抑郁症患者异常归因方式的脑神经机制

发布时间：2019-06-08 17:17

【摘要】：归因是在日常生活中个体对其行为或发生的事件进行解释并总结原因的一种过程,这对于个体情绪表达及认知图式的建构是非常重要的。抑郁症患者发病原因一方面源于自身的认知易感性以及负性生活事件的刺激,另一方面也与他们常用的归因方式有密切的联系。国内关于抑郁症患者归因方式的行为研究很多,但在神经影像学方面的研究却很少,抑郁症患者归因方式产生异常是由于大脑结构局部发生变化、脑功能出现紊乱还是两种情况同时存在,原因还不是很清楚。我们希望能够从神经影像学角度发现抑郁症异常归因方式的大脑特征,以弥补这一领域的不足。所以本文通过探讨抑郁症患者异常归因方式相关的脑结构基础以及大脑活动的特征,来寻找其归因方式异常的大脑证据。本研究包括两个实验,实验一主要探讨抑郁症患者异常归因方式的大脑结构基础,通过大脑结构灰质体积这个指标观察结构的变化。首先,通过应用基于体素水平的VBM分析方法得到抑郁组与正常组的大脑灰质体积,并使用双样本-T检验方法,比较两组大脑灰质体积的差异；其次,我们使用多重回归方法,将两组人口学变量作为协变量回归,重点关注归因方式问卷得分与抑郁症患者以及正常组大脑结构灰质体积的相关性。实验的行为结果显示,两组的归因方式问卷得分均表明两组呈现自利性的归因偏向,但抑郁组的自利偏向不如正常组自利偏向趋势大,而且抑郁症患者消极事件得分高于正常组,说明抑郁组具有偏向非自利归因的趋势。MRI结构分析结果显示：与正常组相比,抑郁组的右侧额上回灰质体积减小；同时,回归分析报告,抑郁组归因方式消极事件得分越高,越消极,右侧额上回体积越小；正常组归因方式积极事件得分越高,越积极,右侧杏仁核体积越小。结构结果表明,抑郁症患者大脑右侧额上回灰质体积减小,可能在结构上出现了萎缩,而且归因方式的异常可能与右侧额上回结构的萎缩有关系：抑郁组与正常组大脑杏仁核的灰质体积与两组各自的自利偏向程度可能呈现一致的相关关系,抑郁症患者的杏仁核体积增大可能与其异常的归因方式有关系。实验二利用fMRI技术探讨抑郁症患者完成归因方式判断任务时的大脑活动。实验采用经过改进的经典归因方式实验范式,将描述积极、消极生活事件的句子作为实验刺激图片。首先,比较两组在自利以及非自利归因时大脑激活情况；其次,我们把两组在负性事件条件下非自利归因的大脑激活情况进行重点分析。行为结果报告,正常组的归因方式问卷得分显示正常人呈现一个自利的归因偏向,而抑郁组归因方式问卷得分显示其在自利与非自利归因趋势上保持平衡,说明抑郁症患者已经出现了偏离正常人的非自利归因偏向；方差分析结果显示,2(抑郁组,正常组)×2(积极得分,消极得分)交互作用显著。fMRI任务态分析结果显示：与正常组比较,抑郁症患者在自利、非自利归因时,额下回以及颞中回分别表现出强烈的激活,说明抑郁症患者归因方式异常可能与大脑额—颞网络的异常激活有关；在对负性事件进行非自利归因时,抑郁症患者大脑顶下小叶激活更强,而且其激活程度与抑郁症患者病程呈显著的正相关。这提示我们,抑郁症患者大脑顶下小叶激活强度的变化可能与其异常的归因方式有关,也可能是抑郁症患者抑郁症状持续的一个大脑生理标记。然而,本研究还存在一定的不足：如抑郁症患者服药与否没有得到严格的控制,服药后疾病有所缓解的情况对实验结果可能会有一定的影响；患者年龄跨度较大,没有把青年抑郁与老年抑郁症进行区分；实验材料涉及生活事件的范围可能不够广泛等。结合实验一与实验二的结果,我们认为：抑郁症患者的归因方式特征,在行为方面表现出非自利的异常归因偏向,在神经影像方面也表现出与正常组不同的脑网络激活模式,尤其是额—颞网络可能出现了异常的激活模式；另外,我们推断,抑郁症患者大脑顶下小叶的活动强度可能与其异常的归因方式有关,也与抑郁症患者抑郁症状的持续有关。因此,抑郁症患者归因方式的异常,不仅与大脑结构的异常变化有关,而且与局部脑区的异常活动有关；结构与功能的异常共同影响了抑郁症的发展以及抑郁症状的持续。更重要的是,在现实意义上,本研究为抑郁症患者的治疗、康复以及人类对精神疾病的预防提供了建设性的意见,提示抑郁症的治疗方向是促进抑郁症患者以更积极的方式解释自身行为,形成积极自利的归因方式。
[Abstract]:Attribution is a process of explaining and summarizing the individual's behavior or events in daily life, which is very important to the individual's emotional expression and the construction of the cognitive schema. The causes of depression in patients with depression are based on their own cognitive susceptibility and the stimulation of negative life events, and on the other hand, they have a close relationship with their common attribution patterns. There are many studies on the behavior of the attribution style of the patients with depression, but the study on the neuroimaging is very low, and the cause of the attribution of the patients with depression is due to the local change of the structure of the brain, the disorder of the brain function and the existence of the two cases, The reason is not clear. We hope to be able to find out the brain features of the abnormal attribution of depression from the neuroimaging perspective in order to make up for the deficiency in this field. So this paper is to find out the brain structure and the characteristics of the brain activity in the study of the abnormal attribution of the patients with depression, to find the evidence of the brain's abnormal attribution. The study included two experiments, one of which mainly discussed the brain structure of the abnormal attribution of the patients with depression, and the change of the structure was observed by the volume of the gray matter in the brain. Firstly, the volume of gray matter in the brain of the depression group and the normal group was obtained by applying the VBM analysis method based on the level of the voxel, and the difference of the volume of the gray matter in the two groups was compared by using the double-sample-T test method. Methods: The two groups of demographic variables were returned as covariates, and the focus was on the correlation between the score of attribution and depression and the volume of gray matter in the normal group. The results of the experiment show that the two groups of attribution style questionnaire scores show that the two groups are self-serving, but the self-interest of the depression group is not as large as that of the normal group, and the negative event score of the depression patients is higher than that of the normal group. The tendency of the group to explain the tendency of the depression group to the non-self-interest attribution Potential. The results of MRI structure analysis showed that the volume of gray matter on the right side of the depression group was reduced as compared with the normal group; meanwhile, the regression analysis reported that the higher the negative event score, the more negative the negative