CAJ | 학술논문

近年来，自杀的心理痛苦三因素模型（包括痛苦唤醒、痛苦体验和痛苦逃避）在临床抑郁症患者群体得到验证。痛苦逃避是该模型的核心成分。行为学研究证据显示，痛苦逃避维度得分对抑郁症患者自杀意念和自杀行为的预测力远高于Beck抑郁问卷得分和痛苦体验得分。由于眶额皮质是介导情绪反应和控制复杂行为的关键界面，主要参与负性情绪引发回避惩罚（痛苦）的动机控制，与动机、决策和行为监控密切相关。眶额皮质及其与前额叶、皮层下结构（扣带前回、杏仁核和下丘脑等）的异常激活模式可能是痛苦体验引发高逃避动机、进而产生自杀行为（风险决策）的重要神经基础。本文在综述以往研究的基础上，提出通过改编和发展情感激励延迟和金钱激励延迟的认知任务，对痛苦体验和痛苦逃避动机阶段进行时间上的分离，建立眶额皮质介导抑郁症自杀的脑功能病理模型的研究思路。
근년래，자살적심리통고삼인소모형（포괄통고환성、통고체험화통고도피）재림상억욱증환자군체득도험증。통고도피시해모형적핵심성분。행위학연구증거현시，통고도피유도득분대억욱증환자자살의념화자살행위적예측력원고우Beck억욱문권득분화통고체험득분。유우광액피질시개도정서반응화공제복잡행위적관건계면，주요삼여부성정서인발회피징벌（통고）적동궤공제，여동궤、결책화행위감공밀절상관。광액피질급기여전액협、피층하결구（구대전회、행인핵화하구뇌등）적이상격활모식가능시통고체험인발고도피동궤、진이산생자살행위（풍험결책）적중요신경기출。본문재종술이왕연구적기출상，제출통과개편화발전정감격려연지화금전격려연지적인지임무，대통고체험화통고도피동궤계단진행시간상적분리，건립광액피질개도억욱증자살적뇌공능병리모형적연구사로。
For a suicidal person, suicide seems to be the only means of escaping the torment of psychological pain. Pain avoidance, representing the wish to escape psychological pain, may be a primary predictor of subsequent suicide. Given that the Orbitofrontal cortex dysfunction may trigger overreaction to a social signal of disapproval （painful feelings） and induced high level motivation for escaping from punishment （pain avoidance）, event-related functional MRI was used to measure orbitofrontal cortex and its neural circuit activity in response to stimuli representing negative/positive emotional incentives among patients with a history of suicidal attempts （vs.no suicidal history） in furture work. Our work will extend interactive modes of motivation and cognitive control circuits underying higher levels of psychological pain and ultimately may provide a empiral evidence for the neural correlates of pain avoidance which trigger suicidal behavior.