中国临床康复
中國臨床康複
중국림상강복
CHINESE JOURNAL OF CLINICAL REHABILITATION
2005年
40期
132-134
,共3页
适应障碍%抑郁障碍%事件相关电位%P300
適應障礙%抑鬱障礙%事件相關電位%P300
괄응장애%억욱장애%사건상관전위%P300
背景:反应性抑郁症和抑郁性神经症为心因性情绪障碍,临床上均有记忆力减退、注意力不集中、反应迟钝、思维迟钝等认知功能损害的主诉,患者这种主观体验是否属实,对这类疾病认知功能损害客观的实验室的依据较少.目的:了解反应性抑郁症及抑郁性神经症患者听觉事件相关电位P300改变与认知功能损害的情况.设计:病例-对照实验.单位:解放军第三军医大学附属医院神经内科临床心理咨询中心.对象:选择1997-09/1998-03解放军第三军医大学西南医院职工为正常对照组40人,男21人,女19人;年龄20～50岁.同期从本院心理咨询门诊选择与正常对照组年龄相匹配的患者80例,其中反应性抑郁症(简称反应症组)40例,男29例,女11例;抑郁性神经症(简称神经症组)40例,男24例,女16例.随机追踪10例P300异常改变患者为随访组,其中反应性抑郁症4例,抑郁性神经症6例. 方法:所有入组的首诊患者及正常被试者在本院脑电生理研究室均采用听觉事件相关电位P300经典方式进行测试,同时由经过心理测评培训过的专业人员对两组患者情绪状态用Zung症状自评量表进行评定.主要观察指标:①80例患者首诊和治疗4周、8周后听觉事件相关电位P300的检测结果及Zung症状自评量表评分,正常对照组听觉事件相关电位P300的检测结果.②10例P300异常改变者治疗前、治疗后P300结果及Zung症状自评量表评分.结果:参加实验的反应性抑郁症患者40例,抑郁性神经症患者40例,正常对照组40人,全部进入结果分析.①两组患者各波潜伏期均显著长于正常对照组(P＜0.05～0.01).两组患者听觉事件相关电位各波波幅较正常对照组低,N1,P2,N2三波波幅呈总体下降趋势,接近显著水平;而反应症组P3波幅明显低于正常对照组[(10.39±4.40),(15.11±4.16)μV,P＜0.001].神经症组各波波幅则明显低于正常对照组.③10例患者治疗前后随着情绪的改善P3潜伏期及波幅相比,P3潜伏期治疗前后差异无显著性意义[(314.10±44.08),(295.4±20.74)ms,t=1.21,P＞0.05],而P3波幅治疗后明显增大并恢复至正常范围[治疗前:(6.38±2.50)μV,治疗后:(14.22±2.51)μV,t=-7.012,P＜0.001].结论:反应性抑郁症及抑郁性神经症患者均存在认知功能的损害,听觉事件相关电位P300可以作为反应性抑郁症及抑郁性神经症患者认知功能评定、疗效观察的辅助指标.
揹景:反應性抑鬱癥和抑鬱性神經癥為心因性情緒障礙,臨床上均有記憶力減退、註意力不集中、反應遲鈍、思維遲鈍等認知功能損害的主訴,患者這種主觀體驗是否屬實,對這類疾病認知功能損害客觀的實驗室的依據較少.目的:瞭解反應性抑鬱癥及抑鬱性神經癥患者聽覺事件相關電位P300改變與認知功能損害的情況.設計:病例-對照實驗.單位:解放軍第三軍醫大學附屬醫院神經內科臨床心理咨詢中心.對象:選擇1997-09/1998-03解放軍第三軍醫大學西南醫院職工為正常對照組40人,男21人,女19人;年齡20～50歲.同期從本院心理咨詢門診選擇與正常對照組年齡相匹配的患者80例,其中反應性抑鬱癥(簡稱反應癥組)40例,男29例,女11例;抑鬱性神經癥(簡稱神經癥組)40例,男24例,女16例.隨機追蹤10例P300異常改變患者為隨訪組,其中反應性抑鬱癥4例,抑鬱性神經癥6例. 方法:所有入組的首診患者及正常被試者在本院腦電生理研究室均採用聽覺事件相關電位P300經典方式進行測試,同時由經過心理測評培訓過的專業人員對兩組患者情緒狀態用Zung癥狀自評量錶進行評定.主要觀察指標:①80例患者首診和治療4週、8週後聽覺事件相關電位P300的檢測結果及Zung癥狀自評量錶評分,正常對照組聽覺事件相關電位P300的檢測結果.②10例P300異常改變者治療前、治療後P300結果及Zung癥狀自評量錶評分.結果:參加實驗的反應性抑鬱癥患者40例,抑鬱性神經癥患者40例,正常對照組40人,全部進入結果分析.①兩組患者各波潛伏期均顯著長于正常對照組(P＜0.05～0.01).兩組患者聽覺事件相關電位各波波幅較正常對照組低,N1,P2,N2三波波幅呈總體下降趨勢,接近顯著水平;而反應癥組P3波幅明顯低于正常對照組[(10.39±4.40),(15.11±4.16)μV,P＜0.001].神經癥組各波波幅則明顯低于正常對照組.③10例患者治療前後隨著情緒的改善P3潛伏期及波幅相比,P3潛伏期治療前後差異無顯著性意義[(314.10±44.08),(295.4±20.74)ms,t=1.21,P＞0.05],而P3波幅治療後明顯增大併恢複至正常範圍[治療前:(6.38±2.50)μV,治療後:(14.22±2.51)μV,t=-7.012,P＜0.001].結論:反應性抑鬱癥及抑鬱性神經癥患者均存在認知功能的損害,聽覺事件相關電位P300可以作為反應性抑鬱癥及抑鬱性神經癥患者認知功能評定、療效觀察的輔助指標.
