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首发精神病人的“冷”和“热”认知探讨: 横向与纵向研究
其他题名“Hot” and “cool” cognitions in patients with first-episode psychosis: cross-sectional and longitudinal studies
吕世裕
学位类型博士
导师陈楚侨
2013-05
学位授予单位中国科学院研究生院
学位授予地点北京
学位专业心理学
关键词首发精神疾病 热认知 冷认知 纵向研究
摘要    “冷”和“热”认知功能是两种不同的认知能力。传统的神经心理学研究只能检测独立于情绪的认知功能(“冷”认知功能),然而,在这方面的证据并未能阐明精神疾病的阴性病征,也很难解释患者的功能表现。因此,能精确检测冷和热认知功能的范式是有必要的。前瞻性记忆,即要记得在未来实行事情的能力,比传统上的冷性认知功能,与服药的依从性更相关联,但很少为此对首发精神疾病者的前瞻性记忆作研究。近期,Heerey  &   Gold               (2007)开发了一个有趣的范式来量度情绪体验到动机行为的转化,其是基于渴求和喜好这两个本质上不同的情感状态之间的重要区别。Huang et al.  (2009) 开发一种生态效度更好的范式来量度在不同的社会背景下的面部情绪知觉。情绪体验和动机行为的连接和面部情绪知觉,这两种重要的情感依赖性(“热”)认知功能类型,可能作为解释快感缺乏、意志减退、不合群这些阴性症状的原因。然而,情绪体验和动机行为的连接很少在过去文献中被研究,而对首发精神疾病患者的面部情绪知觉缺损的证据也是缺少的。 
本论文进行了四个横向研究和一个纵向研究,以评估上述类型的冷和热热认知功能。我们从早期精神疾病介入计划中招募患有首发精神疾病患者,以尽量减少在长期服药、长期住院和社会隔离对个人的认知能力的潜在影响。在研究一中,我们证明了对比起健康对照组,首发精神疾病患者在日常生活中体验了严重的主观性执行功能障碍,并有较少的期待性愉快体验。在研究二中,我们发现了在首发精神疾病患者中有严重的前瞻性记忆缺损,即使控制了其他神经认知功能,这种缺损仍然存在。在研究三中,我们证明了首发精神疾病患者拥有一种较弱的情绪体验和动机行为之间的连接。虽然患者没有广泛的“丧志症”,但相较健康对照组,他们的动机行为和主观情绪强度的配合欠佳。在研究四中,结果表示,当首首发精神病人的“冷”和“热”认知探讨:横向与纵向研究发精神疾病患者判断含糊和生态学上有效的面部表情时,其对愤怒情绪并不敏感。总的来说,我们的横向研究结果表示,首发精神疾病患者有重大的前瞻性记忆、情绪体验和动机行为的连接、以及面部情绪知觉的缺损。在研究五中,我们收集了一部份首发精神疾病患者群组的12 个月的纵向数据。重复检测方差分析 (repeated measure ANOVA )和协方差分析(repeated measure ANCOVA )发现,时间的主要作用在于传统的冷认知能力和前瞻性记忆显著,但非对于情绪体验和动机行为的连接。因此,研究结果似乎说明了,在冷认知得到改善的时候,热认知缺损却会维持。热认知缺损的相对纵向稳定性似乎与持续阴性病征平行。
    本论文的研究结果具有重大的临床意义。我们建议临床医生及早查出首发的精神疾病患者的冷和热的认知缺损。基于练习效应,藉着重复练习相同的范式,患者可以学习如何更好地完成任务,因此研究结果中,冷和热认知缺损之间的表面分离,可能从属于方法学的局限。进一步的研究应以对健康对照组进行平行的纵向评估来核实本研究结果。
其他摘要
      “Cool” and “hot” components are qualitatively different cognitive abilities. Theconventional neuropsychological studies examined only emotion-independent (“cool”) cognitive functions; the empirical evidence in this area, however, explained poorly the negative symptoms of psychosis, and accounted little for patients’ functional outcome. More refined paradigms to examine cool and hot cognition are necessary. Prospective memory, i.e. the ability to remember to carry things out in the future, correlates better than the conventional cool cognitions with drug adherence, but is seldom studied in patients with first-episode psychosis. Recently, Heerey & Gold (2007) developed an interesting paradigm to measure the translation of emotional salience into motivated behaviour, based on the important distinction between   wanting and liking as two qualitative different affective states. Huang et al. (2009) developed   an ecologically valid paradigm to measure facial emotion perception in different social   contexts. Emotion-volition coupling and facial emotion perception, two important types of emotion-dependent (“hot”) cognition, may be conceptualised as frameworks with which negative symptoms of ahedonia, avolition, and asociality could be explained. However,   emotion-volition coupling is rarely studied in the literature, and evidence for facial emotion misperception in patients with first-episode psychosis is scarce.
  We conducted four cross-sectional studies and one longitudinal study to assess the above-mentioned types of cool and hot cognition. Participants with first-episode psychosis were recruited from an early psychosis intervention programme, in order to minimise the potential   confounds of long-term medication, institutionalisation, and social isolation effects on one’s cognitive abilities. In Study 1, we demonstrated that patients with first-episode psychosis     experienced severe subjective dysexecutive symptoms in everyday life, and anticipated less  future pleasure, as compared to healthy individuals. In Study 2, we found severe prospective memory impairments in patients with first-episode psychosis, and demonstrated that such   deficit persisted even after other conventional cool cognitive abilities were controlled for. In Study 3, we demonstrated that patients with first-episode psychosis had a weaker connection between emotion experiences and motivated behaviour. Though the patient groups did not have a general “abulia”, their motivated behaviour corresponded poorly to their subjective   emotional salience, as compared to healthy individuals. In Study 4, the findings suggested that patients with first-episode psychosis were insensitive to angry emotion, when subjected to    ambiguous and ecologically valid facial expressions. Taken together, our findings in  cross-sectional  studies suggested that there were ignificant impairments of prospective memory, emotion-volition coupling, and facial emotion perception in first-episode psychosis.   In Study 5, we collected 12-month longitudinal data of a part of the cohort with first-episode   psychosis. The mixed models of Analysis of Variance (ANOVA) and Analysis of Covariance   (ANCOVA) found that the main effect of time was significant for the conventional cool cognitive
abilities, and prospective memory, but not for emotion-volition decoupling. The results therefore seem to suggest that cool cognition improved over the time, whereas hot cognition persisted. The relative longitudinal stability of deficits in hot cognition seemed to parallel with the group’s persistent negative symptoms. 
      The findings in this dissertation have strong clinical implication. Clinicians are recommended to detect early the deficits in  cool and hot cognitions in patients with first-episode psychosis. Our findings concerning the apparent dissociation between cool and    hot cognition over a 12-month period are subjected to methodological constraints, due to learning effect resulted from repetition of the identical behavioural paradigms. Further studies   should control for practice effect by conducting parallel sequential assessments on the healthy comparison group.
学科领域认知神经科学
语种中文
文献类型学位论文
条目标识符http://ir.psych.ac.cn/handle/311026/19636
专题认知与发展心理学研究室
作者单位中国科学院心理研究所
推荐引用方式
GB/T 7714
吕世裕. 首发精神病人的“冷”和“热”认知探讨: 横向与纵向研究[D]. 北京. 中国科学院研究生院,2013.
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