注意缺陷多动障碍共病破坏性、冲动控制及品行障碍的反应抑制和情绪反应
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摘要
目的了解注意缺陷多动障碍(ADHD)与破坏性、冲动控制及品行障碍(DICCD)在情绪反应中可能存在的神经心理缺陷的特征。方法选择符合美国精神障碍诊断与统计手册第五版(DSM-5)ADHD诊断标准的6～16岁患儿20名,ADHD共病DICCD患儿20名,DICCD患儿20名以及年龄、性别、智力匹配的健康儿童(HC)20名作为对象,选择Golden Stroop测验和情绪Stroop测验对反应抑制和情绪反应进行评估,组间差异采用单因素方差分析,事后分析使用SNK-q检验同质性亚组进行配对比较。结果在Golden Stroop测验中,错误次数(P=0.003)和反应时间(P=0.044)干扰得分组间差异均有统计学意义,进一步Post Hoc分析ADHD组的干扰得分显著高于其余三组。在情绪Stroop测验中,平均反应时间组间差异均有统计学意义(均P<0.05),事后分析ADHD共病DICCD组正性词-色一致平均反应时间低于ADHD组而高于DICCD组,疾病组均高于HC组;ADHD共病DICCD与DICCD组正性词-色不一致、负性词-色一致平均反应时间显著低于ADHD组且高于HC组;DICCD组负性词-色不一致平均反应时间显著低于ADHD组与ADHD共病DICCD组且高于HC组。结论 ADHD的反应抑制缺陷和异常情绪反应均表现为ADHD的核心症状。偏向性情绪刺激可能对于存在冷漠无情特征的DICCD的反应抑制功能具有的负面作用,尤其在处理负性情绪时问题更为突出,而ADHD与DICCD共病更倾向于DICCD的情绪反应特质。
Objective To characterize the traits of neuropsychological functioning deficits in patients with attention-deficit/hyperactivity disorder(ADHD) with comorbid disruptive, impulse-control, and conduct disorders(DICCD). Methods Twenty out-patients with ADHD, 20 with ADHD with comorbid DICCD, and 20 with DICCD, all aged 6-16 years, were enrolled in this study, with 20 healthy subjects matched for age, gender and IQ serving as the healthy controls. The patients were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Revision(DSM-5). All the subjects were assessed with Golden Stroop test and emotional Stroop test to evaluate their response inhibition and emotional responding. Results In Golden Stroop test, the interference scores(IGs) of errors and reaction time both differed significantly among the groups(P<0.05), and were the highest in patients with ADHD only. In emotional Stroop test, the mean reaction time(MRT) showed significant differences among the groups(P<0.05); the MRT of positive-congruent trials in ADHD with comorbid DICCD group was shorter than that in ADHD group but longer than that in group DICCD; the MRT in the 3 case groups were all longer than that in the control group. The MRT of both positive-incongruent trials and negative-congruent trials in ADHD with comorbid DICCD group and DICCD group was shorter than that in ADHD group but longer than that in the control group. The MRT of negative-incongruent trials in DICCD group was shorter than that in ADHD group and ADHD with comorbid DICCD group but longer than that in the control group. Conclusions The response inhibition deficit and abnormal emotional responding are the core symptoms of ADHD. Bias emotional stimuli may render response inhibitory dysfunction in patients with DICCD with callous-unemotional traits of emotional responding disorder, especially in dealing with negative emotional trials, while the comorbidity of ADHD and DICCD tends to have the emotional response trait of DICCD.
