強迫癥患者高發(fā)與散發(fā)一級親屬心理健康狀況及認(rèn)知功能的對照研究

劉長成　張新風(fēng)　徐黎明

[摘要] 目的 探討強迫癥患者一級親屬的心理健康狀況及認(rèn)知功能。 方法 選擇2015年6月～2017年6月在荊州市精神衛(wèi)生中心住院的強迫癥患者的一級親屬72名為研究對象，按照家族中有無其他患病者將72名親屬分為高發(fā)家系組（48名）和散發(fā)家系組（24名）。采用漢密爾頓焦慮量表（HAMA）、耶魯-布朗強迫量表（Y-BOCS）評價兩組的焦慮癥狀和強迫癥狀，采用斯特魯普色詞測驗（Stroop）、威斯康星卡片分類測驗（WCST）、持續(xù)操作測驗（CPT）量表、簡易視覺空間記憶測驗-修訂版（BVMT-R）測試兩組的認(rèn)知功能。 結(jié)果 ①高發(fā)家系組HAMA量表、Y-BOCS量表總分均高于散發(fā)家系組，差異有統(tǒng)計學(xué)意義（P < 0.05）；②高發(fā)家系組Stroop測試的B、C部分得分顯著低于散發(fā)家系組，差異有統(tǒng)計學(xué)意義（P < 0.05）；高發(fā)家系組WCST正確數(shù)、完成分類數(shù)得分顯著低于散發(fā)家系組（P < 0.05），持續(xù)錯誤數(shù)、隨機錯誤數(shù)得分顯著高于散發(fā)家系組，差異有統(tǒng)計學(xué)意義（P < 0.05）。③高發(fā)家系組CPT得分顯著低于散發(fā)家系組，差異有統(tǒng)計學(xué)意義（P < 0.05）；④高發(fā)家系組BVMT-R中聯(lián)想學(xué)習(xí)、圖像自由回憶、人像特點回憶項目顯著低于散發(fā)家系組，差異有統(tǒng)計學(xué)意義（P < 0.05）。 結(jié)論 高發(fā)家系組一級親屬較多出現(xiàn)焦慮、強迫癥狀，更易出現(xiàn)注意力、記憶力等方面的認(rèn)知功能損害。

[關(guān)鍵詞] 強迫癥；一級親屬；高發(fā)與散發(fā)；焦慮；認(rèn)知功能

[中圖分類號] R749.3 [文獻(xiàn)標(biāo)識碼] A [文章編號] 1673-7210（2018）01（c）-0000-04

[Abstract] Objective To investigate the mental health status and the cognitive function in the first-degree relatives of patients with obsessive-compulsive disorder. Methods From June 2015 to June 2017， 72 first-degree relatives of patients with obsessive-compulsive disorder in Jingzhou Mental Health Center were selected as research objects and divided into the high incidence family group （48 cases） and the sporadic incidence family group （24 cases） according to the presence of others in the family. Hamilton anxiety scale （HAMA） and Yale-Brown obsessive compulsive scale （Y-BOCS） were used to assess the anxiety and compulsive symptoms. Stroop color word test （Stroop）， Wisconsin card sorting test （WCST）， continuous performance test （CPT） and brief visuospatial memory test-revised （BVMT-R） were applied to evaluate the cognitive function. Results ①The total scores of HAMA and Y-BOCS in the high incidence family group were all higher than those of sporadic family group， with statistically significant differences （2.6965， P < 0.05）. ②In the Stroop， the scores of B and C in the high incidence family group were lower than those of sporadic family group， with statistically significant differences （P < 0.05）. The WCST scale showed that the number of correctness and completed categories in the high incidence family group were lower than those of sporadic family group， with statistically significant differences （P < 0.05）， while significantly higher as regards the number of persistent error and random error （P < 0.05）. ③The score of CPT in the high incidence family group was significant lower than that of sporadic family group， with statistically significant difference （P < 0.05）.④BVMT-R showed that in terms of associative learning， group image free recall and memorizing the characteristics of human pictures in the high incidence family group were significant lower than those of sporadic family group， with statistically significant differences （P < 0.05）. Conclusion The first-degree family members of patients with high incidence of obsessive-compulsive disorder are more likely to show signs of anxiety and obsessive-compulsive symptom and more likely to suffer from cognitive impairment， such as attention and memory.

[Key words] Obsessive-compulsive disorder； First-degree relatives； High and sporadic incidence； Anxiety； Cognitive function

強迫癥是一種臨床常見的神經(jīng)癥性障礙，患者反復(fù)出現(xiàn)帶有闖入性的強迫思維、強迫知覺或強迫性的行為，在對立與矛盾的焦慮中感覺痛苦，并為緩解焦慮而實施一系列重復(fù)儀式化動作[1]。隨著病情的遷延，容易出現(xiàn)認(rèn)知功能受損癥狀，注意力無法集中，理性思維和邏輯推理能力下降[2]。認(rèn)知功能障礙是強迫癥的重要癥狀之一[3]，探討認(rèn)知功能損害是否為強迫癥的內(nèi)表型指標(biāo)將有助于精確分析強迫癥的遺傳機制。國內(nèi)外研究顯示，強迫癥一級親屬也有焦慮、強迫癥狀，并伴有不同程度的認(rèn)知功能損害[4]。本研究著重調(diào)查一級親屬的心理健康狀況，并對高發(fā)與散發(fā)親屬的認(rèn)知功能進(jìn)行分析對照，進(jìn)一步研究認(rèn)知損害的模式，探討認(rèn)知損害的遺傳易感性及心理遺傳特質(zhì)。……