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。     

百忧解治疗抑郁症伴焦虑症状的临床疗效观察

目的观察百忧解对抑郁症伴焦虑症状的疗效和不良反应.方法将60例抑郁症患者分为研究组(伴焦虑症状)32例和对照组(不伴焦虑症状)28例,均给予百忧解治疗6周,采用Hamilton抑郁量表(HAMD)、Hamilton焦虑量表(HAMA)、Montgomery-Asberg抑郁量表(MADS)、临床大体印象表(CGI)和副反应量表(TESS)评定.结果两组百忧解治疗前后疗效有显著差异(P＜0.01);且不良反应轻.结论提示百忧解治疗抑郁症伴焦虑症状疗效肯定.     

舒必利治疗焦虑,抑郁症状的疗效分析

对４０例患有焦虑，抑郁症状的患者进行舒必利治疗。观察时间为８周，剂量０．４－０．８ｇ／日。治疗１周内开始见效。４０例患者的总有效率为１００％，其中痊愈６０％，显著好转３５％。以对焦虑症状的疗效最为显著，其次为抑郁改善，对失眠亦有治疗作用。提示此药可作为抗焦虑，抑郁剂在临床应用。     

低频rTMS治疗以疼痛症状为主的焦虑患者疗效观察

目的：探讨低频重复经颅磁刺激（低频rTMS）对以疼痛症状为主焦虑患者的治疗作用。方法68例以疼痛症状为主焦虑患者随机分为2组,对照组33例,口服常规抗焦虑药物;治疗组35例,在口服抗焦虑药物的同时,加用低频重复经颅磁刺激治疗,疗程4周,以汉密尔顿焦虑量表（HAMA）、疼痛视觉模拟评分（VAS）对患者的焦虑程度、疼痛程度及改善状况进行评定,并将2组疗效作对比。结果2组治疗前后 HAMA评分和VAS评分对比,差异均有统计学意义（P＜0.05）,组间比较差异有统计学意义（ P＜0.05）;总有效率治疗组94.29％,对照组81.82％,差异有统计学意义（ P＜0.05）。结论低频重复经颅磁刺激（低频rTMS）治疗以疼痛症状为主的焦虑患者安全有效。     

丁螺环酮治疗伴抑郁症状焦虑症的临床研究

目的：观察丁螺环酮治疗伴抑郁症状焦虑症的疗效。方法：31例符合CCMD－2－R诊断标准的焦虑症门诊病人完成6周的治疗观察,治疗前和治疗后每周末评定HAMA、HAMD和TESS来判断疗效和副作用。结果：丁螺环酮治疗焦虑症状的显效率为74．2％,治疗抑郁症状的显效率为74．25,结论：丁螺环酮对伴有抑郁症状的焦虑症有效。     

认知行为治疗和症状特异性药物治疗伴焦虑和抑郁的喉切除术后咽喉癌患者的回顾性比较(英文)

背景:喉切除术是一种常见的治疗喉癌损伤性手术作,可导致巨大的压力,但如何能减轻手术带来的心理影响知道甚少。目标:比较认知行为治疗(CBT)与药物治疗对喉切除术后咽喉癌患者焦虑和抑郁症状的治疗效果。方法:回顾湖州市第三人民医院2009年3月至2013年5月心理门诊中喉切除术后患有抑郁症或焦虑症患者的病历,确定63例患者曾接受过8周一对一的CBT治疗(其中无法说话的患者以书面形式作出回应),以及56例患者曾接受过8周的盐酸丁螺环酮治疗(n=11)、舍曲林治疗(n=9)或两种药物联合治疗(n=36)。治疗的选择(CBT或药物)是根据病人的陈述偏好而定的。采用焦虑自评量表(SAS)和抑郁自评量表(SDS)分别评估治疗前后的焦虑和抑郁症状。结果:治疗8周后,两组的SAS平均分和SDS平均分都明显下降,(根据焦虑自评量表和抑郁自评量表评分标准)伴有有焦虑或者抑郁症状患者的百分比也显著下降了。但是,两种治疗方法之间没有显著差异。药物治疗组32%的参患者在治疗过程出现一个或多个不良反应,但这些都没有严重到需要停药治疗。讨论:CBT是一种有效的、短期的治疗手段,可用于减少一个人被诊断患有癌症或接受癌症治疗后往往产生的焦虑和抑郁症状。众多证据表明,这些心理症状的治疗可以提高癌症患者的生活质量和减短疾病的病程,所以肿瘤学家和其他临床医生需要定期筛查癌症患者和其他危及生命的慢性病患者的抑郁和焦虑症状,如果存在的话,就需要积极对这些症状进行治疗。这项研究表明,CBT对于即使无法说话的癌症患者来说也是有效的。     

