实时人际交互的社会认知脑功能机制及其对精神病发病的影响

Prodrome is identified as critical period for early prevention and intervention in the development of psychosis. The clinical features in prodromal phase are summarized as CHR (clinical high risk). Interpersonal interaction is playing a key role in the conversion from prodromal phase to schizophrenia (SZ), which is a function of social cognition. Unfortunately, the traditional method in magnetic resonance imaging detection method does not reflect the reality social interaction context, this limitation reveals the current research on social cognition related brain function only based on "closed, isolated, virtual situations" of cognitive response, which obviously, far away from the real-time interpersonal interaction in social cognition function. As a result, it is not clear that the brain functional mechanism of interpersonal interaction deficits in the early stage of SZ. In view of this, based on previous research on the CHR clinical recognition, intervention and magnetic resonance detection, try to break through the bottleneck of research in this field. This project further using functional near-infrared spectroscopy (fNIRS) technology, tackling the problems encountered in previous experiments, to explore the interpersonal interaction related brain function in a cohort from CHR (pre-morbid) to SZ. We try to translate the brain functional imaging technology from the laboratory to the real environment, and for the first time, the multiple persons' synchronization features were used as a marker of psychological and cognitive intervention. Our results might be valuable to provide the objective scientific basis for the clinical prevention and treatment of psychosis.

前驱期是精神病发病过程中早期防治的最佳时期，国际上将此阶段的临床特征概括为临床高危综合征（CHR）。从CHR到精神分裂症（SZ）这一关键过程中个体的人际交互功能起着决定性作用。但受限于“多人实时互动”过程的检测技术，以往研究结果仅能反映受试者在密闭、孤立、虚拟的实验室情境下的反应，与真实人际互动中的脑功能状态大相径庭。因此，SZ发病过程中人际交互缺陷的真实脑功能机制不清。鉴于此，本项目在CHR识别、干预和脑功能检测的大量经验积累基础上，尝试突破该领域的研究瓶颈，利用功能性近红外光谱技术在脑功能成像中的特性，攻坚前期实验中遇到的问题，记录CHR（病前）和SZ（病后）在实时人际互动过程中真实的脑功能变化，将脑功能成像技术从实验室移入现实环境，并首次将多人脑功能同步性特征作为心理/认知干预的疗效标记，为此类干预对精神病发病的临床防治价值寻找客观科学依据。

从精神病高危状态（CHR）到精神分裂症（SZ）的发病过程中个体的社会认知功能状态起着关键作用。本课题在完成的151例CHR患者的临床识别、社会认知评估、近红外多人同步脑功能成像、人际交互眼动检测、多面孔脑电诱发电位检测的基础上，进一步采用队列研究方式，对其进行1-2年的纵向随访，系统探索精神病超早期人群在人际互动过程中（双人fNIRS同步检测、眼动、脑电检测）社会认知相关的脑功能机制的变化。研究发现：1）151例CHR患者中有35例在随后2年内发展为SZ患者；2）与成对正常组相比，正常和高危成对组在协同任务中同步性表现出明显的差异，两组在合作任务中有显著差异，而在竞争任务中没有显著差异；3）如果在复杂多人环境中，即在背景情绪与前景情绪矛盾的情况下，精神病临床高危综合征组除了平均注视的次数和扫视的次数减少外，相应的平均注视时间延长，扫视的幅度缩短，即渐渐呈现出一种受限的视图轨迹；4）多面孔脑电诱发电位上，健康对照组N170幅值（绝对值）随着人脸个数的增加而增加(一个人脸: -4.67 ± 0.50 μV, 三个人脸: -6.74 ± 0.48 μV, F(1,17) = 50.16, p < 0.001)，而精神病临床高危综合征患者的N170幅值（绝对值）随着人脸个数的增加而减小(一个人脸: -4.15 ± 0.94 μV, 三个人脸: -1.92 ± 0.91 μV, F(1,16) = 9.44, p = 0.007)。上述结果提示，即使在精神病发作前的风险状态下，患者的人际交互功能已经受损，特别是在高生态效度的复杂人际交互的场景下，风险人群的脑功能同步性、眼动追踪轨迹、N170脑电诱发电位等特征均发生了明显的变化。上述这些检测结果可能为精神病早期识别和干预提供新的靶向指标。