本文選題：精神分裂癥 + 攻擊或暴力行為　； 參考：《濟(jì)寧醫(yī)學(xué)院》2017年碩士論文

【摘要】：目的:精神分裂癥是目前最嚴(yán)重的精神疾病之一,攻擊或暴力行為是精神分裂癥常見臨床癥狀。甲狀腺激素、腦電圖是當(dāng)前研究熱點(diǎn)。探討伴攻擊或暴力行為的首發(fā)精神分裂癥患者的促甲狀腺激素(TSH)、游離三碘甲狀腺原氨(FT3)、游離甲狀腺素(FT4)、三碘甲狀腺原氨酸(TT3)、甲狀腺素(TT4)及腦電圖相關(guān)波形(α波、β波、δ波、θ波)在左前額(Fp1)、右前額(Fp2)、左中顳(T3)、右中顳(T4)、左中央(C3)、右中央(C4)、左枕(O1)、右枕(O2)處波幅改變及其與攻擊行為嚴(yán)重程度、精神癥狀嚴(yán)重程度的關(guān)系,為研究精神分裂癥患者的攻擊或暴力行為提供客觀依據(jù)。方法:根據(jù)第5版美國精神障礙診斷與統(tǒng)計手冊(DSM-5)診斷標(biāo)準(zhǔn),對住院的首發(fā)精神分裂癥患者進(jìn)行收集,采用陽性與陰性癥狀量表(PANSS)對其精神癥狀評定,然后采用修改版外顯攻擊量表(MOAS)評定其攻擊行為,將符合條件的患者分為攻擊組精神分裂癥(簡稱攻擊組)57例和非攻擊組精神分裂癥(簡稱非攻擊組)43例,分別抽取靜脈血行TSH、FT3、FT4、TT3、TT4測量及使用日本光電1200C腦電圖儀對兩組患者Fp1、Fp2、T3、T4、C3、C4、O1、O2處進(jìn)行α波、β波、δ波、θ波波幅測試。結(jié)果:1.一般資料的比較:攻擊組、非攻擊組兩組之間的年齡、性別比例、文化程度、病程均無統(tǒng)計學(xué)差異。2.攻擊組、非攻擊組間甲狀腺激素的比較,結(jié)果顯示:兩組間TSH、FT3、FT4、TT3、TT4無明顯差別(p0.05)。攻擊組TT3明顯高于非攻擊組[(1.97±0.58)nmol/L vs(1.68±0.39)nmol/L,p0.05],差異具有統(tǒng)計學(xué)意義。3.對兩組間的腦電圖分別進(jìn)行比較,結(jié)果顯示:α波:攻擊組與非攻擊組于Fp1、Fp2、T3、T4、C3、C4、O1、O2處α波波幅比較無明顯的差異(p0.05)。β波:攻擊組于Fp1[(4.08±3.23)u V vs(6.69±4.57)u V,p0.05]、Fp2[(4.01±2.96)u V vs(6.01±3.18)u V,p0.05]、T3[(2.71±1.64)u V vs(4.48±2.82)u V,p0.05]、T4[(2.88±2.12)u V vs(4.43±3.05)u V,p0.05]、C3[(4.58±4.67)u V vs(6.36±3.55)u V,p0.05]、C4[(4.45±4.39)u V vs(6.09±3.44)u V,p0.05]、O2[(5.80±5.06)u V vs(8.07±4.94)u V,p0.05]處β波波幅明顯低于非攻擊組,差異具有統(tǒng)計學(xué)意義。兩組間O1處β波波幅無明顯差異(p0.05)。δ波:攻擊組于Fp1[(4.70±3.19)u V vs(9.91±9.40)u V,p0.05]、Fp2[(5.34±3.92)u V vs(8.27±5.97)u V,p0.05]、T3[(2.37±1.37)u V vs(3.57±2.46)u V,p0.05]、T4[(3.23±2.03)u V vs(4.32±2.77)u V,p0.05]、C3[(4.54±3.56)u V vs(6.51±4.10)u V,p0.05]、C4[(5.23±4.13)u V vs(7.19±3.81)u V,p0.05]、O1[(4.81±5.95)u V vs(7.38±5.20)u V,p0.05]、O2[(4.77±3.86)u V vs(8.23±5.48)u V,p0.05]處δ波波幅明顯低于非攻擊組,差異具有統(tǒng)計學(xué)意義。θ波:攻擊組于Fp1[(6.07±5.76)u V vs(10.72±10.35)u V,p0.05]處θ波波幅明顯低于非攻擊組,差異具有統(tǒng)計學(xué)意義。Fp2、T3、T4、C3、C4、O1、O2處θ波波幅比較無明顯的差異(p0.05)。4.相關(guān)性分析4.1甲狀腺激素、腦電圖與MOAS的5項(xiàng)分因子相關(guān)性:TT3與總分呈正相關(guān)(r=0.207,p0.05),TSH、FT3、FT4、TT4與言語攻擊、財產(chǎn)攻擊、自身攻擊、體力攻擊、總分無相關(guān)性(p0.05)。Fp2處α波波幅與財產(chǎn)攻擊呈正相關(guān)(r=0.310,p0.05),Fp2處θ波波幅與財產(chǎn)攻擊呈正相關(guān)(r=0.562,p0.05),Fp1、Fp2、T3、T4、C3、C4、O1、O2處β波、δ波與言語攻擊、財產(chǎn)的攻擊、自身攻擊、體力攻擊、總分無相關(guān)性(p0.05)。4.2甲狀腺激素、腦電圖與PANSS的4項(xiàng)分因子相關(guān)性:TSH、FT3、FT4、TT3、TT4與陽性癥狀分、陰性癥狀分、一般精神病理分、總分無相關(guān)性(p0.05)。O2處α波波幅與陰性癥狀分呈正相關(guān)(r=0.310,p0.05)。O1處δ波波幅與陰性癥狀分呈正相關(guān)(r=0.218,p0.05),O2處δ波波幅與陰性癥狀分呈正相關(guān)(r=0.292,p0.05)。Fp1、Fp2、T3、T4、C3、C4、O1、O2處β波、θ波波幅與陽性癥狀分、陰性癥狀分、一般精神病理分、總分無相關(guān)性(p0.05)。結(jié)論:伴攻擊或暴力行為的首發(fā)精神分裂癥患者的甲狀腺激素、腦電圖改變:1.攻擊組與非攻擊組比較:TT3濃度明顯升高,提示精神分裂癥患者的攻擊或暴力行為與內(nèi)分泌功能改變有關(guān)。2.攻擊組與非攻擊組比較:主要以額葉、顳葉β波波幅、δ波波幅、θ波波幅明顯降低,提示精神分裂癥患者的攻擊或暴力行為與其波幅降低有關(guān)。3.相關(guān)性分析:3.1甲狀腺激素、腦電圖與MOAS的5項(xiàng)分因子相關(guān)結(jié)果:甲狀腺激素、右側(cè)額葉處α波、θ波波幅與精神分裂癥的攻擊或暴力行為的嚴(yán)重程度的指標(biāo)之間有著顯著的相關(guān)性。3.2甲狀腺激素、腦電圖與PANSS的4項(xiàng)分因子相關(guān)結(jié)果:枕葉處α波、δ波波幅與精神分裂癥的陰性癥狀嚴(yán)重程度有顯著的相關(guān)性。總之,伴攻擊或暴力行為的精神分裂癥患者的這些特征性指標(biāo)的研究,為研究精神分裂癥患者攻擊或暴力行為的發(fā)生機(jī)制提供了客觀依據(jù)。
