TE||Psychiatric illness
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导读
神经病和精神病的区别
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听力|精读|翻译|词组
Psychiatric illness
精神疾病
英文部分选自经济学人Science and technology版块
Who is to decide, when doctors disagree?
医生意见相左时，谁来做决定？
A huge international collaboration is attempting to get to the bottom of psychiatric illnesses
大型国际合作组织-头脑风暴联盟探寻精神疾病的根源
DISEASES of the psyche have always been slippery things. Schizophrenia, bipolar disorder, major depression and a host of others have no visible markers in the brain. Their symptoms overlap sufficiently that diagnoses may differ between medical practitioners, or even vary over time when given by a single practitioner. In this they are unlike neurological diseases. These either leave organic traces in the brain that, though not always accessible before a patient’s death, are characteristic of the condition in question, or cause recognisable perturbations of things such as electroencephalograms.
精神疾病向来非常棘手。精神分裂症、躁郁症、重度抑郁症及其他多种病症都无法根据脑部症状显著区分开来。。这些疾病有许多症状都差不多，面对同一种症状，不同的医生可能会诊断出不同的结果，甚至即使是同一名医生，在病患患病的不同时期诊断，其结果也可能会不同。在这方面，它们又和神经系统疾病不同。后者要么会表现在在脑内的组织中（虽然并不是总能在病人去世之前发现），反应出某种疾病的特征，要么会体现在诸如脑电图这类能识别脑部异常的仪器上。
注释：
bipolar disorder , also bipolar affective disorder , and also manic depression 双向型障碍，躁狂抑郁性精神病简称躁郁症（摘自《牛津高阶英汉双解词典》）
The impulse to categorise, though, is enormous—as witness the ever greater number of conditions identified in successive editions of the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association. That is because diagnosis and treatment go hand in hand. But if diagnostic categories are misconceived then treatment may be misapplied. In this context a paper published recently in Science, by a group calling itself the Brainstorm Consortium, is helpful. The consortium has brought together many research groups who work on various psychiatric diseases, as well as on neurological diseases, and has run their collective data through the wringer.
但是人们有澎湃的动力对精神疾病进行分类，在美国精神医学学会《精神疾病诊断与统计手册》的后续版本中，刊登的病例越来越多。鉴于诊断和治疗有连带关系，如果误诊了疾病类型，那么就会用错治疗方法。在此背景下，《科学》杂志近期刊登的一篇论文则大有裨益，这篇论文由整合了诸多研究团队的头脑风暴联盟撰写。这些团队研究各种各样的精神疾病以及神经系统疾病，且绞尽脑汁地运用汇总数据。
注释：
1.The Diagnostic and Statistical Manual of Mental Disorders：简称为DSM，由美国精神医学学会（American Psychiatric Association，简称为APA）出版，是一本在美国与其他国家中最常使用来诊断精神疾病的指导手册。摘自百度百科
2. 习语go hand in hand: if two things go hand in hand , they are closely connected and one thing causes the other 密切关联；相连带；栗子：Poverty and poor health often go hand in hand. 贫困和健康不良常有连带关系。（摘自《牛津高阶英汉双解词典》）
3.习语go through the wringer: (informal) to have a difficult or unpleasant experience, or a series of them 受尽磨难；历尽艰难
Through some ordeal, difficulty, trial, or punishment; through an unpleasant experience. Between my mother's boutwith cancer, Jenny losing her job, and the bank threatening to foreclose on the house, our family has really been putthrough the wringer this year. Jake wasn't a great fit for the military, and he was constantly being put through thewringer for disobedience.
节选自https://idioms.thefreedictionary.com/through+the+wringer
In particular, the consortium’s researchers have looked at what are known as genome-wide association studies, or GWASs. In these, thousands of genomes are searched in order to identify places where differences between people’s DNA seem associated with the presence or absence of particular diseases or symptoms. Past GWASs, comparing pairs of diseases, have shown overlapping genetic involvement in some psychiatric illnesses. But, by pooling the work of so many groups, the Brainstorm Consortium was able to go beyond this and cross-correlate the putative genetic underpinnings of 25 psychiatric and neurological problems. In all, the consortium looked at 265,218 cases of different brain disorders and 784,643 healthy volunteers who acted as controls.
值得一提的是，联盟研究人员还进行了全基因组相关性研究，简称GWASs。在此过程中研究了上千组基因，以便找出DNA不同之处与特定疾病或症状存在与否的相关性。过去的GWASs研究中，把不同的疾病两两一组进行比对后发现，有些精神疾病之间有相同的基因问题。但是头脑风暴联盟的研究更上一层楼。该联盟把众多研究小组的成果汇聚在一起，，可以将25种精神和神经问题的假定基因基础进行交叉比对研究。总之，联盟研究了265,218宗各不相同的大脑紊乱病例，并与784,643名健康志愿者的基因进行了对比。
Metamorphoses Of the 25 conditions in question, ten are conventionally classified as psychiatric. Besides schizophrenia, bipolar disorder and major depression, these include obsessive-compulsive disorder, anorexia nervosa and Tourette’s syndrome. Neurological problems, the remaining 15 conditions, include Alzheimer’s disease, Parkinson’s disease, various forms of epilepsy, strokes and migraines.
