认知行为疗法联合舒肝解郁胶囊对失眠患者的效果及负面情绪及认知功能的影响

目的分析失眠障碍患者应用舒肝解郁胶囊联合认知行为治疗的效果。方法将我院91例失眠障碍患者采用随机数字表法进行分组,对照组45例给予认知行为疗法进行治疗,观察组46例增加舒肝解郁胶囊,对比两组患者治疗后睡眠质量,焦虑、抑郁负面情绪,认知功能及生活质量变化。结果治疗后,观察组PSQI、BAI、BDI评分评分低于对照组,MMSE及SF-36评分高于对照组(P0.05)。结论舒肝解郁胶囊联合认知行为疗法能够有效消除失眠障碍患者的焦虑、抑郁情绪,改善其认知功能,提高其睡眠质量和生活质量。     

青少年失眠状况和睡眠质量及二者相关性分析

目的调查青少年失眠状况和睡眠质量及二者之间的相关性。方法对技工学校学生统一发放4733份调查问卷,最终获得有效问卷3342份,记录社会人口学资料,包括性别、年龄、身高、体重、健康状况、户籍、是否为独生子女、父母受教育程度、家庭收入、学习压力、吸烟和饮酒等,以及睡眠和情绪相关量表评分,包括失眠严重指数(ISI)中文版、匹兹堡睡眠质量指数(PSQI)、Epworth嗜睡量表(ESS)、焦虑自评量表(SAS)和Beck抑郁量表(BDI)。结果 3342名青少年中存在失眠997例(29.83%)、日间嗜睡568例(17.00%)、焦虑243例(7.27%)和抑郁1287例(38.51%)。根据ISI中文版评分分为非失眠组(2345名)和失眠组(997例),失眠组女性(P=0.000)、健康状况不良(P=0.000)、非独生子女(P=0.006)、有学习压力(P=0.000)和吸烟(P=0.027)比例,以及ISI中文版评分(P=0.000)、ESS评分(P=0.000)、SAS评分(P=0.000)和BDI评分(P=0.000)均高于非失眠组。Pearson相关分析显示,ISI中文版评分和PSQI评分均与ESS评分(r=0.361,P=0.000;r=0.064,P=0.000)、SAS评分(r=0.326,P=0.000;r=0.069,P=0.000)和BDI评分(r=0.529,P=0.000;r=0.067,P=0.000)呈正相关,且ISI中文版评分的上述相关性(r=0.300～0.600)高于PSQI评分(r0.100)。进一步偏相关分析显示,ISI中文版评分与PSQI评分呈负相关(r=-0.056,P=0.001)。结论失眠组女性更多、健康状况更差、非独生子女更多、学习压力更大、吸烟比例更高,以及日间嗜睡、焦虑和抑郁更严重。与PSQI量表相比,ISI量表中文版与日间嗜睡、焦虑和抑郁的关系更紧密,可能更适用于筛查和评价青少年失眠状况。     

积极情绪认知治疗联合音乐放松治疗对卒中患者抑郁焦虑情绪影响的临床观察

目的探讨积极情绪认知治疗联合音乐放松治疗对卒中患者抑郁和焦虑情绪的影响。方法将40例脑卒中患者分为实验组和对照组统一进行临床常规治疗和康复治疗,同时给予实验组积极情绪认知治疗和音乐放松治疗干预六周。采用贝克焦虑量表(Beck Anxiety Inventory,BAI)和贝克抑郁量表(Beck Depression Inventory,BDI)评估患者治疗前后焦虑抑郁情绪变化。采用卡方检验、独立样本t检验比较实验组和对照组的一般资料和临床资料,使用配对样本t检验对两组治疗前后BAI和BDI分数进行比较。结果①治疗前,实验组和对照组BAI和BDI得分无明显差异;②治疗后,实验组BAI和BDI得分显著下降,均较对照组低(P0.05),对照组治疗前后的BAI及BDI得分无显著差异。结论积极情绪认知治疗联合音乐放松治疗能显著改善脑卒中患者的抑郁焦虑情绪。     

