本文選題：難治性抑郁癥 + 邊緣型人格障礙�。� 參考：《浙江大學(xué)》2013年博士論文

【摘要】：背景 難治性抑郁癥是一種嚴重的精神障礙,大約有30-40%的抑郁癥患者會由于反復(fù)發(fā)生的惡劣心境和極差的藥物及心理治療反應(yīng)性而被診斷為這種疾患。目前,學(xué)術(shù)界對于難治性抑郁癥的了解并不深入,特別是對其病理機制尚未充分明確,間接導(dǎo)致了臨床對這些患者的診治不當(dāng)。因此,難治性抑郁癥作為抑郁癥中最為嚴重的類型,不僅浪費了大量的醫(yī)療資源,也同時加重了社會福利系統(tǒng)的負擔(dān)。負性情感偏倚等“情緒相關(guān)”的認知功能損傷是難治性抑郁癥患者核心臨床表現(xiàn),同時這些患者也被發(fā)現(xiàn)存在包括注意分配障礙在內(nèi)的“情緒無關(guān)”認知功能水平下降。另外,臨床研究逐漸發(fā)現(xiàn)有很大一部分難治性抑郁癥患者與邊緣型人格障礙存在共病。因此,要從根本上了解難治性抑郁癥的發(fā)病機理,就需要對其在情緒、認知方面的皮層功能損傷進行明確定位,并且將難治性抑郁癥的這些功能損傷與難治性抑郁癥與邊緣型人格障礙共病情況下的相應(yīng)表現(xiàn)進行有效區(qū)分,并以此為臨床對其進行有效診斷和合理治療提供重要的實證基礎(chǔ)。 目的 1.研究難治性抑郁癥“情緒無關(guān)”皮層前注意認知功能。 2.研究難治性抑郁癥“情緒相關(guān)”皮層面部情緒認知功能。 3.探索難治性抑郁癥及其與邊緣型人格障礙共病的情況下,邊緣型人格障礙對共病患者在上述兩類皮層認知功能損傷情況的影響,從而對難治性抑郁癥在這些方面特殊的認知功能損傷進行有效地區(qū)分。 方法 1.在32名正常被試、22名難治性抑郁癥、19名邊緣型人格障礙和22名難治性抑郁癥與邊緣型人格障礙的共病患者中進行事件相關(guān)電位(Event-related Potentials, ERPs)的失匹配負波(Mismatch Negativity, MMN)檢測。 2.在37名正常被試、25名難治性抑郁癥、15名邊緣型人格障礙和22名難治性抑郁癥與邊緣型人格障礙的共病患者中進行Oddball范式面部情緒圖片(平靜、憤怒、快樂和悲傷)誘發(fā)的ERPs成分(N1,P2,N2,P3a和P3b)檢測。 3.對四組被試在MMN檢測中所測得的N1及MMN的波幅及潛伏期進行多因素方差分析。 4.對四組被試在面部情緒圖片檢測中所測得的相關(guān)ERPs的波幅及潛伏期和反應(yīng)時進行多因素方差分析。 5.運用PVP抑郁問卷(Plutchik-van Praag Depression Inventory, PVP)對所有被試的抑郁癥狀進行測量,并將得分與所有被試的年齡、抑郁周期、反應(yīng)時、MMN及面部情緒圖片誘發(fā)ERPs的波幅及潛伏期等進行相關(guān)性檢驗。 結(jié)果 1.難治性抑郁癥患者的MMN波幅較其余各組顯著增大；邊緣型人格障礙及其與難治性抑郁癥共病患者的MMN波幅及潛伏期與正常被試無顯著差異。 2.難治性抑郁癥、邊緣型人格障礙及兩者的共病患者由面部情緒圖片誘發(fā)的ERPs成分的波幅及潛伏期與正常被試無顯著差異。 3.難治性抑郁癥患者對憤怒、快樂和悲傷的面部情緒圖片反應(yīng)時較正常被試顯著延長；難治性抑郁癥與邊緣型人格障礙的共病患者對憤怒及快樂的面部情緒圖片反應(yīng)時較正常被試顯著延長；邊緣型人格障礙患者對四類面部情緒圖片反應(yīng)時較正常被試無明顯異常。 4.在難治性抑郁癥與邊緣型人格障礙的共病患者中,PVP得分與憤怒面部情緒圖片對其誘發(fā)的P2潛伏期呈顯著的正相關(guān)。此外,所有被試對四類面部情緒圖片的反應(yīng)時與PVP得分呈正相關(guān)。 結(jié)論 1.難治性抑郁癥患者存在皮層前注意認知功能損傷,而這種損傷并沒有表現(xiàn)在邊緣型人格障礙及兩者的共病患者中。 2.難治性抑郁癥、邊緣型人格障礙及兩者共病的患者皮層面部情緒認知功能尚未受損。 3.難治性抑郁癥患者表現(xiàn)出對憤怒、快樂和悲傷面部情緒的后期認知處理功能異常；難治性抑郁癥與邊緣型人格障礙的共病患者表現(xiàn)出對憤怒和快樂面部情緒的后期認知處理異常。 4.邊緣型人格障礙在皮層前注意及面部情緒認知功能的完整性可能對其與難治性抑郁癥的共病患者在這兩方面皮層功能的損傷具有潛在的補償作用。 總之,本論文基于本申請人已經(jīng)發(fā)表的兩篇研究報道(He et al.,2010,2012),采用高時間分辨率的ERPs技術(shù)來探索難治性抑郁癥患者的皮層前注意及面部情緒認知功能,明確了難治性抑郁癥患者在皮層前注意認知功能的特異性損傷及皮層面部情緒認知功能的完整性,提示了這些患者表現(xiàn)出的面部情緒識別的行為學(xué)異常發(fā)生于較為后期的認知處理過程。同時,本研究發(fā)現(xiàn)了邊緣型人格障礙在其與難治性抑郁癥共病時對共病患者在上述兩類皮層認知功能的影響。
[Abstract]:background
Refractory depression is a serious mental disorder, about 30-40% of the patients with depression due to repeated drug dysthymia and range and psychological treatment response was diagnosed with the disease. At present, the academic community for refractory depression is not in-depth understanding, especially on its pathological mechanism is not yet fully clear and indirectly led to the diagnosis and treatment of these patients is improper. Therefore, the refractory depression depression as the most serious type, not only waste a large amount of medical resources, but also increase the social welfare system. The burden of negative emotional bias "emotional" cognitive impairment is refractory depression the core of patients with clinical manifestations, and these patients were also found, including the distribution of attention disorder "emotional independent level of cognitive function decline. In addition, the clinical research of existing A large part of patients with refractory depression and borderline personality disorder comorbidity. Therefore, to understand the pathogenesis of refractory depression fundamentally, you need to in the mood, cognitive aspects of cortical function damage of clear positioning, the corresponding function and will damage the performance of these refractory and refractory depression depression and borderline personality disorder comorbid conditions were effectively differentiated, and thereby to provide empirical basis for important clinical effective diagnosis and treatment for it.
objective
1. of the refractory depression mood independent cortex before the attention of cognitive function.
2. study on refractory depression emotion related cortical facial emotion cognitive function.
3. of the refractory depression and borderline personality disorder cases, borderline personality disorder on the influence on the two kinds of cognitive function damage in the cortex in patients, so as to effectively distinguish the damage on the cognitive function of refractory depression in these special areas.
Method