文拉法辛并用阿普唑仑治疗伴焦虑的抑郁症对照观察

目的　探讨文拉法辛并用阿普唑仑对伴有焦虑的抑郁症的疗效及不良反应。方法　采用随机方法将 70例患者分为文拉法辛并用阿普唑仑研究组及文拉法辛对照组 ,两组应用文拉法辛的方法及剂量相同 ,研究组合并阿普唑仑 ,疗程 6周。应用HAMD、HAMA、TESS量表 ,分别在治疗前及治疗后第 4、7、14、2 8、4 2天进行疗效及不良反应评定。结果　文拉法辛并用阿普唑仑组与文拉法辛组治疗前后HAMD总分及减分率比较差异无显著性 (P >0 .0 5 ) ,治疗后HAMA减分率研究组较对照组改变差异有显著性 (P <0 .0 1)。不良反应两组间差异无显著性 (P >0 .0 5 )。结论　文拉法辛并用阿普唑仑治疗伴有焦虑的抑郁症优于单用文拉法辛 ,并且起效更快。     

抑郁症伴焦虑症状与焦虑症的临床特点对照研究

目的为了探讨抑郁症伴焦虑症状的临床特征，力求减少误诊为焦虑症。方法对再入院的４６例焦虑症患者进行再诊断后，保持原诊断者１８例（３９１３％），更正诊断为抑郁症伴焦虑症状者２８例（６０８７％），并对两者的临床特征进行了对照研究。结果发现两者的抑郁症状（ＨＡＭＤ分值）和生物学节律变化方面均存在明显差异。结论正确地判定和区别焦虑、抑郁情绪以及明显的生物节律变化，均有助于诊断和鉴别诊断这两种疾病     

五仁冲剂抗焦虑作用的临床疗效观察

五仁冲剂抗焦虑作用的临床疗效观察四川省人民医院神经内科（６１００７２）肖军廖振德曾宪蓉五仁冲剂是我院院内制剂，由夜交藤、珍珠母、牡蛎、茯苓、五味子、酸枣仁、合欢皮、柏子仁、远志仁等１２味中药加工而成。具有宁心益智，潜镇安神之功，在我院临床上应用于治疗...     

抗焦虑治疗高血压并焦虑患者的疗效分析

目的 探讨抗焦虑治疗对的初诊高血压合并焦虑障碍患者血压达标率的影响。方法 左旋氨氯地平单药未达标的初诊高血压患者,经汉密顿焦虑量表诊断焦虑者共72例,随机分为A组加用替米沙坦,B组加用帕罗西汀,治疗8周,观察血压及达标率。结果 A组平均收缩压为(165.3±9.4)mmHg,平均舒张压为(99.1±5.7)mmHg,治疗8周后分别为(145.6±8.7)mmHg和(90.3±4.8)mmHg(P均<0.01);B组平均收缩压为(166.2±10.1)mmHg,平均舒张压为(99.6±5.9)mmHg,治疗8周后分别为(139.6±9.1)mmHg和(88.3±6.7)mmHg(P均<0.01);A、B组的血压控制达标率分别为68.26%和为79.39%(P<0.05)。结论 抗焦虑治疗可改善初诊高血压合并焦虑患者的血压达标率。     

