强迫症与强迫型人格障碍执行功能的比较研究

发布时间：2018-07-22 19:41

【摘要】：目的:强迫症(obsessive-compulsive disorder,OCD)是一种以强迫思维或强迫行为为主要特征的精神障碍,强迫型人格障碍(obsessive-compulsive personality disorder,OCPD)是一种专注于追求细节、完美,以及精神和人际关系的控制,不惜牺牲灵活性、开放性和效率的精神障碍。虽然强迫症与强迫型人格障碍在美国精神障碍诊断与统计手册第5版上是独立的精神疾病,但它们的核心症状常有重叠,使得在临床上鉴别两种疾病比较困难。当前执行功能是认知神经心理学的研究重点和热点。关于执行功能的研究有很多,大部分的精神障碍都存在不同程度的执行功能损伤,其中包括强迫症和强迫型人格障碍。因此本研究利用认知神经心理学测试,结合事件相关电位技术,探讨强迫症与强迫型人格障碍之间执行功能的差异,为二者之间的关系提供一些行为学及电生理方面的证据。方法:研究一:利用威斯康星卡片分类任务(WCST)、爱荷华博弈测试(IGT)、骰子测试(GDT)对31例强迫症患者,33例强迫型人格障碍患者,33例正常对照的认知灵活性和决策功能进行测试。三组被试年龄,性别,教育年限相匹配。同时利用耶鲁布朗强迫量表来评估强迫症疾病严重程度。研究二:利用停止信号任务对21例强迫症患者,20例强迫型人格障碍患者,20例正常对照的反应抑制能力进行测试,并利用Neuroscan ERP记录与分析系统来记录分析被试的行为学与脑电数据。三组被试年龄,性别,教育年限相匹配。结果:研究一:WCST中OCD组的总错误数、持续性反应数和持续性错误数均大于OCPD组与HC组,且达到统计学差异水平(P0.05)。IGT中,OCD组和OCPD组的block3,block4,总净得分均低于HC组,且达到统计学差异水平(P0.01)。分别对三组被试的决策进程进行单因素方差分析发现,OCPD组(P0.05)和HC组(P0.01)不同block的净得分差异有统计学意义。OCPD组的block3至block5的净得分均大于block1(P0.05),HC组的block2至block5的净得分均大于block1(P0.01)。OCD组不同block的净得分差异无统计学意义。GDT中,三组各项指标均无统计学差异。研究二:(1)行为学结果:OCD组比OCPD组和HC组的Go信号反应时间要长,有统计学意义(P0.01)。OCD组的Stop信号反应时间比OCPD组长,有统计学意义(P0.05)。(2)脑电结果:N2平均波,组间主效应不显著;N2潜伏期,OCD组比HC组短(P0.05)。OCD组的Go-P3波幅在F3,F4,FZ,C3,C4,CZ点上显著大于OCPD组与HC组(P0.05);OCD组的Stop-P3平均波幅在F4,FZ,C3,CZ,P3点上显著大于OCPD组与HC组(P0.05)。P3潜伏期组间主效应不显著。结论:研究一:强迫症患者的认知灵活性差于强迫型人格障碍患者与正常人。强迫症患者和强迫型人格障碍患者在风险不明确情境下的决策功能均存有缺陷,但同时二者的决策模式不同。在风险明确的情境下,二者的决策功能均完整。研究二:强迫症患者抑制能力比强迫型人格障碍患者差,强迫症和强迫型人格障碍患者、正常人的Go-P3和Stop-P3成分存在差异。
[Abstract]:Objective: obsessive-compulsive disorder (obsessive-compulsive) is a mental disorder characterized by obsessive-compulsive thinking or obsessive-compulsive behavior, and obsessive-compulsive personality disorder is a focus on detail, perfection, and control of mental and interpersonal relationships at the expense of flexibility. Mental disorder of openness and efficiency. Although obsessive-compulsive disorder (OCD) and obsessive-compulsive personality disorder (OCD) are independent mental disorders in the fifth edition of the American Handbook for the diagnosis and Statistics of Mental Disorders, their core symptoms often overlap, making it difficult to differentiate the two diseases clinically. Executive function is the focus and focus of cognitive neuropsychology. There are many researches on executive function, most of mental disorders have different degree of executive dysfunction, including obsessive-compulsive disorder and obsessive-compulsive personality disorder. Therefore, using cognitive neuropsychological test and event-related potential technique, this study explored the difference of executive function between obsessive-compulsive disorder and obsessive-compulsive personality disorder, and provided some evidence of behavior and electrophysiology for the relationship between them. Methods: first, the cognitive flexibility and decision-making function of 33 patients with obsessive-compulsive personality disorder (OCD) were tested by Wisconsin Card sorting Task (WCST), Iowa Game Test (IGT) and Dice Test (GDT) in 33 patients with obsessive-compulsive personality disorder (OCD). The three groups matched age, sex, and educational years. The Yale Brown obsessive-compulsive scale was also used to assess the severity of obsessive-compulsive disorder. Study 2: the response inhibition ability of 21 patients with obsessive-compulsive disorder (OCD) and 20 patients with obsessive-compulsive personality disorder (OCD) was measured by stop signal task. Neuroscan ERP recording and analysis system was used to record and analyze behavioral and EEG data. The three groups matched age, sex, and educational years. Results: the total number of errors, the number of persistent reactions and the number of persistent errors in OCD group were higher than those in OCPD group and HC group, and reached the level of statistical difference (P0.05) .The total net score of OCD group and OCPD group in IGT was lower than that in HC group. And reached the level of statistical difference (P0.01). Univariate ANOVA analysis of the decision-making process of the three groups showed that there were significant differences in the net scores of block3 to block5 between OCPD group (P0.05) and HC group (P0.01). The net score of block3 to block5 in OCPD group was higher than that in block1 group (P0.05). In the block1 (P0.01) .OCD group, there was no significant difference in the net score of different block. There was no statistical difference among the three groups. Study 2: (1) Behavioral results showed that the reaction time of go signal in the OCPD group was longer than that in the OCPD group and HC group, and the response time of stop signal in the OCD group was significantly longer than that in the OCPD group (P0.05). (2). The amplitude of Go-P3 in the OCD group was significantly shorter than that in the HC group (P0.05). The amplitude of Go-P3 in the F3F4F4FZC _ 3C _ 4C _ 4C _ 4 CZ was significantly higher than that in the OCPD group and the HC group (P0.05). The mean amplitude of Stop-P3 in the F4FZZC3CZP3 group was significantly higher than that in the OCPD group and the HC group (P0.05) .P3 latency was not significantly different between the OCPD group and the HC group (P0.05). Conclusion: 1. The cognitive flexibility of obsessive-compulsive disorder patients is worse than that of obsessive-compulsive personality disorder patients and normal people. Both the patients with obsessive-compulsive disorder and the patients with obsessive-compulsive personality disorder have defects in their decision-making function in uncertain risk situations, but their decision-making patterns are different at the same time. Under the situation of clear risk, both of them have complete decision-making function. Study 2: the inhibition ability of obsessive-compulsive disorder patients was worse than that of obsessive-compulsive personality disorder patients. There were differences in Go-P3 and Stop-P3 components in patients with obsessive-compulsive disorder and obsessive-compulsive personality disorder.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：B848

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