静脉输注人脐带间充质干细胞治疗慢性失眠的临床观察

目的:观察人脐带间充质干细胞移植治疗慢性失眠的有效性和安全性。方法:选择慢性失眠病人39例,随机分为移植组19例,对照组20例,移植组给予人脐带间充质干细胞移植治疗1次,对照组采用阿普唑仑口服1月,两组患者均采用SF-36健康调查简表和匹兹堡睡眠质量指数来评价临床疗效,两组患者均随访观察12个月。结果:1细胞移植组患者在细胞移植治疗后1个月生活质量评分和睡眠质量评分明显好于治疗前,并在后续的随访中持续好于治疗前;对照组口服阿普唑仑治疗后2周睡眠质量评分即开始明显好于治疗前,但治疗后3个月患者的生活质量及睡眠质量评分出现下降,且同治疗前无差异,并持续到随访结束;2两组比较发现,治疗后2周,对照组的睡眠质量评分明显高于移植组,治疗后1个月两组睡眠质量和生活质量评分无差异,治疗后2个月细胞移植组的睡眠质量评分明显好于对照组,并持续到随访结束。治疗后3个月移植组的生活质量评分明显好于对照组,并持续到随访结束;3阿普唑仑停药后对照组患者有80%出现失眠症状的反弹,而细胞移植组患者经一次治疗患者的睡眠质量和生活质量改善作用可持续12个月,并且无明显不良反应。结论:人脐带间充质干细胞静脉输注治疗可显著改善慢性失眠患者的睡眠质量和生活质量,移植后1个月起效,一次治疗作用可持续达1年之久。     

曲唑酮对治疗脑卒中后抑郁患者睡眠障碍的临床观察

目的探讨曲唑酮治疗脑卒中后抑郁患者睡眠障碍的疗效。方法将脑卒中后抑郁并出现睡眠障碍的患者60例随机分为曲唑酮治疗组和对照组各30名,治疗前,治疗后4、6周分别给予匹兹堡睡眠指数量表(PSQI)及汉密尔顿抑郁量表(HAMD)评分。结果治疗前两组两个量表得分差异无统计学意义,治疗后4周及治疗后6周得分差异均有统计学意义。治疗4周(PSQI:t=5.577,P0.01;HAMD:t=4.917,P0.01),治疗6周后(PSQI:t=7.007,P0.01;HAMD:t=7.888,P0.01),治疗组睡眠质量明显改善,且明显高于对照组(P0.01),曲唑酮治疗组抑郁状态改善明显优于对照组(P0.01)。结论曲唑酮可有效改善脑卒中后抑郁患者睡眠障碍。     

认知行为与安眠药物治疗慢性失眠症临床效果对比分析

目的：比较认知行为、安眠药物和安慰剂治疗慢性失眠症的临床效果。方法：48名慢性失眠症男女患者自愿受试者，随机分成4组，分别接受认知行为、安眠药物、安眠药物和认知行为结合、安慰剂治疗。记录患者在治疗前后的主观和客观（夜间多导睡眠图，简称PSG）指标。结果：治疗开始后第8天，药物组和结合组的主观记录睡眠潜伏期分别为20分钟和27分钟，睡眠效率80％和82％，睡眠总时间分别为381分钟和356分钟，睡眠状况显著改善，效果好于认知行为组。经8周疗程治疗结束时，认知行为组上述睡眠3项指标好于治疗前，安慰剂组与治疗前无显著差异。治疗结束8个月时，认知行为组PSG记录睡眠潜伏期26分钟，睡眠效率84％，睡眠总时间378分钟，睡眠状态好于药物组和结合组，后两组较治疗刚结束时睡眠指标变差，药物组睡眠又恢复到治疗前的水平。结论：药物对睡眠改善起效快，短期效果好，认知行为治疗对睡眠改善有主观和客观（PSG记录）证明的长期效果，对与患者失眠相关的睡眠心理状态也有改善。安眠药物与认知行为结合治疗远期效果不如单纯认知行为治疗。     

放松训练结合中医认知疗法对焦虑症的疗效

目的探讨放松训练结合中医认知疗法对焦虑症的疗效。方法把符合标准的焦虑症患者(67人)随机分为实验组(35人)和对照组(32人),对实验组患者在药物治疗的基础上进行放松训练结合中医认知疗法,对照组患者单纯药物治疗。在治疗前、治疗1个月和3个月对两组患者施测焦虑自评量表(SAS)和汉密尔顿焦虑量表(HAMA)。结果实验组和对照组被试治疗前的SAS总分无显著性差异,在治疗1个月后以及治疗3个月后,实验组被试的SAS总分显著低于对照组(t=2.739,3.663;P0.01);治疗前,实验组被试HAMA总分显著高于对照组(t=-2.062,P0.05),治疗后,实验组和对照组被试在HAMA上的得分不具有显著性差异。结论放松训练结合中医认知疗法能有效改善焦虑症患者的焦虑症状。     