배경:반응성억욱증화억욱성신경증위심인성정서장애,림상상균유기억력감퇴、주의력불집중、반응지둔、사유지둔등인지공능손해적주소,환자저충주관체험시부속실,대저류질병인지공능손해객관적실험실적의거교소.목적:료해반응성억욱증급억욱성신경증환자은각사건상관전위P300개변여인지공능손해적정황.설계:병례-대조실험.단위:해방군제삼군의대학부속의원신경내과림상심리자순중심.대상:선택1997-09/1998-03해방군제삼군의대학서남의원직공위정상대조조40인,남21인,녀19인;년령20～50세.동기종본원심리자순문진선택여정상대조조년령상필배적환자80례,기중반응성억욱증(간칭반응증조)40례,남29례,녀11례;억욱성신경증(간칭신경증조)40례,남24례,녀16례.수궤추종10례P300이상개변환자위수방조,기중반응성억욱증4례,억욱성신경증6례. 방법:소유입조적수진환자급정상피시자재본원뇌전생리연구실균채용은각사건상관전위P300경전방식진행측시,동시유경과심리측평배훈과적전업인원대량조환자정서상태용Zung증상자평량표진행평정.주요관찰지표:①80례환자수진화치료4주、8주후은각사건상관전위P300적검측결과급Zung증상자평량표평분,정상대조조은각사건상관전위P300적검측결과.②10례P300이상개변자치료전、치료후P300결과급Zung증상자평량표평분.결과:삼가실험적반응성억욱증환자40례,억욱성신경증환자40례,정상대조조40인,전부진입결과분석.①량조환자각파잠복기균현저장우정상대조조(P＜0.05～0.01).량조환자은각사건상관전위각파파폭교정상대조조저,N1,P2,N2삼파파폭정총체하강추세,접근현저수평;이반응증조P3파폭명현저우정상대조조[(10.39±4.40),(15.11±4.16)μV,P＜0.001].신경증조각파파폭칙명현저우정상대조조.③10례환자치료전후수착정서적개선P3잠복기급파폭상비,P3잠복기치료전후차이무현저성의의[(314.10±44.08),(295.4±20.74)ms,t=1.21,P＞0.05],이P3파폭치료후명현증대병회복지정상범위[치료전:(6.38±2.50)μV,치료후:(14.22±2.51)μV,t=-7.012,P＜0.001].결론:반응성억욱증급억욱성신경증환자균존재인지공능적손해,은각사건상관전위P300가이작위반응성억욱증급억욱성신경증환자인지공능평정、료효관찰적보조지표.
BACKGROUND: Reactive depression and depressive neurosis are both psychogenic emotional disorders, clinically manifested by memory deterioration,impaired concentration, slow reaction, and bradyphrenia, among other cognitive function impairments. These subjective experiences of such patients still need to be backed up for their actual presence by objective laboratory evidences, which,however, have been scarcely available to our current knowledge.OBJECTIVE: To investigate the changes of auditory event-related Potential (AERP) P300 in patients with reactive depression and depressive neurosis, and their correlation with cognitive function impairments.DESIGN: Case-controlled experiment.SETTING: Clinical Center of Psychological Counseling, Department of Neurology, Third Military Medical University of Chinese PLA. PARTICIPANTS: Forty normal control subjects were recruited from the staff of Southwest Hospital, Third Military Medical University between September 1997 and March 1998, including 21 male and 19 female subjects aged 20-50 years. Eighty patients were selected from the agematched outpatients of the same hospital seeking psychological counseling,including 40 with reactive depression (consisting of 29 male and 11 female patients) and 40 with depressive neurosis (consisting of 24 male and 16 female patients). From these patients 10 with abnormal P300 potential were randomly selected for followed-up study, including4 with reactive depression and4 with depressive neurosis.METHODS: All the patients and normal controls were subjected to conventional examination of AERP P300 in the Laboratory of Cerebral Electrophysiology, and psychological evaluation was carried out by specialists with the assistance of Zung Self-Rating Depression Scale.MAIN OUTCOME MEASURES: ① Results of AERP P300 examination and scores of Zung Self-Rating Depression Scale in the 80 patients upon admission and 4 and 8 weeks after treatment, and results of AERP P300 examination in the control group. ② Results of AERP P300 examination and scores of Zung Self-Rating Depression Scale in the follow-up group. RESULTS: All subjects finished the study. The latency of all waves were remarkably prolonged in the patients as compared to the normal control group (P ＜ 0.05-0.01), with also lower amplitude of AERP than that of the control group; the amplitudes of N1, P2 and N2 waves, in general,tended to decrease to statistically significant levels. In reactive depression group, the amplitude of P3 wave was obviously lower than that of the control group [(10.39±4.40) vs (15.11±4.16) μV, P ＜ 0.001], and the amplitudes of all waves in the neurosis group was obviously lower than those of the control group. Comparison of the latency and amplitude of P3 in the follow-up group before and after treatment revealed no significant difference in the latency of P3 [(314.10±44.08) vs (295.4±20.74) ms, t=1.21, P ＜ 0.05], but the amplitude of P3 obviously increased after treatment to almost the normal level [(6.38±2.50) vs (14.22±2.51) μV, t=-7.012, P ＜ 0.001].CONCLUSION: Patients with reactive depression or depressive neurosis have cognitive function impairment, and auditory event-related potential P300 can be used as a reference for cognitive evaluation and therapeutic effect assessment in these patients.
