首发强迫症患者执行功能障碍的初步研究

Deficits of executive function in patients with first-episode of obsessive-compulsive disorder

目的 比较首发无抑郁的强迫症患者额叶相关执行功能与健康人的差异.方法 28例符合美国精神疾病诊断与统计手册第4版标准的首发且无抑郁的强迫症患者与28例年龄、性别及文化程度相匹配的健康对照者分别进行了一系列执行功能测定,包括stroop色词试验（Stroop-Word-Color Test,SWCT）、连线测验（Trail-Making Test,TMT）及威氏康辛卡片分类试验（Wisconsin Card Sorting Test,WCST）.强迫症状的严重程度用Yale-brown强迫量表衡量,评定其强迫症状严重程度,对其临床症状及执行功能进行分析.结果 在WCST试验中,强迫症组与对照组相比错误总数、正确总数、持续错误数、随机错误数、完成分类数均增加,差异均有统计学意义（均P＜0.05）.在TMT中强迫症组与对照组完成时间及错误数均明显增加（均P＜0.05）.但SWCT反应时两者间比较差异无统计学意义.总错误数及随机错误数与强迫症的严重程度相关.结论 首发强迫症患者存在明显的认知执行功能障碍,且与临床症状严重程度无关.

Objective To investigate the cognitive deficits in non-depressed patients with obsessive-compulsive disor- der（OCD）. Methods Twenty patients with first episode OCD diagnosed according to the criteria of Diagnostic and Statistical Manual（Fourth edition） were enrolled in the study, 28 healthy subjects matched in age, sex and educational levels served as con- trols. The executive function was measured with Stroop-Word-Color Test （SWCT）, Trail-Making Test （TMT） and Wisconsin Card Sorting Test （WCST） in both groups. Yale- Brown Obsessive Compulsive Scale was used to assess the severity of the OCD. Results The OCD group showed poorer performances on the WCST and TMT than the control group; there were significant dif- ferences in the total errors, total corrects and persistent errors and random errors in WCST and the accomplished time and the errors in TMT between two groups （P〈O.05）, but there was no difference in reaction time in SWCT between groups. The total er- rors, total corrects and random errors were correlated with the severity of OCD. Conclusion OCD induce poor executive function, which may be associated with cognitive deficit caused by a dysfunctional frontal cortex.