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    面向世界科技前沿,面向国家重大需求,面向国民经济主战场,率先实现科学技术跨越发展,率先建成国家创新人才高地,率先建成国家高水平科技智库,率先建设国际一流科研机构。

    ——中国科学院办院方针

    首页 > 科研进展

    心理所发现创伤后应激障碍和执行功能损伤的共存模式

    2019-09-30 心理研究所
    【字体:

    语音播报

      创伤后应激障碍(Posttraumatic stress disorder,PTSD)与执行功能损伤(Executive dysfunction, ED)均是个体经历创伤应激事件后常见的负性心理反应。理解这二者的关系对解释PTSD的心理病理过程和开发有效针对PTSD的干预手段都具有十分重要的意义。因此这一问题近年来已经得到了越来越多研究者的关注。尽管目前已经发表了大量关于二者关系的研究,但研究结果的异质性却很高。目前已有的16项研究比较了PTSD患者和健康对照者的执行功能损伤情况,其中仅有9项研究发现PTSD患者具有更严重的执行功能损伤。

      这种研究结果的高度不一致可能是由于不同研究采取了不同的执行功能测量工具造成的。已有研究都是通过神经心理学测验对执行功能进行测量,主要包括连线测试(TMT)、威斯康辛卡片测验(WSCT)、Stroop测验等。但是神经心理学测验的生态效度一直受到质疑。执行功能自评问卷(DEX-S)是一个测量执行功能损伤的量表式工具,具有出色的生态效度,能够很好测量日常生活中的执行功能损伤症状,并涵盖了执行功能不同维度的损伤情况。因此,采用DSX-S测量执行功能损伤为探究PTSD和执行功能损伤提供了一个更好的方法。

      此外需要注意的是,前人的研究大多采用变量中心的研究取向来探讨两者之间的关系,忽视了个体之间的显著差异。因此,研究者很有必要从群体异质性的角度,采用以人为中心的研究取向,如潜在剖面分析(Latent profile analysis, LPA)来进行探讨。该研究取向能够识别出具有相同合并模式的亚群体,有助于人们更好地理解PTSD与执行功能损伤之间的关系。

      针对研究现状,中国科学院心理研究所心理健康重点实验室王力研究组采用LPA的方法对13438名儿童青少年地震幸存者的PTSD与执行功能损伤进行了分析,结果显示最优拟合模型由低症状(36.8%)、中等症状(37.8%)、高症状(21.7%)和特高症状组(3.7%)4种平行的症状合并模式构成(见图1);年龄、性别、民族等人口统计学变量及地震相关的创伤暴露、生活质量与不同合并模式存在特异性或一致性的关联。

      该研究是首个对PTSD和执行功能损伤症状合并模式的研究。研究结果表明PTSD和执行功能损伤的关系稳定存在,不受个体差异的影响。这一结果一方面为进一步从理论上阐释PTSD与认知功能损伤的关系提供了重要基础,同时也提示了在对PTSD症状较为严重的患者进行干预时需要考虑到其执行功能的损伤情况,采取对执行功能依赖更小的干预方案,如药物干预。

      该研究受到国家自然科学基金项目(31271099,31471004)、教育部人文社会科学重点研究基地项目(16JJD190006)、中科院对外合作项目(153111KYSB20160036)、中科院重点部署项目(ZDRW-XH-2019-4)及北京市科学技术委员会(Z171100000117014)的支持,研究成果已在线发表于西班牙行为心理协会期刊International Journal of Clinical and Health Psychology。

        论文链接

    图:不同时间点PTSD总体症状严重程度与5-HTTLPR基因型的关联

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