伴有攻击或暴力行为的首发精神分裂症患者的甲状腺激素、脑电图研究

发布时间：2018-05-13 05:35

本文选题：精神分裂症 + 攻击或暴力行为　；参考：《济宁医学院》2017年硕士论文

【摘要】：目的:精神分裂症是目前最严重的精神疾病之一,攻击或暴力行为是精神分裂症常见临床症状。甲状腺激素、脑电图是当前研究热点。探讨伴攻击或暴力行为的首发精神分裂症患者的促甲状腺激素(TSH)、游离三碘甲状腺原氨(FT3)、游离甲状腺素(FT4)、三碘甲状腺原氨酸(TT3)、甲状腺素(TT4)及脑电图相关波形(α波、β波、δ波、θ波)在左前额(Fp1)、右前额(Fp2)、左中颞(T3)、右中颞(T4)、左中央(C3)、右中央(C4)、左枕(O1)、右枕(O2)处波幅改变及其与攻击行为严重程度、精神症状严重程度的关系,为研究精神分裂症患者的攻击或暴力行为提供客观依据。方法:根据第5版美国精神障碍诊断与统计手册(DSM-5)诊断标准,对住院的首发精神分裂症患者进行收集,采用阳性与阴性症状量表(PANSS)对其精神症状评定,然后采用修改版外显攻击量表(MOAS)评定其攻击行为,将符合条件的患者分为攻击组精神分裂症(简称攻击组)57例和非攻击组精神分裂症(简称非攻击组)43例,分别抽取静脉血行TSH、FT3、FT4、TT3、TT4测量及使用日本光电1200C脑电图仪对两组患者Fp1、Fp2、T3、T4、C3、C4、O1、O2处进行α波、β波、δ波、θ波波幅测试。结果:1.一般资料的比较:攻击组、非攻击组两组之间的年龄、性别比例、文化程度、病程均无统计学差异。2.攻击组、非攻击组间甲状腺激素的比较,结果显示:两组间TSH、FT3、FT4、TT3、TT4无明显差别(p0.05)。攻击组TT3明显高于非攻击组[(1.97±0.58)nmol/L vs(1.68±0.39)nmol/L,p0.05],差异具有统计学意义。3.对两组间的脑电图分别进行比较,结果显示:α波:攻击组与非攻击组于Fp1、Fp2、T3、T4、C3、C4、O1、O2处α波波幅比较无明显的差异(p0.05)。β波:攻击组于Fp1[(4.08±3.23)u V vs(6.69±4.57)u V,p0.05]、Fp2[(4.01±2.96)u V vs(6.01±3.18)u V,p0.05]、T3[(2.71±1.64)u V vs(4.48±2.82)u V,p0.05]、T4[(2.88±2.12)u V vs(4.43±3.05)u V,p0.05]、C3[(4.58±4.67)u V vs(6.36±3.55)u V,p0.05]、C4[(4.45±4.39)u V vs(6.09±3.44)u V,p0.05]、O2[(5.80±5.06)u V vs(8.07±4.94)u V,p0.05]处β波波幅明显低于非攻击组,差异具有统计学意义。两组间O1处β波波幅无明显差异(p0.05)。δ波:攻击组于Fp1[(4.70±3.19)u V vs(9.91±9.40)u V,p0.05]、Fp2[(5.34±3.92)u V vs(8.27±5.97)u V,p0.05]、T3[(2.37±1.37)u V vs(3.57±2.46)u V,p0.05]、T4[(3.23±2.03)u V vs(4.32±2.77)u V,p0.05]、C3[(4.54±3.56)u V vs(6.51±4.10)u V,p0.05]、C4[(5.23±4.13)u V vs(7.19±3.81)u V,p0.05]、O1[(4.81±5.95)u V vs(7.38±5.20)u V,p0.05]、O2[(4.77±3.86)u V vs(8.23±5.48)u V,p0.05]处δ波波幅明显低于非攻击组,差异具有统计学意义。θ波:攻击组于Fp1[(6.07±5.76)u V vs(10.72±10.35)u V,p0.05]处θ波波幅明显低于非攻击组,差异具有统计学意义。Fp2、T3、T4、C3、C4、O1、O2处θ波波幅比较无明显的差异(p0.05)。4.相关性分析4.1甲状腺激素、脑电图与MOAS的5项分因子相关性:TT3与总分呈正相关(r=0.207,p0.05),TSH、FT3、FT4、TT4与言语攻击、财产攻击、自身攻击、体力攻击、总分无相关性(p0.05)。Fp2处α波波幅与财产攻击呈正相关(r=0.310,p0.05),Fp2处θ波波幅与财产攻击呈正相关(r=0.562,p0.05),Fp1、Fp2、T3、T4、C3、C4、O1、O2处β波、δ波与言语攻击、财产的攻击、自身攻击、体力攻击、总分无相关性(p0.05)。4.2甲状腺激素、脑电图与PANSS的4项分因子相关性:TSH、FT3、FT4、TT3、TT4与阳性症状分、阴性症状分、一般精神病理分、总分无相关性(p0.05)。O2处α波波幅与阴性症状分呈正相关(r=0.310,p0.05)。O1处δ波波幅与阴性症状分呈正相关(r=0.218,p0.05),O2处δ波波幅与阴性症状分呈正相关(r=0.292,p0.05)。Fp1、Fp2、T3、T4、C3、C4、O1、O2处β波、θ波波幅与阳性症状分、阴性症状分、一般精神病理分、总分无相关性(p0.05)。结论:伴攻击或暴力行为的首发精神分裂症患者的甲状腺激素、脑电图改变:1.攻击组与非攻击组比较:TT3浓度明显升高,提示精神分裂症患者的攻击或暴力行为与内分泌功能改变有关。2.攻击组与非攻击组比较:主要以额叶、颞叶β波波幅、δ波波幅、θ波波幅明显降低,提示精神分裂症患者的攻击或暴力行为与其波幅降低有关。3.相关性分析:3.1甲状腺激素、脑电图与MOAS的5项分因子相关结果:甲状腺激素、右侧额叶处α波、θ波波幅与精神分裂症的攻击或暴力行为的严重程度的指标之间有着显著的相关性。3.2甲状腺激素、脑电图与PANSS的4项分因子相关结果:枕叶处α波、δ波波幅与精神分裂症的阴性症状严重程度有显著的相关性。总之,伴攻击或暴力行为的精神分裂症患者的这些特征性指标的研究,为研究精神分裂症患者攻击或暴力行为的发生机制提供了客观依据。
