惊恐障碍患者错误加工的事件相关电位研究

发布时间：2018-03-07 00:38

  本文选题：惊恐障碍　切入点：错误加工　出处：《大连医科大学》2013年硕士论文　论文类型：学位论文

【摘要】：目的：惊恐障碍（panic disorder, PD）是一种急性焦虑障碍，以反复的惊恐发作为主要临床表现，其发病机制尚不明确，临床评价缺乏客观生物学指标。因惊恐发作时伴有明显的胸闷、心悸、头晕等多种非特异性症状，因此反复于综合医院急诊、门诊就诊，造成医疗资源的极大浪费。灾难化认知假说从认知加工方面对惊恐发作的触发及维持进行了理论解释，认为惊恐发作源于个体对于某些躯体感觉的一种灾难化的错误判断。惊恐发作能够反复发生、难以控制提示惊恐障碍患者对于这种错误的识别及控制存在障碍，这可能是惊恐障碍发病的重要环节。 监控自己的认知和行为结果，觉察、纠正错误，并防止再犯是人脑对错误信息加工（error processing）的主要内容。事件相关电位（event-related potentials，ERPs）技术以其较准确的锁时性优势被广泛应用于错误加工的研究，且为其提供了两个明确的神经生理指标：ERN和Pe。目前尚未发现应用ERP技术研究惊恐障碍患者错误加工特点的相关报道。本研究采用ERP技术，通过视觉箭头flanker任务诱发被试的错误反应，分析其行为学及错误相关ERP成分，对惊恐障碍患者的错误加工进行初步探讨。 方法：研究对象包括19例首次确诊的惊恐障碍患者与年龄、性别、教育程度无明显差异的20名正常对照。所有被试均经过标准化结构访谈程序（SCID）严格筛查，并完成汉密尔顿焦虑量表(HAMA）及17项汉密尔顿抑郁量表（HAMD-17）量表评分。对于惊恐障碍患者，分别应用惊恐障碍严重程度量表（PDSS）和生活事件量表（LES）评估其疾病严重程度及相关社会心理因素。刺激程序采用视觉箭头flanker范式，要求被试尽可能迅速而准确地对中间箭头的方向做按键反应。记录64导脑电后进行离线分析，分别测量Fz、FCz、Cz三个电极点的ERN，及Cz、CPz、Pz三个电极点的Pe的平均波幅。其中6名被试因脑电伪迹严重或错误叠加数不足25次而剔出数据分析，病例组和对照组分别为16例和17例被试纳入最后统计。行为学数据用t检验比较组间差异，，ERP数据采用二因素重复测量方差分析进行组内及组间比较。 结果： 1、两组被试在箭头flanker任务的行为学数据上无显著性差异。 2、两组被试的ERN平均波幅及Pe平均波幅均存在反应类型主效应（Ps＜0.01），即错误反应的刺激产生了明显的ERN及Pe成分。 3、两组被试的ERN平均波幅存在显著的电极位置主效应(F2,62=21.697，P＜0.001)及电极位置×组别交互效应(F2,62=3.733,P=0.038)，组别主效应无统计学意义(F1,31=0.018,P=0.895)。 4、两组被试的Pe平均波幅存在显著的组别(F1,31=7.617，P=0.010)及电极位置(F2,62=4.257，P=0.039)主效应，电极位置×组别交互效应（F2,62=0.391，P=0.573）无统计学意义。 5、惊恐障碍患者的ERN、Pe平均波幅与疾病相关临床指标（HAMA、HAMD、PDSS评分、LEU总值及病程）无显著相关性（Ps＞0.05）。 结论： 1、惊恐障碍患者的错误加工早期（错误监控）的脑活动分布存在异常，其发生区域集中于额中央区。 2、惊恐障碍患者在晚期错误加工阶段对错误的识别和（或）错误后的行为调节能力存在异常。 3、惊恐障碍患者的错误加工的ERP指标与症状严重程度、病程及社会心理因素无关，ERN和Pe可能是惊恐障碍的一种疾病特质性指标。
[Abstract]:Objective: panic disorder (panic disorder PD) is an acute anxiety disorder, recurrent panic attacks as the main clinical manifestations, its pathogenesis is not clear, the lack of objective index of clinical evaluation. Because of palpitations panic attack with obvious chest tightness, dizziness, and other symptoms were nonspecific, so repeated in general hospital emergency department, outpatient visits, causing a great waste of medical resources. The disaster cognition hypothesis has carried on the explanation to the trigger and maintain a panic attack from cognition, think the wrong judgment of a disaster panic attack based on individual feeling for some body of panic attacks can happen repeatedly, prompt recognition and for patients with panic disorder to control the wrong obstacles difficult to control, which may be an important part of the panic disorder.
To monitor their cognitive and behavioral results, awareness, correct mistakes, and to prevent recidivism is the brain of the error information processing (error processing). The main contents of the event related potential (event-related potentials ERPs) technology to the more accurate lock advantage is widely used in error processing, and provides two a clear indicator of nerve physiology: ERN and Pe. has not yet found the research on the application of ERP reports of panic disorder. The characteristics of error processing based on ERP technology, through the visual error reaction arrow flanker task induced subjects, analyze the behavior and error related ERP components, preliminary study on panic disorder error processing.
Methods: the study included 19 cases of first diagnosed patients with panic disorder with age, gender, 20 normal controls were no significant difference between the level of education. All subjects are standardized through structured interview program (SCID) strict screening, and Hamilton Anxiety Scale (HAMA) and the 17 item Hamilton Depression Rating Scale (HAMD-17) scores for patients with panic disorder were used, panic disorder severity scale (PDSS) and life events scale (LES) assessment of the severity of the disease and related psychosocial factors. Using visual stimulation procedure arrow flanker paradigm, participants were asked as quickly and as accurately as possible in the direction of the arrow key reaction intermediate the off-line analysis were recorded. 64 channel EEG measurements, respectively Fz, FCz, Cz three electrode point ERN, and Cz, CPz, the average amplitude of Pz three electrode Pe. Among the 6 subjects because of artifacts or serious mistakes The number is less than 25 times and from the data analysis, the case group and the control group were 16 cases and 17 cases were included in the final statistics. Behavioral data to test the difference between the groups with T, ERP data using two way ANOVA comparison between group and group.
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