双相障碍患者的心理推理能力研究

Theory of mind in patients with bipolar disorder

目的 探讨双相障碍患者是否存在心理推理（ToM）能力的损伤及其影响因素.方法 被试80名被分成双相障碍组（BD,27人）、精神分裂症组（SZ,27人）和健康对照组（HC,26人）.全部被试以失言觉察任务测量心理推理能力,韦氏成人智力量表测定智力；以PANSS量表判定两个患者组的精神病性症状.结果 3组失言觉察任务分（ToM分）差异有统计学意义（F（2,77）=13.686,P=0.000）,BD组ToM分[（13.81 ±5.66）分]低于HC组[（17.04±3.79）分],高于SZ组[（9.44±6.13）分],其差异均具统计学意义（P=0.048,0.024）.BD组ToM分的性别比较无统计学意义[男（13.20±6.07）分,女（14.58±5.26）分,t=-0.623,P=0.539]；ToM分与年龄、受教育年限、发病年龄、病程、PANSS阴、阳性和一般精神病量表得分及IQ分（＞70）均不相关；对PANSS量表中各具体症状进行线性回归,回归方程为：ToM分=21.79-1.53G12-3.16N6；调整R2为0.46.结论 双相障碍患者存在ToM能力的损伤,这种损伤较精神分裂症患者为轻,受到PANSS中的G12和N6的影响,可解释46％的变异来源.

Objective To explore whether patients with bipolar disorder are deficit in their theory of Mind （ToM） and the factors influencing the ToM.Methods Three groups （27 with bipolar disorder,27 with schizophrenia,and 26 in health control） were tested.All subjects＇ ToM was assessed by Faux pas Questions and IQ by WAISR.The symptoms of groups of patients were measured by Positive and Negative Symptom Scale （PANSS）.Results Three groups＇ scores of Faux pas Questions（ToM scores） displayed significance（One-Way ANOVA：F（2,77） =13.686,P =0.000） ; Post-hoc test （Games-Howell） showed that ToM scores （13.81 ± 5.66） of bipolar disorder group were lower than those of the control group （17.04 ± 3.79） and higher than the schizophrenia group （9.44 ±6.13）.The difference was significant （P =0.048,0.024）.Independent sample t test showed that ToM scores of gender in bipolar disorder group were not significant （male：13.20 ± 6.07,femal：14.58 ± 5.26,t =-0.623,P =0.539）.There was no correlation between ToM scores of patients with bipolar disorder and their age,years of education,age of onset,duration of illness,scores of negative,positive and general psychiatric rating scale of PANSS,and IQ （〉 70）.Linear regression by stepwise regression was used on each specific symptom of the PANSS,and according to the outcome,related factor was selected as independent variables,the ToM scores as the dependent variable.The regression equation was ToM scores =21.79-1.53 G12-3.16 N6 ;R2adjust was 0.46.Conclusion Patients with bipolar disorder as a whole compared to the control have deficit in their ToM,and the deficit is less than that of patients with schizophrenia.G12 and N6 of the PANSS are the influencing factors,which explain 46%of the variation sources.