杨柳;刘靖;李雪;周娱菁;王慧;刘静然;王菲菲;

• 1:北京大学精神卫生研究所
• 2:北京大学第六医院
• 3:卫生部精神卫生重点实验室(北京大学)
• 4:国家精神心理疾病临床医学研究中心(北京大学第六医院)

摘要(Abstract)：

目的:探讨神经性厌食少年情绪、冲动的特点及自伤自杀危险因素。方法:采用儿童多维焦虑量表中文版、流调用抑郁自评量表、认知情绪调节问卷中文版、Barratt冲动量表中文版,对39名符合疾病和有关键康问题的国际统计分类第十次修订有神经性厌食诊断标准的少年,以及78名年龄、性别相匹配的正常对照进行评定,并对两组间评定结果进行比较。同时采用青少年健康相关危险行为问卷对病例组和正常对照组的自伤行为、自杀观念、自杀未遂进行评定和比较,并将人口学资料及上述各量表总分(青少年健康相关危险行为问卷总分除外)引入logistic回归模型,分析自伤行为、自杀观念、自杀未遂的危险因素。结果:病例组流调用抑郁自评量表分高于对照组(P<0.05),认知情绪调节问卷中灾难化思维病例组得分高于对照组(P<0.05)、反思自我得分病例组低于对照组(P<0.05),而焦虑、认知情绪调节、冲动各项总分均无明显差异(均P>0.05)。病例组自伤行为、自杀观念、自杀未遂评分高于对照组(均P<0.05、0.002、0.001),存在自伤行为、自杀观念、自杀未遂的患儿比例分别为43.6%、41.0%、33.3%。Logistic回归分析未发现自伤行为的相关因素;冲动(OR=1.19,95%CI:1.04¹.37)与自杀观念相关联;且冲动(OR=1.15,95%CI:1.031.37)与自杀观念相关联;且冲动(OR=1.15,95%CI:1.03¹.30)与自杀未遂相关联。结论:神经性厌食少年有明显较多的抑郁、灾难化思维、自伤行为、自杀观念及企图;冲动者更易出现自杀观念和自杀未遂。

关键词(KeyWords)： 神经性厌食;少年;情绪;冲动;自伤;自杀;危险因素

Abstract:

Keywords:

基金项目(Foundation): 国家科技支撑计划(2009BAI77B02,2012BAI01B02)

作者(Authors): 杨柳;刘靖;李雪;周娱菁;王慧;刘静然;王菲菲;

