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述情障碍对精神分裂症患者的影响
Alternative TitleThe Effect Of Alexithymia On The Patients With Schizophrenia
代启隆
Contributor张向阳
2021-06
Abstract社会认知障碍是精神分裂症患者重要的常见临床特征。在精神分裂症患者中,社会认知障碍与社会交往、独立生活、工作活动以及预后情况密切相关。述情障碍即一个人难以识别和表达情感,是社会认知的一个重要方面。研究表明精神分裂症患者的述情障碍发生率和严重程度较一般人群均显著升高。少量研究表明,述情障碍与精神分裂症患者的临床症状、认知功能和负性行为密切相关,但研究结论不一,且并未考虑性别因素。同时因为现有研究均为小样本研究,其研究结果的效度也值得商榷。故而采用大样本数据,系统探索述情障碍与精神分裂症患者临床症状、认知功能和自杀行为的关系将有助于进一步确认述情障碍对精神分裂症患者的影响。这为之后提高治疗效果、改善预后和减少自杀行为提供了新的方向和可能。 研究一中采用了阴性阳性症状量表(PANS S)和多伦多述情障碍量表(TAS-20)对818名慢性精神分裂症患者的临床症状和述情障碍进行评估,探索了述情障碍与精神分裂症患者临床症状间的关系。本研究根据TAS-20总分,将所有患者划分为述情障碍组、临界状态组和无述情障碍组后,进行临床症状严重程度的比较。三组在除阳性症状外的其他临床症状得分均存在显著差异。男性患者存在述情障碍的比例显著高于女性。在女性中除阳性症状分仅与难以识别情绪维度相关,抑郁因子分仅与外向思维不相关外,其余临床症状指标均与述情障碍相关指标正相关。在男性患者中PANS S总分和一般病理症状与难以描述情绪维度和外向思维不相关,抑郁因子分与表达情感障碍不相关。 研究二在研究一的基础上,采用重复性成套神经心理状态测验(RBANS }检测精神分裂症患者的认知功能,探索了述情障碍与精神分裂症患者认知功能间的关系。研究发现无述情障碍组、临界状态组和述情障碍组三组在认知功能所有维度上都存在显著的差异,三组间认知能力逐渐下降。除了即时记忆和视觉广度与难以识别情绪不相关外,RBANS总分和其他因子均与TAS-20总分和各因子分负相关。两性患者三组均在RBANS总分和即时记忆上存在显著差异。 研究三进一步采用了贝克自杀意念量表(BSI)对精神分裂症患者的自杀观念强度进行评估,探索了述情障碍对患者自杀观念的影响。结果发现,述情障碍中的难以识别情感与是否有自杀观念,以及自杀观念强度相关。而后发现性别会调节由抑郁症状中介的述情障碍与自杀观念强度之间的关系。 综上,本研究得出如下结论:(1)精神分裂症患者中约有32.27%的患者存在述情障碍,男性精神分裂症患者述情障碍发生率和严重程度更高;(2)精神分裂症患者述情障碍严重程度与除阳性症状外的临床症状严重程度正相关,女性中述情障碍与临床症状间的关系更广泛;(3)精神分裂症患者述情障碍严重程度与认知功能负相关,男性患者中述情障碍与认知功能间的关系更为广泛;(4)述情障碍可能是精神分裂症患者自杀行为的危险因素,性别会调节述情障碍对自杀行为的影响。
Other AbstractPatients with schizophrenia have emotional, cognitive and interpersonal disorders before and after the onset of the disease. Social cognitive impairment is a common and important clinical feature of patients with schizophrenia. In patients with schizophrenia, social cognitive impairment is significantly associated with social interaction, independent life, work activities and recovery. Alexithymia is an important aspect of social cognition, which is characterized by cognitive-affective disorder, that is, it is difficult for a person to identify and express feelings. Previous studies have shown that the incidence and severity of alexithymia in patients with schizophrenia are significantly higher than those in the general population. A few of small sample studies of patients with schizophrenia have shown that alexithymia is closely related to clinical symptoms, cognitive function and negative behavior of patients with schizophrenia. However, the conclusions of the existing studies are not consistent, and gender, which widely affects the emotional processing process, is not taken into account. At the same time, because the existing studies are all small sample studies, the validity of the research results is also open to question. Therefore, using a large sample to systematically explore the relationships between alexithymia and clinical symptoms, cognitive function and suicidal behavior in patients with schizophrenia will further confirm the effect of alexithymia on patients with schizophrenia. It provides a new direction or possibility for reducing the severity of symptoms, cognitive deficits and suicidal behavior. In study 1,the Positive and Negative Syndrome Scale (PANSS) and Toronto alexithymia scale (TAS-20) were used to evaluate the clinical symptoms and the severity of alexithymia of 818 patients with chronic schizophrenia, in order to explore the relationship between alexithymia and clinical symptoms in patients with schizophrenia. According to the total score of TAS-20, all patients were divided into alexithymia group, critical state group or non-alexithymia group, and the severity of clinical symptoms were compared among the three groups. There were significant differences in the scores of other clinical symptoms except positive symptoms among these groups. The results of correlation analysis showed that the positive symptoms score was only positively correlated with DIF (difficulty identifying feelings), while the depression factor was not correlated with EOT (externally oriented thinking). The