伴失眠的抑郁症患者睡眠认知特征及其对睡眠质量的影响

目的 了解伴失眠的抑郁症患者对睡眠的信念与态度,并探讨其对睡眠质量的影响。方法 纳入在首都医科大学附属北京安定医院就诊、符合《精神障碍诊断与统计手册(第4版)》(DSM-IV)诊断标准的伴失眠的抑郁症患者(n=61)和原发性失眠患者(n=62)为研究对象,并招募健康对照组(n=64)。三组被试均接受睡眠功能失调信念和态度量表(DBAS)及匹兹堡睡眠质量指数量表(PSQI)评定,伴失眠的抑郁症患者同时接受汉密尔顿抑郁量表17项版(HAMD-17)评定。采用协方差分析比较三组被试PSQI和DBAS评分。采用多元线性回归分析探讨伴失眠的抑郁症患者PSQI评分的影响因素。结果伴失眠的抑郁症组和原发性失眠组PSQI评分均高于对照组(t=18.932、18.610,P均<0.01),两组DBAS评分均低于对照组(t=-5.561、-5.791,P均<0.01)。以伴失眠的抑郁症患者PSQI评分作为因变量,建立的多元线性回归方程具有统计学意义(F=14.095,R²=0.327,P<0.05),DBAS中对睡眠的预测与控制因子和年龄是患者睡眠质量的影响因素(B...     

认知-行为疗法及结合药物治疗原发性失眠的对照研究

目的了解认知-行为疗法在原发性失眠患者中的治疗作用。方法 99例原发性失眠患者随机分成3组:认知行为治疗组、药物治疗组和联合治疗组。分别使用匹兹堡睡眠质量指数(PSQI)评价认知-行为疗法、药物疗法(唑吡坦10mg)及认知-行为疗法结合药物递减疗法(联合治疗)治疗原发性失眠症患者99例的疗效。结果联合治疗组及药物治疗组在治疗第1周较认知-行为治疗组PSQI值明显下降(P0.01);联合治疗组与药物治疗组PSQI相比差异无统计学意义(P0.05);治疗第6周3组PSQI差异无统计学意义(P0.05);治疗3个月时联合治疗组与认知-行为治疗组较药物治疗组PSQI明显下降(P0.01),联合治疗组与认知-行为治疗组PSQI差异无统计学意义(P0.05)。联合治疗组不同时间点PSQI比较差异有统计学意义(P0.01);药物治疗组治疗第1周及治疗第6周与治疗前PSQI比较明显下降(P0.01),治疗第6周与治疗3个月时PSQI比较差异无统计学意义(P0.05);单纯认知行为治疗组在治疗前与治疗第1周PSQI比较差异无统计学意义(P0.05),与治疗第6周及3个月PSQI明显下降(P0.01)。结论认知-行为疗法结合非苯二氮卓艹类安眠药物治疗失眠,起效快,与认知-行为疗法治疗同样具有显著稳定持久的远期效果。     

康复理疗仪联合盐酸舍曲林治疗抑郁症伴失眠患者的疗效研究

目的 研究康复理疗仪辅助治疗抑郁症伴失眠患者的临床疗效.方法 选取62例抑郁症伴失眠的住院患者,按照随机数字表法分为常规治疗组30例,观察组32例,两组病人均给予盐酸舍曲林片治疗,在此基础上观察组每日加用康复理疗仪辅助治疗,观察治疗8周后两组病人汉密尔顿抑郁量表(HAMD)评分、匹兹堡睡眠质量指数(PSQI)评分的变化.结果 治疗前,两组患者的抑郁量表评分和睡眠质量对比无统计学差异.治疗后,在抑郁情绪改善方面,两组患者HAMD评分差异无统计学意义(P＞0.05).在睡眠改善方面,观察组PSQI评分较常规治疗组差异有统计学意义(P＜0.05).观察组的不良反应总发生率(12.5％)与常规治疗组(16.7％)比较,差异无统计学意义(P＞0.05).结论 康复理疗仪可以改善抑郁症伴失眠患者的睡眠质量,且安全无副作用,值得临床推广使用.     

