门诊式森田疗法治疗首发神经症患者32例效果分析

目的：探讨门诊式森田疗法治疗首发神经症的临床疗效与可行性。方法：收集32例首发神经症患接受门诊森田疗法治疗6个月，前3个月每来1次门诊，后3个月每两周来1次，每次谈话30－50min。每天睡前1h记森田日记，医生定期批示。以疾病程度自评量表（SCL－90）和临床总体印象量表（CGI－SI）进行疗前疗后评定。结果：痊愈13例，显进步12例，进步5例，无效2例，有效率达93．75％，显进步率37．5％，SCL－90量表因子分在治疗后明显降低。结论：门诊式森田疗法治疗首发神经症疗效较好，临床可广泛推行。     

森田疗法治疗新兵适应障碍

目的探讨森田疗法治疗新兵适应障碍的疗效。方法对38例新兵适应障碍患者采用森田疗法进行心理治疗,观察治疗全程。于治疗前后采用症状自评量表进行评定分析。结果入组患者经森田疗法治疗后症状自评量表评分除精神病性因子分无显著变化外,总分及各因子分均显著低于治疗前（P〈0．05或0．01）;所有患者心理冲突减轻或消失,情绪稳定,人际关系得到显著改善,不适应状态基本消除。结论森田疗法能有效缓解新兵适应障碍的各种症状,疗效显著,是治疗新兵适应障碍的有效心理干预方法。     

门诊式森田疗法治疗首发神经症患者 32 例效果分析

目的探讨门诊式森田疗法治疗首发神经症的临床疗效与可行性.方法收集 32例首发神经症患者接受门诊森田疗法治疗 6个月,前 3个月每周来 1次门诊,后 3个月每两周来 1次,每次谈话 30～ 50 min.每天睡前 1 h记森田日记,医生定期批示.以疾病程度自评量表(SCL 90)和临床总体印象量表(CGI SI)进行疗前疗后评定.结果痊愈 13例,显著进步 12例,进步 5例,无效 2例,有效率达 93.75%,显著进步率 37.5%,SCL 90量表因子分在治疗后明显降低.结论门诊式森田疗法治疗首发神经症疗效较好,临床可广泛推行.     

惊恐障碍病人的心理护理

惊恐发作是伴有严重植物性症状的强烈的焦虑发作。这种发作可见于甲亢，自发性低血糖，嗜铬细胞瘤，肺梗塞等躯体疾病的患者，及某些精神异常者。临床上有一类患者反复出现惊恐发作，而发作间歇期无躯体或精神病症状，应诊断为惊恐障碍（惊恐发作障碍）[1]1临床资料23例患者，男6例，女17例，年龄16～65岁。其中12例有一定心理因素作用，余11例发作时无明显精神刺激。发作时同时存在4种以上的下述症状，出现频率依次为呼吸困难或宰息感；心悸或心跳加快；出汗；胸前区病或胸闷；濒死感；失控感；头晕及不稳感；皮肤潮红或苍白发凉；恶心或腹…     

森田疗法治疗强迫症的随访对照研究

目的：研究森田疗法在强迫症治疗中的作用及长期疗效。方法：将60例门诊强迫症患随机分成两组，分别用药物合并森田疗法（研究组30组）和单一药物（对照组30例）治疗；疗程10－12周，无与疗前，疗后及治疗结束后半年做耶鲁布郎强迫症状量表（Y－BOCS），汉密顿焦虑量表（HAMA）评定病人，并于半年后用社会功能缺陷筛选量表（SDSS）评定病人，结果：治疗后及半年随访时研究组强迫症状评分及焦虑症状分均显低于单一用药组，半年后研究组SDSS评分低于单一用药组。结论：森田疗法不仅能减轻强迫症状，而且能改善焦虑症状，增强社会功能，提高生存质量，是全面改善强迫症的治疗方法，且长期应用疗效显，适用于门诊病人。     