[Abstract]:Objective: schizophrenia is one of the most serious mental disorders at present. Attack or violence is a common clinical symptom of schizophrenia. Thyroid hormone and electroencephalogram are the current research hotspots. Thyroid stimulating hormone (TSH), free three iodine thyroid proto ammonia (FT3), free thyroidin (three iodine), free thyroid gland are discussed in the first episode of schizophrenia with attack or violence. Adenosine (FT4), three iodine thyroxine (TT3), thyroxine (TT4) and electroencephalogram related waveforms (alpha, beta, Delta, theta) in the left frontal (Fp1), right anterior frontal (Fp2), Zuo Zhongnie (T3), right middle temporal (T4), Zuo Zhongyang (C3), right central (C4), left occipital (O1), right occipital (O2) wave amplitude change and the severity of mental symptoms, and the severity of mental symptoms To provide an objective basis for the study of attack or violence in patients with schizophrenia. Methods: according to the diagnostic and Statistical Manual (DSM-5) of the fifth edition of the American psychiatric disorder, the first episode schizophrenic patients were collected, the positive and negative symptom scale (PANSS) was used to evaluate the mental symptoms, and then the revised version was adopted. The attack behavior was evaluated by the explicit attack scale (MOAS). The eligible patients were divided into 57 cases of attack group schizophrenia (attack group) and 43 cases of non attack group (non attack group). The venous blood was taken respectively for the measurement of TSH, FT3, FT4, TT3, TT4 and the Japanese photoelectric 1200C electroencephalograph on the two groups of patients Fp1, Fp2, T3, T4, C3, etc. A test of alpha, beta, Delta and theta wave amplitude at O2. Results: 1. comparison of general data: the age, sex ratio, education level and course of disease between the two groups in the attack group and the non attack group were no significant difference between the.2. attack group and the thyroid hormone comparison between the non attack groups, and the results showed that there was no significant difference between the two groups of TSH, FT3, FT4, TT3, TT4 (P0.05). Group TT3 was significantly higher than that of non attack group [(1.97 + 0.58) nmol/L vs (1.68 + 0.39) nmol/L, p0.05], and the difference was statistically significant.3. to the EEG between the two groups. The results showed: alpha wave: there was no significant difference between the attack group and the non attack group in Fp1, Fp2, T3, T4, C3, C4, and the amplitude of the alpha wave. U V vs (6.69 + 4.57) u V, p0.05], Fp2[(4.01 + 2.96) u V vs (6.01 + 3.18) u V. The amplitude of beta wave wave was significantly lower than that of non attack group. There was no significant difference in the amplitude of beta wave between the two groups (P0.05). Delta wave: the attack group was Fp1[(4.70 + 3.19) u V vs (9.91 + 9.40) u V, p0.05], Fp2[(5.34 + 3.92) u V (2.37 + 5.97). V, p0.05], C3[(4.54 + 3.56) u V vs (6.51 + 4.10) u V, p0.05], C4[(5.23 + 4.13) u V (4.81 + 5.95). 