认知行为疗法联合抗焦虑药治疗焦虑症疗效观察

目的探讨认知行为疗法联合抗焦虑药治疗焦虑症的疗效及临床分析。方法 2009-04—2012-04我院诊治的80例焦虑症患者,随机分为对照组(抗焦虑药物治疗)和观察组(对照组基础上加用认知行为疗法治疗),治疗6周,通过汉密尔顿焦虑量表(HAMA)对2组治疗前后HAMA评分、临床疗效和复发情况进行观察和比较。结果与治疗前相比,治疗后2组HAMA评分明显降低,P<0.05;与对照组相比,观察组治疗6周和随访6个月的HAMA评分显著降低,P<0.05;与对照组相比,观察组总有效率明显升高,复发率显著降低,P<0.05。结论认知行为疗法联合抗焦虑药治疗焦虑症的疗效显著,能明显改善患者的预后。     

氟西汀合并认知行为疗法治疗强迫症对照研究

目的：评价氟西汀合并认知行为疗法对强迫症的治疗效果。方法：将符合中国精神障碍分类与诊断标准第3版的诊断标准的57例强迫症患者随机分为治疗组和对照组，治疗组给予氟西汀合并认知行为治疗，对照组单用氟西汀治疗，应用临床疗效标准及耶鲁布朗强迫量表(Y—BOCS)定期评定；观察6个月。结果：在治疗1、2、4个月和6个月时，治疗组疗效显著优于对照组，尤其是对强迫行为疗效更好。结论：氟西汀合并认知行为疗法联合治疗强迫症效果优于单用氟西汀治疗。     

氟西汀合并认知行为疗法治疗强迫症的对照分析

目的　评价氟西汀合并认知行为疗法对强迫症的治疗效果。方法　将符合CCMD - 3诊断标准的 5 7例强迫症患者随机分为治疗组和对照组 ,治疗组给予氟西汀合并认知行为治疗 ,对照组只给予氟西汀治疗。应用临床疗效标准及耶鲁布朗强迫量表 (Y -BOCS)定期评定疗效。疗程 6个月。结果　在治疗第 1、2、4和 6个月末 ,治疗组疗效优于对照组 ,尤其是对强迫行为疗效更好 ,具有极显著性统计学意义 (P <0 0 1)。结论　氟西汀合并认知行为疗法治疗强迫症效果优于单独用氟西汀治疗。     

尼莫地平联合奥拉西坦胶囊治疗2型糖尿病合并轻度血管性认知障碍临床研究

目的分析尼莫地平联合奥拉西坦胶囊治疗2型糖尿病合并轻度血管性认知障碍的临床效果。方法选取我院2012-11—2016-03收治的70例2型糖尿病合并轻度血管性认知障碍患者,采用随机数字表法分为观察组(n=35)和对照组(n=35),2组均给予尼莫地平治疗,观察组在对照组基础上加用奥拉西坦胶囊治疗,比较2组治疗前和治疗5个月后蒙特利尔认知量表(MoCA)评分、Barthel日常生活活动能力量表(ADL)评分及不良反应发生率。结果治疗5个月后观察组视空间功能、命名、注意力、语言、抽象能力、选项、定向力评分高于对照组,差异具有统计学意义(P0.05);观察组治疗5个月后ADL评分与对照组相比明显较高,差异具有统计学意义(P0.05);不良反应发生率组间比较差异无统计学意义(χ2=0.000,P0.05)。结论2型糖尿病合并轻度血管性认知障碍以尼莫地平联合奥拉西坦胶囊治疗,可改善患者认知状况和日常生活能力,安全可靠。     

认知行为疗法对老年抑郁症的治疗作用

目的 :探讨认知行为治疗对老年抑郁症的临床效果。　方法 :将老年抑郁症患者 4 2例 ,随机平分为氟西汀加认知行为疗法组 (联合治疗组 )和氟西汀治疗组 (药物治疗组 ) ,疗程 8周。以Hamilton抑郁量表 (HAMD)、Hamilton焦虑量表 (HAMA)及副反应量表 (TESS)评定疗效及不良反应。　结果 :随访半年后联合治疗组的显效率为 71.4 % ,药物治疗组为 4 7.6 % ,以前组显著较好 (P <0 .0 5 )。　结论 :认知行为疗法联合药物治疗对老年抑郁症患者疗效好而持久     

