惊恐障碍患者述情障碍与内感知的关系

The relationship study on alexithymia and interoception in patents with panic disorder

目的探讨惊恐障碍患者(panic disorder,PD)的述情障碍和内感知特征以及两者关系。方法选取符合美国DSM-Ⅳ诊断标准的37例PD患者和45名健康对照者进行评定分析。采用多伦多述情障碍量表(Toronto alexithymia scale-20,TAS-20)、状态-特质焦虑问卷(state-trait anxiety inventory,STAI)分别评估述情障碍、焦虑症状特点,同时采用心跳知觉心理追踪范式评价内感知水平。结果PD组中述情障碍者共14例,检出率为37.83%(14/37),对照组为2例,检出率4.44%(2/45),两组比例差异有统计学意义(χ^2=14.42,P<0.05)。PD组的TAS总分[(55.11±10.99)分]、TAS因子Ⅰ[(20.62±6.78)分]和TAS因子Ⅱ[(14.68±3.70)分]得分高于对照组[(42.93±9.25)分,(12.82±4.99)分,(11.42±3.04)分,F=20.72,F=31.08,F=15.31,均P<0.01]。PD组内感知觉水平高于对照组[分别为(0.75±0.15)、(0.58±0.19),P<0.01];在PD组中,TAS总分及因子Ⅰ、Ⅱ得分与状态、特质焦虑问卷得分呈正相关(r=0.57,0.61,0.47;r=0.54,0.62,0.39,均P<0.05),与内感知觉水平不相关,也未发现内感知觉水平存在中介效应。结论惊恐障碍患者中述情障碍的检出率和内感知敏感性高于健康人群,述情障碍与焦虑症状之间可能存在相互影响,而内感知敏感性可能是惊恐障碍的临床特点。

Objective To explore the characteristics of alexithymia and interoception in patients with panic disorder(PD) and its relationship. Methods Thirty-seven patients with PD and 45 healthy controls who met the diagnostic criteria of DSM-Ⅳ were selected.Toronto Alexithymia Scale (TAS) and state-trait anxiety inventory (STAI) were used to assess the characteristics of alexithymia and anxiety symptoms respectively.The heartbeat perception levels were tested by the Mental Tracking Paradigm. Results The detection rate of alexithymia in patients with panic disorder was 37.83%(14/37), but the rate in the normal control group was only 4.44%(2/45), and the difference was statistically significant (χ^2=14.42, P<0.05). The total score of TAS (55.11±10.99), factor Ⅰ(20.62±6.78) and factor Ⅱ(14.68±3.70) in the PD group were higher than those in the control group (42.93±9.25, 12.82±4.99, 11.42±3.04;F=20.72, 31.08, 15.31, P<0.01). The levels of the heartbeat perception were higher in the PD group than that in the control group (0.75±0.15, 0.58±0.19;t=4.13, P<0.05). In PD group, the score of STAI were positively correlated with TAS total score and factor Ⅰ and Ⅱ scores(r=0.57, 0.61, 0.47;r=0.54, 0.62, 0.39, P<0.05). There was no significant correlation between the scores of STAI and the level of interoception.The mediating effect of interoception level on alexithymia and state anxiety was not significant while the mediating effect on alexithymia and trait anxiety was also not significant. Conclusions The alexithymia detection rate and interoception sensitivity in patients with panic disorder were higher than those of healthy people.There may be interaction between alexithymia and anxiety symptoms.Interoception may be a clinical feature of panic disorder.