认知疗法治疗神经症伴心律失常临床观察

本文对符合《ＣＣＭＤ -2 -Ｒ》关于神经症的诊断标准 ,同时符合功能性心律失常诊断标准[1] 的住院患者进行了认知治疗临床观察。患者共 5 6例 ,男 2 0例 ,女 3 6例 ,年龄 17-5 0岁 ,平均3 2 5岁。病程 3 -3 6个月。其房性早搏3 5例 ,室性早搏 2 1例 (排除器质性心脏病 ) ,患者随机分为药物治疗组 (对照组 )及药物治疗加认知治疗组 (治疗组 )。对照组 2 6例 ,用安定 5 -10ｍｇ ,心得安 2 0ｍｇ ,奋乃静 4ｍｇ口服 ,每日 2次。疗程 3个月。治疗组 3 0例 ,在上述药物治疗的同时 ,应用认知治疗 ,疗程 3个月。每周谈话一次 ,每次 3 0分钟以上 ,…     

认知领悟疗法治疗恐怖症疗效观察

恐怖症是一种常见神经症，在我国神经症专科门诊中占6．7％[1]。迄今病因不明，疗效不甚满意。本文应用钟氏认知领悟疗法[2]治疗22例恐怖症．取得了一定的疗效（痊愈27．27％，显著进步45％，进步13．64％），治疗后SCL－90焦虑、恐怖、偏执、抑郁和躯体化因于分明显改善。1对象和方法1．1对象来自1994～1997年我院恐怖症病人·人组标准：符合CCMD—Ⅱ—R恐怖症诊断标准；无躯体疾病和其它精神障碍；无酒精依赖和药物滥用；至少近两周未采用心理和药物治疗。共22例．男18冽．女4例；年龄17～48岁．平均274土62岁；病期回～11年·平均5．…     

无症状性脑梗死患者抑郁情绪的干预

无症状脑梗死 (ＳＣＩ)是指临床上无相关症状和既往卒中史、但经ＣＴ或ＭＲＩ证实的脑梗死。ＳＣＩ虽无临床相关躯体症状 ,但其导致的心理功能障碍较常见[1] 。既往由于各种原因对ＳＣＩ伴随的抑郁症状重视不够 ,仅仅针对原发病进行治疗 ,或仅仅给予一些心理安抚。这样做的结果 ,致使患者生活质量下降[2 ] 。本文就此类患者的有效治疗进行探讨。1　资料与方法1.1　研究对象对于 2 0 0 0年 6月～ 2 0 0 2年 6月期间在我院心理门诊就诊的五十岁以上的有抑郁情绪 (Ｈａｍｉｌｔｏｎ抑郁量表测分≥ 2 0 )的 2 5 1名患者行头部ＣＴ和神经系统检查…     

简化认知行为治疗用于抑郁障碍的个案报告

本研究在简化认知行为治疗手册的框架下构建个案概念化,对1例抑郁障碍患者进行治疗。采用自编简化认知行为治疗(SCBT)手册,对其进行5个阶段共12次治疗;采用17项汉密顿抑郁量表(HAMD-17)、患者健康问卷抑郁症状群量表(PHQ-9)、汉密顿焦虑量表(HAMA)评估症状,采用治疗师治疗评价表、患者每次治疗评价表评价治疗效果。结果显示,患者情绪状况及负性自动思维都有明显改善,治疗师和患者均对治疗评价较好。本研究提示,用简化认知行为治疗手册的框架,能够有效地指导抑郁障碍心理治疗的临床实践。     

