心理治疗肠易激综合征疗效的临床研究

目的：观察心理治疗肠易激综合征的临床疗效。方法：入组57例肠易激综合征患者,分为实验组和对照组,实验组给予心理治疗加常规药物治疗,对照组则只给予常规药物治疗,疗程均为12周,观察患者肠易激综合征症状、精神心理状态和生活质量的改善情况。结果：实验组治疗12周后能改善肠易激综合征总体症状和除腹胀以外的肠道症状,其中以腹痛症状的改善明显(5.10±0.74 vs 3.10±1.10,P＜0.05)。实验组症状自评量表 90、汉密尔顿焦虑量表及汉密尔顿抑郁量表总均分较治疗前显著下降,其中以焦虑、抑郁因子下降明显(2.56±0.07 vs 1.46±0.07;2.45±0.03 vs 1.34±0.04,P＜0.01)。结论:心理治疗能改善肠易激综合征症状,能改善患者伴随的焦虑、抑郁,提高患者的生活质量。     

心理治疗辅以氟西汀对前列腺癌患者围手术期焦虑抑郁症状的疗效观察

目的：探讨心理治疗联合氟西汀对前列腺癌患者围手术期焦虑、抑郁症状的治疗效果。方法：本研究对2010年3月至2012年10月住院期间的127例前列腺癌患者采用汉密尔顿焦虑量表（HamiltonAnxietyScale,HAMA）和汉密尔顿抑郁量表（HamiltonDepressionScale,HAMD）进行焦虑、抑郁症状评分。并与127例非肿瘤疾病的男性泌尿系疾病患者对照。将伴焦虑或（和）抑郁症状的83例患者随机分为对照组、心理治疗组、氟西汀治疗组以及心理治疗联合氟西汀治疗组,以汉密尔顿焦虑量表和汉密尔顿抑郁量表的评分作为治疗效果的评价标准。结果：前列腺癌患者伴发焦虑、抑郁症状的发生率明显高于非实体肿瘤的患者（P〈0．05）,患者经心理治疗或氟西汀治疗后汉密尔顿焦虑量表和汉密尔顿抑郁量表的评分较对照组显著下降（P〈0．05）,心理治疗较氟西汀治疗疗效更为显著（P〈0．05）,心理治疗联合氟西汀治疗较单独采用氟西汀或心理治疗的HAMA、HAMD评分下降更为显著（P〈0．05）。结论：心理治疗联合氟西汀治疗前列腺癌围手术期患者的焦虑、抑郁症状疗效满意,且明显提高了患者的生活质量。     

噻奈普汀治疗首发抑郁与焦虑障碍共病40例临床分析

目的评价噻奈普汀治疗首发抑郁与焦虑障碍共病患者的临床疗效。方法对40例首发抑郁与焦虑障碍共病患者进行8周治疗。分别于治疗前和治疗后1、2、3、4、6、8周末采用汉密尔顿抑郁量表(HAMD24)、汉密尔顿焦虑量表(HAMA14)、抑郁症状自评量表(SDS)和焦虑症状自评量表(SAS)进行单盲评定。结果HAMD24总分从治疗2周开始显著下降,有效率达90%(36例),临床痊愈达35%(14例)。HAMA14、SDS和SAS总分从治疗1周末便显著下降,有效率和临床痊愈率分别为:HAMA1490%(36例)、67.5%(27例),SDS100%(40例)、62.5%(25例),SAS100%(40例)、90%(36例)。HAMD24躯体化障碍、体重减轻和睡眠障碍因子分在治疗1周末显著下降,其余在2周末显著下降(<0.05)。HAMA14、SDS、SAS因子分均在治疗1周末显著下降(<0.05)。噻奈普汀对自杀、自卑感和自知力等症状分治疗3周后才显著改善(<0.05)。对性功能障碍、疑病、无望、无用、人格解体及强迫症状治疗8周后仍无显著减分(>0.05)。结论噻奈普汀治疗抑郁焦虑共病患者有效率高,但临床痊愈率不高,改善焦虑发作比抑郁发作疗效好。     

