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。     

帕罗西汀与氟西汀对脑卒中后抑郁总体康复影响的对照研究

目的：比较帕罗西汀与氟西汀（百忧解）对脑卒中后抑郁总体康复的影响。方法：将符合入组标准的脑卒中后抑郁患者随机分为帕罗西汀组,氟西汀组,用汉密顿抑郁量表（HAMD）,汉密顿焦虑量表（HAMD）,副反应量表（TESS）和改良爱丁堡与斯堪的维亚评分（SSS）进行评估。结果：帕罗西汀组与氟西汀组治疗前与治疗后第4,8周SSS评分均有显著差异,帕罗西汀组与氟西汀组之间无差异。治疗后第2周帕罗西汀组与氟西汀组HAMA评分有显著差异。结论：帕罗西汀与氟西汀均能有效地治疗脑卒中后抑郁,加快病人总体康复,帕罗西汀具有较好的治疗依从性。     

老年失眠症患者艾司唑仑治疗前后睡眠脑电Quisi及失匹性负波观察

目的:目的:探讨老年失眠症患者艾司唑仑治疗前后睡眠脑电(Quisi)及失匹性负波变化。方法:对64例老年失眠症患者连续进行4夜Quisi描记,其中第3、4晚上睡前予2mg艾司唑仑,观察用药后Quisi的变化。正常老人组56名,做2夜适应和基础Quisi监测。结果:(1)老年失眠症患者服用艾司唑仑后夜间Quisi显示睡眠效率提高(基线睡眠值87.5%±8.1%,第3晚服药后91.2%±7.9%,第4晚服药后91.9%±3.2%,F值5.94,P0.05),觉醒时间减少(同前,37.9±16.1分,28.4±7.5分,24.3±6.5分,F值7.21,P0.01),S1减少(同前,30.9±18.2%,24.1±11.0%,16.2±6.2%,F值8.90,P0.01),S2增加(同前,43.0±16.3%,59.1±17.2%,59.1±5.7%,F值7.61,P0.01),睡眠潜伏期缩短(同前,34.6±18.9分,26.9±16.5分,20.4±10.9分,F值3.95,P0.05)。(2)与正常老人组相比,老年失眠症患者在MMN潜伏期延迟,波幅下降(P0.01)。与此同时,P300也见同一趋势变化(P0.05或0.01)。结论:(1)艾司唑仑不仅能改善老年患者对睡眠的主观评价,还对夜间睡眠脑电有影响。(2)我们的临床经验并建议,对普通及老年失眠症患者治疗首选艾司唑仑。     

帕罗西汀、阿普唑仑单一及早期联合使用治疗惊恐障碍的对照研究

目的比较帕罗西汀、阿普唑仑单一使用及早期联合使用治疗惊恐障碍急性期的临床疗效和安全性。方法将符合入组标准的90例惊恐障碍患者随机至为阿普唑仑组、帕罗西汀组和两药合用组各30例,为期12周。以临床判断和惊恐症状评定量表(PASS)、汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)评定临床疗效,以副反应量表(TESS)评定药物不良反应。结果在治疗第1周末,阿普唑仑组及合用组PASS、HAMA、HAMD评分即出现明显改善,帕罗西汀组在第4周评分才开始有改善(HAMD为第3周),至治疗结束,3组间PASS总分差异无统计学意义;阿普唑仑组、帕罗西汀组及合用组有效率(%)及治愈率(%)分别为88.9,89.3,92.9,和59.3,60.7,60.7,差异无统计学意义;阿普唑仑组、帕罗西汀组不良反应发生率为51.9%和25%,而合用组仅为14.3%,明显低于前两组。结论阿普唑仑、帕罗西汀早期联合使用治疗惊恐障碍急性期快速、安全、高效,优于单一使用。     

盐酸曲唑酮治疗失眠症效果评价

目的旨在探讨盐酸曲唑酮治疗失眠症患者的临床疗效及安全性。方法选自2005年10月至2006年6月来我院门诊治疗的患有失眠的病人共64例,按住院先后顺序分为两组,A组使用盐酸曲唑酮治疗,B组使用艾司唑仑治疗。使用匹茨堡睡眠质量指数量表作为疗效评定的客观指标,使用TESS作为不良反应评定的客观指标,同时记录病人的心电、血液生化指标和体重的情况,使用t检验对实验数据进行统计分析。结果盐酸曲唑酮和艾司唑仑对失眠症病人均有很好的疗效,在副反应及病人服药依从性方面,盐酸曲唑酮优于艾司唑仑。结论研究结果表明,盐酸曲唑酮对失眠患者的疗效是显著的,而且安全性良好.     