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 …     

认知暴露疗法治疗创伤后应激障碍的研究

目的 探讨认知暴露疗法治疗创伤后应激障碍(PTSD)的效果.方法 连续病例20名被随机分成两组,一组采取药物干预,另一组采用认知暴露疗法结合药物干预.疗效采用创伤后应激障碍症状清单量表(PCLS)、症状自评量表(SCL-90)、贝克抑郁问卷(BDI)、状态-特质焦虑问卷(STAI-Form Y)、汉密顿抑郁量表(HAMD)、汉密顿焦虑量表(HAMA)进行盲法评定.结果 药物治疗和结合治疗都在一定程度上改善了PTSD的症状,但是在再经历方面,结合治疗组下降稳定.其余各量表纵向效应明显.随访时用创伤后应激障碍症状清单量表(PCLS)进行测量,发现结合治疗组有两名被试已经不再符合PTSD诊断阶段,但是统计检验显示两治疗组之间并无差异.结论 认知暴露疗法有助于PTSD患者的心理康复.     

抑郁诊断筛查量表补充条目对自杀行为者抑郁症状的识别能力

<正>自杀行为是严重的公共卫生问题^[1]。抑郁症是自杀行为的重要危险因素。西方国家自杀行为者符合抑郁障碍的诊断比例(50%以上)^[2]明显高于中国(35%～40%)^[3-4]。中国自杀行为者中符合抑郁障碍的诊断比例较低的原因仍不清楚^[5]。本研究基于我国目前使用的抑郁调查工具可能不能敏感的识别出抑郁症状,拟探讨抑郁诊断筛查量表增加补充条目后在自杀行为者中识别出抑郁症状的比例是否高于仅使用原有条目。     

运动游戏与认知治疗抑郁倾向大学生的疗效观察

已有研究表明 :运动对改善人们心理健康水平有显著的效果 ,按摩、握手等亲密行为也具有显著的心理卫生价值[1] 。国内的祝蓓里、姒刚彦等人对此进行了有益的探讨[2 - 3] 。有研究指出 ,抑郁倾向的持续发展可能导致自杀行为[4 ] ,而抑郁的成因则主要认为是内源性的激素水平变化与消极的自我评价[5- 6 ] 。鉴于上述认识 ,我们希望能够以集体心理咨询的方式 ,通过体育游戏、认知干预等措施使有抑郁倾向的大学生的心境状态发生有利的变化 ,并于1997年至 1999年 ,结合省级重点科研课题 ,在阜阳师范学院对一组有抑郁倾向的大学生开展了较长时间的…     

中西医结合与纯西药治疗抑郁症65例的疗效对比

抑郁不但导致患者身心痛苦 ,影响患者的生活质量 ,而且是导致人类自杀死亡的原因之一[1] 。三环类药物仍然是目前用于治疗抑郁症的主要药物 ,然而 ,某些患者由于不能耐受该类药物的副作用而不得不放弃治疗 ,因此寻求一种低毒有效的方法治疗抑郁症很有必要。近两年来 ,我们采用中西医结合与单纯西药方法对 6 5例住院患者进行了治疗观察 ,现将结果报道如下。1资料与方法1 1　一般资料选取 2 0 0 0年 1月至 2 0 0 2年 12月初在我院专科门诊就诊收入院的 6 5例患者 ,均符合下列标准 :①符合CCMD - 3抑郁症诊断标准[2 ] ;②符合Zung氏抑郁自评…     

护士抑郁症状与特质应对、角色认知及控制感的相关研究

抑郁症状对个体心理社会功能的影响几乎可以和抑郁障碍相比[1] ,有效地控制抑郁症状不仅有利于提高个体成功的人际交往、保持放松状态以及快乐感 ,还会间接影响到员工的工作绩效和企业生产率[2 ,3] 。已有研究表明[4 ] ,角色认知是影响工作压力的一重要变量 ,它既直接作用于员工的工作压力 ,又通过控制感认知间接地发挥作用 ,即随着角色冲突和角色模糊的减少 ,控制感的增加 ,工作压力相应减少 ,为此 ,角色认知与控制体验也是联系个体压力应对和组织应激源的重要中介变量。目前 ,有研究表明[5- 7] ,通过减少组织应激源 ,如工作再设计、明确工…     

Recent developments in the psychotherapy of depression

The effectiveness of several types of psychotherapy for ambulatory, nonpsychotic depressed patients has been demonstrated in controlled clinical studies. Psychotherapy combined with antidepressant drug treatment appears to be the most effective form of treatment for most outpatients with major depression, although either treatment alone can be effective for patients who will not accept both. There is no evidence for negative interactions between psychotherapy and drug treatment. Interpersonal psychotherapy, cognitive therapy, and intensive psychodynamic cognitive therapy are types of individual psychotherapy that appear to have particular relevance for depression.     

