文拉法辛配合认知行为疗法治疗抑郁症对照研究

目的评价文拉法辛配合认知行为疗法对抑郁症的疗效。方法将64例抑郁症患者随机分为两组,研究组采用文拉法辛合并认知行为治疗,对照组仅用文拉法辛治疗,两组作8周持续治疗观察,于入组前及入组后第4,8周末分别用汉密尔顿抑郁量表(HAMD),汉密尔顿焦虑量表(HAMA)进行评定。结果①治疗前研究组和对照组HAMD、HAMA评分差异无统计学意义。第4周末研究组HAMD评分低于对照组(t=3.081,P<0.05),直至第8周末两组HAMD评分仍有差异(t=4.077,P<0.05);②第4周末研究组HAMA评分低于对照组(t=3.083,P<0.05),直至第8周末两组HAMA评分仍有差异(t=4.079,P<0.05)。结论文拉法辛配合认知行为疗法对抑郁症有效,并且远期疗效好。     

舍曲林与马普替林对抑郁症患者疗效及生活质量对照研究

目的比较舍曲林和马普替林对抑郁症患者的生活质量的影响。方法将72例抑郁症患者随机分为舍曲林组(36例)和马普替林组(36例),治疗8周,两组均在治疗前后以汉密尔顿抑郁量表(HAM D)、药物副反应量表(TESS)、生活质量综合评定问卷(GQOL I)评定。结果①治疗8周末,舍曲林组和马普替林组HAM D评分均明显下降(P0.01),两组疗效无显著性差异(t=1.226,P0.05);②舍曲林副反应少于马普替林(P0.05);③舍曲林组对生活质量各维度改善明显(P0.01),马普替林组在躯体功能及社会功能无明显改善(P0.05),在物质生活、心理功能方面改善明显(P0.01)。结论舍曲林治疗抑郁症疗效与马普替林无显著差异(P0.05),但不良反应少,对生活质量的改善优于马普替林。     

认知行为疗法治疗精神分裂症后抑郁的研究

目的探讨认知行为疗法对精神分裂症后抑郁的临床疗效。方法 64例精神分裂症后抑郁患者随机分为两组,即西酞普兰合并认知行为治疗组(研究组,32例)及西酞普兰治疗组(对照组,32例)疗程8周。采用汉密尔顿抑郁量表(HAMD)、阳性和阴性症状量表(PANSS)评定临床疗效。副反应量表(TESS)评定副反应。结果研究组4、6、8周末HAMD评分较对照组显著改善(t=10.15,12.98,14.29;P<0.01);入组前及8周末PANSS总分、各因子评分和TESS评分两组比较无显著性差异(t=0.13,0.36;P>0.05)。结论认知行为治疗能促进精神分裂症后抑郁的康复,提高治疗依从性,更好地适应社会生活。     

文拉法辛合并小剂量奥氮平治疗抑郁症的对照研究

目的探讨文拉法辛联合小剂量奥氮平治疗抑郁症的疗效和安全性。方法对60例抑郁症患者,随机分为单用组(单用文拉法辛)和合用组(文拉法辛合用奥氮平),疗程8周。采用汉密尔顿抑郁量表(HAM D)和副反应量表(TESS)评定疗效及不良反应。结果①两组治疗后HAM D评分均较治疗前明显下降(P均<0.01);两组间比较,合用组起效快,治疗第1、2、4周末,合用组HAM D评分显著低于单用组(P均<0.05);②合用组疗效优于单用组,但在第8周末疗效差异无统计学意义(t=1.253,P=0.153);③两组不良反应比较无明显差异(t=0.668,P=0.247)。结论文拉法辛合用小剂量奥氮平治疗抑郁症起效快,可增加疗效,安全性好。     

无抽搐电休克(MECT)在难治性抑郁症维持治疗中的应用

目的研究联合MECT治疗难治性抑郁症急性期及维持期的疗效及安全性。方法对54例难治性抑郁症患者,在急性期及维持期联合MECT治疗,用汉密尔顿抑郁量表(HAMD)评定疗效,用副反应量表(TESS)评定不良反应,用韦氏记忆量表(WMS)进行记忆测定。结果 MECT急性期治疗后41例(75.9%)有效。急性期治疗结束后,HAMD总分下降有非常显著性差异(t=10.36,P<0.01);维持治疗8周末、16周末与治疗前比较,HAMD总分的下降均有非常显著性差异(t=17.22～20.29,P<0.01)。WMS中的再认(t=5.73,P<0.01)、图片(t=4.72,P<0.01)、联想(t=3.93,P<0.01)及背数(t=5.23,P<0.01)在急性期治疗结束后1天较治疗前评分下降有非常显著性差异,但在维持治疗前1天、维持治疗8周末、16周末、18周末较治疗前评分无显著性差异(P>0.05)。无明显不良反应。结论 MECT安全性高,对难治性抑郁症的急性和维持治疗均有效。     

