上海交通大学学报（医学版）

上海交通大学学报（医学版）

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共病强迫型人格障碍对强迫症患者行为抑制/激活系统的影响

周金静1(), 张晨1(), 杨桂萍2, 沈辉1, 张宗凤1,3, 高睿1, 陈永军1,4, 曹璇1,5, 范青1()   

  1. 1.上海交通大学医学院附属精神卫生中心康复科，上海 200030
    2.四川省自贡市荣县精神病医院，荣县 643100
    3.宁波大学附属康宁医院，宁波 315200
    4.南京医科大学附属南京脑科医院，南京 210029
    5.上海交通大学医学院附属新华医院临床心理科，上海 200092
  • 收稿日期:2024-05-27 接受日期:2024-12-09 出版日期:2025-03-21
  • 通讯作者: 范　青，主任医师，博士，电子信箱： fanqing@smhc.org.cn。
  • 作者简介:周金静（1984—），女，主管护师，本科；电子信箱： 727632397@qq.com
    张　晨（2000—），男，硕士生；电子信箱： zhangchenpsy@163.com。
    第一联系人：周金静、张晨为共同第一作者。
  • 基金资助:
    中国康复医学会立项科技发展重点项目;上海市卫生健康委员会面上项目(202140054);上海市卫生健康委员会卫生健康学科带头人项目(2022XD025);上海交通大学医学院源申康复研究院一般项目(yskf1-23-1107-1);上海交通大学“交大之星”计划医工交叉研究基金重点项目(YG2021ZD28)

Effects of comorbid obsessive -compulsive personality disorder on the behavioral inhibition/activation systems in patients with obsessive -compulsive disorder

ZHOU Jinjing1(), ZHANG Chen1(), YANG Guiping2, SHEN Hui1, ZHANG Zongfeng1,3, GAO Rui1, CHEN Yongjun1,4, CAO Xuan1,5, FAN Qing1()   

  1. 1.Department of Rehabilitation, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
    2.Rongxian Psychiatric Hospital, Zigong City, Sichuan Province, Rongxian 643100, China
    3.Department of psychiatry, Affiliated Kangning Hospital of Ningbo University, Ningbo 315200, China
    4.Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing 210029, China
    5.Department of Clinical Psychology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
  • Received:2024-05-27 Accepted:2024-12-09 Online:2025-03-21
  • Contact: FAN Qing, E-mail: fanqing@smhc.org.cn.
  • Supported by:
    Key Project of Science and Technology Development of Chinese Rehabilitation Medical Association;Shanghai Municipal Health Commission(202140054);Leader of the Department of Health of Shanghai Municipal Health Commission(2022XD025);General Project of Yuanshen Rehabilitation Institute of Shanghai Jiao Tong University School of Medicine(yskf1-23-1107-1);The Key project of the “Star of Jiao Tong University” Medical and Industrial Cross Research Foundation of Shanghai Jiao Tong University(YG2021ZD28)