研究中的25种疾病变体中，十种通常被归类为精神疾病。除了精神分裂症，躁郁症和重度抑郁症，这十种还包括强迫症，神经性厌食症及杜尔雷斯综合征。剩下的15种则是神经系统疾病，包括阿尔茨海默病，帕金森病，各种形式的癫痫，中风以及偏头痛。
注释：
重度抑郁症：Major depression, also known as unipolar or major depressive disorder, is characterized by a persistent feeling of sadness or a lack of interest in outside stimuli.
There were many underlying genetic correlations between pairs of psychiatric disorders. Assuming these are in part causative of disease, such overlaps go a long way to explaining the slippery nature of psychiatric diagnosis, by providing a genetic explanation for shared symptoms.
同组的精神疾病之间存在很多潜在的基因相关性。假设这些相关性在一定程度上导致疾病的产生，基因可以解释这些相同的症状，那么这些相关性会对解决精神疾病诊断棘手的难题起到举足轻重的作用。
There were also, however, observable patterns in the data that might help refine the process of classification. Major depression has at least some positive genetic correlation with each of the other nine conditions. Schizophrenia, bipolar disorder, anxiety disorders and attention-deficit hyperactivity disorder (ADHD) are strongly correlated with one another, as well as with major depression. Anorexia nervosa, obsessive-compulsive disorder and schizophrenia also cluster, as do Tourette’s syndrome and obsessive-compulsive disorder. The only psychiatric illness that showed no significant correlation with the others was post-traumatic-stress disorder.
然而，观察数据中的模式也许能完善精神疾病的分类方法。重度抑郁症和其他九种疾病至少有一定程度的正向基因相关性。精神分裂症、躁郁症，焦躁症及儿童多动症（ADHD）之间不仅存在很强的相关性，与重度抑郁症的相关性也很强。神经性厌食症，强迫症和精神分裂症归为同一类别，杜尔雷斯综合征和强迫症归为同一类别。而创伤后遗症，是唯一一种和其他疾病没有显著关联的精神疾病。
Such clustering was absent from most neurological disorders. In particular, Alzheimer’s disease, Parkinson’s disease, multiple sclerosis and epilepsy all stood independent from each other. Nor, with the exception of migraine, which clustered with Tourette’s, major depression and ADHD, did neurological disorders show much correlation with psychiatric ones. This study therefore confirms genetically the idea that the set of diseases dealt with by psychiatry is indeed distinct from that dealt with by neurology and explains why psychiatric disease is a hydra-headed monster that is difficult to pin down.
大多数神经系统疾病并不适用这种分类方法。特别是阿尔茨海默病、帕金森病，多发性硬化症和癫痫这四种疾病，互相之间毫无关联。此外，除了与偏头痛同为一类的杜尔雷斯综合征，重度抑郁症和儿童多动症之外，神经系统疾病和精神疾病之间也无太大关联。因此，这项研究从基因的角度证实了精神病学领域的一系列疾病与神经病学领域的一系列疾病截然不同，也进一步解释了为什么精神疾病是难以确定的顽疾。
注释：
1.儿童多动症，又称注意力缺陷多动障碍（ADHD, attention-deficit/hyperactivity disorder），为一类神经进行性精神疾病，患儿的智力正常或接近正常，但学习、行为及情绪方面有缺陷，主要表现为与年龄和发育水平不相称的注意力不易集中、注意广度缩小、注意时间短暂，不分场合的活动过多、情绪易冲动等，并常伴有认知障碍和学习困难。摘自网络
2. 阿尔兹海默病（AD，Alzheimer’s Disease），为一类慢性神经退化性精神疾病。该病的早期表现为短期记忆丧失，后期常出现失语、无方向感、心情波动剧烈、抑郁、丧失生活自理能力、以及无法控制自身行为，最后因器官衰竭而死。确诊后预期存活时间为三至九年。常发生于65岁以上老人，又称“老年痴呆症”。
3.帕金森病（PD，Parkinson’s Disease），为一类中枢神经系统退化性疾病，主要影响运动神经系统。早期症状为不由自主的颤抖、肌肉僵硬、行动迟缓、行走困难，随时间推移逐渐加剧。三分之一的帕金森病患者同时存在重度抑郁或者焦虑症。60岁以上老人较其他年龄段容易发病，且男性患者数量多于女性（3:2），确诊后预期存活时间为七至十四年。
4.多发性硬化症（MS，multiple sclerosis），为一类由中枢神经系统神经信号传导病变引发的疾病，症状包括视觉等感官障碍、肌肉无力、认知障碍、平衡障碍等。可能以爆发形式出现，而平稳期症状完全消失。常见发病人群为二十至五十岁，且女性发病率为男性的两倍。MS患者和正常人的平均寿命相比，预计会缩短五至十年。