森田疗法配合三线放松法治疗疑病症60例分析

目的：探讨森田疗法结合三线放松法治疗疑病症的疗效。方法：对60例疑病症患者应用森田疗法结合三线放松法治疗，观察12周，采用焦虑自评量表、抑郁自评量表评定临床疗效。结果：治疗4周、8周、12周末焦虑自评量表、抑郁自评量表评分较治疗前显著下降（P〈0．01）。结论：森田疗法结合三线放松法治疗疑病症疗效显著。     

森田疗法在门诊强迫症患者治疗中的应用

将56例符合CCMD-3的门诊强迫症患者随机分成对照组和研究组，每组28例，均接受氯丙咪嗪治疗，研究组同时应用森田疗法。两组分别于治疗前、第12次、18次治疗后进行耶鲁布朗强迫症状量表、焦虑自评量表、抑郁自评量表评定。与治疗前相比，两组治疗后各量表评分均显著降低，差异有显著性(P&;lt;0．01)；疗后组间比较，研究组各量表评分显著低于对照组(P&;lt;0．05～0．01)。药物合并森田疗法治疗强迫症患者中疗效显著，优于单一药物治疗，可用于门诊患者。     

冠心病和惊恐障碍患者的临床对照研究

目的：探讨冠心病及惊恐障碍患者的心理状态及其与疾病严重程度的相关性。方法：应用症状自评量表(SCL-90)对88例明确诊断为冠心病和惊恐障碍的患者进行心理评定，结合患者的机体功能，生活质量及冠状动脉造影结果综合分析。结果：冠心病和惊恐障碍患者SCL-90总分及各项评分均高于常模；女性患者的总分、躯体化、强迫、焦虑、恐怖和精神病性6项因子分明显高于男性患者，差异有显著性意义(P均&;lt;0．01)；冠心病患者年龄与SCL-90无相关性(r=-0．178～0．211，P均&;gt;0．05)；惊恐障碍组患者总分、躯体化、强迫、人际关系、抑郁、焦虑、恐怖及精神病性7项评分明显高于心肌梗死组患者，敌对、偏执狂2个因子分两组间差异无显著性意义；惊恐障碍组患者总分、躯体化、强迫、人际关系、抑郁、恐怖及精神病性7项评分明显高于心绞痛患者组，而焦虑、敌对2个因子分两组间差异无显著性意义；冠状动脉病变各程度患者的心理症状除躯体化外(P&;lt;0．01)，其余各项差异均无显著性意义(P均&;gt;0．05)。结论：冠心病患者焦虑，抑郁等心理症状与躯体症状并存，并相互影响；冠心病患者与惊恐障碍患者的心理症状与躯体症状存在差异；心理症状与冠状动脉病变程度无相关。     

森田疗法与氯硝西泮治疗失眠症：4周复发率比较

目的 比较森田疗法合并苯二氮卓类药物氯硝安定治疗与单纯药物治疗效果的差异，探讨森田疗法在失眠症中的干预作用。方法 选择2003-02／2004-02在青岛市精神卫生中心精神科门诊或病房就诊的失眠症患者40例，均自愿参加本观察。按就诊顺序平均分为2组，联合组和药物组各20例。联合组为森田疗法合并氯硝安定治疗，药物组仅为单纯氯硝安定治疗。治疗12周内，应用临床常用剂量2-6mg／d：联合组在服用药物的同时，给予改良的森田疗法，12周为1个疗程。两组患者于治疗前、治疗后1，2，4，12周给予匹兹堡睡眠质量指数评分（18个条目组成7个成份，每个成份按0～3等级计分，总分范围为0-21分，得分越高，表示睡眠质量越差）。于治疗后行临床疗效评定，分为显著进步、进步、无效3级，显著进步为失眠症状显著改善，睡眠质量较好；进步为失眠症状有改善；无效为失眠症状无缓解。显著进步＋进步：有效。治疗停止后4周评定复发率。结果 联合组和药物组各20例均进入结果分析。①匹兹堡睡眠质量指数评分：治疗后4周联合组显著低于药物组[2．35&;#177;2．05，4．36&;#177;2．75，（t=2．403，P〈0．01）]：治疗后4周联合组和药物组显著低于治疗前[9．42&;#177;3．38，9．36&;#177;3．28，（t=2．432，2．526，P〈0．01）]。②有效率：联合组显著高于药物组[80％，40％，（X^2=3．98，P〈0．05）]。③4周复发率：联合组显著低于药物组[25％，55％，（X^2=3．67，P〈0．01）]。结论 药物治疗与森田疗法联合应用能显著改善失眠症患者的失眠症状，治疗4周后复发率较低。与单纯药物治疗会引起药物依赖相比，联合应用的干预效果占明显优势。     