[Abstract]:Objective: schizophrenia is one of the most serious mental disorders at present. Attack or violence is a common clinical symptom of schizophrenia. Thyroid hormone and electroencephalogram are the current research hotspots. Thyroid stimulating hormone (TSH), free three iodine thyroid proto ammonia (FT3), free thyroidin (three iodine), free thyroid gland are discussed in the first episode of schizophrenia with attack or violence. Adenosine (FT4), three iodine thyroxine (TT3), thyroxine (TT4) and electroencephalogram related waveforms (alpha, beta, Delta, theta) in the left frontal (Fp1), right anterior frontal (Fp2), Zuo Zhongnie (T3), right middle temporal (T4), Zuo Zhongyang (C3), right central (C4), left occipital (O1), right occipital (O2) wave amplitude change and the severity of mental symptoms, and the severity of mental symptoms To provide an objective basis for the study of attack or violence in patients with schizophrenia. Methods: according to the diagnostic and Statistical Manual (DSM-5) of the fifth edition of the American psychiatric disorder, the first episode schizophrenic patients were collected, the positive and negative symptom scale (PANSS) was used to evaluate the mental symptoms, and then the revised version was adopted. The attack behavior was evaluated by the explicit attack scale (MOAS). The eligible patients were divided into 57 cases of attack group schizophrenia (attack group) and 43 cases of non attack group (non attack group). The venous blood was taken respectively for the measurement of TSH, FT3, FT4, TT3, TT4 and the Japanese photoelectric 1200C electroencephalograph on the two groups of patients Fp1, Fp2, T3, T4, C3, etc. A test of alpha, beta, Delta and theta wave amplitude at O2. Results: 1. comparison of general data: the age, sex ratio, education level and course of disease between the two groups in the attack group and the non attack group were no significant difference between the.2. attack group and the thyroid hormone comparison between the non attack groups, and the results showed that there was no significant difference between the two groups of TSH, FT3, FT4, TT3, TT4 (P0.05). Group TT3 was significantly higher than that of non attack group [(1.97 + 0.58) nmol/L vs (1.68 + 0.39) nmol/L, p0.05], and the difference was statistically significant.3. to the EEG between the two groups. The results showed: alpha wave: there was no significant difference between the attack group and the non attack group in Fp1, Fp2, T3, T4, C3, C4, and the amplitude of the alpha wave. U V vs (6.69 + 4.57) u V, p0.05], Fp2[(4.01 + 2.96) u V vs (6.01 + 3.18) u V. The amplitude of beta wave wave was significantly lower than that of non attack group. There was no significant difference in the amplitude of beta wave between the two groups (P0.05). Delta wave: the attack group was Fp1[(4.70 + 3.19) u V vs (9.91 + 9.40) u V, p0.05], Fp2[(5.34 + 3.92) u V (2.37 + 5.97). V, p0.05], C3[(4.54 + 3.56) u V vs (6.51 + 4.10) u V, p0.05], C4[(5.23 + 4.13) u V (4.81 + 5.95). 