阿片类依赖者的抑郁对冲动决策和奖赏惩罚敏感性的影响  

Effects of depression on impulsive decision-making and reward-punishment sensitivity in opioid addicts

作　　者：任其欢[1] 翟婧 董玲萍 李颖 杜江[2] 黄乐萍[1] REN Qi-huan;ZHAI Jing;DONG Lin-ping;LI Ying;DU Jiang;HUANG Le-ping(ShanghaiHongkou Mental Health Center,Shanghai 200083,China;Shanghai Mental Health Center,Shanghai 200030,China)

机构地区：[1]上海市虹口区精神卫生中心,上海200083 [2]上海市精神卫生中心,上海200030

出　　处：《中国药物依赖性杂志》2022年第6期470-474,共5页Chinese Journal of Drug Dependence

基　　金：上海市医学重点专科建设计划(ZK2019A06);虹口区卫生健康委员会临床重点扶持专科建设(HKZK2020A11);虹口区卫生健康委员会科研课题计划资助(虹卫2002-24);虹口区“临床医学优秀青年人才”培养计划(HKYQ2022-13)。

摘　　要：目的探究抑郁情绪对阿片类物质依赖者的冲动风险偏好和决策行为的影响。方法以43名上海居民为健康志愿者(healthy volunteers,HV)组,上海市某美沙酮维持治疗门诊接受美沙酮维持治疗的43名阿片类物质依赖者为美沙酮维持治疗(methadone maintenance treatment,MMT)组,使用贝克抑郁自评量表(Beck Depression Inventory-Ⅱ,BDI-Ⅱ)、冲动性特质量表(Barratt Impulsiveness Scale,BIS-11)和仿真气球冒险任务(Balloon Analogue Risk Task,BART)进行评估。通过独立样本t检验、Pearson相关分析对数据进行统计分析,探讨健康志愿者组和美沙酮维持治疗组的冲动特质、决策行为与正常人群的区别,并进一步探讨抑郁情绪对海洛因依赖症冲动性特质、决策行为的影响。结果(1)MMT组的BDI-Ⅱ量表的分值、BIS-11冲动特质、BART气球爆炸次数显著高于HV组(P<0.01);(2)BSI-11得分与BDI-II的得分无显著相关。实验组BART指标得分气球爆炸次数与BDI-Ⅱ呈显著负相关[r=-0.411,P<0.05],BART指标得平均充气次数与BDI-II呈显著负相关[r=-0.410,P<0.05];(3)MMT组负反馈充气次数改变显著高于HV组。结论接受美沙酮维持治疗的阿片类物质依赖者中常伴有抑郁情绪、高冲动特质,冲动风险决策功能受损,有高风险偏好。在抑郁情绪的影响下,阿片类物质依赖者会采用保守策略;阿片类成瘾患者抑郁时会导致其高复吸风险。Objective To explore the effects of depression on impulse decision risk and bonus-penalty sensitivity in opioid addicts.Methods Forty-three healthy residents in a community in Shanghai were recruited as control group,43 opiate abusers in a methadone clinic in Shanghai as experimental group.The Beck Depression Inventory-Ⅱ(BDI-Ⅱ),the Barratt Impulsiveness Scale(BIS-11)and the Balloon Risk Task(Bart)were used.Using independent sample t test and Pearson Correlation Analysis to analyze the differences of impulsivity,decision-making behavior and depression between healthy subjects and opiate users were investigated,and the relationship between depression,impulsivity,decision-making behavior and reward and punishment sensitivity were discussed.Results(1)The scores of BDI scale,BIS-11 impulsivity and Bart Balloon Explosion in MMT group were significantly higher than those in Control Group(P<0.01).(2)BSI scores were not significantly correlated with BDI-Ⅱscores.There was a significant negative correlation between the number of balloon explosions and BDI-Ⅱ[r=-0.411,P<0.05],and the average number of balloon inflations was significantly negative correlation with BDI-Ⅱ[r=-0.410,P<0.05].(3)The change of negative feedback inflations in MMT group was significantly higher than that in HV group;MMT Group negative feedback inflating times change significantly higher than HV group.Conclusion Opioid addicts receiving methadone maintenance treatment often have the characteristics of depression,high impulsivity,impaired impulsive risk decision-making and high-risk preference.Under the influences of depression,opioid addicts will adopt conservative strategy.In depression,increased sensitivity to punishment led to high relapse rate of opioid addicts,but did not affect their own trait reward reinforcement strategies.

关 键 词：阿片类依赖 抑郁 冲动 

分 类 号：R749[医药卫生—神经病学与精神病学]