精神病高危综合征的临床转归及其社会认知缺陷的神经心理机制研究

发布时间：2018-01-17 13:20

本文关键词：精神病高危综合征的临床转归及其社会认知缺陷的神经心理机制研究　出处：《上海交通大学》2015年博士论文　论文类型：学位论文

【摘要】：【背景和目的】与糖尿病、高血压等慢性病不同,以精神分裂症为代表的重性精神障碍的慢性病程更长,常起病于青少年,病前往往有很长一段时间未能获得有效帮助,且功能受损更加明显。因此,如果能在病前早期识别,则为延缓甚至阻断精神病性障碍发生带来了希望。本研究以精神病临床高危(CHR)人群为切入点,以精神病转化过程中的社会认知及其相关眼动特征为方向,旨在探索中国CHR人群的临床转归、社会认知受损以及相关眼动轨迹特征。【方法】研究分三部分:第一部分临床转归研究以精神病前驱期临床定式访谈(SIPS/SOPS)为识别和确认CHR转化的主要工具,对2011年确认的117例CHR患者进行了为期2年的随访,调查得出转化率,通过比较转化与未转化CHR的基线人口学和临床特征的差异,判断其对临床转归的影响。第二部分社会认知研究入组50例CHR患者,52例健康对照,62例Sz病例对照,以失言觉察测试、眼神阅读测试、全套一般认知功能测试为工具,评估CHR的社会认知特征,并初步探索社会认知对转化的预测效果。第三部分眼动轨迹研究入组40例CHR患者,40例健康对照,以情绪相容性(“人情”)、故事逻辑性(“世故”)眼动实验,应用EYELINK2000桌面式眼动仪采集注视、扫视等相关眼动指标,分析其与健康被试的差异,提出CHR社会认知相关眼动轨迹模式特征。【结果】结果内容分三部分,第一部分临床转归研究在2011年入组的在117例CHR患者中,有86例CHR完成了至少2年的随访(平均随访时间为28.3月),其中有25例(29.1%)CHR在两年内转化为精神病性障碍。117例CHR患者中,从症状出现到寻求专业帮助的平均时间是4.0±3.3个月,而在随访中发生转化的25例CHR患者中,从症状出现到发展为精神病性障碍的平均时间为12.5±6.3个月。一些基线的临床特征如功能受损的程度、阳性症状的严重程度、前驱期症状未治疗期(DUPr S)、精神病性障碍相关的临床印象诊断和处理(抗精神病药物处方)可能对预测前驱期患者进一步转化为精神病性障碍有所帮助。第二部分社会认知研究发现CHR患者在失言觉察和眼神阅读识别准确率均显著低于健康对照组,在反应时间上明显的慢于健康对照组。在CHR患者中,社会认知与一般认知领域中的注意/警觉和工作记忆显著相关,且存在对非负性情绪识别偏倚的特征。第三部分眼动轨迹研究发现从全图自由观察的策略来看,CHR患者除了平均注视的次数和扫视的次数减少外,相应的平均注视时间延长,扫视的幅度缩短,注视点关注背景人物面部情绪的时间明显少于健康对照,CHR患者注视点停留在故事人物上的时间,次数以及注视点进出故事人物的次数上明显地少于健康对照。【结论】在中国识别的CHR患者两年随访的转化率为29.1%,与国外同类研究结果较为接近。一些基线的临床特征如功能受损的程度等可能对预测前驱期患者进一步转化为精神病性障碍有所帮助。CHR患者对他人的心理活动状态的识别和理解存在明显的缺陷,这种缺陷可能与注意和工作记忆等一般认知功能受损有关,基线社会认知受损的程度与精神病性障碍的转化有关联。特别是对他人非负性的心理活动状态的推测能力不足表现地尤为突出。处于精神病前驱期阶段的高危人群已经存在一种“受限的扫描路径模式”以及“分散的注视分布模式”,这两个眼动特征可能导致信息采集和处理的方式改变,进而成为社会认知缺陷的神经心理基础。
[Abstract]:[Objective] background and different with diabetes, hypertension and other chronic diseases, severe mental disorders in schizophrenia as the representative of the chronic course longer, often before disease onset in adolescents, often for a long time failed to get effective help, and impaired function is more obvious. Because of this, if we can in early disease for recognition, even preventing mental disorders occur brings hope. Based on the clinical risk of mental illness (CHR) population as the starting point, to mental illness in the process of transformation of social cognition and related characteristics of eye movement direction, aims to explore the clinical outcome of CHR cable China population, social cognitive impairment and eye movement feature. [method] the study was divided into three parts: the first part clinical outcome study in psychiatric clinical prodromal stage structured interview (SIPS/SOPS) as the main tool to identify and confirm the transformation of CHR, 117 cases of CHR confirmed in 2011 Patients were followed for 2 years, the survey conversion rate, by comparing the differences between transformed and untransformed CHR the baseline demographic and clinical characteristics, determine its impact on clinical outcomes. The second part is the study of social cognition in 50 CHR patients, 52 healthy controls, 62 cases of Sz, with the tongue awareness test, eye reading test, a full set of general cognitive function test as a tool of social cognition characteristics assessment of CHR, and to explore the predictive effect of social cognition on transformation. The third part of eye movement into the group of 40 CHR patients, 40 cases of healthy control, emotional compatibility ("human"), the logic of the story ("worldly") eye movement experiment, application of EYELINK2000 desktop eye tracker acquisition gaze, eye movement indicator saccades, analysis the difference with healthy subjects, the characteristics of eye movement trajectory model CHR social cognition. [results] results Its content is divided into three parts, the research group in 2011 in 117 cases of CHR patients with clinical outcome of the first part, 86 CHR patients completed at least 2 years of follow-up (mean follow-up time was 28.3 months), of which 25 cases (29.1%) within two years CHR into.117 mental disorders in CHR patients, the mean time from symptom onset to seek professional help is 4 + 3.3 months, but in the follow-up of 25 patients with CHR transformation, the average time from onset of symptoms to the development of mental disorders was 12.5 + 6.3 months. Some baseline clinical features such as impaired degree of severity positive symptoms, duration of untreated prodromata (DUPr S), the clinical impression of diagnosis and treatment of related mental disorders (antipsychotic prescriptions) may help to predict patients prodromal period further transformed into a psychotic disorder. In the second part, social cognitive research found CH R patients in the tongue and eyes perceive reading recognition accuracy rate was significantly lower than the healthy control group, the reaction time is obviously slower than the healthy control group. In CHR patients, social cognition and general cognition in the field of attention / vigilance and significantly related to working memory, and has characteristics of non negative emotion recognition bias. The third part of eye movement study found from map free observation strategies, in patients with CHR times and saccade average fixation reduces the average fixation time, the corresponding extension, saccade amplitude shortened, gaze attention background person facial emotion time significantly lower than healthy control, watching a little bit in the story of the characters on time the number of patients with CHR, and the number of fixations on import characters significantly less than in the healthy controls. [Conclusion] the transformation in CHR patients Chinese two-year follow-up recognition rate of 29.1%, and Foreign research results are similar. Some clinical features such as baseline dysfunction may help identify patients with.CHR and understanding of the psychological activity of others has obvious defects in patients with prodromal stage into further prediction of psychiatric disorders, this kind of defect may be related to general cognitive function and attention and working memory. Damage is related to the degree of social transformation baseline cognitive impairment and psychiatric disorders. Especially for others non negative psychological activity that lack of performance is particularly prominent. In the high risk population of psychiatric prodromal stage has been the existence of a "limited scan path mode" and "decentralized distribution at mode, change these two eye movements may lead to information acquisition and processing, and then become the psychological basis of social cognitive defects.

【学位授予单位】：上海交通大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R749

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