帕罗西汀联合催眠疗法治疗强迫症

目的:探讨帕罗西汀联合催眠疗法治疗强迫症的临床可行性。方法:2014年1月-2016年4月门诊就诊强迫症20例患者,在自愿选择方案的情况下分成2组,帕罗西汀联合丁螺环酮组(11例)及帕罗西汀联合催眠疗法组(9例),治疗4周。在治疗前、1周末、4周末予以强迫量表(Y-BOCS)及汉密尔顿焦虑量表测定。结果:两组治疗前后Y-BOCS及HAMA评分均有非常显著差异(t=4.92,7.10,8.31,8.80;P0.01)。治疗第1周及4周末HAMA:催眠组较丁螺环酮组改善显著(t=2.47,2.55,P0.05)。治疗4周末Y-BOCS:催眠组较丁螺环酮组改善显著(t=2.24,P0.05);药物不良反应:丁螺环酮组头昏7例,催眠组1例,(Fisher确切概率法P=0.028),有统计学差异。结论:帕罗西汀联合催眠疗效好,药物不良反应少,临床安全性较高,有利于提高患者的治疗依从性。     

重复经颅磁刺激对失眠症患者睡眠的影响

目的观察重复经颅磁刺激(rTMS)对失眠症患者的临床疗效。方法将60例失眠症患者分为rTMS组和对照组,各30例。对照组每晚口服艾司唑仑1~2mg,rTMS组行rTMS治疗,均治疗14d,予多导睡眠检测仪检测治疗前后两组患者睡眠进程和睡眠结构的变化,治疗前后行匹茨堡睡眠质量指数量表(PSQI)评定,比较两组疗效。结果两组PSQI评分较治疗前均降低,差异有统计学意义(t=6.94,6.19;P0.05),治疗后两组PSQI评分差异无统计学意义。治疗后两组患者的睡眠时间、睡眠潜伏期、觉醒时间、睡眠效率等较治疗前均改善,差异有统计学意义(t=2.61~7.14,P均0.05);治疗后rTMS组较对照组相比,S2较短,S3和REMS较多,差异有统计学意义(t=7.09,6.32,4.61;P均0.05)。结论 rTMS能改善失眠症患者的睡眠质量。     

西酞普兰联合阿普唑仑治疗老年慢性失眠症临床疗效对照观察

目的 探讨治疗慢性失眠症的有效方法。方法 西酞普兰联合阿普唑仑及单纯应用阿普唑仑治疗老年慢性失眠症临床疗效对照观察。结果 西酞普兰联合阿普唑仑组从治．疗第8天开始产生疗效，从第15天开始疗效明显优于单纯应用阿普唑仑组。联合组阿普唑仑剂量明显低手阿普唑仑组。结论 联合应用西酞苷兰与阿普唑仑，能显著提高老年慢性失眠症患者的临床疗效，减少阿苷唑仑的日用量，降低阿普唑仑耐药性和副作用的发生。     

米氮平与帕罗西汀治疗难治性抑郁的对照试验

目的:观察米氮平对难治性抑郁的疗效和不良反应。方法:将符合入组标准的80例患者随机分成米氮平组和帕罗西汀组各40例。于治疗前和治疗第1、4、8周末采用汉密尔顿抑郁量表(HAMD)17项评定疾病严重程度和疗效,采用不良反应量表(TESS)评定药物不良反应,采用生活质量综合评定问卷(WHO.QOL-100)评定生活质量。结果:(1)米氮平组痊愈13例,显著进步13例,进步10例,显效率57.5%;帕罗西汀组痊愈8例,显著进步9例,进步13例,显效率42.5%;两组间显效率比较χ2=4.07,P=0.044。(2)治疗1周时,米氮平组与帕罗西汀组之间HAMD总分的差异有统计学意义,但是在治疗8周末差异没有统计学意义。(3)治疗8周末,米氮平组WHOQOL心理领域、社会关系、环境因素因子分均高于帕罗西汀组,差异有统计学意义。(4)在不良反应方面,食欲增加、性功能障碍和睡眠障碍的发生率组间差异有统计学意义,但是均较轻微。结论:与帕罗西汀相比,米氮平治疗难治性抑郁症起效快,疗效好,安全性好,且能显著改善患者的生存质量。     

