难治性抑郁症的皮层信息加工：共病影响、认知及情绪处理功能

发布时间：2018-04-11 10:31

本文选题：难治性抑郁症 + 边缘型人格障碍　；参考：《浙江大学》2013年博士论文

【摘要】：背景难治性抑郁症是一种严重的精神障碍,大约有30-40%的抑郁症患者会由于反复发生的恶劣心境和极差的药物及心理治疗反应性而被诊断为这种疾患。目前,学术界对于难治性抑郁症的了解并不深入,特别是对其病理机制尚未充分明确,间接导致了临床对这些患者的诊治不当。因此,难治性抑郁症作为抑郁症中最为严重的类型,不仅浪费了大量的医疗资源,也同时加重了社会福利系统的负担。负性情感偏倚等“情绪相关”的认知功能损伤是难治性抑郁症患者核心临床表现,同时这些患者也被发现存在包括注意分配障碍在内的“情绪无关”认知功能水平下降。另外,临床研究逐渐发现有很大一部分难治性抑郁症患者与边缘型人格障碍存在共病。因此,要从根本上了解难治性抑郁症的发病机理,就需要对其在情绪、认知方面的皮层功能损伤进行明确定位,并且将难治性抑郁症的这些功能损伤与难治性抑郁症与边缘型人格障碍共病情况下的相应表现进行有效区分,并以此为临床对其进行有效诊断和合理治疗提供重要的实证基础。目的 1.研究难治性抑郁症“情绪无关”皮层前注意认知功能。 2.研究难治性抑郁症“情绪相关”皮层面部情绪认知功能。 3.探索难治性抑郁症及其与边缘型人格障碍共病的情况下,边缘型人格障碍对共病患者在上述两类皮层认知功能损伤情况的影响,从而对难治性抑郁症在这些方面特殊的认知功能损伤进行有效地区分。方法 1.在32名正常被试、22名难治性抑郁症、19名边缘型人格障碍和22名难治性抑郁症与边缘型人格障碍的共病患者中进行事件相关电位(Event-related Potentials, ERPs)的失匹配负波(Mismatch Negativity, MMN)检测。 2.在37名正常被试、25名难治性抑郁症、15名边缘型人格障碍和22名难治性抑郁症与边缘型人格障碍的共病患者中进行Oddball范式面部情绪图片(平静、愤怒、快乐和悲伤)诱发的ERPs成分(N1,P2,N2,P3a和P3b)检测。 3.对四组被试在MMN检测中所测得的N1及MMN的波幅及潜伏期进行多因素方差分析。 4.对四组被试在面部情绪图片检测中所测得的相关ERPs的波幅及潜伏期和反应时进行多因素方差分析。 5.运用PVP抑郁问卷(Plutchik-van Praag Depression Inventory, PVP)对所有被试的抑郁症状进行测量,并将得分与所有被试的年龄、抑郁周期、反应时、MMN及面部情绪图片诱发ERPs的波幅及潜伏期等进行相关性检验。结果 1.难治性抑郁症患者的MMN波幅较其余各组显著增大；边缘型人格障碍及其与难治性抑郁症共病患者的MMN波幅及潜伏期与正常被试无显著差异。 2.难治性抑郁症、边缘型人格障碍及两者的共病患者由面部情绪图片诱发的ERPs成分的波幅及潜伏期与正常被试无显著差异。 3.难治性抑郁症患者对愤怒、快乐和悲伤的面部情绪图片反应时较正常被试显著延长；难治性抑郁症与边缘型人格障碍的共病患者对愤怒及快乐的面部情绪图片反应时较正常被试显著延长；边缘型人格障碍患者对四类面部情绪图片反应时较正常被试无明显异常。 4.在难治性抑郁症与边缘型人格障碍的共病患者中,PVP得分与愤怒面部情绪图片对其诱发的P2潜伏期呈显著的正相关。此外,所有被试对四类面部情绪图片的反应时与PVP得分呈正相关。结论 1.难治性抑郁症患者存在皮层前注意认知功能损伤,而这种损伤并没有表现在边缘型人格障碍及两者的共病患者中。 2.难治性抑郁症、边缘型人格障碍及两者共病的患者皮层面部情绪认知功能尚未受损。 3.难治性抑郁症患者表现出对愤怒、快乐和悲伤面部情绪的后期认知处理功能异常；难治性抑郁症与边缘型人格障碍的共病患者表现出对愤怒和快乐面部情绪的后期认知处理异常。 4.边缘型人格障碍在皮层前注意及面部情绪认知功能的完整性可能对其与难治性抑郁症的共病患者在这两方面皮层功能的损伤具有潜在的补偿作用。总之,本论文基于本申请人已经发表的两篇研究报道(He et al.,2010,2012),采用高时间分辨率的ERPs技术来探索难治性抑郁症患者的皮层前注意及面部情绪认知功能,明确了难治性抑郁症患者在皮层前注意认知功能的特异性损伤及皮层面部情绪认知功能的完整性,提示了这些患者表现出的面部情绪识别的行为学异常发生于较为后期的认知处理过程。同时,本研究发现了边缘型人格障碍在其与难治性抑郁症共病时对共病患者在上述两类皮层认知功能的影响。
[Abstract]:background
Refractory depression is a serious mental disorder, about 30-40% of the patients with depression due to repeated drug dysthymia and range and psychological treatment response was diagnosed with the disease. At present, the academic community for refractory depression is not in-depth understanding, especially on its pathological mechanism is not yet fully clear and indirectly led to the diagnosis and treatment of these patients is improper. Therefore, the refractory depression depression as the most serious type, not only waste a large amount of medical resources, but also increase the social welfare system. The burden of negative emotional bias "emotional" cognitive impairment is refractory depression the core of patients with clinical manifestations, and these patients were also found, including the distribution of attention disorder "emotional independent level of cognitive function decline. In addition, the clinical research of existing A large part of patients with refractory depression and borderline personality disorder comorbidity. Therefore, to understand the pathogenesis of refractory depression fundamentally, you need to in the mood, cognitive aspects of cortical function damage of clear positioning, the corresponding function and will damage the performance of these refractory and refractory depression depression and borderline personality disorder comorbid conditions were effectively differentiated, and thereby to provide empirical basis for important clinical effective diagnosis and treatment for it.
objective
1. of the refractory depression mood independent cortex before the attention of cognitive function.
2. study on refractory depression emotion related cortical facial emotion cognitive function.
3. of the refractory depression and borderline personality disorder cases, borderline personality disorder on the influence on the two kinds of cognitive function damage in the cortex in patients, so as to effectively distinguish the damage on the cognitive function of refractory depression in these special areas.
Method
1. in 32 normal subjects, 22 patients with refractory depression and event-related potentials of 19 patients with comorbid borderline personality disorder and 22 patients with refractory depression and borderline personality disorder in (Event-related Potentials, ERPs) mismatch negativity (Mismatch Negativity, MMN) detection.