大学生社交焦虑团体治疗的比较研究

目的：对社交焦虑的大学生进行认知与行为疗法的团体治疗，比较两种方法的疗效。方法：选取社交焦虑的大学生22人随机分成两组，分别进行约16人小时团体的认知与行为疗法的治疗。用SAD、IAS、EPQ、ATQ，SCL－90五个量表，结合临床评估与自我报告等对干预疗效全面评估。结果：两组被试干预后在社交焦虑的主要感受、回避行为、自评症状，认知以及人格的N与E维度都有明显的改善。认知疗法对于改善被试的消极自动思维稍优于行为疗法，但未达到显著性水平，两组效果改善在所有指标上都没有显著差异，结论：认知疗法与行为疗法都能有效地改善大学生的社交焦虑水平，由于两组都采用团体治疗的方式、治疗师相同以及共存认知与行为因素，故两种方法疗效差异不显著。采用团体的方式干预社交焦虑有重要的意义。     

认知疗法辅助治疗产后抑郁症疗效观察

目的探讨认知疗法对产后抑郁症患者的辅助治疗效果。方法将60例产后抑郁症患者随机分为舍曲林联合认知治疗组及单用舍曲林治疗组各30例进行对照研究,疗程8周。在治疗前及治疗后、出院后第3个月和第6个月进行随访时各做1次汉密尔顿抑郁量表（HAMD）、Zung氏抑郁自评量表（SDS）评定疗效,其评定结果采用t检验。结果两组在治疗后第8周末,疗效未见统计学差异;在出院后第3个月和第6个月进行随访时,两组疗效有显著性统计学差异,研究组远期效果优于对照组。结论认知疗法辅助治疗产后抑郁症可使治疗效果更持久。     

神经阻滞联合抗病毒药物对带状疱疹患者疼痛及睡眠质量影响

目的 探究神经阻滞联合抗病毒药物对带状疱疹患者治疗效果,为临床疼痛缓解和改善睡眠质量提供依据.方法 选用来我院神经内科就诊带状疱疹患者90例,随机分为甲30例、乙30例、丙30例,甲组采用单纯抗病毒治疗,乙组采用抗病毒联合镇痛消炎药治疗,丙组采用神经阻滞联合抗病毒治疗,记录三组视觉评分(VAS)和睡眠质量评分(QS),分析三组疼痛和睡眠质量改善情况.结果 疼痛评分上,甲组治疗前后未见明显好转,2w后,才出现明显差异(t=4.329、5.424,P＜0.05);乙、丙两组在治疗后1w存在统计学差异(P＜0.05).在睡眠质量上,甲组睡眠质量没有明显改善(P＞0.05),1周后,睡眠质量改善(P＜0.05),乙、丙两组治疗前后存在显著统计学差异(P＜0.05),乙丙两组之间无明显差异(P＞0.05).结论 神经阻滞联合抗病毒药物对带状疱疹患者具有很好缓解疼痛和改善睡眠的作用,可以用于临床治疗.     

控制睡眠行为配合放松训练治疗失眠症临床观察

目的 :验证控制睡眠行为配合放松训练治疗失眠症的效果。方法 :对 44例门诊的失眠症采用控制睡眠行为配合放松训练进行治疗 ,疗程 8周。以作者自制的睡眠情况评定表来判断失眠者的睡眠效率、实际睡眠时间和失眠者的睡眠满意评分。结果 :实际睡眠时间于治疗后第 3周增加明显 (P <0 0 1) ,治疗后第 4、 6、 8周的实际睡眠时间进一步增加 ,均较治疗前 1周显著延长 (P均 <0 0 1) ,睡眠满意评分于治疗后第 4、 6、 8周睡眠较满意率与疗前 1周比增加较为明显 (P均 <0 0 1) ,睡眠较满意率从疗前一周的 2 2 7%增加到第 8周的 86 1%。 44例失眠症有 36例 ( 81 82 % )坚持治疗 8周。结论 :控制睡眠行为配合放松训练法对于治疗失眠症有显著的效果     

