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抑郁症治疗的未来 – 译学馆
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抑郁症治疗的未来

The Future Of Depression Treatment

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医治抑郁症并不容易
Dealing with depression is not easy.
并且效果不明显
And it doesn’t help
因为真的很难找到有效的治疗方式
that it is really difficult to find effective treatments for it.
遗传 环境 和大脑中不同的因素
Your genetics, your environment, and various factors in your brain
都一定程度上影响到你是否会患上抑郁症
all seem to play a role in whether you develop depression
以及会有怎样的经历
and how you experience it.
常见的治疗方式并非对每个人都有效
So the most common treatments don’t work for everyone.
一些研究者认为 解决抑郁症的方法是“个性化用药”:
Some researchers think that the solution tothis is personalized medicine:
利用病人的症状甚至他们的基因组信息
using information about a patient’s symptoms or even their genome
来搭配真正对他们有效的药物
to match them to drugs that actually help.
“个性化用药”有时听起来像个未来的热词
“Personalized medicine” sometimes sounds like a futuristic buzzword,
但已经有大项目在进行深入研究——
but there are already big projects lookinginto it —
并取得了一些进展
and they’re making some progress.
所以对抑郁症来说 这种治疗
So for depression, these kind of treatments
事实上可能也没那么遥远
might actually not be that far off.
其中一个项目由名为CAN-BING的小组牵头
One of these projects is spearheaded by agroup called CAN-BIND,
全称为加拿大抑郁生物标记物集成网络
short for Canadian Biomarker Integration Network in Depression.
这个团队已经发布了许多研究成果
This team has already published a handfulof studies
且仍在进行更多的研究
and is working on many more,
他们目前主要在进行抑郁症生物标记物的检测
and they’re mainly searching for biomarkers for depression.
生物标记物被更大的科学界广泛地定义
Biomarkers are defined pretty broadly by the larger scientific community,
但它们基本上是医生或实验室能可靠测量的东西
but they’re basically something a doctoror lab can reliably measure
这些标记物可以反映你的病情
that tells them about your illness.
从脉搏到血液中特定荷尔蒙都是公平博弈
Anything from your pulse to a specific hormone in your blood is fair game.
医生们可以利用生物标记物
Doctors can use biomarkers to learn how well a patient
了解病人对针对性治疗反应如何
is responding to a specific treatment,
或者他们可以利用这些标记物预测病人
or they can use them to predict how likely a patient is
对这些治疗的普遍反应
to respond to treatments in general.
但说到抑郁症 目前最容易发现的生物标记物
But when it comes to depression, the most sought-after biomarkers
是那些将特定药物与病人的反应联系起来的一类
by far are those that tie a specific drug to a patient’s response.
基本上 标记去掉猜测并且说道
Basically,markers that take out the guesswork and say,
“如果你服用这个 目前就是你能期待的”
“If you take this, here’s what you canprobably expect.”
如果我们能找到治疗抑郁症的标记物
If we could find a marker like this for depression,
医生可以做一些像验血这样的事情
doctors could do something like a blood test,
以寻找一个确定的结果
look for a certain result,
然后在此基础上给病人配一种有效的抗抑郁药
and then match someone to an effective antidepressant based on that.
当然 我们离这个目标还很远
Of course, we’re nowhere near that yet.
但是CAN–BIND小组正在研究这个问题
But the CAN-BIND group is working on it,
尽管还有很长的路要走
and even though there’s a long way to go,
他们正在学很多
they’re learning a lot.
例如 他们调查了人们
For example, they’ve investigated whetheror not people
是否有基因表达标记可以预测 他们对药物的反应
have gene expression markers that can predict how they’ll respond to medication.
这些标记就像信使RNA一样
These markers would be things like messenger RNAs
告诉科学家们一个细胞产生了多少蛋白质
that tell scientists how much protein is being made by a cell.
这反过来又会影响身体对药物的反应
Which could, in turn, affect how the body processes or responds to a drug.
科学家们已经研究了大量的潜在标记
Scientists have studied a ton of potentialmarkers,
但遗憾的是 据CAN-BIND团队在2017年的一篇综述
but unfortunately, the CAN-BIND team concluded in a 2017 review
这些标记还没有为黄金时段做好准备
that none of them are ready for primetimejust yet.