参考文献(References)：

• [1]Selby EA,Smith AR,Bulik CM,et al.Habitual starvation and provocative behaviors:tw o potential routes to extreme suicidal behavior in anorexia nervosa[J].Behav Res Ther,2010,48(7):634-645.
• [2]李亚玲,陈钰,虞一萍,等.神经性厌食患者的人格特征及焦虑抑郁症状[J].临床精神病学,2012,26(8):590-594.
• [3]Lilenfeld LR,Wonderlich S,Riso LP,etal.Eating disorders and personality:a methodological and empirical review[J].Clin Psychol Rev,2006,26(3):299-320.
• [4]Paul T,Schroeter K,Dahme B,et al.Self-injurious behavior in w omen w ith eating disorders[J].Am J Psychiatry,2002,159(3):408-411.
• [5]Preti A,Rocchi M B,Sisti D,et al.A comprehensive meta-analysis of the risk of suicide in eating disorders[J].Acta Psychiatr Scand,2011,124(1):6-17.
• [6]张晓丽,齐军慧,刘靖,等.神经性厌食少年的健康相关危险行为[J].中国心理卫生杂志,2013,27(6):435-439.
• [7]世界卫生组织.ICD-10精神与行为障碍分类临床描述与诊断要点[M].范肖东,汪向东,于欣,等,译.北京:人民卫生出版社,1993:140.
• [8]方积乾.卫生统计学[M].6版.北京:人民卫生出版社,2010:345-350.
• [9]邹涛,姚树桥,朱熊兆,等.M ASC中文版信效度的分析和与西方样本的比较[J].中国临床心理学杂志,2007,15(5):452-455.
• [10]袁家珍,陈建新,朱紫青,等.流调用抑郁自评量表在社区应用的效度研究[J].上海精神医学,1998,10(3):150-151.
• [11]朱熊兆,罗伏生,姚树桥,等.认知情绪调查问卷中文版(CERQC)的信效度研究[J].中国临床心理学杂志,2007,15(2):121-124.
• [12]杨会芹,姚树桥,朱熊兆,等.Barratt冲动量表中文版用于中学生的信度、效度分析[J].中国临床心理学杂志,2007,15(1):4-12.
• [13]王孟成,朱熊兆,姚树桥,等.青少年健康相关危险行为问卷的编制及信效度检验[J].中国心理卫生杂志,2012,26(5):1-6.
• [14]Godart N,Radon L,Curt F,et al.M ood disorders in eating disorder patients:Prevalence and chronology of ONSET[J].J Affect Disord,2015,185:115-122.
• [15]Sternheim L,Startup H,Saeidi S,et al.Understanding catastrophic w orry in eating disorders:process and content characteristics[J].J Behav Ther Exp Psychiatry,2012,43(4):1095-1103.
• [16]Dellava JE,Thornton LM,Hamer RM,et al.Childhood anxiety associated w ith low BM I in w omen w ith anorexia nervosa[J].Behav Res Ther,2010,48(1):60-67.
• [17]Brockmeyer T,Skunde M,Wu M,et al.Difficulties in emotion regulation across the spectrum across the spectrum of eating disorders[J].Compr Psychiatry,2014,55(3):565-571.
• [18]Aldao A,Nolen-Hoeksema S,Schw eizer S.Emotion regulation strategies across psychopathology:a meta-analytic review[J].Clin Psychol Rev,2011,30(2):217-237.
• [19]Startup H,Lavender A,Oldershaw A,et al.Worry and rumination in anorexia nervosa[J].Behav Cognit Psychother,2013,41(3):301-316.
• [20]Raw al A,ParkRJ,Williams JM.Rumination,experiential,avoidance,and dysfunctional thinking in eating disorder[J].Behav Res Ther,2010,48(9):851-859.
• [21]Coughlin JW,Edw ards R,Buenaver L,et al.Pain,Catastrophizing,and depressive symptomatologyin eating disorders[J].Clin J Pain,2008,24(5):406-414.
• [22]Startup HM,Davey GC.Pain,M ood as input and catastrophic w orrying[J].J Abnorm Psychol,2001,110(1):83-96.
• [23]Favaro A,Zanetti T,Tenconi E,et al.The relationship betw een temperament and impulsive behaviors in eating disordered subjects[J].Eat Disord,2005,13(1):61-70.
• [24]Fernandez-Aranda F,Pinheiro AP,Thornton LM,et al.Impulse control disorders in w omen w ith eating disorders[J].Psychiatry Res,2008,157(1-3):147-157.
• [25]Brand-Gothelf A,Leor S,Apter A,et al.The impact of comorbid depressive and anxiety disorders on severity of anorexia nervosa in adolescent girls[J].J Nerv M ent Dis,2014,202(10):759-762.
• [26]Papadopoulos FC,Ekbom A,Brandt L,et al.Excessmortality,causes of death and prognostic factors in anorexia nervosa[J].Br J Psychiatry,2009,194(1):10-17.
• [27]Arcelus J,M itchell AJ,Wales J,et al.M ortality rates in patients w ith anorexia nervosa and other eating disorders.Ameta-analysis of36 studies[J].Arch Gen Psychiatry,2011,68(7):724-731.
• [28]Berkman ND,Lohr KN,Bulik CM.Outcomes of eating disorders:a systematic review of the literature[J].Int J Eat Disord,2007,40(4):293-309.
• [29]Nielsen S,M oller-M adsen S,Isager T,et al.Standardized mortality in eating disorders-aquantitative summary of previously published and new evidence[J].J Psychosom Res,1998,44(3-4):413-434.
• [30]Signorini A,De Filippo E,Panico S,et al.Long-term mortality in anorexia nervosa:areport after an 8-year follow-up and a review of the most recent literature[J].Eur J Clin Nutr,2007,61(1):119-122.
• [31]Paul T,Schroeter K,Dahme B,et al.Self-injurious behavior in w omen w ith eating disorders.Am J Psychiatry,2002,159(3):408-411.
• [32]Preti A,Rocchi M B,Sisti D,et al.A comprehensive meta-analysis of the risk of suicide in eating disorders[J].Acta Psychiatr Scand,2011,124(1):6-17.
• [33]Ruuska J,Kaltiala-Heino R,Rantanen P,et al.Psychopathological distress predicts suicidal ideation and self-harmin adolescent eating disorder outpatients[J].Eur Child Adolesc Psychiatry,2005,14(5):276-281.
• [34]M aser JD,Akiskal HS,Shettler P,et al.Can temperament identify affectively ill patients w ho engage in lethal or near-lethal suicidal behavior?A 14-year prospective study[J].Suicide Life Threat Behav,2002,32(1):10-32.
• [35]Conner KR,Duberstein PR,Conw ell Y,et al.Psychological vulnerability to completed suicide:a review of empirical studies[J].Suicide Life Threat Behav,2001,31(4):367-385.
• [36]Gvion Y,Apter A.Aggression,impulsivity,and suicide behavior:a review of the literature[J].Arch Suicide Res,2011,15(2):93-112.
• [37]Pompili M,Innamorati M,Raja M,et al.Suicide risk in depression and bipolar disorder:do impulsiveness-aggressiveness and pharmacotherapy predictsuicidal intent[J].Neuropsychiatr Dis Treat,2008,4(1):247-255.
• [38]M enon V,Sarkar S,Kattimani S,et al.Do personality traits such as impulsivity and hostility aggressiveness predict severity of intent in attempted suicide?Findings from a record based study in South India[J].Indian J Psychol M ed,2015,37(4):393-398.