10.35) u V, the amplitude of theta wave in p0.05] is obviously lower than that of non attack group, and the difference has statistical significance.Fp2, T3, T4, C3, C4, O1, O2, the amplitude of theta wave is no obvious difference (P0.05).4. correlation analysis 4.1 thyroid hormones, the correlation between the EEG and the 5 components of the total score. Property attack, self attack, physical attack, total score without relevance (P0.05).Fp2, alpha wave amplitude is positively related to property attack (r=0.310, P0.05), Fp2 at Fp2 wave amplitude is positively related to property attack (r=0.562, P0.05), Fp1, Fp2, T3, T4, C3, Delta, delta wave and speech attack, property attack, self attack, physical attack, total score unrelated. Sex (P0.05).4.2 thyroid hormone and electroencephalogram were correlated with 4 sub factors of PANSS: TSH, FT3, FT4, TT3, TT4 and positive symptoms, negative symptoms, general psychopathology, total score without correlation (P0.05).O2 and negative symptom score positive correlation (r= 0.310, P0.05) delta wave amplitude is positively correlated with negative symptom score, O2 (r=0.292, P0.05).Fp1, Fp2, T3, Fp2, T3, T4, C3, C4, O1, O2 beta wave, theta wave amplitude and positive symptoms, negative symptoms, general psychopathology, total score without correlation (P0.05). Conclusion: the thyroid hormone, electroencephalogram changes in first episode schizophrenic patients with attack or violence: 1. attack group Compared with the non attack group, the concentration of TT3 increased significantly, suggesting that the attack or violent behavior of the schizophrenic patients and the changes of the endocrine function were related to the.2. attack group and the non attack group, mainly in the frontal lobe, the temporal lobe beta wave amplitude, the delta wave amplitude, and the theta wave amplitude, suggesting that the attack or violent behavior of the schizophrenic patients and their amplitude decreased. .3. correlation analysis: 3.1 thyroid hormone, electroencephalogram and 5 factors associated with MOAS: thyroid hormone, the right frontal lobe, the alpha, theta wave amplitude, and the severity of the attack or violence of schizophrenia, there is a significant correlation between the.3.2 thyroid hormone, and the results of the 4 factors associated with the electroencephalogram and PANSS: There is a significant correlation between the alpha and delta wave amplitude of the occipital lobe and the severity of the negative symptoms of schizophrenia. In a word, the study of these characteristics of schizophrenic patients with attack or violence provides an objective basis for the study of the mechanism of attack or violent behavior in schizophrenic patients.

【學(xué)位授予單位】：濟(jì)寧醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R749.3

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