反社会人格障碍男性患者决策功能研究

发布时间：2018-06-10 16:13

本文选题：反社会人格障碍 + 决策　；参考：《安徽医科大学》2013年硕士论文

【摘要】：目的既往神经心理学研究发现在众多脑结构与功能障碍疾病中普遍存在着决策功能缺陷，如帕金森病、Wilson病、癫痫、强迫症、病理性赌博等。反社会人格障碍（Antisocial Personality Disorder,ASPD）作为人格障碍领域中备受关注的一员而在临床与科研实践中被频繁提及。本研究采用爱荷华博弈测试（Iowa GamblingTask, IGT）和骰子博弈测试（Game of Dice Task, GDT）探讨ASPD患者在风险模糊情境及风险明确情境下的决策功能，并由此探索其反社会行为病因与神经机制。方法研究一：将76例ASPD患者及与其相匹配的健康对照（Health Controls, HC）作为研究对象，通过IGT进行风险模糊情境决策功能测试，使用简明精神状态量表(Mini-Mmental State Examination, MMSE)、抑郁自评量表(Zung Self-RatingDepression Scale, SDS)、焦虑自评量表(Zung Self-Rating Anxiety Scale, SAS)和Barratt冲动量表（Barratt Impulsiveness Scale-11, BIS-11）对两组被试进行背景测试。研究二：使用风险明确情境下决策功能测评工具骰子博弈测试（GDT）对31例ASPD患者、33例HC进行评估，运用MMSE、汉密尔顿抑郁量表（HamiltonDepression Scale，HAMD）、汉密尔顿焦虑量表（Hamilton Anxiety Scale，HAMA）、BIS-11、Stroop色字实验（Stroop Colour and Word Test, SCWT）、数字广度测试（DigitSpan Test, DS）和词汇流畅性测试（Verbal Fluency Test, VFT）对两组被试测试。结果研究一：ASPD组在IGT中净有利选牌数明显低于HC组[分别为(-4.13±18.27)次，(6.03±19.43)次]，两组之间差异有统计学意义[t(134)=-3.132，P=0.002]。对两组采用2(组)×5(阶段)方差分析，比较两组不同阶段的净有利选择，发现两组间的主效应显著[F(1,134)=9.811，P=0.002]；五个阶段主效应同样显著[F(4,536)=15.456，P＜0.001]。随着IGT选择次数的增多，ASPD组和HC组净有利选择次数均逐渐增多，但在第三、第四、第五阶段，HC组净有利选择数目显著多于ASPD组[第三阶段F（1，134）=5.947，P=0.016；第四阶段F（1，134）=5.023，P=0.027；第五阶段F（1，134）=8.553，，P=0.004]。ASPD组净有利选择数与SAS得分、SDS得分、BIS-11、被试年龄和教育程度均未见明显相关。研究二：ASPD组较HC组更倾向于选择高风险选项[ASPD组为（10.06±5.26）次，HC组为（5.42±3.29）次，t=4.201，P0.001]。HC组负反馈利用率明显高于ASPD组，差异有统计学意义（HC组：0.68±0.32，ASPD组：0.28±0.26，t=－5.311，P0.001）。四个选项中ASPD组选择最多的是两个数字的组合，而HC组选择最多的是三个数字的组合[选择一个数字组合：ASPD组中位数为1（0～8），HC组中位数为1（0～2.5），两组差异有统计学意义(Z=-2.295，P=0.022）。三个数字组合：ASPD组为（4.77±4.23）次，HC组为（6.79±3.43）次；t=－2.100，P=0.04。四个数字组合：ASPD组为（3.06±3.53）次，HC组为（5.82±3.41）次；t=3.176，P=0.002）]，两组差异有统计学意义。Pearson相关分析显示，ASPD组中选择高风险选项次数与Stroop结果（r=0.566，P0.001）、负反馈利用率（r=－0.613，P0.001）、BIS-11运动冲动性（r=0.779，P0.001）和BIS-11总分（r=0.481，P=0.006）相关性显著。结论男性ASPD患者存在决策功能障碍,在风险明确和风险模糊条件下的表现各有不同。研究一：ASPD患者在风险概率模糊条件下决策功能受到损害，且其净有利选择数与SAS得分、SDS得分、BIS-11、被试年龄和教育程度均无相关。研究二：ASPD患者在风险概率明确条件下偏向高风险选项，且高风险选择数与执行功能（Executive function, EF）、行为冲动性和负反馈利用率相关。推测其决策功能缺陷可能与眶额叶（Orbitofrontal Cortex, OFC）、腹内侧前额叶（VentromedialPrefrontal Cortex, VMPFC）、背外侧前额叶（Dorsolateral Prefrontal Cortex, DLPFC）及杏仁核等的脑结构和功能异常有关。
[Abstract]:Objective previous neuropsychological studies have found that there are many defects in the brain structure and dysfunction, such as Parkinson's disease, Wilson disease, epilepsy, obsessive-compulsive disorder, pathological gambling, and so on. Antisocial Personality Disorder (ASPD) is a highly concerned person in the field of personality disorder and is in clinical practice. The research is frequently mentioned in the research practice. This study uses the Iowa game test (Iowa GamblingTask, IGT) and the dice game test (Game of Dice Task, GDT) to explore the decision-making function of the ASPD patients in the risk ambiguous situation and the risky situation, and to explore the cause and the neural mechanism of the antisocial behavior.
Method 1: 76 cases of ASPD patients and Health Controls (HC) matched with them were used as the research subjects. The risk fuzzy situation decision function test was carried out by IGT. The simple mental state scale (Mini-Mmental State Examination, MMSE), the self rating Depression Scale (Zung Self-RatingDepression Scale), and the anxiety self-assessment were used. The Zung Self-Rating Anxiety Scale (SAS) and the Barratt impulse scale (Barratt Impulsiveness Scale-11, BIS-11) were used for the background test of two groups of subjects. Study two: the dice game test (GDT) was used to assess 31 cases of ASPD patients and 33 cases by using the risky situation. The table (HamiltonDepression Scale, HAMD), the Hamilton Anxiety Scale (Hamilton Anxiety Scale, HAMA), BIS-11, Stroop color character experiment (Stroop Colour and), digital breadth test and vocabulary fluency test are tested for two groups.