10.35) u V, the amplitude of theta wave in p0.05] is obviously lower than that of non attack group, and the difference has statistical significance.Fp2, T3, T4, C3, C4, O1, O2, the amplitude of theta wave is no obvious difference (P0.05).4. correlation analysis 4.1 thyroid hormones, the correlation between the EEG and the 5 components of the total score. Property attack, self attack, physical attack, total score without relevance (P0.05).Fp2, alpha wave amplitude is positively related to property attack (r=0.310, P0.05), Fp2 at Fp2 wave amplitude is positively related to property attack (r=0.562, P0.05), Fp1, Fp2, T3, T4, C3, Delta, delta wave and speech attack, property attack, self attack, physical attack, total score unrelated. Sex (P0.05).4.2 thyroid hormone and electroencephalogram were correlated with 4 sub factors of PANSS: TSH, FT3, FT4, TT3, TT4 and positive symptoms, negative symptoms, general psychopathology, total score without correlation (P0.05).O2 and negative symptom score positive correlation (r= 0.310, P0.05) delta wave amplitude is positively correlated with negative symptom score, O2 (r=0.292, P0.05).Fp1, Fp2, T3, Fp2, T3, T4, C3, C4, O1, O2 beta wave, theta wave amplitude and positive symptoms, negative symptoms, general psychopathology, total score without correlation (P0.05). Conclusion: the thyroid hormone, electroencephalogram changes in first episode schizophrenic patients with attack or violence: 1. attack group Compared with the non attack group, the concentration of TT3 increased significantly, suggesting that the attack or violent behavior of the schizophrenic patients and the changes of the endocrine function were related to the.2. attack group and the non attack group, mainly in the frontal lobe, the temporal lobe beta wave amplitude, the delta wave amplitude, and the theta wave amplitude, suggesting that the attack or violent behavior of the schizophrenic patients and their amplitude decreased. .3. correlation analysis: 3.1 thyroid hormone, electroencephalogram and 5 factors associated with MOAS: thyroid hormone, the right frontal lobe, the alpha, theta wave amplitude, and the severity of the attack or violence of schizophrenia, there is a significant correlation between the.3.2 thyroid hormone, and the results of the 4 factors associated with the electroencephalogram and PANSS: There is a significant correlation between the alpha and delta wave amplitude of the occipital lobe and the severity of the negative symptoms of schizophrenia. In a word, the study of these characteristics of schizophrenic patients with attack or violence provides an objective basis for the study of the mechanism of attack or violent behavior in schizophrenic patients.

【学位授予单位】：济宁医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R749.3

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