發(fā)布時間：2018-08-02 18:31

【摘要】：背景:雙相障礙(bipolar disorder,BD)是遺傳-應激綜合作用的結果,環(huán)境因素尤其是早年創(chuàng)傷事件在雙相障礙的發(fā)生發(fā)展中具有重要的作用,成為發(fā)病的危險因素之一。目前雙相障礙已成為嚴重的醫(yī)學問題和社會問題,有75%的緩解期雙相障礙患者無法達到病前的社會功能水平。而社會功能水平的下降和社會認知尤其是情緒認知關系密切。目前關于童年創(chuàng)傷對緩解期雙相障礙患者的情緒認知功能的影響尚不十分清楚。目的:探討童年創(chuàng)傷對緩解期雙相障礙患者情緒認知功能的影響;方法:納入2015年3月至2016年12月期間于河北醫(yī)科大學第一醫(yī)院精神科門診就診的緩解期雙相障礙患者72例,健康對照組70例,收集一般人口學資料、社會心理學資料,評估緩解期雙相障礙患者童年期創(chuàng)傷及情緒認知功能,情緒認知的評估采用情緒面孔識別(Fcial affect recognition,FAR)分析6種表情高興、悲傷、憤怒、厭惡、恐懼和驚訝的識別正確率。采用SPSS21.0統計軟件進行統計分析,計量資料統計描述以均數±標準差表示,兩組間比較采用兩獨立樣本t檢驗或非參數檢驗,計數資料統計描述采用構成比,率的比較采用χ2檢驗,情緒認知影響因素的分析采用逐步線性回歸方法。結果:1緩解期雙相障礙患者對悲傷識別正確率為53.5%,憤怒52.0%,高興89.8%,驚訝64.6%,厭惡35.9%,恐懼23.4%;健康對照組對悲傷識別正確率為60.9%,憤怒58.1%,高興95.5%,驚訝68.7%,厭惡43.3%,恐懼30.9%;兩組在悲傷(t=-2.424,P=0.017),憤怒(t=-2.018,P=0.046),高興(t=-3.492,P=0.001),恐懼(t=-3.331,P=0.001)和厭惡(t=-2.596,P=0.011)識別正確率具有顯著性差異。2雙相障礙組和健康對照組在CTQ總分(t=5.702,P=0.000),情感虐待(t=3.146,P=0.002),情感忽視(t=5.637,P=0.000),性虐待(t=2.277,P=0.025),軀體忽視(t=3.179,P=0.002),軀體虐待(t=3.270,P=0.001)有統計學差異。3緩解期雙相障礙組,有童年創(chuàng)傷(任何一種創(chuàng)傷類型)的患者憤怒面孔識別正確率較差(t=-2.021,P=0.048),有統計學意義;高興面孔識別正確率顯著降低,有統計學意義(t=-2.027,P=0.041);驚訝識別正確率顯著降低(t=-2.019,P=0.049),有統計學意義。4雙相障礙組,采用逐步線性回歸分析,在α入=0.05、α出=0.10水平下,悲傷識別正確率的影響因素有婚姻(t=-2.804,P=0.007),抗精神病藥物種類(t=-3.073,P=0.003)和生活事件(t=2.761,P=0.008);憤怒識別正確率影響因素躁狂發(fā)作次數(t=-2.453,P=0.017)和情感忽視(t=-2.205,P=0.032);高興識別正確率影響因素只有情感忽視(t=-2.030,P=0.047);驚訝識別正確率影響因素有性虐待(t=2.308,P=0.025)和婚姻狀態(tài)(t=-2.007,P=0,050);恐懼識別正確率影響因素為YMRS(t=-2.203,P=0.032);厭惡識別正確率影響因素有伴發(fā)精神病性癥狀(t=2.687,P=0.010)和體重指數(t=-2.310,P=0.025)。結論:1緩解期雙相障礙患者仍對特定表情識別障礙。2雙相障礙患者童年期經歷的創(chuàng)傷類型廣泛及程度嚴重。3經歷童年創(chuàng)傷的雙相障礙患者,緩解期殘留的認知癥狀明顯,尤其是情感忽視對憤怒和高興表情識別的影響嚴重,存在劑量-效應關系。
[Abstract]:Background: bipolar disorder (BD) is the result of the combined effect of genetic stress. Environmental factors, especially early years, have an important role in the development of bipolar disorder and become one of the risk factors of the disease. Bipolar disorder has become a serious medical and social problem, with 75% bipolar disorder in remission period. The decline of social function level and social cognition are closely related to social cognition, especially emotional cognition. The influence of childhood trauma on the emotional cognitive function of patients with bipolar disorder in remission stage is not very clear. Methods: 72 patients with bipolar disorder and 70 healthy controls were included in the psychiatric clinic of the first hospital of Hebei Medical University from March 2015 to December 2016. The general demographic data and social psychology data were collected to assess the childhood trauma and emotional cognitive function of the patients with bipolar disorder during remission. The cognitive assessment used the Fcial affect recognition (FAR) to analyze the recognition accuracy of 6 expressions of happiness, sadness, anger, aversion, fear and surprise. Statistical analysis was carried out by SPSS21.0 statistical software, and the statistical description of the measurement data was shown in the mean number of standard deviation tables, and the two groups