帕罗西汀合并认知行为疗法治疗惊恐障碍对照研究

目的观察帕罗西汀合并认知行为疗法对惊恐障碍的治疗效果。方法将符合ICD-10诊断标准的40例惊恐障碍患者分为治疗组和对照组,治疗组给予帕罗西汀30~40mg/d合并认知行为治疗,对照组只给予帕罗西汀30~40mg/d治疗,应用临床标准疗效及汉密尔顿焦虑量表（HAMA）、临床疗效总评量表（CGI-SI）及副反应量表（TESS）评定疗效和不良反应。观察12周。结果在治疗第4、8和12周末时,治疗组疗效均优于对照组,具有显著性统计学意义（P〈0.05）。两组不良反应轻微,无需处理。结论帕罗西汀合并认知行为疗法治疗惊恐障碍效果优于单纯用药物治疗。     

舍曲林合并认知行为疗法治疗惊恐障碍14例

目的 :观察舍曲林合并认知行为疗法对惊恐障碍的治疗效果。方法 :对符合CCMD -Ⅱ -R诊断标准的 14例惊恐障碍患者给每晨饭后 5 0毫克的舍曲林连续治疗 6个月 ,同时给予认知行为治疗 ,按临床疗效判定标准定期评定。结果 :一个月显效者占 2 1 4% ,好转占 64 3 % ,无效占 14 3 % ;三个月显效者占71 4% ,好转占 2 8 6% ,半年时显效者占 85 7% ,好转者占 14 3 %。 2 1 4%患者在治疗中出现过轻微的副作用 ,随时间延长而消失。结论 :舍曲林合并认知行为治疗能明显缩短疗程 ,减少医疗开支 ,安全性高 ,依从性好     

认知行为疗法并帕罗西汀治疗惊恐障碍疗效分析

目的评价认知行为疗法并帕罗西汀治疗惊恐障碍的治疗效果。方法将符合中国精神障碍分类与诊断标准的69例惊恐障碍患者随机分为研究组（n=37）和对照组（n=32）。研究组给予认知行为并帕罗西汀治疗,对照组单用帕罗西汀治疗,疗程12周,在入组前和治疗2、4、8、12周末应用临床疗效标准和汉密尔顿焦虑量表（HAMA）评定疗效。完成该研究的60名参与者的数据纳入了结果分析。结果汉密顿焦虑量表总分研究组治疗2周末较治疗前有极显著性下降（t=5.56,P〈0.01）;对照组治疗4周末较治疗前有极显著性下降（t=4.27,P〈0.01）;治疗后2、4、8、12周末研究组疗效显著优于对照组。结论认知行为疗法并帕罗西汀治疗惊恐障碍效果优于单用帕罗西汀治疗。     

认知行为疗法与药物治疗社交焦虑障碍的疗效对照研究

目的探讨认知行为疗法联合药物治疗社交焦虑障碍的疗效。方法符合CCMD-3社交焦虑障碍诊断标准的36位病人,随机将其中的18例在常规药物治疗的基础上联用认知行为疗法做为研究组,另18例单纯接受常规药物治疗为对照组,均系统治疗12周,采用临床疗效评定,临床精神症状自评量表及自我评估报告评定两组治疗社交焦虑障碍的疗效。结果认知行为疗法联合药物治疗组的疗效优于单用常规药物治疗组。结论认知行为疗法联合药物治疗可以增强社交焦虑障碍的疗效。     

认知行为疗法联合药物治疗惊恐障碍疗效Meta分析

目的:比较认知行为疗法(CBT)联合药物治疗与单纯药物治疗对惊恐障碍的疗效。方法:对CBT联合药物治疗与单纯药物治疗惊恐障碍的对照研究进行系统评价,使用Revman 5.2进行Meta分析。结果:共纳入6项符合标准的随机对照研究,合计样本量329人。6组数据比较了CBT联合药物治疗与单纯药物治疗惊恐障碍的有效率和显效率,结果显示,联合治疗组的有效率(OR=3.28,Z=2.75,P<0.05)与显效率(OR=2.85,Z=3.90,P<0.05)均优于单纯药物组;5组数据比较了CBT联合药物治疗与单纯药物治疗惊恐障碍的治愈率,结果显示,联合治疗组的治愈率优于单纯药物组(OR=2.08,Z=2.82,P<0.05)。结论:鉴于目前结果推测对于惊恐障碍的改善,认知行为疗法联合药物治疗优于单纯药物治疗,但仍需进一步研究证实。     