桂林高校大学生抑郁症状调查及干预研究

目的了解桂林高校大学生抑郁症发病及干预状况。方法采用抑郁自评量表(SDS)按桂林高校大学生3865名大学生进行抑郁情绪及抑郁症的流行特征及其相关因素抽样调查。并对其中的100名抑郁症患者随机分成两组,单用组使用度洛西汀片,合用组为心理治疗联合度洛西汀片,疗程为8周。采用汉密尔顿抑郁量表(HAM D)和汉密尔顿焦虑量表(HAMA)评定疗效,用症状量表(TESS)评定用药不良反应。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。结果大学生抑郁症状水平远高于全国常模(P<0.01),按其评定界值标准分52分计,≥50分者高达23.1%,大学生抑郁情绪发生率为23.1%,抑郁症的发生率为7.4%,其中女生显著高于男生(P<0.01);干预治疗8周末,合用组有效率为86%,单用组有效率为68%,两组比较差异有显著性(P<0.05)。两组HAM D和HAMA评分均较治疗前有显著下降(P<0.01),合用组(HAM D)和HAMA评分较单用组下降更显著(t=10.71,10.21;P<0.01)。两组TESS评分比较差异无统计学意义(t=1.57,P>0.05)。结论该人群中的抑郁发生率很高。心理治疗联合度洛西汀片能显著提高大学生抑郁症的临床疗效,安全性高,依从性好。     

帕罗西汀联合认知疗法治疗抑郁症对照研究

目的探讨帕罗西汀联合认知疗法治疗抑郁症的临床疗效。方法将90例抑郁症患者随机分为研究组与对照组各45例,两组均口服帕罗西汀治疗,研究组在此基础上联合认知心理治疗。观察8周。于治疗前及治疗第2、4、8周末采用汉密尔顿抑郁量表(HAM D)及副反应量表(TESS)评定临床疗效和不良反应。出院后随访1年,统计复发率。结果治疗8周末,研究组有效率95.6%,对照组为82.2%,两组比较差异有显著性(χ2=4.05,P0.05)。治疗2周末起,两组汉密尔顿抑郁量表总分均较治疗前有显著下降(t=9.627和6.439,P0.01),研究组治疗2周末起较对照组下降更显著(t=1.766,P0.05)。随访1年末研究组复发率15.5%,对照组为33.3%,研究组复发率显著低于对照组(χ2=3.85,P0.05)。结论帕罗西汀联合认知心理治疗能显著提高抑郁症的临床疗效,有效预防复发,改善预后。     

利培酮合并帕罗西汀治疗难治性抑郁症

目的探讨利培酮合并帕罗西汀治疗难治性抑郁症的效果。方法将56例难治性抑郁症患者随机分成两组,分别给予利培酮合并帕罗西汀(合用组)和单用帕罗西汀(单用组)治疗12周,以汉密尔顿抑郁量表(HAM D)和汉密尔顿焦虑量表(HAMA)评定临床疗效,以副反应量表(TESS)和相关检查评定不良反应。结果治疗结束时两组HAM D和HAMA的评分均明显降低,以合用组疗效显著且快(t=3.6688,3.8299;P<0.01)。结论利培酮合并帕罗西汀治疗难治性抑郁症的疗效优于单用帕罗西汀,且耐受性好。     

米氮平合并小剂量奥氮平治疗老年抑郁症的临床研究

目的观察米氮平合并小剂量奥氮平治疗老年抑郁症的临床疗效及不良反应。方法 64例老年抑郁症患者随机分为米氮平合并小剂量奥氮平组和米氮平组,疗程8周。于治疗前,治疗后第1、2、4、6、8周末采用汉密尔顿抑郁量表(HAMD)评定疗效,并同时观察两组药物的不良反应。结果联合用药组在第1周末起效,单药组在疗效第2周末起效;两组治疗后在第1(t=2.323,P0.05)、2(t=2.452,P0.05)、4(t=2.513,P0.05)周末HAMD评分比较差异均有统计学意义,两组不良反应较轻。治疗第8周末,联合用药组与单药组的显效率分别87.50%,62.50%,差异有统计学意义(χ2=5.333,P0.05)。结论联合用药组治疗老年抑郁症起效快,疗效好,不良反应较小。     