结果太不确定了
The results are too inconclusive —
也许是因为我们对自己的遗传物质了解得不够
maybe because we don’t know enough about our genetic material.
但这并不意味着我们应该放弃这种方法
But that doesn’t mean we should give up on this method yet.
这可能只是意味着还有更多的东西需要学习
It likely just means there’s more to learn.
尽管如此 CAN-BIND团队也同时
In the meantime, though, the CAN-BIND
一直在关注其他类别的生物标识
team has also been looking at other kindsof biomarkers.
在2018年 他们发表的一篇综述论文中
In 2018, they published a review that looked at brain imaging
关注了脑成像 而不是分子标记
rather than molecular markers.
这次 他们研究了各种治疗方法
This time, they looked at how all kinds oftreatments —
包括心理治疗 这不仅会影响药物 还会影响大脑
including psychotherapy — could affect the brain, not just drugs.
这一次 他们发现了一些有希望的结果
And this time, they found some promising results.
在这篇综述中 研究小组发现有研究表明
In this review, the team found studies thatsuggested that
比如一些大脑区域的大小和形状的变化
things like size and shape changes in several brain regions
可能与特定的治疗方法有关
could be tied to specific treatments.
例如 他们引用了之前的研究
For example, they cited previous researchwhere both increased activity
在接受认知行为疗法的患者中
in the prefrontal cortex, and decreased activity in
前额皮质活动的增加 和少数其他区域活动的减少
a handful of other regions, were associated with better symptom improvement
都与更好的症状改善有关
in patients who underwent cognitive behavioral therapy.
换句话说 有一些特定的大脑特征可以
In other words, there were specific brainfeatures that predicted
预测一个人对治疗的反应
how well someone would respond to treatment.
这些结果确实需要验证
These results do need to be validated,
但如果他们是正确的 这基本上意味着
but if they’re true, this essentially meansa doctor
医生可以检查某人的大脑
could look at someone’s brain for thingslike
比如前额皮质活动的增加
increased prefrontal cortex activity.
如果他们发现了 他们可以
And if they found it, they could use thatknowledge
用这些知识来推荐某人接受治疗
to recommend someone for therapy.
说到底
At the end of the day,
CAN-BIND还有很多工作要做
CAN-BIND still has a lot to do,
但他们正在为主要医学领域的一些重大进展铺平道路
but they’re paving the way for some majoradvances in medicine.
不过 寻找生物标志物并不是
Looking for biomarkers isn’t the only wayto approach
实现个性化医疗的唯一途径
personalized medicine, though.
另一种方法是寻找人与人之间
Another approach is to look for actual differences
基因序列的实际差异
in the gene sequences among people.
我们讨论的是组成一个人基因密码的
We’re talking differences in those famousfour DNA bases
四个著名的DNA碱基之间的差异
that make up someone’s genetic code.
近年来 随着个人基因测序的广泛应用
This approach has become more feasible in recent years
这种方法变得更加可行
as personal gene sequencing has become widely available,
当我们开始了解基因变异如何起作用
and as we’ve begun to understand how these gene variants function.
例如 有一种肝酶可以处理某些药物
For example, there’s a liver enzyme thatprocesses certain medications,
包括一些用于治疗抑郁症的药物
including some used to treat depression,
甚至在它们到达大脑之前
before they ever reach the brain.
它就是CYP2D6 我确信你会记住它
It’s called CYP2D6, I’m sure you’llremember that
编码这种物质的基因有上百种不同的变异
and the gene that codes for it has over
这些变异可能会对药物产生化学变化
a hundred different variants, which might make chemical changes to medications
使药物或多或少变得有效
that render them more or less effective.
如果我们能追踪所有这些基因变化
If we could track down all of these geneticchanges,
我们就可以开始研究如何根据一个人的
we could start to figure out how to tailormedications
遗传密码来定制药物
to someone’s personal genetic code.
另一项重要的研究叫做指导研究
And another major research effort, called the GUIDED study,
这是一个很大的进步
was a big step forward in that.
该研究于2019年1月在网上发表
The study was published online in January2019,
文中将一千多名抑郁症患者分成两组
and it split over a thousand patients with depression into two groups.
其中一组
In one group,
医生可以使用基因测试的结果
doctors were allowed to use the results of a genetic test
以寻找潜在的药物相互作用