针灸联合心理疗法对初次胰岛素治疗的糖尿病伴郁焦症患者的临床研究

目的:观察针灸联合心理治疗对初次胰岛素治疗的糖尿病伴抑郁焦虑症状患者的疗效.方法:将初次进行胰岛素治疗的50例糖尿病伴抑郁焦意症状的患者随机分为2组(A组和B组),每组25例,2组都给予诺和锐30常规或强化治疗,在此基础上A组同时给予针灸治疗和心理治疗,疗程2周,观察2组血糖控制情况、胰岛素用量、低血糖发生率以及抑郁焦虑改善情况.结果:治疗后2组抑郁焦虑症状都有改善,汉密尔顿抑郁量表(HAMD)及汉密尔顿焦虑量表(HAMA)评分都有下降,A组优于B组(P＜ 0.01).治疗后2组血糖均明显下降,但无统计学意义；在胰岛素用量方面,A组明显少于B组(P＜0.01).在低血糖发生方面,A组亦明显少于B组(P＜0.05).结论:针灸联合心理治疗时初次胰岛素治疗的糖尿病伴抑郁焦虑症状患者在降糖的同时不仅能缓解抑郁焦虑症状,还能减少胰岛素用量,且低血糖发生事件亦明显减少.     

心理治疗在惊恐障碍急诊处理中的应用

目的 探讨心理治疗在惊恐障碍患者急救中的效果.方法 将急诊就诊的30名患者随机分为常规治疗组(A组)和常规治疗组加心理治疗组(B组).用汉密尔顿焦虑量表(HAMA)在治疗前后评定患者情绪变化,根据患者主诉病情是否好转来评定治疗是否有效.结果 治疗后B组HAMA评分明显低于A组,B组治疗后有效率明显高于A组.结论 心理治疗结合药物治疗能有效缓解惊恐障碍的焦虑情绪,从而提高临床治疗效果.     

舍曲林与阿普唑仑治疗广泛性焦虑障碍的疗效比较

目的比较舍曲林与阿普唑仑治疗广泛性焦虑障碍的疗效及副作用。方法对92例符合CCMD-Ⅲ广泛性焦虑障碍诊断标准的患者,随机分为舍曲林组(44例)和阿普唑仑组(48例),治疗12周,用汉密尔顿焦虑量表、汉密尔顿抑郁量表和药物副作用量表评定疗效和副作用。结果治疗12周末舍曲林组的疗效与阿普唑仑组比较,差异无显著性意义。但舍曲林组HAMD的减分率(72.6%)显著高于阿普唑仑组(49.7%),且未出现明显的镇静、嗜睡、乏力等副作用。结论舍曲林能有效地治疗广泛性焦虑障碍,副作用轻,适宜长期治疗。     

心理干预在支气管哮喘患者治疗中的作用

目的 探讨对支气管哮喘患者心理干预的方法和疗效.方法 采用随机对照方法,将符合标准的哮喘患者分为干预和非干预组,两组均进行规范治疗,干预组同时给予12周的心理治疗;采用汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HSRD)对哮喘患者72例进行焦虑和抑郁情绪的心理评估,比较干预前后两组患者在情绪、躯体症状、肺功能和免疫功能的变化.结果 支气管哮喘患者焦虑、抑郁等负性情绪表现明显,经过心理治疗后,干预组和非干预组焦虑、抑郁得分均低于治疗前,但干预组患者的焦虑、抑郁等负性情绪改善明显优于非干预组(P<0.05或0.01);肺功能的改善亦优于非干预组(P<0.01);两组患者CD4 、CD4 /CD8 、EOS较治疗前明显降低,CD8 较治疗前明显升高,但干预组均比非干预组更显著(P<0.05).结论 心理干预能明显改善哮喘患者的情绪障碍、躯体症状、肺功能和免疫功能,是一种有效的辅助治疗方法.     

