青少年品行障碍与抑郁障碍共病的实证及病因学模型研究

The frequent comorbidity of conduct disorder and depressive dosorder in children and adolescents led to chronic and even more serious impairment in all areas functioning compared to those with conduct disorder only and those with depressive disorder only. However, it is surprise that only a small amount of studies have been foused on the comorbidity of conduct disorder and depressive disorder, even, there exists major discrepancy among different research on the nosology of this comorbidity. So,the authors are to address this gap in the literature by adopting case-control stydy and follow up study in a large community sample of school children and adolescents. The aims of current study are to explore the clinical characteristics ,influencing factors, aetiological mechanism and classification of the comorbidity using epidemiological survey,psychological test,executive function and autonomic nervous system assessment, genetics and MRI studies. The findings of this study may lead to increased concetual understanding of the nature of this comorbidity and have implications for improving treatment outcomes for youth with this comorbidity. Also, the results of this study may make a contribution to literature and future study.

在儿童青少年时期，品行障碍和抑郁障碍在一部分患者中常常同时存在或先后出现，导致较"纯"品行障碍与"纯"抑郁障碍患者更加持久、更为严重的社会功能损害。然而学界对此共病现象研究不多，甚至在关于该共病在疾病分类体系中的地位与归属这一基本问题上也存在着重大的分歧。本项目以品行障碍与抑郁障碍共病青少年为研究对象，从心理、环境和生物三个层面，采用流行病学调查、量表评定、心理测验、执行功能评估、自主神经系统功能评定、遗传学分析及脑磁共振成像等方法进行病例对照研究和追踪研究，探索品行障碍与抑郁障碍共病的临床特征、影响因素与发病机制，力求阐明其在精神障碍分类系统中的地位与归属，为品行障碍与抑郁障碍共病患者的预防、治疗及预后评估工作奠定基础，并开展初步的、有针对性的干预工作。

经过筛查与临床诊断，在1524名青少年中，共计有65名青少年被诊断为品行障碍，检出率为4.27%。65名品行障碍青少年均为男性，最小年龄13岁，最大18岁（M=16.11，SD=1.20）。65人中有24人同时符合抑郁障碍诊断标准，占比36.9%。24人中以品行症状为首发症状者17人，占比70.8%，以抑郁症状为首发症状者7人，占比29.2%。研究发现，部分品行障碍患者的抑郁症状较为明显，品行障碍与抑郁障碍共病组、品行障碍组之间的移情能力没有显著性差异。这提示现品行障碍、品行障碍与抑郁障碍共病组两组患者享有共同特征，品行障碍与抑郁障碍共病可能是品行障碍的一个亚型，其作为一个独立诊断类别的效度值得怀疑。