to look for potential drug interactions —
可以使这些药物或多或少有些效果
ones that could make those drugs either more or less effective.
而另外一组 医生不能使用这个信息
In the other group, doctors couldn’t usethat knowledge,
用传统的方式选择药物
and made their drug choices the old-fashioned way.
在基因检测组 患者对治疗的反应
In the genetic testing group, both patients’response to treatment
和抑郁症状缓解的人数
and the number of people who experienced remission of their depression
明显高于正常组
symptoms were significantly higher than inthe business-as-usual group.
在研究进行到一半时 如果病人可以转换
And partway through the study, if patientswere allowed to switch
到他们的基因测试支持的药物
to a drug supported by their genetic tests,
他们也表现出更好的症状改善率
they also showed better rates of symptom improvement,
更好的治疗反应并得到缓解
treatment response, and remission.
这是一个潜在的好消息
Which is potentially awesome news —
尤其是因为这是一个大型的精心控制的研究
especially since this was a large, carefully-controlled study.
科学家们总是要求进行更多的研究
Scientists will always call for more research,
但指导实验表明 对患者基因的了解
but the GUIDED trial shows that knowledgeof a patient’s genes
可能会让他们变得更好 尤以
can potentially help them get better — especially
如果其抑郁症一直很难治疗的话
if their depression has been otherwise tough to treat.
因此仍然有很多
So there is a lot
对抑郁症治疗的未来抱有希望的理由
of reason to be hopeful about the future of depression treatments,
即使仍需要进行更多的研究
even if a lot more research isstill needed.
无论是通过生物标志物或我们实际的基因
Whether it’s through biomarkers or our actual genes,
我们在了解特定治疗方法是否
we’re working on ways to know whether specific treatments
能帮到特殊的人群
will help specific people.
所以可能在未来
So maybe in the future,
没有人需要经过三四次
no one will ever need to go through three,
或十几次治疗才能找到有效的治疗方法
four, or a dozen treatments to findsomething that works.
我们可能会在第一次尝试时就知道该怎么做
We might figure out how to do it on the first try —
这值得庆祝
and that’s worth celebrating.
更多关于心理学的知识
If you want to learn more about psychology—
或其他如历史或科学领域
or other topics in fields like history orscience —
你喜欢的视频我们都能满足你
we think we’ve found some videos you might enjoy.
本期节目来自好奇心流
And that’s why this episode is brought toyou by CuriosityStream.
好奇心流是一个订阅流媒体号
CuriosityStream is a subscription streaming service
提供超过2k部纪录片和非小说类图书
that offers over 2000 documentaries and nonfiction titles
来自一些世界上最好的电影制作人 包括独家原创
from some of the world’s best filmmakers,including exclusive originals.
他们的视频包含自然 历史
They have videos on nature, history,
科技 甚至社会和生活
technology — even society and lifestyles —
这也是我们非常喜欢他们的一个原因
which is one of the reasons we like them so much.
学海无涯呀 比如
There’s so much to learn! Like,
互联网的诞生 这部剧
Birth of the Internet is a
讲的是你正在使用的互联网
show that can tell you about the internet
你是否知道以下问题
you’re using to watch this episode rightnow! Did you know
最早的互联网信息是在1969年传播的
the first Internet message was transmittedway back in 1969,
还是网络的基础是在冷战时期形成的?
or that the foundations of the Web grew out of the Cold War?
这只是我们提供的节目之一
That’s just one of the shows on offer.
你可以无限制地访问这些内容
You can get unlimited access to content like this
只要每月2.99刀
starting at $2.99 a month.
特别感谢心理科学秀的观众
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you can get the first 30 days for free!
您只需注册我们的网站
You just have to sign up at curiositystream.com/psych
并在注册过程中使用促销代码 psych
and use the promo code “psych” duringthe sign-up process.
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视频概述

医治抑郁症并非易事,且治疗效果并不明显。每个人的遗传,环境和大脑都不相同,个性化治疗成为可能的方案。那么什么是个性化治疗?当下发展如何?抑郁症患者是否能够在其治疗下完全康复呢?

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收集自网络

翻译译者

Ida

审核员

审核员 V

视频来源

https://www.youtube.com/watch?v=fvYBu0Ng1xw

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