心理治疗联合度洛西汀治疗躯体化障碍患者中的应用效果研究

目的:探讨度洛西汀联合心理疗法治疗躯体化障碍的临床效果及安全性。方法:选取我院精神科收治的躯体化障碍患者64例,随机分为心理治疗组和度洛西汀组各32例,度洛西汀组患者给予度洛西汀治疗,心理治疗组患者在度洛西汀治疗的基础上联合心理治疗,疗程2个月,应用汉密尔顿焦虑量表(HAMA)、17项汉密尔顿抑郁量表(HAMD17)评价两组临床疗效,观察两组患者用药后不良反应。结果:治疗2个月后心理治疗组患者HAMA、HAMD17评分均显著低于度洛西汀组患者,临床有效率也显著高于度洛西汀组(81.3%vs65.6%)(P0.05),两组间不良反应比较未见显著性差异(P0.05)。结论:心理治疗联合度洛西汀可明显改善躯体化障碍患者抑郁、焦虑情绪,提高临床治疗效果,临床应用安全,值得退广。     

13例神经性厌食症患者的综合治疗

目的观察以心理治疗为主的综合治疗对神经性厌食症患者的疗效。方法对13例神经性厌食症患者采用心理教育、认知行为治疗、营养支持,同时辅以抗抑郁、抗焦虑以及对症治疗,总疗程8周。采用体质量、体质量指数(BMI)、汉密尔顿抑郁量表(HAMD)及汉密尔顿焦虑量表(HAMA)评价治疗效果。结果与治疗前相比,治疗后患者的体质量、体质量指数增高(P<0.05),HAMD及HAMA评分下降(P<0.05)。结论心理治疗为主的综合治疗对AN患者的疗效较为显著。     

奥沙西泮与地西泮对睡眠障碍患者抑郁与焦虑情绪改善的对比研究

目的观察奥沙西泮与地西泮对老年睡眠障碍患者的治疗作用及对老年睡眠障碍患者抑郁及焦虑情绪的改善作用。方法将研究对象分为健康对照组,奥沙西泮治疗组,地西泮治疗组,通多匹兹堡睡眠质量指数(Pittsburgh sleep quality index,PSQI),汉密尔顿焦虑量表(Hamilton anxiety scale,HAMA),汉密尔顿抑郁量表(Hamilton depression scale,HAMD)比较奥沙西泮与地西泮对睡眠障碍,抑郁、焦虑情绪的改善作用。结果地西泮与奥沙西泮在治疗2周时均可以明显改善失眠患者的睡眠质量,PSQI与对照组无差异(P0.05)。治疗2周后奥沙西泮治疗组患者HAMD评分较地西泮组下降,二者比较差异有统计学意义(P0.05)。4周后奥沙西泮治疗组患者HAMA评分较地西泮组下降,二者比较差异有统计学意义(P0.05);治疗4周后奥沙西泮治疗组患者HAMD评分较地西泮组明显下降,二者比较差异有统计学意义(P0.01),且奥沙西泮治疗组HAMD评分与对照组无统计学差异(P0.05)。结论奥沙西泮能够治疗老年患者的睡眠障碍,同时具有较好的缓解抑郁及焦虑情绪的作用。     

惊恐障碍的治疗与咨询：基于病例学习的心理健康案例研究——惊恐障碍

惊恐障碍是一种焦虑障碍，以反复出现不可预期的惊恐发作为特点，常伴有强烈的害怕、心悸、出汗、震颤、窒息感和濒死感等，患者持续担心症状发作或回避相关场所，易发展为广泛性焦虑症。全球范围内惊恐障碍发病率约为2.1%，近年来其发病率逐年增高，疾病负担越来越重。目前我国惊恐障碍患者的首诊几乎全部在综合医院，误诊率较高，尚缺乏快速有效的治疗方法。本文从生物-心理-社会医学模式出发，通过对1例35岁女性惊恐障碍患者诊疗过程进行描述和分析，体现了辨证统合心理治疗过程中的重要环节及其应用情况，以期为提高全科医生对整合取向心理治疗的了解和应用能力提供借鉴。     

