本文選題：驚恐障礙　切入點(diǎn)：錯(cuò)誤加工　出處：《大連醫(yī)科大學(xué)》2013年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：驚恐障礙（panic disorder, PD）是一種急性焦慮障礙，以反復(fù)的驚恐發(fā)作為主要臨床表現(xiàn)，其發(fā)病機(jī)制尚不明確，臨床評(píng)價(jià)缺乏客觀生物學(xué)指標(biāo)。因驚恐發(fā)作時(shí)伴有明顯的胸悶、心悸、頭暈等多種非特異性癥狀，因此反復(fù)于綜合醫(yī)院急診、門診就診，造成醫(yī)療資源的極大浪費(fèi)。災(zāi)難化認(rèn)知假說從認(rèn)知加工方面對(duì)驚恐發(fā)作的觸發(fā)及維持進(jìn)行了理論解釋，認(rèn)為驚恐發(fā)作源于個(gè)體對(duì)于某些軀體感覺的一種災(zāi)難化的錯(cuò)誤判斷。驚恐發(fā)作能夠反復(fù)發(fā)生、難以控制提示驚恐障礙患者對(duì)于這種錯(cuò)誤的識(shí)別及控制存在障礙，這可能是驚恐障礙發(fā)病的重要環(huán)節(jié)。 監(jiān)控自己的認(rèn)知和行為結(jié)果，覺察、糾正錯(cuò)誤，并防止再犯是人腦對(duì)錯(cuò)誤信息加工（error processing）的主要內(nèi)容。事件相關(guān)電位（event-related potentials，ERPs）技術(shù)以其較準(zhǔn)確的鎖時(shí)性優(yōu)勢(shì)被廣泛應(yīng)用于錯(cuò)誤加工的研究，且為其提供了兩個(gè)明確的神經(jīng)生理指標(biāo)：ERN和Pe。目前尚未發(fā)現(xiàn)應(yīng)用ERP技術(shù)研究驚恐障礙患者錯(cuò)誤加工特點(diǎn)的相關(guān)報(bào)道。本研究采用ERP技術(shù)，通過視覺箭頭flanker任務(wù)誘發(fā)被試的錯(cuò)誤反應(yīng)，分析其行為學(xué)及錯(cuò)誤相關(guān)ERP成分，對(duì)驚恐障礙患者的錯(cuò)誤加工進(jìn)行初步探討。 方法：研究對(duì)象包括19例首次確診的驚恐障礙患者與年齡、性別、教育程度無明顯差異的20名正常對(duì)照。所有被試均經(jīng)過標(biāo)準(zhǔn)化結(jié)構(gòu)訪談程序（SCID）嚴(yán)格篩查，并完成漢密爾頓焦慮量表(HAMA）及17項(xiàng)漢密爾頓抑郁量表（HAMD-17）量表評(píng)分。對(duì)于驚恐障礙患者，分別應(yīng)用驚恐障礙嚴(yán)重程度量表（PDSS）和生活事件量表（LES）評(píng)估其疾病嚴(yán)重程度及相關(guān)社會(huì)心理因素。刺激程序采用視覺箭頭flanker范式，要求被試盡可能迅速而準(zhǔn)確地對(duì)中間箭頭的方向做按鍵反應(yīng)。記錄64導(dǎo)腦電后進(jìn)行離線分析，分別測(cè)量Fz、FCz、Cz三個(gè)電極點(diǎn)的ERN，及Cz、CPz、Pz三個(gè)電極點(diǎn)的Pe的平均波幅。其中6名被試因腦電偽跡嚴(yán)重或錯(cuò)誤疊加數(shù)不足25次而剔出數(shù)據(jù)分析，病例組和對(duì)照組分別為16例和17例被試納入最后統(tǒng)計(jì)。行為學(xué)數(shù)據(jù)用t檢驗(yàn)比較組間差異，，ERP數(shù)據(jù)采用二因素重復(fù)測(cè)量方差分析進(jìn)行組內(nèi)及組間比較。 結(jié)果： 1、兩組被試在箭頭flanker任務(wù)的行為學(xué)數(shù)據(jù)上無顯著性差異。 2、兩組被試的ERN平均波幅及Pe平均波幅均存在反應(yīng)類型主效應(yīng)（Ps＜0.01），即錯(cuò)誤反應(yīng)的刺激產(chǎn)生了明顯的ERN及Pe成分。 3、兩組被試的ERN平均波幅存在顯著的電極位置主效應(yīng)(F2,62=21.697，P＜0.001)及電極位置×組別交互效應(yīng)(F2,62=3.733,P=0.038)，組別主效應(yīng)無統(tǒng)計(jì)學(xué)意義(F1,31=0.018,P=0.895)。 4、兩組被試的Pe平均波幅存在顯著的組別(F1,31=7.617，P=0.010)及電極位置(F2,62=4.257，P=0.039)主效應(yīng)，電極位置×組別交互效應(yīng)（F2,62=0.391，P=0.573）無統(tǒng)計(jì)學(xué)意義。 5、驚恐障礙患者的ERN、Pe平均波幅與疾病相關(guān)臨床指標(biāo)（HAMA、HAMD、PDSS評(píng)分、LEU總值及病程）無顯著相關(guān)性（Ps＞0.05）。 結(jié)論： 1、驚恐障礙患者的錯(cuò)誤加工早期（錯(cuò)誤監(jiān)控）的腦活動(dòng)分布存在異常，其發(fā)生區(qū)域集中于額中央?yún)^(qū)。 2、驚恐障礙患者在晚期錯(cuò)誤加工階段對(duì)錯(cuò)誤的識(shí)別和（或）錯(cuò)誤后的行為調(diào)節(jié)能力存在異常。 3、驚恐障礙患者的錯(cuò)誤加工的ERP指標(biāo)與癥狀嚴(yán)重程度、病程及社會(huì)心理因素?zé)o關(guān)，ERN和Pe可能是驚恐障礙的一種疾病特質(zhì)性指標(biāo)。