Alexithymia and anxiety sensitivity in patients with non-cardiac chest pain

The aim of this study was to examine independent and combined influences of alexithymia and anxiety sensitivity on chest pain and life interference in patients with non-cardiac chest pain (NCCP). Theories of NCCP posit a central role for emotion in the experience of chest pain, however, studies have not examined how alexithymia characterized by a difficulty identifying or verbalizing emotions, may influence this relationship. This study examined 231 patients (56% females, M age = 50 years) with chest pain seeking cardiac evaluation, who showed no abnormalities during exercise tolerance testing. Forty percent (40%) scored at or above the moderate range of alexithymia. Whereas health care utilization was associated with elevated alexithymia among men, health care utilization was associated with elevated anxiety sensitivity among women. Hierarchical regression analyses revealed that alexithymia and anxiety sensitivity were both uniquely and independently associated with pain severity and life interference due to pain. Alexithymia-pain links were stronger for men compared to women. Secondary analyses conducted with a subsample suggest that alexithymia may be increasingly stable over time (i.e., 18-month follow-up). Findings are largely congruent with theoretical models of NCCP showing that personality and emotional factors are important in this medically unexplained syndrome.     

心理干预对恶性肿瘤患者疼痛及焦虑抑郁状态的影响

目的 心理干预对恶性肿瘤患者疼痛及焦虑抑郁状态的影响.方法 将85例伴有疼痛的恶性肿瘤患者随机分为对照组42例和观察组43例,对照组给予三阶梯止痛治疗,观察组在给予三阶梯治疗的基础上对患者进行心理干预,采用问卷调查方式进行焦虑自评量表(SAS),抑郁自评量表( SDS)的评定.结果 伴有疼痛的恶性肿瘤病人存在着相当严重程度的焦虑/抑郁情绪,观察组疼痛治疗效果及焦虑抑郁状态均好于对照组,两组差异有统计学意义(P＜0.05).结论 伴有疼痛的恶性肿瘤患者普遍存在抑郁焦虑的心理问题,并且随着癌痛程度加重而加重,心理干预不仅对改善疼痛有着重要的作用;而且能够改善恶性肿瘤患者焦虑抑郁的心理状态,提高患者生活质量.     

Association between anxiety,health-related quality of life and functional impairment in primary care patients with chronic pain

Objective

Anxiety and chronic pain are prevalent and frequently co-occur. Our purpose was to examine the association between anxiety, health-related quality of life (HRQL) and functional impairment in primary care patients with chronic musculoskeletal pain.

Methods

Data were drawn from baseline interviews of the 250 primary care patients enrolled in the Stepped Care to Optimize Pain care Effectiveness trial. Validated measures were used to determine the proportion of patients screening positive for five common anxiety disorders: generalized anxiety, panic, social anxiety, posttraumatic stress and obsessive–compulsive disorder. Bivariate analyses examined associations between the type and number of anxiety disorders for which patients screened positive and representative pain, psychological and other HRQL outcomes. Multivariable models controlling for major depression and other covariates examined the association between the number of screen-positive anxiety conditions and functional impairment in psychological [SF-12 mental component summary (MCS) score], pain [Brief Pain Inventory (BPI) interference score] and work (disability days) domains.

Results

One hundred fourteen (45%) patients screened positive for at least one anxiety disorder and, compared to the 136 screen-negative patients, had significantly worse scores across multiple pain, psychological and other HRQL domains. Substantial impairment was seen for each of the five screen-positive anxiety conditions and progressively worsened as the number of conditions increased from one (n= 54) to two (n= 26) to ≥ 3 (n= 34). The number of screen-positive anxiety conditions was strongly associated (P< .0001) with worse BPI interference and MCS scores and more disability days in models adjusting for age, sex and medical comorbidity. After further adjusting for major depression, associations were attenuated but remained significant for BPI interference (P< .0001) and MCS (P= .018) and marginally significant for disability days (P= .062).