帕罗西汀合并认知行为疗法治疗惊恐障碍疗效分析

目的　评价帕罗西汀合并认知行为疗法治疗惊恐障碍的临床疗效及帕罗西汀副反应。方法　将符合CCMD - 3诊断标准的 30例惊恐障碍患者每日给予 2 0mg帕罗西汀 ,连续治疗 6个月 ,同时给予认知行为治疗 ,采用汉密尔顿焦虑量表 (HAMA)和副反应量表 (TESS)评定疗效和药物副反应。结果　共有 2 8例患者完成了 6个月的临床观察。治疗前后HAMA减分比较差异有非常显著 (P <0 .0 1) ,临床疗效评定显效率为 96 % ,有效率为 10 0 %。帕罗西汀副反应轻微。结论　帕罗西汀合并认知行为疗法治疗惊恐障碍安全有效 ,依从性好     

博乐欣合并认知行为疗法治疗惊恐障碍对照研究

目的 观察博乐欣合并认知行为疗法对惊恐障碍的治疗效果。方法 将符合CCMD-2-R诊断标准的37例惊恐障碍患者分为治疗组和对照组,治疗组给予博乐欣(50—150mg/d)合并认知行为治疗,对照组只给予博乐欣(50—150mg/d)治疗,应用临床标准疗效及HAMA和CGI—SI定期评定;观察6个月。结果 在治疗1个月、3个月和6个月时,治疗组疗效均优于对照组,具有极显著性统计学意义(P<0.01)。两组仅个别病人在治疗的前2周出现头痛、恶心、胃不适症状,无需处理,尤以合并认知治疗组显著较轻。结论 博乐欣合并认知行为治疗效果优于单用药物的治疗,且可明显缩短疗程,减少医疗开支。     

认知-行为疗法及结合药物治疗原发性失眠的对照研究

目的了解认知-行为疗法在原发性失眠患者中的治疗作用。方法 99例原发性失眠患者随机分成3组:认知行为治疗组、药物治疗组和联合治疗组。分别使用匹兹堡睡眠质量指数(PSQI)评价认知-行为疗法、药物疗法(唑吡坦10mg)及认知-行为疗法结合药物递减疗法(联合治疗)治疗原发性失眠症患者99例的疗效。结果联合治疗组及药物治疗组在治疗第1周较认知-行为治疗组PSQI值明显下降(P0.01);联合治疗组与药物治疗组PSQI相比差异无统计学意义(P0.05);治疗第6周3组PSQI差异无统计学意义(P0.05);治疗3个月时联合治疗组与认知-行为治疗组较药物治疗组PSQI明显下降(P0.01),联合治疗组与认知-行为治疗组PSQI差异无统计学意义(P0.05)。联合治疗组不同时间点PSQI比较差异有统计学意义(P0.01);药物治疗组治疗第1周及治疗第6周与治疗前PSQI比较明显下降(P0.01),治疗第6周与治疗3个月时PSQI比较差异无统计学意义(P0.05);单纯认知行为治疗组在治疗前与治疗第1周PSQI比较差异无统计学意义(P0.05),与治疗第6周及3个月PSQI明显下降(P0.01)。结论认知-行为疗法结合非苯二氮卓艹类安眠药物治疗失眠,起效快,与认知-行为疗法治疗同样具有显著稳定持久的远期效果。     