[Abstract]:Objective: panic disorder (panic disorder PD) is an acute anxiety disorder, recurrent panic attacks as the main clinical manifestations, its pathogenesis is not clear, the lack of objective index of clinical evaluation. Because of palpitations panic attack with obvious chest tightness, dizziness, and other symptoms were nonspecific, so repeated in general hospital emergency department, outpatient visits, causing a great waste of medical resources. The disaster cognition hypothesis has carried on the explanation to the trigger and maintain a panic attack from cognition, think the wrong judgment of a disaster panic attack based on individual feeling for some body of panic attacks can happen repeatedly, prompt recognition and for patients with panic disorder to control the wrong obstacles difficult to control, which may be an important part of the panic disorder.
To monitor their cognitive and behavioral results, awareness, correct mistakes, and to prevent recidivism is the brain of the error information processing (error processing). The main contents of the event related potential (event-related potentials ERPs) technology to the more accurate lock advantage is widely used in error processing, and provides two a clear indicator of nerve physiology: ERN and Pe. has not yet found the research on the application of ERP reports of panic disorder. The characteristics of error processing based on ERP technology, through the visual error reaction arrow flanker task induced subjects, analyze the behavior and error related ERP components, preliminary study on panic disorder error processing.
Methods: the study included 19 cases of first diagnosed patients with panic disorder with age, gender, 20 normal controls were no significant difference between the level of education. All subjects are standardized through structured interview program (SCID) strict screening, and Hamilton Anxiety Scale (HAMA) and the 17 item Hamilton Depression Rating Scale (HAMD-17) scores for patients with panic disorder were used, panic disorder severity scale (PDSS) and life events scale (LES) assessment of the severity of the disease and related psychosocial factors. Using visual stimulation procedure arrow flanker paradigm, participants were asked as quickly and as accurately as possible in the direction of the arrow key reaction intermediate the off-line analysis were recorded. 64 channel EEG measurements, respectively Fz, FCz, Cz three electrode point ERN, and Cz, CPz, the average amplitude of Pz three electrode Pe. Among the 6 subjects because of artifacts or serious mistakes The number is less than 25 times and from the data analysis, the case group and the control group were 16 cases and 17 cases were included in the final statistics. Behavioral data to test the difference between the groups with T, ERP data using two way ANOVA comparison between group and group.
Result錛

本文編號(hào)：1577230