放松训练联合帕罗西汀用于脑卒中后焦虑抑郁合并失眠患者的疗效

目的探究放松训练用于脑卒中后焦虑抑郁合并失眠患者的改善效果。方法研究对象选取为2010年12月~2016年12月之间我院收治的150例脑卒中后焦虑抑郁合并失眠患者,采用数字表法随机分为治疗组和对照组,各75例。对照组单纯应用帕罗西汀治疗,治疗组则在对照组基础上加用放松训练,两组患者均连续治疗2个月,采用匹兹堡睡眠质量指数(PSQI)和睡眠脑电图对两组患者治疗前和治疗后的睡眠状况进行评价对比。并对比两组患者治疗前后汉密尔顿抑郁量表(HAMD)和汉密尔顿焦虑量表(HAMA)的评分结果。结果治疗前两组患者的HAMA、HAMD、PSQI评分对比无显著差异(P0.05),治疗后研究组的HAMA、HAMD、PSQI评分均显著低于对照组(P0.05);治疗前两组患者的各项脑电图参数对比无显著差异(P0.05),治疗1个月、治疗2个月时治疗组的睡眠潜伏期(SL)、睡眠总时间(TSA)、觉醒次数(AT)、觉醒时间(ASA)与对照组相比差异均具有统计学意义(P0.05)。结论放松训练联合帕罗西汀用于脑卒中后焦虑抑郁合并失眠症状患者能够更加有效的改善患者的睡眠状况和焦虑抑郁情绪,值得在临床上推广和应用。     

重性抑郁障碍患者失眠严重程度与急性期疗效相关性研究

目的探讨重性抑郁障碍患者失眠严重程度与急性期疗效的相关性。方法对57例重性抑郁障碍患者用失眠严重程度指数(insomnia severity index,ISI)评估失眠程度并分组,匹兹堡睡眠质量指数(Pittsburgh sleep quality index,PSQI)评估睡眠质量,用24项汉密尔顿抑郁量表(Hamilton depression scale,HAMD_(24))评估患者抑郁症状,并用其减分率反映急性期治疗(4～6周)效果,比较不同失眠程度患者疗效。结果经急性期治疗,伴有轻度、中度和重度失眠的3组重性抑郁障碍患者急性期痊愈率(21/21 vs. 19/21 vs. 9/15)存在统计学差异(χ~2=22.34,P0.01),患者治疗前PSQI评分与HAMD减分率呈负相关(r=-0.44,P0.01)。治疗后,重度失眠组的HAMD总分及焦虑/躯体化、阻滞、绝望感因子分高于中度和轻度失眠组,差异有统计学意义(P0.01)。结论重性抑郁障碍患者失眠严重程度可能预测急性期疗效;经急性期治疗后,伴有重度失眠的重性抑郁障碍患者残留焦虑/躯体化、阻滞、绝望感等症状较轻中度失眠患者更明显。     

脑梗死前睡眠质量与脑梗死后失眠的相关性分析

目的探究脑梗死前睡眠质量与脑梗死后失眠的相关性。方法纳入发病2周内的脑梗死住院患者119例,采用匹兹堡睡眠质量指数量表(Pittsburgh sleep quality index, PSQI)对患者脑梗死前1个月睡眠质量及脑梗死后1个月睡眠质量进行评估,依据脑梗死后1个月的PSQI评分,将患者分为无失眠组(PSQI≤5)53例和失眠组(PSQI5)66例,采用多因素logistic回归分析研究患者脑梗死前睡眠质量与脑梗死后失眠的相关性。结果logistic回归分析结果显示,脑梗死前睡眠质量与脑梗死后失眠呈正相关性(OR=1.405,95%CI:1.196～1.650,P0.05)。结论脑梗死前睡眠质量越差,脑梗死后失眠的发生风险越高。     

八段锦结合阿戈美拉汀治疗抑郁症伴失眠患者的疗效观察

目的 观察八段锦结合阿戈美拉汀治疗抑郁症伴失眠患者的临床疗效.方法 选取58例抑郁症伴失眠的住院患者,按照随机数字表法分为对照组29例,八段锦组29例,2组病人均给予阿戈美拉汀片口服,在此基础上八段锦组每日加用八段锦保健功法辅助治疗,观察治疗8周后2组病人汉密尔顿抑郁量表(HAMD)评分、匹兹堡睡眠质量指数(PSQI)...     