认知行为疗法在抑郁患者中的应用疗效对比研究

目的分析认知行为疗法联合常规护理在抑郁症患者护理中的应用。方法选取我院90例抑郁症患者,分为常规组行传统健康教育与娱疗活动,认知组在常规组基础上行认知行为疗法,两组各45例,且所有患者均通过盐酸舍曲林药物治疗及精神科常规护理;对比分析两组治疗后的疗效及复发率。结果治疗7天、15天、45天后认知组田纳西自我概念量表及个体和社会功能量表评分均高于常规组(P0.05),汉密尔顿抑郁量表评分均低于常规组(P0.05);随访1、2年后,认知组复发率均低于常规组(P0.05)。结论认知行为疗法联合常规护理能够改善抑郁症患者临床症状,有效降低复发率,促进疾病康复,因此具有较高的应用价值。     

盐酸氟西汀联合认知行为疗法治疗产后抑郁症疗效观察

目的 探讨盐酸氟西汀联合认知行为疗法治疗产后抑郁症的临床疗效及不良反应.方法 入组103例产后抑郁症患者分为2组,联合治疗组53例接受盐酸氟西汀联合认知行为疗法,对照组50例仅接受盐酸氟西汀治疗.2组均治疗6周.然后采用汉密尔顿抑郁量表（HAMD）评价治疗效果,同时采用不良反应量表（TESS）评价盐酸氟西汀的不良反应.结果 联合治疗组总有效率84.9%,远高于对照组68.0%（P〈0.05）.联合治疗组治疗后HAMD评分低于对照组（P〈0.05）.2组药物不良反应比较差异无统计学意义（P〉0.05）.结论 盐酸氟西汀联合认知行为疗法治疗产后抑郁症的临床疗效优于单用盐酸氟西汀,而不良反应并未增加.     

Cognitive impairment in patients with chronic hepatitis treated with interferon alpha (IFNalpha): results from a prospective study.

BACKGROUND: Treatment with low-dose interferon alpha (IFN-alpha) is often associated with neuropsychiatric side effects. In addition to depression and anxiety, IFN-alpha associated cognitive impairment significantly affects patient's mental health and quality of life. AIMS OF THE STUDY: To measure possible effects of low-dose IFN-alpha on cognitive functioning and its relationship to the development of depression and anxiety. METHOD: We prospectively followed 38 patients with a chronic hepatitis B or C by neuropsychological tests and psychiatric self-rating scales during 12 weeks of low-dose treatment with IFN-alpha. RESULTS: Before IFN-alpha treatment, neuropsychological tests as well as self-ratings in the Beck's Depression Inventory (BDI), the Hospital Anxiety and Depression Scale (HADS) and the Self-Report Symptom Inventory 90 Items-Revised (SCL-90-R) were within the normal range. Following 12 weeks of treatment with IFN-alpha resulted in a slight, but significant increase in depression scores. Neuropsychological assessment after 12 weeks of IFN-alpha treatment showed a significant decrease of the immediate recall in the Auditory-Verbal Learning Test (AVLT) and a significant reduction of words recited in the Controlled Oral Word Association Test (COWA). Cognitive impairment did not significantly correlate with depressive symptoms or anxiety. CONCLUSION: Our results indicate that even low-dose IFN-alpha induces cognitive impairment independent from depressive symptoms, which might be related to functional disturbances in the prefrontal cortex and the hippocampus. We suggest close monitoring of cognitive function during IFN-alpha treatment of chronic hepatitis.     

认知暴露疗法治疗创伤后应激障碍的5年随访

目的:探讨5年随访时认知暴露治疗对创伤后应激障碍(PTSD)患者的效果. 方法:63例PTSD患者随机分为两组,分别进行药物治疗和心理治疗,并且在治疗前、治疗后、治疗后3个月、治疗后5年进行心理状况评定. 结果:重复测量的方差分析表明,在创伤后应激障碍症状清单量表(PCLS)、症状自评量表、贝克抑郁问卷、汉米尔顿抑郁量表、状态-特质焦虑问卷及汉米尔顿焦虑量表上,总体上组间(药物和心理治疗)效应不显著(F=3.111,P＞0.05),时间(重复变量)效应显著(F=9.011,P＜0.01).治疗后心理治疗组PCLS再经历和回避分比药物治疗组下降更显著. 结论:认知暴露治疗和药物治疗对PTSD患者疗效相近,认知暴露治疗对再经历症状和回避症状疗效更好.     