Patient's therapeutic skill acquisition and response to psychotherapy,alone or in combination with medication

BACKGROUND: We tested the hypotheses that the addition of medication to psychotherapy enhances participation in the latter by: (1) speeding the acquisition of the psychotherapy's targeted skill; and (2) facilitating higher skill level acquisition. METHOD: Participants were 431 chronically depressed patients who received Cognitive Behavioral Analysis System of Psychotherapy (CBASP), alone (N=214) or in combination with nefazodone (N=217), as part of a randomized chronic depression study (Keller et al. 2000). CBASP, developed specifically to treat chronic depression, uses a specific procedure, 'situational analysis' to help patients engage in more effective goal-oriented interpersonal behaviours. At the end of each session, therapists rated patients on their performance of situational analysis. Outcome on depressive symptoms was assessed with the 24-item Hamilton Rating Scale for Depression. RESULTS: Although reductions in depression were significantly greater in combined treatment compared to CBASP alone, there were no between-group differences in either the rate of skill acquisition or overall skill level at the end of treatment. Proficiency in the use of the main skill taught in psychotherapy at treatment midpoint predicted outcome independently of medication status and of baseline depressive severity. CONCLUSIONS: Effective participation in CBASP, as reflected by proficiency in the compensatory skill taught in psychotherapy, is not enhanced by the addition of medication and does not mediate the between-group difference in depression outcome.     

Differential efficacy of group and individual/couple psychotherapy with infertile patients

BACKGROUND: The diagnosis of infertility and concurrent medical treatment may inflict an array of negative emotional symptoms in infertile persons. Evidence for the positive effects of psychotherapy on negative affect and also possible influence on conception rates has been discussed in several studies. METHOD: Meta-analyses were conducted in order to evaluate the efficacy of group and individual/couple therapies on (i) the reduction of negative emotional symptoms, and (ii) the possible promotion of pregnancy. RESULTS: Group and individual/couple psychotherapy led to a decrease in feelings of anxiety. Upon termination of psychotherapy, a reduction of depressive symptoms in patients was greater after 6 months. Psychotherapy accompanying IVF treatment yielded similar conception success rates to psychological interventions administered to patients not in specific medical care. CONCLUSION: Results are suggestive of positive effects of psychotherapy for infertile patients. However, these results must be viewed with caution due to methodological and informational bias within the studies analysed.     

Stress reactivity following brief treatment for depression: differential effects of psychotherapy and medication

Psychotherapy and medication treatments are both effective in reducing depressive symptoms. However, only psychotherapy provides an enduring effect by reducing depressive vulnerability following treatment termination. This differential efficacy may reflect mode-specific effects on the longitudinal relationship between depression and stress. The current study examined posttreatment data from 153 outpatients enrolled in the Treatment of Depression Collaborative Research Program. Longitudinal analyses using the latent difference score (LDS) framework (a structural modeling technique that combines features of latent growth curve and cross-lagged regression models) evaluated the temporal relationship between severity of depression and frequency of stressful life events, assessed by interviewers at treatment termination and at 6, 12, and 18 months following treatment. Results supported a stress reactivity model in that stressful events led to elevations in the rate of depression change. Furthermore, multigroup LDS analysis indicated that this longitudinal stress reactivity occurred only for outpatients in the medication conditions. Results demonstrate that the enduring impact of psychotherapy involves the development of enhanced resiliency to stressful life events.     

