發(fā)布時(shí)間：2018-06-10 16:13

  本文選題：反社會人格障礙 + 決策��； 參考：《安徽醫(yī)科大學(xué)》2013年碩士論文

【摘要】：目的既往神經(jīng)心理學(xué)研究發(fā)現(xiàn)在眾多腦結(jié)構(gòu)與功能障礙疾病中普遍存在著決策功能缺陷，如帕金森病、Wilson病、癲癇、強(qiáng)迫癥、病理性賭博等。反社會人格障礙（Antisocial Personality Disorder,ASPD）作為人格障礙領(lǐng)域中備受關(guān)注的一員而在臨床與科研實(shí)踐中被頻繁提及。本研究采用愛荷華博弈測試（Iowa GamblingTask, IGT）和骰子博弈測試（Game of Dice Task, GDT）探討ASPD患者在風(fēng)險(xiǎn)模糊情境及風(fēng)險(xiǎn)明確情境下的決策功能，并由此探索其反社會行為病因與神經(jīng)機(jī)制。 方法研究一：將76例ASPD患者及與其相匹配的健康對照（Health Controls, HC）作為研究對象，通過IGT進(jìn)行風(fēng)險(xiǎn)模糊情境決策功能測試，使用簡明精神狀態(tài)量表(Mini-Mmental State Examination, MMSE)、抑郁自評量表(Zung Self-RatingDepression Scale, SDS)、焦慮自評量表(Zung Self-Rating Anxiety Scale, SAS)和Barratt沖動量表（Barratt Impulsiveness Scale-11, BIS-11）對兩組被試進(jìn)行背景測試。研究二：使用風(fēng)險(xiǎn)明確情境下決策功能測評工具骰子博弈測試（GDT）對31例ASPD患者、33例HC進(jìn)行評估，運(yùn)用MMSE、漢密爾頓抑郁量表（HamiltonDepression Scale，HAMD）、漢密爾頓焦慮量表（Hamilton Anxiety Scale，HAMA）、BIS-11、Stroop色字實(shí)驗(yàn)（Stroop Colour and Word Test, SCWT）、數(shù)字廣度測試（DigitSpan Test, DS）和詞匯流暢性測試（Verbal Fluency Test, VFT）對兩組被試測試。 結(jié)果研究一：ASPD組在IGT中凈有利選牌數(shù)明顯低于HC組[分別為(-4.13±18.27)次，(6.03±19.43)次]，兩組之間差異有統(tǒng)計(jì)學(xué)意義[t(134)=-3.132，P=0.002]。對兩組采用2(組)×5(階段)方差分析，比較兩組不同階段的凈有利選擇，發(fā)現(xiàn)兩組間的主效應(yīng)顯著[F(1,134)=9.811，P=0.002]；五個(gè)階段主效應(yīng)同樣顯著[F(4,536)=15.456，P＜0.001]。隨著IGT選擇次數(shù)的增多，ASPD組和HC組凈有利選擇次數(shù)均逐漸增多，但在第三、第四、第五階段，HC組凈有利選擇數(shù)目顯著多于ASPD組[第三階段F（1，134）=5.947，P=0.016；第四階段F（1，134）=5.023，P=0.027；第五階段F（1，134）=8.553，，P=0.004]。ASPD組凈有利選擇數(shù)與SAS得分、SDS得分、BIS-11、被試年齡和教育程度均未見明顯相關(guān)。 研究二：ASPD組較HC組更傾向于選擇高風(fēng)險(xiǎn)選項(xiàng)[ASPD組為（10.06±5.26）次，HC組為（5.42±3.29）次，t=4.201，P0.001]。HC組負(fù)反饋利用率明顯高于ASPD組，差異有統(tǒng)計(jì)學(xué)意義（HC組：0.68±0.32，ASPD組：0.28±0.26，t=－5.311，P0.001）。四個(gè)選項(xiàng)中ASPD組選擇最多的是兩個(gè)數(shù)字的組合，而HC組選擇最多的是三個(gè)數(shù)字的組合[選擇一個(gè)數(shù)字組合：ASPD組中位數(shù)為1（0～8），HC組中位數(shù)為1（0～2.5），兩組差異有統(tǒng)計(jì)學(xué)意義(Z=-2.295，P=0.022）。三個(gè)數(shù)字組合：ASPD組為（4.77±4.23）次，HC組為（6.79±3.43）次；t=－2.100，P=0.04。四個(gè)數(shù)字組合：ASPD組為（3.06±3.53）次，HC組為（5.82±3.41）次；t=3.176，P=0.002）]，兩組差異有統(tǒng)計(jì)學(xué)意義。Pearson相關(guān)分析顯示，ASPD組中選擇高風(fēng)險(xiǎn)選項(xiàng)次數(shù)與Stroop結(jié)果（r=0.566，P0.001）、負(fù)反饋利用率（r=－0.613，P0.001）、BIS-11運(yùn)動沖動性（r=0.779，P0.001）和BIS-11總分（r=0.481，P=0.006）相關(guān)性顯著。 結(jié)論男性ASPD患者存在決策功能障礙,在風(fēng)險(xiǎn)明確和風(fēng)險(xiǎn)模糊條件下的表現(xiàn)各有不同。研究一：ASPD患者在風(fēng)險(xiǎn)概率模糊條件下決策功能受到損害，且其凈有利選擇數(shù)與SAS得分、SDS得分、BIS-11、被試年齡和教育程度均無相關(guān)。研究二：ASPD患者在風(fēng)險(xiǎn)概率明確條件下偏向高風(fēng)險(xiǎn)選項(xiàng)，且高風(fēng)險(xiǎn)選擇數(shù)與執(zhí)行功能（Executive function, EF）、行為沖動性和負(fù)反饋利用率相關(guān)。推測其決策功能缺陷可能與眶額葉（Orbitofrontal Cortex, OFC）、腹內(nèi)側(cè)前額葉（VentromedialPrefrontal Cortex, VMPFC）、背外側(cè)前額葉（Dorsolateral Prefrontal Cortex, DLPFC）及杏仁核等的腦結(jié)構(gòu)和功能異常有關(guān)。
[Abstract]:Objective previous neuropsychological studies have found that there are many defects in the brain structure and dysfunction, such as Parkinson's disease, Wilson disease, epilepsy, obsessive-compulsive disorder, pathological gambling, and so on. Antisocial Personality Disorder (ASPD) is a highly concerned person in the field of personality disorder and is in clinical practice. The research is frequently mentioned in the research practice. This study uses the Iowa game test (Iowa GamblingTask, IGT) and the dice game test (Game of Dice Task, GDT) to explore the decision-making function of the ASPD patients in the risk ambiguous situation and the risky situation, and to explore the cause and the neural mechanism of the antisocial behavior.
Method 1: 76 cases of ASPD patients and Health Controls (HC) matched with them were used as the research subjects. The risk fuzzy situation decision function test was carried out by IGT. The simple mental state scale (Mini-Mmental State Examination, MMSE), the self rating Depression Scale (Zung Self-RatingDepression Scale), and the anxiety self-assessment were used. The Zung Self-Rating Anxiety Scale (SAS) and the Barratt impulse scale (Barratt Impulsiveness Scale-11, BIS-11) were used for the background test of two groups of subjects. Study two: the dice game test (GDT) was used to assess 31 cases of ASPD patients and 33 cases by using the risky situation. The table (HamiltonDepression Scale, HAMD), the Hamilton Anxiety Scale (Hamilton Anxiety Scale, HAMA), BIS-11, Stroop color character experiment (Stroop Colour and), digital breadth test and vocabulary fluency test are tested for two groups.
