强迫症患者在风险明确及不明确情境下的决策分离

目的:探讨强迫症(OCD)患者在风险明确及不明确情境下的决策功能。方法:对45例符合美国精神障碍诊断与统计手册第4版(DSM-IV)OCD诊断标准的患者和48名性别构成、年龄、受教育年限相匹配的对照组被试进行爱荷华博弈任务(IGT)、色子任务(GDT)、连线任务(TMT)、Stroop色词任务(SCWT)和威斯康星卡片分类任务(WCST)测试,同时对OCD患者进行Yale-Brown强迫症状量表(Y-BOCS)、汉密尔顿焦虑量表(HAMA)和贝克抑郁量表(BDI)评定。结果:OCD组IGT净得分低于对照组(P0.05),而两组GDT净得分差异无统计学意义(P0.05)。两组TMT、SCWT和WCST得分差异无统计学意义(均P0.05)。OCD组在IGT及GDT上的净得分与发病年龄、病程、Y-BOCS、HAM A、BDI得分不相关,OCD组中接受药物治疗与没有接受药物治疗的病人的IGT和GDT净得分差异无统计学意义(均P0.05)。结论:OCD患者在风险不明确情境下决策受损,而在风险明确情境下决策未受损,即OCD患者在风险明确及不明确情境下决策出现明显的分离。

Dissociation of decision making under ambiguity and decision making under risk in patieonts with obsessive-compulsive disorder

Objective: To investigate the decision making under ambiguity and decision making under risk in patients with obsessive-compulsive disorder(OCD).Methods: Forty-five patients who met the Diagnostic and Statistical Manual of Mental Disorders,Fourth Edition(DSM-IV) diagnosis for OCD and 48 healthy control group subjects matched for age,gender,education were assessed with the Iowa Gambling Task(IGT),Game of Dice Task(GDT) and a neuropsychological test battery for executive functions,including Trail Making Test(TMT),Stroop Colour Word Test(SCWT) and Wisconsin Card Sorting Test(WCST).Additionally,the OCD patients were measured with the Yale-Brown Obsessive-Compulsive Scale(Y-BOCS),Hamilton Anxiety Scale(HAMA) and Beck Depression Inventory(BDI).Results: The OCD patients scored lower in IGT than the controls(P=0.023),there was no differences between the two groups in GDT sores(P>0.05).No differences were found between the two groups in scores of TMT,SCWT and WCST(Ps>0.05).The scores of IGT and GDT in the OCD patients were not correlated with age of onset(r=-0.05,-0.20),duration of illness(r=0.02,-0.14),scores of Y-BOCS(r=0.01,0.12),HAMA(r=-0.03,-0.06) and BDI(r=0.09,0.08)(Ps>0.05).And there was no differences between medicated patients and unmedicated patients in the scores of IGT and GDT(Ps>0.05).Conclusion:It suggests that the patients with obsessive-compulsive disorder have impairment in decision making under ambiguity,while no impairment in decision making under risk,i.e.,there may be a clear dissociation of decision making under ambiguity and decision making under risk.