【作者】 马磊；

【导师】 皇甫恩；

【作者基本信息】 第四军医大学 ， 应用心理学， 2004， 硕士

【摘要】 应激障碍（SD）是指一组主要由心理、社会（环境）因素引起的异常心理反应而导致的精神障碍，主要包括急性应激障碍（ASD）和创伤后应激障碍（PTSD）等。SD是战争及重大灾难后影响人类心身健康的主要疾病之一，近来受到越来越多学者的关注。本研究对影响精神科住院SD患者患病的较为重要的危险因素及遗传易感标记进行了初步探讨，以期为军事应激障碍易感人群的筛选方法提供资料；并初步评价了明尼苏达多相人格测验第二版（MMPI-2）对我国SD患者的诊断效果，为平战时SD的筛查和诊断提供依据。 本研究共分为三个部分： 1．应激障碍的危险因素分析 目的：探讨影响精神科住院SD患者患病的较为重要的危险因素。方法：实验组为43名符合DSM-IV诊断标准的SD患者，对照组为44名创伤幸存者。两组被试在医生指导下，填写依据SD患病危险因素的流行病学资料而制定的《应激状况调查表》。结果：应激障碍患者和对照组在研究中所涉及的11项影响因素中，有8项存在有显著差异。Logistic回归分析提示，在控制了精神疾病家族史这一因素后，家庭结构不稳定、酒精依赖家族史和性格内向的个体在经历创伤事件后患有应激障碍的可能性较大。结论：多种因素影响个体对应激的反应，包括创伤前易感素质和创伤后环境支持。 2．应激障碍易感候选基因的关联分析研究 目的：对我国汉族SD患者的多巴胺受体D₂基因（DRD2）Taq Ⅰ多态性进行检测，探讨其与SD的遗传易感性之间的关系。方法：采用聚合酶链式反应（PCR）和限制性片段长度多态性（RFLP）分析方法，检测37名SD患者和 第四军医大学硕士学位论文47名创伤幸存者的DRDZ Taql多态性，并比较其等位基因频率及携带率。结果:SD患者的Al等位基因频率及携带率分别为44.6%和75.7%，对照组为26.6%和46.8%，两组有显著性差异;携带Al等位基因的SD患者的PK分数显著高于未携带者。结论:TSLql多态性与应激障碍相关联，我国汉族人群中A1等位基因的携带者可能对应激障碍易感。 3.应用明尼苏达多相人格测验诊断应激障碍的效果分析 目的:采用枷Pl一2中文版评估我国SD患者的心理病理特征，并探讨其辅助诊断的应用价值。方法:实验组.包括26名ASD患者和13名PTSD患者，对照组为42名创伤幸存者，在无影响测验的精神及躯体症状的情况下完成咖Pl一2测验。结果:SD患者的F、Fb、Fp、D、Hy、Pa、Pt、Se、Ma、PK量表以及除SOD的所有内容量表均显著高于对照组;ASD患者与PTSD患者间差异显著的量表为Hs、D、Hy、ANG和TRT;SD患者平均剖面图呈6一8一7型编码;判别分析得到2个有意义的变量，Pa和Sc，判别函数在训练样本和验证样本中的预测符·合率分别为83.9%和72.0%。不同性别、不同创伤经历和不同诊断分类的SD患者的PK分数无显著差异，使用原始分17分为最佳截断点时，PK诊断SD的灵敏度为94.9%，特异度为66.7%。结论:MMPI一2对应激失常症状比较敏感，Pa和Sc具有较好的鉴别能力;SD患者和适应良好的创伤幸存者有着明显不同的心理病理表现;以原始分17分为截断点，PK量表可以较好的区分应激事件后的适度与过度心理反应，但假阳性率较高。 综合研究的结果提示:在军事或其他特殊职业人员的选拔过程中，应重视应用个人信息收集及分子遗传标记等多种方法对遗传背景、家庭环境、性格特征等易感因素进行综合评估，以预防和减少SD的发生;MMPI一2对应激失常症状具有较好的评估效果和辅助诊断价值，在精神科门诊和灾难后应激人群筛查中，PK可以用来排除个体发生应激失常症状的可能。但研究样本量较小，结果需要进一步的验证，以上结论应慎重对待。更多还原

【Abstract】 Stress disorder (SD) is abnormal psychological response caused by psychological, social and environmental factors. SD includes acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) etc. SD is one of the most important diseases that threaten human health after warfare and severe disaster. Considerable attention has been devoted to SD in recent years. This is a preliminary study investigating several important risk factors and genetic susceptibility markers for patients with SD in psychiatric hospital. This study may be helpful for the screening of army man to exclude those who are susceptive to SD. Diagnostic efficiency with MMPI-2 in patients with SD was also examined to provide usefiil information for the screening and diagnosis of SD during wartime or peacetime.There were mainly three parts in our study:First, risk factors for stress disorders. Objective: To ascertain risk factors associated with SD in psychiatric hospital. Methods: forty-three patients with acute stress disorder or posttraumatic stress disorder and forty-four trauma survivors were investigated with "the questionnaire for stress", which was developed on previous epidemic studies. Results: Of the eleven items examined, significant associations were found in eight risk factors between patients and controls. Logistic regression indicated family instability, family history of alcohol abuse and introversion make significant contributions to stress disorder after controlling for family history of mental disorders. Conclusions: the results confirmed that a group of factors has muchimpact on individual’s response to stress, which including pre-trauma predisposition and after-trauma supports.Second, whether susceptive candidate gene is related to genetic susceptibility of stress disorders. Objective: To investigate the association between Taq I Polymorphism of Dopamine Receptor D2 (DRD2) and genetic susceptibility for stress disorder. Methods: PCR-RFLP was used to determine the DRD2 Taq I genotypes of 37 patients with SD and 47 trauma survivors. Results: There were significant differences in Al allele frequencies and carriers between two groups. Patients carrying Al alleles showed relatively higher elevations of PK raw scores than patients who did not carry Al alleles. Conclusions: Taq I Polymorphism of DRD2 was associated with genetic susceptibility of stress disorder and carrying Al alleles may confers an increased risk to stress disorders.Third, diagnostic efficiency with the MMPI-2 in patients with SD. Objective: To investigate psychopathology and diagnostic efficiency with MMPI-2 in patients with SD. Methods: Chinese version of MMPI-2 were administered to 26 patients with ASD, 13 patients with PTSD and 42 trauma survivors. Results: Patients with SD obtained significantly higher mean scores of MMPI-2 scales F, Fb, Fp, D, Hy, Pa, Pt, Sc, Ma and PK than controls, the same with all content scales except SOD. There were significant differences in mean scores of Hs, D, Hy, ANG and TRT between patients with ASD and PTSD. 6-8-7 codetype was found as the mean profiles for SD patients. Discriminate analysis indicated that Pa and Sc were the most important variables and it successfully classified 83.9% and 72.0% respectively in training sample and cross-validation sample. Gender, types of traumatic events or types of diagnosis in patients with SD did not substantially influence PK scores. When an optimal cut-off point of 17 was utilized, sensitivity and specificity for diagnosis with PK are respectively 94.9% and 66.7%. Conclusions: MMPI-2 scales especially Pa and Sc were sensitive to posttraumatic stress symptoms. Patients with SD and trauma survivors show significantly different psychopathology. PK was moderately successful at identifying abnormal psychological responses after trauma though it produced more false-positive than false-negative errors.Our results suggest that it may be more efficient to assess risk factors such as genetic background, family environment and personality in the course of personnel selec更多还原