脑电生物反馈辅助治疗老年失眠症的疗效观察

目的 研究脑电生物反馈疗法辅助治疗老年失眠症的效果.方法 将67例老年失眠症患者随机分为研究组（34例,使用右佐匹克隆合并脑电生物反馈治疗8周）和对照组（33例,单用右佐匹克隆治疗8周）.采用多导睡眠（PSG）监测技术和匹兹堡睡眠质量指数量表（PSQI）评定疗效.结果 治疗后第8周末,两组多导睡眠脑电图中实际睡眠总时间、睡眠效率、睡眠维持率、睡眠潜伏期、REM（快速眼动）潜伏期、REM睡眠比例、夜间觉醒次数、觉醒总时间较治疗前显著改善（P＜0.05）;且研究组睡眠脑电图各项数据与对照组比较差异有统计学意义（P＜0.05）.两组PSQI评分均低于各自治疗前（P＜0.05）,研究组PSQI评分显著低于对照组（P＜0.05）.结论 脑电生物反馈疗法辅助治疗老年失眠症有较好的效果.     

Metacognitive beliefs relate specifically to sleep quality in primary insomnia: a pilot study

ObjectiveTo identify whether metacognitive aspects are a specific mental pattern of primary insomnia (PI) or an aspecific correlate of sleep alterations.MethodsSleep quality (Pittsburgh Sleep Quality Index: PSQI), anxiety (Self-rating Anxiety State: SAS), depression (Beck Depression Inventory: BDI) and metacognition (Metacognitions Questionnaire – Insomnia: MCQ-I) were evaluated in 24 PI patients, 13 snorers and 17 healthy controls. Rank-transformed PSQI, BDI, SAS and MCQ-I scores were submitted to one-way analysis of variance with group as a between-factor. PSQI was submitted to three-way analysis of covariance (ANCOVA) with MCQ-I, BDI or SAS as covariate and group as a between-factor. Post-hoc analyses were conducted using pairwise comparisons with Sidak correction.ResultsAs expected, PSQI scores significantly differentiated the three groups, one from another: PI had highest scores followed by snorers and healthy controls. PI subjects had MCQ-I scores significantly higher than those of snorers and healthy controls; no difference between the latter groups was found. The ANCOVA on PSQI with MCQ-I as a covariate abolished the difference in sleep quality between PI and snorers, whereas covarying for BDI or SAS left the differences in sleep quality between the groups unchanged.ConclusionThese preliminary results lead to two main conclusions: (i) metacognitive aspects are more prominent in PI when compared to snorers and healthy controls; (ii) MCQI shows higher sensitivity in defining PI patients, with respect to PSQI. If these findings are confirmed and expanded by further studies, the development of a specific metacognitive model of primary insomnia may be warranted.     

失眠职业人群的情绪障碍与其人格特征及防御方式的相关性研究

目的探讨职业失眠人群的情绪障碍与其人格特征及防御方式的相关性。方法使用匹兹堡睡眠质量指数问卷（PSQI）、艾森克人格问卷（EPQ）、防御方式问卷（CSQ）、状态焦虑特质问卷（STAI）、抑郁自评问卷（BDI）,随机抽取500名职业人群进行抽样问卷调查。结果500名职业人群中PSQI评分大于7分者有159人,睡眠障碍的发生率为31.8%。在159人当中存在焦虑障碍者95人,存在抑郁障碍者84人,发生率分别为59.75%、52.83%。焦虑障碍评分和抑郁障碍评分与EPQ中内外向（E）评分呈显著负相关（r=-0.607,r=-0.473）,而与EPQ中的情绪稳定性（N）评分呈显著正相关（r=0.591,r=0.829）,与防御方式中不成熟防御机制（F1）评分呈正相关（r=0.245,r=0.288）。结论职业人群失眠状况仍较严重,而且其伴发的情绪障碍与其不良的人格特征和不成熟防御机制的使用密切相关。     