ES—100H失眠治疗仪合并阿普唑仑对失眠症患者的疗效比较

目的：分析ES-100H失眠治疗仪合并阿普唑仑对失眠症患者的临床疗效和安全性。方法：采用数字随机法将符合国际疾病精神与行为障碍分类第十版（ICD-10）中失眠症的诊断标准共70例失眠症患者,分为研究组和对照组各35例,研究组采用ES-100H失眠治疗仪合并阿普唑仑药治疗,对照组单用阿普唑仑治疗,3周后采用SPIEGEL睡眠量表评分及治疗结束2月后进行远期临床疗效评测。结果：研究组SPIEGEL睡眠量表评分高于对照组（P〈0．05）,两者比较差异具有统计学意义,患者远期临床睡眠改善明显,研究组总有效率97．14％。结论：ES-100H失眠治疗仪合并阿普唑仑对失眠症患者睡眠量改善及远期总显效率均优于单用阿普唑仑治疗,且安全无不良反应,患者依从性好,是一种比较理想的治疗方法,值得推广。     

正念团体训练对改善企业员工身心状况的作用

目的:在企业员工中,使用正念团体训练方法,探索该方法对员工睡眠质量、应对方式以及职业延迟满足的影响.方法:随机选取17名被试,分为实验组和等待组.对实验组进行八周正念团体训练.使用正念、睡眠质量、应对方式(包括积极应对方式和消极应对方式)、职业延迟满足问卷进行训练前测、八周训练结束后测和间隔三个月的追踪测.结果:与对照组比较,两组被试各指标前测差异均不显著；后测中,实验组积极应对方式和职业延迟满足分数显著优于等待组；追踪测中,实验组各指标(除消极应对方式外)均显著优于对照组.实验组的正念水平在前后测差异不显著,但在追踪测中显著优于前、后测(x2=13.613,P＜0.01),睡眠质量、积极应对方式、职业延迟满足分数有显著的上升,消极应对方式分数显著下降.结论:正念团体训练后,员工的身心状况有显著的改善,可以尝试在企业员工中进行推广.其效果和干预模式需要在今后的研究中进一步检验.     

An evaluation of behavioral treatments for insomnia in the older adult.

Behavioral treatments were evaluated for their effect on the subjective and objective sleep of older adult insomniacs (N = 53) aged 47 to 76 years. Conditions were support and sleep hygiene, support and sleep hygiene plus progressive relaxation, support and sleep hygiene plus stimulus control, or a measurement control group. The results indicated that all groups, including the measurement control group, were effective in improving the sleep diary assessed awakenings, nap time, and feeling refreshed upon awakening. Subjects at 3 weeks felt less depressed and felt that they had more control over their sleep. Stimulus control was most effective in improving sleep at the posttherapy period. A 2-year follow-up showed that the stimulus control subjects most frequently used the treatment instructions and had shorter sleep latencies and highest sleep quality. Behavioral treatments were found to be effective in improving the perception of sleep among older adult insomniacs.     

Sleep-related outcomes in persons with mild to moderate Alzheimer disease in a placebo-controlled trial of galantamine

STUDY OBJECTIVES: To recognize the potential effect of acetylcholinesterase-inhibiting medications on sleep quality when used for the treatment of mild to moderate Alzheimer disease and describe sleep outcomes for patients treated with galantamine. DESIGN: This study examined sleep quality among individuals with mild to moderate Alzheimer disease using data from a 3-month, double-blind, flexible-dose trial of galantamine. The hypothesis was no difference in sleep quality between galantamine- and placebo-treated subjects. PATIENTS: 136 patients treated with galantamine 24 mg per day and 125 patients treated with placebo. MEASUREMENTS: Based on caregiver reports, the sleep-related outcome measures were the Pittsburgh Sleep Quality Index and the sleep disorders item from the Neuropsychiatric Inventory. Using a P-value of 0.05 (2-tailed), analysis of covariance was used to compare treatments on mean change from baseline to month 3 (Pittsburgh Sleep Quality Index) or mean score at month 3 (Neuropsychiatric Inventory), adjusted for baseline score and investigator. RESULTS: Both patient groups had an average age of 75 years and a mean Mini-Mental Status Examination score of 20. There were no significant differences between groups on the Pittsburgh Sleep Quality Index total (P=0.59) or subscales. For galantamine and placebo, the mean adjusted changes from baseline on the total Pittsburgh Sleep Quality Index were 0.01 and -0.17, respectively. There also was no difference on the Neuropsychiatric Inventory sleep score at month 3 (P=0.51). CONCLUSIONS: Medications to treat Alzheimer disease should maintain sleep quality and have a neutral effect on sleep. These results further confirm the lack of sleep problems associated with galantamine treatment.     

