惊恐障碍患者药物治疗前后防御方式的比较分析

目的：探讨惊恐障碍（ panic disorder ，PD）患者药物治疗的效果及其与防御方式变化的相关性。方法选取49例PD患者作为PD组，予帕罗西丁或文拉法辛治疗16周，采用临床疗效总评量表、汉密尔顿焦虑量表（ HAMA）评估治疗效果，采用防御方式问卷评估治疗前后防御方式的变化。同期健康人群40人作为对照。结果①PD患者不成熟防御机制总分、中间防御机制总分明显高于对照组（ P＜0.01），成熟防御机制总分明显低于对照组（ P＜0.001）；② PD组治疗后缓解23例（57.5％），不成熟防御机制总分、中间防御机制总分均较治疗前明显下降（ P＜0.001）；无缓解的患者治疗前后各防御因子无明显变化（ P＞0.05）；③HAMA得分、发病年龄、病情严重程度、不成熟防御机制得分是PD药物治疗效果的影响因素，年轻发病、HAMA得分高、病情重、不成熟防御机制得分高与治疗效果欠佳相关。结论 PD患者多使用不成熟防御机制、中间防御机制，使用成熟防御机制减少；药物治疗效果欠佳与HAMA得分、发病年龄、病情严重程度、不成熟防御机制相关。在对PD患者进行治疗时，要针对每个个体的不同情况采取适当的治疗措施。

Comparison of defense mechanisms before and after treatment in adult patients with panic disorder

Objective To explore the correlation between effect of pharmacotherapy and defense mechanisms in adult patients with panic disorder （ PD）.Methods Forty patients with PD were treated with venlafaxin or paroxetine for 16 weeks.The defense mechanisms were evaluated by a Defense Style Questionnaire （DSQ） at the beginning of the study and after 16 weeks of treatment.The effects were evaluated by clinical global impression-disease severity （CGI-SI） and Hamilton Anxiety （HAMA）.At the same time, 40 healthy people were used as controls .Results ①The total scores of immature and neurotic defense mechanisms in the PD patients were significantly higher than that in the controls （ P〈0.01 ） while total scores of mature defense mechanisms were lower than that in the controls （P〈0.001）.②Full remission was observed in 23 patients （57.5%）.The total scores of immature and neurotic defense mechanisms in these patients were significantly reduced when compared to before treatment （P〈0.001）.However, no changes were found in the PD patients without remission .③The HAMA score , age of onset ,severity of PD and scores of immature defenses were fac-tors influencing PD drug effect .Conclusion PD patients use more immature and neurotic defenses and less mature defenses .Poor drug treatment is associated with high HAMA score , age of onset ,severity of PD and immature defenses .These findings could lead to the de-velopment of specific psychotherapeutic interventions .