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 -…     

大学生适应障碍的系统家庭治疗个案报告

适应障碍与个体所处的社会环境有着密切的关系.针对适应障碍的治疗发现,药物治疗[1-2]、心理治疗[3-7]及综合治疗[8-9]均有良好的效果.系统家庭治疗是以系统论、信息论和控制论等为指导,以家庭或系统为单位来解析成员之间的关系,进行心理干预的治疗体系[10],认为出现问题的家庭成员是表征家庭问题的索引病人.治疗应该着眼于整个家庭系统,从扰动成员之间交往模式着手,而不是仅仅只对"索引病人"的症状本身进行治疗[11].     

图式治疗合用氟伏沙明治疗强迫症的随机对照研究

<正>强迫症是严重影响生活质量和社会功能的精神疾病之一,药物和心理治疗可以缓解这类患者的症状,心理治疗的发展趋势是整合性治疗[1-2]。图式治疗(Schema therapy,ST)整合了认知疗法、行为疗法、客体关系和完形治疗等理论观点,形成一种系统的结构化的心理治疗方法[3]。国外有研究报道,图式治疗对强迫症患者有效[4]。本研究通过比较图式治疗合用氟伏沙明和单用氟伏沙明对强迫症患者的疗效,探索开展图式治疗改善强迫症患     

系统家庭治疗精神分裂症对照研究

精神分裂症康复治疗是临床工作中的重大课题。药物治疗只能控制症状 ,却不能阻止或改善其复发及精神衰退。许多学者采用工娱疗法[1 ] 、作业疗法 [2 ] 、支持性心理疗法[3]取得了一定疗效。 90年代初系统家庭治疗理论引入我国 ,并逐渐用于临床收到满意效果 [4]。我们采用系统家庭治疗配合药物治疗与单纯用药对 60例精神分裂症进行 1 2个月对照研究。1　资料与方法1 .1　研究对象　 60例病人为 1 990年 3月～ 1 991年 1 0月在我院住院治疗的出院病人 ,诊断均符合 CCMD— 2诊断标准。治疗时间为 1 2个月 ,出院时随机分为 A、B两组 ,每组 3 …     

神经症多因素治疗方法与疗效分析

本文对200例神经症病人进行治疗观察与对照研究，结果提示：严格的量表评定为有效的心理治疗提供可靠的基础，药物加心理治疗优于单用药物治疗或单用心理治疗，药物治疗与心理治疗疗效相同，药物治疗可作为行为疗法和认知疗法的前期治疗。     

佛教心理治疗对强迫症的疗效观察

强迫症是一种较为常见而又难治的神经症,药物治疗效果为40～60%[1];心理治疗也有同样的疗效[2]。笔者采用佛教心理治疗[3]取得了很好的疗效。1　对象和方法对象:为1997～1999年在我院门诊确诊为强迫症的患者,入组条件符合CCMD-2-R强迫症状诊断标准[4];Yale-Brown强迫症量表(Y-BOCS)>20[5];未服用任何精神药物或停药4周以上;无严重躯体合并症和人格障碍。28例中男16例,女12例;年龄19～52岁,平均31.54岁;病程2～32年,平均5.62年。方法:疗程8周,每周面谈2次,每次50分钟,运用佛教领悟疗法向患者讲解强迫症的发病机制、分析症状产生的原因,…     

心理治疗对癔症性精神病的对照研究

将符合ＣＣＭＤ－２－Ｒ诊断标准的３０例癔症性精神病患者，随机对其中１６例在抗精神病药物治疗的基础联合心理治疗，另１４例以单纯的药物治疗为对照组，结果显示前者疗效明显优于后者，本文认为以认知心理疗法与为主的心理治疗结合药物治疗的癔症性精神病不仅能有效地控制精神症状，并能使病人在出院后对环境具有更好的心理顺应性和社会适应力。     

41例血液系统疾病患者伴发抑郁情绪的调查

躯体疾病伴发的情绪障碍 ,尤其是抑郁和焦虑症状 ,正日益受到临床医师的了解和重视。相关的临床研究多见于健康或住院人群普查分析 ,而某一系统疾病或某一特定疾病伴发的情绪障碍的研究尚不多见 ,而血液系统疾病 ,尤其是恶性肿瘤的治疗效果差 ,副反应多 ,所以病人的心理反应较大。了解病人心理反应的特点 ,给予必要的心理指导或心理治疗 ,或许能改善病人的生活质量。本研究使用Ｚｕｎｇ氏抑郁自评量表 (ＳＤＳ) [1] 对我科 4 1例血液系统疾病患者进行初步调查 ,以了解其伴发抑郁情绪的情况。1　资料和方法1.1　对象1.1.1　研究组　来自我院…     