Predictors of Suicidal Ideation in People with Epilepsy Living in Korea

Background and Purpose

The risk of suicide or suicide attempts is reported higher in people with epilepsy (PWE) than in the general population. Although epileptic, psychiatric, and psychosocial factors are known risk factors for suicide or suicide attempt, no studies have evaluated the predictors of the severity of suicidal ideation-which is a warning sign for suicide attempts-in PWE. Therefore, we measured the severity of suicidal ideation and its risk factors.

Methods

Consecutive PWE who were medicated with antiepileptic drugs (AEDs) and attended epilepsy clinic were included in the study. The subjects completed self-reported questionnaires, which included the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Symptom Checklist-90-Revised (SCL-90-R), and Scale for Suicide Ideation-Beck (SSI-Beck). We compared the patients'' demographic and clinical variables, and BDI, BAI, and SCL-90-R scores with their SSI-Beck score, and used our findings to determine the predictors for suicidal ideation.

Results

In total, 257 PWE were enrolled in the study. SSI-Beck scores correlated strongly with several seizure-related variables, duration of education, IQ, BDI and BAI scores, and nine domains of the SCL-90-R questionnaire. However, the strongest predictor for suicidal ideation was BDI score (β=0.41, p<0.001), followed by several SCL-90-R domains, such as obsessive-compulsive (β=-0.39, p<0.001), depression (β=0.38, p<0.001), hostility (β=0.22, p=0.002), paranoid ideation (β=0.17, p=0.01), and IQ (β=-0.10, p=0.017). These variables explained 59% of the variance in the SSI-Beck score. The seizure-related variables that influenced the BDI score were seizure frequency, duration of education, MRI abnormality, and number of AEDs. However, these variables explained only 18% of the variance in the BDI score.

Conclusions

Major risk factors for suicidal ideation in PWE were depressive and psychiatric symptoms rather than seizure-related variables. Therefore, clinicians should focus on screening for depression and other psychiatric problems and treat them appropriately in order to reduce suicidal behavior in PWE. Since seizure-related variables also exhibited a minor role in determining depressive symptoms, stronger seizure-related risk factors for depression should be sought, such as seizure severity or psychosocial factors, to minimize suicidal behavior.     

氨磺必利合并度洛西汀治疗以躯体症状为主的抑郁症对照研究

目的探讨氨磺必利合并度洛西汀对以躯体症状为主的抑郁症的疗效及安全性。方法采用随机开放对照研究,将符合《国际疾病分类(第10版)》(ICD-10)抑郁症伴躯体症状诊断标准的60例患者按随机数字表法分为氨磺必利合并度洛西汀治疗组(研究组)和单纯度洛西汀治疗组(对照组)各30例,均治疗8周。在治疗前和治疗后2、4、6、8周末采用汉密顿抑郁量表17项版(HRSD-17)、症状自评量表(SCL-90)躯体化因子、副反应量表(TESS)进行疗效及副作用测评。结果治疗后两组HRSD-17评分和SCL-90躯体化因子分值较治疗前差异有统计学意义(P0.01)。在治疗后第2周末起,两组HRSD-17评分和SCL-90因子分值同期比较差异有统计学意义(P0.05或0.01),两组不良反应症状均较轻,患者均能耐受,未做特殊处理。结论氨磺必利合并度洛西汀对躯体症状为主的抑郁症的疗效和安全性可能优于单一使用度洛西汀治疗。     

Psychologists experience of cognitive behaviour therapy in a developing country: a qualitative study from Pakistan

Background  

Psychological therapies especially Cognitive Behaviour Therapy (CBT) are used widely in the West to help patients with psychiatric problems. Cognitive Behaviour Therapy has an established evidence base for the treatment of different emotional disorders. In spite of these developments in the developed world, patients in most developing countries hardly benefit from non pharmacological interventions. Although a significant number of psychologists are trained in Pakistan each year, psychological interventions play only a minor role in treatment plans in Pakistan. We conducted interviews with psychologists in Pakistan, to explore their experiences and their views on "providing CBT in Pakistan". These interviews were conducted as part of a project whose focus was to try to develop culturally-sensitive CBT in Pakistan.     