Objective To characterize the traits of neuropsychological functioning deficits in patients with attention-deficit/hyperactivity disorder(ADHD) with comorbid disruptive, impulse-control, and conduct disorders(DICCD). Methods Twenty out-patients with ADHD, 20 with ADHD with comorbid DICCD, and 20 with DICCD, all aged 6-16 years, were enrolled in this study, with 20 healthy subjects matched for age, gender and IQ serving as the healthy controls. The patients were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Revision(DSM-5). All the subjects were assessed with Golden Stroop test and emotional Stroop test to evaluate their response inhibition and emotional responding. Results In Golden Stroop test, the interference scores(IGs) of errors and reaction time both differed significantly among the groups(P<0.05), and were the highest in patients with ADHD only. In emotional Stroop test, the mean reaction time(MRT) showed significant differences among the groups(P<0.05); the MRT of positive-congruent trials in ADHD with comorbid DICCD group was shorter than that in ADHD group but longer than that in group DICCD; the MRT in the 3 case groups were all longer than that in the control group. The MRT of both positive-incongruent trials and negative-congruent trials in ADHD with comorbid DICCD group and DICCD group was shorter than that in ADHD group but longer than that in the control group. The MRT of negative-incongruent trials in DICCD group was shorter than that in ADHD group and ADHD with comorbid DICCD group but longer than that in the control group. Conclusions The response inhibition deficit and abnormal emotional responding are the core symptoms of ADHD. Bias emotional stimuli may render response inhibitory dysfunction in patients with DICCD with callous-unemotional traits of emotional responding disorder, especially in dealing with negative emotional trials, while the comorbidity of ADHD and DICCD tends to have the emotional response trait of DICCD.
引文
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[23]Kalnin AJ,Edwards CR,Wang Y,et al.The interacting role of media violence exposure and aggressive-disruptive behavior in adolescent brain activation during an emotional Stroop task[J].Psychiatry Res,2011,192(1):12-9.
[24]Euler F,Sterzer P,Stadler C.Cognitive control under distressing emotional stimulation in adolescents with conduct disorder[J].Aggress Behav,2014,40(2):109-19.
[25]朱云程,李国海.注意缺陷多动障碍患者大脑结构和执行功能的相关性探讨[J].临床精神医学杂志,2017,24(5):351-4.
[26]陈雷音,罗学荣,韦臻,等.破坏性行为障碍儿童的行为和情绪问题[J].中国儿童保健杂志,2010,18(8):641-3,663.
[27]Lin YJ,Gau SS.Differential neuropsychological functioning between adolescents with attention-deficit/hyperactivity disorder with and without conduct disorder[J].J Formos Med Assoc,2017,116(12):946-55.
[28]Blair RJ,Veroude K,Buitelaar JK.Neuro-cognitive system dysfunction and symptom sets:A review of fMRI studies in youth with conduct problems[J].Neurosci Biobehav Rev,2016,91(8):69-90.
[29]Schiffer B,Pawliczek C,Mu LB,et al.Neural mechanisms underlying cognitive control of men with lifelong antisocial behavior[J].Psychiatry Res,2014,222(1/2):43-51.
[30]Stahl SM.Stahl's essential psychopharmacology:neuroscientific basis and practical applications[M].Cambridge:Cambridge University Press,2013.
[2]Wang TT,Liu KH,Li ZZ,et al.Prevalence of attention deficit/hyperactivity disorder among children and adolescents in China:a systematic review and meta-analysis[J].BMC Psychiatry,2017,17(1):32.
[3]Reale L,Bartoli B,Cartabia M,et al.Comorbidity prevalence and treatment outcome in children and adolescents with ADHD[J].Eur ChildAdolesc Psychiatry,2017,26(12):1443-57.
[4]Aap A.Diagnostic and statistical manual of mental disorders:DSMV[M].Washington DC:American Psychiatric Pub,2013.
[5]Jehna M,Becker J,Zaar K,et al.Symmetry of the arcuate fasciculus and its impact on language performance of patients with brain tumors in the language-dominant hemisphere[J].J Neurosurg,2017,127(6):1407-16.
[6]Hauser TU,Fiore VG,Moutoussis MA.Computational psychiatry of ADHD:neural gain impairments across marrian levels of analysis[J].Trends Neurosci,2016,39(2):63-73.
[7]Wang XJ,Krystal JH.Computational psychiatry[J].Neuron,2014,84(3):638-54.
[8]Zhu YC,Yang DL,Ji WD,et al.The relationship between neurocircuitry dysfunctions and attention deficit hyperactivity disorder:a review[J].Biomed Res Int,2016,9(10):3821579.
[9]朱云程,王芳,江茜茜,等.皮质-纹状体-丘脑-皮质环路功能失调与注意缺陷多动障碍[J].国际精神病学杂志,2018,45(1):6-8.