Effects of progressive muscle relaxation and music on stress as measured by finger temperature response

Measured the efficacy of music, progressive muscle relaxation, and a combination of both variables on tension reduction. Ss were three sections (N = 76) of an introductory music class. Each section received either sedative music (M), progressive muscle relaxation (PMR), or both (M + PMR) as treatment. Vasoconstriction, or finger temperature, was used to measure stress level prior to and after the intervention. All three groups evidenced significant increases in finger temperature. There was no significant difference among treatment groups, although the M + PMR group's mean increase was greater than the grand mean, while the M and PMR groups' increases were below the grand mean.     

Sleep Beliefs Scale (SBS) and circadian typology

The aim of this work was to present the Sleep Beliefs Scale (SBS), a 20-item reviewed version of the Sleep Hygiene Awareness by Lacks and Rotert. We also examined for the first time the influence of circadian typology in sleep beliefs. Voluntary and unpaid psychology students participated in the study (n = 510; 182 men and 328 women), from Italy and Spain, aged between 18 and 33 (22.80 +/- 4.14 years). The mean score of SBS was 13.05 (SD = 3.46; range 2-20) in the total sample, with a distribution positive skewness to high score (correct beliefs) (Z = 1.82; P = 0.003). The internal consistency was good (Cronbach's alpha = 0.714) and factor analysis extracted three factors labelled 'Sleep-incompatible behaviours' (eight items), 'Sleep-wake cycle behaviours' (seven items) and 'Thoughts and attitudes to sleep' (five items). Circadian typology influences the total score and that of the three factors, as well the majority of the items that compose the SBS. The morning-type showed the best scores, the evening-type the worst, and the neither-type the medium scores. Moreover, in the men sample, the differences between circadian typology groups were higher than in the women sample. The SBS showed good psychometric properties; however, further studies in other countries, with clinical and non-student samples, and more aged subjects are needed so as to validate this psychometric instrument. The circadian typology is an individual difference that presented significant relationships with the sleep beliefs, the possibility of the evening-type being a risk factor for a worse sleep hygiene, and the maintenance of sleep problems such as insomnia may all be investigated in depth in future research.     

Does cognitive-behavioral insomnia therapy alter dysfunctional beliefs about sleep?

STUDY OBJECTIVES: This study was conducted to exam the degree to which cognitive-behavioral insomnia therapy (CBT) reduces dysfunctional beliefs about sleep and to determine if such cognitive changes correlate with sleep improvements. DESIGN: The study used a double-blind, placebo-controlled design in which participants were randomized to CBT, progressive muscle relaxation training or a sham behavioral intervention. Each treatment was provided in 6 weekly, 30-60-minute individual therapy sessions. SETTING: The sleep disorders center of a large university medical center. PARTICIPANTS: Seventy-five individuals (ages 40 to 80 years of age) who met strict criteria for persistent primary sleep-maintenance insomnia were enrolled in this trial. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: Participants completed the Dysfunctional Beliefs and Attitudes About Sleep (DBAS) Scale, as well as other assessment procedures before treatment, shortly after treatment, and at a six-month follow-up. Items composing a factor-analytically derived DBAS short form (DBAS-SF) were then used to compare treatment groups across time points. Results showed CBT produced larger changes on the DBAS-SF than did the other treatments, and these changes endured through the follow-up period. Moreover, these cognitive changes were correlated with improvements noted on both objective and subjective measures of insomnia symptoms, particularly within the CBT group. CONCLUSIONS: CBT is effective for reducing dysfunctional beliefs about sleep and such changes are associated with other positive outcomes in insomnia treatment.     

Psychological treatment for insomnia in the management of long-term hypnotic drug use: a pragmatic randomised controlled trial.

OBJECTIVE: To evaluate the clinical and cost impact of providing cognitive behaviour therapy (CBT) for insomnia (comprising sleep hygiene, stimulus control, relaxation and cognitive therapy components) to long-term hypnotic drug users in general practice. DESIGN: A pragmatic randomised controlled trial with two treatment arms (a CBT treated 'sleep clinic' group, and a 'no additional treatment' control group), with post-treatment assessments commencing at 3 and 6 months. SETTING: Twenty-three general practices in Sheffield, UK. PARTICIPANTS: Two hundred and nine serially referred patients aged 31-92 years with chronic sleep problems who had been using hypnotic drugs for at least 1 month (mean duration = 13.4 years). RESULTS: At 3- and 6-month follow-ups patients treated with CBT reported significant reductions in sleep latency, significant improvements in sleep efficiency, and significant reductions in the frequency of hypnotic drug use (all P<0.01). Among CBT treated patients SF-36 scores showed significant improvements in vitality at 3 months (P<0.01). Older age presented no barrier to successful treatment outcomes. The total cost of service provision was 154.40 per patient, with a mean incremental cost per quality-adjusted life-year of 3416 (at 6 months). However, there was evidence of longer term cost offsets owing to reductions in sleeping tablet use and reduced utilisation of primary care services. CONCLUSIONS: In routine general practice settings, psychological treatments for insomnia can improve sleep quality and reduce hypnotic consumption at a favourable cost among long-term hypnotic users with chronic sleep difficulties.     