Depression and anxiety symptoms are associated to disruption of default mode network in subacute ischemic stroke

Depression and anxiety symptoms are common after stroke and associated to reduction in quality of life and poor physical and social outcomes. The Default Mode Network (DMN) plays an important role in the emotional processing. We investigated whether these symptoms are associated to a disruption of DMN functional connectivity in the first month after stroke. Thirty-four subacute ischemic stroke patients were submitted to: 1) behavioral assessment through Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and Structured Clinical Interview for DSM Disorders; 2) neuropsychological assessment using Mini Mental State Examination and Montreal Cognitive Assessment; 3) resting state functional magnetic resonance imaging acquisition using a 3 T scanner (Philips Achieva). Patients with depression and/or anxiety symptoms showed an increased DMN functional connectivity in left inferior parietal gyrus and left basal nuclei, when compared to stroke controls. Specific correlation between BDI/BAI scores and DMN functional connectivity indicated that depression symptoms are correlated with increased functional connectivity in left inferior parietal gyrus, while anxiety symptoms are correlated with increased functional connectivity in cerebellum, brainstem and right middle frontal gyrus. Our study provides new insights into the underlying mechanisms of post stroke depression and anxiety, suggesting an alternate explanation other than regional structural damage following ischemic event, that these psychiatric symptoms are related to brain network dysfunction.     

失眠伴抑郁与单纯失眠患者失眠认知行为治疗的疗效分析

目的分析失眠认知行为疗法(cognitive behavioral therapy on insomnia,CBT-i)对失眠伴抑郁患者以及单纯失眠患者的疗效。方法71例符合失眠症诊断的患者,根据贝克抑郁量表(Beck Depression Inventory,BDI)得分分为单纯失眠组(<14分,33例)和失眠伴抑郁组(≥14分,38例)。2组患者每天填写睡眠日记,并给予8周标准的CBT-i治疗,在治疗前(基线)、治疗第4周、治疗第8周、治疗结束后4周(第3个月)、治疗结束后16周(第6个月)采用匹兹堡睡眠质量指数(Pittsburgh Sleep Quality Index,PSQI)、失眠严重程度指数(Insomnia Severity Index,ISI)、BDI、贝克焦虑量表(Beck Anxiety Inventory,BAI)、SF-36健康调查简表对2组患者睡眠质量、抑郁焦虑程度、个人健康状况等进行评估,采用独立样本t检验进行组间比较,采用重复测量方差分析进行各时间点组内比较。结果与基线时比较,单纯失眠组和失眠伴抑郁组第8周、第3个月和6个月随访时入睡潜伏期、睡眠效率、PSQI、ISI、BDI、BAI、SF-36组内比较差异均有统计学意义。失眠伴抑郁组较单纯失眠组在基线、第8周、第3个月和6个月随访时BAI(t=-6.340、-3.301、-3.511、-2.982)、SF-36(t=4.162、3.195、2.022、3.629)评分差异有统计学意义(P<0.01或0.05),2组ISI评分在第6个月随访时差异有统计学意义[(7.3±4.6)分与(4.7±3.4)分,t=-2.044,P=0.048]。2组入睡潜伏期和睡眠效率以及PSQI的评分在第8周、第3个月和6个月随访时与基线的变化量差异均无统计学意义;而2组BAI、BDI评分在第8周与第3个月和6个月随访时与基线的变化量差异有统计学意义。结论CBT-i对失眠伴抑郁患者和单纯失眠患者均有效,且可以缓解失眠伴抑郁患者的抑郁症状以及改善患者生活质量。     