Efficacy of Interpersonal Psychotherapy plus pharmacotherapy in chronically depressed inpatients

BACKGROUND: Clinical guidelines recommend the combination of pharmaco- and psychotherapy for the treatment of chronic depression, although there are only a few studies supporting an additive effect of psychotherapy. METHODS: Forty-five inpatients with a chronic Major Depressive Disorder were randomized to 5 weeks of either Interpersonal Psychotherapy (IPT) modified for an inpatient setting (15 individual and 8 group sessions) plus pharmacotherapy or to medication plus Clinical Management (CM). The 17-item Hamilton Rating Scale for Depression was the primary outcome measure. The study included a prospective naturalistic follow-up, 3- and 12-months after discharge. RESULTS: Intent-to-treat analyses revealed a significantly greater reduction of depressive symptoms as well as better global functioning of patients treated with IPT compared to the CM group at week 5. Response and sustained response rates differed significantly between the two treatment conditions, favouring the IPT group. Remission rates were considerably higher for IPT patients who completed the treatment (67% vs. 32%). Patients who initially responded to IPT exhibited greater treatment gains at 12 months since only 7% of these subjects relapsed compared with 25% of the CM subjects. In the long-term, additional IPT led to a lower symptom level and higher global functioning. LIMITATIONS: The study uses data of a subset of patients from a larger trial. Both treatment groups did not receive comparable amounts of therapeutic attention. Extrapolating the data from this inpatient study to chronically depressed outpatients may not be possible. CONCLUSIONS: Intensive combined treatment provides superior acute and long-term effects over standard treatment in chronically depressed inpatients.     

A meta-analysis of psychotherapy and medication in unipolar depression and dysthymia

BACKGROUND: There remains considerable disagreement regarding the relative efficacy of psychotherapy and medication across types of depression. METHOD: We used random effects meta-analysis to examine the relative efficacy of psychotherapy vis-à-vis medication at post-treatment and follow-up. We also estimated the relative efficacy of continued medication versus discontinued psychotherapy. As twenty-eight studies (39 effects, n=3381) met inclusion criteria, we were able to conduct an adequately powered test of between-study heterogeneity and examine if the type of depression influenced relative efficacy. RESULTS: Psychotherapy and medication were not significantly different at post-treatment, however effect sizes were not consistent. Although there was no association between severity and relative efficacy, a small but significant advantage for medications in the treatment of dysthymia did emerge. However, psychotherapy showed a significant advantage over medication at follow-up and this advantage was positively associated with length of follow-up. Moreover, discontinued acute phase psychotherapy did not differ from continued medication at follow-up. LIMITATIONS: Limitations included relatively fewer studies of severe and chronic depression, as well as dysthymia. In addition, only a minority of studies reported follow-up data. CONCLUSIONS: Our results indicated that both psychotherapy and medication are viable treatments for unipolar depression and that psychotherapy may offer a prophylactic effect not provided by medication. However, our analyses diverged from previous findings in that effects were not consistent and medication was significantly more efficacious than psychotherapy in the treatment of dysthymia.     

抑郁障碍青少年及其父母的求助行为

目的：了解抑郁障碍青少年与父母的求助行为（病因解释，求助途径，延误就诊时间与来诊期望）。方法：对61例门诊抑郁障碍青少年家庭采用求助半定式问卷，SDS，C—GAS调查。结果：患者求助延误平均17个月，与父母无明显差异（P〉0．05），母亲是就诊决策的主要因素（77．5％），患者发病年龄越大、功能越好，就诊延迟时间越长；患者将病因归为外界压力与个性缺陷。父母更倾向于家庭养育问题、婚姻不合和个性缺陷；对专业机构有心理治疗需求。结论：考虑家庭求助特征有利于制定抑郁障碍青少年的干预方案。     

Psychodynamic technique early in treatment related to outcome for depressed patients

