摘要
目的:探讨脑外伤所致精神障碍患者的心理理论功能及其相关因素。方法:以2008年在我所鉴定的脑外伤所致精神障碍患者131例为病例组,以我单位职工20名为正常对照组。根据脑损伤的部位将病例组分为额叶组(n=28)、颞叶组(n=31)、顶叶组(n=6)、枕叶组(n=6)、联合组(n=53)和脑震荡组(n=7),根据病史中昏迷指数将病例组分为轻型组(n=83)、中型组(n=28)和重型组(n=20),根据后遗精神症状将病例组分为精神病组(n=14)、神经症组(n=63)、智力缺损组(n=22)和人格改变组(n=32)。应用错误信念、解释性心理理论、失言任务来评估被试的心理理论。结果:病例组的三项心理理论任务得分及总分均低于对照组[如,总分(15.04±3.10)vs.(18.30±1.75),P<0.05]。额叶组、颞叶组、联合组的心理理论任务总分均低于对照组[(14.75±3.08),(15.13±3.17),(14.72±3.37)vs.(18.30±1.75);P<0.05],额叶组、颞叶组、联合组之间差异无统计学意义。轻、中、重型组患者心理理论任务总分均低于对照组[(15.45±2.80),(14.68±3.86),(13.85±2.91)vs.(18.30±1.75);P<0.05],轻、中、重型组之间的差异无统计学意义。以精神病性症状、神经症样综合征、智力缺损、人格改变症状为主的患者的心理理论任务总分均低于对照组[(13.71±3.41),(16.89±1.97),(13.77±2.89)vs.(12.84±2.86);P<0.05],其中精神病性症状、智力缺损、人格改变症状者总分低于神经症样综合征患者(P<0.05)。多元方差分析显示,不同精神症状、精神症状与损伤部位的交互作用的差异具有统计学意义,以人格改变组、额叶损伤合并人格改变患者的得分为最低(P<0.05)。结论:脑外伤所致精神障碍患者心理理论低于正常人,这种降低主要与后遗精神症状以及精神症状与损伤部位的交互作用有关。
Objective： To investigate the theory of mind （TOM） in mental disorders due to brain injury and analysis its related factors. Methods： Totally 131 patients with mental disorders due to brain injury, who had been assessed in our forensic department in 2008, were included in this study. Twenty normal employees of our college were as the controls. The patients were further divided into frontal lobe group （ n = 28 ）, temporal lobe group （ n = 31 ）, parietal lobe group （ n = 6 ）, occipital lobe group （ n = 6 ） , alliance group （ n = 53 ） and cerebral concussion group （ n = 7 ） based on their brain injury area; divide into mild group （ n = 83 ）, moderate group （ n = 28 ） and severe group （ n = 20） based on their GCS scores; divided into psychosis group （ n = 14 ）, neurosis group （ n = 63 ）, intelligence defect group（ n = 22 ） and personal change group （ n = 32 ） based on their mental symptoms. False belief task, interpretive theory of mind task and faux pas task were applied to assess the subject＇ s ToM, and the difference between each group was compared using analysis of variance and the multivariate variance analysis. Results： In three tasks, the scores in patients were lower than that in normal subjects [the total score, （ 15.04 ±3. 10） vs. （ 18.30 ± 1.75 ）, P 〈 0.05 ] . The total scores in patients with frontal lobe injury, temporal lobe injury and multi-lobe injury were all lower than that in normal subjects [ （ 14. 75 ± 3.08 ）, （ 15.13 ±3. 17 ）, （ 14. 72 ±3.37 ） vs. （ 18. 30 ± 1.75 ）, Ps 〈 0.05 ], and there was no significant difference among different brain lobe injury patients. The total score in mild, moderate and severe brain injury patient were all lower than that in normal subjects [ （ 15.45 ±2. 80）, （ 14. 68 ± 3.86）, （13.85±2.91） vs. （18.30±1.75）, Ps〈0.05], therewas no significant difference among different brain injury severity patients. The total score in patients with psychotic symptoms, neurosid-like symptoms, cognitive damage and personality change were all lower than that in normal subjects [ （ 13.71 ±3.41 ） ,（ 16.89 ± 1.97）, （ 13.77 ±2. 89） vs. （ 12.84±2. 86）, P 〈0. 05], and the total score in patients with psychotic symptoms, cognitive damage and personality change were all lower than that in patients with neurosis-like symptoms （ Ps 〈 0. 05 ） . The multivariate variance analysis indicated that the psychiatric symptom and its interaction with the injury area had significant effect on the ToM scores. The scores of personality change group and frontal lobe injured combined with personality change patients were the lowest （ Ps 〈 0. 05） . Conclusion： Mental disorders due to brain injury pa- tients have impairments in theory of mind, which may be related to the psychiatric symptom and its interaction with the injury area.
出处
《中国心理卫生杂志》
CSSCI
CSCD
北大核心
2010年第5期356-361,共6页
Chinese Mental Health Journal
基金
教育部人文社会科学研究青年基金资助(09YJCXLX019)
国家自然科学基金资助(30800360)
关键词
心理理论
脑外伤所致精神障碍
精神症状
损伤部位
随机对照研究
theory of mind
mental disorder due to brain injury
mental symptom
brain injury area
randomized controlled study