家庭心理治疗与精神分裂症患者症状的缓解

目的 :探讨家庭心理治疗的康复作用。方法 :选择符合临床“痊愈”标准的精神分裂症病人。将 80例患者按匹配原则分成治疗组和对照组 ,两组病人都照常规在出院后继续进行药物维持治疗 ,但治疗组病人 ( 4 0人 )则同时接受系统家庭心理治疗。出院时及出院后半年对两组病人分别进行临床症状测评 ( SCL- 90 )及独立观察者的疗效评价。结果 :治疗组病人各种症状较出院时明显减轻 ,而对照组病人平均症状分数则基本没有变化 ;治疗组中无一例复发住院者 ,但对照组中则有 4例因症状严重而再次住院治疗。结论 :提示系统家庭心理治疗能够帮助精神分裂症患者减轻心理障碍 ,提高社会适应能力。     

抑郁症长期治疗措施

文献表明：70％的抑郁症患者有多次发作的可能，至少60％的病人需长期服努“。本文介绍抑郁症急性期、继续治疗期和维持治疗期的治疗方法。1急性治疗期1．三抑郁症急性期治疗’－”的方法，有电抽搐治疗（ECT）、抗抑郁药和心理治疗。对抑郁发作首选治疗方式通常由精神科医师决定，但应基于下列情况：安全性、有效性、病人躯体情况、疾病的严重程度、家庭经济情况。对伴有自杀行为的妄想性抑郁症应首选ECT．经性抑郁症可能只需心理治疗。不管选择哪种治疗，治疗目标是控制抑郁症状，使症状至少减轻50％，达到病人获得明显疗效。1．2ECT…     

心理干预治疗巫术所致精神障碍疗效观察

目的　探讨心理干预对巫术所致精神障碍的作用。方法　将 5 8例巫术所致精神障碍患者随机分为两组 ,治疗组为心理干预合并药物治疗组 ,对照组为单纯药物治疗组。治疗 8周 ,以简明精神病量表 ( BPRS)进行评定 ,随访半年。结果　心理干预对巫术所致精神障碍疗效肯定 ,在治疗 2周、4周、8周后 ,两组病人 BPRS评分与治疗前自身相比差异具有显著性( P<0 .0 1 ) ;治疗 8周后 BPRS评分以治疗组下降更明显 ,且半年随访复发率较低。结论　心理干预合并药物治疗是治疗巫术所致精神障碍的较好方法 ,且能降低巫术所致精神病的复发率     

What Is the Optimal Treatment of Mood and Anxiety Disorders?

In clinical psychiatry, the underlying assumption of using an integrated approach (pharmacotherapy + psychotherapy) is that of an additive model of interaction between pharmacotherapy and psychotherapy, which could take place on the basis of specific changes to be induced by specific treatments. However, the simultaneous administration of pharmacotherapy and psychotherapy is based on a cross-sectional, flat view of the disorders which ignores their longitudinal development. An alternative way of integrating pharmacotherapy and psychotherapy involves their sequential administration. In clinical psychiatry, administration of treatment in sequential order has been mainly limited to instances of treatment resistance and involved different types of drugs, such as in drug-refractory depression. This type of sequential approaches, however, was not targeted to the stages of illness or particularly to residual symptoms. In this paper we describe the development of a sequential strategy based on the use of pharmacotherapy in the acute phase of depression and cognitive therapy in its residual phase. The sequential model introduces a conceptual shift in therapeutic practice. It may also involve the use of pharmacotherapy after psychological treatment, the sequential use of two psychotherapeutic techniques, and two pharmacological strategies. We will discuss the implications of the sequential model and some related issues which have clinical value.     

Moving from empirically supported treatment lists to practice guidelines in psychotherapy: the role of the placebo concept

The use of placebos is the "gold standard" in studies of investigational drugs, and of other medical procedures as well. Several recent trends have suggested the use of placebos in studies of psychotherapy to isolate effective treatment components, and as a basis for establishing lists of empirically supported treatments. Unlike within the domain of medicine, in which the logic of placebos is relatively straightforward, the concept of placebo as applied to psychotherapy is fraught with both conceptual and practical problems. The evidence-based practice of psychotherapy can best be promoted through the development of practice guidelines, for which psychotherapy placebos are unnecessary. Moreover, even if problems associated with psychological placebos could be overcome, they are not necessary in psychotherapy research.     

Pharmacotherapy and psychotherapy in the treatment of psychiatric disturbances.

The type of treatment that most psychiatric disturbances receive at present is a mixture of pharmacotherapy and psychotherapy, following the principle that mental functions are the result of the activities of brain machinery subsequent to the interaction between individuals and their external environment. We now know the molecular mechanism of action of several psychoactive drugs but have scant understanding of the correlation between molecular events and mental function. As for psychotherapy, we know that it may have beneficial effects on patients' behavior but ignore the issue of whether this has any correlate at molecular level. A black box still exists between drugs, neurotransmitters, receptors, and the higher brain functions defined as anxiety, emotion, arousal, etc. Yet mental treatments imply a therapeutic method in which the blend of drugs and words administered to patients is determined by the choice of the therapist and by the specific pathology recognized through clinical diagnosis. In this epistemologically confused situation, the pharmaceutical industry is playing a major role in orientating the medical profession towards the use of more and more powerful neurotropic substances with very detailed molecular actions and plenty of side-effects. Nevertheless, the use of psychotropic drugs has allowed the opening of the psychiatric hospitals and the 'liberation' of millions of psychiatric patients. This beneficial effect is counterbalanced by the dependency of millions of individuals on psychotropic drugs. The situation leads to a number of questions relative to the possible links among words, molecules, and behaviors. The present paper illustrates a theoretical model which can be used to compare and contrast psychotherapy and pharmacotherapy.     

