双相情感障碍疼痛共情能力的ERP研究

发布时间：2018-05-16 02:11

本文选题：双相情感障碍 + 疼痛　；参考：《安徽医科大学》2016年硕士论文

【摘要】：目的:双相情感障碍(Bipolar disorder,BD)是一种既有抑郁发作,又有躁狂或轻躁狂发作的精神疾病。双相情感障碍患者的社会认知功能存在一定程度的损伤,主要涉及理解他人的想法和感受并做出恰当反应的能力,包括情绪加工、心理理论及共情等方面的能力。共情是指对他人的情感状态识别和共享的能力,在社会交往中至关重要。然而,目前对双相情感障碍患者共情能力的研究不多,现有研究大多停留在行为学水平,未涉及神经机制。本研究将运用高时间分辨率的事件相关电位(event-related potential,ERP)手段,采用经典的疼痛共情范式,从时间加工进程的角度探讨双相情感障碍患者疼痛共情的神经机制。方法:(1)被试:30例双相情感障碍患者和25名健康对照。患者要求符合《国际疾病与相关健康问题统计分类》(International Classification of Diseases,ICD-10)双相情感障碍诊断标准;正在服用精神病药物,症状稳定或缓解;近6个月内无电休克治疗史;不伴有精神病性症状。健康对照要求无精神疾病及精神疾病家族史,且年龄、性别和受教育年限与患者组相匹配。所有被试排除重大躯体疾病、视力缺陷及不能独立完成测验者。(2)共情量表:所有被试均完成自评量表中文版人际反应指针量表(Interpersonal Reactivity Index,IRI)。(3)疼痛共情范式:根据既往研究,自行拍摄了140张疼痛和中性图片,由计算机呈现,要求被试对图片中人物是否感到疼痛(疼痛判断任务)或图片中涉及的身体部位(手/脚)为左还是右(左右判断任务)进行判断。判断任务进行的同时,记录被试的脑电图(electroencephalograph,EEG)。两种任务在每组被试内顺序平衡匹配。判断任务结束后,要求被试对图片中人物的疼痛感进行等级评定。结果:(1)行为学结果:双相情感障碍患者在人际反应指针量表的共情性关心得分低于健康对照;患者在两种判断任务的两种刺激条件下,反应时均大于健康对照。(2)脑电结果:早期成分N1(105-155ms),健康对照在疼痛判断任务中,疼痛刺激诱发的波幅大于中性刺激,而左右判断任务中并无此差异;而患者无论在疼痛判断还是左右判断任务,疼痛和中性刺激诱发的脑电波幅均无差异。晚期成分P3(450-550ms和550-650ms),健康对照在疼痛判断任务中,疼痛刺激诱发的波幅大于中性刺激,而左右判断任务中并无此差异。患者组P3在两个区间均和健康对照具有相同的模式。但相对健康对照,患者在疼痛判断任务中,疼痛刺激诱发的波幅更小,而两组中性刺激诱发的波幅无统计学差异。(3)溯源分析结果:健康对照在疼痛判断任务中,相对中性刺激,加工疼痛刺激时,前扣带回(anterior cingutate,ACC)的电流密度更高,验证ACC在疼痛共情中起重要作用,而患者组在两种刺激加工过程中,ACC的电流密度并无统计学差异。结论:双相情感障碍患者在观看他人痛疼时,早期和晚期的疼痛共情脑电均降低,且溯源分析显示患者疼痛共情相关脑区ACC活动减弱,提示双相情感障碍患者疼痛共情能力降低。
[Abstract]:Objective: Bipolar disorder (BD) is a mental illness with both depressive episodes and manic or manic episodes. The social cognitive function of patients with bipolar disorder has a certain degree of impairment, mainly involving the ability to understand the ideas and feelings of others and to respond properly, including emotional processing and psychological theory. Empathy, such as empathy, is the ability to identify and share the emotional state of others, which is very important in social interaction. However, there are few studies on the empathy of patients with bipolar disorder. Most of the current studies remain at the level of behavior and do not involve neural mechanisms. This study will use high time resolution events. Event-related potential (ERP), a classical pain empathy paradigm, was used to investigate the neuro mechanism of pain empathy in patients with bipolar disorder from the point of view of time processing. Methods: (1) subjects: 30 patients with bipolar affective disorder and 25 healthy controls. The patients were required to meet the statistics of the international disease and related health problems. Class > (International Classification of Diseases, ICD-10) diagnostic criteria for bipolar affective disorder; taking psychotropic drugs with stable or remission symptoms; no history of electroshock treatment in the last 6 months; without psychotic symptoms. Healthy controls require no family history of mental illness and mental illness, and age, sex and education and patients Group matching. All subjects were excluded from major physical diseases, visual defects and independent tests. (2) the empathy scale: all subjects completed the Chinese version of Interpersonal Reactivity Index, IRI. (3) pain empathy paradigm: according to previous studies, 140 pain and neutral pictures were taken by themselves, and The computer was presented to determine whether the subjects felt pain in the picture (pain judgment task) or the body part (hand / foot) involved in the picture (hand / foot) was judged by left or right (left and right). While the task was judged, the electroencephalograph (EEG) of the subjects was recorded. The two tasks were balanced in each group. After judging the task, the subjects were asked to rank the pain of the characters in the picture. Results: (1) the behavioral results: the score of empathy care in the bipolar disorder patient was lower than that of the healthy control in the interpersonal response indicator scale; the patients were more than healthy controls in the two stimulus conditions of the two judgment tasks. (2) electroencephalogram (EEG) Results: early component N1 (105-155ms), healthy control in pain judgment task, pain stimulus induced amplitude was greater than neutral stimulus, but there was no difference in the left and right judgment tasks, and the patient no matter in pain judgment or left and right judgment task, pain and neutral stimulation evoked brain wave amplitude. The late component P3 (450-550ms and 550-65) 0ms), in the control of pain, the amplitude of pain evoked by pain stimulation was greater than that in the neutral stimulus, but there was no difference in the left and right judgment tasks. The patient group P3 had the same pattern as the healthy control in the two interval. But in the relative health control, the patient had a smaller amplitude induced by pain stimulation in the pain judgment task and the two group of neutral spines. The amplitude of stimulated amplitude was not statistically significant. (3) the results of traceability analysis: the health control in the pain judgment task, the relative neutral stimulus, the processing of pain stimulation, the anterior cingutate, ACC current density is higher, verifying that ACC plays an important role in the pain empathy, while the patient group is in the process of ACC, the ACC current density. There was no statistical difference. Conclusion: in patients with bipolar disorder, both early and late pain empathy decreased in patients with bipolar affective disorder, and traceability analysis showed that the ACC activity in the brain area of patients with pain empathy decreased, suggesting that the ability of pain empathy in patients with bipolar disorder was reduced.

【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R749.4

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