Efficacy of Posttraumatic Stress Disorder Treatment for Comorbid Panic Disorder: A Critical Review and Future Directions for Treatment Research

A systematic review of trauma treatment outcome literature was conducted to determine the impact of treatment on comorbid panic symptoms. Major databases were searched (from 1989 to 2013) and 64 randomized controlled trials using cognitive behavioral approaches to treat acute stress disorder, subthreshold posttraumatic stress disorder (PTSD), and full PTSD met inclusion criteria for this review. Results showed that 41% of the studies reviewed did not assess for Axis I psychiatric comorbidity at any point during the course of treatment. Only 5% of the studies reviewed reported rates of comorbid panic disorder (PD) at more than one time point during the study. Results indicate that approximately 56% of people no longer meet PD criteria following PTSD treatment.     

国内认知行为疗法联合药物治疗广泛性焦虑疗效的元分析

目的:分析认知行为疗法(CBT)联合药物治疗与单纯使用药物治疗对广泛性焦虑干预的疗效。方法:对CBT和药物联合治疗与单纯使用药物治疗广泛性焦虑的对照研究进行回顾研究,使用Revman 5.3进行系统评价。结果:共获得7篇文献符合本文的元分析选择标准,被试人数共435人。7组数据比较了CBT和药物联合治疗与单独使用药物治疗广泛性焦虑的治愈率、显效率和有效率,结果显示,联合治疗组的治愈率(OR=2.69,Z=4.33,P0.05)、显效率(OR=2.07,Z=3.58,P0.05)与有效率(OR=3.11,Z=3.50,P0.05)均优于单纯药物组。结论:在国内治疗广泛性焦虑中,认知行为疗法联合药物治疗8周后比单独使用药物治疗效果更好。     

An Efficient Method of Identifying Major Depression and Panic Disorder in Primary Care

The research literature is replete with evidence of and concerns about the prevalence and undertreatment of mental disorders in primary care. Although screening, on its own, may not directly affect clinical outcomes, it is still the most efficient and effective way to identify psychologically distressed patients for either research purposes or to provide patients with or refer patients to appropriate care. The current study sought to establish the utility of the MHI-5 for the detection of patients suffering from major depression or panic disorder, two of the most common psychiatric conditions seen in primary care settings. This study was conducted in a family medicine clinic and 246 adult outpatients participated. Patients completed the Mental Health Index-5 (MHI-5) as the screening measure and the PRIME-MD Patient Health Questionnaire (PHQ) as the diagnostic instrument. ROC analyses indicated that a cut-off score of 23 on the MHI-5 yielded a sensitivity of 91% and a specificity of 58% for predicting provisional diagnoses of major depression or panic disorder from the PHQ. Using a single item to screen for a PHQ diagnosis of major depression yielded a sensitivity of 88% and a specificity of 62% and a second question had a sensitivity of 100% and specificity of 63% for PHQ diagnosis of panic disorder. These results indicate that it is possible to use a small number of items to efficiently and effectively screen for mental disorders affecting a significant portion of primary care patients.     

