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  • 學位論文

有、無自殺企圖史鬱症患者的冷、熱執行功能表現

Cold and Hot Executive Functions in MDD patients with and without History of Suicide Attempts

指導教授 : 何明洲

摘要


近20年來台灣的鬱症(Major Depressive Disorder,MDD)患者比例倍增,除了情緒症狀外,患者常出現自殺意念(suicide ideation)或自殺企圖(suicide attempt),亦常伴隨執行功能缺損。本研究目的為探討有、無自殺企圖史MDD個案和健康控制組在冷、熱執行功能上的表現,試圖找出自殺行為的心理預測因子,並探討自殺次數、上次自殺距今時間和冷、熱執行功能間有無關聯。研究對象包含30位具自殺企圖史的MDD患者,32位不具自殺企圖史的MDD患者,35位控制組。冷執行功能部分,研究採用對稱廣度作業測量參與者的更新(Updating)功能,並以情緒轉移作業測量參與者的一般抑制/轉移(Inhibition/Shifting)、情緒特定抑制/轉移;熱執行功能部分,採用愛荷華賭局作業測量情緒性決策(Decision-Making)功能。從階層迴歸分析結果顯示,控制背景變項(年齡、性別比例及教育程度)後,無自殺企圖史MDD組和控制組在情緒特定抑制/轉移功能有差異。其中,無自殺企圖史MDD組的情緒特定抑制優於控制組,而情緒特定轉移較控制組差。另外,上次自殺距今時間和更新功能有正相關,即上次自殺距今時間越久,更新功能表現越好。雖然未能找出MDD患者自殺行為的有效心理預測因子,但更突顯出臨床實務在預測自殺風險個案上的困難,故未來仍有需要針對此領域進行深入研究。

關鍵字

鬱症 自殺 冷和熱執行功能 更新 抑制 轉移 決策功能

並列摘要


In Taiwan, patients with major depressive disorder (MDD) increased dramatically in the last two decades. MDD patients not only reveal emotional symptoms, but also suicide ideation or suicide attempt; furthermore, they often accompanied with executive function impairments。In this study, we investigated the performances of cold/hot executive functions(EFs) in MDD patients with/without history of suicide attempts comparing to healthy controls in order to understand the prediction factors of suicide behaviors. We investigated the association between numbers of suicide attempt、last time since recent suicide and cold/hot EFs. In our study, 30 MDD patients with history of suicide attempts, 32 MDD patients without history of suicide attempts, and 35 healthy controls were included。To exam cold EFs, we used Symmetry Span Task to measure participants’ updating ability. We investigated the general inhibition/shifting and valence-specific inhibition/shifting through Affective Shifting Task. Furthermore, to observe hot EFs, we used Iowa Gambling Task to measure decision-making. According to the results, via hierarchical regression analysis, showed a significant difference in valence-specific inhibition/shifting between MDD without suicide history and controls after controlling demographic variables. Our data showed that valence-specific inhibition of MDD patients without history of suicide attempt was better than controls; however, the performance of valence-specific shifting was worse than controls. In addition, it showed a significant positive correlation between last time since recent suicide and updating ability, suggesting the longer that the last time recent suicide revealed, the better updating ability was shown. Although, we could not find out the effective psychological predictive factors of MDD patients’ suicide behaviors; however, this study highlighted the difficulty in predicting the risky suicide individuals in clinical. Thus, we need further study to understand more about this field in the future.

參考文獻


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