米氮平与阿米替林治疗抑郁症对照研究

目的探讨米氮平治疗抑郁症的疗效及安全性。方法将60例符合CCM D-3诊断标准的抑郁症患者随机分为两组,分别给予米氮平和阿米替林治疗,疗程6周,采用汉密尔顿抑郁量表(HAM D)、汉密尔顿焦虑量表(HAMA)、临床总体评定量表(CG I)评定临床疗效,采用副反应量表(TESS)评定副反应。结果米氮平组显效率80%,阿米替林组显效率76.67%,差异无统计学意义(χ2=0.12,P>0.05),各因子分中米氮平组认知障碍减分多于阿米替林组,比较差异有显著性(t=2.72,P<0.05)。HAM D减分两组差异无统计学意义(t=1.45,P>0.05)。结论米氮平见效快,疗效肯定,副反应发生少而轻微。     

One-year outcomes of a randomized clinical trial treating depression in low-income minority women

This study examines 1-year depressive symptom and functional outcomes of 267 predominantly lowincome, young minority women randomly assigned to antidepressant medication, group or individual cognitive- behavioral therapy (CBT), or community referral. Seventy-six percent assigned to medications received 9 or more weeks of guideline-concordant doses of medications; 36% assigned to psychotherapy received 6 or more CBT sessions. Intent-to-treat, repeated measures analyses revealed that medication (p=.001) and CBT (p=.02) were superior to community referral in lowering depressive symptoms across 1-year follow-up. At Month 12, 50.9% assigned to antidepressants, 56.9% assigned to CBT, and 37.1% assigned to community referral were no longer clinically depressed. These findings suggest that both antidepressant medications and CBT result in clinically significant decreases in depression for low-income minority women.     

医师-药师联合门诊对抑郁症患者 服药依从的作用

目的:探讨医师-药师联合门诊对抑郁症患者抑郁、焦虑及服药依从性的影响。方法:选取某心理科门诊的抑郁症患者650例,随机分为观察组(n=320)与对照组(n=330),观察组在医师-药师门诊就诊,医师给患者诊断并开具药物,药师提供可持续的服药知识辅导和服药不适答疑;对照组仅由普通医师门诊诊疗。采用抑郁自评量表(SDS)、焦虑自评量表(SAS)和Morisky表比较复诊时两组患者的抑郁、焦虑及服药依从情况。结果:复诊时,观察组的SDS与SAS评分均低于对照组(均P<0.05),观察组中服药依从性好的患者多于对照组(P<0.05)。Logistic回归分析表明,联合门诊、大学及以上教育程度的患者服药依从性更好(OR=5.66、5.76)。结论:医师-药师联合门诊能够提高抑郁症患者的治疗效果以及服药依从性。     

Combined brief dynamic therapy and pharmacotherapy in the treatment of major depressive disorder: a pilot study

BACKGROUND: The relative efficacy of supplemental psychotherapy in the treatment of depression is still a matter of debate. Moreover, the superiority of brief dynamic therapy (BDT) over supportive psychotherapies is not well established. The aim of this study is to compare the efficacy of BDT added to medication with that of brief supportive psychotherapy (BSP) added to medication in the treatment of major depressive disorder. METHOD: A 12-month randomized clinical trial compared BDT (n = 18) with BSP (n = 17) combined with antidepressants in outpatients with major depressive disorder. Both psychotherapies were added during the first 6 months of the trial; all patients continued to be treated with only pharmacotherapy (paroxetine or citalopram) in the following 6-month continuation phase. Efficacy was assessed using the 17-item Hamilton Rating Scale for Depression (HAM-D), the Hamilton Rating Scale for Anxiety and the Clinical Global Impression (CGI). The data analysis was conducted on two samples: the per-protocol (PP) sample and the observed-cases (OC) sample. RESULTS: Thirty-two patients completed the study. Although at the end of the combined therapies (T2) no differences emerged between the two treatment approaches, the group of patients treated with BDT showed a further clinical improvement at the end of the study (T3): a significant reduction in symptomatology emerged on the HAM-D (PP sample: F = 75.154, p = 0.03; OC sample: F = 67.149, p = 0.022) and on the CGI total scores (PP sample: F = 78.527, p = 0.016; OC sample: F = 74.104, p = 0.007). The difference in remission rates on the HAM-D (75 vs. 12.5% at T3) is statistically significant favoring BDT. CONCLUSIONS: BDT combined with antidepressants is preferable to supportive psychotherapy combined with medication in the treatment of outpatients with major depression.     

