本文選題：驚恐障礙　切入點(diǎn)：情緒調(diào)節(jié)　出處：《大連醫(yī)科大學(xué)》2017年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的:驚恐障礙(panicdisorder,PD)是一種嚴(yán)重的急性焦慮障礙,其發(fā)病機(jī)制尚不清楚。以往研究多從主動(dòng)情緒調(diào)節(jié)來(lái)探討,本課題著眼于PD患者的核心癥狀—情緒調(diào)節(jié)障礙,和癥狀的自發(fā)性及無(wú)明確指向性,從情緒產(chǎn)生和內(nèi)隱認(rèn)知重評(píng)的角度來(lái)研究PD的發(fā)病機(jī)制。研究采用神經(jīng)心理測(cè)量、情緒體驗(yàn)自我報(bào)告和功能磁共振(functional magnetic resonance imaging,fMRI)技術(shù),對(duì) PD 患者情緒的認(rèn)知調(diào)節(jié)行為學(xué)特點(diǎn)、情緒相關(guān)的社會(huì)心理學(xué)特征、內(nèi)隱認(rèn)知重評(píng)的腦加工機(jī)制進(jìn)行了深入探討。方法:入組PD組26例,健康對(duì)照25例。利用神經(jīng)心理量表考察患者的臨床癥狀和情緒調(diào)節(jié)特點(diǎn);利用fMRI技術(shù),采用內(nèi)隱認(rèn)知重評(píng)任務(wù)探討被試對(duì)負(fù)性圖片的情緒反應(yīng),記錄被試腦激活特點(diǎn),任務(wù)中被試在觀看負(fù)性圖片前給予圖片中性描述或負(fù)性描述;同時(shí)應(yīng)用4點(diǎn)量表記錄被試的情緒自我報(bào)告。對(duì)量表、行為學(xué)和腦激活數(shù)據(jù)進(jìn)行組內(nèi)、組間比較分析以及相關(guān)性分析。結(jié)果:(1)認(rèn)知情緒調(diào)節(jié)問(wèn)卷發(fā)現(xiàn),PD組自我反思、災(zāi)難化策略評(píng)分高于對(duì)照組,認(rèn)知重評(píng)和轉(zhuǎn)換視角評(píng)分低于對(duì)照組,差別均有統(tǒng)計(jì)學(xué)意義。(2)情緒圖片愉悅度的4點(diǎn)量表均發(fā)現(xiàn)了組別×描述類(lèi)型交互效應(yīng)。(3)fMRI結(jié)果發(fā)現(xiàn),在被試觀看預(yù)先中性描述的負(fù)性圖片相比預(yù)先負(fù)性描述的負(fù)性圖片時(shí),對(duì)照組背外側(cè)前額葉(dorsolateral prefrontal cortex,dlPFC)、背內(nèi)側(cè)前額葉(dorsomedial prefrontal cortex，dmPFC)、外側(cè)眶額回(lateral orbitofrontal cortex,IOFC)和顳區(qū)激活更強(qiáng),伴隨杏仁核的激活減弱。(4)而在PD組,dlPFC、dmPFC和顳區(qū)激活較對(duì)照組減弱,杏仁核激活存在組別×描述類(lèi)型交互效應(yīng)。(5)PD組dlPFC/dmPFC條件間差值與HAMA評(píng)分和PDSS評(píng)分呈負(fù)相關(guān),與轉(zhuǎn)換視角策略呈正相關(guān)。結(jié)論:1、內(nèi)隱認(rèn)知重評(píng)能夠有效調(diào)節(jié)情緒反應(yīng),其解剖基礎(chǔ)在于前額葉(dlPFC、dmPFC和1OFC)的激活增強(qiáng)和邊緣系統(tǒng)的激活下降。2、內(nèi)隱認(rèn)知重評(píng)調(diào)控機(jī)制為自上而下的無(wú)意識(shí)認(rèn)知控制,即前額葉通過(guò)對(duì)顳葉施加影響,改變情緒刺激的語(yǔ)義,間接影響邊緣系統(tǒng)的激活。3、PD患者存在顯著情緒調(diào)節(jié)障礙,內(nèi)隱認(rèn)知重評(píng)異常是PD患者驚恐發(fā)作和病理性焦慮產(chǎn)生的重要環(huán)節(jié)。4、dlPFC和dmPFC功能的缺失是PD內(nèi)隱認(rèn)知重評(píng)的重要神經(jīng)機(jī)制。5、PD內(nèi)隱情緒調(diào)節(jié)過(guò)程的失敗與PD臨床癥狀的嚴(yán)重性相關(guān),前額葉激活程度可能成為有應(yīng)用價(jià)值的評(píng)估PD嚴(yán)重程度和情緒調(diào)節(jié)功能的影像學(xué)指標(biāo)。
[Abstract]:Objective: panic disorder (PD) is a kind of severe acute anxiety disorder, and its pathogenesis is not clear. The pathogenesis of PD was studied from the perspective of emotion generation and implicit cognitive reassessment. Neuropsychological measurement, emotional experience self-report and functional magnetic resonance imagingfMRI) were used to study the pathogenesis of PD. The behavioral characteristics of emotion cognitive regulation, the characteristics of emotion related social psychology, and the brain processing mechanism of implicit cognitive reassessment in PD patients were studied. Methods: 26 patients with PD were enrolled in the study. The neuropsychological scale was used to investigate the clinical symptoms and emotional regulation characteristics of the patients, and the implicit cognitive reassessment task was used to study the emotional response of the subjects to negative images by using the fMRI technique, and the activation characteristics of the brain were recorded. Subjects in the