心因性非痫性发作患者的抑郁、焦虑症状及人格特质研究
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北京市临床重点专科卓越项目(2017YFC0907702);首都医科大学宣武医院国自然青年培育项目(QNPY2020007)


Study on depression, anxiety and personality traits in patients with psychogenic non-epileptic seizures
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    目的 分析心因性非痫性发作(PNES)患者的抑郁、焦虑症状及人格特质。方法 选取 2020 年 1 月至 2021 年 3 月在首都医科大学宣武医院神经内科治疗的 22 例 PNES 患者(PNES 组)及 40 例 癫痫患者(癫痫组)的一般人口学及相关临床资料,使用 24 项汉密尔顿抑郁量表(HAMD-24)、汉密尔顿 焦虑量表(HAMA)及明尼苏达多项人格测验(MMPI)评估患者的抑郁、焦虑状态及人格特质。比较两组 患者一般人口学特征、临床资料、抑郁、焦虑状态及人格特质的差异。结果 PNES 组本次发作有诱发 因素者占比、发作频率高于癫痫组,差异有统计学意义(P< 0.05);HAMA 总分[11.80(7.00,15.50)分比 8.50(5.00,14.00)分]、躯体性焦虑因子评分[5.30(2.00,9.50)分比 3.10(1.00,4.75)分]、HAMD-24 总分 [10.60(5.50,14.50)分比7.30(5.00,8.50)分]、焦虑/躯体化症状因子评分[4.00(2.50,5.00)分比2.80(2.00, 4.00)分]、睡眠障碍因子评分[1.80(0,3.00)分比 1.00(0,2.00)分]、绝望感因子评分[1.10(0,2.00)分 比 0.40(0,1.50)分]高于癫痫组,差异有统计学意义(Z=2.13、1.98、1.97、2.64、2.15、2.76;P< 0.05); PNES 组 MMPI 中的疑病[(67.36±2.02)分比(56.79±1.21)分]、抑郁[(64.09±2.10)分比(52.07±1.97)分]、 癔病[(67.00±1.79)分比(54.62±1.17)分]、精神衰弱的标准分[(65.55±2.15)分比(58.40±1.82)分]高 于癫痫组,神经质[(71.32±2.05)分比(56.88±1.12)分]和掩饰性因子评分[(45.09±2.38)分比(38.57± 0.98)分]高于癫痫组(t=4.77、4.15、6.00、2.41、6.74、2.53;P< 0.05),非社会性因子评分低于癫痫组 [(44.91±2.03)分比(53.24±1.63)分],差异有统计学意义(t=-3.10,P< 0.01)。结论 PNES 相对癫痫患 者的抑郁、焦虑症状明显,具有神经质、掩饰性的人格特质,而癫痫患者的非社会化倾向更加明显。

    Abstract:

    Objective To analyze the depression, anxiety symptoms and personality traits of patients with psychogenic non-epileptic seizures (PNES). Methods The general demographic and related clinical data of 22 patients with psychogenic non epileptic seizures (PNES group) and 40 patients with epilepsy (epilepsy group) from the Department of Neurology, Xuanwu Hospital, Capital Medical University from January 2020 to March 2021 were collected. The depression, anxiety and personality traits of the patients were evaluated by Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA) and Minnesota Multiphasic Personality Inventory (MMPI). The differences between the two groups in general demographic characteristics, clinical data, depression, anxiety and personality traits were compared and analyzed. Results The proportion of seizure with inducing factors and seizure frequency in the PNES group were significantly higher than those in the epilepsy group (P < 0.05). In the PNES group, the total score of HAMA [11.80(7.00,15.50) vs 8.50 (5.00,14.00)], somatic anxiety factor [5.30(2.00,9.50) vs 3.10(1.00,4.75)], total score of HAMD [10.60 (5.50,14.50) vs 7.30(5.00,8.50)], anxiety somatization factor [4.00(2.50,5.00) vs 2.80(2.00,4.00)], sleep disorder factor [1.80(0,3.00) vs 1.00(0,2.00)], and the despair factor [1.10(0,2.00) vs 0.40(0,1.50)] were significantly higher than those of epilepsy group (Z=2.13,1.98,1.97,2.64,2.15,2.76; P< 0.05). The standard scores of hypochondriasis [(67.36±2.02) vs (56.79±1.21)], depression [(64.09±2.10) vs (52.07±1.97)], hysteria [(67.00±1.79) vs (54.62±1.17)], neurasthenia [(65.55±2.15) vs (58.40±1.82)] in MMPI of PNES group were higher than those of epilepsy group; The score of neuroticism [(71.32±2.05) vs (56.88±1.12)] and masked factor [(45.09±2.38) vs (38.57±0.98)] in PNES group were significantly higher than those in epilepsy group (t=4.77,4.15, 6.00,2.42,6.72,2.53; P< 0.05). The non-social factor in PNES group was lower than that in epilepsy group [(44.91±2.03) vs (53.24±1.63)], and the difference was statistically significant (t=-3.10, P< 0.01). Conclusions Patients with PNES have significant depression and anxiety symptoms compared with epileptic patients, and have neurotic and masked personality traits, while epileptic patients have a more obvious tendency of non-socialization.

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冷海霞,薛青,王玉平.心因性非痫性发作患者的抑郁、焦虑症状及人格特质研究[J].神经疾病与精神卫生,2022,22(11).
DOI :10.3969/j. issn.1009-6574.2022.11.010.

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  • 在线发布日期: 2022-12-22