首发广泛性焦虑障碍患者认知功能特点

目的:探讨首发广泛性焦虑障碍患者认知功能的特点。方法:应用广泛性焦虑障碍量表(GAD-7)、状态-特质焦虑问卷(STAI)、剑桥神经心理自动化成套测试软件(CANTAB)中RVP、DMS、IED 3项测验对48名首发广泛性焦虑障碍患者及48名正常对照施测,分析两组被试注意能力、工作记忆能力、执行功能的差异,并了解上述认知功能和总体焦虑水平、状态焦虑、特质焦虑的相关性。结果:首发广泛性焦虑障碍组RVP测验正确率显著低于对照组(t=-4.38,P0.05),平均反应时显著长于对照组(t=4.66,P0.05);DMS测验中多项延迟测试任务正确数都显著低于对照组(t=-6.31~-3.62,P0.05),平均反应时都显著长于对照组(t=3.45~4.17,P0.05);IED测验中总错误数(t=3.33,P0.05)、外维转换错误数(t=2.48,P0.05)、完成测试数(t=2.59,P0.05)显著大于对照组。首发广泛性焦虑障碍组DMS多项延迟测试反应时、IED外维转换错误数与GAD-7、SAI、TAI得分呈显著正相关(P0.05),RVP正确率与GAD-7、SAI得分成呈显著负相关(P0.05)。结论:首发广泛性焦虑障碍患者存在多项认知功能异常。     

The Treatment of Dissociative Identity Disorder with Cognitive Analytic Therapy: Experimental Evidence of Sudden Gains

ABSTRACT

The central aim of this study was to assess the effectiveness of cognitive analytic therapy (CAT) with a patient presenting with DID. The methodology employed an A/B single case experimental design with six-months continuous follow-up in seven experimental measures. A and B represent the assessment of seven dissociative experimental variables under two conditions: baseline (A) and treatment (B). Treatment consisted of 24 sessions of CAT with four follow-up sessions, which is standard within the CAT model for personality disorder patients. A battery of measures of general psychological functioning was also completed at assessment, termination, and follow-up. During treatment the intensity of a range of dissociative symptoms was observed to be reduced, with sudden gains evident due to specific CAT interventions in specific dissociative symptoms. The long-term effectiveness of the intervention was established by the illustration of either continued stability or continued improvement in experimental variables across the follow-up period. Analysis of the general measures illustrates clinically significant change across a variety of robust psychometric measures. The study illustrates the utility of single-case approaches with dissociative disorders and the potential for utilizing CAT generally with such presentations.     

婚姻治疗对女性惊恐障碍患者疗效的影响

目的:探讨婚姻治疗对女性惊恐障碍患者的疗效。方法:将53例已婚惊恐障碍女性患者随机分为研究组和对照组,对两组患者病前应激性生活事件调查、常规药物治疗和认知行为治疗6个月,研究组加婚姻治疗;治疗前后OLSON婚姻质量问卷测查。结果:患者病前一年内应激性生活事件婚姻家庭问题研究组为89.2%,对照组为92%;治疗前两组患者的婚姻质量的各维度得分无显著性差异(P>0.05),而治疗后两组患者的婚姻质量中婚姻满意度(34.7±6.1/31.3±5.6,t=2.185)、夫妻交流(31.9±5.2/29.0±5.0,t=2.064)、解决冲突方式(33.2±4.4/30.1±3.2,t=2.902)、性生活(32.9±4.8/30.1±5.3,t=2.018)等4个维度研究组高于对照组,具有统计学差异(P<0.05);治疗6个月后临床有效率:研究组为85.7%,对照组为76%,经χ2检验,两者之间有显著性差异(P<0.05)。结论:已婚惊恐障碍女性患者病前一年内应激性生活事件是以婚姻家庭问题为主。常规药物治疗和认知行为治疗加婚姻治疗能有效提高疗效和婚姻质量。     

Interpersonal Relationships in Panic Disorder With Agoraphobia: A Review of Empirical Evidence

Recently there has been considerable research exploring the interpersonal relationships of patients diagnosed with panic disorder with agoraphobia. In general, recent empirical investigations support the notion that agoraphobics' interpersonal relationships are problematic and can decrease treatment efficacy. In addition, it appears that involving the partner of the agoraphobic in treatment may be more effective than treating the client alone. However, these conclusions are limited by several methodological and conceptual shortcomings, including narrow and/or biased sample selection, lack of adequate measures, and insufficient use of suitable control groups.     

