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精神分裂症、双相情感障碍和抑郁症的情绪缺损鉴别研究
其他题名Profiling of experiential pleasure, emotion expression and regulation in schizophrenia, bipolar disorder and major depressive disorder
邹颖敏
学位类型博士
导师陈楚侨
2018-06
学位授予单位中国科学院研究生院
学位授予地点北京
学位专业认知神经科学
关键词情绪缺损 精神分裂症 跨诊断 聚类分析
摘要

   情绪缺损是精神分裂症阴性症状形成的基础,然而,关于精神分裂症情绪缺损的不一致的研究结果提示可能存在亚型。以往关于精神分裂症情绪缺损的研究多关注情绪体验与表达,而忽略了情绪调节的作用。因此本研究整合情绪调节模型,提出情绪体验、表达与调节的理论框架,用以鉴别精神分裂症、双相情感障碍和抑郁症的不同情绪缺损类型。
    本研究有两个目的,一是鉴别及验证精神分裂症的情绪缺损类型;二是鉴别及验证精神分裂症、双相情感障碍和抑郁症的情绪缺损类型。研究一包含两个实验,实验一招募了146例精神分裂症患者及73例健康对照组,采用情绪体验、表达与调节的自我报告工具进行施测。同时,对精神分裂症患者的阴性症状严重程度进行了临床评估。在精神分裂症患者中进行聚类分析及判别分析。结果显示三类是最佳的聚类方案,情绪缺损的特征分别是:“情绪体验和调节缺损型”,“情绪表达缺损型”,“情绪体验、表达和调节缺损型”。判别分析的结果表明,三类的分组合理。“情绪体验、表达和调节缺损型”比其他两组报告更严重的抑郁症状,而“情绪体验和调节缺损型”和“情绪体验、表达和调节缺损型”比“情绪表达缺损型”表现出更多的情感淡漠。实验二抽取了实验一中的_59例精神分裂症患者及36例健康对照组,完成情绪延迟奖励任务。结果显示,在情绪延迟奖励任务的预期阶段,在正性条件下,健康对照组与“情绪体验和调节缺损型”的渝悦度评分显著高于“情绪表达缺损型”与“情绪体验、表达和调节缺损型”。
    研究二也包含两个实验,实验一独立招募了433例患者(其中包含170例精神分裂症、137例双相情感障碍及126例抑郁症患者)和1 _50例健康对照组,使用一系列测量情绪体验、表达与调节的自评工具在所有被试中进行评估,同时患者组接受了临床症状的评估。结果显示,在精神分裂症、双相情感障碍、抑郁症患者中存在三种不同情绪缺损类型:“情绪体验和调节缺损型”,“情绪表达和调节缺损型”、“情绪体验、表达和调节缺损型”。三种类型在临床诊断类型上有所差异,在阴性症状量表评估的情感淡漠与快感缺乏维度存在差别。实验二抽取了实验一中的77例患者(其中包含精神分裂症患者21例,双相情感障碍患者3 _5例,抑郁症患者21例)及_5 _5例健康对照组,完成金钱延迟奖励任务、情绪延迟奖励任务、努力付出任务和握力付出任务,患者组同时评估了临床症状;结果显示,三种不同的情绪缺损类型在体验相关的任务表现上存在差异,“情绪体验和调节缺损型”、“情绪体验、表达和调节缺损型”在反馈阶段对正性刺激的体验上均出现缺损,而“情绪表达和调节缺损型”在正性刺激的体验上无缺损。三种不同的情绪缺损类型在动机相关的任务表现上存在差异,具体表现为在高获奖概率、高奖励金额条件下,均出现动机缺乏,而缺损的程度无差异;三种不同的类型阴性症状量表评估的情感淡漠和快感缺乏维度上有差异,而在精神病性症状、躁狂和抑郁症状上无差异。
      总体来看,在精神分裂症患者中,存在着三种不同的情绪缺损类型:“情绪体验和调节缺损型”、“情绪表达缺损型”、“情绪体验、表达和调节缺损型”,三种类型在抑郁症状、情感淡漠中表现有所不同,情绪体验相关的行为任务能有效地说明,三种类型在预期阶段的正性情绪体验程度不同。在精神分裂症、双相情感障碍与抑郁症患者中,存在着三种不同的情绪缺损类型:“情绪体验和调节缺损型”、“情绪表达和调节缺损型”、“情绪体验、表达和调节缺损型”,三种不同的缺损类型在阴性症状量表评估的情感淡漠和快感缺失存在差异,而在精神病性症状、躁狂和抑郁症状上无差异;不同类型在情绪体验相关的行为任务中,在反馈阶段的正性情绪体验有所差异,验证了分类的有效性;而动机相关的行为任务并未出现显著差异。本研究基于整合的情绪理论框架,验证了在精神分裂症、双相情感障碍、抑郁症患者、中也存在着“情绪体验、表达、调节”的不同缺损类型,且不同的缺损类型在正性刺激的愉快体验有差异,进一步验证了分类的有效性。这些结果表明,情绪缺损在精神分裂症、双相情感障碍与抑郁症人群中是普遍存在的,且缺损程度有所差异,与阴性症状有一定的关联。本研究以整合的视角,丰富了目前关于精神疾病的情绪缺损方面的理论,同时对日后情绪缺损的早期识别与干预有一定的启示意义。