综合疗法治疗惊恐障碍30例临床疗效观察

[目的] 观察针灸、电针、心理疗法治疗惊恐障碍的临床疗效。[方法] 将60例惊恐障碍患者随机分为治疗组30例、对照组30例。治疗组采用针灸、电针结合心理疗法, 对照组给予口服赛乐特治疗。[结果] 治疗组总有效率为83.33%, 对照组为76.67%, 两组总有效率比较, 差异无统计学意义(P>0.05), 两组汉密尔顿焦虑量表(HAMA)减分率较治疗前显着降低, 差异具有统计学意义(P<0.01).[结论] 针灸、电针、心理疗法综合治疗惊恐障碍临床疗效与对照组相近, 效果较好。     

惊恐障碍48例的躯体症状

目的了解惊恐障碍患者惊恐发作时躯体症状和发生频率。方法对北京协和医院2000年8月至2002年11月门诊诊断为惊恐障碍的48例患者进行临床症状分类。结果惊恐障碍患者最常出现的症状依次为心慌(44/48,91.7%)、胸闷(36/48,75.0%)、出汗(34/48,70.8%)、憋气(33/48,68.8%)、全身发软(31/48,64.6%)、头晕(27/48,56.3%)、濒死感(27/48,56.3%)。按系统来说,惊恐发作时躯体症状平均累及4.8个系统。最常表现为心血管、神经、呼吸和植物神经系统症状。结论惊恐发作的躯体症状广泛,由于症状的广泛性和非特异性,易被误诊或漏诊。     

Hypochondriasis and somatization

Between 60% and 80% of healthy individuals experience somatic symptoms in any one week. About 10% to 20% of a random sample of people worry intermittently about illness. A substantial proportion of patients present physicians with somatic complaints for which no organic cause can be found. Patients who are hypochondriacal do not understand the benign nature of functional somatic symptoms and interpret these as evidence of disease. Hypochondriacal concerns range from common short-lived worries to persistent and distressing fears or convictions of having a disease. Hypochondriasis can be secondary to other psychiatric disorders (eg, melancholia or panic disorder), and hypochondriacal attitudes remit when the primary disorder is successfully treated. Patients with primary hypochondriasis are also anxious or depressed, but the fear of disease, or the false belief of having a disease, persists and is the most important feature of their psychopathology. There are substantial differences among hypochondriacal patients in their personalities and psychopathologies. Psychotherapy as well as psychotropic drugs are effective in the treatment of functional somatic symptoms. There are no adequate controlled studies on the value of psychotherapy in hypochondriasis; the recommended guidelines are based on uncontrolled studies of hypochondriasis and on controlled studies of the psychotherapy in similar disorders. The prognosis of functional somatic symptoms as well as that of hypochondriasis is good in a substantial proportion of patients.     

艾司西酞普兰对惊恐障碍患者情绪图片信息认知偏倚的影响

目的 探讨艾司西酞普兰对惊恐障碍患者情绪图片信息认知偏倚的影响.方法 选择符合CCMD-3惊恐障碍诊断标准的30例患者作为试验组,与试验组匹配性别、年龄的30例健康人作为对照组.实验组予艾斯西酞普兰治疗8周.两组分别在治疗前以及8周后予情绪图片刺激的点探测任务检测,比较治疗前以及8周后反应时以及注意偏向分差别.结果 试验组8周后汉密顿焦虑量表评分[(7.81 ±2.52)分]明显低于治疗前[(17.23 ±3.12)分](P=0.002).重复测量ANOVA显示,探测位置主效应显著[F(1,58)=4.34,P=0.031],异侧位置的反应时长于同侧位置;情绪面孔图片类型与组间水平交互作用显著[F(1,58)=19.21,P=0.000];探测位置与组间水平交瓦作用显著[F(1,58)=16.15,P=0.000];情绪面孔图片类型与探测位置交互作用显著[F(1,58)=9.25,P=0.015];情绪面孔图片类型×探测位置×组间水平交互作用显著[F(1,58)=7.31,P=0.002],ISD比较显示试验组对恐惧面孔图片异侧位置的反应时长于同侧位置(P=0.0009).试验组治疗8周后对恐惧面孔图片反应时以及注意偏向分明显低于治疗前(P=0.032,0.008).结论 惊恐障碍患者对恐惧面孔图片信息表现出认知偏倚,艾斯西酞普兰可能具有改善认知偏倚的作用.

