| [Background]Depression is one of the most common mental illnesses.In China,the annual prevalence rate of depression is 3.6%,and the lifetime prevalence rate is 6.9%.It is one of the main causes of global disability and disease burden,and there is a risk of recurrence in remission.There is a lot of evidence that cognitive symptoms are an important factor affecting the social outcomes of patients with depression,and patients with severe cognitive impairment have a higher risk of recurrence.Studies on cognitive dysfunction in depression have shown that executive dysfunction often has a greater impact on the recovery of patients’social function than dysfunction in other cognitive fields.At present,there are few domestic studies on the characteristics of executive function in patients with depression,and this study may provide a basis for the classification of depression.The most commonly used interventions to treat depression are medication,physical therapy,and psychotherapy.These treatments have their own advantages and disadvantages.Studies have shown that 20 to 30%of depression patients do not respond to drug treatment or have serious side effects;long-term or repeated use of some antidepressants may damage the cognitive function of patients.The currently commonly used method in physical therapy is transcranial magnetic stimulation.Studies have shown that after repeated transcranial magnetic stimulation,the patient’s executive function and attention are improved.However,the duration of improvement in patients’cognitive symptoms by transcranial magnetic stimulation may be shorter.Currently,many guidelines recommend the use of psychotherapy for patients with depression.Compared with drugs and physical interventions,psychotherapy may have a longer-lasting effect on patients’cognitive improvement,but the onset time is relatively long.Cognitive behavior therapy is generally recognized in psychotherapy and has the most evidence-based evidence.However,due to its strong professionalism and higher education requirements for patients,its development has been limited.Therefore,exploring new interventions has become an important aspect of clinical treatment of depression.Compared with cognitive behavioral therapy,the metacognitive intervention technology developed by Professor Jin Hongyuan’s team has the characteristics of simplicity and broad-spectrum.It is not only relatively flexible to implement,but also more likely to help patients recover.However,previous studies were mostly case studies,and the effect of its intervention on executive function of depression has not been reported yet.Therefore,this study intends to further explore the characteristics of executive function of patients with depression and the effect of metacognitive intervention technology on executive function of patients with depression,and analyze the neurophysiological mechanism through EEG technology.[Contents]Study 1:Research on the executive function characteristics of patients with depressionStudy 2:The effect of metacognitive intervention technology combined with antidepressants on executive function of depression[Methods]Study 1:This study included 79 depression subjects and 40 healthy subjects.The general information of subjects was collected by demographic data questionnaire,the clinical symptoms were assessed by clinical symptom scale,and the behavioral data of executive function were collected by computer task.Used an EEG device to collect neurophysiology information.E-prime.3.0 and Matlab2013b were used to preprocess the data of ethology and EEG.SPSS22.0 and Excel 2013 were used to analyze the data.The significance level was p<0.05.Study 2:A total of 70 depression patients were enrolled in this study,divided into three groups,namely the metacognitive intervention combined with antidepressant group,the repetitive transcranial magnetic stimulation combined with antidepressant group,and the drug treatment group.Research tools are the same as research one.After baseline assessment of the three groups of subjects,they were treated with metacognitive technology intervention,repeated transcranial magnetic stimulation intervention,and single drug intervention respectively.The intervention time was 8 weeks.Using SPSS 22.0 for statistical analysis of data,mainly descriptive statistics and analysis of variance,to explore the improvement of depression symptoms and executive functions by different interventions.Take p<0.05 as the significance level.