteria should be fulfilled for a substance to be accepted as a neurotransmitter. The substance must be present within the presynaptic neuron. Clearly, a chemical cannot be se

38、creted from a presynaptic neuron unless it is present there. Because elaborate biochemical pathways are required to produce neurotransmitters, showing that the enzymes and precursors required to synthesize the substance are present in presynaptic neurons provides additional evidence that the substan

39、ce is used as a transmitter. The substance must be released in response to presynaptic depolarization, and the release must be Ca2+ -dependent. Specific receptors for the substance must be present on the postsynaptic cell. A neurotransmitter cannot act on its target unless specific receptors for the

40、 transmitter are present in the postsynaptic membrane. One way to demonstrate receptors is to show that application of exogenous transmitter mimics the post-synaptic effect of presynaptic stimulation. A more rigorous demonstration is to show that specific antagonist molecules, whether delivered thro

41、ugh the circulation or by iontophoresis, must block the effect of the putative ('thought to be') transmitter. The physiologic mode of termination of the transmitter effect must be identified, whether it be by enzymatic degradation or by active transport into theparent neuron or adjacent neur

42、oglial cells.5.2. Categories of NeurotransmittersThe three major types of neurotransmitters in the brain are the biogenic amines, the amino acids, and the peptides. Recent data have led to the identification of at least four other classes of neurotransmitters nucleotides, gases, eicosanoids, and ana

43、ndamides.5.3. Neurotransmitter Synthesis and StorageThe synthesis of small-molecule neurotransmitters occurs locally within presynaptic terminals. The enzymes needed to synthesize these transmitters are produced in the neuronal cell body and transported to the nerve terminal cytoplasm. The precursor

44、 molecules required to make new molecules of neurotransmitter are usually taken into the nerve terminal by transporters found in the plasma membrane of the terminal.The enzymes synthesize neurotransmitters in the cytoplasm of the presynaptic terminal and the transmitters are then loaded into synapti

45、c vesicles via transporters in the vesicular membrane. For some small-molecule neurotransmitters, the final steps of synthesis occur inside the synaptic vesicles. Most small-molecule neurotransmitters are packaged in vesicles 40 to 60 nm in diameter, the centers of which appear clear in electron mic

46、rographs; accordingly, these vesicles are referred to as small clear-core vesicles.Neuropeptides are synthesized in the cell body of a neuron, meaning that the peptide is produced a long distance away from its site of secretion. To solve this problem, peptide-filled vesicles are transported along an

47、 axon and down to the synaptic terminal via fast axonal transport. Neuropeptides are packaged into synaptic vesicles that range from 90 to 250 nm in diameter. These vesicles are electron-dense in electron micrographshence they are referred to as large dense-core vesicles.5.4. Coexistence of Differen

48、t NeurotransmittersIt is now clear that many types of neurons synthesize and release two or more different neurotransmitters. When peptide and small-molecule neurotransmitters act as co-transmitters at the same synapse, they are differentially released according to the pattern of synaptic activity:

49、low-frequency activity often releases only small neurotransmitters, whereas high-frequency activity is required to release neuropeptides from the same presynaptic terminals.5.5. Neurotransmitter ReleaseRelease of transmitter from a neuron is triggered by the arrival of a propagated nerve impulse at

50、its terminals. This wave of excitation causes the opening of voltage-gated Ca2+channels or mobilization of Ca2+ from intracellular stores (e.g. the endoplasmic reticulum). As a result, there is a phasic increase in free intracellular Ca2+ in regions of the terminal adjacent to the site of transmitte

51、r release (the 'active zone'). The subsequent fusion of neurotransmitter storage vesicles with the axolemma, together with the extrusion of their contents into the synapse, is thought to take about 100-200 卩 sthis cascadeis therefore fast eno ugh to effect rapid sig nali ng betwee n neurons.

52、5.6. Receptor-Mediated Modulation of Transmitter ReleaseRegulation of transmitter release does not rest solely on the frequency at which nerve impulses reach the terminals. It is now generally accepted that there are receptors on nerve terminals which, when activated by released transmitter, attenua

53、te its further release; these presynaptic receptors are known as 'autoreceptors'. Many different types of neurons appear to have auto-receptors, including those that release acetylcholine, dopamine, GABA, 5-HT, and histamine.2+5.7. Ca -Independent Release of TransmitterIt is now well establi

54、shed that transmitter in the cytoplasm of neurons can be released by a process which is not dependent on Ca2+. For monoamines, this is best illustrated by the actions of amphetamine and its analogues. Studies of a range of substituted amphetamines have confirmed that amphetamine-induced release of 5

55、-HT represents a reversed efflux of transmitter on the membrane-bound carrier.5.8. Termination of the Action of NeurotransmittersAfter a neurotransmitter has been secreted into the synaptic cleft, it must be removed to enable the postsynaptic cell to engage in another cycle of synaptic transmission.

56、 The removal of neurotransmitters involves diffusion away from the postsynaptic receptors, reuptake into nerve terminals or surrounding glial cells, degradation by specific enzymes, or a combination of these mechanisms. Specific transporter proteins remove most small-molecule neurotransmitters (or t

57、heir metabolites) from the synaptic cleft, ultimately delivering them back to the presynaptic terminal for reuse.6. Neurotransmitter ReceptorsAll neurotransmitters exert their effects by activating membrane-associated proteins called receptors. When receptors are ligand-gated ionic channels, they ar

58、e ionotropic receptors, whereas metabotropic receptors generally refer to receptors that are coupled to G proteins and produce a modification of the concentration of a second, intracellular messenger or the modulation of an ionic channel. Each neurotransmitter stimulates an array of receptors, thereby eliciting a number of postsynaptic responses. Moreover, responsesto a given neurotransmitter can be modified as a result of the simultaneous activation of receptors for another neurotransmitter on the same target