理情行为疗法对卒中后抑郁的心理干预研究

目的应用理情行为疗法(REBT)对卒中后抑郁患者进行心理干预，观察其对患者情绪、认知功能和日常生活活动能力(ADL)等方面的影响。方法将80 例卒中后抑郁患者分为对照组(n=40)和观察组(n=40)。对照组给予新型抗抑郁药盐酸氟西汀，每天20 mg；观察组在此基础上给予REBT，每次20 min，每周3 次。疗程均为8 周。分别在治疗前后应用汉密尔顿抑郁量表(HAMD)、简易智能精神状态检查量表(MMSE)及Barthel 指数(BI)对患者的抑郁障碍、认知功能和ADL3 个方面进行评定。结果治疗后，两组HAMD评分均较治疗前明显降低(P<0.01)，MMSE 和BI 评分较治疗前明显增高(P<0.01)；观察组HAMD评分低于对照组(P<0.05)，MMSE、BI 评分高于对照组(P<0.05)。治疗前后对照组BI 变化与睡眠障碍因子分变化正相关(P<0.05)，观察组BI 变化与睡眠障碍因子分变化和躯体化因子分变化均呈正相关(P<0.05)。两组抑郁改善程度无显著性差异(P>0.05)，但观察组的疗效有优于对照组的趋势。结论REBT 结合抗抑郁药较单用该药能更好地改善卒中后患者的抑郁症状、认知功能和ADL，且REBT 改善情绪障碍中躯体化症状和睡眠障碍可能与ADL 的提高有关。

Application of Rational-emotive-behavior Therapy for Patiens with Poststroke Depression

Objective To explore the effect of the rational-emotive-behavior therapy(REBT) on mood,cognition and activities of daily living(ADL) of patients with poststroke depression(PSD).Methods 80 PSD patients were divided into control group(n=40) and observation group(n=40).Both groups were given Prozac(20 mg/d) for 8 weeks,and the observation group received REBT(3 times per week,20 min every time) additionally.Hamilton Rating Scale for Depression(HAMD),Mini Mental State Examination(MMSE) and Barthel Index(BI) were evaluated before and after treatment.Results After 8-week treatment,the scores of HAMD in two groups reduced significantly(P<0.01),and the scores of MMSE and BI increased significantly(P<0.01).The scores of HAMD were lower in the observation group than in the control group(P<0.05),and the scores of MMSE and BI were higher in the observation group than in the control group(P<0.05).The BI score was related with sleeping disorder in control group(P<0.05).The BI score was both related with sleeping disorder and somatization in the observation group(P<0.05).There was no significant difference in the extent of effectiveness on depression between two groups(P>0.05),but there was the trend that the efficacy of the observation group was better than the control group.Conclusion REBT combined with antidepressant drugs can better relieve the symptoms of depression and improve cognitive function and ADL of PSD patients.The improvement of somatization and sleep disorders by REBT has a relationship with the enhancement of ADL.