其他摘要

  Emotion deficits may play an important role in the development of negative symptoms of schizophrenia. However, inconsistent findings on emotion deficits in schizophrenia suggest that there might be subtypes of emotion deficits. Previous studies on the emotion deficits in schizophrenia have focused on experiential pleasure and emotion expression rather than emotion regulation. In this study, we aimed to propose a theoretical framework of experiential pleasure, expression and regulation to identify subtypes in schizophrenia and across different diagnostic groups.
  In Study 1,we conducted two experiments to identify and validate the different subtypes of emotion deficits in patients with schizophrenia. In Experiment 1,we recruited 146 patients with schizophrenia and 132 demographically matched healthy controls. A set of checklists capturing experiential pleasure, emotion expression and regulation were administered to all participants. We also assessed the severity of negative symptoms in patients with schizophrenia. We used a two-stage cluster analysis to analyze the profile of experiential pleasure, emotion expression and regulation. We found that the best solution  consisted  of three-cluster,  namely "experiential pleasure and emotion regulation deficits", "emotion expression deficits",and "experiential pleasure, emotion expression and regulation deficits". Group-level comparisons showed that patients with "experiential pleasure and emotion expression deficits" reported more severe depressive and anhedonia symptoms than the other two groups.  Moreover,  patients  with "experiential pleasure  and  emotion  expression deficits"  had more  affective  flattening than patients  with "emotion  expression deficits". In Experiment 2, we randomly selected 59 schizophrenia patients and 36 healthy controls from Experiment 1 to complete an Affective Incentives Delay task.We found that on anticipating positive stimuli, patients with "experiential pleasure and emotion regulation deficits" and healthy controls scored significantly higher than participants with "emotional expression deficits" and "experiential pleasure, emotional expression and regulation deficits".
  In  Study 2,  we examined the subtypes  of emotion deficits in patients with schizophrenia, bipolar disorder and major depressive disorder. Two experiments were conducted. In Experiment 1,we recruited 433 patients (170 with schizophrenia, 137 with bipolar disorder and 126 with major depressive disorder patients) and 150 healthy controls. All participants completed a battery of tests measuring experiential pleasure, emotion regulation and expression. Two stage cluster analysis indicated a three-cluster solution, which included the following three clusters:  "experiential pleasure  and  emotion  regulation  deficits",  "experiential  pleasure,  emotional expression  and  regulation  deficits",  and  "emotional  expression  and  regulation deficits". The proportions of the three subtypes of emotion deficits in patients with schizophrenia, bipolar disorder and major depressive disorder were significantly different. Moreover, there were significant differences in the severity of affective flattening and asociality rated by the SANS. In Experiment 2, we selected 77 patients (21 with schizophrenia, 35 with bipolar disorder and 21  with major depressive disorder) and 55 healthy controls at random from Experiment 1.The Monetary Incentives Delay task, the Affective Incentives Delay task, the Effort Expenditure for Reward Task, and the Effort and Pleasure Experience Task were administered to all participants. The clibnical symptoms of the patients were also evaluated. We found that in the feedback phases of the Monetary Incentives Delay Task and the Affective Incentives Delay Task, patients with "experiential pleasure deficits" and "experiential pleasure and emotional expression deficits" scored significantly lower than healthy controls,  and those with  "emotional expression deficits"  showed no  significant difference from healthy controls. The three subtypes displayed comparably less willingness to obtain monetary rewards in high reward probability and high reward magnitude conditions in motivation-related tasks. There was no group difference in clinical symptoms.
  Taken together, these findings suggest that schizophrenia patients may be classified into  three  subtypes  in  terms  of  experiential  pleasure,  emotion  regulation  and expression, which are characterized by distinct clinical characteristics and behavioural manifestations. Moreover, there appears to be three different profiles of experiential pleasure, emotion regulation and expression in patients with schizophrenia, bipolar disorder and major depressive disorder,  and the proportion of these emotional subtypes among the various clinical samples were significantly different.

语种中文
文献类型学位论文
条目标识符http://ir.psych.ac.cn/handle/311026/26134
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
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邹颖敏. 精神分裂症、双相情感障碍和抑郁症的情绪缺损鉴别研究[D]. 北京. 中国科学院研究生院,2018.
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