scores of global PANSS, negative symptoms, general psychopathology symptoms and cognitive factor were positively correlated with the total score and all subscale scores of TAS一20. In this sample, the proportion of male patients with alexithymia was 35.3%, which was significantly higher than that of the female patients (26.5%). In women, except that the score of positive symptoms was only related to the DIF, and the score of depression factor was not related to EOT, the other clinical symptoms indexes were positively correlated with all the indexes of alexithymia. However, in male patients, the total score of PANSS and general pathological symptoms score were not related to the DIF and EOT, while the score of depression factor was only positively correlated with DIF and EOT. In study 2, on the basis of study1,the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) were used to measure cognitive function in patients with schizophrenia, aiming to explore the relationship between alexithymia and cognitive function in patients with schizophrenia. The results showed that there were significant differences in all dimensions of cognitive function among the non-alexithymia group, the critical state group and the alexithymia group, and the cognitive function of the three groups decreased gradually. The relationship between alexithymia and clinical symptoms and the relationship between alexit场mia and cognitive function were opposite. Except for immediate memory and visuospatial skills were not related with DIF. The total score of RBANS and scores of other factors were negatively correlated with the total score and all factor scores of TAS-20. There was consistency between male and female patients, like there were significant differences in RBANS total score and immediate memory among the three groups of male and female patients. Study 3 used the Bake Scale for Suicide Ideation (BSI) to evaluate the severity of suicidal ideation in patients with schizophrenia and to explore the effect of alexithymia on suicidal ideation in patients with schizophrenia. The results showed that the DIF of alexithymia was related to suicidal ideation and the severity of suicidal ideation. It was found that the total score of alexithymia was related to depression factor, and depression factors were positively correlated with the intensity of suicidal ideation in women. In male patients, no correlations were found between the total score of alexit场mia and the depression factor or the severity of suicidal ideation. Furthermore, it was found that gender could moderate the relationship, mediated by depressive symptoms, between alexithymia and the severity of suicidal ideation. To sum up, this study showed that:(1)about 32.27% of the patients with schizophrenia had alexithymia, and the incidence of alexithymia in male patients was significantly higher than that in female patients; (2) the severity of alexithymia in patients with schizophrenia was positively correlated with the severity of clinical symptoms except positive symptoms, and the relationship between alexithymia and clinical symptoms in female patients was more extensive. (3) there was a negative correlation between the severity of alexithymia and cognitive function in patients with schizophrenia, and there were several similar correlations between alexit场mia and cognitive function between male and female patients. (4) alexithymia could be a risk factor for suicidal behaviors in patients with schizophrenia. Gender moderated the effect of alexithymia on suicidal behaviors.
Keyword精神分裂症 述情障碍 述情障碍 临床症状 认知功能 自杀
Subtype硕士
Language中文
Degree Name应用心理硕士
Degree Discipline应用心理
Degree Grantor中国科学院心理研究所
Place of Conferral中国科学院心理研究所
Document Type学位论文
Identifierhttp://ir.psych.ac.cn/handle/311026/39553
Collection健康与遗传心理学研究室
Recommended Citation
GB/T 7714
代启隆. 述情障碍对精神分裂症患者的影响[D]. 中国科学院心理研究所. 中国科学院心理研究所,2021.
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