1. in 32 normal subjects, 22 patients with refractory depression and event-related potentials of 19 patients with comorbid borderline personality disorder and 22 patients with refractory depression and borderline personality disorder in (Event-related Potentials, ERPs) mismatch negativity (Mismatch Negativity, MMN) detection.
2. in 37 normal subjects, 25 patients with refractory depression, the Oddball paradigm of facial emotions in patients. 15 patients with borderline personality disorder and 22 patients with refractory depression and borderline personality disorder (in a calm, angry, happy and sad) ERPs induced (N1, P2, N2. P3a and P3b) detection.
3. of the four groups of subjects were measured by N1 and MMN in the detection of MMN amplitude and latency of multi factor analysis of variance.
By multivariate analysis of variance of 4. subjects of the four groups of ERPs measured in facial emotional pictures in the test of amplitude and latency and response time.
5. using the PVP Depression Inventory (Plutchik-van Praag Depression Inventory, PVP) was measured in all the subjects of depressive symptoms, and the scores of all subjects with age, depression period, reaction time, MMN and facial emotional pictures evoked ERPs amplitude and latency of correlation test.
Result
1. patients with refractory depression MMN amplitude significantly increased compared with the rest of the group; borderline personality disorder and comorbidity in patients with refractory depression MMN amplitude and latency had no significant difference compared with normal subjects.
2. refractory depression, patients with comorbid borderline personality disorder and both by the amplitude and latency of ERPs components by pictures of facial emotions had no significant difference compared with normal subjects.
3. patients with refractory depression to anger, happy and sad facial emotional picture response than that of the normal subjects were significantly prolonged; in patients with refractory depression and borderline personality disorder of angry and happy facial emotional picture response than normal subjects was significantly prolonged; patients with borderline personality disorder in four kinds of face emotional picture response than that of the normal subjects had no obvious abnormalities.
A total of 4. patients with refractory depression and borderline personality disorder, a significant positive correlation between PVP scores and angry facial emotions on the evoked latency of P2 pictures. In addition, all of the subjects of four kinds of facial emotion pictures and reaction time of PVP score was positively correlated.
conclusion
1. patients with refractory depression are attention to cognitive impairment and the cortex before the injury was not reflected in patients with comorbid borderline personality disorder and both.
2. patients with refractory depression, cortical facial emotion cognitive function of patients with borderline personality disorder and the disease has not been damaged.
3. patients with refractory depression show anger, happy and sad facial emotions later cognitive dysfunction; refractory depression and borderline personality disorder in patients exhibiting late cognitive processing of angry and happy facial emotions.
4. borderline personality disorder in cortex can compensate before potential integrity and facial emotion cognitive function may cortex in these two aspects of the function in patients with refractory depression damage.
In conclusion, this thesis is based on two studies have been published reports of the applicant (He et al., 20102012), with high time resolution ERPs technology to explore the attention and facial emotion cognitive function in patients with refractory depression cortex before clear refractory depression patients pay attention to integrity of the specific injury in cortex and facial emotion cognitive function the cognitive function in the skin layer, cognitive processes that occur in relatively late abnormal facial emotion recognition of these patients exhibited behavior. At the same time, this study found a borderline personality disorder in the refractory depression effect on the two kinds of cortical cognitive function comorbidity patients.

【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2013
【分類號】：R749.4

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