不同治疗方法对儿童青少年拒绝上学的疗效观察

目的探讨拒绝上学（School Refusal,SR）的不同治疗方法,并比较各自的疗效,为采取相应的干预措施提供依据。方法将52例SR患者随机分为3个治疗组,其中单独认知行为治疗（CBT）组16人,氟西汀治疗组18人,CBT＋氟西汀治疗组18人,疗程24周。治疗前、后采用焦虑自评量表（SAS）、临床全面印象量表（CGI-S）和返校率进行评估。结果单独CBT治疗组治疗前后SAS、CGI-S评分比较,差异均有统计学意义（P值均〈0.01）,返校率为75.00%;单独氟西汀治疗组治疗前后SAS、CGI-S评分比较,差异均有统计学意义（P值均〈0.01）,返校率为72.22%;CBT＋氟西汀治疗组治疗前后SAS、CGI-S评分比较,差异均有统计学意义（P值均〈0.01）,返校率为83.30%。各组间返校率比较,差异无统计学意义（P〉0.05）。结论CBT、氟西汀及两者联合治疗均可以有效治疗SR,联合治疗疗效可能最佳。

Impact of Different Treatment Methods of School Refusal Among Adolescents

Objective To evaluate the impact of different treatment in school refusal(SR),and to provide evidence for the intervention measures.Methods Fifty-two patients with SR were randomized into three groups:cognitive behavior therapy(CBT)alone(n=16);Fluoxetine alone(n=18);CBT Fluoxetine(n=18).The treatment lasted for 24 weeks.Self-Rating Anxiety Scale(SAS),Clinical Global Impression-Severity Scale(CGI-S)and the school attendance were conducted before and after the treatment.Results After 24 weeks,in the CBT alone group,the SAS score and CGI-S score were significantly decreased(P<0.01),and the percentage of school attendance was 75.00%;in Fluoxetine alone group,the SAS score and CGI-S score were significantly decreased(P<0.01),and the percentage of school attendance was 72.22%;in the combined therapy group,the SAS score and CGI-S score were significantly decreased(P<0.01),and the percentage of school attendance was 83.30%.There was no significant difference in the percentage of school attendance among the three groups(P>0.05).Conclusion The CBT alone,Fluoxetine alone and combined therapy can effectively treat SR,and the combined therapy may be the best one.