双侧丘脑底核脑深部电刺激对PD患者焦虑症状的短期影响

目的探讨双侧丘脑底核脑深部电刺激(STN-DBS)对帕金森病(PD)患者焦虑症状及生活质量的短期影响。方法对上海交通大学附属瑞金医院功能神经外科中心自2017年8月至2019年8月行双侧STN-DBS治疗的39例PD患者,分别于术前、术后1个月和末次随访时进行贝克焦虑自评量表(BAI)、贝克抑郁自评量表(BDI)评分,于术前和术后末次随访时进行帕金森病患者生活质量问卷-8项(PDQ-8)评分,采用统计学方法分析各节点间评分的差异,以及评分改善程度间的相关性;并进一步依据术前BAI评分将患者分为无焦虑组(n=18)、轻度焦虑组(n=10)、中度焦虑组(n=8)和重度焦虑组(n=3),以进行亚组分析。结果(1)39例患者术后1个月及末次随访时的BAI评分[14(8,20)分、9(3,14)分]均明显低于术前[16(9,27)分],术后末次随访时的BDI评分[8(6,16)分]及PDQ-8评分[3(2,6)分]均明显低于术前[15(8,21)分、9(6,13)分],差异均有统计学意义(P<0.05)。(2)相关性分析显示,术后末次随访时的BAI评分较术前的改善程度与BDI评分的改善程度呈正相关关系(rs=0.722,P=0.000),也与术前BDI评分及术前PDQ-8评分呈负相关关系(rs=-0.714,P=0.000;rs=-0.378,P=0.018)。(3)亚组分析显示,轻度焦虑组和中度焦虑组患者中,术后末次随访时的BAI评分均明显低于术前,差异均有统计学意义(P<0.05);轻度焦虑组、中度焦虑组与重度焦虑组患者的术后末次随访时的BAI评分较术前的改善程度均明显高于无焦虑组,差异均有统计学意义(P<0.05)。结论双侧STN-DBS能在短期内显著改善PD患者的焦虑症状,提高其生活质量,提示STN参与了PD患者焦虑症状的神经机制。     

Association between physiological serum concentration of estrogen and the mental health of community-dwelling postmenopausal women age 70 years and over.

OBJECTIVE: The authors investigated the association between physiological levels of estrogen and mood/cognitive functioning among older postmenopausal women. METHODS: This was a cross-sectional study of 265 postmenopausal women (mean age: 74.6 years), who were given a semistructured psychiatric interview (CAMDEX-R) and self-rated their health with the Beck Depression and Anxiety Inventories (BDI and BAI) and the SF-36 Health Survey. Cognitive abilities were assessed with the cognitive subsection of the CAMDEX (CAMCOG), the Word Lists subtest of the Wechsler Memory Scale, and the Block Design and Verbal Fluency subtests of the Wechsler Adult Intelligence Scale. Estradiol- and estrone-sensitive immunoassays were used to measure serum estradiol and estrone. RESULTS: Women in the lowest 50th percentile of serum estradiol were more likely than women in the highest 50th percentile to have BDI scores suggestive of clinically significant or severe depression. Women in the lowest 50th percentile of serum estrone had higher BAI scores. There was no significant association between serum estradiol/estrone and cognitive functioning. CONCLUSIONS: Physiological serum concentrations of estradiol and estrone are inversely associated with depression and anxiety scores in older postmenopausal women. The association between serum estradiol and depression ratings is not linear and seems to be subject to a threshold effect.     

Promotion of mindfulness in psychotherapists in training: preliminary study.

This study examined whether the promotion of mindfulness in psychotherapists in training can influence the treatment results of their patients. The therapeutic course and treatment results of 196 inpatients, who were treated during a nine week period by nine psychotherapists in training, were compared: in the first phase of the study, the treatment group without (CG, historical control group, n=55), and in the second phase the treatment group with, (MFG, n=58) therapists who were currently practicing Zen meditation. The results of treatment were examined (according to the intent-to-treat principle) with the Session Questionnaire for General and Differential Individual Psychotherapy (STEP), the Questionnaire of Changes in Experience and Behaviour (VEV) and the Symptom Checklist (SCL-90-R), and showed significantly better results in the MFG.