男性反社会人格障碍患者风险决策功能的研究

Decision-making under risk in patients with antisocial personality disorder

目的评估男性反社会人格障碍（antisocialpersonalitydisorder，ASPD）患者的风险决策功能，模拟真实情景探讨其在风险条件明确情形下的决策行为和学习反馈过程。方法采用风险概率明确的骰子博弈测试（gameofdicetask，GDT）对31例ASPD患者（ASPD）组、33例健康对照（healthycontrols，HC）组进行风险决策功能测试。结果ASPD组较HC组更倾向于选择风险选项[ASPD组（10．06±5．26）分，HC组（5．42±3．29）分，t=4．201，P〈0．01]。ASPD组负反馈利用率明显低于HC组，差异有统计学意义[ASPD组（0．28±0．26）分，HC组（0．68±0．32）分，t=-5．311，P〈0．01]。4个选项中ASPD组选择最多的是2个数字的联合，而HC组选择最多的是3个数字的联合[选择1个数字的联合，ASPD组中位数为1（0—8），HC组中位数为1（0—2．5）（Z=-2．295，P=0．022）；3个数字：ASPD组（4．77±4．23）分；HC组（6．79±3．43）分；t=-2．100，P=0．04；4个数字：ASPD组（3．06±3．53）分；HC组（5．82±3．41）分；t=3．176，P=0．002]。相关分析发现，ASPD组中选择风险选项的次数与负反馈利用率（r=-0．613，P〈0．01）、Stroop结果（r=0．566，P〈0．01）、BIS-11中运动因子（r=0．779，P〈0．01）和冲动性总分（r=0．481，P=0．006）的相关性显著。结论ASPD患者在风险概率明确条件下存在着明显的决策倾向改变，其偏爱选择高风险选项，并与执行功能、行为冲动性和负反馈利用率相关。推测此种表现可能与前额叶皮层功能减弱有关，并可能通过执行功能和反馈处理两个过程影响决策行为。

Objective To investigate decision making under risk in patients with antisocial personality disorder（ASPD）. Methods The game of dice task （GDT） was a commonly used measure of decision making under risk. 31 ASPD patients and 33 healthy controls （HC） were investigated by GDT with explicit probability. Results ASPD patients performed poorly in the entire task. ASPD selected more risky options （ ASPD ： 10.06 ± 5.26, HC ：5.42 ± 3.29, t = 4. 201, P 〈 O. 01 ） compared with healthy controls. The most frequent choice made by ASPD patients was two numbers. Accordingly,the most frequent choice made by HC group was three numbers（one number： the median of ASPD patients was 1 （ 1-8）, the median of HC was 1 （0-2.5）, Z = - 2. 295, P = 0. 022） ; three numbers ： ASPD ：4. 77 ±4.23;HC：6.79 ±3.43; t= -2. 100, P=0.04;four numbers：ASPD：3.06 ±3.53; HC ： 5.82 ± 3.41 ; t = 3. 176, P = 0. 002 ）. The frequency of choosing the risky options had correlation with the rate of using negative feedback （ r = -0. 613, P 〈 0.01 ） , impulsiveness （ r = 0.481, P = 0. 006 ） and the results of Stroop test （ r = 0. 566, P 〈 0.01 ）. Conclusion Main results reveal that patients with ASPD make risky decisions significantly more often than the HC. Moreover,they show lack of capacity to advantageously utilize feedback,and correlation with executive function, impulsiveness, and negative feedback.