惊恐障碍内隐认知重评异常的脑功能解剖机制

发布时间：2018-03-09 20:31

  本文选题：惊恐障碍　切入点：情绪调节　出处：《大连医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:惊恐障碍(panicdisorder,PD)是一种严重的急性焦虑障碍,其发病机制尚不清楚。以往研究多从主动情绪调节来探讨,本课题着眼于PD患者的核心症状—情绪调节障碍,和症状的自发性及无明确指向性,从情绪产生和内隐认知重评的角度来研究PD的发病机制。研究采用神经心理测量、情绪体验自我报告和功能磁共振(functional magnetic resonance imaging,fMRI)技术,对 PD 患者情绪的认知调节行为学特点、情绪相关的社会心理学特征、内隐认知重评的脑加工机制进行了深入探讨。方法:入组PD组26例,健康对照25例。利用神经心理量表考察患者的临床症状和情绪调节特点;利用fMRI技术,采用内隐认知重评任务探讨被试对负性图片的情绪反应,记录被试脑激活特点,任务中被试在观看负性图片前给予图片中性描述或负性描述;同时应用4点量表记录被试的情绪自我报告。对量表、行为学和脑激活数据进行组内、组间比较分析以及相关性分析。结果:(1)认知情绪调节问卷发现,PD组自我反思、灾难化策略评分高于对照组,认知重评和转换视角评分低于对照组,差别均有统计学意义。(2)情绪图片愉悦度的4点量表均发现了组别×描述类型交互效应。(3)fMRI结果发现,在被试观看预先中性描述的负性图片相比预先负性描述的负性图片时,对照组背外侧前额叶(dorsolateral prefrontal cortex,dlPFC)、背内侧前额叶(dorsomedial prefrontal cortex，dmPFC)、外侧眶额回(lateral orbitofrontal cortex,IOFC)和颞区激活更强,伴随杏仁核的激活减弱。(4)而在PD组,dlPFC、dmPFC和颞区激活较对照组减弱,杏仁核激活存在组别×描述类型交互效应。(5)PD组dlPFC/dmPFC条件间差值与HAMA评分和PDSS评分呈负相关,与转换视角策略呈正相关。结论:1、内隐认知重评能够有效调节情绪反应,其解剖基础在于前额叶(dlPFC、dmPFC和1OFC)的激活增强和边缘系统的激活下降。2、内隐认知重评调控机制为自上而下的无意识认知控制,即前额叶通过对颞叶施加影响,改变情绪刺激的语义,间接影响边缘系统的激活。3、PD患者存在显著情绪调节障碍,内隐认知重评异常是PD患者惊恐发作和病理性焦虑产生的重要环节。4、dlPFC和dmPFC功能的缺失是PD内隐认知重评的重要神经机制。5、PD内隐情绪调节过程的失败与PD临床症状的严重性相关,前额叶激活程度可能成为有应用价值的评估PD严重程度和情绪调节功能的影像学指标。
[Abstract]:Objective: panic disorder (PD) is a kind of severe acute anxiety disorder, and its pathogenesis is not clear. The pathogenesis of PD was studied from the perspective of emotion generation and implicit cognitive reassessment. Neuropsychological measurement, emotional experience self-report and functional magnetic resonance imagingfMRI) were used to study the pathogenesis of PD. The behavioral characteristics of emotion cognitive regulation, the characteristics of emotion related social psychology, and the brain processing mechanism of implicit cognitive reassessment in PD patients were studied. Methods: 26 patients with PD were enrolled in the study. The neuropsychological scale was used to investigate the clinical symptoms and emotional regulation characteristics of the patients, and the implicit cognitive reassessment task was used to study the emotional response of the subjects to negative images by using the fMRI technique, and the activation characteristics of the brain were recorded. Subjects in the task were given neutral or negative picture description before viewing the negative picture. At the same time, the emotional self-report of the subjects was recorded with a 4-point scale. The scale, behavior and brain activation data were measured within the group. Results the scores of self-reflection, disaster strategy, cognitive re-evaluation and change perspective were lower in PD group than those in control group, and the scores of cognitive reassessment and change perspective were lower than those in control group. All the differences were statistically significant. (2) the group 脳 description type interaction effect was found in the 4-point scale of the pleasure degree of emotion picture. The results of fMRI showed that when the subjects looked at the negative picture of the pre-neutral description, they were compared with the negative picture of the pre-negative description. In the control group, the activation of prefrontal cortexes, dorsomedial prefrontal cortexus, lateral orbitofrontal cortexIOFCC and temporal region were stronger in PD group than in the control group, but the activation of dlPFCCand temporal area in PD group was lower than that in control group, but the activation of dlPFCmPFC and temporal area in PD group was lower than that in the control group, and the activation of lateral orbitofrontal cortextexus was stronger in the lateral orbitofrontal gyrus than in the control group, and the activation of amygdaloid nucleus was weaker in PD group than in the control group. The difference between dlPFC/dmPFC condition and HAMA score and PDSS score was negatively correlated with the change of visual angle strategy. Conclusion: 1. Implicit cognitive reassessment can effectively regulate emotional response, and the difference between the dlPFC/dmPFC conditions of the group 脳 description type interaction effect of amygdala activation is negatively correlated with the HAMA score and the PDSS score, and positively correlated with the strategy of switching perspective. Conclusion: 1. Its anatomical basis lies in the enhancement of activation of dlPFC+ dmPFC and 1OFC) and the decrease of activation of the marginal system. The implicit cognitive reassessment mechanism is controlled by unconscious cognition from top to bottom, that is, the prefrontal lobe changes the semantics of emotional stimulation by exerting influence on temporal lobe. There were significant emotional regulation disorders in PD patients who indirectly affected the activation of the limbic system. Abnormal implicit cognitive reassessment is an important link in the generation of panic attack and pathological anxiety in PD patients. The absence of 4 d lPFC and dmPFC is an important neural mechanism of PD implicit cognitive reassessment. 5 the failure of PD implicit emotion regulation process is related to the severity of clinical symptoms of PD. The activation degree of prefrontal lobe may be a valuable imaging index for evaluating PD severity and emotion regulation function.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R749.72
，

本文编号：1590136