心理病理学网络理论、方法与挑战

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陈琛, 王力(

), 曹成琦, 李根

中国科学院心理研究所心理健康重点实验室创伤应激研究实验室, 北京 100101
中国科学院大学心理学系, 北京 100049

收稿日期:2021-03-30出版日期:2021-10-15发布日期:2021-08-23
通讯作者:王力E-mail:wangli1@psych.ac.cn

基金资助:国家自然科学基金项目(31471004);国家自然科学基金项目(31971020);国家社会科学基金重大项目(20ZDA079);中国科学院对外合作重点项目(153111KYSB20160036);中国科学院重点部署项目(ZDRW-XH-2019-4);教育部人文社会科学重点研究基地重大项目(16JJD190006)

Psychopathological network theory, methods and challenges

CHEN Chen, WANG Li(

), CAO Chengqi, LI Gen

Laboratory for Traumatic Stress Studies, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China
Department of Psychology, University of Chinese Academy of Sciences, Beijing 100049, China

Received:2021-03-30Online:2021-10-15Published:2021-08-23
Contact:WANG Li E-mail:wangli1@psych.ac.cn

摘要/Abstract

摘要： 对于精神障碍这一概念的理解, 传统DSM-ICD分类诊断系统和研究领域标准RDoC均基于潜变量视角, 认为精神障碍的症状由其潜在共同原因所致。这2种观点都忽略了症状间的相互作用。不同于分类和维度视角, Borsboom在2008年对精神障碍的概念化提出了的全新视角——心理病理学网络理论。此理论的核心观点是症状之间的动态因果关系构成了精神障碍。基于心理病理学网络理论的网络分析方法, 主要以结合EBIC的glasso算法估计症状间的偏相关网络, 并通过网络中节点中心性与网络连接性等指标, 来考查精神障碍症状的不同特性。近几年来, 研究者发现心理病理学网络分析方法在对症状间因果关系的推断、核心症状的识别和网络结构的可靠性与可重复性方面仍面临一些挑战。这些挑战为心理病理学网络理论与方法指明了未来可能的发展方向。

图/表 10

图1分类诊断视角下, 创伤后应激障碍(PTSD)与其症状之间的关系(Borsboom & Cramer, 2013)。图顶部的椭圆形代表PTSD这一潜在疾病变量, 图底部的方框代表DSM系统中PTSD的症状：闯入性思维、噩梦、闪回等。此模型中, 箭头单向地从PTSD指向其可观测症状, 表示PTSD是引发这些症状的共同原因。

图2RDoC倡议的精神障碍研究框架：研究应关注于负性效价系统、正性效价系统、认知系统、社会加工系统、唤起 / 调节系统和感觉运动系统这六大人类主要功能领域展开, 每个领域包含基因、分子、细胞、环路、生理、行为和自我报告这些基本分析单元。(资料来源：https://www.nimh.nih.gov/research/research-funded-by-nimh/rdoc/about-rdoc.shtml)

图3心理病理学网络理论视角下的PTSD症状网络。17个节点分别代表DSM-IV中17个PTSD症状：闯入性思维、噩梦、闪回、情绪反应、生理反应、回避创伤相关想法、回避创伤提示活动、创伤相关遗忘、丧失兴趣、情感疏离、情感麻木、对未来的负性信念、睡眠问题、易激惹、注意力难以集中、高警觉、惊跳反应。节点间的绿边代表症状间的正相关, 红边代表负相关。边越粗, 相关性越高; 无边相连的节点间无相关。(资料来源：McNally et al., 2017)

图4网络理论中精神障碍的发展阶段。阶段1为无症状阶段, 网络处于稳定的休眠状态; 阶段2为网络初步激活阶段, 某些症状被外部事件E1直接激活; 阶段3为症状传播阶段, 阶段2中被激活的症状激活与其相连接的症状; 阶段4为稳定的网络激活状态, 若网络连接紧密, 外部事件的消失不会使网络恢复, 即网络自我维持并持续处于激活状态。[资料来源：根据Borsboom (2017)绘制]

图5连接较弱的网络(上图)具有韧性。症状可能由外部事件激活, 但症状之间的互相作用不够强, 无法导致自我维持的症状激活。相反, 连接较强的网络(下图)可以自我维持激活状态, 从而发展成为疾病状态。[资料来源：根据Borsboom (2017)绘制]

图6由症状X1-X5组成的网络。症状X1与其他4个症状均为强连接, 为此网络中的核心症状; 症状X2-X5与其他症状的连接均只有1个强连接和2个弱连接, 为此网络中的边缘症状。

图7由症状X1-X5组成的连接性强弱不同的网络及其类比多米诺骨牌图。左图为连接度较弱的网络, 类似于间距较大的多米诺骨牌。右图为连接度较强的网络, 类似于间距较小的多米诺骨牌。(资料来源：Cramer等, 2016)

图8PTSD的贝叶斯网络(DAG)。此网络中, 17个节点代表17个DSM-IV PTSD症状(同图3), 边的厚度表示此边所代表预测方向的概率大小; 位置越靠上的节点可认为越具有驱动力。(资料来源：McNally et al., 2017)

图9PTSD潜变量网络。方块节点B1-E6分别代表20个DSM-5 PTSD症状, 圆圈节点1-7代表7个PTSD潜在维度。(资料来源：Li et al., 2020)

图10左图、中图分别为仅在A、B症状簇内有连接的子样本网络; 右图为合并两样本后的网络。[资料来源：根据Fried和Cramer (2017)绘制]

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