稳定期双相障碍认知功能及相关因素对照研究

目的探讨稳定期双相障碍患者认知功能损害特点及相关因素分析。方法对来我院门诊和住院部的符合ICD-10双相情感障碍,目前为缓解状态诊断标准的60例患者,和本院非临床工作人员或其他单位的60例正常者(对照组),采用蒙特利尔认知评价量表(MoCA)进行测试。结果①研究组总分(25.63±2.96)、视空间与执行功能(3.75±1.10)、记忆(3.05±1.36)、注意(5.18±0.75)与对照组存在明显差异(P0.05);②其中联合用药共38例(63.33%),出现认知功能障碍15例。单一用药22例(36.66%),出现认知功能障碍12例。两组认知功能损害无统计学差异;③病程≥24月与病程24月患者相比较,有统计学意义(χ2=6.613。P0.013)。结论稳定期双相障碍患者存在明显的注意、记忆和执行功能等认知功能损害,与病程的长短存在一定的相关性。     

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。     

人际心理治疗与认知行为治疗对广泛性焦虑障碍治疗效果的对照研究

目的:探讨人际心理治疗与认知行为治疗对广泛性焦虑障碍的疗效。方法:将90例广泛性焦虑障碍患者随机分为人际心理治疗组(IPT)和认知行为治疗组(CBT)各45例,疗程为12周,分别于治疗前后采用汉密尔顿焦虑量表(HAMA)和汉密尔顿抑郁量表(HAMD)评定临床疗效。结果:治疗后,两组的HAMA、HAMD评分都明显低于治疗前(如HAMAt=9.97,11.41;P均0.01);治疗后CBT组的睡眠障碍因子分差值低于IPT组(t=2.34,P0.05),两组间其余因子分差值无显著性差异(如HAMAt=-0.51,P0.05)。结论:人际心理治疗与认知行为治疗对广泛性焦虑障碍均有疗效,认知行为治疗在改善睡眠障碍方面要优于人际心理治疗。     

强迫障碍认知行为治疗技术成分的应用现状调查

目的通过文献复习法了解强迫障碍认知行为治疗技术的应用现状。方法通过自制文献复习表,调查近10年认知行为治疗强迫障碍的随机对照研究文献。结果在18篇随机对照研究文献中,单独使用ER/RP的频率为55.6%,同时使用认知和行为技术的频率为38.9%,单独使用认知技术的频率为5.5%。在所有技术中,ER/RP为88.89%,行为实验为38.89%,检查证据为33.33%。每次治疗的时间在45～120分钟之间,治疗次数在10～24次之间,治疗频率为每周1～5次。结论强迫障碍认知行为治疗技术中,行为技术(特别是暴露与仪式/行为阻止)的使用频率最高,认知与行为技术联合应用次之,认知技术的使用频率较低。治疗设置随病情和治疗情况的不同在治疗次数、治疗频率以及每次治疗时间上均不同。     

帕罗西汀合并认知疗法治疗酒依赖伴发抑郁及对戒酒的影响

目的评价帕罗西汀合并认知疗法治疗酒依赖伴发抑郁的疗效及对戒酒的影响。方法将98例酒依赖伴发抑郁的患者随机分为研究组和对照组,分别用认知疗法合并帕罗西汀、单用帕罗西汀治疗4个月。用汉密顿抑郁量表(HAMD)评定疗效;用复饮率评定戒酒效果。结果治疗1个月后,研究组HAMD评分16.79±6.50与对照组相近17.88±6.59(P>0.05)。治疗4个月后HAMD评分10.76±5.32、明显低于对照组14.54±5.12(P<0.01);临床疗效(痊愈率44.44%、显效率22.22%、有效率33.34%)明显高于对照组(21.74%、21.74%、56.52%)(P<0.05);复饮率(24.44%)低于对照对照组(45.56%)(P<0.05)。结论认知疗法合并帕罗西汀治疗酒依赖伴发抑郁疗效较好,戒酒效果较好。     

利培酮合并西酞普兰及认知疗法治疗强迫症的观察

目的 观察利培酮合并西酞普兰及认知行为疗法治疗强迫症的疗效和不良反应.方法 将84例强迫症患者随机平分为两组,治疗组以利培酮合并西酞普兰及认知行为治疗,对照组以西酞普兰合并认知行为治疗.疗程12周,以强迫症量表(YBOCS)、汉密尔顿焦虑量表(HAMA)评定疗效,以副反应量表(TESS)评定不良反应.结果 利培酮合并西...