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研究生:黃冠中
研究生(外文):Kuan-ChungHuang
論文名稱:情緒平穩雙相情緒障礙症之胰島素阻抗在認知功能的影響
論文名稱(外文):The Effect of Insulin Resistance on Cognitive Function in Euthymic Bipolar Disorder
指導教授:陳柏熹陳柏熹引用關係
指導教授(外文):Po-See Chen
學位類別:碩士
校院名稱:國立成功大學
系所名稱:行為醫學研究所
學門:社會及行為科學學門
學類:心理學類
論文種類:學術論文
論文出版年:2019
畢業學年度:107
語文別:中文
論文頁數:128
中文關鍵詞:雙相情緒障礙症胰島素阻抗認知功能執行功能社會認知
外文關鍵詞:bipolar disorderinsulin resistancecognitive functionexecutive functionsocial cognition
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研究目的:本研究以胰島素阻抗作為代謝異常的分組指標,探討代謝異常在情緒平穩(euthymic)雙相情緒障礙症的認知功能和社會認知的影響。
方法:本研究納入雙相情緒障礙症病人共77位(其中7位非情緒平穩病人),健康控制組242位,收集人口學與臨床變項,並進行血液檢驗,藉由HOMA-IR(homeostatic model assessment-insulin resistance equation)進行胰島素阻抗之分組。本研究以威斯康辛卡片分類測驗、持續注意力表現測驗、手指輕敲測驗及Mayer-Salovery-Caruso Emotional Intelligence Test(MSCEIT)測驗,分別評估執行功能、注意力、動作速度及社會認知表現,並以二因子變異數分析檢驗疾病與胰島阻抗在認知功能和社會認知上的影響。
結果:在代謝指標,雙相情緒障礙症組無論在胰島素濃度、HOMA-IR值及胰島素阻抗的比例,皆顯著較健康控制組高。在認知功能上,雙相情緒障礙症組無論在認知功能或社會認知測驗上,皆較健康控制組的表現差。在二因子變異數分析上,本研究結果顯示在威斯康辛卡片分類測驗的執續錯誤數上有顯著交互作用效果,但在其他認知功能或社會認知測驗分數上,則未發現胰島素的主要效果或交互作用的顯著效果。然而,在組內比較中,發現胰島素阻抗的雙相情緒障礙症病人在MSCEIT使用情緒分支分數顯著較差,相較於無胰島素阻抗的雙相情緒障礙症病人。
結論:本研究結果發現胰島素阻抗的雙相情緒障礙症病人,有較差的執行功能和社會認知表現,反映雙相情緒障礙症病人其特定前額葉功能的不佳,可能同時受到疾病本身和代謝功能不佳的交互作用影響。因此,在臨床上可針對代謝異常進行介入,並進行認知功能的初步篩檢,以利進一步介入。
Previous studies suggested that metabolic disturbances highly prevail among bipolar disorder (BD), also considerable evidence confirmed both cognitive function and social cognition impairments exist. In this study, insulin resistance was used as a metabolic function index to determine the effects of insulin resistance on cognitive function and social cognition. Study samples consisted of 77 BD (7 non-euthymic BD) and 242 health control (HC), all underwent blood tests with survey and evaluation on their demographics and clinical variables. We compared the differences in metabolic function indexes, cognitive function and social cognition between the BD and health control. In addition, we employed two-way ANOVA to examine the effects of disease and insulin resistance on cognitive function and social cognition. The results indicated the fasting insulin level, HOMA-IR value, and prevalence of insulin resistance in the BD group were significantly higher than HC group. BD group performed significantly worse than HC group in each cognitive function test and the social cognition test. After controlling for age, ANOVA test showed a significant interaction effect on the executive function test. In addition, within-group comparison indicated BD patients with insulin resistance performed significantly worse than BD patients without insulin resistance on the social cognition test. This study found that BD patients with insulin resistance had poor executive function and social cognition performance than BD patients without insulin resistance, and which reflected the prefrontal function may be modified by the interaction of BD and poor metabolic function.
第壹章 續論 1
第貳章 文獻回顧 3
第一節 雙相情緒障礙症‬‬ 3
第二節 雙相情緒障礙症之胰島素阻抗 6
第三節 雙相情緒障礙症之胰島素阻抗與功能預後 9
第四節 雙相情緒障礙症之認知功能 12
第五節 雙相情緒障礙症之認知功能與功能預後 15
第六節 雙相情緒障礙症之社會認知 16
第七節 雙相情緒障礙症之社會認知與功能預後 23
第八節 雙相情緒障礙症之代謝異常與認知功能 25
第九節 雙相情緒障礙症之代謝異常與社會認知 27
第參章 研究目的與假設 28
第肆章 研究方法 29
第一節 研究設計 29
第二節 研究對象 29
第三節 研究工具 30
第四節 統計分析方法 36
第伍章 結果 37
第一節 雙相情緒障礙症的人口學與臨床變項 37
第二節 雙相情緒障礙症之認知功能 38
第三節 雙相情緒障礙症之社會認知 38
第四節 雙相情緒障礙症之認知功能與社會認知之相關分析 39
第五節 人口學變項與臨床變項之二因子變異數分析 40
第六節 雙相情緒障礙症之胰島素阻抗與認知功能 43
第七節 雙相情緒障礙症之胰島素阻抗與社會認知 44
第八節 認知功能和社會認知與生活品質之相關分析 45
第陸章 討論 68
第一節 雙相情緒障礙症之代謝功能 68
第二節 雙相情緒障礙症之認知功能 70
第三節 雙相情緒障礙症之社會認知 71
第四節 雙相情緒障礙症的社會認知與執行功能間之關係 72
第五節 雙相情緒障礙症之胰島素阻抗與認知功能之關係 74
第六節 疾病與胰島素阻抗對認知功能與社會認知的交互作用效果 80
第七節 雙相情緒障礙症的認知功能和社會認知與功能預後之關係 82
第八節 結論 84
第九節 研究貢獻 85
第十節 研究限制 86
參考文獻 90
附錄 116
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