注意缺陷多动障碍共病破坏性、冲动控制及品行障碍的反应抑制和情绪反应  

Response inhibition and emotional responding in attention-deficit/hyperactivity disorder with comorbid disruptive, impulse-control, and conduct disorders

作　　者：江茜茜 刘丽[1] 季海峰[1] 高炬[1] 张敏敏[1] 朱云程 李开云 季卫东[1] 李国海 JIANG Xixi;LIU Li;JI Haifeng;GAO Ju;ZHANG Minmin;ZHU Yuncheng;LI Kaiyun;JI Weidong;LI Guohai(Shanghai Changning Mental Health Center, Shanghai 200335, China;Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China;University of Jinan,Jinan 250022, China;Zhenjiang Mental Health Center, Zhenjiang 212000, China)

机构地区：[1]上海市长宁区精神卫生中心,上海200335 [2]上海交通大学附属精神卫生中心,上海200030 [3]济南大学,山东济南250022 [4]镇江市精神卫生中心,江苏镇江212000

出　　处：《南方医科大学学报》2019年第1期30-34,共5页Journal of Southern Medical University

基　　金：上海市长宁区科学技术委员会项目(CNKW2018Y23);上海市长宁区卫生和计划生育委员会课题项目(20164Y013)

摘　　要：目的了解注意缺陷多动障碍(ADHD)与破坏性、冲动控制及品行障碍(DICCD)在情绪反应中可能存在的神经心理缺陷的特征。方法选择符合美国精神障碍诊断与统计手册第五版(DSM-5)ADHD诊断标准的6～16岁患儿20名,ADHD共病DICCD患儿20名,DICCD患儿20名以及年龄、性别、智力匹配的健康儿童(HC)20名作为对象,选择Golden Stroop测验和情绪Stroop测验对反应抑制和情绪反应进行评估,组间差异采用单因素方差分析,事后分析使用SNK-q检验同质性亚组进行配对比较。结果在Golden Stroop测验中,错误次数(P=0.003)和反应时间(P=0.044)干扰得分组间差异均有统计学意义,进一步Post Hoc分析ADHD组的干扰得分显著高于其余三组。在情绪Stroop测验中,平均反应时间组间差异均有统计学意义(均P<0.05),事后分析ADHD共病DICCD组正性词-色一致平均反应时间低于ADHD组而高于DICCD组,疾病组均高于HC组;ADHD共病DICCD与DICCD组正性词-色不一致、负性词-色一致平均反应时间显著低于ADHD组且高于HC组;DICCD组负性词-色不一致平均反应时间显著低于ADHD组与ADHD共病DICCD组且高于HC组。结论 ADHD的反应抑制缺陷和异常情绪反应均表现为ADHD的核心症状。偏向性情绪刺激可能对于存在冷漠无情特征的DICCD的反应抑制功能具有的负面作用,尤其在处理负性情绪时问题更为突出,而ADHD与DICCD共病更倾向于DICCD的情绪反应特质。Objective To characterize the traits of neuropsychological functioning deficits in patients with attention-deficit/ hyperactivity disorder (ADHD) with comorbid disruptive, impulse-control, and conduct disorders (DICCD). Methods Twenty out-patients with ADHD, 20 with ADHD with comorbid DICCD, and 20 with DICCD, all aged 6-16 years, were enrolled in this study, with 20 healthy subjects matched for age, gender and IQ serving as the healthy controls. The patients were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Revision (DSM-5). All the subjects were assessed with Golden Stroop test and emotional Stroop test to evaluate their response inhibition and emotional responding. Results In Golden Stroop test, the interference scores (IGs) of errors and reaction time both differed significantly among the groups (P< 0.05), and were the highest in patients with ADHD only. In emotional Stroop test, the mean reaction time (MRT) showed significant differences among the groups (P<0.05); the MRT of positive-congruent trials in ADHD with comorbid DICCD group was shorter than that in ADHD group but longer than that in group DICCD; the MRT in the 3 case groups were all longer than that in the control group. The MRT of both positive-incongruent trials and negative-congruent trials in ADHD with comorbid DICCD group and DICCD group was shorter than that in ADHD group but longer than that in the control group. The MRT of negative-incongruent trials in DICCD group was shorter than that in ADHD group and ADHD with comorbid DICCD group but longer than that in the control group. Conclusions The response inhibition deficit and abnormal emotional responding are the core symptoms of ADHD. Bias emotional stimuli may render response inhibitory dysfunction in patients with DICCD with callous-unemotional traits of emotional responding disorder, especially in dealing with negative emotional trials, while the comorbidity of ADHD and DICCD tends to have the emotional response trait of DICCD.

关 键 词：注意缺陷多动障碍 破坏性行为障碍 神经网络 反应抑制 STROOP效应 

分 类 号：R749.94[医药卫生—神经病学与精神病学]