注意力缺陷/多动障碍共病破坏性行为障碍、冲动控制障碍和品行障碍患者的认知控制和情绪反应。
Cognitive control and emotional response in attention-deficit/ hyperactivity disorder comorbidity with disruptive, impulse-control, and conduct disorders.
机构信息
Shanghai Hongkou Mental Health Center, Shanghai, 200083, China.
Clinical Research Center, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China.
出版信息
BMC Psychiatry. 2021 May 4;21(1):232. doi: 10.1186/s12888-021-03221-2.
BACKGROUND
This study investigated cognitive and emotional functioning in children and adolescents with attention-deficit/hyperactivity disorder (ADHD) and disruptive, impulse-control, and conduct disorders (DICCD).
METHODS
Thirty patients with ADHD, 26 with DICCD, 22 with ADHD+DICCD were recruited from the outpatient department of Shanghai Changning Mental Health Center, plus 20 healthy controls (HC). Differences between the groups in cognitive and emotional functioning were examined using Golden's Stroop and Emotional Stroop tests. For Emotional Stroop Mean reaction time (RT) of positive word (POS) and negative word (NEG) with color congruence (C) or incongruence (I) were recorded as POS-C, POS-I, NEG-C and NEG-I, respectively.
RESULTS
For Golden's interference scores (IGs), both errors and RTs in the ADHD group were higher than in the other groups. Longer mean RTs of POS-C, POS-I, NEG-C and neural word (NEU) of the ADHD group, and NEG-I of ADHD+DICCD and DICCD groups were observed compared to HC. After 12 weeks of methylphenidate treatment, differences between ADHD subgroups and HC on Golden's Stroop RT disappeared, but differences in Golden's Stroop errors and Emotional Stroop mean RTs remained. The ADHD+DICCD group showed longer mean RTs in NEG-C, NEG-I and NEU of the Emotional Stroop test than the ADHD group.
CONCLUSIONS
Our study shows that regardless of emotional responding, deficit in cognitive control is the core symptom of ADHD. However, emotionally biased stimuli may cause response inhibitory dysfunction among DICCD with callous-unemotional traits, and the comorbidity of ADHD and DICCD tends to account for the negative emotional response characteristic of DICCD. These deficits may be eliminated by medication treatment in ADHD, but not the ADHD with comorbid DICCD. Our results support the notion that ADHD with comorbid DICCD is more closely related to DICCD than to ADHD.
背景
本研究调查了注意缺陷/多动障碍（ADHD）和破坏性行为、冲动控制和品行障碍（DICCD）患儿和青少年的认知和情绪功能。
方法
从上海市长宁区精神卫生中心的门诊招募了 30 名 ADHD 患者、26 名 DICCD 患者、22 名 ADHD+DICCD 患者，以及 20 名健康对照组（HC）。使用 Golden's Stroop 和情绪 Stroop 测试比较各组之间认知和情绪功能的差异。对于情绪 Stroop，记录正字（POS）和负字（NEG）的阳性词（POS-C）、POS-I、NEG-C 和 NEG-I 的平均反应时（RT）。
结果
对于 Golden's 干扰分数（IG），ADHD 组的错误和 RT 均高于其他组。与 HC 相比，ADHD 组的 POS-C、POS-I、NEG-C 和神经字（NEU）的平均 RT 较长，ADHD+DICCD 和 DICCD 组的 NEG-I 较长。经过 12 周的哌甲酯治疗后，ADHD 亚组与 HC 之间在 Golden's Stroop RT 上的差异消失，但 Golden's Stroop 错误和情绪 Stroop 平均 RT 上的差异仍然存在。ADHD+DICCD 组在情绪 Stroop 测试中的 NEG-C、NEG-I 和 NEU 的平均 RT 长于 ADHD 组。
结论
我们的研究表明，无论情绪反应如何，认知控制缺陷都是 ADHD 的核心症状。然而，情绪偏向刺激可能会导致冷酷无情特质的 DICCD 患者出现反应抑制功能障碍，而 ADHD 和 DICCD 的共病可能会导致 DICCD 的负性情绪反应特征。这些缺陷可以通过药物治疗消除 ADHD，但不能消除 ADHD 伴共病 DICCD。我们的结果支持这样一种观点，即 ADHD 伴共病 DICCD 与 DICCD 的关系比与 ADHD 的关系更为密切。
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