Predicting longer-term outcomes following psychological treatment for hypnotic-dependent chronic insomnia

OBJECTIVES: To identify predictors of treatment adherence, patient dropout, and treatment response among long-term hypnotic users recruited into a randomized controlled trial of psychological treatment for insomnia. METHODS: Of 108 treatment and 101 control patients initially recruited, 37 treatment group patients (34.3%) failed to complete all 6 sessions (i.e., were nonadherent), while across both groups 61 (29.2%) patients failed to return postal assessments at 3-month follow-up (i.e., dropped out). Relationships between baseline characteristics and adherence (adherent vs. nonadherent) and attrition (dropout vs. nondropout) were examined in discriminant models. Relationships between baseline characteristics and treatment response (sleep quality, sleep latency, sleep efficiency, and hypnotic drug use) were examined in a series of multiple regression models. RESULTS: Adherent patients showed a significantly greater severity of pretreatment sleep disturbance, as measured by the Pittsburgh Sleep Quality Index (PSQI). Dropout at 3 months was associated with significantly lower perceived health status at baseline. In the regression models, lower Cure/Control subscale scores from the Illness Perception Questionnaire (IPQ) predicted greater posttreatment improvements in sleep efficiency and PSQI scores, while lower baseline anxiety scores predicted a posttreatment increase in hypnotic-free nights/week. CONCLUSION: In routine clinical practice settings, higher anxiety and a less positive attitude towards symptom control were associated with poorer treatment response. Adherence and attrition show a different pattern of associations, with greater need (as indexed by insomnia severity) predicting higher levels of service uptake and poorer general health predicting a higher likelihood of dropout.     

Psychological and behavioral factors in patients with comorbid obstructive sleep apnea and insomnia

Objective

Insomnia symptoms in patients with obstructive sleep apnea (OSA) are commonly assumed to be secondary to respiratory disturbances. Previous studies, however, showed that insomnia might persist after treatment for OSA. Higher levels of emotional disturbances were reported in OSA patients with insomnia than those without insomnia, which suggests that psychological factors may play an important role for their sleep difficulties. This study aimed to further explore sleep-related psychological/behavioral factors that may contribute to insomnia in OSA patients.

Methods

This study included 88 men, of which 33 had OSA (OSA group); 29, primary insomnia; (Insomnia group); and 26, both OSA and insomnia (OSA+Insomnia group). All subjects underwent polysomnography (PSG) overnight and completed a package of questionnaires, including the Insomnia Severity Index (ISI), Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS), Sleep Hygiene Practice Scale (SHPS), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and Pre-Sleep Arousal Scale (PSAS).

Results

The OSA+Insomnia and Insomnia groups had significantly more dysfunctional sleep beliefs, more arousal-inducing sleep-related behaviors, and higher levels of pre-sleep arousal, anxiety, and depression than did the OSA group. The respiratory indices and arousal index were higher for OSA and OSA+Insomnia groups than for the Insomnia group.

Conclusion

Although OSA patients with insomnia showed a similar degree of respiratory disturbances as patients with OSA only, their psychological and behavioral profiles resembled the features of primary insomnia patients. The results support the concept of comorbid insomnia and suggest the importance of evaluating and treating both physiological and psychological factors in these patients.     

Patients with insomnia and subthreshold depression show marked worsening of insomnia after discontinuation of sleep promoting medication

Objective

To investigate whether the outcome of treatment with trazodone CR in primary insomnia differs between patients with and without subthreshold depression.

