【作者】 张超；

【导师】 谭淑平；

【作者基本信息】 北京大学医学部 ， 精神病与精神卫生学（专业学位）， 2021， 硕士

【摘要】 研究目的本研究是在既往有关精神分裂症情绪识别障碍的基础上,探讨具有暴力犯罪行为史的精神分裂症患者与无暴力犯罪行为史的精神分裂症患者在基础情绪感知(面部情绪识别及语音情绪识别)方面的差异;探讨精神分裂症患者的面部或语音情绪识别缺陷与临床症状的相关性;同时进一步分析有过致死性暴力犯罪行为的患者与发生过非致死性暴力犯罪行为的患者在攻击倾向性及童年期创伤方面的差异。以期从基础情绪感知及攻击性和早年创伤角度探讨发生暴力犯罪行为的精神分裂症患者的心理特征,为早期识别、预防精神分裂症患者发生暴力犯罪行为及干预提供循证支持。研究方法本研究选取有暴力犯罪行为史,经精神病司法鉴定为无刑事责任能力的精神分裂症患者92例为研究组,同时选取无暴力犯罪行为的精神分裂症患者79例作为对照。以面孔情绪识别测验和语音情绪识别测试评估两组患者的基础情绪感知能力,同时使用阳性和阴性症状量表评估患者的临床症状、个人和社会功能量表评定社会功能、自尊量表评估自尊程度、快感缺失量表评估快感缺失程度。另外,根据暴力犯罪组发生的暴力伤害的严重程度分为2个亚组(致死组和非致死组),通过自我测评的方式完成Buss-Perry攻击问卷、童年期创伤问卷及精神分裂症病人生活质量量表。研究结果1.面部情绪识别方面,暴力犯罪组在愤怒(3.33 ± 1.59)vs(2.87±1.58)、惊奇(4.02±1.55)vs(3.39±1.76)、平静(5.3± 1.20)vs(4.22±2.06)三个维度的得分及总分(27.99±6.32)vs(25.38±6.98)均显著高于非暴力犯罪组(P均<0.05)。2.语音情绪识别方面,暴力犯罪组的悲伤(3.28±1.68)vs(2.86±1.60)、平静(5.05±1.19)vs(4.27±1.80)维度得分及总分(22.10±6.86)vs(19.29±7.84)均显著高于非暴力犯罪组(P均<0.05)。3.情绪感知与临床症状关系:在暴力犯罪组,厌恶表情识别准确率与PANSS阳性症状呈负相关(r=-0.22,P<0.05);恐惧语音情绪识别准确率与阴性症状呈负相关(r=-0.22,P<0.05)。非暴力犯罪组:厌恶表情识别准确率与阳性症状、阴性症状呈负相关(分别r=-0.30,-0.24,P均<0.05),惊奇表情识别准确率与PANSS阴性症状及一般精神病理症状呈负相关(分别r=-0.31,-0.28,P均<0.05);悲伤语音情绪与阳性症状呈负相关(r=-0.23,P<0.05),惊奇语音情绪与阴性症状、一般精神病理症状呈负相关(r=-0.29,-0.25,P均<0.05)。4.致死性暴力犯罪组与非致死性暴力犯罪组相比,其攻击行为更强,表现为言语攻击性、指向自我的攻击性及攻击性总分更高,童年期遭受躯体虐待更多,CTQ量表的躯体虐待得分更高,同时患者的生活质量更差,生活质量量表中的心理社会分量表、症状和副作用分量表的得分更高(P<0.05)。研究结论 1.精神分裂症患者存在面孔和语音情绪识别缺陷,暴力犯罪组精神分裂症患者对愤怒和惊奇的面孔情绪、悲伤的语音情绪识别能力更强。2.暴力犯罪组精神分裂症的厌恶面孔情绪识别能力与患者的阳性症状呈负相关,恐惧语音情绪识别能力与患者的阴性症状呈负相关。3.致死性暴力犯罪组患者的童年期创伤经历更为严重,生活质量的主观体验更差,具有更强的攻击性倾向。更多还原

