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神经软体征在抑郁症、双相情感障碍和精神分裂症患者中的表现——行为和脑成像研究
其他题名Neurological Soft Signs in Major Depression, Bipolar Disorder, Schizophrenia——Evidence from Behavior and Brain Imaging Findings
赵晴
学位类型硕士
导师陈楚侨
2012-05
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
关键词神经软体征 精神分裂症 双相情感障碍 抑郁症 判别分析
摘要神经软体征 (Neurological Soft Signs, NSS) 是指一组微小的行为损伤,这些损伤在行为上是客观存在的,但却很难找到与之相对应的脑解剖结构的异常。此外,以往的研究认为NSS是精神分裂症患者的特异性表现,但是目前已经有研究发现双相情感障碍等一些精神疾病患者也有严重的NSS缺损,因而NSS是否存在诊断的特异性,也是一个值得探讨的问题。本论文通过四个研究,探索性的回答了上述问题。 研究一进行了一个120人的横断面研究,主要对精神分裂症、双相情感障碍、抑郁症患者和健康对照组(每组30人)的NSS行为学表现进行了方差分析和判别分析。方差分析显示精神分裂症、双相情感障碍都有严重的NSS缺损,而抑郁症患者组的表现和健康对照组相似。判别分析结果发现NSS行为测试结果可以将不同组合形式的被试进行区分,区分度在70%至90%左右。 研究二的主要研究内容是对过往文献进行了一个脑结构和功能元分析,其中对7篇NSS脑结构研究和14篇NSS测试任务脑功能研究进行了总结。研究中使用了激活可能性估计(Activation Likelihood Estimation, ALE)。元分析的结果显示,左侧小脑、中央前回(BA6)等脑区可能是NSS的脑际剖结构。 研究三,进行了NSS脑解剖结构的调查分析。通过使用SPM8中Voxel-Based Morphometry (VBM)分析方法,对8名精神分裂症、16名双相情感障碍、17抑郁症患者和26健康对照组的脑结构和NSS分数之间进行了相关分析。VBM发现与NSS分数负相关的脑区结构在四组中都比较一致,主要负相关的脑区是颞叶、额叶、中央前后回、海马旁回、小脑山顶等等。 研究四,对8名精神分裂症、16名双相情感障碍、17抑郁症患者和26健康对照组进行了“拳边掌”任务的脑功能成像分析。常规分析方法的结果显示,抑郁症患者的脑激活模式和健康对照组最接近,但是抑郁症患者组在海马旁回、小脑、脑岛等区域的激活减弱。而双相情感障碍患者体现的脑激活模式是过度抑制,主要体现在对扣带回、颞叶、额叶等区域的抑制过度。而精神分裂症患者体现的则是抑制不足,主要体现的是对尾状核、脑岛、扣带回等区域的抑制不足。 根据上述研究,我们更倾向于认为NSS并非仅仅局限与精神分裂症一种疾病,在双相情感障碍患者也有体现. 通过论文中脑成像研究,我们发现NSS的缺损可能从行为角度反映了精神疾病患者一些脑区结构萎缩或者功能的紊乱,而且这些紊乱可能在精神分裂症等精神疾病中表现的更为严重。 NSS相关的脑区结构主要包括颞叶、额叶、小脑、中央前后回、海马旁回、丘脑、扣带回等等。
其他摘要Neurological soft signs (NSS) are traditionally defined as minor non-localizable neurological abnormalities. Another unclear issue of NSS is whether it is the “trait marker” of schizophrenia. Nowadays, studies have found that patients with bipolar disorder have also showed significantly higher prevalence of NSS than healthy controls. In this dissertation, we conducted four experiments to examine these issues systematically. In study one, we examined the prevalence of NSS in a total of 120 participants, with 30 participants in each group of schizophrenia, bipolar disorder, major depression, healthy controls. We used Analysis of Variance (ANOVA) and discriminant analysis to test the specificity prevalence of NSS among the four groups. ANOVA analysis showed that both patients with schizophrenia and bipolar disorder but not major depression showed significantly higher NSS than healthy controls. The discriminant analysis showed that the NSS discriminant power was about 70% to 90%. In study two, we conducted an Activation Likelihood Estimation (ALE) meta-analysis of the brain imaging studies of NSS. Seven structural Magnetic Resonance Imaging (sMRI) studies and 14 functional Magnetic Resonance Imaging (fMRI) studies of NSS were included in the final ALE analysis according to a set of rigorous inclusion and exclusion criteria. The results of the ALE showed that the left cerebellum,left pre-central gyrus (BA6) and some other brain regions may the brain location of NSS. In study three, we examined the structural neural basis of NSS in patients with psychotic disorders. Eight patients with schizophrenia, 16 patients with bipolar disorder, 17 patients with major depression and 26 healthy controls were recruited for the structural brain scan. We used the Voxel-Based Morphometry (VBM) analysis from SPM8. Negative correlation of NSS and brain structures were demonstrated across the four groups. These brain regions included the temporal lobe, the prefrontal lobe, the pre- and post-central gyrus, the parahippocampal gyrus and the culmen of cerebellum. In study four, we investigated the neural basis and activation of a motor coordination signs, namely the “fist-edge-palm” signs in the same participants from study 3. We administered an imaging paradigm analogue to the “fist-edge-palm” task. Findings showed that patients with major depression only demonstrated hypo-activity in the parahippocampal gyrus, cerebellum and the insular as compared to healthy controls. On the other hand, patients with bipolar disorder demonstrated a wider neural abnormalities of brain activation in the cingulate gyrus, the temporal gyrus, the prefrontal gyrus as compared to healthy controls. Patients with schizophrenia showed significantly hyper-activity in the caudate, insular, and cingulate gyrus as compared to healthy controls. Taken together, the current findings suggested that NSS might not be only limited to patients with schizophrenia but also patients with bipolar disorders. Neuroimaging findings showed that NSS were associated with both structural and functional brain abnormalities in patients with psychotic disorders, with patients with schizophrenia showing significantly more severe impairments in brain structures and functional activation. Brain regions associated with NSS included the temporal lobe, the prefrontal lobe, the cerebellum, the pre- and post- central lobe, parahippocampal gyrus, thalamus and cingulate gyrus. 
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/311026/20478
专题健康与遗传心理学研究室
作者单位中国科学院心理研究所
推荐引用方式
GB/T 7714
赵晴. 神经软体征在抑郁症、双相情感障碍和精神分裂症患者中的表现——行为和脑成像研究[D]. 北京. 中国科学院研究生院,2012.
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