住院青少年抑郁症患者元认知能力及其与临床症状的关系  

Metacognitive capacities in relation to clinical symptoms in youth hospitalized adolescent patients with major depressive disorder

作　　者：张毛毛 张罗雅 王昱翔 邓娟 成晓彤 刘可智 陈晶 雷威 Zhang Maomao;Zhang Luoya;Wang Yuxiang;Deng Juan;Cheng Xiaotong;Liu Kezhi;Chen Jing;Lei Wei(The Affiliated Hospital of Southwest Medical University,Luzhou 646000,China;Sichuan Mental Health Center·The Third Hospital of Mianyang,Mianyang 621000,China;Zigong Mental Health Center,Zigong 643000,China)

机构地区：[1]西南医科大学附属医院,四川泸州646000 [2]四川省精神卫生中心·绵阳市第三人民医院,四川绵阳621000 [3]自贡市精神卫生中心,四川自贡643000

出　　处：《四川精神卫生》2024年第5期433-438,共6页Sichuan Mental Health

基　　金：泸州科技局-西南医科大学联合项目(项目名称:抑郁症目标导向-习惯学习系统异常及其神经机制,项目编号:2019LZXNYDJ39);西南医科大学校级科研项目(项目名称:rTMS治疗对抑郁障碍患者元认知及其监控决策作用的认知神经机制,项目编号:2022ZD004)。

摘　　要：背景元认知能力是个体对认知过程监督和调控的能力,在决策和行为调整中发挥重要作用。抑郁症(MDD)患者存在认知功能受损,但不同研究关于MDD患者元认知能力的结果不一致,且元认知能力与患者临床症状的关系仍不清楚。目的探讨住院青少年MDD患者元认知能力及其与抑郁和焦虑症状之间的关系,以期为MDD的临床干预提供新的视角。方法选取2022年3月—2023年6月于西南医科大学附属医院精神科住院的、符合《精神障碍诊断与统计手册(第4版)》(DSM-Ⅳ)抑郁症诊断标准的56例青年患者为研究对象(MDD组)。同期在泸州市选取与MDD组年龄和性别相匹配的62名健康人为对照组。采用知觉决策任务和信心评估任务评定两组的元认知能力,指标包括信心偏差、信心评估反应时间和元认知效率。采用贝克抑郁量表(BDI)和贝克焦虑量表(BAI)分别评定患者的抑郁和焦虑症状严重程度。采用Pearson相关分析考查患者元认知能力与临床症状的相关性。结果MDD组BDI评分和BAI评分均高于对照组,差异均有统计学意义(t=-13.722、-9.674,P均<0.01)。在决策表现方面,MDD组和对照组决策准确率和决策反应时间比较,差异均无统计学意义(t=-0.655、0.975,P均>0.05)。在元认知表现方面,MDD组总的信心、决策正确的信心、决策错误的信心及元认知效率均低于对照组,差异均有统计学意义(t=3.044、2.769、2.836、3.667,P均<0.01)。MDD组信心评估反应时间长于对照组,差异有统计学意义(t=-2.561,P<0.05)。相关分析显示,MDD患者总的信心、决策正确的信心、决策错误的信心与BDI评分均呈负相关(r=-0.310、-0.307、-0.298,P均<0.05);MDD患者总的信心、决策正确的信心与BAI评分均呈负相关(r=-0.284、-0.280,P均<0.05),但决策错误的信心与BAI评分的相关性无统计学意义(r=-0.229,P>0.05);MDD患者元认知效率与BDI评分和BAI评分均呈负相关(r=-0.269、-0Background Metacognition,the capacity to monitor and control one′s cognitive processes,has been identified as a crucial component of effective decision-making and behavioral adaptation.Previous research has revealed cognitive deficits in patients with major depressive disorder(MDD),while findings about metacognitive capacities in patients with MDD have been inconsistent across studies,and the exact relationship between metacognitive capacities and clinical symptoms in MDD patients remains uncertain.Objective To examine the metacognitive capacities of adolescent hospitalized patients with MDD and to explore its relationship with depressive and anxiety symptoms,thus providing an unprecedented insight into the prevention of MDD.Methods A coherent 56 adolescent hospitalized patients with MDD in the Psychiatry Department at the Affiliated Hospital of Southwest Medical University from March 2022 to June 2023 and met the diagnostic criteria for depression as defined by the Diagnostic and Statistical Manual of Mental Disorders,fourth edition(DSM-IV)were enrolled as MDD group.At the same time,62 healthy individuals matched with the age and sex of the MDD group residing in Luzhou were concurrently selected as control group.The metacognitive ability of the two groups was evaluated by perceptual decision-making task and confidence rating task,and the indicators included confidence deviation,reaction time of confidence evaluation and metacognitive efficiency.Additionally,the severity of depressive and anxiety symptoms was measured with Beck Depression Inventory(BDI)and Beck Anxiety Inventory(BAI).Pearson correlation analysis was utilized to examine the relationship between metacognitive capacities and clinical symptoms.Results MDD group scored higher on BDI and BAI when compared with control group(t=-13.722,-9.674,P<0.01).In terms of decision-making performance,no statistically significant difference was noted in accuracy and response time between two groups(t=-0.655,0.975,P>0.05).In terms of metacognitive performance,MDD g

关 键 词：抑郁症 抑郁症状 元认知 元认知效率 

分 类 号：R749.4[医药卫生—神经病学与精神病学]