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作者(中文):陳以非
作者(外文):Chen, I-Fei
論文名稱(中文):不同酬賞對喜樂不能思覺失調症患者之情緒與動機腦神經機制的研究
論文名稱(外文):Neural Mechanisms of Anhedonia in Schizophrenia: An fMRI Study of Emotional Experience and Motivation in Different Types of Rewards
指導教授(中文):詹雨臻
指導教授(外文):Chan, Yu-Chen
口試委員(中文):陳淑惠
劉智民
口試委員(外文):Chen, Sue-Huei
Liu, Chih-Min
學位類別:碩士
校院名稱:國立清華大學
系所名稱:學習科學研究所
學號:103002702
出版年(民國):107
畢業學年度:106
語文別:中文
論文頁數:83
中文關鍵詞:思覺失調症核磁共振造影喜樂不能幽默酬賞
外文關鍵詞:schizophreniafMRIanhedoniahumorreward
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在思覺失調症的負性症狀中,喜樂不能(anhedonia)表示患者無法感受到愉悅情緒,然而許多研究指出患者當下可以感受到愉悅情緒,但是無法預期未來的事件是有趣的,此預期能力涉及患者動機之缺陷。後續研究把喜樂不能細分成即時性愉悅感(consummatory pleasure)和預期性愉悅感(anticipatory pleasure),研究思覺失調症患者「喜歡」與「想要」之腦神經機制。本研究共有負性症狀組18位與正常控制組17位,透過功能性磁振造影技術,利用金錢酬賞延遲作業,以2(組別:思覺失調患者/正常控制組)× 3(酬賞類型:無/金錢/幽默圖片)二因子混合設計,探討思覺失調患者與一般人在預期性愉悅感(想要程度)和即時性愉悅感(愉悅程度)的大腦活化差異。fMRI結果顯示在預期階段,相對於患者,一般人對金錢酬賞的預期活化在伏隔核(NAcc)、中腦(midbrain)、前扣帶迴(ACC)、眼眶額葉皮質(OFC)和背外側前額葉皮質(dlPFC);相對於一般人,患者對幽默獎勵的預期活化在尾狀核(caudate body)、前扣帶迴(ACC)、眼眶額葉皮質(OFC)和背外側前額葉皮質(dlPFC)。在獲得酬賞階段,患者和一般人獲得幽默酬賞時,杏仁核(amygdala)和中腦(midbrain)的活化無顯著差異,顯示喜樂不能症狀的患者仍有感受愉悅情緒的能力。然而,在幽默理解部分,一般人在背外側前額葉皮質(dlPFC)和顳頂葉聯合區(TPJ)的活化程度顯著大於患者,可能表示患者的社會認知功能與執行功能有障礙。本研究結果支持喜樂不能症狀的患者仍有感受愉悅情緒的能力,而且可以理解幽默圖片,未來可進一步利用幽默進行患者社會認知與互動的訓練,改善患者的負性症狀。
Negative symptoms are associated with neurocognitive deficits and contribute to poor functional recovery in people with schizophrenia. Patients with anhedonia, which is one of the negative symptoms, have lost interest in attending activities and have a decreased ability to feel pleasure. However, many studies indicated that people with schizophrenia could experience pleasure in-the-moment, but have difficulties in anticipating whether future events will be pleasurable. The present study used functional magnetic resonance imaging (fMRI) to investigate brain activation in patients with anhedonia and healthy controls during reward anticipation and receipt. A total of 18 patients and 17 controls completed a modified version of the monetary incentive delay task (MID) offering three types of rewards (money, humor or non-reward). Controls showed significantly greater activation than people with schizophrenia in nucleus accumbens (NAcc), midbrain, anterior cingulate cortex (ACC), orbitofrontal cortex (OFC) and dorsolateral prefrontal cortex (dlPFC) during the anticipation of monetary rewards. Patients revealed the increased activity in caudate body, ACC, OFC and dlPFC during the anticipation of humor rewards. The groups did not differ in the activation of amygdala (AMG) and midbrain when receiving humor rewards, indicating that patients with anhedonia had a pleasant feel. However, patients had less activation of dlPFC and temporo-parietal junction (TPJ) than control group in humor comprehension, possibly indicating that patients had difficulties in social cognition and execution. In conclusion, the study indicated that patients with anhedonia had abilities not only to experience pleasure, but also to understand and appreciate humor.
中文摘要------------------------------------------iii
英文摘要------------------------------------------iv
目錄----------------------------------------------v
表次----------------------------------------------vii
圖次----------------------------------------------viii
第一章 研究動機與目的-----------------------------1
第二章 文獻回顧----------------------------------3
第一節 思覺失調症--------------------------------3
第二節 思覺失調症患者的喜樂不能症狀研究------------8
第三節 思覺失調患者動機與情緒經驗之整合討論--------18
第四節 思覺失調症患者之社會認知與幽默情緒經驗------19
第三章 思覺失調患者的情緒與動機之行為研究----------22
第一節 研究目的---------------------------------22
第二節 研究假設---------------------------------22
第三節 實驗方法---------------------------------22
一 參與者-------------------------------------22
二 研究工具-----------------------------------23
三 實驗設計-----------------------------------24
四 實驗材料-----------------------------------24
五 實驗流程-----------------------------------24
第四節 實驗結果---------------------------------26
第五節 小節-------------------------------------33
第四章 思覺失調患者的情緒與動機fMRI研究------------35
第一節 研究目的----------------------------------35
第二節 研究假設----------------------------------35
第三節 實驗方法----------------------------------36
一 參與者-------------------------------------36
二 研究工具-----------------------------------36
三 實驗設計-----------------------------------37
四 實驗材料-----------------------------------37
五 實驗流程-----------------------------------37
六 影像擷取-----------------------------------38
七 影像分析-----------------------------------39
第四節 實驗結果----------------------------------41
第五節 小節-------------------------------------56
第五章、綜合討論----------------------------------58
第一節 思覺失調患者的情緒經驗--------------------58
第二節 思覺失調患者的動機------------------------59
第三節 動機與情緒在思覺失調症喜樂不能症狀的討論----62
第四節 思覺失調患者的社會認知功能-----------------64
第六章、建議--------------------------------------66
第一節 研究貢獻與臨床應用------------------------66
第二節 研究限制---------------------------------67
第三節 未來研究方向-----------------------------68
參考文獻-----------------------------------------70
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