Abstract：

Objective To investigate the effect of escitalopram treatment on cognitive bias to the emotional facial information in patients with panic disorder. Methods 30 patients met CCMD-3 criteria for panic disorder were enrolled as research group and marched sexual and age 30 healthy persons enrolled as control group. Patients were treated with escitalopram for 8 weeks. All participants measured with dot-probe task of emotional facial information at base and after 8 weeks. RTs and attentional bias scores were compared respectively. Results After 8 weeks,HAMA scores (7. 81 ± 2. 52) in research group were lower than that of at base ( 17. 23 ± 3. 12) (P = 0.002). A repeated measure ANOVA revealed a significant probe site main effect (F(1,58) =4. 34, P = 0.031 ) , RTs of antarafacial site were longer than that of homonymy site. It revealed a significant probe site and group interaction(F(1,58) =16.15, P=0.000) ,a significant emotional facial information type and probe site interaction(F(1,58)=9.25, P =0.015) ,and a significant emotional facial information type × probe site× group interaction(F(1,58) =7. 31, P = 0. 002). LSD test showed that RTs of antarafacial site to fear facial information in research group were longer than that of homonymy site(P = 0.0009). RTs and attention bias scores of antarafacial site to fear facial information after 8 weeks in research group were lower than that of at base(P=0.032,0.008). Conclusion Patients with panic disorder have the cognitive bias to the fear facial emotional stimulus, and escitalopram treatment might improve the cognitive bias.     

对抑郁症患者接受重复经颅磁刺激治疗前的心理干预

目的:探讨重复经颅磁刺激治疗对抑郁症患者的心理干预。方法:随机抽取50例抑郁症患者,均符合CCMD-3精神疾病诊断标准,其中男性30例,女性20例。在患者接受治疗前均存在不同的抑郁症状,其中大多患者对经颅磁刺激治疗缺少了解,不愿治疗,治疗前往往紧张、害怕、恐惧,甚至排斥,在经颅磁刺激治疗前均给予心理治疗。结果:全部患者精神症状有较明显的改善或消失。有效率达到100%,临床效果显著。结论:通过积极正确的心理干预,50例抑郁症患者均能较好的配合经颅磁刺激仪的治疗。     

艾司西酞普兰与帕罗西汀治疗惊恐障碍对照研究

目的:研究艾司西酞普兰和帕罗西汀治疗惊恐障碍的有效性和安全性。方法:55例惊恐障碍患者随机分入艾司西酞普兰组与帕罗西汀组治疗10周,在治疗前和治疗期间隔周测定惊恐症状评定量表(PASS)、汉密尔顿焦虑量表(HAMA)及每周发作次数,以治疗中出现的症状量表(TESS)评定不良反应。结果:艾司西酞普兰组有效率为96.2%,帕罗西汀组为92.3%,二药相近。两组患者在治疗10周PASS、HAMA的减分率差异无显著性。艾司西酞普兰组的起效时间快于帕罗西汀组,差异具有显著性(P<0.01)。两组患者均有良好的耐受性。结论:艾司西酞普兰是一种起效快、疗效好、安全性高的治疗惊恐障碍的药物。     