Faster remission of chronic depression with combined psychotherapy and medication than with each therapy alone

The main aim of the present novel reanalysis of archival data was to compare the time to remission during 12 weeks of treatment of chronic depression following antidepressant medication (n = 218), psychotherapy (n = 216), and their combination (n = 222). Cox regression survival analyses revealed that the combination of medication and psychotherapy produced full remission from chronic depression more rapidly than either of the single modality treatments, which did not differ from each other. Receiver operating characteristic curve analysis was used to explore predictors (treatment group, demographic, clinical, and psychosocial) of remission. For those receiving the combination treatment, the most likely to succeed were those with low baseline depression (24-item Hamilton Rating Scale for Depression [HRSD; M. Hamilton, 1967] score < 26) and those with high depression scores but low anxiety (HRSD = 26 and Hamilton Anxiety Rating Scale [M. Hamilton, 1959] < 14). Both profiles were associated with at least 40% chance of attaining full remission. The model did not identify predictors for those receiving medication or psychotherapy alone, and it did not distinguish between the 2 monotherapies. The authors conclude that combined antidepressant medications and psychotherapy result in faster full remission of chronic forms of major depressive disorder.     

认知行为治疗与成人注意缺陷多动障碍:认知模式及情绪症状在治疗中的中介作用

目的:探讨认知行为治疗(CBT)对成人注意缺陷多动障碍(ADHD)患者核心症状的直接影响,以及认知模式和情绪症状改变的中介作用。方法:研究纳入既往随机对照试验入组的98名成人ADHD患者,对结果进行二次分析,选取治疗前(T1)、治疗12周结束后(T2)及48周随访(T3)时的核心症状、认知模式及情绪症状得分,构建链式中介模型。结果:CBT可通过焦虑、抑郁情绪症状得分变化影响T2及T3时核心症状得分,也可依次通过认知模式(自动思维和功能失调得分)变化及情绪症状变化影响T3时核心症状得分。结论:CBT短期主要通过改善情绪进而改善ADHD核心症状,同时长期可依次通过认知模式的中介作用影响情绪变化,进而影响ADHD核心症状。     

米氮平合并认知行为疗法治疗躯体形式障碍的疗效

目的:探讨米氮平合并认知行为疗法治疗躯体形式障碍的疗效。方法:将68例躯体形式障碍患者,随机分为研究组和对照组。研究组采用米氮平合并认知行为疗法,对照组单用米氮平治疗,疗程16周。采用症状自评量表(SCL-90)评估两组的疗效。结果:治疗16周末研究组SCL-90躯体化、抑郁、焦虑、恐怖因子分与对照组比较显著降低,差异有统计学意义(t=-2.26,-2.235,-2.15,-2.31;P0.05)。16周末研究组总有效率85.29%,对照组总有效率61.76%,研究组有效率高于对照组(χ~2=4.836,P0.05),差异有统计学意义。结论:米氮平合并认知行为疗法治疗躯体形式障碍优于单用米氮平治疗。     

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.     

百乐眠胶囊联合盐酸氟西汀治疗难治性抑郁症疗效及对患者睡眠质量和记忆商数的影响

目的:探讨百乐眠胶囊联合盐酸氟西汀治疗难治性抑郁症疗效及对患者睡眠质量和记忆商数的影响。方法:收集112例难治性抑郁症患者作为研究对象,按照随机数字表法分为对照组56例和观察组56例。对照组患者给予盐酸氟西汀治疗,观察组在对照组基础上联合应用百乐眠胶囊治疗。8周后,采用汉密尔顿抑郁量表17项目(HAMD)评定难治性抑郁症疗效,匹兹堡睡眠质量指数(PSQI)评定睡眠质量,韦氏成人记忆量表(WMS)测验记忆商数。比较两组患者难治性抑郁症临床疗效、HAMD评分、PSQI评分、记忆商数及不良反应。结果:8周后,观察组患者难治性抑郁症治疗总有效率高于对照组(χ~2=4.75,P0.05)。与对照组相比,观察组患者治疗后2周、4周、8周时的HAMD评分降低(t=8.04,9.59,8.57;P0.01),PSQI评分降低(t=11.35,P0.01),记忆商数升高(t=8.82,P0.01)。治疗过程中,对照组和观察组患者不良反应发生率比较无统计学差异(χ~2=0.18,P0.05)。结论:百乐眠胶囊联合盐酸氟西汀是难治性抑郁症的有效治疗方案,治疗有效率高,能够有效改善临床症状、睡眠质量及记忆功能,且不良反应轻微,临床上值得应用。     

短期心理干预联合药物治疗地震后失眠患者的疗效观察

目的观察短期心理干预联合药物治疗地震后失眠患者的疗效。方法将120例汶川地震后首次出现失眠症状的患者随机分配至研究组和对照组,各60例,分别给予为期2周的心理干预联合药物治疗或单纯药物治疗,并用汉密顿抑郁量表（HAMD）的睡眠因子及每晚总睡眠时间来评定疗效。结果研究组的睡眠因子在治疗第1周末即有显著下降,在第2周末明显低于对照组;两组在治疗第2周末总睡眠时间均有显著增加,但研究组明显多于对照组。结论短期心理干预联合药物治疗地震后失眠患者的疗效优于单纯药物治疗。