晚发型强迫障碍患者风险决策特点

The Characteristic of Risk Decision Making in Patients with the Late-onset Obsessive-compulsive Disorder

目的:探讨晚发型强迫障碍患者风险决策特点及其与强迫思维、强迫动作等临床症状之间的相关性。方法:应用耶鲁布朗(Yale-Brown)强迫量表评估38名晚发型强迫障碍患者及38名正常被试强迫思维、强迫动作及总体强迫症状的严重程度,剑桥神经心理自动化成套测试软件(CANTAB)中剑桥赌博任务(CGT)、信息采集任务(IST)评定其风险决策特点。结果:晚发型强迫障碍组Yale-Brown量表总分(t=35.44,P<0.05)、强迫思维分(t=18.49,P<0.05)、强迫动作分(t=17.75,P<0.05)均显著高于对照组。晚发型强迫障碍组CGT决策时间显著长于对照组(t=9.02,P<0.05),风险值(t=-6.93,P<0.05)、风险校正值(t=-2.23,P<0.05)显著低于对照组,总体下注比例显著低于对照组(t=-6.49,P<0.05);IST总平均翻开方块数(t=5.77,P<0.05)、收益固定(t=5.75,P<0.05)及收益递减(t=7.13,P<0.05)情景下平均翻开方块数均显著多于对照组,总平均翻开方块反应时(t=3.62,P<0.05)、收益固定(t=2.85,P<0.05)及收益递减(t=2.88,P<0.05)情景下平均翻开方块反应时均显著长于对照组。晚发型强迫障碍组Yale-Brown量表总分与CGT总体下注比例呈显著负相关(r=-0.22,P<0.05);强迫思维得分与CGT总体下注比例呈显著负相关(r=-0.31,P<0.05),与IST总正确数(r=0.34,P<0.05)、收益递减情景下正确数(r=0.42,P<0.05)呈显著正相关;强迫动作得分与CGT决策时间呈显著正相关(r=0.34,P<0.05)。结论:晚发型强迫障碍患者风险决策速度较慢,决策时更为保守,更少冒险,即使以牺牲收益为代价,且强迫思维、强迫动作对风险决策存在不同影响。

Objective：To explore the characteristic of risk decision making in patients with the late-onset obsessive-compulsive disorder and the different influence of obsession and compulsion on it.Methods：A total of 38 patients with the late-onset obsessive-compulsive disorder in study group and 38 healthy subjects in control group were recruited.They were assessed with Yale-Brown obsessive-compulsive scale for the level of obsession,compulsion and overall symptoms,Cambridge Gambling Task（CGT）and Information Sampling Task（IST）in Cambridge Neuropsychological Test Automatic Battery（CANTAB）for risk decision making.Results：The scores of Yale-Brown obsessive-compulsive scale of study group were significantly higer than those of control group（t=17.75~35.44,P0.05）.In CGT：The deliberation time of study group was significantly longer than that of control group（t=9.02,P0.05）,risk taking（t=-6.93,P0.05）and risk adjustment（t=-2.23,P0.05）of study group were significantly lower than those of control group,overall proportion bet of study group was significantly less than that of control group（t=-6.49,P0.05）.In IST,the mean number of boxes opened per trial was significantly more than that of control group（（t=5.77,P0.05）,and so it was in the fixed win condition（t=5.75,P0.05）and decreasing win condition（t=7.13,P0.05）.The mean box opening latency was significantly longer than that of control group（t=3.62,P0.05）,and so it was in the fixed win condition（t=2.85,P0.05）and decreasing win condition（t=2.88,P0.05）.In study group,the total score（r=-0.22,P0.05）and the obsession score（r=-0.31,P0.05）of YaleBrown obsessive-compulsive scale were negatively correlated to the overall proportion bet of CGT,The obsession score was positively correlated to the total correct overall（r=0.34,P0.05）and the total correct in the decreasing win condition of IST（r=0.42,P0.05）,The compulsion score was positively correlated to the deliberation time of CGT（r=0.34,P0.05）,Conclusion：Risk decision making is abnormal in patients with the late-onset obsessivecompulsive disorder,that means the speed is slower,tending to avoid risk and the quality is poorer.At the same time,obsession and compulsion have different influences on it.