情感激励延迟任务下抑郁症自杀未遂者痛苦加工的脑激活模式  

Brain Activation Elicited by Affective Punitive Stimulus Is Associated with Psychological Pain and Suicide Risk in Patients with Major Depressive Disorder

作　　者：陈钰莹 贾雅雯 温晓通 李欢欢[1] 郝子雨 林亦轩 蒋松源 CHEN Yu-ying;JIA Ya-wen;WEN Xiao-tong;LI Huan-huan;HAO Zi-yu;LIN Yi-xuan;JIANG Song-yuan(Department of Psychology,Renmin University of China,Beijing 100872,China)

机构地区：[1]中国人民大学心理学系,北京100872

出　　处：《中国临床心理学杂志》2022年第5期1005-1012,共8页Chinese Journal of Clinical Psychology

基　　金：中央高校中国人民大学科学研究基金重大项目(21XNL016)。

摘　　要：目的:基于心理痛苦三因素模型,探索抑郁症自杀未遂者在惩罚加工过程中的脑激活特征及其与自杀意念、自杀未遂的关系,为心理痛苦对自杀未遂的预测提供影像学证据支持。方法:对60名抑郁症患者和31名健康对照组进行临床量表评估和情感激励延迟任务的核磁扫描。其中,依据有无自杀未遂史,患者组分为抑郁自杀未遂组(n=22)和抑郁无自杀未遂组(n=38)。结果:①抑郁自杀未遂组抑郁、痛苦逃避和自杀意念得分显著高于其余两组,但两组患者在快感缺乏得分上无显著差异;②在期待阶段惩罚条件下,抑郁自杀未遂组背内侧前额叶的激活显著低于抑郁无自杀未遂组;在目标反应阶段惩罚条件下,两组抑郁症患者外侧眶额皮层的激活均显著低于健康对照组;③在期待阶段惩罚条件下,外侧眶额皮层激活水平与最严重时自杀意念、三维心理痛苦量表总分显著正相关,在目标反应阶段则相反。结论:心理痛苦,尤其是痛苦逃避,是区分抑郁有无自杀未遂者的行为学指标;外侧眶额皮层作为痛苦加工环路的重要脑区,其激活异常模式可能涉及抑郁症患者自杀的神经基础。Objective:The aim of the present study is to explore brain activation patterns during punish processing in major depressive disorder(MDD)patients with a history of suicide attempts.Methods:Sixty patients with MDD and 31 healthy controls(HC)were required to complete the interested measures and fMRI.According to the history of suicide at⁃tempts,patients were divided into two groups:MDD with a history of suicide attempts(MDD-SA,n=22)and MDD with no such histories(MDD-NSA,n=38).The region of interest(ROI)and whole brain analyses were performed to investigate neu⁃ral activity.Results:①The MDD-SA group had higher scores in depression,pain avoidance and suicide ideation than those in the other groups,whereas there were no significant difference in the anhedonia scores among three groups.②Dur⁃ing the anticipation phase,the MDD-SA group showed lower dorsomedial prefrontal cortex(DMPFC)activation elicited by punitive incentives than the MDD-NSA group.Both MDD-SA and MDD-NSA groups exhibited reduced lateral orbitofron⁃tal cortex(LOFC)response elicited by punitive incentives during the target phase than HC.③There were positive correla⁃tion observed between LOFC and the scores of Beck Scale for Suicidal Ideation at one’s worst point(BSI-W)and three-di⁃mensional psychological pain scale in anticipation of punitive incentives.In contrast,they were negatively correlated during target phase of punitive incentives.Conclusion:Psychological pain,especially pain avoidance is an effective behavioral in⁃dicator to differentiate MDD patients with a history of suicide attempts from those without such histories.Dysfunction of LOFC may characterize abnormal pain processing circuits underlined suicide of MDD patients.

关 键 词：三维心理痛苦 重性抑郁症 自杀未遂 情感激励延迟任务 

分 类 号：R395.1[哲学宗教—心理学]