自杀未遂者及其一级亲属冲动特质与认知功能的比较分析

doi:10.12114/j.issn.1007-9572.2018.00.284

摘要/Abstract

摘要： 背景　自杀是一种自主的、以死亡为目的的复杂行为障碍。近年来认知功能被逐渐作为评估与识别自杀风险的关键靶点，介于基因型和表现型之间的内表型为探究自杀的发生机制提供了新的视角。冲动特质和特定的认知功能与自杀未遂密切相关，但是否可作为内表型有待进一步验证。目的　探讨自杀未遂者及其一级亲属冲动特质及认知功能的特点，为自杀行为的内表型研究提供理论依据。方法　选取2015—2017年因自杀就诊于广东医科大学附属医院心理科或开滦精神卫生中心且符合纳入标准的自杀未遂者47例为自杀未遂组，同期选取自杀未遂组一级亲属47例为亲属组，选取广东医科大学附属医院和开滦精神卫生中心健康体检者55例为对照组。收集研究对象一般资料，采用中文版Barratt冲动量表第二版（BIS-Ⅱ）评估其冲动特质，韦氏记忆测验中的逻辑记忆测验评估其即时记忆与延迟记忆（记忆功能），记录研究对象Stroop实验错误数、完成各项任务所需时间（注意抑制功能）。结果　亲属组注意力冲动、运动冲动维度得分和中文版BIS-Ⅱ总分高于对照组，即时记忆、延迟记忆得分和错误数低于对照组，黑色念字、矛盾念字、字义干扰唱色、无关词唱色、纯色唱色、矛盾唱色所需时间长于对照组（P<0.05）；自杀未遂组注意力冲动、运动冲动、无计划冲动维度得分和中文版BIS-Ⅱ总分及错误数高于对照组，即时记忆、延迟记忆得分低于对照组，黑色念字、矛盾念字、字义干扰唱色、无关词唱色、纯色唱色、矛盾唱色所需时间长于对照组（P<0.05）。自杀未遂组运动冲动维度得分、中文版BIS-Ⅱ总分与即时记忆、延迟记忆得分呈负相关，与纯色唱色、矛盾唱色所需时间呈正相关（P<0.05）；自杀未遂组无计划冲动维度得分与即时记忆、延迟记忆得分呈负相关，与矛盾念字、矛盾唱色所需时间呈正相关（P<0.05）。一元线性回归分析结果显示，即时记忆、延时记忆得分和纯色唱色、矛盾唱色所需时间均与中文版BIS-Ⅱ总分存在线性回归关系（P<0.05）。多因素Logistic回归分析结果显示，运动冲动维度、无计划冲动维度、即时记忆和矛盾唱色所需时间为自杀的影响因素（P<0.05）。结论　自杀未遂者及其一级亲属具有高冲动特质，且存在记忆功能和注意抑制功能受损；冲动水平与记忆功能和注意抑制功能有关；冲动特质、即时记忆、注意抑制功能可作为自杀未遂者的候选内表型。

关键词: 自杀未遂, 冲动控制障碍, 冲动行为, 认知, 记忆, 注意抑制, 内表型

Abstract: Background　Suicide is an autonomous and complex behavioral disorder for death，cognitive function has gradually become a key target for assessing and identifying suicide risk in recent years，the endophenotype between genotype and phenotype provides a new perspective for exploring the mechanism of suicide.Impulsivity and specific cognitive functions are closely related to suicide attempted，however it can be further verified as an endophenotype.Objective　To investigate the characteristics of impulsivity and cognitive function in suicide attempters（SA）and their first-degree relatives，so as to provide theoretical basis for future endophenotype study of suicidal behaviors.Methods　A total of 47 suicide attempters admitted to the Psychology Department of Affiliated Hospital of Guangdong Medical University or Kailuan Mental Health Center from 2015 to 2017，their 47 first-degree relatives，and 55 healthy people were selected as attempted suicide group，relative group and control group，respectively.The general data of the study subjects were collected，their impulsivity were evaluated using the Chinese version of Barratt Impulse Scale（BIS-Ⅱ），and immediate and delayed memory（memory function）were evaluated by the logical memory test in the Wechsler Memory Test.The number of errors subjects made in the Stroop experiment，and the time required to complete each task（attention inhibition function）were recorded.Results　Scores of attention impulsiveness，motor impulsiveness and the Chinese version of BIS-Ⅱ total score of relative group were higher than those of control group，while scores of immediate memory and delayed memory were lower than those of control group；time of reading black words，reading paradoxical words，naming colors of conflict words，naming colors of irrelevant words，naming font colors，naming paradoxical colors were longer than those of control group（P<0.05）．Scores of attention impulsiveness，motor impulsiveness，unplanned impulsiveness and the Chinese version of BIS-Ⅱ total score and the number of errors of attempted suicide group were higher than those of control group，while scores of immediate memory and delayed memory were lower than those of control group；time of reading black words，reading paradoxical words，naming colors of conflict words，naming colors of irrelevant words，naming font colors，naming paradoxical colors were longer than those of control group（P<0.05）．Scores of motor impulsiveness and Chinese version of BIS-Ⅱ in attempted suicide group were negatively correlated with the scores of immediate memory and delayed memory，and positively correlated with the time required for naming font colors and naming paradoxical colors（P<0.05）；scores of unplanned impulsiveness in attempted suicide group were negatively correlated with scores of immediate memory and delayed memory，and positively correlated with the time required for reading paradoxical words and naming paradoxical colors（P<0.05）．The results of one-dimensional linear regression analysis showed that there was a linear regression relationship between scores of immediate and delayed memory，naming font colors，naming paradoxical colors with BIS-Ⅱ total score（P<0.05）．Results of multivariate logistic regression analysis showed that the time required for motor impulsiveness，unplanned impulsiveness，immediate memory and naming paradoxical colors were influencing factors of committing suicide（P<0.05）．Conclusion　Suicide attempters and their first-degree relatives have higher impulsiveness，and their memory and attention inhibition function are impaired；the impulsiveness is related to the memory and attention inhibition function；impulsiveness，immediate memory and attention inhibition may be potential endophenotypes of suicide attempters.

Key words: Suicide, attempted；Impulse control disorders；Impulsive behavior；Cognition；Memory；Attention inhibition；Endophenotype

张琳娜,黄缤慧,褚成静,等. 自杀未遂者及其一级亲属冲动特质与认知功能的比较分析[J]. 中国全科医学, 2019, 22(9): 1090-1095. DOI: 10.12114/j.issn.1007-9572.2018.00.284.
ZHANG Linna,HUANG Binhui,CHU Chengjing, et al. Comparative Analysis of Impulsivity and Cognitive Function in Suicide Attempters and Their First-degree Relatives　[J]. Chinese General Practice, 2019, 22(9): 1090-1095. DOI: 10.12114/j.issn.1007-9572.2018.00.284.

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