【摘要】：目的:為了研究軀體形式障礙伴有疼痛癥狀患者是否存在對負(fù)性信息注意偏向以及該注意偏向障礙與疼痛的關(guān)聯(lián),探究軀體形式障礙的疼痛癥狀的關(guān)聯(lián)因素,為軀體形式障礙疼痛等軀體不適的研究提供新的參考依據(jù),為其癥狀治療提供新的途徑。方法:選擇軀體形式障礙伴疼痛癥狀患者30例作為實驗組;選取30例與實驗組性別、年齡相匹配的正常健康人,同時排除軀體形式障礙及其他精神疾病和軀體嚴(yán)重疾病作為對照組。采用點探測范式和線索-靶范式對30例軀體形式障礙患者(實驗組)與30例正常被試(對照組)的注意偏向反應(yīng)時進(jìn)行測量。采用整體疼痛評估量表中文版(GPS)對實驗組進(jìn)行疼痛測量評估。采用90項癥狀自評量表(SCL-90)對兩組進(jìn)行心理健康狀況的測量。結(jié)果:30例實驗組和30例對照組都完成了實驗前期預(yù)先設(shè)計的一般資料問卷的搜集,且兩組都完成了點探測范式和線索靶范式。兩組的性別、年齡、受教育程度無顯著差異(P=0.796,0.588,0.796)。在點探測范式中,對照組對兩種圖片性質(zhì)(正性,負(fù)性)的反應(yīng)時差異不顯著(F=0.119,P=0.703);實驗組對兩種圖片性質(zhì)(正性,負(fù)性)的反應(yīng)時存在顯著差異,且負(fù)性圖片反應(yīng)時顯著長于正性圖片(F=21.004,P=0.000);實驗組的負(fù)性圖片反應(yīng)時長于對照組的負(fù)性圖片反應(yīng)時(F=42.007,P=0.000)。在線索-靶范式中,實驗組在有效線索和無效線索下對負(fù)性圖片反應(yīng)時差異有顯著性(F=17.33,P=0.00;F=16.51,P=0.00);進(jìn)一步簡單效應(yīng)分析,A1B2在C水平效應(yīng)中,實驗組在無效線索條件下,對負(fù)性圖片刺激的平均反應(yīng)時長于對正性圖片刺激的平均反應(yīng)時(F=16.51,P=0.00)。實驗組整體疼痛評估量表總分為(63.12±19.60),其中疼痛項目分為(17.74±6.43),情緒項目分為(16.38±6.50),臨床表現(xiàn)項目分為(16.00±6.35),日常行為項目分為(13.00±6.17)。實驗組負(fù)性圖片反應(yīng)時與GPS總分以及GPS量表的情緒、疼痛癥狀項目分呈顯著正相關(guān)(r=0.429,0.416,0.534);負(fù)性圖片反應(yīng)時與GPS量表的臨床表現(xiàn)項目分及日常行為項目分不相關(guān)(r=0.064,0.299)。實驗組負(fù)性圖片反應(yīng)時與SCL-90的軀體化、強迫、恐怖、精神病性因子分呈顯著正相關(guān);正性圖片反應(yīng)時與軀體化、精神病性因子分呈負(fù)相關(guān)。結(jié)論:軀體形式障礙疼痛癥狀的患者具有對負(fù)性信息的注意偏向。軀體形式障礙疼痛患者產(chǎn)生負(fù)性情緒的注意偏向的病理心理特點是對負(fù)性信息注意解除的困難。軀體形式障礙疼痛患者的負(fù)性信息注意偏向與疼痛兩者存在相互加強的精神交互作用,這可能是本病疼痛癥狀發(fā)生發(fā)展的機(jī)制之一,也是心理治療需要針對的靶點。軀體形式障礙的軀體化、強迫、恐懼、精神病性癥狀與疼痛存在交互加強機(jī)制,也可能是抗抑郁劑治療本病疼痛的有效機(jī)制之一。
[Abstract]:Objective: to investigate whether there is a negative information attention bias and its association with pain in patients with somatoform disorder accompanied by pain symptoms, and to explore the related factors of pain symptoms in patients with somatoform disorder. It provides a new reference for the study of somatic discomfort such as somatoform disorder pain and provides a new way for the treatment of symptoms. Methods: 30 patients with somatoform disorder with pain symptoms were selected as experimental group. Thirty healthy subjects matched with sex and age in the experimental group were selected, and the control group were excluded from somatoform disorder and other mental disorders and severe somatic diseases at the same time. The attention bias responses of 30 patients with somatoform disorder (experimental group) and 30 normal subjects (control group) were measured by point-detection paradigm and cue-target paradigm. The Chinese version of the global pain assessment scale (GPS) was used to measure and evaluate the pain in the experimental group. 90 symptom Checklist (SCL-90) were used to measure the mental health of the two groups. Results: 30 cases of experimental group and 30 cases of control group completed the pre-designed general information questionnaire, and both groups completed point detection paradigm and clue target paradigm. There was no significant difference in sex, age and education level between the two groups (P < 0. 796 / 0. 588 / 0. 796). In the point detection paradigm, there was no significant difference in the response time of the control group to the two types of image properties (positive and negative) (F0. 1. 19% P + 0. 703). There was significant difference in the reaction time of the two types of images (positive and negative) in the experimental group, and the reaction time of the negative picture was significantly longer than that of the positive image (FF21.004 / P0. 000). The negative picture reaction time of the experimental group was longer than that of the control group. In the cue-target paradigm, there was a significant difference in the response time of the experimental group to negative images under effective cues and ineffective cues (F17. 33, P0. 00F0. 00FN 16. 51 P0. 00). In the C level effect of A1B2, the average response time of the experimental group to the negative picture stimulation was longer than that to the positive picture stimulus under the condition of invalid cues (F 16. 51% P0. 00). The total score of the overall pain assessment scale in the experimental group was (63.12 鹵19.60), in which the pain items were (17.74 鹵6.43), the emotional items were (16.38 鹵6.50), and the clinical manifestations were (16.00 鹵6.35). The daily behavior items were (13.00 鹵6.17). In the experimental group, the time of negative picture reaction was positively correlated with the total score of GPS, the emotion of GPS scale and the item score of pain symptom (r = 0.429 ~ 0.416 鹵0.534). Negative picture reaction time was not correlated with the scores of clinical manifestations and daily behavior items of GPS scale (r = 0.064 鹵0.299). The scores of somatization, compulsion, phobia and psychosis of SCL-90 were positively correlated with the time of negative picture reaction in the experimental group, and negatively correlated with the scores of somatization and psychosis in the positive picture reaction. Conclusion: the patients with somatoform disorder have negative information. The pathophysiological characteristic of attention bias in patients with somatoform disorder pain is the difficulty of paying attention to negative information. The negative information attention bias of patients with somatoform disorder and the psychological interaction between them are mutually reinforcing, which may be one of the mechanisms for the occurrence and development of the pain symptoms of the disease, and is also the target of psychotherapy. The interaction between somatization, compulsion, fear, psychotic symptoms and pain in somatoform disorders may also be one of the effective mechanisms of antidepressants in the treatment of pain.
【學(xué)位授予單位】：皖南醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：B842.3

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