Conclusion

Nearly half of primary care patients with chronic pain screen positive for one or more anxiety disorders, which in turn are adversely associated with impairment across multiple domains of HRQL. Detecting and treating anxiety may be an important component of pain management.     

心理剧治疗对广泛性焦虑症患者生活质量的影响

目的 探讨心理剧治疗对广泛性焦虑症患者生活质量的影响.方法 将76例广泛性焦虑症患者随机分为观察组和对照组各38例.两组均予以米氮平系统治疗,观察组在此基础上则联合心理剧治疗,疗程均为12周.采用Hamilton焦虑量表(HAMA)及生活质量综合评定问卷(GQOLI-74)分别于治疗前及治疗12周末进行评定.结果 治疗...     

百乐眠治疗焦虑症的疗效与安全性Meta分析

目的 评价百乐眠治疗躯体性疾病患者焦虑症的疗效、安全性及与疗程的关系.方法 检索截止到2016年12月在中国知网(CNKI)、万方数据库、中国优秀硕士/博士学位论文数据库、维普中文科技期刊数据库(VIP)、Cochrane图书馆、PubMed、EMBASE、中国学术会议论文数据库中发表的百乐眠治疗焦虑症文献,用Cochrane风险偏倚评估工具评价文献质量,用Stata 14.0和RevMan软件进行Meta分析.结果 纳入文献12篇,患者共1060例,其中试验组536例,对照组524例.总体有效率RR(95%CI)=1.33(1.21~1.45),HAMA评分SMD(95%CI)=-0.36(-0.65~-0.07),不良反应率RR(95%CI)=0.42(0.26~0.70).治疗2,4,8,12周的有效率RR(95%CI)分别为1.34(1.16~1.54),1.24(1.07~1.45),1.36(1.15~1.60)、1.50(1.06~2.13);治疗2,4,8周HAMA评分的SMD(95%CI)分别为-0.96(-1.85~-0.06),-0.28(-0.70~0.14),-0.75(-1.36~-0.13);治疗4,8周的不良反应发生率RR(95%CI)分别为0.25(0.09~0.69),0.41(0.19~0.91).结论 百乐眠胶囊对于改善躯体性疾病患者焦虑症状的总体有效率疗效显著,随着用药疗程的增加其治疗有效率优势越显著,且具有较高的安全性,值得在临床上进一步推广使用.     

Mood and anxiety disorders in patients with chronic low back and neck pain caused by disc herniation

Objective: We investigated the prevalence of mood and anxiety disorders in patients with chronic low back and neck pain caused by disc herniation and the relationships between pain and mood, and anxiety disorders.

Methods: In total, 149 patients with disc herniation and 60 healthy subjects were included. Disc herniation was diagnosed based on a physical examination and magnetic resonance imaging. Mood and anxiety disorders were diagnosed using the Structured Clinical Interview of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition/Clinical Version.

Results: The mean age of the study subjects (n?=?209) was 45.96?±?11.45 years. Seventy (46.6%) patients with disc herniation met the criteria for at least one mood or anxiety disorder. The prevalence rates of mood and anxiety disorders were 16.6% and 35.8%, respectively. The most common specific diagnoses were major depression (n?=?25, 16.9%) and generalised anxiety disorder (n?=?19, 12.8%).

Conclusions: Mood and anxiety disorders were more commonly seen in patients with lumbar or cervical disc herniation than in those without herniation. No relationship was detected between pain severity and mood or anxiety disorders. However, mood and anxiety disorders were associated with neurological deficits.     