Methods

14 patients (9 females, mean age 57.3 ± 13.3) with primary insomnia and increased Beck Depression Inventory (BDI) scores (> 10) and 15 sex- and age-matched patients with primary insomnia and low BDI scores (≤ 10) were treated with trazodone CR 25-150 mg/d for 3 months and followed for 1 month after discontinuation of the medication. The Athens Insomnia Scale (AIS), Sheehan Disability Scale (SDS), and Clinical Global Impression scale (CGI) were completed at baseline, after each month of treatment and after the first week of run-out phase. Additional assessment tools comprised sleep diaries, the Leeds Sleep Evaluation Questionnaire (LSEQ) and actigraphic recordings.

Results

Subjective sleep time increased by 61.5 ± 72.3 min in the group with low BDI and 60.0 ± 59.4 min in the group with increased BDI at the end of the treatment phase. The significant improvements were also observed in the AIS, CGI, LSEQ and SDS. During the run-out phase the improvement was sustained in patients with low BDI, while AIS scores, sleep latency and total sleep time deteriorated in patients with increased BDI.

Conclusions

Patients with subthreshold depression, even if the depressive symptoms do not fulfill the time criteria for depressive episode, show marked worsening of insomnia after discontinuation of sleep promoting medication.     

米氮平与草酸艾司西酞普兰对伴失眠的老年抑郁症的疗效研究

目的比较米氮平与草酸艾司西酞普兰对伴失眠的老年抑郁症的疗效与安全性。方法选取符合《中国精神障碍分类与诊断标准(第3版)》(CCMD-3)诊断标准的老年抑郁症患者68例,采用随机数字表法分为米氮平组(n=35)和草酸艾司西酞普兰组(n=33)。米氮平组起始剂量7.5~15 mg/d,最高不超过45mg/d,草酸艾司西酞普兰组从5 mg/d开始服用,最高量不超过20 mg/d,观察期为8周,使用汉密尔顿抑郁量表(HRSD)和副反应量表(TESS)于治疗前、治疗后1、2、4、8周末测评两组的疗效和安全性,使用匹兹堡睡眠质量指数问卷(PSQI)于治疗前、治疗后1、2、4、8周评定睡眠质量。结果治疗后8周,米氮平组和草酸艾司西酞普兰组有效率差异无统计学意义(91.4%vs.90.9%,χ2=0.124,P0.05)。治疗8周末,米氮平组和草酸艾司西酞普兰组PSQI评分差异有统计学意义[(6.20±2.52)vs.(9.14±2.42),t=4.98,P0.01]。不良反应两组比较差异无统计学意义(χ2=1.32,P0.05)。结论米氮平治疗老年抑郁症安全有效,但米氮平因其可快速改善睡眠质量,更适合对伴有失眠的老年抑郁症患者使用。     

Trait anxiety and sleep-onset insomnia: evaluation of treatment using anxiety management training

OBJECTIVES: This study was initially designed to test the notion that generalized anxiety is a predominant factor in the maintenance of psychologically determined sleep-onset insomnia and that a trait anxiety reducing technique can provide significant therapeutic gains. METHODS: Twenty participants (age 19-63) with moderate to severe sleep-onset chronic insomnia were first asked to monitor their sleep-onset latency (SOL) for a 3-week baseline period at home using a SOL clock device. Then, 10 received anxiety management training (AMT) for 9 weeks, while the remaining 10 were trained in the use of progressive relaxation (PR). All participants were measured before and after therapy using sleep laboratory recordings (three nights each), the Spielberger Trait Anxiety Inventory and the Beck Depression Inventory. Daily home sleep-onset measures with the SOL clock device were also taken during therapy. RESULTS: There was no change in SOL over the 3-week baseline period. However, both groups experienced a significant improvement in SOL from pretreatment (end of baseline) to posttreatment periods. In the laboratory, both groups experienced a reduction in Stage 1 sleep as well as an increase in slow wave sleep (SWS) and sleep satisfaction. On the personality measures, both groups experienced a significant reduction in trait anxiety and a decrease in depression. Overall, there was no indication that one of the therapies was significantly better than the other in effecting changes. CONCLUSION: These results suggest that both PR and AMT are efficient therapies for sleep onset insomnia and overall sleep quality. Improvements in the application of the AMT technique are proposed to maximize its usefulness.