期待愉快体验损伤：精神分裂症和分裂型人格障碍的比较

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	期待愉快体验损伤：精神分裂症和分裂型人格障碍的比较
其他题名	Patients with Schizophrenia but not Individuals with Schizotypal Traits Demonstrate Deficit in Anticipatory Pleasure Experience
	严超
	2013-05
摘要	快感缺失是精神分裂症阴性症状的一个核心症状。然而，现有的研究结果（包括行为和脑成像）显示很强的异质性。最近，越来越多证据表明愉快体验是一个多层次结构的概念，期待和消费愉快体验是其中最具代表性的两个独立成分。本论文探讨精神分裂症和分裂型人格障碍期待和消费愉快体验的行为机制和神经机制。本文通过四个研究来探讨精神分裂症患者愉快体验的行为和生理机制。研究一使用金钱延迟奖赏任务测量46 对精神分裂症和健康对照组的期待和消费愉快体验。结果显示精神分裂症在效价上显示出期待愉快体验（认知成分）的降低而正常的消费愉快体验；然而在唤醒度上不管期待还是消费体验都表现减少；且这个表现在精神分裂症早期阶段就已出现。研究二测量30 名分裂型人格特质和35名对照组的期待和消费性愉快体验，结果显示，分裂型人格特质组不存在期待和消费愉快体验（效价和唤醒度）的异常；研究三对18 个精神分裂症患者测量愉快体验（消费和期待愉快体验）的脑功能研究进行元分析，结果发现精神分裂症加工消费愉快体验存在神经活动的异常，主要是前额叶活动的降低，但小脑区域活动却增强；尽管期待愉快体验的研究有限没有得到显著结果，但研究显示在皮层下区域如腹侧纹状体等活动的降低。研究四使用fMRI 实验测量33 名分裂型人格特质和23 名对照组期待和消费性愉快体验的神经机制。利用单元分析(canonical univariate analysis) 和多元模式分析 (multivariate pattern analysis)分别对大脑激活水平和激活模式进行探讨，结果发现尽管分裂型人格特质组没有表现行为上的区别，但在大脑激活水平的结果显示，无论是在期待还是消费愉快体验都出现前额叶区域的活动增强，而大脑激活模式则基本没有区别。总结，精神分裂症的快感缺失不能再简单理解为愉快体验能力的丧失，而可能主要是期待愉快体验的损伤，但这个损伤在分裂型特质群体并未表现出来。
其他摘要	Anhedonia is a core negative symptom of schizophrenia. However, inconsistent findings have been shown of experiential pleasure deficits in schizophrenia have been demonstrated in the extant literature. However, most of the previous findings were limited to the unitary construct of anhedonia. Recently, pleasure experience has been considered as a multi-dimensional concept consisting of at least two components, namely anticipatory and consummatory pleasure experience. The current thesis aimed to examine the anticipatory and consummatory pleasure in patients with schizophrenia and individuals with schizotypal trait. In study 1, the Monetary Incentive Delay (MID) task was used to examine the anticipatory and consummatory pleasure in 46 pairs of schizophrenia patients and healthy controls. It was found that patients with schizophrenia showed diminished anticipatory pleasure (cognitive component) but intact consummatory pleasure compared with healthy controls with respect to the valence rating. However, significant reduction in arousal rating was observed in patients with schizophrenia in both anticipatory and consummatory pleasure experience. Subsequent analysis of the sub-division of patients with early and chronic stages of the illness showed that patients with early stage of the illness demonstrated similar patterns of deficits compared with their chronic counterparts. In stduy 2, we recruited 30 individuals with schizotypal trait and 35 individuals without schizotypal trait to perform MID task.Results showed that individuals with schizotypal trait did not demonstrate deficit in both anticipatory and consummatory pleasure compared to individuals without schizotypal trait. In study 3, an ALE analysis was performed to identify and validate the neural substrates of associated with the consummatory pleasure experience in patients with schizophrenia. However, the ALE analysis was not able to be performed for anticipatory pleasure because of the limited number of studies idenfied from the literature. Patients with schizophrenia were found to show hypoactivation of the prefrontal and limbic regions but hyperactivation of the culmen region during the consummatory pleasure experience. In study 4, 33 individuals with schizotypal trait and 23 individuals without schizotypal trait were recruited to perform the MID task during MRI scanning. Both canonical univariate and multivariate pattern analysis were used to compute the voxel-wise activation and region-wise activation pattern, respectively. Although normal pleasure rating (anticipatory and consummatory) was demonstrated in individuals with SPD trait, elevated prefrontal activation was observed in this subclinical group during both anticipatory and consummatory pleasure processing. Individuals with schizotypal trait displayed similar orbitofrontal and striatal activation patterns to individuals without schizotypal trait during anticipatory and consummatory pleasure experience. Taken together, the current findings suggest that anhedonia could not be simply interpreted as a diminished capacity to experience pleasure in schizophrenia. Instead, anticipatory pleasure was found impaired in patients with schizophrenia. However, this impairement could not be extent to individuals with schizotypal trait.
学科领域	认知神经科学
关键词	精神分裂症谱系快感缺失期待愉快体验消费愉快体验元分析
学位类型	博士
语种	中文
学位专业	心理学
学位授予单位	中国科学院研究生院
学位授予地点	北京
文献类型	学位论文
条目标识符	https://ir.psych.ac.cn/handle/311026/19740
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	严超. 期待愉快体验损伤：精神分裂症和分裂型人格障碍的比较[D]. 北京. 中国科学院研究生院,2013.

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