生物反馈在焦虑症早期辅助治疗的疗效

目的:观察丁螺环酮、生物反馈在焦虑症早期治疗的临床疗效。方法:36例首发焦虑症患者随机分为3组:帕罗西汀加生物反馈组、帕罗西汀加丁螺环酮组和只用帕罗西汀组。于治疗前及治疗后第1、2周末用汉密尔顿焦虑量表(HAMA)评定疗效。结果:HAMA评分比较,1周末,丁螺环酮组、生物反馈组两组比较无明显差异(P0.05),与帕罗西汀组比较差异显著(q=3.63,4.46;P0.05)。2周末,丁螺环酮组、生物反馈组HAMA两组比较无明显差异(P0.05),丁螺环酮组与帕罗西汀组比较差异显著(q=4.09,P0.05),生物反馈组与帕罗西汀组比较差异显著(q=4.03,P0.01)。3组治疗有效率无显著差异(P0.05)。结论:帕罗西汀联合丁螺环酮、生物反馈在焦虑症早期治疗中对疾病缓解更快。生物反馈有助于改变不良的行为模式。     

Comparison of sleep condition and sleep-related psychological activity after cognitive-behavior and pharmacological therapy for chronic insomnia

BACKGROUND: Previous studies of insomnia focused mainly on the improvement of sleep condition and ignored the effects of sleep-related psychological activity and daytime function after pharmacological and behavioral treatments. We compared the clinical effects of both therapies on sleep condition, sleep-related psychological activity and daytime function in chronic insomnia. METHODS: Seventy-one patients with chronic insomnia were randomly divided into 4 groups and either received cognitive-behavior therapy (CBT, n = 19), pharmacological therapy (PCT, n = 17), CBT plus medication (Combined, n = 18) or placebo (n = 17). The treatments lasted for 8 weeks with follow-ups conducted at 3 and 8 months. On the day after treatment ended, all patients were assessed using a polysomnogram (PSG), a sleep diary and a psychological assessment. RESULTS: The three active treatments were more effective than placebo at the time the treatments were completed. Subjective sleep-onset latency, sleep efficacy and total sleep time were better in the PCT group than in the CBT group. At the 3-month follow-up, subjective and objective sleep-onset latency, sleep efficacy and total sleep time were better in the CBT group than in both the PCT and the Combined group. At the 8-month follow-up, the CBT group showed a steady comfortable sleep state, while the PCT and Combined groups were gradually returning to the pre-treatment condition. The Combined group showed a variable long-term effect. On the other hand, pre-sleep arousal at nighttime, dysfunctional beliefs about sleep as well as daytime functioning in the CBT group not only improved, but was better than in the other active treatment groups. CONCLUSION: Medication and Combined therapy produced a short-term effect on chronic insomnia while CBT had a long-term effect of improved sleep-related psychological activity and daytime functioning.     

认知行为疗法对失眠症患者睡眠和生活质量的影响

目的探讨认知行为疗法对失眠症患者睡眠质量和生活质量的影响。方法39例失眠症患者随机分成研究组和对照组，研究组给予安眠药物与认知行为疗法治疗，对照组单纯药物治疗。匹兹堡睡眠质量指数（PSQI）评价睡眠质量，总体幸福感量表（GWB）评价生活质量。结果匹兹堡睡眠质量（PSQJ）总分、睡眠质量、入睡时间、睡眠时间、睡眠效率、睡眠障碍、催眠药物使用、日间功能因子分．以及总体幸福感（GWB）总分治疗前后均有显著性差异（P〈0．05）；在第三周末，研究组PSQI及GWB总分均优于对照组。结论认知行为疗法对失眠症患者有良好的疗效，同时提高患者生活质量。     

Is exercise an alternative treatment for chronic insomnia?

The purposes of this systematic/critical review are: 1) to identify studies on the effects of exercise on chronic insomnia and sleep complaints in middle-aged and older adults and to compare the results of exercise with those obtained with hypnotic medications and 2) to discuss potential mechanisms by which exercise could promote sleep in insomniac patients. We identified studies from 1983 through 2011 using MEDLINE, SCOPUS and Web of Science. For systematic analyses, only studies assessing the chronic effects of exercise on sleep in people with sleep complaints or chronic insomnia were considered. We used the following keywords when searching for articles: insomnia, sleep, sleep complaints, exercise and physical activity. For a critical review, studies were selected on the effects of exercise and possible mechanisms that may explain the effects of exercise on insomnia. We identified five studies that met our inclusion criteria for systematic review. Exercise training is effective at decreasing sleep complaints and insomnia. Aerobic exercise has been more extensively studied, and its effects are similar to those observed after hypnotic medication use. Mechanisms are proposed to explain the effects of exercise on insomnia. There is additional documented evidence on the antidepressant and anti-anxiety effects of exercise. Exercise is effective to decrease sleep complaints and to treat chronic insomnia. Exercise presented similar results when compared with hypnotics; however, prospective studies comparing the effects of exercise with medical and non-medical treatments are warranted before including exercise as a first-line treatment for chronic insomnia are necessary.     