惊恐障碍患者抑制性控制缺陷的事件相关电位研究

目的 探讨惊恐障碍患者抑制性控制缺陷的神经电生理机制.方法 采用视觉事件相关电位Go/Nogo实验方式,对16例惊恐障碍患者(PD)和13名健康对照(NC)进行研究.任务为随机出现的等概率双英文字母和单英文字母,要求被试者对双英文字母进行按键反应(Go),单英文字母不按键(Nogo),记录行为学数据和32导脑电数据.结果 惊恐障碍患者和止常对照组均产生了明显的额中央区Nogo-N2(PD组:F1,30=8.00,P=0.08;NC组:F1,24=4.60,P=0.042)和Nogo-P3效应(PD组:F1,30=7.85,P=0.09;NC组:F1,24=13.57,P=0.000),但是惊恐障碍患者的Nogo-N2和Nogo-P3波幅明显低于正常对照组(Fz:F=9.135,P=0.005;F=8.511,P=0.006),潜伏期差异无统计学意义.结论 惊恐障碍患者脑信息加工过程特定时间窗抑制性控制障碍,为进一步揭示惊恐障碍的发病机制提供了新的脑电生理证据.     

Use of medical services and treatment for panic disorder with agoraphobia and for social phobia.

OBJECTIVE: To examine the medical services and treatment for anxiety disorders reported by patients who had either panic disorder with agoraphobia or else social phobia. DESIGN: Archival research of consecutive records of psychiatric interviews conducted between January 1990 and December 1991. The records were examined by a trained research assistant who had had no contact with the patients. PATIENTS: One hundred patients who had panic disorder with agoraphobia and twenty-eight patients who had social phobia. SETTING: An anxiety disorders clinic in a university-affiliated psychiatric institute. OUTCOME MEASURES: Variables related to the use of medical services included history of hospitalization, emergency department visits and referrals to specialists. Variables related to treatment included types of medication received, whether behaviour therapy was received and types of health care professionals seen. RESULTS: Almost 30% of the patients with panic disorder and more than 20% of those with social phobia had a history of a major depressive episode at some time in their lives; 30% and 25% respectively had a current nonpsychiatric medical diagnosis. In the past year nearly one-third of both patient groups had seen three or more different health care professionals and almost one-fifth of those with panic disorder had gone to a general hospital emergency department. Of the patients with panic disorder 9% had previously been assessed by a cardiologist and 17% by a neurologist. At least two-thirds of each group had received benzodiazepines, often for use as needed. Although most of the patients in both groups had been seen by mental health professionals such as psychiatrists, few had received optimal treatment. Of those with panic disorder, only 15% had received the tricyclic antidepressant imipramine, 13% alprazolam and 11% cognitive-behavioural therapy. Only 4% of the patients with social phobia had received cognitive-behavioural therapy. CONCLUSIONS: Both groups of patients, and particularly those with panic disorder, are frequent users of medical services. Although most have had contact with mental health professionals, few have received appropriate treatment. Benzodiazepines appear to be overprescribed, whereas forms of treatment that have been shown to reduce the use of medical services, such as cognitive-behavioural therapy, are infrequently given.     

惊恐障碍误诊为低钾性周期性瘫痪的临床分析

目的探讨惊恐障碍和低钾性周期性瘫痪患者的临床鉴别诊断方法以减少误诊。方法选择2008年1月至2011年1月该院急诊科以低钾性周期性瘫痪收治的惊恐障碍患者7例(惊恐障碍组),同期本院收治的低钾性周期性瘫痪患者192例(低钾周期性瘫痪组),比较两组患者临床资料。结果惊恐障碍组患者平均肌力[(3.7±0.81)级]、平均血钾[(3.1±0.56)mmol/L]与低钾性周期性瘫痪组平均肌力、平均血钾分别为[(2.4±0.84)级、(2.3±0.83)mmol/L]比较,差异有统计学意义(P<0.05)。结论对临床急性发病的肢体无力伴有明显焦虑情绪者,应当考虑到惊恐障碍的可能性以减少误诊。