Interpersonal psychotherapy as augmentation treatment in depressed elderly responding poorly to antidepressant drugs: a case series

BACKGROUND: Medication is often the first choice in the treatment of depression, even though large numbers of depressed patients do not respond to antidepressant drugs or fail to achieve symptom remission or recovery. Generally, other drugs, rather than other therapeutic approaches such as psychotherapy, are used as augmentation treatment. This applies in particular to elderly patients. The aim of this work is to assess whether augmentation with interpersonal psychotherapy (IPT) can bring about symptom remission in depressed elderly responding poorly to medication. METHOD: Five cognitively intact patients aged over 60 and suffering from major depression were first treated for 6 weeks with a selective serotonin reuptake inhibitor compound. Owing to poor outcome, IPT was added to the treatment. IPT is a brief psychotherapy addressing the interpersonal problems linked to depression, and has been modified for use with elderly patients. RESULTS: All patients achieved symptom remission after a cycle of psychotherapy lasting a minimum of 16 and a maximum of 20 weekly sessions. CONCLUSIONS: The methodological limitations of this open study do not allow us to generalize from the positive outcomes. Further studies might confirm these initial observations and establish whether an equally satisfactory therapeutic response can be attained if medication is discontinued after the start of psychotherapy.     

Psychodynamic aspects of psychopharmacology in functional somatic complaints.

Psychiatrists as well as general practitioners frequently prescribe psychotropic drugs (tranquilizers such as benzodiazepines and increasingly low-dose long-acting neuroleptics) to treat functional organic complaints. We are interested in finding out the psychodynamics in the doctor-patient relationship that determine whether the doctor puts more emphasis on eliminating symptoms by prescribing psychotropic drugs or on solving the underlying conflicts by psychotherapy. Furthermore we describe some interactions which are of importance for illustrating whether drugs are effective or lead to side effects.     

Schlafbezogene Interventionen zur Augmentation von Psychotherapie

Background

The neurobiological augmentation of psychotherapy has drawn increasing attention in research on psychotherapy over the past years. In this context, the manipulation of sleep with its beneficial effect on memory formation and underlying neuronal plasticity is of particular interest as a non-invasive intervention.

Objectives

How do sleep and its selective manipulation influence the effectiveness of psychotherapy and how can sleep be used as an intervention to augment learning processes in psychotherapy?

Materials and methods

Important studies that examine the effects of sleep on processes of memory formation and psychotherapy are presented and discussed.

Results

Sleep represents a promising approach to augment the effects of psychotherapy. Sleep patterns are relevant both before and after psychotherapy. Another possibility is the manipulation of sleep and associated neuronal processes, e.?g. by transcranial direct current stimulation (tDCS) or drugs, which might influence learning processes and neuronal plasticity in the context of psychotherapy.

Conclusion

Sleep represents a promising approach to augment psychotherapy. Future studies are needed to further unravel the underlying mechanisms and to test whether this approach can be transferred to clinical practice.

     

Evaluation of combined pharmacological and psychotherapeutic treatment in patients with functional abdominal disorders.

78 patients suffering from various functional abdominal complaints have been trated in a 2 x 2 double-blind design: (a) psychotherapy with Ro 5-3350 (TH/Ro); (b) psychotherapy with placebo (TH/P); (c) Ro 5-3350 without psychotherapy (NIH/Ro); (d) placebo without psychotherapy (NTH/P). Results show that a considerable amount of improvement cannot be ascribed to the two critical factors or the interaction of both, but are due to unspecific influences in the course of treatment. Some of the results concerning the combination of TH and the psychotropic drug pose interesting questions for further research and bare implications for double-blind trials of psychotropic drugs. The results suggest that possibly properties of any psychotropic drug have to be related to a doctor-patient relationship within which the personal problems of the patient are dealt with. In order to evaluate such properties, special methodological precautions have to be taken. These will be briefly discussed.     

Psychosomatic medicine today: an overview.

The current status of several areas of interest in psychosomatic medicine, including specificity theory, life changes, and peptic ulcers, is reviewed, and their relevance to the practice of psychosomatic medicine discussed. The importance of neuro-psychopharmacological research to psychosomatic medicine is stressed, and a perspective is given on the usefulness of drugs in conjunction with intensive psychotherapy.     

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。