西酞普兰结合心理治疗对产后抑郁疗效观察

目的：比较单用西酞普兰与西酞普兰结合心理疗法治疗产后抑郁的临床疗效。方法：将58例符合CCMD-3抑郁症诊断标准的产后抑郁患者随机分成两组，分别给予单用西酞普兰20mg／日与西酞普兰20mg／日结合心理治疗，疗程6周。治疗前及治疗后1、2、4、6周末分别用汉密顿抑郁量表（HAMD）进行评定。结果：单用西酞普兰与西酞普兰结合心理疗法治疗产后抑郁均有比较理想的效果，但后者疗效更佳（t=2.24-6、64，P〈0．05）。结论：两酞普兰结合心理疗法治疗产后抑郁效果更好。     

中国道家认知疗法治疗焦虑障碍

目的：探讨中国道人知疗法对焦虑障碍的疗效。方法：将１４３名焦虑障碍患者随机分为三第一组使用道家认知疗法,第二组使用药物治疗、第三组使用道家认知疗法合并药物治疗,标准治疗期一个月,跟踪随访半年,结果：道家认知疗法有效缓解患者症状,与药物疗法相比,起效慢、但远期疗铲好;道家认知疗法结合药物治疗,可以取长补短,是治疗焦虑障碍的最佳选择。     

Combined Psychotherapy and Pharmacotherapy for Mood and Anxiety Disorders in Adults: Review and Analysis

Studies suggest a complex relationship between cognitive-behavior therapy (CBT) and pharmacotherapy for the combined treatment of mood disorders and anxiety disorders. Combined treatment for depression may have beneficial effects when applied to patients with chronic depression and in cases to prevent relapse. In bipolar disorder there is evidence for a strong effect of psychosocial treatment on the course of the disorder. In the anxiety disorders, there are some benefits in the short term, but combined treatment may limit the maintenance of treatment gains offered by CBT alone. Combined treatment should not be considered the default treatment for mood and anxiety disorders, with the possible exception of bipolar disorder. Instead, decisions whether combined treatment is worth the added cost and effort should be made in relation to the disorder under treatment, the level of severity or chronicity, and the stage of treatment (e.g., acute vs. relapse prevention).     

Combined and Multimodal Treatments in Child and Adolescent Psychotherapy: Issues, Challenges, and Research Directions

Combinations of treatment are used increasingly in child and adolescent therapy research, following a pattern long evident in clinical practice. The present article evaluates the multiple influences leading to the use of combined treatments, different ways in which treatments are combined, and challenges that combined treatments raise for research and practice. The central thesis is that combined treatments are unlikely to contribute to treatment outcome unless there are significant changes in the way research is conceptualized and conducted. Limitations in methods of combining treatment, the absence of explicit and empirically defensible decision rules for individually tailored treatments, perpetuation of current limitations in the ways treatments are tested and delivered, and methodological obstacles for evaluating combined treatments are used to bolster the thesis. Recommendations are made for Improving research on combined treatments, such as investigating the decision-making process guiding the combinations of treatment, the constituent techniques that are used to form combinations, novel models of delivering services to bolster outcome, and processes and mechanisms of therapeutic change.     

住院抑郁症患者团体治疗研究

目的探讨住院抑郁症患者团体治疗的效果。方法符合CCMD-3抑郁发作诊断标准的抑郁症患者60例,实验组30例进行联合治疗（药物治疗＋团体心理治疗）,对照组30例进行药物治疗。结果采用HAMD、SDS、SES及应付方式问卷进行评定。结果治疗前各量表评分实验组及对照组无明显差异。治疗后实验组及对照组HAMD、SDS评分均下降,而联合治疗组明显低于单纯药物组,自尊评分联合治疗组高于单纯药物组,差异具有显著性（P〈0.05）。治疗后应付方式中自责及合理化应付方式实验组明显低于对照组（P〈0.01）。结论联合治疗比单纯药物治疗能更有效缓解抑郁症状,减少自责,提高自尊。     

功能失调性态度、认知偏差与抑郁障碍的关系

目的：探讨随着抑郁严重程度的变化,抑郁障碍患者功能失调性态度和认知偏差的变化情况。方法：采用功能失调性态度问卷（DAS）、认知偏差问卷（CBQ）和汉密尔顿抑郁量表（HRSD）对122例抑郁障碍患者于入组时（基线）、8周末的两个时点进行评定,采用DAS、CBQ和抑郁自评量表（SDS）对51名正常对照进行评定。结果：（1）基线时抑郁障碍组DAS总分（158.2±34.6）和CBQ评分（5.19±3.77）均显著高于对照组（DAS总分：119.3±23.4,CBQ评分：1.69±1.83）（t=8.559、8.208,P均为0.000）;（2）基线、8周末病例组自身比较,HRSD评分降至中位数7.0,DAS总分由158.2±34.6降至143.3±29.3（t=3.611,P=0.000）,CBQ评分由中位数5.0降至3.0（z=4.670,P=0.000）;（3）8周末,抑郁障碍完全恢复组的DAS总分（131.1±25.7）、CBQ评分（中位数为3.0）显著高于正常对照组（t=2.397,P=0.018;z=3.990,P=0.000）。结论：抑郁障碍患者的功能失调性态度和认知偏差既随抑郁症状的变化而变化,又有一定的稳定特质性,具有状态-特质性。     

