基于症状网络分析探讨情绪失调在注意缺陷多动障碍与对立违抗障碍间的作用  

The role of emotional dysregulation between attention-deficit/hyperactivity disorder and oppositional defiant disorder based on symptom network analysis

作　　者：高媛 刘倩溶 李海梅[1] 潘美蓉 朱子青 司飞飞[1] 赵梦婕[1] 岳鑫鑫 王玉凤[1] 钱秋谨[1] 刘璐[1] Gao Yuan;Liu Qianrong;Li Haimei;Pan Meirong;Zhu Ziqing;Si Feifei;Zhao Mengjie;Yue Xinxin;Wang Yufeng;Qian Qiujin;Liu Lu(Peking University Sixth Hospital,Peking University Institute of Mental Health,the Key Laboratory of Mental Health,Ministry of Health(Peking University),National Clinical Research Center for Mental Disorders(Peking University Sixth Hospital),Beijing 100191,China)

机构地区：[1]北京大学第六医院、北京大学精神卫生研究所、国家卫生健康委员会精神卫生学重点实验室(北京大学)、国家精神心理疾病临床医学研究中心(北京大学第六医院),北京100191

出　　处：《中华精神科杂志》2024年第9期586-594,共9页Chinese Journal of Psychiatry

基　　金：首都卫生发展科研专项(CFH:2022-2-4114);国家自然科学基金(81641163);北京市科技新星计划(20220484061);北京大学临床医学+X青年专项(PKU2023LCXQ043);国家重点基础研究发展计划(2014CB846104);北京市卫健委第三批研究型病房项目。

摘　　要：目的基于偏相关网络模型与贝叶斯网络模型探讨情绪失调与注意缺陷多动障碍(attention-deficit/hyperactivity disorder,ADHD)和对立违抗障碍(oppositional defiant disorder,ODD)症状系统间的关系。方法采用横断面研究,纳入2002年9月至2022年6月北京大学第六医院门诊就诊的ADHD共患ODD的患儿967例,采用ADHD症状评定量表评估ADHD症状,儿童临床诊断性会谈量表评估ODD症状,Conners父母症状问卷评估患儿情绪失调问题。使用R语言(版本4.1.2)的mgm包、qgraph包、bnlearn包等进行网络分析,基于ADHD、ODD、情绪不稳定因子共30个症状条目,构建偏相关网络模型与贝叶斯网络模型,基于节点指标探索核心症状与桥连症状。结果偏相关网络分析结果显示,情绪失调症状与ODD症状之间的关联更为紧密;ODD症状有较高的强度,尤其是"很敏感,很容易生气"(强度=3.57)与"经常和大人争吵"(强度=2.32)症状;情绪失调症状有较高的桥连强度,其中"好斗或容易被激怒"(桥连强度=2.64)最突出。贝叶斯网络分析结果显示,ADHD症状位于有向无环图(directed acyclic graphs,DAG)的中上部,主要通过直接关联情绪失调症状间接关联DAG下部的ODD症状。结论相较于ADHD,情绪失调与ODD的症状关联更强,并在ADHD与ODD的症状连接中发挥桥连作用;ADHD症状可以通过直接驱动情绪失调症状间接驱动ODD症状。Objective:This study explores the relationship between emotional dysregulation,attention-deficit/hyperactivity disorder(ADHD)and oppositional defiant disorder(ODD)symptoms using network models.Method:A total of 967 children with ADHD comorbid ODD were recruited from the outpatient department of Peking University Sixth Hospital from September 2002 to June 2022.All subjects were rated for the ADHD symptom severity using the ADHD symptom rating scale.ODD symptoms and emotional dysregulation symptoms were assessed by the Children′s Clinical Diagnostic Interview Scale,and the Conners′Parent Symptom Questionnaire.R(version 4.2.1)packages mgm,qgraph,bnlearn,etc.were used for network analysis,and centrality indices were calculated to define central symptoms and bridge symptoms.Results:The relationship between emotional dysregulation and ODD symptoms was closer.ODD symptoms had higher strength indices,especially the items"gets annoyed or irritated by the behavior of adults"(strength=3.57)and"loses temper or gets angry with adults when does not get his or her own way"(strength=2.32).Emotional dysregulation symptoms had a higher bridge strength indices,with"temper outbursts,explosive and unpredictable behavior"(bridge strength=2.64)as the most prominent item.Bayesian network analysis showed that ADHD symptoms were at the upper of DAG,directly linked with emotional dysregulation symptoms and indirectly linked with ODD symptoms through emotional dysregulation symptoms.Conclusion:Emotional dysregulation symptoms were more closely associated with ODD symptoms than ADHD symptoms,and might potentially acted as bridge symptoms between ADHD and ODD.ADHD symptoms might drive ODD symptoms indirectly through emotional dysregulation symptoms.

关 键 词：注意力缺陷障碍伴多动 对立违抗障碍 情绪失调 网络分析 

分 类 号：R749.94[医药卫生—神经病学与精神病学]