task were given neutral or negative picture description before viewing the negative picture. At the same time, the emotional self-report of the subjects was recorded with a 4-point scale. The scale, behavior and brain activation data were measured within the group. Results the scores of self-reflection, disaster strategy, cognitive re-evaluation and change perspective were lower in PD group than those in control group, and the scores of cognitive reassessment and change perspective were lower than those in control group. All the differences were statistically significant. (2) the group 脳 description type interaction effect was found in the 4-point scale of the pleasure degree of emotion picture. The results of fMRI showed that when the subjects looked at the negative picture of the pre-neutral description, they were compared with the negative picture of the pre-negative description. In the control group, the activation of prefrontal cortexes, dorsomedial prefrontal cortexus, lateral orbitofrontal cortexIOFCC and temporal region were stronger in PD group than in the control group, but the activation of dlPFCCand temporal area in PD group was lower than that in control group, but the activation of dlPFCmPFC and temporal area in PD group was lower than that in the control group, and the activation of lateral orbitofrontal cortextexus was stronger in the lateral orbitofrontal gyrus than in the control group, and the activation of amygdaloid nucleus was weaker in PD group than in the control group. The difference between dlPFC/dmPFC condition and HAMA score and PDSS score was negatively correlated with the change of visual angle strategy. Conclusion: 1. Implicit cognitive reassessment can effectively regulate emotional response, and the difference between the dlPFC/dmPFC conditions of the group 脳 description type interaction effect of amygdala activation is negatively correlated with the HAMA score and the PDSS score, and positively correlated with the strategy of switching perspective. Conclusion: 1. Its anatomical basis lies in the enhancement of activation of dlPFC+ dmPFC and 1OFC) and the decrease of activation of the marginal system. The implicit cognitive reassessment mechanism is controlled by unconscious cognition from top to bottom, that is, the prefrontal lobe changes the semantics of emotional stimulation by exerting influence on temporal lobe. There were significant emotional regulation disorders in PD patients who indirectly affected the activation of the limbic system. Abnormal implicit cognitive reassessment is an important link in the generation of panic attack and pathological anxiety in PD patients. The absence of 4 d lPFC and dmPFC is an important neural mechanism of PD implicit cognitive reassessment. 5 the failure of PD implicit emotion regulation process is related to the severity of clinical symptoms of PD. The activation degree of prefrontal lobe may be a valuable imaging index for evaluating PD severity and emotion regulation function.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R749.72
，

本文編號(hào)：1590136