We examined the relationship between psychodynamic techniques early in treatment with reliable change in depressive symptomatology. Forty‐six patients admitted for individual psychodynamic psychotherapy who received a diagnosis representative of a depressive spectrum disorder were assessed pretreatment and posttreatment through self‐report of depressive symptoms. Videotapes from two early treatment sessions (3rd and 9th) were independently rated on the Comparative Psychotherapy Process Scale for use of psychodynamic‐interpersonal and cognitive–behavioural techniques, with excellent interrater reliability (intraclass correlation coefficient > .75). We found a significant relationship between overall use of psychodynamic technique across early treatment (r = .31, p = .036), as well as specific psychodynamic techniques delivered across early treatment, with change in patient‐reported depressive symptoms. Our findings suggest that focusing on affective experiencing and expression, as well as providing interpretations are particularly helpful early in psychodynamic treatment for depression. Clinical implications and future directions are discussed.     

A comparison of nefazodone, the cognitive behavioral-analysis system of psychotherapy, and their combination for the treatment of chronic depression

BACKGROUND: Patients with chronic forms of major depression are difficult to treat, and the relative efficacy of medications and psychotherapy is uncertain. METHODS: We randomly assigned 681 adults with a chronic nonpsychotic major depressive disorder to 12 weeks of outpatient treatment with nefazodone (maximal dose, 600 mg per day), the cognitive behavioral-analysis system of psychotherapy (16 to 20 sessions), or both. At base line, all patients had scores of at least 20 on the 24-item Hamilton Rating Scale for Depression (indicating clinically significant depression). Remission was defined as a score of 8 or less at weeks 10 and 12. For patients who did not have remission, a satisfactory response was defined as a reduction in the score by at least 50 percent from base line and a score of 15 or less. Raters were unaware of the patients' treatment assignments. RESULTS: Of the 681 patients, 662 attended at least one treatment session and were included in the analysis of response. The overall rate of response (both remission and satisfactory response) was 48 percent in both the nefazodone group and in the psychotherapy group, as compared with 73 percent in the combined-treatment group. (P<0.001 for both comparisons). Among the 519 subjects who completed the study, the rates of response were 55 percent in the nefazodone group and 52 percent in the psychotherapy group, as compared with 85 percent in the combined-treatment group (P<0.001 for both comparisons). The rates of withdrawal were similar in the three groups. Adverse events in the nefazodone group were consistent with the known side effects of the drug (e.g., headache, somnolence, dry mouth, nausea, and dizziness). CONCLUSIONS: Although about half of patients with chronic forms of major depression have a response to short-term treatment with either nefazodone or a cognitive behavioral-analysis system of psychotherapy, the combination of the two is significantly more efficacious than either treatment alone.     

A comparative trial of psychotherapy and pharmacotherapy for "pure" dysthymic patients

BACKGROUND: Psychotherapy of "pure" dysthymic disorder remains understudied. This article reports outcomes of an acute randomized trial of 94 subjects treated for 16 weeks with either interpersonal psychotherapy (IPT), brief supportive psychotherapy (BSP), sertraline, or sertraline plus IPT. METHODS: Recruited by clinical referral and advertising, subjects met DSM-IV criteria for early onset dysthymic disorder, with no episode of major depression in the prior six months. They were randomly assigned to one of four 16-week treatments, with options for crossover or continuation treatment. Results were analyzed from the intention-to-treat sample by ANCOVA, controlling for baseline depressive severity. RESULTS: Subjects improved in all conditions over time, with the cells including sertraline pharmacotherapy showing superiority over psychotherapy alone for response and remission. Response rates were 58% for sertraline alone, 57% for combined treatment, 35% for IPT, and 31% for BSP. LIMITATIONS: The study was underpowered and may have employed too "active" a control condition. Follow-up data were unobtainable. CONCLUSIONS: In this acute trial for "pure" dysthymic disorder, sertraline with or without IPT showed advantages relative to IPT and BSP. Methodological difficulties may have limited differential outcome findings. This study bolsters a small but growing literature on the treatment of dysthymic disorder, suggesting that pharmacotherapy may acutely benefit patients more than psychotherapy.