老年焦虑抑郁障碍共病54例临床研究

目的 探讨老年焦虑抑郁障碍的临床特征、诊断及治疗方法.方法 选取54例符合入组标准及排除标准的患者进行临床研究,归纳临床症状并进行统计分析.用汉密尔顿焦虑量表(HAMA)和汉密尔顿抑郁量表(HAMD)进行评分,对比治疗前后的评分变化,并以HAMA和HAMD减分率判定疗效.结果 老年焦虑障碍多与抑郁共病,躯体主诉多为其主要特点.治疗后第2周末开始起效,疗效随时间延长同步上升,治疗后第2、4、8周末HAMA、HAMD量表评分与治疗前比较,有显著性差异(P ＜0.05,P＜0.01).药物及心理治疗的总有效率90.75％.结论 老年焦虑障碍多与抑郁共病,及时干预治疗效果满意.     

持续性躯体形式疼痛障碍生命质量的相关因素研究

目的探讨持续性躯体形式疼痛障碍（persist somatoform pain disorder,PSPD）患者的生命质量及相关因素。方法采用横断面调查研究,对60例PSPD患者应用健康状况调查问卷（SF-36）评定其生命质量,医疗结局研究用疼痛量表（MOSPM）评定PSPD严重程度,汉密顿抑郁量表（HAMD17）,汉密顿焦虑量表（HAMA）评定伴随的情绪状态。结果（1）除精神健康和精力分量表外,SF-36各分量表评分均显著低于普通居民（P〈0．01）;（2）除一般健康状况分量表外,SF-36各分量表评分与MOSPM总分及各因子分均显著负相关,与HAMD17及HAMA总分显著负相关;（3）除一般健康状况分量表外,有抑郁组的SF-36各分量表、躯体健康总评（PCS）及精神健康总评（MCS）分均显著低于无抑郁组（P〈0．01）;（4）多元逐步回归结果,SF-36的PCS与年龄和MOSPM总分相关,MCS则与HAMD总分和MOSPM总分相关。结论PSPD患者的生命质量显著低于普通人群,疼痛症状、抑郁和焦虑情绪与患者的生命质量密切相关,年龄、疼痛、抑郁为PCS和MCS重要影响因素。     

焦虑症患者的生命质量与焦虑症状的相关性研究

目的 探讨焦虑症患者的生命质量以及与焦虑症状的关系.方法 采用生命质量量表(LQS)及Hamilton焦虑量表(HAMA)对60例焦虑症患者进行了问卷调查,并与60例正常对照者比较.结果 焦虑症患者的生命质量总分及各因子评分均明显低于正常对照者(P＜0.01).焦虑症患者的生命质量总分及各因子评分与HAMA总分及因子分均呈显著性负相关(P＜0.01).结论 焦虑症患者的生命质量较差,且与焦虑症状有关,即焦虑症状越重,其生命质量越差.     

Anxiety sensitivity and pain-related anxiety in the prediction of fear responding to bodily sensations: A laboratory test

Objective

The present investigation sought to examine the simultaneous effects of anxiety sensitivity and pain-related anxiety on fear and anxious responding to a 10% carbon dioxide enriched air challenge.

Methods

Participants included 247 adults (53% women; mean age=21.91 years, S.D.=8.41) recruited from the community. At the laboratory, participants were administered a structured clinical interview, completed a battery of self-report measures, and underwent a 10% carbon dioxide enriched air challenge.

Results

Both anxiety sensitivity and pain-related anxiety were significantly and uniquely predictive of post-challenge panic attacks, total post-challenge panic attack symptoms, and intensity of cognitive panic attack symptoms. Anxiety sensitivity, but not pain-related anxiety, also was predictive of post-challenge physical panic symptoms. The observed significant effects for both anxiety sensitivity and pain-related anxiety were evident above and beyond the variance accounted for by gender, age, current level of nonspecific bodily pain, and negative affectivity. Neither anxiety sensitivity nor pain-related anxiety was significantly predictive of change in anxiety focused on bodily sensations or heart rate.

Conclusion

Results suggest that anxiety sensitivity and pain-related anxiety, although related to one another, may be independently important variables underlying fear reactivity to bodily sensations.