双相障碍躁狂发作和抑郁障碍患者心理理论研究  

The comparison of theory of mind in the manic phase of bipolar disorder and major depressive disorder

作　　者：亢何慧娴 莫菲萍 刘梦慧 施剑飞[3,4] KANG Hehuixian;MO Feiping;LIU Menghui;SHI Jianfei(Affiliated Mental Health Center&Hangzhou Seventh People's Hospital,Zhejiang University School of Medicine,Hangzhou 310013,China)

机构地区：[1]浙江中医药大学第四临床医学院,杭州310053 [2]杭州市富阳区第三人民医院 [3]浙江大学医学院附属精神卫生中心 [4]杭州市第七人民医院

出　　处：《中国神经精神疾病杂志》2023年第2期92-96,共5页Chinese Journal of Nervous and Mental Diseases

摘　　要：目的 比较双相障碍躁狂发作和抑郁障碍患者心理理论(theory of mind,ToM)损害及其错误类型与临床症状的相关性。方法 纳入躁狂发作患者54例,抑郁障碍患者54例,健康对照者52名。采用中文版社会认知视频测查工具(Chinese version of the movie for the assessment of social cognition,MASC-C)评估被试ToM能力,计算被试在MASC-C任务中正确得分及三种错误ToM得分(包括“ToM-过度”、“ToM-不足”及“没有-ToM”)。躁狂发作组采用杨氏躁狂量表(Young manic rating scale,YMRS)评定躁狂症状,抑郁障碍组使用24项汉密尔顿抑郁量表(24-item Hamilton depression scale,HAMD-24)评估抑郁症状。结果 躁狂发作组和抑郁障碍组MASC-C总分均低于对照组[25.0(23.0,28.0)、29.5(25.0,32.0) vs. 31.5(29.3,33.0),均P<0.01]。躁狂发作组“ToM-过度”得分高于其他两组[9.5(8.0,10.0) vs. 6.0(3.8,7.3)、5.0(3.3,6.0),均P<0.01],躁狂发作组、抑郁障碍组“ToM-不足”得分高于对照组[5.0(4.0,7.0)、6.0(4.0,7.3) vs. 5.0(4.0,6.0),P<0.05]。MASC-C总分与YMRS量表分(r=-0.277,P=0.042)、HAMD-24量表分(r=-0.635,P<0.001)呈负相关,“ToM-过度”得分与YMRS量表分呈正相关(r=0.460,P<0.001),“没有-ToM”得分与HAMD-24量表分呈正相关(r=0.540,P<0.001)。结论 躁狂发作及抑郁障碍患者均存在不同程度的ToM损害,躁狂发作ToM损害重于抑郁障碍,且主要表现为过度加工,抑郁障碍则主要表现为加工不足,情感症状的严重程度与ToM损害有关,ToM损害可能是情感性精神障碍的核心特征。Objective This study aims to evaluate the error types and clinical correlates in theory of mind between patients with the manic phase of bipolar disorder and major depressive disorder.Methods The Chinese version of the Movie for the Assessment of Social Cognition(MASC-C)was conducted in subjects of the manic phase of bipolar disorder(n=54),major depressive disorder(n=54)and healthy controls(n=52).Outcome variables in MASC-C entered into the statistical analysis included the total scores of MASC-C,and the error numbers of“hyper-ToM”,“less-ToM”and“no-ToM”.The psychiatric symptoms of manic symptoms of the manic phase of bipolar disorder patients and depressive symptoms of major depressive patients were assessed using Young Manic Rating Scale(YMRS)and 24-item Hamilton Depression Scale(HAMD-24).Results The total score of MASC-C in the manic phase of bipolar disorder and major depressive disorder group were lower than in healthy controls[25.0(23.0,28.0),29.5(25.0,32.0)vs.31.5(29.3,33.0),P<0.01].The error numbers of“hyper-ToM”were higher in the manic phase of bipolar disorder than in other two groups[9.5(8.0,10.0)vs.6.0(3.8,7.3),5.0(3.3,6.0),P<0.01].The error numbers of“less-ToM”were higher in major depressive disorder than in healthy controls[5.0(4.0,7.0),6.0(4.0,7.3)vs.5.0(4.0,6.0),P<0.01].The total score of MASC-C was negatively correlated with the score of YMRS(r=-0.277,P=0.042)and the score of HAMD-24(r=-0.635,P<0.001),and the score of“hyper-ToM”was positively correlated with the score of YMRS(r=0.460,P<0.001),and the score of“no-ToM”was positively correlated with the score of HAMD-24(r=0.540,P<0.001).Conclusions Patients with the manic phase of bipolar disorder and major depressive disorder have different degrees of theory of mind dysfunction.Theory of mind function impairments are worse in the patients with manic episode than patients with major depressive disorder.Namely“hyper-ToM”in manic episode and“less-ToM”in major depressive disorder.It is possible that theory of mind rep

关 键 词：心理理论 双相障碍躁狂发作 抑郁障碍 情感症状 社会功能 认知功能 

分 类 号：R749.4[医药卫生—神经病学与精神病学]