2. in 37 normal subjects, 25 patients with refractory depression, the Oddball paradigm of facial emotions in patients. 15 patients with borderline personality disorder and 22 patients with refractory depression and borderline personality disorder (in a calm, angry, happy and sad) ERPs induced (N1, P2, N2. P3a and P3b) detection.
3. of the four groups of subjects were measured by N1 and MMN in the detection of MMN amplitude and latency of multi factor analysis of variance.
By multivariate analysis of variance of 4. subjects of the four groups of ERPs measured in facial emotional pictures in the test of amplitude and latency and response time.
5. using the PVP Depression Inventory (Plutchik-van Praag Depression Inventory, PVP) was measured in all the subjects of depressive symptoms, and the scores of all subjects with age, depression period, reaction time, MMN and facial emotional pictures evoked ERPs amplitude and latency of correlation test.
Result
1. patients with refractory depression MMN amplitude significantly increased compared with the rest of the group; borderline personality disorder and comorbidity in patients with refractory depression MMN amplitude and latency had no significant difference compared with normal subjects.
2. refractory depression, patients with comorbid borderline personality disorder and both by the amplitude and latency of ERPs components by pictures of facial emotions had no significant difference compared with normal subjects.
3. patients with refractory depression to anger, happy and sad facial emotional picture response than that of the normal subjects were significantly prolonged; in patients with refractory depression and borderline personality disorder of angry and happy facial emotional picture response than normal subjects was significantly prolonged; patients with borderline personality disorder in four kinds of face emotional picture response than that of the normal subjects had no obvious abnormalities.
A total of 4. patients with refractory depression and borderline personality disorder, a significant positive correlation between PVP scores and angry facial emotions on the evoked latency of P2 pictures. In addition, all of the subjects of four kinds of facial emotion pictures and reaction time of PVP score was positively correlated.
conclusion
1. patients with refractory depression are attention to cognitive impairment and the cortex before the injury was not reflected in patients with comorbid borderline personality disorder and both.
2. patients with refractory depression, cortical facial emotion cognitive function of patients with borderline personality disorder and the disease has not been damaged.
3. patients with refractory depression show anger, happy and sad facial emotions later cognitive dysfunction; refractory depression and borderline personality disorder in patients exhibiting late cognitive processing of angry and happy facial emotions.
4. borderline personality disorder in cortex can compensate before potential integrity and facial emotion cognitive function may cortex in these two aspects of the function in patients with refractory depression damage.
In conclusion, this thesis is based on two studies have been published reports of the applicant (He et al., 20102012), with high time resolution ERPs technology to explore the attention and facial emotion cognitive function in patients with refractory depression cortex before clear refractory depression patients pay attention to integrity of the specific injury in cortex and facial emotion cognitive function the cognitive function in the skin layer, cognitive processes that occur in relatively late abnormal facial emotion recognition of these patients exhibited behavior. At the same time, this study found a borderline personality disorder in the refractory depression effect on the two kinds of cortical cognitive function comorbidity patients.

【学位授予单位】：浙江大学
【学位级别】：博士
【学位授予年份】：2013
【分类号】：R749.4

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