药物与心理疗法治疗抑郁障碍的疗效对照研究

国外的一些研究发现 ,抑郁障碍已成为降低人类生活质量、反复就医 ,患病率较高的疾病之一[1] 。甚至认为每十个男性中就有一位可能患抑郁 ,每五个女性中就可能有一位患有抑郁。因为抑郁障碍存在特征性的认知模式 ,这种认知模式构成抑郁易患性、阻碍抑郁缓解[2 ] 。而单纯药物治疗虽然能短期改善症状 ,不能改变病人的认知模式使其人格得到改善 ,不能阻止其社会功能的缺损。为此我们用药物和心理治疗结合治疗与单用药物治疗作了比较研究 ,下面是此研究的结果。1　资料与方法1.1　资料收集徐州市精神病防治院 1995～ 1996年门诊符合ＣＣＭＤ -…     

广泛性焦虑症心理与药物治疗效果研究

目的探讨广泛性焦虑症心理与药物治疗效果。方法将72例广泛性焦虑症患者随机分为研究组和对照组各36例。研究组使用心理治疗联合抗焦虑药物治疗,对照组单纯使用抗焦虑药物治疗。分别于治疗前和治疗第2、4、8周末采用汉密尔顿焦虑量表(HAMA)和焦虑自评量表(SAS)进行疗效评定,用副反应量表(TESS)评定不良反应。结果治疗8周后研究组有效率为94.4%,对照组有效率为72.2%,两组有效率比较有明显差异(P0.05)。治疗后两组汉密尔顿焦虑量表总分和焦虑自评量表评分较治疗前都有所降低,研究组在治疗第4、8周末HAMA、SAS评分下降更明显,与对照组比较差异显著(P0.01)。且研究组使用药物剂量明显低于对照组(P0.05),不良反应较少。结论与单纯药物治疗相比,心理联合抗焦虑药物治疗广泛性焦虑,有效率增加,能够减少服药剂量和药物副反应,是治疗广泛性焦虑的有效方法,对缩短病程、预防复发有积极意义。     

重度抑郁症对负性情绪面孔的注意偏向

目的:探讨重度抑郁症患者对负性情绪面孔的注意偏向.方法:从35名符合中国精神疾病诊断与分类手册第三版(CCMD-3)抑郁症诊断标准的被试中,筛选出符合汉密尔顿抑郁量表( Hamilton Depression Scale,HAMD)及Beck抑郁自评问卷(Beck Depression Inventory,BDI)重度抑郁症诊断标准的重度抑郁症患者(抑郁组)20名.选取在年龄、性别及受教育程度方面与抑郁组相匹配的正常对照20名.采用NimStim情绪面孔图片库中的负性情绪面孔和中性情绪面孔作为刺激材料,应用注意偏向研究中常用的线索-靶子任务进行研究,比较两组被试线索效应、注意施加、注意解除得分.结果:抑郁组对负性情绪面孔线索效应得分大于对中性情绪面孔线索效应得分(21.73 ms vs.3.91 ms,P<0.01);抑郁组注意施加得分大于对照组(17.25 ms vs.1.64 ms,P<0.001);对照组与抑郁组注意解除得分差别无统计学意义(-1.50 ms vs.0.57 ms, P>0.05).结论:抑郁症患者对负性情绪信息加工存在注意偏向,对负性情绪信息缺乏保护性偏向.     

综合性心理治疗对癌症患者焦虑、抑郁情绪的作用

目的：了解综合性心理治疗对癌症患者焦虑、抑郁情绪的作用。方法：对８３例肿瘤患者进行对照治疗和观察,研究组在常规放疗、化疗等生物治疗的基础上合并应用一般性心理支持治疗、疾病知识教育、个别心理治疗、患者互助治疗、家庭和社会支持治疗、音乐结合肌网放松训练及内心意念引导等常用的综合心理治疗方法。对照组仅用常规肿瘤治疗。观察治疗前后焦虑、抑郁情绪变化。结果：研究组较对照组患者焦虑、抑郁情绪有明显改善。结论：     

Seeing the Complexities: A Comment on "Combined Psychotherapy and Pharmacotherapy for Mood and Anxiety Disorders in Adults: Review and Analysis"