【Abstract】 Objective:The purpose of this study is to explore the differences in basic emotion perception(facial emotion recognition and voice emotion recognition)between schizophrenic patients with a history of violent crime and schizophrenic patients without a history of violent crime;To explore the correlation between facial or voice emotion recognition defects and clinical symptoms in patients with schizophrenia;At the same time,the differences in aggression tendency and childhood trauma between patients with fatal violent crime and patients with non-fatal violent crime were further analyzed.In order to explore the psychological characteristics of schizophrenic patients with violent crime from the perspective of basic emotional perception,aggression and early trauma,and provide evidence-based support for early identification,prevention and intervention of violent crime in schizophrenic patients.Methods:In this study,92 schizophrenic patients with a history of violent crime and without criminal responsibility identified by psychiatric justice were selected as the research group,and 79 schizophrenic patients without violent crime were selected as the control.The basic emotion perception ability of the two groups was evaluated by facial emotion recognition test and voice emotion recognition test.At the same time,the clinical symptoms of the patients were evaluated by Positive and Negative Syndrome Scale,the social function was evaluated by Personal and Social Performance scale,the degree of self-esteem was evaluated by The Self-Esteem Scale,and the degree of loss of pleasure was evaluated by Temporal Experience of Pleasure Scale.In addition,the violent crime group was divided into two subgroups(lethal group and non-lethal group)according to the severity of violent injury.Buss&Perry aggression questionnaire,Childhood Trauma Questionnaire and Self-report quality of life measure for people with schizophrenia were completed through selfevaluation.Results:1.In terms of facial emotion recognition,the scores of anger(3.33±1.59)vs(2.87±1.58),surprise(4.02±1.55)vs(3.39±1.76),calm(5.3±1.20)vs(4.22±2.06)and the total score(27.99± 6.32)vs(25.38 ± 6.98)in violent crime group were significantly higher than those in non-violent crime group(P<0.05).2.In voice emotion recognition,the scores of sadness(3.28 ± 1.68)vs(2.86 ± 1.60),calm(5.05±1.19)vs(4.27 ± 1.80)and total score(22.10 ± 6.86)vs(19.29 ±7.84)in violent crime group were significantly higher than those in non-violent crime group(P<0.05).3.Relationship between emotion perception and clinical symptoms:in the violent crime group,the recognition accuracy of aversive expression was negatively correlated with PANSS positive symptoms(r=-0.22,P<0.05);The accuracy of fear voice emotion recognition was negatively correlated with negative symptoms(r=-0.22,P<0.05).In non-violent crime group,the accuracy of aversion expression recognition was negatively correlated with positive and negative symptoms(r=0.30,-0.24,P<0.05),and the accuracy of surprise expression recognition was negatively correlated with PANSS negative symptoms and general psychopathological symptoms(r=0.31,-0.28,P<0.05);Sad voice emotion was negatively correlated with positive symptoms(r=-0.23,P<0.05),surprised voice emotion was negatively correlated with negative symptoms and general psychopathological symptoms(r=-0.29,-0.25,P<0.05).4.Compared with the non-lethal violence crime group,the lethal violence crime group has stronger aggressive behavior,including verbal aggression,self-directed aggression and higher total score of aggression.Childhood suffered more physical abuse,and the score of physical abuse on CTQ was higher.At the same time,the quality of life of patients was worse,and the scores of psychosocial subscale,symptoms and side effects subscale in the quality of life scale were higher(P<0.05).Conclusion:1.Schizophrenic patients have defects in facial and voice emotion recognition.Schizophrenic patients in violent crime group have stronger ability to recognize angry and surprised facial emotions and sad voice emotions.2.The aversive facial emotion recognition ability of schizophrenia in violent crime group was negatively correlated with the positive symptoms,and the fear voice emotion recognition ability was negatively correlated with the negative symptoms.3.The patients in the lethal violence crime group had more severe childhood trauma experience,worse subjective experience of quality of life and stronger aggressive tendency.更多还原