5.癫痫（epilepsy），为一系列神经系统病变引发的综合结果，最常见的症状为全身性的剧烈震颤，短则不及一秒、长则数十分钟，由此造成严重的外伤和骨折。
6.偏头痛（migraine），中度至重度的头部反复疼痛，可能伴随呕吐和异常敏锐的五感。约三分之一的患者在头痛发作前，会看见一圈光晕，但看见光晕之后痛感也可能并不发作。
7.杜尔雷斯综合征（TS，Tourette’s），为一类常发病于少年儿童的神经内科疾病。主要包括声音和运动抽动，具体表现为清嗓子、耸肩、摇头晃脑，而患者本身并无主观意识或习惯动作，严重程度与患者所受的心理压力相关。到青春期后症状会逐步减轻，21岁后完全消失。
8.重度抑郁症（MDD，major depression disorder），为一类精神异常疾病，典型症状为持续性心情低落、自尊心低下、对从前喜欢的活动丧失兴趣、容易疲惫、无原因的疼痛、部分还伴有幻听、幻视等。目前认为遗传、环境和心理因素的综合作用可以导致该病，自杀的人群中，半数以上身患重度抑郁症。
9.Hydra-headed monster：九头蛇(hydra)源于希腊神话，是一头长有九个头的怪兽。当切去一个头后，在相同的位置会迅速长出两个头。英雄海格力斯在伙伴的帮助下，砍去一个头后立刻用火把烧灼伤口，阻止新头再生，最终杀死了九头蛇。英语从希腊文中吸取hydra一词，来表达难以彻底消除的弊病、不良事物的意思，也有“野火烧不尽，春风吹又生”的意味。
Going from the sorts of GWASs on which the consortium relied to an underlying understanding of psychiatric illness will, though, be a long haul. The genetic differences picked out are often things called single-nucleotide polymorphisms (SNPs), which are places in the genome where a lone pair of bases, the chemical letters in which genetic messages are written, can vary between individuals. Frequently, such SNPs are not even in the bits of the genome that directly encode proteins. Rather, they are in what was once called junk DNA, because its function was unknown.
然而，要从各种全基因组相关性研究发展到根本认识精神疾病，该联盟还有漫长的路程要跋涉。对基因差异的研究往往是针对名为单核苷酸多太性(SNPs)的研究。SNPs存在于基因组的碱基对中，是编码基因信息的化学单位，因个体的不同而不同。直接编码蛋白质的基因片段中常常不存在这些SNPs。相反，它们存在于垃圾DNA中——过去没有发现这些DNA的功能，垃圾DNA由此得名。
Recent research suggests that much of the junk serves to regulate when genes are translated into proteins, and how much protein is thus produced. That, in turn, determines how cells grow and what sorts of cell they turn into. With luck, analysing the genetic patterns exposed by studies such as this will eventually point out where to look in the brain’s microanatomy to find whatever miswiring is causing psychiatric disease. For, though that may not be visible at the moment, even the psyche must somehow be manifested physically in the brain and its debilitations must thus be recognisable. When that moment of understanding occurs psychiatry will truly have taken a great leap forward.
最新的研究显示，大部分“垃圾DNA”可以调节基因编码蛋白质的时间，控制蛋白质合成的数量，进而决定细胞生长的程度及生成的类型。如果一切顺利的话，详细分析这类研究揭示的基因模式，最终，我们有可能在脑组织中，找出导致精神疾病的那个异常部位。虽然这一目标看似遥不可及，但终有一日人类的精神世界也能具象地在大脑中反映出来，因此有缺陷的部位便显而易见。只有达到这种程度的认知，精神病学才会取得重大突破。
翻译组：
Nikolai，男，小硕, science追随者
Yifei：女，英专硕士，专八，catti二笔
Minjia，女，广告策划，经济学人读者
校核组：
Li Xia, 女， HR, 经济学人发烧友
Helga，女，笔译民工，经济学人爱好者
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观点|评论|思考
本次观点由Joel独家奉献
Joel，男，数据分析，科技类外刊爱好者
可能你会在心里画圈圈并送上“神经病”和“精神不正常”给那些让你不爽的人，也觉得这两个“祝福”并没什么区别，但实际上精神病和神经病是不一样的，神经病指神经系统发生的器质性疾病（中枢与周围神经或者说内脏神经与躯体神经表现出解剖学上的病理特征），常见的神经性疾病有帕金森病，阿尔茨海默病、多发性硬化症、癫痫等疾病。精神疾病是指大脑功能失调，导致认知、情感、意志和行为等精神活动出现不同程度障碍为临床表现的疾病，常见的精神疾病有分裂症，躁郁症、重度抑郁症、强迫症、神经性厌食症等。和神经系统疾病不同，精神病症状不明显，无法根据脑部症状显著区分开来，这也是精神疾病治疗向来非常棘手的原因之一。但精神疾病有较强的基因相关性（大多数神经系统疾病基因相关性并不强），这对解决精神疾病诊断棘手的难题起到举足轻重的作用。大型国际合作组织-头脑风暴联盟正在努力探寻精神疾病的根源，最终我们有可能在脑组织中，找出导致精神疾病的那个异常部位，祝愿他们尽早取得突破。
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