were compared with two independent samples t test or non parameter. The statistical description of the count data used the ratio of composition, the ratio of the rate was compared with the chi 2 test, and the analysis of the influence factors of emotional cognition was carried out by stepwise linear regression. Results: the correct rate of distress recognition in the 1 patients with bipolar disorder was 53.5%, 52%, 89.8%, 64.6%, 35.9%, and 23.4%. The correct rate was 60.9%, the anger 58.1%, the happy 95.5%, the surprise 68.7%, the aversion 43.3%, the fear 30.9%, the two groups in t=-2.424, P=0.017, t=-2.018, P=0.046, t=-3.492, P=0.001, t=-3.331, P=0.001, and aversion (t=-2.596, P= 0.011), the accuracy of identification was significant difference between the.2 biphasic disorder group and the healthy control group in the total CTQ total. 5.702, P=0.000), t=3.146 (P=0.002), emotional neglect (t=5.637, P=0.000), t=2.277 (P=0.025), physical neglect (t=3.179, P=0.002), physical abuse (t=3.270, P=0.001), there were statistical differences in the biphasic disorder group, with a childhood trauma (any type of trauma) with a poor correct rate of face recognition. P=0.048) was statistically significant; the correct rate of recognition of happy faces was significantly reduced, with statistical significance (t=-2.027, P=0.041); the correct rate of surprise recognition was significantly reduced (t=-2.019, P=0.049), and there was a statistically significant.4 biphasic disorder group, by stepwise linear regression analysis, the influence factors of the correct rate of sadness identification at alpha into =0.05 and alpha =0.10 level T=-2.804 (P=0.007), antipsychotic drugs (t=-3.073, P=0.003) and life events (t=2.761, P=0.008); anger recognition accuracy affects the frequency of manic episodes (t=-2.453, P=0.017) and emotional neglect (t=-2.205, P=0.032); the factors affecting the positive rate of happiness recognition are only emotional neglect (t=-2.030, P=0.047); and the correct rate of surprise recognition The influencing factors were t=2.308 (P=0.025) and marital status (t=-2.007, P=0050); the influencing factors of the correct rate of fear recognition were YMRS (t=-2.203, P=0.032); the factors affecting the correct rate of aversion identification were associated with psychosis (t=2.687, P=0.010) and body mass index (t= -2.310, P=0.025). Conclusion: 1 patients with bipolar disorder still have specific facial expressions. The types of childhood experience in patients with.2 bipolar disorder have extensive and severe types of childhood traumas, and.3 experienced childhood trauma with bipolar disorder. The cognitive symptoms remained in the remission period, especially the effect of emotional neglect on anger and expression recognition, and there was a dose effect relationship.
【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R749.4

【參考文獻】

相關期刊論文 前2條

1 陀檸瑜;劉鐵榜;楊海晨;榮晗;張建;沈其杰;;雙相障礙患者社會認知功能的比較研究[J];中華精神科雜志;2013年06期

2 鄭尤民;張程峧;;心理干預對雙相障礙患者認知功能影響的對照研究[J];中國民康醫(yī)學;2010年17期

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本文編號：2160328