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摘要：

目的·探讨共病强迫型人格障碍（obsessive-compulsive personality disorder，OCPD）对强迫症（obsessive-compulsive disorder，OCD）患者行为抑制系统（behavioral inhibition system，BIS）/行为激活系统（behavioral activation system，BAS）的影响。方法·纳入2014—2018年上海交通大学医学院附属精神卫生中心确诊的247例未用药OCD患者，分为OCD组（ n=202）和OCD+OCPD组（ n=45）；招募107例健康对照（healthy control，HC）。通过耶鲁-布朗强迫量表（Yale-Brown Obsessive-Compulsion Scale，YBOCS）、BIS/BAS量表、汉密尔顿抑郁量表（Hamilton Depression Scale，HAMD）、汉密尔顿焦虑量表（Hamilton Anxiety Scale，HAMA）评估患者的心理病理学特征。采用 χ2检验比较3组的性别差异；采用单因素方差分析比较人口学信息、心理病理学特征及BIS/BAS的差异；采用LSD检验法进行事后两两比较；采用回归分析探究心理病理学特征与BIS/BAS的关系。结果·3组在性别、年龄、受教育年限方面均无显著差异。OCD+OCPD组的YBOCS得分（ t=2.925， P=0.004）、HAMD得分（ t=2.130， P=0.034）、HAMA得分（ t=2.568， P=0.011）均显著高于OCD组。3组被试BIS总分和BAS总分差异均有统计学意义（BIS： F=39.573， P<0.001；BAS： F=3.915， P=0.021）。事后比较结果发现：对于BIS，3组之间两两比较差异均有统计学意义（OCD+OCPD vs OCD： P=0.002；OCD+OCPD vs HC： P<0.001；OCD vs HC： P<0.001），得分从低到高依次为：OCD+OCPD<OCD<HC。对于BAS，OCD组得分显著高于OCD+OCPD组和HC组（OCD+OCPD vs OCD： P=0.018；OCD vs HC： P=0.043），但OCD+OCPD组和HC组之间无显著差异。构建OCD患者BIS和BAS的回归模型，结果显示：对于BIS总分，模型整体预测效果显著（ F=2.599， P=0.013），且只有OCPD严重程度可以显著预测BIS得分（ t=-2.282， P=0.023）；对于BAS总分，模型整体预测效果不显著（ F=1.438， P=0.191）。结论·共病OCPD可能是OCD患者BIS异常的不利因素，是BAS异常的保护因素。

关键词: 强迫症, 强迫型人格障碍, 行为抑制系统, 行为激活系统

Abstract:

Methods A total of 247 patients with unmedicated OCD diagnosed in the Mental Health Center, Shanghai Jiao Tong University School of Medicine from 2014 to 2018 were included and divided into an OCD group ( n=202), and an OCD+OCPD group ( n=45), and 107 healthy controls were recruited as a comparison group. Yale-Brown Obsessive-Compulsion Scale (YBOCS), BIS/BAS Scale, Hamilton Depression Scale (HAMD), and Hamilton Anxiety Scale (HAMA) were used to assess psychopathological features. Gender differences among the three groups were analyzed using the χ² test. One-way analysis of variance (ANOVA) was used to compare differences in demographic characteristics, psychopathological features, and BIS/BAS scores, followed by the least significant difference (LSD) test for pairwise comparisons. Regression analysis was conducted to explore the relationships between psychopathological features and BIS/BAS scores. Results There were no significant differences in gender, age, and years of education among the three groups. The scores of YBOCS ( t=2.925, P=0.004), HAMD ( t=2.130, P=0.034) and HAMA ( t=2.568, P=0.011) in the OCD+OCPD group were significantly higher than those in the OCD group. There were statistically significant differences in BIS and BAS scores among the three groups (BIS: F=39.573, P<0.001; BAS: F=3.915, P=0.021). The results showed that for BIS, there were statistically significant differences in pairwise comparisons among the three groups (OCD+OCPD vs OCD: P=0.002; OCD+OCPD vs HC: P<0.001; OCD vs HC: P<0.001), and the scores were OCD+OCPD<OCD<HC from low to high. For BAS, the OCD group scored significantly higher than the OCD+OCPD and HC groups (OCD+OCPD vs OCD: P=0.018; OCD vs HC: P=0.043), but there was no significant difference between the OCD+OCPD and HC groups. Regression models of BIS and BAS were constructed for OCD patients with OCPD, and the results showed that the overall prediction effect of the model was significant for BIS total scores ( F=2.599, P=0.013). Only the severity of OCPD symptoms can significantly predict BIS scores ( t=-2.282, P=0.023). For BAS total scores, the overall prediction effect of the model was not significant ( F=1.438, P=0.191). Conclusion Comorbid OCPD may be an adverse factor for abnormal BIS and a protective factor for abnormal BAS in patients with OCD. Object To explore the effects of comorbid obsessive-compulsive personality disorder (OCPD) on the behavioral inhibition system (BIS)/behavioral activation system (BAS) in patients with obsessive-compulsive disorder (OCD).

Key words: obsessive-compulsive disorder, obsessive-compulsive personality disorder, behavioral inhibition system, behavioral activation system

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