Results 1: the number of net favorable selection in group ASPD was significantly lower than that in group HC [-4.13 + 18.27), (6.03 + 19.43), and the difference between the two groups was [t (134) =-3.132, P=0.002]. was used in two groups by 2 (Group) x 5 (stage) variance analysis to compare the net favorable choices of the two groups at different stages, and found that the main effect of the two groups was significant [F ( 1134) =9.811, P=0.002]; the main effect of the five stages was also significant [F (4536) =15.456, P < 0.001]. with the increase of IGT selection times, ASPD and HC group net favorable selection times increased gradually, but in the third, fourth, fifth stage, the net favorable selection number of HC group was much more than ASPD Group [Third Stage F (1134)]. 1 134) 134) =5.023, P=0.027, fifth stage F (1134) =8.553, P=0.004].ASPD group net favorable selection and SAS score, SDS score, BIS-11, and no significant correlation between the age and educational level of the subjects.
Study two: group ASPD was more likely to choose higher risk options than group HC (10.06 + 5.26), HC group (5.42 + 3.29), t=4.201, P0.001].HC group was significantly higher than ASPD group, the difference was statistically significant (HC group: 0.68 + 0.32, ASPD group: 0.28 + 0.26, t = - 5. 3, P0.001). Four options were two in ASPD group choosing the most was two. The combination of numbers, and the most selected group of HC groups is the combination of three numbers [selecting a number combination: the median of the ASPD group is 1 (0~8), the median of the HC group is 1 (0 to 2.5), the two groups are statistically significant (Z=-2.295, P=0.022). Three digital combinations: the ASPD group is (4.77 + 4.23), and the HC group is (6.79 + 3.43) times; t = - 2. 100, P=0.04. four. Word combination: group ASPD was (3.06 + 3.53), group HC was (5.82 + 3.41), t=3.176, P=0.002), and two groups were statistically significant.Pearson correlation analysis showed that the number of high risk options in group ASPD and Stroop results (r=0.566, P0.001), negative feedback utilization (r = 0. 6 13, P0.001), BIS-11 motion impulsivity and total score ( R=0.481, P=0.006) have a significant correlation.
Conclusion the male ASPD patients have decision-making dysfunction, and there are different manifestations in the condition of risk ambiguity and risk ambiguity. Study 1: ASPD patients are impaired under the risk probability fuzzy condition, and the net favorable selection is not related to the SAS score, the SDS score, the BIS-11, the age of the trial and the educational level. Two: ASPD patients The high risk option was biased under the risk probability, and the high risk selection was related to the executive function (Executive function, EF), the behavioral impulsivity and the negative feedback utilization. It is presumed that the defect of the decision function may be with the orbital frontal lobe (Orbitofrontal Cortex, OFC), the ventral medial prefrontal lobe (VentromedialPrefrontal Cortex, VMPFC), and the dorsolateral. Dorsolateral Prefrontal Cortex (DLPFC) and amygdala are related to abnormal brain structure and function.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R749.91

【參考文獻(xiàn)】

相關(guān)期刊論文 前3條

1 戴云飛;肖澤萍;王振;張海音;陳玨;鄒政;何燕玲;趙介城;張明園;;人格障礙診斷問卷(SCID-Ⅱ)第2版的信度和效度[J];上海精神醫(yī)學(xué);2006年01期

2 周亮;肖水源;何曉燕;厲潔;劉慧銘;;BIS-11中文版的信度與效度檢驗(yàn)[J];中國臨床心理學(xué)雜志;2006年04期

3 黃悅勤,董問天,王燕玲,崔玉華,許又新,韓菁;美國人格診斷問卷(PDQ-R)在中國的試測[J];中國心理衛(wèi)生雜志;1998年05期

本文編號：2003817