帕罗西汀治疗躯体形式障碍

目的：探讨躯体形式障碍的临床特点及治疗措施。方法：80例符合中国精神疾病诊断标准（CCMD-3）的躯体形式障碍患者,每天服用帕罗西汀20 mg,治疗前后进行汉密尔顿抑郁量表（HAMD）和汉密尔顿焦虑量表（HAMA）评分。结果：治疗8周后,HAMD和HAMA评分与治疗前比较均明显下降（P〈0.01）,痊愈68.8%,显效15.0%,进步11.3%,无效5.0%。结论：帕罗西汀可有效缓解躯体形式障碍患者的不适症状。     

Treatment of panic disorder

Panic disorder with or without agoraphobia occurs commonly in patients in primary care settings. This article assesses multiple evidence-based reviews of effective treatments for panic disorder. Antidepressant medications successfully reduce the severity of panic symptoms and eliminate panic attacks. Selective serotonin reuptake inhibitors and tricyclic antidepressants are equally effective in the treatment of panic disorder. The choice of medication is based on side effect profiles and patient preferences. Strong evidence supports the effectiveness of cognitive behavior therapy in treating panic disorder. Family physicians who are not trained in cognitive behavior therapy may refer patients with panic disorder to therapists with such training. Cognitive behavior therapy can be used alone or in combination with antidepressants to treat patients with panic disorder. Benzodiazepines are effective in treating panic disorder symptoms, but they are less effective than antidepressants and cognitive behavior therapy.     

Identifying and treating patients with panic attacks.

Panic disorder occurs in up to 3 percent of the population and can be socially, emotionally and occupationally disabling. A thorough clinical evaluation is crucial to exclude illnesses with similar presentations, particularly acute cardiac, gastrointestinal or neurologic disease. The noradrenergic nervous system is involved in panic attacks. These attacks are described as sudden, unexpected episodes of intense fear or discomfort, usually lasting five to 30 minutes. Appropriate medications include benzodiazepines, tricyclic antidepressants and monoamine oxidase inhibitors. Alprazolam and clonazepam are quickly effective in alleviating panic, but they cause significant symptoms upon discontinuation. The best-studied drug in the treatment of panic disorder is imipramine; like other tricyclic antidepressants, it can cause increased jitteriness early in treatment. Monoamine oxidase inhibitors may be particularly helpful in patients with panic disorder who exhibit social avoidance. Behavior therapy, an important component of treatment, involves the patient's confrontation of fears or phobias.     

精神科与心理咨询门诊焦虑障碍患者就诊情况分析

目的探讨焦虑障碍患者在心理咨询门诊和精神科门诊就诊情况,为焦虑障碍患者提供就诊指导.方法随机抽取2003年1月～2005年5月在上海市心理咨询中心和精神卫生中心门诊就诊的431例焦虑障碍患者的临床资料进行回顾性分析.结果心理咨询门诊焦虑障碍初诊患者（19.3%）明显高于精神科门诊（8.4%）,且以年龄小、病程短、未婚、职员、科教文卫、离退休者为多.两门诊使用频率最高的抗焦虑剂为苯二氮[艹卓]类、5-羟色胺再摄取抑制剂.心理咨询门诊以心理干预或联合药物治疗者为多,脱失率60%;精神科门诊应用药物治疗者为多,脱失率30%,两门诊比较差异有极显著性（P＜0.01）.结论焦虑障碍患者在两门诊就诊特点的不同表现在人口学资料、干预措施及疗效等方面.     