event score was, the smaller the volume of the upper back volume on the right side, and the higher the positive event score in the normal group attribution High, the more positive, the larger the right amygdala volume The results show that the volume of the gray matter on the right of the brain of the patients with depression is reduced, and atrophy may occur in the structure, and the abnormality of the attribution pattern may be related to the atrophy of the back structure on the right. The relationship between the gray matter volume of the amygdala in the depression group and the normal group and the degree of self-interest of the two groups may be consistent, and the increase of the amygdala volume in the patients with depression may be related to the attribution of the abnormality. System. The experiment 2 uses fMRI to study the large-scale factor in the determination of the attribution of the patients with depression. The experiment uses the improved classical attribution style experimental paradigm, which will describe the positive and negative life events as the experimental stinging. First, we compare two groups of brain activation with self-interest and non-self-interest; secondly, we re-focus the two groups of the non-self-interest attribution of the brain in the negative event. Point analysis. The behavior result reported that the normal group's attribution style questionnaire score showed that the normal person presented a self-interest self-interest, and the depression group attribution style questionnaire score showed that the self-interest and non-self-interest attribution trend The results of analysis of variance showed that 2 (depression group, normal group) and 2 (positive score and negative score) interacted with each other. Compared with the normal group, the results of the analysis of the results showed that the patients with depression showed a strong activation in the self-interest, self-interest attribution, the amount of return and the return of the brain, indicating that the abnormal behavior of the patients with depression could be related to the abnormal excitation of the brain amount and the abnormal network. In the event of non-self-interest attribution to negative events, the lower lobe of the middle of the brain of the patients with depression was more active and the degree of activation was significant than that of the patients with depression. There is a positive correlation. This suggests that the change in the intensity of the activation of the lobule in the top of the brain of a patient with depression may be related to the manner of attribution of the abnormality, or may be a persistent brain in the depression of a patient with depression. However, there is a certain deficiency in this study: if the patients with depression are not subject to strict control, the results may have a certain effect on the results of the experiment after taking the medicine. The patient's age span is large, and the depression of the young people and the depression of the old people are not considered. the case may be distinguished; the range of the experimental material involved in the living event may In combination with the results of experiment 1 and experiment 2, we consider that the attribution style of the patients with depression is characterized by non-self-interest in behavior, and in the aspect of neuroimaging, it is different from that of the normal group. In addition, we conclude that the activity intensity of the lower lobule of the lower brain of the depression is related to the attribution of the abnormality, and is also associated with the depression of the patients with depression. It is related to the persistence of symptoms. Therefore, the abnormal behavior of the patients with depression is related not only to the abnormal changes of the structure of the brain, but also to the abnormal activities of the local brain regions. The abnormality of the structure and function affects the development of the depression. Depression-like persistence. More importantly, in the practical sense, this study provides a constructive view of the treatment, rehabilitation, and prevention of mental illness in patients with depression, suggesting that the direction of treatment for depression is a more active way to promote depression to explain its own behavior and form a positive one
【学位授予单位】：西南大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：B845

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