Impaired sleep-related memory consolidation in primary insomnia--a pilot study

STUDY OBJECTIVES: To compare sleep-related consolidation of procedural memory in patients with primary insomnia and healthy controls. DESIGN: Controlled comparison pilot study. SETTING: Sleep Laboratory of the Department of Psychiatry and Psychotherapy, University of Freiburg, Germany. PATIENTS OR PARTICIPANTS: Seven patients with primary insomnia and 7 sex-, age-, and IQ-matched healthy controls. INTERVENTIONS: Subjects spent 1 night in the sleep laboratory with polysomnographic monitoring. Performance on a mirror tracing task was measured before and after sleep. MEASUREMENTS AND RESULTS: Polysomnography revealed a trend toward disturbed sleep in the patients, compared with the control group, without reaching significance. Performance in the mirror tracing task before sleep did not differ between the groups. Both groups performed significantly better in the retest condition after sleep. Healthy controls showed an improvement of 42.8% +/- 5.8% in the mirror tracing draw time, whereas patients with insomnia showed an improvement of 20.4% +/- 14.8% (multivariate analyses of variance test session x group interaction: F(3,10) = 10.9, p = .002). CONCLUSIONS: These preliminary findings support the view that sleep-associated consolidation of procedural memories may be impaired in patients with primary insomnia.     

A primary care "friendly" cognitive behavioral insomnia therapy

OBJECTIVES: This study was conducted to test the effectiveness of an abbreviated cognitive-behavioral insomnia therapy (ACBT) with primary DESIGN: A single-blind, randomized group design was used in which study patients were randomized to either a brief, 2-session ACBT or a similarly brief intervention (SHC) that included only generic sleep hygiene recommendations. SETTING: A university-affiliated Department of Veterans Affairs medical center. PARTICIPANTS: Twenty (2 women) veteran patients (M(age) = 51.0 yrs., SD = 13.7 years) who met criteria for chronic primary insomnia. MEASUREMENTS AND RESULTS: Participants completed sleep logs for 2 weeks and questionnaires to measures insomnia symptoms, sleep-related self-efficacy, and dysfunctional beliefs about sleep before treatment, during a 2-week posttreatment assessment, and again at a 3-month posttreatment follow-up. Statistical analyses showed that ACBT produced significantly larger improvements across a majority of outcome measures than did SHC. Case-by-case analyses showed that only the ACBT produced consistent positive effects across study patients, and a sizeable proportion of these patients receiving this treatment achieved clinically significant improvements by their study endpoints. Approximately 52% of those receiving the ACBT reported at least a 50% reduction in their wake time after sleep onset, and 55.6% of ACBT-treated patients who entered the study with pathologic scores on an Insomnia Symptom Questionnaire (ISQ), achieved normal ISQ scores by their final outcome assessment. CONCLUSIONS: ACBT is effective for reducing subjective sleep disturbance and insomnia symptoms in primary care patients.     

Quality of sleep and P300 amplitude in primary insomnia: a preliminary study

STUDY OBJECTIVE: The aim of this study is to evaluate whether the cortical arousal level in subjects with primary insomnia varies according to their quality of nighttime sleep. DESIGN: The P300 ERP was recorded each day, before and after sleep actigraphically monitored for 1 week. For each participant, the nights of worst- and best-quality sleep were identified. PARTICIPANTS: Seven subjects with primary insomnia and 7 control subjects. MEASUREMENTS AND RESULTS: The P300 amplitudes were compared by considering group (insomnia vs control), night (worst vs best), and moment of recording (before vs after sleep) as factors. The subjects with insomnia showed higher P300 amplitudes, as compared with amplitudes of control subjects, only for the worst night of sleep. CONCLUSIONS: Results indicate a relationship between variations in sleep quality and cortical arousal level in subjects with primary insomnia.     

右佐匹克隆片治疗更年期失眠疗效分析

目的评价右佐匹克隆片治疗失眠症的临床疗效与不良反应。方法将68例更年期失眠患者分成治疗组和对照组各34例。治疗组患者每晚睡前服用右佐匹克隆片1.5～3mg;对照组患者每晚睡前服用氯硝西泮片1～4mg。连续服用3周。采用睡眠障碍量表(SDRS)评定疗效,副反应量表(TESS)评定药物的不良反应;治疗前、后分别对患者行血常规、肝功能、肾功能、心电图检查以评价安全性。结果两组均有显著疗效,治疗组和对照组的有效率分别为88.2%和82.4%,两组比较差异无显著性(χ2=0.47,P>0.05)。两组TESS评分比较差异有显著性(t=2.66,3.71,5.98;P<0.01)。结论右佐匹克隆治疗更年期失眠疗效确切、不良反应较氯硝西泮少。