Panic Control Treatment and Its Applications

Panic Control Treatment (PCT) is a widely used, empirically validated cognitive-behavioral treatment for panic disorder. Initially developed for the treatment of panic disorder with limited agoraphobic avoidance, PCT more recently has been finding broader applications. It has been used as an aid to pharmacotherapy discontinuation in panic disorder; in the treatment of panic attacks associated with other disorders such as schizophrenia; and, in combination with a situational exposure component, in the treatment of patients with moderate to severe agoraphobia. The authors critically review the evidence for the clinical efficacy of PCT and recent work directed at further enhancing the long-term efficacy and cost-effectiveness of treatment. (The Journal of Psychotherapy Practice and Research 1999; 8:3–11)Since panic disorder was formally recognized as a discrete entity in DSM-III, it has become one of the most intensively studied anxiety disorders. By definition, panic disorder causes significant distress or interference with the individual''s life, exacting substantial personal costs. In addition, the disorder imposes high direct and indirect costs on the nation in medical resources used for care, treatment, and rehabilitation and in reduced or lost productivity.¹A growing body of evidence supports both the efficacy and effectiveness (clinical utility) of psychosocial interventions for panic disorder. For example, a recent meta-analysis of 43 controlled studies found that cognitive and cognitive-behavioral treatments, collectively, had a higher mean treatment effect size and a lower attrition rate than pharmacological treatments.² In addition, evidence is beginning to appear from naturalistic studies that cognitive-behavioral therapy for panic disorder may be more cost-effective than pharmacotherapy, even within the first treatment year.³Yet despite the demonstrated efficacy and favorable cost profile of cognitive-behavioral therapy for panic disorder,⁴ most patients treated in clinical practice settings do not receive it.^5–7 That situation is due in large part to two problems: limited knowledge by physicians and the general public about the nature and benefits of cognitive-behavioral therapies, and the lack of an effective means for disseminating new treatments, resulting in reduced treatment availability.⁸ The present article provides an overview of one of the most well-studied forms of cognitive-behavioral therapy for panic disorder, Panic Control Treatment (PCT),^9,10 and reviews the evidence for its efficacy. Also reviewed is some recent work directed at extending the application of PCT to new populations and enhancing its long-term efficacy and cost-effectiveness.     

Functional impact and health utility of anxiety disorders in primary care outpatients

OBJECTIVE: The objective of this study was to examine the relative impact of anxiety disorders and major depression on functional status and health-related quality of life of primary care outpatients. METHOD: Four hundred eighty adult outpatients at an index visit to their primary care provider were classified by structured diagnostic interview as having anxiety disorders (panic disorder with or without agoraphobia, social phobia, and posttraumatic stress disorder; generalized anxiety disorder was also assessed in a subset) with or without major depression. Functional status, sick days from work, and health-related quality of life (including a preference-based measure) were assessed using standardized measures adjusting for the impact of comorbid medical illnesses. Relative impact of the various anxiety disorders and major depression on these indices was evaluated. RESULTS: In multivariate regression analyses simultaneously adjusting for age, sex, number of chronic medical conditions, education, and/or poverty status, each of major depression, panic disorder, posttraumatic stress disorder, and social phobia contributed independently and relatively equally to the prediction of disability and functional outcomes. Generalized anxiety disorder had relatively little impact on these indices when the effects of comorbid major depression were considered. Overall, anxiety disorders were associated with substantial decrements in preference-based health states. CONCLUSIONS: These observations demonstrate that the presence of each of 3 common anxiety disorders (ie, panic disorder, posttraumatic stress disorder, and social phobia)-over and above the impact of chronic physical illness, major depression, and other socioeconomic factors-contributes in an approximately additive fashion to the prediction of poor functioning, reduced health-related quality of life, and more sick days from work. Greater awareness of the deleterious impact of anxiety disorders in primary care is warranted.     

Panic attacks. Psychologic response or medical illness?

Panic attacks are surprisingly common in the United States, costing our economy more than $100 million per year in disability benefits and health care expenses. However, diagnosis is difficult and consequently many patients are treated for other conditions. When an underlying disorder is determined to be present, treatment of that disorder may ameliorate attacks. If none is present, panic symptoms will respond to a variety of drugs. Behavioral therapy may be necessary in severe cases or as adjunctive therapy after attacks abate.     

