强迫症患者、强迫型人格障碍患者和健康对照者之间的认知灵活性和计划能力比较

摘要

背景：强迫症患者(Obsessive Compulsive Disorder, OCD)与强迫型人格障碍患者(Obsessive Compulsive Personality Disorder, OCPD)的认知功能还没有得到充分的研究。　　目标：验证OCD和OCPD患者的认知灵活性和计划能力。　　方法：本研究在德黑兰心理咨询门诊选定了25例OCD患者和20例OCPD患者，他们在既往两周都没有服药，并且从大学工作人员和当地社区居民中选定了25名健康对照者。对所有参与者均进行28项一般健康问卷(28-item version of the General Health Quesitonnaire, GHQ-28)、威斯康星卡片分类测验(Wisconsin Card Soritng Test, WCST)、和伦敦塔试验(Tower of London test, TOL)）。本研究运用WCTS的两个测量指标（持续错误数和完成分类数）评估认知灵活性以及TOL的三个测量指标（12个试验总共的移动次数、总应答时和计划时间）评估计划能力。　　结果：2组患者的当前心理困扰程度显著高于对照组。在控制人口学因素和心理困扰水平后，OCD患者和OCPD患者在WCST测试中比对照组更容易出现持续性错误，而OCD患者（不包括OCPD患者）的完成分类数比对照组显著减少。OCD患者和OCDP患者都比对照组需要更多的移动次数来完成12项TOL任务，并且OCD患者比OCPD患者和对照组需要花更长的时间来完成任务。　　结论：与健康对照组相比，OCD和OCPD患者的认知灵活性和计划能力都有所受损，并且OCD和OCPD患者之间的认知功能测试也存在一些差异。我们需要对OCD和OCPD患者进行长期随访研究评估在强迫症状严重性加重与减轻时认知功能的改变，从而决定此类认知评估指标对于强迫症是否有诊断或临床关联性。%Background:Cognitive functioning in individuals with Obsessive Compulsive Disorder(OCD) and with Obsessive Compulsive Personality Disorder (OCPD) has not been adequately studied. Aim: Examine the cogniitve lfexibility and planning ability of individuals with OCD and OCPD. Methods: Twenty patients with OCD and 25 patients with OCPD who had not taken medication in the previous two weeks were identified in an outpatient psychology clinic in Tehran, and 25 healthy control subjects were identified from the university staff and local community residents. All participants were administered the 28-item version of the General Health Quesitonnaire (GHQ-28), the Wisconsin Card Soritng Test (WCST), and the Tower of London (TOL) test. Two measures of the WCTS (number of perseverative errors and number of categories completed) were used to assess cogniitve lfexibility and three measures of the TOL (total number of moves in 12 trials, total response itme, and planning itme) were used to assess planning ability. Results: The level of current psychological distress in the two paitent groups was signiifcantly greater than that in the control group. Atfer adjusitng for demographic variables and the level of psychological distress, both OCD paitents and OCPD paitents made more perseveraitve errors on the WCST than control subjects, and the OCD paitents (but not the OCPD paitents) completed signiifcantly fewer categories than the control subjects. Both the OCD paitents and OCPD paitents required signiifcantly more moves than control subjects to complete the 12 TOL tasks and OCD paitents took signiifcantly longer than both OCPD paitents and control subjects to complete the tasks. Conclusions:Individuals with OCD and OCPD have impaired cognitive flexibility and planning ability compared to healthy controls, and there are some differences in these measures of cogniitve funcitoning between OCD and OCPD. Long term follow-up studies of OCD and OCPD that assess changes in cogniitve measures as the severity of obsessive compulsive symptoms wax and wane will be needed to determine whether or not such cognitive measures have diagnostic or clinical relevance for obsessive compulsive disorders.