[Results]Study 1:Behavioral indicators.In the Go/No-go task,the correct rate of the No-go task of the healthy group was significantly higher than that of the depression group（t=2.855,p<0.01）;in the Stroop color-word inconsistency task,the response time of the healthy group was significant Shorter than the depression group（t=-2.269,p<0.01）.ERP indicators.The N2 amplitude(F（1,86）=81.693,p<0.001,η2=0.290),P3amplitude(F（1,86）=56.700,p<0.001,η2=0.221)and N2 difference amplitude（No-go minus Go）（t=-3.830,p<0.001）in the depression group were significantly smaller than the healthy group.Among the stimulus types,the No-go task induced larger N2 amplitude(F（1,86）=232.353,p<0.001,η2=0.537)and P3 amplitude(F（1,86）=50.878,p<0.001,η2=0.203)than the Go task.Study 2:Clinical efficacy evaluation results.The HAMD scores(F（1,53）=201.892,p<0.001,η2=0.792)and HAMA scores(F（1,53）=61.331,p<0.001,η2=0.536)of the three groups before and after the test were significantly different.In the post-test HAMD assessment,the CEI group and r TMS group were significantly better than the drug treatment group;in the post-test HAMA assessment,the CEI group was significantly better than the drug treatment group.A statistical analysis of the effective rates of the three groups after treatment found that in the HAMD（χ2=6.055,p<0.05）and HAMA（χ2=7.154,p<0.05）scores,the differences in the total effective rates of the three groups were statistically significant.Behavioral results.In the Go/No-go task,the main effect of the correct rate among groups of No-go task was not significant;the main effect of pretest and posttest was significant(F（1,53）=33.732,p<0.001,η2=0.393),and the accuracy of posttest（65.06）was significantly higher than that of pretest（58.04）;the interaction between group and pre-test was not significant.In the Stroop task,the correct rate and the reaction time among the group of the color-word discordant task were not significant;the main effect of the correctness rate pre-and post-test was not significant;and the interaction between the group and the pre-and post-test was not significant;the main effect of the pre-and post-test of the reaction time was significant(F（1,53）=24.680,p<0.001,η2=0.326),and the post-test response time（751.91）was significantly shorter than the pre-test response time（821.27）.The interaction between the pre-and post-test and the group was significant(F（2,53）=4.494,p<0.05,η2=0.150),and the response time of the CEI group and the r TMS group of the post-test was significantly lower than that of the drug treatment group.ERP results.The No-go N2 component was improved after treatment in the three groups compared with before treatment(F（1,53）=67.455,p<0.001,η2=0.310).The comparison between the groups found that the CEI group and the r TMS group had a more obvious improvement effect than the drug treatment group.For the No-go P3 component,the average amplitude of the CEI group and r TMS group before and after the test was significantly different(F（1,53）=1281.237,p<0.001,η2=0.895),and the difference in the average amplitude of the drug treatment group before and after the test was not significant.The comparison between the groups found that the lifting effect of the CEI group and the r TMS group was significantly better than that of the drug treatment group,and the difference between the CEI group and the r TMS group was not significant.The amplitude of No-go N2 difference between the groups was significantly different(F（2,53）=10.786,p<0.001,η2=0.126).Compared with the drug treatment group,the CEI group and the r TMS group had a larger No-go N2 difference wave amplitude,and the difference between the CEI group and the r TMS group was not significant.The amplitude of No-go P3 difference between the groups was significantly different(F（2,53）=347.024,p<0.001,η2=0.822).Compared with the drug treatment group,the No-go P3 difference wave of the CEI group and the r TMS group was larger,and the No-go P3 difference wave of the r TMS group was greater than that of the CEI group.[Conclusion]Study 1 used behavioral assessment and neurophysiological techniques to explore the characteristics of executive control functions in patients with depression from two aspects:response inhibition and conflict control.The results showed that compared with the healthy group,the depression group had a higher error rate in the Go/No-go task,and the N2,P3,and N2 difference wave amplitude was smaller.In the Stroop discordant task,the reaction time was longer.These results indicated that the depressive patients had poorer response inhibition and conflict monitoring ability than the healthy subjects,and had impaired executive function,which had specific performance.Study 2 verified the effect of CEI combined with antidepressants on the symptoms and executive function of depression patients by comparing with r TMS combined with antidepressants and drug therapy alone.The results found that in the improvement of depressive symptoms,the effect of CEI combined with antidepressants and r TMS combined with antidepressants was more obvious,and there is no significant difference between the two groups.In terms of improving anxiety symptoms,the effect of CEI combined with antidepressants is better than r TMS combined with antidepressants and medication alone.In the aspect of executive function improvement,compared with pure drug intervention,CEI combined with antidepressants and r TMS combined with antidepressants can improve executive control function more effectively,and there is no significant difference between the two groups.This indicates that CEI combined with antidepressants could achieve similar therapeutic effect as that of r TMS combined with antidepressants. |