A comparison of alprazolam and behavior therapy in treatment of panic disorder

The results of a clinical outcome study (N = 57) comparing behavior therapy directed at panic disorder (panic control treatment [PCT]) with alprazolam were reported. These conditions were compared with a medication placebo and a waiting-list control group. Patterns of results on measures of panic attacks, generalized anxiety, and global clinical ratings reveal that PCT was significantly more effective than placebo and waiting-list conditions on most measures. The alprazolam group differed significantly from neither PCT nor placebo. The percentage of clients completing the study who were free of panic attacks following PCT was 87%, compared with 50% for alprazolam, 36% for placebo, and 33% for the waiting-list group. Since alprazolam may work more quickly than PCT but may also interfere with the effects of behavioral treatment, these data suggest a series of studies on the feasibility of integrating these treatments and on the precise patterns and mechanisms of action of various successful treatment approaches to panic disorder.     

Changes in cerebral glucose utilization in patients with panic disorder treated with cognitive-behavioral therapy

Several neuroanatomical hypotheses of panic disorder have been proposed focusing on the significant role of the amygdala and PAG-related "panic neurocircuitry." Although cognitive-behavioral therapy is effective in patients with panic disorder, its therapeutic mechanism of action in the brain remains unclear. The present study was performed to investigate regional brain glucose metabolic changes associated with successful completion of cognitive-behavioral therapy in panic disorder patients. The regional glucose utilization in patients with panic disorder was compared before and after cognitive-behavioral therapy using positron emission tomography with (18)F-fluorodeoxyglucose. In 11 of 12 patients who showed improvement after cognitive-behavioral therapy, decreased glucose utilization was detected in the right hippocampus, left anterior cingulate, left cerebellum, and pons, whereas increased glucose utilization was seen in the bilateral medial prefrontal cortices. Significant correlations were found between the percent change relative to the pretreatment value of glucose utilization in the left medial prefrontal cortex and those of anxiety and agoraphobia-related subscale of the Panic Disorder Severity Scale, and between that of the midbrain and that of the number of panic attacks during the 4 weeks before each scan in all 12 patients. The completion of successful cognitive-behavioral therapy involved not only reduction of the baseline hyperactivity in several brain areas but also adaptive metabolic changes of the bilateral medial prefrontal cortices in panic disorder patients.     

The role of psychotherapy in treating psychiatric disorders

Psychotherapy has shifted from long-term to short-term approaches, which have been found to be effective for the treatment of specific psychiatric disorders. These psychotherapy interventions (primarily behavior therapy, CBT, and IPT) have been found useful in presenting an educational framework for disorders and the treatment rationale for intervention programs. Short-term and maintenance empirical data support the effectiveness of using behavior therapy and CBT as adjunctive interventions with medications for bipolar I disorder and schizophrenia. In major randomized clinical trials, psychotherapy interventions (primarily behavior therapy, CBT, and IPT) have been shown to be effective as primary treatments (treatments of choice) for the major psychiatric problems of obsessive-compulsive disorder, panic disorder, and major depression as well as several other psychiatric disorders. The combination of psychotherapy and psychotropic medications is not always additive for acute treatment effects or especially for the maintenance of treatment effects so that the combination of psychotherapy and medications is not the most effective treatment for all psychiatric disorders. Badly needed, additional randomized controlled trials of psychotherapy, medications, and their combinations are under way in large, NIMH-supported studies of the treatment of several psychiatric disorders.     

Theory and technique in psychodynamic treatment of panic disorder.

The authors elaborate psychodynamic factors that are relevant to the treatment of panic disorder. They outline psychoanalytic concepts that were employed to develop a psychodynamic approach to panic disorder, including the idea of unconscious mental life and the existence of defense mechanisms, compromise formations, the pleasure principle, and the transference. The authors then describe a panic-focused psychodynamic treatment based on a psychodynamic formulation of panic. Clinical techniques used in this approach, such as working with transference and working through, are described. Finally, a case vignette is employed to illustrate the relevance of these factors to panic disorder and the use of this treatment.(The Journal of Psychotherapy Practice and Research 1999; 8:234-242)