[10]Hwang S,Nolan ZT,White SF,et al.Dual neurocircuitry dysfunctions in disruptive behavior disorders:emotional responding and response inhibition[J].PsycholMed,2016,46(7):1485-96.
[11]Antonini TN,Becker SP,Tamm L,et al.Hot and cool executive functions in children with attention-deficit/hyperactivity disorder and comorbid oppositional defiant disorder[J].J Int Neuropsychol Soc,2015,21(8):584-95.
[12]Poon K.Hot and cool executive functions in adolescence:development and contributions to important developmental outcomes[J].Front Psychol,2017,8(1):2311.
[13]朱云程,江茜茜,刘丽,等.抽动秽语综合征共患注意缺陷多动障碍男性儿童的反应抑制和精细调节[J].中国心理卫生杂志,2015,29(5):343-8.
[14]朱云程,江茜茜,陈玄玄,等.强迫性障碍与注意缺陷多动障碍男性儿童的延迟厌恶任务测试[J].中国心理卫生杂志,2015(4):273-8.
[15]Sonuga-Barke EJ.Psychological heterogeneity in AD/HD-a dual pathway model of behaviour and cognition.Behav Brain Res[J].2002,130(1):29-36.
[16]张厚粲.韦氏儿童智力量表第四版(WISC-IV)中文版的修订[J].心理科学,2009,32(5):1177-9.
[17]范娟,杜亚松,王立伟.Conners父母用症状问卷的中国城市常模和信度研究[J].上海精神医学,2005,17(6):321-3.
[18]宋永宁,箱田裕司.基于电脑的新Stroop/逆Stroop测验--测验的信效度、练习及顺序效果[J].心理科学,2010,33(6):1481-4.
[19]曾瑜芬.正性词的情绪Stroop效应的实验研究[D].广州:华南师范大学,2005.
[20]Zhu YC,Jiang XX,Ji WD.The mechanism of cortico-striatothalamocortical neurocircuitry in response inhibition and emotional responding in attention deficit hyperactivity disorder with comorbid disruptive behavior disorder[J].Neurosci Bull,2018,34(3):566-72.
[21]Anokhin AP,Golosheykin S,Grant JD,et al.Heritability of brain activity related to response inhibition:A longitudinal genetic study in adolescent twins[J].Int J Psychophysiol,2017,115(5):112-24.
[22]Florez G,Ferrer V,Garcia LS,et al.Clinician ratings of the comprehensive assessment of psychopathic personality(CAPP)in a representative sample of spanish prison inmates:New validity evidence[J].PLoS One,2018,13(4):e0195483.
[23]Kalnin AJ,Edwards CR,Wang Y,et al.The interacting role of media violence exposure and aggressive-disruptive behavior in adolescent brain activation during an emotional Stroop task[J].Psychiatry Res,2011,192(1):12-9.
[24]Euler F,Sterzer P,Stadler C.Cognitive control under distressing emotional stimulation in adolescents with conduct disorder[J].Aggress Behav,2014,40(2):109-19.
[25]朱云程,李国海.注意缺陷多动障碍患者大脑结构和执行功能的相关性探讨[J].临床精神医学杂志,2017,24(5):351-4.
[26]陈雷音,罗学荣,韦臻,等.破坏性行为障碍儿童的行为和情绪问题[J].中国儿童保健杂志,2010,18(8):641-3,663.
[27]Lin YJ,Gau SS.Differential neuropsychological functioning between adolescents with attention-deficit/hyperactivity disorder with and without conduct disorder[J].J Formos Med Assoc,2017,116(12):946-55.
[28]Blair RJ,Veroude K,Buitelaar JK.Neuro-cognitive system dysfunction and symptom sets:A review of fMRI studies in youth with conduct problems[J].Neurosci Biobehav Rev,2016,91(8):69-90.
[29]Schiffer B,Pawliczek C,Mu LB,et al.Neural mechanisms underlying cognitive control of men with lifelong antisocial behavior[J].Psychiatry Res,2014,222(1/2):43-51.
[30]Stahl SM.Stahl's essential psychopharmacology:neuroscientific basis and practical applications[M].Cambridge:Cambridge University Press,2013.