Psychiatry of old age is coming of age.
Psychiatry of old age is coming of age.
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老年精神病学正在走向成熟。
DOI：
10.1176/ajp.154.10.1356
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发表时间：
1997
期刊：
影响因子：
--
通讯作者：
Jeste,DV
中科院分区：
文献类型：
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作者：
Jeste,DV
许多诺贝尔奖都是授予60多岁或70多岁的科学家，以表彰他们在成年早期所做的工作。然而，这位诺贝尔奖获得者在这段时间内遭受精神分裂症的蹂躏是罕见的。这就是约翰·F的故事。纳什博士，这篇文章发表在1994年的纽约时报上（2）。纳什博士是一位数学家，他在66岁时因20多岁时在博弈论方面的工作而获得诺贝尔经济学奖。1958年，当纳什博士30岁时，他被诊断出患有偏执型精神分裂症;在接下来的25年里，他作为住院病人和门诊病人接受药物和心理治疗。他被描述为有可怕的妄想和混乱的思维。他变成了“一个哑巴，在数学大楼的黑板上潦草地写下奇怪的方程式，并焦急地寻找数字中的秘密信息”（2）。1958年后，他没有发表过一篇科学论文，1959年后也没有担任过学术职务。幸运的是，纳什博士从家人和朋友那里得到了相当多的心理支持。到50多岁时，他开始走出孤立，开始研究数学，并再次与同龄人交流。他康复的最明显的标志是他巧妙地使用计算机。许多临床研究人员对精神分裂症患者进行了跟踪调查，直到老年，他们发现，这些患者中有20%至35%的人，即使在患病数十年后，在晚年也会得到缓解或至少有明显的改善。（它确实有几个），至少它应该表明，衰老并不全是悲观和厄运。在精神病学中，一个关于衰老的积极影响的小而有趣的例子是，老年人中精神抑制剂诱导的急性肌张力障碍的风险实际上比年轻人低得多。这里要强调的一点并不是衰老一定是美妙的（尽管它可以是），而是它对大脑和其他器官系统的功能有着不同的影响。流行病学的统计数据突出了老年医学和老年学的重要性。在整个世界历史上，三分之二的65岁以上的人今天还活着。此外，今天65岁的美国女性中有一半将活到85岁（4）。从1980年到1990年，美国85岁以上的人口增长了40%，百岁老人的数量翻了一番。关于精神病患者的统计数据是不可用的，但考虑到最近（和预期的）精神药理学和其他认知、情绪和精神障碍治疗的进展，精神病患者的寿命可能比一般人群的寿命增加更大。心理健康专业人员的任务将是帮助执行肯尼迪总统的建议，即新的生命被添加到晚年（1）。有一件事可能破坏这种乐观的前景，那就是向慢性精神病患者提供医疗保健服务的不利变化。有很大
Many a Nobel prize has been awarded to scientists in their 60s or 70s for the work that they had done in their early adulthood. It is rare, however, for the Nobel laureate to have suffered from the ravages of schizophrenia in the intervening time period. Such is the story of John F. Nash, Ph. D., which was published in the New York Times in 1994 (2). Dr. Nash, a mathematician, received the Nobel prize in economics at the age of 66 for the work on game theory that he had done in his 20s. In 1958, when he was 30 years old, Dr. Nash was diagnosed with paranoid schizophrenia; he spent the next 25 years of his life being treated, as an inpatient and as an outpatient, with medications and psychotherapy. He is described as having fearful delusions and disordered thinking. He became “a mute figure who scribbled strange equations on blackboards in the mathematics building and searched anxiously for secret messages in numbers”(2). He did not publish a scientific paper after 1958, nor did he hold an academic post after 1959. Fortunately for him, Dr. Nash had considerable psychosocial support from his family and friends. By his mid-50s, he began to come out of his isolation, starting to work on mathematics and communicating with peers again. The most clear sign of his remarkable recovery was his use of the computer in ingenious ways. A number of clinical researchers who have followed patients with schizophrenia into old age have found that 20% to 35% of these patients, even after decades of illness, have remission or at least marked improvement in their later years.Whatever implications the possibility of “remission” of schizophrenia in old age may have for researchers (and it does have several), at least it should suggest that aging is not all gloom and doom. In psychiatry, one small but interesting example of a positive effect of aging is that the risk of neuroleptic-induced acute dystonia is actually much lower in the elderly than it is in younger adults. The point to stress here is not that aging is necessarily wonderful (although it can be) but that it has heterogeneous effects on the functioning of the brain as well as other organ systems. The importance of geriatrics and gerontology is highlighted by the epidemiologic statistics. Two-thirds of all the people in the entire history of the world who have reached the age of 65 are alive today (3). Moreover, half of the women in the United States who are 65 today will survive to the age of 85 (4). From 1980 to 1990, the population older than 85 years in the United States grew by 40%, and the number of centenarians doubled (4). The statistics on the mentally ill are not available, but it is possible that, given the recent (and expected) advances in the psychopharmacological and other treatments of cognitive, mood, and psychotic disorders, the longevity of psychiatric patients could increase by an even greater proportion than that of the general population. The mental health professionals’ task will be to help implement President Kennedy’s suggestion that new life be added to later years (1). The one thing that could torpedo this optimistic scenario is an adverse change in the delivery of health care services to chronically mentally ill patients. There is a great