Results 1: the number of net favorable selection in group ASPD was significantly lower than that in group HC [-4.13 + 18.27), (6.03 + 19.43), and the difference between the two groups was [t (134) =-3.132, P=0.002]. was used in two groups by 2 (Group) x 5 (stage) variance analysis to compare the net favorable choices of the two groups at different stages, and found that the main effect of the two groups was significant [F ( 1134) =9.811, P=0.002]; the main effect of the five stages was also significant [F (4536) =15.456, P < 0.001]. with the increase of IGT selection times, ASPD and HC group net favorable selection times increased gradually, but in the third, fourth, fifth stage, the net favorable selection number of HC group was much more than ASPD Group [Third Stage F (1134)]. 1 134) 134) =5.023, P=0.027, fifth stage F (1134) =8.553, P=0.004].ASPD group net favorable selection and SAS score, SDS score, BIS-11, and no significant correlation between the age and educational level of the subjects.
Study two: group ASPD was more likely to choose higher risk options than group HC (10.06 + 5.26), HC group (5.42 + 3.29), t=4.201, P0.001].HC group was significantly higher than ASPD group, the difference was statistically significant (HC group: 0.68 + 0.32, ASPD group: 0.28 + 0.26, t = - 5. 3, P0.001). Four options were two in ASPD group choosing the most was two. The combination of numbers, and the most selected group of HC groups is the combination of three numbers [selecting a number combination: the median of the ASPD group is 1 (0~8), the median of the HC group is 1 (0 to 2.5), the two groups are statistically significant (Z=-2.295, P=0.022). Three digital combinations: the ASPD group is (4.77 + 4.23), and the HC group is (6.79 + 3.43) times; t = - 2. 100, P=0.04. four. Word combination: group ASPD was (3.06 + 3.53), group HC was (5.82 + 3.41), t=3.176, P=0.002), and two groups were statistically significant.Pearson correlation analysis showed that the number of high risk options in group ASPD and Stroop results (r=0.566, P0.001), negative feedback utilization (r = 0. 6 13, P0.001), BIS-11 motion impulsivity and total score ( R=0.481, P=0.006) have a significant correlation.
Conclusion the male ASPD patients have decision-making dysfunction, and there are different manifestations in the condition of risk ambiguity and risk ambiguity. Study 1: ASPD patients are impaired under the risk probability fuzzy condition, and the net favorable selection is not related to the SAS score, the SDS score, the BIS-11, the age of the trial and the educational level. Two: ASPD patients The high risk option was biased under the risk probability, and the high risk selection was related to the executive function (Executive function, EF), the behavioral impulsivity and the negative feedback utilization. It is presumed that the defect of the decision function may be with the orbital frontal lobe (Orbitofrontal Cortex, OFC), the ventral medial prefrontal lobe (VentromedialPrefrontal Cortex, VMPFC), and the dorsolateral. Dorsolateral Prefrontal Cortex (DLPFC) and amygdala are related to abnormal brain structure and function.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R749.91

【参考文献】