In their comprehensive review of the literature on combined treatments for mood and anxiety disorders in adults, Otto, Smits, and Reese (this issue) suggested that the data do not support the use of combined approaches as the default treatment for these conditions. They advocated a nuanced view of the existing findings and emphasized that much is yet to be discovered about whether and how best to combine psychosocial and pharmacological interventions. An empirical update from several recently completed randomized controlled trials (RCTs) examining combined treatment is provided here, and points of convergence and divergence between these findings and the broader literature are considered. Additionally, this commentary supplements their discussion by (a) supporting their strong emphasis on interdisciplinary research and creativity in conceptualizing and designing combined treatments, (b) emphasizing the importance of studying predictors of treatment response in adequately powered trials to better clarify which subgroups require the additional expenditure of resources associated with combined treatment, and (c) encouraging the development and empirical evaluation of combined treatments for children and adolescents.     

The Efficacy of Group Psychotherapy for Depression: A Meta-analysis and Review of the Empirical Research

We conducted a meta-analysis of 48 research reports on the efficacy of group therapy for depression. In 15 studies in which treated participants were compared to untreated controls, the average effect size was 1.03, suggesting that the average treated participant was better off than about 85% of the untreated participants. Analyses of clinically significant change suggested that treated participants improved substantially. However, even after treatment, participants still had pronounced depressive symptomatology relative to normative levels of depressive symptoms seen in non-depressed individuals. We conclude that group therapy is an efficacious treatment for depressed patients. However, numerous questions remain unanswered. For example, little empirical work has investigated what advantages group therapy might have over individual therapy. We conclude by making recommendations for future research in this area.     

单相抑郁症父母育龄及胎次效应的研究

为了了解单相抑郁症有否父母育龄及胎次效应，用Haldane和Smith方法对此进行了研究。结果表明单相抑郁症有父母育龄及胎次效应，这种效应为父母育龄越小或胎次早者易患单相抑郁症，提示适龄婚育对防止这种疾病的发生具有重要意义。     

Introduction: Attachment Theory and Psychotherapy

In this introduction to the JCLP: In Session 69(11) issue on attachment theory and psychotherapy, the key points of attachment theory (Bowlby, 1969 , 1973 , 1981) and its relevance to psychotherapy are briefly described. The aim of this issue is to provide case illustrations of how an attachment theory perspective and principles can expand our understanding of psychotherapy practice.     

Risk of psychosis exacerbation by tricyclic antidepressants in unipolar Major Depressive Disorder with psychotic features

BACKGROUND: We conducted a systematic review of the published trials in unipolar Major Depressive Disorder with psychotic features (MDDP) to examine the risk of psychosis exacerbation by antidepressants. METHODS: We searched Medline, Cochrane Central Register of Controlled Trials, PsychINFO, and EMBASE for English language, controlled, open or retrospective acute antidepressant and/or antipsychotic treatment studies of unipolar MDDP. Studies without a clear delineation of treatment course or between bipolar disorder and unipolar MDDP were excluded. We evaluated studies for the number of subjects with psychosis exacerbation, and contacted the corresponding author for ambiguous cases. Studies in which we were unable to determine rates of psychosis exacerbation were excluded. Psychosis exacerbation was determined on a categorical basis, and analyzed with Fisher's exact test, a modified Wald confidence interval and odds ratio. RESULTS: 20 studies meeting criteria provided sufficient adverse event reporting for inclusion. 15 of 177 subjects (8.5%) on antidepressant monotherapy had a psychosis exacerbation, 8 of whom were on tricyclics. 2 of 129 subjects on either antipsychotic or combination treatment had a psychosis exacerbation. Tricyclic monotherapy was significantly more likely to be temporally associated with psychosis exacerbation (p=0.007). LIMITATIONS: Limitations include the small number of placebo-controlled trials, and numerous studies in which the relevant information was missing. Additionally, most trials were designed as treatment outcome studies, and not to determine the rate of psychosis exacerbation. CONCLUSIONS: Although rare, the present study indicates that tricyclic monotherapy may be temporally associated with an exacerbation of psychotic symptoms in patients with unipolar MDDP, potentially worsening prognosis.     

Psychological Assessment and Psychotherapy in Long-Term Care

The continued growth of the older adult population, combined with the inclusion of psychologists in Medicare, is leading to psychological services increasingly being delivered in long-term care settings. This article reviews some basic concepts in psychological assessment and psychotherapy with older adults in long-term care settings. A guide is provided for the assessment of dementia, delirium, and depression. The use of validated empirical instruments, the collection of multiple sources of historical data, and the incorporation of assessment results in treatment planning are emphasized. Psychotherapy with persons having a dementia, and psychotherapy with persons having a personality disorder are the focus of the treatment section of this article. We argue that these have been neglected areas of practice, and yet treatment can produce significant benefits to these patients.