认知行为治疗联合氟西汀干预儿童及青少年抑郁症的研究

目的探讨治疗儿童及青少年抑郁症的有效方法。方法采用开放式的随机对照研究（RCT）方法将符合抑郁症诊断标准（年龄在12—18岁）的儿童及青少年患者122例，随机分为治疗组42例[认知行为治疗（CBT）＋氟西汀治疗]；单纯CBT治疗组43例和单纯氟西汀治疗组37例。在治疗前和治疗后应用全面功能评估量表（GAF）、全面关系功能评估量表（GARF）、临床全面印象量表（CGI—S）进行评估；在治疗前和治疗第2、第4、第6、第8、第12周应用汉密尔顿抑郁量表（HRSD）、抑郁情绪温度计（T—s）和暴躁情绪温度计（T-I）进行评估，以判断疗效。结果三组的HRSD、T—I、T-S评分随着治疗的时间增加逐步减分，治疗前后有明显的差异（P〈0．01），而三组间比较差异无统计学意义（P〉0．05）。三组治疗前后的CGI、GARF、GAF评分均有明显的差异（P〈0．01）；而其中以CBT组的CGI、GARF、GAF评分治疗前后比较差异最为明显（P〈0．01），与其他组比较差异亦有统计学意义（P〈0．01）。结论国际上通用的CBT治疗指南适用于儿童及青少年抑郁症的治疗。CBT＋氟西汀治疗、单纯CBT治疗、单纯氟西汀治疗三种方法都可以有效治疗儿童及青少年抑郁症，但以CBT单纯治疗的效果更优。

A study of the cognitive behavioral therapy combined with fluoxetine intervention for children and adolescents depression

Objective To study the most effective treatment for children and adolescents depression. Meth- ods The open mode of randomized controlled study （RCT） was conducted. The children and adolescents （ n = 122） at the age of 12 - 18 years who were complied with depression diagnosis standard were divided into the 3 groups： cognitive behavioral therapy（CBT） ＋ Fluoxetine group （n =42） ; CBT group （n =43） and Fluoxetine group （n =37）. Before treatment and after treatment, the Global Assessment Function （GAF）, the Global Assessment of Relational Functioning （GARF）, Clinical Global Impression （CGI-S）,and before treatment, 2nd w, 4th w, 6th w, 8th w and 12th w after the beginning of treatment, the Hamilton depression scale （HRSD）, Depressed mood thermometer （T- S） and Irritable mood thermometer （T-I） were conducted to evaluate the treatment effect. Results HRSD, T-I and T-S scores of 3 groups were reducing gradually with the time of treatment were found, and before and after treatment were significantly different （ P 〈 0.01 ）, but within the three groups were not different. Before and after treatment CGI, GARF, GAF scores of the 3 groups were significandy different （P 〈0.01 ）. Before and after the treatment, CGI, GARF, GAF scores of the CBT group were significantly different with the other group （P 〈0. 01 ）. Conclusion The international general CBT treatment guidelines can be used for children and adolescents depression. The CBT, CBT ＋ Fluoxetine and Fluoxetine alone could be an effective treatment for children and adolescents depression. CBT seemed to be most effective therapy for children and adolescents depression.