The efficacy of affective and sensory psychotherapy module for sleep disturbances in generalized anxiety disorder

ObjectiveThis study was aimed to examine the effectiveness of a newly developed therapeutic method focusing on affective and sensory processes in the treatment of sleep problems in outpatients with Generalized Anxiety Disorder (GAD), called the ‘Affective and Sensory Psychotherapy Module’ (ASPM).MethodA randomised controlled trial was conducted, there were 60 outpatient participants. The Generalized Anxiety Disorder 7-Item Scale (GAD-7) and the Pittsburgh Sleep Quality Index (PSQI) were used at baseline, post-treatment, and 3 month follow-up.ResultsThere were no significant differences between the therapeutic and control groups at baseline. The therapeutic group showed a significant improvement in sleep quality and anxiety decrease compared to the control group. Sex differences did not occur in the results for within-subjects and between-group effects in this study.ConclusionsThe present study supported the efficacy of ASPM in the treatment of sleep problems in adult outpatients with GAD.     

Behavioral and Hypnotic Treatments for Insomnia Subtypes

This investigation compared progressive muscle relaxation plus cognitive distraction (PMR/CD), hypothesized to better improve sleep onset, versus sleep restriction and stimulus control (SR/SC), hypothesized to better improve sleep maintenance, versus a flurazepam (Dalmane) positive contrast condition (MED) and a sleep hygiene education minimal treatment control condition (SHE). Participants with chronic insomnia (N = 53), completed 2 baseline weeks of sleep diaries, and were randomly assigned to a treatment group for 2 more weeks. In the second phase, PMR/CD participants were assigned to 2 weeks of PMR/CD + SR/SC + SHE while SHE participants continued SHE. Results indicated that PMR/CD had greater effect upon sleep onset than SR/SC and SHE, SR/SC had greater effect on sleep maintenance than PMR/CD, and MED was better than the other treatments. In the second phase, the treatment package produced modest additional improvements and SHE performed superior to expectations.     

Behavioral and hypnotic treatments for insomnia subtypes

This investigation compared progressive muscle relaxation plus cognitive distraction (PMR/CD), hypothesized to better improve sleep onset, versus sleep restriction and stimulus control (SR/SC), hypothesized to better improve sleep maintenance, versus a flurazepam (Dalmane) positive contrast condition (MED) and a sleep hygiene education minimal treatment control condition (SHE). Participants with chronic insomnia (N = 53), completed 2 baseline weeks of sleep diaries, and were randomly assigned to a treatment group for 2 more weeks. In the second phase, PMR/CD participants were assigned to 2 weeks of PMR/CD + SR/SC + SHE while SHE participants continued SHE. Results indicated that PMR/CD had greater effect upon sleep onset than SR/SC and SHE, SR/SC had greater effect on sleep maintenance than PMR/CD, and MED was better than the other treatments. In the second phase, the treatment package produced modest additional improvements and SHE performed superior to expectations.     

Randomised controlled trial of therapeutic massage in the management of stress.

BACKGROUND: Many patients presenting in general practice are suffering from stress. Approaches using complementary therapeies are gaining popularity but have not been systematically evaluated. AIM: To compare the effect of six sessions of therapeutic massage with the use of a relaxation tape on stress, as measured by The General Health Questionnaire (GHQ-30). DESIGN OF STUDY: Randomised controlled trial. SETTING: A stress reduction clinic in general practice. METHOD: There were three treatment groups. Patients in the first group received six sessions of therapeutic massage, which was carried out by a nurse trained in this technique. Patients in the second group were given six sessions using a relaxation tape in the surgery and those in the third group were given a relaxation tape to use at home. The main outcome measures were: the GHQ-30, the Adapted Well Being Index (AWBI); a sleep scale; general practitioner (GP) consultations for any reason in the six weeks before treatment, during treatment, and the six weeks following treatment; and patient satisfaction. RESULTS: Sixty-nine patients completed the treatment. There were significant improvements across all four outcome measures and all three treatment groups. Following treatment the majority of patients felt far less emotional disturbance, were sleeping better, and consulting their GP less. CONCLUSION: Despite very strong patient preference for therapeutic massage, it did not show any benefits over either a relaxation tape used in the surgery or a relaxation tape used at home.